Impact of SMNs on Mortality in the Cohort
In a recent analysis of the mortality of this large cohort, 2,831 5-year survivors (13%) who enrolled in the CCSS subsequently died.21 Death certificate information was available for deaths occurring between January 1, 1979, and December 31, 2002. The leading cause of death was recurrence of primary disease in 67% of the members. Death was attributable to SMNs in 18.6%. At 20-year follow-up, death due to SNs exceeded that due to all other causes of death. Exposure to radiation therapy was cited as the most frequent predisposing factor of SNs, but a few cases were attributable to chemotherapy or genetic predisposition.