Risks of second primary cancers among 584,965 female and male breast cancer survivors in England: a 25-year retrospective cohort study
Risks of second primary cancers among 584,965 female and male breast cancer survivors in England: a 25-year retrospective cohort study
Background: second primary cancers (SPCs) after breast cancer (BC) present an increasing public health burden, with little existing research on socio-demographic, tumour, and treatment effects. We addressed this in the largest BC survivor cohort to date, using a novel linkage of National Disease Registration Service datasets.
Methods: the cohort included 581,403 female and 3562 male BC survivors diagnosed between 1995 and 2019. We estimated standardized incidence ratios (SIRs) for combined and site-specific SPCs using incidences for England, overall and by age at BC and socioeconomic status. We estimated incidences and Kaplan–Meier cumulative risks stratified by age at BC, and assessed risk variation by socio-demographic, tumour, and treatment characteristics using Cox regression.
Findings: both genders were at elevated contralateral breast (SIR: 2.02 (95% CI: 1.99–2.06) females; 55.4 (35.5–82.4) males) and non-breast (1.10 (1.09–1.11) females, 1.10 (1.00–1.20) males) SPC risks. Non-breast SPC risks were higher for females younger at BC diagnosis (SIR: 1.34 (1.31–1.38) <50 y, 1.07 (1.06–1.09) ≥50 y) and more socioeconomically deprived (SIR: 1.00 (0.98–1.02) least deprived quintile, 1.34 (1.30–1.37) most). Interpretation: Enhanced SPC surveillance may benefit BC survivors, although specific recommendations require more detailed multifactorial risk and cost-benefit analyses. The associations between deprivation and SPC risks could provide clinical management insights. Funding: CRUK Catalyst Award CanGene-CanVar (C61296/A27223). Cancer Research UK grant: PPRPGM-Nov 20∖100,002. This work was supported by core funding from the NIHR Cambridge Biomedical Research Centre (NIHR203312)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Breast cancer, Deprivation, Epidemiology, Incidence, Pathology, Risk, Second primary cancer, Treatment
Allen, Isaac
6268ab30-a744-4c41-8ea5-51fdaf383a99
Hassan, Hend
f6df8c3f-7aca-4f59-9bce-87f557b0cbeb
Walburga, Yvonne
956bed58-8779-472d-9017-239f08b7d116
Eccles, Diana
5b59bc73-11c9-4cf0-a9d5-7a8e523eee23
May 2024
Allen, Isaac
6268ab30-a744-4c41-8ea5-51fdaf383a99
Hassan, Hend
f6df8c3f-7aca-4f59-9bce-87f557b0cbeb
Walburga, Yvonne
956bed58-8779-472d-9017-239f08b7d116
Eccles, Diana
5b59bc73-11c9-4cf0-a9d5-7a8e523eee23
Allen, Isaac, Hassan, Hend and Walburga, Yvonne
,
et al.
(2024)
Risks of second primary cancers among 584,965 female and male breast cancer survivors in England: a 25-year retrospective cohort study.
The Lancet Regional Health – Europe, 40, [100903].
(doi:10.1016/j.lanepe.2024.100903).
Abstract
Background: second primary cancers (SPCs) after breast cancer (BC) present an increasing public health burden, with little existing research on socio-demographic, tumour, and treatment effects. We addressed this in the largest BC survivor cohort to date, using a novel linkage of National Disease Registration Service datasets.
Methods: the cohort included 581,403 female and 3562 male BC survivors diagnosed between 1995 and 2019. We estimated standardized incidence ratios (SIRs) for combined and site-specific SPCs using incidences for England, overall and by age at BC and socioeconomic status. We estimated incidences and Kaplan–Meier cumulative risks stratified by age at BC, and assessed risk variation by socio-demographic, tumour, and treatment characteristics using Cox regression.
Findings: both genders were at elevated contralateral breast (SIR: 2.02 (95% CI: 1.99–2.06) females; 55.4 (35.5–82.4) males) and non-breast (1.10 (1.09–1.11) females, 1.10 (1.00–1.20) males) SPC risks. Non-breast SPC risks were higher for females younger at BC diagnosis (SIR: 1.34 (1.31–1.38) <50 y, 1.07 (1.06–1.09) ≥50 y) and more socioeconomically deprived (SIR: 1.00 (0.98–1.02) least deprived quintile, 1.34 (1.30–1.37) most). Interpretation: Enhanced SPC surveillance may benefit BC survivors, although specific recommendations require more detailed multifactorial risk and cost-benefit analyses. The associations between deprivation and SPC risks could provide clinical management insights. Funding: CRUK Catalyst Award CanGene-CanVar (C61296/A27223). Cancer Research UK grant: PPRPGM-Nov 20∖100,002. This work was supported by core funding from the NIHR Cambridge Biomedical Research Centre (NIHR203312)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
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Accepted/In Press date: 27 March 2024
e-pub ahead of print date: 24 April 2024
Published date: May 2024
Keywords:
Breast cancer, Deprivation, Epidemiology, Incidence, Pathology, Risk, Second primary cancer, Treatment
Identifiers
Local EPrints ID: 489019
URI: http://eprints.soton.ac.uk/id/eprint/489019
ISSN: 2666-7762
PURE UUID: 3c345ef0-41e2-405b-a0e9-82b446a2088b
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Date deposited: 11 Apr 2024 16:32
Last modified: 22 May 2024 04:01
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Author:
Isaac Allen
Author:
Hend Hassan
Author:
Yvonne Walburga
Corporate Author: et al.
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