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Risk of Second Primary Cancer among Esophageal Cancer Patients: a Pooled Analysis of 13 Cancer Registries

¹ IARC, Lyon, France; ² Department of Epidemiology, UCLA School of Public Health, Los Angeles, California; ³ Scottish Cancer Registry, Information Services, NHS National Services Scotland, Edinburgh, Scotland, United Kingdom; ⁴ Finnish Cancer Registry, Institute for Statistical and Epidemiology Cancer Research, Helsinki, Finland; ⁵ Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; ⁶ New South Wales Cancer Registry, Eveleigh, New South Wales, Australia; ⁷ The Cancer Registry of Norway, Oslo, Norway; ⁸ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; ⁹ Samfundet Folkhalsan, Department of Genetic Epidemiology, Helsinki, Finland; ¹⁰ Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; ¹¹ Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden; ¹² British Columbia Cancer Agency, Vancouver, British Columbia, Canada; ¹³ Center for Molecular Epidemiology and ¹⁴ Singapore Cancer Registry, Singapore; ¹⁵ Cancer Registry of Slovenia, Institute of Oncology, Ljubljana, Slovenia; ¹⁶ Epidemiology and Cancer Registry, CancerCare Manitoba, ¹⁷ Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; ¹⁸ Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada; ¹⁹ Cancer Registry of Zaragoza, Health Department of Aragon Government, Saragossa, Spain; ²⁰ Icelandic Cancer Registry, Icelandic Cancer Society and ²¹ Faculty of Medicine, University of Iceland, Reykjavik, Iceland

Requests for reprints: Mia Hashibe, IARC, 150 Cours Albert Thomas, 69008 Lyon, France. Fax: 33-47273-8320. E-mail: hashibe{at}iarc.fr

Background: The objective of this study is to assess the risk of second primary cancers following a first primary esophageal cancer as well as the risk of esophageal cancer as a second primary, following first primary cancers of other sites.

Methods: The present investigation is a multicenter study of 13 population-based cancer registries in Europe, Australia, Canada, and Singapore. To assess excess occurrence of second cancers after esophageal cancers, we calculated standardized incidence ratios (SIR) by dividing the observed numbers of second cancers by the expected number of cancers calculated from the accumulated person-years and the age-, sex-, calendar period-, and registry-specific first primary cancer incidence rates.

Results: During the study period, 959 cases of second primary cancers occurred after an initial esophageal cancer, resulting in a SIR of 1.15 (95% confidence interval, 1.08-1.22). Second primary stomach cancers were associated with first primary esophageal adenocarcinomas (SIR, 2.13; 95% confidence interval, 1.26-3.37) and second primary cancers of the oral cavity and pharynx (6.68; 5.33-8.26), stomach (1.53; 1.14-2.01), larynx (3.24; 1.88-5.18), lung (1.55; 1.28-1.87), kidney (1.88; 1.18-2.85), and thyroid (2.92; 1.18-6.02) were associated with first primary squamous cell carcinomas of the esophagus. An excess of esophageal cancer as a second primary were observed following first primary cancers of the aerodigestive tract, female breast, cervix, testis, bladder, Hodgkin's lymphoma, and non–Hodgkin lymphoma.

Conclusion: We observed associations of esophageal cancer with second primary head and neck cancers and lung cancer regardless of years of follow-up, which may suggest that common risk factors play a role in multiple tumor development. (Cancer Epidemiol Biomarkers Prev 2008;17(6):1543–9)