title: Second cancers after squamous cell carcinoma and adenocarcinoma of the cervix.
abstract: OBJECTIVE
  Although cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC) are both caused by human papillomavirus (HPV) infection, they differ in cofactors such as cigarette smoking. We assessed whether these cofactor differences translate into differences in second cancer risk.
  
  
  METHODS
  We assessed second cancer risk among 85,109 cervical SCC and 10,280 AC survivors reported to population-based cancer registries in Denmark, Finland, Norway, Sweden, and the United States. Risks compared to the general population were assessed using standardized incidence ratios (SIR).
  
  
  RESULTS
  Overall cancer risk was significantly increased among both cervical SCC survivors (n = 10,559 second cancers; SIR, 1.31; 95% CI, 1.29 to 1.34) and AC survivors (n = 920 second cancers; SIR, 1.29; 95% CI, 1.22 to 1.38). Risks of HPV-related and radiation-related cancers were increased to a similar extent among cervical SCC and AC survivors. Although significantly increased in both groups when compared with the general population, risk of smoking-related cancers was significantly higher among cervical SCC than AC survivors (P = .015; SIR for cervical SCC = 2.07 v AC = 1.78). This difference was limited to lung cancer (SIR for cervical SCC = 2.69 v AC = 2.18; P = .026). The increased lung cancer risk among cervical AC survivors was observed for both lung SCC and lung AC. SIRs for second cancers of the colon, soft tissue, melanoma, and non-Hodgkin's lymphoma were significantly higher among cervical AC than SCC survivors.
  
  
  CONCLUSIONS
  The second cancer profiles among cervical SCC and AC survivors mirror the similarities and differences in cofactors for these two histologies. Because smoking is not a cofactor for cervical AC, the increased lung cancer risk suggests a role for additional factors.
authors.affiliation: Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Blvd, EPS 7072, Rockville, MD 20852, USA. chaturva@mail.nih.gov
authors.forename: Anil K
authors.initials: AK
authors.lastname: Chaturvedi
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Kleinerman
authors.forename: Allan
authors.initials: A
authors.lastname: Hildesheim
authors.forename: Ethel S
authors.initials: ES
authors.lastname: Gilbert
authors.forename: Hans
authors.initials: H
authors.lastname: Storm
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.forename: Per
authors.initials: P
authors.lastname: Hall
authors.forename: Froydis
authors.initials: F
authors.lastname: Langmark
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
authors.forename: Magnus
authors.initials: M
authors.lastname: Kaijser
authors.forename: Michael
authors.initials: M
authors.lastname: Andersson
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fossa
authors.forename: Heikki
authors.initials: H
authors.lastname: Joensuu
authors.forename: Lois B
authors.initials: LB
authors.lastname: Travis
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology*; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*