Risk for a Second Cancer after Childhood Cancer


You likely don't want to think about the chances of having another cancer down the road. But research has shown that risk for a second cancer is slightly higher for childhood cancer survivors than is the risk for cancer in people of the same age in the general population. Here's what you need to know to assess your risk and help prevent a second cancer.

Am I at Risk?

Factors that affect risk for a second cancer are your age at cancer treatment, the specific treatment you received, and your genes and family history.

Chemotherapy Drugs 

Certain chemotherapy drugs can increase your risk for acute myeloid leukemia (AML). Although it is rare, it tends to occur within 10 years of treatment of your original cancer. These types of chemotherapy drugs increase risk:

  • high doses of alkylating agents (such as cyclophosphamide or nitrogen mustard),
  • epipodophyllotoxins (such as etoposide or teniposide), and
  • anthracyclines (such as doxorubicin or daunorubicin).

Risk for AML is also higher for people who underwent a stem cell transplant.

Radiation Therapy 

Radiation for childhood cancer increases risk for secondary solid tumors as you age. The most common tumor sites include the skin, breast, brain or spine, thyroid gland, and bones. Most often, these tumors occur 10 or more years after treatment for childhood cancer. Risk is greater for people who received higher doses of radiation over larger fields.

Family History of Cancer 

Some survivors may have inherited changes in their genes that raise risk for a second cancer. Signs that you might have a "cancer gene" include if your family has young people with cancer in every generation, or if you have a cancer that occurs in both sides of paired organs (such as the eyes, breasts, or kidneys). However, fewer than 1 out of 10 people with cancer have these gene problems. Talk with your doctor if you think that cancer may "run in your family." A review of your family's medical history will tell if you need genetic counseling or testing.

What If I Am at Risk for a Second Cancer?

Being proactive about your health, knowing your medical history, and developing a relationship with your doctor can boost the odds that any future health problems will be found at earlier stages. Follow these tips:

  • Have a childhood cancer long-term follow-up visit every year (see related Health Link: "Long-Term Follow-Up after Childhood Cancer").
  • Be sure to get all the screening tests that your doctor suggests for you based on your age, sex, and treatment history. If you are at high risk for a second cancer, your doctor may suggest that you have early or more frequent screenings to boost the chance that any second cancer is caught and treated early.
  • Learn the details of your medical history, including any exposure to chemotherapy, radiation, and surgery (see related Health Link: "Long-Term Follow-Up after Childhood Cancer").
  • Develop a relationship with a primary care doctor who knows your cancer treatment history, risks for late-effects, and recommended screening tests.
  • Report any new or ongoing symptoms to your doctor, including these:
    • easy bruising or bleeding
    • paleness of the skin
    • excessive fatigue
    • bone pain
    • changes in moles
    • sores that don’t heal
    • lumps
    • trouble swallowing
    • changes in bowel habits
    • ongoing stomach pain
    • blood in stools or urine
    • painful urination or bowel movements
    • ongoing cough or hoarseness
    • shortness of breath
    • bloody sputum
    • discolored areas or sores in the mouth that don’t heal
    • ongoing headaches
    • vision changes
    • ongoing early morning throwing up

How Can I Help Prevent a Second Cancer?

Certain lifestyle choices, including these, can help you prevent a second cancer.

Avoid Tobacco 

Don't smoke or chew tobacco and avoid secondhand smoke.

Protect Your Skin 

Skin cancers are one of the most common second cancers after childhood cancer, especially among people who were treated with radiation. That's why it's important to protect your skin from the sun's rays. Follow these tips:

  • Use sunscreen with a sun protection factor (SPF) of 15 or higher.
  • Wear protective clothing when outdoors.
  • Avoid outdoor activities from 10 am to 2 pm when the sun’s rays are strongest.
  • Don't tan.

Drink Alcohol in Moderation 

Heavy drinkers, especially those who use tobacco, have a high risk for cancer of the mouth, throat, and esophagus. Risk for breast cancer may be higher among women who drink alcohol, too. Limit your intake to lower these cancer risks as well as risk for other problems related to alcohol, such as liver disease.

Eat Right 

Intake of certain food has been linked with cancer risk. Help lower your odds for a second cancer by following these healthy eating tips:

  • Limit daily fat intake to 30% or less of your total calories. High-fat diets have been linked to several common adult cancers, including colon cancer.
  • Eat more fiber, which is found in whole grains and many fruits and vegetables.
  • Eat lots of fresh fruits and vegetables that contain vitamins C and A, which may lower risk for cancer. Citrus fruit, melon, and cruciferous vegetables are good sources of vitamin C. Dark green and deep yellow vegetables and certain fruits are high in vitamin A.
  • Add cruciferous vegetables (such as cabbage and cauliflower) to your diet. Eating these vegetables is thought to help prevent cancer by blocking the effects of chemicals in other foods that cause cancer.
  • Rarely eat salt-cured and pickled foods and lunchmeats that contain nitrites. They can increase risk for cancer of the stomach and esophagus.

Keep a Healthy Weight and Get Active 

Being overweight or obese is linked with increased risk for a number of cancers, including breast cancer in women after menopause and cancer of the colon and rectum. Avoiding weight gain as an adult is important not only because it might lower cancer risk but also because it can help reduce risk for many other health problems.

People who get moderate to vigorous levels of physical activity have a lower risk for several cancers, including breast and colon cancer. What's more, exercise plays a major role in keeping a healthy weight and helps lower risk for heart disease, diabetes, and other health problems.

For information on how to eat a healthy diet overall and get active, see related Health Link: "Eating Right and Being Active after Childhood Cancer."

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