http://www.jco.org/cgi/content/abstract/24/3/476

 Journal of Clinical Oncology, Vol 24, No 3 (January 20), 2006: pp. 476-483
© 2006 American Society of Clinical Oncology
DOI: 10.1200/JCO.2005.02.7235

Risk of Selected Subsequent Carcinomas in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Mylène Bassal, Ann C. Mertens, Leslie Taylor, Joseph P. Neglia, Brian S. Greffe, Sue Hammond, Cécile M. Ronckers, Debra L. Friedman, Marilyn Stovall, Yutaka Y. Yasui, Leslie L. Robison, Anna T. Meadows, Nina S. Kadan-Lottick

From the Division of Pediatric Hematology/Oncology/BMT, University of Colorado Health Sciences Center, Denver, CO; Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN; Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Pathology, Ohio State University, Columbus, OH; National Cancer Institute, Division of Cancer Epidemiology and Genetics, National Institutes of Health, Department of Health and Human Services, Bethesda, MD; Department of Pediatrics, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Public Health Sciences, University of Alberta Edmonton, Canada; Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Pediatrics, Section of Pediatric Hematology-Oncology, Yale University School of Medicine, New Haven, CT

Address reprint requests to Nina S. Kadan-Lottick, MD, MSPH, Yale University School of Medicine, 333 Cedar St, LMP 2073, PO Box 208064, New Haven, CT 06520; e-mail: nina.kadan-lottick@yale.edu

PURPOSE: 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.

PATIENTS AND METHODS: Subsequent malignant neoplasm history was determined in 13,136 participants (surviving ≥ 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).

CONCLUSION: 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.

Supported by Grant No. U24-CA55727 from the National Institutes of Health and by funding provided to the University of Minnesota by the Children's Cancer Research Fund. N.S.K.-L. was supported in part by Grant No. K12RR17594 from the National Center for Research Resources.

Presented in part at the 40th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, June 5-8, 2004 (poster discussion).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.