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Risk of Subsequent Neoplasms During the Fifth and Sixth Decades of Life in the Childhood Cancer Survivor Study Cohort.

Abstract

PURPOSE

Survivors of childhood cancer have an increased risk for subsequent neoplasms (SNs), but the incidence beyond the age of 40 years and associations with therapeutic exposures have not been well described.

PATIENTS AND METHODS

Among 14,364 survivors of childhood cancer diagnosed between 1970 and 1986, 3,171 had an attained age of 40 years or older at the time of last contact. Cumulative incidence of SNs, standardized incidence ratios (SIRs), excess absolute risk of subsequent malignant neoplasms (SMNs), and relative risks (RRs) for SMNs and nonmelanoma skin cancers were calculated.

RESULTS

In total, 679 SNs were diagnosed in patients age 40 years or older. These included 196 SMNs, 419 nonmelanoma skin cancers, 21 nonmalignant meningiomas, and 43 other benign neoplasms. At age 55 years, the cumulative incidence of new SNs and SMNs occurring after age 40 years was 34.6% (95% CI, 28.7 to 40.6) and 16.3% (95% CI, 11.7 to 20.9), respectively. Survivors were twice as likely as the general population to receive a diagnosis of SMN after age 40 years (SIR, 2.2; 95% CI, 1.9 to 2.5). Among SMNs, risk was increased for breast cancer (SIR, 5.5; 95% CI, 4.5 to 6.7), renal cancer (SIR, 3.9; 95% CI, 2.0 to 7.5), soft tissue sarcoma (SIR, 2.6; 95% CI, 1.5 to 4.4), and thyroid cancer (SIR, 1.9; 95% CI, 1.0 to 3.5). Female sex (RR, 1.9; 95% CI, 1.3 to 2.6; P < .001) and therapeutic radiation exposure (RR, 2.2; 95% CI, 1.4 to 3.3; P < .001) were associated with an increased for risk for SMN in multivariable analysis.

CONCLUSION

Even after age 40 years, survivors of childhood cancer remain at increased risk for treatment-related SNs. These data suggest the need for life-long monitoring and should inform anticipatory guidance provided to survivors of childhood cancer.

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  • Authors+Show Affiliations

    ,

    Lucie M. Turcotte and Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; John A. Whitton and Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Debra L. Friedman, Vanderbilt University School of Medicine, Nashville; Gregory T. Armstrong and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; and Sue Hammond, Ohio State University, Columbus, OH. turc0023@umn.edu.

    ,

    Lucie M. Turcotte and Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; John A. Whitton and Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Debra L. Friedman, Vanderbilt University School of Medicine, Nashville; Gregory T. Armstrong and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; and Sue Hammond, Ohio State University, Columbus, OH.

    ,

    Lucie M. Turcotte and Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; John A. Whitton and Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Debra L. Friedman, Vanderbilt University School of Medicine, Nashville; Gregory T. Armstrong and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; and Sue Hammond, Ohio State University, Columbus, OH.

    ,

    Lucie M. Turcotte and Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; John A. Whitton and Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Debra L. Friedman, Vanderbilt University School of Medicine, Nashville; Gregory T. Armstrong and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; and Sue Hammond, Ohio State University, Columbus, OH.

    ,

    Lucie M. Turcotte and Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; John A. Whitton and Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Debra L. Friedman, Vanderbilt University School of Medicine, Nashville; Gregory T. Armstrong and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; and Sue Hammond, Ohio State University, Columbus, OH.

    ,

    Lucie M. Turcotte and Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; John A. Whitton and Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Debra L. Friedman, Vanderbilt University School of Medicine, Nashville; Gregory T. Armstrong and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; and Sue Hammond, Ohio State University, Columbus, OH.

    ,

    Lucie M. Turcotte and Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; John A. Whitton and Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Debra L. Friedman, Vanderbilt University School of Medicine, Nashville; Gregory T. Armstrong and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; and Sue Hammond, Ohio State University, Columbus, OH.

    Lucie M. Turcotte and Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; John A. Whitton and Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Debra L. Friedman, Vanderbilt University School of Medicine, Nashville; Gregory T. Armstrong and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; and Sue Hammond, Ohio State University, Columbus, OH.

    Source

    MeSH

    Adolescent
    Adult
    Breast Neoplasms
    Child
    Female
    Follow-Up Studies
    Humans
    Incidence
    Kidney Neoplasms
    Longitudinal Studies
    Male
    Meningeal Neoplasms
    Meningioma
    Middle Aged
    Multivariate Analysis
    Neoplasms, Second Primary
    Retrospective Studies
    Risk Factors
    Sarcoma
    Skin Neoplasms
    Survivors
    Thyroid Neoplasms

    Pub Type(s)

    Journal Article
    Observational Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    26261260

    Citation

    Turcotte, Lucie M., et al. "Risk of Subsequent Neoplasms During the Fifth and Sixth Decades of Life in the Childhood Cancer Survivor Study Cohort." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 33, no. 31, 2015, pp. 3568-75.
    Turcotte LM, Whitton JA, Friedman DL, et al. Risk of Subsequent Neoplasms During the Fifth and Sixth Decades of Life in the Childhood Cancer Survivor Study Cohort. J Clin Oncol. 2015;33(31):3568-75.
    Turcotte, L. M., Whitton, J. A., Friedman, D. L., Hammond, S., Armstrong, G. T., Leisenring, W., ... Neglia, J. P. (2015). Risk of Subsequent Neoplasms During the Fifth and Sixth Decades of Life in the Childhood Cancer Survivor Study Cohort. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 33(31), pp. 3568-75. doi:10.1200/JCO.2015.60.9487.
    Turcotte LM, et al. Risk of Subsequent Neoplasms During the Fifth and Sixth Decades of Life in the Childhood Cancer Survivor Study Cohort. J Clin Oncol. 2015 Nov 1;33(31):3568-75. PubMed PMID: 26261260.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Risk of Subsequent Neoplasms During the Fifth and Sixth Decades of Life in the Childhood Cancer Survivor Study Cohort. AU - Turcotte,Lucie M, AU - Whitton,John A, AU - Friedman,Debra L, AU - Hammond,Sue, AU - Armstrong,Gregory T, AU - Leisenring,Wendy, AU - Robison,Leslie L, AU - Neglia,Joseph P, Y1 - 2015/08/10/ PY - 2015/8/12/entrez PY - 2015/8/12/pubmed PY - 2016/3/15/medline SP - 3568 EP - 75 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J. Clin. Oncol. VL - 33 IS - 31 N2 - PURPOSE: Survivors of childhood cancer have an increased risk for subsequent neoplasms (SNs), but the incidence beyond the age of 40 years and associations with therapeutic exposures have not been well described. PATIENTS AND METHODS: Among 14,364 survivors of childhood cancer diagnosed between 1970 and 1986, 3,171 had an attained age of 40 years or older at the time of last contact. Cumulative incidence of SNs, standardized incidence ratios (SIRs), excess absolute risk of subsequent malignant neoplasms (SMNs), and relative risks (RRs) for SMNs and nonmelanoma skin cancers were calculated. RESULTS: In total, 679 SNs were diagnosed in patients age 40 years or older. These included 196 SMNs, 419 nonmelanoma skin cancers, 21 nonmalignant meningiomas, and 43 other benign neoplasms. At age 55 years, the cumulative incidence of new SNs and SMNs occurring after age 40 years was 34.6% (95% CI, 28.7 to 40.6) and 16.3% (95% CI, 11.7 to 20.9), respectively. Survivors were twice as likely as the general population to receive a diagnosis of SMN after age 40 years (SIR, 2.2; 95% CI, 1.9 to 2.5). Among SMNs, risk was increased for breast cancer (SIR, 5.5; 95% CI, 4.5 to 6.7), renal cancer (SIR, 3.9; 95% CI, 2.0 to 7.5), soft tissue sarcoma (SIR, 2.6; 95% CI, 1.5 to 4.4), and thyroid cancer (SIR, 1.9; 95% CI, 1.0 to 3.5). Female sex (RR, 1.9; 95% CI, 1.3 to 2.6; P < .001) and therapeutic radiation exposure (RR, 2.2; 95% CI, 1.4 to 3.3; P < .001) were associated with an increased for risk for SMN in multivariable analysis. CONCLUSION: Even after age 40 years, survivors of childhood cancer remain at increased risk for treatment-related SNs. These data suggest the need for life-long monitoring and should inform anticipatory guidance provided to survivors of childhood cancer. SN - 1527-7755 UR - https://www.unboundmedicine.com/medline/citation/26261260/Risk_of_Subsequent_Neoplasms_During_the_Fifth_and_Sixth_Decades_of_Life_in_the_Childhood_Cancer_Survivor_Study_Cohort_ L2 - http://ascopubs.org/doi/full/10.1200/JCO.2015.60.9487?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -