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JAMA. 2011 Jun 8;305(22):2311-9. doi: 10.1001/jama.2011.747.

Long-term risks of subsequent primary neoplasms among survivors of childhood cancer.

Author information

1
Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom. r.c.reulen@bham.ac.uk

Abstract

CONTEXT:

Survivors of childhood cancer are at excess risk of developing subsequent primary neoplasms but the long-term risks are uncertain.

OBJECTIVES:

To investigate long-term risks of subsequent primary neoplasms in survivors of childhood cancer, to identify the types that contribute most to long-term excess risk, and to identify subgroups of survivors at substantially increased risk of particular subsequent primary neoplasms that may require specific interventions.

DESIGN, SETTING, AND PARTICIPANTS:

British Childhood Cancer Survivor Study--a population-based cohort of 17,981 5-year survivors of childhood cancer diagnosed with cancer at younger than 15 years between 1940 and 1991 in Great Britain, followed up through December 2006.

MAIN OUTCOME MEASURES:

Standardized incidence ratios (SIRs), absolute excess risks (AERs), and cumulative incidence of subsequent primary neoplasms.

RESULTS:

After a median follow-up time of 24.3 years (mean = 25.6 years), 1354 subsequent primary neoplasms were ascertained; the most frequently observed being central nervous system (n = 344), nonmelanoma skin cancer (n = 278), digestive (n = 105), genitourinary (n = 100), breast (n = 97), and bone (n = 94). The overall SIR was 4 times more than expected (SIR, 3.9; 95% confidence interval [CI], 3.6-4.2; AER, 16.8 per 10,000 person-years). The AER at older than 40 years was highest for digestive and genitourinary subsequent primary neoplasms (AER, 5.9 [95% CI, 2.5-9.3]; and AER, 6.0 [95%CI, 2.3-9.6] per 10,000 person-years, respectively); 36% of the total AER was attributable to these 2 subsequent primary neoplasm sites. The cumulative incidence of colorectal cancer for survivors treated with direct abdominopelvic irradiation was 1.4% (95% CI, 0.7%-2.6%) by age 50 years, comparable with the 1.2% risk in individuals with at least 2 first-degree relatives affected by colorectal cancer.

CONCLUSION:

Among a cohort of British childhood cancer survivors, the greatest excess risk associated with subsequent primary neoplasms at older than 40 years was for digestive and genitourinary neoplasms.

PMID:
21642683
DOI:
10.1001/jama.2011.747
[Indexed for MEDLINE]

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