title: Trends over three decades of the risk of second primary cancer among patients with head and neck cancer.
abstract: OBJECTIVE
  Patients with a head and neck squamous cell carcinoma (HNSCC) carry a high risk of second primary cancer (SPC). In recent years, a rise in incidence of human papillomavirus (HPV)-associated HNSCC has been recorded. Moreover, tobacco and alcohol consumption levels have changed and major advances have been made in radiation treatment approaches. This raises the question of a modification to the risk of SPC, taking into account variations of patient characteristics related to the HPV-cancer epidemic.
  
  
  METHODS
  All patients with a first HNSCC diagnosed between 1975 and 2006 in the French Bas-Rhin region were followed up for 10 years. Multivariate Poisson regression models were used to model standardized incidence rates and excess absolute risks (EARs) over years of diagnosis, taking into account confounders such as sex, age, subsite of first HNSCC and follow-up.
  
  
  RESULTS
  Among these 6258 patients, 1326 presented with a SPC. High EAR values were observed for SPC of lung, head and neck, and esophagus sites (EAR of 172.8, 159.3 and 72.5 excess cancers per 10,000 person-years, respectively). Multivariate analysis showed that the excess risk of SPC of head and neck (P<.001) and esophagus (P=.029) sites decreased, with 53% lower EARs values in 2000-2006 compared to 1975-1979. In contrast, the excess risk of SPC of the lung did not change significantly (P=.174).
  
  
  CONCLUSIONS
  Efforts made by public health policy-makers and oncology care providers should be sustained to develop effective smoking cessation interventions, as the excess risk of lung SPC remains high and unchanged.
authors: Bas-Rhin Cancer Registry, Department of Epidemiology and Public Health, EA 3430, Faculty of Medicine, University of Strasbourg, and Department of Public Health, University Hospital of Strasbourg, 1 place de l’hôpital, 67000 Strasbourg, France. jeremie.jegu@unistra.fr
authors: Jérémie
authors: J
authors: Jégu
authors: Florence
authors: F
authors: Binder-Foucard
authors: Christian
authors: C
authors: Borel
authors: Michel
authors: M
authors: Velten
mesh_terms: D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D052685:Alphapapillomavirus / Q000302:isolation & purification; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000821:virology; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D004938:Esophageal Neoplasms / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000453:epidemiology; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000453:epidemiology; D008175:Lung Neoplasms / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000453:epidemiology; D011159:Population Surveillance; D011878:Radiotherapy / Q000639:trends; D012042:Registries; D018570:Risk Assessment; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology