Table 2.
Risks of developing or dying from subsequent primary cancers (SPCs)a by first primary index cancer types among 5 or more years AYA cancer survivors with first cancer diagnosis in 1975-2013 in 9 SEER registries
| First AYA cancer | Survivors, n (%) | Person-years, total (mean) | SPC cases |
SPC death |
Mean age |
||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 35-year cumulative incidence, % (95% CI) | Observed/Expectedb | SIR (95% CI)c | AEI per 10 000d | 35-year cumulative mortality, % (95% CI) | Observed/Expectedb | SMR (95% CI)c | AEM per 10 000d | First cancer | SPC diagnosis | SPC death | |||
| Totale | 170 404 (100) | 2 492 830 (14.6) | 13.7 (13.4 to 14.0) | 13 420/10 721 | 1.25 (1.23 to 1.27) | 10.8 | 6.2 (6.0 to 6.5) | 5008/2719 | 1.84 (1.79 to 1.89) | 9.2 | 31.6 | 53.5 | 54.7 |
| Breast (F)f | 27 176 (15.9) | 369 017 (13.6) | 10.8 (10.2 to 11.5) | 1821/1394 | 1.31 (1.25 to 1.37) | 11.6 | 5.9 (5.5 to 6.5) | 768/430 | 1.79 (1.66 to 1.92) | 9.2 | 35.4 | 54.9 | 57.7 |
| Melanoma of the skin | 24 000 (14.1) | 375 984 (15.7) | 11.6 (10.9 to 12.3) | 1594/1826 | 0.87 (0.83 to 0.92) | −6.2 | 4.0 (3.6 to 4.5) | 427/461 | 0.93 (0.84 to 1.02) | −0.9 | 31.7 | 54.9 | 56.5 |
| Thyroid | 23 408 (13.7) | 336 131 (14.4) | 13.0 (12.2 to 13.8) | 1514/1513 | 1 (0.95 to 1.05) | 0 | 3.7 (3.3 to 4.2) | 365/361 | 1.01 (0.91 to 1.12) | 0.1 | 31 | 53.3 | 55.5 |
| Testis | 16 501 (9.7) | 263 825 (16) | 15.1 (14.1 to 16.1) | 1280/1061 | 1.21 (1.14 to 1.27) | 8.3 | 7.2 (6.5 to 8.0) | 484/278 | 1.74 (1.59 to 1.9) | 7.8 | 29.6 | 55.1 | 56.7 |
| Cervix uteri | 10 314 (6.1) | 184 623 (17.9) | 13.4 (12.5 to 14.5) | 950/904 | 1.05 (0.99 to 1.12) | 2.5 | 6.1 (5.4 to 6.9) | 369/220 | 1.68 (1.51 to 1.86) | 8.1 | 32.8 | 55.5 | 57.2 |
| Non-Hodgkin lymphomag | 9474 (5.6) | 122 395 (12.9) | 17.9 (16.3 to 19.5) | 803/490 | 1.64 (1.53 to 1.76) | 25.6 | 7.5 (6.48 to 8.71) | 291/120 | 2.43 (2.16 to 2.72) | 14 | 31.2 | 53.1 | 52.5 |
| Hodgkin lymphoma (M) | 6854 (4.0) | 104 855 (15.3) | 18.8 (17.3 to 20.3) | 769/343 | 2.24 (2.09 to 2.41) | 40.6 | 12.3 (11.0 to 13.6) | 422/87 | 4.84 (4.39 to 5.32) | 31.9 | 27.4 | 51.8 | 51.9 |
| Hodgkin lymphoma (F) | 6550 (3.8) | 102 533 (15.7) | 25.9 (24.2 to 27.6) | 1113/365 | 3.05 (2.88 to 3.24) | 73 | 13.0 (11.6 to 14.5) | 399/72 | 5.54 (5.01 to 6.11) | 31.9 | 26.7 | 47.8 | 50.4 |
| Brain and other nervous system cancer | 6499 (3.8) | 73 731 (11.3) | 6.56 (5.57 to 7.65) | 250/226 | 1.11 (0.97 to 1.25) | 3.3 | 2.8 (2.17 to 3.5) | 100/48 | 2.08 (1.69 to 2.53) | 7 | 28.5 | 48.6 | 47.5 |
| Colon and rectum | 5843 (3.4) | 77 069 (13.2) | 15.8 (14.2 to 17.5) | 536/394 | 1.36 (1.25 to 1.48) | 18.5 | 6.9 (5.75 to 8.2) | 178/101 | 1.76 (1.51 to 2.04) | 10 | 33.9 | 54.6 | 54.2 |
| Head and neck | 4683 (2.7) | 70 464 (15) | 13.6 (12.1 to 15.1) | 412/348 | 1.18 (1.07 to 1.3) | 9.1 | 7.2 (6.07 to 8.4) | 181/90 | 2.01 (1.73 to 2.32) | 12.9 | 32.1 | 54 | 53.7 |
| Ovary | 4066 (2.4) | 69 792 (17.2) | 12.2 (10.8 to 13.8) | 357/299 | 1.19 (1.07 to 1.33) | 8.3 | 4.5 (3.6 to 5.6) | 115/70 | 1.65 (1.36 to 1.98) | 6.5 | 30.3 | 53.2 | 56.1 |
| Corpus uteri (including not otherwise specified) | 3608 (2.1) | 53 474 (14.8) | 15.4 (13.5 to 17.5) | 332/278 | 1.19 (1.07 to 1.33) | 10.1 | 6.6 (5.3 to 8.1) | 118/68 | 1.73 (1.43 to 2.07) | 9.3 | 34.8 | 55.7 | 57.2 |
| Soft tissue including heart | 3207 (1.9) | 47 565 (14.8) | 14.0 (12.0 to 16.1) | 257/204 | 1.26 (1.11 to 1.43) | 11.2 | 6.8 (5.5 to 8.3) | 134/50 | 2.69 (2.25 to 3.18) | 17.7 | 29 | 51.6 | 46.3 |
| Kidney and renal pelvis | 2916 (1.7) | 33 780 (11.6) | 16.4 (13.6 to 19.4) | 205/162 | 1.26 (1.1 to 1.45) | 12.6 | 6.9 (5.1 to 9.1) | 70/41 | 1.72 (1.34 to 2.18) | 8.7 | 34 | 53.6 | 54.4 |
| Urinary bladder | 2709 (1.6) | 50 379 (18.6) | 16.5 (14.4 to 18.7) | 296/300 | 0.99 (0.88 to 1.1) | −0.9 | 6.6 (5.3 to 8.1) | 102/83 | 1.23 (1 to 1.49) | 3.7 | 33.3 | 58 | 59.1 |
| Bones and joints | 1978 (1.2) | 29 386 (14.9) | 11.5 (9.3 to 13.9) | 146/98 | 1.48 (1.25 to 1.74) | 16.2 | 8.5 (6.5 to 10.8) | 85/23 | 3.73 (2.98 to 4.61) | 21.2 | 25.6 | 48 | 45.9 |
| Kaposi sarcoma (M)f | 1561 (0.9) | 15 256 (9.8) | 13.7 (11.1 to 16.7) | 145/56 | 2.58 (2.18 to 3.03) | 58.2 | 5.1 (3.4 to 7.3) | 42/14 | 2.96 (2.14 to 4.01) | 18.2 | 33.5 | 47.6 | 48.9 |
| Acute myeloid leukemia | 1477 (0.9) | 17 141 (11.6) | 16.8 (12.6 to 21.6) | 93/55 | 1.68 (1.36 to 2.06) | 22 | 5.7 (3.3 to 9.1) | 27/12 | 2.28 (1.51 to 3.32) | 8.9 | 28.6 | 49.7 | 47.6 |
| Lung and bronchus | 1456 (0.9) | 20 821 (14.3) | 10.4 (8.2 to 12.9) | 105/99 | 1.06 (0.87 to 1.28) | 2.9 | 6.9 (5.1 to 9.1) | 50/20 | 2.52 (1.87 to 3.32) | 14.5 | 32.7 | 54.2 | 51.9 |
| Chronic myeloid leukemia | 1259 (0.7) | 11 184 (8.9) | 13.2 (9.3 to 17.7) | 59/36 | 1.65 (1.26 to 2.13) | 20.8 | 5.9 (3.3 to 9.5) | 29/8 | 3.78 (2.53 to 5.43) | 19.1 | 31 | 48.8 | 45.7 |
| Vagina and vulva | 1123 (0.7) | 19 471 (17.3) | 10.7 (8.3 to 14.0) | 102/94 | 1.09 (0.89 to 1.32) | 4.2 | 8.2 (6.1 to 10.7) | 56/22 | 2.57 (1.94 to 3.34) | 17.6 | 30.7 | 53.2 | 51.7 |
| Acute lymphocytic leukemia | 1113 (0.7) | 13 750 (12.4) | 8.1 (5.6 to 11.1) | 55/31 | 1.77 (1.33 to 2.3) | 17.4 | 5.3 (3.1 to 8.3) | 23/6 | 3.65 (2.31 to 5.47) | 12.1 | 23.4 | 41.8 | 39.6 |
| Stomach | 566 (0.3) | 6829 (12.1) | 10.0 (6.5 to 14.5) | 45/34 | 1.34 (0.98 to 1.79) | 16.7 | 8.6 (4.9 to 13.6) | 24/8 | 2.89 (1.85 to 4.3) | 23 | 33.9 | 51.6 | 52.1 |
| Eye and orbit | 562 (0.3) | 8143 (14.5) | 11.1 (7.7 to 15.1) | 48/41 | 1.16 (0.85 to 1.54) | 8 | 17.6 (13.4 to 22.3)h | 67/10 | 6.53 (5.06 to 8.29)h | 69.7h | 31.7 | 53 | 46.8 |
| Myeloma | 478 (0.3) | 3832 (8) | 14.5 (9.1 to 21.1) | 32/16 | 1.95 (1.34 to 2.76) | 40.8 | 4.7 (2.1 to 8.8) | 44504 | 2.67 (1.33 to 4.77) | 18 | 35.1 | 52.1 | 48.3 |
| Small intestine | 390 (0.2) | 4408 (11.3) | 17.7 (9.3 to 28.3) | 33/20 | 1.67 (1.15 to 2.35) | 30 | 11.2 (7.0 to 16.5) | 33/5 | 6.97 (4.8 to 9.79) | 64.1 | 33.5 | 52.4 | 48.1 |
| Pancreas | 333 (0.2) | 3230 (9.7) | 13.4 (8.0 to 20.2) | 28/14 | 2.04 (1.35 to 2.94) | 44.1 | 4.5 (3.6 to 5.6) | 9/3 | 2.81 (1.28 to 5.33) | 17.9 | 31.8 | 47.8 | 47.9 |
| Anus | 300 (0.2) | 3766 (12.6) | 20.2 (13.0 to 28.5) | 40/19 | 2.14 (1.53 to 2.91) | 56.5 | 22.8 (13.8 to 33.1)i | 29/5 | 6.34 (4.25 to 9.11)i | 64.9i | 35.1 | 54.7 | 53.5 |
Includes second and later primaries and encompasses all cancer sites, except for nonmelanoma skin and same-type cancer as the index AYA cancer. Refer to Supplementary Table 2 (available online) for the definition of same-type cancer. AEI = absolute excess incidence; AEM = absolute excess mortality; AYA = adolescent and young adult; CI = confidence interval; F = female; ICD = International Classification of Diseases for Oncology; M = male; SEER = Surveillance, Epidemiology, and End Results Program; SIR = standardized incidence ratio; SMR = standardized mortality ratio; SPC = subsequent primary cancers.
The expected number of SPC cases and deaths from subsequent primary cancers were extrapolated from the incidence and mortality rates of 9 SEER areas, respectively, with a comparable distribution of race, sex, age, and calendar year. The expected risk of SPC deaths can be interpreted as the risk of dying from newly diagnosed cancer if survivors experienced the same cancer death rates as persons in the general reference population.
Calculated as the observed divided by the expected. The SIR and SMR are generally considered a measure of the strength of an association between the first and subsequent primary cancers.
Calculated as the observed minus the expected, divided by the total person-years of follow-up, and multiplied by 10 000. The modest or small relative excess risk (SIR or SMR) can result in high absolute excess risk (AEI or AEM) when the cancer rates in the general population are high.
Sum of 29 types of index AYA cancers.
Male breast cancer survivors were excluded because they accounted for only 0.2% (n = 60) of breast cancer survivors, as were female Kaposi sarcoma survivors because they accounted for only 1.6% (n = 25) of all Kaposi sarcoma survivors. For all other excluded cancers, refer to Supplementary Table 1 (available online).
Includes chronic lymphocytic leukemia (ICD-O-3 histology 9823 and site codes C420, C421, C424) and acute lymphoblastic lymphoma (ICD-O-3 histology codes 9811-9818, 9837 and all site codes except C024, C098-C099, C111, C142, C379, C420-C422, C424, C770-C779).
When excluding death from subsequent melanoma (n = 53), 35-year cumulative mortality, SMR (95% CI) and AEM were 3.7% (1.7-6.8) and 1.40 (0.77-2.35), and 4.9 per 10 000, respectively.
When excluding death from subsequent colorectal cancer (n = 11), 35-year cumulative mortality, SMR (95% CI) and AEM were 17.8% (9.5- 28.2) and 4.37 (2.59- 6.90), and 36.9 per 10 000, respectively.