Tuesday, July 13, 2010 (Last Updated: 07/16/2010)
TUESDAY, July 13 (HealthDay News) -- Long-term childhood cancer survivors face an increased mortality risk even 45 years after diagnosis, with the bulk of the excess mortality being from second primary cancers and circulatory diseases, according to research published in the July 14 issue of the Journal of the American Medical Association.
Raoul C. Reulen, Ph.D., of the University of Birmingham in Edgbaston, U.K., and colleagues conducted a population-based cohort study of 17,981 five-year childhood cancer survivors diagnosed with cancer before age 15 years between 1940 and 1991. The cohort was followed up through 2006. Measured outcomes included cause-specific standardized mortality ratios and absolute excess risks (AERs).
The researchers found that overall mortality (3,049 deaths) was 11 times higher than expected over the follow-up period, but declined over time. At 45 years from diagnosis, the mortality rate remained elevated at three times higher than expected. AER for death from cancer recurrence declined over time, from 97 extra deaths per 10,000 person-years at five to 14 years from diagnosis, to eight extra deaths after 45 years from diagnosis. Conversely, AER for death from second primary cancers and circulatory diseases increased over this time period, from eight and two extra deaths to 58 and 29 extra deaths, respectively. Past 45 years from diagnosis, circulatory deaths and second primary cancers accounted for 77 percent of the excess deaths.
"In terms of absolute risk, survivors diagnosed more than 25 years ago are currently most at risk of dying of a second primary cancer or circulatory disease, yet these survivors are much less likely to be actively followed up than those diagnosed more recently. The findings of this study suggest that survivors should be able to access health care intervention programs even many years after survival from their first cancer," the authors write.
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