In a new study published by Hyuna Sung, PhD, and colleagues in JAMA Network Open, non-Hispanic Black individuals diagnosed with a second primary cancer experienced 21% higher cancer-related death rates and 41% higher cardiovascular-related death rates compared with non-Hispanic White individuals; Hispanic individuals diagnosed with a second primary cancer also experienced 10% higher cancer-related death rates compared with non-Hispanic White individuals, but 10% lower cardiovascular-related death rates.
“These disparities were, in part, attributable to unfavorable stage distributions at second primary cancer diagnosis among Black and Hispanic populations, particularly for breast cancer, uterine cancer, and melanoma,” said Dr. Sung, Senior Principal Scientist of Cancer Surveillance Research at the American Cancer Society. “Complementing the currently expanding knowledge on second primary cancer risk and care, the findings highlight research priorities to address survival disparities among the growing population of multiple primary cancer survivors.”
Hyuna Sung, PhD
Study Details
Study authors examined a retrospective cohort from 18 Surveillance, Epidemiology, and End Results registries in the United States, including adults diagnosed with the most common second primary cancers, representing approximately 84% of all adult-onset second primary cancers.
The results showed among 230,370 persons with second primary cancers, 109,757 cancer deaths and 18,283 cardiovascular deaths occurred during a median follow-up of 54 months. When the results were stratified by 13 second primary cancer types, compared with White individuals, the risk of cancer death was higher for 10 second primary cancer types among Black individuals (with the greatest disparity seen for survivors of second uterine cancers) and for 7 second primary cancer types among Hispanic people (most notably for melanoma). The risk of cardiovascular death was higher among Black individuals with 11 second primary cancer types, but generally lower among Asian or Pacific Islander and Hispanic populations than White individuals. Including county attributes (household income and urbanicity) and clinical characteristics (stage at diagnosis, tumor subtypes, and treatment receipt) in the models reduced the racial and ethnic disparities substantially.
“Persons with multiple primary cancers may face unique challenges such as limited treatment options, multiple chronic morbidities, complexity in navigating health-care systems, and exacerbated financial hardship,” added Dr. Sung. “Issues of financial hardship may be particularly relevant to the observed racial and ethnic disparities in second primary cancer survival, as prior cancer-related disruptions and employment consequences are disproportionately experienced by racial and ethnic minority groups.”
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
