It has been suspected for a long time that patients successfully treated for Hodgkin Lymphoma (formerly known as Hodgkin’s Disease) have a higher than average risk of getting heart disease. Causes for this are radiation to the heart as part of treatment of lymph nodes in the chest, and the use of Adriamycin chemotherapy, which can be toxic. Some patients get both radiation and Adriamycin. Recently published in JAMA Internal Medicine is a very sobering article from the Netherlands in which they examined the medical records of people treated for Hodgkin treated between 1965 and 1995. Average follow up for these patients was thus very long. An astonishing 50% of patients who received both radiation and chemotherapy with Adriamycin had evidence of significant heart disease. For radiation alone it was 45%; for chemo alone 28%. Patients treated for HL who received neither radiation nor Adriamycin had an incidence of only 15%. Not only did patients get the expected heart muscle disease known as cardiomyopathy, but they got coronary artery disease and diseases of the heart valves. The last was a totally unexpected finding and is unexplained by any known mechanism. What is the take-home lesson? Dr. Stark weighs in, “We wouldn’t be having this discussion but for the extreme success in treating Hodgkin Lymphoma. Fifty years ago this was a fatal disease; now deaths are rare. As with other cancers quality of life among cancer survivors is a challenge for patients and their doctors. We must be forever mindful to do as little harm as possible. Given these data if there is a way to avoid radiation and still get a cure, this seems like a desirable way to treat this curable disease.”