Risk of selected subsequent carcinomas in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study

J Clin Oncol. 2006 Jan 20;24(3):476-83. doi: 10.1200/JCO.2005.02.7235.


Purpose: To determine the risk of subsequent carcinomas other than breast, thyroid, and skin, and to identify factors that influence the risk among survivors of childhood cancer.

Patients and methods: Subsequent malignant neoplasm history was determined in 13,136 participants (surviving > or = 5 years postmalignancy, diagnosed from 1970 to 1986 at age < 21 years) of the Childhood Cancer Survivor Study to calculate standardized incidence ratios (SIRs), using Surveillance, Epidemiology, and End Results data.

Results: In 71 individuals, 71 carcinomas were diagnosed at a median age of 27 years and a median elapsed time of 15 years in the genitourinary system (35%), head and neck area (32%), gastrointestinal tract (23%), and other sites (10%). Fifty-nine patients (83%) had received radiotherapy, and 42 (59%) developed a second malignant neoplasm in a previous radiotherapy field. Risk was significantly elevated following all childhood diagnoses except CNS neoplasms, and was highest following neuroblastoma (SIR = 24.2) and soft tissue sarcoma (SIR = 6.2). Survivors of neuroblastoma had a 329-fold increased risk of renal cell carcinomas; survivors of Hodgkin's lymphoma had a 4.5-fold increased risk of gastrointestinal carcinomas. Significantly elevated risk of head and neck carcinoma occurred in survivors of soft tissue sarcoma (SIR = 22.6), neuroblastoma (SIR = 20.9), and leukemia (SIR = 20.9).

Conclusion: Young survivors of childhood cancers are at increased risk of developing subsequent carcinomas typical of later adulthood, underscoring the importance of long-term follow-up and risk-based screening. Follow-up of the cohort is ongoing to determine lifetime risk and delineate individual characteristics that contribute to risk.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Female
  • Gastrointestinal Neoplasms / epidemiology
  • Gastrointestinal Neoplasms / etiology
  • Head and Neck Neoplasms / epidemiology
  • Head and Neck Neoplasms / etiology
  • Humans
  • Incidence
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / etiology
  • Male
  • Middle Aged
  • Neoplasms / radiotherapy*
  • Neoplasms, Radiation-Induced / epidemiology*
  • Neoplasms, Radiation-Induced / etiology*
  • Neoplasms, Second Primary / epidemiology*
  • Neoplasms, Second Primary / etiology*
  • Risk Assessment
  • SEER Program
  • Survivors / statistics & numerical data*
  • Time Factors
  • United States / epidemiology
  • Urogenital Neoplasms / epidemiology
  • Urogenital Neoplasms / etiology