Incidence of second and higher order smoking-related primary cancers following lung cancer: a population-based cohort study

Abstract

Background: Lung cancer 5-year survival has doubled over 15 years. Although the risk of second primary cancer is recognised, quantification over time is lacking. We describe the incidence of second and higher order smoking-related primary cancers in lung cancer survivors, identifying high-incidence groups and how incidence changes over time from first diagnosis.

Methods: Data on smoking-related primary cancers (lung, laryngeal, head and neck, oesophageal squamous cell carcinoma and bladder) diagnosed in England between 2000 and 2014 were obtained from Public Health England National Cancer Registration and Analysis Service. We calculated absolute incidence rates and standardised incidence rate ratios, both overall and for various subgroups of second primary cancer for up to 10 years from the initial diagnosis of lung cancer, using Poisson regression.

Results: Elevated incidence of smoking-related second primary cancer persists for at least 10 years from first lung cancer diagnosis with those aged 50 and 79 at first diagnosis at particularly high risk. The most frequent type of second malignancy was lung cancer although the highest standardised incidence rate ratios were for oesophageal squamous cell carcinoma (2.4) and laryngeal cancers (2.8) and consistently higher in women than in men. Over the last decade, the incidence of second primary lung cancer has doubled.

Conclusion: Lung cancer survivors have increased the incidence of subsequent lung, laryngeal, head and neck and oesophageal squamous cell carcinoma for at least a decade from the first diagnosis. Consideration should be given to increasing routine follow-up from 5 years to 10 years for those at highest risk, alongside surveillance for other smoking-related cancers.

Keywords: clinical epidemiology; lung cancer; non-small cell lung cancer.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Absolute incidence of second and higher order smoking-related primary cancers after lung diagnosis up to 10 years follow-up, by sex and age group.

Figure 2

Standardised incidence rate ratios for second and higher order smoking-related primary cancers after lung diagnosis up to 10 years follow-up, by sex and age group. Results for the 30–49 age group are imprecise due to the small number of cancers expected in this group.

Figure 3

Standardised incidence rate ratios for second and higher order smoking-related primary cancers after lung diagnosis up to 10 years follow-up, by site of second primary cancer. SCC, squamous cell carcinoma.

Figure 4

Incidence rate ratio for incidence of second primary cancers between 6 and 60 months after first primary lung cancer diagnosis in patients diagnosed with first primary lung cancer in 2005–2009 and 2010–2014 compared with 2000–2004, split into lung cancer, bladder cancer and OSCC, laryngeal, head and neck cancer. Note that most patients diagnosed in 2010–2014 have less than 5 years follow-up in our analysis dataset. OSCC,  oesophageal squamous cell carcinomas.