2025 Annual Report

increased risk even more. Radiation raised the odds of a second cancer more than 16 times, and a type of chemotherapy called platinum-based treatment doubled the risk. Survivors with a TP53 mutation, a gene that plays a major role in protecting the body from cancer, had an especially high risk. The most common second cancers found in the study were skin, thyroid, brain, breast, and bone cancers, as well as soft tissue sarcomas. Many of these cancers appeared more than 10 years after the first cancer, showing the importance of long-term follow-up care. Smita Bhatia, M.D., MPH, distinguished professor in the Division of Pediatric Hematology and Oncology, led the UAB team for this national study “Childhood cancer survivors are at increased risk of new cancers that are directly related to the radiation

“Childhood cancer survivors are at increased risk of new cancers that are directly related to the radiation and chemotherapy used to treat the primary cancer.”

SMITA BHATIA, M.D., MPH

To help physicians know who needs closer monitoring, the team created a risk calculator that uses simple information such as a survivor’s age at diagnosis, cancer type, and past treatments. When genetic test results were added, the tool became even more accurate. Using this tool, researchers found that about one in five survivors were at low risk, while nearly four in five were at moderate to high risk for developing a second cancer. Most survivors who carried a harmful mutation were in the higher risk group. The findings offer a new way to personalize care for childhood cancer survivors by helping doctors decide who may need genetic testing and closer screening. The goal is to catch second cancers earlier and improve long-term health for survivors. ●

and chemotherapy used to treat the primary cancer,” said Bhatia. She explained that carrying a harmful genetic mutation increases that risk even more and that these patients benefit from closer follow-up and screening to find new cancers early. “We have developed a risk calculator that allows health care providers to identify which childhood cancer survivors would benefit from genetic testing that would identify survivors who are at the high est risk of developing second cancers,” Bhatia explained.

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2025 ACADEMIC ANNUAL REPORT