title: Incidence of subsequent pancreatic adenocarcinoma in patients with a history of nonpancreatic primary cancers.
abstract: BACKGROUND
  Several environmental risk factors are known to predispose individuals to pancreatic cancer, and up to 15% of pancreatic cancers have an inherited component. Understanding metachronous cancer associations can modify pancreas cancer risk. The objective of this study was to investigate the association of nonpancreatic cancers with subsequent pancreatic adenocarcinoma.
  
  
  METHODS
  The authors used data from the US Surveillance, Epidemiology, and End Results (SEER) registries to identify 1,618,834 individuals who had a primary malignancy and subsequent pancreatic adenocarcinoma (n = 4013). Standardized incidence ratios were calculated as an approximation of relative risk (RR) for the occurrence of pancreatic adenocarcinoma after another primary malignancy.
  
  
  RESULTS
  Among patients who were diagnosed with a first primary malignancy at ages 20 to 49 years, the risk of subsequent pancreatic adenocarcinoma was increased among patients who had cancers of the ascending colon (relative risk [RR], 4.62; 95% confidence interval [CI], 1.86-9.52), hepatic flexure (RR, 5.42; 95% CI, 1.12-15.84), biliary system (RR, 13.14; 95% CI, 4.27-30.66), breast (RR, 1.32; 95% CI, 1.09-1.59), uterine cervix (RR, 1.61; 95% CI, 1.02-2.41), testes (RR, 2.78; 95% CI, 1.83-4.05), and hematopoietic system (RR, 1.83; 95% CI, 1.28-2.53). Among patients who had a first malignancy at ages 50 to 64 years, the risk was increased after cancers of the stomach (RR, 1.88; 95% CI, 1.13-2.93), hepatic flexure (RR, 2.25; 95% CI, 1.08-4.13), lung and bronchus (RR, 1.46; 95% CI, 1.16-1.82), pharynx (RR, 2.26; 95% CI, 1.13-4.04), and bladder (RR, 1.24; 95% CI, 1.03-1.48). Among patients who had a primary cancer after age 65 years, the risk was increased after cancers of the stomach (RR, 1.79; 95% CI, 1.23-2.53), hepatic flexure (RR, 1.76; 95% CI, 1.06-2.75), biliary system (RR, 2.35; 95% CI, 1.17-4.20), and uterus (RR, 1.23; 95% CI, 1.03-1.47).
  
  
  CONCLUSIONS
  The results from the current population-based data set suggested that pancreatic adenocarcinoma is associated with certain primary cancers. Genetic predisposition and common environmental and behavioral risk factors all may contribute to this observation. Specific tumor associations will guide future risk-stratification efforts.
authors: College of Physicians and Surgeons, Columbia University and New York Presbyterian Hospital, New York, New York, USA.
authors: Sunil
authors: S
authors: Amin
authors: Russell B
authors: RB
authors: McBride
authors: Jennie K
authors: JK
authors: Kline
authors: Elana B
authors: EB
authors: Mitchel
authors: Aimee L
authors: AL
authors: Lucas
authors: Alfred I
authors: AI
authors: Neugut
authors: Harold
authors: H
authors: Frucht
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000235:genetics; D000328:Adult; D000368:Aged; D004781:Environmental Exposure / Q000706:statistics & numerical data; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D015994:Incidence; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000235:genetics / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000235:genetics; D010190:Pancreatic Neoplasms / Q000453:epidemiology* / Q000235:genetics; D012307:Risk Factors; D018426:SEER Program; D055815:Young Adult