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- Title
A Methodological Issue in the Analysis of Second-Primary Cancer Incidence in Long-Term Survivors of Childhood Cancers.
- Authors
Yutaka Yasui; Yan Liu; Joseph P. Neglia; Debra L. Friedman; Smita Bhatia; Anna T. Meadows; Lisa R. Diller; Ann C. Mertens; John Whitton; Leslie L. Robison
- Abstract
Survival of childhood cancer patients has increased remarkably in the last several decades due to therapeutic improvements. Associated with this progress is the emerging need to accurately assess/minimize late effects of cancer therapy in long-term survivors. This paper considers a methodological issue in assessing the risk of second-primary malignant neoplasms, a major late effect of concern, using second-primary female breast cancer as an example. In the assessment of second-primary malignant neoplasm risk, attained age is a critical factor that must be taken into account. Even with follow-up of decades, childhood-cancer survivors are still at relatively young ages for developing adult-onset diseases. Attained ages at follow-up, however, modify cancer risk considerably; for example, in the general population, women aged 40 years have about fivefold increased breast cancer risk compared with women aged 30 years. A failure to account for the natural age-associated increase of risk could alter, or even reverse, analytical conclusions. This problem was studied empirically by both descriptive and regression analyses of two major studies of long-term childhood-cancer survivors, the Childhood Cancer Survivor Study (1975-1999) and the Late Effects Study Group (1955-1994). These showed appreciable differences in the analytical results by not accounting for the natural age-associated increase of risk, illustrating a significant impact of this methodological issue on study conclusions.
- Subjects
TUMORS in children; THERAPEUTICS; TUMORS; REGRESSION analysis
- Publication
American Journal of Epidemiology, 2003, Vol 158, Issue 11, p1108
- ISSN
0002-9262
- Publication type
Article
- DOI
10.1093/aje/kwg278