Increased Risk of Cancers After Age 40 in Childhood Cancer Survivors
In an analysis from the Childhood Cancer Survivor Study reported in the Journal of Clinical Oncology, Turcotte et al found that survivors of childhood cancer are at increased risk of subsequent malignant neoplasms after age 40 years.
Study Details
The study involved data from 3,171 survivors of childhood cancer diagnosed between 1970 and 1986 who were aged ≥ 40 years at the time of last contact. Patients had a median age of 44 years. A total of 679 subsequent neoplasms were diagnosed, including 196 subsequent malignant neoplasms, 419 nonmelanoma skin cancers, 21 nonmalignant meningiomas, and 43 other benign neoplasms.
Increased Risk
At age 55 years, the cumulative incidence of new subsequent neoplasms and subsequent malignant neoplasms occurring after age 40 years was 34.6% and 16.3%. The standardized incidence ratio (SIR) for subsequent malignant neoplasms in survivors vs the general population was 2.2, with SIRs of 5.5 for breast cancer, 3.9 for renal cancer, 2.6 for soft-tissue sarcoma, and 1.9 for thyroid cancer.
On multivariate analysis, female sex (relative risk [RR] = 1.9, P < .001), therapeutic radiation exposure (RR = 2.2, P < .001), and platinum chemotherapy (RR = 2.3, P = .05) were associated with an increased risk for subsequent malignant neoplasms, whereas history of subsequent neoplasm before age 40 was not a significant predictor.
The investigators concluded: “Even after age 40 years, survivors of childhood cancer remain at increased risk for treatment-related [subsequent neoplasms]. These data suggest the need for life-long monitoring and should inform anticipatory guidance provided to survivors of childhood cancer.”
Lucie M. Turcotte, MD, MPH, of the University of Minnesota, is the corresponding author of the Journal of Clinical Oncology article.
The study was supported by the National Cancer Institute, National Institutes of Health, American Lebanese-Syrian Associated Charities, and Children’s Cancer Research Fund. For full disclosures of the study authors, visit jco.ascopubs.org.
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