Risk of selected subsequent carcinomas in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.
OBJECTIVE
To determine the risk of subsequent carcinomas other than breast, thyroid, and skin, and to identify factors that influence the risk among survivors of childhood cancer.


METHODS
Subsequent malignant neoplasm history was determined in 13,136 participants (surviving > or = 5 years postmalignancy, diagnosed from 1970 to 1986 at age < 21 years) of the Childhood Cancer Survivor Study to calculate standardized incidence ratios (SIRs), using Surveillance, Epidemiology, and End Results data.


RESULTS
In 71 individuals, 71 carcinomas were diagnosed at a median age of 27 years and a median elapsed time of 15 years in the genitourinary system (35%), head and neck area (32%), gastrointestinal tract (23%), and other sites (10%). Fifty-nine patients (83%) had received radiotherapy, and 42 (59%) developed a second malignant neoplasm in a previous radiotherapy field. Risk was significantly elevated following all childhood diagnoses except CNS neoplasms, and was highest following neuroblastoma (SIR = 24.2) and soft tissue sarcoma (SIR = 6.2). Survivors of neuroblastoma had a 329-fold increased risk of renal cell carcinomas; survivors of Hodgkin's lymphoma had a 4.5-fold increased risk of gastrointestinal carcinomas. Significantly elevated risk of head and neck carcinoma occurred in survivors of soft tissue sarcoma (SIR = 22.6), neuroblastoma (SIR = 20.9), and leukemia (SIR = 20.9).


CONCLUSIONS
Young survivors of childhood cancers are at increased risk of developing subsequent carcinomas typical of later adulthood, underscoring the importance of long-term follow-up and risk-based screening. Follow-up of the cohort is ongoing to determine lifetime risk and delineate individual characteristics that contribute to risk.
Bassal
Mylène
M
Division of Pediatric Hematology/Oncology/BMT, University of Colorado Health Sciences Center, Denver, CO, USA.
Mertens
Ann C
AC
Taylor
Leslie
L
Neglia
Joseph P
JP
Greffe
Brian S
BS
Hammond
Sue
S
Ronckers
Cécile M
CM
Friedman
Debra L
DL
Stovall
Marilyn
M
Yasui
Yutaka Y
YY
Robison
Leslie L
LL
Meadows
Anna T
AT
Kadan-Lottick
Nina S
NS
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000453:epidemiology / Q000209:etiology; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000532:radiotherapy*; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000209:etiology*; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology*; D018570:Risk Assessment; D018426:SEER Program; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014565:Urogenital Neoplasms / Q000453:epidemiology / Q000209:etiology