INCIDENCE OF 2ND PRIMARY MALIGNANCIES AFTER A MALIGNANT-TUMOR IN CHILDHOOD - A POPULATION-BASED SURVEY IN PIEDMONT (ITALY)

We have studied the frequency of second primary malignancies (SPM) amo ng the 2,328 children registered in 1967-1989 at the Childhood Cancer Registry of Piedmont, the largest population-based childhood cancer re gistry in Southern Europe, Since the population of Piedmont is not ser ved by a conventional cancer registry covering all ages, SPMs were ide ntified through a number of ad hoc surveys within a variety of sources , Eighteen SPM (all histologically diagnosed) were observed after a th orough survey conducted in the oncological departments in Piedmont and after a postal questionnaire addressed to general practitioners. Deat h certificates were also examined. The crude incidence rate was 116.5 per 100,000 person-years. Risk was higher among children whose first m alignancy was diagnosed more recently (SIR = 9.8 for diagnoses in 1983 -1989 vs. 4.5 for diagnoses in 1967-1974). The same tendency was confi rmed in analyses restricted to children in whom leukemia was diagnosed as the first cancer. Clinical data regarding the treatment of the fir st malignancy were available for 16 children out of 18: 15 had receive d chemotherapy and 12 radiotherapy (9 SPM originated in the irradiatio n field). The interest of measuring the risk of SPM on a population ba sis (and not only in clinical series) and the advantage of close coope ration between epidemiologists and clinical oncologists are underlined . (C) 1996 Wiley-Liss, Inc.