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National cancer survey data have indicated an unprecedented decline in the rate of Hodgkin's disease among white Americans over the age of 40. The authors have hypothesized that this difference may not represent an actual decrease in the incidence of the disease, but changes in diagnostic accuracy over the past two decades. The Repository Center for Lymphoma Studies provides a unique resource for evaluating changes in diagnostic accuracy over time. The repository contains both original diagnoses and expert reevaluations for a large number of lymphoma specimens. In reviewing the data, it was found that the accuracy of diagnosis of Hodgkin's disease has improved over time, as might be expected. One consequence of this fact, however, is that Hodgkin's disease was overdiagnosed in the past. Therefore, improved accuracy of diagnosis alone would result in an apparent decrease in the incidence of Hodgkin's disease. Furthermore, the accuracy of diagnosis was found to decrease with the patient's age, and thus improvements in diagnosis are likely to be more noticeable in the incidence figures for older people. A reevaluation of the incidence rates, taking estimated diagnostic errors into account, suggests that the changes in the incidence among older patients may, in fact, be the result of diagnostic errors. However, the review estimated that the increase in Hodgkin's disease among younger people, particularly Hodgkin's disease of the nodular sclerosis type, may actually be greater than previously estimated. The authors provide a detailed breakdown of the incidence of Hodgkin's disease according to different age groups and different disease subtypes. They suggest that the available data are consistent with an unknown infectious cause of Hodgkin's disease, and indicate that the most significant trend in the incidence of Hodgkin's disease is an increase among teenagers and young adults. (Consumer Summary produced by Reliance Medical Information, Inc.)

We analyzed specimens from 268 patients with small lymphocytic lymphoma (SL) to identify prognostic factors significant for survival. These patients were staged and treated according to the protocols of the Cancer and Leukemia Group B, Eastern Cooperative Oncology Group, Southeastern Cancer Study Group, and the Southwest Oncology Group. Univariate analysis showed that a large-cell grade > I, WBC > 10,000/μL, hemoglobin (Hgb) < 11 g/dL, age ≥ 55 years, and failure to respond to treatment were all poor prognostic factors. Multivariate analysis showed that large-cell grade, age, degree of capsular invasion, and symptom type were independently associated with survival. Separate analyses of cases with and without leukocytosis indicated differences in survival. In patients without leukocytosis, age, presence or absence of anemia, and treatment response were significant prognostic variables; in patients with leukocytosis, large-cell grade, presence or absence of anemia, symptom type, and treatment response were significantly related to survival. Multivariate analysis showed that age was the only significant independent prognostic variable in patients without leukocytosis; in patients with leukocytosis, symptom type, large-cell grade, and bone marrow involvement were independently associated with survival. We conclude that several parameters, both clinical and pathologic, should be assessed at the initial diagnosis of SL to predict prognosis better.