title: Stage I lung cancer survivorship: risk of second malignancies and need for individualized care plan.
abstract: BACKGROUND
  Survivors of stage I lung cancer are at increased risk of subsequent malignancies. Specific data on risk of subsequent malignancies are underreported in the literature. We studied the incidence of stage I lung cancer and the incidence of all second malignancies in survivors.
  
  
  METHODS
  Data from the Surveillance, Epidemiology and End Results 9 database were analyzed to calculate the incidence of stage I lung cancer and subsequent malignancies from 1998 to 2007. The risk of subsequent malignancies is reported as a standardized incidence ratio (observed incidence [O]/expected incidence [E]).
  
  
  RESULTS
  The incidence rate of stage I lung cancer increased slowly from 1988 (8, confidence interval [CI]: 7.6-8.4) to 2003 (9.2, CI: 8.9-9.6) and more rapidly from 2003 to 2007 (11.2, CI: 10.8-11.7). The risk of developing a second lung cancer is highest in the first year with the O/E at 6.78 (CI: 6.29-7.31) and continues to be high at 10 years (O/E 4.12; CI: 4.44-4.80). Laryngeal cancer has the highest incidence in the first year (O/E 9.78; CI: 7.51-12.51) and continues to be high at 10 years (O/E 3.55; CI: 1.77-6.34). For gastrointestinal cancers, there is increased risk of colon (O/E 1.33; CI: 1.22-1.44), esophagus (O/E 2.29; CI: 1.85-2.89), and stomach (O/E 1.43; CI: 1.15-1.75) cancers. The increased risk of bladder cancer (O/E 1.83; CI: 1.65-2.03) remains high even at 10 years after the diagnosis of stage I lung cancer.
  
  
  CONCLUSIONS
  There is increasing incidence of stage I lung cancer. Survivors of stage I are at increased risk of certain second malignancies.
authors.affiliation: Department of Hematology and Oncology, Cooper Cancer Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ 08103 , USA.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Surapaneni
authors.forename: Priya
authors.initials: P
authors.lastname: Singh
authors.forename: Kumar
authors.initials: K
authors.lastname: Rajagopalan
authors.forename: Alexandre
authors.initials: A
authors.lastname: Hageboutros
mesh_terms: D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology*; D020380:Needs Assessment; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology*; D011379:Prognosis; D012372:ROC Curve; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*