title: Risk of salivary gland cancer after childhood cancer: a report from the Childhood Cancer Survivor Study.
abstract: OBJECTIVE
  To evaluate effects of radiation therapy, chemotherapy, cigarette smoking, and alcohol consumption on the risk of second primary salivary gland cancer (SGC) in the Childhood Cancer Survivor Study (CCSS).
  
  
  METHODS
  Standardized incidence ratios (SIR) and excess absolute risks (EAR) of SGC in the CCSS were calculated using incidence rates from Surveillance, Epidemiology, and End Results population-based cancer registries. Radiation dose to the salivary glands was estimated based on medical records. Poisson regression was used to assess risks with respect to radiation dose, chemotherapy, smoking, and alcohol consumption.
  
  
  RESULTS
  During the time period of the study, 23 cases of SGC were diagnosed among 14,135 childhood cancer survivors. The mean age at diagnosis of the first primary cancer was 8.3 years, and the mean age at SGC diagnosis was 24.8 years. The incidence of SGC was 39-fold higher in the cohort than in the general population (SIR = 39.4; 95% CI = 25.4-57.8). The EAR was 9.8 per 100,000 person-years. Risk increased linearly with radiation dose (excess relative risk = 0.36/Gy; 95% CI = 0.06-2.5) and remained elevated after 20 years. There was no significant trend of increasing risk with increasing dose of chemotherapeutic agents, pack-years of cigarette smoking, or alcohol intake.
  
  
  CONCLUSIONS
  Although the cumulative incidence of SGC was low, childhood cancer survivors treated with radiation experienced significantly increased risk for at least 2 decades after exposure, and risk was positively associated with radiation dose. Results underscore the importance of long-term follow up of childhood cancer survivors for the development of new malignancies.
authors: Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
authors: Houda
authors: H
authors: Boukheris
authors: Marilyn
authors: M
authors: Stovall
authors: Ethel S
authors: ES
authors: Gilbert
authors: Kayla L
authors: KL
authors: Stratton
authors: Susan A
authors: SA
authors: Smith
authors: Rita
authors: R
authors: Weathers
authors: Sue
authors: S
authors: Hammond
authors: Ann C
authors: AC
authors: Mertens
authors: Sarah S
authors: SS
authors: Donaldson
authors: Gregory T
authors: GT
authors: Armstrong
authors: Leslie L
authors: LL
authors: Robison
authors: Joseph P
authors: JP
authors: Neglia
authors: Peter D
authors: PD
authors: Inskip
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000428:Alcohol Drinking / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology*; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology; D016012:Poisson Distribution; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012306:Risk; D018426:SEER Program; D012468:Salivary Gland Neoplasms / Q000453:epidemiology* / Q000209:etiology; D012469:Salivary Glands / Q000528:radiation effects*; D012907:Smoking / Q000009:adverse effects; D017741:Survivors; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents