Researchers from NCI's Division of Cancer Epidemiology and Genetics (DCEG) and Division of Cancer Control and Population Sciences (DCCPS) recently published a monograph, New Malignancies Among Cancer Survivors: SEER Cancer Registries, 1973-2000. The monograph is the first publication to provide a comprehensive analysis of the risk for U.S. cancer survivors of developing a new malignancy.

"This is by far the largest study to date to assess risk of subsequent cancers. It includes more than 2 million cancer survivors during a nearly 30-year period and more than 185,000 subsequent primary cancers," said lead editor Rochelle Curtis of DCEG's Radiation Epidemiology Branch. "Other studies have evaluated risk of subsequent cancers for individual cancer types or groups of cancers, usually related to the late effects of treatment, but this report provides the first complete evaluation of subsequent cancer risk in the U.S. for most first primary cancer sites."

The report used data from nine cancer registries participating in the Surveillance, Epidemiology, and End Results (SEER) Program from 1973 to 2000.

"This report adds a new dimension to cancer surveillance in that it pinpoints which cancers are more likely to be followed by another primary. This knowledge is possible because of the depth of information from almost 30 years of consistently reliable SEER data," noted co-editor Lynn Ries of DCCPS's Cancer Statistics Branch.

More than 50 adult and 18 childhood cancers were evaluated in the new report, which includes new data on less common cancer sites. More than 350 data tables present the risk of subsequent cancer by time since initial diagnosis, sex, age at initial diagnosis, and when appropriate, by treatment and cancer cell type. Each chapter compares the findings with other published studies and discusses the results in terms of potential risk factors and mechanisms.

Overall, the results showed that cancer survivors have a 14-percent increased risk of developing a subsequent cancer than would be expected in the general population. Many of the patterns of multiple cancers suggested an effect of shared risk factors (such as tobacco and alcohol consumption, nutritional factors, hormones, infections and immunosuppression, and genetic predisposition) or a carcinogenic effect of cancer therapies. Although a sizable portion of multiple cancers in the SEER database represented tumors that occurred in the same or neighboring organ systems, most of the subsequent cancers occurred in diverse organ sites.

One of the most striking findings was that tobacco smoking, excess alcohol intake, or the interaction of the two exposures appeared to account for more than 35 percent of the excess cancer risk observed in the survivor population.

"This effort represents an important collaboration between two NCI divisions," said Dr. Joseph F. Fraumeni, Jr., DCEG director and senior editor of the monograph. "It should provide a tremendous resource for clinicians, researchers, and other health professionals, and it should be useful in alerting cancer survivors to the importance of medical supervision for prevention and early detection of new malignancies."

The monograph may be viewed or ordered at http://seer.cancer.gov/publications/mpmono/.