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"Child's Cancer Therapy Can Lead to Tumors Later On"
Child's Cancer Therapy Can Lead to Tumors Later On
NEW ORLEANS (Reuters Health) - Children who survive a bout
of cancer are about six times more likely to develop a second
type of cancer later in life, according to a report presented
here at the American Association for Cancer Research meeting.
The excess cancer risk appears to be due to the effects of
cancer treatment, such as chemotherapy and radiation, although
some cases may be due to an increased genetic susceptibility to
cancer. Dr. Joseph Neglia of the University of Minnesota
presented the findings.
The results showed that 282 of 13,581 people studied (3%)
who had cancer as children, developed a secondary cancer later
in life that seemed unrelated to the original cancer. Study
participants were followed an average of 15 years after initial
cancer treatment, with some followed up to 20 years.
The average age of those studied was 23, but some were in
their mid- to late-40s, said Neglia.
The most common secondary tumor was breast cancer, found in
60 women. Forty-three people had thyroid tumors and 36 had
Neglia said it was difficult to separate out if the tumors
were partly caused by some underlying genetic defect, but that
he was confident that children treated with radiation had a
high risk of later tumor development.
Children treated for Hodgkin's disease are also at higher
risk, partly because the standard treatment 20 years ago was
aggressive radiation. That is not true any longer.
Women, especially, seem to be at risk. But Neglia said that
getting radiation therapy during puberty was not an additional
risk factor for later breast cancer development.
He urged women who had radiation treatment at any point in
childhood to get a baseline mammogram in their 20s.
Neglia said anyone who received childhood cancer treatment
should talk with a physician about their risk factors and
potential monitoring strategies.
Doctors walk a fine line in balancing the benefit of
treating a childhood cancer with the risk that the therapy
itself could lead to later cancers in adulthood.
With so much of their lives ahead, the stakes are high,
said oncologists, who also noted there has been a slight rise
in pediatric cancer cases over the past several decades. There
are about 8,000 to 10,000 new cases a year in the US, with
leukemias and brain tumors leading in incidence, said Dr.
Barton Kamen, a pediatric oncologist affiliated with the Robert
Wood Johnson Medical School in New Jersey. He addressed
reporters at the meeting.
Noting that cancer is the leading disease-related cause of
death in children, and that pediatric cancer usually doesn't
respond to multiple therapeutic attempts, Kamen said
oncologists must err on the side of aggressive initial
treatment, despite more data showing that therapies can cause
other cancers later in life.
"You don't get a second chance to treat a child with
cancer," Kamen stated. "You have to win the first time out."
Both Kamen and Neglia cautioned that oncologists should not
pull back in their treatment of childhood tumors, noting that
some 70% of children diagnosed with cancer today will be cured
of their initial disease.
"The progress we've made in pediatric oncology has been
just astonishing," said Neglia. "We just need to understand the
ramifications," he added.
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Cancer Toll Set to Double by 2020 (March 26)
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