Detection of the late effects of cancer: Surveillance and the role of genetic risk factors


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Kevin Oeffinger1
1Memorial Sloan-Kettering Cancer Center, New York, NY, USA

Abstract

More than 80% of children and adolescents with cancer will become long-term survivors. While childhood cancer survivors represent a relatively small fraction of the overall cancer survivor population, many will have long and productive lives. Thus, they account for a significant proportion of the person-years of the overall population of survivors.

Importantly, the curative therapy administered for the cancer also affects growing and developing organ systems. By 20 to 30 years after diagnosis, 75% of survivors will have at lease one chronic health condition and almost half will develop a severe or life-threatening condition or die from a chronic condition. Excess risk does not appear to plateau with aging, with many second cancers and serious chronic diseases developing in the mid-adult years.

Because of the general lack of pre-existing comorbidities prior to the primary cancer, childhood cancer survivors represent a unique paradigm for studying the late effects of cancer therapy and modifying factors such as lifestyle behaviors and family history. Recently, studies have begun to investigate the role of genetic polymorphisms in the development of therapy-related adverse outcomes. Assessing the interactions of these genetic factors with lifestyle behaviors, such as tobacco abuse, will further inform our understanding of the causal chain of events leading to a late effect.

This talk with provide an overview of late effects following curative therapy of children with cancer, followed by a discussion of current approaches to detecting late effects through surveillance, the development of risk prediction models, and the incorporation of genetic risk factors into such models.