Risk of Second Primary Cancer among Esophageal Cancer Patients: a Pooled Analysis of 13 Cancer Registries
- Shu-Chun Chuang1,2,
- Mia Hashibe1,
- Ghislaine Scelo1,
- David H. Brewster3,
- Eero Pukkala4,
- Soren Friis5,
- Elizabeth Tracey6,
- Elisabete Weiderpass7,8,9,
- Kari Hemminki10,11,
- Sharon Tamaro12,
- Kee-Seng Chia13,14,
- Vera Pompe-Kirn15,
- Erich V. Kliewer16,17,
- Jon M. Tonita18,
- Carmen Martos19,
- Jon G. Jonasson20,21,
- Carolyn M. Dresler1,
- Paolo Boffetta1 and
- Paul Brennan1
- 1IARC, Lyon, France; 2Department of Epidemiology, UCLA School of Public Health, Los Angeles, California; 3Scottish Cancer Registry, Information Services, NHS National Services Scotland, Edinburgh, Scotland, United Kingdom; 4Finnish Cancer Registry, Institute for Statistical and Epidemiology Cancer Research, Helsinki, Finland; 5Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; 6New South Wales Cancer Registry, Eveleigh, New South Wales, Australia; 7The Cancer Registry of Norway, Oslo, Norway; 8Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 9Samfundet Folkhalsan, Department of Genetic Epidemiology, Helsinki, Finland; 10Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; 11Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden; 12British Columbia Cancer Agency, Vancouver, British Columbia, Canada; 13Center for Molecular Epidemiology and 14Singapore Cancer Registry, Singapore; 15Cancer Registry of Slovenia, Institute of Oncology, Ljubljana, Slovenia; 16Epidemiology and Cancer Registry, CancerCare Manitoba, 17Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; 18Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada; 19Cancer Registry of Zaragoza, Health Department of Aragon Government, Saragossa, Spain; 20Icelandic Cancer Registry, Icelandic Cancer Society and 21Faculty 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
Abstract
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)
Footnotes
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Grant support: National Cancer Institute, NIH grant R03 CA101442. G. Scelo and S-C. Chuang worked on this study during the tenure of a Special Training Award from the IARC.
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- Accepted April 8, 2008.
- Received December 7, 2007.
- Revision received April 2, 2008.
