Association of first primary cancer with risk of subsequent primary cancer among survivors of adult-onset cancers in Kentucky and Appalachian Kentucky

Quan Chen; Bin Huang; Abigail M Anderson; Eric B Durbin; Susanne M Arnold; Jill M Kolesar

doi:10.3389/fonc.2023.1193487

Association of first primary cancer with risk of subsequent primary cancer among survivors of adult-onset cancers in Kentucky and Appalachian Kentucky

Front Oncol. 2023 Aug 17:13:1193487. doi: 10.3389/fonc.2023.1193487. eCollection 2023.

Authors

Quan Chen^{1

2}, Bin Huang^{1

2}, Abigail M Anderson¹, Eric B Durbin^{1

3}, Susanne M Arnold^{1

4}, Jill M Kolesar^{1

5

6}

Affiliations

¹ Markey Cancer Center, University of Kentucky, Lexington, KY, United States.
² Division of Cancer Biostatistics, University of Kentucky, Lexington, KY, United States.
³ Department of Radiology, University of Kentucky, Lexington, KY, United States.
⁴ Department of Internal Medicine, University of Kentucky, Lexington, KY, United States.
⁵ Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, United States.
⁶ Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, United States.

Abstract

Background: Appalachia is a region with significant cancer disparities in incidence and mortality compared to Kentucky and the United States. However, the contribution of these cancer health disparities to subsequent primary cancers (SPCs) among survivors of adult-onset cancers is limited. This study aimed to quantify the overall and cancer type-specific risks of SPCs among adult-onset cancer survivors by first primary cancer (FPC) types, residence and sex.

Methods: This retrospective cohort study from the Kentucky Cancer Registry included 148,509 individuals aged 20-84 years diagnosed with FPCs from 2000-2014 (followed until December 31, 2019) and survived at least 5 years. Expected numbers of SPC were derived from incidence rates in the Kentucky population; standardized incidence ratio (SIR) compared with those expected in the general Kentucky population.

Results: Among 148,509 survivors (50.2% women, 27.9% Appalachian), 17,970 SPC cases occurred during 829,530 person-years of follow-up (mean, 5.6 years). Among men, the overall risk of developing any SPCs was statistically significantly higher for 20 of the 30 FPC types, as compared with risks in the general population. Among women, the overall risk of developing any SPCs was statistically significantly higher for 20 of the 31 FPC types, as compared to the general population. The highest overall SIR were estimated among oral cancer survivors (SIR, 2.14 [95% CI, 1.97-2.33] among men, and among laryngeal cancer survivors (SIR, 3.62 [95% CI, 2.93-4.42], among women. Appalachian survivors had significantly increased risk of overall SPC and different site specific SPC when compared to non-Appalachian survivors. The highest overall SIR were estimated among laryngeal cancer survivors for both Appalachian and non-Appalachian residents (SIR, 2.50: 95%CI, 2.10-2.95; SIR, 2.02: 95% CI, 1.77-2.03, respectively).

Conclusion: Among adult-onset cancer survivors in Kentucky, several FPC types were significantly associated with greater risk of developing an SPC, compared with the general population. Risk for Appalachian survivors was even higher when compared to non-Appalachian residents, but was not explained by higher risk of smoking related cancers. Cancers associated with smoking comprised substantial proportions of overall SPC incidence among all survivors and highlight the importance of ongoing surveillance and efforts to prevent new cancers among survivors.

Keywords: Appalachian Kentucky; cancer associated risk factors; cancer disparities; cancer survivors; first primary cancer; subsequent primary cancer; surveillance.

Grants and funding

P30 CA177558/CA/NCI NIH HHS/United States