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

Reulen, Raoul C. ; Garwicz, Stanislaw LU ; Linge, Helena LU ; Wiebe, Thomas LU ; Hjorth, Lars LU and Hawkins, Michael M. (2021) In Gut 70(8). p.1520-1528
Abstract
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. Wilms tumour (WT) and Hodgkin lymphoma (HL) survivors were at greatest risk (SIR 12.1; 95% CI... (More)
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. Wilms tumour (WT) and Hodgkin lymphoma (HL) survivors were at greatest risk (SIR 12.1; 95% CI 9.6 to 15.1; SIR 7.3; 95% CI 5.9 to 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 seven times that expected. By age 55 years, 2.3% of both WT (95% CI 1.4 to 3.9) and HL (95% CI 1.6 to 3.2) survivors had developed a colorectal SPN - comparable to the risk among members of the general population with at least two 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 while further evaluation of its benefits, harms and cost-effectiveness in WT and HL survivors is undertaken. © 2020 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ. (Less)
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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cancer epidemiology, colorectal cancer, colorectal cancer screening, gastrointestinal cancer
in
Gut
volume
70
issue
8
pages
9 pages
publisher
BMJ Publishing Group
external identifiers
  • scopus:85095995713
  • pmid:33139271
ISSN
1468-3288
DOI
10.1136/gutjnl-2020-322237
language
English
LU publication?
yes
id
f307a38d-c2bc-46e8-ba6f-9ac5ee8e960c
alternative location
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85095995713&doi=10.1136%2fgutjnl-2020-322237&partnerID=40&md5=6ca23e518363a5950938aa3cc85f52db
date added to LUP
2020-11-27 11:41:42
date last changed
2022-10-07 11:12:52
@article{f307a38d-c2bc-46e8-ba6f-9ac5ee8e960c,
  abstract     = {{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. Wilms tumour (WT) and Hodgkin lymphoma (HL) survivors were at greatest risk (SIR 12.1; 95% CI 9.6 to 15.1; SIR 7.3; 95% CI 5.9 to 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 seven times that expected. By age 55 years, 2.3% of both WT (95% CI 1.4 to 3.9) and HL (95% CI 1.6 to 3.2) survivors had developed a colorectal SPN - comparable to the risk among members of the general population with at least two 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 while further evaluation of its benefits, harms and cost-effectiveness in WT and HL survivors is undertaken. © 2020 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.}},
  author       = {{Reulen, Raoul C. and Garwicz, Stanislaw and Linge, Helena and Wiebe, Thomas and Hjorth, Lars and Hawkins, Michael M.}},
  issn         = {{1468-3288}},
  keywords     = {{Cancer epidemiology; colorectal cancer; colorectal cancer screening; gastrointestinal cancer}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{8}},
  pages        = {{1520--1528}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Gut}},
  title        = {{Risk of digestive cancers in a cohort of 69 460 five-year survivors of childhood cancer in Europe: The PanCareSurFup study}},
  url          = {{http://dx.doi.org/10.1136/gutjnl-2020-322237}},
  doi          = {{10.1136/gutjnl-2020-322237}},
  volume       = {{70}},
  year         = {{2021}},
}