Table 2. The Risk of Developing and Dying From Any Types of Subsequent Primary Cancersa Sorted by Standardized Incidence Ratios of First Primary Cancer Types Among 5-Year Cancer Survivors With First Diagnosis Between 1992 and 2011 in 12 SEER Registries.
| FPC | Survivors, No. (%)b | Observed SPCs, No. (%) | Incidence per 10 000 person-years | Expected SPCs, No.c | SIR (95% CI)d | Observed SPC deaths, No. (%) | Mortality per 10 000 person-years | Expected SPC deaths, No.c | SMR (95% CI)d | Mean age at FPC diagnosise | Mean age at SPC diagnosise | Mean age at SPC deathe | Follow-up since 5 y after FPC, total (mean)b,e |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Men | |||||||||||||
| Larynx | 9107 (1.2) | 2261 (2.4) | 373 | 1291 | 1.75 (1.68-1.83) | 1518 (2.8) | 251 | 571 | 2.66 (2.53-2.80) | 62.5 | 72.7 | 73.7 | 60 693 (6.7) |
| Hodgkin lymphoma | 7278 (0.9) | 659 (0.7) | 101 | 415 | 1.59 (1.47-1.72) | 392 (0.7) | 61 | 145 | 2.71 (2.45-2.99) | 40.1 | 61.2 | 63.2 | 65 167 (9) |
| Kaposi sarcoma | 3962 (0.5) | 424 (0.5) | 119 | 275 | 1.54 (1.40-1.70) | 140 (0.3) | 41 | 98 | 1.43 (1.21-1.69) | 43.4 | 58.3 | 60.8 | 35 753 (9) |
| Pancreas | 1674 (0.2) | 188 (0.2) | 240 | 136 | 1.38 (1.19-1.60) | 110 (0.2) | 141 | 57 | 1.93 (1.59-2.33) | 60.0 | 71.3 | 71.5 | 7846 (4.7) |
| Esophagus | 2746 (0.3) | 416 (0.4) | 273 | 308 | 1.35 (1.23-1.49) | 245 (0.5) | 162 | 132 | 1.86 (1.64-2.11) | 62.8 | 72.2 | 72.6 | 15 226 (5.5) |
| Oral cavity and pharynx | 22 937 (2.9) | 3361 (3.6) | 216 | 2503 | 1.34 (1.30-1.39) | 2704 (5) | 176 | 1028 | 2.63 (2.54-2.73) | 57.5 | 70.1 | 70.6 | 155 247 (6.8) |
| Acute lymphocytic leukemia | 612 (0.1) | 36 (0) | 76 | 27 | 1.31 (0.92-1.82) | 34 (0.1) | 73 | 9 | 3.69 (2.55-5.15) | 38.7 | 60.9 | 64.8 | 4721 (7.7) |
| Gallbladder and other biliary | 1010 (0.1) | 143 (0.2) | 246 | 113 | 1.27 (1.07-1.50) | 197 (0.4) | 341 | 52 | 3.82 (3.31-4.39) | 62.6 | 71.8 | 71.6 | 5812 (5.8) |
| Breast | 1878 (0.2) | 311 (0.3) | 255 | 258 | 1.21 (1.08-1.35) | 157 (0.3) | 131 | 118 | 1.33 (1.13-1.56) | 63.1 | 74.7 | 75.9 | 12 175 (6.5) |
| Lung and bronchus | 20 874 (2.7) | 2447 (2.6) | 223 | 2034 | 1.20 (1.16-1.26) | 1252 (2.3) | 114 | 756 | 1.66 (1.57-1.76) | 64.3 | 73.7 | 74.6 | 109 575 (5.2) |
| Penis and other genital organs | 1592 (0.2) | 252 (0.3) | 230 | 213 | 1.18 (1.05-1.34) | 179 (0.3) | 167 | 97 | 1.84 (1.59-2.14) | 61.5 | 72.8 | 73.4 | 10 939 (6.9) |
| Chronic myeloid leukemia | 2772 (0.4) | 229 (0.2) | 131 | 194 | 1.18 (1.03-1.34) | 150 (0.3) | 87 | 75 | 2.01 (1.70-2.36) | 51.6 | 64.6 | 70.6 | 17 477 (6.3) |
| Anus, anal canal, and anorectum | 1956 (0.2) | 247 (0.3) | 185 | 210 | 1.17 (1.04-1.33) | 210 (0.4) | 158 | 86 | 2.44 (2.13-2.80) | 55.8 | 68.8 | 69.0 | 13 347 (6.8) |
| Non-Hodgkin lymphomaf | 44 576 (5.7) | 5523 (5.9) | 189 | 4751 | 1.16 (1.14-1.20) | 3058 (5.7) | 106 | 2081 | 1.47 (1.42-1.53) | 59.1 | 71.9 | 74.2 | 292 887 (6.6) |
| Thyroid | 12 442 (1.6) | 1268 (1.3) | 129 | 1117 | 1.14 (1.08-1.20) | 456 (0.8) | 47 | 428 | 1.07 (0.97-1.17) | 49.8 | 67.3 | 70.9 | 98 651 (7.9) |
| Acute nonlymphocytic leukemia | 1907 (0.2) | 156 (0.2) | 111 | 137 | 1.14 (0.97-1.33) | 103 (0.2) | 73 | 49 | 2.08 (1.70-2.53) | 47.5 | 66.1 | 65.3 | 14 105 (7.4) |
| Stomach | 6149 (0.8) | 795 (0.8) | 213 | 707 | 1.13 (1.05-1.21) | 637 (1.2) | 171 | 326 | 1.95 (1.81-2.11) | 63.1 | 73.9 | 73.4 | 37 358 (6.1) |
| Eye and orbit | 1645 (0.2) | 230 (0.2) | 192 | 203 | 1.13 (0.99-1.29) | 241 (0.4) | 206 | 87 | 2.76 (2.42-3.13) | 57.9 | 73.3 | 70.7 | 12 010 (7.3) |
| Soft tissue including heart | 5151 (0.7) | 593 (0.6) | 149 | 538 | 1.10 (1.02-1.20) | 402 (0.7) | 103 | 227 | 1.77 (1.61-1.96) | 52.9 | 70.4 | 69.1 | 39 760 (7.7) |
| Urinary bladder | 51 513 (6.6) | 7758 (8.2) | 222 | 7179 | 1.08 (1.06-1.11) | 4732 (8.8) | 136 | 3615 | 1.31 (1.28-1.35) | 65.6 | 75.6 | 77.6 | 349 592 (6.8) |
| Kidney and renal pelvis | 25 977 (3.3) | 3185 (3.4) | 189 | 2957 | 1.08 (1.04-1.12) | 1455 (2.7) | 87 | 1280 | 1.14 (1.08-1.20) | 59.5 | 71.9 | 74.8 | 168 223 (6.5) |
| Testis | 17 913 (2.3) | 834 (0.9) | 47 | 793 | 1.05 (0.99-1.13) | 297 (0.6) | 17 | 243 | 1.23 (1.09-1.38) | 35.8 | 57.4 | 59.6 | 179 310 (10) |
| Small intestine | 2771 (0.4) | 313 (0.3) | 183 | 298 | 1.05 (0.94-1.18) | 430 (0.8) | 254 | 127 | 3.39 (3.08-3.73) | 59.0 | 71.0 | 70.8 | 17 059 (6.2) |
| Brain and other nervous system | 4817 (0.6) | 250 (0.3) | 73 | 239 | 1.05 (0.93-1.19) | 146 (0.3) | 43 | 81 | 1.81 (1.53-2.14) | 42.0 | 61.2 | 60.4 | 34 324 (7.1) |
| Bones and joints | 1402 (0.2) | 110 (0.1) | 93 | 108 | 1.02 (0.84-1.24) | 128 (0.2) | 110 | 41 | 3.13 (2.62-3.73) | 44.5 | 64.2 | 63.7 | 11 818 (8.4) |
| Myeloma | 6728 (0.9) | 555 (0.6) | 184 | 550 | 1.01 (0.93-1.10) | 290 (0.5) | 97 | 231 | 1.25 (1.12-1.41) | 61.1 | 70.4 | 72.7 | 30 095 (4.5) |
| Colon and rectum | 74 722 (9.5) | 9720 (10.3) | 190 | 9807 | 0.99 (0.98-1.02) | 5173 (9.6) | 102 | 4650 | 1.11 (1.09-1.15) | 63.3 | 74.9 | 76.8 | 510 732 (6.8) |
| Liver and intrahepatic bile duct | 3629 (0.5) | 215 (0.2) | 132 | 230 | 0.93 (0.82-1.07) | 169 (0.3) | 104 | 85 | 1.99 (1.71-2.32) | 58.9 | 67.8 | 70.0 | 16 276 (4.5) |
| Melanoma of the skin | 46 007 (5.9) | 5098 (5.4) | 138 | 5556 | 0.92 (0.90-0.95) | 2100 (3.9) | 59 | 2412 | 0.87 (0.84-0.91) | 56.3 | 71.6 | 74.6 | 369 019 (8) |
| Prostate | 390 274 (49.6) | 45 029 (47.9) | 165 | 49 246 | 0.91 (0.91-0.93) | 25 476 (47.2) | 94 | 28 456 | 0.9 (0.89-0.91) | 66.4 | 77.4 | 78.7 | 2 732 289 (7) |
| Other and unspecified primary sitesg | 10 363 (1.3) | 1488 (1.6) | 207 | 1160 | 1.28 (1.22-1.35) | 1358 (2.5) | 191 | 479 | 2.84 (2.69-2.99) | 57.6 | 71.1 | 71.3 | 71 938 (6.9) |
| Total | 786 384 | 94 094 | 171 | 93 553 | 1.01 (1.00-1.01) | 53 939 | 99 | 48 121 | 1.12 (1.11-1.13) | 62.4 | 74.4 | 76.0 | 5 499 426 (7) |
| Total excluding prostate cancerh | 396 110 (50.4) | 49 065 (52.1) | 177 | 44 307 | 1.11 (1.10-1.12) | 28 463 (52.8) | 104 | 19 665 | 1.45 (1.43-1.46) | 58.5 | 71.5 | 73.3 | 2 767 137 (7) |
| Women | |||||||||||||
| Larynx | 2096 (0.3) | 463 (0.7) | 336 | 186 | 2.48 (2.27-2.72) | 367 (1.1) | 268 | 80 | 4.56 (4.11-5.06) | 60.9 | 71.1 | 72.6 | 13 767 (6.6) |
| Esophagus | 846 (0.1) | 127 (0.2) | 275 | 67 | 1.89 (1.58-2.25) | 83 (0.2) | 180 | 31 | 2.69 (2.15-3.34) | 65.0 | 72.6 | 73.5 | 4615 (5.5) |
| Hodgkin lymphoma | 6263 (0.8) | 588 (0.9) | 100 | 317 | 1.86 (1.71-2.02) | 259 (0.7) | 44 | 94 | 2.75 (2.42-3.10) | 38.5 | 58.1 | 62.7 | 58 879 (9.4) |
| Acute lymphocytic leukemia | 486 (0.1) | 32 (0.1) | 89 | 21 | 1.53 (1.05-2.17) | 21 (0.1) | 59 | 6 | 3.37 (2.09-5.16) | 41.3 | 62.1 | 59.8 | 3579 (7.4) |
| Anus, anal canal, and anorectum | 3042 (0.4) | 381 (0.6) | 184 | 264 | 1.44 (1.30-1.60) | 313 (0.9) | 152 | 112 | 2.80 (2.51-3.14) | 59.8 | 69.9 | 72.4 | 20 702 (6.8) |
| Oral cavity and pharynx | 10 788 (1.4) | 1220 (2) | 159 | 880 | 1.39 (1.31-1.47) | 1069 (3.1) | 141 | 369 | 2.89 (2.73-3.08) | 58.0 | 70.5 | 72.4 | 76 805 (7.1) |
| Pancreas | 1675 (0.2) | 140 (0.2) | 159 | 102 | 1.37 (1.16-1.62) | 99 (0.3) | 113 | 42 | 2.33 (1.90-2.85) | 59.8 | 70.2 | 70.2 | 8791 (5.2) |
| Kaposi sarcoma | 166 (0) | 17 (0) | 167 | 13 | 1.33 (0.78-2.14) | 8 (0) | 79 | 6 | 1.30 (0.56-2.56) | 63.8 | 73.8 | 78.7 | 1020 (6.1) |
| Urinary bladder | 15 717 (2.1) | 1999 (3.2) | 182 | 1622 | 1.23 (1.18-1.29) | 1159 (3.3) | 106 | 788 | 1.47 (1.39-1.56) | 66.3 | 75.3 | 78.1 | 110 012 (7) |
| Liver and intrahepatic bile duct | 1458 (0.2) | 93 (0.1) | 136 | 76 | 1.22 (0.99-1.50) | 102 (0.3) | 149 | 30 | 3.44 (2.81-4.18) | 60.4 | 69.5 | 71.8 | 6845 (4.7) |
| Non-Hodgkin lymphomaf | 37 467 (5) | 3719 (6) | 148 | 3081 | 1.21 (1.17-1.25) | 2159 (6.2) | 87 | 1373 | 1.57 (1.51-1.64) | 61.5 | 72.7 | 76.0 | 250 718 (6.7) |
| Vulva and other genital organs | 6079 (0.8) | 628 (1) | 143 | 521 | 1.21 (1.12-1.31) | 490 (1.4) | 113 | 225 | 2.18 (1.99-2.38) | 58.9 | 71.1 | 71.7 | 43 858 (7.2) |
| Gallbladder and other biliary | 1314 (0.2) | 138 (0.2) | 169 | 114 | 1.21 (1.02-1.44) | 210 (0.6) | 258 | 54 | 3.90 (3.40-4.47) | 64.4 | 74.3 | 74.3 | 8156 (6.2) |
| Small intestine | 2506 (0.3) | 231 (0.4) | 152 | 195 | 1.19 (1.04-1.35) | 372 (1.1) | 246 | 85 | 4.39 (3.96-4.86) | 60.4 | 72.4 | 71.6 | 15 215 (6.1) |
| Acute nonlymphocytic leukemia | 1861 (0.2) | 136 (0.2) | 93 | 115 | 1.18 (0.99-1.40) | 68 (0.2) | 47 | 38 | 1.77 (1.38-2.25) | 46.9 | 65.5 | 69.2 | 14 649 (7.9) |
| Lung and bronchus | 24 065 (3.2) | 1900 (3) | 144 | 1627 | 1.17 (1.12-1.23) | 1021 (2.9) | 78 | 644 | 1.59 (1.49-1.69) | 64.8 | 73.9 | 75.3 | 131 788 (5.5) |
| Kidney and renal pelvis | 15 980 (2.1) | 1547 (2.5) | 146 | 1337 | 1.16 (1.10-1.22) | 713 (2) | 68 | 582 | 1.22 (1.14-1.32) | 60.5 | 72.2 | 75.0 | 105 906 (6.6) |
| Soft tissue including heart | 4243 (0.6) | 383 (0.6) | 113 | 335 | 1.14 (1.04-1.27) | 260 (0.7) | 78 | 133 | 1.96 (1.73-2.21) | 52.8 | 68.3 | 68.7 | 33 991 (8) |
| Ovary | 18 169 (2.4) | 1399 (2.2) | 107 | 1244 | 1.12 (1.07-1.19) | 709 (2) | 54 | 495 | 1.43 (1.33-1.55) | 55.0 | 68.2 | 71.1 | 131 220 (7.2) |
| Cervix uteri | 20 153 (2.7) | 1632 (2.6) | 86 | 1460 | 1.12 (1.07-1.18) | 1027 (2.9) | 55 | 483 | 2.13 (2.00-2.27) | 46.4 | 63.7 | 67.5 | 189 721 (9.4) |
| Eye and orbit | 1378 (0.2) | 138 (0.2) | 135 | 123 | 1.12 (0.95-1.33) | 222 (0.6) | 223 | 51 | 4.35 (3.80-4.97) | 57.9 | 70.6 | 70.7 | 10 217 (7.4) |
| Thyroid | 43 436 (5.8) | 2861 (4.6) | 81 | 2597 | 1.10 (1.07-1.15) | 890 (2.6) | 26 | 878 | 1.01 (0.95-1.09) | 46.4 | 63.6 | 69.0 | 351 553 (8.1) |
| Breast | 334 273 (44.5) | 25 152 (40.3) | 95 | 23 655 | 1.06 (1.05-1.08) | 13 710 (39.3) | 52 | 12 154 | 1.13 (1.11-1.15) | 58.8 | 72.1 | 74.8 | 2 638 663 (7.9) |
| Colon and rectum | 68 770 (9.2) | 6290 (10.1) | 134 | 6025 | 1.04 (1.02-1.07) | 3415 (9.8) | 73 | 2959 | 1.15 (1.12-1.20) | 65.1 | 75.0 | 77.7 | 470 117 (6.8) |
| Chronic myeloid leukemia | 1969 (0.3) | 123 (0.2) | 97 | 119 | 1.04 (0.86-1.23) | 140 (0.4) | 113 | 44 | 3.21 (2.70-3.79) | 53.4 | 67.4 | 71.5 | 12 633 (6.4) |
| Corpus and uterus, NOS | 62 859 (8.4) | 6145 (9.9) | 124 | 5968 | 1.03 (1.01-1.06) | 2844 (8.2) | 58 | 2611 | 1.09 (1.05-1.13) | 60.3 | 72.4 | 74.8 | 495 025 (7.9) |
| Myeloma | 5578 (0.7) | 324 (0.5) | 134 | 313 | 1.03 (0.93 to 1.16) | 198 (0.6) | 82 | 135 | 1.47 (1.27-1.69) | 63.0 | 71.5 | 74.0 | 24 210 (4.3) |
| Stomach | 4518 (0.6) | 351 (0.6) | 127 | 353 | 1.00 (0.90-1.11) | 270 (0.8) | 98 | 165 | 1.64 (1.45-1.85) | 63.8 | 75.2 | 74.1 | 27 740 (6.1) |
| Melanoma of the skin | 40 414 (5.4) | 3125 (5) | 90 | 3226 | 0.97 (0.94-1.01) | 1229 (3.5) | 37 | 1229 | 1.00 (0.95 to 1.06) | 51.3 | 67.8 | 72.6 | 345 686 (8.6) |
| Brain and other nervous system | 4123 (0.5) | 195 (0.3) | 63 | 201 | 0.97 (0.84-1.12) | 113 (0.3) | 37 | 61 | 1.85 (1.53-2.23) | 42.8 | 60.0 | 62.3 | 31 005 (7.5) |
| Bones and joints | 1252 (0.2) | 76 (0.1) | 69 | 86 | 0.88 (0.70-1.11) | 73 (0.2) | 67 | 29 | 2.48 (1.95-3.12) | 45.6 | 65.6 | 65.6 | 10 972 (8.8) |
| Other and unspecified primary sitesg | 7773 (1) | 795 (1.3) | 158 | 608 | 1.31 (1.22-1.40) | 1266 (22.1) | 254 | 255 | 4.97 (4.70-5.25) | 59.5 | 70.6 | 71.3 | 50 404 (6.5) |
| Total | 750 717 (100) | 62 348 (100) | 109 | 56 853 | 1.10 (1.09-1.11) | 34 879 (100) | 62 | 26243 | 1.33 (1.32-1.34) | 58.2 | 71.2 | 73.9 | 5 698 464 (7.6) |
Abbreviation: FPC, first primary cancer; NOS, not otherwise specified; SEER, Surveillance, Epidemiology, and End Results Program; SIR, standardized incidence ratio; SMR, standardized mortality ratio; SPC, subequent primary cancer.
a
Includes second and later primary cancers and all cancer sites except nonmelanoma skin and same-site cancers (see eTable 2 in Supplement 1 for same-site cancers).
b
See eTable 4 in Supplement 1 for values by FPC types and sex included in the mortality analysis.
c
Values were extrapolated from the incidence and mortality rates of 12 SEER registries with a comparable distribution of race, sex, age, and calendar year (eMethods in Supplement 1).
d
SIR indicates the ratio of the observed to the expected number of SPC cases; SMR indicates the ratio of the observed to the expected number of SPC deaths. The SIR and SMR indicate the strength of an association between the FPC and the SPC, which can vary by age at and time since first cancer diagnosis.4
e
The current version of the SEER database did not allow determination of variation (standard deviation) for survivor age and person-years of follow-up.
f
Includes chronic lymphocyte leukemia.
g
Excluded in the further analysis (see eTable 5 in Supplement 1 for specific other sites).
h
Reported due to the substantially lower than expected risk for SPCs after prostate cancer.