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


 Journal of Clinical Oncology, Vol 24, No 3 (January 20), 2006: pp.
© 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.

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.

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