New findings published by Hyuna Sung, PhD, and colleagues in the Journal of the National Cancer Institute showed that 5-year survivors of adolescent and young adult (AYA) cancer in the United States have a higher risk of developing—and nearly double the risk of dying from—a new primary cancer, compared with the general population.  

Hyuna Sung, PhD

“The risk of subsequent primary cancer among cancer survivors has been extensively studied among childhood cancer survivors, but relatively less is known about AYA cancer survivors,” said Dr. Sung, principal scientist, cancer surveillance research at the American Cancer Society and lead author of the study. “These results strongly stress the need to expand research on and strengthen efforts for surveillance of subsequent cancers among childhood and AYA cancer survivors, as well as develop age-specific, exposure-based, and risk-stratified prevention strategies in this growing population of survivors.”

Analysis and Results

In this study, researchers sought to provide a comprehensive profile of the risk of developing and dying from subsequent cancers among survivors of 29 AYA cancers diagnosed from ages 15 to 39. The analysis included more than 170,000 individuals in nine Surveillance, Epidemiology, and End Results registries who survived 5 years since their initial cancer diagnosis from 1975 to 2013 in the United States.

By 35 years post–cancer diagnosis, 1 in 7 survivors developed a new cancer and 1 in 16 survivors died from a new cancer. The risk among survivors overall compared with the general population was 25% higher for cancer incidence and 84% higher for cancer death.

The types of subsequent primary cancer and the magnitude of the risk varied substantially by the first cancer type; however, female breast, lung, and colorectal cancers were the most common, constituting 36% of all subsequent cancers and 39% of all subsequent cancer deaths. Lung cancer alone represented 11% of all subsequent cancers and 24% of all deaths from subsequent cancers.

“These findings underscore the critical role of providing high-quality posttreatment survivorship care to reduce the risk of subsequent cancers,” Dr. Sung said. “Given the younger age at diagnosis, there often should be more opportunities for prevention and early detection of subsequent cancers in this survivor group. However, preventing and managing such risk requires knowledge of its impact and optimal risk-based screening in place. Access to easily understood information and tailored resources based on survivors’ history of cancer are needed to support survivors to navigate survivorship care and maximize wellness as they age.”

Disclosure: For full disclosures of the study authors, visit academic.oup.com/jnci.