Excess risk of subsequent primary cancers among colorectal carcinoma survivors, 1975–2001

Abstract

METHODS. Using 1975Using -2001 data from the Surveillance, Epidemiology, and End Results (SEER) Program, we assembled 262,600 index cases of colorectal carcinoma to assess the occurrence of subsequent primary cancers in 13 noncolonic sites. Observed (O) subsequent cancers were compared with those expected (E) based on age-/sex-/race-/year-/site-specific rates in the SEER population. The standardized incidence ratio (SIR) and the absolute excess risk (AER) represent 'O 7 E' and 'O -E,' respectively. RESULTS.Colorectal carcinoma patients had significantly elevated SIRs for small gut, stomach (males), kidney, and corpus uteri cancers, ranging from 1.13 for stomach cancer in males to 3.45 for small gut cancer in females. Elevated SIRs for additional sites were seen in certain population subgroups: pancreas and ovary in persons aged <50 years, and prostate in black males. The excess burden, as assessed by AER, was notable for prostate cancer in black males and for corpus uteri cancer in females aged <50 years (26.5 and 9.5 cancers per 10,000 personyears, respectively), and it persisted beyond 5 years of follow-up.CONCLUSIONS. Although significantly elevated SIRs were found for several cancers, the excess burden was notable only for cancer of the prostate in black males and of the corpus uteri in females under age 50. KEYWORDS: colorectal neoplasms, second primary neoplasms, uterine neoplasms, ovarian neoplasms, stomach neoplasms, gastrointestinal neoplasms, pancreatic neoplasms, prostatic neoplasms, kidney neoplasms, breast neoplasms.M ore effective screening and treatment regimens, coupled with more cancer diagnoses because of an aging population, have resulted in increasing numbers of cancer survivors who are at risk for subsequent cancers. 1 In 2002, there were an estimated 1.1 million colorectal cancer survivors in the United States. 2 The increased risk of a second primary cancer among colorectal cancer patients, when compared with the risk of persons without colorectal cancer, may result from environmental or genetic factors shared between the two cancers or from treatment effects. 3,4 However, it is possible that the intensive medical follow-up of colorectal cancer patients may produce an artifactual association. 3,4 A unidirectional altered risk of a given cancer following colorectal cancer suggests a treat- We appreciate the in-kind support from all the contributors to this monograph and also are grateful for the contributions of Jessica King for the preparation of analytic files and to Faruque Ahmed for his leadership of the colorectal cancer monograph project.

Multiple primary malignancies involving colorectal cancer—clinical characteristics and prognosis with reference to surveillance

“…In this study, colorectal cancer and stomach cancer showed the highest incidences of occurrence as second primary cancers, and this finding is consistent with previous studies (Table 4) [13][14][15][16][17][18]. It is conceivable that the high occurrence of gastric cancer in Korean colorectal cancer patients is merely a reflection of the high incidence of gastric cancer in Korea.…”

Multiple primary cancers among colorectal cancer survivors in Queensland, Australia, 1996–2007

“…Each MPC was analyzed as if it was the first multiple primary with no regard for any intervening cancer diagnoses and associated treatment. Other studies have used a similar approach [7,9,11].…”

“…[3] One of the challenges faced by the growing number of survivors is the possibility of being diagnosed with a subsequent tumor, [4] with its associated implications in terms of poorer quality of life [5] and decreased long-term survival. [6] Several Australian and international studies in recent years have examined the risk of developing new primary cancers following an initial CRC diagnosis [7][8][9][10][11][12]. The focus of most of these studies has been on identifying which cancer types were more likely to occur after the initial CRC, with inconsistent results.…”

Descriptive epidemiology of colorectal cancer in the United States, 1998–2001

“…21 Cress et al use 1992-2001 SEER data to examine temporal changes in CRC incidence, 22 whereas Ahmed et al use 1975Ahmed et al use -2001 SEER data to examine the excess risk of noncolonic primary cancers among CRC survivors. 59 Parikh-Patel et al utilize data from the California Cancer Registry to examine stage at diagnosis with respect to urban/rural residence. 60 Finally, Coughlin et al describe eight intervention projects funded by CDC's Division of Cancer Prevention and Control intended to promote CRC screening among diverse populations.…”