Cancer Risk in Childhood Cancer Survivors (CRICCS) is a collaborative population-based project funded by Children with Cancer UK. The project was launched on 2 November 2020 and will be conducted over a 3-year period.
The CRICCS project has the following objectives:
- To estimate the prevalence of childhood cancer survivors in Europe.
- To quantify and characterize the risk of second primary neoplasms (SPNs) in childhood cancer survivors in Europe.
- To assess the risk of SPNs according to treatment and predisposing characteristics in childhood cancer survivors in selected countries, including outside Europe.
- To develop guidelines for routine population-level monitoring of SPNs in childhood cancer survivors by cancer registries.
Rationale
Successful treatment of childhood cancers has resulted in a high probability of survival for many years after cancer diagnosis. However, the survivors of childhood cancer often experience serious late effects, which include developing a new cancer. The risk of developing a new cancer varies by the type of the first cancer, the age at diagnosis of the first cancer, the time since diagnosis, the administered therapy, the sex of the patient, and other factors. Second cancers occur relatively rarely, but the risk of such an event increases with time. By 30 years after the first diagnosis, about 10% of childhood cancer survivors will have been diagnosed with a second cancer. A second cancer is a leading cause of death in survivors. Knowing the patterns of occurrence of second cancers will facilitate their prevention.
Currently, no definite estimate is available of the number of people who were diagnosed with cancer before age 20 years and may need medical follow-up and care. Knowing the size of this population would enable the necessary resources to be allocated to secure adapted surveillance with the aim of preventing late effects, including second cancers.
Information collected by cancer registries on all cancers occurring in a defined population is an ideal resource to study differences in the occurrence of second cancers. In Europe, about 50% of the childhood population is covered by such population-based cancer registries. Although these registries enumerate all cancers fairly completely, details on diagnosis and treatment are less often collected. Linking registries with clinical databases will make it possible to evaluate the impact of various treatment regimens on the development of second cancers in populations of survivors.
Second cancers are relatively rare events in survivors of childhood cancers, which are themselves rare. Therefore, large populations need to be studied to derive solid knowledge, on which policy decisions can be confidently based. The CRICCS project will use the maximum available data, quality-assured and comparable on an international level, to help reduce the risk of a second cancer in each individual survivor.
Programme of workProgramme of Work
The work in the CRICCS project will be driven by data collected by population-based cancer registries.
First, the existing large studies will be used to estimate the total number of childhood cancer survivors in Europe today. This number will be the sum of all registered survivors and those whose first cancer diagnosis occurred before cancer registration had begun. In addition to the overall total, the numbers will be estimated according to sex, current age, and type of cancer, for 40 European countries.
Data already collected from 49 cancer registries in 23 European countries with a complete record of second cancers in all registered patients will be used to examine the impact and patterns of occurrence of second cancers. It will be possible to compare the risk of second cancers between men and women, between younger and older survivors, and among survivors of different cancer types.
New data will be collected from cancer registries around the world, which will provide information on specified pre-existing health conditions and treatment for the first cancer. It will therefore be possible to evaluate the risk of second cancers as sequelae of treatment or as unfavourable outcomes associated with a known pre-existing health condition.
Work on the above-mentioned topics will lead to the development of international guidelines for improving the quality of data collected on second cancers in populations of survivors. This will further increase the understanding of the causes of second cancers and facilitate their prevention.
FundingFunding
Children with Cancer UK is a leading charity dedicated to the fight against childhood cancer in the United Kingdom. The mission of Children with Cancer UK is to improve survival rates across all types of childhood cancer and to support children and their families to live better during and after treatment. The charity achieves its mission by funding vital research into cancers in children, teenagers, and young adults, by supporting families, and by raising awareness. The research aims of Children with Cancer UK are to understand the causes of cancer, identify diagnostic and prognostic markers, develop more-effective and less-toxic treatments, and understand more about the long-term risks faced by childhood cancer survivors.
Children with Cancer UK is funding the project “Cancer risk in childhood cancer survivors (CRICCS): understanding the causes to target prevention” over the period 2021–2023. This support will help to generate crucial information about the health risks faced by people who were treated for cancer in childhood or adolescence, such as baseline data for planning health care and follow-up. Data collected on all patients with childhood cancer in many countries will thus become useful for each survivor who was treated for cancer at a young age.
Research team
Research team
The CRICCS project is led by Eva Steliarova-Foucher from the International Agency for Research on Cancer (IARC), in cooperation with:
– Charles Stiller (Public Health England, United Kingdom)
– Kathy Pritchard-Jones (University College London, United Kingdom)
– Lars Hjorth (Lund University, Sweden).
This leadership team is supported by the Scientific Advisory Board:
– Joanne Aitken (Cancer Council Queensland and University of Queensland, Australia)
– Friederike Erdmann (University of Mainz, Germany)
– Jeanette Falck Winther (Danish Cancer Society Research Center, Aarhus University and University Hospital, Denmark)
– Delphine Heenen (Childhood Cancer International – Europe and KickCancer, Belgium)
– Claudia Kuehni (University of Bern, Switzerland)
– Zuzana Tomášiková (Childhood Cancer International – Europe and Childhood Cancer, Switzerland)
– Danny Youlden (Cancer Council Queensland and Griffith University, Australia).
The project is supported at IARC by:
– Andrea Gini
– Neimar de Paula Silva
– Murielle Colombet
– Anastasia Dolya
– Freddie Bray
– Isabelle Soerjomataram
– Marion Piñeros.
The CRICCS project will benefit from the link between IARC and the International Association of Cancer Registries.
Members of the CRICCS Consortium have experience with leading and contributing to research studies, in particular those related to cancer registration, prevalence, survival, late effects, biology, and treatment, and include representatives of patients with childhood cancer. Several of the members have collaborated in large national or European survivorship studies devoted to issues encountered by survivors of childhood cancer.
Expected outcomesExpected outcomes
The knowledge generated by this project will be used to address specific dimensions of the cancer burden in survivors, at both the individual and population levels.
The results will provide a useful basis for planning health care within countries, and will enable international comparisons. As a result, adequate health care could be planned to provide optimal follow-up for the survivors, on the basis of the combined international evidence and best standards.
Understanding the extent and patterns of occurrence of second cancers will provide useful indications for tailoring clinical follow-up, taking into account the sex, age, region of residence, time since diagnosis, cancer type, treatment, and other characteristics of each patient. Each future survivor will thus benefit from information contributed by all other survivors and enhanced by population-based registries.
Activities
The first meeting of the CRICCS Consortium took place on 1–2 December 2020 and was held remotely via web conference, due to travel restrictions put in place to counter the COVID-19 pandemic. At the meeting, the planned course of action was discussed in detail. The Consortium members discussed the call for data, practicalities of data acquisition, methodological aspects, and the communication strategy.
ContactContact
Correspondence should be sent to the IARC Childhood Cancer Studies email address at ccs@iarc.fr