The good news-bad news about Hodgkin's disease.

Named after the English physician who first described it in 1832, Hodgkin's disease affects some 8,000 to 10,000 Americans each year. Like many cancers, causative factors are not well known. Most of its victims are young (median age 32 years), but it occurs in two peaks--between 15 and 35 years and then after age 50.

While there is evidence to suggest that prior infection, particularly of a viral type, may lead to the development of Hodgkin's disease, no clear link has yet been shown between a prior infection and subsequent diagnosis of the disease. There is also evidence of genetic factors being involved; in rare instances the disease has been very common in families. (Mickey Mantle's father and grandfather both died of Hodgkin's disease, and Mantle's son has been treated for it.)

Like the leukemias and other cancers of blood cells, diagnosis of this disease was once a death sentence. Advances in radiation therapy and chemotherapy, together with the realization that the disease can be cured, have now enabled many to survive this once dread disease. In particular, the survival rate in children is a model of successful therapy for childhood cancer. Chemotherapy and low-dose radiation now produce cure rates of over 90 percent.

With this marked improvement in survival rates, however, comes a new problem--an increased risk of developing another type of cancer. In adults acute leukemia has been the most common of the secondary cancers in patients successfully treated for Hodgkin's disease. As the length of survival times increases with more successful methods of treatment, however, doctors are now seeing more solid tumors in these patients later in life. The March 21, 1996, issue of the New England Journal of Medicine featured a report of the Late Effects Study Group (LESG) on breast cancer and other second cancers in persons treated in childhood for Hodgkin's disease.

The LESG, comprising cancer specialists in 15 major hospitals worldwide, followed a group of 1,380 children with Hodgkin's disease treated between 1955 and 1986 to assess their risk of developing a second malignancy. Their findings showed the risk of a second neoplasm (abnormal cell growth) is increased about 18 times in long-term survivors of childhood Hodgkin's disease. The older the patient at the time of treatment, the higher the risk, with 74 percent of the cancers occurring in those diagnosed between 10 and 16 years of age.

Of the 1,380 subjects in the study, 79 developed malignant neoplasms, including leukemias (26), non-Hodgkin's lymphomas (6), breast cancer (17), thyroid cancer (10), bone cancer (4), brain cancer (4), colorectal cancer (3), gastric cancer (2), and other types (7). The degree of risk was much higher in patients who had been treated with both radiation and chemotherapy than with only one or the other.

The authors stressed the importance of systematic screening for breast cancer in Hodgkin's survivors, with the possible use of tamoxifen and retinoids as preventive measures in those otherwise at high risk (e.g., family history) for breast cancer. They also pointed out the need to develop effective treatment measures for Hodgkin's disease that are less carcinogenic. Given the inevitably fatal course of Hodgkin's disease in years past, however, is the possibility of a second cancer later in life a small potential price to pay for a Hodgkin's cure?