Subsequent Primary Neoplasms in Survivors of Adolescent and Young Adult Cancers
In a UK population-based cohort study (Teenage and Young Adult Cancer Survivor Study) reported in The Lancet Oncology, Bright et al found that subsequent primary neoplasms were most common in survivors of adolescent and young adult (AYA) breast, cervical, and testicular cancers, as well as Hodgkin lymphoma.
The study involved data from 200,945 5-year survivors of cancer diagnosed at ages 15 to 39 years in England and Wales between January 1971 and December 2006. The study end date was in December 2012. The risk of subsequent primary neoplasms after 16 types of AYA cancer was assessed.
Risk of Subsequent Primary Neoplasms
Overall, there were 2,631,326 person-years of follow-up, with median follow-up of 16.8 years. Key findings were:
- 12,321 subsequent primary neoplasms were diagnosed in 11,565 survivors, most frequently among survivors of breast cancer, cervical cancer, testicular cancer, and Hodgkin lymphoma.
- Absolute excess risk of any subsequent primary neoplasm per 10,000 person-years compared with cancer rates in the general population were 19.5 for survivors of breast cancer, 10.2 for survivors of cervical cancer, 18.9 for survivors of testicular cancer, 55.7 for female survivors of Hodgkin lymphoma, and 29.9 for male survivors of Hodgkin lymphoma.
- The cumulative incidence of all subsequent primary neoplasms 35 years after diagnosis was 11.9% in survivors of breast cancer, 15.8% in survivors of cervical cancer, 20.2% in survivors of testicular cancer, 26.6% in female survivors of Hodgkin lymphoma, and 16.5% in male survivors of Hodgkin lymphoma.
- In patients who had survived at least 30 years from diagnosis of cervical cancer, testicular cancer, Hodgkin lymphoma in women, breast cancer, and Hodgkin lymphoma in men, a small number of specific subsequent primary neoplasms were identified that accounted for 82%, 61%, 58%, 45%, and 41% of the total excess number of neoplasms, respectively.
- Standardized incidence ratios for subsequent neoplasms were significantly increased for: ovarian, lung, corpus uteri, other genital, melanoma, and colorectal sites among breast cancer survivors; bladder, lung, and colorectal sites for cervical cancer survivors; bladder, colorectal, lung, and prostate sites for testicular cancer survivors; breast and lung sites for female Hodgkin lymphoma survivors; and lung sites for male Hodgkin lymphoma survivors.
- Lung cancer accounted for a high proportion of the excess number of neoplasms among patients surviving at least 30 years from diagnosis of breast, cervical, and testicular cancer and Hodgkin lymphoma.
- An excess number of subsequent neoplasms was also identified in potentially irradiated sites.
The investigators concluded, “Our finding that a small number of specific subsequent primary neoplasms account for a large percentage of the total excess number of neoplasms in long-term survivors of cervical, breast, and testicular cancer, and Hodgkin lymphoma provides an evidence base to inform priorities for clinical long-term follow-up. The prominence of lung cancer after each of these AYA cancers indicates the need for further work aimed at preventing and reducing the burden of this cancer in future survivors of AYA cancer.”
Michael M. Hawkins, DPhil, of the Centre for Childhood Cancer Survivor Studies, University of Birmingham, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by Cancer Research UK, National Institute for Health Research, Academy of Medical Sciences, and Children With Cancer UK. The study authors' full disclosures can be found at thelancet.com.
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