Increased risk of colon cancer after external radiation therapy for prostate cancer

Radiotherapy can induce second cancers. Controversies still exist regarding the risk of second malignancies after irradiation for prostate cancer. We evaluated the risk of developing colon and rectum cancers after prostate cancer in irradiated and nonirradiated patients. Using data from the population-based Geneva cancer registry, we included in the study all men with prostate cancer diagnosed between 1980 and 1998 who survived at least 5 years after diagnosis. Of the 1,134 patients, 264 were treated with external radiotherapy. Patients were followed for occurrence of colorectal cancer up to 31 December, 2003. We calculated standardized incidence ratios (SIR) using incidence rates for the general population to obtain the expected cancer incidence. The cohort yielded to 3,798 person-years. At the end of follow-up 19 patients had developed a colorectal cancer. Among irradiated patients the SIR for colorectal cancer was 3.4 (95% confidence intervals [CI] 1.7-6.0). Compared to the general population, the risk was significantly higher for colon cancer (SIR = 4.0, 95% CI: 1.8-7.6), but not for rectal cancer (SIR = 2.0, 95% CI: 0.2-7.2). The risk of colon cancer was increased in the period of 5-9 years after diagnosis (SIR = 4.7, 95% CI: 2.0-9.2). The overall SIR of secondary cancer in patients treated with radiotherapy was 1.35 (p = 0.056). Nonirradiated patients did not have any increased risk of rectal or colon cancer. This study shows a significant increase of colon but not rectum cancer after radiotherapy for prostate cancer. The risk of second cancer after irradiation, although probably small, needs nevertheless to be carefully monitored.     

Second primary cancers in patients with squamous cell carcinoma of the skin: A population‐based study in Sweden

We studied second primary cancer among 25,947 patients diagnosed with squamous cell carcinoma of the skin (SCC) in Sweden between 1958 and 1992. In total, 5,706 patients developed a second primary cancer at any site, compared with an expected number of 2,651 [standardized incidence ratio (SIR) = 2.15; 95% confidence interval (CI) = 2.10–2.21]. Men below 60 years of age at diagnosis of SCC had higher SIR (2.5; CI = 2.2–2.8) with the highest risk during the first year of follow‐up (SIR = 9.2; CI = 6.9–12.2). If second primary SCC was excluded, the SIR was reduced to 1.30 (CI = 1.25–1.34); the relationships by sex, age and time since diagnosis remained similar. For skin cancer, the SIR for second SCC was markedly elevated (SIR = 15.6) and the risk of malignant melanoma was elevated 3‐fold. Significantly increased risks were found for most second cancers in squamous cell epithelium: lip (SIR = 5.2), respiratory organs (SIR = 1.7), esophagus (SIR = 1.5), cervix uteri (SIR = 2.2), and vulva including vagina (SIR = 2.3). There was a generally increased risk of almost 2‐fold for second cancer in hematopoietic or lymphoproliferative tissues. Slightly increased rates (SIR = 1.0–1.5) were seen for second tumors in digestive tissues. Finally, a high SIR (SIR = 5.5) was observed for second primary cancer in salivary glands. In conclusion, patients with SCC are at increased risk to develop new primary cancer, especially in skin, squamous cell epithelial and tobacco‐related tissues. Common risk factors among the tumor types might explain our findings, however, an intrinsic susceptibility among SCC patients to develop cancer is also possible. Int. J. Cancer 80:511–515, 1999. © 1999 Wiley‐Liss, Inc.     

Risk of malignancy among patients with rheumatic conditions

Previous studies have described an increased risk of malignancy in subjects diagnosed with rheumatic conditions, most notably rheumatoid arthritis (RA). Our aim was to quantify and compare risks for site-specific malignancy among hospitalized patients with RA, osteoarthritis (OA) and other rheumatic conditions in a nationwide, population-based cohort. Subjects were identified from Scottish hospital in-patient records from 1981 to 1996 and followed up by computer linkage of the Scottish Cancer Registry and the national registry of deaths. Expected cancer incidence was calculated from national cancer rates and related to the observed incidence by the standardized incidence ratio (SIR). Among RA patients, there was an increased risk for hematopoietic [males SIR= 2.13, 95% confidence interval (CI) 1.7-2.7; females SIR = 1.76, 95% CI 1.5-2.1], lung (males SIR = 1.32, 95% CI 1.2-1.5; females SIR = 1.44, 95% CI 1.3-1.6) and prostate (SIR = 1.26, 95% CI 1.0-1.6) cancers. Reduced risk were seen for colorectal cancer (males SIR = 0.87, 95% CI 0.7-1.1; females SIR = 0.71, 95% CI 0.6-0.9) and, among females, stomach cancer (SIR = 0.70, 95% CI 0.5-1.0). The excess risk for hematopoietic cancer and the reduced risk for colorectal and stomach cancers were sustained over 10 years of follow-up. An overall decreased risk of cancer was observed for patients with OA; the greatest reductions were observed for colorectal (males SIR = 0.88, 95% CI 0.8-1.0; females SIR = 0.84, 95% CI 0.8-0.9), stomach (males SIR = 0.79, 95% CI 0.7-0.9; females SIR = 0.66, 95% CI 0.6-0.8) and lung (males SIR = 0.72, 95% CI 0.7-0.8; females SIR = 0.84, 95% CI 0.8-0.9) malignancies, with decreased risks generally still evident at 10 years of follow-up. Our results support several previous findings regarding the incidence of hematopoietic and colorectal malignancies in RA patients. In addition, we have shown a large decrease in stomach cancer among patients with OA and females with RA that warrants further investigation since it may provide clues to possible prevention strategies. To further our knowledge about the underlying mechanisms of altered risk in cancer patients with rheumatic conditions, population studies requiring primary data collection are required.     

Cancer patterns in nasopharyngeal carcinoma multiplex families in Taiwan

Genetic and environmental factors have been implicated in the etiology of nasopharyngeal carcinoma (NPC), a tumor known to be closely associated with Epstein‐Barr virus (EBV) infection. Studies have reported familial aggregation of NPC and have suggested the possible aggregation of NPC and other cancers. We evaluated familial aggregation of cancer in 358 high‐risk families with two or more NPC cases enrolled in a NPC genetics study in Taiwan. Participants were linked to the Taiwan National Cancer Registry to identify incident cancers diagnosed after study enrollment (started in 1996) and before December 31, 2005, or death. In total, 2,870 individuals from the NPC Multiplex Family Study contributed 15,151 person‐years over an average of 5.3 years of follow‐up. One hundred ten incident cancers were identified. Multiple‐primary standardized incidence ratios (MP‐SIRs) were computed to evaluate overall cancer risk associated with infectious agents and with other tumors. The overall MP‐SIR was 1.3 (95% CI: 1.1–1.6), which was largely explained by an excess in NPC (MP‐SIR = 15; 95% CI: 10–23). Exclusion of incident NPC diagnoses led to an overall MP‐SIR of 1.0 (95% CI: 0.83–1.3). Similarly, the observed excess risk of cancers associated with infectious agents (MP‐SIR = 2.0; 95% CI: 1.5–2.6) was driven by the excess in NPC; exclusion of NPC cases led to a reduced MP‐SIR that did not differ from 1.0. Analysis of the largest NPC multiplex family study to date confirms the presence of coaggregation of NPC within families in Taiwan but does not provide evidence for a broader familial syndrome involving NPC and other tumors. © 2008 Wiley‐Liss, Inc.     

Cancer risks among relatives of children with Hodgkin and non-Hodgkin lymphoma

A role for genetic susceptibility in the aetiology of childhood lymphomas was investigated in 454 families of children with histologically confirmed Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) from Northwest England. Cancers in parents were obtained from the UK National Health Service Central Register and in other close relatives by interview with the parents. The cancer incidence among relatives was compared with expected incidence based on cancer registry data for England. There were 197 cancers in relatives (SIR 1.0 95% CI 0.8-1.1). In families of children with HL, there was an excess of HL in the first degree relatives (SIR 5.8 95% CI 1.2-16.9). Excesses of HL diagnosed under population median age (SIR 4.1 95% CI 1.1-10.6) were seen among all relatives and relatives of children who were below the median age at diagnosis (SIR 5.5 95% CI 1.1-16.0). In families of children with NHL, there were non-significant excesses of central nervous system (CNS) tumours in the first degree relatives (SIR 2.9 95% CI 0.8-7.4) and in the second and third degree relatives (SIR 1.5). There were significant excesses of CNS tumours diagnosed under the population median age (SIR 2.8 95% CI 1.1-5.8) in all relatives. Excess CNS tumours were also seen among relatives of children below the median age at diagnosis (SIR 3.2 95% CI 1.1-7.6). In conclusion, genetic susceptibility in some families of children with lymphoma might be operating, but aetiologies in HL and NHL appear to be different. Possible interpretations of our findings, in the context of putative genetic and infectious aetiologies, are discussed.     

Risk of prostate, breast and colorectal cancer after skin cancer diagnosis

Ultraviolet radiation is the major cause of skin cancer, but promotes vitamin D synthesis, and vitamin D has been inversely related to the risk of several common cancers including prostate, breast and colorectum. We therefore computed the incidence of prostate, breast and colorectal cancer following skin cancer using the datasets of the Swiss cancer Registries of Vaud and Neuchatel. Between 1974 and 2005, 6,985 histologically confirmed squamous cell skin cancers, 21,046 basal cell carcinomas and 3,346 cutaneous malignant melanomas were registered, and followed up to the end of 2005 for the occurrence of second primary cancer of the prostate, breast and colorectum. Overall, 680 prostate cancers were observed versus 568.3 expected (standardized incidence ratio (SIR) = 1.20; 95% confidence interval (CI): 1.11-1.29), 440 breast cancers were observed versus 371.5 expected (SIR = 1.18; 95% CI: 1.08-1.30) and 535 colorectal cancers were observed versus 464.6 expected (SIR = 1.15; 95% CI: 1.06-1.25). When basal cell, squamous cell and skin melanoma were considered separately, all the SIRs for prostate, breast and colorectal cancers were around or slightly above unity. Likewise, the results were consistent across strata of age at skin cancer diagnosis and location (head and neck versus others), and for male and female colorectal cancers. These findings, based on a population with a long tradition of systematic histologic examination of all surgically treated skin lesions, do not support the hypothesis that prostate, breast and colorectal cancer risk is decreased following skin cancer.     

A population‐based assessment of mortality and morbidity patterns among patients with thymoma

Thymomas are rare tumors of the mediastinum; a limited number of small studies have evaluated the outcomes in these patients. We identified 668 patients with thymoma from the Swedish Cancer Registry, and 2,719 population‐based matched controls. We obtained information on autoimmunity from the nationwide inpatient/outpatient hospital discharge Registry. We constructed Kaplan‐Meier curves for survival analysis, conditional regression and Cox proportional hazards models to evaluate the association between thymoma and autoimmune diseases, and standardized incidence ratios (SIRs) to evaluate the risk for second cancers following thymoma. Compared with controls, patients with benign or malignant thymoma had a poorer (p < 0.001) 5‐year (79%, 53% vs. 91%), 10‐year (65%, 39% vs. 78%) and 20‐year (43%, 18% vs. 55%) overall survival. For thymoma patients, younger age at diagnosis and being diagnosed in recent years were associated with a better survival. Compared with controls, thymoma patients were more likely to have an autoimmune disease at some point during their lives (32.7% vs. 2.4%, respectively, p < 0.001), most frequently myasthenia gravis (24.5%), systemic lupus erythematosus (2.4%) and red cell aplasia (1.2%). Thymoma patients had twofold excess risk for second cancers compared with the general population, most notably: non‐melanoma skin cancer (SIR = 10.6, 95% confidence intervals (CI) = 6.0–17.3), non‐Hodgkin lymphoma (SIR = 6.8, 95% CI = 3.00–13.0), and cervical (SIR = 6.9, 95% CI = 1.4–20.1), endocrine (SIR = 4.7, 95% CI = 1.3–12.0), and prostate cancer (SIR = 3.0, 95% CI = 1.7–4.8). Despite the improved survival for thymoma patients over time, they have worse survival than controls. Thymoma patients are in need for follow‐up to detect and manage autoimmune diseases and cancer.     

Primary Malignancy after Primary Female Breast Cancer in the South of the Netherlands, 1972–2001

Summary Objectives. To assess the risk of second primary cancers among women with previous breast cancer and calculate the excess burden of second cancer in the population. Methods. A population-based longitudinal study was conducted using the Eindhoven cancer registry data on 9919 breast cancer patients diagnosed in the period 1972–2000 and followed until 2001. Standardised incidence ratios (SIR) and absolute excess risks (AER) were calculated. Results. In total, 1298 (13%) women developed a second primary cancer. The risk of overall second cancer was higher among breast cancer patients compared to the general population (SIR: 2.8; 95% CI: 2.6–2.9), with an AER of 115 second cancers for every 10,000 breast cancer patients per year. High SIR and AER were observed for breast cancer (SIR: 4.1; 95% CI: 3.8–4.4; AER: 64/10,000 patients/year) and ovarian cancer (SIR: 2.0; 95% CI: 1.5–2.7; AER: 4.5/10,000 patients/year). Conclusions. Our recent data show that women with previous breast cancer have an elevated risk of developing a second cancer compared to the general population. Excess burden for the population is especially high for second cancers of the breast, ovary and colon. Screening may only be justified for breast, ovary and colon cancer in certain groups of patients.     

Cancer incidence among Finnish women with surgical treatment for cervical intraepithelial neoplasia, 1987–2006

A cohort of 26,876 women with surgical treatment for cervical intraepithelial neoplasia (CIN) during 1986–2004 was identified from the national Hospital Discharge Register. This cohort was followed up until December 31, 2006 (mean 8.4 years) through the Finnish Cancer Registry for cancer incidence during 1987–2006. There were 572 cases of cancer which is slightly more than would be expected on the basis of the national average cancer incidence in Finland. The standardized incidence ratio (SIR) was 1.14 and 95% confidence interval (CI) was 1.05–1.24. There was a statistically significant excess of cancers of the vulva (SIR: 6.15, 95% CI: 3.18–10.7), vagina (SIR: 9.08, 95% CI: 2.95–21.2), cervical cancer (SIR: 1.69, 95% CI: 1.07–2.53) and precancerous high‐grade lesion of the uterine cervix (SIR: 1.29, 95% CI: 1.10–1.50). The SIR for smoking‐related cancers combined, excluding cervical cancer, was 1.45 (95% CI: 1.12–1.86). The differences in cancer risk between treatment modalities were minor. Delivery after the CIN surgery did not decrease the overall cancer risk. In conclusion, women previously treated for CIN have an increased long‐term risk of cancers related to human papillomavirus (HPV) and smoking.     

Risk of new primary cancer in patients with oropharyngeal cancer.

The relative risk of subsequent cancers was evaluated for a total of 9,092 patients with lip and oropharyngeal cancer recorded between 1953 and 1989 in the nationwide Finnish Cancer Registry. The observed numbers of patients were compared with those expected on the basis of the incidence rates in the Finnish population. There were 1,130 patients (12%) with a new cancer. The standardised incidence ratio (SIR) of contracting a new primary cancer was 1.2 for lip cancer patients (95% CI 1.1-1.3) and 1.4 for patients with oropharyngeal cancer (95% CI 1.2-1.4). Among lip cancer patients, a statistically significant excess risk was found for subsequent cancers in the oropharyngeal area (SIR 1.9, 95% CI 1.1-3.1), larynx (SIR 2.0, 95% CI 1.2-2.9) and lung (SIR 1.4, 95% CI 1.3-1.6), i.e. for cancers with tobacco aetiology. Among patients with oropharyngeal cancer there was an excess of lip cancer (SIR, 3.5, 95% CI 1.5-6.9), lung cancer (SIR 1.8, 95% CI 1.3-2.3) and leukaemia (SIR 2.3, 95% CI 1.0-4.3). Radiotherapy for the first primary did not increase the risk of new cancer.     

Risk of cancer among children of cancer patients—a nationwide study in Finland

Cancer treatments have the potential to cause germline mutations that might increase the risk of cancer in the offspring of former cancer patients. This risk was evaluated in a population‐based study of early onset cancer patients in Finland. Using the nationwide registry data, 26,331 children of pediatric and early onset cancer patients (diagnosed under age 35 between 1953 and 2004) were compared to 58,155 children of siblings. Cancer occurrence among the children was determined by linkage with the cancer registry, and the standardized incidence ratios (SIRs) were calculated comparing the observed number of cancers with that expected, based on rates in the general population of Finland. Among the 9,877 children born after their parent's diagnosis, cancer risk was increased (SIR 1.67; 95% CI 1.29–2.12). However, after removing those with hereditary cancer syndromes, this increase disappeared (SIR 1.03; 95% CI 0.74–1.40). The overall risk of cancer among the offspring of siblings (SIR 1.07; 95% CI 0.94–1.21) was the same as among the offspring of the patients with nonhereditary cancer. Risk of cancer in offspring, born before their parents cancer diagnosis, was elevated (SIR 1.37, 95% CI 1.20‐1.54), but removing hereditary syndromes resulted in a diminished and nonsignificant association (SIR 1.08, 95% CI 0.93‐1.25). This study shows that offspring of cancer patients are not at an increased risk of cancer except when the patient has a cancer‐predisposing syndrome. These findings are directly relevant to counseling cancer survivors with regard to family planning.     

Incident cancer burden attributable to excess body mass index in 30 European countries

Excess adiposity is associated with increased risks of developing adult malignancies. To inform public health policy and guide further research, the incident cancer burden attributable to excess body mass index (BMI ≥ 25 kg/m²) across 30 European countries were estimated. Population attributable risks (PARs) were calculated using European‐ and gender‐specific risk estimates from a published meta‐analysis and gender‐specific mean BMI estimates from a World Health Organization Global Infobase. Country‐specific numbers of new cancers were derived from Globocan2002. A ten‐year lag‐period between risk exposure and cancer incidence was assumed and 95% confidence intervals (CI) were estimated in Monte Carlo simulations. In 2002, there were 2,171,351 new all cancer diagnoses in the 30 countries of Europe. Estimated PARs were 2.5% (95% CI 1.5–3.6%) in men and 4.1% (2.3–5.9%) in women. These collectively corresponded to 70,288 (95% CI 40,069–100,668) new cases. Sensitivity analyses revealed estimates were most influenced by the assumed shape of the BMI distribution in the population and cancer‐specific risk estimates. In a scenario analysis of a plausible contemporary (2008) population, the estimated PARs increased to 3.2% (2.1–4.3%) and 8.6% (5.6–11.5%), respectively, in men and women. Endometrial, post‐menopausal breast and colorectal cancers accounted for 65% of these cancers. This analysis quantifies the burden of incident cancers attributable to excess BMI in Europe. The estimates reported here provide a baseline for future modelling, and underline the need for research into interventions to control weight in the context of endometrial, breast and colorectal cancer.     

Cancer risk of Lichen planus: A cohort study of 13,100 women in Finland

The association between Lichen planus (LP) and cancer has been under debate for decades. We studied the connection via population‐based Finnish register data. All women with the diagnosis of LP (n = 13,100) were identified from the Finnish Hospital Discharge Registry from 1969–2012. These patients were linked with subsequent cancer diagnoses from the Finnish Cancer Registry until 2014. Standardized incidence ratios (SIRs) were counted for different cancers by dividing the observed numbers of cancers by expected numbers, which were based on national cancer incidence rates. In total, 1,520 women with LP were diagnosed with cancer (SIR 1.15, 95% confidence interval [CI] 1.09–1.20). LP was associated with an increased risk of cancer of lip (SIR 5.17, 95% CI 3.06–8.16), cancer of tongue (SIR 12.4, 95% CI 9.45–16.0), cancer of oral cavity (SIR 7.97, 95% CI 6.79–9.24), cancer of esophagus (SIR 1.95, 95% CI 1.17–3.04), cancer of larynx (SIR of 3.47, 95% CI 1.13–8.10) and cancer of vulva (SIR 1.99, 95% CI 1.18–3.13). The risk of cancer was not increased in other locations where LP manifests (pharynx and skin). Patients with diagnosed LP have an increased risk of developing cancer of lip, tongue, oral cavity, esophagus, larynx and vulva. These data are important when considering treatment and follow‐up of patients with LP diagnosis.     

Cancer risk among patients with coal workers' pneumoconiosis in Taiwan: A nationwide population‐based study

This study is aimed to evaluate the cancer risk among patients with coal workers' pneumoconiosis (CWP) using a nationwide population‐based dataset. Patients without previous cancer who had been diagnosed with CWP and followed‐up for more than 1 year between 1997 and 2006 were recruited from the Taiwan National Health Insurance database. Standardized incidence ratios (SIRs) of cancers in CWP patients were calculated and compared to the cancer incidence in the general population. Risk factors for cancer development were also analyzed. After a median follow‐up of 9.68 years, 954 cancers developed among 8,051 recruited CWP patients, with a follow‐up of 69,398 person‐years. The SIR for all cancers was 1.12 [95% confidence interval (CI) 1.04–1.18]. Males older than 80 years had a SIR of 1.27 (95% CI: 1.06–1.51). The SIRs of esophageal (1.76, 95% CI: 1.24–2.44), gastric (1.42, 95% CI: 1.13–1.76), liver and biliary tract (1.18, 95% CI: 1.01–1.37) and lung and mediastinal (1.45, 95% CI: 1.26–1.66) cancers were significantly higher in the CWP group than in the general population. Multivariate analysis showed that age ≥ 60 years [hazard ratio (HR) 1.70, 95% CI: 1.41–2.05), male gender (HR = 1.79, 95% CI: 1.44–2.23) and liver cirrhosis (HR = 3.99, 95% CI: 2.89–5.51) were significant predictors of cancer development in patients with CWP. We concluded that patients with CWP, especially elderly males, were at increased risk of cancer. Age, male gender and liver cirrhosis were independent risk factors for cancer development.     

Sleep apnea and subsequent cancer incidence

Purpose

In vitro and animal models suggest that the physiological effects of sleep apnea could contribute to cancer risk, yet epidemiologic studies have been inconsistent.

Methods

We identified a cohort of adults diagnosed with sleep apnea between 2005 and 2014 using regional administrative databases. Linking this cohort to a population-based cancer registry, we identified first incident cancers diagnosed after sleep apnea diagnosis through 2015. We calculated age–sex standardized cancer incidence ratios (SIRs) to compare the observed number of cancers among those with sleep apnea with expected population estimates over a comparable period.

Results

Among 34,402 individuals with sleep apnea, 1,575 first incident cancers were diagnosed during follow-up (mean?±?SD; 5.3?±?2.0 years). Compared to the general population, cancer incidence (SIR 1.26, 95% CI 1.20–1.32) was elevated among sleep apnea patients. We observed significantly elevated incidence for kidney (SIR 2.24, 95% CI 1.82–2.72), melanoma (SIR 1.71, 95% CI 1.42–2.03), breast (SIR 1.43, 95% CI 1.76–2.00), and corpus uteri (SIR 2.80, 95% CI 2.24–2.47) while risk for lung (SIR 0.66, 95% CI 0.54–0.79) and colorectal cancer (SIR 0.71, 95% CI 0.56–0.89) was lower.

Conclusion

These findings suggest an elevated cancer burden, particularly at certain sites, among individuals with diagnosed sleep apnea. Results should be interpreted with caution due to unmeasured confounders (e.g., BMI, diabetes).

     

Inverse association between cancer risks and age in schizophrenic patients: A 12‐year nationwide cohort study

The association between schizophrenia and cancer risk is contentious in the clinical and epidemiological literature. Studies from different populations, tumor sites, or health care systems have provided inconsistent findings. In the present study, we examined a less well‐investigated hypothesis that age plays a crucial role in cancer risk in schizophrenia. We conducted a nationwide cohort study using Taiwan's National Health Insurance Research Database (NHIRD) between 1995 and 2007. Overall, gender‐, and age‐stratified standardized incidence ratios (SIR) were used to investigate the pattern of cancer risk by age. Of the 102 202 schizophrenic patients, 1738 developed cancer after a diagnosis of schizophrenia (SIR = 0.92; 95% confidence interval [CI] 0.90–0.96). However, the age‐stratified SIR declined with age (e.g. SIR [95% CI] = 1.97 [1.85–2.33], 0.68 [0.65–0.78], and 0.36 [0.34–0.45] for those aged 20–29, 60–69, and ≥70 years, respectively) in both genders and for major cancers. Cancer risks in schizophrenic patients were lower for cancers that are more likely to develop at an older age in the general population (e.g. stomach cancer [SIR = 0.62; 95% CI 0.57–0.80], pancreatic cancer [SIR = 0.49; 95% CI 0.39–0.84], and prostate cancer [SIR = 0.35; 95% CI 0.29–0.58]). In contrast, cancer risks were higher for cancers that have a younger age of onset, such as cancers of the nasopharynx (SIR = 1.18; 95% CI 1.08–1.49), breast (SIR = 1.50; 95% CI 1.44–1.66) and uterine corpus (SIR = 2.15; 95% CI 1.98–2.74). The unique age structures and early aging potential of schizophrenia populations may contribute to the observed inverse relationship between age and cancer risk. Higher cancer comorbidity in young schizophrenic patients deserves more attention.     

Risk of Second Primary Female Genital Malignancies in Women with Breast Cancer: a SEER Analysis

Breast cancer survivors are at an increased risk of second primary cancers, and the risk factors for the latter may have clinical significance. The aims of our study were to evaluate the incidences and risk factors of second primary female genital cancers (corpus uteri, cervix uteri plus ovary) in a large cohort of breast cancer survivors. Using the Surveillance, Epidemiology, and End Results (SEER) database, we examined the standardized incidence ratio (SIR) and risk factors for second primary female genital cancers observed between 2000 and 2014. Breast cancer survivors had increased SIRs for second corpus uteri cancers and second ovarian cancers and a decreased SIR for second cervical cancers (SIR 1.17, 1.12, and 0.64, respectively). Risk factors of second corpus uteri cancers were the age at first cancer diagnosis, race (black vs. white, aHR?=?1.142 95% CI 1.005–1.298), and progesterone receptor (PR) status (PR+ vs. PR?, aHR?=?1.131 95% CI 1.004–1.273). In addition, the risk of second ovarian cancer was positively associated with age while inversely associated with race (black vs. white, aHR?=?0.691 95% CI 0.555–0.859) and estrogen receptor (ER) status (ER+ vs. ER?, aHR?=?0.655 95% CI 0.544–0.788). Age, race, and hormone receptor status are risk factors of developing second female genital cancers among breast cancer survivors. Older age, black race, and a PR+ status in survivors are associated with a higher risk of second corpus uteri cancers. Additionally, older age and an ER? status should increase vigilance for potential second ovarian cancers.     

Cancer incidence among alcoholic liver disease patients in Finland: A retrospective registry study during years 1996–2013

Both alcohol abuse and liver cirrhosis are known risk factors for various cancers. This article was aimed to assess the long‐term risk of malignancies among patients with severe alcoholic liver disease (ALD), i.e., alcoholic liver cirrhosis and alcoholic hepatitis. A cohort of 8,796 male and 3,077 female ALD patients from 1996 to 2012 was identified from the Finnish National Hospital Discharge Register. This nationwide cohort was combined with the data from the Finnish Cancer Registry for incidence of malignancies during the years 1996–2013. The cancer cases diagnosed were compared with the number of cancers in the general population. The number of malignancies in our cohort was 1,052 vs. 368 expected. There was statistically significant excess of cancers of the liver, (standardized incidence ratio [SIR] 59.20; 95% CI 53.11–65.61), pancreas (SIR 3.71; 95% CI 2.72–4.94), pharynx (SIR 9.25; 95% CI 6.05–13.56), mouth (SIR 8.31; 95% CI 4.84–13,29), oesophagus (SIR 7.92; 95% CI 5.49–11.07), tongue (SIR 7,21; 95% CI 3.60–12.89), larynx (SIR 5.20; 95% CI 2.77–8.89), lung (SIR 2.77; 95% CI 2.27–3.32), stomach (SIR 2.76; 95% CI 1.79–4.07), kidney (SIR 2.69; 95% CI 1.84–3.79) and colon (SIR 2.33; 95% CI 1.70–3.11). There was no decreased risk of any cancer among ALD patients. Severe ALD is associated with markedly increased risk of malignancies. The risk is especially high for hepatocellular carcinoma, but also significantly increased for cancers of the upper aerodigestive tract, pancreas and kidneys, and warrants cancer surveillance in selected cases.