Risk of subsequent primary oral cancer in a cohort of 69,460 5-year survivors of childhood and adolescent cancer in Europe: the PanCareSurFup study

Ceren Sunguc, Michael M. Hawkins, David L. Winter, Isabelle M. Dudley, Emma J. Heymer, Jop C. Teepen, Rodrigue S. Allodji, Fabiën N. Belle, Francesca Bagnasco, Julianne Byrne, Edit Bárdi, C. cile M. Ronckers, Nadia Haddy, Thorgerdur Gudmundsdottir, Stanislaw Garwicz, Momcilo Jankovic, Helena J. H. van der Pal, Maja Česen Mazić, Christina Schindera, Desiree GrabowMilena M. Maule, Peter Kaatsch, Melanie Kaiser, Brice Fresneau, Gisela Michel, Roderick Skinner, Thomas Wiebe, Carlotta Sacerdote, Zsuzsanna Jakab, Maria Winther Gunnes, Monica Terenziani, Jeanette F. Winther, P. ivi M. Lähteenmäki, Lorna Zadravec Zaletel, Claudia E. Kuehni, Leontien C. Kremer, Riccardo Haupt, Florent de Vathaire, Lars Hjorth, Raoul C. Reulen

Research output: Contribution to journalArticleAcademicpeer-review


Background: Survivors of childhood cancer are at risk of subsequent primary malignant neoplasms (SPNs), but the risk for rarer types of SPNs, such as oral cancer, is uncertain. Previous studies included few oral SPNs, hence large-scale cohorts are required to identify groups at risks. Methods: The PanCareSurFup cohort includes 69,460 5-year survivors of childhood cancer across Europe. Risks of oral SPNs were defined by standardised incidence ratios (SIRs), absolute excess risks and cumulative incidence. Results: One hundred and forty-five oral SPNs (64 salivary gland, 38 tongue, 20 pharynx, 2 lip, and 21 other) were ascertained among 143 survivors. Survivors were at 5-fold risk of an oral SPN (95% CI: 4.4–5.6). Survivors of leukaemia were at greatest risk (SIR = 19.2; 95% CI: 14.6–25.2) followed by bone sarcoma (SIR = 6.4, 95% CI: 3.7–11.0), Hodgkin lymphoma (SIR = 6.2, 95% CI: 3.9–9.9) and soft-tissue sarcoma (SIR = 5.0, 95% CI: 3.0–8.5). Survivors treated with radiotherapy were at 33-fold risk of salivary gland SPNs (95% CI: 25.3–44.5), particularly Hodgkin lymphoma (SIR = 66.2, 95% CI: 43.6–100.5) and leukaemia (SIR = 50.5, 95% CI: 36.1–70.7) survivors. Survivors treated with chemotherapy had a substantially increased risk of a tongue SPN (SIR = 15.9, 95% CI: 10.6–23.7). Conclusions: Previous radiotherapy increases the risk of salivary gland SPNs considerably, while chemotherapy increases the risk of tongue SPNs substantially. Awareness of these risks among both health-care professionals and survivors could play a crucial role in detecting oral SPNs early.
Original languageEnglish
Pages (from-to)80-90
Number of pages11
JournalBritish journal of cancer
Issue number1
Early online date2022
Publication statusPublished - 26 Jan 2023

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