{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T06:10:37Z","timestamp":1778393437113,"version":"3.51.4"},"reference-count":80,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Kids Cancer Care Foundation"},{"DOI":"10.13039\/100008459","name":"University of Calgary","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008459","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003206","name":"Alberta Children\u2019s Hospital Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003206","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: While research shows childhood cancer survivors experience elevated subsequent primary neoplasm (SPN) and premature mortality risks, few studies have included contemporary survivors. Methods: This study quantifies the risk of SPNs and mortality among modern survivors of childhood cancer. Utilizing a retrospective, population-based cohort of individuals diagnosed with cancer before the age of 18 in Alberta, Canada (2001\u20132018), we evaluated their risks of SPNs and mortality compared to the general population in Alberta, overall and after 5-year survival, using standardized mortality and incidence ratios, and absolute excess risks per 10,000 person-years. Results: Among 2581 survivors, including 1385 5-year survivors, 50 individuals developed at least one SPNs and 408 deaths were observed, with 21 SPNs and 38 deaths occurring after 5-year survival. The SPN incidence was 13.3- (95% CI: 9.8\u201317.5) and 10.0-fold (95% CI: 6.2\u201315.2) higher than expected overall and in 5-year survivors, respectively, with risks varying depending on the treatment received. For mortality, survivors experienced 62.5-fold (95% CI: 56.5\u201368.8) higher mortality than expected overall, equating to 233.9 (95% CI: 210.8\u2013257.0) excess deaths per 10,000 person-years, with corresponding risks among 5-year survivors at 10.9 (95% CI: 7.7\u201315.0) and 43.8 (95% CI: 28.4\u201359.1), respectively. The excess deaths were predominantly due to recurrence\/progression (89.9% overall, 66.4% in 5-year survivors), with SPNs and non-neoplastic causes contributing more excess deaths with increasing follow-up time. Risks for mortality included treatment and cancer type. Conclusions: Contemporary childhood cancer survivors in Alberta experience substantial excess SPNs and mortality, highlighting the need for long-term surveillance and tailored risk mitigation interventions.<\/jats:p>","DOI":"10.3390\/cancers18040694","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T10:32:37Z","timestamp":1771583557000},"page":"694","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Subsequent Primary Neoplasms and Mortality Among Survivors of Childhood Cancer in Alberta, Canada"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1465-6468","authenticated-orcid":false,"given":"King Wa","family":"Tam","sequence":"first","affiliation":[{"name":"Department of Oncology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6804-8858","authenticated-orcid":false,"given":"Tona M.","family":"Pitt","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada"},{"name":"Department of Paediatrics, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada"},{"name":"Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Arthur Child Comprehensive Cancer Centre, 3395 Hospital Drive NW, Calgary, AB T2N 5G2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada"},{"name":"Long Term Survivors Clinic, Alberta Children\u2019s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4307-6289","authenticated-orcid":false,"given":"Maria","family":"Spavor","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Alberta, 11405-87 Avenue NW, Edmonton, AB T6G 1C9, Canada"},{"name":"Northern Alberta Childhood Cancer Survivor Program, 11135-84 Avenue NW, Edmonton, AB T6G 0V9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tony H.","family":"Truong","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada"},{"name":"Haematology, Oncology, and Transplant Program, Alberta Children\u2019s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Giles","sequence":"additional","affiliation":[{"name":"Long Term Survivors Clinic, Alberta Children\u2019s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory M. T.","family":"Guilcher","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada"},{"name":"Department of Paediatrics, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada"},{"name":"Haematology, Oncology, and Transplant Program, Alberta Children\u2019s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Logie","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6821-5936","authenticated-orcid":false,"given":"Iqra","family":"Rahamatullah","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3076-9676","authenticated-orcid":false,"given":"Fiona","family":"Schulte","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9594-9881","authenticated-orcid":false,"given":"Miranda M.","family":"Fidler-Benaoudia","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada"},{"name":"Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Arthur Child Comprehensive Cancer Centre, 3395 Hospital Drive NW, Calgary, AB T2N 5G2, Canada"},{"name":"Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"SEER cancer statistics review, 1975\u20132018","volume":"15","author":"Howlader","year":"2021","journal-title":"Natl. 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