Childhood Cancer Survivors at Risk for GI Cancers Later in Life: Screening Recommended

July 2012, Vol 3, No 5

In childhood cancer survivors, subsequent malignant neoplasms are a leading cause of premature death, second only to recurrence of the primary cancer. The Childhood Cancer Survivor Study included a cohort of 14,337 childhood cancer survivors (which is believed to be the largest cohort of this type) and assessed the risk for gastrointestinal (GI) malignant neoplasms in this population (Henderson TO, et al. Ann Intern Med. 2012;156:757-766).

Results show that survivors of childhood cancer, especially patients who received abdominal radiation, those who survived Hodgkin lymphoma or Wilms’ tumor, and those who took certain chemotherapies (high-dose procarbazine and platinum drugs), are at an increased risk for GI cancers.

All participants were diagnosed with cancer before age 21 years, were treated at 1 of 26 centers in the United States and Canada, and survived for at least 5 years after the initial cancer diagnosis; their data were compared with a general population from a national cancer database.

The risk for GI cancer later in life was 4.6-fold higher in the childhood cancer survivors than in the general population (95% confidence interval [CI], 3.4- 6.1). The highest risk for GI cancer was associated with abdominal radiation, although survivors who were not exposed to radiation were also at increased risk. Among 11,807 patients with complete data available, the risk for GI cancer later in life was increased with the use of platinum drugs (relative risk [RR], 7.6; CI, 2.3-25.5) and highdose procarbazine (RR, 3.2; CI, 1.1-9.4).

One limitation of this study is that most cancer survivors had not yet attained an age when GI cancer typically occurs in the general population, so additional cases and risk factors may yet be identified.

These results support the recommendation to consider screening for GI cancers earlier in patients who survive childhood cancer.

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