title: Second cancers among 40,576 testicular cancer patients: focus on long-term survivors.
abstract: BACKGROUND
  Although second primary cancers are a leading cause of death among men with testicular cancer, few studies have quantified risks among long-term survivors.
  
  
  METHODS
  Within 14 population-based tumor registries in Europe and North America (1943-2001), we identified 40,576 1-year survivors of testicular cancer and ascertained data on any new incident solid tumors among these patients. We used Poisson regression analysis to model relative risks (RRs) and excess absolute risks (EARs) of second solid cancers. All statistical tests were two-sided.
  
  
  RESULTS
  A total of 2,285 second solid cancers were reported in the cohort. The relative risk and EAR decreased with increasing age at testicular cancer diagnosis (P < .001); the EAR increased with attained age (P < .001) but the excess RR decreased. Among 10-year survivors diagnosed with testicular cancer at age 35 years, the risk of developing a second solid tumor was increased (RR = 1.9, 95% confidence interval [CI] = 1.8 to 2.1). Risk remained statistically significantly elevated for 35 years (RR = 1.7, 95% CI = 1.5 to 2.0; P < .001). We observed statistically significantly elevated risks, for the first time, for cancers of the pleura (malignant mesothelioma; RR = 3.4, 95% CI = 1.7 to 5.9) and esophagus (RR = 1.7, 95% CI = 1.0 to 2.6). Cancers of the lung (RR = 1.5, 95% CI = 1.2 to 1.7), colon (RR = 2.0, 95% CI = 1.7 to 2.5), bladder (RR = 2.7, 95% CI = 2.2 to 3.1), pancreas (RR = 3.6, 95% CI = 2.8 to 4.6), and stomach (RR = 4.0, 95% CI = 3.2 to 4.8) accounted for almost 60% of the total excess. Overall patterns were similar for seminoma and nonseminoma patients, with lower risks observed for nonseminoma patients treated after 1975. Statistically significantly increased risks of solid cancers were observed among patients treated with radiotherapy alone (RR = 2.0, 95% CI = 1.9 to 2.2), chemotherapy alone (RR = 1.8, 95% CI = 1.3 to 2.5), and both (RR = 2.9, 95% CI = 1.9 to 4.2). For patients diagnosed with seminomas or nonseminomatous tumors at age 35 years, cumulative risks of solid cancer 40 years later (i.e., to age 75 years) were 36% and 31%, respectively, compared with 23% for the general population.
  
  
  CONCLUSIONS
  Testicular cancer survivors are at statistically significantly increased risk of solid tumors for at least 35 years after treatment. Young patients may experience high levels of risk as they reach older ages. The statistically significantly increased risk of malignant mesothelioma in testicular cancer survivors has, to our knowledge, not been observed previously in a cohort of patients treated with radiotherapy.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA. travisl@mail.nih.gov
authors.forename: Lois B
authors.initials: LB
authors.lastname: Travis
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fosså
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Schonfeld
authors.forename: Mary L
authors.initials: ML
authors.lastname: McMaster
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.forename: Hans
authors.initials: H
authors.lastname: Storm
authors.forename: Per
authors.initials: P
authors.lastname: Hall
authors.forename: Eric
authors.initials: E
authors.lastname: Holowaty
authors.forename: Aage
authors.initials: A
authors.lastname: Andersen
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
authors.forename: Michael
authors.initials: M
authors.lastname: Andersson
authors.forename: Magnus
authors.initials: M
authors.lastname: Kaijser
authors.forename: Mary
authors.initials: M
authors.lastname: Gospodarowicz
authors.forename: Timo
authors.initials: T
authors.lastname: Joensuu
authors.forename: Randi J
authors.initials: RJ
authors.lastname: Cohen
authors.forename: John D
authors.initials: JD
authors.lastname: Boice
authors.forename: Graça M
authors.initials: GM
authors.lastname: Dores
authors.forename: Ethel S
authors.initials: ES
authors.lastname: Gilbert
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003110:Colonic Neoplasms / Q000453:epidemiology; D016001:Confidence Intervals; D004938:Esophageal Neoplasms / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000453:epidemiology; D008175:Lung Neoplasms / Q000453:epidemiology; D008297:Male; D008654:Mesothelioma / Q000453:epidemiology; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D009656:North America / Q000453:epidemiology; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000453:epidemiology; D010997:Pleural Neoplasms / Q000453:epidemiology; D016012:Poisson Distribution; D011878:Radiotherapy / Q000009:adverse effects; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012042:Registries; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000453:epidemiology; D017741:Survivors / Q000706:statistics & numerical data*; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents