Increased Risk of Second Primary Malignancies in Patients with Gynecological Cancer: A Swedish record-linkage study

The Stockholm-Gotland Cancer Register was used to study the risk of developing second primary malignancies (SPM) in women diagnosed with cancer of the uterine cervix, uterine corpus and ovaries during the period 1958-1992. Among 5 325 patients with uterine cervix cancer, 619 developed SPM. Standardized incidence ratio (SIR) was 1.29 (95% confidence interval (CI) 1.19-1.39). Significantly increased risks were observed for cancer of the colon, rectum, lung, vulva, kidney and bladder. A total of 4 815 women with uterine corpus cancer were followed and 660 SPM were found. The overall SIR was 1.21 (95% CI 1.12-1.30) with significantly increased risk for cancer of the colon, ovary, vulva and bladder. The incidence of leukemia was also significantly elevated (SIR = 3.03; 95% CI 1.70-5.00). Among 5060 patients with ovarian cancer, 379 SPM were found (SIR 1.49; 95% CI 1.34-1.64). Increased risks of cancer of the colon, rectum, breast, uterine corpus, bladder and leukemia were observed. All three primary sites showed elevated risks of cancer of the colon and bladder. For patients with a primary cancer of the corpus and ovary an elevated risk of leukemia was also noted. The conclusion from these findings is that SPM to some extent can be explained by previously known factors, i.e. treatment and common risk factors. However, further studies concerning the role of common etiology, for instance hereditary and hormonal factors, are needed to increase the knowledge on the etiology of second primary malignancies.     

Second Primary Cancers Following Breast Cancer in the Japanese Female Population

To assess the risk of developing second primary cancers following breast cancer in Japanese females, we performed a retrospective cohort study of 2786 patients who were newly diagnosed with breast cancer at our hospital between 1970-1994, until the end of 1995 (average follow-up period, 8.6 years). The expected number of each second primary cancer was calculated by multiplying the number of appropriate person-years at risk by the corresponding age- and calendar period-specific cancer incidence rates for women obtained from the Osaka Cancer Registry. One hundred and seventeen patients developed a second primary cancer other than subsequent breast cancer, yielding an observed-to-expected ratio (O/E) of 1.3 [95% confidence interval (CI)=1.1-1.6]. The risk for developing a second primary cancer was significantly elevated during the first year following the diagnosis of breast cancer, and decreased with the passage of tune to unity. A significantly increased risk was noted for the development of ovarian cancer (O/E=2.4, 95% CI=1.0-4.6), thyroid cancer (O/E=3.7, 95% CI=1.5-7.6) and non-Hodgkin's lymphoma (NHL) (O/E=3.5, 95% CI=1.4-7.1) among the breast cancer patients compared with the general population. Patients who received hormonal therapy as the breast cancer treatment showed a significantly increased risk for ovarian cancer (O/E=5.5, 95% CI=1.8-12.9). Patients who received chemotherapy as the breast cancer treatment had an increased risk for NHL (O/E=5.0, 95% CI=1.6-11.6). These findings indicate that Japanese female patients with breast cancer had a 30% higher risk of developing a second primary cancer than the general population, the higher risk being manifested in the early period following the diagnosis of breast cancer. Medical surveillance of breast cancer patients for NHL, as well as for ovarian cancer and thyroid cancer, is required.     

The Risk of Second Primary Malignancies in Patients With Lung Neuroendocrine Tumors: A Population-Based Study on SEER Database

PurposeWe investigated the at-risk sites of second primary malignancies (SPMs) and evaluate the risk factors of SPMs among lung neuroendocrine tumors (LNETs) survivors by using the surveillance, epidemiology, and end results (SEER) database.MethodsPropensity-score matching was performed to conduct a case-control study from the surveillance, epidemiology, and end results (SEER) database. Cox regression analysis and multiple primary standardized incidence ratios were performed to investigate the risk factors of occurrence of SPMs among patients with LNETs.ResultsOf 3,206 patients with LNETs after matching, 539 developed SPMs. The risk of developing SPMs was higher in older patients (55–74 vs ≦54: hazard ratios [HR] 1.875; age ≧75 vs ≦54: HR 2.713), higher-stage of LNETs (regional vs localized: HR 1.387; distant vs localized: HR 2.732) and recent periods of diagnosis (2004–2014 vs 1984–1993: HR 1.735). Patients with SCLC, TC and LENEC had a higher risk for SPMs compared to general population. Lung and bronchus, larynx and some digestive organs had higher risk for SPMs while some sex hormone related organs like prostate, breast, and female reproductive system had a lower incidence of SPMs.ConclusionsPatients with LNETs had overall higher risks of SPMs than general population. Different types of second primary malignancies occurred in different periods after LNETs were diagnosed. Further investigations are required to screen different second primary malignancies for those with primary LNETs.     

Characterization of Second Primary Malignancies in Mucosa-Associated Lymphoid Tissue Lymphomas: A SEER Database Interrogation.

Introduction: Second primary malignancies (SPMs) are long-term complications in cancer survivors. Mucosa-associated lymphoid tissue (MALT) lymphomas are indolent extra-nodal marginal zone lymphomas, the majority of which typically have long-term survival. In this study, we investigated the incidence and pattern of SPMs in adult patients diagnosed with MALT lymphomas between January 2000 and December 2016.Methods: Using the SEER-18 database and multiple primary standardized incidence ratio (MP-SIR) session of SEER stat software for statistical analysis, we assessed SPMs in MALT lymphomas.Results: During this time, a total of 12,500 cases of MALT lymphomas were diagnosed, of which 1466 patients developed 1626 SPMs (O/E ratio: 1.48, 95% CI:1.41-1.55, P<.001). The median latency period for development of SPMs was 54 months (range 6-201 months). Secondary non-Hodgkin lymphomas, as defined by SEER as distinct from the primary lymphoma, was the most common SPM with 299 cases, followed by lung cancer (O/E ratio: 6.15, 95% CI:5.47-6.89, P<.0001). There were 898 SPMs that developed between 6- 59 months (O/E ratio: 1.47, 95% CI:1.37-1.57, P<.0001) and 728 after 60 months latency (O/E ratio: 1.5, 95% CI:1.39-1.61, P<.0001) after diagnosis of the primary MALT lymphomas. An increased incidence of both solid and hematologic cancers occurred in patients as early as 6 months after diagnosis of MALT lymphoma.Conclusion: These findings indicate that despite the indolent nature of most MALT lymphomas, there is an increased risk for SPMs warranting long-term follow up.     

Risk of Breast Cancer in Japanese Women with Benign Breast Disease

To investigate the risk of breast cancer development in women with benign breast disease (BBD), 387 screen-detected BBD women and 1,489 normal women, taken from participants in the breast cancer screening program during 1978–1986, were followed through 1991. While 2,811 person-years in the BBD group and 11,018 person-years in the normal group were accumulated, 5 women in the BBD group and 6 women in the normal group developed breast cancer. Using the Mantel-Haenszel method, relative risks (RR) were estimated for all women with BBD and women in some BBD types. Significantly elevated risk of breast cancer was observed in all women with BBD (RR=3.26, 95% confidence interval (CI) 1.08−9.83). Women with proliferative BBD were at high risk of breast cancer (RR=8.48, 95%CI 2.99−24.10), but no increased risk was observed for women with non-proliferative BBD (RR=0.93, 95%CI 0.11−7.66). These results are consistent with those in high-risk countries for breast cancer. In the management of women with BBD, histopathological diagnosis of the breast lesion is essential and women with proliferative BBD should be followed up carefully.     

Second Primary Cancers Following Female Breast Cancer in Osaka, Japan--A Population-Based Cohort Study

Using the data accumulated in the Osaka Cancer Registry, a cohortstudy was conducted on the occurrence of second primary cancersfollowing the first breast cancer in females. Of the 9, 503breast cancer patients newly diagnosed in the period 1965–1982who were followed up until the end of 1983 (average follow-upperiod, 5.7 years), 344 developed second cancers, whereas theexpected number had been 211 (relative risk (RR) = 1.6; 95%confidence interval (CI) = 1.5–1.8). The increased riskwas observed throughout the observation period, and was higherin patients of less than 45 years of age at diagnosis than inolder women. Significant excess risks were found for secondcancers of the opposite breast (RR = 4.2; 95% CI = 3.4–5.2),buccal cavity (RR = 3.6; 95% CI = 1.6–7.2), stomach (RR= 1.4; 95% CI = 1.2–1.8), colon (RR = 1.8; 95% CI = 1.1–2.1)and thyroid gland (RR = 3.2; 95% CI % 1.5–6.1). The effectsof chemo- and radiotherapy administered for initial breast canceron the increased risk of the above mentioned second cancerswere also examined. These therapeutic measures were found notlikely to be related to the excess risks for cancers of thebuccal cavity, stomach and colon. For second cancer of the oppositebreast, however, both chemotherapy and radiotherapy remainedas possible risk factors. The effect of radiation was proposedas being a likely explanation for the excess risk of secondthyroid cancer.     

Benign Breast Disease as a Breast Cancer Risk in Japanese Women

A hospital-based retrospective cohort study of benign breast disease (BBD) as a risk factor of future breast cancer (BC) development was conducted. Four hundred and twenty-eight patients with biopsied BBD were followed-up for a median period of 8 years, together with age-matched women with normal breasts (normal control) and BC patients (cancer control), at the ratio of 1:2:2. Twenty-one breast cancers developed, 7 in the cases, 4 in the normal controls, and 10 in the BC controls, showing the relative risk (RR) with 95% confidence intervals (CD to be 3.5 (1.03–11.9) in the cases with respect to the normal controls. The RR of the cases is not lower than that of contralateral breast cancer incidence. There were no significant differences in the risks of cancers in other organs among the groups. Pathological examination revealed that only atypical hyperplasia increased the RR of BC, as compared with the normal control breast group, or with non-proliferative disease. These results suggest that in a low-risk country, Japan, BBD is a definite risk factor for BC development as in high-risk countries.     

Risk of Second Primary Malignancy in Breast Cancer Survivors: A Nested Population-Based Case-Control Study

Purpose

Evolving therapies have improved the prognoses of patients with breast cancer; and currently, the number of long-term survivors is continuously increasing. However, these patients are at increased risk of developing a second cancer. Thus, late side effects are becoming an important issue. In this study, we aimed to investigate whether patient and tumor characteristics, and treatment type correlate with secondary tumor risk.

Methods

This case-control study included 305 patients with a diagnosed second malignancy after almost 6 months after the diagnosis of primary breast cancer and 1,525 controls (ratio 1:5 of cases to controls) from a population-based cohort of 6,325 women. The control patients were randomly selected from the cohort and matched to the cases according to age at diagnosis, calendar period of diagnosis, disease stage, and time of follow-up.

Results

BRCA1 or BRCA2 mutation, human epidermal growth factor receptor 2 (HER2)+ status, chemotherapy, and radiotherapy were related to increased risk of developing a second cancer, whereas hormonotherapy showed a protective effect. Chemotherapy, radiotherapy, and estrogenic receptor level <10% increased the risk of controlateral breast cancer. HER2+ status increased the risk of digestive system and thyroid tumors, while BRCA1 or BRCA2 mutation increased the risk of cancer in the genital system.

Conclusion

Breast cancer survivors are exposed to an excess of risk of developing a second primary cancer. The development of excess of malignancies may be related either to patient and tumor characteristics, such as BRCA1 or BRCA2 mutation and HER2+ status, or to treatments factors.     

Coping Strategies and Experiences in Women with a Primary Breast Cancer Diagnosis

Background: Women with breast cancer experience problems in multiple aspects of their lives, but applying effective strategies can result in enhancing their quality of life and their psychosocial adaptation to the disease. However, there is little information about the strategies that women use to cope with complications associated with their experiences following a breast cancer diagnosis. Objectives: The aim of this study was to explore the experience of coping behavior and the main strategies that women use in dealing with a breast cancer diagnosis. Methods: This study was conducted according to a qualitative phenomenological design to investigate women’s experiences in living with breast cancer and the related complications and how they cope with these issues. Purposive sampling was used for recruiting participants with breast cancer, and data collection was conducted by semi-structured, in-depth interviews with 22 patients. The transcribed interviews were analyzed using Van Manen’s thematic approach. Results: The age range of the women was 32-68. Most were married and received adjuvant therapy (i.e., mastectomy surgery and chemo-radiation). Three dominant themes that emerged from the interviews were emotional turmoil, avoidance, and logical efforts. Conclusion: The findings highlight the importance of addressing psycho-oncology intervention programs to address the unmet pyscho-social and palliative care needs of patients suffering from breast cancer.     

Risk Factors Associated with a Second Primary Lung Cancer in Patients with an Initial Primary Lung Cancer

BackgroundIncreased patient survivorship following initial primary lung cancer (IPLC) diagnosis and treatment has uncovered new clinical challenges as individuals post-IPLC are at growing subsequent risk of developing second primary lung cancer (SPLC). Proper SPLC surveillance guidelines aimed at monitoring IPLC survivors are crucial to enhancing health outcomes. This study aims to categorize risk factors associated with SPLC emergence in IPLC survivors for clinical use following IPLC treatment.Materials and MethodsUsing the Karmanos Cancer Institute Tumor Registry, patients diagnosed with IPLC from 2000 to 2017 were identified. Patients diagnosed with SPLC were matched to individuals who did not develop SPLC. Logistic and Cox regression analyses were performed to identify risk factors for SPLC emergence and overall survival (OS).ResultsOne hundred twenty-one patients diagnosed with IPLC who later developed SPLC were identified and compared with 120 patients with IPLC who did not develop SPLC. Several factors such as stage at first diagnosis, histology, age, and smoking history were not associated with SPLC risk. The median time to SPLC was 1.79 years. Patients who were treated with surgical resection had a significantly higher probability of developing SPLC. After correcting for potential immortal time bias, the median OS was 3.63 years (95% confidence interval [CI], 3.05-5.00) and 7.31 years (95% CI, 4.62-10.90) for SPLC and no SPLC groups, respectively.ConclusionThis study uncovered notable associations and lack thereof between several competing SPLC risk factors, as well as mortality. Further characterization of SPLC risk factors is essential for enhancing surveillance recommendations.     

女性乳腺癌危险因素Meta分析

[目的]运用Meta分析方法综合分析评价中国女性乳腺癌的危险因素。[方法]收集1994-2006年国内有关乳腺癌危险因素的研究文献，采用Meta分析的随机效应模型，计算有关危险因素的OR值及95％CI。[结果]共筛选出相关文献18篇。前5位乳腺癌危险因素及OR值依次为良性乳腺疾病4．87（2．99-6．841、精神创伤3．96（1．87-5．56）、肿瘤家族史3．68（1．51-5．41）、行经时间3．11（1．26～4．89）、哺乳时间2．95（1．42～4．97）。[结论]控制中国人群乳腺癌的发生，应从降低良性乳腺疾病、避免生活精神刺激、提倡母乳喂养和注意高危人群筛检等方面采取有效措施。     

女性乳腺癌危险因素的研究现状

研究乳腺癌的易感因素,进行有的放矢的干预性预防及早期发现和有效的治疗是降低乳腺癌死亡率的因素之一.乳腺癌的病因学尚不完全清楚,但从目前研究的现状看,乳腺癌是机体内外多种危险因素共同作用的结果.女性乳腺癌的易感因素包括以下方面年龄因素、家族史、某些分子生物学因素、先前的乳腺病史、影响内源及外源性雌激素变化的因素、生活环境及生活方式等.     

Radiation Therapy for Invasive Breast Cancer Increases the Risk of Second Primary Lung Cancer: A Nationwide Population-Based Cohort Analysis

IntroductionAlthough the risk factors for lung cancer are well documented, whether previous radiation therapy (RT) to treat breast cancer (BC) increases the incidence of second primary lung cancer remains unclear. We determined the overall incidence of second primary lung cancer after previous RT for all clinical stages of BC.MethodsAfter an analysis of the Longitudinal Health Insurance Database, 986,713 individuals were randomly enrolled from 2000 to 2010 for cohort analysis. All women with newly diagnosed invasive BC, aged 18 years or older, and without other types of malignancy before 2000 or in the follow-up periods were enrolled and allocated to the RT or non-RT groups. Age, comorbidities, insurance premium, urbanization level, location, date of event, and hospital care level were analyzed. The hazard ratios of parameters were calculated by Cox regression analysis.ResultsA total of 7408 individuals met the inclusion criteria, including 5695 patients with BC who underwent RT and 128 (2.25%) in whom lung cancer developed. In contrast, lung cancer was diagnosed in only four of 1713 individuals in the non-RT group (0.23%) during the follow-up period. Cox regression analysis showed that the adjusted hazard ratio was 10.078 times higher in the RT group than in the non-RT group for individuals with previous BC.ConclusionsThe incidence of second primary lung cancer was significantly higher in the RT group than in the non-RT group for individuals with previous BC. Patients with BC treated by RT should be extensively surveyed to assess the incidence of subsequent lung cancer.     

女性原发乳腺癌浸润乳头的临床病理前瞻性研究

对131例女性乳腺癌进行前瞻性研究。首次采用乳头横断多层面取材病检方法检出乳头浸润者28例，总阳性率21．4％。其中Ⅰ期乳腺癌乳头阳性率13．6％，Ⅱ期16．7％，Ⅲ期38．7％。观察研究肿瘤期别、肿瘤位置、乳头临床表现等特征与乳头受累的密切关系。肿瘤期别与乳头受累成正比（P＜0．05）。肿瘤位置距乳头越近，乳头受累机率越大（P＜0．01），肿瘤伴于中央区或距乳头5cm以内者，乳头受累已难幸免。不宜行保守性手术。乳头临床表现一旦异常，镜下多已有浸润（P＜0．05）。     

中国女性乳腺癌危险因素的Meta分析

[目的]评价中国女性乳腺癌部分危险因素的作用,探讨乳腺癌的病因。[方法]运用Meta分析方法对我国1996～2006年间公开发表的有关乳腺癌危险因素病例对照研究的12篇文献资料进行定量综合分析。[结果]各因素合并OR值分别为：初潮年龄OR=1．5401（95％CI：1．3437～1．7654）;哺乳OR=0．6837（95％CI：0．4779—0．9782）;口服避孕药OR=1．3278（95％CI：1．0627—1．6589）;良性乳腺疾病史OR=2．6180（95％CI：2．0275—3．3804）;吸烟OR=1．8576（95％CI：1．5394—2．2415）;饮酒OR=0．8137（95％CI：0．6196～1．0686）;饮茶OR=0．8625（95％CI：0．7646～0．9728）。[结论]初潮年龄、口服避孕药、良性乳腺疾病史及吸烟是乳腺癌发生的危险因素,哺乳及饮茶则是乳腺癌的保护因素。