Mortality after colorectal cancer among survivors of childhood cancer

Mortality after diagnosis of colorectal subsequent malignant neoplasms (CRC-SMN) among childhood cancer survivors is understudied. Using data from the Childhood Cancer Survivor Study (CCSS) and the Surveillance, Epidemiology, and End Results (SEER) program, we compared all-cause mortality of survivors with CRC-SMN to survivors without CRC-SMN and CRC patients in the general population without a childhood cancer history. Among 25,656 childhood cancer survivors, 96 developed CRC-SMN, with 50% diagnosed before age 40 and 19% before age 30. Of those diagnosed before age 40, 35% had no prior abdominal/pelvic-directed radiation therapy. The cumulative incidence of CRC-SMN in CCSS survivors was 0.7% (95%CI: 0.5%-0.9%) by age 45 and 1.1% (95%CI: 0.8%-1.4%) by age 50. There were 31 deaths after CRC-SMN. Adjusted all-cause mortality was threefold higher (HR 3.34, 95%CI: 2.25-4.59) than for survivors without CRC and significantly higher for survivors diagnosed under age 30 compared to SEER CRC patients (HR 2.51, 95%CI: 1.29-4.89).