Risk of Cancer Among Offspring of Childhood-Cancer Survivors
ABSTRACT & COMMENTARY
Synopsis: There is no evidence of a significantly increased risk of nonhereditary cancer among the offspring of survivors of cancer in childhood.
Source: Sankila R, et al. N Engl J Med 1998;338:1339-1344.
Increasing numbers of children with cancer are cured and reach adulthood. The risk of cancer among their progeny remains uncertain. Using data from national cancer and birth registries, Sankila and associates assessed the risk of cancer among 5847 offspring of 14,652 survivors of cancer in childhood or adolescence diagnosed since the 1940s and 1950s in Denmark, Finland, Iceland, Norway, and Sweden. The offspring were followed up for a diagnosis of cancer for 86,780 person-years. Among the 5847 offspring, 44 malignant tumors were diagnosed. There were 17 retinoblastomas and 27 neoplasms other than retinoblastoma.
The second most common primary site of cancer among the offspring was the brain and nervous system, in which eight tumors were observed. There were between zero and four apparently sporadic cases of cancer in other primary sites among the offspring. Excluding four likely cases of hereditary cancer and two subsequent cancers among the offspring with hereditary retinoblastoma, there were 22 sporadic cancers. Sankila et al conclude that there is no evidence of a significantly increased risk of nonhereditary cancer among the offspring of survivors of cancer in childhood.
COMMENT BY DAVID M. GERSHENSON, MD
This collaborative study from five countries represents a major contribution to our understanding of cancer biology and the potential late effects of treatment. The five-year survival rates for children and adolescents with malignancies have been improving over the past few decades. As Sankila et al point out, five-year survival rates for these groups range from approximately 65-75% in the countries involved in this study. The two greatest concerns regarding survivors of childhood cancer have been the risk of congenital anomalies in their offspring and the incidence of cancer in their offspring. Of course, both aspects were related to the possibility of treatment-related genetic mutations. The mounting body of evidence is comforting on both counts. Other large studies have found no evidence of an increase in the incidence of congenital aberrations among offspring of cancer survivors. Although other investigations have also found no evidence of an increased risk of cancer in offspring, the importance of this study is that it includes such a large study population. Interestingly, there was a slight trend toward an increased risk of cancer in the offspring of cancer survivors who were younger (less than 10 years) at diagnosis, but the heterogeneity of the population precluded any detailed analysis of this observation. In addition to the above concerns, we clearly need to investigate other potential late effects of cancer treatment in more depth, including the influence on fertility, an array of medical conditions, psychological well-being, and the overall quality of life compared with the normal population.
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