Risk of second primary cancer among patients with early operable breast cancer registered or randomised in Danish Breast Cancer cooperative Group (DBCG) protocols of the 77, 82 and 89 programmes during 1977-2001

Breast cancer survivors have increased risks of developing second primary cancers due to shared etiology, life style factors but also to primary breast cancer treatment. Among 53 418 patients registered by the population based Danish Breast Cancer Cooperative Group (DBCG) during 1977-2001, 31 818 patients were treated and followed according to guidelines of DBCG. In addition to surgery 23% received tamoxifen, 23% chemotherapy and 35% radiotherapy as treatment for primary breast cancer. Second primary cancers were identified by linkage to the population based Danish Cancer Register. Cancer incidence rates of the Danish population were used for calculation of standardized incidence ratios (SIRs). Time at risk was from diagnosis of breast cancer+1 year until death or through 2002. Risk for all second primary cancers combined was increased, SIR=1.04 (95% confidence interval 0.99-1.08). Sites with significantly elevated risks included corpus uteri (SIR=1.23), ovary (1.39), soft tissues (2.24), acute leukaemia (2.02), and sites potentially inducible by breast cancer radiotherapy combined (1.11). For irradiated patients compared to non-irradiated the risk was increased for all sited combined, radiotherapy-related sites, colon and soft tissues. Tamoxifen treated had, compared to non-treated, elevated risk for cancer of corpus uteri (SIR=1.83 vs 1.04). Patients given adjuvant chemotherapy had, compared to those not, elevated risks for all sites combined (SIR=1.24 vs 1.01) and for ovary (2.16 vs 1.24). Risk for cancer of the lung, uterus and ovary was analysed using multivariate Poisson regression. For lung cancer the risk was related to radiotherapy and time since diagnosis, the relative risk for lung cancer being 1.33 (95% CI 1.00-1.77) (irradiated vs non-irradiated). Ovary cancer risk was inversely related to age at diagnosis but not to treatment and corpus uteri cancer risk related to tamoxifen treatment, relative risk 1.57. The findings are in accordance to other population based studies.     

Second primary cancers in breast cancer patients in Slovenia

Data from the Cancer Registry of Slovenia were used in a cohort studyto determine whether the incidence of second primary cancers in patients withfirst primary breast cancer differs from the incidence expected in thegeneral population. Special interest was given to long-term survivors. Theexpected numbers of second primary cancers were calculated by multiplying thenumber of appropriate person-years at risk by the corresponding age-andcalendar-period-specific cancer incidence rates for women in Slovenia. Therisk of a second primary cancer was expressed as the standardized incidenceratio (SIR). Of the 8,917 patients newly diagnosed in the period 1961-85 andfollowed-up to the end of 1994, 547 (6.2 percent) developed second primarycancers, whereas 410 (4.7 percent) were expected (SIR = 1.3, 95 percentconfidence interval [CI] = 1.2-1.4). The risk was higher among youngerpatients. In long-term survivors, the risk was increased significantly forsecond primary cancer of th e breast (SIR = 1.4, CI = 1.1-1.7), lung cancer(SIR = 1.6, CI = 1.1-2.3), melanoma (SIR = 2.7, CI = 1.5-4.4) andnon-melanoma skin cancers (SIR = 2.0, CI = 1.6-2.4), corpus uteri cancer (SIR= 1.6, CI = 1.2-2.1), ovarian cancer (SIR = 2.3, CI = 1.7-3.0), and thyroidcancer (SIR = 2.5, CI = 1.2-4.6). Our results confirm the findings of severalcohort studies carried out in Europe, the United States, and Japan,indicating that breast cancer patients should be monitored carefully for theoccurrence of second primary cancers.     

Second primary ovarian cancer among women diagnosed previously with cancer.

This study assessed the risk of second primary ovarian cancer among United States women diagnosed previously with invasive cancer. We analyzed data from cancer registries participating in the Surveillance, Epidemiology, and End Results program for women diagnosed with invasive cancer between 1973 and 1996. We calculated the risk [observed (O)/expected numbers (E)] of second primary ovarian cancer by cancer site and age at diagnosis of first primary cancer (<50 years and > or =50 years), race (all, white, and black), and years since first cancer (0-4, 5-9, 10-14, and 15-24 years). Statistical tests and 95% confidence intervals (CI) assumed a Poisson distribution. A significantly increased risk of ovarian cancer was found for women who were aged <50 years at diagnosis with melanoma (O/E = 3.5, 95% CI = 2.1-5.5) or cancer of the breast (O/E = 6.0, 95% CI = 4.9-7.2), cervix (O/E = 4.2, 95% CI = 2.6-6.3), corpus uteri (O/E = 11.9, 95% CI = 7.3-18.4), colon (O/E = 17.9, 95% CI = 11.1-27.3), or ovary (O/E = 4.9, 95% CI = 2.7-8.2). No increased risk was found for women aged > or =50 years. Ovarian cancer risk remained elevated after these first primary cancers 5-9 years after diagnosis; for breast and colon cancer, risk remained elevated 15-24 years after diagnosis. Women > or =50 years at diagnosis with melanoma or cancer of the cervix, corpus uteri, ovary, rectum, or lung and bronchus were at a decreased risk for second primary ovarian cancer. Ovarian cancer risk is higher than expected for women who were diagnosed with certain types of cancer at <50 years of age.     

Estrogen receptor positive tumors: Do reproductive factors explain differences in incidence between black and white women?

Purpose

The incidence of estrogen receptor positive (ER+) breast cancer is higher among white women relative to black women. In two large prospective cohorts, the Black Women’s Health Study (BWHS) and the Nurses’ Health Study II (NHSII), we investigated whether reproductive factors explain the difference.

Methods

During 1,582,083 person-years of follow-up of 140,914 women observed from 1995 to 2007, 327 ER+ breast cancers were identified among black women in BWHS and NHSII and 1,179 among white women in NHSII. Cox proportional hazards regression models, stratified by race and pooled, were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for the association of race, parity, age at first birth, and lactation in relation to risk of ER+ cancer with adjustment for age and other breast cancer risk factors.

Results

Age at first birth differed markedly in the two groups, with 66 % of parous black women having their first child before age 25 as compared with 36 % of white women. Each additional year of age at first birth was associated with a 4 % increased risk of ER+ breast cancer among both racial groups. Relative to nulliparous women, parous women were at decreased risk of ER+ breast cancer (HR 0.59, 95 % CI 0.20, 1.77), in black women and (HR 0.63, 95 % CI 0.45, 0.87) in white women. The HR for the association of black race with ER+ cancer was 0.67 (95 % CI 0.53, 0.84) in a model that adjusted for age only, 0.77 (95 % CI 0.61, 0.99) in a model that controlled for parity, age at first birth, and other reproductive/hormonal factors, and 0.83 (95 % CI 0.70, 0.98) in a model that additionally controlled for other breast cancer risk factors such as alcohol consumption and use of hormone supplements. Similar associations were seen among premenopausal women and in an analysis restricted to ER+PR+ tumors.

Conclusions

Reproductive factors explained some of the higher incidence of ER+ tumors among white women as compared to black women.     

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.     

The risk of a second primary lung cancer after a first invasive breast cancer according to estrogen receptor status

Purpose

Lung cancers account for 5?% of second primary cancers after breast cancer. The low overall 5-year relative survival rate of lung cancer makes it a particularly concerning new malignancy for breast cancer survivors. It is unknown whether second lung cancer risk varies by estrogen receptor (ER) expression of the first breast cancer.

Methods

We evaluated second primary lung cancer risks using standardized incidence ratios (SIRs) (95?% confidence intervals (CIs)) among 222,148 one-year breast cancer survivors in the NCI-SEER Program registry database (1992–2008). Relative risks (RRs) and 95?% CIs for lung cancer following ER^? compared with ER⁺ breast cancer were estimated using Poisson regression, adjusted for age, year, and stage of breast cancer diagnosis, attained age, latency, and radiotherapy. We also examined the reciprocal association of second ER^? and ER⁺ breast cancers among 28,107 1-year lung cancer survivors.

Results

There were 418 and 1,444 second lung cancers diagnosed following 50,781 ER^? and 171,367 ER⁺ breast cancers. Second lung cancer rates were significantly elevated after ER^? (SIR?=?1.20 (1.09–1.33)), but not ER⁺ (SIR?=?0.96 (0.91–1.01)) breast cancer. The adjusted RR for a second lung cancer following ER^? compared with ER⁺ breast cancer was 1.22 (1.10–1.37). The reciprocal adjusted RR for a second ER^? compared with ER⁺ breast cancer following lung cancer was 1.29 (0.98–1.70).

Conclusion

The parallel increase for a second lung cancer following an ER^? first breast cancer and for a second ER^? breast cancer after a first lung cancer suggests that there may be shared etiologic factors for these cancers. Further evaluation of lung cancer risk after ER^? breast cancer may identify women at high risk for this fatal malignancy.     

Racial/ethnic differences in breast cancer survival by inflammatory status and hormonal receptor status: an analysis of the Surveillance,Epidemiology, and End Results data

Background

Compared to non-inflammatory breast cancer (non-IBC), inflammatory breast cancer (IBC) has less favorable survival and is more likely to be estrogen receptor (ER) and progesterone receptor (PR) negative. ER?/PR? tumors, regardless of histology, have less favorable survival. While black women are more likely to have IBC and ER?/PR? tumors than white women, it is unclear whether the racial disparity in survival is explained by these factors. The objective of this study was to assess racial/ethnic differences in breast cancer survival by inflammatory status and hormone receptor status.

Methods

This study examined breast cancer mortality among non-Hispanic white (NHW), Hispanic white, black, and Asian/Pacific Islander (API) women diagnosed between 1990 and 2004 using the National Cancer Institute’s Surveillance, Epidemiology, and End Results data. Kaplan–Meier survival curves and Cox proportional hazard ratios (HRs) assessed the relationship between race/ethnicity and survival.

Results

Black women had significantly poorer survival than NHW women regardless of inflammatory status and hormone receptor status. Compared to NHWs, the HRs for black women were 1.32 (95 % confidence interval (CI) 1.21–1.44), 1.43 (95 % CI 1.20–1.69), and 1.30 (95 % CI 1.16–1.47) for IBC, IBC with ER+/PR+, and with ER?/PR?, respectively. Similar HRs were found for non-IBC, non-IBC with ER+/PR?, and non-IBC with ER?/PR?. API women had significantly better survival than NHW women regardless of inflammatory status and hormone receptor status.

Conclusion

Compared to NHW women, black women had poorer survival regardless of inflammatory status and hormone receptor status and API women had better survival. These results suggest that factors other than inflammatory status and hormone receptor status may play a role in racial/ethnic disparities in breast cancer survival.     

Second malignancies among survivors of germ-cell testicular cancer: a pooled analysis between 13 cancer registries

We investigated the risk of second malignancies among 29,511 survivors of germ-cell testicular cancer recorded in 13 cancer registries. Standardized incidence ratios (SIRs) were estimated comparing the observed numbers of second malignancies with the expected numbers obtained from sex-, age-, period- and population-specific incidence rates. Seminomas and nonseminomas, the 2 main histological groups of testicular cancer, were analyzed separately. During a median follow-up period of 8.3 years (0-35 years), we observed 1,811 second tumors, with a corresponding SIR of 1.65 (95% confidence interval (CI): 1.57-1.73). Statistically significant increased risks were found for fifteen cancer types, including SIRs of 2.0 or higher for cancers of the stomach, gallbladder and bile ducts, pancreas, bladder, kidney, thyroid, and for soft-tissue sarcoma, nonmelanoma skin cancer and myeloid leukemia. The SIR for myeloid leukemia was 2.39 (95% CI: 1.41-3.77) after seminomas, and 6.77 (95% CI: 4.14-10.5) after nonseminomas. It increased to 37.9 (95% CI: 18.9-67.8; based on 11 observed cases of leukemia) among nonseminoma patients diagnosed since 1990. SIRs for most solid cancers increased with follow-up duration, whereas they did not change with year of testicular cancer diagnosis. Among subjects diagnosed before 1980, 20 year survivors of seminoma had a cumulative risk of solid cancer of 9.6% (95% CI: 8.7-10.5%) vs. 6.5% expected, whereas 20 years survivors of nonseminoma had a risk of 5.0% (95% CI: 4.2-6.0%) vs. 3.1% expected. In conclusion, survivors of testicular cancers have an increased risk of several second primaries, where the effect of the treatment seems to play a major role.     

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).

     

Angiosarcoma after radiotherapy: a cohort study of 332,163 Finnish cancer patients

We evaluated the risk of angiosarcoma after radiotherapy among all patients with cancers of breast, cervix uteri, corpus uteri, lung, ovary, prostate, or rectum, and lymphoma diagnosed in Finland during 1953-2003, identified from the Finnish Cancer Registry. Only angiosarcomas of the trunk were considered, this being the target of radiotherapy for the first cancer. In the follow-up of 1.8 million person-years at risk, 19 angiosarcomas developed, all after breast and gynaecological cancer. Excess of angiosarcomas over national incidence rates were observed after radiotherapy without chemotherapy (standardised incidence ratio (SIR) 6.0, 95% confidence interval (CI) 2.7-11), after both radiotherapy and chemotherapy (SIR 100, 95% CI 12-360), and after other treatments (SIR 3.6, 95% CI 1.6-7.1). In the regression analysis however, the adjusted rate ratio for radiotherapy was 1.0 (95% CI 0.23-4.4). Although an increased risk of angiosarcoma among cancer patients is evident, especially with breast and gynaecological cancer, the excess does not appear to be strongly related to radiotherapy.     

Alcohol Consumption and Cancers of Hormone-related Organs in Females

The relations between alcohol consumption and cancers of thebreast, corpus uteri and ovary were investigated in a case-controlstudy involving 1,740 cases of breast cancer, 239 cases of cancerof the corpus uteri, 417 cases of ovarian cancer and 8,920 controlswith other cancer sites identified from the Aichi Cancer Registry,Japan 1980–1986. The age-adjusted relative risk (RR) ofdaily alcohol drinkers compared to non-drinkers was significantlyincreased for breast cancer (RR= 1.36, 95% cofidence interval(Cl) 1.04–1.78), that for cancer of the corpus uteri waslowered insignificantly (RR=0.44, 95% Cl 0.15–1.38) andthat for ovarian cancer was sig nificantly lowered (RR=0.38,95% CI 0.16–0.90). The increase in the risk of breastcancer associated with daily alcohol drinking was evident inthe age range 50 and over, the risk specified by type of alcoholicbeverage being highest for beer. Multivariate analyses controlledfor age, residence, marital status, occupation, smoking habitand family history of breast cancer did not materially changethe RRs of daily alcohol drinkers. Despite the several limitationsof the study, the results were consistent with those of previousstudies from other countries, suggesting that alcohol consumptionmay contribute to the risk of breast cancer in Japanese woman,as it dose elsewhere. The present study also suggested alcoholconsumption not to be associated with elevated risks of cancerin other hormone-related organs in females, and possibly tobe associated with a decreased risk of ovarian cancer.     

Increased Risk of Second Primary Malignancies in Patients with Gynecological Cancer: A Swedish record-linkage study

The Stockholm-Gotland Cancer Register was used to study the risk of developing second primary malignancies (SPM) in women diagnosed with cancer of the uterine cervix, uterine corpus and ovaries during the period 1958-1992. Among 5 325 patients with uterine cervix cancer, 619 developed SPM. Standardized incidence ratio (SIR) was 1.29 (95% confidence interval (CI) 1.19-1.39). Significantly increased risks were observed for cancer of the colon, rectum, lung, vulva, kidney and bladder. A total of 4 815 women with uterine corpus cancer were followed and 660 SPM were found. The overall SIR was 1.21 (95% CI 1.12-1.30) with significantly increased risk for cancer of the colon, ovary, vulva and bladder. The incidence of leukemia was also significantly elevated (SIR = 3.03; 95% CI 1.70-5.00). Among 5060 patients with ovarian cancer, 379 SPM were found (SIR 1.49; 95% CI 1.34-1.64). Increased risks of cancer of the colon, rectum, breast, uterine corpus, bladder and leukemia were observed. All three primary sites showed elevated risks of cancer of the colon and bladder. For patients with a primary cancer of the corpus and ovary an elevated risk of leukemia was also noted. The conclusion from these findings is that SPM to some extent can be explained by previously known factors, i.e. treatment and common risk factors. However, further studies concerning the role of common etiology, for instance hereditary and hormonal factors, are needed to increase the knowledge on the etiology of second primary malignancies.     

Estrogen receptor, progesterone receptor, and HER2-neu expression in first primary breast cancers and risk of second primary contralateral breast cancer

Breast cancer survivors have a 60?% higher risk of developing a second primary asynchronous contralateral breast cancer (CBC) compared to women's risk of developing a first primary breast cancer (FBC). However, little is known about how expression of tumor markers in first breast cancers influences CBC risk. We conducted a population-based nested case-control study among women 20-74?years of age diagnosed with a first breast cancer between 1996 and 2008 in western Washington State to evaluate the association between their tumor's estrogen receptor (ER), progesterone receptor (PR) and HER2-neu (HER2) expression, and risk of CBC. The study included 482 cases diagnosed with both a FBC and a CBC and 1,506 control women diagnosed only once with breast cancer identified through our local Surveillance, Epidemiology and End Results (SEER) cancer registry. Compared to the women whose FBC was ER+/PR+, those with ER-/PR- first tumors had a 1.6-fold (95?% confidence interval (CI): 1.2-2.3) increased risk of developing a CBC. When evaluated by joint ER/PR/HER2 status, compared to women with ER+/HER2- first cancers, those with HER2-overexpressing (ER-/HER2+) and triple-negative disease (ER-/PR-/HER2-) had 2.0-fold (95?% CI: 1.1-3.8) and 1.4-fold (95?% CI: 0.9-2.3) elevated risks of developing CBC, respectively. Beyond the known higher risks of mortality among patients diagnosed with more aggressive BC subtypes, here, we observe that they may also have increased risks of developing CBC.     

Second primary cancer among 217702 colorectal cancer survivors: An analysis of national German cancer registry data

With improvements in survival after colorectal cancer (CRC), more survivors are at risk of developing a second cancer, particularly in younger populations where CRC incidence is increasing. We estimated the incidence of second primary cancer (SPC) in CRC survivors and its potential risk factors. We identified CRC cases diagnosed between 1990 and 2011 and SPCs until 2013 from nine German cancer registries. Standardized incidence ratios (SIR) and absolute excess risk (AER) per 10 000 person-years were calculated and were stratified by index site: colon cancer (CC) and rectal cancer (RC), age and sex. Cox regression assessed potential SPC risk factors, including primary tumor-related therapy considering death as a competing risk. We included 217 202 primary CRC cases. SPC occurred in 18 751 CRC survivors (8.6%; median age: 69 years). Risk of cancer was significantly higher in CRC survivors than in the general population (SIR males 1.14, 95% confidence interval [CI] 1.12-1.17, AER = 24.7; SIR females 1.20, 95% CI 1.17-1.23, AER = 22.8). Increased risks of SPCs were observed for the digestive system, urinary system and female and male reproductive organs. CRC incidence increased in younger persons (<50 years) and SPC incidence was 4-fold in this group (SIR males 4.51, 95% CI 4.04-5.01, AER = 64.2; SIR females 4.03, 95% CI 3.62-4.48, AER = 77.0). Primary tumor-related factors associated with SPC risk were right-sided cancer and smaller primary tumor size. Treatment and risk of SPC differed for CC (no effect) and RC (lower risk after chemotherapy). CRC survivors have excess risk of developing SPC, with particular characteristics that could guide targeted surveillance.     

Weight and weight changes in early adulthood and later breast cancer risk

Obesity is a well‐established cause of postmenopausal breast cancer. However, early life adiposity is inversely associated with breast cancer incidence. To understand these conflicting relations, we use validated measures to assess adiposity in childhood and late adolescence, as well as weight change, in relation to total invasive breast cancer incidence and receptor subtypes. We conducted a prospective observational study among 74,177 women from the Nurses’ Health Study from 1980–2012, with updated risk factors every 2 years during which 4,965 incident invasive breast cancers occurred. Overall, weight at age 18 was inversely associated with both premenopausal (HR per 30 kg = 0.52, 95% CI = 0.39–0.71) and postmenopausal (HR per 30 kg = 0.81, 95% CI = 0.72–0.92) breast cancer which was largely explained by adiposity at age 10. Long‐term weight gain from age 18 both during premenopause and postmenopause were positively associated with postmenopausal breast cancer risk. However, premenopausal weight gain was not related to premenopausal breast cancer risk. Furthermore, weight gain since age 18 was positively associated with ER+/PR+ postmenopausal breast cancer (HR per 30 kg = 1.50, 95% CI = 1.36–1.65) but not ER+/PR? (HR per 30 kg = 0.96, 95% CI = 0.78–1.19) or ER?/PR? (HR per 30 kg = 1.16, 95% CI = 0.95–1.42) postmenopausal breast cancer. Overall, 17% of ER+/PR+ postmenopausal breast cancer and 14% of total postmenopausal breast cancer are attributable to weight gain of > 5 kg since age 18.     

Incidence of bone and soft tissue sarcoma after radiotherapy: a cohort study of 295,712 Finnish cancer patients

Radiotherapy is commonly used for treatment of malignant disease. As a consequence of radiotherapy, an increased risk of developing a second malignant neoplasm has been shown. However, little is known about the effects of radiation on developing sarcoma. The aim of this study was to examine the risk of developing a bone or soft tissue sarcoma after radiotherapy for a first primary cancer. The study population included all the patients with primary cancers of breast, cervix uteri, corpus uteri, lung, ovary, prostate, rectum and lymphoma diagnosed during 1953-2000 and identified from the Finnish Cancer Registry. Patients were followed up for subsequent sarcomas. The follow-up yielded 1.5 million person-years at risk and 147 sarcomas. Compared to the national incidence rates, after 10 years of follow-up sarcoma risk was increased among patients who had received neither radiotherapy nor chemotherapy (standardised incidence ratio (SIR) 2.0, 95% CI 1.3-3.0), radiotherapy without chemotherapy (SIR 3.2, 95% CI 2.3-4.3), chemotherapy without radiotherapy (SIR 4.9, 95% CI 1.0-14.4), as well as combined radiotherapy and chemotherapy (SIR 3.4, 95% CI 0.4-12.5). For radiotherapy in ages below 55 the SIR was 4.2 (95% CI 2.9-5.8). In the adjusted regression analysis the rate ratio was 1.5 (95% CI 0.9-2.6) for the radiotherapy group. In conclusion, radiotherapy appears to be associated with an increased risk of developing sarcoma especially among younger patients. Further investigation is needed to clarify the dose-response of the preceding ionizing radiation.     

Chronic disease burden among cancer survivors in the California Behavioral Risk Factor Surveillance System, 2009–2010

Purpose

The California Behavioral Risk Factor Surveillance System estimates that 56.6 % of cancer survivors report ever being diagnosed with a chronic disease. Few studies have assessed potential variability in comorbidity by cancer type.

Methods

We used data collected from a representative sample of adult participants in the 2009 and 2010 California Behavioral Risk Factor Surveillance System (n?=?18,807). Chronic diseases were examined with cancer survivorship in case/non-case and case/case analyses. Prevalence ratios (PR) and corresponding 95 % confidence intervals (95 % CI) were estimated using Cox proportional hazards models, with adjustment on race, sex, age, education, smoking, and drinking.

Results

Obesity was associated with gynecological cancers (PR 1.74; 95 % CI 1.26–2.41), and being overweight was associated with gynecological (PR 1.40; 95 % CI 1.05–1.86) and urinary (PR 2.19; 95 % CI 1.21–3.95) cancers. Arthritis was associated with infection-related (PR 1.78; 95 % CI 1.12–2.83) and hormone-related (PR 1.20; 95 % CI 1.01–1.42) cancers. Asthma was associated with infection- (PR 2.26; 95 % CI 1.49–3.43), hormone- (PR 1.46; 95 % CI 1.21–1.77), and tobacco- (PR 1.86; 95 % CI 1.25–2.77) related cancers. Chronic obstructive pulmonary disease (COPD) was associated with infection- (PR 2.16; 95 % CI 1.22–3.83) and tobacco-related (PR 2.24; 95 % CI 1.37–3.66) cancers and with gynecological cancers (PR 1.60; 95 % 1.00–2.56).

Conclusions

This is the first study to examine chronic disease burden among cancer survivors in California. Our findings suggest that the chronic disease burden varies by cancer etiology.

Implications for Cancer Survivors

A clear need has emerged for future biological and epidemiological studies of the interaction between chronic disease and cancer etiology in survivors.     

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.     

Risks of second primary breast and urogenital cancer following female breast cancer in the south of The Netherlands, 1972-2001

A cohort of 9919 breast cancer patients from the population-based Eindhoven Cancer Registry was followed for vital status and development of second cancer. Person-year analysis was applied to determine the risk of second primary breast or urogenital cancer among breast cancer patients and to assess its correlation with age, treatment and time since the first breast cancer diagnosis. Women with previous breast cancer have an elevated risk of overall second breast or urogenital cancer. The largest relative risk was observed for second breast cancer (SIR (standardised incidence ratio) 3.5; 95% confidence interval (CI) 3.2-3.8) and second ovarian cancer (SIR 1.7; 95% CI 1.2-2.3). The absolute excess risk was highest for second breast cancer (64/10,000 patients/year). However, breast cancer has an inverse relationship to risk of cervical cancer. Changes in behavioural risk factors are important for lowering the risk of second cancer after breast cancer.     

Risk of second non-hematological malignancies among 376,825 breast cancer survivors

Breast cancer survivors are at increased risk of treatment-related second cancers. This study is the first to examine risk 30 or more years after diagnosis and to present absolute risks of second cancer which accounts for competing mortality. We identified 23,158 second non-hematological malignancies excluding breast in a population-based cohort of 376,825 one-year survivors of breast cancer diagnosed from 1943 to 2002 and reported to four Scandinavian cancer registries. We calculated standardized incidence ratios (SIR) and utilized a competing-risk model to calculate absolute risk of developing second cancers. The overall SIR for second cancers was 1.15 (95% confidence interval [CI] = 1.14–1.17). The SIR for potentially radiotherapy-associated cancers 30 or more years after breast cancer diagnosis was 2.19 (95% CI = 1.87–2.55). However, the largest SIRs were observed for women aged <40 years followed for 1–9 years. At 20 years after breast cancer diagnosis, the absolute risk of developing a second cancer ranged from 0.6 to 10.3%, depending on stage and age; the difference in the absolute risk compared to the background population was greatest for women aged <40 years with localized disease, 2.3%. At 30 years post breast cancer diagnosis, this difference reached 3.2%. These risks were small compared to the corresponding risk of dying from breast cancer. Although the absolute risks were small, we found persistent risks of second non-hematological malignancies excluding breast 30 or more years after breast cancer diagnosis, particularly for women diagnosed at young ages with localized disease.