Birth defects and childhood cancer in offspring of survivors of childhood cancer

Objective: To determine the effect of chemotherapy for cancer during childhood and adolescence on subsequent pregnancy outcome and the occurrence of cancer in the offspring. Design: We reviewed the history of 405 former patients with pediatric cancer. A self-administered questionnaire was completed by members of a cohort of consecutively treated patients who were aged 18 years or older at the most recent follow-up visit and who were at least 5 years beyond the initial diagnosis of their cancer. Setting: Department of Pediatrics of a National Cancer Institute-designated comprehensive cancer center. Results: One hundred forty-eight patients reported 280 pregnancies. Ninety-one of the patients who reported 1 or more liveborn or stillborn infants following the completion of treatment had received 1 or more chemotherapeutic agents as part of their treatment of cancer. The frequency of congenital anomalies was 3.3% among the liveborn offspring of the treated women and 3.3% among the liveborn offspring of the spouses or female companions of the treated men. No cases of childhood cancer have been diagnosed among the offspring. Conclusions: The present data suggest that prior treatment with mutagenic chemotherapeutic agents, in the dosage ranges examined, does not increase the frequency of congenital anomalies in the offspring of former pediatric and adolescent patients with cancer. Although no cases of childhood cancer have been observed thus far among the offspring, additional follow-up is necessary to adequately assess their risk of childhood cancer.