title: Second malignancies after childhood noncentral nervous system solid cancer: Results from 13 cancer registries.
abstract: Children diagnosed with noncentral nervous system solid cancers (NCNSSC) experience several adverse late effects, including second malignant neoplasm. The aim of our study was to assess the risk of specific second malignancies after a childhood NCNSSC. Diagnosis and follow-up data on 10,988 cases of NCNSSC in children (0-14 years) were obtained from 13 registries. Standardized incidence ratios (SIRs) with 95% confidence intervals (CI) and cumulative incidence of second malignancies were computed. We observed 175 second malignant neoplasms, yielding a SIR of 4.6, 95% CI: 3.9-5.3. When considering second cancers with at least 10 occurrences, highest relative risks were found for second malignant bone tumors (SIR = 26.4, 16.6-40.0), soft tissue sarcomas (SIR = 14.1, 6.7-25.8) and myeloid leukemia (SIR = 12.7, 6.3-22.8). Significant increased risks for all malignancies combined were observed after sympathetic nervous system tumors (SIR = 11.4, 5.2-21.6), retinoblastomas (SIR = 7.3, 5.4-9.8), renal tumors (SIR = 5.7, 3.8-8.0), malignant bone tumors (SIR = 5.6, 3.7-8.2), soft tissue sarcomas (SIR = 4.7, 3.2-6.8), germ-cell, trophoblastic and other gonadal neoplasms (SIR = 2.5, 1.1-4.9), carcinomas and other malignant epithelial neoplasms (SIR = 2.2, 1.4-3.3). The highest risk of a second malignancy of any type occurred 5 to 9 years after NCNSSC (SIR = 9.9, 6.8-13.9). The cumulative incidence of second malignancies 10 years after the first neoplasm was eight times higher among NCNSSC survivors than in the general population, with the absolute difference between observed and expected cumulative incidence still increasing after 50 years of follow-up. Children who survived a NCNSSC experience a large increased risk of developing a new malignancy, even many years after their initial diagnosis.
authors.affiliation: Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, CPO Piemonte, CeRMS, University of Turin, Turin, Italy. milena.maule@cpo.it
authors.forename: Milena
authors.initials: M
authors.lastname: Maule
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Scélo
authors.forename: Guido
authors.initials: G
authors.lastname: Pastore
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.forename: Kari
authors.initials: K
authors.lastname: Hemminki
authors.forename: Jorgen H
authors.initials: JH
authors.lastname: Olsen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tracey
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.forename: David H
authors.initials: DH
authors.lastname: Brewster
authors.forename: Sharon
authors.initials: S
authors.lastname: Tamaro
authors.forename: Kee-Seng
authors.initials: KS
authors.lastname: Chia
authors.forename: Vera
authors.initials: V
authors.lastname: Pompe-Kirn
authors.forename: Erich V
authors.initials: EV
authors.lastname: Kliewer
authors.forename: Jon M
authors.initials: JM
authors.lastname: Tonita
authors.forename: Carmen
authors.initials: C
authors.lastname: Martos
authors.forename: Jon G
authors.initials: JG
authors.lastname: Jonasson
authors.forename: Franco
authors.initials: F
authors.lastname: Merletti
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D012042:Registries; D012306:Risk; D017741:Survivors