Question ID: Feb 4-2
Submitted by: February 4, 2011 Behavioral, Population, Epidemiology, and Prevention Provocative Questions workshop - Submitted to the website
March 27, 2011
Why do second, independent cancers occur at high rates in patients who have survived a primary cancer?
Background: Second cancers are a major problem in cancer survivorship. Grouped as a single outcome in the SEER database, second cancers rank fourth in overall cancer incidence and are often associated with poor outcomes. However, researchers have not taken full advantage of this population to study risk factors and mechanisms. The influence of prior therapeutic interventions (including chemo- and radio-therapies) and somatic mutations in this population has been studied to some degree. However, the extent to which underlying genetic predispositions, environmental factors, and life-style behaviors influence risk remain relatively underexplored. It is likely that at least some of the identified risk factors and mechanisms would also be relevant to patients who have not yet had cancer.
Feasibility: It is substantially easier to follow patients who have had one cancer for the development of a second cancer than to observe healthy individuals for the development of a first cancer. These individuals are often followed prospectively for treatment response and complications as well as disease progression. Technologies that identify somatic alterations can be integrated with genome-wide annotation of germ-line DNA to investigate the relationship between genetic susceptibility in high-risk individuals and second cancers. With the advent of new, more efficient technologies, it is feasible to broaden these efforts to large-scale clinical trial studies. Efforts to capture clinical, epidemiological, and therapeutic data could also be centered on the development of large-scale cohorts of cancer survivors at risk for second cancers. Because of their heightened risk of cancer, this population of patients may be more motivated, and therefore well suited for prospective prevention studies of all types, such as chemoprevention or behavioral modifications. Increasing use of electronic medical records could facilitate such studies, including the identification of appropriate patients for particular studies.
Implications of success: Studying patients who have had primary cancers for the development of second cancer would help uncover pathogenic mechanisms of both cancers, including shared etiologic pathways and therapy-related risks. These insights are likely to inform new strategies for preventive interventions.
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