Second primary cancers in survivors of cervical cancer in The Netherlands: Implications for prevention and surveillance.
OBJECTIVE
We investigated the effects of socio-demographic, treatment- and tumor-specific determinants on the risk of developing a second malignancy among patients treated for cervical cancer.


METHODS
We included patients with a first cervical cancer (N=12,048) from the Netherlands Cancer Registry (NCR), 1989-2008. Standardized incidence ratios (SIR) and absolute excess risks (AER) per 10,000 person-years were calculated to estimate the burden of second cancers in cervical cancer survivors. Incidence rate ratios (IRR) were computed to identify predictors for second cancers among cervical cancer survivors.


RESULTS
During the study period, 676 (5.6%) patients were diagnosed with a second cancer. Smoking-related cancers contributed the most to the overall burden of second cancers (AER=21) and risks remained elevated after 10 years of follow-up (SIR=1.8, 95% CI: 1.4-2.2), yet it decreased markedly in the younger birth cohorts. Cervical cancer survivors who underwent radiotherapy were at higher risk for a second tumor when compared to those without radiotherapy, especially at smoking-related sites (IRR=1.6 (1.2-2.3)).


CONCLUSIONS
Patients with cervical cancer had a significantly increased risk for a second cancer compared to the general population, especially for smoking- and irradiation-related tumors. Long-term follow-up suggested the importance of smoking cessation and the benefits of counseling cervical cancer patients accordingly, particularly those who received radiotherapy.
Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands; Section of Cancer Information, International Agency for Research on Cancer, Lyon, France.
Melina
M
Arnold
Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
Lifang
L
Liu
Department of Obstetrics and Gynecology, Center for Gynecologic Oncology, Amsterdam, The Netherlands.
Gemma G
GG
Kenter
Department of Clinical Oncology, Leiden University Medical Center, The Netherlands.
Carien L
CL
Creutzberg
Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands; Comprehensive Cancer Center South, Eindhoven Cancer Registry, Eindhoven, The Netherlands. Electronic address: j.coebergh@erasmusmc.nl.
Jan Willem
JW
Coebergh
Section of Cancer Information, International Agency for Research on Cancer, Lyon, France.
Isabelle
I
Soerjomataram
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D012042:Registries; D012306:Risk; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D017741:Survivors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy; D055815:Young Adult
Cancer registry; Cervical cancer; HPV; Second primary cancers; Smoking