title: Declining second primary ovarian cancer after first primary breast cancer.
abstract: OBJECTIVE
  Although ovarian cancer incidence rates have declined in the United States, less is known of ovarian cancer trends among survivors of breast cancer. Therefore, we examined second primary ovarian cancers after first primary breast cancer.
  
  
  METHODS
  Data were obtained from the Surveillance, Epidemiology, and End Results program (1973 to 2008). Standardized incidence ratios (SIRs) were calculated as the observed numbers of ovarian cancers among survivors of breast cancer compared with the expected numbers in the general population. Absolute rates were measured as the incidence rates for second primary ovarian cancer by year of diagnosis of the first primary breast cancer adjusted for age of breast cancer diagnosis and years since diagnosis.
  
  
  RESULTS
  SIRs for second primary ovarian cancer were elevated over the entire study period (SIR, 1.24; 95% CI, 1.2 to 1.3), whereas the absolute rates declined with an estimated annual percentage change near 1% (-1.34% to -0.09% per year). Secular trends for second ovarian cancers were similar after estrogen receptor (ER) -positive and ER-negative breast cancers, whereas the age-specific patterns varied significantly by ER expression (P for interaction < .001). The largest SIR was among women age less than 50 years with ER-negative breast cancer (SIR, 4.35; 95% CI, 3.5 to 5.4).
  
  
  CONCLUSIONS
  Persistently elevated SIRs along with decreasing absolute rates over the entire study period suggest that ovarian cancers in both the general population and survivors of breast cancer are declining in parallel, possibly because of common risk factor exposures. Analytic studies are needed to further assess the parallel overall trends and the age-specific interaction by ER expression.
authors.affiliation: Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Schonfeld
authors.forename: Amy
authors.initials: A
authors.lastname: Berrington de Gonzalez
authors.forename: Kala
authors.initials: K
authors.lastname: Visvanathan
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Pfeiffer
authors.forename: William F
authors.initials: WF
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D010051:Ovarian Neoplasms / Q000453:epidemiology*; D016012:Poisson Distribution; D011960:Receptors, Estrogen / Q000378:metabolism; D012044:Regression Analysis; D012307:Risk Factors; D018426:SEER Program / Q000706:statistics & numerical data; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
chemical_list: D011960:Receptors, Estrogen