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Background: Survivors of childhood cancer may develop a second malignant neoplasm during adulthood and therefore require regular surveillance. Objective: To examine adherence to population cancer screening guidelines by survivors at average risk for a second malignant neoplasm and adherence to cancer surveillance guidelines by survivors at high risk for a second malignant neoplasm. Design: Retrospective cohort study. Setting: The Childhood Cancer Survivor Study (CCSS), a 26-center study of long-term survivors of childhood cancer that was diagnosed between 1970 and 1986. Patients: 4329 male and 4018 female survivors of childhood cancer who completed a CCSS questionnaire assessing screening and surveillance for new cases of cancer. Measurements: Patient-reported receipt and timing of mammography, Papanicolaou smear, colonoscopy, or skin examination was categorized as adherent to the U.S. Preventive Services Task Force guidelines for survivors at average risk for breast or cervical cancer or the Children's Oncology Group guidelines for survivors at high risk for breast, colorectal, or skin cancer as a result of cancer therapy. Results: In average-risk female survivors, 2743 of 3392 (80.9%) reported having a Papanicolaou smear within the recommended period, and 140 of 209 (67.0%) reported mammography within the recommended period. In high-risk survivors, rates of recommended mammography among women were only 241 of 522 (46.2%) and the rates of colonoscopy and complete skin examinations among both sexes were 91 of 794 (11.5%) and 1290 of 4850 (26.6%), respectively. Limitations: Data were self-reported. Participants in the CCSS are a selected group of survivors, and their adherence may not be representative of all survivors of childhood cancer. Conclusion: Female survivors at average risk for a second malignant neoplasm show reasonable rates of screening for cervical and breast cancer. However, surveillance for new cases of cancer is very low in survivors at the highest risk for colon, breast, or skin cancer, suggesting that survivors and their physicians need education about their risks and recommended surveillance. Primary Funding Source: The National Cancer Institute, National Institutes of Health, and the American Lebanese Syrian Associated Charities.

Researchers in numerous studies have suggested that preconception paternal occupational exposures to various substances, including pesticides and herbicides, may be involved in the etiology of childhood cancers. Using data from the Northern Region Young Persons' Malignant Disease Registry, the authors investigated whether paternal occupations likely to involve such exposures, as recorded at the time of a child's birth, were associated with children's cancer risk. The authors matched cases (n = 4,723), on sex and year of birth, to controls from 2 independent sources: (1) all other patients from the registry with a different cancer and (2) 100 cancer-free individuals per case from the Cumbrian Births Database. An inverse association existed, particularly in males, between lymphoid leukemia and paternal occupations with likely exposures to pesticides and/or herbicides. However, this was not significant after stratifying by residential status (urban versus rural). Results do not support a role for preconception paternal occupational exposures to pesticides or herbicides in the etiology of childhood cancer. KEYWORDS: agriculture, cancer, epidemiology, herbicides, paternal exposures, pesticides, Results of numerous studies have suggested that preconception paternal occupational exposures may have a role in the etiology of childhood cancers. (1) In particular, occupations with exposures to pesticides and [...]

Background. During the initial period after the Chernobyl accident, large amounts of radioactive iodine were released in fallout, resulting in serious exposure to the thyroid gland in the residents of areas around the nuclear power station. Beginning in 1990, a definite increase in the incidence of thyroid cancer was noted in children of the Republic of Belarus. Methods. Morphologic and clinical features of 84 cases of post-Chernobyl thyroid carcinoma in Belarussian children from 5 to 14 years of age are reported. The latent period for tumor development was 4-6 years, with a mean of 5.8 years. Results. Papillary carcinoma was found in 83 patients and medullary carcinoma in one. Besides typical papillary carcinoma (14%), solid (34%), follicular (33%), mixed (10%), and diffuse sclerosing (9%) variants were observed. The follow-up period ranged from 8 months to 2.5 years. One patient died, local recurrence developed in 2, and cervical lymph node metastases developed in 10. To date, the incidence of local recurrence or metastatic disease after surgery was significantly higher in patients 5-8 years of age and in residents of areas nearest to the Chernobyl station. Conclusions. Post-Chernobyl pediatric thyroid carcinoma is characterized by a short latency, a higher proportion of tumors arising in young children, and an almost equal sex ratio. Microscopically, these tumors were usually aggressive, often demonstrating intragiandular tumor dissemination (92%), thyroid capsular and adjacent soft tissue invasion (89%), and cervical lymph node metastases (88%). Papillary carcinoma was diagnosed in 99% of cases, with an unusually high frequency of solid growth patterns. Morphologic changes in nonneoplastic thyroid tissue were present in 90% of the glands, and the most specific findings were vascular changes and perifollicular fibrosis. Cancer 1994; 74:748-66.

Background. Non-Hodgkin lymphomas (NHL) account for approximately 50% of neoplasms in patients with ataxia teleangiectasia (AT). Prognosis is poor. Published data regarding the treatment of NHL in patients with AT suggested that these children respond poorly to therapy. The authors report on an infant with AT with mediastinal high-grade T-NHL who remained in continuous complete remission after chemotherapy. Diagnosis of AT was established after tumor diagnosis. Methods and Results. The 7-month-old boy was treated according to the acute lymphoblastic leukemia-Berlin, Frankfurt, Munster 86 protocol. The therapeutic response was prompt, but therapy had to be stopped because of severe side effects. Surprisingly, the boy remained in a stable complete remission for 3 1/2 years. Then tumors in both kidneys occurred and the child died a few months later. Postmortem examination demonstrated large tumors in both kidneys caused by a low-grade malignant lymphoma of B-cell lineage. Conclusion. Congenital immune deficiency should be ruled out at diagnosis of rare malignancies in respect to age. NHL in patients with AT can be cured, but poor tolerance to chemotherapy has to be considered. Patients whose disease has been cured may be at high risk for development of a second independent malignancy. Cancer 1994; 73:1522-5.

Background. Extrapulmonary inflammatory pseudotumor (plasma cell granuloma) is an uncommon lesion in adults and children, and little is known either of its etiology or clinical characteristics. However, it remains a significant source of morbidity to patients and confusion to clinicians. Methods. Case reports are presented of three patients with intraabdominal inflammatory pseudotumor who recently underwent surgery. A review of the recent world literature is also presented. Clinical and laboratory characteristics of omental-mesenteric inflammatory pseudotumor are reviewed along with a discussion of its etiology. Results. Cytogenetic data from cells of one patient show a derivative chromosome evolved from a translocation between the long arm of chromosome 2 and the short arm of chromosome 9 [(2;9) (q1,3;p2,2)]. Conclusions. The lesion is monoclonal, and genetic changes may play a crucial role in the development of this neoplasm. Omental-mesenteric inflammatory pseudotumor appears to represent a distinct clinicopathologic entity as a benign neoplasm in children. Cancer 1994; 73:1433-7.

Hepatitis B virus (HBV) infections have been associated with an increased risk for developing a type of liver cancer, hepatocellular carcinoma. In Taiwan, the prevalence of HBV infection is high, where hepatocellular carcinoma affects adults more often than children. The relationship of HBV to hepatocellular carcinoma in children was investigated in 51 children diagnosed with this disease. The family members of the children with liver cancer, who could be carriers of HBV, were also examined. A test for hepatitis B virus antigen, which indicates hepatitis B exposure, was positive in 39 patients. Thirty-one mothers (of 33 liver cancer patients) and two pairs of siblings, out of 29, tested positive for HBV antigen. Both the mothers and siblings of children with hepatocellular carcinoma had higher positivity rates than the mothers and siblings of children identified as HBV carriers. This was not true of the fathers of children with hepatocellular carcinoma. It was concluded that the time it takes from infection to the development of the cancer is shorter in children than adults. In Taiwan an HBV infection in mothers is the major mode of transmission of HBV to children with hepatocellular carcinoma. Transmission of HBV probably occurs around the time of birth or in early childhood. Widespread vaccination may help to lower the incidence of hepatocellular carcinoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Most young women who received chest radiation for childhood cancer are not being appropriately screened for breast cancer, despite their high risk. The primary barrier to screening is not a [...]