Second primary cancer risk - the impact of applying different definitions of multiple primaries: results from a retrospective population-based cancer registry study

Background: There is evidence that cancer survivors are at increased risk of second primary cancers. Changes in the prevalence of risk factors and diagnostic techniques may have affected more recent risks. Methods: We examined the incidence of second primary cancer among adults in the West of Scotland, UK, diagnosed with cancer between 2000 and 2004 ( n = 57,393). We used National Cancer Institute Surveillance Epidemiology and End Results and International Agency for Research on Cancer definitions of multiple primary cancers and estimated indirectly standardised incidence ratios ( SIR) with 95% confidence intervals ( CI). Results: There was a high incidence of cancer during the first 60 days following diagnosis ( SIR = 2.36, 95% CI = 2.12 to 2.63). When this period was excluded the risk was not raised, but it was high for some patient groups; in particular women aged < 50 years with breast cancer ( SIR = 2.13, 95% CI = 1.58 to 2.78), patients with bladder ( SIR = 1.41, 95% CI = 1.19 to 1.67) and head & neck ( SIR = 1.93, 95% CI = 1.67 to 2.21) cancer. Head & neck cancer patients had increased risks of lung cancer ( SIR = 3.75, 95% CI = 3.01 to 4.62), oesophageal ( SIR = 4.62, 95% CI = 2.73 to 7.29) and other head & neck tumours ( SIR = 6.10, 95% CI = 4.17 to 8.61). Patients with bladder cancer had raised risks of lung ( SIR = 2.18, 95% CI = 1.62 to 2.88) and prostate ( SIR = 2.41, 95% CI = 1.72 to 3.30) cancer. Conclusions: Relative risks of second primary cancers may be smaller than previously reported. Premenopausal women with breast cancer and patients with malignant melanomas, bladder and head & neck cancers may benefit from increased surveillance and advice to avoid known risk factors.