title: Long-term cause-specific mortality among survivors of childhood cancer.
abstract: BACKGROUND
  Survivors of childhood cancer are at increased risk of premature mortality compared with the general population, but little is known about the long-term risks of specific causes of death, particularly beyond 25 years from diagnosis at ages when background mortality in the general population starts to increase substantially.
  
  
  OBJECTIVE
  To investigate long-term cause-specific mortality among 5-year survivors of childhood cancer in a large-scale population-based cohort.
  
  
  METHODS
  British Childhood Cancer Survivor Study, a population-based cohort of 17,981 5-year survivors of childhood cancer diagnosed with cancer before age 15 years between 1940 and 1991 in Britain and followed up until the end of 2006.
  
  
  METHODS
  Cause-specific standardized mortality ratios (SMRs) and absolute excess risks (AERs).
  
  
  RESULTS
  Overall, 3049 deaths were observed, which was 11 times the number expected (SMR, 10.7; 95% confidence interval [CI], 10.3-11.1). The SMR declined with follow-up but was still 3-fold higher than expected (95% CI, 2.5-3.9) 45 years from diagnosis. The AER for deaths from recurrence declined from 97 extra deaths (95% CI, 92-101) per 10,000 person-years at 5 to 14 years from diagnosis, to 8 extra deaths (95% CI, 3-22) beyond 45 years from diagnosis. In contrast, during the same periods of follow-up, the AER for deaths from second primary cancers and circulatory causes increased from 8 extra deaths (95% CI, 7-10) and 2 extra deaths (95% CI, 2-3) to 58 extra deaths (95% CI, 38-90) and 29 extra deaths (95% CI, 16-56), respectively. Beyond 45 years from diagnosis, recurrence accounted for 7% of the excess number of deaths observed while second primary cancers and circulatory deaths together accounted for 77%.
  
  
  CONCLUSIONS
  Among a cohort of British survivors of childhood cancer, excess mortality from second primary cancers and circulatory diseases continued to occur beyond 25 years from diagnosis.
authors.affiliation: Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, England. r.c.reulen@bham.ac.uk
authors.forename: Raoul C
authors.initials: RC
authors.lastname: Reulen
authors.forename: David L
authors.initials: DL
authors.lastname: Winter
authors.forename: Clare
authors.initials: C
authors.lastname: Frobisher
authors.forename: Emma R
authors.initials: ER
authors.lastname: Lancashire
authors.forename: Charles A
authors.initials: CA
authors.lastname: Stiller
authors.forename: Meriel E
authors.initials: ME
authors.lastname: Jenney
authors.forename: Roderick
authors.initials: R
authors.lastname: Skinner
authors.forename: Michael C
authors.initials: MC
authors.lastname: Stevens
authors.forename: Michael M
authors.initials: MM
authors.lastname: Hawkins
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D016609:Neoplasms, Second Primary / Q000401:mortality*; D017741:Survivors; D006113:United Kingdom / Q000453:epidemiology; D014652:Vascular Diseases / Q000401:mortality