This study, done in collaboration with investigators in the Division of Cancer Etiology, was designed to detect the effects of cancer and its treatment on childhood patients who survived to adulthood as well as any effects that might have been transmitted to their offspring. Specific issues for investigation were the occurrence of subsequent primary cancers, quality of life, late morbidity other than cancer and infertility among the cases and cancer and birth defects among offspring. Cases, selected from five U.S. cancer registries, had a histologically confirmed malignant neoplasm or brain tumor diagnosed under age 20 years, between 1945 and 1974, survived at least five years after diagnosis, and reached the age of 21 years. Up to two sibling controls were selected for each case with sequential priority given to full blood relationship, same sex, closest in age. Interviewer administered questionnaires were obtained for 2,285 (91%) cases and 3,265 (91%) controls. The relative risk among married subjects (surviving cancer patients versus their sibling controls) of establishing at least one pregnancy was 0.73 (95% CL 0.69-0.79). The reduction in risk of establishing a pregnancy was in part a function of treatment of the index cancer. For surviving male patients the major risk reduction was associated with alkylating agent chemotherapy (RR=0.33, 95% CL 0.21-0.51) while for females the largest effect was due to radiation therapy (RR=0.56, 95% CL 0.43-0.73). Relative risks for combined effects of radiation plus alkylating agent chemotherapy were 0.28 for male and 0.52 for female cancer patient survivors. Thus, the combination of radiation and alkylating agents did not appreciably alter the risk when compared to the major single modality effect for each sex.
