Second Malignant Neoplasms in Five-Year Survivors of Childhood Cancer: Childhood Cancer Survivor Study

Background: Because survival rates among childhood cancer patients are increasing, assessing the risk of second and subsequent malignant neoplasms (SMNs) is ever more important. Using the Childhood Cancer Survivor Study cohort, we identified the risk of SMNs. Methods: A retrospective cohort of 13 58...

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Bibliographic Details
Published in:JNCI : Journal of the National Cancer Institute 2001-04, Vol.93 (8), p.618-629
Main Authors: Neglia, Joseph P., Friedman, Debra L., Yasui, Yutaka, Mertens, Ann C., Hammond, Sue, Stovall, Marilyn, Donaldson, Sarah S., Meadows, Anna T., Robison, Leslie L.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Biological and medical sciences
Child
Cohort Studies
Female
Humans
Incidence
Male
Medical sciences
Middle Aged
Multiple tumors. Solid tumors. Tumors in childhood (general aspects)
Multivariate Analysis
Neoplasms, Second Primary - epidemiology
Retrospective Studies
Risk Factors
Tumors
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Summary:Background: Because survival rates among childhood cancer patients are increasing, assessing the risk of second and subsequent malignant neoplasms (SMNs) is ever more important. Using the Childhood Cancer Survivor Study cohort, we identified the risk of SMNs. Methods: A retrospective cohort of 13 581 children diagnosed with common cancers before age 21 years and surviving at least 5 years was constructed with the use of data from patients treated at 25 U.S. and Canadian institutions. SMNs were ascertained through self-administered questionnaires and verified by pathology reports. Information on therapeutic exposures was abstracted from medical records. The risk of SMN was evaluated by standardized incidence ratios (SIRs) and excess absolute risk. Poisson multiple regression models were used to assess the impact of host and therapy factors on the risk of developing SMNs. All statistical tests were two-sided. Results: In 298 individuals, 314 SMNs were identified (SIR = 6.38; 95% confidence interval [CI] = 5.69 to 7.13). The largest observed excess SMNs were bone and breast cancers (SIR = 19.14 [95% CI = 12.72 to 27.67] and SIR = 16.18 [95% CI = 12.35 to 20.83], respectively). A statistically significant excess of SMNs followed all childhood cancers. In multivariate regression models adjusted for therapeutic radiation exposure, SMNs of any type were independently associated with female sex (P
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/93.8.618