Testicular cancer,occupation and exposure to chemical agents among Finnish men in 1971–1995

Objective: To find associations between testicular cancer, occupation and chemical exposure.Methods: A cohort of all economically active Finnish men born between 1906 and 1945 was followed-up for 19.7 million person-years during 1971–1995. Incident cases of testicular cancer (n=387) were identified in a record linkage with the Finnish Cancer Registry. The Census occupations in 1970 were converted to chemical exposures with a job-exposure matrix (FINJEM). Cumulative exposure (CE) was calculated as the product of prevalence, level, and duration of the exposure. Standardised incidence ratio (SIR) was calculated for each of the 393 occupations, and for CE categories of the 43 chemical agents, using average male population as reference. Relative risks (RR) comparing various CE-categories with unexposed ones were defined for selected agents by Poisson regression analysis.Results: Elevated SIRs were observed among railway traffic supervisors (5.8, 95% CI 1.6–14.7), programmers (4.3, 1.4–9.9), university teachers (4.1, 1.3–9.5) and electrical engineers (3.9, 1.1–10.1). A significant exposure-response trend (mainly contributed by seminoma) was observed for pesticides, textile dust, aliphatic and alicyclic hydrocarbons, and some other organic solvents.Conclusions: Risk of testicular cancer increased only in four occupations. Pesticides, textile dust, and some organic solvents may be related to an excess risk of seminoma.     

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

Data collected by the Cancer Registry of the Swiss Canton of Vaud (whose population in 1980 was about 530,000 inhabitants) were used to estimate the incidence of second metachronous primary cancers following any specific neoplasm. Among 34,615 cases of incident neoplasms registered between 1974 and 1989 and followed through integrated active follow-up to the end of 1989, for a total of 118,241 person-years at risk, there were 2,185 second primaries (1,280 males, 905 females). For both sexes, the standardised incidence ratios (SIR) were significantly elevated by about 20%. Overall significantly elevated ratios were registered for cancers of the oral cavity and pharynx (SIR = 1.6 for males, 2.0 for females), oesophagus in males (SIR = 1.5), lung in males (SIR = 1.4), skin melanoma (SIR = 1.7 for males, 1.5 for females), non-melanomatous skin cancers (SIR = 1.6 for males, 1.5 for females), female breast (SIR = 1.3), kidney (SIR = 1.5 for males, 1.9 for females), and thyroid in males (SIR = 2.4). When specific first cancer sites were considered, the SIR following a cancer of the oral cavity and pharynx was around 3 in both sexes, mainly on account of a substantial excess of second primaries of the oral cavity, oesophagus, larynx and lung. The overall SIR following laryngeal cancer was 3.0, and significant excesses were observed for oral cavity and pharynx, oesophagus and lung. After lung cancer, the overall SIR was 1.7 for males and 2.6 for females, and significantly elevated SIRs were observed for oral cavity, lung and oesophagus. Following non-melanomatous skin cancers, elevated SIRs were observed in both sexes for skin melanoma and non-melanomas. The incidence of any cancer after breast cancer was significantly elevated (SIR = 1.2), mainly on account of an elevated risk of subsequent breast cancer (SIR = 1.7). With reference to cervical cancer, there was a significant excess for any subsequent primary (SIR = 1.6), and for lung cancer (SIR = 7.8). Significantly elevated SIRs were observed for kidney following bladder cancer, and for bladder after kidney cancer. In both sexes, the incidence of cancers of any site was elevated following leukaemias (SIR = 1.7 for males, 2.5 for females), and a significant excess was registered for lung in males and non-melanomatous skin cancers in both sexes.(ABSTRACT TRUNCATED AT 400 WORDS)     

Geographic pattern of cancers related to tobacco and alcohol in Connecticut: implications for cancer control

The purpose of this study was to examine the geographic distribution of standardized incidence ratios (SIRs) for Connecticut's 169 towns for 18,382 cancers diagnosed in 1995-2000 at sites most strongly associated with tobacco and/or alcohol (i.e, lung, oral cavity-pharynx, and esophagus), with consideration of census-derived indicators of socioeconomic status (SES) at the town level. For males, the state's four largest towns, all in the highest poverty-rate quartile, had statistically significantly elevated SIRs for both lung cancer and oral cavity-pharynx cancers, and also had elevated SIRs for esophageal cancer. Two of these four towns also had statistically significantly elevated SIRs for oral cavity-pharynx cancer for females. SIRs for both males and females were lowest for the lowest poverty quartile and highest for the highest poverty quartile, for each cancer-site group. Among 15,271 patients diagnosed with their first cancer at any of the selected sites in 1995-2000, risk of diagnosis of a second primary cancer at any of these sites (139 patients) was highest in the highest poverty-rate quartile. These surveillance methods should be useful for targeting cancer control efforts aimed at prevention or cessation of tobacco and/or heavy alcohol use, and early detection or chemoprevention of these cancers, including second primary cancers.     

Trends in cancer mortality, France 1950-1985

Trends in mortality for main cancer sites in France between 1950 and 1985 are presented by sex. In the population aged 35-65, where long term trends can most reliably be assessed, an overall 1.1% mean annual increase is observed for males and a 0.6% mean annual decrease is observed for females. For males, this increase in total cancer mortality is mostly due to the sites associated with tobacco and alcohol. The important increase for lung cancer, and lesser increases for bladder, pancreas and kidney cancers are related to the increase in tobacco consumption from 4.7 g per adult per day in 1950 to 6.3 g in 1976. For cancer sites associated with alcohol and tobacco, namely oesophagus, pharynx, larynx, tongue and mouth, mortality is increasing similarly for males and for females, although these cancers are much less frequent among females. For females, the overall moderate decrease is mostly due to the decrease in cervix and stomach cancer mortality, uncompensated by the observed increase in breast cancer; there is no marked increase in lung cancer mortality for women, contrary to what is observed in other Western countries.     

Exposure to cement dust, related occupational groups and laryngeal cancer risk: results of a population based case-control study

A population-based case-control study was performed in the Rhein-Neckar region, Germany, to evaluate occupational risk factors for the development of laryngeal cancer ("Rhein-Neckar-Larynx Study"). Between May 1998 and December 2000, 257 patients (236 males, 21 females), aged 37-80, with histologically confirmed laryngeal cancer, as well as 769 population control persons (702 males, 67 females), were included (1:3 frequency matched by age and sex). History of occupational exposures, as well as other risk factors (tobacco, alcohol), was obtained with face-to-face interviews using a detailed standardized questionnaire. The complete individual work history was assessed. A detailed assessment of work conditions was obtained by job-specific questionnaires (JSQs) for selected jobs known to be associated with exposure to potential laryngeal carcinogens. Estimates for total exposure hours by substance were calculated based on JSQs. Published occupational hygiene data were used to infer semiquantitative scores of exposure intensity for specific job tasks. After adjustment for tobacco and alcohol intake, a significant elevated odds ratios (OR) could be demonstrated for persons that were exposed to cement during their work as building and construction workers. An OR of 2.42 was calculated for workers of the high exposed subgroup (95% confidence interval: 1.14-5.15; p < 0.001). Smoking was the main confounding factor because the unadjusted cement OR of 3.20 dropped down to 2.42 after adjustment for tobacco intake. We conclude that there is good evidence for cement dust exposure acting as a tobacco, alcohol and asbestos independent risk factor for laryngeal carcinoma. Our study gives a base for further toxicologic investigations on this topic.     

Overview of available data on diet and cancer mortality in France

We are reasonably sure today that diet plays an important role in the etiology of many common types of cancer, although the mechanisms and the relevant components of the diet have not yet been clearly identified. Data on the temporal and geographical variations of diet, and of cancer mortality, are presented here for France. There were important modifications in the dietary habits of the French population between 1950 and 1985. The consumption of bread and potatoes went down by a factor 2, and alcohol consumption decreased by 20%. Simultaneously, increases varying between 50% and 100% were observed for butter, fish, fruits and vegetables; the consumptions of pork meat, oil, and margarine were more than doubled; and lastly the consumption of poultry went up by a factor 3.5, and cheese or yogurt by a factor 4.5. The variations between regions for France are also very large. The largest increases in cancer mortality between 1950 and 1985 were observed for mouth and pharynx, both in males and females, and for lung cancer in males. The largest geographical variations were observed for mouth and pharynx, for esophagus, and for stomach. For these sites, the highest rates were observed in Brittany. In our present state of knowledge on the relation between diet and the risk of cancer, we cannot reliably attribute the variations in cancer mortality to specific dietary habits.     

Incidence of Smoking-Related Second Primary Cancers After Lung Cancer in Germany: An Analysis of Nationwide Cancer Registry Data

IntroductionApproximately 80% of lung cancer cases in Germany are attributable to smoking. Patients with a lung cancer diagnosis may remain at increased risk of developing smoking-related second primary cancers (SPCs).MethodsAnonymous data from 11 population-based cancer registries covering approximately 50% of the German population were pooled for the analysis. Included patients were diagnosed with having an index lung cancer between 2002 and 2013, aged 30 to 99 years old at diagnosis, and survived for at least 6 months. We calculated standardized incidence ratios (SIRs)—stratified by age, sex, region, and period—comparing the incidence of smoking-related and other SPCs to the general population.ResultsOf the 135,589 lung cancer survivors (68.2% male; mean follow-up 30.8 mo) analyzed, 5298 developed an SPC. In males, the risk was particularly high for SPCs of the larynx (SIR = 3.70, 95% confidence interval [CI]: 3.14–4.34), pharynx (3.17, 2.61–3.81), and oral cavity (2.86, 2.38–3.41). For females, SIRs were notably elevated for the esophagus (4.66, 3.15–6.66), oral cavity (3.14, 2.03–4.63), and urinary tract (2.68, 2.04–3.45). When combining all smoking-related cancer sites, SIR was 1.41 in males (95% CI: 1.36–1.47) and 1.81 in females (95% CI: 1.68–1.94). We observed that males had a 1.46-fold (95% CI: 1.37–1.56) and females a 1.33-fold (95% CI: 1.20–1.47) increased risk for smoking-related compared with other cancers.ConclusionsPatients with primary lung cancer were at increased risk for developing a smoking-related SPC. Therefore, the advantages of increased patient surveillance and the benefits of smoking cessation strategies should be considered.     

Cancer of the Oral Cavity and Pharynx in Karachi - Identification of Potential Risk Factors

The objective of the study was to provide an overview of the demographics of cancer of the oral cavity and ‍pharynx in Karachi South (1995-2001), and identify potential risk factors. Cases recorded for Karachi South, at ‍Karachi Cancer Registry during 1st January 1995 to 31st December 2002 were analysed. For maximum completion ‍of data cancer cases, recorded from 1st January 1995 to 31st December 2001 were included for final analysis. The age ‍standardized incidence rates per 100,000 population (ASIRs) for cancer of the oral cavity (excluding salivary gland) ‍in Karachi South were 17.1 and 16.5 in males and females whereas the ASIRs for cancer of the pharynx (excluding ‍nasopharynx) were 7.1 and 2.4 in males and females, respectively. The oral pharyngeal ratios were 2.4 and 6.9 for ‍males and females and gender ratios (M F) were 1.04 for the oral cavity and 3.0 for the pharynx. The mean ages were ‍51 years (95% CI 49.6; 52.2) and 56.1 years (95% CI 54.4; 57.8) respectively. Cancer of the oral cavity ranked 2nd in ‍Karachi in both genders. Cancer of the pharynx ranked 7th in males and 14th in females. Approximately 97% of the ‍oral cavity and pharyngeal cancers were histologically confirmed. The majority of the oral (47.1%) and pharyngeal ‍(51.9%) cancer cases presented as grade II lesions, and were discovered at advanced stages. Of the cancers reported ‍during 1995-2001, 60.4% of the oral and 78.1% of the pharyngeal lesions had spread to a distant site at the time of ‍diagnosis. Squamous cell carcinoma comprised 96.5% and 91.8% of the totals. The incidences of these cancers are ‍comparable to the highest risk regions of the world. As distinct from other geographical areas oral cancer is as ‍common in females as in males, which may reflect the pattern of exposure to known risk factors such as betal quid, ‍arecanut and tobacco and the absence of alcohol as a risk factor in both genders. Apergillus contamination of ‍arecanut could also be a risk factor but no confirmation studies or quantification is available. Despite the common ‍risk factors, incidence of pharyngeal cancer is three times higher in men as compared with women. The keys to ‍reducing the incidence and mortality due to oral and pharyngeal cancers are prevention and control, emphasizing ‍cessation of tobacco use and cancer screening. However a targeted cancer and tobacco control program does not ‍presently exist in Pakistan. ‍     

Sauna, dust and migration as risk factors in lung cancer among smoking and non-smoking males in Finland

To study possible causes of the high lung cancer incidence among Finnish males, the Finnish Cancer Registry and the Cancer Registry of Norway in 1962 performed a population survey covering smoking habits, occupational and residential history and, in Finland, sauna habits. The cohort of 4,475 Finnish men has now been followed up for incidence of lung cancer in 1964-1979. The relative importance of 3 factors--sauna baths, occupational exposure to dust, and migration to urban areas--was studied in different smoking categories. Among smokers of greater than or equal to 25 g/day, takers of frequent saunas (more than once a week) displayed some excess risk (RR 1.7). In smokers an increased risk was also found among those exposed to dust (RR 1.3), and those who had migrated to urban areas (RR 1.8, when compared to native urban population). Dust exposure and migration factors act synergistically with smoking. Migration was the only factor apart from smoking to show a substantial population-attributable risk, which amounted to 10%.     

Risk of cancers of the lung, head and neck in patients hospitalized for alcoholism in Sweden

Alcoholic patients are at increased risk of cancers of the head and neck but little information is available on the magnitude of the risk for specific sites and for different histological types. We followed 182 667 patients with a hospital discharge diagnosis of alcoholism during 1965-1994, for an average of 10.2 years. We compared their incidence of site- and histological type-specific cancers of the oral cavity, pharynx, larynx and lung with that of the national population. The standardized incidence ratio (SIR) of cancer of the oral cavity and pharynx was 5.33 (95% confidence interval [CI] 5.04-5.64, based on 1207 cases). The SIRs of laryngeal and lung cancer were 4.21 (95% Cl 3.78-4.68, 347 cases) and 2.40 (2.29-2.51, 1880 cases), respectively. The SIR was highest for cancers of the hypopharynx, floor of the mouth, mesopharynx and base of the tongue. The relative excess of lung cancer was similar for squamous cell carcinoma and adenocarcinoma. Low age at first hospitalization was associated with higher SIRs for all sites under study. 25 years after first hospitalization for alcoholism, the cumulative probability of developing a lung cancer was in the order of 5%, for oral and pharyngeal cancer it was 2.5%, and for oesophageal or laryngeal cancer 1% each. Our study shows that the risk of head and neck cancer among heavy drinkers is highest for sites in direct contact with alcohol. The high risk of head and neck neoplasms may justify specific medical attention.     

Cancer Incidence and Mortality in Central Myanmar: Report of Nay Pyi Taw Population-Based Cancer Registry

Background: Cancer is a major public health problem in Myanmar, and cancer registration activities are currently underway through both hospital-based and population-based approaches. So far, there are no population-based cancer incidence and mortality estimates in the country. Methods: According to the 2014 census, the total population of Nay Pyi Taw Union Territory was 1,160,242 within the area of 70,571 km2. Nay Pyi Taw Cancer Registry team collected data of new cancer cases both actively and passively from all data sources in the region. The data were registered, updated, cross-checked, quality-assured, and analyzed in CanReg5. The results were presented as the number of cases by site, sex, and age, cumulative risk (CR), crude rate, age-specific, and age-standardized incidence rates (ASRs) per 100,000. Results: Total 5,952 new cancer cases and 1874 cancer deaths were recorded among the population of the Nay Pyi Taw Union Territory between 2013 and 2017. The age-standardized incidence rate for all cancer sites excluding non-melanoma skin cancers in males was 125.9 and 107.3 for females. For both sexes combined, the most common cancers were lung (14%), breast (11.4%), liver (10.2%), mouth and pharynx (8.5%), and stomach cancers (7.8%). In males, the most common were lung (18.1%), liver (14.8%), mouth and pharynx (13%), stomach (8.9%) and colon, rectum, and anus (7.4%) cancers. In females, these were breast (21.2%), cervix (13.0%), lung (10.3%), stomach (6.9%) and colon, rectum, and anus (6.3%) cancers. The most common cancer deaths were caused by liver (20.8%), lung (15.7%), mouth and pharynx (9.3%), stomach (7.5%), and Colon, rectum, and anus (6.8%) cancers. Conclusion: The findings in this study are salient and have potential to serve as important information for the National Cancer Control Program to formulate prevention and control strategies.     

Silica dust and lung cancer: results from the Nordic occupational mortality and cancer incidence registers

Autopsy studies of the relationship between silicosis and lung cancer have been mainly negative; but recent epidemiologic studies have indicated a positive association, and an excess lung cancer risk has been observed in some occupational groups with exposure to silica dust. For the further shedding of light on the possible association between silica dust and lung cancer, analysis was made on mortality and cancer incidence data available in census-based record linkage studies from the Nordic countries for males in occupational groups with potential exposure to silica dust. The study showed an excess lung cancer risk for foundry workers in all the Nordic countries and for miners in Sweden. These results were consistent with findings from previous in-depth epidemiologic studies. The lung cancer risk did not differ significantly from that of the respective national populations for males working in excavation; stone quarries; sand and gravel pits; and glass, porcelain, ceramic, and tile manufacture. Stonecutters, who are probably not exposed to known lung carcinogens at the workplace but in some places to high concentrations of silica dust, showed a significant excess lung cancer risk in both Finland and Denmark. Excess lung cancer risks furthermore were seen for Finish miners, for Finnish males in excavation work, and for Danish glassworkers.     

Cancer risk in farmers: Results from a multi-site case-control study in north-eastern italy

The relationship between farming and cancer risk was investigated in an integrated series of case-control studies conducted from 1985 to 1991 in the Friuli Venezia Giulia region, north-east Italy. Patients with cancer of the oral cavity and pharynx, larynx, oesophagus, colon and rectum, pancreas, breast, thyroid gland, kidney and urinary tract, bladder, prostate, soft-tissue sarcomas, Hodgkin's diseases, non-Hodgkin's lymphomas and multiple myelomas, and controls admitted to hospital for acute, non-neoplastic conditions, were interviewed. For males, a significantly elevated relative risk was seen for oral cavity and pharynx. Farming, however, was associated with a significant protection against cancer of the colon and rectum and bladder. In females, only one significant association emerged, for multiple myeloma. A few significant interactions between cancer risk and year of birth (i.e., before 1930 or 1930 and after) were observed. The risk of cancer of the larynx was significantly elevated in younger male farmers but not in older ones. Our multi-site case-control study confirms that farmers have, for some cancer sites, a distinctive pattern. Excesses of cancer of the oral cavity and pharynx in farmers are characteristic of the present study area and, possibly, of similar European rural populations who have in common high levels of alcohol consumption and, at least in the past, unbalanced diets.     

Cancer mortality in Indian and British ethnic immigrants from the Indian subcontinent to England and Wales.

Risk of cancer mortality from 1973 to 1985 in persons born in the Indian subcontinent who migrated to England and Wales was analysed by ethnicity, and compared with cancer mortality in the England and Wales native population, using data from England and Wales death certificates. There were substantial highly significant raised risks in Indian ethnic migrants for cancers of the mouth and pharynx, gall bladder, and liver in each sex, larynx and thyroid in males, and oesophagus in females. There were also substantial raised risks in these migrants of each sex for non-Hodgkin''s lymphoma and myeloma. For the mouth and pharynx, and liver in each sex, and gall bladder in females, there were also raised risks of lesser magnitude in British ethnic migrants. For colon and rectal cancer and cutaneous melanoma in each sex, ovarian cancer in women and bladder cancer in men, there were appreciable significantly reduced risks in the Indian ethnic migrants not shared by those of British ethnicity. Appreciable raised risks in British ethnic migrants not shared by those of Indian ethnicity occurred for nasopharyngeal cancer in males, soft tissue malignancy in both sexes and non-melanoma skin cancer in males. In migrants of both ethnicities there were appreciable significantly raised risks in each sex for leukaemia and decreased risks in each sex for gastric cancer, for lung cancer except in females of British ethnicity and in males for testicular cancer. The results suggest the need for public health measures to combat the high risks of oral and pharyngeal cancers and liver cancer in the Indian ethnic immigrant population of England and Wales, by prevention of betel quid chewing and hepatitis transmission respectively. The data also imply that early exposures or early acquired behaviours in India, or exposures during migration, may increase the risk of leukaemia and reduce the risks of gastric and testicular cancers in the migrants irrespective of their ethnicity. Aetiological studies would be worthwhile to investigate the reasons for the sizeable decreased risk of colon and rectal cancer and increased risk of gall bladder cancer in each sex and the increased risk of thyroid and laryngeal cancer in males and oesophageal cancer in females of Indian ethnicity but not of British ethnicity who have migrated from the Indian subcontinent.     

Occupational exposure to wood dust and risk of nasal and nasopharyngeal cancer: A case‐control study among men in four nordic countries—With an emphasis on nasal adenocarcinoma

The current study aims to provide stronger evidence to aid in our understanding of the role of cumulative occupational exposure to (softwood‐dominated) mixed wood dust in aetiology of nasal cancer. We included broad exposure occurred in a range of wood‐processing occupation across varied industries in four Nordic countries. A population‐based case‐control study was conducted on all male cases with nasal adenocarcinoma (393 cases), other types of nasal cancer (2,446) and nasopharyngeal cancer (1,747) diagnosed in Finland, Sweden, Norway and Iceland between 1961 and 2005. For each case, five male controls, who were alive at the time of diagnosis of the case (index date), were randomly selected, matched by birth‐year and country. Cumulative exposures (CE)s to wood dust and formaldehyde before the index date were quantified based on a job‐exposure matrix linked to occupational titles derived from population censuses. Hazard ratios (HRs) for the CE of wood dust were estimated by conditional logistic regression, adjusted for CE to formaldehyde and 95% confidence intervals (CIs) were calculated. There was an increasing risk of nasal adenocarcinoma related to wood dust exposure. The HR in the highest CE category of wood dust (≥ 28.82 mg/m³‐years) was 16.5 (95% CI 5.05–54.1). Neither nonadenocarcinoma of the nose nor nasopharyngeal cancer could be linked to wood dust exposure. CE to softwood‐dominated mixed wood dusts is strongly linked with elevated risk in nasal adenocarcinoma but not with other types of nasal or nasopharyngeal cancer.     

Lymphoma,myeloma and occupation: Results of a case-control study

The known risk factors for lymphoma and myeloma cannot account for the current incidence rates of these cancers, and there is increasing interest in exploring occupational causes. We present results regarding lymphoma and myeloma from a large case-control study of hundreds of occupational exposures and 19 cancer sites. We examine in more detail those exposures previously considered to be related to these cancers, as well as exposures which were strongly related in our initial analyses. Lymphoma was not associated in our data with exposure to solvents or pesticides, or employment in agriculture or wood-related occupations, although numbers of exposed cases were sometimes small. Hodgkin's lymphoma was associated with exposure to fabric dust, and non-Hodgkin's lymphoma was associated with exposure to copper dust, ammonia and a number of fabric and textile-related occupations and exposures. Employment as a sheet metal worker was associated with development of myeloma. © 1996 Wiley-Liss, Inc.     

Exposure histories in acute nonlymphocytic leukemia patients with a prior preleukemic condition

A subset of patients with acute nonlymphocytic leukemia (ANLL) have evidence of a myelodysplastic syndrome (MDS), low infiltrate leukemia, or other preleukemic condition that may be present for several months before onset of disease. The hypothesis that these conditions act as markers for environmentally induced cancer was examined in 270 ANLL patients, 46 with a preleukemic phase and 224 with an acute onset. Although the effects of previously identified risk factors (male sex, age older than 50 years, prior cytotoxic therapy) were demonstrated, no associations with common environmental conditions (cigarette smoking, alcohol use, occupations with exposure to chemicals or radiation) were present with the exception of hobbies involving potential chemical exposure, odds ratio (OR) and 95% confidence intervals = 4.2 (1.4 to 12.3) and self-reported exposure to pesticides, OR = 10.2 (1.8 to 63.1). These may be chance associations although a previous case-control study of MDS reported similar findings.     

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.     

Skin cancer and non-Hodgkin's lymphoma as second malignancies. markers of impaired immune function?

Successes in cancer therapy have led to increasing numbers of cancer survivors, who are at risk of developing second primary cancers. Therapy- or disease-induced suppression of the immune function may predispose cancer patients to a second malignancy. An excess of squamous cell skin cancers (SCC) and non-Hodgkin's lymphomas has been found in immunosuppressed patients. We used the nationwide Swedish Family-Cancer Database on 10.2 million individuals to calculate the risk of second primary skin cancers and non-Hodgkin's lymphomas following a previous malignancy. A total of 4301 second skin cancers and 1672 non-Hodgkin's lymphomas were identified. Standardised incidence ratios (SIR)s and 95% Confidence Intervals (CIs) were calculated and compared. Among 14 different sites for male or female first primary malignancies, 11 of these sites were followed by an increased risk of skin cancer (SIRs for males for risk of skin cancer as a second primary cancer: 14.1 for SCC; 9.7 for melanoma; 6.1 for leukaemia as the first site; SIRs for females for risk of skin cancer: 14.6 for SCC; 6.8 for larynx; 6.2 for upper aerodigestive tract (UADT) as the first site). The risk of non-Hodgkin's lymphoma was increased after 10 of 14 different male neoplasms and 12 of 17 different female neoplasms. (SIRs for males for risk of non-Hodgkin's lymphoma as a second primary cancer: 6.4 for non-Hodgkin's lymphoma; 3.2 for leukaemias; 3.1 for multiple myeloma as the first site; SIRs for females for risk of non-Hodgkin's lymphoma as a second primary cancer: 12.5 for leukaemias; 7.0 for Hodgkin's disease; 3.6 for UADT as the first site). The high, and after certain sites, very high risks of second skin cancer and non-Hodgkin's lymphoma suggest that immune suppression may be a contributory mechanism.