Women who survived pediatric cancer but developed breast cancer as an adult are more than twice as likely to die prematurely, mostly from comorbid conditions, according to results of a study published in the Journal of Clinical Oncology.

Researchers identified 274 female childhood cancer survivors in the Childhood Cancer Survivor Study database who subsequently developed breast cancer and compared them to a control group of 1,095 women with breast cancer but no previous personal history of cancer. A total of 92 pediatric cancer survivors died during follow-up: 49 from breast cancer and 43 from other causes (mostly other types of cancer, cardiac disease, and pulmonary complications).

The researchers said that that the risk of dying from breast cancer was modestly increased compared to the control group, but pediatric survivors were more than five times as likely to die from the other health issues. In total, the 10-year overall survival was 73% for pediatric survivors compared to 84% for the control group.

“Our results emphasize the need for this population to be followed by clinicians familiar with the health conditions faced by childhood cancer survivors,” the researchers wrote. “It is imperative that at the time of a secondary breast cancer diagnosis, they have a comprehensive evaluation that extends beyond a singular focus of breast cancer.”