Risk of digestive cancers in a cohort of 69 460 five-year survivors of childhood cancer in Europe: the PanCareSurFup study.
Reulen RCCentre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK.
Wong KFNational Cancer Registration and Analysis Service, Public Health England, London, UK.
Bright CJNational Cancer Registration and Analysis Service, Public Health England, London, UK.
Winter DLCentre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK.
Alessi DChildhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Italy, Childhood cancer registry of piedmont, Turin, Italy.
Allodji RMCancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France.
Bagnasco FEpidemiology and Biostatistics Unit, Instituto Giannina Gaslini, Genova, Italy.
Bárdi E2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary.
Bautz AChildhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.
Byrne JBoyne Research Institute, Drogheda, Ireland.
Feijen EAPrincess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Fidler-Benaoudia MMEpidemiology and Prevention Research, Departments of Oncology and Community Health Sciences, Calgary, Alberta, Canada.
Diallo IRadiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.
Garwicz SDepartment of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden.
Grabow DGerman Childhood Cancer Registry, University Medical Centre Mainz, Mainz, Germany.
Gudmundsdottir TChildhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.
Guha JPublic Health England and NHS England & Improvement, Birmingham, UK.
Haddy NRadiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.
Høgsholt SChildhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.
Jankovic MPediatric Clinic, University of Milan-Bicocca, Hospital San Gerardo, Monza, Lombardia, Italy.
Kaatsch PGerman Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
Kaiser MGerman Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
Kuonen RSwiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland.
Linge HDepartment of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden.
Øfstaas HNorwegian National Advisory Unit on solid tumors in children, Oslo, Norway.
Ronckers CMPrincess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Hau EMSwiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland.
Skinner RGreat North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle University Centre for Cancer, Newcastle Upon Tyne, UK.
van Leeuwen FEDepartment of Epidemiology, Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Teepen JCPrincess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Veres CRadiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.
Zrafi WRadiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.
Debiche GRadiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.
Llanas DRadiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.
Terenziani MPediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy.
Vu-Bezin GRadiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.
Wesenberg FNorwegian Cancer Registry and Dept. of Pediatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, Faculty of medicine, University of Oslo, Oslo, Norway.
Wiebe TDepartment of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden.
Sacerdote CChildhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Italy, Childhood cancer registry of piedmont, Turin, Italy.
Jakab ZHungarian Childhood Cancer Registry, Semmelweis University, 2nd Department of Pediatrics, Budapest, Hungary.
Haupt REpidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.
Lähteenmäki PMDepartment of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland.
Zadravec Zaletel LDivision of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia.
Kuehni CESwiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland.
Winther JFChildhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.
de Vathaire FRadiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.
Kremer LCPrincess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Hjorth LDepartment of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden.
Hawkins MMCentre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK m.m.hawkins@bham.ac.uk.
English
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.