Annalisa Trama1, Andrea Tittarelli1, Giulio Barigelletti1, Laura Botta1, Gemma Gatta1, Giovanna Tagliabue1, Paolo Contiero1, Stefano Guzzinati2, Anita Andreano3, Gianfranco Manneschi4, Fabio Falcini5, Marine Castaing6, Rosa A Filiberti7, Cinzia Gasparotti8, Claudia Cirilli9, Walter Mazzucco10, Lucia Mangone11, Silvia Iacovacci12, Maria F Vitale13, Fabrizio Stracci14, Silvano Piffer15, Rosario Tumino16, Simona Carone17, Giuseppe Sampietro18, Anna Melcarne19, Paola Ballotari20, Lorenza Boschetti21, Salvatore Pisani22, Luca Cavalieri D'Oro23, Francesco Cuccaro24, Angelo D'Argenzio25, Giancarlo D'Orsi26, Anna C Fanetti27, Antonino Ardizzone28, Giuseppa Candela29, Fabio Savoia30, Cristiana Pascucci31, Maurizio Castelli32, Cinzia Storchi11, Alice Bernasconi1. 1. Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy. 2. Veneto Tumor Registry, Azienda Zero, Padova, Italy. 3. Epidemiology Unit, Agency for Health Protection of Milan, Milano, Italy. 4. Clinical Epidemiology Unit, Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Firenze, Italy. 5. Department of Clinical and Experimental Oncology and Ematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy. 6. Department of Hygiene and Public Health, Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Università di Catania, Catania, Italy. 7. Liguria Cancer Registry, IRCCS Ospedale Policlinico San Martino, Genova, Italy. 8. Epidemiology Unit, Agency for Health Protection of Brescia, Brescia, Italy. 9. Modena Cancer Registry, Azienda Unità Sanitaria Locale Modena, Modena, Italy. 10. Department of Medicine and Surgery, Università degli Studi di Palermo, Palermo, Italy. 11. Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy. 12. Active Prevention Unit, Azienda Sanitaria Locale Latina, Latina, Italy. 13. Napoli 3 Sud Cancer Registry, Brusciano, Italy. 14. Department of Experimental Medicine, Università degli Studi di Perugia, Perugia, Italy. 15. Evaluative and Clinical Epidemiological Service, Azienda Provinciale per i Servizi Sanitari, Trento, Italy. 16. Cancer Registry and Histopathology Unit, Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy. 17. Taranto Cancer Registry, Azienda Sanitaria Locale di Taranto, Taranto, Italy. 18. Epidemiological Service, Agenzia di Tutela della Salute di Bergamo, Bergamo, Italy. 19. Cancer Registry Epidemiology Unit, Azienda Sanitaria Locale di Lecce, Lecce, Italy. 20. Epidemiologic Observatory, Azienda di Tutela della Salute della Val Padana, Mantova, Italy. 21. Epidemiologic Observatory, Cancer Registry, Agenzia di Tutela della Salute di Pavia, Pavia, Italy. 22. Epidemiology Unit, Agenzia di Tutela della Salute dell'Insubria, Varese, Italy. 23. Epidemiology Unit, Agenzia per la Tutela della Salute della Brianza, Monza, Italy. 24. Epidemiology Unit - Cancer Registry, Azienda Sanitaria Locale di Barletta-Andria-Trani, Barletta, Italy. 25. Epidemiology Unit, Azienda Sanitaria Locale Caserta 2, Caserta, Italy. 26. Department of Prevention, Azienda Sanitaria Locale Napoli 2, Napoli, Italy. 27. Epidemiology Unit, Azienda di Tutela della Salute della Montagna, Sondrio, Italy. 28. Statistic and Epidemiology Unit - Cancer Registry, Azienda Sanitaria Locale di Brindisi, Brindisi, Italy. 29. Cancer Registry Unit, Azienda Sanitaria Provinciale di Trapani, Trapani, Italy. 30. Childhood Cancer Registry of Campania Region, AORN Santobono Pausilipon, Napoli, Italy. 31. Department of Experimental Medicine and Public Health, Università di Camerino, Camerino, Italy. 32. Prevention Unit, Azienda Unità Sanitaria Locale della Valle d'Aosta, Aosta, Italy.
Abstract
BACKGROUND: Evidence about late effects in adolescent and young adult (AYA) cancer survivors is scarce. This study assessed the risk of subsequent malignant neoplasms (SMNs) to identify the most common SMNs to be considered in follow-up care. METHODS: Population-based cancer registries retrospectively identified first primary tumors (between 1976 and 2013) and SMNs in AYAs (15-39 years old at their cancer diagnosis). AYA cancer survivors were those alive at least 5 years after their first cancer diagnosis. The excess risk of SMNs was measured as standardized incidence ratios (SIRs) and absolute excess risk together with the cumulative incidence of SMNs. RESULTS: The cohort included 67,692 AYA cancer survivors. The excess risk of developing any SMN (SIR, 1.6; 95% confidence interval, 1.5-1.7) was 60%. The excess risk of SMNs was significantly high for survivors of lymphomas; cancers of the breast, thyroid, female genital tract, digestive organs, gonads, and urinary tract; and melanomas. The cumulative incidence of all SMNs in AYA cancer survivors within 25 years of their first cancer diagnosis was approximately 10%. Subsequent tumors contributing to approximately 60% of all SMNs were breast cancer, colorectal cancer, corpus uteri cancer, and ovarian cancer in females and colorectal cancer, bladder cancer, prostate cancer, lung cancer, and lymphomas in males. CONCLUSIONS: These results highlight the need to personalize follow-up strategies for AYA cancer survivors.
BACKGROUND: Evidence about late effects in adolescent and young adult (AYA) cancer survivors is scarce. This study assessed the risk of subsequent malignant neoplasms (SMNs) to identify the most common SMNs to be considered in follow-up care. METHODS: Population-based cancer registries retrospectively identified first primary tumors (between 1976 and 2013) and SMNs in AYAs (15-39 years old at their cancer diagnosis). AYA cancer survivors were those alive at least 5 years after their first cancer diagnosis. The excess risk of SMNs was measured as standardized incidence ratios (SIRs) and absolute excess risk together with the cumulative incidence of SMNs. RESULTS: The cohort included 67,692 AYA cancer survivors. The excess risk of developing any SMN (SIR, 1.6; 95% confidence interval, 1.5-1.7) was 60%. The excess risk of SMNs was significantly high for survivors of lymphomas; cancers of the breast, thyroid, female genital tract, digestive organs, gonads, and urinary tract; and melanomas. The cumulative incidence of all SMNs in AYA cancer survivors within 25 years of their first cancer diagnosis was approximately 10%. Subsequent tumors contributing to approximately 60% of all SMNs were breast cancer, colorectal cancer, corpus uteri cancer, and ovarian cancer in females and colorectal cancer, bladder cancer, prostate cancer, lung cancer, and lymphomas in males. CONCLUSIONS: These results highlight the need to personalize follow-up strategies for AYA cancer survivors.