Abstract
BackgroundThere is evidence that cancer survivors are at increased risk of second primary cancers. Changes in the prevalence of risk factors and diagnostic techniques may have affected more recent risks.MethodsWe examined the incidence of second primary cancer among adults in the West of Scotland, UK, diagnosed with cancer between 2000 and 2004 (n = 57,393). We used National Cancer Institute Surveillance Epidemiology and End Results and International Agency for Research on Cancer definitions of multiple primary cancers and estimated indirectly standardised incidence ratios (SIR) with 95% confidence intervals (CI).ResultsThere was a high incidence of cancer during the first 60 days following diagnosis (SIR = 2.36, 95% CI = 2.12 to 2.63). When this period was excluded the risk was not raised, but it was high for some patient groups; in particular women aged <50 years with breast cancer (SIR = 2.13, 95% CI = 1.58 to 2.78), patients with bladder (SIR = 1.41, 95% CI = 1.19 to 1.67) and head & neck (SIR = 1.93, 95% CI = 1.67 to 2.21) cancer. Head & neck cancer patients had increased risks of lung cancer (SIR = 3.75, 95% CI = 3.01 to 4.62), oesophageal (SIR = 4.62, 95% CI = 2.73 to 7.29) and other head & neck tumours (SIR = 6.10, 95% CI = 4.17 to 8.61). Patients with bladder cancer had raised risks of lung (SIR = 2.18, 95% CI = 1.62 to 2.88) and prostate (SIR = 2.41, 95% CI = 1.72 to 3.30) cancer.ConclusionsRelative risks of second primary cancers may be smaller than previously reported. Premenopausal women with breast cancer and patients with malignant melanomas, bladder and head & neck cancers may benefit from increased surveillance and advice to avoid known risk factors.
Highlights
There is evidence that cancer survivors are at increased risk of second primary cancers
Two sets of rules are widely used; the rules of the Surveillance Epidemiology and End IARC International Agency for Research on Cancer (Results) (SEER) Program [21] are used mainly by North American cancer registries; the rules developed by the International Association of Cancer Registries (IACR) and the International Agency for Research on Cancer (IARC) [22,23] are used internationally, mainly for reporting
Population Using the Scottish Cancer Registry we identified all patients resident in the West of Scotland, aged ≥15 years who had a first diagnosis of a malignant primary cancer between January 2000 and December 2004 (n = 58,364)
Summary
There is evidence that cancer survivors are at increased risk of second primary cancers. Changes in the prevalence of risk factors and diagnostic techniques may have affected more recent risks. The prevalence of patients living after a diagnosis of cancer has increased due to rising incidence and improving survival [1,2,3]. A new evaluation of second primary cancer risk is needed for several reasons. There have been significant temporal changes in the prevalence of risk factors – such as smoking [14], alcohol consumption [15] and obesity [16] - which may affect cancer incidence among survivors of cancer. The criteria for defining second primary cancers have changed over time and differ between studies. The IARC/IACR rules are more exclusive; only one tumour is registered for an organ, irrespective of time, unless there are histological differences
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