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Background: Young adult survivors of childhood cancer have an increased risk for treatment-related morbidity and mortality. In this study, the authors assessed how treatment for childhood cancer affects older-adult health and health practices., Methods: One hundred seven adults treated for childhood cancer between 1947 and 1968, known to have survived past age 50 years, were identified from a single-institution cohort established in 1975. Updated vital status on eligible cases was obtained from public records. Survivors and a control group of their age-matched siblings and cousins completed a mailed survey to assess physical and social function, healthcare practices, and the prevalence of common adult illnesses., Results: Of the 107 survivors known to be alive at age 50 years, 16 were deceased at follow-up; 7 deaths could be associated with prior treatment (second malignancy in radiation field [3], small bowel obstruction after abdominal radiation [2], and cardiac disease after chest irradiation [2]). The 55 survivors (median age, 56 years; range, 51-71 years), and 32 family controls (median age, 58 years; range, 48-70 years), reported similar health practices, health-related quality of life, and social function. However, survivors reported more frequent visits to healthcare providers (P < .05), more physical impairments (P < .05), fatigue (P = .02), hypertension (P = .001), and coronary artery disease (P = .01). An increased risk of hypertension was associated with nephrectomy during childhood (odds ratio, 18.9; 95% confidence interval, 3.0-118.8)., Conclusions: The oldest adult survivors of childhood cancer continue to be at risk for treatment-related complications that potentially decrease their life expectancy and compromise their quality of life.

The Asian American Network for Cancer Awareness, Research, and Training (AANCART) is the first special populations network for Asian Americans on a national basis and includes collaborating organizations from Boston, New York, Houston, Seattle, San Francisco, Los Angeles, Hawaii, and Sacramento (where it is headquartered at the University of California, Davis). NCI funding of AANCART in 2000 brought together investigators and leaders from 9 cities across 6 states to establish an infrastructure for addressing cancer awareness, research, and training. Since 2000, AANCART has conducted needs assessments, held community awareness activities and trainings, trained trainees, sponsored National Asian American Cancer Control Academies, and produced presentations, publications, and grants. All specific aims have been attained, including the establishment of an infrastructure to promote Asian American cancer awareness, research, and training in 4 targeted regions; the establishment of partnerships to promote accrual to clinical trials, training, and pilot studies; and the formulation and successful implementation of grant-funded research to reduce the cancer burden among Asian Americans. AANCART's first 5 years have increased cancer awareness, trained special populations scientists, and advanced the field of Asian American cancer control research. Cancer 2006. (c) 2006 American Cancer Society.

The literature on health behaviors of young adult cancer survivors is very limited, and thus little is known about preventable risk factors in this population. This paper describes the prevalence of five behavioral risk factors among 541 young adult survivors of childhood cancers from the CCSS cohort who were identified as smokers and enrolled in a randomized controlled trial of a smoking cessation intervention. The relationship between presence of multiple risk factors and a number of smoking-related factors was examined. About 31% of the sample engaged in zero or one health-risk behavior in addition to smoking; 63% engaged in 2 or 3, and 6% engaged in 4 or 5. There were positive linear relationships between number of risk factors and smoking rate and nicotine dependence. Number of risk factors was not associated with self-efficacy for quitting, but was related to readiness to quit. This study demonstrated that childhood cancer survivors who smoke have a number of other risk factors for the development of preventable disease and the presence of these risks was associated with factors that decrease the likelihood of quitting smoking. Attention to other health behaviors may be an important strategy for helping smokers quit. In particular, helping childhood cancer survivors who smoke to reduce other risk behaviors might also encourage them to quit smoking., (Copyright 2003 John Wiley & Sons, Ltd.)

Background: Pregnancy outcome was reported by 139 survivors of advanced Hodgkin disease treated on nine protocols of Cancer and Leukemia Group B from 1966 to 1986., Methods: These patients provided data on 302 singleton pregnancies of a duration of at least 20 weeks that occurred before, during, or after treatment for Hodgkin disease (252, 26, and 24 pregnancies, respectively)., Results: There were 4 perinatal deaths, as compared with 5.7 expected. Cancer subsequently developed in 2 offspring (expected, 1.2). However, 22 newborn infants had low a birth weight, exceeding the expected number of 13.7 (relative risk 1.6; 95% confidence interval, 1.0-2.4). The excess number of low weight births occurred primarily during the period of Hodgkin disease diagnosis and treatment but is based on small numbers., Conclusion: No increase in adverse outcome occurred in pregnancies that antedated the development of Hodgkin disease.

Relatives of 88 long-term survivors of childhood sarcoma were examined for the familial cancer syndrome of sarcoma, breast cancer, and other neoplasms (Li-Fraumeni syndrome). Twenty-six of 402 close relatives developed cancer (expected, 23.8), including breast cancer in four mothers (expected, 3.1). Two sarcoma probands who developed second malignant tumors have multiple relatives with cancer and might have an inherited predisposition. An increased cancer risk and exceptional requirement for disease screening appear to be confined to first-degree relatives of a small fraction of children with sarcoma, notably probands with second cancers.

Choroid plexus neoplasms are rare epithelial tumors of the central nervous system. A carcinoma of the choroid plexus occurred in a child from a family with the breast cancer-sarcoma syndrome (Li-Fraumeni or SBLA syndrome), an inherited condition characterized by the development of diverse neoplasms (sarcoma, breast cancer, brain tumors, leukemia, adrenal cortical carcinoma, and others). Choroid plexus carcinomas were identified in two kindreds previously reported with the syndrome. The literature contains reports of choroid plexus neoplasms occurring in families and in individuals with multiple primary tumors. Choroid plexus neoplasm may be a manifestation of the inherited proclivity to tumor development in the breast cancer-sarcoma syndrome.

Among 910 survivors of childhood cancer, four developed infiltrating carcinoma of the breast and another had noninfiltrating breast tumor. Expected frequency was 0.3 cases of breast cancer in the series. The affected women developed breast carcinoma at ages 20, 25 and 38 years, and the men at ages 38 and 39 years, respectively. Each patient had received orthovoltage chest irradiation for treatment of Wilms' tumor or bone sarcoma between seven and 34 years previously, and estimated radiation dose to the breast exceeded 300 rad in each instance. Four patients also received diverse forms of chemotherapy. Survivors of childhood cancer have increased risk of developing breast cancer and should undergo periodic screening, particularly after breast tissue had been irradiated. Individualized radiotherapy planning can help exclude the breasts from treatment fields for some thoracic neoplasms.

A history of prolonged diphenylhydantoin (Dilantin) therapy was reported by 8 of 516 patients (1.6%) with Hodgkin's disease or non-Hodgkin's lymphoma, as compared with 3 of 516 patients (0.6%) with other cancers, and 2 of 516 (0.4%) tumor-free individuals. The findings, together with other published data, suggest a small excess risk of malignant lymphomas in patients receiving long-term treatment with this drug. The immunosuppressive effects of chronic diphenylhydantoin therapy may be involved in the pathogenesis of these neoplasms.

A man developed breast cancer 30 years after chest radiation for metastatic osteogenic sarcoma. At least eight previous cases of radiation-associated breast cancers have been reported in males, but this man represents the first to develop breast cancer following a childhood malignancy.

Twenty-seven women and the wives of nine men who survived unilateral Wilms' tumor in childhood had a total of 59 live born offspring. Among the 33 infants born to women who had received orthovoltage abdominal irradiation, ten weighed less than 2500 g at birth and three died during the perinatal period. In addition, one term infant of normal weight died of complications of a breech delivery. Only one of 26 infants born to the wives of Wilms' tumor patients and unirradiated female patients weighed less than 2500 g at birth and none died. The frequency of congenital malformations and spontaneous abortions in this series was not increased, and no offspring has developed cancer. The findings suggest that the risk of Wilms' tumor is low among progeny of survivors of nonfamilial, unilateral lesions. Damage from abdominal irradiation given to girls with Wilms' tumor may predispose them to the subsequent delivery of low birthweight children.

Clues to causes of cancer in man can be identified through clinical observation of patients. Alert practitioners have, for example, recently discovered carcinogenic effects of occupational exposure to vinyl chloride and of diethylstilbestrol therapy during gestation. Clinical case studies have also clarified the role of host susceptibility in development of cancer. In most instances, validity of initial clinical observations was established by more detailed epidemiologic and laboratory studies. Clinicians can contribute to carcinogenesis studies by being alert to causes of cancer in their patients, and by referring exceptional observations to clinical epidemiologists and basic scientists for further study. Knowledge of risk factors can be applied to cancer prevention and early detection.

Osteosarcoma or chondrosarcoma developed as a second malignant neoplasm (SMN) in 40 of 188 individuals with SMN whose first neoplasm occurred in childhood. A genetic susceptibility to cancer was found in 23; the SMN developed in an irradiated field in 32; both factors wer present in 16; neither in one. When a genetic predisposition was present, radiation shortened the interval to SMN. The intervals between tumors and the age at which the bone sarcomas developed in relation to genetic disease and therapy were analyzed by a two-mutation hypothesis. Studies of SMN in childhood permit us to make observation about the role of genetic factors and environmental mutagens in cancer etiology.

Two brothers developed multiple primary neoplasms in childhood; one had glioblastoma and non-Hodgkin's lymphoma at age 11 years, and the other brain tumor and acute leukemia at six years. A third brother died with myelogenous leukemia at thre years, and a fourth with cyanotic congenital heart disease at 11 weeks. Each child also had at least one hamartomatous lesion of the skin. The clinical features suggested von Recklinghausen's neurofibromatosis or other inherited cancer syndrome, but laboratory studies identified no markers of susceptibility to familial neoplasia.

A registry has been established of survivors of childhood cancer treated at the Sidney Farber Cancer Institute, Boston. This resource provides opportunities for studies of physiologic, genetic, psychologic, and social sequelae of childhood neoplasia. Findings indicate potential in most patients for a high quality of extended life. Comprehensive long-term care may further reduce late morbidity and mortality.

Two sisters had breast cancer at four years and 11 years after diagnosis of Hodgkin's disease. The affected breast tissues had received several hundred rads of scatter radiation during treatment of the lymphoma. Family history revealed breast cancer in a third sister and five other women in the paternal line. Cytogenetic and HLA studies showed no markers of susceptibility to neoplasia. Development of second primary neoplasms of the breast in the two sisters may have resulted from interactions between genetic factors and carcinogenic effects of radiation exposure.

A new malignancy was diagnosed in 19 of 414 long-term survivors of cancer in childhood. All but two lesions were attributable to prior radiotherapy; eight were successfully treated. Excluding 4 patients ascertained in connection with the second malignancy, there were 15 in the series who developed a new cancer, in contrast to 0.7 cases expected (p less than 0.001). The 20-year (5-24 years after initial diagnosis) cumulative probability of a second cancer was 12% (S.E. 4%), and the radiation-related cancer rate was 1.8 cases in exposed tissues per million person-years per rad. Host susceptibility may have had an etiologic role, but an oncogenic effect of chemotherapy was not demonstrable. Another 13 study patients developed benign tumors. These findings emphasize the importance of long-term surveillance of children with cancer.

A woman was treated for Hodgkin's disease, remained disease-free for 25 years, and then developed waxing and waning adenopathy during the next 2 years. The histologic examination of a lymph node biopsy specimen showed a T-cell non-Hodgkin's lymphoma. The patient's indolent clinical course prompted a second biopsy to obtain tissue for T-cell receptor gene rearrangement studies. A southern blot analysis using a human T-cell receptor beta chain probe showed a new band of rearranged DNA, which confirmed the diagnosis of T-cell lymphoma.

Cryptorchism was diagnosed in all 3 male members of 2 pairs of dizygotic twins in a sibship. Two of these brothers developed seminomas at age 31 and 33 years. Studies revealed a nephew with an atrophic testicle, but no additional instances of twinning, cryptorchism or testis cancer. Cryptorchism has been reported previously in 3 of 8 sets of twins with testis cancer, but rarely in familial testis cancer affecting other relatives. Hormonal factors may be involved in the association of twinning, cryptorchism and testis cancer in this family.

Studies were made of the development of second malignant tumors in children treated at the Sidney Farber Cancer Institute. In 1973 a retrospective analysis identified second cancers in 15 of 410 patients who survived a childhood cancer. During the period 5-24 years after diagnosis of the first cancer, the cumulative probability of developing a new cancer was 12%. This frequency was approximately 20-fold higher than the expected rate for the general population. Prospective study of the series since 1973 has identified a second primary cancer in five additional patients. The majority of second cancers were in the field of prior radiotherapy, and were attributable to the oncogenic effect of radiation. Genetic susceptibility factors were identified in individual patients.

One hundred two patients were evaluated for late effects of brain tumor in childhood by a medical record review and follow-up questionnaire. The patients had survived brain tumor for 5 to 47 years (median, 18 years). Among 30 patients who had received brain irradiation, 3 were successfully treated for second neoplasms that developed within the radiotherapy field 11, 16, and 29, years later, respectively. Moderate or severe functional deficits were present in 24 patients (24%), more commonly among those treated before 2 years of age and among those with cerebral astrocytoma. The other 78 patients (76%) had mild or no gross deficits, and all but 1 of them were attending school or were employed. Twenty-one patients in the series reported a total of 41 offspring, none of whom had cancer or mental retardation. Although markedly diverse performance levels were found among the 102 long-term survivors of childhood brain tumors, the majority had an acceptable quality of life.

Study was made of a kindred with a strong history of carcinoma of the colon. Twenty-three family members were screened for the tumor with carcinoembryonic antigen (CEA) assay, barium enema, and proctoscopy; one occult colon cancer was diagnosed. Identification and surveillance of families at high colon cancer was diagnosed. Identification and surveillance of families at high risk of cancer can provide unusual opportunities for early tumor detection.