title: Second primary cancer after treatment for cervical cancer. An international cancer registries study.
abstract: BACKGROUND
  The pattern of second cancers after treatment for cervical cancer provides important information on the risk of radiation-induced malignancies. Large numbers of women survive many years and can be studied for late effects.
  
  
  METHODS
  Incident second cancers in 86,193 patients with cervical cancer reported to 13 population-based cancer registries in 5 countries were evaluated to estimate the risk of second cancer among very long term survivors.
  
  
  RESULTS
  Overall, 7543 second cancers were observed versus 6015 cancers expected based on population rates (observed/expected = 1.2). Lung cancer accounted for nearly half of the excess cancers. Among the 49,828 women treated with radiation, 3750 survived 30 or more years and a two-fold risk of cancers of heavily irradiated organs was seen. Most of the excess cancers were of the rectum, vagina, vulva, ovary, and bladder. Patterns of risk over time since treatment were consistent with a radiation etiology. Significant increases of nonchronic lymphocytic leukemia and cancers of the bone and kidney were also linked to radiotherapy. Women treated surgically were also at significant risk of second cancers, in all likelihood related to cigarette smoking and risk factors similar to those of cervical cancer.
  
  
  CONCLUSIONS
  Curative therapy for cervical cancer results in large numbers of long term survivors who develop second cancers very late in life. Radiation is an important cause of this increase and there is no evidence that risk returns to normal levels.
authors.affiliation: Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-7362, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Kleinerman
authors.forename: J D
authors.initials: JD
authors.lastname: Boice
authors.forename: H H
authors.initials: HH
authors.lastname: Storm
authors.forename: P
authors.initials: P
authors.lastname: Sparen
authors.forename: A
authors.initials: A
authors.lastname: Andersen
authors.forename: E
authors.initials: E
authors.lastname: Pukkala
authors.forename: C F
authors.initials: CF
authors.lastname: Lynch
authors.forename: B F
authors.initials: BF
authors.lastname: Hankey
authors.forename: J T
authors.initials: JT
authors.lastname: Flannery
mesh_terms: D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D012307:Risk Factors; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*