A Population-Based Study of Subsequent Primary Malignancies After Endometrial Cancer: Genetic, Environmental, and Treatment-Related Associations
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT (United States)
- Department of Statistics, Brigham Young University, Provo, UT (United States)
- Division of Oncology, Department of Internal Medicine, University of Utah, Salt Lake City, UT (United States)
Purpose: To examine the risk of subsequent primary malignancies (SPMs) in women diagnosed with endometrial cancer. Methods and Materials: The National Cancer Institute's Survival, Epidemiology, and End Results database was used to determine the risk of SPM after endometrial cancer in 69,739 women diagnosed between 1973 and 2005. Standardized incidence ratios were calculated (observed/expected [O/E]) for SPM sites. Results: Median follow-up was 11.2 years, representing 757,567 person-years of follow-up. The risk of SPM was significantly increased for small intestine (O/E = 1.48; 99% confidence interval [CI], 1.03-2.05), colon (O/E = 1.16; CI, 1.09-1.24), vagina (O/E = 2.71; CI, 1.86-3.8), and urinary bladder (O/E = 1.41; CI, 1.25-1.59) SPMs and decreased for oral cavity and pharynx (O/E = 0.75; CI, 0.6-0.93), lung and bronchus (O/E = 0.78; CI, 0.72-0.84), and esophagus (O/E = 0.58; CI, 0.37-0.86) SPMs. Patients receiving external-beam radiotherapy for endometrial cancer had an increased risk of colon (p < 0.001), bladder (p < 0.001), vagina (p = 0.04), and soft-tissue (p = 0.014) SPMs. Patients treated with brachytherapy had an increased risk of bladder SPM (p = 0.006). A positive bidirectional association with endometrial cancer was observed for colorectal cancer, with a negative bidirectional association for oropharyngeal and lung cancers. Conclusions: Genetic, environmental, and treatment-related factors influence SPM risk. Genetic factors may contribute to the increased risk of colorectal cancer. Smoking's negative effect on endometrial cancer risk factors might explain the decreased risk of lung and oropharyngeal cancer. Patients treated with radiotherapy likely have a small but significantly increased risk of bladder, vagina, colon, and soft-tissue SPM.
- OSTI ID:
- 21436151
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 78, Issue 1; Other Information: DOI: 10.1016/j.ijrobp.2009.07.1692; PII: S0360-3016(09)02797-7; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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BLADDER
BRACHYTHERAPY
ESOPHAGUS
LARGE INTESTINE
LUNGS
NEOPLASMS
ORAL CAVITY
PHARYNX
SMALL INTESTINE
UTERUS
BODY
DIGESTIVE SYSTEM
DISEASES
FEMALE GENITALS
GASTROINTESTINAL TRACT
INTESTINES
MEDICINE
NUCLEAR MEDICINE
ORGANS
RADIOLOGY
RADIOTHERAPY
RESPIRATORY SYSTEM
THERAPY
URINARY TRACT