Subsequent primary neoplasms: risks, risk factors, surveillance, and future research

Research output: Contribution to journalReview articlepeer-review


  • Smita Bhatia
  • Tara O Henderson
  • Paul C Nathan
  • Adam Yan
  • Jop C Teepen
  • Lindsay M Morton

Colleges, School and Institutes

External organisations

  • University of Alabama
  • University of Chicago
  • The Hospital for Sick Children, Toronto, Canada
  • Princess Maxima Centre for Paediatric Oncology BV
  • National Cancer Research Institute


Survivors of childhood cancer experience substantial premature mortality; in the British Childhood Cancer Survivor Study (BCCSS) cohort, by 50 years from diagnosis 30% of 5-year survivors had died when 6% were expected to have died from mortality rates in the general population.1 Analysis of the same cohort revealed that among survivors at least 45 years from diagnosis 51% of excess number of deaths were caused by subsequent primary neoplasm (SPN).1 However, efforts to reduce therapeutic exposures in more recent decades has contributed to a decline in late mortality in general and from SPN in particular, among 5-year survivors of childhood cancer.2 In this article the authors consider the risks of SPN after childhood cancer and compare these risks with those observed after adolescent and young adult (AYA) cancer; the carcinogenic impact of treatment of childhood cancer with radiotherapy and chemotherapy; the influence of inherited genetic susceptibility on the development of SPNs; and the role of surveillance, screening, and clinical follow-up guidelines.


Original languageEnglish
Pages (from-to)1135-1154
Number of pages20
JournalPed Clin N Am
Issue number6
Early online date30 Oct 2020
Publication statusPublished - Dec 2020


  • subsequent primary neoplasms, second malignant neoplasms, second primary cancers`, secondary cancers, radiotherapy, chemotherapy, genetic variation, genetic susceptibility, surveillance, screening, follow-up guidelines