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Long-term population-based risks of second malignant neoplasms after childhood cancer in Britain

British Journal of Cancer
Nature Publishing Group
Publication Date
DOI: 10.1038/sj.bjc.6602226
  • Epidemiology
  • Medicine


Long-term population-based risks of second malignant neoplasms after childhood cancer in Britain HC Jenkinson1,2, MM Hawkins*,2, CA Stiller3, DL Winter2, HB Marsden4 and MCG Stevens5 1Department of Paediatric Oncology, Birmingham Children’s Hospital NHS Trust, Birmingham B4 6NH, UK; 2Department of Public Health and Epidemiology, Centre for Childhood Cancer Survivor Studies, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; 3Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford OX2 6HJ, UK; 4Department of Paediatric Pathology, Royal Manchester Children’s Hospital, Pendlebury, Manchester M27 4HA, UK; 5Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK In a population-based, retrospective cohort study of 16 541 3-year survivors of childhood cancer treated in Britain up to the end of 1987, 278 second malignant neoplasms (SMNs) were identified against 39.4 expected giving a standardised incidence ratio (SIR) of 6.2. The overall cumulative risk of an SMN by 25 years from 3-year survival from childhood cancer was 4.2%. Analysis of the cohort of nonretinoblastoma childhood cancers combined revealed a significant decline in SIR of SMN with increasing duration of follow-up. There was a greater risk of developing a SMN, particularly secondary acute myeloid leukaemia, in those diagnosed with childhood cancer from 1980 onwards. However, on multivariate modeling, this was not an independent risk factor. There was significant heterogeneity (Po0.001) in SIR of SMN across different treatment groups, the greatest risk observed in the group exposed to both radiotherapy and chemotherapy. The risks of SMN observed were comparable with those in other population-based studies. While the decline in SIR with duration of follow-up and the small excess numbers of cancers observed over later decades after diagnosis are reassuring, the high excess risk, particularly of leukaemia, associated with recent more intense therapy is of co

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