Risk of second primary cancer among women in the Kaiser Permanente Breast Cancer Survivors Cohort

Breast Cancer Research

Research

Heather Spencer Feigelson¹  Jacqueline B. Vo²  Lene H. S. Veiga²  Rochelle E. Curtis²  Clara Bodelon²  Gretchen L. Gierach²  Cody Ramin³  Amy Berrington de Gonzalez⁴  Sheila Weinmann⁵  Erin J. Aiello Bowles⁶  Diana S. M. Buist⁷ 

[1] Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA;Institute for Health Research, Kaiser Permanente, Denver, CO, USA;Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA;Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA;Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, USA;Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA;Division of Genetics and Epidemiology, ICR, London, UK;Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA;Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA;Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA;Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA;

关键词: Breast cancer;    Cancer survivorship;    Second cancers;    Second non-breast cancers;    Endocrine therapy;    Radiotherapy;    Chemotherapy;   

DOI  :  10.1186/s13058-023-01647-y

 received in 2022-05-24, accepted in 2023-04-03,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundBreast cancer survivors are living longer due to early detection and advances in treatment and are at increased risk for second primary cancers. Comprehensive evaluation of second cancer risk among patients treated in recent decades is lacking.MethodsWe identified 16,004 females diagnosed with a first primary stage I-III breast cancer between 1990 and 2016 (followed through 2017) and survived ≥ 1 year at Kaiser Permanente (KP) Colorado, Northwest, and Washington. Second cancer was defined as an invasive primary cancer diagnosed ≥ 12 months after the first primary breast cancer. Second cancer risk was evaluated for all cancers (excluding ipsilateral breast cancer) using standardized incidence ratios (SIRs), and a competing risk approach for cumulative incidence and hazard ratios (HRs) adjusted for KP center, treatment, age, and year of first cancer diagnosis.ResultsOver a median follow-up of 6.2 years, 1,562 women developed second cancer. Breast cancer survivors had a 70% higher risk of any cancer (95%CI = 1.62–1.79) and 45% higher risk of non-breast cancer (95%CI = 1.37–1.54) compared with the general population. SIRs were highest for malignancies of the peritoneum (SIR = 3.44, 95%CI = 1.65–6.33), soft tissue (SIR = 3.32, 95%CI = 2.51–4.30), contralateral breast (SIR = 3.10, 95%CI = 2.82–3.40), and acute myeloid leukemia (SIR = 2.11, 95%CI = 1.18–3.48)/myelodysplastic syndrome (SIR = 3.25, 95%CI = 1.89–5.20). Women also had elevated risks for oral, colon, pancreas, lung, and uterine corpus cancer, melanoma, and non-Hodgkin lymphoma (SIR range = 1.31–1.97). Radiotherapy was associated with increased risk for all second cancers (HR = 1.13, 95%CI = 1.01–1.25) and soft tissue sarcoma (HR = 2.36, 95%CI = 1.17–4.78), chemotherapy with decreased risk for all second cancers (HR = 0.87, 95%CI = 0.78–0.98) and increased myelodysplastic syndrome risk (HR = 3.01, 95%CI = 1.01–8.94), and endocrine therapy with lower contralateral breast cancer risk (HR = 0.48, 95%CI = 0.38–0.60). Approximately 1 in 9 women who survived ≥ 1 year developed second cancer, 1 in 13 developed second non-breast cancer, and 1 in 30 developed contralateral breast cancer by 10 years. Trends in cumulative incidence declined for contralateral breast cancer but not for second non-breast cancers.ConclusionsElevated risks of second cancer among breast cancer survivors treated in recent decades suggests that heightened surveillance is warranted and continued efforts to reduce second cancers are needed.

【 授权许可】

CC BY   
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023

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