This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bassal, M. Articles by Kadan-Lottick, N. S. Search for Related Content PubMed Articles by Bassal, M. Articles by Kadan-Lottick, N. S. Social Bookmarking                            What's this?

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

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{at}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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				A. T. Meadows, D. L. Friedman, J. P. Neglia, A. C. Mertens, S. S. Donaldson, M. Stovall, S. Hammond, Y. Yasui, and P. D. Inskip Second Neoplasms in Survivors of Childhood Cancer: Findings From the Childhood Cancer Survivor Study Cohort J. Clin. Oncol., May 10, 2009; 27(14): 2356 - 2362. [Abstract] [Full Text] [PDF]

				M. M. Hudson, D. A. Mulrooney, D. C. Bowers, C. A. Sklar, D. M. Green, S. S. Donaldson, K. C. Oeffinger, J. P. Neglia, A. T. Meadows, and L. L. Robison High-Risk Populations Identified in Childhood Cancer Survivor Study Investigations: Implications for Risk-Based Surveillance J. Clin. Oncol., May 10, 2009; 27(14): 2405 - 2414. [Abstract] [Full Text] [PDF]

				L. L. Robison, G. T. Armstrong, J. D. Boice, E. J. Chow, S. M. Davies, S. S. Donaldson, D. M. Green, S. Hammond, A. T. Meadows, A. C. Mertens, et al. The Childhood Cancer Survivor Study: A National Cancer Institute-Supported Resource for Outcome and Intervention Research J. Clin. Oncol., May 10, 2009; 27(14): 2308 - 2318. [Abstract] [Full Text] [PDF]

				J. D. Rizzo, R. E. Curtis, G. Socie, K. A. Sobocinski, E. Gilbert, O. Landgren, L. B. Travis, W. D. Travis, M. E. D. Flowers, D. L. Friedman, et al. Solid cancers after allogeneic hematopoietic cell transplantation Blood, January 29, 2009; 113(5): 1175 - 1183. [Abstract] [Full Text] [PDF]

				K. A. Goodman, E. Riedel, V. Serrano, S. Gulati, C. H. Moskowitz, and J. Yahalom Long-Term Effects of High-Dose Chemotherapy and Radiation for Relapsed and Refractory Hodgkin's Lymphoma J. Clin. Oncol., November 10, 2008; 26(32): 5240 - 5247. [Abstract] [Full Text] [PDF]

				N. S. Kadan-Lottick, I. Dinu, K. Wasilewski-Masker, S. Kaste, L. R. Meacham, A. Mahajan, M. Stovall, Y. Yasui, L. L. Robison, and C. A. Sklar Osteonecrosis in Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study J. Clin. Oncol., June 20, 2008; 26(18): 3038 - 3045. [Abstract] [Full Text] [PDF]

				E. C. Bluhm, C. Ronckers, R. J. Hayashi, J. P. Neglia, A. C. Mertens, M. Stovall, A. T. Meadows, P. A. Mitby, J. A. Whitton, S. Hammond, et al. Cause-specific mortality and second cancer incidence after non-Hodgkin lymphoma: a report from the Childhood Cancer Survivor Study Blood, April 15, 2008; 111(8): 4014 - 4021. [Abstract] [Full Text] [PDF]

				M. L. Metzger, S. M. Castellino, M. M. Hudson, S. N. Rai, S. C. Kaste, M. J. Krasin, L. E. Kun, C.-H. Pui, and S. C. Howard Effect of Race on the Outcome of Pediatric Patients With Hodgkin's Lymphoma J. Clin. Oncol., March 10, 2008; 26(8): 1282 - 1288. [Abstract] [Full Text] [PDF]

				M. M. Benoit, N. Bhattacharyya, W. Faquin, and M. Cunningham Cancer of the Nasal Cavity in the Pediatric Population Pediatrics, January 1, 2008; 121(1): e141 - e145. [Abstract] [Full Text] [PDF]

				G. T. Armstrong, C. A. Sklar, M. M. Hudson, and L. L. Robison Long-Term Health Status Among Survivors of Childhood Cancer: Does Sex Matter? J. Clin. Oncol., October 1, 2007; 25(28): 4477 - 4489. [Abstract] [Full Text] [PDF]

				M. Maule, G. Scelo, G. Pastore, P. Brennan, K. Hemminki, E. Tracey, R. Sankila, E. Weiderpass, J. H. Olsen, M. L. McBride, et al. Risk of Second Malignant Neoplasms After Childhood Leukemia and Lymphoma: An International Study J Natl Cancer Inst, May 16, 2007; 99(10): 790 - 800. [Abstract] [Full Text] [PDF]

				N. Hijiya, M. M. Hudson, S. Lensing, M. Zacher, M. Onciu, F. G. Behm, B. I. Razzouk, R. C. Ribeiro, J. E. Rubnitz, J. T. Sandlund, et al. Cumulative Incidence of Secondary Neoplasms as a First Event After Childhood Acute Lymphoblastic Leukemia JAMA, March 21, 2007; 297(11): 1207 - 1215. [Abstract] [Full Text] [PDF]

				J. D. Dickerman The Late Effects of Childhood Cancer Therapy Pediatrics, March 1, 2007; 119(3): 554 - 568. [Abstract] [Full Text] [PDF]

				A. T. Meadows Retinoblastoma Survivors: Sarcomas and Surveillance J Natl Cancer Inst, January 3, 2007; 99(1): 3 - 5. [Full Text] [PDF]

				E. Ron Childhood cancer--treatment at a cost. J Natl Cancer Inst, November 1, 2006; 98(21): 1510 - 1511. [Full Text] [PDF]

				D. Cross and J. K. Burmester Gene therapy for cancer treatment: past, present and future. Clin. Med. Res., September 1, 2006; 4(3): 218 - 227. [Abstract] [Full Text] [PDF]