title: Cervical cancer survivors at increased risk of subsequent tobacco-related malignancies, United States 1992-2008.
abstract: OBJECTIVE
  Persistent smoking among cancer survivors may increase their risk of subsequent malignancies, including tobacco-related malignancies. Despite these risks, nearly 40 % of women diagnosed with cervical cancer continue to smoke after diagnosis. This study describes the relative risk of developing any subsequent and tobacco-related malignancy among cervical cancer survivors.
  
  
  METHODS
  We examined data from the year 1992 to 2008 in 13 Surveillance, Epidemiology and End Results registries. We calculated the standardized incidence ratio (SIR) and 95 % confidence limits (CLs) for all subsequent and tobacco-related malignancies among cervical cancer survivors. Tobacco-related malignancies were defined according to the 2004 Surgeon General's Report on the Health Consequences of Smoking. For comparison with cervical cancer survivors, SIRs for subsequent malignancies were also calculated for female survivors of breast or colorectal cancers.
  
  
  RESULTS
  The SIR of developing a subsequent tobacco-related malignancy was higher among cervical cancer survivors (SIR = 2.2, 95 % CL = 2.0-2.4). Female breast (SIR = 1.1, 95 % CL = 1.0-1.1) and colorectal cancer survivors (1.1, 1.1-1.2) also had an elevated risk. The increased risk of a subsequent tobacco-related malignancy among cervical cancer survivors was greatest in the first 5 years after the initial diagnosis and decreased as time since diagnosis elapsed.
  
  
  CONCLUSIONS
  Women with cervical cancer have a two-fold increased risk of subsequent tobacco-related malignancies, compared with breast and colorectal cancer survivors. In an effort to decrease their risk of subsequent tobacco-related malignancies, cancer survivors should be targeted for tobacco prevention and cessation services. Special attention should be given to cervical cancer survivors whose risk is almost twice that of breast or colorectal cancer survivors.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. jmunderwood@cdc.gov
authors.forename: J Michael
authors.initials: JM
authors.lastname: Underwood
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Rim
authors.forename: Temeika L
authors.initials: TL
authors.lastname: Fairley
authors.forename: Eric
authors.initials: E
authors.lastname: Tai
authors.forename: Sherri L
authors.initials: SL
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D018426:SEER Program / Q000706:statistics & numerical data; D012907:Smoking / Q000009:adverse effects*; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*