Multiple primary cancers in the Vaud Cancer Registry, Switzerland, 1974-89

Increased risk of subsequent primary lung cancer among female hormone-related cancer patients: A meta-analysis based on over four million cases

BACKGROUND

The incidence rate of lung cancer in women has significantly increased over the past decade, and previous evidence has indicated a significant relationship between the elevated levels of sex hormones and the risk of lung cancer. Therefore, we hypothesized that female hormone-related cancer (FHRC) patients, including breast, endometrial, cervical, and ovarian cancer patients, may experience a higher risk of developing subsequent lung cancer. This meta-analysis aimed to identify the risk of lung cancer among FHRC patients compared to the general population.

METHODS

The PubMed, Web of Science, EMBASE, Cochrane Library, and CNKI databases were searched up to May 11, 2022. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were used to identify the risk of subsequent lung cancer after FHRC. Subgroup analyses based on the follow-up time and tumor type were also conducted.

RESULTS

A total of 58 retrospective cohort studies involving 4,360,723 FHRC participants were included. The pooled results demonstrated that FHRC patients had a significantly increased risk of developing subsequent primary lung cancer (SIR = 1.61, 95% CI: 1.48-1.76, P <0.001). Subgroup analysis revealed an obvious trend of increasing lung cancer risk over time (SIRs for <5 years, ≥5 years, ≥10 years, ≥20 years, and ≥30 years after FHRC: 1.32, 1.59, 1.57, 1.68, and 1.95, respectively). In addition, subgroup analysis stratified by tumor type indicated an increased risk of developing subsequent lung cancer after breast (SIR = 1.25, P <0.001), endometrial (SIR = 1.40, P = 0.019), cervical (SIR = 2.56, P <0.001), and ovarian cancer (SIR = 1.50, P = 0.010).

CONCLUSION

FHRC patients are more likely to develop lung cancer than the general population. Furthermore, the increased risk of subsequent primary lung cancer is more obvious with a longer survival time and is observed in all types of hormone-related cancer.

REGISTRATION

International Platform of Registered Systematic Review and Meta-analysis Protocols: No. INPLASY202270044; https://inplasy.com/.

The risk for subsequent primary lung cancer after cervical carcinoma: A quantitative analysis based on 864,627 cases

PURPOSE

To compare the risk of developing subsequent primary lung cancer among cervical cancer patients and the general population.

METHODS

Several databases were searched from inception to April 25, 2023. The standard incidence ratios (SIRs) with 95% confidence intervals (CIs) were combined to identify the risk for second primary lung cancer after cervical carcinoma. Subgroup analyses based on the follow-up period, age, degree of malignancy and source of SIR were conducted. All the statistical analyses were performed with STATA 15.0 software.

RESULTS

A total of 22 retrospective studies involving 864,627 participants were included. The pooled results demonstrated that cervical cancer patients had a significantly greater risk for lung cancer than did the general population (SIR = 2.63, 95% CI: 2.37-2.91, P<0.001). Furthermore, subgroup analyses stratified by follow-up period (<5 years and ≥5 years), age (≤50 years and <50 years), and degree of malignancy (invasive and in situ) also revealed an increased risk of developing lung cancer among cervical carcinoma patients.

CONCLUSION

Cervical cancer patients are more likely to develop subsequent primary lung cancer than the general population, regardless of age, follow-up time or degree of malignancy. However, more high-quality prospective studies are still needed to verify our findings.

Comparative analysis through propensity score matching in thyroid cancer: unveiling the impact of multiple malignancies

Background

The incidence of thyroid cancer is on the rise worldwide, with childhood exposure to radiation being the sole acknowledged catalyst for its emergence. Nonetheless, numerous other factors that may pose risks are awaiting thorough examination and validation. This retrospective study aims to explore the malignancies linked to thyroid cancer and contrast the survival rates of those afflicted with a solitary tumor versus those with multiple primary neoplasms (MPN).

Methods

This retrospective study examined data from King Hussein Cancer Center (KHCC), Jordan. Among 563 patients diagnosed with thyroid cancer, 30 patients had thyroid malignancy as part of MPN. For a 1:3 propensity score-matched analysis, 90 patients with only a primary thyroid malignancy were also enrolled.

Results

Hematologic and breast malignancies were among the most frequent observed cancers alongside thyroid neoplasm. Patients who had MPN were diagnosed at older age, had higher body mass index and presented with higher thyroglobulin antibody levels (p < 0.05 for each). Additionally, MPN patient displayed a stronger family history for cancers (p= 0.002). A median follow-up duration of 135 months unveiled that MPN patients faced a worse 5-year survival compared to their counterparts with a singular neoplasm (87% vs 100% respectively; p < 0.01). However, no distinction emerged in the 5-year event-free survival between these two groups.

Conclusion

MPN correlates with a significantly altered survival outcome of thyroid cancer patients. The diagnosis of thyroid carcinoma at an older age, accompanied by elevated initial thyroglobulin antibody levels and a notable familial predisposition, may raise concerns about the potential occurrence of synchronous or metachronous tumors.

Clinical and prognostic features of multiple primary cancers with oral squamous cell carcinoma

OBJECTIVE

To characterize the epidemiological, clinical, and prognostic features of multiple primary cancers (MPC) following oral squamous cell carcinoma (OSCC).

DESIGN

Data from the Surveillance, Epidemiology, and End Results Program database were analyzed to determine the standardized incidence ratio (SIR) of multiple subsequent sites, difference in clinical and prognostic features between MPC and single primary OSCC.

RESULTS

The sites with the highest SIRs were the oral cavity (SIR = 69.48), other oral cavity and pharynx (SIR=55.46), pharynx (SIR=39.21), tonsils (SIR=33.52), trachea (SIR=33.24), esophagus (SIR=18.00), and larynx (SIR=13.12). The 5- and 10-year survival rates for single primary OSCC were 57.9% (95% CI: 56.7-59.2%) and 47.1% (95% CI: 45.7-48.6%), respectively, while those for MPC were 66.9% (95% CI: 64.6-69.4%) and 42.2% (95% CI: 39.5-45.2%), respectively. The mean age of MPC patients was significantly higher than that of single primary OSCC patients. MPC are more common in the gums and other sites of the oral cavity, and more likely to be detected in early TNM stage and pathological grade. Age, site, T-stage, and N-stage were significantly associated with prognosis of MPC.

CONCLUSIONS

Significant differences in clinical and prognostic features were found between MPC and single primary OSCC. Considering MPC has a poor long-term prognosis, it is necessary to identify MPC and single primary OSCC early.

The risk of developing second primary malignancies among colorectal cancer patients

Background: The increasing number of young colorectal cancer (CRC) survivors has led to ongoing concerns about the risk of secondary primary malignancies (SPMs). Here, we intended to comprehensively explore the pooled standardized incidence rates (SIRs) for total and site-specific SPMs in CRC survivors with different restriction to lag period.

Methods: Pubmed, Embase, Cochrane Library, and Web of science databases were searched to identify any studies reporting the SIRs of SPM following CRC until August 2021. Total and site-specific SIRs with different restriction to lag period were pooled using fixed/random effect models.

Results: A total of 42 full-text publications with more than 1, 524, 236 CRC survivors and 166, 210 SPM patients were included in the meta-analysis. Pooled data showed an increased SIRs for all SPMs in CRC survivors with different restriction to lag period (no restriction to lag period, SIR = 1.15, 95% CI = [1.08–1.23]; 1-year lag, 1.16 [1.10–1.23]; 5-year lag, 1.18 [1.09–1.28]; 10-year lag, 1.24 [1.11–1.39]). The conclusions were consistent for neoplasms of colorectum, corpus uteri, and small intestine with different restriction to lag period. However, limited evidence was presented for associations between CRC survivors and SPM for prostate, breast (female), ovarian, stomach, urinary bladder, kidney, thyroid, bone and soft tissue.

Conclusion: CRC survivors are associated with an increased risk of SPMs, especially neoplasms of colorectum, corpus uteri, and small intestine. Further studies should explore the risks for these neoplasms in CRC survivors, thus providing the reference for future follow-up care.

Comparability and validity of cancer registry data in the northwest of Russia

BACKGROUND

Despite the elaborate history of statistical reporting in the USSR, Russia established modern population-based cancer registries (PBCR) only in the 1990s. The quality of PBCRs data has not been thoroughly analyzed. This study aims at assessing the comparability and validity of cancer statistics in regions of the Northwestern Federal District (NWFD) of Russia.

MATERIAL AND METHODS

Data from ten Russian regional PBCRs covering ∼13 million (∼5 million in St. Petersburg) were processed in line with IARC/IACR and ENCR recommendations. We extracted and analyzed all registered cases but focused on cases diagnosed between 2008 and 2017. For comparability and validity assessment, we applied established qualitative and quantitative methods.

RESULTS

Data collection in NWFD is in line with international standards. Distributions of diagnosis dates revealed higher variation in several regions, but overall, distributions are relatively uniform. The proportion of multiple primaries between 2008 and 2017 ranged from 6.7% in Vologda Oblast to 12.4% in Saint-Petersburg. We observed substantial regional heterogeneity for most indicators of validity. In 2013-2017, proportions of morphologically verified cases ranged between 61.7 and 89%. Death certificates only (DCO) cases proportion was in the range of 1-14% for all regions, except for Saint-Petersburg (up to 23%). The proportion of cases with a primary site unknown was between 1 and 3%. Certain cancer types (e.g., pancreas, liver, hematological malignancies, and CNS tumors) and cancers in older age groups showed lower validity.

CONCLUSION

While the overall level of comparability and validity of PBCRs data of four out of ten regions of NWFD of Russia meets the international standards, differences between the regions are substantial. The local instructions for cancer registration need to be updated and implemented. The data validity assessment also reflects pitfalls in the quality of diagnosis of certain cancer types and patient groups.

What is the most appropriate period to define synchronous cancers?

BACKGROUND

Studies about second primary cancers (SPC) incidence exclude a period following the first cancer diagnosis given the high probability of diagnosing another primary cancer during this phase (synchronous cancers). However, definition of synchronicity period varies widely, from one to six months, without clear epidemiological justification. The objective of this study was to determine the most appropriate synchronicity period.

METHODS

Data from 13 French population-based cancer registries were used to establish a cohort of all patients diagnosed with a first cancer between 1989 and 2010. The incidence rate of subsequent cancer was computed by day within 1 year of follow-up after the first diagnosis. Incidence was modelized by joinpoint regression models with an initial quadratic trend and a second constant part (plateau). The joinpoint was the point from which the plateau began and defining the synchronicity period.

RESULTS

Our cohort included 696,775 patients with a first cancer, of which 12,623 presented a SPC. The median joinpoint for all sites combined was estimated at 120.5 days [112.0-129.0]. Analysis by gender reported a higher difference in 32 days for males (127.8 vs 96.1 days). Noteworthy differences were found depending on patient age and the site of first cancer, with joinpoint ranging from 84.7 (oesophagus cancer) to 250.1 days (bladder cancer).

CONCLUSION

Although some heterogeneity was observed based on the characteristic of the patients, the appropriate synchronicity period appears to be 4 months after the diagnosis of first cancer.

Disparities in colorectal cancer screening among breast and prostate cancer survivors

Background

Colorectal cancer (CRC) screening is recommended as an integral part of cancer survivorship care. We compared the rates of CRC screening among breast and prostate cancer survivors by primary cancer type, patient, and geographic characteristics in a community‐based health‐care system with a mix of large and small metro urban areas.

Materials and Methods

Data for this retrospective study were abstracted from medical records of a multi‐specialty practice serving about 250,000 individuals in southern Maryland. Breast (N = 1056) and prostate (N = 891) cancer patients diagnosed prior to 2015 were followed up till June 2018. Screening colonoscopy within the last 10 years was considered to be guideline concordant. Multivariate logistic regression was used to determine the prevalence odds ratios of being concordant on CRC screening by age, gender, race, metro area type, obesity, diabetes, and hypertension.

Results

Overall 51% of survivors had undergone a screening colonoscopy. However, there was a difference in CRC screening rate between prostate (54%) and breast (44%) cancer survivors. Older age (≥65 years), being a breast cancer survivor compared to prostate cancer, and living in a large compared to small metropolitan area were associated with a lower probability of receiving CRC screening. Having hypertension was associated with higher likelihood of being current on colonoscopy screening guidelines among survivors; but diabetes and obesity were not associated with CRC screening.

Conclusions

Low levels of CRC screening utilization were found among breast and prostate cancer survivors in a single center in Southern Maryland. Gender, comorbidities, and residential factors were associated with receipt of CRC screening.

The Melanoma and Breast Cancer Association: An Overview of their 'Second Primary Cancers' and the Epidemiological, Genetic and Biological correlations

This study reviews the relevant epidemiological studies associating cutaneous melanoma and breast carcinomas and provides an overview of the possible genetic, biological and bias factors that underpin this relationship. Standardised incidence ratio (SIR) for primary cutaneous melanoma after breast carcinoma ranged from 1.16 to 5.13 and ranged from 1.03 to 4.10 for primary breast carcinoma after cutaneous melanoma. Epidemiological studies highlight age, gender and use of radiotherapy and chemotherapy as potential risk factors for second primary cancers (SPCs). Mutations in BRCA2, CDKN2A, CDK4 and BAP1 may partly underlie any SPC association. The impact of socio-cultural factors and surveillance bias may be attributed to the findings of SPC partially or entirely. In conclusion, this study has highlighted the association between breast carcinoma and melanoma and identified various factors for further research and the optimised management of patients with both cancers.

The relative risk of second primary cancers in Switzerland: a population-based retrospective cohort study

BACKGROUND

More people than ever before are currently living with a diagnosis of cancer and the number of people concerned is likely to continue to rise. Cancer survivors are at risk of developing a second primary cancer (SPC). This study aims to investigate the risk of SPC in Switzerland.

METHODS

The study cohort included all patients with a first primary cancer recorded in 9 Swiss population-based cancer registries 1981-2009 who had a minimum survival of 6 months, and a potential follow-up until the end of 2014. We calculated standardized incidence ratios (SIR) to estimate relative risks (RR) of SPC in cancer survivors compared with the cancer risk of the general population. SIR were stratified by type of first cancer, sex, age and period of first diagnosis, survival period and site of SPC.

RESULTS

A total of 33,793 SPC were observed in 310,113 cancer patients. Both male (SIR 1.18, 95%CI 1.16-1.19) and female (SIR 1.20, 95%CI 1.18-1.22) cancer survivors had an elevated risk of developing a SPC. Risk estimates varied substantially according to type of first cancer and were highest in patients initially diagnosed with cancer of the oral cavity and pharynx, Hodgkin lymphoma, laryngeal, oesophageal, or lung cancer. Age-stratified analyses revealed a tendency towards higher RR in patients first diagnosed at younger ages. Stratified by survival period, risk estimates showed a rising trend with increasing time from the initial diagnosis. We observed strong associations between particular types of first and SPC, i.e. cancer types sharing common risk factors such as smoking or alcohol consumption (e.g. repeated cancer of the oral cavity and pharynx (SIRmales 20.12, 95%CI 17.91-22.33; SIRfemales 37.87, 95%CI 30.27-45.48).

CONCLUSION

Swiss cancer survivors have an increased risk of developing a SPC compared to the general population, particularly patients first diagnosed before age 50 and those surviving more than 10 years. Cancer patients should remain under continued surveillance not only for recurrent cancers but also for new cancers. Some first and SPCs share lifestyle associated risk factors making it important to promote healthier lifestyles in both the general population and cancer survivors.

Agreement Estimate among three Italian Cancer Registries in the Coding of Multiple Primary Cancers

Aims

The aim of the study was to compare agreement on the coding of multiple primary cancers (MPs) between three Italian cancer registries, the Ragusa Cancer Registry (RCR), the Cancer Registry of Romagna (RTRo), and the Tuscany Tumor Registry (RTT), that adhere to different rules for accepting MPs and to study whether coding according to common international rules (IARC-IACR) increased comparability.

Methods

One hundred cases were randomly extracted from the archives of each registry from those recorded as having more than one cancer. For each of the 300 patients, the number of independent cancers was attributed independently by one coder from each registry. The coders coded the series twice: once following the local registry rules and once according to the IARC-IACR rules. The agreement was estimated by couples of coders by means of Cohen's kappa statistics.

Results

The agreement on MP status between coders using local rules and definitions was good between the RTT and RCR (kappa = 0.77) and very good between the RTRo and RCR (kappa = 0.81) and the RTT and RTRo (kappa = 0.96). Exclusion of 23 expected discordant cases increased the agreement. The agreement reached with the use of the IARC-IACR rules was very good (RTRo vs RCR, 0.95; RTT vs RTR, 0.94; RTT vs RTRo, 0.95).

Conclusions

The comparison among the RTT, RTRo and RCR confirmed that the number of tumors considered MPs may be modified depending on the rules adopted. There were minor differences between the RTT and the RTRo since their rules were very similar. Most differences in agreement were with the RCR since its classification was conceptually different from the other two. The result on agreement with IARC-IACR rules is encouraging from the point of view of conducting a cooperative study among different registries on the incidence of MPs.

Synchronous and Metachronous Diagnosis of Multiple Primary Cancers

Aims

In the time period near to the diagnosis of a new cancer, other tumors (synchronous cancers), especially slow-growing tumors, may be detected because several diagnostic examinations are performed. The frequency of synchronous in comparison with metachronous carcinomas has been evaluated in a population-based series of multiple primary cancers.

Methods

The case series of multiple primary cancers of the Tuscany Tumor Registry, incident during the period 1985-1991 was analyzed. For each site of a second independent tumor, the proportions of synchronous (diagnosed within 2 months of the first primary) and metachronous cancers were compared with the mean distribution (all sites except the specific one).

Results

During 1985-1991, 1095 patients had two independent tumors diagnosed; 216 were synchronous. The proportion of synchronous compared to metachronous cancers was significantly higher for bladder, prostate and renal cell carcinomas; it was significantly lower for lung cancer. When cancers following skin epitheliomas were evaluated, only the proportion of synchronous skin cancers was significantly increased.

Conclusions

Silent slow-growing tumors are suspected to be more frequent in patients with prostate, bladder or renal cell carcinomas. In fact, they were most frequently diagnosed during ascertainment for another cancer. When few examinations were performed, as after the diagnosis of a skin epithelioma, no difference between metachronous and synchronous cancers was evident, except for skin.

Tobacco Smoking, Alcohol Drinking and Dietary Factors as Determinants of New Primaries among Male Laryngeal Cancer Patients: A Case-Cohort Study

Aims and Background

The paper examines the determinants associated with second primary occurrence in laryngeal cancer cases.

Methods

A series of 220 incident male laryngeal cancer cases was interviewed 10 years ago within the framework of a population-based, case-control study. The occurrence of other primaries among these patients was assessed by means of the Lombardy Cancer Registry, which covers their area of residence. The relationship between tobacco, alcohol, dietary factors and the risk of occurrence of new primaries was analyzed by means of a nested case-control study. Cases were defined as those subjects who developed a new primary, and controls as those without.

Results

New primaries occurred among 36 subjects during an 8-year follow-up; 147 control cancer patients were matched for age and length of follow-up. A twofold risk increase was associated with the highest tobacco consumption, as registered at time of first primary; a weaker relationship, i.e. risk of 1.2 for the highest tertile, was seen for alcohol drinking. The occurrence of new primaries was also influenced by dietary habits. In particular, those who had a high intake of monosaturated fatty acids had a one-third lower risk of developing a new primary.

Conclusions

Our results support the hypothesis that a healthy diet is protective among those who experience a laryngeal neoplasm and suggests that diet could be a potential preventive agent against the occurrence of new primaries among these patients.

Risk of Endometrial Cancer in Breast Cancer Patients under Long-Term Adjuvant Treatment with Tamoxifen

Aims

To evaluate the relative risk of endometrial cancer with respect to the expected underlying incidence in breast cancer patients undergoing long-term adjuvant tamoxifen therapy.

Methods

A total of 1010 postmenopausal breast cancer patients receiving adjuvant tamoxifen and with a first negative endometrial ultrasonography (cutoff for abnormal endometrial thickness >5 mm) were followed by annual transvaginal ultrasonography. Abnormal endometrial thickness prompted an outpatient endometrial biopsy or curettage under anesthesia in the case of cervical stenosis and increasing endometrial thickness. The standardized incidence ratio (SIR) with respect to underlying incidence was determined.

Results

A total of 1,010 eligible subjects who had been receiving tamoxifen for an average of 51 months were enrolled and followed for a total of 2,361 patient-years between January 1993 and December 1996. Five cases of endometrial cancer were observed in the study period: 1 was detected at screening, and 4 were diagnosed for vaginal bleeding in the interval between screening examinations. SIR was 4.0 (95% confidence interval, 1.39.4) and increased to 4.8 (CI, 1.6-10.5) when the single cancer detected at first screening was considered as incident.

Conclusions

This study adds evidence to the hypothesis that long-term tamoxifen treatment may be responsible for a relevant increase in the risk of developing endometrial cancer. Surveillance based on endometrial ultrasonography was poorly sensitive, but the favorable stage at diagnosis of screen-detected or interval endometrial cancers does not support a more aggressive screening approach.

Young patients with colorectal cancer have increased risk of second primary cancers

OBJECTIVE

Because the number of long-term survivors of colorectal cancer has increased, second primary cancer has become an important issue. However, previous studies were heterogeneous in design, and few data for Asia-Pacific area were available.

METHODS

This was a retrospective population-based study conducted using the national database of the Taiwan Cancer Registry. Patients who have histology-proven primary colon cancer and rectal cancer from 1995 to 2005 were enrolled in this study. All second primary cancer events had to be histology proven. The standardized incidence ratio of second primary cancer was used as an indicator. Standardized incidence ratio was counted as the number of observed second primary cancer divided by the expected number of cancer cases in the general population.

RESULTS

A total of 65 648 eligible index patients were enrolled, and 3810 second primary cancer events were identified. The standardized incidence ratio for all of the patients was 1.03 (95% confidence interval: 0.99-1.06), which implied that the risk of second primary cancer was not significantly elevated in the index patients compared with that of the general population. The standardized incidence ratio for the patients aged <50, 50-70 and >70 years was 2.52 (95% confidence interval: 2.28-2.78), 1.18 (95% confidence interval: 1.12-1.23) and 0.80 (95% confidence interval: 0.76-0.84), respectively. In young patients (aged <50 years), the standardized incidence ratio increase was statistically significant and persisted for over 10 years and this significantly increased across all subgroups. The small intestine, the large intestine, the female genital organs and the lungs were the most common sites of second primary cancer in young patients.

CONCLUSIONS

Young patients with colorectal cancer have an increased risk of developing second primary cancer.

The association between breast cancer and thyroid cancer: a meta-analysis

Previous studies have suggested an association between breast cancer and thyroid cancer; however, there has not been a formal meta-analysis which collates the existing evidence supporting the hypothesis that breast cancer or thyroid cancer predisposes an individual to developing the other. A systematic search was carried out using PubMed and Medline. We searched for articles containing epidemiological evidence of breast cancer following thyroid cancer and vice versa. Additionally, we searched for articles that included epidemiological data involving the incidence of all second primary malignancies (SPMs) following both breast cancer and thyroid cancer, and compared the datasets. The meta-analysis performed in a total of 18 studies showed that there is a significantly increased risk of developing thyroid cancer as a second primary malignancy of breast cancer (SIR = 1.59, 95 % confidence interval (CI) 1.28-1.99). Additionally, there was marginally increased risk of developing breast cancer as a second primary malignancy of thyroid cancer (SIR = 1.24, 95 % CI 1.16-1.33), compared to the general risk of developing a second primary malignancy following thyroid cancer. The findings suggest that the risk of developing thyroid cancer as a second primary malignancy of breast cancer and vice versa is increased compared to the background risk of developing other SPMs. The risk of developing thyroid cancer after a primary breast cancer was higher than the risk of developing breast cancer as a second primary malignancy of thyroid cancer. This suggests that the effects of treatment-related factors and specific pathological processes of each cancer may contribute to the increased risk rather than common risk factors including genetic factors. Elucidation of the common mechanisms between breast cancer and thyroid cancer will have important implications in both diagnostic and therapeutic management of these cancers. Benefit of thyroid ultrasound screening after breast cancer surgery needs to be assessed.

Metachronous double primary cancer after treatment of breast cancer

Purpose

The pattern of double primary cancer after treatment for breast cancer is important for patient survival.

Materials and Methods

We analyzed 108 cases of metachronous double primary cancer in breast cancer patients treated from 1999 to 2012.

Results

Metachronous double primary cancers occurred in 108 of 2,657 patients (4.1%) with breast cancer. The median time to the occurrence of second cancer after diagnosis of the first was 58.4±41.2 months (range, 6.9 to 180.2 months). The most common cancer was thyroid cancer, which occurred in 45 patients (41.7%). This was followed by gastric cancer in 16 patients (14.8%), endometrial cancer in 10 patients (9.3%), and cervical cancer in seven patients (6.5%). The relative risk showed a significant increase in endometrial (4.78; 95% confidence interval [CI], 1.66 to 13.79), gastric (2.61; 95% CI, 1.68 to 4.06), and thyroid cancer (1.95; 95% CI, 1.37 to 2.79). At 5 years after diagnosis of breast cancer, secondary cancer occurred in 48 patients (44.4%), with 50.0% of the endometrial, 56.3% of the stomach, and 37.8% of the thyroid cancer cases being diagnosed after 5 years. Median survival after diagnosis of the second cancer was 123.9±11.2 months. The prognosis was mainly influenced by the anatomic site.

Conclusion

The incidence of endometrial, stomach, and thyroid cancer increased significantly after treatment with primary breast cancer, and survival was dependent on early detection and the type of second primary cancer. A prolonged follow-up examination for metachronous double primary cancer is needed to provide early detection and improve survival time in patients with breast cancer.

The effect of patient characteristics on second primary cancer risk in France

Background

Although cancer survivors are known to be at greater risk of developing second primary cancer (SPC), SPC incidence estimates in France are thus far lacking. We used a multivariate approach to compute these estimates and analyzed the effect of patient characteristics (gender, age at diagnosis, first cancer site, year of diagnosis and follow-up) on SPC risk.

Methods

Data from ten French population-based cancer registries were used to establish a cohort of all patients diagnosed with a first cancer between 1989 and 2004 and followed up until December 31, 2007. The person-year approach was used to estimate standardized incidence ratios (SIRs) and excess absolute risks (EARs) of metachronous SPC. Multivariate Poisson regression models were then used to model SIRs and EARs separately by gender, adjusting for age, year of diagnosis, follow-up and first cancer site.

Results

Among the 289,967 followed-up patients with a first primary cancer, 21,226 developed a SPC. The SIR was of 1.36 (95% CI, 1.35-1.38) and the EAR was of 39.4 excess cancers per 10,000 person-years (95% CI, 37.4-41.3). Among male and female patients, multivariate analyses showed that age, year of diagnosis, follow-up and first cancer site were often independently associated with SIRs and EARs. Moreover, the EAR of SPC remained elevated during patient follow-up.

Conclusions

French cancer survivors face a dramatically increased risk of SPC which is probably related to the high rate of tobacco and alcohol consumption in France. Multivariate modeling of SPC risk will facilitate the construction of a tailored prediction tool to optimize SPC prevention and early detection strategies.

Incidental intraoperative discovery of colonic growth in a patient with esophageal carcinoma- lessons learnt!

Presentation of more than one malignancy at the intial time of diagnosis is rare. Recently we encountered a patient who was diagnosed with carcinoma esophagus found to have another incidental growth in his right colon at the time of surgery. When managed appropriately such patients do well depending on the stage of their malignancy. Here in this article we have reviewed the literature pertaining to multiple primary malignancy.

A population-based comparison of second primary cancers in Germany and Sweden between 1997 and 2006: clinical implications and etiologic aspects

Second primary cancer (SPC) has become an increasing concern in cancer survivorship. Patterns of SPCs in different populations may offer clinical implications and research priorities into SPCs. This study is devoted to compare the occurrences and rank correlations of SPCs between Germany and Sweden. Patients diagnosed with 10 common first primaries between 1997 and 2006 from the Swedish Family-Cancer Database and 10 German cancer registries were included in this population-based study. Spearman's rank correlation coefficients were used to evaluate the strength of the relationship of SPCs between the German and Swedish datasets. Spearman's rank correlation coefficients suggested a strong positive correlation between the German and Swedish datasets based on the ranks of thirty possible SPCs after all selected first cancers. This was also true when we compared the rankings and proportions of the five most common SPCs after site-specific first primaries between the two populations. For kidney cancer, non-Hodgkin's lymphoma, and leukemia the components of the five most common SPCs was exactly the same. Also, the ranking and the proportions for the three most common SPCs (i.e., colorectal, bladder, and lung cancers) after prostate cancer were identical in the two populations, as were those after most other primary cancers. The strikingly consistent patterns of SPCs in the two populations provide excellent opportunities for joint studies and they also suggest that many underlying reasons for SPC may have universal and tangible causes that await mechanistic dissection.

Role of preoperative colonoscopy in patients with gastric cancer: a case control study of the prevalence of coexisting colorectal neoplasms

BACKGROUND

We evaluated the prevalence of coexisting asymptomatic colorectal neoplasm (CRN) in patients with gastric cancer (GC).

METHODS

Preoperative colonoscopic examinations were performed in 495 patients with GC who underwent gastrectomy between January 2009 and December 2010. To compare the prevalence of CRN in these patients with that in a normal population, we selected 495 sex- and age-matched persons who underwent colonoscopies for health screening. Risk factors for CRN were evaluated by univariate and multivariate analyses.

RESULTS

The overall incidence of CRN was 41.8 % (414/990). The prevalence of overall CRN, high-risk CRN, and colorectal carcinoma (CRC) were significantly higher in the GC group than in the control group (overall CRN: 48.9 % vs. 34.7 %; high-risk CRN: 28.3 % vs. 13.5 %; CRC: 2.6 % vs. 0.2 %; all P < 0.001). The presence of GC [odds ratio (OR), 1.82; 95 % confidence interval (CI), 1.4-2.38; P < 0.001], age ≥50 years (OR, 2.58; 95 % CI, 1.75-3.81; P < 0.001), and male sex (OR, 2.28; 95 % CI, 1.72-3.02; P < 0.001) were risk factors for overall CRN. In patients with GC, age ≥40 years (OR, 3.22; 95 % CI, 1.24-8.37; P = 0.016) and male sex (OR, 3.21; 95 % CI, 2.17-4.76; P < 0.001) were risk factors for overall CRN.

CONCLUSIONS

The prevalence of coexisting CRN, including CRC, was higher in patients with GC than in the normal population. Preoperative colonoscopy is strongly indicated in patients with GC who are male and/or ≥40 years of age.

High constant incidence of second primary colorectal cancer

Patients who had a colorectal cancer have a 1.5- to 2-fold excess risk of a second colorectal cancer as compared to the general population, the excess being higher at younger age at diagnosis. To further investigate the risk and the age-relation of the incidence of second primary colorectal cancer, we considered 9,389 first colon and rectal cancers registered in the Vaud Cancer Registry, Switzerland, between 1974 and 2008, and followed-up to the end of 2008 for a total of 44,113 person-years. There were 136 second colorectal cancers versus 90.5 expected, corresponding to a standardized incidence ratio (SIR) of 1.5 (95% confidence interval, CI, 1.3-1.8). The SIRs were not heterogeneous between men and women, and in strata of calendar year at diagnosis, duration of follow-up, and subsite. However, the SIR was 7.5 (95% CI 4.2-12.4) for subjects diagnosed below age 50 and declined thereafter to reach 1.0 (95% CI 0.6-1.6) at age 80 or over. Consequently, the incidence of second primary colorectal cancer was stable, and exceedingly high, around 300-400/100,000 between age 30-39 and 70 or over. This age pattern is consistent with the existence of a single mutational event in a population of highly susceptible individuals.

Risks of primary extracolonic cancers following colorectal cancer in lynch syndrome

BACKGROUND

Lynch syndrome is a highly penetrant cancer predisposition syndrome caused by germline mutations in DNA mismatch repair (MMR) genes. We estimated the risks of primary cancers other than colorectal cancer following a diagnosis of colorectal cancer in mutation carriers.

METHODS

We obtained data from the Colon Cancer Family Registry for 764 carriers of an MMR gene mutation (316 MLH1, 357 MSH2, 49 MSH6, and 42 PMS2), who had a previous diagnosis of colorectal cancer. The Kaplan-Meier method was used to estimate their cumulative risk of cancers 10 and 20 years after colorectal cancer. We estimated the age-, sex-, country- and calendar period-specific standardized incidence ratios (SIRs) of cancers following colorectal cancer, compared with the general population.

RESULTS

Following colorectal cancer, carriers of MMR gene mutations had the following 10-year risk of cancers in other organs: kidney, renal pelvis, ureter, and bladder (2%, 95% confidence interval [CI] = 1% to 3%); small intestine, stomach, and hepatobiliary tract (1%, 95% CI = 0.2% to 2%); prostate (3%, 95% CI = 1% to 5%); endometrium (12%, 95% CI = 8% to 17%); breast (2%, 95% CI = 1% to 4%); and ovary (1%, 95% CI = 0% to 2%). They were at elevated risk compared with the general population: cancers of the kidney, renal pelvis, and ureter (SIR = 12.54, 95% CI = 7.97 to 17.94), urinary bladder (SIR = 7.22, 95% CI = 4.08 to 10.99), small intestine (SIR = 72.68, 95% CI = 39.95 to 111.29), stomach (SIR = 5.65, 95% CI = 2.32 to 9.69), and hepatobiliary tract (SIR = 5.94, 95% CI = 1.81 to 10.94) for both sexes; cancer of the prostate (SIR = 2.05, 95% CI = 1.23 to 3.01), endometrium (SIR = 40.23, 95% CI = 27.91 to 56.06), breast (SIR = 1.76, 95% CI = 1.07 to 2.59), and ovary (SIR = 4.19, 95% CI = 1.28 to 7.97).

CONCLUSION

Carriers of MMR gene mutations who have already had a colorectal cancer are at increased risk of a greater range of cancers than the recognized spectrum of Lynch syndrome cancers, including breast and prostate cancers.

The synchronous prevalence of colorectal neoplasms in patients with stomach cancer

Purpose

The association between stomach cancer and colorectal cancer is controversial. The purpose of this study was to determine the synchronous prevalence of colorectal neoplasms in patients with stomach cancer.

Methods

A total of 123 patients with stomach cancer (86 male) and 246 consecutive, age- and sex-matched persons without stomach cancer were analyzed from July 2005 to June 2010. All of them underwent colonoscopy within 6 months after undergoing gastroscopy.

Results

The prevalence of colorectal neoplasms was significantly higher in the stomach cancer group (35.8%) than in the control group (17.9%) (P < 0.001). Colorectal neoplasms were more prevalent in the patients with stomach cancer (odds ratio [OR], 3.10; 95% confidence interval [CI], 1.71 to 5.63). In particular, the difference in the prevalence of colorectal neoplasms was more prominent in the patients above 50 years old (OR, 3.54; 95% CI, 1.80 to 6.98).

Conclusion

The results showed that the synchronous prevalence of colorectal neoplasms was higher in patients with stomach cancer than in those without stomach cancer. Therefore, patients with stomach cancer should be regarded as a high-risk group for colorectal neoplasms, and colonoscopy should be recommended for screening.

The prevalence of colorectal neoplasia in patients with gastric cancer: a Korean Association for the Study of Intestinal Disease (KASID) Study

GOALS

The goal of this study was to determine the prevalence of colorectal neoplasia, using colonoscopy surveillance, in a cohort of patients with gastric cancers.

BACKGROUND

The association between gastric cancer and colorectal cancer has been conflicting.

STUDY

A total of 543 patients (males, 362; females, 181) with gastric cancer were matched with 2 persons from the population without a diagnosis of gastric cancer as confirmed by endoscopy according to age (+/-2 y), sex, date of colonoscopy examination (+/-2 wk), and endoscopist. Main Outcome was the prevalence of colorectal neoplasia diagnosed by colonoscopy.

RESULTS

A significantly higher colorectal cancer prevalence was found in the gastric cancer group, that is, 19 of 543 (3.5%) versus 14 of 1086 (1.3%; P<0.001). The odds of developing colorectal cancer were higher in the presence of gastric cancer (odds ratios, 3.46; 95% confidence interval: 1.51-7.91). Four of the 119 (3.4%) gastric cancer patients below 50 years of age had colorectal cancer in contrast with no cases in the matched controls. The prevalence of colorectal adenoma was higher in the gastric cancer group, with a prevalence of 215 in 543 (39.6%) versus 311 in 1086 (28.6%; P<0.001). The risk of adenoma was also greater among gastric cancer patients (odds ratios, 1.76; 95% confidence interval: 1.34-2.25).

CONCLUSIONS

Our data reveal a higher prevalence and risk of colorectal cancer in patients diagnosed with gastric cancer, particularly in patients below 50 years of age. Additional studies are needed to explore the geographical differences in the association between gastric cancer and colon cancer.

[Metachronous four primary malignancies in gastro-intestinal tract]

Multiple primary malignancy was reported firstly by Billroth in 1889. Recently, multiple primary malignancies are considered to increase due to improved survival rate of cancer patients, advanced diagnostic tools, and increased use of chemotherapy and radiotherapy. In Korea, several cases of triple primary malignancies were reported. However, four primary malignancies in gastro-intestinal tract was rarely reported. Recently, we experienced a 70 year-old male who was diagnosed with metachronous four primary malignancies in rectum, ascending colon, stomach, and ampulla of Vater. We report this rare case of metachronous four primary malignancies with a review of literature.

Management of patients who have undergone head and neck cancer therapy

Patients who undergo treatment for head and neck cancers often suffer from acute or late reactions to therapy. Severity of these oral complications may be based on the location and extent of tumor, as well as the type and extent of treatment. Some complications are transient, whereas others require a lifetime of management secondary to damage that results in permanent dysfunction. Patients who have a history of head and neck cancers are also at an increased risk for recurrences or second malignancies, and therefore require close follow-up. Dental professionals should provide preventive and supportive care, including education and symptom management, for patients experiencing oral complications related to cancer therapy, and should closely monitor patients' level of distress, ability to cope, and treatment response.

Second primary oral and pharyngeal cancers in subjects diagnosed with oral and pharyngeal cancer

Patients diagnosed with oral and pharyngeal (OP) cancer have a substantial excess risk of second OP cancer, but risk quantification is still uncertain and scanty information is available on the absolute excess risk of second OP cancer. We considered the risk of second OP primary cancer in a population-based series of 3,092 first primary OP cancers registered between 1974 and 2003 in the Swiss Cantons of Vaud and Neuchâtel (total population of about 786,000 inhabitants). A total of 233 second OP cancers were registered, versus 7.4 expected, corresponding to a SIR of 31.7 (95% confidence interval (CI) 27.7-36.0). The SIR was 68.5 in the first year after diagnosis of the first primary, and declined thereafter, leveling around 20. The SIR was 30.7 when the site of first neoplasm was the oral cavity, 42.5 for the tongue and 28.1 for the oropharynx or hypo-pharynx. Corresponding values for topographies of second primaries were 28.8, 50.4 and 26.2. The cumulative risk of second OP cancer 15 years after diagnosis of first OP cancer approached 22% in men and 17% in women. The incidence of first primaries increased over 20-fold between age 30-39 and 70-79, whereas there was no rise with age for second neoplasms.

Excess risk of subsequent primary cancers among colorectal carcinoma survivors, 1975-2001

BACKGROUND

Studies of persons with colorectal cancer have reported increased risk of subsequent primary cancers. Results have not been consistent, however, and there is little information about such risk in specific races and ethnic populations.

METHODS

Using 1975-2001 data from the Surveillance, Epidemiology, and End Results (SEER) Program, we assembled 262,600 index cases of colorectal carcinoma to assess the occurrence of subsequent primary cancers in 13 noncolonic sites. Observed (O) subsequent cancers were compared with those expected (E) based on age-/sex-/race-/year-/site-specific rates in the SEER population. The standardized incidence ratio (SIR) and the absolute excess risk (AER) represent 'O / E' and 'O - E,' respectively.

RESULTS

Colorectal carcinoma patients had significantly elevated SIRs for small gut, stomach (males), kidney, and corpus uteri cancers, ranging from 1.13 for stomach cancer in males to 3.45 for small gut cancer in females. Elevated SIRs for additional sites were seen in certain population subgroups: pancreas and ovary in persons aged <50 years, and prostate in black males. The excess burden, as assessed by AER, was notable for prostate cancer in black males and for corpus uteri cancer in females aged <50 years (26.5 and 9.5 cancers per 10,000 person-years, respectively), and it persisted beyond 5 years of follow-up.

CONCLUSIONS

Although significantly elevated SIRs were found for several cancers, the excess burden was notable only for cancer of the prostate in black males and of the corpus uteri in females under age 50.

Second primary cancers in thyroid cancer patients: a multinational record linkage study

CONTEXT

Increasing incidence and improved prognosis of thyroid cancer have led to concern about the development of second primary cancers, especially after radioiodine treatment. Thyroid cancer can also arise as a second primary neoplasm after other cancers.

OBJECTIVE

The objective of the study was to assess the risk of second primary cancer after thyroid cancer and vice versa.

DESIGN

This was a multinational record linkage study.

SETTING

The study was conducted at 13 population-based cancer registries in Europe, Canada, Australia, and Singapore.

PATIENTS OR OTHER PARTICIPANTS

A cohort of 39,002 people (356,035 person-yr of follow-up) with primary thyroid cancer were followed up for SPN for up to 25 yr, and 1,990 cases of thyroid cancer were diagnosed after another primary cancer.

MAIN OUTCOME MEASURES

To assess any possible excess of second primary neoplasms after thyroid cancer, the observed numbers of neoplasms were compared with expected numbers derived from age-, sex-, and calendar period-specific cancer incidence rates from each of the cancer registries, yielding standardized incidence ratios (SIRs). The SIR of second primary thyroid cancer after various types of cancer was also calculated.

RESULTS

During the observation period, there were 2821 second primary cancers (all sites combined) after initial diagnosis of thyroid cancer, SIR of 1.31 (95% confidence interval 1.26-1.36) with significantly elevated risks for many specific cancers. Significantly elevated risks of second primary thyroid cancer were also seen after many types of cancer.

CONCLUSION

Pooled data from 13 cancer registries show a 30% increased risk of second primary cancer after thyroid cancer and increased risks of thyroid cancer after various primary cancers. Although bias (detection, surveillance, misclassification) and chance may contribute to some of these observations, it seems likely that shared risk factors and treatment effects are implicated in many. When following up patients who have been treated for primary thyroid cancer, clinicians should maintain a high index of suspicion for second primary cancers.

Skin cancer in survivors of childhood and adolescent cancer

The incidence of basal cell carcinoma (BCC) has been related to ionizing radiation, particularly for exposure occurring at young age. In this study, we considered the incidence of second skin neoplasms in long-term survivors from childhood cancer. We considered second primary cancers occurring among 776 subjects (436 males, 340 females) with first primary cancer diagnosed before age 20 years, between 1974 and 2001, in the Swiss Cantons of Vaud and Neuchâtel (786,000 inhabitants). Five BCC were observed versus 0.43 expected (standardized incidence ratio: 11.6, 95% confidence interval: 3.7-27.1). No case of cutaneous squamous cell carcinoma, nor of malignant melanoma was observed. The estimated radiation doses at 1mm through the skin ranged between 7 and 27 Sv. These data confirm that BCC are strongly related to ionizing radiation exposure in childhood. All the BCC were located within the radiation field, thus indicating that ionizing radiation is the key aetiological factor, even in the absence of any meaningful interaction with UV.

Cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia

Patients with chronic lymphocytic leukemia are at heightened risk for the development of cutaneous malignancies, especially squamous cell carcinoma. These tumors portend a worse prognosis than is typically seen in immunocompetent patients. Patients with chronic lymphocytic leukemia who develop squamous cell carcinoma are more likely to develop multiple tumors, recurrences after treatment, and regional or distant spread of their tumor. Evaluation of the literature substantiates the ominous nature of squamous cell carcinoma in patients with underlying lymphocytic malignancies.

Increased risk of esophageal cancer after breast cancer

BACKGROUND

Adjuvant radiation therapy for breast cancer has been related to excess esophageal cancer risk, but population-based data are scanty.

PATIENTS AND METHODS

We considered esophageal cancer risk among 11 130 breast cancer patients diagnosed between 1974 and 2002 in the Swiss cantons of Vaud and Neuchâtel, and followed-up to the end of 2002, for a total of 75 900 women-years at risk.

RESULTS

Overall, 18 cases were observed compared with 8.9 expected, corresponding to a standardised incidence ratio (SIR) of 2.0 [95% confidence interval (CI) 1.2-3.2]. The SIR was 1.6 in the first 10 years after diagnosis and 3.3 for >/=10 years after diagnosis, 2.3 for cases diagnosed between 1974 and 1988 and 1.5 for those diagnosed after 1988, 2.3 (based on 15 cases) for squamous cell cancer and 1.3 (based on three cases) for adenocarcinomas, and 2.9 for the upper third, 2.3 for the middle third and 1.9 for the lower third of the esophagus.

CONCLUSIONS

These data confirm an excess esophageal cancer risk following treatment for breast cancer which could not be explained by confounding of tobacco or alcohol alone. The excess risk tended to decrease for cases diagnosed after 1988, leaving open the issue of the risk of modern radiotherapy for breast cancer on esophageal cancer.

Clinical analysis of multiple primary malignancies in the digestive system: A hospital-based study

AIM: To analyze the characteristics of multiple primary malignancies (MPMs) of digestive system; including incidence, types of tumor combinations, time intervals between development of multiple tumors, clinical course, and prognostic factors affecting survival and mortality.

METHODS: Data from a total of 129 patients treated from January 1991 to December 2000 for pathologically proved MPMs, including at least one originating from the digestive system, were reviewed retrospectively.

RESULTS: Among 129 patients, 120 (93.02%) had two primary cancers and 9 (6.98%) had three primary cancers. The major sites of MPMs of the digestive system were large intestine, stomach, and liver. Associated non-digestive cancers included 40 cases of gynecological cancers, of which 31 were carcinoma of cervix and 10 cases of genitourinary cancers, of which 5 were bladder cancers. Other cancers originated from the lung, breast, nasopharynx, larynx, thyroid, brain, muscle, and skin. Reproductive tract cancers, especially cervical, ovarian, bladder, and prostate cancers were the most commonly associated non-GI cancers, followed by cancer of the lung and breasts. Forty-three cases were synchronous, while the rest (86 cases) were metachronous cancers. Staging of MPMs and treatment regimes correlated with the prognosis between survival and non-survival groups.

CONCLUSION: As advances in cancer therapy bring about a progressively larger percentage of long-term survivors, the proportion of patients with subsequent primary lesions will increase. Early diagnosis of these lesions, based on an awareness of the possibility of second and third cancers, and multidisciplinary treatment strategies will substantially increase the survival of these patients.

Family History of Cancer, Its Combination with Smoking and Drinking, and Risk of Squamous Cell Carcinoma of the Esophagus

We analyzed the association between history of cancer in first-degree relatives and the risk of squamous cell carcinoma of the esophagus (SCCE) using data from three case-control studies conducted in Italy and Switzerland on 805 incident, histologically confirmed SCCE, and 3,461 hospital controls. The alcohol- and tobacco-adjusted odds ratio (OR) for a family history of esophageal cancer was 3.2 [95% confidence interval (CI), 1.7-6.2], and the OR was higher when the affected relative was a brother or was diagnosed at age <55 years. Compared to subjects without family history of esophageal cancer, non-current smokers, drinking <49 drinks per week, the OR was 2.9 (95% CI, 1.1-7.5) for family history alone, 15.5 (95% CI, 11.7-20.5) for current smokers drinking > or = 49 drinks per week without family history of esophageal cancer, and 107.0 (95% CI, 13.0-880.2) for current smokers drinking > or = 49 drinks per week who also had a family history of esophageal cancer. The risk of SCCE was also increased in subjects with a family history of cancer of the oral cavity/pharynx (OR, 3.7; 95% CI, 1.5-9.0) and stomach (OR, 2.0; 95% CI, 1.1-3.6), but not of other cancers, nor for a family history of any cancer (OR, 1.0; 95% CI, 0.8-1.4). These data show that, as for many other epithelial cancers, the risk of SCCE is increased in subjects with a family history of the disease, and that--in Western countries--avoidance of alcohol and tobacco is also the best way to prevent SCCE in subjects with a family history of the disease.

Double primary cancers of the prostate and bladder: a literature review

A number of studies report a high frequency of double primary cancers of the bladder and prostate. The coincidence was as high as 70% for prostate cancers in patients with bladder cancer, and 3.4% for bladder cancers in patients with prostate cancer. Two studies reviewing medical records reported a significant risk of bladder cancer after prostate cancer and of prostate cancer after bladder cancer. Only 1 of 3 cancer registry studies reported a significantly increased risk of prostate cancer after bladder cancer, and 3 of 11 studies reported a significantly increased risk in bladder cancer after prostate cancer. There was an association between DNA repair and N-acetyltransferase polymorphisms and risk of prostate and bladder cancer. These data suggest that these cancers may share a common carcinogenic process or that these patients are particularly susceptible to both cancers. Because of the association between these cancers, patients who are diagnosed with prostate or bladder cancer should be followed closely for the detection of the second urologic malignancy.

Cancer risk in women with previous breast cancer

BACKGROUND

Excess risks of several second neoplasms following breast cancer have been reported. However, these risks have still to be quantified.

PATIENTS AND METHODS

We considered 9,729 breast cancer patients registered by the Swiss Cancer Registries of Vaud and Neuchâtel (covering about 786,000 inhabitants) and followed up from 1974 to 1998.

RESULTS

Overall, 443 second primary neoplasms (other than second primary breast cancers) were observed versus 389 expected [standardised incidence ratio (SIR): 1.14; 95% confidence interval (CI) 1.04-1.25]. The SIRs were above unity for endometrium (SIR = 1.5), ovary (1.3), colorectum (1.1), gallbladder (1.4), cutaneous malignant melanoma (1.4), kidney (1.4), lymphomas (1.4) and leukaemias (1.2), as well as for selected tobacco-related neoplasms. The largest excess risk was found for soft tissue sarcomas (STS) with 10 cases observed versus 3.1 expected (SIR = 3.2; 95% CI 1.5-5.9). Of these, eight occurred in potentially irradiated areas.

CONCLUSIONS

This analysis confirms the existence of a modest excess in several neoplasms occurring after breast cancer. The substantial excess of STS confirms the strong association between irradiation and STS.

Cancer-specific survival of patients with multiple cancers: an application to patients with multiple breast cancers

In the analysis of cause-specific survival, the causes of death must be known. For single-cancer patients with a known cause of death, the estimation of the cause-specific survival rate is straightforward. For multiple-cancer patients with two primary cancers, however, the analysis of cause-specific survival rates is more complex, particularly if the cancers are of the same primary site. In these situations, a concept of cancer-specific survival may also be distinguished from cause-specific survival. Cancer-specific survival rates are studied here by introducing two models, the primary one where the death from cancer is attributed to one of the cancers, and an alternative where such an attribution is not necessary. The models are illustrated using data on patients with multiple breast cancers. The model-based survival rates are compared with each other and with the corresponding relative survival rates based on analogous modelling of relative survival. The results show that for the subsequent breast cancer, the cancer-specific survival rates based on the alternative, where the distinction between the cancers as a cause of death was not necessary, tended to be higher than those based on that distinction. It is thus possible that the subsequent cancer was too often coded as a cause of death, particularly when being localized at diagnosis.

The risk of subsequent primary cancers after colorectal cancer in southeast England

BACKGROUND

Multiple cancers may occur in an individual because of a genetic predisposition, environmental exposure, cancer therapy, or immunological deficiency. Colorectal cancer is one of the most commonly diagnosed cancers, and inherited factors play an important role in its aetiology.

AIMS

To characterise the occurrence of multiple primary cancers in patients diagnosed with colorectal cancer and explore the possibility of a common aetiology for different cancer sites.

PATIENTS

The Thames Cancer Registry database was used to identify patients with a first colorectal cancer, resident in the North or South Thames region, diagnosed between 1 January 1961 and 31 December 1995. A total of 127 281 patients were included, 61 433 men and 65 848 women.

METHODS

Observed numbers of cancers occurring after the diagnosis of colorectal cancer were compared with expected numbers, calculated using appropriate age, sex, and period specific rates, to obtain standardised incidence ratios. The occurrence of colorectal cancers subsequent to cancers at other sites was also examined.

RESULTS

Small intestinal cancer was significantly increased in men diagnosed with colorectal cancer before the age of 60 years and in women diagnosed with colorectal cancer after the age of 65 years. Colorectal cancer was also significantly increased after a first diagnosis of cancer of the small intestine. Other cancer sites with a significant increase after colorectal cancer included the cervix uteri, corpus uteri, and ovary.

CONCLUSIONS

Patients with colorectal cancer are at increased risk of developing cancer at a number of other sites. Some of these associations are consistent with the effects of known inherited cancer susceptibility genes.

Multiple primary cancer incidence in Italy

Data collected from eleven Italian population-based cancer registries (overall population 7,200,000 inhabitants) were used to compute the incidence of second independent cancers (MP) in a cohort of cancer patients aged 15 years or more. Overall, 240111 patients have been followed for 544438 person-years during which 8766 second primary cancers were diagnosed leading to an observed to expected ratio (SIR) of MP of 1.08 (95% Confidence Interval (CI): 1.05-1.12). Restricting the analysis to metachronous cancers, there were 6974 second primary cancers diagnosed among 198303 patients during 508,648 person-years with an SIR of 0.93 (95% CI: 0.90-0.96). According to the time since first cancer diagnosis, the SIR was significantly higher than expected during the first 2 months, then the overall risk was slightly lower than 1 up to 10 years after diagnosis. No differences were observed according to gender. The SIR significantly differed among the age groups with consistent excess risks in subjects younger than 65 years in comparison with older ones. Overall, significantly elevated SIR for metachronous cancers were evidenced for oral cavity and pharynx, larynx, connective, skin non-melanoma, ovary and kidney cancers. For each cancer site, the site-specific risk of further MP has been evaluated. The identification of strong site-specific associations may be useful for clinicians when following-up patients.

Second primary neoplasms in 633,964 cancer patients in Sweden, 1958-1996

The Swedish Family-Cancer Database was used to analyze concordant (same site) and discordant (different site) second primary neoplasms in 633,964 cancer patients diagnosed from 1958 to 1996. Cases of second malignant neoplasms were extracted from the Database if the diagnosis date of the first and second cancer differed by at least 1 month. The expected numbers of cancers were obtained by applying site-, sex-, age-, period-, residence- and socioeconomic level-specific rates in the corresponding population in the Database to the appropriate person-years at risk. The standardized incidence ratio (SIRs) of a second cancer was taken to be the ratio of observed to expected numbers of second cancers. Of all cancers, 8.5% were subsequent neoplasms (8.4% for males and 8.7% for females). SIRs for both concordant and discordant subsequent cancer were elevated in patients with cancer of the upper aerodigestive tract, colon, nose, breast, other female genitals, testis, kidney, urinary, bladder, skin, nervous system, endocrine, bone, connective tissue, melanoma, lymphoma and leukemia. The risks at some concordant sites, such as nose, squamous cell skin, bone and connective tissue in both sexes, breast in males and upper aerodigestive tract and leukemia in females, were very high (>10). At discordant sites, SIRs were less than 2 but significantly increased after all but gastric and prostatic cancer. Compared with the general population, cancer patients were at a modestly increased risk for new primary cancer after cancers at many sites, calling for attention in treatment, management and prevention.

Second primary cancers following breast cancer in the Japanese female population

To assess the risk of developing second primary cancers following breast cancer in Japanese females, we performed a retrospective cohort study of 2786 patients who were newly diagnosed with breast cancer at our hospital between 1970 - 1994, until the end of 1995 (average follow-up period, 8.6 years). The expected number of each second primary cancer was calculated by multiplying the number of appropriate person-years at risk by the corresponding age- and calendar period-specific cancer incidence rates for women obtained from the Osaka Cancer Registry. One hundred and seventeen patients developed a second primary cancer other than subsequent breast cancer, yielding an observed-to-expected ratio (O / E) of 1.3 [95% confidence interval (CI) = 1.1 - 1.6]. The risk for developing a second primary cancer was significantly elevated during the first year following the diagnosis of breast cancer, and decreased with the passage of time to unity. A significantly increased risk was noted for the development of ovarian cancer (O / E = 2.4, 95% CI = 1.0 - 4.6), thyroid cancer (O / E = 3.7, 95% CI = 1.5 - 7.6) and non-Hodgkin's lymphoma (NHL) (O / E = 3.5, 95% CI = 1.4 - 7.1) among the breast cancer patients compared with the general population. Patients who received hormonal therapy as the breast cancer treatment showed a significantly increased risk for ovarian cancer (O / E = 5.5, 95% CI = 1.8 - 12.9). Patients who received chemotherapy as the breast cancer treatment had an increased risk for NHL (O / E = 5.0, 95% CI = 1.6 - 11.6). These findings indicate that Japanese female patients with breast cancer had a 30% higher risk of developing a second primary cancer than the general population, the higher risk being manifested in the early period following the diagnosis of breast cancer. Medical surveillance of breast cancer patients for NHL, as well as for ovarian cancer and thyroid cancer, is required.

Quadruple cancer in a single patient: a report of four cases

Multiple primary neoplasia was once considered a rare curiosity but is now a well recognized phenomenon. Only a few papers have been published in the English literature with regard to occurrence of four or more primary malignancies in a single patient. We report four cases of quadruple cancer; a review of the literature about this topic is discussed.