Risk of subsequent primary neoplasms in survivors of adolescent and young adult cancer: The Teenage and Young Adult Cancer Survivor Study – a population-based cohort study

Research output: Contribution to journalArticle


  • Chloe Bright
  • David Winter
  • Daniel P. Stark
  • Martin McCabe
  • Angela B Edgar
  • Clare Frobisher

Colleges, School and Institutes


Background: There is little literature addressing the risks of subsequent primary neoplasms after adolescent and young adult (AYA) cancer; particularly the risks of specific subsequent primary neoplasms after specific AYA cancers. We provide a comprehensive report on the risk of subsequent primary neoplasms after specific AYA cancers.

Methods: The Teenage and Young Adult Cancer Survivor Study is a population-based cohort of 200,945 five-year survivors of cancer diagnosed when aged 15-39 years, between 01/01/1971-31/12/2006, in England and Wales. The cohort was established using cancer registrations from the Office for National Statistics and the Welsh Cancer registry. We focus on the risk of specific subsequent primary neoplasms after 16 types of AYA cancer: breast; cervical; testicular; Hodgkin lymphoma (females); Hodgkin lymphoma (males); melanoma; central nervous system (intracranial); colorectal; non-Hodgkin lymphoma; thyroid; soft tissue sarcoma; ovarian; bladder; other female genital; leukaemia; head and neck cancer. We report absolute excess risks (per 10,000 person-years) and cumulative incidence of specific types of subsequent primary neoplasm after each type of AYA cancer.

Findings: Overall, 12,321 subsequent primary neoplasms were diagnosed in 11,565 survivors; most frequently among survivors of breast, cervical, testicular cancer, and Hodgkin lymphoma. The corresponding cumulative incidence of all subsequent primary neoplasms at 35 years from diagnosis was 11·9 (95%CI = 11·3-12·6) for breast cancer survivors, 15·8 (95%CI=14·8-16·7) for cervical cancer survivors, 20·2 (95%CI=18·9-21·5) for testicular cancer survivors, 26·6 (95%CI=24·7-28·6) for female survivors of Hodgkin lymphoma, and 16·5 (95%CI=15·2-18·0) for male survivors of Hodgkin lymphoma. Among patients who had survived at least 30 years from diagnosis of cervical cancer, testicular cancer, Hodgkin lymphoma in women, breast cancer, and Hodgkin lymphoma in men, we have identified just a small number of specific SPNs which account for 82%, 61%, 58%, 45% and 41% of the total excess number of neoplasms, respectively. Noteworthy was the excess number of neoplasms accounted for by lung cancer across all AYA groups investigated.

Interpretation: We report excess numbers of specific subsequent primary neoplasms developing after each specific type of AYA cancer. Importantly, we have identified a small number of specific subsequent primary neoplasms which account for a large percentage of the total excess number of neoplasms among long-term survivors of cervical, breast, testicular cancer and Hodgkin lymphoma providing an evidence-base to inform priorities for clinical long-term follow-up. The prominence of lung cancer after each of these AYA cancers indicates the need for further work aimed at prevention and reducing the burden of this cancer among future survivors.

Funding: Cancer Research UK


Original languageEnglish
Pages (from-to)531-545
Number of pages15
JournalThe Lancet Oncology
Issue number4
Early online date21 Feb 2019
Publication statusPublished - Apr 2019