Second primary cancers in people who had cancer as children: an Australian Childhood Cancer Registry population‐based study

Abstract

Objective To investigate the incidence of second primary cancers in people diagnosed with cancer during childhood. Design, setting Retrospective, population‐based study; analysis of Australian Childhood Cancer Registry data. Participants People alive at least two months after being diagnosed before the age of 15 years with a primary cancer, 1983–2013, followed until 31 December 2015 (2–33 years' follow‐up). Main outcome measures Risks of second primary cancer compared with the general population, expressed as standardised incidence ratios (SIRs). Results Among 18 230 people diagnosed with cancer during childhood, 388 (2%) were later diagnosed with second primary cancers; the estimated 30‐year cumulative incidence of second cancers was 4.4% (95% CI, 3.8–5.0%). The risk of a new primary cancer was five times as high as for the general population (SIR, 5.13; 95% CI, 4.65–5.67). Relative risk of a second primary cancer was greatest for people who had childhood rhabdomyosarcoma (SIR, 19.9; 95% CI, 14.4–27.6). Relative risk was particularly high for children who had undergone both chemotherapy and radiotherapy (SIR, 9.80; 95% CI, 8.35–11.5). Relative risk peaked during the 5 years following the first diagnosis (2 to less than 5 years: SIR, 10.3; 95% CI, 8.20–13.0), but was still significant at 20–33 years (SIR, 2.58; 95% CI, 2.02–3.30). The most frequent second primary cancers were thyroid carcinomas (65 of 388, 17%) and acute myeloid leukaemias (57, 15%). Conclusions Survivors of childhood cancer remain at increased risk of a second primary cancer well into adulthood. As the late effects of cancer treatment probably contribute to this risk, treatments need to be refined and their toxicity reduced, without reducing their benefit for survival.

A New Year, the top research articles, and a call to deliver a “net zero” Australian health care system by 2040

“…It is therefore a privilege to announce the top articles published by the MJA in 2020 as chosen by the editors. [13][14][15][16][17][18][19][20][21][22][23] The MJA published leading research and perspectives on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including the first SARS-CoV-2 isolated in Australia, uploaded to GenBank for immediate sharing with the global scientific community. 13 On 19 January 2020, a man from Wuhan was admitted in a hospital due to progressive respiratory symptoms 5 days after arrival in Melbourne.…”

“…Paediatric cancers are increasing in Australia and new evidence about outcomes were highlighted in two important research articles. 21,22 An analysis of data from the Australian Childhood Cancer Registry by Youlden and colleagues 21 found that, having been stable between 1996 and 2005, the overall incidence of childhood cancers rose by 1.2% per year between 2005 and 2015. Further, the authors conservatively estimated that the incidence rate of childhood cancers would increase by 7% over the next 20 years.…”

“…It is therefore a privilege to announce the top articles published by the MJA in 2020 as chosen by the editors 13‐23 . The MJA published leading research and perspectives on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), including the first SARS‐CoV‐2 isolated in Australia, uploaded to GenBank for immediate sharing with the global scientific community 13 .…”

“…A second retrospective, population‐based analysis of the Australian Childhood Cancer Registry showed that that 388 out of 18 230 people with cancer during childhood developed second primary cancers later in life. The 30‐year cumulative incidence of second cancers was estimated to be 4.4% (95% CI, 3.8–5.0%) 22 . Children with a history of receiving both chemotherapy and radiotherapy had a high relative risk for second cancers during the first 5 years after diagnosis of a first cancer.…”

Childhood cancer: unique opportunities and inherent challenges

“…As survival rates improve for children and young adults with cancer, there is emerging awareness of the pervading physical, emotional and psychological tolls on survivors of a childhood cancer diagnosis and treatment. Two‐thirds of patients with childhood cancers have significant long term treatment side effects, including organ dysfunction, neurocognitive deficits, impaired fertility, and secondary malignancies . The impact of the late sequelae of childhood cancer and treatment is extremely significant and it is imperative that efforts to minimise late effects continue, as well as providing services that meet the physical, emotional and psychological needs of survivors …”