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      The relative risk of second primary cancers in Queensland, Australia: a retrospective cohort study

      research-article
      2 , , 1 , 2
      BMC Cancer
      BioMed Central

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          Abstract

          Background

          Cancer survivors face an increased likelihood of being subsequently diagnosed with another cancer. The aim of this study was to quantify the relative risk of survivors developing a second primary cancer in Queensland, Australia.

          Methods

          Standardised incidence rates stratified by type of first primary cancer, type of second primary cancer, sex, age at first diagnosis, period of first diagnosis and follow-up interval were calculated for residents of Queensland, Australia, who were diagnosed with a first primary invasive cancer between 1982 and 2001 and survived for a minimum of 2 months.

          Results

          A total of 23,580 second invasive primary cancers were observed over 1,370,247 years of follow-up among 204,962 cancer patients. Both males (SIR = 1.22; 95% CI = 1.20-1.24) and females (SIR = 1.36; 95% CI = 1.33-1.39) within the study cohort were found to have a significant excess risk of developing a second cancer relative to the incidence of cancer in the general population. The observed number of second primary cancers was also higher than expected within each age group, across all time periods and during each follow-up interval.

          Conclusions

          The excess risk of developing a second malignancy among cancer survivors can likely be attributed to factors including similar aetiologies, genetics and the effects of treatment, underlining the need for ongoing monitoring of cancer patients to detect subsequent tumours at an early stage. Education campaigns developed specifically for survivors may be required to lessen the prevalence of known cancer risk factors.

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          Most cited references15

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          Health behaviors of cancer survivors: examining opportunities for cancer control intervention.

          A population-based investigation was conducted to examine the prevalence of health behaviors (smoking, alcohol use, physical activity, and cancer screening) of cancer survivors by age, time since diagnosis, and cancer site. Understanding health behaviors of survivors is imperative, as many survivors are living longer and are at risk for cancer recurrence, second cancers, and complications from treatment. Using the National Health Interview Survey, this study examined the prevalence of smoking and alcohol use as well as whether cancer survivors (n = 7,384) are meeting current recommendations for physical activity and cancer screening compared with noncancer controls (n = 121,347). Cancer survivors are similar to controls with respect to smoking status and alcohol consumption after adjusting for group differences. However, younger survivors (18 to 40 years) are at greater risk for continued smoking than controls. Survivors are 9% more likely to meet physical activity recommendations compared with controls. chi2 tests indicate no significant differences in smoking, alcohol consumption, and physical activity by time since diagnosis, but differences by cancer site exist. Female cancer survivors are 34% and 36% more likely to meet mammogram and Papanicolaou smear screening recommendations, respectively, compared with controls. Similar screening patterns were found for prostate-specific antigen screening in men. This study provides benchmark approximations of the prevalence of risky health behaviors of survivors by time since diagnosis and cancer site. As part of the collective effort to reduce late effects of cancer treatment, oncologists may be in the best position to offer initial guidance for promoting healthy lifestyle behaviors among cancer survivors.
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            Multiple cancer prevalence: a growing challenge in long-term survivorship.

            The present study was designed to estimate the number of and describe the pattern of disease among cancer survivors living with a history of multiple malignant tumors in the United States. Incidence and follow-up data from the Surveillance, Epidemiology, and End Results program (1975-2001) were used to calculate the number of survivors with more than one malignant primary at January 1, 2002. U.S. prevalence counts were calculated by multiplying the age, sex, and race-specific prevalence proportions from the Surveillance, Epidemiology, and End Results program by the corresponding U.S. populations. We estimate that 756,467 people in the United States have been affected by cancer more than once between 1975 and 2001, representing almost 8% of the current cancer survivor population. Women whose first primary in that period was breast cancer represent 25% of survivors with multiple cancers, followed by men and women (15%) whose first primary was colorectal cancer and men (13%) whose first primary was prostate cancer. The findings in this report have important implications for public health practice. With individuals diagnosed with cancer living longer and the aging of the U.S. population, the number who will develop multiple malignancies is expected to increase. As a consequence, there is a growing need to promote effective cancer screening along with healthy life-styles among these at-risk populations if we are to ensure optimal physical and psychosocial well-being of these long-term cancer survivors and their families. Efforts to design and evaluate effective, efficient, and equitable approaches to surveillance for second malignancies will be critical in reducing the national burden of cancer.
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              Variation in incidence of breast, lung and cervical cancer and malignant melanoma of skin by socioeconomic group in England

              Background Cancer incidence varies by socioeconomic group and these variations have been linked with environmental and lifestyle factors, differences in access to health care and health seeking behaviour. Socioeconomic variations in cancer incidence by region and age are less clearly understood but they are crucial for targeting prevention measures and health care commissioning. Methods Data were obtained from all eight English cancer registries for patients diagnosed between 1998 and 2003, for all invasive cases of female breast cancer (ICD-10 code C50), lung cancer (ICD-10 codes C33-C34), cervical cancer (ICD-10 code C53), and malignant melanoma of the skin (ICD-10 code C43). Socioeconomic status was assigned to each patient based on their postcode of residence at diagnosis, using the income domain of the Index of Multiple Deprivation 2004. We analysed the socioeconomic variations in the incidence of breast, lung and cervical cancer and malignant melanoma of the skin for England, and regionally and by age. Results Incidence was highest for the most deprived patients for lung cancer and cervical cancer, whilst the opposite was observed for malignant melanoma and breast cancer. The difference in incidence between the most and the least deprived groups was higher for lung cancer patients aged under 65 at diagnosis than those over 65 at diagnosis, which may indicate a cohort effect. There were regional differences in the socioeconomic gradients with the gap being widest for lung and cervical cancer in the North (North East, North West and Yorkshire and Humberside) and for malignant melanoma in the East and South West. There were only modest variations in breast cancer incidence by region. If the incidence of lung and cervical cancer were decreased to that of the least deprived group it would prevent 36% of lung cancer cases in men, 38% of lung cancer cases in women and 28% of cervical cancer cases. Incidence of breast cancer and melanoma was highest in the least deprived group, therefore if all socioeconomic groups had incidence rates similar to the least deprived group it is estimated that the number of cases would increase by 7% for breast cancer, 27% for melanoma in men and 29% for melanoma in women. Conclusion National comparison of socioeconomic variations in cancer incidence by region and age can provide an unbiased basis for public health prevention and health commissioning. Decreasing inequalities in incidence requires the integration of information on risk factors, incidence and projected incidence but targeted public health interventions could help to reduce regional inequalities in incidence and reduce the future cancer burden.
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                Author and article information

                Journal
                BMC Cancer
                BMC Cancer
                BioMed Central
                1471-2407
                2011
                23 February 2011
                : 11
                : 83
                Affiliations
                [1 ]Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Australia
                [2 ]School of Public Health, Queensland University of Technology, Brisbane, Australia
                Article
                1471-2407-11-83
                10.1186/1471-2407-11-83
                3052198
                21342533
                5063dee2-8216-4d51-9c31-11b05c75a1bf
                Copyright ©2011 Youlden and Baade; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 June 2010
                : 23 February 2011
                Categories
                Research Article

                Oncology & Radiotherapy
                Oncology & Radiotherapy

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