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Sung H, Nisotel L, Sedeta E, Islami F, Jemal A. Racial and Ethnic Disparities in Survival Among People With Second Primary Cancer in the US. JAMA Netw Open 2023; 6:e2327429. [PMID: 37540510 PMCID: PMC10403787 DOI: 10.1001/jamanetworkopen.2023.27429] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/24/2023] [Indexed: 08/05/2023] Open
Abstract
Importance Comprehensive data for racial and ethnic disparities after second primary cancers (SPCs) are lacking despite the growing burden of SPCs. Objective To quantify racial and ethnic disparities in survival among persons with SPCs. Design, Setting, and Participants This population-based, retrospective cohort study used data from 18 Surveillance, Epidemiology, and End Results registries in the US for persons diagnosed with the most common SPCs at age 20 years or older from January 1, 2000, to December 31, 2013 (with follow-up through December 31, 2018). Data were analyzed between January and April 2023. Exposure Race and ethnicity (Hispanic, non-Hispanic Asian or Pacific Islander, non-Hispanic Black, and non-Hispanic White). Main Outcomes and Measures The main outcomes were 5-year relative survival and cause-specific survival. Cause-specific hazard ratios (HRs) were calculated for death from cancer or cardiovascular disease (CVD) in each racial and ethnic minority population compared with the White population overall and stratified by SPC type, with adjustment for sex, year and age at SPC diagnosis, and prior cancer type and stage (baseline model) and additionally for county attributes (household income, urbanicity), SPC characteristics (stage, subtype), and treatment. Results Among 230 370 persons with SPCs (58.4% male), 4.5% were Asian or Pacific Islander, 9.6% were Black, 6.4% were Hispanic, and 79.5% were White. A total of 109 757 cancer-related deaths (47.6%) and 18 283 CVD-related deaths (7.9%) occurred during a median follow-up of 54 months (IQR, 12-93 months). In baseline models, compared with the White population, the risk of cancer-related death overall was higher in the Black (HR, 1.21; 95% CI, 1.18-1.23) and Hispanic (HR, 1.10; 95% CI, 1.07-1.13) populations but lower in the Asian or Pacific Islander population (HR, 0.93; 95% CI, 0.90-0.96). When stratified by 13 SPC types, the risk of cancer-related death was higher for 10 SPCs in the Black population, with the highest HR for uterine cancer (HR, 1.87; 95% CI, 1.63-2.15), and for 7 SPCs in the Hispanic population, most notably for melanoma (HR, 1.46; 95% CI, 1.21-1.76). For CVD-related death, the overall HR was higher in the Black population (HR, 1.41; 95% CI, 1.34-1.49), with elevated risks evident for 11 SPCs, but lower in the Asian or Pacific Islander (HR, 0.75; 95% CI, 0.69-0.81) and Hispanic (HR, 0.90; 95% CI, 0.84-0.96) populations than in the White population. After further adjustments for county attributes and SPC characteristics and treatment, HRs were reduced for cancer-related death and for CVD-related death and associations in the same direction remained. Conclusions and Relevance In this cohort study of SPC survivors, the Black population had the highest risk of both death from cancer and death from CVD, and the Hispanic population had a higher risk of death from cancer than the White population. Attenuations in HRs after adjustment for potentially modifiable factors highlight opportunities to reduce survival disparities among persons with multiple primary cancers.
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Affiliation(s)
- Hyuna Sung
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Lauren Nisotel
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Ephrem Sedeta
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York
| | - Farhad Islami
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
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Li C, Du C, Wang Y, Liu M, Zhao F, Li J, Wang W, Wei X, Qu J, Zhou Z, Zhang Y, Zhang S. Risk, molecular subtype and prognosis of second primary breast cancer: an analysis based on first primary cancers. Am J Cancer Res 2023; 13:3203-3220. [PMID: 37559977 PMCID: PMC10408461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/08/2023] [Indexed: 08/11/2023] Open
Abstract
Second primary breast cancer (SPBC) was potentially related to other cancers, which may impact its incidence, prognosis and therapeutic approaches. Nevertheless, few studies have characterized this relationship and analyzed the subtypes of SPBC. Our study intended to investigate the occurrence and prognosis of SPBC. We analyzed the patterns, clinical characteristics, standardized incidence ratio (SIR) and standardized mortality ratio (SMR) of patients with SPBC. The propensity score matching (PSM) approach was further used to balance the differences in clinical features between patients with primary breast cancer (PBC) and SPBC, then Kaplan-Meier (KM) survival analysis was used to compare their overall survival and breast cancer-specific survival. Finally, a predictive model was constructed to estimate the 3- and 5-year survival rates of SPBC patients. We found that the SIR of individuals with SPBC was significantly higher in cancer survivors than in the general population (SIR=1.16, 95% CI=1.15-1.17, P<0.05). SPBC patients with first primary lung/bronchus cancer had a much higher SMR (SMR=1.71, 95% CI=1.58-1.85, P<0.05) compared with survivors of other malignancies. Individuals with SPBC had a larger proportion of the HR-/HER2- subtype than those with PBC. Particularly among survivors of estrogen-dependent ovarian and breast cancer, the proportion of the HR-/HER2- subtype of SPBC considerably rose. After propensity score matching, we discovered that SPBC patients' overall survival remained poorer than that of PBC patients (HR=1.43, 95% CI=1.39-1.47, P<0.001). However, the prognosis of SPBC in first primary thyroid cancer survivors was better than PBC patients (HR=0.64, 95% CI=0.55-0.75, P<0.001). Also, an extreme gradient boosting (XGBoost) model was developed to evaluate the 3-year (AUC=0.817) and 5-year survival (AUC=0.825) of SPBC patients. Our data demonstrated the distinct biological performance of SPBC with various first primary cancers. Furthermore, our findings revealed an indispensable role of first primary cancer (FPC) in the development of SPBC and provided an additional theoretical basis for the clinical follow-up and identification of SPBC.
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Affiliation(s)
- Chaofan Li
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong UniversityNo. 157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Chong Du
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong UniversityNo. 157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Yusheng Wang
- Department of Otolaryngology, The Second Affiliated Hospital of Xi’an Jiaotong UniversityNo. 157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Mengjie Liu
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong UniversityNo. 157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Fang Zhao
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong UniversityNo. 157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Jia Li
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong UniversityNo. 157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Weiwei Wang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong UniversityNo. 157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Xinyu Wei
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong UniversityNo. 157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Jingkun Qu
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong UniversityNo. 157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Zhangjian Zhou
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong UniversityNo. 157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Yinbin Zhang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong UniversityNo. 157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Shuqun Zhang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong UniversityNo. 157 West Fifth Street, Xi’an, Shaanxi, P. R. China
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Sung H, Siegel RL, Hyun N, Miller KD, Yabroff KR, Jemal A. Subsequent primary cancer risk among five-year survivors of adolescent and young adult cancers. J Natl Cancer Inst 2022; 114:1095-1108. [PMID: 35511931 PMCID: PMC9360462 DOI: 10.1093/jnci/djac091] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/15/2021] [Accepted: 03/24/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A comprehensive examination of the incidence and mortality of subsequent primary cancers (SPCs) among adolescent and young adult (AYA) cancer survivors in the US is lacking. METHODS Cancer incidence and mortality among 170,404 ≥ 5-year cancer survivors aged 15-39 years at first primary cancer diagnosis during 1975-2013 in 9 Surveillance, Epidemiology, and End Results registries were compared to those in the general population using standardized incidence ratio (SIR), absolute excess incidence (AEI), standardized mortality ratio (SMR), and absolute excess mortality (AEM). RESULTS During a mean follow-up of 14.6 years, 13,420 SPC cases and 5,008 SPC deaths occurred among survivors (excluding the same-site as index cancer), corresponding to 25% higher incidence (95%CI = 1.23-1.27; AEI = 10.8 per 10,000) and 84% higher mortality (95%CI = 1.79-1.89; AEM = 9.2 per 10,000) than that in the general population. Overall SPC risk was statistically significantly higher for 20 of 29 index cancers for incidence and 26 for mortality, with the highest SIR among female Hodgkin lymphoma survivors (SIR = 3.05, 95%CI = 2.88-3.24; AEI = 73.0 per 10,000) and the highest SMR among small intestine cancer survivors (SMR = 6.97, 95%CI = 4.80-9.79; AEM = 64.1 per 10,000). Type-specific SPC risks varied substantially by index cancers; however, SPCs of the female breast, lung, and colorectum combined constituted 36% of all SPC cases and 39% of all SPC deaths, with lung cancer alone representing 11% and 24% of all cases and deaths, respectively. CONCLUSION AYA cancer survivors are almost twice as likely to die from a new primary cancer as the general population, highlighting the need for primary care clinicians to prioritize cancer prevention and targeted surveillance strategies in these individuals.
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Affiliation(s)
- Hyuna Sung
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, US
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, US
| | - Noorie Hyun
- Division of Biostatistics, Kaiser Permanente Washington Health Research Institute, Seattle, WA, US
| | - Kimberly D Miller
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, US
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, US
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, US
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Wang C, Hu K, Luo C, Deng L, Fall K, Tamimi RM, Valdimarsdóttir UA, Fang F, Lu D. Cardiovascular mortality among cancer survivors who developed breast cancer as a second primary malignancy. Br J Cancer 2021; 125:1450-1458. [PMID: 34580431 PMCID: PMC8575780 DOI: 10.1038/s41416-021-01549-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/17/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To assess the risk of cardiovascular mortality among cancer survivors who developed breast cancer as a second malignancy (BCa-2) compared with patients with first primary breast cancer (BCa-1) and the general population. METHODS Using the Surveillance, Epidemiology, and End Results database, we conducted a population-based cohort study including 1,024,047 BCa-1 and 41,744 BCa-2 patients diagnosed from the age 30 between 1975 and 2016, and the corresponding US female population (994,415,911 person-years; 5,403,551 cardiovascular deaths). Compared with the general population and BCa-1 patients, we calculated incidence rate ratios (IRRs) of cardiovascular deaths among BCa-2 patients using Poisson regression. To adjust for unmeasured confounders, we performed a nested, case-crossover analysis among BCa-2 patients who died from cardiovascular disease. RESULTS Although BCa-2 patients had a mildly increased risk of cardiovascular mortality compared with the population (IRR 1.08) and BCa-1 patients (IRR 1.15), the association was pronounced among individuals aged 30-49 years (BCa-2 vs. population: IRR 6.61; BCa-2 vs. BCa-1: IRR 3.03). The risk elevation was greatest within the first month after diagnosis, compared with the population, but comparable with BCa-1 patients. The case-crossover analysis confirmed these results. CONCLUSION Our findings suggest that patients with BCa-2 are at increased risk of cardiovascular mortality.
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Affiliation(s)
- Chengshi Wang
- grid.13291.380000 0001 0807 1581Laboratory of Molecular Diagnosis of Cancer, and Department of Medical Oncology, Clinical Research Center for Breast Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan P. R. China ,grid.54549.390000 0004 0369 4060Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Kejia Hu
- grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Chuanxu Luo
- grid.13291.380000 0001 0807 1581Laboratory of Molecular Diagnosis of Cancer, and Department of Medical Oncology, Clinical Research Center for Breast Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan P. R. China
| | - Lei Deng
- grid.240614.50000 0001 2181 8635Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY USA
| | - Katja Fall
- grid.15895.300000 0001 0738 8966Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 701 85 Örebro, Sweden
| | - Rulla M. Tamimi
- grid.38142.3c000000041936754XDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA USA ,grid.5386.8000000041936877XDepartment of Population Health Sciences, Weill Cornell Medicine, New York, NY USA
| | - Unnur A. Valdimarsdóttir
- grid.38142.3c000000041936754XDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA USA ,grid.14013.370000 0004 0640 0021Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, 101 Reykjavik, Iceland ,grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12a, 171 77 Solna, Sweden
| | - Fang Fang
- grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Donghao Lu
- grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden ,grid.38142.3c000000041936754XDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA USA ,grid.13291.380000 0001 0807 1581West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
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Chattu V, Umakanthan S, Bukelo M, Maharaj R, Khan N, Keane K, Khadoo N, Khan A, Khan A, Kong R, Korkmaz S, Kovoor A. Breast cancer in Trinidad and Tobago: Etiopathogenesis, histopathology and receptor study. J Family Med Prim Care 2021; 10:4438-4445. [PMID: 35280639 PMCID: PMC8884328 DOI: 10.4103/jfmpc.jfmpc_627_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/09/2022] Open
Abstract
Background: Breast Carcinoma (BCa) is the leading cause of cancer among females in Trinidad and Tobago (TnT). This twin-island has a diversified population of 1.3 million individuals that display and are exposed to a variety of lifestyle choices that have been linked to the development of BCa. Therefore, this study aimed to identify the risk factors that influence the development of BCa, analyze the common histopathological details, and categorize BCa based on receptor study. Methods: Cancer information for 120 BCa cases at Eric Williams Medical Sciences Complex from 2012 to 2019 was retrieved, analyzed, and statistically estimated. The clinical details were categorized based on data tabulations, and histological assessment was performed to identify specific features. The receptor analysis was classified based on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor-2 (HER-2neu) staining intensity. A descriptive data analysis and comparison were statistically evaluated in all these cases. Results: Epidemiological factors influencing the development of BCa were age with a peak of 56–65 years 27.5% (n = 33), ethnicity predominated in Indo-Trinidadians 48.33% (n = 58), and marital status primarily in unmarried/single/widowed patients 55% (n = 66). Infiltrating ductal carcinoma was the principal histopathological type 91.66% (n = 110). Receptor analysis revealed ER/PR + HER-2neu as the most common type 40% (n = 18) for therapeutic surveillance. Conclusion: This study highlights various epidemiological factors that influence the development of BCa among females in TnT. Histopathological analysis and receptor studies would provide a useful link between the tumor behavior and its prognosis.
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