Adolescent and Young Cancer Survivors Face Long-Term Health Problems

A recent study in the journal Cancer suggests that teenagers and young adults (15-29 years old at diagnosis) who survived cancer often have poor health compared to their peers later in life.  Long-term consequences of cancer, treatments and behavior (including approach to life) affect health of body and mind.


Researchers from the Center for Disease Control and Prevention, Atlanta, Georgia, led by Eric Tai, examined data from 4054 adolescent and young adult (AYA) cancer survivors in the registry called Behavioral Risk Factor Surveillance System (BRFSS).

Taking the bite out of second cancer risk attributable to radiotherapy of primary first cancer

 Extract of my guest post at maiBlog, a radiology-focused blog.

"The increasing ranks of cancer survivors have brought new concerns into focus—second primary cancers now account for 18% of all cancer diagnosis and are the third most common cancer diagnosis in US. ... Radiotherapy, while a highly effective cancer treatment option, has long been considered to increase the risk of subsequent cancers, but convincing data had been lacking.  Now, an epidemiological study published by the National Cancer Institute in the April 2011 issue of Lancet Oncology journal shows that 92% of all second cancers are due to causes other than the radiation treatment of previous cancer. ..."

Click here to read full post at maiBlog.

(Find complete post at InternetArchive here.) ___________________________

Complete Post Below:

By Ajay K Malik, PhD

Over the last forty years, we have made great strides in the diagnosis and treatment of cancer. According to the Centre for Disease Control and Prevention (CDC), the number of cancer survivors have steadily increased from three million in 1971 to over eleven million today; one in twenty Americans is a cancer survivor. The increasing ranks of cancer survivors have brought new concerns into focus‚Äîsecond primary cancers now account for 18% of all cancer diagnosis and are the third most common cancer diagnosis in US. Similar data is also emerging from other countries. Second primary cancers (a.k.a. second cancers) are new cancers that arise after the first incidence of any cancer. Second cancer may be in the same, surrounding or distant organs, and differ from metastatic cancer which is a result of primary first cancer cells disseminating to a distant organs (see a definition here).

Genetics and lifestyle behaviors, for instance, smoking, alcohol or poor diet, are partly responsible for second cancer, the treatment modalities during first cancer may also have a role. Both chemotherapy and radiotherapy can increase predisposition of other cells to cancer. Radiotherapy, while a highly effective cancer treatment option, has long been considered to increase the risk of subsequent cancers, but convincing data had been lacking. Now, an epidemiological study published by the National Cancer Institute in the April 2011 issue of Lancet Oncology journal shows that 92% of all second cancers are due to causes other than the radiation treatment of previous cancer.

This study relied on a National Cancer Institute resource called US Surveillance, Epidemiology and End Results (SEER) cancer registries. Since 1973, SEER registries have been collecting and reporting data on patient demographics, cancer diagnosis, tumor morphology tumor stage at diagnosis, first-line treatment and follow-up status. There are fifteen SEER registries which cover 28% of the US population from Conn. to Calif. with a racial make-up reflecting the overall US population. The authors analyzed data (collected from nine registries) for 647,672 patients who were 20 years or older (adult) and had been followed for a mean of 12 years since the primary cancer diagnosis. Their analyses included all (i.e., fifteen) solid-cancer sites, and cancers which had appeared after 5 years of first cancer were counted as second cancers. In this analysis, patients who had survived five or more years, nine percent developed second tumors‚Äînot all had received radiotherapy.

Radiotherapy, as part of initial first cancer management included external beam, brachytherapy or a combination of both. There was a variation in the use of radiotherapy across various cancer types. In this cohort, 60-80% of testicular (seminomas), brain, anal and laryngeal cancers were treated with radiotherapy, whereas less than 30% of non-small-cell lung and eye & orbit cancers were managed with radiotherapy. Yet, for every cancer type analyzed, the risk of second cancer was significant (Relative Risk, RR>1); the highest risk was for testicular (34%) and cervical(17%) cancers. However, of all the second cancers, only 8% could be attributed to radiotherapy during first cancer management. This is a much smaller percent than expected, and is a very good news for the radiology community. It helps communicate long-term risk of radiotherapy with respect to the potential benefit of tumor control and patient survival. Furthermore, the overall risk also decreases with time and by 15 years after the first diagnosis, only five excess cancers were found per 1000 cancer survivors.

The strengths of this study were: systemic analysis of all first cancer sites in adults, large population and over three decades of follow-up population data. However, there are some limitations: pediatric populations were excluded, also excluded from the study were patients who survived <5 years, those with hematological cancers, non-seminoma testicular cancers and small-cell lung cancer. The radiotherapy tools and equipment are continuously evolving and new technologies are being adopted. Thus, another look at these statistics will be warranted in coming years. But, for now, radiotherapy must be considered safe and should help professionals address anxiety of patients choosing a radiotherapy option.

This study was led by Amy Berrington de Gonzalez of Radiation Epidemiology Branch of National Cancer Institute, Bethesda, and included researchers from MD Anderson Cancer Institute, Houston, Texas.

Read more about the author, cancer biologist and biotech writer,Ajay K. Malik, PhD

References

Cancer Survivors‚ÄîUnited States, 2007. Morbidity and Mortality Weekly Report (MMWR). March 11, 2011;60(9):269-272 | FreeFullText |

de Gonzalez AB, Curtis RE, Kry SF, et al. Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries.Lancet Oncol. 2011 Apr;12(4):353-60. | PubMed | Scholar |

Tags: radiation therapy, radiotherapy, secondary cancer

The "non-survivors" in the dance of cancer

Elizabeth Edwards died in her home, at the age of 61, on December 7th, after a six year battle with advanced breast cancer.  It was 2006, when on Senator John Edward's presidential campaign trail, with her cancer in remission, she was being hailed as a survivor.  With a glow in her skin, her hair showing no sign of chemo/radiation tox and with her seemingly unlimited enthusiasm and energy, she inspired fellow cancer patients, she met on the campaign trail and all over the country.  That was the time when she was one of the "celebrity cancer survivors" who often are celebrated by the media.[read here, here, here]

 Je suis un "Survivor".

"But in March 2007, during her husband’s campaign for the presidency, Ms. Edwards announced at a news conference that the breast cancer had recurred, certainly in a rib and possibly her lung. What she did next was rare for celebrity patients: She announced that the cancer was terminal. Yes, Elizabeth Edwards was a breast cancer survivor, according to the lingo. But she would not survive the disease." - Lessons From Elizabeth Edwards.  By Barron H. Lerner, M.D., December 7, 2010, Well Blog NYTimes

Today, her death tells the story of thousands of ordinary cancer patients,

Diagnosed with cancer! So, what are my chances?

"One in four deaths in the United States is due to cancer." [...]  Statements such as this will make people sit up and really take notice.   Also true are the facts that, "among men, cancers of the prostate, lung and bronchus, and colorectum account for 52% of all newly diagnosed cancers. Prostate cancer alone accounts for 28% (217,730) of incident cases in men. . . The 3 most commonly diagnosed types of cancer among women in 2010 will be cancers of the breast, lung and bronchus, and colorectum, accounting for 52% of estimated cancer cases in women. Breast cancer alone is expected to account for 28% (207,090) of all new cancer cases" [read here].