Risk of Subsequent Neoplasms in Long-Term Survivors of Childhood Cancer

Strategic Insights -

Long-term survivors of childhood cancer are at increased risk of developing subsequent neoplasms (SNs), particularly those exposed to radiotherapy and chemotherapy, as well as those with genetic predisposition. This risk is substantial, with cancer treatments and genetic risk jointly contributing to a substantial proportion of incident SN cases. The study, conducted by researchers from the University of Alberta, analyzed data from two cohorts and used multivariable piecewise-exponential models to estimate the contributions of these risk factors.

Key Takeaways:

  • The study analyzed data from 12,344 survivors of childhood cancer, with a median attained age of 33.0 years in the St Jude Lifetime Cohort and 36.0 years in the Childhood Cancer Survivor Study.
  • The median follow-up from primary cancer diagnosis was 24.2 years in the St Jude Lifetime Cohort and 28.0 years in the Childhood Cancer Survivor Study.
  • Cancer treatments and genetic risk jointly contributed to a substantial proportion of incident SN cases, with attributable fractions ranging from 30% (95% CI 6-49; sarcoma) to 92% (89-94; meningioma).
  • Higher exposure levels of radiotherapy contributed most to the risk of SNs, particularly in older survivors.
  • The study suggests that lifestyle factors, such as physical activity, smoking, alcohol consumption, obesity, and diet, do not contribute substantially to the risk of SNs.
  • The researchers used data from the St Jude Lifetime Cohort (4401 participants; NCT00760656) and the Childhood Cancer Survivor Study (7943 participants; NCT01120353).

Statistics:

  • 49.6% of survivors were men, and 50.4% were women.
  • Most patients were White, accounting for 88.4% of the study population.
  • The study found that 44.7% (95% CI 41.9-47.5) of SNs in older survivors (35 years and above) were attributable to higher exposure levels of radiotherapy.
  • The attributable fractions to cancer treatment and genetic predisposition for different types of SNs ranged from 30% to 92%.

Sources:

  • Liu, Q., et al. (2025). Contributions of cancer treatment and genetic predisposition to risk of subsequent neoplasms in long-term survivors of childhood cancer: a report from the St Jude Lifetime Cohort and the Childhood Cancer Survivor Study. Lancet Oncology, 26(6), 806-816.
  • NewsRx. (2025). University of Alberta Reports Findings in Neoplasms (Contributions of cancer treatment and genetic predisposition to risk of subsequent neoplasms in long-term survivors of childhood cancer: a report from the St Jude Lifetime Cohort and the ...). Pediatrics Week, June 21, 2025; p 643.