Risk of digestive cancers in a cohort of 69 460 five-year survivors of childhood cancer in Europe: the PanCareSurFup study

Raoul Reulen, Kwok-Fai Wong, Chloe Bright, David Winter, Daniela Alessi, Francesca Bagnasco, Edit Bárdi, Andrea Bautz, Julianne Byrne, Miranda M Fidler-Benaoudia, Ibrahima Diallo, Stanislaw Garwicz, Desiree Grabow, Thorgerdur Gudmundsdottir, Joyeeta Guha, Nadia Haddy, Stine Høgsholt, Moncilo Jankovic, Peter Kaatsch, Melanie KaiserRahel Kuonen, Helena Linge, Hilde Øfstaas, Cecile M Ronckers, Eva-Maria Hau, Roderick Skinner, Flora E. van Leeuwen, Jop C Teepen, Christina Veres, Rodrigue Allodji, Elizabeth Am Feijen, Wael Zrafi, Ghazi Debiche, Damien Llanas, Monica Terenziani, Giao Vu-Bezin, Finn Wesenberg, Thomas Wiebe, Carlotta Sacerdote, Zsuzsanna Jakab, Riccardo Haupt, Päivi Maria Lähteenmäki, Lorna Zadravec Zaletel, Claudia E Kuehni, Jeanette F Winther, Florent De Vathaire, Leontien C M Kremer, Lars Hjorth, Michael Hawkins

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Background: Survivors of childhood cancer are at risk of subsequent primary neoplasms (SPNs), but the risk of developing specific digestive SPNs beyond age 40 years remains uncertain. We investigated risks of specific digestive SPNs within the largest available cohort worldwide.

Methods: The PanCareSurFup cohort includes 69,460 five-year survivors of childhood cancer from 12 countries in Europe. Risks of digestive SPNs were quantified using standardised incidence ratios (SIRs), absolute excess risks, and cumulative incidence.

Results: 427 digestive SPNs (214 colorectal, 62 liver, 48 stomach, 44 pancreas, 59 other) were diagnosed in 413 survivors. Wims tumour (WT) and Hodgkin lymphoma (HL) survivors were at greatest risk (SIR=12.1;95%CI:9.6-15.1; SIR=7.3;95%CI:5.9-9.0, respectively). The cumulative incidence increased the most steeply with increasing age for WT survivors, reaching 7.4% by age 55 and 9.6% by age 60 years (1.0% expected based on general population rates). Regarding colorectal SPNs, WT and HL survivors were at greatest risk; both 7-times that expected. By age 55 years, 2.3% of both WT (95%CI:1.4-3.9) and HL (95%CI:1.6-3.2) survivors had developed a colorectal SPN—comparable to the risk among members of the general population with at least 2 first-degree relatives affected.

Conclusions: Colonoscopy surveillance before age 55 is recommended in many European countries for individuals with a family history of colorectal cancer, but not for WT and HL survivors despite a comparable risk profile. Clinically, serious consideration should be given to the implementation of colonoscopy surveillance whilst further evaluation of its benefits, harms and cost-effectiveness in WT and HL survivors is undertaken.
Original languageEnglish
Early online date2 Nov 2020
Publication statusE-pub ahead of print - 2 Nov 2020


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