By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, May 12, 1998; Page Z07

In 1983 when she was an 18-year-old junior at the University of Michigan, Sheryl Lozowski-Sullivan was treated for Hodgkin's disease, a form of lymph cancer. She had surgery and eight weeks of radiation treatments that eradicated her disease, which has not recurred.

But for much of the past 15 years, Lozowski-Sullivan has worried about the potential impact of her cancer -- and her treatment -- on the health of any children she might have.

"First I was concerned about whether I could conceive, and then when I did, I worried about whether my cancer was in some way hereditary," said Lozowski-Sullivan, now 34, and the mother of two boys, a 3-year-old and a 5-month-old. "There are just so many unknown factors."

For Lozowski-Sullivan and other survivors, one of the most haunting fears of cancer's impact may have been assuaged last week by a long-term study of more than 20,000 pediatric cancer survivors and their offspring from five Scandinavian countries, published in the New England Journal of Medicine. Most children whose parents survived cancer in childhood or adolescence do not appear to have a higher risk of developing the disease than children whose parents did not have cancer as children, the study found. The exception was children whose parents survived rare, hereditary cancers such as certain forms of retinoblastoma, an eye tumor that usually strikes infants.

"I feel tremendously relieved," said Lozowski-Sullivan, a writer who lives near Kalamazoo, Mich., with her husband, a chemical engineer, and their sons. "For those of us who are having kids and trying to go on with our lives, this is very exciting news."

Many young cancer survivors are concerned that their disease might be familial or that the treatment they underwent damaged genes that could be passed on to their own children. The Scandinavian study is the second this year that failed to find ill-effects in the offspring of people who had cancer as children. A large study published in January and funded by the National Cancer Institute concluded that children born to parents who were treated for cancer before 1976 were not more likely to suffer from birth defects than the general population.

"This is a relatively new concern because of the successes of treating childhood cancer," said Michael Thun, vice president for epidemiology and surveillance for the American Cancer Society. Thun called the Scandinavian study, led by Risto Sankila of the Finnish Cancer Registry, "a very informative study, about as good as you can get."

"It's good news for survivors of childhood cancer," Thun added. "The issue of inherited [health] risks affects a lot of people."

Thun and other experts noted that the study, which tracked 5,847 sons and daughters of 14,652 childhood cancer survivors in Norway, Sweden, Denmark, Iceland and Finland, does not assess the risk of cancer in later life. The children of pediatric cancer survivors in the study ranged from newborns to 43-year-olds; the median age was 14. Of the 5,847 children, 44 developed cancer. Nearly 40 percent of those cases involved retinoblastoma. Most of the remaining 27 cases were deemed sporadic and occurred for no clearly discernible reason.

Because Scandinavian countries maintain detailed cancer registries, the study tracks tumors diagnosed between 1943 and 1991 in a population of 20 million people.

"The Nordic countries have the best national tumor registry system in the world," said Gregory H. Reaman, chairman of the department of hematology and oncology at Children's National Medical Center in Washington. "This is an excellent way to get a total population-based study."

"I think this news will be very helpful for parents of children with cancer. One of the first things they bring up is the risk for fertility and sterility from treatment, which is a concern for older cancer patients as well," Reaman added.

Continued surveillance is necessary, said Anna T. Meadows, director of the NCI's Office of Cancer Survivorship, because of the unknown risks of newer combinations of chemotherapy drugs, as well as radiation and other nonsurgical treatments.

"There is some concern about whether chemotherapy and radiation might have affected" the cells that produce sperm and egg, Meadows said. "It's possible that girls [with cancer] who don't become sterile [during treatment] will sustain some kind of damage to their eggs with some of the new combinations of drugs."

But Meadows, who is also director of pediatric oncology at the Children's Hospital of Philadelphia, added that she does not find the results surprising. "I can think of two cases in my 26 years here" of children with cancer whose parents were treated for malignancies as children, she said.

Meadows noted that the Scandinavian results are similar to preliminary data from an ongoing NCI study of 18,000 American children who were diagnosed with cancer between 1970 and 1986. These survivors are being tracked to determine, among other things, their risk of developing second cancers and the incidence of cancer in their children.

"So far the data are scant because a lot of these patients have not gone through their childbearing years," Meadows said. "But we're not finding any red flags so far."

To date few large, long-term studies of the children of cancer survivors have been conducted, in part because of the difficulty of finding enough people to enroll. As Sankila and his colleagues noted in their article, "Estimating the risk of [cancer] among the offspring of these patients has been difficult because of the rarity of childhood cancer."

This year the American Cancer Society estimates that there will be 8,700 new cases of cancer and 1,700 deaths from cancer in children under 14 in a population of about 56 million youths. The risk of developing most cancers increases with age.

Large, multi-generational studies are now possible because the chances of surviving pediatric cancer have improved, in some cases dramatically. The five-year survival rate for all cancers in children under 15 is now about 72 percent, up from 28 percent in 1963. In that year, only 4 percent of children diagnosed with acute lymphocytic leukemia were alive five years after diagnosis; today about 80 percent survive that long. For Hodgkin's disease, the cancer Lozowski-Sullivan had, the five-year survival rate has nearly doubled, from 52 percent in 1963 to 94 percent in 1993.

The Scandinavian team found no second-generation cancers in children whose parents survived leukemia, liver tumors or neuroblastoma, a tumor of the adrenal glands or sympathetic nervous system. All but one of the second-generation cancer patients were born more than eight years after the mother was diagnosed.

For Reaman of Children's, the importance of the Scandinavian study is psychological as well as scientific. "This is one more piece of reasssurance that is sorely needed for children and parents of children with cancer."