Survivors of Hodgkin lymphoma (HL) may have a higher risk of developing lung cancer than former smokers, according to a study published in Clinical Lung Cancer.

The study showed a high incidence of secondary lung cancer in HL survivors and significantly shorter survival among patients who developed lung cancer. 

The risk of lung cancer after HL was significantly higher in men, patients who were older, and those who had received radiotherapy.   

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This study included 58,856 patients with HL enrolled in the SEER database between 1973 and 2015. A total of 862 patients developed secondary lung cancer, resulting in an incidence rate of 157 per 100,000 person-years.

“The crude incidence rate of our data is higher than former smokers,” the researchers wrote, noting that the incidence among former smokers was 63 per 100,000 person-years for women in the Nurse Health Study and 81 per 100,000 person-years for men in the Professional Health Study.

Patients who developed lung cancer in the current study had significantly shorter overall survival than patients without lung cancer. The median overall survival was 12.1 years and 27.1 years, respectively (P <.01). 

In a multivariable analysis, patients with lung cancer had a 26% higher risk of death than patients without lung cancer (hazard ratio [HR], 1.26; 95% CI, 1.16-1.36; P <.01). 

Multivariable analysis also suggested the following factors are associated with an increased risk of developing lung cancer:

  • Receiving radiotherapy for HL (HR, 1.232; 95% CI, 1.002-1.55; P =.048)
  • Older age at HL diagnosis (HR, 1.07; 95% CI, 1.062-1.073; P <.01)
  • Male sex (HR, 1.602; 95% CI, 1.33-1.94; P <.01).

Overall, the risk of lung cancer was decreased for patients who received chemotherapy for HL (HR, 0.44; 95% CI, 0.29-0.67; P <.01). However, the risk was increased for older patients who received chemotherapy (HR, 1.013; 95% CI, 1.01-1.02; P <.01).

There were no significant differences in the risk of lung cancer according to race.

“We found that patients who had HL at an older age, particularly those above the age of 40, male, and who received radiation therapy, are at higher risk for secondary lung cancer,” the researchers summarized. 

“Therefore, screening for secondary lung cancer among HL survivors is imperative and likely [to] be cost-effective. Future research that validates our predictors for secondary lung cancer in a cohort of HL survivors could help establish a model to tailor screening for high-risk patients.”


Alnimer Y, Ali MKM. Predictors of secondary lung cancer among Hodgkin lymphoma survivors: A nationwide analysis. Clin Lung Cancer. Published online August 6, 2022. doi:10.1016/j.cllc.2022.08.003

This article originally appeared on Cancer Therapy Advisor