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

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.