Improved patient outcomes have resulted in a growing population of cancer survivors. According to the American Cancer Society, the number is expected to increase to nearly $20 million by 2024.1
Are cancer survivors especially susceptible to developing second primary malignancies?
As a cancer survivor, this topic holds great interest. A study by Donin et al. describes the incidence, most common sites, and mortality of second primary malignancies among survivors of common cancers. The objective of the study was to understand the risk of developing and dying of a second primary malignancy for survivors of the most commonly diagnosed cancers.2
The patient cohort included patients diagnosed with a primary malignancy among the 10 cancer sites with the highest incidence in both sexes ( i.e., prostate, breast, lung, colon, rectum, bladder, uterus, kidney, melanoma and non-Hodgkin lymphoma).The study included patients diagnosed between 1992 and 2008 to ensure 3 years of follow-up after a cancer diagnosis.
Descriptive statistics were generated and evaluated the association between covariates of interest and the development of a secondary primary malignancy using chi-square and two-sided student t tests. The study included 2,116,163 patients with first incident cancer among whom 170,865 (8.1%) developed a second primary malignancy. The majority of patients (60%) who developed a second primary malignancy were over 65 years of age. In this large population-based study, there were four notable findings:
- One in 12 survivors of common cancers developed a second primary malignancy with lung cancer as the most commonly diagnosed.
- Greater than one-half (55%) died of their secondary malignancy.
- Patients with bladder cancer had the highest risk of being diagnosed with a second malignancy, with lung cancer being the most commonly diagnosed second primary malignancy.
- Among patients with two malignancies, a lung cancer diagnosis was the most lethal.
In a multivariable model controlling for age, race, tumor grade, stage of disease, marital status, educational level, and income, a history of non-Hodgkin lymphoma and bladder cancer predicted the highest risk of developing a second cancer.
What are the implications of this study? What factors can explain these findings (environmental such as tobacco smoke, prior treatment with chemotherapy and radiotherapy)? How can we utilize these research findings in our care and education of cancer survivors? Survivorship guidelines can emphasize the need for ongoing health monitoring for our cancer survivors utilizing recommended screening guidelines for high-risk individuals.
As a non-Hodgkin lymphoma survivor, I am concerned that I have the highest risk of developing a second primary cancer. While I have followed the suggested screening from my survivorship guidelines, I intend to have a further discussion with my oncologist. We can share these findings with our colleagues and explore interventions into effective detection and treatment strategies.
- American Cancer Society. Cancer Treatment & Survivorship Facts & Figures 2014-2015. 2014 Jan 1.
- Donin N, Filson C, Drakaki A, et al. Risk of second primary malignancies among cancer survivors in the United States, 1992 through 2008. Cancer., 2016 Jul 5.