title: Potential role of human papillomavirus in the development of subsequent primary in situ and invasive cancers among cervical cancer survivors.
abstract: BACKGROUND
  The recent licensure of human papillomavirus (HPV) vaccines will likely decrease the development of primary in situ and invasive cervical cancers and possibly other HPV-associated cancers such as vaginal, vulvar, and anal cancers. Because the HPV vaccine has the ability to impact the development of >1 HPV-associated cancer in the same individual, the risk of developing subsequent primary cancers among cervical cancer survivors was examined.
  
  
  METHODS
  Using the 1992 through 2004 data from the Surveillance, Epidemiology, and End Results (SEER) program, 23,509 cervical cancer survivors were followed (mean of 4.8 person-years) for the development of subsequent primary cancers. The observed number (O) of subsequent cancers of all sites were compared with those expected (E) based on age-/race-/year-/site-specific rates in the SEER population. Standardized incidence ratios (SIRs = O/E) were considered statistically significant if they differed from 1, with an alpha level of 0.05.
  
  
  RESULTS
  Among cervical cancer index cases, there was a significant elevated risk for subsequent in situ cancers of the vagina and vulva (SIRs of 53.8 and 6.6, respectively); and invasive vaginal, vulvar, and rectal cancers (SIRs of 29.9, 5.7, and 2.2, respectively). Significantly elevated risks were observed across race and ethnic populations for subsequent vaginal in situ (SIR for whites of 49.4; blacks, 52.8; Asian/Pacific Islander [API], 91.4; and Hispanics, 55.7) and invasive cancers (SIR for whites of 25.7; blacks, 34.5; API, 48.5; and Hispanics, 25.2).
  
  
  CONCLUSIONS
  The results of the current study demonstrate a substantially increased risk of the development of subsequent primary in situ and invasive cancers among cervical cancer survivors and have implications for the development of prevention and early detection strategies as the role of HPV infection becomes evident.
authors.affiliation: Arkansas Central Cancer Registry/Epidemiology Branch, Arkansas Department of Health, Little Rock, Arkansas, USA. Appathurai.Balamurugan@arkansas.gov
authors.forename: Appathurai
authors.initials: A
authors.lastname: Balamurugan
authors.forename: Faruque
authors.initials: F
authors.lastname: Ahmed
authors.forename: Mona
authors.initials: M
authors.lastname: Saraiya
authors.forename: Carol
authors.initials: C
authors.lastname: Kosary
authors.forename: Molly
authors.initials: M
authors.lastname: Schwenn
authors.forename: Vilma
authors.initials: V
authors.lastname: Cokkinides
authors.forename: Lisa
authors.initials: L
authors.lastname: Flowers
authors.forename: Lori A
authors.initials: LA
authors.lastname: Pollack
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000453:epidemiology; D002278:Carcinoma in Situ / Q000150:complications / Q000453:epidemiology* / Q000821:virology*; D002648:Child; D005260:Female; D006801:Humans; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000821:virology*; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology; D044469:Racial Groups; D012306:Risk; D018426:SEER Program; D017741:Survivors; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000208:ethnology; D014625:Vaginal Neoplasms / Q000453:epidemiology / Q000821:virology; D014846:Vulvar Neoplasms / Q000453:epidemiology / Q000821:virology