A study published by Hyuna Sung, PhD, and colleagues in JAMA found that adult-onset cancer survivors may have a greater risk of developing and dying from subsequent primary cancers than the general population. Cancers associated with smoking or obesity accounted for a majority of subsequent primary malignancies and associated deaths among all survivors.
Hyuna Sung, PhD
“These findings highlight the importance of ongoing surveillance and efforts to prevent new cancers among survivors,” said lead study author Dr. Sung in a press release. “The number of cancer survivors who develop new cancers is projected to increase, but, until now, comprehensive data on the risk of subsequent primary cancers among survivors of adult-onset cancers has been limited.”
For the study, investigators analyzed data on nearly 1.54 million cancer survivors from 1992 to 2017 from 12 Surveillance, Epidemiology, and End Results registries in the United States. The survivors analyzed were between the ages of 20 to 84 (mean age = 60.4 years); 48.8% were women; and 81.5% were White.
Risk of Subsequent Primary Cancers
The findings suggest that among the 1,537,101 survivors, 156,442 were diagnosed with a subsequent primary cancer, and 88,818 died of a subsequent primary cancer. Results found that male survivors had an 11% higher risk of developing subsequent primary cancers and a 45% higher risk of dying from them compared with the risk in the general population. Female survivors had a 10% higher risk of developing subsequent primary cancers and a 33% higher risk of dying from them.
The investigators found men who survived laryngeal cancer and Hodgkin lymphoma ran the greatest risk of developing a subsequent primary cancer, while men who survived gallbladder cancer ran the greatest risk of dying from a subsequent primary cancer. Among women, survivors of laryngeal and esophageal cancers ran the greatest risk of developing a subsequent primary cancer, and laryngeal cancer survivors also ran the greatest risk of subsequent primary cancer mortality.
Substantial variation existed in the associations of specific types of first cancers with specific types of subsequent primary cancer risk. However, the study authors noted the prevalence of smoking- and obesity-related cancers in subsequent primary cancer incidence and mortality.
Results showed the risks of smoking-related subsequent primary cancers were commonly elevated among survivors of smoking-related first cancers. Among survivors of all cancers, four common smoking-related subsequent primary cancers—including lung cancer, bladder cancer, oral cavity/pharyngeal cancer, and esophageal cancer—accounted for 26% to 45% of the total subsequent primary cancer incidence and mortality. Furthermore, lung cancer alone comprised 31% to 33% of the total mortality from subsequent primary cancers.
Similarly, survivors of many obesity-related cancers had an elevated risk of developing obesity-related subsequent primary cancers. Among survivors of all cancers, four common obesity-related cancers—colorectal, pancreatic, endometrial, and liver—comprised 22% to 26% of total subsequent primary cancer mortality.
Ahmedin Jemal, DVM, PhD
“These findings reinforce the importance of coordinated efforts by primary care clinicians to mitigate the risks of subsequent primary cancers through survivorship care, with greater focus on lifestyle factors, including smoking cessation, weight management, physical activity, and healthy eating,” concluded Ahmedin Jemal, DVM, PhD, senior author of the paper.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
