Second malignant neoplasms in childhood cancer survivors.

Anna T. Meadows, MD, is a Senior Physician in the Department of Medicine and Director of Epidemiology, Etiology, and Genetics at the Children’s Cancer Research Centerat Children’s Hospital of Philadelphia and Professor of Pediatrics in the University of Pennsylvania School of Medicine in Philadelphia, Pennsylvania. Of the various late complications of cancer therapy, none is more serious or devastating than the development of a second malignant neoplasm (SMN). Studies have demonstrated that, as with adults who have cancer, children are also at increased risk of developing SMN.’-’ In general, the risk is estimated to be at least ten times greater than the cancer incidence among age-matched individuals. In addition, since large numbers of cured children have not yet experienced life spans approaching that expected in the general population, the total life-time cancer incidence is not yet known. However, all childhood cancer survivors are not equally susceptible. Specific treatment modalities and defined host conditions have been associated