HMN 2026: How Teen and young adult cancer survivors face double the risk of later cancers

Survivors of cancer in their teen and young adult years are at double the risk of most types of later cancers, according to research from Alberta published in the Canadian Medical Association Journal. Primary neoplasms—new cancers that develop after an earlier cancer—are a known late effect of previous cancers, often because of the effects of treatment.

“When combined with the relatively high survival rates in this age range, at approximately 86%, there is a growing population of young cancer survivors that will be adversely affected by their cancer diagnosis and its treatment even decades later,” writes Dr. Miranda Fidler-Benaoudia, a cancer epidemiologist at the University of Calgary Cumming School of Medicine and Cancer Care Alberta, Calgary, Alberta, with co-authors.

The Alberta Adolescent and Young Adult Cancer Survivor Study included all people in Alberta aged 15 to 39 years diagnosed with a first cancer between 1983 and 2017.

In this 34-year study period, researchers analyzed risks of future cancers to better understand the impact on this demographic and risks of future disease and death.

Of the 24,459 people included with a median follow-up of 7.4 years, 1,442 (6%) developed at least one subsequent cancer. Lymphoma and breast cancer were the most common types of cancer, after which later cancers developed. Breast, colorectal, and lung cancers were the most common new cancers, making up 43% of subsequent primary neoplasms.

“Although people with nearly all types of adolescent and young adult cancer investigated were at an increased risk of developing a subsequent primary neoplasm, survivors of Hodgkin lymphoma and breast cancer were identified as particularly vulnerable populations, with nearly one-third of subsequent primary neoplasms occurring after 5-year survival diagnosed in these survivor groups,” the authors write.

“These findings are consistent with previous studies and reflect the established late effects of radiotherapy, chemotherapy, and hormone therapy.”

They note genetic factors may also play a role, and that genetic counseling and education on maintaining healthy lifestyles are important in caring for survivors.

At 30 years after the original diagnosis, one in six survivors of adolescent and young adult cancer will experience a new cancer. As these cancers develop in survivors decades earlier than in the general population, the authors suggest earlier screening may be beneficial.

“Our findings suggest that earlier cancer surveillance in this population may be warranted, which agrees with numerous survivorship guidelines that recommend earlier breast and colorectal cancer surveillance for at-risk cancer survivors,” the authors write.

Cancer rates in adolescents and young adults have increased 1.3% per year in Canada. When combined with relatively high survival rates, this means that there is a growing population of young cancer survivors at risk of developing another cancer.

“Given that subsequent primary neoplasms are major contributors to morbidity and premature mortality, these findings underscore the need for innovative solutions to prevent, detect, and treat subsequent primary neoplasms among survivors of adolescent and young adult cancer,” the authors conclude.

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