Second Cancers
With the increased survival of cancer patients, more than 10 percent of all invasive cancers are second or later primary cancers, making this an important area of concern for patients and their physicians. The large numbers of cancers available from the SEER population-based tumor registries and the long 30-year followup period provide an ideal resource with unique opportunities to study second cancers and add to our understanding of the causes of human cancer. One important area of research has been the late complications of cancer therapy, including second cancers induced by radiotherapy or chemotherapeutic and hormonal agents. In addition, investigators have used SEER data to explore hypotheses on the environmental, genetic, and other causes of increased second cancer risk. Highlights include the following:
- Young women treated with radiotherapy for Hodgkin’s disease (HD) experienced a threefold increased risk of breast cancer, which rose with higher radiation doses to the breast. HD patients treated with radiotherapy had a sixfold risk of lung cancer, with risk related to dose of radiation received.
- Breast cancer patients initially treated with tamoxifen have a twofold increased risk of uterine corpus cancer, with particularly high risks seen for rare tumors of the mixed mullerian type.
- Platinum-based chemotherapy for ovarian cancer increased the risk of leukemia three- to fourfold, and risk rose with increasing cumulative doses to reach eightfold.
- Men with testicular cancer continue to be at significantly increased risk of second malignancies for more than 20 years after treatment.
- Women who received pelvic radiotherapy for cervical cancer were found to have a twofold risk of new cancers in organs that were heavily irradiated.
An NCI Monograph is being prepared to describe the risk of developing a second cancer among nearly 2 million cancer patients reported to SEER.
Selected References
Kleinerman RA, Boice JD Jr, Storm HH, Sparen P, Andersen A, Pukkala E, Lynch CF, Hankey BF, Flannery JT. Second primary cancer after treatment for cervical cancer. An international cancer registries study. Cancer 1995;76:442-452.
Travis LB, Curtis RE, Storm H, Hall P, Holowaty E, Van Leeuwen FE, Kohler BA, Pukkala E, Lynch CF, Andersson M, Bergfeldt K, Clarke EA, Wiklund T, Stoter G, Gospodarowicz M, Sturgeon J, Fraumeni JF Jr, Boice JD Jr. Risk of second malignant neoplasms among long-term survivors of testicular cancer. J Natl Cancer Inst 1997;89:1429-1439.
Travis LB, Holowaty EJ, Bergfeldt K, Lynch CF, Kohler BA, Wiklund T, Curtis RE, Hall P, Andersson M, Pukkala E, Sturgeon J, Stovall M. Risk of leukemia after platinum-based chemotherapy for ovarian cancer. N Engl J Med 1999; 340:351-357.
Travis LB, Gospodarowicz M, Curtis RE, Clarke EA, Andersson M, Glimelius B, Joensuu T, Lynch CF, van Leeuwen FE, Holowaty E, Storm H, Glimelius I, Pukkala E, Stovall M, Fraumeni JF Jr, Boice JD Jr, Gilbert E. Lung cancer following chemotherapy and radiotherapy for Hodgkin’s disease. J Natl Cancer Inst 2002;94:182-192.
Travis LB, Hill DA, Dores GM, Gospodarowicz M, van Leewen FE, Holowaty E, Glimelius B, Andersson M, Wiklund T, Lynch CF, Van’t Veer MB, Glimelius I, Storm H, Pukkala E, Stovall M, Curtis R, Boice JD Jr, Gilbert E. Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin’s disease. JAMA 2003; 290:465-475.
Curtis RE, Freedman M, Sherman M, Fraumeni JF Jr. Uterine corpus cancer following tamoxifen therapy for breast cancer: difference in risk by histologic subtype. J Natl Cancer Inst 2003 (In Press).
