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.
