New Malignancies Among 

Cancer Survivors:

SEER Cancer Registries, 1973-2000

Edited by

Rochelle E. Curtis1

D. Michal Freedman1

Elaine Ron1

Lynn A. G. Ries2

David G. Hacker3

Brenda K. Edwards2

Margaret A. Tucker1

Joseph F. Fraumeni Jr.1

1Division of Cancer Epidemiology and Genetics, 

National Cancer Institute (NCI), National Institutes of Health (NIH), 

Department of Health and Human Services (DHHS)

2Division of Cancer Control and Population Sciences, NCI, NIH, DHHS

3Information Management Services, Inc., Silver Spring, MD
Acknowledgments:

The editors and contributors are indebted to the staff at the National Cancer Institute (NCI) and the cancer registries that

participate in the SEER Program who provided high-quality incidence and survival data for this monograph. We are

especially grateful to Shannon Merkle and Nathan Appel (Information Management Services, Inc.) for data management

and critical programming support and to Alyssa Minutillo (NCI) for skillful project management and coordination of the

manuscripts. We also thank Jayne Sutton, project manager, and the staff of EEI Communications, Inc., for publishing

services, including data table management, design, editing, layout, and graphics; Drs. B. J. Stone and Milton Eisner (NCI)

for editorial review; Ursula Leitzmann and Jennifer Donaldson (NCI) for administrative assistance; and Brian Befano, 

Eric Berger, John Baumgartner, and Roberta McClimens (Information Management Services, Inc.) for additional

programming support, quality control, and assistance in the cover design.

Suggested citation:

Curtis RE, Freedman DM, Ron E, Ries LAG, Hacker DG, Edwards BK, Tucker MA, Fraumeni JF Jr. (eds). 

New Malignancies Among Cancer Survivors: SEER Cancer Registries, 1973-2000. National Cancer Institute, 

NIH Publ. No. 05-5302. Bethesda, MD, 2006.

Citation for a chapter should also include the chapter’s authors and title.

Copyright information:

All material in this report is in the public domain and may be reproduced or copied without permission; citation as to

source, however, is appreciated.

This publication is available at http://seer.cancer.gov under Publications. Updates will be posted on the SEER website,

http://seer.cancer.gov.
CONTENTS

CONTENTS iii

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Joseph F. Fraumeni Jr., Rochelle E. Curtis, Brenda K. Edwards, Margaret A. Tucker

2. Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Rochelle E. Curtis, Lynn A. G. Ries

3. New Malignancies Following Cancer of the Buccal Cavity and Pharynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Linda Morris Brown, Peter McCarron, D. Michal Freedman 

4. New Malignancies Following Cancer of the Digestive Tract, Excluding Colorectal Cancer . . . . . . . . . . . . . . . . . . . 59

Rachael Z. Stolzenberg-Solomon, Joseph F. Fraumeni Jr., Louise Wideroff, Demetrius Albanes, Rochelle E. Curtis

5. New Malignancies Following Cancer of the Colon, Rectum, and Anus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Pauline A. Mysliwiec, Kathleen A. Cronin, Arthur Schatzkin 

6. New Malignancies Following Cancer of the Respiratory Tract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

Neil E. Caporaso, Kevin W. Dodd, Margaret A. Tucker

7. New Malignancies Following Breast Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

Rochelle E. Curtis, Elaine Ron, Benjamin F. Hankey, Robert N. Hoover

8. New Malignancies Following Cancer of the Cervix Uteri, Vagina, and Vulva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

Ruth A. Kleinerman, Carol Kosary, Allan Hildesheim 

9. New Malignancies Following Cancer of the Uterine Corpus and Ovary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231

D. Michal Freedman, Rochelle E. Curtis, Lois B. Travis, Joseph F. Fraumeni Jr.

10. New Malignancies Following Cancer of the Male Genital Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257

Mary L. McMaster, Eric J. Feuer, Margaret A. Tucker 

11. New Malignancies Following Cancer of the Urinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285

Robin Taylor Wilson, Debra T. Silverman, Joseph F. Fraumeni Jr., Rochelle E. Curtis

12. New Malignancies Following Cancer of the Bone and Soft Tissue, and Kaposi Sarcoma . . . . . . . . . . . . . . . . . . . . 313

Eric A. Engels, Joseph F. Fraumeni Jr.

13. New Malignancies Following Melanoma of the Skin, Eye Melanoma, and Non-melanoma Eye Cancer . . . . . . 339

D. Michal Freedman, Barry A. Miller, Margaret A. Tucker

14. New Malignancies Following Cancer of the Brain and Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . 363

Peter D. Inskip, Ellen F. Heineman

15. New Malignancies Following Cancer of the Thyroid and Other Endocrine Glands . . . . . . . . . . . . . . . . . . . . . . . . 375

Cécile M. Ronckers, Peter McCarron, Eric A. Engels, Elaine Ron

16. New Malignancies Following Hodgkin Lymphoma, Non-Hodgkin Lymphoma, and Myeloma. . . . . . . . . . . . . . 397

Graça M. Dores, Timothy R. Coté, Lois B. Travis

Table of Contents
iv NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

17. New Malignancies Following Leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437

Naoko Ishibe, Rochelle E. Curtis

18. New Malignancies Following Childhood Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465

Peter D. Inskip, Lynn A. G. Ries, Randi J. Cohen, Rochelle E. Curtis

Appendices

Appendix 1 Cumulative incidence of developing a second cancer and cumulative probability of death 

due to competing causes, by site of initial cancer, SEER 1973-2000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483

Appendix 2.A Initial primary cancer site definitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489

Appendix 2.B Subsequent primary cancer site definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490

Appendix 2.C All subsequent cancers excluding same-site definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491

Appendix 2.D Histology/primary site group definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 492

CONTENTS
CONTRIBUTORS v

CONTRIBUTORS

Demetrius Albanes, M.D.

Chief, Office of Education

Nutritional Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 3044

Bethesda, MD 20892-7242

Email: albanesd@mail.nih.gov 

Linda Morris Brown, Dr.P.H., M.P.H. 

Captain, U.S. Public Health Service 

Assistant Chief, Biostatistics Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 8026

Bethesda, MD 20892-7244

Email: brownl@mail.nih.gov

Neil E. Caporaso, M.D.

Genetic Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 7116

Bethesda, MD 20892-7236

Email: caporasn@mail.nih.gov

Randi J. Cohen, M.D., M.S.

Radiation Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard 

Bethesda, MD 20892-7238

Timothy R. Coté, M.D., M.P.H.

Division of Cancer Control and Population Sciences

National Cancer Institute, NIH, DHHS

6116 Executive Boulevard.

Bethesda, MD 20892

Current address: D.C. Department of Health

Centers for Disease Control and Prevention, DHHS

64 New York Avenue, NE

Suite 5000

Washington, DC 20001

Email: tcote@cdc.gov

Kathleen A. Cronin, Ph.D., M.P.H.

Statistical Research and Applications Branch

Division of Cancer Control and Population Sciences

National Cancer Institute, NIH, DHHS

6116 Executive Boulevard

Room 5051

Bethesda, MD 20892-8317

Email: cronink@mail.nih.gov

Rochelle E. Curtis, M.A.

Radiation Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 7042

Bethesda, MD 20892-7238

Email: rcurtis@mail.nih.gov

Kevin W. Dodd, Ph.D.

Statistical Research and Applications Branch

Surveillance Research Program

Division of Cancer Control and Population Sciences 

National Cancer Institute, NIH, DHHS

6116 Executive Boulevard

Room 5050

Bethesda, MD 20892-8317

Email: doddk@mail.nih.gov

Contributors 
Graça M. Dores, M.D., M.P.H.

Division of Cancer Prevention

National Cancer Institute, NIH, DHHS

6130 Executive Boulevard

EPN 321

Bethesda, MD 20892-7361

Email: doresg@mail.nih.gov

Brenda K. Edwards, Ph.D.

Associate Director, Surveillance Research Program

Division of Cancer Control and Population Sciences

National Cancer Institute, NIH, DHHS

6116 Executive Boulevard

Room 5029

Bethesda, MD 20892-8317

Email: edwardsb@mail.nih.gov

Eric A. Engels, M.D., M.P.H.

Viral Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 8010

Bethesda, MD 20892-7248

Email: engelse@mail.nih.gov

Eric J. Feuer, Ph.D.

Chief, Statistical Research and Applications Branch 

Surveillance Research Program

Division of Cancer Control and Population Sciences

National Cancer Institute, NIH, DHHS

6116 Executive Boulevard

Room 5041

Bethesda, MD 20892-8317

Email: feuerr@mail.nih.gov

Joseph F. Fraumeni Jr., M.D.

Director, Division of Cancer Epidemiology and Genetics 

National Cancer Institute, NIH, DHHS 

6120 Executive Boulevard

EPS 8070

Bethesda, MD 20892-7242

Email: fraumenij@mail.nih.gov

D. Michal Freedman, Ph.D., M.P.H.

Radiation Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 7036

Bethesda, MD 20892-7238

Email: mf101e@nih.gov

David G. Hacker, B.S.

Information Management Services, Inc.

12501 Prosperity Drive, Suite 200

Silver Spring, MD 20904

Email: hacker@imsweb.com

Benjamin F. Hankey, Sc.D.

Chief, Cancer Statistics Branch

Surveillance Research Program

Division of Cancer Control and Population Sciences

National Cancer Institute, NIH, DHHS

6116 Executive Boulevard

Room 5023

Bethesda, MD 20892-8316

Email: bh43a@nih.gov

Ellen F. Heineman, Ph.D.

Division of Cancer Control and Population Sciences

National Cancer Institute, NIH, DHHS

6116 Executive Boulevard

Room 5108

Bethesda, MD 20892

Email: heineman@mail.nih.gov

Allan Hildesheim, Ph.D.

Hormonal and Reproductive Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 7062

Bethesda, MD 20892-7234

Email: hildesha@mail.nih.gov

Robert N. Hoover, M.D., Sc.D.

Director, Epidemiology and Biostatistics Program

Division of Cancer Epidemiology and Genetics

National Cancer Institute NIH, DHHS

6120 Executive Boulevard

EPS 8094

Bethesda, MD 20892-7246

Email: hooverr@mail.nih.gov

Peter D. Inskip, Sc.D.

Radiation Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 7052

Bethesda, MD 20892-7238

Email: inskippe@mail.nih.gov

vi NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CONTRIBUTORS
Naoko Ishibe, Sc.D.

Genetic Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 7002

Bethesda, MD 20892-7236

Email: ishiben@mail.nih.gov

Ruth A. Kleinerman, M.P.H.

Radiation Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 7044

Bethesda, MD 20892-7238

Email: kleinerr@mail.nih.gov

Carol Kosary, M.A.

Cancer Statistics Branch

Division of Cancer Control and Population Sciences

National Cancer Institute, NIH, DHHS

6116 Executive Boulevard

Room 5025

Bethesda, MD 20892-8316

Email: kosaryc@mail.nih.gov

Peter McCarron, Ph.D., M.F.P.H.M.

Division of Cancer Control and Population Sciences

National Cancer Institute, NIH, DHHS

6116 Executive Boulevard

Bethesda, MD 20892

Current address: Department of Epidemiology and

Public Health

Queen’s University Belfast, Royal Victoria Hospital

Mulhouse Building, Grosvenor Road

Belfast, BT12 6BJ

United Kingdom

Email: peter.mccarron@qub.ac.uk

Mary L. McMaster, M.D.

Genetic Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 7010

Bethesda, MD 20892-7236

Email: mcmastem@mail.nih.gov

Barry A. Miller, Dr.P.H.

Cancer Statistics Branch

Division of Cancer Control and Population Sciences

National Cancer Institute, NIH, DHHS

6116 Executive Boulevard

Room 5015

Bethesda, MD 20892-8316

Email: millerb@mail.nih.gov

Pauline A. Mysliwiec, M.D., M.P.H.

Nutritional Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

Bethesda, MD 20892-7232

Current address: Division of Gastroenterology

Kaiser Permanente

975 Sereno Drive

Vallejo, CA 94589

Email: Pauline.A.Mysliwiec@kp.org

Lynn A. G. Ries, M.S.

Cancer Statistics Branch

Surveillance Epidemiology and End Results (SEER)

Program

Division of Cancer Control and Population Sciences

National Cancer Institute, NIH, DHHS

6116 Executive Boulevard

Room 5003

Bethesda, MD 20892-8316

Email: rieslynn@mail.nih.gov

Elaine Ron, Ph.D.

Radiation Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 7054

Bethesda, MD 20892-7238

Email: eron@mail.nih.gov

Cécile M. Ronckers, Ph.D.

Radiation Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

Bethesda, MD 20892-7238

Current Address: Academic Medical Center/

Emma Children’s Hospital

Department of Pediatric Oncology, Room A.SO-225

Meibergdreef 9

1105 AZ Amsterdam

The Netherlands

Email: c.m.ronckers@amc.uva.nl

CONTRIBUTORS vii

CONTRIBUTORS
viii NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

Arthur Schatzkin, M.D., Dr.P.H.

Chief, Nutritional Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 3040

Bethesda, MD 20892-7232

Email: schatzka@mail.nih.gov

Rachael Z. Stolzenberg-Solomon, Ph.D., M.P.H.

Nutritional Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 3022

Bethesda, MD 20892-7232

Email: stolzenr@mail.nih.gov

Lois B. Travis, M.D., Sc.D.

Radiation Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 7086

Bethesda, MD 20892-7238

Email: travisl@mail.nih.gov

Margaret A. Tucker, M.D.

Director, Human Genetics Program

Chief, Genetic Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 7122

Bethesda, MD 20892-7236

Email: tuckerp@mail.nih.gov

Debra T. Silverman, Sc.D.

Occupational and Environmental Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

EPS 8108

Bethesda, MD 20892-7240

Email: silvermd@mail.nih.gov

Louise Wideroff, Ph.D., M.S.P.H.

Risk Factor Monitoring and Methods Branch

Applied Research Program

Division of Cancer Control and Population Sciences

National Cancer Institute, NIH, DHHS

6130 Executive Boulevard

EPN 4005

Bethesda, MD 20892-7344

Email: widerofl@mail.nih.gov

Robin Taylor Wilson, Ph.D.

Occupational and Environmental Epidemiology Branch

Division of Cancer Epidemiology and Genetics

National Cancer Institute, NIH, DHHS

6120 Executive Boulevard

Bethesda, MD 20892-7240

Current address: Epidemiology Division

Department of Health Evaluation Sciences

Penn State College of Medicine and 

Penn State Cancer Institute

600 Centerview Drive, Suite 2200

Mail Code A210

Hershey, PA 17033-0855

Email: rwilson@psu.edu

CONTRIBUTORS
INTRODUCTION 1

Survival from cancer has improved dramatically as a

result of recent advances in the treatment of cancer and its

detection at an early stage. In the U.S., 5-year relative survival rates for all cancers combined increased steadily,

from 50% in 1975-1979 to 66% in 1996-2002 among adults,

and from 61% to 79% among children (Ries et al, 2006).

Moreover, 10-year survival rates are approaching 59% in

adults and 75% in children. As of January 1, 2003, about

10.5 million people in the U.S. were living with cancer

(Ries et al, 2006). For some, the improvements in survival

have come at a cost, however, in the form of long-term

physical and psychosocial consequences of the disease and

its treatment. A fuller understanding of these late effects

has been achieved by an expanded research and policy

agenda in cancer survivorship in the U.S. (Aziz and

Rowland, 2003; Hewitt et al, 2003, 2005; CDC and LAF,

2004; NCI, 2004). Among the major medical concerns for

cancer survivors is the risk of developing new primary

cancers. It has been estimated that among those cancer

survivors alive as of January 1, 2002, at least 750,000

(nearly 8%) had more than one form of cancer diagnosed

between 1975 and 2001 (Mariotto, 2006). As a result, there

is a growing need for a national system of populationbased statistics to monitor the risk of developing new

malignancies among long-term survivors of cancer.

Twenty years have passed since the publication of the

National Cancer Institute (NCI) monograph titled Multiple Primary Cancers in Connecticut and Denmark, a comprehensive survey of two populations with long-standing

cancer registries (Boice et al, 1985). This study was useful

in characterizing the site-specific risks of second cancers

and suggesting clues to underlying causal factors shared

by constellations of multiple cancers and to the carcinogenic potential of treatment modalities. The current

monograph builds and expands on that earlier work by

reporting on more contemporary patterns of multiple

cancers across the U.S. population and suggesting explanations based on our current understanding of cancer

causation through epidemiologic research. Herein we

report on the risk of new malignancies that have arisen

among cancer survivors for the 27-year period 1973 to

2000, utilizing data from NCI’s Surveillance, Epidemiology and End Results (SEER) Program (NCI, 2006).

The SEER Program represents a unique populationbased resource for evaluating the risk of subsequent cancers due to its large size, long follow-up of cancer survivors, and largely representative sample covering more

than 10% of the U.S. population. With chapters organized

according to the initial site of cancer, this monograph

reports on the risks of subsequent malignancies for more

than 50 adult and 18 childhood tumors, including new

data on some uncommon sites and individual histologic

types. The risks of subsequent cancers are systematically

examined by gender, age at diagnosis of the initial cancer,

and time since diagnosis, as well as the initial treatment

and histologic type of certain cancers. Whenever relevant, the differences in subsequent cancer risk are noted

by racial group (black and white); a subsequent publication will examine the racial and ethnic patterns in more

detail. This monograph is intended primarily to provide

new incidence data, rather than a comprehensive review

of the literature on multiple primary cancers (Neugut

et al, 1999; van Leeuwen and Travis, 2005; Schottenfeld

and Beebe-Dimmer, 2006). However, in each chapter, the

patterns of multiple cancers observed are compared with

findings from other studies and discussed in terms of

potential risk factors and mechanisms. In addition,

efforts are made to cite previous analyses of second cancers that utilized SEER data for specific tumors covered

in this monograph.

Overall Risks of Subsequent Cancers

Based on the 9 original cancer registries, the SEER Program provided data on more than 2 million cancer

patients who survived at least 2 months (including nearly

390,000 patients surviving at least 10 years and 76,000

patients surviving 20 or more years), yielding close to

11 million person-years at risk over the follow-up period

from 1973 to 2000. Overall, we found that cancer survivors had a 14% higher risk of developing a new malignancy than would have been expected in the general

SEER population (O/E=1.14, 95% CI=1.14-1.15) (Table 1.A).

A total of 185,407 new primary cancers were observed

compared with 162,602 expected. (The risk of subsequent

prostate cancers diagnosed following an initial prostate

cancer was excluded from the analysis, since typically

these second tumors are not reportable to SEER.) The

INTRODUCTION

Chapter 1

Introduction

Joseph F. Fraumeni Jr., Rochelle E. Curtis, Brenda K. Edwards, Margaret A. Tucker

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated as

[(O-E)/PYR]10,000).

Author affiliations: Joseph F. Fraumeni Jr., Rochelle E. Curtis, and

Margaret A. Tucker, Division of Cancer Epidemiology and Genetics,

NCI, NIH, DHHS; Brenda K. Edwards, Division of Cancer Control and

Population Sciences, NCI, NIH, DHHS.
estimate of the excess absolute risk (EAR) among all

patients combined was 21 excess subsequent cancer cases

per 10,000 person-years. A very large proportion (93%)

of the patients with multiple cancers had microscopic

confirmation of each malignancy (first, second, and subsequent cancers), reflecting the high reliability of the

SEER database and the low likelihood that metastatic

spread from the original malignancy would be reported

as a new primary cancer.

For most cancer sites, we examined the subsequent

cancer risk according to age at diagnosis. As shown in

Table 1.A, striking differences were observed by age,

with relative risks surpassing 6-fold for survivors of

childhood cancer (O/E=6.13). This finding is consistent

with previous studies of childhood tumors, which have

implicated initial therapy and genetic susceptibility as

major risk factors for new cancers (Neglia et al, 2001;

Bhatia, 2005). An age effect was further illustrated by 

the 2- to 3-fold increased risks for patients diagnosed 

as young adults (ages 18-39 years), and by the 1.2- to

1.6 -fold elevated risks for those ages 40-59 years. In contrast, the observed number of new malignancies was

lower than expected for survivors whose first cancer

occurred at older ages (ages ≥80 years, O/E=0.92), which

may be due to underreporting of second cancers among

elderly patients related to competing risks from comorbid

conditions and shortened life expectancies. In the combined analysis of all initial cancer sites, we found that 

the greatest burden of new malignancies was experienced by cancer patients initially diagnosed at ages 30 to

59 years, with EARs ranging from 32 to 39 per 10,000

person-years.

Overall, females had a slightly higher relative risk than

males for all subsequent cancers combined (O/E=1.17 for

females, versus 1.11 for males) (Table 1.A). However, the

risk for males consistently exceeded that for females

among patients whose initial cancer occurred before age

60 years. Similar patterns by age and sex were seen in

analyses that excluded gender-specific initial cancers

(cancers of the breast and genital tract), with the overall

relative risk of developing a new malignancy being

nearly equivalent among females (O/E=1.25) and males

(O/E=1.22). For all ages combined, blacks had much

higher risks of developing a new malignancy when compared with whites (blacks: O/E=1.31, EAR=46; whites:

O/E=1.13, EAR=20). The racial differences in risk persisted among women and men in practically all age

groups, indicating the need for further analyses that take

into account racial differences in stage of disease, initial

treatment, and other potential confounders.

In analyses by time after initial diagnosis and calendar

year, we found that risks of new cancers were highest in

the first 5 years after diagnosis and tended to decline

somewhat among long-term survivors (Table 1.B).

Heightened medical surveillance during the early followup period may partly explain the early excess, while

lower risks in later follow-up intervals may be influenced

by underascertainment of second malignancies for cancer

survivors who migrate out of SEER geographic areas,

and possibly by changes in behavioral patterns. In the

most recent calendar year period (initial cancers diagnosed from 1995 to 2000), there was evidence of a higher

rate of new malignancies compared with earlier periods

with equivalent follow-up intervals, although longer surveillance will be needed to confirm this pattern.

In each chapter of this monograph, we estimated the

percentage of patients diagnosed with a first primary

cancer who developed a second cancer over time. For all

cancers combined, nearly 14% of SEER patients developed a second cancer by 25 years of follow-up (cumula2 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

INTRODUCTION

Notes: All first primary cancers, except for non-melanoma skin, are included in the analysis. Subsequent cancers include 2nd, 3rd, and later primaries and encompass 

all cancer sites, except for non-melanoma skin and subsequent prostate cancers following first primary prostate cancer. Due to their large impact on subsequent cancer

risks for males, O, O/E, and EAR were adjusted by excluding observed and expected numbers of subsequent prostate cancers following an initial prostate cancer (O=44,

E=15,185). The population at risk includes 2,036,597 patients who survived 2 or more months after initial diagnosis during 1973 to 2000 (1,038,089 males and 998,508

females, 9 SEER registries). Numbers of patients surviving at least 5, 10, and 20 years were 789,221, 387,436, and 75,859 patients, respectively. The age distribution at

initial diagnosis was 3.4%, 14.2%, 44.2%, 25.6%, and 12.6% for age groups <30, 30-49, 50-69, 70-79, and >80 years, respectively. The average age at initial cancer

diagnosis was 64.6 years for men and 62.5 years for women.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; E=expected numbers of subsequent cancers; O/E=ratio of observed to expected

cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000).

*P <0.05.

Table 1.A: Risk of subsequent primary cancer after any initial cancer, by age at initial diagnosis, SEER 1973-2000.

Total Males Females

Age at initial

diagnosis O O/E EAR O O/E EAR O O/E EAR

All ages 185,407 1.14* 21 100,428 1.11* 22 84,979 1.17* 21

00–17 351 6.13* 15 176 6.44* 15 175 5.84* 15

18–29 1,401 2.92* 22 562 3.39* 22 839 2.67* 23

30–39 4,909 2.37* 39 1,530 2.88* 40 3,379 2.20* 38

40–49 13,537 1.61* 39 4,466 1.83* 52 9,071 1.52* 34

50–59 34,159 1.27* 32 15,957 1.33* 46 18,202 1.21* 24

60–69 62,286 1.13* 23 35,986 1.11* 25 26,300 1.14* 22

70–79 52,321 1.02* 4 32,419 1.00 0 19,902 1.05* 9

80–115 16,443 0.92* -19 9,332 0.92* -26 7,111 0.93* -14
INTRODUCTION 3

INTRODUCTION

tive incidence of 5.0%, 8.4%, 10.8%, and 13.7% at 5, 10,

15, and 25 years, respectively). The cumulative incidence

also varied markedly by age at initial cancer diagnosis,

with the overall frequency of second cancers being highest among those diagnosed between 50 and 69 years of

age (16.4% at 25 years of follow-up). Children (ages <18

years) experienced a 3.5% cumulative incidence of second cancer at 25 years, but further increases are expected

as the young survivors (maximum age <45 years at the

end of current follow-up) enter the period of rising cancer incidence.

Patterns of Multiple Primary Cancers

Although a sizable fraction of multiple cancers in the

SEER database represented multicentric or multifocal

tumors arising in the same site or organ system, most of

the tumor constellations affected diverse organ sites.

Whenever an excess risk of subsequent cancer was

observed, a search was made for a reciprocal association

that might suggest the presence of an underlying risk

factor predisposing to multiple cancers. Of course,

follow-up would be insufficient to detect risks among

patients initially diagnosed with cancers that are often

rapidly fatal (e.g., pancreas, liver).

Multicentric Tumors Versus Multiple Tumors of Diverse

Sites—New malignancies that occurred in the same site

or organ as the first primary cancer accounted for 13.2%

of the 185,407 subsequent cancers occurring among

patients in SEER surviving 2 months or more, with new

tumors in the female breast (O=13,428; 7.2%), colon

(O=3,630; 2.0%), lung (O=3,346; 1.8%), as well as

melanoma of the skin (O=1,579; 0.9%) making up the

large majority of the cases. While multicentric tumors are

likely to reflect shared exposures and/or genetic predisposition, it is possible that heightened medical surveillance and mistaken diagnoses of cancer recurrence may

play a role in some cases. An additional 3.8% of new

malignancies originated in neighboring tissues or organs,

at least partly from a “field cancerization” process whereby carcinogenic exposures and susceptibility states contribute to multicentric tumors that occur, for example,

along the upper aerodigestive tract, the colon and rectum,

and the lower urinary tract. Recent molecular studies of

head and neck tumors and urinary tract cancers have

indicated that multicentric involvement may actually

result from the spread and implantation of a single clone

of mutated cells (Tabor et al, 2002; Habuchi, 2005).

However, the majority of multiple primary cancers

reported in the SEER database (more than 80%) arose in

separate or independent organ systems. While a certain

fraction of the subsequent tumors would be expected to

develop at the same rate as in the general population,

the patterns of excess risk that emerged are sufficiently

distinctive to suggest risk factors that may be shared by

the primary and subsequent tumors, or an effect of cancer therapies that are potentially carcinogenic. In interpreting the findings, however, one must consider the

potential biases that may be introduced by diagnostic

and reporting inaccuracies and other methodologic limitations of second cancer studies that are discussed in the

next chapter.

Notes: All first primary cancers, except for non-melanoma skin, are included in the analysis. Subsequent cancers include 2nd, 3rd, and later primaries and encompass all

cancer sites, except for non-melanoma skin and subsequent prostate cancers following first primary prostate cancer. O, O/E, and EAR were adjusted by excluding

observed and expected numbers of subsequent prostate cancers following an initial prostate cancer (O=44, E=15,185). The population at risk includes 2,036,597 patients

who survived 2 or more months after initial diagnosis during 1973 to 2000, 9 SEER registries.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; E=expected numbers of subsequent cancers; O/E=ratio of observed to expected

cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000).

*P <0.05.

Table 1.B: Risk of subsequent primary cancer after any initial cancer, by calendar year at initial diagnosis and time since initial

diagnosis, SEER 1973-2000.

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years 10-14 years 15-19 years >20 years Total

Calendar year 

of diagnosis O O/E O O/E O O/E O O/E O O/E O O/E O O/E

Relative risks (O/E ratios)

1973–79 3,701 1.17* 12,375 1.18* 11,258 1.13* 8,861 1.08* 6,846 1.05* 4,355 1.05* 47,396 1.12*

1980–84 3,566 1.16* 12,086 1.17* 11,035 1.13* 8,429 1.14* 4,109 1.11* 87 1.03 39,312 1.14*

1985–89 4,493 1.16* 15,732 1.15* 14,208 1.13* 7,071 1.12* 167 1.21* — — 41,671 1.14*

1990–94 5,744 1.18* 19,320 1.13* 12,493 1.13* 295 1.24* — — — — 37,852 1.14*

1995–2000 6,512 1.28* 12,208 1.17* 456 1.29* — — — — — — 19,176 1.21*

Absolute excess risks (EARs)

O EAR O EAR O EAR O EAR O EAR O EAR O EAR

1973–79 3,701 21 12,375 23 11,258 18 8,861 13 6,846 8 4,355 9 47,396 17

1980–84 3,566 22 12,086 24 11,035 20 8,429 23 4,109 19 87 6 39,312 22

1985–89 4,493 23 15,732 23 14,208 20 7,071 20 167 37 — — 41,671 22

1990–94 5,744 28 19,320 20 12,493 21 295 42 — — — — 37,852 21

1995–2000 6,512 40 12,208 25 456 45 — — — — — — 19,176 30
Tobacco and Alcohol—Tobacco smoking and alcohol

intake are major causes of cancer in the general population and also appear to account for a sizable proportion

of the new malignancies among cancer survivors (Vineis

et al, 2004; Boffetta et al, 2006). More than 11,000 of the

25,000 subsequent cancers observed following initial

cancers that are typically related to tobacco and/or alcohol (e.g., oral cavity/pharynx, esophagus, larynx, and

lung) occurred at a variety of sites also related to these

exposures (Table 1.C). In terms of absolute excess risk,

tobacco/alcohol-related cancer sites accounted for about

10,000 excess subsequent cancers or more than 35% of

the total excess subsequent cancers occurring in this survey (initial cancer sites with O/E>1.0). The rate of excess

cancers (EAR) was estimated at 114 cases per 10,000

person-years. More detailed data provided in this monograph suggest a differential effect of tobacco or alcohol

when the initial cancers are analyzed by histologic type

(e.g., squamous cell carcinoma versus adenocarcinoma of

the esophagus), by cancer subsite (e.g., renal pelvis versus renal parenchyma), or by earlier age at initial diagnosis (e.g., ages <70 versus *70 years). The impact of

tobacco and alcohol on the risk of second cancers is also

evident in the risk reductions that have been reported

with cessation of exposures after the initial cancer diagnosis (Do et al, 2004).

Nutrition and Hormones—Although we could not

directly measure the impact of diet, obesity, physical

inactivity, reproductive, and other lifestyle risk factors

on the incidence of subsequent tumors in our survey, it

seems likely that these factors contributed to the excess

risk of new malignancies we and others have observed

among patients with cancers of the female breast, reproductive organs, and the upper and lower digestive tract

(Henderson and Feigelson, 2000; Calle et al, 2003; Key et

al, 2004, Pike et al, 2004; Samanic et al, 2006). For example, along with tobacco and alcohol, low consumption

of fruits and vegetables may have influenced the risk of

multicentric tumors along the upper aerodigestive tract,

while caloric excess, obesity, physical inactivity, and

reproductive factors probably contributed to the constellation of hormone-dependent tumors (breast, uterine

corpus, ovary, and prostate), as well as cancers of the

large bowel.

Infections and Immunosuppression—There is growing

awareness that certain infectious agents (e.g., human

papillomavirus [HPV], human immunodeficiency virus,

human herpesvirus 8, Epstein-Barr virus, hepatitis B and

C, Helicobacter pylori) as well as altered immune regulation and inflammation may have contributed to certain

combinations of tumors (Hisada and Rabkin, 2005;

Morgan et al, 2006). For example, cancers of the cervix

and anogenital tract were likely to occur together as a

result of HPV infections and underlying immunologic

defects. The combination of anal tumors and tonsillar

cancers also appeared to reflect HPV infections. With

lymphoproliferative tumors such as chronic lymphocytic

leukemia, the accompanying immune dysfunction probably contributed to the excess risks of certain cancers, such

as cutaneous melanoma, as reported also in immunosuppressed transplant recipients.

Genetic Predisposition—Because heritable cancers tend

to present earlier in life than sporadic tumors, the detailed

analyses of risk by age at diagnosis, along with the find4 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

INTRODUCTION

Notes: The population at risk includes 336,929 patients who survived 2 or more months after an initial diagnosis of cancer of the oral cavity/pharynx, esophagus, larynx,

or lung/bronchus during 1973 to 2000 (221,000 males and 115,929 females, 9 SEER registries). Cancers of the oral cavity/pharynx are defined to include cancers of the

tongue, tonsil, mouth/floor of mouth, oropharynx, and hypopharynx. All subsequent cancers include 2nd, 3rd, and later primaries and encompass all cancer sites, except

for non-melanoma skin.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; E=expected numbers of subsequent cancers; O/E=ratio of observed to expected

cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000).

*P <0.05.

Table 1.C: Risk of subsequent primary cancers following first primary cancers that are strongly related to tobacco and/or alcohol

exposure (oral cavity and pharynx, esophagus, larynx, lung, and bronchus), by sex, SEER 1973-2000.

Total Males Females

Subsequent

primary cancer O O/E EAR O O/E EAR O O/E EAR

All subsequent cancers 24,688 1.64* 114 17,491 1.58* 120 7,197 1.82* 105

Oral/pharynx, esophagus, larynx,

and lung/bronchus 11,593 3.62* 99 8,184 3.20* 105 3,409 5.33* 90

Oral/pharynx 2,510 9.04* 26 1,742 7.78* 28 768 14.29* 23

Larynx, lung/bronchus 8,084 2.95* 63 5,704 2.62* 66 2,380 4.26* 59

Esophagus 999 5.49* 10 738 4.74* 11 261 9.94* 8

Bladder, renal pelvis, ureter,

and kidney parenchyma 1,772 1.44* 6 1,449 1.39* 8 323 1.71* 4

Bladder, renal pelvis, ureter 1,325 1.42* 5 1,116 1.38* 6 209 1.68* 3

Kidney parenchyma 447 1.48* 2 333 1.40* 2 114 1.78* 2

Pancreas 531 1.36* 2 346 1.28* 1 185 1.55* 2

Cervix uteri 60 1.16 <1 — — — 60 1.16 <1

Stomach 474 1.39* 2 395 1.44* 2 79 1.17 <1

All other cancers 10,258 1.05* 5 7,117 1.03* 4 3,141 1.08* 8
ing of reciprocal associations, may point to underlying

genetic susceptibility (Garber and Offit, 2005). In particular, some constellations of tumors found in our study

appeared to be manifestations of a familial cancer syndrome. Following early-onset colon cancer, the excess

risks of cancers of the uterine corpus, ovary, bile ducts,

small intestine, and renal pelvis resemble features of

hereditary nonpolyposis colon cancer (Lynch syndrome),

due to inherited mismatch repair genes (Umar et al,

2004). Among younger women with breast cancer, the

remarkably high risks of contralateral breast and ovarian

cancer are consistent with heritable syndromes associated with germline mutations of BRCA1/2 (Thompson and

Easton, 2004). In addition, the association of breast cancer, sarcomas, and certain other cancers in children and

young adults may reflect the occurrence of Li-Fraumeni

syndrome, related mainly to germline mutations of p53

(Hisada et al, 1998). In clarifying the role of genetic susceptibility in multiple primary cancers, special insights

have come from population-based family surveys of cancer carried out in Utah (Goldgar et al, 1994) and Sweden

(Hemminki and Boffetta, 2004).

Treatment Effects—The overall data from the monograph suggested that cancer therapy among older

adults was not associated with a substantial increase 

in subsequent cancer risk. In contrast, children and

young adults seemed to be especially prone to the carcinogenic effects of intensive radio-chemotherapy regimens (Bhatia, 2005; van Leeuwen and Travis, 2005).

Children who survived 5 or more years after initial

radiotherapy had the greatest risks of solid tumors, in

keeping with the long latency typically seen for radiogenic solid cancers. In young adults, radiation contributed to the heightened risk for solid tumors arising

in the fields of intense radiation exposure. Especially

pronounced were the elevated risks of breast, lung, 

and other cancers among patients given radiotherapy

for Hodgkin lymphoma. Although radiogenic cancers

were not common following most adult-onset malignancies, excess risks were seen for cancers of the lung

and esophagus, as well as sarcomas, following initial

radiotherapy for breast cancer, while elevated risks

were noted for acute leukemia after pelvic irradiation

for cancers of the cervix and uterine corpus. Although

the effects of chemotherapy and hormonal therapy 

were not directly assessed in our survey, markedly elevated risks of acute leukemia were observed following

several cancers that have been generally treated with

agents that are potentially leukemogenic. Among breast

cancer patients, hormonal therapy (primarily tamoxifen) appeared to increase the incidence of cancer of the

uterine corpus while decreasing the risk of contralateral

breast cancer.

Future Directions

The results from the SEER Program and other surveys

reported in the literature show clearly that the burden of

second cancer occurrence is not borne equally among all

cancer survivors. Instead, there are specific constellations

of multiple tumors, so that it is possible to tailor strategies

for primary and secondary prevention, including longterm medical surveillance aimed at the early diagnosis

and treatment of subsequent tumors. The lowering of

second cancer risk reported among survivors who

changed their high-risk behaviors, most notably by cessation of smoking and alcohol drinking, indicates the need

for behavioral research and educational programs to

reinforce the importance of lifestyle changes that curtail

exposure to cancer risk factors (Bellizzi et al, 2005; Pinto

and Trunzo, 2005). While further work is needed to identify the causal factors underpinning some combinations

of multiple cancers (e.g., thyroid and renal cancers), it

seems reasonable that dietary and physical activity programs aimed at reducing excess body weight should also

help lower not only the risk of a first primary cancer, but

also the risk of subsequent cancers, along with increasing

fruit and vegetable intake, reducing exposures to carcinogens in the workplace and environment, and limiting

exposure to ultraviolet light and ionizing radiation

whenever possible.

In addition to identifying the role of shared risk

factors, studies of multiple primary cancers have been

invaluable in detecting the late effects of cancer therapy,

including leukemia and solid tumors, so that risk-benefit

calculations can be made and appropriate patient groups

identified for preventive interventions, including screening for new malignancies and chemopreventive strategies (van Leeuwen and Travis, 2005). The emergence of

solid tumors as a late consequence of certain cancer

therapies indicates the importance of long-term surveillance for subsequent cancers in SEER and other cancer

registries, followed by case-control studies of tumors

that occur excessively. Special emphasis should be

placed on long-term follow-up of patients enrolled in

clinical trials so that precise treatment details are available to monitor the potential adverse effects of specific

therapies, which can then be weighed against their benefits. The results should inform clinical decision-making

and the search for improved treatments that result in

better survival rates as well as fewer late effects.

Several of the multiple cancer patterns presented in

this monograph appear to reflect the activity of highpenetrant gene mutations that also underlie hereditary

cancer syndromes (Garber and Offit, 2005). The challenge

now is to identify the more common low-penetrant gene

polymorphisms involved in modifying the carcinogenic

risks of lifestyle and other environmental exposures,

including the risks of radiation- and chemotherapyrelated cancers. The recent report of an NCI workshop on

cancer survivorship outlined the clinical, epidemiologic,

molecular, and interdisciplinary research strategies that

will enable a more complete understanding of the role of

genetic predisposition in new malignancies among cancer survivors (Travis et al, 2006). Because recent advances

in genomic and molecular sciences can now be incorporated into epidemiologic research, it should be possible to

INTRODUCTION 5

INTRODUCTION
6 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

illuminate the mechanisms of susceptibility to multiple

cancers and provide insights into the long-term medical

care and preventive interventions that will benefit the

growing population of cancer survivors.

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INTRODUCTION
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INTRODUCTION

The maturation of large cancer registries in the U.S. and

internationally has greatly enhanced our ability to identify large numbers of patients with multiple primary cancers (Boice et al, 1985; Curtis et al, 1985; Sankila et al,

1995; Travis et al, 1996, 2005; Neugut et al, 1999; Crocetti

et al, 2001; Dong and Hemminki, 2001; van Leeuwen and

Travis, 2005; Mellemkjaer et al, 2006; Schottenfeld and

Beebe-Dimmer, 2006). The high-quality, population-based

cancer registries from the National Cancer Institute’s

(NCI’s) Surveillance, Epidemiology, and End Results

(SEER) Program (Ries et al, 2006) provide a unique

resource with which to evaluate the risk of subsequent

cancers due to the extremely large number of survivors

(more than 2 million), long follow-up period (since 1973),

and standardized registry methods.

This current monograph utilizes the SEER database to

provide a comprehensive evaluation of the risk of subsequent malignancies among patients initially diagnosed

with 1 of more than 50 types of adult and 18 types of

childhood primary cancer. The purpose of this chapter

is to lay the foundation for subsequent chapters by

describing the SEER study populations and analytic

methodology used for the monograph. The presentation

and interpretation of the statistical results are explained,

along with the strengths and limitations of the study.

Study Population:

SEER Cancer Registries

The SEER Program was established in 1973 to collect

high-quality, population-based data on cancer incidence

and survival in the U.S. (Hankey et al, 1999). Areas initially included in 1973 were the states of Connecticut,

Iowa, New Mexico, Utah, and Hawaii, and the metropolitan areas of Detroit and San Francisco-Oakland (Ries et

al, 2006; NCI, 2006a). The 13-county Seattle-Puget Sound

area was added in 1974, and the metropolitan area of

Atlanta was included in 1975. Persons in the SEER geographic areas resemble the U.S. population in the proportion of persons below the poverty level or with less than

a high school diploma but differ in having higher percentages of urban and foreign-born residents. The study

population for the current monograph includes the nearly 2 million cancer patients reported to the 9 SEER registries from 1973 to 2000, with follow-up for subsequent

cancer occurrence extending up to 27 years, in order to

ensure consistency of geographic areas over the longest

time period possible. Additional SEER registries that contribute to cancer incidence reporting, but are not included in the current survey, are the more recently added

areas of Los Angeles and San Jose-Monterey, Kentucky,

New Jersey, the remaining geographic areas in California,

Louisiana, and the smaller registries of rural Georgia and

Alaska natives.

The SEER registries maintain a high level of ascertainment of incident cancer cases through searches of records

of hospitals and radiotherapy units, as well as private

diagnostic laboratories and treatment centers. All cancers

occurring among residents of the defined geographic

areas are reportable to SEER; however, second or later

(“subsequent”) cancers diagnosed among patients who

migrate out of their SEER registry area are not reportable,

and migration status is not recorded in the SEER database. Information routinely collected by the registries

includes patient demographics (sex, race, age, place of

residence), date of cancer diagnosis, primary cancer site

and morphology, diagnosis confirmation by microscopic

study or other methods, extent of disease (stage), first

course of cancer-directed treatment, vital status, date last

known to be alive or date of death, and cause of death for

those who have died. A high rate of follow-up (97%)

for vital status (alive/dead) is achieved by actively tracing all living patients (regardless of out-migration) and

by linking with state and national death registries.

The SEER rules for classifying multiple primary cancers depend on the cancer site of origin, date of diagnosis, histology, tumor behavior (i.e., in situ versus invasive), and laterality of paired organs (NCI, 2006b). In

general, all metachronous cancers (occurring 2 or more

months after initial diagnosis) are considered as separate

primaries unless the medical record states that the tumor

is recurrent or metastatic. Notable exceptions to this rule

are multiple adenocarcinomas of the prostate and multiple transitional cell carcinomas of the bladder (histology

8120-8130), which are reported as single primaries. Multiple tumors occurring on both sides of paired organs,

such as the breast and testes, are generally considered to

be independent cancers. Rules for determining multiple

primaries of the lymphatic and hematopoietic system are

METHODS

METHODS 9

Chapter 2

Methods

Rochelle E. Curtis, Lynn A. G. Ries

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

PYR=person-years at risk; EAR=excess absolute risk (excess cancers

per 10,000 person-years, calculated as [(O-E)/PYR]10,000).

Author affiliations: Rochelle E. Curtis, Division of Cancer

Epidemiology and Genetics, NCI, NIH, DHHS; Lynn A. G. Ries,

Division of Cancer Control and Population Sciences, NCI, NIH, DHHS.
more complex and depend on the specific histologic types

involved. International coding rules for multiple cancers

are more restrictive than those used in the U.S. Cancers

that occur at the same site or different sides of a paired

organ are usually considered to be 1 primary under

international coding rules, unless the 2 tumors belong

to separate histologic categories (IARC, 2004).

The SEER Program collects data on the first course of

cancer-directed therapy (surgery, radiation, chemotherapy, hormonal therapy, immunotherapy, and other

therapy). Prior to 1988, the first course was defined to

include all treatment administered to the patient within

4 months after the initiation of therapy (2 months for

leukemias) or until disease progression, whichever was

earlier. Beginning in 1988, all case reports included the

entire first course of therapy, regardless of duration 

(NCI, 2006b). Because cancer patients commonly receive

surgery and radiation therapy at hospitals or medical

centers that routinely report to the central registries,

these treatments are captured for the large majority of

patients. Data on treatments commonly given outside 

the hospital setting—such as chemotherapy, hormonal

therapy, and immunotherapy—are incomplete and therefore are not included in the public-use SEER database or

in this monograph. The SEER Program also does not

record palliative therapy or therapy given after the initial

course of treatment.

Analytic Methods

The cohort study is the most frequent epidemiologic

approach used to determine if an observed number of

subsequent cancers occurs more or less frequently than

would be expected by chance alone. With this study

design, a defined population of persons with a specific

first cancer is followed over time for a number of years to

examine the risk of developing a subsequent primary

cancer, with the person-years at risk (PYR) allocated by

age, sex, and other factors (Monson, 1974; Schoenberg

and Myers, 1977). The ratio of observed to expected

subsequent cancers (O/E) is then calculated by dividing

the observed number of new cancers by the number

expected if patients in the cohort experienced the same

cancer rates as persons in the general reference population (Boice et al, 1985; Begg, 1999; van Leeuwen and

Travis, 2005). The O/E ratio (or standardized incidence

ratio, SIR) is frequently referred to as the “relative risk”

because it compares the incidence rate of the event of

interest (e.g., subsequent breast cancer) to the baseline

incidence rate of that cancer (e.g., all breast cancer) in a

general population of persons of comparable age, sex,

and time distribution. The relative risk is generally

considered a measure of the strength of an association.

Another useful statistic is the excess absolute risk 

(EAR), which is calculated as the difference between 

the subsequent cancer rate in the cohort being evaluated

and the rate expected in the standard population. The

EAR is frequently used to measure the overall burden

due to subsequent cancers.

O/E and EAR Calculations

For the monograph, we evaluated all patients diagnosed

with an invasive cancer as a first primary malignancy

who were reported to 1 of 9 SEER registries between

January 1, 1973, and December 31, 2000. Because heightened screening of cancer patients during the initial medical work-up tends to identify many simultaneous cancers,

we excluded from the calculations the first 2 months of

follow-up and the new malignancies occurring within

this initial 2-month period. The PYR for each individual

began at 2 months after the date of the initial cancer

diagnosis and ended at the date of last known vital

status, death, or the end of study (December 31, 2000),

whichever occurred first. SEER cancer registry incidence

files were searched for subsequent primary cancers that

developed at least 2 months after the patient’s first primary diagnosis and before the study cutoff date. All

second and later (third, fourth, etc.) invasive cancers

were included in the observed numbers of cases to be

comparable with the expected number derived from

baseline SEER incidence rates, which include all multiple

tumors. Non-melanoma skin cancers, with the exception

of Kaposi sarcoma, were excluded because most such

tumors (i.e., basal cell and squamous cell skin cancers)

are not reportable to the SEER Program. For each initial

cancer site grouping, the PYR and observed cases of cancer were stratified according to age at initial diagnosis

(5-year groups), race (whites/unknown, blacks, other

races), sex, and 5-year calendar year intervals. Cancer

incidence rates were computed for the 9 SEER areas combined for each type of invasive cancer, by race, sex, age,

and calendar-year group, and were multiplied by the

accumulated PYR to estimate the expected number of

subsequent malignancies for each stratum. The total

observed and expected numbers of subsequent cancers

for each stratum were then summed. The O/E ratios for

each subsequent cancer site were calculated as the

observed number divided by the expected number of

subsequent cancer cases.

Tests on the statistical significance of the O/E ratios

were performed under the assumptions that the

observed number of subsequent cancers followed a

Poisson distribution, and that no variation was associated

with the expected number of cases. Byar’s accurate

approximation to the exact Poisson distribution was 

used to calculate 95% confidence intervals (Breslow and

Day, 1987). The O/E ratios for which the 95% confidence

interval excluded 1.0 were designated as statistically significant (P<0.05) and are indicated in the monograph

tables with an asterisk (*).

To compute the excess absolute risk or EAR, we subtracted the expected number of subsequent cancers from

the observed number of cancer cases; the difference was

then divided by the PYR, and the number of excess cancer

cases was expressed per 10,000 PYR, [(O-E)/PYR]  10,000.

O/E and EAR calculations were performed using the

“MP-SIR” session of SEER*Stat, a publicly available, interactive, Windows-based program for analyzing cancer registry data (NCI, 2006c).

10 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

METHODS
METHODS

METHODS 11

Understanding Relative Versus

Absolute Risks

The relative risk (O/E) provides a useful tool to test etiologic hypotheses and to screen for significantly increased

or decreased risks of developing new malignancies

(Begg, 1999). A sharply elevated relative risk based on a

large number of subsequent cancer cases provides strong

evidence of a positive association with the first primary

cancer. Significantly increased risks between 2 malignancies that are bidirectional in nature (elevated risks for

cancer B after cancer A, and also for cancer A after cancer

B), are suggestive of shared etiologic factors, particularly

when the elevation in risk persists beyond the initial

follow-up period (5 years) and the risk appears unrelated to initial therapy. High relative risks of subsequent

cancer can sometimes be associated with low EARs, for

example when the baseline cancer incidence rate in the

referent population is low, as with therapy-related acute

leukemia or when studying children and young adults.

In contrast, modest or even small increases in the relative

risk can result in high EARs of new malignancies at older

ages, when the background cancer burden in the referent

population is greatest. In general, the EAR is often the

most useful measure of risk to assess the impact of the

subsequent cancer burden in a specific population of

cancer patients, or when interest centers on the potential

effectiveness of screening or prevention programs.

Both relative risks and EARs of subsequent cancers

can vary by age, sex, time since diagnosis, or other baseline factors. Thus, comparisons of risk for different types

of second cancers or across cohorts can be misleading

when patient groups being compared have different

underlying distributions of one or more of these factors

(Armstrong, 1995). In this case, it may be necessary to

stratify the analysis to evaluate risk within homogeneous

patient subgroups, for example, within similar age and

time intervals. Alternatively, multivariate regression

methods may be employed to adjust for differences in

baseline characteristics of age and other factors and to

account for confounding variables, as used in studies 

of treatment-related second cancers (Yasui et al, 2003;

Zablotska and Neugut, 2003; Travis et al, 2005; 

van Leeuwen and Travis, 2005). In this monograph, 

we have stratified most results by sex, age, time since

diagnosis, and radiation treatment, whenever possible.

Cumulative Incidence

We calculated the cumulative incidence as the percentage

of patients developing a second malignancy by a specified time (10, 15, or 25 years) after the initial cancer diagnosis, while taking into account the competing risk of

death among patients who did not develop a second

malignancy (Gooley et al, 1999; see Appendix 1). It is

important to recognize that when the risk from competing outcomes is large, the cumulative incidence function

is the more appropriate statistic to use as compared with

actuarial methods of cumulative risk (e.g., Kaplan Meier

methods, Kaplan and Meier, 1958), which censor patients

at the time of the competing event. The cumulative incidence is an absolute measure of second cancer incidence

and, in general, tends to rise with increasing age of the

cohort at risk. The measure, by itself, provides no indication of whether the second cancer incidence is higher or

lower than the cancer incidence rate prevailing in the

general population. Cumulative incidence calculations

were performed for the monograph using a program by

Gooley et al. (1999), and 95% confidence intervals by a

program developed by Choudhury (2002). (See also the

software program “stcompet” from StataCorp, described

in Coviello and Boggess, 2004.)

Presentation of Results

Results are presented in 16 chapters, organized by grouping of initial cancer sites. Cancer diagnoses were categorized according to the International Classification of Diseases for Oncology, second edition (ICD-O-2) (Percy et al,

1990). Definitions of the first and subsequent cancer sites,

and groupings by histologic type, are given in Appendices 2.A-2.D. Each chapter provides background information for the first cancer(s) (survival statistics, usual

therapy, etc.), major risk factors, and a Results and Discussion section that describes the patterns of subsequent

cancer risks and discusses the findings in relation to

potential risk factors and previous studies of multiple

primary cancers.

Standard data tables are typically included at the end

of each chapter. Initial tables provide patient characteristics by sex, race, age, first course of cancer-directed therapy (surgery and/or radiation), and PYR. The number of

patients with exactly 1, 2, 3, or 4 or more cancers is tabulated. The percentage of patients developing multiple

primary tumors who have their cancers confirmed by

histologic or other methods are described in overlapping

categories: the percentage of cases with at least the first

and second primary cancers (but not necessarily later

cancers) histologically confirmed; the percentage with

first, second, and all later primary cancers confirmed;

and the percentage with only the first primary cancer

confirmed, but not second, third, or later primary cancers. Tables that follow present the risk of developing a

subsequent primary cancer (O/E and EAR) by years after

diagnosis of the first cancer (time since diagnosis intervals: 2 months to 1 yr; 1-4 yrs; 5-9 yrs; 10 yrs; and total

2 months) for both sexes combined, by sex, and, when

numbers are sufficient, by age at initial diagnosis. For

selected sites of initial cancers, results are tabulated for

long-term survivors (time since diagnosis intervals: 2

months to 9 yrs; 10-14 yrs; 15-19 yrs; 20 yrs; and total

2 months), by initial treatment (any radiotherapy, no

radiotherapy), and, when informative, by histologic type.

The number of patients at risk at the beginning of the

follow-up interval (“number starting interval”) is given,

as well as the total PYR accumulated during the followup interval (“person-years in interval”). Note that the

number of patients starting the interval decreases with

each succeeding observation period (except for the total),
as patients are withdrawn from analysis due to death,

loss to follow-up, or study end, whereas the sum of the

PYR for each follow-up interval equals the total PYR.

The cumulative incidence (%) of developing a second

cancer is provided for each initial cancer site grouping in

the respective chapters, and for selected sites in line

graphs within the text. Monograph Appendix 1 includes

line graphs for 48 first primary cancer sites, giving the

cumulative incidence of any second cancer and the

cumulative probability of death from competing causes

at 25 years after initial diagnosis. When the patterns of

risk by age are of interest, bar graphs are included in the

chapter text, displaying the O/E and EAR of subsequent

cancers by age at initial cancer diagnosis.

Methodologic Limitations

The monograph results should be viewed in light of the

potential sources of ascertainment bias, as well as diagnostic and other biases inherent in studies of multiple

primary cancers, and these limitations should be taken

into account in evaluating the results.

Assessment of Cancer Independence—A key assumption in the analysis of multiple primary cancers is that

the individual malignancies are biologically independent.

SEER registries rely on the pathology report as to

whether a new malignancy is a separate primary cancer

as opposed to a metastatic lesion or local recurrence of

the original cancer. Histopathologic confirmation of the

new malignancy increases the confidence in the diagnosis of a subsequent primary cancer, but it may not provide definitive evidence of independence. Correct classification as a multiple primary cancer may also be

problematic when new malignancies arise at the same

anatomic site and with the same histology as the first

tumor, particularly in paired or contiguous organs. To

address this issue, the monograph tables provide separate estimates of the risk of developing a subsequent cancer of an organ different from the first. (See Appendix 2.C

for cancer site definitions.) Further difficulties occur

when multiple tumors arise in the same tissue in what is

known as the “field cancerization” process, for example,

tobacco- and/or alcohol-related tumors of the oral cavity

and pharynx. While SEER registries generally consider

these field-related cancers to be separate malignancies,

this research area is still evolving, and recent molecular

studies report that multifocal tumors in some organs, such

as the lower urinary tract, are likely to originate from a

single transformed molecular clone (Habuchi, 2005).

Medical Surveillance Bias—Cancer patients are often

under closer medical surveillance than persons in the

general population. This increased scrutiny may lead to

an ascertainment bias in the early detection of asymptomatic cancers that otherwise might not have been clinically evident for several years (known as lead-time bias).

In addition, increased cancer screening and autopsy

investigations frequently uncover indolent tumors that

otherwise might not have been clinically detected during

the patient’s lifetime. Malignancies that are especially susceptible to detection by medical screening include cancers

of the thyroid, kidney, and prostate. Conversely, underreporting of second and later cancers may occur among

cancer survivors who have metastases or other serious

comorbid conditions, or among those diagnosed at older

ages whose life expectancy is short. New contralateral

tumors of the lung, for example, are often underreported,

as they are assumed to represent spread of the original

cancer (Johnson, 1998). Artifactually reduced risks of subsequent cancers can also occur when surgery for the initial tumor removes one or more organs from risk, for

example, when the uterus and ovaries are surgically

removed during treatment for gynecologic cancers.

Underascertainment of Subsequent Cancers Due to

Out-migration—Subsequent cancers are not recorded in

the SEER database for patients who migrate from their

original SEER geographic area, regardless of whether

they move into another SEER area. This underascertainment of subsequent cancer cases results in conservative

(negatively biased) estimates of subsequent cancer risk,

as the expected number of new malignancies is based on

the assumption that patients remain at risk until their

date of last known vital status or death. Although the

impact of out-migration on subsequent cancer risk has

not been assessed, this factor is likely to be important for

highly mobile metropolitan areas, for the longest followup observation periods (10 and 20 years after initial diagnosis), and for children and young adults.

Radiation-related Cancers—O/E comparisons of irradiated with nonirradiated patients may underestimate the

risk of radiation-related cancers when patients classified

as “without initial radiotherapy” actually received radiotherapy that was not reported to registry databases

(Du et al, 1999). Moreover, subsequent cancer risks for

patients treated with radiotherapy may be difficult to

interpret without accounting for the carcinogenic effects

of chemotherapy, particularly in the case of therapyrelated leukemia.

Interpretation of Small Numbers—In contrast to most

other SEER reports of incidence and survival, the monograph tables include results for individual cancers that

are based on small numbers of observed cases (less than

5 cases) over a large number of PYR. This comprehensive

approach to data reporting for all subgroups enables the

monograph user to combine observed and expected

numbers over several cancer sites to detect broad etiologic patterns and permits comparison of findings for

uncommon cancers with those of other studies.

Multiple Comparisons—The monograph aimed for the

presentation of subsequent cancer risks by sex, age, time

since diagnosis, and other factors, resulting in a large

number of multiple comparisons for each initial cancer

site. Multiple testing of stratified data tends to identify a

number of statistically significant risks of subsequent

cancer that may have occurred by chance alone (Savitz

and Olshan, 1995; Goodman, 1998). To distinguish real

from chance findings, the results should be viewed in

light of the biologic plausibility of the association, consistency with previous second cancer studies, and epidemiologic characteristics of the tumors involved.

12 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

METHODS
Methodologic Strengths

Notwithstanding the potential biases and caveats noted

above, the SEER registry database represents a powerful

analytic resource for assessing the incidence of new

malignancies among cancer survivors. The SEER Program is generally considered to be the standard for quality among cancer registries around the world, with nearly

complete reporting of incident cancer cases within the

covered geographic areas. Because the SEER registries

are population-based and are broadly representative of

the U.S. population, these analyses avoid potential biases

that can be introduced in hospital-based studies as a

result of area referral patterns and incomplete follow-up.

High rates of microscopic confirmation for new cancer

cases, and the use of precise rules to ascertain and code

first and later primary cancers, are key features of the

SEER Program that help ensure the validity of the patterns observed.

This monograph provides the largest assessment to

date of the risk of new cancers among cancer survivors.

The study covers more than 2 million cancer survivors;

nearly 390,000 patients were at risk for 10 or more years

after the initial cancer developed, and almost 76,000

patients were at risk for 20 or more years. There were

more than 11 million person-years at risk in the analysis,

yielding 186,000 subsequent primary cancers. Because of

these large numbers, the monograph is able to provide a

wealth of new data on the risk of developing a subsequent cancer for most initial forms of cancer, including

some uncommon sites. The detailed presentation in the

monograph of subsequent cancer risks by time since initial diagnosis, sex, age, treatment, and histologic type

provides a comprehensive resource from which causal

hypotheses can be generated and tested in more focused

analytic studies in the SEER Program or in other populations where second primary cancers can be evaluated

(Curtis et al, 1992; Travis et al, 2000, 2002, 2003). Finally,

the results presented in this monograph should be useful

to clinicians in advising their cancer patients on long-term

outcomes and the importance of medical supervision for

prevention and early detection of new malignancies.

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METHODS

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METHODS
NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 15

Synopsis

The risk of subsequent primary cancer was assessed

in more than 56,000 patients diagnosed with cancers

of the buccal cavity or pharynx—including lip,

tongue, salivary gland, mouth, nasopharynx, tonsil,

oropharynx, and hypopharynx cancers—between

1973 and 2000. The overall risk of new malignancies

was significantly elevated among survivors of cancers

of the lip (O/E=1.16, O=1,814, EAR=34 per 10,000

person-years), oral cavity and pharynx (tongue, tonsil, 

mouth, oropharynx and hypopharynx) (O/E=2.45,

O=7,076, EAR=231), salivary gland (O/E=1.25, O=644,

EAR=33), and nasopharynx (O/E=1.49, O=267, EAR=47).

Tobacco smoking and/or alcohol consumption

probably account for the excess risks of many new

malignancies, including tumors of the buccal cavity

and pharynx, esophagus, larynx, lung, nasal cavity,

stomach, urinary bladder, pancreas, and liver. Exposure to ultraviolet radiation from sunlight exposure

probably contributed to the excess risk of melanoma

following cancer of the lip. In addition, Epstein-Barr

virus infection may have played a role in the increase

of non-Hodgkin lymphoma following nasopharyngeal cancer, and human papillomavirus infection may

have been a factor in the excess of anogenital tumors

following certain types of oral cancer. 

Lip Cancer

Cancer of the lip is relatively rare, accounting for less

than 10% of all cancers of the buccal cavity and pharynx. More than 95% of lip cancers are squamous cell

carcinomas, and most occur on the lower lip (Moore

et al, 1999; Veness, 2001). Lip cancer is extremely rare

in the black population, probably due to the protective

effects of skin pigmentation on sun exposure (Moore

et al, 1999), and it is 5 times more common in white

men than women, probably because women have less

occupational sun exposure and use more lip protection

(de Visscher and van der Waal, 1998). Most patients

present with early-stage disease; thus the 5- and 10-year

relative survival rates have been high in recent years,

92.9% and 90.0%, respectively. Surgery alone, the preferred treatment for comparatively superficial disease,

is used for the majority of patients (Veness, 2001).

Patients with more advanced disease often receive

radiotherapy alone to avoid unacceptable disfigurement or loss of function. Adjuvant radiotherapy has

been used for patients presenting with regional or

nodal metastasis (Veness, 2001).

The best-documented risk factors for lip cancer are

prolonged ultraviolet (UV) radiation exposure from

sunlight, use of tobacco products, and fair complexion.

Other suspected risk factors include genetic susceptibility,

immunosuppression, low socioeconomic status, poor

oral hygiene, and perhaps heavy alcohol consumption

(de Visscher and van der Waal, 1998; Moore et al, 1999).

Results and Discussion

There was a small increased risk of all new malignancies

combined among the 8,188 2-month survivors of lip

cancer (O/E=1.16, O=1,814, 95% CI=1.11-1.22, EAR=34

per 10,000 person-years). The cumulative incidence of

developing a second cancer following lip cancer adjusting for the competing risk of death due to other causes

was 26.8% at 25 years (95% CI=25.6%-28.0%). Elevated

risk was limited to the first 10 years of follow-up.

Patients diagnosed at younger than age 50 years had a

43% higher relative risk of new malignancies, whereas

patients ages 70 years and older had a 13% increased

risk. Nonetheless, the excess absolute cancer risk was

more than 40% higher in the older patients compared

with the younger patients. The relative risk of subsequent primary cancers was similar in males and females,

but the excess absolute risk was higher in men (EAR=35)

than in women (EAR=28). Significantly elevated risks

of 3-fold or greater were seen for subsequent cancers of

the buccal cavity (especially the lip, salivary gland, and

mouth), as well as for Hodgkin lymphoma. Risks were

also significantly elevated, but to a lesser extent, for

cancers of the larynx and lung, as well as for melanoma

of the skin. In contrast, the risk for subsequent brain

cancer was significantly decreased after lip cancer. The

increased risks for new malignancies of the buccal cavity

BUCCAL CAVITY AND PHARYNX

Chapter 3

New Malignancies Following Cancer

of the Buccal Cavity and Pharynx

Linda Morris Brown, Peter McCarron, D. Michal Freedman 

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated

as [(O-E)/PYR]10,000).

Author affiliations: Linda Morris Brown and D. Michal Freedman,

Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS;

Peter McCarron, Division of Cancer Control and Population Sciences,

NCI, NIH, DHHS. Present address for Dr. McCarron: Department 

of Epidemiology and Public Health, Queen’s University Belfast, 

Royal Victoria Hospital, Belfast, United Kingdom. Dr. McCarron is

supported by a career scientist award funded by the Research and

Development Office for Health and Personal Social Services in

Northern Ireland.
and respiratory system were found in a previous survey

of lip cancer (Winn and Blot, 1985). 

Tobacco use is a risk factor for primary cancers of

the lip, oral cavity, and respiratory system and likely

contributes to the tendency toward multiple cancers

at these sites (Day and Blot, 1992; de Visscher and van

der Waal, 1998). The role of tobacco is underscored by

the significant reciprocal excess of lip cancer following

other cancers of the buccal cavity, although significant

excesses of lip cancer were not seen following cancers

of the lung in this survey.

The elevated risk of cutaneous melanoma after lip

cancer, which was limited to males, is consistent with

the role of UV radiation following occupational and

other exposures to sunlight, especially in light-skinned

individuals (de Visscher and van der Waal, 1998;

Armstrong and Kricker, 2001). 

In addition, an elevated risk for Hodgkin lymphoma

was seen following lip cancer, although the reasons are

unclear. It is interesting, however, that a significant

reciprocal excess of lip cancer was noted after Hodgkin

lymphoma and other lymphoproliferative malignancies,

mainly non-Hodgkin lymphoma (NHL) and chronic

lymphocytic leukemia. Increased risk of subsequent lip

cancer has been previously observed following NHL

(Brennan et al, 2000) and following transplantation

(King et al, 1995; Curtis et al, 1997), suggesting the role

of underlying immunologic alterations.

Cancers of the Oral Cavity and Pharynx

Cancers of the tongue, tonsil, mouth, hypopharynx,

and oropharynx are grouped for this section and hereafter referred to as cancers of the oral cavity and pharynx. Together, these primarily squamous cell cancers

account for about 1% of all cancers. The 5-year relative

survival rate is slightly higher for females (61.5%)

than males (57.8%), and higher for whites (61.2%)

than blacks (39.5%). Surgery or radiation therapy is

standard treatment for early disease (Barzan et al,

1998; Forastiere et al, 2001). Advanced disease requires

surgery, usually with postoperative radiotherapy.

Recently, multiple-modality treatments that include

chemotherapy have been employed to achieve organ

preservation and improve survival (Barzan et al, 1998;

Forastiere et al, 2001).

The major risk factors for oral and pharyngeal cancer

are use of alcohol and tobacco, which increase risk multiplicatively when combined (Blot et al, 1988; Franceschi

et al, 1999). Other factors include poor oral hygiene and

dentition, poor diet with insufficient fresh fruits and

vegetables, and/or low socioeconomic status, even after

adjusting for other risk factors (Greenberg et al, 1991;

Brown et al, 2001). Recent studies have linked human

papillomavirus infection (HPV) to a subset of oral cancers, predominantly those located in the tonsillar area

or oropharynx (Gillison and Shah, 2003).

Results and Discussion

Among the 39,501 2-month survivors of cancers of the

oral cavity and pharynx, 7,076 subsequent primary

cancers were observed (O/E=2.45, O=7,076, 95%

CI=2.39-2.51, EAR=231). The cumulative incidence of

developing any second cancer was 21.4% at 25 years

(95% CI=20.8%-21.9%), which includes a 4.5% incidence

of second cancers of the oral cavity and pharynx

(Figure 3.1). Subsequent cancer risks were elevated

about 2- to 3-fold for initial cancers of the tongue, tonsil,

mouth, oropharynx, and hypopharynx. Because patterns of subsequent cancers were similar across subsites

of the oral cavity and pharynx, we combined them for

purposes of discussion, but the data tables also show

risks separately by individual sites. In the cohort of all

oral cavity and pharyngeal cancers, only slight variations

in subsequent cancer risks were seen across latency

periods and by gender. However, susceptibility to a

subsequent cancer varied substantially by age at diagnosis, with the highest relative risks (a nearly 5-fold

increase) observed for patients diagnosed with oral and

pharyngeal cancer at ages younger than 50 years (Figure 3.2). In contrast, absolute risks were highest in those

diagnosed at ages 50 to 69 years (Figure 3.2). Blacks had

a higher risk of new malignancies than whites. Although

more than 60% of the patients with cancers of the oral

cavity and pharynx received initial radiotherapy, this

therapy did not appear to have a major effect on the

risk of subsequent cancers arising in the radiotherapy

field or in sites receiving scatter radiation.

For all oral and pharyngeal cancers combined, the

increased risks of subsequent subsites of oral/pharyngeal

cancer and esophageal cancer were very high, ranging

from 16- to 33-fold. In addition, risks were significantly

elevated, but to a lesser extent (4- to 7-fold), for new

cancers of the lip, salivary glands, and nasopharynx.

Risks were also significantly elevated for subsequent

16 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BUCCAL CAVITY AND PHARYNX

All second cancers

Respiratory system 

Oral and pharynx

Esophagus

Years after initial cancer diagnosis

Cumulative incidence (%)

0 5 10 15 20 25

0

5

10

15

20

25

Figure 3.1: Cumulative incidence of developing a second

cancer among patients with cancer of the oral cavity or

pharynx (tongue, mouth, tonsil, oropharynx, hypopharynx),

both sexes, SEER 1973-2000.
BUCCAL CAVITY AND PHARYNX

malignancies of the nasal cavity, larynx, and lung (4- to

6-fold); for malignancies of the colon, rectum, stomach,

liver, pancreas, and urinary bladder (1.2- to 3-fold); and

for non-melanoma eye cancer (5-fold). In addition, significant or borderline significant elevated risks were

found for new malignancies of the anogenital region

(anus, cervix, vagina, vulva, and penis). Taken together,

these findings resemble other studies of oral and

pharyngeal cancers indicating elevated risks for subsequent oral, esophageal, respiratory, digestive, and

anogenital cancers (Tepperman and Fitzpatrick, 1981;

Schou et al, 1985; Winn and Blot, 1985; Day and Blot,

1992; Day et al, 1994; Macfarlane et al, 1995; Crosher

and McIlroy, 1998; Hemminki et al, 2001; Rafferty and

O’Dwyer, 2001).

Tobacco and/or alcohol consumption, the major causes of oral/pharynx cancer, probably account for much of

the increased risk of subsequent oral/pharynx and

esophageal cancers (La Vecchia et al, 1997), in addition

to contributing to new malignancies of the larynx, liver,

nasal cavity, lung, stomach, urinary bladder, and pancreas (Day and Blot, 1992). The modestly elevated risks

of colon (O/E=1.17) and rectal (O/E=1.32) cancers may

also reflect alcohol consumption, smoking, and possibly

dietary deficiencies (e.g., folic acid) (Potter, 1999;

Giovannucci, 2002). The tendency toward multicentric

cancers of the upper aerodigestive system appears to

involve “field cancerization” mechanisms resulting

from the interplay of smoking, alcohol, dietary factors,

and genetic alterations.

The elevated risk of anogenital tumors following oral

and pharyngeal cancer may be attributed in part to

HPV infection, especially because significant reciprocal

excesses of oral cancer were seen following cancers of

the anus, cervix, vulva, and penis (Table 3.A). Several

recent studies have suggested that HPV infection, the

major risk factor for cancers of the anogenital tract, is

also involved in certain subsites of oral cancer, particularly the tonsils and the base of the tongue (Gillison 

and Shah, 2003; Herrero et al, 2003). Smoking may also

be involved, as it is a risk factor for cervical as well as

oral cancers. Finally, the 5-fold elevated risk of nonmelanoma eye cancer, based on 4 cases of squamous

cell carcinoma of the conjunctiva and lacrimal ducts,

deserves further study, in light of the possible role of

HPV infection in conjunctival squamous cell carcinomas

(Gillison and Shah, 2003). 

Salivary Gland Cancers

Malignant tumors of the salivary gland are a heterogeneous and uncommon group, constituting somewhat

more than 10% of all buccal cavity and pharyngeal cancers. Standard treatment is surgical excision (Shrestha et

al, 1996) and prognosis is generally good, with 5- and

10-year relative survival rates of 75.3% and 70.5%,

respectively. Approximately 50% of SEER patients

received adjuvant radiation therapy to minimize

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; O/E=ratio of observed to expected cancers.

*P <0.05 (95% confidence interval does not include 1.0).

Table 3.A: Risk of a subsequent oral and pharyngeal cancer following a primary anogenital cancer.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 17

Age at diagnosis of oral and pharynx cancer (years)

EAR (per 10,000 person-years) O/E

3.22*

2.09*

2.61*

1.68*

4.50*

267

97 106

50 50-69 70

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

1.38*

All subsequent cancers

All subsequent cancers excluding 

oral cavity and pharynx

0

50

100

150

200

250

300

50 50-69 70

172 178 178

350

All subsequent cancers

All subsequent cancers 

excluding oral cavity 

and pharynx

Figure 3.2: Observed-to-expected ratio (O/E) and excess

absolute risk (EAR) of subsequent primary cancers after cancer

of the oral cavity and pharynx, both sexes, SEER 1973-2000.

*P <0.05.

Note: EAR = Excess number of subsequent cancers per 10,000 person-years.

Observed No. 827 573 4,770 3,752 1,479 1,195

Subsequent primary oral and pharyngeal cancer site

All buccal cavity 

Tonsil Tongue Mouth Hypopharynx Oropharynx and pharynx

First primary anogenital

cancer site O O/E O O/E O O/E O O/E O O/E O O/E

Anus 7 8.1* 9 4.6* 5 1.9 1 1.2 0 0.0 24 2.6*

Cervix uteri 13 3.9* 10 1.3 20 1.8* 8 3.4* 1 1.2 65 1.9*

Vulva 1 1.6 7 3.8* 9 3.1* 2 4.0 0 0.0 21 2.5*

Penis 2 3.0 5 3.7* 4 2.3 2 2.5 0 0.0 17 2.3*
disfigurement and recurrence, while chemotherapy was

reserved for advanced and recurrent disease (Shrestha

et al, 1996). 

The only well-established risk factor for salivary gland

cancer is ionizing radiation (Land et al, 1996; Saku et al,

1997; Modan et al, 1998). Positive associations, however,

have been reported in certain industries, including rubber manufacturing and woodworking in the automobile

industry, and also with occupational exposure to nickel

and radioactive materials (Horn-Ross et al, 1997;

Swanson and Burns, 1997; Sun et al, 1999). There is

uncertainty about the possible role of smoking, alcohol,

and UV exposures (Horn-Ross et al, 1997; Muscat and

Wynder, 1998; Hayes et al, 1999).

Results and Discussion

Of the 5,551 individuals who survived at least 2 months

after a diagnosis of salivary gland cancer, 644 new

malignancies were observed (O/E=1.25, O=644, 

95% CI=1.16-1.35, EAR=33). The estimated cumulative

incidence of second cancer was 17.3% at 25 years 

(95% CI=15.8%-18.8%). A 37% increased risk of subsequent cancer was observed for the period 1 to 5 years

after salivary gland cancer diagnosis, but the increased

risk declined to 11% among long-term survivors

(≥10 years). The overall risk was similar in younger

(ages <60 years) and older patients (≥60 years), but it

was slightly higher in males compared with females.

No significant excess of subsequent primary cancer was

observed in the small proportion of black patients. Significantly elevated risks were observed for subsequent

cancers of the buccal cavity (i.e., salivary gland, lip,

tongue, and mouth), respiratory system (particularly

lung and bronchus), male breast, and thyroid gland.

These findings are generally consistent with previous

population-based surveys of salivary gland cancers in

Connecticut (Winn and Blot, 1985) and in the SEER Program through 1992 (Sun et al, 1999). 

The risk of subsequent buccal cavity cancer was elevated by 3-fold or greater and may be related in part to

diagnostic surveillance. The risk of subsequent lung

cancer was increased about 60% for reasons that are

unclear, although radiotherapy and smoking may have

played a role. However, the risk of subsequent thyroid

cancer was increased about 3-fold following salivary

gland cancer, and a 2.8-fold increased risk of subsequent salivary gland cancer was seen after an initial

thyroid cancer. This reciprocal association may be related in part to heightened medical screening of the head

and neck area, radiotherapy, or earlier radiation exposures affecting both of these radiosensitive organs. The

excess of male breast cancer, based on 3 cases, occurred

in men treated with initial radiotherapy, but the short

latency period for 2 of the cases appeared inconsistent

with a radiation effect. Although salivary gland tumors

have been linked to female breast cancer in some previous studies (Horn-Ross et al, 1999), no relationship was 

seen in this survey, except for a nonsignificant 51%

excess for those younger than 35 years of age, based on

only 4 cases.

Nasopharyngeal Cancer

Nasopharyngeal cancer (NPC) is relatively rare in the

U.S., constituting less than 10% of cancers of the buccal

cavity and pharynx. The incidence rate is greater in men

than women, and in blacks than whites. The highest

rates are seen in Asian populations, especially Chinese

(Hildesheim and Levine, 1993). The overall 5-year relative survival rate is about 57.5%. The main histologic

types of NPC are squamous cell, nonkeratinizing, and

undifferentiated carcinomas (McDermott et al, 2001).

Radiation therapy has been the treatment of choice,

although in recent years it has been combined with

chemotherapy for more advanced tumors (Forastiere

et al, 2001).

The causal factors for this tumor include immunogenetic predisposition, Epstein-Barr virus (EBV) infection, and consumption of preserved foods or salted

fish containing nitrosamines (Lu et al, 1990; Hildesheim

and Levine, 1993; McDermott et al, 2001). Long-term

smoking and occupational exposure to wood and

formaldehyde may also increase risk, but eating fruit

appears protective (Hildesheim and Levine, 1993;

Vaughan et al, 1996; Farrow et al, 1998).

Results and Discussion

Among the 3,651 individuals who survived at least 2

months following nasopharyngeal cancer, 267 subsequent primary cancers were observed, resulting in a

significant 49% excess (O/E=1.49, O=267, 95% 

CI=1.31-1.68, EAR=47). Approximately 10% of patients

with NPC developed a second cancer within 20 years

of follow-up (cumulative incidence=10.1%, 95% 

CI=8.8%-11.4%). Subsequent primary cancer risks were

substantially higher for short-term (<10 years) than

long-term survivors (≥10 years). Patients younger than

60 years of age at initial diagnosis had a substantially

greater relative risk of new malignancies than older

patients, but a lower excess absolute risk. Risks did

not differ substantially by sex or race. About 90% of

patients received radiotherapy, which limited our ability to compare subsequent primary cancer risks with the

non-irradiated group. Risks were significantly increased

for subsequent cancers of the buccal cavity and pharynx

(especially the tongue and nasopharynx), esophagus,

lung, nasal cavities and sinuses, and bone and joints, as

well as for NHL. A previous survey of NPC revealed

elevated risks for second cancers of the head and neck

(Wang et al, 2000), but not for other sites with excess

rates in our study.

The reasons for the associations observed are unclear,

but tobacco use (Vaughan et al, 1996; McDermott et al,

2001) may have contributed to the excess risks of cancers

of the buccal cavity, esophagus, and lung. However, it is

possible that tumors arising close to the pharynx may

18 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BUCCAL CAVITY AND PHARYNX
have been initially misclassified as NPC. In addition,

radiotherapy probably contributed to the excess of bone

tumors, which arose in irradiated fields involving the

head in the 2 patients receiving initial radiotherapy. EBV

infection, which has been etiologically linked to NPC

(Hildesheim and Levine, 1993; McDermott et al, 2001)

and NHL, may have contributed to this combination of

multiple cancers.

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BUCCAL CAVITY AND PHARYNX
LIP

Lip

Both Sexes

Table 3.1.1: Characteristics of patients with an initial cancer of the lip, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 7,077 100.0 1,111 100.0 8,188 100.0

Initial treatment

Any radiation 428 6.0 97 8.7 525 6.4

With surgery 242 3.4 60 5.4 302 3.7

Without surgery 186 2.6 37 3.3 223 2.7

No radiation 6,649 94.0 1,014 91.3 7,663 93.6

With surgery 6,116 86.4 914 82.3 7,030 85.9

Without surgery 533 7.5 100 9.0 633 7.7

Race

White 6,925 97.9 1,055 95.0 7,980 97.5

Black 24 0.3 19 1.7 43 0.5

Other 40 0.6 16 1.4 56 0.7

Unknown 88 1.2 21 1.9 109 1.3

Age at 1st primary cancer diagnosis, years

< 30 77 1.1 15 1.4 92 1.1

30–49 926 13.1 128 11.5 1,054 12.9

50–69 3,333 47.1 374 33.7 3,707 45.3

70–79 1,780 25.2 309 27.8 2,089 25.5

> 80 961 13.6 285 25.7 1,246 15.2

Number of patients with one or more

primary cancers

One primary cancer only 5,610 79.3 969 87.2 6,579 80.3

1st and 2nd cancers 1,292 18.3 132 11.9 1,424 17.4

1st, 2nd, and 3rd cancers 161 2.3 10 0.9 171 2.1

1st, 2nd, 3rd, and additional cancers 14 0.2 0 0.0 14 0.2

Other statistics

Median age at 1st cancer diagnosis 66.4 — 71.5 — 67.0 —

Median year of 1st cancer diagnosis 1984.1 — 1987.9 — 1984.6 —

Median person-years at risk 7.6 — 6.2 — 7.5 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 94.0 — 90.8 — 93.7

1st, 2nd, and additional cancers — 92.8 — 90.8 — 92.7

1st cancer only — 5.3 — 8.5 — 5.6

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 21
All subsequent cancers 131 1.09 645 1.29* 532 1.19* 506 1.02 1,814 1,562.42 1.16* 34.17

All excluding same site 126 1.06 616 1.24* 512 1.16* 485 0.98 1,739 1,553.50 1.12* 25.19

Buccal cavity, pharynx 15 4.07* 65 4.42* 44 3.62* 34 2.83* 158 42.59 3.71* 15.67

Lip 5 6.09* 29 9.10* 20 7.87* 21 8.85* 75 8.92 8.41* 8.97

Tongue 0 0.00 5 1.88 6 2.67 1 0.43 12 7.86 1.53 0.56

Salivary gland 1 3.41 9 7.33* 5 4.53* 4 3.14 19 3.90 4.87* 2.05

Mouth 9 10.04* 18 5.04* 8 2.75* 8 2.88* 43 10.15 4.24* 4.46

Nasopharynx 0 0.00 0 0.00 1 2.76 0 0.00 1 1.27 0.78 -0.04

Tonsil 0 0.00 2 1.60 2 1.96 0 0.00 4 3.58 1.12 0.06

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.13 0.00 -0.15

Hypopharynx 0 0.00 2 1.33 2 1.61 0 0.00 4 4.31 0.93 -0.04

Digestive system 18 0.65 111 0.98 106 1.07 97 0.93 332 344.49 0.96 -1.70

Esophagus 2 1.45 6 1.05 6 1.18 7 1.19 21 18.06 1.16 0.40

Stomach 2 0.64 15 1.20 9 0.86 9 0.85 35 36.71 0.95 -0.23

Small intestine 0 0.00 2 1.44 0 0.00 2 1.34 4 4.46 0.90 -0.06

Colon 7 0.56 42 0.82 53 1.17 48 1.00 150 156.81 0.96 -0.92

Rectum, rectosigmoid junction 5 0.97 26 1.24 19 1.07 14 0.78 64 61.67 1.04 0.32

Anus, anal canal 1 5.35 1 1.30 1 1.48 3 4.12 6 2.36 2.54 0.49

Liver 1 1.19 1 0.28 2 0.63 6 1.56 10 11.39 0.88 -0.19

Gallbladder 0 0.00 2 1.66 1 1.01 1 1.04 4 3.46 1.16 0.07

Bile ducts, other biliary 0 0.00 3 1.27 3 1.40 3 1.16 9 7.66 1.18 0.18

Pancreas 0 0.00 11 0.84 12 1.08 4 0.34* 27 39.12 0.69 -1.65

Respiratory system 26 1.14 158 1.68* 148 1.81* 123 1.41* 455 285.25 1.60* 23.05

Nose, nasal cavity, ear 1 5.37 1 1.32 1 1.54 3 4.35 6 2.29 2.62 0.50

Larynx 3 1.71 15 2.11* 12 2.01* 9 1.53 39 20.70 1.88* 2.49

Lung, bronchus 22 1.06 141 1.65* 135 1.80* 111 1.38* 409 261.52 1.56* 20.03

Female breast 4 1.27 14 1.15 11 1.12 11 1.24 40 34.03 1.18 6.75

Female genital system 3 2.10 4 0.74 4 0.96 1 0.28 12 14.58 0.82 -2.92

Cervix uteri 0 0.00 1 1.85 0 0.00 0 0.00 1 1.35 0.74 -0.40

Corpus uteri 1 1.40 3 1.11 3 1.46 0 0.00 7 7.28 0.96 -0.32

Ovary 1 2.37 0 0.00 0 0.00 1 0.88 2 4.46 0.45 -2.78

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.28

Vulva 0 0.00 0 0.00 1 3.92 0 0.00 1 0.87 1.15 0.15

Male genital system 30 0.97 139 1.04 111 0.88 125 0.81* 405 446.32 0.91 -6.38

Prostate 29 0.95 138 1.04 110 0.88 124 0.81* 401 441.87 0.91 -6.31

Testis 0 0.00 0 0.00 0 0.00 1 3.14 1 1.46 0.69 -0.07

Urinary system 7 0.59 65 1.32* 46 1.05 39 0.78 157 154.67 1.02 0.32

Urinary bladder 6 0.69 46 1.27 37 1.14 31 0.84 120 114.23 1.05 0.78

Kidney parenchyma 0 0.00 12 1.21 6 0.67 6 0.58 24 31.45 0.76 -1.01

Renal pelvis, other urinary 1 1.36 7 2.32 3 1.17 2 0.75 13 8.99 1.45 0.54

Ureter 0 0.00 1 0.97 1 1.13 2 2.19 4 3.08 1.30 0.12

Bone, joints 0 0.00 1 2.33 1 2.83 0 0.00 2 1.25 1.60 0.10

Soft tissue including heart 0 0.00 2 1.05 0 0.00 2 1.04 4 5.94 0.67 -0.26

Kaposi sarcoma 1 5.30 1 1.29 0 0.00 0 0.00 2 2.28 0.88 -0.04

Melanoma of skin 5 1.99 18 1.66 8 0.78 22 1.68* 53 36.81 1.44* 2.20

Eye, orbit 0 0.00 2 2.60 0 0.00 0 0.00 2 2.30 0.87 -0.04

Brain, central nervous system 1 0.83 0 0.00* 1 0.23 2 0.43 4 15.05 0.27* -1.50

Thyroid 0 0.00 3 1.78 1 0.70 1 0.67 5 5.03 0.99 0.00

Lymphatic, hematopoietic 15 1.66 44 1.17 40 1.19 39 1.03 138 118.14 1.17 2.70

Hodgkin lymphoma 3 9.34* 6 4.86* 2 2.07 1 1.08 12 3.45 3.48* 1.16

Non-Hodgkin lymphoma 9 2.44* 23 1.48 15 1.05 13 0.77 60 50.56 1.19 1.28

Myeloma 1 0.68 1 0.16* 6 1.11 9 1.47 17 19.09 0.89 -0.28

Leukemia 2 0.56 14 0.95 17 1.32 16 1.15 49 45.04 1.09 0.54

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.14 0.00 -0.16

Chronic lymphocytic 0 0.00 8 1.32 4 0.75 7 1.25 19 18.46 1.03 0.07

Acute non-lymphocytic 1 0.87 3 0.63 7 1.68 6 1.30 17 14.68 1.16 0.31

Chronic myeloid 1 2.10 2 1.03 4 2.37 2 1.06 9 6.00 1.50 0.41

Lip

Both Sexes

Table 3.1.2: Risk of subsequent primary cancers after cancer of the lip, both sexes,

SEER 1973-2000.

22 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LIP

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 8,188 7,689 5,374 3,156 8,188

Person-years in interval 6,607 25,889 20,897 20,240 73,634

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 8,839 PYR and for male cancers on 64,795 PYR.
Lip

Females

Table 3.1.3: Risk of subsequent primary cancers after cancer of the lip, females,

SEER 1973-2000.

LIP

All subsequent cancers 18 1.52 61 1.33* 44 1.20 29 0.89 152 126.88 1.20* 28.42

All excluding same site 17 1.44 58 1.27 42 1.14 29 0.89 146 126.69 1.15 21.84

Buccal cavity, pharynx 2 9.64* 5 6.27* 7 11.12* 1 1.84 15 2.18 6.88* 14.50

Lip 1 56.63 3 44.54* 2 37.09* 0 0.00 6 0.19 32.36* 6.58

Tongue 0 0.00 0 0.00 2 14.42* 0 0.00 2 0.48 4.19 1.72

Salivary gland 0 0.00 0 0.00 0 0.00 1 15.24 1 0.26 3.90 0.84

Mouth 1 13.50 2 6.99 3 13.29* 0 0.00 6 0.78 7.69* 5.91

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.08

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.18

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.14

Digestive system 4 1.28 14 1.17 10 1.05 8 1.01 36 32.61 1.10 3.84

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.82 0.00 -0.93

Stomach 0 0.00 2 2.14 0 0.00 1 1.80 3 2.46 1.22 0.62

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.48

Colon 1 0.62 7 1.13 6 1.21 2 0.49 16 16.88 0.95 -1.00

Rectum, rectosigmoid junction 2 4.13 3 1.63 2 1.42 1 0.88 8 4.87 1.64 3.54

Rectum 2 6.29 3 2.48 1 1.08 1 1.31 7 3.22 2.17 4.27

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.44

Liver 1 17.77 0 0.00 0 0.00 2 12.44* 3 0.61 4.90 2.70

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.75 0.00 -0.84

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 5.06 1 0.75 1.33 0.28

Pancreas 0 0.00 1 0.65 2 1.61 1 0.94 4 4.24 0.94 -0.27

Respiratory system 3 2.21 11 2.03* 9 1.96 4 0.88 27 15.89 1.70* 12.57

Nose, nasal cavity, ear 1 62.02 0 0.00 0 0.00 0 0.00 1 0.18 5.71 0.93

Larynx 1 24.14 0 0.00 0 0.00 0 0.00 1 0.45 2.24 0.63

Lung, bronchus 1 0.77 11 2.12* 9 2.05 4 0.92 25 15.22 1.64* 11.06

Female breast 4 1.27 14 1.15 11 1.12 11 1.24 40 34.03 1.18 6.75

Female genital system 3 2.10 4 0.74 4 0.96 1 0.28 12 14.58 0.82 -2.92

Cervix uteri 0 0.00 1 1.85 0 0.00 0 0.00 1 1.35 0.74 -0.40

Corpus uteri 1 1.40 3 1.11 3 1.46 0 0.00 7 7.28 0.96 -0.32

Ovary 1 2.37 0 0.00 0 0.00 1 0.88 2 4.46 0.45 -2.78

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.28

Vulva 0 0.00 0 0.00 1 3.92 0 0.00 1 0.87 1.15 0.15

Urinary system 1 1.67 1 0.43 2 1.06 2 1.18 6 6.53 0.92 -0.60

Urinary bladder 1 2.67 1 0.69 2 1.70 1 0.97 5 4.04 1.24 1.09

Kidney parenchyma 0 0.00 0 0.00 0 0.00 1 1.89 1 1.94 0.52 -1.06

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.63

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.20

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.13

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.57

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.08

Melanoma of skin 0 0.00 3 3.50 0 0.00 0 0.00 3 2.45 1.22 0.62

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.21

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 1.22 0.00 -1.38

Thyroid 0 0.00 2 5.94 0 0.00 0 0.00 2 0.90 2.22 1.24

Lymphatic, hematopoietic 1 1.04 6 1.60 1 0.33 2 0.74 10 10.45 0.96 -0.50

Hodgkin lymphoma 0 0.00 1 9.50 0 0.00 0 0.00 1 0.27 3.64 0.82

Non-Hodgkin lymphoma 0 0.00 3 1.72 1 0.69 1 0.75 5 4.97 1.01 0.03

Myeloma 1 6.29 0 0.00 0 0.00 0 0.00 1 1.70 0.59 -0.80

Leukemia 0 0.00 2 1.56 0 0.00 1 1.15 3 3.50 0.86 -0.56

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.11

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.37 0.00 -1.55

Acute non-lymphocytic 0 0.00 1 2.29 0 0.00 1 3.27 2 1.20 1.66 0.90

Chronic myeloid 0 0.00 1 5.70 0 0.00 0 0.00 1 0.48 2.09 0.59

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,111 1,026 670 366 1,111

Person-years in interval 886 3,348 2,526 2,079 8,839

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 23
All subsequent cancers 113 1.05 584 1.29* 488 1.19* 477 1.03 1,662 1,435.54 1.16* 34.95

All excluding same site 109 1.02 558 1.24* 470 1.16* 456 0.99 1,593 1,426.81 1.12* 25.65

Buccal cavity, pharynx 13 3.74* 60 4.31* 37 3.21* 33 2.87* 143 40.41 3.54* 15.83

Lip 4 4.98* 26 8.34* 18 7.24* 21 9.03* 69 8.73 7.90* 9.30

Tongue 0 0.00 5 2.02 4 1.90 1 0.46 10 7.39 1.35 0.40

Salivary gland 1 3.72 9 7.93* 5 4.86* 3 2.48 18 3.64 4.94* 2.22

Mouth 8 9.73* 16 4.87* 5 1.86 8 3.10* 37 9.37 3.95* 4.26

Nasopharynx 0 0.00 0 0.00 1 2.92 0 0.00 1 1.20 0.83 -0.03

Tonsil 0 0.00 2 1.68 2 2.05 0 0.00 4 3.42 1.17 0.09

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.08 0.00 -0.17

Hypopharynx 0 0.00 2 1.38 2 1.66 0 0.00 4 4.18 0.96 -0.03

Digestive system 14 0.57* 97 0.95 96 1.08 89 0.92 296 311.88 0.95 -2.45

Esophagus 2 1.53 6 1.11 6 1.24 7 1.23 21 17.24 1.22 0.58

Stomach 2 0.69 13 1.12 9 0.92 8 0.80 32 34.25 0.93 -0.35

Small intestine 0 0.00 2 1.61 0 0.00 2 1.46 4 4.04 0.99 -0.01

Colon 6 0.55 35 0.77 47 1.17 46 1.05 134 139.92 0.96 -0.91

Rectum, rectosigmoid junction 3 0.64 23 1.21 17 1.04 13 0.78 56 56.79 0.99 -0.12

Anus, anal canal 1 6.62 1 1.58 1 1.78 3 4.80 6 1.97 3.05* 0.62

Liver 0 0.00 1 0.30 2 0.66 4 1.09 7 10.78 0.65 -0.58

Gallbladder 0 0.00 2 2.18 1 1.30 1 1.26 4 2.71 1.48 0.20

Bile ducts, other biliary 0 0.00 3 1.43 3 1.56 2 0.84 8 6.90 1.16 0.17

Pancreas 0 0.00 10 0.87 10 1.01 3 0.28* 23 34.88 0.66* -1.83

Respiratory system 23 1.08 147 1.66* 139 1.80* 119 1.44* 428 269.36 1.59* 24.48

Nose, nasal cavity, ear 0 0.00 1 1.43 1 1.67 3 4.65 5 2.11 2.37 0.45

Larynx 2 1.16 15 2.16* 12 2.06* 9 1.56 38 20.25 1.88* 2.74

Lung, bronchus 21 1.08 130 1.61* 126 1.79* 107 1.41* 384 246.30 1.56* 21.25

Male breast 0 0.00 1 1.19 1 1.34 0 0.00 2 2.66 0.75 -0.10

Male genital system 30 0.97 139 1.04 111 0.88 125 0.81* 405 446.32 0.91 -6.38

Prostate 29 0.95 138 1.04 110 0.88 124 0.81* 401 441.87 0.91 -6.31

Testis 0 0.00 0 0.00 0 0.00 1 3.14 1 1.46 0.69 -0.07

Urinary system 6 0.54 64 1.37* 44 1.05 37 0.77 151 148.15 1.02 0.44

Urinary bladder 5 0.60 45 1.29 35 1.12 30 0.84 115 110.19 1.04 0.74

Kidney parenchyma 0 0.00 12 1.30 6 0.71 5 0.51 23 29.52 0.78 -1.01

Renal pelvis, other urinary 1 1.47 7 2.49 3 1.25 2 0.79 13 8.44 1.54 0.70

Ureter 0 0.00 1 1.04 1 1.20 2 2.29 4 2.91 1.38 0.17

Bone, joints 0 0.00 1 2.58 1 3.11 0 0.00 2 1.14 1.76 0.13

Soft tissue including heart 0 0.00 2 1.16 0 0.00 2 1.12 4 5.43 0.74 -0.22

Kaposi sarcoma 1 5.48 1 1.33 0 0.00 0 0.00 2 2.22 0.90 -0.03

Melanoma of skin 5 2.17 15 1.50 8 0.83 22 1.76* 50 34.36 1.46* 2.41

Eye, orbit 0 0.00 2 2.86 0 0.00 0 0.00 2 2.12 0.95 -0.02

Brain, central nervous system 1 0.92 0 0.00* 1 0.25 2 0.47 4 13.83 0.29* -1.52

Thyroid 0 0.00 1 0.74 1 0.86 1 0.78 3 4.12 0.73 -0.17

Lymphatic, hematopoietic 14 1.73 38 1.12 39 1.28 37 1.05 128 107.69 1.19 3.13

Hodgkin lymphoma 3 10.25* 5 4.43* 2 2.24 1 1.16 11 3.17 3.47* 1.21

Non-Hodgkin lymphoma 9 2.78* 20 1.45 14 1.09 12 0.77 55 45.59 1.21 1.45

Myeloma 0 0.00 1 0.18 6 1.22 9 1.58 16 17.39 0.92 -0.21

Leukemia 2 0.61 12 0.89 17 1.44 15 1.15 46 41.54 1.11 0.69

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.05 0.00 -0.16

Chronic lymphocytic 0 0.00 8 1.44 4 0.82 7 1.32 19 17.09 1.11 0.30

Acute non-lymphocytic 1 0.97 2 0.46 7 1.83 5 1.16 15 13.48 1.11 0.23

Chronic myeloid 1 2.32 1 0.56 4 2.58 2 1.13 8 5.52 1.45 0.38

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 7,077 6,663 4,704 2,790 7,077

Person-years in interval 5,722 22,541 18,371 18,161 64,795

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Lip

Males

Table 3.1.4: Risk of subsequent primary cancers after cancer of the lip, males,

SEER 1973-2000.

24 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LIP

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Lip

<50 Years of Age

Table 3.1.5: Risk of subsequent primary cancers after cancer of the lip, both sexes,

<50 years of age, SEER 1973-2000.

LIP

All subsequent cancers 5 2.80 17 1.68 31 1.89* 78 1.23 131 91.53 1.43* 27.45

All excluding same site 4 2.26 15 1.49 27 1.66* 74 1.18 120 91.03 1.32* 20.15

Buccal cavity, pharynx 2 20.63* 2 3.53 7 8.00* 8 3.61* 19 3.75 5.06* 10.60

Lip 1 56.46 2 22.59* 4 34.74* 4 14.19* 11 0.50 21.86* 7.30

Tongue 0 0.00 0 0.00 1 5.26 0 0.00 1 0.83 1.20 0.12

Salivary gland 0 0.00 0 0.00 0 0.00 1 6.15 1 0.27 3.69 0.51

Mouth 1 42.58 0 0.00 1 4.43 3 5.67* 5 0.92 5.44* 2.84

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.11

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.32

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.08

Hypopharynx 0 0.00 0 0.00 1 11.73 0 0.00 1 0.37 2.67 0.44

Digestive system 0 0.00 3 1.69 6 1.94 13 1.14 22 16.59 1.33 3.76

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 1.23 0.00 -0.86

Stomach 0 0.00 2 9.39* 1 2.95 2 1.83 5 1.68 2.97 2.31

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.23

Colon 0 0.00 0 0.00 3 2.63 5 1.11 8 6.37 1.26 1.13

Rectum, rectosigmoid junction 0 0.00 1 2.65 0 0.00 4 1.71 5 3.46 1.45 1.07

Anus, anal canal 0 0.00 0 0.00 0 0.00 1 7.30 1 0.22 4.49 0.54

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.75 0.00 -0.52

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.07

Bile ducts, other biliary 0 0.00 0 0.00 1 17.62 0 0.00 1 0.34 2.98 0.46

Pancreas 0 0.00 0 0.00 1 2.71 1 0.76 2 1.95 1.03 0.04

Respiratory system 2 6.83 1 0.53 10 2.96* 29 2.42* 42 17.55 2.39* 17.00

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 2 19.46* 2 0.17 11.51* 1.27

Larynx 0 0.00 0 0.00 3 7.65* 2 1.78 5 1.78 2.81 2.24

Lung, bronchus 2 8.03 1 0.62 7 2.39 25 2.33* 35 15.54 2.25* 13.53

Female breast 0 0.00 2 2.95 0 0.00 2 1.36 4 3.09 1.29 5.99

Female genital system 0 0.00 1 3.59 0 0.00 0 0.00 1 1.25 0.80 -1.64

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -1.42

Corpus uteri 0 0.00 1 9.41 0 0.00 0 0.00 1 0.58 1.73 2.80

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -2.56

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.08

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.24

Male genital system 0 0.00 0 0.00 1 0.47 10 0.53* 11 21.81 0.50* -8.40

Prostate 0 0.00 0 0.00 1 0.54 9 0.49* 10 20.94 0.48* -8.50

Testis 0 0.00 0 0.00 0 0.00 1 5.70 1 0.70 1.42 0.23

Urinary system 0 0.00 1 1.07 1 0.63 4 0.68 6 8.57 0.70 -1.79

Urinary bladder 0 0.00 1 1.83 0 0.00 3 0.78 4 5.47 0.73 -1.02

Kidney parenchyma 0 0.00 0 0.00 1 1.80 1 0.57 2 2.72 0.73 -0.50

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.26

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.08

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.10

Soft tissue including heart 0 0.00 0 0.00 0 0.00 1 3.68 1 0.50 1.99 0.35

Kaposi sarcoma 0 0.00 1 3.91 0 0.00 0 0.00 1 0.82 1.23 0.13

Melanoma of skin 1 6.24 2 2.53 1 0.99 5 1.99 9 4.47 2.01 3.15

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.14

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 1.60 0.00 -1.11

Thyroid 0 0.00 0 0.00 1 4.52 1 2.42 2 0.89 2.25 0.77

Lymphatic, hematopoietic 0 0.00 4 3.40 4 2.42 3 0.63 11 7.83 1.40 2.20

Hodgkin lymphoma 0 0.00 1 6.84 0 0.00 0 0.00 1 0.53 1.88 0.33

Non-Hodgkin lymphoma 0 0.00 3 4.92 2 2.35 2 0.84 7 3.97 1.76 2.11

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.99 0.00 -0.69

Leukemia 0 0.00 0 0.00 2 4.23 1 0.67 3 2.35 1.28 0.45

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.08

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 1 1.58 1 0.92 1.09 0.05

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.74 0.00 -0.51

Chronic myeloid 0 0.00 0 0.00 1 14.21 0 0.00 1 0.34 2.98 0.46

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,146 1,102 901 655 1,146

Person-years in interval 936 3,994 3,866 5,584 14,380

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 1,513 PYR and for male cancers on 12,868 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 25
All subsequent cancers 54 1.34* 269 1.31* 300 1.22* 349 1.00 972 840.12 1.16* 33.52

All excluding same site 53 1.33 261 1.28* 290 1.19* 334 0.96 938 835.51 1.12* 26.05

Buccal cavity, pharynx 5 2.98 27 3.56* 22 2.97* 23 2.83* 77 24.81 3.10* 13.27

Lip 1 3.43 8 6.01* 10 7.35* 15 9.24* 34 4.61 7.38* 7.47

Tongue 0 0.00 3 2.01 3 2.06 1 0.64 7 4.84 1.45 0.55

Salivary gland 0 0.00 2 4.28 3 5.61* 2 2.43 7 1.92 3.65* 1.29

Mouth 4 9.37* 11 5.81* 3 1.67 5 2.69 23 5.97 3.85* 4.33

Nasopharynx 0 0.00 0 0.00 1 4.26 0 0.00 1 0.78 1.28 0.06

Tonsil 0 0.00 2 2.69 2 2.94 0 0.00 4 2.25 1.78 0.45

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.74 0.00 -0.19

Hypopharynx 0 0.00 1 1.11 0 0.00 0 0.00 1 2.81 0.36 -0.46

Digestive system 4 0.47 37 0.87 58 1.16 64 0.90 163 172.85 0.94 -2.50

Esophagus 0 0.00 1 0.37 5 1.65 6 1.45 12 10.44 1.15 0.40

Stomach 0 0.00 4 0.88 4 0.77 6 0.84 14 17.81 0.79 -0.97

Small intestine 0 0.00 1 1.69 0 0.00 2 1.95 3 2.43 1.23 0.14

Colon 1 0.29 13 0.73 28 1.29 30 0.92 72 75.44 0.95 -0.87

Rectum, rectosigmoid junction 2 1.11 11 1.25 11 1.12 8 0.64 32 32.84 0.97 -0.21

Anus, anal canal 0 0.00 1 2.83 1 2.63 2 4.25 4 1.28 3.13 0.69

Liver 1 3.33 0 0.00 1 0.55 3 1.10 5 6.34 0.79 -0.34

Gallbladder 0 0.00 0 0.00 1 2.39 1 1.59 2 1.47 1.36 0.14

Bile ducts, other biliary 0 0.00 2 2.49 0 0.00 3 1.75 5 3.66 1.37 0.34

Pancreas 0 0.00 4 0.80 7 1.22 3 0.37 14 19.81 0.71 -1.48

Respiratory system 15 1.62 91 2.01* 88 1.76* 83 1.32* 277 167.63 1.65* 27.80

Nose, nasal cavity, ear 0 0.00 1 3.02 1 2.87 1 2.16 3 1.21 2.47 0.45

Larynx 3 3.37 12 2.97* 6 1.50 6 1.44 27 13.09 2.06* 3.53

Lung, bronchus 12 1.45 77 1.89* 81 1.78* 76 1.30* 246 152.92 1.61* 23.66

Female breast 0 0.00 5 1.12 8 1.76 8 1.47 21 15.43 1.36 14.57

Female genital system 2 3.97 0 0.00 1 0.49 1 0.45 4 6.93 0.58 -7.67

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -1.56

Corpus uteri 0 0.00 0 0.00 1 0.89 0 0.00 1 3.80 0.26 -7.32

Ovary 1 7.22 0 0.00 0 0.00 1 1.44 2 2.04 0.98 -0.10

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.24

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.72

Male genital system 9 0.99 40 0.76 68 0.95 96 0.85 213 246.33 0.86* -9.38

Prostate 9 1.00 40 0.77 68 0.95 96 0.86 213 244.28 0.87* -8.81

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.16

Urinary system 3 0.77 27 1.37 23 0.97 26 0.75 79 82.07 0.96 -0.78

Urinary bladder 3 1.12 20 1.45 20 1.18 22 0.85 65 59.24 1.10 1.46

Kidney parenchyma 0 0.00 6 1.27 2 0.38 3 0.42 11 18.13 0.61 -1.81

Renal pelvis, other urinary 0 0.00 1 0.84 1 0.73 1 0.53 3 4.70 0.64 -0.43

Ureter 0 0.00 0 0.00 1 2.06 1 1.51 2 1.64 1.22 0.09

Bone, joints 0 0.00 1 5.08 1 4.90 0 0.00 2 0.68 2.96 0.34

Soft tissue including heart 0 0.00 2 2.68 0 0.00 1 0.79 3 3.01 1.00 0.00

Kaposi sarcoma 1 21.86 0 0.00 0 0.00 0 0.00 1 0.71 1.41 0.07

Melanoma of skin 4 3.80* 8 1.57 3 0.52 13 1.50 28 20.60 1.36 1.88

Eye, orbit 0 0.00 1 2.82 0 0.00 0 0.00 1 1.28 0.78 -0.07

Brain, central nervous system 0 0.00 0 0.00 1 0.38 2 0.63 3 8.89 0.34* -1.50

Thyroid 0 0.00 3 3.52 0 0.00 0 0.00 3 2.81 1.07 0.05

Lymphatic, hematopoietic 9 3.11* 20 1.38 22 1.28 25 0.97 76 60.42 1.26 3.96

Hodgkin lymphoma 2 15.05* 1 1.76 1 1.89 1 1.69 5 1.82 2.75 0.81

Non-Hodgkin lymphoma 6 4.71* 12 1.89 9 1.18 7 0.60 34 26.86 1.27 1.81

Myeloma 0 0.00 1 0.43 2 0.71 8 1.87 11 9.86 1.12 0.29

Leukemia 1 0.97 6 1.15 10 1.59 9 0.96 26 21.88 1.19 1.05

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -0.14

Chronic lymphocytic 0 0.00 4 1.76 2 0.75 4 1.06 10 9.20 1.09 0.20

Acute non-lymphocytic 1 3.18 1 0.61 5 2.44 3 0.94 10 7.21 1.39 0.71

Chronic myeloid 0 0.00 0 0.00 2 2.56 1 0.79 3 2.82 1.06 0.05

Lip

50-69 Years of Age

Table 3.1.6: Risk of subsequent primary cancers after cancer of the lip, both sexes,

50-69 years of age, SEER 1973-2000.

26 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LIP

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,707 3,566 2,786 1,827 3,707

Person-years in interval 3,028 12,702 11,466 12,144 39,341

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 3,821 PYR and for male cancers on 35,520 PYR.
Lip

≥70 Years of Age

Table 3.1.7: Risk of subsequent primary cancers after cancer of the lip, both sexes,

≥70 years of age, SEER 1973-2000.

LIP

All subsequent cancers 72 0.92 359 1.26* 201 1.09 79 0.93 711 630.77 1.13* 40.29

All excluding same site 69 0.89 340 1.20* 195 1.07 77 0.91 681 626.96 1.09* 27.14

Buccal cavity, pharynx 8 4.20* 36 5.49* 15 3.88* 3 1.77 62 14.03 4.42* 24.09

Lip 3 5.86* 19 10.76* 6 5.64* 2 4.28 30 3.81 7.88* 13.15

Tongue 0 0.00 2 1.92 2 3.34 0 0.00 4 2.19 1.83 0.91

Salivary gland 1 5.25 7 9.75* 2 3.91 1 3.46 11 1.71 6.44* 4.67

Mouth 4 8.97* 7 4.56* 4 4.50* 0 0.00 15 3.26 4.61* 5.90

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.17

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.87 0.00 -0.44

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.14

Hypopharynx 0 0.00 1 1.79 1 3.43 0 0.00 2 1.13 1.77 0.44

Digestive system 14 0.74 71 1.03 42 0.92 20 0.93 147 155.04 0.95 -4.04

Esophagus 2 2.47 5 1.73 1 0.55 1 1.15 9 6.39 1.41 1.31

Stomach 2 0.92 9 1.17 4 0.81 1 0.42 16 17.21 0.93 -0.61

Small intestine 0 0.00 1 1.33 0 0.00 0 0.00 1 1.70 0.59 -0.35

Colon 6 0.67 29 0.88 22 0.98 13 1.21 70 75.00 0.93 -2.51

Rectum, rectosigmoid junction 3 0.91 14 1.20 8 1.11 2 0.64 27 25.37 1.06 0.82

Anus, anal canal 1 9.29 0 0.00 0 0.00 0 0.00 1 0.86 1.16 0.07

Liver 0 0.00 1 0.52 1 0.80 3 5.09* 5 4.30 1.16 0.35

Gallbladder 0 0.00 2 2.37 0 0.00 0 0.00 2 1.88 1.06 0.06

Bile ducts, other biliary 0 0.00 1 0.65 2 1.81 0 0.00 3 3.66 0.82 -0.33

Pancreas 0 0.00 7 0.90 4 0.79 0 0.00 11 17.37 0.63 -3.20

Respiratory system 9 0.68 66 1.41* 50 1.77* 11 0.92 136 100.07 1.36* 18.04

Nose, nasal cavity, ear 1 9.12 0 0.00 0 0.00 0 0.00 1 0.90 1.11 0.05

Larynx 0 0.00 3 1.06 3 1.91 1 1.70 7 5.83 1.20 0.59

Lung, bronchus 8 0.66 63 1.45* 47 1.78* 10 0.90 128 93.06 1.38* 17.55

Female breast 4 1.99 7 0.99 3 0.67 1 0.52 15 15.50 0.97 -1.43

Female genital system 1 1.15 3 1.01 3 1.67 0 0.00 7 6.40 1.09 1.71

Cervix uteri 0 0.00 1 3.86 0 0.00 0 0.00 1 0.54 1.85 1.31

Corpus uteri 1 2.41 2 1.44 2 2.52 0 0.00 5 2.91 1.72 5.97

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 2.03 0.00 -5.80

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.42

Vulva 0 0.00 0 0.00 1 5.92 0 0.00 1 0.56 1.79 1.26

Male genital system 21 0.97 99 1.23* 42 0.80 19 0.81 181 178.19 1.02 1.72

Prostate 20 0.93 98 1.23 41 0.79 19 0.82 178 176.65 1.01 0.82

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.12

Urinary system 4 0.52 37 1.30 22 1.17 9 0.99 72 64.04 1.12 4.00

Urinary bladder 3 0.51 25 1.14 17 1.16 6 0.84 51 49.52 1.03 0.74

Kidney parenchyma 0 0.00 6 1.25 3 0.98 2 1.43 11 10.60 1.04 0.20

Renal pelvis, other urinary 1 2.02 6 3.37* 2 1.79 1 1.93 10 3.91 2.56* 3.06

Ureter 0 0.00 1 1.64 0 0.00 1 6.05 2 1.33 1.51 0.34

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.22

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 2.42 0.00 -1.22

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.76 0.00 -0.38

Melanoma of skin 0 0.00 8 1.62 4 1.14 4 2.02 16 11.75 1.36 2.13

Eye, orbit 0 0.00 1 2.63 0 0.00 0 0.00 1 0.83 1.21 0.09

Brain, central nervous system 1 1.71 0 0.00 0 0.00 0 0.00 1 4.56 0.22 -1.79

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.32 0.00 -0.66

Lymphatic, hematopoietic 6 1.01 20 0.91 14 0.95 11 1.52 51 49.88 1.02 0.56

Hodgkin lymphoma 1 6.51 4 7.67* 1 3.37 0 0.00 6 1.09 5.48* 2.46

Non-Hodgkin lymphoma 3 1.31 8 0.93 4 0.68 4 1.36 19 19.73 0.96 -0.37

Myeloma 1 1.01 0 0.00 4 1.65 1 0.85 6 8.25 0.73 -1.13

Leukemia 1 0.40 8 0.87 5 0.82 6 2.00 20 20.81 0.96 -0.41

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -0.25

Chronic lymphocytic 0 0.00 4 1.09 2 0.82 2 1.66 8 8.34 0.96 -0.17

Acute non-lymphocytic 0 0.00 2 0.67 2 1.01 3 3.18 7 6.73 1.04 0.13

Chronic myeloid 1 2.99 2 1.61 1 1.19 1 2.37 5 2.84 1.76 1.08

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,335 3,021 1,687 674 3,335

Person-years in interval 2,643 9,193 5,565 2,512 19,913

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 3,505 PYR and for male cancers on 16,408 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 27
Oral and Pharynx

Both Sexes

Table 3.2.1: Characteristics of patients with an initial cancer of the oral cavity or pharynx (tongue, mouth, tonsil,

oropharynx, hypopharynx), both sexes, SEER 1973-2000.

28 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ORAL AND PHARYNX

Number of patients with 1st primary cancer

Total 26,258 100.0 13,243 100.0 39,501 100.0

Initial treatment

Any radiation 17,261 65.7 7,348 55.5 24,609 62.3

With surgery 8,568 32.6 3,524 26.6 12,092 30.6

Without surgery 8,693 33.1 3,824 28.9 12,517 31.7

No radiation 8,997 34.3 5,895 44.5 14,892 37.7

With surgery 7,255 27.6 5,055 38.2 12,310 31.2

Without surgery 1,742 6.6 840 6.3 2,582 6.5

Race

White 21,665 82.5 11,358 85.8 33,023 83.6

Black 3,448 13.1 1,240 9.4 4,688 11.9

Other 1,096 4.2 567 4.3 1,663 4.2

Unknown 49 0.2 78 0.6 127 0.3

Age at 1st primary cancer diagnosis, years

< 30 204 0.8 228 1.7 432 1.1

30–49 4,202 16.0 1,645 12.4 5,847 14.8

50–69 15,823 60.3 6,925 52.3 22,748 57.6

70–79 4,589 17.5 2,883 21.8 7,472 18.9

> 80 1,440 5.5 1,562 11.8 3,002 7.6

Number of patients with one or more

primary cancers

One primary cancer only 22,113 84.2 11,315 85.4 33,428 84.6

1st and 2nd cancers 3,592 13.7 1,642 12.4 5,234 13.3

1st, 2nd, and 3rd cancers 478 1.8 236 1.8 714 1.8

1st, 2nd, 3rd, and additional cancers 75 0.3 50 0.4 125 0.3

Other statistics

Median age at 1st cancer diagnosis 61.4 — 64.3 — 62.3 —

Median year of 1st cancer diagnosis 1987.4 — 1987.1 — 1987.3 —

Median person-years at risk 2.1 — 3.0 — 2.3 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 95.2 — 95.0 — 95.1

1st, 2nd, and additional cancers — 94.5 — 94.3 — 94.5

1st cancer only — 4.4 — 4.6 — 4.4

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Oral and Pharynx

Both Sexes

Table 3.2.2: Risk of subsequent primary cancers after cancer of the oral cavity or pharynx (tongue, mouth, tonsil,

oropharynx, hypopharynx), both sexes, SEER 1973-2000.

ORAL AND PHARYNX

All subsequent cancers 902 2.30* 2,981 2.71* 1,934 2.50* 1,259 2.02* 7,076 2,891.21 2.45* 230.82

All excluding same site 722 1.88* 2,364 2.19* 1,471 1.93* 963 1.57* 5,520 2,835.93 1.95* 148.04

Buccal cavity, pharynx 201 16.19* 701 21.46* 507 24.89* 324 23.23* 1,733 79.40 21.83* 91.21

Lip 8 4.37* 21 4.39* 11 3.67* 9 4.35* 49 11.68 4.20* 2.06

Tongue 47 19.14* 206 31.58* 149 36.18* 91 32.01* 493 15.94 30.92* 26.31

Salivary gland 2 2.25 13 5.26* 7 4.09* 2 1.43 24 6.46 3.71* 0.97

Mouth 91 27.82* 265 30.92* 195 36.81* 127 35.25* 678 20.74 32.69* 36.25

Nasopharynx 2 4.07 13 10.28* 5 6.59* 2 3.96 22 3.02 7.28* 1.05

Tonsil 23 17.99* 56 17.02* 48 24.54* 25 20.24* 152 7.76 19.59* 7.96

Oropharynx 5 13.47* 20 20.53* 14 23.29* 18 45.27* 57 2.34 24.32* 3.01

Hypopharynx 14 10.19* 70 19.58* 57 26.27* 35 25.44* 176 8.49 20.72* 9.24

Digestive system 201 2.29* 565 2.33* 386 2.30* 221 1.66* 1,373 631.29 2.17* 40.91

Esophagus 88 17.31* 234 17.33* 166 18.56* 71 10.39* 559 34.36 16.27* 28.94

Stomach 14 1.47 47 1.86* 22 1.30 14 1.09 97 64.62 1.50* 1.79

Small intestine 2 1.67 3 0.89 3 1.25 4 1.98 12 8.99 1.33 0.17

Colon 47 1.24 133 1.25* 91 1.20 58 0.94 329 282.34 1.17* 2.57

Rectum, rectosigmoid junction 14 0.89 60 1.38* 43 1.48* 28 1.29 145 109.96 1.32* 1.93

Anus, anal canal 3 3.81 6 2.69 1 0.65 2 1.66 12 5.77 2.08* 0.34

Liver 13 4.21* 28 3.31* 21 3.60* 11 2.26* 73 22.26 3.28* 2.80

Gallbladder 2 1.81 2 0.65 2 0.94 0 0.00 6 7.99 0.75 -0.11

Bile ducts, other biliary 2 1.15 10 2.04 7 1.95 7 2.18 26 13.44 1.93* 0.69

Pancreas 16 1.52 41 1.42* 30 1.49* 24 1.48 111 75.74 1.47* 1.94

Respiratory system 228 3.06* 1,042 5.10* 597 4.31* 362 3.42* 2,229 522.76 4.26* 94.11

Nose, nasal cavity, ear 2 3.21 8 4.74* 6 5.36* 1 1.17 17 4.28 3.97* 0.70

Larynx 28 4.82* 109 7.14* 62 6.53* 40 6.35* 239 36.87 6.48* 11.15

Lung, bronchus 197 2.91* 919 4.92* 525 4.12* 319 3.24* 1,960 480.30 4.08* 81.61

Female breast 43 1.38 102 1.09 64 0.93 60 1.04 269 251.57 1.07 2.45

Female genital system 19 1.27 41 0.94 26 0.86 18 0.76 104 112.41 0.93 -1.18

Cervix uteri 6 3.33* 9 1.83 2 0.65 2 0.93 19 11.97 1.59 0.99

Corpus uteri 7 0.90 12 0.53* 8 0.52 6 0.50 33 58.05 0.57* -3.52

Ovary 3 0.71 9 0.72 13 1.45 8 1.09 33 33.05 1.00 -0.01

Vagina 2 9.19* 4 6.28* 1 2.16 0 0.00 7 1.70 4.11* 0.74

Vulva 1 1.62 6 3.23* 2 1.42 1 0.78 10 5.16 1.94 0.68

Male genital system 83 1.03 229 1.00 146 0.86 119 0.83* 577 620.87 0.93 -3.98

Prostate 80 1.01 226 1.00 145 0.86 118 0.83* 569 614.32 0.93 -4.11

Testis 0 0.00 0 0.00 0 0.00 1 3.28 1 2.58 0.39 -0.14

Urinary system 35 1.09 91 1.02 88 1.40* 54 1.06 268 235.35 1.14* 1.80

Urinary bladder 24 1.09 63 1.02 64 1.47* 38 1.07 189 162.47 1.16* 1.46

Kidney parenchyma 10 1.24 22 0.98 21 1.35 13 1.05 66 58.52 1.13 0.41

Renal pelvis, other urinary 1 0.50 6 1.08 3 0.79 3 1.01 13 14.36 0.91 -0.07

Ureter 0 0.00 2 1.09 2 1.57 1 1.02 5 4.76 1.05 0.01

Bone, joints 0 0.00 2 2.01 3 4.70 1 2.15 6 2.47 2.43 0.19

Soft tissue including heart 0 0.00 5 1.18 7 2.41 1 0.42 13 11.07 1.17 0.11

Kaposi sarcoma 1 1.50 4 2.37 1 1.03 0 0.00 6 3.92 1.53 0.11

Melanoma of skin 16 1.90* 20 0.82 14 0.81 17 1.18 67 64.53 1.04 0.14

Eye, orbit 1 1.68 3 1.83 1 0.92 2 2.45 7 4.14 1.69 0.16

Brain, central nervous system 7 1.64 8 0.68 2 0.26* 6 1.03 23 29.69 0.77 -0.37

Thyroid 12 5.78* 7 1.21 2 0.53 2 0.71 23 14.44 1.59* 0.47

Lymphatic, hematopoietic 28 0.97 75 0.93 50 0.88 28 0.60* 181 213.29 0.85* -1.78

Hodgkin lymphoma 0 0.00 1 0.35 3 1.73 0 0.00 4 6.87 0.58 -0.16

Non-Hodgkin lymphoma 17 1.36 36 1.00 24 0.93 19 0.87 96 95.92 1.00 0.00

Myeloma 2 0.40 9 0.65 9 0.92 5 0.62 25 36.79 0.68 -0.65

Leukemia 9 0.89 29 1.03 14 0.71 4 0.25* 56 73.71 0.76* -0.98

Acute lymphocytic 0 0.00 1 1.26 0 0.00 0 0.00 1 2.04 0.49 -0.06

Chronic lymphocytic 1 0.24 6 0.52 3 0.37 0 0.00* 10 29.88 0.33* -1.10

Acute non-lymphocytic 6 1.81 17 1.83* 4 0.61 1 0.18 28 24.62 1.14 0.19

Chronic myeloid 1 0.73 4 1.06 4 1.52 1 0.46 10 9.94 1.01 0.00

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 39,501 29,707 13,108 6,132 39,501

Person-years in interval 28,564 75,465 45,956 31,319 181,304

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 71,137 PYR and for male cancers on 110,166 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 29
All subsequent cancers 5,817 2.56* 895 2.22* 281 1.68* 83 1.59* 7,076 2,891.21 2.45* 230.82

All excluding same site 4,557 2.05* 684 1.72* 215 1.31* 64 1.25 5,520 2,835.93 1.95* 148.04

Buccal cavity, pharynx 1,409 21.53* 232 24.85* 71 20.02* 21 19.67* 1,733 79.40 21.83* 91.21

Lip 40 4.16* 8 5.79* 1 1.90 0 0.00 49 11.68 4.20* 2.06

Tongue 402 30.69* 65 34.26* 23 31.72* 3 13.58* 493 15.94 30.92* 26.31

Salivary gland 22 4.34* 1 1.12 1 2.66 0 0.00 24 6.46 3.71* 0.97

Mouth 551 32.15* 87 36.14* 27 29.38* 13 47.07* 678 20.74 32.69* 36.25

Nasopharynx 20 7.95* 2 5.91 0 0.00 0 0.00 22 3.02 7.28* 1.05

Tonsil 127 19.46* 17 20.16* 7 23.06* 1 11.33 152 7.76 19.59* 7.96

Oropharynx 39 20.04* 14 52.01* 3 30.30* 1 33.97 57 2.34 24.32* 3.01

Hypopharynx 141 19.81* 28 29.58* 6 17.88* 1 10.67 176 8.49 20.72* 9.24

Digestive system 1,152 2.31* 152 1.76* 51 1.43* 18 1.57 1,373 631.29 2.17* 40.91

Esophagus 488 17.73* 54 12.10* 11 6.10* 6 10.53* 559 34.36 16.27* 28.94

Stomach 83 1.60* 11 1.31 3 0.88 0 0.00 97 64.62 1.50* 1.79

Small intestine 8 1.15 3 2.33 1 1.81 0 0.00 12 8.99 1.33 0.17

Colon 271 1.23* 36 0.91 16 0.97 6 1.12 329 282.34 1.17* 2.57

Rectum, rectosigmoid junction 117 1.33* 15 1.05 9 1.59 4 2.28 145 109.96 1.32* 1.93

Anus, anal canal 10 2.19* 1 1.28 1 3.08 0 0.00 12 5.77 2.08* 0.34

Liver 62 3.57* 8 2.59* 3 2.25 0 0.00 73 22.26 3.28* 2.80

Gallbladder 6 0.95 0 0.00 0 0.00 0 0.00 6 7.99 0.75 -0.11

Bile ducts, other biliary 19 1.86* 5 2.51 1 1.10 1 3.25 26 13.44 1.93* 0.69

Pancreas 87 1.46* 17 1.63 6 1.38 1 0.71 111 75.74 1.47* 1.94

Respiratory system 1,867 4.48* 252 3.64* 91 3.26* 19 2.20* 2,229 522.76 4.26* 94.11

Nose, nasal cavity, ear 16 4.66* 1 1.81 0 0.00 0 0.00 17 4.28 3.97* 0.70

Larynx 199 6.51* 28 6.51* 12 7.72* 0 0.00 239 36.87 6.48* 11.15

Lung, bronchus 1,641 4.30* 221 3.44* 79 3.03* 19 2.34* 1,960 480.30 4.08* 81.61

Female breast 209 1.08 45 1.23 11 0.69 4 0.77 269 251.57 1.07 2.45

Female genital system 86 0.97 12 0.79 4 0.62 2 0.97 104 112.41 0.93 -1.18

Cervix uteri 17 1.73* 2 1.41 0 0.00 0 0.00 19 11.97 1.59 0.99

Corpus uteri 27 0.59* 5 0.65 1 0.31 0 0.00 33 58.05 0.57* -3.52

Ovary 25 0.97 5 1.07 2 1.00 1 1.55 33 33.05 1.00 -0.01

Vagina 7 5.31* 0 0.00 0 0.00 0 0.00 7 1.70 4.11* 0.74

Vulva 9 2.32* 0 0.00 1 2.77 0 0.00 10 5.16 1.94 0.68

Male genital system 458 0.96 88 0.94 24 0.63* 7 0.64 577 620.87 0.93 -3.98

Prostate 451 0.95 87 0.94 24 0.63* 7 0.65 569 614.32 0.93 -4.11

Testis 0 0.00 1 4.63 0 0.00 0 0.00 1 2.58 0.39 -0.14

Urinary system 214 1.16* 37 1.13 13 0.95 4 0.90 268 235.35 1.14* 1.80

Urinary bladder 151 1.19* 27 1.18 9 0.94 2 0.64 189 162.47 1.16* 1.46

Kidney parenchyma 53 1.15 8 1.00 4 1.21 1 0.95 66 58.52 1.13 0.41

Renal pelvis, other urinary 10 0.88 2 1.04 0 0.00 1 3.92 13 14.36 0.91 -0.07

Ureter 4 1.06 1 1.56 0 0.00 0 0.00 5 4.76 1.05 0.01

Bone, joints 5 2.50 1 3.30 0 0.00 0 0.00 6 2.47 2.43 0.19

Soft tissue including heart 12 1.38 1 0.66 0 0.00 0 0.00 13 11.07 1.17 0.11

Kaposi sarcoma 6 1.81 0 0.00 0 0.00 0 0.00 6 3.92 1.53 0.11

Melanoma of skin 50 1.00 14 1.54 1 0.25 2 1.47 67 64.53 1.04 0.14

Eye, orbit 5 1.50 1 1.88 1 4.60 0 0.00 7 4.14 1.69 0.16

Brain, central nervous system 17 0.71 4 1.05 1 0.66 1 2.09 23 29.69 0.77 -0.37

Thyroid 21 1.81* 2 1.09 0 0.00 0 0.00 23 14.44 1.59* 0.47

Lymphatic, hematopoietic 153 0.92 21 0.70 6 0.47 1 0.24 181 213.29 0.85* -1.78

Hodgkin lymphoma 4 0.70 0 0.00 0 0.00 0 0.00 4 6.87 0.58 -0.16

Non-Hodgkin lymphoma 77 1.04 13 0.94 5 0.84 1 0.50 96 95.92 1.00 0.00

Myeloma 20 0.70 4 0.77 1 0.46 0 0.00 25 36.79 0.68 -0.65

Leukemia 52 0.90 4 0.39 0 0.00* 0 0.00 56 73.71 0.76* -0.98

Acute lymphocytic 1 0.61 0 0.00 0 0.00 0 0.00 1 2.04 0.49 -0.06

Chronic lymphocytic 10 0.42* 0 0.00* 0 0.00 0 0.00 10 29.88 0.33* -1.10

Acute non-lymphocytic 27 1.41 1 0.29 0 0.00 0 0.00 28 24.62 1.14 0.19

Chronic myeloid 9 1.16 1 0.72 0 0.00 0 0.00 10 9.94 1.01 0.00

Oral and Pharynx

Both Sexes, Long-term Follow-up

Table 3.2.3: Risk of subsequent primary cancers after cancer of the oral cavity or pharynx (tongue, mouth, tonsil, oropharynx,

hypopharynx), both sexes, long-term follow-up, SEER 1973-2000.

30 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ORAL AND PHARYNX

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 39,501 6,132 2,583 879 39,501

Person-years in interval 149,984 20,816 8,018 2,485 181,304

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 71,137 PYR and for male cancers on 110,166 PYR.
Oral and Pharynx

Females

Table 3.2.4: Risk of subsequent primary cancers after cancer of the oral cavity or pharynx (tongue, mouth, tonsil, oropharynx,

hypopharynx), females, SEER 1973-2000.

ORAL AND PHARYNX

All subsequent cancers 268 2.45* 903 2.75* 628 2.58* 477 2.29* 2,276 890.42 2.56* 194.78

All excluding same site 208 1.93* 686 2.12* 471 1.96* 360 1.75* 1,725 878.26 1.96* 119.03

Buccal cavity, pharynx 70 33.39* 240 38.81* 168 38.24* 134 38.33* 612 16.17 37.85* 83.76

Lip 4 31.30* 4 10.40* 3 10.29* 6 22.99* 17 1.06 15.96* 2.24

Tongue 19 41.24* 72 52.90* 50 51.15* 32 41.35* 173 3.57 48.42* 23.82

Salivary gland 2 9.28* 4 6.23* 0 0.00 1 2.49 7 1.72 4.06* 0.74

Mouth 35 48.30* 109 51.09* 72 47.53* 61 49.95* 277 5.59 49.52* 38.15

Nasopharynx 0 0.00 3 12.31* 2 11.70* 2 14.69* 7 0.63 11.03* 0.89

Tonsil 4 19.72* 14 24.08* 17 43.88* 9 33.36* 44 1.44 30.53* 5.98

Oropharynx 0 0.00 5 30.65* 5 43.63* 7 84.32* 17 0.41 40.98* 2.33

Hypopharynx 2 13.17* 17 37.95* 13 42.28* 8 35.55* 40 1.13 35.33* 5.46

Digestive system 50 1.98* 157 2.09* 131 2.32* 80 1.63* 418 206.05 2.03* 29.79

Esophagus 23 31.70* 55 25.47* 56 34.70* 29 21.04* 163 5.88 27.73* 22.09

Stomach 1 0.50 12 2.05* 8 1.87 0 0.00 21 15.81 1.33 0.73

Small intestine 1 2.93 1 0.96 2 2.48 0 0.00 4 2.95 1.36 0.15

Colon 16 1.28 43 1.15 35 1.24 23 0.93 117 103.03 1.14 1.96

Rectum, rectosigmoid junction 4 0.98 17 1.40 12 1.37 12 1.68 45 32.15 1.40* 1.81

Rectum 4 1.50 13 1.65 11 1.92 7 1.47 35 21.03 1.66* 1.96

Anus, anal canal 0 0.00 2 1.97 1 1.32 0 0.00 3 2.76 1.09 0.03

Liver 1 1.92 6 3.82* 2 1.64 3 2.58 12 4.48 2.68* 1.06

Gallbladder 1 1.69 2 1.16 1 0.80 0 0.00 4 4.58 0.87 -0.08

Bile ducts, other biliary 0 0.00 4 2.51 3 2.39 1 0.84 8 4.57 1.75 0.48

Pancreas 3 0.92 15 1.53 11 1.47 11 1.65 40 27.19 1.47* 1.80

Respiratory system 58 4.11* 264 6.02* 185 5.45* 135 4.44* 642 122.32 5.25* 73.05

Nose, nasal cavity, ear 1 6.64 1 2.23 2 6.02 0 0.00 4 1.22 3.28 0.39

Larynx 4 7.91* 19 12.58* 14 13.02* 17 20.70* 54 3.91 13.80* 7.04

Lung, bronchus 53 3.95* 243 5.81* 168 5.17* 118 4.04* 582 116.88 4.98* 65.38

Female breast 43 1.38 102 1.09 64 0.93 60 1.04 269 251.57 1.07 2.45

Female genital system 19 1.27 41 0.94 26 0.86 18 0.76 104 112.41 0.93 -1.18

Cervix uteri 6 3.33* 9 1.83 2 0.65 2 0.93 19 11.97 1.59 0.99

Corpus uteri 7 0.90 12 0.53* 8 0.52 6 0.50 33 58.05 0.57* -3.52

Ovary 3 0.71 9 0.72 13 1.45 8 1.09 33 33.05 1.00 -0.01

Vagina 2 9.19* 4 6.28* 1 2.16 0 0.00 7 1.70 4.11* 0.74

Vulva 1 1.62 6 3.23* 2 1.42 1 0.78 10 5.16 1.94 0.68

Urinary system 7 1.37 22 1.42 15 1.27 12 1.14 56 42.98 1.30 1.83

Urinary bladder 5 1.65 15 1.64 8 1.15 6 0.97 34 25.33 1.34 1.22

Kidney parenchyma 2 1.21 5 0.99 7 1.80 4 1.15 18 14.09 1.28 0.55

Renal pelvis, other urinary 0 0.00 2 1.53 0 0.00 2 2.37 4 3.56 1.12 0.06

Ureter 0 0.00 1 2.49 0 0.00 0 0.00 1 1.10 0.91 -0.01

Bone, joints 0 0.00 0 0.00 1 4.67 0 0.00 1 0.80 1.25 0.03

Soft tissue including heart 0 0.00 2 1.57 2 2.12 0 0.00 4 3.48 1.15 0.07

Kaposi sarcoma 0 0.00 1 8.78 0 0.00 0 0.00 1 0.32 3.09 0.10

Melanoma of skin 2 0.98 5 0.80 3 0.65 6 1.48 16 16.99 0.94 -0.14

Eye, orbit 0 0.00 2 4.01 0 0.00 0 0.00 2 1.29 1.55 0.10

Brain, central nervous system 2 1.74 3 0.86 0 0.00 2 0.97 7 9.21 0.76 -0.31

Thyroid 3 3.04 3 1.04 1 0.50 0 0.00 7 7.48 0.94 -0.07

Lymphatic, hematopoietic 9 1.11 32 1.30 19 1.01 10 0.60 70 68.34 1.02 0.23

Hodgkin lymphoma 0 0.00 1 1.27 1 1.84 0 0.00 2 2.02 0.99 0.00

Non-Hodgkin lymphoma 6 1.56 17 1.44 8 0.87 5 0.60 36 33.12 1.09 0.40

Myeloma 1 0.70 4 0.93 3 0.92 3 1.04 11 11.90 0.92 -0.13

Leukemia 2 0.77 10 1.29 7 1.20 2 0.39 21 21.30 0.99 -0.04

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -0.09

Chronic lymphocytic 1 0.99 4 1.32 3 1.31 0 0.00 8 8.31 0.96 -0.04

Acute non-lymphocytic 0 0.00 5 1.83 0 0.00 1 0.54 6 7.53 0.80 -0.21

Chronic myeloid 1 2.78 1 0.94 1 1.25 1 1.43 4 2.92 1.37 0.15

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 13,243 10,326 5,239 2,643 13,243

Person-years in interval 9,746 28,162 18,932 14,298 71,137

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 31
All subsequent cancers 634 2.24* 2,078 2.69* 1,306 2.46* 782 1.89* 4,800 2,000.79 2.40* 254.09

All excluding same site 514 1.86* 1,678 2.23* 1,000 1.92* 603 1.48* 3,795 1,957.67 1.94* 166.78

Buccal cavity, pharynx 131 12.69* 461 17.41* 339 21.22* 190 18.18* 1,121 63.23 17.73* 96.02

Lip 4 2.35 17 3.87* 8 2.96* 3 1.66 32 10.61 3.02* 1.94

Tongue 28 14.03* 134 25.95* 99 31.52* 59 28.52* 320 12.37 25.87* 27.92

Salivary gland 0 0.00 9 4.92* 7 5.63* 1 1.00 17 4.74 3.59* 1.11

Mouth 56 21.99* 156 24.23* 123 32.51* 66 27.72* 401 15.15 26.47* 35.02

Nasopharynx 2 4.90 10 9.79* 3 5.10* 0 0.00 15 2.39 6.29* 1.15

Tonsil 19 17.66* 42 15.50* 31 19.76* 16 16.58* 108 6.32 17.09* 9.23

Oropharynx 5 15.77* 15 18.49* 9 18.50* 11 34.97* 40 1.93 20.73* 3.46

Hypopharynx 12 9.82* 53 16.95* 44 23.63* 27 23.46* 136 7.36 18.47* 11.68

Digestive system 151 2.42* 408 2.45* 255 2.28* 141 1.67* 955 425.25 2.25* 48.09

Esophagus 65 14.91* 179 15.78* 110 15.01* 42 7.70* 396 28.48 13.90* 33.36

Stomach 13 1.73 35 1.80* 14 1.11 14 1.52 76 48.81 1.56* 2.47

Small intestine 1 1.17 2 0.86 1 0.63 4 3.17 8 6.04 1.32 0.18

Colon 31 1.21 90 1.30* 56 1.17 35 0.95 212 179.31 1.18* 2.97

Rectum, rectosigmoid junction 10 0.85 43 1.38 31 1.52* 16 1.10 100 77.80 1.29* 2.01

Anus, anal canal 3 6.65* 4 3.30 0 0.00 2 3.55 9 3.01 2.99* 0.54

Liver 12 4.67* 22 3.19* 19 4.12* 8 2.16 61 17.78 3.43* 3.92

Gallbladder 1 1.96 0 0.00 1 1.13 0 0.00 2 3.41 0.59 -0.13

Bile ducts, other biliary 2 1.66 6 1.81 4 1.71 6 2.98* 18 8.87 2.03* 0.83

Pancreas 13 1.79 26 1.36 19 1.51 13 1.37 71 48.55 1.46* 2.04

Respiratory system 170 2.82* 778 4.85* 412 3.94* 227 3.01* 1,587 400.44 3.96* 107.71

Nose, nasal cavity, ear 1 2.11 7 5.65* 4 5.08* 1 1.76 13 3.07 4.24* 0.90

Larynx 24 4.52* 90 6.54* 48 5.70* 23 4.20* 185 32.96 5.61* 13.80

Lung, bronchus 144 2.65* 676 4.67* 357 3.76* 201 2.91* 1,378 363.42 3.79* 92.10

Male breast 0 0.00 2 1.36 1 1.01 1 1.29 4 3.79 1.05 0.02

Male genital system 83 1.03 229 1.00 146 0.86 119 0.83* 577 620.87 0.93 -3.98

Prostate 80 1.01 226 1.00 145 0.86 118 0.83* 569 614.32 0.93 -4.11

Testis 0 0.00 0 0.00 0 0.00 1 3.28 1 2.58 0.39 -0.14

Urinary system 28 1.04 69 0.93 73 1.43* 42 1.04 212 192.36 1.10 1.78

Urinary bladder 19 1.00 48 0.92 56 1.54* 32 1.09 155 137.14 1.13 1.62

Kidney parenchyma 8 1.25 17 0.97 14 1.20 9 1.02 48 44.43 1.08 0.32

Renal pelvis, other urinary 1 0.63 4 0.94 3 1.06 1 0.47 9 10.79 0.83 -0.16

Ureter 0 0.00 1 0.70 2 2.06 1 1.38 4 3.66 1.09 0.03

Bone, joints 0 0.00 2 2.89 2 4.71 1 3.46 5 1.67 3.00 0.30

Soft tissue including heart 0 0.00 3 1.01 5 2.56 1 0.65 9 7.60 1.18 0.13

Kaposi sarcoma 1 1.59 3 1.91 1 1.14 0 0.00 5 3.59 1.39 0.13

Melanoma of skin 14 2.19* 15 0.83 11 0.87 11 1.06 51 47.54 1.07 0.31

Eye, orbit 1 2.34 1 0.87 1 1.35 2 3.73 5 2.85 1.76 0.20

Brain, central nervous system 5 1.60 5 0.60 2 0.38 4 1.07 16 20.48 0.78 -0.41

Thyroid 9 8.26* 4 1.39 1 0.56 2 1.65 16 6.96 2.30* 0.82

Lymphatic, hematopoietic 19 0.92 43 0.77 31 0.81 18 0.60* 111 144.95 0.77* -3.08

Hodgkin lymphoma 0 0.00 0 0.00 2 1.68 0 0.00 2 4.85 0.41 -0.26

Non-Hodgkin lymphoma 11 1.26 19 0.79 16 0.96 14 1.04 60 62.80 0.96 -0.25

Myeloma 1 0.28 5 0.52 6 0.92 2 0.39 14 24.88 0.56* -0.99

Leukemia 7 0.93 19 0.93 7 0.51 2 0.19* 35 52.41 0.67* -1.58

Acute lymphocytic 0 0.00 1 1.78 0 0.00 0 0.00 1 1.41 0.71 -0.04

Chronic lymphocytic 0 0.00 2 0.24* 0 0.00* 0 0.00* 2 21.57 0.09* -1.78

Acute non-lymphocytic 6 2.49 12 1.83 4 0.89 0 0.00 22 17.09 1.29 0.45

Chronic myeloid 0 0.00 3 1.11 3 1.64 0 0.00 6 7.02 0.86 -0.09

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 26,258 19,381 7,869 3,489 26,258

Person-years in interval 18,818 47,303 27,024 17,022 110,166

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Oral and Pharynx

Males

Table 3.2.5: Risk of subsequent primary cancers after cancer of the oral cavity or pharynx (tongue, mouth, tonsil, oropharynx,

hypopharynx), males, SEER 1973-2000.

32 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ORAL AND PHARYNX

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Oral and Pharynx

Both Sexes, <50 Years of Age

Table 3.2.6: Risk of subsequent primary cancers after cancer of the oral cavity or pharynx (tongue, mouth, tonsil, oropharynx,

hypopharynx), both sexes, <50 years of age, SEER 1973-2000.

ORAL AND PHARYNX

All subsequent cancers 79 6.68* 291 6.71* 242 5.16* 215 2.64* 827 183.62 4.50* 172.07

All excluding same site 51 4.50* 210 5.03* 156 3.44* 156 1.96* 573 178.03 3.22* 105.63

Buccal cavity, pharynx 32 50.11* 91 42.28* 93 44.80* 63 24.76* 279 7.41 37.65* 72.63

Lip 3 55.35* 1 5.47 0 0.00 1 4.46 5 0.63 7.96* 1.17

Tongue 6 42.53* 27 55.68* 33 69.81* 19 32.95* 85 1.68 50.74* 22.28

Salivary gland 0 0.00 0 0.00 3 21.56* 0 0.00 3 0.53 5.65* 0.66

Mouth 15 90.23* 30 54.69* 33 62.08* 22 34.30* 100 1.89 52.97* 26.24

Nasopharynx 0 0.00 4 30.40* 2 17.35* 1 7.79 7 0.42 16.85* 1.76

Tonsil 5 50.64* 9 27.74* 12 39.61* 10 30.73* 36 1.05 34.24* 9.35

Oropharynx 1 53.15 3 46.74* 3 47.90* 0 0.00 7 0.23 30.62* 1.81

Hypopharynx 1 17.58 12 58.86* 5 23.12* 8 29.12* 26 0.75 34.58* 6.75

Digestive system 21 10.81* 51 7.08* 43 5.31* 35 2.47* 150 31.43 4.77* 31.71

Esophagus 16 86.91* 32 50.22* 24 35.10* 15 14.51* 87 2.54 34.27* 22.59

Stomach 0 0.00 2 2.50 1 1.22 4 3.05 7 3.17 2.21 1.03

Small intestine 0 0.00 0 0.00 0 0.00 1 3.45 1 0.71 1.41 0.08

Colon 4 6.13* 4 1.59 7 2.36 7 1.25 22 11.74 1.87* 2.74

Rectum, rectosigmoid junction 0 0.00 6 4.29* 3 1.87 4 1.48 13 6.06 2.14* 1.86

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.15

Liver 1 8.27 4 9.64* 4 9.37* 0 0.00 9 1.68 5.37* 1.96

Gallbladder 0 0.00 1 17.96 1 14.71 0 0.00 2 0.28 7.23 0.46

Bile ducts, other biliary 0 0.00 0 0.00 2 13.85* 1 3.45 3 0.59 5.07* 0.64

Pancreas 0 0.00 2 2.37 1 1.04 3 1.76 6 3.74 1.60 0.60

Respiratory system 7 3.76* 104 14.80* 69 8.48* 58 4.06* 238 31.32 7.60* 55.28

Nose, nasal cavity, ear 0 0.00 0 0.00 1 10.66 0 0.00 1 0.35 2.88 0.17

Larynx 2 9.36* 11 14.22* 16 19.17* 12 10.22* 41 3.00 13.68* 10.16

Lung, bronchus 5 3.11* 92 15.03* 52 7.24* 46 3.55* 195 27.87 7.00* 44.70

Female breast 3 1.66 7 1.03 9 1.30 15 1.43 34 26.09 1.30 5.66

Female genital system 1 1.39 2 0.72 3 1.08 5 1.18 11 10.50 1.05 0.36

Cervix uteri 1 4.22 2 2.64 0 0.00 0 0.00 3 2.19 1.37 0.58

Corpus uteri 0 0.00 0 0.00 2 1.68 0 0.00 2 4.55 0.44 -1.82

Ovary 0 0.00 0 0.00 1 1.18 4 3.14 5 3.15 1.58 1.32

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.08

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.22

Male genital system 3 4.06 5 1.45 8 1.39 14 0.83 30 26.82 1.12 1.36

Prostate 2 3.93 5 1.77 8 1.49 14 0.84 29 25.34 1.14 1.57

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 1.23 0.00 -0.52

Urinary system 1 1.25 3 1.00 7 2.10 7 1.21 18 12.91 1.39 1.36

Urinary bladder 1 2.46 1 0.63 2 1.08 3 0.86 7 7.34 0.95 -0.09

Kidney parenchyma 0 0.00 2 1.56 4 2.99 4 1.97 10 5.01 2.00 1.33

Renal pelvis, other urinary 0 0.00 0 0.00 1 7.31 0 0.00 1 0.56 1.78 0.12

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.04

Bone, joints 0 0.00 1 10.34 2 25.79* 0 0.00 3 0.30 10.16* 0.72

Soft tissue including heart 0 0.00 0 0.00 0 0.00 1 2.79 1 1.11 0.90 -0.03

Kaposi sarcoma 1 3.58 2 2.78 1 2.47 0 0.00 4 1.63 2.45 0.63

Melanoma of skin 1 1.36 4 1.59 1 0.45 4 1.46 10 8.24 1.21 0.47

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.09

Brain, central nervous system 0 0.00 2 2.16 0 0.00 4 4.00* 6 3.02 1.99 0.80

Thyroid 3 10.56* 2 2.13 0 0.00 1 1.20 6 2.82 2.13 0.85

Lymphatic, hematopoietic 1 0.81 7 1.69 2 0.51 3 0.52 13 15.00 0.87 -0.54

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.15 0.00 -0.31

Non-Hodgkin lymphoma 1 1.55 4 1.85 2 1.00 3 1.05 10 7.66 1.30 0.62

Myeloma 0 0.00 2 4.24 0 0.00 0 0.00 2 2.07 0.97 -0.02

Leukemia 0 0.00 1 0.92 0 0.00 0 0.00 1 4.12 0.24 -0.84

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.06

Chronic lymphocytic 0 0.00 1 3.14 0 0.00 0 0.00 1 1.43 0.70 -0.12

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.36 0.00 -0.36

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.67 0.00 -0.18

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,279 5,062 2,626 1,435 6,279

Person-years in interval 4,739 13,896 9,924 8,831 37,391

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 13,982 PYR and for male cancers on 23,409 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 33
All subsequent cancers 532 2.64* 1,968 3.08* 1,361 2.60* 909 1.95* 4,770 1,829.69 2.61* 267.09

All excluding same site 427 2.18* 1,570 2.52* 1,054 2.05* 701 1.53* 3,752 1,791.15 2.09* 178.12

Buccal cavity, pharynx 116 14.90* 458 21.10* 335 23.31* 232 23.14* 1,141 53.89 21.17* 98.75

Lip 3 3.11 13 4.65* 7 3.51* 8 5.18* 31 7.29 4.25* 2.15

Tongue 34 21.42* 137 30.86* 94 31.93* 67 32.95* 332 11.00 30.17* 29.16

Salivary gland 0 0.00 11 7.94* 3 2.78 2 2.03 16 3.90 4.10* 1.10

Mouth 45 21.70* 162 28.36* 124 33.37* 85 32.95* 416 14.08 29.54* 36.51

Nasopharynx 1 3.08 9 10.39* 3 5.62* 1 2.94 14 2.06 6.78* 1.08

Tonsil 14 15.74* 37 15.68* 31 21.85* 14 16.60* 96 5.51 17.42* 8.22

Oropharynx 4 15.53* 12 16.99* 10 21.93* 16 54.98* 42 1.71 24.55* 3.66

Hypopharynx 8 8.49* 50 19.25* 48 28.78* 26 25.38* 132 6.23 21.18* 11.42

Digestive system 117 2.82* 355 2.73* 272 2.56* 158 1.61* 902 375.98 2.40* 47.78

Esophagus 57 18.73* 159 18.25* 124 19.58* 49 9.61* 389 23.19 16.77* 33.23

Stomach 6 1.36 25 1.87* 12 1.15 7 0.75 50 37.59 1.33 1.13

Small intestine 1 1.60 1 0.51 2 1.25 3 2.02 7 5.67 1.24 0.12

Colon 21 1.27 76 1.41* 64 1.38* 42 0.93 203 162.22 1.25* 3.70

Rectum, rectosigmoid junction 8 0.98 35 1.39 32 1.64* 20 1.24 95 68.86 1.38* 2.37

Anus, anal canal 3 6.87* 4 2.98 1 0.97 2 2.34 10 3.66 2.73* 0.58

Liver 9 5.49* 18 3.63* 13 3.30* 11 3.04* 51 14.16 3.60* 3.35

Gallbladder 2 4.81 1 0.72 0 0.00 0 0.00 3 4.24 0.71 -0.11

Bile ducts, other biliary 0 0.00 8 3.35* 3 1.43 5 2.16 16 7.53 2.12* 0.77

Pancreas 10 1.98 27 1.72* 21 1.64* 18 1.51 76 45.45 1.67* 2.77

Respiratory system 156 3.62* 755 5.77* 450 4.47* 276 3.37* 1,637 356.38 4.59* 116.33

Nose, nasal cavity, ear 2 5.76 6 6.00* 3 4.13 0 0.00 11 2.69 4.09* 0.75

Larynx 21 5.39* 86 7.89* 43 5.93* 26 5.50* 176 26.78 6.57* 13.55

Lung, bronchus 132 3.41* 661 5.58* 401 4.34* 248 3.25* 1,442 326.07 4.42* 101.37

Female breast 27 1.67* 61 1.15 42 0.95 37 0.91 167 154.12 1.08 3.15

Female genital system 11 1.30 31 1.17 20 0.99 10 0.60 72 71.78 1.00 0.05

Cervix uteri 3 2.96 7 2.44 2 1.06 2 1.53 14 7.07 1.98* 1.69

Corpus uteri 4 0.85 10 0.68 5 0.45 4 0.45 23 39.27 0.59* -3.98

Ovary 3 1.33 7 0.96 11 1.88 3 0.58 24 20.52 1.17 0.85

Vagina 0 0.00 2 6.50 1 3.74 0 0.00 3 0.94 3.19 0.50

Vulva 1 4.56 4 5.19* 1 1.38 1 1.16 7 2.58 2.71* 1.08

Male genital system 39 1.01 133 1.00 104 0.85 88 0.79* 364 405.73 0.90* -6.03

Prostate 39 1.02 131 1.00 103 0.85 87 0.78* 360 402.14 0.90* -6.09

Testis 0 0.00 0 0.00 0 0.00 1 7.87 1 1.15 0.87 -0.02

Urinary system 13 0.81 52 1.02 61 1.46* 38 0.99 164 147.22 1.11 1.52

Urinary bladder 8 0.76 35 1.04 44 1.55* 28 1.04 115 99.67 1.15 1.39

Kidney parenchyma 5 1.08 15 1.06 15 1.38 7 0.77 42 38.78 1.08 0.29

Renal pelvis, other urinary 0 0.00 2 0.66 2 0.80 3 1.32 7 8.77 0.80 -0.16

Ureter 0 0.00 1 1.01 2 2.37 1 1.31 4 2.90 1.38 0.10

Bone, joints 0 0.00 1 1.69 1 2.37 1 3.09 3 1.54 1.95 0.13

Soft tissue including heart 0 0.00 4 1.70 5 2.77 0 0.00 9 6.63 1.36 0.22

Kaposi sarcoma 0 0.00 1 1.64 0 0.00 0 0.00 1 1.48 0.67 -0.04

Melanoma of skin 10 2.09 7 0.47* 8 0.70 9 0.89 34 41.05 0.83 -0.64

Eye, orbit 0 0.00 2 2.00 1 1.36 1 1.66 4 2.67 1.50 0.12

Brain, central nervous system 4 1.57 4 0.53 2 0.37 2 0.47 12 19.79 0.61 -0.71

Thyroid 7 5.75* 3 0.85 0 0.00 1 0.57 11 8.90 1.24 0.19

Lymphatic, hematopoietic 15 1.08 39 0.89 34 0.94 22 0.64* 110 128.56 0.86 -1.69

Hodgkin lymphoma 0 0.00 1 0.60 2 1.83 0 0.00 3 4.16 0.72 -0.11

Non-Hodgkin lymphoma 9 1.44 20 1.01 14 0.85 13 0.81 56 58.74 0.95 -0.25

Myeloma 1 0.40 4 0.52 8 1.25 5 0.83 18 22.64 0.80 -0.42

Leukemia 5 1.08 14 0.96 10 0.82 4 0.34* 33 43.02 0.77 -0.91

Acute lymphocytic 0 0.00 1 2.38 0 0.00 0 0.00 1 1.17 0.85 -0.02

Chronic lymphocytic 0 0.00 2 0.32 2 0.39 0 0.00* 4 18.02 0.22* -1.27

Acute non-lymphocytic 4 2.77 8 1.71 3 0.74 1 0.25 16 14.26 1.12 0.16

Chronic myeloid 0 0.00 3 1.58 3 1.92 1 0.64 7 5.65 1.24 0.12

Oral and Pharynx

Both Sexes, 50-69 Years of Age

Table 3.2.7: Risk of subsequent primary cancers after cancer of the oral cavity or pharynx (tongue, mouth, tonsil, oropharynx,

hypopharynx), both sexes, 50-69 years of age, SEER 1973-2000.

34 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ORAL AND PHARYNX

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 22,748 17,545 7,944 3,881 22,748

Person-years in interval 16,714 45,245 28,430 19,700 110,089

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 40,888 PYR and for male cancers on 69,200 PYR.
Oral and Pharynx

Both Sexes, ≥70 Years of Age

Table 3.2.8: Risk of subsequent primary cancers after cancer of the oral cavity or pharynx (tongue, mouth, tonsil, oropharynx,

hypopharynx), both sexes, ≥70 years of age, SEER 1973-2000.

ORAL AND PHARYNX

All subsequent cancers 291 1.63* 722 1.72* 331 1.62* 135 1.80* 1,479 877.90 1.68* 177.71

All excluding same site 244 1.38* 584 1.41* 261 1.29* 106 1.43* 1,195 866.75 1.38* 97.05

Buccal cavity, pharynx 53 13.28* 152 17.27* 79 20.16* 29 21.06* 313 18.09 17.30* 87.19

Lip 2 2.46 7 3.87* 4 4.80* 0 0.00 13 3.75 3.46* 2.73

Tongue 7 9.61* 42 26.25* 22 31.35* 5 21.44* 76 3.26 23.29* 21.50

Salivary gland 2 5.10 2 2.14 1 2.03 0 0.00 5 2.04 2.46 0.88

Mouth 31 30.05* 73 31.61* 38 36.19* 20 52.38* 162 4.77 33.94* 46.48

Nasopharynx 1 7.92 0 0.00 0 0.00 0 0.00 1 0.54 1.85 0.14

Tonsil 4 13.78* 10 16.48* 5 21.33* 1 15.12 20 1.20 16.70* 5.56

Oropharynx 0 0.00 5 24.57* 1 12.15 2 84.89* 8 0.40 19.79* 2.25

Hypopharynx 5 13.32* 8 10.35* 4 14.01* 1 13.01 18 1.51 11.91* 4.88

Digestive system 63 1.42* 159 1.52* 71 1.32* 28 1.34 321 223.89 1.43* 28.71

Esophagus 15 8.08* 43 10.36* 18 9.34* 7 9.99* 83 8.63 9.61* 21.99

Stomach 8 1.64 20 1.79* 9 1.61 3 1.36 40 23.86 1.68* 4.77

Small intestine 1 1.92 2 1.63 1 1.62 0 0.00 4 2.61 1.53 0.41

Colon 22 1.06 53 1.05 20 0.75 9 0.85 104 108.37 0.96 -1.29

Rectum, rectosigmoid junction 6 0.82 19 1.13 8 1.00 4 1.40 37 35.04 1.06 0.58

Anus, anal canal 0 0.00 2 2.72 0 0.00 0 0.00 2 1.56 1.28 0.13

Liver 3 2.26 6 1.94 4 2.72 0 0.00 13 6.42 2.02* 1.95

Gallbladder 0 0.00 0 0.00 1 1.18 0 0.00 1 3.47 0.29 -0.73

Bile ducts, other biliary 2 2.07 2 0.83 2 1.48 1 1.67 7 5.32 1.32 0.50

Pancreas 6 1.14 12 0.97 8 1.26 3 1.19 29 26.55 1.09 0.72

Respiratory system 65 2.21* 183 2.76* 78 2.63* 28 2.91* 354 135.06 2.62* 64.73

Nose, nasal cavity, ear 0 0.00 2 3.39 2 6.69 1 8.88 5 1.25 4.00* 1.11

Larynx 5 2.94 12 3.34* 3 2.13 2 4.97 22 7.10 3.10* 4.40

Lung, bronchus 60 2.19* 166 2.68* 72 2.58* 25 2.76* 323 126.36 2.56* 58.14

Female breast 13 0.99 34 1.01 13 0.73 8 1.19 68 71.36 0.95 -2.07

Female genital system 7 1.21 8 0.55 3 0.42 3 1.11 21 30.13 0.70 -5.61

Cervix uteri 2 3.62 0 0.00 0 0.00 0 0.00 2 2.71 0.74 -0.44

Corpus uteri 3 1.05 2 0.29 1 0.30 2 1.79 8 14.23 0.56 -3.83

Ovary 0 0.00 2 0.45 1 0.44 1 1.12 4 9.38 0.43 -3.31

Vagina 2 17.08* 2 6.60 0 0.00 0 0.00 4 0.66 6.10* 2.06

Vulva 0 0.00 2 1.99 1 1.66 0 0.00 3 2.27 1.32 0.45

Male genital system 41 1.01 91 0.99 34 0.81 17 1.23 183 188.32 0.97 -3.03

Prostate 39 0.96 90 0.99 34 0.82 17 1.24 180 186.84 0.96 -3.90

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.11

Urinary system 21 1.38 36 1.01 20 1.13 9 1.36 86 75.21 1.14 3.19

Urinary bladder 15 1.35 27 1.03 18 1.37 7 1.40 67 55.45 1.21 3.41

Kidney parenchyma 5 1.63 5 0.70 2 0.59 2 1.70 14 14.73 0.95 -0.22

Renal pelvis, other urinary 1 0.97 4 1.66 0 0.00 0 0.00 5 5.03 0.99 -0.01

Ureter 0 0.00 1 1.22 0 0.00 0 0.00 1 1.71 0.59 -0.21

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -0.19

Soft tissue including heart 0 0.00 1 0.64 2 2.49 0 0.00 3 3.34 0.90 -0.10

Kaposi sarcoma 0 0.00 1 2.79 0 0.00 0 0.00 1 0.80 1.24 0.06

Melanoma of skin 5 1.72 9 1.26 5 1.36 4 2.60 23 15.24 1.51 2.29

Eye, orbit 1 4.22 1 1.84 0 0.00 1 10.93 3 1.13 2.66 0.55

Brain, central nervous system 3 2.08 2 0.59 0 0.00 0 0.00 5 6.88 0.73 -0.55

Thyroid 2 3.48 2 1.50 2 3.31 0 0.00 6 2.72 2.20 0.97

Lymphatic, hematopoietic 12 0.88 29 0.89 14 0.83 3 0.46 58 69.73 0.83 -3.47

Hodgkin lymphoma 0 0.00 0 0.00 1 2.93 0 0.00 1 1.57 0.64 -0.17

Non-Hodgkin lymphoma 7 1.24 12 0.87 8 1.11 3 1.08 30 29.52 1.02 0.14

Myeloma 1 0.42 3 0.53 1 0.35 0 0.00 5 12.08 0.41* -2.09

Leukemia 4 0.77 14 1.13 4 0.63 0 0.00 22 26.57 0.83 -1.35

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -0.19

Chronic lymphocytic 1 0.48 3 0.61 1 0.40 0 0.00 5 10.43 0.48 -1.60

Acute non-lymphocytic 2 1.13 9 2.13 1 0.46 0 0.00 12 8.99 1.33 0.89

Chronic myeloid 1 1.45 1 0.60 1 1.12 0 0.00 3 3.62 0.83 -0.18

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 10,474 7,100 2,538 816 10,474

Person-years in interval 7,110 16,324 7,602 2,788 33,824

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 16,268 PYR and for male cancers on 17,556 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 35
All subsequent cancers 537 2.22* 1,669 2.82* 983 2.67* 566 2.14* 3,755 1,466.29 2.56* 248.04

All excluding same site 448 1.89* 1,374 2.38* 774 2.14* 440 1.69* 3,036 1,436.89 2.11* 173.31

Buccal cavity, pharynx 97 12.31* 334 18.47* 227 22.79* 141 23.29* 799 41.97 19.04* 82.04

Lip 2 1.74 7 2.68* 1 0.69 6 6.71* 16 6.11 2.62* 1.07

Tongue 28 17.91* 111 30.61* 81 40.16* 38 30.80* 258 8.44 30.57* 27.05

Salivary gland 0 0.00 5 3.77* 3 3.70 1 1.70 9 3.27 2.75* 0.62

Mouth 44 21.38* 119 25.40* 83 32.42* 53 34.39* 299 10.84 27.57* 31.23

Nasopharynx 2 6.37 7 9.92* 5 13.33* 0 0.00 14 1.62 8.65* 1.34

Tonsil 8 9.65* 26 13.88* 16 16.34* 11 20.06* 61 4.23 14.42* 6.15

Oropharynx 1 4.17 8 14.53* 5 16.62* 9 50.89* 23 1.27 18.13* 2.36

Hypopharynx 8 8.99* 31 15.35* 24 22.07* 15 24.32* 78 4.61 16.90* 7.95

Digestive system 131 2.45* 322 2.52* 207 2.63* 95 1.69* 755 316.47 2.39* 47.53

Esophagus 63 19.26* 142 18.78* 101 22.96* 38 12.71* 344 18.22 18.88* 35.31

Stomach 9 1.52 26 1.92* 12 1.50 4 0.73 51 32.97 1.55* 1.95

Small intestine 0 0.00 2 1.10 0 0.00 2 2.34 4 4.57 0.88 -0.06

Colon 29 1.27 73 1.31* 44 1.25 22 0.86 168 139.19 1.21* 3.12

Rectum, rectosigmoid junction 10 1.03 34 1.47* 15 1.09 10 1.08 69 55.89 1.23 1.42

Anus, anal canal 2 4.18 4 3.40 0 0.00 1 2.01 7 2.87 2.44 0.45

Liver 6 3.05* 15 3.18* 11 3.85* 5 2.36 37 11.67 3.17* 2.75

Gallbladder 2 3.14 1 0.66 2 2.11 0 0.00 5 3.79 1.32 0.13

Bile ducts, other biliary 2 1.92 5 1.95 4 2.41 0 0.00 11 6.60 1.67 0.48

Pancreas 8 1.25 20 1.31 18 1.92* 12 1.77 58 37.88 1.53* 2.18

Respiratory system 142 3.03* 654 5.84* 330 4.91* 178 3.87* 1,304 272.09 4.79* 111.84

Nose, nasal cavity, ear 1 2.59 3 3.29 2 3.75 0 0.00 6 2.19 2.74 0.41

Larynx 13 3.46* 56 6.50* 26 5.46* 20 7.08* 115 19.96 5.76* 10.30

Lung, bronchus 128 3.00* 590 5.78* 300 4.85* 157 3.68* 1,175 249.26 4.71* 100.33

Female breast 29 1.70* 47 1.06 31 1.06 25 1.14 132 112.61 1.17 6.13

Female genital system 8 0.97 18 0.87 11 0.85 3 0.33* 40 50.93 0.79 -3.45

Cervix uteri 4 3.99* 6 2.55 2 1.53 1 1.25 13 5.47 2.38* 2.38

Corpus uteri 1 0.23 3 0.28* 4 0.60 1 0.21 9 26.59 0.34* -5.56

Ovary 1 0.43 2 0.34 4 1.05 0 0.00 7 14.82 0.47* -2.47

Vagina 1 8.51 2 6.81 1 5.19 0 0.00 4 0.75 5.32* 1.03

Vulva 1 3.08 4 4.79* 0 0.00 1 2.14 6 2.20 2.73 1.20

Male genital system 46 0.88 129 0.99 68 0.80 56 0.87 299 331.52 0.90 -5.36

Prostate 45 0.87 126 0.98 67 0.80 55 0.86 293 328.01 0.89 -5.78

Testis 0 0.00 0 0.00 0 0.00 1 8.03 1 1.39 0.72 -0.06

Urinary system 25 1.25 52 1.07 45 1.49* 26 1.19 148 120.91 1.22* 2.94

Urinary bladder 15 1.10 32 0.96 35 1.68* 19 1.24 101 83.25 1.21 1.92

Kidney parenchyma 9 1.77 16 1.29 9 1.19 6 1.13 40 30.38 1.32 1.04

Renal pelvis, other urinary 1 0.81 4 1.35 1 0.55 1 0.79 7 7.28 0.96 -0.03

Ureter 0 0.00 1 1.02 1 1.65 0 0.00 2 2.40 0.83 -0.04

Bone, joints 0 0.00 1 1.87 2 6.61 1 5.16 4 1.26 3.18 0.30

Soft tissue including heart 0 0.00 1 0.44 6 4.39* 0 0.00 7 5.60 1.25 0.15

Kaposi sarcoma 0 0.00 3 3.22 1 2.20 0 0.00 4 2.05 1.95 0.21

Melanoma of skin 7 1.34 10 0.75 9 1.09 7 1.16 33 32.79 1.01 0.02

Eye, orbit 1 2.74 2 2.28 1 1.94 0 0.00 4 2.10 1.90 0.21

Brain, central nervous system 3 1.14 6 0.94 1 0.27 2 0.81 12 15.20 0.79 -0.35

Thyroid 8 6.41* 4 1.32 2 1.15 1 0.89 15 7.13 2.10* 0.85

Lymphatic, hematopoietic 19 1.08 43 1.00 26 0.97 13 0.66 101 106.97 0.94 -0.65

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 3.53 0.00 -0.38

Non-Hodgkin lymphoma 11 1.44 21 1.10 15 1.24 10 1.10 57 47.92 1.19 0.98

Myeloma 1 0.32 5 0.67 4 0.86 1 0.29 11 18.63 0.59 -0.83

Leukemia 7 1.13 17 1.14 7 0.76 2 0.30 33 36.90 0.89 -0.42

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.02 0.00 -0.11

Chronic lymphocytic 1 0.40 3 0.49 1 0.27 0 0.00 5 15.03 0.33* -1.09

Acute non-lymphocytic 5 2.48 10 2.04 2 0.65 0 0.00 17 12.27 1.39 0.51

Chronic myeloid 0 0.00 3 1.50 3 2.45 1 1.10 7 4.97 1.41 0.22

Oral and Pharynx

Both Sexes, Radiotherapy

Table 3.2.9: Risk of subsequent primary cancers after cancer of the oral cavity or pharynx (tongue, mouth, tonsil, oropharynx,

hypopharynx), both sexes, with initial radiotherapy, SEER 1973-2000.

36 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ORAL AND PHARYNX

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 24,609 17,568 6,472 2,686 24,609

Person-years in interval 17,546 40,322 21,557 12,846 92,270

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 31,656 PYR and for male cancers on 60,614 PYR.
Oral and Pharynx

Both Sexes, No Radiotherapy

Table 3.2.10: Risk of subsequent primary cancers after cancer of the oral cavity or pharynx (tongue, mouth, tonsil, oropharynx,

hypopharynx), both sexes, without initial radiotherapy, SEER 1973-2000.

ORAL AND PHARYNX

All subsequent cancers 365 2.43* 1,312 2.57* 951 2.34* 693 1.94* 3,321 1,424.92 2.33* 212.96

All excluding same site 274 1.86* 990 1.98* 697 1.74* 523 1.48* 2,484 1,399.03 1.78* 121.86

Buccal cavity, pharynx 104 22.92* 367 25.17* 280 26.90* 183 23.18* 934 37.42 24.96* 100.70

Lip 6 8.77* 14 6.46* 10 6.49* 3 2.56 33 5.57 5.93* 3.08

Tongue 19 21.27* 95 32.78* 68 32.36* 53 32.94* 235 7.50 31.33* 25.55

Salivary gland 2 5.86 8 7.00* 4 4.45* 1 1.24 15 3.19 4.70* 1.33

Mouth 47 38.73* 146 37.58* 112 40.91* 74 35.90* 379 9.90 38.29* 41.46

Nasopharynx 0 0.00 6 10.73* 0 0.00 2 7.11 8 1.40 5.71* 0.74

Tonsil 15 33.35* 30 21.17* 32 32.75* 14 20.39* 91 3.53 25.78* 9.82

Oropharynx 4 30.49* 12 28.34* 9 29.99* 9 40.77* 34 1.08 31.61* 3.70

Hypopharynx 6 12.40* 39 25.09* 33 30.50* 20 26.35* 98 3.88 25.26* 10.57

Digestive system 70 2.05* 243 2.13* 179 2.00* 126 1.63* 618 314.82 1.96* 34.05

Esophagus 25 13.80* 92 15.49* 65 14.30* 33 8.58* 215 16.14 13.32* 22.34

Stomach 5 1.38 21 1.79* 10 1.13 10 1.36 46 31.65 1.45* 1.61

Small intestine 2 4.41 1 0.65 3 2.39 2 1.72 8 4.42 1.81 0.40

Colon 18 1.19 60 1.17 47 1.15 36 1.00 161 143.15 1.12 2.01

Rectum, rectosigmoid junction 4 0.66 26 1.29 28 1.83* 18 1.44 76 54.07 1.41* 2.46

Anus, anal canal 1 3.24 2 1.90 1 1.21 1 1.41 5 2.90 1.73 0.24

Liver 7 6.24* 13 3.47* 10 3.36* 6 2.19 36 10.59 3.40* 2.85

Gallbladder 0 0.00 1 0.65 0 0.00 0 0.00 1 4.20 0.24 -0.36

Bile ducts, other biliary 0 0.00 5 2.14 3 1.55 7 3.72* 15 6.84 2.19* 0.92

Pancreas 8 1.95 21 1.54 12 1.12 12 1.28 53 37.87 1.40* 1.70

Respiratory system 86 3.13* 388 4.21* 267 3.75* 184 3.08* 925 250.67 3.69* 75.74

Nose, nasal cavity, ear 1 4.21 5 6.43* 4 6.83* 1 2.03 11 2.09 5.26* 1.00

Larynx 15 7.28* 53 7.98* 36 7.60* 20 5.75* 124 16.91 7.33* 12.03

Lung, bronchus 69 2.75* 329 3.89* 225 3.42* 162 2.91* 785 231.04 3.40* 62.22

Female breast 14 0.99 55 1.11 33 0.83 35 0.98 137 138.96 0.99 -0.50

Female genital system 11 1.63 23 1.01 15 0.87 15 1.02 64 61.48 1.04 0.64

Cervix uteri 2 2.50 3 1.17 0 0.00 1 0.75 6 6.50 0.92 -0.13

Corpus uteri 6 1.72 9 0.76 4 0.46 5 0.68 24 31.46 0.76 -1.89

Ovary 2 1.05 7 1.06 9 1.74 8 1.76 26 18.23 1.43 1.97

Vagina 1 9.98 2 5.82 0 0.00 0 0.00 3 0.95 3.15 0.52

Vulva 0 0.00 2 1.96 2 2.40 0 0.00 4 2.96 1.35 0.26

Male genital system 37 1.32 100 1.02 78 0.92 63 0.80 278 289.35 0.96 -2.29

Prostate 35 1.27 100 1.03 78 0.93 63 0.81 276 286.31 0.96 -2.08

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 1.19 0.00 -0.24

Urinary system 10 0.83 39 0.96 43 1.32 28 0.97 120 114.44 1.05 0.62

Urinary bladder 9 1.08 31 1.10 29 1.29 19 0.94 88 79.22 1.11 0.99

Kidney parenchyma 1 0.34 6 0.59 12 1.50 7 1.00 26 28.14 0.92 -0.24

Renal pelvis, other urinary 0 0.00 2 0.77 2 1.00 2 1.17 6 7.08 0.85 -0.12

Ureter 0 0.00 1 1.16 1 1.49 1 1.78 3 2.35 1.28 0.07

Bone, joints 0 0.00 1 2.17 1 2.98 0 0.00 2 1.21 1.65 0.09

Soft tissue including heart 0 0.00 4 2.03 1 0.65 1 0.72 6 5.48 1.10 0.06

Kaposi sarcoma 1 4.15 1 1.33 0 0.00 0 0.00 2 1.87 1.07 0.01

Melanoma of skin 9 2.80* 10 0.90 5 0.55 10 1.19 34 31.74 1.07 0.25

Eye, orbit 0 0.00 1 1.31 0 0.00 2 4.23 3 2.04 1.47 0.11

Brain, central nervous system 4 2.46 2 0.37 1 0.25 4 1.20 11 14.49 0.76 -0.39

Thyroid 4 4.83* 3 1.09 0 0.00 1 0.59 8 7.31 1.09 0.08

Lymphatic, hematopoietic 9 0.81 32 0.85 24 0.80 15 0.55* 80 106.32 0.75* -2.96

Hodgkin lymphoma 0 0.00 1 0.76 3 3.30 0 0.00 4 3.34 1.20 0.07

Non-Hodgkin lymphoma 6 1.23 15 0.89 9 0.66 9 0.71 39 48.01 0.81 -1.01

Myeloma 1 0.52 4 0.62 5 0.97 4 0.86 14 18.15 0.77 -0.47

Leukemia 2 0.51 12 0.91 7 0.67 2 0.22* 23 36.81 0.62* -1.55

Acute lymphocytic 0 0.00 1 2.69 0 0.00 0 0.00 1 1.01 0.99 0.00

Chronic lymphocytic 0 0.00 3 0.56 2 0.47 0 0.00 5 14.85 0.34* -1.11

Acute non-lymphocytic 1 0.77 7 1.60 2 0.57 1 0.31 11 12.35 0.89 -0.15

Chronic myeloid 1 1.87 1 0.56 1 0.71 0 0.00 3 4.97 0.60 -0.22

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 14,892 12,139 6,636 3,446 14,892

Person-years in interval 11,018 35,143 24,399 18,473 89,033

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 39,481 PYR and for male cancers on 49,552 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 37
Tongue

Both Sexes

Table 3.3.1: Characteristics of patients with an initial cancer of the tongue, both sexes,

SEER 1973-2000.

38 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

TONGUE

Number of patients with 1st primary cancer

Total 7,733 100.0 3,950 100.0 11,683 100.0

Initial treatment

Any radiation 4,848 62.7 2,077 52.6 6,925 59.3

With surgery 2,302 29.8 1,081 27.4 3,383 29.0

Without surgery 2,546 32.9 996 25.2 3,542 30.3

No radiation 2,885 37.3 1,873 47.4 4,758 40.7

With surgery 2,362 30.5 1,631 41.3 3,993 34.2

Without surgery 523 6.8 242 6.1 765 6.5

Race

White 6,501 84.1 3,388 85.8 9,889 84.6

Black 861 11.1 309 7.8 1,170 10.0

Other 354 4.6 227 5.7 581 5.0

Unknown 17 0.2 26 0.7 43 0.4

Age at 1st primary cancer diagnosis, years

< 30 99 1.3 88 2.2 187 1.6

30–49 1,415 18.3 559 14.2 1,974 16.9

50–69 4,473 57.8 1,970 49.9 6,443 55.1

70–79 1,337 17.3 846 21.4 2,183 18.7

> 80 409 5.3 487 12.3 896 7.7

Number of patients with one or more

primary cancers

One primary cancer only 6,652 86.0 3,431 86.9 10,083 86.3

1st and 2nd cancers 951 12.3 451 11.4 1,402 12.0

1st, 2nd, and 3rd cancers 106 1.4 60 1.5 166 1.4

1st, 2nd, 3rd, and additional cancers 24 0.3 8 0.2 32 0.3

Other statistics

Median age at 1st cancer diagnosis 60.8 — 64.2 — 61.8 —

Median year of 1st cancer diagnosis 1988.3 — 1988.0 — 1988.2 —

Median person-years at risk 2.0 — 2.7 — 2.2 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 95.2 — 95.2 — 95.2

1st, 2nd, and additional cancers — 94.8 — 93.6 — 94.4

1st cancer only — 4.5 — 4.6 — 4.6

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Tongue

Both Sexes

Table 3.3.2: Risk of subsequent primary cancers after cancer of the tongue, both sexes,

SEER 1973-2000.

TONGUE

All subsequent cancers 252 2.23* 749 2.41* 506 2.28* 328 1.81* 1,835 826.02 2.22* 189.74

All excluding same site 247 2.20* 716 2.32* 477 2.17* 306 1.70* 1,746 821.47 2.13* 173.86

Buccal cavity, pharynx 53 15.14* 167 18.40* 148 25.64* 84 20.49* 452 22.45 20.14* 80.78

Lip 4 7.71* 6 4.52* 0 0.00 2 3.27 12 3.31 3.62* 1.63

Tongue 5 7.10* 33 18.04* 29 24.72* 22 26.04* 89 4.55 19.55* 15.88

Salivary gland 1 3.89 5 7.12* 1 2.03 0 0.00 7 1.86 3.76* 0.97

Mouth 30 32.85* 65 27.49* 65 43.67* 32 30.60* 192 5.81 33.04* 35.01

Nasopharynx 0 0.00 1 2.71 0 0.00 0 0.00 1 0.90 1.11 0.02

Tonsil 4 11.20* 18 19.80* 22 40.00* 11 30.38* 55 2.18 25.25* 9.93

Oropharynx 1 9.68 5 18.61* 4 23.60* 7 61.06* 17 0.66 25.91* 3.07

Hypopharynx 4 10.54* 21 21.50* 21 34.74* 10 25.02* 56 2.36 23.72* 10.09

Digestive system 56 2.24* 143 2.09* 101 2.09* 57 1.45* 357 180.93 1.97* 33.11

Esophagus 21 14.75* 48 12.86* 47 18.57* 17 8.50* 133 9.68 13.73* 23.19

Stomach 1 0.37 18 2.52* 5 1.02 5 1.30 29 18.62 1.56* 1.95

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 2.56 0.00 -0.48

Colon 21 1.93* 42 1.39* 19 0.87 18 1.00 100 80.85 1.24* 3.60

Rectum, rectosigmoid junction 3 0.67 13 1.07 13 1.56 5 0.78 34 31.43 1.08 0.48

Anus, anal canal 1 4.38 2 3.15 0 0.00 0 0.00 3 1.65 1.82 0.25

Liver 4 4.48* 10 4.10* 5 2.89 2 1.33 21 6.56 3.20* 2.72

Gallbladder 0 0.00 0 0.00 1 1.62 0 0.00 1 2.30 0.43 -0.24

Bile ducts, other biliary 2 3.96 2 1.41 3 2.81 3 3.12 10 3.96 2.53* 1.14

Pancreas 3 1.00 8 0.98 8 1.39 6 1.27 25 21.63 1.16 0.63

Respiratory system 62 2.95* 252 4.44* 134 3.43* 75 2.45* 523 147.44 3.55* 70.63

Nose, nasal cavity, ear 1 5.62 1 2.10 1 3.09 0 0.00 3 1.23 2.44 0.33

Larynx 10 6.16* 23 5.49* 14 5.26* 6 3.28* 53 10.30 5.14* 8.03

Lung, bronchus 51 2.66* 227 4.37* 116 3.22* 69 2.43* 463 135.54 3.42* 61.58

Female breast 8 0.88 31 1.16 20 1.05 18 1.13 77 70.89 1.09 3.01

Female genital system 2 0.46 12 0.98 6 0.73 7 1.07 27 31.36 0.86 -2.15

Cervix uteri 0 0.00 1 0.72 1 1.18 1 1.65 3 3.36 0.89 -0.18

Corpus uteri 1 0.45 4 0.63 0 0.00* 2 0.61 7 16.03 0.44* -4.44

Ovary 0 0.00 3 0.84 5 2.01 3 1.48 11 9.29 1.18 0.84

Vagina 1 15.81 2 10.97* 0 0.00 0 0.00 3 0.49 6.18* 1.24

Vulva 0 0.00 2 3.68 0 0.00 1 2.77 3 1.50 2.00 0.74

Male genital system 27 1.17 64 0.99 36 0.73 36 0.86 163 178.42 0.91 -4.69

Prostate 26 1.14 64 1.01 36 0.74 36 0.87 162 176.42 0.92 -4.39

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.87 0.00 -0.26

Urinary system 14 1.51 23 0.91 24 1.33 20 1.33 81 67.71 1.20 2.50

Urinary bladder 10 1.58 14 0.81 19 1.52 14 1.33 57 46.78 1.22 1.92

Kidney parenchyma 4 1.72 7 1.09 4 0.89 5 1.38 20 16.83 1.19 0.60

Renal pelvis, other urinary 0 0.00 2 1.28 1 0.91 1 1.15 4 4.10 0.98 -0.02

Ureter 0 0.00 1 1.93 1 2.71 0 0.00 2 1.37 1.46 0.12

Bone, joints 0 0.00 1 3.51 1 5.43 0 0.00 2 0.71 2.81 0.24

Soft tissue including heart 0 0.00 2 1.64 3 3.57 0 0.00 5 3.22 1.55 0.33

Kaposi sarcoma 1 4.77 1 1.87 1 3.20 0 0.00 3 1.26 2.38 0.33

Melanoma of skin 7 2.76* 4 0.56 6 1.18 7 1.61 24 19.16 1.25 0.91

Eye, orbit 1 5.78 0 0.00 0 0.00 1 4.16 2 1.19 1.68 0.15

Brain, central nervous system 2 1.62 3 0.89 1 0.45 4 2.34 10 8.54 1.17 0.27

Thyroid 4 6.41* 2 1.17 0 0.00 0 0.00 6 4.29 1.40 0.32

Lymphatic, hematopoietic 8 0.96 26 1.13 14 0.85 8 0.58 56 61.53 0.91 -1.04

Hodgkin lymphoma 0 0.00 1 1.21 0 0.00 0 0.00 1 2.00 0.50 -0.19

Non-Hodgkin lymphoma 5 1.36 11 1.06 9 1.20 7 1.09 32 27.97 1.14 0.76

Myeloma 0 0.00 4 1.03 3 1.08 1 0.43 8 10.41 0.77 -0.45

Leukemia 3 1.03 10 1.26 2 0.35 0 0.00* 15 21.16 0.71 -1.16

Acute lymphocytic 0 0.00 1 4.32 0 0.00 0 0.00 1 0.60 1.67 0.08

Chronic lymphocytic 0 0.00 0 0.00 1 0.44 0 0.00 1 8.50 0.12* -1.41

Acute non-lymphocytic 2 2.09 6 2.27 1 0.53 0 0.00 9 7.11 1.27 0.35

Chronic myeloid 0 0.00 2 1.87 0 0.00 0 0.00 2 2.86 0.70 -0.16

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 11,683 8,750 3,802 1,811 11,683

Person-years in interval 8,439 21,905 13,388 9,445 53,177

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 20,315 PYR and for male cancers on 32,861 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 39
Gum and Mouth

Both Sexes

Table 3.4.1: Characteristics of patients with an initial cancer of the gum or mouth, both sexes,

SEER 1973-2000.

40 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

GUM AND MOUTH

Number of patients with 1st primary cancer

Total 9,287 100.0 6,014 100.0 15,301 100.0

Initial treatment

Any radiation 4,798 51.7 2,632 43.8 7,430 48.6

With surgery 2,708 29.2 1,393 23.2 4,101 26.8

Without surgery 2,090 22.5 1,239 20.6 3,329 21.8

No radiation 4,489 48.3 3,382 56.2 7,871 51.4

With surgery 3,909 42.1 3,027 50.3 6,936 45.3

Without surgery 580 6.2 355 5.9 935 6.1

Race

White 7,760 83.6 5,206 86.6 12,966 84.7

Black 1,159 12.5 527 8.8 1,686 11.0

Other 345 3.7 239 4.0 584 3.8

Unknown 23 0.2 42 0.7 65 0.4

Age at 1st primary cancer diagnosis, years

< 30 87 0.9 125 2.1 212 1.4

30–49 1,383 14.9 673 11.2 2,056 13.4

50–69 5,553 59.8 2,933 48.8 8,486 55.5

70–79 1,655 17.8 1,404 23.3 3,059 20.0

> 80 609 6.6 879 14.6 1,488 9.7

Number of patients with one or more

primary cancers

One primary cancer only 7,480 80.5 5,040 83.8 12,520 81.8

1st and 2nd cancers 1,529 16.5 817 13.6 2,346 15.3

1st, 2nd, and 3rd cancers 239 2.6 129 2.1 368 2.4

1st, 2nd, 3rd, and additional cancers 39 0.4 28 0.5 67 0.4

Other statistics

Median age at 1st cancer diagnosis 61.8 — 65.7 — 63.2 —

Median year of 1st cancer diagnosis 1986.1 — 1986.9 — 1986.4 —

Median person-years at risk 2.9 — 4.0 — 3.3 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 95.1 — 94.7 — 95.0

1st, 2nd, and additional cancers — 94.4 — 94.3 — 94.4

1st cancer only — 4.2 — 5.0 — 4.5

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Gum and Mouth

Both Sexes

Table 3.4.2: Risk of subsequent primary cancers after cancer of the gum or mouth, both sexes,

SEER 1973-2000.

GUM AND MOUTH

All subsequent cancers 371 2.34* 1,328 2.67* 946 2.53* 667 2.10* 3,312 1,347.46 2.46* 235.11

All excluding same site 331 2.10* 1,193 2.42* 853 2.29* 588 1.86* 2,965 1,337.89 2.22* 194.73

Buccal cavity, pharynx 89 18.28* 350 24.28* 242 24.95* 181 25.86* 862 35.98 23.96* 98.85

Lip 3 4.10 13 6.05* 10 7.05* 7 6.87* 33 5.32 6.21* 3.31

Tongue 21 22.07* 105 36.84* 64 32.74* 46 32.34* 236 7.18 32.88* 27.38

Salivary gland 1 2.79 5 4.51* 4 4.86* 2 2.82 12 3.00 4.00* 1.08

Mouth 40 30.46* 135 35.05* 93 36.27* 79 42.93* 347 9.57 36.26* 40.38

Nasopharynx 0 0.00 7 12.95* 2 5.69 2 8.16 11 1.33 8.30* 1.16

Tonsil 13 26.84* 27 19.13* 21 22.80* 8 13.01* 69 3.43 20.11* 7.85

Oropharynx 4 28.16* 11 26.08* 5 17.67* 8 40.20* 28 1.05 26.77* 3.23

Hypopharynx 4 7.64* 33 21.32* 30 29.34* 20 29.25* 87 3.78 23.03* 9.96

Digestive system 72 1.99* 241 2.17* 192 2.34* 112 1.64* 617 297.64 2.07* 38.22

Esophagus 35 17.88* 96 16.35* 76 18.03* 36 10.55* 243 15.46 15.72* 27.23

Stomach 5 1.29 14 1.22 11 1.35 4 0.62 34 29.97 1.13 0.48

Small intestine 2 4.16 2 1.33 3 2.59 4 3.85* 11 4.18 2.63* 0.82

Colon 17 1.06 59 1.19 50 1.34 29 0.91 155 134.99 1.15 2.40

Rectum, rectosigmoid junction 4 0.62 31 1.57* 22 1.56 17 1.55 74 51.34 1.44* 2.71

Anus, anal canal 1 3.07 2 1.96 1 1.31 1 1.58 5 2.75 1.82 0.27

Liver 5 4.21* 9 2.47* 11 4.06* 6 2.51 31 9.92 3.12* 2.52

Gallbladder 0 0.00 1 0.67 1 0.92 0 0.00 2 3.98 0.50 -0.24

Bile ducts, other biliary 0 0.00 6 2.67 4 2.30 3 1.83 13 6.34 2.05* 0.80

Pancreas 3 0.69 20 1.50 13 1.32 11 1.32 47 35.92 1.31 1.33

Respiratory system 103 3.51* 416 4.59* 291 4.40* 199 3.72* 1,009 239.43 4.21* 92.10

Nose, nasal cavity, ear 1 3.98 2 2.63 3 5.57* 0 0.00 6 1.98 3.03* 0.48

Larynx 13 5.85* 60 9.08* 39 8.78* 24 7.70* 136 16.39 8.30* 14.31

Lung, bronchus 88 3.29* 353 4.26* 248 4.07* 175 3.52* 864 220.46 3.92* 77.02

Female breast 22 1.50 48 1.01 30 0.81 33 1.02 133 131.68 1.01 0.36

Female genital system 11 1.56 24 1.08 18 1.11 11 0.82 64 58.79 1.09 1.41

Cervix uteri 3 3.60 5 2.01 1 0.59 1 0.83 10 6.21 1.61 1.02

Corpus uteri 5 1.37 8 0.70 7 0.84 4 0.59 24 30.29 0.79 -1.70

Ovary 2 1.01 4 0.63 7 1.44 5 1.21 18 17.32 1.04 0.18

Vagina 1 9.45 2 6.07 1 3.98 0 0.00 4 0.90 4.43* 0.84

Vulva 0 0.00 4 4.13* 2 2.62 0 0.00 6 2.76 2.17 0.88

Male genital system 29 0.97 102 1.06 80 1.04 55 0.80 266 272.22 0.98 -1.34

Prostate 28 0.95 100 1.06 79 1.03 55 0.80 262 269.44 0.97 -1.60

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 1.02 0.00 -0.22

Urinary system 8 0.63 45 1.13 41 1.38 24 0.95 118 107.61 1.10 1.24

Urinary bladder 4 0.46 33 1.20 30 1.46 17 0.96 84 74.30 1.13 1.16

Kidney parenchyma 4 1.27 10 1.01 10 1.35 6 0.97 30 26.62 1.13 0.40

Renal pelvis, other urinary 0 0.00 2 0.79 1 0.55 1 0.67 4 6.69 0.60 -0.32

Ureter 0 0.00 0 0.00 0 0.00 1 2.03 1 2.21 0.45 -0.14

Bone, joints 0 0.00 0 0.00 2 6.48 0 0.00 2 1.14 1.75 0.10

Soft tissue including heart 0 0.00 1 0.53 4 2.86 1 0.83 6 5.14 1.17 0.10

Kaposi sarcoma 0 0.00 3 4.37 0 0.00 0 0.00 3 1.65 1.82 0.16

Melanoma of skin 7 2.13 12 1.13 6 0.74 8 1.11 33 29.25 1.13 0.45

Eye, orbit 0 0.00 1 1.34 0 0.00 1 2.42 2 1.92 1.04 0.01

Brain, central nervous system 3 1.76 2 0.38 1 0.27 2 0.68 8 13.68 0.58 -0.68

Thyroid 7 8.31* 4 1.54 1 0.54 2 1.37 14 6.77 2.07* 0.87

Lymphatic, hematopoietic 9 0.77 32 0.87 20 0.72 14 0.59* 75 99.89 0.75* -2.98

Hodgkin lymphoma 0 0.00 0 0.00 2 2.39 0 0.00 2 3.15 0.63 -0.14

Non-Hodgkin lymphoma 5 0.98 17 1.05 7 0.56 7 0.63 36 44.79 0.80 -1.05

Myeloma 0 0.00 3 0.47 4 0.84 3 0.72 10 17.29 0.58 -0.87

Leukemia 4 0.96 12 0.93 7 0.73 4 0.50 27 34.66 0.78 -0.92

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.95 0.00 -0.11

Chronic lymphocytic 0 0.00 4 0.76 1 0.26 0 0.00 5 14.06 0.36* -1.08

Acute non-lymphocytic 3 2.19 8 1.88 3 0.94 1 0.36 15 11.58 1.30 0.41

Chronic myeloid 1 1.77 0 0.00 1 0.78 1 0.91 3 4.67 0.64 -0.20

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 15,301 12,248 6,203 3,088 15,301

Person-years in interval 11,407 33,704 22,375 16,073 83,559

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 37,019 PYR and for male cancers on 46,540 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 41
Tonsil

Both Sexes

Table 3.5.1: Characteristics of patients with an initial cancer of the tonsil, both sexes,

SEER 1973-2000.

42 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

TONSIL

Number of patients with 1st primary cancer

Total 4,178 100.0 1,710 100.0 5,888 100.0

Initial treatment

Any radiation 3,501 83.8 1,389 81.2 4,890 83.1

With surgery 1,687 40.4 537 31.4 2,224 37.8

Without surgery 1,814 43.4 852 49.8 2,666 45.3

No radiation 677 16.2 321 18.8 998 16.9

With surgery 444 10.6 218 12.7 662 11.2

Without surgery 233 5.6 103 6.0 336 5.7

Race

White 3,400 81.4 1,429 83.6 4,829 82.0

Black 643 15.4 218 12.7 861 14.6

Other 129 3.1 54 3.2 183 3.1

Unknown 6 0.1 9 0.5 15 0.3

Age at 1st primary cancer diagnosis, years

< 30 11 0.3 9 0.5 20 0.3

30–49 888 21.3 257 15.0 1,145 19.4

50–69 2,518 60.3 1,050 61.4 3,568 60.6

70–79 601 14.4 297 17.4 898 15.3

> 80 160 3.8 97 5.7 257 4.4

Number of patients with one or more

primary cancers

One primary cancer only 3,612 86.5 1,458 85.3 5,070 86.1

1st and 2nd cancers 500 12.0 210 12.3 710 12.1

1st, 2nd, and 3rd cancers 58 1.4 32 1.9 90 1.5

1st, 2nd, 3rd, and additional cancers 8 0.2 10 0.6 18 0.3

Other statistics

Median age at 1st cancer diagnosis 59.1 — 61.7 — 59.9 —

Median year of 1st cancer diagnosis 1988.8 — 1986.4 — 1988.1 —

Median person-years at risk 2.0 — 2.6 — 2.1 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 94.9 — 96.0 — 95.2

1st, 2nd, and additional cancers — 94.2 — 95.2 — 94.5

1st cancer only — 4.8 — 3.6 — 4.4

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Tonsil

Both Sexes

Table 3.5.2: Risk of subsequent primary cancers after cancer of the tonsil, both sexes,

SEER 1973-2000.

TONSIL

All subsequent cancers 133 2.50* 421 2.92* 249 2.66* 144 2.16* 947 357.64 2.65* 244.14

All excluding same site 129 2.43* 417 2.90* 246 2.63* 140 2.11* 932 356.53 2.61* 238.39

Buccal cavity, pharynx 30 16.76* 97 21.37* 74 28.43* 32 20.87* 233 10.47 22.26* 92.19

Lip 1 4.04 1 1.60 0 0.00 0 0.00 2 1.46 1.37 0.22

Tongue 9 25.00* 36 38.87* 37 69.02* 13 40.94* 95 2.14 44.39* 38.47

Salivary gland 0 0.00 1 3.05 2 9.57* 0 0.00 3 0.80 3.73 0.91

Mouth 11 23.66* 36 30.71* 21 31.48* 10 25.56* 78 2.70 28.94* 31.20

Nasopharynx 0 0.00 1 5.73 3 31.09* 0 0.00 4 0.40 10.06* 1.49

Tonsil 4 19.74* 4 8.06* 3 11.30* 4 28.28* 15 1.11 13.57* 5.76

Oropharynx 0 0.00 4 28.64* 4 50.51* 0 0.00 8 0.32 25.08* 3.18

Hypopharynx 3 14.86* 10 19.72* 4 14.07* 1 6.41 18 1.15 15.66* 6.98

Digestive system 30 2.62* 73 2.39* 45 2.29* 23 1.66* 171 75.54 2.26* 39.54

Esophagus 10 13.55* 30 15.88* 17 14.86* 8 10.79* 65 4.51 14.41* 25.06

Stomach 4 3.19 9 2.80* 3 1.52 1 0.77 17 7.74 2.20* 3.84

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 1.13 0.00 -0.47

Colon 2 0.41 14 1.07 14 1.61 4 0.63 34 32.94 1.03 0.44

Rectum, rectosigmoid junction 4 1.91 5 0.90 4 1.15 3 1.30 16 13.45 1.19 1.06

Anus, anal canal 1 9.12 1 3.35 0 0.00 1 7.74 3 0.73 4.13 0.94

Liver 3 6.98* 6 5.22* 4 5.48* 2 3.80 15 2.83 5.29* 5.04

Gallbladder 1 7.70 1 2.84 0 0.00 0 0.00 2 0.88 2.28 0.47

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.56 0.00 -0.65

Pancreas 5 3.61* 7 1.91 3 1.28 4 2.39 19 9.08 2.09* 4.11

Respiratory system 29 2.80* 167 6.09* 82 4.76* 53 4.59* 331 66.56 4.97* 109.54

Nose, nasal cavity, ear 0 0.00 3 13.41* 1 7.32 1 11.03 5 0.54 9.31* 1.85

Larynx 2 2.35 20 9.27* 6 4.83* 7 9.85* 35 4.96 7.06* 12.44

Lung, bronchus 27 2.88* 143 5.72* 75 4.75* 44 4.10* 289 60.90 4.75* 94.49

Female breast 8 2.07 15 1.34 11 1.45 5 0.84 39 28.59 1.36 12.65

Female genital system 4 2.09 4 0.75 1 0.30 0 0.00 9 13.02 0.69 -4.88

Cervix uteri 2 8.10 3 4.73 0 0.00 0 0.00 5 1.44 3.47* 4.33

Corpus uteri 1 0.99 0 0.00 1 0.57 0 0.00 2 6.84 0.29 -5.89

Ovary 1 1.90 1 0.67 0 0.00 0 0.00 2 3.76 0.53 -2.14

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.23

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.52 0.00 -0.63

Male genital system 10 0.89 32 1.02 13 0.61 16 1.01 71 79.92 0.89 -5.61

Prostate 10 0.90 32 1.03 13 0.61 15 0.96 70 79.00 0.89 -5.66

Testis 0 0.00 0 0.00 0 0.00 1 30.22 1 0.41 2.45 0.37

Urinary system 9 2.06 8 0.68 9 1.17 7 1.28 33 29.32 1.13 1.53

Urinary bladder 7 2.38 6 0.75 5 0.95 5 1.31 23 20.00 1.15 1.24

Kidney parenchyma 2 1.74 1 0.32 4 2.03 1 0.74 8 7.59 1.05 0.17

Renal pelvis, other urinary 0 0.00 1 1.43 0 0.00 1 3.19 2 1.73 1.16 0.11

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.23

Bone, joints 0 0.00 0 0.00 0 0.00 1 19.85 1 0.32 3.17 0.28

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 1.39 0.00 -0.58

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.24

Melanoma of skin 1 0.82 2 0.58 0 0.00 1 0.63 4 8.46 0.47 -1.85

Eye, orbit 0 0.00 0 0.00 1 7.45 0 0.00 1 0.52 1.91 0.20

Brain, central nervous system 0 0.00 3 1.86 0 0.00 0 0.00 3 3.84 0.78 -0.35

Thyroid 0 0.00 0 0.00 1 2.13 0 0.00 1 1.86 0.54 -0.36

Lymphatic, hematopoietic 5 1.29 10 0.95 10 1.47 4 0.81 29 26.13 1.11 1.19

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.90 0.00 -0.37

Non-Hodgkin lymphoma 5 2.93 4 0.85 5 1.61 3 1.30 17 11.85 1.43 2.13

Myeloma 0 0.00 1 0.55 2 1.70 1 1.18 4 4.52 0.89 -0.21

Leukemia 0 0.00 5 1.40 3 1.30 0 0.00 8 8.86 0.90 -0.36

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.11

Chronic lymphocytic 0 0.00 2 1.37 1 1.06 0 0.00 3 3.62 0.83 -0.26

Acute non-lymphocytic 0 0.00 2 1.71 0 0.00 0 0.00 2 2.94 0.68 -0.39

Chronic myeloid 0 0.00 1 2.08 2 6.51 0 0.00 3 1.20 2.51 0.75

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,888 4,388 1,757 707 5,888

Person-years in interval 4,251 10,723 5,820 3,346 24,140

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 8,223 PYR and for male cancers on 15,917 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 43
Oropharynx

Both Sexes

Table 3.6.1: Characteristics of patients with an initial cancer of the oropharynx, both sexes,

SEER 1973-2000.

44 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

OROPHARYNX

Number of patients with 1st primary cancer

Total 1,064 100.0 414 100.0 1,478 100.0

Initial treatment

Any radiation 855 80.4 330 79.7 1,185 80.2

With surgery 287 27.0 92 22.2 379 25.6

Without surgery 568 53.4 238 57.5 806 54.5

No radiation 209 19.6 84 20.3 293 19.8

With surgery 108 10.2 46 11.1 154 10.4

Without surgery 101 9.5 38 9.2 139 9.4

Race

White 868 81.6 358 86.5 1,226 82.9

Black 168 15.8 41 9.9 209 14.1

Other 27 2.5 15 3.6 42 2.8

Unknown 1 0.1 0 0.0 1 0.1

Age at 1st primary cancer diagnosis, years

< 30 2 0.2 4 1.0 6 0.4

30–49 139 13.1 43 10.4 182 12.3

50–69 691 64.9 243 58.7 934 63.2

70–79 183 17.2 94 22.7 277 18.7

> 80 49 4.6 30 7.2 79 5.3

Number of patients with one or more

primary cancers

One primary cancer only 921 86.6 361 87.2 1,282 86.7

1st and 2nd cancers 125 11.7 45 10.9 170 11.5

1st, 2nd, and 3rd cancers 17 1.6 8 1.9 25 1.7

1st, 2nd, 3rd, and additional cancers 1 0.1 0 0.0 1 0.1

Other statistics

Median age at 1st cancer diagnosis 62.3 — 63.7 — 62.6 —

Median year of 1st cancer diagnosis 1987.5 — 1987.1 — 1987.4 —

Median person-years at risk 1.3 — 1.5 — 1.4 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 97.2 — 94.3 — 96.4

1st, 2nd, and additional cancers — 95.8 — 94.3 — 95.4

1st cancer only — 2.8 — 5.7 — 3.6

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Oropharynx

Both Sexes

Table 3.6.2: Risk of subsequent primary cancers after cancer of the oropharynx, both sexes,

SEER 1973-2000.

OROPHARYNX

All subsequent cancers 42 2.99* 110 3.50* 42 2.38* 29 1.98* 223 77.73 2.87* 301.90

All excluding same site 42 3.00* 110 3.50* 42 2.39* 28 1.91* 222 77.66 2.86* 299.97

Buccal cavity, pharynx 11 23.82* 27 27.42* 4 8.28* 11 32.53* 53 2.27 23.37* 105.43

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.71

Tongue 4 43.58* 13 65.47* 2 20.42* 5 74.36* 24 0.46 52.68* 48.93

Salivary gland 0 0.00 1 14.27 0 0.00 0 0.00 1 0.17 5.73 1.72

Mouth 4 33.31* 8 31.74* 0 0.00 3 35.65* 15 0.58 25.89* 29.97

Nasopharynx 0 0.00 1 27.60 0 0.00 0 0.00 1 0.08 12.25 1.91

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.47

Oropharynx 0 0.00 0 0.00 0 0.00 1 105.27* 1 0.07 14.10 1.93

Hypopharynx 3 56.80* 3 26.81* 2 38.09* 1 29.95 9 0.25 35.91* 18.18

Digestive system 9 2.96* 22 3.35* 9 2.46* 8 2.60* 48 16.36 2.93* 65.76

Esophagus 5 26.13* 10 24.45* 5 24.11* 3 18.68* 23 0.97 23.75* 45.79

Stomach 1 3.02 2 2.95 1 2.80 1 3.48 5 1.66 3.02 6.95

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.50

Colon 0 0.00 4 1.42 1 0.61 3 2.10 8 7.17 1.12 1.71

Rectum, rectosigmoid junction 2 3.57 3 2.46 1 1.52 1 1.92 7 2.96 2.37 8.40

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.31

Liver 0 0.00 1 4.06 0 0.00 0 0.00 1 0.60 1.67 0.83

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.38

Bile ducts, other biliary 0 0.00 1 7.73 0 0.00 0 0.00 1 0.34 2.97 1.38

Pancreas 1 2.74 1 1.28 1 2.30 0 0.00 3 1.95 1.54 2.19

Respiratory system 10 3.60* 38 6.18* 18 5.44* 5 1.95 71 14.80 4.80* 116.79

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.24

Larynx 3 13.26* 3 6.17* 1 4.26 1 6.39 8 1.10 7.25* 14.33

Lung, bronchus 7 2.78* 34 6.07* 17 5.59* 4 1.68 62 13.54 4.58* 100.70

Female breast 4 4.39* 3 1.40 1 0.71 1 0.87 9 5.61 1.60 21.70

Female genital system 1 2.27 0 0.00 0 0.00 0 0.00 1 2.52 0.40 -9.72

Cervix uteri 1 19.38 0 0.00 0 0.00 0 0.00 1 0.25 3.94 4.78

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 1.34 0.00 -8.58

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.74 0.00 -4.71

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.22

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.65

Male genital system 6 1.92 5 0.69 3 0.74 3 0.84 17 17.97 0.95 -2.99

Prostate 6 1.94 5 0.70 3 0.75 3 0.85 17 17.79 0.96 -2.42

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.22

Urinary system 0 0.00 4 1.52 2 1.35 0 0.00 6 6.57 0.91 -1.19

Urinary bladder 0 0.00 3 1.66 1 0.98 0 0.00 4 4.54 0.88 -1.13

Kidney parenchyma 0 0.00 1 1.48 1 2.70 0 0.00 2 1.64 1.22 0.75

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.81

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.27

Bone, joints 0 0.00 1 35.02 0 0.00 0 0.00 1 0.07 14.81 1.94

Soft tissue including heart 0 0.00 1 8.42 0 0.00 0 0.00 1 0.29 3.42 1.47

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.21

Melanoma of skin 0 0.00 0 0.00 0 0.00 0 0.00 0 1.81 0.00 -3.76

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.24

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -1.72

Thyroid 0 0.00 1 6.39 0 0.00 0 0.00 1 0.37 2.71 1.31

Lymphatic, hematopoietic 1 0.99 3 1.33 3 2.35 0 0.00 7 5.64 1.24 2.83

Hodgkin lymphoma 0 0.00 0 0.00 1 25.07 0 0.00 1 0.19 5.33 1.69

Non-Hodgkin lymphoma 0 0.00 2 1.99 0 0.00 0 0.00 2 2.54 0.79 -1.12

Myeloma 1 5.59 0 0.00 0 0.00 0 0.00 1 0.97 1.03 0.07

Leukemia 0 0.00 1 1.30 2 4.56 0 0.00 3 1.94 1.54 2.19

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.11

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.80 0.00 -1.67

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -1.34

Chronic myeloid 0 0.00 1 9.72 1 17.41 0 0.00 2 0.26 7.72 3.62

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,478 957 309 133 1,478

Person-years in interval 988 2,110 1,029 684 4,812

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 1,562 PYR and for male cancers on 3,250 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 45
Hypopharynx

Both Sexes

Table 3.7.1: Characteristics of patients with an initial cancer of the hypopharynx, both sexes,

SEER 1973-2000.

46 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

HYPOPHARYNX

Number of patients with 1st primary cancer

Total 3,996 100.0 1,155 100.0 5,151 100.0

Initial treatment

Any radiation 3,259 81.6 920 79.7 4,179 81.1

With surgery 1,584 39.6 421 36.5 2,005 38.9

Without surgery 1,675 41.9 499 43.2 2,174 42.2

No radiation 737 18.4 235 20.3 972 18.9

With surgery 432 10.8 133 11.5 565 11.0

Without surgery 305 7.6 102 8.8 407 7.9

Race

White 3,136 78.5 977 84.6 4,113 79.8

Black 617 15.4 145 12.6 762 14.8

Other 241 6.0 32 2.8 273 5.3

Unknown 2 0.1 1 0.1 3 0.1

Age at 1st primary cancer diagnosis, years

< 30 5 0.1 2 0.2 7 0.1

30–49 377 9.4 113 9.8 490 9.5

50–69 2,588 64.8 729 63.1 3,317 64.4

70–79 813 20.3 242 21.0 1,055 20.5

> 80 213 5.3 69 6.0 282 5.5

Number of patients with one or more

primary cancers

One primary cancer only 3,448 86.3 1,025 88.7 4,473 86.8

1st and 2nd cancers 487 12.2 119 10.3 606 11.8

1st, 2nd, and 3rd cancers 58 1.5 7 0.6 65 1.3

1st, 2nd, 3rd, and additional cancers 3 0.1 4 0.3 7 0.1

Other statistics

Median age at 1st cancer diagnosis 63.4 — 63.4 — 63.4 —

Median year of 1st cancer diagnosis 1986.9 — 1986.2 — 1986.7 —

Median person-years at risk 1.3 — 1.5 — 1.3 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 95.1 — 95.4 — 95.1

1st, 2nd, and additional cancers — 94.3 — 95.4 — 94.5

1st cancer only — 4.6 — 3.1 — 4.3

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Hypopharynx

Both Sexes

Table 3.7.2: Risk of subsequent primary cancers after cancer of the hypopharynx, both sexes,

SEER 1973-2000.

HYPOPHARYNX

All subsequent cancers 104 1.93* 373 3.17* 191 2.82* 91 2.11* 759 282.36 2.69* 305.21

All excluding same site 104 1.94* 370 3.15* 191 2.83* 88 2.04* 753 281.41 2.68* 301.98

Buccal cavity, pharynx 18 10.03* 60 16.43* 39 21.54* 16 16.37* 133 8.23 16.15* 79.89

Lip 0 0.00 1 1.85 1 3.54 0 0.00 2 1.25 1.60 0.48

Tongue 8 22.93* 19 26.38* 17 47.66* 5 26.20* 49 1.62 30.31* 30.34

Salivary gland 0 0.00 1 3.85 0 0.00 0 0.00 1 0.63 1.60 0.24

Mouth 6 13.05* 21 22.57* 16 35.12* 3 12.45* 46 2.09 22.04* 28.12

Nasopharynx 2 26.97* 3 20.80* 0 0.00 0 0.00 5 0.31 15.93* 3.00

Tonsil 2 10.77* 7 18.86* 2 11.55* 2 23.00* 13 0.82 15.91* 7.80

Oropharynx 0 0.00 0 0.00 1 18.19 2 68.12* 3 0.25 11.90* 1.76

Hypopharynx 0 0.00 3 6.96* 0 0.00 3 29.09* 6 0.96 6.28* 3.23

Digestive system 34 2.87* 86 3.38* 39 2.70* 21 2.31* 180 60.82 2.96* 76.31

Esophagus 17 21.96* 50 31.24* 21 24.81* 7 13.48* 95 3.74 25.40* 58.44

Stomach 3 2.19 4 1.42 2 1.31 3 3.23 12 6.63 1.81 3.44

Small intestine 0 0.00 1 2.78 0 0.00 0 0.00 1 0.87 1.15 0.08

Colon 7 1.41 14 1.29 7 1.09 4 0.96 32 26.39 1.21 3.59

Rectum, rectosigmoid junction 1 0.46 8 1.73 3 1.19 2 1.36 14 10.78 1.30 2.06

Anus, anal canal 0 0.00 1 4.69 0 0.00 0 0.00 1 0.50 2.01 0.32

Liver 1 2.14 2 2.01 1 1.87 1 2.93 5 2.34 2.14 1.70

Gallbladder 1 7.97 0 0.00 0 0.00 0 0.00 1 0.65 1.54 0.22

Bile ducts, other biliary 0 0.00 1 1.98 0 0.00 1 4.71 2 1.25 1.61 0.48

Pancreas 4 2.85 5 1.67 5 2.95 3 2.78 17 7.17 2.37* 6.29

Respiratory system 24 2.20* 169 7.26* 72 5.67* 30 3.93* 295 54.53 5.41* 153.99

Nose, nasal cavity, ear 0 0.00 2 11.14* 1 10.51 0 0.00 3 0.42 7.17* 1.65

Larynx 0 0.00 3 1.64 2 2.20 2 4.09 7 4.12 1.70 1.84

Lung, bronchus 24 2.42* 162 7.64* 69 5.91* 27 3.82* 282 49.85 5.66* 148.65

Female breast 1 0.38 5 0.81 2 0.54 3 1.31 11 14.78 0.74 -9.42

Female genital system 1 0.79 1 0.35 1 0.62 0 0.00 3 6.72 0.45 -9.26

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.71 0.00 -1.76

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 3.56 0.00 -8.85

Ovary 0 0.00 1 1.21 1 2.07 0 0.00 2 1.95 1.03 0.13

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.24

Vulva 1 22.03 0 0.00 0 0.00 0 0.00 1 0.28 3.62 1.80

Male genital system 11 0.85 26 0.89 14 0.78 9 0.73 60 72.33 0.83 -10.63

Prostate 10 0.78 25 0.86 14 0.79 9 0.74 58 71.67 0.81 -11.79

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.18

Urinary system 4 0.87 11 1.10 12 2.07* 3 0.80 30 24.13 1.24 3.76

Urinary bladder 3 0.95 7 1.01 9 2.21* 2 0.75 21 16.84 1.25 2.66

Kidney parenchyma 0 0.00 3 1.21 2 1.45 1 1.17 6 5.84 1.03 0.10

Renal pelvis, other urinary 1 3.53 1 1.64 1 2.92 0 0.00 3 1.45 2.07 0.99

Ureter 0 0.00 1 4.93 1 8.64 0 0.00 2 0.48 4.15 0.97

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.15

Soft tissue including heart 0 0.00 1 2.29 0 0.00 0 0.00 1 1.04 0.96 -0.02

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.21

Melanoma of skin 1 0.93 2 0.81 2 1.43 1 1.09 6 5.85 1.03 0.10

Eye, orbit 0 0.00 2 11.97* 0 0.00 0 0.00 2 0.39 5.18 1.03

Brain, central nervous system 2 3.52 0 0.00 0 0.00 0 0.00 2 2.79 0.72 -0.51

Thyroid 1 4.15 0 0.00 0 0.00 0 0.00 1 1.15 0.87 -0.10

Lymphatic, hematopoietic 5 1.31 4 0.48 3 0.62 2 0.64 14 20.11 0.70 -3.91

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -0.40

Non-Hodgkin lymphoma 2 1.23 2 0.55 3 1.41 2 1.44 9 8.78 1.03 0.14

Myeloma 1 1.45 1 0.67 0 0.00 0 0.00 2 3.61 0.55 -1.03

Leukemia 2 1.47 1 0.34 0 0.00 0 0.00 3 7.09 0.42 -2.62

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.12

Chronic lymphocytic 1 1.79 0 0.00 0 0.00 0 0.00 1 2.91 0.34 -1.22

Acute non-lymphocytic 1 2.26 1 1.03 0 0.00 0 0.00 2 2.35 0.85 -0.22

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.95 0.00 -0.61

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,151 3,364 1,037 393 5,151

Person-years in interval 3,478 7,024 3,343 1,772 15,617

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 4,018 PYR and for male cancers on 11,599 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 47
Salivary Gland

Both Sexes

Table 3.8.1: Characteristics of patients with an initial cancer of the salivary gland, both sexes,

SEER 1973-2000.

48 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

SALIVARY GLAND

Number of patients with 1st primary cancer

Total 3,008 100.0 2,543 100.0 5,551 100.0

Initial treatment

Any radiation 1,747 58.1 1,197 47.1 2,944 53.0

With surgery 1,531 50.9 1,094 43.0 2,625 47.3

Without surgery 216 7.2 103 4.1 319 5.7

No radiation 1,261 41.9 1,346 52.9 2,607 47.0

With surgery 1,143 38.0 1,223 48.1 2,366 42.6

Without surgery 118 3.9 123 4.8 241 4.3

Race

White 2,622 87.2 2,167 85.2 4,789 86.3

Black 206 6.8 207 8.1 413 7.4

Other 165 5.5 153 6.0 318 5.7

Unknown 15 0.5 16 0.6 31 0.6

Age at 1st primary cancer diagnosis, years

< 30 176 5.9 251 9.9 427 7.7

30–49 572 19.0 652 25.6 1,224 22.1

50–69 1,260 41.9 866 34.1 2,126 38.3

70–79 629 20.9 458 18.0 1,087 19.6

> 80 371 12.3 316 12.4 687 12.4

Number of patients with one or more

primary cancers

One primary cancer only 2,639 87.7 2,323 91.3 4,962 89.4

1st and 2nd cancers 335 11.1 203 8.0 538 9.7

1st, 2nd, and 3rd cancers 31 1.0 17 0.7 48 0.9

1st, 2nd, 3rd, and additional cancers 3 0.1 0 0.0 3 0.1

Other statistics

Median age at 1st cancer diagnosis 62.7 — 59.3 — 61.3 —

Median year of 1st cancer diagnosis 1988.9 — 1988.4 — 1988.7 —

Median person-years at risk 3.6 — 6.2 — 4.7 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 96.5 — 95.0 — 95.9

1st, 2nd, and additional cancers — 95.7 — 94.5 — 95.2

1st cancer only — 3.0 — 4.5 — 3.6

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Salivary Gland

Both Sexes

Table 3.8.2: Risk of subsequent primary cancers after cancer of the salivary gland, both sexes,

SEER 1973-2000.

SALIVARY GLAND

All subsequent cancers 81 1.49* 240 1.37* 158 1.17 165 1.11 644 513.68 1.25* 33.08

All excluding same site 80 1.47* 233 1.34* 158 1.17 162 1.09 633 512.48 1.24* 30.59

Buccal cavity, pharynx 7 4.82* 19 4.20* 9 2.72* 12 3.62* 47 12.59 3.73* 8.73

Lip 2 8.39 4 5.74* 3 6.30* 2 4.53 11 1.85 5.94* 2.32

Tongue 1 3.58 1 1.13 3 4.48 3 4.32 8 2.53 3.16* 1.39

Salivary gland 1 7.43 7 17.02* 0 0.00 3 8.74* 11 1.20 9.17* 2.49

Mouth 1 2.65 6 5.04* 1 1.14 3 3.42 11 3.33 3.31* 1.95

Nasopharynx 0 0.00 0 0.00 1 7.47 0 0.00 1 0.51 1.95 0.12

Tonsil 1 7.58 0 0.00 0 0.00 1 3.24 2 1.17 1.72 0.21

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.09

Hypopharynx 1 7.00 1 2.24 1 3.13 0 0.00 3 1.21 2.48 0.45

Digestive system 17 1.38 47 1.21 26 0.88 28 0.89 118 112.64 1.05 1.36

Esophagus 0 0.00 0 0.00 5 3.57* 1 0.66 6 5.38 1.12 0.16

Stomach 2 1.54 3 0.75 2 0.68 0 0.00 7 11.21 0.62 -1.07

Small intestine 0 0.00 0 0.00 0 0.00 1 2.01 1 1.61 0.62 -0.15

Colon 10 1.78 25 1.40 8 0.58 21 1.43 64 51.81 1.24 3.09

Rectum, rectosigmoid junction 0 0.00 9 1.34 2 0.40 4 0.78 15 18.98 0.79 -1.01

Anus, anal canal 0 0.00 0 0.00 3 10.35* 0 0.00 3 1.09 2.75 0.48

Liver 0 0.00 3 2.34 1 1.02 0 0.00 4 3.78 1.06 0.06

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.59 0.00 -0.40

Bile ducts, other biliary 0 0.00 1 1.20 0 0.00 1 1.31 2 2.52 0.79 -0.13

Pancreas 5 3.42* 6 1.29 5 1.40 0 0.00* 16 13.55 1.18 0.62

Respiratory system 14 1.52 60 2.05* 32 1.44 27 1.13 133 84.61 1.57* 12.28

Nose, nasal cavity, ear 0 0.00 1 3.83 0 0.00 1 4.79 2 0.75 2.67 0.32

Larynx 0 0.00 1 0.51 3 2.14 0 0.00 4 5.36 0.75 -0.35

Lung, bronchus 14 1.65 58 2.15* 29 1.41 26 1.16 127 78.28 1.62* 12.37

Female breast 5 0.97 17 0.92 16 0.99 21 1.07 59 59.60 0.99 -0.29

Female genital system 1 0.42 6 0.71 10 1.44 5 0.63 22 25.77 0.85 -1.82

Cervix uteri 0 0.00 0 0.00 3 3.40 0 0.00 3 3.23 0.93 -0.11

Corpus uteri 0 0.00 4 0.96 2 0.59 3 0.77 9 12.64 0.71 -1.76

Ovary 1 1.45 2 0.82 5 2.39 2 0.81 10 7.70 1.30 1.11

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.19

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 1.23 0.00 -0.59

Male genital system 16 1.46 37 1.10 28 1.13 30 1.08 111 97.15 1.14 7.40

Prostate 16 1.48 37 1.11 28 1.14 30 1.10 111 95.88 1.16 8.07

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -0.34

Urinary system 5 1.12 12 0.87 10 0.96 13 1.16 40 39.94 1.00 0.01

Urinary bladder 4 1.28 6 0.62 6 0.84 7 0.92 23 27.56 0.83 -1.16

Kidney parenchyma 1 0.96 6 1.79 4 1.53 6 2.04 17 9.93 1.71 1.79

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 2.45 0.00 -0.62

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.80 0.00 -0.20

Bone, joints 0 0.00 0 0.00 1 8.07 0 0.00 1 0.47 2.11 0.13

Soft tissue including heart 0 0.00 0 0.00 0 0.00 2 3.27 2 2.09 0.96 -0.02

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 1 3.89 1 0.93 1.08 0.02

Melanoma of skin 3 2.43 6 1.47 7 2.14 2 0.52 18 12.41 1.45 1.42

Eye, orbit 1 12.36 1 3.90 0 0.00 1 4.93 3 0.73 4.10 0.58

Brain, central nervous system 1 1.79 4 2.20 0 0.00 3 2.03 8 5.25 1.52 0.70

Thyroid 3 9.03* 4 3.52 2 2.22 2 1.99 11 3.37 3.26* 1.94

Lymphatic, hematopoietic 5 1.21 18 1.36 14 1.36 11 0.97 48 39.01 1.23 2.28

Hodgkin lymphoma 1 6.31 2 3.93 0 0.00 1 2.83 4 1.39 2.88 0.66

Non-Hodgkin lymphoma 2 1.11 8 1.36 5 1.07 5 0.93 20 17.73 1.13 0.58

Myeloma 0 0.00 3 1.36 2 1.17 1 0.53 6 6.51 0.92 -0.13

Leukemia 2 1.35 5 1.08 7 1.99 4 1.07 18 13.38 1.35 1.17

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.10

Chronic lymphocytic 2 3.41 0 0.00 3 2.17 2 1.38 7 5.25 1.33 0.44

Acute non-lymphocytic 0 0.00 3 1.91 2 1.68 1 0.77 6 4.55 1.32 0.37

Chronic myeloid 0 0.00 1 1.57 1 2.07 0 0.00 2 1.85 1.08 0.04

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,551 4,715 2,737 1,598 5,551

Person-years in interval 4,240 14,064 10,571 10,524 39,399

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 20,673 PYR and for male cancers on 18,727 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 49
All subsequent cancers 25 1.37 85 1.32* 57 1.03 70 1.05 237 205.14 1.16* 15.41

All excluding same site 25 1.38 80 1.24 57 1.03 67 1.00 229 204.72 1.12 11.75

Buccal cavity, pharynx 1 3.04 8 6.91* 4 4.11* 6 5.37* 19 3.58 5.31* 7.46

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.12

Tongue 0 0.00 0 0.00 2 9.29* 1 3.99 3 0.79 3.81 1.07

Salivary gland 0 0.00 5 37.08* 0 0.00 3 22.09* 8 0.42 18.94* 3.67

Mouth 0 0.00 3 7.58* 0 0.00 2 5.26 5 1.22 4.09* 1.83

Nasopharynx 0 0.00 0 0.00 1 23.63 0 0.00 1 0.16 6.44 0.41

Tonsil 1 35.37 0 0.00 0 0.00 0 0.00 1 0.30 3.31 0.34

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.04

Hypopharynx 0 0.00 0 0.00 1 15.61 0 0.00 1 0.23 4.31 0.37

Digestive system 7 1.63 19 1.27 10 0.79 13 0.88 49 46.73 1.05 1.10

Esophagus 0 0.00 0 0.00 1 2.91 1 2.41 2 1.27 1.57 0.35

Stomach 1 2.86 0 0.00 0 0.00 0 0.00 1 3.63 0.28 -1.27

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.68 0.00 -0.33

Colon 3 1.40 13 1.73 4 0.63 9 1.21 29 23.45 1.24 2.68

Rectum, rectosigmoid junction 0 0.00 2 0.84 1 0.51 2 0.91 5 7.22 0.69 -1.08

Rectum 0 0.00 1 0.64 0 0.00 2 1.36 3 4.75 0.63 -0.85

Anus, anal canal 0 0.00 0 0.00 3 17.51* 0 0.00 3 0.63 4.75 1.15

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 1.02 0.00 -0.49

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.03 0.00 -0.50

Bile ducts, other biliary 0 0.00 1 3.15 0 0.00 1 2.81 2 1.04 1.91 0.46

Pancreas 3 5.45* 3 1.56 1 0.60 0 0.00 7 6.12 1.14 0.43

Respiratory system 3 1.37 13 1.63 5 0.70 10 1.09 31 26.48 1.17 2.19

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.13

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -0.40

Lung, bronchus 3 1.44 13 1.72 5 0.73 10 1.14 31 25.30 1.23 2.76

Female breast 5 0.97 17 0.92 16 0.99 21 1.07 59 59.60 0.99 -0.29

Female genital system 1 0.42 6 0.71 10 1.44 5 0.63 22 25.77 0.85 -1.82

Cervix uteri 0 0.00 0 0.00 3 3.40 0 0.00 3 3.23 0.93 -0.11

Corpus uteri 0 0.00 4 0.96 2 0.59 3 0.77 9 12.64 0.71 -1.76

Ovary 1 1.45 2 0.82 5 2.39 2 0.81 10 7.70 1.30 1.11

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.19

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 1.23 0.00 -0.59

Urinary system 1 1.17 5 1.65 1 0.38 3 0.93 10 9.71 1.03 0.14

Urinary bladder 1 1.95 4 2.23 0 0.00 1 0.53 6 5.72 1.05 0.14

Kidney parenchyma 0 0.00 1 1.03 1 1.16 2 1.81 4 3.21 1.25 0.38

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -0.38

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.12

Bone, joints 0 0.00 0 0.00 1 18.10 0 0.00 1 0.20 4.89 0.38

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.85 0.00 -0.41

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.04

Melanoma of skin 1 2.63 2 1.44 2 1.63 1 0.66 6 4.52 1.33 0.72

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.14

Brain, central nervous system 0 0.00 1 1.46 0 0.00 1 1.49 2 2.13 0.94 -0.06

Thyroid 2 9.91* 3 4.10 1 1.63 2 2.85 8 2.25 3.56* 2.78

Lymphatic, hematopoietic 4 2.86 7 1.42 7 1.64 5 0.97 23 15.78 1.46 3.49

Hodgkin lymphoma 1 17.60 0 0.00 0 0.00 0 0.00 1 0.58 1.73 0.20

Non-Hodgkin lymphoma 2 3.08 4 1.72 2 0.98 4 1.56 12 7.58 1.58 2.14

Myeloma 0 0.00 1 1.20 1 1.39 0 0.00 2 2.66 0.75 -0.32

Leukemia 1 2.20 2 1.26 4 3.00 1 0.63 8 4.96 1.61 1.47

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.08

Chronic lymphocytic 1 5.82 0 0.00 3 5.92* 1 1.69 5 1.87 2.67 1.51

Acute non-lymphocytic 0 0.00 1 1.78 1 2.11 0 0.00 2 1.77 1.13 0.11

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.70 0.00 -0.34

Salivary Gland

Females

Table 3.8.3: Risk of subsequent primary cancers after cancer of the salivary gland, females,

SEER 1973-2000.

50 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

SALIVARY GLAND

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,543 2,228 1,435 887 2,543

Person-years in interval 1,976 7,052 5,689 5,956 20,673

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Salivary Gland

Males

Table 3.8.4: Risk of subsequent primary cancers after cancer of the salivary gland, males,

SEER 1973-2000.

SALIVARY GLAND

All subsequent cancers 56 1.54* 155 1.41* 101 1.27* 95 1.15 407 308.54 1.32* 52.58

All excluding same site 55 1.52* 153 1.39* 101 1.27* 95 1.16 404 307.76 1.31* 51.39

Buccal cavity, pharynx 6 5.33* 11 3.27* 5 2.14 6 2.73 28 9.02 3.11* 10.14

Lip 2 9.26* 4 6.46* 3 7.32* 2 5.55 11 1.61 6.85* 5.02

Tongue 1 4.80 1 1.57 1 2.20 2 4.50 5 1.74 2.87 1.74

Salivary gland 1 10.56 2 7.24 0 0.00 0 0.00 3 0.78 3.86 1.19

Mouth 1 3.77 3 3.78 1 1.83 1 2.01 6 2.11 2.85* 2.08

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.19

Tonsil 0 0.00 0 0.00 0 0.00 1 4.56 1 0.86 1.16 0.07

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.14

Hypopharynx 1 8.24 1 2.71 0 0.00 0 0.00 2 0.98 2.04 0.54

Digestive system 10 1.24 28 1.17 16 0.94 15 0.89 69 65.90 1.05 1.65

Esophagus 0 0.00 0 0.00 4 3.78* 0 0.00 4 4.10 0.98 -0.05

Stomach 1 1.05 3 1.07 2 1.02 0 0.00 6 7.58 0.79 -0.84

Small intestine 0 0.00 0 0.00 0 0.00 1 3.83 1 0.93 1.07 0.04

Colon 7 2.02 12 1.16 4 0.54 12 1.66 35 28.36 1.23 3.55

Rectum, rectosigmoid junction 0 0.00 7 1.61 1 0.33 2 0.69 10 11.75 0.85 -0.94

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.25

Liver 0 0.00 3 3.09 1 1.41 0 0.00 4 2.75 1.45 0.67

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.30

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.47 0.00 -0.79

Pancreas 2 2.19 3 1.11 4 2.09 0 0.00 9 7.43 1.21 0.84

Respiratory system 11 1.57 47 2.21* 27 1.79* 17 1.15 102 58.13 1.75* 23.43

Nose, nasal cavity, ear 0 0.00 1 5.78 0 0.00 1 8.39 2 0.47 4.24 0.82

Larynx 0 0.00 1 0.59 3 2.56 0 0.00 4 4.53 0.88 -0.28

Lung, bronchus 11 1.73 45 2.33* 24 1.75* 16 1.18 96 52.98 1.81* 22.97

Male breast 1 14.36 1 4.77 0 0.00 1 6.35 3 0.59 5.09* 1.29

Male genital system 16 1.46 37 1.10 28 1.13 30 1.08 111 97.15 1.14 7.40

Prostate 16 1.48 37 1.11 28 1.14 30 1.10 111 95.88 1.16 8.07

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -0.34

Urinary system 4 1.11 7 0.65 9 1.15 10 1.25 30 30.23 0.99 -0.12

Urinary bladder 3 1.15 2 0.26* 6 1.07 6 1.04 17 21.84 0.78 -2.59

Kidney parenchyma 1 1.30 5 2.11 3 1.72 4 2.17 13 6.73 1.93* 3.35

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.66 0.00 -0.89

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.30

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.14

Soft tissue including heart 0 0.00 0 0.00 0 0.00 2 6.01 2 1.24 1.61 0.41

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 1 4.34 1 0.84 1.19 0.08

Melanoma of skin 2 2.34 4 1.49 5 2.45 1 0.43 12 7.89 1.52 2.20

Eye, orbit 1 18.88 1 6.30 0 0.00 1 8.88 3 0.44 6.86* 1.37

Brain, central nervous system 1 2.72 3 2.64 0 0.00 2 2.46 6 3.13 1.92 1.54

Thyroid 1 7.68 1 2.47 1 3.50 0 0.00 3 1.12 2.68 1.00

Lymphatic, hematopoietic 1 0.37 11 1.33 7 1.16 6 0.97 25 23.23 1.08 0.95

Hodgkin lymphoma 0 0.00 2 6.47 0 0.00 1 5.21 3 0.81 3.69 1.17

Non-Hodgkin lymphoma 0 0.00 4 1.13 3 1.14 1 0.35 8 10.15 0.79 -1.15

Myeloma 0 0.00 2 1.46 1 1.00 1 0.98 4 3.85 1.04 0.08

Leukemia 1 0.97 3 0.98 3 1.38 3 1.39 10 8.42 1.19 0.84

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.13

Chronic lymphocytic 1 2.42 0 0.00 0 0.00 1 1.16 2 3.38 0.59 -0.74

Acute non-lymphocytic 0 0.00 2 1.99 1 1.40 1 1.38 4 2.78 1.44 0.65

Chronic myeloid 0 0.00 1 2.41 1 3.38 0 0.00 2 1.15 1.74 0.45

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,008 2,487 1,302 711 3,008

Person-years in interval 2,264 7,012 4,883 4,567 18,727

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 51
All subsequent cancers 17 2.15* 52 1.53* 49 1.17 93 1.06 211 171.65 1.23* 16.03

All excluding same site 17 2.16* 48 1.41* 49 1.18 91 1.04 205 171.23 1.20* 13.76

Buccal cavity, pharynx 1 3.13 7 5.48* 3 2.19 9 4.10* 20 5.16 3.88* 6.04

Lip 0 0.00 2 15.63* 1 7.32 2 8.17 5 0.54 9.22* 1.82

Tongue 0 0.00 0 0.00 1 3.37 1 2.07 2 1.12 1.78 0.36

Salivary gland 0 0.00 4 40.90* 0 0.00 2 10.12* 6 0.42 14.13* 2.27

Mouth 0 0.00 1 2.97 1 2.76 3 5.36* 5 1.34 3.73* 1.49

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.11

Tonsil 0 0.00 0 0.00 0 0.00 1 4.17 1 0.60 1.67 0.16

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.06

Hypopharynx 1 32.17 0 0.00 0 0.00 0 0.00 1 0.52 1.91 0.19

Digestive system 4 3.02 9 1.56 10 1.38 6 0.38* 29 30.19 0.96 -0.48

Esophagus 0 0.00 0 0.00 2 4.32 1 1.08 3 1.87 1.61 0.46

Stomach 0 0.00 0 0.00 1 1.43 0 0.00 1 2.86 0.35 -0.76

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.23

Colon 2 3.99 4 1.79 1 0.34 3 0.44 10 12.48 0.80 -1.01

Rectum, rectosigmoid junction 0 0.00 1 0.85 1 0.70 2 0.70 4 5.74 0.70 -0.71

Anus, anal canal 0 0.00 0 0.00 2 18.30* 0 0.00 2 0.44 4.58 0.64

Liver 0 0.00 2 7.84 1 3.24 0 0.00 3 1.29 2.32 0.70

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.14

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.25

Pancreas 2 12.88* 2 2.97 2 2.33 0 0.00 6 3.62 1.66 0.97

Respiratory system 5 3.76* 10 1.73 13 1.79 17 1.12 45 29.51 1.53* 6.31

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.11

Larynx 0 0.00 0 0.00 1 1.66 0 0.00 1 2.26 0.44 -0.52

Lung, bronchus 5 4.25* 10 1.94 12 1.82 17 1.22 44 26.89 1.64* 6.97

Female breast 0 0.00 7 1.17 4 0.57 14 1.09 25 27.19 0.92 -1.67

Female genital system 0 0.00 2 0.73 4 1.31 4 0.77 10 11.63 0.86 -1.24

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 1.94 0.00 -1.48

Corpus uteri 0 0.00 2 1.62 2 1.40 3 1.14 7 5.56 1.26 1.10

Ovary 0 0.00 0 0.00 2 2.23 1 0.64 3 3.43 0.87 -0.33

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.10

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.27

Male genital system 1 1.31 3 0.83 6 1.04 19 1.13 29 26.94 1.08 1.80

Prostate 1 1.44 3 0.89 6 1.08 19 1.15 29 26.20 1.11 2.45

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.49

Urinary system 0 0.00 2 0.90 2 0.72 8 1.27 12 11.82 1.01 0.07

Urinary bladder 0 0.00 0 0.00 1 0.59 3 0.74 4 7.36 0.54 -1.37

Kidney parenchyma 0 0.00 2 2.48 1 1.05 5 2.63 8 3.85 2.08 1.69

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -0.25

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.08

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.09

Soft tissue including heart 0 0.00 0 0.00 0 0.00 1 2.77 1 0.81 1.23 0.08

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -0.27

Melanoma of skin 0 0.00 1 0.69 3 2.00 0 0.00 4 5.92 0.68 -0.78

Eye, orbit 0 0.00 0 0.00 0 0.00 1 7.81 1 0.28 3.56 0.29

Brain, central nervous system 1 6.94 1 1.75 0 0.00 1 1.00 3 2.30 1.30 0.28

Thyroid 2 12.92* 3 4.99* 2 3.52 2 2.50 9 2.13 4.23* 2.80

Lymphatic, hematopoietic 1 1.58 3 1.15 2 0.66 7 1.12 13 12.54 1.04 0.19

Hodgkin lymphoma 1 15.37 1 4.20 0 0.00 1 3.90 3 0.77 3.92 0.91

Non-Hodgkin lymphoma 0 0.00 1 0.79 1 0.68 2 0.64 4 6.17 0.65 -0.88

Myeloma 0 0.00 0 0.00 0 0.00 1 0.99 1 1.87 0.53 -0.36

Leukemia 0 0.00 1 1.31 1 1.12 3 1.58 5 3.74 1.34 0.51

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.07

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 1 1.36 1 1.40 0.72 -0.16

Acute non-lymphocytic 0 0.00 1 3.84 1 3.34 1 1.50 3 1.29 2.33 0.70

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.22

Salivary Gland

Both Sexes, <60 Years of Age

Table 3.8.5: Risk of subsequent primary cancers after cancer of the salivary gland, both sexes,

<60 years of age, SEER 1973-2000.

52 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

SALIVARY GLAND

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,629 2,389 1,611 1,085 2,629

Person-years in interval 2,085 7,720 6,665 8,081 24,551

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 13,138 PYR and for male cancers on 11,414 PYR.
Salivary Gland

Both Sexes, ≥60 Years of Age

Table 3.8.6: Risk of subsequent primary cancers after cancer of the salivary gland, both sexes,

≥60 years of age, SEER 1973-2000.

SALIVARY GLAND

All subsequent cancers 64 1.37* 188 1.34* 109 1.17 72 1.18 433 342.03 1.27* 61.27

All excluding same site 63 1.35* 185 1.32* 109 1.17 71 1.16 428 341.25 1.25* 58.42

Buccal cavity, pharynx 6 5.29* 12 3.70* 6 3.09* 3 2.68 27 7.43 3.63* 13.18

Lip 2 9.74* 2 3.51 2 5.89 0 0.00 6 1.31 4.58* 3.16

Tongue 1 4.72 1 1.63 2 5.37 2 9.43* 6 1.41 4.25* 3.09

Salivary gland 1 9.18 3 9.57* 0 0.00 1 6.86 5 0.78 6.45* 2.85

Mouth 1 3.39 5 5.86* 0 0.00 0 0.00 6 1.99 3.02* 2.70

Nasopharynx 0 0.00 0 0.00 1 16.30 0 0.00 1 0.24 4.13 0.51

Tonsil 1 10.86 0 0.00 0 0.00 0 0.00 1 0.57 1.77 0.29

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.13

Hypopharynx 0 0.00 1 3.14 1 5.68 0 0.00 2 0.69 2.91 0.88

Digestive system 13 1.18 38 1.14 16 0.71 22 1.39 89 82.45 1.08 4.41

Esophagus 0 0.00 0 0.00 3 3.20 0 0.00 3 3.51 0.85 -0.34

Stomach 2 1.73 3 0.88 1 0.45 0 0.00 6 8.34 0.72 -1.58

Small intestine 0 0.00 0 0.00 0 0.00 1 4.87 1 1.04 0.96 -0.03

Colon 8 1.57 21 1.35 7 0.65 18 2.29* 54 39.33 1.37* 9.88

Rectum, rectosigmoid junction 0 0.00 8 1.44 1 0.28 2 0.89 11 13.23 0.83 -1.50

Anus, anal canal 0 0.00 0 0.00 1 5.54 0 0.00 1 0.65 1.53 0.23

Liver 0 0.00 1 0.97 0 0.00 0 0.00 1 2.48 0.40 -1.00

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.24 0.00 -0.84

Bile ducts, other biliary 0 0.00 1 1.37 0 0.00 1 2.42 2 1.90 1.05 0.07

Pancreas 3 2.30 4 1.01 3 1.11 0 0.00 10 9.93 1.01 0.04

Respiratory system 9 1.14 50 2.13* 19 1.27 10 1.13 88 55.10 1.60* 22.16

Nose, nasal cavity, ear 0 0.00 1 5.06 0 0.00 1 11.44 2 0.48 4.16 1.02

Larynx 0 0.00 1 0.71 2 2.51 0 0.00 3 3.10 0.97 -0.06

Lung, bronchus 9 1.24 48 2.21* 17 1.22 9 1.08 83 51.39 1.62* 21.29

Female breast 5 1.32 10 0.80 12 1.30 7 1.02 34 32.41 1.05 2.11

Female genital system 1 0.57 4 0.70 6 1.53 1 0.36 12 14.14 0.85 -2.84

Cervix uteri 0 0.00 0 0.00 3 8.82* 0 0.00 3 1.29 2.33 2.27

Corpus uteri 0 0.00 2 0.68 0 0.00 0 0.00 2 7.08 0.28 -6.74

Ovary 1 1.97 2 1.20 3 2.51 1 1.12 7 4.26 1.64 3.63

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.35

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.88 0.00 -1.16

Male genital system 15 1.47 34 1.13 22 1.15 11 1.01 82 70.21 1.17 16.13

Prostate 15 1.48 34 1.14 22 1.16 11 1.02 82 69.68 1.18 16.85

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.12

Urinary system 5 1.27 10 0.86 8 1.05 5 1.01 28 28.12 1.00 -0.08

Urinary bladder 4 1.42 6 0.72 5 0.91 4 1.11 19 20.20 0.94 -0.81

Kidney parenchyma 1 1.18 4 1.58 3 1.81 1 0.96 9 6.09 1.48 1.96

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.83 0.00 -1.23

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.41

Bone, joints 0 0.00 0 0.00 1 14.92 0 0.00 1 0.25 3.95 0.50

Soft tissue including heart 0 0.00 0 0.00 0 0.00 1 4.00 1 1.28 0.78 -0.19

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 1 18.22 1 0.27 3.67 0.49

Melanoma of skin 3 3.43 5 1.90 4 2.26 2 1.65 14 6.49 2.16* 5.06

Eye, orbit 1 15.54 1 5.24 0 0.00 0 0.00 2 0.45 4.43 1.04

Brain, central nervous system 0 0.00 3 2.40 0 0.00 2 4.12 5 2.95 1.69 1.38

Thyroid 1 5.64 1 1.87 0 0.00 0 0.00 2 1.24 1.61 0.51

Lymphatic, hematopoietic 4 1.14 15 1.41 12 1.65 4 0.78 35 26.47 1.32 5.74

Hodgkin lymphoma 0 0.00 1 3.69 0 0.00 0 0.00 1 0.63 1.60 0.25

Non-Hodgkin lymphoma 2 1.34 7 1.52 4 1.25 3 1.32 16 11.57 1.38 2.98

Myeloma 0 0.00 3 1.61 2 1.57 0 0.00 5 4.63 1.08 0.25

Leukemia 2 1.54 4 1.03 6 2.29 1 0.54 13 9.64 1.35 2.26

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.16

Chronic lymphocytic 2 3.81 0 0.00 3 2.86 1 1.40 6 3.85 1.56 1.45

Acute non-lymphocytic 0 0.00 2 1.53 1 1.12 0 0.00 3 3.26 0.92 -0.18

Chronic myeloid 0 0.00 1 1.94 1 2.84 0 0.00 2 1.30 1.54 0.47

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,922 2,326 1,126 513 2,922

Person-years in interval 2,155 6,344 3,906 2,443 14,848

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 7,535 PYR and for male cancers on 7,313 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 53
Nasopharynx

Both Sexes

Table 3.9.1: Characteristics of patients with an initial cancer of the nasopharynx, both sexes,

SEER 1973-2000.

54 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

NASOPHARYNX

Number of patients with 1st primary cancer

Total 2,526 100.0 1,125 100.0 3,651 100.0

Initial treatment

Any radiation 2,277 90.1 1,002 89.1 3,279 89.8

With surgery 340 13.5 174 15.5 514 14.1

Without surgery 1,937 76.7 828 73.6 2,765 75.7

No radiation 249 9.9 123 10.9 372 10.2

With surgery 60 2.4 38 3.4 98 2.7

Without surgery 189 7.5 85 7.6 274 7.5

Race

White 1,338 53.0 620 55.1 1,958 53.6

Black 228 9.0 96 8.5 324 8.9

Other 952 37.7 402 35.7 1,354 37.1

Unknown 8 0.3 7 0.6 15 0.4

Age at 1st primary cancer diagnosis, years

< 30 196 7.8 125 11.1 321 8.8

30–49 758 30.0 329 29.2 1,087 29.8

50–69 1,238 49.0 458 40.7 1,696 46.5

70–79 276 10.9 153 13.6 429 11.8

> 80 58 2.3 60 5.3 118 3.2

Number of patients with one or more

primary cancers

One primary cancer only 2,359 93.4 1,049 93.2 3,408 93.3

1st and 2nd cancers 148 5.9 73 6.5 221 6.1

1st, 2nd, and 3rd cancers 17 0.7 3 0.3 20 0.5

1st, 2nd, 3rd, and additional cancers 2 0.1 0 0.0 2 0.1

Other statistics

Median age at 1st cancer diagnosis 54.5 — 55.7 — 54.8 —

Median year of 1st cancer diagnosis 1988.4 — 1988.4 — 1988.4 —

Median person-years at risk 2.7 — 3.2 — 2.8 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 92.2 — 94.7 — 93.0

1st, 2nd, and additional cancers — 92.2 — 94.7 — 93.0

1st cancer only — 7.8 — 3.9 — 6.6

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Nasopharynx

Both Sexes

Table 3.9.2: Risk of subsequent primary cancers after cancer of the nasopharynx, both sexes,

SEER 1973-2000.

NASOPHARYNX

All subsequent cancers 38 1.66* 94 1.44* 79 1.72* 56 1.24 267 179.49 1.49* 46.79

All excluding same site 38 1.67* 93 1.43* 77 1.68* 55 1.22 263 178.79 1.47* 45.02

Buccal cavity, pharynx 2 2.56 6 2.82* 4 2.95 5 4.36* 17 5.41 3.14* 6.20

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.31

Tongue 1 6.77 3 7.39* 1 3.81 4 17.21* 9 1.05 8.59* 4.25

Salivary gland 0 0.00 0 0.00 1 9.35 0 0.00 1 0.42 2.38 0.31

Mouth 1 5.34 1 1.99 0 0.00 0 0.00 2 1.27 1.57 0.39

Nasopharynx 0 0.00 1 3.58 2 11.53* 1 7.13 4 0.69 5.79* 1.77

Tonsil 0 0.00 1 5.01 0 0.00 0 0.00 1 0.50 2.00 0.27

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.07

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.32

Digestive system 7 1.29 23 1.48 13 1.21 10 0.98 53 41.96 1.26 5.90

Esophagus 4 13.02* 3 3.54 2 3.49 2 3.81 11 2.25 4.88* 4.68

Stomach 0 0.00 1 0.49 3 2.14 1 0.80 5 5.42 0.92 -0.23

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.30

Colon 2 0.94 12 1.98* 1 0.24 5 1.21 20 16.56 1.21 1.84

Rectum, rectosigmoid junction 0 0.00 3 1.08 4 2.11 1 0.58 8 7.40 1.08 0.32

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.18

Liver 0 0.00 0 0.00 0 0.00 1 1.39 1 2.86 0.35 -0.99

Gallbladder 0 0.00 0 0.00 1 7.34 0 0.00 1 0.54 1.86 0.25

Bile ducts, other biliary 1 8.45 1 2.81 0 0.00 0 0.00 2 1.00 2.00 0.53

Pancreas 0 0.00 3 1.75 2 1.68 0 0.00 5 4.67 1.07 0.18

Respiratory system 8 1.86 31 2.58* 27 3.30* 16 2.10* 82 32.11 2.55* 26.67

Nose, nasal cavity, ear 1 22.89 2 16.36* 1 12.08 0 0.00 4 0.32 12.40* 1.97

Larynx 0 0.00 1 1.14 1 1.78 1 2.17 3 2.23 1.35 0.41

Lung, bronchus 7 1.79 28 2.55* 25 3.32* 15 2.12* 75 29.47 2.55* 24.34

Female breast 4 2.27 3 0.57 5 1.37 7 1.71 19 14.72 1.29 6.66

Female genital system 0 0.00 1 0.41 3 1.83 2 1.17 6 6.66 0.90 -1.03

Cervix uteri 0 0.00 0 0.00 2 7.37 0 0.00 2 1.08 1.85 1.43

Corpus uteri 0 0.00 1 0.84 0 0.00 1 1.22 2 3.21 0.62 -1.89

Ovary 0 0.00 0 0.00 1 2.14 1 1.98 2 1.90 1.05 0.16

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.14

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.37

Male genital system 3 0.68 11 0.84 6 0.59 7 0.68 27 37.95 0.71 -8.91

Prostate 3 0.69 11 0.85 6 0.60 7 0.69 27 37.32 0.72 -8.40

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.29

Urinary system 5 2.87 6 1.21 1 0.29 3 0.89 15 13.54 1.11 0.78

Urinary bladder 3 2.61 3 0.93 0 0.00 1 0.45 7 8.89 0.79 -1.01

Kidney parenchyma 2 4.12 2 1.43 1 1.02 2 2.12 7 3.81 1.84 1.71

Renal pelvis, other urinary 0 0.00 1 3.19 0 0.00 0 0.00 1 0.85 1.18 0.08

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.15

Bone, joints 0 0.00 0 0.00 2 45.17* 1 24.73 3 0.18 16.41* 1.51

Soft tissue including heart 0 0.00 0 0.00 1 5.00 0 0.00 1 0.79 1.26 0.11

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.22

Melanoma of skin 1 2.23 0 0.00 1 1.12 1 1.05 3 3.57 0.84 -0.30

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.11

Brain, central nervous system 1 3.88 2 2.77 2 4.22 0 0.00 5 1.89 2.64 1.66

Thyroid 2 9.78* 1 1.66 0 0.00 0 0.00 3 1.56 1.93 0.77

Lymphatic, hematopoietic 4 2.38 8 1.67 10 3.00* 2 0.61 24 13.10 1.83* 5.82

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.53 0.00 -0.28

Non-Hodgkin lymphoma 4 5.24* 5 2.24 5 3.17* 2 1.23 16 6.19 2.58* 5.24

Myeloma 0 0.00 1 1.26 1 1.81 0 0.00 2 2.17 0.92 -0.09

Leukemia 0 0.00 2 1.28 4 3.73* 0 0.00 6 4.22 1.42 0.95

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.09

Chronic lymphocytic 0 0.00 0 0.00 1 2.70 0 0.00 1 1.45 0.69 -0.24

Acute non-lymphocytic 0 0.00 1 1.74 1 2.49 0 0.00 2 1.57 1.28 0.23

Chronic myeloid 0 0.00 1 4.32 1 6.42 0 0.00 2 0.62 3.22 0.74

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,651 2,901 1,296 646 3,651

Person-years in interval 2,698 7,608 4,589 3,810 18,705

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 6,422 PYR and for male cancers on 12,283 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 55
All subsequent cancers 13 2.20* 21 1.22 19 1.58 26 1.90* 79 48.88 1.62* 46.90

All excluding same site 13 2.20* 21 1.22 18 1.50 25 1.83* 77 48.78 1.58* 43.95

Buccal cavity, pharynx 0 0.00 2 6.14 1 4.62 2 8.68 5 0.89 5.64* 6.41

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.07

Tongue 0 0.00 2 28.58* 0 0.00 1 19.05 3 0.19 15.51* 4.37

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.16

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.42

Nasopharynx 0 0.00 0 0.00 1 37.74 1 40.92 2 0.11 18.97* 2.95

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.11

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.03

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.09

Digestive system 4 3.04 4 1.05 2 0.75 5 1.63 15 10.86 1.38 6.45

Esophagus 3 86.04* 1 9.99 1 14.46 1 12.76 6 0.28 21.24* 8.90

Stomach 0 0.00 0 0.00 0 0.00 1 3.31 1 1.12 0.89 -0.19

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.24

Colon 1 1.64 3 1.73 0 0.00 3 2.11 7 4.97 1.41 3.16

Rectum, rectosigmoid junction 0 0.00 0 0.00 1 2.39 0 0.00 1 1.71 0.59 -1.10

Rectum 0 0.00 0 0.00 0 0.00 0 0.00 0 1.13 0.00 -1.75

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.21

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.65

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.40

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.42

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 1.39 0.00 -2.16

Respiratory system 1 1.39 6 2.80* 2 1.29 5 2.70 14 6.27 2.23* 12.04

Nose, nasal cavity, ear 0 0.00 1 38.02 0 0.00 0 0.00 1 0.07 13.83 1.44

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.31

Lung, bronchus 1 1.46 5 2.46 2 1.35 5 2.81 13 5.98 2.17* 10.94

Female breast 4 2.27 3 0.57 5 1.37 7 1.71 19 14.72 1.29 6.66

Female genital system 0 0.00 1 0.41 3 1.83 2 1.17 6 6.66 0.90 -1.03

Cervix uteri 0 0.00 0 0.00 2 7.37 0 0.00 2 1.08 1.85 1.43

Corpus uteri 0 0.00 1 0.84 0 0.00 1 1.22 2 3.21 0.62 -1.89

Ovary 0 0.00 0 0.00 1 2.14 1 1.98 2 1.90 1.05 0.16

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.14

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.37

Urinary system 1 4.06 1 1.42 0 0.00 2 3.31 4 2.06 1.95 3.03

Urinary bladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.14 0.00 -1.77

Kidney parenchyma 1 11.64 1 3.95 0 0.00 2 9.18* 4 0.74 5.39* 5.07

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.28

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.09

Bone, joints 0 0.00 0 0.00 0 0.00 1 77.10* 1 0.05 19.89 1.48

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.33

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.02

Melanoma of skin 0 0.00 0 0.00 0 0.00 1 3.97 1 0.84 1.20 0.26

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.09

Brain, central nervous system 1 16.43 0 0.00 0 0.00 0 0.00 1 0.49 2.04 0.79

Thyroid 1 10.19 0 0.00 0 0.00 0 0.00 1 0.81 1.23 0.29

Lymphatic, hematopoietic 0 0.00 4 3.34 5 5.87* 1 0.99 10 3.48 2.88* 10.16

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.21

Non-Hodgkin lymphoma 0 0.00 3 5.14* 2 4.75 1 1.93 6 1.72 3.49* 6.67

Myeloma 0 0.00 0 0.00 1 6.47 0 0.00 1 0.61 1.63 0.60

Leukemia 0 0.00 1 2.83 2 8.24 0 0.00 3 1.01 2.97 3.10

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.07

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.51

Acute non-lymphocytic 0 0.00 1 7.13 1 10.24 0 0.00 2 0.40 4.97 2.49

Chronic myeloid 0 0.00 0 0.00 1 27.80 0 0.00 1 0.15 6.70 1.32

Nasopharynx

Females

Table 3.9.3: Risk of subsequent primary cancers after cancer of the nasopharynx, females,

SEER 1973-2000.

56 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

NASOPHARYNX

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,125 890 434 246 1,125

Person-years in interval 829 2,447 1,599 1,547 6,422

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Nasopharynx

Males

Table 3.9.4: Risk of subsequent primary cancers after cancer of the nasopharynx, males,

SEER 1973-2000.

NASOPHARYNX

All subsequent cancers 25 1.48 73 1.52* 60 1.76* 30 0.95 188 130.60 1.44* 46.73

All excluding same site 25 1.49 72 1.50* 59 1.74* 30 0.96 186 130.02 1.43* 45.58

Buccal cavity, pharynx 2 3.00 4 2.22 3 2.63 3 3.27 12 4.52 2.65* 6.09

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.53 0.00 -0.43

Tongue 1 8.08 1 2.98 1 4.65 3 16.67* 6 0.85 7.02* 4.19

Salivary gland 0 0.00 0 0.00 1 12.13 0 0.00 1 0.32 3.14 0.55

Mouth 1 6.58 1 2.48 0 0.00 0 0.00 2 1.00 2.00 0.81

Nasopharynx 0 0.00 1 4.19 1 6.80 0 0.00 2 0.59 3.41 1.15

Tonsil 0 0.00 1 5.80 0 0.00 0 0.00 1 0.43 2.33 0.47

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.10

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -0.44

Digestive system 3 0.73 19 1.62 11 1.35 5 0.70 38 31.10 1.22 5.61

Esophagus 1 3.67 2 2.68 1 1.98 1 2.24 5 1.97 2.54 2.47

Stomach 0 0.00 1 0.61 3 2.67 0 0.00 4 4.30 0.93 -0.24

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.33

Colon 1 0.66 9 2.08 1 0.33 2 0.74 13 11.59 1.12 1.15

Rectum, rectosigmoid junction 0 0.00 3 1.38 3 2.03 1 0.79 7 5.69 1.23 1.07

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.16

Liver 0 0.00 0 0.00 0 0.00 1 1.69 1 2.44 0.41 -1.17

Gallbladder 0 0.00 0 0.00 1 13.51 0 0.00 1 0.28 3.54 0.58

Bile ducts, other biliary 1 11.33 1 3.79 0 0.00 0 0.00 2 0.73 2.74 1.03

Pancreas 0 0.00 3 2.43 2 2.36 0 0.00 5 3.28 1.52 1.40

Respiratory system 7 1.96 25 2.54* 25 3.77* 11 1.91 68 25.84 2.63* 34.32

Nose, nasal cavity, ear 1 28.52 1 10.42 1 15.37 0 0.00 3 0.25 11.98* 2.24

Larynx 0 0.00 1 1.24 1 1.95 1 2.44 3 2.03 1.48 0.79

Lung, bronchus 6 1.86 23 2.58* 23 3.81* 10 1.89 62 23.49 2.64* 31.35

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.19

Male genital system 3 0.68 11 0.84 6 0.59 7 0.68 27 37.95 0.71 -8.91

Prostate 3 0.69 11 0.85 6 0.60 7 0.69 27 37.32 0.72 -8.40

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.29

Urinary system 4 2.67 5 1.18 1 0.34 1 0.36 11 11.49 0.96 -0.40

Urinary bladder 3 2.97 3 1.06 0 0.00 1 0.53 7 7.75 0.90 -0.61

Kidney parenchyma 1 2.50 1 0.87 1 1.26 0 0.00 3 3.06 0.98 -0.05

Renal pelvis, other urinary 0 0.00 1 3.97 0 0.00 0 0.00 1 0.67 1.49 0.27

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.19

Bone, joints 0 0.00 0 0.00 2 61.51* 0 0.00 2 0.13 15.09* 1.52

Soft tissue including heart 0 0.00 0 0.00 1 6.80 0 0.00 1 0.58 1.72 0.34

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.32

Melanoma of skin 1 2.88 0 0.00 1 1.44 0 0.00 2 2.73 0.73 -0.60

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.13

Brain, central nervous system 0 0.00 2 3.67 2 5.66 0 0.00 4 1.40 2.86 2.12

Thyroid 1 9.40 1 3.35 0 0.00 0 0.00 2 0.75 2.68 1.02

Lymphatic, hematopoietic 4 3.16 4 1.11 5 2.02 1 0.44 14 9.63 1.45 3.56

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.32

Non-Hodgkin lymphoma 4 7.07* 2 1.21 3 2.59 1 0.91 10 4.47 2.24* 4.50

Myeloma 0 0.00 1 1.72 0 0.00 0 0.00 1 1.55 0.64 -0.45

Leukemia 0 0.00 1 0.83 2 2.41 0 0.00 3 3.21 0.94 -0.17

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.10

Chronic lymphocytic 0 0.00 0 0.00 1 3.43 0 0.00 1 1.12 0.89 -0.10

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.16 0.00 -0.95

Chronic myeloid 0 0.00 1 5.60 0 0.00 0 0.00 1 0.47 2.12 0.43

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,526 2,011 862 400 2,526

Person-years in interval 1,869 5,162 2,990 2,263 12,283

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BUCCAL CAVITY AND PHARYNX 57

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 59

Synopsis

The risk of developing a subsequent primary cancer

was evaluated in 124,524 patients diagnosed with cancers of the digestive tract (excluding colorectal and anal

cancers) between 1973 and 2000. Significant excesses of

all new malignancies combined were observed after

cancers of the esophagus (O/E=1.38, O=635, EAR=70

per 10,000 person-years) and small intestine (O/E=1.11,

O=422, EAR=18) but not after cancers of the stomach

(O/E=0.91, O=1,609), liver and intrahepatic bile ducts

(O/E=1.05, O=168, EAR=7), gallbladder (O/E=1.10,

O=167, EAR=16), extrahepatic bile ducts/other biliary

tract (O/E=0.86, O=175), or pancreas (O/E=0.75, O=377).

Elevated risks of cancers of the buccal cavity and respiratory tract following esophageal cancer are likely related to tobacco and/or alcohol exposure, with increased

risks seen among those with an initial esophageal

squamous cell cancer (O/E=1.63) but not those with

adenocarcinomas (O/E=0.87). Excesses of new cancers

were seen among patients with small intestine adenocarcinomas and sarcomas. Following small intestine

adenocarcinoma, the increased risks involved mainly

digestive tract cancers, including colorectal cancer,

while survivors of small intestine sarcomas had excesses of kidney cancer, as well as soft tissue sarcomas and

cutaneous melanoma. Younger patients with small

intestine adenocarcinomas, as well as those with stomach cancers, had a pattern of subsequent cancer risk

suggestive of genetic syndromes, including hereditary

nonpolyposis colorectal cancer. In addition, there were

elevated risks of ovarian and pancreatic tumors following gallbladder cancer, and excesses of cancers of the

mouth, ovary, kidney, and thyroid following liver cancer. Common etiologic factors may contribute to some

patterns of multiple cancers (e.g., alcohol abuse with

liver and mouth cancer), while other associations may

be related to increased surveillance, difficulties in distinguishing primary from metastatic tumors, or incidental autopsy findings.

Esophageal Cancer

Esophageal cancer accounts for only 1% of incident

malignancies in the U.S., but it is the seventh leading

cause of cancer death in men. Death rates are higher

among black men compared with white men (Brown

and Devesa, 2002; Jemal et al, 2005). More than 90% of

esophageal cancers are squamous cell carcinomas (SCE)

or adenocarcinomas (ACE). The histologic pattern of the

disease has changed significantly over the past 20 years,

with the incidence of SCE decreasing in all race and

gender groups and incidence of ACE increasing, particularly among white men (Brown and Devesa, 2002).

The 5-year relative survival rate is quite low, approximately 14.2%. Surgical resection, radiotherapy, chemotherapy, or a combination of these treatments is used for

localized tumors of both histologic types (Enzinger and

Mayer, 2003). Combination chemotherapy (cisplatin and

5-fluorouracil), radiotherapy, and stenting are used for

palliative therapy (Enzinger and Mayer, 2003).

Tobacco smoking, alcohol abuse, low fruit and vegetable intake, and other correlates of low socioeconomic

status may explain 98% of SCE in the U.S. (Brown and

Devesa, 2002). Gastroesophageal reflux disease, obesity,

smoking, and low intake of fruits and vegetables may

account for up to 80% of ACE (Engel et al, 2003). Tylosis,

a rare autosomal dominant disorder, is the only recognized familial syndrome that has been associated with

SCE (Enzinger and Mayer, 2003).

Results and Discussion

Among the 18,402 patients initially diagnosed with

esophageal cancer who survived 2 months or more,

there was a 38% increased risk of subsequent primary

cancers (O/E=1.38, O=635, 95% CI=1.28-1.49, EAR=70 per

10,000 person-years). The cumulative incidence of developing a second cancer, adjusted for the competing risk

of death due to other causes, was 4.0% at 15 years

(95% CI=3.7%-4.4%). The elevated risks of new malignancies were seen throughout all follow-up periods.

Overall relative and absolute risks were substantially

higher for blacks (O/E=1.89, EAR=158) than for whites

(O/E=1.28, EAR=52). Excess risks were limited to patients

diagnosed with esophageal cancer at ages younger than

70 years and to those with SCE (O/E=1.63, EAR=115), but

not ACE (O/E=0.87, EAR=-24). Although the overall relative risk was somewhat higher for females than for males,

the excess absolute risks were similar. The elevated risks

DIGESTIVE TRACT, EXCL.

COLON, RECTUM, AND ANUS

Chapter 4

New Malignancies Following Cancer of the

Digestive Tract, Excluding Colorectal Cancer

Rachael Z. Stolzenberg-Solomon, Joseph F. Fraumeni Jr., Louise Wideroff, Demetrius Albanes, Rochelle E. Curtis

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated as

[(O-E)/PYR]10,000).

Author affiliations: Rachael Z. Stolzenberg-Solomon, Joseph F.

Fraumeni Jr., Demetrius Albanes, and Rochelle E. Curtis, Division

of Cancer Epidemiology and Genetics, NCI, NIH, DHHS; Louise

Wideroff, Division of Cancer Control and Population Sciences, NCI,

NIH, DHHS.
were 9- to 17-fold for subsequent oral cancers (tongue,

tonsil, mouth, oropharynx, and hypopharynx) and 1.7-

to 4-fold for cancers of the respiratory tract (larynx, lung,

and bronchus), thyroid, stomach (males only), and small

intestine. Significant deficits of prostate cancer were seen

following esophageal cancer overall (O/E=0.81), primarily among patients with initial ACE (O/E=0.59) but not

SCE (O/E=0.92). The findings are generally consistent

with earlier surveys of subsequent cancers after

esophageal cancer (Berg et al, 1970; Hoar et al, 1985;

Dong and Hemminki, 2001; Matsubara et al, 2003).

Exposure of the epithelial surface along the upper

aerodigestive tract to the carcinogenic effects of smoking

and drinking contributes to the increased risks of multiple cancers (buccal cavity, larynx, lung) following SCE

but not ACE (Ahsan et al, 1997; Hemminki and Jiang,

2002). This field cancerogenic effect is also due to the

clonal migration of mutated cells (van Oijen and

Slootweg, 2000). These factors also account for the reciprocally increased risk of SCE following initial cancers of

the buccal cavity and respiratory tract.

The significantly lower-than-expected rate of prostate cancers following esophageal cancer, particularly

among patients with ACE, is not consistent with a previous study indicating a positive association between

esophageal cancer (all types combined) and prostate

cancer (Hoar et al, 1985). The excess of subsequent thyroid cancers in our study appeared as a result of incidental autopsy findings (4 of 6 cases). Reasons for the

increased risk of stomach cancer following SCE and

ACE are unclear.

Stomach Cancer

Stomach cancer is the second leading cause of cancer

mortality in the world, although in the U.S. it ranks

13th among both men and women (Brown and Devesa,

2002; Jemal et al, 2005). The majority of stomach cancers

(85-90%) are adenocarcinomas, with 76% being intestinal

type and 13% diffuse type (Henson et al, 2004). During

the past 60 years, incidence and mortality rates have

declined strikingly in the U.S. and in other industrial

countries as a result of decreases in noncardia gastric

adenocarcinoma (Brown and Devesa, 2002). In contrast,

the incidence rates for cancers in the esophagogastric

junction and gastric cardia have increased or remained

stable (Brown and Devesa, 2002; Hohenberger and

Gretschel, 2003). Stomach cancer occurs more often in

men and in minority populations of the U.S. (Brown and

Devesa, 2002). Prognosis following stomach cancer has

remained poor, with 5-year relative survival rates at

17.0% for gastric cardia cancers and 25.6% for noncardia

gastric cancers. For patients with localized disease, surgical removal of the tumor and adjacent lymph nodes

offers the only cure, although radiation and chemotherapy are often given (Hohenberger and Gretschel, 2003).

Gastric carriage of Helicobacter pylori has emerged as

the major risk factor in the development and progression

of chronic atrophic gastritis to intestinal metaplasia,

dysplasia, and eventually stomach cancer (Brown and

Devesa, 2002). Dietary factors also play a role through

poorly refrigerated or preserved foods (e.g., salted, pickled, smoked) and low fruit and vegetable intake. Cigarette smoking has also been linked to stomach cancer

(Brown and Devesa, 2002). Changes in the prevalence

of these risk factors have probably contributed to the

marked decline in noncardia gastric adenocarcinoma.

For tumors of the gastric cardia, the risk factors resemble

those of ACE, including obesity and gastroesophageal

reflux disease (Brown and Devesa, 2002; Engel et al,

2003). Genetic predisposition to stomach cancer may

also occur with hereditary nonpolyposis colorectal cancer, familial adenomatous polyposis, familial gastric

cancer of the diffuse type caused by germline mutations

of E-cadherin (Lindor and Greene, 1998; Graziano et al,

2003), and immunogenetic susceptibility to gastric atrophy caused by proinflammatory cytokines (El-Omar

et al, 2003).

Results and Discussion

Among the 39,998 patients who survived at least

2 months after their initial diagnosis of stomach

cancer, a significantly reduced risk of subsequent primary cancers was observed (O/E=0.91, O=1,609, 95%

CI=0.86-0.95). The estimated cumulative incidence of

second cancer was 5.0% at 20 years (95% CI=4.7%-5.3%).

The observed number of new malignancies among the

8,847 patients with gastric cardia cancers did not differ

from that expected (O/E=0.97), while a significant deficit

in risk was seen among 31,151 patients with noncardia

gastric cancers (O/E=0.90). The overall risk of subsequent cancers was decreased during the first year after

stomach cancer diagnosis and then rose to levels prevailing in the general population for the remaining

follow-up intervals. The risk of new cancers did not differ by gender, but blacks had higher risks than whites,

with practically all (93%) of the new malignancies

among blacks occurring after noncardia gastric cancer

(O/E=1.08, O=214). The risks of subsequent primary

cancers were increased for patients diagnosed before

age 50 years (O/E=1.50, EAR=24), were similar to

expected values for those diagnosed at ages 50-69 years

(O/E=1.03, EAR=5), and were lower than expected at

older ages (≥70 years, O/E=0.77). Risks were significantly elevated for new cancers of the small intestine

and thyroid and were decreased for cancers of the lip,

uterine corpus, and prostate. Our results are consistent

with previous surveys of stomach cancer showing either

no increased risk or deficits in risk for all second cancers

combined (Hoar et al, 1985; Lynge et al, 1985; Buiatti et

al, 1997). However, some studies of stomach cancer have

suggested elevated risks for certain subsequent cancers,

including those of the colon, liver, pancreas, lung, and

breast, as well as for lymphoma (Lynge et al, 1985; Ikeda

et al, 1995; Neugut and Gold, 1999; Bozzetti et al, 2000;

Kinoshita et al, 2000; Dinis-Ribeiro et al, 2002).

60 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

DIGESTIVE TRACT, EXCL.

COLON, RECTUM, AND ANUS
NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 61

DIGESTIVE TRACT, EXCL.

Although smoking is generally considered a risk factor

COLON, RECTUM, AND ANUS

for gastric cancer (Engel et al, 2003) and may predispose

to subsequent primary cancers (Kinoshita et al, 2000), 

we found no excess of new malignancies at tobaccorelated sites, except for an increased risk of respiratory

cancer among stomach cancer patients diagnosed at ages

younger than 50 years (O/E=1.74, O=17). The excess of

colorectal cancers among younger patients suggests the

influence of genetic factors, such as hereditary nonpolyposis colon cancer, which features certain extracolonic

tumors, including gastric cancer (Umar, 2004). The excess

cancers of the small intestine and thyroid were most pronounced in the first year of follow-up, suggesting the

role of medical surveillance, or incidental tumors seen

during the initial medical work-up or at autopsy.

Small Intestine Cancer

Cancer of the small intestine is relatively rare in the U.S.,

accounting for about 0.4% of incident cancers and 0.2%

of cancer deaths (Jemal et al, 2005). Although this site

represents 90% of the gastrointestinal surface area, the

cancer frequency is less than 3% of all gastrointestinal

cancers combined (Neugut et al, 1998; Rustgi, 2002).

Adenocarcinomas, carcinoids, lymphomas, and sarcomas

account for approximately 95% of malignant tumors of

the small bowel (Neugut et al, 1998). Since the mid-1980s,

small intestine tumors described as carcinoids NOS (not

otherwise specified) have been considered malignant 

and reportable to the SEER Program. Lymphomas of the

small intestine are grouped with other non-Hodgkin

lymphomas in this survey and are thus excluded from

this chapter. Adenocarcinomas and carcinoids occur

more often among males than females, and more often

among blacks than whites (Neugut et al, 1998). Five-year

relative survival rates for cancers of the small intestine

are 24.4% for adenocarcinomas, 78.6% for carcinoids, and

45.1% for sarcomas. Treatments include surgery and

adjuvant chemotherapy for adenocarcinomas and carcinoids (Anthony and Kim, 2002; Rustgi, 2002) and surgery

for leiomyosarcomas (Rustgi, 2002).

Although the etiology of cancers arising in the small

intestine is unclear, adenocarcinomas of the small and

large intestine are thought to have similar risk factors

(Neugut et al, 1998). Some studies have suggested an

effect of obesity, alcohol consumption, and cigarette

smoking (Neugut et al, 1998; Kaerlev et al, 2000; Wolk et

al, 2001; Samanic et al, 2004). Genetic factors are involved

in cases associated with familial adenomatous polyposis,

hereditary nonpolyposis colon cancer, and Peutz-Jeghers

syndrome (Delaunoit et al, 2005). In addition, small intestine cancer occurs excessively in patients with celiac disease and Crohn’s disease (Neugut et al, 1998; Delaunoit

et al, 2005).

Results and Discussion

Overall, 422 subsequent primary cancers were observed

among 5,432 2-month survivors of cancer of the small

intestine, with an overall 11% elevated risk compared

with the general population (O/E=1.11, 95% CI=1.01-1.22,

EAR=18). Eleven percent of patients developed a second

primary cancer over a 20-year interval (cumulative incidence=10.8%, 95% CI=9.6%-12.0%). The 2,110 patients

with adenocarcinoma of the small intestine had a significant 25% increase in subsequent cancer risk (O/E=1.25,

O=137, EAR=42), while no excess was found among

2,332 patients diagnosed with carcinoids (O/E=1.02,

O=222, EAR=3). A nonsignificant 23% elevation in subsequent cancer risk was seen in 749 patients with small

intestine sarcomas (O/E=1.23, O=48, EAR=30). The risk

of new malignancy was increased more than 2-fold when

small intestine cancers were diagnosed before 50 years of

age, whereas observed numbers did not differ from

expectation at older ages. Risks of subsequent cancers

did not vary substantially by race, gender, or follow-up

interval. Significantly increased risks were observed for

new cancers of the small intestine and kidney, as well as

melanomas and soft tissue sarcomas. Previous studies

using the SEER database have reported elevated risks for

colorectal and other digestive tract cancers after small

intestine adenocarcinomas, for melanoma after small

intestine sarcomas among males only, and for prostate

cancer following small intestine carcinoids (Neugut and

Santos, 1993). Excesses of subsequent digestive cancers

have also been reported in other cancer registry studies

(Hoar et al, 1985; Lynge et al, 1985; Neugut and Santos,

1993; Ripley and Weinerman, 1997; Neugut et al, 1998;

Neugut and Gold, 1999).

In the current SEER survey, patients with small intestine adenocarcinomas had 2-fold or greater increases in

risks of subsequent digestive tract cancers, especially

colon cancer, which did not occur in excess following

small intestine sarcomas or carcinoids. Since reciprocally

increased risks of small intestine cancers were seen following cancers of the colon and other digestive sites, it

is likely that shared risk factors are involved (Neugut

and Santos, 1993; Neugut et al, 1998). In particular,

patients with small intestine adenocarcinoma diagnosed

at younger than age 50 years had 10- to 18-fold increased

risks for new cancers of the colon and rectum (O=10)

and corpus uteri (O=2), a constellation of tumors associated with hereditary nonpolyposis colon cancer (Umar,

2004). Other genetic syndromes, such as familial adenomatous polyposis and Peutz-Jeghers syndrome, may

also predispose to small and large intestine cancers at

a young age (Delaunoit et al, 2005). 

Both males and females with small intestine sarcoma

had an increased risk of cutaneous melanoma, an association previously reported in SEER registries among

males only (Neugut and Santos, 1993). This finding was

most pronounced among younger patients (ages <50

years, O/E=24.74, O=5), suggesting genetic or immunologic factors, although some sarcomas and melanomas

may be difficult to separate on diagnostic grounds (Matz

et al, 2002). The increased risk of renal cancer after small

intestine sarcoma is noteworthy, as 3 of the 4 cases had

documented leiomyosarcoma of the small intestine,

raising the possibility of hereditary leiomyomatosis
associated with renal cell cancer, even though the leiomyomas in this syndrome are primarily cutaneous and uterine (Kiuru et al, 2002).

Liver and Intrahepatic Bile Duct Cancers

Although liver and intrahepatic bile duct cancers account

for an estimated 1.3% of incident cancers and 2.7% of

cancer deaths in the U.S. (Jemal et al, 2005), they are the

fifth most common malignant neoplasm worldwide and

the third most common cause of cancer death (Llovet et

al, 2003). The incidence and mortality rates for liver and

intrahepatic bile duct cancers have been increasing in the

U.S. (El-Serag, 2004; Shaib and El-Serag, 2004). Hepatocellular carcinoma (HCC) constitutes the majority of primary liver cancers, followed by intrahepatic bile duct

cancer or cholangiocarcinoma (Carriaga and Henson,

1995). Prognosis is especially poor for all forms of primary liver cancer, with a 5-year relative survival rate

of 8.2%. Curative surgery and liver transplantation are

used to treat the small proportion of liver cancers that

are localized and resectable. Treatment options for unresectable tumors include palliative surgery to relieve

obstruction of the biliary tree and limited use of adjuvant

chemotherapy, radiation, and/or photodynamic therapy

(Khan et al, 2002; Valea, 2002).

The major risk factors for HCC include hepatitis B and

C virus, chronic alcoholism, and the cirrhosis associated

with these exposures. The fungal metabolite aflatoxin B1

from food sources plays an important role in developing

countries. In addition, metabolic diseases such as

tyrosinemia, hemochromatosis, and porphyrias contribute to a small proportion of the cancers (Valea, 2002).

Recent studies have implicated obesity and diabetes mellitus as conditions predisposing to nonalcoholic steatohepatitis and to HCC (El-Serag, 2004).

Results and Discussion

No overall excess of subsequent primary cancer was

observed among the 11,500 patients who survived

2 months or more following cancer of the liver or intrahepatic bile duct (O/E=1.05, O=168, 95% CI=0.90-1.22,

EAR=7). Notably, 15% of the new malignancies were

diagnosed at autopsy. As with other cancers that are

rapidly fatal, the cumulative incidence of developing

a second cancer was very low (1.8% at 15 years, 95%

CI=1.5%-2.2%). However, the rate of new cancers tended

to increase over time, with a nonsignificant 64% excess

seen among 200 patients surviving 10 years or more

(O=15). Risks for all subsequent cancers combined did

not differ substantially by gender, race, or treatment. Significantly elevated risks were observed for new malignancies of the mouth, ovary, kidney, and thyroid, based

on small numbers. Among the 1,937 patients diagnosed

with liver cancer at ages younger than 50 years, there

was a significantly increased risk of all subsequent cancers combined (O/E=3.15, O=23, EAR=40), with 10- to 

27-fold elevated risks for cancers of the colon, ovary, and

bladder, as well as for acute non-lymphocytic leukemia,

based on fewer than 5 cases each. Common risk factors

(e.g., alcohol for oral cavity cancer), incidental autopsy

findings (e.g., thyroid cancer), treatment effects (e.g.,

acute myeloid leukemia), and misdiagnosed metastases

(e.g., ovarian and digestive tract cancers) may have contributed to these results. Previous reports of second cancers following primary liver cancer are sparse and based

on small numbers (Kaczynski et al, 1995).

Gallbladder Cancer

Gallbladder cancers account for an estimated 0.2% of

incident cancers in the U.S., with rates for women being

2 to 6 times higher than for men (Misra et al, 2003). Most

tumors (90%) are adenocarcinomas, and the relative survival rate is low (14.9% at 5 years). Surgical resection is

used to treat patients with localized disease; therapies for

more advanced stages may include palliative surgery,

radiation, and chemotherapy (Misra et al, 2003).

Because the major precursor state is cholesterol gallstones, the risk factors for stones resemble those for gallbladder cancer; they include female gender, obesity, parity,

and physical inactivity (Lazcano-Ponce et al, 2001). Native

Americans have the highest rates of stones and gallbladder cancer in the U.S. (Lazcano-Ponce et al, 2001). The

mechanisms by which stones predispose to gallbladder

cancer are not entirely clear, but they appear to involve

chronic inflammatory processes (Misra et al, 2003).

Results and Discussion

Among the 5,343 patients diagnosed with gallbladder

cancer who survived at least 2 months, the subsequent

cancer risk did not differ significantly from that expected

(O/E=1.10, O=167, 95% CI=0.94-1.27, EAR=16). Overall

risks were similar by gender and race. The cumulative

incidence of second cancers at 15 years was 3.4%

(95% CI=2.9%-4.0%). An increased risk of subsequent

ovarian cancers in excess of 4-fold was observed, as

reported in a previous SEER survey (Su et al, 1999), and 

a nearly 3-fold excess of pancreatic cancer was seen, in

agreement with a Connecticut registry study (Hoar et al,

1985). In addition, a 12-fold increased risk of subsequent

bile duct cancer was noted. Although the associations

may result in part from misdiagnosed metastases, it is

possible that the increased risk of pancreatic and bile

duct tumors was caused by a common etiologic factor

such as obesity, or predisposing conditions such as gallstones or sclerosing cholangitis (de Groen et al, 1999).

Other Biliary Tract Cancers

Cancers of other segments of the biliary tract include

tumors of the extrahepatic bile ducts and the ampulla

of Vater, as well as other and unspecified biliary malignancies. These tumors are more common in men than

women, and relative survival is typically poor, 20.0% at

5 years. Surgical resection is the primary treatment for

those without metastasis or nodal involvement. Palliative

surgery, adjuvant chemotherapy, and radiation are treatment options for unresectable tumors (Khan et al, 2002).

62 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

DIGESTIVE TRACT, EXCL.

COLON, RECTUM, AND ANUS
The main risk factor for extrahepatic bile duct cancer

is primary sclerosing cholangitis, a chronic autoimmune

inflammatory process that is often associated with ulcerative colitis (Cullen and Chapman, 2003). Gallstones also

predispose to bile duct cancers (de Groen et al, 1999;

Khan et al, 2002). Familial adenomatous polyposis may

be associated with ampulla of Vater cancer in some cases

(Lillemoe, 2003).

Results and Discussion

Among the 5,498 patients who survived 2 months or

longer following a diagnosis of other biliary cancer, a

total of 175 subsequent primary cancers were observed,

yielding a significant deficit in risk (O/E=0.86, 95%

CI=0.74-1.00). The cumulative incidence of second cancers

was estimated at 3.8% at 15 years (95% CI=3.2%-4.4%).

Overall, 65 new malignancies were observed among

3,110 patients with extrahepatic bile duct cancer

(O/E=0.78, 95% CI=0.61-1.00); 108 subsequent malignancies occurred among 1,961 patients with carcinoma 

of the ampulla of Vater (O/E=0.94, 95% CI=0.77-1.14);

and 2 new malignancies were observed among 427

patients with other/unspecified biliary tumors. Overall, 

a significant increased risk of subsequent rectal cancer

(excluding rectosigmoid junction) was found (O/E=2.28,

O=12), especially among patients with an initial diagnosis of ampulla of Vater cancer (O/E=2.76, O=8). In the

reverse direction, there were significant increased risks

for extrahepatic bile duct cancer (O/E=1.41, O=86) and

ampulla of Vater cancer (O/E=1.45, O=52) after colorectal

cancer. These associations are consistent with previous

SEER evaluations that reported an elevated risk of colorectal cancers after extrahepatic bile duct and/or ampulla

of Vater cancer (Su et al, 1999; Das et al, 2004), as well as

an excess of these cancers after colorectal cancer (Hatch

et al, 1992; Su et al, 1999). These findings suggest the

influence of a genetic susceptibility syndrome, such as

hereditary nonpolyposis colon cancer or familial adenomatous polyposis (de Groen et al, 1999), or a predisposing condition, such as sclerosing cholangitis (de Groen et

al, 1999). Contrary to an earlier report (Hatch et al, 1992),

there was no elevation in the risk of ovarian cancer following cancers of the ampulla of Vater in this extended

follow-up study. Prior reports have also shown no excess

risk for cancers of the breast, female genital organs, or for

smoking-related aerodigestive tract cancers after extrahepatic and ampullary biliary tract cancers (Su et al, 1999).

Pancreatic Cancer

Pancreatic cancer is estimated to be the eleventh most frequent incident cancer, and the fourth most common cause

of cancer mortality for men and women in the U.S. (Jemal

et al, 2005). More than 90% of pancreatic cancers are ductal adenocarcinomas, with islet-cell tumors constituting

about 5% (Mayer, 2005). The incidence of pancreatic cancer is higher in men compared with women, and in blacks

compared with whites (Ries et al, 2004). Pancreatic cancer

is most often diagnosed at advanced stages, resulting in a

5-year relative survival rate of only 4.3%. For patients

with localized disease, surgical resection of the pancreas

offers the only effective treatment; palliative treatments,

such as surgery for biliary decompression and adjunctive

radiation and chemotherapy (fluorouracil), are used for

nonresectable tumors (Mayer, 2005).

Of the few risk factors that have been identified,

cigarette smoking is the most consistent (Mayer, 2005).

Diabetes mellitus (Huxley et al, 2005) and chronic pancreatitis also predispose to the disease (Lowenfels et al,

1999). An association with obesity has been reported in

several studies (Berrington de Gonzalez et al, 2003), but

the effect of dietary factors and physical activity is

unclear. Genetic susceptibility plays a role, with some

cases being familial or related to hereditary melanoma,

Peutz-Jeghers syndrome, hereditary breast or ovarian

cancer, familial pancreatitis, or hereditary nonpolyposis

colon cancer (Hansel et al, 2003).

Results and Discussion

Among 38,351 2-month survivors of pancreatic cancer,

a deficit in risk of subsequent primary cancers was

observed (O/E=0.75, O=377, 95% CI 0.67-0.82). Nearly

16% of the 377 new malignancies were diagnosed at

autopsy. The cumulative incidence of second cancer 

was very low, 1.0% at 10 years (95% CI=0.9%-1.1%), consistent with very poor survival rates. The 578 patients

diagnosed with primary islet-cell tumors had fewer new

malignancies than expected (O/E=0.85, O=23). Males had

a rate of subsequent cancer that was similar to that of

females, while risks appeared to be somewhat higher in

blacks (O/E=0.96) than whites (O/E=0.68). A 27%

nonsignificant increase in subsequent cancer risk was

observed among those who were younger than age

50 years when diagnosed with pancreatic cancer. Over 

all ages combined, risks were significantly increased for

subsequent cancers of the small intestine and thyroid,

but deficits in risk were seen for cancers of the colon,

liver, respiratory tract, uterine corpus, and bladder, as

well as myeloma. In 2 other registry-based studies of

pancreatic cancer, the risk of second cancers did not differ from that of the general population (Hoar et al, 1985;

Lynge et al, 1985), although significant deficits were

noted in a third study (Dong and Hemminki, 2001).

The extremely poor survival associated with pancreatic

cancer impedes the detection of new primaries and 

likely explains the deficits in risk for many cancers. The

elevated risk of new thyroid tumors was related to incidental findings at autopsy (10 of 12 thyroid cancers),

while misclassified metastases probably explained the

increased risk for small intestine cancer, which was limited to the early follow-up period. Cigarette smoking may

underlie the elevated risk of lung cancer following pancreatic cancer among patients diagnosed at younger than

50 years of age (O/E=2.84, O=7), especially because a

reciprocal increased risk of subsequent pancreatic cancer

was associated with other smoking-related cancers (lung,

head and neck, and bladder) in a previous SEER survey

(Neugut et al, 1995; Neugut and Gold, 1999). Although

an elevated risk of pancreatic cancer has been reported in

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 63

DIGESTIVE TRACT, EXCL.

COLON, RECTUM, AND ANUS
64 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

melanoma-prone families (Goldstein et al, 1995) and in

patients with early-onset melanoma in an earlier SEER

study (Schenk et al, 1998), we found no evidence in the

current SEER data of a significantly increased risk of

melanoma after pancreatic cancer at any age.

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DIGESTIVE TRACT, EXCL.

COLON, RECTUM, AND ANUS
Esophagus

Both Sexes

Table 4.1.1: Characteristics of patients with an initial cancer of the esophagus, both sexes,

SEER 1973-2000.

66 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ESOPHAGUS

Number of patients with 1st primary cancer

Total 13,496 100.0 4,906 100.0 18,402 100.0

Initial treatment

Any radiation 8,901 66.0 3,310 67.5 12,211 66.4

With surgery 2,066 15.3 585 11.9 2,651 14.4

Without surgery 6,835 50.6 2,725 55.5 9,560 52.0

No radiation 4,595 34.0 1,596 32.5 6,191 33.6

With surgery 2,315 17.2 685 14.0 3,000 16.3

Without surgery 2,280 16.9 911 18.6 3,191 17.3

Race

White 10,070 74.6 3,763 76.7 13,833 75.2

Black 2,590 19.2 960 19.6 3,550 19.3

Other 825 6.1 178 3.6 1,003 5.5

Unknown 11 0.1 5 0.1 16 0.1

Age at 1st primary cancer diagnosis, years

< 30 21 0.2 7 0.1 28 0.2

30–49 1,251 9.3 285 5.8 1,536 8.3

50–69 7,704 57.1 2,343 47.8 10,047 54.6

70–79 3,373 25.0 1,366 27.8 4,739 25.8

> 80 1,147 8.5 905 18.4 2,052 11.2

Number of patients with one or more

primary cancers

One primary cancer only 13,066 96.8 4,759 97.0 17,825 96.9

1st and 2nd cancers 388 2.9 139 2.8 527 2.9

1st, 2nd, and 3rd cancers 37 0.3 6 0.1 43 0.2

1st, 2nd, 3rd, and additional cancers 5 0.0 2 0.0 7 0.0

Other statistics

Median age at 1st cancer diagnosis 65.2 — 68.7 — 66.2 —

Median year of 1st cancer diagnosis 1989.1 — 1987.8 — 1988.8 —

Median person-years at risk 0.5 — 0.6 — 0.6 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 94.9 — 90.5 — 93.8

1st, 2nd, and additional cancers — 94.4 — 89.8 — 93.2

1st cancer only — 4.0 — 6.1 — 4.5

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Esophagus

Both Sexes

Table 4.1.2: Risk of subsequent primary cancers after cancer of the esophagus, both sexes,

SEER 1973-2000.

ESOPHAGUS

All subsequent cancers 197 1.23* 296 1.57* 94 1.31* 48 1.22 635 459.74 1.38* 70.18

All excluding same site 196 1.24* 294 1.59* 93 1.31* 48 1.23 631 453.53 1.39* 71.07

Buccal cavity, pharynx 39 8.33* 46 8.94* 21 11.95* 11 12.66* 117 12.46 9.39* 41.86

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 1.76 0.00 -0.70

Tongue 7 7.56* 14 13.48* 6 16.73* 0 0.00 27 2.50 10.81* 9.81

Salivary gland 1 2.83 1 2.44 1 6.37 0 0.00 3 1.01 2.97 0.80

Mouth 12 9.96* 15 11.42* 3 6.72* 1 4.56 31 3.18 9.74* 11.14

Nasopharynx 0 0.00 1 4.98 0 0.00 0 0.00 1 0.49 2.06 0.21

Tonsil 6 12.56* 9 17.29* 5 29.57* 1 12.99 21 1.24 16.88* 7.91

Oropharynx 2 13.85* 2 12.55* 1 18.46 0 0.00 5 0.38 13.03* 1.85

Hypopharynx 8 14.76* 4 6.82* 4 21.01* 7 80.01* 23 1.41 16.36* 8.65

Digestive system 47 1.30 52 1.27 11 0.70 11 1.26 121 101.41 1.19 7.85

Esophagus 1 0.43 2 0.79 1 1.11 0 0.00 4 6.20 0.64 -0.88

Stomach 12 2.95* 10 2.25* 2 1.23 2 2.24 26 11.04 2.36* 5.99

Small intestine 2 4.01 3 5.04* 0 0.00 1 7.48 6 1.46 4.10* 1.82

Colon 21 1.35 21 1.17 2 0.29 4 1.00 48 44.47 1.08 1.41

Rectum, rectosigmoid junction 5 0.81 8 1.14 2 0.78 1 0.73 16 17.07 0.94 -0.43

Anus, anal canal 1 3.44 0 0.00 0 0.00 0 0.00 1 0.84 1.19 0.06

Liver 0 0.00 1 0.62 0 0.00 0 0.00 1 3.94 0.25 -1.18

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.18 0.00 -0.47

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 4.69 1 2.14 0.47 -0.46

Pancreas 5 1.16 4 0.81 3 1.59 2 1.89 14 12.18 1.15 0.73

Respiratory system 39 1.28 89 2.57* 27 2.12* 7 1.04 162 84.55 1.92* 31.02

Nose, nasal cavity, ear 0 0.00 1 3.68 0 0.00 0 0.00 1 0.67 1.50 0.13

Larynx 7 3.03* 10 3.94* 4 4.65* 2 4.85 23 6.11 3.76* 6.76

Lung, bronchus 32 1.15 77 2.42* 23 1.96* 4 0.64 136 77.56 1.75* 23.40

Female breast 7 0.78 16 1.41 5 1.05 2 0.75 30 27.79 1.08 3.01

Female genital system 2 0.47 3 0.59 1 0.49 1 0.92 7 12.48 0.56 -7.45

Cervix uteri 1 1.91 0 0.00 1 4.68 0 0.00 2 1.42 1.40 0.78

Corpus uteri 1 0.47 2 0.77 0 0.00 0 0.00 3 6.30 0.48 -4.48

Ovary 0 0.00 1 0.68 0 0.00 1 2.97 2 3.62 0.55 -2.21

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.30

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.83

Male genital system 31 0.78 44 0.92 12 0.65 8 0.79 95 115.84 0.82 -11.83

Prostate 31 0.79 42 0.89 12 0.66 8 0.80 93 114.82 0.81* -12.39

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.19

Urinary system 15 1.13 20 1.29 7 1.18 1 0.30 43 38.01 1.13 2.00

Urinary bladder 10 1.09 15 1.40 5 1.22 1 0.43 31 26.35 1.18 1.86

Kidney parenchyma 5 1.53 2 0.52 2 1.36 0 0.00 9 9.41 0.96 -0.16

Renal pelvis, other urinary 0 0.00 3 3.27 0 0.00 0 0.00 3 2.26 1.33 0.30

Ureter 0 0.00 1 3.34 0 0.00 0 0.00 1 0.74 1.36 0.11

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.14

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 1.73 0.00 -0.69

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.22

Melanoma of skin 2 0.64 6 1.52 2 1.31 0 0.00 10 9.45 1.06 0.22

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.24

Brain, central nervous system 1 0.66 2 1.12 0 0.00 0 0.00 3 4.30 0.70 -0.52

Thyroid 4 5.92* 2 2.52 0 0.00 0 0.00 6 1.90 3.17* 1.64

Lymphatic, hematopoietic 5 0.43 8 0.59 4 0.76 5 1.68 22 33.32 0.66* -4.53

Hodgkin lymphoma 0 0.00 1 2.47 0 0.00 0 0.00 1 0.98 1.02 0.01

Non-Hodgkin lymphoma 3 0.61 4 0.67 1 0.43 2 1.49 10 14.53 0.69 -1.82

Myeloma 1 0.46 1 0.40 1 1.02 2 3.65 5 6.22 0.80 -0.49

Leukemia 1 0.25 2 0.43 2 1.11 1 0.98 6 11.58 0.52 -2.24

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.12

Chronic lymphocytic 0 0.00 1 0.53 0 0.00 1 2.50 2 4.67 0.43 -1.07

Acute non-lymphocytic 0 0.00 1 0.64 1 1.63 0 0.00 2 3.88 0.52 -0.75

Chronic myeloid 0 0.00 0 0.00 1 4.07 0 0.00 1 1.59 0.63 -0.24

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 18,402 7,034 1,199 382 18,402

Person-years in interval 9,311 10,370 3,572 1,719 24,972

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 7,357 PYR and for male cancers on 17,615 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 67
All subsequent cancers 45 1.35 74 1.78* 25 1.41 13 1.26 157 102.94 1.53* 73.48

All excluding same site 44 1.33 74 1.79* 24 1.36 13 1.27 155 102.17 1.52* 71.81

Buccal cavity, pharynx 12 19.64* 14 18.85* 8 26.37* 4 24.30* 38 1.82 20.86* 49.18

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.17

Tongue 1 7.54 6 37.20* 2 30.28* 0 0.00 9 0.40 22.74* 11.70

Salivary gland 0 0.00 1 12.70 1 30.18 0 0.00 2 0.19 10.26* 2.45

Mouth 4 18.73* 5 19.29* 1 9.36 1 16.65 11 0.64 17.20* 14.08

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.10

Tonsil 3 53.10* 2 30.31* 2 80.08* 0 0.00 7 0.16 44.19* 9.30

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.06

Hypopharynx 3 68.84* 0 0.00 1 48.61 3 318.17* 7 0.13 55.34* 9.34

Digestive system 10 1.20 8 0.78 4 0.90 2 0.73 24 25.75 0.93 -2.38

Esophagus 1 3.89 0 0.00 1 7.71 0 0.00 2 0.77 2.60 1.67

Stomach 1 1.46 0 0.00 0 0.00 0 0.00 1 2.08 0.48 -1.46

Small intestine 1 8.94 0 0.00 0 0.00 0 0.00 1 0.36 2.78 0.87

Colon 5 1.21 3 0.59 1 0.44 2 1.43 11 12.92 0.85 -2.60

Rectum, rectosigmoid junction 1 0.78 5 3.21* 1 1.54 0 0.00 7 3.86 1.81 4.27

Rectum 0 0.00 5 4.91* 1 2.35 0 0.00 6 2.53 2.38 4.72

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.43

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.77

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.77

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.75

Pancreas 1 0.91 0 0.00 0 0.00 0 0.00 1 3.45 0.29 -3.33

Respiratory system 7 1.61 19 3.37* 3 1.21 2 1.38 31 13.91 2.23* 23.23

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.19

Larynx 0 0.00 2 10.99* 0 0.00 1 27.43 3 0.44 6.80* 3.48

Lung, bronchus 7 1.69 16 2.97* 3 1.27 1 0.72 27 13.29 2.03* 18.63

Female breast 7 0.78 16 1.41 5 1.05 2 0.75 30 27.79 1.08 3.01

Female genital system 2 0.47 3 0.59 1 0.49 1 0.92 7 12.48 0.56 -7.45

Cervix uteri 1 1.91 0 0.00 1 4.68 0 0.00 2 1.42 1.40 0.78

Corpus uteri 1 0.47 2 0.77 0 0.00 0 0.00 3 6.30 0.48 -4.48

Ovary 0 0.00 1 0.68 0 0.00 1 2.97 2 3.62 0.55 -2.21

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.30

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.83

Urinary system 2 1.24 7 3.43* 1 1.12 0 0.00 10 5.10 1.96 6.67

Urinary bladder 0 0.00 3 2.49 1 1.89 0 0.00 4 3.02 1.32 1.33

Kidney parenchyma 2 3.88 2 3.02 0 0.00 0 0.00 4 1.64 2.44 3.21

Renal pelvis, other urinary 0 0.00 2 11.55* 0 0.00 0 0.00 2 0.43 4.62 2.13

Ureter 0 0.00 1 19.18 0 0.00 0 0.00 1 0.13 7.66 1.18

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.12

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.56

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.06

Melanoma of skin 1 1.91 1 1.47 0 0.00 0 0.00 2 1.66 1.21 0.46

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.19

Brain, central nervous system 0 0.00 1 2.47 0 0.00 0 0.00 1 0.99 1.01 0.02

Thyroid 1 4.01 1 3.26 0 0.00 0 0.00 2 0.74 2.70 1.71

Lymphatic, hematopoietic 2 0.78 2 0.62 2 1.40 1 1.14 7 8.12 0.86 -1.53

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.29

Non-Hodgkin lymphoma 1 0.85 2 1.32 0 0.00 0 0.00 3 3.77 0.79 -1.05

Myeloma 0 0.00 0 0.00 1 3.65 1 6.06 2 1.56 1.28 0.60

Leukemia 1 1.21 0 0.00 1 2.24 0 0.00 2 2.57 0.78 -0.78

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.10

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.00 0.00 -1.37

Acute non-lymphocytic 0 0.00 0 0.00 1 6.37 0 0.00 1 0.90 1.11 0.13

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.49

Esophagus

Females

Table 4.1.3: Risk of subsequent primary cancers after cancer of the esophagus, females,

SEER 1973-2000.

68 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ESOPHAGUS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,906 1,974 375 129 4,906

Person-years in interval 2,543 3,029 1,184 601 7,357

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Esophagus

Males

Table 4.1.4: Risk of subsequent primary cancers after cancer of the esophagus, males,

SEER 1973-2000.

ESOPHAGUS

All subsequent cancers 152 1.19* 222 1.52* 69 1.28 35 1.20 478 356.80 1.34* 68.81

All excluding same site 152 1.21* 220 1.53* 69 1.29* 35 1.22 476 351.36 1.35* 70.76

Buccal cavity, pharynx 27 6.63* 32 7.26* 13 8.94* 7 9.93* 79 10.64 7.43* 38.81

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 1.63 0.00 -0.93

Tongue 6 7.56* 8 9.12* 4 13.67* 0 0.00 18 2.10 8.56* 9.02

Salivary gland 1 3.46 0 0.00 0 0.00 0 0.00 1 0.81 1.23 0.11

Mouth 8 8.07* 10 9.49* 2 5.89 0 0.00 20 2.54 7.86* 9.91

Nasopharynx 0 0.00 1 5.82 0 0.00 0 0.00 1 0.42 2.40 0.33

Tonsil 3 7.13* 7 15.40* 3 20.82* 1 15.14 14 1.09 12.89* 7.33

Oropharynx 2 15.51* 2 14.27* 1 21.43 0 0.00 5 0.34 14.80* 2.65

Hypopharynx 5 10.03* 4 7.50* 3 17.67* 4 51.25* 16 1.28 12.50* 8.36

Digestive system 37 1.34 44 1.43* 7 0.63 9 1.51 97 75.66 1.28* 12.12

Esophagus 0 0.00 2 0.90 0 0.00 0 0.00 2 5.44 0.37 -1.95

Stomach 11 3.25* 10 2.76* 2 1.57 2 2.98 25 8.96 2.79* 9.11

Small intestine 1 2.58 3 6.64* 0 0.00 1 10.70 5 1.10 4.53* 2.21

Colon 16 1.41 18 1.40 1 0.21 2 0.77 37 31.56 1.17 3.09

Rectum, rectosigmoid junction 4 0.82 3 0.55 1 0.52 1 1.01 9 13.21 0.68 -2.39

Anus, anal canal 1 5.32 0 0.00 0 0.00 0 0.00 1 0.52 1.92 0.27

Liver 0 0.00 1 0.72 0 0.00 0 0.00 1 3.37 0.30 -1.35

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.35

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 6.86 1 1.59 0.63 -0.33

Pancreas 4 1.24 4 1.13 3 2.35 2 2.94 13 8.73 1.49 2.42

Respiratory system 32 1.23 70 2.41* 24 2.34* 5 0.95 131 70.64 1.85* 34.27

Nose, nasal cavity, ear 0 0.00 1 4.66 0 0.00 0 0.00 1 0.53 1.90 0.27

Larynx 7 3.24* 8 3.40* 4 5.09* 1 2.66 20 5.67 3.53* 8.13

Lung, bronchus 25 1.06 61 2.31* 20 2.13* 3 0.62 109 64.27 1.70* 25.39

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.68 0.00 -0.39

Male genital system 31 0.78 44 0.92 12 0.65 8 0.79 95 115.84 0.82 -11.83

Prostate 31 0.79 42 0.89 12 0.66 8 0.80 93 114.82 0.81* -12.39

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.19

Urinary system 13 1.12 13 0.96 6 1.19 1 0.36 33 32.92 1.00 0.05

Urinary bladder 10 1.22 12 1.26 4 1.12 1 0.50 27 23.32 1.16 2.09

Kidney parenchyma 3 1.09 0 0.00 2 1.70 0 0.00 5 7.77 0.64 -1.57

Renal pelvis, other urinary 0 0.00 1 1.34 0 0.00 0 0.00 1 1.83 0.55 -0.47

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.34

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.15

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 1.32 0.00 -0.75

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.51 0.00 -0.29

Melanoma of skin 1 0.38 5 1.53 2 1.62 0 0.00 8 7.79 1.03 0.12

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.26

Brain, central nervous system 1 0.83 1 0.72 0 0.00 0 0.00 2 3.32 0.60 -0.75

Thyroid 3 7.04* 1 2.06 0 0.00 0 0.00 4 1.16 3.46 1.61

Lymphatic, hematopoietic 3 0.33* 6 0.58 2 0.52 4 1.91 15 25.20 0.60* -5.79

Hodgkin lymphoma 0 0.00 1 3.15 0 0.00 0 0.00 1 0.77 1.30 0.13

Non-Hodgkin lymphoma 2 0.53 2 0.45 1 0.60 2 2.16 7 10.76 0.65 -2.13

Myeloma 1 0.59 1 0.53 0 0.00 1 2.62 3 4.66 0.64 -0.94

Leukemia 0 0.00 2 0.55 1 0.74 1 1.35 4 9.01 0.44 -2.84

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.13

Chronic lymphocytic 0 0.00 1 0.67 0 0.00 1 3.39 2 3.66 0.55 -0.94

Acute non-lymphocytic 0 0.00 1 0.82 0 0.00 0 0.00 1 2.98 0.34 -1.12

Chronic myeloid 0 0.00 0 0.00 1 5.43 0 0.00 1 1.23 0.81 -0.13

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 13,496 5,060 824 253 13,496

Person-years in interval 6,768 7,341 2,388 1,118 17,615

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 69
All subsequent cancers 48 2.45* 86 2.99* 37 2.23* 30 1.80* 201 81.65 2.46* 135.95

All excluding same site 48 2.51* 86 3.05* 37 2.26* 30 1.82* 201 80.17 2.51* 137.64

Buccal cavity, pharynx 20 19.40* 19 14.56* 13 21.84* 8 18.28* 60 3.37 17.81* 64.51

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.33

Tongue 4 18.17* 7 24.57* 4 30.70* 0 0.00 15 0.73 20.57* 16.26

Salivary gland 1 18.39 0 0.00 0 0.00 0 0.00 1 0.20 4.95 0.91

Mouth 7 25.11* 6 17.54* 2 13.09* 1 9.31 16 0.88 18.16* 17.22

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.18

Tonsil 3 20.24* 4 22.16* 3 39.46* 1 20.82 11 0.45 24.30* 12.01

Oropharynx 1 28.52 0 0.00 0 0.00 0 0.00 1 0.12 8.54 1.01

Hypopharynx 2 15.87* 2 12.74* 3 41.37* 5 97.42* 12 0.41 29.49* 13.21

Digestive system 6 1.50 13 2.30* 2 0.63 5 1.56 26 16.02 1.62* 11.37

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 1.48 0.00 -1.69

Stomach 3 6.62* 3 4.94 1 3.12 0 0.00 7 1.70 4.12* 6.04

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.35

Colon 1 0.72 7 3.38* 0 0.00 1 0.74 9 6.05 1.49 3.37

Rectum, rectosigmoid junction 1 1.35 1 0.93 0 0.00 1 1.80 3 2.96 1.01 0.05

Anus, anal canal 1 17.98 0 0.00 0 0.00 0 0.00 1 0.20 4.96 0.91

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.82 0.00 -0.93

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.15

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 15.06 1 0.29 3.49 0.81

Pancreas 0 0.00 2 2.92 1 2.60 2 5.10 5 1.95 2.56 3.47

Respiratory system 11 2.55* 36 5.97* 12 3.63* 6 1.91 65 16.78 3.87* 54.93

Nose, nasal cavity, ear 0 0.00 1 18.08 0 0.00 0 0.00 1 0.15 6.79 0.97

Larynx 3 6.49* 4 6.51* 1 3.33 2 8.56 10 1.61 6.21* 9.56

Lung, bronchus 8 2.11 31 5.80* 11 3.70* 3 1.04 53 14.98 3.54* 43.31

Female breast 1 0.69 1 0.51 1 0.88 1 1.09 4 5.46 0.73 -7.39

Female genital system 0 0.00 0 0.00 0 0.00 1 2.58 1 2.48 0.40 -7.45

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -2.02

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 1.24 0.00 -6.28

Ovary 0 0.00 0 0.00 0 0.00 1 8.70 1 0.68 1.47 1.62

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.16

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.37

Male genital system 3 0.96 9 1.54 1 0.24 6 1.22 19 18.09 1.05 1.33

Prostate 3 1.00 8 1.40 1 0.24 6 1.23 18 17.77 1.01 0.35

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.30

Urinary system 2 1.35 4 1.79 5 3.97* 1 0.75 12 6.31 1.90 6.48

Urinary bladder 1 1.18 4 3.04 4 5.18* 1 1.12 10 3.82 2.62* 7.04

Kidney parenchyma 1 1.76 0 0.00 1 2.35 0 0.00 2 2.18 0.92 -0.21

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.35

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.10

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.10

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.42

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.31

Melanoma of skin 0 0.00 0 0.00 1 2.23 0 0.00 1 2.38 0.42 -1.57

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.14

Brain, central nervous system 1 3.39 0 0.00 0 0.00 0 0.00 1 1.05 0.96 -0.05

Thyroid 2 11.08* 0 0.00 0 0.00 0 0.00 2 0.60 3.35 1.60

Lymphatic, hematopoietic 2 1.31 1 0.47 2 1.76 2 1.75 7 5.94 1.18 1.21

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.33

Non-Hodgkin lymphoma 1 1.41 1 0.99 0 0.00 1 1.89 3 2.79 1.08 0.24

Myeloma 0 0.00 0 0.00 1 4.68 1 4.61 2 1.08 1.85 1.04

Leukemia 1 2.25 0 0.00 1 2.92 0 0.00 2 1.78 1.12 0.25

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.08

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.73 0.00 -0.84

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.63

Chronic myeloid 0 0.00 0 0.00 1 21.05 0 0.00 1 0.26 3.87 0.84

Esophagus

Both Sexes, <60 Years of Age

Table 4.1.5: Risk of subsequent primary cancers after cancer of the esophagus, both sexes,

<60 years of age, SEER 1973-2000.

70 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ESOPHAGUS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,581 2,268 453 165 5,581

Person-years in interval 2,959 3,513 1,428 878 8,778

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 1,982 PYR and for male cancers on 6,796 PYR.
Esophagus

Both Sexes, 60-69 Years of Age

Table 4.1.6: Risk of subsequent primary cancers after cancer of the esophagus, both sexes,

60-69 years of age, SEER 1973-2000.

ESOPHAGUS

All subsequent cancers 73 1.35* 112 1.57* 31 1.03 12 0.72 228 172.46 1.32* 63.97

All excluding same site 72 1.35* 111 1.58* 30 1.01 12 0.73 225 169.99 1.32* 63.36

Buccal cavity, pharynx 13 7.33* 20 9.81* 5 7.30* 2 6.24 40 4.82 8.30* 40.52

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -0.72

Tongue 2 5.60 5 12.07* 1 7.05 0 0.00 8 0.98 8.19* 8.09

Salivary gland 0 0.00 1 7.11 1 17.20 0 0.00 2 0.34 5.82 1.91

Mouth 4 8.79* 8 15.58* 0 0.00 0 0.00 12 1.22 9.83* 12.41

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.22

Tonsil 2 10.42* 4 18.94* 2 31.21* 0 0.00 8 0.49 16.29* 8.65

Oropharynx 0 0.00 1 14.37 1 45.60 0 0.00 2 0.16 12.30* 2.12

Hypopharynx 5 21.58* 1 3.88 0 0.00 1 34.24 7 0.60 11.71* 7.37

Digestive system 21 1.88* 18 1.25 3 0.48 4 1.03 46 35.60 1.29 11.97

Esophagus 1 1.13 1 0.97 1 2.66 0 0.00 3 2.47 1.21 0.61

Stomach 5 4.02* 2 1.32 0 0.00 1 2.47 8 3.82 2.09 4.81

Small intestine 2 12.25* 1 4.57 0 0.00 1 17.75 4 0.53 7.48* 3.99

Colon 7 1.56 5 0.84 1 0.37 2 1.09 15 14.98 1.00 0.02

Rectum, rectosigmoid junction 2 0.97 3 1.16 1 0.97 0 0.00 6 6.27 0.96 -0.31

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.36

Liver 0 0.00 1 1.62 0 0.00 0 0.00 1 1.51 0.66 -0.58

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.43

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.70 0.00 -0.80

Pancreas 4 2.93 2 1.14 0 0.00 0 0.00 6 4.34 1.38 1.91

Respiratory system 15 1.30 33 2.30* 11 1.96 0 0.00 59 34.25 1.72* 28.51

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.28

Larynx 4 4.08* 4 3.58 2 5.45 0 0.00 10 2.61 3.84* 8.52

Lung, bronchus 11 1.05 28 2.14* 9 1.73 0 0.00 48 31.32 1.53* 19.21

Female breast 3 1.07 6 1.48 3 1.51 1 0.76 13 10.17 1.28 10.86

Female genital system 1 0.70 1 0.51 0 0.00 0 0.00 2 4.81 0.42 -10.76

Cervix uteri 1 5.80 0 0.00 0 0.00 0 0.00 1 0.52 1.94 1.86

Corpus uteri 0 0.00 1 0.94 0 0.00 0 0.00 1 2.59 0.39 -6.09

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.35 0.00 -5.18

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.28

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.67

Male genital system 10 0.72 17 0.87 5 0.60 1 0.25 33 45.73 0.72 -20.96

Prostate 10 0.72 17 0.88 5 0.60 1 0.26 33 45.41 0.73 -20.43

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.13

Urinary system 4 0.94 9 1.60 1 0.42 0 0.00 14 13.69 1.02 0.36

Urinary bladder 2 0.71 7 1.84 0 0.00 0 0.00 9 9.28 0.97 -0.32

Kidney parenchyma 2 1.71 1 0.66 1 1.65 0 0.00 4 3.60 1.11 0.46

Renal pelvis, other urinary 0 0.00 1 3.02 0 0.00 0 0.00 1 0.81 1.23 0.22

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.31

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.15

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.68

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.12

Melanoma of skin 1 0.96 3 2.10 0 0.00 0 0.00 4 3.39 1.18 0.70

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.25

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 1.66 0.00 -1.91

Thyroid 1 4.16 1 3.33 0 0.00 0 0.00 2 0.71 2.83 1.49

Lymphatic, hematopoietic 1 0.28 2 0.42 1 0.48 2 1.53 6 11.62 0.52 -6.47

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.40

Non-Hodgkin lymphoma 1 0.66 2 0.96 0 0.00 1 1.69 4 5.11 0.78 -1.28

Myeloma 0 0.00 0 0.00 0 0.00 1 4.19 1 2.27 0.44 -1.46

Leukemia 0 0.00 0 0.00 1 1.44 0 0.00 1 3.90 0.26 -3.34

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.12

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.62 0.00 -1.87

Acute non-lymphocytic 0 0.00 0 0.00 1 4.14 0 0.00 1 1.30 0.77 -0.35

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.53 0.00 -0.61

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,030 2,405 417 138 6,030

Person-years in interval 3,132 3,652 1,268 629 8,682

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 2,608 PYR and for male cancers on 6,074 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 71
All subsequent cancers 76 0.88 98 1.12 26 1.04 6 1.00 206 205.63 1.00 0.50

All excluding same site 76 0.89 97 1.12 26 1.05 6 1.01 205 203.37 1.01 2.16

Buccal cavity, pharynx 6 3.19* 7 3.88* 3 6.29* 1 9.00 17 4.27 3.98* 16.94

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.84 0.00 -1.12

Tongue 1 2.86 2 5.89 1 11.56 0 0.00 4 0.79 5.04* 4.27

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.62

Mouth 1 2.12 1 2.19 1 8.08 0 0.00 3 1.08 2.77 2.55

Nasopharynx 0 0.00 1 17.59 0 0.00 0 0.00 1 0.13 7.41 1.15

Tonsil 1 7.28 1 7.75 0 0.00 0 0.00 2 0.30 6.66 2.26

Oropharynx 1 21.40 1 22.28 0 0.00 0 0.00 2 0.10 19.22* 2.52

Hypopharynx 1 5.43 1 5.82 1 25.95 1 143.73* 4 0.40 9.96* 4.79

Digestive system 20 0.96 21 1.00 6 0.96 2 1.24 49 49.78 0.98 -1.04

Esophagus 0 0.00 1 1.05 0 0.00 0 0.00 1 2.25 0.44 -1.67

Stomach 4 1.68 5 2.16 1 1.53 1 5.89 11 5.52 1.99 7.30

Small intestine 0 0.00 2 7.52 0 0.00 0 0.00 2 0.62 3.21 1.83

Colon 13 1.35 9 0.91 1 0.33 1 1.23 24 23.45 1.02 0.74

Rectum, rectosigmoid junction 2 0.60 4 1.20 1 1.07 0 0.00 7 7.84 0.89 -1.11

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.44

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 1.62 0.00 -2.15

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.68 0.00 -0.91

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.16 0.00 -1.54

Pancreas 1 0.41 0 0.00 2 2.70 0 0.00 3 5.89 0.51 -3.84

Respiratory system 13 0.89 20 1.40 4 1.05 1 1.19 38 33.52 1.13 5.96

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.38

Larynx 0 0.00 2 2.48 1 5.19 0 0.00 3 1.90 1.58 1.47

Lung, bronchus 13 0.96 18 1.35 3 0.84 1 1.27 35 31.26 1.12 4.98

Female breast 3 0.63 9 1.69 1 0.61 0 0.00 13 12.16 1.07 3.05

Female genital system 1 0.48 2 0.88 1 1.49 0 0.00 4 5.20 0.77 -4.33

Cervix uteri 0 0.00 0 0.00 1 16.06 0 0.00 1 0.51 1.97 1.78

Corpus uteri 1 0.99 1 0.92 0 0.00 0 0.00 2 2.47 0.81 -1.69

Ovary 0 0.00 1 1.44 0 0.00 0 0.00 1 1.59 0.63 -2.14

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.41

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -1.32

Male genital system 18 0.80 18 0.81 6 1.02 1 0.79 43 52.02 0.83 -19.01

Prostate 18 0.80 17 0.77 6 1.03 1 0.80 42 51.64 0.81 -20.32

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.10

Urinary system 9 1.20 7 0.91 1 0.44 0 0.00 17 18.01 0.94 -1.35

Urinary bladder 7 1.27 4 0.71 1 0.59 0 0.00 12 13.25 0.91 -1.66

Kidney parenchyma 2 1.31 1 0.64 0 0.00 0 0.00 3 3.63 0.83 -0.83

Renal pelvis, other urinary 0 0.00 2 4.15 0 0.00 0 0.00 2 1.14 1.75 1.14

Ureter 0 0.00 1 6.17 0 0.00 0 0.00 1 0.38 2.61 0.82

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.19

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.77 0.00 -1.02

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.23

Melanoma of skin 1 0.68 3 1.88 1 2.03 0 0.00 5 3.68 1.36 1.75

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.34

Brain, central nervous system 0 0.00 2 2.90 0 0.00 0 0.00 2 1.60 1.25 0.54

Thyroid 1 3.93 1 3.91 0 0.00 0 0.00 2 0.59 3.38 1.87

Lymphatic, hematopoietic 2 0.31 5 0.75 1 0.49 1 1.91 9 15.76 0.57 -9.00

Hodgkin lymphoma 0 0.00 1 6.74 0 0.00 0 0.00 1 0.35 2.86 0.87

Non-Hodgkin lymphoma 1 0.37 1 0.35 1 1.14 0 0.00 3 6.64 0.45 -4.84

Myeloma 1 0.83 1 0.82 0 0.00 0 0.00 2 2.87 0.70 -1.16

Leukemia 0 0.00 2 0.80 0 0.00 1 4.98 3 5.90 0.51 -3.86

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.18

Chronic lymphocytic 0 0.00 1 1.03 0 0.00 1 13.04 2 2.31 0.86 -0.42

Acute non-lymphocytic 0 0.00 1 1.17 0 0.00 0 0.00 1 2.02 0.49 -1.36

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.80 0.00 -1.07

Esophagus

Both Sexes, ≥70 Years of Age

Table 4.1.7: Risk of subsequent primary cancers after cancer of the esophagus, both sexes,

≥70 years of age, SEER 1973-2000.

72 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ESOPHAGUS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,791 2,361 329 79 6,791

Person-years in interval 3,220 3,205 875 212 7,511

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 2,767 PYR and for male cancers on 4,744 PYR.
Esophagus

Squamous Cell Carcinoma, Both Sexes

Table 4.1.8: Risk of subsequent primary cancers after squamous cell carcinoma of the esophagus,

both sexes, SEER 1973-2000.

ESOPHAGUS

All subsequent cancers 149 1.45* 222 1.87* 72 1.49* 43 1.54* 486 297.71 1.63* 114.53

All excluding same site 148 1.46* 221 1.89* 71 1.49* 43 1.55* 483 293.53 1.65* 115.24

Buccal cavity, pharynx 37 12.04* 43 13.22* 21 18.04* 11 18.10* 112 8.10 13.83* 63.20

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 1.03 0.00 -0.63

Tongue 7 11.66* 13 20.09* 6 25.38* 0 0.00 26 1.61 16.18* 14.84

Salivary gland 0 0.00 1 4.06 1 9.84 0 0.00 2 0.63 3.20 0.84

Mouth 12 14.71* 13 15.11* 3 9.78* 1 6.34 29 2.14 13.55* 16.34

Nasopharynx 0 0.00 1 7.39 0 0.00 0 0.00 1 0.34 2.97 0.40

Tonsil 6 18.79* 9 27.13* 5 44.31* 1 18.27 21 0.82 25.65* 12.28

Oropharynx 2 20.50* 2 19.44* 1 27.22 0 0.00 5 0.26 19.58* 2.89

Hypopharynx 8 21.46* 4 10.40* 4 30.91* 7 112.28* 23 0.95 24.23* 13.41

Digestive system 29 1.21 31 1.15 9 0.84 10 1.59 79 67.94 1.16 6.73

Esophagus 1 0.63 1 0.60 1 1.64 0 0.00 3 4.18 0.72 -0.72

Stomach 8 2.81* 8 2.65* 2 1.76 2 3.06 20 7.65 2.61* 7.51

Small intestine 1 3.10 3 7.90* 0 0.00 1 10.27 5 0.96 5.20* 2.46

Colon 13 1.27 8 0.68 1 0.21 4 1.38 26 29.75 0.87 -2.28

Rectum, rectosigmoid junction 3 0.75 6 1.35 2 1.17 0 0.00 11 11.10 0.99 -0.06

Anus, anal canal 1 5.21 0 0.00 0 0.00 0 0.00 1 0.56 1.78 0.27

Liver 0 0.00 1 0.97 0 0.00 0 0.00 1 2.61 0.38 -0.98

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.86 0.00 -0.52

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 6.56 1 1.37 0.73 -0.23

Pancreas 2 0.68 2 0.61 2 1.52 2 2.58 8 8.30 0.96 -0.18

Respiratory system 31 1.56* 71 3.23* 21 2.46* 6 1.26 129 55.20 2.34* 44.89

Nose, nasal cavity, ear 0 0.00 1 5.82 0 0.00 0 0.00 1 0.44 2.30 0.34

Larynx 5 3.31* 9 5.67* 3 5.30* 1 3.50 18 3.95 4.56* 8.55

Lung, bronchus 26 1.43 60 2.97* 18 2.28* 4 0.90 108 50.68 2.13* 34.86

Female breast 6 0.84 12 1.31 4 1.00 2 0.89 24 22.54 1.06 2.42

Female genital system 1 0.30 2 0.48 1 0.58 1 1.08 5 10.20 0.49 -8.62

Cervix uteri 1 2.26 0 0.00 1 5.57 0 0.00 2 1.20 1.66 1.32

Corpus uteri 0 0.00 1 0.48 0 0.00 0 0.00 1 5.13 0.19 -6.85

Ovary 0 0.00 1 0.84 0 0.00 1 3.50 2 2.94 0.68 -1.56

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.30

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -0.82

Male genital system 24 1.03 28 1.03 7 0.61 6 0.89 65 68.78 0.95 -3.63

Prostate 24 1.04 26 0.96 7 0.61 6 0.89 63 68.19 0.92 -4.98

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.16

Urinary system 8 1.02 15 1.66 3 0.82 0 0.00 26 22.81 1.14 1.94

Urinary bladder 5 0.93 11 1.79 3 1.20 0 0.00 19 15.53 1.22 2.11

Kidney parenchyma 3 1.50 1 0.43 0 0.00 0 0.00 4 5.84 0.68 -1.12

Renal pelvis, other urinary 0 0.00 3 5.28* 0 0.00 0 0.00 3 1.44 2.09 0.95

Ureter 0 0.00 1 5.53 0 0.00 0 0.00 1 0.46 2.19 0.33

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.14

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 1.10 0.00 -0.67

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.20

Melanoma of skin 2 1.26 3 1.49 0 0.00 0 0.00 5 5.05 0.99 -0.03

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.22

Brain, central nervous system 1 1.08 2 1.88 0 0.00 0 0.00 3 2.65 1.13 0.22

Thyroid 4 9.11* 2 3.91 0 0.00 0 0.00 6 1.25 4.79* 2.89

Lymphatic, hematopoietic 4 0.55 5 0.60 3 0.86 5 2.39 17 21.20 0.80 -2.56

Hodgkin lymphoma 0 0.00 1 4.01 0 0.00 0 0.00 1 0.62 1.60 0.23

Non-Hodgkin lymphoma 2 0.67 2 0.56 1 0.66 2 2.12 7 8.98 0.78 -1.20

Myeloma 1 0.67 1 0.60 1 1.46 2 5.02 5 4.24 1.18 0.46

Leukemia 1 0.39 1 0.34 1 0.85 1 1.41 4 7.36 0.54 -2.04

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.12

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 1 3.61 1 2.95 0.34 -1.19

Acute non-lymphocytic 0 0.00 1 1.03 0 0.00 0 0.00 1 2.47 0.41 -0.89

Chronic myeloid 0 0.00 0 0.00 1 6.18 0 0.00 1 1.02 0.98 -0.01

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 12,221 4,513 791 269 12,221

Person-years in interval 6,100 6,648 2,445 1,248 16,441

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 6,029 PYR and for male cancers on 10,412 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 73
All subsequent cancers 43 0.80 64 0.99 19 0.89 5 0.48 131 149.89 0.87 -24.39

All excluding same site 43 0.81 64 1.00 19 0.90 5 0.48 131 148.01 0.89 -21.96

Buccal cavity, pharynx 2 1.33 2 1.13 0 0.00 0 0.00 4 4.05 0.99 -0.06

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.68 0.00 -0.88

Tongue 0 0.00 1 2.74 0 0.00 0 0.00 1 0.83 1.21 0.22

Salivary gland 1 7.77 0 0.00 0 0.00 0 0.00 1 0.36 2.79 0.83

Mouth 0 0.00 1 2.40 0 0.00 0 0.00 1 0.96 1.04 0.05

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.18

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.51

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.15

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.55

Digestive system 18 1.62 16 1.22 2 0.46 1 0.46 37 30.71 1.20 8.12

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 1.88 0.00 -2.43

Stomach 4 3.55 2 1.53 0 0.00 0 0.00 6 3.09 1.94 3.75

Small intestine 1 6.10 0 0.00 0 0.00 0 0.00 1 0.46 2.16 0.69

Colon 8 1.65 11 1.93 1 0.52 0 0.00 20 13.47 1.48 8.42

Rectum, rectosigmoid junction 2 0.99 1 0.42 0 0.00 1 2.75 4 5.50 0.73 -1.94

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.32

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 1.24 0.00 -1.60

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.37

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.71 0.00 -0.92

Pancreas 3 2.34 1 0.66 1 2.00 0 0.00 5 3.54 1.41 1.88

Respiratory system 7 0.71 16 1.35 5 1.31 1 0.55 29 27.25 1.06 2.25

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.28

Larynx 2 2.68 0 0.00 1 3.70 1 8.33 4 2.02 1.98 2.55

Lung, bronchus 5 0.56 16 1.48 4 1.14 0 0.00 25 24.95 1.00 0.06

Female breast 1 0.65 4 2.38 0 0.00 0 0.00 5 3.91 1.28 11.43

Female genital system 1 1.53 1 1.42 0 0.00 0 0.00 2 1.64 1.22 3.77

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -1.50

Corpus uteri 1 3.00 1 2.73 0 0.00 0 0.00 2 0.84 2.39 12.22

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -5.29

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.29

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.97

Male genital system 4 0.26* 15 0.77 5 0.76 2 0.61 26 44.79 0.58* -27.65

Prostate 4 0.26* 15 0.78 5 0.77 2 0.62 26 44.38 0.59* -27.04

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.23

Urinary system 6 1.18 5 0.82 3 1.45 1 0.96 15 14.30 1.05 0.90

Urinary bladder 4 1.11 4 0.92 1 0.67 1 1.31 10 10.20 0.98 -0.26

Kidney parenchyma 2 1.68 1 0.69 2 4.28 0 0.00 5 3.33 1.50 2.16

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.77 0.00 -0.99

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.34

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.16

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.75

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.27

Melanoma of skin 0 0.00 3 1.64 2 3.37 0 0.00 5 4.17 1.20 1.07

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.29

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 1.54 0.00 -1.99

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.75

Lymphatic, hematopoietic 1 0.25 2 0.42 1 0.62 0 0.00 4 11.22 0.36* -9.32

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.43

Non-Hodgkin lymphoma 1 0.55 1 0.45 0 0.00 0 0.00 2 5.16 0.39 -4.08

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.81 0.00 -2.34

Leukemia 0 0.00 1 0.60 1 1.79 0 0.00 2 3.92 0.51 -2.47

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.13

Chronic lymphocytic 0 0.00 1 1.48 0 0.00 0 0.00 1 1.59 0.63 -0.76

Acute non-lymphocytic 0 0.00 0 0.00 1 5.24 0 0.00 1 1.31 0.76 -0.40

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.53 0.00 -0.68

Esophagus

Adenocarcinoma, Both Sexes

Table 4.1.9: Risk of subsequent primary cancers after adenocarcinoma of the esophagus,

both sexes, SEER 1973-2000.

74 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ESOPHAGUS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,636 2,330 356 99 5,636

Person-years in interval 2,964 3,400 976 407 7,748

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 952 PYR and for male cancers on 6,796 PYR.
STOMACH

Stomach

Both Sexes

Table 4.2.1: Characteristics of patients with an initial cancer of the stomach, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 24,914 100.0 15,084 100.0 39,998 100.0

Initial treatment

Any radiation 4,809 19.3 1,765 11.7 6,574 16.4

With surgery 2,381 9.6 882 5.8 3,263 8.2

Without surgery 2,428 9.7 883 5.9 3,311 8.3

No radiation 20,105 80.7 13,319 88.3 33,424 83.6

With surgery 12,880 51.7 8,108 53.8 20,988 52.5

Without surgery 7,225 29.0 5,211 34.5 12,436 31.1

Race

White 18,783 75.4 11,151 73.9 29,934 74.8

Black 2,866 11.5 1,752 11.6 4,618 11.5

Other 3,225 12.9 2,154 14.3 5,379 13.4

Unknown 40 0.2 27 0.2 67 0.2

Age at 1st primary cancer diagnosis, years

< 30 125 0.5 108 0.7 233 0.6

30–49 2,328 9.3 1,379 9.1 3,707 9.3

50–69 11,683 46.9 5,084 33.7 16,767 41.9

70–79 7,213 29.0 4,518 30.0 11,731 29.3

> 80 3,565 14.3 3,995 26.5 7,560 18.9

Number of patients with one or more

primary cancers

One primary cancer only 23,890 95.9 14,629 97.0 38,519 96.3

1st and 2nd cancers 942 3.8 416 2.8 1,358 3.4

1st, 2nd, and 3rd cancers 73 0.3 39 0.3 112 0.3

1st, 2nd, 3rd, and additional cancers 9 0.0 0 0.0 9 0.0

Other statistics

Median age at 1st cancer diagnosis 67.8 — 72.3 — 69.4 —

Median year of 1st cancer diagnosis 1987.0 — 1986.9 — 1987.0 —

Median person-years at risk 0.7 — 0.8 — 0.8 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 93.4 — 93.8 — 93.5

1st, 2nd, and additional cancers — 92.8 — 93.8 — 93.1

1st cancer only — 6.2 — 4.6 — 5.7

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 75

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 259 0.69* 657 0.96 376 0.96 317 1.00 1,609 1,770.56 0.91* -17.03

All excluding same site 256 0.70* 646 0.97 369 0.98 308 1.00 1,579 1,718.52 0.92* -14.70

Buccal cavity, pharynx 11 1.09 11 0.63 6 0.67 7 1.04 35 43.17 0.81 -0.86

Lip 0 0.00 0 0.00 0 0.00 1 1.03 1 6.44 0.16* -0.57

Tongue 3 1.56 1 0.30 1 0.57 2 1.48 7 8.38 0.84 -0.15

Salivary gland 0 0.00 1 0.67 0 0.00 1 1.39 2 3.90 0.51 -0.20

Mouth 5 1.90 2 0.44 2 0.85 1 0.58 10 11.25 0.89 -0.13

Nasopharynx 1 1.98 1 1.11 1 2.17 1 3.01 4 2.20 1.82 0.19

Tonsil 1 1.11 4 2.63 0 0.00 0 0.00 5 3.73 1.34 0.13

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.18 0.00 -0.12

Hypopharynx 0 0.00 1 0.54 1 1.07 1 1.48 3 4.55 0.66 -0.16

Digestive system 60 0.65* 194 1.15 99 1.03 76 1.00 429 432.88 0.99 -0.41

Esophagus 4 0.87 11 1.34 7 1.58 5 1.40 27 20.78 1.30 0.66

Stomach 3 0.26* 11 0.54* 7 0.61 9 1.02 30 52.04 0.58* -2.32

Small intestine 9 8.09* 5 2.44 1 0.83 2 1.93 17 5.41 3.14* 1.22

Colon 25 0.61* 78 1.05 44 1.02 37 1.08 184 193.06 0.95 -0.95

Rectum, rectosigmoid junction 10 0.64 39 1.41* 13 0.86 17 1.48 79 69.65 1.13 0.99

Anus, anal canal 0 0.00 1 0.79 2 2.77 0 0.00 3 3.23 0.93 -0.02

Liver 2 0.57 4 0.61 3 0.80 2 0.64 11 16.98 0.65 -0.63

Gallbladder 0 0.00 1 0.40 1 0.71 0 0.00 2 6.31 0.32 -0.45

Bile ducts, other biliary 2 1.00 7 1.84 1 0.43 1 0.50 11 10.11 1.09 0.09

Pancreas 5 0.45 37 1.85* 20 1.75* 3 0.33* 65 51.47 1.26 1.43

Respiratory system 31 0.47* 115 0.98 61 0.95 74 1.43* 281 300.00 0.94 -2.00

Nose, nasal cavity, ear 0 0.00 2 1.90 0 0.00 0 0.00 2 2.68 0.75 -0.07

Larynx 4 0.88 5 0.65 6 1.53 7 2.38 22 19.13 1.15 0.30

Lung, bronchus 27 0.44* 108 0.99 54 0.90 67 1.39* 256 277.42 0.92 -2.26

Female breast 24 0.86 55 1.02 35 1.08 13 0.53* 127 139.04 0.91 -3.05

Female genital system 6 0.46* 25 1.01 12 0.85 1 0.10* 44 62.05 0.71* -4.58

Cervix uteri 1 0.57 1 0.32 2 1.21 0 0.00 4 7.63 0.52 -0.92

Corpus uteri 4 0.63 10 0.84 3 0.45 0 0.00* 17 29.86 0.57* -3.26

Ovary 1 0.27 9 1.26 4 0.95 1 0.32 15 18.21 0.82 -0.81

Vagina 0 0.00 1 2.08 1 3.54 0 0.00 2 1.21 1.65 0.20

Vulva 0 0.00 4 3.03 1 1.19 0 0.00 5 3.49 1.43 0.38

Male genital system 59 0.72* 124 0.84* 73 0.85 73 0.97 329 390.54 0.84* -11.09

Prostate 59 0.73* 122 0.83* 73 0.86 73 0.98 327 386.99 0.84* -10.81

Testis 0 0.00 1 2.49 0 0.00 0 0.00 1 0.95 1.06 0.01

Urinary system 30 0.99 59 1.09 33 1.08 30 1.17 152 140.79 1.08 1.18

Urinary bladder 15 0.70 38 1.00 27 1.26 22 1.21 102 98.94 1.03 0.32

Kidney parenchyma 14 2.01* 15 1.19 4 0.56 6 1.01 39 32.63 1.20 0.67

Renal pelvis, other urinary 1 0.49 6 1.66 2 1.00 2 1.26 11 9.23 1.19 0.19

Ureter 1 1.48 3 2.46 0 0.00 1 1.92 5 3.09 1.62 0.20

Bone, joints 0 0.00 1 1.87 0 0.00 1 4.71 2 1.33 1.50 0.07

Soft tissue including heart 2 1.38 2 0.76 5 3.35* 2 1.59 11 6.83 1.61 0.44

Kaposi sarcoma 0 0.00 1 1.34 0 0.00 0 0.00 1 1.89 0.53 -0.09

Melanoma of skin 5 0.78 8 0.69 6 0.89 5 0.82 24 30.85 0.78 -0.72

Eye, orbit 0 0.00 0 0.00 2 4.41 0 0.00 2 2.14 0.93 -0.02

Brain, central nervous system 1 0.30 7 1.17 3 0.93 3 1.18 14 15.11 0.93 -0.12

Thyroid 9 4.99* 2 0.61 4 2.25 0 0.00 15 8.22 1.83* 0.71

Lymphatic, hematopoietic 17 0.61* 47 0.93 26 0.89 22 0.91 112 131.61 0.85 -2.07

Hodgkin lymphoma 0 0.00 1 0.70 1 1.38 0 0.00 2 3.54 0.57 -0.16

Non-Hodgkin lymphoma 8 0.69 21 0.97 11 0.86 7 0.64 47 57.00 0.82 -1.05

Myeloma 5 0.98 10 1.07 1 0.19 5 1.15 21 24.17 0.87 -0.33

Leukemia 4 0.39 15 0.83 13 1.26 10 1.20 42 46.90 0.90 -0.52

Acute lymphocytic 0 0.00 1 2.07 0 0.00 0 0.00 1 1.23 0.81 -0.02

Chronic lymphocytic 1 0.25 7 1.00 1 0.26 5 1.60 14 17.99 0.78 -0.42

Acute non-lymphocytic 1 0.29 4 0.64 7 1.95 3 1.02 15 16.26 0.92 -0.13

Chronic myeloid 2 1.44 2 0.80 3 2.11 2 1.70 9 6.48 1.39 0.27

Stomach

Both Sexes

Table 4.2.2: Risk of subsequent primary cancers after cancer of the stomach, both sexes,

SEER 1973-2000.

76 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

STOMACH

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 39,998 19,462 5,722 2,698 39,998

Person-years in interval 22,066 38,430 19,888 14,508 94,892

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 39,417 PYR and for male cancers on 55,476 PYR.
Stomach

Females

Table 4.2.3: Risk of subsequent primary cancers after cancer of the stomach, females,

SEER 1973-2000.

STOMACH

All subsequent cancers 78 0.73* 218 1.04 125 0.98 73 0.76* 494 541.73 0.91* -12.11

All excluding same site 77 0.74* 213 1.04 122 0.98 72 0.77* 484 527.17 0.92 -10.95

Buccal cavity, pharynx 4 2.13 3 0.83 1 0.47 1 0.64 9 9.22 0.98 -0.06

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.67 0.00 -0.17

Tongue 1 2.46 0 0.00 0 0.00 1 2.85 2 2.03 0.99 -0.01

Salivary gland 0 0.00 1 2.46 0 0.00 0 0.00 1 1.04 0.96 -0.01

Mouth 3 4.53 1 0.78 1 1.32 0 0.00 5 3.25 1.54 0.44

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -0.12

Tonsil 0 0.00 1 3.50 0 0.00 0 0.00 1 0.70 1.44 0.08

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.53 0.00 -0.14

Digestive system 19 0.64* 64 1.10 43 1.20 21 0.79 147 149.99 0.98 -0.76

Esophagus 2 2.68 2 1.38 1 1.14 2 3.01 7 3.74 1.87 0.83

Stomach 1 0.34 5 0.88 3 0.86 1 0.40 10 14.56 0.69 -1.16

Small intestine 4 11.47* 0 0.00 0 0.00 1 2.75 5 1.86 2.70 0.80

Colon 7 0.48* 35 1.22 23 1.30 13 0.99 78 74.10 1.05 0.99

Rectum, rectosigmoid junction 3 0.67 13 1.53 6 1.20 1 0.28 23 21.53 1.07 0.37

Rectum 2 0.69 8 1.43 3 0.90 0 0.00 13 14.21 0.91 -0.31

Anus, anal canal 0 0.00 0 0.00 2 5.24 0 0.00 2 1.61 1.24 0.10

Liver 0 0.00 0 0.00 1 1.06 0 0.00 1 3.90 0.26 -0.74

Gallbladder 0 0.00 1 0.70 1 1.20 0 0.00 2 3.58 0.56 -0.40

Bile ducts, other biliary 0 0.00 0 0.00 1 1.11 1 1.42 2 3.65 0.55 -0.42

Pancreas 2 0.52 8 1.06 5 1.06 2 0.56 17 19.72 0.86 -0.69

Respiratory system 4 0.32* 29 1.15 13 0.83 18 1.42 64 66.15 0.97 -0.55

Nose, nasal cavity, ear 0 0.00 1 3.21 0 0.00 0 0.00 1 0.81 1.24 0.05

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.86 0.00 -0.47

Lung, bronchus 4 0.34* 28 1.16 13 0.87 18 1.47 63 63.30 1.00 -0.08

Female breast 24 0.86 55 1.02 35 1.08 13 0.53* 127 139.04 0.91 -3.05

Female genital system 6 0.46* 25 1.01 12 0.85 1 0.10* 44 62.05 0.71* -4.58

Cervix uteri 1 0.57 1 0.32 2 1.21 0 0.00 4 7.63 0.52 -0.92

Corpus uteri 4 0.63 10 0.84 3 0.45 0 0.00* 17 29.86 0.57* -3.26

Ovary 1 0.27 9 1.26 4 0.95 1 0.32 15 18.21 0.82 -0.81

Vagina 0 0.00 1 2.08 1 3.54 0 0.00 2 1.21 1.65 0.20

Vulva 0 0.00 4 3.03 1 1.19 0 0.00 5 3.49 1.43 0.38

Urinary system 5 0.94 8 0.77 8 1.24 6 1.21 27 27.22 0.99 -0.06

Urinary bladder 3 0.92 5 0.78 7 1.77 2 0.66 17 16.63 1.02 0.09

Kidney parenchyma 1 0.64 2 0.64 0 0.00 3 1.95 6 8.16 0.74 -0.55

Renal pelvis, other urinary 1 2.06 1 1.05 1 1.74 1 2.38 4 2.43 1.65 0.40

Ureter 1 6.41 0 0.00 0 0.00 0 0.00 1 0.80 1.26 0.05

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.12

Soft tissue including heart 1 2.31 1 1.17 1 1.90 0 0.00 3 2.22 1.35 0.20

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.07

Melanoma of skin 0 0.00 4 1.28 2 1.03 2 1.28 8 8.19 0.98 -0.05

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.69 0.00 -0.17

Brain, central nervous system 1 1.04 6 3.20* 1 0.90 2 2.40 10 4.78 2.09* 1.32

Thyroid 4 4.50* 1 0.58 2 2.03 0 0.00 7 4.32 1.62 0.68

Lymphatic, hematopoietic 10 1.17 20 1.19 6 0.57 6 0.75 42 43.94 0.96 -0.49

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.09 0.00 -0.28

Non-Hodgkin lymphoma 6 1.57 11 1.43 3 0.62 3 0.78 23 20.22 1.14 0.71

Myeloma 1 0.61 3 0.94 1 0.51 1 0.68 6 8.22 0.73 -0.56

Leukemia 3 1.04 6 1.08 2 0.58 2 0.78 13 14.41 0.90 -0.36

Acute lymphocytic 0 0.00 1 6.35 0 0.00 0 0.00 1 0.41 2.45 0.15

Chronic lymphocytic 1 0.92 2 0.96 0 0.00 2 2.13 5 5.37 0.93 -0.09

Acute non-lymphocytic 1 0.99 1 0.50 0 0.00 0 0.00 2 5.16 0.39 -0.80

Chronic myeloid 1 2.51 1 1.30 1 2.09 0 0.00 3 2.01 1.49 0.25

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 15,084 7,533 2,505 1,193 15,084

Person-years in interval 8,374 15,864 8,913 6,266 39,417

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 77
All subsequent cancers 181 0.67* 439 0.92 251 0.96 244 1.10 1,115 1,228.83 0.91* -20.52

All excluding same site 179 0.68* 433 0.94 247 0.97 236 1.10 1,095 1,191.35 0.92* -17.37

Buccal cavity, pharynx 7 0.85 8 0.58 5 0.73 6 1.15 26 33.96 0.77 -1.43

Lip 0 0.00 0 0.00 0 0.00 1 1.18 1 5.77 0.17* -0.86

Tongue 2 1.32 1 0.39 1 0.78 1 1.00 5 6.35 0.79 -0.24

Salivary gland 0 0.00 0 0.00 0 0.00 1 1.86 1 2.86 0.35 -0.33

Mouth 2 1.02 1 0.31 1 0.63 1 0.85 5 8.00 0.63 -0.54

Nasopharynx 1 2.45 1 1.41 1 2.88 1 4.00 4 1.71 2.34 0.41

Tonsil 1 1.34 3 2.43 0 0.00 0 0.00 4 3.03 1.32 0.17

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.96 0.00 -0.17

Hypopharynx 0 0.00 1 0.61 1 1.23 1 1.69 3 4.01 0.75 -0.18

Digestive system 41 0.65* 130 1.18 56 0.93 55 1.12 282 282.89 1.00 -0.16

Esophagus 2 0.52 9 1.34 6 1.69 3 1.04 20 17.04 1.17 0.53

Stomach 2 0.24* 6 0.41* 4 0.50 8 1.26 20 37.48 0.53* -3.15

Small intestine 5 6.54* 5 3.68* 1 1.32 1 1.49 12 3.55 3.38* 1.52

Colon 18 0.69 43 0.94 21 0.82 24 1.13 106 118.96 0.89 -2.34

Rectum, rectosigmoid junction 7 0.63 26 1.36 7 0.70 16 2.02* 56 48.12 1.16 1.42

Anus, anal canal 0 0.00 1 1.58 0 0.00 0 0.00 1 1.62 0.62 -0.11

Liver 2 0.72 4 0.78 2 0.71 2 0.85 10 13.08 0.76 -0.56

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 2.73 0.00 -0.49

Bile ducts, other biliary 2 1.51 7 2.87* 0 0.00 0 0.00 9 6.46 1.39 0.46

Pancreas 3 0.42 29 2.34* 15 2.24* 1 0.18 48 31.75 1.51* 2.93

Respiratory system 27 0.50* 86 0.93 48 0.98 56 1.43* 217 233.85 0.93 -3.04

Nose, nasal cavity, ear 0 0.00 1 1.35 0 0.00 0 0.00 1 1.87 0.54 -0.16

Larynx 4 0.96 5 0.72 6 1.72 7 2.67* 22 17.27 1.27 0.85

Lung, bronchus 23 0.47* 80 0.95 41 0.91 49 1.36* 193 214.13 0.90 -3.81

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 2.27 0.00 -0.41

Male genital system 59 0.72* 124 0.84* 73 0.85 73 0.97 329 390.54 0.84* -11.09

Prostate 59 0.73* 122 0.83* 73 0.86 73 0.98 327 386.99 0.84* -10.81

Testis 0 0.00 1 2.49 0 0.00 0 0.00 1 0.95 1.06 0.01

Urinary system 25 1.00 51 1.17 25 1.04 24 1.16 125 113.57 1.10 2.06

Urinary bladder 12 0.66 33 1.05 20 1.14 20 1.32 85 82.30 1.03 0.49

Kidney parenchyma 13 2.40* 13 1.37 4 0.77 3 0.68 33 24.47 1.35 1.54

Renal pelvis, other urinary 0 0.00 5 1.87 1 0.70 1 0.86 7 6.80 1.03 0.04

Ureter 0 0.00 3 3.31 0 0.00 1 2.60 4 2.29 1.74 0.31

Bone, joints 0 0.00 1 2.83 0 0.00 1 7.24 2 0.88 2.28 0.20

Soft tissue including heart 1 0.99 1 0.56 4 4.14* 2 2.34 8 4.61 1.74 0.61

Kaposi sarcoma 0 0.00 1 1.56 0 0.00 0 0.00 1 1.61 0.62 -0.11

Melanoma of skin 5 1.03 4 0.47 4 0.84 3 0.66 16 22.66 0.71 -1.20

Eye, orbit 0 0.00 0 0.00 2 6.67 0 0.00 2 1.46 1.37 0.10

Brain, central nervous system 0 0.00 1 0.24 2 0.94 1 0.58 4 10.33 0.39* -1.14

Thyroid 5 5.47* 1 0.64 2 2.53 0 0.00 8 3.89 2.05 0.74

Lymphatic, hematopoietic 7 0.36* 27 0.80 20 1.07 16 1.00 70 87.66 0.80 -3.18

Hodgkin lymphoma 0 0.00 1 1.00 1 2.09 0 0.00 2 2.44 0.82 -0.08

Non-Hodgkin lymphoma 2 0.25* 10 0.71 8 1.01 4 0.57 24 36.78 0.65* -2.30

Myeloma 4 1.15 7 1.14 0 0.00 4 1.38 15 15.95 0.94 -0.17

Leukemia 1 0.14* 9 0.72 11 1.60 8 1.39 29 32.49 0.89 -0.63

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -0.15

Chronic lymphocytic 0 0.00 5 1.02 1 0.38 3 1.37 9 12.62 0.71 -0.65

Acute non-lymphocytic 0 0.00 3 0.70 7 2.95* 3 1.49 13 11.10 1.17 0.34

Chronic myeloid 1 1.01 1 0.58 2 2.12 2 2.45 6 4.47 1.34 0.28

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 24,914 11,929 3,217 1,505 24,914

Person-years in interval 13,692 22,566 10,976 8,242 55,476

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Stomach

Males

Table 4.2.4: Risk of subsequent primary cancers after cancer of the stomach, males,

SEER 1973-2000.

78 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

STOMACH

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Stomach

Both Sexes, <50 Years of Age

Table 4.2.5: Risk of subsequent primary cancers after cancer of the stomach, both sexes,

<50 years of age, SEER 1973-2000.

STOMACH

All subsequent cancers 8 1.49 23 1.78* 14 1.17 42 1.50* 87 58.16 1.50* 23.55

All excluding same site 7 1.33 23 1.82* 13 1.11 40 1.46* 83 56.98 1.46* 21.24

Buccal cavity, pharynx 1 3.92 0 0.00 0 0.00 1 1.13 2 2.26 0.88 -0.21

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.14

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.39

Salivary gland 0 0.00 0 0.00 0 0.00 1 15.23 1 0.17 5.96 0.68

Mouth 1 16.29 0 0.00 0 0.00 0 0.00 1 0.56 1.78 0.36

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.18

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.24

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.19

Digestive system 4 4.72* 10 4.61* 3 1.40 12 2.28* 29 10.41 2.78* 15.18

Esophagus 0 0.00 0 0.00 0 0.00 2 5.21 2 0.78 2.56 1.00

Stomach 1 8.87 0 0.00 1 4.13 2 3.60 4 1.18 3.39 2.30

Small intestine 1 44.75 1 19.03 0 0.00 0 0.00 2 0.22 9.12* 1.45

Colon 1 3.49 5 6.74* 1 1.31 3 1.49 10 3.81 2.63* 5.06

Rectum, rectosigmoid junction 0 0.00 3 7.23* 0 0.00 2 2.06 5 1.96 2.55 2.48

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.13

Liver 0 0.00 1 6.42 0 0.00 2 5.98 3 0.69 4.34 1.88

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.09

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.17

Pancreas 1 10.96 0 0.00 1 4.12 1 1.64 3 1.18 2.53 1.48

Respiratory system 0 0.00 1 0.51 4 1.96 12 2.39* 17 9.77 1.74* 5.91

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.09

Larynx 0 0.00 0 0.00 0 0.00 1 2.48 1 0.88 1.13 0.10

Lung, bronchus 0 0.00 1 0.58 3 1.66 11 2.41* 15 8.74 1.72 5.11

Female breast 1 0.92 1 0.38 0 0.00 4 1.20 6 9.27 0.65 -6.19

Female genital system 0 0.00 3 2.78 1 1.09 1 0.74 5 3.80 1.32 2.27

Cervix uteri 0 0.00 1 3.12 0 0.00 0 0.00 1 0.89 1.12 0.20

Corpus uteri 0 0.00 2 5.13 0 0.00 0 0.00 2 1.59 1.26 0.77

Ovary 0 0.00 0 0.00 1 3.71 1 2.54 2 1.10 1.81 1.70

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.07

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.19

Male genital system 0 0.00 0 0.00 0 0.00 8 1.36 8 7.90 1.01 0.14

Prostate 0 0.00 0 0.00 0 0.00 8 1.38 8 7.50 1.07 0.72

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.47

Urinary system 1 3.18 2 2.61 1 1.34 3 1.55 7 3.77 1.86 2.64

Urinary bladder 1 6.26 0 0.00 1 2.49 2 1.72 4 2.12 1.89 1.54

Kidney parenchyma 0 0.00 2 5.86 0 0.00 1 1.47 3 1.48 2.03 1.24

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.14

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.04

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.07

Soft tissue including heart 0 0.00 1 9.76 1 13.53 0 0.00 2 0.35 5.76 1.35

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.37

Melanoma of skin 0 0.00 1 1.63 0 0.00 0 0.00 1 2.14 0.47 -0.93

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.08

Brain, central nervous system 0 0.00 0 0.00 1 5.29 0 0.00 1 0.87 1.15 0.10

Thyroid 1 6.18 0 0.00 1 4.37 0 0.00 2 1.00 2.00 0.81

Lymphatic, hematopoietic 0 0.00 4 3.50 2 2.13 0 0.00 6 4.52 1.33 1.21

Hodgkin lymphoma 0 0.00 1 8.39 0 0.00 0 0.00 1 0.33 3.00 0.54

Non-Hodgkin lymphoma 0 0.00 1 1.71 1 2.11 0 0.00 2 2.28 0.88 -0.23

Myeloma 0 0.00 1 7.57 0 0.00 0 0.00 1 0.65 1.54 0.29

Leukemia 0 0.00 1 3.27 1 3.86 0 0.00 2 1.26 1.59 0.61

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.06

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.33

Acute non-lymphocytic 0 0.00 1 8.81 1 11.08 0 0.00 2 0.45 4.47 1.27

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.17

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,940 2,131 708 405 3,940

Person-years in interval 2,342 4,421 2,652 2,833 12,248

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 5,282 PYR and for male cancers on 6,966 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 79
All subsequent cancers 106 0.85 281 1.08 195 1.02 230 1.08 812 789.80 1.03 4.80

All excluding same site 105 0.87 276 1.09 191 1.02 224 1.08 796 769.78 1.03 5.67

Buccal cavity, pharynx 8 1.76 6 0.71 2 0.40 5 1.12 21 22.44 0.94 -0.31

Lip 0 0.00 0 0.00 0 0.00 1 1.55 1 2.82 0.36 -0.39

Tongue 2 2.21 1 0.60 0 0.00 1 1.12 4 4.49 0.89 -0.11

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 1.64 0.00 -0.36

Mouth 4 3.38 0 0.00 0 0.00 1 0.88 5 5.76 0.87 -0.16

Nasopharynx 1 3.76 1 2.01 1 3.55 1 4.56 4 1.26 3.17 0.59

Tonsil 1 2.02 3 3.41 0 0.00 0 0.00 4 2.22 1.80 0.39

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.69 0.00 -0.15

Hypopharynx 0 0.00 0 0.00 1 1.65 1 2.08 2 2.70 0.74 -0.15

Digestive system 20 0.74 71 1.26 45 1.08 54 1.12 190 173.03 1.10 3.67

Esophagus 1 0.52 8 2.11 4 1.63 3 1.23 16 10.61 1.51 1.16

Stomach 1 0.32 5 0.76 4 0.83 6 1.10 16 20.03 0.80 -0.87

Small intestine 3 7.98* 2 2.51 1 1.69 2 2.93 8 2.45 3.27* 1.20

Colon 9 0.85 24 1.06 16 0.91 28 1.30 77 72.27 1.07 1.02

Rectum, rectosigmoid junction 3 0.58 10 0.96 7 0.97 14 1.85* 34 30.29 1.12 0.80

Anus, anal canal 0 0.00 1 1.98 1 2.90 0 0.00 2 1.46 1.37 0.12

Liver 1 0.78 0 0.00 2 1.01 0 0.00 3 8.11 0.37 -1.11

Gallbladder 0 0.00 0 0.00 1 1.95 0 0.00 1 2.06 0.49 -0.23

Bile ducts, other biliary 0 0.00 3 2.79 0 0.00 1 0.83 4 3.64 1.10 0.08

Pancreas 2 0.62 18 2.68* 9 1.82 0 0.00* 29 20.63 1.41 1.81

Respiratory system 19 0.72 65 1.22 39 1.06 53 1.43* 176 153.34 1.15 4.90

Nose, nasal cavity, ear 0 0.00 1 2.42 0 0.00 0 0.00 1 1.20 0.83 -0.04

Larynx 4 1.75 3 0.71 5 1.98 5 2.35 17 11.16 1.52 1.26

Lung, bronchus 15 0.63 61 1.26 34 1.01 48 1.39* 158 140.62 1.12 3.76

Female breast 11 1.20 27 1.35 18 1.25 9 0.61 65 58.37 1.11 4.01

Female genital system 1 0.21 9 0.91 7 1.07 0 0.00* 17 27.33 0.62* -6.25

Cervix uteri 0 0.00 0 0.00 2 2.77 0 0.00 2 3.22 0.62 -0.74

Corpus uteri 1 0.39 3 0.56 1 0.29 0 0.00 5 14.49 0.35* -5.75

Ovary 0 0.00 3 1.12 2 1.07 0 0.00 5 7.67 0.65 -1.62

Vagina 0 0.00 1 7.68 1 10.10 0 0.00 2 0.40 4.99 0.97

Vulva 0 0.00 2 6.96 0 0.00 0 0.00 2 0.98 2.05 0.62

Male genital system 18 0.72 48 0.84 36 0.77 55 1.00 157 183.96 0.85* -9.06

Prostate 18 0.73 48 0.85 36 0.77 55 1.01 157 182.41 0.86 -8.54

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.14

Urinary system 14 1.45 21 1.06 23 1.57 20 1.15 78 61.49 1.27* 3.57

Urinary bladder 4 0.63 12 0.92 18 1.82* 16 1.31 50 41.47 1.21 1.84

Kidney parenchyma 9 3.27* 6 1.09 3 0.78 3 0.73 21 16.19 1.30 1.04

Renal pelvis, other urinary 1 1.68 3 2.41 2 2.15 1 0.94 7 3.83 1.83 0.68

Ureter 1 5.22 2 4.89 0 0.00 1 2.80 4 1.27 3.15 0.59

Bone, joints 0 0.00 1 4.44 0 0.00 1 7.33 2 0.62 3.21 0.30

Soft tissue including heart 1 2.11 0 0.00 1 1.50 2 2.54 4 2.88 1.39 0.24

Kaposi sarcoma 0 0.00 1 4.87 0 0.00 0 0.00 1 0.58 1.71 0.09

Melanoma of skin 2 0.79 1 0.20 3 0.89 4 1.01 10 14.80 0.68 -1.04

Eye, orbit 0 0.00 0 0.00 1 4.43 0 0.00 1 0.99 1.01 0.00

Brain, central nervous system 0 0.00 3 1.09 1 0.56 3 1.70 7 7.75 0.90 -0.16

Thyroid 4 5.14* 0 0.00 1 1.09 0 0.00 5 4.00 1.25 0.22

Lymphatic, hematopoietic 6 0.71 23 1.32 11 0.84 17 1.09 57 54.55 1.04 0.53

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.65 0.00 -0.36

Non-Hodgkin lymphoma 2 0.54 10 1.29 5 0.85 7 0.98 24 24.49 0.98 -0.11

Myeloma 2 1.28 5 1.50 0 0.00 3 1.03 10 10.30 0.97 -0.06

Leukemia 2 0.72 8 1.39 6 1.39 7 1.34 23 18.11 1.27 1.06

Acute lymphocytic 0 0.00 1 6.01 0 0.00 0 0.00 1 0.49 2.02 0.11

Chronic lymphocytic 1 0.87 5 2.12 1 0.58 3 1.51 10 7.21 1.39 0.60

Acute non-lymphocytic 0 0.00 1 0.52 4 2.63 3 1.58 8 6.25 1.28 0.38

Chronic myeloid 1 2.57 0 0.00 1 1.74 1 1.38 3 2.46 1.22 0.12

Stomach

Both Sexes, 50-69 Years of Age

Table 4.2.6: Risk of subsequent primary cancers after cancer of the stomach, both sexes,

50-69 years of age, SEER 1973-2000.

80 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

STOMACH

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 16,767 8,814 2,729 1,493 16,767

Person-years in interval 9,775 17,651 10,060 8,774 46,261

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 16,514 PYR and for male cancers on 29,747 PYR.
Stomach

Both Sexes, ≥70 Years of Age

Table 4.2.7: Risk of subsequent primary cancers after cancer of the stomach, both sexes,

≥70 years of age, SEER 1973-2000.

STOMACH

All subsequent cancers 145 0.58* 353 0.86* 167 0.90 45 0.59* 710 922.60 0.77* -58.43

All excluding same site 144 0.60* 347 0.87* 165 0.92 44 0.60* 700 891.77 0.78* -52.71

Buccal cavity, pharynx 2 0.38 5 0.60 4 1.16 1 0.72 12 18.47 0.65 -1.78

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 3.45 0.00 -0.95

Tongue 1 1.03 0 0.00 1 1.54 1 3.89 3 3.41 0.88 -0.11

Salivary gland 0 0.00 1 1.10 0 0.00 0 0.00 1 2.09 0.48 -0.30

Mouth 0 0.00 2 0.90 2 2.11 0 0.00 4 4.93 0.81 -0.26

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.72 0.00 -0.20

Tonsil 0 0.00 1 1.78 0 0.00 0 0.00 1 1.22 0.82 -0.06

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.11

Hypopharynx 0 0.00 1 1.31 0 0.00 0 0.00 1 1.62 0.62 -0.17

Digestive system 36 0.55* 113 1.03 51 0.98 10 0.45* 210 249.44 0.84* -10.84

Esophagus 3 1.14 3 0.71 3 1.67 0 0.00 9 9.39 0.96 -0.11

Stomach 1 0.12* 6 0.44* 2 0.31 1 0.36 10 30.83 0.32* -5.73

Small intestine 5 6.99* 2 1.66 0 0.00 0 0.00 7 2.74 2.55* 1.17

Colon 15 0.50* 49 0.96 27 1.08 6 0.55 97 116.98 0.83 -5.49

Rectum, rectosigmoid junction 7 0.68 26 1.55* 6 0.81 1 0.34 40 37.40 1.07 0.71

Anus, anal canal 0 0.00 0 0.00 1 2.94 0 0.00 1 1.61 0.62 -0.17

Liver 1 0.46 3 0.80 1 0.61 0 0.00 5 8.18 0.61 -0.87

Gallbladder 0 0.00 1 0.54 0 0.00 0 0.00 1 4.15 0.24 -0.87

Bile ducts, other biliary 2 1.34 4 1.48 1 0.71 0 0.00 7 6.26 1.12 0.20

Pancreas 2 0.26* 19 1.46 10 1.60 2 0.74 33 29.65 1.11 0.92

Respiratory system 12 0.31* 49 0.78 18 0.70 9 0.94 88 136.89 0.64* -13.44

Nose, nasal cavity, ear 0 0.00 1 1.64 0 0.00 0 0.00 1 1.37 0.73 -0.10

Larynx 0 0.00 2 0.61 1 0.84 1 2.45 4 7.09 0.56 -0.85

Lung, bronchus 12 0.33* 46 0.79 17 0.70 8 0.88 83 128.06 0.65* -12.39

Female breast 12 0.68 27 0.85 17 1.07 0 0.00* 56 71.40 0.78 -8.74

Female genital system 5 0.63 13 0.94 4 0.61 0 0.00 22 30.92 0.71 -5.06

Cervix uteri 1 1.06 0 0.00 0 0.00 0 0.00 1 3.52 0.28 -1.43

Corpus uteri 3 0.82 5 0.80 2 0.71 0 0.00 10 13.78 0.73 -2.14

Ovary 1 0.43 6 1.44 1 0.48 0 0.00 8 9.43 0.85 -0.81

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.77 0.00 -0.44

Vulva 0 0.00 2 1.99 1 1.73 0 0.00 3 2.41 1.25 0.34

Male genital system 41 0.73* 76 0.84 37 0.99 10 0.69 164 198.67 0.83* -18.48

Prostate 41 0.73* 74 0.82 37 1.00 10 0.70 162 197.09 0.82* -18.70

Testis 0 0.00 1 10.97 0 0.00 0 0.00 1 0.19 5.15 0.43

Urinary system 15 0.74 36 1.07 9 0.60 7 1.10 67 75.53 0.89 -2.35

Urinary bladder 10 0.67 26 1.06 8 0.72 4 0.83 48 55.35 0.87 -2.02

Kidney parenchyma 5 1.22 7 1.04 1 0.34 2 1.72 15 14.96 1.00 0.01

Renal pelvis, other urinary 0 0.00 3 1.28 0 0.00 1 2.35 4 5.22 0.77 -0.33

Ureter 0 0.00 1 1.25 0 0.00 0 0.00 1 1.77 0.56 -0.21

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -0.17

Soft tissue including heart 1 1.08 1 0.63 3 3.99 0 0.00 5 3.60 1.39 0.38

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.86 0.00 -0.24

Melanoma of skin 3 0.84 6 0.98 3 1.04 1 0.74 13 13.91 0.93 -0.25

Eye, orbit 0 0.00 0 0.00 1 4.79 0 0.00 1 1.06 0.94 -0.02

Brain, central nervous system 1 0.56 4 1.35 1 0.80 0 0.00 6 6.49 0.92 -0.13

Thyroid 4 4.63* 2 1.37 2 3.15 0 0.00 8 3.21 2.49* 1.32

Lymphatic, hematopoietic 11 0.58 20 0.63* 13 0.86 5 0.76 49 72.54 0.68* -6.47

Hodgkin lymphoma 0 0.00 0 0.00 1 3.44 0 0.00 1 1.55 0.65 -0.15

Non-Hodgkin lymphoma 6 0.78 10 0.75 5 0.78 0 0.00 21 30.23 0.69 -2.54

Myeloma 3 0.86 4 0.68 1 0.37 2 1.77 10 13.23 0.76 -0.89

Leukemia 2 0.28* 6 0.50 6 1.05 3 1.18 17 27.53 0.62* -2.90

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.66 0.00 -0.18

Chronic lymphocytic 0 0.00 2 0.44 0 0.00 2 2.14 4 10.38 0.39* -1.75

Acute non-lymphocytic 1 0.40 2 0.47 2 1.01 0 0.00 5 9.56 0.52 -1.25

Chronic myeloid 1 1.03 2 1.21 2 2.48 1 2.67 6 3.80 1.58 0.60

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 19,291 8,517 2,285 800 19,291

Person-years in interval 9,948 16,358 7,176 2,901 36,383

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 17,620 PYR and for male cancers on 18,763 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 81
All subsequent cancers 61 0.75* 120 1.04 57 1.12 36 1.04 274 283.24 0.97 -6.12

All excluding same site 61 0.76* 118 1.04 54 1.08 36 1.07 269 276.48 0.97 -4.95

Buccal cavity, pharynx 2 0.83 1 0.31 1 0.78 0 0.00 4 7.72 0.52 -2.46

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 1.29 0.00 -0.85

Tongue 1 2.11 0 0.00 0 0.00 0 0.00 1 1.53 0.65 -0.35

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.66 0.00 -0.43

Mouth 1 1.66 0 0.00 0 0.00 0 0.00 1 1.90 0.53 -0.59

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.20

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.71 0.00 -0.47

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.15

Hypopharynx 0 0.00 0 0.00 1 7.28 0 0.00 1 0.83 1.20 0.11

Digestive system 19 1.05 33 1.31 13 1.17 7 0.93 72 61.84 1.16 6.72

Esophagus 1 0.98 3 2.10 1 1.66 0 0.00 5 3.45 1.45 1.02

Stomach 0 0.00 2 0.73 3 2.46 0 0.00 5 6.76 0.74 -1.17

Small intestine 1 4.09 2 5.73 0 0.00 0 0.00 3 0.86 3.51 1.42

Colon 10 1.27 12 1.09 5 1.01 5 1.49 32 27.15 1.18 3.21

Rectum, rectosigmoid junction 4 1.22 6 1.34 1 0.53 2 1.61 13 10.91 1.19 1.39

Anus, anal canal 0 0.00 1 5.02 0 0.00 0 0.00 1 0.48 2.08 0.34

Liver 1 1.47 0 0.00 0 0.00 0 0.00 1 2.45 0.41 -0.96

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.68 0.00 -0.45

Bile ducts, other biliary 1 2.59 1 1.78 0 0.00 0 0.00 2 1.41 1.42 0.39

Pancreas 1 0.48 6 2.05 3 2.33 0 0.00 10 7.18 1.39 1.86

Respiratory system 8 0.52 22 1.02 12 1.32 7 1.18 49 52.02 0.94 -2.00

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.28

Larynx 0 0.00 0 0.00 0 0.00 1 2.68 1 3.77 0.27 -1.83

Lung, bronchus 8 0.57 22 1.12 11 1.32 6 1.09 47 47.71 0.99 -0.47

Female breast 3 0.90 8 1.59 5 2.11 0 0.00 16 12.17 1.31 11.74

Female genital system 0 0.00 2 0.90 0 0.00 0 0.00 2 5.30 0.38 -10.12

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -1.70

Corpus uteri 0 0.00 1 0.89 0 0.00 0 0.00 1 2.67 0.37 -5.12

Ovary 0 0.00 1 1.52 0 0.00 0 0.00 1 1.58 0.63 -1.79

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.27

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.84

Male genital system 15 0.71 28 0.91 11 0.79 15 1.51 69 75.71 0.91 -5.66

Prostate 15 0.72 28 0.92 11 0.79 15 1.52 69 74.98 0.92 -5.05

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.21

Urinary system 10 1.34 12 1.15 8 1.76 4 1.25 34 25.64 1.33 5.53

Urinary bladder 5 0.94 6 0.81 7 2.15 4 1.73 22 18.23 1.21 2.49

Kidney parenchyma 4 2.31 4 1.64 1 0.96 0 0.00 9 5.91 1.52 2.04

Renal pelvis, other urinary 1 2.26 2 3.29 0 0.00 0 0.00 3 1.49 2.01 1.00

Ureter 1 6.64 1 4.78 0 0.00 0 0.00 2 0.51 3.92 0.99

Bone, joints 0 0.00 1 10.60 0 0.00 0 0.00 1 0.23 4.40 0.51

Soft tissue including heart 0 0.00 1 2.27 1 5.19 0 0.00 2 1.08 1.84 0.61

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.25

Melanoma of skin 0 0.00 1 0.36 1 0.85 0 0.00 2 6.68 0.30 -3.10

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.27

Brain, central nervous system 0 0.00 1 0.85 0 0.00 0 0.00 1 2.82 0.35 -1.20

Thyroid 1 2.85 0 0.00 0 0.00 0 0.00 1 1.17 0.86 -0.11

Lymphatic, hematopoietic 1 0.16* 8 0.94 4 1.06 2 0.77 15 20.95 0.72 -3.94

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -0.41

Non-Hodgkin lymphoma 1 0.37 4 1.04 1 0.59 0 0.00 6 9.41 0.64 -2.25

Myeloma 0 0.00 2 1.40 0 0.00 1 2.31 3 3.51 0.85 -0.34

Leukemia 0 0.00 2 0.67 3 2.27 1 1.10 6 7.41 0.81 -0.94

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.13

Chronic lymphocytic 0 0.00 1 0.83 1 1.91 1 2.83 3 2.97 1.01 0.02

Acute non-lymphocytic 0 0.00 1 0.99 2 4.39 0 0.00 3 2.51 1.20 0.33

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.00 0.00 -0.66

Stomach

Cardia, Both Sexes

Table 4.2.8: Risk of subsequent primary cancers after cancer of the stomach cardia,

both sexes, SEER 1973-2000.

82 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

STOMACH

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 8,847 4,020 765 303 8,847

Person-years in interval 4,833 6,383 2,450 1,448 15,113

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 3,262 PYR and for male cancers on 11,852 PYR.
Stomach

Excluding Cardia, Both Sexes

Table 4.2.9: Risk of subsequent primary cancers after cancer of the stomach excluding cardia,

both sexes, SEER 1973-2000.

STOMACH

All subsequent cancers 198 0.67* 537 0.94 319 0.94 281 0.99 1,335 1,487.32 0.90* -19.09

All excluding same site 195 0.68* 528 0.96 315 0.96 272 0.99 1,310 1,442.04 0.91* -16.55

Buccal cavity, pharynx 9 1.17 10 0.71 5 0.65 7 1.17 31 35.45 0.87 -0.56

Lip 0 0.00 0 0.00 0 0.00 1 1.19 1 5.15 0.19 -0.52

Tongue 2 1.38 1 0.37 1 0.66 2 1.68 6 6.85 0.88 -0.11

Salivary gland 0 0.00 1 0.81 0 0.00 1 1.56 2 3.24 0.62 -0.16

Mouth 4 1.97 2 0.54 2 0.98 1 0.65 9 9.35 0.96 -0.04

Nasopharynx 1 2.43 1 1.29 1 2.45 1 3.32 4 1.89 2.11 0.26

Tonsil 1 1.49 4 3.28 0 0.00 0 0.00 5 3.02 1.66 0.25

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.96 0.00 -0.12

Hypopharynx 0 0.00 1 0.66 0 0.00 1 1.68 2 3.71 0.54 -0.21

Digestive system 41 0.55* 161 1.12 86 1.01 69 1.01 357 371.05 0.96 -1.76

Esophagus 3 0.84 8 1.18 6 1.57 5 1.58 22 17.33 1.27 0.59

Stomach 3 0.32* 9 0.51* 4 0.39 9 1.13 25 45.28 0.55* -2.54

Small intestine 8 9.21* 3 1.76 1 0.95 2 2.15 14 4.55 3.07* 1.18

Colon 15 0.46* 66 1.04 39 1.02 32 1.03 152 165.91 0.92 -1.74

Rectum, rectosigmoid junction 6 0.49 33 1.43 12 0.91 15 1.47 66 58.74 1.12 0.91

Anus, anal canal 0 0.00 0 0.00 2 3.14 0 0.00 2 2.75 0.73 -0.09

Liver 1 0.35 4 0.71 3 0.91 2 0.71 10 14.53 0.69 -0.57

Gallbladder 0 0.00 1 0.45 1 0.77 0 0.00 2 5.64 0.35 -0.46

Bile ducts, other biliary 1 0.62 6 1.85 1 0.49 1 0.56 9 8.70 1.03 0.04

Pancreas 4 0.45 31 1.82* 17 1.68 3 0.37 55 44.29 1.24 1.34

Respiratory system 23 0.45* 93 0.97 49 0.88 67 1.46* 232 247.97 0.94 -2.00

Nose, nasal cavity, ear 0 0.00 2 2.28 0 0.00 0 0.00 2 2.26 0.89 -0.03

Larynx 4 1.19 5 0.82 6 1.82 6 2.34 21 15.37 1.37 0.71

Lung, bronchus 19 0.41* 86 0.97 43 0.84 61 1.43* 209 229.71 0.91 -2.60

Female breast 21 0.86 47 0.96 30 1.00 13 0.56* 111 126.87 0.87 -4.39

Female genital system 6 0.52 23 1.02 12 0.92 1 0.10* 42 56.75 0.74 -4.08

Cervix uteri 1 0.63 1 0.34 2 1.29 0 0.00 4 7.07 0.57 -0.85

Corpus uteri 4 0.71 9 0.83 3 0.49 0 0.00* 16 27.19 0.59* -3.09

Ovary 1 0.30 8 1.23 4 1.02 1 0.34 14 16.62 0.84 -0.73

Vagina 0 0.00 1 2.26 1 3.77 0 0.00 2 1.12 1.78 0.24

Vulva 0 0.00 4 3.31 1 1.27 0 0.00 5 3.21 1.56 0.49

Male genital system 44 0.73* 96 0.82* 62 0.87 58 0.89 260 314.83 0.83* -12.57

Prostate 44 0.74* 94 0.81* 62 0.88 58 0.89 258 312.01 0.83* -12.38

Testis 0 0.00 1 3.42 0 0.00 0 0.00 1 0.69 1.44 0.07

Urinary system 20 0.87 47 1.07 25 0.96 26 1.16 118 115.15 1.02 0.36

Urinary bladder 10 0.62 32 1.05 20 1.10 18 1.14 80 80.70 0.99 -0.09

Kidney parenchyma 10 1.90 11 1.08 3 0.50 6 1.15 30 26.71 1.12 0.41

Renal pelvis, other urinary 0 0.00 4 1.33 2 1.16 2 1.42 8 7.73 1.03 0.03

Ureter 0 0.00 2 1.98 0 0.00 1 2.18 3 2.58 1.16 0.05

Bone, joints 0 0.00 0 0.00 0 0.00 1 5.32 1 1.11 0.90 -0.01

Soft tissue including heart 2 1.77 1 0.46 4 3.08 2 1.78 9 5.74 1.57 0.41

Kaposi sarcoma 0 0.00 1 1.70 0 0.00 0 0.00 1 1.51 0.66 -0.06

Melanoma of skin 5 1.11 7 0.79 5 0.90 5 0.95 22 24.17 0.91 -0.27

Eye, orbit 0 0.00 0 0.00 2 5.19 0 0.00 2 1.74 1.15 0.03

Brain, central nervous system 1 0.40 6 1.25 3 1.09 3 1.34 13 12.29 1.06 0.09

Thyroid 8 5.50* 2 0.71 4 2.54 0 0.00 14 7.05 1.99* 0.87

Lymphatic, hematopoietic 16 0.74 39 0.93 22 0.87 20 0.93 97 110.65 0.88 -1.71

Hodgkin lymphoma 0 0.00 1 0.85 1 1.60 0 0.00 2 2.91 0.69 -0.11

Non-Hodgkin lymphoma 7 0.78 17 0.95 10 0.91 7 0.72 41 47.59 0.86 -0.83

Myeloma 5 1.22 8 1.01 1 0.21 4 1.02 18 20.66 0.87 -0.33

Leukemia 4 0.50 13 0.86 10 1.11 9 1.21 36 39.49 0.91 -0.44

Acute lymphocytic 0 0.00 1 2.48 0 0.00 0 0.00 1 1.04 0.96 0.00

Chronic lymphocytic 1 0.32 6 1.04 0 0.00 4 1.44 11 15.02 0.73 -0.50

Acute non-lymphocytic 1 0.37 3 0.57 5 1.59 3 1.14 12 13.75 0.87 -0.22

Chronic myeloid 2 1.82 2 0.96 3 2.41 2 1.90 9 5.48 1.64 0.44

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 31,151 15,442 4,957 2,395 31,151

Person-years in interval 17,233 32,047 17,439 13,060 79,779

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 36,155 PYR and for male cancers on 43,624 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 83
Small Intestine

Both Sexes

Table 4.3.1: Characteristics of patients with an initial cancer of the small intestine, both sexes,

SEER 1973-2000.

84 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

SMALL INTESTINE

Number of patients with 1st primary cancer

Total 2,796 100.0 2,636 100.0 5,432 100.0

Initial treatment

Any radiation 223 8.0 154 5.8 377 6.9

With surgery 140 5.0 97 3.7 237 4.4

Without surgery 83 3.0 57 2.2 140 2.6

No radiation 2,573 92.0 2,482 94.2 5,055 93.1

With surgery 2,164 77.4 2,051 77.8 4,215 77.6

Without surgery 409 14.6 431 16.4 840 15.5

Race

White 2,317 82.9 2,174 82.5 4,491 82.7

Black 332 11.9 344 13.1 676 12.4

Other 143 5.1 110 4.2 253 4.7

Unknown 4 0.1 8 0.3 12 0.2

Age at 1st primary cancer diagnosis, years

< 30 39 1.4 38 1.4 77 1.4

30–49 511 18.3 434 16.5 945 17.4

50–69 1,374 49.1 1,120 42.5 2,494 45.9

70–79 641 22.9 656 24.9 1,297 23.9

> 80 231 8.3 388 14.7 619 11.4

Number of patients with one or more

primary cancers

One primary cancer only 2,567 91.8 2,486 94.3 5,053 93.0

1st and 2nd cancers 204 7.3 139 5.3 343 6.3

1st, 2nd, and 3rd cancers 19 0.7 10 0.4 29 0.5

1st, 2nd, 3rd, and additional cancers 6 0.2 1 0.0 7 0.1

Other statistics

Median age at 1st cancer diagnosis 63.1 — 66.3 — 64.5 —

Median year of 1st cancer diagnosis 1990.3 — 1990.7 — 1990.5 —

Median person-years at risk 2.2 — 2.5 — 2.4 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 95.2 — 95.3 — 95.3

1st, 2nd, and additional cancers — 94.3 — 95.3 — 94.7

1st cancer only — 4.4 — 4.7 — 4.5

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Small Intestine

Both Sexes

Table 4.3.2: Risk of subsequent primary cancers after cancer of the small intestine, both sexes,

SEER 1973-2000.

SMALL INTESTINE

All subsequent cancers 68 1.26 165 1.06 104 1.08 85 1.15 422 379.79 1.11* 17.73

All excluding same site 68 1.26 160 1.03 102 1.07 83 1.13 413 378.55 1.09 14.47

Buccal cavity, pharynx 0 0.00 4 1.03 3 1.32 2 1.26 9 9.17 0.98 -0.07

Lip 0 0.00 1 1.85 0 0.00 0 0.00 1 1.28 0.78 -0.12

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 1.86 0.00 -0.78

Salivary gland 0 0.00 0 0.00 1 4.66 1 6.02 2 0.85 2.37 0.48

Mouth 0 0.00 0 0.00 1 1.66 1 2.39 2 2.44 0.82 -0.19

Nasopharynx 0 0.00 0 0.00 1 11.65 0 0.00 1 0.35 2.84 0.27

Tonsil 0 0.00 1 2.67 0 0.00 0 0.00 1 0.87 1.15 0.06

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.11

Hypopharynx 0 0.00 1 2.54 0 0.00 0 0.00 1 0.92 1.09 0.04

Digestive system 15 1.24 40 1.16 23 1.09 24 1.51 102 83.46 1.22 7.79

Esophagus 1 1.64 0 0.00 0 0.00 0 0.00 1 4.17 0.24 -1.33

Stomach 1 0.81 2 0.58 0 0.00 1 0.67 4 8.21 0.49 -1.77

Small intestine 0 0.00 5 9.92* 2 6.39 2 8.00 9 1.24 7.23* 3.26

Colon 8 1.46 21 1.33 11 1.13 10 1.35 50 38.39 1.30 4.88

Rectum, rectosigmoid junction 2 0.97 6 1.04 3 0.87 5 1.99 16 13.80 1.16 0.92

Anus, anal canal 0 0.00 1 3.02 1 4.97 1 6.57 3 0.80 3.75 0.92

Liver 1 2.46 1 0.86 0 0.00 2 3.62 4 2.84 1.41 0.49

Gallbladder 1 5.81 0 0.00 1 3.51 0 0.00 2 1.15 1.74 0.36

Bile ducts, other biliary 0 0.00 1 1.35 3 6.39* 1 2.64 5 1.84 2.71 1.33

Pancreas 1 0.68 3 0.71 2 0.78 2 1.02 8 10.19 0.78 -0.92

Respiratory system 12 1.29 19 0.72 11 0.68 7 0.57 49 64.33 0.76 -6.44

Nose, nasal cavity, ear 0 0.00 0 0.00 1 7.33 0 0.00 1 0.54 1.84 0.19

Larynx 1 1.60 1 0.58 0 0.00 0 0.00 2 4.05 0.49 -0.86

Lung, bronchus 11 1.28 18 0.73 10 0.67 7 0.61 46 59.58 0.77 -5.70

Female breast 4 0.66 15 0.85 7 0.67 7 0.85 33 42.44 0.78 -7.88

Female genital system 1 0.36 10 1.28 2 0.45 5 1.48 18 18.39 0.98 -0.33

Cervix uteri 0 0.00 2 2.25 0 0.00 0 0.00 2 2.00 1.00 0.00

Corpus uteri 1 0.72 5 1.27 2 0.89 3 1.74 11 9.30 1.18 1.42

Ovary 0 0.00 3 1.31 0 0.00 2 1.92 5 5.47 0.91 -0.40

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.24

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.90 0.00 -0.75

Male genital system 13 1.30 34 1.14 27 1.38 17 1.10 91 74.95 1.21 13.56

Prostate 13 1.31 32 1.08 27 1.39 17 1.11 89 74.20 1.20 12.51

Testis 0 0.00 2 14.34* 0 0.00 0 0.00 2 0.30 6.75 1.44

Urinary system 11 2.68* 15 1.26 13 1.74 5 0.87 44 29.20 1.51* 6.22

Urinary bladder 7 2.50* 6 0.74 10 1.94 3 0.76 26 19.99 1.30 2.52

Kidney parenchyma 4 3.80* 6 1.98 3 1.59 1 0.69 14 7.42 1.89* 2.77

Renal pelvis, other urinary 0 0.00 3 4.05 0 0.00 1 2.93 4 1.80 2.23 0.93

Ureter 0 0.00 1 4.16 0 0.00 1 9.09 2 0.58 3.43 0.60

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.13

Soft tissue including heart 1 4.68 1 1.64 2 5.41 1 3.55 5 1.48 3.39* 1.48

Kaposi sarcoma 0 0.00 2 8.82 0 0.00 0 0.00 2 0.51 3.96 0.63

Melanoma of skin 4 3.50 6 1.78 1 0.47 5 2.99 16 8.32 1.92* 3.22

Eye, orbit 0 0.00 0 0.00 1 7.78 0 0.00 1 0.52 1.94 0.20

Brain, central nervous system 1 1.83 2 1.29 1 1.08 1 1.47 5 3.70 1.35 0.55

Thyroid 2 6.44 1 1.15 0 0.00 0 0.00 3 2.04 1.47 0.40

Lymphatic, hematopoietic 4 0.99 9 0.78 10 1.39 7 1.26 30 28.38 1.06 0.68

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.85 0.00 -0.36

Non-Hodgkin lymphoma 2 1.12 3 0.57 5 1.53 4 1.55 14 12.85 1.09 0.48

Myeloma 0 0.00 3 1.46 2 1.58 0 0.00 5 5.03 0.99 -0.01

Leukemia 2 1.45 3 0.76 3 1.23 3 1.61 11 9.65 1.14 0.57

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.11

Chronic lymphocytic 1 1.82 2 1.27 1 1.03 1 1.36 5 3.84 1.30 0.49

Acute non-lymphocytic 1 2.14 1 0.74 0 0.00 1 1.55 3 3.29 0.91 -0.12

Chronic myeloid 0 0.00 0 0.00 2 5.96 1 3.92 3 1.32 2.27 0.70

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,432 4,016 1,726 741 5,432

Person-years in interval 3,801 10,344 5,778 3,886 23,809

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 11,972 PYR and for male cancers on 11,837 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 85
All subsequent cancers 24 1.11 59 0.95 37 1.00 42 1.43* 162 150.22 1.08 9.84

All excluding same site 24 1.12 58 0.93 36 0.98 41 1.40* 159 149.69 1.06 7.77

Buccal cavity, pharynx 0 0.00 2 1.81 1 1.56 1 2.02 4 2.63 1.52 1.15

Lip 0 0.00 1 13.26 0 0.00 0 0.00 1 0.18 5.47 0.68

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.48

Salivary gland 0 0.00 0 0.00 0 0.00 1 17.54 1 0.29 3.39 0.59

Mouth 0 0.00 0 0.00 1 4.49 0 0.00 1 0.91 1.10 0.07

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.08

Tonsil 0 0.00 1 10.34 0 0.00 0 0.00 1 0.22 4.48 0.65

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.15

Digestive system 8 1.57 13 0.89 11 1.28 12 1.76 44 35.18 1.25 7.36

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 1.00 0.00 -0.84

Stomach 0 0.00 0 0.00 0 0.00 1 2.02 1 2.68 0.37 -1.40

Small intestine 0 0.00 1 4.62 1 7.78 1 9.27 3 0.53 5.69* 2.07

Colon 5 1.96 6 0.82 7 1.61 5 1.45 23 17.70 1.30 4.42

Rectum, rectosigmoid junction 2 2.53 4 1.78 1 0.77 2 2.00 9 5.34 1.69 3.06

Rectum 1 1.93 4 2.71 1 1.17 2 3.01 8 3.51 2.28 3.75

Anus, anal canal 0 0.00 1 5.20 0 0.00 1 10.95 2 0.46 4.30 1.28

Liver 0 0.00 1 3.22 0 0.00 1 6.26 2 0.77 2.61 1.03

Gallbladder 1 8.75 0 0.00 0 0.00 0 0.00 1 0.76 1.32 0.20

Bile ducts, other biliary 0 0.00 0 0.00 1 5.20 0 0.00 1 0.79 1.27 0.18

Pancreas 0 0.00 0 0.00 1 0.87 1 1.08 2 4.69 0.43 -2.25

Respiratory system 3 1.07 6 0.72 5 0.99 4 0.93 18 20.48 0.88 -2.07

Nose, nasal cavity, ear 0 0.00 0 0.00 1 19.80 0 0.00 1 0.21 4.87 0.66

Larynx 1 10.86 0 0.00 0 0.00 0 0.00 1 0.63 1.58 0.31

Lung, bronchus 2 0.75 6 0.75 4 0.83 4 0.97 16 19.59 0.82 -2.99

Female breast 4 0.66 15 0.85 7 0.67 7 0.85 33 42.44 0.78 -7.88

Female genital system 1 0.36 10 1.28 2 0.45 5 1.48 18 18.39 0.98 -0.33

Cervix uteri 0 0.00 2 2.25 0 0.00 0 0.00 2 2.00 1.00 0.00

Corpus uteri 1 0.72 5 1.27 2 0.89 3 1.74 11 9.30 1.18 1.42

Ovary 0 0.00 3 1.31 0 0.00 2 1.92 5 5.47 0.91 -0.40

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.24

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.90 0.00 -0.75

Urinary system 2 1.94 6 1.99 3 1.66 1 0.68 12 7.33 1.64 3.90

Urinary bladder 1 1.64 3 1.68 3 2.83 0 0.00 7 4.32 1.62 2.24

Kidney parenchyma 1 2.97 2 2.02 0 0.00 1 2.03 4 2.42 1.66 1.32

Renal pelvis, other urinary 0 0.00 1 4.03 0 0.00 0 0.00 1 0.60 1.67 0.34

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.15

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.11

Soft tissue including heart 0 0.00 0 0.00 1 6.80 1 8.53 2 0.60 3.31 1.17

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.05

Melanoma of skin 3 7.47* 2 1.66 0 0.00 3 5.14* 8 2.90 2.75* 4.26

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.18

Brain, central nervous system 0 0.00 1 1.59 0 0.00 0 0.00 1 1.51 0.66 -0.42

Thyroid 2 10.33* 0 0.00 0 0.00 0 0.00 2 1.29 1.55 0.59

Lymphatic, hematopoietic 1 0.60 0 0.00* 5 1.74 4 1.71 10 11.70 0.85 -1.42

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.28

Non-Hodgkin lymphoma 0 0.00 0 0.00 2 1.45 2 1.72 4 5.63 0.71 -1.36

Myeloma 0 0.00 0 0.00 1 1.97 0 0.00 1 2.08 0.48 -0.90

Leukemia 1 1.91 0 0.00 2 2.23 2 2.80 5 3.66 1.37 1.12

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.09

Chronic lymphocytic 0 0.00 0 0.00 1 2.89 1 3.64 2 1.41 1.42 0.49

Acute non-lymphocytic 1 5.39 0 0.00 0 0.00 0 0.00 1 1.30 0.77 -0.25

Chronic myeloid 0 0.00 0 0.00 1 8.04 1 10.24 2 0.51 3.94 1.25

Small Intestine

Females

Table 4.3.3: Risk of subsequent primary cancers after cancer of the small intestine, females,

SEER 1973-2000.

86 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

SMALL INTESTINE

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,636 1,959 869 387 2,636

Person-years in interval 1,847 5,173 2,895 2,056 11,972

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Small Intestine

Males

Table 4.3.4: Risk of subsequent primary cancers after cancer of the small intestine, males,

SEER 1973-2000.

SMALL INTESTINE

All subsequent cancers 44 1.35 106 1.13 67 1.13 43 0.97 260 229.57 1.13 25.71

All excluding same site 44 1.36 102 1.09 66 1.12 42 0.95 254 228.86 1.11 21.24

Buccal cavity, pharynx 0 0.00 2 0.72 2 1.22 1 0.91 5 6.54 0.76 -1.30

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 1.10 0.00 -0.93

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 1.28 0.00 -1.08

Salivary gland 0 0.00 0 0.00 1 6.99 0 0.00 1 0.55 1.82 0.38

Mouth 0 0.00 0 0.00 0 0.00 1 4.06 1 1.53 0.65 -0.45

Nasopharynx 0 0.00 0 0.00 1 16.37 0 0.00 1 0.25 3.98 0.63

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -0.55

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.17

Hypopharynx 0 0.00 1 3.15 0 0.00 0 0.00 1 0.74 1.35 0.22

Digestive system 7 1.00 27 1.37 12 0.97 12 1.32 58 48.28 1.20 8.21

Esophagus 1 2.15 0 0.00 0 0.00 0 0.00 1 3.16 0.32 -1.83

Stomach 1 1.21 2 0.87 0 0.00 0 0.00 3 5.53 0.54 -2.14

Small intestine 0 0.00 4 13.92* 1 5.42 1 7.03 6 0.72 8.37* 4.46

Colon 3 1.02 15 1.79 4 0.74 5 1.26 27 20.68 1.31 5.34

Rectum, rectosigmoid junction 0 0.00 2 0.57 2 0.93 3 1.98 7 8.46 0.83 -1.23

Anus, anal canal 0 0.00 0 0.00 1 11.66 0 0.00 1 0.33 2.99 0.56

Liver 1 3.36 0 0.00 0 0.00 1 2.54 2 2.07 0.96 -0.06

Gallbladder 0 0.00 0 0.00 1 9.98 0 0.00 1 0.39 2.55 0.51

Bile ducts, other biliary 0 0.00 1 2.39 2 7.21 1 4.62 4 1.06 3.79* 2.49

Pancreas 1 1.24 3 1.33 1 0.71 1 0.97 6 5.50 1.09 0.42

Respiratory system 9 1.39 13 0.71 6 0.54 3 0.37 31 43.86 0.71 -10.86

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.28

Larynx 0 0.00 1 0.69 0 0.00 0 0.00 1 3.42 0.29 -2.04

Lung, bronchus 9 1.53 12 0.72 6 0.59 3 0.41 30 40.00 0.75 -8.45

Male breast 0 0.00 1 5.60 0 0.00 0 0.00 1 0.44 2.26 0.47

Male genital system 13 1.30 34 1.14 27 1.38 17 1.10 91 74.95 1.21 13.56

Prostate 13 1.31 32 1.08 27 1.39 17 1.11 89 74.20 1.20 12.51

Testis 0 0.00 2 14.34* 0 0.00 0 0.00 2 0.30 6.75 1.44

Urinary system 9 2.92* 9 1.02 10 1.76 4 0.94 32 21.87 1.46* 8.56

Urinary bladder 6 2.74* 3 0.48 7 1.71 3 0.97 19 15.67 1.21 2.81

Kidney parenchyma 3 4.20 4 1.95 3 2.33 0 0.00 10 5.00 2.00 4.22

Renal pelvis, other urinary 0 0.00 2 4.06 0 0.00 1 4.46 3 1.20 2.50 1.52

Ureter 0 0.00 1 6.06 0 0.00 1 13.42 2 0.40 4.98 1.35

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.15

Soft tissue including heart 1 7.90 1 2.80 1 4.50 0 0.00 3 0.87 3.44 1.80

Kaposi sarcoma 0 0.00 2 9.92* 0 0.00 0 0.00 2 0.45 4.49 1.31

Melanoma of skin 1 1.35 4 1.84 1 0.71 2 1.83 8 5.42 1.48 2.18

Eye, orbit 0 0.00 0 0.00 1 12.82 0 0.00 1 0.31 3.28 0.59

Brain, central nervous system 1 3.03 1 1.09 1 1.80 1 2.56 4 2.19 1.82 1.53

Thyroid 0 0.00 1 3.12 0 0.00 0 0.00 1 0.75 1.33 0.21

Lymphatic, hematopoietic 3 1.27 9 1.33 5 1.16 3 0.93 20 16.68 1.20 2.81

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.52 0.00 -0.44

Non-Hodgkin lymphoma 2 1.98 3 1.03 3 1.59 2 1.41 10 7.23 1.38 2.34

Myeloma 0 0.00 3 2.51 1 1.32 0 0.00 4 2.95 1.36 0.89

Leukemia 1 1.17 3 1.23 1 0.65 1 0.87 6 5.99 1.00 0.01

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.13

Chronic lymphocytic 1 2.88 2 2.02 0 0.00 0 0.00 3 2.43 1.24 0.49

Acute non-lymphocytic 0 0.00 1 1.24 0 0.00 1 2.58 2 1.99 1.01 0.01

Chronic myeloid 0 0.00 0 0.00 1 4.73 0 0.00 1 0.82 1.23 0.16

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,796 2,057 857 354 2,796

Person-years in interval 1,953 5,171 2,883 1,830 11,837

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 87
All subsequent cancers 8 4.45* 15 2.29* 16 2.41* 20 1.76* 59 26.36 2.24* 57.78

All excluding same site 8 4.47* 15 2.30* 15 2.26* 18 1.59 56 26.26 2.13* 52.65

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 1 3.08 1 0.88 1.13 0.21

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.12

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.36

Salivary gland 0 0.00 0 0.00 0 0.00 1 36.92 1 0.07 13.50 1.64

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.40

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.09

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.22

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.14

Digestive system 3 12.37* 6 6.41* 4 3.84* 6 3.14* 19 4.13 4.60* 26.32

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.49

Stomach 1 37.19 2 20.70* 0 0.00 0 0.00 3 0.38 7.92* 4.64

Small intestine 0 0.00 0 0.00 1 37.33 2 49.43* 3 0.10 29.43* 5.13

Colon 2 22.95* 3 8.74* 3 7.65* 1 1.27 9 1.61 5.60* 13.09

Rectum, rectosigmoid junction 0 0.00 1 5.46 0 0.00 2 5.47 3 0.80 3.74 3.89

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.15

Liver 0 0.00 0 0.00 0 0.00 1 11.55 1 0.21 4.71 1.39

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.08

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.14

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -0.86

Respiratory system 0 0.00 0 0.00 0 0.00 1 0.53 1 3.90 0.26 -5.14

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.08

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.59

Lung, bronchus 0 0.00 0 0.00 0 0.00 1 0.58 1 3.51 0.28 -4.44

Female breast 0 0.00 2 1.25 3 2.07 2 0.99 7 5.51 1.27 5.25

Female genital system 1 5.71 3 4.82 0 0.00 2 2.46 6 2.18 2.75* 13.44

Cervix uteri 0 0.00 1 5.78 0 0.00 0 0.00 1 0.45 2.21 1.93

Corpus uteri 1 18.10 2 8.84 0 0.00 1 2.41 4 0.94 4.24* 10.75

Ovary 0 0.00 0 0.00 0 0.00 1 4.09 1 0.66 1.53 1.21

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.08

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.23

Male genital system 0 0.00 1 2.60 1 1.57 1 0.55 3 2.92 1.03 0.28

Prostate 0 0.00 1 3.33 1 1.69 1 0.56 3 2.73 1.10 0.97

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.59

Urinary system 1 10.78 0 0.00 2 5.05 0 0.00 3 1.60 1.87 2.47

Urinary bladder 1 22.01 0 0.00 2 9.58* 0 0.00 3 0.88 3.40 3.75

Kidney parenchyma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -1.16

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.13

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.03

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.08

Soft tissue including heart 1 63.08 1 19.49 1 24.30 1 19.80 4 0.16 25.19* 6.80

Kaposi sarcoma 0 0.00 1 9.37 0 0.00 0 0.00 1 0.23 4.37 1.37

Melanoma of skin 1 9.07 1 2.75 0 0.00 3 7.64* 5 1.17 4.27* 6.78

Eye, orbit 0 0.00 0 0.00 1 81.88* 0 0.00 1 0.05 21.36 1.69

Brain, central nervous system 1 26.20 0 0.00 1 9.18 0 0.00 2 0.41 4.83 2.81

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.86

Lymphatic, hematopoietic 0 0.00 0 0.00 3 5.72* 2 2.50 5 2.08 2.41 5.18

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.29

Non-Hodgkin lymphoma 0 0.00 0 0.00 3 10.93* 2 4.86 5 1.08 4.62* 6.93

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.49

Leukemia 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.98

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.06

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.32

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.34

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.17

Small Intestine

Both Sexes, <50 Years of Age

Table 4.3.5: Risk of subsequent primary cancers after cancer of the small intestine, both sexes,

<50 years of age, SEER 1973-2000.

88 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

SMALL INTESTINE

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,022 803 389 207 1,022

Person-years in interval 747 2,177 1,465 1,260 5,648

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 2,843 PYR and for male cancers on 2,805 PYR.
Small Intestine

Both Sexes, ≥50 Years of Age

Table 4.3.6: Risk of subsequent primary cancers after cancer of the small intestine, both sexes,

≥50 years of age, SEER 1973-2000.

SMALL INTESTINE

All subsequent cancers 60 1.15 150 1.00 88 0.98 65 1.04 363 353.43 1.03 5.27

All excluding same site 60 1.15 145 0.97 87 0.98 65 1.05 357 352.29 1.01 2.60

Buccal cavity, pharynx 0 0.00 4 1.10 3 1.47 1 0.79 8 8.29 0.97 -0.16

Lip 0 0.00 1 1.92 0 0.00 0 0.00 1 1.21 0.83 -0.12

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 1.66 0.00 -0.91

Salivary gland 0 0.00 0 0.00 1 5.11 0 0.00 1 0.77 1.30 0.13

Mouth 0 0.00 0 0.00 1 1.85 1 2.98 2 2.22 0.90 -0.12

Nasopharynx 0 0.00 0 0.00 1 13.84 0 0.00 1 0.30 3.31 0.38

Tonsil 0 0.00 1 2.97 0 0.00 0 0.00 1 0.74 1.35 0.14

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.13

Hypopharynx 0 0.00 1 2.69 0 0.00 0 0.00 1 0.84 1.20 0.09

Digestive system 12 1.01 34 1.02 19 0.95 18 1.29 83 79.33 1.05 2.02

Esophagus 1 1.69 0 0.00 0 0.00 0 0.00 1 3.89 0.26 -1.59

Stomach 0 0.00 0 0.00 0 0.00 1 0.74 1 7.83 0.13* -3.76

Small intestine 0 0.00 5 10.48* 1 3.49 0 0.00 6 1.14 5.25* 2.67

Colon 6 1.11 18 1.17 8 0.86 9 1.36 41 36.78 1.11 2.32

Rectum, rectosigmoid junction 2 0.99 5 0.90 3 0.92 3 1.40 13 13.00 1.00 0.00

Anus, anal canal 0 0.00 1 3.25 1 5.58 1 8.28 3 0.72 4.19 1.26

Liver 1 2.55 1 0.90 0 0.00 1 2.14 3 2.63 1.14 0.20

Gallbladder 1 5.89 0 0.00 1 3.65 0 0.00 2 1.11 1.81 0.49

Bile ducts, other biliary 0 0.00 1 1.38 3 6.66* 1 2.94 5 1.76 2.84 1.78

Pancreas 1 0.69 3 0.73 2 0.82 2 1.16 8 9.70 0.82 -0.94

Respiratory system 12 1.32 19 0.74 11 0.72 6 0.58 48 60.43 0.79 -6.84

Nose, nasal cavity, ear 0 0.00 0 0.00 1 8.03 0 0.00 1 0.50 2.01 0.28

Larynx 1 1.66 1 0.61 0 0.00 0 0.00 2 3.72 0.54 -0.95

Lung, bronchus 11 1.31 18 0.76 10 0.71 6 0.62 45 56.07 0.80 -6.10

Female breast 4 0.71 13 0.81 4 0.45 5 0.80 26 36.93 0.70 -11.98

Female genital system 0 0.00 7 0.97 2 0.51 3 1.17 12 16.21 0.74 -4.62

Cervix uteri 0 0.00 1 1.40 0 0.00 0 0.00 1 1.55 0.65 -0.60

Corpus uteri 0 0.00 3 0.81 2 1.00 2 1.53 7 8.36 0.84 -1.49

Ovary 0 0.00 3 1.42 0 0.00 1 1.25 4 4.82 0.83 -0.90

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.30

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -0.91

Male genital system 13 1.31 33 1.12 26 1.38 16 1.18 88 72.03 1.22 17.69

Prostate 13 1.32 31 1.06 26 1.39 16 1.18 86 71.47 1.20 16.09

Testis 0 0.00 2 32.02* 0 0.00 0 0.00 2 0.13 15.43* 2.07

Urinary system 10 2.49* 15 1.30 11 1.55 5 1.00 41 27.60 1.49* 7.38

Urinary bladder 6 2.18 6 0.76 8 1.62 3 0.86 23 19.11 1.20 2.14

Kidney parenchyma 4 3.97* 6 2.09 3 1.75 1 0.85 14 6.76 2.07* 3.98

Renal pelvis, other urinary 0 0.00 3 4.14 0 0.00 1 3.27 4 1.73 2.32 1.25

Ureter 0 0.00 1 4.21 0 0.00 1 10.05 2 0.56 3.54 0.79

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.15

Soft tissue including heart 0 0.00 0 0.00 1 3.05 0 0.00 1 1.32 0.76 -0.17

Kaposi sarcoma 0 0.00 1 8.33 0 0.00 0 0.00 1 0.28 3.62 0.40

Melanoma of skin 3 2.91 5 1.66 1 0.55 2 1.56 11 7.15 1.54 2.12

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.47 0.00 -0.26

Brain, central nervous system 0 0.00 2 1.41 0 0.00 1 1.85 3 3.28 0.91 -0.16

Thyroid 2 7.82 1 1.43 0 0.00 0 0.00 3 1.56 1.92 0.79

Lymphatic, hematopoietic 4 1.04 9 0.82 7 1.05 5 1.05 25 26.31 0.95 -0.72

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.69 0.00 -0.38

Non-Hodgkin lymphoma 2 1.18 3 0.61 2 0.67 2 0.92 9 11.77 0.76 -1.53

Myeloma 0 0.00 3 1.50 2 1.67 0 0.00 5 4.75 1.05 0.14

Leukemia 2 1.49 3 0.79 3 1.30 3 1.84 11 9.10 1.21 1.05

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.13

Chronic lymphocytic 1 1.85 2 1.30 1 1.08 1 1.54 5 3.66 1.37 0.74

Acute non-lymphocytic 1 2.22 1 0.77 0 0.00 1 1.76 3 3.09 0.97 -0.05

Chronic myeloid 0 0.00 0 0.00 2 6.41 1 4.50 3 1.23 2.44 0.98

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,410 3,213 1,337 534 4,410

Person-years in interval 3,054 8,167 4,313 2,626 18,161

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 9,129 PYR and for male cancers on 9,032 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 89
All subsequent cancers 23 1.19 55 1.35* 28 1.07 31 1.32 137 109.60 1.25* 41.59

All excluding same site 23 1.20 51 1.26 27 1.03 30 1.29 131 109.24 1.20* 33.03

Buccal cavity, pharynx 0 0.00 1 0.98 1 1.64 1 2.03 3 2.62 1.14 0.57

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.57

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.53 0.00 -0.80

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.36

Mouth 0 0.00 0 0.00 1 6.22 1 7.55 2 0.70 2.85 1.97

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.16

Tonsil 0 0.00 1 10.40 0 0.00 0 0.00 1 0.24 4.13 1.15

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.11

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.40

Digestive system 8 1.80 24 2.60* 9 1.54 9 1.70 50 24.81 2.01* 38.23

Esophagus 1 4.56 0 0.00 0 0.00 0 0.00 1 1.19 0.84 -0.29

Stomach 0 0.00 2 2.11 0 0.00 0 0.00 2 2.49 0.80 -0.75

Small intestine 0 0.00 4 30.61* 1 11.85 1 12.51 6 0.36 16.72* 8.56

Colon 6 2.97* 13 3.08* 5 1.84 6 2.39 30 11.46 2.62* 28.14

Rectum, rectosigmoid junction 0 0.00 4 2.58 0 0.00 2 2.43 6 4.09 1.47 2.90

Anus, anal canal 0 0.00 0 0.00 1 18.56 0 0.00 1 0.23 4.41 1.17

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -1.26

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.54

Bile ducts, other biliary 0 0.00 0 0.00 2 15.39* 0 0.00 2 0.54 3.68 2.21

Pancreas 1 1.84 1 0.89 0 0.00 0 0.00 2 3.03 0.66 -1.56

Respiratory system 5 1.51 7 1.01 3 0.69 4 1.05 19 18.44 1.03 0.85

Nose, nasal cavity, ear 0 0.00 0 0.00 1 26.42 0 0.00 1 0.16 6.30 1.28

Larynx 0 0.00 1 2.22 0 0.00 0 0.00 1 1.15 0.87 -0.23

Lung, bronchus 5 1.63 6 0.94 2 0.49 4 1.12 17 17.08 1.00 -0.13

Female breast 2 0.96 1 0.22 1 0.37 2 0.76 6 11.92 0.50 -18.06

Female genital system 0 0.00 7 3.42* 1 0.84 1 0.93 9 5.28 1.70 11.33

Cervix uteri 0 0.00 2 8.03 0 0.00 0 0.00 2 0.59 3.38 4.29

Corpus uteri 0 0.00 2 1.94 1 1.67 1 1.85 4 2.66 1.50 4.09

Ovary 0 0.00 3 5.10* 0 0.00 0 0.00 3 1.55 1.93 4.41

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.28

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.80

Male genital system 2 0.56 7 0.90 6 1.10 5 1.08 20 21.42 0.93 -4.29

Prostate 2 0.57 7 0.91 6 1.11 5 1.08 20 21.21 0.94 -3.66

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.23

Urinary system 5 3.40* 2 0.65 3 1.44 3 1.64 13 8.48 1.53 6.87

Urinary bladder 4 3.98* 2 0.94 2 1.39 2 1.58 10 5.83 1.71 6.32

Kidney parenchyma 1 2.71 0 0.00 1 1.96 0 0.00 2 2.11 0.95 -0.16

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 8.94 1 0.53 1.87 0.71

Ureter 0 0.00 0 0.00 0 0.00 1 27.32 1 0.17 5.72 1.25

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.14

Soft tissue including heart 0 0.00 0 0.00 0 0.00 1 11.16 1 0.42 2.37 0.88

Kaposi sarcoma 0 0.00 1 18.02 0 0.00 0 0.00 1 0.14 7.28 1.31

Melanoma of skin 0 0.00 1 1.23 0 0.00 2 3.94 3 2.26 1.33 1.12

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.22

Brain, central nervous system 0 0.00 0 0.00 0 0.00 1 4.66 1 1.05 0.95 -0.08

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.84

Lymphatic, hematopoietic 1 0.70 3 1.00 4 2.04 0 0.00 8 8.23 0.97 -0.35

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.36

Non-Hodgkin lymphoma 1 1.60 2 1.51 4 4.53* 0 0.00 7 3.68 1.90 5.05

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.48 0.00 -2.25

Leukemia 0 0.00 1 0.96 0 0.00 0 0.00 1 2.83 0.35 -2.78

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.12

Chronic lymphocytic 0 0.00 1 2.41 0 0.00 0 0.00 1 1.12 0.89 -0.19

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.97 0.00 -1.47

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.59

Small Intestine

Adenocarcinoma, Both Sexes

Table 4.3.7: Risk of subsequent primary cancers after adenocarcinoma of the small intestine,

both sexes, SEER 1973-2000.

90 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

SMALL INTESTINE

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,110 1,247 418 209 2,110

Person-years in interval 1,308 2,631 1,486 1,162 6,587

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 3,281 PYR and for male cancers on 3,306 PYR.
LIVER

Liver

Both Sexes

Table 4.4.1: Characteristics of patients with an initial cancer of the liver or intrahepatic bile duct,

both sexes, SEER 1973-2000.

Number of patients with 1st primary cancer

Total 7,511 100.0 3,989 100.0 11,500 100.0

Initial treatment

Any radiation 875 11.6 450 11.3 1,325 11.5

With surgery 100 1.3 74 1.9 174 1.5

Without surgery 775 10.3 376 9.4 1,151 10.0

No radiation 6,636 88.4 3,539 88.7 10,175 88.5

With surgery 1,023 13.6 674 16.9 1,697 14.8

Without surgery 5,613 74.7 2,865 71.8 8,478 73.7

Race

White 4,813 64.1 2,862 71.7 7,675 66.7

Black 855 11.4 366 9.2 1,221 10.6

Other 1,832 24.4 756 19.0 2,588 22.5

Unknown 11 0.1 5 0.1 16 0.1

Age at 1st primary cancer diagnosis, years

< 30 243 3.2 211 5.3 454 3.9

30–49 1,047 13.9 436 10.9 1,483 12.9

50–69 3,708 49.4 1,456 36.5 5,164 44.9

70–79 1,846 24.6 1,179 29.6 3,025 26.3

> 80 667 8.9 707 17.7 1,374 11.9

Number of patients with one or more

primary cancers

One primary cancer only 7,408 98.6 3,937 98.7 11,345 98.7

1st and 2nd cancers 96 1.3 46 1.2 142 1.2

1st, 2nd, and 3rd cancers 7 0.1 6 0.2 13 0.1

1st, 2nd, 3rd, and additional cancers 0 0.0 0 0.0 0 0.0

Other statistics

Median age at 1st cancer diagnosis 64.6 — 68.8 — 65.8 —

Median year of 1st cancer diagnosis 1992.8 — 1992.0 — 1992.5 —

Median person-years at risk 0.3 — 0.4 — 0.3 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 85.4 — 86.5 — 85.8

1st, 2nd, and additional cancers — 85.4 — 86.5 — 85.8

1st cancer only — 3.9 — 7.7 — 5.2

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 91

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 67 0.99 65 0.98 21 1.29 15 1.64 168 159.83 1.05 6.60

All excluding same site 67 1.00 64 0.98 21 1.31 14 1.55 166 157.62 1.05 6.78

Buccal cavity, pharynx 3 1.70 4 2.43 0 0.00 0 0.00 7 3.97 1.76 2.45

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.38

Tongue 1 2.84 1 3.00 0 0.00 0 0.00 2 0.80 2.50 0.97

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.29

Mouth 1 2.27 3 7.28* 0 0.00 0 0.00 4 1.00 3.99* 2.42

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.24

Tonsil 1 6.05 0 0.00 0 0.00 0 0.00 1 0.37 2.71 0.51

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.09

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.34

Digestive system 12 0.76 13 0.85 5 1.34 3 1.44 33 36.97 0.89 -3.21

Esophagus 1 1.20 2 2.55 2 11.48* 0 0.00 5 1.88 2.67 2.53

Stomach 1 0.53 1 0.54 0 0.00 0 0.00 2 4.37 0.46 -1.91

Small intestine 1 4.72 1 4.80 0 0.00 0 0.00 2 0.51 3.96 1.21

Colon 5 0.74 4 0.61 3 1.82 1 1.05 13 15.83 0.82 -2.29

Rectum, rectosigmoid junction 1 0.38 1 0.40 0 0.00 0 0.00 2 6.06 0.33 -3.28

Anus, anal canal 0 0.00 1 7.92 0 0.00 0 0.00 1 0.31 3.24 0.56

Liver 0 0.00 1 1.20 0 0.00 1 11.54 2 1.92 1.04 0.06

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.52 0.00 -0.42

Bile ducts, other biliary 1 2.65 0 0.00 0 0.00 0 0.00 1 0.91 1.10 0.08

Pancreas 2 1.09 2 1.12 0 0.00 1 3.79 5 4.34 1.15 0.54

Respiratory system 13 1.10 8 0.71 3 1.14 4 2.81 28 27.12 1.03 0.71

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.20

Larynx 1 1.29 2 2.86 0 0.00 0 0.00 3 1.69 1.78 1.06

Lung, bronchus 12 1.10 6 0.58 3 1.22 4 2.99 25 25.11 1.00 -0.09

Female breast 4 0.77 6 1.02 3 1.50 3 1.82 16 14.74 1.09 2.32

Female genital system 1 0.43 4 1.55 3 3.43 0 0.00 8 6.45 1.24 2.87

Cervix uteri 0 0.00 1 3.07 0 0.00 0 0.00 1 0.81 1.24 0.36

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 3.17 0.00 -5.86

Ovary 1 1.48 3 3.95 2 7.63 0 0.00 6 1.91 3.15* 7.57

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.19

Vulva 0 0.00 0 0.00 1 23.32 0 0.00 1 0.31 3.23 1.28

Male genital system 14 0.89 10 0.68 0 0.00 1 0.90 25 34.56 0.72 -13.74

Prostate 14 0.90 10 0.68 0 0.00 1 0.91 25 34.19 0.73 -13.21

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.22

Urinary system 9 1.69 7 1.39 2 1.73 0 0.00 18 12.10 1.49 4.77

Urinary bladder 2 0.55 5 1.47 2 2.59 0 0.00 9 8.18 1.10 0.67

Kidney parenchyma 6 4.40* 2 1.51 0 0.00 0 0.00 8 3.16 2.53* 3.91

Renal pelvis, other urinary 1 3.00 0 0.00 0 0.00 0 0.00 1 0.76 1.31 0.19

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.21

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.11

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.66 0.00 -0.53

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.16

Melanoma of skin 0 0.00 0 0.00 0 0.00 1 5.16 1 3.21 0.31 -1.79

Eye, orbit 0 0.00 0 0.00 1 49.13 0 0.00 1 0.20 5.07 0.65

Brain, central nervous system 1 1.57 1 1.59 0 0.00 0 0.00 2 1.53 1.31 0.38

Thyroid 1 2.57 4 9.67* 1 8.69 0 0.00 6 1.00 6.01* 4.05

Lymphatic, hematopoietic 6 1.20 8 1.64 2 1.62 2 2.82 18 11.82 1.52 5.00

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.30

Non-Hodgkin lymphoma 3 1.32 2 0.88 1 1.74 1 2.97 7 5.46 1.28 1.25

Myeloma 2 2.28 3 3.56 0 0.00 0 0.00 5 2.05 2.44 2.39

Leukemia 1 0.59 3 1.84 1 2.47 1 4.53 6 3.94 1.52 1.67

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.13

Chronic lymphocytic 0 0.00 0 0.00 1 6.96 0 0.00 1 1.43 0.70 -0.34

Acute non-lymphocytic 0 0.00 3 5.13* 0 0.00 1 12.29 4 1.41 2.84 2.10

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.45

Liver

Both Sexes

Table 4.4.2: Risk of subsequent primary cancers after cancer of the liver or intrahepatic bile duct,

both sexes, SEER 1973-2000.

92 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LIVER

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 11,500 3,414 498 200 11,500

Person-years in interval 4,644 5,059 1,594 1,066 12,363

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 5,409 PYR and for male cancers on 6,954 PYR.
Liver

Females

Table 4.4.3: Risk of subsequent primary cancers after cancer of the liver or intrahepatic bile duct,

females, SEER 1973-2000.

LIVER

All subsequent cancers 15 0.79 21 0.99 11 1.52 11 1.85 58 53.17 1.09 8.93

All excluding same site 15 0.80 21 1.00 11 1.54 11 1.87 58 52.68 1.10 9.84

Buccal cavity, pharynx 0 0.00 1 2.72 0 0.00 0 0.00 1 0.92 1.08 0.14

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.11

Tongue 0 0.00 1 12.07 0 0.00 0 0.00 1 0.21 4.81 1.46

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.19

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.58

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.10

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.14

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.04

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.11

Digestive system 4 0.86 3 0.59 3 1.73 2 1.43 12 12.92 0.93 -1.69

Esophagus 0 0.00 1 7.48 0 0.00 0 0.00 1 0.34 2.93 1.22

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 1.21 0.00 -2.24

Small intestine 1 15.78 0 0.00 0 0.00 0 0.00 1 0.18 5.54 1.51

Colon 3 1.33 1 0.41 3 3.56 1 1.48 8 6.23 1.28 3.27

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 0 0.00 0 1.91 0.00 -3.53

Rectum 0 0.00 0 0.00 0 0.00 0 0.00 0 1.27 0.00 -2.34

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.29

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.72

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.55

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.60

Pancreas 0 0.00 1 1.50 0 0.00 1 5.36 2 1.70 1.18 0.56

Respiratory system 1 0.40 3 1.07 1 1.03 3 3.61 8 7.10 1.13 1.67

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.14

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.38

Lung, bronchus 1 0.42 3 1.12 1 1.08 3 3.77 8 6.79 1.18 2.23

Female breast 4 0.77 6 1.02 3 1.50 3 1.82 16 14.74 1.09 2.32

Female genital system 1 0.43 4 1.55 3 3.43 0 0.00 8 6.45 1.24 2.87

Cervix uteri 0 0.00 1 3.07 0 0.00 0 0.00 1 0.81 1.24 0.36

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 3.17 0.00 -5.86

Ovary 1 1.48 3 3.95 2 7.63 0 0.00 6 1.91 3.15* 7.57

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.19

Vulva 0 0.00 0 0.00 1 23.32 0 0.00 1 0.31 3.23 1.28

Urinary system 1 1.11 2 2.00 0 0.00 0 0.00 3 2.53 1.19 0.87

Urinary bladder 0 0.00 1 1.72 0 0.00 0 0.00 1 1.47 0.68 -0.88

Kidney parenchyma 1 3.38 1 3.00 0 0.00 0 0.00 2 0.84 2.38 2.14

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.40

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.13

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.10

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.42

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.04

Melanoma of skin 0 0.00 0 0.00 0 0.00 1 8.02 1 0.99 1.01 0.03

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.13

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.53 0.00 -0.99

Thyroid 1 5.22 2 8.76 0 0.00 0 0.00 3 0.57 5.29* 4.50

Lymphatic, hematopoietic 2 1.37 0 0.00 1 1.75 1 2.14 4 4.13 0.97 -0.25

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.25

Non-Hodgkin lymphoma 2 2.83 0 0.00 1 3.64 0 0.00 3 2.00 1.50 1.85

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.72 0.00 -1.34

Leukemia 0 0.00 0 0.00 0 0.00 1 7.09 1 1.27 0.78 -0.51

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.11

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.83

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 1 18.94 1 0.47 2.12 0.98

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.33

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,989 1,325 253 117 3,989

Person-years in interval 1,712 2,175 866 657 5,409

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 93
All subsequent cancers 52 1.06 44 0.97 10 1.10 4 1.24 110 106.66 1.03 4.80

All excluding same site 52 1.08 43 0.97 10 1.12 3 0.94 108 104.95 1.03 4.39

Buccal cavity, pharynx 3 2.09 3 2.34 0 0.00 0 0.00 6 3.05 1.97 4.24

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.60

Tongue 1 3.59 0 0.00 0 0.00 0 0.00 1 0.59 1.68 0.58

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.36

Mouth 1 3.04 3 10.41* 0 0.00 0 0.00 4 0.69 5.79* 4.76

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.35

Tonsil 1 7.20 0 0.00 0 0.00 0 0.00 1 0.29 3.41 1.02

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.13

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.53

Digestive system 8 0.72 10 0.97 2 1.00 1 1.46 21 24.05 0.87 -4.39

Esophagus 1 1.40 1 1.54 2 15.70* 0 0.00 4 1.54 2.61 3.54

Stomach 1 0.69 1 0.74 0 0.00 0 0.00 2 3.16 0.63 -1.66

Small intestine 0 0.00 1 7.27 0 0.00 0 0.00 1 0.32 3.08 0.97

Colon 2 0.45 3 0.74 0 0.00 0 0.00 5 9.59 0.52 -6.60

Rectum, rectosigmoid junction 1 0.52 1 0.57 0 0.00 0 0.00 2 4.14 0.48 -3.08

Anus, anal canal 0 0.00 1 15.70 0 0.00 0 0.00 1 0.15 6.66 1.22

Liver 0 0.00 1 1.48 0 0.00 1 22.42 2 1.53 1.31 0.68

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.32

Bile ducts, other biliary 1 3.82 0 0.00 0 0.00 0 0.00 1 0.58 1.72 0.60

Pancreas 2 1.63 1 0.89 0 0.00 0 0.00 3 2.64 1.14 0.52

Respiratory system 12 1.29 5 0.59 2 1.20 1 1.69 20 20.02 1.00 -0.04

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.25

Larynx 1 1.43 2 3.23 0 0.00 0 0.00 3 1.48 2.02 2.18

Lung, bronchus 11 1.29 3 0.39 2 1.31 1 1.84 17 18.32 0.93 -1.90

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.27

Male genital system 14 0.89 10 0.68 0 0.00 1 0.90 25 34.56 0.72 -13.74

Prostate 14 0.90 10 0.68 0 0.00 1 0.91 25 34.19 0.73 -13.21

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.22

Urinary system 8 1.80 5 1.24 2 2.45 0 0.00 15 9.57 1.57 7.81

Urinary bladder 2 0.64 4 1.42 2 3.50 0 0.00 8 6.70 1.19 1.87

Kidney parenchyma 5 4.69* 1 1.01 0 0.00 0 0.00 6 2.32 2.58 5.29

Renal pelvis, other urinary 1 3.93 0 0.00 0 0.00 0 0.00 1 0.55 1.83 0.65

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.27

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.13

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.62

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.25

Melanoma of skin 0 0.00 0 0.00 0 0.00 0 0.00 0 2.23 0.00 -3.20

Eye, orbit 0 0.00 0 0.00 1 94.57* 0 0.00 1 0.13 7.93 1.26

Brain, central nervous system 1 2.21 1 2.39 0 0.00 0 0.00 2 0.99 2.01 1.45

Thyroid 0 0.00 2 10.79* 1 27.39 0 0.00 3 0.43 6.96* 3.69

Lymphatic, hematopoietic 4 1.14 8 2.46* 1 1.51 1 4.14 14 7.68 1.82 9.08

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.34

Non-Hodgkin lymphoma 1 0.64 2 1.35 0 0.00 1 9.21 4 3.46 1.16 0.78

Myeloma 2 3.25 3 5.37* 0 0.00 0 0.00 5 1.32 3.77* 5.28

Leukemia 1 0.81 3 2.67 1 4.38 0 0.00 5 2.66 1.88 3.36

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.15

Chronic lymphocytic 0 0.00 0 0.00 1 12.28 0 0.00 1 0.98 1.03 0.04

Acute non-lymphocytic 0 0.00 3 7.53* 0 0.00 0 0.00 3 0.94 3.20 2.97

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.54

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 7,511 2,089 245 83 7,511

Person-years in interval 2,932 2,884 729 410 6,954

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Liver

Males

Table 4.4.4: Risk of subsequent primary cancers after cancer of the liver or intrahepatic bile duct,

males, SEER 1973-2000.

94 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LIVER

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Liver

Both Sexes, <50 Years of Age

Table 4.4.5: Risk of subsequent primary cancers after cancer of the liver or intrahepatic bile duct, both sexes,

<50 years of age, SEER 1973-2000.

LIVER

All subsequent cancers 4 2.44 12 4.89* 1 0.84 6 2.97* 23 7.31 3.15* 39.57

All excluding same site 4 2.49 11 4.56* 1 0.85 6 3.00* 22 7.20 3.05* 37.32

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.62

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.03

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.13

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.06

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.13

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.10

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.08

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.02

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.05

Digestive system 1 3.78 5 13.64* 0 0.00 1 3.14 7 1.11 6.29* 14.85

Esophagus 0 0.00 1 44.69 0 0.00 0 0.00 1 0.06 15.82 2.36

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.29

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.07

Colon 1 12.08 2 16.64* 0 0.00 1 7.50 4 0.40 10.08* 9.09

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.54

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.06

Liver 0 0.00 1 25.99 0 0.00 0 0.00 1 0.10 10.08 2.27

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.03

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.06

Pancreas 0 0.00 1 26.84 0 0.00 0 0.00 1 0.12 8.37 2.22

Respiratory system 1 5.35 0 0.00 0 0.00 0 0.00 1 0.86 1.16 0.34

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.04

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.17

Lung, bronchus 1 6.19 0 0.00 0 0.00 0 0.00 1 0.77 1.29 0.57

Female breast 0 0.00 1 1.92 0 0.00 1 1.73 2 1.75 1.14 1.28

Female genital system 1 7.64 3 13.76* 0 0.00 0 0.00 4 0.73 5.47* 16.78

Cervix uteri 0 0.00 1 15.44 0 0.00 0 0.00 1 0.19 5.37 4.18

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -1.45

Ovary 1 25.46 2 30.14* 0 0.00 0 0.00 3 0.22 13.55* 14.26

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.04

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.11

Male genital system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -2.15

Prostate 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -1.69

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.42

Urinary system 0 0.00 2 14.81* 1 19.45 0 0.00 3 0.37 8.14* 6.64

Urinary bladder 0 0.00 1 16.17 1 41.02 0 0.00 2 0.17 11.46* 4.60

Kidney parenchyma 0 0.00 1 14.61 0 0.00 0 0.00 1 0.18 5.59 2.07

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.04

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 -0.01

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.07

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.17

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.20

Melanoma of skin 0 0.00 0 0.00 0 0.00 1 14.33 1 0.36 2.75 1.60

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.05

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.43

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.54

Lymphatic, hematopoietic 1 5.68 1 3.96 0 0.00 2 12.70* 4 0.70 5.75* 8.33

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.22

Non-Hodgkin lymphoma 1 11.39 0 0.00 0 0.00 1 13.95 2 0.32 6.17 4.23

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.17

Leukemia 0 0.00 1 11.81 0 0.00 1 22.66 2 0.22 9.24* 4.50

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.16

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.09

Acute non-lymphocytic 0 0.00 1 37.61 0 0.00 1 59.27 2 0.07 27.37* 4.86

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.08

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,937 807 204 114 1,937

Person-years in interval 946 1,521 791 707 3,965

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 1,948 PYR and for male cancers on 2,016 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 95
All subsequent cancers 63 0.95 53 0.83 20 1.32 9 1.26 145 152.52 0.95 -8.96

All excluding same site 63 0.96 53 0.84 20 1.34 8 1.13 144 150.42 0.96 -7.64

Buccal cavity, pharynx 3 1.77 4 2.57 0 0.00 0 0.00 7 3.73 1.88 3.90

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.55

Tongue 1 2.98 1 3.20 0 0.00 0 0.00 2 0.75 2.67 1.49

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.39

Mouth 1 2.35 3 7.64* 0 0.00 0 0.00 4 0.95 4.21* 3.63

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.31

Tonsil 1 6.48 0 0.00 0 0.00 0 0.00 1 0.34 2.98 0.79

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.13

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.48

Digestive system 11 0.71 8 0.53 5 1.40 2 1.13 26 35.86 0.73 -11.74

Esophagus 1 1.22 1 1.31 2 12.04* 0 0.00 4 1.81 2.21 2.60

Stomach 1 0.54 1 0.56 0 0.00 0 0.00 2 4.25 0.47 -2.68

Small intestine 1 4.88 1 5.02 0 0.00 0 0.00 2 0.48 4.18 1.81

Colon 4 0.60 2 0.31 3 1.89 0 0.00 9 15.43 0.58 -7.65

Rectum, rectosigmoid junction 1 0.39 1 0.41 0 0.00 0 0.00 2 5.84 0.34 -4.57

Anus, anal canal 0 0.00 1 8.46 0 0.00 0 0.00 1 0.28 3.51 0.85

Liver 0 0.00 0 0.00 0 0.00 1 14.38 1 1.82 0.55 -0.98

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.60

Bile ducts, other biliary 1 2.69 0 0.00 0 0.00 0 0.00 1 0.88 1.13 0.14

Pancreas 2 1.10 1 0.57 0 0.00 1 4.45 4 4.22 0.95 -0.26

Respiratory system 12 1.03 8 0.73 3 1.20 4 3.49 27 26.26 1.03 0.88

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.28

Larynx 1 1.33 2 2.96 0 0.00 0 0.00 3 1.62 1.85 1.64

Lung, bronchus 11 1.02 6 0.59 3 1.28 4 3.70 24 24.34 0.99 -0.41

Female breast 4 0.82 5 0.93 3 1.81 2 1.87 14 12.99 1.08 2.91

Female genital system 0 0.00 1 0.42 3 4.10 0 0.00 4 5.72 0.70 -4.96

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -1.79

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 2.89 0.00 -8.34

Ovary 0 0.00 1 1.44 2 9.15* 0 0.00 3 1.69 1.78 3.80

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.28

Vulva 0 0.00 0 0.00 1 25.62 0 0.00 1 0.29 3.46 2.05

Male genital system 14 0.90 10 0.69 0 0.00 1 0.98 25 34.12 0.73 -18.48

Prostate 14 0.91 10 0.69 0 0.00 1 0.99 25 33.85 0.74 -17.92

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.13

Urinary system 9 1.72 5 1.02 1 0.90 0 0.00 15 11.73 1.28 3.89

Urinary bladder 2 0.56 4 1.20 1 1.34 0 0.00 7 8.00 0.87 -1.19

Kidney parenchyma 6 4.57* 1 0.80 0 0.00 0 0.00 7 2.98 2.35 4.78

Renal pelvis, other urinary 1 3.03 0 0.00 0 0.00 0 0.00 1 0.75 1.34 0.30

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.30

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.14

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.70

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.14

Melanoma of skin 0 0.00 0 0.00 0 0.00 0 0.00 0 2.85 0.00 -3.39

Eye, orbit 0 0.00 0 0.00 1 55.81 0 0.00 1 0.18 5.59 0.98

Brain, central nervous system 1 1.68 1 1.77 0 0.00 0 0.00 2 1.36 1.47 0.77

Thyroid 1 2.99 4 11.93* 1 12.99 0 0.00 6 0.78 7.66* 6.21

Lymphatic, hematopoietic 5 1.04 7 1.51 2 1.78 0 0.00 14 11.12 1.26 3.43

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.34

Non-Hodgkin lymphoma 2 0.91 2 0.93 1 1.90 0 0.00 5 5.13 0.97 -0.16

Myeloma 2 2.32 3 3.65 0 0.00 0 0.00 5 1.98 2.52 3.59

Leukemia 1 0.61 2 1.30 1 2.71 0 0.00 4 3.72 1.08 0.33

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.12

Chronic lymphocytic 0 0.00 0 0.00 1 7.23 0 0.00 1 1.39 0.72 -0.47

Acute non-lymphocytic 0 0.00 2 3.58 0 0.00 0 0.00 2 1.34 1.50 0.79

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.52 0.00 -0.62

Liver

Both Sexes, ≥50 Years of Age

Table 4.4.6: Risk of subsequent primary cancers after cancer of the liver or intrahepatic bile duct, both sexes,

≥50 years of age, SEER 1973-2000.

96 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LIVER

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 9,563 2,607 294 86 9,563

Person-years in interval 3,697 3,538 804 359 8,398

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 3,461 PYR and for male cancers on 4,937 PYR.
GALLBLADDER

Gallbladder

Both Sexes

Table 4.5.1: Characteristics of patients with an initial cancer of the gallbladder, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 1,413 100.0 3,930 100.0 5,343 100.0

Initial treatment

Any radiation 268 19.0 705 17.9 973 18.2

With surgery 190 13.4 520 13.2 710 13.3

Without surgery 78 5.5 185 4.7 263 4.9

No radiation 1,145 81.0 3,225 82.1 4,370 81.8

With surgery 764 54.1 2,237 56.9 3,001 56.2

Without surgery 381 27.0 988 25.1 1,369 25.6

Race

White 1,125 79.6 3,339 85.0 4,464 83.5

Black 98 6.9 241 6.1 339 6.3

Other 189 13.4 345 8.8 534 10.0

Unknown 1 0.1 5 0.1 6 0.1

Age at 1st primary cancer diagnosis, years

< 30 1 0.1 5 0.1 6 0.1

30–49 79 5.6 191 4.9 270 5.1

50–69 603 42.7 1,467 37.3 2,070 38.7

70–79 484 34.3 1,286 32.7 1,770 33.1

> 80 246 17.4 981 25.0 1,227 23.0

Number of patients with one or more

primary cancers

One primary cancer only 1,356 96.0 3,832 97.5 5,188 97.1

1st and 2nd cancers 52 3.7 91 2.3 143 2.7

1st, 2nd, and 3rd cancers 5 0.4 7 0.2 12 0.2

1st, 2nd, 3rd, and additional cancers 0 0.0 0 0.0 0 0.0

Other statistics

Median age at 1st cancer diagnosis 70.5 — 72.4 — 71.8 —

Median year of 1st cancer diagnosis 1987.0 — 1987.0 — 1987.0 —

Median person-years at risk 0.4 — 0.4 — 0.4 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 91.2 — 84.7 — 87.1

1st, 2nd, and additional cancers — 91.2 — 84.7 — 87.1

1st cancer only — 7.0 — 15.3 — 12.3

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 97

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 41 1.09 65 1.10 43 1.31 18 0.80 167 152.46 1.10 16.15

All excluding same site 40 1.07 65 1.10 43 1.31 18 0.80 166 151.71 1.09 15.88

Buccal cavity, pharynx 1 1.23 0 0.00 0 0.00 0 0.00 1 3.13 0.32 -2.37

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.45

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -0.71

Salivary gland 1 12.68 0 0.00 0 0.00 0 0.00 1 0.32 3.11 0.75

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.93 0.00 -1.03

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.16

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.27

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.09

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.29

Digestive system 15 1.57 22 1.45 19 2.23* 7 1.24 63 38.89 1.62* 26.79

Esophagus 0 0.00 1 1.89 0 0.00 0 0.00 1 1.36 0.74 -0.40

Stomach 2 2.04 1 0.64 2 2.37 2 3.75 7 3.93 1.78 3.42

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.53

Colon 3 0.66 8 1.10 6 1.45 2 0.73 19 18.70 1.02 0.33

Rectum, rectosigmoid junction 1 0.65 4 1.66 1 0.78 1 1.23 7 6.04 1.16 1.06

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.40

Liver 1 3.64 0 0.00 1 3.98 1 5.57 3 1.16 2.59 2.05

Gallbladder 1 5.10 0 0.00 0 0.00 0 0.00 1 0.76 1.32 0.27

Bile ducts, other biliary 3 14.18* 4 11.47* 3 14.60* 1 6.72 11 0.91 12.03* 11.21

Pancreas 4 3.42 4 2.16 6 5.69* 0 0.00 14 4.78 2.93* 10.24

Respiratory system 5 0.91 6 0.70 5 1.06 0 0.00 16 22.18 0.72 -6.87

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.25

Larynx 0 0.00 0 0.00 1 4.70 0 0.00 1 1.06 0.94 -0.07

Lung, bronchus 5 0.97 6 0.74 4 0.90 0 0.00 15 20.84 0.72 -6.49

Female breast 6 0.95 5 0.51 4 0.72 1 0.27 16 25.32 0.63 -14.01

Female genital system 6 2.06 16 3.71* 2 0.86 2 1.33 26 11.06 2.35* 22.46

Cervix uteri 1 3.04 3 6.48* 0 0.00 0 0.00 4 1.15 3.48 4.29

Corpus uteri 1 0.68 5 2.34 0 0.00 1 1.37 7 5.45 1.28 2.33

Ovary 4 4.74* 8 6.25* 2 2.80 1 2.10 15 3.31 4.53* 17.57

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.31

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -0.98

Male genital system 4 0.95 3 0.43 6 1.59 3 1.04 16 17.85 0.90 -7.87

Prostate 4 0.96 3 0.43 6 1.60 3 1.05 16 17.69 0.90 -7.21

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.16

Urinary system 1 0.40 6 1.51 2 0.91 3 1.96 12 10.20 1.18 2.00

Urinary bladder 0 0.00 3 1.11 2 1.35 1 0.97 6 6.91 0.87 -1.01

Kidney parenchyma 0 0.00 2 2.04 0 0.00 1 2.55 3 2.54 1.18 0.51

Renal pelvis, other urinary 1 5.32 1 3.38 0 0.00 1 9.43 3 0.75 3.99 2.50

Ureter 0 0.00 1 10.07 0 0.00 0 0.00 1 0.25 4.01 0.83

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.14

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.66

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.13

Melanoma of skin 0 0.00 1 0.98 1 1.72 0 0.00 2 2.69 0.74 -0.76

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.22

Brain, central nervous system 0 0.00 0 0.00 0 0.00 1 5.20 1 1.35 0.74 -0.39

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.87 0.00 -0.96

Lymphatic, hematopoietic 2 0.69 5 1.09 4 1.53 1 0.55 12 11.94 1.00 0.07

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.34

Non-Hodgkin lymphoma 1 0.78 4 1.93 4 3.35 0 0.00 9 5.40 1.67 4.00

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 2.08 0.00 -2.31

Leukemia 1 0.98 1 0.62 0 0.00 1 1.63 3 4.16 0.72 -1.29

Acute lymphocytic 0 0.00 1 22.96 0 0.00 0 0.00 1 0.11 9.01 0.99

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.60 0.00 -1.78

Acute non-lymphocytic 1 2.85 0 0.00 0 0.00 1 4.63 2 1.44 1.39 0.62

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.63

Gallbladder

Both Sexes

Table 4.5.2: Risk of subsequent primary cancers after cancer of the gallbladder, both sexes,

SEER 1973-2000.

98 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

GALLBLADDER

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,343 1,830 554 248 5,343

Person-years in interval 2,371 3,559 1,862 1,207 8,999

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 6,652 PYR and for male cancers on 2,347 PYR.
Gallbladder

Females

Table 4.5.3: Risk of subsequent primary cancers after cancer of the gallbladder, females,

SEER 1973-2000.

GALLBLADDER

All subsequent cancers 26 1.09 43 1.16 27 1.26 9 0.63 105 96.85 1.08 12.25

All excluding same site 25 1.05 43 1.16 27 1.27 9 0.63 104 96.22 1.08 11.69

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.66 0.00 -2.50

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.20

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.55

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.29

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.89

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.11

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.18

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.14

Digestive system 10 1.57 11 1.09 13 2.22* 4 1.06 38 26.07 1.46* 17.93

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -0.95

Stomach 1 1.77 1 1.12 0 0.00 1 3.32 3 2.26 1.33 1.11

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.48

Colon 1 0.31 3 0.59 6 2.01 1 0.52 11 13.19 0.83 -3.29

Rectum, rectosigmoid junction 1 1.02 3 1.98 0 0.00 1 1.92 5 3.87 1.29 1.71

Rectum 0 0.00 3 3.00 0 0.00 1 2.83 4 2.56 1.56 2.17

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.44

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.87

Gallbladder 1 6.15 0 0.00 0 0.00 0 0.00 1 0.63 1.59 0.56

Bile ducts, other biliary 3 21.15* 2 8.59 2 13.97* 1 9.86 8 0.62 12.92* 11.10

Pancreas 3 3.68 2 1.55 5 6.56* 0 0.00 10 3.37 2.97* 9.97

Respiratory system 3 1.05 3 0.67 3 1.14 0 0.00 9 11.88 0.76 -4.33

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.21

Larynx 0 0.00 0 0.00 1 14.67 0 0.00 1 0.33 3.04 1.01

Lung, bronchus 3 1.10 3 0.70 2 0.79 0 0.00 8 11.38 0.70 -5.08

Female breast 6 0.95 5 0.51 4 0.72 1 0.27 16 25.32 0.63 -14.01

Female genital system 6 2.06 16 3.71* 2 0.86 2 1.33 26 11.06 2.35* 22.46

Cervix uteri 1 3.04 3 6.48* 0 0.00 0 0.00 4 1.15 3.48 4.29

Corpus uteri 1 0.68 5 2.34 0 0.00 1 1.37 7 5.45 1.28 2.33

Ovary 4 4.74* 8 6.25* 2 2.80 1 2.10 15 3.31 4.53* 17.57

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.31

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -0.98

Urinary system 1 0.83 5 2.64 1 0.90 0 0.00 7 4.95 1.41 3.08

Urinary bladder 0 0.00 2 1.70 1 1.45 0 0.00 3 3.06 0.98 -0.10

Kidney parenchyma 0 0.00 2 3.64 0 0.00 0 0.00 2 1.45 1.38 0.82

Renal pelvis, other urinary 1 9.28 1 5.90 0 0.00 0 0.00 2 0.44 4.57 2.35

Ureter 0 0.00 1 18.04 0 0.00 0 0.00 1 0.14 7.03 1.29

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.13

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.58

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.08

Melanoma of skin 0 0.00 1 1.63 1 2.71 0 0.00 2 1.64 1.22 0.54

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.20

Brain, central nervous system 0 0.00 0 0.00 0 0.00 1 7.78 1 0.89 1.12 0.17

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.70 0.00 -1.05

Lymphatic, hematopoietic 0 0.00 2 0.66 3 1.68 1 0.83 6 7.94 0.76 -2.92

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.30

Non-Hodgkin lymphoma 0 0.00 2 1.42 3 3.54 0 0.00 5 3.73 1.34 1.91

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.36 0.00 -2.04

Leukemia 0 0.00 0 0.00 0 0.00 1 2.52 1 2.65 0.38 -2.49

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.11

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.02 0.00 -1.53

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 1 7.13 1 0.93 1.08 0.11

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.55

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,930 1,348 406 189 3,930

Person-years in interval 1,746 2,602 1,399 905 6,652

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 99
All subsequent cancers 15 1.09 22 1.00 16 1.38 9 1.08 62 55.61 1.11 27.20

All excluding same site 15 1.10 22 1.00 16 1.39 9 1.09 62 55.49 1.12 27.75

Buccal cavity, pharynx 1 2.55 0 0.00 0 0.00 0 0.00 1 1.46 0.68 -1.98

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -1.15

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -1.15

Salivary gland 1 31.30 0 0.00 0 0.00 0 0.00 1 0.13 7.64 3.70

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -1.44

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.32

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.52

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.17

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.71

Digestive system 5 1.56 11 2.15* 6 2.26 3 1.63 25 12.82 1.95* 51.90

Esophagus 0 0.00 1 3.49 0 0.00 0 0.00 1 0.72 1.38 1.17

Stomach 1 2.42 0 0.00 2 5.82 1 4.32 4 1.67 2.40 9.95

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.67

Colon 2 1.47 5 2.29 0 0.00 1 1.24 8 5.51 1.45 10.62

Rectum, rectosigmoid junction 0 0.00 1 1.13 1 2.26 0 0.00 2 2.18 0.92 -0.76

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.30

Liver 1 7.34 0 0.00 1 8.26 1 10.85 3 0.58 5.20* 10.32

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.55

Bile ducts, other biliary 0 0.00 2 17.24* 1 16.05 0 0.00 3 0.30 10.16* 11.52

Pancreas 1 2.81 2 3.54 1 3.42 0 0.00 4 1.42 2.82 11.00

Respiratory system 2 0.76 3 0.73 2 0.95 0 0.00 7 10.30 0.68 -14.08

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.36

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.73 0.00 -3.12

Lung, bronchus 2 0.83 3 0.79 2 1.03 0 0.00 7 9.46 0.74 -10.49

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.43

Male genital system 4 0.95 3 0.43 6 1.59 3 1.04 16 17.85 0.90 -7.87

Prostate 4 0.96 3 0.43 6 1.60 3 1.05 16 17.69 0.90 -7.21

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.16

Urinary system 0 0.00 1 0.48 1 0.92 3 3.86 5 5.25 0.95 -1.05

Urinary bladder 0 0.00 1 0.66 1 1.26 1 1.75 3 3.84 0.78 -3.59

Kidney parenchyma 0 0.00 0 0.00 0 0.00 1 6.09 1 1.09 0.92 -0.38

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 23.29 1 0.31 3.19 2.92

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.46

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.17

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.87

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.30

Melanoma of skin 0 0.00 0 0.00 0 0.00 0 0.00 0 1.05 0.00 -4.46

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.28

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -1.96

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.71

Lymphatic, hematopoietic 2 2.02 3 1.90 1 1.21 0 0.00 6 4.00 1.50 8.52

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.45

Non-Hodgkin lymphoma 1 2.46 2 3.04 1 2.89 0 0.00 4 1.67 2.39 9.93

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.72 0.00 -3.08

Leukemia 1 2.64 1 1.68 0 0.00 0 0.00 2 1.50 1.33 2.11

Acute lymphocytic 0 0.00 1 64.55 0 0.00 0 0.00 1 0.04 26.10 4.10

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -2.50

Acute non-lymphocytic 1 7.87 0 0.00 0 0.00 0 0.00 1 0.51 1.95 2.07

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.87

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,413 482 148 59 1,413

Person-years in interval 624 957 464 302 2,347

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Gallbladder

Males

Table 4.5.4: Risk of subsequent primary cancers after cancer of the gallbladder, males,

SEER 1973-2000.

100 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

GALLBLADDER

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
OTHER BILIARY TRACT

Other Biliary Tract

Both Sexes

Table 4.6.1: Characteristics of patients with an initial cancer of the extrahepatic bile duct or other biliary tract,

both sexes, SEER 1973-2000.

Number of patients with 1st primary cancer

Total 2,817 100.0 2,681 100.0 5,498 100.0

Initial treatment

Any radiation 705 25.0 587 21.9 1,292 23.5

With surgery 323 11.5 226 8.4 549 10.0

Without surgery 382 13.6 361 13.5 743 13.5

No radiation 2,112 75.0 2,094 78.1 4,206 76.5

With surgery 1,057 37.5 874 32.6 1,931 35.1

Without surgery 1,055 37.5 1,220 45.5 2,275 41.4

Race

White 2,372 84.2 2,246 83.8 4,618 84.0

Black 137 4.9 157 5.9 294 5.3

Other 306 10.9 276 10.3 582 10.6

Unknown 2 0.1 2 0.1 4 0.1

Age at 1st primary cancer diagnosis, years

< 30 16 0.6 4 0.1 20 0.4

30–49 246 8.7 165 6.2 411 7.5

50–69 1,279 45.4 975 36.4 2,254 41.0

70–79 830 29.5 843 31.4 1,673 30.4

> 80 446 15.8 694 25.9 1,140 20.7

Number of patients with one or more

primary cancers

One primary cancer only 2,710 96.2 2,619 97.7 5,329 96.9

1st and 2nd cancers 102 3.6 61 2.3 163 3.0

1st, 2nd, and 3rd cancers 5 0.2 1 0.0 6 0.1

1st, 2nd, 3rd, and additional cancers 0 0.0 0 0.0 0 0.0

Other statistics

Median age at 1st cancer diagnosis 68.5 — 72.3 — 70.3 —

Median year of 1st cancer diagnosis 1988.4 — 1988.3 — 1988.4 —

Median person-years at risk 0.9 — 0.7 — 0.8 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 90.7 — 93.5 — 91.7

1st, 2nd, and additional cancers — 90.7 — 91.9 — 91.1

1st cancer only — 2.8 — 0.0 — 1.8

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 101

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 37 0.70* 73 0.88 46 1.23 19 0.63* 175 203.42 0.86* -24.89

All excluding same site 37 0.70* 73 0.88 45 1.20 18 0.60* 173 202.62 0.85* -25.94

Buccal cavity, pharynx 2 1.50 1 0.47 0 0.00 0 0.00 3 5.00 0.60 -1.75

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.78 0.00 -0.68

Tongue 1 3.88 1 2.41 0 0.00 0 0.00 2 0.98 2.03 0.89

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.40

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 1.31 0.00 -1.15

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.20

Tonsil 1 8.76 0 0.00 0 0.00 0 0.00 1 0.43 2.33 0.50

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.12

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.44

Digestive system 13 1.02 17 0.88 15 1.73 6 0.87 51 47.75 1.07 2.84

Esophagus 0 0.00 0 0.00 1 2.45 0 0.00 1 2.20 0.45 -1.05

Stomach 1 0.71 1 0.47 2 2.17 0 0.00 4 5.16 0.77 -1.02

Small intestine 0 0.00 2 7.96 0 0.00 1 10.32 3 0.62 4.82 2.08

Colon 6 1.04 6 0.68 7 1.77 3 0.94 22 21.71 1.01 0.25

Rectum, rectosigmoid junction 4 1.86 5 1.52 3 2.09 1 0.91 13 7.96 1.63 4.41

Anus, anal canal 1 9.55 0 0.00 0 0.00 0 0.00 1 0.40 2.51 0.53

Liver 0 0.00 1 1.43 0 0.00 0 0.00 1 1.73 0.58 -0.64

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.71 0.00 -0.62

Bile ducts, other biliary 0 0.00 0 0.00 1 4.81 1 5.54 2 1.12 1.78 0.77

Pancreas 1 0.66 2 0.87 1 0.96 0 0.00 4 5.68 0.70 -1.47

Respiratory system 1 0.11* 13 0.92 10 1.57 3 0.60 27 34.32 0.79 -6.41

Nose, nasal cavity, ear 0 0.00 0 0.00 2 36.35* 0 0.00 2 0.30 6.60 1.49

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 2.15 0.00 -1.89

Lung, bronchus 1 0.12* 13 1.00 8 1.36 3 0.64 25 31.78 0.79 -5.94

Female breast 5 0.97 5 0.62 4 1.15 2 0.84 16 19.13 0.84 -6.11

Female genital system 1 0.42 2 0.55 3 2.04 1 1.04 7 8.44 0.83 -2.81

Cervix uteri 0 0.00 0 0.00 1 6.81 1 11.77 2 0.90 2.23 2.15

Corpus uteri 1 0.83 0 0.00 0 0.00 0 0.00 1 4.23 0.24 -6.30

Ovary 0 0.00 2 1.87 2 4.47 0 0.00 4 2.51 1.60 2.92

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.29

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.88

Male genital system 7 0.69 12 0.74 7 0.89 3 0.42 29 41.23 0.70 -19.42

Prostate 7 0.70 12 0.75 7 0.90 3 0.43 29 40.85 0.71 -18.81

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.19

Urinary system 6 1.42 6 0.90 4 1.31 2 0.78 18 16.47 1.09 1.34

Urinary bladder 4 1.35 3 0.65 2 0.93 2 1.10 11 11.55 0.95 -0.48

Kidney parenchyma 1 1.03 3 1.90 2 2.75 0 0.00 6 3.86 1.55 1.87

Renal pelvis, other urinary 1 3.57 0 0.00 0 0.00 0 0.00 1 1.05 0.95 -0.05

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.31

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.14

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -0.69

Kaposi sarcoma 0 0.00 1 11.13 0 0.00 0 0.00 1 0.21 4.86 0.70

Melanoma of skin 0 0.00 1 0.59 0 0.00 2 3.00 3 4.20 0.71 -1.05

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.24

Brain, central nervous system 0 0.00 1 1.24 0 0.00 0 0.00 1 1.92 0.52 -0.81

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.99 0.00 -0.87

Lymphatic, hematopoietic 1 0.25 10 1.60 2 0.70 0 0.00 13 15.40 0.84 -2.10

Hodgkin lymphoma 0 0.00 1 5.44 0 0.00 0 0.00 1 0.43 2.32 0.50

Non-Hodgkin lymphoma 0 0.00 2 0.72 0 0.00 0 0.00 2 6.91 0.29 -4.30

Myeloma 0 0.00 3 2.81 0 0.00 0 0.00 3 2.63 1.14 0.32

Leukemia 1 0.70 4 1.82 2 2.02 0 0.00 7 5.42 1.29 1.38

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.13

Chronic lymphocytic 1 1.77 1 1.16 0 0.00 0 0.00 2 2.13 0.94 -0.11

Acute non-lymphocytic 0 0.00 1 1.33 2 5.85 0 0.00 3 1.86 1.61 0.99

Chronic myeloid 0 0.00 2 6.80 0 0.00 0 0.00 2 0.73 2.73 1.11

Other Biliary Tract

Both Sexes

Table 4.6.2: Risk of subsequent primary cancers after cancer of the extrahepatic bile duct or other biliary tract,

both sexes, SEER 1973-2000.

102 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

OTHER BILIARY TRACT

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,498 2,788 626 262 5,498

Person-years in interval 3,115 4,932 2,017 1,358 11,422

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 5,124 PYR and for male cancers on 6,298 PYR.
Other Biliary Tract

Females

Table 4.6.3: Risk of subsequent primary cancers after cancer of the extrahepatic bile duct or other biliary tract,

females, SEER 1973-2000.

OTHER BILIARY TRACT

All subsequent cancers 16 0.82 24 0.79 15 1.14 8 0.86 63 72.17 0.87 -17.90

All excluding same site 16 0.82 24 0.80 15 1.15 7 0.76 62 71.85 0.86 -19.22

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.25 0.00 -2.45

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.18

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.54

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.28

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.86

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.11

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.19

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.15

Digestive system 9 1.75 7 0.90 3 0.88 2 0.81 21 18.78 1.12 4.33

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.93

Stomach 1 2.15 0 0.00 0 0.00 0 0.00 1 1.66 0.60 -1.30

Small intestine 0 0.00 2 19.89* 0 0.00 0 0.00 2 0.24 8.21 3.43

Colon 5 1.95 3 0.78 2 1.17 1 0.80 11 9.36 1.17 3.19

Rectum, rectosigmoid junction 2 2.55 2 1.71 1 2.01 0 0.00 5 2.79 1.79 4.31

Rectum 2 3.90 2 2.61 1 3.05 0 0.00 5 1.84 2.72 6.18

Anus, anal canal 1 17.12 0 0.00 0 0.00 0 0.00 1 0.22 4.61 1.53

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.88

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.87

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 15.12 1 0.45 2.21 1.07

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 2.45 0.00 -4.77

Respiratory system 0 0.00 3 0.77 3 1.73 1 0.79 7 9.33 0.75 -4.55

Nose, nasal cavity, ear 0 0.00 0 0.00 2 105.32* 0 0.00 2 0.10 19.33* 3.70

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.52

Lung, bronchus 0 0.00 3 0.80 1 0.60 1 0.82 5 8.94 0.56 -7.69

Female breast 5 0.97 5 0.62 4 1.15 2 0.84 16 19.13 0.84 -6.11

Female genital system 1 0.42 2 0.55 3 2.04 1 1.04 7 8.44 0.83 -2.81

Cervix uteri 0 0.00 0 0.00 1 6.81 1 11.77 2 0.90 2.23 2.15

Corpus uteri 1 0.83 0 0.00 0 0.00 0 0.00 1 4.23 0.24 -6.30

Ovary 0 0.00 2 1.87 2 4.47 0 0.00 4 2.51 1.60 2.92

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.29

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.88

Urinary system 0 0.00 1 0.67 0 0.00 0 0.00 1 3.63 0.28 -5.13

Urinary bladder 0 0.00 0 0.00 0 0.00 0 0.00 0 2.20 0.00 -4.29

Kidney parenchyma 0 0.00 1 2.15 0 0.00 0 0.00 1 1.11 0.90 -0.21

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.62

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.20

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.12

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.56

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.06

Melanoma of skin 0 0.00 0 0.00 0 0.00 2 12.28* 2 1.22 1.64 1.52

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.19

Brain, central nervous system 0 0.00 1 3.41 0 0.00 0 0.00 1 0.69 1.46 0.61

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -1.08

Lymphatic, hematopoietic 0 0.00 3 1.26 2 1.88 0 0.00 5 5.80 0.86 -1.56

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.29

Non-Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 2.76 0.00 -5.38

Myeloma 0 0.00 2 4.73 0 0.00 0 0.00 2 1.02 1.97 1.92

Leukemia 0 0.00 1 1.30 2 5.86 0 0.00 3 1.87 1.60 2.20

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.10

Chronic lymphocytic 0 0.00 1 3.41 0 0.00 0 0.00 1 0.71 1.40 0.56

Acute non-lymphocytic 0 0.00 0 0.00 2 16.39* 0 0.00 2 0.67 2.99 2.60

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.50

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,681 1,265 283 112 2,681

Person-years in interval 1,455 2,228 889 552 5,124

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 103
All subsequent cancers 21 0.63* 49 0.93 31 1.27 11 0.53* 112 131.25 0.85 -30.57

All excluding same site 21 0.63* 49 0.93 30 1.23 11 0.53* 111 130.78 0.85 -31.40

Buccal cavity, pharynx 2 2.02 1 0.64 0 0.00 0 0.00 3 3.75 0.80 -1.18

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.69 0.00 -1.09

Tongue 1 5.48 1 3.36 0 0.00 0 0.00 2 0.71 2.82 2.05

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.51

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.87 0.00 -1.38

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.28

Tonsil 1 11.53 0 0.00 0 0.00 0 0.00 1 0.33 3.02 1.06

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.17

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.67

Digestive system 4 0.53 10 0.86 12 2.28* 4 0.90 30 28.97 1.04 1.64

Esophagus 0 0.00 0 0.00 1 3.11 0 0.00 1 1.73 0.58 -1.15

Stomach 0 0.00 1 0.71 2 3.21 0 0.00 3 3.50 0.86 -0.79

Small intestine 0 0.00 0 0.00 0 0.00 1 16.17 1 0.38 2.64 0.99

Colon 1 0.31 3 0.61 5 2.22 2 1.03 11 12.35 0.89 -2.14

Rectum, rectosigmoid junction 2 1.47 3 1.42 2 2.13 1 1.32 8 5.17 1.55 4.49

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.29

Liver 0 0.00 1 1.95 0 0.00 0 0.00 1 1.28 0.78 -0.44

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.42

Bile ducts, other biliary 0 0.00 0 0.00 1 8.17 0 0.00 1 0.67 1.49 0.52

Pancreas 1 1.18 2 1.53 1 1.71 0 0.00 4 3.23 1.24 1.22

Respiratory system 1 0.16* 10 0.98 7 1.51 2 0.54 20 24.99 0.80 -7.93

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.32

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.89 0.00 -3.00

Lung, bronchus 1 0.17* 10 1.07 7 1.65 2 0.58 20 22.84 0.88 -4.51

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.39

Male genital system 7 0.69 12 0.74 7 0.89 3 0.42 29 41.23 0.70 -19.42

Prostate 7 0.70 12 0.75 7 0.90 3 0.43 29 40.85 0.71 -18.81

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.19

Urinary system 6 1.85 5 0.97 4 1.67 2 0.97 17 12.84 1.32 6.60

Urinary bladder 4 1.68 3 0.81 2 1.15 2 1.31 11 9.35 1.18 2.62

Kidney parenchyma 1 1.47 2 1.79 2 3.83 0 0.00 5 2.75 1.82 3.57

Renal pelvis, other urinary 1 5.17 0 0.00 0 0.00 0 0.00 1 0.74 1.36 0.42

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.40

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.16

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.80

Kaposi sarcoma 0 0.00 1 13.05 0 0.00 0 0.00 1 0.17 5.80 1.31

Melanoma of skin 0 0.00 1 0.84 0 0.00 0 0.00 1 2.97 0.34 -3.14

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.28

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 1.24 0.00 -1.96

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.69

Lymphatic, hematopoietic 1 0.41 7 1.82 0 0.00 0 0.00 8 9.60 0.83 -2.54

Hodgkin lymphoma 0 0.00 1 8.40 0 0.00 0 0.00 1 0.28 3.56 1.14

Non-Hodgkin lymphoma 0 0.00 2 1.21 0 0.00 0 0.00 2 4.16 0.48 -3.42

Myeloma 0 0.00 1 1.55 0 0.00 0 0.00 1 1.61 0.62 -0.97

Leukemia 1 1.08 3 2.10 0 0.00 0 0.00 4 3.55 1.13 0.71

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.15

Chronic lymphocytic 1 2.72 0 0.00 0 0.00 0 0.00 1 1.41 0.71 -0.66

Acute non-lymphocytic 0 0.00 1 2.10 0 0.00 0 0.00 1 1.20 0.84 -0.31

Chronic myeloid 0 0.00 2 10.53* 0 0.00 0 0.00 2 0.48 4.19 2.42

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,817 1,523 343 150 2,817

Person-years in interval 1,660 2,704 1,128 805 6,298

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Other Biliary Tract

Males

Table 4.6.4: Risk of subsequent primary cancers after cancer of the extrahepatic bile duct or other biliary tract,

males, SEER 1973-2000.

104 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

OTHER BILIARY TRACT

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
PANCREAS

Pancreas

Both Sexes

Table 4.7.1: Characteristics of patients with an initial cancer of the pancreas, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 18,914 100.0 19,437 100.0 38,351 100.0

Initial treatment

Any radiation 4,602 24.3 4,014 20.7 8,616 22.5

With surgery 817 4.3 760 3.9 1,577 4.1

Without surgery 3,785 20.0 3,254 16.7 7,039 18.4

No radiation 14,312 75.7 15,423 79.3 29,735 77.5

With surgery 1,610 8.5 1,725 8.9 3,335 8.7

Without surgery 12,702 67.2 13,698 70.5 26,400 68.8

Race

White 15,717 83.1 16,192 83.3 31,909 83.2

Black 1,981 10.5 2,140 11.0 4,121 10.7

Other 1,196 6.3 1,083 5.6 2,279 5.9

Unknown 20 0.1 22 0.1 42 0.1

Age at 1st primary cancer diagnosis, years

< 30 40 0.2 72 0.4 112 0.3

30–49 1,699 9.0 1,168 6.0 2,867 7.5

50–69 9,799 51.8 7,833 40.3 17,632 46.0

70–79 5,262 27.8 6,187 31.8 11,449 29.9

> 80 2,114 11.2 4,177 21.5 6,291 16.4

Number of patients with one or more

primary cancers

One primary cancer only 18,705 98.9 19,288 99.2 37,993 99.1

1st and 2nd cancers 201 1.1 139 0.7 340 0.9

1st, 2nd, and 3rd cancers 7 0.0 10 0.1 17 0.0

1st, 2nd, 3rd, and additional cancers 1 0.0 0 0.0 1 0.0

Other statistics

Median age at 1st cancer diagnosis 66.8 — 71.0 — 68.8 —

Median year of 1st cancer diagnosis 1988.0 — 1988.5 — 1988.2 —

Median person-years at risk 0.3 — 0.3 — 0.3 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 79.9 — 75.2 — 77.9

1st, 2nd, and additional cancers — 79.9 — 74.5 — 77.7

1st cancer only — 2.4 — 5.4 — 3.6

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 105

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 141 0.59* 149 0.87 64 1.07 23 0.62* 377 505.82 0.75* -40.92

All excluding same site 140 0.61* 149 0.90 64 1.11 23 0.64* 376 491.26 0.77* -36.61

Buccal cavity, pharynx 1 0.16* 3 0.71 2 1.45 1 1.25 7 12.51 0.56 -1.75

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 1.83 0.00 -0.58

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 2.48 0.00 -0.79

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 1.11 0.00 -0.35

Mouth 0 0.00 2 1.74 0 0.00 1 4.61 3 3.39 0.88 -0.12

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.16

Tonsil 1 1.78 1 2.52 1 7.92 0 0.00 3 1.16 2.60 0.59

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.11

Hypopharynx 0 0.00 0 0.00 1 7.42 0 0.00 1 1.25 0.80 -0.08

Digestive system 35 0.62* 38 0.95 8 0.57 2 0.24* 83 118.59 0.70* -11.31

Esophagus 2 0.76 4 2.13 0 0.00 1 2.55 7 5.55 1.26 0.46

Stomach 7 1.19 3 0.72 3 2.06 1 1.17 14 12.38 1.13 0.52

Small intestine 2 2.74 5 9.31* 0 0.00 0 0.00 7 1.59 4.39* 1.72

Colon 17 0.66 16 0.87 3 0.46 0 0.00* 36 54.48 0.66* -5.87

Rectum, rectosigmoid junction 3 0.32* 9 1.36 2 0.91 0 0.00 14 19.58 0.72 -1.77

Anus, anal canal 1 2.00 1 2.73 0 0.00 0 0.00 2 1.07 1.87 0.29

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 3.87 0.00* -1.23

Gallbladder 1 1.15 0 0.00 0 0.00 0 0.00 1 1.80 0.56 -0.25

Bile ducts, other biliary 1 0.85 0 0.00 0 0.00 0 0.00 1 2.56 0.39 -0.50

Pancreas 1 0.15* 0 0.00* 0 0.00 0 0.00 1 14.57 0.07* -4.31

Respiratory system 14 0.35* 23 0.81 22 2.29* 6 1.01 65 84.26 0.77* -6.12

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.74 0.00 -0.24

Larynx 1 0.38 0 0.00 1 1.72 0 0.00 2 5.36 0.37 -1.07

Lung, bronchus 12 0.32* 23 0.87 21 2.35* 6 1.08 62 77.95 0.80 -5.07

Female breast 13 0.48* 25 1.27 5 0.71 4 0.93 47 57.95 0.81 -6.63

Female genital system 6 0.48 11 1.25 2 0.67 1 0.57 20 26.02 0.77 -3.65

Cervix uteri 1 0.69 0 0.00 0 0.00 0 0.00 1 3.06 0.33 -1.24

Corpus uteri 0 0.00* 2 0.46 1 0.69 0 0.00 3 12.97 0.23* -6.04

Ovary 4 1.12 8 3.10* 1 1.11 0 0.00 13 7.59 1.71 3.27

Vagina 1 4.68 0 0.00 0 0.00 0 0.00 1 0.46 2.20 0.33

Vulva 0 0.00 1 2.27 0 0.00 1 9.94 2 1.31 1.53 0.42

Male genital system 42 1.00 23 0.75 13 1.18 1 0.14* 79 91.21 0.87 -8.16

Prostate 42 1.01 22 0.72 12 1.10 1 0.14* 77 90.27 0.85 -8.87

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.22

Urinary system 8 0.44* 7 0.54 5 1.12 1 0.35 21 38.38 0.55* -5.52

Urinary bladder 4 0.32* 4 0.45 4 1.31 0 0.00 12 26.40 0.45* -4.58

Kidney parenchyma 4 0.90 2 0.62 1 0.90 1 1.39 8 9.46 0.85 -0.46

Renal pelvis, other urinary 0 0.00 1 1.18 0 0.00 0 0.00 1 2.51 0.40 -0.48

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.82 0.00 -0.26

Bone, joints 1 4.96 0 0.00 0 0.00 0 0.00 1 0.42 2.38 0.18

Soft tissue including heart 0 0.00 2 2.98 0 0.00 0 0.00 2 1.97 1.02 0.01

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.19

Melanoma of skin 3 0.67 1 0.30 0 0.00 2 2.49 6 9.88 0.61 -1.23

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.68 0.00 -0.22

Brain, central nervous system 0 0.00 2 1.23 0 0.00 0 0.00 2 4.78 0.42 -0.88

Thyroid 11 8.95* 0 0.00 1 3.10 0 0.00 12 2.68 4.48* 2.96

Lymphatic, hematopoietic 4 0.23* 8 0.62 6 1.33 5 1.76 23 38.01 0.61* -4.77

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.15 0.00 -0.36

Non-Hodgkin lymphoma 3 0.39 6 1.06 3 1.52 2 1.55 14 16.65 0.84 -0.84

Myeloma 0 0.00 0 0.00 0 0.00 1 1.93 1 6.87 0.15* -1.87

Leukemia 1 0.16* 2 0.44 3 1.90 2 2.08 8 13.34 0.60 -1.70

Acute lymphocytic 0 0.00 0 0.00 1 22.46 0 0.00 1 0.36 2.77 0.20

Chronic lymphocytic 1 0.40 1 0.56 0 0.00 0 0.00 2 5.30 0.38 -1.05

Acute non-lymphocytic 0 0.00 1 0.66 2 3.76 2 6.01 5 4.50 1.11 0.16

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.82 0.00 -0.58

Pancreas

Both Sexes

Table 4.7.2: Risk of subsequent primary cancers after cancer of the pancreas, both sexes,

SEER 1973-2000.

106 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

PANCREAS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 38,351 9,136 1,160 438 38,351

Person-years in interval 14,736 10,883 3,683 2,176 31,479

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 16,515 PYR and for male cancers on 14,964 PYR.
Pancreas

Females

Table 4.7.3: Risk of subsequent primary cancers after cancer of the pancreas, females,

SEER 1973-2000.

PANCREAS

All subsequent cancers 47 0.47* 72 0.99 27 1.04 13 0.82 159 214.06 0.74* -33.34

All excluding same site 46 0.48* 72 1.03 27 1.08 13 0.85 158 206.86 0.76* -29.59

Buccal cavity, pharynx 0 0.00 2 1.59 0 0.00 0 0.00 2 3.72 0.54 -1.04

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.16

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.81 0.00 -0.49

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.25

Mouth 0 0.00 2 4.54 0 0.00 0 0.00 2 1.31 1.53 0.42

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.09

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.19

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.15

Digestive system 12 0.47* 17 0.93 4 0.61 1 0.25 34 54.21 0.63* -12.24

Esophagus 1 1.45 2 4.00 0 0.00 0 0.00 3 1.48 2.02 0.92

Stomach 0 0.00 1 0.65 1 1.78 1 2.95 3 4.57 0.66 -0.95

Small intestine 1 3.04 2 8.13 0 0.00 0 0.00 3 0.73 4.10 1.37

Colon 7 0.55 9 0.99 1 0.30 0 0.00 17 27.14 0.63 -6.14

Rectum, rectosigmoid junction 0 0.00* 2 0.73 2 2.13 0 0.00 4 8.13 0.49 -2.50

Rectum 0 0.00 1 0.56 1 1.62 0 0.00 2 5.33 0.38 -2.02

Anus, anal canal 0 0.00 1 4.50 0 0.00 0 0.00 1 0.65 1.53 0.21

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 1.20 0.00 -0.73

Gallbladder 1 1.67 0 0.00 0 0.00 0 0.00 1 1.23 0.81 -0.14

Bile ducts, other biliary 1 1.83 0 0.00 0 0.00 0 0.00 1 1.20 0.84 -0.12

Pancreas 1 0.30 0 0.00 0 0.00 0 0.00 1 7.20 0.14* -3.76

Respiratory system 7 0.55 9 0.96 13 3.86* 4 1.88 33 27.47 1.20 3.35

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.18

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.85 0.00 -0.52

Lung, bronchus 7 0.58 9 1.01 13 4.03* 4 1.96 33 26.25 1.26 4.09

Female breast 13 0.48* 25 1.27 5 0.71 4 0.93 47 57.95 0.81 -6.63

Female genital system 6 0.48 11 1.25 2 0.67 1 0.57 20 26.02 0.77 -3.65

Cervix uteri 1 0.69 0 0.00 0 0.00 0 0.00 1 3.06 0.33 -1.24

Corpus uteri 0 0.00* 2 0.46 1 0.69 0 0.00 3 12.97 0.23* -6.04

Ovary 4 1.12 8 3.10* 1 1.11 0 0.00 13 7.59 1.71 3.27

Vagina 1 4.68 0 0.00 0 0.00 0 0.00 1 0.46 2.20 0.33

Vulva 0 0.00 1 2.27 0 0.00 1 9.94 2 1.31 1.53 0.42

Urinary system 1 0.20 1 0.28 1 0.78 0 0.00 3 10.58 0.28* -4.59

Urinary bladder 0 0.00 1 0.47 1 1.30 0 0.00 2 6.35 0.31 -2.64

Kidney parenchyma 1 0.66 0 0.00 0 0.00 0 0.00 1 3.32 0.30 -1.41

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.90 0.00 -0.55

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.17

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.11

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.86 0.00 -0.52

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.06

Melanoma of skin 2 1.21 0 0.00 0 0.00 2 7.09 4 3.66 1.09 0.21

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.18

Brain, central nervous system 0 0.00 2 2.87 0 0.00 0 0.00 2 2.05 0.98 -0.03

Thyroid 3 3.88 0 0.00 0 0.00 0 0.00 3 1.72 1.74 0.77

Lymphatic, hematopoietic 1 0.13* 3 0.52 2 0.96 1 0.78 7 16.92 0.41* -6.00

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.47 0.00 -0.29

Non-Hodgkin lymphoma 1 0.28 2 0.75 0 0.00 1 1.66 4 7.83 0.51 -2.32

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 3.15 0.00 -1.91

Leukemia 0 0.00 1 0.54 2 3.00 0 0.00 3 5.47 0.55 -1.49

Acute lymphocytic 0 0.00 0 0.00 1 50.49 0 0.00 1 0.15 6.48 0.51

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 2.11 0.00 -1.28

Acute non-lymphocytic 0 0.00 1 1.55 1 4.25 0 0.00 2 1.92 1.04 0.05

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.76 0.00 -0.46

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 19,437 4,700 629 255 19,437

Person-years in interval 7,549 5,711 2,055 1,199 16,515

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 107
All subsequent cancers 94 0.68* 77 0.78* 37 1.10 10 0.47* 218 291.76 0.75* -49.29

All excluding same site 94 0.70* 77 0.80 37 1.13 10 0.48* 218 284.40 0.77* -44.37

Buccal cavity, pharynx 1 0.23 1 0.33 2 2.11 1 1.83 5 8.79 0.57 -2.53

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 1.56 0.00 -1.04

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 1.67 0.00 -1.11

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.69 0.00 -0.46

Mouth 0 0.00 0 0.00 0 0.00 1 7.91 1 2.09 0.48 -0.73

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.23

Tonsil 1 2.44 1 3.45 1 10.97 0 0.00 3 0.84 3.55 1.44

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.17

Hypopharynx 0 0.00 0 0.00 1 9.26 0 0.00 1 1.01 0.99 0.00

Digestive system 23 0.75 21 0.96 4 0.54 1 0.22 49 64.38 0.76 -10.28

Esophagus 1 0.51 2 1.45 0 0.00 1 3.58 4 4.07 0.98 -0.04

Stomach 7 1.86 2 0.76 2 2.23 0 0.00 11 7.81 1.41 2.13

Small intestine 1 2.49 3 10.30* 0 0.00 0 0.00 4 0.86 4.64* 2.10

Colon 10 0.77 7 0.76 2 0.62 0 0.00 19 27.34 0.69 -5.57

Rectum, rectosigmoid junction 3 0.54 7 1.81 0 0.00 0 0.00 10 11.44 0.87 -0.96

Anus, anal canal 1 5.09 0 0.00 0 0.00 0 0.00 1 0.42 2.39 0.39

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 2.67 0.00 -1.79

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.38

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.36 0.00 -0.91

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 7.37 0.00* -4.92

Respiratory system 7 0.25* 14 0.73 9 1.44 2 0.52 32 56.79 0.56* -16.57

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.30

Larynx 1 0.45 0 0.00 1 2.07 0 0.00 2 4.50 0.44 -1.67

Lung, bronchus 5 0.20* 14 0.80 8 1.40 2 0.57 29 51.70 0.56* -15.17

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.37

Male genital system 42 1.00 23 0.75 13 1.18 1 0.14* 79 91.21 0.87 -8.16

Prostate 42 1.01 22 0.72 12 1.10 1 0.14* 77 90.27 0.85 -8.87

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.22

Urinary system 7 0.53 6 0.64 4 1.26 1 0.49 18 27.80 0.65 -6.55

Urinary bladder 4 0.42 3 0.44 3 1.31 0 0.00 10 20.05 0.50* -6.72

Kidney parenchyma 3 1.04 2 0.96 1 1.42 1 2.19 7 6.14 1.14 0.57

Renal pelvis, other urinary 0 0.00 1 1.84 0 0.00 0 0.00 1 1.61 0.62 -0.41

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -0.36

Bone, joints 1 8.91 0 0.00 0 0.00 0 0.00 1 0.23 4.33 0.51

Soft tissue including heart 0 0.00 2 5.30 0 0.00 0 0.00 2 1.10 1.81 0.60

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -0.33

Melanoma of skin 1 0.35 1 0.47 0 0.00 0 0.00 2 6.22 0.32 -2.82

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.26

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 2.73 0.00 -1.83

Thyroid 8 17.58* 0 0.00 1 9.52 0 0.00 9 0.96 9.39* 5.37

Lymphatic, hematopoietic 3 0.30* 5 0.70 4 1.64 4 2.56 16 21.10 0.76 -3.41

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.68 0.00 -0.45

Non-Hodgkin lymphoma 2 0.49 4 1.33 3 2.95 1 1.45 10 8.82 1.13 0.79

Myeloma 0 0.00 0 0.00 0 0.00 1 3.65 1 3.73 0.27 -1.82

Leukemia 1 0.27 1 0.37 1 1.10 2 3.57 5 7.87 0.64 -1.92

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.14

Chronic lymphocytic 1 0.66 1 0.93 0 0.00 0 0.00 2 3.19 0.63 -0.79

Acute non-lymphocytic 0 0.00 0 0.00 1 3.36 2 10.66* 3 2.58 1.16 0.28

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.07 0.00 -0.71

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 18,914 4,436 531 183 18,914

Person-years in interval 7,186 5,172 1,628 977 14,964

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Pancreas

Males

Table 4.7.4: Risk of subsequent primary cancers after cancer of the pancreas, males,

SEER 1973-2000.

108 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

PANCREAS

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Pancreas

Both Sexes, <50 Years of Age

Table 4.7.5: Risk of subsequent primary cancers after cancer of the pancreas, both sexes,

<50 years of age, SEER 1973-2000.

PANCREAS

All subsequent cancers 4 1.13 6 1.17 2 0.49 12 1.97* 24 18.85 1.27 10.35

All excluding same site 4 1.15 6 1.19 2 0.50 12 2.01* 24 18.50 1.30 11.05

Buccal cavity, pharynx 0 0.00 1 4.73 0 0.00 0 0.00 1 0.69 1.45 0.62

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.12

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.31

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.12

Mouth 0 0.00 1 18.43 0 0.00 0 0.00 1 0.18 5.60 1.65

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.08

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.20

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.04

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.13

Digestive system 0 0.00 1 1.32 0 0.00 1 0.96 2 2.95 0.68 -1.90

Esophagus 0 0.00 0 0.00 0 0.00 1 14.75 1 0.21 4.67 1.58

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.59

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.14

Colon 0 0.00 1 3.67 0 0.00 0 0.00 1 1.12 0.89 -0.24

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -1.14

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.12

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.29

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.06

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.11

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.70

Respiratory system 0 0.00 1 1.43 2 3.24 4 4.02* 7 2.77 2.53* 8.51

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.07

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.51

Lung, bronchus 0 0.00 1 1.63 2 3.64 4 4.40* 7 2.47 2.84* 9.11

Female breast 0 0.00 1 0.86 0 0.00 3 2.70 4 4.03 0.99 -0.11

Female genital system 2 6.11 0 0.00 0 0.00 1 2.24 3 1.61 1.86 5.31

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -1.58

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -2.40

Ovary 2 20.61* 0 0.00 0 0.00 0 0.00 2 0.48 4.21 5.83

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.07

Vulva 0 0.00 0 0.00 0 0.00 1 72.01 1 0.05 21.22 3.64

Male genital system 0 0.00 0 0.00 0 0.00 0 0.00 0 1.69 0.00 -7.16

Prostate 0 0.00 0 0.00 0 0.00 0 0.00 0 1.53 0.00 -6.47

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.60

Urinary system 0 0.00 0 0.00 0 0.00 1 2.51 1 1.12 0.89 -0.25

Urinary bladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -1.22

Kidney parenchyma 0 0.00 0 0.00 0 0.00 1 6.88 1 0.47 2.15 1.07

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.10

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.02

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.07

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.25

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.38

Melanoma of skin 0 0.00 0 0.00 0 0.00 2 9.45* 2 0.90 2.22 2.21

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.07

Brain, central nervous system 0 0.00 1 9.80 0 0.00 0 0.00 1 0.32 3.10 1.36

Thyroid 2 19.36* 0 0.00 0 0.00 0 0.00 2 0.41 4.91 3.20

Lymphatic, hematopoietic 0 0.00 1 2.22 0 0.00 0 0.00 1 1.53 0.65 -1.06

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.29

Non-Hodgkin lymphoma 0 0.00 1 4.34 0 0.00 0 0.00 1 0.78 1.28 0.44

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.40

Leukemia 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.82

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.06

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.25

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.29

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.14

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,979 1,025 276 126 2,979

Person-years in interval 1,394 1,780 968 834 4,976

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 2,615 PYR and for male cancers on 2,361 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE DIGESTIVE TRACT, EXCLUDING COLORECTAL CANCER 109
All subsequent cancers 137 0.58* 143 0.86 62 1.12 11 0.35* 353 486.97 0.72* -50.55

All excluding same site 136 0.60* 143 0.89 62 1.15 11 0.36* 352 472.75 0.74* -45.56

Buccal cavity, pharynx 1 0.17* 2 0.50 2 1.63 1 1.60 6 11.82 0.51 -2.20

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 1.77 0.00 -0.67

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 2.33 0.00 -0.88

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 1.05 0.00 -0.40

Mouth 0 0.00 1 0.91 0 0.00 1 5.84 2 3.21 0.62 -0.46

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.17

Tonsil 1 1.86 1 2.74 1 9.60 0 0.00 3 1.06 2.84 0.73

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.12

Hypopharynx 0 0.00 0 0.00 1 8.36 0 0.00 1 1.19 0.84 -0.07

Digestive system 35 0.63* 37 0.94 8 0.60 1 0.13* 81 115.64 0.70* -13.07

Esophagus 2 0.77 4 2.20 0 0.00 0 0.00 6 5.33 1.12 0.25

Stomach 7 1.20 3 0.73 3 2.15 1 1.31 14 12.08 1.16 0.72

Small intestine 2 2.79 5 9.67* 0 0.00 0 0.00 7 1.52 4.60* 2.07

Colon 17 0.67 15 0.83 3 0.48 0 0.00 35 53.36 0.66* -6.93

Rectum, rectosigmoid junction 3 0.32* 9 1.39 2 0.97 0 0.00 14 19.01 0.74 -1.89

Anus, anal canal 1 2.05 1 2.87 0 0.00 0 0.00 2 1.01 1.98 0.37

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 3.73 0.00* -1.41

Gallbladder 1 1.16 0 0.00 0 0.00 0 0.00 1 1.77 0.57 -0.29

Bile ducts, other biliary 1 0.86 0 0.00 0 0.00 0 0.00 1 2.50 0.40 -0.57

Pancreas 1 0.15* 0 0.00* 0 0.00 0 0.00 1 14.22 0.07* -4.99

Respiratory system 14 0.35* 22 0.79 20 2.22* 2 0.40 58 81.50 0.71* -8.87

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.71 0.00 -0.27

Larynx 1 0.39 0 0.00 1 1.91 0 0.00 2 5.10 0.39 -1.17

Lung, bronchus 12 0.33* 22 0.86 19 2.27* 2 0.43 55 75.48 0.73* -7.73

Female breast 13 0.50* 24 1.29 5 0.82 1 0.32 43 53.92 0.80 -7.86

Female genital system 4 0.33* 11 1.32 2 0.76 0 0.00 17 24.41 0.70 -5.33

Cervix uteri 1 0.74 0 0.00 0 0.00 0 0.00 1 2.64 0.38 -1.18

Corpus uteri 0 0.00* 2 0.47 1 0.77 0 0.00 3 12.34 0.24* -6.72

Ovary 2 0.57 8 3.28* 1 1.27 0 0.00 11 7.12 1.55 2.79

Vagina 1 4.74 0 0.00 0 0.00 0 0.00 1 0.44 2.28 0.40

Vulva 0 0.00 1 2.35 0 0.00 0 0.00 1 1.26 0.79 -0.19

Male genital system 42 1.00 23 0.76 13 1.22 1 0.15* 79 89.52 0.88 -8.35

Prostate 42 1.01 22 0.73 12 1.13 1 0.16* 77 88.74 0.87 -9.31

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.15

Urinary system 8 0.45* 7 0.55 5 1.19 0 0.00 20 37.25 0.54* -6.51

Urinary bladder 4 0.32* 4 0.46 4 1.36 0 0.00 12 25.80 0.47* -5.21

Kidney parenchyma 4 0.92 2 0.65 1 0.99 0 0.00 7 9.00 0.78 -0.75

Renal pelvis, other urinary 0 0.00 1 1.20 0 0.00 0 0.00 1 2.46 0.41 -0.55

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.80 0.00 -0.30

Bone, joints 1 5.19 0 0.00 0 0.00 0 0.00 1 0.39 2.59 0.23

Soft tissue including heart 0 0.00 2 3.17 0 0.00 0 0.00 2 1.84 1.08 0.06

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.15

Melanoma of skin 3 0.70 1 0.32 0 0.00 0 0.00 4 8.98 0.45 -1.88

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -0.24

Brain, central nervous system 0 0.00 1 0.66 0 0.00 0 0.00 1 4.46 0.22 -1.31

Thyroid 9 8.00* 0 0.00 1 4.19 0 0.00 10 2.27 4.40* 2.92

Lymphatic, hematopoietic 4 0.23* 7 0.56 6 1.43 5 2.08 22 36.49 0.60* -5.47

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.00 0.00 -0.38

Non-Hodgkin lymphoma 3 0.40 5 0.92 3 1.65 2 1.88 13 15.87 0.82 -1.08

Myeloma 0 0.00 0 0.00 0 0.00 1 2.23 1 6.68 0.15* -2.14

Leukemia 1 0.16* 2 0.45 3 2.01 2 2.39 8 12.93 0.62 -1.86

Acute lymphocytic 0 0.00 0 0.00 1 25.78 0 0.00 1 0.33 3.00 0.25

Chronic lymphocytic 1 0.40 1 0.57 0 0.00 0 0.00 2 5.18 0.39 -1.20

Acute non-lymphocytic 0 0.00 1 0.68 2 3.97 2 6.89 5 4.35 1.15 0.24

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.75 0.00 -0.66

Pancreas

Both Sexes, ≥50 Years of Age

Table 4.7.6: Risk of subsequent primary cancers after cancer of the pancreas, both sexes,

≥50 years of age, SEER 1973-2000.

110 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

PANCREAS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 35,372 8,111 884 312 35,372

Person-years in interval 13,342 9,103 2,716 1,342 26,502

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 13,899 PYR and for male cancers on 12,603 PYR.
NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 111

Synopsis

The risk of subsequent primary cancer was evaluated

in more than 260,000 men and women diagnosed with

cancer of the colon, rectum, or anus between 1973 and

2000. The overall risk of subsequent cancers was

increased among survivors of both colon cancer

(O/E=1.07, O=20,847, EAR=13 per 10,000 person-years)

and anal cancer (O/E=1.24, O=509, EAR=36), but not

among those with rectal cancer (O/E=1.00, O=8,117).

Shared lifestyle and environmental risk factors—such

as diet, obesity, and physical inactivity—possibly contributed to the increased risks of other digestive tract

cancers seen after colon and rectal cancer. In addition,

genetic factors likely influenced the elevated risks of

new tumors among younger colorectal cancer patients

(ages <40 years). In particular, the constellation of subsequent tumors—including cancers of the stomach,

small intestine, colon, rectum, bile ducts, uterine corpus, ovary, renal pelvis/ureter, and brain—was suggestive of hereditary nonpolyposis colon cancer, familial

adenomatous polyposis, or Turcot syndrome. The

excess of lung cancer occurring after rectal cancer may

be related to an effect of cigarette smoking on both

tumors. Long-term survivors of rectal cancer initially

treated with radiation had increased risks of cancers of

the uterine corpus and urinary bladder, suggesting a

carcinogenic effect of treatment. Patients with anal

cancer had elevated risks for cancers of the buccal

cavity and pharynx (tongue and tonsil), lung, vulva,

and vagina, as well as for Kaposi sarcoma. These associations pointed to underlying risk factors, including

infection with human papillomaviruses and the human

immunodeficiency virus (HIV).

Colon Cancer

Colon cancer is the fourth most frequent cancer in both

men and women in the U.S., and colon and rectal cancers

combined account for 10% of all cancer deaths (Jemal et

al, 2005). The incidence of colon cancer is higher among

American men than women, and the overall 5-year relative survival rate for the most recent time period is 63.0%

(Ries et al, 2004). The primary treatment for the vast

majority of colon cancers is surgical (or endoscopic) excision. In those with stage III disease, risk of recurrence is

high and adjuvant chemotherapy is recommended (NIH

Consensus Conference, 1990). 

The 20-fold international variation in incidence and

mortality rates for colon cancer and the rapid rise in incidence among persons migrating from low- to highincidence areas indicate the importance of lifestyle and

environmental determinants (Potter, 1999; Giovannucci,

2002; Martinez, 2005). A growing body of evidence points

to the role of energy balance, with obesity and physical

inactivity shown as risk factors for colon cancer in most

studies. In addition to caloric intake, several studies have

reported elevated risks associated with the high consumption of red and processed meat, and with low intake

of vegetables and fruits. An inverse association between

dietary fiber intake and colon cancer risk has been reported, but the evidence to date is not conclusive. High alcohol

consumption, particularly in the presence of a diet low in

micronutrients such as folate, and cigarette smoking early

in life have been associated with modest elevations of colorectal cancer risk in several recent studies (Giovannucci,

2001; Cho et al, 2004; Corrao et al, 2004). An excess of

colon cancer has been noted among persons with chronic

inflammatory bowel disease, including ulcerative colitis

and Crohn’s disease (Ekbom et al, 1990a,b). Use of nonsteroidal anti-inflammatory drugs, postmenopausal hormone replacement therapy, and calcium and vitamin D

intake are considered to be protective for colon cancer.

Approximately 10% to 20% of colon cancers are associated with familial occurrences involving a first-degree

relative (Burt, 2000). Some of the familial cases are attributable to hereditary syndromes such as familial adenomatous polyposis (FAP), which is due to germline mutations of the APC gene, and hereditary nonpolyposis colon

cancer (HNPCC), which is caused by inherited mutations

in mismatch repair genes (Burt et al, 1995; Marra and

Boland, 1995; Peltomaki and Vasen, 1997; Lynch and de la

Chapelle, 1999). Both syndromes are characterized by early

onset of multiple colorectal cancers, but account for only a

small percentage (3%) of these malignancies (Burt, 2000).

Results and Discussion

Overall, 179,370 patients who survived 2 months or

longer after a diagnosis of colon cancer were reported to

COLON, RECTUM, AND ANUS

Chapter 5

New Malignancies Following Cancer of the

Colon, Rectum, and Anus 

Pauline A. Mysliwiec, Kathleen A. Cronin, Arthur Schatzkin

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated as

[(O-E)/PYR]10,000).

Affiliations: Pauline A. Mysliwiec and Arthur Schatzkin, Division of

Cancer Epidemiology and Genetics, NCI, NIH, DHHS; Kathleen A.

Cronin, Division of Cancer Control and Population Sciences, NCI,

NIH, DHHS. Present address for Dr. Mysliwiec: Division of

Gastroenterology, Kaiser Permanente, Vallejo, CA.
the SEER Program during 1973-2000. There was an

overall 7% increased risk of developing a subsequent

primary cancer (O/E=1.07, O=20,847, 95% CI=1.05-1.08,

EAR=13 per 10,000 person-years), but risk diminished to

levels prevailing in the general population when subsequent cancers of the colon, rectum, and anus were

excluded (O/E=0.98). In an analysis adjusted for the

competing risk of death, the cumulative incidence of all

second cancers combined was 15.2% at 25 years (95%

CI=15.0%-15.5%), with a 3.2% incidence of second

colorectal cancers (Figure 5.1). The relative and excess

absolute risks of developing a new malignancy varied

inversely with age at diagnosis of colon cancer, with 

O/E ratios of 3.19, 1.27, and 1.07 and EARs of 55, 32, and

15 observed for ages younger than 40 years, 40-59 years,

and 60-69 years, respectively (Figure 5.2). This decreasing

trend in relative and excess absolute risks with increasing

age remained evident when subsequent cancers of the

colon, rectum, and anus were excluded. No excess was

observed among patients diagnosed with colon cancer at

ages older than 70 years. The relative risk of all new

cancers combined was slightly higher in females and in

blacks. Risks were increased by about 10% in the first 

5 years after initial diagnosis, and then decreased to near

normal levels for later follow-up intervals. The risks of

subsequent malignancies were significantly increased 

for cancers of the tongue, oropharynx, stomach, small

intestine, colon, rectum, anus, bile ducts, uterine corpus,

kidney, and ureter. In contrast, deficits in risk were seen

for cancers of the lip, larynx, lung, liver, and gallbladder,

as well as for chronic lymphocytic leukemia. In earlier

SEER surveys of colorectal cancer, there were reciprocally

increased risks associated with cancers of the small intestine, female breast, colon, and rectum (Neugut et al, 1991;

Neugut and Santos, 1993; Shureiqi et al, 2001). Other registry-based studies of colon cancer have reported elevations in risk for second cancers of the larynx, breast, uterine corpus, ovary, prostate, bladder, and kidney (Hoar et

al, 1985; Lynge et al, 1985; Levi et al, 1993; McCredie et al,

1997; Evans et al, 2002).

Most excesses of new malignancies after colon cancer

occurred in the digestive tract and may be related to

shared lifestyle factors, including diet, obesity, and physical inactivity (Giovannucci, 2002). The effect of these

risk factors on hormonal metabolism, along with genetic

susceptibility (Potter, 1999; Kaaks and Lukanova, 2002;

Brinton et al, 2004), may explain the elevated risk of

uterine corpus cancer seen among younger (ages <60

years) women diagnosed with colon cancer, as well as

the reciprocal increased risk of colon cancer among

younger women with uterine corpus cancer. Obesity

may also have contributed to the elevated risk of cancer

of the kidney parenchyma after colon cancer (Calle et al,

2003). However, the excesses were limited to the first

5 years of follow-up with no reciprocal increase in risk

of colon cancer observed after cancer of the kidney

parenchyma, suggesting that medical surveillance may

have played a role.

Consistent with previous studies (Hoar et al, 1985;

Lynge et al, 1985; Teppo et al, 1985; Enblad et al, 1990;

McCredie et al, 1997; Evans et al, 2002), we found either

deficits in risk or no excesses for most smoking- and

alcohol-related cancers (lip, mouth, esophagus, larynx,

and lung), although risks for subsequent cancers of the

tongue and oropharynx were increased. While recent

studies have suggested that cigarette smoking and alcohol use are risk factors for colorectal cancer (Giovannucci,

112 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

COLON, RECTUM, AND ANUS

0.5

1.0

1.5

2.0

2.5

3.0

3.5

40 40-59 60-69 70

O/E

1.11*

1.27*

0.98 1.07* 0.99 0.92*

3.19* All subsequent cancers

All subsequent cancers excluding 

colon, rectum, and anus

2.14*

-20

-10

0

10

20

30

40

50

60

Age at diagnosis of colon cancer (years)

EAR (per 10,000 person-years)

All subsequent cancers

All subsequent cancers excluding 

colon, rectum, and anus

12

32

-4

15

-2 -16

55

27

40 40-59 60-69 70

Figure 5.2: Observed-to-expected ratio (O/E) and excess

absolute risk (EAR) of subsequent primary cancers after

cancer of the colon, both sexes, SEER 1973-2000.

*P <0.05.

Note: EAR = Excess number of subsequent cancers per 10,000 person-years.

Observed No. 210 130 3,582 2,762 6,832 5,380 10,223 7,849

Years after initial cancer diagnosis

Cumulative incidence (%)

0 5 10 15 20 25

0

5

10

15

20

All second cancers

Digestive system

Colon and rectum

Figure 5.1: Cumulative incidence of developing a second

cancer among patients with cancer of the colon, both sexes,

SEER 1973-2000.
NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 113

2001; Corrao et al, 2004; Wei et al, 2004), the association

COLON, RECTUM, AND ANUS

with smoking appears only after an induction period of

at least 35 years.

The heritable syndrome HNPCC predisposes not only

to multicentric cancers of the colon and rectum, but also

to early-onset cancers of the small intestine, stomach, bile

ducts, uterine corpus, ovary, renal pelvis/ureter, and

brain (Watson and Lynch, 1993). Similarly, the extracolonic tumors associated with the FAP syndrome

include the stomach and small intestine (duodenal and

periampullary) in addition to thyroid and brain tumors

(Burt, 2000). These syndromes or variants, such as Turcot

syndrome (colon polyps and brain tumors), may be

implicated in the notably high risks for subsequent

tumors of diverse sites among younger patients (ages

<40 years) with colon cancer, although excess risks were

also seen to a limited extent among older persons. The

role of genetic susceptibility suggesting HNPCC is also

evident in the reciprocally increased risks for colon cancer following cancers of the uterine corpus, ovary, and

renal pelvis/ureter diagnosed at young ages. 

Cancers of the Rectum and

Rectosigmoid Junction

Rectal cancer, including tumors of the rectosigmoid junction, accounts for 3% of cancers in the U.S. (Jemal et al,

2005), with a higher incidence among men than women.

The overall 5-year relative survival rate is 64.2% (Ries 

et al, 2004). Surgery alone is the primary treatment for

localized-stage disease, with the addition of radiotherapy

and chemotherapy for more advanced stages (NIH Consensus Conference, 1990). 

The risk factors for rectal cancer are similar to those

for colon cancer, although the evidence generally is less

clear-cut (Mao et al, 2003; Slattery et al, 2003; Wei et al,

2004; Martinez, 2005). Some studies have suggested 

that cigarette smoking and alcohol consumption may

play a greater role in rectal cancer risk (Potter, 1999;

Giovannucci, 2001). 

Results and Discussion

The overall risk of subsequent primary cancers was not

increased among the 77,436 persons who survived 2

months or longer following a diagnosis of rectal cancer,

including cancers of the rectosigmoid junction (O/E=1.00,

O=8,117, 95% CI=0.98-1.02). A significant deficit in overall risk was seen after excluding subsequent cancers of

the colon, rectum, and anus (O/E=0.94, 95% CI=0.92-0.97).

The cumulative incidence of all second cancers combined

was 14.4% at 25 years (95% CI=14.1%-14.8%), with new

malignancies of the colon and rectum accounting for

2.7% of the cancer incidence. Increased relative risks of

subsequent cancer were confined to women (O/E=1.07)

and blacks (O/E=1.17). Individuals diagnosed with rectal

cancer at ages younger than 50 years had a 51% increase

in risk of subsequent cancer, but risk dropped to lower

levels at older ages. An 8% elevation in risk of subsequent cancers was found in the first year after diagnosis,

but no excess was seen in subsequent time intervals.

Observed risks were significantly increased over those

expected for subsequent cancers of the small intestine,

colon, anus, lung, vagina, and kidney. In contrast, significantly reduced risks were observed for cancers of the

tongue, liver, pancreas, ovary, and prostate, as well as

chronic lymphocytic leukemia. Several registry-based

surveys have noted that patients with rectal cancer have

generally lower risks of second cancers than patients

with an initial colon cancer, although increased risks

have been reported for new malignancies of the colon,

uterine corpus, and prostate (Hoar, 1985; Lynge et al,

1985; McCredie et al, 1997).

Digestive system malignancies accounted for 27% of

subsequent primary cancers following rectal cancer, with

significantly increased risks for cancers of the small intestine and colon, which are likely due to shared risk factors

(McCredie et al, 1997). The elevated risk for lung cancer

after rectal cancer may be related to the effects of cigarette smoking on both tumors. Among rectal cancer

patients diagnosed at younger ages (<50 years), elevated

risks were observed for subsequent cancers of the small

intestine, colon, bile ducts, and uterine corpus; this pattern resembles the spectrum of tumors associated with

colon cancer and with genetic susceptibility syndromes

such as HNPCC (Watson and Lynch, 1993). 

Rectal cancer patients receiving radiation as part of

their initial course of therapy had high doses delivered to

the pelvic area. Therefore, it is not surprising that excess

risks of uterine corpus and urinary bladder cancers

among long-term survivors were confined to irradiated

patients. This finding is consistent with earlier studies on

radiation-related excesses of bladder and endometrial

cancers among women receiving pelvic radiotherapy for

cancers of the cervix or ovary (Boice et al, 1988; Travis et

al, 1996). Although the vagina also received high radiation doses, the increases in risk of vaginal malignancies

following rectal cancer were seen in all therapy groups.

As with initial colon cancer, there was an increased risk

of cancer of the kidney parenchyma after rectal cancer.

The elevated risk was most pronounced in the first year

of follow-up and then gradually declined over time to

normal levels, suggesting the role of heightened medical

surveillance.

Cancers of the Anus, Anal Canal, and

Anorectum

Anal cancer constitutes only 0.3% of all malignancies

diagnosed in the U.S. and an estimated 0.1% of all cancer

deaths (Jemal et al, 2005). The overall 5-year relative

survival rate is 67.5% (Ries et al, 2004). Squamous cell

carcinoma is the predominant histologic type. Current

treatment for anal cancer includes surgical resection and

either radiation, chemotherapy, or both (Ryan et al, 2000).

The major causal factor for anal cancer is human

papillomavirus (HPV) infection. The risk is greatest for

HPV types 16 and 18—the predominant causes of tumors

along the anogenital tract, including cancers of the cervix,
vagina, vulva, penis, and the anal canal (Schiffman and

Kjaer, 2003). The risk of anal cancer is increased among

individuals with impaired cellular immunity (caused by

HIV infection or organ transplantation), high-risk sexual

behaviors, or a history of other HPV-related cancers

(Fairley et al, 1994; Birkeland et al, 1995; Frisch, 2002;

Palefsky and Holly, 2003). 

Results and Discussion

The overall risk of developing a new primary cancer

among 4,905 patients who survived 2 months or more

after anal cancer was significantly increased by 24%

(O/E=1.24, O=509, 95% CI=1.13-1.35, EAR=36). The

estimated cumulative incidence of a second cancer was

16.6% at 25 years (95% CI=15.0%-18.4%). Relative risks of

subsequent cancers were similar among men (O/E=1.27)

and women (O/E=1.21), although men had substantially

higher excess absolute risks (EAR=50) than women

(EAR=28). The risk of new cancers decreased with

increasing age at anal cancer diagnosis, with a 5-fold

increase in risk of new cancers observed for patients

diagnosed at ages younger than 40 years and a 2.5-fold

increase in risk for those younger than 50 years. Excess

risks were also observed among those diagnosed at ages

50 to 69 years; risks then diminished to lower levels at

older ages. Significantly increased risks were observed

for subsequent cancers of the buccal cavity and pharynx

(tongue, tonsil), lung, vagina, vulva, and anus, as well as

for Kaposi sarcoma, while lower-than-expected risks were

apparent for prostate cancer. An earlier SEER survey of

patients with in situ and invasive anal cancer reported

excesses of second cancers of the lung and prostate

(Rabkin et al, 1992), and a Danish study noted increased

risks of new malignancies of the lung, bladder, breast,

vulva/vagina, and small intestine (Frisch et al, 1994). 

In the current survey, 5- to 8-fold increased risks of

subsequent cancers of the tongue, tonsil, and anogenital

tract were observed, consistent with previous studies

suggesting a carcinogenic effect of HPV infection at 

these sites (Frisch and Biggar, 1999; Gillison et al, 2000;

Schiffman and Kjaer, 2003). As noted previously (Frisch

et al, 1994; Schiffman and Kjaer, 2003), women with anal

cancer experienced significant increases in the risk of

vulvar and vaginal cancers, which share a causal relationship to HPV. In particular, the basaloid/warty form 

of squamous cell vulvar cancer has been associated with

HPV infection, especially in younger, sexually active

women (Trimble et al, 1996). The available evidence suggests that cancers of the vagina, vulva, and anus arise as

a multicentric field effect due to HPV infection (Brinton

et al, 2004). However, as shown in an earlier SEER survey

(Rabkin et al, 1992), there was no overall increase in cervical cancer risk following anal cancer (O/E=0.69, O=2),

whereas a 3-fold excess of anal cancer was seen after

cervical cancer (O/E=3.24, O=19). 

Excesses were also observed for several subsequent

cancers that are associated with HIV infection. A 13-fold

increased risk of Kaposi sarcoma was found among men

but not among women, and a 5-fold increase of nonHodgkin lymphoma (NHL) was seen in persons diagnosed with anal cancer at ages younger than 50 years. It

is well established that HIV-infected individuals are

prone to anogenital cancers (Ferenczy et al, 2003;

Palefsky and Holly, 2003), caused by HIV-related

immunosuppression that predisposes to the carcinogenic

effects of the sexually transmitted HPV. The role of HIV

infection is apparent also from the increased risk of anal

cancer seen among men diagnosed before age 50 years

with Kaposi sarcoma or NHL.

In addition, we observed 2- to 3-fold significantly

increased risks for subsequent cancers of the lung and

buccal cavity, which may be due to the high frequency of

smoking in patients with HIV infection. Cigarette smoking may also be a cofactor with HPV infection in the

development of anal cancer, reminiscent of the combined

effect of smoking and HPV infection in the etiology of

cervical cancer (Daling et al, 1992, 1996; Giulian et al,

2002; Castellsague and Munoz, 2003). 

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COLON, RECTUM, AND ANUS
COLON

Colon

Both Sexes

Table 5.1.1: Characteristics of patients with an initial cancer of the colon, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 85,768 100.0 93,602 100.0 179,370 100.0

Initial treatment

Any radiation 3,528 4.1 3,185 3.4 6,713 3.7

With surgery 3,052 3.6 2,783 3.0 5,835 3.3

Without surgery 476 0.6 402 0.4 878 0.5

No radiation 82,240 95.9 90,417 96.6 172,657 96.3

With surgery 76,137 88.8 83,069 88.7 159,206 88.8

Without surgery 6,103 7.1 7,348 7.9 13,451 7.5

Race

White 73,673 85.9 80,765 86.3 154,438 86.1

Black 6,641 7.7 8,089 8.6 14,730 8.2

Other 5,222 6.1 4,519 4.8 9,741 5.4

Unknown 232 0.3 229 0.2 461 0.3

Age at 1st primary cancer diagnosis, years

< 30 376 0.4 401 0.4 777 0.4

30–49 6,019 7.0 5,858 6.3 11,877 6.6

50–69 38,302 44.7 33,258 35.5 71,560 39.9

70–79 27,170 31.7 29,746 31.8 56,916 31.7

> 80 13,901 16.2 24,339 26.0 38,240 21.3

Number of patients with one or more

primary cancers

One primary cancer only 75,213 87.7 85,597 91.4 160,810 89.7

1st and 2nd cancers 9,361 10.9 7,171 7.7 16,532 9.2

1st, 2nd, and 3rd cancers 1,072 1.2 738 0.8 1,810 1.0

1st, 2nd, 3rd, and additional cancers 122 0.1 96 0.1 218 0.1

Other statistics

Median age at 1st cancer diagnosis 69.4 — 72.6 — 70.9 —

Median year of 1st cancer diagnosis 1988.0 — 1987.6 — 1987.8 —

Median person-years at risk 3.2 — 3.2 — 3.2 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 94.6 — 94.7 — 94.6

1st, 2nd, and additional cancers — 93.9 — 94.2 — 94.0

1st cancer only — 4.9 — 4.9 — 4.9

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 117

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 2,522 1.09* 8,266 1.11* 5,487 1.02 4,572 1.03 20,847 19,563.96 1.07* 13.07

All excluding same site 1,844 0.94* 6,190 0.99 4,431 0.98 3,656 0.97 16,121 16,523.81 0.98* -4.10

Buccal cavity, pharynx 50 0.89 171 0.99 126 1.08 83 0.93 430 435.20 0.99 -0.05

Lip 3 0.32* 19 0.67 18 0.95 6 0.42* 46 70.98 0.65* -0.25

Tongue 15 1.39 36 1.08 33 1.45* 22 1.26 106 84.49 1.25* 0.22

Salivary gland 10 1.96 17 1.03 9 0.74 7 0.67 43 44.24 0.97 -0.01

Mouth 9 0.59 49 1.04 32 1.02 21 0.86 111 118.03 0.94 -0.07

Nasopharynx 1 0.47 4 0.62 4 0.96 1 0.32 10 15.79 0.63 -0.06

Tonsil 4 0.83 12 0.83 7 0.76 9 1.38 32 34.90 0.92 -0.03

Oropharynx 2 1.35 7 1.54 5 1.68 5 2.27 19 11.20 1.70* 0.08

Hypopharynx 6 1.10 22 1.33 12 1.13 8 1.07 48 40.11 1.20 0.08

Digestive system 868 1.54* 2,782 1.55* 1,548 1.19* 1,370 1.28* 6,568 4,726.44 1.39* 18.76

Esophagus 23 0.94 81 1.05 61 1.12 46 1.02 211 200.97 1.05 0.10

Stomach 55 0.93 207 1.12 154 1.18* 140 1.34* 556 478.38 1.16* 0.79

Small intestine 33 4.76* 89 3.96* 43 2.56* 45 3.02* 210 61.05 3.44* 1.52

Colon 519 1.98* 1,529 1.81* 857 1.38* 725 1.40* 3,630 2,247.46 1.62* 14.08

Rectum, rectosigmoid junction 152 1.62* 518 1.76* 187 0.91 178 1.11 1,035 753.17 1.37* 2.87

Anus, anal canal 7 1.49 29 1.94* 12 1.11 13 1.43 61 39.52 1.54* 0.22

Liver 9 0.53 39 0.72* 20 0.51* 31 0.91 99 144.86 0.68* -0.47

Gallbladder 8 0.89 12 0.43* 12 0.60 11 0.70 43 72.76 0.59* -0.30

Bile ducts, other biliary 10 0.83 46 1.16 46 1.52* 38 1.38 140 109.58 1.28* 0.31

Pancreas 49 0.72* 220 1.02 148 0.94 133 1.01 550 573.04 0.96 -0.23

Respiratory system 276 0.73* 1,149 0.96 854 1.01 588 0.85* 2,867 3,113.40 0.92* -2.51

Nose, nasal cavity, ear 3 0.88 14 1.31 9 1.18 3 0.48 29 27.96 1.04 0.01

Larynx 17 0.72 60 0.83 43 0.90 31 0.90 151 178.32 0.85* -0.28

Lung, bronchus 255 0.73* 1,074 0.97 801 1.01 552 0.85* 2,682 2,899.22 0.93* -2.21

Female breast 218 0.88 826 1.06 580 1.02 494 1.00 2,118 2,087.78 1.01 0.58

Female genital system 132 1.16 422 1.21* 251 1.04 215 1.07 1,020 905.34 1.13* 2.18

Cervix uteri 16 1.25 36 0.97 30 1.29 11 0.64 93 90.19 1.03 0.05

Corpus uteri 62 1.09 220 1.27* 135 1.14 121 1.25* 538 445.45 1.21* 1.76

Ovary 47 1.42* 138 1.34* 64 0.87 56 0.89 305 273.33 1.12 0.60

Vagina 2 0.97 5 0.77 3 0.65 8 2.06 18 17.02 1.06 0.02

Vulva 4 0.65 17 0.85 15 0.98 14 1.00 50 55.26 0.90 -0.10

Male genital system 453 1.07 1,409 1.00 1,023 0.98 837 0.99 3,722 3,718.79 1.00 0.07

Prostate 448 1.07 1,403 1.01 1,012 0.98 826 0.98 3,689 3,687.31 1.00 0.04

Testis 0 0.00 1 0.30 1 0.54 1 0.91 3 7.45 0.40 -0.10

Urinary system 223 1.23* 623 1.06 407 0.95 367 1.02 1,620 1,553.50 1.04 0.68

Urinary bladder 124 0.97 412 0.99 287 0.95 241 0.95 1,064 1,100.52 0.97 -0.37

Kidney parenchyma 85 2.05* 161 1.21* 88 0.91 90 1.11 424 351.94 1.20* 0.73

Renal pelvis, other urinary 14 1.15 50 1.29 32 1.16 36 1.60* 132 101.04 1.31* 0.32

Ureter 4 0.98 23 1.78* 11 1.20 17 2.33* 55 33.43 1.65* 0.22

Bone, joints 0 0.00 6 1.02 2 0.50 4 1.25 12 15.00 0.80 -0.03

Soft tissue including heart 13 1.48 25 0.89 24 1.17 12 0.67 74 75.32 0.98 -0.01

Kaposi sarcoma 1 0.43 8 1.09 4 0.78 4 1.01 17 18.71 0.91 -0.02

Melanoma of skin 56 1.33* 146 1.05 74 0.70* 92 0.97 368 381.24 0.97 -0.13

Eye, orbit 3 0.93 11 1.09 6 0.86 5 0.89 25 25.84 0.97 -0.01

Brain, central nervous system 18 0.85 56 0.84 45 0.96 33 0.87 152 172.49 0.88 -0.21

Thyroid 19 1.78* 33 1.01 29 1.31 16 0.90 97 83.34 1.16 0.14

Lymphatic, hematopoietic 150 0.85 499 0.88* 414 0.99 352 0.99 1,415 1,516.58 0.93* -1.03

Hodgkin lymphoma 7 1.37 15 0.98 6 0.60 5 0.66 33 37.92 0.87 -0.05

Non-Hodgkin lymphoma 66 0.88 220 0.89 181 0.98 168 1.03 635 667.80 0.95 -0.33

Myeloma 27 0.87 81 0.81 78 1.07 57 0.92 243 265.29 0.92 -0.23

Leukemia 50 0.78 183 0.89 149 0.99 122 0.97 504 545.57 0.92 -0.42

Acute lymphocytic 2 1.21 3 0.57 8 2.11 1 0.33 14 13.73 1.02 0.00

Chronic lymphocytic 13 0.51* 55 0.67* 48 0.81 39 0.80 155 216.12 0.72* -0.62

Acute non-lymphocytic 25 1.17 70 1.01 52 1.03 44 1.02 191 184.49 1.04 0.07

Chronic myeloid 8 0.92 31 1.11 20 0.98 22 1.26 81 74.45 1.09 0.07

Colon

Both Sexes

Table 5.1.2: Risk of subsequent primary cancers after cancer of the colon, both sexes,

SEER 1973-2000.

118 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

COLON

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 179,370 140,231 71,025 36,532 179,370

Person-years in interval 129,484 391,397 259,576 201,337 981,794

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 525,390 PYR and for male cancers on 456,404 PYR.
Colon

Both Sexes, Long-term Follow-up

Table 5.1.3: Risk of subsequent primary cancers after cancer of the colon, both sexes,

long-term follow-up, SEER 1973-2000.

COLON

All subsequent cancers 16,275 1.08* 2,919 1.03 1,263 1.03 390 0.94 20,847 19,563.96 1.07* 13.07

All excluding same site 12,465 0.98* 2,356 0.99 1,010 0.98 290 0.83* 16,121 16,523.81 0.98* -4.10

Buccal cavity, pharynx 347 1.00 53 0.92 22 0.93 8 1.02 430 435.20 0.99 -0.05

Lip 40 0.70* 5 0.54 1 0.27 0 0.00 46 70.98 0.65* -0.25

Tongue 84 1.25* 14 1.24 5 1.07 3 1.92 106 84.49 1.25* 0.22

Salivary gland 36 1.07 5 0.77 1 0.35 1 0.96 43 44.24 0.97 -0.01

Mouth 90 0.96 14 0.90 5 0.76 2 0.92 111 118.03 0.94 -0.07

Nasopharynx 9 0.71 1 0.50 0 0.00 0 0.00 10 15.79 0.63 -0.06

Tonsil 23 0.81 6 1.40 2 1.19 1 1.89 32 34.90 0.92 -0.03

Oropharynx 14 1.56 1 0.70 4 6.92* 0 0.00 19 11.20 1.70* 0.08

Hypopharynx 40 1.23 7 1.41 1 0.52 0 0.00 48 40.11 1.20 0.08

Digestive system 5,198 1.42* 862 1.27* 373 1.28* 135 1.33* 6,568 4,726.44 1.39* 18.76

Esophagus 165 1.06 32 1.12 12 0.98 2 0.47 211 200.97 1.05 0.10

Stomach 416 1.11* 79 1.19 47 1.67* 14 1.46 556 478.38 1.16* 0.79

Small intestine 165 3.57* 25 2.71* 14 3.37* 6 4.01* 210 61.05 3.44* 1.52

Colon 2,905 1.68* 447 1.37* 194 1.37* 84 1.71* 3,630 2,247.46 1.62* 14.08

Rectum, rectosigmoid junction 857 1.44* 109 1.06 53 1.24 16 1.11 1,035 753.17 1.37* 2.87

Anus, anal canal 48 1.58* 7 1.23 6 2.38 0 0.00 61 39.52 1.54* 0.22

Liver 68 0.61* 22 1.04 7 0.74 2 0.59 99 144.86 0.68* -0.47

Gallbladder 32 0.56* 7 0.70 3 0.70 1 0.69 43 72.76 0.59* -0.30

Bile ducts, other biliary 102 1.24* 28 1.65* 7 0.90 3 1.05 140 109.58 1.28* 0.31

Pancreas 417 0.95 100 1.21 26 0.72 7 0.55 550 573.04 0.96 -0.23

Respiratory system 2,279 0.94* 375 0.86* 157 0.83* 56 0.87 2,867 3,113.40 0.92* -2.51

Nose, nasal cavity, ear 26 1.20 2 0.51 1 0.58 0 0.00 29 27.96 1.04 0.01

Larynx 120 0.83* 22 0.97 6 0.67 3 1.06 151 178.32 0.85* -0.28

Lung, bronchus 2,130 0.95* 349 0.85* 150 0.85* 53 0.87 2,682 2,899.22 0.93* -2.21

Female breast 1,624 1.02 308 1.00 135 0.99 51 1.04 2,118 2,087.78 1.01 0.58

Female genital system 805 1.14* 144 1.15 61 1.10 10 0.51* 1,020 905.34 1.13* 2.18

Cervix uteri 82 1.12 5 0.45 4 0.88 2 1.34 93 90.19 1.03 0.05

Corpus uteri 417 1.20* 77 1.27* 41 1.54* 3 0.32* 538 445.45 1.21* 1.76

Ovary 249 1.18* 42 1.07 12 0.68 2 0.32 305 273.33 1.12 0.60

Vagina 10 0.76 8 3.29* 0 0.00 0 0.00 18 17.02 1.06 0.02

Vulva 36 0.87 9 1.06 4 1.01 1 0.69 50 55.26 0.90 -0.10

Male genital system 2,885 1.01 558 1.02 230 0.99 49 0.72* 3,722 3,718.79 1.00 0.07

Prostate 2,863 1.01 550 1.01 227 0.99 49 0.72* 3,689 3,687.31 1.00 0.04

Testis 2 0.32 1 1.32 0 0.00 0 0.00 3 7.45 0.40 -0.10

Urinary system 1,253 1.05 239 1.06 98 1.00 30 0.88 1,620 1,553.50 1.04 0.68

Urinary bladder 823 0.97 158 0.98 64 0.92 19 0.79 1,064 1,100.52 0.97 -0.37

Kidney parenchyma 334 1.23* 60 1.17 22 0.99 8 1.03 424 351.94 1.20* 0.73

Renal pelvis, other urinary 96 1.22 21 1.48 12 1.97* 3 1.40 132 101.04 1.31* 0.32

Ureter 38 1.45* 8 1.72 6 3.07* 3 4.46 55 33.43 1.65* 0.22

Bone, joints 8 0.68 1 0.50 1 1.13 2 6.53 12 15.00 0.80 -0.03

Soft tissue including heart 62 1.08 6 0.54 6 1.20 0 0.00 74 75.32 0.98 -0.01

Kaposi sarcoma 13 0.88 3 1.16 1 0.95 0 0.00 17 18.71 0.91 -0.02

Melanoma of skin 276 0.96 59 1.01 29 1.09 4 0.41 368 381.24 0.97 -0.13

Eye, orbit 20 0.99 2 0.56 3 1.96 0 0.00 25 25.84 0.97 -0.01

Brain, central nervous system 119 0.88 22 0.91 8 0.78 3 0.85 152 172.49 0.88 -0.21

Thyroid 81 1.24 9 0.80 6 1.24 1 0.59 97 83.34 1.16 0.14

Lymphatic, hematopoietic 1,063 0.92* 220 0.98 101 1.02 31 0.89 1,415 1,516.58 0.93* -1.03

Hodgkin lymphoma 28 0.92 2 0.41 2 0.99 1 1.53 33 37.92 0.87 -0.05

Non-Hodgkin lymphoma 467 0.92 106 1.05 48 1.06 14 0.86 635 667.80 0.95 -0.33

Myeloma 186 0.91 39 1.01 12 0.71 6 1.02 243 265.29 0.92 -0.23

Leukemia 382 0.91 73 0.92 39 1.14 10 0.84 504 545.57 0.92 -0.42

Acute lymphocytic 13 1.21 1 0.51 0 0.00 0 0.00 14 13.73 1.02 0.00

Chronic lymphocytic 116 0.69* 27 0.87 7 0.53 5 1.13 155 216.12 0.72* -0.62

Acute non-lymphocytic 147 1.04 28 1.04 15 1.26 1 0.23 191 184.49 1.04 0.07

Chronic myeloid 59 1.03 6 0.55 13 2.72* 3 1.81 81 74.45 1.09 0.07

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 179,370 36,532 16,813 6,257 179,370

Person-years in interval 780,457 128,698 54,137 18,503 981,794

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 525,390 PYR and for male cancers on 456,404 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 119
All subsequent cancers 1,019 1.08* 3,533 1.18* 2,316 1.05* 2,086 1.08* 8,954 8,073.34 1.11* 16.76

All excluding same site 736 0.95 2,500 1.02 1,779 0.99 1,566 0.99 6,581 6,611.03 1.00 -0.57

Buccal cavity, pharynx 16 0.97 50 0.97 37 1.00 28 0.90 131 136.47 0.96 -0.10

Lip 0 0.00 6 1.46 3 0.96 2 0.71 11 11.36 0.97 -0.01

Tongue 7 1.96 12 1.07 12 1.48 6 0.88 37 29.78 1.24 0.14

Salivary gland 4 2.16 7 1.19 4 0.93 3 0.79 18 15.84 1.14 0.04

Mouth 1 0.17* 17 0.92 15 1.13 11 0.96 44 49.22 0.89 -0.10

Nasopharynx 0 0.00 2 1.03 0 0.00 1 0.93 3 4.96 0.60 -0.04

Tonsil 1 0.76 2 0.51 1 0.38 1 0.52 5 9.78 0.51 -0.09

Oropharynx 1 2.59 1 0.83 0 0.00 1 1.53 3 3.06 0.98 0.00

Hypopharynx 2 1.94 2 0.63 2 0.95 2 1.24 8 7.91 1.01 0.00

Digestive system 371 1.47* 1,318 1.63* 721 1.20* 728 1.39* 3,138 2,184.51 1.44* 18.15

Esophagus 10 1.55 25 1.22 12 0.79 18 1.34 65 55.53 1.17 0.18

Stomach 20 0.94 76 1.13 48 0.99 59 1.43* 203 178.38 1.14 0.47

Small intestine 15 4.89* 51 5.14* 20 2.62* 20 2.77* 106 27.85 3.81* 1.49

Colon 227 1.77* 781 1.89* 446 1.44* 415 1.53* 1,869 1,121.34 1.67* 14.23

Rectum, rectosigmoid junction 51 1.33 237 1.96* 82 0.95 93 1.31* 463 316.37 1.46* 2.79

Rectum 36 1.43* 154 1.94* 60 1.06 74 1.55* 324 209.01 1.55* 2.19

Anus, anal canal 5 1.75 15 1.65 9 1.34 12 2.03* 41 24.59 1.67* 0.31

Liver 3 0.59 9 0.55 5 0.41* 8 0.70 25 45.16 0.55* -0.38

Gallbladder 3 0.49 8 0.42* 7 0.52 11 1.01 29 49.62 0.58* -0.39

Bile ducts, other biliary 6 1.09 9 0.50* 20 1.42 17 1.28 52 50.77 1.02 0.02

Pancreas 29 0.88 103 0.98 66 0.83 69 0.98 267 288.56 0.93 -0.41

Respiratory system 89 0.79* 392 1.07 299 1.09 231 0.91 1,011 1,004.39 1.01 0.13

Nose, nasal cavity, ear 1 0.76 5 1.19 3 0.96 2 0.72 11 11.46 0.96 -0.01

Larynx 1 0.29 8 0.75 8 1.08 3 0.49 20 27.69 0.72 -0.15

Lung, bronchus 87 0.81* 379 1.09 288 1.10 225 0.93 979 962.60 1.02 0.31

Female breast 218 0.88 826 1.06 580 1.02 494 1.00 2,118 2,087.78 1.01 0.58

Female genital system 132 1.16 422 1.21* 251 1.04 215 1.07 1,020 905.34 1.13* 2.18

Cervix uteri 16 1.25 36 0.97 30 1.29 11 0.64 93 90.19 1.03 0.05

Corpus uteri 62 1.09 220 1.27* 135 1.14 121 1.25* 538 445.45 1.21* 1.76

Ovary 47 1.42* 138 1.34* 64 0.87 56 0.89 305 273.33 1.12 0.60

Vagina 2 0.97 5 0.77 3 0.65 8 2.06 18 17.02 1.06 0.02

Vulva 4 0.65 17 0.85 15 0.98 14 1.00 50 55.26 0.90 -0.10

Urinary system 54 1.13 161 1.05 121 1.05 103 1.00 439 419.04 1.05 0.38

Urinary bladder 25 0.85 90 0.95 75 1.05 64 1.00 254 259.35 0.98 -0.10

Kidney parenchyma 25 1.79* 55 1.22 31 0.92 31 1.01 142 123.55 1.15 0.35

Renal pelvis, other urinary 4 0.95 16 1.19 15 1.52 8 0.93 43 36.14 1.19 0.13

Ureter 0 0.00 7 1.64 4 1.28 2 0.75 13 11.39 1.14 0.03

Bone, joints 0 0.00 4 1.52 1 0.54 3 1.93 8 6.87 1.16 0.02

Soft tissue including heart 6 1.61 8 0.67 12 1.36 4 0.50 30 32.42 0.93 -0.05

Kaposi sarcoma 0 0.00 1 0.62 2 1.54 0 0.00 3 4.53 0.66 -0.03

Melanoma of skin 18 1.18 48 0.98 28 0.76 37 1.07 131 136.14 0.96 -0.10

Eye, orbit 2 1.46 4 0.95 2 0.68 3 1.19 11 11.06 0.99 0.00

Brain, central nervous system 8 0.90 28 1.00 27 1.35 15 0.87 78 74.08 1.05 0.07

Thyroid 11 1.65 19 0.94 22 1.59 9 0.78 61 52.40 1.16 0.16

Lymphatic, hematopoietic 75 0.98 216 0.88 180 0.97 176 1.06 647 672.61 0.96 -0.49

Hodgkin lymphoma 2 0.96 7 1.11 4 0.93 2 0.57 15 16.17 0.93 -0.02

Non-Hodgkin lymphoma 35 1.01 106 0.94 85 0.99 83 1.05 309 312.96 0.99 -0.08

Myeloma 12 0.87 33 0.75 40 1.23 27 0.94 112 118.85 0.94 -0.13

Leukemia 26 1.01 70 0.85 51 0.83 64 1.17 211 224.63 0.94 -0.26

Acute lymphocytic 1 1.48 1 0.46 2 1.23 1 0.70 5 5.89 0.85 -0.02

Chronic lymphocytic 7 0.69 18 0.56* 18 0.75 21 1.00 64 87.42 0.73* -0.45

Acute non-lymphocytic 15 1.70 31 1.09 17 0.80 28 1.46 91 77.65 1.17 0.25

Chronic myeloid 3 0.85 11 0.97 7 0.83 10 1.32 31 30.87 1.00 0.00

Colon

Females

Table 5.1.4: Risk of subsequent primary cancers after cancer of the colon, females,

SEER 1973-2000.

120 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

COLON

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 93,602 72,818 37,706 19,976 93,602

Person-years in interval 67,381 204,457 139,546 114,006 525,390

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Colon

Males

Table 5.1.5: Risk of subsequent primary cancers after cancer of the colon, males,

SEER 1973-2000.

COLON

All subsequent cancers 1,503 1.10* 4,733 1.07* 3,171 1.00 2,486 0.98 11,893 11,490.62 1.04* 8.82

All excluding same site 1,108 0.94* 3,690 0.97* 2,652 0.97 2,090 0.95* 9,540 9,912.78 0.96* -8.17

Buccal cavity, pharynx 34 0.85 121 0.99 89 1.12 55 0.95 299 298.73 1.00 0.01

Lip 3 0.37 13 0.53* 15 0.94 4 0.35* 35 59.63 0.59* -0.54

Tongue 8 1.10 24 1.08 21 1.44 16 1.50 69 54.70 1.26 0.31

Salivary gland 6 1.84 10 0.94 5 0.64 4 0.60 25 28.40 0.88 -0.07

Mouth 8 0.85 32 1.13 17 0.94 10 0.78 67 68.80 0.97 -0.04

Nasopharynx 1 0.67 2 0.44 4 1.41 0 0.00 7 10.83 0.65 -0.08

Tonsil 3 0.86 10 0.95 6 0.91 8 1.75 27 25.11 1.08 0.04

Oropharynx 1 0.91 6 1.80 5 2.32 4 2.57 16 8.14 1.97* 0.17

Hypopharynx 4 0.91 20 1.49 10 1.17 6 1.02 40 32.19 1.24 0.17

Digestive system 497 1.61* 1,464 1.48* 827 1.19* 642 1.17* 3,430 2,541.93 1.35* 19.46

Esophagus 13 0.73 56 0.99 49 1.24 28 0.89 146 145.44 1.00 0.01

Stomach 35 0.93 131 1.11 106 1.30* 81 1.29* 353 300.00 1.18* 1.16

Small intestine 18 4.66* 38 3.03* 23 2.52* 25 3.26* 104 33.20 3.13* 1.55

Colon 292 2.17* 748 1.72* 411 1.32* 310 1.25* 1,761 1,126.12 1.56* 13.91

Rectum, rectosigmoid junction 101 1.82* 281 1.61* 105 0.89 85 0.96 572 436.80 1.31* 2.96

Anus, anal canal 2 1.09 14 2.40* 3 0.74 1 0.31 20 14.92 1.34 0.11

Liver 6 0.51 30 0.79 15 0.55* 23 1.02 74 99.69 0.74* -0.56

Gallbladder 5 1.75 4 0.44 5 0.79 0 0.00* 14 23.13 0.61 -0.20

Bile ducts, other biliary 4 0.61 37 1.71* 26 1.59* 21 1.46 88 58.81 1.50* 0.64

Pancreas 20 0.57* 117 1.05 82 1.06 64 1.05 283 284.48 0.99 -0.03

Respiratory system 187 0.71* 757 0.91* 555 0.97 357 0.82* 1,856 2,109.01 0.88* -5.54

Nose, nasal cavity, ear 2 0.97 9 1.39 6 1.34 1 0.29 18 16.50 1.09 0.03

Larynx 16 0.79 52 0.84 35 0.87 28 0.98 131 150.63 0.87 -0.43

Lung, bronchus 168 0.70* 695 0.91* 513 0.97 327 0.81* 1,703 1,936.62 0.88* -5.12

Male breast 3 1.17 3 0.37 3 0.52 8 1.67 17 21.31 0.80 -0.09

Male genital system 453 1.07 1,409 1.00 1,023 0.98 837 0.99 3,722 3,718.79 1.00 0.07

Prostate 448 1.07 1,403 1.01 1,012 0.98 826 0.98 3,689 3,687.31 1.00 0.04

Testis 0 0.00 1 0.30 1 0.54 1 0.91 3 7.45 0.40 -0.10

Urinary system 169 1.26* 462 1.07 286 0.92 264 1.03 1,181 1,134.46 1.04 1.02

Urinary bladder 99 1.01 322 1.01 212 0.91 177 0.93 810 841.17 0.96 -0.68

Kidney parenchyma 60 2.19* 106 1.20 57 0.91 59 1.17 282 228.40 1.23* 1.17

Renal pelvis, other urinary 10 1.25 34 1.34 17 0.96 28 2.02* 89 64.90 1.37* 0.53

Ureter 4 1.47 16 1.84* 7 1.16 15 3.24* 42 22.04 1.91* 0.44

Bone, joints 0 0.00 2 0.61 1 0.46 1 0.61 4 8.13 0.49 -0.09

Soft tissue including heart 7 1.38 17 1.05 12 1.03 8 0.81 44 42.90 1.03 0.02

Kaposi sarcoma 1 0.54 7 1.23 2 0.53 4 1.42 14 14.18 0.99 0.00

Melanoma of skin 38 1.41 98 1.09 46 0.68* 55 0.91 237 245.10 0.97 -0.18

Eye, orbit 1 0.54 7 1.20 4 1.00 2 0.65 14 14.79 0.95 -0.02

Brain, central nervous system 10 0.81 28 0.72 18 0.68 18 0.87 74 98.41 0.75* -0.53

Thyroid 8 2.00 14 1.12 7 0.85 7 1.12 36 30.95 1.16 0.11

Lymphatic, hematopoietic 75 0.76* 283 0.88* 234 1.01 176 0.92 768 843.97 0.91* -1.66

Hodgkin lymphoma 5 1.65 8 0.89 2 0.35 3 0.74 18 21.74 0.83 -0.08

Non-Hodgkin lymphoma 31 0.77 114 0.86 96 0.98 85 1.02 326 354.84 0.92 -0.63

Myeloma 15 0.87 48 0.86 38 0.95 30 0.91 131 146.44 0.89 -0.34

Leukemia 24 0.62* 113 0.91 98 1.11 58 0.82 293 320.94 0.91 -0.61

Acute lymphocytic 1 1.02 2 0.64 6 2.77* 0 0.00 9 7.83 1.15 0.03

Chronic lymphocytic 6 0.38* 37 0.74 30 0.85 18 0.65 91 128.70 0.71* -0.83

Acute non-lymphocytic 10 0.79 39 0.96 35 1.19 16 0.67 100 106.85 0.94 -0.15

Chronic myeloid 5 0.97 20 1.20 13 1.09 12 1.22 50 43.59 1.15 0.14

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 85,768 67,413 33,319 16,556 85,768

Person-years in interval 62,103 186,940 120,030 87,331 456,404

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 121
All subsequent cancers 14 4.78* 52 4.58* 43 3.17* 101 2.66* 210 65.78 3.19* 55.28

All excluding same site 9 3.24* 31 2.90* 27 2.14* 63 1.82* 130 60.73 2.14* 26.55

Buccal cavity, pharynx 1 13.29 1 3.10 0 0.00 1 0.83 3 2.04 1.47 0.37

Lip 1 107.84* 0 0.00 0 0.00 0 0.00 1 0.17 5.80 0.32

Tongue 0 0.00 1 14.45 0 0.00 0 0.00 1 0.47 2.12 0.20

Salivary gland 0 0.00 0 0.00 0 0.00 1 9.23 1 0.23 4.38 0.30

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.47 0.00 -0.18

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.07

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.11

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.02

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.05

Digestive system 5 19.48* 26 23.25* 20 12.67* 49 8.89* 100 8.46 11.82* 35.08

Esophagus 0 0.00 0 0.00 0 0.00 1 2.83 1 0.50 2.01 0.19

Stomach 0 0.00 0 0.00 0 0.00 4 8.09* 4 0.85 4.73* 1.21

Small intestine 0 0.00 4 104.90* 1 19.99 2 13.80* 7 0.24 28.95* 2.59

Colon 4 40.04* 15 35.89* 12 21.20* 29 14.08* 60 3.14 19.08* 21.79

Rectum, rectosigmoid junction 1 21.73 6 29.38* 4 12.96* 8 7.14* 19 1.68 11.31* 6.64

Anus, anal canal 0 0.00 0 0.00 0 0.00 1 7.95 1 0.22 4.50 0.30

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.19

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.03

Bile ducts, other biliary 0 0.00 0 0.00 2 63.15* 3 26.74* 5 0.17 29.10* 1.85

Pancreas 0 0.00 1 9.57 1 6.10 1 1.56 3 0.93 3.23 0.79

Respiratory system 2 13.64* 2 2.73 2 1.67 5 1.00 11 7.06 1.56 1.51

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.05

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -0.24

Lung, bronchus 2 16.41* 2 3.21 2 1.91 5 1.12 11 6.26 1.76 1.82

Female breast 0 0.00 0 0.00 0 0.00* 14 1.54 14 16.32 0.86 -1.69

Female genital system 3 8.43* 10 7.74* 8 5.62* 12 3.61* 33 6.39 5.16* 19.40

Cervix uteri 0 0.00 2 3.33 0 0.00 0 0.00 2 2.00 1.00 0.00

Corpus uteri 1 16.31 2 7.50 8 20.62* 7 4.98* 18 2.12 8.49* 11.58

Ovary 2 21.78* 5 14.37* 0 0.00 4 3.89* 11 1.89 5.81* 6.64

Vagina 0 0.00 1 81.83* 0 0.00 1 31.35 2 0.06 32.75* 1.41

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.14

Male genital system 0 0.00 1 2.12 2 4.07 4 1.02 7 5.05 1.39 1.58

Prostate 0 0.00 0 0.00 2 9.54* 4 1.08 6 3.96 1.52 1.65

Testis 0 0.00 1 2.45 0 0.00 0 0.00 1 1.03 0.98 -0.02

Urinary system 0 0.00 2 4.48 3 4.76 5 2.26 10 3.39 2.95* 2.53

Urinary bladder 0 0.00 1 4.64 2 6.57 2 1.70 5 1.75 2.86 1.25

Kidney parenchyma 0 0.00 0 0.00 1 3.31 1 1.05 2 1.52 1.32 0.19

Renal pelvis, other urinary 0 0.00 1 58.13 0 0.00 2 23.18* 3 0.13 22.82* 1.10

Ureter 0 0.00 0 0.00 0 0.00 1 47.32 1 0.03 34.76 0.37

Bone, joints 0 0.00 1 19.60 0 0.00 0 0.00 1 0.17 5.81 0.32

Soft tissue including heart 0 0.00 1 7.18 0 0.00 0 0.00 1 0.54 1.86 0.18

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.28 0.00 -0.49

Melanoma of skin 1 3.48 0 0.00 2 1.95 1 0.52 4 4.24 0.94 -0.09

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.05

Brain, central nervous system 0 0.00 1 3.00 2 6.36 2 3.34 5 1.34 3.72* 1.40

Thyroid 1 5.48 1 1.69 1 1.93 1 1.23 4 2.11 1.90 0.73

Lymphatic, hematopoietic 1 2.65 3 2.28 3 2.28 6 2.05 13 5.93 2.19* 2.71

Hodgkin lymphoma 0 0.00 1 3.53 1 5.02 0 0.00 2 0.81 2.48 0.46

Non-Hodgkin lymphoma 1 5.70 0 0.00 1 1.42 4 2.55 6 3.11 1.93 1.11

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -0.21

Leukemia 0 0.00 2 6.42 1 3.14 2 2.63 5 1.48 3.38* 1.35

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.05

Chronic lymphocytic 0 0.00 0 0.00 1 18.57 0 0.00 1 0.33 3.00 0.26

Acute non-lymphocytic 0 0.00 2 14.93* 0 0.00 2 7.52 4 0.57 7.03* 1.32

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.11

Colon

Both Sexes, <40 Years of Age

Table 5.1.6: Risk of subsequent primary cancers after cancer of the colon, both sexes,

<40 years of age, SEER 1973-2000.

122 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

COLON

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,722 3,009 1,634 1,070 3,722

Person-years in interval 2,769 8,521 6,610 8,190 26,090

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 13,716 PYR and for male cancers on 12,375 PYR.
Colon

Both Sexes, 40-59 Years of Age

Table 5.1.7: Risk of subsequent primary cancers after cancer of the colon, both sexes,

40-59 years of age, SEER 1973-2000.

COLON

All subsequent cancers 278 1.75* 990 1.58* 899 1.26* 1,415 1.08* 3,582 2,816.13 1.27* 32.33

All excluding same site 183 1.30* 693 1.24* 728 1.15* 1,158 1.00 2,762 2,483.41 1.11* 11.76

Buccal cavity, pharynx 6 0.92 26 1.09 30 1.32 28 0.93 90 83.31 1.08 0.28

Lip 1 1.62 3 1.33 3 1.31 1 0.28 8 8.74 0.92 -0.03

Tongue 2 1.45 4 0.78 12 2.47* 10 1.55 28 17.77 1.58* 0.43

Salivary gland 0 0.00 2 1.29 2 1.27 2 0.74 6 6.23 0.96 -0.01

Mouth 1 0.56 9 1.38 5 0.83 8 1.02 23 22.21 1.04 0.03

Nasopharynx 0 0.00 0 0.00 2 1.83 0 0.00 2 4.04 0.50 -0.09

Tonsil 1 1.20 2 0.68 1 0.38 4 1.34 8 9.36 0.86 -0.06

Oropharynx 1 5.07 2 2.64 2 2.66 0 0.00 5 2.64 1.89 0.10

Hypopharynx 0 0.00 3 1.15 2 0.77 1 0.31 6 9.15 0.66 -0.13

Digestive system 118 4.09* 385 3.30* 245 1.82* 391 1.51* 1,139 538.41 2.12* 25.36

Esophagus 2 0.96 6 0.73 14 1.58 13 0.89 35 33.70 1.04 0.05

Stomach 6 2.03 22 1.88* 21 1.64* 37 1.55* 86 51.24 1.68* 1.47

Small intestine 6 10.80* 18 8.53* 9 3.95* 18 4.14* 51 9.29 5.49* 1.76

Colon 72 6.49* 205 4.45* 130 2.34* 189 1.66* 596 226.79 2.63* 15.59

Rectum, rectosigmoid junction 23 3.95* 88 3.75* 40 1.54* 63 1.43* 214 99.24 2.16* 4.85

Anus, anal canal 0 0.00 4 2.37 1 0.58 5 1.76 10 6.70 1.49 0.14

Liver 1 0.79 3 0.60 5 0.88 14 1.32 23 22.61 1.02 0.02

Gallbladder 0 0.00 1 0.78 1 0.65 1 0.31 3 6.41 0.47 -0.14

Bile ducts, other biliary 0 0.00 4 1.90 4 1.59 12 2.07* 20 10.93 1.83* 0.38

Pancreas 8 2.31 31 2.23* 19 1.17 35 1.09 93 65.71 1.42* 1.15

Respiratory system 26 0.89 138 1.16 163 1.20* 200 0.84* 527 522.14 1.01 0.21

Nose, nasal cavity, ear 0 0.00 2 1.77 1 0.89 2 1.14 5 4.30 1.16 0.03

Larynx 1 0.36 11 1.03 10 0.93 8 0.56 30 38.56 0.78 -0.36

Lung, bronchus 25 0.96 124 1.16 151 1.22* 189 0.85* 489 478.07 1.02 0.46

Female breast 25 0.91 102 1.03 107 1.10 159 1.00 393 382.40 1.03 0.90

Female genital system 35 2.67* 85 1.81* 67 1.51* 79 1.19 266 170.75 1.56* 8.06

Cervix uteri 6 2.73 3 0.43 8 1.50 8 1.36 25 20.31 1.23 0.40

Corpus uteri 12 1.80 48 1.96* 40 1.69* 44 1.24 144 90.52 1.59* 4.52

Ovary 16 4.43* 31 2.37* 16 1.26 19 0.95 82 49.31 1.66* 2.76

Vagina 0 0.00 0 0.00 1 1.93 3 3.26 4 2.05 1.95 0.16

Vulva 0 0.00 0 0.00 0 0.00 3 1.14 3 5.30 0.57 -0.19

Male genital system 23 1.49 86 1.10 129 1.05 284 1.02 522 495.24 1.05 2.26

Prostate 23 1.55 85 1.12 128 1.05 281 1.01 517 489.46 1.06 2.32

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 2.76 0.00 -0.23

Urinary system 14 1.32 73 1.70* 60 1.19 97 0.99 244 201.80 1.21* 1.78

Urinary bladder 4 0.65 37 1.43* 36 1.14 55 0.85 132 128.41 1.03 0.15

Kidney parenchyma 10 2.59* 29 1.94* 18 1.12 24 0.88 81 62.14 1.30* 0.80

Renal pelvis, other urinary 0 0.00 7 3.07* 6 2.17 18 3.18* 31 11.25 2.76* 0.83

Ureter 0 0.00 5 7.76* 2 2.32 11 6.01* 18 3.48 5.17* 0.61

Bone, joints 0 0.00 0 0.00 1 1.48 2 2.00 3 2.62 1.14 0.02

Soft tissue including heart 2 2.46 2 0.70 6 2.17 3 0.63 13 11.20 1.16 0.08

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 3.56 0.00 -0.15

Melanoma of skin 8 1.47 24 1.23 18 0.96 27 0.90 77 73.80 1.04 0.14

Eye, orbit 0 0.00 0 0.00 1 0.93 0 0.00 1 4.18 0.24 -0.13

Brain, central nervous system 0 0.00 11 1.26 6 0.71 14 1.08 31 32.59 0.95 -0.07

Thyroid 8 3.99* 8 1.21 4 0.72 6 0.86 26 21.19 1.23 0.20

Lymphatic, hematopoietic 11 0.96 41 0.93 51 1.06 98 1.05 201 196.70 1.02 0.18

Hodgkin lymphoma 2 2.88 2 0.89 0 0.00 1 0.41 5 7.28 0.69 -0.10

Non-Hodgkin lymphoma 4 0.72 27 1.27 29 1.25 52 1.16 112 94.77 1.18 0.73

Myeloma 3 1.69 4 0.56 13 1.56 18 1.09 38 33.76 1.13 0.18

Leukemia 2 0.59 8 0.60 9 0.60 27 0.92 46 60.89 0.76 -0.63

Acute lymphocytic 0 0.00 0 0.00 2 3.74 1 1.23 3 2.03 1.47 0.04

Chronic lymphocytic 1 0.77 3 0.56 3 0.48 13 1.11 20 24.61 0.81 -0.19

Acute non-lymphocytic 0 0.00 3 0.70 1 0.21 3 0.29* 7 20.59 0.34* -0.57

Chronic myeloid 1 1.92 2 1.05 3 1.49 9 2.32* 15 8.33 1.80* 0.28

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 33,276 27,204 15,316 9,909 33,276

Person-years in interval 24,809 79,046 61,715 71,286 236,857

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 118,241 PYR and for male cancers on 118,616 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 123
All subsequent cancers 654 1.19* 2,374 1.15* 1,941 1.02 1,863 1.00 6,832 6,370.41 1.07* 15.13

All excluding same site 473 0.99 1,812 1.01 1,584 0.96 1,511 0.96 5,380 5,487.80 0.98 -3.53

Buccal cavity, pharynx 15 0.89 53 0.94 45 1.05 35 1.00 148 151.28 0.98 -0.11

Lip 1 0.45 5 0.64 5 0.78 2 0.34 13 22.43 0.58* -0.31

Tongue 5 1.47 14 1.23 10 1.16 7 1.02 36 30.27 1.19 0.19

Salivary gland 1 0.89 3 0.72 1 0.27 3 0.73 8 13.10 0.61 -0.17

Mouth 2 0.45 13 0.88 11 0.99 7 0.73 33 39.95 0.83 -0.23

Nasopharynx 1 1.38 1 0.43 2 1.25 1 0.91 5 5.75 0.87 -0.02

Tonsil 3 1.73 7 1.27 5 1.35 5 2.10 20 13.32 1.50 0.22

Oropharynx 1 1.82 3 1.70 2 1.62 4 4.61* 10 4.42 2.26* 0.18

Hypopharynx 1 0.50 6 0.91 6 1.28 4 1.35 17 16.27 1.04 0.02

Digestive system 229 2.01* 773 1.80* 532 1.31* 528 1.19* 2,062 1,391.23 1.48* 21.98

Esophagus 9 1.30 31 1.26 28 1.36 21 1.13 89 70.67 1.26* 0.60

Stomach 13 1.13 50 1.16 57 1.43* 56 1.30 176 137.29 1.28* 1.27

Small intestine 9 5.60* 35 5.71* 14 2.40* 17 2.76* 75 19.74 3.80* 1.81

Colon 133 2.75* 400 2.14* 305 1.66* 292 1.36* 1,130 633.25 1.78* 16.28

Rectum, rectosigmoid junction 45 2.07* 152 1.92* 49 0.71* 56 0.84 302 237.00 1.27* 2.13

Anus, anal canal 3 2.61 10 2.39* 3 0.83 4 1.17 20 12.36 1.62 0.25

Liver 4 0.95 12 0.76 6 0.41* 9 0.62 31 49.07 0.63* -0.59

Gallbladder 1 0.70 1 0.18 2 0.37 6 0.96 10 18.65 0.54* -0.28

Bile ducts, other biliary 4 1.90 17 2.05* 16 1.88* 7 0.62 44 30.25 1.45* 0.45

Pancreas 7 0.50 62 1.18 49 0.99 56 1.03 174 170.04 1.02 0.13

Respiratory system 84 0.77* 368 0.93 322 0.94 245 0.82* 1,019 1,146.97 0.89* -4.19

Nose, nasal cavity, ear 1 1.20 2 0.70 5 2.06 0 0.00 8 8.70 0.92 -0.02

Larynx 7 0.83 26 0.93 17 0.83 17 1.20 67 70.79 0.95 -0.12

Lung, bronchus 76 0.76* 340 0.93 300 0.94 227 0.81* 943 1,064.83 0.89* -3.99

Female breast 45 0.78 206 1.02 194 1.08 167 0.91 612 623.96 0.98 -0.81

Female genital system 32 1.07 115 1.16 72 0.91 76 1.02 295 282.77 1.04 0.82

Cervix uteri 2 0.61 9 0.90 8 1.17 1 0.17* 20 25.84 0.77 -0.39

Corpus uteri 16 0.95 61 1.11 39 0.91 43 1.17 159 151.35 1.05 0.51

Ovary 13 1.62 40 1.45* 20 0.85 25 1.07 98 82.48 1.19 1.04

Vagina 0 0.00 1 0.76 0 0.00 1 0.69 2 4.36 0.46 -0.16

Vulva 1 1.18 3 0.91 4 1.14 4 0.80 12 12.67 0.95 -0.05

Male genital system 109 1.05 435 1.00 421 0.97 371 0.98 1,336 1,355.02 0.99 -1.21

Prostate 107 1.04 434 1.00 419 0.97 366 0.97 1,326 1,345.50 0.99 -1.25

Testis 0 0.00 0 0.00 1 2.06 1 3.11 2 1.91 1.05 0.01

Urinary system 63 1.52* 177 1.12 140 0.94 167 1.08 547 503.30 1.09 1.43

Urinary bladder 35 1.27 113 1.06 93 0.90 110 0.99 351 348.87 1.01 0.07

Kidney parenchyma 25 2.23* 51 1.24 36 0.99 45 1.33 157 122.36 1.28* 1.14

Renal pelvis, other urinary 3 1.14 13 1.28 11 1.15 12 1.23 39 32.07 1.22 0.23

Ureter 0 0.00 6 1.75 2 0.62 5 1.55 13 10.77 1.21 0.07

Bone, joints 0 0.00 0 0.00 1 0.71 1 0.80 2 4.81 0.42 -0.09

Soft tissue including heart 3 1.58 10 1.43 12 1.87 5 0.69 30 22.58 1.33 0.24

Kaposi sarcoma 0 0.00 2 1.90 1 1.01 4 3.03 7 3.66 1.91 0.11

Melanoma of skin 17 1.56 45 1.12 26 0.72 48 1.28 136 124.64 1.09 0.37

Eye, orbit 1 1.21 5 1.69 3 1.21 4 1.74 13 8.58 1.52 0.14

Brain, central nervous system 6 0.98 21 0.97 14 0.77 13 0.82 54 61.59 0.88 -0.25

Thyroid 4 1.35 10 1.01 9 1.19 7 1.13 30 26.60 1.13 0.11

Lymphatic, hematopoietic 37 1.00 127 0.90 115 0.85 144 0.97 423 462.37 0.91 -1.29

Hodgkin lymphoma 3 2.31 4 0.92 3 0.87 3 0.99 13 12.17 1.07 0.03

Non-Hodgkin lymphoma 18 1.09 57 0.90 48 0.77 66 0.96 189 210.36 0.90 -0.70

Myeloma 7 1.04 19 0.74 22 0.90 23 0.87 71 83.20 0.85 -0.40

Leukemia 9 0.73 47 0.99 42 0.92 52 1.02 150 156.65 0.96 -0.22

Acute lymphocytic 1 2.89 0 0.00 3 2.68 0 0.00 4 3.84 1.04 0.01

Chronic lymphocytic 2 0.38 8 0.40* 8 0.43* 19 0.96 37 63.71 0.58* -0.88

Acute non-lymphocytic 5 1.25 23 1.46 19 1.19 20 1.10 67 53.95 1.24 0.43

Chronic myeloid 0 0.00 10 1.64 7 1.18 6 0.85 23 20.71 1.11 0.08

Colon

Both Sexes, 60-69 Years of Age

Table 5.1.8: Risk of subsequent primary cancers after cancer of the colon, both sexes,

60-69 years of age, SEER 1973-2000.

124 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

COLON

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 47,216 38,643 21,795 12,686 47,216

Person-years in interval 35,118 113,469 84,511 72,077 305,176

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 148,569 PYR and for male cancers on 156,607 PYR.
Colon

Both Sexes, ≥70 Years of Age

Table 5.1.9: Risk of subsequent primary cancers after cancer of the colon, both sexes,

≥70 years of age, SEER 1973-2000.

COLON

All subsequent cancers 1,576 0.98 4,850 1.03 2,604 0.95* 1,193 0.96 10,223 10,311.64 0.99 -2.14

All excluding same site 1,179 0.89* 3,654 0.94* 2,092 0.93* 924 0.91* 7,849 8,491.87 0.92* -15.54

Buccal cavity, pharynx 28 0.85 91 0.98 51 1.01 19 0.85 189 198.58 0.95 -0.23

Lip 0 0.00* 11 0.60 10 0.98 3 0.67 24 39.63 0.61* -0.38

Tongue 8 1.33 17 1.00 11 1.21 5 1.27 41 35.97 1.14 0.12

Salivary gland 9 2.53* 12 1.11 6 0.88 1 0.28 28 24.69 1.13 0.08

Mouth 6 0.67 27 1.05 16 1.13 6 0.91 55 55.41 0.99 -0.01

Nasopharynx 0 0.00 3 1.07 0 0.00 0 0.00 3 5.82 0.52 -0.07

Tonsil 0 0.00 3 0.50 1 0.36 0 0.00 4 11.94 0.33* -0.19

Oropharynx 0 0.00 2 1.00 1 1.02 1 2.72 4 4.09 0.98 0.00

Hypopharynx 5 1.82 13 1.77 4 1.20 3 2.64 25 14.55 1.72* 0.25

Digestive system 516 1.23* 1,598 1.28* 751 0.99 402 1.10 3,267 2,788.33 1.17* 11.57

Esophagus 12 0.78 44 0.99 19 0.76 11 0.97 86 96.10 0.89 -0.24

Stomach 36 0.81 135 1.03 76 0.98 43 1.17 290 289.00 1.00 0.02

Small intestine 18 3.78* 32 2.25* 19 2.21* 8 1.89 77 31.78 2.42* 1.09

Colon 310 1.53* 909 1.48* 410 1.08 215 1.15 1,844 1,384.27 1.33* 11.11

Rectum, rectosigmoid junction 83 1.25 272 1.42* 94 0.86 51 1.05 500 415.26 1.20* 2.05

Anus, anal canal 4 1.30 15 1.66 8 1.48 3 1.11 30 20.24 1.48 0.24

Liver 4 0.35* 24 0.71 9 0.47* 8 0.94 45 72.68 0.62* -0.67

Gallbladder 7 0.97 10 0.47* 9 0.70 4 0.65 30 47.61 0.63* -0.43

Bile ducts, other biliary 6 0.64 25 0.86 24 1.25 16 1.54 71 68.23 1.04 0.07

Pancreas 34 0.67* 126 0.84 79 0.87 41 0.91 280 336.36 0.83* -1.36

Respiratory system 164 0.69* 641 0.94 367 1.00 138 0.93 1,310 1,437.24 0.91* -3.08

Nose, nasal cavity, ear 2 0.89 10 1.49 3 0.75 1 0.53 16 14.85 1.08 0.03

Larynx 9 0.72 23 0.68 16 0.99 6 1.05 54 68.34 0.79 -0.35

Lung, bronchus 152 0.68* 608 0.95 348 1.01 131 0.93 1,239 1,350.07 0.92* -2.68

Female breast 148 0.92 518 1.09 279 0.97 154 1.09 1,099 1,065.10 1.03 1.38

Female genital system 62 0.88 212 1.05 104 0.89 48 0.85 426 445.44 0.96 -0.79

Cervix uteri 8 1.12 22 1.13 14 1.33 2 0.41 46 42.04 1.09 0.16

Corpus uteri 33 0.98 109 1.16 48 0.94 27 1.18 217 201.46 1.08 0.63

Ovary 16 0.75 62 0.99 28 0.75 8 0.43* 114 139.65 0.82* -1.05

Vagina 2 1.29 3 0.65 2 0.70 3 2.04 10 10.54 0.95 -0.02

Vulva 3 0.60 14 0.91 11 1.05 7 1.13 35 37.09 0.94 -0.09

Male genital system 321 1.06 887 1.00 471 0.97 178 0.96 1,857 1,863.48 1.00 -0.38

Prostate 318 1.06 884 1.00 463 0.97 175 0.95 1,840 1,848.39 1.00 -0.50

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 1.76 0.00 -0.10

Urinary system 146 1.13 371 0.96 204 0.90 98 0.94 819 845.01 0.97 -0.63

Urinary bladder 85 0.90 261 0.93 156 0.93 74 0.95 576 621.49 0.93 -1.10

Kidney parenchyma 50 1.91* 81 1.05 33 0.76 20 1.04 184 165.93 1.11 0.44

Renal pelvis, other urinary 11 1.22 29 1.10 15 0.99 4 0.58 59 57.59 1.02 0.03

Ureter 4 1.32 12 1.35 7 1.39 0 0.00 23 19.15 1.20 0.09

Bone, joints 0 0.00 5 1.46 0 0.00 1 1.13 6 7.40 0.81 -0.03

Soft tissue including heart 8 1.33 12 0.66 6 0.54 4 0.71 30 41.00 0.73 -0.27

Kaposi sarcoma 1 0.73 6 1.38 3 1.04 0 0.00 10 10.22 0.98 -0.01

Melanoma of skin 30 1.17 77 0.98 28 0.57* 16 0.63 151 178.56 0.85* -0.67

Eye, orbit 2 0.96 6 1.00 2 0.59 1 0.66 11 12.95 0.85 -0.05

Brain, central nervous system 12 0.96 23 0.64* 23 1.16 4 0.48 62 76.97 0.81 -0.36

Thyroid 6 1.09 14 0.89 15 1.77 2 0.53 37 33.45 1.11 0.09

Lymphatic, hematopoietic 101 0.80* 328 0.86* 245 1.06 104 0.93 778 851.57 0.91* -1.78

Hodgkin lymphoma 2 0.67 8 0.95 2 0.45 1 0.55 13 17.67 0.74 -0.11

Non-Hodgkin lymphoma 43 0.81 136 0.85 103 1.05 46 0.96 328 359.57 0.91 -0.76

Myeloma 17 0.75 58 0.87 43 1.08 16 0.87 134 147.79 0.91 -0.33

Leukemia 39 0.80 126 0.87 97 1.09 41 0.93 303 326.55 0.93 -0.57

Acute lymphocytic 1 0.87 3 0.87 3 1.42 0 0.00 7 7.72 0.91 -0.02

Chronic lymphocytic 10 0.52* 44 0.77 36 1.05 7 0.41* 97 127.46 0.76* -0.74

Acute non-lymphocytic 20 1.23 42 0.86 32 1.08 19 1.32 113 109.38 1.03 0.09

Chronic myeloid 7 1.07 19 0.96 10 0.81 7 1.11 43 45.11 0.95 -0.05

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 95,156 71,375 32,280 12,867 95,156

Person-years in interval 66,789 190,360 106,739 49,783 413,671

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 244,864 PYR and for male cancers on 168,807 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 125
Rectum

Both Sexes

Table 5.2.1: Characteristics of patients with an initial cancer of the rectum or rectosigmoid junction,

both sexes, SEER 1973-2000.

126 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

RECTUM

Number of patients with 1st primary cancer

Total 43,403 100.0 34,033 100.0 77,436 100.0

Initial treatment

Any radiation 13,276 30.6 8,624 25.3 21,900 28.3

With surgery 10,997 25.3 7,008 20.6 18,005 23.3

Without surgery 2,279 5.3 1,616 4.7 3,895 5.0

No radiation 30,127 69.4 25,409 74.7 55,536 71.7

With surgery 27,151 62.6 22,398 65.8 49,549 64.0

Without surgery 2,976 6.9 3,011 8.8 5,987 7.7

Race

White 37,509 86.4 29,649 87.1 67,158 86.7

Black 2,523 5.8 2,379 7.0 4,902 6.3

Other 3,245 7.5 1,907 5.6 5,152 6.7

Unknown 126 0.3 98 0.3 224 0.3

Age at 1st primary cancer diagnosis, years

< 30 178 0.4 149 0.4 327 0.4

30–49 3,603 8.3 2,858 8.4 6,461 8.3

50–69 22,288 51.4 14,209 41.8 36,497 47.1

70–79 12,213 28.1 9,841 28.9 22,054 28.5

> 80 5,121 11.8 6,976 20.5 12,097 15.6

Number of patients with one or more

primary cancers

One primary cancer only 38,819 89.4 31,306 92.0 70,125 90.6

1st and 2nd cancers 4,120 9.5 2,461 7.2 6,581 8.5

1st, 2nd, and 3rd cancers 428 1.0 236 0.7 664 0.9

1st, 2nd, 3rd, and additional cancers 36 0.1 30 0.1 66 0.1

Other statistics

Median age at 1st cancer diagnosis 67.1 — 69.8 — 68.2 —

Median year of 1st cancer diagnosis 1987.5 — 1987.2 — 1987.4 —

Median person-years at risk 3.1 — 3.3 — 3.2 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 94.8 — 94.7 — 94.7

1st, 2nd, and additional cancers — 94.2 — 94.0 — 94.1

1st cancer only — 4.9 — 4.9 — 4.9

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Rectum

Both Sexes

Table 5.2.2: Risk of subsequent primary cancers after cancer of the rectum or rectosigmoid junction,

both sexes, SEER 1973-2000.

RECTUM

All subsequent cancers 1,042 1.08* 3,019 0.99 2,194 1.01 1,862 0.96 8,117 8,133.64 1.00 -0.40

All excluding same site 815 0.99 2,355 0.90* 1,834 1.00 1,527 0.92* 6,531 6,923.21 0.94* -9.34

Buccal cavity, pharynx 23 0.89 75 0.96 39 0.78 31 0.77 168 193.74 0.87 -0.61

Lip 4 0.93 13 1.01 4 0.48 8 1.21 29 32.11 0.90 -0.07

Tongue 4 0.81 10 0.66 6 0.61 5 0.64 25 37.63 0.66* -0.30

Salivary gland 0 0.00 9 1.32 4 0.82 3 0.66 16 18.39 0.87 -0.06

Mouth 6 0.88 17 0.83 11 0.84 12 1.14 46 50.94 0.90 -0.12

Nasopharynx 2 1.90 4 1.29 3 1.59 0 0.00 9 7.49 1.20 0.04

Tonsil 2 0.87 8 1.18 3 0.72 2 0.66 15 16.25 0.92 -0.03

Oropharynx 1 1.44 2 0.95 0 0.00 0 0.00 3 5.15 0.58 -0.05

Hypopharynx 1 0.38 9 1.14 7 1.44 1 0.28 18 18.91 0.95 -0.02

Digestive system 308 1.35* 883 1.24* 519 1.04 498 1.11* 2,208 1,891.93 1.17* 7.53

Esophagus 12 1.13 29 0.88 20 0.88 12 0.60 73 86.35 0.85 -0.32

Stomach 27 1.10 59 0.79 49 0.97 56 1.27 191 194.20 0.98 -0.08

Small intestine 8 2.82* 29 3.19* 9 1.37 16 2.56* 62 24.76 2.50* 0.89

Colon 177 1.71* 527 1.61* 297 1.27* 301 1.41* 1,302 879.86 1.48* 10.05

Rectum, rectosigmoid junction 44 1.11 122 0.99 57 0.69* 32 0.46* 255 314.84 0.81* -1.42

Anus, anal canal 6 3.19* 15 2.52* 6 1.44 2 0.54 29 15.72 1.84* 0.32

Liver 3 0.41 9 0.38* 11 0.67 7 0.46* 30 62.64 0.48* -0.78

Gallbladder 4 1.19 6 0.58 8 1.13 3 0.48 21 27.01 0.78 -0.14

Bile ducts, other biliary 3 0.63 19 1.24 16 1.40 18 1.56 56 43.12 1.30 0.31

Pancreas 21 0.77 61 0.72* 44 0.74* 44 0.81 170 225.73 0.75* -1.33

Respiratory system 135 0.81* 534 1.02 452 1.25* 318 1.02 1,439 1,361.78 1.06* 1.84

Nose, nasal cavity, ear 0 0.00 3 0.67 7 2.28 5 1.85 15 11.73 1.28 0.08

Larynx 11 0.97 38 1.10 26 1.20 11 0.67 86 83.89 1.03 0.05

Lung, bronchus 123 0.80* 493 1.02 417 1.25* 301 1.03 1,334 1,262.74 1.06* 1.70

Female breast 104 1.18 281 1.00 201 1.01 167 0.89 753 755.75 1.00 -0.14

Female genital system 25 0.60* 110 0.86 114 1.33* 71 0.93 320 331.18 0.97 -0.58

Cervix uteri 6 1.27 11 0.81 10 1.22 3 0.48 30 32.71 0.92 -0.14

Corpus uteri 11 0.52* 55 0.85 69 1.59* 42 1.11 177 167.10 1.06 0.51

Ovary 5 0.42* 32 0.86 22 0.84 17 0.71 76 99.13 0.77* -1.19

Vagina 2 2.89 4 1.87 8 5.36* 3 2.15 17 5.72 2.97* 0.58

Vulva 0 0.00 5 0.77 3 0.62 4 0.80 12 18.35 0.65 -0.33

Male genital system 217 1.14 472 0.75* 380 0.82* 357 0.87* 1,426 1,692.72 0.84* -11.81

Prostate 214 1.13 465 0.75* 376 0.82* 352 0.86* 1,407 1,677.97 0.84* -12.00

Testis 0 0.00 1 0.56 1 1.11 0 0.00 2 3.88 0.52 -0.08

Urinary system 122 1.55* 300 1.20* 181 1.02 158 0.98 761 668.09 1.14* 2.21

Urinary bladder 65 1.17 208 1.18* 125 0.99 117 1.01 515 473.61 1.09 0.99

Kidney parenchyma 49 2.71* 74 1.29* 44 1.09 30 0.83 197 152.02 1.30* 1.07

Renal pelvis, other urinary 8 1.54 18 1.11 12 1.07 11 1.11 49 42.46 1.15 0.16

Ureter 2 1.15 5 0.91 6 1.59 4 1.22 17 14.27 1.19 0.07

Bone, joints 1 1.21 0 0.00 2 1.22 4 2.89 7 6.37 1.10 0.01

Soft tissue including heart 4 1.09 8 0.69 8 0.99 7 0.92 27 30.92 0.87 -0.09

Kaposi sarcoma 2 1.88 4 1.26 3 1.50 0 0.00 9 7.87 1.14 0.03

Melanoma of skin 22 1.18 65 1.07 45 1.02 45 1.06 177 166.17 1.07 0.26

Eye, orbit 2 1.43 2 0.46 2 0.69 3 1.21 9 11.12 0.81 -0.05

Brain, central nervous system 6 0.64 23 0.79 18 0.91 17 1.00 64 75.34 0.85 -0.27

Thyroid 5 1.08 15 1.06 8 0.88 10 1.32 38 35.45 1.07 0.06

Lymphatic, hematopoietic 55 0.76* 207 0.90 170 1.04 122 0.80* 554 617.43 0.90* -1.51

Hodgkin lymphoma 1 0.44 6 0.89 5 1.20 2 0.60 14 16.50 0.85 -0.06

Non-Hodgkin lymphoma 26 0.84 94 0.94 87 1.19 65 0.93 272 274.33 0.99 -0.06

Myeloma 11 0.88 36 0.91 23 0.82 27 1.05 97 105.66 0.92 -0.21

Leukemia 17 0.65 71 0.86 55 0.94 28 0.52* 171 220.95 0.77* -1.19

Acute lymphocytic 0 0.00 2 0.92 0 0.00 1 0.78 3 5.66 0.53 -0.06

Chronic lymphocytic 4 0.38* 16 0.48* 24 1.03 10 0.48* 54 88.02 0.61* -0.81

Acute non-lymphocytic 8 0.91 34 1.23 21 1.06 9 0.49* 72 74.81 0.96 -0.07

Chronic myeloid 2 0.57 8 0.72 6 0.76 6 0.81 22 29.91 0.74 -0.19

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 77,436 62,770 29,489 15,055 77,436

Person-years in interval 57,405 170,451 106,735 85,351 419,941

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 194,197 PYR and for male cancers on 225,744 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 127
All subsequent cancers 6,255 1.01 1,179 0.99 480 0.88* 203 1.02 8,117 8,133.64 1.00 -0.40

All excluding same site 5,004 0.95* 982 0.96 393 0.84* 152 0.90 6,531 6,923.21 0.94* -9.34

Buccal cavity, pharynx 137 0.89 24 0.95 5 0.46 2 0.52 168 193.74 0.87 -0.61

Lip 21 0.82 7 1.68 0 0.00 1 1.60 29 32.11 0.90 -0.07

Tongue 20 0.67 2 0.40 3 1.40 0 0.00 25 37.63 0.66* -0.30

Salivary gland 13 0.94 3 1.09 0 0.00 0 0.00 16 18.39 0.87 -0.06

Mouth 34 0.84 9 1.36 2 0.69 1 0.97 46 50.94 0.90 -0.12

Nasopharynx 9 1.49 0 0.00 0 0.00 0 0.00 9 7.49 1.20 0.04

Tonsil 13 0.98 2 1.02 0 0.00 0 0.00 15 16.25 0.92 -0.03

Oropharynx 3 0.73 0 0.00 0 0.00 0 0.00 3 5.15 0.58 -0.05

Hypopharynx 17 1.11 1 0.43 0 0.00 0 0.00 18 18.91 0.95 -0.02

Digestive system 1,710 1.19* 296 1.08 134 1.06 68 1.42* 2,208 1,891.93 1.17* 7.53

Esophagus 61 0.92 6 0.49 5 0.90 1 0.48 73 86.35 0.85 -0.32

Stomach 135 0.90 31 1.14 18 1.46 7 1.50 191 194.20 0.98 -0.08

Small intestine 46 2.49* 11 2.91* 4 2.23 1 1.45 62 24.76 2.50* 0.89

Colon 1,001 1.50* 172 1.32* 79 1.30* 50 2.18* 1,302 879.86 1.48* 10.05

Rectum, rectosigmoid junction 223 0.91 24 0.55* 7 0.37* 1 0.14* 255 314.84 0.81* -1.42

Anus, anal canal 27 2.25* 1 0.44 1 0.94 0 0.00 29 15.72 1.84* 0.32

Liver 23 0.49* 4 0.43 2 0.46 1 0.59 30 62.64 0.48* -0.78

Gallbladder 18 0.87 2 0.52 1 0.57 0 0.00 21 27.01 0.78 -0.14

Bile ducts, other biliary 38 1.20 11 1.62 6 1.76 1 0.73 56 43.12 1.30 0.31

Pancreas 126 0.74* 30 0.91 9 0.58 5 0.85 170 225.73 0.75* -1.33

Respiratory system 1,121 1.07* 219 1.13 72 0.83 27 0.86 1,439 1,361.78 1.06* 1.84

Nose, nasal cavity, ear 10 1.11 4 2.42 1 1.31 0 0.00 15 11.73 1.28 0.08

Larynx 75 1.11 7 0.66 3 0.69 1 0.70 86 83.89 1.03 0.05

Lung, bronchus 1,033 1.06 208 1.15* 67 0.82 26 0.88 1,334 1,262.74 1.06* 1.70

Female breast 586 1.03 114 1.00 38 0.71* 15 0.75 753 755.75 1.00 -0.14

Female genital system 249 0.98 44 0.94 21 0.96 6 0.76 320 331.18 0.97 -0.58

Cervix uteri 27 1.02 2 0.50 0 0.00 1 1.77 30 32.71 0.92 -0.14

Corpus uteri 135 1.04 25 1.08 13 1.22 4 1.04 177 167.10 1.06 0.51

Ovary 59 0.79 12 0.82 4 0.58 1 0.40 76 99.13 0.77* -1.19

Vagina 14 3.23* 2 2.37 1 2.49 0 0.00 17 5.72 2.97* 0.58

Vulva 8 0.60 1 0.34 3 2.02 0 0.00 12 18.35 0.65 -0.33

Male genital system 1,069 0.83* 228 0.88 88 0.76* 41 1.10 1,426 1,692.72 0.84* -11.81

Prostate 1,055 0.83* 226 0.88 85 0.74* 41 1.11 1,407 1,677.97 0.84* -12.00

Testis 2 0.60 0 0.00 0 0.00 0 0.00 2 3.88 0.52 -0.08

Urinary system 603 1.19* 92 0.93 49 1.08 17 0.98 761 668.09 1.14* 2.21

Urinary bladder 398 1.11* 69 0.98 36 1.10 12 0.96 515 473.61 1.09 0.99

Kidney parenchyma 167 1.44* 15 0.68 11 1.08 4 1.07 197 152.02 1.30* 1.07

Renal pelvis, other urinary 38 1.17 8 1.32 2 0.72 1 0.95 49 42.46 1.15 0.16

Ureter 13 1.18 3 1.48 0 0.00 1 2.98 17 14.27 1.19 0.07

Bone, joints 3 0.60 3 3.53 1 2.55 0 0.00 7 6.37 1.10 0.01

Soft tissue including heart 20 0.86 6 1.31 1 0.46 0 0.00 27 30.92 0.87 -0.09

Kaposi sarcoma 9 1.44 0 0.00 0 0.00 0 0.00 9 7.87 1.14 0.03

Melanoma of skin 132 1.07 29 1.14 9 0.73 7 1.43 177 166.17 1.07 0.26

Eye, orbit 6 0.70 3 1.95 0 0.00 0 0.00 9 11.12 0.81 -0.05

Brain, central nervous system 47 0.80 12 1.14 5 1.07 0 0.00 64 75.34 0.85 -0.27

Thyroid 28 1.00 6 1.27 3 1.43 1 1.33 38 35.45 1.07 0.06

Lymphatic, hematopoietic 432 0.93 69 0.75* 39 0.90 14 0.84 554 617.43 0.90* -1.51

Hodgkin lymphoma 12 0.91 1 0.47 1 1.10 0 0.00 14 16.50 0.85 -0.06

Non-Hodgkin lymphoma 207 1.01 35 0.83 19 0.94 11 1.40 272 274.33 0.99 -0.06

Myeloma 70 0.88 16 1.02 9 1.23 2 0.73 97 105.66 0.92 -0.21

Leukemia 143 0.85 17 0.52* 10 0.66 1 0.17* 171 220.95 0.77* -1.19

Acute lymphocytic 2 0.46 1 1.22 0 0.00 0 0.00 3 5.66 0.53 -0.06

Chronic lymphocytic 44 0.66* 8 0.62 2 0.34 0 0.00 54 88.02 0.61* -0.81

Acute non-lymphocytic 63 1.12 4 0.36* 4 0.76 1 0.49 72 74.81 0.96 -0.07

Chronic myeloid 16 0.71 2 0.45 4 1.91 0 0.00 22 29.91 0.74 -0.19

Rectum

Both Sexes, Long-term Follow-up

Table 5.2.3: Risk of subsequent primary cancers after cancer of the rectum or rectosigmoid junction, both sexes,

long-term follow-up SEER 1973-2000.

128 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

RECTUM

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 77,436 15,055 7,108 2,744 77,436

Person-years in interval 334,591 53,684 23,321 8,346 419,941

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 194,197 PYR and for male cancers on 225,744 PYR.
Rectum

Females

Table 5.2.4: Risk of subsequent primary cancers after cancer of the rectum or rectosigmoid junction,

females, SEER 1973-2000.

RECTUM

All subsequent cancers 355 1.08 1,086 1.05 845 1.13* 739 1.03 3,025 2,833.07 1.07* 9.88

All excluding same site 256 0.94 818 0.95 683 1.10* 582 0.98 2,339 2,344.68 1.00 -0.29

Buccal cavity, pharynx 2 0.34 14 0.76 7 0.54 9 0.76 32 49.03 0.65* -0.88

Lip 1 2.35 1 0.74 0 0.00 2 1.95 4 3.81 1.05 0.01

Tongue 0 0.00 3 0.75 2 0.70 1 0.38 6 10.75 0.56 -0.24

Salivary gland 0 0.00 3 1.48 2 1.39 0 0.00 5 5.52 0.91 -0.03

Mouth 1 0.48 2 0.31 1 0.22 5 1.17 9 17.43 0.52* -0.43

Nasopharynx 0 0.00 1 1.37 1 2.05 0 0.00 2 1.89 1.06 0.01

Tonsil 0 0.00 2 1.32 0 0.00 1 1.29 3 3.77 0.79 -0.04

Oropharynx 0 0.00 1 2.23 0 0.00 0 0.00 1 1.15 0.87 -0.01

Hypopharynx 0 0.00 1 0.83 1 1.25 0 0.00 2 3.03 0.66 -0.05

Digestive system 123 1.46* 339 1.28* 217 1.13 238 1.27* 917 728.56 1.26* 9.70

Esophagus 2 0.92 6 0.88 2 0.40 7 1.44 17 18.82 0.90 -0.09

Stomach 5 0.71 14 0.65 16 1.05 17 1.18 52 58.28 0.89 -0.32

Small intestine 2 1.93 14 4.18* 5 1.98 9 3.41* 30 9.54 3.14* 1.05

Colon 79 1.86* 203 1.51* 136 1.39* 144 1.49* 562 370.97 1.51* 9.84

Rectum, rectosigmoid junction 20 1.52 57 1.39* 23 0.81 11 0.42* 111 108.76 1.02 0.12

Rectum 17 1.97* 49 1.83* 19 1.01 9 0.51* 94 71.59 1.31* 1.15

Anus, anal canal 0 0.00 8 2.53* 3 1.31 2 0.91 13 8.65 1.50 0.22

Liver 0 0.00 0 0.00* 3 0.74 4 0.95 7 15.42 0.45* -0.43

Gallbladder 2 0.97 5 0.80 6 1.38 2 0.51 15 16.62 0.90 -0.08

Bile ducts, other biliary 2 1.11 6 1.04 5 1.13 9 1.89 22 16.75 1.31 0.27

Pancreas 11 1.02 23 0.67 18 0.71 30 1.19 82 95.77 0.86 -0.71

Respiratory system 34 0.86 152 1.17 138 1.41* 112 1.14 436 365.68 1.19* 3.62

Nose, nasal cavity, ear 0 0.00 1 0.69 2 1.91 3 2.92 6 3.97 1.51 0.10

Larynx 1 0.78 4 0.99 3 1.08 1 0.42 9 10.47 0.86 -0.08

Lung, bronchus 32 0.85 147 1.18 132 1.41* 108 1.14 419 350.29 1.20* 3.54

Female breast 104 1.18 281 1.00 201 1.01 167 0.89 753 755.75 1.00 -0.14

Female genital system 25 0.60* 110 0.86 114 1.33* 71 0.93 320 331.18 0.97 -0.58

Cervix uteri 6 1.27 11 0.81 10 1.22 3 0.48 30 32.71 0.92 -0.14

Corpus uteri 11 0.52* 55 0.85 69 1.59* 42 1.11 177 167.10 1.06 0.51

Ovary 5 0.42* 32 0.86 22 0.84 17 0.71 76 99.13 0.77* -1.19

Vagina 2 2.89 4 1.87 8 5.36* 3 2.15 17 5.72 2.97* 0.58

Vulva 0 0.00 5 0.77 3 0.62 4 0.80 12 18.35 0.65 -0.33

Urinary system 24 1.48 74 1.43* 37 0.97 35 0.92 170 143.90 1.18* 1.34

Urinary bladder 9 0.91 47 1.49* 26 1.12 21 0.90 103 87.76 1.17 0.78

Kidney parenchyma 13 2.68* 20 1.28 9 0.77 11 0.95 53 43.78 1.21 0.47

Renal pelvis, other urinary 2 1.40 7 1.55 2 0.61 3 0.95 14 12.35 1.13 0.08

Ureter 0 0.00 1 0.70 0 0.00 0 0.00 1 3.90 0.26 -0.15

Bone, joints 0 0.00 0 0.00 2 3.16 1 1.71 3 2.45 1.23 0.03

Soft tissue including heart 0 0.00 2 0.49 2 0.68 2 0.68 6 11.18 0.54 -0.27

Kaposi sarcoma 0 0.00 2 4.17 1 2.68 0 0.00 3 1.38 2.17 0.08

Melanoma of skin 8 1.44 11 0.61 17 1.30 14 1.07 50 49.70 1.01 0.02

Eye, orbit 2 4.05 1 0.66 1 0.97 1 1.05 5 4.00 1.25 0.05

Brain, central nervous system 4 1.25 9 0.88 10 1.38 9 1.35 32 27.29 1.17 0.24

Thyroid 1 0.39 8 1.02 5 0.97 6 1.34 20 20.00 1.00 0.00

Lymphatic, hematopoietic 26 1.01 69 0.84 71 1.17 56 0.92 222 230.06 0.96 -0.42

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 5.87 0.00* -0.30

Non-Hodgkin lymphoma 13 1.09 40 1.04 39 1.34 31 1.04 123 109.15 1.13 0.71

Myeloma 5 1.09 9 0.62 13 1.23 13 1.26 40 39.93 1.00 0.00

Leukemia 8 0.93 20 0.74 19 0.96 12 0.61 59 75.10 0.79 -0.83

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 2.02 0.00 -0.10

Chronic lymphocytic 2 0.59 4 0.38* 7 0.90 4 0.53 17 29.31 0.58* -0.63

Acute non-lymphocytic 4 1.35 11 1.17 6 0.87 5 0.72 26 26.18 0.99 -0.01

Chronic myeloid 1 0.85 2 0.54 4 1.48 3 1.12 10 10.26 0.98 -0.01

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 34,033 27,579 13,512 7,206 34,033

Person-years in interval 25,195 76,159 49,989 42,854 194,197

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 129
All subsequent cancers 687 1.08 1,933 0.95* 1,349 0.95 1,123 0.92* 5,092 5,300.57 0.96* -9.24

All excluding same site 559 1.02 1,537 0.88* 1,151 0.94* 945 0.89* 4,192 4,578.53 0.92* -17.12

Buccal cavity, pharynx 21 1.06 61 1.03 32 0.86 22 0.78 136 144.71 0.94 -0.39

Lip 3 0.77 12 1.04 4 0.55 6 1.08 25 28.29 0.88 -0.15

Tongue 4 1.09 7 0.63 4 0.58 4 0.76 19 26.87 0.71 -0.35

Salivary gland 0 0.00 6 1.25 2 0.59 3 0.95 11 12.87 0.85 -0.08

Mouth 5 1.06 15 1.07 10 1.17 7 1.11 37 33.51 1.10 0.15

Nasopharynx 2 2.46 3 1.26 2 1.43 0 0.00 7 5.60 1.25 0.06

Tonsil 2 1.12 6 1.13 3 0.95 1 0.45 12 12.48 0.96 -0.02

Oropharynx 1 1.80 1 0.60 0 0.00 0 0.00 2 4.00 0.50 -0.09

Hypopharynx 1 0.45 8 1.20 6 1.48 1 0.34 16 15.87 1.01 0.01

Digestive system 185 1.29* 544 1.21* 302 0.98 260 0.99 1,291 1,163.38 1.11* 5.65

Esophagus 10 1.18 23 0.88 18 1.02 5 0.33* 56 67.53 0.83 -0.51

Stomach 22 1.26 45 0.84 33 0.93 39 1.31 139 135.92 1.02 0.14

Small intestine 6 3.33* 15 2.61* 4 0.99 7 1.93 32 15.22 2.10* 0.74

Colon 98 1.60* 324 1.67* 161 1.18* 157 1.33* 740 508.89 1.45* 10.24

Rectum, rectosigmoid junction 24 0.90 65 0.79 34 0.63* 21 0.48* 144 206.08 0.70* -2.75

Anus, anal canal 6 6.72* 7 2.52* 3 1.61 0 0.00 16 7.07 2.26* 0.40

Liver 3 0.53 9 0.50* 8 0.64 3 0.27* 23 47.22 0.49* -1.07

Gallbladder 2 1.54 1 0.25 2 0.73 1 0.43 6 10.39 0.58 -0.19

Bile ducts, other biliary 1 0.34 13 1.36 11 1.57 9 1.32 34 26.37 1.29 0.34

Pancreas 10 0.61 38 0.75 26 0.76 14 0.48* 88 129.96 0.68* -1.86

Respiratory system 101 0.80* 382 0.97 314 1.20* 206 0.97 1,003 996.09 1.01 0.31

Nose, nasal cavity, ear 0 0.00 2 0.65 5 2.47 2 1.19 9 7.77 1.16 0.05

Larynx 10 0.99 34 1.12 23 1.21 10 0.71 77 73.42 1.05 0.16

Lung, bronchus 91 0.79* 346 0.96 285 1.18* 193 0.98 915 912.45 1.00 0.11

Male breast 2 1.68 1 0.27 6 2.33 4 1.77 13 9.74 1.34 0.14

Male genital system 217 1.14 472 0.75* 380 0.82* 357 0.87* 1,426 1,692.72 0.84* -11.81

Prostate 214 1.13 465 0.75* 376 0.82* 352 0.86* 1,407 1,677.97 0.84* -12.00

Testis 0 0.00 1 0.56 1 1.11 0 0.00 2 3.88 0.52 -0.08

Urinary system 98 1.57* 226 1.14 144 1.03 123 1.00 591 524.19 1.13* 2.96

Urinary bladder 56 1.23 161 1.11 99 0.96 96 1.04 412 385.84 1.07 1.16

Kidney parenchyma 36 2.73* 54 1.29 35 1.22 19 0.78 144 108.24 1.33* 1.58

Renal pelvis, other urinary 6 1.60 11 0.94 10 1.26 8 1.19 35 30.11 1.16 0.22

Ureter 2 1.55 4 0.99 6 2.18 4 1.76 16 10.36 1.54 0.25

Bone, joints 1 1.91 0 0.00 0 0.00 3 3.74 4 3.92 1.02 0.00

Soft tissue including heart 4 1.67 6 0.80 6 1.16 5 1.06 21 19.74 1.06 0.06

Kaposi sarcoma 2 2.18 2 0.74 2 1.23 0 0.00 6 6.49 0.93 -0.02

Melanoma of skin 14 1.07 54 1.26 28 0.90 31 1.05 127 116.47 1.09 0.47

Eye, orbit 0 0.00 1 0.36 1 0.53 2 1.30 4 7.12 0.56 -0.14

Brain, central nervous system 2 0.32 14 0.73 8 0.64 8 0.78 32 48.05 0.67* -0.71

Thyroid 4 1.92 7 1.11 3 0.76 4 1.29 18 15.45 1.16 0.11

Lymphatic, hematopoietic 29 0.63* 138 0.94 99 0.96 66 0.72* 332 387.37 0.86* -2.45

Hodgkin lymphoma 1 0.65 6 1.35 5 1.88 2 1.00 14 10.62 1.32 0.15

Non-Hodgkin lymphoma 13 0.68 54 0.88 48 1.09 34 0.84 149 165.18 0.90 -0.72

Myeloma 6 0.76 27 1.08 10 0.57 14 0.90 57 65.72 0.87 -0.39

Leukemia 9 0.51* 51 0.92 36 0.93 16 0.47* 112 145.84 0.77* -1.50

Acute lymphocytic 0 0.00 2 1.39 0 0.00 1 1.30 3 3.64 0.82 -0.03

Chronic lymphocytic 2 0.28 12 0.53* 17 1.09 6 0.45* 37 58.71 0.63* -0.96

Acute non-lymphocytic 4 0.69 23 1.25 15 1.16 4 0.35* 46 48.63 0.95 -0.12

Chronic myeloid 1 0.42 6 0.81 2 0.39 3 0.64 12 19.65 0.61 -0.34

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 43,403 35,191 15,977 7,849 43,403

Person-years in interval 32,210 94,292 56,746 42,496 225,744

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Rectum

Males

Table 5.2.5: Risk of subsequent primary cancers after cancer of the rectum or rectosigmoid junction,

males, SEER 1973-2000.

130 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

RECTUM

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Rectum

Both Sexes, <50 Years of Age

Table 5.2.6: Risk of subsequent primary cancers after cancer of the rectum or rectosigmoid junction, both sexes,

<50 years of age, SEER 1973-2000.

RECTUM

All subsequent cancers 32 2.43* 101 1.98* 76 1.44* 148 1.24* 357 236.36 1.51* 28.40

All excluding same site 24 1.99* 72 1.55* 64 1.34* 111 1.04 271 212.54 1.28* 13.76

Buccal cavity, pharynx 2 3.78 0 0.00 1 0.50 1 0.29 4 8.02 0.50 -0.95

Lip 1 19.30 0 0.00 0 0.00 0 0.00 1 0.72 1.38 0.07

Tongue 0 0.00 0 0.00 1 2.21 0 0.00 1 1.79 0.56 -0.19

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -0.15

Mouth 1 7.86 0 0.00 0 0.00 0 0.00 1 2.01 0.50 -0.24

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.14

Tonsil 0 0.00 0 0.00 0 0.00 1 2.49 1 1.04 0.96 -0.01

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.75 0.00 -0.18

Digestive system 8 4.28* 39 5.03* 18 2.06* 52 2.46* 117 39.54 2.96* 18.23

Esophagus 0 0.00 2 3.99 0 0.00 0 0.00 2 2.55 0.78 -0.13

Stomach 0 0.00 0 0.00 2 2.32 4 2.07 6 3.84 1.56 0.51

Small intestine 0 0.00 5 25.82* 2 10.00* 1 2.45 8 0.85 9.39* 1.68

Colon 7 10.53* 16 5.68* 9 2.73* 37 4.31* 69 15.35 4.50* 12.63

Rectum, rectosigmoid junction 1 2.68 10 6.34* 3 1.67 0 0.00* 14 7.78 1.80 1.46

Anus, anal canal 0 0.00 3 17.48* 0 0.00 0 0.00 3 0.68 4.40 0.55

Liver 0 0.00 0 0.00 0 0.00 2 1.84 2 2.14 0.94 -0.03

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.10

Bile ducts, other biliary 0 0.00 0 0.00 1 5.96 3 6.61* 4 0.80 4.98* 0.75

Pancreas 0 0.00 3 3.43 0 0.00 5 1.98 8 4.61 1.74 0.80

Respiratory system 6 3.72* 14 1.99* 13 1.55 19 0.91 52 37.91 1.37* 3.32

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.10

Larynx 1 6.04 0 0.00 1 1.28 0 0.00 2 3.18 0.63 -0.28

Lung, bronchus 5 3.55* 14 2.26* 12 1.60 19 0.99 50 34.19 1.46* 3.72

Female breast 4 1.28 16 1.39 3 0.28* 13 0.74 36 42.93 0.84 -3.46

Female genital system 1 0.81 7 1.52 8 1.88 9 1.26 25 17.24 1.45 3.88

Cervix uteri 0 0.00 0 0.00 1 1.24 1 1.17 2 3.20 0.62 -0.60

Corpus uteri 1 2.40 3 1.67 7 3.65* 6 1.61 17 7.84 2.17* 4.57

Ovary 0 0.00 4 2.86 0 0.00 0 0.00 4 5.20 0.77 -0.60

Vagina 0 0.00 0 0.00 0 0.00 1 12.38 1 0.17 5.75 0.41

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -0.25

Male genital system 0 0.00 5 1.64 7 1.39 20 0.90 32 30.81 1.04 0.53

Prostate 0 0.00 4 1.62 5 1.06 19 0.87 28 29.44 0.95 -0.64

Testis 0 0.00 0 0.00 1 4.05 0 0.00 1 1.10 0.91 -0.05

Urinary system 6 8.08* 8 2.60* 8 2.33* 8 0.95 30 15.65 1.92* 3.38

Urinary bladder 1 2.62 2 1.23 5 2.62 7 1.36 15 9.04 1.66 1.40

Kidney parenchyma 5 15.16* 4 3.02 3 2.17 1 0.35 13 5.88 2.21* 1.68

Renal pelvis, other urinary 0 0.00 2 15.52* 0 0.00 0 0.00 2 0.72 2.79 0.30

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.05

Bone, joints 0 0.00 0 0.00 0 0.00 1 8.31 1 0.34 2.95 0.16

Soft tissue including heart 0 0.00 1 2.65 1 3.23 3 6.01* 5 1.30 3.86* 0.87

Kaposi sarcoma 0 0.00 0 0.00 1 3.04 0 0.00 1 1.40 0.71 -0.09

Melanoma of skin 2 2.39 6 2.08 1 0.42 9 2.41* 18 9.84 1.83* 1.92

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.10

Brain, central nervous system 0 0.00 0 0.00 1 1.15 1 0.71 2 3.57 0.56 -0.37

Thyroid 0 0.00 0 0.00 3 3.22 2 1.79 5 3.72 1.34 0.30

Lymphatic, hematopoietic 3 2.49 5 1.13 6 1.46 9 1.09 23 18.00 1.28 1.18

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.19 0.00 -0.28

Non-Hodgkin lymphoma 1 1.57 3 1.29 5 2.34 3 0.71 12 9.30 1.29 0.64

Myeloma 2 18.11* 1 2.10 0 0.00 5 3.79* 8 2.46 3.26* 1.30

Leukemia 0 0.00 1 0.85 1 0.88 1 0.41 3 5.06 0.59 -0.48

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.06

Chronic lymphocytic 0 0.00 0 0.00 1 2.53 0 0.00 1 1.75 0.57 -0.18

Acute non-lymphocytic 0 0.00 1 2.38 0 0.00 0 0.00 1 1.75 0.57 -0.18

Chronic myeloid 0 0.00 0 0.00 0 0.00 1 2.94 1 0.80 1.24 0.05

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,788 5,678 2,777 1,577 6,788

Person-years in interval 5,159 15,657 10,487 11,182 42,485

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 20,021 PYR and for male cancers on 22,464 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 131
All subsequent cancers 437 1.24* 1,358 1.03 1,229 1.02 1,338 0.95 4,362 4,280.51 1.02 3.44

All excluding same site 343 1.12* 1,086 0.94* 1,057 1.01 1,110 0.92* 3,596 3,712.21 0.97 -4.90

Buccal cavity, pharynx 11 0.90 39 0.95 26 0.85 20 0.69 96 113.13 0.85 -0.72

Lip 0 0.00 5 0.90 3 0.68 3 0.65 11 16.15 0.68 -0.22

Tongue 3 1.21 7 0.84 3 0.48 3 0.52 16 22.90 0.70 -0.29

Salivary gland 0 0.00 5 1.77 1 0.41 3 0.98 9 9.10 0.99 0.00

Mouth 3 0.93 9 0.84 8 1.01 9 1.19 29 29.46 0.98 -0.02

Nasopharynx 1 1.70 1 0.54 3 2.38 0 0.00 5 4.75 1.05 0.01

Tonsil 1 0.76 5 1.18 2 0.70 1 0.44 9 10.69 0.84 -0.07

Oropharynx 1 2.57 2 1.56 0 0.00 0 0.00 3 3.39 0.89 -0.02

Hypopharynx 0 0.00 4 0.83 6 1.74 1 0.36 11 12.46 0.88 -0.06

Digestive system 134 1.85* 360 1.33* 261 1.05 345 1.11 1,100 902.38 1.22* 8.33

Esophagus 5 1.09 15 0.92 11 0.81 8 0.54 39 49.16 0.79 -0.43

Stomach 14 1.85* 19 0.69 27 1.10 42 1.40* 102 90.02 1.13 0.51

Small intestine 5 4.75* 14 3.53* 4 1.10 10 2.23* 33 13.13 2.51* 0.84

Colon 70 2.36* 218 1.91* 138 1.26* 205 1.41* 631 398.89 1.58* 9.78

Rectum, rectosigmoid junction 21 1.46 47 0.90 31 0.69* 22 0.44* 121 160.98 0.75* -1.69

Anus, anal canal 3 3.96 7 2.55* 3 1.29 1 0.39 14 8.43 1.66 0.23

Liver 2 0.69 6 0.56 9 0.94 5 0.44 22 34.41 0.64* -0.52

Gallbladder 2 2.43 0 0.00 1 0.32 3 0.73 6 11.20 0.54 -0.22

Bile ducts, other biliary 2 1.49 9 1.73 10 1.95 10 1.30 31 19.38 1.60* 0.49

Pancreas 8 0.92 24 0.74 26 0.88 32 0.85 90 108.40 0.83 -0.78

Respiratory system 74 1.04 293 1.12 298 1.33* 252 1.05 917 794.55 1.15* 5.16

Nose, nasal cavity, ear 0 0.00 0 0.00 5 3.04 5 2.62 10 6.14 1.63 0.16

Larynx 7 1.17 22 1.09 16 1.07 11 0.86 56 53.88 1.04 0.09

Lung, bronchus 67 1.04 271 1.14* 277 1.34* 235 1.05 850 732.68 1.16* 4.95

Female breast 40 1.16 126 1.02 111 1.02 117 0.90 394 397.35 0.99 -0.33

Female genital system 9 0.50* 53 0.87 80 1.62* 49 0.92 191 181.25 1.05 0.96

Cervix uteri 3 1.43 3 0.46 7 1.56 1 0.25 14 17.17 0.82 -0.31

Corpus uteri 3 0.30* 30 0.89 46 1.71* 29 1.05 108 98.22 1.10 0.96

Ovary 3 0.63 17 1.01 17 1.18 12 0.73 49 52.51 0.93 -0.34

Vagina 0 0.00 2 2.75 7 10.48* 2 2.23 11 2.50 4.41* 0.84

Vulva 0 0.00 1 0.55 2 1.07 4 1.32 7 7.20 0.97 -0.02

Male genital system 76 1.18 189 0.70* 217 0.79* 259 0.82* 741 926.61 0.80* -13.70

Prostate 73 1.14 187 0.70* 216 0.79* 256 0.81* 732 919.15 0.80* -13.82

Testis 0 0.00 1 1.12 0 0.00 0 0.00 1 2.03 0.49 -0.08

Urinary system 47 1.71* 142 1.37* 88 0.92 115 0.99 392 343.85 1.14* 2.03

Urinary bladder 22 1.21 90 1.29* 58 0.88 85 1.03 255 236.00 1.08 0.80

Kidney parenchyma 24 3.10* 46 1.64* 23 0.95 20 0.75 113 86.79 1.30* 1.10

Renal pelvis, other urinary 1 0.60 6 0.94 7 1.19 10 1.41 24 21.05 1.14 0.12

Ureter 0 0.00 2 0.94 4 2.00 4 1.68 10 7.07 1.41 0.12

Bone, joints 0 0.00 0 0.00 2 2.10 3 3.08 5 3.45 1.45 0.07

Soft tissue including heart 2 1.50 2 0.42 2 0.48 4 0.76 10 15.51 0.64 -0.23

Kaposi sarcoma 0 0.00 0 0.00 1 1.37 0 0.00 1 2.94 0.34 -0.08

Melanoma of skin 7 0.85 26 0.88 24 0.95 29 0.96 86 93.21 0.92 -0.30

Eye, orbit 2 3.47 0 0.00 1 0.60 3 1.67 6 6.08 0.99 0.00

Brain, central nervous system 3 0.69 14 0.93 8 0.66 13 1.02 38 44.25 0.86 -0.26

Thyroid 3 1.33 10 1.34 4 0.72 4 0.76 21 20.49 1.02 0.02

Lymphatic, hematopoietic 23 0.95 83 0.92 80 0.95 87 0.81* 273 306.34 0.89 -1.41

Hodgkin lymphoma 1 1.02 3 0.93 3 1.25 2 0.84 9 8.98 1.00 0.00

Non-Hodgkin lymphoma 12 1.09 40 0.96 34 0.88 49 0.98 135 141.54 0.95 -0.28

Myeloma 5 1.20 14 0.89 15 1.03 14 0.76 48 52.90 0.91 -0.21

Leukemia 5 0.63 26 0.86 28 0.99 22 0.61* 81 102.93 0.79* -0.92

Acute lymphocytic 0 0.00 1 1.15 0 0.00 1 1.18 2 2.72 0.74 -0.03

Chronic lymphocytic 1 0.30 6 0.47 15 1.28 7 0.49 29 42.10 0.69* -0.55

Acute non-lymphocytic 3 1.17 12 1.20 8 0.83 7 0.54 30 35.10 0.85 -0.22

Chronic myeloid 0 0.00 5 1.28 4 1.10 5 1.01 14 13.57 1.03 0.02

Rectum

Both Sexes, 50-69 Years of Age

Table 5.2.7: Risk of subsequent primary cancers after cancer of the rectum or rectosigmoid junction, both sexes,

50-69 years of age, SEER 1973-2000.

132 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

RECTUM

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 36,497 31,013 16,247 9,429 36,497

Person-years in interval 27,882 88,631 62,341 58,379 237,233

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 101,793 PYR and for male cancers on 135,440 PYR.
Rectum

Both Sexes, ≥70 Years of Age

Table 5.2.8: Risk of subsequent primary cancers after cancer of the rectum or rectosigmoid junction, both sexes,

≥70 years of age, SEER 1973-2000.

RECTUM

All subsequent cancers 573 0.95 1,560 0.92* 889 0.98 376 0.90* 3,398 3,616.77 0.94* -15.60

All excluding same site 448 0.89* 1,197 0.85* 713 0.95 306 0.90 2,664 2,998.46 0.89* -23.85

Buccal cavity, pharynx 10 0.77 36 1.04 12 0.69 10 1.31 68 72.59 0.94 -0.33

Lip 3 1.13 8 1.11 1 0.27 5 3.02 17 15.24 1.12 0.13

Tongue 1 0.43 3 0.48 2 0.65 2 1.54 8 12.94 0.62 -0.35

Salivary gland 0 0.00 4 1.04 3 1.33 0 0.00 7 8.65 0.81 -0.12

Mouth 2 0.59 8 0.87 3 0.64 3 1.40 16 19.47 0.82 -0.25

Nasopharynx 1 2.43 3 2.83 0 0.00 0 0.00 4 2.15 1.86 0.13

Tonsil 1 1.11 3 1.31 1 1.00 0 0.00 5 4.53 1.10 0.03

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.54 0.00 -0.11

Hypopharynx 1 0.88 5 1.72 1 0.82 0 0.00 7 5.69 1.23 0.09

Digestive system 166 1.08 484 1.11* 240 0.99 101 0.85 991 950.01 1.04 2.92

Esophagus 7 1.18 12 0.74 9 1.05 4 1.03 32 34.64 0.92 -0.19

Stomach 13 0.78 40 0.86 20 0.79 10 0.82 83 100.34 0.83 -1.24

Small intestine 3 1.73 10 2.03 3 1.09 5 3.67* 21 10.78 1.95* 0.73

Colon 100 1.36* 293 1.39* 150 1.24* 59 0.98 602 465.63 1.29* 9.73

Rectum, rectosigmoid junction 22 0.88 65 0.94 23 0.64* 10 0.62 120 146.07 0.82* -1.86

Anus, anal canal 3 2.78 5 1.65 3 1.80 1 1.19 12 6.61 1.81 0.38

Liver 1 0.23 3 0.24* 2 0.31 0 0.00 6 26.10 0.23* -1.43

Gallbladder 2 0.79 6 0.85 7 1.79 0 0.00 15 15.38 0.98 -0.03

Bile ducts, other biliary 1 0.29 10 1.00 5 0.81 5 1.48 21 22.94 0.92 -0.14

Pancreas 13 0.71 34 0.66* 18 0.63* 7 0.49 72 112.72 0.64* -2.90

Respiratory system 55 0.59* 227 0.89 141 1.10 47 0.91 470 529.32 0.89* -4.23

Nose, nasal cavity, ear 0 0.00 3 1.26 2 1.51 0 0.00 5 5.18 0.97 -0.01

Larynx 3 0.58 16 1.18 9 1.49 0 0.00 28 26.83 1.04 0.08

Lung, bronchus 51 0.58* 208 0.87* 128 1.06 47 0.97 434 495.87 0.88* -4.41

Female breast 60 1.18 139 0.96 87 1.09 37 0.92 323 315.47 1.02 1.04

Female genital system 15 0.67 50 0.81 26 0.80 13 0.81 104 132.69 0.78* -3.96

Cervix uteri 3 1.33 8 1.37 2 0.70 1 0.74 14 12.34 1.13 0.23

Corpus uteri 7 0.65 22 0.75 16 1.10 7 1.08 52 61.03 0.85 -1.25

Ovary 2 0.30 11 0.58 5 0.48 5 0.94 23 41.42 0.56* -2.54

Vagina 2 4.17 2 1.45 1 1.28 0 0.00 5 3.05 1.64 0.27

Vulva 0 0.00 4 0.88 1 0.35 0 0.00 5 10.66 0.47 -0.78

Male genital system 141 1.12 278 0.78* 156 0.86 78 1.08 653 735.29 0.89* -12.13

Prostate 141 1.13 274 0.78* 155 0.86 77 1.08 647 729.38 0.89* -12.14

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.74 0.00 -0.11

Urinary system 69 1.37* 150 1.05 85 1.08 35 0.96 339 308.60 1.10 2.17

Urinary bladder 42 1.14 116 1.10 62 1.06 25 0.90 245 228.56 1.07 1.17

Kidney parenchyma 20 2.00* 24 0.86 18 1.22 9 1.38 71 59.35 1.20 0.83

Renal pelvis, other urinary 7 2.01 10 1.03 5 0.97 1 0.42 23 20.69 1.11 0.16

Ureter 2 1.69 3 0.91 2 1.15 0 0.00 7 6.99 1.00 0.00

Bone, joints 1 2.21 0 0.00 0 0.00 0 0.00 1 2.59 0.39 -0.11

Soft tissue including heart 2 0.90 5 0.79 5 1.37 0 0.00 12 14.11 0.85 -0.15

Kaposi sarcoma 2 3.89 4 2.63 1 1.06 0 0.00 7 3.52 1.99 0.25

Melanoma of skin 13 1.35 33 1.17 20 1.21 7 0.81 73 63.12 1.16 0.70

Eye, orbit 0 0.00 2 0.92 1 0.88 0 0.00 3 4.62 0.65 -0.12

Brain, central nervous system 3 0.63 9 0.68 9 1.34 3 1.06 24 27.52 0.87 -0.25

Thyroid 2 1.01 5 0.93 1 0.37 4 3.40 12 11.24 1.07 0.05

Lymphatic, hematopoietic 29 0.62* 119 0.89 84 1.11 26 0.70 258 293.09 0.88* -2.50

Hodgkin lymphoma 0 0.00 3 0.98 2 1.33 0 0.00 5 6.33 0.79 -0.10

Non-Hodgkin lymphoma 13 0.67 51 0.91 48 1.49* 13 0.83 125 123.50 1.01 0.11

Myeloma 4 0.49 21 0.90 8 0.62 8 1.33 41 50.30 0.82 -0.66

Leukemia 12 0.67 44 0.86 26 0.90 5 0.34* 87 112.96 0.77* -1.85

Acute lymphocytic 0 0.00 1 0.82 0 0.00 0 0.00 1 2.67 0.37 -0.12

Chronic lymphocytic 3 0.42 10 0.50* 8 0.71 3 0.53 24 44.18 0.54* -1.44

Acute non-lymphocytic 5 0.82 21 1.21 13 1.33 2 0.42 41 37.96 1.08 0.22

Chronic myeloid 2 0.83 3 0.43 2 0.49 0 0.00 7 15.53 0.45* -0.61

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 34,151 26,079 10,465 4,049 34,151

Person-years in interval 24,364 66,163 33,906 15,789 140,223

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 72,383 PYR and for male cancers on 67,840 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 133
All subsequent cancers 268 1.05 658 0.91* 471 1.14* 283 1.11 1,680 1,644.35 1.02 3.89

All excluding same site 214 0.97 522 0.84* 412 1.16* 233 1.06 1,381 1,420.85 0.97 -4.35

Buccal cavity, pharynx 9 1.30 25 1.35 8 0.83 6 1.10 48 40.56 1.18 0.81

Lip 1 0.95 6 2.17 1 0.69 3 3.61 11 6.09 1.81 0.54

Tongue 2 1.44 4 1.07 3 1.54 0 0.00 9 8.20 1.10 0.09

Salivary gland 0 0.00 4 2.50 1 1.08 0 0.00 5 3.68 1.36 0.14

Mouth 2 1.12 4 0.85 1 0.41 2 1.44 9 10.36 0.87 -0.15

Nasopharynx 0 0.00 1 1.27 1 2.58 0 0.00 2 1.69 1.18 0.03

Tonsil 1 1.51 1 0.57 0 0.00 1 2.18 3 3.73 0.80 -0.08

Oropharynx 1 5.01 0 0.00 0 0.00 0 0.00 1 1.16 0.87 -0.02

Hypopharynx 0 0.00 4 2.05 1 1.02 0 0.00 5 4.19 1.19 0.09

Digestive system 84 1.50* 179 1.16 100 1.13 70 1.26 433 354.50 1.22* 8.57

Esophagus 3 1.02 7 0.86 5 1.09 2 0.72 17 18.49 0.92 -0.16

Stomach 8 1.37 14 0.89 14 1.60 11 2.02* 47 35.80 1.31 1.22

Small intestine 7 8.98* 7 3.14* 1 0.77 0 0.00 15 5.14 2.92* 1.08

Colon 44 1.76* 115 1.66* 53 1.32 47 1.84* 259 159.88 1.62* 10.83

Rectum, rectosigmoid junction 7 0.70 15 0.56* 5 0.34* 2 0.23* 29 60.47 0.48* -3.44

Anus, anal canal 3 5.96* 6 4.32* 1 1.28 1 2.07 11 3.16 3.48* 0.86

Liver 1 0.49 0 0.00* 3 0.88 1 0.46 5 13.50 0.37* -0.93

Gallbladder 1 1.38 0 0.00 2 1.84 0 0.00 3 4.43 0.68 -0.16

Bile ducts, other biliary 0 0.00 5 1.48 4 1.93 2 1.39 11 8.08 1.36 0.32

Pancreas 9 1.35 10 0.55 10 0.95 4 0.60 33 42.18 0.78 -1.00

Respiratory system 34 0.74 163 1.28* 110 1.55* 63 1.47* 370 287.75 1.29* 8.98

Nose, nasal cavity, ear 0 0.00 2 1.93 1 1.74 1 2.82 4 2.35 1.71 0.18

Larynx 1 0.31 12 1.39 9 2.04 2 0.83 24 18.66 1.29 0.58

Lung, bronchus 33 0.78 149 1.26* 100 1.52* 60 1.49* 342 266.08 1.29* 8.29

Female breast 17 0.77 50 0.82 38 1.09 15 0.67 120 140.12 0.86 -5.43

Female genital system 3 0.30* 18 0.68 38 2.62* 21 2.34* 80 59.68 1.34* 5.48

Cervix uteri 1 0.90 1 0.37 1 0.75 0 0.00 3 5.89 0.51 -0.78

Corpus uteri 1 0.20 13 0.96 27 3.63* 13 2.85* 54 30.64 1.76* 6.31

Ovary 0 0.00 1 0.13* 7 1.57 4 1.43 12 17.99 0.67 -1.62

Vagina 1 6.67 2 5.02 1 4.40 2 13.68* 6 0.92 6.51* 1.37

Vulva 0 0.00 0 0.00 2 2.73 1 1.95 3 2.89 1.04 0.03

Male genital system 47 0.84 60 0.36* 62 0.63* 39 0.65* 208 378.08 0.55* -31.21

Prostate 45 0.81 57 0.35* 61 0.63* 37 0.63* 200 374.76 0.53* -32.07

Testis 0 0.00 1 1.81 1 4.57 0 0.00 2 1.09 1.83 0.17

Urinary system 44 2.10* 82 1.39* 50 1.46* 36 1.67* 212 135.87 1.56* 8.32

Urinary bladder 21 1.45 59 1.44* 38 1.58* 32 2.10* 150 94.69 1.58* 6.04

Kidney parenchyma 21 4.07* 20 1.37 9 1.09 0 0.00* 50 33.11 1.51* 1.85

Renal pelvis, other urinary 2 1.56 3 0.85 3 1.49 4 3.19 12 8.07 1.49 0.43

Ureter 1 2.34 2 1.69 2 2.98 0 0.00 5 2.69 1.86 0.25

Bone, joints 0 0.00 0 0.00 1 3.18 0 0.00 1 1.31 0.76 -0.03

Soft tissue including heart 1 1.02 2 0.74 3 1.92 3 3.00 9 6.26 1.44 0.30

Kaposi sarcoma 0 0.00 2 2.31 1 2.50 0 0.00 3 1.81 1.66 0.13

Melanoma of skin 7 1.23 15 0.91 8 0.84 5 0.82 35 37.88 0.92 -0.31

Eye, orbit 0 0.00 0 0.00 0 0.00 1 3.03 1 2.25 0.44 -0.14

Brain, central nervous system 1 0.38 2 0.28 4 1.02 2 0.86 9 16.08 0.56 -0.77

Thyroid 2 1.49 1 0.28 4 2.14 2 1.85 9 7.91 1.14 0.12

Lymphatic, hematopoietic 16 0.85 51 0.97 30 0.98 12 0.61 109 121.87 0.89 -1.41

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 3.44 0.00 -0.38

Non-Hodgkin lymphoma 6 0.71 26 1.08 19 1.34 5 0.54 56 56.02 1.00 0.00

Myeloma 5 1.56 11 1.22 3 0.57 4 1.21 23 20.72 1.11 0.25

Leukemia 5 0.77 14 0.77 8 0.77 3 0.45 30 41.69 0.72 -1.28

Acute lymphocytic 0 0.00 1 1.99 0 0.00 0 0.00 1 1.12 0.89 -0.01

Chronic lymphocytic 2 0.76 1 0.14* 2 0.48 2 0.78 7 16.62 0.42* -1.05

Acute non-lymphocytic 2 0.91 9 1.47 5 1.39 1 0.43 17 14.28 1.19 0.30

Chronic myeloid 0 0.00 2 0.82 1 0.71 0 0.00 3 5.64 0.53 -0.29

Rectum

Both Sexes, Radiotherapy

Table 5.2.9: Risk of subsequent primary cancers after cancer of the rectum or rectosigmoid junction, both sexes,

with initial radiotherapy, SEER 1973-2000.

134 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

RECTUM

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 21,900 17,470 6,403 2,650 21,900

Person-years in interval 16,267 42,329 21,167 11,782 91,545

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 37,049 PYR and for male cancers on 54,496 PYR.
Rectum

Both Sexes, No Radiotherapy

Table 5.2.10: Risk of subsequent primary cancers after cancer of the rectum or rectosigmoid junction, both sexes,

without initial radiotherapy, SEER 1973-2000.

RECTUM

All subsequent cancers 774 1.09* 2,361 1.01 1,723 0.98 1,579 0.94* 6,437 6,489.29 0.99 -1.59

All excluding same site 601 1.00 1,833 0.92* 1,422 0.96 1,294 0.90* 5,150 5,502.37 0.94* -10.73

Buccal cavity, pharynx 14 0.75 50 0.84 31 0.77 25 0.72 120 153.18 0.78* -1.01

Lip 3 0.92 7 0.69 3 0.44 5 0.87 18 26.02 0.69 -0.24

Tongue 2 0.56 6 0.53 3 0.38 5 0.74 16 29.43 0.54* -0.41

Salivary gland 0 0.00 5 0.96 3 0.76 3 0.76 11 14.71 0.75 -0.11

Mouth 4 0.80 13 0.82 10 0.94 10 1.09 37 40.59 0.91 -0.11

Nasopharynx 2 2.67 3 1.29 2 1.33 0 0.00 7 5.80 1.21 0.04

Tonsil 1 0.62 7 1.38 3 0.91 1 0.39 12 12.53 0.96 -0.02

Oropharynx 0 0.00 2 1.27 0 0.00 0 0.00 2 4.00 0.50 -0.06

Hypopharynx 1 0.53 5 0.84 6 1.54 1 0.33 13 14.72 0.88 -0.05

Digestive system 224 1.30* 704 1.26* 419 1.02 428 1.09 1,775 1,537.43 1.15* 7.23

Esophagus 9 1.17 22 0.88 15 0.83 10 0.58 56 67.86 0.83 -0.36

Stomach 19 1.02 45 0.76 35 0.84 45 1.16 144 158.39 0.91 -0.44

Small intestine 1 0.49 22 3.20* 8 1.52 16 2.95* 47 19.62 2.40* 0.83

Colon 133 1.69* 412 1.59* 244 1.26* 254 1.35* 1,043 719.98 1.45* 9.84

Rectum, rectosigmoid junction 37 1.24 107 1.12 52 0.77 30 0.49* 226 254.38 0.89 -0.86

Anus, anal canal 3 2.17 9 1.98 5 1.48 1 0.31 18 12.56 1.43 0.17

Liver 2 0.37 9 0.51* 8 0.61 6 0.46* 25 49.15 0.51* -0.74

Gallbladder 3 1.14 6 0.72 6 1.00 3 0.54 18 22.58 0.80 -0.14

Bile ducts, other biliary 3 0.84 14 1.17 12 1.28 16 1.58 45 35.04 1.28 0.30

Pancreas 12 0.59 51 0.77 34 0.69* 40 0.84 137 183.55 0.75* -1.42

Respiratory system 101 0.84 371 0.94 342 1.18* 255 0.95 1,069 1,074.03 1.00 -0.15

Nose, nasal cavity, ear 0 0.00 1 0.29 6 2.40 4 1.70 11 9.39 1.17 0.05

Larynx 10 1.23 26 1.01 17 0.98 9 0.64 62 65.23 0.95 -0.10

Lung, bronchus 90 0.81* 344 0.94 317 1.18* 241 0.96 992 996.66 1.00 -0.14

Female breast 87 1.31* 231 1.06 163 0.99 152 0.92 633 615.63 1.03 1.11

Female genital system 22 0.70 92 0.91 76 1.06 50 0.74* 240 271.50 0.88 -2.00

Cervix uteri 5 1.38 10 0.92 9 1.32 3 0.54 27 26.82 1.01 0.01

Corpus uteri 10 0.62 42 0.82 42 1.17 29 0.87 123 136.46 0.90 -0.86

Ovary 5 0.56 31 1.06 15 0.69 13 0.61 64 81.14 0.79 -1.09

Vagina 1 1.84 2 1.15 7 5.53* 1 0.80 11 4.80 2.29* 0.39

Vulva 0 0.00 5 0.94 1 0.24 3 0.67 9 15.46 0.58 -0.41

Male genital system 170 1.26* 412 0.89* 318 0.87* 318 0.91 1,218 1,314.64 0.93* -5.64

Prostate 169 1.26* 408 0.89* 315 0.87* 315 0.90 1,207 1,303.22 0.93* -5.62

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 2.78 0.00 -0.16

Urinary system 78 1.35* 218 1.14 131 0.91 122 0.87 549 532.22 1.03 0.51

Urinary bladder 44 1.08 149 1.10 87 0.85 85 0.85 365 378.92 0.96 -0.42

Kidney parenchyma 28 2.17* 54 1.26 35 1.09 30 0.97 147 118.92 1.24* 0.86

Renal pelvis, other urinary 6 1.54 15 1.18 9 0.98 7 0.81 37 34.39 1.08 0.08

Ureter 1 0.76 3 0.70 4 1.28 4 1.40 12 11.57 1.04 0.01

Bone, joints 1 1.65 0 0.00 1 0.75 4 3.34 6 5.06 1.19 0.03

Soft tissue including heart 3 1.11 6 0.68 5 0.76 4 0.60 18 24.66 0.73 -0.20

Kaposi sarcoma 2 2.77 2 0.87 2 1.25 0 0.00 6 6.05 0.99 0.00

Melanoma of skin 15 1.16 50 1.13 37 1.07 40 1.10 142 128.29 1.11 0.42

Eye, orbit 2 1.93 2 0.60 2 0.85 2 0.93 8 8.87 0.90 -0.03

Brain, central nervous system 5 0.74 21 0.95 14 0.88 15 1.03 55 59.25 0.93 -0.13

Thyroid 3 0.91 14 1.33 4 0.55 8 1.23 29 27.55 1.05 0.04

Lymphatic, hematopoietic 39 0.73 156 0.89 140 1.05 110 0.83* 445 495.57 0.90* -1.54

Hodgkin lymphoma 1 0.60 6 1.17 5 1.48 2 0.70 14 13.06 1.07 0.03

Non-Hodgkin lymphoma 20 0.89 68 0.90 68 1.15 60 0.99 216 218.31 0.99 -0.07

Myeloma 6 0.65 25 0.82 20 0.88 23 1.02 74 84.94 0.87 -0.33

Leukemia 12 0.61 57 0.88 47 0.98 25 0.53* 141 179.25 0.79* -1.16

Acute lymphocytic 0 0.00 1 0.60 0 0.00 1 0.89 2 4.54 0.44 -0.08

Chronic lymphocytic 2 0.25* 15 0.58* 22 1.14 8 0.44* 47 71.40 0.66* -0.74

Acute non-lymphocytic 6 0.91 25 1.16 16 0.99 8 0.50* 55 60.52 0.91 -0.17

Chronic myeloid 2 0.75 6 0.69 5 0.77 6 0.93 19 24.26 0.78 -0.16

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 55,536 45,300 23,086 12,405 55,536

Person-years in interval 41,138 128,122 85,568 73,569 328,397

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 157,148 PYR and for male cancers on 171,248 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 135
All subsequent cancers 1,397 1.01 207 1.15 57 0.93 19 1.41 1,680 1,644.35 1.02 3.89

All excluding same site 1,148 0.96 172 1.10 47 0.89 14 1.21 1,381 1,420.85 0.97 -4.35

Buccal cavity, pharynx 42 1.20 5 1.28 0 0.00 1 3.65 48 40.56 1.18 0.81

Lip 8 1.52 2 3.39 0 0.00 1 23.24 11 6.09 1.81 0.54

Tongue 9 1.27 0 0.00 0 0.00 0 0.00 9 8.20 1.10 0.09

Salivary gland 5 1.62 0 0.00 0 0.00 0 0.00 5 3.68 1.36 0.14

Mouth 7 0.78 2 2.00 0 0.00 0 0.00 9 10.36 0.87 -0.15

Nasopharynx 2 1.36 0 0.00 0 0.00 0 0.00 2 1.69 1.18 0.03

Tonsil 2 0.61 1 2.99 0 0.00 0 0.00 3 3.73 0.80 -0.08

Oropharynx 1 0.99 0 0.00 0 0.00 0 0.00 1 1.16 0.87 -0.02

Hypopharynx 5 1.36 0 0.00 0 0.00 0 0.00 5 4.19 1.19 0.09

Digestive system 363 1.21* 48 1.23 15 1.12 7 2.30 433 354.50 1.22* 8.57

Esophagus 15 0.96 0 0.00 2 2.98 0 0.00 17 18.49 0.92 -0.16

Stomach 36 1.19 6 1.56 3 2.29 2 6.61 47 35.80 1.31 1.22

Small intestine 15 3.48* 0 0.00 0 0.00 0 0.00 15 5.14 2.92* 1.08

Colon 212 1.58* 32 1.78* 10 1.61 5 3.55* 259 159.88 1.62* 10.83

Rectum, rectosigmoid junction 27 0.52* 2 0.32 0 0.00 0 0.00 29 60.47 0.48* -3.44

Anus, anal canal 10 3.74* 1 2.91 0 0.00 0 0.00 11 3.16 3.48* 0.86

Liver 4 0.35* 1 0.65 0 0.00 0 0.00 5 13.50 0.37* -0.93

Gallbladder 3 0.80 0 0.00 0 0.00 0 0.00 3 4.43 0.68 -0.16

Bile ducts, other biliary 9 1.35 2 2.03 0 0.00 0 0.00 11 8.08 1.36 0.32

Pancreas 29 0.82 4 0.85 0 0.00 0 0.00 33 42.18 0.78 -1.00

Respiratory system 307 1.25* 50 1.64* 10 0.98 3 1.33 370 287.75 1.29* 8.98

Nose, nasal cavity, ear 3 1.51 1 4.01 0 0.00 0 0.00 4 2.35 1.71 0.18

Larynx 22 1.35 2 1.15 0 0.00 0 0.00 24 18.66 1.29 0.58

Lung, bronchus 282 1.25* 47 1.65* 10 1.05 3 1.41 342 266.08 1.29* 8.29

Female breast 105 0.89 14 0.88 1 0.19 0 0.00 120 140.12 0.86 -5.43

Female genital system 59 1.16 15 2.32* 4 1.94 2 4.39 80 59.68 1.34* 5.48

Cervix uteri 3 0.58 0 0.00 0 0.00 0 0.00 3 5.89 0.51 -0.78

Corpus uteri 41 1.57* 9 2.74* 2 1.92 2 8.65 54 30.64 1.76* 6.31

Ovary 8 0.53 4 1.99 0 0.00 0 0.00 12 17.99 0.67 -1.62

Vagina 4 5.16* 1 9.58 1 29.45 0 0.00 6 0.92 6.51* 1.37

Vulva 2 0.84 0 0.00 1 7.99 0 0.00 3 2.89 1.04 0.03

Male genital system 169 0.53* 29 0.68* 7 0.49 3 1.02 208 378.08 0.55* -31.21

Prostate 163 0.52* 28 0.67* 6 0.42* 3 1.03 200 374.76 0.53* -32.07

Testis 2 1.99 0 0.00 0 0.00 0 0.00 2 1.09 1.83 0.17

Urinary system 176 1.54* 24 1.60* 10 1.89 2 1.65 212 135.87 1.56* 8.32

Urinary bladder 118 1.49* 20 1.89* 10 2.65* 2 2.29 150 94.69 1.58* 6.04

Kidney parenchyma 50 1.78* 0 0.00 0 0.00 0 0.00 50 33.11 1.51* 1.85

Renal pelvis, other urinary 8 1.17 4 4.57* 0 0.00 0 0.00 12 8.07 1.49 0.43

Ureter 5 2.19 0 0.00 0 0.00 0 0.00 5 2.69 1.86 0.25

Bone, joints 1 0.89 0 0.00 0 0.00 0 0.00 1 1.31 0.76 -0.03

Soft tissue including heart 6 1.14 2 2.87 1 4.07 0 0.00 9 6.26 1.44 0.30

Kaposi sarcoma 3 1.87 0 0.00 0 0.00 0 0.00 3 1.81 1.66 0.13

Melanoma of skin 30 0.94 5 1.18 0 0.00 0 0.00 35 37.88 0.92 -0.31

Eye, orbit 0 0.00 1 4.30 0 0.00 0 0.00 1 2.25 0.44 -0.14

Brain, central nervous system 7 0.51 2 1.21 0 0.00 0 0.00 9 16.08 0.56 -0.77

Thyroid 7 1.03 1 1.28 1 4.00 0 0.00 9 7.91 1.14 0.12

Lymphatic, hematopoietic 97 0.95 7 0.51 4 0.84 1 0.92 109 121.87 0.89 -1.41

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 3.44 0.00 -0.38

Non-Hodgkin lymphoma 51 1.09 3 0.47 1 0.44 1 1.92 56 56.02 1.00 0.00

Myeloma 19 1.09 3 1.29 1 1.26 0 0.00 23 20.72 1.11 0.25

Leukemia 27 0.77 1 0.22 2 1.24 0 0.00 30 41.69 0.72 -1.28

Acute lymphocytic 1 1.04 0 0.00 0 0.00 0 0.00 1 1.12 0.89 -0.01

Chronic lymphocytic 5 0.36* 1 0.55 1 1.62 0 0.00 7 16.62 0.42* -1.05

Acute non-lymphocytic 16 1.34 0 0.00 1 1.72 0 0.00 17 14.28 1.19 0.30

Chronic myeloid 3 0.63 0 0.00 0 0.00 0 0.00 3 5.64 0.53 -0.29

Rectum

Both Sexes, Long-term Follow-up, Radiotherapy

Table 5.2.11: Risk of subsequent primary cancers after cancer of the rectum or rectosigmoid junction, both sexes,

long-term follow-up, with initial radiotherapy, SEER 1973-2000.

136 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

RECTUM

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 21,900 2,650 950 239 21,900

Person-years in interval 79,763 8,511 2,697 573 91,545

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 37,049 PYR and for male cancers on 54,496 PYR.
Rectum

Both Sexes, Long-term Follow-up, No Radiotherapy

Table 5.2.12: Risk of subsequent primary cancers after cancer of the rectum or rectosigmoid junction, both sexes,

long-term follow-up, without initial radiotherapy, SEER 1973-2000.

RECTUM

All subsequent cancers 4,858 1.01 972 0.96 423 0.87* 184 0.99 6,437 6,489.29 0.99 -1.59

All excluding same site 3,856 0.95* 810 0.94 346 0.84* 138 0.88 5,150 5,502.37 0.94* -10.73

Buccal cavity, pharynx 95 0.80* 19 0.89 5 0.52 1 0.28 120 153.18 0.78* -1.01

Lip 13 0.64 5 1.40 0 0.00 0 0.00 18 26.02 0.69 -0.24

Tongue 11 0.49* 2 0.48 3 1.60 0 0.00 16 29.43 0.54* -0.41

Salivary gland 8 0.74 3 1.29 0 0.00 0 0.00 11 14.71 0.75 -0.11

Mouth 27 0.86 7 1.24 2 0.78 1 1.04 37 40.59 0.91 -0.11

Nasopharynx 7 1.53 0 0.00 0 0.00 0 0.00 7 5.80 1.21 0.04

Tonsil 11 1.10 1 0.61 0 0.00 0 0.00 12 12.53 0.96 -0.02

Oropharynx 2 0.64 0 0.00 0 0.00 0 0.00 2 4.00 0.50 -0.06

Hypopharynx 12 1.03 1 0.51 0 0.00 0 0.00 13 14.72 0.88 -0.05

Digestive system 1,347 1.18* 248 1.05 119 1.05 61 1.36* 1,775 1,537.43 1.15* 7.23

Esophagus 46 0.91 6 0.58 3 0.61 1 0.52 56 67.86 0.83 -0.36

Stomach 99 0.83 25 1.07 15 1.36 5 1.15 144 158.39 0.91 -0.44

Small intestine 31 2.18* 11 3.44* 4 2.51 1 1.55 47 19.62 2.40* 0.83

Colon 789 1.48* 140 1.24* 69 1.27 45 2.09* 1,043 719.98 1.45* 9.84

Rectum, rectosigmoid junction 196 1.01 22 0.59* 7 0.41* 1 0.15* 226 254.38 0.89 -0.86

Anus, anal canal 17 1.83* 0 0.00 1 1.05 0 0.00 18 12.56 1.43 0.17

Liver 19 0.53* 3 0.39 2 0.52 1 0.63 25 49.15 0.51* -0.74

Gallbladder 15 0.88 2 0.60 1 0.63 0 0.00 18 22.58 0.80 -0.14

Bile ducts, other biliary 29 1.16 9 1.55 6 1.97 1 0.78 45 35.04 1.28 0.30

Pancreas 97 0.71* 26 0.92 9 0.65 5 0.91 137 183.55 0.75* -1.42

Respiratory system 814 1.01 169 1.04 62 0.81 24 0.82 1,069 1,074.03 1.00 -0.15

Nose, nasal cavity, ear 7 1.00 3 2.14 1 1.48 0 0.00 11 9.39 1.17 0.05

Larynx 53 1.03 5 0.56 3 0.80 1 0.76 62 65.23 0.95 -0.10

Lung, bronchus 751 1.01 161 1.06 57 0.79 23 0.83 992 996.66 1.00 -0.14

Female breast 481 1.07 100 1.02 37 0.76 15 0.80 633 615.63 1.03 1.11

Female genital system 190 0.93 29 0.72 17 0.86 4 0.54 240 271.50 0.88 -2.00

Cervix uteri 24 1.13 2 0.58 0 0.00 1 1.88 27 26.82 1.01 0.01

Corpus uteri 94 0.91 16 0.80 11 1.14 2 0.55 123 136.46 0.90 -0.86

Ovary 51 0.85 8 0.64 4 0.64 1 0.42 64 81.14 0.79 -1.09

Vagina 10 2.81* 1 1.35 0 0.00 0 0.00 11 4.80 2.29* 0.39

Vulva 6 0.55 1 0.39 2 1.47 0 0.00 9 15.46 0.58 -0.41

Male genital system 900 0.93* 199 0.92 81 0.80* 38 1.11 1,218 1,314.64 0.93* -5.64

Prostate 892 0.93* 198 0.93 79 0.79* 38 1.12 1,207 1,303.22 0.93* -5.62

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 2.78 0.00 -0.16

Urinary system 427 1.09 68 0.81 39 0.97 15 0.93 549 532.22 1.03 0.51

Urinary bladder 280 1.00 49 0.82 26 0.90 10 0.86 365 378.92 0.96 -0.42

Kidney parenchyma 117 1.33* 15 0.81 11 1.23 4 1.15 147 118.92 1.24* 0.86

Renal pelvis, other urinary 30 1.16 4 0.77 2 0.81 1 1.01 37 34.39 1.08 0.08

Ureter 8 0.92 3 1.73 0 0.00 1 3.19 12 11.57 1.04 0.01

Bone, joints 2 0.52 3 4.18 1 2.88 0 0.00 6 5.06 1.19 0.03

Soft tissue including heart 14 0.78 4 1.03 0 0.00 0 0.00 18 24.66 0.73 -0.20

Kaposi sarcoma 6 1.30 0 0.00 0 0.00 0 0.00 6 6.05 0.99 0.00

Melanoma of skin 102 1.11 24 1.13 9 0.84 7 1.54 142 128.29 1.11 0.42

Eye, orbit 6 0.89 2 1.53 0 0.00 0 0.00 8 8.87 0.90 -0.03

Brain, central nervous system 40 0.90 10 1.13 5 1.21 0 0.00 55 59.25 0.93 -0.13

Thyroid 21 1.00 5 1.27 2 1.08 1 1.43 29 27.55 1.05 0.04

Lymphatic, hematopoietic 335 0.92 62 0.79 35 0.90 13 0.84 445 495.57 0.90* -1.54

Hodgkin lymphoma 12 1.18 1 0.56 1 1.24 0 0.00 14 13.06 1.07 0.03

Non-Hodgkin lymphoma 156 0.99 32 0.90 18 1.01 10 1.36 216 218.31 0.99 -0.07

Myeloma 51 0.82 13 0.97 8 1.22 2 0.78 74 84.94 0.87 -0.33

Leukemia 116 0.88 16 0.57* 8 0.59 1 0.19 141 179.25 0.79* -1.16

Acute lymphocytic 1 0.29 1 1.43 0 0.00 0 0.00 2 4.54 0.44 -0.08

Chronic lymphocytic 39 0.73 7 0.63 1 0.19 0 0.00 47 71.40 0.66* -0.74

Acute non-lymphocytic 47 1.06 4 0.42 3 0.64 1 0.52 55 60.52 0.91 -0.17

Chronic myeloid 13 0.73 2 0.52 4 2.14 0 0.00 19 24.26 0.78 -0.16

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 55,536 12,405 6,158 2,505 55,536

Person-years in interval 254,828 45,172 20,624 7,773 328,397

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 157,148 PYR and for male cancers on 171,248 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 137
Anus

Both Sexes

Table 5.3.1: Characteristics of patients with an initial cancer of the anus or anal canal,

both sexes, SEER 1973-2000.

138 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ANUS

Number of patients with 1st primary cancer

Total 1,948 100.0 2,957 100.0 4,905 100.0

Initial treatment

Any radiation 1,191 61.1 1,921 65.0 3,112 63.4

With surgery 609 31.3 924 31.2 1,533 31.3

Without surgery 582 29.9 997 33.7 1,579 32.2

No radiation 757 38.9 1,036 35.0 1,793 36.6

With surgery 652 33.5 892 30.2 1,544 31.5

Without surgery 105 5.4 144 4.9 249 5.1

Race

White 1,635 83.9 2,587 87.5 4,222 86.1

Black 231 11.9 269 9.1 500 10.2

Other 71 3.6 96 3.2 167 3.4

Unknown 11 0.6 5 0.2 16 0.3

Age at 1st primary cancer diagnosis, years

< 30 23 1.2 11 0.4 34 0.7

30–49 484 24.8 444 15.0 928 18.9

50–69 950 48.8 1,307 44.2 2,257 46.0

70–79 341 17.5 722 24.4 1,063 21.7

> 80 150 7.7 473 16.0 623 12.7

Number of patients with one or more

primary cancers

One primary cancer only 1,741 89.4 2,696 91.2 4,437 90.5

1st and 2nd cancers 190 9.8 239 8.1 429 8.7

1st, 2nd, and 3rd cancers 15 0.8 22 0.7 37 0.8

1st, 2nd, 3rd, and additional cancers 2 0.1 0 0.0 2 0.0

Other statistics

Median age at 1st cancer diagnosis 60.3 — 66.7 — 64.0 —

Median year of 1st cancer diagnosis 1990.5 — 1989.4 — 1989.9 —

Median person-years at risk 2.9 — 3.6 — 3.3 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 94.2 — 95.0 — 94.7

1st, 2nd, and additional cancers — 91.8 — 94.6 — 93.4

1st cancer only — 5.8 — 5.0 — 5.3

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Anus

Both Sexes

Table 5.3.2: Risk of subsequent primary cancers after cancer of the anus or anal canal,

both sexes, SEER 1973-2000.

ANUS

All subsequent cancers 61 1.26 172 1.12 159 1.46* 117 1.16 509 411.75 1.24* 35.96

All excluding same site 60 1.24 171 1.12 157 1.44* 115 1.15 503 410.75 1.22* 34.11

Buccal cavity, pharynx 3 2.50 14 3.80* 3 1.22 4 1.95 24 9.40 2.55* 5.40

Lip 0 0.00 1 2.12 0 0.00 0 0.00 1 1.21 0.83 -0.08

Tongue 0 0.00 7 9.19* 1 1.96 1 2.33 9 1.95 4.62* 2.61

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.88 0.00 -0.33

Mouth 1 2.93 2 1.90 0 0.00 2 3.39 5 2.69 1.86 0.85

Nasopharynx 0 0.00 1 7.25 0 0.00 0 0.00 1 0.34 2.94 0.24

Tonsil 2 17.22* 2 5.68 2 8.86 1 5.78 7 0.87 8.08* 2.27

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.10

Hypopharynx 0 0.00 1 2.89 0 0.00 0 0.00 1 0.86 1.16 0.05

Digestive system 13 1.17 30 0.86 37 1.50* 25 1.09 105 93.55 1.12 4.23

Esophagus 0 0.00 2 1.33 5 4.80* 1 1.05 8 3.98 2.01 1.49

Stomach 1 0.94 4 1.23 6 2.70 0 0.00 11 8.53 1.29 0.91

Small intestine 0 0.00 1 2.05 0 0.00 2 5.82 3 1.34 2.24 0.61

Colon 7 1.35 13 0.79 18 1.53 11 1.00 49 44.37 1.10 1.71

Rectum, rectosigmoid junction 3 1.60 6 1.03 1 0.25 3 0.85 13 15.24 0.85 -0.83

Anus, anal canal 1 8.26 1 2.65 2 7.57 2 8.31 6 1.00 5.98* 1.85

Liver 0 0.00 0 0.00 0 0.00 2 2.92 2 2.74 0.73 -0.27

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.53 0.00 -0.57

Bile ducts, other biliary 1 4.28 2 2.67 2 3.64 0 0.00 5 2.09 2.39 1.08

Pancreas 0 0.00 1 0.23 3 0.97 4 1.37 8 11.72 0.68 -1.37

Respiratory system 14 1.81 51 2.07* 42 2.39* 32 1.99* 139 66.05 2.10* 26.98

Nose, nasal cavity, ear 0 0.00 0 0.00 1 6.48 0 0.00 1 0.59 1.70 0.15

Larynx 0 0.00 2 1.37 4 4.11* 2 2.55 8 3.69 2.17 1.59

Lung, bronchus 14 1.95* 49 2.14* 37 2.25* 30 1.99* 130 61.61 2.11* 25.29

Female breast 8 1.06 13 0.53* 20 1.16 14 0.89 55 64.92 0.85 -5.75

Female genital system 3 0.87 8 0.73 14 1.88* 12 1.86 37 28.29 1.31 5.05

Cervix uteri 0 0.00 2 1.66 0 0.00 0 0.00 2 2.88 0.69 -0.51

Corpus uteri 1 0.57 1 0.18* 8 2.10 4 1.23 14 14.43 0.97 -0.25

Ovary 1 1.00 1 0.31 1 0.45 5 2.50 8 8.45 0.95 -0.26

Vagina 0 0.00 0 0.00 1 8.26 2 18.14* 3 0.46 6.55* 1.47

Vulva 1 6.26 4 7.78* 3 8.01* 1 2.68 9 1.42 6.33* 4.39

Male genital system 7 1.08 11 0.54* 12 0.80 10 0.69 40 56.40 0.71* -16.75

Prostate 7 1.10 10 0.49* 12 0.81 10 0.70 39 55.78 0.70* -17.13

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.28

Urinary system 3 0.89 12 1.12 12 1.57 4 0.56 31 28.88 1.07 0.78

Urinary bladder 3 1.33 9 1.26 8 1.57 2 0.41 22 19.31 1.14 0.99

Kidney parenchyma 0 0.00 2 0.70 4 1.97 1 0.53 7 7.66 0.91 -0.24

Renal pelvis, other urinary 0 0.00 1 1.39 0 0.00 1 2.17 2 1.91 1.05 0.03

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -0.23

Bone, joints 0 0.00 0 0.00 1 10.96 0 0.00 1 0.35 2.83 0.24

Soft tissue including heart 0 0.00 1 1.66 0 0.00 1 2.55 2 1.61 1.24 0.14

Kaposi sarcoma 2 25.53* 3 14.24* 0 0.00 0 0.00 5 0.50 10.07* 1.67

Melanoma of skin 1 0.96 6 1.80 4 1.72 3 1.36 14 8.90 1.57 1.89

Eye, orbit 0 0.00 0 0.00 1 6.59 0 0.00 1 0.58 1.71 0.15

Brain, central nervous system 1 1.99 0 0.00 2 1.83 1 1.05 4 4.14 0.97 -0.05

Thyroid 0 0.00 0 0.00 1 1.60 1 1.93 2 2.44 0.82 -0.16

Lymphatic, hematopoietic 5 1.36 14 1.20 6 0.72 7 0.89 32 31.56 1.01 0.16

Hodgkin lymphoma 0 0.00 1 2.66 0 0.00 0 0.00 1 0.93 1.08 0.03

Non-Hodgkin lymphoma 4 2.41 9 1.68 3 0.77 4 1.07 20 14.65 1.37 1.98

Myeloma 0 0.00 0 0.00 3 2.07 0 0.00 3 5.44 0.55 -0.90

Leukemia 1 0.80 4 1.02 0 0.00 3 1.15 8 10.54 0.76 -0.94

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.11

Chronic lymphocytic 0 0.00 1 0.64 0 0.00 1 0.97 2 4.20 0.48 -0.81

Acute non-lymphocytic 0 0.00 2 1.51 0 0.00 0 0.00 2 3.60 0.56 -0.59

Chronic myeloid 1 5.86 1 1.88 0 0.00 0 0.00 2 1.43 1.40 0.21

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,905 4,045 1,916 964 4,905

Person-years in interval 3,689 11,021 6,883 5,449 27,042

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 17,250 PYR and for male cancers on 9,792 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 139
All subsequent cancers 24 0.89 91 1.05 96 1.54* 72 1.24 283 234.22 1.21* 28.28

All excluding same site 24 0.90 91 1.05 95 1.53* 72 1.24 282 233.49 1.21* 28.12

Buccal cavity, pharynx 1 2.06 4 2.56 1 0.92 1 1.04 7 4.10 1.71 1.68

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.17

Tongue 0 0.00 3 8.70* 1 4.15 0 0.00 4 0.91 4.42* 1.79

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.26

Mouth 1 5.91 1 1.84 0 0.00 0 0.00 2 1.44 1.39 0.33

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.09

Tonsil 0 0.00 0 0.00 0 0.00 1 14.31 1 0.34 2.92 0.38

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.16

Digestive system 4 0.62 16 0.78 22 1.47 15 1.05 57 56.25 1.01 0.43

Esophagus 0 0.00 1 1.75 2 4.81 0 0.00 3 1.56 1.93 0.84

Stomach 1 1.94 2 1.24 5 4.41* 0 0.00 8 4.33 1.85 2.13

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.80 0.00 -0.46

Colon 2 0.62 10 0.97 11 1.46 9 1.24 32 28.40 1.13 2.09

Rectum, rectosigmoid junction 1 0.99 1 0.31 0 0.00 2 0.98 4 8.52 0.47 -2.62

Rectum 1 1.52 0 0.00 0 0.00 2 1.47 3 5.60 0.54 -1.51

Anus, anal canal 0 0.00 0 0.00 1 5.15 0 0.00 1 0.73 1.37 0.16

Liver 0 0.00 0 0.00 0 0.00 1 3.07 1 1.21 0.83 -0.12

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.23 0.00 -0.71

Bile ducts, other biliary 0 0.00 1 2.23 1 2.96 0 0.00 2 1.28 1.57 0.42

Pancreas 0 0.00 1 0.37 2 1.00 3 1.54 6 7.48 0.80 -0.86

Respiratory system 6 1.76 28 2.44* 23 2.66* 18 2.15* 75 31.87 2.35* 25.00

Nose, nasal cavity, ear 0 0.00 0 0.00 1 11.67 0 0.00 1 0.32 3.10 0.39

Larynx 0 0.00 1 2.72 1 3.85 1 4.57 3 0.96 3.13 1.18

Lung, bronchus 6 1.84 27 2.47* 21 2.54* 17 2.12* 71 30.51 2.33* 23.47

Female breast 8 1.06 13 0.53* 20 1.16 14 0.89 55 64.92 0.85 -5.75

Female genital system 3 0.87 8 0.73 14 1.88* 12 1.86 37 28.29 1.31 5.05

Cervix uteri 0 0.00 2 1.66 0 0.00 0 0.00 2 2.88 0.69 -0.51

Corpus uteri 1 0.57 1 0.18* 8 2.10 4 1.23 14 14.43 0.97 -0.25

Ovary 1 1.00 1 0.31 1 0.45 5 2.50 8 8.45 0.95 -0.26

Vagina 0 0.00 0 0.00 1 8.26 2 18.14* 3 0.46 6.55* 1.47

Vulva 1 6.26 4 7.78* 3 8.01* 1 2.68 9 1.42 6.33* 4.39

Urinary system 1 0.78 8 1.90 2 0.65 3 1.00 14 11.60 1.21 1.39

Urinary bladder 1 1.30 7 2.80* 1 0.54 2 1.11 11 6.91 1.59 2.37

Kidney parenchyma 0 0.00 0 0.00 1 1.00 1 1.03 2 3.73 0.54 -1.00

Renal pelvis, other urinary 0 0.00 1 2.83 0 0.00 0 0.00 1 0.96 1.04 0.02

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.17

Bone, joints 0 0.00 0 0.00 1 18.63 0 0.00 1 0.21 4.87 0.46

Soft tissue including heart 0 0.00 1 2.94 0 0.00 0 0.00 1 0.92 1.08 0.04

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.06

Melanoma of skin 0 0.00 2 1.21 4 3.45 3 2.74 9 4.41 2.04 2.66

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.19

Brain, central nervous system 1 3.67 0 0.00 1 1.60 0 0.00 2 2.35 0.85 -0.20

Thyroid 0 0.00 0 0.00 1 2.14 0 0.00 1 1.82 0.55 -0.48

Lymphatic, hematopoietic 0 0.00 7 1.04 4 0.81 5 1.05 16 18.47 0.87 -1.43

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.29

Non-Hodgkin lymphoma 0 0.00 6 1.87 2 0.84 4 1.70 12 8.91 1.35 1.79

Myeloma 0 0.00 0 0.00 2 2.29 0 0.00 2 3.24 0.62 -0.72

Leukemia 0 0.00 1 0.47 0 0.00 1 0.67 2 5.82 0.34 -2.21

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.09

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 2.27 0.00 -1.31

Acute non-lymphocytic 0 0.00 1 1.34 0 0.00 0 0.00 1 2.05 0.49 -0.61

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.80 0.00 -0.46

Anus

Females

Table 5.3.3: Risk of subsequent primary cancers after cancer of the anus or anal canal,

females, SEER 1973-2000.

140 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ANUS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,957 2,483 1,231 624 2,957

Person-years in interval 2,240 6,918 4,441 3,651 17,250

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Anus

Males

Table 5.3.4: Risk of subsequent primary cancers after cancer of the anus or anal canal,

males, SEER 1973-2000.

ANUS

All subsequent cancers 37 1.71* 81 1.21 63 1.35* 45 1.06 226 177.53 1.27* 49.51

All excluding same site 36 1.67* 80 1.20 62 1.33* 43 1.02 221 177.25 1.25* 44.68

Buccal cavity, pharynx 2 2.80 10 4.70* 2 1.46 3 2.77 17 5.30 3.21* 11.95

Lip 0 0.00 1 2.73 0 0.00 0 0.00 1 0.91 1.09 0.09

Tongue 0 0.00 4 9.60* 0 0.00 1 4.61 5 1.04 4.80* 4.04

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.44

Mouth 0 0.00 1 1.97 0 0.00 2 8.13 3 1.25 2.40 1.79

Nasopharynx 0 0.00 1 12.66 0 0.00 0 0.00 1 0.19 5.31 0.83

Tonsil 2 27.57* 2 9.34* 2 14.87* 0 0.00 6 0.52 11.44* 5.59

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.16

Hypopharynx 0 0.00 1 4.18 0 0.00 0 0.00 1 0.59 1.69 0.42

Digestive system 9 1.92 14 0.98 15 1.53 10 1.17 48 37.30 1.29 10.92

Esophagus 0 0.00 1 1.08 3 4.80 1 1.78 5 2.42 2.06 2.63

Stomach 0 0.00 2 1.22 1 0.92 0 0.00 3 4.20 0.71 -1.23

Small intestine 0 0.00 1 4.92 0 0.00 2 15.38* 3 0.54 5.57* 2.51

Colon 5 2.55 3 0.50 7 1.66 2 0.53 17 15.97 1.06 1.05

Rectum, rectosigmoid junction 2 2.32 5 1.91 1 0.57 1 0.67 9 6.73 1.34 2.32

Anus, anal canal 1 27.47 1 9.45 1 14.32 2 32.78* 5 0.27 18.31* 4.83

Liver 0 0.00 0 0.00 0 0.00 1 2.78 1 1.53 0.65 -0.54

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.31

Bile ducts, other biliary 1 10.40 1 3.34 1 4.72 0 0.00 3 0.81 3.70 2.23

Pancreas 0 0.00 0 0.00 1 0.90 1 1.03 2 4.24 0.47 -2.29

Respiratory system 8 1.85 23 1.74* 19 2.12* 14 1.82 64 34.17 1.87* 30.46

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.27

Larynx 0 0.00 1 0.92 3 4.21 1 1.77 5 2.73 1.83 2.32

Lung, bronchus 8 2.05 22 1.84* 16 1.96* 13 1.84 59 31.09 1.90* 28.50

Male breast 1 24.05 0 0.00 0 0.00 0 0.00 1 0.34 2.97 0.68

Male genital system 7 1.08 11 0.54* 12 0.80 10 0.69 40 56.40 0.71* -16.75

Prostate 7 1.10 10 0.49* 12 0.81 10 0.70 39 55.78 0.70* -17.13

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.28

Urinary system 2 0.96 4 0.62 10 2.20* 1 0.24 17 17.28 0.98 -0.29

Urinary bladder 2 1.35 2 0.43 7 2.14 0 0.00 11 12.41 0.89 -1.43

Kidney parenchyma 0 0.00 2 1.34 3 2.91 0 0.00 5 3.93 1.27 1.09

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 4.60 1 0.95 1.05 0.05

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.33

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.15

Soft tissue including heart 0 0.00 0 0.00 0 0.00 1 6.29 1 0.69 1.46 0.32

Kaposi sarcoma 2 29.58* 3 17.03* 0 0.00 0 0.00 5 0.40 12.53* 4.70

Melanoma of skin 1 1.88 4 2.39 0 0.00 0 0.00 5 4.48 1.11 0.53

Eye, orbit 0 0.00 0 0.00 1 15.33 0 0.00 1 0.25 3.97 0.76

Brain, central nervous system 0 0.00 0 0.00 1 2.14 1 2.57 2 1.79 1.12 0.21

Thyroid 0 0.00 0 0.00 0 0.00 1 7.90 1 0.62 1.62 0.39

Lymphatic, hematopoietic 5 3.10 7 1.41 2 0.58 2 0.64 16 13.09 1.22 2.98

Hodgkin lymphoma 0 0.00 1 5.56 0 0.00 0 0.00 1 0.43 2.33 0.58

Non-Hodgkin lymphoma 4 5.77* 3 1.39 1 0.67 0 0.00 8 5.73 1.40 2.31

Myeloma 0 0.00 0 0.00 1 1.74 0 0.00 1 2.20 0.45 -1.23

Leukemia 1 1.71 3 1.67 0 0.00 2 1.80 6 4.72 1.27 1.30

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.13

Chronic lymphocytic 0 0.00 1 1.37 0 0.00 1 2.22 2 1.93 1.04 0.07

Acute non-lymphocytic 0 0.00 1 1.72 0 0.00 0 0.00 1 1.55 0.65 -0.56

Chronic myeloid 1 12.61 1 4.16 0 0.00 0 0.00 2 0.64 3.14 1.39

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,948 1,562 685 340 1,948

Person-years in interval 1,448 4,103 2,443 1,798 9,792

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 141
All subsequent cancers 5 2.71 22 3.19* 21 3.29* 24 1.76* 72 28.76 2.50* 78.40

All excluding same site 4 2.18 21 3.05* 20 3.15* 22 1.62* 67 28.67 2.34* 69.50

Buccal cavity, pharynx 0 0.00 2 8.26 1 4.26 0 0.00 3 0.92 3.26 3.77

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.13

Tongue 0 0.00 2 35.87* 1 18.41 0 0.00 3 0.21 14.16* 5.06

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.14

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.43

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.08

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.23

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.16

Digestive system 1 4.29 2 2.14 2 2.02 6 2.59 11 4.47 2.46* 11.83

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.56

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.73

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.19

Colon 0 0.00 0 0.00 1 2.64 3 3.12 4 1.77 2.26 4.04

Rectum, rectosigmoid junction 0 0.00 1 5.35 0 0.00 1 2.34 2 0.86 2.33 2.07

Anus, anal canal 1 128.76* 1 38.05 1 45.85 2 53.85* 5 0.09 53.77* 8.90

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.36

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.09

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.16

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -0.97

Respiratory system 0 0.00 8 9.53* 8 8.17* 5 2.09 21 4.41 4.77* 30.09

Nose, nasal cavity, ear 0 0.00 0 0.00 1 88.11* 0 0.00 1 0.05 21.32 1.73

Larynx 0 0.00 0 0.00 2 22.40* 2 11.67* 4 0.36 11.12* 6.60

Lung, bronchus 0 0.00 8 10.77* 5 5.71* 3 1.36 16 3.99 4.01* 21.78

Female breast 0 0.00 2 1.08 4 2.77 5 2.13 11 6.14 1.79 17.19

Female genital system 0 0.00 1 1.42 2 3.55 3 3.16 6 2.41 2.49 12.71

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -1.58

Corpus uteri 0 0.00 0 0.00 2 7.93 0 0.00 2 1.08 1.85 3.25

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.74 0.00 -2.61

Vagina 0 0.00 0 0.00 0 0.00 2 193.88* 2 0.02 82.87* 6.99

Vulva 0 0.00 1 47.04 0 0.00 1 33.21 2 0.07 27.13* 6.82

Male genital system 0 0.00 0 0.00 1 1.97 0 0.00 1 3.18 0.31 -8.12

Prostate 0 0.00 0 0.00 1 2.15 0 0.00 1 2.99 0.33 -7.41

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.61

Urinary system 0 0.00 0 0.00 1 2.64 2 2.25 3 1.72 1.75 2.33

Urinary bladder 0 0.00 0 0.00 1 4.91 1 1.89 2 0.96 2.09 1.89

Kidney parenchyma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.68 0.00 -1.23

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 23.29 1 0.08 12.93 1.67

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.04

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.08

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.29

Kaposi sarcoma 2 47.69* 3 28.80* 0 0.00 0 0.00 5 0.23 21.68* 8.65

Melanoma of skin 0 0.00 1 2.48 0 0.00 2 4.66 3 1.25 2.40 3.17

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.09

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.78

Thyroid 0 0.00 0 0.00 1 8.67 0 0.00 1 0.48 2.06 0.93

Lymphatic, hematopoietic 2 11.79* 3 5.18* 1 2.02 1 1.06 7 2.19 3.20* 8.73

Hodgkin lymphoma 0 0.00 1 16.42 0 0.00 0 0.00 1 0.16 6.34 1.53

Non-Hodgkin lymphoma 2 21.74* 2 6.45 1 3.86 1 2.10 6 1.14 5.27* 8.82

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.55

Leukemia 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -1.07

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.06

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.36

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.37

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.18

Anus

Both Sexes, <50 Years of Age

Table 5.3.5: Risk of subsequent primary cancers after cancer of the anus or anal canal,

both sexes, <50 years of age, SEER 1973-2000.

142 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ANUS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 962 811 357 192 962

Person-years in interval 730 2,149 1,321 1,316 5,515

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 2,826 PYR and for male cancers on 2,689 PYR.
Anus

Both Sexes, 50-69 Years of Age

Table 5.3.6: Risk of subsequent primary cancers after cancer of the anus or anal canal,

both sexes, 50-69 years of age, SEER 1973-2000.

ANUS

All subsequent cancers 29 1.45 88 1.19 100 1.51* 81 1.12 298 232.04 1.28* 44.63

All excluding same site 29 1.45 88 1.20 99 1.50* 81 1.12 297 231.48 1.28* 44.34

Buccal cavity, pharynx 2 3.23 9 4.32* 2 1.26 4 2.81 17 5.71 2.98* 7.64

Lip 0 0.00 1 4.39 0 0.00 0 0.00 1 0.67 1.49 0.22

Tongue 0 0.00 3 6.83* 0 0.00 1 3.40 4 1.20 3.33 1.89

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.32

Mouth 0 0.00 1 1.72 0 0.00 2 4.90 3 1.61 1.87 0.94

Nasopharynx 0 0.00 1 12.32 0 0.00 0 0.00 1 0.21 4.70 0.53

Tonsil 2 28.32* 2 8.84 2 12.81* 1 8.74 7 0.57 12.34* 4.35

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.12

Hypopharynx 0 0.00 1 4.44 0 0.00 0 0.00 1 0.59 1.71 0.28

Digestive system 7 1.81 16 1.11 23 1.71* 15 0.93 61 47.91 1.27 8.86

Esophagus 0 0.00 2 2.50 4 6.03* 1 1.48 7 2.37 2.95* 3.13

Stomach 1 2.83 2 1.54 5 4.28* 0 0.00 8 4.21 1.90 2.57

Small intestine 0 0.00 1 4.35 0 0.00 2 8.18 3 0.75 4.03 1.53

Colon 4 2.44 6 0.95 10 1.63 6 0.77 26 21.86 1.19 2.80

Rectum, rectosigmoid junction 2 2.69 2 0.74 0 0.00 1 0.40 5 8.35 0.60 -2.27

Anus, anal canal 0 0.00 0 0.00 1 6.30 0 0.00 1 0.56 1.78 0.30

Liver 0 0.00 0 0.00 0 0.00 2 4.00 2 1.53 1.31 0.32

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.71 0.00 -0.48

Bile ducts, other biliary 0 0.00 2 7.33 1 3.65 0 0.00 3 1.00 2.99 1.35

Pancreas 0 0.00 1 0.55 2 1.18 3 1.45 6 6.04 0.99 -0.03

Respiratory system 6 1.62 30 2.22* 28 2.36* 26 2.16* 90 41.06 2.19* 33.12

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.22

Larynx 0 0.00 0 0.00 1 1.42 0 0.00 1 2.48 0.40 -1.00

Lung, bronchus 6 1.77 30 2.42* 27 2.45* 26 2.29* 89 38.16 2.33* 34.40

Female breast 3 0.91 7 0.59 11 1.07 8 0.72 29 36.56 0.79 -8.04

Female genital system 3 1.84 5 0.87 6 1.29 6 1.31 20 16.57 1.21 3.65

Cervix uteri 0 0.00 1 1.63 0 0.00 0 0.00 1 1.59 0.63 -0.63

Corpus uteri 1 1.11 1 0.32 2 0.79 2 0.84 6 8.98 0.67 -3.16

Ovary 1 2.24 0 0.00 1 0.74 4 2.84 6 4.80 1.25 1.27

Vagina 0 0.00 0 0.00 1 15.94 0 0.00 1 0.23 4.42 0.82

Vulva 1 22.69 3 17.29* 1 5.79 0 0.00 5 0.64 7.86* 4.64

Male genital system 3 1.12 4 0.39* 9 0.89 10 0.92 26 34.07 0.76 -15.04

Prostate 3 1.13 4 0.39* 9 0.90 10 0.92 26 33.79 0.77 -14.51

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.17

Urinary system 2 1.49 4 0.80 7 1.53 1 0.19 14 16.12 0.87 -1.43

Urinary bladder 2 2.37 3 0.95 3 1.00 1 0.28 9 10.54 0.85 -1.04

Kidney parenchyma 0 0.00 1 0.67 4 3.10 0 0.00 5 4.55 1.10 0.30

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.03 0.00 -0.69

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.22

Bone, joints 0 0.00 0 0.00 1 18.34 0 0.00 1 0.19 5.15 0.55

Soft tissue including heart 0 0.00 0 0.00 0 0.00 1 3.71 1 0.85 1.18 0.10

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.09

Melanoma of skin 0 0.00 2 1.19 3 2.14 1 0.67 6 5.06 1.19 0.64

Eye, orbit 0 0.00 0 0.00 1 10.53 0 0.00 1 0.34 2.95 0.45

Brain, central nervous system 1 4.11 0 0.00 1 1.42 1 1.46 3 2.48 1.21 0.35

Thyroid 0 0.00 0 0.00 0 0.00 1 2.97 1 1.37 0.73 -0.25

Lymphatic, hematopoietic 1 0.74 6 1.19 5 1.06 4 0.72 16 16.70 0.96 -0.47

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.34

Non-Hodgkin lymphoma 1 1.56 4 1.68 2 0.89 2 0.75 9 7.93 1.13 0.72

Myeloma 0 0.00 0 0.00 3 3.62 0 0.00 3 2.93 1.02 0.05

Leukemia 0 0.00 2 1.25 0 0.00 2 1.10 4 5.33 0.75 -0.90

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.10

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 1 1.39 1 2.19 0.46 -0.81

Acute non-lymphocytic 0 0.00 1 1.88 0 0.00 0 0.00 1 1.82 0.55 -0.56

Chronic myeloid 0 0.00 1 4.77 0 0.00 0 0.00 1 0.70 1.42 0.20

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,257 1,922 1,041 593 2,257

Person-years in interval 1,737 5,579 3,974 3,488 14,778

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 9,409 PYR and for male cancers on 5,369 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE COLON, RECTUM, AND ANUS 143
All subsequent cancers 27 1.02 62 0.85 38 1.04 12 0.82 139 150.95 0.92 -17.71

All excluding same site 27 1.02 62 0.85 38 1.04 12 0.82 139 150.60 0.92 -17.19

Buccal cavity, pharynx 1 1.94 3 2.20 0 0.00 0 0.00 4 2.76 1.45 1.83

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.69

Tongue 0 0.00 2 7.51 0 0.00 0 0.00 2 0.54 3.73 2.17

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.49

Mouth 1 6.56 1 2.45 0 0.00 0 0.00 2 0.84 2.37 1.72

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.12

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.25

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.09

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.28

Digestive system 5 0.71 12 0.62 12 1.17 4 0.90 33 41.17 0.80 -12.11

Esophagus 0 0.00 0 0.00 1 3.27 0 0.00 1 1.30 0.77 -0.45

Stomach 0 0.00 2 1.07 1 1.04 0 0.00 3 3.92 0.77 -1.36

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -0.72

Colon 3 0.87 7 0.72 7 1.33 2 0.86 19 20.73 0.92 -2.57

Rectum, rectosigmoid junction 1 0.92 3 1.02 1 0.69 1 1.74 6 6.03 0.99 -0.05

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.51

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 1.01 0.00 -1.50

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.77 0.00 -1.14

Bile ducts, other biliary 1 6.32 0 0.00 1 3.87 0 0.00 2 1.00 2.00 1.48

Pancreas 0 0.00 0 0.00 1 0.78 1 1.77 2 5.14 0.39 -4.65

Respiratory system 8 2.09 13 1.26 6 1.25 1 0.61 28 20.59 1.36 10.99

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.32

Larynx 0 0.00 2 4.51 1 5.57 0 0.00 3 0.85 3.52 3.18

Lung, bronchus 8 2.22 11 1.13 5 1.10 1 0.64 25 19.46 1.28 8.20

Female breast 5 1.33 4 0.38* 5 0.91 1 0.43 15 22.21 0.68 -14.38

Female genital system 0 0.00 2 0.44 6 2.68 3 3.27 11 9.32 1.18 3.35

Cervix uteri 0 0.00 1 2.42 0 0.00 0 0.00 1 0.84 1.19 0.31

Corpus uteri 0 0.00 0 0.00 4 3.91* 2 5.27 6 4.37 1.37 3.25

Ovary 0 0.00 1 0.72 0 0.00 1 3.27 2 2.91 0.69 -1.81

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.41

Vulva 0 0.00 0 0.00 2 10.78* 0 0.00 2 0.71 2.81 2.57

Male genital system 4 1.08 7 0.72 2 0.46 0 0.00 13 19.14 0.68 -35.45

Prostate 4 1.09 6 0.62 2 0.46 0 0.00 12 19.00 0.63 -40.36

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.10

Urinary system 1 0.51 8 1.49 4 1.50 1 0.93 14 11.05 1.27 4.37

Urinary bladder 1 0.73 6 1.59 4 2.11 0 0.00 11 7.82 1.41 4.72

Kidney parenchyma 0 0.00 1 0.84 0 0.00 1 4.53 2 2.42 0.83 -0.63

Renal pelvis, other urinary 0 0.00 1 2.55 0 0.00 0 0.00 1 0.81 1.24 0.28

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.40

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.17

Soft tissue including heart 0 0.00 1 3.55 0 0.00 0 0.00 1 0.60 1.67 0.59

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.19

Melanoma of skin 1 2.30 3 2.42 1 1.59 0 0.00 5 2.59 1.93 3.57

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.29

Brain, central nervous system 0 0.00 0 0.00 1 3.50 0 0.00 1 1.22 0.82 -0.33

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.86

Lymphatic, hematopoietic 2 0.93 5 0.83 0 0.00 2 1.49 9 12.67 0.71 -5.44

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.40

Non-Hodgkin lymphoma 1 1.08 3 1.12 0 0.00 1 1.71 5 5.58 0.90 -0.85

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 2.21 0.00 -3.27

Leukemia 1 1.28 2 0.92 0 0.00 1 1.94 4 4.62 0.87 -0.92

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.16

Chronic lymphocytic 0 0.00 1 1.17 0 0.00 0 0.00 1 1.80 0.55 -1.19

Acute non-lymphocytic 0 0.00 1 1.34 0 0.00 0 0.00 1 1.57 0.64 -0.85

Chronic myeloid 1 9.59 0 0.00 0 0.00 0 0.00 1 0.63 1.58 0.54

Anus

Both Sexes, ≥70 Years of Age

Table 5.3.7: Risk of subsequent primary cancers after cancer of the anus or anal canal,

both sexes, ≥70 years of age, SEER 1973-2000.

144 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ANUS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,686 1,312 518 179 1,686

Person-years in interval 1,221 3,293 1,589 646 6,749

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 5,016 PYR and for male cancers on 1,733 PYR.
NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 145

Synopsis

The risk of subsequent primary cancer was evaluated

in 286,675 persons with initial cancers of the respiratory tract diagnosed between 1973 and 2000. Overall

risk of a new malignancy was significantly increased

among survivors of lung cancer (O/E=1.36, O=11,700,

EAR=65 per 10,000 person-years), laryngeal cancer

(O/E=1.71, O=5,277, EAR=140), and nasal cavity cancer

(O/E=1.44, O=405, EAR=68), but not mesothelioma

(O/E=0.98, O=91). The risk of subsequent cancers

following lung, laryngeal, and nasal cancers appeared

strongly related to tobacco exposures, with excesses

for most smoking-related sites. These risks appeared

relatively constant over time. When lung cancer was

treated initially with radiation, however, there was a

delayed increase of esophageal cancer after 5 or more

years, suggesting a radiation effect. There was an

excess of acute non-lymphocytic leukemia, especially

after small cell carcinoma of the lung, which has previously been linked to treatment with alkylating

agent chemotherapy. Following laryngeal cancer, the

risk was particularly elevated (3- to 6-fold) for subsequent cancers of the buccal cavity, pharynx, and

lung. This pattern reflects a “field cancerization”

phenomenon involving multiple patches of genetically transformed cells resulting from tobacco exposure (and alcohol for some sites) or the spread and

implantation of single clones. Following nasal cavity

cancer, excesses of buccal and respiratory tract tumors

were consistent with tobacco exposure, although the

numbers were small. After mesothelioma, a nearly

7-fold excess of thyroid cancer was observed, but the

increase was based on only 3 cases. 

Lung and Bronchus Cancer 

Primary cancers of the lung and bronchus represent

13% of all cancers occurring in the U.S. (13% in men

and 12% in women), with approximately 172,570 new

cases diagnosed annually (Jemal et al, 2005). Lung

cancer ranks third in incidence (behind breast cancer

in women and prostate cancer in men). It is the leading cause of cancer mortality in the U.S., accounting

for 29% of all cancer deaths (31% in men and 27%

in women)—more than breast, colon, prostate, and

pancreas cancers combined. Lung cancer incidence is

greatest for black men, followed by white men, black

women, and white women. The relative survival rate

remains disappointingly low, with only 15.2% surviving for 5 years. The distribution of cell types in SEER

includes squamous (26%), adenocarcinoma (31%,

including 3% bronchioloalveolar), small cell (16%),

large cell (9%), and others (18%). Among patients in

SEER with non-small cell lung cancer (NSCLC)

histologies in the current survey, surgery was the

initial therapy in 31% of the cases; among those with

small cell lung cancer (SCLC), only 5% had surgery.

For those with NSCLC, radiation occasionally results

in long-term survival, but it is most effective for palliation and local tumor control (Ginsberg et al, 2001).

Chemotherapy and newer combined modality and

molecular therapies for NSCLC have not had a marked

impact on survival during the period of this SEER

study (Selvaggi and Seagliotti, 2002; Jemal et al, 2005).

Among those with SCLC, combination chemotherapy

is the treatment of choice, with radiotherapy often

incorporated. At presentation, 30-40% of SCLC patients

have limited disease and 60-70% have extensive disease. Five-year relative survival rates are 10-20% in

SCLC patients with limited disease and 3-5% in those

with extensive disease (Hanna and Einhorn, 2002; 

Ries et al, 2004; Jemal et al, 2005).

Tobacco smoking is the dominant etiologic factor

responsible for the vast majority of lung cancers

(Ruano-Ravina et al, 2003). Other exposures also contribute to risk, including asbestos, radon, radiotherapy,

polycyclic aromatic hydrocarbons, and nutritional and

dietary factors, as well as environmental tobacco smoke

(Blot and Fraumeni, 1996; Ruano-Ravina et al, 2003;

Alberg et al, 2005). Familial susceptibility to lung cancer

has been documented and traced to inherited factors

(Bailey-Wilson et al, 2004). Although etiologic factors

are not strongly related to lung cancer histology, the

dose-response relationship with tobacco exposure is less

steep for adenocarcinoma than for other histologies

(Suzuki et al, 1990).

Chapter 6

RESPIRATORY TRACT

New Malignancies Following

Cancer of the Respiratory Tract

Neil E. Caporaso, Kevin W. Dodd, Margaret A. Tucker

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated

as [(O-E)/PYR]10,000).

Author affiliations: Neil E. Caporaso and Margaret A. Tucker,

Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS;

Kevin W. Dodd, Division of Cancer Control and Population Sciences,

NCI, NIH, DHHS.
Results and Discussion

A total of 11,700 subsequent primary cancers were

observed in 255,083 patients surviving at least 2 months

after an initial cancer of the lung or bronchus diagnosed

between 1973 and 2000 (O/E=1.36, 95% CI=1.34-1.39,

EAR=65 per 10,000 person-years). In analyses adjusting

for the competing risk of death due to other causes,

the cumulative incidence of developing any second

cancer was 5.7% at 25 years (95% CI=5.5%-5.8%), 

which included an incidence of 1.7% (1.7%-1.8%) for

second cancers of the lung or bronchus. Significantly

increased risks were observed for subsequent cancers

of the respiratory tract (with 90% of subsequent respiratory tumors occurring in the lung), buccal cavity

(including tongue, tonsils, mouth, oropharynx, and

hypopharynx), esophagus, stomach, small intestine,

colon, rectum, pancreas, bladder, kidney, renal pelvis,

and thyroid, as well as for acute non-lymphocytic

leukemia (ANLL). The risk of all new malignancies

combined decreased when subsequent lung cancers

were excluded (O/E=1.17, 95% CI=1.15-1.20, EAR=25).

The risk for all subsequent cancers remained elevated

up to 20 years after diagnosis, with those surviving 10

or more years showing a 49% increased relative risk of

subsequent cancer. The risks of new primary cancers

were slightly higher in blacks (O/E=1.47, EAR=88) than

in whites (O/E=1.34, EAR=61). Although the relative

risk of developing a subsequent neoplasm was higher

in women (O/E=1.50, EAR=65) than in men (O/E=1.31,

EAR=65), the excess absolute risks were nearly identical. The higher relative risks of new malignancies

among women, many of which are smoking-related,

were likely due to the fact that a greater proportion of

men than women are smokers in the general population (MMWR, 2004) from whom the expected values

are derived. The virtually identical absolute risks suggest cautious interpretation of gender effects in the

development of subsequent cancers. Relative risks for

all subsequent cancers were higher in those diagnosed

with lung cancer before age 50 years (O/E=2.35, 

EAR= 70), compared with those between 50 and 69

years of age (O/E=1.51, EAR=83) or older (≥70 years,

O/E=1.07, EAR=20) (Figure 6.1). This is similar to the

pattern observed in data from Finland (Salminen et al,

1995) and Switzerland (Levi et al, 1999). However, in

our survey the excess absolute risks were similar

among lung cancer survivors diagnosed at ages

younger than 70 years (Figure 6.1). In contrast,

observed numbers of subsequent cancers were significantly below those expected for cancers of the female

genital system (notably uterine corpus and vulva),

brain, prostate, and testis, as well as melanoma and

chronic lymphocytic leukemia. The lower rates for

new cancers of the uterine corpus may reflect

decreased estrogen levels associated with tobacco

smoking (Michnovicz et al, 1986).

Tobacco smoking is the dominant risk factor underlying the pattern of new malignancies associated with

lung cancer. Subsequent lung cancers constituted 29%

of all new primary cancers, with increases in risk being

highest (greater than 3-fold) in those surviving 5 or

more years after initial diagnosis. A similar pattern of

smoking-related subsequent cancers has been observed

in previous studies of lung cancer (Boice and Fraumeni,

1985; Richardson et al, 1993; Salminen et al, 1995; Tucker et al, 1997), with sustained risk increases beyond 5

years for cancers of the larynx, esophagus, and bladder.

The risks of subsequent cancers of the lung and buccal

cavity are especially high among lung cancer survivors

who continue to smoke cigarettes (Tucker et al, 1997;

Johnson, 1998), mandating a high priority for smoking

cessation efforts in this group. Some data indicate that

smoking cessation following lung cancer lowers the

risk of new smoking-related malignancies (Richardson

et al, 1993; Ebbert et al, 2003).

Overall, subsequent cancer risks were higher among

patients diagnosed with NSCLC (O/E=1.38, EAR=69)

than SCLC (O/E=1.13, EAR=21). This pattern has been

observed previously, although the number of longterm SCLC survivors was small (Levi et al, 1999).

Among 5-or-more-year survivors in our survey, new

primary cancer risks were higher among those initially

diagnosed with SCLC (O/E=1.87) than with NSCLC

(O/E=1.52). The pattern of subsequent cancers after

NSCLC and SCLC involved mainly smoking-related

cancers, but the risk of ANLL after SCLC (O/E=6.57)

was much higher than after NSCLC (O/E=1.47), most

146 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

RESPIRATORY TRACT

O/E

1.67*

2.35* All subsequent cancers

All subsequent cancers excluding 

lung and bronchus

50 50-69 70

Age at diagnosis of lung cancer (years)

EAR (per 10,000 person-years)

All subsequent cancers

All subsequent cancers 

excluding lung and 

bronchus

1.51*

1.26*

1.07*

1.00

50 50-69 70

70

30

83

35

20

1 0

15

30

45

60

75

90

1.00

1.25

1.50

1.75

2.00

2.25

2.50

Figure 6.1: Observed-to-expected ratio (O/E) and excess

absolute risk (EAR) of subsequent primary cancers after cancer

of the lung or bronchus, both sexes, SEER 1973-2000.

*P <0.05.

Note: EAR = Excess number of subsequent cancers per 10,000 person-years.

Observed No. 698 422 7,350 5,042 3,652 2,890
NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 147

RESPIRATORY TRACT

likely due to treatment with alkylating agents, as previously reported (Pedersen-Bjergaard et al, 1985; Sagman et al, 1992; Tucker et al, 1997; Johnson, 1998). In

our series, 36 out of 38 patients with subsequent primary ANLL had received chemotherapy as their initial

therapy following SCLC. After both NSCLC and

SCLC, there was an elevated risk of thyroid cancer

within the first year, which probably reflects increased

medical surveillance and incidental findings at autopsy, since 34 of the 84 (40%) thyroid cancers were diagnosed at autopsy.

The temporal pattern of increased risks for several

cancer sites near the field of radiation appeared consistent with radiation-related effects. After radiation for

NSCLC, the relative risk of cancer of the esophagus

increased to 6-fold for the 5-9 year follow-up period,

and to 11-fold among patients who survived 10 or more

years. Similar radiation-related risks were seen for

esophageal cancer following SCLC, based on smaller

numbers. For laryngeal cancer following NSCLC, an

excess of radiation-related tumors was suggested only

in the period 5-9 years after initial treatment. For subsequent cancers of the lung following radiation, substantial excesses were limited to the follow-up periods

of 5-10 years and greater than 10 years for both SCLC

and NSCLC. In previously reported studies, continued

tobacco use appeared to interact with radiotherapy

(and possibly chemotherapy as well) to augment the

risk of second tumors (Tucker et al, 1997).

Although the contribution of genetic susceptibility to

multiple primary cancers cannot be directly addressed

in our study, there was a higher risk of subsequent cancers among lung cancer patients diagnosed at younger

ages. The recent finding of a genetic locus that may

account for familial lung cancer (Bailey-Wilson et al,

2004) provides an opportunity for further studies of

susceptibility factors that contribute to subsequent

tumors associated with lung cancer.

Laryngeal Cancer

The larynx accounts for approximately 0.7% of all incident cancers (about 9,880 per year) in the U.S. and

0.7% of all cancer deaths (about 3,770 per year) (Jemal

et al, 2005). Laryngeal cancer is 4 times more common

in men than women and occurs more frequently in

blacks than whites. The overall relative 5-year survival

rate for larynx cancer is 65.0%, although patients diagnosed with localized disease have an 83.7% survival

rate. The vast majority of cancers of the larynx are

squamous cell carcinomas. Treatment may include

surgery, radiation, and occasionally chemotherapy or

combined modalities. 

The major risk factors for laryngeal cancer are tobacco smoking and alcohol consumption. Dietary factors

(low consumption of fruits and vegetables, high consumption of processed meats) and certain occupational

exposures may contribute as well (Dietz et al, 2004; Levi

et al, 2004). 

Results and Discussion

A total of 5,277 subsequent primary cancers developed

among 23,943 patients surviving at least 2 months after

an initial cancer of the larynx. The risk of developing

any new malignancy was significantly increased by

71% (O/E=1.71, 95% CI=1.66-1.76, EAR=140). The

cumulative incidence of developing a second cancer

was 26.7% at 25 years (95% CI=25.9%-27.4%) (Figure

6.2). Both the relative and absolute risks of a new

neoplasm were greater among women (O/E=2.41,

EAR=177) than men (O/E=1.62, EAR=132), and among

blacks (O/E=1.98, EAR=203) than whites (O/E=1.68,

EAR=135). Although the relative risk for any subsequent tumor was higher in those diagnosed with

laryngeal cancer before the age of 50 years (O/E=2.36,

EAR=91) compared with older patients (age 50-69,

O/E=1.78, EAR=154; age ≥70, O/E=1.42, EAR=131),

the absolute risk was lower in the younger group.

Risk of all subsequent cancers decreased over time

following diagnosis of the initial cancer, from a 94%

excess in the 1- to 4-year interval to a 16% excess at

20 or more years after diagnosis. The risk of developing a subsequent cancer was increased for a variety of

sites, including cancers of the buccal cavity and pharynx, esophagus, colon, liver, nasal cavity, lung, larynx,

urinary bladder, kidney, and thyroid. Risks were significantly below that expected for prostate cancer,

chronic lymphocytic leukemia, and melanoma.

The pattern of tumors associated with laryngeal

cancer, with pronounced excesses of tumors in the

upper aerodigestive tract (oral cavity, pharynx, esophagus), resembles that in previous surveys (McDonald

et al, 1989; Fujita et al, 1998; Gao et al, 2003; Do et al,

2003; Dikshit et al, 2005) implicating “field cancerization” due to tobacco and alcohol exposure, or the spread

and implantation of single clones of mutant cells. Tobacco smoking is also likely to have contributed to excess

tumors of the lung, bladder, and kidney, while alcohol

Years after initial cancer diagnosis

Cumulative incidence (%)

0 5 10 15 20 25

0

5

10

15

20

30

25

All second cancers

Respiratory system 

Oral, pharynx, 

and esophagus

Urinary

Figure 6.2: Cumulative incidence of developing a second

cancer among patients with cancer of the larynx, both sexes,

SEER 1973-2000.
is likely to have contributed to an elevated risk of liver

cancer (O/E=1.92). The increase in thyroid cancer was

limited to the first year following diagnosis, suggesting

an effect of increased medical surveillance. 

Most (74%) of the patients with cancer of the larynx

received radiation as part of the initial treatment. There

was some suggestion of a modest increase in risk of

subsequent cancer over time in some adjacent irradiated

sites, especially the pharynx (O/E=5.88), with most

cases occurring 5-9 years (O/E=8.86, O=27) or 10 or

more years (O/E=8.19, O=18) after laryngeal cancer

diagnosis. These results are consistent with a radiation

effect and with the findings of others (Holland et al,

2002; Gao et al, 2003). 

Nose, Nasal Cavity, and Middle Ear

Cancers

Cancers of the nose, nasal cavity, and middle ear

account for only 0.2% of all cancers in the SEER Program. Tobacco use and exposures in wood-dust and

metal-related occupations are documented risk factors

(Dong and Hemminki, 2001). Additional workplace

exposures include nickel, chromates, textiles, radium,

leather dust, and petroleum (Blot et al, 1997; Caplan

et al, 2000). The 5-year relative survival rate is 52.4%,

with substantially lower survival among blacks

(32.4%) compared with whites (56.0%). The majority

of patients are treated with radiation (65.1%) and/or

surgery (69.5%). 

Results and Discussion

Among 3,543 2-month survivors with cancers of the

nose, nasal cavity, and middle ear, 405 subsequent primary cancers were observed, reflecting a significantly

increased risk of new malignancies (O/E=1.44, 

95% CI=1.31-1.59, EAR=68). The cumulative incidence

of developing a second cancer was 14.4% at 20 years

(95% CI=12.9%-16.0%). The overall risk of new malignancies decreased slightly over time. Although the

relative risk was slightly higher for women (O/E=1.60)

than for men (O/E=1.37), the excess absolute risks were

identical (EAR=68). The relative risks were similar for

blacks and whites but did not reach statistical significance for blacks. The excess risk of developing subsequent cancers of the buccal cavity, pharynx, larynx, 

and lung is consistent with the effects of prior tobacco

smoking. Based on a small number of cases, there was

an increased risk of soft tissue cancers (O/E=5.49, O=6), 

as well as extranodal non-Hodgkin lymphoma (NHL)

(O/E=2.57, O=7), although the risk for NHL overall was

not significantly elevated. An increase in NHL has been

observed by others (Boice and Fraumeni, 1985; Dong

and Hemminki, 2001).

Mesothelioma

Mesothelioma is a rare malignancy that arises from the

mesothelial lining of the lung (pleura) or the abdomen

(peritoneum), primarily due to asbestos exposure in

the workplace with no effect from smoking (Blot and

Fraumeni, 1996). The annual number of mesothelioma

cases increased from the 1970s through the mid-1990s

but then leveled off in the U.S. (Price and Ware, 2004)

and Europe. However, age-adjusted rates for females

have been low and constant over the last century. There

is no standard curative approach (Khalil et al, 2003),

although surgery (van Ruth et al, 2003), chemotherapy

(Janne, 2003), and radiotherapy (Senan, 2003) have

limited roles. Prognosis is poor following a diagnosis

of mesothelioma, with a 5-year relative survival rate

of 8.4%.

Results and Discussion

Among 4,106 2-month survivors of mesothelioma, 91

subsequent primary cancers were observed, reflecting

no overall increase in subsequent cancer risk (O/E=0.98,

95% CI=0.79-1.20). The cumulative incidence of developing a second cancer among patients with mesothelioma

was 2.0% at 10 years (95% CI=1.6%-2.5%). 

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NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 149

RESPIRATORY TRACT
Lung and Bronchus

Both Sexes

Table 6.1.1: Characteristics of patients with an initial cancer of the lung or bronchus,

both sexes, SEER 1973-2000.

150 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LUNG AND BRONCHUS

Number of patients with 1st primary cancer

Total 161,672 100.0 93,411 100.0 255,083 100.0

Initial treatment

Any radiation 90,753 56.1 47,327 50.7 138,080 54.1

With surgery 13,219 8.2 6,961 7.5 20,180 7.9

Without surgery 77,534 48.0 40,366 43.2 117,900 46.2

No radiation 70,919 43.9 46,084 49.3 117,003 45.9

With surgery 29,033 18.0 18,931 20.3 47,964 18.8

Without surgery 41,886 25.9 27,153 29.1 69,039 27.1

Race

White 135,151 83.6 80,844 86.5 215,995 84.7

Black 18,120 11.2 8,245 8.8 26,365 10.3

Other 8,244 5.1 4,210 4.5 12,454 4.9

Unknown 157 0.1 112 0.1 269 0.1

Age at 1st primary cancer diagnosis, years

< 30 201 0.1 249 0.3 450 0.2

30–49 11,863 7.3 8,248 8.8 20,111 7.9

50–69 90,809 56.2 49,759 53.3 140,568 55.1

70–79 45,278 28.0 25,789 27.6 71,067 27.9

> 80 13,521 8.4 9,366 10.0 22,887 9.0

Number of patients with one or more

primary cancers

One primary cancer only 154,642 95.7 89,849 96.2 244,491 95.8

1st and 2nd cancers 6,350 3.9 3,244 3.5 9,594 3.8

1st, 2nd, and 3rd cancers 611 0.4 289 0.3 900 0.4

1st, 2nd, 3rd, and additional cancers 69 0.0 29 0.0 98 0.0

Other statistics

Median age at 1st cancer diagnosis 66.3 — 66.5 — 66.4 —

Median year of 1st cancer diagnosis 1987.5 — 1990.3 — 1988.5 —

Median person-years at risk 0.6 — 0.8 — 0.7 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 93.5 — 94.1 — 93.7

1st, 2nd, and additional cancers — 93.1 — 93.8 — 93.3

1st cancer only — 4.4 — 3.7 — 4.2

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Lung and Bronchus

Both Sexes

Table 6.1.2: Risk of subsequent primary cancers after cancer of the lung or bronchus,

both sexes, SEER 1973-2000.

LUNG AND BRONCHUS

All subsequent cancers 2,460 1.09* 4,760 1.40* 2,690 1.57* 1,790 1.49* 11,700 8,580.71 1.36* 64.64

All excluding same site 2,046 1.10* 3,456 1.22* 1,695 1.19* 1,157 1.14* 8,354 7,134.70 1.17* 25.27

Buccal cavity, pharynx 169 2.66* 223 2.43* 104 2.46* 40 1.51* 536 224.15 2.39* 6.46

Lip 13 1.32 19 1.38 7 1.10 4 1.01 43 33.89 1.27 0.19

Tongue 42 3.38* 47 2.59* 15 1.78 11 2.05* 115 44.38 2.59* 1.46

Salivary gland 12 2.44* 6 0.81 6 1.62 1 0.37 25 18.66 1.34 0.13

Mouth 46 2.77* 67 2.79* 35 3.19* 9 1.32 157 58.39 2.69* 2.04

Nasopharynx 2 0.80 9 2.53* 1 0.63 1 1.03 13 8.62 1.51 0.09

Tonsil 24 3.93* 26 2.99* 11 2.84* 6 2.61 67 20.96 3.20* 0.95

Oropharynx 3 1.61 6 2.23 4 3.24 2 2.64 15 6.55 2.29* 0.18

Hypopharynx 16 2.28* 34 3.39* 17 3.77* 6 2.26 73 24.22 3.01* 1.01

Digestive system 590 1.19* 990 1.33* 479 1.30* 342 1.32* 2,401 1,867.36 1.29* 11.06

Esophagus 54 1.95* 96 2.37* 70 3.60* 48 3.61* 268 100.93 2.66* 3.46

Stomach 82 1.53* 118 1.52* 42 1.13 26 1.02 268 193.91 1.38* 1.54

Small intestine 21 3.06* 22 2.10* 6 1.12 0 0.00* 49 26.60 1.84* 0.46

Colon 220 1.01 404 1.22* 199 1.19* 171 1.43* 994 836.00 1.19* 3.27

Rectum, rectosigmoid junction 95 1.08 161 1.24* 73 1.16 35 0.84 364 321.70 1.13* 0.88

Anus, anal canal 3 0.70 4 0.61 2 0.61 5 2.20 14 16.46 0.85 -0.05

Liver 11 0.62 15 0.57* 14 1.07 11 1.15 51 66.58 0.77 -0.32

Gallbladder 5 0.81 5 0.54 4 0.86 1 0.31 15 23.32 0.64 -0.17

Bile ducts, other biliary 11 1.09 18 1.17 4 0.50 12 1.92 45 39.83 1.13 0.11

Pancreas 86 1.44* 141 1.58* 62 1.40* 29 0.93 318 224.60 1.42* 1.94

Respiratory system 496 1.17* 1,457 2.31* 1,073 3.50* 673 3.26* 3,699 1,568.35 2.36* 44.15

Nose, nasal cavity, ear 6 1.78 11 2.21* 5 2.08 2 1.22 24 12.39 1.94* 0.24

Larynx 76 2.49* 130 2.98* 69 3.46* 38 3.13* 313 106.16 2.95* 4.29

Lung, bronchus 414 1.06 1,304 2.25* 995 3.51* 633 3.29* 3,346 1,446.02 2.31* 39.37

Female breast 143 0.78* 319 1.06 160 1.05 131 1.22* 753 746.86 1.01 0.31

Female genital system 41 0.49* 112 0.83* 57 0.87 35 0.79 245 328.81 0.75* -4.18

Cervix uteri 5 0.54 16 1.14 6 0.95 3 0.79 30 33.36 0.90 -0.17

Corpus uteri 16 0.36* 50 0.71* 26 0.76 14 0.62 106 171.83 0.62* -3.29

Ovary 16 0.66 42 1.06 21 1.06 14 1.03 93 97.15 0.96 -0.21

Vagina 2 1.65 1 0.51 2 2.01 1 1.40 6 4.88 1.23 0.06

Vulva 1 0.29 2 0.35 1 0.33 3 1.28 7 14.51 0.48* -0.37

Male genital system 470 0.96 729 0.99 364 0.95 234 0.83* 1,797 1,890.32 0.95* -3.31

Prostate 469 0.97 717 0.98 362 0.96 233 0.83* 1,781 1,873.36 0.95* -3.27

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 5.12 0.00* -0.18

Urinary system 293 1.60* 455 1.66* 209 1.51* 143 1.45* 1,100 695.03 1.58* 8.39

Urinary bladder 169 1.33* 318 1.67* 159 1.65* 113 1.63* 759 482.66 1.57* 5.73

Kidney parenchyma 103 2.30* 113 1.68* 41 1.22 21 0.89 278 169.45 1.64* 2.25

Renal pelvis, other urinary 21 1.82* 24 1.40 9 1.07 9 1.55 63 42.93 1.47* 0.42

Ureter 6 1.57 5 0.88 2 0.71 3 1.57 16 14.23 1.12 0.04

Bone, joints 1 0.53 5 1.78 1 0.75 1 1.14 8 6.90 1.16 0.02

Soft tissue including heart 11 1.31 14 1.11 8 1.28 2 0.44 35 31.82 1.10 0.07

Kaposi sarcoma 2 0.84 3 0.90 0 0.00 1 0.95 6 8.40 0.71 -0.05

Melanoma of skin 33 0.73 45 0.64* 36 1.00 33 1.23 147 178.41 0.82* -0.65

Eye, orbit 2 0.63 3 0.63 0 0.00 1 0.65 6 11.75 0.51 -0.12

Brain, central nervous system 12 0.53* 32 0.94 6 0.36* 11 1.00 61 84.06 0.73* -0.48

Thyroid 45 4.17* 23 1.40 9 1.16 7 1.37 84 40.00 2.10* 0.91

Lymphatic, hematopoietic 119 0.73* 282 1.15* 130 1.04 94 1.04 625 623.10 1.00 0.04

Hodgkin lymphoma 5 0.94 4 0.53 2 0.58 2 0.92 13 18.55 0.70 -0.11

Non-Hodgkin lymphoma 51 0.72* 111 1.02 64 1.14 51 1.23 277 277.94 1.00 -0.02

Myeloma 24 0.83 41 0.94 17 0.77 9 0.57 91 110.56 0.82 -0.41

Leukemia 39 0.68* 126 1.47* 47 1.10 32 1.05 244 216.06 1.13 0.58

Acute lymphocytic 2 1.31 4 1.76 2 1.75 0 0.00 8 5.71 1.40 0.05

Chronic lymphocytic 9 0.39* 23 0.66* 12 0.69 12 0.99 56 87.34 0.64* -0.65

Acute non-lymphocytic 19 1.00 81 2.81* 23 1.58 14 1.32 137 73.05 1.88* 1.33

Chronic myeloid 4 0.52 12 1.05 7 1.22 5 1.20 28 29.03 0.96 -0.02

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 255,083 113,036 27,559 11,400 255,083

Person-years in interval 136,004 198,776 90,804 56,954 482,539

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 200,312 PYR and for male cancers on 282,226 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 151
All subsequent cancers 9,910 1.34* 1,230 1.57* 447 1.39* 113 1.12 11,700 8,580.71 1.36* 64.64

All excluding same site 7,197 1.18* 792 1.21* 292 1.08 73 0.86 8,354 7,134.70 1.17* 25.27

Buccal cavity, pharynx 496 2.51* 33 1.86* 6 0.89 1 0.49 536 224.15 2.39* 6.46

Lip 39 1.30 3 1.13 1 0.99 0 0.00 43 33.89 1.27 0.19

Tongue 104 2.67* 8 2.24 3 2.18 0 0.00 115 44.38 2.59* 1.46

Salivary gland 24 1.50 1 0.58 0 0.00 0 0.00 25 18.66 1.34 0.13

Mouth 148 2.87* 9 1.97 0 0.00 0 0.00 157 58.39 2.69* 2.04

Nasopharynx 12 1.57 1 1.53 0 0.00 0 0.00 13 8.62 1.51 0.09

Tonsil 61 3.27* 4 2.56 1 1.74 1 5.99 67 20.96 3.20* 0.95

Oropharynx 13 2.24* 2 3.92 0 0.00 0 0.00 15 6.55 2.29* 0.18

Hypopharynx 67 3.11* 5 2.74 1 1.53 0 0.00 73 24.22 3.01* 1.01

Digestive system 2,059 1.28* 239 1.42* 79 1.15 24 1.07 2,401 1,867.36 1.29* 11.06

Esophagus 220 2.51* 37 4.27* 9 2.57* 2 1.80 268 100.93 2.66* 3.46

Stomach 242 1.44* 20 1.20 4 0.60 2 0.92 268 193.91 1.38* 1.54

Small intestine 49 2.16* 0 0.00 0 0.00 0 0.00 49 26.60 1.84* 0.46

Colon 823 1.15* 115 1.49* 40 1.26 16 1.53 994 836.00 1.19* 3.27

Rectum, rectosigmoid junction 329 1.18* 25 0.91 8 0.74 2 0.59 364 321.70 1.13* 0.88

Anus, anal canal 9 0.63 2 1.36 2 3.30 1 5.02 14 16.46 0.85 -0.05

Liver 40 0.70* 8 1.31 3 1.17 0 0.00 51 66.58 0.77 -0.32

Gallbladder 14 0.70 0 0.00 1 1.15 0 0.00 15 23.32 0.64 -0.17

Bile ducts, other biliary 33 0.98 8 2.04 4 2.31 0 0.00 45 39.83 1.13 0.11

Pancreas 289 1.50* 21 1.04 7 0.84 1 0.36 318 224.60 1.42* 1.94

Respiratory system 3,026 2.22* 467 3.44* 165 3.05* 41 2.43* 3,699 1,568.35 2.36* 44.15

Nose, nasal cavity, ear 22 2.05* 2 1.88 0 0.00 0 0.00 24 12.39 1.94* 0.24

Larynx 275 2.93* 27 3.27* 10 3.30* 1 1.15 313 106.16 2.95* 4.29

Lung, bronchus 2,713 2.16* 438 3.47* 155 3.07* 40 2.53* 3,346 1,446.02 2.31* 39.37

Female breast 622 0.97 87 1.25* 31 1.08 13 1.39 753 746.86 1.01 0.31

Female genital system 210 0.74* 23 0.80 8 0.69 4 1.08 245 328.81 0.75* -4.18

Cervix uteri 27 0.91 3 1.17 0 0.00 0 0.00 30 33.36 0.90 -0.17

Corpus uteri 92 0.62* 8 0.54 4 0.68 2 1.07 106 171.83 0.62* -3.29

Ovary 79 0.95 9 1.02 3 0.83 2 1.71 93 97.15 0.96 -0.21

Vagina 5 1.20 1 2.18 0 0.00 0 0.00 6 4.88 1.23 0.06

Vulva 4 0.33* 2 1.37 1 1.52 0 0.00 7 14.51 0.48* -0.37

Male genital system 1,563 0.97 163 0.89 60 0.79 11 0.50* 1,797 1,890.32 0.95* -3.31

Prostate 1,548 0.97 162 0.89 60 0.79 11 0.51* 1,781 1,873.36 0.95* -3.27

Testis 0 0.00* 0 0.00 0 0.00 0 0.00 0 5.12 0.00* -0.18

Urinary system 957 1.60* 102 1.60* 38 1.44* 3 0.35 1,100 695.03 1.58* 8.39

Urinary bladder 646 1.56* 79 1.77* 32 1.73* 2 0.33 759 482.66 1.57* 5.73

Kidney parenchyma 257 1.76* 16 1.04 4 0.64 1 0.50 278 169.45 1.64* 2.25

Renal pelvis, other urinary 54 1.45* 7 1.86 2 1.30 0 0.00 63 42.93 1.47* 0.42

Ureter 13 1.05 3 2.41 0 0.00 0 0.00 16 14.23 1.12 0.04

Bone, joints 7 1.16 1 1.75 0 0.00 0 0.00 8 6.90 1.16 0.02

Soft tissue including heart 33 1.21 2 0.69 0 0.00 0 0.00 35 31.82 1.10 0.07

Kaposi sarcoma 5 0.68 1 1.41 0 0.00 0 0.00 6 8.40 0.71 -0.05

Melanoma of skin 114 0.75* 17 1.00 12 1.64 4 1.58 147 178.41 0.82* -0.65

Eye, orbit 5 0.49 0 0.00 1 2.47 0 0.00 6 11.75 0.51 -0.12

Brain, central nervous system 50 0.68* 8 1.11 3 1.05 0 0.00 61 84.06 0.73* -0.48

Thyroid 77 2.21* 5 1.49 2 1.52 0 0.00 84 40.00 2.10* 0.91

Lymphatic, hematopoietic 531 1.00 55 0.95 30 1.24 9 1.12 625 623.10 1.00 0.04

Hodgkin lymphoma 11 0.67 2 1.38 0 0.00 0 0.00 13 18.55 0.70 -0.11

Non-Hodgkin lymphoma 226 0.96 26 0.98 19 1.68* 6 1.58 277 277.94 1.00 -0.02

Myeloma 82 0.87 7 0.69 1 0.24 1 0.73 91 110.56 0.82 -0.41

Leukemia 212 1.14 20 1.01 10 1.23 2 0.75 244 216.06 1.13 0.58

Acute lymphocytic 8 1.62 0 0.00 0 0.00 0 0.00 8 5.71 1.40 0.05

Chronic lymphocytic 44 0.58* 9 1.14 3 0.94 0 0.00 56 87.34 0.64* -0.65

Acute non-lymphocytic 123 1.97* 7 1.03 5 1.74 2 2.07 137 73.05 1.88* 1.33

Chronic myeloid 23 0.93 3 1.12 2 1.79 0 0.00 28 29.03 0.96 -0.02

Lung and Bronchus

Both Sexes, Long-term Follow-up

Table 6.1.3: Risk of subsequent primary cancers after cancer of the lung or bronchus, both sexes,

long-term follow-up, SEER 1973-2000.

152 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LUNG AND BRONCHUS

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 255,083 11,400 4,649 1,578 255,083

Person-years in interval 425,585 37,950 14,495 4,508 482,539

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 200,312 PYR and for male cancers on 282,226 PYR.
Lung and Bronchus

Females

Table 6.1.4: Risk of subsequent primary cancers after cancer of the lung or bronchus,

females, SEER 1973-2000.

LUNG AND BRONCHUS

All subsequent cancers 721 1.13* 1,561 1.49* 951 1.77* 681 1.75* 3,914 2,615.88 1.50* 64.80

All excluding same site 556 1.01 1,093 1.21* 561 1.21* 409 1.23* 2,619 2,253.77 1.16* 18.23

Buccal cavity, pharynx 44 3.74* 54 2.83* 24 2.52* 10 1.53 132 46.90 2.81* 4.25

Lip 0 0.00 6 5.08* 0 0.00 0 0.00 6 3.00 2.00 0.15

Tongue 12 4.63* 15 3.55* 3 1.42 3 2.08 33 10.38 3.18* 1.13

Salivary gland 1 0.82 2 1.00 2 1.97 1 1.35 6 4.97 1.21 0.05

Mouth 14 3.48* 15 2.29* 8 2.44* 3 1.32 40 16.13 2.48* 1.19

Nasopharynx 1 2.07 2 2.60 0 0.00 0 0.00 3 1.87 1.60 0.06

Tonsil 8 7.21* 5 2.84 4 4.82* 0 0.00 17 4.20 4.04* 0.64

Oropharynx 0 0.00 3 5.93* 2 8.01 1 6.39 6 1.22 4.91* 0.24

Hypopharynx 3 3.47 2 1.43 3 4.43 2 4.72 10 3.37 2.97* 0.33

Digestive system 161 1.14 330 1.42* 161 1.33* 132 1.45* 784 586.84 1.34* 9.84

Esophagus 13 3.09* 23 3.34* 16 4.53* 12 4.66* 64 17.19 3.72* 2.34

Stomach 11 1.01 21 1.20 10 1.11 6 0.88 48 44.09 1.09 0.20

Small intestine 6 2.85* 6 1.70 3 1.62 0 0.00 15 8.90 1.69 0.30

Colon 68 0.98 150 1.30* 75 1.24 73 1.59* 366 291.40 1.26* 3.72

Rectum, rectosigmoid junction 26 1.15 51 1.38* 24 1.28 10 0.75 111 91.57 1.21 0.97

Rectum 15 1.02 31 1.29 19 1.55 7 0.79 72 59.92 1.20 0.60

Anus, anal canal 1 0.51 1 0.31 1 0.60 4 3.33 7 8.11 0.86 -0.06

Liver 3 0.94 5 0.95 8 2.88* 5 2.27 21 13.44 1.56 0.38

Gallbladder 2 0.64 4 0.79 1 0.38 1 0.53 8 12.70 0.63 -0.23

Bile ducts, other biliary 5 1.65 5 0.99 1 0.37 6 2.69 17 13.05 1.30 0.20

Pancreas 26 1.39 60 1.94* 21 1.29 13 1.05 120 78.40 1.53* 2.08

Respiratory system 176 1.95* 500 3.30* 407 5.16* 278 4.79* 1,361 378.40 3.60* 49.05

Nose, nasal cavity, ear 1 1.16 2 1.41 2 2.74 0 0.00 5 3.55 1.41 0.07

Larynx 10 3.33* 28 5.75* 15 6.28* 6 3.86* 59 11.82 4.99* 2.36

Lung, bronchus 165 1.92* 468 3.23* 390 5.16* 272 4.87* 1,295 362.12 3.58* 46.57

Female breast 143 0.78* 319 1.06 160 1.05 131 1.22* 753 746.86 1.01 0.31

Female genital system 41 0.49* 112 0.83* 57 0.87 35 0.79 245 328.81 0.75* -4.18

Cervix uteri 5 0.54 16 1.14 6 0.95 3 0.79 30 33.36 0.90 -0.17

Corpus uteri 16 0.36* 50 0.71* 26 0.76 14 0.62 106 171.83 0.62* -3.29

Ovary 16 0.66 42 1.06 21 1.06 14 1.03 93 97.15 0.96 -0.21

Vagina 2 1.65 1 0.51 2 2.01 1 1.40 6 4.88 1.23 0.06

Vulva 1 0.29 2 0.35 1 0.33 3 1.28 7 14.51 0.48* -0.37

Urinary system 69 2.29* 80 1.60* 54 2.05* 33 1.67* 236 126.33 1.87* 5.47

Urinary bladder 31 1.78* 46 1.58* 38 2.49* 25 2.15* 140 73.37 1.91* 3.33

Kidney parenchyma 33 3.23* 27 1.59* 15 1.69 5 0.76 80 42.68 1.87* 1.86

Renal pelvis, other urinary 5 2.02 7 1.71 1 0.47 3 1.89 16 10.28 1.56 0.29

Ureter 1 1.33 0 0.00 0 0.00 1 2.06 2 3.13 0.64 -0.06

Bone, joints 1 1.76 1 1.08 1 2.16 1 3.07 4 2.29 1.75 0.09

Soft tissue including heart 5 2.03 8 1.98 3 1.45 0 0.00 16 10.10 1.58 0.29

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -0.04

Melanoma of skin 9 0.74 15 0.75 11 1.07 7 0.93 42 50.04 0.84 -0.40

Eye, orbit 0 0.00 0 0.00 0 0.00 1 1.92 1 3.73 0.27 -0.14

Brain, central nervous system 3 0.45 13 1.17 4 0.71 2 0.52 22 27.25 0.81 -0.26

Thyroid 20 3.60* 9 1.01 5 1.17 3 1.05 37 21.58 1.71* 0.77

Lymphatic, hematopoietic 42 0.88 98 1.24* 42 1.01 32 1.02 214 199.21 1.07 0.74

Hodgkin lymphoma 3 2.09 1 0.43 1 0.88 1 1.30 6 5.65 1.06 0.02

Non-Hodgkin lymphoma 19 0.82 39 1.00 20 0.97 20 1.28 98 98.10 1.00 0.00

Myeloma 10 1.18 10 0.71 3 0.41 3 0.55 26 35.18 0.74 -0.46

Leukemia 10 0.69 48 2.01* 18 1.44 8 0.84 84 60.29 1.39* 1.18

Acute lymphocytic 0 0.00 4 5.70* 1 2.75 0 0.00 5 1.75 2.85 0.16

Chronic lymphocytic 1 0.18* 7 0.75 2 0.41 3 0.82 13 23.57 0.55* -0.53

Acute non-lymphocytic 7 1.36 33 3.87* 10 2.23* 5 1.45 55 21.59 2.55* 1.67

Chronic myeloid 0 0.00 3 0.93 3 1.77 0 0.00 6 8.18 0.73 -0.11

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 93,411 44,985 11,895 5,000 93,411

Person-years in interval 52,217 82,900 39,512 25,683 200,312

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 153
All subsequent cancers 1,739 1.07* 3,199 1.35* 1,739 1.49* 1,109 1.36* 7,786 5,964.83 1.31* 64.53

All excluding same site 1,490 1.13* 2,363 1.23* 1,134 1.18* 748 1.10* 5,735 4,880.93 1.17* 30.26

Buccal cavity, pharynx 125 2.41* 169 2.33* 80 2.44* 30 1.50* 404 177.25 2.28* 8.03

Lip 13 1.43 13 1.03 7 1.23 4 1.15 37 30.88 1.20 0.22

Tongue 30 3.05* 32 2.30* 12 1.90 8 2.04 82 34.00 2.41* 1.70

Salivary gland 11 2.98* 4 0.75 4 1.49 0 0.00 19 13.69 1.39 0.19

Mouth 32 2.55* 52 2.98* 27 3.50* 6 1.32 117 42.26 2.77* 2.65

Nasopharynx 1 0.49 7 2.51* 1 0.83 1 1.39 10 6.75 1.48 0.12

Tonsil 16 3.21* 21 3.03* 7 2.31 6 3.34* 50 16.76 2.98* 1.18

Oropharynx 3 1.93 3 1.37 2 2.03 1 1.66 9 5.33 1.69 0.13

Hypopharynx 13 2.11* 32 3.71* 14 3.65* 4 1.79 63 20.85 3.02* 1.49

Digestive system 429 1.21* 660 1.29* 318 1.28* 210 1.25* 1,617 1,280.52 1.26* 11.92

Esophagus 41 1.74* 73 2.17* 54 3.39* 36 3.36* 204 83.74 2.44* 4.26

Stomach 71 1.66* 97 1.62* 32 1.13 20 1.07 220 149.82 1.47* 2.49

Small intestine 15 3.16* 16 2.30* 3 0.86 0 0.00 34 17.70 1.92* 0.58

Colon 152 1.02 254 1.18* 124 1.16 98 1.33* 628 544.60 1.15* 2.96

Rectum, rectosigmoid junction 69 1.06 110 1.19 49 1.11 25 0.88 253 230.13 1.10 0.81

Anus, anal canal 2 0.86 3 0.90 1 0.62 1 0.93 7 8.35 0.84 -0.05

Liver 8 0.55 10 0.47* 6 0.58 6 0.82 30 53.14 0.56* -0.82

Gallbladder 3 1.00 1 0.24 3 1.48 0 0.00 7 10.62 0.66 -0.13

Bile ducts, other biliary 6 0.85 13 1.25 3 0.57 6 1.49 28 26.78 1.05 0.04

Pancreas 60 1.46* 81 1.39* 41 1.47* 16 0.85 198 146.19 1.35* 1.84

Respiratory system 320 0.96 957 2.00* 666 2.92* 395 2.66* 2,338 1,189.95 1.96* 40.68

Nose, nasal cavity, ear 5 1.99 9 2.54* 3 1.79 2 1.81 19 8.84 2.15* 0.36

Larynx 66 2.40* 102 2.63* 54 3.08* 32 3.02* 254 94.34 2.69* 5.66

Lung, bronchus 249 0.82* 836 1.92* 605 2.91* 361 2.64* 2,051 1,083.90 1.89* 34.27

Male breast 2 0.66 3 0.68 3 1.39 3 1.97 11 11.12 0.99 0.00

Male genital system 470 0.96 729 0.99 364 0.95 234 0.83* 1,797 1,890.32 0.95* -3.31

Prostate 469 0.97 717 0.98 362 0.96 233 0.83* 1,781 1,873.36 0.95* -3.27

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 5.12 0.00* -0.18

Urinary system 224 1.46* 375 1.67* 155 1.38* 110 1.39* 864 568.70 1.52* 10.46

Urinary bladder 138 1.26* 272 1.69* 121 1.50* 88 1.53* 619 409.29 1.51* 7.43

Kidney parenchyma 70 2.03* 86 1.71* 26 1.05 16 0.94 198 126.76 1.56* 2.52

Renal pelvis, other urinary 16 1.76* 17 1.30 8 1.27 6 1.42 47 32.65 1.44* 0.51

Ureter 5 1.63 5 1.13 2 0.93 2 1.41 14 11.09 1.26 0.10

Bone, joints 0 0.00 4 2.13 0 0.00 0 0.00 4 4.61 0.87 -0.02

Soft tissue including heart 6 1.01 6 0.70 5 1.20 2 0.67 19 21.71 0.88 -0.10

Kaposi sarcoma 2 0.91 3 0.99 0 0.00 1 1.11 6 7.57 0.79 -0.06

Melanoma of skin 24 0.72 30 0.60* 25 0.97 26 1.34 105 128.37 0.82* -0.83

Eye, orbit 2 0.89 3 0.93 0 0.00 0 0.00 5 8.02 0.62 -0.11

Brain, central nervous system 9 0.56 19 0.83 2 0.18* 9 1.27 39 56.81 0.69* -0.63

Thyroid 25 4.77* 14 1.87* 4 1.16 4 1.79 47 18.42 2.55* 1.01

Lymphatic, hematopoietic 77 0.67* 184 1.10 88 1.06 62 1.05 411 423.89 0.97 -0.46

Hodgkin lymphoma 2 0.52 3 0.57 1 0.43 1 0.71 7 12.90 0.54 -0.21

Non-Hodgkin lymphoma 32 0.67* 72 1.02 44 1.23 31 1.19 179 179.84 1.00 -0.03

Myeloma 14 0.68 31 1.04 14 0.95 6 0.58 65 75.38 0.86 -0.37

Leukemia 29 0.68* 78 1.27* 29 0.95 24 1.14 160 155.77 1.03 0.15

Acute lymphocytic 2 1.82 0 0.00 1 1.28 0 0.00 3 3.96 0.76 -0.03

Chronic lymphocytic 8 0.46* 16 0.63 10 0.80 9 1.06 43 63.77 0.67* -0.74

Acute non-lymphocytic 12 0.86 48 2.37* 13 1.29 9 1.25 82 51.46 1.59* 1.08

Chronic myeloid 4 0.70 9 1.10 4 0.99 5 1.73 22 20.84 1.06 0.04

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 161,672 68,051 15,664 6,400 161,672

Person-years in interval 83,787 115,876 51,293 31,270 282,226

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Lung and Bronchus

Males

Table 6.1.5: Risk of subsequent primary cancers after cancer of the lung or bronchus,

males, SEER 1973-2000.

154 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LUNG AND BRONCHUS

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Lung and Bronchus

Both Sexes, <50 Years of Age

Table 6.1.6: Risk of subsequent primary cancers after cancer of the lung or bronchus, both sexes,

<50 years of age, SEER 1973-2000.

LUNG AND BRONCHUS

All subsequent cancers 95 2.88* 185 2.71* 160 2.47* 258 1.97* 698 297.31 2.35* 70.25

All excluding same site 77 2.67* 111 1.88* 84 1.53* 150 1.37* 422 252.50 1.67* 29.72

Buccal cavity, pharynx 10 6.74* 7 2.39 11 4.16* 5 1.26 33 11.04 2.99* 3.85

Lip 0 0.00 1 3.95 0 0.00 0 0.00 1 0.97 1.03 0.01

Tongue 1 3.21 3 4.73 1 1.71 2 2.24 7 2.42 2.89* 0.80

Salivary gland 1 8.58 1 4.51 0 0.00 0 0.00 2 0.83 2.42 0.21

Mouth 4 10.15* 0 0.00 7 9.91* 1 0.98 12 2.90 4.13* 1.59

Nasopharynx 1 9.23 1 5.11 0 0.00 0 0.00 2 0.64 3.11 0.24

Tonsil 3 14.53* 0 0.00 2 5.53 1 2.05 6 1.46 4.10* 0.80

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.06

Hypopharynx 0 0.00 1 3.68 1 3.60 1 2.28 3 1.11 2.69 0.33

Digestive system 22 4.48* 30 2.85* 26 2.40* 56 2.45* 134 49.16 2.73* 14.87

Esophagus 5 12.87* 6 7.31* 6 7.21* 11 6.79* 28 3.66 7.65* 4.27

Stomach 6 10.29* 6 5.19* 0 0.00 6 2.87* 18 4.92 3.66* 2.29

Small intestine 2 15.39* 1 3.89 0 0.00 0 0.00 3 1.08 2.77 0.34

Colon 1 0.57 7 1.83 9 2.21* 28 3.04* 45 18.86 2.39* 4.58

Rectum, rectosigmoid junction 3 3.21 1 0.48 9 4.14* 2 0.46 15 9.53 1.57 0.96

Anus, anal canal 1 8.89 0 0.00 1 5.03 2 6.03 4 0.87 4.61* 0.55

Liver 1 3.79 0 0.00 0 0.00 0 0.00 1 2.41 0.41 -0.25

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.08

Bile ducts, other biliary 0 0.00 1 5.54 0 0.00 1 2.15 2 0.92 2.16 0.19

Pancreas 3 5.38* 8 6.53* 1 0.78 4 1.46 16 5.81 2.75* 1.79

Respiratory system 22 4.62* 80 7.64* 81 7.23* 114 4.84* 297 50.01 5.94* 43.30

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 1 5.11 1 0.53 1.88 0.08

Larynx 4 7.97* 6 5.63* 5 4.65* 5 2.68 20 4.51 4.44* 2.72

Lung, bronchus 18 4.33* 74 8.03* 76 7.62* 108 5.03* 276 44.82 6.16* 40.53

Female breast 8 1.06 12 0.78 9 0.73 20 1.14 49 52.96 0.93 -1.51

Female genital system 3 1.03 8 1.32 8 1.61 8 1.12 27 21.05 1.28 2.26

Cervix uteri 0 0.00 4 2.63 3 3.19 1 1.12 8 4.22 1.90 1.44

Corpus uteri 0 0.00 1 0.42 3 1.35 3 0.82 7 9.23 0.76 -0.85

Ovary 3 3.41 3 1.62 2 1.32 4 1.87 12 6.38 1.88 2.13

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.08

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.23

Male genital system 5 3.68* 8 2.19 4 0.67 21 0.80 38 37.24 1.02 0.25

Prostate 5 5.42* 8 2.66* 4 0.71 21 0.81 38 35.43 1.07 0.84

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 1.46 0.00 -0.47

Urinary system 12 6.25* 10 2.46* 11 2.60* 9 0.97 42 19.52 2.15* 3.94

Urinary bladder 2 2.02 4 1.86 7 2.97* 8 1.40 21 11.19 1.88* 1.72

Kidney parenchyma 10 11.84* 6 3.45* 4 2.37 1 0.32 21 7.44 2.82* 2.38

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.90 0.00 -0.16

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.04

Bone, joints 0 0.00 1 7.38 0 0.00 0 0.00 1 0.44 2.26 0.10

Soft tissue including heart 0 0.00 1 2.06 1 2.67 1 1.82 3 1.68 1.79 0.23

Kaposi sarcoma 1 1.97 2 2.75 0 0.00 1 3.25 4 1.95 2.05 0.36

Melanoma of skin 0 0.00 5 1.41 0 0.00 6 1.44 11 12.37 0.89 -0.24

Eye, orbit 0 0.00 1 6.93 0 0.00 0 0.00 1 0.54 1.86 0.08

Brain, central nervous system 3 4.31 2 1.53 0 0.00 2 1.28 7 4.62 1.51 0.42

Thyroid 2 2.36 1 0.65 1 0.95 1 0.83 5 4.66 1.07 0.06

Lymphatic, hematopoietic 4 1.37 12 2.11* 5 1.00 6 0.66 27 22.72 1.19 0.75

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.65 0.00 -0.29

Non-Hodgkin lymphoma 3 1.99 2 0.68 1 0.39 5 1.10 11 11.52 0.95 -0.09

Myeloma 0 0.00 1 1.49 2 2.84 1 0.68 4 3.17 1.26 0.15

Leukemia 1 1.29 9 5.85* 2 1.43 0 0.00 12 6.38 1.88 0.99

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.06

Chronic lymphocytic 0 0.00 0 0.00 1 2.00 0 0.00 1 2.20 0.45 -0.21

Acute non-lymphocytic 1 3.49 7 12.90* 1 2.19 0 0.00 9 2.17 4.14* 1.20

Chronic myeloid 0 0.00 1 3.50 0 0.00 0 0.00 1 1.04 0.96 -0.01

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 20,561 10,052 3,303 1,925 20,561

Person-years in interval 11,759 19,858 12,667 12,753 57,038

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 26,322 PYR and for male cancers on 30,716 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 155
All subsequent cancers 1,313 1.30* 2,777 1.54* 1,932 1.70* 1,328 1.43* 7,350 4,882.82 1.51* 82.84

All excluding same site 1,056 1.29* 1,939 1.32* 1,193 1.27* 854 1.10* 5,042 4,005.81 1.26* 34.79

Buccal cavity, pharynx 110 3.09* 157 2.77* 71 2.37* 29 1.46 367 142.02 2.58* 7.55

Lip 9 2.05 10 1.39 5 1.22 3 1.00 27 18.65 1.45 0.28

Tongue 28 3.87* 30 2.60* 13 2.12* 7 1.74 78 28.93 2.70* 1.65

Salivary gland 8 3.65* 3 0.79 2 0.86 1 0.51 14 10.25 1.37 0.13

Mouth 30 3.18* 53 3.55* 20 2.58* 8 1.58 111 37.19 2.98* 2.48

Nasopharynx 1 0.65 7 2.96* 1 0.87 0 0.00 9 5.77 1.56 0.11

Tonsil 14 3.57* 19 3.17* 8 2.75* 3 1.79 44 14.51 3.03* 0.99

Oropharynx 1 0.85 4 2.18 3 3.18 2 3.47 10 4.53 2.21* 0.18

Hypopharynx 11 2.56* 23 3.39* 13 3.75* 5 2.43 52 16.61 3.13* 1.19

Digestive system 283 1.38* 526 1.45* 338 1.46* 231 1.18* 1,378 995.94 1.38* 12.83

Esophagus 30 2.08* 64 2.69* 55 4.03* 35 3.42* 184 62.08 2.96* 4.09

Stomach 43 2.00* 54 1.46* 29 1.26 15 0.79 141 100.57 1.40* 1.36

Small intestine 12 3.86* 13 2.33* 6 1.70 0 0.00 31 15.19 2.04* 0.53

Colon 90 1.08 196 1.29* 139 1.37* 106 1.18 531 426.87 1.24* 3.50

Rectum, rectosigmoid junction 51 1.29 92 1.34* 48 1.16 28 0.88 219 181.52 1.21* 1.26

Anus, anal canal 1 0.46 2 0.53 1 0.45 3 1.79 7 9.90 0.71 -0.10

Liver 3 0.37 8 0.57 12 1.36 9 1.22 32 38.44 0.83 -0.22

Gallbladder 2 0.93 2 0.49 1 0.37 1 0.41 6 11.34 0.53 -0.18

Bile ducts, other biliary 2 0.54 11 1.61 2 0.43 10 2.16* 25 19.79 1.26 0.17

Pancreas 49 1.96* 79 1.79* 43 1.54* 23 0.97 194 120.93 1.60* 2.45

Respiratory system 316 1.49* 938 2.57* 801 3.67* 507 3.11* 2,562 957.37 2.68* 53.88

Nose, nasal cavity, ear 4 2.43 7 2.59* 4 2.58 1 0.82 16 7.13 2.25* 0.30

Larynx 55 3.06* 82 2.87* 55 3.65* 32 3.40* 224 71.00 3.16* 5.14

Lung, bronchus 257 1.34* 838 2.52* 739 3.68* 474 3.11* 2,308 877.00 2.63* 48.05

Female breast 79 0.83 186 1.07 114 1.10 98 1.25* 477 451.48 1.06 2.12

Female genital system 25 0.54* 69 0.85 39 0.85 24 0.74 157 205.97 0.76* -4.07

Cervix uteri 3 0.57 9 1.06 3 0.73 2 0.79 17 20.47 0.83 -0.29

Corpus uteri 12 0.47* 32 0.71 18 0.72 11 0.64 73 112.45 0.65* -3.28

Ovary 8 0.62 25 1.08 16 1.19 8 0.80 57 59.27 0.96 -0.19

Vagina 0 0.00 1 1.02 0 0.00 0 0.00 1 2.65 0.38 -0.14

Vulva 1 0.79 1 0.40 1 0.59 3 1.80 6 7.14 0.84 -0.09

Male genital system 215 1.10 386 1.04 250 0.95 187 0.83* 1,038 1,052.05 0.99 -0.79

Prostate 214 1.11 377 1.03 250 0.96 186 0.83* 1,027 1,042.91 0.98 -0.90

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 2.85 0.00 -0.16

Urinary system 147 1.89* 256 1.85* 148 1.65* 115 1.51* 666 382.08 1.74* 9.53

Urinary bladder 77 1.51* 166 1.81* 112 1.84* 88 1.65* 443 256.64 1.73* 6.26

Kidney parenchyma 59 2.63* 75 1.94* 29 1.24 19 1.05 182 102.51 1.78* 2.67

Renal pelvis, other urinary 11 2.37* 15 1.79* 7 1.29 8 1.77 41 22.92 1.79* 0.61

Ureter 2 1.35 1 0.37 2 1.11 3 2.00 8 7.52 1.06 0.02

Bone, joints 0 0.00 3 1.89 1 1.11 1 1.57 5 4.08 1.23 0.03

Soft tissue including heart 7 1.84 5 0.77 6 1.53 1 0.30 19 17.56 1.08 0.05

Kaposi sarcoma 1 1.06 1 0.71 0 0.00 0 0.00 2 3.62 0.55 -0.05

Melanoma of skin 23 1.00 24 0.60* 27 1.13 22 1.12 96 106.42 0.90 -0.35

Eye, orbit 0 0.00 2 0.75 0 0.00 1 0.86 3 6.96 0.43 -0.13

Brain, central nervous system 6 0.50 17 0.84 5 0.43 7 0.84 35 52.08 0.67* -0.57

Thyroid 31 5.02* 15 1.49 7 1.33 6 1.72 59 24.99 2.36* 1.14

Lymphatic, hematopoietic 56 0.81 152 1.24* 90 1.14 73 1.07 371 338.51 1.10 1.09

Hodgkin lymphoma 2 0.73 4 0.92 1 0.44 2 1.27 9 10.94 0.82 -0.07

Non-Hodgkin lymphoma 22 0.71 56 1.00 42 1.16 39 1.23 159 154.56 1.03 0.15

Myeloma 15 1.21 17 0.77 10 0.71 5 0.41* 47 60.67 0.77 -0.46

Leukemia 17 0.75 75 1.85* 37 1.40 27 1.18 156 112.33 1.39* 1.47

Acute lymphocytic 1 1.48 2 1.72 2 2.82 0 0.00 5 3.10 1.61 0.06

Chronic lymphocytic 1 0.10* 14 0.82 9 0.82 8 0.88 32 46.84 0.68* -0.50

Acute non-lymphocytic 10 1.39 49 3.70* 19 2.14* 13 1.61 91 37.41 2.43* 1.80

Chronic myeloid 2 0.65 6 1.13 5 1.47 5 1.63 18 14.85 1.21 0.11

Lung and Bronchus

Both Sexes, 50-69 Years of Age

Table 6.1.7: Risk of subsequent primary cancers after cancer of the lung or bronchus, both sexes,

50-69 years of age, SEER 1973-2000.

156 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LUNG AND BRONCHUS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 140,568 65,918 17,717 7,787 140,568

Person-years in interval 77,879 120,852 60,188 38,893 297,812

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 120,427 PYR and for male cancers on 177,384 PYR.
Lung and Bronchus

Both Sexes, ≥70 Years of Age

Table 6.1.8: Risk of subsequent primary cancers after cancer of the lung or bronchus, both sexes,

≥70 years of age, SEER 1973-2000.

LUNG AND BRONCHUS

All subsequent cancers 1,052 0.87* 1,798 1.17* 598 1.19* 204 1.38* 3,652 3,400.58 1.07* 19.69

All excluding same site 913 0.90* 1,406 1.08* 418 0.97 153 1.18* 2,890 2,876.39 1.00 1.07

Buccal cavity, pharynx 49 1.84* 59 1.84* 22 2.27* 6 2.19 136 71.09 1.91* 5.08

Lip 4 0.75 8 1.26 2 0.98 1 1.67 15 14.27 1.05 0.06

Tongue 13 2.65* 14 2.36* 1 0.58 2 4.34 30 13.02 2.30* 1.33

Salivary gland 3 1.15 2 0.60 4 3.33 0 0.00 9 7.58 1.19 0.11

Mouth 12 1.78 14 1.69 8 3.16* 0 0.00 34 18.29 1.86* 1.23

Nasopharynx 0 0.00 1 0.99 0 0.00 1 13.32 2 2.21 0.91 -0.02

Tonsil 7 3.56* 7 3.06* 1 1.67 2 14.77* 17 4.99 3.41* 0.94

Oropharynx 2 3.07 2 2.59 1 4.70 0 0.00 5 1.69 2.97 0.26

Hypopharynx 5 1.94 10 3.36* 3 3.93 0 0.00 18 6.49 2.77* 0.90

Digestive system 285 0.99 434 1.18* 115 0.91 55 1.36* 889 822.26 1.08* 5.23

Esophagus 19 1.47 26 1.64* 9 1.81 2 1.39 56 35.19 1.59* 1.63

Stomach 33 1.05 58 1.48* 13 0.98 5 1.14 109 88.42 1.23* 1.61

Small intestine 7 1.94 8 1.72 0 0.00 0 0.00 15 10.33 1.45 0.37

Colon 129 0.97 201 1.15 51 0.82 37 1.82* 418 390.27 1.07 2.17

Rectum, rectosigmoid junction 41 0.87 68 1.15 16 0.84 5 0.90 130 130.65 1.00 -0.05

Anus, anal canal 1 0.50 2 0.78 0 0.00 0 0.00 3 5.69 0.53 -0.21

Liver 7 0.76 7 0.60 2 0.53 2 1.85 18 25.73 0.70 -0.61

Gallbladder 3 0.76 3 0.58 3 1.67 0 0.00 9 11.50 0.78 -0.20

Bile ducts, other biliary 9 1.42 6 0.71 2 0.63 1 0.86 18 19.12 0.94 -0.09

Pancreas 34 1.00 54 1.23 18 1.20 2 0.41 108 97.85 1.10 0.79

Respiratory system 158 0.76* 439 1.71* 191 2.47* 52 2.63* 840 560.97 1.50* 21.85

Nose, nasal cavity, ear 2 1.21 4 1.88 1 1.37 0 0.00 7 4.74 1.48 0.18

Larynx 17 1.42 42 3.00* 9 2.37* 1 1.16 69 30.66 2.25* 3.00

Lung, bronchus 139 0.72* 392 1.64* 180 2.47* 51 2.73* 762 524.20 1.45* 18.62

Female breast 56 0.69* 121 1.07 37 0.99 13 1.15 227 242.41 0.94 -2.88

Female genital system 13 0.37* 35 0.74 10 0.66 3 0.66 61 101.79 0.60* -7.62

Cervix uteri 2 0.66 3 0.75 0 0.00 0 0.00 5 8.67 0.58 -0.68

Corpus uteri 4 0.23* 17 0.72 5 0.70 0 0.00 26 50.14 0.52* -4.51

Ovary 5 0.47 14 0.96 3 0.62 2 1.34 24 31.50 0.76 -1.40

Vagina 2 3.08 0 0.00 2 5.99 1 8.65 5 2.03 2.47 0.55

Vulva 0 0.00 1 0.33 0 0.00 0 0.00 1 6.76 0.15* -1.08

Male genital system 250 0.85* 335 0.92 110 0.97 26 0.86 721 801.02 0.90* -10.80

Prostate 250 0.86* 332 0.92 108 0.96 26 0.87 716 795.02 0.90* -10.66

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.81 0.00 -0.11

Urinary system 134 1.29* 189 1.43* 50 1.12 19 1.41 392 293.43 1.34* 7.72

Urinary bladder 90 1.19 148 1.54* 40 1.21 17 1.67 295 214.82 1.37* 6.28

Kidney parenchyma 34 1.59* 32 1.18 8 0.93 1 0.42 75 59.50 1.26 1.21

Renal pelvis, other urinary 10 1.46 9 1.05 2 0.71 1 1.18 22 19.11 1.15 0.23

Ureter 4 1.72 4 1.37 0 0.00 0 0.00 8 6.48 1.24 0.12

Bone, joints 1 1.16 1 0.93 0 0.00 0 0.00 2 2.37 0.84 -0.03

Soft tissue including heart 4 0.92 8 1.42 1 0.51 0 0.00 13 12.58 1.03 0.03

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 2.83 0.00 -0.22

Melanoma of skin 10 0.49* 16 0.60* 9 0.96 5 1.64 40 59.62 0.67* -1.54

Eye, orbit 2 1.30 0 0.00 0 0.00 0 0.00 2 4.26 0.47 -0.18

Brain, central nervous system 3 0.30* 13 1.03 1 0.26 2 1.97 19 27.36 0.69 -0.65

Thyroid 12 3.19* 7 1.46 1 0.71 0 0.00 20 10.36 1.93* 0.76

Lymphatic, hematopoietic 59 0.65* 118 1.00 35 0.86 15 1.17 227 261.88 0.87* -2.73

Hodgkin lymphoma 3 1.36 0 0.00 1 1.22 0 0.00 4 5.95 0.67 -0.15

Non-Hodgkin lymphoma 26 0.68* 53 1.05 21 1.20 7 1.29 107 111.86 0.96 -0.38

Myeloma 9 0.55 23 1.09 5 0.70 3 1.37 40 46.72 0.86 -0.53

Leukemia 21 0.62* 42 0.97 8 0.53 5 1.00 76 97.34 0.78* -1.67

Acute lymphocytic 1 1.26 2 1.98 0 0.00 0 0.00 3 2.27 1.32 0.06

Chronic lymphocytic 8 0.60 9 0.53 2 0.34 4 2.08 23 38.30 0.60* -1.20

Acute non-lymphocytic 8 0.69 25 1.67* 3 0.57 1 0.60 37 33.47 1.11 0.28

Chronic myeloid 2 0.45 5 0.86 2 0.94 0 0.00 9 13.14 0.68 -0.32

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 93,954 37,066 6,539 1,688 93,954

Person-years in interval 46,366 58,066 17,949 5,308 127,689

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 53,563 PYR and for male cancers on 74,127 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 157
All subsequent cancers 234 0.72* 324 1.27* 166 1.88* 80 1.86* 804 709.86 1.13* 21.03

All excluding same site 201 0.75* 258 1.22* 102 1.39* 53 1.46* 614 589.67 1.04 5.44

Buccal cavity, pharynx 10 1.08 19 2.84* 7 3.34* 4 4.32* 40 18.95 2.11* 4.70

Lip 0 0.00 2 2.21 1 3.50 1 8.01 4 2.65 1.51 0.30

Tongue 4 2.16 3 2.20 1 2.31 1 5.19 9 3.84 2.35* 1.15

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 1.52 0.00 -0.34

Mouth 3 1.23 8 4.47* 3 5.35* 0 0.00 14 5.04 2.78* 2.00

Nasopharynx 0 0.00 1 3.76 0 0.00 0 0.00 1 0.74 1.35 0.06

Tonsil 0 0.00 1 1.52 0 0.00 1 11.98 2 1.85 1.08 0.03

Oropharynx 0 0.00 1 5.06 2 32.60* 0 0.00 3 0.56 5.36* 0.55

Hypopharynx 1 0.98 2 2.79 0 0.00 1 11.28 4 2.04 1.96 0.44

Digestive system 47 0.68* 68 1.29 36 1.96* 21 2.30* 172 149.12 1.15 5.11

Esophagus 6 1.57 5 1.77 6 6.45* 1 2.30 18 8.00 2.25* 2.23

Stomach 5 0.71 7 1.36 6 3.52* 1 1.23 19 14.66 1.30 0.97

Small intestine 0 0.00 2 2.52 0 0.00 0 0.00 2 2.21 0.90 -0.05

Colon 19 0.63* 24 1.02 11 1.31 12 2.81* 66 66.54 0.99 -0.12

Rectum, rectosigmoid junction 7 0.56 13 1.39 8 2.55* 3 2.03 31 26.42 1.17 1.02

Anus, anal canal 0 0.00 0 0.00 0 0.00 1 10.71 1 1.49 0.67 -0.11

Liver 1 0.42 2 1.08 1 1.60 0 0.00 4 5.18 0.77 -0.26

Gallbladder 0 0.00 0 0.00 1 4.03 0 0.00 1 1.93 0.52 -0.21

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 3.08 0.00 -0.69

Pancreas 8 0.96 13 2.02* 3 1.33 2 1.76 26 18.14 1.43 1.76

Respiratory system 46 0.75 78 1.69* 72 4.61* 31 4.23* 227 130.37 1.74* 21.59

Nose, nasal cavity, ear 2 4.14 0 0.00 0 0.00 0 0.00 2 1.03 1.95 0.22

Larynx 11 2.50* 12 3.89* 8 8.44* 4 9.95* 35 8.83 3.96* 5.85

Lung, bronchus 33 0.59* 66 1.55* 64 4.41* 27 3.94* 190 120.20 1.58* 15.59

Female breast 9 0.28* 23 0.76 8 0.73 7 1.27 47 79.25 0.59* -15.07

Female genital system 2 0.13* 7 0.52 4 0.85 4 1.76 17 35.32 0.48* -8.56

Cervix uteri 0 0.00 3 2.22 0 0.00 1 5.39 4 3.55 1.13 0.21

Corpus uteri 0 0.00* 2 0.28 3 1.20 1 0.85 6 18.85 0.32* -6.00

Ovary 2 0.46 2 0.51 1 0.71 0 0.00 5 10.35 0.48 -2.50

Vagina 0 0.00 0 0.00 0 0.00 1 28.59 1 0.48 2.09 0.24

Vulva 0 0.00 0 0.00 0 0.00 1 8.68 1 1.38 0.72 -0.18

Male genital system 52 0.81 39 0.81 10 0.60 3 0.37 104 137.38 0.76* -14.29

Prostate 52 0.81 38 0.80 10 0.60 3 0.37 103 136.05 0.76* -14.15

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.47 0.00 -0.20

Urinary system 30 1.17 23 1.19 14 2.10* 5 1.53 72 54.83 1.31* 3.84

Urinary bladder 15 0.86 18 1.38 11 2.43* 5 2.26 49 37.19 1.32 2.64

Kidney parenchyma 11 1.67 4 0.79 2 1.15 0 0.00 17 14.25 1.19 0.61

Renal pelvis, other urinary 4 2.51 1 0.84 1 2.45 0 0.00 6 3.39 1.77 0.58

Ureter 1 1.90 0 0.00 1 7.47 0 0.00 2 1.12 1.79 0.20

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.13

Soft tissue including heart 2 1.66 2 2.12 0 0.00 0 0.00 4 2.63 1.52 0.31

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.69 0.00 -0.15

Melanoma of skin 7 1.00 2 0.35 3 1.53 1 1.02 13 15.63 0.83 -0.59

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 1.03 0.00 -0.23

Brain, central nervous system 0 0.00 4 1.50 0 0.00 0 0.00 4 7.46 0.54 -0.77

Thyroid 7 4.04* 3 2.11 2 4.34 0 0.00 12 3.83 3.13* 1.82

Lymphatic, hematopoietic 16 0.69 53 2.91* 8 1.25 3 0.93 80 51.05 1.57* 6.47

Hodgkin lymphoma 2 2.54 0 0.00 0 0.00 0 0.00 2 1.63 1.23 0.08

Non-Hodgkin lymphoma 5 0.48 16 1.90* 2 0.67 2 1.30 25 23.38 1.07 0.36

Myeloma 1 0.25 3 0.95 0 0.00 0 0.00 4 8.88 0.45 -1.09

Leukemia 8 1.01 34 5.60* 6 2.82* 1 0.94 49 17.16 2.86* 7.11

Acute lymphocytic 1 4.57 3 17.59* 1 17.02 0 0.00 5 0.48 10.49* 1.01

Chronic lymphocytic 1 0.31 0 0.00 1 1.16 0 0.00 2 7.01 0.29 -1.12

Acute non-lymphocytic 5 1.90 30 14.62* 3 4.10 0 0.00 38 5.79 6.57* 7.20

Chronic myeloid 0 0.00 1 1.23 1 3.55 1 6.99 3 2.29 1.31 0.16

Lung and Bronchus

Small Cell Carcinoma, Both Sexes

Table 6.1.9: Risk of subsequent primary cancers after small cell carcinoma of the lung or bronchus,

both sexes, SEER 1973-2000.

158 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LUNG AND BRONCHUS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 39,737 15,328 1,695 528 39,737

Person-years in interval 21,197 16,283 5,046 2,243 44,769

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 21,407 PYR and for male cancers on 23,362 PYR.
Lung and Bronchus

Non-small Cell Carcinoma, Both Sexes

Table 6.1.10: Risk of subsequent primary cancers after non-small cell carcinoma of the lung or bronchus,

both sexes, SEER 1973-2000.

LUNG AND BRONCHUS

All subsequent cancers 2,226 1.15* 4,436 1.40* 2,524 1.56* 1,710 1.47* 10,896 7,870.85 1.38* 69.10

All excluding same site 1,845 1.15* 3,198 1.22* 1,593 1.18* 1,104 1.13* 7,740 6,545.03 1.18* 27.30

Buccal cavity, pharynx 159 2.92* 204 2.40* 97 2.41* 36 1.41 496 205.19 2.42* 6.64

Lip 13 1.53 17 1.32 6 0.99 3 0.78 39 31.24 1.25 0.18

Tongue 38 3.59* 44 2.62* 14 1.75 10 1.93 106 40.54 2.61* 1.50

Salivary gland 12 2.85* 6 0.88 6 1.71 1 0.39 25 17.14 1.46 0.18

Mouth 43 3.04* 59 2.66* 32 3.07* 9 1.37 143 53.35 2.68* 2.05

Nasopharynx 2 0.93 8 2.43* 1 0.67 1 1.07 12 7.88 1.52 0.09

Tonsil 24 4.63* 25 3.11* 11 3.00* 5 2.25 65 19.12 3.40* 1.05

Oropharynx 3 1.88 5 2.00 2 1.70 2 2.74 12 5.99 2.00* 0.14

Hypopharynx 15 2.50* 32 3.44* 17 3.96* 5 1.94 69 22.18 3.11* 1.07

Digestive system 543 1.27* 922 1.34* 443 1.26* 321 1.28* 2,229 1,718.24 1.30* 11.67

Esophagus 48 2.01* 91 2.42* 64 3.46* 47 3.66* 250 92.93 2.69* 3.59

Stomach 77 1.65* 111 1.53* 36 1.01 25 1.01 249 179.25 1.39* 1.59

Small intestine 21 3.58* 20 2.06* 6 1.19 0 0.00* 47 24.38 1.93* 0.52

Colon 201 1.07 380 1.24* 188 1.18* 159 1.38* 928 769.46 1.21* 3.62

Rectum, rectosigmoid junction 88 1.17 148 1.23* 65 1.09 32 0.79 333 295.28 1.13* 0.86

Anus, anal canal 3 0.83 4 0.66 2 0.65 4 1.83 13 14.96 0.87 -0.04

Liver 10 0.66 13 0.53* 13 1.04 11 1.19 47 61.39 0.77 -0.33

Gallbladder 5 0.95 5 0.58 3 0.68 1 0.32 14 21.39 0.65 -0.17

Bile ducts, other biliary 11 1.26 18 1.25 4 0.52 12 1.99* 45 36.75 1.22 0.19

Pancreas 78 1.52* 128 1.54* 59 1.40* 27 0.89 292 206.46 1.41* 1.95

Respiratory system 450 1.24* 1,379 2.36* 1,001 3.44* 642 3.22* 3,472 1,437.99 2.41* 46.46

Nose, nasal cavity, ear 4 1.38 11 2.39* 5 2.19 2 1.26 22 11.37 1.94* 0.24

Larynx 65 2.49* 118 2.91* 61 3.21* 34 2.90* 278 97.33 2.86* 4.13

Lung, bronchus 381 1.14* 1,238 2.30* 931 3.46* 606 3.27* 3,156 1,325.82 2.38* 41.81

Female breast 134 0.88 296 1.09 152 1.07 124 1.22* 706 667.61 1.06 2.15

Female genital system 39 0.57* 105 0.86 53 0.87 31 0.74 228 293.48 0.78* -3.66

Cervix uteri 5 0.66 13 1.03 6 1.02 2 0.55 26 29.81 0.87 -0.21

Corpus uteri 16 0.44* 48 0.75* 23 0.72 13 0.61 100 152.98 0.65* -2.96

Ovary 14 0.70 40 1.12 20 1.09 14 1.08 88 86.80 1.01 0.07

Vagina 2 1.97 1 0.56 2 2.16 0 0.00 5 4.41 1.13 0.03

Vulva 1 0.35 2 0.39 1 0.35 2 0.90 6 13.12 0.46* -0.40

Male genital system 418 0.98 690 1.00 354 0.97 231 0.84* 1,693 1,752.94 0.97 -2.32

Prostate 417 0.99 679 1.00 352 0.97 230 0.85* 1,678 1,737.31 0.97 -2.29

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 4.66 0.00* -0.18

Urinary system 263 1.66* 432 1.69* 195 1.48* 138 1.45* 1,028 640.20 1.61* 8.86

Urinary bladder 154 1.40* 300 1.70* 148 1.62* 108 1.61* 710 445.47 1.59* 6.04

Kidney parenchyma 92 2.41* 109 1.75* 39 1.22 21 0.92 261 155.20 1.68* 2.42

Renal pelvis, other urinary 17 1.71 23 1.44 8 1.00 9 1.60 57 39.54 1.44* 0.40

Ureter 5 1.52 5 0.94 1 0.37 3 1.63 14 13.11 1.07 0.02

Bone, joints 1 0.62 5 1.93 1 0.80 1 1.19 8 6.30 1.27 0.04

Soft tissue including heart 9 1.25 12 1.03 8 1.35 2 0.46 31 29.18 1.06 0.04

Kaposi sarcoma 2 0.97 3 0.96 0 0.00 1 0.98 6 7.71 0.78 -0.04

Melanoma of skin 26 0.68* 43 0.67* 33 0.97 32 1.24 134 162.78 0.82* -0.66

Eye, orbit 2 0.74 3 0.69 0 0.00 1 0.68 6 10.73 0.56 -0.11

Brain, central nervous system 12 0.63 28 0.89 6 0.39* 11 1.04 57 76.61 0.74* -0.45

Thyroid 38 4.19* 20 1.34 7 0.96 7 1.43 72 36.17 1.99* 0.82

Lymphatic, hematopoietic 103 0.74* 229 1.00 122 1.03 91 1.05 545 572.06 0.95 -0.62

Hodgkin lymphoma 3 0.66 4 0.57 2 0.61 2 0.95 11 16.92 0.65 -0.14

Non-Hodgkin lymphoma 46 0.76 95 0.94 62 1.16 49 1.22 252 254.56 0.99 -0.06

Myeloma 23 0.92 38 0.94 17 0.81 9 0.59 87 101.68 0.86 -0.34

Leukemia 31 0.63* 92 1.16 41 1.01 31 1.05 195 198.90 0.98 -0.09

Acute lymphocytic 1 0.77 1 0.47 1 0.92 0 0.00 3 5.24 0.57 -0.05

Chronic lymphocytic 8 0.40* 23 0.71 11 0.67 12 1.03 54 80.33 0.67* -0.60

Acute non-lymphocytic 14 0.85 51 1.91* 20 1.44 14 1.37 99 67.27 1.47* 0.72

Chronic myeloid 4 0.60 11 1.04 6 1.10 4 0.99 25 26.74 0.93 -0.04

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 215,346 97,708 25,864 10,872 215,346

Person-years in interval 114,808 182,493 85,759 54,710 437,770

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 178,906 PYR and for male cancers on 258,864 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 159
All subsequent cancers 126 0.71* 213 1.41* 92 1.93* 52 2.71* 483 394.10 1.23* 33.73

All excluding same site 111 0.76* 166 1.32* 52 1.31 29 1.80* 358 326.93 1.10 11.79

Buccal cavity, pharynx 6 1.15 15 3.72* 6 5.22* 2 4.62 29 10.84 2.68* 6.89

Lip 0 0.00 1 1.90 1 6.61 0 0.00 2 1.47 1.36 0.20

Tongue 3 2.86 2 2.41 1 4.15 0 0.00 6 2.21 2.71 1.44

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.85 0.00 -0.32

Mouth 1 0.72 7 6.50* 2 6.53 0 0.00 10 2.89 3.47* 2.70

Nasopharynx 0 0.00 1 6.14 0 0.00 0 0.00 1 0.43 2.32 0.22

Tonsil 0 0.00 1 2.47 0 0.00 1 24.43 2 1.08 1.84 0.35

Oropharynx 0 0.00 1 8.28 2 58.52* 0 0.00 3 0.32 9.24* 1.02

Hypopharynx 1 1.73 1 2.31 0 0.00 1 23.79 3 1.17 2.56 0.69

Digestive system 26 0.70 40 1.30 20 2.08* 10 2.58* 96 81.48 1.18 5.51

Esophagus 2 0.94 4 2.38 4 8.02* 1 5.15 11 4.50 2.45* 2.47

Stomach 3 0.79 5 1.68 5 5.65* 0 0.00 13 8.01 1.62 1.89

Small intestine 0 0.00 2 4.21 0 0.00 0 0.00 2 1.23 1.62 0.29

Colon 8 0.50* 12 0.88 4 0.92 7 3.92* 31 35.95 0.86 -1.88

Rectum, rectosigmoid junction 5 0.74 8 1.45 5 3.00 1 1.52 19 14.63 1.30 1.66

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.85 0.00 -0.32

Liver 0 0.00 1 0.91 0 0.00 0 0.00 1 2.88 0.35 -0.71

Gallbladder 0 0.00 0 0.00 1 7.79 0 0.00 1 1.04 0.96 -0.01

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.67 0.00 -0.63

Pancreas 7 1.55 8 2.12 1 0.85 0 0.00 16 9.93 1.61 2.30

Respiratory system 24 0.71 54 1.96* 43 5.07* 25 7.54* 146 72.98 2.00* 27.70

Nose, nasal cavity, ear 1 3.74 0 0.00 0 0.00 0 0.00 1 0.58 1.73 0.16

Larynx 8 3.22* 7 3.76* 3 5.76* 2 10.58* 20 5.06 3.95* 5.67

Lung, bronchus 15 0.49* 47 1.85* 40 5.08* 23 7.44* 125 67.17 1.86* 21.94

Female breast 7 0.38* 18 0.98 3 0.49 6 2.43 34 45.21 0.75 -8.94

Female genital system 2 0.24* 3 0.37 2 0.76 2 1.97 9 20.29 0.44* -9.01

Cervix uteri 0 0.00 1 1.19 0 0.00 1 12.80 2 2.08 0.96 -0.07

Corpus uteri 0 0.00* 2 0.46 2 1.42 1 1.84 5 10.89 0.46 -4.70

Ovary 2 0.83 0 0.00 0 0.00 0 0.00 2 5.91 0.34 -3.12

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.21

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.75 0.00 -0.60

Male genital system 28 0.82 24 0.85 3 0.33* 0 0.00* 55 74.79 0.74* -14.32

Prostate 28 0.83 23 0.82 3 0.34* 0 0.00 54 74.02 0.73* -14.48

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.21

Urinary system 16 1.16 18 1.59 8 2.23 3 2.04 45 30.22 1.49* 5.61

Urinary bladder 8 0.86 13 1.71 7 2.90* 3 3.02 31 20.34 1.52* 4.05

Kidney parenchyma 6 1.66 4 1.30 1 1.04 0 0.00 11 8.04 1.37 1.12

Renal pelvis, other urinary 2 2.32 1 1.45 0 0.00 0 0.00 3 1.85 1.62 0.44

Ureter 1 3.54 0 0.00 0 0.00 0 0.00 1 0.60 1.66 0.15

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.13

Soft tissue including heart 0 0.00 1 1.77 0 0.00 0 0.00 1 1.48 0.68 -0.18

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.15

Melanoma of skin 4 1.03 1 0.29 3 2.67 0 0.00 8 8.99 0.89 -0.38

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.22

Brain, central nervous system 0 0.00 4 2.48 0 0.00 0 0.00 4 4.25 0.94 -0.09

Thyroid 4 3.99* 2 2.24 0 0.00 0 0.00 6 2.26 2.66 1.42

Lymphatic, hematopoietic 6 0.48 32 2.98* 4 1.16 3 2.10 45 28.18 1.60* 6.38

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.94 0.00 -0.36

Non-Hodgkin lymphoma 2 0.35 10 2.00 1 0.61 2 2.87 15 12.98 1.16 0.77

Myeloma 1 0.46 0 0.00 0 0.00 0 0.00 1 4.87 0.21 -1.47

Leukemia 3 0.71 22 6.21* 3 2.66 1 2.16 29 9.39 3.09* 7.44

Acute lymphocytic 0 0.00 1 9.83 1 31.50 0 0.00 2 0.27 7.51 0.66

Chronic lymphocytic 1 0.57 0 0.00 0 0.00 0 0.00 1 3.84 0.26 -1.08

Acute non-lymphocytic 1 0.71 21 17.55* 2 5.17 0 0.00 24 3.16 7.60* 7.91

Chronic myeloid 0 0.00 0 0.00 0 0.00 1 16.24 1 1.25 0.80 -0.10

Lung and Bronchus

Small Cell Carcinoma, Both Sexes, Radiotherapy

Table 6.1.11: Risk of subsequent primary cancers after small cell carcinoma of the lung or bronchus, both sexes,

with initial radiotherapy, SEER 1973-2000.

160 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LUNG AND BRONCHUS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 22,199 9,235 1,017 274 22,199

Person-years in interval 12,306 10,118 2,867 1,068 26,359

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 12,540 PYR and for male cancers on 13,819 PYR.
Lung and Bronchus

Small Cell Carcinoma, Both Sexes, No Radiotherapy

Table 6.1.12: Risk of subsequent primary cancers after small cell carcinoma of the lung or bronchus, both sexes,

without initial radiotherapy, SEER 1973-2000.

LUNG AND BRONCHUS

All subsequent cancers 108 0.73* 111 1.07 74 1.83* 28 1.17 321 315.76 1.02 2.84

All excluding same site 90 0.73* 92 1.07 50 1.48* 24 1.19 256 262.73 0.97 -3.66

Buccal cavity, pharynx 4 1.00 4 1.50 1 1.06 2 4.05 11 8.12 1.36 1.57

Lip 0 0.00 1 2.63 0 0.00 1 14.80 2 1.18 1.70 0.45

Tongue 1 1.25 1 1.87 0 0.00 1 9.95 3 1.63 1.84 0.75

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.67 0.00 -0.36

Mouth 2 1.89 1 1.41 1 3.93 0 0.00 4 2.16 1.85 1.00

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.17

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.76 0.00 -0.41

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.13

Hypopharynx 0 0.00 1 3.53 0 0.00 0 0.00 1 0.86 1.16 0.07

Digestive system 21 0.66 28 1.27 16 1.83* 11 2.10* 76 67.64 1.12 4.54

Esophagus 4 2.36 1 0.88 2 4.64 0 0.00 7 3.50 2.00 1.90

Stomach 2 0.63 2 0.93 1 1.22 1 2.07 6 6.66 0.90 -0.36

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.98 0.00 -0.53

Colon 11 0.78 12 1.20 7 1.73 5 2.02 35 30.59 1.14 2.40

Rectum, rectosigmoid junction 2 0.35 5 1.29 3 2.04 2 2.43 12 11.79 1.02 0.11

Anus, anal canal 0 0.00 0 0.00 0 0.00 1 19.63 1 0.65 1.55 0.19

Liver 1 0.91 1 1.34 1 3.44 0 0.00 3 2.31 1.30 0.38

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.89 0.00 -0.48

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.41 0.00 -0.77

Pancreas 1 0.26 5 1.87 2 1.87 2 3.04 10 8.21 1.22 0.97

Respiratory system 22 0.80 24 1.28 29 4.06* 6 1.49 81 57.39 1.41* 12.82

Nose, nasal cavity, ear 1 4.64 0 0.00 0 0.00 0 0.00 1 0.45 2.22 0.30

Larynx 3 1.57 5 4.09* 5 11.71* 2 9.39* 15 3.77 3.98* 6.10

Lung, bronchus 18 0.71 19 1.10 24 3.61* 4 1.06 65 53.03 1.23 6.50

Female breast 2 0.14* 5 0.42* 5 1.03 1 0.33 13 34.05 0.38* -23.73

Female genital system 0 0.00* 4 0.76 2 0.96 2 1.60 8 15.03 0.53 -7.93

Cervix uteri 0 0.00 2 3.88 0 0.00 0 0.00 2 1.47 1.36 0.60

Corpus uteri 0 0.00 0 0.00 1 0.92 0 0.00 1 7.96 0.13* -7.85

Ovary 0 0.00 2 1.30 1 1.60 0 0.00 3 4.44 0.68 -1.62

Vagina 0 0.00 0 0.00 0 0.00 1 48.05 1 0.21 4.66 0.89

Vulva 0 0.00 0 0.00 0 0.00 1 14.68 1 0.64 1.57 0.41

Male genital system 24 0.79 15 0.76 7 0.91 3 0.67 49 62.59 0.78 -14.24

Prostate 24 0.79 15 0.76 7 0.91 3 0.68 49 62.03 0.79 -13.66

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.18

Urinary system 14 1.19 5 0.63 6 1.95 2 1.12 27 24.61 1.10 1.30

Urinary bladder 7 0.86 5 0.92 4 1.90 2 1.63 18 16.85 1.07 0.62

Kidney parenchyma 5 1.69 0 0.00 1 1.28 0 0.00 6 6.21 0.97 -0.12

Renal pelvis, other urinary 2 2.73 0 0.00 1 5.14 0 0.00 3 1.54 1.95 0.79

Ureter 0 0.00 0 0.00 1 15.54 0 0.00 1 0.51 1.95 0.27

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.14

Soft tissue including heart 2 3.70 1 2.65 0 0.00 0 0.00 3 1.15 2.60 1.00

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.16

Melanoma of skin 3 0.96 1 0.46 0 0.00 1 2.01 5 6.63 0.75 -0.89

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.24

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 3.21 0.00 -1.74

Thyroid 3 4.10 1 1.88 2 10.14* 0 0.00 6 1.57 3.81* 2.40

Lymphatic, hematopoietic 10 0.94 21 2.81* 4 1.34 0 0.00 35 22.87 1.53* 6.59

Hodgkin lymphoma 2 5.92 0 0.00 0 0.00 0 0.00 2 0.69 2.91 0.71

Non-Hodgkin lymphoma 3 0.63 6 1.76 1 0.73 0 0.00 10 10.40 0.96 -0.22

Myeloma 0 0.00 3 2.30 0 0.00 0 0.00 3 4.01 0.75 -0.55

Leukemia 5 1.37 12 4.74* 3 3.00 0 0.00 20 7.78 2.57* 6.64

Acute lymphocytic 1 10.10 2 29.06* 0 0.00 0 0.00 3 0.21 14.28* 1.52

Chronic lymphocytic 0 0.00 0 0.00 1 2.47 0 0.00 1 3.18 0.31 -1.18

Acute non-lymphocytic 4 3.28 9 10.52* 1 2.91 0 0.00 14 2.63 5.33* 6.18

Chronic myeloid 0 0.00 1 2.98 1 7.54 0 0.00 2 1.03 1.94 0.53

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 17,538 6,093 678 254 17,538

Person-years in interval 8,891 6,166 2,179 1,175 18,410

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 8,867 PYR and for male cancers on 9,543 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 161
All subsequent cancers 979 1.04 1,287 1.31* 514 1.73* 264 1.78* 3,044 2,369.95 1.28* 48.20

All excluding same site 887 1.14* 1,015 1.25* 336 1.36* 164 1.32* 2,402 1,959.92 1.23* 31.61

Buccal cavity, pharynx 76 2.77* 61 2.25* 23 2.98* 5 1.41 165 65.89 2.50* 7.09

Lip 3 0.71 5 1.25 0 0.00 0 0.00 8 9.79 0.82 -0.13

Tongue 19 3.54* 9 1.67 6 3.84* 0 0.00 34 13.03 2.61* 1.50

Salivary gland 7 3.42* 2 0.94 0 0.00 0 0.00 9 5.15 1.75 0.28

Mouth 14 1.97* 20 2.85* 6 3.03* 3 3.37 43 17.01 2.53* 1.86

Nasopharynx 2 1.81 4 3.67 0 0.00 0 0.00 6 2.64 2.27 0.24

Tonsil 16 5.97* 9 3.42* 4 5.35* 0 0.00 29 6.40 4.53* 1.62

Oropharynx 2 2.44 2 2.46 1 4.29 0 0.00 5 1.97 2.54 0.22

Hypopharynx 8 2.58* 9 2.96* 5 5.86* 2 5.23 24 7.37 3.25* 1.19

Digestive system 264 1.28* 278 1.31* 116 1.85* 51 1.68* 709 512.12 1.38* 14.08

Esophagus 23 1.90* 28 2.29* 22 6.13* 19 10.77* 92 29.70 3.10* 4.45

Stomach 41 1.80* 36 1.58* 7 1.08 5 1.66 89 55.04 1.62* 2.43

Small intestine 10 3.50* 9 2.95* 1 1.06 0 0.00 20 7.33 2.73* 0.91

Colon 93 1.04 109 1.17 58 2.09* 17 1.26 277 224.27 1.24* 3.77

Rectum, rectosigmoid junction 40 1.09 45 1.21 10 0.93 2 0.39 97 89.63 1.08 0.53

Anus, anal canal 0 0.00 0 0.00 1 1.76 0 0.00 1 4.44 0.23 -0.25

Liver 2 0.26* 5 0.63 5 2.06 1 0.81 13 19.15 0.68 -0.44

Gallbladder 2 0.83 2 0.79 1 1.37 1 2.94 6 6.01 1.00 0.00

Bile ducts, other biliary 6 1.46 5 1.14 3 2.22 0 0.00 14 10.55 1.33 0.25

Pancreas 46 1.86* 39 1.53* 7 0.93 5 1.37 97 61.38 1.58* 2.55

Respiratory system 124 0.69* 325 1.76* 199 3.65* 104 3.92* 752 446.72 1.68* 21.83

Nose, nasal cavity, ear 3 2.11 5 3.46* 1 2.36 0 0.00 9 3.49 2.58* 0.39

Larynx 29 2.16* 44 3.33* 18 4.82* 4 2.33 95 32.11 2.96* 4.50

Lung, bronchus 92 0.56* 272 1.60* 178 3.55* 100 4.08* 642 410.03 1.57* 16.59

Female breast 59 0.87 72 0.94 24 0.99 15 1.27 170 180.92 0.94 -2.15

Female genital system 17 0.55* 27 0.79 8 0.77 7 1.44 59 80.31 0.73* -4.20

Cervix uteri 3 0.85 5 1.35 1 0.95 2 4.50 11 8.74 1.26 0.45

Corpus uteri 4 0.25* 9 0.51* 6 1.11 4 1.58 23 41.91 0.55* -3.73

Ovary 8 0.89 10 1.00 0 0.00 1 0.68 19 23.52 0.81 -0.89

Vagina 1 2.25 1 2.02 1 6.59 0 0.00 3 1.16 2.58 0.36

Vulva 0 0.00 1 0.71 0 0.00 0 0.00 1 3.29 0.30 -0.45

Male genital system 200 0.94 219 0.97 57 0.81 32 0.85 508 545.76 0.93 -4.24

Prostate 199 0.94 216 0.97 57 0.82 32 0.86 504 540.57 0.93 -4.10

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 1.69 0.00 -0.19

Urinary system 129 1.67* 169 2.11* 43 1.79* 19 1.57 360 193.45 1.86* 11.91

Urinary bladder 73 1.36* 106 1.92* 28 1.69* 14 1.67 221 133.73 1.65* 6.24

Kidney parenchyma 47 2.49* 52 2.62* 14 2.31* 5 1.62 118 47.87 2.46* 5.02

Renal pelvis, other urinary 9 1.86 11 2.24* 1 0.70 0 0.00 21 11.85 1.77* 0.65

Ureter 4 2.50 3 1.85 1 2.13 0 0.00 8 3.92 2.04 0.29

Bone, joints 0 0.00 2 2.48 0 0.00 0 0.00 2 1.94 1.03 0.00

Soft tissue including heart 7 2.00 6 1.64 1 0.91 0 0.00 14 8.81 1.59 0.37

Kaposi sarcoma 2 1.86 2 1.85 0 0.00 0 0.00 4 2.60 1.54 0.10

Melanoma of skin 14 0.75 13 0.64 5 0.77 4 1.16 36 48.99 0.73 -0.93

Eye, orbit 1 0.76 1 0.75 0 0.00 0 0.00 2 3.24 0.62 -0.09

Brain, central nervous system 9 0.95 8 0.82 1 0.34 1 0.71 19 23.55 0.81 -0.33

Thyroid 21 4.72* 6 1.28 2 1.42 0 0.00 29 11.20 2.59* 1.27

Lymphatic, hematopoietic 44 0.66* 78 1.11 23 1.08 18 1.68 163 169.60 0.96 -0.47

Hodgkin lymphoma 1 0.44 1 0.45 0 0.00 1 3.56 3 5.37 0.56 -0.17

Non-Hodgkin lymphoma 11 0.38* 31 1.00 16 1.66 12 2.41* 70 74.78 0.94 -0.34

Myeloma 13 1.07 10 0.79 0 0.00* 3 1.59 26 30.56 0.85 -0.33

Leukemia 19 0.80 36 1.47* 7 0.96 2 0.56 64 58.90 1.09 0.36

Acute lymphocytic 1 1.57 1 1.51 0 0.00 0 0.00 2 1.59 1.26 0.03

Chronic lymphocytic 3 0.31* 5 0.50 1 0.34 0 0.00 9 23.90 0.38* -1.07

Acute non-lymphocytic 10 1.27 26 3.17* 4 1.63 2 1.63 42 19.75 2.13* 1.59

Chronic myeloid 3 0.94 1 0.30 2 2.04 0 0.00 6 7.94 0.76 -0.14

Lung and Bronchus

Non-small Cell Carcinoma, Both Sexes, Radiotherapy

Table 6.1.13: Risk of subsequent primary cancers after non-small cell carcinoma of the lung or bronchus,

both sexes, with initial radiotherapy, SEER 1973-2000.

162 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LUNG AND BRONCHUS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 115,881 43,458 5,771 1,775 115,881

Person-years in interval 57,612 57,970 16,756 7,499 139,837

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 50,724 PYR and for male cancers on 89,113 PYR.
Lung and Bronchus

Non-small Cell Carcinoma, Both Sexes, No Radiotherapy

Table 6.1.14: Risk of subsequent primary cancers after non-small cell carcinoma of the lung or bronchus,

both sexes, without initial radiotherapy, SEER 1973-2000.

LUNG AND BRONCHUS

All subsequent cancers 1,247 1.26* 3,149 1.45* 2,010 1.52* 1,446 1.43* 7,852 5,500.90 1.43* 78.91

All excluding same site 958 1.16* 2,183 1.21* 1,257 1.14* 940 1.10* 5,338 4,585.11 1.16* 25.27

Buccal cavity, pharynx 83 3.08* 143 2.47* 74 2.28* 31 1.40 331 139.31 2.38* 6.43

Lip 10 2.33* 12 1.36 6 1.21 3 0.89 31 21.44 1.45 0.32

Tongue 19 3.63* 35 3.07* 8 1.24 10 2.25* 72 27.51 2.62* 1.49

Salivary gland 5 2.31 4 0.85 6 2.09 1 0.44 16 11.99 1.33 0.13

Mouth 29 4.13* 39 2.57* 26 3.08* 6 1.05 100 36.34 2.75* 2.14

Nasopharynx 0 0.00 4 1.81 1 0.84 1 1.25 6 5.24 1.15 0.03

Tonsil 8 3.19* 16 2.96* 7 2.39 5 2.66 36 12.72 2.83* 0.78

Oropharynx 1 1.29 3 1.78 1 1.06 2 3.21 7 4.02 1.74 0.10

Hypopharynx 7 2.42 23 3.66* 12 3.49* 3 1.37 45 14.80 3.04* 1.01

Digestive system 279 1.26* 644 1.35* 327 1.13* 270 1.23* 1,520 1,206.12 1.26* 10.54

Esophagus 25 2.12* 63 2.48* 42 2.81* 28 2.53* 158 63.23 2.50* 3.18

Stomach 36 1.51* 75 1.51* 29 1.00 20 0.92 160 124.21 1.29* 1.20

Small intestine 11 3.66* 11 1.65 5 1.22 0 0.00 27 17.06 1.58* 0.33

Colon 108 1.09 271 1.27* 130 0.99 142 1.40* 651 545.19 1.19* 3.55

Rectum, rectosigmoid junction 48 1.25 103 1.24* 55 1.13 30 0.85 236 205.65 1.15* 1.02

Anus, anal canal 3 1.59 4 0.95 1 0.40 4 2.10 12 10.52 1.14 0.05

Liver 8 1.04 8 0.48* 8 0.80 10 1.25 34 42.25 0.80 -0.28

Gallbladder 3 1.05 3 0.49 2 0.55 0 0.00 8 15.38 0.52 -0.25

Bile ducts, other biliary 5 1.08 13 1.30 1 0.16* 12 2.25* 31 26.20 1.18 0.16

Pancreas 32 1.20 89 1.55* 52 1.51* 22 0.83 195 145.07 1.34* 1.68

Respiratory system 326 1.79* 1,054 2.64* 802 3.39* 538 3.11* 2,720 991.27 2.74* 58.02

Nose, nasal cavity, ear 1 0.68 6 1.90 4 2.15 2 1.45 13 7.87 1.65 0.17

Larynx 36 2.85* 74 2.71* 43 2.82* 30 2.99* 183 65.23 2.81* 3.95

Lung, bronchus 289 1.73* 966 2.62* 753 3.44* 506 3.14* 2,514 915.79 2.75* 53.64

Female breast 75 0.90 224 1.15* 128 1.09 109 1.21 536 486.69 1.10* 3.85

Female genital system 22 0.58* 78 0.89 45 0.89 24 0.65* 169 213.17 0.79* -3.45

Cervix uteri 2 0.49 8 0.89 5 1.03 0 0.00 15 21.07 0.71 -0.47

Corpus uteri 12 0.61 39 0.85 17 0.64 9 0.48* 77 111.07 0.69* -2.66

Ovary 6 0.55 30 1.17 20 1.31 13 1.14 69 63.28 1.09 0.45

Vagina 1 1.75 0 0.00 1 1.29 0 0.00 2 3.24 0.62 -0.10

Vulva 1 0.60 1 0.26 1 0.42 2 0.99 5 9.83 0.51 -0.38

Male genital system 218 1.03 471 1.02 297 1.01 199 0.84* 1,185 1,207.18 0.98 -1.31

Prostate 218 1.04 463 1.01 295 1.01 198 0.84* 1,174 1,196.74 0.98 -1.34

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 2.97 0.00 -0.17

Urinary system 134 1.66* 263 1.50* 152 1.41* 119 1.43* 668 446.76 1.50* 7.43

Urinary bladder 81 1.44* 194 1.60* 120 1.60* 94 1.60* 489 311.74 1.57* 5.95

Kidney parenchyma 45 2.34* 57 1.34* 25 0.97 16 0.81 143 107.33 1.33* 1.20

Renal pelvis, other urinary 8 1.56 12 1.09 7 1.06 9 1.83 36 27.69 1.30 0.28

Ureter 1 0.59 2 0.54 0 0.00 3 1.85 6 9.20 0.65 -0.11

Bone, joints 1 1.22 3 1.68 1 0.98 1 1.37 6 4.36 1.38 0.06

Soft tissue including heart 2 0.54 6 0.75 7 1.45 2 0.52 17 20.37 0.83 -0.11

Kaposi sarcoma 0 0.00 1 0.49 0 0.00 1 1.13 2 5.11 0.39 -0.10

Melanoma of skin 12 0.61 30 0.68* 28 1.01 28 1.25 98 113.80 0.86 -0.53

Eye, orbit 1 0.72 2 0.66 0 0.00 1 0.78 4 7.48 0.53 -0.12

Brain, central nervous system 3 0.31* 20 0.93 5 0.39* 10 1.09 38 53.06 0.72* -0.51

Thyroid 17 3.69* 14 1.36 5 0.85 7 1.66 43 24.97 1.72* 0.61

Lymphatic, hematopoietic 59 0.82 151 0.96 99 1.02 73 0.96 382 402.46 0.95 -0.69

Hodgkin lymphoma 2 0.88 3 0.62 2 0.75 1 0.55 8 11.56 0.69 -0.12

Non-Hodgkin lymphoma 35 1.12 64 0.92 46 1.06 37 1.05 182 179.78 1.01 0.07

Myeloma 10 0.78 28 1.00 17 1.00 6 0.45* 61 71.13 0.86 -0.34

Leukemia 12 0.47* 56 1.02 34 1.01 29 1.12 131 139.99 0.94 -0.30

Acute lymphocytic 0 0.00 0 0.00 1 1.13 0 0.00 1 3.64 0.27 -0.09

Chronic lymphocytic 5 0.48 18 0.81 10 0.74 12 1.17 45 56.43 0.80 -0.38

Acute non-lymphocytic 4 0.47 25 1.35 16 1.40 12 1.33 57 47.52 1.20 0.32

Chronic myeloid 1 0.29 10 1.36 4 0.89 4 1.13 19 18.80 1.01 0.01

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 99,465 54,250 20,093 9,097 99,465

Person-years in interval 57,196 124,523 69,003 47,211 297,933

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 128,182 PYR and for male cancers on 169,751 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 163
Larynx

Both Sexes

Table 6.2.1: Characteristics of patients with an initial cancer of the larynx, both sexes,

SEER 1973-2000.

164 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LARYNX

Number of patients with 1st primary cancer

Total 19,574 100.0 4,369 100.0 23,943 100.0

Initial treatment

Any radiation 14,370 73.4 3,247 74.3 17,617 73.6

With surgery 6,764 34.6 1,584 36.3 8,348 34.9

Without surgery 7,606 38.9 1,663 38.1 9,269 38.7

No radiation 5,204 26.6 1,122 25.7 6,326 26.4

With surgery 4,196 21.4 874 20.0 5,070 21.2

Without surgery 1,008 5.1 248 5.7 1,256 5.2

Race

White 16,580 84.7 3,657 83.7 20,237 84.5

Black 2,347 12.0 587 13.4 2,934 12.3

Other 597 3.0 108 2.5 705 2.9

Unknown 50 0.3 17 0.4 67 0.3

Age at 1st primary cancer diagnosis, years

< 30 31 0.2 32 0.7 63 0.3

30–49 1,991 10.2 556 12.7 2,547 10.6

50–69 12,216 62.4 2,681 61.4 14,897 62.2

70–79 4,209 21.5 834 19.1 5,043 21.1

> 80 1,127 5.8 266 6.1 1,393 5.8

Number of patients with one or more

primary cancers

One primary cancer only 15,688 80.1 3,615 82.7 19,303 80.6

1st and 2nd cancers 3,408 17.4 667 15.3 4,075 17.0

1st, 2nd, and 3rd cancers 426 2.2 78 1.8 504 2.1

1st, 2nd, 3rd, and additional cancers 52 0.3 9 0.2 61 0.3

Other statistics

Median age at 1st cancer diagnosis 63.7 — 62.7 — 63.5 —

Median year of 1st cancer diagnosis 1986.5 — 1988.0 — 1986.8 —

Median person-years at risk 4.5 — 4.3 — 4.5 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 94.9 — 96.6 — 95.1

1st, 2nd, and additional cancers — 94.1 — 96.0 — 94.4

1st cancer only — 4.8 — 3.4 — 4.5

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Larynx

Both Sexes

Table 6.2.2: Risk of subsequent primary cancers after cancer of the larynx, both sexes,

SEER 1973-2000.

LARYNX

All subsequent cancers 515 1.75* 2,057 1.94* 1,477 1.68* 1,228 1.44* 5,277 3,087.41 1.71* 140.47

All excluding same site 509 1.76* 2,032 1.95* 1,461 1.68* 1,215 1.45* 5,217 3,042.66 1.71* 139.49

Buccal cavity, pharynx 45 4.66* 188 5.72* 143 5.87* 118 5.90* 494 86.88 5.69* 26.12

Lip 2 1.26 6 1.11 3 0.74 6 1.76 17 14.46 1.18 0.16

Tongue 20 10.73* 55 8.64* 35 7.35* 31 7.84* 141 16.95 8.32* 7.96

Salivary gland 0 0.00 3 1.25 8 4.04* 4 2.02 15 7.03 2.13* 0.51

Mouth 12 4.92* 64 7.79* 40 6.69* 23 4.86* 139 21.36 6.51* 7.55

Nasopharynx 1 2.77 3 2.52 4 4.73* 2 3.01 10 3.06 3.27* 0.45

Tonsil 3 3.10 25 7.78* 19 8.30* 19 10.76* 66 8.24 8.01* 3.71

Oropharynx 2 6.81 4 4.03* 8 10.92* 4 6.76* 18 2.61 6.90* 0.99

Hypopharynx 5 4.46* 13 3.42* 18 6.46* 20 9.34* 56 9.85 5.68* 2.96

Digestive system 74 1.15 336 1.46* 263 1.41* 221 1.26* 894 656.65 1.36* 15.23

Esophagus 13 3.14* 65 4.52* 50 4.41* 40 3.81* 168 40.37 4.16* 8.19

Stomach 12 1.63 26 1.01 28 1.38 17 0.92 83 71.87 1.15 0.71

Small intestine 1 1.13 4 1.26 5 1.87 5 1.89 15 9.38 1.60 0.36

Colon 27 0.99 124 1.26* 97 1.18 91 1.15 339 286.85 1.18* 3.35

Rectum, rectosigmoid junction 8 0.68 46 1.10 39 1.18 25 0.85 118 116.21 1.02 0.12

Anus, anal canal 0 0.00 2 1.13 2 1.42 3 2.35 7 4.95 1.41 0.13

Liver 3 1.25 19 2.22* 11 1.56 15 2.15* 48 24.96 1.92* 1.48

Gallbladder 0 0.00 4 1.79 5 2.78 0 0.00 9 6.33 1.42 0.17

Bile ducts, other biliary 1 0.81 7 1.54 2 0.51 5 1.20 15 13.83 1.08 0.08

Pancreas 9 1.18 38 1.41 23 1.06 18 0.88 88 76.56 1.15 0.73

Respiratory system 198 3.30* 887 4.18* 578 3.43* 433 2.85* 2,096 592.96 3.53* 96.42

Nose, nasal cavity, ear 2 4.31 15 9.32* 3 2.39 0 0.00 20 4.47 4.48* 1.00

Larynx 6 1.21 25 1.48 16 1.27 13 1.27 60 44.75 1.34* 0.98

Lung, bronchus 188 3.45* 841 4.36* 559 3.62* 419 2.99* 2,007 542.33 3.70* 93.96

Female breast 10 0.94 49 1.34 30 1.03 25 0.97 114 101.75 1.12 4.35

Female genital system 7 1.38 22 1.29 18 1.41 9 0.85 56 45.45 1.23 3.75

Cervix uteri 1 1.59 5 2.53 2 1.52 1 1.04 9 4.89 1.84 1.46

Corpus uteri 2 0.75 6 0.67 6 0.90 6 1.10 20 23.75 0.84 -1.33

Ovary 3 2.11 6 1.24 8 2.12 2 0.62 19 13.28 1.43 2.03

Vagina 0 0.00 2 8.33 1 5.26 0 0.00 3 0.67 4.48 0.83

Vulva 0 0.00 2 3.10 1 1.85 0 0.00 3 1.90 1.58 0.39

Male genital system 85 1.13 264 0.93 213 0.84* 208 0.79* 770 874.15 0.88* -8.15

Prostate 84 1.12 262 0.94 210 0.84* 206 0.79* 762 866.46 0.88* -8.18

Testis 0 0.00 0 0.00 0 0.00 1 2.59 1 2.31 0.43 -0.10

Urinary system 34 1.30 140 1.47* 108 1.36* 96 1.22 378 279.43 1.35* 6.32

Urinary bladder 19 1.03 91 1.35* 81 1.43* 72 1.27 263 198.90 1.32* 4.11

Kidney parenchyma 15 2.40* 41 1.83* 19 1.04 19 1.09 94 64.37 1.46* 1.90

Renal pelvis, other urinary 0 0.00 8 1.40 8 1.75 5 1.16 21 16.16 1.30 0.31

Ureter 0 0.00 3 1.57 4 2.58 1 0.69 8 5.42 1.48 0.17

Bone, joints 0 0.00 0 0.00 0 0.00 3 5.18* 3 2.41 1.25 0.04

Soft tissue including heart 3 2.69 2 0.51 2 0.63 2 0.64 9 11.32 0.79 -0.15

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 3.60 0.00 -0.23

Melanoma of skin 2 0.32 14 0.62 16 0.83 12 0.60 44 67.95 0.65* -1.54

Eye, orbit 0 0.00 0 0.00 3 2.53 0 0.00 3 4.22 0.71 -0.08

Brain, central nervous system 2 0.64 10 0.92 7 0.83 7 0.93 26 29.93 0.87 -0.25

Thyroid 13 10.53* 9 2.15 1 0.32 2 0.74 25 11.27 2.22* 0.88

Lymphatic, hematopoietic 26 1.23 89 1.17 60 0.95 50 0.81 225 221.56 1.02 0.22

Hodgkin lymphoma 1 1.29 3 1.18 4 2.20 3 2.04 11 6.61 1.66 0.28

Non-Hodgkin lymphoma 13 1.46 45 1.39* 29 1.06 26 0.94 113 96.13 1.18 1.08

Myeloma 5 1.33 15 1.11 6 0.54 5 0.46 31 39.32 0.79 -0.53

Leukemia 7 0.92 26 0.95 21 0.93 16 0.73 70 79.49 0.88 -0.61

Acute lymphocytic 0 0.00 0 0.00 0 0.00 2 3.80 2 2.05 0.98 0.00

Chronic lymphocytic 1 0.32 2 0.18* 5 0.54 3 0.34* 11 32.63 0.34* -1.39

Acute non-lymphocytic 6 2.43 14 1.56 9 1.21 6 0.81 35 26.33 1.33 0.56

Chronic myeloid 0 0.00 5 1.37 5 1.67 3 1.01 13 10.64 1.22 0.15

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 23,943 20,423 11,510 6,136 23,943

Person-years in interval 18,353 60,395 42,867 34,261 155,877

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 28,157 PYR and for male cancers on 127,719 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 165
All subsequent cancers 4,049 1.81* 795 1.53* 335 1.36* 98 1.16 5,277 3,087.41 1.71* 140.47

All excluding same site 4,002 1.82* 788 1.54* 331 1.36* 96 1.15 5,217 3,042.66 1.71* 139.49

Buccal cavity, pharynx 376 5.62* 76 5.97* 33 6.01* 9 4.98* 494 86.88 5.69* 26.12

Lip 11 1.00 5 2.32 1 1.07 0 0.00 17 14.46 1.18 0.16

Tongue 110 8.47* 18 7.18* 13 11.92* 0 0.00 141 16.95 8.32* 7.96

Salivary gland 11 2.18* 2 1.69 2 3.48 0 0.00 15 7.03 2.13* 0.51

Mouth 116 6.97* 18 5.95* 5 3.89* 0 0.00 139 21.36 6.51* 7.55

Nasopharynx 8 3.34* 1 2.33 0 0.00 1 17.69 10 3.06 3.27* 0.45

Tonsil 47 7.26* 14 12.28* 4 8.42* 1 6.69 66 8.24 8.01* 3.71

Oropharynx 14 6.94* 2 5.27 2 12.42* 0 0.00 18 2.61 6.90* 0.99

Hypopharynx 36 4.67* 12 8.57* 5 8.79* 3 17.36* 56 9.85 5.68* 2.96

Digestive system 673 1.40* 151 1.40* 57 1.14 13 0.72 894 656.65 1.36* 15.23

Esophagus 128 4.28* 26 4.03* 9 3.01* 5 4.75* 168 40.37 4.16* 8.19

Stomach 66 1.24 16 1.40 1 0.19 0 0.00 83 71.87 1.15 0.71

Small intestine 10 1.48 2 1.25 2 2.61 1 3.56 15 9.38 1.60 0.36

Colon 248 1.19* 55 1.14 31 1.38 5 0.61 339 286.85 1.18* 3.35

Rectum, rectosigmoid junction 93 1.07 17 0.92 7 0.85 1 0.35 118 116.21 1.02 0.12

Anus, anal canal 4 1.09 3 3.82 0 0.00 0 0.00 7 4.95 1.41 0.13

Liver 33 1.83* 12 2.88* 2 0.98 1 1.33 48 24.96 1.92* 1.48

Gallbladder 9 1.93 0 0.00 0 0.00 0 0.00 9 6.33 1.42 0.17

Bile ducts, other biliary 10 1.03 4 1.65 1 0.80 0 0.00 15 13.83 1.08 0.08

Pancreas 70 1.25 14 1.13 4 0.69 0 0.00 88 76.56 1.15 0.73

Respiratory system 1,663 3.77* 292 3.09* 102 2.38* 39 2.66* 2,096 592.96 3.53* 96.42

Nose, nasal cavity, ear 20 6.01* 0 0.00 0 0.00 0 0.00 20 4.47 4.48* 1.00

Larynx 47 1.36* 7 1.06 4 1.44 2 2.31 60 44.75 1.34* 0.98

Lung, bronchus 1,588 3.95* 285 3.28* 97 2.44* 37 2.71* 2,007 542.33 3.70* 93.96

Female breast 89 1.17 19 1.21 6 0.80 0 0.00 114 101.75 1.12 4.35

Female genital system 47 1.35 8 1.21 1 0.33 0 0.00 56 45.45 1.23 3.75

Cervix uteri 8 2.04 1 1.60 0 0.00 0 0.00 9 4.89 1.84 1.46

Corpus uteri 14 0.77 6 1.77 0 0.00 0 0.00 20 23.75 0.84 -1.33

Ovary 17 1.69 1 0.50 1 1.07 0 0.00 19 13.28 1.43 2.03

Vagina 3 6.01* 0 0.00 0 0.00 0 0.00 3 0.67 4.48 0.83

Vulva 3 2.19 0 0.00 0 0.00 0 0.00 3 1.90 1.58 0.39

Male genital system 562 0.92* 124 0.77* 66 0.85 18 0.72 770 874.15 0.88* -8.15

Prostate 556 0.92* 124 0.78* 64 0.83 18 0.73 762 866.46 0.88* -8.18

Testis 0 0.00 0 0.00 1 10.32 0 0.00 1 2.31 0.43 -0.10

Urinary system 282 1.40* 60 1.27 27 1.19 9 1.07 378 279.43 1.35* 6.32

Urinary bladder 191 1.34* 45 1.32 21 1.27 6 0.97 263 198.90 1.32* 4.11

Kidney parenchyma 75 1.60* 11 1.03 5 1.00 3 1.70 94 64.37 1.46* 1.90

Renal pelvis, other urinary 16 1.35 4 1.52 1 0.82 0 0.00 21 16.16 1.30 0.31

Ureter 7 1.76 1 1.13 0 0.00 0 0.00 8 5.42 1.48 0.17

Bone, joints 0 0.00 2 5.56 1 6.12 0 0.00 3 2.41 1.25 0.04

Soft tissue including heart 7 0.85 2 1.07 0 0.00 0 0.00 9 11.32 0.79 -0.15

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 3.60 0.00 -0.23

Melanoma of skin 32 0.67* 8 0.68 3 0.51 1 0.43 44 67.95 0.65* -1.54

Eye, orbit 3 0.96 0 0.00 0 0.00 0 0.00 3 4.22 0.71 -0.08

Brain, central nervous system 19 0.85 5 1.07 1 0.47 1 1.36 26 29.93 0.87 -0.25

Thyroid 23 2.69* 0 0.00 2 2.64 0 0.00 25 11.27 2.22* 0.88

Lymphatic, hematopoietic 175 1.10 25 0.67* 23 1.28 2 0.30 225 221.56 1.02 0.22

Hodgkin lymphoma 8 1.56 1 1.07 1 2.47 1 7.51 11 6.61 1.66 0.28

Non-Hodgkin lymphoma 87 1.27* 13 0.79 13 1.60 0 0.00 113 96.13 1.18 1.08

Myeloma 26 0.91 4 0.60 1 0.32 0 0.00 31 39.32 0.79 -0.53

Leukemia 54 0.94 7 0.53 8 1.27 1 0.43 70 79.49 0.88 -0.61

Acute lymphocytic 0 0.00 1 2.98 1 6.82 0 0.00 2 2.05 0.98 0.00

Chronic lymphocytic 8 0.34* 2 0.37 1 0.40 0 0.00 11 32.63 0.34* -1.39

Acute non-lymphocytic 29 1.54* 3 0.67 2 0.92 1 1.22 35 26.33 1.33 0.56

Chronic myeloid 10 1.31 1 0.56 2 2.31 0 0.00 13 10.64 1.22 0.15

Larynx

Both Sexes, Long-term Follow-up

Table 6.2.3: Risk of subsequent primary cancers after cancer of the larynx, both sexes,

long-term follow-up, SEER 1973-2000.

166 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LARYNX

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 23,943 6,136 2,909 1,052 23,943

Person-years in interval 121,615 21,794 9,379 3,088 155,877

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 28,157 PYR and for male cancers on 127,719 PYR.
Larynx

Females

Table 6.2.4: Risk of subsequent primary cancers after cancer of the larynx, females,

SEER 1973-2000.

LARYNX

All subsequent cancers 94 2.62* 338 2.71* 238 2.36* 180 1.97* 850 352.54 2.41* 176.67

All excluding same site 93 2.61* 333 2.69* 236 2.36* 178 1.96* 840 350.82 2.39* 173.73

Buccal cavity, pharynx 11 15.74* 32 13.40* 24 13.04* 21 13.61* 88 6.47 13.60* 28.96

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.14

Tongue 7 45.51* 9 17.11* 8 19.67* 4 11.77* 28 1.43 19.63* 9.44

Salivary gland 0 0.00 0 0.00 2 10.57* 1 5.79 3 0.67 4.47 0.83

Mouth 4 16.88* 11 13.55* 3 4.76 6 11.23* 24 2.21 10.84* 7.74

Nasopharynx 0 0.00 1 10.89 1 14.41 0 0.00 2 0.25 8.15 0.62

Tonsil 0 0.00 5 20.72* 4 23.27* 3 23.54* 12 0.61 19.57* 4.04

Oropharynx 0 0.00 1 15.20 2 40.42* 2 51.88* 5 0.17 28.92* 1.71

Hypopharynx 0 0.00 3 16.16* 1 7.26 4 37.44* 8 0.48 16.50* 2.67

Digestive system 13 1.71 59 2.20* 33 1.48* 26 1.25 131 77.46 1.69* 19.01

Esophagus 3 12.14* 17 19.81* 7 10.15* 5 8.04* 32 2.42 13.24* 10.51

Stomach 1 1.75 3 1.51 2 1.24 3 2.02 9 5.67 1.59 1.18

Small intestine 0 0.00 1 2.46 1 2.92 0 0.00 2 1.20 1.67 0.28

Colon 5 1.34 18 1.36 10 0.90 9 0.86 42 38.43 1.09 1.27

Rectum, rectosigmoid junction 1 0.79 11 2.51* 4 1.14 2 0.65 18 12.24 1.47 2.05

Rectum 1 1.22 8 2.82* 3 1.32 1 0.49 13 7.96 1.63 1.79

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 1.10 0.00 -0.39

Liver 0 0.00 0 0.00 2 4.14 0 0.00 2 1.70 1.18 0.11

Gallbladder 0 0.00 1 1.71 0 0.00 0 0.00 1 1.65 0.61 -0.23

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 2.07 1 1.64 0.61 -0.23

Pancreas 3 2.99 8 2.25 7 2.34 6 2.10 24 10.39 2.31* 4.83

Respiratory system 31 6.26* 143 8.12* 107 7.26* 80 5.76* 361 51.18 7.05* 110.03

Nose, nasal cavity, ear 0 0.00 1 6.01 0 0.00 0 0.00 1 0.47 2.12 0.19

Larynx 1 5.22 5 7.78* 2 4.09 2 5.09 10 1.72 5.83* 2.94

Lung, bronchus 30 6.38* 137 8.18* 105 7.45* 78 5.85* 350 48.87 7.16* 106.94

Female breast 10 0.94 49 1.34 30 1.03 25 0.97 114 101.75 1.12 4.35

Female genital system 7 1.38 22 1.29 18 1.41 9 0.85 56 45.45 1.23 3.75

Cervix uteri 1 1.59 5 2.53 2 1.52 1 1.04 9 4.89 1.84 1.46

Corpus uteri 2 0.75 6 0.67 6 0.90 6 1.10 20 23.75 0.84 -1.33

Ovary 3 2.11 6 1.24 8 2.12 2 0.62 19 13.28 1.43 2.03

Vagina 0 0.00 2 8.33 1 5.26 0 0.00 3 0.67 4.48 0.83

Vulva 0 0.00 2 3.10 1 1.85 0 0.00 3 1.90 1.58 0.39

Urinary system 5 3.08 12 2.09* 6 1.25 2 0.44 25 16.77 1.49 2.92

Urinary bladder 1 1.08 7 2.12 2 0.72 1 0.38 11 9.66 1.14 0.48

Kidney parenchyma 4 7.09* 4 2.01 3 1.82 1 0.64 12 5.76 2.08* 2.22

Renal pelvis, other urinary 0 0.00 1 2.15 1 2.58 0 0.00 2 1.35 1.49 0.23

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.14

Bone, joints 0 0.00 0 0.00 0 0.00 1 13.13 1 0.31 3.25 0.25

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 1.36 0.00 -0.48

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.04

Melanoma of skin 0 0.00 0 0.00 2 1.06 2 1.14 4 6.69 0.60 -0.96

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.18

Brain, central nervous system 0 0.00 0 0.00 2 1.89 1 1.09 3 3.70 0.81 -0.25

Thyroid 5 14.75* 1 0.90 0 0.00 0 0.00 6 2.95 2.03 1.08

Lymphatic, hematopoietic 3 1.17 11 1.22 12 1.58 7 0.97 33 26.36 1.25 2.36

Hodgkin lymphoma 0 0.00 0 0.00 1 4.57 1 5.52 2 0.78 2.58 0.43

Non-Hodgkin lymphoma 0 0.00 4 0.92 8 2.17 4 1.12 16 12.83 1.25 1.13

Myeloma 2 4.23 5 3.00 2 1.45 1 0.78 10 4.81 2.08 1.84

Leukemia 1 1.29 2 0.73 1 0.44 1 0.46 5 7.96 0.63 -1.05

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.08

Chronic lymphocytic 1 3.29 0 0.00 0 0.00 0 0.00 1 3.13 0.32 -0.76

Acute non-lymphocytic 0 0.00 2 2.07 1 1.24 1 1.29 4 2.82 1.42 0.42

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.09 0.00 -0.39

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,369 3,684 2,068 1,102 4,369

Person-years in interval 3,321 10,858 7,780 6,199 28,157

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 167
All subsequent cancers 421 1.63* 1,719 1.83* 1,239 1.59* 1,048 1.38* 4,427 2,734.88 1.62* 132.49

All excluding same site 416 1.64* 1,699 1.85* 1,225 1.60* 1,037 1.38* 4,377 2,691.84 1.63* 131.94

Buccal cavity, pharynx 34 3.79* 156 5.12* 119 5.29* 97 5.25* 406 80.41 5.05* 25.49

Lip 2 1.29 6 1.13 3 0.76 6 1.82 17 14.07 1.21 0.23

Tongue 13 7.60* 46 7.88* 27 6.20* 27 7.47* 113 15.52 7.28* 7.63

Salivary gland 0 0.00 3 1.39 6 3.35* 3 1.66 12 6.36 1.89 0.44

Mouth 8 3.64* 53 7.15* 37 6.92* 17 4.05* 115 19.15 6.01* 7.50

Nasopharynx 1 3.00 2 1.82 3 3.86 2 3.29 8 2.81 2.84* 0.41

Tonsil 3 3.35 20 6.73* 15 7.09* 16 9.77* 54 7.62 7.08* 3.63

Oropharynx 2 7.29 3 3.24 6 8.79* 2 3.62 13 2.44 5.34* 0.83

Hypopharynx 5 4.69* 10 2.77* 17 6.41* 16 7.86* 48 9.37 5.12* 3.02

Digestive system 61 1.07 277 1.37* 230 1.40* 195 1.26* 763 579.19 1.32* 14.39

Esophagus 10 2.57* 48 3.55* 43 4.03* 35 3.55* 136 37.96 3.58* 7.68

Stomach 11 1.62 23 0.97 26 1.39 14 0.83 74 66.21 1.12 0.61

Small intestine 1 1.30 3 1.08 4 1.72 5 2.17 13 8.18 1.59 0.38

Colon 22 0.93 106 1.24* 87 1.23 82 1.20 297 248.42 1.20* 3.80

Rectum, rectosigmoid junction 7 0.66 35 0.94 35 1.18 23 0.87 100 103.97 0.96 -0.31

Anus, anal canal 0 0.00 2 1.45 2 1.84 3 3.02 7 3.85 1.82 0.25

Liver 3 1.34 19 2.38* 9 1.37 15 2.31* 46 23.26 1.98* 1.78

Gallbladder 0 0.00 3 1.82 5 3.78* 0 0.00 8 4.69 1.71 0.26

Bile ducts, other biliary 1 0.92 7 1.75 2 0.58 4 1.09 14 12.19 1.15 0.14

Pancreas 6 0.91 30 1.28 16 0.86 12 0.69 64 66.17 0.97 -0.17

Respiratory system 167 3.03* 744 3.83* 471 3.06* 353 2.55* 1,735 541.78 3.20* 93.43

Nose, nasal cavity, ear 2 4.81 14 9.70* 3 2.68 0 0.00 19 3.99 4.76* 1.17

Larynx 5 1.05 20 1.23 14 1.15 11 1.12 50 43.04 1.16 0.55

Lung, bronchus 158 3.17* 704 3.99* 454 3.23* 341 2.68* 1,657 493.46 3.36* 91.10

Male breast 0 0.00 2 1.14 2 1.39 1 0.70 5 5.12 0.98 -0.01

Male genital system 85 1.13 264 0.93 213 0.84* 208 0.79* 770 874.15 0.88* -8.15

Prostate 84 1.12 262 0.94 210 0.84* 206 0.79* 762 866.46 0.88* -8.18

Testis 0 0.00 0 0.00 0 0.00 1 2.59 1 2.31 0.43 -0.10

Urinary system 29 1.18 128 1.43* 102 1.37* 94 1.27* 353 262.66 1.34* 7.07

Urinary bladder 18 1.03 84 1.31* 79 1.47* 71 1.31* 252 189.24 1.33* 4.91

Kidney parenchyma 11 1.93 37 1.82* 16 0.96 18 1.13 82 58.60 1.40* 1.83

Renal pelvis, other urinary 0 0.00 7 1.34 7 1.67 5 1.27 19 14.81 1.28 0.33

Ureter 0 0.00 3 1.70 4 2.79 1 0.75 8 5.02 1.59 0.23

Bone, joints 0 0.00 0 0.00 0 0.00 2 3.97 2 2.10 0.95 -0.01

Soft tissue including heart 3 3.07 2 0.58 2 0.72 2 0.72 9 9.96 0.90 -0.08

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 3.49 0.00 -0.27

Melanoma of skin 2 0.36 14 0.69 14 0.81 10 0.55 40 61.26 0.65* -1.66

Eye, orbit 0 0.00 0 0.00 3 2.87 0 0.00 3 3.71 0.81 -0.06

Brain, central nervous system 2 0.74 10 1.05 5 0.68 6 0.91 23 26.23 0.88 -0.25

Thyroid 8 8.94* 8 2.61* 1 0.43 2 0.99 19 8.32 2.28* 0.84

Lymphatic, hematopoietic 23 1.24 78 1.17 48 0.87 43 0.79 192 195.19 0.98 -0.25

Hodgkin lymphoma 1 1.46 3 1.33 3 1.88 2 1.55 9 5.83 1.54 0.25

Non-Hodgkin lymphoma 13 1.70 41 1.47* 21 0.89 22 0.91 97 83.30 1.16 1.07

Myeloma 3 0.91 10 0.84 4 0.41 4 0.42 21 34.52 0.61* -1.06

Leukemia 6 0.88 24 0.97 20 0.99 15 0.76 65 71.54 0.91 -0.51

Acute lymphocytic 0 0.00 0 0.00 0 0.00 2 4.29 2 1.81 1.10 0.01

Chronic lymphocytic 0 0.00 2 0.19* 5 0.59 3 0.38 10 29.50 0.34* -1.53

Acute non-lymphocytic 6 2.74* 12 1.50 8 1.20 5 0.75 31 23.50 1.32 0.59

Chronic myeloid 0 0.00 5 1.53 5 1.87 3 1.12 13 9.55 1.36 0.27

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 19,574 16,739 9,442 5,034 19,574

Person-years in interval 15,032 49,537 35,087 28,062 127,719

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Larynx

Males

Table 6.2.5: Risk of subsequent primary cancers after cancer of the larynx, males,

SEER 1973-2000.

168 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LARYNX

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Larynx

Both Sexes, <50 Years of Age

Table 6.2.6: Risk of subsequent primary cancers after cancer of the larynx, both sexes,

<50 years of age, SEER 1973-2000.

LARYNX

All subsequent cancers 23 4.31* 99 4.05* 66 2.03* 168 1.90* 356 150.91 2.36* 91.36

All excluding same site 22 4.21* 94 3.93* 66 2.07* 165 1.90* 347 147.98 2.34* 88.65

Buccal cavity, pharynx 4 12.76* 20 14.22* 12 7.06* 27 9.02* 63 6.41 9.82* 25.21

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -0.28

Tongue 2 29.94* 4 13.09* 3 8.04* 7 10.54* 16 1.41 11.35* 6.50

Salivary gland 0 0.00 0 0.00 1 10.04 1 4.75 2 0.42 4.78 0.70

Mouth 1 12.07 8 21.57* 2 4.46 4 5.38* 15 1.64 9.12* 5.95

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.13

Tonsil 0 0.00 6 29.38* 2 8.38 3 8.07* 11 0.86 12.78* 4.52

Oropharynx 0 0.00 0 0.00 1 19.10 2 19.31* 3 0.21 14.34* 1.24

Hypopharynx 1 35.89 0 0.00 2 10.44* 8 22.87* 11 0.71 15.53* 4.58

Digestive system 1 1.07 11 2.46* 5 0.81 22 1.37 39 27.70 1.41* 5.03

Esophagus 0 0.00 4 9.56* 2 3.53 5 3.81* 11 2.38 4.61* 3.84

Stomach 0 0.00 2 3.79 1 1.49 0 0.00 3 2.89 1.04 0.05

Small intestine 0 0.00 0 0.00 0 0.00 1 3.26 1 0.57 1.75 0.19

Colon 1 3.16 1 0.65 0 0.00 9 1.42 11 10.42 1.06 0.26

Rectum, rectosigmoid junction 0 0.00 2 2.32 1 0.81 3 0.97 6 5.36 1.12 0.28

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.18

Liver 0 0.00 1 4.22 1 3.26 3 3.82 5 1.38 3.62* 1.61

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.09

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 3.12 1 0.51 1.95 0.22

Pancreas 0 0.00 1 1.84 0 0.00 0 0.00 1 3.32 0.30 -1.03

Respiratory system 9 9.46* 51 10.79* 35 5.20* 60 3.53* 155 29.43 5.27* 55.93

Nose, nasal cavity, ear 0 0.00 1 16.36 0 0.00 0 0.00 1 0.28 3.53 0.32

Larynx 1 8.79 5 9.15* 0 0.00 3 1.96 9 2.93 3.07* 2.70

Lung, bronchus 8 9.78* 45 10.98* 35 5.93* 57 3.72* 145 26.13 5.55* 52.95

Female breast 0 0.00 3 1.15 5 1.80 5 1.01 13 10.99 1.18 3.92

Female genital system 3 11.71* 2 1.87 0 0.00 3 1.49 8 4.47 1.79 6.91

Cervix uteri 0 0.00 1 3.49 0 0.00 1 3.69 2 0.87 2.29 2.21

Corpus uteri 1 12.09 0 0.00 0 0.00 2 1.96 3 2.00 1.50 1.95

Ovary 2 26.99* 0 0.00 0 0.00 0 0.00 2 1.33 1.51 1.32

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.10

Vulva 0 0.00 1 32.82 0 0.00 0 0.00 1 0.13 7.63 1.70

Male genital system 0 0.00 1 0.48 0 0.00* 21 0.86 22 31.46 0.70 -5.46

Prostate 0 0.00 1 0.57 0 0.00* 21 0.87 22 30.51 0.72 -4.91

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.71 0.00 -0.41

Urinary system 1 2.49 4 2.08 1 0.37 9 1.24 15 12.30 1.22 1.20

Urinary bladder 0 0.00 0 0.00 1 0.64 7 1.51 8 7.46 1.07 0.24

Kidney parenchyma 1 5.81 4 5.06* 0 0.00 2 0.87 7 4.29 1.63 1.21

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.25

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.07

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.09

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.80 0.00 -0.36

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.98 0.00 -0.43

Melanoma of skin 0 0.00 0 0.00 0 0.00 5 1.77 5 5.97 0.84 -0.43

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.12

Brain, central nervous system 0 0.00 0 0.00 1 1.70 2 1.91 3 2.32 1.30 0.30

Thyroid 1 8.91 2 4.73 1 2.58 1 1.72 5 1.51 3.32* 1.56

Lymphatic, hematopoietic 2 3.51 3 1.25 4 1.42 7 1.13 16 11.98 1.34 1.79

Hodgkin lymphoma 1 14.88 0 0.00 0 0.00 0 0.00 1 0.74 1.34 0.11

Non-Hodgkin lymphoma 1 3.38 2 1.63 2 1.42 2 0.67 7 5.93 1.18 0.48

Myeloma 0 0.00 1 3.45 0 0.00 0 0.00 1 1.80 0.56 -0.36

Leukemia 0 0.00 0 0.00 2 2.50 5 2.62 7 3.50 2.00 1.56

Acute lymphocytic 0 0.00 0 0.00 0 0.00 1 14.68 1 0.16 6.35 0.38

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 1 1.24 1 1.36 0.74 -0.16

Acute non-lymphocytic 0 0.00 0 0.00 1 4.17 3 4.96 4 1.11 3.61 1.29

Chronic myeloid 0 0.00 0 0.00 1 8.17 0 0.00 1 0.52 1.91 0.21

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,610 2,317 1,477 981 2,610

Person-years in interval 2,055 7,198 6,011 7,186 22,449

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 5,112 PYR and for male cancers on 17,338 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 169
All subsequent cancers 286 1.88* 1,323 2.14* 1,105 1.78* 967 1.43* 3,681 2,063.40 1.78* 153.51

All excluding same site 284 1.91* 1,308 2.16* 1,090 1.79* 957 1.43* 3,639 2,030.38 1.79* 152.66

Buccal cavity, pharynx 32 5.25* 132 5.99* 117 6.51* 88 5.74* 369 61.45 6.01* 29.19

Lip 2 2.42 5 1.60 1 0.36 6 2.25 14 9.36 1.49 0.44

Tongue 14 11.47* 35 7.92* 27 7.46* 24 7.90* 100 12.30 8.13* 8.32

Salivary gland 0 0.00 1 0.74 6 4.64* 3 2.01 10 4.47 2.24* 0.52

Mouth 9 5.67* 46 8.17* 36 8.13* 17 4.73* 108 15.25 7.08* 8.80

Nasopharynx 0 0.00 3 3.57 3 4.69 2 4.01 8 2.22 3.60* 0.55

Tonsil 2 2.94 18 7.71* 17 9.67* 16 12.26* 53 6.08 8.72* 4.45

Oropharynx 2 9.75* 3 4.14 6 10.35* 1 2.19 12 1.97 6.10* 0.95

Hypopharynx 3 3.95 12 4.37* 14 6.35* 12 7.17* 41 7.38 5.55* 3.19

Digestive system 41 1.29 204 1.60* 197 1.57* 173 1.26* 615 422.43 1.46* 18.27

Esophagus 8 3.23* 50 5.38* 35 4.18* 33 3.99* 126 28.42 4.43* 9.26

Stomach 8 2.25 13 0.93 20 1.49 16 1.12 57 45.33 1.26 1.11

Small intestine 1 2.13 1 0.53 3 1.60 3 1.45 8 6.30 1.27 0.16

Colon 10 0.80 70 1.35* 75 1.41* 70 1.13 225 179.28 1.26* 4.34

Rectum, rectosigmoid junction 6 0.96 26 1.05 31 1.34 17 0.73 80 77.35 1.03 0.25

Anus, anal canal 0 0.00 1 0.88 2 1.98 3 3.11 6 3.40 1.76 0.25

Liver 2 1.54 10 1.96 7 1.39 12 2.16* 31 16.98 1.83* 1.33

Gallbladder 0 0.00 2 1.83 3 2.68 0 0.00 5 3.76 1.33 0.12

Bile ducts, other biliary 0 0.00 6 2.61 1 0.41 4 1.25 11 8.51 1.29 0.24

Pancreas 6 1.56 24 1.58* 19 1.29 13 0.81 62 49.73 1.25 1.16

Respiratory system 116 3.38* 607 4.52* 445 3.55* 343 2.80* 1,511 416.29 3.63* 103.89

Nose, nasal cavity, ear 1 3.80 10 10.26* 3 3.49 0 0.00 14 2.97 4.71* 1.05

Larynx 2 0.62 15 1.27 15 1.52 10 1.24 42 33.01 1.27 0.85

Lung, bronchus 111 3.61* 577 4.77* 427 3.74* 332 2.93* 1,447 379.35 3.81* 101.32

Female breast 8 1.23 33 1.38 20 0.97 17 0.91 78 69.59 1.12 4.58

Female genital system 0 0.00 17 1.46 14 1.50 5 0.64 36 32.08 1.12 2.14

Cervix uteri 0 0.00 4 3.04 2 2.24 0 0.00 6 3.24 1.85 1.50

Corpus uteri 0 0.00 5 0.78 4 0.79 3 0.73 12 17.44 0.69 -2.96

Ovary 0 0.00 5 1.55 7 2.59* 2 0.84 14 9.19 1.52 2.62

Vagina 0 0.00 1 6.97 1 7.94 0 0.00 2 0.43 4.61 0.85

Vulva 0 0.00 1 2.94 0 0.00 0 0.00 1 1.14 0.88 -0.08

Male genital system 32 0.93 148 0.95 150 0.83* 174 0.81* 504 585.60 0.86* -9.38

Prostate 31 0.91 148 0.96 148 0.83* 172 0.81* 499 580.88 0.86* -9.41

Testis 0 0.00 0 0.00 0 0.00 1 4.28 1 1.35 0.74 -0.04

Urinary system 21 1.61 79 1.48* 77 1.42* 80 1.28* 257 182.83 1.41* 7.04

Urinary bladder 11 1.27 51 1.41* 55 1.46* 60 1.33* 177 127.67 1.39* 4.68

Kidney parenchyma 10 2.77* 23 1.64* 17 1.27 15 1.10 65 44.71 1.45* 1.93

Renal pelvis, other urinary 0 0.00 5 1.60 5 1.60 5 1.45 15 10.45 1.44 0.43

Ureter 0 0.00 2 1.93 2 1.89 1 0.86 5 3.51 1.42 0.14

Bone, joints 0 0.00 0 0.00 0 0.00 3 6.87* 3 1.63 1.84 0.13

Soft tissue including heart 1 1.72 2 0.90 0 0.00 1 0.42 4 7.31 0.55 -0.31

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.75 0.00 -0.17

Melanoma of skin 2 0.56 11 0.79 13 0.97 6 0.39* 32 46.22 0.69* -1.35

Eye, orbit 0 0.00 0 0.00 2 2.38 0 0.00 2 2.86 0.70 -0.08

Brain, central nervous system 1 0.53 8 1.13 6 0.97 4 0.68 19 21.07 0.90 -0.20

Thyroid 10 12.80* 5 1.80 0 0.00 1 0.51 16 7.79 2.05* 0.78

Lymphatic, hematopoietic 15 1.42 50 1.18 38 0.90 40 0.83 143 143.34 1.00 -0.03

Hodgkin lymphoma 0 0.00 0 0.00 3 2.38 3 2.72 6 4.41 1.36 0.15

Non-Hodgkin lymphoma 9 1.95 26 1.41 17 0.92 23 1.06 75 63.28 1.19 1.11

Myeloma 3 1.58 9 1.18 4 0.53 3 0.35 19 25.75 0.74 -0.64

Leukemia 3 0.84 15 1.03 14 0.95 11 0.65 43 49.90 0.86 -0.65

Acute lymphocytic 0 0.00 0 0.00 0 0.00 1 2.55 1 1.28 0.78 -0.03

Chronic lymphocytic 0 0.00 1 0.16* 4 0.64 2 0.29 7 20.94 0.33* -1.32

Acute non-lymphocytic 3 2.73 6 1.30 5 1.03 3 0.51 17 16.45 1.03 0.05

Chronic myeloid 0 0.00 3 1.59 3 1.59 3 1.30 9 6.55 1.37 0.23

Larynx

Both Sexes, 50-69 Years of Age

Table 6.2.7: Risk of subsequent primary cancers after cancer of the larynx, both sexes,

50-69 years of age, SEER 1973-2000.

170 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LARYNX

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 14,897 12,985 7,764 4,380 14,897

Person-years in interval 11,575 39,440 29,868 24,492 105,375

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 18,362 PYR and for male cancers on 87,013 PYR.
Larynx

Both Sexes, ≥70 Years of Age

Table 6.2.8: Risk of subsequent primary cancers after cancer of the larynx, both sexes,

≥70 years of age, SEER 1973-2000.

LARYNX

All subsequent cancers 206 1.50* 635 1.51* 306 1.34* 93 1.08 1,240 873.10 1.42* 130.79

All excluding same site 203 1.49* 630 1.52* 305 1.34* 93 1.08 1,231 864.29 1.42* 130.72

Buccal cavity, pharynx 9 2.77* 36 3.83* 14 3.00* 3 1.78 62 19.02 3.26* 15.32

Lip 0 0.00 1 0.46 2 1.75 0 0.00 3 4.46 0.67 -0.52

Tongue 4 6.94* 16 9.77* 5 6.46* 0 0.00 25 3.24 7.72* 7.76

Salivary gland 0 0.00 2 2.07 1 1.69 0 0.00 3 2.14 1.40 0.31

Mouth 2 2.61 10 4.51* 2 1.82 2 5.14 16 4.47 3.58* 4.11

Nasopharynx 1 10.14 0 0.00 1 8.08 0 0.00 2 0.54 3.71 0.52

Tonsil 1 4.11 1 1.48 0 0.00 0 0.00 2 1.30 1.54 0.25

Oropharynx 0 0.00 1 4.49 1 9.99 1 32.80 3 0.43 6.93* 0.92

Hypopharynx 1 3.00 1 1.09 2 5.09 0 0.00 4 1.76 2.27 0.80

Digestive system 32 1.01 121 1.24* 61 1.11 26 1.19 240 206.52 1.16* 11.93

Esophagus 5 3.15* 11 2.36* 13 5.40* 2 2.21 31 9.56 3.24* 7.64

Stomach 4 1.08 11 0.98 7 1.13 1 0.40 23 23.66 0.97 -0.24

Small intestine 0 0.00 3 2.51 2 3.04 1 3.77 6 2.51 2.39 1.24

Colon 16 1.11 53 1.17 22 0.83 12 1.11 103 97.16 1.06 2.08

Rectum, rectosigmoid junction 2 0.37 18 1.11 7 0.81 5 1.59 32 33.50 0.96 -0.53

Anus, anal canal 0 0.00 1 1.80 0 0.00 0 0.00 1 1.16 0.87 -0.06

Liver 1 0.95 8 2.50* 3 1.76 0 0.00 12 6.59 1.82 1.93

Gallbladder 0 0.00 2 1.80 2 3.15 0 0.00 4 2.37 1.69 0.58

Bile ducts, other biliary 1 1.50 1 0.46 1 0.74 0 0.00 3 4.81 0.62 -0.64

Pancreas 3 0.82 13 1.16 4 0.64 5 2.03 25 23.52 1.06 0.53

Respiratory system 73 2.95* 229 3.13* 98 2.66* 30 2.41* 430 147.24 2.92* 100.80

Nose, nasal cavity, ear 1 5.34 4 6.97* 0 0.00 0 0.00 5 1.21 4.12* 1.35

Larynx 3 1.87 5 1.10 1 0.49 0 0.00 9 8.81 1.02 0.07

Lung, bronchus 69 3.01* 219 3.22* 97 2.82* 30 2.57* 415 136.84 3.03* 99.16

Female breast 2 0.58 13 1.30 5 0.88 3 1.46 23 21.17 1.09 3.92

Female genital system 4 2.64 3 0.70 4 1.74 1 1.23 12 8.91 1.35 6.61

Cervix uteri 1 7.22 0 0.00 0 0.00 0 0.00 1 0.78 1.29 0.48

Corpus uteri 1 1.31 1 0.47 2 1.85 1 2.91 5 4.30 1.16 1.49

Ovary 1 2.20 1 0.77 1 1.37 0 0.00 3 2.76 1.09 0.51

Vagina 0 0.00 1 11.63 0 0.00 0 0.00 1 0.19 5.38 1.74

Vulva 0 0.00 0 0.00 1 5.55 0 0.00 1 0.63 1.59 0.79

Male genital system 53 1.30 115 0.92 63 0.94 13 0.54* 244 257.08 0.95 -5.60

Prostate 53 1.31 113 0.91 62 0.93 13 0.54* 241 255.08 0.94 -6.03

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.11

Urinary system 12 0.94 57 1.42* 30 1.33 7 0.78 106 84.29 1.26* 7.74

Urinary bladder 8 0.84 40 1.33 25 1.45 5 0.72 78 63.77 1.22 5.07

Kidney parenchyma 4 1.62 14 1.87* 2 0.50 2 1.39 22 15.37 1.43 2.36

Renal pelvis, other urinary 0 0.00 3 1.21 3 2.23 0 0.00 6 5.15 1.16 0.30

Ureter 0 0.00 1 1.17 2 4.35 0 0.00 3 1.76 1.71 0.44

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.20

Soft tissue including heart 2 4.15 0 0.00 2 2.32 1 2.67 5 3.22 1.55 0.64

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.87 0.00 -0.31

Melanoma of skin 0 0.00 3 0.41 3 0.70 1 0.53 7 15.77 0.44* -3.12

Eye, orbit 0 0.00 0 0.00 1 3.56 0 0.00 1 1.08 0.92 -0.03

Brain, central nervous system 1 0.93 2 0.62 0 0.00 1 1.73 4 6.54 0.61 -0.91

Thyroid 2 5.87 2 2.03 0 0.00 0 0.00 4 1.98 2.02 0.72

Lymphatic, hematopoietic 9 0.90 36 1.16 18 1.01 3 0.41 66 66.24 1.00 -0.08

Hodgkin lymphoma 0 0.00 3 4.11 1 2.80 0 0.00 4 1.46 2.74 0.90

Non-Hodgkin lymphoma 3 0.75 17 1.35 10 1.36 1 0.34 31 26.91 1.15 1.46

Myeloma 2 1.11 5 0.89 2 0.64 2 1.60 11 11.77 0.93 -0.28

Leukemia 4 1.02 11 0.90 5 0.71 0 0.00 20 26.09 0.77 -2.17

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.22

Chronic lymphocytic 1 0.64 1 0.21 1 0.36 0 0.00 3 10.33 0.29* -2.61

Acute non-lymphocytic 3 2.29 8 1.94 3 1.27 0 0.00 14 8.76 1.60 1.87

Chronic myeloid 0 0.00 2 1.21 1 1.02 0 0.00 3 3.56 0.84 -0.20

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,436 5,121 2,269 775 6,436

Person-years in interval 4,723 13,758 6,988 2,583 28,052

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 4,683 PYR and for male cancers on 23,369 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 171
All subsequent cancers 387 1.75* 1,525 1.95* 1,050 1.68* 839 1.52* 3,801 2,178.17 1.75* 148.48

All excluding same site 384 1.77* 1,513 1.97* 1,039 1.69* 831 1.52* 3,767 2,146.93 1.75* 148.22

Buccal cavity, pharynx 36 5.06* 133 5.61* 119 7.00* 78 6.03* 366 60.75 6.02* 27.93

Lip 2 1.74 5 1.30 2 0.71 1 0.46 10 9.99 1.00 0.00

Tongue 15 10.86* 39 8.46* 29 8.69* 19 7.44* 102 11.89 8.58* 8.24

Salivary gland 0 0.00 3 1.71 6 4.26* 2 1.55 11 4.96 2.22* 0.55

Mouth 11 6.14* 47 7.95* 35 8.41* 16 5.23* 109 14.92 7.31* 8.61

Nasopharynx 1 3.71 2 2.30 3 5.02* 1 2.29 7 2.17 3.22* 0.44

Tonsil 2 2.79 17 7.31* 14 8.77* 14 12.26* 47 5.78 8.13* 3.77

Oropharynx 1 4.61 3 4.18 8 15.60* 2 5.25 14 1.83 7.66* 1.11

Hypopharynx 4 4.83* 8 2.92* 16 8.27* 15 10.86* 43 6.89 6.25* 3.30

Digestive system 52 1.08 252 1.50* 178 1.35* 149 1.30* 631 462.98 1.36* 15.37

Esophagus 6 1.93 54 5.11* 33 4.11* 33 4.84* 126 28.53 4.42* 8.92

Stomach 11 2.00 20 1.06 17 1.18 10 0.83 58 50.80 1.14 0.66

Small intestine 0 0.00 3 1.27 2 1.05 4 2.33 9 6.64 1.36 0.22

Colon 19 0.93 92 1.27* 64 1.10 57 1.11 232 202.07 1.15* 2.74

Rectum, rectosigmoid junction 5 0.57 32 1.05 26 1.12 17 0.89 80 81.53 0.98 -0.14

Anus, anal canal 0 0.00 1 0.77 1 1.00 1 1.21 3 3.50 0.86 -0.05

Liver 2 1.10 17 2.66* 11 2.17* 10 2.19* 40 17.86 2.24* 2.03

Gallbladder 0 0.00 0 0.00 4 3.13 0 0.00 4 4.48 0.89 -0.04

Bile ducts, other biliary 1 1.07 5 1.49 2 0.72 3 1.10 11 9.82 1.12 0.11

Pancreas 8 1.41 27 1.37 17 1.11 12 0.90 64 53.98 1.19 0.92

Respiratory system 153 3.43* 657 4.25* 419 3.53* 299 3.04* 1,528 416.15 3.67* 101.73

Nose, nasal cavity, ear 1 2.90 11 9.38* 1 1.13 0 0.00 13 3.14 4.14* 0.90

Larynx 3 0.82 12 0.98 11 1.25 8 1.21 34 31.24 1.09 0.25

Lung, bronchus 147 3.63* 631 4.48* 407 3.75* 291 3.20* 1,476 380.78 3.88* 100.20

Female breast 8 0.99 35 1.30 18 0.87 22 1.31 83 72.46 1.15 5.29

Female genital system 5 1.32 14 1.12 11 1.22 8 1.15 38 32.25 1.18 2.89

Cervix uteri 1 2.13 3 2.08 1 1.08 1 1.60 6 3.46 1.73 1.28

Corpus uteri 0 0.00 5 0.76 4 0.85 5 1.39 14 16.83 0.83 -1.42

Ovary 3 2.80 3 0.84 5 1.87 2 0.94 13 9.44 1.38 1.79

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.24

Vulva 0 0.00 2 4.17 1 2.58 0 0.00 3 1.36 2.21 0.83

Male genital system 64 1.11 188 0.89 151 0.84* 146 0.86 549 620.10 0.89* -7.95

Prostate 63 1.11 186 0.89 149 0.83* 144 0.85 542 614.73 0.88* -8.14

Testis 0 0.00 0 0.00 0 0.00 1 4.12 1 1.60 0.63 -0.07

Urinary system 24 1.23 111 1.59* 60 1.07 60 1.18 255 196.32 1.30* 5.37

Urinary bladder 14 1.02 76 1.55* 49 1.22 45 1.23 184 139.58 1.32* 4.06

Kidney parenchyma 10 2.13* 29 1.76* 8 0.62 11 0.97 58 45.43 1.28 1.15

Renal pelvis, other urinary 0 0.00 6 1.45 3 0.93 4 1.44 13 11.31 1.15 0.15

Ureter 0 0.00 1 0.72 2 1.84 1 1.07 4 3.79 1.05 0.02

Bone, joints 0 0.00 0 0.00 0 0.00 2 5.36 2 1.68 1.19 0.03

Soft tissue including heart 3 3.60 2 0.70 1 0.45 1 0.49 7 7.99 0.88 -0.09

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 2.53 0.00 -0.23

Melanoma of skin 2 0.43 12 0.72 13 0.95 8 0.62 35 47.94 0.73 -1.18

Eye, orbit 0 0.00 0 0.00 2 2.40 0 0.00 2 2.94 0.68 -0.09

Brain, central nervous system 2 0.87 8 1.02 5 0.84 6 1.24 21 20.95 1.00 0.00

Thyroid 9 9.70* 9 2.93* 1 0.45 0 0.00 19 7.99 2.38* 1.01

Lymphatic, hematopoietic 14 0.89 67 1.20 47 1.05 34 0.85 162 156.23 1.04 0.53

Hodgkin lymphoma 1 1.76 3 1.64 2 1.58 3 3.17 9 4.61 1.95 0.40

Non-Hodgkin lymphoma 5 0.75 34 1.43 22 1.13 16 0.89 77 67.94 1.13 0.83

Myeloma 3 1.06 12 1.21 6 0.76 4 0.56 25 27.81 0.90 -0.26

Leukemia 5 0.88 18 0.90 17 1.06 11 0.78 51 55.87 0.91 -0.45

Acute lymphocytic 0 0.00 0 0.00 0 0.00 2 5.90 2 1.44 1.39 0.05

Chronic lymphocytic 1 0.43 1 0.12* 4 0.61 1 0.18* 7 22.86 0.31* -1.45

Acute non-lymphocytic 4 2.17 10 1.52 6 1.13 5 1.03 25 18.56 1.35 0.59

Chronic myeloid 0 0.00 4 1.50 5 2.36 1 0.52 10 7.49 1.33 0.23

Larynx

Both Sexes, Radiotherapy

Table 6.2.9: Risk of subsequent primary cancers after cancer of the larynx, both sexes,

with initial radiotherapy, SEER 1973-2000.

172 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LARYNX

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 17,617 15,036 8,174 4,206 17,617

Person-years in interval 13,570 43,650 29,976 22,103 109,298

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 19,917 PYR and for male cancers on 89,381 PYR.
Larynx

Both Sexes, No Radiotherapy

Table 6.2.10: Risk of subsequent primary cancers after cancer of the larynx, both sexes,

without initial radiotherapy, SEER 1973-2000.

LARYNX

All subsequent cancers 128 1.74* 532 1.89* 427 1.67* 389 1.30* 1,476 909.24 1.62* 121.68

All excluding same site 125 1.73* 519 1.88* 422 1.67* 384 1.30* 1,450 895.73 1.62* 119.00

Buccal cavity, pharynx 9 3.55* 55 6.01* 24 3.27* 40 5.65* 128 26.13 4.90* 21.87

Lip 0 0.00 1 0.64 1 0.81 5 4.09* 7 4.47 1.57 0.54

Tongue 5 10.37* 16 9.12* 6 4.21* 12 8.57* 39 5.06 7.70* 7.29

Salivary gland 0 0.00 0 0.00 2 3.48 2 2.89 4 2.07 1.93 0.41

Mouth 1 1.55 17 7.36* 5 2.76 7 4.19* 30 6.44 4.66* 5.06

Nasopharynx 0 0.00 1 3.15 1 4.04 1 4.38 3 0.88 3.39 0.45

Tonsil 1 3.96 8 9.00* 5 7.24* 5 8.02* 19 2.46 7.74* 3.55

Oropharynx 1 13.07 1 3.65 0 0.00 2 9.50* 4 0.78 5.12* 0.69

Hypopharynx 1 3.42 5 4.71* 2 2.35 5 6.57* 13 2.97 4.38* 2.15

Digestive system 22 1.35 84 1.36* 85 1.56* 72 1.17 263 193.68 1.36* 14.88

Esophagus 7 6.74* 11 2.88* 17 5.13* 7 1.91 42 11.85 3.55* 6.47

Stomach 1 0.53 6 0.87 11 1.86 7 1.10 25 21.07 1.19 0.84

Small intestine 1 4.59 1 1.21 3 3.90 1 1.08 6 2.74 2.19 0.70

Colon 8 1.16 32 1.21 33 1.38 34 1.23 107 84.78 1.26* 4.77

Rectum, rectosigmoid junction 3 0.98 14 1.22 13 1.32 8 0.77 38 34.67 1.10 0.71

Anus, anal canal 0 0.00 1 2.13 1 2.44 2 4.45 4 1.45 2.75 0.55

Liver 1 1.74 2 0.92 0 0.00 5 2.09 8 7.10 1.13 0.19

Gallbladder 0 0.00 4 6.66* 1 1.92 0 0.00 5 1.85 2.70 0.68

Bile ducts, other biliary 0 0.00 2 1.70 0 0.00 2 1.39 4 4.01 1.00 0.00

Pancreas 1 0.52 11 1.52 6 0.95 6 0.85 24 22.58 1.06 0.30

Respiratory system 45 2.92* 230 3.99* 159 3.17* 134 2.50* 568 176.82 3.21* 83.98

Nose, nasal cavity, ear 1 8.37 4 9.14* 2 5.41 0 0.00 7 1.32 5.28* 1.22

Larynx 3 2.30 13 2.75* 5 1.30 5 1.37 26 13.52 1.92* 2.68

Lung, bronchus 41 2.94* 210 4.01* 152 3.32* 128 2.59* 531 161.54 3.29* 79.32

Female breast 2 0.78 14 1.48 12 1.42 3 0.34* 31 29.28 1.06 2.08

Female genital system 2 1.58 8 1.76 7 1.87 1 0.27 18 13.20 1.36 5.83

Cervix uteri 0 0.00 2 3.72 1 2.55 0 0.00 3 1.43 2.10 1.91

Corpus uteri 2 2.97 1 0.42 2 1.02 1 0.53 6 6.92 0.87 -1.11

Ovary 0 0.00 3 2.35 3 2.73 0 0.00 6 3.84 1.56 2.62

Vagina 0 0.00 2 32.15* 1 18.33 0 0.00 3 0.19 15.68* 3.41

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -0.66

Male genital system 21 1.16 76 1.06 62 0.87 62 0.67* 221 254.05 0.87* -8.62

Prostate 21 1.17 76 1.07 61 0.86 62 0.67* 220 251.74 0.87* -8.28

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.72 0.00 -0.19

Urinary system 10 1.50 29 1.13 48 2.07* 36 1.30 123 83.10 1.48* 8.57

Urinary bladder 5 1.07 15 0.83 32 1.94* 27 1.35 79 59.32 1.33* 4.23

Kidney parenchyma 5 3.21* 12 2.03* 11 2.06* 8 1.30 36 18.94 1.90* 3.66

Renal pelvis, other urinary 0 0.00 2 1.28 5 3.69* 1 0.66 8 4.85 1.65 0.68

Ureter 0 0.00 2 3.81 2 4.35 0 0.00 4 1.63 2.45 0.51

Bone, joints 0 0.00 0 0.00 0 0.00 1 4.84 1 0.72 1.38 0.06

Soft tissue including heart 0 0.00 0 0.00 1 1.09 1 0.92 2 3.33 0.60 -0.29

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.07 0.00 -0.23

Melanoma of skin 0 0.00 2 0.34 3 0.54 4 0.57 9 20.01 0.45* -2.36

Eye, orbit 0 0.00 0 0.00 1 2.82 0 0.00 1 1.27 0.79 -0.06

Brain, central nervous system 0 0.00 2 0.67 2 0.79 1 0.37 5 8.98 0.56 -0.85

Thyroid 4 13.08* 0 0.00 0 0.00 2 2.10 6 3.29 1.83 0.58

Lymphatic, hematopoietic 12 2.27* 22 1.09 13 0.71 16 0.74 63 65.32 0.96 -0.50

Hodgkin lymphoma 0 0.00 0 0.00 2 3.63 0 0.00 2 2.00 1.00 0.00

Non-Hodgkin lymphoma 8 3.65* 11 1.30 7 0.89 10 1.03 36 28.18 1.28 1.68

Myeloma 2 2.14 3 0.85 0 0.00 1 0.26 6 11.52 0.52 -1.18

Leukemia 2 1.03 8 1.08 4 0.61 5 0.65 19 23.62 0.80 -0.99

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.13

Chronic lymphocytic 0 0.00 1 0.32 1 0.36 2 0.64 4 9.77 0.41 -1.24

Acute non-lymphocytic 2 3.21 4 1.68 3 1.39 1 0.38 10 7.77 1.29 0.48

Chronic myeloid 0 0.00 1 1.02 0 0.00 2 1.92 3 3.14 0.95 -0.03

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,326 5,387 3,336 1,930 6,326

Person-years in interval 4,783 16,745 12,891 12,159 46,579

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 8,241 PYR and for male cancers on 38,338 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 173
Nasal Cavities

Both Sexes

Table 6.3.1: Characteristics of patients with an initial cancer of the nose, nasal cavities or middle ear,

both sexes, SEER 1973-2000.

174 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

NASAL CAVITIES

Number of patients with 1st primary cancer

Total 2,063 100.0 1,480 100.0 3,543 100.0

Initial treatment

Any radiation 1,366 66.2 939 63.4 2,305 65.1

With surgery 878 42.6 584 39.5 1,462 41.3

Without surgery 488 23.7 355 24.0 843 23.8

No radiation 697 33.8 541 36.6 1,238 34.9

With surgery 567 27.5 431 29.1 998 28.2

Without surgery 130 6.3 110 7.4 240 6.8

Race

White 1,683 81.6 1,222 82.6 2,905 82.0

Black 187 9.1 135 9.1 322 9.1

Other 180 8.7 117 7.9 297 8.4

Unknown 13 0.6 6 0.4 19 0.5

Age at 1st primary cancer diagnosis, years

< 30 89 4.3 85 5.7 174 4.9

30–49 354 17.2 227 15.3 581 16.4

50–69 1,012 49.1 616 41.6 1,628 45.9

70–79 410 19.9 323 21.8 733 20.7

> 80 198 9.6 229 15.5 427 12.1

Number of patients with one or more

primary cancers

One primary cancer only 1,835 88.9 1,350 91.2 3,185 89.9

1st and 2nd cancers 198 9.6 118 8.0 316 8.9

1st, 2nd, and 3rd cancers 28 1.4 10 0.7 38 1.1

1st, 2nd, 3rd, and additional cancers 2 0.1 2 0.1 4 0.1

Other statistics

Median age at 1st cancer diagnosis 62.3 — 65.0 — 63.4 —

Median year of 1st cancer diagnosis 1987.6 — 1988.0 — 1987.8 —

Median person-years at risk 2.5 — 2.9 — 2.7 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 90.4 — 96.2 — 92.5

1st, 2nd, and additional cancers — 90.4 — 96.2 — 92.5

1st cancer only — 8.8 — 3.8 — 7.0

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Nasal Cavities

Both Sexes

Table 6.3.2: Risk of subsequent primary cancers after cancer of the nose, nasal cavities, or middle ear,

both sexes, SEER 1973-2000.

NASAL CAVITIES

All subsequent cancers 60 1.71* 154 1.52* 100 1.33* 91 1.32* 405 280.68 1.44* 67.65

All excluding same site 57 1.62* 153 1.51* 98 1.30* 88 1.28* 396 280.26 1.41* 62.98

Buccal cavity, pharynx 6 6.10* 12 4.35* 4 2.09 6 3.84* 28 7.22 3.88* 11.31

Lip 3 19.40* 3 7.07* 0 0.00 1 4.19 7 1.11 6.29* 3.20

Tongue 0 0.00 2 3.68 0 0.00 2 6.27 4 1.43 2.79 1.40

Salivary gland 0 0.00 1 4.35 0 0.00 1 6.40 2 0.64 3.14 0.74

Mouth 3 11.60* 4 5.56* 0 0.00 1 2.53 8 1.87 4.29* 3.34

Nasopharynx 0 0.00 0 0.00 0 0.00 1 16.22 1 0.31 3.23 0.38

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.66 0.00 -0.36

Oropharynx 0 0.00 1 12.96 0 0.00 0 0.00 1 0.20 4.94 0.43

Hypopharynx 0 0.00 1 3.48 3 15.24* 0 0.00 4 0.74 5.42* 1.77

Digestive system 12 1.47 33 1.44 28 1.70* 14 0.96 87 62.17 1.40* 13.51

Esophagus 1 2.46 2 1.76 2 2.44 1 1.34 6 3.11 1.93 1.57

Stomach 0 0.00 8 3.23* 0 0.00 3 2.12 11 6.49 1.69 2.45

Small intestine 0 0.00 0 0.00 1 4.36 0 0.00 1 0.86 1.16 0.08

Colon 3 0.82 12 1.17 17 2.27* 4 0.60 36 28.05 1.28 4.33

Rectum, rectosigmoid junction 6 4.22* 5 1.25 4 1.41 3 1.24 18 10.68 1.68 3.98

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.30

Liver 0 0.00 2 2.45 1 1.70 0 0.00 3 2.24 1.34 0.41

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -0.45

Bile ducts, other biliary 0 0.00 1 2.03 1 2.70 0 0.00 2 1.39 1.44 0.33

Pancreas 2 2.05 3 1.10 2 1.02 3 1.72 10 7.38 1.35 1.42

Respiratory system 17 2.75* 48 2.69* 23 1.76* 25 2.15* 113 48.77 2.32* 34.95

Nose, nasal cavity, ear 3 50.50* 1 6.37 2 18.36* 3 31.68* 9 0.42 21.43* 4.67

Larynx 2 4.60 3 2.43 1 1.15 2 2.86 8 3.24 2.47* 2.59

Lung, bronchus 12 2.11* 44 2.68* 20 1.65* 20 1.85* 96 44.99 2.13* 27.76

Female breast 6 1.86 13 1.40 9 1.33 6 0.95 34 25.67 1.32 10.35

Female genital system 0 0.00 6 1.40 1 0.34 3 1.16 10 11.34 0.88 -1.66

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 1.28 0.00 -1.59

Corpus uteri 0 0.00 2 0.92 1 0.67 0 0.00 3 5.74 0.52 -3.41

Ovary 0 0.00 2 1.62 0 0.00 2 2.51 4 3.35 1.19 0.80

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.22

Vulva 0 0.00 2 10.41* 0 0.00 1 7.56 3 0.53 5.65* 3.07

Male genital system 5 0.73 14 0.68 9 0.55 11 0.69 39 59.67 0.65* -20.00

Prostate 5 0.74 14 0.69 9 0.55 11 0.70 39 59.02 0.66* -19.38

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.26

Urinary system 3 1.06 11 1.34 9 1.46 7 1.23 30 22.87 1.31 3.88

Urinary bladder 3 1.53 7 1.23 7 1.63 6 1.50 23 15.94 1.44 3.84

Kidney parenchyma 0 0.00 2 1.01 2 1.35 0 0.00 4 5.52 0.72 -0.83

Renal pelvis, other urinary 0 0.00 2 3.86 0 0.00 1 3.03 3 1.41 2.13 0.87

Ureter 0 0.00 1 5.78 0 0.00 0 0.00 1 0.47 2.13 0.29

Bone, joints 1 30.59 0 0.00 0 0.00 1 18.30 2 0.24 8.21 0.96

Soft tissue including heart 0 0.00 1 2.52 3 10.37* 2 7.52 6 1.09 5.49* 2.67

Kaposi sarcoma 0 0.00 1 6.47 0 0.00 0 0.00 1 0.39 2.54 0.33

Melanoma of skin 1 1.38 1 0.45 0 0.00 3 1.80 5 6.30 0.79 -0.70

Eye, orbit 1 19.40 0 0.00 0 0.00 0 0.00 1 0.40 2.52 0.33

Brain, central nervous system 0 0.00 1 0.96 1 1.33 1 1.52 3 2.82 1.07 0.10

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.51 0.00 -0.82

Lymphatic, hematopoietic 6 2.28 9 1.19 8 1.43 9 1.74 32 20.94 1.53* 6.02

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 1 7.10 1 0.68 1.48 0.18

Non-Hodgkin lymphoma 4 3.50 4 1.19 3 1.18 5 2.07 16 9.46 1.69 3.56

Myeloma 1 2.20 3 2.36 0 0.00 0 0.00 4 3.53 1.13 0.26

Leukemia 1 1.07 2 0.76 5 2.57 3 1.71 11 7.28 1.51 2.02

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.12

Chronic lymphocytic 0 0.00 0 0.00 2 2.58 2 2.89 4 2.89 1.38 0.60

Acute non-lymphocytic 1 3.20 1 1.12 1 1.52 0 0.00 3 2.47 1.21 0.29

Chronic myeloid 0 0.00 0 0.00 2 7.62 0 0.00 2 0.99 2.03 0.55

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,543 2,715 1,298 667 3,543

Person-years in interval 2,582 7,213 4,773 3,809 18,377

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 8,043 PYR and for male cancers on 10,334 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 175
All subsequent cancers 21 1.80* 48 1.45* 41 1.73* 35 1.58* 145 90.63 1.60* 67.60

All excluding same site 19 1.63 48 1.45* 39 1.65* 34 1.53* 140 90.50 1.55* 61.54

Buccal cavity, pharynx 3 14.22* 5 8.34* 0 0.00 3 8.02* 11 1.61 6.84* 11.68

Lip 1 71.54 0 0.00 0 0.00 1 37.44 2 0.11 18.53* 2.35

Tongue 0 0.00 1 7.58 0 0.00 1 11.88 2 0.36 5.62 2.04

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.22

Mouth 2 27.24* 3 14.47* 0 0.00 0 0.00 5 0.56 9.01* 5.53

Nasopharynx 0 0.00 0 0.00 0 0.00 1 61.43 1 0.07 13.94 1.15

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.17

Oropharynx 0 0.00 1 65.73 0 0.00 0 0.00 1 0.04 24.74 1.19

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.13

Digestive system 4 1.41 10 1.28 10 1.85 5 0.99 29 21.13 1.37 9.79

Esophagus 0 0.00 2 9.57* 0 0.00 1 7.11 3 0.57 5.24* 3.02

Stomach 0 0.00 1 1.52 0 0.00 2 5.23 3 1.71 1.76 1.61

Small intestine 0 0.00 0 0.00 1 12.80 0 0.00 1 0.30 3.36 0.87

Colon 2 1.42 3 0.78 6 2.22 1 0.40 12 10.50 1.14 1.86

Rectum, rectosigmoid junction 1 2.25 2 1.62 2 2.37 1 1.32 6 3.28 1.83 3.39

Rectum 1 3.45 2 2.49 1 1.81 0 0.00 4 2.15 1.86 2.30

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.34

Liver 0 0.00 2 11.26* 0 0.00 0 0.00 2 0.49 4.07 1.88

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.59

Bile ducts, other biliary 0 0.00 0 0.00 1 8.05 0 0.00 1 0.48 2.07 0.64

Pancreas 1 2.71 0 0.00 0 0.00 0 0.00 1 2.77 0.36 -2.20

Respiratory system 5 3.43* 10 2.35* 8 2.47* 8 2.50* 31 12.15 2.55* 23.44

Nose, nasal cavity, ear 2 110.66* 0 0.00 2 61.53* 1 33.31 5 0.13 39.09* 6.06

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.47

Lung, bronchus 3 2.16 10 2.47* 6 1.94 7 2.28 26 11.61 2.24* 17.89

Female breast 6 1.86 13 1.40 9 1.33 6 0.95 34 25.67 1.32 10.35

Female genital system 0 0.00 6 1.40 1 0.34 3 1.16 10 11.34 0.88 -1.66

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 1.28 0.00 -1.59

Corpus uteri 0 0.00 2 0.92 1 0.67 0 0.00 3 5.74 0.52 -3.41

Ovary 0 0.00 2 1.62 0 0.00 2 2.51 4 3.35 1.19 0.80

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.22

Vulva 0 0.00 2 10.41* 0 0.00 1 7.56 3 0.53 5.65* 3.07

Urinary system 0 0.00 1 0.64 2 1.77 0 0.00 3 4.35 0.69 -1.68

Urinary bladder 0 0.00 1 1.07 2 3.01 0 0.00 3 2.57 1.17 0.53

Kidney parenchyma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.42 0.00 -1.77

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.45

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.14

Bone, joints 1 88.32* 0 0.00 0 0.00 0 0.00 1 0.09 11.55 1.14

Soft tissue including heart 0 0.00 0 0.00 2 21.17* 2 22.26* 4 0.37 10.95* 4.52

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.04

Melanoma of skin 0 0.00 1 1.56 0 0.00 2 4.33 3 1.80 1.67 1.49

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.16

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.93 0.00 -1.16

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.86 0.00 -1.07

Lymphatic, hematopoietic 2 2.24 1 0.40 5 2.74 5 2.86 13 6.99 1.86 7.48

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 1 19.76 1 0.22 4.49 0.97

Non-Hodgkin lymphoma 2 4.79 1 0.83 2 2.23 2 2.28 7 3.39 2.06 4.48

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.19 0.00 -1.48

Leukemia 0 0.00 0 0.00 3 5.33* 2 3.79 5 2.18 2.29 3.51

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.09

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 1 5.01 1 0.83 1.21 0.21

Acute non-lymphocytic 0 0.00 0 0.00 1 4.96 0 0.00 1 0.78 1.28 0.27

Chronic myeloid 0 0.00 0 0.00 2 25.76* 0 0.00 2 0.30 6.65 2.11

Nasal Cavities

Females

Table 6.3.3: Risk of subsequent primary cancers after cancer of the nose, nasal cavities, or middle ear,

females, SEER 1973-2000.

176 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

NASAL CAVITIES

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,480 1,127 560 299 1,480

Person-years in interval 1,075 3,093 2,103 1,772 8,043

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Nasal Cavities

Males

Table 6.3.4: Risk of subsequent primary cancers after cancer of the nose, nasal cavities, or middle ear,

males, SEER 1973-2000.

NASAL CAVITIES

All subsequent cancers 39 1.66* 106 1.55* 59 1.14 56 1.20 260 190.05 1.37* 67.69

All excluding same site 38 1.62* 105 1.54* 59 1.15 54 1.16 256 189.76 1.35* 64.10

Buccal cavity, pharynx 3 3.88 7 3.24* 4 2.68 3 2.53 17 5.61 3.03* 11.02

Lip 2 14.22* 3 7.78* 0 0.00 0 0.00 5 1.01 4.97* 3.87

Tongue 0 0.00 1 2.43 0 0.00 1 4.26 2 1.08 1.86 0.89

Salivary gland 0 0.00 1 6.06 0 0.00 1 8.83 2 0.46 4.35 1.49

Mouth 1 5.40 1 1.95 0 0.00 1 3.76 3 1.31 2.29 1.63

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.23

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.53 0.00 -0.51

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.16

Hypopharynx 0 0.00 1 4.06 3 17.88* 0 0.00 4 0.63 6.35* 3.26

Digestive system 8 1.50 23 1.52 18 1.63 9 0.94 58 41.04 1.41* 16.41

Esophagus 1 3.02 0 0.00 2 2.97 0 0.00 3 2.54 1.18 0.45

Stomach 0 0.00 7 3.85* 0 0.00 1 0.97 8 4.79 1.67 3.11

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.54

Colon 1 0.45 9 1.41 11 2.30* 3 0.72 24 17.55 1.37 6.25

Rectum, rectosigmoid junction 5 5.11* 3 1.08 2 1.00 2 1.20 12 7.41 1.62 4.44

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.27

Liver 0 0.00 0 0.00 1 2.15 0 0.00 1 1.75 0.57 -0.73

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.34

Bile ducts, other biliary 0 0.00 1 3.14 0 0.00 0 0.00 1 0.90 1.11 0.09

Pancreas 1 1.65 3 1.76 2 1.61 3 2.82 9 4.62 1.95 4.24

Respiratory system 12 2.54* 38 2.80* 15 1.52 17 2.01* 82 36.62 2.24* 43.91

Nose, nasal cavity, ear 1 24.19 1 9.13 0 0.00 2 30.92* 4 0.29 13.70* 3.59

Larynx 2 5.16 3 2.73 1 1.31 2 3.28 8 2.86 2.80* 4.97

Lung, bronchus 9 2.10 34 2.76* 14 1.56 13 1.68 70 33.37 2.10* 35.44

Male breast 1 22.14 0 0.00 0 0.00 0 0.00 1 0.35 2.82 0.62

Male genital system 5 0.73 14 0.68 9 0.55 11 0.69 39 59.67 0.65* -20.00

Prostate 5 0.74 14 0.69 9 0.55 11 0.70 39 59.02 0.66* -19.38

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.26

Urinary system 3 1.32 10 1.51 7 1.39 7 1.52 27 18.52 1.46 8.21

Urinary bladder 3 1.84 6 1.26 5 1.37 6 1.79 20 13.37 1.50 6.41

Kidney parenchyma 0 0.00 2 1.35 2 1.80 0 0.00 4 4.10 0.98 -0.09

Renal pelvis, other urinary 0 0.00 2 5.19 0 0.00 1 4.12 3 1.04 2.87 1.89

Ureter 0 0.00 1 7.62 0 0.00 0 0.00 1 0.36 2.80 0.62

Bone, joints 0 0.00 0 0.00 0 0.00 1 28.97 1 0.16 6.37 0.82

Soft tissue including heart 0 0.00 1 3.80 1 5.14 0 0.00 2 0.73 2.75 1.23

Kaposi sarcoma 0 0.00 1 7.05 0 0.00 0 0.00 1 0.36 2.77 0.62

Melanoma of skin 1 1.95 0 0.00 0 0.00 1 0.83 2 4.49 0.44 -2.41

Eye, orbit 1 29.23 0 0.00 0 0.00 0 0.00 1 0.27 3.76 0.71

Brain, central nervous system 0 0.00 1 1.42 1 1.98 1 2.31 3 1.88 1.59 1.08

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -0.63

Lymphatic, hematopoietic 4 2.30 8 1.60 3 0.79 4 1.17 19 13.96 1.36 4.88

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.44

Non-Hodgkin lymphoma 2 2.75 3 1.39 1 0.61 3 1.94 9 6.07 1.48 2.84

Myeloma 1 3.38 3 3.58 0 0.00 0 0.00 4 2.34 1.71 1.61

Leukemia 1 1.54 2 1.09 2 1.45 1 0.82 6 5.10 1.18 0.87

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.14

Chronic lymphocytic 0 0.00 0 0.00 2 3.57 1 2.03 3 2.06 1.46 0.91

Acute non-lymphocytic 1 4.74 1 1.64 0 0.00 0 0.00 2 1.69 1.18 0.30

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.69 0.00 -0.66

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,063 1,588 738 368 2,063

Person-years in interval 1,507 4,120 2,670 2,037 10,334

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 177
Mesothelioma

Both Sexes

Table 6.4.1: Characteristics of patients with an initial mesothelioma, both sexes,

SEER 1973-2000.

178 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

MESOTHELIOMA

Number of patients with 1st primary cancer

Total 3,213 100.0 893 100.0 4,106 100.0

Initial treatment

Any radiation 732 22.8 173 19.4 905 22.0

With surgery 220 6.8 57 6.4 277 6.7

Without surgery 512 15.9 116 13.0 628 15.3

No radiation 2,481 77.2 720 80.6 3,201 78.0

With surgery 524 16.3 220 24.6 744 18.1

Without surgery 1,957 60.9 500 56.0 2,457 59.8

Race

White 2,957 92.0 814 91.2 3,771 91.8

Black 136 4.2 52 5.8 188 4.6

Other 114 3.5 25 2.8 139 3.4

Unknown 6 0.2 2 0.2 8 0.2

Age at 1st primary cancer diagnosis, years

< 30 12 0.4 16 1.8 28 0.7

30–49 229 7.1 117 13.1 346 8.4

50–69 1,560 48.6 388 43.4 1,948 47.4

70–79 1,056 32.9 254 28.4 1,310 31.9

> 80 356 11.1 118 13.2 474 11.5

Number of patients with one or more

primary cancers

One primary cancer only 3,149 98.0 874 97.9 4,023 98.0

1st and 2nd cancers 60 1.9 16 1.8 76 1.9

1st, 2nd, and 3rd cancers 4 0.1 2 0.2 6 0.1

1st, 2nd, 3rd, and additional cancers 0 0.0 1 0.1 1 0.0

Other statistics

Median age at 1st cancer diagnosis 68.6 — 66.8 — 68.3 —

Median year of 1st cancer diagnosis 1989.9 — 1988.8 — 1989.7 —

Median person-years at risk 0.6 — 0.7 — 0.6 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 92.2 — 94.7 — 92.8

1st, 2nd, and additional cancers — 92.2 — 94.7 — 92.8

1st cancer only — 4.7 — 0.0 — 3.6

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Mesothelioma

Both Sexes

Table 6.4.2: Risk of subsequent primary cancers after mesothelioma, both sexes,

SEER 1973-2000.

MESOTHELIOMA

All subsequent cancers 34 0.86 42 1.18 5 0.54 10 1.18 91 92.79 0.98 -3.18

All excluding same site 33 0.84 41 1.15 5 0.54 10 1.18 89 92.49 0.96 -6.21

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 2.49 0.00 -4.43

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.73

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -0.88

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.38

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -1.12

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.16

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.41

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.13

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.47

Digestive system 7 0.82 12 1.59 0 0.00 2 1.16 21 19.77 1.06 2.19

Esophagus 0 0.00 1 2.41 0 0.00 0 0.00 1 1.08 0.93 -0.13

Stomach 1 1.10 0 0.00 0 0.00 0 0.00 1 2.04 0.49 -1.84

Small intestine 1 8.62 0 0.00 0 0.00 0 0.00 1 0.28 3.54 1.28

Colon 2 0.53 7 2.07 0 0.00 2 2.54 11 8.83 1.25 3.86

Rectum, rectosigmoid junction 3 1.95 3 2.22 0 0.00 0 0.00 6 3.51 1.71 4.44

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.30

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.70 0.00 -1.25

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.40

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.76

Pancreas 0 0.00 1 1.12 0 0.00 0 0.00 1 2.33 0.43 -2.37

Respiratory system 4 0.54 7 1.08 1 0.63 2 1.42 14 16.89 0.83 -5.15

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.24

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.19 0.00 -2.13

Lung, bronchus 4 0.59 7 1.17 1 0.68 2 1.52 14 15.52 0.90 -2.71

Female breast 1 0.62 2 0.79 1 0.86 0 0.00 4 6.52 0.61 -12.21

Female genital system 0 0.00 2 1.74 0 0.00 1 2.02 3 2.89 1.04 0.52

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -1.62

Corpus uteri 0 0.00 0 0.00 0 0.00 1 4.04 1 1.48 0.68 -2.32

Ovary 0 0.00 2 5.99 0 0.00 0 0.00 2 0.85 2.35 5.56

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.20

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.60

Male genital system 13 1.24 7 0.83 1 0.60 2 1.28 23 22.21 1.04 2.22

Prostate 13 1.25 6 0.72 1 0.60 2 1.29 22 21.99 1.00 0.03

Testis 0 0.00 1 30.18 0 0.00 0 0.00 1 0.08 12.32 2.59

Urinary system 5 1.39 3 0.98 1 1.42 0 0.00 9 7.99 1.13 1.80

Urinary bladder 2 0.78 1 0.46 1 2.10 0 0.00 4 5.63 0.71 -2.90

Kidney parenchyma 3 3.72 2 2.75 0 0.00 0 0.00 5 1.89 2.65 5.54

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.85

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.28

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.14

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.63

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.21

Melanoma of skin 1 1.12 3 3.53 0 0.00 1 4.68 5 2.18 2.29 5.02

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.24

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.95 0.00 -1.69

Thyroid 0 0.00 2 11.14* 0 0.00 1 17.57 3 0.45 6.61* 4.53

Lymphatic, hematopoietic 1 0.35 3 1.15 1 1.45 1 1.60 6 6.80 0.88 -1.43

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.39

Non-Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 3.04 0.00 -5.41

Myeloma 0 0.00 1 2.26 0 0.00 0 0.00 1 1.15 0.87 -0.27

Leukemia 1 0.96 2 2.19 1 4.34 1 5.01 5 2.39 2.09 4.65

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.11

Chronic lymphocytic 0 0.00 1 2.70 0 0.00 1 12.76 2 0.97 2.07 1.84

Acute non-lymphocytic 1 2.89 0 0.00 1 12.76 0 0.00 2 0.80 2.50 2.13

Chronic myeloid 0 0.00 1 8.12 0 0.00 0 0.00 1 0.32 3.12 1.21

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,106 1,674 230 84 4,106

Person-years in interval 2,131 2,229 680 576 5,617

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 2,065 PYR and for male cancers on 3,552 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE RESPIRATORY TRACT 179

NEW MALIGNANCIES FOLLOWING BREAST CANCER 181

Synopsis

The overall risk of subsequent cancer was increased by

18% among 322,863 women diagnosed with a first primary cancer of the breast during 1973-2000 (O/E=1.18,

O=34,500, EAR=23 per 10,000 person-years). The highest cancer risks for a new cancer occurred after earlyonset breast cancer (ages <40 years, O/E=3.33, EAR=71;

ages 40-49 years, O/E=1.59, EAR=38). New primary cancers of the breast accounted for nearly 40% of all subsequent malignancies, with increased risks likely reflecting hormonal, genetic, and other risk factors that

predisposed women to the initial breast malignancy, as

well as intensive medical screening of the opposite

breast. Genetic predisposition, notably from BRCA1/2

susceptibility genes, probably contributed to the pronounced excesses of subsequent breast and ovarian

malignancies among younger women (ages <50 years).

Risks were significantly elevated for subsequent cancers of the uterine corpus, which have been reported in

association with the wide use of tamoxifen therapy

since the early 1980s. In addition, the constellation of

multiple primary cancers involving the breast, ovary,

and uterine corpus may reflect shared hormonal, genetic, and lifestyle factors, such as nulliparity. Radiotherapy appeared to account for the observed excesses of

cancers of the esophagus, lung, bone, and soft tissues

among long-term survivors, while chemotherapy probably played the primary role in the elevated risk of

acute non-lymphocytic leukemia. The increased risks

for thyroid cancer and cutaneous melanoma after breast

cancer, as well as reciprocally elevated risks of breast

cancer after these tumors, provide clues to shared etiologic factors, including genetic susceptibility (e.g.,

BRCA2 and melanoma). Other cancer excesses may be

related to increased medical surveillance (salivary

gland cancer) or, in unusual cases, misclassified metastases (stomach cancer). Women with breast cancer also

had significantly lower than expected risks for several

subsequent malignancies, particularly cancers of the

pancreas, cervix, and lung, as well as non-Hodgkin

lymphoma and chronic lymphocytic leukemia. Some of

these decreased risks have been related to lower rates

of tobacco use among women with breast cancer than

those seen in the general population, or to other differences in social-class-related lifestyle factors.

The overall risk of subsequent cancers among 2,158

men diagnosed with breast cancer showed a borderline

significant elevation (O/E=1.11, O=355, EAR=24). The

large excess of new breast cancers was probably related

to genetic predisposition, particularly BRCA2 mutations. A moderate elevation in risk of prostate cancer,

noted only in the most recent period (1995 and later),

may be related to increased medical surveillance 

or, less commonly, genetic factors such as BRCA2

mutations.

Female Breast Cancer

Invasive breast cancer is the most frequently diagnosed

new malignancy and the second most common cause of

cancer death, after lung cancer, among women in the U.S.

This malignancy currently accounts for 32% of all new

cancer cases and 15% of cancer deaths among American

women (Jemal et al, 2005). Incidence rates in the SEER

database vary greatly by race and ethnic group, with

lower rates seen for black, Asian, and Hispanic women

than for white women. Although breast cancer incidence

rates have been increasing since the 1980s, death rates

have declined by about 2.3% per year since 1990

(Edwards et al, 2005), with some of the downturn related

to increases in early detection by mammography and to

effective treatment with adjuvant chemotherapy (Berry et

al, 2005). About 72% of the invasive breast cancers

reported to SEER are ductal carcinomas, not otherwise

specified (NOS); 9% are lobular carcinomas; and the

remaining 19% are other histologic types. The current relative survival rates for all breast cancers combined are

88.8% at 5 years (79.5% at 10 years) for white females,

but only 75.3% at 5 years (63.9% at 10 years) for black

females. Treatment for early-stage invasive breast cancer

shifted in the 1980s and 1990s from radical mastectomy

with or without regional radiotherapy to the chest wall

and lymph nodes (post-mastectomy radiation) to increasing use of breast-conserving surgery followed by breast

radiation (post-lumpectomy radiation) (Veronesi et al,

2005; Wood et al, 2005). Adjuvant chemotherapy (including alkylating agents) and hormones (tamoxifen) are also

widely used.

BREAST

Chapter 7

New Malignancies Following Breast Cancer

Rochelle E. Curtis, Elaine Ron, Benjamin F. Hankey, Robert N. Hoover

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated as

[(O-E)/PYR]10,000).

Author affiliations: Rochelle E. Curtis, Elaine Ron, and Robert N.

Hoover, Division of Cancer Epidemiology and Genetics, NCI, NIH,

DHHS; Benjamin F. Hankey, Division of Cancer Control and

Population Sciences, NCI, NIH, DHHS.
A large body of epidemiologic evidence links reproductive risk factors to breast cancer risk (Willett et al,

2000; Brinton et al, 2002). There is strong evidence that

exogenous estrogens increase breast cancer risk close in

time to the diagnosis, and that specific endogenous hormones play an important role in explaining risk. Factors

consistently associated with an increased risk of breast

cancer include late age at first birth, low parity (less than

2 births), early onset of menarche, late age at menopause,

and hormone replacement therapy, while early

menopause from ovarian ablation and longer lactation

periods are associated with a reduction in risk. In addition, physical inactivity, regular alcohol use (>1 drink/

day), greater height, and postmenopausal obesity have

been shown to heighten risk. Breast cancer incidence is

positively associated with higher socioeconomic status,

which has been explained largely by known lifestyle and

reproductive risk factors. Although relatively uncommon, exposure to ionizing radiation before the age of 40

years increases the risk of breast cancer, with elevated

risks detected even from low-dose exposures (Ronckers

et al, 2005a).

A family history of breast cancer is an important risk

factor for this disease (Willett et al, 2000; Brinton et al,

2002; Thompson and Easton, 2004). The increased risk of

breast cancer among women with at least one affected

first-degree relative is about 2-fold, and the risk rises

with increasing numbers and younger ages of affected

relatives. Approximately 2% to 5% of breast cancers are

probably attributable to the inheritance of rare, highly

penetrant susceptibility genes, such as BRCA1/2. Women

with BRCA1/2 mutations have a high cumulative risk of

developing cancers of the breast (35%-84% by age 70

years) and ovary (10%-50%), with tumors tending to

arise at an earlier age compared with sporadic cases

(Nelson et al, 2005). Germline mutations of p53

(Li-Fraumeni syndrome) and the PTEN gene (Cowden

disease) are rare and account for less than 1% of inherited breast cancer (Wood et al, 2005).

Results and Discussion

A total of 34,500 subsequent primary cancers were

observed among 322,863 women who had survived 2

months or more after an invasive breast cancer diagnosed during 1973-2000, reflecting an overall 18% elevation in the risk of new primary malignancies (O/E=1.18,

95% CI=1.17-1.20, EAR=23 per 10,000 person-years). Subsequent cancers occurred excessively in all follow-up

intervals except among women surviving 20 years or

more. The cumulative incidence of developing any second cancer after breast cancer, in analyses accounting for

the competing risk of death, was 17.6% at 25 years (95%

CI=17.4%-17.8%), which included a 6.9% incidence of

new primary breast cancers (Figure 7.1). For all cancers

combined, black women had higher risks of new malignancies than white women (O/E=1.52, EAR=52 versus

O/E=1.16, EAR=20). The risk of subsequent cancer did

not differ by histologic type of the original breast cancer

(ductal versus lobular carcinomas). A strong inverse

trend in subsequent cancer risk was observed with

increasing age at first breast cancer diagnosis, with the

highest risks occurring after early-onset breast cancer

(ages <40 years, O/E=3.33, EAR=71; ages 40-49 years,

O/E=1.59, EAR=38) (Figure 7.2). No excess risk was evident among women with breast cancer diagnosed at 70

years or older (O/E=0.98). When subsequent primary

breast cancers were excluded from the analysis, the overall risk for all subsequent cancers combined declined to

near unity (O/E=1.01); however, significant elevations in

risk persisted for the younger age groups (ages <40

years, O/E=1.81, EAR=14; ages 40-49 years, O/E=1.25,

EAR=10) (Figure 7.2). Women with an initial breast

malignancy experienced significantly elevated risks for

subsequent cancers of the salivary gland, esophagus,

stomach, colon, breast, uterine corpus, ovary, thyroid,

and soft tissues, as well as melanoma of the skin and

acute non-lymphocytic leukemia (ANLL). Significant

deficits in risk were observed for cancers of the liver,

gallbladder, pancreas, lung (ages ≥60 years), cervix, vagina, vulva, and brain and other parts of the central nervous system, as well as for non-Hodgkin lymphoma and

chronic lymphocytic leukemia.

Second cancers after breast cancer have been extensively studied over the last 3 decades (reviewed in Daly

and Costalas, 1999; Matesich and Shapiro, 2003; van

Leeuwen and Travis, 2005), and many surveys using the

SEER database have been published recently (Newcomb

et al, 1999; Hall et al, 2001; Huang and Mackillop, 2001;

Huang et al, 2001; Newschaffer et al, 2001; Yap et al,

2002; Bernstein et al, 2003; Gao et al, 2003; Kmet et al,

2003; Zablotska and Neugut, 2003; Curtis et al, 2004;

Goggins et al, 2004; Zablotska et al, 2005). Overall estimates of second cancer risk from other registry-based

studies have varied widely, with O/E ratios ranging from

1.0 to 2.4 (Adami et al, 1984; Ewertz and Mouridsen,

1985; Harvey and Brinton, 1985; Teppo et al, 1985;

182 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BREAST

Years after initial cancer diagnosis

Cumulative incidence (%)

0 5 10 15 20 25

0

5

10

15

20

All second cancers

Female breast

Colon

Corpus uteri

Ovary

Figure 7.1: Cumulative incidence of developing a second

cancer among patients with cancer of the breast, females,

SEER 1973-2000.
NEW MALIGNANCIES FOLLOWING BREAST CANCER 183

BREAST

Brenner et al, 1993; Volk and Pompe-Kirn, 1997; Dong

and Hemminki, 2001a; Evans et al, 2001; Levi et al, 2003;

Soerjomataram et al, 2005; Mellemkjaer et al, 2006).

Subsequent breast cancers, occurring predominantly

in the opposite breast, accounted for nearly 40% of all

new malignancies after an initial breast cancer in the current study. The risk of developing a new breast cancer

was increased 67% over that expected in the general

population during the first 10 years of follow-up, with

significant elevations persisting at lower levels for at

least 2 decades, consistent with the intense surveillance

of the opposite breast for new disease. Young age at initial diagnosis (<50 years) and black race—but not histology (ductal versus lobular)—were strong predictors of

elevated risk, similar to the results in previous studies

(Chen et al, 1999; reviewed in Daly and Costalas, 1999;

Gao et al, 2003). Genetic predisposition—in particular,

germline mutations in the BRCA1/2 genes, which predispose to early-onset breast and ovarian cancers

(Metcalfe et al, 2004; Thompson and Easton, 2004)—

probably contributed to the notably high risks of subsequent breast cancers that occurred after an initial cancer

diagnosed at ages younger than 40 years (O/E=5.36) 

and ages 40 to 49 years (O/E=2.13). In the current SEER

study, women treated with radiotherapy had marginally

higher risks of developing a subsequent breast tumor

than nonirradiated women. While these results are

generally consistent with the estimated 18% excess of

contralateral breast cancer observed among irradiated

women treated in randomized clinical trials (Clarke et al,

2005), other studies have reported that radiation has no

effect on the overall risk of new breast cancers (Storm et

al, 1992; Chen et al, 1999), except possibly for long-term

survivors who were irradiated at a young age (Boice et

al, 1992; Chen et al, 1999; Gao et al, 2003; van Leeuwen

and Travis, 2005). In contrast, there is strong evidence

that hormonal therapy with tamoxifen substantially

reduces the risk of subsequent breast cancer by an estimated 33% (EBCTCG, 2005), and that adjuvant chemotherapy is associated with a modest protective effect.

Other risk factors for second breast cancer risk cited in

some, but not all, studies include higher body-mass

index (Dignam et al, 2003; Li et al, 2003) and reproductive risk factors (late age at first birth, low parity) 

(Cook et al, 1996; Chen et al, 1999; Vaittinen and

Hemminki, 2000).

The risk of subsequent ovarian cancer fell sharply

with increasing age at initial breast cancer diagnosis

(O/E=4.18, 1.78, and 1.30 for ages <40, 40-49, and 50-59

years, respectively); little or no excess was observed 

for ages 60 to 69 years (O/E=1.08) or 70 years or more

(O/E=0.97). Breast cancer also occurred excessively after

early-onset ovarian cancer (ages <50 years). This reciprocally increased risk in younger survivors has been noted

in earlier registry-based studies (Evans et al, 2001; Hall 

et al, 2001; Mellemkjaer et al, 2006) and is partly related

to BRCA1/2 heritable syndromes. In addition, breast 

and ovarian cancers share endocrine-related risk factors,

such as nulligravity, which may also contribute to these

excesses (Hall et al, 2001; Brinton et al, 2005).

Breast cancer patients had an overall 35% increased

risk of subsequent cancers of the uterine corpus. Significantly increased risks were observed in all age groups,

with the highest absolute risk of uterine malignancies

occurring among women ages 70 years or more at breast

cancer diagnosis (O/E=1.59, EAR=5). Previous studies

have indicated that tamoxifen therapy for breast cancer is

associated with a 2- to 3-fold increased risk of adenocarcinomas of the uterine corpus, with risks rising with

increasing duration of tamoxifen use (Fisher et al, 1994;

Curtis et al, 1996, 2004; EBCTCG, 2005; Swerdlow et al,

2005). In addition, notably higher risks (4- to 13-fold)

have been reported for tamoxifen-related uterine sarcomas, although these tumors are very rare and the excess

absolute risk is small (Curtis et al, 2004; Swerdlow et al,

2005). Breast and uterine corpus cancers also share common risk factors, such as low parity, obesity, and hormone replacement therapy (Brinton et al, 2002, 2005),

which may contribute to the reciprocally elevated risks

observed for these tumors at older ages (ages ≥70 years).

Previous investigators have attributed the elevated

risks of ANLL following breast cancer primarily to alkylating agent chemotherapy, with radiotherapy possibly

adding to this risk (Curtis et al, 1992; Diamandidou et

al, 1996; Smith et al, 2003; Praga et al, 2005). Some

40 40-49 50-69 70

O/E

1.25*

1.59*

1.03* 1.16*

0.98* 0.90*

All subsequent cancers

All subsequent cancers excluding 

female breast

40 40-49 50-69 70

Age at diagnosis of breast cancer (years)

EAR (per 10,000 person-years)

All subsequent cancers

All subsequent cancers excluding 

female breast

1.0

1.5

2.0

2.5

3.0

3.5

4.0

-20

0

20

40

60

80

10

3

21

-5 -14

71

14

38

3.33*

1.81*

Figure 7.2: Observed-to-expected ratio (O/E) and excess

absolute risk (EAR) of subsequent primary cancers after

cancer of the breast, females, SEER 1973-2000.

*P < 0.05.

Note: EAR = Excess number of subsequent cancers per 10,000 person-years.

Observed No. 1,907 592 4,782 2,308 17,837 11,145 9,974 7,027
studies (Fisher et al, 1985; Curtis et al, 1992), but not all

(Curtis et al, 1989), have suggested that post-mastectomy

radiotherapy (without chemotherapy) may confer a

small increased risk of leukemia, with risks rising in

relation to increasing bone marrow dose. Melphalanbased chemotherapy, which was used mainly in the

1970s, is known to be highly leukemogenic (Fisher et al,

1985; Curtis et al, 1992); however, only a negligible or

small increase in risk has been reported following standard dose cyclophosphamide-methotrexate-fluorouracil

(CMF) chemotherapy (Curtis et al, 1992; Valagussa et al,

1994; Tallman et al, 1995; Kaplan et al, 2004).

Cyclophophamide-anthracycline-based regimens, in

wider use in recent years, may be associated with higher leukemia risks, but in absolute terms the risk appears

low when standard doses are administered (cumulative

incidence less than 0.5% at 8-10 years) (Smith et al,

2003). However, at least 2 reports from clinical trial

series indicate that leukemia risk may rise sharply with

more intensive, higher-dose chemotherapy regimens

(Smith et al, 2003; Praga et al, 2005), indicating that

these patients need to be monitored closely for the late

effects of therapy.

Although there was an overall decreased lung cancer

risk following breast cancer, women who were initially

treated with radiation had a significantly elevated risk

for developing a new lung malignancy 10 years or more

after irradiation (O/E=1.47, EAR=9), with the highest risk

occurring among 20-year survivors (O/E=1.86, EAR=21).

Risk was greater for the lung on the same side as the initial breast cancer, which would have received the higher

radiation dose. Previous studies have also reported

excess lung cancer incidence (Deutsch et al, 2003;

Zablotska and Neugut, 2003; Clarke et al, 2005;

Mellemkjaer et al, 2006) and mortality (Clarke et al, 2005;

Darby et al, 2005) among women treated with radiation

for breast malignancies. Most investigators have attributed the increased risk to post-mastectomy radiotherapy,

which typically delivers high doses to thoracic organs,

including the lungs, with a Connecticut study indicating

that lung cancer risk increases with the radiation dose

received (Inskip et al, 1994). Smoking may further heighten the risk of radiation-related lung cancer (Neugut et al,

1994; Ford et al, 2003), as has been observed following

irradiation for Hodgkin disease (Travis et al, 2002). While

no significant lung cancer excess has been reported following newer treatments with post-lumpectomy breast

radiation (Zablotska and Neugut, 2003), the long-term

hazards of these therapies remain to be clarified.

Radiation also appeared to contribute to the elevated

risk of cancers of the esophagus, bone, and soft tissue

among long-term survivors of breast cancer, with higher risks observed among irradiated patients compared

with nonirradiated patients. The heightened risk of

esophageal cancer was evident 5 years or more after

radiation treatment, and risk rose to nearly 3-fold

among 10-year survivors (O/E=2.93, O=28). Similar

results were reported in a previous SEER survey

(Zablotska et al, 2005) and in a study of women

enrolled in breast cancer clinical trials (Clarke et al,

2005). Increased risks involved mainly squamous cell

carcinomas of the esophagus arising in the upper and

middle sections (Zablotska et al, 2005), which would

have received the highest radiation doses. Elevated

risks of radiation-related bone sarcomas in our series

appeared 10 years or more after initial exposure

(O/E=6.11, O=8), while excesses of soft tissue sarcomas

after radiotherapy were evident earlier in the follow-up

period (≥5 years, O/E=3.24, O=46). Particularly high

risks were observed for subsequent angiosarcomas

(O/E=17.44, O=11) and fibrosarcomas/fibrous histiocytomas (O/E=4.25, O=20) occurring 5 or more years after

irradiation, whereas no excess of either tumor type was

evident among patients treated with surgery alone. Several earlier studies have reported an elevated risk of

radiation-related soft tissue sarcomas (Huang and

Mackillop, 2001; Clarke et al, 2005; Kirova et al, 2005;

Rubino et al, 2005) arising in the irradiated breast (after

breast-conserving therapy), the chest/chest wall, or

upper limb/shoulders. Some soft tissue sarcomas of the

upper limbs may be related to the lymphedema that

may complicate radical mastectomy and predispose to

lymphangiosarcoma in the Stewart-Treves syndrome

(Stewart and Treves, 1948). In rare cases, breast cancer

and sarcomas may arise as components of the heritable

Li-Fraumeni syndrome.

Although the increased risk of melanoma of the skin

appeared to be limited to breast cancer patients treated

with radiation (O/E=1.46 for irradiated patients versus

O/E=1.07 for nonirradiated patients), a direct carcinogenic effect from radiation seems unlikely. There was no

evidence of an increasing trend in risk over time, as

might be expected with radiation-related solid tumors,

and risks were similarly increased for melanomas that

occurred at sites distant from the radiation fields, as well

as for sites within or close to irradiated areas. Another

possibility is that immunologic alterations associated

with radiotherapy or chemotherapy may be involved.

However, a reciprocally elevated risk of breast cancer

after cutaneous melanoma suggests that these tumors

may share hormonal or genetic mechanisms, such as

BRCA2 mutations (Goggins et al, 2004; Thompson and

Easton, 2004; Mellemkjaer et al, 2006).

The co-occurrence of breast and thyroid cancer at

increased levels has been reported in several previous

surveys (Harvey and Brinton, 1985; Huang et al, 2001;

Sadetzki et al, 2003; Ronckers et al, 2005b; Mellemkjaer et

al, 2006), but reasons for this association remain unclear.

Although female gender is a risk factor for thyroid cancer, only weak associations with hormonal risk factors

have been noted previously (Negri et al, 1999). Both

breast and follicular thyroid cancers are linked to

Cowden disease, but this genetic condition is rare. Risks

in the current study (Ronckers et al, 2005b) were similar

among irradiated and nonirradiated women (O/E=1.28

versus 1.33), in agreement with most other investigations

(Harvey and Brinton, 1985; Huang et al, 2001; Sadetzki et

al, 2003; Clarke et al, 2005) and with reports indicating

184 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BREAST
little or no elevation in thyroid cancer following radiation exposures at older ages (Ron et al, 1995).

Although a history of breast cancer has long been

thought to be a risk factor for colorectal cancer, only a

small increased risk of subsequent colon cancer

(O/E=1.04) and no excess of rectal cancer (O/E=0.95)

were observed in the current survey. The lack of a substantial elevated risk of colorectal cancer after breast

cancer is consistent with 2 other registry-based studies

(Evans et al, 2001; Levi et al, 2003) and a previous SEER

analysis (Newschaffer et al, 2001). However, other surveys of breast cancer patients have reported 20% to 80%

increased risks of subsequent colon and/or rectal cancer

compared with that expected in the general population

(Harvey and Brinton, 1985; Murakami et al, 1987; Neugut

et al, 1991; Soerjomataram et al, 2005; Mellemkjaer et al,

2006), leading previous investigators to hypothesize that

breast and colorectal cancers may share common dietary

and hormonal risk factors. A recent study observed a

2-fold increase in the risk of colon cancer among breast

cancer patients who had either a family history of breast

cancer or a high body-mass index; the risk was unrelated

to menopausal status, prior hormonal replacement

therapy, or parity (Kmet et al, 2003). Although it has 

been reported that breast cancer may be part of the

hereditary nonpolyposis colon cancer syndrome

(Risinger et al, 1996), we did not observe an increased

risk of breast cancer at any age after an initial cancer of

the colon or rectum.

The increased risk of stomach cancer was restricted to

women with lobular breast cancer (O/E=2.36, O=80). One

explanation for this association may be misclassification

of the stomach cancer, because the lobular subtype is

overrepresented in gastric metastases secondary to the

breast (Taal et al, 2000). A small number of subsequent

stomach malignancies may be related to genetic predisposition, since carriers of BRCA2 mutations have been

reported to have an increased risk of stomach cancer

(Thompson and Easton, 2004).

Most of the heightened risk of salivary gland cancer

was observed in the first 5 years following breast cancer

diagnosis, suggesting increased diagnostic scrutiny of the

head and neck area in the initial follow-up period.

Although the salivary glands may receive substantial

radiation doses during breast cancer therapy, the excesses

in our study were observed among both irradiated and

nonirradiated patients. No reciprocal elevation of breast

cancer was noted after salivary gland cancer.

Significant deficits in risk of several subsequent

smoking-related cancers, such as cancers of the respiratory tract, pancreas, and cervix, probably reflect lower

rates of smoking and social-class-related lifestyle differences among breast cancer survivors. Significantly

lower than expected risks of non-Hodgkin lymphoma

and chronic lymphocytic leukemia were confined to the

first 10 years of follow-up.

Male Breast Cancer

Breast cancer among men is uncommon, accounting for

less than 1% of breast cancers in the U.S. (Weiss et al,

2005). Incidence, however, has been rising (Giordano,

2005), and almost 1,700 new cases were expected to be

diagnosed in 2005 (Jemal et al, 2005). Geographic and

temporal variation in incidence rates resembles that for

female breast cancer, with higher rates in Europe and

North America (Weiss et al, 2005). Treatment for male

breast cancer is similar to that for females, although conservative surgery is less frequently used (Winchester,

2002). Relative survival rates in SEER are somewhat

lower for males (80.8% at 5 years and 68.6% at 10 years)

than for females, reflecting in part a tendency toward a

higher stage of disease at presentation for men. The histologic distribution of male and female breast cancer differed somewhat, with males having a higher percentage

of ductal carcinoma and a lower percentage of lobular

carcinoma than females.

Although the etiology of breast cancer in men is not

well understood, hormonal and genetic factors appear to

play a role (Weiss et al, 2005). As in women, an increased

risk of breast cancer in men has been associated with a

family history of breast cancer. BRCA2 mutations

account for a higher percentage of inherited cases of male

breast cancer than BRCA1 mutations (Winchester, 2002;

Thompson and Easton, 2004). Other known or suspected

risk factors include hormonal abnormalities, such as

Klinefelter syndrome, gynecomastia, testicular disease,

liver cirrhosis, treatment with exogenous estrogens, and

radiation exposure.

Results and Discussion

A borderline significant increased risk of subsequent

cancers was observed among 2,158 men who survived

2 months or more following a diagnosis of breast 

cancer between 1973 and 2000 (O/E=1.11, O=355,

95% CI=0.99-1.23, EAR=24). Overall risk of developing a

new malignancy was increased 31% among men initially

diagnosed at ages younger than 65 years, whereas no

excess was noted among older men (O/E=0.99). The

cumulative incidence of developing a second cancer after

male breast cancer rose to 21.8% (95% CI=19.4%-24.2%)

at 25 years. Few studies have evaluated risks of new

malignancies among men with breast cancer, although

increased risks have been reported for second cancers of

the contralateral breast, small intestine, rectum, pancreas,

and prostate, as well as non-melanoma skin cancer and

myeloid leukemia (Dong and Hemminki, 2001b;

Auvinen et al, 2002; Hemminki et al, 2005).

The risk of subsequent breast cancer was strongly elevated (O/E=29.36, O=18, EAR=12), as was also reported

in an earlier survey from the SEER registries (Auvinen et

al, 2002) and a study from the Swedish Family-Cancer

Database (Dong and Hemminki, 2001b). Men diagnosed

with their first breast cancer before age 65 years had a

higher relative risk of developing a new breast malignancy (O/E=44.51) than older men (O/E=20.60), although the

NEW MALIGNANCIES FOLLOWING BREAST CANCER 185

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186 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BREAST

excess absolute risks were equivalent (close to 12 in both

age groups). Risks were significantly elevated throughout the follow-up period. While the risk of subsequent

breast cancer was about 2 times higher among men who

received radiation compared with those who did not,

the difference between the groups was not statistically

significant. These findings are consistent with genetic

predisposition in male breast cancer, due mainly to

BRCA2 germline mutations (Giordano, 2005) or to hormonal factors, as illustrated by the elevated risk in

Klinefelter syndrome.

Our survey revealed a statistically increased risk of

subsequent prostate cancer (O/E=1.22) that was not

detected in an earlier SEER survey of cases diagnosed

through 1996 (Auvinen et al, 2002). A similarly elevated

risk of prostate cancer after breast cancer was noted in a

large international cancer registry study of 3,409 men

with breast cancer (Hemminki et al, 2005). On the other

hand, no significant excess of male breast cancer following prostate cancer was seen in the international study

or in our survey, although an increased risk (2-fold) was

noted in a Swedish registry series (Thellenberg et al,

2003). Genetic factors may contribute to the association

because BRCA2 mutation carriers appear to have an

increased risk of prostate cancer as well as male breast

cancer (Kirchhoff et al, 2004). Medical surveillance may

also play a role, as prostate-specific antigen (PSA) testing has increased among cancer patients in more recent

years, and the excess risk in our series was limited to

men diagnosed with localized-stage prostate cancer during the period 1995 to 2000.

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Breast

Females

Table 7.1.1: Characteristics of patients with an initial cancer of the breast, females,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total — — 322,863 100.0 322,863 100.0

Initial treatment

Any radiation — — 109,188 33.8 109,188 33.8

With surgery — — 103,445 32.0 103,445 32.0

Without surgery — — 5,743 1.8 5,743 1.8

No radiation — — 213,675 66.2 213,675 66.2

With surgery — — 201,453 62.4 201,453 62.4

Without surgery — — 12,222 3.8 12,222 3.8

Race

White — — 281,056 87.1 281,056 87.1

Black — — 24,378 7.6 24,378 7.6

Other — — 16,341 5.1 16,341 5.1

Unknown — — 1,088 0.3 1,088 0.3

Age at 1st primary cancer diagnosis, years

< 30 — — 2,372 0.7 2,372 0.7

30–49 — — 76,342 23.6 76,342 23.6

50–69 — — 145,405 45.0 145,405 45.0

70–79 — — 63,896 19.8 63,896 19.8

> 80 — — 34,848 10.8 34,848 10.8

Number of patients with one or more

primary cancers

One primary cancer only — — 291,176 90.2 291,176 90.2

1st and 2nd cancers — — 29,092 9.0 29,092 9.0

1st, 2nd, and 3rd cancers — — 2,391 0.7 2,391 0.7

1st, 2nd, 3rd, and additional cancers — — 204 0.1 204 0.1

Other statistics

Median age at 1st cancer diagnosis — — 61.7 — 61.7 —

Median year of 1st cancer diagnosis — — 1989.5 — 1989.5 —

Median person-years at risk — — 5.6 — 5.6 —

Percent histologically confirmed*

Both 1st and 2nd cancers — — — 96.8 — 96.8

1st, 2nd, and additional cancers — — — 96.4 — 96.4

1st cancer only — — — 2.9 — 2.9

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING BREAST CANCER 189

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 3,054 1.13* 12,656 1.22* 9,859 1.19* 8,931 1.15* 34,500 29,141.37 1.18* 22.54

All excluding same site 1,788 0.94* 7,396 1.00 6,071 1.03* 5,817 1.04* 21,072 20,761.09 1.01* 1.31

Buccal cavity, pharynx 49 1.00 189 1.02 171 1.18* 142 1.09 551 510.33 1.08 0.17

Lip 2 0.64 10 0.81 7 0.69 14 1.42 33 35.48 0.93 -0.01

Tongue 14 1.30 43 1.05 35 1.09 29 1.00 121 113.04 1.07 0.03

Salivary gland 12 2.22* 36 1.74* 21 1.30 22 1.45 91 57.44 1.58* 0.14

Mouth 13 0.78 56 0.88 62 1.24 45 0.99 176 176.26 1.00 0.00

Nasopharynx 2 0.96 12 1.55 7 1.21 3 0.59 24 20.69 1.16 0.01

Tonsil 3 0.67 12 0.73 19 1.56 13 1.29 47 43.20 1.09 0.02

Oropharynx 1 0.83 4 0.86 6 1.68 1 0.32 12 12.51 0.96 0.00

Hypopharynx 2 0.60 8 0.63 8 0.84 9 1.09 27 33.83 0.80 -0.03

Digestive system 533 0.88* 2,395 1.02 1,884 0.99 1,864 1.03 6,676 6,676.17 1.00 0.00

Esophagus 18 1.08 68 1.05 71 1.36* 86 1.71* 243 183.56 1.32* 0.25

Stomach 43 0.90 221 1.21* 151 1.05 158 1.20* 573 507.10 1.13* 0.28

Small intestine 2 0.23* 33 0.98 33 1.18 38 1.36 106 98.04 1.08 0.03

Colon 284 0.94 1,265 1.07* 1,016 1.06 918 1.01 3,483 3,351.80 1.04* 0.55

Rectum, rectosigmoid junction 77 0.79* 380 1.02 275 0.94 279 1.05 1,011 1,028.57 0.98 -0.07

Rectum 55 0.86 233 0.95 180 0.94 175 0.99 643 676.99 0.95 -0.14

Anus, anal canal 8 0.97 29 0.91 26 1.01 23 0.95 86 90.12 0.95 -0.02

Liver 9 0.70 30 0.60* 23 0.55* 36 0.85 98 147.46 0.66* -0.21

Gallbladder 9 0.64 34 0.64* 20 0.48* 40 1.08 103 145.80 0.71* -0.18

Bile ducts, other biliary 16 1.24 50 0.98 30 0.69* 43 0.97 139 151.85 0.92 -0.05

Pancreas 63 0.80 257 0.84* 221 0.88* 219 0.90 760 880.96 0.86* -0.51

Respiratory system 281 0.82* 1,228 0.91* 1,043 0.93* 1,168 1.04 3,720 3,949.93 0.94* -0.97

Nose, nasal cavity, ear 3 0.82 14 1.00 10 0.89 10 0.94 37 39.57 0.94 -0.01

Larynx 12 1.03 41 0.93 23 0.67 31 1.00 107 121.06 0.88 -0.06

Lung, bronchus 263 0.81* 1,171 0.91* 1,007 0.93* 1,122 1.04 3,563 3,779.40 0.94* -0.91

Female breast 1,266 1.60* 5,260 1.74* 3,788 1.59* 3,114 1.42* 13,428 8,380.29 1.60* 21.24

Female genital system 406 1.13* 1,672 1.25* 1,322 1.31* 1,014 1.14* 4,414 3,603.65 1.22* 3.41

Cervix uteri 37 0.82 142 0.91 71 0.68* 45 0.57* 295 384.43 0.77* -0.38

Corpus uteri 218 1.20* 934 1.37* 776 1.51* 538 1.18* 2,466 1,830.03 1.35* 2.68

Ovary 131 1.26* 499 1.27* 395 1.29* 349 1.26* 1,374 1,079.84 1.27* 1.24

Vagina 1 0.19 15 0.75 11 0.71 12 0.85 39 54.81 0.71* -0.07

Vulva 9 0.58 50 0.83 38 0.77 40 0.84 137 172.86 0.79* -0.15

Urinary system 152 1.22* 475 0.97 440 1.09 412 1.05 1,479 1,409.47 1.05 0.29

Urinary bladder 67 0.91 269 0.93 273 1.15* 266 1.15* 875 831.20 1.05 0.18

Kidney parenchyma 77 1.87* 172 1.07 132 1.00 115 0.89 496 464.18 1.07 0.13

Renal pelvis, other urinary 8 0.78 34 0.85 35 1.07 31 1.00 108 114.09 0.95 -0.03

Ureter 2 0.64 6 0.49 10 1.00 12 1.27 30 34.96 0.86 -0.02

Bone, joints 2 0.77 7 0.72 11 1.49 16 2.42* 36 26.32 1.37 0.04

Soft tissue including heart 6 0.56 51 1.23 58 1.77* 47 1.51* 162 116.16 1.39* 0.19

Kaposi sarcoma 0 0.00 1 0.26 1 0.31 4 1.31 6 11.16 0.54 -0.02

Melanoma of skin 74 1.32* 251 1.17* 196 1.16* 179 1.14 700 595.34 1.18* 0.44

Eye, orbit 1 0.25 20 1.30 14 1.20 12 1.14 47 41.66 1.13 0.02

Brain, central nervous system 21 0.74 110 1.02 68 0.81 55 0.72* 254 296.76 0.86* -0.18

Thyroid 56 2.01* 127 1.25* 97 1.33* 65 1.07 345 262.84 1.31* 0.35

Lymphatic, hematopoietic 176 0.88 735 0.94 625 0.97 649 1.05 2,185 2,246.18 0.97 -0.26

Hodgkin lymphoma 11 1.61 14 0.57* 17 0.94 20 1.31 62 64.78 0.96 -0.01

Non-Hodgkin lymphoma 81 0.85 278 0.74* 272 0.87* 330 1.06 961 1,097.39 0.88* -0.57

Myeloma 33 0.96 134 1.00 98 0.90 99 0.95 364 382.33 0.95 -0.08

Leukemia 51 0.80 309 1.25* 238 1.19* 200 1.05 798 701.68 1.14* 0.41

Acute lymphocytic 3 1.53 10 1.34 7 1.18 2 0.37 22 20.80 1.06 0.01

Chronic lymphocytic 11 0.45* 45 0.47* 53 0.69* 69 0.94 178 269.96 0.66* -0.39

Acute non-lymphocytic 25 1.11 206 2.35* 127 1.79* 84 1.22 442 249.80 1.77* 0.81

Chronic myeloid 8 0.90 31 0.90 30 1.09 29 1.12 98 96.91 1.01 0.00

Breast

Females

Table 7.1.2: Risk of subsequent primary cancers after cancer of the breast, females,

SEER 1973-2000.

190 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BREAST

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 322,863 294,980 178,161 93,331 322,863

Person-years in interval 256,649 925,212 658,170 536,956 2,376,987

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Breast

Females, Long-term Follow-up

Table 7.1.3: Risk of subsequent primary cancers after cancer of the breast, females,

long-term follow-up, SEER 1973-2000.

BREAST

All subsequent cancers 25,569 1.20* 5,428 1.18* 2,463 1.12* 1,040 1.05 34,500 29,141.37 1.18* 22.54

All excluding same site 15,255 1.01 3,447 1.05* 1,627 1.02 743 1.03 21,072 20,761.09 1.01* 1.31

Buccal cavity, pharynx 409 1.08 75 0.96 54 1.47* 13 0.81 551 510.33 1.08 0.17

Lip 19 0.74 8 1.41 3 1.06 3 2.27 33 35.48 0.93 -0.01

Tongue 92 1.10 13 0.75 14 1.71 2 0.57 121 113.04 1.07 0.03

Salivary gland 69 1.63* 11 1.24 7 1.62 4 2.05 91 57.44 1.58* 0.14

Mouth 131 1.00 24 0.88 19 1.49 2 0.36 176 176.26 1.00 0.00

Nasopharynx 21 1.34 2 0.66 1 0.71 0 0.00 24 20.69 1.16 0.01

Tonsil 34 1.03 6 0.97 7 2.49 0 0.00 47 43.20 1.09 0.02

Oropharynx 11 1.17 1 0.54 0 0.00 0 0.00 12 12.51 0.96 0.00

Hypopharynx 18 0.70 7 1.40 1 0.44 1 1.03 27 33.83 0.80 -0.03

Digestive system 4,812 0.99 1,068 1.01 540 1.06 256 1.09 6,676 6,676.17 1.00 0.00

Esophagus 157 1.18* 48 1.64* 26 1.83* 12 1.80 243 183.56 1.32* 0.25

Stomach 415 1.11* 94 1.20 40 1.08 24 1.43 573 507.10 1.13* 0.28

Small intestine 68 0.97 23 1.43 14 1.73 1 0.26 106 98.04 1.08 0.03

Colon 2,565 1.05* 525 0.98 261 1.01 132 1.11 3,483 3,351.80 1.04* 0.55

Rectum, rectosigmoid junction 732 0.96 159 1.01 90 1.22 30 0.91 1,011 1,028.57 0.98 -0.07

Rectum 468 0.94 94 0.90 63 1.28 18 0.80 643 676.99 0.95 -0.14

Anus, anal canal 63 0.96 11 0.77 7 1.02 5 1.63 86 90.12 0.95 -0.02

Liver 62 0.59* 21 0.87 7 0.57 8 1.30 98 147.46 0.66* -0.21

Gallbladder 63 0.58* 24 1.09 12 1.16 4 0.89 103 145.80 0.71* -0.18

Bile ducts, other biliary 96 0.89 25 0.99 11 0.86 7 1.13 139 151.85 0.92 -0.05

Pancreas 541 0.85* 124 0.87 67 0.97 28 0.87 760 880.96 0.86* -0.51

Respiratory system 2,552 0.90* 656 1.01 341 1.05 171 1.12 3,720 3,949.93 0.94* -0.97

Nose, nasal cavity, ear 27 0.93 7 1.12 3 1.01 0 0.00 37 39.57 0.94 -0.01

Larynx 76 0.84 18 0.97 11 1.27 2 0.55 107 121.06 0.88 -0.06

Lung, bronchus 2,441 0.91* 629 1.01 324 1.03 169 1.14 3,563 3,779.40 0.94* -0.91

Female breast 10,314 1.67* 1,981 1.52* 836 1.36* 297 1.10 13,428 8,380.29 1.60* 21.24

Female genital system 3,400 1.25* 660 1.23* 258 1.03 96 0.90 4,414 3,603.65 1.22* 3.41

Cervix uteri 250 0.82* 28 0.56* 16 0.76 1 0.13* 295 384.43 0.77* -0.38

Corpus uteri 1,928 1.40* 366 1.35* 127 0.99 45 0.82 2,466 1,830.03 1.35* 2.68

Ovary 1,025 1.28* 216 1.31* 91 1.17 42 1.25 1,374 1,079.84 1.27* 1.24

Vagina 27 0.66* 7 0.83 4 1.02 1 0.57 39 54.81 0.71* -0.07

Vulva 97 0.78* 28 1.00 9 0.66 3 0.47 137 172.86 0.79* -0.15

Urinary system 1,067 1.05 238 1.05 127 1.13 47 0.90 1,479 1,409.47 1.05 0.29

Urinary bladder 609 1.01 155 1.15 77 1.17 34 1.10 875 831.20 1.05 0.18

Kidney parenchyma 381 1.14* 68 0.90 38 1.02 9 0.52* 496 464.18 1.07 0.13

Renal pelvis, other urinary 77 0.93 15 0.83 12 1.36 4 0.96 108 114.09 0.95 -0.03

Ureter 18 0.71 4 0.73 6 2.24 2 1.59 30 34.96 0.86 -0.02

Bone, joints 20 1.01 14 3.60* 1 0.54 1 1.19 36 26.32 1.37 0.04

Soft tissue including heart 115 1.35* 27 1.48 12 1.34 8 1.99 162 116.16 1.39* 0.19

Kaposi sarcoma 2 0.25* 3 1.63 1 1.16 0 0.00 6 11.16 0.54 -0.02

Melanoma of skin 521 1.19* 115 1.25* 36 0.81 28 1.37 700 595.34 1.18* 0.44

Eye, orbit 35 1.13 6 0.96 4 1.32 2 1.55 47 41.66 1.13 0.02

Brain, central nervous system 199 0.90 32 0.70* 18 0.84 5 0.53 254 296.76 0.86* -0.18

Thyroid 280 1.39* 45 1.22 11 0.66 9 1.27 345 262.84 1.31* 0.35

Lymphatic, hematopoietic 1,536 0.94* 393 1.09 182 1.03 74 0.90 2,185 2,246.18 0.97 -0.26

Hodgkin lymphoma 42 0.85 5 0.54 13 3.04* 2 1.13 62 64.78 0.96 -0.01

Non-Hodgkin lymphoma 631 0.80* 209 1.17* 84 0.94 37 0.88 961 1,097.39 0.88* -0.57

Myeloma 265 0.95 62 1.01 27 0.90 10 0.73 364 382.33 0.95 -0.08

Leukemia 598 1.17* 117 1.05 58 1.07 25 1.02 798 701.68 1.14* 0.41

Acute lymphocytic 20 1.30 1 0.31 1 0.66 0 0.00 22 20.80 1.06 0.01

Chronic lymphocytic 109 0.55* 42 0.97 17 0.82 10 1.09 178 269.96 0.66* -0.39

Acute non-lymphocytic 358 1.98* 46 1.15 25 1.28 13 1.40 442 249.80 1.77* 0.81

Chronic myeloid 69 0.97 19 1.24 8 1.09 2 0.61 98 96.91 1.01 0.00

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 322,863 93,331 43,611 18,188 322,863

Person-years in interval 1,840,031 329,888 146,612 60,456 2,376,987

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING BREAST CANCER 191
All subsequent cancers 135 5.14* 674 5.43* 497 3.43* 601 2.17* 1,907 571.85 3.33* 70.88

All excluding same site 32 1.96* 139 1.92* 131 1.66* 290 1.82* 592 326.71 1.81* 14.08

Buccal cavity, pharynx 0 0.00 1 0.57 4 1.83 8 1.76 13 8.84 1.47 0.22

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.02

Tongue 0 0.00 1 2.62 1 2.09 1 0.91 3 2.04 1.47 0.05

Salivary gland 0 0.00 0 0.00 1 2.25 6 9.54* 7 1.70 4.11* 0.28

Mouth 0 0.00 0 0.00 2 3.62 1 0.75 3 2.32 1.29 0.04

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.74 0.00 -0.04

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.91 0.00 -0.05

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.01

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.02

Digestive system 3 1.82 7 0.82 7 0.60 52 1.70* 69 52.44 1.32* 0.88

Esophagus 0 0.00 0 0.00 0 0.00 3 3.23 3 1.36 2.21 0.09

Stomach 0 0.00 2 2.12 2 1.87 3 1.40 7 4.35 1.61 0.14

Small intestine 0 0.00 0 0.00 0 0.00 1 1.18 1 1.58 0.63 -0.03

Colon 1 1.41 4 1.12 0 0.00* 21 1.61 26 22.09 1.18 0.21

Rectum, rectosigmoid junction 1 3.15 0 0.00 2 0.81 10 1.59 13 10.79 1.20 0.12

Rectum 1 4.36 0 0.00 0 0.00 5 1.19 6 7.33 0.82 -0.07

Anus, anal canal 0 0.00 0 0.00 1 2.11 3 3.23 4 1.77 2.25 0.12

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 1.59 0.00 -0.08

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.87 0.00 -0.05

Bile ducts, other biliary 0 0.00 1 6.10 0 0.00 0 0.00 1 1.07 0.94 0.00

Pancreas 1 7.64 0 0.00 1 0.88 8 2.22 10 5.60 1.79 0.23

Respiratory system 2 2.20 22 4.09* 21 2.42* 41 1.44* 86 43.46 1.98* 2.26

Nose, nasal cavity, ear 0 0.00 1 5.86 1 5.81 0 0.00 2 0.69 2.89 0.07

Larynx 0 0.00 0 0.00 1 2.20 3 2.34 4 2.10 1.91 0.10

Lung, bronchus 2 2.49 21 4.33* 18 2.25* 37 1.38 78 40.46 1.93* 1.99

Female breast 103 10.40* 535 10.32* 366 5.54* 311 2.65* 1,315 245.14 5.36* 56.80

Female genital system 10 1.90 40 1.75* 60 2.49* 107 2.50* 217 94.88 2.29* 6.48

Cervix uteri 5 1.90 3 0.30* 6 0.75 11 1.39 25 28.59 0.87 -0.19

Corpus uteri 3 3.14 7 1.37 22 3.07* 32 1.68* 64 32.25 1.98* 1.69

Ovary 2 1.45 28 4.40* 30 4.02* 59 4.44* 119 28.50 4.18* 4.80

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.88 0.00 -0.05

Vulva 0 0.00 1 1.42 0 0.00 1 0.79 2 2.89 0.69 -0.05

Urinary system 2 4.10 3 1.19 3 0.90 12 1.36 20 15.18 1.32 0.26

Urinary bladder 0 0.00 2 2.03 2 1.51 6 1.50 10 6.49 1.54 0.19

Kidney parenchyma 2 7.29 1 0.69 1 0.53 5 1.13 9 8.03 1.12 0.05

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 2.40 1 0.65 1.53 0.02

Ureter 0 0.00 0 0.00 0 0.00 1 11.19 1 0.12 8.51 0.05

Bone, joints 0 0.00 2 5.81 0 0.00 1 2.67 3 1.11 2.70 0.10

Soft tissue including heart 0 0.00 4 3.94* 2 2.20 5 3.70* 11 3.53 3.12* 0.40

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.01

Melanoma of skin 1 0.41 12 1.20 12 1.33 15 1.36 40 32.45 1.23 0.40

Eye, orbit 0 0.00 2 9.93* 1 4.55 0 0.00 3 0.86 3.47 0.11

Brain, central nervous system 1 1.75 6 2.55 3 1.40 5 1.53 15 8.33 1.80* 0.35

Thyroid 7 3.45* 8 1.03 6 0.93 9 1.25 30 23.45 1.28 0.35

Lymphatic, hematopoietic 5 2.62 30 3.78* 11 1.35 28 1.78* 74 33.73 2.19* 2.14

Hodgkin lymphoma 1 1.82 1 0.57 1 0.93 2 2.03 5 4.37 1.14 0.03

Non-Hodgkin lymphoma 0 0.00 7 1.95 3 0.72 14 1.66 24 16.95 1.42 0.37

Myeloma 0 0.00 0 0.00 1 1.44 3 1.38 4 3.35 1.19 0.03

Leukemia 4 7.73* 22 10.14* 6 2.70 9 2.17 41 9.06 4.52* 1.70

Acute lymphocytic 1 16.70 1 4.05 0 0.00 0 0.00 2 0.78 2.55 0.06

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 1 0.88 1 1.66 0.60 -0.03

Acute non-lymphocytic 3 11.18* 19 17.39* 4 3.85* 7 4.12* 33 4.10 8.05* 1.53

Chronic myeloid 0 0.00 1 2.10 1 2.19 1 1.32 3 1.81 1.66 0.06

Breast

Females, <40 Years of Age

Table 7.1.4: Risk of subsequent primary cancers after cancer of the breast, females,

<40 years of age, SEER 1973-2000.

192 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BREAST

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 22,902 21,399 13,131 7,773 22,902

Person-years in interval 18,485 67,341 51,066 51,480 188,371

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Breast

Females, 40-49 Years of Age

Table 7.1.5: Risk of subsequent primary cancers after cancer of the breast, females,

40-49 years of age, SEER 1973-2000.

BREAST

All subsequent cancers 365 2.20* 1,472 1.98* 1,270 1.64* 1,675 1.26* 4,782 3,011.07 1.59* 37.79

All excluding same site 109 1.20 591 1.41* 609 1.32* 999 1.14* 2,308 1,848.91 1.25* 9.80

Buccal cavity, pharynx 4 1.44 19 1.46 21 1.44 26 1.07 70 54.66 1.28 0.33

Lip 0 0.00 0 0.00 0 0.00 3 2.67 3 2.29 1.31 0.02

Tongue 0 0.00 3 1.06 5 1.46 8 1.38 16 12.62 1.27 0.07

Salivary gland 2 4.46 8 4.33* 1 0.59 1 0.38 12 6.63 1.81 0.11

Mouth 2 2.57 6 1.55 5 1.11 9 1.19 22 16.74 1.31 0.11

Nasopharynx 0 0.00 2 2.10 1 1.27 0 0.00 3 3.11 0.96 0.00

Tonsil 0 0.00 0 0.00 5 2.89 1 0.39 6 6.14 0.98 0.00

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.40 0.00 -0.03

Hypopharynx 0 0.00 0 0.00 3 2.86 3 1.56 6 3.98 1.51 0.04

Digestive system 16 1.04 88 1.15 113 1.20 230 1.09 447 397.15 1.13* 1.06

Esophagus 1 2.35 2 0.91 6 1.97 15 2.04* 24 13.00 1.85* 0.23

Stomach 2 1.50 9 1.50 12 1.83 21 1.53 44 27.61 1.59* 0.35

Small intestine 0 0.00 2 0.96 2 0.88 9 2.04 13 9.21 1.41 0.08

Colon 6 0.91 32 0.98 52 1.26 89 0.91 179 178.34 1.00 0.01

Rectum, rectosigmoid junction 5 1.56 19 1.18 21 1.08 50 1.33 95 76.49 1.24* 0.39

Rectum 3 1.40 11 1.03 14 1.11 29 1.16 57 50.28 1.13 0.14

Anus, anal canal 0 0.00 5 2.12 2 0.79 6 1.39 13 9.71 1.34 0.07

Liver 0 0.00 1 0.48 2 0.83 4 0.69 7 10.77 0.65 -0.08

Gallbladder 0 0.00 1 0.72 0 0.00 6 1.45 7 7.64 0.92 -0.01

Bile ducts, other biliary 0 0.00 2 1.36 2 1.10 6 1.31 10 8.16 1.22 0.04

Pancreas 1 0.64 12 1.46 13 1.18 22 0.80 48 48.31 0.99 -0.01

Respiratory system 13 1.05 105 1.59* 119 1.34* 262 1.25* 499 377.09 1.32* 2.60

Nose, nasal cavity, ear 0 0.00 2 2.20 1 1.06 2 1.24 5 3.66 1.36 0.03

Larynx 0 0.00 6 1.74 4 0.95 6 0.77 16 16.11 0.99 0.00

Lung, bronchus 13 1.13 97 1.58* 114 1.36* 253 1.27* 477 356.29 1.34* 2.58

Female breast 256 3.41* 881 2.73* 661 2.12* 676 1.49* 2,474 1,162.16 2.13* 27.99

Female genital system 25 0.90 198 1.60* 181 1.47* 190 1.02 594 460.96 1.29* 2.84

Cervix uteri 4 0.52 24 0.87 14 0.70 7 0.36* 49 74.94 0.65* -0.55

Corpus uteri 5 0.50 86 1.70* 79 1.35* 96 0.96 266 218.86 1.22* 1.01

Ovary 14 1.62 80 2.08* 80 2.11* 76 1.36* 250 140.80 1.78* 2.33

Vagina 0 0.00 1 0.91 2 1.74 2 0.97 5 4.57 1.09 0.01

Vulva 0 0.00 3 0.88 0 0.00 5 0.87 8 13.21 0.61 -0.11

Urinary system 8 1.95 27 1.32 30 1.18 72 1.26 137 107.15 1.28* 0.64

Urinary bladder 1 0.56 15 1.61 17 1.39 47 1.58* 80 52.96 1.51* 0.58

Kidney parenchyma 6 2.79* 10 0.98 12 1.00 22 0.92 50 48.16 1.04 0.04

Renal pelvis, other urinary 1 5.55 2 2.03 1 0.73 3 0.86 7 6.03 1.16 0.02

Ureter 1 29.93 0 0.00 0 0.00 1 1.02 2 1.52 1.32 0.01

Bone, joints 1 3.67 0 0.00 2 2.27 6 4.98* 9 3.43 2.63* 0.12

Soft tissue including heart 0 0.00 5 1.36 6 1.73 6 1.14 17 13.30 1.28 0.08

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.01

Melanoma of skin 17 2.13* 38 1.20 32 1.18 47 1.39* 134 100.67 1.33* 0.71

Eye, orbit 0 0.00 1 0.88 3 2.58 3 1.55 7 4.49 1.56 0.05

Brain, central nervous system 3 1.39 17 1.82* 11 1.18 11 0.77 42 35.13 1.20 0.15

Thyroid 11 1.97 21 0.99 27 1.64* 19 1.15 78 59.77 1.31* 0.39

Lymphatic, hematopoietic 7 0.81 60 1.53* 54 1.25 104 1.21 225 176.95 1.27* 1.03

Hodgkin lymphoma 0 0.00 0 0.00 2 0.87 3 1.04 5 8.84 0.57 -0.08

Non-Hodgkin lymphoma 2 0.45 12 0.58 19 0.82 55 1.20 88 93.78 0.94 -0.12

Myeloma 0 0.00 2 0.41 4 0.65 19 1.34 25 26.11 0.96 -0.02

Leukemia 5 2.05 46 4.18* 29 2.45* 27 1.18 107 48.23 2.22* 1.25

Acute lymphocytic 0 0.00 3 4.17 1 1.54 0 0.00 4 2.49 1.61 0.03

Chronic lymphocytic 1 2.18 5 1.90 4 1.11 11 1.29 21 15.26 1.38 0.12

Acute non-lymphocytic 2 1.87 34 7.46* 21 4.54* 12 1.40 69 18.81 3.67* 1.07

Chronic myeloid 1 1.99 2 0.91 2 0.95 4 1.22 9 8.09 1.11 0.02

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 55,812 51,916 33,035 19,043 55,812

Person-years in interval 44,883 166,731 127,378 129,660 468,653

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING BREAST CANCER 193
All subsequent cancers 1,351 1.18* 5,947 1.24* 5,112 1.14* 5,427 1.10* 17,837 15,335.64 1.16* 21.37

All excluding same site 791 1.02 3,505 1.06* 3,194 1.01 3,655 1.02 11,145 10,816.09 1.03* 2.81

Buccal cavity, pharynx 20 0.85 107 1.11 93 1.12 90 1.10 310 284.82 1.09 0.22

Lip 0 0.00 5 1.10 3 0.65 6 0.98 14 16.27 0.86 -0.02

Tongue 5 0.94 28 1.30 17 0.91 16 0.89 66 63.46 1.04 0.02

Salivary gland 4 1.78 13 1.41 12 1.45 14 1.54 43 28.85 1.49* 0.12

Mouth 7 0.91 31 0.98 37 1.33 31 1.07 106 96.02 1.10 0.09

Nasopharynx 1 0.93 7 1.66 5 1.44 2 0.63 15 11.91 1.26 0.03

Tonsil 2 0.74 8 0.77 10 1.25 9 1.43 29 27.38 1.06 0.01

Oropharynx 0 0.00 3 1.09 2 0.85 1 0.49 6 7.80 0.77 -0.02

Hypopharynx 1 0.51 7 0.88 5 0.76 6 1.08 19 22.02 0.86 -0.03

Digestive system 208 1.04 988 1.11* 881 0.96 1,194 1.04 3,271 3,154.43 1.04* 1.00

Esophagus 8 1.14 44 1.47* 41 1.43* 53 1.62* 146 98.21 1.49* 0.41

Stomach 15 1.07 90 1.45* 58 0.91 108 1.31* 271 222.39 1.22* 0.42

Small intestine 1 0.29 20 1.33 25 1.68* 20 1.11 66 51.29 1.29 0.13

Colon 110 1.18 472 1.12* 445 1.00 593 1.02 1,620 1,538.43 1.05* 0.70

Rectum, rectosigmoid junction 36 0.98 168 1.06 141 0.93 161 0.95 506 516.27 0.98 -0.09

Rectum 25 1.05 102 1.00 89 0.91 99 0.88 315 336.35 0.94 -0.18

Anus, anal canal 4 1.12 13 0.85 16 1.13 13 0.86 46 48.07 0.96 -0.02

Liver 3 0.66 18 0.88 15 0.68 25 0.88 61 75.34 0.81 -0.12

Gallbladder 1 0.24 17 0.89 10 0.51* 25 1.06 53 66.66 0.80 -0.12

Bile ducts, other biliary 4 1.05 19 1.08 14 0.73 31 1.11 68 68.45 0.99 0.00

Pancreas 23 0.89 115 0.98 105 0.85 150 0.95 393 423.55 0.93 -0.26

Respiratory system 143 0.87 711 0.98 658 0.93 771 1.00 2,283 2,364.67 0.97 -0.70

Nose, nasal cavity, ear 3 1.97 7 1.14 7 1.21 5 0.74 22 20.24 1.09 0.02

Larynx 8 1.15 28 1.01 16 0.70 20 1.03 72 77.16 0.93 -0.04

Lung, bronchus 130 0.84* 675 0.98 634 0.93 743 1.00 2,182 2,261.83 0.96 -0.68

Female breast 560 1.53* 2,442 1.64* 1,918 1.45* 1,772 1.32* 6,692 4,519.55 1.48* 18.56

Female genital system 198 1.10 853 1.20* 700 1.19* 595 1.08 2,346 2,027.68 1.16* 2.72

Cervix uteri 17 0.81 68 0.90 35 0.66* 24 0.57* 144 191.62 0.75* -0.41

Corpus uteri 102 1.03 503 1.28* 436 1.36* 339 1.17* 1,380 1,102.00 1.25* 2.38

Ovary 72 1.46* 242 1.22* 196 1.14 186 1.09 696 590.51 1.18* 0.90

Vagina 0 0.00 8 0.97 4 0.52 9 1.02 21 26.76 0.78 -0.05

Vulva 4 0.83 18 0.85 18 0.83 22 0.76 62 76.70 0.81 -0.13

Urinary system 70 1.48* 194 0.92 241 1.14 260 1.02 765 723.38 1.06 0.36

Urinary bladder 26 1.01 100 0.86 149 1.25* 166 1.11 441 410.31 1.07 0.26

Kidney parenchyma 40 2.19* 82 1.04 76 1.00 70 0.84 268 256.16 1.05 0.10

Renal pelvis, other urinary 4 1.16 12 0.76 16 0.95 24 1.15 56 56.90 0.98 -0.01

Ureter 0 0.00 2 0.43 4 0.78 9 1.41 15 17.20 0.87 -0.02

Bone, joints 1 0.95 1 0.23 7 1.84 9 2.23* 18 13.18 1.37 0.04

Soft tissue including heart 2 0.46 29 1.63* 29 1.79* 32 1.70* 92 57.22 1.61* 0.30

Kaposi sarcoma 0 0.00 1 1.57 0 0.00 2 1.20 3 3.23 0.93 0.00

Melanoma of skin 37 1.50* 114 1.15 97 1.13 93 1.03 341 299.79 1.14* 0.35

Eye, orbit 0 0.00 6 0.78 8 1.21 6 0.91 20 22.71 0.88 -0.02

Brain, central nervous system 10 0.77 58 1.07 38 0.77 35 0.70* 141 166.70 0.85* -0.22

Thyroid 28 2.17* 62 1.29 53 1.45* 30 0.94 173 129.18 1.34* 0.37

Lymphatic, hematopoietic 62 0.85 319 0.99 313 0.96 411 1.03 1,105 1,118.95 0.99 -0.12

Hodgkin lymphoma 1 0.37 6 0.56 10 1.08 12 1.28 29 32.11 0.90 -0.03

Non-Hodgkin lymphoma 36 0.99 115 0.71* 125 0.75* 207 1.02 483 566.72 0.85* -0.72

Myeloma 11 0.87 57 1.02 51 0.90 65 0.94 184 194.78 0.94 -0.09

Leukemia 14 0.67 141 1.53* 127 1.36* 127 1.07 409 325.35 1.26* 0.71

Acute lymphocytic 1 1.30 2 0.64 5 1.78 1 0.32 9 9.84 0.91 -0.01

Chronic lymphocytic 3 0.37 17 0.46* 27 0.72 46 0.99 93 129.15 0.72* -0.31

Acute non-lymphocytic 9 1.21 107 3.24* 69 2.06* 53 1.22 238 117.49 2.03* 1.03

Chronic myeloid 1 0.33 10 0.79 14 1.14 15 0.97 40 43.33 0.92 -0.03

Breast

Females, 50-69 Years of Age

Table 7.1.6: Risk of subsequent primary cancers after cancer of the breast, females,

50-69 years of age, SEER 1973-2000.

194 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BREAST

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 145,405 134,297 85,924 48,956 145,405

Person-years in interval 116,270 432,699 329,430 291,836 1,170,235

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Breast

Females, ≥70 Years of Age

Table 7.1.7: Risk of subsequent primary cancers after cancer of the breast, females,

≥70 years of age, SEER 1973-2000.

BREAST

All subsequent cancers 1,203 0.88* 4,563 0.97* 2,980 1.03 1,228 0.98 9,974 10,222.81 0.98* -4.53

All excluding same site 856 0.84* 3,161 0.89* 2,137 0.97 873 0.90* 7,027 7,769.38 0.90* -13.50

Buccal cavity, pharynx 25 1.13 62 0.82 53 1.18 18 0.92 158 162.01 0.98 -0.07

Lip 2 1.00 5 0.69 4 0.82 5 2.07 16 16.55 0.97 -0.01

Tongue 9 1.89 11 0.68 12 1.24 4 0.94 36 34.93 1.03 0.02

Salivary gland 6 2.31 15 1.65 7 1.21 1 0.36 29 20.26 1.43 0.16

Mouth 4 0.49 19 0.68 18 1.05 4 0.52 45 61.17 0.74* -0.29

Nasopharynx 1 1.38 3 1.26 1 0.75 1 1.97 6 4.94 1.21 0.02

Tonsil 1 0.71 4 0.90 4 1.78 3 4.50 12 8.77 1.37 0.06

Oropharynx 1 2.08 1 0.64 4 4.92* 0 0.00 6 3.14 1.91 0.05

Hypopharynx 1 0.82 1 0.26 0 0.00 0 0.00 2 7.41 0.27* -0.10

Digestive system 306 0.79* 1,312 0.95 883 0.99 388 0.95 2,889 3,072.15 0.94* -3.33

Esophagus 9 0.97 22 0.68 24 1.19 15 1.62 70 71.00 0.99 -0.02

Stomach 26 0.81 120 1.06 79 1.08 26 0.77 251 252.75 0.99 -0.03

Small intestine 1 0.22 11 0.68 6 0.58 8 1.67 26 35.95 0.72 -0.18

Colon 167 0.83* 757 1.05 519 1.10* 215 0.97 1,658 1,612.94 1.03 0.82

Rectum, rectosigmoid junction 35 0.61* 193 0.98 111 0.93 58 1.13 397 425.02 0.93 -0.51

Rectum 26 0.69 120 0.92 77 0.96 42 1.19 265 283.03 0.94 -0.33

Anus, anal canal 4 0.98 11 0.78 7 0.82 1 0.26 23 30.57 0.75 -0.14

Liver 6 0.77 11 0.40* 6 0.35* 7 0.95 30 59.76 0.50* -0.54

Gallbladder 8 0.85 16 0.49* 10 0.50* 9 1.05 43 70.62 0.61* -0.50

Bile ducts, other biliary 12 1.37 28 0.87 14 0.63 6 0.54 60 74.17 0.81 -0.26

Pancreas 38 0.75 130 0.72* 102 0.87 39 0.71* 309 403.51 0.77* -1.72

Respiratory system 123 0.75* 390 0.70* 245 0.76* 94 0.77* 852 1,164.71 0.73* -5.69

Nose, nasal cavity, ear 0 0.00 4 0.59 1 0.23 3 1.54 8 14.97 0.53 -0.13

Larynx 4 1.01 7 0.55 2 0.30 2 0.85 15 25.69 0.58* -0.19

Lung, bronchus 118 0.75* 378 0.70* 241 0.78* 89 0.76* 826 1,120.83 0.74* -5.36

Female breast 347 1.03 1,402 1.21* 843 1.24* 355 1.27* 2,947 2,453.44 1.20* 8.98

Female genital system 173 1.18* 581 1.19* 381 1.38* 122 1.10 1,257 1,020.13 1.23* 4.31

Cervix uteri 11 0.81 47 1.08 16 0.69 3 0.33* 77 89.28 0.86 -0.22

Corpus uteri 108 1.51* 338 1.45* 239 1.90* 71 1.54* 756 476.92 1.59* 5.08

Ovary 43 0.97 149 0.99 89 1.01 28 0.76 309 320.03 0.97 -0.20

Vagina 1 0.34 6 0.58 5 0.78 1 0.36 13 22.60 0.58* -0.17

Vulva 5 0.52 28 0.80 20 0.85 12 1.01 65 80.05 0.81 -0.27

Urinary system 72 0.99 251 0.98 166 1.03 68 0.94 557 563.77 0.99 -0.12

Urinary bladder 40 0.87 152 0.93 105 1.01 47 0.97 344 361.44 0.95 -0.32

Kidney parenchyma 29 1.42 79 1.11 43 1.01 18 1.01 169 151.83 1.11 0.31

Renal pelvis, other urinary 3 0.45 20 0.86 18 1.25 3 0.49 44 50.50 0.87 -0.12

Ureter 1 0.47 4 0.54 6 1.30 1 0.51 12 16.13 0.74 -0.08

Bone, joints 0 0.00 4 0.99 2 0.83 0 0.00 6 8.61 0.70 -0.05

Soft tissue including heart 4 0.75 13 0.69 21 1.71* 4 0.70 42 42.11 1.00 0.00

Kaposi sarcoma 0 0.00 0 0.00 1 0.43 2 1.63 3 7.42 0.40 -0.08

Melanoma of skin 19 0.92 87 1.19 55 1.18 24 1.08 185 162.43 1.14 0.41

Eye, orbit 1 0.53 11 1.74 2 0.54 3 1.81 17 13.59 1.25 0.06

Brain, central nervous system 7 0.56 29 0.69* 16 0.68 4 0.45 56 86.60 0.65* -0.56

Thyroid 10 1.36 36 1.48* 11 0.81 7 1.33 64 50.44 1.27 0.25

Lymphatic, hematopoietic 102 0.87 326 0.78* 247 0.93 106 0.89 781 916.55 0.85* -2.47

Hodgkin lymphoma 9 3.23* 7 0.75 4 0.75 3 1.51 23 19.46 1.18 0.06

Non-Hodgkin lymphoma 43 0.80 144 0.75* 125 1.03 54 1.01 366 419.95 0.87* -0.98

Myeloma 22 1.06 75 1.03 42 0.93 12 0.63 151 158.10 0.96 -0.13

Leukemia 28 0.70 100 0.70* 76 0.82 37 0.83 241 319.04 0.76* -1.42

Acute lymphocytic 1 1.06 4 1.17 1 0.45 1 0.92 7 7.68 0.91 -0.01

Chronic lymphocytic 7 0.44* 23 0.41* 22 0.62* 11 0.66 63 123.89 0.51* -1.11

Acute non-lymphocytic 11 0.80 46 0.94 33 1.04 12 0.81 102 109.40 0.93 -0.13

Chronic myeloid 6 1.13 18 0.94 13 1.02 9 1.40 46 43.69 1.05 0.04

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 98,744 87,368 46,071 17,559 98,744

Person-years in interval 77,011 258,442 150,295 63,981 549,729

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING BREAST CANCER 195
All subsequent cancers 933 1.12* 3,971 1.32* 2,845 1.39* 2,176 1.44* 9,925 7,400.22 1.34* 38.35

All excluding same site 523 0.91* 2,217 1.06* 1,649 1.15* 1,338 1.25* 5,727 5,167.83 1.11* 8.49

Buccal cavity, pharynx 19 1.28 51 0.96 49 1.38* 21 0.82 140 129.15 1.08 0.16

Lip 0 0.00 4 1.23 1 0.43 1 0.56 6 8.22 0.73 -0.03

Tongue 6 1.80 11 0.92 9 1.13 5 0.88 31 28.93 1.07 0.03

Salivary gland 5 2.99 12 2.00* 7 1.75 6 2.05 30 14.61 2.05* 0.23

Mouth 7 1.42 13 0.73 18 1.50 2 0.23* 40 43.55 0.92 -0.05

Nasopharynx 0 0.00 1 0.42 1 0.66 1 0.97 3 5.61 0.53 -0.04

Tonsil 0 0.00 6 1.22 8 2.58* 2 0.96 16 11.50 1.39 0.07

Oropharynx 0 0.00 2 1.48 0 0.00 0 0.00 2 3.26 0.61 -0.02

Hypopharynx 1 0.95 1 0.27 3 1.23 3 1.77 8 8.93 0.90 -0.01

Digestive system 133 0.80* 652 1.06 451 1.04 352 1.06 1,588 1,549.84 1.02 0.58

Esophagus 4 0.82 20 1.12 28 2.24* 28 2.93* 80 44.83 1.78* 0.53

Stomach 13 1.04 83 1.82* 44 1.39* 30 1.26 170 113.69 1.50* 0.86

Small intestine 1 0.37 15 1.50 6 0.85 4 0.73 26 25.21 1.03 0.01

Colon 62 0.77* 310 1.03 227 1.05 167 1.01 766 764.10 1.00 0.03

Rectum, rectosigmoid junction 21 0.77 102 1.03 69 1.02 45 0.90 237 244.46 0.97 -0.11

Rectum 15 0.84 72 1.10 47 1.05 30 0.90 164 161.40 1.02 0.04

Anus, anal canal 4 1.55 11 1.17 5 0.78 7 1.48 27 23.10 1.17 0.06

Liver 3 0.76 9 0.61 6 0.58 7 0.86 25 37.18 0.67* -0.19

Gallbladder 2 0.56 14 1.07 4 0.44 4 0.60 24 32.52 0.74 -0.13

Bile ducts, other biliary 2 0.55 14 1.02 9 0.90 10 1.25 35 35.40 0.99 -0.01

Pancreas 20 0.92 69 0.85 50 0.86 47 1.05 186 205.79 0.90 -0.30

Respiratory system 78 0.69* 361 0.86* 312 1.07 330 1.46* 1,081 1,049.08 1.03 0.48

Nose, nasal cavity, ear 2 1.84 6 1.52 2 0.74 5 2.46 15 9.80 1.53 0.08

Larynx 4 1.04 8 0.59 2 0.22* 4 0.63 18 32.67 0.55* -0.22

Lung, bronchus 71 0.66* 347 0.87* 306 1.09 318 1.47* 1,042 1,004.09 1.04 0.58

Female breast 410 1.59* 1,754 1.90* 1,196 1.95* 838 1.90* 4,198 2,232.39 1.88* 29.86

Female genital system 120 1.06 526 1.33* 358 1.40* 232 1.30* 1,236 944.32 1.31* 4.43

Cervix uteri 15 1.05 51 1.10 18 0.67 11 0.68 95 103.73 0.92 -0.13

Corpus uteri 63 1.09 300 1.48* 221 1.68* 122 1.32* 706 483.77 1.46* 3.38

Ovary 34 1.03 149 1.27* 98 1.27* 79 1.44* 360 282.76 1.27* 1.17

Vagina 0 0.00 5 0.93 2 0.55 7 2.61* 14 13.19 1.06 0.01

Vulva 5 1.15 13 0.80 10 0.88 7 0.80 35 40.72 0.86 -0.09

Urinary system 46 1.24 150 1.09 110 1.13 81 1.09 387 346.43 1.12* 0.62

Urinary bladder 18 0.86 77 0.98 65 1.17 49 1.14 209 197.94 1.06 0.17

Kidney parenchyma 24 1.80* 64 1.31* 39 1.16 25 0.97 152 121.61 1.25* 0.46

Renal pelvis, other urinary 4 1.39 9 0.84 6 0.79 7 1.21 26 26.88 0.97 -0.01

Ureter 2 2.34 2 0.63 0 0.00 4 2.30 8 8.07 0.99 0.00

Bone, joints 0 0.00 2 0.69 3 1.60 8 6.11* 13 6.89 1.89* 0.09

Soft tissue including heart 2 0.59 19 1.56 28 3.42* 18 2.99* 67 29.72 2.25* 0.57

Kaposi sarcoma 0 0.00 1 1.19 0 0.00 1 2.00 2 2.19 0.91 0.00

Melanoma of skin 33 1.70* 93 1.35* 63 1.39* 53 1.66* 242 165.36 1.46* 1.16

Eye, orbit 0 0.00 4 0.91 3 1.04 5 2.43 12 10.55 1.14 0.02

Brain, central nervous system 8 0.89 28 0.87 22 1.03 15 0.98 73 77.83 0.94 -0.07

Thyroid 20 1.98* 36 1.06 25 1.22 18 1.38 99 77.61 1.28* 0.32

Lymphatic, hematopoietic 49 0.82 255 1.16* 194 1.26* 165 1.41* 663 550.35 1.20* 1.71

Hodgkin lymphoma 5 2.30 6 0.82 11 2.41* 7 2.30 29 17.13 1.69* 0.18

Non-Hodgkin lymphoma 21 0.71 75 0.68* 75 0.97 82 1.38* 253 276.32 0.92 -0.35

Myeloma 10 1.00 37 1.00 26 1.00 21 1.06 94 92.91 1.01 0.02

Leukemia 13 0.74 137 2.10* 82 1.78* 55 1.57* 287 164.00 1.75* 1.87

Acute lymphocytic 3 4.98* 4 1.86 4 2.78 0 0.00 11 5.23 2.10* 0.09

Chronic lymphocytic 1 0.15* 15 0.61 17 0.97 25 1.87* 58 61.99 0.94 -0.06

Acute non-lymphocytic 6 0.93 95 3.96* 44 2.62* 23 1.79* 168 60.06 2.80* 1.64

Chronic myeloid 3 1.20 15 1.65 9 1.42 6 1.26 33 22.68 1.45* 0.16

Breast

Females, Radiotherapy

Table 7.1.8: Risk of subsequent primary cancers after cancer of the breast, females,

with initial radiotherapy, SEER 1973-2000.

196 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BREAST

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 109,188 97,776 51,143 21,912 109,188

Person-years in interval 86,112 288,415 173,271 110,498 658,296

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Breast

Females, No Radiotherapy

Table 7.1.9: Risk of subsequent primary cancers after cancer of the breast, females,

without initial radiotherapy, SEER 1973-2000.

BREAST

All subsequent cancers 2,121 1.14* 8,685 1.18* 7,014 1.12* 6,755 1.08* 24,575 21,741.16 1.13* 16.49

All excluding same site 1,265 0.95 5,179 0.98 4,422 0.99 4,479 0.99 15,345 15,593.26 0.98* -1.44

Buccal cavity, pharynx 30 0.88 138 1.04 122 1.12 121 1.15 411 381.18 1.08 0.17

Lip 2 0.88 6 0.66 6 0.77 13 1.62 27 27.25 0.99 0.00

Tongue 8 1.08 32 1.10 26 1.07 24 1.03 90 84.11 1.07 0.03

Salivary gland 7 1.87 24 1.63* 14 1.15 16 1.31 61 42.83 1.42* 0.11

Mouth 6 0.51 43 0.93 44 1.16 43 1.17 136 132.71 1.02 0.02

Nasopharynx 2 1.43 11 2.05* 6 1.40 2 0.50 21 15.08 1.39 0.03

Tonsil 3 0.99 6 0.52 11 1.21 11 1.38 31 31.69 0.98 0.00

Oropharynx 1 1.20 2 0.61 6 2.25 1 0.41 10 9.24 1.08 0.00

Hypopharynx 1 0.44 7 0.79 5 0.70 6 0.91 19 24.90 0.76 -0.03

Digestive system 400 0.91 1,743 1.00 1,433 0.97 1,512 1.03 5,088 5,126.33 0.99 -0.22

Esophagus 14 1.19 48 1.03 43 1.08 58 1.43* 163 138.73 1.17* 0.14

Stomach 30 0.85 138 1.01 107 0.95 128 1.18 403 393.41 1.02 0.06

Small intestine 1 0.17* 18 0.77 27 1.29 34 1.51* 80 72.82 1.10 0.04

Colon 222 1.01 955 1.09* 789 1.06 751 1.01 2,717 2,587.70 1.05* 0.75

Rectum, rectosigmoid junction 56 0.80 278 1.01 206 0.92 234 1.09 774 784.11 0.99 -0.06

Rectum 40 0.87 161 0.90 133 0.90 145 1.01 479 515.59 0.93 -0.21

Anus, anal canal 4 0.71 18 0.80 21 1.09 16 0.82 59 67.03 0.88 -0.05

Liver 6 0.68 21 0.59* 17 0.54* 29 0.85 73 110.28 0.66* -0.22

Gallbladder 7 0.68 20 0.50* 16 0.49* 36 1.19 79 113.28 0.70* -0.20

Bile ducts, other biliary 14 1.51 36 0.96 21 0.63* 33 0.91 104 116.45 0.89 -0.07

Pancreas 43 0.76 188 0.83* 171 0.88 172 0.87 574 675.17 0.85* -0.59

Respiratory system 203 0.89 867 0.93* 731 0.88* 838 0.93* 2,639 2,900.86 0.91* -1.52

Nose, nasal cavity, ear 1 0.39 8 0.80 8 0.94 5 0.58 22 29.77 0.74 -0.05

Larynx 8 1.02 33 1.07 21 0.83 27 1.10 89 88.39 1.01 0.00

Lung, bronchus 192 0.88 824 0.92* 701 0.88* 804 0.93* 2,521 2,775.31 0.91* -1.48

Female breast 856 1.61* 3,506 1.67* 2,592 1.47* 2,276 1.30* 9,230 6,147.90 1.50* 17.93

Female genital system 286 1.16* 1,146 1.21* 964 1.28* 782 1.10* 3,178 2,659.33 1.20* 3.02

Cervix uteri 22 0.72 91 0.83 53 0.68* 34 0.54* 200 280.69 0.71* -0.47

Corpus uteri 155 1.25* 634 1.33* 555 1.46* 416 1.15* 1,760 1,346.26 1.31* 2.41

Ovary 97 1.37* 350 1.26* 297 1.30* 270 1.22* 1,014 797.08 1.27* 1.26

Vagina 1 0.27 10 0.69 9 0.76 5 0.44 25 41.62 0.60* -0.10

Vulva 4 0.36* 37 0.84 28 0.74 33 0.84 102 132.13 0.77* -0.18

Urinary system 106 1.21 325 0.92 330 1.08 331 1.04 1,092 1,063.05 1.03 0.17

Urinary bladder 49 0.93 192 0.91 208 1.14 217 1.15* 666 633.26 1.05 0.19

Kidney parenchyma 53 1.91* 108 0.96 93 0.94 90 0.86 344 342.57 1.00 0.01

Renal pelvis, other urinary 4 0.54 25 0.85 29 1.16 24 0.95 82 87.21 0.94 -0.03

Ureter 0 0.00 4 0.44 10 1.29 8 1.04 22 26.89 0.82 -0.03

Bone, joints 2 1.13 5 0.73 8 1.45 8 1.51 23 19.43 1.18 0.02

Soft tissue including heart 4 0.54 32 1.10 30 1.22 29 1.15 95 86.44 1.10 0.05

Kaposi sarcoma 0 0.00 0 0.00 1 0.38 3 1.17 4 8.96 0.45 -0.03

Melanoma of skin 41 1.13 158 1.09 133 1.08 126 1.01 458 429.98 1.07 0.16

Eye, orbit 1 0.35 16 1.46 11 1.25 7 0.82 35 31.12 1.12 0.02

Brain, central nervous system 13 0.68 82 1.08 46 0.73* 40 0.65* 181 218.93 0.83* -0.22

Thyroid 36 2.03* 91 1.36* 72 1.37* 47 0.98 246 185.23 1.33* 0.35

Lymphatic, hematopoietic 127 0.90 480 0.85* 431 0.88* 484 0.96 1,522 1,695.83 0.90* -1.01

Hodgkin lymphoma 6 1.29 8 0.46* 6 0.45* 13 1.07 33 47.65 0.69* -0.09

Non-Hodgkin lymphoma 60 0.91 203 0.76* 197 0.83* 248 0.99 708 821.08 0.86* -0.66

Myeloma 23 0.94 97 1.00 72 0.87 78 0.92 270 289.42 0.93 -0.11

Leukemia 38 0.83 172 0.94 156 1.01 145 0.93 511 537.69 0.95 -0.16

Acute lymphocytic 0 0.00 6 1.13 3 0.67 2 0.45 11 15.57 0.71 -0.03

Chronic lymphocytic 10 0.56 30 0.42* 36 0.60* 44 0.74* 120 207.97 0.58* -0.51

Acute non-lymphocytic 19 1.19 111 1.74* 83 1.53* 61 1.09 274 189.74 1.44* 0.49

Chronic myeloid 5 0.78 16 0.63 21 0.99 23 1.08 65 74.23 0.88 -0.05

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 213,675 197,204 127,018 71,419 213,675

Person-years in interval 170,537 636,797 484,899 426,458 1,718,691

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING BREAST CANCER 197
All subsequent cancers 7,749 1.32* 1,433 1.50* 520 1.34* 223 1.32* 9,925 7,400.22 1.34* 38.35

All excluding same site 4,389 1.07* 855 1.27* 323 1.17* 160 1.31* 5,727 5,167.83 1.11* 8.49

Buccal cavity, pharynx 119 1.15 13 0.80 5 0.77 3 1.10 140 129.15 1.08 0.16

Lip 5 0.78 0 0.00 0 0.00 1 4.70 6 8.22 0.73 -0.03

Tongue 26 1.12 1 0.27 3 2.07 1 1.66 31 28.93 1.07 0.03

Salivary gland 24 2.06* 5 2.70 0 0.00 1 3.05 30 14.61 2.05* 0.23

Mouth 38 1.09 2 0.36 0 0.00 0 0.00 40 43.55 0.92 -0.05

Nasopharynx 2 0.44 0 0.00 1 3.84 0 0.00 3 5.61 0.53 -0.04

Tonsil 14 1.48 1 0.74 1 1.89 0 0.00 16 11.50 1.39 0.07

Oropharynx 2 0.76 0 0.00 0 0.00 0 0.00 2 3.26 0.61 -0.02

Hypopharynx 5 0.69 3 2.75 0 0.00 0 0.00 8 8.93 0.90 -0.01

Digestive system 1,236 1.02 224 1.08 83 0.97 45 1.16 1,588 1,549.84 1.02 0.58

Esophagus 52 1.47* 16 2.68* 10 4.06* 2 1.78 80 44.83 1.78* 0.53

Stomach 140 1.56* 23 1.54 2 0.32 5 1.82 170 113.69 1.50* 0.86

Small intestine 22 1.11 2 0.59 2 1.41 0 0.00 26 25.21 1.03 0.01

Colon 599 1.00 108 1.04 39 0.91 20 1.03 766 764.10 1.00 0.03

Rectum, rectosigmoid junction 192 0.99 27 0.85 12 0.95 6 1.09 237 244.46 0.97 -0.11

Rectum 134 1.05 17 0.81 8 0.95 5 1.33 164 161.40 1.02 0.04

Anus, anal canal 20 1.09 6 2.01 1 0.82 0 0.00 27 23.10 1.17 0.06

Liver 18 0.62* 4 0.81 1 0.47 2 1.91 25 37.18 0.67* -0.19

Gallbladder 20 0.77 2 0.47 1 0.58 1 1.36 24 32.52 0.74 -0.13

Bile ducts, other biliary 25 0.91 6 1.22 3 1.42 1 1.00 35 35.40 0.99 -0.01

Pancreas 139 0.86 29 1.04 10 0.86 8 1.50 186 205.79 0.90 -0.30

Respiratory system 751 0.91* 192 1.37* 90 1.53* 48 1.79* 1,081 1,049.08 1.03 0.48

Nose, nasal cavity, ear 10 1.29 5 3.90* 0 0.00 0 0.00 15 9.80 1.53 0.08

Larynx 14 0.53* 2 0.49 2 1.24 0 0.00 18 32.67 0.55* -0.22

Lung, bronchus 724 0.92* 184 1.37* 86 1.52* 48 1.86* 1,042 1,004.09 1.04 0.58

Female breast 3,360 1.87* 578 2.05* 197 1.77* 63 1.34* 4,198 2,232.39 1.88* 29.86

Female genital system 1,004 1.31* 160 1.39* 49 1.08 23 1.24 1,236 944.32 1.31* 4.43

Cervix uteri 84 0.96 7 0.64 4 1.01 0 0.00 95 103.73 0.92 -0.13

Corpus uteri 584 1.49* 88 1.49* 24 1.03 10 1.03 706 483.77 1.46* 3.38

Ovary 281 1.23* 53 1.51* 15 1.08 11 1.90 360 282.76 1.27* 1.17

Vagina 7 0.67 4 2.35 3 4.41 0 0.00 14 13.19 1.06 0.01

Vulva 28 0.88 4 0.73 2 0.89 1 0.98 35 40.72 0.86 -0.09

Urinary system 306 1.13* 53 1.14 22 1.14 6 0.68 387 346.43 1.12* 0.62

Urinary bladder 160 1.03 33 1.23 11 0.98 5 0.98 209 197.94 1.06 0.17

Kidney parenchyma 127 1.32* 17 1.06 7 1.05 1 0.34 152 121.61 1.25* 0.46

Renal pelvis, other urinary 19 0.90 3 0.84 4 2.68 0 0.00 26 26.88 0.97 -0.01

Ureter 4 0.63 1 0.93 3 6.66* 0 0.00 8 8.07 0.99 0.00

Bone, joints 5 0.90 7 8.36* 1 3.04 0 0.00 13 6.89 1.89* 0.09

Soft tissue including heart 49 2.07* 11 2.90* 4 2.57 3 4.44 67 29.72 2.25* 0.57

Kaposi sarcoma 1 0.59 1 3.18 0 0.00 0 0.00 2 2.19 0.91 0.00

Melanoma of skin 189 1.42* 35 1.72* 9 1.13 9 2.57* 242 165.36 1.46* 1.16

Eye, orbit 7 0.82 4 3.06 1 1.89 0 0.00 12 10.55 1.14 0.02

Brain, central nervous system 58 0.93 6 0.61 8 2.07 1 0.61 73 77.83 0.94 -0.07

Thyroid 81 1.25 15 1.75 2 0.63 1 0.79 99 77.61 1.28* 0.32

Lymphatic, hematopoietic 498 1.15* 106 1.44* 42 1.38 17 1.24 663 550.35 1.20* 1.71

Hodgkin lymphoma 22 1.56 1 0.51 4 5.22* 2 6.55 29 17.13 1.69* 0.18

Non-Hodgkin lymphoma 171 0.79* 56 1.51* 15 0.98 11 1.57 253 276.32 0.92 -0.35

Myeloma 73 1.00 14 1.13 7 1.35 0 0.00 94 92.91 1.01 0.02

Leukemia 232 1.80* 35 1.59* 16 1.77* 4 1.00 287 164.00 1.75* 1.87

Acute lymphocytic 11 2.63* 0 0.00 0 0.00 0 0.00 11 5.23 2.10* 0.09

Chronic lymphocytic 33 0.68* 18 2.15* 6 1.73 1 0.67 58 61.99 0.94 -0.06

Acute non-lymphocytic 145 3.07* 13 1.62 9 2.73* 1 0.65 168 60.06 2.80* 1.64

Chronic myeloid 27 1.51 3 1.00 1 0.82 2 3.81 33 22.68 1.45* 0.16

Breast

Females, Long-term Follow-up, Radiotherapy

Table 7.1.10: Risk of subsequent primary cancers after cancer of the breast, females, long-term follow-up,

with initial radiotherapy, SEER 1973-2000.

198 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BREAST

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 109,188 21,912 8,686 3,168 109,188

Person-years in interval 547,798 72,946 26,986 10,566 658,296

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Breast

Females, Long-term Follow-up, No Radiotherapy

Table 7.1.11: Risk of subsequent primary cancers after cancer of the breast, females, long-term follow-up,

without initial radiotherapy, SEER 1973-2000.

BREAST

All subsequent cancers 17,820 1.15* 3,995 1.10* 1,943 1.07* 817 0.99 24,575 21,741.16 1.13* 16.49

All excluding same site 10,866 0.98* 2,592 1.00 1,304 0.99 583 0.97 15,345 15,593.26 0.98* -1.44

Buccal cavity, pharynx 290 1.05 62 1.01 49 1.62* 10 0.76 411 381.18 1.08 0.17

Lip 14 0.73 8 1.75 3 1.27 2 1.81 27 27.25 0.99 0.00

Tongue 66 1.09 12 0.87 11 1.64 1 0.34 90 84.11 1.07 0.03

Salivary gland 45 1.47* 6 0.86 7 1.96 3 1.84 61 42.83 1.42* 0.11

Mouth 93 0.97 22 1.02 19 1.80* 2 0.43 136 132.71 1.02 0.02

Nasopharynx 19 1.72* 2 0.85 0 0.00 0 0.00 21 15.08 1.39 0.03

Tonsil 20 0.84 5 1.03 6 2.63 0 0.00 31 31.69 0.98 0.00

Oropharynx 9 1.33 1 0.69 0 0.00 0 0.00 10 9.24 1.08 0.00

Hypopharynx 13 0.71 4 1.02 1 0.54 1 1.25 19 24.90 0.76 -0.03

Digestive system 3,576 0.98 844 0.99 457 1.08 211 1.07 5,088 5,126.33 0.99 -0.22

Esophagus 105 1.07 32 1.37 16 1.36 10 1.80 163 138.73 1.17* 0.14

Stomach 275 0.96 71 1.12 38 1.23 19 1.35 403 393.41 1.02 0.06

Small intestine 46 0.92 21 1.66* 12 1.80 1 0.31 80 72.82 1.10 0.04

Colon 1,966 1.07* 417 0.97 222 1.03 112 1.12 2,717 2,587.70 1.05* 0.75

Rectum, rectosigmoid junction 540 0.95 132 1.05 78 1.28* 24 0.87 774 784.11 0.99 -0.06

Rectum 334 0.90* 77 0.92 55 1.34* 13 0.69 479 515.59 0.93 -0.21

Anus, anal canal 43 0.90 5 0.45 6 1.06 5 1.96 59 67.03 0.88 -0.05

Liver 44 0.58* 17 0.89 6 0.60 6 1.17 73 110.28 0.66* -0.22

Gallbladder 43 0.52* 22 1.23 11 1.28 3 0.80 79 113.28 0.70* -0.20

Bile ducts, other biliary 71 0.88 19 0.94 8 0.75 6 1.16 104 116.45 0.89 -0.07

Pancreas 402 0.84* 95 0.83 57 0.99 20 0.74 574 675.17 0.85* -0.59

Respiratory system 1,801 0.90* 464 0.91 251 0.94 123 0.97 2,639 2,900.86 0.91* -1.52

Nose, nasal cavity, ear 17 0.80 2 0.40 3 1.22 0 0.00 22 29.77 0.74 -0.05

Larynx 62 0.97 16 1.11 9 1.28 2 0.67 89 88.39 1.01 0.00

Lung, bronchus 1,717 0.90* 445 0.91 238 0.93 121 0.99 2,521 2,775.31 0.91* -1.48

Female breast 6,954 1.58* 1,403 1.37* 639 1.26* 234 1.05 9,230 6,147.90 1.50* 17.93

Female genital system 2,396 1.23* 500 1.19* 209 1.02 73 0.83 3,178 2,659.33 1.20* 3.02

Cervix uteri 166 0.76* 21 0.54* 12 0.70 1 0.15* 200 280.69 0.71* -0.47

Corpus uteri 1,344 1.37* 278 1.31* 103 0.98 35 0.77 1,760 1,346.26 1.31* 2.41

Ovary 744 1.29* 163 1.26* 76 1.19 31 1.12 1,014 797.08 1.27* 1.26

Vagina 20 0.66 3 0.45 1 0.31 1 0.69 25 41.62 0.60* -0.10

Vulva 69 0.74* 24 1.07 7 0.61 2 0.38 102 132.13 0.77* -0.18

Urinary system 761 1.02 185 1.02 105 1.13 41 0.94 1,092 1,063.05 1.03 0.17

Urinary bladder 449 1.01 122 1.14 66 1.20 29 1.13 666 633.26 1.05 0.19

Kidney parenchyma 254 1.07 51 0.86 31 1.01 8 0.56 344 342.57 1.00 0.01

Renal pelvis, other urinary 58 0.94 12 0.83 8 1.10 4 1.15 82 87.21 0.94 -0.03

Ureter 14 0.73 3 0.68 3 1.35 2 1.90 22 26.89 0.82 -0.03

Bone, joints 15 1.06 7 2.29 0 0.00 1 1.43 23 19.43 1.18 0.02

Soft tissue including heart 66 1.08 16 1.11 8 1.08 5 1.50 95 86.44 1.10 0.05

Kaposi sarcoma 1 0.16* 2 1.31 1 1.37 0 0.00 4 8.96 0.45 -0.03

Melanoma of skin 332 1.09 80 1.12 27 0.74 19 1.12 458 429.98 1.07 0.16

Eye, orbit 28 1.24 2 0.40 3 1.20 2 1.86 35 31.12 1.12 0.02

Brain, central nervous system 141 0.89 26 0.73 10 0.57 4 0.51 181 218.93 0.83* -0.22

Thyroid 199 1.45* 30 1.06 9 0.66 8 1.37 246 185.23 1.33* 0.35

Lymphatic, hematopoietic 1,038 0.87* 287 1.00 140 0.95 57 0.84 1,522 1,695.83 0.90* -1.01

Hodgkin lymphoma 20 0.56* 4 0.55 9 2.56* 0 0.00 33 47.65 0.69* -0.09

Non-Hodgkin lymphoma 460 0.81* 153 1.08 69 0.94 26 0.75 708 821.08 0.86* -0.66

Myeloma 192 0.94 48 0.98 20 0.81 10 0.88 270 289.42 0.93 -0.11

Leukemia 366 0.96 82 0.91 42 0.93 21 1.02 511 537.69 0.95 -0.16

Acute lymphocytic 9 0.81 1 0.39 1 0.80 0 0.00 11 15.57 0.71 -0.03

Chronic lymphocytic 76 0.51* 24 0.69 11 0.64 9 1.18 120 207.97 0.58* -0.51

Acute non-lymphocytic 213 1.59* 33 1.04 16 0.98 12 1.55 274 189.74 1.44* 0.49

Chronic myeloid 42 0.79 16 1.30 7 1.14 0 0.00 65 74.23 0.88 -0.05

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 213,675 71,419 34,925 15,020 213,675

Person-years in interval 1,292,233 256,942 119,626 49,890 1,718,691

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING BREAST CANCER 199
All subsequent cancers 2,054 1.10* 8,795 1.21* 6,831 1.18* 5,972 1.15* 23,652 20,131.63 1.17* 21.33

All excluding same site 1,253 0.95 5,158 1.00 4,248 1.03 3,901 1.04* 14,560 14,315.82 1.02* 1.48

Buccal cavity, pharynx 33 0.97 134 1.03 120 1.19 96 1.10 383 352.06 1.09 0.19

Lip 2 0.93 7 0.82 6 0.85 11 1.68 26 24.33 1.07 0.01

Tongue 9 1.20 35 1.22 23 1.02 18 0.93 85 78.13 1.09 0.04

Salivary gland 8 2.13 23 1.59* 16 1.41 18 1.78* 65 39.64 1.64* 0.15

Mouth 8 0.69 36 0.81 45 1.29 30 0.99 119 121.30 0.98 -0.01

Nasopharynx 1 0.68 8 1.45 4 0.97 1 0.29 14 14.53 0.96 0.00

Tonsil 3 0.97 9 0.78 13 1.54 9 1.35 34 29.81 1.14 0.03

Oropharynx 1 1.18 3 0.92 4 1.61 0 0.00 8 8.64 0.93 0.00

Hypopharynx 1 0.43 5 0.56 4 0.60 7 1.27 17 23.34 0.73 -0.04

Digestive system 375 0.91 1,605 0.98 1,282 0.97 1,215 1.01 4,477 4,572.17 0.98 -0.58

Esophagus 10 0.87 48 1.07 50 1.38* 57 1.71* 165 125.96 1.31* 0.24

Stomach 26 0.80 132 1.05 94 0.94 97 1.10 349 345.95 1.01 0.02

Small intestine 1 0.17* 22 0.93 25 1.28 18 0.96 66 67.84 0.97 -0.01

Colon 201 0.98 861 1.06 701 1.05 593 0.98 2,356 2,291.94 1.03 0.39

Rectum, rectosigmoid junction 60 0.90 250 0.97 186 0.92 200 1.13 696 704.84 0.99 -0.05

Rectum 43 0.99 151 0.89 120 0.90 126 1.07 440 464.13 0.95 -0.15

Anus, anal canal 7 1.22 19 0.85 16 0.89 15 0.93 57 62.28 0.92 -0.03

Liver 7 0.78 19 0.54* 18 0.61* 20 0.70 64 102.54 0.62* -0.23

Gallbladder 7 0.74 21 0.57* 11 0.38* 25 1.02 64 99.31 0.64* -0.21

Bile ducts, other biliary 11 1.25 33 0.92 19 0.62* 28 0.94 91 104.65 0.87 -0.08

Pancreas 42 0.78 181 0.85* 148 0.84* 149 0.92 520 603.87 0.86* -0.51

Respiratory system 202 0.84* 889 0.93* 770 0.97 843 1.11* 2,704 2,749.05 0.98 -0.27

Nose, nasal cavity, ear 3 1.19 9 0.92 8 1.02 7 0.98 27 27.29 0.99 0.00

Larynx 7 0.86 27 0.87 19 0.79 19 0.93 72 83.85 0.86 -0.07

Lung, bronchus 191 0.84* 851 0.93* 740 0.97 813 1.12* 2,595 2,631.06 0.99 -0.22

Female breast 801 1.45* 3,637 1.71* 2,583 1.55* 2,071 1.41* 9,092 5,815.81 1.56* 19.85

Female genital system 302 1.21* 1,190 1.27* 927 1.31* 644 1.08 3,063 2,489.76 1.23* 3.47

Cervix uteri 28 0.90 100 0.92 44 0.61* 31 0.60* 203 264.21 0.77* -0.37

Corpus uteri 163 1.29* 665 1.39* 561 1.57* 350 1.15* 1,739 1,265.74 1.37* 2.87

Ovary 95 1.31* 355 1.28* 260 1.22* 208 1.13 918 747.71 1.23* 1.03

Vagina 1 0.28 12 0.87 10 0.93 9 0.96 32 37.48 0.85 -0.03

Vulva 5 0.47 36 0.86 31 0.90 27 0.85 99 118.63 0.83 -0.12

Urinary system 100 1.16 340 0.99 306 1.09 279 1.06 1,025 971.47 1.06 0.32

Urinary bladder 44 0.87 201 1.00 193 1.17* 183 1.18* 621 570.99 1.09* 0.30

Kidney parenchyma 49 1.71* 114 1.00 87 0.94 76 0.87 326 322.13 1.01 0.02

Renal pelvis, other urinary 7 0.99 25 0.90 26 1.15 20 0.97 78 78.35 1.00 0.00

Ureter 1 0.46 6 0.70 8 1.14 5 0.79 20 24.02 0.83 -0.02

Bone, joints 2 1.11 4 0.59 8 1.55 12 2.71* 26 18.18 1.43 0.05

Soft tissue including heart 5 0.67 37 1.28 45 1.96* 32 1.54* 119 80.27 1.48* 0.23

Kaposi sarcoma 0 0.00 1 0.38 1 0.45 1 0.50 3 7.54 0.40 -0.03

Melanoma of skin 48 1.22 171 1.13 149 1.25* 117 1.11 485 415.17 1.17* 0.42

Eye, orbit 0 0.00 19 1.78* 10 1.23 10 1.41 39 28.72 1.36 0.06

Brain, central nervous system 19 0.96 69 0.91 49 0.83 43 0.84 180 205.88 0.87 -0.16

Thyroid 35 1.77* 81 1.12 71 1.38* 41 1.00 228 184.37 1.24* 0.26

Lymphatic, hematopoietic 110 0.79* 520 0.95 422 0.94 440 1.06 1,492 1,548.36 0.96 -0.34

Hodgkin lymphoma 7 1.47 11 0.64 14 1.12 17 1.67 49 44.78 1.09 0.03

Non-Hodgkin lymphoma 55 0.83 197 0.74* 187 0.85* 228 1.10 667 760.33 0.88* -0.57

Myeloma 17 0.72 98 1.05 55 0.73* 62 0.89 232 262.53 0.88 -0.19

Leukemia 31 0.71 214 1.25* 166 1.20* 133 1.05 544 480.71 1.13* 0.38

Acute lymphocytic 2 1.47 7 1.33 5 1.21 1 0.28 15 14.37 1.04 0.00

Chronic lymphocytic 7 0.42* 32 0.49* 36 0.67* 46 0.95 121 184.62 0.66* -0.39

Acute non-lymphocytic 16 1.04 145 2.38* 90 1.82* 54 1.18 305 171.75 1.78* 0.81

Chronic myeloid 4 0.65 17 0.71 19 0.99 19 1.10 59 66.38 0.89 -0.04

Breast

Infiltrating Ductal Carcinoma NOS, Females

Table 7.1.12: Risk of subsequent primary cancers after infiltrating ductal carcinoma of the breast,

females, SEER 1973-2000.

200 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BREAST

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 225,778 207,743 124,981 64,754 225,778

Person-years in interval 180,326 651,897 459,611 358,272 1,650,107

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Breast

Lobular Carcinoma, Females

Table 7.1.13: Risk of subsequent primary cancers after lobular carcinoma of the breast,

females, SEER 1973-2000.

BREAST

All subsequent cancers 248 1.22* 890 1.15* 716 1.24* 561 1.14* 2,415 2,045.17 1.18* 23.45

All excluding same site 127 0.89 526 0.96 474 1.15* 374 1.05 1,501 1,458.28 1.03 2.71

Buccal cavity, pharynx 3 0.83 16 1.17 16 1.60 6 0.72 41 35.65 1.15 0.34

Lip 0 0.00 1 1.05 1 1.38 0 0.00 2 2.56 0.78 -0.04

Tongue 0 0.00 2 0.66 3 1.35 1 0.54 6 7.90 0.76 -0.12

Salivary gland 1 2.48 4 2.61 1 0.89 2 2.07 8 4.03 1.99 0.25

Mouth 1 0.80 8 1.69 7 2.01 2 0.69 18 12.38 1.45 0.36

Nasopharynx 1 7.11 1 1.92 1 2.68 0 0.00 3 1.34 2.23 0.11

Tonsil 0 0.00 0 0.00 2 2.42 0 0.00 2 2.96 0.68 -0.06

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.88 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 1 1.52 1 1.89 2 2.36 0.85 -0.02

Digestive system 39 0.87 183 1.05 152 1.15 139 1.22* 513 465.20 1.10* 3.03

Esophagus 2 1.62 3 0.63 8 2.22 4 1.27 17 12.76 1.33 0.27

Stomach 7 2.09 28 2.18* 25 2.60* 20 2.47* 80 33.91 2.36* 2.92

Small intestine 0 0.00 2 0.78 1 0.51 3 1.70 6 6.93 0.87 -0.06

Colon 20 0.89 94 1.07 68 1.02 59 1.02 241 234.95 1.03 0.38

Rectum, rectosigmoid junction 5 0.70 32 1.17 24 1.19 23 1.38 84 71.42 1.18 0.80

Rectum 4 0.85 18 1.00 15 1.13 17 1.52 54 47.13 1.15 0.44

Anus, anal canal 0 0.00 1 0.42 1 0.56 2 1.30 4 6.35 0.63 -0.15

Liver 0 0.00 4 1.09 0 0.00 2 0.77 6 10.04 0.60 -0.26

Gallbladder 0 0.00 2 0.52 1 0.35 2 0.86 5 9.98 0.50 -0.32

Bile ducts, other biliary 1 1.01 3 0.77 1 0.33 4 1.42 9 10.74 0.84 -0.11

Pancreas 4 0.68 12 0.52* 21 1.20 15 0.98 52 61.56 0.84 -0.61

Respiratory system 25 0.93 68 0.65* 88 1.10 65 0.90 246 283.73 0.87* -2.39

Nose, nasal cavity, ear 0 0.00 1 0.96 1 1.28 1 1.48 3 2.77 1.08 0.01

Larynx 2 2.31 3 0.92 0 0.00 4 2.03 9 8.43 1.07 0.04

Lung, bronchus 23 0.89 64 0.64* 87 1.14 60 0.86 234 271.84 0.86* -2.40

Female breast 121 2.04* 364 1.62* 242 1.47* 187 1.35* 914 586.89 1.56* 20.74

Female genital system 19 0.73 121 1.24* 88 1.27* 52 0.92 280 249.36 1.12 1.94

Cervix uteri 1 0.35 8 0.79 4 0.61 3 0.64 16 24.31 0.66 -0.53

Corpus uteri 11 0.82 76 1.52* 54 1.53* 34 1.17 175 127.95 1.37* 2.98

Ovary 5 0.65 33 1.13 23 1.09 13 0.74 74 75.50 0.98 -0.09

Vagina 0 0.00 1 0.70 0 0.00 0 0.00 1 3.74 0.27 -0.17

Vulva 2 1.70 2 0.44 4 1.15 2 0.65 10 12.26 0.82 -0.14

Urinary system 11 1.14 34 0.91 29 1.03 31 1.24 105 100.21 1.05 0.30

Urinary bladder 6 1.06 19 0.86 18 1.07 19 1.28 62 59.25 1.05 0.17

Kidney parenchyma 5 1.57 13 1.06 9 0.97 8 0.97 35 32.92 1.06 0.13

Renal pelvis, other urinary 0 0.00 2 0.66 2 0.88 4 2.03 8 8.05 0.99 0.00

Ureter 0 0.00 0 0.00 1 1.43 2 3.32 3 2.46 1.22 0.03

Bone, joints 0 0.00 0 0.00 0 0.00 1 2.37 1 1.82 0.55 -0.05

Soft tissue including heart 0 0.00 3 0.99 4 1.76 3 1.53 10 8.08 1.24 0.12

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.77 0.00 -0.05

Melanoma of skin 5 1.17 22 1.36 16 1.35 10 0.99 53 42.47 1.25 0.67

Eye, orbit 1 3.28 0 0.00 0 0.00 1 1.46 2 2.96 0.68 -0.06

Brain, central nervous system 0 0.00 10 1.24 2 0.34 0 0.00* 12 20.94 0.57 -0.57

Thyroid 4 2.09 11 1.59 8 1.69 5 1.34 28 17.31 1.62* 0.68

Lymphatic, hematopoietic 18 1.18 49 0.83 54 1.20 45 1.14 166 158.94 1.04 0.45

Hodgkin lymphoma 2 4.21 1 0.58 0 0.00 0 0.00 3 4.38 0.68 -0.09

Non-Hodgkin lymphoma 9 1.20 16 0.55* 24 1.08 22 1.11 71 78.63 0.90 -0.48

Myeloma 3 1.17 8 0.81 12 1.61 8 1.23 31 26.43 1.17 0.29

Leukemia 4 0.83 24 1.29 18 1.28 15 1.24 61 49.49 1.23 0.73

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.44 0.00 -0.09

Chronic lymphocytic 1 0.54 5 0.70 5 0.92 7 1.50 18 19.16 0.94 -0.07

Acute non-lymphocytic 1 0.59 12 1.83 9 1.81 5 1.14 27 17.63 1.53* 0.59

Chronic myeloid 2 3.02 5 1.96 2 1.04 3 1.83 12 6.77 1.77 0.33

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 21,957 20,156 12,120 5,919 21,957

Person-years in interval 17,510 63,508 43,390 33,273 157,682

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING BREAST CANCER 201
Breast

Males

Table 7.2.1: Characteristics of patients with an initial cancer of the breast, males,

SEER 1973-2000.

202 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BREAST

Number of patients with 1st primary cancer

Total 2,158 100.0 — — 2,158 100.0

Initial treatment

Any radiation 543 25.2 — — 543 25.2

With surgery 487 22.6 — — 487 22.6

Without surgery 56 2.6 — — 56 2.6

No radiation 1,615 74.8 — — 1,615 74.8

With surgery 1,524 70.6 — — 1,524 70.6

Without surgery 91 4.2 — — 91 4.2

Race

White 1,835 85.0 — — 1,835 85.0

Black 235 10.9 — — 235 10.9

Other 79 3.7 — — 79 3.7

Unknown 9 0.4 — — 9 0.4

Age at 1st primary cancer diagnosis, years

< 30 6 0.3 — — 6 0.3

30–49 255 11.8 — — 255 11.8

50–69 1,059 49.1 — — 1,059 49.1

70–79 548 25.4 — — 548 25.4

> 80 290 13.4 — — 290 13.4

Number of patients with one or more

primary cancers

One primary cancer only 1,843 85.4 — — 1,843 85.4

1st and 2nd cancers 280 13.0 — — 280 13.0

1st, 2nd, and 3rd cancers 31 1.4 — — 31 1.4

1st, 2nd, 3rd, and additional cancers 4 0.2 — — 4 0.2

Other statistics

Median age at 1st cancer diagnosis 66.0 — — — 66.0 —

Median year of 1st cancer diagnosis 1989.0 — — — 1989.0 —

Median person-years at risk 4.9 — — — 4.9 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 97.5 — — — 97.5

1st, 2nd, and additional cancers — 96.5 — — — 96.5

1st cancer only — 1.9 — — — 1.9

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Breast

Males

Table 7.2.2: Risk of subsequent primary cancers after cancer of the breast, males,

SEER 1973-2000.

BREAST

All subsequent cancers 38 1.14 133 1.07 114 1.24* 70 0.99 355 320.94 1.11 24.10

All excluding same site 36 1.08 123 0.99 110 1.20 68 0.96 337 320.33 1.05 11.80

Buccal cavity, pharynx 1 0.99 2 0.55 3 1.21 3 1.76 9 8.81 1.02 0.13

Lip 1 5.26 0 0.00 0 0.00 1 3.21 2 1.65 1.22 0.25

Tongue 0 0.00 0 0.00 0 0.00 1 3.05 1 1.66 0.60 -0.47

Salivary gland 0 0.00 1 3.32 0 0.00 0 0.00 1 0.78 1.28 0.15

Mouth 0 0.00 1 1.17 2 3.46 0 0.00 3 2.07 1.45 0.66

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.22

Tonsil 0 0.00 0 0.00 1 4.50 0 0.00 1 0.80 1.25 0.14

Oropharynx 0 0.00 0 0.00 0 0.00 1 20.31 1 0.25 3.97 0.53

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.97 0.00 -0.69

Digestive system 9 1.22 24 0.88 23 1.15 12 0.80 68 69.79 0.97 -1.27

Esophagus 0 0.00 1 0.59 2 1.66 0 0.00 3 4.26 0.70 -0.89

Stomach 1 1.12 5 1.54 4 1.72 1 0.59 11 8.16 1.35 2.01

Small intestine 0 0.00 0 0.00 1 3.67 0 0.00 1 0.95 1.05 0.04

Colon 5 1.58 10 0.84 10 1.13 8 1.20 33 30.51 1.08 1.76

Rectum, rectosigmoid junction 1 0.76 5 1.03 4 1.16 1 0.40 11 12.11 0.91 -0.78

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.31

Liver 1 3.56 1 0.95 1 1.28 0 0.00 3 2.73 1.10 0.19

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.43

Bile ducts, other biliary 1 6.51 1 1.71 0 0.00 0 0.00 2 1.55 1.29 0.32

Pancreas 0 0.00 1 0.32 1 0.44 2 1.19 4 7.93 0.50 -2.78

Respiratory system 1 0.15* 23 0.96 14 0.81 14 1.11 52 60.19 0.86 -5.79

Nose, nasal cavity, ear 0 0.00 1 5.38 0 0.00 0 0.00 1 0.47 2.15 0.38

Larynx 0 0.00 0 0.00 0 0.00 1 1.14 1 4.52 0.22 -2.49

Lung, bronchus 1 0.17* 22 1.01 14 0.89 13 1.12 50 55.05 0.91 -3.57

Male breast 2 29.48* 10 42.19* 4 23.17* 2 14.77* 18 0.61 29.36* 12.30

Male genital system 13 1.26 45 1.15 41 1.37 27 1.12 126 103.62 1.22* 15.84

Prostate 13 1.27 44 1.13 41 1.38 27 1.13 125 102.69 1.22* 15.79

Testis 0 0.00 1 8.08 0 0.00 0 0.00 1 0.27 3.76 0.52

Urinary system 4 1.25 11 0.91 14 1.56 4 0.57 33 31.24 1.06 1.25

Urinary bladder 3 1.29 8 0.91 13 1.97* 3 0.58 27 22.86 1.18 2.93

Kidney parenchyma 1 1.45 3 1.17 1 0.53 0 0.00 5 6.61 0.76 -1.14

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 2.68 1 1.77 0.57 -0.54

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.42

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.17

Soft tissue including heart 1 7.94 0 0.00 0 0.00 0 0.00 1 1.20 0.83 -0.14

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.32

Melanoma of skin 4 5.75* 3 1.13 2 0.99 3 1.74 12 7.10 1.69 3.47

Eye, orbit 0 0.00 0 0.00 0 0.00 1 11.23 1 0.42 2.37 0.41

Brain, central nervous system 0 0.00 1 0.87 1 1.23 0 0.00 2 2.87 0.70 -0.62

Thyroid 0 0.00 1 2.65 0 0.00 0 0.00 1 0.93 1.07 0.05

Lymphatic, hematopoietic 2 0.82 8 0.88 8 1.19 3 0.57 21 23.42 0.90 -1.71

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -0.46

Non-Hodgkin lymphoma 0 0.00 4 1.07 2 0.71 2 0.87 8 9.87 0.81 -1.32

Myeloma 2 4.64 1 0.63 3 2.55 0 0.00 6 4.11 1.46 1.33

Leukemia 0 0.00 3 0.88 3 1.19 1 0.52 7 8.79 0.80 -1.26

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.16

Chronic lymphocytic 0 0.00 1 0.72 2 1.95 0 0.00 3 3.56 0.84 -0.39

Acute non-lymphocytic 0 0.00 2 1.78 1 1.20 0 0.00 3 2.90 1.03 0.07

Chronic myeloid 0 0.00 0 0.00 0 0.00 1 3.75 1 1.19 0.84 -0.13

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,158 1,917 1,087 519 2,158

Person-years in interval 1,686 5,919 3,895 2,633 14,133

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING BREAST CANCER 203
All subsequent cancers 10 1.47 43 1.37 51 1.53* 47 1.07 151 115.28 1.31* 46.10

All excluding same site 10 1.47 37 1.18 48 1.44* 46 1.05 141 115.06 1.23* 33.48

Buccal cavity, pharynx 0 0.00 0 0.00 1 0.84 1 0.86 2 4.08 0.49 -2.69

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.73

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.84 0.00 -1.09

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.35

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 1.00 0.00 -1.29

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.21

Tonsil 0 0.00 0 0.00 1 7.50 0 0.00 1 0.45 2.20 0.70

Oropharynx 0 0.00 0 0.00 0 0.00 1 26.83 1 0.14 7.38 1.12

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.64

Digestive system 4 2.79 7 1.08 10 1.51 6 0.70 27 23.05 1.17 5.10

Esophagus 0 0.00 1 1.80 1 1.90 0 0.00 2 1.81 1.10 0.24

Stomach 0 0.00 1 1.37 2 2.76 0 0.00 3 2.52 1.19 0.62

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.48

Colon 3 5.75* 2 0.82 6 2.28 5 1.38 16 9.21 1.74 8.77

Rectum, rectosigmoid junction 0 0.00 1 0.77 1 0.78 0 0.00 2 4.39 0.46 -3.08

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.26

Liver 1 14.02 1 3.17 0 0.00 0 0.00 2 1.09 1.83 1.17

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.20

Bile ducts, other biliary 0 0.00 1 8.60 0 0.00 0 0.00 1 0.46 2.17 0.70

Pancreas 0 0.00 0 0.00 0 0.00 1 1.03 1 2.68 0.37 -2.16

Respiratory system 0 0.00 8 1.12 6 0.85 14 1.70 28 24.03 1.17 5.12

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.24

Larynx 0 0.00 0 0.00 0 0.00 1 1.58 1 2.18 0.46 -1.52

Lung, bronchus 0 0.00 8 1.26 6 0.94 13 1.73 27 21.62 1.25 6.95

Male breast 0 0.00 6 93.03* 3 47.12* 1 12.37 10 0.22 44.51* 12.62

Male genital system 3 1.86 11 1.32 17 1.63 16 1.04 47 35.74 1.32 14.54

Prostate 3 1.91 10 1.22 17 1.65 16 1.05 46 35.33 1.30 13.78

Testis 0 0.00 1 11.27 0 0.00 0 0.00 1 0.20 5.09 1.04

Urinary system 0 0.00 3 1.03 9 2.93* 4 0.96 16 10.77 1.49 6.75

Urinary bladder 0 0.00 2 1.05 8 3.84* 3 1.01 13 7.35 1.77 7.29

Kidney parenchyma 0 0.00 1 1.17 1 1.21 0 0.00 2 2.86 0.70 -1.11

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 4.68 1 0.56 1.78 0.57

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.24

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.14

Soft tissue including heart 1 30.24 0 0.00 0 0.00 0 0.00 1 0.45 2.23 0.71

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.32

Melanoma of skin 2 8.84 2 2.11 0 0.00 2 1.75 6 3.21 1.87 3.60

Eye, orbit 0 0.00 0 0.00 0 0.00 1 17.27 1 0.17 5.78 1.07

Brain, central nervous system 0 0.00 1 2.31 0 0.00 0 0.00 1 1.34 0.75 -0.44

Thyroid 0 0.00 1 5.83 0 0.00 0 0.00 1 0.49 2.02 0.65

Lymphatic, hematopoietic 0 0.00 3 1.29 3 1.29 1 0.32 7 8.27 0.85 -1.64

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.41

Non-Hodgkin lymphoma 0 0.00 2 1.88 1 0.95 0 0.00 3 3.77 0.80 -1.00

Myeloma 0 0.00 1 2.58 1 2.52 0 0.00 2 1.40 1.43 0.78

Leukemia 0 0.00 0 0.00 1 1.26 1 0.94 2 2.79 0.72 -1.02

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.11

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.17 0.00 -1.51

Acute non-lymphocytic 0 0.00 0 0.00 1 3.99 0 0.00 1 0.89 1.12 0.14

Chronic myeloid 0 0.00 0 0.00 0 0.00 1 6.92 1 0.37 2.68 0.81

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,007 912 568 312 1,007

Person-years in interval 793 2,927 2,154 1,873 7,748

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Breast

Males, <65 Years of Age

Table 7.2.3: Risk of subsequent primary cancers after cancer of the breast, males,

<65 years of age, SEER 1973-2000.

204 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BREAST

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Breast

Males, ≥65 Years of Age

Table 7.2.4: Risk of subsequent primary cancers after cancer of the breast, males,

≥65 years of age, SEER 1973-2000.

BREAST

All subsequent cancers 28 1.06 90 0.97 63 1.07 23 0.85 204 205.66 0.99 -2.59

All excluding same site 26 0.98 86 0.93 62 1.06 22 0.81 196 205.27 0.95 -14.51

Buccal cavity, pharynx 1 1.49 2 0.90 2 1.56 2 3.65 7 4.73 1.48 3.55

Lip 1 6.73 0 0.00 0 0.00 1 7.64 2 1.08 1.85 1.44

Tongue 0 0.00 0 0.00 0 0.00 1 11.38 1 0.82 1.22 0.29

Salivary gland 0 0.00 1 4.49 0 0.00 0 0.00 1 0.51 1.95 0.76

Mouth 0 0.00 1 1.97 2 6.98 0 0.00 3 1.07 2.81 3.03

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.22

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.54

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.18

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.75

Digestive system 5 0.84 17 0.81 13 0.97 6 0.93 41 46.74 0.88 -8.98

Esophagus 0 0.00 0 0.00 1 1.48 0 0.00 1 2.45 0.41 -2.26

Stomach 1 1.37 4 1.58 2 1.25 1 1.28 8 5.64 1.42 3.70

Small intestine 0 0.00 0 0.00 1 5.98 0 0.00 1 0.58 1.72 0.66

Colon 2 0.76 8 0.85 4 0.65 3 0.98 17 21.30 0.80 -6.74

Rectum, rectosigmoid junction 1 0.97 4 1.13 3 1.38 1 1.03 9 7.72 1.17 2.01

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.38

Liver 0 0.00 0 0.00 1 2.11 0 0.00 1 1.64 0.61 -1.01

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.71

Bile ducts, other biliary 1 7.81 0 0.00 0 0.00 0 0.00 1 1.09 0.91 -0.15

Pancreas 0 0.00 1 0.42 1 0.67 1 1.40 3 5.26 0.57 -3.54

Respiratory system 1 0.20 15 0.89 8 0.79 0 0.00* 24 36.15 0.66* -19.03

Nose, nasal cavity, ear 0 0.00 1 7.84 0 0.00 0 0.00 1 0.28 3.53 1.12

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 2.34 0.00 -3.67

Lung, bronchus 1 0.22 14 0.90 8 0.85 0 0.00* 23 33.43 0.69 -16.34

Male breast 2 38.35* 4 23.18* 1 9.17 1 18.32 8 0.39 20.60* 11.92

Male genital system 10 1.15 34 1.10 24 1.23 11 1.26 79 67.88 1.16 17.41

Prostate 10 1.16 34 1.11 24 1.24 11 1.27 79 67.37 1.17 18.22

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.11

Urinary system 4 1.56 8 0.88 5 0.85 0 0.00 17 20.47 0.83 -5.43

Urinary bladder 3 1.56 6 0.87 5 1.11 0 0.00 14 15.51 0.90 -2.36

Kidney parenchyma 1 2.03 2 1.17 0 0.00 0 0.00 3 3.75 0.80 -1.18

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.20 0.00 -1.89

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.64

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.20

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.75 0.00 -1.18

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.32

Melanoma of skin 2 4.26 1 0.59 2 1.77 1 1.72 6 3.89 1.54 3.31

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.39

Brain, central nervous system 0 0.00 0 0.00 1 2.31 0 0.00 1 1.54 0.65 -0.84

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.68

Lymphatic, hematopoietic 2 1.06 5 0.74 5 1.14 2 0.93 14 15.15 0.92 -1.80

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.53

Non-Hodgkin lymphoma 0 0.00 2 0.75 1 0.56 2 2.25 5 6.10 0.82 -1.72

Myeloma 2 5.78 0 0.00 2 2.57 0 0.00 4 2.72 1.47 2.01

Leukemia 0 0.00 3 1.12 2 1.16 0 0.00 5 6.00 0.83 -1.57

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.22

Chronic lymphocytic 0 0.00 1 0.94 2 2.92 0 0.00 3 2.39 1.26 0.96

Acute non-lymphocytic 0 0.00 2 2.25 0 0.00 0 0.00 2 2.01 1.00 -0.01

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.81 0.00 -1.27

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,151 1,005 519 207 1,151

Person-years in interval 893 2,991 1,741 760 6,385

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING BREAST CANCER 205

NEW MALIGNANCIES FOLLOWING CANCER OF THE CERVIX UTERI, VAGINA, AND VULVA 207

Synopsis

Subsequent primary cancer risk was evaluated in 

37,757 women diagnosed with cancers of the cervix

uteri, vagina, or vulva between 1973 and 2000. The overall risk of new malignancies was significantly increased

among survivors of cervical cancer (O/E=1.32,1 O=2,451,

EAR=24 per 10,000 person-years) and vulvar cancer

(O/E=1.12,1 O=540, EAR=16) but not vaginal cancer

(O/E=1.06,1 O=109, EAR=7). Cancers of the lung and

bronchus accounted for 24% of all new malignancies

after cervical cancer, resulting in a 2.6-fold significant

risk, likely due to cigarette smoking, which has been

related to both of these malignancies. In addition,

smoking and possibly human papillomavirus (HPV)

infection may have contributed to the increased risks

for certain cancers of the buccal cavity and pharynx

after cervical and vulvar cancer and to the elevated risk

for cancer of the esophagus after vaginal cancer. The

excess of anal and vaginal cancer after cervical and vulvar cancer, as well as the excess of vulvar cancer following vaginal and cervical cancer, suggests a shared etiology involving HPV infection. Consistent with previous

studies, radiotherapy for cervical cancer appeared to

contribute to the increased risk among long-term survivors for subsequent primary cancers of the stomach,

rectum, urinary bladder, and bone and joints. 

Cervical Cancer

Cervical cancer ranks as the 12th most common cancer

among women in the U.S., constituting 1.6% of incident

cancers and 1.3% of cancer deaths among females (Jemal

et al, 2005). The median age at diagnosis of cervical cancer is 47 years, and it is the fourth most common cancer

among women under 40 years of age. Squamous cell carcinomas accounted for 74% of cervical cancers in the current analyses, and adenocarcinoma and other histologies

for the remaining 26% of cervical cancers. Patients with

an initial in situ cervical cancer were excluded from the

current analyses. Slightly more than half of cervical cancer patients received initial radiotherapy, either alone or

in combination with surgery. Surgery alone, usually

involving removal of the uterus, fallopian tubes, and

ovaries, accounted for the majority of other treatments.

The relative survival rate was 72.9% at 5 years and 67.2%

at 10 years. White females had better survival rates than

black females.

Oncogenic types of human papillomavirus (HPV)

account for 95% or more of all cervical cancer

(Walboomers et al, 1999; Munoz et al, 2003). Risk factors

associated with the progression of HPV infection to

high-grade cervical disease and cancer include cigarette

smoking (Hildesheim et al, 2001; Plummer et al, 2003),

multiparity and long-term oral contraceptive use

(Hildesheim et al, 2001), and impaired host immunity

(Tsukui et al, 1996; Hildesheim and Wang, 2002).

Results and Discussion

Overall, we observed a significant 32% increase in subsequent primary cancers excluding cancer of the cervix

uteri among the 30,563 women who survived 2 or more

months following cervical cancer (O/E=1.32, O=2,451,

95% CI=1.26-1.37, EAR=24 per 10,000 person-years).

The cumulative incidence of developing any second

cancer after cervical cancer, adjusted for the competing

causes of death due to other causes, was 13.2% at 25

years (95% CI=12.5%-13.8%). Risk remained elevated

over all time periods and did not vary substantially by

histology of cervical cancer (O/E=1.34 for squamous

cell carcinoma and O/E=1.23 for adenocarcinoma). The

relative risk of subsequent cancer was somewhat higher

among younger women, with 30% to 35% increases in

risk seen among women diagnosed under age 70 years

and 20% excesses among those ages 70 years and older at

diagnosis. Women who received radiotherapy had higher

risks for a new malignancy than women who did not

receive radiotherapy (O/E=1.46, EAR=44 versus

O/E=1.13, EAR=8). Risks also varied by racial group,

with higher risks observed for black compared with

white females (O/E=1.53, EAR=40 versus O/E=1.27,

EAR=21). Significantly increased risks were noted for

cancers of the following sites: buccal cavity and pharynx,

especially the tonsil, mouth, and hypopharynx; digestive

system, including the stomach, colon, rectum, anus, and

pancreas; respiratory system, including the larynx, lung,

and bronchus; vulva and vagina; and urinary bladder and

CERVIX UTERI, VAGINA,

AND VULVA

Chapter 8

New Malignancies Following Cancer

of the Cervix Uteri, Vagina, and Vulva

Ruth A. Kleinerman, Carol Kosary, Allan Hildesheim

1Observed-to-expected ratios of subsequent primary cancers

following cancers of the cervix, vagina, and vulva exclude new

cancers of the cervix, vagina, and vulva, respectively.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated as

[(O-E)/PYR]10,000).

Author affiliations: Ruth A. Kleinerman and Allan Hildesheim,

Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS;

Carol Kosary, Division of Cancer Control and Population Sciences,

NCI, NIH, DHHS.
ureter. Significant deficits were seen for cancers of the

breast and corpus uteri and melanoma of the skin. Our

findings are consistent with previous large-scale studies

of cervical cancer reporting increased risks for a similar

array of subsequent primary cancers (Boice et al, 1988;

Kleinerman et al, 1995; Hemminki et al, 2000).

Tobacco-related cancers accounted for the majority of

excess subsequent cancers occurring after cervical cancer.

Cancers of the lung and bronchus (O/E=2.57) constituted

24% of all subsequent malignancies, consistent with previous studies (Frisch and Melbye, 1995; Kleinerman et al,

1995). We also observed increased risks for cancers of the

buccal cavity and pharynx (O/E=1.91), notably of the

tonsil and hypopharynx, which have also been linked to

tobacco smoking. The 2-fold risk for cancers of the lung

and bronchus, and of the buccal cavity and pharynx,

remained relatively constant across all age groups and

time periods. Smoking may also have contributed to the

excess risk for urinary bladder cancer, although radiotherapy probably contributed to the late-occurring cases

among survivors of 10 years or more (Boice et al, 1988).

We estimated that tobacco increased the risk of these

subsequent cancers about 2-fold (Table 8.A), and the

effect was more pronounced following squamous cell

carcinoma compared with adenocarcinoma of the cervix

uteri (O/E=2.36 versus O/E=1.49), consistent with other

studies (Berrington de Gonzalez et al, 2004).

Similar to cervical cancer, cancers of the vagina,

vulva, and anus have a causal relation to HPV (Melbye

and Sprogel, 1991; Rabkin et al, 1992; Hemminki et al,

2000; Daling et al, 2002, 2004). Thus, risks for these cancers were elevated following cervical cancer in all age

and treatment groups, although radiotherapy probably

contributed to the excess of vaginal cancer (Boice et al,

1988; Kleinerman et al, 1995). In our study, the risks for

vaginal cancer, but not for vulvar cancer, increased

with time since radiotherapy for cervical cancer, reaching 24-fold among those surviving 10 or more years after

cervical cancer. The occurrence of squamous cell cancer

of the vagina within 5 years of cervical cancer, however,

may reflect recurrent cancer of the cervix uteri rather

than a new primary cancer (Zaino et al, 2002). 

It seems likely that HPV infection plays a role in

certain cancers of the buccal cavity and pharynx,

especially cancers of the tonsil and oropharynx (Herrero,

2003; Herrero et al, 2003). In our series, a significant

208 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CERVIX UTERI, VAGINA,

AND VULVA

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; O/E=ratio of observed to expected cancers.

*P <0.05.

†Risks for cancers of the same site as the first cancer were excluded from the analysis.

Table 8.A: Ratio of observed to expected number of subsequent primary cancers related to tobacco or human papillomavirus (HPV)

following cancer of the cervix uteri, vagina, or vulva.

Subsequent primary cancer site First cancer site

Cervix uteri Vagina Vulva

Tobacco-related cancer sites O O/E O O/E O O/E

Buccal cavity, pharynx 65 1.91* 0 0.00 21 2.52*

Esophagus 19 1.60 4 5.54* 6 1.87

Pancreas 67 1.31* 2 0.57 17 1.05

Larynx 28 3.17* 1 2.42 6 3.42*

Lung, bronchus 593 2.57* 17 1.35 87 1.50*

Cervix uteri † † 4 2.52 9 1.52

Urinary bladder 116 2.55* 7 2.30 6 0.40*

Kidney parenchyma 33 1.11 1 0.62 5 0.67

Total 921 2.23* 36 1.43 157 1.36*

HPV-related cancer sites

Tonsil 13 3.92* 0 0.00 1 1.59

Oropharynx 1 1.17 0 0.00 0 0.00

Esophagus 19 1.60 4 5.54* 6 1.87

Anus, anal canal 19 3.24* 1 3.18 12 8.04*

Cervix uteri † † 4 2.52 9 1.52

Vagina 63 16.87* † † 6 6.12*

Vulva 51 5.12* 5 8.06* † †

Total 166 4.66* 14 4.08* 34 2.74*
NEW MALIGNANCIES FOLLOWING CANCER OF THE CERVIX UTERI, VAGINA, AND VULVA 209

CERVIX UTERI, VAGINA,

AND VULVA

4-fold risk for subsequent tonsillar cancer was noted,

and the risk was slightly higher for women under age

50 years. Overall, there was close to a 5-fold significant

excess risk of all subsequent genital and extragenital

cancers likely to be HPV-related (Table 8.A). 

High-dose radiotherapy for cervical cancer has

been linked to cancers arising in a variety of subsequent primary cancer sites, including the stomach,

rectum, bone, vagina, vulva, ovary, and urinary bladder (Boice et al, 1988). In our study, risks for each of

these cancers, except bone and ovary, were significantly

increased among those surviving 10 years or more who

had received radiotherapy, consistent with previous

large-scale studies following radiotherapy for cervical

cancer (Boice et al, 1988; Kleinerman et al, 1995).

Increased medical surveillance or possibly misclassification may have contributed to the early excesses of

some cancers, such as cancers of the vagina and urinary

bladder. The risk of stomach cancer was significantly

increased following radiotherapy (O/E=2.19) but not

other treatments (O/E=0.93). We also noted a significantly increased risk of rectal cancer following radiotherapy (O/E=1.68), with a significant 3-fold risk among

those surviving 10 years or more. Colon cancer was significantly increased among survivors of 10 years or

more following radiotherapy (O/E=1.43) but not other

treatments (O/E=0.98). This finding contrasts with earlier studies reporting no increased risk of colon cancer

following radiotherapy for cervical cancer (Boice et al,

1988; Kleinerman et al, 1995), although colon cancer

was noted to be excessive following radiotherapy for

benign gynecologic disease (Inskip et al, 1990). PeutzJeghers syndrome is a rare hereditary disorder that predisposes to intestinal tumors and cervical adenocarcinoma and should be considered when these tumor types

are noted, especially in younger women (Hemminki,

1999).

Subsequent primary cancer of the urinary bladder

has been attributed to high-dose radiotherapy and to

cigarette smoking in previous surveys of cervical cancer

(Boice et al, 1988; Kleinerman et al, 1995). An overall

3-fold risk for urinary bladder cancer was seen in the

radiotherapy group, with that risk reaching 7-fold

among 20-year survivors. Among women who did not

receive radiotherapy for cervical cancer, urinary bladder

cancer was significantly increased (O/E=1.87), due at

least partly to cigarette smoking, although heightened

surveillance may have played a role. 

Bone sarcomas have been linked to high-dose radiotherapy (Boice et al, 1988). In our study, the risk of subsequent bone and joint cancers was significantly increased

(O/E=3.96) after radiotherapy, based on 4 cases, 3 of

which had tumors arising in the pelvic bones.

Radiotherapy also has been linked to ovarian cancer

in previous studies of women irradiated for benign menstrual conditions (Inskip et al, 1990) and in long-term

survivors of cervical cancer (Boice et al, 1988). Our study

revealed an overall nonsignificant increase in subsequent

ovarian cancer that was limited to irradiated women

(O/E=1.30). A slight deficit of ovarian cancer (O/E=0.89)

among nonirradiated women was probably related to

surgical removal of the ovaries at the time of cervical

cancer treatment. 

Various forms of leukemia, with the exception of

chronic lymphocytic leukemia, have been associated

with moderate doses of radiation for cervical cancer

(Boice et al, 1987), primarily within 10 years of radiotherapy. In our series, a significant 2-fold risk for acute

non-lymphocytic leukemia was noted during the first

10 years after radiotherapy, as compared with a nonsignificant 12% excess risk among nonirradiated

women.

Our study revealed significant deficits for subsequent

melanoma of the skin (O/E=0.69), and cancers of the

breast (O/E=0.77) and corpus uteri (O/E=0.57), following

cervical cancer. It seems likely that some of the deficit of

breast cancer was related to ovarian ablation by radiotherapy (Boice et al, 1989), whereas the deficit of corpus

uteri cancer may have resulted from surgical removal of

the uterus.

Vaginal Cancer

Cancer of the vagina is an uncommon tumor, constituting 0.3% of incident cancers and 0.3% of cancer deaths

among U.S. women (Jemal et al, 2005). It occurs primarily in older women (median age, 69 years). Radiotherapy is the main treatment (65%), and the 5-year

relative survival rate is 43.8%. Women undergoing

surgery for vaginal cancer often have their ovaries and

uterus removed as well. 

Similar to cervical cancer, vaginal cancer has been

linked to HPV infection and cigarette smoking (Daling

et al, 2002). Additional risk factors include low socioeconomic status, history of genital warts or inflammation, and previous abnormal pap smears (Daling et al,

2002). A rare form of vaginal cancer (clear cell carcinoma)

in young women has been traced to in utero exposure

to diethylstilbestrol, used from the 1950s through the

1970s to prevent miscarriage (Herbst et al, 1986).

Results and Discussion

Among the 1,623 women with vaginal cancer surviving

2 or more months, the risk of all subsequent primary

cancers, excluding new cancers of the vagina, was close to

expectation (O/E=1.06, O=109, 95% CI=0.87-1.28, EAR=7).

The cumulative incidence of a second cancer was 9.1% at

20 years after vaginal cancer diagnosis (95% CI=7.4%-

10.9%). Based on small numbers, significantly increased

risks were seen for cancers of the vulva, esophagus, and

ureter. One prior survey of second cancers following

vaginal cancer that used the SEER database revealed

increased risks for tobacco-related cancers, primarily

cancers of the lung and esophagus (Sturgeon et al, 1996). 

HPV has been linked mainly to a subtype of vulvar

cancer, especially in young women (Trimble et al, 1996;

Hildesheim et al, 1997), and probably contributed to

the elevated risk of subsequent vulvar cancer. However,
the risk of vulvar cancer was also elevated in older

women whose tumors are less likely to be associated

with HPV. HPV also may have contributed to the excess

of esophageal cancer, because a causal relation has been

suggested in some but not all studies (Gillison and Shah,

2003). While the overall risk for subsequent HPV-related

cancers following vaginal cancer was significantly

increased (O/E=4.08), it was based on only 14 cancers,

5 of which were vulvar cancer (Table 8.A).

Tobacco may have contributed to the increased risk

of subsequent esophageal, ureter, and possibly vulvar

cancers, although no significant excess of lung cancer

was seen. For esophageal cancer, other important risk

factors (alcohol intake, dietary deficiency, low socioeconomic status) may have played a role. Overall, the

risk for tobacco-related cancers following vaginal cancer

was only slightly increased (O/E=1.43) (Table 8.A).

In previous surveys, an excess of urinary bladder

cancer was linked to high-dose pelvic irradiation, as well

as tobacco smoking (Boice et al, 1988). In our study, the

risk of urinary bladder cancer was significantly increased

among 10-year survivors (O/E=5.04) based on 4 cases,

with higher risks among women who had received

radiotherapy (O/E=6.15).

Vulvar Cancer

Cancer of the vulva is another uncommon cancer in

women, accounting for 0.6% of incident cancers and 0.3%

of cancer deaths (Jemal et al, 2005). Patients tend to be

older at diagnosis (median age, 71 years). Most are treated with surgery (88%), which ranges from local excision

of the tumor and surrounding tissue to radical vulvectomy, including resection of pelvic lymph nodes. Few

patients (16%) receive radiotherapy. The 5-year relative

survival rate is somewhat lower for black women compared with white women (65.3% versus 77.1%).

HPV is a risk factor for the basaloid/warty form of

squamous cell vulvar cancer, particularly among younger

women (Trimble et al, 1996; Hildesheim et al, 1997); however, the more common keratinizing tumor types may not

be HPV-related (Trimble et al, 1996; Sturgeon and Sherman, 2000). Because basaloid/warty tumors of the vulva

typically occur at a younger age than the more common

keratinizing tumors, age is often used as a proxy to distinguish HPV-related and -unrelated tumors. Other risk factors may include cigarette smoking and impaired

immune mechanisms (Brinton et al, 1990; Trimble et al,

1996; Madeleine et al, 1997; Sturgeon and Sherman, 2000).

Results and Discussion

Among 5,571 women with vulvar cancer, we observed a

significant increase of 12% in the risk of all subsequent

primary cancers excluding the vulva (O/E=1.12, O=540,

95% CI=1.03-1.22, EAR=16). The cumulative incidence

of second cancer reached 15.4% (95% CI=14.0%-16.8%)

within 25 years of vulvar cancer diagnosis. The excess

risk was confined to women diagnosed younger than

age 55 years (O/E=1.75, 95% CI=1.46-2.09, EAR=45)

and included cancers of the anus and anal canal, vulva,

vagina, buccal cavity and pharynx, larynx, lung and

bronchus, and brain and central nervous system. Significant excess risks for some of these cancers (anus, lung

and bronchus, vulva, and vagina) were also noted for

older women. In an earlier SEER analysis of vulvar cancer, significantly increased risks were reported for cancers of the lung and bronchus, anus, brain and central

nervous system, and melanoma of the skin, as well as

non-Hodgkin lymphoma (Sturgeon et al, 1996). 

Our survey revealed 31 newly detected vulvar

cancers, with a significant 7-fold risk among 10-year

survivors. The tendency for multiple tumors of the

vulva was detected in both younger (O/E=18.93, O=6)

and older women (O/E=8.53, O=25). While some subsequent vulvar cancers could have been influenced by

increased medical surveillance, especially in older

women, they could have arisen from persistent HPV

infection and untreated vulvar intraepithelial neoplasia. 

There is evidence that cancers of the vagina, vulva,

and anus tend to arise as multiple foci in a field cancerization process triggered by HPV infection and possibly

immunologic defects (Brinton et al, 2005). Although HPV

appears to be related to basaloid/warty vulvar cancer,

arising at younger ages, the risk of subsequent vaginal

cancer was significantly increased for both younger

(O/E=17.20) and older women (O/E=4.63), based on

small numbers of cases. The risk for anal and anal canal

cancer also was increased in both younger (O/E=22.02,

O=5) and older women (O/E=5.53, O=7), suggesting the

possible role of HPV and other factors, such as impaired

immunity (Williams et al, 1994). Reciprocal significant

increases of vulvar cancer were seen after vaginal and

anal cancer. It is interesting that the risk of cervical

cancer, which is strongly associated with HPV, was not

significantly elevated among younger or older vulvar

cancer patients, possibly due to effective screening. 

The overall risk for all HPV-related cancers (including

genital, anal, and some buccal cavity, pharyngeal, and

esophageal cancers) was significantly increased after

vulvar cancer for all age groups combined (O/E=2.74)

(Table 8.A), with the risk being higher for younger compared with older women (O/E=4.00 versus O/E=2.38).

Cigarette smoking, a likely cofactor for vulvar cancer

(Trimble et al, 1996; Madeleine et al, 1997), probably

accounts for the significantly elevated risks for subsequent lung and bronchus cancer in both age groups in

our study, and may have contributed to some of the

excess risk of buccal cavity and pharyngeal cancer in

younger women. The risk for all tobacco-related subsequent primary cancers was significantly increased after

vulvar cancer (O/E=1.36, O=157) (Table 8.A), with a

significantly higher risk for younger compared with

older women (O/E=2.70 versus O/E= 1.13).

210 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CERVIX UTERI, VAGINA,

AND VULVA
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In Kurman RJ (ed): Blaustein’s Pathology of the Female Genital

Tract, 5th ed. New York, Springer, pp. 151-206.

NEW MALIGNANCIES FOLLOWING CANCER OF THE CERVIX UTERI, VAGINA, AND VULVA 211

CERVIX UTERI, VAGINA,

AND VULVA
Cervix Uteri

Females

Table 8.1.1: Characteristics of patients with an initial cancer of the cervix uteri, females,

SEER 1973-2000.

212 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CERVIX UTERI

Number of patients with 1st primary cancer

Total — — 30,563 100.0 30,563 100.0

Initial treatment

Any radiation — — 16,404 53.7 16,404 53.7

With surgery — — 4,980 16.3 4,980 16.3

Without surgery — — 11,424 37.4 11,424 37.4

No radiation — — 14,159 46.3 14,159 46.3

With surgery — — 12,039 39.4 12,039 39.4

Without surgery — — 2,120 6.9 2,120 6.9

Race

White — — 23,175 75.8 23,175 75.8

Black — — 4,626 15.1 4,626 15.1

Other — — 2,525 8.3 2,525 8.3

Unknown — — 237 0.8 237 0.8

Age at 1st primary cancer diagnosis, years

< 30 — — 2,694 8.8 2,694 8.8

30–49 — — 13,411 43.9 13,411 43.9

50–69 — — 9,922 32.5 9,922 32.5

70–79 — — 2,930 9.6 2,930 9.6

> 80 — — 1,606 5.3 1,606 5.3

Number of patients with one or more

primary cancers

One primary cancer only — — 28,309 92.6 28,309 92.6

1st and 2nd cancers — — 2,060 6.7 2,060 6.7

1st, 2nd, and 3rd cancers — — 174 0.6 174 0.6

1st, 2nd, 3rd, and additional cancers — — 20 0.1 20 0.1

Other statistics

Median age at 1st cancer diagnosis — — 48.6 — 48.6 —

Median year of 1st cancer diagnosis — — 1986.5 — 1986.5 —

Median person-years at risk — — 5.5 — 5.5 —

Percent histologically confirmed*

Both 1st and 2nd cancers — — — 95.3 — 95.3

1st, 2nd, and additional cancers — — — 94.8 — 94.8

1st cancer only — — — 4.1 — 4.1

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Cervix Uteri

Females

Table 8.1.2: Risk of subsequent primary cancers after cancer of the cervix uteri, females,

SEER 1973-2000.

CERVIX UTERI

All subsequent cancers 255 1.74* 674 1.32* 639 1.32* 906 1.19* 2,474 1,905.05 1.30* 23.12

All excluding same site 249 1.76* 671 1.35* 635 1.34* 896 1.20* 2,451 1,862.45 1.32* 23.92

Buccal cavity, pharynx 7 2.53* 23 2.40* 11 1.25 24 1.86* 65 34.05 1.91* 1.26

Lip 0 0.00 0 0.00 0 0.00 2 2.68 2 1.83 1.09 0.01

Tongue 0 0.00 3 1.44 2 1.02 5 1.71 10 7.57 1.32 0.10

Salivary gland 3 9.21* 2 1.77 0 0.00 0 0.00 5 3.97 1.26 0.04

Mouth 2 2.21 8 2.56* 1 0.35 9 2.12 20 11.14 1.80* 0.36

Nasopharynx 0 0.00 1 1.80 1 2.11 1 1.58 3 1.82 1.65 0.05

Tonsil 1 3.53 6 6.17* 3 3.43 3 2.53 13 3.32 3.92* 0.39

Oropharynx 0 0.00 0 0.00 0 0.00 1 3.11 1 0.86 1.17 0.01

Hypopharynx 1 5.09 3 4.33 3 4.79 1 1.14 8 2.39 3.35* 0.23

Digestive system 41 1.34 140 1.34* 124 1.27* 217 1.40* 522 387.71 1.35* 5.46

Esophagus 3 3.20 6 1.88 2 0.67 8 1.69 19 11.87 1.60 0.29

Stomach 7 2.51* 18 1.96* 10 1.22 21 1.71* 56 32.45 1.73* 0.96

Small intestine 3 6.75* 1 0.64 4 2.58 4 1.47 12 6.29 1.91 0.23

Colon 15 1.02 59 1.18 56 1.19 93 1.24* 223 186.67 1.19* 1.48

Rectum, rectosigmoid junction 2 0.40 24 1.40 16 1.01 44 1.85* 86 61.80 1.39* 0.98

Rectum 1 0.31 16 1.43 11 1.07 31 1.97* 59 40.43 1.46* 0.75

Anus, anal canal 0 0.00 4 2.61 5 3.32* 10 4.17* 19 5.86 3.24* 0.53

Liver 2 2.79 2 0.80 2 0.83 3 0.72 9 9.81 0.92 -0.03

Gallbladder 2 2.85 3 1.29 4 1.87 5 1.60 14 8.29 1.69 0.23

Bile ducts, other biliary 0 0.00 2 0.97 1 0.50 2 0.56 5 8.26 0.61 -0.13

Pancreas 6 1.52 21 1.56 19 1.48 21 1.01 67 51.05 1.31* 0.65

Respiratory system 45 2.73* 212 3.53* 166 2.74* 202 1.90* 625 243.25 2.57* 15.51

Nose, nasal cavity, ear 0 0.00 1 1.43 0 0.00 1 0.99 2 2.57 0.78 -0.02

Larynx 4 5.90* 6 2.50 8 3.51* 10 2.88* 28 8.83 3.17* 0.78

Lung, bronchus 41 2.63* 203 3.58* 158 2.75* 191 1.88* 593 231.17 2.57* 14.70

Female breast 44 0.99 121 0.76* 143 0.93 150 0.63* 458 595.18 0.77* -5.58

Female genital system 60 2.71* 62 0.82 73 1.09 111 1.15 306 261.13 1.17* 1.82

Cervix uteri 6 1.38 3 0.21* 4 0.35* 10 0.79 23 42.60 0.54* -0.80

Corpus uteri 18 1.76* 10 0.29* 17 0.54* 25 0.53* 70 123.42 0.57* -2.17

Ovary 23 3.84* 18 0.86 13 0.67 30 1.03 84 75.74 1.11 0.34

Vagina 7 22.37* 15 14.16* 16 16.80* 25 17.74* 63 3.73 16.87* 2.41

Vulva 2 2.61 14 5.31* 20 8.00* 15 3.69* 51 9.96 5.12* 1.67

Urinary system 19 3.17* 41 1.96* 36 1.77* 75 2.19* 171 81.56 2.10* 3.63

Urinary bladder 11 3.23* 33 2.80* 23 2.03* 49 2.58* 116 45.46 2.55* 2.87

Kidney parenchyma 6 2.87* 3 0.40 8 1.08 16 1.25 33 29.80 1.11 0.13

Renal pelvis, other urinary 2 4.02 5 2.95 5 3.14* 10 3.97* 22 6.30 3.49* 0.64

Ureter 0 0.00 2 4.10 1 2.14 8 10.88* 11 1.83 6.00* 0.37

Bone, joints 0 0.00 0 0.00 3 5.68* 2 2.77 5 2.03 2.46 0.12

Soft tissue including heart 0 0.00 1 0.43 5 2.36 4 1.24 10 8.33 1.20 0.07

Kaposi sarcoma 1 21.29 0 0.00 1 6.65 0 0.00 2 0.59 3.38 0.06

Melanoma of skin 3 0.84 6 0.46* 8 0.65 15 0.85 32 46.54 0.69* -0.59

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 2.59 0.00 -0.11

Brain, central nervous system 1 0.61 4 0.69 4 0.75 6 0.77 15 20.55 0.73 -0.23

Thyroid 8 3.20* 9 1.02 3 0.40 6 0.63 26 28.36 0.92 -0.10

Lymphatic, hematopoietic 20 1.95* 34 0.95 35 1.03 57 1.03 146 135.42 1.08 0.43

Hodgkin lymphoma 1 1.62 2 0.98 0 0.00 2 1.09 5 6.07 0.82 -0.04

Non-Hodgkin lymphoma 7 1.53 16 0.98 20 1.23 38 1.39 81 64.58 1.25 0.67

Myeloma 1 0.54 4 0.62 7 1.15 6 0.60 18 24.37 0.74 -0.26

Leukemia 11 3.44* 12 1.10 8 0.78 11 0.69 42 40.40 1.04 0.07

Acute lymphocytic 1 7.91 0 0.00 0 0.00 1 1.74 2 1.55 1.29 0.02

Chronic lymphocytic 3 2.70 1 0.26 2 0.55 6 1.03 12 14.32 0.84 -0.09

Acute non-lymphocytic 4 3.39 8 1.97 3 0.80 3 0.50 18 14.99 1.20 0.12

Chronic myeloid 0 0.00 1 0.60 1 0.65 1 0.43 3 6.03 0.50 -0.12

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 30,563 26,061 16,153 10,491 30,563

Person-years in interval 23,398 79,894 65,587 77,182 246,060

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE CERVIX UTERI, VAGINA, AND VULVA 213
All subsequent cancers 1,568 1.37* 443 1.20* 285 1.15* 178 1.22* 2,474 1,905.05 1.30* 23.12

All excluding same site 1,555 1.40* 439 1.21* 281 1.15* 176 1.22* 2,451 1,862.45 1.32* 23.92

Buccal cavity, pharynx 41 1.94* 15 2.35* 7 1.69 2 0.85 65 34.05 1.91* 1.26

Lip 0 0.00 1 2.84 1 4.09 0 0.00 2 1.83 1.09 0.01

Tongue 5 1.08 2 1.39 3 3.16 0 0.00 10 7.57 1.32 0.10

Salivary gland 5 2.03 0 0.00 0 0.00 0 0.00 5 3.97 1.26 0.04

Mouth 11 1.60 6 2.86* 2 1.47 1 1.28 20 11.14 1.80* 0.36

Nasopharynx 2 1.68 0 0.00 1 5.04 0 0.00 3 1.82 1.65 0.05

Tonsil 10 4.70* 3 4.90 0 0.00 0 0.00 13 3.32 3.92* 0.39

Oropharynx 0 0.00 1 6.20 0 0.00 0 0.00 1 0.86 1.17 0.01

Hypopharynx 7 4.62* 0 0.00 0 0.00 1 6.59 8 2.39 3.35* 0.23

Digestive system 305 1.31* 103 1.39* 75 1.49* 39 1.29 522 387.71 1.35* 5.46

Esophagus 11 1.54 6 2.64 2 1.30 0 0.00 19 11.87 1.60 0.29

Stomach 35 1.73* 12 2.00* 6 1.52 3 1.30 56 32.45 1.73* 0.96

Small intestine 8 2.24 1 0.80 1 1.11 2 3.48 12 6.29 1.91 0.23

Colon 130 1.16 42 1.17 31 1.27 20 1.37 223 186.67 1.19* 1.48

Rectum, rectosigmoid junction 42 1.10 17 1.46 20 2.63* 7 1.56 86 61.80 1.39* 0.98

Rectum 28 1.13 12 1.58 16 3.17* 3 0.98 59 40.43 1.46* 0.75

Anus, anal canal 9 2.60* 6 5.21* 3 3.79 1 2.20 19 5.86 3.24* 0.53

Liver 6 1.07 2 1.06 1 0.72 0 0.00 9 9.81 0.92 -0.03

Gallbladder 9 1.74 1 0.65 3 2.97 1 1.74 14 8.29 1.69 0.23

Bile ducts, other biliary 3 0.64 1 0.62 1 0.83 0 0.00 5 8.26 0.61 -0.13

Pancreas 46 1.52* 12 1.22 5 0.73 4 0.96 67 51.05 1.31* 0.65

Respiratory system 423 3.09* 105 2.14* 67 1.90* 30 1.37 625 243.25 2.57* 15.51

Nose, nasal cavity, ear 1 0.64 0 0.00 1 3.10 0 0.00 2 2.57 0.78 -0.02

Larynx 18 3.36* 4 2.32 4 3.57 2 3.16 28 8.83 3.17* 0.78

Lung, bronchus 402 3.10* 101 2.16* 62 1.84* 28 1.33 593 231.17 2.57* 14.70

Female breast 308 0.86* 69 0.59* 51 0.66* 30 0.68* 458 595.18 0.77* -5.58

Female genital system 195 1.18* 55 1.15 33 1.06 23 1.32 306 261.13 1.17* 1.82

Cervix uteri 13 0.43* 4 0.57 4 1.04 2 1.14 23 42.60 0.54* -0.80

Corpus uteri 45 0.59* 14 0.61 5 0.33* 6 0.67 70 123.42 0.57* -2.17

Ovary 54 1.16 15 1.04 12 1.27 3 0.57 84 75.74 1.11 0.34

Vagina 38 16.34* 10 14.29* 10 22.16* 5 19.33* 63 3.73 16.87* 2.41

Vulva 36 6.10* 10 5.17* 1 0.75 4 5.05* 51 9.96 5.12* 1.67

Urinary system 96 2.03* 35 2.18* 13 1.15 27 3.88* 171 81.56 2.10* 3.63

Urinary bladder 67 2.53* 22 2.48* 9 1.44 18 4.68* 116 45.46 2.55* 2.87

Kidney parenchyma 17 1.00 9 1.51 3 0.70 4 1.54 33 29.80 1.11 0.13

Renal pelvis, other urinary 12 3.17* 4 3.35 1 1.22 5 9.90* 22 6.30 3.49* 0.64

Ureter 3 2.73 4 11.44* 0 0.00 4 27.31* 11 1.83 6.00* 0.37

Bone, joints 3 2.30 1 2.74 1 4.39 0 0.00 5 2.03 2.46 0.12

Soft tissue including heart 6 1.18 3 1.92 1 0.95 0 0.00 10 8.33 1.20 0.07

Kaposi sarcoma 2 5.62 0 0.00 0 0.00 0 0.00 2 0.59 3.38 0.06

Melanoma of skin 17 0.59* 8 0.91 3 0.53 4 1.23 32 46.54 0.69* -0.59

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 2.59 0.00 -0.11

Brain, central nervous system 9 0.71 3 0.77 1 0.40 2 1.43 15 20.55 0.73 -0.23

Thyroid 20 1.06 6 1.20 0 0.00 0 0.00 26 28.36 0.92 -0.10

Lymphatic, hematopoietic 89 1.11 25 0.95 22 1.21 10 0.92 146 135.42 1.08 0.43

Hodgkin lymphoma 3 0.71 1 1.03 1 1.76 0 0.00 5 6.07 0.82 -0.04

Non-Hodgkin lymphoma 43 1.16 17 1.32 16 1.77* 5 0.90 81 64.58 1.25 0.67

Myeloma 12 0.84 1 0.21 4 1.21 1 0.51 18 24.37 0.74 -0.26

Leukemia 31 1.27 6 0.77 1 0.19 4 1.30 42 40.40 1.04 0.07

Acute lymphocytic 1 1.03 1 3.38 0 0.00 0 0.00 2 1.55 1.29 0.02

Chronic lymphocytic 6 0.71 2 0.71 1 0.52 3 2.75 12 14.32 0.84 -0.09

Acute non-lymphocytic 15 1.66 2 0.70 0 0.00 1 0.84 18 14.99 1.20 0.12

Chronic myeloid 2 0.54 1 0.87 0 0.00 0 0.00 3 6.03 0.50 -0.12

Cervix Uteri

Females, Long-term Follow-up

Table 8.1.3: Risk of subsequent primary cancers after cancer of the cervix uteri, females,

long-term follow-up, SEER 1973-2000.

214 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CERVIX UTERI

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 30,563 10,491 6,351 3,308 30,563

Person-years in interval 168,878 41,539 23,744 11,899 246,060

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Cervix Uteri

Females, <50 Years of Age

Table 8.1.4: Risk of subsequent primary cancers after cancer of the cervix uteri, females,

<50 years of age, SEER 1973-2000.

CERVIX UTERI

All subsequent cancers 67 2.52* 167 1.44* 193 1.36* 382 1.14* 809 619.62 1.31* 12.54

All excluding same site 61 2.47* 166 1.53* 189 1.40* 376 1.15* 792 595.92 1.33* 12.98

Buccal cavity, pharynx 3 6.64* 8 4.00* 2 0.79 10 1.70 23 10.88 2.11* 0.80

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.03

Tongue 0 0.00 1 2.41 0 0.00 3 2.15 4 2.47 1.62 0.10

Salivary gland 1 10.42 0 0.00 0 0.00 0 0.00 1 1.59 0.63 -0.04

Mouth 0 0.00 2 3.79 0 0.00 4 2.27 6 3.13 1.92 0.19

Nasopharynx 0 0.00 1 5.30 0 0.00 1 2.91 2 0.77 2.60 0.08

Tonsil 1 21.81 2 9.48* 1 3.45 1 1.53 5 1.20 4.16* 0.25

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.02

Hypopharynx 1 42.92 2 17.50* 1 6.17 1 2.33 5 0.73 6.86* 0.28

Digestive system 5 2.23 13 1.23 20 1.33 81 1.73* 119 74.62 1.59* 2.94

Esophagus 0 0.00 2 6.14 0 0.00 5 2.96 7 2.59 2.70* 0.29

Stomach 0 0.00 2 2.03 4 3.25 3 0.90 9 5.76 1.56 0.21

Small intestine 2 28.89* 0 0.00 2 4.97 1 0.90 5 1.89 2.65 0.21

Colon 2 2.09 4 0.89 7 1.09 27 1.29 40 32.78 1.22 0.48

Rectum, rectosigmoid junction 0 0.00 1 0.47 2 0.66 21 2.45* 24 14.18 1.69* 0.65

Rectum 0 0.00 1 0.70 1 0.50 16 2.81* 18 9.42 1.91* 0.57

Anus, anal canal 0 0.00 2 6.21 0 0.00 6 5.44* 8 1.94 4.13* 0.40

Liver 0 0.00 0 0.00 0 0.00 1 0.70 1 2.26 0.44 -0.08

Gallbladder 0 0.00 0 0.00 2 7.41 3 3.40 5 1.36 3.67* 0.24

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.49 0.00 -0.10

Pancreas 0 0.00 2 1.87 3 1.82 12 2.04* 17 8.81 1.93* 0.54

Respiratory system 6 3.70* 59 7.27* 45 3.55* 75 1.72* 185 66.06 2.80* 7.87

Nose, nasal cavity, ear 0 0.00 1 6.62 0 0.00 1 2.46 2 0.77 2.59 0.08

Larynx 0 0.00 1 2.16 4 5.96* 7 3.85* 12 3.05 3.94* 0.59

Lung, bronchus 6 4.06* 56 7.52* 41 3.48* 67 1.62* 170 62.02 2.74* 7.15

Female breast 13 1.19 41 0.85 58 0.99 81 0.64* 193 244.44 0.79* -3.41

Female genital system 25 5.11* 18 0.87 32 1.37 56 1.14 131 98.08 1.34* 2.18

Cervix uteri 6 3.11* 1 0.14* 4 0.62 6 0.73 17 23.70 0.72 -0.44

Corpus uteri 4 3.05 1 0.16* 9 1.05 16 0.69 30 39.42 0.76 -0.62

Ovary 12 8.72* 10 1.68 8 1.14 16 1.08 46 29.20 1.58* 1.11

Vagina 2 46.32* 6 32.33* 5 21.85* 8 14.90* 21 0.99 21.11* 1.32

Vulva 0 0.00 0 0.00 6 8.95* 7 4.68* 13 2.89 4.50* 0.67

Urinary system 1 1.72 12 4.36* 10 2.56* 29 2.34* 52 19.62 2.65* 2.14

Urinary bladder 0 0.00 8 6.81* 5 2.88 15 2.52* 28 9.11 3.07* 1.25

Kidney parenchyma 1 3.19 2 1.39 3 1.52 8 1.40 14 9.44 1.48 0.30

Renal pelvis, other urinary 0 0.00 2 14.74* 2 9.88* 6 8.60* 10 1.06 9.40* 0.59

Ureter 0 0.00 2 94.62* 0 0.00 5 28.44* 7 0.24 29.31* 0.45

Bone, joints 0 0.00 0 0.00 1 4.16 1 2.57 2 0.95 2.11 0.07

Soft tissue including heart 0 0.00 0 0.00 2 2.52 1 0.65 3 3.30 0.91 -0.02

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.01

Melanoma of skin 2 1.19 3 0.44 6 0.88 8 0.74 19 26.06 0.73 -0.47

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.89 0.00 -0.06

Brain, central nervous system 0 0.00 0 0.00 0 0.00 4 1.07 4 7.96 0.50 -0.26

Thyroid 5 3.59* 3 0.57 1 0.20 6 0.88 15 18.39 0.82 -0.22

Lymphatic, hematopoietic 7 4.24* 7 1.01 7 0.86 20 0.98 41 37.14 1.10 0.26

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 3.46 0.00 -0.23

Non-Hodgkin lymphoma 3 4.14 4 1.25 1 0.25 13 1.22 21 18.63 1.13 0.16

Myeloma 0 0.00 0 0.00 2 2.06 1 0.30 3 5.07 0.59 -0.14

Leukemia 4 8.80* 3 1.57 4 1.81 6 1.11 17 9.97 1.71 0.47

Acute lymphocytic 1 22.14 0 0.00 0 0.00 1 3.46 2 0.68 2.92 0.09

Chronic lymphocytic 0 0.00 0 0.00 2 4.29 3 1.77 5 2.50 2.00 0.17

Acute non-lymphocytic 2 9.13* 3 3.41 1 1.04 1 0.47 7 4.19 1.67 0.19

Chronic myeloid 0 0.00 0 0.00 0 0.00 1 1.12 1 1.84 0.54 -0.06

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 16,105 14,490 9,715 6,623 16,105

Person-years in interval 12,740 46,474 40,377 51,463 151,053

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE CERVIX UTERI, VAGINA, AND VULVA 215
All subsequent cancers 121 1.77* 327 1.28* 348 1.37* 464 1.25* 1,260 947.47 1.33* 41.15

All excluding same site 121 1.82* 326 1.31* 348 1.39* 461 1.26* 1,256 932.90 1.35* 42.54

Buccal cavity, pharynx 4 2.67 12 2.22* 8 1.62 10 1.62 34 17.99 1.89* 2.11

Lip 0 0.00 0 0.00 0 0.00 1 2.39 1 0.92 1.08 0.01

Tongue 0 0.00 1 0.84 1 0.91 1 0.74 3 3.97 0.75 -0.13

Salivary gland 2 14.86* 0 0.00 0 0.00 0 0.00 2 1.75 1.15 0.03

Mouth 2 4.09 6 3.37* 1 0.61 4 1.86 13 6.06 2.15* 0.91

Nasopharynx 0 0.00 0 0.00 1 4.20 0 0.00 1 0.86 1.16 0.02

Tonsil 0 0.00 4 6.48* 2 3.95 1 2.01 7 1.80 3.89* 0.68

Oropharynx 0 0.00 0 0.00 0 0.00 1 6.39 1 0.50 2.00 0.07

Hypopharynx 0 0.00 1 2.16 2 4.92 0 0.00 3 1.42 2.11 0.21

Digestive system 22 1.74* 69 1.39* 73 1.36* 116 1.30* 280 205.23 1.36* 9.84

Esophagus 1 1.97 2 1.06 2 1.07 3 1.14 8 6.88 1.16 0.15

Stomach 4 3.97* 4 1.01 4 0.96 11 1.56 23 16.16 1.42 0.90

Small intestine 1 4.90 1 1.28 1 1.21 3 2.18 6 3.19 1.88 0.37

Colon 9 1.56 30 1.29 31 1.20 58 1.32* 128 98.76 1.30* 3.85

Rectum, rectosigmoid junction 0 0.00 13 1.48 10 1.12 19 1.47 42 32.90 1.28 1.20

Rectum 0 0.00 8 1.42 8 1.40 12 1.42 28 21.28 1.32 0.88

Anus, anal canal 0 0.00 2 2.51 4 5.01* 4 3.55 10 2.93 3.41* 0.93

Liver 1 3.27 2 1.64 1 0.74 2 0.84 6 5.26 1.14 0.10

Gallbladder 1 3.71 2 1.88 2 1.72 2 1.09 7 4.33 1.62 0.35

Bile ducts, other biliary 0 0.00 1 1.08 1 0.95 2 0.96 4 4.29 0.93 -0.04

Pancreas 5 3.04 12 1.83 13 1.78 8 0.65 38 27.88 1.36 1.33

Respiratory system 25 2.69* 111 3.04* 99 2.56* 115 2.01* 350 141.79 2.47* 27.41

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 1.29 0.00 -0.17

Larynx 4 9.18* 3 1.94 3 2.14 2 1.29 12 4.94 2.43* 0.93

Lung, bronchus 21 2.40* 107 3.10* 96 2.60* 113 2.05* 337 135.22 2.49* 26.57

Female breast 17 0.80 53 0.68* 67 0.91 65 0.65* 202 272.88 0.74* -9.33

Female genital system 24 2.10* 27 0.68* 36 1.03 48 1.14 135 128.27 1.05 0.89

Cervix uteri 0 0.00 1 0.19 0 0.00* 3 0.78 4 14.57 0.27* -1.39

Corpus uteri 9 1.45 6 0.28* 7 0.37* 7 0.32* 29 68.44 0.42* -5.19

Ovary 7 2.35 4 0.38* 4 0.41 13 1.02 28 36.20 0.77 -1.08

Vagina 4 29.68* 8 16.00* 10 20.41* 16 22.11* 38 1.85 20.56* 4.76

Vulva 1 3.55 8 7.39* 12 10.47* 7 3.39* 28 4.57 6.12* 3.08

Urinary system 12 4.45* 18 1.70* 20 1.74* 42 2.24* 92 43.54 2.11* 6.38

Urinary bladder 7 4.84* 14 2.41* 13 2.03* 32 2.95* 66 24.52 2.69* 5.46

Kidney parenchyma 4 3.86* 1 0.25 5 1.20 6 0.95 16 15.48 1.03 0.07

Renal pelvis, other urinary 1 4.70 3 3.55 2 2.13 4 2.58 10 3.55 2.82* 0.85

Ureter 0 0.00 0 0.00 0 0.00 3 6.34* 3 1.05 2.85 0.26

Bone, joints 0 0.00 0 0.00 2 9.33* 1 3.41 3 0.80 3.74 0.29

Soft tissue including heart 0 0.00 1 1.02 3 3.17 2 1.40 6 3.61 1.66 0.31

Kaposi sarcoma 1 116.63* 0 0.00 0 0.00 0 0.00 1 0.22 4.61 0.10

Melanoma of skin 1 0.79 1 0.22 1 0.24 6 1.00 9 16.08 0.56 -0.93

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 1.29 0.00 -0.17

Brain, central nervous system 1 1.31 4 1.43 4 1.48 2 0.55 11 9.93 1.11 0.14

Thyroid 2 2.49 5 1.85 2 0.91 0 0.00 9 8.20 1.10 0.11

Lymphatic, hematopoietic 7 1.65 16 0.96 21 1.17 32 1.08 76 68.47 1.11 0.99

Hodgkin lymphoma 1 5.95 1 1.70 0 0.00 2 2.91 4 1.98 2.02 0.27

Non-Hodgkin lymphoma 2 0.99 7 0.88 13 1.49 20 1.38 42 33.24 1.26 1.15

Myeloma 1 1.20 2 0.61 5 1.41 5 0.88 13 13.35 0.97 -0.05

Leukemia 3 2.42 6 1.24 3 0.58 5 0.58 17 19.90 0.85 -0.38

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.08

Chronic lymphocytic 1 2.14 1 0.53 0 0.00 3 0.89 5 7.78 0.64 -0.37

Acute non-lymphocytic 1 2.25 3 1.73 1 0.54 2 0.63 7 7.19 0.97 -0.03

Chronic myeloid 0 0.00 1 1.45 1 1.42 0 0.00 2 2.74 0.73 -0.10

Cervix Uteri

Females, 50-69 Years of Age

Table 8.1.5: Risk of subsequent primary cancers after cancer of the cervix uteri, females,

50-69 years of age, SEER 1973-2000.

216 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CERVIX UTERI

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 9,922 8,387 5,030 3,243 9,922

Person-years in interval 7,562 25,223 20,370 22,798 75,954

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Cervix Uteri

Females, ≥70 Years of Age

Table 8.1.6: Risk of subsequent primary cancers after cancer of the cervix uteri, females,

≥70 years of age, SEER 1973-2000.

CERVIX UTERI

All subsequent cancers 67 1.31* 180 1.28* 98 1.09 60 1.07 405 337.97 1.20* 35.18

All excluding same site 67 1.33* 179 1.29* 98 1.11 59 1.06 403 333.63 1.21* 36.41

Buccal cavity, pharynx 0 0.00 3 1.37 1 0.74 4 4.80* 8 5.18 1.54 1.48

Lip 0 0.00 0 0.00 0 0.00 1 10.98 1 0.48 2.07 0.27

Tongue 0 0.00 1 2.12 1 3.39 1 5.49 3 1.12 2.67 0.98

Salivary gland 0 0.00 2 7.73 0 0.00 0 0.00 2 0.64 3.14 0.72

Mouth 0 0.00 0 0.00 0 0.00 1 2.98 1 1.95 0.51 -0.50

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.10

Tonsil 0 0.00 0 0.00 0 0.00 1 30.04 1 0.31 3.21 0.36

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.12

Digestive system 14 0.89 58 1.32* 31 1.06 20 1.05 123 107.86 1.14 7.94

Esophagus 2 5.52 2 2.02 0 0.00 0 0.00 4 2.39 1.67 0.84

Stomach 3 1.94 12 2.82* 2 0.71 7 3.67* 24 10.52 2.28* 7.07

Small intestine 0 0.00 0 0.00 1 3.09 0 0.00 1 1.22 0.82 -0.11

Colon 4 0.51 25 1.12 18 1.20 8 0.80 55 55.14 1.00 -0.07

Rectum, rectosigmoid junction 2 0.87 10 1.60 4 1.02 4 1.75 20 14.73 1.36 2.77

Rectum 1 0.67 7 1.71 2 0.78 3 1.93 13 9.73 1.34 1.72

Anus, anal canal 0 0.00 0 0.00 1 3.78 0 0.00 1 1.00 1.00 0.00

Liver 1 2.95 0 0.00 1 1.63 0 0.00 2 2.29 0.87 -0.15

Gallbladder 1 2.52 1 0.91 0 0.00 0 0.00 2 2.59 0.77 -0.31

Bile ducts, other biliary 0 0.00 1 1.05 0 0.00 0 0.00 1 2.48 0.40 -0.78

Pancreas 1 0.48 7 1.21 3 0.78 1 0.38 12 14.36 0.84 -1.24

Respiratory system 14 2.50* 42 2.73* 22 2.40* 12 2.27* 90 35.41 2.54* 28.65

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.51 0.00 -0.27

Larynx 0 0.00 2 5.21 1 4.95 1 9.15 4 0.84 4.76* 1.66

Lung, bronchus 14 2.61* 40 2.72* 21 2.39* 11 2.17* 86 33.94 2.53* 27.33

Female breast 14 1.15 27 0.82 18 0.88 4 0.33* 63 77.87 0.81 -7.80

Female genital system 11 1.90 17 1.12 5 0.57 7 1.39 40 34.78 1.15 2.74

Cervix uteri 0 0.00 1 0.51 0 0.00 1 1.74 2 4.34 0.46 -1.23

Corpus uteri 5 1.85 3 0.43 1 0.26 2 1.00 11 15.55 0.71 -2.39

Ovary 4 2.44 4 0.91 1 0.37 1 0.62 10 10.35 0.97 -0.18

Vagina 1 7.41 1 2.67 1 4.28 1 6.72 4 0.89 4.49* 1.63

Vulva 1 2.90 6 6.17* 2 2.93 1 1.99 10 2.50 4.00* 3.94

Urinary system 6 2.21 11 1.46 6 1.22 4 1.24 27 18.40 1.47 4.51

Urinary bladder 4 2.33 11 2.30* 5 1.57 2 0.93 22 11.83 1.86* 5.34

Kidney parenchyma 1 1.35 0 0.00 0 0.00 2 2.50 3 4.89 0.61 -0.99

Renal pelvis, other urinary 1 3.90 0 0.00 1 2.21 0 0.00 2 1.69 1.18 0.16

Ureter 0 0.00 0 0.00 1 6.72 0 0.00 1 0.54 1.84 0.24

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.15

Soft tissue including heart 0 0.00 0 0.00 0 0.00 1 3.79 1 1.41 0.71 -0.22

Kaposi sarcoma 0 0.00 0 0.00 1 13.53 0 0.00 1 0.25 4.01 0.39

Melanoma of skin 0 0.00 2 1.14 1 0.85 1 1.19 4 4.40 0.91 -0.21

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.21

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 2.66 0.00 -1.40

Thyroid 1 3.35 1 1.28 0 0.00 0 0.00 2 1.78 1.13 0.12

Lymphatic, hematopoietic 6 1.38 11 0.90 7 0.87 5 0.95 29 29.82 0.97 -0.43

Hodgkin lymphoma 0 0.00 1 3.57 0 0.00 0 0.00 1 0.63 1.59 0.19

Non-Hodgkin lymphoma 2 1.09 5 0.96 6 1.74 5 2.27 18 12.71 1.42 2.78

Myeloma 0 0.00 2 0.80 0 0.00 0 0.00 2 5.95 0.34 -2.07

Leukemia 4 2.65 3 0.71 1 0.35 0 0.00 8 10.53 0.76 -1.33

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.13

Chronic lymphocytic 2 3.38 0 0.00 0 0.00 0 0.00 2 4.04 0.49 -1.07

Acute non-lymphocytic 1 1.94 2 1.38 1 1.02 0 0.00 4 3.61 1.11 0.20

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.45 0.00 -0.76

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,536 3,184 1,408 625 4,536

Person-years in interval 3,096 8,197 4,839 2,920 19,052

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE CERVIX UTERI, VAGINA, AND VULVA 217
All subsequent cancers 151 1.55* 455 1.46* 391 1.44* 540 1.37* 1,537 1,072.72 1.43* 42.69

All excluding same site 151 1.59* 454 1.49* 391 1.47* 537 1.39* 1,533 1,052.27 1.46* 44.20

Buccal cavity, pharynx 6 3.20* 11 1.85 6 1.20 12 1.80 35 19.48 1.80* 1.43

Lip 0 0.00 0 0.00 0 0.00 1 2.39 1 1.10 0.91 -0.01

Tongue 0 0.00 1 0.78 2 1.80 4 2.68 7 4.29 1.63 0.25

Salivary gland 3 14.69* 1 1.57 0 0.00 0 0.00 4 2.12 1.89 0.17

Mouth 2 3.19 6 3.01* 0 0.00 4 1.77 12 6.55 1.83 0.50

Nasopharynx 0 0.00 0 0.00 1 4.03 0 0.00 1 0.98 1.02 0.00

Tonsil 1 5.15 3 4.97 2 4.09 1 1.73 7 1.86 3.76* 0.47

Oropharynx 0 0.00 0 0.00 0 0.00 1 6.05 1 0.50 2.01 0.05

Hypopharynx 0 0.00 0 0.00 1 2.74 1 2.23 2 1.39 1.44 0.06

Digestive system 29 1.33 98 1.41* 82 1.34* 142 1.61* 351 240.51 1.46* 10.16

Esophagus 2 3.00 4 1.90 2 1.09 5 1.90 13 7.23 1.80 0.53

Stomach 7 3.51* 16 2.58* 7 1.34 15 2.09* 45 20.57 2.19* 2.25

Small intestine 2 6.70 1 1.03 3 3.40 1 0.70 7 3.58 1.95 0.31

Colon 7 0.67 39 1.16 36 1.21 62 1.43* 144 117.04 1.23* 2.48

Rectum, rectosigmoid junction 2 0.56 14 1.24 8 0.83 33 2.53* 57 37.50 1.52* 1.79

Rectum 1 0.43 9 1.23 7 1.12 24 2.78* 41 24.46 1.68* 1.52

Anus, anal canal 0 0.00 2 2.13 1 1.19 8 6.57* 11 3.29 3.35* 0.71

Liver 1 2.02 1 0.62 2 1.38 0 0.00 4 5.90 0.68 -0.17

Gallbladder 1 1.97 1 0.63 2 1.46 2 1.10 6 5.29 1.13 0.07

Bile ducts, other biliary 0 0.00 2 1.45 1 0.79 2 0.96 5 5.14 0.97 -0.01

Pancreas 6 2.13 18 1.99* 15 1.86* 10 0.83 49 31.91 1.54* 1.57

Respiratory system 30 2.66* 164 4.35* 111 3.15* 127 2.26* 432 140.52 3.07* 26.80

Nose, nasal cavity, ear 0 0.00 1 2.32 0 0.00 0 0.00 1 1.49 0.67 -0.04

Larynx 2 4.34 4 2.70 2 1.57 5 2.88 13 4.95 2.63* 0.74

Lung, bronchus 28 2.63* 158 4.42* 109 3.26* 122 2.26* 417 133.71 3.12* 26.05

Female breast 27 0.94 73 0.80 65 0.81 57 0.50* 222 315.37 0.70* -8.59

Female genital system 28 1.93* 37 0.83 45 1.25 80 1.69* 190 142.47 1.33* 4.37

Cervix uteri 0 0.00 1 0.14* 0 0.00* 3 0.56 4 20.45 0.20* -1.51

Corpus uteri 10 1.43 8 0.37* 15 0.85 24 1.02 57 69.97 0.81 -1.19

Ovary 12 3.09* 11 0.89 8 0.77 22 1.54 53 40.87 1.30 1.12

Vagina 3 13.89* 5 7.41* 4 7.15* 18 23.62* 30 2.21 13.56* 2.55

Vulva 1 1.95 11 6.75* 15 10.45* 8 3.66* 35 5.77 6.07* 2.69

Urinary system 10 2.41* 29 2.15* 27 2.23* 40 2.14* 106 48.48 2.19* 5.29

Urinary bladder 7 2.92* 26 3.35* 20 2.87* 30 2.81* 83 27.78 2.99* 5.08

Kidney parenchyma 2 1.43 0 0.00* 3 0.72 5 0.76 10 16.74 0.60 -0.62

Renal pelvis, other urinary 1 2.80 3 2.63 4 3.99* 5 3.44* 13 3.95 3.29* 0.83

Ureter 0 0.00 1 2.96 1 3.31 4 9.16* 6 1.18 5.08* 0.44

Bone, joints 0 0.00 0 0.00 2 7.82 2 5.96 4 1.01 3.96* 0.27

Soft tissue including heart 0 0.00 1 0.77 3 2.71 4 2.48 8 4.44 1.80 0.33

Kaposi sarcoma 1 31.81 0 0.00 1 10.82 0 0.00 2 0.36 5.50 0.15

Melanoma of skin 1 0.52 2 0.32 2 0.37 9 1.18 14 21.12 0.66 -0.66

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 1.44 0.00 -0.13

Brain, central nervous system 0 0.00 4 1.22 2 0.71 1 0.26 7 10.96 0.64 -0.36

Thyroid 6 4.65* 4 1.02 3 0.99 5 1.32 18 12.02 1.50 0.55

Lymphatic, hematopoietic 8 1.16 19 0.86 23 1.17 35 1.17 85 78.58 1.08 0.59

Hodgkin lymphoma 0 0.00 2 2.24 0 0.00 1 1.24 3 2.68 1.12 0.03

Non-Hodgkin lymphoma 5 1.64 6 0.60 15 1.62 24 1.64* 50 36.97 1.35* 1.20

Myeloma 0 0.00 3 0.71 4 1.07 5 0.90 12 14.84 0.81 -0.26

Leukemia 3 1.37 8 1.15 4 0.66 5 0.56 20 24.08 0.83 -0.38

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -0.07

Chronic lymphocytic 0 0.00 0 0.00 1 0.44 3 0.90 4 8.96 0.45 -0.46

Acute non-lymphocytic 2 2.55 7 2.80* 2 0.92 1 0.31 12 8.70 1.38 0.30

Chronic myeloid 0 0.00 0 0.00 0 0.00 1 0.79 1 3.47 0.29 -0.23

Cervix Uteri

Females, Radiotherapy

Table 8.1.7: Risk of subsequent primary cancers after cancer of the cervix uteri, females,

with initial radiotherapy, SEER 1973-2000.

218 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CERVIX UTERI

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 16,404 13,304 6,953 4,380 16,404

Person-years in interval 12,330 36,721 27,648 32,060 108,760

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Cervix Uteri

Females, No Radiotherapy

Table 8.1.8: Risk of subsequent primary cancers after cancer of the cervix uteri, females,

without initial radiotherapy, SEER 1973-2000.

CERVIX UTERI

All subsequent cancers 104 2.13* 219 1.09 248 1.16* 366 0.99 937 832.34 1.13* 7.62

All excluding same site 98 2.08* 217 1.12 244 1.18* 359 0.99 918 810.19 1.13* 7.85

Buccal cavity, pharynx 1 1.12 12 3.29* 5 1.31 12 1.93 30 14.57 2.06* 1.12

Lip 0 0.00 0 0.00 0 0.00 1 3.05 1 0.73 1.37 0.02

Tongue 0 0.00 2 2.52 0 0.00 1 0.70 3 3.27 0.92 -0.02

Salivary gland 0 0.00 1 2.04 0 0.00 0 0.00 1 1.85 0.54 -0.06

Mouth 0 0.00 2 1.77 1 0.84 5 2.52 8 4.59 1.74 0.25

Nasopharynx 0 0.00 1 4.25 0 0.00 1 3.11 2 0.84 2.37 0.08

Tonsil 0 0.00 3 8.16* 1 2.59 2 3.28 6 1.45 4.13* 0.33

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.03

Hypopharynx 1 16.81 3 11.96* 2 7.67 0 0.00 6 1.00 6.02* 0.36

Digestive system 12 1.35 42 1.21 42 1.13 75 1.13 171 147.20 1.16 1.73

Esophagus 1 3.67 2 1.83 0 0.00 3 1.43 6 4.63 1.30 0.10

Stomach 0 0.00 2 0.67 3 1.00 6 1.18 11 11.88 0.93 -0.06

Small intestine 1 6.85 0 0.00 1 1.50 3 2.33 5 2.71 1.85 0.17

Colon 8 1.90 20 1.22 20 1.14 31 0.98 79 69.63 1.13 0.68

Rectum, rectosigmoid junction 0 0.00 10 1.70 8 1.28 11 1.03 29 24.30 1.19 0.34

Rectum 0 0.00 7 1.82 4 0.98 7 0.99 18 15.98 1.13 0.15

Anus, anal canal 0 0.00 2 3.38 4 6.03* 2 1.69 8 2.58 3.10* 0.39

Liver 1 4.51 1 1.13 0 0.00 3 1.63 5 3.91 1.28 0.08

Gallbladder 1 5.19 2 2.73 2 2.62 3 2.30 8 3.00 2.67* 0.36

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 3.12 0.00 -0.23

Pancreas 0 0.00 3 0.68 4 0.84 11 1.24 18 19.14 0.94 -0.08

Respiratory system 15 2.87* 48 2.16* 55 2.17* 75 1.50* 193 102.73 1.88* 6.57

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 1 2.12 1 1.09 0.92 -0.01

Larynx 2 9.18* 2 2.18 6 5.97* 5 2.87 15 3.88 3.86* 0.81

Lung, bronchus 13 2.64* 45 2.14* 49 2.04* 69 1.45* 176 97.46 1.81* 5.72

Female breast 17 1.08 48 0.72* 78 1.07 93 0.75* 236 279.81 0.84* -3.19

Female genital system 32 4.20* 25 0.81 28 0.90 31 0.63* 116 118.66 0.98 -0.19

Cervix uteri 6 3.36* 2 0.29 4 0.65 7 0.97 19 22.15 0.86 -0.23

Corpus uteri 8 2.50* 2 0.15* 2 0.15* 1 0.04* 13 53.45 0.24* -2.95

Ovary 11 5.21* 7 0.80 5 0.55 8 0.54 31 34.87 0.89 -0.28

Vagina 4 41.24* 10 26.01* 12 30.50* 7 10.81* 33 1.52 21.68* 2.29

Vulva 1 3.97 3 2.98 5 4.70* 7 3.74* 16 4.19 3.82* 0.86

Urinary system 9 4.89* 12 1.61 9 1.10 35 2.25* 65 33.08 1.96* 2.32

Urinary bladder 4 3.97* 7 1.75 3 0.69 19 2.29* 33 17.67 1.87* 1.12

Kidney parenchyma 4 5.79* 3 1.03 5 1.54 11 1.77 23 13.07 1.76* 0.72

Renal pelvis, other urinary 1 7.15 2 3.62 1 1.69 5 4.70* 9 2.35 3.84* 0.48

Ureter 0 0.00 1 6.64 0 0.00 4 13.39* 5 0.65 7.67* 0.32

Bone, joints 0 0.00 0 0.00 1 3.68 0 0.00 1 1.02 0.98 0.00

Soft tissue including heart 0 0.00 0 0.00 2 1.98 0 0.00 2 3.89 0.51 -0.14

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.02

Melanoma of skin 2 1.22 4 0.58 6 0.87 6 0.60 18 25.42 0.71 -0.54

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 1.15 0.00 -0.08

Brain, central nervous system 1 1.64 0 0.00 2 0.79 5 1.27 8 9.59 0.83 -0.12

Thyroid 2 1.66 5 1.03 0 0.00* 1 0.17* 8 16.34 0.49* -0.61

Lymphatic, hematopoietic 12 3.53* 15 1.10 12 0.84 22 0.86 61 56.85 1.07 0.30

Hodgkin lymphoma 1 3.21 0 0.00 0 0.00 1 0.98 2 3.39 0.59 -0.10

Non-Hodgkin lymphoma 2 1.31 10 1.58 5 0.72 14 1.09 31 27.61 1.12 0.25

Myeloma 1 1.84 1 0.46 3 1.27 1 0.23 6 9.52 0.63 -0.26

Leukemia 8 7.86* 4 1.00 4 0.96 6 0.84 22 16.32 1.35 0.41

Acute lymphocytic 1 19.26 0 0.00 0 0.00 1 3.40 2 0.76 2.64 0.09

Chronic lymphocytic 3 9.51* 1 0.81 1 0.75 3 1.21 8 5.37 1.49 0.19

Acute non-lymphocytic 2 5.05 1 0.64 1 0.62 2 0.73 6 6.29 0.95 -0.02

Chronic myeloid 0 0.00 1 1.54 1 1.51 0 0.00 2 2.56 0.78 -0.04

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 14,159 12,757 9,200 6,111 14,159

Person-years in interval 11,067 43,172 37,939 45,122 137,300

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE CERVIX UTERI, VAGINA, AND VULVA 219
All subsequent cancers 997 1.47* 273 1.38* 166 1.31* 101 1.46* 1,537 1,072.72 1.43* 42.69

All excluding same site 996 1.50* 273 1.40* 163 1.31* 101 1.48* 1,533 1,052.27 1.46* 44.20

Buccal cavity, pharynx 23 1.79* 8 2.32 2 0.95 2 1.82 35 19.48 1.80* 1.43

Lip 0 0.00 1 4.89 0 0.00 0 0.00 1 1.10 0.91 -0.01

Tongue 3 1.07 2 2.59 2 4.22 0 0.00 7 4.29 1.63 0.25

Salivary gland 4 2.92 0 0.00 0 0.00 0 0.00 4 2.12 1.89 0.17

Mouth 8 1.86 3 2.58 0 0.00 1 2.65 12 6.55 1.83 0.50

Nasopharynx 1 1.50 0 0.00 0 0.00 0 0.00 1 0.98 1.02 0.00

Tonsil 6 4.66* 1 3.18 0 0.00 0 0.00 7 1.86 3.76* 0.47

Oropharynx 0 0.00 1 11.39 0 0.00 0 0.00 1 0.50 2.01 0.05

Hypopharynx 1 1.06 0 0.00 0 0.00 1 14.59 2 1.39 1.44 0.06

Digestive system 209 1.37* 67 1.52* 51 1.80* 24 1.52 351 240.51 1.46* 10.16

Esophagus 8 1.74 3 2.27 2 2.38 0 0.00 13 7.23 1.80 0.53

Stomach 30 2.24* 8 2.19 4 1.76 3 2.41 45 20.57 2.19* 2.25

Small intestine 6 2.79* 0 0.00 0 0.00 1 3.59 7 3.58 1.95 0.31

Colon 82 1.11 29 1.34 21 1.51 12 1.55 144 117.04 1.23* 2.48

Rectum, rectosigmoid junction 24 0.98 13 1.93* 15 3.65* 5 2.24 57 37.50 1.52* 1.79

Rectum 17 1.07 10 2.28* 12 4.41* 2 1.32 41 24.46 1.68* 1.52

Anus, anal canal 3 1.45 4 6.55* 3 7.60* 1 4.73 11 3.29 3.35* 0.71

Liver 4 1.13 0 0.00 0 0.00 0 0.00 4 5.90 0.68 -0.17

Gallbladder 4 1.15 0 0.00 2 3.47 0 0.00 6 5.29 1.13 0.07

Bile ducts, other biliary 3 0.98 1 1.02 1 1.45 0 0.00 5 5.14 0.97 -0.01

Pancreas 39 1.96* 7 1.18 2 0.51 1 0.46 49 31.91 1.54* 1.57

Respiratory system 305 3.62* 74 2.71* 39 2.11* 14 1.33 432 140.52 3.07* 26.80

Nose, nasal cavity, ear 1 1.06 0 0.00 0 0.00 0 0.00 1 1.49 0.67 -0.04

Larynx 8 2.49* 1 1.11 3 5.48* 1 3.54 13 4.95 2.63* 0.74

Lung, bronchus 295 3.70* 73 2.80* 36 2.03* 13 1.29 417 133.71 3.12* 26.05

Female breast 165 0.82* 28 0.48* 16 0.44* 13 0.66 222 315.37 0.70* -8.59

Female genital system 110 1.15 37 1.51* 27 1.80* 16 2.06* 190 142.47 1.33* 4.37

Cervix uteri 1 0.07* 0 0.00 3 1.86 0 0.00 4 20.45 0.20* -1.51

Corpus uteri 33 0.71* 14 1.16 5 0.67 5 1.26 57 69.97 0.81 -1.19

Ovary 31 1.17 11 1.50 9 1.98 2 0.84 53 40.87 1.30 1.12

Vagina 12 8.28* 6 15.22* 8 33.19* 4 31.56* 30 2.21 13.56* 2.55

Vulva 27 7.54* 5 4.64* 1 1.40 2 5.02 35 5.77 6.07* 2.69

Urinary system 66 2.22* 18 1.96* 6 0.98 16 4.63* 106 48.48 2.19* 5.29

Urinary bladder 53 3.10* 13 2.49* 4 1.15 13 6.61* 83 27.78 2.99* 5.08

Kidney parenchyma 5 0.49 3 0.93 1 0.46 1 0.82 10 16.74 0.60 -0.62

Renal pelvis, other urinary 8 3.20* 2 2.78 1 2.14 2 7.55 13 3.95 3.29* 0.83

Ureter 2 2.69 2 9.20* 0 0.00 2 25.39* 6 1.18 5.08* 0.44

Bone, joints 2 2.96 1 5.82 1 9.41 0 0.00 4 1.01 3.96* 0.27

Soft tissue including heart 4 1.42 3 3.73 1 1.91 0 0.00 8 4.44 1.80 0.33

Kaposi sarcoma 2 8.89 0 0.00 0 0.00 0 0.00 2 0.36 5.50 0.15

Melanoma of skin 5 0.37* 5 1.31 2 0.82 2 1.46 14 21.12 0.66 -0.66

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 1.44 0.00 -0.13

Brain, central nervous system 6 0.84 1 0.50 0 0.00 0 0.00 7 10.96 0.64 -0.36

Thyroid 13 1.58 5 2.51 0 0.00 0 0.00 18 12.02 1.50 0.55

Lymphatic, hematopoietic 50 1.03 16 1.08 14 1.44 5 0.93 85 78.58 1.08 0.59

Hodgkin lymphoma 2 1.07 1 2.34 0 0.00 0 0.00 3 2.68 1.12 0.03

Non-Hodgkin lymphoma 26 1.16 11 1.55 9 1.88 4 1.47 50 36.97 1.35* 1.20

Myeloma 7 0.75 1 0.36 4 2.22 0 0.00 12 14.84 0.81 -0.26

Leukemia 15 0.99 3 0.67 1 0.35 1 0.64 20 24.08 0.83 -0.38

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -0.07

Chronic lymphocytic 1 0.18* 1 0.59 1 0.92 1 1.78 4 8.96 0.45 -0.46

Acute non-lymphocytic 11 2.02* 1 0.63 0 0.00 0 0.00 12 8.70 1.38 0.30

Chronic myeloid 0 0.00 1 1.56 0 0.00 0 0.00 1 3.47 0.29 -0.23

Cervix Uteri

Females, Long-term Follow-up, Radiotherapy

Table 8.1.9: Risk of subsequent primary cancers after cancer of the cervix uteri, females,

long-term follow-up, with initial radiotherapy, SEER 1973-2000.

220 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CERVIX UTERI

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 16,404 4,380 2,652 1,344 16,404

Person-years in interval 76,700 17,380 9,827 4,853 108,760

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Cervix Uteri

Females, Long-term Follow-up, No Radiotherapy

Table 8.1.10: Risk of subsequent primary cancers after cancer of the cervix uteri, females,

long-term follow-up, without initial radiotherapy, SEER 1973-2000.

CERVIX UTERI

All subsequent cancers 571 1.23* 170 1.00 119 0.98 77 1.00 937 832.34 1.13* 7.62

All excluding same site 559 1.25* 166 1.00 118 0.99 75 0.99 918 810.19 1.13* 7.85

Buccal cavity, pharynx 18 2.16* 7 2.38 5 2.45 0 0.00 30 14.57 2.06* 1.12

Lip 0 0.00 0 0.00 1 9.24 0 0.00 1 0.73 1.37 0.02

Tongue 2 1.09 0 0.00 1 2.11 0 0.00 3 3.27 0.92 -0.02

Salivary gland 1 0.91 0 0.00 0 0.00 0 0.00 1 1.85 0.54 -0.06

Mouth 3 1.15 3 3.20 2 3.08 0 0.00 8 4.59 1.74 0.25

Nasopharynx 1 1.92 0 0.00 1 9.83 0 0.00 2 0.84 2.37 0.08

Tonsil 4 4.75* 2 6.71 0 0.00 0 0.00 6 1.45 4.13* 0.33

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.03

Hypopharynx 6 10.50* 0 0.00 0 0.00 0 0.00 6 1.00 6.02* 0.36

Digestive system 96 1.19 36 1.20 24 1.09 15 1.03 171 147.20 1.16 1.73

Esophagus 3 1.18 3 3.17 0 0.00 0 0.00 6 4.63 1.30 0.10

Stomach 5 0.74 4 1.70 2 1.19 0 0.00 11 11.88 0.93 -0.06

Small intestine 2 1.41 1 1.78 1 2.33 1 3.38 5 2.71 1.85 0.17

Colon 48 1.26 13 0.92 10 0.96 8 1.16 79 69.63 1.13 0.68

Rectum, rectosigmoid junction 18 1.32 4 0.81 5 1.43 2 0.89 29 24.30 1.19 0.34

Rectum 11 1.24 2 0.62 4 1.72 1 0.65 18 15.98 1.13 0.15

Anus, anal canal 6 4.30* 2 3.70 0 0.00 0 0.00 8 2.58 3.10* 0.39

Liver 2 0.97 2 2.53 1 1.61 0 0.00 5 3.91 1.28 0.08

Gallbladder 5 2.96 1 1.66 1 2.31 1 3.68 8 3.00 2.67* 0.36

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 3.12 0.00 -0.23

Pancreas 7 0.68 5 1.27 3 1.02 3 1.52 18 19.14 0.94 -0.08

Respiratory system 118 2.23* 31 1.42 28 1.67* 16 1.41 193 102.73 1.88* 6.57

Nose, nasal cavity, ear 0 0.00 0 0.00 1 6.57 0 0.00 1 1.09 0.92 -0.01

Larynx 10 4.67* 3 3.67 1 1.74 1 2.85 15 3.88 3.86* 0.81

Lung, bronchus 107 2.14* 28 1.35 26 1.63* 15 1.37 176 97.46 1.81* 5.72

Female breast 143 0.92 41 0.70* 35 0.86 17 0.69 236 279.81 0.84* -3.19

Female genital system 85 1.22 18 0.77 6 0.37* 7 0.73 116 118.66 0.98 -0.19

Cervix uteri 12 0.80 4 1.01 1 0.45 2 1.93 19 22.15 0.86 -0.23

Corpus uteri 12 0.40* 0 0.00* 0 0.00* 1 0.20 13 53.45 0.24* -2.95

Ovary 23 1.15 4 0.56 3 0.61 1 0.34 31 34.87 0.89 -0.28

Vagina 26 29.72* 4 13.10* 2 9.51* 1 7.58 33 1.52 21.68* 2.29

Vulva 9 3.88* 5 5.83* 0 0.00 2 5.09 16 4.19 3.82* 0.86

Urinary system 30 1.71* 17 2.47* 7 1.34 11 3.15* 65 33.08 1.96* 2.32

Urinary bladder 14 1.49 9 2.47* 5 1.81 5 2.66 33 17.67 1.87* 1.12

Kidney parenchyma 12 1.75 6 2.18 2 0.96 3 2.18 23 13.07 1.76* 0.72

Renal pelvis, other urinary 4 3.12 2 4.22 0 0.00 3 12.48* 9 2.35 3.84* 0.48

Ureter 1 2.83 2 15.13* 0 0.00 2 29.54* 5 0.65 7.67* 0.32

Bone, joints 1 1.59 0 0.00 0 0.00 0 0.00 1 1.02 0.98 0.00

Soft tissue including heart 2 0.88 0 0.00 0 0.00 0 0.00 2 3.89 0.51 -0.14

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.02

Melanoma of skin 12 0.78 3 0.61 1 0.31 2 1.06 18 25.42 0.71 -0.54

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 1.15 0.00 -0.08

Brain, central nervous system 3 0.53 2 1.05 1 0.78 2 2.64 8 9.59 0.83 -0.12

Thyroid 7 0.66 1 0.33 0 0.00 0 0.00 8 16.34 0.49* -0.61

Lymphatic, hematopoietic 39 1.24 9 0.78 8 0.95 5 0.92 61 56.85 1.07 0.30

Hodgkin lymphoma 1 0.42 0 0.00 1 3.19 0 0.00 2 3.39 0.59 -0.10

Non-Hodgkin lymphoma 17 1.15 6 1.05 7 1.64 1 0.35 31 27.61 1.12 0.25

Myeloma 5 0.98 0 0.00 0 0.00 1 1.03 6 9.52 0.63 -0.26

Leukemia 16 1.75 3 0.91 0 0.00 3 1.99 22 16.32 1.35 0.41

Acute lymphocytic 1 2.16 1 6.79 0 0.00 0 0.00 2 0.76 2.64 0.09

Chronic lymphocytic 5 1.73 1 0.89 0 0.00 2 3.77 8 5.37 1.49 0.19

Acute non-lymphocytic 4 1.12 1 0.80 0 0.00 1 1.71 6 6.29 0.95 -0.02

Chronic myeloid 2 1.35 0 0.00 0 0.00 0 0.00 2 2.56 0.78 -0.04

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 14,159 6,111 3,699 1,964 14,159

Person-years in interval 92,179 24,158 13,917 7,047 137,300

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE CERVIX UTERI, VAGINA, AND VULVA 221
Vagina

Females

Table 8.2.1: Characteristics of patients with an initial cancer of the vagina, females,

SEER 1973-2000.

222 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

VAGINA

Number of patients with 1st primary cancer

Total — — 1,623 100.0 1,623 100.0

Initial treatment

Any radiation — — 1,061 65.4 1,061 65.4

With surgery — — 272 16.8 272 16.8

Without surgery — — 789 48.6 789 48.6

No radiation — — 562 34.6 562 34.6

With surgery — — 327 20.1 327 20.1

Without surgery — — 235 14.5 235 14.5

Race

White — — 1,299 80.0 1,299 80.0

Black — — 239 14.7 239 14.7

Other — — 76 4.7 76 4.7

Unknown — — 9 0.6 9 0.6

Age at 1st primary cancer diagnosis, years

< 30 — — 81 5.0 81 5.0

30–49 — — 218 13.4 218 13.4

50–69 — — 589 36.3 589 36.3

70–79 — — 385 23.7 385 23.7

> 80 — — 350 21.6 350 21.6

Number of patients with one or more

primary cancers

One primary cancer only — — 1,519 93.6 1,519 93.6

1st and 2nd cancers — — 99 6.1 99 6.1

1st, 2nd, and 3rd cancers — — 5 0.3 5 0.3

1st, 2nd, 3rd, and additional cancers — — 0 0.0 0 0.0

Other statistics

Median age at 1st cancer diagnosis — — 68.2 — 68.2 —

Median year of 1st cancer diagnosis — — 1986.6 — 1986.6 —

Median person-years at risk — — 2.4 — 2.4 —

Percent histologically confirmed*

Both 1st and 2nd cancers — — — 98.1 — 98.1

1st, 2nd, and additional cancers — — — 98.1 — 98.1

1st cancer only — — — 1.0 — 1.0

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Vagina

Females

Table 8.2.2: Risk of subsequent primary cancers after cancer of the vagina, females,

SEER 1973-2000.

VAGINA

All subsequent cancers 10 0.75 40 1.09 31 1.18 28 1.05 109 103.12 1.06 6.78

All excluding same site 10 0.75 40 1.09 31 1.18 28 1.05 109 102.89 1.06 7.04

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.75 0.00 -2.02

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.14

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.44

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.23

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -0.71

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.08

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.17

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.13

Digestive system 1 0.29 10 1.07 7 1.06 10 1.52 28 25.99 1.08 2.31

Esophagus 1 10.65 2 7.83 0 0.00 1 5.36 4 0.72 5.54* 3.78

Stomach 0 0.00 3 3.71 0 0.00 0 0.00 3 2.22 1.35 0.90

Small intestine 0 0.00 1 8.22 0 0.00 0 0.00 1 0.36 2.77 0.74

Colon 0 0.00 1 0.22 6 1.80 1 0.30 8 13.01 0.61 -5.78

Rectum, rectosigmoid junction 0 0.00 1 0.70 0 0.00 5 5.47* 6 3.84 1.56 2.49

Rectum 0 0.00 1 1.08 0 0.00 4 6.61* 5 2.51 1.99 2.87

Anus, anal canal 0 0.00 0 0.00 1 12.38 0 0.00 1 0.31 3.18 0.79

Liver 0 0.00 0 0.00 0 0.00 1 6.32 1 0.57 1.76 0.50

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.66

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.65

Pancreas 0 0.00 1 0.80 0 0.00 1 1.09 2 3.51 0.57 -1.74

Respiratory system 1 0.64 6 1.32 10 2.95* 1 0.27 18 13.20 1.36 5.52

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.17

Larynx 1 18.93 0 0.00 0 0.00 0 0.00 1 0.41 2.42 0.68

Lung, bronchus 0 0.00 6 1.38 10 3.08* 1 0.28 17 12.61 1.35 5.05

Female breast 2 0.56 6 0.60 5 0.70 9 1.23 22 27.95 0.79 -6.85

Female genital system 3 1.76 8 1.71 5 1.60 1 0.33 17 12.53 1.36 5.15

Cervix uteri 1 4.29 1 1.62 2 5.17 0 0.00 4 1.59 2.52 2.78

Corpus uteri 1 1.20 1 0.43 2 1.31 0 0.00 4 6.12 0.65 -2.44

Ovary 0 0.00 4 3.01 0 0.00 0 0.00 4 3.66 1.09 0.40

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.26

Vulva 1 12.45 2 9.23* 1 6.28 1 6.10 5 0.62 8.06* 5.05

Urinary system 0 0.00 4 2.24 1 0.77 5 3.72* 10 5.07 1.97 5.68

Urinary bladder 0 0.00 3 2.78 0 0.00 4 5.04* 7 3.04 2.30 4.56

Kidney parenchyma 0 0.00 1 1.80 0 0.00 0 0.00 1 1.61 0.62 -0.70

Renal pelvis, other urinary 0 0.00 0 0.00 1 9.35 1 9.51 2 0.42 4.77 1.82

Ureter 0 0.00 0 0.00 1 31.19 1 32.31 2 0.13 15.89* 2.16

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.11

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.49

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.06

Melanoma of skin 0 0.00 2 3.13 0 0.00 1 1.93 3 1.85 1.62 1.32

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.16

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.99 0.00 -1.15

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.88 0.00 -1.02

Lymphatic, hematopoietic 3 2.88 2 0.70 1 0.48 1 0.46 7 8.16 0.86 -1.34

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.29

Non-Hodgkin lymphoma 1 2.17 1 0.78 1 1.04 0 0.00 3 3.72 0.81 -0.83

Myeloma 1 4.95 0 0.00 0 0.00 0 0.00 1 1.58 0.63 -0.67

Leukemia 1 2.88 1 1.07 0 0.00 1 1.50 3 2.62 1.15 0.44

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.09

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.01 0.00 -1.16

Acute non-lymphocytic 1 8.36 1 3.11 0 0.00 1 4.15 3 0.92 3.27 2.40

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.42

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,623 1,218 573 335 1,623

Person-years in interval 1,156 3,201 2,191 2,134 8,682

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE CERVIX UTERI, VAGINA, AND VULVA 223
All subsequent cancers 3 0.96 13 1.20 10 0.98 17 1.05 43 40.25 1.07 5.40

All excluding same site 3 0.96 13 1.21 10 0.98 17 1.06 43 40.18 1.07 5.55

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.77 0.00 -1.51

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.07

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.34

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.16

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.49

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.07

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.16

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.04

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.12

Digestive system 1 2.06 2 1.14 2 1.10 6 1.86 11 7.29 1.51 7.30

Esophagus 1 49.29 0 0.00 0 0.00 0 0.00 1 0.27 3.74 1.44

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.52 0.00 -1.03

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.26

Colon 0 0.00 0 0.00 2 2.34 1 0.64 3 3.45 0.87 -0.88

Rectum, rectosigmoid junction 0 0.00 1 3.06 0 0.00 4 8.02* 5 1.23 4.05* 7.41

Rectum 0 0.00 1 4.76 0 0.00 3 9.19* 4 0.80 5.01* 6.29

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.25

Liver 0 0.00 0 0.00 0 0.00 1 11.76 1 0.18 5.63 1.62

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.29

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.28

Pancreas 0 0.00 1 4.46 0 0.00 0 0.00 1 0.98 1.02 0.04

Respiratory system 0 0.00 1 0.69 3 1.99 1 0.40 5 5.86 0.85 -1.69

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.10

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.44

Lung, bronchus 0 0.00 1 0.73 3 2.10 1 0.42 5 5.56 0.90 -1.11

Female breast 0 0.00 2 0.55 3 0.92 5 1.03 10 12.80 0.78 -5.51

Female genital system 2 3.75 5 2.85 2 1.35 1 0.49 10 5.79 1.73 8.28

Cervix uteri 1 11.01 0 0.00 1 4.75 0 0.00 2 0.82 2.45 2.33

Corpus uteri 1 3.72 1 1.11 1 1.33 0 0.00 3 2.94 1.02 0.12

Ovary 0 0.00 3 6.20* 0 0.00 0 0.00 3 1.66 1.80 2.63

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.15

Vulva 0 0.00 1 22.06 0 0.00 1 12.38 2 0.18 10.90* 3.57

Urinary system 0 0.00 0 0.00 0 0.00 3 4.01 3 1.70 1.76 2.55

Urinary bladder 0 0.00 0 0.00 0 0.00 2 4.86 2 0.92 2.18 2.13

Kidney parenchyma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.66 0.00 -1.30

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 18.06 1 0.12 8.07 1.72

Ureter 0 0.00 0 0.00 0 0.00 1 63.41 1 0.03 29.20 1.90

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.08

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.33

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Melanoma of skin 0 0.00 0 0.00 0 0.00 0 0.00 0 0.98 0.00 -1.93

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.11

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.90

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -1.08

Lymphatic, hematopoietic 0 0.00 2 2.96 0 0.00 1 0.84 3 2.74 1.09 0.50

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.26

Non-Hodgkin lymphoma 0 0.00 1 3.07 0 0.00 0 0.00 1 1.34 0.74 -0.68

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.97

Leukemia 0 0.00 1 5.16 0 0.00 1 3.01 2 0.77 2.59 2.41

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.07

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.55

Acute non-lymphocytic 0 0.00 1 14.04 0 0.00 1 8.01 2 0.29 6.99 3.37

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.22

Vagina

Females, <65 Years of Age

Table 8.2.3: Risk of subsequent primary cancers after cancer of the vagina, females,

<65 years of age, SEER 1973-2000.

224 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

VAGINA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 693 585 320 215 693

Person-years in interval 532 1,664 1,309 1,581 5,086

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Vagina

Females, ≥65 Years of Age

Table 8.2.4: Risk of subsequent primary cancers after cancer of the vagina, females,

≥65 years of age, SEER 1973-2000.

VAGINA

All subsequent cancers 7 0.69 27 1.04 21 1.31 11 1.04 66 62.86 1.05 8.73

All excluding same site 7 0.69 27 1.04 21 1.31 11 1.04 66 62.71 1.05 9.16

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.98 0.00 -2.73

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.24

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.59

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.33

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -1.02

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.09

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.18

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.15

Digestive system 0 0.00 8 1.06 5 1.04 4 1.19 17 18.71 0.91 -4.75

Esophagus 0 0.00 2 10.74* 0 0.00 1 12.81 3 0.45 6.61* 7.08

Stomach 0 0.00 3 4.40 0 0.00 0 0.00 3 1.69 1.77 3.64

Small intestine 0 0.00 1 11.04 0 0.00 0 0.00 1 0.23 4.36 2.14

Colon 0 0.00 1 0.26 4 1.62 0 0.00 5 9.57 0.52 -12.70

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 1 2.41 1 2.60 0.38 -4.45

Rectum 0 0.00 0 0.00 0 0.00 1 3.59 1 1.71 0.58 -1.98

Anus, anal canal 0 0.00 0 0.00 1 20.76 0 0.00 1 0.19 5.32 2.26

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -1.08

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -1.18

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -1.16

Pancreas 0 0.00 0 0.00 0 0.00 1 2.13 1 2.54 0.39 -4.27

Respiratory system 1 0.85 5 1.61 7 3.71* 0 0.00 13 7.35 1.77 15.72

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.25

Larynx 1 30.06 0 0.00 0 0.00 0 0.00 1 0.19 5.35 2.26

Lung, bronchus 0 0.00 5 1.68 7 3.86* 0 0.00 12 7.05 1.70 13.77

Female breast 2 0.80 4 0.63 2 0.52 4 1.65 12 15.15 0.79 -8.76

Female genital system 1 0.86 3 1.03 3 1.81 0 0.00 7 6.74 1.04 0.73

Cervix uteri 0 0.00 1 2.91 1 5.66 0 0.00 2 0.77 2.59 3.42

Corpus uteri 0 0.00 0 0.00 1 1.29 0 0.00 1 3.18 0.31 -6.05

Ovary 0 0.00 1 1.19 0 0.00 0 0.00 1 1.99 0.50 -2.76

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.43

Vulva 1 14.86 1 5.84 1 8.70 0 0.00 3 0.44 6.87* 7.13

Urinary system 0 0.00 4 2.92 1 1.15 2 3.35 7 3.37 2.08 10.10

Urinary bladder 0 0.00 3 3.49 0 0.00 2 5.23 5 2.13 2.35 7.99

Kidney parenchyma 0 0.00 1 2.57 0 0.00 0 0.00 1 0.95 1.06 0.15

Renal pelvis, other urinary 0 0.00 0 0.00 1 13.23 0 0.00 1 0.30 3.38 1.96

Ureter 0 0.00 0 0.00 1 43.02 0 0.00 1 0.09 10.91 2.53

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.15

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.71

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.11

Melanoma of skin 0 0.00 2 5.65 0 0.00 1 6.55 3 0.87 3.44 5.92

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.22

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -1.49

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.93

Lymphatic, hematopoietic 3 3.51 0 0.00 1 0.71 0 0.00 4 5.42 0.74 -3.94

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.32

Non-Hodgkin lymphoma 1 2.70 0 0.00 1 1.61 0 0.00 2 2.37 0.84 -1.03

Myeloma 1 5.89 0 0.00 0 0.00 0 0.00 1 1.08 0.92 -0.23

Leukemia 1 3.41 0 0.00 0 0.00 0 0.00 1 1.84 0.54 -2.35

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.12

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.72 0.00 -2.01

Acute non-lymphocytic 1 10.06 0 0.00 0 0.00 0 0.00 1 0.63 1.59 1.03

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.70

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 930 633 253 120 930

Person-years in interval 624 1,537 882 553 3,596

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE CERVIX UTERI, VAGINA, AND VULVA 225
Vulva

Females

Table 8.3.1: Characteristics of patients with an initial cancer of the vulva, females,

SEER 1973-2000.

226 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

VULVA

Number of patients with 1st primary cancer

Total — — 5,571 100.0 5,571 100.0

Initial treatment

Any radiation — — 895 16.1 895 16.1

With surgery — — 616 11.1 616 11.1

Without surgery — — 279 5.0 279 5.0

No radiation — — 4,676 83.9 4,676 83.9

With surgery — — 4,297 77.1 4,297 77.1

Without surgery — — 379 6.8 379 6.8

Race

White — — 4,997 89.7 4,997 89.7

Black — — 358 6.4 358 6.4

Other — — 175 3.1 175 3.1

Unknown — — 41 0.7 41 0.7

Age at 1st primary cancer diagnosis, years

< 30 — — 110 2.0 110 2.0

30–49 — — 876 15.7 876 15.7

50–69 — — 1,703 30.6 1,703 30.6

70–79 — — 1,504 27.0 1,504 27.0

> 80 — — 1,378 24.7 1,378 24.7

Number of patients with one or more

primary cancers

One primary cancer only — — 5,050 90.6 5,050 90.6

1st and 2nd cancers — — 472 8.5 472 8.5

1st, 2nd, and 3rd cancers — — 48 0.9 48 0.9

1st, 2nd, 3rd, and additional cancers — — 1 0.0 1 0.0

Other statistics

Median age at 1st cancer diagnosis — — 70.7 — 70.7 —

Median year of 1st cancer diagnosis — — 1989.0 — 1989.0 —

Median person-years at risk — — 4.5 — 4.5 —

Percent histologically confirmed*

Both 1st and 2nd cancers — — — 95.2 — 95.2

1st, 2nd, and additional cancers — — — 94.6 — 94.6

1st cancer only — — — 4.4 — 4.4

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Vulva

Females

Table 8.3.2: Risk of subsequent primary cancers after cancer of the vulva, females,

SEER 1973-2000.

VULVA

All subsequent cancers 54 1.02 213 1.20* 155 1.14 149 1.24* 571 485.23 1.18* 23.62

All excluding same site 54 1.03 201 1.14 142 1.06 143 1.20* 540 481.98 1.12* 15.98

Buccal cavity, pharynx 2 2.17 5 1.62 8 3.44* 6 3.01* 21 8.32 2.52* 3.49

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.67 0.00 -0.18

Tongue 1 4.96 1 1.49 4 7.78* 1 2.27 7 1.83 3.83* 1.42

Salivary gland 0 0.00 0 0.00 0 0.00 1 4.17 1 0.97 1.03 0.01

Mouth 1 3.04 3 2.75 3 3.64 2 2.81 9 2.96 3.05* 1.66

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.08

Tonsil 0 0.00 1 4.17 0 0.00 0 0.00 1 0.63 1.59 0.10

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 1 7.11 1 8.76 2 0.50 4.00 0.41

Digestive system 13 0.94 45 0.99 37 1.07 37 1.23 132 124.11 1.06 2.17

Esophagus 2 5.77 3 2.59 1 1.12 0 0.00 6 3.21 1.87 0.77

Stomach 1 0.87 2 0.55 3 1.12 1 0.45 7 9.73 0.72 -0.75

Small intestine 0 0.00 1 1.74 2 4.41 0 0.00 3 1.63 1.84 0.38

Colon 6 0.85 20 0.86 22 1.24 17 1.10 65 63.62 1.02 0.38

Rectum, rectosigmoid junction 0 0.00 7 1.01 3 0.58 4 0.94 14 18.44 0.76 -1.22

Rectum 0 0.00 5 1.10 0 0.00 3 1.05 8 12.18 0.66 -1.15

Anus, anal canal 2 12.44* 4 7.40* 1 2.39 5 13.40* 12 1.49 8.04* 2.89

Liver 1 3.70 0 0.00 0 0.00 0 0.00 1 2.51 0.40 -0.41

Gallbladder 0 0.00 1 0.93 1 1.28 1 1.60 3 2.81 1.07 0.05

Bile ducts, other biliary 0 0.00 2 1.97 0 0.00 2 2.68 4 2.86 1.40 0.31

Pancreas 1 0.56 5 0.85 4 0.88 7 1.73 17 16.25 1.05 0.21

Respiratory system 10 1.61 36 1.68* 21 1.23 27 1.68* 94 60.75 1.55* 9.15

Nose, nasal cavity, ear 0 0.00 1 4.08 0 0.00 0 0.00 1 0.67 1.48 0.09

Larynx 1 5.31 1 1.55 2 4.07 2 4.67 6 1.75 3.42* 1.17

Lung, bronchus 9 1.52 34 1.66* 19 1.16 25 1.61* 87 58.17 1.50* 7.94

Female breast 8 0.56 55 1.15 28 0.76 29 0.89 120 131.08 0.92 -3.05

Female genital system 13 2.03* 34 1.61* 29 1.86* 24 1.82* 100 56.36 1.77* 12.02

Cervix uteri 2 2.71 5 2.12 2 1.24 0 0.00 9 5.91 1.52 0.85

Corpus uteri 4 1.27 7 0.67 7 0.91 11 1.70 29 27.76 1.04 0.34

Ovary 7 3.72* 6 0.96 5 1.05 3 0.73 21 17.03 1.23 1.09

Vagina 0 0.00 4 10.90* 0 0.00 2 8.74 6 0.98 6.12* 1.38

Vulva 0 0.00 12 10.26* 13 14.45* 6 7.32* 31 3.25 9.54* 7.64

Urinary system 1 0.38 6 0.68 4 0.58 5 0.81 16 24.55 0.65 -2.35

Urinary bladder 1 0.61 3 0.55 1 0.24 1 0.27 6 15.04 0.40* -2.49

Kidney parenchyma 0 0.00 1 0.38 1 0.48 3 1.55 5 7.45 0.67 -0.67

Renal pelvis, other urinary 0 0.00 2 2.63 2 3.47 1 2.00 5 2.07 2.42 0.81

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -0.18

Bone, joints 0 0.00 1 6.08 0 0.00 0 0.00 1 0.44 2.29 0.15

Soft tissue including heart 0 0.00 0 0.00 1 1.84 0 0.00 1 1.96 0.51 -0.27

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.07

Melanoma of skin 1 1.03 8 2.42* 6 2.32 1 0.42 16 9.24 1.73 1.86

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.69 0.00 -0.19

Brain, central nervous system 0 0.00 4 2.34 2 1.54 0 0.00 6 4.64 1.29 0.37

Thyroid 0 0.00 1 0.70 0 0.00 1 1.13 2 3.77 0.53 -0.49

Lymphatic, hematopoietic 3 0.70 14 0.98 12 1.09 14 1.41 43 39.50 1.09 0.96

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 1 4.14 1 1.08 0.92 -0.02

Non-Hodgkin lymphoma 3 1.53 8 1.20 6 1.15 8 1.66 25 18.67 1.34 1.74

Myeloma 0 0.00 4 1.65 2 1.07 3 1.79 9 6.70 1.34 0.63

Leukemia 0 0.00 2 0.42 4 1.10 2 0.62 8 13.05 0.61 -1.39

Acute lymphocytic 0 0.00 0 0.00 1 9.96 0 0.00 1 0.36 2.76 0.18

Chronic lymphocytic 0 0.00 0 0.00 3 2.13 1 0.81 4 5.05 0.79 -0.29

Acute non-lymphocytic 0 0.00 2 1.21 0 0.00 1 0.89 3 4.53 0.66 -0.42

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.81 0.00 -0.50

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,571 4,646 2,662 1,444 5,571

Person-years in interval 4,203 13,909 10,028 8,178 36,318

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE CERVIX UTERI, VAGINA, AND VULVA 227
All subsequent cancers 8 2.24 33 2.07* 36 2.01* 51 1.57* 128 69.87 1.83* 50.41

All excluding same site 8 2.25 32 2.01* 33 1.85* 49 1.52* 122 69.55 1.75* 45.48

Buccal cavity, pharynx 1 15.32 2 6.51 3 8.45* 6 10.35* 12 1.31 9.18* 9.27

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.05

Tongue 1 68.93 0 0.00 1 12.09 1 7.52 3 0.30 10.00* 2.34

Salivary gland 0 0.00 0 0.00 0 0.00 1 15.42 1 0.15 6.52 0.73

Mouth 0 0.00 1 10.79 1 9.01 2 10.97* 4 0.41 9.87* 3.12

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.05

Tonsil 0 0.00 1 26.82 0 0.00 0 0.00 1 0.15 6.65 0.74

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.03

Hypopharynx 0 0.00 0 0.00 1 36.74 1 21.94 2 0.10 20.09* 1.65

Digestive system 1 2.69 3 1.62 3 1.25 10 1.83 17 10.10 1.68 5.99

Esophagus 0 0.00 0 0.00 1 10.19 0 0.00 1 0.38 2.62 0.54

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.71 0.00 -0.61

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.19

Colon 0 0.00 1 1.23 2 1.85 3 1.18 6 4.60 1.30 1.21

Rectum, rectosigmoid junction 0 0.00 1 2.67 0 0.00 2 2.17 3 1.84 1.63 1.01

Rectum 0 0.00 1 4.11 0 0.00 1 1.65 2 1.20 1.66 0.69

Anus, anal canal 1 89.45* 1 19.57 0 0.00 3 28.42* 5 0.23 22.02* 4.14

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.23

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.17

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.17

Pancreas 0 0.00 0 0.00 0 0.00 2 2.71 2 1.28 1.56 0.62

Respiratory system 1 3.24 7 4.33* 6 2.72 10 2.00 24 9.13 2.63* 12.90

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.08

Larynx 0 0.00 1 11.67 1 9.44 2 10.88* 4 0.39 10.18* 3.13

Lung, bronchus 1 3.50 6 3.99* 5 2.41 8 1.68 20 8.62 2.32* 9.87

Female breast 2 1.36 14 2.20* 6 0.89 11 1.02 33 25.33 1.30 6.65

Female genital system 3 4.81 3 1.11 6 2.12 8 1.81 20 10.59 1.89* 8.16

Cervix uteri 2 12.19* 0 0.00 0 0.00 0 0.00 2 1.84 1.09 0.14

Corpus uteri 0 0.00 0 0.00 1 0.76 1 0.44 2 4.98 0.40 -2.59

Ovary 1 5.48 1 1.26 0 0.00 2 1.51 4 3.14 1.27 0.75

Vagina 0 0.00 1 38.78 0 0.00 1 18.33 2 0.12 17.20* 1.63

Vulva 0 0.00 1 13.34 3 38.51* 2 13.71* 6 0.32 18.93* 4.93

Urinary system 0 0.00 1 2.08 1 1.61 2 1.44 4 2.59 1.55 1.22

Urinary bladder 0 0.00 0 0.00 1 3.29 0 0.00 1 1.30 0.77 -0.26

Kidney parenchyma 0 0.00 0 0.00 0 0.00 2 3.49 2 1.13 1.77 0.76

Renal pelvis, other urinary 0 0.00 1 36.77 0 0.00 0 0.00 1 0.16 6.25 0.73

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.03

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.07

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.28

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Melanoma of skin 0 0.00 1 1.48 4 6.46* 0 0.00 5 2.29 2.18 2.35

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.09

Brain, central nervous system 0 0.00 2 9.40* 2 9.21* 0 0.00 4 0.83 4.83* 2.75

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.38 0.00 -1.20

Lymphatic, hematopoietic 0 0.00 0 0.00 2 1.90 3 1.38 5 4.34 1.15 0.58

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.23

Non-Hodgkin lymphoma 0 0.00 0 0.00 1 1.87 2 1.80 3 2.20 1.37 0.70

Myeloma 0 0.00 0 0.00 1 6.12 1 2.59 2 0.69 2.89 1.13

Leukemia 0 0.00 0 0.00 0 0.00 0 0.00 0 1.18 0.00 -1.03

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.05

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.33

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.40

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.17

Vulva

Females, <55 Years of Age

Table 8.3.3: Risk of subsequent primary cancers after cancer of the vulva, females,

<55 years of age, SEER 1973-2000.

228 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

VULVA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,306 1,182 779 507 1,306

Person-years in interval 1,031 3,853 3,168 3,480 11,532

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Vulva

Females, ≥55 Years of Age

Table 8.3.4: Risk of subsequent primary cancers after cancer of the vulva, females,

≥55 years of age, SEER 1973-2000.

VULVA

All subsequent cancers 46 0.93 180 1.12 119 1.01 98 1.12 443 415.37 1.07 11.15

All excluding same site 46 0.94 169 1.06 109 0.93 94 1.08 418 412.43 1.01 2.25

Buccal cavity, pharynx 1 1.17 3 1.08 5 2.54 0 0.00 9 7.02 1.28 0.80

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.25

Tongue 0 0.00 1 1.66 3 6.95* 0 0.00 4 1.53 2.62 1.00

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.82 0.00 -0.33

Mouth 1 3.23 2 2.00 2 2.81 0 0.00 5 2.55 1.96 0.99

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.10

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.19

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.16

Digestive system 12 0.89 42 0.96 34 1.06 27 1.10 115 114.01 1.01 0.40

Esophagus 2 5.99 3 2.76 0 0.00 0 0.00 5 2.83 1.77 0.88

Stomach 1 0.90 2 0.57 3 1.19 1 0.54 7 9.03 0.78 -0.82

Small intestine 0 0.00 1 1.89 2 5.00 0 0.00 3 1.41 2.13 0.64

Colon 6 0.87 19 0.85 20 1.20 14 1.08 59 59.02 1.00 -0.01

Rectum, rectosigmoid junction 0 0.00 6 0.92 3 0.64 2 0.60 11 16.60 0.66 -2.26

Rectum 0 0.00 4 0.93 0 0.00 2 0.89 6 10.98 0.55 -2.01

Anus, anal canal 1 6.68 3 6.13* 1 2.79 2 7.48 7 1.27 5.53* 2.31

Liver 1 3.83 0 0.00 0 0.00 0 0.00 1 2.25 0.45 -0.50

Gallbladder 0 0.00 1 0.96 1 1.36 1 1.93 3 2.62 1.14 0.15

Bile ducts, other biliary 0 0.00 2 2.04 0 0.00 2 3.17 4 2.66 1.50 0.54

Pancreas 1 0.57 5 0.88 4 0.94 5 1.51 15 14.97 1.00 0.01

Respiratory system 9 1.53 29 1.46 15 1.01 17 1.53 70 51.63 1.36* 7.41

Nose, nasal cavity, ear 0 0.00 1 4.44 0 0.00 0 0.00 1 0.59 1.70 0.17

Larynx 1 5.85 0 0.00 1 2.59 0 0.00 2 1.36 1.47 0.26

Lung, bronchus 8 1.42 28 1.48 14 0.98 17 1.59 67 49.54 1.35* 7.04

Female breast 6 0.47 41 0.99 22 0.73 18 0.83 87 105.75 0.82 -7.57

Female genital system 10 1.73 31 1.68* 23 1.80* 16 1.83* 80 45.77 1.75* 13.81

Cervix uteri 0 0.00 5 2.87 2 1.81 0 0.00 7 4.07 1.72 1.18

Corpus uteri 4 1.37 7 0.75 6 0.94 10 2.38* 27 22.78 1.19 1.70

Ovary 6 3.54* 5 0.91 5 1.28 1 0.36 17 13.89 1.22 1.25

Vagina 0 0.00 3 8.79* 0 0.00 1 5.74 4 0.86 4.63* 1.26

Vulva 0 0.00 11 10.05* 10 12.17* 4 5.94* 25 2.93 8.53* 8.90

Urinary system 1 0.39 5 0.60 3 0.48 3 0.62 12 21.96 0.55* -4.02

Urinary bladder 1 0.62 3 0.57 0 0.00* 1 0.33 5 13.74 0.36* -3.52

Kidney parenchyma 0 0.00 1 0.41 1 0.56 1 0.73 3 6.32 0.47 -1.34

Renal pelvis, other urinary 0 0.00 1 1.36 2 3.71 1 2.44 4 1.91 2.09 0.84

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.24

Bone, joints 0 0.00 1 7.10 0 0.00 0 0.00 1 0.35 2.82 0.26

Soft tissue including heart 0 0.00 0 0.00 1 2.16 0 0.00 1 1.65 0.61 -0.26

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.10

Melanoma of skin 1 1.25 7 2.66* 2 1.02 1 0.64 11 6.95 1.58 1.63

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.24

Brain, central nervous system 0 0.00 2 1.34 0 0.00 0 0.00 2 3.82 0.52 -0.73

Thyroid 0 0.00 1 1.02 0 0.00 1 2.25 2 2.39 0.84 -0.16

Lymphatic, hematopoietic 3 0.74 14 1.05 10 1.00 11 1.41 38 35.16 1.08 1.14

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 1 6.32 1 0.82 1.22 0.07

Non-Hodgkin lymphoma 3 1.61 8 1.29 5 1.07 6 1.61 22 16.47 1.34 2.23

Myeloma 0 0.00 4 1.73 1 0.59 2 1.55 7 6.01 1.16 0.40

Leukemia 0 0.00 2 0.44 4 1.20 2 0.76 8 11.87 0.67 -1.56

Acute lymphocytic 0 0.00 0 0.00 1 11.85 0 0.00 1 0.30 3.32 0.28

Chronic lymphocytic 0 0.00 0 0.00 3 2.27 1 0.98 4 4.67 0.86 -0.27

Acute non-lymphocytic 0 0.00 2 1.30 0 0.00 1 1.10 3 4.07 0.74 -0.43

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.61 0.00 -0.65

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,265 3,464 1,883 937 4,265

Person-years in interval 3,172 10,055 6,861 4,698 24,786

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE CERVIX UTERI, VAGINA, AND VULVA 229

NEW MALIGNANCIES FOLLOWING CANCER OF THE UTERINE CORPUS AND OVARY 231

Synopsis

The risk of subsequent primary cancers was evaluated

in more than 115,000 women diagnosed with cancer

of the uterine corpus (UCC) or cancer of the ovary

between 1973 and 2000. The overall risk of subsequent

primary cancers outside the female genital tract was

significantly increased among survivors of ovarian

cancer (O/E=1.18,1 O=2,091, EAR=15 per 10,000 personyears) but not of UCC (O/E=0.99,1 O=8,409). Overall,

nongenital cancer risk did not increase over time

among UCC patients, but it rose to 31% among those

surviving 5 years or more after ovarian cancer diagnosis. Excess new malignancies of the colon, rectum,

urinary bladder, and breast were associated with both

gynecologic cancer sites. Hormonal and dietary factors,

as well as genetic predisposition, may have contributed

to the elevated risks of cancers of the breast and colon.

In particular, BRCA1/2 susceptibility genes are

involved in hereditary forms of breast and ovarian cancer. In addition, UCC and ovarian cancers are associated with hereditary nonpolyposis colorectal cancer,

which may explain the excess of colorectal cancer

among younger gynecologic patients and also account

for some of the excess cancers of the small intestine,

renal pelvis, and biliary tract among ovarian cancer

patients. Radiotherapy may have also contributed to the

observed excess of certain solid tumors following UCC

and ovarian cancers, particularly sarcomas, and cancers

of the urinary bladder and colon, as well as rectal cancer following UCC. While the excess of acute leukemia

following UCC appeared to be related to radiotherapy,

the elevated risks after ovarian cancer were more likely

due to chemotherapy regimens that include alkylating

agents or platinum compounds. Ovarian cancer was

also associated with other new malignancies, including

ocular melanoma. Further studies are needed to untangle the genetic and other risk factors linking colorectal

cancer to both gynecologic tumors and to clarify the

relation of ovarian cancer to less common tumors,

such as cancers of the biliary tract and ocular

melanoma.

Uterine Corpus Cancer

Uterine corpus cancer (UCC) is the fourth most common cancer among U.S. women, accounting for about

6% of incident cancers and 2.7% of cancer deaths

among females (Jemal et al, 2005). The relative survival

rate is 87.0% at 5 years (83.0% at 10 years) among

white females but only 64.7% at 5 years among black

females, reflecting racial disparities in the stage of

disease at the time of diagnosis. Because most women

(91%) are treated surgically with removal of the uterus,

cervix, ovaries, and fallopian tubes (Rose, 1996), few

remain at risk to develop subsequent cancers of the

female genital tract. Adjuvant radiotherapy to the

pelvis is given to 35% of patients, while primary radiotherapy is administered to a much smaller percentage

of cases, usually those considered at high risk of surgical complications. 

Most of the established risk factors for UCC involve

sustained estrogen stimulation of the endometrium,

including estrogen replacement therapy, nulliparity,

late menopause, and obesity (Hulka, 1997; Brinton and

Hoover, 2000). Some, but not all, studies have reported

a positive relation to socioeconomic status, diabetes,

and hypertension, and an inverse relation to cigarette

smoking (Hulka, 1997; Brinton and Hoover, 2000).

Results and Discussion 

The overall risk of subsequent primary cancers was

not increased at any time among the 74,185 women

who survived 2 months or more following a diagnosis of

UCC (O/E= 0.99 excluding female genital sites, O=8,409,

95% CI=0.97-1.01). The cumulative incidence of developing a second cancer following uterine cancer, adjusting

for the competing risk of death due to other causes, was

17.5% at 25 years, 95% CI=17.1%-17.9% (Figure 9.1).

The risk of developing a new malignancy (including

2nd, 3rd, and 4th cancers), however, varied significantly by age at diagnosis, race, and subsequent cancer

site athough not substantially by histologic type of

UCC (leiomyosarcomas, other sarcomas, carcinomas).

Elevated risks were limited to younger women (25%

excess for women diagnosed at younger than 50 years

of age, and 47% for those diagnosed at younger than

40 years), while black women (O/E=1.27, EAR=29

per 10,000 person-years) had a higher risk of new

UTERINE CORPUS AND OVARY

Chapter 9

New Malignancies Following

Cancer of the Uterine Corpus and Ovary

D. Michal Freedman, Rochelle E. Curtis, Lois B. Travis, Joseph F. Fraumeni Jr.

1Observed-to-expected ratios of subsequent primary cancers

following cancers of the UCC and ovary exclude new cancers of

the female genital sites.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated

as [(O-E)/PYR]10,000).

Author affiliations: D. Michal Freedman, Rochelle E. Curtis, Lois B.

Travis, and Joseph F. Fraumeni Jr., Division of Cancer Epidemiology

and Genetics, NCI, NIH, DHHS.
malignancies than white women (O/E=0.98). There

were significantly increased risks for subsequent

cancers of the small intestine, colon, urinary bladder,

breast, vagina, and soft tissue, as well as for acute

leukemia. Also noteworthy was a 64% nonsignificant

higher risk for bone cancer after uterine cancer and

a small (12%), but borderline significant, risk for subsequent rectal cancer. Significant deficits were seen

for new malignancies of the buccal cavity, esophagus,

and respiratory system, as well as for chronic lymphocytic leukemia. Our findings are consistent with

previous surveys of UCC revealing elevated risks

for subsequent cancers of the colon, urinary bladder,

and breast, as well as for leukemia (Annegers and

Malkasian, 1981; Curtis et al, 1985, 1994; Schwartz et

al, 1985; Storm and Ewertz, 1985; Schoen et al, 1994;

Bergfeldt et al, 1995; Re et al, 1997; Zimmerman and

Westhoff, 1999).

Subsequent breast and colon cancers were the

2 most frequent cancers after a diagnosis of UCC.

While the underlying mechanisms are unclear, it has

been shown that endometrial, ovarian, and breast cancers have many similar reproductive and menstrual

risk factors (Schottenfeld, 1996; Brinton and Hoover,

2000; McPherson et al, 2000). Hormonal factors may

also play a role in subsequent colon cancers; however,

while hormone replacement therapy increases the risk

of breast cancer and UCC, it appears to lower the risk

of colon cancer (Potter, 1999). A number of studies also

suggest that obesity and physical inactivity increase

the risk of UCC, colon cancer, and postmenopausal

breast cancer (Potter, 1999; Brinton and Hoover, 2000;

Willett, 2001). In addition, we found a reciprocal significantly increased risk for UCC following both

breast and colon cancer, providing further evidence

of shared risk factors with UCC. Radiotherapy probably contributed to the elevated risk of colon cancer

(UNSCEAR, 2000), particularly because the excess in

our study seemed limited to women who received

radiotherapy in the initial regimen.

The risks of subsequent breast and colon cancers

varied by age at UCC diagnosis. While breast cancer

risks were highest in the oldest age groups, the

increase in colon cancer was limited to women

younger than 50 years at UCC diagnosis (a nearly

4-fold risk increase, rising to 7-fold among women

younger than 40 years). This tendency to early onset

of multiple primary cancers is characteristic of

genetic syndromes such as hereditary nonpolyposis

colorectal cancer, which encompasses endometrial

and certain other extracolonic cancers (Lynch et al,

1991; Weinberg et al, 1999). This syndrome may provide insights into the increased risk we observed for

small intestinal cancer after UCC and for the 3-fold

excess of rectal cancer among women younger than

50 years of age.

It seems likely that radiotherapy contributed to

the elevated risks observed for subsequent acute

non-lymphocytic leukemia (ANLL) and cancers of

the rectum, urinary bladder, bone, and soft tissue,

particularly because the excesses were noted primarily

among women who received radiotherapy in the initial treatment regimen (Boice et al, 1988; UNSCEAR,

2000). For example, a large majority of new soft tissue

and bone sarcomas diagnosed among UCC survivors

receiving initial radiotherapy occurred in the irradiated

pelvic fields. The excesses of rectal and urinary bladder cancer in our study are interesting in view of the

dose-dependent excesses of urinary bladder and

rectal cancers previously reported following comparable pelvic radiotherapy for cervical cancer (Boice et al,

1988). Similarly, the increased risk for acute leukemia

in our study is consistent with the radiogenic effects

described in an international survey of patients with

UCC (Curtis et al, 1994). Although the temporal

sequence of these new malignancies was generally

consistent with the latency periods of radiogenic cancers, there was some excess risk of solid tumors in the

first 5 years of follow-up, suggesting that heightened

medical surveillance may have played some role.

The reduced risk of new malignancies of the buccal

cavity and lung is noteworthy in view of reports suggesting that cigarette smoking may lower the risk of

UCC (Brinton and Hoover, 2000), perhaps through its

inhibition of ovarian function and relation to early

menopause. Significant excesses of new malignancies

of the vagina and ovary within the first year of followup are likely to reflect uncertainties in the diagnosis of

the primary or subsequent tumor, although heightened

gynecologic surveillance may improve cancer detection.

The deficit in chronic lymphocytic leukemia among

survivors of UCC was seen with other first primary

cancer sites and could be related to earlier detection

during the first 2 months of follow-up and thus

excluded from this analysis. 

232 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

UTERINE CORPUS AND OVARY

Years after initial cancer diagnosis

Cumulative incidence (%)

0

5

10

15

20

0 5 10 15 20 25

All second cancers

Female breast 

Colon

Bladder

Figure 9.1: Cumulative incidence of developing a second

cancer among patients with cancer of the corpus uteri,

females, SEER 1973-2000.
NEW MALIGNANCIES FOLLOWING CANCER OF THE UTERINE CORPUS AND OVARY 233

Ovarian Cancer

UTERINE CORPUS AND OVARY

Ovarian cancer, while accounting for only 3% of female

malignancies, is the leading cause of gynecologic cancer

death and the fourth most common cause of cancer

mortality in women (Jemal et al, 2005). Because most

patients present with late-stage disease, the 5-year relative survival rate is only 43.9% (excluding borderline

ovarian tumors). Treatment for ovarian cancer typically

includes surgery (including removal of most genital

tract organs), followed by chemotherapy, depending on

disease stage (Cannistra, 1993); less than 10% of patients

also receive radiotherapy during the first course of

treatment. 

Several factors increase the risk of ovarian cancer,

including nulliparity, antecedent breast cancer, and a

family history of ovarian cancer. Total years of ovulation, use of fertility drugs, using talc on the perineum,

and high dietary fat or lactose intake have also been

implicated in some, but not all, studies. In addition, a

reduced risk has been reported with oral contraceptive

use, tubal ligation, and hysterectomy (Hulka, 1997;

Brinton and Hoover, 2000). 

Results and Discussion

A total of 2,091 subsequent nongenital primary cancers

were observed among 41,489 2-month survivors of ovarian cancer (O/E=1.18 excluding female genital sites, 95%

CI=1.13-1.23, EAR=15). The cumulative incidence of second cancer, adjusted for the competing risk of death due

to other causes, was 9.4% within 25 years (95% CI=8.9%-

9.9%). Subsequent primary cancer risk was low during

the first 5 years of follow-up, but rose to a 31% excess

among those surviving 5 years or more. Excluding

female genital sites, overall subsequent cancer risk was

higher in blacks (O/E=1.42, EAR=29) than whites

(O/E=1.16, EAR=14). Women younger than age 50 years

at ovarian cancer diagnosis had a 58% increased risk of

new malignancies, whereas risk declined to below unity

among patients diagnosed at ages older than 70 years.

Most of the overall excess was attributable to significantly increased risks for acute leukemia, as well as for cancers of the breast, colon, rectum, small intestine, bladder,

renal pelvis, eye, and intrahepatic bile ducts. Significant

deficits were noted only for cancers of the female genital

tract, due to surgical removal of those organs. The findings are generally consistent with prior studies of ovarian cancer, which have shown significantly increased

risks for acute leukemia and for cancers of the breast,

colon, rectum, and urinary bladder (Reimer et al, 1978;

Curtis et al, 1985; Storm and Ewertz, 1985; Coleman

et al, 1987; Kaldor et al, 1987; Prior and Pope, 1989;

Bergfeldt et al, 1995; Travis et al, 1996).

As observed for UCC, breast and colon cancers were

the most common new malignancies. Subsequent primary breast cancer excesses were strongly related to age

at initial ovarian cancer diagnosis, with the largest

increase in risk (27%) among women diagnosed before

age 50 years. The findings are consistent with genetic

susceptibility, as hereditary breast and ovarian cancer

tend to affect younger women as a result of germline

mutations in the BRCA1/2 genes (Li and Karlan, 2001).

The role of genetic factors is also consistent with the

reciprocal 2-fold increased risk of ovarian cancer following early-onset breast cancer. Among women diagnosed

with ovarian cancer at ages younger than 50 years, there

was a rapid decline in breast cancer risk 5 years or more

after initial surgery, probably caused by therapeutic ablation of gonadal function. Older patients with ovarian

cancer (diagnosed at age ≥50 years) had only a small

(4%) nonsignificant increased risk of subsequent breast

cancer, with the excesses attributable to women between

the ages of 50 and 69 years. The association between

breast and ovarian cancer at least partly reflects shared

reproductive factors, which also may contribute to the

reciprocal 27% increased risk for ovarian neoplasms seen

after breast cancer in our survey. 

Breast cancer risks varied somewhat by histologic

type, with highest, nonsignificant risks after endometrioid tumors of the ovary, although confidence intervals

overlapped with those of other histologic types. There is

some evidence that distinct histologic types may be

associated with different risk factors, including family

cancer history (Travis et al, 1996).

The increased risk for subsequent primary colon cancer

may also reflect shared risk factors with ovarian cancer,

including nutritional, hormonal, and genetic influences

(Weinberg et al, 1999). The early onset of ovarian cancer

was a strong predictor of increased colon cancer risk, with

3-fold increased risks for women younger than age 50

years at ovarian cancer diagnosis, and 4-fold for those

younger than age 35 years. It is noteworthy that subsequent endometrial and ovarian cancers have been associated with hereditary nonpolyposis colorectal cancer,

a syndrome that may also contribute to the 2- to 3-fold

excesses we observed for new malignancies of the small

intestine, bile ducts, and renal pelvis (Lynch et al, 1991).

The role of genetic factors is further suggested by the

reciprocal 6-fold increase in ovarian cancer risk among

colon cancer patients diagnosed at younger than age 40

years. Excesses of colon cancer also have been reported in

some studies of familial breast/ovarian cancer, as well as

in individuals with BRCA1 mutations, although the

results have not been consistent (Ford et al, 1994). In addition, radiation may have contributed to excess colon cancers, as risks were particularly high in women surviving

10 years or more who had received initial radiotherapy.

The possibility exists, however, that some subsequent

intestinal cancers following ovarian cancer may represent

misclassified metastases (Bergfeldt et al, 2000).

Similar genetic and other risk factors may contribute

to the excess of subsequent primary rectal cancers,

although interpretation is limited by small numbers.

However, no differential risk was seen between women

with and without radiotherapy during initial treatment

of their ovarian cancer, in contrast to the excess of rectal

cancer linked to pelvic radiotherapy for cervical cancer

(Boice et al, 1988).
The increased risks of subsequent primary urinary

bladder, soft tissue, and bone cancers after ovarian cancer appeared related to treatment. Risk of urinary bladder cancer was substantially higher among irradiated

patients, with 3- to 4-fold increases in risk observed

10 years or more after initial treatment. This finding

resembles an earlier study revealing a radiation-related

excess of bladder cancer following ovarian cancer

(Kaldor et al, 1995). Chemotherapy may have played a

role also, since some patients in earlier years probably

received long-term treatment with cyclophosphamide,

a known bladder carcinogen (Kaldor et al, 1995; Travis

et al, 1995). Excess risks for soft tissue and bone cancers

were seen only among irradiated women, with 5 of the

7 sarcomas arising within the radiation field. 

A significantly increased risk of subsequent primary

acute leukemia, including non-lymphocytic and lymphocytic types, occurred within the first 10 years after

diagnosis of ovarian cancer. Previous analytic studies of

ovarian cancer have attributed these risks primarily to

treatment with alkylating agents (especially melphalan

and chlorambucil) and platinum-based chemotherapy

(Kaldor et al, 1990; Travis et al, 1999).

Increased risks were also noted for subsequent primary ocular melanoma (the most common form of eye

cancer in adults). Reports of this tumor in families with

hereditary breast and ovarian cancer suggest the role of

genetic factors (Houlston and Damato, 1999), although

endogenous hormones may be involved as well (Hartge

et al, 1989). 

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NEW MALIGNANCIES FOLLOWING CANCER OF THE UTERINE CORPUS AND OVARY 235

UTERINE CORPUS AND OVARY
Corpus Uteri

Females

Table 9.1.1: Characteristics of patients with an initial cancer of the corpus uteri, females,

SEER 1973-2000.

236 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CORPUS UTERI

Number of patients with 1st primary cancer

Total — — 74,185 100.0 74,185 100.0

Initial treatment

Any radiation — — 29,629 39.9 29,629 39.9

With surgery — — 26,161 35.3 26,161 35.3

Without surgery — — 3,468 4.7 3,468 4.7

No radiation — — 44,556 60.1 44,556 60.1

With surgery — — 41,162 55.5 41,162 55.5

Without surgery — — 3,394 4.6 3,394 4.6

Race

White — — 66,697 89.9 66,697 89.9

Black — — 3,607 4.9 3,607 4.9

Other — — 3,556 4.8 3,556 4.8

Unknown — — 325 0.4 325 0.4

Age at 1st primary cancer diagnosis, years

< 30 — — 304 0.4 304 0.4

30–49 — — 8,864 11.9 8,864 11.9

50–69 — — 42,589 57.4 42,589 57.4

70–79 — — 16,203 21.8 16,203 21.8

> 80 — — 6,225 8.4 6,225 8.4

Number of patients with one or more

primary cancers

One primary cancer only — — 66,199 89.2 66,199 89.2

1st and 2nd cancers — — 7,253 9.8 7,253 9.8

1st, 2nd, and 3rd cancers — — 673 0.9 673 0.9

1st, 2nd, 3rd, and additional cancers — — 60 0.1 60 0.1

Other statistics

Median age at 1st cancer diagnosis — — 63.7 — 63.7 —

Median year of 1st cancer diagnosis — — 1986.8 — 1986.8 —

Median person-years at risk — — 7.7 — 7.7 —

Percent histologically confirmed*

Both 1st and 2nd cancers — — — 95.9 — 95.9

1st, 2nd, and additional cancers — — — 95.5 — 95.5

1st cancer only — — — 4.0 — 4.0

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Corpus Uteri

Females

Table 9.1.2: Risk of subsequent primary cancers after cancer of the corpus uteri, females,

SEER 1973-2000.

CORPUS UTERI

All subsequent cancers 699 1.07 2,421 0.93* 2,347 0.91* 3,324 0.86* 8,791 9,695.69 0.91* -12.83

All excluding same site 542 0.97 2,326 1.03 2,289 1.01 3,252 0.95* 8,409 8,485.35 0.99 -1.08

Buccal cavity, pharynx 6 0.48 24 0.48* 39 0.82 54 0.83 123 174.30 0.71* -0.73

Lip 0 0.00 3 0.99 5 1.59 9 1.76 17 12.05 1.41 0.07

Tongue 1 0.37 7 0.64 7 0.67 11 0.77 26 38.34 0.68* -0.18

Salivary gland 2 1.56 1 0.20 6 1.23 3 0.41 12 18.53 0.65 -0.09

Mouth 2 0.47 8 0.47* 9 0.55 18 0.78 37 60.99 0.61* -0.34

Nasopharynx 0 0.00 2 1.00 2 1.09 1 0.43 5 6.70 0.75 -0.02

Tonsil 0 0.00 2 0.43 3 0.72 4 0.84 9 14.86 0.61 -0.08

Oropharynx 1 3.09 0 0.00 2 1.58 2 1.32 5 4.42 1.13 0.01

Hypopharynx 0 0.00 0 0.00 3 0.88 4 0.98 7 12.03 0.58 -0.07

Digestive system 133 0.92 626 1.07 623 1.05 969 1.04 2,351 2,251.37 1.04* 1.41

Esophagus 5 1.23 15 0.92 4 0.25* 13 0.52* 37 61.46 0.60* -0.35

Stomach 8 0.71 38 0.87 39 0.89 57 0.85 142 165.68 0.86 -0.34

Small intestine 7 3.49* 8 0.99 17 2.06* 18 1.32 50 31.95 1.56* 0.26

Colon 56 0.78 344 1.19* 351 1.17* 520 1.09* 1,271 1,135.40 1.12* 1.92

Rectum, rectosigmoid junction 19 0.79 93 0.96 109 1.15 148 1.09 369 351.72 1.05 0.25

Rectum 16 1.02 65 1.04 69 1.12 109 1.21 259 230.31 1.12 0.41

Anus, anal canal 0 0.00 3 0.37 5 0.63 11 0.93 19 29.78 0.64* -0.15

Liver 2 0.68 11 0.92 7 0.57 16 0.76 36 48.16 0.75 -0.17

Gallbladder 5 1.48 10 0.75 8 0.60 14 0.72 37 49.54 0.75 -0.18

Bile ducts, other biliary 7 2.36 10 0.83 15 1.17 22 0.96 54 50.77 1.06 0.05

Pancreas 17 0.91 79 1.05 57 0.73* 133 1.06 286 297.58 0.96 -0.16

Respiratory system 54 0.64* 314 0.90 304 0.84* 419 0.75* 1,091 1,356.45 0.80* -3.77

Nose, nasal cavity, ear 1 1.12 5 1.41 6 1.70 4 0.75 16 13.30 1.20 0.04

Larynx 0 0.00 4 0.33* 3 0.26* 14 0.98 21 40.82 0.51* -0.28

Lung, bronchus 53 0.66* 304 0.91 294 0.85* 400 0.74* 1,051 1,298.94 0.81* -3.52

Female breast 217 1.15* 802 1.07 824 1.13* 973 0.93* 2,816 2,709.68 1.04* 1.51

Female genital system 157 1.68* 95 0.26* 58 0.18* 72 0.17* 382 1,210.34 0.32* -11.75

Cervix uteri 7 0.66 4 0.10* 5 0.16* 3 0.09* 19 112.95 0.17* -1.33

Corpus uteri 9 0.18* 3 0.02* 3 0.02* 7 0.03* 22 638.59 0.03* -8.75

Ovary 124 4.78* 47 0.46* 23 0.24* 18 0.14* 212 357.89 0.59* -2.07

Vagina 7 5.61* 16 3.25* 10 2.10* 17 2.45* 50 17.85 2.80* 0.46

Vulva 3 0.85 19 1.33 17 1.16 25 1.02 64 56.93 1.12 0.10

Urinary system 41 1.36 163 1.33* 131 1.04 255 1.28* 590 477.46 1.24* 1.60

Urinary bladder 22 1.24 105 1.46* 94 1.26* 183 1.53* 404 283.64 1.42* 1.71

Kidney parenchyma 18 1.82* 45 1.12 27 0.66* 45 0.71* 135 153.97 0.88 -0.27

Renal pelvis, other urinary 1 0.39 13 1.26 10 0.95 27 1.64* 51 39.86 1.28 0.16

Ureter 0 0.00 4 1.25 2 0.60 10 1.97 16 12.38 1.29 0.05

Bone, joints 1 1.62 4 1.65 6 2.63 3 0.93 14 8.54 1.64 0.08

Soft tissue including heart 0 0.00 18 1.83* 16 1.66 18 1.19 52 37.08 1.40* 0.21

Kaposi sarcoma 1 5.04 2 2.45 0 0.00 1 0.63 4 3.51 1.14 0.01

Melanoma of skin 12 0.96 59 1.17 44 0.91 74 1.02 189 183.79 1.03 0.07

Eye, orbit 2 1.89 3 0.72 3 0.78 2 0.37 10 14.42 0.69 -0.06

Brain, central nervous system 6 0.84 22 0.77 18 0.65 38 0.98 84 101.76 0.83 -0.25

Thyroid 11 1.82 21 0.92 10 0.50* 20 0.80 62 73.81 0.84 -0.17

Lymphatic, hematopoietic 39 0.82 184 0.95 180 0.91 330 1.04 733 755.97 0.97 -0.33

Hodgkin lymphoma 1 0.63 5 0.82 3 0.53 9 1.21 18 20.77 0.87 -0.04

Non-Hodgkin lymphoma 22 0.97 82 0.88 85 0.87 175 1.10 364 372.61 0.98 -0.12

Myeloma 7 0.85 23 0.70 34 1.01 56 1.07 120 127.31 0.94 -0.10

Leukemia 9 0.60 74 1.22 58 0.94 90 0.92 231 235.28 0.98 -0.06

Acute lymphocytic 0 0.00 2 1.15 4 2.30 1 0.38 7 6.54 1.07 0.01

Chronic lymphocytic 4 0.68 15 0.63 16 0.65 34 0.88 69 93.01 0.74* -0.34

Acute non-lymphocytic 4 0.76 37 1.74* 27 1.25 40 1.14 108 83.23 1.30* 0.35

Chronic myeloid 0 0.00 11 1.35 6 0.73 9 0.68 26 31.63 0.82 -0.08

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 74,185 66,708 46,323 31,087 74,185

Person-years in interval 58,340 219,992 191,268 235,402 705,002

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE UTERINE CORPUS AND OVARY 237
All subsequent cancers 5,467 0.93* 1,646 0.86* 1,099 0.88* 579 0.85* 8,791 9,695.69 0.91* -12.83

All excluding same site 5,157 1.02 1,611 0.95* 1,073 0.97 568 0.93 8,409 8,485.35 0.99 -1.08

Buccal cavity, pharynx 69 0.63* 30 0.90 16 0.78 8 0.74 123 174.30 0.71* -0.73

Lip 8 1.16 4 1.64 2 1.18 3 3.00 17 12.05 1.41 0.07

Tongue 15 0.62 6 0.81 4 0.89 1 0.43 26 38.34 0.68* -0.18

Salivary gland 9 0.80 1 0.28 2 0.84 0 0.00 12 18.53 0.65 -0.09

Mouth 19 0.50* 9 0.77 6 0.82 3 0.76 37 60.99 0.61* -0.34

Nasopharynx 4 0.92 0 0.00 1 1.35 0 0.00 5 6.70 0.75 -0.02

Tonsil 5 0.49 3 1.12 0 0.00 1 1.65 9 14.86 0.61 -0.08

Oropharynx 3 1.03 2 2.49 0 0.00 0 0.00 5 4.42 1.13 0.01

Hypopharynx 3 0.38 3 1.34 1 0.80 0 0.00 7 12.03 0.58 -0.07

Digestive system 1,382 1.05 469 1.04 335 1.11 165 0.95 2,351 2,251.37 1.04* 1.41

Esophagus 24 0.66* 8 0.65 3 0.37 2 0.43 37 61.46 0.60* -0.35

Stomach 85 0.86 26 0.79 22 1.01 9 0.72 142 165.68 0.86 -0.34

Small intestine 32 1.74* 8 1.24 6 1.32 4 1.53 50 31.95 1.56* 0.26

Colon 751 1.14* 258 1.12 179 1.16 83 0.92 1,271 1,135.40 1.12* 1.92

Rectum, rectosigmoid junction 221 1.02 72 1.04 56 1.29 20 0.85 369 351.72 1.05 0.25

Rectum 150 1.07 53 1.18 42 1.45* 14 0.86 259 230.31 1.12 0.41

Anus, anal canal 8 0.45* 4 0.68 4 1.04 3 1.45 19 29.78 0.64* -0.15

Liver 20 0.74 8 0.82 7 1.00 1 0.23 36 48.16 0.75 -0.17

Gallbladder 23 0.76 8 0.82 5 0.79 1 0.30 37 49.54 0.75 -0.18

Bile ducts, other biliary 32 1.15 7 0.67 8 1.04 7 1.47 54 50.77 1.06 0.05

Pancreas 153 0.89 61 1.01 38 0.92 34 1.44 286 297.58 0.96 -0.16

Respiratory system 672 0.84* 205 0.74* 133 0.72* 81 0.81 1,091 1,356.45 0.80* -3.77

Nose, nasal cavity, ear 12 1.51 2 0.77 2 1.17 0 0.00 16 13.30 1.20 0.04

Larynx 7 0.26* 7 0.90 3 0.68 4 1.90 21 40.82 0.51* -0.28

Lung, bronchus 651 0.86* 196 0.74* 127 0.71* 77 0.80* 1,051 1,298.94 0.81* -3.52

Female breast 1,843 1.11* 518 0.97 316 0.95 139 0.80* 2,816 2,709.68 1.04* 1.51

Female genital system 310 0.40* 35 0.16* 26 0.19* 11 0.16* 382 1,210.34 0.32* -11.75

Cervix uteri 16 0.20* 1 0.05* 2 0.20* 0 0.00* 19 112.95 0.17* -1.33

Corpus uteri 15 0.04* 4 0.03* 3 0.04* 0 0.00* 22 638.59 0.03* -8.75

Ovary 194 0.86* 7 0.10* 10 0.23* 1 0.05* 212 357.89 0.59* -2.07

Vagina 33 3.02* 8 2.29 3 1.35 6 4.96* 50 17.85 2.80* 0.46

Vulva 39 1.20 14 1.21 7 0.87 4 0.84 64 56.93 1.12 0.10

Urinary system 335 1.20* 116 1.20 85 1.30* 54 1.46* 590 477.46 1.24* 1.60

Urinary bladder 221 1.35* 87 1.51* 53 1.35* 43 1.90* 404 283.64 1.42* 1.71

Kidney parenchyma 90 0.99 19 0.61* 20 0.96 6 0.53 135 153.97 0.88 -0.27

Renal pelvis, other urinary 24 1.02 10 1.25 12 2.22* 5 1.64 51 39.86 1.28 0.16

Ureter 6 0.82 3 1.21 5 3.01 2 2.13 16 12.38 1.29 0.05

Bone, joints 11 2.07* 1 0.63 1 0.95 1 1.72 14 8.54 1.64 0.08

Soft tissue including heart 34 1.54* 8 1.10 9 1.80 1 0.36 52 37.08 1.40* 0.21

Kaposi sarcoma 3 1.56 1 1.33 0 0.00 0 0.00 4 3.51 1.14 0.01

Melanoma of skin 115 1.03 35 0.99 26 1.10 13 0.96 189 183.79 1.03 0.07

Eye, orbit 8 0.88 1 0.37 0 0.00 1 1.13 10 14.42 0.69 -0.06

Brain, central nervous system 46 0.73* 20 1.00 12 0.97 6 0.95 84 101.76 0.83 -0.25

Thyroid 42 0.86 9 0.69 7 0.89 4 0.99 62 73.81 0.84 -0.17

Lymphatic, hematopoietic 403 0.92 144 0.94 108 1.04 78 1.32* 733 755.97 0.97 -0.33

Hodgkin lymphoma 9 0.68 2 0.52 4 1.64 3 2.53 18 20.77 0.87 -0.04

Non-Hodgkin lymphoma 189 0.88 73 0.96 56 1.07 46 1.53* 364 372.61 0.98 -0.12

Myeloma 64 0.85 26 1.01 20 1.17 10 1.05 120 127.31 0.94 -0.10

Leukemia 141 1.03 43 0.90 28 0.87 19 1.03 231 235.28 0.98 -0.06

Acute lymphocytic 6 1.53 0 0.00 1 1.18 0 0.00 7 6.54 1.07 0.01

Chronic lymphocytic 35 0.64* 15 0.79 15 1.19 4 0.58 69 93.01 0.74* -0.34

Acute non-lymphocytic 68 1.41* 24 1.44 7 0.61 9 1.30 108 83.23 1.30* 0.35

Chronic myeloid 17 0.92 1 0.16* 4 0.93 4 1.64 26 31.63 0.82 -0.08

Corpus Uteri

Females, Long-term Follow-up

Table 9.1.3: Risk of subsequent primary cancers after cancer of the corpus uteri, females,

long-term follow-up, SEER 1973-2000.

238 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CORPUS UTERI

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 74,185 31,087 19,421 10,396 74,185

Person-years in interval 469,600 124,854 73,364 37,184 705,002

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Corpus Uteri

Females, <50 Years of Age

Table 9.1.4: Risk of subsequent primary cancers after cancer of the corpus uteri, females,

<50 years of age, SEER 1973-2000.

CORPUS UTERI

All subsequent cancers 63 2.71* 146 1.30* 142 1.01 368 1.10 719 610.71 1.18* 10.97

All excluding same site 27 1.41 131 1.41* 135 1.15 352 1.22* 645 516.77 1.25* 13.00

Buccal cavity, pharynx 0 0.00 1 0.50 0 0.00 3 0.50 4 11.09 0.36* -0.72

Lip 0 0.00 0 0.00 0 0.00 1 3.48 1 0.49 2.05 0.05

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 2.54 0.00 -0.26

Salivary gland 0 0.00 1 3.26 0 0.00 0 0.00 1 1.37 0.73 -0.04

Mouth 0 0.00 0 0.00 0 0.00 1 0.53 1 3.37 0.30 -0.24

Nasopharynx 0 0.00 0 0.00 0 0.00 1 3.18 1 0.71 1.41 0.03

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 1.19 0.00 -0.12

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.03

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -0.08

Digestive system 8 3.76* 39 3.41* 43 2.56* 132 2.53* 222 82.49 2.69* 14.14

Esophagus 0 0.00 0 0.00 0 0.00 1 0.59 1 2.50 0.40 -0.15

Stomach 0 0.00 1 1.04 2 1.62 3 0.87 6 5.84 1.03 0.02

Small intestine 1 16.64 0 0.00 0 0.00 2 1.87 3 1.81 1.65 0.12

Colon 4 4.38* 24 4.84* 32 4.32* 76 3.16* 136 37.36 3.64* 10.00

Rectum, rectosigmoid junction 1 2.25 10 4.09* 6 1.72 30 3.20* 47 15.78 2.98* 3.16

Rectum 1 3.33 8 4.99* 2 0.89 24 3.86* 35 10.37 3.38* 2.50

Anus, anal canal 0 0.00 0 0.00 0 0.00 5 4.64* 5 1.92 2.60 0.31

Liver 0 0.00 3 9.42* 0 0.00 0 0.00 3 2.28 1.31 0.07

Gallbladder 0 0.00 0 0.00 0 0.00 1 0.96 1 1.62 0.62 -0.06

Bile ducts, other biliary 1 24.35 0 0.00 0 0.00 3 2.58 4 1.75 2.28 0.23

Pancreas 1 4.78 1 0.83 1 0.52 10 1.50 13 10.02 1.30 0.30

Respiratory system 3 1.82 11 1.15 18 1.16 43 0.84 75 77.79 0.96 -0.28

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.75 0.00 -0.08

Larynx 0 0.00 0 0.00 0 0.00 3 1.62 3 3.16 0.95 -0.02

Lung, bronchus 3 1.97 11 1.23 17 1.17 40 0.82 71 73.65 0.96 -0.27

Female breast 7 0.69 35 0.73 42 0.75 92 0.79* 176 229.82 0.77* -5.45

Female genital system 36 8.76* 15 0.76 7 0.31* 16 0.34* 74 93.94 0.79* -2.02

Cervix uteri 0 0.00 2 0.43 0 0.00* 2 0.37 4 15.34 0.26* -1.15

Corpus uteri 0 0.00 0 0.00* 1 0.09* 4 0.16* 5 44.81 0.11* -4.03

Ovary 35 28.00* 10 1.68 5 0.71 4 0.28* 54 28.51 1.89* 2.58

Vagina 1 28.77 1 6.09 1 4.80 3 5.93* 6 0.91 6.57* 0.52

Vulva 0 0.00 1 1.99 0 0.00 2 1.37 3 2.67 1.13 0.03

Urinary system 2 3.58 5 1.65 7 1.57 26 1.84* 40 22.17 1.80* 1.81

Urinary bladder 1 4.00 1 0.71 4 1.85 14 1.89* 20 11.21 1.78* 0.89

Kidney parenchyma 1 3.52 4 2.70 2 0.97 10 1.71 17 9.67 1.76* 0.74

Renal pelvis, other urinary 0 0.00 0 0.00 1 4.14 2 2.29 3 1.29 2.33 0.17

Ureter 0 0.00 0 0.00 0 0.00 2 8.02 2 0.34 5.84 0.17

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.70 0.00 -0.07

Soft tissue including heart 0 0.00 2 3.43 1 1.56 2 1.49 5 2.70 1.85 0.23

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.01

Melanoma of skin 1 0.84 11 2.14* 7 1.32 8 0.88 27 20.68 1.31 0.64

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.93 0.00 -0.09

Brain, central nervous system 0 0.00 4 2.62 1 0.56 2 0.54 7 7.31 0.96 -0.03

Thyroid 4 4.46* 7 1.94 2 0.61 3 0.65 16 12.44 1.29 0.36

Lymphatic, hematopoietic 1 0.81 12 1.99* 8 1.02 29 1.35 50 36.63 1.37* 1.36

Hodgkin lymphoma 0 0.00 1 1.82 0 0.00 1 1.28 2 1.97 1.02 0.00

Non-Hodgkin lymphoma 1 1.61 5 1.61 3 0.72 16 1.38 25 19.45 1.29 0.56

Myeloma 0 0.00 0 0.00 0 0.00 3 0.90 3 5.13 0.58 -0.22

Leukemia 0 0.00 6 3.49* 5 2.30 9 1.54 20 10.08 1.98* 1.01

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.52 0.00 -0.05

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 1 0.47 1 3.21 0.31 -0.22

Acute non-lymphocytic 0 0.00 6 8.25* 3 3.44 7 3.18* 16 3.96 4.04* 1.22

Chronic myeloid 0 0.00 0 0.00 1 2.59 1 1.19 2 1.64 1.22 0.04

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 9,168 8,491 6,324 4,377 9,168

Person-years in interval 7,335 29,204 26,434 35,698 98,670

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE UTERINE CORPUS AND OVARY 239
All subsequent cancers 353 1.05 1,313 0.88* 1,546 0.90* 2,597 0.84* 5,809 6,638.75 0.88* -17.50

All excluding same site 276 0.98 1,270 1.00 1,513 1.02 2,548 0.93* 5,607 5,769.92 0.97* -3.44

Buccal cavity, pharynx 2 0.28* 14 0.45* 31 0.92 49 0.95 96 124.02 0.77* -0.59

Lip 0 0.00 0 0.00 4 2.19 7 1.76 11 7.58 1.45 0.07

Tongue 0 0.00 6 0.86 4 0.54 11 0.97 21 27.34 0.77 -0.13

Salivary gland 1 1.53 0 0.00 4 1.28 3 0.53 8 12.33 0.65 -0.09

Mouth 1 0.41 3 0.28* 7 0.61 16 0.87 27 42.86 0.63* -0.33

Nasopharynx 0 0.00 2 1.52 2 1.51 0 0.00 4 4.81 0.83 -0.02

Tonsil 0 0.00 2 0.57 3 0.91 4 1.03 9 11.49 0.78 -0.05

Oropharynx 0 0.00 0 0.00 2 2.02 2 1.60 4 3.36 1.19 0.01

Hypopharynx 0 0.00 0 0.00 3 1.11 4 1.16 7 9.39 0.75 -0.05

Digestive system 61 1.01 337 1.18* 355 0.99 708 0.96 1,461 1,441.84 1.01 0.40

Esophagus 3 1.46 8 0.87 3 0.28* 9 0.45* 23 42.11 0.55* -0.40

Stomach 6 1.39 20 1.00 23 0.92 44 0.84 93 101.50 0.92 -0.18

Small intestine 4 4.09* 8 1.81 13 2.43* 14 1.28 39 21.68 1.80* 0.37

Colon 21 0.74 174 1.28* 186 1.06 375 1.00 756 715.26 1.06 0.86

Rectum, rectosigmoid junction 10 0.88 52 0.99 66 1.07 102 0.94 230 234.00 0.98 -0.08

Rectum 9 1.23 36 1.07 44 1.11 74 1.03 163 152.19 1.07 0.23

Anus, anal canal 0 0.00 1 0.21 4 0.74 6 0.64 11 20.55 0.54* -0.20

Liver 2 1.59 7 1.18 4 0.52 15 0.88 28 32.04 0.87 -0.09

Gallbladder 2 1.51 9 1.42 5 0.62 12 0.78 28 31.13 0.90 -0.07

Bile ducts, other biliary 3 2.67 4 0.74 10 1.39 17 0.95 34 31.64 1.07 0.05

Pancreas 7 0.90 46 1.24 35 0.73 101 1.01 189 192.61 0.98 -0.08

Respiratory system 28 0.60* 165 0.75* 213 0.81* 332 0.71* 738 997.68 0.74* -5.48

Nose, nasal cavity, ear 1 2.17 5 2.52 3 1.32 3 0.70 12 8.98 1.34 0.06

Larynx 0 0.00 3 0.35 2 0.22* 10 0.86 15 31.38 0.48* -0.35

Lung, bronchus 27 0.61* 157 0.76* 208 0.82* 318 0.71* 710 954.93 0.74* -5.17

Female breast 120 1.14 465 1.02 600 1.20* 784 0.95 1,969 1,888.21 1.04 1.70

Female genital system 77 1.36* 43 0.18* 33 0.14* 49 0.14* 202 868.83 0.23* -14.07

Cervix uteri 4 0.62 1 0.04* 4 0.19* 1 0.04* 10 76.68 0.13* -1.41

Corpus uteri 2 0.06* 0 0.00* 1 0.01* 3 0.02* 6 476.25 0.01* -9.92

Ovary 60 4.03* 22 0.35* 12 0.18* 12 0.11* 106 251.80 0.42* -3.08

Vagina 4 6.83* 5 1.93 6 2.02 12 2.19* 27 11.64 2.32* 0.32

Vulva 2 1.40 12 1.80 10 1.19 20 1.06 44 35.30 1.25 0.18

Urinary system 21 1.50 93 1.42* 75 0.92 202 1.26* 391 320.93 1.22* 1.48

Urinary bladder 11 1.42 60 1.62* 48 1.03 148 1.55* 267 186.64 1.43* 1.69

Kidney parenchyma 10 1.94 26 1.11 20 0.71 31 0.60* 87 107.90 0.81* -0.44

Renal pelvis, other urinary 0 0.00 7 1.35 7 1.04 23 1.71* 37 26.38 1.40 0.22

Ureter 0 0.00 2 1.28 2 0.96 8 1.93 12 8.12 1.48 0.08

Bone, joints 0 0.00 3 2.18 4 2.65 3 1.17 10 5.77 1.73 0.09

Soft tissue including heart 0 0.00 10 1.85 11 1.82 15 1.27 36 24.44 1.47* 0.24

Kaposi sarcoma 0 0.00 1 4.70 0 0.00 1 0.88 2 1.72 1.16 0.01

Melanoma of skin 4 0.58 27 0.91 28 0.88 60 1.08 119 124.01 0.96 -0.11

Eye, orbit 0 0.00 2 0.77 3 1.11 2 0.47 7 10.14 0.69 -0.07

Brain, central nervous system 5 1.26 11 0.63 14 0.71 36 1.13 66 73.04 0.90 -0.15

Thyroid 5 1.42 9 0.64 5 0.38* 15 0.81 34 49.29 0.69* -0.32

Lymphatic, hematopoietic 18 0.84 90 0.90 112 0.90 271 1.07 491 500.34 0.98 -0.20

Hodgkin lymphoma 1 1.21 1 0.29 2 0.54 8 1.34 12 14.00 0.86 -0.04

Non-Hodgkin lymphoma 9 0.85 43 0.86 52 0.83 150 1.17 254 251.93 1.01 0.04

Myeloma 3 0.82 11 0.64 21 0.98 46 1.08 81 84.81 0.96 -0.08

Leukemia 5 0.79 35 1.19 37 1.01 67 0.87 144 149.60 0.96 -0.12

Acute lymphocytic 0 0.00 1 1.07 4 3.76* 1 0.50 6 4.20 1.43 0.04

Chronic lymphocytic 3 1.20 6 0.50 10 0.66 30 0.98 49 60.26 0.81 -0.24

Acute non-lymphocytic 2 0.90 17 1.63 17 1.32 27 0.97 63 53.37 1.18 0.20

Chronic myeloid 0 0.00 6 1.53 3 0.63 5 0.50 14 19.66 0.71 -0.12

Corpus Uteri

Females, 50-69 Years of Age

Table 9.1.5: Risk of subsequent primary cancers after cancer of the corpus uteri, females,

50-69 years of age, SEER 1973-2000.

240 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CORPUS UTERI

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 42,589 39,355 29,567 21,666 42,589

Person-years in interval 34,020 135,113 127,377 177,594 474,104

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Corpus Uteri

Females, ≥70 Years of Age

Table 9.1.6: Risk of subsequent primary cancers after cancer of the corpus uteri, females,

≥70 years of age, SEER 1973-2000.

CORPUS UTERI

All subsequent cancers 283 0.96 962 0.96 659 0.92* 359 0.83* 2,263 2,446.23 0.93* -13.86

All excluding same site 239 0.92 925 1.03 641 0.99 352 0.89* 2,157 2,198.66 0.98 -3.15

Buccal cavity, pharynx 4 0.83 9 0.56 8 0.71 2 0.29 23 39.19 0.59* -1.22

Lip 0 0.00 3 2.01 1 0.82 1 1.16 5 3.99 1.25 0.08

Tongue 1 0.96 1 0.29 3 1.24 0 0.00 5 8.45 0.59 -0.26

Salivary gland 1 1.80 0 0.00 2 1.42 0 0.00 3 4.83 0.62 -0.14

Mouth 1 0.56 5 0.83 2 0.47 1 0.37 9 14.76 0.61 -0.44

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.18 0.00 -0.09

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 2.18 0.00 -0.16

Oropharynx 1 9.06 0 0.00 0 0.00 0 0.00 1 0.77 1.29 0.02

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.85 0.00 -0.14

Digestive system 64 0.78* 250 0.88* 225 1.03 129 0.91 668 727.03 0.92* -4.46

Esophagus 2 1.02 7 1.04 1 0.20 3 0.94 13 16.85 0.77 -0.29

Stomach 2 0.30 17 0.74 14 0.80 10 0.89 43 58.33 0.74* -1.16

Small intestine 2 2.06 0 0.00 4 1.58 2 1.24 8 8.46 0.95 -0.03

Colon 31 0.73 146 0.98 133 1.15 69 0.90 379 382.79 0.99 -0.29

Rectum, rectosigmoid junction 8 0.65 31 0.74 37 1.24 16 0.90 92 101.95 0.90 -0.75

Rectum 6 0.74 21 0.76 23 1.16 11 0.90 61 67.75 0.90 -0.51

Anus, anal canal 0 0.00 2 0.67 1 0.47 0 0.00 3 7.32 0.41 -0.33

Liver 0 0.00 1 0.18* 3 0.73 1 0.41 5 13.84 0.36* -0.67

Gallbladder 3 1.50 1 0.15* 3 0.61 1 0.33 8 16.78 0.48* -0.66

Bile ducts, other biliary 3 1.67 6 0.93 5 0.94 2 0.52 16 17.38 0.92 -0.10

Pancreas 9 0.84 32 0.86 21 0.74 22 1.18 84 94.95 0.88 -0.83

Respiratory system 23 0.64* 138 1.13 73 0.90 44 1.05 278 280.97 0.99 -0.22

Nose, nasal cavity, ear 0 0.00 0 0.00 3 2.78 1 1.52 4 3.56 1.12 0.03

Larynx 0 0.00 1 0.35 1 0.59 1 1.25 3 6.27 0.48 -0.25

Lung, bronchus 23 0.66* 136 1.16 69 0.88 42 1.04 270 270.36 1.00 -0.03

Female breast 90 1.22 302 1.22* 182 1.06 97 0.99 671 591.65 1.13* 6.00

Female genital system 44 1.35 37 0.35* 18 0.26* 7 0.18* 106 247.57 0.43* -10.71

Cervix uteri 3 0.99 1 0.11* 1 0.18* 0 0.00 5 20.93 0.24* -1.21

Corpus uteri 7 0.43* 3 0.06* 1 0.03* 0 0.00* 11 117.53 0.09* -8.06

Ovary 29 2.96* 15 0.46* 6 0.27* 2 0.16* 52 77.58 0.67* -1.93

Vagina 2 3.18 10 4.63* 3 1.91 2 2.12 17 5.30 3.21* 0.88

Vulva 1 0.50 6 0.84 7 1.23 3 0.73 17 18.96 0.90 -0.15

Urinary system 18 1.15 65 1.21 49 1.23 27 1.08 159 134.36 1.18* 1.86

Urinary bladder 10 1.03 44 1.30 42 1.64* 21 1.25 117 85.78 1.36* 2.36

Kidney parenchyma 7 1.58 15 0.99 5 0.47 4 0.65 31 36.39 0.85 -0.41

Renal pelvis, other urinary 1 0.70 6 1.20 2 0.55 2 0.93 11 12.19 0.90 -0.09

Ureter 0 0.00 2 1.25 0 0.00 0 0.00 2 3.92 0.51 -0.14

Bone, joints 1 3.86 1 1.15 2 3.30 0 0.00 4 2.08 1.93 0.15

Soft tissue including heart 0 0.00 6 1.55 4 1.34 1 0.51 11 9.95 1.11 0.08

Kaposi sarcoma 1 6.60 1 1.70 0 0.00 0 0.00 2 1.73 1.16 0.02

Melanoma of skin 7 1.57 21 1.36 9 0.79 6 0.77 43 39.11 1.10 0.29

Eye, orbit 2 4.70 1 0.72 0 0.00 0 0.00 3 3.35 0.90 -0.03

Brain, central nervous system 1 0.36 7 0.75 3 0.49 0 0.00 11 21.42 0.51* -0.79

Thyroid 2 1.23 5 0.95 3 0.88 2 1.11 12 12.08 0.99 -0.01

Lymphatic, hematopoietic 20 0.80 82 0.94 60 0.92 30 0.73 192 219.01 0.88 -2.04

Hodgkin lymphoma 0 0.00 3 1.45 1 0.72 0 0.00 4 4.80 0.83 -0.06

Non-Hodgkin lymphoma 12 1.03 34 0.83 30 0.99 9 0.48* 85 101.24 0.84 -1.23

Myeloma 4 0.90 12 0.79 13 1.17 7 1.07 36 37.36 0.96 -0.10

Leukemia 4 0.48 33 1.13 16 0.71 14 0.91 67 75.60 0.89 -0.65

Acute lymphocytic 0 0.00 1 1.44 0 0.00 0 0.00 1 1.82 0.55 -0.06

Chronic lymphocytic 1 0.30 9 0.78 6 0.68 3 0.51 19 29.54 0.64 -0.80

Acute non-lymphocytic 2 0.70 14 1.39 7 0.90 6 1.16 29 25.90 1.12 0.23

Chronic myeloid 0 0.00 5 1.28 2 0.65 3 1.34 10 10.33 0.97 -0.02

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 22,428 18,862 10,432 5,044 22,428

Person-years in interval 16,985 55,676 37,457 22,110 132,228

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE UTERINE CORPUS AND OVARY 241
All subsequent cancers 312 1.16* 1,062 1.00 1,003 0.93* 1,637 0.97 4,014 4,091.70 0.98 -2.69

All excluding same site 224 0.98 1,034 1.14* 978 1.04 1,609 1.07* 3,845 3,580.08 1.07* 9.16

Buccal cavity, pharynx 4 0.76 10 0.49* 14 0.70 26 0.91 54 74.09 0.73* -0.69

Lip 0 0.00 3 2.41 1 0.76 6 2.63 10 5.15 1.94 0.17

Tongue 1 0.88 1 0.22 4 0.91 3 0.48 9 16.23 0.55 -0.25

Salivary gland 2 3.85 0 0.00 3 1.50 2 0.62 7 7.76 0.90 -0.03

Mouth 1 0.55 5 0.70 3 0.43 11 1.08 20 26.11 0.77 -0.21

Nasopharynx 0 0.00 1 1.24 0 0.00 0 0.00 1 2.77 0.36 -0.06

Tonsil 0 0.00 0 0.00 1 0.57 0 0.00 1 6.32 0.16* -0.18

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.89 0.00 -0.07

Hypopharynx 0 0.00 0 0.00 1 0.70 2 1.12 3 5.13 0.58 -0.07

Digestive system 53 0.87 279 1.15* 283 1.12 523 1.26* 1,138 972.13 1.17* 5.74

Esophagus 2 1.17 5 0.74 2 0.29 7 0.63 16 26.37 0.61* -0.36

Stomach 5 1.04 18 0.97 20 1.07 36 1.20 79 72.23 1.09 0.23

Small intestine 3 3.74 2 0.62 5 1.48 11 1.84 21 13.36 1.57 0.26

Colon 22 0.73 158 1.31* 170 1.33* 289 1.36* 639 491.75 1.30* 5.09

Rectum, rectosigmoid junction 5 0.48 38 0.94 51 1.26 79 1.31* 173 151.96 1.14 0.73

Rectum 5 0.75 29 1.10 32 1.22 60 1.50* 126 99.24 1.27* 0.93

Anus, anal canal 0 0.00 3 0.93 2 0.60 4 0.77 9 12.53 0.72 -0.12

Liver 1 0.83 5 1.05 2 0.40 12 1.30 20 20.25 0.99 -0.01

Gallbladder 3 2.05 6 1.05 4 0.69 6 0.69 19 21.67 0.88 -0.09

Bile ducts, other biliary 5 4.14* 5 1.02 2 0.37 12 1.18 24 21.62 1.11 0.08

Pancreas 7 0.89 34 1.09 23 0.69 61 1.09 125 128.30 0.97 -0.11

Respiratory system 26 0.77 151 1.09 145 0.98 194 0.79* 516 565.13 0.91* -1.70

Nose, nasal cavity, ear 1 2.72 2 1.38 1 0.68 1 0.42 5 5.65 0.89 -0.02

Larynx 0 0.00 2 0.41 1 0.21 8 1.29 11 17.12 0.64 -0.21

Lung, bronchus 25 0.78 146 1.11 142 1.01 184 0.78* 497 540.92 0.92 -1.52

Female breast 86 1.13 336 1.13* 298 1.00 413 0.91 1,133 1,125.76 1.01 0.25

Female genital system 88 2.24* 28 0.19* 25 0.18* 28 0.15* 169 511.62 0.33* -11.85

Cervix uteri 5 1.11 1 0.06* 4 0.31* 0 0.00* 10 47.59 0.21* -1.30

Corpus uteri 7 0.33* 1 0.01* 2 0.03* 1 0.01* 11 270.80 0.04* -8.98

Ovary 71 6.67* 7 0.17* 7 0.17* 3 0.05* 88 150.21 0.59* -2.15

Vagina 1 1.89 7 3.41* 4 1.98 9 2.93* 21 7.69 2.73* 0.46

Vulva 1 0.69 11 1.90 8 1.31 15 1.38 35 24.25 1.44* 0.37

Urinary system 16 1.29 81 1.63* 69 1.32* 162 1.84* 328 202.63 1.62* 4.34

Urinary bladder 11 1.50 58 1.96* 52 1.66* 122 2.30* 243 121.16 2.01* 4.21

Kidney parenchyma 4 1.01 16 1.01 11 0.66 23 0.83 54 64.26 0.84 -0.35

Renal pelvis, other urinary 1 0.93 7 1.62 6 1.33 17 2.33* 31 17.22 1.80* 0.48

Ureter 0 0.00 2 1.48 2 1.41 7 3.09* 11 5.37 2.05* 0.19

Bone, joints 0 0.00 1 1.02 4 4.23* 3 2.12 8 3.59 2.23 0.15

Soft tissue including heart 0 0.00 9 2.29* 5 1.26 12 1.81 26 15.53 1.67* 0.36

Kaposi sarcoma 1 12.16 1 2.94 0 0.00 1 1.37 3 1.55 1.94 0.05

Melanoma of skin 6 1.26 25 1.31 19 0.99 31 0.99 81 74.30 1.09 0.23

Eye, orbit 1 2.24 2 1.16 0 0.00 1 0.43 4 6.13 0.65 -0.07

Brain, central nervous system 4 1.37 7 0.60 7 0.61 17 1.00 35 42.91 0.82 -0.27

Thyroid 4 1.74 9 1.04 5 0.64 13 1.23 31 29.24 1.06 0.06

Lymphatic, hematopoietic 13 0.66 83 1.06 89 1.07 163 1.16 348 321.21 1.08 0.93

Hodgkin lymphoma 0 0.00 1 0.40 1 0.43 6 1.84 8 8.74 0.92 -0.03

Non-Hodgkin lymphoma 6 0.65 35 0.94 42 1.04 90 1.29* 173 156.83 1.10 0.56

Myeloma 3 0.87 11 0.80 15 1.05 22 0.94 51 54.73 0.93 -0.13

Leukemia 4 0.64 36 1.45* 31 1.19 45 1.03 116 100.91 1.15 0.52

Acute lymphocytic 0 0.00 1 1.45 2 2.79 0 0.00 3 2.73 1.10 0.01

Chronic lymphocytic 1 0.40 3 0.30* 7 0.67 19 1.10 30 40.21 0.75 -0.35

Acute non-lymphocytic 2 0.92 20 2.31* 18 2.00* 19 1.22 59 35.41 1.67* 0.82

Chronic myeloid 0 0.00 8 2.40* 2 0.58 6 1.02 16 13.53 1.18 0.09

Corpus Uteri

Females, Radiotherapy

Table 9.1.7: Risk of subsequent primary cancers after cancer of the corpus uteri, females,

with initial radiotherapy, SEER 1973-2000.

242 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CORPUS UTERI

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 29,629 26,592 18,380 12,886 29,629

Person-years in interval 23,322 86,844 77,434 101,556 289,155

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Corpus Uteri

Females, No Radiotherapy

Table 9.1.8: Risk of subsequent primary cancers after cancer of the corpus uteri, females,

without initial radiotherapy, SEER 1973-2000.

CORPUS UTERI

All subsequent cancers 387 1.00 1,359 0.87* 1,344 0.89* 1,687 0.78* 4,777 5,603.98 0.85* -19.89

All excluding same site 318 0.96 1,292 0.96 1,311 0.99 1,643 0.86* 4,564 4,905.27 0.93* -8.21

Buccal cavity, pharynx 2 0.28* 14 0.48* 25 0.91 28 0.77 69 100.20 0.69* -0.75

Lip 0 0.00 0 0.00 4 2.20 3 1.05 7 6.90 1.01 0.00

Tongue 0 0.00 6 0.93 3 0.49 8 1.00 17 22.11 0.77 -0.12

Salivary gland 0 0.00 1 0.33 3 1.05 1 0.24 5 10.77 0.46 -0.14

Mouth 1 0.40 3 0.30* 6 0.63 7 0.54 17 34.87 0.49* -0.43

Nasopharynx 0 0.00 1 0.83 2 1.83 1 0.75 4 3.93 1.02 0.00

Tonsil 0 0.00 2 0.73 2 0.83 4 1.49 8 8.54 0.94 -0.01

Oropharynx 1 5.35 0 0.00 2 2.75 2 2.35 5 2.53 1.98 0.06

Hypopharynx 0 0.00 0 0.00 2 1.02 2 0.87 4 6.90 0.58 -0.07

Digestive system 80 0.96 347 1.02 340 1.00 446 0.87* 1,213 1,279.24 0.95 -1.59

Esophagus 3 1.28 10 1.05 2 0.21* 6 0.43* 21 35.10 0.60* -0.34

Stomach 3 0.47 20 0.79 19 0.77 21 0.57* 63 93.45 0.67* -0.73

Small intestine 4 3.32 6 1.23 12 2.46* 7 0.92 29 18.59 1.56* 0.25

Colon 34 0.82 186 1.10 181 1.06 231 0.88 632 643.66 0.98 -0.28

Rectum, rectosigmoid junction 14 1.01 55 0.98 58 1.07 69 0.91 196 199.76 0.98 -0.09

Rectum 11 1.22 36 0.99 37 1.04 49 0.98 133 131.07 1.01 0.05

Anus, anal canal 0 0.00 0 0.00* 3 0.64 7 1.06 10 17.25 0.58 -0.17

Liver 1 0.57 6 0.84 5 0.69 4 0.34* 16 27.92 0.57* -0.29

Gallbladder 2 1.05 4 0.52 4 0.53 8 0.75 18 27.87 0.65 -0.24

Bile ducts, other biliary 2 1.14 5 0.69 13 1.74 10 0.79 30 29.15 1.03 0.02

Pancreas 10 0.92 45 1.02 34 0.76 72 1.04 161 169.27 0.95 -0.20

Respiratory system 28 0.55* 163 0.77* 159 0.75* 225 0.71* 575 791.32 0.73* -5.20

Nose, nasal cavity, ear 0 0.00 3 1.43 5 2.44 3 1.01 11 7.65 1.44 0.08

Larynx 0 0.00 2 0.28 2 0.30 6 0.74 10 23.70 0.42* -0.33

Lung, bronchus 28 0.58* 158 0.78* 152 0.75* 216 0.71* 554 758.01 0.73* -4.91

Female breast 131 1.16 466 1.03 526 1.22* 560 0.95 1,683 1,583.92 1.06* 2.38

Female genital system 69 1.27 67 0.32* 33 0.17* 44 0.18* 213 698.72 0.30* -11.68

Cervix uteri 2 0.33 3 0.13* 1 0.06* 3 0.16* 9 65.36 0.14* -1.36

Corpus uteri 2 0.07* 2 0.02* 1 0.01* 6 0.05* 11 367.79 0.03* -8.58

Ovary 53 3.47* 40 0.66* 16 0.28* 15 0.20* 124 207.68 0.60* -2.01

Vagina 6 8.35* 9 3.14* 6 2.20 8 2.08 29 10.17 2.85* 0.45

Vulva 2 0.96 8 0.94 9 1.05 10 0.74 29 32.68 0.89 -0.09

Urinary system 25 1.41 82 1.13 62 0.85 93 0.84 262 274.83 0.95 -0.31

Urinary bladder 11 1.06 47 1.10 42 0.97 61 0.92 161 162.48 0.99 -0.04

Kidney parenchyma 14 2.36* 29 1.20 16 0.67 22 0.62* 81 89.71 0.90 -0.21

Renal pelvis, other urinary 0 0.00 6 1.00 4 0.66 10 1.10 20 22.64 0.88 -0.06

Ureter 0 0.00 2 1.08 0 0.00 3 1.06 5 7.01 0.71 -0.05

Bone, joints 1 2.75 3 2.09 2 1.50 0 0.00 6 4.95 1.21 0.03

Soft tissue including heart 0 0.00 9 1.52 11 1.93 6 0.71 26 21.55 1.21 0.11

Kaposi sarcoma 0 0.00 1 2.10 0 0.00 0 0.00 1 1.97 0.51 -0.02

Melanoma of skin 6 0.77 34 1.09 25 0.85 43 1.04 108 109.49 0.99 -0.04

Eye, orbit 1 1.64 1 0.41 3 1.33 1 0.33 6 8.29 0.72 -0.06

Brain, central nervous system 2 0.48 15 0.89 11 0.68 21 0.97 49 58.85 0.83 -0.24

Thyroid 7 1.87 12 0.84 5 0.41* 7 0.49* 31 44.56 0.70* -0.33

Lymphatic, hematopoietic 26 0.93 101 0.88 91 0.79* 167 0.95 385 434.77 0.89* -1.20

Hodgkin lymphoma 1 1.07 4 1.10 2 0.61 3 0.72 10 12.03 0.83 -0.05

Non-Hodgkin lymphoma 16 1.18 47 0.84 43 0.75 85 0.96 191 215.79 0.89 -0.60

Myeloma 4 0.84 12 0.62 19 0.98 34 1.17 69 72.58 0.95 -0.09

Leukemia 5 0.57 38 1.07 27 0.76 45 0.83 115 134.37 0.86 -0.47

Acute lymphocytic 0 0.00 1 0.95 2 1.96 1 0.68 4 3.81 1.05 0.00

Chronic lymphocytic 3 0.88 12 0.86 9 0.64 15 0.70 39 52.81 0.74 -0.33

Acute non-lymphocytic 2 0.65 17 1.35 9 0.72 21 1.07 49 47.82 1.02 0.03

Chronic myeloid 0 0.00 3 0.62 4 0.84 3 0.41 10 18.10 0.55 -0.19

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 44,556 40,116 27,943 18,201 44,556

Person-years in interval 35,018 133,148 113,834 133,846 415,847

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE UTERINE CORPUS AND OVARY 243
All subsequent cancers 2,377 0.99 791 0.95 547 0.98 299 0.98 4,014 4,091.70 0.98 -2.69

All excluding same site 2,236 1.08* 778 1.06 539 1.09 292 1.06 3,845 3,580.08 1.07* 9.16

Buccal cavity, pharynx 28 0.61* 11 0.76 11 1.20 4 0.83 54 74.09 0.73* -0.69

Lip 4 1.39 1 0.94 2 2.62 3 6.57* 10 5.15 1.94 0.17

Tongue 6 0.60 3 0.94 0 0.00 0 0.00 9 16.23 0.55 -0.25

Salivary gland 5 1.10 0 0.00 2 1.87 0 0.00 7 7.76 0.90 -0.03

Mouth 9 0.56 4 0.78 6 1.82 1 0.56 20 26.11 0.77 -0.21

Nasopharynx 1 0.57 0 0.00 0 0.00 0 0.00 1 2.77 0.36 -0.06

Tonsil 1 0.24 0 0.00 0 0.00 0 0.00 1 6.32 0.16* -0.18

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.89 0.00 -0.07

Hypopharynx 1 0.30 1 1.04 1 1.80 0 0.00 3 5.13 0.58 -0.07

Digestive system 615 1.10* 250 1.25* 184 1.35* 89 1.12 1,138 972.13 1.17* 5.74

Esophagus 9 0.59 4 0.75 1 0.28 2 0.95 16 26.37 0.61* -0.36

Stomach 43 1.02 18 1.24 13 1.32 5 0.88 79 72.23 1.09 0.23

Small intestine 10 1.35 5 1.80 5 2.47 1 0.85 21 13.36 1.57 0.26

Colon 350 1.25* 145 1.43* 98 1.40* 46 1.12 639 491.75 1.30* 5.09

Rectum, rectosigmoid junction 94 1.03 38 1.26 30 1.54* 11 1.03 173 151.96 1.14 0.73

Rectum 66 1.11 30 1.52* 23 1.77* 7 0.95 126 99.24 1.27* 0.93

Anus, anal canal 5 0.68 1 0.39 0 0.00 3 3.23 9 12.53 0.72 -0.12

Liver 8 0.73 5 1.19 6 1.92 1 0.52 20 20.25 0.99 -0.01

Gallbladder 13 1.00 5 1.15 1 0.35 0 0.00 19 21.67 0.88 -0.09

Bile ducts, other biliary 12 1.05 4 0.88 4 1.15 4 1.84 24 21.62 1.11 0.08

Pancreas 64 0.88 23 0.86 23 1.24 15 1.40 125 128.30 0.97 -0.11

Respiratory system 322 1.00 101 0.85 62 0.76* 31 0.70* 516 565.13 0.91* -1.70

Nose, nasal cavity, ear 4 1.21 1 0.88 0 0.00 0 0.00 5 5.65 0.89 -0.02

Larynx 3 0.27* 4 1.21 1 0.51 3 3.21 11 17.12 0.64 -0.21

Lung, bronchus 313 1.03 96 0.84 60 0.76* 28 0.65* 497 540.92 0.92 -1.52

Female breast 720 1.07 218 0.95 135 0.91 60 0.77* 1,133 1,125.76 1.01 0.25

Female genital system 141 0.43* 13 0.13* 8 0.13* 7 0.23* 169 511.62 0.33* -11.85

Cervix uteri 10 0.30* 0 0.00* 0 0.00* 0 0.00 10 47.59 0.21* -1.30

Corpus uteri 10 0.06* 0 0.00* 1 0.03* 0 0.00* 11 270.80 0.04* -8.98

Ovary 85 0.92 3 0.10* 0 0.00* 0 0.00* 88 150.21 0.59* -2.15

Vagina 12 2.60* 3 1.95 2 2.00 4 7.35* 21 7.69 2.73* 0.46

Vulva 20 1.49 7 1.38 5 1.37 3 1.38 35 24.25 1.44* 0.37

Urinary system 166 1.45* 71 1.69* 57 1.94* 34 2.04* 328 202.63 1.62* 4.34

Urinary bladder 121 1.78* 55 2.19* 39 2.21* 28 2.74* 243 121.16 2.01* 4.21

Kidney parenchyma 31 0.85 9 0.67 10 1.08 4 0.79 54 64.26 0.84 -0.35

Renal pelvis, other urinary 14 1.41 7 2.00 8 3.29* 2 1.45 31 17.22 1.80* 0.48

Ureter 4 1.29 2 1.83 3 4.02 2 4.70 11 5.37 2.05* 0.19

Bone, joints 5 2.29 1 1.46 1 2.14 1 3.83 8 3.59 2.23 0.15

Soft tissue including heart 14 1.57 5 1.60 6 2.69 1 0.79 26 15.53 1.67* 0.36

Kaposi sarcoma 2 2.45 1 2.93 0 0.00 0 0.00 3 1.55 1.94 0.05

Melanoma of skin 50 1.16 12 0.81 11 1.06 8 1.31 81 74.30 1.09 0.23

Eye, orbit 3 0.79 1 0.85 0 0.00 0 0.00 4 6.13 0.65 -0.07

Brain, central nervous system 18 0.69 8 0.93 6 1.09 3 1.06 35 42.91 0.82 -0.27

Thyroid 18 0.96 5 0.93 5 1.47 3 1.68 31 29.24 1.06 0.06

Lymphatic, hematopoietic 185 1.02 67 1.00 50 1.07 46 1.72* 348 321.21 1.08 0.93

Hodgkin lymphoma 2 0.37 1 0.61 2 1.84 3 5.63* 8 8.74 0.92 -0.03

Non-Hodgkin lymphoma 83 0.96 35 1.06 28 1.19 27 1.99* 173 156.83 1.10 0.56

Myeloma 29 0.92 11 0.97 5 0.65 6 1.40 51 54.73 0.93 -0.13

Leukemia 71 1.24 20 0.96 15 1.03 10 1.19 116 100.91 1.15 0.52

Acute lymphocytic 3 1.90 0 0.00 0 0.00 0 0.00 3 2.73 1.10 0.01

Chronic lymphocytic 11 0.48* 8 0.95 8 1.41 3 0.96 30 40.21 0.75 -0.35

Acute non-lymphocytic 40 2.02* 12 1.65 2 0.39 5 1.59 59 35.41 1.67* 0.82

Chronic myeloid 10 1.31 0 0.00 4 2.06 2 1.80 16 13.53 1.18 0.09

Corpus Uteri

Females, Long-term Follow-up, Radiotherapy

Table 9.1.9: Risk of subsequent primary cancers after cancer of the corpus uteri, females, long-term follow-up,

with initial radiotherapy, SEER 1973-2000.

244 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CORPUS UTERI

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 29,629 12,886 8,385 4,657 29,629

Person-years in interval 187,600 52,739 32,217 16,599 289,155

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Corpus Uteri

Females, Long-term Follow-up, No Radiotherapy

Table 9.1.10: Risk of subsequent primary cancers after cancer of the corpus uteri, females, long-term follow-up,

without initial radiotherapy, SEER 1973-2000.

CORPUS UTERI

All subsequent cancers 3,090 0.90* 855 0.78* 552 0.80* 280 0.75* 4,777 5,603.98 0.85* -19.89

All excluding same site 2,921 0.98 833 0.87* 534 0.87* 276 0.82* 4,564 4,905.27 0.93* -8.21

Buccal cavity, pharynx 41 0.64* 19 1.00 5 0.44 4 0.68 69 100.20 0.69* -0.75

Lip 4 0.99 3 2.19 0 0.00 0 0.00 7 6.90 1.01 0.00

Tongue 9 0.64 3 0.71 4 1.61 1 0.78 17 22.11 0.77 -0.12

Salivary gland 4 0.60 1 0.49 0 0.00 0 0.00 5 10.77 0.46 -0.14

Mouth 10 0.45* 5 0.75 0 0.00* 2 0.93 17 34.87 0.49* -0.43

Nasopharynx 3 1.15 0 0.00 1 2.40 0 0.00 4 3.93 1.02 0.00

Tonsil 4 0.68 3 1.98 0 0.00 1 2.97 8 8.54 0.94 -0.01

Oropharynx 3 1.79 2 4.36 0 0.00 0 0.00 5 2.53 1.98 0.06

Hypopharynx 2 0.44 2 1.57 0 0.00 0 0.00 4 6.90 0.58 -0.07

Digestive system 767 1.00 219 0.86* 151 0.91 76 0.80* 1,213 1,279.24 0.95 -1.59

Esophagus 15 0.71 4 0.58 2 0.45 0 0.00 21 35.10 0.60* -0.34

Stomach 42 0.74 8 0.44* 9 0.76 4 0.59 63 93.45 0.67* -0.73

Small intestine 22 2.01* 3 0.81 1 0.40 3 2.08 29 18.59 1.56* 0.25

Colon 401 1.05 113 0.88 81 0.96 37 0.75 632 643.66 0.98 -0.28

Rectum, rectosigmoid junction 127 1.02 34 0.88 26 1.09 9 0.69 196 199.76 0.98 -0.09

Rectum 84 1.04 23 0.91 19 1.19 7 0.79 133 131.07 1.01 0.05

Anus, anal canal 3 0.28* 3 0.89 4 1.88 0 0.00 10 17.25 0.58 -0.17

Liver 12 0.74 3 0.54 1 0.26 0 0.00 16 27.92 0.57* -0.29

Gallbladder 10 0.58 3 0.55 4 1.16 1 0.55 18 27.87 0.65 -0.24

Bile ducts, other biliary 20 1.22 3 0.51 4 0.95 3 1.15 30 29.15 1.03 0.02

Pancreas 89 0.89 38 1.12 15 0.66 19 1.47 161 169.27 0.95 -0.20

Respiratory system 350 0.74* 104 0.66* 71 0.69* 50 0.91 575 791.32 0.73* -5.20

Nose, nasal cavity, ear 8 1.71 1 0.68 2 2.12 0 0.00 11 7.65 1.44 0.08

Larynx 4 0.26* 3 0.68 2 0.81 1 0.85 10 23.70 0.42* -0.33

Lung, bronchus 338 0.74* 100 0.66* 67 0.68* 49 0.92 554 758.01 0.73* -4.91

Female breast 1,123 1.13* 300 0.98 181 0.97 79 0.82 1,683 1,583.92 1.06* 2.38

Female genital system 169 0.37* 22 0.17* 18 0.24* 4 0.11* 213 698.72 0.30* -11.68

Cervix uteri 6 0.13* 1 0.09* 2 0.36 0 0.00 9 65.36 0.14* -1.36

Corpus uteri 5 0.02* 4 0.06* 2 0.05* 0 0.00* 11 367.79 0.03* -8.58

Ovary 109 0.82* 4 0.10* 10 0.42* 1 0.08* 124 207.68 0.60* -2.01

Vagina 21 3.33* 5 2.55 1 0.82 2 3.00 29 10.17 2.85* 0.45

Vulva 19 0.99 7 1.07 2 0.45 1 0.38 29 32.68 0.89 -0.09

Urinary system 169 1.03 45 0.82 28 0.78 20 0.99 262 274.83 0.95 -0.31

Urinary bladder 100 1.04 32 0.98 14 0.65 15 1.21 161 162.48 0.99 -0.04

Kidney parenchyma 59 1.09 10 0.56 10 0.87 2 0.32 81 89.71 0.90 -0.21

Renal pelvis, other urinary 10 0.74 3 0.67 4 1.34 3 1.79 20 22.64 0.88 -0.06

Ureter 2 0.48 1 0.72 2 2.18 0 0.00 5 7.01 0.71 -0.05

Bone, joints 6 1.91 0 0.00 0 0.00 0 0.00 6 4.95 1.21 0.03

Soft tissue including heart 20 1.53 3 0.73 3 1.09 0 0.00 26 21.55 1.21 0.11

Kaposi sarcoma 1 0.91 0 0.00 0 0.00 0 0.00 1 1.97 0.51 -0.02

Melanoma of skin 65 0.95 23 1.12 15 1.14 5 0.67 108 109.49 0.99 -0.04

Eye, orbit 5 0.94 0 0.00 0 0.00 1 2.07 6 8.29 0.72 -0.06

Brain, central nervous system 28 0.75 12 1.06 6 0.88 3 0.86 49 58.85 0.83 -0.24

Thyroid 24 0.80 4 0.52 2 0.45 1 0.45 31 44.56 0.70* -0.33

Lymphatic, hematopoietic 218 0.84* 77 0.89 58 1.01 32 0.98 385 434.77 0.89* -1.20

Hodgkin lymphoma 7 0.89 1 0.46 2 1.48 0 0.00 10 12.03 0.83 -0.05

Non-Hodgkin lymphoma 106 0.84 38 0.88 28 0.96 19 1.15 191 215.79 0.89 -0.60

Myeloma 35 0.81 15 1.04 15 1.59 4 0.76 69 72.58 0.95 -0.09

Leukemia 70 0.88 23 0.86 13 0.74 9 0.89 115 134.37 0.86 -0.47

Acute lymphocytic 3 1.28 0 0.00 1 2.14 0 0.00 4 3.81 1.05 0.00

Chronic lymphocytic 24 0.76 7 0.66 7 1.01 1 0.27 39 52.81 0.74 -0.33

Acute non-lymphocytic 28 0.99 12 1.27 5 0.79 4 1.05 49 47.82 1.02 0.03

Chronic myeloid 7 0.65 1 0.28 0 0.00 2 1.50 10 18.10 0.55 -0.19

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 44,556 18,201 11,036 5,739 44,556

Person-years in interval 282,000 72,115 41,147 20,585 415,847

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE UTERINE CORPUS AND OVARY 245
Ovary

Females

Table 9.2.1: Characteristics of patients with an initial cancer of the ovary, females,

SEER 1973-2000.

246 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

OVARY

Number of patients with 1st primary cancer

Total — — 41,489 100.0 41,489 100.0

Initial treatment

Any radiation — — 3,462 8.3 3,462 8.3

With surgery — — 2,958 7.1 2,958 7.1

Without surgery — — 504 1.2 504 1.2

No radiation — — 38,027 91.7 38,027 91.7

With surgery — — 31,302 75.4 31,302 75.4

Without surgery — — 6,725 16.2 6,725 16.2

Race

White — — 36,685 88.4 36,685 88.4

Black — — 2,435 5.9 2,435 5.9

Other — — 2,252 5.4 2,252 5.4

Unknown — — 117 0.3 117 0.3

Age at 1st primary cancer diagnosis, years

< 30 — — 2,241 5.4 2,241 5.4

30–49 — — 9,173 22.1 9,173 22.1

50–69 — — 18,906 45.6 18,906 45.6

70–79 — — 7,739 18.7 7,739 18.7

> 80 — — 3,430 8.3 3,430 8.3

Number of patients with one or more

primary cancers

One primary cancer only — — 39,440 95.1 39,440 95.1

1st and 2nd cancers — — 1,894 4.6 1,894 4.6

1st, 2nd, and 3rd cancers — — 144 0.3 144 0.3

1st, 2nd, 3rd, and additional cancers — — 11 0.0 11 0.0

Other statistics

Median age at 1st cancer diagnosis — — 60.4 — 60.4 —

Median year of 1st cancer diagnosis — — 1988.8 — 1988.8 —

Median person-years at risk — — 2.4 — 2.4 —

Percent histologically confirmed*

Both 1st and 2nd cancers — — — 96.4 — 96.4

1st, 2nd, and additional cancers — — — 95.9 — 95.9

1st cancer only — — — 3.0 — 3.0

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Ovary

Females

Table 9.2.2: Risk of subsequent primary cancers after cancer of the ovary, females,

SEER 1973-2000.

OVARY

All subsequent cancers 264 0.96 714 0.99 575 1.17* 662 1.18* 2,215 2,044.83 1.08* 8.18

All excluding same site 220 0.93 668 1.08 553 1.30* 650 1.32* 2,091 1,775.72 1.18* 15.16

Buccal cavity, pharynx 3 0.59 14 1.06 16 1.82* 9 0.95 42 36.55 1.15 0.26

Lip 0 0.00 0 0.00 0 0.00 1 1.52 1 2.29 0.44 -0.06

Tongue 2 1.78 8 2.74* 4 2.03 2 0.94 16 8.15 1.96* 0.38

Salivary gland 1 1.80 0 0.00 0 0.00 2 1.80 3 4.12 0.73 -0.05

Mouth 0 0.00 3 0.68 7 2.38 3 0.93 13 12.31 1.06 0.03

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.61 0.00 -0.08

Tonsil 0 0.00 1 0.80 4 5.02* 0 0.00 5 3.31 1.51 0.08

Oropharynx 0 0.00 1 2.96 0 0.00 0 0.00 1 0.92 1.09 0.00

Hypopharynx 0 0.00 1 1.07 1 1.65 0 0.00 2 2.53 0.79 -0.03

Digestive system 68 1.17 139 0.94 145 1.42* 187 1.56* 539 428.61 1.26* 5.31

Esophagus 1 0.61 1 0.24 6 2.10 2 0.59 10 12.09 0.83 -0.10

Stomach 3 0.67 10 0.89 8 1.06 16 1.85* 37 31.94 1.16 0.24

Small intestine 4 4.71* 4 1.77 3 1.90 3 1.53 14 6.65 2.11* 0.35

Colon 37 1.29 71 0.97 70 1.39* 90 1.50* 268 211.86 1.26* 2.70

Rectum, rectosigmoid junction 8 0.83 28 1.14 31 1.88* 34 1.86* 101 68.91 1.47* 1.54

Rectum 5 0.79 16 1.00 24 2.23* 21 1.73* 66 45.20 1.46* 1.00

Anus, anal canal 2 2.39 2 0.90 3 1.96 3 1.71 10 6.33 1.58 0.18

Liver 0 0.00 0 0.00 1 0.43 4 1.38 5 9.75 0.51 -0.23

Gallbladder 1 0.75 1 0.30 2 0.90 2 0.82 6 9.29 0.65 -0.16

Bile ducts, other biliary 2 1.65 4 1.26 3 1.33 7 2.42 16 9.53 1.68 0.31

Pancreas 7 0.93 16 0.83 14 1.05 23 1.43 60 56.15 1.07 0.18

Respiratory system 17 0.48* 70 0.73* 83 1.24 100 1.23* 270 279.03 0.97 -0.43

Nose, nasal cavity, ear 0 0.00 0 0.00 1 1.53 0 0.00 1 2.73 0.37 -0.08

Larynx 2 1.59 2 0.61 1 0.46 6 2.56 11 9.09 1.21 0.09

Lung, bronchus 15 0.44* 68 0.75* 81 1.27* 94 1.20 258 266.49 0.97 -0.41

Female breast 72 0.88 239 1.09 175 1.18* 184 1.11 670 614.79 1.09* 2.65

Female genital system 44 1.14 46 0.46* 22 0.34* 12 0.18* 124 269.10 0.46* -6.98

Cervix uteri 4 0.82 3 0.24* 1 0.13* 2 0.29 10 31.99 0.31* -1.06

Corpus uteri 31 1.57* 17 0.34* 6 0.19* 2 0.06* 56 136.61 0.41* -3.87

Ovary 6 0.54 18 0.62* 9 0.47* 2 0.10* 35 79.91 0.44* -2.16

Vagina 1 1.95 4 3.05 2 2.28 3 3.07 10 3.68 2.72* 0.30

Vulva 1 0.68 2 0.52 4 1.49 3 0.92 10 11.26 0.89 -0.06

Urinary system 14 1.13 36 1.11 28 1.25 52 1.92* 130 94.26 1.38* 1.72

Urinary bladder 3 0.42 24 1.29 18 1.40 32 2.04* 77 54.31 1.42* 1.09

Kidney parenchyma 10 2.39* 11 0.98 8 1.03 13 1.39 42 32.55 1.29 0.45

Renal pelvis, other urinary 1 0.99 1 0.39 2 1.14 7 3.37* 11 7.40 1.49 0.17

Ureter 0 0.00 0 0.00 0 0.00 2 3.18 2 2.25 0.89 -0.01

Bone, joints 0 0.00 0 0.00 3 6.11* 1 1.94 4 2.04 1.96 0.09

Soft tissue including heart 2 1.82 1 0.34 6 3.01* 5 2.20 14 8.30 1.69 0.27

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -0.03

Melanoma of skin 11 1.82 14 0.82 7 0.60 14 1.10 46 47.38 0.97 -0.07

Eye, orbit 3 6.97* 1 0.91 1 1.39 5 6.39* 10 3.03 3.29* 0.33

Brain, central nervous system 2 0.66 6 0.75 6 1.12 6 1.03 20 22.24 0.90 -0.11

Thyroid 4 1.27 10 1.13 9 1.55 9 1.59 32 23.52 1.36 0.41

Lymphatic, hematopoietic 20 1.00 116 2.22* 62 1.71* 55 1.28 253 151.49 1.67* 4.88

Hodgkin lymphoma 1 1.24 0 0.00 1 0.72 3 2.27 5 5.68 0.88 -0.03

Non-Hodgkin lymphoma 10 1.04 26 1.02 16 0.89 25 1.14 77 74.98 1.03 0.10

Myeloma 4 1.19 5 0.58 4 0.68 8 1.13 21 24.95 0.84 -0.19

Leukemia 5 0.81 85 5.35* 41 3.75* 19 1.47 150 45.88 3.27* 5.01

Acute lymphocytic 0 0.00 5 9.04* 2 5.28 1 2.44 8 1.55 5.17* 0.31

Chronic lymphocytic 1 0.43 4 0.67 4 0.97 4 0.82 13 17.34 0.75 -0.21

Acute non-lymphocytic 3 1.36 69 12.00* 28 7.08* 9 1.91 109 16.62 6.56* 4.44

Chronic myeloid 1 1.15 4 1.79 5 3.27* 2 1.13 12 6.40 1.87 0.27

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 41,489 31,251 13,817 7,411 41,489

Person-years in interval 29,464 80,058 50,876 47,623 208,021

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE UTERINE CORPUS AND OVARY 247
All subsequent cancers 1,553 1.05 345 1.15* 216 1.25* 101 1.17 2,215 2,044.83 1.08* 8.18

All excluding same site 1,441 1.12* 340 1.29* 212 1.39* 98 1.28* 2,091 1,775.72 1.18* 15.16

Buccal cavity, pharynx 33 1.22 5 0.96 4 1.38 0 0.00 42 36.55 1.15 0.26

Lip 0 0.00 0 0.00 1 4.83 0 0.00 1 2.29 0.44 -0.06

Tongue 14 2.33* 1 0.85 1 1.53 0 0.00 16 8.15 1.96* 0.38

Salivary gland 1 0.33 2 3.38 0 0.00 0 0.00 3 4.12 0.73 -0.05

Mouth 10 1.10 1 0.57 2 2.04 0 0.00 13 12.31 1.06 0.03

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.61 0.00 -0.08

Tonsil 5 1.98 0 0.00 0 0.00 0 0.00 5 3.31 1.51 0.08

Oropharynx 1 1.44 0 0.00 0 0.00 0 0.00 1 0.92 1.09 0.00

Hypopharynx 2 1.05 0 0.00 0 0.00 0 0.00 2 2.53 0.79 -0.03

Digestive system 352 1.14* 89 1.39* 68 1.83* 30 1.58* 539 428.61 1.26* 5.31

Esophagus 8 0.92 0 0.00 2 1.90 0 0.00 10 12.09 0.83 -0.10

Stomach 21 0.90 7 1.50 7 2.64* 2 1.52 37 31.94 1.16 0.24

Small intestine 11 2.35* 3 2.97 0 0.00 0 0.00 14 6.65 2.11* 0.35

Colon 178 1.17* 48 1.51* 26 1.40 16 1.68 268 211.86 1.26* 2.70

Rectum, rectosigmoid junction 67 1.32* 11 1.11 18 3.23* 5 1.81 101 68.91 1.47* 1.54

Rectum 45 1.36 6 0.92 12 3.22* 3 1.59 66 45.20 1.46* 1.00

Anus, anal canal 7 1.53 2 2.14 1 1.83 0 0.00 10 6.33 1.58 0.18

Liver 1 0.15* 2 1.35 1 1.09 1 1.99 5 9.75 0.51 -0.23

Gallbladder 4 0.58 1 0.75 0 0.00 1 2.78 6 9.29 0.65 -0.16

Bile ducts, other biliary 9 1.36 5 3.38* 2 2.17 0 0.00 16 9.53 1.68 0.31

Pancreas 37 0.92 10 1.18 9 1.79 4 1.55 60 56.15 1.07 0.18

Respiratory system 170 0.86* 58 1.36* 32 1.25 10 0.76 270 279.03 0.97 -0.43

Nose, nasal cavity, ear 1 0.50 0 0.00 0 0.00 0 0.00 1 2.73 0.37 -0.08

Larynx 5 0.74 4 3.07 2 2.83 0 0.00 11 9.09 1.21 0.09

Lung, bronchus 164 0.87 54 1.32 30 1.22 10 0.79 258 266.49 0.97 -0.41

Female breast 486 1.08 94 1.05 63 1.24 27 1.09 670 614.79 1.09* 2.65

Female genital system 112 0.56* 5 0.13* 4 0.19* 3 0.31* 124 269.10 0.46* -6.98

Cervix uteri 8 0.32* 1 0.25 0 0.00 1 1.21 10 31.99 0.31* -1.06

Corpus uteri 54 0.53* 1 0.05* 0 0.00* 1 0.20 56 136.61 0.41* -3.87

Ovary 33 0.56* 1 0.09* 1 0.16* 0 0.00 35 79.91 0.44* -2.16

Vagina 7 2.59* 0 0.00 2 6.74 1 6.77 10 3.68 2.72* 0.30

Vulva 7 0.87 2 1.17 1 0.98 0 0.00 10 11.26 0.89 -0.06

Urinary system 78 1.16 26 1.82* 19 2.24* 7 1.60 130 94.26 1.38* 1.72

Urinary bladder 45 1.16 16 1.94* 14 2.86* 2 0.79 77 54.31 1.42* 1.09

Kidney parenchyma 29 1.25 6 1.22 3 1.02 4 2.68 42 32.55 1.29 0.45

Renal pelvis, other urinary 4 0.75 4 3.66 2 3.09 1 2.96 11 7.40 1.49 0.17

Ureter 0 0.00 1 3.01 1 5.10 0 0.00 2 2.25 0.89 -0.01

Bone, joints 3 1.97 1 3.58 0 0.00 0 0.00 4 2.04 1.96 0.09

Soft tissue including heart 9 1.49 3 2.48 1 1.41 1 2.83 14 8.30 1.69 0.27

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -0.03

Melanoma of skin 32 0.92 11 1.61 3 0.76 0 0.00 46 47.38 0.97 -0.07

Eye, orbit 5 2.22 2 4.71 2 8.22 1 8.71 10 3.03 3.29* 0.33

Brain, central nervous system 14 0.85 3 0.94 1 0.56 2 2.33 20 22.24 0.90 -0.11

Thyroid 23 1.29 4 1.27 3 1.76 2 2.51 32 23.52 1.36 0.41

Lymphatic, hematopoietic 198 1.83* 32 1.40 8 0.59 15 2.18* 253 151.49 1.67* 4.88

Hodgkin lymphoma 2 0.46 2 2.67 0 0.00 1 5.68 5 5.68 0.88 -0.03

Non-Hodgkin lymphoma 52 0.98 13 1.14 5 0.73 7 1.96 77 74.98 1.03 0.10

Myeloma 13 0.73 4 1.07 2 0.91 2 1.79 21 24.95 0.84 -0.19

Leukemia 131 3.97* 13 1.89* 1 0.25 5 2.47 150 45.88 3.27* 5.01

Acute lymphocytic 7 6.15* 1 4.40 0 0.00 0 0.00 8 1.55 5.17* 0.31

Chronic lymphocytic 9 0.72 2 0.76 0 0.00 2 2.68 13 17.34 0.75 -0.21

Acute non-lymphocytic 100 8.40* 6 2.43 1 0.68 2 2.59 109 16.62 6.56* 4.44

Chronic myeloid 10 2.16* 2 2.10 0 0.00 0 0.00 12 6.40 1.87 0.27

Ovary

Females, Long-term Follow-up

Table 9.2.3: Risk of subsequent primary cancers after cancer of the ovary, females,

long-term follow-up, SEER 1973-2000.

248 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

OVARY

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 41,489 7,411 3,956 1,866 41,489

Person-years in interval 160,398 27,227 14,106 6,290 208,021

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Ovary

Females, <50 Years of Age

Table 9.2.4: Risk of subsequent primary cancers after cancer of the ovary, females,

<50 years of age, SEER 1973-2000.

OVARY

All subsequent cancers 58 2.70* 144 1.71* 125 1.49* 186 1.19* 513 345.49 1.48* 19.56

All excluding same site 42 2.38* 115 1.65* 116 1.66* 185 1.39* 458 290.44 1.58* 19.56

Buccal cavity, pharynx 0 0.00 1 0.73 2 1.37 2 0.73 5 5.90 0.85 -0.11

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.03

Tongue 0 0.00 1 3.32 0 0.00 1 1.53 2 1.36 1.47 0.07

Salivary gland 0 0.00 0 0.00 0 0.00 1 2.94 1 0.88 1.14 0.01

Mouth 0 0.00 0 0.00 1 2.37 0 0.00 1 1.70 0.59 -0.08

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.05

Tonsil 0 0.00 0 0.00 1 6.29 0 0.00 1 0.62 1.61 0.04

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.02

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.04

Digestive system 13 7.17* 17 2.21* 19 2.14* 55 2.51* 104 40.28 2.58* 7.44

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 1.17 0.00 -0.14

Stomach 1 6.06 0 0.00 0 0.00 6 4.07* 7 2.96 2.37 0.47

Small intestine 0 0.00 0 0.00 0 0.00 1 2.04 1 0.99 1.01 0.00

Colon 6 7.76* 10 3.05* 10 2.60* 29 2.93* 55 17.80 3.09* 4.34

Rectum, rectosigmoid junction 2 5.28 3 1.83 7 3.74* 10 2.46* 22 7.95 2.77* 1.64

Rectum 1 3.89 3 2.74 4 3.26 6 2.22 14 5.28 2.65* 1.02

Anus, anal canal 1 16.37 1 3.98 0 0.00 2 3.95 4 1.09 3.69 0.34

Liver 0 0.00 0 0.00 0 0.00 1 1.60 1 1.15 0.87 -0.02

Gallbladder 0 0.00 0 0.00 1 6.03 0 0.00 1 0.75 1.33 0.03

Bile ducts, other biliary 1 28.61 0 0.00 0 0.00 2 4.16 3 0.85 3.54 0.25

Pancreas 2 11.41* 3 3.81 0 0.00 3 1.10 8 4.70 1.70 0.39

Respiratory system 3 2.16 10 1.60 14 1.76 22 1.04 49 36.75 1.33 1.43

Nose, nasal cavity, ear 0 0.00 0 0.00 1 9.77 0 0.00 1 0.42 2.39 0.07

Larynx 0 0.00 0 0.00 0 0.00 2 2.46 2 1.59 1.25 0.05

Lung, bronchus 3 2.34 10 1.72 13 1.75 20 0.99 46 34.61 1.33 1.33

Female breast 15 1.64 61 1.72* 44 1.29 52 0.91 172 135.68 1.27* 4.24

Female genital system 16 4.23* 29 1.99* 9 0.65 1 0.04* 55 55.05 1.00 -0.01

Cervix uteri 1 0.83 2 0.49 1 0.32 0 0.00 4 11.90 0.34* -0.92

Corpus uteri 11 9.19* 5 0.97 0 0.00* 1 0.09* 17 23.12 0.74 -0.71

Ovary 4 3.43 17 3.77* 7 1.64 0 0.00* 28 16.88 1.66* 1.30

Vagina 0 0.00 4 32.02* 1 8.05 0 0.00 5 0.52 9.67* 0.52

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 1.60 0.00 -0.19

Urinary system 2 3.99 4 1.86 6 2.43 12 1.99* 24 11.15 2.15* 1.50

Urinary bladder 0 0.00 3 3.12 1 0.87 6 1.98 10 5.37 1.86 0.54

Kidney parenchyma 2 7.67 1 0.91 3 2.49 3 1.13 9 5.21 1.73 0.44

Renal pelvis, other urinary 0 0.00 0 0.00 2 16.67* 3 8.73* 5 0.58 8.67* 0.52

Ureter 0 0.00 0 0.00 0 0.00 2 21.45* 2 0.14 14.04* 0.22

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.07

Soft tissue including heart 0 0.00 1 1.92 3 6.60* 2 2.85 6 1.82 3.30* 0.49

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.01

Melanoma of skin 3 2.28 3 0.62 1 0.25 6 1.14 13 15.49 0.84 -0.29

Eye, orbit 0 0.00 0 0.00 0 0.00 3 12.99* 3 0.54 5.55* 0.29

Brain, central nervous system 0 0.00 1 0.77 2 1.71 2 1.10 5 4.63 1.08 0.04

Thyroid 3 3.00 5 1.40 8 2.87* 7 2.23 23 10.49 2.19* 1.46

Lymphatic, hematopoietic 0 0.00 9 1.79 13 2.63* 16 1.63 38 21.07 1.80* 1.98

Hodgkin lymphoma 0 0.00 0 0.00 1 1.79 1 1.77 2 2.14 0.93 -0.02

Non-Hodgkin lymphoma 0 0.00 0 0.00 3 1.20 6 1.15 9 10.74 0.84 -0.20

Myeloma 0 0.00 0 0.00 0 0.00 1 0.70 1 2.53 0.40 -0.18

Leukemia 0 0.00 9 6.58* 9 6.77* 8 3.06* 26 5.66 4.59* 2.37

Acute lymphocytic 0 0.00 0 0.00 1 9.56 1 7.30 2 0.41 4.89 0.19

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 2 2.32 2 1.48 1.35 0.06

Acute non-lymphocytic 0 0.00 9 14.80* 6 10.67* 4 3.92* 19 2.35 8.08* 1.94

Chronic myeloid 0 0.00 0 0.00 2 8.11 0 0.00 2 1.00 2.00 0.12

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 11,414 10,007 5,864 3,398 11,414

Person-years in interval 8,886 30,378 22,586 23,808 85,658

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE UTERINE CORPUS AND OVARY 249
All subsequent cancers 131 0.98 373 0.97 336 1.16* 421 1.21* 1,261 1,154.37 1.09* 11.52

All excluding same site 113 1.01 362 1.11* 329 1.31* 410 1.33* 1,214 996.40 1.22* 23.51

Buccal cavity, pharynx 2 0.71 9 1.16 12 2.18* 6 1.02 29 21.92 1.32 0.77

Lip 0 0.00 0 0.00 0 0.00 1 2.35 1 1.20 0.83 -0.02

Tongue 2 3.17 4 2.29 4 3.22 1 0.78 11 4.90 2.24* 0.66

Salivary gland 0 0.00 0 0.00 0 0.00 1 1.56 1 2.18 0.46 -0.13

Mouth 0 0.00 3 1.18 4 2.18 2 0.98 9 7.35 1.23 0.18

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.93 0.00 -0.10

Tonsil 0 0.00 1 1.18 3 5.53* 0 0.00 4 2.18 1.84 0.20

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.07

Hypopharynx 0 0.00 1 1.57 1 2.28 0 0.00 2 1.72 1.16 0.03

Digestive system 32 1.37 71 1.02 86 1.49* 111 1.40* 300 229.82 1.31* 7.58

Esophagus 0 0.00 0 0.00 5 2.76 2 0.88 7 7.19 0.97 -0.02

Stomach 2 1.21 4 0.83 7 1.76 8 1.43 21 16.06 1.31 0.53

Small intestine 2 5.05 3 2.55 3 3.20 1 0.80 9 3.76 2.39* 0.57

Colon 18 1.65 38 1.16 39 1.40 53 1.33 148 111.48 1.33* 3.95

Rectum, rectosigmoid junction 4 0.92 15 1.19 17 1.74* 22 1.86* 58 38.56 1.50* 2.10

Rectum 2 0.71 10 1.23 15 2.37* 14 1.79 41 25.07 1.64* 1.72

Anus, anal canal 1 2.40 1 0.82 2 2.18 0 0.00 4 3.62 1.11 0.04

Liver 0 0.00 0 0.00 1 0.73 3 1.55 4 5.41 0.74 -0.15

Gallbladder 0 0.00 0 0.00 1 0.80 1 0.61 2 4.87 0.41 -0.31

Bile ducts, other biliary 1 2.25 1 0.73 2 1.66 4 2.10 8 4.92 1.63 0.33

Pancreas 3 1.00 7 0.77 6 0.78 15 1.38 31 30.62 1.01 0.04

Respiratory system 9 0.47* 43 0.75 55 1.20 71 1.30* 178 176.79 1.01 0.13

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 1.53 0.00 -0.16

Larynx 1 1.22 1 0.45 1 0.65 4 2.82 7 6.01 1.17 0.11

Lung, bronchus 8 0.44* 42 0.77 54 1.24 67 1.27 171 168.84 1.01 0.23

Female breast 36 0.84 125 1.04 95 1.09 116 1.21* 372 345.84 1.08 2.83

Female genital system 18 0.84 11 0.19* 7 0.18* 11 0.28* 47 157.97 0.30* -11.99

Cervix uteri 3 1.20 1 0.16* 0 0.00 2 0.67 6 15.24 0.39* -1.00

Corpus uteri 12 1.00 8 0.25* 5 0.23* 1 0.05* 26 86.49 0.30* -6.54

Ovary 1 0.17* 1 0.06* 1 0.09* 2 0.16* 5 45.61 0.11* -4.39

Vagina 0 0.00 0 0.00 1 2.02 3 4.90 4 1.98 2.02 0.22

Vulva 1 1.78 1 0.60 0 0.00 3 1.50 5 5.61 0.89 -0.07

Urinary system 8 1.44 20 1.21 17 1.26 39 2.20* 84 53.44 1.57* 3.30

Urinary bladder 3 0.99 12 1.31 14 1.84* 26 2.50* 55 30.20 1.82* 2.68

Kidney parenchyma 4 1.90 7 1.13 3 0.62 9 1.52 23 19.10 1.20 0.42

Renal pelvis, other urinary 1 2.45 1 0.81 0 0.00 4 2.75 6 4.15 1.45 0.20

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 1.25 0.00 -0.14

Bone, joints 0 0.00 0 0.00 3 12.04* 1 3.51 4 1.00 3.99* 0.32

Soft tissue including heart 2 3.97 0 0.00 2 1.90 2 1.52 6 4.29 1.40 0.18

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.02

Melanoma of skin 7 2.41 7 0.86 6 1.05 6 0.93 26 23.26 1.12 0.30

Eye, orbit 3 13.34* 0 0.00 1 2.28 2 4.20 6 1.76 3.41* 0.46

Brain, central nervous system 1 0.64 3 0.68 4 1.24 4 1.11 12 12.75 0.94 -0.08

Thyroid 1 0.67 4 1.01 1 0.41 1 0.44 7 10.21 0.69 -0.35

Lymphatic, hematopoietic 11 1.30 68 2.69* 39 1.88* 35 1.26 153 82.32 1.86* 7.64

Hodgkin lymphoma 1 3.11 0 0.00 0 0.00 2 3.01 3 2.46 1.22 0.06

Non-Hodgkin lymphoma 5 1.18 14 1.09 8 0.76 18 1.27 45 41.87 1.07 0.34

Myeloma 2 1.38 3 0.70 4 1.12 6 1.26 15 14.08 1.07 0.10

Leukemia 3 1.22 51 7.03* 27 4.55* 9 1.09 90 23.91 3.76* 7.14

Acute lymphocytic 0 0.00 5 20.03* 0 0.00 0 0.00 5 0.75 6.69* 0.46

Chronic lymphocytic 0 0.00 2 0.70 2 0.83 1 0.31 5 9.49 0.53 -0.49

Acute non-lymphocytic 2 2.28 41 15.74* 21 9.88* 5 1.66 69 8.62 8.01* 6.52

Chronic myeloid 1 2.85 1 1.00 2 2.56 1 0.93 5 3.20 1.56 0.19

Ovary

Females, 50-69 Years of Age

Table 9.2.5: Risk of subsequent primary cancers after cancer of the ovary, females,

50-69 years of age, SEER 1973-2000.

250 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

OVARY

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 18,906 14,579 6,017 3,271 18,906

Person-years in interval 13,734 35,699 22,225 20,886 92,544

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Ovary

Females, ≥70 Years of Age

Table 9.2.6: Risk of subsequent primary cancers after cancer of the ovary, females,

≥70 years of age, SEER 1973-2000.

OVARY

All subsequent cancers 75 0.63* 197 0.78* 114 0.98 55 0.96 441 544.97 0.81* -34.87

All excluding same site 65 0.61* 191 0.85* 108 1.03 55 1.05 419 488.89 0.86* -23.44

Buccal cavity, pharynx 1 0.51 4 0.99 2 1.11 1 1.11 8 8.73 0.92 -0.24

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.84 0.00 -0.28

Tongue 0 0.00 3 3.43 0 0.00 0 0.00 3 1.89 1.59 0.37

Salivary gland 1 4.46 0 0.00 0 0.00 0 0.00 1 1.05 0.95 -0.02

Mouth 0 0.00 0 0.00 2 2.91 1 2.83 3 3.26 0.92 -0.09

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.09

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.51 0.00 -0.17

Oropharynx 0 0.00 1 11.20 0 0.00 0 0.00 1 0.18 5.54 0.27

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.15

Digestive system 23 0.70 51 0.72* 40 1.13 21 1.12 135 158.51 0.85 -7.88

Esophagus 1 1.25 1 0.59 1 1.24 0 0.00 3 3.73 0.80 -0.25

Stomach 0 0.00 6 1.04 1 0.34 2 1.28 9 12.92 0.70 -1.31

Small intestine 2 5.02 1 1.15 0 0.00 1 4.62 4 1.90 2.11 0.71

Colon 13 0.77 23 0.63* 21 1.12 8 0.79 65 82.58 0.79 -5.89

Rectum, rectosigmoid junction 2 0.41 10 0.97 7 1.45 2 0.85 21 22.40 0.94 -0.47

Rectum 2 0.62 3 0.44 5 1.56 1 0.62 11 14.85 0.74 -1.29

Anus, anal canal 0 0.00 0 0.00 1 2.91 1 5.70 2 1.63 1.23 0.12

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 3.20 0.00 -1.07

Gallbladder 1 1.25 1 0.60 0 0.00 1 2.49 3 3.67 0.82 -0.23

Bile ducts, other biliary 0 0.00 3 1.82 1 1.14 1 1.96 5 3.77 1.33 0.41

Pancreas 2 0.46 6 0.64 8 1.72 5 2.01 21 20.84 1.01 0.05

Respiratory system 5 0.33* 17 0.54* 14 1.06 7 1.27 43 65.49 0.66* -7.54

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -0.26

Larynx 1 2.70 1 1.36 0 0.00 0 0.00 2 1.48 1.35 0.17

Lung, bronchus 4 0.28* 16 0.52* 14 1.10 7 1.32 41 63.04 0.65* -7.39

Female breast 21 0.70 53 0.84 36 1.31 16 1.25 126 133.26 0.95 -2.44

Female genital system 10 0.76 6 0.23* 6 0.54 0 0.00* 22 56.08 0.39* -11.43

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 4.84 0.00* -1.62

Corpus uteri 8 1.21 4 0.30* 1 0.19 0 0.00 13 27.00 0.48* -4.69

Ovary 1 0.25 0 0.00* 1 0.28 0 0.00 2 17.42 0.11* -5.17

Vagina 1 3.99 0 0.00 0 0.00 0 0.00 1 1.18 0.85 -0.06

Vulva 0 0.00 1 0.56 4 4.35* 0 0.00 5 4.05 1.23 0.32

Urinary system 4 0.63 12 0.88 5 0.78 1 0.30 22 29.67 0.74 -2.57

Urinary bladder 0 0.00* 9 1.06 3 0.72 0 0.00 12 18.74 0.64 -2.26

Kidney parenchyma 4 2.20 3 0.77 2 1.16 1 1.23 10 8.24 1.21 0.59

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 2.68 0.00 -0.90

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.86 0.00 -0.29

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.16

Soft tissue including heart 0 0.00 0 0.00 1 2.05 1 3.85 2 2.19 0.91 -0.06

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.12

Melanoma of skin 1 0.54 4 1.01 0 0.00 2 1.99 7 8.63 0.81 -0.55

Eye, orbit 0 0.00 1 2.94 0 0.00 0 0.00 1 0.73 1.36 0.09

Brain, central nervous system 1 0.88 2 0.85 0 0.00 0 0.00 3 4.86 0.62 -0.62

Thyroid 0 0.00 1 0.74 0 0.00 1 4.11 2 2.82 0.71 -0.27

Lymphatic, hematopoietic 9 0.88 39 1.78* 10 0.95 4 0.74 62 48.10 1.29 4.66

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.07 0.00 -0.36

Non-Hodgkin lymphoma 5 1.05 12 1.16 5 1.03 1 0.41 23 22.37 1.03 0.21

Myeloma 2 1.11 2 0.52 0 0.00 1 1.15 5 8.34 0.60 -1.12

Leukemia 2 0.59 25 3.44* 5 1.37 2 0.98 34 16.31 2.08* 5.93

Acute lymphocytic 0 0.00 0 0.00 1 11.32 0 0.00 1 0.39 2.55 0.20

Chronic lymphocytic 1 0.75 2 0.70 2 1.42 1 1.30 6 6.37 0.94 -0.12

Acute non-lymphocytic 1 0.86 19 7.49* 1 0.79 0 0.00 21 5.65 3.72* 5.15

Chronic myeloid 0 0.00 3 3.11 1 2.00 1 3.40 5 2.20 2.27 0.94

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 11,169 6,665 1,936 742 11,169

Person-years in interval 6,844 13,980 6,066 2,930 29,819

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE UTERINE CORPUS AND OVARY 251
All subsequent cancers 28 1.43 79 1.33* 74 1.25 167 1.40* 348 257.12 1.35* 34.52

All excluding same site 26 1.61* 74 1.49* 71 1.40* 163 1.56* 334 220.67 1.51* 43.05

Buccal cavity, pharynx 0 0.00 3 2.41 3 2.55 3 1.44 9 4.91 1.83 1.55

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.11

Tongue 0 0.00 2 7.57 1 3.85 2 4.30 5 1.08 4.64* 1.49

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.51 0.00 -0.20

Mouth 0 0.00 1 2.35 2 5.03 1 1.42 4 1.67 2.40 0.89

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.08

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.18

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.14

Digestive system 8 1.97 14 1.15 14 1.13 46 1.83* 82 53.79 1.52* 10.72

Esophagus 0 0.00 0 0.00 0 0.00 2 2.79 2 1.53 1.30 0.18

Stomach 1 2.98 2 2.06 2 2.14 4 2.24 9 4.03 2.23* 1.89

Small intestine 1 18.69 0 0.00 0 0.00 1 2.50 2 0.79 2.54 0.46

Colon 5 2.54 7 1.18 7 1.15 25 1.99* 44 26.54 1.66* 6.63

Rectum, rectosigmoid junction 0 0.00 2 0.91 4 1.86 5 1.27 11 9.03 1.22 0.75

Rectum 0 0.00 1 0.71 4 2.91 4 1.54 9 5.85 1.54 1.19

Anus, anal canal 0 0.00 0 0.00 0 0.00 1 2.70 1 0.78 1.28 0.08

Liver 0 0.00 0 0.00 0 0.00 2 3.40 2 1.14 1.76 0.33

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.21 0.00 -0.46

Bile ducts, other biliary 1 13.43 0 0.00 0 0.00 0 0.00 1 1.12 0.89 -0.05

Pancreas 0 0.00 3 1.99 1 0.63 4 1.19 8 6.94 1.15 0.40

Respiratory system 1 0.46 6 0.85 9 1.16 19 1.09 35 34.44 1.02 0.21

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.13

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.22 0.00 -0.47

Lung, bronchus 1 0.49 6 0.90 9 1.22 19 1.13 35 32.77 1.07 0.85

Female breast 11 1.89 30 1.69* 27 1.52* 40 1.13 108 76.53 1.41* 11.96

Female genital system 2 0.59 5 0.51 3 0.35 4 0.27* 14 36.45 0.38* -8.53

Cervix uteri 0 0.00 0 0.00 0 0.00 1 0.68 1 4.40 0.23 -1.29

Corpus uteri 2 1.08 3 0.57 2 0.45 1 0.13* 8 19.12 0.42* -4.22

Ovary 0 0.00 1 0.39 0 0.00 0 0.00* 1 10.38 0.10* -3.56

Vagina 0 0.00 0 0.00 1 9.11 1 4.86 2 0.47 4.28 0.58

Vulva 0 0.00 1 3.37 0 0.00 1 1.51 2 1.36 1.47 0.24

Urinary system 2 2.48 4 1.61 4 1.54 18 3.15* 28 11.60 2.41* 6.23

Urinary bladder 1 2.11 4 2.75 2 1.33 12 3.64* 19 6.73 2.82* 4.66

Kidney parenchyma 1 3.81 0 0.00 2 2.28 6 3.04* 9 3.93 2.29* 1.93

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.95 0.00 -0.36

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.11

Bone, joints 0 0.00 0 0.00 1 16.88 1 9.35 2 0.25 7.95 0.66

Soft tissue including heart 0 0.00 0 0.00 3 13.18* 2 4.28 5 1.00 4.98* 1.52

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.03

Melanoma of skin 2 5.16 1 0.79 1 0.77 3 1.15 7 5.54 1.26 0.56

Eye, orbit 1 27.24 0 0.00 0 0.00 0 0.00 1 0.41 2.44 0.22

Brain, central nervous system 1 4.28 1 1.40 0 0.00 2 1.58 4 2.90 1.38 0.42

Thyroid 0 0.00 0 0.00 0 0.00 3 2.64 3 2.74 1.09 0.10

Lymphatic, hematopoietic 0 0.00 12 2.99* 9 2.15 16 1.77* 37 18.54 2.00* 7.01

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 1 3.64 1 0.71 1.42 0.11

Non-Hodgkin lymphoma 0 0.00 1 0.54 3 1.49 8 1.75 12 9.07 1.32 1.11

Myeloma 0 0.00 0 0.00 0 0.00 2 1.35 2 3.08 0.65 -0.41

Leukemia 0 0.00 11 8.63* 6 4.65* 5 1.85 22 5.69 3.87* 6.20

Acute lymphocytic 0 0.00 1 24.72 0 0.00 1 11.64 2 0.18 10.98* 0.69

Chronic lymphocytic 0 0.00 0 0.00 2 3.98 2 1.91 4 2.20 1.82 0.68

Acute non-lymphocytic 0 0.00 10 22.08* 4 8.77* 1 1.03 15 2.03 7.39* 4.93

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -0.30

Ovary

Females, Radiotherapy

Table 9.2.7: Risk of subsequent primary cancers after cancer of the ovary, females,

with initial radiotherapy, SEER 1973-2000.

252 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

OVARY

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,462 2,628 1,499 1,117 3,462

Person-years in interval 2,501 7,483 6,458 9,881 26,323

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Ovary

Females, No Radiotherapy

Table 9.2.8: Risk of subsequent primary cancers after cancer of the ovary, females,

without initial radiotherapy, SEER 1973-2000.

OVARY

All subsequent cancers 236 0.93 635 0.96 501 1.16* 495 1.12* 1,867 1,787.71 1.04 4.36

All excluding same site 194 0.88 594 1.04 482 1.28* 487 1.25* 1,757 1,555.05 1.13* 11.11

Buccal cavity, pharynx 3 0.64 11 0.92 13 1.71 6 0.81 33 31.63 1.04 0.08

Lip 0 0.00 0 0.00 0 0.00 1 1.92 1 2.01 0.50 -0.06

Tongue 2 1.93 6 2.26 3 1.76 0 0.00 11 7.07 1.55 0.22

Salivary gland 1 1.95 0 0.00 0 0.00 2 2.28 3 3.60 0.83 -0.03

Mouth 0 0.00 2 0.50 5 1.97 2 0.80 9 10.64 0.85 -0.09

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.40 0.00 -0.08

Tonsil 0 0.00 1 0.90 4 5.90* 0 0.00 5 2.84 1.76 0.12

Oropharynx 0 0.00 1 3.28 0 0.00 0 0.00 1 0.79 1.26 0.01

Hypopharynx 0 0.00 1 1.20 1 1.93 0 0.00 2 2.17 0.92 -0.01

Digestive system 60 1.11 125 0.92 131 1.46* 141 1.49* 457 374.82 1.22* 4.52

Esophagus 1 0.66 1 0.26 6 2.39 0 0.00 8 10.56 0.76 -0.14

Stomach 2 0.48 8 0.78 6 0.90 12 1.75 28 27.91 1.00 0.00

Small intestine 3 3.77 4 1.91 3 2.13 2 1.28 12 5.86 2.05* 0.34

Colon 32 1.20 64 0.96 63 1.42* 65 1.37* 224 185.32 1.21* 2.13

Rectum, rectosigmoid junction 8 0.90 26 1.17 27 1.89* 29 2.02* 90 59.88 1.50* 1.66

Rectum 5 0.86 15 1.03 20 2.13* 17 1.78* 57 39.34 1.45* 0.97

Anus, anal canal 2 2.56 2 0.98 3 2.23 2 1.45 9 5.55 1.62 0.19

Liver 0 0.00 0 0.00 1 0.48 2 0.87 3 8.62 0.35 -0.31

Gallbladder 1 0.81 1 0.33 2 1.04 2 1.04 6 8.08 0.74 -0.11

Bile ducts, other biliary 1 0.88 4 1.36 3 1.49 7 3.03* 15 8.41 1.78 0.36

Pancreas 7 1.00 13 0.73 13 1.10 19 1.49 52 49.21 1.06 0.15

Respiratory system 16 0.48* 64 0.72* 74 1.25 81 1.27* 235 244.58 0.96 -0.53

Nose, nasal cavity, ear 0 0.00 0 0.00 1 1.75 0 0.00 1 2.38 0.42 -0.08

Larynx 2 1.72 2 0.67 1 0.53 6 3.30* 11 7.86 1.40 0.17

Lung, bronchus 14 0.44* 62 0.74* 72 1.28 75 1.22 223 233.72 0.95 -0.59

Female breast 61 0.80 209 1.04 148 1.13 144 1.11 562 538.26 1.04 1.31

Female genital system 42 1.20 41 0.46* 19 0.34* 8 0.15* 110 232.66 0.47* -6.75

Cervix uteri 4 0.91 3 0.27* 1 0.15* 1 0.19 9 27.58 0.33* -1.02

Corpus uteri 29 1.62* 14 0.31* 4 0.14* 1 0.04* 48 117.49 0.41* -3.82

Ovary 6 0.59 17 0.65 9 0.54 2 0.12* 34 69.53 0.49* -1.96

Vagina 1 2.11 4 3.35 1 1.30 2 2.59 8 3.21 2.49* 0.26

Vulva 1 0.72 1 0.28 4 1.68 2 0.78 8 9.91 0.81 -0.10

Urinary system 12 1.04 32 1.07 24 1.21 34 1.59* 102 82.66 1.23* 1.06

Urinary bladder 2 0.30 20 1.17 16 1.40 20 1.62 58 47.58 1.22 0.57

Kidney parenchyma 9 2.29* 11 1.06 6 0.87 7 0.95 33 28.62 1.15 0.24

Renal pelvis, other urinary 1 1.07 1 0.43 2 1.30 7 4.28* 11 6.46 1.70 0.25

Ureter 0 0.00 0 0.00 0 0.00 2 4.04 2 1.96 1.02 0.00

Bone, joints 0 0.00 0 0.00 2 4.63 0 0.00 2 1.78 1.12 0.01

Soft tissue including heart 2 1.95 1 0.37 3 1.70 3 1.66 9 7.30 1.23 0.09

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.03

Melanoma of skin 9 1.59 13 0.83 6 0.58 11 1.09 39 41.84 0.93 -0.16

Eye, orbit 2 5.08 1 1.01 1 1.60 5 8.15* 9 2.63 3.43* 0.35

Brain, central nervous system 1 0.36 5 0.68 6 1.28 4 0.88 16 19.34 0.83 -0.18

Thyroid 4 1.37 10 1.22 9 1.75 6 1.32 29 20.77 1.40 0.45

Lymphatic, hematopoietic 20 1.07 104 2.16* 53 1.66* 39 1.14 216 132.95 1.62* 4.57

Hodgkin lymphoma 1 1.35 0 0.00 1 0.82 2 1.91 4 4.97 0.80 -0.05

Non-Hodgkin lymphoma 10 1.11 25 1.05 13 0.82 17 0.99 65 65.91 0.99 -0.05

Myeloma 4 1.28 5 0.63 4 0.77 6 1.07 19 21.88 0.87 -0.16

Leukemia 5 0.87 74 5.07* 35 3.63* 14 1.37 128 40.19 3.18* 4.83

Acute lymphocytic 0 0.00 4 7.80* 2 5.95 0 0.00 6 1.37 4.39* 0.26

Chronic lymphocytic 1 0.46 4 0.73 2 0.55 2 0.52 9 15.14 0.59 -0.34

Acute non-lymphocytic 3 1.46 59 11.14* 24 6.86* 8 2.14 94 14.59 6.44* 4.37

Chronic myeloid 1 1.24 4 1.95 5 3.70* 2 1.43 12 5.61 2.14* 0.35

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 38,027 28,623 12,318 6,294 38,027

Person-years in interval 26,963 72,575 44,418 37,742 181,698

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE UTERINE CORPUS AND OVARY 253
All subsequent cancers 181 1.31* 74 1.45* 50 1.26 43 1.53* 348 257.12 1.35* 34.52

All excluding same site 171 1.47* 73 1.64* 49 1.41* 41 1.64* 334 220.67 1.51* 43.05

Buccal cavity, pharynx 6 2.12 1 1.07 2 2.93 0 0.00 9 4.91 1.83 1.55

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.11

Tongue 3 4.91 1 4.77 1 6.48 0 0.00 5 1.08 4.64* 1.49

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.51 0.00 -0.20

Mouth 3 3.11 0 0.00 1 4.37 0 0.00 4 1.67 2.40 0.89

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.08

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.18

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.14

Digestive system 36 1.26 19 1.78* 15 1.80* 12 1.96* 82 53.79 1.52* 10.72

Esophagus 0 0.00 0 0.00 2 8.49 0 0.00 2 1.53 1.30 0.18

Stomach 5 2.23 2 2.58 1 1.69 1 2.39 9 4.03 2.23* 1.89

Small intestine 1 2.58 1 6.37 0 0.00 0 0.00 2 0.79 2.54 0.46

Colon 19 1.36 11 2.06* 6 1.45 8 2.61* 44 26.54 1.66* 6.63

Rectum, rectosigmoid junction 6 1.18 2 1.14 2 1.56 1 1.12 11 9.03 1.22 0.75

Rectum 5 1.53 1 0.88 2 2.36 1 1.64 9 5.85 1.54 1.19

Anus, anal canal 0 0.00 1 6.34 0 0.00 0 0.00 1 0.78 1.28 0.08

Liver 0 0.00 2 8.89 0 0.00 0 0.00 2 1.14 1.76 0.33

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.21 0.00 -0.46

Bile ducts, other biliary 1 1.87 0 0.00 0 0.00 0 0.00 1 1.12 0.89 -0.05

Pancreas 4 1.11 0 0.00 3 2.68 1 1.20 8 6.94 1.15 0.40

Respiratory system 16 0.94 12 1.68 6 1.02 1 0.23 35 34.44 1.02 0.21

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.13

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.22 0.00 -0.47

Lung, bronchus 16 1.00 12 1.76 6 1.06 1 0.24 35 32.77 1.07 0.85

Female breast 68 1.65* 14 0.90 14 1.20 12 1.49 108 76.53 1.41* 11.96

Female genital system 10 0.46* 1 0.15* 1 0.21 2 0.63 14 36.45 0.38* -8.53

Cervix uteri 0 0.00 0 0.00 0 0.00 1 3.93 1 4.40 0.23 -1.29

Corpus uteri 7 0.60 0 0.00 0 0.00 1 0.61 8 19.12 0.42* -4.22

Ovary 1 0.17* 0 0.00 0 0.00 0 0.00 1 10.38 0.10* -3.56

Vagina 1 3.81 0 0.00 1 14.91 0 0.00 2 0.47 4.28 0.58

Vulva 1 1.44 1 3.68 0 0.00 0 0.00 2 1.36 1.47 0.24

Urinary system 10 1.70 9 3.81* 4 2.08 5 3.51* 28 11.60 2.41* 6.23

Urinary bladder 7 2.04 7 5.13* 3 2.72 2 2.42 19 6.73 2.82* 4.66

Kidney parenchyma 3 1.53 2 2.46 1 1.50 3 6.14* 9 3.93 2.29* 1.93

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.95 0.00 -0.36

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.11

Bone, joints 1 6.92 1 21.49 0 0.00 0 0.00 2 0.25 7.95 0.66

Soft tissue including heart 3 5.60* 1 5.13 1 6.29 0 0.00 5 1.00 4.98* 1.52

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.03

Melanoma of skin 4 1.36 1 0.91 2 2.32 0 0.00 7 5.54 1.26 0.56

Eye, orbit 1 4.16 0 0.00 0 0.00 0 0.00 1 0.41 2.44 0.22

Brain, central nervous system 2 1.22 1 1.77 0 0.00 1 3.54 4 2.90 1.38 0.42

Thyroid 0 0.00 0 0.00 1 2.67 2 8.07 3 2.74 1.09 0.10

Lymphatic, hematopoietic 21 2.21* 8 2.13 2 0.66 6 2.68 37 18.54 2.00* 7.01

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 1 17.71 1 0.71 1.42 0.11

Non-Hodgkin lymphoma 4 0.89 5 2.68 2 1.29 1 0.86 12 9.07 1.32 1.11

Myeloma 0 0.00 1 1.61 0 0.00 1 2.77 2 3.08 0.65 -0.41

Leukemia 17 5.69* 2 1.75 0 0.00 3 4.58 22 5.69 3.87* 6.20

Acute lymphocytic 1 10.39 1 25.73 0 0.00 0 0.00 2 0.18 10.98* 0.69

Chronic lymphocytic 2 1.74 0 0.00 0 0.00 2 8.23 4 2.20 1.82 0.68

Acute non-lymphocytic 14 13.25* 0 0.00 0 0.00 1 3.99 15 2.03 7.39* 4.93

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -0.30

Ovary

Females, Long-term Follow-up, Radiotherapy

Table 9.2.9: Risk of subsequent primary cancers after cancer of the ovary, females, long-term follow-up,

with initial radiotherapy, SEER 1973-2000.

254 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

OVARY

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 3,462 1,117 770 510 3,462

Person-years in interval 16,442 4,722 3,187 1,972 26,323

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Ovary

Females, Long-term Follow-up, No Radiotherapy

Table 9.2.10: Risk of subsequent primary cancers after cancer of the ovary, females, long-term follow-up,

without initial radiotherapy, SEER 1973-2000.

OVARY

All subsequent cancers 1,372 1.02 271 1.09 166 1.24* 58 0.99 1,867 1,787.71 1.04 4.36

All excluding same site 1,270 1.09* 267 1.22* 163 1.38* 57 1.10 1,757 1,555.05 1.13* 11.11

Buccal cavity, pharynx 27 1.11 4 0.94 2 0.90 0 0.00 33 31.63 1.04 0.08

Lip 0 0.00 0 0.00 1 6.23 0 0.00 1 2.01 0.50 -0.06

Tongue 11 2.03* 0 0.00 0 0.00 0 0.00 11 7.07 1.55 0.22

Salivary gland 1 0.37 2 4.05 0 0.00 0 0.00 3 3.60 0.83 -0.03

Mouth 7 0.86 1 0.69 1 1.33 0 0.00 9 10.64 0.85 -0.09

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.40 0.00 -0.08

Tonsil 5 2.24 0 0.00 0 0.00 0 0.00 5 2.84 1.76 0.12

Oropharynx 1 1.62 0 0.00 0 0.00 0 0.00 1 0.79 1.26 0.01

Hypopharynx 2 1.19 0 0.00 0 0.00 0 0.00 2 2.17 0.92 -0.01

Digestive system 316 1.13* 70 1.32* 53 1.84* 18 1.40 457 374.82 1.22* 4.52

Esophagus 8 1.01 0 0.00 0 0.00 0 0.00 8 10.56 0.76 -0.14

Stomach 16 0.76 5 1.29 6 2.92* 1 1.11 28 27.91 1.00 0.00

Small intestine 10 2.32* 2 2.35 0 0.00 0 0.00 12 5.86 2.05* 0.34

Colon 159 1.15 37 1.40 20 1.39 8 1.24 224 185.32 1.21* 2.13

Rectum, rectosigmoid junction 61 1.34* 9 1.10 16 3.74* 4 2.15 90 59.88 1.50* 1.66

Rectum 40 1.34 5 0.92 10 3.48* 2 1.57 57 39.34 1.45* 0.97

Anus, anal canal 7 1.68 1 1.29 1 2.37 0 0.00 9 5.55 1.62 0.19

Liver 1 0.16* 0 0.00 1 1.40 1 2.95 3 8.62 0.35 -0.31

Gallbladder 4 0.65 1 0.91 0 0.00 1 4.13 6 8.08 0.74 -0.11

Bile ducts, other biliary 8 1.31 5 3.99* 2 2.78 0 0.00 15 8.41 1.78 0.36

Pancreas 33 0.90 10 1.41 6 1.54 3 1.71 52 49.21 1.06 0.15

Respiratory system 154 0.85* 46 1.30 26 1.32 9 1.02 235 244.58 0.96 -0.53

Nose, nasal cavity, ear 1 0.56 0 0.00 0 0.00 0 0.00 1 2.38 0.42 -0.08

Larynx 5 0.83 4 3.78* 2 3.73 0 0.00 11 7.86 1.40 0.17

Lung, bronchus 148 0.86 42 1.24 24 1.27 9 1.06 223 233.72 0.95 -0.59

Female breast 418 1.02 80 1.08 49 1.25 15 0.89 562 538.26 1.04 1.31

Female genital system 102 0.57* 4 0.13* 3 0.19* 1 0.15* 110 232.66 0.47* -6.75

Cervix uteri 8 0.36* 1 0.30 0 0.00 0 0.00 9 27.58 0.33* -1.02

Corpus uteri 47 0.52* 1 0.07* 0 0.00* 0 0.00 48 117.49 0.41* -3.82

Ovary 32 0.60* 1 0.11* 1 0.20 0 0.00 34 69.53 0.49* -1.96

Vagina 6 2.46 0 0.00 1 4.35 1 9.98 8 3.21 2.49* 0.26

Vulva 6 0.82 1 0.70 1 1.26 0 0.00 8 9.91 0.81 -0.10

Urinary system 68 1.11 17 1.43 15 2.29* 2 0.68 102 82.66 1.23* 1.06

Urinary bladder 38 1.08 9 1.31 11 2.91* 0 0.00 58 47.58 1.22 0.57

Kidney parenchyma 26 1.22 4 0.97 2 0.88 1 0.99 33 28.62 1.15 0.24

Renal pelvis, other urinary 4 0.83 4 4.39* 2 4.00 1 4.42 11 6.46 1.70 0.25

Ureter 0 0.00 1 3.62 1 6.62 0 0.00 2 1.96 1.02 0.00

Bone, joints 2 1.45 0 0.00 0 0.00 0 0.00 2 1.78 1.12 0.01

Soft tissue including heart 6 1.09 2 1.97 0 0.00 1 4.16 9 7.30 1.23 0.09

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.03

Melanoma of skin 28 0.88 10 1.75 1 0.33 0 0.00 39 41.84 0.93 -0.16

Eye, orbit 4 1.99 2 5.70 2 10.80* 1 12.93 9 2.63 3.43* 0.35

Brain, central nervous system 12 0.81 2 0.76 1 0.74 1 1.74 16 19.34 0.83 -0.18

Thyroid 23 1.42 4 1.51 2 1.50 0 0.00 29 20.77 1.40 0.45

Lymphatic, hematopoietic 177 1.79* 24 1.26 6 0.58 9 1.94 216 132.95 1.62* 4.57

Hodgkin lymphoma 2 0.51 2 3.22 0 0.00 0 0.00 4 4.97 0.80 -0.05

Non-Hodgkin lymphoma 48 0.99 8 0.84 3 0.57 6 2.50 65 65.91 0.99 -0.05

Myeloma 13 0.80 3 0.96 2 1.17 1 1.32 19 21.88 0.87 -0.16

Leukemia 114 3.80* 11 1.92 1 0.32 2 1.46 128 40.19 3.18* 4.83

Acute lymphocytic 6 5.76* 0 0.00 0 0.00 0 0.00 6 1.37 4.39* 0.26

Chronic lymphocytic 7 0.62 2 0.92 0 0.00 0 0.00 9 15.14 0.59 -0.34

Acute non-lymphocytic 86 7.93* 6 2.89* 1 0.87 1 1.91 94 14.59 6.44* 4.37

Chronic myeloid 10 2.37* 2 2.52 0 0.00 0 0.00 12 5.61 2.14* 0.35

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 38,027 6,294 3,186 1,356 38,027

Person-years in interval 143,956 22,506 10,919 4,318 181,698

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE UTERINE CORPUS AND OVARY 255

NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 257

Synopsis

The risk of subsequent primary cancer was evaluated

in more than 308,000 men diagnosed between 1973 and

2000 with cancer of the prostate, testis, or penis. The

overall risk for new cancers was significantly increased

among survivors of testis cancer (O/E=1.62, O=803,

EAR=21 per 10,000 person-years), but not of penile cancer (O/E=1.12, O=293, EAR=26). The overall risk for

new cancers was significantly decreased among survivors of prostate cancer (O/E=0.90,1 O=27,112). Prostate

cancer was associated with excess melanoma and subsequent cancers of the small intestine, soft tissue, bladder, thyroid, and thymus. The risk of new malignancies

varied by age at prostate cancer diagnosis, with significant excesses seen only among younger men (ages <50

years). Treatment for prostate cancer with radiotherapy

may have contributed to the observed excess of certain

solid tumors occurring within the abdominal and

pelvic fields, particularly bladder cancer. Risks for subsequent acute non-lymphocytic leukemia (ANLL) and

cancers of the rectum, pancreas, testis, bladder, and kidney were significantly increased following testis cancer. Men with seminoma of the testis had substantially

higher increased risks of new malignancies, excluding

contralateral testis, than men with non-seminoma.

Radiation treatment for testis cancer appeared to contribute to the increased risk for certain solid tumors,

while chemotherapy and radiotherapy appeared largely

responsible for the elevated risk of ANLL. Smoking

may have contributed to the elevated risks for subsequent buccal cavity and lung cancers among patients

with penile cancer, although alcohol consumption and

infection with human papillomavirus may also have

played a role in new cancers of the buccal cavity.

Prostate Cancer

Prostate carcinoma, the most common malignancy

among American men, constitutes 33% of all new cancer

cases and 10% of all cancer deaths among males (Jemal

et al, 2005). The introduction of prostate-specific antigen

(PSA) screening in the late 1980s was associated with a

doubling of the observed incidence of prostate cancer;

approximately 75% of prostate cancer cases are now

diagnosed while the disease is still clinically organconfined, whereas only 25% of prostate cancers were

localized prior to PSA screening (Catalona et al, 1993).

The incidence of prostate cancer varies with race, with

low rates among Asians and the highest rates among

blacks, who typically present with more advanced disease, and may have a poorer prognosis within each

stage category, than white patients (Pienta et al, 1995).

Overall, the 5- and 10-year relative survival rates are

99.3% and 88.7%, respectively. Therapy for prostate

cancer is not standardized for any stage, and treatment

decisions are based on tumor stage and grade combined

with an assessment of patient age and performance

status (Bahnson et al, 2000). Approximately 26% of

patients are treated initially with radiotherapy to a

pelvic field encompassing a portion of the rectum and

dome of the bladder. More recent radiation strategies,

including interstitial brachytherapy and 3-dimensional

conformational radiotherapy, produce lower radiation

doses to adjacent normal tissue. Radical prostatectomy

is frequently the initial therapy in younger patients,

who may present with higher-grade tumors. Hormonal

therapy and chemotherapy are generally reserved for

patients with metastatic disease.

Established risk factors for prostate cancer include

age, family history, and ethnicity (Key, 1995). Diet,

including fat intake, is also associated with prostate

cancer risk (Giovannucci et al, 1993), while the roles of

smoking, body weight, and vasectomy remain uncertain

(Key, 1995).

Results and Discussion

We observed a significant overall deficit of subsequent

primary cancers, excluding subsequent prostate cancer,

among 292,029 patients at risk (O/E=0.90, O=27,112,

95% CI=0.89-0.91). The cumulative incidence of developing any second cancer following prostate cancer,

adjusted for the competing risk of death due to other

causes, was 15.2% at 25 years (95% CI=15.0%-15.4%).

The deficit in relative risk (O/E) of subsequent cancers

was observed only for whites and persisted throughout

20 years of follow-up. In contrast, no significant overall

deficit or excess was observed among blacks (O/E=1.00

Chapter 10

MALE GENITAL TRACT

New Malignancies Following 

Cancer of the Male Genital Tract

Mary L. McMaster, Eric J. Feuer, Margaret A. Tucker

1

Observed-to-expected ratios for prostrate cancer exclude

subsequent primary prostate cancers.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated

as [(O-E)/PYR]10,000).

Author affiliations: Mary L. McMaster and Margaret A. Tucker,

Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS; Eric

J. Feuer, Division of Cancer Control and Population Sciences, NCI,

NIH, DHHS.
excluding subsequent prostate cancers, O=2,817). Significantly elevated risks were observed for subsequent

cancers of the small intestine, soft tissue, bladder, thyroid, and thymus, as well as for melanoma. Significant

deficits in risk were seen for cancers of the buccal cavity (specifically tongue, tonsil, mouth, and pharynx),

digestive system (particularly esophagus, stomach,

colon, rectum, liver, and gallbladder), and respiratory

system (larynx and lung), as well as for chronic lymphocytic leukemia and Kaposi sarcoma. A significantly

high overall risk for new malignancies (excluding

prostate cancer) was seen among men diagnosed with

prostate cancer at a young age (O/E=1.30, ages <50

years). In contrast, those diagnosed at ages 50 to 59

years had no increase in cancer risk (O/E=0.95), and

significant deficits in risk were observed for all age

groups older than 60 years. Other large surveys

(Kleinerman et al, 1985; Osterlind et al, 1985; Levi et al,

1999), including a previous SEER survey (Brenner et al,

2000), have noted overall deficits in second cancers

following prostate cancer, particularly at older ages,

suggesting that medical surveillance may be reduced

among older men diagnosed with prostate cancer.

Radiation treatment may contribute to the excess risk

at certain sites. Increased risks for cancers of the bladder

(53%) and rectum excluding rectosigmoid junction (37%)

among 10-year survivors, and a 2-fold excess of cancers

of the soft tissues among 5-year survivors, were observed

for patients receiving radiation during their initial course

of therapy. At these new cancer sites, risk increased with

time since initial radiation, consistent with a radiogenic

effect. In contrast, patients who did not receive radiation

had significant deficits of subsequent bladder and rectal

cancers after 10 years of observation. Similar patterns of

subsequent bladder cancers (Neugut et al, 1997; Brenner

et al, 2000) and rectal cancers (Brenner et al, 2000; Baxter

et al, 2005) have been linked to radiotherapy in earlier

surveys of prostate cancer in the SEER Program. A prior

study also revealed that the risk of developing sarcoma

was significantly higher (2-fold) after radiotherapy compared with surgery (Brenner et al, 2000). In addition, we

observed a 31% increase in risk for acute myeloid

leukemia among patients receiving radiation as part

of their initial therapy, with elevated risk concentrated

in the first 10 years of follow-up. A similar temporal pattern has been shown in previous studies linking excess

leukemia to pelvic radiotherapy for cancers of the uterine

corpus (Curtis et al, 1994) and cervix (Boice et al, 1988).

Among the excess malignancies occurring in men

diagnosed with early-onset prostate cancer was pancreatic cancer, with a 2.6-fold increase in risk for men

younger than 50 years, based on 6 cases. Among older

patients, there were 4 cases in which prostate cancer

was followed by both melanoma and pancreatic cancer.

Genetic factors may have been involved, because this

pattern of tumors has been described in some individuals with BRCA2 mutations (Breast Cancer Linkage

Consortium, 1999). The risk for melanoma was most

pronounced in the first year of follow-up, suggesting

the influence of increased medical surveillance.

The significant excess risks for cancers of the small

intestine, thyroid, and thymus cancers after prostate

cancer appear to be new findings. As more than 50% of

small intestinal tumors were carcinoid, it is possible that

hormonal factors were involved (Quaedvlieg et al, 2001;

Thellenberg et al, 2003). In addition, an increased reciprocal risk for prostate cancer following an initial diagnosis

of thyroid cancer (O/E=1.31, O=257) also points to shared

hormonal or other risk factors. Genetic factors may have

been involved, particularly because mutations in RET

have been described in prostate cancer as well as thyroid

cancer (Dawson et al, 1998).

Testis Cancer

Testicular cancer is rare, accounting for only 1% of all

incident cancers and 0.1% of all deaths in males (Jemal

et al, 2005). It is the most common cancer in white men

ages 20 to 35 years, but it occurs less frequently among

blacks. The incidence, which is age-dependent, has been

increasing since the mid-twentieth century, a trend

related to birth cohort (McKiernan et al, 1999). Germ

cell tumors are the most common histology and are categorized as seminoma (56%) or non-seminoma (44%).

Treatment depends on histology and usually consists

of surgery followed by radiotherapy for seminoma, or

surgery followed by combination chemotherapy for

non-seminoma. The 5- and 10-year relative survival

rates (95.8% and 94.8%, respectively) improved dramatically following introduction of platinum-based combination chemotherapy in the late 1970s. During the 25-

year period of this survey, most patients with seminoma

were initially treated with radiation, and only a small

percentage received chemotherapy as part of their initial

treatment. In contrast, substantially more patients in the

SEER cohort diagnosed with non-seminoma received

chemotherapy during their initial treatment, and many

likely had chemotherapy as part of their subsequent

treatment, whereas only 3% received radiation alone as

initial therapy.

Cryptorchidism and family history of testis cancer are

well-established risk factors for testis cancer (Schottenfeld,

1996). A variety of perinatal factors, such as genitourinary

anomalies (e.g., hydrocele, inguinal hernia, testicular

atrophy), hormone use during pregnancy, and increased

maternal body weight, as well as postnatal factors (e.g.,

higher socioeconomic status, infertility, late-age puberty,

testicular trauma) have been related to testis cancer

with variable levels of confirmation. Environmental

endocrine modulators, particularly exposure to certain

organochlorines, may increase risk by binding estrogen

and androgen receptors, but definitive data are lacking.

Results and Discussion

A total of 803 subsequent primary cancers were observed

among 14,984 2-month survivors of testicular cancer

258 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

MALE GENITAL TRACT
NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 259

MALE GENITAL TRACT

(O/E=1.62, O=803, 95% CI=1.51-1.74, EAR=21 per 10,000

person-years). The cumulative incidence of developing

a second cancer following testis cancer was 14.1% at 25

years (95% CI=12.6%-15.7%), with new malignancies of

the testis accounting for 1.9% of the incidence (Figure

10.1). Significantly elevated risks occurred only in whites,

appeared early, and persisted throughout follow-up.

Overall increases in relative risk were higher in patients

diagnosed at ages younger than 35 years (O/E=2.80,

EAR=21) as compared with older patients (O/E=1.31,

EAR=23). Elevated risks were highest in the first year

following diagnosis (O/E=2.58) but persisted among

20-year survivors (O/E=1.47, O=76).

Approximately 25% of the subsequent cancers were

metachronous tumors in the contralateral testis. When

subsequent primary testis cancers were excluded, however, the significant elevations in risk persisted, with an

overall relative risk of 1.29 (95% CI=1.19-1.39, EAR=10).

Significantly increased risks were seen for acute nonlymphocytic leukemia (ANLL) as well as cancers of the

rectum, pancreas, testis, bladder, kidney, and thyroid.

These findings are generally consistent with previous

surveys of testicular cancer that revealed elevated risks

for subsequent cancers of the stomach, rectum, pancreas,

testis, bladder, and kidney, as well as for melanoma,

non-Hodgkin lymphoma, and leukemia (Kaldor et al,

1987; Jacobsen et al, 1993; Moller et al, 1993; Travis et al,

1997, 2005).

Risk for all subsequent cancers combined (excluding

testicular cancer) differed by histologic type of testicular

cancer, with significant excesses following seminoma

(O/E=1.33, O=458), but not non-seminoma (O/E=1.14,

O=136). Among men with seminoma, significantly elevated risks were seen for ANLL and new malignancies

of the esophagus, rectum, pancreas, and bladder, and

for the combination of renal pelvis, ureters, and other

urinary sites. Those with non-seminoma had increased

risks for ANLL and cancers of the buccal cavity and kidney. In an international survey (Travis et al, 1997), the

overall risks of second cancers were similar for seminoma (O/E=1.42) and non-seminoma (O/E=1.50), and both

tumor types showed elevated risks for melanoma as well

as cancers of the stomach, bladder, thyroid, and soft tissue. In this earlier study, however, there were substantial

numbers of patients diagnosed in the prechemotherapy

era (thus more likely to be treated with radiation) and

greater numbers of long-term survivors, which may

help explain the differences between studies.

There was a tendency for risks to increase with time

for specific sites, with significant elevations observed for

cancers of the rectum (excluding rectosigmoid junction)

and pancreas among 15-year survivors and for bladder

cancer among 20-year survivors. In contrast, significantly elevated risks for ANLL and renal cancer were

confined to the first 10 years of follow-up. Among

patients with seminoma who received initial radiotherapy, the excess risk for all subsequent solid tumors

(excluding contralateral testis) increased significantly to

67% (O=128) among 15-year survivors. These late-onset

risks affected several sites within or near the radiation

field, including a 2-fold or greater increase in risks for

cancers of the digestive tract (O=32), especially the stomach, rectum, and pancreas. Among 20-year survivors of

seminoma treated initially with radiation, a 3-fold excess

risk was seen for bladder cancer. The radiation-related

risks for bladder cancer and other pelvic sites are consistent with findings from large international studies of

cervical cancer implicating pelvic radiotherapy (Boice

et al, 1985, 1988). For ANLL, the risks were increased up

to 3-fold in both the irradiated and nonirradiated seminoma groups, with the 2 nonirradiated cases known to

have received chemotherapy.

Among patients with non-seminoma, the overall

risk for subsequent solid tumors (excluding testis) following radiation was not increased among 15- or 20-

year survivors. Significant excesses for ANLL were confined to the first 10 years of follow-up and were likely

related to chemotherapy, specifically alkylating agents

and platinum-based chemotherapy (Travis et al, 2000).

Increased risks of cancers of the buccal cavity, pancreas,

and kidney occurred among men not known to have

received radiotherapy.

Among patients initially diagnosed with a testicular

germ cell tumor, new cancers arising in the contralateral testis were the most common new malignancies

(O/E=13.44, EAR=12). In patients diagnosed with testis

cancer at ages younger than 20 years, tumors of the contralateral testis accounted for about 90% of the excess

subsequent cancer risk. The increased risk of contralateral

testis cancer is well established (Bokemeyer et al, 1993;

Fosså et al, 2005) and may reflect genetic susceptibility

(Rapley et al, 2000).

Penis Cancer

Cancer of the penis, while uncommon in the U.S., is of

major significance worldwide, accounting for 10% to 20%

of cancers in males in Asia, Africa, and South America.

Years after initial cancer diagnosis

Cumulative incidence (%)

0

5

10

15

20

0 5 10 15 20 25

All second cancers

Digestive system

Testis

Urinary system

Figure 10.1: Cumulative incidence of developing a second

cancer among patients with cancer of the testis, males, SEER

1973-2000.
More than 90% of reported penile cancers are squamous

cell carcinomas. The wide population variation in incidence appears related to circumcision and hygienic

practices, and preexisting inflammatory states, including

phimosis (Brinton et al, 1991). The risk of penile cancer

has been associated in some studies with smoking and

psoralen-plus-ultraviolet-A therapy (Stern 1990; Tseng et

al, 2001). It seems likely that human papillomavirus

(HPV) is involved in many cases, although further work

is needed to clarify the risk. The 5-year relative survival

rate is 76.9%, decreasing to 63.5% at 10 years. Treatment

is based on tumor extent at diagnosis; surgery is the

mainstay, with radiation usually reserved for smaller

lesions.

Results and Discussion

There was a borderline significant increase in overall

subsequent primary cancer risk among 1,808 men

surviving at least 2 months following diagnosis of

penile cancer (O/E=1.12, O=293, 95% CI=0.99-1.25,

EAR=26). For these patients, the cumulative incidence

of developing a second cancer following penis cancer

was 19.7% at 20 years (95% CI=17.5%-22.1%). Only a

small percentage of patients received radiotherapy

as part of their initial treatment. The excess risk of

subsequent cancers was most pronounced for cancers

of the buccal cavity (especially the tongue) and respiratory tract, more than half of which were squamous cell

cancers, and these risks remained elevated for up to

10 years after initial diagnosis. Cancers of the tonsil,

tongue, and mouth constituted the majority of buccal

cavity tumors. Smoking probably contributed to both

buccal and respiratory cancers, while alcohol and HPV

may have played a role in buccal cancers, particularly

those of the tonsil and tongue (Herrero et al, 2003).

Interestingly, there were no cases of subsequent anal

cancer, which might have been expected from a field

effect involving HPV infections of the anogenital epithelium (Peters et al, 1984).

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NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 261

MALE GENITAL TRACT
Prostate

Males

Table 10.1.1: Characteristics of patients with an initial cancer of the prostate gland, males,

SEER 1973-2000.

262 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

PROSTATE

Number of patients with 1st primary cancer

Total 292,029 100.0 — — 292,029 100.0

Initial treatment

Any radiation 90,538 31.0 — — 90,538 31.0

With surgery 23,513 8.1 — — 23,513 8.1

Without surgery 67,025 23.0 — — 67,025 23.0

No radiation 201,491 69.0 — — 201,491 69.0

With surgery 132,941 45.5 — — 132,941 45.5

Without surgery 68,550 23.5 — — 68,550 23.5

Race

White 245,375 84.0 — — 245,375 84.0

Black 32,026 11.0 — — 32,026 11.0

Other 12,490 4.3 — — 12,490 4.3

Unknown 2,138 0.7 — — 2,138 0.7

Age at 1st primary cancer diagnosis, years

< 30 43 0.0 — — 43 0.0

30–49 3,410 1.2 — — 3,410 1.2

50–69 127,466 43.6 — — 127,466 43.6

70–79 113,625 38.9 — — 113,625 38.9

> 80 47,485 16.3 — — 47,485 16.3

Number of patients with one or more

primary cancers

One primary cancer only 266,741 91.3 — — 266,741 91.3

1st and 2nd cancers 23,570 8.1 — — 23,570 8.1

1st, 2nd, and 3rd cancers 1,579 0.5 — — 1,579 0.5

1st, 2nd, 3rd, and additional cancers 139 0.0 — — 139 0.0

Other statistics

Median age at 1st cancer diagnosis 71.2 — — — 71.2 —

Median year of 1st cancer diagnosis 1992.0 — — — 1992.0 —

Median person-years at risk 4.4 — — — 4.4 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 93.1 — — — 93.1

1st, 2nd, and additional cancers — 92.7 — — — 92.7

1st cancer only — 5.4 — — — 5.4

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Prostate

Males

Table 10.1.2: Risk of subsequent primary cancers after cancer of the prostate gland, males,

SEER 1973-2000.

PROSTATE

All subsequent cancers 3,769 0.63* 12,624 0.59* 7,706 0.60* 3,057 0.59* 27,156 45,242.80 0.60* -115.18

All excluding same site 3,765 0.96* 12,611 0.89* 7,690 0.90* 3,046 0.88* 27,112 30,057.55 0.90* -18.76

Buccal cavity, pharynx 118 0.76* 421 0.80* 243 0.83* 85 0.78* 867 1,086.53 0.80* -1.40

Lip 21 0.71 92 0.91 53 0.90 21 0.90 187 213.24 0.88 -0.17

Tongue 18 0.61* 71 0.71* 39 0.72* 16 0.83 144 202.24 0.71* -0.37

Salivary gland 11 0.82 51 1.03 35 1.09 17 1.20 114 109.27 1.04 0.03

Mouth 36 0.99 77 0.64* 53 0.81 11 0.46* 177 247.19 0.72* -0.45

Nasopharynx 3 0.56 9 0.51* 10 1.09 5 1.58 27 35.24 0.77 -0.05

Tonsil 10 0.72 40 0.87 14 0.60 6 0.78 70 91.14 0.77* -0.13

Oropharynx 3 0.66 15 0.99 4 0.50 0 0.00 22 30.41 0.72 -0.05

Hypopharynx 14 0.79 51 0.87 24 0.79 7 0.68 96 116.56 0.82 -0.13

Digestive system 1,208 0.95 4,267 0.94* 2,474 0.89* 980 0.86* 8,929 9,762.64 0.91* -5.31

Esophagus 78 1.00 232 0.84* 133 0.83* 53 0.85 496 575.62 0.86* -0.51

Stomach 144 0.95 427 0.80* 247 0.77* 103 0.79* 921 1,135.58 0.81* -1.37

Small intestine 25 1.46 74 1.19 54 1.40* 21 1.33 174 134.07 1.30* 0.25

Colon 513 0.93 1,994 0.99 1,115 0.89* 437 0.83* 4,059 4,349.55 0.93* -1.85

Rectum, rectosigmoid junction 187 0.84* 743 0.96 452 0.99 143 0.81* 1,525 1,629.58 0.94* -0.67

Anus, anal canal 14 1.81 18 0.66 17 1.07 15 2.46* 64 57.22 1.12 0.04

Liver 28 0.55* 126 0.69* 76 0.69* 39 0.91 269 385.76 0.70* -0.74

Gallbladder 8 0.72 24 0.60* 19 0.76 7 0.66 58 86.92 0.67* -0.18

Bile ducts, other biliary 23 0.84 85 0.82 66 0.96 30 0.98 204 230.26 0.89 -0.17

Pancreas 179 1.23* 503 0.97 268 0.86* 122 0.96 1,072 1,103.09 0.97 -0.20

Respiratory system 842 0.76* 3,075 0.79* 1,865 0.82* 697 0.80* 6,479 8,156.00 0.79* -10.68

Nose, nasal cavity, ear 10 1.21 23 0.79 11 0.63 7 1.00 51 61.90 0.82 -0.07

Larynx 62 0.75* 253 0.91 120 0.80* 44 0.84 479 561.92 0.85* -0.53

Lung, bronchus 768 0.76* 2,793 0.78* 1,729 0.82* 644 0.80* 5,934 7,513.30 0.79* -10.06

Male breast 13 1.19 36 0.91 29 1.18 12 1.19 90 85.19 1.06 0.03

Male genital system 18 0.01* 47 0.01* 43 0.01* 26 0.02* 134 15,296.30 0.01* -96.56

Prostate 4 0.00* 13 0.00* 16 0.00* 11 0.01* 44 15,185.25 0.00* -96.43

Testis 2 0.62 6 0.61 2 0.44 1 0.72 11 19.04 0.58 -0.05

Urinary system 749 1.34* 2,063 1.01 1,248 0.97 542 1.02 4,602 4,418.29 1.04* 1.17

Urinary bladder 448 1.10 1,560 1.04 975 1.02 429 1.06 3,412 3,276.74 1.04* 0.86

Kidney parenchyma 255 2.16* 372 0.88* 203 0.80* 84 0.86 914 894.17 1.02 0.13

Renal pelvis, other urinary 46 1.43* 131 1.14 70 0.99 29 1.00 276 247.38 1.12 0.18

Ureter 10 0.92 27 0.69 30 1.26 8 0.84 75 83.10 0.90 -0.05

Bone, joints 5 1.21 15 1.05 14 1.72 6 1.89 40 29.74 1.35 0.07

Soft tissue including heart 22 1.05 75 0.98 74 1.54* 25 1.23 196 165.62 1.18* 0.19

Kaposi sarcoma 4 0.68 15 0.75 3 0.25* 5 0.94 27 43.20 0.62* -0.10

Melanoma of skin 153 1.31* 494 1.12* 330 1.15* 123 1.03 1,100 966.30 1.14* 0.85

Eye, orbit 6 0.81 32 1.22 14 0.89 5 0.82 57 55.40 1.03 0.01

Brain, central nervous system 46 0.93 187 1.07 105 1.02 40 1.02 378 366.98 1.03 0.07

Thyroid 27 1.70* 56 1.03 34 1.16 16 1.51 133 110.04 1.21* 0.15

Lymphatic, hematopoietic 433 1.04 1,416 0.93* 958 1.00 379 0.96 3,186 3,286.63 0.97 -0.64

Hodgkin lymphoma 15 1.35 23 0.62* 19 0.94 4 0.54 61 75.97 0.80 -0.10

Non-Hodgkin lymphoma 210 1.22* 589 0.92 396 0.97 161 0.95 1,356 1,385.79 0.98 -0.19

Myeloma 74 0.98 265 0.97 187 1.10 64 0.91 590 590.05 1.00 0.00

Leukemia 134 0.85 539 0.94 356 1.00 150 1.00 1,179 1,234.82 0.95 -0.36

Acute lymphocytic 4 1.01 12 0.88 14 1.78 2 0.65 32 28.57 1.12 0.02

Chronic lymphocytic 60 0.94 160 0.70* 142 1.01 70 1.19 432 493.28 0.88* -0.39

Acute non-lymphocytic 40 0.77 212 1.11 125 1.03 45 0.88 422 416.29 1.01 0.04

Chronic myeloid 16 0.75 94 1.21 48 0.98 18 0.86 176 168.89 1.04 0.05

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 292,029 259,830 135,663 41,363 292,029

Person-years in interval 228,817 767,997 418,967 154,474 1,570,255

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 263
All subsequent cancers 24,099 0.60* 2,238 0.58* 665 0.61* 154 0.67* 27,156 45,242.80 0.60* -115.18

All excluding same site 24,066 0.90* 2,231 0.87* 662 0.91* 153 0.94 27,112 30,057.55 0.90* -18.76

Buccal cavity, pharynx 782 0.80* 64 0.78* 17 0.77 4 0.85 867 1,086.53 0.80* -1.40

Lip 166 0.87 16 0.92 3 0.62 2 1.95 187 213.24 0.88 -0.17

Tongue 128 0.70* 13 0.89 3 0.78 0 0.00 144 202.24 0.71* -0.37

Salivary gland 97 1.02 12 1.17 5 1.59 0 0.00 114 109.27 1.04 0.03

Mouth 166 0.74* 7 0.38* 2 0.41 2 1.94 177 247.19 0.72* -0.45

Nasopharynx 22 0.69 3 1.26 2 3.15 0 0.00 27 35.24 0.77 -0.05

Tonsil 64 0.77* 5 0.84 1 0.68 0 0.00 70 91.14 0.77* -0.13

Oropharynx 22 0.80 0 0.00 0 0.00 0 0.00 22 30.41 0.72 -0.05

Hypopharynx 89 0.84 7 0.88 0 0.00 0 0.00 96 116.56 0.82 -0.13

Digestive system 7,949 0.92* 728 0.86* 209 0.87* 43 0.79 8,929 9,762.64 0.91* -5.31

Esophagus 443 0.86* 43 0.93 9 0.69 1 0.35 496 575.62 0.86* -0.51

Stomach 818 0.81* 68 0.70* 31 1.12 4 0.64 921 1,135.58 0.81* -1.37

Small intestine 153 1.29* 15 1.28 6 1.77 0 0.00 174 134.07 1.30* 0.25

Colon 3,622 0.95* 335 0.86* 79 0.70* 23 0.90 4,059 4,349.55 0.93* -1.85

Rectum, rectosigmoid junction 1,382 0.95 106 0.80* 33 0.90 4 0.51 1,525 1,629.58 0.94* -0.67

Anus, anal canal 49 0.96 11 2.43* 4 3.10 0 0.00 64 57.22 1.12 0.04

Liver 230 0.67* 29 0.92 7 0.77 3 1.49 269 385.76 0.70* -0.74

Gallbladder 51 0.67* 4 0.52 1 0.44 2 3.70 58 86.92 0.67* -0.18

Bile ducts, other biliary 174 0.87 22 1.00 7 1.02 1 0.60 204 230.26 0.89 -0.17

Pancreas 950 0.97 90 0.96 29 1.08 3 0.49 1,072 1,103.09 0.97 -0.20

Respiratory system 5,782 0.79* 522 0.80* 143 0.80* 32 0.84 6,479 8,156.00 0.79* -10.68

Nose, nasal cavity, ear 44 0.80 6 1.16 0 0.00 1 2.94 51 61.90 0.82 -0.07

Larynx 435 0.85* 31 0.77 11 1.07 2 0.99 479 561.92 0.85* -0.53

Lung, bronchus 5,290 0.79* 483 0.80* 132 0.79* 29 0.82 5,934 7,513.30 0.79* -10.06

Male breast 78 1.04 9 1.22 2 0.92 1 2.02 90 85.19 1.06 0.03

Male genital system 108 0.01* 14 0.01* 8 0.02* 4 0.06* 134 15,296.30 0.01* -96.56

Prostate 33 0.00* 7 0.01* 3 0.01* 1 0.01* 44 15,185.25 0.00* -96.43

Testis 10 0.57 0 0.00 1 3.90 0 0.00 11 19.04 0.58 -0.05

Urinary system 4,060 1.04* 374 0.96 141 1.24* 27 1.04 4,602 4,418.29 1.04* 1.17

Urinary bladder 2,983 1.04* 297 1.00 109 1.26* 23 1.15 3,412 3,276.74 1.04* 0.86

Kidney parenchyma 830 1.04 58 0.79 23 1.12 3 0.67 914 894.17 1.02 0.13

Renal pelvis, other urinary 247 1.13 19 0.89 9 1.46 1 0.69 276 247.38 1.12 0.18

Ureter 67 0.91 6 0.84 2 1.01 0 0.00 75 83.10 0.90 -0.05

Bone, joints 34 1.28 4 1.70 1 1.47 1 6.87 40 29.74 1.35 0.07

Soft tissue including heart 171 1.18* 16 1.08 8 1.80 1 0.95 196 165.62 1.18* 0.19

Kaposi sarcoma 22 0.58* 4 1.04 1 0.84 0 0.00 27 43.20 0.62* -0.10

Melanoma of skin 977 1.15* 89 1.02 24 0.91 10 1.56 1,100 966.30 1.14* 0.85

Eye, orbit 52 1.05 3 0.66 2 1.58 0 0.00 57 55.40 1.03 0.01

Brain, central nervous system 338 1.03 31 1.05 9 1.10 0 0.00 378 366.98 1.03 0.07

Thyroid 117 1.18 14 1.75 1 0.46 1 2.20 133 110.04 1.21* 0.15

Lymphatic, hematopoietic 2,807 0.97 278 0.95 78 0.91 23 1.17 3,186 3,286.63 0.97 -0.64

Hodgkin lymphoma 57 0.83 4 0.71 0 0.00 0 0.00 61 75.97 0.80 -0.10

Non-Hodgkin lymphoma 1,195 0.98 124 1.00 32 0.88 5 0.59 1,356 1,385.79 0.98 -0.19

Myeloma 526 1.01 43 0.83 10 0.66 11 3.24* 590 590.05 1.00 0.00

Leukemia 1,029 0.95 107 0.97 36 1.12 7 0.94 1,179 1,234.82 0.95 -0.36

Acute lymphocytic 30 1.18 1 0.42 0 0.00 1 8.80 32 28.57 1.12 0.02

Chronic lymphocytic 362 0.83* 48 1.11 18 1.44 4 1.41 432 493.28 0.88* -0.39

Acute non-lymphocytic 377 1.03 36 0.96 7 0.64 2 0.77 422 416.29 1.01 0.04

Chronic myeloid 158 1.07 11 0.71 7 1.55 0 0.00 176 168.89 1.04 0.05

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 292,029 41,363 11,503 2,837 292,029

Person-years in interval 1,415,781 115,960 31,647 6,867 1,570,255

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Prostate

Males, Long-term Follow-up

Table 10.1.3: Risk of subsequent primary cancers after cancer of the prostate gland, males,

long-term follow-up, SEER 1973-2000.

264 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

PROSTATE

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Prostate

Males, <60 Years of Age

Table 10.1.4: Risk of subsequent primary cancers after cancer of the prostate gland, males,

<60 years of age, SEER 1973-2000.

PROSTATE

All subsequent cancers 203 0.91 644 0.66* 538 0.66* 447 0.57* 1,832 2,801.23 0.65* -50.03

All excluding same site 203 1.22* 642 0.94 538 0.99 446 0.89* 1,829 1,896.27 0.96 -3.47

Buccal cavity, pharynx 15 1.32 28 0.66* 27 0.95 22 1.11 92 102.27 0.90 -0.53

Lip 0 0.00 5 1.19 9 2.62* 3 0.98 17 11.76 1.45 0.27

Tongue 2 0.80 9 0.96 4 0.66 2 0.48 17 22.17 0.77 -0.27

Salivary gland 0 0.00 0 0.00 5 2.74 4 2.41 9 6.70 1.34 0.12

Mouth 5 1.75 5 0.47 6 0.86 5 1.11 21 24.96 0.84 -0.20

Nasopharynx 1 1.87 1 0.56 0 0.00 3 4.39 5 4.13 1.21 0.05

Tonsil 4 2.41 3 0.53 1 0.30 0 0.00 8 12.65 0.63 -0.24

Oropharynx 1 2.55 0 0.00 1 0.96 0 0.00 2 3.64 0.55 -0.08

Hypopharynx 2 1.52 5 1.01 1 0.28 3 1.24 11 12.23 0.90 -0.06

Digestive system 49 1.09 160 0.84* 132 0.85 110 0.74* 451 539.81 0.84* -4.58

Esophagus 4 0.89 20 1.11 13 0.97 11 1.00 48 46.89 1.02 0.06

Stomach 7 1.46 12 0.59 13 0.80 13 0.82 45 57.24 0.79 -0.63

Small intestine 0 0.00 5 1.35 4 1.54 5 2.08 14 9.67 1.45 0.22

Colon 14 0.89 63 0.92 48 0.80 39 0.62* 164 207.40 0.79* -2.24

Rectum, rectosigmoid junction 9 1.01 29 0.77 18 0.60* 17 0.65 73 103.03 0.71* -1.55

Anus, anal canal 0 0.00 2 0.93 1 0.68 1 0.91 4 5.31 0.75 -0.07

Liver 1 0.37 6 0.56 5 0.63 10 1.42 22 28.49 0.77 -0.33

Gallbladder 0 0.00 1 0.98 0 0.00 1 0.95 2 3.23 0.62 -0.06

Bile ducts, other biliary 0 0.00 3 0.85 7 2.35 3 0.91 13 10.64 1.22 0.12

Pancreas 13 2.37* 17 0.75 23 1.26 9 0.52* 62 63.86 0.97 -0.10

Respiratory system 43 0.90 182 0.89 151 0.90 128 0.85 504 569.18 0.89* -3.36

Nose, nasal cavity, ear 2 4.26 0 0.00 1 0.80 1 1.00 4 4.53 0.88 -0.03

Larynx 5 0.93 19 0.88 9 0.57 12 1.05 45 54.21 0.83 -0.48

Lung, bronchus 36 0.86 163 0.91 141 0.94 114 0.83* 454 509.17 0.89* -2.85

Male breast 1 1.77 5 2.21 3 1.87 2 1.41 11 5.85 1.88 0.27

Male genital system 3 0.05* 5 0.02* 3 0.01* 4 0.01* 15 913.96 0.02* -46.40

Prostate 0 0.00* 2 0.01* 0 0.00* 1 0.00* 3 904.96 0.00* -46.56

Testis 1 1.36 1 0.49 0 0.00 1 2.66 3 4.03 0.74 -0.05

Urinary system 43 2.12* 104 1.21 95 1.32* 65 0.89 307 251.06 1.22* 2.89

Urinary bladder 22 1.83* 59 1.12 60 1.26 52 1.01 193 164.24 1.18* 1.48

Kidney parenchyma 18 2.44* 36 1.23 31 1.48* 11 0.64 96 74.87 1.28* 1.09

Renal pelvis, other urinary 3 3.64 9 2.38* 4 1.13 2 0.53 18 11.95 1.51 0.31

Ureter 0 0.00 2 1.73 3 2.51 0 0.00 5 3.85 1.30 0.06

Bone, joints 1 3.29 1 0.91 0 0.00 0 0.00 2 2.66 0.75 -0.03

Soft tissue including heart 1 0.87 2 0.47 3 1.02 8 2.98* 14 11.03 1.27 0.15

Kaposi sarcoma 0 0.00 2 0.85 0 0.00 1 1.83 3 4.75 0.63 -0.09

Melanoma of skin 11 1.27 36 1.09 28 1.22 17 0.89 92 83.70 1.10 0.43

Eye, orbit 0 0.00 1 0.63 3 2.71 1 1.02 5 4.10 1.22 0.05

Brain, central nervous system 4 1.16 21 1.61 6 0.65 13 1.83 44 32.76 1.34 0.58

Thyroid 2 1.23 9 1.58 3 0.84 4 1.76 18 13.14 1.37 0.25

Lymphatic, hematopoietic 23 1.28 68 0.97 62 1.13 61 1.14 214 196.62 1.09 0.90

Hodgkin lymphoma 3 3.12 0 0.00 4 2.03 1 0.74 8 7.53 1.06 0.02

Non-Hodgkin lymphoma 12 1.38 27 0.80 25 0.99 21 0.88 85 91.64 0.93 -0.34

Myeloma 2 0.66 14 1.16 14 1.46 13 1.34 43 34.43 1.25 0.44

Leukemia 6 1.15 27 1.26 19 1.07 26 1.40 78 63.03 1.24 0.77

Acute lymphocytic 0 0.00 3 3.73 0 0.00 1 2.24 4 2.01 1.99 0.10

Chronic lymphocytic 4 1.76 2 0.21* 9 1.16 15 1.97* 30 27.06 1.11 0.15

Acute non-lymphocytic 1 0.67 12 1.90 7 1.26 5 0.79 25 19.68 1.27 0.27

Chronic myeloid 1 1.39 7 2.47 3 1.28 4 1.62 15 8.37 1.79* 0.34

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 34,272 30,225 15,355 5,634 34,272

Person-years in interval 26,796 88,147 49,102 29,693 193,738

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 265
All subsequent cancers 1,126 0.71* 3,924 0.59* 2,985 0.59* 1,597 0.61* 9,632 15,951.86 0.60* -104.72

All excluding same site 1,123 1.07* 3,919 0.91* 2,977 0.91* 1,590 0.91* 9,609 10,365.45 0.93* -12.53

Buccal cavity, pharynx 30 0.58* 160 0.84* 100 0.83 47 0.86 337 416.73 0.81* -1.32

Lip 4 0.55 33 1.14 19 0.92 12 1.07 68 68.26 1.00 0.00

Tongue 7 0.68 26 0.67* 20 0.81 11 1.08 64 83.68 0.76* -0.33

Salivary gland 1 0.31 22 1.64* 9 0.87 11 1.70 43 33.48 1.28 0.16

Mouth 9 0.72 21 0.47* 18 0.67 4 0.33* 52 95.87 0.54* -0.73

Nasopharynx 0 0.00 2 0.28 5 1.24 1 0.64 8 14.83 0.54 -0.11

Tonsil 3 0.56 18 0.94 7 0.62 4 1.02 32 39.70 0.81 -0.13

Oropharynx 0 0.00 8 1.24 3 0.79 0 0.00 11 13.53 0.81 -0.04

Hypopharynx 6 0.89 20 0.82 12 0.83 4 0.74 42 50.95 0.82 -0.15

Digestive system 344 1.11 1,192 0.92* 884 0.89* 500 0.89* 2,920 3,159.28 0.92* -3.96

Esophagus 29 1.16 73 0.75* 48 0.71* 27 0.84 177 222.33 0.80* -0.75

Stomach 35 1.02 110 0.77* 89 0.80* 43 0.69* 277 350.68 0.79* -1.22

Small intestine 5 1.09 29 1.48 19 1.24 11 1.35 64 47.68 1.34* 0.27

Colon 149 1.22* 505 0.96 391 0.92 210 0.81* 1,255 1,333.60 0.94* -1.30

Rectum, rectosigmoid junction 59 1.00 227 0.95 176 1.01 87 0.97 549 561.38 0.98 -0.21

Anus, anal canal 7 2.90* 4 0.41 6 0.91 10 3.42* 27 21.60 1.25 0.09

Liver 7 0.47* 43 0.71* 31 0.69* 21 0.95 102 142.45 0.72* -0.67

Gallbladder 1 0.48 6 0.65 6 0.77 6 1.21 19 24.20 0.79 -0.09

Bile ducts, other biliary 6 1.03 19 0.73 18 0.82 16 1.12 59 68.05 0.87 -0.15

Pancreas 45 1.24 163 1.08 95 0.83 64 1.02 367 364.61 1.01 0.04

Respiratory system 260 0.78* 1,052 0.78* 827 0.86* 370 0.80* 2,509 3,106.08 0.81* -9.89

Nose, nasal cavity, ear 4 1.74 6 0.67 6 0.96 4 1.15 20 20.94 0.96 -0.02

Larynx 20 0.68 91 0.83 56 0.81 20 0.71 187 237.07 0.79* -0.83

Lung, bronchus 236 0.78* 951 0.78* 763 0.86* 345 0.81* 2,295 2,841.41 0.81* -9.05

Male breast 5 1.78 9 0.77 13 1.45 7 1.37 34 28.50 1.19 0.09

Male genital system 4 0.01* 16 0.01* 13 0.01* 18 0.02* 51 5,621.72 0.01* -92.31

Prostate 3 0.01* 5 0.00* 8 0.00* 7 0.01* 23 5,586.41 0.00* -92.18

Testis 0 0.00 4 1.11 0 0.00 0 0.00 4 7.31 0.55 -0.05

Urinary system 233 1.67* 637 1.07 461 0.97 285 1.07 1,616 1,475.73 1.10* 2.32

Urinary bladder 132 1.39* 450 1.08 358 1.05 219 1.09 1,159 1,053.89 1.10* 1.74

Kidney parenchyma 90 2.48* 145 0.99 79 0.74* 53 1.04 367 340.51 1.08 0.44

Renal pelvis, other urinary 11 1.44 42 1.26 24 0.92 13 0.90 90 81.33 1.11 0.14

Ureter 5 1.94 7 0.62 9 1.02 5 1.02 26 27.60 0.94 -0.03

Bone, joints 1 0.82 6 1.23 9 2.63* 3 1.99 19 11.05 1.72* 0.13

Soft tissue including heart 5 0.97 25 1.14 33 1.95* 11 1.11 74 53.82 1.38* 0.33

Kaposi sarcoma 0 0.00 6 1.41 0 0.00 2 0.93 8 10.74 0.74 -0.05

Melanoma of skin 56 1.57* 174 1.18* 134 1.20* 70 1.18 434 354.60 1.22* 1.32

Eye, orbit 1 0.50 9 1.07 1 0.16* 3 0.94 14 19.84 0.71 -0.10

Brain, central nervous system 20 1.25 72 1.15 42 0.97 18 0.87 152 142.59 1.07 0.16

Thyroid 9 1.61 17 0.82 14 1.08 9 1.69 49 44.59 1.10 0.07

Lymphatic, hematopoietic 125 1.22* 415 0.95 341 0.98 194 0.98 1,075 1,082.30 0.99 -0.12

Hodgkin lymphoma 4 1.18 10 0.80 5 0.61 2 0.52 21 27.89 0.75 -0.11

Non-Hodgkin lymphoma 71 1.58* 172 0.90 168 1.11 80 0.93 491 472.91 1.04 0.30

Myeloma 16 0.85 79 0.98 55 0.88 38 1.08 188 197.70 0.95 -0.16

Leukemia 34 0.97 154 1.01 113 0.91 74 1.03 375 383.79 0.98 -0.15

Acute lymphocytic 1 1.08 1 0.26 6 2.13 1 0.67 9 9.06 0.99 0.00

Chronic lymphocytic 20 1.33 48 0.75* 47 0.93 36 1.29 151 157.60 0.96 -0.11

Acute non-lymphocytic 9 0.81 59 1.16 34 0.79 21 0.83 123 130.07 0.95 -0.12

Chronic myeloid 2 0.42 31 1.54* 14 0.86 9 0.89 56 51.17 1.09 0.08

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 96,647 88,716 52,254 18,753 96,647

Person-years in interval 77,104 277,494 172,290 76,621 603,508

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Prostate

Males, 60-69 Years of Age

Table 10.1.5: Risk of subsequent primary cancers after cancer of the prostate gland, males,

60-69 years of age, SEER 1973-2000.

266 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

PROSTATE

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Prostate

Males, ≥70 Years of Age

Table 10.1.6: Risk of subsequent primary cancers after cancer of the prostate gland, males,

≥70 years of age, SEER 1973-2000.

PROSTATE

All subsequent cancers 2,440 0.59* 8,056 0.59* 4,183 0.60* 1,013 0.59* 15,692 26,489.71 0.59* -139.68

All excluding same site 2,439 0.90* 8,050 0.88* 4,175 0.88* 1,010 0.84* 15,674 17,795.83 0.88* -27.45

Buccal cavity, pharynx 73 0.78* 233 0.79* 116 0.81* 16 0.46* 438 567.53 0.77* -1.68

Lip 17 0.80 54 0.79 25 0.73 6 0.67 102 133.21 0.77* -0.40

Tongue 9 0.55 36 0.70* 15 0.64 3 0.61 63 96.40 0.65* -0.43

Salivary gland 10 1.05 29 0.87 21 1.05 2 0.33 62 69.09 0.90 -0.09

Mouth 22 1.05 51 0.77 29 0.92 2 0.27* 104 126.36 0.82* -0.29

Nasopharynx 2 0.72 6 0.70 5 1.26 1 1.10 14 16.28 0.86 -0.03

Tonsil 3 0.43 19 0.90 6 0.67 2 1.09 30 38.79 0.77 -0.11

Oropharynx 2 0.86 7 0.98 0 0.00 0 0.00 9 13.23 0.68 -0.05

Hypopharynx 6 0.63 26 0.90 11 0.90 0 0.00 43 53.38 0.81 -0.13

Digestive system 815 0.89* 2,915 0.95* 1,458 0.89* 370 0.87* 5,558 6,063.54 0.92* -6.54

Esophagus 45 0.92 139 0.87 72 0.90 15 0.79 271 306.40 0.88* -0.46

Stomach 102 0.91 305 0.82* 145 0.75* 47 0.90 599 727.66 0.82* -1.66

Small intestine 20 1.73* 40 1.02 31 1.49* 5 0.95 96 76.72 1.25* 0.25

Colon 350 0.84* 1,426 1.01 676 0.88* 188 0.91 2,640 2,808.55 0.94* -2.18

Rectum, rectosigmoid junction 119 0.78* 487 0.98 258 1.03 39 0.64* 903 965.17 0.94* -0.80

Anus, anal canal 7 1.48 12 0.77 10 1.27 4 1.94 33 30.31 1.09 0.03

Liver 20 0.60* 77 0.69* 40 0.70* 8 0.60 145 214.82 0.67* -0.90

Gallbladder 7 0.79 17 0.57* 13 0.79 0 0.00* 37 59.50 0.62* -0.29

Bile ducts, other biliary 17 0.82 63 0.85 41 0.93 11 0.85 132 151.58 0.87 -0.25

Pancreas 121 1.17 323 0.94 150 0.83* 49 1.05 643 674.63 0.95 -0.41

Respiratory system 539 0.74* 1,841 0.78* 887 0.78* 199 0.77* 3,466 4,480.74 0.77* -13.13

Nose, nasal cavity, ear 4 0.73 17 0.92 4 0.40 2 0.78 27 36.43 0.74 -0.12

Larynx 37 0.78 143 0.98 55 0.86 12 0.91 247 270.64 0.91 -0.31

Lung, bronchus 496 0.74* 1,679 0.77* 825 0.78* 185 0.77* 3,185 4,162.71 0.77* -12.65

Male breast 7 0.92 22 0.85 13 0.93 3 0.85 45 50.84 0.89 -0.08

Male genital system 11 0.01* 26 0.01* 27 0.01* 4 0.01* 68 8,760.62 0.01* -112.45

Prostate 1 0.00* 6 0.00* 8 0.00* 3 0.01* 18 8,693.88 0.00* -112.24

Testis 1 0.73 1 0.24 2 1.10 0 0.00 4 7.70 0.52 -0.05

Urinary system 473 1.18* 1,322 0.97 692 0.94 192 1.01 2,679 2,691.50 1.00 -0.16

Urinary bladder 294 0.98 1,051 1.01 557 0.98 158 1.05 2,060 2,058.61 1.00 0.02

Kidney parenchyma 147 1.97* 191 0.77* 93 0.74* 20 0.68 451 478.79 0.94 -0.36

Renal pelvis, other urinary 32 1.36 80 1.02 42 1.02 14 1.30 168 154.10 1.09 0.18

Ureter 5 0.62 18 0.68 18 1.31 3 0.89 44 51.64 0.85 -0.10

Bone, joints 3 1.16 8 0.96 5 1.26 3 2.65 19 16.03 1.19 0.04

Soft tissue including heart 16 1.10 48 0.96 38 1.35 6 0.77 108 100.78 1.07 0.09

Kaposi sarcoma 4 1.05 7 0.52 3 0.38 2 0.75 16 27.71 0.58* -0.15

Melanoma of skin 86 1.18 284 1.09 168 1.10 36 0.87 574 528.00 1.09 0.60

Eye, orbit 5 1.02 22 1.36 10 1.19 1 0.52 38 31.47 1.21 0.08

Brain, central nervous system 22 0.73 94 0.94 57 1.13 9 0.78 182 191.63 0.95 -0.12

Thyroid 16 1.84* 30 1.08 17 1.32 3 0.99 66 52.32 1.26 0.18

Lymphatic, hematopoietic 285 0.96 933 0.92* 555 1.00 124 0.85 1,897 2,007.72 0.94* -1.43

Hodgkin lymphoma 8 1.19 13 0.61 10 0.98 1 0.44 32 40.55 0.79 -0.11

Non-Hodgkin lymphoma 127 1.08 390 0.94 203 0.88 60 1.01 780 821.24 0.95 -0.53

Myeloma 56 1.04 172 0.95 118 1.21* 13 0.52* 359 357.93 1.00 0.01

Leukemia 94 0.80* 358 0.90 224 1.04 50 0.85 726 788.00 0.92* -0.80

Acute lymphocytic 3 1.07 8 0.89 8 1.78 0 0.00 19 17.49 1.09 0.02

Chronic lymphocytic 36 0.77 110 0.71* 86 1.03 19 0.82 251 308.62 0.81* -0.75

Acute non-lymphocytic 30 0.76 141 1.05 84 1.15 19 0.99 274 266.54 1.03 0.10

Chronic myeloid 13 0.82 56 1.03 31 1.01 5 0.60 105 109.35 0.96 -0.06

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 161,110 140,889 68,054 16,976 161,110

Person-years in interval 124,918 402,356 197,576 48,160 773,010

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 267
All subsequent cancers 1,055 0.57* 4,350 0.63* 2,920 0.68* 1,155 0.69* 9,480 14,724.07 0.64* -103.10

All excluding same site 1,054 0.87* 4,347 0.96* 2,915 1.02 1,155 1.03 9,471 9,744.29 0.97* -5.37

Buccal cavity, pharynx 34 0.70* 133 0.78* 90 0.92 31 0.87 288 351.95 0.82* -1.26

Lip 3 0.36 30 0.97 16 0.84 5 0.67 54 65.72 0.82 -0.23

Tongue 3 0.32* 22 0.67 13 0.72 7 1.10 45 67.05 0.67* -0.43

Salivary gland 2 0.51 17 1.11 14 1.31 4 0.87 37 34.58 1.07 0.05

Mouth 16 1.41 25 0.64* 16 0.73 6 0.76 63 80.37 0.78 -0.34

Nasopharynx 0 0.00 1 0.17* 4 1.30 1 0.96 6 11.62 0.52 -0.11

Tonsil 4 0.89 11 0.73 11 1.42 3 1.17 29 29.92 0.97 -0.02

Oropharynx 1 0.66 3 0.59 2 0.75 0 0.00 6 10.20 0.59 -0.08

Hypopharynx 5 0.87 18 0.93 10 0.98 3 0.88 36 38.80 0.93 -0.06

Digestive system 284 0.75* 1,406 0.98 885 0.96 356 0.97 2,931 3,107.99 0.94* -3.48

Esophagus 16 0.64 79 0.87 50 0.92 11 0.54* 156 190.58 0.82* -0.68

Stomach 37 0.85 136 0.83* 95 0.91 41 0.99 309 353.16 0.87* -0.87

Small intestine 3 0.55 28 1.35 16 1.21 8 1.55 55 44.51 1.24 0.21

Colon 137 0.85 650 1.04 403 0.97 164 0.97 1,354 1,376.37 0.98 -0.44

Rectum, rectosigmoid junction 42 0.63* 241 0.98 161 1.07 65 1.13 509 520.80 0.98 -0.23

Anus, anal canal 7 2.90* 7 0.80 7 1.35 6 3.03* 27 18.38 1.47 0.17

Liver 3 0.18* 60 0.98 23 0.62* 12 0.86 98 128.61 0.76* -0.60

Gallbladder 2 0.65 5 0.42* 5 0.61 3 0.89 15 26.65 0.56* -0.23

Bile ducts, other biliary 2 0.25* 24 0.74 22 0.95 12 1.21 60 73.77 0.81 -0.27

Pancreas 34 0.79 165 1.01 86 0.83 33 0.80 318 351.63 0.90 -0.66

Respiratory system 249 0.70* 1,121 0.86* 710 0.92* 262 0.92 2,342 2,707.89 0.86* -7.19

Nose, nasal cavity, ear 3 1.21 9 0.97 3 0.51 3 1.31 18 19.88 0.91 -0.04

Larynx 23 0.86 97 1.05 42 0.84 12 0.69 174 186.93 0.93 -0.25

Lung, bronchus 222 0.69* 1,010 0.85* 663 0.93 247 0.93 2,142 2,495.22 0.86* -6.94

Male breast 1 0.30 10 0.79 13 1.57 4 1.22 28 27.60 1.01 0.01

Male genital system 3 0.00* 17 0.01* 15 0.01* 7 0.01* 42 5,014.40 0.01* -97.76

Prostate 1 0.00* 3 0.00* 5 0.00* 0 0.00* 9 4,979.78 0.00* -97.73

Testis 0 0.00 3 0.99 2 1.37 0 0.00 5 5.93 0.84 -0.02

Urinary system 227 1.33* 747 1.13* 537 1.24* 233 1.34* 1,744 1,434.40 1.22* 6.09

Urinary bladder 118 0.96 581 1.21* 444 1.38* 201 1.53* 1,344 1,057.63 1.27* 5.63

Kidney parenchyma 93 2.44* 136 0.96 77 0.90 23 0.71 329 297.34 1.11 0.62

Renal pelvis, other urinary 16 1.67 30 0.82 16 0.67 9 0.95 71 79.43 0.89 -0.17

Ureter 4 1.22 5 0.40* 5 0.62 1 0.32 15 26.89 0.56* -0.23

Bone, joints 1 0.78 5 1.10 2 0.75 2 1.95 10 9.52 1.05 0.01

Soft tissue including heart 8 1.27 32 1.32 36 2.22* 15 2.26* 91 53.44 1.70* 0.74

Kaposi sarcoma 2 1.31 3 0.53 2 0.53 1 0.60 8 12.58 0.64 -0.09

Melanoma of skin 64 1.68* 159 1.08 105 1.07 52 1.30 380 322.70 1.18* 1.13

Eye, orbit 2 0.88 12 1.41 3 0.56 2 0.99 19 18.14 1.05 0.02

Brain, central nervous system 11 0.68 66 1.12 44 1.25 15 1.14 136 122.98 1.11 0.26

Thyroid 10 1.97 21 1.20 12 1.24 7 2.00 50 35.81 1.40* 0.28

Lymphatic, hematopoietic 126 1.00 480 0.99 363 1.13* 127 0.98 1,096 1,062.07 1.03 0.67

Hodgkin lymphoma 2 0.60 7 0.59 10 1.49 1 0.41 20 24.33 0.82 -0.09

Non-Hodgkin lymphoma 58 1.07 214 1.02 155 1.12 55 0.99 482 458.22 1.05 0.47

Myeloma 17 0.74 89 1.01 62 1.09 25 1.10 193 190.90 1.01 0.04

Leukemia 49 1.07 170 0.96 136 1.16 46 0.95 401 388.62 1.03 0.24

Acute lymphocytic 0 0.00 6 1.45 9 3.60* 0 0.00 15 8.75 1.72 0.12

Chronic lymphocytic 26 1.40 34 0.48* 52 1.13 19 1.01 131 154.64 0.85 -0.46

Acute non-lymphocytic 15 0.97 83 1.37* 50 1.23 15 0.91 163 133.21 1.22* 0.59

Chronic myeloid 3 0.49 28 1.16 14 0.85 8 1.18 53 53.32 0.99 -0.01

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 90,538 81,681 44,522 13,657 90,538

Person-years in interval 71,646 247,334 138,888 50,767 508,635

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Prostate

Males, Radiotherapy

Table 10.1.7: Risk of subsequent primary cancers after cancer of the prostate gland, males,

with initial radiotherapy, SEER 1973-2000.

268 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

PROSTATE

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Prostate

Males, No Radiotherapy

Table 10.1.8: Risk of subsequent primary cancers after cancer of the prostate gland, males,

without initial radiotherapy, SEER 1973-2000.

PROSTATE

All subsequent cancers 2,714 0.66* 8,274 0.57* 4,786 0.56* 1,902 0.55* 17,676 30,518.73 0.58* -120.97

All excluding same site 2,711 0.99 8,264 0.86* 4,775 0.84* 1,891 0.81* 17,641 20,313.26 0.87* -25.17

Buccal cavity, pharynx 84 0.78* 288 0.80* 153 0.78* 54 0.74* 579 734.57 0.79* -1.47

Lip 18 0.84 62 0.88 37 0.94 16 1.02 133 147.52 0.90 -0.14

Tongue 15 0.76 49 0.74* 26 0.72 9 0.70 99 135.19 0.73* -0.34

Salivary gland 9 0.95 34 1.00 21 0.98 13 1.35 77 74.69 1.03 0.02

Mouth 20 0.80 52 0.63* 37 0.85 5 0.31* 114 166.82 0.68* -0.50

Nasopharynx 3 0.83 8 0.68 6 0.99 4 1.89 21 23.61 0.89 -0.02

Tonsil 6 0.63 29 0.94 3 0.19* 3 0.58 41 61.22 0.67* -0.19

Oropharynx 2 0.66 12 1.19 2 0.38 0 0.00 16 20.21 0.79 -0.04

Hypopharynx 9 0.76 33 0.85 14 0.70 4 0.58 60 77.76 0.77* -0.17

Digestive system 924 1.03 2,861 0.92* 1,589 0.85* 624 0.81* 5,998 6,654.65 0.90* -6.19

Esophagus 62 1.17 153 0.83* 83 0.78* 42 1.01 340 385.04 0.88* -0.42

Stomach 107 0.99 291 0.79* 152 0.71* 62 0.69* 612 782.42 0.78* -1.61

Small intestine 22 1.89* 46 1.10 38 1.49* 13 1.22 119 89.56 1.33* 0.28

Colon 376 0.96 1,344 0.97 712 0.85* 273 0.76* 2,705 2,973.18 0.91* -2.53

Rectum, rectosigmoid junction 145 0.94 502 0.95 291 0.96 78 0.65* 1,016 1,108.78 0.92* -0.87

Anus, anal canal 7 1.31 11 0.59 10 0.93 9 2.19 37 38.84 0.95 -0.02

Liver 25 0.73 66 0.54* 53 0.73* 27 0.94 171 257.15 0.66* -0.81

Gallbladder 6 0.74 19 0.68 14 0.83 4 0.56 43 60.27 0.71* -0.16

Bile ducts, other biliary 21 1.09 61 0.86 44 0.96 18 0.87 144 156.49 0.92 -0.12

Pancreas 145 1.42* 338 0.95 182 0.87 89 1.04 754 751.45 1.00 0.02

Respiratory system 593 0.79* 1,954 0.75* 1,155 0.77* 435 0.75* 4,137 5,448.11 0.76* -12.35

Nose, nasal cavity, ear 7 1.21 14 0.70 8 0.69 4 0.85 33 42.01 0.79 -0.08

Larynx 39 0.70* 156 0.84* 78 0.79* 32 0.91 305 374.99 0.81* -0.66

Lung, bronchus 546 0.79* 1,783 0.74* 1,066 0.77* 397 0.73* 3,792 5,018.08 0.76* -11.55

Male breast 12 1.57 26 0.97 16 0.99 8 1.18 62 57.58 1.08 0.04

Male genital system 15 0.01* 30 0.01* 28 0.01* 19 0.02* 92 10,281.90 0.01* -95.98

Prostate 3 0.00* 10 0.00* 11 0.00* 11 0.01* 35 10,205.47 0.00* -95.80

Testis 2 0.88 3 0.44 0 0.00 1 1.08 6 13.11 0.46* -0.07

Urinary system 522 1.35* 1,316 0.95 711 0.83* 309 0.87* 2,858 2,983.89 0.96* -1.19

Urinary bladder 330 1.16* 979 0.96 531 0.83* 228 0.84* 2,068 2,219.11 0.93* -1.42

Kidney parenchyma 162 2.02* 236 0.83* 126 0.75* 61 0.93 585 596.83 0.98 -0.11

Renal pelvis, other urinary 30 1.33 101 1.28* 54 1.15 20 1.02 205 167.95 1.22* 0.35

Ureter 6 0.79 22 0.83 25 1.59* 7 1.09 60 56.20 1.07 0.04

Bone, joints 4 1.40 10 1.03 12 2.19* 4 1.86 30 20.22 1.48* 0.09

Soft tissue including heart 14 0.96 43 0.83 38 1.19 10 0.73 105 112.18 0.94 -0.07

Kaposi sarcoma 2 0.46 12 0.84 1 0.12* 4 1.09 19 30.62 0.62* -0.11

Melanoma of skin 89 1.13 335 1.13* 225 1.19* 71 0.89 720 643.60 1.12* 0.72

Eye, orbit 4 0.79 20 1.13 11 1.06 3 0.74 38 37.26 1.02 0.01

Brain, central nervous system 35 1.05 121 1.04 61 0.90 25 0.95 242 244.00 0.99 -0.02

Thyroid 17 1.57 35 0.96 22 1.12 9 1.27 83 74.23 1.12 0.08

Lymphatic, hematopoietic 307 1.06 936 0.91* 595 0.94 252 0.94 2,090 2,224.56 0.94* -1.27

Hodgkin lymphoma 13 1.68 16 0.63 9 0.66 3 0.60 41 51.64 0.79 -0.10

Non-Hodgkin lymphoma 152 1.29* 375 0.88* 241 0.90 106 0.94 874 927.57 0.94 -0.50

Myeloma 57 1.08 176 0.94 125 1.11 39 0.82 397 399.15 0.99 -0.02

Leukemia 85 0.76* 369 0.94 220 0.92 104 1.03 778 846.19 0.92* -0.64

Acute lymphocytic 4 1.42 6 0.63 5 0.93 2 0.95 17 19.82 0.86 -0.03

Chronic lymphocytic 34 0.75 126 0.80* 90 0.95 51 1.28 301 338.64 0.89* -0.35

Acute non-lymphocytic 25 0.68 129 0.98 75 0.93 30 0.87 259 283.07 0.91 -0.23

Chronic myeloid 13 0.86 66 1.24 34 1.04 10 0.70 123 115.56 1.06 0.07

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 201,491 178,149 91,141 27,706 201,491

Person-years in interval 157,172 520,663 280,079 103,707 1,061,620

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 269
All subsequent cancers 8,325 0.64* 838 0.67* 252 0.72* 65 0.98 9,480 14,724.07 0.64* -103.10

All excluding same site 8,316 0.96* 838 1.00 252 1.07 65 1.39* 9,471 9,744.29 0.97* -5.37

Buccal cavity, pharynx 257 0.81* 26 0.96 4 0.55 1 0.73 288 351.95 0.82* -1.26

Lip 49 0.84 3 0.53 1 0.65 1 3.43 54 65.72 0.82 -0.23

Tongue 38 0.63* 6 1.23 1 0.78 0 0.00 45 67.05 0.67* -0.43

Salivary gland 33 1.10 4 1.19 0 0.00 0 0.00 37 34.58 1.07 0.05

Mouth 57 0.79 5 0.83 1 0.63 0 0.00 63 80.37 0.78 -0.34

Nasopharynx 5 0.47 1 1.26 0 0.00 0 0.00 6 11.62 0.52 -0.11

Tonsil 26 0.95 3 1.52 0 0.00 0 0.00 29 29.92 0.97 -0.02

Oropharynx 6 0.65 0 0.00 0 0.00 0 0.00 6 10.20 0.59 -0.08

Hypopharynx 33 0.93 3 1.13 0 0.00 0 0.00 36 38.80 0.93 -0.06

Digestive system 2,575 0.94* 264 0.96 73 0.95 19 1.23 2,931 3,107.99 0.94* -3.48

Esophagus 145 0.85 10 0.65 1 0.24 0 0.00 156 190.58 0.82* -0.68

Stomach 268 0.86* 30 0.97 8 0.92 3 1.71 309 353.16 0.87* -0.87

Small intestine 47 1.19 7 1.82 1 0.92 0 0.00 55 44.51 1.24 0.21

Colon 1,190 0.99 120 0.95 33 0.92 11 1.52 1,354 1,376.37 0.98 -0.44

Rectum, rectosigmoid junction 444 0.96 49 1.12 14 1.19 2 0.88 509 520.80 0.98 -0.23

Anus, anal canal 21 1.28 5 3.37* 1 2.40 0 0.00 27 18.38 1.47 0.17

Liver 86 0.75* 8 0.76 3 1.02 1 1.71 98 128.61 0.76* -0.60

Gallbladder 12 0.52* 2 0.80 0 0.00 1 6.60 15 26.65 0.56* -0.23

Bile ducts, other biliary 48 0.75* 10 1.38 2 0.92 0 0.00 60 73.77 0.81 -0.27

Pancreas 285 0.92 23 0.75 10 1.16 0 0.00 318 351.63 0.90 -0.66

Respiratory system 2,080 0.86* 196 0.90 53 0.91 13 1.18 2,342 2,707.89 0.86* -7.19

Nose, nasal cavity, ear 15 0.85 2 1.17 0 0.00 1 10.19 18 19.88 0.91 -0.04

Larynx 162 0.96 8 0.60 4 1.18 0 0.00 174 186.93 0.93 -0.25

Lung, bronchus 1,895 0.85* 186 0.93 49 0.90 12 1.16 2,142 2,495.22 0.86* -6.94

Male breast 24 0.99 3 1.24 1 1.44 0 0.00 28 27.60 1.01 0.01

Male genital system 35 0.01* 4 0.01* 2 0.02* 1 0.05* 42 5,014.40 0.01* -97.76

Prostate 9 0.00* 0 0.00* 0 0.00* 0 0.00* 9 4,979.78 0.00* -97.73

Testis 5 0.91 0 0.00 0 0.00 0 0.00 5 5.93 0.84 -0.02

Urinary system 1,511 1.20* 156 1.21* 64 1.74* 13 1.74 1,744 1,434.40 1.22* 6.09

Urinary bladder 1,143 1.23* 132 1.35* 57 2.03* 12 2.09* 1,344 1,057.63 1.27* 5.63

Kidney parenchyma 306 1.15* 18 0.74 4 0.59 1 0.76 329 297.34 1.11 0.62

Renal pelvis, other urinary 62 0.89 6 0.85 3 1.50 0 0.00 71 79.43 0.89 -0.17

Ureter 14 0.59* 1 0.42 0 0.00 0 0.00 15 26.89 0.56* -0.23

Bone, joints 8 0.94 2 2.60 0 0.00 0 0.00 10 9.52 1.05 0.01

Soft tissue including heart 76 1.62* 9 1.84 6 4.15* 0 0.00 91 53.44 1.70* 0.74

Kaposi sarcoma 7 0.64 1 0.82 0 0.00 0 0.00 8 12.58 0.64 -0.09

Melanoma of skin 328 1.16* 36 1.23 10 1.14 6 3.22* 380 322.70 1.18* 1.13

Eye, orbit 17 1.05 2 1.31 0 0.00 0 0.00 19 18.14 1.05 0.02

Brain, central nervous system 121 1.10 12 1.21 3 1.11 0 0.00 136 122.98 1.11 0.26

Thyroid 43 1.33 6 2.25 1 1.42 0 0.00 50 35.81 1.40* 0.28

Lymphatic, hematopoietic 969 1.04 96 1.00 25 0.91 6 1.07 1,096 1,062.07 1.03 0.67

Hodgkin lymphoma 19 0.87 1 0.54 0 0.00 0 0.00 20 24.33 0.82 -0.09

Non-Hodgkin lymphoma 427 1.06 43 1.04 11 0.92 1 0.41 482 458.22 1.05 0.47

Myeloma 168 1.00 17 1.01 4 0.83 4 4.11* 193 190.90 1.01 0.04

Leukemia 355 1.04 35 0.98 10 0.97 1 0.48 401 388.62 1.03 0.24

Acute lymphocytic 15 1.93* 0 0.00 0 0.00 0 0.00 15 8.75 1.72 0.12

Chronic lymphocytic 112 0.82* 12 0.85 6 1.51 1 1.25 131 154.64 0.85 -0.46

Acute non-lymphocytic 148 1.27* 14 1.14 1 0.28 0 0.00 163 133.21 1.22* 0.59

Chronic myeloid 45 0.97 5 1.00 3 2.06 0 0.00 53 53.32 0.99 -0.01

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 90,538 13,657 3,750 888 90,538

Person-years in interval 457,868 38,421 10,353 1,993 508,635

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Prostate

Males, Long-term Follow-up, Radiotherapy

Table 10.1.9: Risk of subsequent primary cancers after cancer of the prostate gland, males, long-term follow-up,

with initial radiotherapy, SEER 1973-2000.

270 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

PROSTATE

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Prostate

Males, Long-term Follow-up, No Radiotherapy

Table 10.1.10: Risk of subsequent primary cancers after cancer of the prostate gland, males, long-term follow-up,

without initial radiotherapy, SEER 1973-2000.

PROSTATE

All subsequent cancers 15,774 0.58* 1,400 0.54* 413 0.56* 89 0.54* 17,676 30,518.73 0.58* -120.97

All excluding same site 15,750 0.88* 1,393 0.81* 410 0.83* 88 0.76* 17,641 20,313.26 0.87* -25.17

Buccal cavity, pharynx 525 0.79* 38 0.69* 13 0.87 3 0.89 579 734.57 0.79* -1.47

Lip 117 0.89 13 1.11 2 0.61 1 1.36 133 147.52 0.90 -0.14

Tongue 90 0.74* 7 0.72 2 0.78 0 0.00 99 135.19 0.73* -0.34

Salivary gland 64 0.98 8 1.16 5 2.33 0 0.00 77 74.69 1.03 0.02

Mouth 109 0.72* 2 0.16* 1 0.31 2 2.73 114 166.82 0.68* -0.50

Nasopharynx 17 0.79 2 1.25 2 4.69 0 0.00 21 23.61 0.89 -0.02

Tonsil 38 0.68* 2 0.50 1 1.02 0 0.00 41 61.22 0.67* -0.19

Oropharynx 16 0.87 0 0.00 0 0.00 0 0.00 16 20.21 0.79 -0.04

Hypopharynx 56 0.79 4 0.75 0 0.00 0 0.00 60 77.76 0.77* -0.17

Digestive system 5,374 0.91* 464 0.82* 136 0.83* 24 0.62* 5,998 6,654.65 0.90* -6.19

Esophagus 298 0.87* 33 1.07 8 0.92 1 0.50 340 385.04 0.88* -0.42

Stomach 550 0.79* 38 0.58* 23 1.20 1 0.22 612 782.42 0.78* -1.61

Small intestine 106 1.34* 8 1.02 5 2.18 0 0.00 119 89.56 1.33* 0.28

Colon 2,432 0.93* 215 0.82* 46 0.60* 12 0.66 2,705 2,973.18 0.91* -2.53

Rectum, rectosigmoid junction 938 0.95 57 0.64* 19 0.77 2 0.35 1,016 1,108.78 0.92* -0.87

Anus, anal canal 28 0.81 6 1.97 3 3.44 0 0.00 37 38.84 0.95 -0.02

Liver 144 0.63* 21 1.00 4 0.66 2 1.40 171 257.15 0.66* -0.81

Gallbladder 39 0.73 2 0.38 1 0.65 1 2.57 43 60.27 0.71* -0.16

Bile ducts, other biliary 126 0.93 12 0.81 5 1.07 1 0.84 144 156.49 0.92 -0.12

Pancreas 665 1.00 67 1.06 19 1.04 3 0.69 754 751.45 1.00 0.02

Respiratory system 3,702 0.76* 326 0.75* 90 0.75* 19 0.71 4,137 5,448.11 0.76* -12.35

Nose, nasal cavity, ear 29 0.78 4 1.16 0 0.00 0 0.00 33 42.01 0.79 -0.08

Larynx 273 0.80* 23 0.86 7 1.01 2 1.40 305 374.99 0.81* -0.66

Lung, bronchus 3,395 0.76* 297 0.74* 83 0.74* 17 0.68 3,792 5,018.08 0.76* -11.55

Male breast 54 1.06 6 1.21 1 0.67 1 2.84 62 57.58 1.08 0.04

Male genital system 73 0.01* 10 0.01* 6 0.02* 3 0.06* 92 10,281.90 0.01* -95.98

Prostate 24 0.00* 7 0.01* 3 0.01* 1 0.02* 35 10,205.47 0.00* -95.80

Testis 5 0.41* 0 0.00 1 5.89 0 0.00 6 13.11 0.46* -0.07

Urinary system 2,549 0.97 218 0.83* 77 1.01 14 0.76 2,858 2,983.89 0.96* -1.19

Urinary bladder 1,840 0.94* 165 0.83* 52 0.89 11 0.77 2,068 2,219.11 0.93* -1.42

Kidney parenchyma 524 0.99 40 0.82 19 1.38 2 0.63 585 596.83 0.98 -0.11

Renal pelvis, other urinary 185 1.25* 13 0.91 6 1.43 1 0.96 205 167.95 1.22* 0.35

Ureter 53 1.06 5 1.05 2 1.49 0 0.00 60 56.20 1.07 0.04

Bone, joints 26 1.44 2 1.27 1 2.16 1 9.60 30 20.22 1.48* 0.09

Soft tissue including heart 95 0.96 7 0.70 2 0.66 1 1.33 105 112.18 0.94 -0.07

Kaposi sarcoma 15 0.56* 3 1.13 1 1.21 0 0.00 19 30.62 0.62* -0.11

Melanoma of skin 649 1.15* 53 0.92 14 0.80 4 0.88 720 643.60 1.12* 0.72

Eye, orbit 35 1.05 1 0.33 2 2.36 0 0.00 38 37.26 1.02 0.01

Brain, central nervous system 217 1.00 19 0.97 6 1.10 0 0.00 242 244.00 0.99 -0.02

Thyroid 74 1.10 8 1.50 0 0.00 1 3.11 83 74.23 1.12 0.08

Lymphatic, hematopoietic 1,838 0.94* 182 0.93 53 0.92 17 1.21 2,090 2,224.56 0.94* -1.27

Hodgkin lymphoma 38 0.81 3 0.79 0 0.00 0 0.00 41 51.64 0.79 -0.10

Non-Hodgkin lymphoma 768 0.94 81 0.98 21 0.85 4 0.66 874 927.57 0.94 -0.50

Myeloma 358 1.02 26 0.75 6 0.58 7 2.88* 397 399.15 0.99 -0.02

Leukemia 674 0.90* 72 0.97 26 1.19 6 1.13 778 846.19 0.92* -0.64

Acute lymphocytic 15 0.85 1 0.62 0 0.00 1 12.30 17 19.82 0.86 -0.03

Chronic lymphocytic 250 0.84* 36 1.23 12 1.41 3 1.48 301 338.64 0.89* -0.35

Acute non-lymphocytic 229 0.92 22 0.88 6 0.81 2 1.08 259 283.07 0.91 -0.23

Chronic myeloid 113 1.11 6 0.58 4 1.30 0 0.00 123 115.56 1.06 0.07

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 201,491 27,706 7,753 1,949 201,491

Person-years in interval 957,913 77,539 21,294 4,874 1,061,620

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 271
Testis

Males

Table 10.2.1: Characteristics of patients with an initial cancer of the testis, males,

SEER 1973-2000.

272 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

TESTIS

Number of patients with 1st primary cancer

Total 14,984 100.0 — — 14,984 100.0

Initial treatment

Any radiation 6,751 45.1 — — 6,751 45.1

With surgery 6,658 44.4 — — 6,658 44.4

Without surgery 93 0.6 — — 93 0.6

No radiation 8,233 54.9 — — 8,233 54.9

With surgery 7,884 52.6 — — 7,884 52.6

Without surgery 349 2.3 — — 349 2.3

Race

White 13,979 93.3 — — 13,979 93.3

Black 317 2.1 — — 317 2.1

Other 580 3.9 — — 580 3.9

Unknown 108 0.7 — — 108 0.7

Age at 1st primary cancer diagnosis, years

< 30 5,893 39.3 — — 5,893 39.3

30–49 7,822 52.2 — — 7,822 52.2

50–69 1,113 7.4 — — 1,113 7.4

70–79 120 0.8 — — 120 0.8

> 80 36 0.2 — — 36 0.2

Number of patients with one or more

primary cancers

One primary cancer only 14,246 95.1 — — 14,246 95.1

1st and 2nd cancers 679 4.5 — — 679 4.5

1st, 2nd, and 3rd cancers 54 0.4 — — 54 0.4

1st, 2nd, 3rd, and additional cancers 5 0.0 — — 5 0.0

Other statistics

Median age at 1st cancer diagnosis 32.6 — — — 32.6 —

Median year of 1st cancer diagnosis 1989.6 — — — 1989.6 —

Median person-years at risk 8.4 — — — 8.4 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 98.0 — — — 98.0

1st, 2nd, and additional cancers — 97.4 — — — 97.4

1st cancer only — 1.6 — — — 1.6

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Testis

Males

Table 10.2.2: Risk of subsequent primary cancers after cancer of the testis, males,

SEER 1973-2000.

TESTIS

All subsequent cancers 56 2.58* 208 2.07* 197 1.59* 342 1.38* 803 494.61 1.62* 21.38

All excluding same site 44 2.15* 127 1.33* 141 1.18 308 1.26* 620 480.99 1.29* 9.64

Buccal cavity, pharynx 2 2.21 1 0.24 6 1.15 16 1.70 25 19.74 1.27 0.36

Lip 0 0.00 0 0.00 1 1.33 2 1.66 3 2.78 1.08 0.02

Tongue 1 5.21 1 1.09 1 0.86 4 1.80 7 4.50 1.56 0.17

Salivary gland 0 0.00 0 0.00 1 2.40 2 2.67 3 1.61 1.87 0.10

Mouth 1 5.03 0 0.00 2 1.73 3 1.47 6 4.32 1.39 0.12

Nasopharynx 0 0.00 0 0.00 0 0.00 1 2.20 1 1.08 0.92 -0.01

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 2.65 0.00 -0.18

Oropharynx 0 0.00 0 0.00 0 0.00 1 3.76 1 0.52 1.91 0.03

Hypopharynx 0 0.00 0 0.00 0 0.00 3 3.49 3 1.72 1.75 0.09

Digestive system 4 1.07 29 1.65* 24 1.07 69 1.50* 126 89.74 1.40* 2.51

Esophagus 0 0.00 3 2.61 2 1.29 6 1.73 11 6.41 1.72 0.32

Stomach 1 2.28 2 1.00 1 0.41 7 1.51 11 9.53 1.15 0.10

Small intestine 0 0.00 2 5.58 0 0.00 1 1.07 3 1.83 1.64 0.08

Colon 1 0.69 9 1.33 7 0.81 18 1.02 35 34.47 1.02 0.04

Rectum, rectosigmoid junction 1 1.34 8 2.27 7 1.55 12 1.32 28 17.84 1.57* 0.70

Anus, anal canal 0 0.00 0 0.00 1 2.84 1 1.53 2 1.34 1.49 0.05

Liver 0 0.00 1 1.17 1 0.87 4 1.55 6 4.76 1.26 0.09

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.04

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 2 1.96 2 1.92 1.04 0.01

Pancreas 0 0.00 3 1.52 5 1.98 17 3.25* 25 10.14 2.47* 1.03

Respiratory system 3 0.88 13 0.81 21 1.02 56 1.34* 93 82.01 1.13 0.76

Nose, nasal cavity, ear 0 0.00 1 4.52 0 0.00 1 2.16 2 0.99 2.01 0.07

Larynx 0 0.00 0 0.00 2 0.95 5 1.24 7 8.16 0.86 -0.08

Lung, bronchus 3 1.01 12 0.86 19 1.05 50 1.34 84 72.37 1.16 0.81

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 1.01 0.00 -0.07

Male genital system 21 4.67* 102 4.83* 91 3.28* 91 1.29* 305 124.15 2.46* 12.54

Prostate 9 2.80* 20 1.25 35 1.50* 56 0.84 120 109.54 1.10 0.73

Testis 12 9.73* 81 16.53* 56 13.61* 34 10.10* 183 13.62 13.44* 11.75

Urinary system 9 4.87* 13 1.48 13 1.14 42 1.76* 77 45.92 1.68* 2.16

Urinary bladder 3 2.53 7 1.24 10 1.37 27 1.75* 47 29.51 1.59* 1.21

Kidney parenchyma 6 10.57* 6 2.19 3 0.83 10 1.34 25 14.36 1.74* 0.74

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 5 4.91* 5 2.04 2.45 0.20

Ureter 0 0.00 0 0.00 0 0.00 2 6.24 2 0.63 3.19 0.10

Bone, joints 0 0.00 1 2.61 0 0.00 0 0.00 1 1.25 0.80 -0.02

Soft tissue including heart 0 0.00 1 1.03 4 3.96* 3 1.97 8 3.73 2.15 0.30

Kaposi sarcoma 4 4.13* 3 0.68 3 0.66 3 0.74 13 13.94 0.93 -0.06

Melanoma of skin 5 3.33* 13 1.88* 6 0.75 13 0.98 37 29.73 1.24 0.50

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 1.13 0.00 -0.08

Brain, central nervous system 3 4.67 4 1.44 4 1.35 7 1.61 18 10.72 1.68 0.50

Thyroid 0 0.00 4 2.48 3 1.78 5 2.09 12 6.06 1.98* 0.41

Lymphatic, hematopoietic 5 1.76 22 1.75* 19 1.35 25 1.07 71 52.86 1.34* 1.26

Hodgkin lymphoma 0 0.00 0 0.00 3 1.77 2 1.19 5 5.94 0.84 -0.07

Non-Hodgkin lymphoma 4 2.98 8 1.29 8 1.09 11 0.90 31 27.14 1.14 0.27

Myeloma 0 0.00 0 0.00 0 0.00 5 1.79 5 5.29 0.95 -0.02

Leukemia 1 1.33 14 4.24* 8 2.12 7 1.05 30 14.49 2.07* 1.08

Acute lymphocytic 0 0.00 1 3.03 0 0.00 0 0.00 1 1.05 0.95 0.00

Chronic lymphocytic 1 5.33 2 2.23 1 0.85 2 0.82 6 4.72 1.27 0.09

Acute non-lymphocytic 0 0.00 10 8.88* 6 4.86* 3 1.40 19 4.76 3.99* 0.99

Chronic myeloid 0 0.00 0 0.00 1 1.55 0 0.00 1 2.39 0.42 -0.10

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 14,984 13,764 10,011 6,602 14,984

Person-years in interval 11,930 46,730 41,264 44,290 144,214

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 273
All subsequent cancers 461 1.87* 147 1.32* 119 1.39* 76 1.47* 803 494.61 1.62* 21.38

All excluding same site 312 1.32* 119 1.09 115 1.36* 74 1.44* 620 480.99 1.29* 9.64

Buccal cavity, pharynx 9 0.87 7 1.56 5 1.57 4 2.30 25 19.74 1.27 0.36

Lip 1 0.63 2 3.36 0 0.00 0 0.00 3 2.78 1.08 0.02

Tongue 3 1.32 1 0.96 2 2.64 1 2.35 7 4.50 1.56 0.17

Salivary gland 1 1.17 1 2.81 1 3.98 0 0.00 3 1.61 1.87 0.10

Mouth 3 1.31 1 1.02 1 1.46 1 2.73 6 4.32 1.39 0.12

Nasopharynx 0 0.00 0 0.00 1 6.73 0 0.00 1 1.08 0.92 -0.01

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 2.65 0.00 -0.18

Oropharynx 0 0.00 1 8.09 0 0.00 0 0.00 1 0.52 1.91 0.03

Hypopharynx 0 0.00 1 2.47 0 0.00 2 12.43* 3 1.72 1.75 0.09

Digestive system 57 1.30 27 1.31 26 1.65* 16 1.66 126 89.74 1.40* 2.51

Esophagus 5 1.70 1 0.67 2 1.65 3 3.94 11 6.41 1.72 0.32

Stomach 4 0.82 3 1.40 3 1.92 1 1.09 11 9.53 1.15 0.10

Small intestine 2 2.23 1 2.36 0 0.00 0 0.00 3 1.83 1.64 0.08

Colon 17 1.01 8 1.02 4 0.66 6 1.61 35 34.47 1.02 0.04

Rectum, rectosigmoid junction 16 1.82* 4 0.97 6 1.94 2 1.08 28 17.84 1.57* 0.70

Anus, anal canal 1 1.45 1 3.23 0 0.00 0 0.00 2 1.34 1.49 0.05

Liver 2 0.92 3 2.71 1 1.11 0 0.00 6 4.76 1.26 0.09

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.04

Bile ducts, other biliary 0 0.00 0 0.00 2 5.68 0 0.00 2 1.92 1.04 0.01

Pancreas 8 1.63 6 2.60 8 4.45* 3 2.69 25 10.14 2.47* 1.03

Respiratory system 37 0.92 20 1.06 28 1.95* 8 0.92 93 82.01 1.13 0.76

Nose, nasal cavity, ear 1 1.88 0 0.00 1 6.45 0 0.00 2 0.99 2.01 0.07

Larynx 2 0.48 2 1.06 2 1.46 1 1.28 7 8.16 0.86 -0.08

Lung, bronchus 34 0.97 18 1.08 25 1.95* 7 0.90 84 72.37 1.16 0.81

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 1.01 0.00 -0.07

Male genital system 214 4.01* 42 1.47* 25 0.98 24 1.44 305 124.15 2.46* 12.54

Prostate 64 1.50* 13 0.50* 21 0.86 22 1.34 120 109.54 1.10 0.73

Testis 149 14.54* 28 12.73* 4 4.42* 2 7.66 183 13.62 13.44* 11.75

Urinary system 35 1.59* 19 1.80* 10 1.22 13 2.55* 77 45.92 1.68* 2.16

Urinary bladder 20 1.42 11 1.63 6 1.13 10 2.98* 47 29.51 1.59* 1.21

Kidney parenchyma 15 2.17* 6 1.79 2 0.78 2 1.32 25 14.36 1.74* 0.74

Renal pelvis, other urinary 0 0.00 2 4.38 2 5.77 1 4.65 5 2.04 2.45 0.20

Ureter 0 0.00 1 7.12 1 9.16 0 0.00 2 0.63 3.19 0.10

Bone, joints 1 1.21 0 0.00 0 0.00 0 0.00 1 1.25 0.80 -0.02

Soft tissue including heart 5 2.27 3 3.93 0 0.00 0 0.00 8 3.73 2.15 0.30

Kaposi sarcoma 10 1.01 2 0.71 0 0.00 1 5.15 13 13.94 0.93 -0.06

Melanoma of skin 24 1.46 7 1.08 5 1.13 1 0.42 37 29.73 1.24 0.50

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 1.13 0.00 -0.08

Brain, central nervous system 11 1.72 4 1.80 2 1.42 1 1.39 18 10.72 1.68 0.50

Thyroid 7 1.91 1 0.80 4 5.18* 0 0.00 12 6.06 1.98* 0.41

Lymphatic, hematopoietic 46 1.56* 10 0.88 10 1.29 5 1.17 71 52.86 1.34* 1.26

Hodgkin lymphoma 3 0.70 1 1.02 0 0.00 1 5.00 5 5.94 0.84 -0.07

Non-Hodgkin lymphoma 20 1.34 5 0.83 4 0.99 2 0.92 31 27.14 1.14 0.27

Myeloma 0 0.00 2 1.64 3 3.10 0 0.00 5 5.29 0.95 -0.02

Leukemia 23 2.94* 2 0.64 3 1.34 2 1.54 30 14.49 2.07* 1.08

Acute lymphocytic 1 1.42 0 0.00 0 0.00 0 0.00 1 1.05 0.95 0.00

Chronic lymphocytic 4 1.76 0 0.00 1 1.19 1 1.97 6 4.72 1.27 0.09

Acute non-lymphocytic 16 6.10* 1 1.01 2 2.79 0 0.00 19 4.76 3.99* 0.99

Chronic myeloid 1 0.72 0 0.00 0 0.00 0 0.00 1 2.39 0.42 -0.10

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 14,984 6,602 3,721 1,713 14,984

Person-years in interval 99,924 25,553 13,331 5,407 144,214

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Testis

Males, Long-term Follow-up

Table 10.2.3: Risk of subsequent primary cancers after cancer of the testis, males,

long-term follow-up, SEER 1973-2000.

274 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

TESTIS

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Testis

Males, <35 Years of Age

Table 10.2.4: Risk of subsequent primary cancers after cancer of the testis, males,

<35 years of age, SEER 1973-2000.

TESTIS

All subsequent cancers 17 4.27* 80 4.14* 71 2.90* 124 2.19* 292 104.47 2.80* 20.70

All excluding same site 9 2.87* 20 1.27 26 1.23 95 1.77* 150 93.83 1.60* 6.20

Buccal cavity, pharynx 0 0.00 1 1.92 1 1.17 7 2.40 9 4.39 2.05 0.51

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.07

Tongue 0 0.00 1 8.13 1 4.76 2 2.64 4 1.11 3.60 0.32

Salivary gland 0 0.00 0 0.00 0 0.00 2 8.07 2 0.47 4.24 0.17

Mouth 0 0.00 0 0.00 0 0.00 1 1.83 1 0.76 1.31 0.03

Nasopharynx 0 0.00 0 0.00 0 0.00 1 5.38 1 0.37 2.73 0.07

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.70 0.00 -0.08

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.01

Hypopharynx 0 0.00 0 0.00 0 0.00 1 5.68 1 0.20 4.95 0.09

Digestive system 1 4.08 2 1.39 4 1.57 22 2.34* 29 13.64 2.13* 1.70

Esophagus 0 0.00 0 0.00 0 0.00 2 2.74 2 0.92 2.18 0.12

Stomach 0 0.00 0 0.00 0 0.00 3 3.08 3 1.47 2.04 0.17

Small intestine 0 0.00 0 0.00 0 0.00 1 3.61 1 0.43 2.32 0.06

Colon 0 0.00 1 1.81 1 1.11 4 1.31 6 4.61 1.30 0.15

Rectum, rectosigmoid junction 1 23.17 0 0.00 1 2.09 4 2.06 6 2.72 2.20 0.36

Anus, anal canal 0 0.00 0 0.00 1 9.37 1 3.61 2 0.45 4.40 0.17

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.98 0.00 -0.11

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.01

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.03

Pancreas 0 0.00 0 0.00 1 4.12 6 5.73* 7 1.42 4.94* 0.62

Respiratory system 0 0.00 0 0.00 1 0.73 11 1.68 12 8.68 1.38 0.37

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.03

Larynx 0 0.00 0 0.00 0 0.00 2 2.37 2 1.10 1.82 0.10

Lung, bronchus 0 0.00 0 0.00 1 0.93 9 1.64 10 7.06 1.42 0.32

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.02

Male genital system 8 9.35* 60 16.49* 45 12.84* 40 4.46* 153 16.96 9.02* 15.02

Prostate 0 0.00 0 0.00 0 0.00 10 1.69 10 6.12 1.63 0.43

Testis 8 9.45* 60 16.73* 45 13.66* 29 9.95* 142 10.64 13.34* 14.50

Urinary system 2 14.98* 1 1.28 3 2.15 16 3.15* 22 7.39 2.98* 1.61

Urinary bladder 0 0.00 0 0.00 2 2.58 6 2.20 8 4.06 1.97 0.44

Kidney parenchyma 2 44.09* 1 3.46 1 1.75 6 2.76* 10 3.08 3.25* 0.76

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 4 24.25* 4 0.25 16.08* 0.41

Ureter 0 0.00 0 0.00 0 0.00 2 55.04* 2 0.05 37.38* 0.21

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.70 0.00 -0.08

Soft tissue including heart 0 0.00 1 2.44 3 6.92* 1 1.46 5 1.62 3.08 0.37

Kaposi sarcoma 2 4.11 2 0.74 2 0.58 3 0.87 9 10.05 0.90 -0.12

Melanoma of skin 1 2.14 5 2.09 2 0.63 4 0.66 12 12.03 1.00 0.00

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.04

Brain, central nervous system 1 4.01 1 0.90 2 1.64 6 3.18* 10 4.46 2.24* 0.61

Thyroid 0 0.00 2 2.76 2 2.40 2 1.51 6 3.03 1.98 0.33

Lymphatic, hematopoietic 2 2.10 5 1.16 6 1.21 7 0.82 20 18.81 1.06 0.13

Hodgkin lymphoma 0 0.00 0 0.00 1 0.89 2 1.83 3 3.92 0.76 -0.10

Non-Hodgkin lymphoma 2 5.21 0 0.00 3 1.10 1 0.20 6 10.10 0.59 -0.45

Myeloma 0 0.00 0 0.00 0 0.00 1 1.70 1 0.80 1.25 0.02

Leukemia 0 0.00 5 5.56* 2 2.03 3 1.59 10 3.99 2.51* 0.66

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.07

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 1 2.10 1 0.62 1.61 0.04

Acute non-lymphocytic 0 0.00 5 13.97* 2 5.38 1 1.63 8 1.43 5.60* 0.73

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.89 0.00 -0.10

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 8,939 8,277 6,184 4,237 8,939

Person-years in interval 7,148 28,423 25,878 29,148 90,596

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 275
All subsequent cancers 39 2.20* 128 1.58* 126 1.27* 218 1.14 511 390.14 1.31* 22.54

All excluding same site 35 2.02* 107 1.34* 115 1.17 213 1.11 470 387.17 1.21* 15.45

Buccal cavity, pharynx 2 2.47 0 0.00* 5 1.15 9 1.38 16 15.36 1.04 0.12

Lip 0 0.00 0 0.00 1 1.68 2 2.27 3 2.17 1.38 0.15

Tongue 1 5.84 0 0.00 0 0.00 2 1.37 3 3.39 0.89 -0.07

Salivary gland 0 0.00 0 0.00 1 3.29 0 0.00 1 1.14 0.88 -0.03

Mouth 1 5.37 0 0.00 2 1.95 2 1.34 5 3.56 1.41 0.27

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.72 0.00 -0.13

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 1.95 0.00 -0.36

Oropharynx 0 0.00 0 0.00 0 0.00 1 5.04 1 0.44 2.25 0.10

Hypopharynx 0 0.00 0 0.00 0 0.00 2 2.93 2 1.51 1.32 0.09

Digestive system 3 0.86 27 1.67* 20 1.00 47 1.29 97 76.10 1.27* 3.90

Esophagus 0 0.00 3 2.74 2 1.40 4 1.46 9 5.50 1.64 0.65

Stomach 1 2.44 2 1.09 1 0.46 4 1.10 8 8.06 0.99 -0.01

Small intestine 0 0.00 2 6.58 0 0.00 0 0.00 2 1.40 1.43 0.11

Colon 1 0.74 8 1.29 6 0.78 14 0.96 29 29.86 0.97 -0.16

Rectum, rectosigmoid junction 0 0.00 8 2.46* 6 1.49 8 1.12 22 15.12 1.45 1.28

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.89 0.00 -0.17

Liver 0 0.00 1 1.28 1 1.01 4 2.18 6 3.78 1.59 0.41

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -0.09

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 2 2.48 2 1.61 1.24 0.07

Pancreas 0 0.00 3 1.61 4 1.75 11 2.63* 18 8.72 2.06* 1.73

Respiratory system 3 0.91 13 0.84 20 1.04 45 1.27 81 73.33 1.10 1.43

Nose, nasal cavity, ear 0 0.00 1 5.66 0 0.00 1 3.19 2 0.73 2.74 0.24

Larynx 0 0.00 0 0.00 2 1.03 3 0.94 5 7.07 0.71 -0.39

Lung, bronchus 3 1.04 12 0.89 18 1.06 41 1.29 74 65.31 1.13 1.62

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -0.15

Male genital system 13 3.57* 42 2.40* 46 1.90* 51 0.82 152 107.19 1.42* 8.36

Prostate 9 2.80* 20 1.25 35 1.51* 46 0.75 110 103.42 1.06 1.23

Testis 4 10.37* 21 15.96* 11 13.38* 5 11.06* 41 2.98 13.78* 7.09

Urinary system 7 4.09* 12 1.50 10 1.00 26 1.38 55 38.53 1.43* 3.07

Urinary bladder 3 2.71 7 1.36 8 1.23 21 1.66* 39 25.46 1.53* 2.53

Kidney parenchyma 4 7.66* 5 2.04 2 0.66 4 0.76 15 11.28 1.33 0.69

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 1.17 1 1.79 0.56 -0.15

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.11

Bone, joints 0 0.00 1 6.33 0 0.00 0 0.00 1 0.54 1.84 0.09

Soft tissue including heart 0 0.00 0 0.00 1 1.73 2 2.39 3 2.10 1.43 0.17

Kaposi sarcoma 2 4.16 1 0.59 1 0.90 0 0.00 4 3.89 1.03 0.02

Melanoma of skin 4 3.87* 8 1.77 4 0.82 9 1.24 25 17.71 1.41 1.36

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -0.15

Brain, central nervous system 2 5.08 3 1.79 2 1.15 1 0.41 8 6.26 1.28 0.32

Thyroid 0 0.00 2 2.26 1 1.17 3 2.81 6 3.02 1.98 0.56

Lymphatic, hematopoietic 3 1.60 17 2.07* 13 1.43 18 1.21 51 34.05 1.50* 3.16

Hodgkin lymphoma 0 0.00 0 0.00 2 3.51 0 0.00 2 2.02 0.99 0.00

Non-Hodgkin lymphoma 2 2.09 8 1.90 5 1.08 10 1.38 25 17.04 1.47 1.48

Myeloma 0 0.00 0 0.00 0 0.00 4 1.81 4 4.48 0.89 -0.09

Leukemia 1 1.84 9 3.74* 6 2.16 4 0.84 20 10.50 1.90* 1.77

Acute lymphocytic 0 0.00 1 8.08 0 0.00 0 0.00 1 0.45 2.23 0.10

Chronic lymphocytic 1 5.49 2 2.34 1 0.92 1 0.51 5 4.10 1.22 0.17

Acute non-lymphocytic 0 0.00 5 6.51* 4 4.63* 2 1.31 11 3.33 3.30* 1.43

Chronic myeloid 0 0.00 0 0.00 1 2.53 0 0.00 1 1.50 0.67 -0.09

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,045 5,487 3,827 2,365 6,045

Person-years in interval 4,782 18,307 15,387 15,143 53,619

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Testis

Males, ≥35 Years of Age

Table 10.2.5: Risk of subsequent primary cancers after cancer of the testis, males,

≥35 years of age, SEER 1973-2000.

276 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

TESTIS

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Testis

Males, Radiotherapy

Table 10.2.6: Risk of subsequent primary cancers after cancer of the testis, males,

with initial radiotherapy, SEER 1973-2000.

TESTIS

All subsequent cancers 31 2.60* 126 2.19* 119 1.61* 227 1.47* 503 297.77 1.69* 29.88

All excluding same site 25 2.20* 71 1.28* 93 1.29* 212 1.39* 401 292.02 1.37* 15.87

Buccal cavity, pharynx 0 0.00 1 0.39 5 1.56 5 0.87 11 12.07 0.91 -0.16

Lip 0 0.00 0 0.00 1 2.19 0 0.00 1 1.68 0.59 -0.10

Tongue 0 0.00 1 1.82 0 0.00 2 1.48 3 2.72 1.10 0.04

Salivary gland 0 0.00 0 0.00 1 4.13 0 0.00 1 0.94 1.07 0.01

Mouth 0 0.00 0 0.00 2 2.74 1 0.79 3 2.70 1.11 0.04

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -0.09

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 1.60 0.00 -0.23

Oropharynx 0 0.00 0 0.00 0 0.00 1 5.95 1 0.33 3.01 0.10

Hypopharynx 0 0.00 0 0.00 0 0.00 1 1.82 1 1.10 0.91 -0.01

Digestive system 4 1.87 17 1.61 15 1.07 48 1.67* 84 55.43 1.52* 4.16

Esophagus 0 0.00 2 2.86 1 1.03 5 2.28 8 4.01 2.00 0.58

Stomach 1 4.02 2 1.67 0 0.00 6 2.09 9 5.84 1.54 0.46

Small intestine 0 0.00 2 9.48* 0 0.00 0 0.00 2 1.11 1.81 0.13

Colon 1 1.22 6 1.49 3 0.56 12 1.08 22 21.34 1.03 0.10

Rectum, rectosigmoid junction 1 2.31 4 1.87 6 2.12 7 1.23 18 11.09 1.62 1.01

Anus, anal canal 0 0.00 0 0.00 1 4.94 1 2.67 2 0.77 2.60 0.18

Liver 0 0.00 0 0.00 1 1.40 3 1.88 4 2.92 1.37 0.16

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.05

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 2 3.16 2 1.18 1.70 0.12

Pancreas 0 0.00 1 0.84 3 1.90 11 3.35* 15 6.30 2.38* 1.27

Respiratory system 0 0.00 6 0.60 18 1.36 45 1.67* 69 52.14 1.32* 2.45

Nose, nasal cavity, ear 0 0.00 1 7.80 0 0.00 1 3.58 2 0.59 3.39 0.21

Larynx 0 0.00 0 0.00 2 1.48 5 1.95 7 5.18 1.35 0.26

Lung, bronchus 0 0.00 5 0.57 16 1.37 39 1.63* 60 46.13 1.30 2.02

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -0.09

Male genital system 11 4.66* 69 5.84* 51 3.05* 57 1.25 188 76.37 2.46* 16.25

Prostate 5 2.80 14 1.47 25 1.68* 41 0.94 85 70.01 1.21 2.18

Testis 6 10.93* 55 25.69* 26 15.27* 15 10.99* 102 5.76 17.72* 14.01

Urinary system 6 5.66* 7 1.32 9 1.27 26 1.74* 48 28.43 1.69* 2.85

Urinary bladder 2 2.95 6 1.77 7 1.54 17 1.74* 32 18.36 1.74* 1.99

Kidney parenchyma 4 12.13* 1 0.60 2 0.90 5 1.09 12 8.79 1.37 0.47

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 4 6.19* 4 1.28 3.13 0.40

Ureter 0 0.00 0 0.00 0 0.00 2 9.71* 2 0.40 5.05 0.23

Bone, joints 0 0.00 1 5.70 0 0.00 0 0.00 1 0.60 1.65 0.06

Soft tissue including heart 0 0.00 0 0.00 3 5.56* 1 1.17 4 2.00 2.00 0.29

Kaposi sarcoma 3 6.19* 1 0.47 0 0.00 2 1.09 6 6.49 0.92 -0.07

Melanoma of skin 3 3.73 8 2.12 5 1.13 7 0.93 23 16.54 1.39 0.94

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.66 0.00 -0.10

Brain, central nervous system 1 3.03 3 2.04 3 1.87 4 1.62 11 5.88 1.87 0.75

Thyroid 0 0.00 1 1.19 1 1.14 4 3.11 6 3.20 1.88 0.41

Lymphatic, hematopoietic 3 2.05 12 1.79 8 1.02 20 1.47 43 29.63 1.45* 1.95

Hodgkin lymphoma 0 0.00 0 0.00 1 1.30 1 1.22 2 2.73 0.73 -0.11

Non-Hodgkin lymphoma 3 4.17 6 1.77 3 0.74 10 1.42 22 15.22 1.45 0.99

Myeloma 0 0.00 0 0.00 0 0.00 3 1.71 3 3.27 0.92 -0.04

Leukemia 0 0.00 6 3.30* 4 1.83 6 1.49 16 8.41 1.90* 1.10

Acute lymphocytic 0 0.00 1 7.18 0 0.00 0 0.00 1 0.49 2.02 0.07

Chronic lymphocytic 0 0.00 1 1.83 1 1.34 1 0.65 3 2.95 1.02 0.01

Acute non-lymphocytic 0 0.00 3 4.93 2 2.85 3 2.35 8 2.72 2.94* 0.77

Chronic myeloid 0 0.00 0 0.00 1 2.83 0 0.00 1 1.33 0.75 -0.05

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,751 6,308 4,719 3,134 6,751

Person-years in interval 5,429 21,780 19,525 21,949 68,683

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 277
All subsequent cancers 25 2.55* 82 1.91* 78 1.56* 115 1.22* 300 196.84 1.52* 13.66

All excluding same site 19 2.08* 56 1.40* 48 1.01 96 1.04 219 188.98 1.16* 3.97

Buccal cavity, pharynx 2 5.31 0 0.00 1 0.50 11 3.02* 14 7.67 1.82 0.84

Lip 0 0.00 0 0.00 0 0.00 2 4.26 2 1.10 1.82 0.12

Tongue 1 12.44 0 0.00 1 2.20 2 2.29 4 1.77 2.25 0.29

Salivary gland 0 0.00 0 0.00 0 0.00 2 6.62 2 0.67 2.99 0.18

Mouth 1 12.41 0 0.00 0 0.00 2 2.62 3 1.62 1.85 0.18

Nasopharynx 0 0.00 0 0.00 0 0.00 1 5.53 1 0.44 2.30 0.07

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 1.05 0.00 -0.14

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.03

Hypopharynx 0 0.00 0 0.00 0 0.00 2 6.47 2 0.62 3.23 0.18

Digestive system 0 0.00 12 1.70 9 1.06 21 1.22 42 34.31 1.22 1.02

Esophagus 0 0.00 1 2.23 1 1.73 1 0.78 3 2.41 1.25 0.08

Stomach 0 0.00 0 0.00 1 1.07 1 0.57 2 3.69 0.54 -0.22

Small intestine 0 0.00 0 0.00 0 0.00 1 2.75 1 0.73 1.38 0.04

Colon 0 0.00 3 1.10 4 1.23 6 0.92 13 13.13 0.99 -0.02

Rectum, rectosigmoid junction 0 0.00 4 2.89 1 0.59 5 1.48 10 6.75 1.48 0.43

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.08

Liver 0 0.00 1 2.93 0 0.00 1 1.02 2 1.84 1.09 0.02

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.03

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.75 0.00 -0.10

Pancreas 0 0.00 2 2.58 2 2.13 6 3.09* 10 3.83 2.61* 0.82

Respiratory system 3 2.16 7 1.15 3 0.40 11 0.73 24 29.87 0.80 -0.78

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.05

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 2.98 0.00 -0.39

Lung, bronchus 3 2.48 7 1.33 3 0.46 11 0.83 24 26.25 0.91 -0.30

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.05

Male genital system 10 4.68* 33 3.54* 40 3.64* 34 1.34 117 47.78 2.45* 9.16

Prostate 4 2.79 6 0.93 10 1.18 15 0.65 35 39.53 0.89 -0.60

Testis 6 8.77* 26 9.42* 30 12.43* 19 9.49* 81 7.86 10.31* 9.68

Urinary system 3 3.82 6 1.72 4 0.93 16 1.80* 29 17.49 1.66* 1.52

Urinary bladder 1 1.96 1 0.44 3 1.10 10 1.77 15 11.15 1.35 0.51

Kidney parenchyma 2 8.41 5 4.60* 1 0.72 5 1.75 13 5.57 2.33* 0.98

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 2.69 1 0.77 1.31 0.03

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.03

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -0.08

Soft tissue including heart 0 0.00 1 2.14 1 2.12 2 2.99 4 1.72 2.32 0.30

Kaposi sarcoma 1 2.07 2 0.88 3 1.20 1 0.45 7 7.45 0.94 -0.06

Melanoma of skin 2 2.88 5 1.60 1 0.28 6 1.04 14 13.19 1.06 0.11

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.47 0.00 -0.06

Brain, central nervous system 2 6.39 1 0.76 1 0.74 3 1.60 7 4.85 1.44 0.29

Thyroid 0 0.00 3 3.90 2 2.48 1 0.90 6 2.86 2.10 0.42

Lymphatic, hematopoietic 2 1.46 10 1.72 11 1.75 5 0.51 28 23.22 1.21 0.63

Hodgkin lymphoma 0 0.00 0 0.00 2 2.16 1 1.17 3 3.22 0.93 -0.03

Non-Hodgkin lymphoma 1 1.60 2 0.71 5 1.52 1 0.19 9 11.92 0.76 -0.39

Myeloma 0 0.00 0 0.00 0 0.00 2 1.92 2 2.01 0.99 0.00

Leukemia 1 2.78 8 5.38* 4 2.53 1 0.38 14 6.07 2.30* 1.05

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.07

Chronic lymphocytic 1 12.69 1 2.84 0 0.00 1 1.11 3 1.77 1.70 0.16

Acute non-lymphocytic 0 0.00 7 13.53* 4 7.50* 0 0.00 11 2.03 5.41* 1.19

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.06 0.00 -0.14

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 8,233 7,456 5,292 3,468 8,233

Person-years in interval 6,501 24,950 21,739 22,342 75,532

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Testis

Males, No Radiotherapy

Table 10.2.7: Risk of subsequent primary cancers after cancer of the testis, males,

without initial radiotherapy, SEER 1973-2000.

278 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

TESTIS

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Testis

Males, Long-term Follow-up, Radiotherapy

Table 10.2.8: Risk of subsequent primary cancers after cancer of the testis, males, long-term follow-up,

with initial radiotherapy, SEER 1973-2000.

TESTIS

All subsequent cancers 276 1.92* 85 1.24 91 1.70* 51 1.58* 503 297.77 1.69* 29.88

All excluding same site 189 1.36* 75 1.11 88 1.65* 49 1.52* 401 292.02 1.37* 15.87

Buccal cavity, pharynx 6 0.95 2 0.73 1 0.51 2 1.86 11 12.07 0.91 -0.16

Lip 1 1.05 0 0.00 0 0.00 0 0.00 1 1.68 0.59 -0.10

Tongue 1 0.73 0 0.00 1 2.20 1 3.83 3 2.72 1.10 0.04

Salivary gland 1 2.05 0 0.00 0 0.00 0 0.00 1 0.94 1.07 0.01

Mouth 2 1.40 1 1.62 0 0.00 0 0.00 3 2.70 1.11 0.04

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -0.09

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 1.60 0.00 -0.23

Oropharynx 0 0.00 1 12.74 0 0.00 0 0.00 1 0.33 3.01 0.10

Hypopharynx 0 0.00 0 0.00 0 0.00 1 9.84 1 1.10 0.91 -0.01

Digestive system 36 1.35 16 1.25 20 2.02* 12 1.99* 84 55.43 1.52* 4.16

Esophagus 3 1.66 1 1.05 1 1.31 3 6.26* 8 4.01 2.00 0.58

Stomach 3 1.01 2 1.51 3 3.08 1 1.75 9 5.84 1.54 0.46

Small intestine 2 3.76 0 0.00 0 0.00 0 0.00 2 1.11 1.81 0.13

Colon 10 0.98 3 0.61 4 1.04 5 2.14 22 21.34 1.03 0.10

Rectum, rectosigmoid junction 11 2.04* 3 1.16 3 1.54 1 0.86 18 11.09 1.62 1.01

Anus, anal canal 1 2.53 1 5.69 0 0.00 0 0.00 2 0.77 2.60 0.18

Liver 1 0.75 2 2.93 1 1.80 0 0.00 4 2.92 1.37 0.16

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.05

Bile ducts, other biliary 0 0.00 0 0.00 2 9.04* 0 0.00 2 1.18 1.70 0.12

Pancreas 4 1.32 4 2.76 6 5.29* 1 1.43 15 6.30 2.38* 1.27

Respiratory system 24 0.95 15 1.24 23 2.48* 7 1.27 69 52.14 1.32* 2.45

Nose, nasal cavity, ear 1 3.22 0 0.00 1 10.64 0 0.00 2 0.59 3.39 0.21

Larynx 2 0.77 2 1.66 2 2.29 1 2.03 7 5.18 1.35 0.26

Lung, bronchus 21 0.95 13 1.21 20 2.42* 6 1.21 60 46.13 1.30 2.02

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -0.09

Male genital system 131 4.24* 21 1.16 20 1.20 16 1.50 188 76.37 2.46* 16.25

Prostate 44 1.68* 10 0.58 17 1.05 14 1.34 85 70.01 1.21 2.18

Testis 87 19.81* 10 11.42* 3 8.12* 2 16.71* 102 5.76 17.72* 14.01

Urinary system 22 1.63* 9 1.36 9 1.73 8 2.51* 48 28.43 1.69* 2.85

Urinary bladder 15 1.74 5 1.18 5 1.48 7 3.32* 32 18.36 1.74* 1.99

Kidney parenchyma 7 1.66 2 0.97 2 1.27 1 1.06 12 8.79 1.37 0.47

Renal pelvis, other urinary 0 0.00 2 6.92 2 8.99* 0 0.00 4 1.28 3.13 0.40

Ureter 0 0.00 1 11.15 1 13.99 0 0.00 2 0.40 5.05 0.23

Bone, joints 1 2.61 0 0.00 0 0.00 0 0.00 1 0.60 1.65 0.06

Soft tissue including heart 3 2.60 1 2.41 0 0.00 0 0.00 4 2.00 2.00 0.29

Kaposi sarcoma 4 0.86 1 0.79 0 0.00 1 10.28 6 6.49 0.92 -0.07

Melanoma of skin 16 1.78* 5 1.39 2 0.79 0 0.00 23 16.54 1.39 0.94

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.66 0.00 -0.10

Brain, central nervous system 7 2.05 2 1.63 1 1.24 1 2.32 11 5.88 1.87 0.75

Thyroid 2 1.05 0 0.00 4 9.61* 0 0.00 6 3.20 1.88 0.41

Lymphatic, hematopoietic 23 1.44 9 1.39 8 1.74 3 1.16 43 29.63 1.45* 1.95

Hodgkin lymphoma 1 0.52 1 2.16 0 0.00 0 0.00 2 2.73 0.73 -0.11

Non-Hodgkin lymphoma 12 1.47 4 1.18 4 1.69 2 1.52 22 15.22 1.45 0.99

Myeloma 0 0.00 2 2.62 1 1.64 0 0.00 3 3.27 0.92 -0.04

Leukemia 10 2.28* 2 1.08 3 2.19 1 1.26 16 8.41 1.90* 1.10

Acute lymphocytic 1 3.23 0 0.00 0 0.00 0 0.00 1 0.49 2.02 0.07

Chronic lymphocytic 2 1.43 0 0.00 1 1.87 0 0.00 3 2.95 1.02 0.01

Acute non-lymphocytic 5 3.46* 1 1.72 2 4.58 0 0.00 8 2.72 2.94* 0.77

Chronic myeloid 1 1.34 0 0.00 0 0.00 0 0.00 1 1.33 0.75 -0.05

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 6,751 3,134 1,818 898 6,751

Person-years in interval 46,734 12,279 6,683 2,987 68,683

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 279
All subsequent cancers 185 1.80* 62 1.44* 28 0.88 25 1.30 300 196.84 1.52* 13.66

All excluding same site 123 1.27* 44 1.05 27 0.86 25 1.31 219 188.98 1.16* 3.97

Buccal cavity, pharynx 3 0.74 5 2.89 4 3.21 2 3.00 14 7.67 1.82 0.84

Lip 0 0.00 2 8.53 0 0.00 0 0.00 2 1.10 1.82 0.12

Tongue 2 2.22 1 2.46 1 3.30 0 0.00 4 1.77 2.25 0.29

Salivary gland 0 0.00 1 6.83 1 10.00 0 0.00 2 0.67 2.99 0.18

Mouth 1 1.16 0 0.00 1 3.87 1 7.26 3 1.62 1.85 0.18

Nasopharynx 0 0.00 0 0.00 1 16.84 0 0.00 1 0.44 2.30 0.07

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 1.05 0.00 -0.14

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.03

Hypopharynx 0 0.00 1 6.99 0 0.00 1 16.88 2 0.62 3.23 0.18

Digestive system 21 1.22 11 1.42 6 1.03 4 1.11 42 34.31 1.22 1.02

Esophagus 2 1.78 0 0.00 1 2.24 0 0.00 3 2.41 1.25 0.08

Stomach 1 0.52 1 1.22 0 0.00 0 0.00 2 3.69 0.54 -0.22

Small intestine 0 0.00 1 6.01 0 0.00 0 0.00 1 0.73 1.38 0.04

Colon 7 1.06 5 1.70 0 0.00 1 0.71 13 13.13 0.99 -0.02

Rectum, rectosigmoid junction 5 1.48 1 0.66 3 2.61 1 1.43 10 6.75 1.48 0.43

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.08

Liver 1 1.17 1 2.35 0 0.00 0 0.00 2 1.84 1.09 0.02

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.03

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.75 0.00 -0.10

Pancreas 4 2.11 2 2.33 2 3.02 2 4.77 10 3.83 2.61* 0.82

Respiratory system 13 0.87 5 0.74 5 0.98 1 0.31 24 29.87 0.80 -0.78

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.05

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 2.98 0.00 -0.39

Lung, bronchus 13 1.00 5 0.85 5 1.11 1 0.35 24 26.25 0.91 -0.30

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.05

Male genital system 83 3.70* 21 2.03* 5 0.56 8 1.32 117 47.78 2.45* 9.16

Prostate 20 1.22 3 0.34* 4 0.48 8 1.36 35 39.53 0.89 -0.60

Testis 62 10.58* 18 13.60* 1 1.86 0 0.00 81 7.86 10.31* 9.68

Urinary system 13 1.51 10 2.53* 1 0.33 5 2.62 29 17.49 1.66* 1.52

Urinary bladder 5 0.91 6 2.40 1 0.52 3 2.40 15 11.15 1.35 0.51

Kidney parenchyma 8 2.95* 4 3.09 0 0.00 1 1.74 13 5.57 2.33* 0.98

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 12.46 1 0.77 1.31 0.03

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.03

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -0.08

Soft tissue including heart 2 1.90 2 5.74 0 0.00 0 0.00 4 1.72 2.32 0.30

Kaposi sarcoma 6 1.14 1 0.64 0 0.00 0 0.00 7 7.45 0.94 -0.06

Melanoma of skin 8 1.08 2 0.69 3 1.58 1 1.04 14 13.19 1.06 0.11

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.47 0.00 -0.06

Brain, central nervous system 4 1.34 2 2.02 1 1.68 0 0.00 7 4.85 1.44 0.29

Thyroid 5 2.85 1 1.68 0 0.00 0 0.00 6 2.86 2.10 0.42

Lymphatic, hematopoietic 23 1.71* 1 0.20 2 0.63 2 1.20 28 23.22 1.21 0.63

Hodgkin lymphoma 2 0.85 0 0.00 0 0.00 1 11.13 3 3.22 0.93 -0.03

Non-Hodgkin lymphoma 8 1.19 1 0.38 0 0.00 0 0.00 9 11.92 0.76 -0.39

Myeloma 0 0.00 0 0.00 2 5.60 0 0.00 2 2.01 0.99 0.00

Leukemia 13 3.79* 0 0.00 0 0.00 1 2.00 14 6.07 2.30* 1.05

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.07

Chronic lymphocytic 2 2.31 0 0.00 0 0.00 1 5.23 3 1.77 1.70 0.16

Acute non-lymphocytic 11 9.34* 0 0.00 0 0.00 0 0.00 11 2.03 5.41* 1.19

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.06 0.00 -0.14

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 8,233 3,468 1,903 815 8,233

Person-years in interval 53,190 13,273 6,649 2,419 75,532

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Testis

Males, Long-term Follow-up, No Radiotherapy

Table 10.2.9: Risk of subsequent primary cancers after cancer of the testis, males, long-term follow-up,

without initial radiotherapy, SEER 1973-2000.

280 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

TESTIS

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Testis

Testicular Seminoma, Males

Table 10.2.10: Risk of subsequent primary cancers after seminoma of the testis, males,

SEER 1973-2000.

TESTIS

All subsequent cancers 41 2.70* 142 1.96* 135 1.50* 242 1.39* 560 351.71 1.59* 26.60

All excluding same site 35 2.41* 88 1.26* 110 1.25* 225 1.30* 458 345.12 1.33* 14.42

Buccal cavity, pharynx 2 3.02 1 0.32 4 1.04 6 0.94 13 14.04 0.93 -0.13

Lip 0 0.00 0 0.00 1 1.84 1 1.21 2 1.97 1.01 0.00

Tongue 1 7.15 1 1.47 0 0.00 2 1.34 4 3.16 1.26 0.11

Salivary gland 0 0.00 0 0.00 1 3.44 0 0.00 1 1.10 0.91 -0.01

Mouth 1 6.76 0 0.00 2 2.31 1 0.71 4 3.13 1.28 0.11

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.74 0.00 -0.09

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 1.85 0.00 -0.24

Oropharynx 0 0.00 0 0.00 0 0.00 1 5.36 1 0.39 2.59 0.08

Hypopharynx 0 0.00 0 0.00 0 0.00 1 1.63 1 1.28 0.78 -0.04

Digestive system 4 1.45 23 1.72* 20 1.17 51 1.56* 98 65.85 1.49* 4.11

Esophagus 0 0.00 3 3.40 2 1.68 5 2.02 10 4.73 2.12* 0.67

Stomach 1 3.11 2 1.31 1 0.54 7 2.14 11 6.97 1.58 0.51

Small intestine 0 0.00 2 7.59 0 0.00 0 0.00 2 1.29 1.55 0.09

Colon 1 0.94 6 1.16 4 0.61 12 0.94 23 25.48 0.90 -0.32

Rectum, rectosigmoid junction 1 1.80 7 2.60* 6 1.75 8 1.25 22 13.10 1.68* 1.14

Anus, anal canal 0 0.00 0 0.00 1 4.08 1 2.41 2 0.90 2.21 0.14

Liver 0 0.00 0 0.00 1 1.16 4 2.24 5 3.43 1.46 0.20

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.05

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 2 2.76 2 1.40 1.42 0.08

Pancreas 0 0.00 3 1.98 5 2.60 11 2.95* 19 7.48 2.54* 1.47

Respiratory system 2 0.78 9 0.72 19 1.19 47 1.54* 77 61.42 1.25 1.99

Nose, nasal cavity, ear 0 0.00 1 6.29 0 0.00 1 3.22 2 0.69 2.90 0.17

Larynx 0 0.00 0 0.00 2 1.24 5 1.74 7 6.04 1.16 0.12

Lung, bronchus 2 0.90 8 0.73 17 1.21 41 1.51* 68 54.42 1.25 1.73

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.73 0.00 -0.09

Male genital system 11 3.55* 69 4.50* 53 2.54* 61 1.17 194 91.32 2.12* 13.11

Prostate 5 2.08 15 1.19 28 1.50 44 0.87 92 84.02 1.10 1.02

Testis 6 9.03* 54 21.12* 25 12.76* 17 12.04* 102 6.59 15.47* 12.19

Urinary system 7 5.14* 9 1.35 12 1.39 31 1.83* 59 33.59 1.76* 3.25

Urinary bladder 2 2.28 7 1.63 9 1.62 21 1.89* 39 21.81 1.79* 2.20

Kidney parenchyma 5 11.97* 2 0.97 3 1.12 5 0.98 15 10.26 1.46 0.61

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 5 6.78* 5 1.52 3.29* 0.44

Ureter 0 0.00 0 0.00 0 0.00 2 8.45 2 0.47 4.23 0.20

Bone, joints 0 0.00 1 4.77 0 0.00 0 0.00 1 0.69 1.44 0.04

Soft tissue including heart 0 0.00 0 0.00 3 4.69 2 2.12 5 2.33 2.14 0.34

Kaposi sarcoma 4 6.57* 1 0.38 2 0.84 2 1.09 9 7.44 1.21 0.20

Melanoma of skin 4 4.00* 8 1.73 5 0.95 7 0.84 24 19.17 1.25 0.62

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.77 0.00 -0.10

Brain, central nervous system 2 4.94 3 1.68 3 1.59 4 1.48 12 6.79 1.77 0.67

Thyroid 0 0.00 1 0.98 2 1.93 4 2.87 7 3.69 1.90 0.42

Lymphatic, hematopoietic 5 2.73 16 1.92* 10 1.07 20 1.32 51 34.71 1.47* 2.08

Hodgkin lymphoma 0 0.00 0 0.00 2 2.27 1 1.15 3 3.11 0.97 -0.01

Non-Hodgkin lymphoma 4 4.42* 8 1.89 5 1.03 10 1.28 27 17.79 1.52 1.18

Myeloma 0 0.00 0 0.00 0 0.00 3 1.51 3 3.88 0.77 -0.11

Leukemia 1 2.02 8 3.53* 3 1.14 6 1.32 18 9.92 1.81* 1.03

Acute lymphocytic 0 0.00 1 5.98 0 0.00 0 0.00 1 0.57 1.76 0.06

Chronic lymphocytic 1 7.09 1 1.44 1 1.10 1 0.57 4 3.50 1.14 0.06

Acute non-lymphocytic 0 0.00 5 6.63* 1 1.18 3 2.08 9 3.21 2.80* 0.74

Chronic myeloid 0 0.00 0 0.00 1 2.37 0 0.00 1 1.56 0.64 -0.07

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 8,108 7,525 5,522 3,554 8,108

Person-years in interval 6,490 25,836 22,554 23,417 78,297

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 281
All subsequent cancers 9 1.78 54 2.35* 58 1.95* 93 1.35* 214 126.59 1.69* 13.90

All excluding same site 3 0.67 29 1.40 27 0.98 77 1.15 136 119.80 1.14 2.58

Buccal cavity, pharynx 0 0.00 0 0.00 2 1.62 10 3.51* 12 5.19 2.31* 1.08

Lip 0 0.00 0 0.00 0 0.00 1 2.83 1 0.72 1.39 0.04

Tongue 0 0.00 0 0.00 1 3.49 2 2.87 3 1.23 2.45 0.28

Salivary gland 0 0.00 0 0.00 0 0.00 2 8.57 2 0.46 4.32 0.24

Mouth 0 0.00 0 0.00 0 0.00 2 3.39 2 1.07 1.86 0.15

Nasopharynx 0 0.00 0 0.00 0 0.00 1 6.75 1 0.32 3.15 0.11

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.74 0.00 -0.12

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.02

Hypopharynx 0 0.00 0 0.00 0 0.00 2 8.64 2 0.39 5.15 0.26

Digestive system 0 0.00 5 1.57 4 0.87 18 1.48 27 20.61 1.31 1.02

Esophagus 0 0.00 0 0.00 0 0.00 1 1.08 1 1.48 0.67 -0.08

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 2.19 0.00 -0.35

Small intestine 0 0.00 0 0.00 0 0.00 1 3.60 1 0.48 2.06 0.08

Colon 0 0.00 3 2.53 3 1.77 6 1.34 12 7.60 1.58 0.70

Rectum, rectosigmoid junction 0 0.00 1 1.58 1 1.08 4 1.63 6 4.14 1.45 0.30

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.06

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 1.18 0.00 -0.19

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.02

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.07

Pancreas 0 0.00 0 0.00 0 0.00 6 4.37* 6 2.29 2.62 0.59

Respiratory system 0 0.00 1 0.37 1 0.25 9 0.86 11 17.78 0.62 -1.08

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.04

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.89 0.00 -0.30

Lung, bronchus 0 0.00 1 0.43 1 0.30 9 0.97 11 15.42 0.71 -0.70

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.04

Male genital system 7 7.13* 28 6.45* 35 6.28* 27 1.57* 97 28.06 3.46* 10.96

Prostate 1 2.34 3 1.47 4 1.17 10 0.66 18 21.02 0.86 -0.48

Testis 6 11.00* 25 11.06* 31 14.81* 16 8.46* 78 6.79 11.49* 11.33

Urinary system 1 2.88 4 2.43 1 0.42 9 1.41 15 10.75 1.39 0.68

Urinary bladder 0 0.00 0 0.00 1 0.69 5 1.27 6 6.60 0.91 -0.10

Kidney parenchyma 1 8.64 4 7.13* 0 0.00 4 1.82 9 3.71 2.43* 0.84

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.07

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.02

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.52 0.00 -0.08

Soft tissue including heart 0 0.00 1 3.07 1 2.89 1 1.82 3 1.30 2.31 0.27

Kaposi sarcoma 0 0.00 2 1.18 1 0.47 1 0.47 4 6.28 0.64 -0.36

Melanoma of skin 0 0.00 5 2.39 1 0.39 6 1.25 12 9.93 1.21 0.33

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.05

Brain, central nervous system 1 4.64 1 1.09 1 1.00 2 1.29 5 3.69 1.36 0.21

Thyroid 0 0.00 1 1.80 1 1.62 1 1.04 3 2.26 1.33 0.12

Lymphatic, hematopoietic 0 0.00 6 1.59 9 2.08 5 0.65 20 16.66 1.20 0.53

Hodgkin lymphoma 0 0.00 0 0.00 1 1.28 1 1.30 2 2.71 0.74 -0.11

Non-Hodgkin lymphoma 0 0.00 0 0.00 3 1.31 1 0.24 4 8.64 0.46 -0.74

Myeloma 0 0.00 0 0.00 0 0.00 2 2.70 2 1.21 1.65 0.12

Leukemia 0 0.00 6 6.76* 5 4.95* 1 0.51 12 4.09 2.94* 1.26

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.07

Chronic lymphocytic 0 0.00 1 6.65 0 0.00 1 1.56 2 1.05 1.90 0.15

Acute non-lymphocytic 0 0.00 5 15.50* 5 14.31* 0 0.00 10 1.39 7.21* 1.37

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.76 0.00 -0.12

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,459 5,893 4,270 2,932 6,459

Person-years in interval 5,125 19,805 17,906 20,042 62,878

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Testis

Testicular Non-seminoma, Males

Table 10.2.11: Risk of subsequent primary cancers after non-seminoma of the testis, males,

SEER 1973-2000.

282 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

TESTIS

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
PENIS

Penis

Males

Table 10.3.1: Characteristics of patients with an initial cancer of the penis, males,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 1,808 100.0 — — 1,808 100.0

Initial treatment

Any radiation 212 11.7 — — 212 11.7

With surgery 157 8.7 — — 157 8.7

Without surgery 55 3.0 — — 55 3.0

No radiation 1,596 88.3 — — 1,596 88.3

With surgery 1,517 83.9 — — 1,517 83.9

Without surgery 79 4.4 — — 79 4.4

Race

White 1,547 85.6 — — 1,547 85.6

Black 174 9.6 — — 174 9.6

Other 72 4.0 — — 72 4.0

Unknown 15 0.8 — — 15 0.8

Age at 1st primary cancer diagnosis, years

< 30 13 0.7 — — 13 0.7

30–49 241 13.3 — — 241 13.3

50–69 816 45.1 — — 816 45.1

70–79 480 26.5 — — 480 26.5

> 80 258 14.3 — — 258 14.3

Number of patients with one or more

primary cancers

One primary cancer only 1,545 85.5 — — 1,545 85.5

1st and 2nd cancers 233 12.9 — — 233 12.9

1st, 2nd, and 3rd cancers 30 1.7 — — 30 1.7

1st, 2nd, 3rd, and additional cancers 0 0.0 — — 0 0.0

Other statistics

Median age at 1st cancer diagnosis 66.8 — — — 66.8 —

Median year of 1st cancer diagnosis 1986.6 — — — 1986.6 —

Median person-years at risk 4.6 — — — 4.6 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 92.8 — — — 92.8

1st, 2nd, and additional cancers — 92.8 — — — 92.8

1st cancer only — 4.9 — — — 4.9

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING CANCER OF THE MALE GENITAL TRACT 283

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 52 1.94* 96 1.02 78 1.07 67 0.98 293 262.20 1.12 25.88

All excluding same site 51 1.91* 94 1.00 78 1.07 66 0.96 289 261.78 1.10 22.87

Buccal cavity, pharynx 4 4.85* 4 1.45 6 3.01* 3 1.73 17 7.31 2.33* 8.14

Lip 0 0.00 0 0.00 1 2.59 0 0.00 1 1.41 0.71 -0.35

Tongue 1 6.67 2 3.96 1 2.68 1 2.99 5 1.36 3.67* 3.06

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -0.54

Mouth 1 5.08 1 1.53 1 2.14 1 2.53 4 1.71 2.34 1.92

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.21

Tonsil 0 0.00 0 0.00 2 11.13* 0 0.00 2 0.66 3.02 1.12

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.17

Hypopharynx 1 10.99 0 0.00 1 4.55 0 0.00 2 0.80 2.49 1.01

Digestive system 7 1.15 19 0.91 15 0.94 18 1.27 59 57.15 1.03 1.55

Esophagus 0 0.00 2 1.61 0 0.00 2 2.23 4 3.44 1.16 0.47

Stomach 0 0.00 0 0.00 2 1.09 2 1.29 4 6.61 0.61 -2.19

Small intestine 0 0.00 0 0.00 1 4.65 0 0.00 1 0.77 1.29 0.19

Colon 5 1.90 11 1.20 4 0.56 5 0.79 25 25.17 0.99 -0.15

Rectum, rectosigmoid junction 1 0.91 3 0.80 2 0.72 5 2.08 11 9.99 1.10 0.85

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.30

Liver 0 0.00 0 0.00 2 3.44 2 3.47 4 2.14 1.87 1.57

Gallbladder 0 0.00 0 0.00 2 14.42* 0 0.00 2 0.50 4.03 1.26

Bile ducts, other biliary 0 0.00 0 0.00 1 2.88 0 0.00 1 1.25 0.80 -0.21

Pancreas 1 1.43 3 1.26 1 0.55 1 0.63 6 6.49 0.93 -0.41

Respiratory system 13 2.46* 30 1.64* 24 1.74* 18 1.47 85 49.55 1.72* 29.79

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.32

Larynx 2 4.79 1 0.71 2 1.94 1 1.13 6 3.75 1.60 1.89

Lung, bronchus 11 2.29* 29 1.74* 22 1.74* 17 1.51 79 45.30 1.74* 28.32

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.42

Male genital system 15 1.87* 25 0.87 14 0.60 20 0.86 74 83.46 0.89 -7.95

Prostate 13 1.64 23 0.81 14 0.60 19 0.82 69 82.66 0.83 -11.48

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.20

Urinary system 6 2.29 6 0.65 5 0.70 4 0.59 21 25.76 0.82 -4.00

Urinary bladder 2 1.04 5 0.74 2 0.38 4 0.81 13 18.92 0.69 -4.98

Kidney parenchyma 4 7.39* 1 0.53 1 0.67 0 0.00 6 5.38 1.12 0.52

Renal pelvis, other urinary 0 0.00 0 0.00 2 4.92 0 0.00 2 1.46 1.37 0.45

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -0.41

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.17

Soft tissue including heart 1 9.74 0 0.00 0 0.00 0 0.00 1 0.99 1.01 0.01

Kaposi sarcoma 0 0.00 0 0.00 1 8.65 0 0.00 1 0.41 2.43 0.49

Melanoma of skin 1 1.87 3 1.54 2 1.25 1 0.58 7 5.80 1.21 1.01

Eye, orbit 0 0.00 0 0.00 1 10.21 0 0.00 1 0.35 2.83 0.54

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 2.39 0.00 -2.01

Thyroid 1 12.31 1 3.61 0 0.00 0 0.00 2 0.75 2.65 1.05

Lymphatic, hematopoietic 3 1.53 5 0.73 8 1.49 2 0.40 18 19.27 0.93 -1.06

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.47

Non-Hodgkin lymphoma 1 1.27 3 1.07 4 1.78 0 0.00 8 8.04 0.99 -0.04

Myeloma 0 0.00 1 0.83 0 0.00 1 1.14 2 3.37 0.59 -1.15

Leukemia 2 2.61 1 0.38 4 1.96 1 0.54 8 7.29 1.10 0.59

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.15

Chronic lymphocytic 1 3.20 0 0.00 2 2.41 0 0.00 3 2.97 1.01 0.03

Acute non-lymphocytic 0 0.00 1 1.16 2 2.99 0 0.00 3 2.39 1.26 0.52

Chronic myeloid 0 0.00 0 0.00 0 0.00 1 3.94 1 0.99 1.01 0.01

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,808 1,511 887 447 1,808

Person-years in interval 1,371 4,513 3,218 2,799 11,901

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Penis

Males

Table 10.3.2: Risk of subsequent primary cancers after cancer of the penis, males,

SEER 1973-2000.

284 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

PENIS

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
NEW MALIGNANCIES FOLLOWING CANCER OF THE URINARY TRACT 285

Synopsis

The risk of subsequent primary cancer was assessed in

137,571 patients with a first primary cancer of the urinary tract diagnosed during 1973-2000. Overall risk of

new malignancy was significantly increased among

patients with an initial cancer of the bladder (O/E=1.17,1

O=14,568, EAR=34 per 10,000 person-years), kidney

(O/E=1.13, O=3,570, EAR=23), and renal pelvis/ureter

(O/E=1.29,1 O=935, EAR=55). Patients with cancers of

the urinary bladder and renal pelvis/ureter had elevated risks of subsequent cancers of the respiratory tract,

probably related to tobacco smoking, and pronounced

excesses of tumors of the urinary tract due to the multifocal nature of transitional cell carcinomas. Bladder

cancer was also associated with significant excesses of

cancers of the pancreas, prostate, vagina, and kidney, as

well as acute leukemia. Some of these cancers may be

related to increased medical surveillance (e.g., prostate,

kidney) or a rare consequence of treatment (e.g.,

leukemia). Patients with an initial cancer of the kidney

parenchyma were at increased risk for a variety of subsequent primary cancers, including cancers of the kidney, ureter, bladder, prostate, and thyroid, as well as

melanoma and leukemia. Increased medical and urologic surveillance, and shared risk factors, including

genetic predisposition, may contribute in various

degrees to these patterns. Patients with renal pelvis/

ureter cancers were also prone to develop cancers of 

the breast and colon. The excess of colon tumors was

concentrated among younger patients in a pattern suggesting the syndrome of hereditary nonpolyposis colorectal cancer.

Bladder Cancer

Cancers of the urinary bladder (including both invasive

and in situ tumors) constitute nearly 5% of all incident

cancers and 2% of cancer deaths, with approximately

63,000 new cases diagnosed annually in the U.S. (Jemal et

al, 2005). Bladder cancer occurs about 3 times more frequently among men than women and is the fourth most

commonly diagnosed cancer among men. The overall 5-

year and 10-year relative survival rates are 81.6% and

76.5%, with higher survival rates in men compared with

women, and among whites compared with blacks. Standard initial treatment for superficial lesions is a complete

cystoscopic resection (Herr et al, 2001). Intravesical treatments with chemotherapeutic or immunologic agents are

frequently used to prevent recurrences. Typical therapy

for muscle-infiltrating tumors is radical cystectomy,

which may be combined with chemotherapy or radiation

in selected cases.

The overwhelming majority of cancers of the bladder

and renal pelvis/ureter are transitional cell carcinomas.

Multifocal cancers tend to develop along the transitional

epithelial lining, with new tumors sometimes occurring

several decades after the initial cancer diagnosis (Sharir

and Jewett, 1999; Rabbani et al, 2001). SEER rules prohibit reporting of a subsequent bladder cancer following a

diagnosis of an initial bladder cancer (with the exception

of invasive bladder cancer following in situ bladder cancer), but subsequent tumors of the renal pelvis or ureter

following an initial bladder cancer are recorded in the

SEER database. Because assessment of subsequent cancer

risk is complicated by the different methods of recording

multifocal tumors, we present the overall O/E ratios for

bladder cancer and cancers of the renal pelvis/ureter

excluding the observed and expected numbers of subsequent primary cancers of the renal pelvis, ureter, bladder, urethra, and other urinary organs (except kidney

parenchyma).

Tobacco smoking and occupational exposure to aromatic amines are the main risk factors for bladder cancer

(Silverman et al, 1999). Tobacco use accounts for the greatest share of cases—approximately 50% to 65% among

men and 20% to 30% among women. Much less common

risk factors include cyclophosphamide chemotherapy,

phenacetin-containing analgesics, ionizing radiation, and

high levels of inorganic arsenic in drinking water.

Results and Discussion

A total of 14,568 subsequent primary cancers (excluding

cancers of the renal pelvis/ureter, bladder, and other

URINARY TRACT

Chapter 11

New Malignancies Following Cancer of the

Urinary Tract

Robin Taylor Wilson, Debra T. Silverman, Joseph F. Fraumeni Jr., Rochelle E. Curtis

1

Observed-to-expected ratios for patients with cancers of the renal

pelvis/ureter and urinary bladder exclude subsequent primary

cancers of the renal pelvis, ureter, bladder, urethra, and other and

unspecified urinary organs.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated as

[(O-E)/PYR]10,000).

Author affiliations: Robin Taylor Wilson, Debra T. Silverman, 

Joseph F. Fraumeni Jr., and Rochelle E. Curtis, Division of Cancer

Epidemiology and Genetics, NCI, NIH, DHHS. Present address for 

Dr. Wilson: Epidemiology Division, Department of Health Evaluation

Sciences, Penn State College of Medicine and Penn State Cancer

Institute, Hershey, PA.
urinary organs) were observed among 94,383 patients

who had survived 2 months or more after an invasive or

in situ bladder cancer (O/E=1.17, 95% CI=1.15-1.19,

EAR=34 per 10,000 person-years). The cumulative incidence of all second cancers combined was 22.6% at 25

years (competing risk analyses, 95% CI=22.2%-23.0%),

with a 1.1% incidence seen for new cancers of the renal

pelvis/ureter and other urinary organs. Subsequent cancer risks were significantly elevated during the first 10

years of follow-up but then decreased among long-term

survivors. Risks were somewhat higher among blacks

(O/E=1.31, EAR=66) than whites (O/E=1.17, EAR=33)

but were similar among males and females. Although

relative risks were greater for those diagnosed at ages

less than 50 years compared with patients age 70 years 

or older (O/E=1.30 versus 1.11), excess absolute risks

were lower (EAR=16 versus 31). In addition to the pronounced excesses seen for subsequent cancers of the

renal pelvis/ureter, we found significantly increased risks 

for subsequent cancers of the pancreas, larynx, lung,

vagina, prostate, and kidney, as well as for acute nonlymphocytic leukemia (ANLL). Significant deficits of

subsequent non-Hodgkin lymphoma and bladder cancer

were seen, the latter reflecting SEER rules for reporting

multiple tumors of the bladder. These results are generally consistent with previous studies (Jensen et al, 1985;

Kantor and McLaughlin, 1985; Greven et al, 1992;

Salminen et al, 1994; Crocetti et al, 2001; Dong and

Hemminki, 2001; Rabbani et al, 2001), including previous

SEER analyses (Ahsan et al, 1995; Neugut et al, 1995).

It is not surprising that the cancer risks were significantly elevated for several smoking-related sites, such as

the lung, larynx, pancreas, and kidney. New tumors of

the respiratory tract constituted 67% of the excess cancers

outside the urinary tract, with risks for lung cancer being

significantly increased for more than 2 decades following

initial diagnosis of bladder cancer (20 years, O/E=1.57).

Consistent with previous reports, we found higher relative risks for subsequent cancers of the lung among

women compared with men (Teppo et al, 1985; Salminen

et al, 1994; Crocetti et al, 2001), but risks were similar

when measured on an absolute scale. Differences in the

relative risk by gender may be due to the historically

lower smoking rates among women and consequent

lower baseline risks for respiratory tract cancers in the

female population.

A total of 838 subsequent tumors of the renal pelvis,

ureter, urethra, and other urinary organs were reported

following cancer of the bladder, with increased risks persisting at a high level for more than 20 years. The wellknown tendency to develop multifocal tumors affecting

the renal pelvis, ureter, and bladder has been attributed

to smoking-related field defects of the transitional cell

epithelium (Sharir and Jewett, 1999), although several

molecular studies have implicated the seeding and

implantation of a single transformed epithelial cell clone

(Muto et al, 2000; Vriesema et al, 2001). In addition, close

medical surveillance may have contributed to the elevated risks seen for subsequent kidney cancer and other

cancers of the urinary tract.

Increased risk for ANLL following bladder cancer is

consistent with reports implicating cisplatin-based

chemotherapy combined with radiotherapy (Theodore et

al, 2002). Increased medical surveillance may explain the

3-fold risk of subsequent prostate cancer seen in the first

year of follow-up, which declined to below-normal levels

in later time intervals. The reasons for the elevated risk of

subsequent vaginal cancer are unclear; risk rose over

time to reach 3- to 4-fold among survivors of 5 or more

years, but the excess did not appear to be associated with

initial treatment.

Cancer of the Kidney Parenchyma

Cancers of the kidney parenchyma are the most fatal of

adult cancers of the urinary tract. Incidence rates have

been increasing over the last 30 years in the U.S., particularly among blacks (Chow et al, 1999). Kidney cancer

patients represent about 2% of all cancer diagnoses and

2% of cancer deaths (Jemal et al, 2005). Excluding Wilms

tumor and other childhood tumors of the kidney, discussed elsewhere in this volume, the 5-year relative survival rate for patients with cancers of the kidney

parenchyma is 64.6%. Nearly all cancers originating in

the kidney parenchyma are renal cell carcinomas (RCC).

An estimated 85% of RCC are classified as the clear cell

type, and another 10% are papillary (Linehan et al, 2001).

Radical nephrectomy is standard treatment for renal cancer (Linehan et al, 2001). RCC is generally considered

resistant to most chemotherapeutic agents; however,

biologic therapy (interferon, interleukin-2) is widely

used, particularly in the treatment of metastatic disease.

Radiotherapy is infrequently used as an initial treatment

(12% in SEER).

The major risk factors for RCC include smoking,

obesity, and hypertension (McLaughlin et al, 1995, 1996;

Benichou et al, 1998; Chow et al, 2000). An estimated 20%

to 40% of RCC among men and 10% to 20% among

women are caused by tobacco smoking, while an estimated 20% are attributable to excess weight. Although an

uncommon risk factor, dialysis has been associated with

a 3- to 26-fold excess risk compared with the general

population (Stewart et al, 2003). Several heritable syndromes account for approximately 5% of cases of RCC,

most notably von Hippel-Lindau (VHL) syndrome; nearly half of VHL patients develop multifocal or bilateral

RCC in addition to a constellation of other tumors and

cystic lesions (Linehan et al, 2003).

Results and Discussion

Overall, 3,570 subsequent primary cancers were

observed among 36,835 patients who survived 2 months

or more after cancer of the kidney parenchyma (excluding childhood cancers, ages <18 years), reflecting an

overall 13% elevated risk compared with the general

population (O/E=1.13, 95% CI=1.10-1.17, EAR=23). This

286 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

URINARY TRACT
NEW MALIGNANCIES FOLLOWING CANCER OF THE URINARY TRACT 287

URINARY TRACT

overall risk decreased after subsequent cancers of the

kidney parenchyma were excluded (O/E=1.07, 95%

CI=1.04-1.11, EAR=12), and an increased risk of only 5%

was seen when the index cancer was limited to RCC

(O/E=1.05 excluding subsequent kidney cancers, 95%

CI=1.01-1.09, EAR=8). Relative risks were highest among

those diagnosed with kidney cancer from ages 18 to 49

years for all new malignancies (O/E=1.60) and for all

cancers excluding kidney cancer (O/E=1.27), although

excess risks on an absolute scale were similar across age

groups (excluding subsequent kidney cancer) (Figure

11.1). Overall risks of new malignancies were not substantially different by gender, but risks were slightly

higher for blacks compared with whites (O/E=1.17 versus 1.06, excluding subsequent kidney cancer). The

cumulative incidence of developing any subsequent

cancer following cancer of the kidney parenchyma was

15.3% at 25 years (95% CI=14.7%-15.9%), including a

1.1% incidence of second kidney cancer (Figure 11.2).

Our results are similar to previous studies indicating an

elevated risk of subsequent cancers of the prostate, bladder, kidney, ureter, and thyroid, as well as melanoma,

and overall deficits of cancers of the oral cavity and

pharynx, larynx, and ovary (Jensen et al, 1985; Kantor

and McLaughlin, 1985; Teppo et al, 1985; Kantor et al,

1986; Begg et al, 1995; McCredie et al, 1996; Rabbani 

et al, 1998, 2000), including an earlier SEER report

(Rabbani et al, 2002).

Subsequent cancers of the kidney parenchyma

accounted for the largest excess of new malignancies

among patients with an initial kidney cancer. Risks of

new malignancies of the kidney, including the contralateral kidney, were substantially higher among blacks

(O/E=9.85, EAR=30) than whites (O/E=3.49, EAR=9), a

finding attributed in earlier studies to the higher prevalence of obesity, hypertension, and end-stage renal

disease among blacks than whites (Martins et al, 2002;

Rabbani et al, 2002). Patients diagnosed with kidney

cancer at ages 18 to 49 were particularly prone to develop

a new kidney cancer (O/E=13.25), suggesting the influence of genetic susceptibility (Linehan et al, 2003).

Among all patients combined, the risk of developing 

a new kidney cancer was greatest in the first year of

follow-up (more than 7-fold), presumably related to

heightened screening, but the increased risk remained

elevated (3- to 4-fold) for more than 20 years after initial

diagnosis. Increased urologic surveillance may have

contributed to the excess of cancers of the bladder and

ureter, because elevated risks were limited to the early

years of follow-up.

Kidney cancer patients experienced a 3-fold elevated

risk of subsequent thyroid cancer, consistent with a previous survey (Teppo et al, 1985). Heightened medical

surveillance may be involved, since 20% of the thyroid

tumors were first diagnosed at autopsy. In addition, risk

was increased, especially in the first year of follow-up

(O/E=7.57, O=15), then decreased to near-normal levels

among survivors of 10 years or more. However, reciprocal increases in the risk of subsequent kidney cancer

were seen following thyroid cancer in the SEER data

(Ronckers et al, 2005) and in other studies (Hemminki

and Jiang, 2001; Rubino et al, 2003), suggesting a role of

shared risk factors, such as described with the heritable

syndrome of papillary thyroid cancer and papillary

O/E

1.08*

1.14*

1.60*

18–49 50–69 70

1.00

1.25

1.50

1.75

2.00

1.03

All subsequent cancers

All subsequent cancers excluding 

kidney parenchyma

Age at diagnosis of kidney cancer (years)

EAR (per 10,000 person-years)

0

5

10

15

20

25

30

35

40

45

All subsequent cancers

All subsequent cancers excluding 

kidney parenchyma

18–49 50–69 70

1.27*

1.04

30

8

13

24

14 12

Figure 11.1: Observed-to-expected ratio (O/E) and excess

absolute risk (EAR) of subsequent primary cancers after cancer

of the kidney parenchyma, both sexes, SEER 1973-2000.

*P <0.05.

Note: EAR = Excess number of subsequent cancers per 10,000 person-years.

Observed No. 333 257 2,085 1,934 1,152 1,118

Years after initial cancer diagnosis

Cumulative incidence (%)

0

5

10

15

20

0 5 10 15 20 25

All second cancers*

Prostate†

Kidney parenchyma

Figure 11.2: Cumulative incidence of developing a second

cancer among patients with cancer of the kidney parenchyma,

both sexes, ages ≥18 years, SEER 1973-2000.

* Cumulative incidence for all second cancers at 25 years is 16.9% for males and 

12.3% for females.

† Prostate cancer curve is based on male kidney cancer patients only.
RCC (Takahashi et al, 2002). Another consideration is

that kidney cancers occasionally metastasize to the

thyroid (Koo et al, 2004), even decades after initial

RCC diagnosis.

It is difficult to explain the elevated risk for other cancers. Risks for subsequent melanoma of the skin were

highest in the first year after kidney cancer diagnosis

(O/E=1.89). Although significant excesses of melanoma

have not been reported in previous studies of kidney cancer (Jensen et al, 1985; Kantor and McLaughlin, 1985; Levi

et al, 1993), a reciprocal excess risk of kidney cancer was

seen following melanoma in the SEER data, mainly in the

early years of follow-up. In addition, an increased incidence of subsequent leukemia was found among patients

with RCC, especially 1-4 years after initial diagnosis

(O/E=1.63, O=45), but the risks were related to several

subtypes of leukemia. The excess of prostate cancer was

mainly in the first year of follow-up, consistent with urologic surveillance and detection of early-stage tumors.

The decreased risk of subsequent ovarian cancers we

observed among kidney cancer patients has been reported in previous surveys, although based on small numbers (Jensen et al, 1985; Kantor et al, 1986; McCredie et al,

1996). Epidemiologic studies linking RCC to hormonal

factors are inconclusive, but a small excess of renal cell

cancer has been associated in some studies with

increased parity (Chow et al, 1995), which reduces the

risk of ovarian cancer. We also found deficits of several

smoking-related cancers (e.g., buccal cavity and larynx)

following kidney cancer, as seen in earlier studies (Jensen

et al, 1985; Teppo et al, 1985; Kantor et al, 1986; McCredie

et al, 1996). These results are surprising because smoking

increases the risk of kidney cancer, although the relative

risk is less than that seen for cancers of the bladder and

renal pelvis.

Cancers of the Renal Pelvis and Ureter

Cancers of the renal pelvis and ureter are rare, constituting only 5% to 7% of urinary tract cancers in SEER.

About 90% of cancers of the renal pelvis/ureter arise

from the transitional cell epithelium. Incidence is 2.5

times higher in men than women and is greater among

whites than blacks. The 5-year relative survival rate is

55.3%. Because of the recurrent and multifocal nature of

these tumors, nephroureterectomy (excision of the kidney, renal pelvis, and ureter) with bladder cuff excision is

considered standard treatment (Kirkali and Tuzel, 2003).

Chemotherapy and radiotherapy are used less frequently.

Established risk factors for renal pelvis cancer include

tobacco use and heavy use of phenacetin-containing

analgesics (McLaughlin et al, 1996). Smoking is thought

to explain 70% to 80% of cases in men and 40% to 60%

in women. Moreover, ionizing radiation has been shown

to induce cancers of the renal pelvis and ureter (Boice et

al, 1989).

Results and Discussion

Among 6,353 patients who survived 2 months or more

following diagnosis of cancers of the renal pelvis or

ureter, 935 subsequent primary cancers (excluding cancers of the renal pelvis/ureter, bladder, and other urinary

organs) were observed (O/E=1.29, 95% CI=1.21-1.38,

EAR=55). The cumulative incidence of developing

any second cancer at 25 years was 31.1% (95%

CI=29.8%-32.5%), with a 16.2% incidence attributable to

new tumors of the bladder and other urinary organs.

Observed-to-expected ratios of subsequent cancers

remained elevated over 15 years of follow-up and then

decreased. Blacks appeared to be more prone to develop

new malignancies than whites (O/E=2.06 versus 1.27),

and females had slightly greater risks than males

(O/E=1.44 versus 1.23). Relative risks were somewhat

higher among those diagnosed at ages less than 60

years, although excess absolute risks of subsequent

cancers were not appreciably different. Significantly

increased risks were seen for new cancers of the colon,

lung, and female breast, in addition to exceptionally

high risks for subsequent tumors of the bladder and

other urinary tract organs—a pattern generally consistent with previous reports (Kantor et al, 1986; McCredie

et al, 1996).

The 2-fold increased risk of subsequent lung cancer

following cancers of the renal pelvis/ureter can be attributed to cigarette smoking, a potent risk factor for both

cancer sites (Kantor et al, 1986). The excess lung cancer

risk did not decrease with time and persisted among

long-term survivors (10 years, O/E=2.11).

The elevated risk for subsequent cancers of the renal

pelvis, ureter, and bladder varied from 19- to 27-fold,

consistent with the multicentric nature of urothelial

tumors. The relative risk of subsequent bladder cancer

was higher among females than males (O/E=46.81 versus

15.31), a finding resembling other studies (Kirkali and

Tuzel, 2003), whereas the excess absolute risks were similar (EAR=223 for females and 251 for males).

The excess of subsequent colon cancer was greater

among renal pelvis/ureter patients diagnosed at less than

60 years of age (O/E=3.06, EAR=19), as compared with

those at older ages (O/E=1.32, EAR=9). Reciprocally

increased risks of renal pelvis/ureter cancer were also

seen among younger colon cancer patients in SEER (ages

<60 years, O/E=3.63), and similar elevations in risk have

been reported in at least one other registry-based study

(McCredie et al, 1997). This association is possibly related

to the syndrome of hereditary nonpolyposis colon cancer,

which predisposes to certain extra-colonic tumors,

including cancers of the renal pelvis and ureter (Umar

et al, 2004).

In women, risk of breast cancer among renal

pelvis/ureter cancer patients was elevated (O/E=1.28,

EAR=11), making up 17% of the excess subsequent cancers among women (excluding cancers of the bladder,

renal pelvis/ureter, and other urinary organs). This

association has not been reported previously. Since

288 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

URINARY TRACT
reciprocally elevated risks of renal pelvis/ureter cancer

were not seen following breast cancer, this observation

may be due to chance.

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URINARY TRACT
BLADDER

Bladder

Both Sexes

Table 11.1.1: Characteristics of patients with an initial cancer of the urinary bladder, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 70,354 100.0 24,029 100.0 94,383 100.0

Initial treatment

Any radiation 6,515 9.3 2,692 11.2 9,207 9.8

With surgery 5,761 8.2 2,272 9.5 8,033 8.5

Without surgery 754 1.1 420 1.7 1,174 1.2

No radiation 63,839 90.7 21,337 88.8 85,176 90.2

With surgery 60,692 86.3 19,963 83.1 80,655 85.5

Without surgery 3,147 4.5 1,374 5.7 4,521 4.8

Race

White 65,498 93.1 21,885 91.1 87,383 92.6

Black 2,473 3.5 1,319 5.5 3,792 4.0

Other 2,068 2.9 723 3.0 2,791 3.0

Unknown 315 0.4 102 0.4 417 0.4

Age at 1st primary cancer diagnosis, years

< 30 417 0.6 202 0.8 619 0.7

30–49 5,172 7.4 1,596 6.6 6,768 7.2

50–69 31,687 45.0 9,100 37.9 40,787 43.2

70–79 22,057 31.4 7,287 30.3 29,344 31.1

> 80 11,021 15.7 5,844 24.3 16,865 17.9

Number of patients with one or more

primary cancers

One primary cancer only 58,790 83.6 21,336 88.8 80,126 84.9

1st and 2nd cancers 10,373 14.7 2,454 10.2 12,827 13.6

1st, 2nd, and 3rd cancers 1,072 1.5 218 0.9 1,290 1.4

1st, 2nd, 3rd, and additional cancers 119 0.2 21 0.1 140 0.1

Other statistics

Median age at 1st cancer diagnosis 69.2 — 71.5 — 69.7 —

Median year of 1st cancer diagnosis 1988.4 — 1988.3 — 1988.4 —

Median person-years at risk 4.8 — 4.6 — 4.8 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 95.0 — 93.4 — 94.7

1st, 2nd, and additional cancers — 94.5 — 93.1 — 94.2

1st cancer only — 4.5 — 6.0 — 4.8

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING CANCER OF THE URINARY TRACT 291

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 2,529 1.78* 5,953 1.18* 4,123 1.08* 3,236 1.02 15,841 13,460.89 1.18* 38.33

All excluding same site 2,247 1.71* 5,454 1.17* 3,827 1.08* 3,040 1.03 14,568 12,478.28 1.17* 33.65

Buccal cavity, pharynx 32 0.83 141 1.06 93 0.99 63 0.88 329 336.93 0.98 -0.13

Lip 5 0.66 27 1.05 14 0.78 10 0.76 56 64.30 0.87 -0.13

Tongue 2 0.28 18 0.72 21 1.17 18 1.30 59 63.81 0.92 -0.08

Salivary gland 2 0.60 13 1.09 6 0.65 8 1.01 29 32.33 0.90 -0.05

Mouth 7 0.73 41 1.25 24 1.04 15 0.87 87 82.59 1.05 0.07

Nasopharynx 1 0.77 6 1.37 3 0.99 4 1.79 14 10.96 1.28 0.05

Tonsil 1 0.30 15 1.32 8 1.02 3 0.52 27 28.25 0.96 -0.02

Oropharynx 3 2.91 3 0.85 5 1.98 1 0.52 12 9.02 1.33 0.05

Hypopharynx 6 1.52 14 1.03 10 1.06 2 0.30 32 33.74 0.95 -0.03

Digestive system 384 1.19* 1,172 1.03 854 1.00 678 0.98 3,088 3,003.90 1.03 1.35

Esophagus 14 0.86 45 0.78 41 0.95 43 1.19 143 152.94 0.93 -0.16

Stomach 48 1.35 145 1.19* 79 0.89 67 0.96 339 315.71 1.07 0.38

Small intestine 8 1.97 11 0.76 12 1.06 12 1.21 43 39.82 1.08 0.05

Colon 170 1.16 506 0.98 418 1.06 316 0.98 1,410 1,379.00 1.02 0.50

Rectum, rectosigmoid junction 51 0.89 215 1.08 126 0.87 103 0.91 495 514.99 0.96 -0.32

Anus, anal canal 1 0.43 12 1.45 7 1.12 6 1.15 26 22.10 1.18 0.06

Liver 15 1.41 44 1.17 21 0.73 20 0.80 100 102.28 0.98 -0.04

Gallbladder 5 1.29 10 0.76 11 1.13 7 0.90 33 34.60 0.95 -0.03

Bile ducts, other biliary 8 1.16 24 0.97 24 1.23 15 0.85 71 68.81 1.03 0.04

Pancreas 58 1.54* 147 1.12 111 1.13 81 1.00 397 347.71 1.14* 0.79

Respiratory system 333 1.30* 1,448 1.61* 1,081 1.62* 899 1.68* 3,761 2,359.11 1.59* 22.58

Nose, nasal cavity, ear 3 1.43 5 0.68 8 1.48 6 1.36 22 19.23 1.14 0.04

Larynx 23 1.26 83 1.32* 59 1.32* 44 1.34 209 158.34 1.32* 0.82

Lung, bronchus 306 1.31* 1,357 1.64* 1,013 1.64* 848 1.70* 3,524 2,175.69 1.62* 21.71

Female breast 68 1.04 217 0.96 168 0.95 154 0.98 607 625.24 0.97 -1.16

Female genital system 39 1.30 94 0.93 65 0.86 69 1.08 267 270.39 0.99 -0.22

Cervix uteri 4 1.25 5 0.49 4 0.58 3 0.59 16 25.20 0.63 -0.58

Corpus uteri 20 1.31 45 0.87 24 0.63* 38 1.20 127 136.63 0.93 -0.61

Ovary 12 1.37 30 1.00 22 0.96 17 0.85 81 81.79 0.99 -0.05

Vagina 0 0.00 3 1.75 5 3.87* 4 3.59 12 4.63 2.59* 0.47

Vulva 1 0.64 7 1.29 8 1.84 5 1.22 21 15.44 1.36 0.35

Male genital system 1,083 3.01* 1,459 1.11* 901 0.88* 638 0.73* 4,081 3,567.57 1.14* 11.08

Prostate 1,079 3.03* 1,444 1.11* 891 0.87* 634 0.73* 4,048 3,536.05 1.14* 11.05

Testis 2 1.78 5 1.35 3 1.27 2 1.31 12 8.73 1.37 0.07

Urinary system 360 2.76* 653 1.41* 380 1.07 277 0.93 1,670 1,246.06 1.34* 6.83

Urinary bladder 118 1.24* 186 0.55* 71 0.27* 60 0.28* 435 909.02 0.48* -7.63

Kidney parenchyma 78 2.84* 154 1.57* 84 1.12 81 1.29* 397 263.45 1.51* 2.15

Renal pelvis, other urinary 164 20.45* 313 11.15* 225 10.82* 136 8.14* 838 73.59 11.39* 12.31

Ureter 62 22.77* 118 12.35* 104 14.68* 55 9.83* 339 24.96 13.58* 5.06

Bone, joints 4 3.45 7 1.75 3 1.04 1 0.44 15 10.32 1.45 0.08

Soft tissue including heart 6 1.12 12 0.64 17 1.18 26 2.09* 61 50.97 1.20 0.16

Kaposi sarcoma 3 1.71 2 0.32 1 0.22 4 1.16 10 15.97 0.63 -0.10

Melanoma of skin 27 0.91 111 1.02 80 0.92 69 0.88 287 303.23 0.95 -0.26

Eye, orbit 2 0.97 7 0.98 4 0.76 4 0.94 17 18.77 0.91 -0.03

Brain, central nervous system 13 0.97 54 1.14 37 1.05 19 0.67 123 124.43 0.99 -0.02

Thyroid 9 1.72 16 0.89 11 0.84 9 0.85 45 47.03 0.96 -0.03

Lymphatic, hematopoietic 112 1.06 369 0.98 282 0.97 226 0.92 989 1,017.03 0.97 -0.45

Hodgkin lymphoma 5 1.55 13 1.20 14 1.86* 5 0.88 37 27.26 1.36 0.16

Non-Hodgkin lymphoma 48 1.07 153 0.95 112 0.88 89 0.80* 402 443.90 0.91* -0.67

Myeloma 14 0.78 55 0.87 44 0.91 39 0.96 152 169.87 0.89 -0.29

Leukemia 45 1.12 148 1.05 112 1.05 93 1.06 398 376.01 1.06 0.35

Acute lymphocytic 0 0.00 1 0.28 3 1.11 5 2.38 9 9.41 0.96 -0.01

Chronic lymphocytic 17 1.04 50 0.87 33 0.76 30 0.86 130 151.84 0.86 -0.35

Acute non-lymphocytic 17 1.29 57 1.22 49 1.38* 36 1.20 159 125.23 1.27* 0.54

Chronic myeloid 5 0.93 22 1.17 17 1.19 14 1.16 58 50.60 1.15 0.12

Bladder

Both Sexes

Table 11.1.2: Risk of subsequent primary cancers after cancer of the urinary bladder, both sexes,

SEER 1973-2000.

292 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BLADDER

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 94,383 79,948 47,100 24,133 94,383

Person-years in interval 71,749 244,270 172,665 132,268 620,952

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 157,730 PYR and for male cancers on 463,222 PYR.
Bladder

Females

Table 11.1.3: Risk of subsequent primary cancers after cancer of the urinary bladder, females,

SEER 1973-2000.

BLADDER

All subsequent cancers 400 1.63* 1,086 1.28* 779 1.18* 689 1.16* 2,954 2,341.29 1.26* 38.85

All excluding same site 328 1.39* 994 1.22* 730 1.15* 655 1.15* 2,707 2,257.40 1.20* 28.50

Buccal cavity, pharynx 3 0.69 14 0.94 13 1.15 9 0.92 39 40.18 0.97 -0.07

Lip 0 0.00 1 0.88 2 2.20 2 2.35 5 3.23 1.55 0.11

Tongue 1 1.06 3 0.93 3 1.21 1 0.47 8 8.81 0.91 -0.05

Salivary gland 0 0.00 1 0.60 0 0.00 1 0.86 2 4.60 0.43 -0.16

Mouth 2 1.30 5 0.95 5 1.24 3 0.85 15 14.35 1.05 0.04

Nasopharynx 0 0.00 0 0.00 0 0.00 1 3.08 1 1.39 0.72 -0.02

Tonsil 0 0.00 3 2.56 1 1.18 0 0.00 4 3.02 1.32 0.06

Oropharynx 0 0.00 1 2.80 0 0.00 0 0.00 1 0.94 1.07 0.00

Hypopharynx 0 0.00 0 0.00 2 2.89 0 0.00 2 2.46 0.81 -0.03

Digestive system 94 1.48* 242 1.12 175 1.04 141 0.94 652 599.15 1.09* 3.35

Esophagus 0 0.00 3 0.55 6 1.40 6 1.54 15 15.31 0.98 -0.02

Stomach 10 1.92 25 1.45 8 0.62 10 0.90 53 46.48 1.14 0.41

Small intestine 1 1.27 2 0.73 5 2.25 6 2.81* 14 7.89 1.78 0.39

Colon 47 1.46* 111 1.01 97 1.12 72 0.92 327 307.17 1.06 1.26

Rectum, rectosigmoid junction 19 1.94* 35 1.05 20 0.80 13 0.61 87 89.36 0.97 -0.15

Rectum 11 1.71 24 1.10 16 0.97 10 0.70 61 58.93 1.04 0.13

Anus, anal canal 1 1.34 5 1.93 2 0.99 3 1.65 11 7.19 1.53 0.24

Liver 0 0.00 4 0.94 3 0.89 2 0.63 9 12.08 0.74 -0.20

Gallbladder 2 1.31 4 0.78 5 1.31 3 0.96 14 13.58 1.03 0.03

Bile ducts, other biliary 1 0.73 6 1.26 3 0.78 2 0.53 12 13.80 0.87 -0.11

Pancreas 12 1.46 43 1.53* 25 1.13 20 0.99 100 78.75 1.27* 1.35

Respiratory system 60 2.00* 240 2.25* 189 2.20* 175 2.16* 664 303.64 2.19* 22.85

Nose, nasal cavity, ear 0 0.00 0 0.00 2 2.19 2 2.41 4 3.25 1.23 0.05

Larynx 2 2.16 8 2.51* 6 2.50 4 2.01 20 8.50 2.35* 0.73

Lung, bronchus 58 2.02* 232 2.27* 180 2.18* 168 2.16* 638 291.12 2.19* 21.99

Female breast 68 1.04 217 0.96 168 0.95 154 0.98 607 625.24 0.97 -1.16

Female genital system 39 1.30 94 0.93 65 0.86 69 1.08 267 270.39 0.99 -0.22

Cervix uteri 4 1.25 5 0.49 4 0.58 3 0.59 16 25.20 0.63 -0.58

Corpus uteri 20 1.31 45 0.87 24 0.63* 38 1.20 127 136.63 0.93 -0.61

Ovary 12 1.37 30 1.00 22 0.96 17 0.85 81 81.79 0.99 -0.05

Vagina 0 0.00 3 1.75 5 3.87* 4 3.59 12 4.63 2.59* 0.47

Vulva 1 0.64 7 1.29 8 1.84 5 1.22 21 15.44 1.36 0.35

Urinary system 84 6.79* 114 2.66* 59 1.74* 47 1.51* 304 120.16 2.53* 11.66

Urinary bladder 22 2.88* 28 1.07 13 0.63 11 0.58 74 73.70 1.00 0.02

Kidney parenchyma 12 3.27* 22 1.72* 10 0.98 13 1.36 57 36.28 1.57* 1.31

Renal pelvis, other urinary 50 46.53* 64 17.36* 36 12.58* 23 8.97* 173 10.19 16.98* 10.32

Ureter 16 47.23* 32 27.46* 19 21.05* 10 12.57* 77 3.20 24.05* 4.68

Bone, joints 2 8.90 3 3.94 0 0.00 0 0.00 5 2.04 2.45 0.19

Soft tissue including heart 0 0.00 2 0.61 1 0.39 6 2.50 9 9.21 0.98 -0.01

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 2 6.56 2 1.16 1.73 0.05

Melanoma of skin 2 0.47 20 1.32 12 1.00 10 0.87 44 42.91 1.03 0.07

Eye, orbit 1 2.70 2 1.59 0 0.00 0 0.00 3 3.37 0.89 -0.02

Brain, central nervous system 4 1.68 6 0.72 9 1.40 3 0.53 22 22.69 0.97 -0.04

Thyroid 2 1.12 7 1.16 5 1.12 3 0.79 17 16.06 1.06 0.06

Lymphatic, hematopoietic 28 1.43 79 1.16 52 0.96 48 0.96 207 191.47 1.08 0.98

Hodgkin lymphoma 1 1.82 3 1.63 2 1.47 1 0.88 7 4.89 1.43 0.13

Non-Hodgkin lymphoma 12 1.32 30 0.94 25 0.97 17 0.69 84 91.34 0.92 -0.47

Myeloma 1 0.29 14 1.20 6 0.66 10 1.22 31 32.39 0.96 -0.09

Leukemia 14 2.13* 32 1.42 19 1.08 20 1.24 85 62.86 1.35* 1.40

Acute lymphocytic 0 0.00 0 0.00 0 0.00 1 2.34 1 1.68 0.60 -0.04

Chronic lymphocytic 4 1.54 13 1.46 7 1.01 5 0.80 29 24.67 1.18 0.27

Acute non-lymphocytic 6 2.65 16 2.06* 5 0.82 8 1.41 35 21.82 1.60* 0.84

Chronic myeloid 3 3.36 2 0.66 4 1.67 3 1.37 12 8.53 1.41 0.22

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 24,029 19,606 11,701 6,279 24,029

Person-years in interval 17,845 59,848 43,776 36,261 157,730

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE URINARY TRACT 293
All subsequent cancers 2,129 1.82* 4,867 1.16* 3,344 1.05* 2,547 0.98 12,887 11,119.60 1.16* 38.15

All excluding same site 1,919 1.78* 4,460 1.16* 3,097 1.06* 2,385 1.00 11,861 10,220.88 1.16* 35.41

Buccal cavity, pharynx 29 0.85 127 1.08 80 0.96 54 0.88 290 296.75 0.98 -0.15

Lip 5 0.69 26 1.06 12 0.70 8 0.65 51 61.07 0.84 -0.22

Tongue 1 0.16* 15 0.69 18 1.17 17 1.46 51 55.01 0.93 -0.09

Salivary gland 2 0.70 12 1.17 6 0.76 7 1.04 27 27.73 0.97 -0.02

Mouth 5 0.62 36 1.31 19 1.00 12 0.87 72 68.24 1.06 0.08

Nasopharynx 1 0.88 6 1.55 3 1.13 3 1.57 13 9.57 1.36 0.07

Tonsil 1 0.34 12 1.18 7 1.00 3 0.59 23 25.23 0.91 -0.05

Oropharynx 3 3.23 2 0.63 5 2.21 1 0.59 11 8.08 1.36 0.06

Hypopharynx 6 1.63 14 1.11 8 0.91 2 0.32 30 31.28 0.96 -0.03

Digestive system 290 1.11 930 1.01 679 0.99 537 0.99 2,436 2,404.76 1.01 0.67

Esophagus 14 0.95 42 0.81 35 0.90 37 1.15 128 137.63 0.93 -0.21

Stomach 38 1.25 120 1.15 71 0.94 57 0.97 286 269.23 1.06 0.36

Small intestine 7 2.13 9 0.76 7 0.77 6 0.77 29 31.93 0.91 -0.06

Colon 123 1.08 395 0.97 321 1.05 244 0.99 1,083 1,071.83 1.01 0.24

Rectum, rectosigmoid junction 32 0.67* 180 1.09 106 0.88 90 0.98 408 425.63 0.96 -0.38

Anus, anal canal 0 0.00 7 1.23 5 1.18 3 0.88 15 14.91 1.01 0.00

Liver 15 1.60 40 1.20 18 0.70 18 0.83 91 90.20 1.01 0.02

Gallbladder 3 1.28 6 0.74 6 1.01 4 0.86 19 21.03 0.90 -0.04

Bile ducts, other biliary 7 1.26 18 0.90 21 1.34 13 0.94 59 55.01 1.07 0.09

Pancreas 46 1.56* 104 1.01 86 1.13 61 1.01 297 268.96 1.10 0.61

Respiratory system 273 1.21* 1,208 1.53* 892 1.53* 724 1.59* 3,097 2,055.47 1.51* 22.48

Nose, nasal cavity, ear 3 1.71 5 0.81 6 1.33 4 1.12 18 15.99 1.13 0.04

Larynx 21 1.21 75 1.26 53 1.26 40 1.30 189 149.84 1.26* 0.85

Lung, bronchus 248 1.21* 1,125 1.55* 833 1.56* 680 1.62* 2,886 1,884.57 1.53* 21.62

Male breast 2 0.91 10 1.30 7 1.20 1 0.21 20 20.59 0.97 -0.01

Male genital system 1,083 3.01* 1,459 1.11* 901 0.88* 638 0.73* 4,081 3,567.57 1.14* 11.08

Prostate 1,079 3.03* 1,444 1.11* 891 0.87* 634 0.73* 4,048 3,536.05 1.14* 11.05

Testis 2 1.78 5 1.35 3 1.27 2 1.31 12 8.73 1.37 0.07

Urinary system 276 2.34* 539 1.28* 321 1.00 230 0.87* 1,366 1,125.90 1.21* 5.18

Urinary bladder 96 1.10 158 0.51* 58 0.24* 49 0.25* 361 835.32 0.43* -10.24

Kidney parenchyma 66 2.77* 132 1.55* 74 1.14 68 1.27 340 227.17 1.50* 2.44

Renal pelvis, other urinary 114 16.41* 249 10.21* 189 10.54* 113 7.99* 665 63.40 10.49* 12.99

Ureter 46 19.29* 86 10.25* 85 13.75* 45 9.38* 262 21.75 12.04* 5.19

Bone, joints 2 2.14 4 1.23 3 1.30 1 0.56 10 8.27 1.21 0.04

Soft tissue including heart 6 1.37 10 0.64 16 1.36 20 1.99* 52 41.76 1.25 0.22

Kaposi sarcoma 3 1.83 2 0.35 1 0.24 2 0.64 8 14.81 0.54 -0.15

Melanoma of skin 25 0.99 91 0.98 68 0.91 59 0.88 243 260.32 0.93 -0.37

Eye, orbit 1 0.59 5 0.84 4 0.92 4 1.17 14 15.40 0.91 -0.03

Brain, central nervous system 9 0.82 48 1.23 28 0.97 16 0.70 101 101.74 0.99 -0.02

Thyroid 7 2.03 9 0.75 6 0.69 6 0.88 28 30.98 0.90 -0.06

Lymphatic, hematopoietic 84 0.97 290 0.94 230 0.98 178 0.91 782 825.56 0.95 -0.94

Hodgkin lymphoma 4 1.49 10 1.11 12 1.95* 4 0.89 30 22.37 1.34 0.16

Non-Hodgkin lymphoma 36 1.01 123 0.95 87 0.86 72 0.83 318 352.56 0.90 -0.75

Myeloma 13 0.90 41 0.80 38 0.97 29 0.89 121 137.47 0.88 -0.36

Leukemia 31 0.93 116 0.98 93 1.04 73 1.01 313 313.15 1.00 0.00

Acute lymphocytic 0 0.00 1 0.34 3 1.35 4 2.39 8 7.73 1.03 0.01

Chronic lymphocytic 13 0.95 37 0.77 26 0.72 25 0.87 101 127.17 0.79* -0.56

Acute non-lymphocytic 11 1.01 41 1.06 44 1.50* 28 1.15 124 103.42 1.20 0.44

Chronic myeloid 2 0.45 20 1.27 13 1.09 11 1.11 46 42.08 1.09 0.08

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 70,354 60,342 35,399 17,854 70,354

Person-years in interval 53,904 184,423 128,889 96,007 463,222

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Bladder

Males

Table 11.1.4: Risk of subsequent primary cancers after cancer of the urinary bladder, males,

SEER 1973-2000.

294 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BLADDER

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Bladder

Both Sexes, <50 Years of Age

Table 11.1.5: Risk of subsequent primary cancers after cancer of the urinary bladder, both sexes,

<50 years of age, SEER 1973-2000.

BLADDER

All subsequent cancers 69 5.28* 117 1.76* 126 1.33* 313 1.14* 625 448.72 1.39* 22.84

All excluding same site 56 4.49* 99 1.56* 109 1.22 287 1.11 551 424.29 1.30* 16.42

Buccal cavity, pharynx 2 3.13 1 0.30 5 1.13 5 0.55 13 17.36 0.75 -0.57

Lip 1 11.94 0 0.00 2 4.20 1 0.98 4 1.97 2.03 0.26

Tongue 1 7.13 1 1.37 0 0.00 2 0.97 4 3.93 1.02 0.01

Salivary gland 0 0.00 0 0.00 0 0.00 1 1.46 1 1.30 0.77 -0.04

Mouth 0 0.00 0 0.00 1 0.90 0 0.00 1 4.27 0.23 -0.42

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.87 0.00 -0.11

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 2.28 0.00 -0.30

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.51 0.00 -0.07

Hypopharynx 0 0.00 0 0.00 2 4.72 0 0.00 2 1.69 1.19 0.04

Digestive system 5 2.47 17 1.55 16 0.96 56 1.15 94 78.30 1.20 2.03

Esophagus 0 0.00 0 0.00 2 1.65 4 1.12 6 5.69 1.05 0.04

Stomach 1 4.20 0 0.00 0 0.00 7 1.55 8 7.71 1.04 0.04

Small intestine 0 0.00 1 3.68 0 0.00 0 0.00 1 1.64 0.61 -0.08

Colon 1 1.40 7 1.78 12 1.96* 29 1.51* 49 30.00 1.63* 2.46

Rectum, rectosigmoid junction 0 0.00 3 1.32 2 0.57 7 0.72 12 15.93 0.75 -0.51

Anus, anal canal 0 0.00 0 0.00 0 0.00 1 1.54 1 1.21 0.83 -0.03

Liver 0 0.00 4 7.08* 0 0.00 2 0.85 6 3.86 1.56 0.28

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.08

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.59 0.00 -0.21

Pancreas 3 12.87* 2 1.54 0 0.00 6 1.05 11 9.20 1.20 0.23

Respiratory system 8 4.25* 21 1.96* 34 2.00* 89 1.79* 152 79.43 1.91* 9.40

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 1 2.30 1 0.83 1.20 0.02

Larynx 0 0.00 1 0.82 3 1.63 5 1.15 9 7.61 1.18 0.18

Lung, bronchus 8 4.95* 20 2.15* 31 2.08* 83 1.85* 142 70.73 2.01* 9.23

Female breast 2 1.13 6 0.72 4 0.40 19 0.96 31 39.82 0.78 -4.71

Female genital system 1 1.41 3 0.89 1 0.25 5 0.63 10 16.08 0.62 -3.25

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 2.73 0.00 -1.46

Corpus uteri 1 4.16 1 0.76 0 0.00 3 0.73 5 7.49 0.67 -1.33

Ovary 0 0.00 2 1.93 0 0.00 1 0.41 3 4.94 0.61 -1.04

Vagina 0 0.00 0 0.00 1 27.31 0 0.00 1 0.15 6.47 0.45

Vulva 0 0.00 0 0.00 0 0.00 1 4.02 1 0.47 2.14 0.28

Male genital system 25 28.05* 18 3.16* 18 1.46 52 0.74* 113 88.79 1.27* 4.14

Prostate 25 47.53* 16 3.68* 17 1.51 51 0.74* 109 84.89 1.28* 4.12

Testis 0 0.00 2 1.62 1 1.11 1 1.38 4 3.19 1.25 0.14

Urinary system 15 15.27* 21 3.98* 20 2.54* 37 1.61* 93 37.17 2.50* 7.23

Urinary bladder 8 14.85* 7 2.36 4 0.87 5 0.34* 24 22.81 1.05 0.15

Kidney parenchyma 2 4.99 3 1.43 3 1.02 11 1.51 19 12.74 1.49 0.81

Renal pelvis, other urinary 5 118.70* 11 50.42* 13 40.59* 21 20.30* 50 1.62 30.96* 6.27

Ureter 3 357.71* 5 103.14* 3 35.85* 9 27.07* 20 0.47 42.29* 2.53

Bone, joints 0 0.00 1 5.79 0 0.00 0 0.00 1 0.70 1.44 0.04

Soft tissue including heart 0 0.00 0 0.00 1 1.59 2 1.67 3 2.52 1.19 0.06

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 1 1.04 1 4.00 0.25 -0.39

Melanoma of skin 4 3.83* 7 1.48 5 0.93 14 1.35 30 21.54 1.39 1.10

Eye, orbit 0 0.00 0 0.00 1 4.39 0 0.00 1 0.92 1.08 0.01

Brain, central nervous system 2 5.45 6 3.57* 4 2.08 1 0.28 13 7.58 1.71 0.70

Thyroid 1 2.93 2 1.38 3 2.08 3 1.36 9 5.43 1.66 0.46

Lymphatic, hematopoietic 4 2.70 8 1.14 11 1.26 22 1.08 45 37.53 1.20 0.97

Hodgkin lymphoma 0 0.00 3 3.80 1 1.41 1 1.10 5 2.61 1.92 0.31

Non-Hodgkin lymphoma 3 3.81 2 0.54 6 1.32 8 0.78 19 19.33 0.98 -0.04

Myeloma 0 0.00 1 1.51 0 0.00 6 2.01 7 4.78 1.46 0.29

Leukemia 1 2.64 2 1.07 4 1.65 7 1.14 14 10.81 1.29 0.41

Acute lymphocytic 0 0.00 0 0.00 0 0.00 1 4.11 1 0.56 1.78 0.06

Chronic lymphocytic 1 10.74 1 1.83 1 1.13 3 1.19 6 4.05 1.48 0.25

Acute non-lymphocytic 0 0.00 1 1.61 2 2.65 3 1.52 6 3.49 1.72 0.33

Chronic myeloid 0 0.00 0 0.00 1 2.67 0 0.00 1 1.61 0.62 -0.08

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 7,387 6,807 5,070 3,473 7,387

Person-years in interval 5,904 23,462 21,227 26,587 77,179

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 18,715 PYR and for male cancers on 58,464 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE URINARY TRACT 295
All subsequent cancers 992 2.22* 2,593 1.31* 2,352 1.13* 2,328 1.02 8,265 6,790.48 1.22* 44.13

All excluding same site 887 2.12* 2,378 1.28* 2,173 1.12* 2,190 1.04 7,628 6,323.91 1.21* 39.03

Buccal cavity, pharynx 18 1.10 67 1.03 47 0.83 45 0.90 177 188.30 0.94 -0.34

Lip 2 0.82 9 0.90 4 0.43 6 0.66 21 30.86 0.68 -0.30

Tongue 0 0.00 9 0.68 14 1.22 13 1.31 36 37.80 0.95 -0.05

Salivary gland 1 0.99 7 1.61 4 0.91 5 0.96 17 14.95 1.14 0.06

Mouth 3 0.72 19 1.16 12 0.86 11 0.91 45 46.46 0.97 -0.04

Nasopharynx 1 1.53 5 2.03 1 0.51 4 2.60 11 6.61 1.66 0.13

Tonsil 1 0.58 4 0.61 5 0.94 3 0.74 13 17.66 0.74 -0.14

Oropharynx 2 3.82 2 0.98 3 1.73 1 0.71 8 5.72 1.40 0.07

Hypopharynx 4 2.07 10 1.30 4 0.61 1 0.20 19 21.25 0.89 -0.07

Digestive system 126 1.39* 402 1.00 412 0.98 460 0.96 1,400 1,388.82 1.01 0.33

Esophagus 5 0.82 25 0.97 23 0.91 33 1.26 86 83.31 1.03 0.08

Stomach 11 1.15 45 1.09 41 0.97 40 0.85 137 140.29 0.98 -0.10

Small intestine 2 1.51 6 1.02 6 0.98 8 1.15 22 20.31 1.08 0.05

Colon 58 1.57* 160 0.96 190 1.04 202 0.92 610 606.78 1.01 0.10

Rectum, rectosigmoid junction 18 0.98 80 1.01 62 0.79 72 0.90 232 255.51 0.91 -0.70

Anus, anal canal 1 1.15 4 1.09 3 0.85 5 1.42 13 11.59 1.12 0.04

Liver 5 1.42 14 0.91 12 0.74 16 0.88 47 53.32 0.88 -0.19

Gallbladder 0 0.00 1 0.27 3 0.73 5 0.99 9 13.71 0.66 -0.14

Bile ducts, other biliary 3 1.77 7 0.91 11 1.27 10 0.86 31 29.71 1.04 0.04

Pancreas 22 2.03* 55 1.16 59 1.21 62 1.11 198 162.59 1.22* 1.06

Respiratory system 131 1.38* 717 1.76* 660 1.64* 667 1.66* 2,175 1,306.63 1.66* 25.99

Nose, nasal cavity, ear 1 1.35 2 0.67 3 1.06 5 1.65 11 9.60 1.15 0.04

Larynx 11 1.29 50 1.47* 40 1.35 36 1.47* 137 96.61 1.42* 1.21

Lung, bronchus 119 1.39* 664 1.79* 617 1.67* 625 1.68* 2,025 1,197.43 1.69* 24.77

Female breast 29 1.23 105 1.10 101 1.08 101 0.98 336 316.56 1.06 2.49

Female genital system 14 1.18 45 0.97 35 0.83 50 1.18 144 142.32 1.01 0.21

Cervix uteri 0 0.00 1 0.22 2 0.56 1 0.33 4 12.41 0.32* -1.08

Corpus uteri 7 1.05 21 0.81 16 0.69 29 1.31 73 77.68 0.94 -0.60

Ovary 5 1.55 16 1.23 10 0.81 12 0.91 43 41.71 1.03 0.17

Vagina 0 0.00 2 3.72 2 3.61 4 5.78* 8 1.92 4.18* 0.78

Vulva 1 3.09 2 1.39 4 2.45 3 1.25 10 5.78 1.73 0.54

Male genital system 458 4.45* 645 1.28* 546 0.93 491 0.75* 2,140 1,846.13 1.16* 11.47

Prostate 455 4.48* 637 1.28* 538 0.93 489 0.75* 2,119 1,831.71 1.16* 11.22

Testis 2 4.02 1 0.61 2 1.85 1 1.39 6 3.94 1.52 0.08

Urinary system 141 3.60* 288 1.65* 231 1.25* 198 0.94 858 610.93 1.40* 7.39

Urinary bladder 40 1.51* 63 0.52* 31 0.24* 41 0.27* 175 431.41 0.41* -7.67

Kidney parenchyma 36 3.46* 73 1.64* 52 1.18 60 1.32* 221 144.35 1.53* 2.29

Renal pelvis, other urinary 65 28.68* 152 14.83* 148 13.79* 97 8.14* 462 35.16 13.14* 12.77

Ureter 19 24.91* 58 16.59* 73 19.64* 38 9.35* 188 12.04 15.61* 5.27

Bone, joints 1 2.32 3 1.69 1 0.61 1 0.65 6 5.39 1.11 0.02

Soft tissue including heart 3 1.79 4 0.57 9 1.26 18 2.14* 34 24.28 1.40 0.29

Kaposi sarcoma 0 0.00 0 0.00 1 0.66 1 0.63 2 5.33 0.38 -0.10

Melanoma of skin 11 0.96 45 0.93 40 0.83 43 0.80 139 162.18 0.86 -0.69

Eye, orbit 1 1.33 2 0.64 1 0.34 3 1.00 7 9.88 0.71 -0.09

Brain, central nervous system 4 0.71 28 1.22 24 1.13 15 0.73 71 70.30 1.01 0.02

Thyroid 5 2.12 8 0.88 5 0.64 5 0.72 23 26.33 0.87 -0.10

Lymphatic, hematopoietic 35 1.12 155 1.13 153 1.05 168 0.98 511 484.79 1.05 0.78

Hodgkin lymphoma 3 2.35 7 1.43 7 1.68 4 1.04 21 14.17 1.48 0.20

Non-Hodgkin lymphoma 15 1.06 61 0.98 63 0.96 65 0.83 204 220.35 0.93 -0.49

Myeloma 5 0.97 23 1.00 21 0.86 26 0.90 75 81.38 0.92 -0.19

Leukemia 12 1.13 64 1.35* 62 1.22 73 1.22 211 168.89 1.25* 1.26

Acute lymphocytic 0 0.00 1 0.76 2 1.53 2 1.47 5 4.30 1.16 0.02

Chronic lymphocytic 4 0.87 22 1.08 21 0.98 23 0.96 70 70.27 1.00 -0.01

Acute non-lymphocytic 7 2.10 24 1.56* 27 1.58* 29 1.39 87 56.56 1.54* 0.91

Chronic myeloid 1 0.73 11 1.83 8 1.24 12 1.48 32 21.97 1.46 0.30

Bladder

Both Sexes, 50-69 Years of Age

Table 11.1.6: Risk of subsequent primary cancers after cancer of the urinary bladder, both sexes,

50-69 years of age, SEER 1973-2000.

296 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BLADDER

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 40,787 36,512 24,855 14,697 40,787

Person-years in interval 32,056 119,781 97,571 84,737 334,145

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 77,985 PYR and for male cancers on 256,160 PYR.
Bladder

Both Sexes, ≥70 Years of Age

Table 11.1.7: Risk of subsequent primary cancers after cancer of the urinary bladder, both sexes,

≥70 years of age, SEER 1973-2000.

BLADDER

All subsequent cancers 1,468 1.53* 3,243 1.09* 1,645 0.99 595 0.95 6,951 6,221.69 1.12* 34.79

All excluding same site 1,304 1.47* 2,977 1.09* 1,545 1.01 563 0.97 6,389 5,730.08 1.11* 31.43

Buccal cavity, pharynx 12 0.56* 73 1.14 41 1.23 13 1.07 139 131.27 1.06 0.37

Lip 2 0.40 18 1.18 8 0.98 3 1.01 31 31.47 0.99 -0.02

Tongue 1 0.27 8 0.73 7 1.27 3 1.60 19 22.09 0.86 -0.15

Salivary gland 1 0.44 6 0.82 2 0.45 2 0.99 11 16.08 0.68 -0.24

Mouth 4 0.76 22 1.42 11 1.36 4 1.32 41 31.86 1.29 0.44

Nasopharynx 0 0.00 1 0.58 2 2.38 0 0.00 3 3.48 0.86 -0.02

Tonsil 0 0.00 11 2.57* 3 1.54 0 0.00 14 8.31 1.68 0.27

Oropharynx 1 2.03 1 0.71 2 2.99 0 0.00 4 2.79 1.43 0.06

Hypopharynx 2 1.02 4 0.72 4 1.60 1 1.35 11 10.80 1.02 0.01

Digestive system 253 1.10 753 1.04 426 1.02 162 0.97 1,594 1,536.78 1.04 2.73

Esophagus 9 0.89 20 0.65 16 0.96 6 0.95 51 63.94 0.80 -0.62

Stomach 36 1.40 100 1.26* 38 0.85 20 1.11 194 167.72 1.16 1.25

Small intestine 6 2.23 4 0.48 6 1.24 4 2.05 20 17.87 1.12 0.10

Colon 111 1.02 339 0.98 216 1.06 85 1.01 751 742.22 1.01 0.42

Rectum, rectosigmoid junction 33 0.86 132 1.12 62 0.97 24 1.02 251 243.55 1.03 0.36

Anus, anal canal 0 0.00 8 1.83 4 1.63 0 0.00 12 9.30 1.29 0.13

Liver 10 1.43 26 1.20 9 0.75 2 0.45 47 45.10 1.04 0.09

Gallbladder 5 1.65 9 0.96 8 1.45 2 0.86 24 20.28 1.18 0.18

Bile ducts, other biliary 5 0.96 17 1.01 13 1.23 5 1.02 40 37.51 1.07 0.12

Pancreas 33 1.24 90 1.09 52 1.10 13 0.67 188 175.92 1.07 0.58

Respiratory system 194 1.22* 710 1.48* 387 1.55* 143 1.69* 1,434 973.05 1.47* 21.99

Nose, nasal cavity, ear 2 1.51 3 0.72 5 2.09 0 0.00 10 8.80 1.14 0.06

Larynx 12 1.26 32 1.16 16 1.22 3 0.77 63 54.11 1.16 0.42

Lung, bronchus 179 1.21* 673 1.51* 365 1.56* 140 1.76* 1,357 907.53 1.50* 21.44

Female breast 37 0.92 106 0.86 63 0.87 34 1.02 240 268.86 0.89 -4.73

Female genital system 24 1.37 46 0.89 29 0.99 14 1.06 113 111.99 1.01 0.17

Cervix uteri 4 2.36 4 0.84 2 0.79 2 1.84 12 10.06 1.19 0.32

Corpus uteri 12 1.43 23 0.94 8 0.61 6 1.11 49 51.45 0.95 -0.40

Ovary 7 1.32 12 0.75 12 1.28 4 0.90 35 35.14 1.00 -0.02

Vagina 0 0.00 1 0.87 2 2.85 0 0.00 3 2.56 1.17 0.07

Vulva 0 0.00 5 1.28 4 1.54 1 0.69 10 9.19 1.09 0.13

Male genital system 600 2.34* 796 1.00 337 0.78* 95 0.65* 1,828 1,632.65 1.12* 13.15

Prostate 599 2.36* 791 1.00 336 0.79* 94 0.65* 1,820 1,619.45 1.12* 13.50

Testis 0 0.00 2 2.37 0 0.00 0 0.00 2 1.60 1.25 0.03

Urinary system 204 2.26* 344 1.21* 129 0.80* 42 0.67* 719 597.96 1.20* 5.77

Urinary bladder 70 1.03 116 0.54* 36 0.29* 14 0.29* 236 454.79 0.52* -10.44

Kidney parenchyma 40 2.40* 78 1.52* 29 1.03 10 0.98 157 106.36 1.48* 2.42

Renal pelvis, other urinary 94 16.46* 150 8.52* 64 6.57* 18 4.80* 326 36.81 8.86* 13.80

Ureter 40 20.49* 55 9.15* 28 8.53* 8 6.70* 131 12.44 10.53* 5.66

Bone, joints 3 4.37 3 1.46 2 1.88 0 0.00 8 4.23 1.89 0.18

Soft tissue including heart 3 0.85 8 0.71 7 1.06 6 2.12 24 24.17 0.99 -0.01

Kaposi sarcoma 3 3.33 2 0.67 0 0.00 2 2.24 7 6.63 1.06 0.02

Melanoma of skin 12 0.70 59 1.07 35 1.06 12 0.84 118 119.51 0.99 -0.07

Eye, orbit 1 0.79 5 1.30 2 0.96 1 1.32 9 7.97 1.13 0.05

Brain, central nervous system 7 0.94 20 0.88 9 0.74 3 0.70 39 46.55 0.84 -0.36

Thyroid 3 1.19 6 0.80 3 0.78 1 0.70 13 15.27 0.85 -0.11

Lymphatic, hematopoietic 73 1.00 206 0.89 118 0.87 36 0.66* 433 494.71 0.88* -2.94

Hodgkin lymphoma 2 1.14 3 0.58 6 2.27 0 0.00 11 10.48 1.05 0.02

Non-Hodgkin lymphoma 30 1.01 90 0.94 43 0.76 16 0.70 179 204.22 0.88 -1.20

Myeloma 9 0.72 31 0.79 23 1.01 7 0.78 70 83.71 0.84 -0.65

Leukemia 32 1.10 82 0.89 46 0.86 13 0.59 173 196.30 0.88 -1.11

Acute lymphocytic 0 0.00 0 0.00 1 0.80 2 4.05 3 4.55 0.66 -0.07

Chronic lymphocytic 12 1.03 27 0.74 11 0.52* 4 0.46 54 77.51 0.70* -1.12

Acute non-lymphocytic 10 1.03 32 1.04 20 1.13 4 0.56 66 65.18 1.01 0.04

Chronic myeloid 4 1.02 11 0.88 8 1.07 2 0.64 25 27.02 0.93 -0.10

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 46,209 36,629 17,175 5,963 46,209

Person-years in interval 33,790 101,027 53,867 20,944 209,628

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 61,031 PYR and for male cancers on 148,597 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE URINARY TRACT 297
Kidney Parenchyma

Both Sexes, ≥18 Years of Age

Table 11.2.1: Characteristics of patients with an initial cancer of the kidney parenchyma, both sexes,

≥18 years of age, SEER 1973-2000.

298 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

KIDNEY PARENCHYMA

Number of patients with 1st primary cancer

Total 23,211 100.0 13,624 100.0 36,835 100.0

Initial treatment

Any radiation 3,022 13.0 1,495 11.0 4,517 12.3

With surgery 1,415 6.1 664 4.9 2,079 5.6

Without surgery 1,607 6.9 831 6.1 2,438 6.6

No radiation 20,189 87.0 12,129 89.0 32,318 87.7

With surgery 16,955 73.0 9,794 71.9 26,749 72.6

Without surgery 3,234 13.9 2,335 17.1 5,569 15.1

Race

White 20,071 86.5 11,685 85.8 31,756 86.2

Black 1,961 8.4 1,320 9.7 3,281 8.9

Other 1,122 4.8 575 4.2 1,697 4.6

Unknown 57 0.2 44 0.3 101 0.3

Age at 1st primary cancer diagnosis, years

< 30 163 0.7 182 1.3 345 0.9

30–49 3,779 16.3 2,031 14.9 5,810 15.8

50–69 12,557 54.1 6,288 46.2 18,845 51.2

70–79 5,030 21.7 3,452 25.3 8,482 23.0

> 80 1,682 7.2 1,671 12.3 3,353 9.1

Number of patients with one or more

primary cancers

One primary cancer only 20,892 90.0 12,701 93.2 33,593 91.2

1st and 2nd cancers 2,107 9.1 839 6.2 2,946 8.0

1st, 2nd, and 3rd cancers 194 0.8 76 0.6 270 0.7

1st, 2nd, 3rd, and additional cancers 18 0.1 8 0.1 26 0.1

Other statistics

Median age at 1st cancer diagnosis 62.8 — 65.7 — 63.8 —

Median year of 1st cancer diagnosis 1990.0 — 1990.5 — 1990.2 —

Median person-years at risk 2.8 — 2.8 — 2.8 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 95.1 — 94.1 — 94.8

1st, 2nd, and additional cancers — 94.9 — 94.1 — 94.7

1st cancer only — 3.1 — 3.9 — 3.3

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Kidney Parenchyma

Both Sexes, ≥18 Years of Age

Table 11.2.2: Risk of subsequent primary cancers after cancer of the kidney parenchyma, both sexes,

≥18 years of age, SEER 1973-2000.

KIDNEY PARENCHYMA

All subsequent cancers 568 1.53* 1,288 1.09* 960 1.11* 754 1.05 3,570 3,145.79 1.13* 22.88

All excluding same site 510 1.40* 1,205 1.04 898 1.06 696 0.99 3,309 3,081.60 1.07* 12.27

Buccal cavity, pharynx 11 1.05 17 0.53* 19 0.87 10 0.61 57 80.82 0.71* -1.28

Lip 1 0.62 2 0.41 5 1.51 7 2.81* 15 12.25 1.22 0.15

Tongue 3 1.44 3 0.47 2 0.45 0 0.00 8 16.28 0.49* -0.45

Salivary gland 1 1.18 2 0.74 3 1.53 1 0.60 7 7.17 0.98 -0.01

Mouth 5 1.85 3 0.36 6 1.08 1 0.24 15 20.64 0.73 -0.30

Nasopharynx 1 2.35 3 2.36 0 0.00 0 0.00 4 3.10 1.29 0.05

Tonsil 0 0.00 1 0.32 2 0.97 1 0.68 4 7.68 0.52 -0.20

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 2.34 0.00 -0.13

Hypopharynx 0 0.00 1 0.30 1 0.44 0 0.00 2 8.40 0.24* -0.35

Digestive system 77 0.95 227 0.89 220 1.18* 157 1.02 681 678.14 1.00 0.15

Esophagus 5 1.13 10 0.72 6 0.60 4 0.49 25 36.64 0.68 -0.63

Stomach 8 0.94 18 0.68 19 1.01 20 1.32 65 68.85 0.94 -0.21

Small intestine 4 3.45 4 1.08 3 1.09 3 1.28 14 9.97 1.40 0.22

Colon 31 0.86 113 0.99 109 1.29* 68 0.96 321 305.21 1.05 0.85

Rectum, rectosigmoid junction 11 0.77 36 0.81 37 1.17 23 0.92 107 115.80 0.92 -0.47

Anus, anal canal 1 1.36 3 1.29 4 2.41 1 0.74 9 6.06 1.49 0.16

Liver 3 1.02 5 0.53 7 1.03 3 0.52 18 24.89 0.72 -0.37

Gallbladder 1 0.98 3 0.96 3 1.34 2 1.09 9 8.21 1.10 0.04

Bile ducts, other biliary 2 1.18 6 1.10 3 0.72 4 1.07 15 15.10 0.99 -0.01

Pancreas 10 1.03 26 0.85 27 1.22 29 1.57* 92 81.00 1.14 0.59

Respiratory system 53 0.79 192 0.90 146 0.96 121 0.98 512 555.97 0.92 -2.37

Nose, nasal cavity, ear 0 0.00 4 2.29 1 0.81 0 0.00 5 4.54 1.10 0.02

Larynx 1 0.21 9 0.60 9 0.88 5 0.66 24 37.63 0.64* -0.74

Lung, bronchus 52 0.84 179 0.92 136 0.96 116 1.02 483 512.47 0.94 -1.59

Female breast 27 0.88 77 0.80 75 1.09 48 0.86 227 251.28 0.90 -3.50

Female genital system 18 1.29 42 0.99 28 0.96 17 0.75 105 107.91 0.97 -0.42

Cervix uteri 1 0.61 8 1.69 4 1.35 3 1.49 16 11.33 1.41 0.67

Corpus uteri 11 1.55 26 1.20 16 1.08 10 0.88 63 54.97 1.15 1.16

Ovary 4 0.99 6 0.48 6 0.68 4 0.57 20 32.28 0.62* -1.77

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 1.68 0.00 -0.24

Vulva 1 1.65 1 0.53 2 1.40 0 0.00 4 5.19 0.77 -0.17

Male genital system 154 1.91* 313 1.17* 213 1.05 189 1.06 869 730.19 1.19* 11.97

Prostate 152 1.91* 312 1.18* 212 1.05 187 1.06 863 723.04 1.19* 12.07

Testis 1 2.29 1 0.81 1 1.49 1 2.70 4 2.71 1.48 0.11

Urinary system 145 4.73* 221 2.25* 118 1.63* 102 1.67* 586 262.61 2.23* 17.44

Urinary bladder 82 3.87* 126 1.85* 52 1.03 42 0.98 302 182.95 1.65* 6.42

Kidney parenchyma 58 7.59* 83 3.41* 62 3.51* 58 3.98* 261 64.20 4.07* 10.61

Renal pelvis, other urinary 5 2.68 12 2.04* 4 0.94 2 0.57 23 15.47 1.49 0.41

Ureter 4 6.50* 6 3.10* 3 2.13 0 0.00 13 5.10 2.55* 0.43

Bone, joints 1 3.02 0 0.00 0 0.00 2 3.72 3 2.59 1.16 0.02

Soft tissue including heart 3 2.05 6 1.31 5 1.51 3 1.08 17 12.16 1.40 0.26

Kaposi sarcoma 0 0.00 2 1.10 1 0.89 0 0.00 3 4.31 0.70 -0.07

Melanoma of skin 16 1.89* 37 1.35 29 1.43 14 0.81 96 73.52 1.31* 1.21

Eye, orbit 0 0.00 1 0.59 1 0.84 1 1.06 3 4.37 0.69 -0.07

Brain, central nervous system 6 1.54 9 0.74 7 0.82 8 1.20 30 31.22 0.96 -0.07

Thyroid 15 7.57* 17 2.80* 8 1.96 5 1.64 45 15.19 2.96* 1.61

Lymphatic, hematopoietic 34 1.23 102 1.16 64 0.99 61 1.12 261 234.03 1.12 1.45

Hodgkin lymphoma 0 0.00 4 1.40 2 1.07 1 0.74 7 7.04 0.99 0.00

Non-Hodgkin lymphoma 16 1.30 35 0.89 26 0.89 31 1.24 108 106.14 1.02 0.10

Myeloma 12 2.53* 17 1.12 14 1.26 8 0.85 51 40.29 1.27 0.58

Leukemia 6 0.63 46 1.52* 22 0.99 21 1.13 95 80.57 1.18 0.78

Acute lymphocytic 0 0.00 1 1.18 1 1.66 2 4.26 4 2.19 1.83 0.10

Chronic lymphocytic 3 0.78 11 0.90 8 0.90 11 1.50 33 32.31 1.02 0.04

Acute non-lymphocytic 3 0.94 16 1.57 6 0.80 4 0.63 29 27.24 1.06 0.09

Chronic myeloid 0 0.00 10 2.44* 3 1.00 1 0.39 14 10.93 1.28 0.17

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 36,835 26,826 13,844 6,603 36,835

Person-years in interval 25,340 75,850 49,070 35,145 185,404

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 69,480 PYR and for male cancers on 115,924 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE URINARY TRACT 299
All subsequent cancers 2,816 1.16* 473 1.06 204 1.00 77 1.08 3,570 3,145.79 1.13* 22.88

All excluding same site 2,613 1.10* 431 0.99 193 0.97 72 1.03 3,309 3,081.60 1.07* 12.27

Buccal cavity, pharynx 47 0.73* 7 0.67 2 0.45 1 0.66 57 80.82 0.71* -1.28

Lip 8 0.82 5 3.17* 1 1.46 1 4.30 15 12.25 1.22 0.15

Tongue 8 0.62 0 0.00 0 0.00 0 0.00 8 16.28 0.49* -0.45

Salivary gland 6 1.09 1 0.98 0 0.00 0 0.00 7 7.17 0.98 -0.01

Mouth 14 0.85 0 0.00 1 0.90 0 0.00 15 20.64 0.73 -0.30

Nasopharynx 4 1.59 0 0.00 0 0.00 0 0.00 4 3.10 1.29 0.05

Tonsil 3 0.48 1 1.05 0 0.00 0 0.00 4 7.68 0.52 -0.20

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 2.34 0.00 -0.13

Hypopharynx 2 0.30 0 0.00 0 0.00 0 0.00 2 8.40 0.24* -0.35

Digestive system 524 1.00 97 1.02 40 0.92 20 1.29 681 678.14 1.00 0.15

Esophagus 21 0.74 2 0.39 1 0.43 1 1.21 25 36.64 0.68 -0.63

Stomach 45 0.84 10 1.06 4 0.94 6 4.03* 65 68.85 0.94 -0.21

Small intestine 11 1.44 2 1.39 0 0.00 1 4.08 14 9.97 1.40 0.22

Colon 253 1.08 47 1.08 14 0.70 7 0.97 321 305.21 1.05 0.85

Rectum, rectosigmoid junction 84 0.93 12 0.76 8 1.16 3 1.24 107 115.80 0.92 -0.47

Anus, anal canal 8 1.70 0 0.00 1 2.66 0 0.00 9 6.06 1.49 0.16

Liver 15 0.79 2 0.57 1 0.60 0 0.00 18 24.89 0.72 -0.37

Gallbladder 7 1.10 1 0.89 1 1.93 0 0.00 9 8.21 1.10 0.04

Bile ducts, other biliary 11 0.97 2 0.89 1 0.91 1 2.41 15 15.10 0.99 -0.01

Pancreas 63 1.01 19 1.67* 9 1.73 1 0.53 92 81.00 1.14 0.59

Respiratory system 391 0.90* 83 1.08 28 0.82 10 0.83 512 555.97 0.92 -2.37

Nose, nasal cavity, ear 5 1.41 0 0.00 0 0.00 0 0.00 5 4.54 1.10 0.02

Larynx 19 0.63* 5 1.03 0 0.00 0 0.00 24 37.63 0.64* -0.74

Lung, bronchus 367 0.92 78 1.10 28 0.88 10 0.89 483 512.47 0.94 -1.59

Female breast 179 0.91 30 0.86 17 1.10 1 0.18 227 251.28 0.90 -3.50

Female genital system 88 1.03 11 0.77 5 0.80 1 0.47 105 107.91 0.97 -0.42

Cervix uteri 13 1.40 1 0.76 2 3.74 0 0.00 16 11.33 1.41 0.67

Corpus uteri 53 1.22 7 0.97 2 0.64 1 0.93 63 54.97 1.15 1.16

Ovary 16 0.63 3 0.69 1 0.51 0 0.00 20 32.28 0.62* -1.77

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 1.68 0.00 -0.24

Vulva 4 1.02 0 0.00 0 0.00 0 0.00 4 5.19 0.77 -0.17

Male genital system 680 1.23* 108 0.99 60 1.16 21 1.22 869 730.19 1.19* 11.97

Prostate 676 1.24* 107 0.99 59 1.15 21 1.23 863 723.04 1.19* 12.07

Testis 3 1.29 0 0.00 1 11.22 0 0.00 4 2.71 1.48 0.11

Urinary system 484 2.40* 68 1.82* 24 1.39 10 1.57 586 262.61 2.23* 17.44

Urinary bladder 260 1.86* 25 0.95 12 0.98 5 1.10 302 182.95 1.65* 6.42

Kidney parenchyma 203 4.09* 42 4.66* 11 2.69* 5 3.39* 261 64.20 4.07* 10.61

Renal pelvis, other urinary 21 1.75* 1 0.47 1 1.03 0 0.00 23 15.47 1.49 0.41

Ureter 13 3.28* 0 0.00 0 0.00 0 0.00 13 5.10 2.55* 0.43

Bone, joints 1 0.49 0 0.00 2 13.43* 0 0.00 3 2.59 1.16 0.02

Soft tissue including heart 14 1.49 0 0.00 3 3.78 0 0.00 17 12.16 1.40 0.26

Kaposi sarcoma 3 0.84 0 0.00 0 0.00 0 0.00 3 4.31 0.70 -0.07

Melanoma of skin 82 1.46* 10 0.95 2 0.41 2 1.05 96 73.52 1.31* 1.21

Eye, orbit 2 0.58 1 1.71 0 0.00 0 0.00 3 4.37 0.69 -0.07

Brain, central nervous system 22 0.90 6 1.44 2 1.09 0 0.00 30 31.22 0.96 -0.07

Thyroid 40 3.30* 1 0.52 2 2.41 2 7.00 45 15.19 2.96* 1.61

Lymphatic, hematopoietic 200 1.11 38 1.14 14 0.91 9 1.59 261 234.03 1.12 1.45

Hodgkin lymphoma 6 1.05 1 1.16 0 0.00 0 0.00 7 7.04 0.99 0.00

Non-Hodgkin lymphoma 77 0.95 18 1.18 8 1.12 5 1.87 108 106.14 1.02 0.10

Myeloma 43 1.39* 5 0.87 2 0.75 1 1.05 51 40.29 1.27 0.58

Leukemia 74 1.19 14 1.23 4 0.76 3 1.58 95 80.57 1.18 0.78

Acute lymphocytic 2 1.16 2 6.69 0 0.00 0 0.00 4 2.19 1.83 0.10

Chronic lymphocytic 22 0.88 7 1.54 2 0.97 2 2.74 33 32.31 1.02 0.04

Acute non-lymphocytic 25 1.20 3 0.77 0 0.00 1 1.48 29 27.24 1.06 0.09

Chronic myeloid 13 1.55 1 0.64 0 0.00 0 0.00 14 10.93 1.28 0.17

Kidney Parenchyma

Both Sexes, Long-term Follow-up, ≥18 Years of Age

Table 11.2.3: Risk of subsequent primary cancers after cancer of the kidney parenchyma, both sexes,

long-term follow-up, ≥18 years of age, SEER 1973-2000.

300 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

KIDNEY PARENCHYMA

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 36,835 6,603 2,894 1,080 36,835

Person-years in interval 150,259 22,557 9,410 3,177 185,404

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 69,480 PYR and for male cancers on 115,924 PYR.
Kidney Parenchyma

Females, ≥18 Years of Age

Table 11.2.4: Risk of subsequent primary cancers after cancer of the kidney parenchyma, females,

≥18 years of age, SEER 1973-2000.

KIDNEY PARENCHYMA

All subsequent cancers 165 1.54* 369 1.11 277 1.14* 204 1.01 1,015 884.60 1.15* 18.77

All excluding same site 152 1.44* 342 1.04 257 1.08 187 0.95 938 870.21 1.08* 9.76

Buccal cavity, pharynx 2 1.04 5 0.84 5 1.19 2 0.60 14 15.40 0.91 -0.20

Lip 0 0.00 0 0.00 0 0.00 1 3.88 1 1.06 0.94 -0.01

Tongue 0 0.00 2 1.53 1 1.07 0 0.00 3 3.41 0.88 -0.06

Salivary gland 1 4.79 1 1.54 2 4.28 0 0.00 4 1.71 2.33 0.33

Mouth 0 0.00 0 0.00 2 1.37 0 0.00 2 5.34 0.37 -0.48

Nasopharynx 1 12.71 2 8.44 0 0.00 0 0.00 3 0.60 5.00* 0.35

Tonsil 0 0.00 0 0.00 0 0.00 1 3.95 1 1.31 0.76 -0.04

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.04 0.00 -0.15

Digestive system 28 1.14 62 0.82 63 1.12 44 0.92 197 204.26 0.96 -1.04

Esophagus 1 1.43 0 0.00 0 0.00 1 0.74 2 5.82 0.34 -0.55

Stomach 4 2.09 2 0.34 5 1.19 5 1.42 16 15.45 1.04 0.08

Small intestine 1 2.82 1 0.89 2 2.36 1 1.35 5 3.06 1.63 0.28

Colon 11 0.90 34 0.90 31 1.10 21 0.87 97 102.43 0.95 -0.78

Rectum, rectosigmoid junction 2 0.52 9 0.76 9 1.06 9 1.31 29 31.12 0.93 -0.31

Rectum 0 0.00 5 0.64 5 0.89 4 0.87 14 20.49 0.68 -0.93

Anus, anal canal 1 3.03 1 0.97 1 1.33 1 1.60 4 2.74 1.46 0.18

Liver 0 0.00 1 0.60 0 0.00 0 0.00 1 4.58 0.22 -0.52

Gallbladder 1 1.81 1 0.60 2 1.66 0 0.00 4 4.39 0.91 -0.06

Bile ducts, other biliary 1 1.91 1 0.60 2 1.57 1 0.86 5 4.62 1.08 0.06

Pancreas 5 1.55 11 1.10 10 1.33 5 0.77 31 27.25 1.14 0.54

Respiratory system 17 1.19 58 1.27 35 1.02 29 1.00 139 123.22 1.13 2.27

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 1.20 0.00 -0.17

Larynx 0 0.00 0 0.00 1 0.97 0 0.00 1 3.74 0.27 -0.39

Lung, bronchus 17 1.24 58 1.33* 34 1.04 29 1.04 138 117.98 1.17 2.88

Female breast 27 0.88 77 0.80 75 1.09 48 0.86 227 251.28 0.90 -3.50

Female genital system 18 1.29 42 0.99 28 0.96 17 0.75 105 107.91 0.97 -0.42

Cervix uteri 1 0.61 8 1.69 4 1.35 3 1.49 16 11.33 1.41 0.67

Corpus uteri 11 1.55 26 1.20 16 1.08 10 0.88 63 54.97 1.15 1.16

Ovary 4 0.99 6 0.48 6 0.68 4 0.57 20 32.28 0.62* -1.77

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 1.68 0.00 -0.24

Vulva 1 1.65 1 0.53 2 1.40 0 0.00 4 5.19 0.77 -0.17

Urinary system 37 7.26* 56 3.51* 26 2.19* 27 2.64* 146 43.19 3.38* 14.80

Urinary bladder 22 7.39* 27 2.90* 5 0.72 10 1.66 64 25.31 2.53* 5.57

Kidney parenchyma 13 7.65* 27 5.05* 20 5.04* 17 5.04* 77 14.38 5.35* 9.01

Renal pelvis, other urinary 2 4.77 2 1.54 1 1.04 0 0.00 5 3.50 1.43 0.22

Ureter 2 15.67* 1 2.53 0 0.00 0 0.00 3 1.06 2.82 0.28

Bone, joints 0 0.00 0 0.00 0 0.00 1 5.88 1 0.79 1.27 0.03

Soft tissue including heart 0 0.00 2 1.51 2 2.08 2 2.46 6 3.52 1.70 0.36

Kaposi sarcoma 0 0.00 1 8.32 0 0.00 0 0.00 1 0.34 2.98 0.10

Melanoma of skin 7 3.37* 10 1.52 6 1.25 2 0.51 25 17.39 1.44 1.10

Eye, orbit 0 0.00 0 0.00 1 2.98 0 0.00 1 1.24 0.81 -0.03

Brain, central nervous system 2 1.80 4 1.16 1 0.41 2 1.03 9 8.95 1.01 0.01

Thyroid 10 10.05* 9 2.96* 2 0.98 2 1.33 23 7.59 3.03* 2.22

Lymphatic, hematopoietic 15 1.85* 32 1.26 25 1.32 23 1.41 95 68.69 1.38* 3.79

Hodgkin lymphoma 0 0.00 2 2.58 0 0.00 0 0.00 2 1.96 1.02 0.01

Non-Hodgkin lymphoma 10 2.58* 11 0.89 13 1.41 13 1.62 47 33.45 1.40* 1.95

Myeloma 5 3.45* 5 1.11 3 0.90 3 1.07 16 12.10 1.32 0.56

Leukemia 0 0.00 14 1.79 9 1.55 7 1.40 30 21.18 1.42 1.27

Acute lymphocytic 0 0.00 0 0.00 1 5.91 1 7.12 2 0.62 3.24 0.20

Chronic lymphocytic 0 0.00 4 1.32 2 0.89 4 2.09 10 8.18 1.22 0.26

Acute non-lymphocytic 0 0.00 5 1.79 2 0.96 1 0.55 8 7.57 1.06 0.06

Chronic myeloid 0 0.00 4 3.71 2 2.51 0 0.00 6 2.91 2.06 0.44

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 13,624 9,824 5,159 2,523 13,624

Person-years in interval 9,293 27,970 18,577 13,640 69,480

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE URINARY TRACT 301
All subsequent cancers 403 1.52* 919 1.08* 683 1.09* 550 1.06 2,555 2,261.20 1.13* 25.34

All excluding same site 358 1.38* 863 1.04 641 1.05 509 1.00 2,371 2,211.38 1.07* 13.77

Buccal cavity, pharynx 9 1.05 12 0.46* 14 0.79 8 0.61 43 65.42 0.66* -1.93

Lip 1 0.68 2 0.45 5 1.65 6 2.68 14 11.19 1.25 0.24

Tongue 3 1.80 1 0.19 1 0.29 0 0.00 5 12.88 0.39* -0.68

Salivary gland 0 0.00 1 0.49 1 0.67 1 0.79 3 5.45 0.55 -0.21

Mouth 5 2.45 3 0.48 4 0.97 1 0.34 13 15.30 0.85 -0.20

Nasopharynx 0 0.00 1 0.97 0 0.00 0 0.00 1 2.50 0.40 -0.13

Tonsil 0 0.00 1 0.38 2 1.17 0 0.00 3 6.37 0.47 -0.29

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.95 0.00 -0.17

Hypopharynx 0 0.00 1 0.34 1 0.50 0 0.00 2 7.36 0.27* -0.46

Digestive system 49 0.86 165 0.91 157 1.20* 113 1.06 484 473.88 1.02 0.87

Esophagus 4 1.07 10 0.85 6 0.71 3 0.44 23 30.83 0.75 -0.68

Stomach 4 0.60 16 0.78 14 0.96 15 1.29 49 53.40 0.92 -0.38

Small intestine 3 3.74 3 1.16 1 0.53 2 1.24 9 6.90 1.30 0.18

Colon 20 0.84 79 1.03 78 1.39* 47 1.01 224 202.78 1.10 1.83

Rectum, rectosigmoid junction 9 0.86 27 0.82 28 1.21 14 0.77 78 84.68 0.92 -0.58

Anus, anal canal 0 0.00 2 1.56 3 3.31 0 0.00 5 3.32 1.51 0.15

Liver 3 1.25 4 0.52 7 1.26 3 0.64 17 20.31 0.84 -0.29

Gallbladder 0 0.00 2 1.38 1 0.96 2 2.33 5 3.82 1.31 0.10

Bile ducts, other biliary 1 0.85 5 1.31 1 0.34 3 1.16 10 10.48 0.95 -0.04

Pancreas 5 0.77 15 0.73 17 1.16 24 2.00* 61 53.76 1.13 0.62

Respiratory system 36 0.68* 134 0.80* 111 0.94 92 0.98 373 432.75 0.86* -5.15

Nose, nasal cavity, ear 0 0.00 4 3.08 1 1.11 0 0.00 5 3.34 1.50 0.14

Larynx 1 0.23 9 0.66 8 0.87 5 0.74 23 33.90 0.68 -0.94

Lung, bronchus 35 0.73 121 0.80* 102 0.94 87 1.01 345 394.49 0.87* -4.27

Male breast 3 5.90* 2 1.23 1 0.85 1 1.02 7 4.28 1.63 0.23

Male genital system 154 1.91* 313 1.17* 213 1.05 189 1.06 869 730.19 1.19* 11.97

Prostate 152 1.91* 312 1.18* 212 1.05 187 1.06 863 723.04 1.19* 12.07

Testis 1 2.29 1 0.81 1 1.49 1 2.70 4 2.71 1.48 0.11

Urinary system 108 4.22* 165 2.01* 92 1.52* 75 1.47* 440 219.42 2.01* 19.03

Urinary bladder 60 3.30* 99 1.69* 47 1.08 32 0.86 238 157.64 1.51* 6.93

Kidney parenchyma 45 7.58* 56 2.95* 42 3.07* 41 3.66* 184 49.81 3.69* 11.58

Renal pelvis, other urinary 3 2.08 10 2.19* 3 0.91 2 0.75 18 11.97 1.50 0.52

Ureter 2 4.10 5 3.24* 3 2.69 0 0.00 10 4.04 2.48* 0.51

Bone, joints 1 4.31 0 0.00 0 0.00 1 2.72 2 1.80 1.11 0.02

Soft tissue including heart 3 2.90 4 1.22 3 1.28 1 0.51 11 8.63 1.27 0.20

Kaposi sarcoma 0 0.00 1 0.59 1 0.97 0 0.00 2 3.98 0.50 -0.17

Melanoma of skin 9 1.41 27 1.29 23 1.48 12 0.90 71 56.13 1.26 1.28

Eye, orbit 0 0.00 1 0.82 0 0.00 1 1.49 2 3.13 0.64 -0.10

Brain, central nervous system 4 1.43 5 0.57 6 0.99 6 1.27 21 22.27 0.94 -0.11

Thyroid 5 5.07* 8 2.64* 6 2.95* 3 1.95 22 7.60 2.89* 1.24

Lymphatic, hematopoietic 19 0.98 70 1.12 39 0.86 38 1.00 166 165.34 1.00 0.06

Hodgkin lymphoma 0 0.00 2 0.96 2 1.49 1 1.05 5 5.08 0.98 -0.01

Non-Hodgkin lymphoma 6 0.71 24 0.88 13 0.65 18 1.06 61 72.68 0.84 -1.01

Myeloma 7 2.13 12 1.13 11 1.42 5 0.76 35 28.20 1.24 0.59

Leukemia 6 0.85 32 1.43 13 0.79 14 1.03 65 59.38 1.09 0.48

Acute lymphocytic 0 0.00 1 1.63 0 0.00 1 3.04 2 1.57 1.27 0.04

Chronic lymphocytic 3 1.04 7 0.76 6 0.90 7 1.29 23 24.13 0.95 -0.10

Acute non-lymphocytic 3 1.31 11 1.49 4 0.74 3 0.65 21 19.67 1.07 0.11

Chronic myeloid 0 0.00 6 1.99 1 0.45 1 0.54 8 8.02 1.00 0.00

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 23,211 17,002 8,685 4,080 23,211

Person-years in interval 16,047 47,880 30,492 21,505 115,924

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Kidney Parenchyma

Males, ≥18 Years of Age

Table 11.2.5: Risk of subsequent primary cancers after cancer of the kidney parenchyma, males,

≥18 years of age, SEER 1973-2000.

302 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

KIDNEY PARENCHYMA

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Kidney Parenchyma

Both Sexes, 18-49 Years of Age

Table 11.2.6: Risk of subsequent primary cancers after cancer of the kidney parenchyma, both sexes,

18-49 years of age, SEER 1973-2000.

KIDNEY PARENCHYMA

All subsequent cancers 38 3.53* 84 1.84* 78 1.51* 133 1.32* 333 208.66 1.60* 30.24

All excluding same site 23 2.20* 59 1.33* 61 1.22 114 1.16 257 202.92 1.27* 13.15

Buccal cavity, pharynx 2 4.16 1 0.49 1 0.46 2 0.62 6 7.91 0.76 -0.46

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.73 0.00 -0.18

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 1.82 0.00 -0.44

Salivary gland 1 24.13 0 0.00 0 0.00 1 4.03 2 0.61 3.30 0.34

Mouth 1 8.60 0 0.00 0 0.00 0 0.00 1 1.97 0.51 -0.24

Nasopharynx 0 0.00 1 7.52 0 0.00 0 0.00 1 0.44 2.29 0.14

Tonsil 0 0.00 0 0.00 1 3.12 1 2.43 2 1.11 1.80 0.22

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.76 0.00 -0.18

Digestive system 1 0.63 11 1.54 16 1.86* 21 1.20 49 34.90 1.40* 3.43

Esophagus 0 0.00 0 0.00 0 0.00 2 1.56 2 2.59 0.77 -0.14

Stomach 0 0.00 3 3.92 3 3.51 2 1.25 8 3.40 2.35* 1.12

Small intestine 0 0.00 1 5.33 0 0.00 0 0.00 1 0.80 1.24 0.05

Colon 0 0.00 1 0.40 6 1.90 8 1.15 15 13.17 1.14 0.44

Rectum, rectosigmoid junction 0 0.00 3 2.10 2 1.14 4 1.17 9 6.91 1.30 0.51

Anus, anal canal 0 0.00 0 0.00 2 12.03* 0 0.00 2 0.63 3.18 0.33

Liver 1 10.04 2 4.66 1 2.16 1 1.16 5 1.86 2.69 0.76

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.07

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 2.77 1 0.68 1.47 0.08

Pancreas 0 0.00 0 0.00 2 1.96 3 1.43 5 4.12 1.21 0.21

Respiratory system 0 0.00 7 1.07 10 1.18 22 1.24 39 34.16 1.14 1.18

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.09

Larynx 0 0.00 0 0.00 0 0.00 1 0.68 1 3.21 0.31 -0.54

Lung, bronchus 0 0.00 7 1.22 10 1.34 21 1.31 38 30.45 1.25 1.84

Female breast 0 0.00 4 0.49 8 0.98 12 1.03 24 30.17 0.80 -4.02

Female genital system 0 0.00 4 1.26 1 0.32 3 0.65 8 11.75 0.68 -2.44

Cervix uteri 0 0.00 1 1.15 0 0.00 0 0.00 1 2.40 0.42 -0.91

Corpus uteri 0 0.00 3 2.62 1 0.74 2 0.86 6 5.09 1.18 0.59

Ovary 0 0.00 0 0.00 0 0.00 1 0.72 1 3.56 0.28 -1.67

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.08

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.23

Male genital system 5 7.92* 3 0.84 10 1.62 29 1.33 47 32.13 1.46* 5.77

Prostate 4 9.85* 2 0.70 9 1.57 28 1.31 43 30.46 1.41* 4.87

Testis 1 4.82 1 1.62 1 2.85 1 4.82 4 1.38 2.89 1.01

Urinary system 21 30.36* 37 12.06* 19 5.16* 25 3.30* 102 15.02 6.79* 21.15

Urinary bladder 6 16.88* 11 6.82* 2 0.98 6 1.29 25 8.65 2.89* 3.98

Kidney parenchyma 15 48.75* 25 18.78* 17 11.41* 19 7.29* 76 5.73 13.25* 17.09

Renal pelvis, other urinary 0 0.00 1 8.14 0 0.00 0 0.00 1 0.64 1.56 0.09

Ureter 0 0.00 1 39.80 0 0.00 0 0.00 1 0.17 5.88 0.20

Bone, joints 0 0.00 0 0.00 0 0.00 1 8.93 1 0.33 2.99 0.16

Soft tissue including heart 0 0.00 0 0.00 1 3.04 1 2.23 2 1.25 1.60 0.18

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.85 0.00 -0.45

Melanoma of skin 3 3.93 3 1.04 3 1.15 3 0.84 12 9.84 1.22 0.53

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.10

Brain, central nervous system 2 7.73 1 1.02 1 1.09 2 1.56 6 3.44 1.75 0.62

Thyroid 4 12.95* 5 4.56* 2 2.26 2 2.11 13 3.24 4.01* 2.37

Lymphatic, hematopoietic 0 0.00 8 1.82 4 0.92 9 1.24 21 17.11 1.23 0.95

Hodgkin lymphoma 0 0.00 1 2.16 0 0.00 1 3.08 2 1.26 1.58 0.18

Non-Hodgkin lymphoma 0 0.00 2 0.85 1 0.44 5 1.36 8 8.89 0.90 -0.22

Myeloma 0 0.00 2 4.35 2 3.51 0 0.00 4 2.27 1.76 0.42

Leukemia 0 0.00 3 2.66 1 0.85 3 1.42 7 4.70 1.49 0.56

Acute lymphocytic 0 0.00 0 0.00 0 0.00 1 11.41 1 0.26 3.78 0.18

Chronic lymphocytic 0 0.00 0 0.00 1 2.41 2 2.37 3 1.64 1.83 0.33

Acute non-lymphocytic 0 0.00 2 5.13 0 0.00 0 0.00 2 1.56 1.28 0.11

Chronic myeloid 0 0.00 1 4.79 0 0.00 0 0.00 1 0.75 1.33 0.06

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,155 4,970 2,911 1,620 6,155

Person-years in interval 4,529 15,066 11,078 10,448 41,121

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 15,346 PYR and for male cancers on 25,775 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE URINARY TRACT 303
All subsequent cancers 263 1.60* 696 1.15* 590 1.09* 536 1.02 2,085 1,832.73 1.14* 24.35

All excluding same site 235 1.47* 653 1.11* 549 1.03 497 0.97 1,934 1,793.45 1.08* 13.57

Buccal cavity, pharynx 6 1.04 8 0.42* 13 0.90 7 0.62 34 50.74 0.67* -1.62

Lip 0 0.00 1 0.41 3 1.48 6 3.35* 10 6.98 1.43 0.29

Tongue 3 2.51 0 0.00* 2 0.67 0 0.00 5 10.45 0.48 -0.53

Salivary gland 0 0.00 0 0.00 3 2.66 0 0.00 3 3.93 0.76 -0.09

Mouth 2 1.33 3 0.61 3 0.82 1 0.35 9 12.93 0.70 -0.38

Nasopharynx 1 3.86 1 1.23 0 0.00 0 0.00 2 2.01 0.99 0.00

Tonsil 0 0.00 1 0.48 1 0.70 0 0.00 2 5.11 0.39 -0.30

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.60 0.00 -0.15

Hypopharynx 0 0.00 1 0.45 1 0.60 0 0.00 2 5.77 0.35 -0.36

Digestive system 33 1.01 107 0.90 113 1.04 111 1.01 364 370.26 0.98 -0.60

Esophagus 1 0.44 6 0.76 5 0.75 2 0.33 14 22.82 0.61 -0.85

Stomach 1 0.30 7 0.58 13 1.22 14 1.30 35 36.71 0.95 -0.16

Small intestine 3 5.79* 2 1.06 1 0.60 2 1.20 8 5.76 1.39 0.22

Colon 14 1.06 52 1.05 47 1.00 50 0.99 163 160.09 1.02 0.28

Rectum, rectosigmoid junction 5 0.78 16 0.70 25 1.27 15 0.83 61 66.83 0.91 -0.56

Anus, anal canal 1 2.79 2 1.59 1 0.97 1 1.10 5 3.56 1.40 0.14

Liver 2 1.47 3 0.61 4 0.93 2 0.47 11 14.79 0.74 -0.37

Gallbladder 1 3.02 1 0.81 2 1.69 1 0.79 5 4.02 1.24 0.09

Bile ducts, other biliary 0 0.00 3 1.30 2 0.90 3 1.15 8 7.74 1.03 0.02

Pancreas 4 1.02 14 0.97 12 0.92 21 1.59 51 44.52 1.15 0.63

Respiratory system 34 1.02 116 0.97 100 0.97 88 0.95 338 348.94 0.97 -1.06

Nose, nasal cavity, ear 0 0.00 3 3.30 1 1.35 0 0.00 4 2.61 1.53 0.13

Larynx 1 0.35 6 0.62 5 0.68 4 0.72 16 25.39 0.63 -0.91

Lung, bronchus 33 1.10 107 0.98 94 0.99 84 0.98 318 320.15 0.99 -0.21

Female breast 13 0.90 51 1.03 42 1.03 29 0.80 135 141.43 0.95 -1.77

Female genital system 13 1.88* 17 0.74 16 0.89 12 0.80 58 62.97 0.92 -1.37

Cervix uteri 0 0.00 1 0.41 1 0.61 2 1.73 4 6.03 0.66 -0.56

Corpus uteri 10 2.63* 13 1.03 11 1.12 7 0.90 41 34.11 1.20 1.89

Ovary 2 1.05 2 0.31 3 0.57 3 0.65 10 18.35 0.55 -2.29

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.85 0.00 -0.23

Vulva 1 5.24 1 1.41 1 1.48 0 0.00 3 2.38 1.26 0.17

Male genital system 63 1.88* 197 1.44* 145 1.07 134 0.98 539 443.15 1.22* 14.26

Prostate 62 1.88* 197 1.46* 145 1.07 133 0.97 537 439.61 1.22* 14.49

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 1.08 0.00 -0.16

Urinary system 56 4.30* 98 2.03* 73 1.65* 76 1.70* 303 150.20 2.02* 14.75

Urinary bladder 27 3.19* 51 1.60* 31 1.02 35 1.11 144 102.27 1.41* 4.03

Kidney parenchyma 28 7.32* 43 3.18* 41 3.57* 39 3.74* 151 39.28 3.84* 10.78

Renal pelvis, other urinary 1 1.36 4 1.45 1 0.39 2 0.78 8 8.65 0.93 -0.06

Ureter 1 4.22 2 2.21 1 1.16 0 0.00 4 2.86 1.40 0.11

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 1.49 0.00 -0.14

Soft tissue including heart 1 1.56 4 1.80 3 1.59 2 1.05 10 6.65 1.50 0.32

Kaposi sarcoma 0 0.00 2 3.57 0 0.00 0 0.00 2 1.45 1.38 0.05

Melanoma of skin 10 2.37* 25 1.70* 18 1.46 10 0.86 63 42.88 1.47* 1.94

Eye, orbit 0 0.00 1 1.09 1 1.34 1 1.51 3 2.59 1.16 0.04

Brain, central nervous system 2 0.99 5 0.73 5 0.91 6 1.27 18 19.12 0.94 -0.11

Thyroid 10 9.51* 10 2.96* 5 2.05 3 1.63 28 8.72 3.21* 1.86

Lymphatic, hematopoietic 17 1.50 44 1.06 39 1.04 45 1.17 145 129.14 1.12 1.53

Hodgkin lymphoma 0 0.00 3 2.04 1 0.91 0 0.00 4 3.92 1.02 0.01

Non-Hodgkin lymphoma 11 2.09* 16 0.84 14 0.81 22 1.24 63 59.57 1.06 0.33

Myeloma 3 1.53 6 0.83 7 1.06 7 1.03 23 22.62 1.02 0.04

Leukemia 3 0.81 19 1.39 17 1.35 16 1.22 55 43.02 1.28 1.16

Acute lymphocytic 0 0.00 1 2.47 1 2.95 1 3.24 3 1.17 2.56 0.18

Chronic lymphocytic 1 0.64 4 0.69 6 1.14 9 1.72 20 17.82 1.12 0.21

Acute non-lymphocytic 2 1.71 5 1.13 5 1.18 4 0.87 16 14.46 1.11 0.15

Chronic myeloid 0 0.00 5 2.81 3 1.84 1 0.57 9 5.67 1.59 0.32

Kidney Parenchyma

Both Sexes, 50-69 Years of Age

Table 11.2.7: Risk of subsequent primary cancers after cancer of the kidney parenchyma, both sexes,

50-69 years of age, SEER 1973-2000.

304 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

KIDNEY PARENCHYMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 18,845 14,065 7,726 3,958 18,845

Person-years in interval 13,191 40,896 28,301 21,211 103,600

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 36,393 PYR and for male cancers on 67,207 PYR.
Kidney Parenchyma

Both Sexes, ≥70 Years of Age

Table 11.2.8: Risk of subsequent primary cancers after cancer of the kidney parenchyma, both sexes,

≥70 years of age, SEER 1973-2000.

KIDNEY PARENCHYMA

All subsequent cancers 267 1.35* 508 0.95 292 1.07 85 0.88 1,152 1,104.41 1.04 11.70

All excluding same site 252 1.30* 493 0.93 288 1.07 85 0.89 1,118 1,085.22 1.03 8.06

Buccal cavity, pharynx 3 0.71 8 0.73 5 0.96 1 0.55 17 22.18 0.77 -1.27

Lip 1 1.20 1 0.45 2 1.81 1 2.52 5 4.54 1.10 0.11

Tongue 0 0.00 3 1.49 0 0.00 0 0.00 3 4.02 0.75 -0.25

Salivary gland 0 0.00 2 1.64 0 0.00 0 0.00 2 2.63 0.76 -0.15

Mouth 2 1.85 0 0.00 3 2.21 0 0.00 5 5.73 0.87 -0.18

Nasopharynx 0 0.00 1 3.04 0 0.00 0 0.00 1 0.65 1.53 0.08

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 1.46 0.00 -0.36

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.12

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.87 0.00 -0.46

Digestive system 43 0.91 109 0.84 91 1.31* 25 0.94 268 272.98 0.98 -1.22

Esophagus 4 1.94 4 0.72 1 0.37 0 0.00 9 11.23 0.80 -0.55

Stomach 7 1.39 8 0.59 3 0.41 4 1.41 22 28.74 0.77 -1.66

Small intestine 1 1.68 1 0.61 2 2.34 1 3.16 5 3.40 1.47 0.39

Colon 17 0.76 60 0.97 56 1.64* 10 0.75 143 131.95 1.08 2.72

Rectum, rectosigmoid junction 6 0.78 17 0.83 10 0.97 4 1.10 37 42.07 0.88 -1.25

Anus, anal canal 0 0.00 1 1.12 1 2.18 0 0.00 2 1.87 1.07 0.03

Liver 0 0.00 0 0.00* 2 0.98 0 0.00 2 8.25 0.24* -1.54

Gallbladder 0 0.00 2 1.09 1 1.01 1 2.51 4 3.89 1.03 0.03

Bile ducts, other biliary 2 1.89 3 0.98 1 0.56 0 0.00 6 6.68 0.90 -0.17

Pancreas 6 1.07 12 0.78 13 1.59 5 1.58 36 32.36 1.11 0.89

Respiratory system 19 0.58* 69 0.80 36 0.88 11 0.87 135 172.87 0.78* -9.31

Nose, nasal cavity, ear 0 0.00 1 1.35 0 0.00 0 0.00 1 1.55 0.65 -0.13

Larynx 0 0.00 3 0.64 4 2.02 0 0.00 7 9.03 0.78 -0.50

Lung, bronchus 19 0.62* 65 0.80 32 0.83 11 0.92 127 161.86 0.78* -8.57

Female breast 14 0.98 22 0.58* 25 1.27 7 0.93 68 79.68 0.85 -6.59

Female genital system 5 0.81 21 1.31 11 1.38 2 0.67 39 33.19 1.17 3.27

Cervix uteri 1 1.75 6 4.23* 3 4.46 1 4.12 11 2.91 3.79* 4.56

Corpus uteri 1 0.33 10 1.28 4 1.09 1 0.80 16 15.78 1.01 0.12

Ovary 2 1.06 4 0.81 3 1.18 0 0.00 9 10.37 0.87 -0.77

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.71 0.00 -0.40

Vulva 0 0.00 0 0.00 1 1.52 0 0.00 1 2.46 0.41 -0.82

Male genital system 86 1.84* 113 0.88 58 0.95 26 1.35 283 254.90 1.11 12.25

Prostate 86 1.86* 113 0.89 58 0.95 26 1.37 283 252.97 1.12 13.09

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.10

Urinary system 68 4.01* 86 1.83* 26 1.06 1 0.11* 181 97.39 1.86* 20.55

Urinary bladder 49 3.97* 64 1.85* 19 1.03 1 0.15* 133 72.03 1.85* 14.99

Kidney parenchyma 15 4.28* 15 1.59 4 0.86 0 0.00 34 19.19 1.77* 3.64

Renal pelvis, other urinary 4 3.63 7 2.34 3 1.96 0 0.00 14 6.18 2.27* 1.92

Ureter 3 8.05* 3 2.98 2 3.92 0 0.00 8 2.07 3.87* 1.46

Bone, joints 1 7.08 0 0.00 0 0.00 1 14.87 2 0.76 2.63 0.30

Soft tissue including heart 2 2.77 2 1.00 1 0.91 0 0.00 5 4.26 1.17 0.18

Kaposi sarcoma 0 0.00 0 0.00 1 3.72 0 0.00 1 1.01 0.99 0.00

Melanoma of skin 3 0.86 9 0.91 8 1.50 1 0.48 21 20.79 1.01 0.05

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 1.38 0.00 -0.34

Brain, central nervous system 2 1.24 3 0.70 1 0.48 0 0.00 6 8.67 0.69 -0.66

Thyroid 1 1.61 2 1.25 1 1.33 0 0.00 4 3.23 1.24 0.19

Lymphatic, hematopoietic 17 1.13 50 1.20 21 0.94 7 0.83 95 87.78 1.08 1.77

Hodgkin lymphoma 0 0.00 0 0.00 1 2.29 0 0.00 1 1.85 0.54 -0.21

Non-Hodgkin lymphoma 5 0.78 17 0.95 11 1.14 4 1.11 37 37.68 0.98 -0.17

Myeloma 9 3.35* 9 1.21 5 1.28 1 0.71 24 15.41 1.56 2.11

Leukemia 3 0.54 24 1.55 4 0.48 2 0.60 33 32.85 1.00 0.04

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.75 0.00 -0.19

Chronic lymphocytic 2 0.90 7 1.15 1 0.31 0 0.00 10 12.85 0.78 -0.70

Acute non-lymphocytic 1 0.52 9 1.69 1 0.35 0 0.00 11 11.22 0.98 -0.06

Chronic myeloid 0 0.00 4 1.90 0 0.00 0 0.00 4 4.51 0.89 -0.12

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 11,835 7,791 3,207 1,025 11,835

Person-years in interval 7,619 19,887 9,691 3,485 40,683

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 17,741 PYR and for male cancers on 22,942 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE URINARY TRACT 305
All subsequent cancers 481 1.44* 1,144 1.05 879 1.09* 708 1.06 3,212 2,890.10 1.11* 18.76

All excluding same site 427 1.31* 1,065 1.00 819 1.04 656 1.01 2,967 2,830.88 1.05* 7.93

Buccal cavity, pharynx 10 1.06 15 0.51* 19 0.94 9 0.59 53 74.44 0.71* -1.25

Lip 1 0.70 2 0.45 5 1.64 6 2.61 14 11.19 1.25 0.16

Tongue 2 1.06 2 0.34 2 0.49 0 0.00 6 15.04 0.40* -0.53

Salivary gland 1 1.32 2 0.81 3 1.65 1 0.65 7 6.57 1.06 0.02

Mouth 5 2.05 2 0.26* 6 1.16 1 0.26 14 19.02 0.74 -0.29

Nasopharynx 1 2.58 3 2.55 0 0.00 0 0.00 4 2.87 1.40 0.07

Tonsil 0 0.00 1 0.35 2 1.04 1 0.73 4 7.11 0.56 -0.18

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 2.16 0.00 -0.13

Hypopharynx 0 0.00 1 0.32 1 0.47 0 0.00 2 7.75 0.26* -0.34

Digestive system 72 0.99 206 0.88 195 1.13 150 1.06 623 620.40 1.00 0.15

Esophagus 5 1.26 9 0.70 6 0.65 4 0.53 24 33.68 0.71 -0.56

Stomach 7 0.93 18 0.75 17 0.98 18 1.29 60 62.76 0.96 -0.16

Small intestine 4 3.84* 3 0.88 2 0.78 2 0.92 11 9.18 1.20 0.11

Colon 30 0.94 99 0.95 97 1.25* 65 1.00 291 278.83 1.04 0.71

Rectum, rectosigmoid junction 10 0.78 34 0.83 33 1.12 22 0.95 99 106.17 0.93 -0.42

Anus, anal canal 1 1.51 1 0.47 4 2.59 1 0.80 7 5.59 1.25 0.08

Liver 3 1.14 5 0.58 6 0.95 3 0.56 17 22.88 0.74 -0.34

Gallbladder 1 1.12 3 1.06 2 0.97 2 1.19 8 7.49 1.07 0.03

Bile ducts, other biliary 2 1.33 6 1.20 2 0.52 4 1.16 14 13.82 1.01 0.01

Pancreas 9 1.04 25 0.90 24 1.17 29 1.70* 87 74.14 1.17 0.75

Respiratory system 41 0.68* 175 0.89 132 0.93 117 1.03 465 511.74 0.91* -2.72

Nose, nasal cavity, ear 0 0.00 4 2.50 1 0.87 0 0.00 5 4.17 1.20 0.05

Larynx 1 0.23 8 0.58 8 0.84 5 0.72 22 34.70 0.63* -0.74

Lung, bronchus 40 0.72* 163 0.91 123 0.94 112 1.06 438 471.65 0.93 -1.96

Female breast 25 0.90 71 0.80 70 1.08 43 0.83 209 233.15 0.90 -3.75

Female genital system 18 1.43 37 0.95 23 0.84 16 0.76 94 100.11 0.94 -0.95

Cervix uteri 1 0.68 7 1.61 3 1.09 3 1.60 14 10.46 1.34 0.55

Corpus uteri 11 1.70 24 1.20 16 1.15 10 0.94 61 51.14 1.19 1.53

Ovary 4 1.10 5 0.43 3 0.36 3 0.46 15 29.94 0.50* -2.32

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 1.54 0.00 -0.24

Vulva 1 1.87 0 0.00 1 0.75 0 0.00 2 4.76 0.42 -0.43

Male genital system 139 1.92* 293 1.20* 201 1.07 177 1.08 810 669.29 1.21* 13.13

Prostate 137 1.92* 292 1.21* 200 1.07 175 1.08 804 662.73 1.21* 13.18

Testis 1 2.48 1 0.88 1 1.60 1 2.91 4 2.51 1.59 0.14

Urinary system 100 3.64* 160 1.78* 107 1.59* 90 1.60* 457 240.89 1.90* 12.60

Urinary bladder 44 2.33* 74 1.19 43 0.92 37 0.93 198 167.52 1.18* 1.78

Kidney parenchyma 54 7.82* 79 3.53* 60 3.65* 52 3.85* 245 59.22 4.14* 10.83

Renal pelvis, other urinary 2 1.20 7 1.31 4 1.02 1 0.31 14 14.15 0.99 -0.01

Ureter 1 1.82 5 2.83 3 2.31 0 0.00 9 4.67 1.93 0.25

Bone, joints 1 3.35 0 0.00 0 0.00 2 4.01 3 2.38 1.26 0.04

Soft tissue including heart 3 2.29 6 1.42 3 0.98 3 1.16 15 11.17 1.34 0.22

Kaposi sarcoma 0 0.00 2 1.19 1 0.95 0 0.00 3 3.98 0.75 -0.06

Melanoma of skin 14 1.82 34 1.34 29 1.53* 14 0.87 91 68.08 1.34* 1.34

Eye, orbit 0 0.00 1 0.64 0 0.00 1 1.15 2 4.03 0.50 -0.12

Brain, central nervous system 5 1.41 8 0.71 7 0.88 8 1.30 28 28.87 0.97 -0.05

Thyroid 15 8.31* 16 2.84* 8 2.10 4 1.41 43 14.09 3.05* 1.69

Lymphatic, hematopoietic 32 1.30 98 1.22 61 1.02 58 1.16 249 214.84 1.16* 1.99

Hodgkin lymphoma 0 0.00 4 1.52 2 1.15 1 0.80 7 6.48 1.08 0.03

Non-Hodgkin lymphoma 15 1.36 33 0.91 25 0.92 29 1.25 102 97.76 1.04 0.25

Myeloma 11 2.60* 16 1.16 12 1.17 8 0.93 47 36.93 1.27 0.59

Leukemia 6 0.71 45 1.63* 22 1.07 20 1.17 93 73.66 1.26* 1.13

Acute lymphocytic 0 0.00 1 1.29 1 1.79 2 4.62 4 2.01 1.99 0.12

Chronic lymphocytic 3 0.87 10 0.90 8 0.97 10 1.48 31 29.55 1.05 0.08

Acute non-lymphocytic 3 1.06 16 1.73 6 0.86 4 0.68 29 24.93 1.16 0.24

Chronic myeloid 0 0.00 10 2.69* 3 1.08 1 0.43 14 9.99 1.40 0.23

Kidney Parenchyma

Renal Cell Carcinoma, Both Sexes, ≥18 Years of Age

Table 11.2.9: Risk of subsequent primary cancers after renal cell carcinoma of the kidney parenchyma, both sexes,

≥18 years of age, SEER 1973-2000.

306 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

KIDNEY PARENCHYMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 32,992 24,626 12,859 6,158 32,992

Person-years in interval 23,064 70,144 45,712 32,626 171,546

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 64,390 PYR and for male cancers on 107,156 PYR.
Renal Pelvis and Ureter

RENAL PELVIS AND URETER

Both Sexes

Table 11.3.1: Characteristics of patients with an initial cancer of the renal pelvis or ureter, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 3,824 100.0 2,529 100.0 6,353 100.0

Initial treatment

Any radiation 375 9.8 257 10.2 632 9.9

With surgery 304 7.9 202 8.0 506 8.0

Without surgery 71 1.9 55 2.2 126 2.0

No radiation 3,449 90.2 2,272 89.8 5,721 90.1

With surgery 3,130 81.9 2,041 80.7 5,171 81.4

Without surgery 319 8.3 231 9.1 550 8.7

Race

White 3,448 90.2 2,264 89.5 5,712 89.9

Black 130 3.4 124 4.9 254 4.0

Other 238 6.2 136 5.4 374 5.9

Unknown 8 0.2 5 0.2 13 0.2

Age at 1st primary cancer diagnosis, years

< 30 16 0.4 8 0.3 24 0.4

30–49 286 7.5 103 4.1 389 6.1

50–69 1,771 46.3 918 36.3 2,689 42.3

70–79 1,214 31.7 892 35.3 2,106 33.1

> 80 537 14.0 608 24.0 1,145 18.0

Number of patients with one or more

primary cancers

One primary cancer only 2,707 70.8 1,981 78.3 4,688 73.8

1st and 2nd cancers 923 24.1 465 18.4 1,388 21.8

1st, 2nd, and 3rd cancers 174 4.6 70 2.8 244 3.8

1st, 2nd, 3rd, and additional cancers 20 0.5 13 0.5 33 0.5

Other statistics

Median age at 1st cancer diagnosis 68.8 — 72.6 — 70.4 —

Median year of 1st cancer diagnosis 1985.6 — 1987.0 — 1986.2 —

Median person-years at risk 3.9 — 3.2 — 3.6 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 97.5 — 97.3 — 97.4

1st, 2nd, and additional cancers — 96.6 — 96.2 — 96.5

1st cancer only — 1.9 — 2.4 — 2.0

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING CANCER OF THE URINARY TRACT 307

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 527 6.29* 826 3.00* 350 1.64* 277 1.35* 1,980 777.94 2.55* 315.73

All excluding same site 93 1.19 347 1.35* 258 1.30* 237 1.24* 935 725.01 1.29* 55.15

Buccal cavity, pharynx 4 1.78 8 1.11 1 0.19 6 1.34 19 19.12 0.99 -0.03

Lip 0 0.00 1 0.74 0 0.00 1 1.27 2 3.50 0.57 -0.39

Tongue 1 2.39 1 0.74 0 0.00 0 0.00 2 3.62 0.55 -0.42

Salivary gland 1 5.29 1 1.60 0 0.00 1 2.03 3 1.81 1.66 0.31

Mouth 1 1.71 4 2.14 0 0.00 2 1.77 7 4.91 1.43 0.55

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.69 0.00 -0.18

Tonsil 0 0.00 0 0.00 0 0.00 1 2.90 1 1.56 0.64 -0.15

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.13

Hypopharynx 1 4.46 1 1.38 1 1.96 1 2.40 4 1.88 2.13 0.56

Digestive system 17 0.84 88 1.34* 64 1.28 56 1.20 225 182.85 1.23* 11.07

Esophagus 1 1.10 3 1.01 4 1.76 3 1.36 11 8.35 1.32 0.70

Stomach 3 1.36 6 0.85 4 0.76 5 1.05 18 19.34 0.93 -0.35

Small intestine 0 0.00 2 2.53 0 0.00 0 0.00 2 2.29 0.87 -0.08

Colon 8 0.87 46 1.52* 44 1.88* 34 1.55* 132 84.88 1.56* 12.38

Rectum, rectosigmoid junction 0 0.00 13 1.14 4 0.47 6 0.81 23 30.87 0.74 -2.07

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 1.41 0.00 -0.37

Liver 2 3.17 0 0.00 1 0.62 1 0.60 4 5.96 0.67 -0.52

Gallbladder 0 0.00 2 2.15 2 2.95 1 1.69 5 2.49 2.01 0.66

Bile ducts, other biliary 0 0.00 2 1.42 0 0.00 2 1.68 4 4.15 0.96 -0.04

Pancreas 2 0.84 10 1.30 5 0.85 3 0.55 20 21.46 0.93 -0.38

Respiratory system 26 1.78* 95 1.98* 78 2.15* 71 2.12* 270 132.47 2.04* 36.12

Nose, nasal cavity, ear 0 0.00 0 0.00 1 3.21 1 3.48 2 1.14 1.76 0.23

Larynx 0 0.00 5 1.55 3 1.30 3 1.54 11 8.48 1.30 0.66

Lung, bronchus 26 1.93* 90 2.03* 74 2.21* 66 2.11* 256 122.52 2.09* 35.06

Female breast 6 0.89 27 1.29 20 1.31 20 1.41 73 57.10 1.28* 11.09

Female genital system 3 0.96 10 1.05 8 1.22 6 1.04 27 24.98 1.08 1.41

Cervix uteri 0 0.00 1 1.03 0 0.00 0 0.00 1 2.41 0.42 -0.98

Corpus uteri 2 1.25 4 0.83 4 1.22 5 1.77 15 12.51 1.20 1.74

Ovary 1 1.10 4 1.44 3 1.50 1 0.55 9 7.51 1.20 1.04

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.31

Vulva 0 0.00 1 1.93 0 0.00 0 0.00 1 1.47 0.68 -0.33

Male genital system 26 1.52 74 1.26 47 0.96 50 0.99 197 175.09 1.13 9.23

Prostate 25 1.48 73 1.25 45 0.93 50 1.00 193 173.49 1.11 8.22

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.18

Urinary system 434 60.99* 485 20.48* 95 5.11* 41 2.27* 1,055 67.47 15.64* 259.38

Urinary bladder 411 80.76* 439 25.80* 85 6.33* 30 2.29* 965 48.65 19.83* 240.68

Kidney parenchyma 0 0.00 6 1.18 3 0.75 1 0.26 10 14.54 0.69 -1.19

Renal pelvis, other urinary 23 47.79* 40 25.71* 7 6.01* 10 9.37* 80 4.27 18.73* 19.89

Ureter 12 73.32* 18 33.91* 5 12.51* 4 11.15* 39 1.45 26.85* 9.86

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.16

Soft tissue including heart 0 0.00 0 0.00 1 1.26 1 1.25 2 2.93 0.68 -0.25

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.84 0.00 -0.22

Melanoma of skin 1 0.64 6 1.14 4 0.92 5 1.06 16 15.90 1.01 0.03

Eye, orbit 0 0.00 1 2.51 0 0.00 1 3.73 2 1.08 1.85 0.24

Brain, central nervous system 5 6.24* 5 1.92 2 1.03 0 0.00 12 7.16 1.68 1.27

Thyroid 0 0.00 2 1.77 0 0.00 1 1.35 3 3.04 0.99 -0.01

Lymphatic, hematopoietic 3 0.48 18 0.86 22 1.35 10 0.63 53 59.30 0.89 -1.65

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.60 0.00 -0.42

Non-Hodgkin lymphoma 1 0.37 9 1.01 8 1.13 3 0.41 21 25.91 0.81 -1.29

Myeloma 0 0.00 3 0.85 4 1.47 2 0.76 9 9.95 0.90 -0.25

Leukemia 2 0.85 6 0.77 10 1.67 5 0.88 23 21.84 1.05 0.31

Acute lymphocytic 0 0.00 0 0.00 0 0.00 1 7.17 1 0.56 1.79 0.12

Chronic lymphocytic 1 1.05 2 0.64 5 2.06 2 0.89 10 8.75 1.14 0.33

Acute non-lymphocytic 0 0.00 2 0.77 2 1.00 2 1.03 6 7.32 0.82 -0.35

Chronic myeloid 1 3.17 1 0.97 2 2.50 0 0.00 4 2.93 1.36 0.28

Renal Pelvis and Ureter

Both Sexes

Table 11.3.2: Risk of subsequent primary cancers after cancer of the renal pelvis or ureter, both sexes,

SEER 1973-2000.

308 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

RENAL PELVIS AND URETER

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,353 4,983 2,738 1,471 6,353

Person-years in interval 4,597 14,469 10,184 8,823 38,073

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 14,345 PYR and for male cancers on 23,728 PYR.
Renal Pelvis and Ureter

Females

Table 11.3.3: Risk of subsequent primary cancers after cancer of the renal pelvis or ureter, females,

SEER 1973-2000.

RENAL PELVIS AND URETER

All subsequent cancers 187 7.29* 276 3.46* 95 1.62* 87 1.59* 645 218.71 2.95* 297.16

All excluding same site 27 1.09 118 1.53* 78 1.38* 80 1.52* 303 210.73 1.44* 64.32

Buccal cavity, pharynx 2 4.41 4 2.86 0 0.00 0 0.00 6 3.76 1.60 1.56

Lip 0 0.00 1 9.12 0 0.00 0 0.00 1 0.31 3.25 0.48

Tongue 0 0.00 1 3.28 0 0.00 0 0.00 1 0.82 1.22 0.12

Salivary gland 1 19.93 0 0.00 0 0.00 0 0.00 1 0.43 2.33 0.40

Mouth 1 6.20 2 4.00 0 0.00 0 0.00 3 1.35 2.23 1.15

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.10

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.19

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.16

Digestive system 8 1.17 26 1.22 19 1.21 23 1.58* 76 58.24 1.31* 12.38

Esophagus 1 5.91 0 0.00 0 0.00 1 2.71 2 1.45 1.38 0.38

Stomach 0 0.00 4 2.26 2 1.57 2 1.78 8 4.75 1.69 2.27

Small intestine 0 0.00 1 3.92 0 0.00 0 0.00 1 0.73 1.37 0.19

Colon 3 0.87 10 0.93 15 1.87* 15 1.99* 43 29.80 1.44* 9.20

Rectum, rectosigmoid junction 0 0.00 6 1.84 1 0.43 2 0.99 9 8.63 1.04 0.26

Rectum 0 0.00 3 1.41 1 0.66 1 0.74 5 5.69 0.88 -0.48

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.67 0.00 -0.46

Liver 1 7.25 0 0.00 0 0.00 0 0.00 1 1.21 0.83 -0.14

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.35 0.00 -0.94

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 2.70 1 1.35 0.74 -0.25

Pancreas 2 2.28 4 1.46 1 0.49 1 0.51 8 7.60 1.05 0.28

Respiratory system 6 1.94 34 3.48* 21 2.86* 20 2.77* 81 27.42 2.95* 37.35

Nose, nasal cavity, ear 0 0.00 0 0.00 1 12.05 1 12.71 2 0.31 6.47 1.18

Larynx 0 0.00 0 0.00 1 4.99 1 5.64 2 0.76 2.63 0.86

Lung, bronchus 6 2.03 34 3.64* 19 2.70* 18 2.59* 77 26.28 2.93* 35.36

Female breast 6 0.89 27 1.29 20 1.31 20 1.41 73 57.10 1.28* 11.09

Female genital system 3 0.96 10 1.05 8 1.22 6 1.04 27 24.98 1.08 1.41

Cervix uteri 0 0.00 1 1.03 0 0.00 0 0.00 1 2.41 0.42 -0.98

Corpus uteri 2 1.25 4 0.83 4 1.22 5 1.77 15 12.51 1.20 1.74

Ovary 1 1.10 4 1.44 3 1.50 1 0.55 9 7.51 1.20 1.04

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.31

Vulva 0 0.00 1 1.93 0 0.00 0 0.00 1 1.47 0.68 -0.33

Urinary system 160 122.79* 159 39.08* 17 5.64* 7 2.41 343 11.29 30.37* 231.23

Urinary bladder 155 192.75* 151 59.95* 17 9.11* 4 2.23 327 6.99 46.81* 223.08

Kidney parenchyma 0 0.00 1 0.84 0 0.00 0 0.00 1 3.32 0.30 -1.62

Renal pelvis, other urinary 5 42.17* 7 19.27* 0 0.00 3 12.36* 15 0.99 15.21* 9.77

Ureter 5 131.04* 4 34.18* 0 0.00 3 39.55* 12 0.31 38.15* 8.15

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.13

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.86 0.00 -0.60

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.08

Melanoma of skin 0 0.00 1 0.76 3 2.99 3 2.97 7 3.75 1.87 2.26

Eye, orbit 0 0.00 1 8.49 0 0.00 1 13.56 2 0.31 6.42 1.18

Brain, central nervous system 1 4.05 1 1.31 1 1.80 0 0.00 3 2.07 1.45 0.65

Thyroid 0 0.00 2 3.66 0 0.00 0 0.00 2 1.44 1.39 0.39

Lymphatic, hematopoietic 0 0.00 9 1.39 4 0.83 2 0.43 15 18.07 0.83 -2.14

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.31

Non-Hodgkin lymphoma 0 0.00 6 1.99 3 1.31 0 0.00 9 8.52 1.06 0.33

Myeloma 0 0.00 2 1.78 0 0.00 0 0.00 2 3.09 0.65 -0.76

Leukemia 0 0.00 1 0.46 1 0.62 2 1.30 4 6.01 0.67 -1.40

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.11

Chronic lymphocytic 0 0.00 1 1.17 0 0.00 1 1.69 2 2.35 0.85 -0.24

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 1 1.86 1 2.08 0.48 -0.75

Chronic myeloid 0 0.00 0 0.00 1 4.58 0 0.00 1 0.82 1.22 0.13

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,529 1,941 1,016 548 2,529

Person-years in interval 1,807 5,468 3,778 3,292 14,345

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE URINARY TRACT 309
All subsequent cancers 340 5.85* 550 2.81* 255 1.64* 190 1.26* 1,335 559.23 2.39* 326.95

All excluding same site 66 1.24 229 1.27* 180 1.26* 157 1.14 632 514.28 1.23* 49.61

Buccal cavity, pharynx 2 1.12 4 0.69 1 0.24 6 1.68 13 15.37 0.85 -1.00

Lip 0 0.00 0 0.00 0 0.00 1 1.42 1 3.19 0.31 -0.92

Tongue 1 3.12 0 0.00 0 0.00 0 0.00 1 2.80 0.36 -0.76

Salivary gland 0 0.00 1 2.12 0 0.00 1 2.61 2 1.38 1.45 0.26

Mouth 0 0.00 2 1.46 0 0.00 2 2.50 4 3.56 1.12 0.19

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.23

Tonsil 0 0.00 0 0.00 0 0.00 1 3.48 1 1.28 0.78 -0.12

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.17

Hypopharynx 1 5.12 1 1.57 1 2.21 1 2.72 4 1.65 2.42 0.99

Digestive system 9 0.68 62 1.39* 45 1.30 33 1.02 149 124.61 1.20* 10.28

Esophagus 0 0.00 3 1.23 4 2.13 2 1.09 9 6.90 1.31 0.89

Stomach 3 1.85 2 0.38 2 0.50 3 0.82 10 14.59 0.69 -1.93

Small intestine 0 0.00 1 1.86 0 0.00 0 0.00 1 1.56 0.64 -0.24

Colon 5 0.87 36 1.85* 29 1.88* 19 1.32 89 55.08 1.62* 14.30

Rectum, rectosigmoid junction 0 0.00 7 0.85 3 0.49 4 0.74 14 22.24 0.63 -3.47

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.74 0.00 -0.31

Liver 1 2.03 0 0.00 1 0.78 1 0.74 3 4.76 0.63 -0.74

Gallbladder 0 0.00 2 4.82 2 6.37 1 3.50 5 1.14 4.39* 1.63

Bile ducts, other biliary 0 0.00 2 2.14 0 0.00 1 1.21 3 2.80 1.07 0.08

Pancreas 0 0.00 6 1.20 4 1.05 2 0.56 12 13.86 0.87 -0.78

Respiratory system 20 1.74* 61 1.59* 57 1.97* 51 1.94* 189 105.05 1.80* 35.38

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -0.35

Larynx 0 0.00 5 1.70 2 0.95 2 1.13 9 7.72 1.17 0.54

Lung, bronchus 20 1.90* 56 1.60* 55 2.07* 48 1.98* 179 96.24 1.86* 34.88

Male breast 0 0.00 1 2.80 0 0.00 0 0.00 1 1.02 0.98 -0.01

Male genital system 26 1.52 74 1.26 47 0.96 50 0.99 197 175.09 1.13 9.23

Prostate 25 1.48 73 1.25 45 0.93 50 1.00 193 173.49 1.11 8.22

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.18

Urinary system 274 47.14* 326 16.63* 78 5.01* 34 2.24* 712 56.17 12.67* 276.40

Urinary bladder 256 59.74* 288 19.86* 68 5.88* 26 2.30* 638 41.67 15.31* 251.32

Kidney parenchyma 0 0.00 5 1.28 3 0.97 1 0.33 9 11.22 0.80 -0.94

Renal pelvis, other urinary 18 49.63* 33 27.67* 7 7.75* 7 8.49* 65 3.28 19.79* 26.01

Ureter 7 55.77* 14 33.83* 5 15.82* 1 3.54 27 1.14 23.72* 10.90

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.18

Soft tissue including heart 0 0.00 0 0.00 1 1.77 1 1.74 2 2.07 0.96 -0.03

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.72 0.00 -0.30

Melanoma of skin 1 0.87 5 1.26 1 0.30 2 0.54 9 12.14 0.74 -1.33

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.77 0.00 -0.32

Brain, central nervous system 4 7.22* 4 2.17 1 0.72 0 0.00 9 5.09 1.77 1.65

Thyroid 0 0.00 0 0.00 0 0.00 1 2.47 1 1.60 0.62 -0.25

Lymphatic, hematopoietic 3 0.71 9 0.63 18 1.58 8 0.71 38 41.22 0.92 -1.36

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.15 0.00 -0.48

Non-Hodgkin lymphoma 1 0.58 3 0.51 5 1.04 3 0.60 12 17.39 0.69 -2.27

Myeloma 0 0.00 1 0.42 4 2.11 2 1.07 7 6.86 1.02 0.06

Leukemia 2 1.20 5 0.89 9 2.05 3 0.72 19 15.82 1.20 1.34

Acute lymphocytic 0 0.00 0 0.00 0 0.00 1 10.15 1 0.40 2.51 0.25

Chronic lymphocytic 1 1.48 1 0.44 5 2.80 1 0.61 8 6.40 1.25 0.68

Acute non-lymphocytic 0 0.00 2 1.09 2 1.38 1 0.71 5 5.23 0.96 -0.10

Chronic myeloid 1 4.52 1 1.35 1 1.72 0 0.00 3 2.11 1.42 0.37

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,824 3,042 1,722 923 3,824

Person-years in interval 2,790 9,000 6,406 5,531 23,728

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Renal Pelvis and Ureter

Males

Table 11.3.4: Risk of subsequent primary cancers after cancer of the renal pelvis or ureter, males,

SEER 1973-2000.

310 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

RENAL PELVIS AND URETER

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Renal Pelvis and Ureter

Both Sexes, <60 Years of Age

Table 11.3.5: Risk of subsequent primary cancers after cancer of the renal pelvis or ureter, both sexes,

<60 years of age, SEER 1973-2000.

RENAL PELVIS AND URETER

All subsequent cancers 83 14.73* 134 5.08* 83 2.39* 115 1.52* 415 142.27 2.92* 224.72

All excluding same site 11 2.06* 37 1.49* 56 1.71* 95 1.34* 199 133.87 1.49* 53.67

Buccal cavity, pharynx 0 0.00 2 1.74 0 0.00 2 1.03 4 4.61 0.87 -0.51

Lip 0 0.00 1 7.14 0 0.00 0 0.00 1 0.59 1.69 0.34

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.97 0.00 -0.80

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.27

Mouth 0 0.00 1 3.26 0 0.00 1 2.11 2 1.18 1.69 0.68

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.18

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.41

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.12

Hypopharynx 0 0.00 0 0.00 0 0.00 1 4.63 1 0.51 1.95 0.40

Digestive system 3 2.76 9 1.74 14 2.06* 22 1.50 48 27.73 1.73* 16.70

Esophagus 0 0.00 0 0.00 0 0.00 2 2.23 2 1.77 1.13 0.19

Stomach 1 8.35 0 0.00 1 1.44 2 1.38 4 2.82 1.42 0.97

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.37

Colon 2 4.87 9 4.49* 9 3.27* 15 2.39* 35 11.44 3.06* 19.41

Rectum, rectosigmoid junction 0 0.00 0 0.00 2 1.44 2 0.75 4 5.35 0.75 -1.12

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.25

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 1.21 0.00 -1.00

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.23

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.47

Pancreas 0 0.00 0 0.00 2 2.50 0 0.00 2 3.28 0.61 -1.05

Respiratory system 5 4.33* 8 1.46 18 2.53* 32 2.30* 63 27.64 2.28* 29.13

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.19

Larynx 0 0.00 0 0.00 2 3.19 2 2.08 4 2.25 1.78 1.44

Lung, bronchus 5 4.91* 8 1.64 16 2.50* 29 2.26* 58 25.09 2.31* 27.11

Female breast 0 0.00 2 0.72 4 1.27 9 1.65 15 12.08 1.24 7.59

Female genital system 0 0.00 1 0.72 2 1.38 3 1.32 6 5.46 1.10 1.40

Cervix uteri 0 0.00 1 5.08 0 0.00 0 0.00 1 0.63 1.59 0.96

Corpus uteri 0 0.00 0 0.00 1 1.28 2 1.64 3 2.92 1.03 0.20

Ovary 0 0.00 0 0.00 1 2.40 1 1.46 2 1.57 1.27 1.11

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.16

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.44

Male genital system 0 0.00 6 1.69 7 1.06 19 0.95 32 30.62 1.05 1.66

Prostate 0 0.00 6 1.75 7 1.08 19 0.96 32 30.17 1.06 2.20

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.30

Urinary system 72 161.35* 98 46.09* 28 9.85* 20 3.17* 218 11.73 18.58* 169.96

Urinary bladder 68 250.06* 88 66.27* 23 12.44* 14 3.24* 193 7.76 24.86* 152.63

Kidney parenchyma 0 0.00 1 1.46 1 1.19 0 0.00 2 3.33 0.60 -1.10

Renal pelvis, other urinary 4 164.84* 9 78.06* 4 25.96* 6 17.39* 23 0.64 36.01* 18.43

Ureter 1 149.37* 4 116.76* 3 60.01* 2 17.17* 10 0.21 48.21* 8.07

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.12

Soft tissue including heart 0 0.00 0 0.00 1 7.05 0 0.00 1 0.58 1.72 0.35

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.24

Melanoma of skin 0 0.00 2 2.15 1 0.95 3 1.51 6 4.18 1.44 1.50

Eye, orbit 0 0.00 1 18.59 0 0.00 0 0.00 1 0.23 4.33 0.63

Brain, central nervous system 3 29.73* 2 4.73 1 2.15 0 0.00 6 1.78 3.38* 3.48

Thyroid 0 0.00 1 3.87 0 0.00 1 2.64 2 0.96 2.08 0.86

Lymphatic, hematopoietic 0 0.00 1 0.50 4 1.61 3 0.56 8 10.30 0.78 -1.89

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.34

Non-Hodgkin lymphoma 0 0.00 1 1.04 2 1.68 0 0.00 3 4.95 0.61 -1.61

Myeloma 0 0.00 0 0.00 1 2.57 1 1.14 2 1.62 1.23 0.31

Leukemia 0 0.00 0 0.00 1 1.25 2 1.15 3 3.31 0.91 -0.25

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.09

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 2 2.83 2 1.36 1.47 0.53

Acute non-lymphocytic 0 0.00 0 0.00 1 3.96 0 0.00 1 1.10 0.91 -0.08

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.36

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,296 1,101 779 555 1,296

Person-years in interval 984 3,659 3,280 4,213 12,136

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 3,845 PYR and for male cancers on 8,291 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE URINARY TRACT 311
All subsequent cancers 444 5.68* 692 2.78* 267 1.49* 162 1.25* 1,565 635.67 2.46* 358.31

All excluding same site 82 1.13 310 1.34* 202 1.22* 142 1.18 736 591.15 1.25* 55.85

Buccal cavity, pharynx 4 2.02 6 0.99 1 0.25 4 1.58 15 14.51 1.03 0.19

Lip 0 0.00 0 0.00 0 0.00 1 1.92 1 2.90 0.34 -0.73

Tongue 1 2.74 1 0.90 0 0.00 0 0.00 2 2.65 0.76 -0.25

Salivary gland 1 5.79 1 1.80 0 0.00 1 3.03 3 1.47 2.04 0.59

Mouth 1 1.94 3 1.92 0 0.00 1 1.53 5 3.73 1.34 0.49

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.18

Tonsil 0 0.00 0 0.00 0 0.00 1 6.56 1 1.06 0.94 -0.02

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.14

Hypopharynx 1 5.08 1 1.66 1 2.73 0 0.00 3 1.36 2.20 0.63

Digestive system 14 0.73 79 1.30* 50 1.15 34 1.06 177 155.11 1.14 8.44

Esophagus 1 1.20 3 1.15 4 2.19 1 0.76 9 6.58 1.37 0.93

Stomach 2 0.96 6 0.92 3 0.65 3 0.90 14 16.52 0.85 -0.97

Small intestine 0 0.00 2 2.84 0 0.00 0 0.00 2 1.84 1.08 0.06

Colon 6 0.68 37 1.31 35 1.69* 19 1.21 97 73.44 1.32* 9.08

Rectum, rectosigmoid junction 0 0.00 13 1.26 2 0.28 4 0.83 19 25.52 0.74 -2.51

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 1.10 0.00 -0.42

Liver 2 3.42 0 0.00 1 0.75 1 1.01 4 4.76 0.84 -0.29

Gallbladder 0 0.00 2 2.26 2 3.27 1 2.29 5 2.22 2.26 1.07

Bile ducts, other biliary 0 0.00 2 1.53 0 0.00 2 2.33 4 3.58 1.12 0.16

Pancreas 2 0.89 10 1.41 3 0.59 3 0.80 18 18.18 0.99 -0.07

Respiratory system 21 1.56 87 2.04* 60 2.06* 39 1.98* 207 104.83 1.97* 39.39

Nose, nasal cavity, ear 0 0.00 0 0.00 1 3.98 1 5.47 2 0.91 2.20 0.42

Larynx 0 0.00 5 1.87 1 0.59 1 1.01 7 6.23 1.12 0.30

Lung, bronchus 21 1.69* 82 2.08* 58 2.14* 37 2.01* 198 97.42 2.03* 38.78

Female breast 6 0.99 25 1.38 16 1.32 11 1.26 58 45.01 1.29 12.37

Female genital system 3 1.08 9 1.11 6 1.17 3 0.85 21 19.52 1.08 1.41

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 1.78 0.00 -1.69

Corpus uteri 2 1.41 4 0.98 3 1.20 3 1.86 12 9.58 1.25 2.30

Ovary 1 1.23 4 1.66 2 1.26 0 0.00 7 5.93 1.18 1.01

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.37

Vulva 0 0.00 1 2.06 0 0.00 0 0.00 1 1.30 0.77 -0.29

Male genital system 26 1.57* 68 1.23 40 0.95 31 1.02 165 144.47 1.14 13.30

Prostate 25 1.53 67 1.22 38 0.91 31 1.03 161 143.32 1.12 11.45

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.12

Urinary system 362 54.28* 387 17.96* 67 4.26* 21 1.78* 837 55.74 15.02* 301.22

Urinary bladder 343 71.20* 351 22.37* 62 5.35* 16 1.82* 772 40.89 18.88* 281.88

Kidney parenchyma 0 0.00 5 1.13 2 0.64 1 0.44 8 11.21 0.71 -1.24

Renal pelvis, other urinary 19 41.58* 31 21.52* 3 2.97 4 5.54* 57 3.63 15.70* 20.58

Ureter 11 70.08* 14 28.19* 2 5.72 2 8.26 29 1.25 23.29* 10.70

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.47 0.00 -0.18

Soft tissue including heart 0 0.00 0 0.00 0 0.00 1 1.91 1 2.35 0.42 -0.52

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.21

Melanoma of skin 1 0.74 4 0.92 3 0.91 2 0.74 10 11.72 0.85 -0.66

Eye, orbit 0 0.00 0 0.00 0 0.00 1 6.17 1 0.85 1.18 0.06

Brain, central nervous system 2 2.86 3 1.37 1 0.67 0 0.00 6 5.39 1.11 0.24

Thyroid 0 0.00 1 1.15 0 0.00 0 0.00 1 2.08 0.48 -0.42

Lymphatic, hematopoietic 3 0.51 17 0.90 18 1.31 7 0.66 45 49.00 0.92 -1.54

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.18 0.00 -0.45

Non-Hodgkin lymphoma 1 0.41 8 1.01 6 1.02 3 0.64 18 20.96 0.86 -1.14

Myeloma 0 0.00 3 0.93 3 1.29 1 0.57 7 8.32 0.84 -0.51

Leukemia 2 0.90 6 0.84 9 1.73 3 0.76 20 18.53 1.08 0.57

Acute lymphocytic 0 0.00 0 0.00 0 0.00 1 11.13 1 0.45 2.23 0.21

Chronic lymphocytic 1 1.11 2 0.69 5 2.40 0 0.00 8 7.39 1.08 0.23

Acute non-lymphocytic 0 0.00 2 0.84 1 0.57 2 1.50 5 6.22 0.80 -0.47

Chronic myeloid 1 3.39 1 1.05 2 2.87 0 0.00 4 2.49 1.61 0.58

Renal Pelvis and Ureter

Both Sexes, ≥60 Years of Age

Table 11.3.6: Risk of subsequent primary cancers after cancer of the renal pelvis or ureter, both sexes,

≥60 years of age, SEER 1973-2000.

312 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

RENAL PELVIS AND URETER

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,057 3,882 1,959 916 5,057

Person-years in interval 3,614 10,809 6,904 4,610 25,937

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 10,501 PYR and for male cancers on 15,436 PYR.
NEW MALIGNANCIES FOLLOWING CANCER OF THE BONE AND SOFT TISSUE, AND KAPOSI SARCOMA 313

Synopsis

We evaluated the risk of subsequent primary cancer in

4,807 persons with malignancies of bone, 12,448 persons with malignancies of soft tissue, and 11,679 persons with Kaposi sarcoma (KS). The overall risk of subsequent cancers was significantly increased among

survivors of bone sarcomas (O/E=1.24, O=223, EAR=13

per 10,000 person-years) and soft tissue sarcomas

(O/E=1.19, O=1,006, EAR=20). Among patients with

bone or soft tissue sarcomas, there were excess risks of

subsequent primary tumors of bone or soft tissue.

Some tumors were of the same histologic type

(osteosarcoma, chondrosarcoma, neurilemmoma), representing multicentric lesions. In other cases, radiotherapy for the primary malignancy or an underlying

hereditary predisposition (e.g., Li-Fraumeni syndrome)

played a role. The effect of radiotherapy was greatest in

patients with Ewing sarcoma, who displayed 60- to

70-fold excesses of bone and soft tissue sarcomas,

arising mostly in the field of radiation. Radiotherapy,

chemotherapy, and/or hereditary syndromes may also

account for observed excesses of lung cancer and acute

non-lymphocytic leukemia (ANLL) following bone sarcomas. Radiotherapy and/or increased surveillance may

have contributed to excesses of stomach and thyroid

cancers following soft tissue sarcoma, whereas both

radiotherapy and chemotherapy were likely related to

the increased risk of ANLL. The nearly 2-fold elevation

in risk of melanoma following soft tissue sarcoma

could have been caused by shared risk factors or diagnostic overlap. No new cancers were found in excess

following KS diagnosed before 1980 (O/E=0.89 excluding subsequent KS, O=43). However, beginning in

1980, with the onset of the acquired immunodeficiency

syndrome (AIDS) epidemic, KS was significantly associated with several subsequent malignancies (O/E=4.77

excluding subsequent KS, O=716, EAR=230). Most

notably, non-Hodgkin lymphoma (O/E=75.99) occurred

in marked excess following KS, caused by the strong

immunosuppressive effects of human immunodeficiency virus infection on lymphoma risk. Immunosuppression was also likely responsible for the 9-fold increase

in risk of Hodgkin lymphoma. In addition, patients

with KS during the AIDS era were prone to cancers of

the anus, cervix, and liver, likely caused by concomitant

viral infections. A 3-fold increase in the risk of ANLL

also was observed in individuals with AIDS-related

KS, possibly related to chemotherapy.

Bone and Joint Sarcomas

Malignancies arising in bones and joint cartilage account

for 0.2% of new cancers and 0.2% of cancer deaths (Miller

et al, 1996; Jemal et al, 2005). Three distinct histologic

subtypes constitute the majority of cases (osteosarcoma

35%, Ewing sarcoma [ES] 16%, and chondrosarcoma

28%) (Table 12.A). There is a slight predominance of

males with bone/joint malignancies overall (57%) and

within each of the 3 major subtypes. Prognosis varies by

histologic subtype, with 5-year relative survival rates of

62.2%, 56.8%, and 84.1% for osteosarcoma, ES, and

chondrosarcoma, respectively. Osteosarcomas have a

bimodal age of onset, with peaks of incidence in adolescence and old age. The adolescent peak and the predominance of tumors arising in the metaphyses of long bones

suggest that the pubertal growth spurt may be etiologically important. ES occurs in adolescence and young

adulthood; it is very uncommon after age 30 years. It

appears to be derived from primitive neural tissue and

often affects the axial skeleton. For unknown reasons, the

tumor is extremely rare in blacks (1.6% of ES cases in

SEER). Chondrosarcoma, which develops in joint cartilage, steadily increases in incidence with advancing age.

Treatment for bone/joint malignancies usually includes

surgical resection, although many patients with ES

receive primary radiotherapy instead (Table 12.A). Beginning in the 1980s, multidrug adjuvant chemotherapy,

including doxorubicin and often an alkylating agent, has

become an important part of the treatment of osteosarcoma (Malawer et al, 2001). Similar chemotherapy regimens have also been used for ES.

Several risk factors for bone sarcomas have been identified, but together they explain only a small portion of

cases. Radiotherapy and chemotherapy with alkylating

agents, given in high doses to treat other tumors,

increase the risk for osteosarcoma in a dose-response

manner (Tucker et al, 1987; Le Vu et al, 1998). Sarcomas

can also arise as components of hereditary neoplastic or

preneoplastic disorders. For example, Li-Fraumeni syndrome (LFS) is a dominantly inherited constellation of

BONE, SOFT TISSUE, AND

KAPOSI SARCOMA

Chapter 12

New Malignancies Following Cancer of the

Bone and Soft Tissue, and Kaposi Sarcoma

Eric A. Engels, Joseph F. Fraumeni Jr.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated as

[(O-E)/PYR]10,000).

Author affiliations: Eric A. Engels and Joseph F. Fraumeni Jr., Division

of Cancer Epidemiology and Genetics, NCI, NIH, DHHS.
diverse malignancies in children and young adults,

including osteosarcoma, chondrosarcoma, soft tissue

sarcomas, brain tumors, adrenocortical neoplasia, breast

carcinoma, acute leukemia, and other tumors to a lesser

degree (Li et al, 1988; Hisada et al, 1998; Nichols et al,

2001). Patients with this syndrome are prone to multiple

primary cancers and to the carcinogenic effects of radiotherapy. Most LFS cases have been associated with

germline mutations of the p53 tumor suppressor gene. In

addition, osteosarcomas occur excessively in individuals

with germline mutations of the RB1 gene (hereditary

retinoblastoma) or the DNA helicase genes (Werner syndrome and Rothmund-Thomson syndrome) (Miller et al,

1996; Spurney et al, 1998). The excess risk of osteosarcoma among adults with Paget disease of bone, which has

a hereditary component, contributes to the subsequent

primary peak of this tumor in later life (Miller et al,

1996). Chondrosarcoma, osteosarcoma, and other bone

tumors have been reported in association with various

disorders of skeletal development, including fibrous dysplasia and hereditary osteochondromas (Miller et al,

1996; Gigante et al, 2001). In contrast, no clear-cut risk

factor for ES has been identified.

Results and Discussion

A total of 223 subsequent primary cancers were observed

in 4,807 individuals surviving at least 2 months with a

primary bone/joint tumor (O/E=1.24, 95% CI=1.08-1.41,

EAR=13 per 10,000 person-years). The cumulative incidence at 25 years of developing a second cancer, adjusted

for the competing risk of death due to other causes, was

8.6% (95% CI=7.2%-10.1%). The risk of developing a new

malignancy was relatively constant over time since initial

diagnosis, and overall there was no difference in risk by

gender. Risk was especially high for children with bone

sarcomas (ages <18 years, O/E=7.79, EAR=24), as noted

previously (Neglia et al, 2001); risk was lower for young

adults (ages 18-29 years, O/E=1.89, EAR=8) and was not

elevated for older adults (ages 30 years, O/E=1.08,

EAR=9) (Figure 12.1). Risk was increased beyond expectation for acute non-lymphocytic leukemia (ANLL) and

for malignancies of the lung, bone, and soft tissue. The

overall relative risk and excess absolute risk of new

cancers was highest for persons with ES (O/E=6.45,

EAR=41). Among persons with osteosarcoma, the relative risk was higher for those younger than age 30 years

(O/E=3.69) than for older individuals (O/E=1.42),

although the older patients had higher excess absolute

risks (EAR=39) than the younger ones (EAR=15). Little

elevation in cancer risk was seen among patients with

chondrosarcoma (O/E=1.09, EAR=8).

Ten subsequent primary sarcomas of the bone were

reported (O/E=30.36). Five of these cases (4 chondrosarcomas, 1 osteosarcoma) represented multicentric primary

lesions, as they followed tumors of identical histology

and arose at second locations separated by an interval of

0.5 to 5 years. Multicentric osteosarcomas have been

reported with genetic susceptibility states such as LFS

and Rothmund-Thomson syndrome (Spurney et al,

1998). In addition, 3 bone malignancies, all osteosarcomas, arose in patients with ES (O/E=62.40) at sites

previously treated with radiotherapy. The marked excess

314 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BONE, SOFT TISSUE, AND

KAPOSI SARCOMA

Table 12.A: Risk of subsequent primary cancers by age at initial diagnosis and histologic type of bone and soft tissue sarcoma,

SEER 1973-2000.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; O/E=ratio of observed to expected cancers; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000).

*P <0.05.

Mean age at 

Age at initial Number of initial Mean Radiation, Surgery,

Histologic type diagnosis, yr patients diagnosis, yr PYR % % O O/E EAR

All bone sarcomas All ages 4,807 37.4 6.7 26.5 73.5 223 1.24* 13.27

Ewing sarcoma All ages 789 17.9 6.0 62.1 44.7 23 6.45* 41.04

Osteosarcoma 18 750 13.3 7.1 6.5 80.4 10 5.15* 15.11

18-29 376 22.8 7.2 10.1 82.4 6 2.51 13.44

30 578 55.5 4.7 25.1 70.8 36 1.42 39.29

Chondrosarcoma 30 243 21.9 10.2 12.8 87.7 2 0.86 -1.29

30 1,106 55.6 7.4 14.6 86.3 104 1.09 10.76

Other histologies All ages 965 49.9 6.3 37.2 71.5 42 0.85 -12.16

All soft tissue sarcomas All ages 12,448 50.2 6.5 40.8 84.8 1,006 1.19* 19.81

Rhabdomyosarcoma 18 361 7.8 6.8 65.9 60.4 5 8.25* 17.94

18 320 48.1 4.4 50.3 72.2 19 1.37 36.72

Fibrosarcoma 18 248 10.8 9.8 21.8 90.7 7 8.35* 25.25

18-29 421 24.5 9.2 33.7 91.4 15 3.60* 27.85

30 3,821 61.1 6.2 43.9 90.4 402 1.18* 26.23

Neuroblastoma All ages 342 6.2 8.5 34.2 71.1 0 0.00 -4.14

Liposarcomas All ages 2,158 56.9 8.4 39.0 91.9 259 1.04 5.95

Leiomyosarcomas All ages 1,299 58.4 5.3 28.4 83.2 103 1.17 21.27

Other histologies All ages 3,478 45.9 5.5 42.4 78.5 196 1.31* 24.77
NEW MALIGNANCIES FOLLOWING CANCER OF THE BONE AND SOFT TISSUE, AND KAPOSI SARCOMA 315

BONE, SOFT TISSUE, AND

KAPOSI SARCOMA

risk of osteosarcoma is consistent with the radiation

effect previously described in ES, although chemotherapy

and possibly genetic factors could play a role (Tucker 

et al, 1987; Travis et al, 1994; Kuttesch et al, 1996; Le Vu

et al, 1998).

Soft tissue sarcomas also occurred in excess following

bone cancer (O/E=9.70, O=9). Risk was much higher

when radiotherapy was given during initial treatment

(O/E=18.59, O=3) than when it was not (O/E=7.83, O=6).

The risk was greatest following ES (O/E=69.43), with

most subsequent sarcomas (3 of 4 cases) arising in the

field of radiation. The findings are consistent with previous reports documenting an exceptional risk of soft tissue tumors following radiotherapy for ES (Travis et al,

1994; Kuttesch et al, 1996). In 2 cases in our series, soft

tissue sarcomas followed childhood-onset osteosarcoma,

suggesting underlying LFS (Hisada et al, 1998).

The risk of lung cancer was excessive following 

bone sarcomas (O/E=1.45). Risk was highest after ES

(O/E=8.35, O=2), with the lung cancers arising 9 and 15

years after radiotherapy. This finding is consistent with

the elevated risk of lung cancer reported after radiotherapy for breast cancer and Hodgkin lymphoma (Travis et

al, 1995; Metayer et al, 2000; Travis et al, 2002). We also

found an excess risk of lung cancer following osteosarcoma (O/E=2.73, O=11), arising mostly in the lower

limbs, consistent with the notion that chemotherapy

may increase the risk of some lung cancers (Travis et al,

2002). The complex of osteosarcoma and lung cancer

might also result from genetic susceptibility to both

tumors (e.g., LFS or hereditary retinoblastoma) (Sanders

et al, 1989; Hisada et al, 1998; Kleinerman et al, 2000;

Nichols et al, 2001).

Ten cases of ANLL occurred after bone sarcomas in

our survey (7 myeloid, 2 monocytic, 1 not specified,

O/E=6.11). The elevated risk was most pronounced for

osteosarcoma (O/E=9.96, O=3) and ES (O/E=86.62, O=5).

Nine of the 10 cases received initial chemotherapy, suggesting an effect of multiagent chemotherapy (Dunst et

al, 1998; Rodriguez-Galindo, 2000), along with genetic

factors, particularly because osteosarcoma and leukemia

are both components of LFS.

For patients with osteosarcoma, we also observed an

excess of tumors at various sites of the digestive system

(O/E=2.34), including the esophagus, stomach, colon and

rectum, liver, pancreas, and retroperitoneum. This finding is difficult to explain, given the diversity of tumors

and the small numbers at each site.

Soft Tissue Sarcomas, Including Heart

Malignancies that arise in the soft tissues account for

about 0.7% of human cancers and 0.6% of all cancer

deaths (Zahm et al, 1996; Jemal et al, 2005). This group

includes tumors with various histologies derived from

the spectrum of cells that make up normal connective tissue. In SEER, 55% of cases of soft tissue sarcoma arose in

males, and the median age at diagnosis was 53 years.

Among 1,448 children (ages <18 years) the most frequent

soft tissue malignancies were rhabdomyosarcoma (25%

of cases), neuroblastoma (21%), and fibrosarcoma (17%).

Among 11,000 adults (ages 18 years), the most common

tumors were fibrosarcomas (39%), liposarcomas (19%),

and leiomyosarcomas (12%). Some tumors of connective

tissue arise in visceral organs (e.g., leiomyosarcomas of

the uterus), but they are not included in this analysis.

Prognosis was more favorable for soft tissue sarcoma in

children than in adults: 5-year relative survival rates

were 74.4% for ages younger than 18 years versus 66.9%

for ages 18 years or older. Therapy for soft tissue malignancies usually consists of surgical resection, with some

patients receiving radiotherapy or chemotherapy as well

(Brennan et al, 2001).

The etiology of most soft tissue malignancies is

unknown, and because of their rarity, the histologic types

are often combined. Risk for soft tissue sarcomas is

increased by radiation therapy and possibly chemotherapy for other malignant conditions (Zahm et al,

1996). An excess risk has been suggested for occupational

exposures to certain herbicides, but the evidence is not

clear-cut (Zahm et al, 1996). In some cases, especially in

childhood, genetic factors are important, particularly in

1

2

3

4

5

6

7

8

9

18 18-29 30

0

5

10

15

20

25

30

18 18-29 30

Age at diagnosis of cancer of the bone or soft tissues (years) EAR (per 10,000 person-years) O/E

6.07*

2.56*

1.89*

1.08 1.15*

Bone and joints

Soft tissues including heart

Bone and joints

Soft tissues including heart

7.79*

16

8

22

24

14

9

All subsequent cancers after:

All subsequent cancers after:

Figure 12.1: Observed-to-expected ratio (O/E) and excess

absolute risk (EAR) of subsequent primary cancers after cancer

of the bone or soft tissues, both sexes, SEER 1973-2000.

*P <0.05.

Note: EAR = Excess number of subsequent cancers per 10,000 person-years.

Observed No. 27 20 13 27 183 959
LFS, neurofibromatosis type 1, and hereditary retinoblastoma (Bader, 1987; Li et al, 1988; Hisada et al, 1998).

Results and Discussion

We studied 12,448 individuals who survived at least 2

months with a soft tissue malignancy, a category that

included 83 patients (0.7%) with primary malignancies of

the heart. A total of 1,006 subsequent primary cancers

were diagnosed (O/E=1.19, 95% CI=1.12-1.27, EAR=20).

Thirteen percent of patients with soft tissue sarcoma

developed a second cancer within 25 years (cumulative

incidence 12.9%, 95% CI=11.9%-13.9%). Excluding 342

patients with soft tissue neuroblastomas did not affect

the results (O/E=1.19). The relative risk for a subsequent

primary cancer was much higher for children diagnosed

with a soft tissue malignancy (ages <18 years, O/E=6.07,

EAR=14) than for adults (ages 18-29, O/E=2.56, EAR=16;

ages 30, O/E=1.15, EAR=22) (Figure 12.1), primarily

among those with an initial fibrosarcoma or rhabdomyosarcoma (Table 12.A). Risks were similar among males

and females and remained relatively constant throughout

the first 10 years of follow-up. Significantly increased

risks were seen for subsequent cancers of the stomach,

thyroid, bone, and soft tissues, as well as for melanoma

and acute myeloid leukemia.

Subsequent primary soft tissue sarcomas arose in

excess following the initial tumor (O/E=9.30, O=34).

Twenty-three of these cases had histologies that were

identical or similar to the primary tumors, consistent

with multicentric lesions. Six cases had multiple neoplasms of Schwann cells (neurilemmomas, neurofibrosarcomas), possibly caused by neurofibromatosis type 1

(Bader, 1987).

Twelve subsequent primary bone malignancies followed soft tissue tumors (O/E=13.30). Radiotherapy may

have been involved (Tucker et al, 1987; Heyn et al, 1993;

Le Vu et al, 1998; Cohen et al, 2005), because the risk 

was higher in irradiated (O/E=25.19, O=8) than in nonirradiated persons (O/E=6.84, O=4); among irradiated

individuals, 7 of the bone tumors (5 osteosarcomas, 

2 chondrosarcomas) arose at irradiated sites. Genetic

predisposition probably contributed to the excess risk

(Hisada et al, 1998), which was pronounced in the childhood cases (O/E=47.38, O=5).

An excess of acute myelogenous leukemia (AML) was

observed following soft tissue sarcoma (O/E=3.06).

Although only 2 of the 18 cases occurred in children,

their relative risk was much higher (O/E=23.82 versus

2.76 for adults). Both children developed AML within 3

years of radiotherapy. The overall risk for AML was

higher in irradiated (O/E=4.87) compared with nonirradiated individuals (O/E=2.09), consistent with reports of

radiotherapy-related leukemia (Preston et al, 1994).

However, an effect of chemotherapy also seems likely

(Heyn et al, 1994), since 9 of the AML cases received

chemotherapy as part of their initial treatment for soft

tissue sarcoma.

We observed excess risks for cancers of the thyroid

(O/E=2.39) and stomach (O/E=1.80) following soft tissue

malignancies, all of which were diagnosed in adult life.

Radiotherapy may have played a role, even though risks

were similar in patients who were or were not irradiated

during their initial course of treatment. It also seems possible that the excess of thyroid cancer could have been

the result of increased surveillance.

Finally, the risk of melanoma was elevated (O/E=1.80)

following soft tissue tumors with a wide range of histologies, in both irradiated (O/E=2.11) and nonirradiated

(O/E=1.62) patients. An association between soft tissue

sarcomas and melanoma has been noted previously

(Tucker et al, 1985; Berking and Brady, 1997), suggesting

common risk factors or diagnostic overlap in some cases

(Sandberg and Bridge, 2001).

Kaposi Sarcoma

Kaposi sarcoma (KS) is a distinctive cutaneous tumor of

vascular origin. It occurred only rarely in the U.S. before

the 1980-1981 onset of the human immunodeficiency

virus (HIV)-associated epidemic of acquired immunodeficiency syndrome (AIDS). In the pre-AIDS era, KS arose

almost exclusively in the elderly, particularly among men

of Mediterranean or central/eastern European origin

(classic KS). The HIV/AIDS epidemic ushered in a sharp

increase in KS incidence, especially in homosexual men

(Beral et al, 1990). Before the advent of effective anti-HIV

therapy in the mid-1990s, KS risk was extremely high in

HIV-infected individuals, with a lifetime cumulative incidence of 10% (Frisch et al, 2001).

A recently discovered virus, KS-associated herpesvirus

(KSHV, also known as human herpesvirus 8), is a necessary cofactor for KS (Chang et al, 1994). Most KSHV

infections are asymptomatic, but in the presence of

AIDS-related immunosuppression, KSHV causes KS

through incompletely understood mechanisms (Moore

and Chang, 2001). KSHV infection is highly prevalent in

HIV-infected homosexual men, consistent with sexual

transmission (Martin et al, 1998).

By distinguishing KS cases according to year of

diagnosis in the SEER Program (1973-1979 versus 1980-

2000), it is possible largely to separate classic and AIDSassociated cases. In the earlier group of 210 2-month survivors, 74% were male, the median age was 73 years, and

the 5-year survival rate (relative to the general population) was 88%, reflecting the epidemiology of classic KS

and its indolent nature. In the later group of 11,469

2-month survivors, 97% were male, the median age was

38 years, and the 5-year relative survival rate was 44%, a

pattern consistent with the dramatic rise of KS in young,

HIV-infected homosexual men and the poorer prognosis

for AIDS patients. Still, recent improvements in anti-HIV

therapy have prolonged post-KS survival. Localized KS

is usually treated with intralesional chemotherapy or

low-dose radiotherapy. Because of the aggressive nature

of AIDS-associated KS, it is sometimes treated with systemic chemotherapy (McGarvey et al, 1998).

316 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BONE, SOFT TISSUE, AND

KAPOSI SARCOMA
Results and Discussion

The risk of subsequent primary cancer following pre1980 diagnoses of KS in 210 patients was not increased

overall (O/E=0.89, O=43, 95% CI=0.64-1.19, excluding

subsequent KS), consistent with a previous analysis of

SEER data (Biggar et al, 1994). Although an Israeli study

of classic KS revealed elevated risks of non-Hodgkin

lymphoma (NHL)(O/E=3.94, O=8) and melanoma

(O/E=5.81, O=5) (Iscovich et al, 1999), we found only a

slight, nonsignificant excess of NHL (O/E=1.41, O=2,

95% CI=0.16-5.08) and no cases of melanoma. KSHV is

not known to play a major role in NHL in HIV-uninfected

persons, though it has been implicated in a rare variant,

primary effusion lymphoma (Cesarman et al, 1995).

By contrast, in the AIDS era (1980-2000), our study

revealed that 11,469 persons with KS were at elevated

risk for subsequent primary malignancies (O/E=4.77,

O=716, 95% CI=4.43-5.13, EAR=230, excluding second

KS). The 10-year cumulative incidence of second cancer

did not change appreciably during the AIDS era (6.2%,

95% CI=5.5%-6.9% for 1980-1989 versus 7.1%, 95%

CI=6.4%-7.9% for 1990-2000). Individuals with KS were

particularly prone to develop a new malignancy early in

the follow-up period (<1 year, O/E=9.60; 1-4 years,

O/E=5.22); thereafter the risk declined. Excess risks of

subsequent cancer were confined to the 11,175 men with

KS (O/E=5.35) with only 23 non-KS tumors seen among

the 294 women with KS (O/E=1.12). Risk increases in

excess of 4-fold were seen for both whites and blacks.

Patients diagnosed at ages younger than 40 years had

particularly high risks of subsequent cancers (O/E=29.50,

O=362, EAR=264), although approximately 2-fold risk

increases were seen among older patients (ages 40 years,

O/E=2.57, O=354, EAR=190). Several malignancies were

significantly increased among KS patients, including

cancers of the anus, cervix, and liver, as well as NHL,

Hodgkin lymphoma, and ANLL.

A markedly increased risk of NHL (O/E=75.99, O=539,

EAR=216) explained most of the overall cancer excess

(Cannon et al, 2000). The 10-year cumulative incidence of

NHL among KS patients diagnosed between 1980 and

2000 was 5.1% (95% CI=4.7%-5.5%). The relationship

between KS and NHL is readily explained by the potent

effect of AIDS-related immune suppression on the risks

of both tumors (Frisch et al, 2001). In HIV infection, NHL

may arise because of defective immunological control of

lymphoproliferative stimuli, especially from Epstein-Barr

virus (EBV) infection (Shibata et al, 1993). In addition, it

is possible that KSHV acts independently to increase the

risk for NHL, particularly primary effusion lymphoma or

other high-grade variants (Cesarman et al, 1995; Engels

et al, 2001), although this effect appears to be small compared with the influence of HIV itself. Risk for NHL was

higher in men (O/E=85.50) than women (O/E=3.64),

which may reflect varying proportions of classic and

AIDS-associated KS cases even in the AIDS era. Supporting this possibility, in the AIDS era only 3% of males with

KS were older than 70 years of age at diagnosis, compared with 67% of females.

In the AIDS era, individuals with KS had a 37-fold

increase in risk of anal cancer, with all cases arising in

men, presumably due to the high prevalence of human

papillomavirus infection in homosexual men (Palefsky et

al, 1998). Similarly, a 10-fold elevation in risk was seen

for cervical cancer, based on 2 cases, probably because of

frequent infections with human papillomavirus in HIVinfected women. Hepatitis B and C virus infections as

well as alcohol abuse are common in some HIV-infected

groups and probably account for the 5-fold increase in

risk of liver cancer in our study. AIDS-related immunosuppression and poor control of EBV infection appear to

account for an excess of Hodgkin lymphoma reported

among persons with AIDS (Frisch et al, 2001), consistent

with the relationship we observed between KS and

Hodgkin lymphoma (O/E=9.01). An excess of ANLL

also was seen following KS, which may be related to

chemotherapy, although an elevated risk of AML has

previously been reported in individuals with AIDS alone

(Frisch et al, 2001).

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BONE, SOFT TISSUE, AND

KAPOSI SARCOMA
BONE

Bone

Both Sexes

Table 12.1.1: Characteristics of patients with an initial cancer of the bones or joints, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 2,749 100.0 2,058 100.0 4,807 100.0

Initial treatment

Any radiation 736 26.8 537 26.1 1,273 26.5

With surgery 362 13.2 298 14.5 660 13.7

Without surgery 374 13.6 239 11.6 613 12.8

No radiation 2,013 73.2 1,521 73.9 3,534 73.5

With surgery 1,652 60.1 1,221 59.3 2,873 59.8

Without surgery 361 13.1 300 14.6 661 13.8

Race

White 2,357 85.7 1,717 83.4 4,074 84.8

Black 199 7.2 189 9.2 388 8.1

Other 177 6.4 132 6.4 309 6.4

Unknown 16 0.6 20 1.0 36 0.7

Age at 1st primary cancer diagnosis, years

< 30 1,359 49.4 939 45.6 2,298 47.8

30–49 555 20.2 428 20.8 983 20.4

50–69 573 20.8 393 19.1 966 20.1

70–79 204 7.4 184 8.9 388 8.1

> 80 58 2.1 114 5.5 172 3.6

Number of patients with one or more

primary cancers

One primary cancer only 2,624 95.5 1,978 96.1 4,602 95.7

1st and 2nd cancers 114 4.1 74 3.6 188 3.9

1st, 2nd, and 3rd cancers 10 0.4 6 0.3 16 0.3

1st, 2nd, 3rd, and additional cancers 1 0.0 0 0.0 1 0.0

Other statistics

Median age at 1st cancer diagnosis 30.4 — 33.8 — 31.7 —

Median year of 1st cancer diagnosis 1987.9 — 1988.0 — 1988.0 —

Median person-years at risk 3.5 — 4.3 — 3.9 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 96.0 — 97.5 — 96.6

1st, 2nd, and additional cancers — 96.0 — 97.5 — 96.6

1st cancer only — 3.2 — 2.5 — 2.9

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING CANCER OF THE BONE AND SOFT TISSUE, AND KAPOSI SARCOMA 319

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 21 1.15 70 1.22 55 1.24 77 1.27* 223 180.22 1.24* 13.27

All excluding same site 20 1.10 65 1.14 52 1.18 76 1.26 213 179.89 1.18* 10.27

Buccal cavity, pharynx 0 0.00 0 0.00 1 0.84 0 0.00 1 4.80 0.21 -1.18

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.66 0.00 -0.21

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 1.00 0.00 -0.31

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.14

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 1.22 0.00 -0.38

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.07

Tonsil 0 0.00 0 0.00 1 8.29 0 0.00 1 0.49 2.05 0.16

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.04

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.14

Digestive system 6 1.54 9 0.77 10 1.13 20 1.71* 45 36.10 1.25 2.76

Esophagus 0 0.00 3 5.03* 1 2.24 1 1.63 5 1.85 2.70 0.98

Stomach 0 0.00 1 0.85 2 2.32 4 3.67 7 3.54 1.98 1.07

Small intestine 1 18.32 0 0.00 0 0.00 1 4.94 2 0.57 3.49 0.44

Colon 2 1.16 4 0.77 3 0.76 6 1.15 15 16.10 0.93 -0.34

Rectum, rectosigmoid junction 1 1.42 1 0.48 1 0.64 4 2.00 7 6.37 1.10 0.20

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.13

Liver 1 7.58 0 0.00 2 6.32 0 0.00 3 1.32 2.28 0.52

Gallbladder 0 0.00 0 0.00 0 0.00 1 7.20 1 0.46 2.15 0.17

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.78 0.00 -0.24

Pancreas 1 2.15 0 0.00 0 0.00 3 2.15 4 4.31 0.93 -0.10

Respiratory system 4 1.31 19 2.00* 9 1.24 11 1.16 43 29.31 1.47* 4.25

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.09

Larynx 0 0.00 2 2.92 1 1.98 0 0.00 3 2.03 1.48 0.30

Lung, bronchus 4 1.43 17 1.96* 8 1.21 10 1.14 39 26.90 1.45* 3.75

Female breast 1 0.49 4 0.60 3 0.56 14 1.99* 22 21.09 1.04 0.62

Female genital system 0 0.00 4 1.31 2 0.85 1 0.34 7 9.38 0.75 -1.63

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 1.53 0.00 -1.05

Corpus uteri 0 0.00 4 2.80 2 1.85 0 0.00 6 4.29 1.40 1.17

Ovary 0 0.00 0 0.00 0 0.00 1 1.08 1 2.83 0.35 -1.26

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.09

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.27

Male genital system 1 0.32 5 0.50 8 1.03 14 1.17 28 32.94 0.85 -2.79

Prostate 0 0.00 4 0.42 8 1.08 14 1.21 26 31.58 0.82 -3.16

Testis 0 0.00 1 2.76 0 0.00 0 0.00 1 1.13 0.88 -0.08

Urinary system 3 2.17 3 0.70 3 0.91 3 0.65 12 13.57 0.88 -0.49

Urinary bladder 1 1.07 2 0.70 3 1.36 2 0.65 8 9.10 0.88 -0.34

Kidney parenchyma 2 5.59 1 0.87 0 0.00 1 0.78 4 3.68 1.09 0.10

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -0.24

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.08

Bone, joints 1 23.71 5 40.55* 3 37.30* 1 11.98 10 0.33 30.36* 3.00

Soft tissue including heart 0 0.00 1 3.34 4 17.29* 4 13.18* 9 0.93 9.70* 2.50

Kaposi sarcoma 1 13.11 0 0.00 0 0.00 0 0.00 1 0.98 1.02 0.01

Melanoma of skin 1 1.98 3 1.74 2 1.39 0 0.00 6 5.80 1.03 0.06

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.09

Brain, central nervous system 0 0.00 1 1.24 0 0.00 0 0.00 1 2.44 0.41 -0.45

Thyroid 0 0.00 1 1.63 2 3.90 2 2.82 5 2.01 2.48 0.93

Lymphatic, hematopoietic 3 2.01 14 2.98* 4 1.09 6 1.21 27 14.79 1.83* 3.79

Hodgkin lymphoma 0 0.00 0 0.00 1 3.12 0 0.00 1 1.19 0.84 -0.06

Non-Hodgkin lymphoma 2 3.10 3 1.45 0 0.00 2 0.84 7 6.76 1.04 0.08

Myeloma 0 0.00 1 1.49 0 0.00 0 0.00 1 2.11 0.47 -0.35

Leukemia 1 1.96 10 6.48* 3 2.59 4 2.63 18 4.73 3.80* 4.12

Acute lymphocytic 0 0.00 1 9.01 0 0.00 1 14.54 2 0.29 6.93 0.53

Chronic lymphocytic 0 0.00 1 1.84 0 0.00 1 1.81 2 1.69 1.18 0.10

Acute non-lymphocytic 1 5.81 6 11.35* 2 4.99 1 1.87 10 1.64 6.11* 2.60

Chronic myeloid 0 0.00 1 4.67 1 6.05 1 4.46 3 0.67 4.46 0.72

Bone

Both Sexes

Table 12.1.2: Risk of subsequent primary cancers after cancer of the bones or joints, both sexes,

SEER 1973-2000.

320 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BONE

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,807 3,999 2,156 1,250 4,807

Person-years in interval 3,636 11,418 8,283 8,896 32,232

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 14,569 PYR and for male cancers on 17,664 PYR.
Bone

Females

Table 12.1.3: Risk of subsequent primary cancers after cancer of the bones or joints, females,

SEER 1973-2000.

BONE

All subsequent cancers 6 0.86 22 0.99 26 1.48 32 1.40 86 69.58 1.24 11.27

All excluding same site 6 0.86 20 0.90 24 1.37 31 1.36 81 69.46 1.17 7.92

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.21 0.00 -0.83

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.05

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.18

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.11

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.27

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.04

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.07

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.02

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.05

Digestive system 3 1.99 1 0.22 5 1.46 9 2.08 18 13.75 1.31 2.92

Esophagus 0 0.00 0 0.00 1 10.31 0 0.00 1 0.39 2.59 0.42

Stomach 0 0.00 0 0.00 1 3.92 2 6.38 3 1.04 2.90 1.35

Small intestine 1 47.53 0 0.00 0 0.00 0 0.00 1 0.22 4.51 0.53

Colon 1 1.34 1 0.45 1 0.59 5 2.35 8 6.79 1.18 0.83

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 1 1.49 1 2.21 0.45 -0.83

Rectum 0 0.00 0 0.00 0 0.00 1 2.23 1 1.45 0.69 -0.31

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.14

Liver 0 0.00 0 0.00 2 25.50* 0 0.00 2 0.32 6.34 1.16

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.20

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.21

Pancreas 1 5.24 0 0.00 0 0.00 1 1.74 2 1.78 1.12 0.15

Respiratory system 0 0.00 6 2.25 2 0.91 2 0.68 10 8.63 1.16 0.94

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.06

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.20

Lung, bronchus 0 0.00 6 2.37 2 0.96 2 0.71 10 8.22 1.22 1.22

Female breast 1 0.49 4 0.60 3 0.56 14 1.99* 22 21.09 1.04 0.62

Female genital system 0 0.00 4 1.31 2 0.85 1 0.34 7 9.38 0.75 -1.63

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 1.53 0.00 -1.05

Corpus uteri 0 0.00 4 2.80 2 1.85 0 0.00 6 4.29 1.40 1.17

Ovary 0 0.00 0 0.00 0 0.00 1 1.08 1 2.83 0.35 -1.26

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.09

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.27

Urinary system 1 3.22 1 1.04 2 2.64 1 1.00 5 3.03 1.65 1.35

Urinary bladder 0 0.00 1 1.81 2 4.66 0 0.00 3 1.72 1.74 0.88

Kidney parenchyma 1 9.69 0 0.00 0 0.00 1 2.70 2 1.08 1.85 0.63

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.16

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.05

Bone, joints 0 0.00 2 45.52* 2 65.20* 1 30.13 5 0.12 40.81* 3.35

Soft tissue including heart 0 0.00 1 8.91 1 11.12 1 8.74 3 0.35 8.54* 1.82

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.02

Melanoma of skin 0 0.00 0 0.00 2 3.68 0 0.00 2 2.13 0.94 -0.09

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.07

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.88 0.00 -0.61

Thyroid 0 0.00 1 2.45 2 5.72 1 2.05 4 1.36 2.94 1.81

Lymphatic, hematopoietic 1 1.82 2 1.16 3 2.19 2 1.13 8 5.42 1.48 1.77

Hodgkin lymphoma 0 0.00 0 0.00 1 7.68 0 0.00 1 0.47 2.13 0.36

Non-Hodgkin lymphoma 0 0.00 1 1.27 0 0.00 0 0.00 1 2.53 0.40 -1.05

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.80 0.00 -0.55

Leukemia 1 5.67 1 1.88 2 4.94 2 3.94 6 1.62 3.70* 3.01

Acute lymphocytic 0 0.00 0 0.00 0 0.00 1 39.95 1 0.10 9.86 0.62

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -0.37

Acute non-lymphocytic 1 15.76 0 0.00 1 6.58 1 5.12 3 0.61 4.95 1.64

Chronic myeloid 0 0.00 0 0.00 1 17.12 0 0.00 1 0.23 4.31 0.53

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,058 1,715 973 584 2,058

Person-years in interval 1,552 5,044 3,809 4,164 14,569

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BONE AND SOFT TISSUE, AND KAPOSI SARCOMA 321
All subsequent cancers 15 1.33 48 1.37* 29 1.09 45 1.19 137 110.64 1.24* 14.92

All excluding same site 14 1.25 45 1.29 28 1.05 45 1.20 132 110.43 1.20* 12.21

Buccal cavity, pharynx 0 0.00 0 0.00 1 1.13 0 0.00 1 3.59 0.28 -1.47

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.33

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.73 0.00 -0.41

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.16

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -0.47

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.10

Tonsil 0 0.00 0 0.00 1 10.72 0 0.00 1 0.38 2.62 0.35

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.21

Digestive system 3 1.25 8 1.11 5 0.92 11 1.50 27 22.36 1.21 2.63

Esophagus 0 0.00 3 6.36* 0 0.00 1 2.04 4 1.46 2.73 1.44

Stomach 0 0.00 1 1.20 1 1.64 2 2.58 4 2.50 1.60 0.85

Small intestine 0 0.00 0 0.00 0 0.00 1 8.02 1 0.35 2.84 0.37

Colon 1 1.02 3 1.01 2 0.89 1 0.32 7 9.31 0.75 -1.31

Rectum, rectosigmoid junction 1 2.19 1 0.73 1 0.99 3 2.26 6 4.16 1.44 1.04

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.11

Liver 1 9.99 0 0.00 0 0.00 0 0.00 1 1.00 1.00 0.00

Gallbladder 0 0.00 0 0.00 0 0.00 1 18.66 1 0.17 5.86 0.47

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.27

Pancreas 0 0.00 0 0.00 0 0.00 2 2.43 2 2.53 0.79 -0.30

Respiratory system 4 1.79 13 1.90* 7 1.39 9 1.37 33 20.69 1.60* 6.97

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.10

Larynx 0 0.00 2 3.39 1 2.32 0 0.00 3 1.75 1.72 0.71

Lung, bronchus 4 1.99 11 1.79 6 1.32 8 1.34 29 18.68 1.55* 5.84

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.12

Male genital system 1 0.32 5 0.50 8 1.03 14 1.17 28 32.94 0.85 -2.79

Prostate 0 0.00 4 0.42 8 1.08 14 1.21 26 31.58 0.82 -3.16

Testis 0 0.00 1 2.76 0 0.00 0 0.00 1 1.13 0.88 -0.08

Urinary system 2 1.87 2 0.60 1 0.39 2 0.55 7 10.53 0.66 -2.00

Urinary bladder 1 1.33 1 0.43 1 0.56 2 0.79 5 7.38 0.68 -1.35

Kidney parenchyma 1 3.93 1 1.23 0 0.00 0 0.00 2 2.60 0.77 -0.34

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.32

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.10

Bone, joints 1 36.39 3 37.80* 1 20.10 0 0.00 5 0.21 24.17* 2.71

Soft tissue including heart 0 0.00 0 0.00 3 21.21* 3 15.88* 6 0.58 10.41* 3.07

Kaposi sarcoma 1 13.58 0 0.00 0 0.00 0 0.00 1 0.96 1.05 0.02

Melanoma of skin 1 3.10 3 2.76 0 0.00 0 0.00 4 3.67 1.09 0.19

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.10

Brain, central nervous system 0 0.00 1 1.94 0 0.00 0 0.00 1 1.55 0.64 -0.31

Thyroid 0 0.00 0 0.00 0 0.00 1 4.50 1 0.65 1.53 0.20

Lymphatic, hematopoietic 2 2.12 12 4.05* 1 0.44 4 1.26 19 9.37 2.03* 5.45

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.72 0.00 -0.41

Non-Hodgkin lymphoma 2 5.02 2 1.56 0 0.00 2 1.32 6 4.23 1.42 1.00

Myeloma 0 0.00 1 2.41 0 0.00 0 0.00 1 1.31 0.76 -0.18

Leukemia 0 0.00 9 8.90* 1 1.33 2 1.97 12 3.11 3.86* 5.03

Acute lymphocytic 0 0.00 1 13.74 0 0.00 0 0.00 1 0.19 5.34 0.46

Chronic lymphocytic 0 0.00 1 2.73 0 0.00 1 2.61 2 1.15 1.74 0.48

Acute non-lymphocytic 0 0.00 6 18.02* 1 4.02 0 0.00 7 1.03 6.80* 3.38

Chronic myeloid 0 0.00 1 7.16 0 0.00 1 6.68 2 0.44 4.53 0.88

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,749 2,284 1,183 666 2,749

Person-years in interval 2,083 6,374 4,474 4,733 17,664

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Bone

Males

Table 12.1.4: Risk of subsequent primary cancers after cancer of the bones or joints, males,

SEER 1973-2000.

322 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BONE

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
SOFT TISSUES

Soft Tissues

Both Sexes

Table 12.2.1: Characteristics of patients with an initial cancer of the soft tissues including heart, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 6,787 100.0 5,661 100.0 12,448 100.0

Initial treatment

Any radiation 2,786 41.0 2,289 40.4 5,075 40.8

With surgery 2,338 34.4 1,911 33.8 4,249 34.1

Without surgery 448 6.6 378 6.7 826 6.6

No radiation 4,001 59.0 3,372 59.6 7,373 59.2

With surgery 3,436 50.6 2,867 50.6 6,303 50.6

Without surgery 565 8.3 505 8.9 1,070 8.6

Race

White 5,617 82.8 4,652 82.2 10,269 82.5

Black 664 9.8 619 10.9 1,283 10.3

Other 449 6.6 349 6.2 798 6.4

Unknown 57 0.8 41 0.7 98 0.8

Age at 1st primary cancer diagnosis, years

< 30 1,441 21.2 1,299 22.9 2,740 22.0

30–49 1,662 24.5 1,279 22.6 2,941 23.6

50–69 2,175 32.0 1,619 28.6 3,794 30.5

70–79 1,014 14.9 812 14.3 1,826 14.7

> 80 495 7.3 652 11.5 1,147 9.2

Number of patients with one or more

primary cancers

One primary cancer only 6,217 91.6 5,330 94.2 11,547 92.8

1st and 2nd cancers 501 7.4 301 5.3 802 6.4

1st, 2nd, and 3rd cancers 65 1.0 29 0.5 94 0.8

1st, 2nd, 3rd, and additional cancers 4 0.1 1 0.0 5 0.0

Other statistics

Median age at 1st cancer diagnosis 52.9 — 53.3 — 53.1 —

Median year of 1st cancer diagnosis 1989.2 — 1989.0 — 1989.1 —

Median person-years at risk 3.8 — 4.0 — 3.9 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 95.3 — 95.8 — 95.4

1st, 2nd, and additional cancers — 95.1 — 95.5 — 95.2

1st cancer only — 3.9 — 3.9 — 3.9

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING CANCER OF THE BONE AND SOFT TISSUE, AND KAPOSI SARCOMA 323

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 117 1.31* 354 1.24* 267 1.22* 268 1.07 1,006 845.73 1.19* 19.81

All excluding same site 111 1.25* 338 1.19* 260 1.19* 263 1.05 972 842.07 1.15* 16.06

Buccal cavity, pharynx 3 1.25 6 0.79 5 0.89 6 1.02 20 21.53 0.93 -0.19

Lip 0 0.00 0 0.00 1 1.24 0 0.00 1 3.12 0.32 -0.26

Tongue 0 0.00 2 1.32 2 1.75 2 1.63 6 4.35 1.38 0.20

Salivary gland 2 9.56* 1 1.49 0 0.00 0 0.00 3 1.98 1.51 0.13

Mouth 0 0.00 1 0.50 1 0.68 2 1.34 4 5.59 0.72 -0.20

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.93 0.00 -0.11

Tonsil 0 0.00 1 1.38 0 0.00 1 1.76 2 2.06 0.97 -0.01

Oropharynx 0 0.00 1 4.77 0 0.00 0 0.00 1 0.60 1.66 0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 1 1.76 1 2.13 0.47 -0.14

Digestive system 21 1.04 54 0.85 50 1.05 52 0.99 177 183.77 0.96 -0.84

Esophagus 1 1.02 1 0.32 3 1.24 4 1.45 9 9.31 0.97 -0.04

Stomach 4 1.86 9 1.35 10 2.05 11 2.12* 34 18.88 1.80* 1.87

Small intestine 1 3.67 0 0.00 1 1.44 1 1.19 3 2.69 1.12 0.04

Colon 8 0.88 26 0.91 19 0.88 15 0.63 68 83.09 0.82 -1.87

Rectum, rectosigmoid junction 4 1.16 10 0.92 5 0.62 6 0.70 25 31.02 0.81 -0.74

Anus, anal canal 0 0.00 0 0.00 1 2.18 0 0.00 1 1.76 0.57 -0.09

Liver 1 1.46 1 0.46 1 0.59 1 0.50 4 6.57 0.61 -0.32

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 2.45 0.00 -0.30

Bile ducts, other biliary 1 2.33 0 0.00 1 0.95 3 2.40 5 4.09 1.22 0.11

Pancreas 0 0.00 6 0.79 6 1.05 11 1.74 23 22.08 1.04 0.11

Respiratory system 18 1.20 52 1.08 37 1.00 44 1.06 151 141.78 1.07 1.14

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 1.25 0.00 -0.15

Larynx 0 0.00 5 1.52 2 0.81 3 1.16 10 9.39 1.06 0.08

Lung, bronchus 18 1.31 47 1.06 35 1.02 40 1.04 140 130.74 1.07 1.14

Female breast 13 1.41 26 0.88 38 1.66* 23 0.90 100 87.36 1.14 3.39

Female genital system 3 0.71 16 1.20 15 1.53 11 1.05 45 37.81 1.19 1.93

Cervix uteri 0 0.00 0 0.00 1 0.75 1 0.76 2 5.12 0.39 -0.84

Corpus uteri 2 0.97 8 1.25 8 1.71 6 1.20 24 18.13 1.32 1.57

Ovary 0 0.00 6 1.54 6 2.03 2 0.62 14 11.31 1.24 0.72

Vagina 1 15.10 0 0.00 0 0.00 0 0.00 1 0.59 1.69 0.11

Vulva 0 0.00 1 1.64 0 0.00 2 3.90 3 1.78 1.68 0.33

Male genital system 27 1.61* 70 1.28 51 1.18 47 0.85 195 169.84 1.15 5.77

Prostate 26 1.58* 70 1.30* 49 1.15 45 0.83 190 166.88 1.14 5.30

Testis 0 0.00 0 0.00 2 4.17 0 0.00 2 1.86 1.08 0.03

Urinary system 10 1.42 28 1.24 18 1.04 25 1.26 81 66.60 1.22 1.78

Urinary bladder 4 0.82 21 1.35 15 1.27 19 1.40 59 45.80 1.29 1.63

Kidney parenchyma 5 2.91 5 0.89 3 0.69 2 0.39 15 16.79 0.89 -0.22

Renal pelvis, other urinary 1 2.25 2 1.42 0 0.00 4 3.56 7 4.01 1.74 0.37

Ureter 0 0.00 1 2.18 0 0.00 0 0.00 1 1.31 0.76 -0.04

Bone, joints 0 0.00 7 21.96* 2 8.56 3 12.04* 12 0.90 13.30* 1.37

Soft tissue including heart 6 15.03* 16 12.80* 7 7.53* 5 4.65* 34 3.65 9.30* 3.75

Kaposi sarcoma 3 13.23* 2 2.63 0 0.00 0 0.00 5 2.22 2.26 0.34

Melanoma of skin 1 0.48 12 1.74 10 1.82 15 2.25* 38 21.12 1.80* 2.09

Eye, orbit 0 0.00 1 2.31 0 0.00 0 0.00 1 1.22 0.82 -0.03

Brain, central nervous system 0 0.00 7 2.22 3 1.26 2 0.78 12 9.09 1.32 0.36

Thyroid 2 3.24 6 2.98* 3 1.97 3 1.75 14 5.87 2.39* 1.00

Lymphatic, hematopoietic 7 1.01 42 1.90* 20 1.19 23 1.20 92 65.12 1.41* 3.32

Hodgkin lymphoma 0 0.00 2 1.98 0 0.00 1 1.35 3 2.80 1.07 0.02

Non-Hodgkin lymphoma 0 0.00 7 0.72 9 1.18 12 1.34 28 29.37 0.95 -0.17

Myeloma 2 1.76 10 2.76* 1 0.36 2 0.62 15 10.76 1.39 0.52

Leukemia 5 2.05 23 2.99* 10 1.75 8 1.26 46 22.19 2.07* 2.94

Acute lymphocytic 0 0.00 2 5.81 0 0.00 0 0.00 2 0.90 2.21 0.14

Chronic lymphocytic 3 3.25 6 2.05 4 1.82 2 0.83 15 8.47 1.77 0.81

Acute non-lymphocytic 2 2.45 9 3.47* 4 2.06 5 2.28 20 7.54 2.65* 1.54

Chronic myeloid 0 0.00 5 4.71* 1 1.27 1 1.12 7 3.08 2.27 0.48

Soft Tissues

Both Sexes

Table 12.2.2: Risk of subsequent primary cancers after cancer of the soft tissues including heart, both sexes,

SEER 1973-2000.

324 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

SOFT TISSUES

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 12,448 10,117 5,565 3,172 12,448

Person-years in interval 9,261 29,365 21,136 21,149 80,911

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 37,323 PYR and for male cancers on 43,588 PYR.
Soft Tissues

Females

Table 12.2.3: Risk of subsequent primary cancers after cancer of the soft tissues including heart, females,

SEER 1973-2000.

SOFT TISSUES

All subsequent cancers 45 1.39* 118 1.15 105 1.33* 94 1.08 362 300.92 1.20* 16.37

All excluding same site 42 1.30 110 1.07 100 1.28* 92 1.06 344 299.58 1.15* 11.90

Buccal cavity, pharynx 1 1.73 1 0.55 3 2.20 1 0.70 6 5.20 1.15 0.22

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.09

Tongue 0 0.00 0 0.00 1 3.31 1 3.11 2 1.15 1.74 0.23

Salivary gland 1 14.80 0 0.00 0 0.00 0 0.00 1 0.62 1.61 0.10

Mouth 0 0.00 0 0.00 1 2.16 0 0.00 1 1.77 0.57 -0.21

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.06

Tonsil 0 0.00 1 6.30 0 0.00 0 0.00 1 0.44 2.26 0.15

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.03

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.09

Digestive system 8 1.05 14 0.59* 11 0.62 15 0.79 48 67.92 0.71* -5.34

Esophagus 0 0.00 0 0.00 1 2.04 0 0.00 1 1.88 0.53 -0.24

Stomach 1 1.58 3 1.56 3 2.13 2 1.36 9 5.43 1.66 0.96

Small intestine 0 0.00 0 0.00 1 3.78 1 3.19 2 1.02 1.97 0.26

Colon 3 0.79 9 0.76 4 0.45 6 0.64 22 33.84 0.65* -3.17

Rectum, rectosigmoid junction 2 1.68 1 0.27 0 0.00 1 0.36 4 10.37 0.39* -1.71

Rectum 2 2.56 0 0.00 0 0.00 1 0.54 3 6.83 0.44 -1.03

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.92 0.00 -0.25

Liver 0 0.00 0 0.00 0 0.00 1 2.14 1 1.55 0.65 -0.15

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.48 0.00 -0.40

Bile ducts, other biliary 1 6.09 0 0.00 0 0.00 1 2.21 2 1.53 1.31 0.13

Pancreas 0 0.00 1 0.33 1 0.43 3 1.17 5 8.97 0.56 -1.06

Respiratory system 8 2.04 15 1.17 9 0.89 12 1.01 44 38.66 1.14 1.43

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.11

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.23 0.00 -0.33

Lung, bronchus 8 2.14 15 1.23 9 0.93 11 0.97 43 36.91 1.17 1.63

Female breast 13 1.41 26 0.88 38 1.66* 23 0.90 100 87.36 1.14 3.39

Female genital system 3 0.71 16 1.20 15 1.53 11 1.05 45 37.81 1.19 1.93

Cervix uteri 0 0.00 0 0.00 1 0.75 1 0.76 2 5.12 0.39 -0.84

Corpus uteri 2 0.97 8 1.25 8 1.71 6 1.20 24 18.13 1.32 1.57

Ovary 0 0.00 6 1.54 6 2.03 2 0.62 14 11.31 1.24 0.72

Vagina 1 15.10 0 0.00 0 0.00 0 0.00 1 0.59 1.69 0.11

Vulva 0 0.00 1 1.64 0 0.00 2 3.90 3 1.78 1.68 0.33

Urinary system 2 1.32 7 1.46 3 0.81 10 2.44* 22 14.11 1.56 2.11

Urinary bladder 0 0.00 5 1.77 3 1.39 8 3.39* 16 8.24 1.94* 2.08

Kidney parenchyma 2 4.07 2 1.26 0 0.00 1 0.70 5 4.75 1.05 0.07

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 3.22 1 1.12 0.89 -0.03

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.09

Bone, joints 0 0.00 3 24.98* 2 22.41* 1 10.50 6 0.34 17.51* 1.52

Soft tissue including heart 3 20.45* 8 17.42* 5 14.52* 2 5.19 18 1.34 13.48* 4.46

Kaposi sarcoma 1 73.88 0 0.00 0 0.00 0 0.00 1 0.12 8.07 0.23

Melanoma of skin 0 0.00 2 0.87 3 1.64 1 0.48 6 6.91 0.87 -0.24

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.12

Brain, central nervous system 0 0.00 3 2.67 1 1.18 0 0.00 4 3.23 1.24 0.21

Thyroid 1 2.60 2 1.58 1 1.04 2 1.85 6 3.69 1.63 0.62

Lymphatic, hematopoietic 3 1.19 17 2.13* 9 1.47 12 1.78 41 23.34 1.76* 4.73

Hodgkin lymphoma 0 0.00 1 2.74 0 0.00 0 0.00 1 1.02 0.98 -0.01

Non-Hodgkin lymphoma 0 0.00 5 1.35 6 2.08 8 2.44* 19 11.02 1.72* 2.14

Myeloma 1 2.34 5 3.71* 0 0.00 1 0.87 7 3.96 1.77 0.81

Leukemia 2 2.43 6 2.34 3 1.56 3 1.47 14 7.34 1.91* 1.78

Acute lymphocytic 0 0.00 1 7.60 0 0.00 0 0.00 1 0.34 2.94 0.18

Chronic lymphocytic 0 0.00 2 2.15 1 1.43 1 1.36 4 2.67 1.50 0.36

Acute non-lymphocytic 2 6.91 2 2.20 1 1.46 2 2.66 7 2.63 2.66* 1.17

Chronic myeloid 0 0.00 1 2.79 0 0.00 0 0.00 1 1.03 0.97 -0.01

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,661 4,619 2,560 1,475 5,661

Person-years in interval 4,217 13,474 9,815 9,818 37,323

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BONE AND SOFT TISSUE, AND KAPOSI SARCOMA 325
All subsequent cancers 72 1.27 236 1.29* 162 1.15 174 1.06 644 544.81 1.18* 22.76

All excluding same site 69 1.22 228 1.25* 160 1.14 171 1.05 628 542.49 1.16* 19.62

Buccal cavity, pharynx 2 1.10 5 0.86 2 0.47 5 1.12 14 16.33 0.86 -0.53

Lip 0 0.00 0 0.00 1 1.40 0 0.00 1 2.77 0.36 -0.41

Tongue 0 0.00 2 1.80 1 1.19 1 1.10 4 3.20 1.25 0.18

Salivary gland 1 7.06 1 2.18 0 0.00 0 0.00 2 1.36 1.47 0.15

Mouth 0 0.00 1 0.73 0 0.00 2 1.99 3 3.82 0.79 -0.19

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.70 0.00 -0.16

Tonsil 0 0.00 0 0.00 0 0.00 1 2.21 1 1.62 0.62 -0.14

Oropharynx 0 0.00 1 6.05 0 0.00 0 0.00 1 0.48 2.10 0.12

Hypopharynx 0 0.00 0 0.00 0 0.00 1 2.09 1 1.79 0.56 -0.18

Digestive system 13 1.04 40 1.00 39 1.30 37 1.11 129 115.85 1.11 3.02

Esophagus 1 1.29 1 0.40 2 1.04 4 1.80 8 7.42 1.08 0.13

Stomach 3 1.98 6 1.26 7 2.02 9 2.42* 25 13.45 1.86* 2.65

Small intestine 1 5.94 0 0.00 0 0.00 0 0.00 1 1.67 0.60 -0.15

Colon 5 0.95 17 1.01 15 1.18 9 0.63 46 49.25 0.93 -0.75

Rectum, rectosigmoid junction 2 0.88 9 1.25 5 0.93 5 0.87 21 20.65 1.02 0.08

Anus, anal canal 0 0.00 0 0.00 1 4.62 0 0.00 1 0.84 1.19 0.04

Liver 1 1.94 1 0.60 1 0.78 0 0.00 3 5.02 0.60 -0.46

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.96 0.00 -0.22

Bile ducts, other biliary 0 0.00 0 0.00 1 1.54 2 2.52 3 2.57 1.17 0.10

Pancreas 0 0.00 5 1.10 5 1.48 8 2.12 18 13.11 1.37 1.12

Respiratory system 10 0.91 37 1.04 28 1.04 32 1.08 107 103.12 1.04 0.89

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.84 0.00 -0.19

Larynx 0 0.00 5 1.74 2 0.93 3 1.34 10 8.16 1.23 0.42

Lung, bronchus 10 1.00 32 0.99 26 1.06 29 1.07 97 93.83 1.03 0.73

Male breast 0 0.00 0 0.00 1 3.79 1 3.20 2 1.03 1.94 0.22

Male genital system 27 1.61* 70 1.28 51 1.18 47 0.85 195 169.84 1.15 5.77

Prostate 26 1.58* 70 1.30* 49 1.15 45 0.83 190 166.88 1.14 5.30

Testis 0 0.00 0 0.00 2 4.17 0 0.00 2 1.86 1.08 0.03

Urinary system 8 1.45 21 1.18 15 1.11 15 0.95 59 52.49 1.12 1.49

Urinary bladder 4 1.01 16 1.26 12 1.24 11 0.98 43 37.56 1.14 1.25

Kidney parenchyma 3 2.44 3 0.75 3 0.96 1 0.27 10 12.04 0.83 -0.47

Renal pelvis, other urinary 1 3.14 2 1.97 0 0.00 3 3.69 6 2.89 2.08 0.71

Ureter 0 0.00 1 2.94 0 0.00 0 0.00 1 0.97 1.03 0.01

Bone, joints 0 0.00 4 20.14* 0 0.00 2 12.99* 6 0.56 10.72* 1.25

Soft tissue including heart 3 11.87* 8 10.11* 2 3.42 3 4.35 16 2.32 6.90* 3.14

Kaposi sarcoma 2 9.38* 2 2.79 0 0.00 0 0.00 4 2.09 1.91 0.44

Melanoma of skin 1 0.73 10 2.17* 7 1.91 14 3.06* 32 14.21 2.25* 4.08

Eye, orbit 0 0.00 1 3.63 0 0.00 0 0.00 1 0.78 1.27 0.05

Brain, central nervous system 0 0.00 4 1.97 2 1.31 2 1.20 8 5.86 1.37 0.49

Thyroid 1 4.29 4 5.32* 2 3.56 1 1.57 8 2.18 3.66* 1.33

Lymphatic, hematopoietic 4 0.91 25 1.77* 11 1.02 11 0.88 51 41.77 1.22 2.12

Hodgkin lymphoma 0 0.00 1 1.55 0 0.00 1 2.15 2 1.78 1.13 0.05

Non-Hodgkin lymphoma 0 0.00 2 0.33 3 0.63 4 0.70 9 18.35 0.49* -2.15

Myeloma 1 1.41 5 2.19 1 0.57 1 0.49 8 6.80 1.18 0.28

Leukemia 3 1.86 17 3.31* 7 1.84 5 1.16 32 14.85 2.16* 3.93

Acute lymphocytic 0 0.00 1 4.70 0 0.00 0 0.00 1 0.56 1.77 0.10

Chronic lymphocytic 3 4.80 4 2.00 3 2.00 1 0.59 11 5.80 1.90 1.19

Acute non-lymphocytic 0 0.00 7 4.16* 3 2.38 3 2.08 13 4.91 2.65* 1.86

Chronic myeloid 0 0.00 4 5.69* 1 1.92 1 1.66 6 2.05 2.93* 0.91

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,787 5,498 3,005 1,697 6,787

Person-years in interval 5,044 15,891 11,321 11,331 43,588

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Soft Tissues

Males

Table 12.2.4: Risk of subsequent primary cancers after cancer of the soft tissues including heart, males,

SEER 1973-2000.

326 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

SOFT TISSUES

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Soft Tissues

Both Sexes, <18 Years of Age

Table 12.2.5: Risk of subsequent primary cancers after cancer of the soft tissues including heart, both sexes,

<18 years of age, SEER 1973-2000.

SOFT TISSUES

All subsequent cancers 0 0.00 5 7.85* 4 6.32* 11 5.98* 20 3.29 6.07* 14.28

All excluding same site 0 0.00 5 8.32* 3 4.94 11 6.13* 19 3.17 5.99* 13.53

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 3 81.37* 3 0.06 49.72* 2.51

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Tongue 0 0.00 0 0.00 0 0.00 1 133.20* 1 0.01 99.97* 0.85

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.02

Mouth 0 0.00 0 0.00 0 0.00 1 171.24* 1 0.01 100.34* 0.85

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Tonsil 0 0.00 0 0.00 0 0.00 1 .† 1 0.00 475.45* 0.85

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Digestive system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.12

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Colon 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.04

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.02

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.02

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Respiratory system 0 0.00 0 0.00 1 108.74* 0 0.00 1 0.06 15.51 0.80

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Lung, bronchus 0 0.00 0 0.00 1 280.75* 0 0.00 1 0.04 28.41 0.82

Female breast 0 0.00 0 0.00 0 0.00 4 19.24* 4 0.22 18.08* 6.47

Female genital system 0 0.00 0 0.00 0 0.00 1 5.16 1 0.26 3.82 1.26

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.19

Corpus uteri 0 0.00 0 0.00 0 0.00 1 47.90 1 0.02 43.47 1.67

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.19

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Male genital system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.44

Prostate 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 -0.01

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.43

Urinary system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.09

Urinary bladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.02

Kidney parenchyma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.06

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Bone, joints 0 0.00 2 64.32* 1 34.32 2 54.36* 5 0.11 47.38* 4.18

Soft tissue including heart 0 0.00 0 0.00 1 38.03 0 0.00 1 0.12 8.34 0.75

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.08

Melanoma of skin 0 0.00 0 0.00 0 0.00 1 4.76 1 0.29 3.44 0.61

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.02

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.28

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.21

Lymphatic, hematopoietic 0 0.00 3 12.30* 0 0.00 0 0.00 3 0.90 3.32 1.79

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.26

Non-Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.20

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Leukemia 0 0.00 3 20.83* 0 0.00 0 0.00 3 0.37 8.14* 2.25

Acute lymphocytic 0 0.00 1 9.43 0 0.00 0 0.00 1 0.23 4.38 0.66

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Acute non-lymphocytic 0 0.00 2 66.03* 0 0.00 0 0.00 2 0.10 19.63* 1.62

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.02

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,448 1,238 753 501 1,448

Person-years in interval 1,117 3,729 3,073 3,778 11,697

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. †O/E > 500. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.)

primary cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per

10,000 person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 5,839 PYR and for male cancers on 5,858 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BONE AND SOFT TISSUE, AND KAPOSI SARCOMA 327
All subsequent cancers 2 4.71 8 4.30* 7 3.02* 10 1.68 27 10.57 2.56* 16.14

All excluding same site 1 2.42 6 3.30* 6 2.63 9 1.52 22 10.41 2.11* 11.38

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.27

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.03

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.06

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.05

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.05

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.04

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.03

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Digestive system 0 0.00 0 0.00 0 0.00 3 4.41 3 0.95 3.15 2.01

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.04

Stomach 0 0.00 0 0.00 0 0.00 1 14.25 1 0.10 9.59 0.88

Small intestine 0 0.00 0 0.00 0 0.00 1 44.66 1 0.03 30.78 0.95

Colon 0 0.00 0 0.00 0 0.00 1 4.27 1 0.34 2.95 0.65

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.19

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.04

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.07

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.02

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.08

Respiratory system 0 0.00 0 0.00 0 0.00 2 4.67 2 0.54 3.71 1.43

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.02

Larynx 0 0.00 0 0.00 0 0.00 1 23.55 1 0.05 19.19 0.93

Lung, bronchus 0 0.00 0 0.00 0 0.00 1 2.71 1 0.45 2.23 0.54

Female breast 0 0.00 1 5.49 3 7.93* 1 0.69 5 2.04 2.45 6.21

Female genital system 0 0.00 0 0.00 0 0.00 1 1.73 1 1.11 0.90 -0.24

Cervix uteri 0 0.00 0 0.00 0 0.00 1 4.86 1 0.50 2.02 1.06

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.46

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.70

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.02

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.07

Male genital system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.76 0.00 -1.41

Prostate 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.31

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -1.09

Urinary system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.39

Urinary bladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.19

Kidney parenchyma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.18

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.07

Soft tissue including heart 1 85.87* 2 48.84* 1 27.04 1 16.28 5 0.15 33.11* 4.76

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.52 0.00 -0.51

Melanoma of skin 0 0.00 1 4.38 1 3.72 1 1.93 3 1.07 2.81 1.90

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.03

Brain, central nervous system 0 0.00 1 10.77 1 10.98 0 0.00 2 0.36 5.60 1.61

Thyroid 0 0.00 1 5.69 0 0.00 1 3.87 2 0.65 3.07 1.32

Lymphatic, hematopoietic 1 10.23 2 5.51 0 0.00 0 0.00 3 1.47 2.04 1.50

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.41

Non-Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.68 0.00 -0.66

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.05

Leukemia 1 45.22 2 25.78* 0 0.00 0 0.00 3 0.32 9.37* 2.63

Acute lymphocytic 0 0.00 1 55.96 0 0.00 0 0.00 1 0.05 18.86 0.93

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.03

Acute non-lymphocytic 1 94.35* 1 27.00 0 0.00 0 0.00 2 0.14 14.44* 1.83

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.07

Soft Tissues

Both Sexes, 18-29 Years of Age

Table 12.2.6: Risk of subsequent primary cancers after cancer of the soft tissues including heart, both sexes,

18-29 years of age, SEER 1973-2000.

328 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

SOFT TISSUES

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,292 1,087 665 431 1,292

Person-years in interval 990 3,343 2,700 3,151 10,183

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 4,769 PYR and for male cancers on 5,415 PYR.
Soft Tissues

Both Sexes, ≥30 Years of Age

Table 12.2.7: Risk of subsequent primary cancers after cancer of the soft tissues including heart, both sexes,

≥30 years of age, SEER 1973-2000.

SOFT TISSUES

All subsequent cancers 115 1.30* 341 1.20* 256 1.18* 247 1.02 959 831.87 1.15* 21.54

All excluding same site 110 1.25* 327 1.16* 251 1.17* 243 1.00 931 828.49 1.12* 17.37

Buccal cavity, pharynx 3 1.26 6 0.79 5 0.90 3 0.53 17 21.19 0.80 -0.71

Lip 0 0.00 0 0.00 1 1.26 0 0.00 1 3.08 0.32 -0.35

Tongue 0 0.00 2 1.33 2 1.77 1 0.85 5 4.28 1.17 0.12

Salivary gland 2 9.72* 1 1.52 0 0.00 0 0.00 3 1.92 1.57 0.18

Mouth 0 0.00 1 0.50 1 0.69 1 0.69 3 5.53 0.54 -0.43

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.88 0.00 -0.15

Tonsil 0 0.00 1 1.38 0 0.00 0 0.00 1 2.03 0.49 -0.17

Oropharynx 0 0.00 1 4.77 0 0.00 0 0.00 1 0.60 1.67 0.07

Hypopharynx 0 0.00 0 0.00 0 0.00 1 1.79 1 2.11 0.47 -0.19

Digestive system 21 1.05 54 0.85 50 1.05 49 0.95 174 182.67 0.95 -1.47

Esophagus 1 1.02 1 0.32 3 1.24 4 1.47 9 9.27 0.97 -0.04

Stomach 4 1.87 9 1.35 10 2.06 10 1.96 33 18.76 1.76* 2.41

Small intestine 1 3.68 0 0.00 1 1.45 0 0.00 2 2.65 0.75 -0.11

Colon 8 0.88 26 0.91 19 0.88 14 0.60 67 82.71 0.81 -2.66

Rectum, rectosigmoid junction 4 1.16 10 0.92 5 0.62 6 0.71 25 30.80 0.81 -0.98

Anus, anal canal 0 0.00 0 0.00 1 2.21 0 0.00 1 1.72 0.58 -0.12

Liver 1 1.47 1 0.46 1 0.60 1 0.51 4 6.48 0.62 -0.42

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 2.44 0.00 -0.41

Bile ducts, other biliary 1 2.33 0 0.00 1 0.96 3 2.44 5 4.07 1.23 0.16

Pancreas 0 0.00 6 0.79 6 1.05 11 1.76 23 21.98 1.05 0.17

Respiratory system 18 1.20 52 1.08 36 0.97 42 1.03 148 141.17 1.05 1.16

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 1.23 0.00 -0.21

Larynx 0 0.00 5 1.52 2 0.81 2 0.79 9 9.33 0.96 -0.06

Lung, bronchus 18 1.31 47 1.06 34 1.00 39 1.03 138 130.26 1.06 1.31

Female breast 13 1.42 25 0.85 35 1.56* 18 0.75 91 85.10 1.07 2.21

Female genital system 3 0.72 16 1.23 15 1.58 9 0.93 43 36.44 1.18 2.46

Cervix uteri 0 0.00 0 0.00 1 0.86 0 0.00 1 4.51 0.22 -1.31

Corpus uteri 2 0.98 8 1.25 8 1.73 5 1.04 23 17.89 1.29 1.91

Ovary 0 0.00 6 1.57 6 2.10 2 0.67 14 10.87 1.29 1.17

Vagina 1 15.25 0 0.00 0 0.00 0 0.00 1 0.58 1.73 0.16

Vulva 0 0.00 1 1.66 0 0.00 2 4.10 3 1.74 1.72 0.47

Male genital system 27 1.61* 70 1.28* 51 1.18 47 0.86 195 168.82 1.16 8.10

Prostate 26 1.58* 70 1.30* 49 1.15 45 0.83 190 166.71 1.14 7.21

Testis 0 0.00 0 0.00 2 7.90 0 0.00 2 1.02 1.96 0.30

Urinary system 10 1.43 28 1.25 18 1.05 25 1.28 81 66.11 1.23 2.52

Urinary bladder 4 0.82 21 1.35 15 1.27 19 1.41 59 45.58 1.29 2.27

Kidney parenchyma 5 2.93 5 0.90 3 0.69 2 0.40 15 16.53 0.91 -0.26

Renal pelvis, other urinary 1 2.25 2 1.43 0 0.00 4 3.59 7 4.00 1.75 0.51

Ureter 0 0.00 1 2.18 0 0.00 0 0.00 1 1.31 0.77 -0.05

Bone, joints 0 0.00 5 18.86* 1 5.33 1 5.22 7 0.73 9.61* 1.06

Soft tissue including heart 5 13.30* 14 11.94* 5 5.77* 4 4.13* 28 3.38 8.28* 4.17

Kaposi sarcoma 3 14.21* 2 3.05 0 0.00 0 0.00 5 1.60 3.12* 0.58

Melanoma of skin 1 0.50 11 1.65 9 1.74 13 2.19* 34 19.76 1.72* 2.41

Eye, orbit 0 0.00 1 2.43 0 0.00 0 0.00 1 1.16 0.86 -0.03

Brain, central nervous system 0 0.00 6 2.03 2 0.91 2 0.86 10 8.41 1.19 0.27

Thyroid 2 3.50 5 2.76 3 2.31 2 1.54 12 4.98 2.41* 1.19

Lymphatic, hematopoietic 6 0.89 37 1.72* 20 1.23 23 1.26 86 62.74 1.37* 3.94

Hodgkin lymphoma 0 0.00 2 2.53 0 0.00 1 2.03 3 2.08 1.44 0.16

Non-Hodgkin lymphoma 0 0.00 7 0.73 9 1.21 12 1.42 28 28.46 0.98 -0.08

Myeloma 2 1.76 10 2.76* 1 0.36 2 0.63 15 10.70 1.40 0.73

Leukemia 4 1.69 18 2.41* 10 1.79 8 1.31 40 21.50 1.86* 3.13

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -0.11

Chronic lymphocytic 3 3.25 6 2.05 4 1.82 2 0.84 15 8.44 1.78 1.11

Acute non-lymphocytic 1 1.26 6 2.38 4 2.12 5 2.39 16 7.30 2.19* 1.47

Chronic myeloid 0 0.00 5 4.81* 1 1.31 1 1.19 7 2.98 2.35 0.68

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 9,708 7,792 4,147 2,240 9,708

Person-years in interval 7,154 22,293 15,363 14,221 59,031

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 26,715 PYR and for male cancers on 32,315 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BONE AND SOFT TISSUE, AND KAPOSI SARCOMA 329
All subsequent cancers 49 1.33 149 1.33* 93 1.21 82 1.20 373 294.37 1.27* 27.89

All excluding same site 46 1.25 142 1.27* 91 1.19 80 1.17 359 293.10 1.22* 23.38

Buccal cavity, pharynx 1 1.03 2 0.70 1 0.53 2 1.28 6 7.31 0.82 -0.46

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 1.03 0.00 -0.36

Tongue 0 0.00 1 1.72 0 0.00 1 3.00 2 1.50 1.33 0.18

Salivary gland 1 11.69 0 0.00 0 0.00 0 0.00 1 0.68 1.46 0.11

Mouth 0 0.00 0 0.00 1 2.03 1 2.51 2 1.90 1.06 0.04

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.11

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.70 0.00 -0.25

Oropharynx 0 0.00 1 12.67 0 0.00 0 0.00 1 0.20 4.94 0.28

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.72 0.00 -0.26

Digestive system 8 0.98 24 0.98 15 0.91 14 0.99 61 63.19 0.97 -0.78

Esophagus 1 2.48 0 0.00 2 2.39 1 1.34 4 3.21 1.25 0.28

Stomach 2 2.32 3 1.19 3 1.83 3 2.17 11 6.39 1.72 1.63

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.94 0.00 -0.33

Colon 3 0.81 14 1.27 5 0.67 3 0.46 25 28.61 0.87 -1.28

Rectum, rectosigmoid junction 2 1.42 5 1.20 1 0.36 2 0.87 10 10.61 0.94 -0.21

Anus, anal canal 0 0.00 0 0.00 1 6.18 0 0.00 1 0.62 1.62 0.14

Liver 0 0.00 1 1.15 0 0.00 0 0.00 1 2.30 0.43 -0.46

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -0.30

Bile ducts, other biliary 0 0.00 0 0.00 1 2.67 1 2.89 2 1.44 1.39 0.20

Pancreas 0 0.00 0 0.00 1 0.51 4 2.32 5 7.60 0.66 -0.92

Respiratory system 6 0.96 20 1.06 12 0.94 14 1.26 52 49.05 1.06 1.05

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.15

Larynx 0 0.00 3 2.40 1 1.21 1 1.47 5 3.18 1.57 0.65

Lung, bronchus 6 1.05 17 0.98 11 0.93 13 1.26 47 45.31 1.04 0.60

Female breast 7 1.79 10 0.85 11 1.34 7 0.97 35 31.07 1.13 3.01

Female genital system 1 0.57 8 1.55 3 0.87 2 0.69 14 13.27 1.05 0.56

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 1.70 0.00 -1.30

Corpus uteri 1 1.17 5 2.00 1 0.60 2 1.44 9 6.41 1.40 1.98

Ovary 0 0.00 2 1.30 2 1.90 0 0.00 4 4.02 1.00 -0.01

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.15

Vulva 0 0.00 1 4.17 0 0.00 0 0.00 1 0.64 1.56 0.28

Male genital system 10 1.42 27 1.23 17 1.09 18 1.19 72 59.59 1.21 8.21

Prostate 9 1.31 27 1.25 16 1.05 18 1.21 70 58.52 1.20 7.59

Testis 0 0.00 0 0.00 1 5.83 0 0.00 1 0.69 1.44 0.20

Urinary system 3 1.04 14 1.60 7 1.17 5 0.93 29 23.03 1.26 2.12

Urinary bladder 0 0.00 12 1.99* 7 1.71 3 0.82 22 15.80 1.39 2.20

Kidney parenchyma 3 4.16 1 0.45 0 0.00 0 0.00 4 5.86 0.68 -0.66

Renal pelvis, other urinary 0 0.00 1 1.87 0 0.00 2 6.57 3 1.37 2.18 0.58

Ureter 0 0.00 1 5.70 0 0.00 0 0.00 1 0.45 2.23 0.20

Bone, joints 0 0.00 4 32.69* 2 24.56* 2 27.71* 8 0.32 25.19* 2.73

Soft tissue including heart 3 18.34* 7 14.47* 2 6.09 2 6.73 14 1.27 11.00* 4.51

Kaposi sarcoma 2 20.36* 0 0.00 0 0.00 0 0.00 2 0.78 2.57 0.43

Melanoma of skin 1 1.13 6 2.14 2 1.00 7 3.74* 16 7.57 2.11* 2.99

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.15

Brain, central nervous system 0 0.00 3 2.44 1 1.21 0 0.00 4 3.18 1.26 0.29

Thyroid 1 3.87 1 1.26 2 3.68 1 2.07 5 2.08 2.41 1.04

Lymphatic, hematopoietic 5 1.75 19 2.20* 12 2.03* 6 1.13 42 22.73 1.85* 6.84

Hodgkin lymphoma 0 0.00 1 2.59 0 0.00 0 0.00 1 0.98 1.02 0.01

Non-Hodgkin lymphoma 0 0.00 3 0.77 6 2.19 4 1.61 13 10.40 1.25 0.92

Myeloma 2 4.29 5 3.56* 1 1.04 0 0.00 8 3.70 2.16 1.52

Leukemia 3 3.04 10 3.39* 5 2.53 2 1.16 20 7.64 2.62* 4.39

Acute lymphocytic 0 0.00 1 7.89 0 0.00 0 0.00 1 0.31 3.21 0.24

Chronic lymphocytic 2 5.35 1 0.89 1 1.33 0 0.00 4 2.90 1.38 0.39

Acute non-lymphocytic 1 2.99 5 4.99* 3 4.43 2 3.30 11 2.62 4.20* 2.97

Chronic myeloid 0 0.00 2 4.92 1 3.65 0 0.00 3 1.06 2.83 0.69

Soft Tissues

Both Sexes, Radiotherapy

Table 12.2.8: Risk of subsequent primary cancers after cancer of the soft tissues including heart, both sexes,

with initial radiotherapy, SEER 1973-2000.

330 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

SOFT TISSUES

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,075 4,053 1,971 1,027 5,075

Person-years in interval 3,767 11,106 7,241 6,075 28,189

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 13,070 PYR and for male cancers on 15,119 PYR.
Soft Tissues

Both Sexes, No Radiotherapy

Table 12.2.9: Risk of subsequent primary cancers after cancer of the soft tissues including heart, both sexes,

without initial radiotherapy, SEER 1973-2000.

SOFT TISSUES

All subsequent cancers 68 1.30* 205 1.18* 174 1.22* 186 1.02 633 551.36 1.15* 15.49

All excluding same site 65 1.25 196 1.13 169 1.19* 183 1.01 613 548.97 1.12* 12.14

Buccal cavity, pharynx 2 1.41 4 0.84 4 1.07 4 0.92 14 14.22 0.98 -0.04

Lip 0 0.00 0 0.00 1 1.85 0 0.00 1 2.09 0.48 -0.21

Tongue 0 0.00 1 1.08 2 2.67 1 1.11 4 2.85 1.40 0.22

Salivary gland 1 8.08 1 2.42 0 0.00 0 0.00 2 1.30 1.54 0.13

Mouth 0 0.00 1 0.80 0 0.00 1 0.91 2 3.69 0.54 -0.32

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.12

Tonsil 0 0.00 1 2.22 0 0.00 1 2.39 2 1.36 1.47 0.12

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.08

Hypopharynx 0 0.00 0 0.00 0 0.00 1 2.38 1 1.41 0.71 -0.08

Digestive system 13 1.09 30 0.77 35 1.12 38 0.99 116 120.57 0.96 -0.87

Esophagus 0 0.00 1 0.52 1 0.63 3 1.49 5 6.10 0.82 -0.21

Stomach 2 1.56 6 1.45 7 2.16 8 2.10 23 12.48 1.84* 2.00

Small intestine 1 6.32 0 0.00 1 2.23 1 1.64 3 1.75 1.72 0.24

Colon 5 0.93 12 0.68 14 0.99 12 0.70 43 54.49 0.79 -2.18

Rectum, rectosigmoid junction 2 0.97 5 0.74 4 0.75 4 0.64 15 20.41 0.73 -1.03

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 1.14 0.00 -0.22

Liver 1 2.54 0 0.00 1 0.93 1 0.68 3 4.27 0.70 -0.24

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.61 0.00 -0.31

Bile ducts, other biliary 1 3.97 0 0.00 0 0.00 2 2.22 3 2.65 1.13 0.07

Pancreas 0 0.00 6 1.28 5 1.33 7 1.52 18 14.47 1.24 0.67

Respiratory system 12 1.37 32 1.09 25 1.03 30 0.99 99 92.73 1.07 1.19

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.82 0.00 -0.16

Larynx 0 0.00 2 0.98 1 0.60 2 1.05 5 6.22 0.80 -0.23

Lung, bronchus 12 1.50 30 1.11 24 1.07 27 0.97 93 85.43 1.09 1.44

Female breast 6 1.13 16 0.90 27 1.84* 16 0.87 65 56.29 1.15 3.59

Female genital system 2 0.80 8 0.98 12 1.89 9 1.19 31 24.54 1.26 2.66

Cervix uteri 0 0.00 0 0.00 1 1.12 1 1.03 2 3.42 0.58 -0.59

Corpus uteri 1 0.83 3 0.77 7 2.32 4 1.11 15 11.72 1.28 1.35

Ovary 0 0.00 4 1.69 4 2.10 2 0.86 10 7.29 1.37 1.12

Vagina 1 25.70 0 0.00 0 0.00 0 0.00 1 0.39 2.57 0.25

Vulva 0 0.00 0 0.00 0 0.00 2 5.52 2 1.14 1.75 0.35

Male genital system 17 1.74* 43 1.31 34 1.22 29 0.73 123 110.26 1.12 4.48

Prostate 17 1.77* 43 1.34 33 1.21 27 0.69* 120 108.37 1.11 4.09

Testis 0 0.00 0 0.00 1 3.24 0 0.00 1 1.16 0.86 -0.06

Urinary system 7 1.69 14 1.02 11 0.98 20 1.38 52 43.58 1.19 1.60

Urinary bladder 4 1.39 9 0.95 8 1.04 16 1.61 37 30.01 1.23 1.33

Kidney parenchyma 2 2.00 4 1.18 3 1.06 2 0.54 11 10.93 1.01 0.01

Renal pelvis, other urinary 1 3.79 1 1.15 0 0.00 2 2.44 4 2.64 1.52 0.26

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.86 0.00 -0.16

Bone, joints 0 0.00 3 15.28* 0 0.00 1 5.65 4 0.58 6.84* 0.65

Soft tissue including heart 3 12.72* 9 11.74* 5 8.31* 3 3.86 20 2.38 8.40* 3.34

Kaposi sarcoma 1 7.78 2 4.39 0 0.00 0 0.00 3 1.44 2.08 0.30

Melanoma of skin 0 0.00 6 1.46 8 2.30 8 1.67 22 13.55 1.62* 1.60

Eye, orbit 0 0.00 1 3.74 0 0.00 0 0.00 1 0.80 1.26 0.04

Brain, central nervous system 0 0.00 4 2.07 2 1.29 2 1.07 8 5.91 1.35 0.40

Thyroid 1 2.78 5 4.10* 1 1.02 2 1.62 9 3.79 2.37* 0.99

Lymphatic, hematopoietic 2 0.49 23 1.71* 8 0.73 17 1.22 50 42.39 1.18 1.44

Hodgkin lymphoma 0 0.00 1 1.60 0 0.00 1 1.90 2 1.82 1.10 0.03

Non-Hodgkin lymphoma 0 0.00 4 0.68 3 0.61 8 1.24 15 18.97 0.79 -0.75

Myeloma 0 0.00 5 2.25 0 0.00 2 0.85 7 7.05 0.99 -0.01

Leukemia 2 1.38 13 2.74* 5 1.33 6 1.30 26 14.55 1.79* 2.17

Acute lymphocytic 0 0.00 1 4.60 0 0.00 0 0.00 1 0.59 1.69 0.08

Chronic lymphocytic 1 1.82 5 2.77 3 2.07 2 1.13 11 5.57 1.98 1.03

Acute non-lymphocytic 1 2.08 4 2.52 1 0.79 3 1.89 9 4.92 1.83 0.77

Chronic myeloid 0 0.00 3 4.58 0 0.00 1 1.54 4 2.02 1.98 0.38

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 7,373 6,064 3,594 2,145 7,373

Person-years in interval 5,493 18,259 13,895 15,074 52,722

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 24,253 PYR and for male cancers on 28,469 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BONE AND SOFT TISSUE, AND KAPOSI SARCOMA 331
Kaposi Sarcoma

Both Sexes, Diagnosis Years 1973-1979

Table 12.3.1: Characteristics of patients with an initial Kaposi sarcoma, both sexes,

SEER 1973-1979, with follow-up through 2000.

332 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

KAPOSI SARCOMA

Number of patients with 1st primary cancer

Total 155 100.0 55 100.0 210 100.0

Initial treatment

Any radiation 52 33.5 13 23.6 65 31.0

With surgery 13 8.4 4 7.3 17 8.1

Without surgery 39 25.2 9 16.4 48 22.9

No radiation 103 66.5 42 76.4 145 69.0

With surgery 66 42.6 32 58.2 98 46.7

Without surgery 37 23.9 10 18.2 47 22.4

Race

White 138 89.0 51 92.7 189 90.0

Black 10 6.5 3 5.5 13 6.2

Other 7 4.5 0 0.0 7 3.3

Unknown 0 0.0 1 1.8 1 0.5

Age at 1st primary cancer diagnosis, years

< 30 0 0.0 1 1.8 1 0.5

30–49 11 7.1 3 5.5 14 6.7

50–69 50 32.3 15 27.3 65 31.0

70–79 55 35.5 22 40.0 77 36.7

> 80 39 25.2 14 25.5 53 25.2

Number of patients with one or more

primary cancers

One primary cancer only 124 80.0 49 89.1 173 82.4

1st and 2nd cancers 25 16.1 6 10.9 31 14.8

1st, 2nd, and 3rd cancers 4 2.6 0 0.0 4 1.9

1st, 2nd, 3rd, and additional cancers 2 1.3 0 0.0 2 1.0

Other statistics

Median age at 1st cancer diagnosis 72.2 — 74.6 — 73.3 —

Median year of 1st cancer diagnosis 1976.5 — 1977.6 — 1977.0 —

Median person-years at risk 6.9 — 12.3 — 8.3 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 90.3 — 83.3 — 89.2

1st, 2nd, and additional cancers — 90.3 — 83.3 — 89.2

1st cancer only — 6.5 — 16.7 — 8.1

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Kaposi Sarcoma

Both Sexes, Diagnosis Years 1973-1979

Table 12.3.2: Risk of subsequent primary cancers after Kaposi sarcoma, both sexes,

SEER 1973-1979, with follow-up through 2000.

KAPOSI SARCOMA

All subsequent cancers 4 1.25 16 1.25 8 0.65 17 0.84 45 48.57 0.93 -16.36

All excluding same site 4 1.25 15 1.17 7 0.57 17 0.84 43 48.51 0.89 -25.23

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 2 4.68 2 1.23 1.63 3.53

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -1.27

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.95

Salivary gland 0 0.00 0 0.00 0 0.00 1 19.39 1 0.12 8.54 4.04

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -1.41

Nasopharynx 0 0.00 0 0.00 0 0.00 1 77.56* 1 0.04 26.20 4.41

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.43

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.13

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.53

Digestive system 1 1.14 3 0.86 1 0.31 5 1.03 10 12.42 0.81 -11.08

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.52 0.00 -2.39

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 1.49 0.00 -6.80

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.60

Colon 1 2.61 1 0.64 1 0.66 4 1.72 7 5.80 1.21 5.50

Rectum, rectosigmoid junction 0 0.00 2 3.21 0 0.00 1 1.35 3 2.08 1.45 4.23

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.36

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -1.58

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.79

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -1.18

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 1.44 0.00 -6.61

Respiratory system 0 0.00 2 0.90 2 0.96 1 0.32 5 7.99 0.63 -13.71

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.34

Larynx 0 0.00 0 0.00 1 7.17 0 0.00 1 0.53 1.90 2.17

Lung, bronchus 0 0.00 2 0.98 1 0.52 1 0.34 4 7.37 0.54 -15.43

Female breast 0 0.00 1 1.78 1 1.61 1 0.83 3 2.52 1.19 7.10

Female genital system 0 0.00 0 0.00 0 0.00 0 0.00 0 1.18 0.00 -17.42

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -1.94

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -8.49

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -5.05

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.36

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -1.07

Male genital system 0 0.00 6 2.12 1 0.36 3 0.58 10 11.52 0.87 -10.11

Prostate 0 0.00 6 2.15 1 0.36 3 0.58 10 11.40 0.88 -9.31

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.18

Urinary system 1 3.40 0 0.00 1 0.91 1 0.55 3 4.37 0.69 -6.25

Urinary bladder 1 4.45 0 0.00 1 1.21 0 0.00 2 3.27 0.61 -5.82

Kidney parenchyma 0 0.00 0 0.00 0 0.00 1 2.81 1 0.81 1.24 0.89

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -1.33

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.44

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.17

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.84

Kaposi sarcoma 0 0.00 1 66.50 1 61.45 0 0.00 2 0.06 32.07* 8.88

Melanoma of skin 0 0.00 0 0.00 0 0.00 0 0.00 0 0.77 0.00 -3.51

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.30

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -1.76

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.71

Lymphatic, hematopoietic 2 8.31 2 2.07 1 1.08 3 1.89 8 3.72 2.15 19.60

Hodgkin lymphoma 1 105.92* 0 0.00 0 0.00 0 0.00 1 0.10 9.61 4.10

Non-Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 2 3.01 2 1.42 1.41 2.65

Myeloma 1 23.37 0 0.00 1 6.07 1 3.56 3 0.66 4.53 10.71

Leukemia 0 0.00 2 4.67 0 0.00 0 0.00 2 1.53 1.30 2.14

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.17

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -2.83

Acute non-lymphocytic 0 0.00 1 7.40 0 0.00 0 0.00 1 0.49 2.03 2.32

Chronic myeloid 0 0.00 1 17.66 0 0.00 0 0.00 1 0.21 4.86 3.64

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 210 191 138 98 210

Person-years in interval 165 644 556 818 2,183

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 678 PYR and for male cancers on 1,505 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BONE AND SOFT TISSUE, AND KAPOSI SARCOMA 333
Kaposi Sarcoma

Both Sexes, Diagnosis Years 1980-2000

Table 12.3.3: Characteristics of patients with an initial Kaposi sarcoma, both sexes,

SEER 1980-2000.

334 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

KAPOSI SARCOMA

Number of patients with 1st primary cancer

Total 11,175 100.0 294 100.0 11,469 100.0

Initial treatment

Any radiation 2,798 25.0 91 31.0 2,889 25.2

With surgery 302 2.7 27 9.2 329 2.9

Without surgery 2,496 22.3 64 21.8 2,560 22.3

No radiation 8,377 75.0 203 69.0 8,580 74.8

With surgery 1,236 11.1 101 34.4 1,337 11.7

Without surgery 7,141 63.9 102 34.7 7,243 63.2

Race

White 9,567 85.6 228 77.6 9,795 85.4

Black 1,207 10.8 51 17.3 1,258 11.0

Other 304 2.7 9 3.1 313 2.7

Unknown 97 0.9 6 2.0 103 0.9

Age at 1st primary cancer diagnosis, years

< 30 1,349 12.1 13 4.4 1,362 11.9

30–49 8,539 76.4 56 19.0 8,595 74.9

50–69 940 8.4 29 9.9 969 8.4

70–79 196 1.8 64 21.8 260 2.3

> 80 151 1.4 132 44.9 283 2.5

Number of patients with one or more

primary cancers

One primary cancer only 10,487 93.8 272 92.5 10,759 93.8

1st and 2nd cancers 678 6.1 20 6.8 698 6.1

1st, 2nd, and 3rd cancers 9 0.1 2 0.7 11 0.1

1st, 2nd, 3rd, and additional cancers 1 0.0 0 0.0 1 0.0

Other statistics

Median age at 1st cancer diagnosis 37.6 — 78.1 — 37.8 —

Median year of 1st cancer diagnosis 1991.0 — 1991.8 — 1991.0 —

Median person-years at risk 1.2 — 2.9 — 1.2 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 69.6 — 77.3 — 69.9

1st, 2nd, and additional cancers — 69.5 — 77.3 — 69.7

1st cancer only — 6.5 — 18.2 — 6.9

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Kaposi Sarcoma

Both Sexes, Diagnosis Years 1980-2000

Table 12.3.4: Risk of subsequent primary cancers after Kaposi sarcoma, both sexes,

SEER 1980-2000.

KAPOSI SARCOMA

All subsequent cancers 260 9.60* 370 5.22* 73 1.95* 20 1.12 723 153.23 4.72* 231.23

All excluding same site 259 10.01* 366 5.28* 71 1.91* 20 1.12 716 150.12 4.77* 229.65

Buccal cavity, pharynx 0 0.00 3 1.38 0 0.00 0 0.00 3 4.52 0.66 -0.62

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.70 0.00 -0.28

Tongue 0 0.00 2 4.34 0 0.00 0 0.00 2 0.95 2.10 0.43

Salivary gland 0 0.00 1 4.83 0 0.00 0 0.00 1 0.44 2.26 0.23

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 1.05 0.00 -0.43

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.08

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.52 0.00 -0.21

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.16

Digestive system 8 1.48 24 1.57* 14 1.68 7 1.78 53 32.91 1.61* 8.15

Esophagus 0 0.00 1 1.19 0 0.00 1 4.45 2 1.83 1.10 0.07

Stomach 2 3.32 2 1.22 1 1.14 1 2.46 6 3.53 1.70 1.00

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -0.22

Colon 1 0.43 7 1.04 4 1.06 2 1.12 14 14.60 0.96 -0.24

Rectum, rectosigmoid junction 1 1.07 1 0.39 3 2.23 2 3.24 7 5.46 1.28 0.62

Anus, anal canal 3 41.27* 6 34.68* 3 39.38* 1 31.97 13 0.35 36.81* 5.13

Liver 0 0.00 5 7.96* 2 5.91 0 0.00 7 1.36 5.16* 2.29

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.14

Bile ducts, other biliary 1 8.52 0 0.00 0 0.00 0 0.00 1 0.78 1.29 0.09

Pancreas 0 0.00 1 0.57 1 1.04 0 0.00 2 3.80 0.53 -0.73

Respiratory system 6 1.47 9 0.82 6 1.01 1 0.34 22 23.89 0.92 -0.77

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.11

Larynx 0 0.00 1 1.17 2 4.79 0 0.00 3 1.81 1.65 0.48

Lung, bronchus 6 1.65 7 0.71 4 0.73 1 0.37 18 21.71 0.83 -1.51

Female breast 1 1.31 2 0.82 0 0.00 0 0.00 3 4.98 0.60 -15.58

Female genital system 1 3.13 1 1.00 0 0.00 0 0.00 2 2.04 0.98 -0.29

Cervix uteri 1 28.35 1 9.74 0 0.00 0 0.00 2 0.20 9.95* 14.13

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.91 0.00 -7.17

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -5.06

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.36

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -1.30

Male genital system 6 1.06 16 0.95 10 0.99 4 0.77 36 37.71 0.95 -0.73

Prostate 4 0.82 15 0.96 9 0.92 4 0.78 32 35.38 0.90 -1.44

Testis 2 2.70 1 0.93 1 4.86 0 0.00 4 2.06 1.94 0.83

Urinary system 0 0.00 6 0.96 5 1.46 2 1.15 13 13.69 0.95 -0.28

Urinary bladder 0 0.00 6 1.41 4 1.65 0 0.00 10 9.47 1.06 0.22

Kidney parenchyma 0 0.00 0 0.00 1 1.22 2 5.23 3 3.50 0.86 -0.20

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.72 0.00 -0.29

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.09

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.10

Soft tissue including heart 0 0.00 1 2.33 0 0.00 0 0.00 1 0.89 1.12 0.04

Kaposi sarcoma 1 0.83 4 2.50 2 7.56 0 0.00 7 3.11 2.25 1.58

Melanoma of skin 4 2.94 1 0.35 4 3.43 2 3.80 11 5.88 1.87 2.08

Eye, orbit 1 19.09 0 0.00 0 0.00 0 0.00 1 0.25 3.98 0.30

Brain, central nervous system 2 3.77 0 0.00 0 0.00 0 0.00 2 2.16 0.93 -0.06

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.13 0.00 -0.46

Lymphatic, hematopoietic 227 75.25* 297 43.11* 30 9.41* 4 2.74 558 14.55 38.35* 220.55

Hodgkin lymphoma 2 6.29 5 9.89* 2 14.80* 0 0.00 9 1.00 9.01* 3.25

Non-Hodgkin lymphoma 222 143.61* 287 84.87* 28 18.72* 2 2.99 539 7.09 75.99* 215.87

Myeloma 1 3.16 0 0.00 0 0.00 0 0.00 1 1.93 0.52 -0.38

Leukemia 2 2.39 5 2.36 0 0.00 2 3.92 9 4.53 1.99 1.81

Acute lymphocytic 0 0.00 1 9.96 0 0.00 0 0.00 1 0.20 4.95 0.32

Chronic lymphocytic 1 3.75 1 1.34 0 0.00 0 0.00 2 1.61 1.24 0.16

Acute non-lymphocytic 1 3.61 3 4.30 0 0.00 1 5.76 5 1.50 3.33* 1.42

Chronic myeloid 0 0.00 0 0.00 0 0.00 1 13.70 1 0.71 1.40 0.12

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 11,469 7,342 1,365 318 11,469

Person-years in interval 7,668 12,571 3,407 994 24,641

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 1,273 PYR and for male cancers on 23,367 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BONE AND SOFT TISSUE, AND KAPOSI SARCOMA 335
All subsequent cancers 144 32.99* 194 26.44* 24 11.41* 3 4.29 365 14.50 25.17* 264.28

All excluding same site 144 41.04* 191 30.91* 24 12.57* 3 4.45 362 12.27 29.50* 263.70

Buccal cavity, pharynx 0 0.00 1 3.79 0 0.00 0 0.00 1 0.53 1.88 0.35

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.06

Tongue 0 0.00 1 15.63 0 0.00 0 0.00 1 0.13 7.58 0.65

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.05

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.07

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.04

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.06

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Digestive system 1 2.51 6 7.27* 1 3.16 0 0.00 8 1.67 4.80* 4.77

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.07

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.15

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.05

Colon 0 0.00 2 7.14 0 0.00 0 0.00 2 0.56 3.56 1.08

Rectum, rectosigmoid junction 0 0.00 1 6.53 0 0.00 0 0.00 1 0.31 3.21 0.52

Anus, anal canal 1 53.48 2 50.87* 1 75.05 0 0.00 4 0.08 53.15* 2.96

Liver 0 0.00 1 19.02 0 0.00 0 0.00 1 0.11 8.87 0.67

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.03

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.12

Respiratory system 2 9.57* 3 6.61* 0 0.00 0 0.00 5 0.94 5.32* 3.06

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.03

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.09

Lung, bronchus 2 12.45* 2 5.54 0 0.00 0 0.00 4 0.75 5.33* 2.45

Female breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -4.10

Female genital system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -2.25

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -1.19

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 -0.29

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.61

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 -0.02

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 -0.07

Male genital system 2 3.40 1 1.10 0 0.00 0 0.00 3 1.86 1.61 0.86

Prostate 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.19

Testis 2 3.50 1 1.21 0 0.00 0 0.00 3 1.59 1.89 1.07

Urinary system 0 0.00 0 0.00 0 0.00 1 15.27 1 0.85 1.18 0.11

Urinary bladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.34

Kidney parenchyma 0 0.00 0 0.00 0 0.00 1 33.72 1 0.38 2.67 0.47

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.02

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.07

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.18

Kaposi sarcoma 0 0.00 3 2.59 0 0.00 0 0.00 3 2.23 1.34 0.58

Melanoma of skin 2 4.01 1 1.16 0 0.00 0 0.00 3 1.68 1.79 1.00

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.03

Brain, central nervous system 1 4.85 0 0.00 0 0.00 0 0.00 1 0.64 1.57 0.27

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.34

Lymphatic, hematopoietic 136 149.35* 178 119.28* 23 59.53* 2 19.88* 339 2.89 117.31* 253.44

Hodgkin lymphoma 2 9.84* 1 3.45 0 0.00 0 0.00 3 0.56 5.32* 1.84

Non-Hodgkin lymphoma 134 256.67* 175 199.40* 23 99.50* 1 17.13 333 1.69 197.13* 249.82

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.08

Leukemia 0 0.00 2 7.26 0 0.00 1 44.47 3 0.54 5.59* 1.86

Acute lymphocytic 0 0.00 1 25.94 0 0.00 0 0.00 1 0.07 13.38 0.70

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.05

Acute non-lymphocytic 0 0.00 1 9.90 0 0.00 1 135.18* 2 0.20 10.15* 1.36

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.11

Kaposi Sarcoma

Both Sexes, <40 Years of Age, Diagnosis Years 1980-2000

Table 12.3.5: Risk of subsequent primary cancers after Kaposi sarcoma, both sexes,

<40 years of age, SEER 1980-2000.

336 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

KAPOSI SARCOMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,931 4,302 656 120 6,931

Person-years in interval 4,581 6,856 1,508 317 13,262

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 115 PYR and for male cancers on 13,147 PYR.
Kaposi Sarcoma

Both Sexes, ≥40 Years of Age, Diagnosis Years 1980-2000

Table 12.3.6: Risk of subsequent primary cancers after Kaposi sarcoma, both sexes,

≥40 years of age, SEER 1980-2000.

KAPOSI SARCOMA

All subsequent cancers 116 5.11* 176 2.77* 49 1.39* 17 0.99 358 138.73 2.58* 192.71

All excluding same site 115 5.14* 175 2.77* 47 1.33 17 0.99 354 137.85 2.57* 189.96

Buccal cavity, pharynx 0 0.00 2 1.05 0 0.00 0 0.00 2 3.99 0.50 -1.75

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -0.54

Tongue 0 0.00 1 2.52 0 0.00 0 0.00 1 0.82 1.22 0.16

Salivary gland 0 0.00 1 5.73 0 0.00 0 0.00 1 0.38 2.63 0.54

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.96 0.00 -0.84

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.14

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.39

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.10

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.33

Digestive system 7 1.39 18 1.25 13 1.63 7 1.84 45 31.24 1.44* 12.09

Esophagus 0 0.00 1 1.26 0 0.00 1 4.67 2 1.73 1.16 0.24

Stomach 2 3.61 2 1.30 1 1.19 1 2.54 6 3.33 1.80 2.34

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.42

Colon 1 0.46 5 0.78 4 1.09 2 1.14 12 14.04 0.85 -1.79

Rectum, rectosigmoid junction 1 1.16 0 0.00 3 2.33 2 3.39 6 5.15 1.17 0.75

Anus, anal canal 2 37.04* 4 29.92* 2 31.81* 1 36.56 9 0.28 32.39* 7.67

Liver 0 0.00 4 6.95* 2 6.39 0 0.00 6 1.24 4.83* 4.18

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.30

Bile ducts, other biliary 1 9.21 0 0.00 0 0.00 0 0.00 1 0.74 1.35 0.23

Pancreas 0 0.00 1 0.60 1 1.07 0 0.00 2 3.63 0.55 -1.43

Respiratory system 4 1.04 6 0.57 6 1.04 1 0.35 17 22.95 0.74 -5.23

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.20

Larynx 0 0.00 1 1.25 2 5.10 0 0.00 3 1.70 1.77 1.15

Lung, bronchus 4 1.15 5 0.52 4 0.76 1 0.38 14 20.96 0.67 -6.12

Female breast 1 1.33 2 0.83 0 0.00 0 0.00 3 4.94 0.61 -16.72

Female genital system 1 3.20 1 1.01 0 0.00 0 0.00 2 2.01 0.99 -0.09

Cervix uteri 1 31.68 1 10.50 0 0.00 0 0.00 2 0.19 10.68* 15.65

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.91 0.00 -7.85

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -5.50

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.39

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -1.43

Male genital system 4 0.79 15 0.94 10 1.02 4 0.79 33 35.85 0.92 -2.78

Prostate 4 0.82 15 0.97 9 0.92 4 0.80 32 35.13 0.91 -3.06

Testis 0 0.00 0 0.00 1 23.70 0 0.00 1 0.47 2.15 0.52

Urinary system 0 0.00 6 1.03 5 1.53 1 0.60 12 12.84 0.93 -0.73

Urinary bladder 0 0.00 6 1.49 4 1.71 0 0.00 10 9.02 1.11 0.86

Kidney parenchyma 0 0.00 0 0.00 1 1.35 1 2.84 2 3.12 0.64 -0.99

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.69 0.00 -0.61

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.20

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.12

Soft tissue including heart 0 0.00 1 3.30 0 0.00 0 0.00 1 0.65 1.54 0.31

Kaposi sarcoma 1 2.86 1 2.27 2 28.59* 0 0.00 4 0.88 4.55* 2.74

Melanoma of skin 2 2.32 0 0.00 4 4.34* 2 4.40 8 4.20 1.90 3.34

Eye, orbit 1 24.75 0 0.00 0 0.00 0 0.00 1 0.21 4.81 0.70

Brain, central nervous system 1 3.08 0 0.00 0 0.00 0 0.00 1 1.52 0.66 -0.46

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.69 0.00 -0.60

Lymphatic, hematopoietic 91 43.21* 119 22.05* 7 2.50* 2 1.47 219 11.66 18.78* 182.22

Hodgkin lymphoma 0 0.00 4 18.53* 2 26.46* 0 0.00 6 0.43 13.81* 4.89

Non-Hodgkin lymphoma 88 85.95* 112 44.73* 5 3.95* 1 1.64 206 5.40 38.12* 176.29

Myeloma 1 3.39 0 0.00 0 0.00 0 0.00 1 1.83 0.55 -0.73

Leukemia 2 2.97 3 1.63 0 0.00 1 2.05 6 3.99 1.50 1.76

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.11

Chronic lymphocytic 1 3.95 1 1.40 0 0.00 0 0.00 2 1.55 1.29 0.39

Acute non-lymphocytic 1 4.66 2 3.36 0 0.00 0 0.00 3 1.31 2.30 1.49

Chronic myeloid 0 0.00 0 0.00 0 0.00 1 14.52 1 0.57 1.75 0.38

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,538 3,040 709 198 4,538

Person-years in interval 3,087 5,715 1,899 677 11,378

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 1,158 PYR and for male cancers on 10,220 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BONE AND SOFT TISSUE, AND KAPOSI SARCOMA 337

NEW MALIGNANCIES FOLLOWING MELANOMA OF THE SKIN, EYE MELANOMA, AND NON-MELANOMA EYE CANCER 339

Synopsis

The risk of subsequent primary cancer was assessed

in 66,059 patients with cutaneous melanoma and 4,393

patients with cancers of the eye diagnosed between

1973 and 2000. The overall risk of new malignancies

was significantly elevated among survivors of cutaneous melanoma (O/E=1.24, O=7,260, EAR=27 per

10,000 person-years), but no overall increase in new

malignancies was observed (O/E=1.00) when subsequent cutaneous melanomas were excluded. There

were also elevated risks of new malignancies among

survivors of ocular melanoma (O/E=1.16, O=436,

EAR=24), other ocular cancers (excluding retinoblastoma) (O/E=1.35, O=87, EAR=51), and retinoblastoma

(O/E=14.59, O=15, EAR=24). More than 20% of new

malignancies after cutaneous melanoma were melanomas. The excess risk of subsequent primary breast

and prostate cancers, the next most common subsequent tumors after cutaneous melanoma, may reflect

higher socioeconomic status (SES), increased diagnostic surveillance, or shared risk factors, including

endogenous hormones or genetic factors such as

BRCA2. Also elevated were subsequent non-Hodgkin

lymphoma and soft tissue sarcomas, which may

reflect underlying immunological deficiencies. The

lower risk associated with new tobacco-related cancers

(e.g., lung and bronchus, larynx, gum and mouth,

esophagus, pancreas, stomach, and cervix) may be due

in part to lower smoking rates and other correlates of

higher SES among melanoma survivors. The excess

risk of cutaneous melanoma subsequent to ocular melanoma may reflect shared risk factors, such as light eye

color, exposure to ultraviolet radiation, and susceptibility genes. The very high risk of new malignancies—

particularly bone and soft tissue sarcomas—observed

in children with retinoblastoma is consistent with the

effects of genetic susceptibility combined with radiotherapy. Several subsequent cancer sites, including the

salivary gland, lung, and kidney, had elevated risks

following non-melanoma eye cancers (excluding

retinoblastoma), and excesses of kidney cancer were

also seen after cutaneous and ocular melanomas; but

the mechanisms for these associations are unclear.

Cutaneous Malignant Melanoma 

Although cutaneous malignant melanoma is a relatively

uncommon tumor, representing 4% of all incident cancers and a little more than 1% of cancer deaths in the U.S.

(Jemal et al, 2005), melanoma incidence rates have been

increasing over time. Cutaneous melanoma occurs predominantly in the white population; it affects more

women than men under age 40 years but more men than

women at older ages. Relative survival rates are high,

with 5- and 10-year rates of 90.5% and 87.5%, respectively.

The primary treatment for melanoma is surgical excision,

with only about 2% of patients receiving initial radiotherapy and 3% receiving chemotherapy.

The major environmental risk factor for cutaneous

melanoma is ultraviolet radiation from sunlight exposure (Tucker and Goldstein, 2003). Host susceptibility

factors include dysplastic nevi, increased numbers of

nevi, freckling, a family history of melanoma, fair complexion, light eyes, blond or red hair, and immunosuppression. High socioeconomic status (SES) has also been

associated with elevated melanoma rates (Harrison et al,

1998). Studies of melanoma risk in relation to anthropometric and hormonal/reproductive factors have reported

inconsistent results.

Results and Discussion

The overall risk of subsequent primary cancers was

increased by 24% among the 66,059 men and women who

survived 2 months or more following a diagnosis of cutaneous melanoma (O/E=1.24, O=7,260, 95% CI=1.21-1.27,

EAR=27 per 10,000 person-years), due primarily to

excesses of subsequent primary melanoma (O/E=8.80). In

analyses adjusted for the competing risk of death due to

other causes, the cumulative incidence of developing a

second cancer following cutaneous melanoma was 19.6%

at 25 years (95% CI=19.0%-20.3%), which included a 3.7%

incidence of second melanomas (Figure 13.1). When subsequent cutaneous melanomas were excluded, no overall

increase in risk of new malignancies was observed

Chapter 13

MELANOMA AND EYE

New Malignancies Following Melanoma of the

Skin, Eye Melanoma, and Non-melanoma 

Eye Cancer

D. Michal Freedman, Barry A. Miller, Margaret A. Tucker

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated as

[(O-E)/PYR]10,000).

Author affiliations: D. Michal Freedman and Margaret A. Tucker,

Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS;

Barry A. Miller, Division of Cancer Control and Population Sciences,

NCI, NIH, DHHS.
(O/E=1.00). There was, however, a slight excess risk of

cancers other than melanoma during the initial 5 years

following diagnosis of melanoma. The risk of developing

a new malignancy varied by age at diagnosis (Figure 13.2),

but there were no substantial differences by gender or

histologic type of melanoma. The risks were significantly

increased for new malignancies of the salivary gland,

small intestine, female breast, prostate, kidney, thyroid,

and soft tissue, as well as for non-Hodgkin lymphoma

(NHL). Deficits in risk were seen for subsequent cancers

of the gum and mouth, esophagus, stomach, pancreas,

larynx, lung, and cervix. Several of these findings have

been reported in previous surveys of cancer risk following melanoma (Osterlind et al, 1985; Tucker et al, 1985a;

Gutman et al, 1991; Swerdlow et al, 1995; Wassberg et al,

1996, 1999; Levi et al, 1997; Schmid-Wendtner et al, 2001;

Crocetti and Carli, 2004), including several SEER surveys

(Neugut and Santos, 1993; Goggins et al, 2001, 2004;

Goggins and Tsao, 2003).

More than 20% of subsequent cancers in the current

survey were cutaneous melanomas. The relative risk

was similar in men and women (about 9-fold), although

excess absolute risks of new melanomas were greater in

men. Markedly higher relative risks (15-fold) of developing a subsequent melanoma were seen for those initially

diagnosed at ages less than 30 years, while absolute

risks were highest in those more than 50 years of age at

first diagnosis.

Subsequent breast and prostate cancers were the next

most frequent cancers after an initial cutaneous melanoma. Although the risk of these tumors was fairly constant across most latency periods, there was some decline

in prostate cancer risk among long-term survivors

(10 years), suggesting that early medical surveillance

may have increased short-term risks by shortening the

lead time. The reciprocal increases in cutaneous

melanoma risk were seen following primary prostate and

breast cancers, suggesting that the tumors may share

hormonal or genetic mechanisms such as BRCA2 mutations (Breast Cancer Linkage Consortium, 1999; Goggins

et al, 2004). Although epidemiologic evidence of a hormonal role in melanoma is inconsistent (Tucker and

Goldstein, 2003), the changing ratio of female to male

incidence after menopause has suggested that endogenous estrogens may be involved as a promoting agent. It

is also possible the relationships with breast and prostate

cancer may partly reflect correlates of higher SES, including increased diagnostic surveillance.

The excess of subsequent NHL was most pronounced

in the first year after initial diagnosis but remained nonsignificantly elevated among 20-year survivors. As

reciprocal increases in subsequent primary cutaneous

melanoma are seen after NHL (Travis et al, 1993; Goggins

et al, 2001), there may be shared causal factors, especially

immunologic defects, as suggested by the excess risks of

both tumors in a variety of immunosuppressed populations (Greene et al, 1981; Curtis et al, 1997).

The risk of soft tissue sarcoma generally was increased

over time, with somewhat higher risk among women.

Although differentiating melanoma from soft tissue sarcoma may pose diagnostic difficulties, previous reports

suggest that the association remains after careful histo340 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

MELANOMA AND EYE

O/E

1.09*

1.56*

3.09*

30 30-49 50

1.0

1.5

2.0

2.5

3.0

3.5

0.98

All subsequent cancers

All subsequent cancers excluding 

melanoma of the skin

Age at diagnosis of skin melanoma (years)

EAR (per 10,000 person-years)

-5

0

5

10

15

20

25

30

35

40

45

All subsequent cancers

All subsequent cancers excluding 

melanoma of the skin

30 30-49 50

1.48*

1.15*

25 26

-4

4

29

5

Figure 13.2: Observed-to-expected ratio (O/E) and excess

absolute risk (EAR) of subsequent primary cancers after

melanoma of the skin, both sexes, SEER 1973-2000.

*P <0.05.

Note: EAR = Excess number of subsequent cancers per 10,000 person-years.

Observed No. 215 91 1,462 957 5,583 4,633

Years after initial cancer diagnosis 

Cumulative incidence (%) 0

5

10

15

20

0 5 10 15 20 25 

All second cancers*

Prostate†

Female breast†

Melanoma of the skin

Non-Hodgkin lymphoma

Figure 13.1: Cumulative incidence of developing a second

cancer among patients with melanoma of the skin, both

sexes, SEER 1973-2000.

* Cumulative incidence for all second cancers at 25 years is 22.2% for males and 

16.9% for females.

† Prostate and female breast cancer curves are based on male and female melanoma

patients, respectively.
NEW MALIGNANCIES FOLLOWING MELANOMA OF THE SKIN, EYE MELANOMA, AND NON-MELANOMA EYE CANCER 341

MELANOMA AND EYE

logic review (Tucker et al, 1985a; Dunbar et al, 1994).

Radiation does not appear to explain the increased risk

of soft tissue sarcoma, because the excess was not seen

among those receiving initial radiotherapy. Immunologic

defects, which have been linked to soft tissue sarcoma

(Zahm and Fraumeni, 1997), may contribute to the association with melanoma. Also noteworthy was the disproportionately high number of nerve sheath tumors among

subsequent soft tissue sarcomas (13%), a finding that has

been observed previously (Berking and Brady, 1997) and

may reflect common embryological origins from the

neural crest (Swerdlow et al, 1995; Wassberg et al, 1996)

or genetic susceptibility (Randerson-Moor et al, 2001).

The excess risk of small intestine tumors appeared to be

partly due to the high percentage of soft tissue sarcomas

(27%) in this diagnostic category.

The excess risks of kidney, salivary gland, and thyroid

cancers were highest in the early years, at least partly

due to increased medical surveillance and early cancer

detection. However, the associations may provide clues

to unrecognized risk factors, particularly for subsequent

primary thyroid cancer, which remained elevated for 

20 years. 

The lower than expected risks associated with several

tobacco-related cancers, such as those of the lung and

bronchus, larynx, gum and mouth, esophagus, pancreas,

stomach, and cervix, suggest lower smoking rates and

other correlates of higher SES among melanoma survivors.

Cancers of the Eye

Cancers of the eye include ocular melanomas (of the

uveal tract, iris, ciliary body, and choroid) and other histologic types, particularly conjunctival squamous cell carcinomas and retinoblastomas. Together these eye cancers

represent just 0.2% of all incident cancers in the U.S. and

0.04% of all cancer deaths (Jemal et al, 2005). In adults,

ocular melanoma is the most common malignancy of the

eye, and, after the skin, the eye is the predominant site

for melanoma. Among children under age 15 years, most

eye tumors are retinoblastomas. The 5-year (and 10-year)

relative survival rates for cancers of the eye are about

78.7% (65.3%) for ocular melanoma, 81.4% (73.6%) for

other eye cancers excluding retinoblastoma, and 97.3%

(95.2%) for retinoblastoma. The most common treatments

for cancers of the eye are surgical removal of the eye and

irradiation. About one-fourth of SEER patients received

initial radiotherapy, with or without surgery.

Both cutaneous and ocular melanomas derive from

melanocytes, although risk factors for ocular melanomas

are less well characterized (Vajdic et al, 2002; Hurst et al,

2003). Although sunlight appears to be a causal factor for

some types of ocular melanoma (Tucker et al, 1985b;

Vajdic et al, 2002), the geographic and temporal patterns

of incidence differ from those of cutaneous melanomas.

Nonetheless, ocular melanomas, like cutaneous

melanomas, arise mainly in the white population and

share host susceptibility factors, such as light eye and

hair color. Occupational exposures to welding, possibly

due to artificial ultraviolet radiation, may also be etiologically relevant (Hurst et al, 2003). Genetic factors that

increase susceptibility to ocular melanoma are not clearly

defined (Vajdic et al, 2003).

The largest group of adult ocular cancers other than

melanomas are squamous cell carcinomas of the conjunctiva, which may be due in part to ultraviolet-B (UVB)

radiation exposure, as well as to infection by human

papillomavirus (HPV) and human immunodeficiency

virus (HIV) (Newton, 1996; Sun et al, 1997; Gillison and

Shah, 2003). Approximately 30% to 40% of retinoblastomas, which are tumors of the retina occurring mainly

in the first years of life, are hereditary and bilateral and

involve germline mutations of the tumor suppressor

gene RB1 (Friend et al, 1986).

Results and Discussion

Ocular Melanoma 

A 16% elevated risk of subsequent primary cancers was

observed among 3,217 2-month survivors of ocular

melanoma (O/E=1.16, O=436, 95% CI=1.05-1.27,

EAR=24). The cumulative incidence of developing a second cancer following ocular melanoma was 19.2% at 25

years (95% CI=17.2%-21.3%). The excess was primarily

observed among women (O/E=1.26, O=190 for women

versus O/E=1.09, O=246 for men), due partly to excesses

in cutaneous melanoma and female genital tumors, especially nonsignificant increases in ovarian cancer. Risk was

also higher among patients diagnosed under 50 years of

age compared with older patients (O/E=1.72, O=57,

EAR=32 versus O/E=1.11, O=379, EAR=21). Overall risk

was highest in the first year following diagnosis

(O/E=1.29), then declined over time (O/E=1.09 among

10-year survivors). Significantly elevated risks were

observed for subsequent primary cancer of the kidney,

soft tissue sarcoma, and cutaneous melanoma, as well as

subsequent ocular melanoma.

The 4-fold increased risk of cutaneous melanoma following ocular melanoma is consistent with previous

studies from Denmark (Swerdlow et al, 1995) and the

SEER registries (Shors et al, 2002), and with shared host

factors (light skin and eye color), UVB radiation exposure, and possibly susceptibility genes. The heightened

risks of kidney cancer and soft tissue sarcoma resemble

the patterns of risk following cutaneous melanoma, but

the underlying mechanisms are obscure. However, in

contrast to the reciprocal excess of cutaneous melanoma

after kidney cancer and soft tissue sarcoma, no increase

in ocular melanoma was seen after these tumors. Risks

of these subsequent primary cancers did not show any

particular temporal pattern and were not related to initial radiotherapy.

The excess of ovarian cancer, although nonsignificant,

is interesting, because an elevated risk of ocular

melanoma has been observed previously among ovarian

cancer patients (Travis et al, 1996), suggesting that genetic

and/or hormonal factors may be involved. Although the

role of hormonal factors in ocular melanoma is limited
(Hartge et al, 1989), BRCA2 mutations have been

described in family-based studies (Sinilnikova et al,

1999). However, the risk of breast cancer was not elevated

in our survey of ocular melanoma.

Non-melanoma Cancers of the Eye 

(Excluding Retinoblastoma)

The risk of subsequent primary cancers was elevated by

35% among 594 2-month survivors of cancers of the eye

other than melanoma and retinoblastoma (O/E=1.35,

O=87, 95% CI=1.08-1.66, EAR=51). The cumulative incidence of developing a second cancer following nonmelanoma cancers of the eye (excluding retinoblastoma)

was 15.6% at 15 years (95% CI=12.2%-19.4%). Subsequent

primary cancer risk was highest in the 5 years following

initial diagnosis and decreased thereafter almost to population levels. Excess risks were due entirely to new malignancies after squamous cell carcinoma of the eye

(O/E=1.47). Significantly elevated risks were observed for

new malignancies of the salivary gland, kidney, and lung. 

Risks for subsequent lung and kidney cancers were

increased primarily in the first 5 years following nonmelanoma ocular cancer. There is no evidence that radiation played a role in subsequent salivary gland or kidney

cancers, as excess risks were not seen in those receiving

initial radiotherapy. In addition, the role of radiotherapy

seemed limited in the subsequent lung cancers, because

the early excess risk is inconsistent with the longer latency period expected for radiation-induced lung cancer.

The increased risk of subsequent kidney cancers may be

an incidental finding, because 2 out of 6 of these tumors

were diagnosed at autopsy. It is also possible that smoking, which is a causal factor for lung and kidney cancers,

and possibly for salivary gland cancer, may have played

an etiologic role. 

Retinoblastoma

The risk of subsequent primary cancers was increased

15-fold among 582 children who were 2-month survivors

of retinoblastoma (O/E=14.59, O=15, 95% CI=8.16-24.07,

EAR=24) (Table 13.A). The cumulative incidence of

developing a second cancer following retinoblastoma

was 5.6% at 25 years (95% CI=2.9%-9.4%). Overall risks

were especially high in patients receiving initial radiotherapy (O/E=43.76, O=12), compared with nonirradiated children (O/E=3.98, O=3). In particular, elevated risks

were seen for osteosarcomas, soft tissue sarcomas, and

acute lymphocytic leukemia (Table 13.A). New malignancies also included a pineoblastoma, which occurred

in an irradiated patient. Our findings are generally consistent with other surveys of second cancers following

retinoblastoma (Draper et al, 1986; Eng et al, 1993; Moll

et al, 1996; Wong et al, 1997; Kleinerman et al, 2005). 

Previous studies have documented that hereditary

retinoblastoma patients are prone to sarcomas and that

high-dose radiotherapy further increases the risk (Tucker

et al, 1987; Hawkins et al, 1996; Wong et al, 1997). In our

survey, the excesses of soft tissue and bone cancers were

limited to irradiated patients, with 9 of the 10 sarcomas

occurring in the radiotherapy group. A high incidence of

pineoblastoma, often referred to as trilateral retinoblastoma, has previously been reported for hereditary

retinoblastoma (Moll et al, 1996; Wong et al, 1997). The

excess of acute leukemia, based on 3 cases, has also been

noted in other studies, although risk has not been quantified (Moll et al, 1997). 

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342 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

MELANOMA AND EYE

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NEW MALIGNANCIES FOLLOWING MELANOMA OF THE SKIN, EYE MELANOMA, AND NON-MELANOMA EYE CANCER 343

MELANOMA AND EYE
344 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

MELANOMA AND EYE

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MELANOMA OF SKIN

Melanoma of Skin

Both Sexes

Table 13.1.1: Characteristics of patients with an initial melanoma of the skin, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 34,949 100.0 31,110 100.0 66,059 100.0

Initial treatment

Any radiation 948 2.7 452 1.5 1,400 2.1

With surgery 440 1.3 227 0.7 667 1.0

Without surgery 508 1.5 225 0.7 733 1.1

No radiation 34,001 97.3 30,658 98.5 64,659 97.9

With surgery 32,133 91.9 29,124 93.6 61,257 92.7

Without surgery 1,868 5.3 1,534 4.9 3,402 5.1

Race

White 33,607 96.2 29,709 95.5 63,316 95.8

Black 164 0.5 204 0.7 368 0.6

Other 285 0.8 264 0.8 549 0.8

Unknown 893 2.6 933 3.0 1,826 2.8

Age at 1st primary cancer diagnosis, years

< 30 2,271 6.5 3,696 11.9 5,967 9.0

30–49 11,233 32.1 12,112 38.9 23,345 35.3

50–69 14,291 40.9 9,555 30.7 23,846 36.1

70–79 5,050 14.4 3,454 11.1 8,504 12.9

> 80 2,104 6.0 2,293 7.4 4,397 6.7

Number of patients with one or more

primary cancers

One primary cancer only 31,047 88.8 28,624 92.0 59,671 90.3

1st and 2nd cancers 3,414 9.8 2,218 7.1 5,632 8.5

1st, 2nd, and 3rd cancers 426 1.2 244 0.8 670 1.0

1st, 2nd, 3rd, and additional cancers 62 0.2 24 0.1 86 0.1

Other statistics

Median age at 1st cancer diagnosis 55.6 — 49.5 — 52.9 —

Median year of 1st cancer diagnosis 1991.0 — 1990.3 — 1990.6 —

Median person-years at risk 5.3 — 6.6 — 5.8 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 96.7 — 97.4 — 97.0

1st, 2nd, and additional cancers — 96.3 — 97.1 — 96.6

1st cancer only — 2.7 — 2.2 — 2.5

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING MELANOMA OF THE SKIN, EYE MELANOMA, AND NON-MELANOMA EYE CANCER 345

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 800 1.55* 2,571 1.32* 1,933 1.20* 1,956 1.09* 7,260 5,857.52 1.24* 27.30

All excluding same site 558 1.12* 2,001 1.06* 1,554 0.99 1,568 0.90* 5,681 5,678.02 1.00 0.06

Buccal cavity, pharynx 16 1.15 46 0.90 31 0.77 37 0.91 130 145.96 0.89 -0.31

Lip 8 3.61* 11 1.39 4 0.67 4 0.70 27 21.80 1.24 0.10

Tongue 1 0.35 8 0.76 7 0.83 7 0.80 23 30.60 0.75 -0.15

Salivary gland 2 1.57 10 2.11* 4 1.04 8 1.89 24 14.10 1.70* 0.19

Mouth 2 0.56 10 0.76 5 0.48 9 0.86 26 37.62 0.69 -0.23

Nasopharynx 2 4.05 0 0.00 3 2.17 0 0.00 5 5.04 0.99 0.00

Tonsil 0 0.00 4 0.80 4 1.02 6 1.52 14 14.22 0.98 0.00

Oropharynx 0 0.00 2 1.42 1 0.90 1 0.90 4 4.01 1.00 0.00

Hypopharynx 1 0.76 1 0.21 3 0.80 2 0.55 7 13.56 0.52 -0.13

Digestive system 97 0.91 401 1.02 294 0.91 274 0.78* 1,066 1,173.64 0.91* -2.10

Esophagus 2 0.38 12 0.61 9 0.56 8 0.45* 31 58.44 0.53* -0.53

Stomach 9 0.88 32 0.86 23 0.79 20 0.66 84 107.01 0.78* -0.45

Small intestine 1 0.64 15 2.53* 7 1.40 7 1.21 30 18.27 1.64* 0.23

Colon 41 0.85 188 1.05 154 1.05 145 0.89 528 536.67 0.98 -0.17

Rectum, rectosigmoid junction 24 1.25 73 1.03 46 0.81 37 0.62* 180 206.88 0.87 -0.52

Anus, anal canal 1 0.91 9 2.15 4 1.13 4 0.98 18 12.91 1.39 0.10

Liver 3 0.88 12 0.94 6 0.57 5 0.41* 26 38.95 0.67* -0.25

Gallbladder 2 1.46 4 0.79 3 0.73 4 0.89 13 14.99 0.87 -0.04

Bile ducts, other biliary 4 1.73 11 1.27 7 0.96 9 1.05 31 26.81 1.16 0.08

Pancreas 9 0.72 40 0.86 32 0.84 33 0.77 114 140.00 0.81* -0.51

Respiratory system 62 0.72* 255 0.79* 205 0.77* 225 0.77* 747 964.43 0.77* -4.23

Nose, nasal cavity, ear 0 0.00 2 0.70 3 1.30 4 1.62 9 8.41 1.07 0.01

Larynx 5 0.82 12 0.54* 8 0.46* 7 0.41* 32 62.85 0.51* -0.60

Lung, bronchus 57 0.72* 240 0.81* 193 0.79* 212 0.78* 702 890.68 0.79* -3.67

Female breast 57 1.04 246 1.14 214 1.10 248 1.06 765 699.65 1.09* 2.50

Female genital system 27 1.10 84 0.88 76 0.94 73 0.78* 260 294.36 0.88* -1.31

Cervix uteri 2 0.57 8 0.60 3 0.29* 3 0.31* 16 37.02 0.43* -0.80

Corpus uteri 18 1.52 40 0.87 43 1.09 35 0.74 136 144.49 0.94 -0.32

Ovary 5 0.69 30 1.05 24 0.96 32 1.09 91 89.97 1.01 0.04

Vagina 0 0.00 0 0.00 1 0.95 1 0.82 2 3.83 0.52 -0.07

Vulva 1 0.97 4 1.00 3 0.85 1 0.23 9 12.90 0.70 -0.15

Male genital system 131 1.30* 480 1.27* 370 1.18* 348 1.01 1,329 1,137.17 1.17* 7.62

Prostate 126 1.27* 472 1.27* 363 1.18* 345 1.01 1,306 1,118.90 1.17* 7.43

Testis 4 2.92 5 1.07 4 1.30 1 0.47 14 11.25 1.24 0.11

Urinary system 55 1.31 168 1.07 123 0.96 134 0.95 480 468.43 1.02 0.23

Urinary bladder 30 1.03 107 0.99 82 0.93 85 0.88 304 322.01 0.94 -0.35

Kidney parenchyma 22 2.10* 54 1.36* 37 1.12 41 1.11 154 119.79 1.29* 0.67

Renal pelvis, other urinary 3 1.22 7 0.77 4 0.55 8 1.02 22 26.63 0.83 -0.09

Ureter 0 0.00 0 0.00 1 0.42 2 0.79 3 8.75 0.34 -0.11

Bone, joints 0 0.00 2 0.97 0 0.00 3 1.83 5 5.88 0.85 -0.02

Soft tissue including heart 3 1.34 22 2.65* 10 1.48 19 2.57* 54 24.66 2.19* 0.57

Kaposi sarcoma 2 1.29 9 1.60 6 1.43 1 0.32 18 14.50 1.24 0.07

Melanoma of skin 242 15.41* 570 9.55* 379 7.65* 388 7.12* 1,579 179.50 8.80* 27.24

Eye, orbit 0 0.00 4 1.26 4 1.58 8 2.97* 16 9.25 1.73 0.13

Brain, central nervous system 5 0.81 27 1.18 22 1.19 17 0.88 71 66.90 1.06 0.08

Thyroid 20 4.70* 32 2.00* 21 1.64* 20 1.52 93 46.19 2.01* 0.91

Lymphatic, hematopoietic 65 1.63* 168 1.13 127 1.03 126 0.92 486 448.14 1.08 0.74

Hodgkin lymphoma 4 2.06 6 0.87 2 0.40 5 1.12 17 18.29 0.93 -0.03

Non-Hodgkin lymphoma 39 2.13* 84 1.21 75 1.28* 69 1.03 267 213.13 1.25* 1.05

Myeloma 5 0.84 27 1.21 11 0.59 15 0.72 58 67.74 0.86 -0.19

Leukemia 17 1.25 51 1.02 39 0.96 37 0.83 144 148.98 0.97 -0.10

Acute lymphocytic 1 2.19 1 0.60 5 3.77* 0 0.00 7 4.78 1.46 0.04

Chronic lymphocytic 11 2.07* 24 1.22 17 1.06 15 0.86 67 58.57 1.14 0.16

Acute non-lymphocytic 3 0.66 15 0.89 7 0.51 17 1.10 42 50.69 0.83 -0.17

Chronic myeloid 2 1.07 3 0.43 5 0.89 2 0.33 12 20.52 0.58 -0.17

Melanoma of Skin

Both Sexes

Table 13.1.2: Risk of subsequent primary cancers after melanoma of the skin, both sexes,

SEER 1973-2000.

346 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

MELANOMA OF SKIN

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 66,059 59,553 37,037 21,240 66,059

Person-years in interval 51,979 188,371 141,971 131,391 513,712

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 261,817 PYR and for male cancers on 251,895 PYR.
Melanoma of Skin

Both Sexes, Long-term Follow-up

Table 13.1.3: Risk of subsequent primary cancers after melanoma of the skin, both sexes,

long-term follow-up, SEER 1973-2000.

MELANOMA OF SKIN

All subsequent cancers 5,304 1.30* 1,145 1.13* 561 1.03 250 1.07 7,260 5,857.52 1.24* 27.30

All excluding same site 4,113 1.04* 903 0.92* 458 0.87* 207 0.92 5,681 5,678.02 1.00 0.06

Buccal cavity, pharynx 93 0.88 18 0.76 12 0.99 7 1.42 130 145.96 0.89 -0.31

Lip 23 1.43 2 0.59 2 1.20 0 0.00 27 21.80 1.24 0.10

Tongue 16 0.73 4 0.79 1 0.38 2 1.84 23 30.60 0.75 -0.15

Salivary gland 16 1.62 3 1.25 4 3.14 1 1.80 24 14.10 1.70* 0.19

Mouth 17 0.63 3 0.49 3 0.96 3 2.35 26 37.62 0.69 -0.23

Nasopharynx 5 1.37 0 0.00 0 0.00 0 0.00 5 5.04 0.99 0.00

Tonsil 8 0.78 5 2.16 0 0.00 1 2.17 14 14.22 0.98 0.00

Oropharynx 3 1.04 0 0.00 1 3.03 0 0.00 4 4.01 1.00 0.00

Hypopharynx 5 0.50 1 0.46 1 0.94 0 0.00 7 13.56 0.52 -0.13

Digestive system 792 0.96 162 0.81* 76 0.71* 36 0.77 1,066 1,173.64 0.91* -2.10

Esophagus 23 0.56* 3 0.30* 4 0.75 1 0.43 31 58.44 0.53* -0.53

Stomach 64 0.84 12 0.69 5 0.55 3 0.78 84 107.01 0.78* -0.45

Small intestine 23 1.84* 4 1.24 2 1.13 1 1.25 30 18.27 1.64* 0.23

Colon 383 1.02 86 0.94 41 0.84 18 0.83 528 536.67 0.98 -0.17

Rectum, rectosigmoid junction 143 0.97 19 0.55* 11 0.61 7 0.91 180 206.88 0.87 -0.52

Anus, anal canal 14 1.58 2 0.88 1 0.80 1 1.84 18 12.91 1.39 0.10

Liver 21 0.78 3 0.45 1 0.27 1 0.58 26 38.95 0.67* -0.25

Gallbladder 9 0.86 3 1.19 0 0.00 1 1.68 13 14.99 0.87 -0.04

Bile ducts, other biliary 22 1.21 8 1.70 1 0.38 0 0.00 31 26.81 1.16 0.08

Pancreas 81 0.83 21 0.88 9 0.69 3 0.52 114 140.00 0.81* -0.51

Respiratory system 522 0.77* 127 0.77* 69 0.78* 29 0.76 747 964.43 0.77* -4.23

Nose, nasal cavity, ear 5 0.84 2 1.42 1 1.35 1 3.14 9 8.41 1.07 0.01

Larynx 25 0.55* 5 0.49 2 0.40 0 0.00 32 62.85 0.51* -0.60

Lung, bronchus 490 0.79* 119 0.78* 65 0.79 28 0.78 702 890.68 0.79* -3.67

Female breast 517 1.11* 129 0.99 88 1.21 31 0.98 765 699.65 1.09* 2.50

Female genital system 187 0.93 40 0.76 21 0.73 12 0.97 260 294.36 0.88* -1.31

Cervix uteri 13 0.48* 3 0.50 0 0.00 0 0.00 16 37.02 0.43* -0.80

Corpus uteri 101 1.04 15 0.58* 13 0.89 7 1.10 136 144.49 0.94 -0.32

Ovary 59 0.97 20 1.23 8 0.88 4 1.03 91 89.97 1.01 0.04

Vagina 1 0.38 1 1.48 0 0.00 0 0.00 2 3.83 0.52 -0.07

Vulva 8 0.93 1 0.43 0 0.00 0 0.00 9 12.90 0.70 -0.15

Male genital system 981 1.24* 208 1.06 95 0.91 45 1.05 1,329 1,137.17 1.17* 7.62

Prostate 961 1.23* 206 1.06 94 0.91 45 1.06 1,306 1,118.90 1.17* 7.43

Testis 13 1.42 0 0.00 1 1.87 0 0.00 14 11.25 1.24 0.11

Urinary system 346 1.06 85 1.06 33 0.78 16 0.86 480 468.43 1.02 0.23

Urinary bladder 219 0.97 55 1.01 19 0.66 11 0.86 304 322.01 0.94 -0.35

Kidney parenchyma 113 1.36* 24 1.16 12 1.07 5 1.03 154 119.79 1.29* 0.67

Renal pelvis, other urinary 14 0.74 6 1.35 2 0.85 0 0.00 22 26.63 0.83 -0.09

Ureter 1 0.16* 1 0.69 1 1.32 0 0.00 3 8.75 0.34 -0.11

Bone, joints 2 0.47 2 2.12 0 0.00 1 4.89 5 5.88 0.85 -0.02

Soft tissue including heart 35 2.03* 8 1.92 7 3.13* 4 4.13* 54 24.66 2.19* 0.57

Kaposi sarcoma 17 1.49 0 0.00 1 1.30 0 0.00 18 14.50 1.24 0.07

Melanoma of skin 1,191 9.53* 242 7.83* 103 6.25* 43 6.00* 1,579 179.50 8.80* 27.24

Eye, orbit 8 1.22 5 3.25* 2 2.47 1 2.92 16 9.25 1.73 0.13

Brain, central nervous system 54 1.13 10 0.90 6 1.04 1 0.42 71 66.90 1.06 0.08

Thyroid 73 2.21* 13 1.70 6 1.54 1 0.64 93 46.19 2.01* 0.91

Lymphatic, hematopoietic 360 1.16* 75 0.97 31 0.75 20 1.10 486 448.14 1.08 0.74

Hodgkin lymphoma 12 0.87 4 1.48 1 0.78 0 0.00 17 18.29 0.93 -0.03

Non-Hodgkin lymphoma 198 1.35* 37 0.99 18 0.88 14 1.55 267 213.13 1.25* 1.05

Myeloma 43 0.92 10 0.85 5 0.78 0 0.00 58 67.74 0.86 -0.19

Leukemia 107 1.02 24 0.95 7 0.52 6 1.03 144 148.98 0.97 -0.10

Acute lymphocytic 7 2.02 0 0.00 0 0.00 0 0.00 7 4.78 1.46 0.04

Chronic lymphocytic 52 1.26 10 1.01 2 0.38 3 1.34 67 58.57 1.14 0.16

Acute non-lymphocytic 25 0.71 10 1.16 4 0.86 3 1.44 42 50.69 0.83 -0.17

Chronic myeloid 10 0.69 2 0.58 0 0.00 0 0.00 12 20.52 0.58 -0.17

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 66,059 21,240 11,047 4,663 66,059

Person-years in interval 382,322 79,064 37,834 14,493 513,712

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 261,817 PYR and for male cancers on 251,895 PYR.

NEW MALIGNANCIES FOLLOWING MELANOMA OF THE SKIN, EYE MELANOMA, AND NON-MELANOMA EYE CANCER 347
All subsequent cancers 279 1.56* 933 1.33* 722 1.17* 855 1.14* 2,789 2,246.66 1.24* 20.71

All excluding same site 192 1.11 710 1.05 595 0.99 699 0.96 2,196 2,182.33 1.01 0.52

Buccal cavity, pharynx 2 0.63 14 1.14 8 0.75 12 0.96 36 38.69 0.93 -0.10

Lip 1 4.72 1 1.23 1 1.40 1 1.14 4 2.62 1.53 0.05

Tongue 0 0.00 3 1.09 3 1.24 3 1.05 9 8.74 1.03 0.01

Salivary gland 0 0.00 5 3.31* 0 0.00 2 1.30 7 4.73 1.48 0.09

Mouth 0 0.00 4 0.96 1 0.28 5 1.19 10 13.00 0.77 -0.11

Nasopharynx 1 8.38 0 0.00 1 2.55 0 0.00 2 1.42 1.40 0.02

Tonsil 0 0.00 1 0.91 0 0.00 1 0.95 2 3.39 0.59 -0.05

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.95 0.00 -0.04

Hypopharynx 0 0.00 0 0.00 2 2.86 0 0.00 2 2.51 0.80 -0.02

Digestive system 42 1.16 137 0.98 99 0.82* 124 0.84 402 444.96 0.90* -1.64

Esophagus 0 0.00 0 0.00* 1 0.31 2 0.49 3 11.98 0.25* -0.34

Stomach 1 0.37 7 0.70 8 0.95 5 0.51 21 30.98 0.68 -0.38

Small intestine 1 1.85 5 2.35 2 1.04 2 0.79 10 7.13 1.40 0.11

Colon 22 1.21 73 1.04 52 0.86 68 0.92 215 222.41 0.97 -0.28

Rectum, rectosigmoid junction 9 1.50 23 1.00 18 0.91 16 0.69 66 71.95 0.92 -0.23

Rectum 7 1.78 15 0.99 14 1.08 10 0.65 46 47.50 0.97 -0.06

Anus, anal canal 1 1.83 4 1.85 2 1.03 3 1.25 10 7.04 1.42 0.11

Liver 2 2.79 2 0.72 2 0.81 1 0.31 7 9.23 0.76 -0.09

Gallbladder 0 0.00 3 0.98 1 0.39 2 0.68 6 9.43 0.64 -0.13

Bile ducts, other biliary 2 2.53 2 0.66 1 0.37 5 1.40 10 10.13 0.99 -0.01

Pancreas 3 0.65 15 0.84 10 0.64 18 0.92 46 57.80 0.80 -0.45

Respiratory system 21 0.97 79 0.91 79 0.98 94 0.89 273 295.58 0.92 -0.86

Nose, nasal cavity, ear 0 0.00 1 1.09 2 2.49 3 3.14 6 2.91 2.06 0.12

Larynx 0 0.00 2 0.68 3 1.15 2 0.65 7 9.36 0.75 -0.09

Lung, bronchus 21 1.02 76 0.91 73 0.95 88 0.87 258 282.53 0.91 -0.94

Female breast 57 1.04 246 1.14 214 1.10 248 1.06 765 699.65 1.09* 2.50

Female genital system 27 1.10 84 0.88 76 0.94 73 0.78* 260 294.36 0.88* -1.31

Cervix uteri 2 0.57 8 0.60 3 0.29* 3 0.31* 16 37.02 0.43* -0.80

Corpus uteri 18 1.52 40 0.87 43 1.09 35 0.74 136 144.49 0.94 -0.32

Ovary 5 0.69 30 1.05 24 0.96 32 1.09 91 89.97 1.01 0.04

Vagina 0 0.00 0 0.00 1 0.95 1 0.82 2 3.83 0.52 -0.07

Vulva 1 0.97 4 1.00 3 0.85 1 0.23 9 12.90 0.70 -0.15

Urinary system 9 1.13 38 1.22 30 1.08 32 0.91 109 102.17 1.07 0.26

Urinary bladder 4 0.86 17 0.94 17 1.06 16 0.79 54 59.03 0.91 -0.19

Kidney parenchyma 4 1.50 20 1.88* 12 1.24 15 1.20 51 35.48 1.44* 0.59

Renal pelvis, other urinary 1 1.62 1 0.42 1 0.48 1 0.39 4 7.66 0.52 -0.14

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 2.31 0.00 -0.09

Bone, joints 0 0.00 1 1.24 0 0.00 0 0.00 1 2.43 0.41 -0.05

Soft tissue including heart 1 1.29 11 3.67* 6 2.32 9 2.92* 27 9.44 2.86* 0.67

Kaposi sarcoma 0 0.00 1 4.38 0 0.00 0 0.00 1 0.70 1.42 0.01

Melanoma of skin 87 16.55* 223 10.81* 127 7.09* 156 7.60* 593 64.33 9.22* 20.19

Eye, orbit 0 0.00 2 1.78 3 3.14 6 5.39* 11 3.48 3.16* 0.29

Brain, central nervous system 2 0.96 9 1.10 5 0.71 7 0.86 23 25.44 0.90 -0.09

Thyroid 10 3.66* 16 1.53 13 1.51 15 1.66 54 30.87 1.75* 0.88

Lymphatic, hematopoietic 18 1.36 57 1.10 47 1.03 64 1.14 186 166.66 1.12 0.74

Hodgkin lymphoma 2 2.70 3 1.11 1 0.49 3 1.56 9 7.39 1.22 0.06

Non-Hodgkin lymphoma 6 0.94 30 1.19 30 1.32 39 1.34 105 83.56 1.26* 0.82

Myeloma 2 1.02 6 0.78 3 0.44 6 0.70 17 25.02 0.68 -0.31

Leukemia 8 1.93 18 1.13 13 0.94 16 0.96 55 50.68 1.09 0.16

Acute lymphocytic 1 6.33 1 1.66 3 5.90* 0 0.00 5 1.84 2.72 0.12

Chronic lymphocytic 4 2.63 8 1.36 5 0.97 4 0.64 21 18.82 1.12 0.08

Acute non-lymphocytic 2 1.34 4 0.69 2 0.40 10 1.63 18 18.43 0.98 -0.02

Chronic myeloid 1 1.68 1 0.44 1 0.51 1 0.43 4 7.17 0.56 -0.12

Melanoma of Skin

Females

Table 13.1.4: Risk of subsequent primary cancers after melanoma of the skin, females,

SEER 1973-2000.

348 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

MELANOMA OF SKIN

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 31,110 28,461 18,659 11,190 31,110

Person-years in interval 24,678 92,363 73,085 71,692 261,817

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Melanoma of Skin

Males

Table 13.1.5: Risk of subsequent primary cancers after melanoma of the skin, males,

SEER 1973-2000.

MELANOMA OF SKIN

All subsequent cancers 521 1.54* 1,638 1.32* 1,211 1.22* 1,101 1.06 4,471 3,610.86 1.24* 34.15

All excluding same site 366 1.12* 1,291 1.07* 959 1.00 869 0.87* 3,485 3,495.69 1.00 -0.42

Buccal cavity, pharynx 14 1.30 32 0.83 23 0.78 25 0.89 94 107.28 0.88 -0.53

Lip 7 3.49* 10 1.41 3 0.57 3 0.62 23 19.18 1.20 0.15

Tongue 1 0.47 5 0.64 4 0.66 4 0.67 14 21.86 0.64 -0.31

Salivary gland 2 2.27 5 1.55 4 1.56 6 2.22 17 9.37 1.81* 0.30

Mouth 2 0.80 6 0.67 4 0.59 4 0.63 16 24.62 0.65 -0.34

Nasopharynx 1 2.67 0 0.00 2 2.03 0 0.00 3 3.61 0.83 -0.02

Tonsil 0 0.00 3 0.77 4 1.34 5 1.73 12 10.84 1.11 0.05

Oropharynx 0 0.00 2 1.82 1 1.18 1 1.23 4 3.07 1.30 0.04

Hypopharynx 1 0.90 1 0.25 1 0.33 2 0.70 5 11.05 0.45 -0.24

Digestive system 55 0.79 264 1.04 195 0.98 150 0.73* 664 728.68 0.91* -2.57

Esophagus 2 0.46 12 0.76 8 0.63 6 0.44* 28 46.46 0.60* -0.73

Stomach 8 1.06 25 0.92 15 0.72 15 0.73 63 76.03 0.83 -0.52

Small intestine 0 0.00 10 2.63* 5 1.64 5 1.54 20 11.13 1.80* 0.35

Colon 19 0.63* 115 1.05 102 1.18 77 0.87 313 314.27 1.00 -0.05

Rectum, rectosigmoid junction 15 1.14 50 1.05 28 0.75 21 0.57* 114 134.93 0.84 -0.83

Anus, anal canal 0 0.00 5 2.45 2 1.24 1 0.60 8 5.86 1.36 0.08

Liver 1 0.37 10 1.00 4 0.49 4 0.45 19 29.72 0.64* -0.43

Gallbladder 2 3.63 1 0.51 2 1.32 2 1.30 7 5.56 1.26 0.06

Bile ducts, other biliary 2 1.31 9 1.61 6 1.32 4 0.80 21 16.68 1.26 0.17

Pancreas 6 0.76 25 0.87 22 0.98 15 0.65 68 82.20 0.83 -0.56

Respiratory system 41 0.64* 176 0.75* 126 0.68* 131 0.71* 474 668.85 0.71* -7.74

Nose, nasal cavity, ear 0 0.00 1 0.51 1 0.66 1 0.66 3 5.49 0.55 -0.10

Larynx 5 0.94 10 0.52* 5 0.34* 5 0.36* 25 53.49 0.47* -1.13

Lung, bronchus 36 0.62* 164 0.77* 120 0.72* 124 0.73* 444 608.16 0.73* -6.52

Male breast 2 3.08 3 1.26 3 1.58 1 0.50 9 6.94 1.30 0.08

Male genital system 131 1.30* 480 1.27* 370 1.18* 348 1.01 1,329 1,137.17 1.17* 7.62

Prostate 126 1.27* 472 1.27* 363 1.18* 345 1.01 1,306 1,118.90 1.17* 7.43

Testis 4 2.92 5 1.07 4 1.30 1 0.47 14 11.25 1.24 0.11

Urinary system 46 1.35 130 1.03 93 0.92 102 0.96 371 366.26 1.01 0.19

Urinary bladder 26 1.06 90 1.00 65 0.90 69 0.90 250 262.98 0.95 -0.52

Kidney parenchyma 18 2.30* 34 1.17 25 1.08 26 1.07 103 84.31 1.22 0.74

Renal pelvis, other urinary 2 1.08 6 0.90 3 0.58 7 1.33 18 18.97 0.95 -0.04

Ureter 0 0.00 0 0.00 1 0.56 2 1.12 3 6.44 0.47 -0.14

Bone, joints 0 0.00 1 0.79 0 0.00 3 3.37 4 3.44 1.16 0.02

Soft tissue including heart 2 1.37 11 2.07* 4 0.96 10 2.33* 27 15.21 1.77* 0.47

Kaposi sarcoma 2 1.34 8 1.48 6 1.50 1 0.35 17 13.79 1.23 0.13

Melanoma of skin 155 14.84* 347 8.88* 252 7.96* 232 6.82* 986 115.17 8.56* 34.57

Eye, orbit 0 0.00 2 0.98 1 0.63 2 1.26 5 5.77 0.87 -0.03

Brain, central nervous system 3 0.74 18 1.22 17 1.49 10 0.90 48 41.45 1.16 0.26

Thyroid 10 6.57* 16 2.90* 8 1.90 5 1.23 39 15.33 2.54* 0.94

Lymphatic, hematopoietic 47 1.77* 111 1.14 80 1.03 62 0.77* 300 281.49 1.07 0.73

Hodgkin lymphoma 2 1.66 3 0.72 1 0.34 2 0.78 8 10.90 0.73 -0.12

Non-Hodgkin lymphoma 33 2.77* 54 1.22 45 1.26 30 0.80 162 129.57 1.25* 1.29

Myeloma 3 0.75 21 1.44 8 0.68 9 0.73 41 42.72 0.96 -0.07

Leukemia 9 0.96 33 0.96 26 0.96 21 0.76 89 98.30 0.91 -0.37

Acute lymphocytic 0 0.00 0 0.00 2 2.44 0 0.00 2 2.95 0.68 -0.04

Chronic lymphocytic 7 1.84 16 1.16 12 1.10 11 0.99 46 39.75 1.16 0.25

Acute non-lymphocytic 1 0.33 11 0.99 5 0.57 7 0.76 24 32.26 0.74 -0.33

Chronic myeloid 1 0.78 2 0.43 4 1.10 1 0.26 8 13.35 0.60 -0.21

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 34,949 31,092 18,378 10,050 34,949

Person-years in interval 27,302 96,008 68,887 59,699 251,895

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING MELANOMA OF THE SKIN, EYE MELANOMA, AND NON-MELANOMA EYE CANCER 349
All subsequent cancers 20 8.46* 54 4.59* 41 2.63* 100 2.50* 215 69.66 3.09* 24.74

All excluding same site 4 1.98 17 1.70 14 1.04 56 1.55* 91 61.63 1.48* 5.00

Buccal cavity, pharynx 1 24.12 0 0.00 1 3.72 4 4.41* 6 1.42 4.23* 0.78

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.03

Tongue 0 0.00 0 0.00 1 15.39 2 8.33 3 0.36 8.43* 0.45

Salivary gland 1 67.13 0 0.00 0 0.00 0 0.00 1 0.29 3.39 0.12

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.05

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.02

Tonsil 0 0.00 0 0.00 0 0.00 2 14.64* 2 0.16 12.45* 0.31

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 0.00

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.01

Digestive system 0 0.00 1 1.90 2 2.27 7 1.90 10 5.19 1.93 0.82

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.03

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -0.08

Small intestine 0 0.00 0 0.00 2 58.59* 2 16.59* 4 0.18 22.22* 0.65

Colon 0 0.00 0 0.00 0 0.00 2 1.48 2 1.96 1.02 0.01

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 1 1.24 1 1.10 0.91 -0.02

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.04

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.04

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.01

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.02

Pancreas 0 0.00 1 27.97 0 0.00 2 5.45 3 0.48 6.29* 0.43

Respiratory system 0 0.00 1 4.86 0 0.00 2 0.81 3 3.13 0.96 -0.02

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.02

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.05

Lung, bronchus 0 0.00 1 7.11 0 0.00 2 0.93 3 2.65 1.13 0.06

Female breast 0 0.00 1 0.70 3 0.95 15 1.23 19 16.98 1.12 0.55

Female genital system 1 3.09 5 2.96 2 0.90 8 1.64 16 9.12 1.75* 1.86

Cervix uteri 0 0.00 2 2.09 0 0.00 1 0.60 3 3.95 0.76 -0.26

Corpus uteri 0 0.00 0 0.00 1 3.44 2 1.46 3 1.82 1.65 0.32

Ovary 0 0.00 3 6.01* 1 1.56 4 2.55 8 2.81 2.84* 1.40

Vagina 0 0.00 0 0.00 0 0.00 1 24.93 1 0.07 13.95 0.25

Vulva 1 150.16* 0 0.00 0 0.00 0 0.00 1 0.28 3.61 0.20

Male genital system 1 4.91 1 1.14 2 2.42 2 1.22 6 3.54 1.69 1.13

Prostate 0 0.00 0 0.00 0 0.00 2 2.44 2 0.83 2.41 0.54

Testis 1 4.95 1 1.15 2 2.46 0 0.00 4 2.68 1.49 0.61

Urinary system 0 0.00 0 0.00 1 2.54 4 2.49 5 2.29 2.19 0.46

Urinary bladder 0 0.00 0 0.00 1 4.92 3 3.82 4 1.15 3.48 0.49

Kidney parenchyma 0 0.00 0 0.00 0 0.00 1 1.29 1 1.07 0.94 -0.01

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.01

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.07

Soft tissue including heart 0 0.00 1 4.57 0 0.00 0 0.00 1 0.84 1.19 0.03

Kaposi sarcoma 0 0.00 2 4.10 2 2.64 0 0.00 4 2.26 1.77 0.30

Melanoma of skin 16 45.99* 37 21.42* 27 12.70* 44 11.48* 124 8.03 15.44* 19.74

Eye, orbit 0 0.00 1 25.62 0 0.00 1 11.21 2 0.18 11.12* 0.31

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 2.20 0.00 -0.37

Thyroid 1 3.57 2 1.57 0 0.00 4 2.00 7 4.90 1.43 0.36

Lymphatic, hematopoietic 0 0.00 2 0.99 1 0.49 9 2.45* 12 8.21 1.46 0.64

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 1 1.61 1 2.50 0.40 -0.25

Non-Hodgkin lymphoma 0 0.00 1 1.54 0 0.00 4 2.01 5 3.64 1.37 0.23

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.04

Leukemia 0 0.00 1 2.36 1 2.28 4 4.69* 6 1.82 3.30* 0.71

Acute lymphocytic 0 0.00 0 0.00 1 12.41 0 0.00 1 0.31 3.26 0.12

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.03

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 3 8.59* 3 0.80 3.73 0.37

Chronic myeloid 0 0.00 1 11.39 0 0.00 1 5.72 2 0.38 5.21 0.28

Melanoma of Skin

Both Sexes, <30 Years of Age

Table 13.1.6: Risk of subsequent primary cancers after melanoma of the skin, both sexes,

<30 years of age, SEER 1973-2000.

350 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

MELANOMA OF SKIN

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,967 5,542 3,927 2,678 5,967

Person-years in interval 4,767 18,664 16,254 19,065 58,749

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 36,967 PYR and for male cancers on 21,783 PYR.
Melanoma of Skin

Both Sexes, 30-49 Years of Age

Table 13.1.7: Risk of subsequent primary cancers after melanoma of the skin, both sexes,

30-49 years of age, SEER 1973-2000.

MELANOMA OF SKIN

All subsequent cancers 120 3.01* 383 2.01* 349 1.53* 610 1.28* 1,462 934.36 1.56* 25.88

All excluding same site 55 1.52* 215 1.22* 232 1.08 455 1.00 957 881.81 1.09* 3.69

Buccal cavity, pharynx 4 3.33 4 0.67 3 0.41 10 0.76 21 27.80 0.76 -0.33

Lip 2 13.22* 0 0.00 0 0.00 0 0.00 2 2.84 0.70 -0.04

Tongue 0 0.00 1 0.71 1 0.57 2 0.63 4 6.61 0.60 -0.13

Salivary gland 0 0.00 2 2.98 0 0.00 1 0.85 3 2.69 1.12 0.02

Mouth 0 0.00 1 0.70 0 0.00 4 1.19 5 6.92 0.72 -0.09

Nasopharynx 2 29.87* 0 0.00 1 2.93 0 0.00 3 1.25 2.41 0.09

Tonsil 0 0.00 0 0.00 1 0.96 2 1.17 3 3.74 0.80 -0.04

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.73 0.00 -0.04

Hypopharynx 0 0.00 0 0.00 0 0.00 1 0.84 1 2.22 0.45 -0.06

Digestive system 5 1.15 26 1.14 31 1.01 65 0.88 127 132.08 0.96 -0.25

Esophagus 0 0.00 4 3.53 1 0.59 4 0.90 9 7.47 1.20 0.08

Stomach 1 2.22 3 1.35 0 0.00 5 0.84 9 11.45 0.79 -0.12

Small intestine 0 0.00 0 0.00 0 0.00 2 1.26 2 3.13 0.64 -0.06

Colon 3 1.81 8 0.92 13 1.09 31 1.02 55 52.50 1.05 0.12

Rectum, rectosigmoid junction 1 1.09 4 0.82 8 1.20 8 0.53 21 27.45 0.76 -0.32

Anus, anal canal 0 0.00 0 0.00 1 1.31 2 1.46 3 2.92 1.03 0.00

Liver 0 0.00 1 1.04 1 0.80 1 0.34 3 5.38 0.56 -0.12

Gallbladder 0 0.00 0 0.00 1 3.09 0 0.00 1 1.42 0.71 -0.02

Bile ducts, other biliary 0 0.00 2 4.29 0 0.00 3 1.87 5 2.78 1.80 0.11

Pancreas 0 0.00 2 0.79 6 1.69 8 0.90 16 15.46 1.03 0.03

Respiratory system 1 0.28 18 0.90 31 1.06 61 0.82 111 127.46 0.87 -0.81

Nose, nasal cavity, ear 0 0.00 1 2.88 0 0.00 0 0.00 1 1.50 0.67 -0.02

Larynx 0 0.00 2 1.04 1 0.38 3 0.54 6 10.45 0.57 -0.22

Lung, bronchus 1 0.32 15 0.86 29 1.11 58 0.85 103 115.04 0.90 -0.59

Female breast 9 0.86 54 1.08 60 1.05 103 1.12 226 209.78 1.08 1.47

Female genital system 3 0.70 22 1.11 22 1.02 29 0.81 76 81.33 0.93 -0.48

Cervix uteri 1 0.70 4 0.72 2 0.44 0 0.00* 7 16.06 0.44* -0.82

Corpus uteri 1 0.79 5 0.73 10 1.12 16 0.88 32 35.12 0.91 -0.28

Ovary 1 0.75 12 1.93 8 1.16 13 1.17 34 25.52 1.33 0.77

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.74 0.00 -0.07

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 2.45 0.00 -0.22

Male genital system 3 1.83 12 1.28 26 1.56* 83 1.16 124 99.39 1.25* 2.62

Prostate 0 0.00 8 1.26 24 1.63* 82 1.17 114 92.09 1.24* 2.33

Testis 3 3.56 3 1.06 2 1.16 1 1.00 9 6.39 1.41 0.28

Urinary system 6 2.98* 22 2.13* 9 0.66 23 0.72 60 58.20 1.03 0.09

Urinary bladder 3 2.83 11 1.98 5 0.66 8 0.41* 27 33.52 0.81 -0.32

Kidney parenchyma 3 3.44 10 2.27* 4 0.71 15 1.32 32 22.25 1.44 0.48

Renal pelvis, other urinary 0 0.00 1 2.51 0 0.00 0 0.00 1 2.43 0.41 -0.07

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.66 0.00 -0.03

Bone, joints 0 0.00 1 2.09 0 0.00 1 1.74 2 1.60 1.25 0.02

Soft tissue including heart 1 2.85 6 4.04* 2 1.38 9 4.15* 18 5.46 3.30* 0.62

Kaposi sarcoma 2 2.01 6 1.69 4 1.66 1 0.76 13 8.27 1.57 0.23

Melanoma of skin 65 18.39* 168 11.25* 117 8.16* 155 7.85* 505 52.55 9.61* 22.19

Eye, orbit 0 0.00 0 0.00 0 0.00 1 1.17 1 1.93 0.52 -0.05

Brain, central nervous system 1 1.01 7 1.64 5 1.17 5 0.78 18 15.93 1.13 0.10

Thyroid 10 6.27* 12 1.89 8 1.46 13 2.11* 43 19.59 2.19* 1.15

Lymphatic, hematopoietic 9 2.36* 24 1.41 25 1.36 44 1.30 102 73.12 1.39* 1.42

Hodgkin lymphoma 4 6.76* 2 0.94 0 0.00 3 1.85 9 5.95 1.51 0.15

Non-Hodgkin lymphoma 4 1.97 17 1.85* 18 1.80* 22 1.23 61 39.15 1.56* 1.07

Myeloma 1 4.12 3 2.24 1 0.53 6 1.30 11 8.06 1.36 0.14

Leukemia 0 0.00 2 0.46 6 1.22 13 1.34 21 19.96 1.05 0.05

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.22 0.00 -0.06

Chronic lymphocytic 0 0.00 1 0.94 3 1.92 7 1.86 11 6.59 1.67 0.22

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 5 1.53 5 6.96 0.72 -0.10

Chronic myeloid 0 0.00 0 0.00 1 1.20 0 0.00 1 3.23 0.31 -0.11

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 23,345 21,503 14,469 8,777 23,345

Person-years in interval 18,595 70,899 57,024 57,398 203,916

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 110,042 PYR and for male cancers on 93,874 PYR.

NEW MALIGNANCIES FOLLOWING MELANOMA OF THE SKIN, EYE MELANOMA, AND NON-MELANOMA EYE CANCER 351
All subsequent cancers 660 1.39* 2,134 1.23* 1,543 1.13* 1,246 0.98 5,583 4,853.49 1.15* 29.06

All excluding same site 499 1.08 1,769 1.04 1,308 0.98 1,057 0.85* 4,633 4,734.58 0.98 -4.05

Buccal cavity, pharynx 11 0.87 42 0.94 27 0.83 23 0.86 103 116.74 0.88 -0.55

Lip 6 2.91* 11 1.53 4 0.77 4 0.92 25 18.79 1.33 0.25

Tongue 1 0.39 7 0.77 5 0.75 3 0.56 16 23.63 0.68 -0.30

Salivary gland 1 0.91 8 2.00 4 1.29 7 2.40 20 11.12 1.80* 0.35

Mouth 2 0.61 9 0.77 5 0.59 5 0.72 21 30.43 0.69 -0.38

Nasopharynx 0 0.00 0 0.00 2 1.97 0 0.00 2 3.70 0.54 -0.07

Tonsil 0 0.00 4 0.96 3 1.04 2 0.95 9 10.32 0.87 -0.05

Oropharynx 0 0.00 2 1.58 1 1.08 1 1.39 4 3.26 1.23 0.03

Hypopharynx 1 0.80 1 0.23 3 0.94 1 0.41 6 11.31 0.53 -0.21

Digestive system 92 0.90 374 1.01 261 0.90 202 0.74* 929 1,036.36 0.90* -4.28

Esophagus 2 0.40 8 0.43* 8 0.56 4 0.31* 22 50.79 0.43* -1.15

Stomach 8 0.82 29 0.83 23 0.87 15 0.62 75 95.08 0.79* -0.80

Small intestine 1 0.70 15 2.85* 5 1.20 3 0.74 24 14.95 1.60* 0.36

Colon 38 0.82 180 1.06 141 1.04 112 0.86 471 482.22 0.98 -0.45

Rectum, rectosigmoid junction 23 1.26 69 1.05 38 0.76 28 0.63* 158 178.33 0.89 -0.81

Anus, anal canal 1 1.04 9 2.55* 3 1.09 2 0.79 15 9.78 1.53 0.21

Liver 3 0.93 11 0.93 5 0.54 4 0.44 23 33.31 0.69 -0.41

Gallbladder 2 1.50 4 0.83 2 0.53 4 1.11 12 13.52 0.89 -0.06

Bile ducts, other biliary 4 1.80 9 1.10 7 1.06 6 0.87 26 23.91 1.09 0.08

Pancreas 9 0.74 37 0.84 26 0.75 23 0.69 95 124.06 0.77* -1.16

Respiratory system 61 0.74* 236 0.78* 174 0.74* 162 0.76* 633 833.84 0.76* -8.00

Nose, nasal cavity, ear 0 0.00 1 0.40 3 1.59 4 2.33 8 6.80 1.18 0.05

Larynx 5 0.87 10 0.49* 7 0.48* 4 0.35* 26 52.13 0.50* -1.04

Lung, bronchus 56 0.74* 224 0.80* 164 0.75* 152 0.76* 596 772.99 0.77* -7.05

Female breast 48 1.09 191 1.16 151 1.13 130 1.00 520 472.89 1.10* 4.10

Female genital system 23 1.15 57 0.78 52 0.91 36 0.68* 168 203.91 0.82* -3.13

Cervix uteri 1 0.52 2 0.30 1 0.21 2 0.54 6 17.00 0.35* -0.96

Corpus uteri 17 1.61 35 0.90 32 1.05 17 0.62* 101 107.56 0.94 -0.57

Ovary 4 0.68 15 0.69 15 0.86 15 0.91 49 61.63 0.80 -1.10

Vagina 0 0.00 0 0.00 1 1.18 0 0.00 1 3.02 0.33 -0.18

Vulva 0 0.00 4 1.18 3 1.06 1 0.33 8 10.17 0.79 -0.19

Male genital system 127 1.28* 467 1.27* 342 1.15* 263 0.97 1,199 1,034.24 1.16* 12.09

Prostate 126 1.28* 464 1.27* 339 1.15* 261 0.97 1,190 1,025.98 1.16* 12.04

Testis 0 0.00 1 1.00 0 0.00 0 0.00 1 2.18 0.46 -0.09

Urinary system 49 1.22 146 1.00 113 0.99 107 1.00 415 407.94 1.02 0.28

Urinary bladder 27 0.96 96 0.94 76 0.94 74 0.97 273 287.35 0.95 -0.57

Kidney parenchyma 19 1.98* 44 1.25 33 1.22 25 1.01 121 96.47 1.25* 0.98

Renal pelvis, other urinary 3 1.26 6 0.69 4 0.59 8 1.26 21 24.13 0.87 -0.12

Ureter 0 0.00 0 0.00 1 0.44 2 0.95 3 8.07 0.37 -0.20

Bone, joints 0 0.00 1 0.68 0 0.00 2 2.14 3 3.88 0.77 -0.04

Soft tissue including heart 2 1.09 15 2.27* 8 1.58 10 2.06 35 18.36 1.91* 0.66

Kaposi sarcoma 0 0.00 1 0.63 0 0.00 0 0.00 1 3.96 0.25 -0.12

Melanoma of skin 161 13.62* 365 8.48* 235 7.10* 189 6.11* 950 118.91 7.99* 33.10

Eye, orbit 0 0.00 3 1.13 4 2.01 6 3.42* 13 7.14 1.82 0.23

Brain, central nervous system 4 0.80 20 1.10 17 1.25 12 1.00 53 48.76 1.09 0.17

Thyroid 9 3.78* 18 2.15* 13 2.17* 3 0.60 43 21.70 1.98* 0.85

Lymphatic, hematopoietic 56 1.58* 142 1.09 101 0.99 73 0.74* 372 366.80 1.01 0.21

Hodgkin lymphoma 0 0.00 4 1.05 2 0.74 1 0.45 7 9.85 0.71 -0.11

Non-Hodgkin lymphoma 35 2.16* 66 1.11 57 1.20 43 0.92 201 170.34 1.18* 1.22

Myeloma 4 0.70 24 1.14 10 0.60 9 0.56 47 59.41 0.79 -0.49

Leukemia 17 1.36 48 1.06 32 0.90 20 0.59* 117 127.21 0.92 -0.41

Acute lymphocytic 1 2.94 1 0.83 4 4.37* 0 0.00 6 3.26 1.84 0.11

Chronic lymphocytic 11 2.14* 23 1.23 14 0.96 8 0.59 56 51.81 1.08 0.17

Acute non-lymphocytic 3 0.73 15 0.99 7 0.59 9 0.77 34 42.93 0.79 -0.36

Chronic myeloid 2 1.20 2 0.33 4 0.85 1 0.22 9 16.91 0.53 -0.32

Melanoma of Skin

Both Sexes, ≥50 Years of Age

Table 13.1.8: Risk of subsequent primary cancers after melanoma of the skin, both sexes,

≥50 years of age, SEER 1973-2000.

352 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

MELANOMA OF SKIN

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 36,747 32,508 18,641 9,785 36,747

Person-years in interval 28,617 98,808 68,694 54,928 251,047

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 114,809 PYR and for male cancers on 136,238 PYR.
OCULAR MELANOMA

Ocular Melanoma

Both Sexes

Table 13.2.1: Characteristics of patients with an initial ocular melanoma, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 1,671 100.0 1,546 100.0 3,217 100.0

Initial treatment

Any radiation 432 25.9 368 23.8 800 24.9

With surgery 98 5.9 87 5.6 185 5.8

Without surgery 334 20.0 281 18.2 615 19.1

No radiation 1,239 74.1 1,178 76.2 2,417 75.1

With surgery 1,087 65.1 1,037 67.1 2,124 66.0

Without surgery 152 9.1 141 9.1 293 9.1

Race

White 1,622 97.1 1,513 97.9 3,135 97.5

Black 17 1.0 8 0.5 25 0.8

Other 14 0.8 8 0.5 22 0.7

Unknown 18 1.1 17 1.1 35 1.1

Age at 1st primary cancer diagnosis, years

< 30 62 3.7 64 4.1 126 3.9

30–49 359 21.5 275 17.8 634 19.7

50–69 821 49.1 702 45.4 1,523 47.3

70–79 327 19.6 323 20.9 650 20.2

> 80 102 6.1 182 11.8 284 8.8

Number of patients with one or more

primary cancers

One primary cancer only 1,450 86.8 1,369 88.6 2,819 87.6

1st and 2nd cancers 197 11.8 164 10.6 361 11.2

1st, 2nd, and 3rd cancers 23 1.4 13 0.8 36 1.1

1st, 2nd, 3rd, and additional cancers 1 0.1 0 0.0 1 0.0

Other statistics

Median age at 1st cancer diagnosis 60.1 — 64.3 — 62.1 —

Median year of 1st cancer diagnosis 1987.4 — 1987.4 — 1987.4 —

Median person-years at risk 5.5 — 5.7 — 5.6 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 81.0 — 79.1 — 80.2

1st, 2nd, and additional cancers — 80.1 — 79.1 — 79.6

1st cancer only — 0.5 — 7.3 — 3.5

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING MELANOMA OF THE SKIN, EYE MELANOMA, AND NON-MELANOMA EYE CANCER 353

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 43 1.29 149 1.20* 114 1.15 130 1.09 436 375.67 1.16* 23.96

All excluding same site 43 1.30 147 1.19* 113 1.14 128 1.08 431 375.18 1.15* 22.16

Buccal cavity, pharynx 0 0.00 3 0.90 2 0.80 2 0.76 7 9.40 0.75 -0.95

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 1.51 0.00 -0.60

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 1.89 0.00 -0.75

Salivary gland 0 0.00 2 7.03 0 0.00 1 3.59 3 0.87 3.46 0.85

Mouth 0 0.00 0 0.00 1 1.49 1 1.43 2 2.51 0.80 -0.20

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.12

Tonsil 0 0.00 1 3.24 0 0.00 0 0.00 1 0.85 1.18 0.06

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.10

Hypopharynx 0 0.00 0 0.00 1 4.17 0 0.00 1 0.89 1.13 0.04

Digestive system 7 0.95 29 1.06 22 1.00 17 0.66 75 82.43 0.91 -2.95

Esophagus 1 3.02 3 2.44 1 1.01 0 0.00 5 3.75 1.33 0.50

Stomach 0 0.00 0 0.00 2 0.99 0 0.00 2 7.61 0.26* -2.23

Small intestine 0 0.00 1 2.72 1 3.34 1 2.64 3 1.15 2.62 0.74

Colon 5 1.48 14 1.10 10 0.97 12 0.98 41 38.70 1.06 0.91

Rectum, rectosigmoid junction 0 0.00 4 0.81 3 0.78 1 0.24 8 14.30 0.56 -2.50

Anus, anal canal 0 0.00 0 0.00 1 4.72 1 4.02 2 0.80 2.50 0.48

Liver 0 0.00 1 1.29 2 3.16 1 1.24 4 2.42 1.65 0.63

Gallbladder 0 0.00 1 2.47 0 0.00 0 0.00 1 1.18 0.85 -0.07

Bile ducts, other biliary 1 6.61 0 0.00 0 0.00 0 0.00 1 1.82 0.55 -0.32

Pancreas 0 0.00 5 1.52 2 0.77 1 0.32 8 9.89 0.81 -0.75

Respiratory system 6 1.06 16 0.76 18 1.07 21 1.08 61 62.89 0.97 -0.75

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -0.22

Larynx 1 2.55 1 0.70 0 0.00 0 0.00 2 4.01 0.50 -0.80

Lung, bronchus 5 0.96 15 0.77 18 1.16 21 1.16 59 58.18 1.01 0.33

Female breast 4 1.03 8 0.55 7 0.62 17 1.31 36 42.59 0.85 -5.39

Female genital system 3 1.61 6 0.89 8 1.63 12 2.29* 29 18.78 1.54* 8.35

Cervix uteri 2 9.74* 0 0.00 1 2.07 0 0.00 3 1.84 1.63 0.95

Corpus uteri 0 0.00 2 0.57 5 1.98 6 2.27 13 9.68 1.34 2.72

Ovary 0 0.00 2 1.02 2 1.35 6 3.63* 10 5.63 1.77 3.57

Vagina 0 0.00 1 10.41 0 0.00 0 0.00 1 0.28 3.60 0.59

Vulva 0 0.00 1 3.28 0 0.00 0 0.00 1 0.93 1.07 0.05

Male genital system 5 0.89 29 1.36 19 1.04 22 0.91 75 69.41 1.08 4.32

Prostate 5 0.90 28 1.33 19 1.05 22 0.92 74 68.53 1.08 4.23

Testis 0 0.00 1 5.78 0 0.00 0 0.00 1 0.43 2.33 0.44

Urinary system 5 1.89 17 1.72* 8 0.99 11 1.13 41 30.32 1.35 4.24

Urinary bladder 4 2.19 7 1.02 5 0.89 7 1.02 23 21.15 1.09 0.73

Kidney parenchyma 1 1.56 10 4.17* 3 1.55 4 1.73 18 7.29 2.47* 4.25

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.88 0.00 -0.75

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -0.25

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.13

Soft tissue including heart 0 0.00 3 6.13* 1 2.62 2 4.24 6 1.48 4.07* 1.80

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.24

Melanoma of skin 5 6.29* 14 4.65* 8 3.29* 10 3.30* 37 9.27 3.99* 11.01

Eye, orbit 1 17.50 2 9.74* 1 6.50 2 11.76* 6 0.59 10.23* 2.15

Brain, central nervous system 1 2.66 1 0.72 3 2.81 2 1.71 7 4.00 1.75 1.19

Thyroid 1 4.91 2 2.67 2 3.67 0 0.00 5 2.07 2.41 1.16

Lymphatic, hematopoietic 5 1.98 12 1.27 8 1.05 8 0.86 33 28.88 1.14 1.64

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.96 0.00 -0.38

Non-Hodgkin lymphoma 4 3.54 4 0.94 3 0.86 3 0.69 14 13.26 1.06 0.29

Myeloma 0 0.00 5 3.34* 1 0.82 2 1.34 8 4.60 1.74 1.35

Leukemia 1 1.12 3 0.91 4 1.50 3 0.94 11 10.05 1.09 0.38

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.11

Chronic lymphocytic 1 2.77 1 0.75 2 1.85 1 0.78 5 4.06 1.23 0.37

Acute non-lymphocytic 0 0.00 0 0.00 1 1.13 2 1.85 3 3.36 0.89 -0.14

Chronic myeloid 0 0.00 2 4.52 0 0.00 0 0.00 2 1.35 1.48 0.26

Ocular Melanoma

Both Sexes

Table 13.2.2: Risk of subsequent primary cancers after ocular melanoma, both sexes,

SEER 1973-2000.

354 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

OCULAR MELANOMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,217 3,018 1,780 993 3,217

Person-years in interval 2,602 9,352 6,664 6,569 25,186

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 12,241 PYR and for male cancers on 12,945 PYR.
Ocular Melanoma

Females

Table 13.2.3: Risk of subsequent primary cancers after ocular melanoma, females,

SEER 1973-2000.

OCULAR MELANOMA

All subsequent cancers 22 1.61* 60 1.18 47 1.19 61 1.31* 190 150.94 1.26* 31.91

All excluding same site 22 1.61* 60 1.18 46 1.16 60 1.29 188 150.73 1.25* 30.45

Buccal cavity, pharynx 0 0.00 1 1.07 0 0.00 1 1.28 2 2.68 0.75 -0.55

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.16

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.48

Salivary gland 0 0.00 1 9.74 0 0.00 0 0.00 1 0.30 3.32 0.57

Mouth 0 0.00 0 0.00 0 0.00 1 3.61 1 0.94 1.06 0.05

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.07

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.18

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.14

Digestive system 4 1.28 14 1.19 12 1.29 9 0.81 39 35.23 1.11 3.08

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.91 0.00 -0.75

Stomach 0 0.00 0 0.00 1 1.50 0 0.00 1 2.53 0.39 -1.25

Small intestine 0 0.00 0 0.00 1 8.07 1 6.18 2 0.48 4.13 1.24

Colon 3 1.90 6 1.01 4 0.84 5 0.87 18 18.02 1.00 -0.01

Rectum, rectosigmoid junction 0 0.00 2 1.04 3 2.03 0 0.00 5 5.54 0.90 -0.44

Rectum 0 0.00 1 0.80 2 2.08 0 0.00 3 3.64 0.82 -0.52

Anus, anal canal 0 0.00 0 0.00 1 8.14 1 6.88 2 0.47 4.29 1.25

Liver 0 0.00 1 4.61 1 5.78 1 4.50 3 0.67 4.48 1.90

Gallbladder 0 0.00 1 3.60 0 0.00 0 0.00 1 0.80 1.26 0.17

Bile ducts, other biliary 1 15.31 0 0.00 0 0.00 0 0.00 1 0.79 1.27 0.17

Pancreas 0 0.00 4 2.66 1 0.84 1 0.68 6 4.57 1.31 1.17

Respiratory system 3 1.76 4 0.62 5 0.96 8 1.24 20 19.84 1.01 0.13

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.17

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.49

Lung, bronchus 3 1.85 4 0.65 5 1.00 8 1.29 20 18.98 1.05 0.84

Female breast 4 1.03 8 0.55 7 0.62 17 1.31 36 42.59 0.85 -5.39

Female genital system 3 1.61 6 0.89 8 1.63 12 2.29* 29 18.78 1.54* 8.35

Cervix uteri 2 9.74* 0 0.00 1 2.07 0 0.00 3 1.84 1.63 0.95

Corpus uteri 0 0.00 2 0.57 5 1.98 6 2.27 13 9.68 1.34 2.72

Ovary 0 0.00 2 1.02 2 1.35 6 3.63* 10 5.63 1.77 3.57

Vagina 0 0.00 1 10.41 0 0.00 0 0.00 1 0.28 3.60 0.59

Vulva 0 0.00 1 3.28 0 0.00 0 0.00 1 0.93 1.07 0.05

Urinary system 2 3.07 4 1.63 1 0.51 2 0.84 9 7.44 1.21 1.27

Urinary bladder 1 2.55 2 1.36 0 0.00 0 0.00 3 4.48 0.67 -1.21

Kidney parenchyma 1 4.88 2 2.59 1 1.63 2 2.64 6 2.35 2.56 2.99

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -0.51

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.16

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.12

Soft tissue including heart 0 0.00 2 10.15* 0 0.00 1 5.35 3 0.59 5.09* 1.97

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.05

Melanoma of skin 3 10.53* 9 8.31* 4 4.79* 5 5.00* 21 3.20 6.56* 14.54

Eye, orbit 0 0.00 0 0.00 1 16.45 1 14.82 2 0.24 8.45 1.44

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 1.60 0.00 -1.30

Thyroid 1 7.82 1 2.12 2 5.93 0 0.00 4 1.29 3.11 2.22

Lymphatic, hematopoietic 2 1.92 7 1.79 1 0.32 3 0.78 13 11.87 1.10 0.92

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.30

Non-Hodgkin lymphoma 1 2.02 3 1.60 0 0.00 0 0.00 4 5.79 0.69 -1.46

Myeloma 0 0.00 3 4.75 1 2.00 2 3.31 6 1.90 3.15* 3.35

Leukemia 1 2.97 1 0.79 0 0.00 1 0.82 3 3.80 0.79 -0.65

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.09

Chronic lymphocytic 1 7.54 1 2.01 0 0.00 1 2.11 3 1.50 2.01 1.23

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.33 0.00 -1.08

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.52 0.00 -0.42

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,546 1,463 872 474 1,546

Person-years in interval 1,256 4,552 3,220 3,213 12,241

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING MELANOMA OF THE SKIN, EYE MELANOMA, AND NON-MELANOMA EYE CANCER 355
All subsequent cancers 21 1.07 89 1.22 67 1.12 69 0.95 246 224.72 1.09 16.44

All excluding same site 21 1.07 87 1.19 67 1.12 68 0.94 243 224.45 1.08 14.33

Buccal cavity, pharynx 0 0.00 2 0.84 2 1.11 1 0.54 5 6.72 0.74 -1.33

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 1.31 0.00 -1.01

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 1.30 0.00 -1.00

Salivary gland 0 0.00 1 5.49 0 0.00 1 5.38 2 0.57 3.54 1.11

Mouth 0 0.00 0 0.00 1 2.36 0 0.00 1 1.57 0.64 -0.44

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.17

Tonsil 0 0.00 1 4.41 0 0.00 0 0.00 1 0.63 1.59 0.29

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.15

Hypopharynx 0 0.00 0 0.00 1 5.18 0 0.00 1 0.71 1.40 0.22

Digestive system 3 0.71 15 0.96 10 0.79 8 0.54 36 47.20 0.76 -8.65

Esophagus 1 3.99 3 3.24 1 1.33 0 0.00 5 2.84 1.76 1.67

Stomach 0 0.00 0 0.00 1 0.73 0 0.00 1 5.08 0.20 -3.15

Small intestine 0 0.00 1 4.71 0 0.00 0 0.00 1 0.66 1.51 0.26

Colon 2 1.11 8 1.19 6 1.08 7 1.07 23 20.68 1.11 1.79

Rectum, rectosigmoid junction 0 0.00 2 0.67 0 0.00 1 0.39 3 8.76 0.34 -4.45

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.26

Liver 0 0.00 0 0.00 1 2.18 0 0.00 1 1.75 0.57 -0.58

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.29

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.03 0.00 -0.80

Pancreas 0 0.00 1 0.56 1 0.71 0 0.00 2 5.32 0.38 -2.57

Respiratory system 3 0.76 12 0.82 13 1.12 13 1.01 41 43.06 0.95 -1.59

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.26

Larynx 1 3.00 1 0.82 0 0.00 0 0.00 2 3.41 0.59 -1.09

Lung, bronchus 2 0.56 11 0.83 13 1.23 13 1.10 39 39.20 0.99 -0.16

Male breast 0 0.00 1 7.27 0 0.00 0 0.00 1 0.42 2.36 0.45

Male genital system 5 0.89 29 1.36 19 1.04 22 0.91 75 69.41 1.08 4.32

Prostate 5 0.90 28 1.33 19 1.05 22 0.92 74 68.53 1.08 4.23

Testis 0 0.00 1 5.78 0 0.00 0 0.00 1 0.43 2.33 0.44

Urinary system 3 1.51 13 1.75 7 1.15 9 1.22 32 22.88 1.40 7.04

Urinary bladder 3 2.09 5 0.93 5 1.12 7 1.29 20 16.68 1.20 2.57

Kidney parenchyma 0 0.00 8 4.92* 2 1.52 2 1.28 12 4.94 2.43* 5.45

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.26 0.00 -0.98

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.34

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.15

Soft tissue including heart 0 0.00 1 3.43 1 4.34 1 3.51 3 0.89 3.38 1.63

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -0.42

Melanoma of skin 2 3.92 5 2.59 4 2.51 5 2.47 16 6.07 2.64* 7.67

Eye, orbit 1 29.86 2 16.58* 0 0.00 1 9.75 4 0.35 11.43* 2.82

Brain, central nervous system 1 4.43 1 1.20 3 4.67 2 2.84 7 2.40 2.91* 3.55

Thyroid 0 0.00 1 3.61 0 0.00 0 0.00 1 0.79 1.27 0.16

Lymphatic, hematopoietic 3 2.02 5 0.91 7 1.55 5 0.91 20 17.01 1.18 2.31

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.46

Non-Hodgkin lymphoma 3 4.73 1 0.42 3 1.51 3 1.22 10 7.47 1.34 1.96

Myeloma 0 0.00 2 2.31 0 0.00 0 0.00 2 2.70 0.74 -0.54

Leukemia 0 0.00 2 0.98 4 2.39 2 1.01 8 6.25 1.28 1.35

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.13

Chronic lymphocytic 0 0.00 0 0.00 2 2.90 0 0.00 2 2.56 0.78 -0.44

Acute non-lymphocytic 0 0.00 0 0.00 1 1.84 2 3.05 3 2.04 1.47 0.74

Chronic myeloid 0 0.00 2 7.37 0 0.00 0 0.00 2 0.83 2.40 0.90

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,671 1,555 908 519 1,671

Person-years in interval 1,346 4,799 3,444 3,355 12,945

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Ocular Melanoma

Males

Table 13.2.4: Risk of subsequent primary cancers after ocular melanoma, males,

SEER 1973-2000.

356 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

OCULAR MELANOMA

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Ocular Melanoma

Both Sexes, <50 Years of Age

Table 13.2.5: Risk of subsequent primary cancers after ocular melanoma, both sexes,

<50 years of age, SEER 1973-2000.

OCULAR MELANOMA

All subsequent cancers 2 1.64 9 1.45 17 2.31* 29 1.58* 57 33.17 1.72* 31.74

All excluding same site 2 1.64 9 1.45 17 2.32* 27 1.47 55 33.11 1.66* 29.16

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.12 0.00 -1.49

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.16

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.34

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.13

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.37

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.07

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.19

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.04

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.13

Digestive system 0 0.00 0 0.00 3 2.71 2 0.67 5 5.08 0.98 -0.11

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.43

Stomach 0 0.00 0 0.00 1 9.19 0 0.00 1 0.47 2.12 0.70

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.15

Colon 0 0.00 0 0.00 0 0.00 1 0.83 1 2.00 0.50 -1.33

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 0 0.00 0 1.04 0.00 -1.39

Anus, anal canal 0 0.00 0 0.00 0 0.00 1 20.09 1 0.10 10.42 1.20

Liver 0 0.00 0 0.00 1 22.04 0 0.00 1 0.21 4.69 1.05

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.06

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.14

Pancreas 0 0.00 0 0.00 1 7.74 0 0.00 1 0.60 1.68 0.54

Respiratory system 0 0.00 2 2.54 1 0.89 4 1.29 7 5.14 1.36 2.48

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.08

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.61

Lung, bronchus 0 0.00 2 2.90 1 1.01 4 1.42 7 4.61 1.52 3.19

Female breast 0 0.00 0 0.00 1 0.71 6 2.33 7 5.60 1.25 4.30

Female genital system 0 0.00 0 0.00 1 1.76 2 1.96 3 2.26 1.33 2.27

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -1.39

Corpus uteri 0 0.00 0 0.00 1 4.23 1 1.97 2 0.98 2.04 3.13

Ovary 0 0.00 0 0.00 0 0.00 1 3.17 1 0.70 1.42 0.91

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.06

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.20

Male genital system 0 0.00 1 2.90 1 1.63 6 1.72 8 4.51 1.77 8.20

Prostate 0 0.00 0 0.00 1 1.90 6 1.76 7 4.18 1.67 6.63

Testis 0 0.00 1 8.89 0 0.00 0 0.00 1 0.29 3.42 1.66

Urinary system 1 14.54 0 0.00 1 1.99 1 0.73 3 2.32 1.30 0.91

Urinary bladder 1 26.76 0 0.00 1 3.48 1 1.18 3 1.38 2.17 2.16

Kidney parenchyma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -1.11

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.13

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.04

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.08

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.26

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.44

Melanoma of skin 0 0.00 4 8.60* 2 4.41 2 2.60 8 1.79 4.47* 8.27

Eye, orbit 0 0.00 0 0.00 0 0.00 2 60.85* 2 0.07 28.48* 2.57

Brain, central nervous system 0 0.00 0 0.00 0 0.00 1 3.91 1 0.59 1.70 0.55

Thyroid 1 22.36 0 0.00 2 12.53* 0 0.00 3 0.61 4.92 3.18

Lymphatic, hematopoietic 0 0.00 1 1.69 3 4.66 2 1.46 6 2.73 2.20 4.36

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.33

Non-Hodgkin lymphoma 0 0.00 0 0.00 2 5.94 1 1.41 3 1.41 2.12 2.12

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.41

Leukemia 0 0.00 1 6.42 1 5.69 1 2.51 3 0.76 3.94 2.98

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.06

Chronic lymphocytic 0 0.00 0 0.00 1 17.55 0 0.00 1 0.26 3.88 0.99

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 1 7.58 1 0.26 3.85 0.99

Chronic myeloid 0 0.00 1 34.44 0 0.00 0 0.00 1 0.12 8.27 1.17

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 760 737 518 324 760

Person-years in interval 625 2,519 2,021 2,343 7,509

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 3,254 PYR and for male cancers on 4,255 PYR.

NEW MALIGNANCIES FOLLOWING MELANOMA OF THE SKIN, EYE MELANOMA, AND NON-MELANOMA EYE CANCER 357
All subsequent cancers 41 1.28 140 1.19 97 1.05 101 1.01 379 342.49 1.11 20.65

All excluding same site 41 1.28 138 1.17 96 1.04 101 1.01 376 342.07 1.10 19.19

Buccal cavity, pharynx 0 0.00 3 0.97 2 0.90 2 0.96 7 8.28 0.85 -0.72

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 1.38 0.00 -0.78

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 1.63 0.00 -0.92

Salivary gland 0 0.00 2 7.64 0 0.00 1 4.30 3 0.77 3.90 1.26

Mouth 0 0.00 0 0.00 1 1.67 1 1.79 2 2.23 0.90 -0.13

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.14

Tonsil 0 0.00 1 3.59 0 0.00 0 0.00 1 0.70 1.42 0.17

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.13

Hypopharynx 0 0.00 0 0.00 1 4.65 0 0.00 1 0.79 1.27 0.12

Digestive system 7 0.97 29 1.09 19 0.91 15 0.66 70 77.35 0.90 -4.16

Esophagus 1 3.09 3 2.54 1 1.09 0 0.00 5 3.43 1.46 0.89

Stomach 0 0.00 0 0.00 1 0.52 0 0.00 1 7.14 0.14* -3.47

Small intestine 0 0.00 1 2.88 1 3.65 1 3.15 3 1.03 2.90 1.11

Colon 5 1.50 14 1.13 10 1.01 11 0.99 40 36.70 1.09 1.87

Rectum, rectosigmoid junction 0 0.00 4 0.84 3 0.83 1 0.28 8 13.26 0.60 -2.97

Anus, anal canal 0 0.00 0 0.00 1 5.29 0 0.00 1 0.71 1.42 0.17

Liver 0 0.00 1 1.35 1 1.70 1 1.47 3 2.21 1.36 0.45

Gallbladder 0 0.00 1 2.52 0 0.00 0 0.00 1 1.13 0.89 -0.07

Bile ducts, other biliary 1 6.74 0 0.00 0 0.00 0 0.00 1 1.71 0.58 -0.40

Pancreas 0 0.00 5 1.57 1 0.40 1 0.36 7 9.30 0.75 -1.30

Respiratory system 6 1.09 14 0.69 17 1.09 17 1.05 54 57.76 0.93 -2.12

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -0.27

Larynx 1 2.64 1 0.74 0 0.00 0 0.00 2 3.56 0.56 -0.88

Lung, bronchus 5 0.98 13 0.69 17 1.17 17 1.12 52 53.57 0.97 -0.89

Female breast 4 1.11 8 0.61 6 0.61 11 1.06 29 36.99 0.78 -8.89

Female genital system 3 1.72 6 0.97 7 1.61 10 2.36* 26 16.51 1.57* 10.55

Cervix uteri 2 11.91* 0 0.00 1 2.77 0 0.00 3 1.39 2.16 1.79

Corpus uteri 0 0.00 2 0.60 4 1.74 5 2.34 11 8.69 1.27 2.56

Ovary 0 0.00 2 1.12 2 1.53 5 3.74* 9 4.93 1.83 4.53

Vagina 0 0.00 1 10.95 0 0.00 0 0.00 1 0.26 3.89 0.83

Vulva 0 0.00 1 3.46 0 0.00 0 0.00 1 0.87 1.15 0.15

Male genital system 5 0.90 28 1.33 18 1.02 16 0.78 67 64.90 1.03 2.42

Prostate 5 0.91 28 1.34 18 1.02 16 0.78 67 64.35 1.04 3.05

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.16

Urinary system 4 1.56 17 1.79* 7 0.93 10 1.19 38 28.01 1.36 5.65

Urinary bladder 3 1.68 7 1.06 4 0.75 6 1.00 20 19.77 1.01 0.13

Kidney parenchyma 1 1.63 10 4.46* 3 1.73 4 2.15 18 6.45 2.79* 6.53

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.78 0.00 -1.01

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.34

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.16

Soft tissue including heart 0 0.00 3 6.85* 1 3.01 2 5.18 6 1.28 4.70* 2.67

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.15

Melanoma of skin 5 7.21* 10 3.92* 6 3.03* 8 3.54* 29 7.48 3.88* 12.17

Eye, orbit 1 18.67 2 10.59* 1 7.32 0 0.00 4 0.52 7.75* 1.97

Brain, central nervous system 1 2.92 1 0.81 3 3.27 1 1.09 6 3.41 1.76 1.46

Thyroid 0 0.00 2 3.58 0 0.00 0 0.00 2 1.46 1.37 0.30

Lymphatic, hematopoietic 5 2.09 11 1.24 5 0.72 6 0.76 27 26.15 1.03 0.48

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.72 0.00 -0.41

Non-Hodgkin lymphoma 4 3.75* 4 1.01 1 0.32 2 0.55 11 11.85 0.93 -0.48

Myeloma 0 0.00 5 3.45* 1 0.87 2 1.54 8 4.29 1.86 2.10

Leukemia 1 1.16 2 0.63 3 1.21 2 0.72 8 9.29 0.86 -0.73

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.13

Chronic lymphocytic 1 2.83 1 0.77 1 0.97 1 0.89 4 3.80 1.05 0.11

Acute non-lymphocytic 0 0.00 0 0.00 1 1.21 1 1.05 2 3.10 0.64 -0.62

Chronic myeloid 0 0.00 1 2.42 0 0.00 0 0.00 1 1.23 0.81 -0.13

Ocular Melanoma

Both Sexes, ≥50 Years of Age

Table 13.2.6: Risk of subsequent primary cancers after ocular melanoma, both sexes,

≥50 years of age, SEER 1973-2000.

358 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

OCULAR MELANOMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,457 2,281 1,262 669 2,457

Person-years in interval 1,977 6,833 4,643 4,225 17,678

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 8,988 PYR and for male cancers on 8,690 PYR.
EYE (NON-MELANOMA)

Eye (Non-melanoma)

Both Sexes

Table 13.3.1: Characteristics of patients with an initial cancer of the eye (non-melanoma, excluding retinoblastoma), both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 388 100.0 206 100.0 594 100.0

Initial treatment

Any radiation 98 25.3 74 35.9 172 29.0

With surgery 65 16.8 53 25.7 118 19.9

Without surgery 33 8.5 21 10.2 54 9.1

No radiation 290 74.7 132 64.1 422 71.0

With surgery 259 66.8 108 52.4 367 61.8

Without surgery 31 8.0 24 11.7 55 9.3

Race

White 338 87.1 167 81.1 505 85.0

Black 25 6.4 16 7.8 41 6.9

Other 18 4.6 16 7.8 34 5.7

Unknown 7 1.8 7 3.4 14 2.4

Age at 1st primary cancer diagnosis, years

< 30 54 13.9 52 25.2 106 17.8

30–49 56 14.4 37 18.0 93 15.7

50–69 121 31.2 46 22.3 167 28.1

70–79 88 22.7 31 15.0 119 20.0

> 80 69 17.8 40 19.4 109 18.4

Number of patients with one or more

primary cancers

One primary cancer only 333 85.8 191 92.7 524 88.2

1st and 2nd cancers 44 11.3 11 5.3 55 9.3

1st, 2nd, and 3rd cancers 10 2.6 3 1.5 13 2.2

1st, 2nd, 3rd, and additional cancers 1 0.3 1 0.5 2 0.3

Other statistics

Median age at 1st cancer diagnosis 65.8 — 58.0 — 63.5 —

Median year of 1st cancer diagnosis 1988.3 — 1987.9 — 1988.3 —

Median person-years at risk 5.3 — 5.3 — 5.3 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 87.3 — 100.0 — 90.0

1st, 2nd, and additional cancers — 87.3 — 100.0 — 90.0

1st cancer only — 7.3 — 0.0 — 5.7

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING MELANOMA OF THE SKIN, EYE MELANOMA, AND NON-MELANOMA EYE CANCER 359

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 13 1.88 37 1.49* 18 0.99 19 1.30 87 64.65 1.35* 51.32

All excluding same site 13 1.88 37 1.49* 18 0.99 19 1.30 87 64.63 1.35* 51.38

Buccal cavity, pharynx 1 5.50 4 6.25* 2 4.59 1 3.12 8 1.58 5.07* 14.75

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.70

Tongue 0 0.00 0 0.00 0 0.00 1 16.48 1 0.29 3.39 1.62

Salivary gland 1 58.86 3 48.55* 2 45.10* 0 0.00 6 0.16 37.10* 13.41

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.89

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.13

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.30

Oropharynx 0 0.00 1 60.24 0 0.00 0 0.00 1 0.04 24.99 2.20

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.34

Digestive system 3 1.83 4 0.70 4 0.98 3 0.93 14 14.63 0.96 -1.45

Esophagus 1 13.01 0 0.00 0 0.00 0 0.00 1 0.70 1.43 0.69

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 1.55 0.00 -3.56

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.44

Colon 1 1.33 2 0.76 3 1.58 2 1.32 8 6.79 1.18 2.78

Rectum, rectosigmoid junction 0 0.00 2 2.04 1 1.46 0 0.00 3 2.46 1.22 1.24

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.25

Liver 1 19.07 0 0.00 0 0.00 0 0.00 1 0.48 2.07 1.19

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.41

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.80

Pancreas 0 0.00 0 0.00 0 0.00 1 2.68 1 1.69 0.59 -1.59

Respiratory system 4 3.39 11 2.59* 4 1.30 5 2.12 24 10.85 2.21* 30.19

Nose, nasal cavity, ear 0 0.00 0 0.00 1 37.38 0 0.00 1 0.09 10.66 2.08

Larynx 0 0.00 1 3.48 0 0.00 1 7.42 2 0.70 2.86 2.99

Lung, bronchus 4 3.69 10 2.55* 3 1.06 4 1.83 21 10.03 2.09* 25.19

Female breast 0 0.00 4 2.98 1 1.00 1 0.96 6 3.77 1.59 14.45

Female genital system 0 0.00 0 0.00 0 0.00 0 0.00 0 1.63 0.00 -10.51

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -1.21

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -5.08

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -3.19

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.17

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.59

Male genital system 0 0.00 6 0.97 3 0.64 5 1.41 14 16.08 0.87 -7.40

Prostate 0 0.00 6 0.98 3 0.65 5 1.43 14 15.89 0.88 -6.72

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.29

Urinary system 2 3.19 4 1.76 3 1.81 2 1.53 11 5.87 1.87 11.79

Urinary bladder 0 0.00 1 0.60 2 1.65 2 2.10 5 4.29 1.16 1.62

Kidney parenchyma 2 15.51* 3 6.38* 1 2.89 0 0.00 6 1.22 4.90* 10.97

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.80

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.27

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.14

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.61

Kaposi sarcoma 0 0.00 1 26.15 0 0.00 0 0.00 1 0.11 9.20 2.05

Melanoma of skin 0 0.00 1 1.83 0 0.00 0 0.00 1 1.49 0.67 -1.12

Eye, orbit 0 0.00 1 27.54 0 0.00 0 0.00 1 0.09 10.85 2.08

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -1.42

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.65

Lymphatic, hematopoietic 2 3.74 1 0.52 1 0.71 2 1.70 6 5.03 1.19 2.24

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 1 22.39 1 0.17 5.98 1.91

Non-Hodgkin lymphoma 1 4.46 1 1.23 1 1.63 1 1.89 4 2.18 1.84 4.18

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.81 0.00 -1.86

Leukemia 1 4.87 0 0.00 0 0.00 0 0.00 1 1.87 0.53 -2.00

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.15

Chronic lymphocytic 1 12.46 0 0.00 0 0.00 0 0.00 1 0.73 1.37 0.61

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -1.42

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.58

Eye (Non-melanoma)

Both Sexes

Table 13.3.2: Risk of subsequent primary cancers after cancer of the eye (non-melanoma, excluding retinoblastoma), both sexes,

SEER 1973-2000.

360 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

EYE (NON-MELANOMA)

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 594 535 315 167 594

Person-years in interval 469 1,650 1,167 1,069 4,354

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 1,547 PYR and for male cancers on 2,808 PYR.
Eye (Non-melanoma)

Females

Table 13.3.3: Risk of subsequent primary cancers after cancer of the eye (non-melanoma, excluding retinoblastoma), females,

SEER 1973-2000.

EYE (NON-MELANOMA)

All subsequent cancers 2 1.39 9 1.82 3 0.83 6 1.59 20 13.77 1.45 40.26

All excluding same site 2 1.39 9 1.82 3 0.83 6 1.59 20 13.77 1.45 40.28

Buccal cavity, pharynx 0 0.00 1 11.20 0 0.00 0 0.00 1 0.24 4.13 4.90

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.12

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.35

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.19

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.54

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.06

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.12

Oropharynx 0 0.00 1 .† 0 0.00 0 0.00 1 0.01 184.28* 6.43

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.10

Digestive system 0 0.00 0 0.00 1 1.13 2 2.28 3 3.40 0.88 -2.56

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.57

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -1.75

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.30

Colon 0 0.00 0 0.00 0 0.00 1 2.23 1 1.73 0.58 -4.70

Rectum, rectosigmoid junction 0 0.00 0 0.00 1 7.58 0 0.00 1 0.51 1.98 3.20

Rectum 0 0.00 0 0.00 1 11.44 0 0.00 1 0.34 2.98 4.30

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.27

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.47

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.50

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.53

Pancreas 0 0.00 0 0.00 0 0.00 1 8.51 1 0.44 2.26 3.61

Respiratory system 0 0.00 2 3.37 0 0.00 2 3.88 4 1.73 2.31 14.69

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.12

Larynx 0 0.00 0 0.00 0 0.00 1 69.92 1 0.05 19.73 6.14

Lung, bronchus 0 0.00 2 3.53 0 0.00 1 2.02 3 1.65 1.81 8.70

Female breast 0 0.00 4 2.98 1 1.00 1 0.96 6 3.77 1.59 14.45

Female genital system 0 0.00 0 0.00 0 0.00 0 0.00 0 1.63 0.00 -10.51

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -1.21

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -5.08

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -3.19

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.17

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.59

Urinary system 0 0.00 2 8.22 1 5.55 0 0.00 3 0.68 4.40 14.99

Urinary bladder 0 0.00 0 0.00 1 9.10 0 0.00 1 0.41 2.41 3.78

Kidney parenchyma 0 0.00 2 27.29* 0 0.00 0 0.00 2 0.21 9.50* 11.57

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.37

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.12

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.10

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.38

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.04

Melanoma of skin 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -1.88

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.13

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.92

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.88

Lymphatic, hematopoietic 2 17.05* 0 0.00 0 0.00 1 3.20 3 1.12 2.67 12.13

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.28

Non-Hodgkin lymphoma 1 18.86 0 0.00 0 0.00 1 6.66 2 0.53 3.77 9.50

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -1.15

Leukemia 1 24.27 0 0.00 0 0.00 0 0.00 1 0.37 2.69 4.06

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.11

Chronic lymphocytic 1 66.61 0 0.00 0 0.00 0 0.00 1 0.14 7.28 5.58

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.84

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.33

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 206 184 105 60 206

Person-years in interval 163 564 395 425 1,547

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. †O/E > 500. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.)

primary cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per

10,000 person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING MELANOMA OF THE SKIN, EYE MELANOMA, AND NON-MELANOMA EYE CANCER 361
All subsequent cancers 11 2.00 28 1.40 15 1.03 13 1.20 67 50.88 1.32* 57.42

All excluding same site 11 2.01 28 1.40 15 1.03 13 1.20 67 50.86 1.32* 57.49

Buccal cavity, pharynx 1 6.40 3 5.45* 2 5.37 1 3.89 7 1.34 5.24* 20.17

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -1.01

Tongue 0 0.00 0 0.00 0 0.00 1 21.38 1 0.24 4.15 2.70

Salivary gland 1 71.77 3 58.13* 2 54.28* 0 0.00 6 0.13 45.16* 20.90

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -1.09

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.16

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.40

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.12

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.48

Digestive system 3 2.40 4 0.90 3 0.94 1 0.43 11 11.24 0.98 -0.85

Esophagus 1 14.80 0 0.00 0 0.00 0 0.00 1 0.61 1.64 1.39

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 1.28 0.00 -4.55

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.52

Colon 1 1.80 2 1.00 3 2.07 1 0.94 7 5.06 1.38 6.90

Rectum, rectosigmoid junction 0 0.00 2 2.52 0 0.00 0 0.00 2 1.96 1.02 0.16

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.24

Liver 1 22.70 0 0.00 0 0.00 0 0.00 1 0.41 2.43 2.10

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.36

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.95

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 1.25 0.00 -4.45

Respiratory system 4 3.92* 9 2.46* 4 1.53 3 1.63 20 9.13 2.19* 38.73

Nose, nasal cavity, ear 0 0.00 0 0.00 1 46.03 0 0.00 1 0.07 13.43 3.30

Larynx 0 0.00 1 3.71 0 0.00 0 0.00 1 0.65 1.54 1.25

Lung, bronchus 4 4.29* 8 2.39* 3 1.25 3 1.77 18 8.38 2.15* 34.27

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.33

Male genital system 0 0.00 6 0.97 3 0.64 5 1.41 14 16.08 0.87 -7.40

Prostate 0 0.00 6 0.98 3 0.65 5 1.43 14 15.89 0.88 -6.72

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.29

Urinary system 2 3.60 2 0.98 2 1.35 2 1.79 8 5.19 1.54 10.03

Urinary bladder 0 0.00 1 0.66 1 0.90 2 2.38 4 3.88 1.03 0.43

Kidney parenchyma 2 18.43* 1 2.52 1 3.44 0 0.00 4 1.01 3.95* 10.64

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -1.05

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.36

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.16

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.73

Kaposi sarcoma 0 0.00 1 27.87 0 0.00 0 0.00 1 0.10 9.80 3.20

Melanoma of skin 0 0.00 1 2.23 0 0.00 0 0.00 1 1.20 0.83 -0.71

Eye, orbit 0 0.00 1 35.06 0 0.00 0 0.00 1 0.07 13.98 3.31

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.47 0.00 -1.69

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.52

Lymphatic, hematopoietic 0 0.00 1 0.66 1 0.90 1 1.16 3 3.90 0.77 -3.21

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 1 33.48 1 0.12 8.09 3.12

Non-Hodgkin lymphoma 0 0.00 1 1.60 1 2.12 0 0.00 2 1.65 1.21 1.25

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -2.25

Leukemia 0 0.00 0 0.00 0 0.00 0 0.00 0 1.50 0.00 -5.33

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.17

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -2.12

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -1.75

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.72

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 388 351 210 107 388

Person-years in interval 306 1,085 773 644 2,808

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Eye (Non-melanoma)

Males

Table 13.3.4: Risk of subsequent primary cancers after cancer of the eye (non-melanoma, excluding retinoblastoma), males,

SEER 1973-2000.

362 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

EYE (NON-MELANOMA)

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
NEW MALIGNANCIES FOLLOWING CANCER OF THE BRAIN AND CENTRAL NERVOUS SYSTEM 363

Synopsis

The incidence of multiple primary cancers was evaluated in a cohort of 31,336 persons diagnosed with a

first primary cancer of the brain and central nervous

system (CNS) during 1973-2000 and followed for an

average of 3.4 years. The overall incidence of new

malignancies was 11% higher than expected (O/E=1.11,

O=496, EAR=4 per 10,000 person-years). The O/E ratio

increased over the first 10 years of follow-up and then

decreased. Although the risk of subsequent cancer was

increased only slightly overall, considerably larger, statistically significant relative excesses were observed

for several uncommon types, including cancers of the

bone, soft tissue, brain and CNS, salivary gland, and

thyroid gland, as well as acute non-lymphocytic

leukemia and melanoma of the skin. Relative and

absolute risks were markedly higher for those with

first cancers diagnosed in childhood (age <17 years)

than for those first diagnosed at older ages. The risk of

new cancers was significantly increased following

medulloblastoma, ependymoma, and astrocytoma, but

not following glioblastoma or meningioma. Radiotherapy appeared to contribute to the excess of new malignancies of the bone, brain, and thyroid gland, whereas

chemotherapy probably played a major role in the

excess of subsequent leukemia. The etiology of the

new soft tissue cancers and melanoma is unclear, but it

may involve shared genetic susceptibility factors.

Brain and Other Central Nervous

System Cancers

Approximately 18,500 cancers of the brain and other

central nervous system (CNS) are diagnosed each year in

the U.S. (Jemal et al, 2005). Brain and other CNS cancers

are relatively uncommon, accounting for 1.3% of all 

new cancer cases and 2.2% of cancer deaths. Most CNS

tumors (94%) arise in the brain. Incidence is higher

among males than females and higher among whites

than blacks (Ries et al, 2004). The 5-year relative survival

rate is 33.1%, but survival is inversely associated with

age at diagnosis. Just 6% of persons diagnosed over the

age of 65 live more than 5 years (Ries et al, 2004).

Treatments during 1973-2000 typically included surgery and radiation. Radiation was used more often in the

treatment of brain cancer (74%) than for cancers in other

parts of the CNS (47%). Because most cancers of the

nervous system are intracranial and rarely metastasize

outside of the CNS, the volume of tissue that receives

high doses of radiation generally is limited and confined

to the head or neck regions (Black, 1991a,b; Pollack,

1994). However, for medulloblastoma and anaplastic

ependymoma, which may spread throughout the spinal

axis, craniospinal irradiation sometimes is given (Pollack,

1994; Levin et al, 2001). Today, cranial radiotherapy often

is deferred in very young children to avoid the harmful

effects of radiation on the developing nervous system

(Pollack, 1994; Packer, 1995). Few chemotherapy agents

have been proven effective in the treatment of cancers of

the brain and CNS (Levin et al, 2001). The following

agents have been used: bleomycin, chloroethylnitrosoureas, cisplatin, cyclophosphamide, doxorubicin,

etoposide, procarbazine, temozolomide, and vincristine

(Greene et al, 1985; Duffner et al, 1998; Levin et al, 2001).

Very little is known about the etiology of cancers of

the brain and CNS. Established risk factors include moderate to high doses of ionizing radiation and certain rare

familial cancer syndromes, but these account for a very

small percentage of cases (Inskip et al, 1995; Louis and

von Deimling, 1995). There is inconsistent evidence linking brain cancer to certain occupational and dietary

exposures, reproductive factors, and some medical conditions (Inskip et al, 1995; Preston-Martin and Mack, 1996;

Wrensch et al, 2002).

Results and Discussion

Among 31,336 persons who survived at least 2 months

following a first cancer of the brain or CNS, 29,361

patients (93.7%) had brain cancers, and 1,975 (6.3%) had

cancers in other parts of the CNS. A total of 496 new primary cancers were identified in 464 persons (O/E=1.11,

95% CI=1.01-1.21, EAR=4 per 10,000 person-years).

Exclusive of new cancers of the brain and CNS, the

observed and expected numbers of new malignancies

were nearly equal (O/E=1.02, 95% CI=0.93-1.12). Risk

was higher after a first cancer of the brain (O/E=1.15,

O=408) than when the first cancer occurred elsewhere in

the CNS (O/E=0.94, O=88). The relative risk (O/E)

Chapter 14

BRAIN AND OTHER CNS

New Malignancies Following Cancer of the

Brain and Central Nervous System

Peter D. Inskip, Ellen F. Heineman

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated as

[(O-E)/PYR]10,000).

Author affiliations: Peter D. Inskip, Division of Cancer Epidemiology

and Genetics, NCI, NIH, DHHS; Ellen F. Heineman, Division of

Cancer Control and Population Sciences, NCI, NIH, DHHS.
increased over the first 10 years of follow-up but then

decreased. The risk of developing a second cancer within

25 years, adjusted for the competing risk of death from

other causes, was 2.5% (95% CI=2.2%-2.8%). Risk for all

new malignancies combined was higher for males than

for females (O/E=1.18 versus 1.00) and higher for blacks

than for whites (O/E=1.34 versus 1.10). Striking differences in the risk of subsequent tumors were apparent

between persons diagnosed with cancer of the brain or

CNS before age 17 years (mean age, 7.7 years; O/E=6.64,

O=54, 95% CI=4.99-8.67, EAR=14) and those diagnosed

at older ages (O/E=1.00, O=442, 95% CI=0.91-1.10).

With respect to the histopathology of the first cancer,

the excess absolute risks were highest among persons first

diagnosed with medulloblastoma or ependymoma; these

tumors tend to be diagnosed at younger ages and have

better-than-average survival, and they are often treated

with radiation (Table 14.A). Intermediate excess absolute

risks were observed for new cancers following an initial

astrocytoma, oligodendroglioma, or mixed glioma. New

malignancies occurred less often than expected following

glioblastoma and malignant meningioma. These tumors

tend to be diagnosed at older ages, and glioblastoma is

associated with poor survival, so there is limited time for

treatment-induced cancers to appear.

Significantly elevated subsequent cancer risks were

observed only for relatively uncommon cancers, including those of the brain and CNS, bone, soft tissue, salivary

gland, and thyroid gland, as well as for acute nonlymphocytic leukemia (ANLL) and melanoma of the

skin. The highest relative risk was observed for bone

cancer and the highest EAR for subsequent brain and

CNS cancer. A statistically significant deficit was seen for

breast cancer, and deficits approaching statistical significance were observed for cancers of the lung and prostate.

With the exception of melanoma, all of the subsequent

cancers that occurred significantly in excess of expectation have been linked to medical irradiation in previous

studies, particularly for exposures occurring during

childhood (Tucker et al, 1987, 1991; Ron et al, 1988, 1995;

NRC, 1990; Neglia et al, 1991; Hawkins et al, 1996; Wong

et al, 1997; Karlsson et al, 1998; Little et al, 1998; Schneider

et al, 1998; Walter et al, 1998; Bhatia et al, 2002). However,

evidence of radiogenic excesses in the present study was

mixed. The risks for bone, soft tissue, brain, and thyroid

cancer were higher among persons whose baseline treatment included radiation, whereas the risks for leukemia,

salivary gland cancer, and melanoma of the skin were

not (data not shown). Excess cancer incidence was apparent even within the first 5 years of follow-up, which is

shorter than the minimal latent period for most radiation-related solid cancers (NRC, 1990). Although some of

the subsequent brain cancers might have been misclassified recurrences rather than new primaries, the excess

was greater after the first 5 years of follow-up than during the first 5 years. The relative risk for cancer of the

salivary gland increased with time, which is compatible

with a radiation effect, but the number of cases was

small. The small number of long-term survivors limits

the ability to assess late effects of treatment.

Although radiation is a well-established cause of

leukemia, it probably was of limited importance in

explaining the excess risk in this study cohort. Most

patients given radiotherapy for their first cancer would

have received radiation only to the skull, which contains a

relatively small proportion of the body’s active bone marrow after childhood (Cristy, 1981). Chemotherapy, which

exposes marrow throughout the body, probably played a

greater role. At least 7 of the 12 cases of acute myeloid

leukemia received chemotherapy, based on the data covering the initial course of therapy. Nitrosoureas and other

chemotherapy agents used in the treatment of brain cancer have been linked with increased occurrence of ANLL

(Boice et al, 1983; Greene et al, 1985; Duffner et al, 1998).

Bone and soft tissue sarcoma are known sequelae of

irradiation at high doses, typically in excess of 10 Gy

364 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BRAIN AND OTHER CNS

Notes: ICD-O Revision 2 morphology (M) codes: glioblastoma and gliosarcoma (M9440-9442); pilocytic astrocytoma (M9421); other astrocytoma (M9400-9420, 9424);

oligodendroglioma (M9450-9451); mixed glioma (M9382); ependymoma (M9391-9394); medulloblastoma/PNET (M9470-9473); malignant meningioma (M9530-9539);

includes patients surviving 2 months or more after diagnosis; EAR calculated as [(O-E)/ PYR]10,000.

Abbreviations: RT=initial radiotherapy; PNET=primitive neuroectodermal tumor; O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; O/E=ratio of

observed to expected cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000).

Table 14.A: Observed (O) numbers of new malignancies, and measures of relative risk (O/E) and excess absolute risk (EAR), by

histopathological subtype of the first brain or other CNS cancer. Numbers of patients, mean age at diagnosis, duration of follow-up

(mean PYR), and use of radiotherapy (RT) in treatment of the first cancer also are shown.

First primary No. Mean Mean Baseline EAR 

tumor subtype patients age (yr) PYR RT (%) O O/E 95% CI (per 104 PYR)

All types 31,336 48.0 3.38 72.0 496 1.11 1.01-1.21 4.47

Glioblastoma 12,169 59.8 0.91 81.0 75 0.81 0.63-1.01 -16.09

Pilocytic astrocytoma 960 16.6 6.72 25.3 9 1.55 0.71-2.93 4.92

Other astrocytoma 9,083 44.6 4.58 75.2 166 1.22 1.04-1.42 7.19

Oligodendroglioma 1,813 42.1 4.99 62.8 46 1.16 0.85-1.54 6.92

Mixed glioma 676 39.0 5.36 75.9 15 1.14 0.64-1.88 5.12

Ependymoma 1,055 31.1 6.84 57.8 46 1.41 1.03-1.88 18.53

Medulloblastoma/PNET 1,207 14.2 6.28 83.8 23 3.71 2.35-5.57 22.16

Malignant meningioma 591 60.3 5.97 39.8 39 0.85 0.61-1.16 -19.24

Other and unspecified 3,782 44.3 4.17 55.7 77 1.01 0.80-1.26 0.44
NEW MALIGNANCIES FOLLOWING CANCER OF THE BRAIN AND CENTRAL NERVOUS SYSTEM 365

BRAIN AND OTHER CNS

(Tucker et al, 1987; Hawkins et al, 1996; Wong et al,

1997). Risk drops off sharply outside of the irradiated

field. Seven of the 12 subsequent bone cancers

occurred in the skull or face, and all 7 had received

radiotherapy. Chemotherapy with alkylating agents

also has been linked to second primary bone sarcoma

and might potentiate the effects of radiation or shorten

the induction period of radiation-related tumors

(Tucker et al, 1987; Hawkins et al, 1996). On the other

hand, only 4 of the 13 soft tissue cancers occurred in

the head or neck, 3 of which had received baseline

radiotherapy. Few cases had chemotherapy recorded

in SEER as part of their initial course of therapy. Thus,

neither radiotherapy nor chemotherapy can be linked

clearly to the excess occurrence of subsequent soft tissue cancers based on these data.

Radiotherapy probably contributed to the moderate

excess of thyroid cancer. Brain cancers in children commonly occur in the cerebellum (Russell and Rubenstein,

1989), and radiation directed to the cerebellum can

involve sizable incidental doses to the thyroid gland.

Susceptibility to radiation-induced thyroid cancer is

known to be greater among children than among adults

(Ron et al, 1995), and the relative risk of thyroid cancer

following brain or other CNS cancer among children was

higher than among adults in the present study as well.

However, if the increased incidence of thyroid cancer

was due entirely to radiotherapy, one would expect the

excess to show a stronger inverse association with age at

exposure and to appear at least 5 or more years after irradiation. Close medical surveillance of cancer patients

might have led to early detection of small thyroid cancers. It is not clear whether the greater relative excess of

thyroid cancer among males compared with females

reflects differences in radiation exposure to the thyroid

gland, chance, or some other factor.

Shared genetic susceptibility might contribute to some

of the observed associations (Malkin et al, 1992; Louis

and von Deimling, 1995), particularly for sarcomas,

leukemia, and new primary cancers of the brain and

CNS. Li-Fraumeni syndrome is associated with brain

cancer, soft tissue sarcoma, osteosarcoma, and leukemia,

among other types of tumors (Hisada et al, 1998; Nichols

et al, 2001), while astrocytoma, non-lymphocytic

leukemia, and neurofibrosarcoma are associated with

neurofibromatosis type 1 (Bader and Miller, 1978). The

sarcomas that occurred following a first cancer of the

brain and CNS tended to occur at young ages (median of

26 years for soft tissue, 25 years for bone). Five of the 13

cancers of soft tissue were neurofibrosarcomas or malignant schwannomas; the corresponding first cancers

included 4 astrocytomas.

The numbers of specific types of subsequent cancers

following different histopathologic types of first cancer of

the brain and CNS were small, but there were several

suggestive associations. Elevated risks following medulloblastoma were seen for leukemia (O/E=9.97, O=3),

brain and CNS cancer (O/E=19.62, O=5), soft tissue sarcoma (O/E=21.61, O=2), and cancers of the digestive tract

(O/E=6.50, O=5). The latter might be related to Turcot

syndrome, which involves a genetic predisposition to

colon polyps and brain tumors (Hamilton et al, 1995;

Goldstein et al, 1997). There was a significantly increased

risk of stomach cancer following glioblastoma (O/E=3.33,

O=6), and 3 of the 6 cases occurred among blacks

(O/E=29.48). Subsequent colon cancers occurred more

often than expected among persons with mixed glioma

(O/E=5.53, O=5), most of which would be expected to be

oligoastrocytoma (Kleihues and Cavenee, 1997). It is

noteworthy that astrocytomas and oligodendrogliomas

are among the tumors that have been associated with

hereditary nonpolyposis colon cancer (Vasen et al, 1996).

Contrary to earlier reports (Schoenberg et al, 1975;

Malmer et al, 2000; Custer et al, 2002), neither breast cancer (O/E=0.72, O=5) nor colon cancer risk (O/E=0.86,

O=4) was increased following malignant meningioma.

Cutaneous melanoma occurred more often than

expected among brain cancer patients in SEER, which

parallels a finding from Finland (Salminen et al, 1999).

Melanoma is not established as a late effect of radiotherapy or chemotherapy, although the issue is unsettled.

Whether the excess risk might signify a genetic disorder

is unclear, but familial clustering of astrocytoma and

cutaneous melanoma has been reported (Kaufman et al,

1993; Azizi et al, 1995; Paunu et al, 2002). It also is possible

that the excess of melanoma is related to close medical

surveillance of cancer patients.

The comparatively low incidence of new primary cancers of the respiratory tract and buccal cavity and other

smoking-related cancers probably reflects a low prevalence of smoking in the study cohort, relative to the general population. Smoking does not appear to cause brain

cancer, which tends to occur more often among persons

of higher social class (Preston-Martin, 1989; Inskip et al,

1995, 2003), who smoke less than the general population.

In summary, excess risk of a new malignancy following a first cancer of the brain and CNS was relatively

small for the cohort as a whole, but much larger relative

and absolute risks were indicated among persons whose

first cancer was diagnosed during childhood. Increases

were not seen for the common adult cancers. Instead,

cancers of the brain, bone, soft tissue, thyroid, and salivary glands, as well as leukemia, accounted for most of

the excess. Radiotherapy for the first cancer appears to be

linked to new bone and brain cancers and may have contributed to thyroid and salivary gland cancers as well.

Chemotherapy and shared genetic susceptibility likely

also played contributory roles, particularly for subsequent leukemias and sarcomas. The very high relative

risks following a first cancer of childhood probably

reflect a combination of low background risks, effects of

treatment during a vulnerable period of life, and genetic

predisposition. It will be important to document the cancer experience of childhood brain cancer survivors after

they reach the ages at which the usual adult cancers

become common. The risk of therapy-related subsequent

cancers among glioblastoma patients is not a major clinical issue at this time, given their extremely poor survival.
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NEW MALIGNANCIES FOLLOWING CANCER OF THE BRAIN AND CENTRAL NERVOUS SYSTEM 367

BRAIN AND OTHER CNS
Brain and Other CNS

Both Sexes

Table 14.1.1: Characteristics of patients with an initial cancer of the brain or other central nervous system,

both sexes, SEER 1973-2000.

368 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BRAIN AND OTHER CNS

Number of patients with 1st primary cancer

Total 17,734 100.0 13,602 100.0 31,336 100.0

Initial treatment

Any radiation 13,162 74.2 9,392 69.0 22,554 72.0

With surgery 9,557 53.9 6,652 48.9 16,209 51.7

Without surgery 3,605 20.3 2,740 20.1 6,345 20.2

No radiation 4,572 25.8 4,210 31.0 8,782 28.0

With surgery 3,048 17.2 2,661 19.6 5,709 18.2

Without surgery 1,524 8.6 1,549 11.4 3,073 9.8

Race

White 15,948 89.9 12,188 89.6 28,136 89.8

Black 1,007 5.7 823 6.1 1,830 5.8

Other 739 4.2 565 4.2 1,304 4.2

Unknown 40 0.2 26 0.2 66 0.2

Age at 1st primary cancer diagnosis, years

< 30 4,064 22.9 3,200 23.5 7,264 23.2

30–49 4,379 24.7 2,892 21.3 7,271 23.2

50–69 6,632 37.4 4,583 33.7 11,215 35.8

70–79 2,131 12.0 2,170 16.0 4,301 13.7

> 80 528 3.0 757 5.6 1,285 4.1

Number of patients with one or more

primary cancers

One primary cancer only 17,451 98.4 13,421 98.7 30,872 98.5

1st and 2nd cancers 264 1.5 169 1.2 433 1.4

1st, 2nd, and 3rd cancers 18 0.1 12 0.1 30 0.1

1st, 2nd, 3rd, and additional cancers 1 0.0 0 0.0 1 0.0

Other statistics

Median age at 1st cancer diagnosis 51.5 — 53.7 — 52.3 —

Median year of 1st cancer diagnosis 1988.5 — 1988.6 — 1988.6 —

Median person-years at risk 0.9 — 0.9 — 0.9 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 83.4 — 85.6 — 84.3

1st, 2nd, and additional cancers — 83.0 — 85.6 — 84.1

1st cancer only — 4.9 — 3.3 — 4.3

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Brain and Other CNS

Both Sexes

Table 14.1.2: Risk of subsequent primary cancers after cancer of the brain or other central nervous system,

both sexes, SEER 1973-2000.

BRAIN AND OTHER CNS

All subsequent cancers 113 0.92 173 1.18* 125 1.36* 85 0.98 496 448.67 1.11* 4.47

All excluding same site 107 0.88 161 1.12 109 1.21 72 0.84 449 441.52 1.02 0.71

Buccal cavity, pharynx 2 0.54 2 0.46 7 2.72* 3 1.36 14 12.88 1.09 0.11

Lip 0 0.00 0 0.00 1 3.37 0 0.00 1 1.61 0.62 -0.06

Tongue 1 1.31 1 1.08 0 0.00 0 0.00 2 2.75 0.73 -0.07

Salivary gland 0 0.00 1 2.55 2 8.09 2 8.55 5 1.17 4.27* 0.36

Mouth 0 0.00 0 0.00 3 4.63 1 1.86 4 3.28 1.22 0.07

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.67 0.00 -0.06

Tonsil 1 2.59 0 0.00 1 3.43 0 0.00 2 1.41 1.42 0.06

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.03

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.20 0.00 -0.11

Digestive system 23 0.92 28 1.03 18 1.10 16 1.08 85 83.57 1.02 0.14

Esophagus 0 0.00 0 0.00 1 1.16 1 1.26 2 4.46 0.45 -0.23

Stomach 7 2.79* 3 1.11 3 1.90 0 0.00 13 8.17 1.59 0.46

Small intestine 0 0.00 0 0.00 1 3.39 0 0.00 1 1.43 0.70 -0.04

Colon 13 1.19 15 1.28 5 0.71 9 1.42 42 36.04 1.17 0.56

Rectum, rectosigmoid junction 2 0.43 3 0.59 6 1.99 2 0.75 13 15.39 0.84 -0.23

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 1.11 0.00 -0.10

Liver 0 0.00 1 0.95 0 0.00 1 1.55 2 3.24 0.62 -0.12

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.06 0.00 -0.10

Bile ducts, other biliary 0 0.00 1 1.80 1 2.88 0 0.00 2 1.75 1.14 0.02

Pancreas 1 0.33 5 1.54 1 0.51 2 1.13 9 9.95 0.90 -0.09

Respiratory system 19 0.88 19 0.81 12 0.86 7 0.56 57 71.51 0.80 -1.37

Nose, nasal cavity, ear 0 0.00 1 4.14 1 6.77 0 0.00 2 0.72 2.78 0.12

Larynx 0 0.00 0 0.00 2 1.97 0 0.00 2 5.30 0.38 -0.31

Lung, bronchus 19 0.96 18 0.85 9 0.71 7 0.61 53 65.19 0.81 -1.15

Female breast 8 0.56 24 1.16 10 0.70 5 0.37* 47 62.79 0.75* -3.28

Female genital system 5 0.74 4 0.42 5 0.82 4 0.70 18 28.01 0.64 -2.08

Cervix uteri 0 0.00 0 0.00 3 2.59 0 0.00 3 5.00 0.60 -0.42

Corpus uteri 3 0.89 3 0.71 1 0.38 1 0.41 8 12.71 0.63 -0.98

Ovary 2 1.03 1 0.36 0 0.00 3 1.68 6 8.42 0.71 -0.50

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.07

Vulva 0 0.00 0 0.00 1 4.58 0 0.00 1 0.99 1.01 0.00

Male genital system 12 0.57* 18 0.84 17 1.29 11 0.77 58 69.96 0.83 -2.07

Prostate 11 0.54* 16 0.80 17 1.39 10 0.75 54 65.81 0.82 -2.04

Testis 1 1.95 2 1.51 0 0.00 1 1.10 4 3.63 1.10 0.06

Urinary system 8 0.85 12 1.17 5 0.81 7 1.21 32 31.73 1.01 0.03

Urinary bladder 5 0.79 6 0.92 2 0.51 4 1.10 17 20.41 0.83 -0.32

Kidney parenchyma 3 1.16 4 1.27 2 1.02 3 1.62 12 9.55 1.26 0.23

Renal pelvis, other urinary 0 0.00 2 3.45 1 3.00 0 0.00 3 1.78 1.69 0.12

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.05

Bone, joints 0 0.00 8 23.30* 4 16.55* 0 0.00 12 0.97 12.38* 1.04

Soft tissue including heart 0 0.00 4 4.54* 7 12.39* 2 3.75 13 2.56 5.07* 0.99

Kaposi sarcoma 2 3.98 0 0.00 0 0.00 0 0.00 2 3.33 0.60 -0.13

Melanoma of skin 5 1.38 11 1.93 5 1.31 5 1.31 26 16.95 1.53* 0.85

Eye, orbit 0 0.00 0 0.00 0 0.00 1 6.90 1 0.81 1.23 0.02

Brain, central nervous system 6 3.49* 12 4.76* 16 10.30* 13 9.55* 47 7.15 6.57* 3.76

Thyroid 1 0.89 7 3.21* 5 3.30* 1 0.64 14 6.39 2.19* 0.72

Lymphatic, hematopoietic 8 0.83 21 1.67* 13 1.64 7 0.94 49 37.52 1.31 1.08

Hodgkin lymphoma 0 0.00 1 0.81 0 0.00 0 0.00 1 3.49 0.29 -0.24

Non-Hodgkin lymphoma 4 0.91 5 0.87 1 0.27 3 0.83 13 17.48 0.74 -0.42

Myeloma 2 1.40 1 0.63 2 2.06 1 1.11 6 4.89 1.23 0.11

Leukemia 2 0.62 14 3.55* 10 4.21* 3 1.41 29 11.66 2.49* 1.64

Acute lymphocytic 0 0.00 0 0.00 2 8.03 1 5.82 3 1.10 2.72 0.18

Chronic lymphocytic 1 0.84 2 1.60 3 3.99 1 1.47 7 3.87 1.81 0.30

Acute non-lymphocytic 0 0.00 8 6.02* 4 4.88* 1 1.31 13 3.98 3.27* 0.85

Chronic myeloid 0 0.00 4 7.17* 0 0.00 0 0.00 4 1.66 2.41 0.22

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 31,336 17,036 7,017 3,658 31,336

Person-years in interval 18,621 39,694 25,714 21,892 105,921

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 48,074 PYR and for male cancers on 57,847 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BRAIN AND CENTRAL NERVOUS SYSTEM 369
All subsequent cancers 37 0.79 64 1.00 49 1.16 43 1.07 193 192.83 1.00 0.04

All excluding same site 37 0.80 59 0.94 44 1.05 33 0.84 173 190.12 0.91 -3.56

Buccal cavity, pharynx 1 1.15 0 0.00 4 5.50* 1 1.53 6 3.39 1.77 0.54

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.04

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.76 0.00 -0.16

Salivary gland 0 0.00 0 0.00 1 9.69 1 10.02 2 0.46 4.38 0.32

Mouth 0 0.00 0 0.00 2 8.84 0 0.00 2 1.08 1.86 0.19

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.04

Tonsil 1 11.67 0 0.00 1 14.71 0 0.00 2 0.32 6.23 0.35

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.02

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.05

Digestive system 6 0.66 12 1.11 8 1.17 8 1.29 34 33.00 1.03 0.21

Esophagus 0 0.00 0 0.00 1 5.30 1 5.75 2 0.93 2.15 0.22

Stomach 1 1.44 0 0.00 2 3.85 0 0.00 3 2.51 1.20 0.10

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.12

Colon 2 0.45 9 1.73 1 0.31 5 1.72 17 15.82 1.07 0.25

Rectum, rectosigmoid junction 2 1.29 1 0.54 3 2.55 1 0.95 7 5.64 1.24 0.28

Rectum 2 1.99 1 0.82 3 3.87 0 0.00 6 3.70 1.62 0.48

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.12

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.81 0.00 -0.17

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.70 0.00 -0.15

Bile ducts, other biliary 0 0.00 1 4.40 0 0.00 0 0.00 1 0.71 1.41 0.06

Pancreas 1 0.85 1 0.73 1 1.15 1 1.26 4 4.20 0.95 -0.04

Respiratory system 10 1.68 5 0.67 3 0.61 3 0.63 21 23.00 0.91 -0.42

Nose, nasal cavity, ear 0 0.00 1 11.64 0 0.00 0 0.00 1 0.26 3.92 0.15

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.84 0.00 -0.18

Lung, bronchus 10 1.77 4 0.57 3 0.64 3 0.67 20 21.82 0.92 -0.38

Female breast 8 0.56 24 1.16 10 0.70 5 0.37* 47 62.79 0.75* -3.28

Female genital system 5 0.74 4 0.42 5 0.82 4 0.70 18 28.01 0.64 -2.08

Cervix uteri 0 0.00 0 0.00 3 2.59 0 0.00 3 5.00 0.60 -0.42

Corpus uteri 3 0.89 3 0.71 1 0.38 1 0.41 8 12.71 0.63 -0.98

Ovary 2 1.03 1 0.36 0 0.00 3 1.68 6 8.42 0.71 -0.50

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.07

Vulva 0 0.00 0 0.00 1 4.58 0 0.00 1 0.99 1.01 0.00

Urinary system 0 0.00 2 0.80 1 0.61 3 1.93 6 7.71 0.78 -0.36

Urinary bladder 0 0.00 0 0.00 0 0.00 2 2.43 2 4.20 0.48 -0.46

Kidney parenchyma 0 0.00 2 2.08 1 1.55 1 1.58 4 2.96 1.35 0.22

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.11

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.03

Bone, joints 0 0.00 2 15.53* 2 21.31* 0 0.00 4 0.37 10.85* 0.76

Soft tissue including heart 0 0.00 0 0.00 4 17.10* 0 0.00 4 1.02 3.94* 0.62

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.01

Melanoma of skin 1 0.82 2 0.87 1 0.60 3 1.76 7 6.88 1.02 0.02

Eye, orbit 0 0.00 0 0.00 0 0.00 1 15.96 1 0.32 3.08 0.14

Brain, central nervous system 0 0.00 5 5.32* 5 8.14* 10 18.09* 20 2.71 7.39* 3.60

Thyroid 0 0.00 1 0.67 3 2.77 0 0.00 4 4.43 0.90 -0.09

Lymphatic, hematopoietic 3 0.88 6 1.28 2 0.64 4 1.34 15 14.18 1.06 0.17

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.37 0.00 -0.29

Non-Hodgkin lymphoma 2 1.24 1 0.46 0 0.00 2 1.40 5 6.66 0.75 -0.35

Myeloma 1 1.88 0 0.00 0 0.00 1 2.65 2 1.95 1.03 0.01

Leukemia 0 0.00 5 3.51* 2 2.21 1 1.23 8 4.20 1.91 0.79

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.08

Chronic lymphocytic 0 0.00 1 2.38 1 3.78 1 4.18 3 1.29 2.32 0.36

Acute non-lymphocytic 0 0.00 3 5.67* 1 2.87 0 0.00 4 1.58 2.53 0.50

Chronic myeloid 0 0.00 1 4.93 0 0.00 0 0.00 1 0.61 1.65 0.08

Brain and Other CNS

Females

Table 14.1.3: Risk of subsequent primary cancers after cancer of the brain or other central nervous system,

females, SEER 1973-2000.

370 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BRAIN AND OTHER CNS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 13,602 7,310 3,200 1,732 13,602

Person-years in interval 7,974 17,614 11,926 10,559 48,074

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Brain and Other CNS

Males

Table 14.1.4: Risk of subsequent primary cancers after cancer of the brain or other central nervous system,

males, SEER 1973-2000.

BRAIN AND OTHER CNS

All subsequent cancers 76 0.99 109 1.31* 76 1.54* 42 0.90 303 255.85 1.18* 8.15

All excluding same site 70 0.93 102 1.25* 65 1.34* 39 0.85 276 251.40 1.10 4.25

Buccal cavity, pharynx 1 0.35 2 0.62 3 1.63 2 1.28 8 9.49 0.84 -0.26

Lip 0 0.00 0 0.00 1 3.88 0 0.00 1 1.43 0.70 -0.07

Tongue 1 1.76 1 1.49 0 0.00 0 0.00 2 1.98 1.01 0.00

Salivary gland 0 0.00 1 4.20 1 6.93 1 7.45 3 0.72 4.19 0.39

Mouth 0 0.00 0 0.00 1 2.37 1 2.96 2 2.21 0.91 -0.04

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.09

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 1.09 0.00 -0.19

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.98 0.00 -0.17

Digestive system 17 1.07 16 0.97 10 1.05 8 0.93 51 50.56 1.01 0.08

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 3.53 0.00 -0.61

Stomach 6 3.31* 3 1.61 1 0.94 0 0.00 10 5.66 1.77 0.75

Small intestine 0 0.00 0 0.00 1 5.87 0 0.00 1 0.85 1.18 0.03

Colon 11 1.69 6 0.92 4 1.06 4 1.17 25 20.22 1.24 0.83

Rectum, rectosigmoid junction 0 0.00 2 0.63 3 1.64 1 0.61 6 9.74 0.62 -0.65

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.53 0.00 -0.09

Liver 0 0.00 1 1.26 0 0.00 1 2.10 2 2.44 0.82 -0.08

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.06

Bile ducts, other biliary 0 0.00 0 0.00 1 5.10 0 0.00 1 1.04 0.96 -0.01

Pancreas 0 0.00 4 2.13 0 0.00 1 1.03 5 5.76 0.87 -0.13

Respiratory system 9 0.57 14 0.88 9 1.00 4 0.51 36 48.51 0.74 -2.16

Nose, nasal cavity, ear 0 0.00 0 0.00 1 10.88 0 0.00 1 0.46 2.16 0.09

Larynx 0 0.00 0 0.00 2 2.39 0 0.00 2 4.46 0.45 -0.43

Lung, bronchus 9 0.64 14 0.98 6 0.75 4 0.57 33 43.37 0.76 -1.79

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.09

Male genital system 12 0.57* 18 0.84 17 1.29 11 0.77 58 69.96 0.83 -2.07

Prostate 11 0.54* 16 0.80 17 1.39 10 0.75 54 65.81 0.82 -2.04

Testis 1 1.95 2 1.51 0 0.00 1 1.10 4 3.63 1.10 0.06

Urinary system 8 1.07 10 1.29 4 0.88 4 0.94 26 24.02 1.08 0.34

Urinary bladder 5 0.97 6 1.16 2 0.66 2 0.71 15 16.20 0.93 -0.21

Kidney parenchyma 3 1.60 2 0.92 1 0.76 2 1.63 8 6.59 1.21 0.24

Renal pelvis, other urinary 0 0.00 2 5.01 1 4.51 0 0.00 3 1.23 2.44 0.31

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.07

Bone, joints 0 0.00 6 27.95* 2 13.53* 0 0.00 8 0.60 13.32* 1.28

Soft tissue including heart 0 0.00 4 7.45* 3 9.06* 2 6.53 9 1.55 5.81* 1.29

Kaposi sarcoma 2 4.08 0 0.00 0 0.00 0 0.00 2 3.28 0.61 -0.22

Melanoma of skin 4 1.67 9 2.64* 4 1.85 2 0.95 19 10.07 1.89* 1.54

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.49 0.00 -0.08

Brain, central nervous system 6 5.36* 7 4.43* 11 11.72* 3 3.71 27 4.45 6.07* 3.90

Thyroid 1 2.35 6 8.76* 2 4.63 1 2.42 10 1.96 5.11* 1.39

Lymphatic, hematopoietic 5 0.80 15 1.91* 11 2.29* 3 0.67 34 23.34 1.46* 1.84

Hodgkin lymphoma 0 0.00 1 1.31 0 0.00 0 0.00 1 2.12 0.47 -0.19

Non-Hodgkin lymphoma 2 0.72 4 1.11 1 0.44 1 0.46 8 10.82 0.74 -0.49

Myeloma 1 1.11 1 1.05 2 3.56 0 0.00 4 2.94 1.36 0.18

Leukemia 2 0.93 9 3.57* 8 5.44* 2 1.53 21 7.46 2.81* 2.34

Acute lymphocytic 0 0.00 0 0.00 2 12.69* 1 9.25 3 0.70 4.27 0.40

Chronic lymphocytic 1 1.21 1 1.20 2 4.11 0 0.00 4 2.58 1.55 0.24

Acute non-lymphocytic 0 0.00 5 6.25* 3 6.35* 1 2.29 9 2.40 3.75* 1.14

Chronic myeloid 0 0.00 3 8.45* 0 0.00 0 0.00 3 1.06 2.84 0.34

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 17,734 9,726 3,817 1,926 17,734

Person-years in interval 10,647 22,080 13,788 11,333 57,847

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BRAIN AND CENTRAL NERVOUS SYSTEM 371
All subsequent cancers 4 8.24* 17 10.61* 18 10.77* 15 3.43* 54 8.13 6.64* 14.39

All excluding same site 3 7.77* 11 8.44* 13 8.93* 7 1.70 34 7.25 4.69* 8.39

Buccal cavity, pharynx 0 0.00 0 0.00 2 61.44* 0 0.00 2 0.15 13.53* 0.58

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Salivary gland 0 0.00 0 0.00 1 78.90* 0 0.00 1 0.05 19.77 0.30

Mouth 0 0.00 0 0.00 1 168.74* 0 0.00 1 0.02 40.02 0.31

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.01

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Digestive system 1 60.49 1 23.18 2 47.71* 1 4.74 5 0.31 16.00* 1.47

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.01

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Colon 1 .† 0 0.00 0 0.00 0 0.00 1 0.09 10.57 0.28

Rectum, rectosigmoid junction 0 0.00 0 0.00 2 332.98* 0 0.00 2 0.05 39.45* 0.61

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.01

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Pancreas 0 0.00 1 .† 0 0.00 1 68.70 2 0.02 101.07* 0.62

Respiratory system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.04

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Lung, bronchus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.02

Female breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.26

Female genital system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.41

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.17

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.03

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.18

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Male genital system 0 0.00 0 0.00 0 0.00 1 2.27 1 0.65 1.53 0.20

Prostate 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Testis 0 0.00 0 0.00 0 0.00 1 2.30 1 0.64 1.57 0.21

Urinary system 0 0.00 0 0.00 1 30.84 0 0.00 1 0.22 4.53 0.24

Urinary bladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.02

Kidney parenchyma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.05

Renal pelvis, other urinary 0 0.00 0 0.00 1 .† 0 0.00 1 0.00 300.22* 0.31

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Bone, joints 0 0.00 3 30.44* 2 20.20* 0 0.00 5 0.31 15.89* 1.47

Soft tissue including heart 0 0.00 2 22.64* 3 38.93* 1 8.66 6 0.31 19.38* 1.78

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.06

Melanoma of skin 1 111.04* 0 0.00 0 0.00 1 1.87 2 0.73 2.74 0.40

Eye, orbit 0 0.00 0 0.00 0 0.00 1 87.21* 1 0.06 17.23 0.30

Brain, central nervous system 1 10.07 6 20.09* 5 23.15* 8 30.76* 20 0.87 22.88* 6.00

Thyroid 0 0.00 0 0.00 1 7.95 1 2.38 2 0.62 3.23 0.43

Lymphatic, hematopoietic 1 5.07 5 7.76* 2 3.41 1 1.02 9 2.41 3.74* 2.07

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.84 0.00 -0.26

Non-Hodgkin lymphoma 1 32.45 0 0.00 0 0.00 1 3.12 2 0.60 3.31 0.44

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Leukemia 0 0.00 5 13.64* 2 9.08* 0 0.00 7 0.96 7.33* 1.90

Acute lymphocytic 0 0.00 0 0.00 2 14.88* 0 0.00 2 0.59 3.37 0.44

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Acute non-lymphocytic 0 0.00 3 38.78* 0 0.00 0 0.00 3 0.27 11.22* 0.86

Chronic myeloid 0 0.00 2 162.46* 0 0.00 0 0.00 2 0.07 29.57* 0.61

Brain and Other CNS

Both Sexes, <17 Years of Age

Table 14.1.5: Risk of subsequent primary cancers after cancer of the brain or other central nervous system,

both sexes, <17 years of age, SEER 1973-2000.

372 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

BRAIN AND OTHER CNS

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,356 3,504 2,145 1,351 4,356

Person-years in interval 3,260 10,614 8,542 9,470 31,887

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. †O/E > 500. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.)

primary cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per

10,000 person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 14,484 PYR and for male cancers on 17,402 PYR.
Brain and Other CNS

Both Sexes, ≥17 Years of Age

Table 14.1.6: Risk of subsequent primary cancers after cancer of the brain or other central nervous system,

both sexes, ≥17 years of age, SEER 1973-2000.

BRAIN AND OTHER CNS

All subsequent cancers 109 0.89 156 1.07 107 1.19 70 0.85 442 440.55 1.00 0.20

All excluding same site 104 0.86 150 1.05 96 1.08 65 0.80 415 434.27 0.96 -2.60

Buccal cavity, pharynx 2 0.54 2 0.46 5 1.97 3 1.41 12 12.73 0.94 -0.10

Lip 0 0.00 0 0.00 1 3.38 0 0.00 1 1.60 0.62 -0.08

Tongue 1 1.31 1 1.09 0 0.00 0 0.00 2 2.72 0.73 -0.10

Salivary gland 0 0.00 1 2.62 1 4.26 2 9.63* 4 1.12 3.57 0.39

Mouth 0 0.00 0 0.00 2 3.11 1 1.91 3 3.26 0.92 -0.04

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -0.09

Tonsil 1 2.59 0 0.00 1 3.44 0 0.00 2 1.41 1.42 0.08

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.05

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.20 0.00 -0.16

Digestive system 22 0.88 27 0.99 16 0.98 15 1.03 80 83.25 0.96 -0.44

Esophagus 0 0.00 0 0.00 1 1.16 1 1.26 2 4.45 0.45 -0.33

Stomach 7 2.79* 3 1.11 3 1.90 0 0.00 13 8.14 1.60 0.66

Small intestine 0 0.00 0 0.00 1 3.40 0 0.00 1 1.41 0.71 -0.06

Colon 12 1.10 15 1.28 5 0.71 9 1.44 41 35.94 1.14 0.68

Rectum, rectosigmoid junction 2 0.43 3 0.60 4 1.33 2 0.76 11 15.34 0.72 -0.59

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 1.10 0.00 -0.15

Liver 0 0.00 1 0.96 0 0.00 1 1.59 2 3.20 0.63 -0.16

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.05 0.00 -0.14

Bile ducts, other biliary 0 0.00 1 1.80 1 2.89 0 0.00 2 1.74 1.15 0.03

Pancreas 1 0.33 4 1.24 1 0.52 1 0.57 7 9.93 0.70 -0.40

Respiratory system 19 0.88 19 0.81 12 0.87 7 0.56 57 71.37 0.80 -1.94

Nose, nasal cavity, ear 0 0.00 1 4.22 1 6.97 0 0.00 2 0.70 2.86 0.18

Larynx 0 0.00 0 0.00 2 1.97 0 0.00 2 5.29 0.38 -0.45

Lung, bronchus 19 0.96 18 0.85 9 0.71 7 0.61 53 65.12 0.81 -1.64

Female breast 8 0.56 24 1.16 10 0.70 5 0.38* 47 62.41 0.75 -4.59

Female genital system 5 0.74 4 0.43 5 0.83 4 0.76 18 27.42 0.66 -2.80

Cervix uteri 0 0.00 0 0.00 3 2.65 0 0.00 3 4.75 0.63 -0.52

Corpus uteri 3 0.89 3 0.71 1 0.38 1 0.42 8 12.67 0.63 -1.39

Ovary 2 1.03 1 0.36 0 0.00 3 1.85 6 8.15 0.74 -0.64

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.10

Vulva 0 0.00 0 0.00 1 4.63 0 0.00 1 0.98 1.02 0.01

Male genital system 12 0.57 18 0.84 17 1.30 10 0.72 57 69.30 0.82 -3.04

Prostate 11 0.54* 16 0.80 17 1.39 10 0.75 54 65.80 0.82 -2.92

Testis 1 1.99 2 1.57 0 0.00 0 0.00 3 3.00 1.00 0.00

Urinary system 8 0.85 12 1.18 4 0.65 7 1.23 31 31.51 0.98 -0.07

Urinary bladder 5 0.79 6 0.92 2 0.51 4 1.11 17 20.34 0.84 -0.45

Kidney parenchyma 3 1.17 4 1.30 2 1.03 3 1.66 12 9.40 1.28 0.35

Renal pelvis, other urinary 0 0.00 2 3.46 0 0.00 0 0.00 2 1.77 1.13 0.03

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.08

Bone, joints 0 0.00 5 20.42* 2 14.02* 0 0.00 7 0.65 10.70* 0.86

Soft tissue including heart 0 0.00 2 2.52 4 8.20* 1 2.39 7 2.26 3.10* 0.64

Kaposi sarcoma 2 3.98 0 0.00 0 0.00 0 0.00 2 3.14 0.64 -0.15

Melanoma of skin 4 1.11 11 1.95 5 1.36 4 1.22 24 16.22 1.48 1.05

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.76 0.00 -0.10

Brain, central nervous system 5 3.09 6 2.70 11 8.23* 5 4.54* 27 6.28 4.30* 2.80

Thyroid 1 0.89 7 3.31* 4 2.88 0 0.00 12 5.77 2.08* 0.84

Lymphatic, hematopoietic 7 0.74 16 1.35 11 1.50 6 0.93 40 35.12 1.14 0.66

Hodgkin lymphoma 0 0.00 1 0.93 0 0.00 0 0.00 1 2.66 0.38 -0.22

Non-Hodgkin lymphoma 3 0.69 5 0.88 1 0.28 2 0.61 11 16.88 0.65 -0.79

Myeloma 2 1.40 1 0.63 2 2.06 1 1.12 6 4.88 1.23 0.15

Leukemia 2 0.65 9 2.51* 8 3.71* 3 1.59 22 10.71 2.06* 1.53

Acute lymphocytic 0 0.00 0 0.00 0 0.00 1 11.37 1 0.51 1.96 0.07

Chronic lymphocytic 1 0.84 2 1.60 3 4.00 1 1.48 7 3.87 1.81 0.42

Acute non-lymphocytic 0 0.00 5 3.99* 4 5.31* 1 1.50 10 3.71 2.70* 0.85

Chronic myeloid 0 0.00 2 3.67 0 0.00 0 0.00 2 1.59 1.25 0.05

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 26,980 13,532 4,872 2,307 26,980

Person-years in interval 15,361 29,080 17,172 12,422 74,034

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 33,590 PYR and for male cancers on 40,445 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE BRAIN AND CENTRAL NERVOUS SYSTEM 373

NEW MALIGNANCIES FOLLOWING CANCER OF THE THYROID AND OTHER ENDOCRINE GLANDS 375

Synopsis

The risk of subsequent primary cancers was evaluated

in 31,230 survivors of cancers of the thyroid and other

endocrine glands, diagnosed between 1973 and 2000.

We found an 11% increased risk of subsequent cancers

among 29,456 survivors of thyroid cancer (O/E=1.11,

O=2,214, EAR=8 per 10,000 person-years). For up to

15 years after initial diagnosis, thyroid cancer patients

were at increased risk of developing a subsequent

thyroid cancer as well as a variety of other malignancies—including cancers of the salivary glands, trachea,

female breast, prostate, scrotum, kidney parenchyma,

adrenal glands, brain and central nervous system, and

hematopoietic malignancies. Although some new

cancers (e.g., leukemia) may be associated with radiotherapy, the pattern for others suggests the role of

increased medical surveillance, shared risk factors,

and/or genetic susceptibility. The overall risk of subsequent malignancy in 811 survivors of adrenal gland

cancer (excluding neuroblastoma) was increased

almost 2-fold (O/E=1.76, O=57, EAR=71), with excesses

observed for cancers of the lung, prostate, and bladder.

Also seen was a pronounced excess of subsequent cancers that are characteristic of Li-Fraumeni syndrome

among young patients with adrenal carcinoma. Following pheochromocytoma, only kidney cancer risk was

elevated, with no overall increase in cancer risk. Among

963 survivors of thymus cancer, the overall risk of

subsequent malignancy was elevated (O/E=1.53, O=91,

EAR=60), with increased risks observed for cancers of

the salivary glands and digestive system, soft tissue

sarcoma, and non-Hodgkin lymphoma. The latter may

have been related to altered immunity associated with

thymoma or to misclassified thymoma.

Thyroid Cancer

Currently, thyroid cancer accounts for 1.9% of the estimated new cancer cases in the U.S., with rates increasing

in recent decades (Howe et al, 2001; Jemal et al, 2005).

Three in 4 patients are female, 83% are white, 5% are

black, and 9% are of Asian descent. Most thyroid

malignancies are papillary (78%) or follicular (15%)

adenocarcinomas. The median age at thyroid cancer

diagnosis in our survey was 43.3 years, which is young

compared with other malignancies, but age at diagnosis

varies by histology. Treatment for differentiated thyroid

cancer typically consists of surgery followed by iodine131 (131I) ablation and sometimes includes subsequent

external beam radiotherapy (Gimm, 2001). According to

a 1996 survey, more than 50% of U.S. patients with

differentiated thyroid cancer received treatment with 131I,

whereas more than 70% of the relatively few patients

with undifferentiated (primarily anaplastic) thyroid cancer received external beam radiotherapy (Hundahl et al,

2000). The overall 5- and 10-year relative survival rates

are both close to 95%, although anaplastic thyroid cancer

is among the most aggressive and fatal cancers, with a

median survival of less than 6 months (Gimm, 2001). 

Childhood radiation exposure to the head and neck

area is a well-established risk factor for both papillary

thyroid cancer and, to a lesser extent, follicular thyroid

cancer (Ron et al, 1995). A history of benign thyroid nodules is associated with increased risk of papillary and follicular thyroid cancer (Franceschi et al, 1999). In women,

there are weak associations with late menarche, late age

at first birth (Negri et al, 1999), and oral contraceptive

use (LaVecchia et al, 1999). Smoking is associated with

a decreased risk (Mack et al, 2003). Papillary thyroid

cancer has been associated with specific rearrangements

of the RET proto-oncogene (Segev et al, 2003). Familial

occurrences of non-medullary thyroid cancer have been

described, although the role of genetic predisposition

is unclear except for a few genetic syndromes, such as

Cowden disease and familial adenomatous polyposis

(Eng, 2000a).

Sparsely available epidemiologic data suggest that

medullary thyroid cancer is associated with prior medical conditions such as thyroid nodules, hypertension,

gallbladder disease, and allergies (Negri et al, 2002).

Approximately 20% of medullary thyroid cancers show

a familial tendency as part of the genetic syndrome

Chapter 15

New Malignancies Following Cancer of

the Thyroid and Other Endocrine Glands

Cécile M. Ronckers, Peter McCarron, Eric A. Engels, Elaine Ron 

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated

as [(O-E)/PYR]10,000).

Author affiliations: Cécile M. Ronckers, Eric A. Engels, Elaine Ron,

Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS;

Peter McCarron, Division of Cancer Control and Population Sciences,

NCI, NIH, DHHS. Present address for Dr. McCarron: Department of

Epidemiology and Public Health, Queen’s University Belfast, Royal

Victoria Hospital, Belfast, United Kingdom. Dr. McCarron is

supported by a career scientist award funded by the Research and

Development Office for Health and Personal Social Services

in Northern Ireland. Present address for Dr. Ronckers: Department of

Pediatric Oncology, Academic Medical Center/Emma Children’s

Hospital, Amsterdam, The Netherlands.
multiple endocrine neoplasia (MEN) type 2, caused by

germline mutations of RET (Eng, 2000b).

Results and Discussion

Of 29,456 thyroid cancer patients surviving 2 months or

more, 95% were treated with surgery, and slightly more

than one-third received radiotherapy. We observed a

small overall increased risk of subsequent cancers

(O/E=1.11, O=2,214, 95% CI=1.06-1.15, EAR=8 per 10,000

person-years). The cumulative incidence of developing

any second cancer following thyroid cancer, adjusted for

the competing risk of death from other causes, was 15.9%

at 25 years (95% CI=15.0%-16.8%) (Figure 15.1). Risk

varied by time since thyroid cancer diagnosis, with the

highest risk (26%) seen in the first year, mainly for subsequent thyroid and stomach cancers. Increased medical

surveillance may explain the elevated risks in the early

years but not the persistent elevation throughout the

follow-up period. Patients younger than 40 years of age

at thyroid cancer diagnosis had a 39% increased risk of

subsequent cancer, whereas the average increase was

only 6% among thyroid patients 40 years or older (Figure

15.2). The relative risk for all malignancies combined was

similar for males and females, but the excess absolute

risk was 12 for males and 6 for females. There were no

major differences in risk by race. The overall risks of subsequent cancer following papillary and follicular thyroid

cancer were similar, whereas no increased risk was

observed following medullary thyroid cancer. A total of

50 patients developed a new primary thyroid cancer

according to the SEER registry coding definitions. In clinical practice, however, the majority of these new cases

would be considered recurrences, except for the 5 cases

that had clearly different histologies for the first and subsequent thyroid malignancies. Thus the risk estimate for

subsequent thyroid cancer was likely inflated due to misdiagnosis of recurrent cancers as new primary cancers.

When we repeated our analyses of subsequent cancer

risk excluding all individuals with a second thyroid cancer, the overall result was similar (O/E=1.10).

Breast cancer accounted for 36% of all cancers following thyroid cancer in females and constituted the

highest absolute excess risk among women (EAR=4).

The significantly elevated risk (O/E=1.21) was in agreement with some studies (Vassilopoulou-Sellin et al, 1999;

Simon et al, 2002; Adjadj et al, 2003), but not all (Hall

et al, 1990; Hemminki and Jiang, 2001; Sadetzki et al,

2003). Risk was elevated throughout the follow-up period, but it was most pronounced 1 to 5 years following

thyroid cancer diagnosis. The reciprocal risk of thyroid

cancer among breast cancer survivors was elevated 30%.

The 1.4-fold increase in risk of developing breast cancer

among women who were less than 40 years of age at

thyroid cancer diagnosis suggests an influence of hormonal or genetic factors or both. This mechanism

would be consistent with the elevated risk of endocrinedependent cancers reported among first-degree relatives

of patients with non-medullary thyroid cancer (Pal et al,

2001). Although Cowden disease features both breast

and follicular thyroid cancer (Eng, 2000b), the excess

risk of subsequent breast cancer was similar following

papillary or follicular thyroid cancer in our survey. 

Among males, the highest absolute risk following

thyroid cancer was observed for prostate cancer

(EAR=9). The excess risk was restricted to the first 10

years after diagnosis of papillary thyroid cancer, which

may reflect increased surveillance and detection of

otherwise indolent prostate tumors. An increased risk

of thyroid cancer following prostate cancer was also

observed; however, the elevation in risk was concentrated

in the first year following prostate cancer diagnosis.

376 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

40 40-49 50-69 70 40 40-49 50-69 70

Age at diagnosis of thyroid cancer (years)

EAR (per 10,000 person-years)

1.11*

1.01

1.06

7

8

2

8

1.39*

1.0

1.1

1.2

1.3

1.4

1.5

0

1

2

3

4

5

6

7

8

9

O/E

Figure 15.2: Observed-to-expected ratio (O/E) and excess

absolute risk (EAR) of subsequent primary cancers after

thryoid cancer, both sexes, SEER 1973-2000.

*P <0.05.

Notes: EAR = Excess number of subsequent cancers per 10,000 person-years. Observed

number of subsequent cancers are 397, 423, 1,084 and 310, for age groups <40, 40-49,

50-69 and >70 years, respectively.

Years after initial cancer diagnosis

Cumulative incidence (%)

0

5

10

15

20

0 5 10 15 20 25

All second cancers*

Prostate†

Female breast† 

Kidney parenchyma

Figure 15.1: Cumulative incidence of developing a second

cancer among patients with cancer of the thyroid, both sexes,

SEER 1973-2000.

* Cumulative incidence for all second cancers at 25 years is 20.3% for males and 

14.2% for females.

† Prostate and female breast cancer curves are based on male and female thyroid cancer

patients, respectively.

THYROID AND OTHER

ENDOCRINE GLANDS
NEW MALIGNANCIES FOLLOWING CANCER OF THE THYROID AND OTHER ENDOCRINE GLANDS 377

In agreement with 2 other large studies (Hemminki

and Jiang, 2001; Rubino et al, 2003), we found a morethan-2-fold increase in risk for kidney parenchyma

cancer following papillary and follicular thyroid cancer.

In addition, consistent with the findings of Hall et al

(1990), we noted a 2-fold increase in risk of renal pelvis

cancer, which appeared to be higher in males and in

those with follicular thyroid cancer. Survivors of kidney

parenchyma cancer had an almost 3-fold increased risk

of thyroid cancer. The mechanisms underlying the complex of thyroid and kidney cancers are unclear but may

reflect a heritable cancer syndrome, such as that

described for the combination of papillary thyroid cancer and papillary renal neoplasia (Eng, 2000b). In our

series, we could not evaluate risk for the renal papillary

histologic type separately, because most of these tumors

were registered under the more general category of renal

cell carcinoma. On rare occasions, renal cancers may

metastasize to the thyroid and may be hard to distinguish from primary thyroid cancer (Heffess et al, 2002).

Unlike most other malignancies, the predominant

form of radiotherapy for thyroid cancer consists of 131I

treatment rather than external beam radiation. Information on type of radiotherapy has been reported in SEER

since 1988. Of 17,055 thyroid cancer patients diagnosed

between 1988 and 2000, 6,745 (40%) were treated with

131I, 614 (4%) with beam radiation, and 185 (1%) with a

combination of modalities, which suggests underreporting of 131I treatment. The thyroid receives the highest

dose of iodine by far, but 131I also concentrates in other

organs, such as the salivary glands, stomach, small intestine, and bladder (ICRP, 1987; Ron, 1997). Although the

dose to the bone marrow is lower, leukemia has been

reported following 131I therapy (Ron, 1997). However,

bone marrow is known to be very sensitive to external

radiation (Preston et al, 1994). Following 131I treatment,

we found increased risks of stomach cancer (O/E=2.41,

O=8) and non-chronic lymphocytic leukemia (O/E=3.69,

O=11). For the combined group of non-chronic lymphocytic leukemia and cancers of the salivary glands, stomach, small intestine, and bladder, we found an almost

2-fold increased risk among patients treated with 131I

(O/E=1.92, O=29). A pooled study of 4,225 European

patients with thyroid cancer treated with 131I also

showed increased risks for leukemia and salivary

gland malignancies (Rubino et al, 2003).

The lower-than-expected rates of lung and bronchus

carcinoma in survivors of thyroid cancer compared to the

general U.S. population may reflect a low prevalence of

smoking among thyroid cancer patients relative to the

general population. Thyroid cancer is one of the few cancers reported to be inversely associated with smoking

(Mack et al, 2003). Decreased O/E ratios were observed

for most other smoking-related cancers, including cancers of the buccal cavity (excluding the salivary glands),

larynx, esophagus, pancreas, cervix, and bladder,

although not all risks were statistically significant. In

contrast, based on 5 cases, a 14-fold increased risk of

tracheal cancer was observed, possibly related to diagnostic misclassification of metastatic thyroid cancer presenting as endotracheal nodules (Datta and Lahiri, 2002). 

An increased risk of adrenal cancer was seen

(O/E=4.72, O=4), in particular following medullary

thyroid cancer (O/E=70.42, O=2), consistent with MEN

type 2, which features pheochromocytoma in addition to

medullary thyroid cancer. In addition, an 8-fold

increased risk for scrotal cancer was observed

(O/E=11.58, O=3), as well as an increased reciprocal risk,

but the reasons are unclear. In addition, female thyroid

cancer patients had a 1.6-fold increased risk for brain

cancer (O/E=1.64, O=24), although no clear pattern by

brain tumor histologic subtype was observed. Finally,

salivary gland cancers occurred in excess (O/E=2.78,

O=13), but this did not appear to be a radiation effect.

Cancer of the Adrenal Glands

Malignant neoplasms of the adrenal glands are extremely

rare and heterogeneous tumors (Correa and Chen, 1995),

accounting for less than 0.05% of cancers in the U.S. (We

have excluded childhood neuroblastomas, which are discussed elsewhere in this volume.) Adrenal gland cancers

occur almost as frequently in men as in women, and the

median age at diagnosis is 54.6 years. The most common

histologic subtypes for adults are adrenocortical carcinoma and pheochromocytoma, which arises in the medulla.

The 5-year relative survival rate is 47.9%. The mainstay

of treatment is surgical resection, often supplemented

with adjuvant chemotherapy (Kopf et al, 2001). 

The etiology of adrenocortical cancers is largely

unknown, but there is limited evidence that cigarette

smoking and oral contraceptive use increase risk (Hsing

et al, 1996). Most cases are sporadic, except for a familial

tendency for childhood cases, often arising in combination with other tumors constituting Li-Fraumeni syndrome (Li et al, 1988). Approximately 90% of pheochromocytomas are sporadic tumors, with the remaining

10% arising as a component of the genetic syndrome

MEN type 2 (Klingler et al, 2001).

Results and Discussion

Of 811 individuals with adrenal cancer who survived at

least 2 months, 81% were diagnosed with carcinomas.

Malignant pheochromocytoma occurred in 14%, and

the remaining 5% presented with other histologic types.

Overall, patients with adrenal gland cancers were at

elevated risk of subsequent malignancies (O/E=1.76,

O=57, 95% CI=1.33-2.27, EAR=71), with a 2-fold excess

for men. The cumulative incidence of any second cancer

following adrenal cancer was 8.3% at 15 years (95%

CI=6.1%-10.8%). Increased risks were found for lung

and bladder cancers for both sexes combined, and for

prostate cancers among men. Together these cancers

accounted for almost half of the subsequent malignancies. Among women, an elevated risk was observed

only for melanoma (O/E=8.10, O=3), but the excess was

found only in the first year following adrenal cancer

diagnosis.
Analysis by histology highlighted differences in the

risk of subsequent primary cancers. Among patients with

adrenal carcinoma, there was a 2-fold overall increased

risk of subsequent cancer (O/E=2.04, O=48), particularly

in the first year after diagnosis. Increased risks were

observed for smoking-related cancers, including lung

(O/E=2.70) and bladder (O/E=5.50), which is consistent

with the association reported between adrenal carcinoma

and smoking (Hsing et al, 1996). There also was an

elevated risk of prostate cancer (O/E=2.58), especially

in the first year, suggesting an effect of increased medical surveillance. Patients younger than 45 years of age

at adrenal carcinoma diagnosis had a particularly high

risk of subsequent cancer (O/E=5.32, O=10), whereas

among those 45 years and older the risk was lower

(O/E=1.76, O=38). In particular, young patients had a

10-fold increased risk (O/E=10.89, O=5) for the combined group of tumors characteristic of Li-Fraumeni

syndrome, notably adrenocortical cancer, breast cancer,

bone and soft tissue sarcoma, brain tumor, and acute

leukemia (Nichols et al, 2001).

Following pheochromocytoma, the overall risk of

subsequent cancers was not elevated. However, based

on only 2 cases, a significant excess risk was found for

kidney parenchyma cancer (O/E=12.6), consistent with

recent population-based findings (Hemminki and Jiang,

2001) and possibly related to the von Hippel-Lindau

syndrome, which genetically predisposes to renal

adenocarcinomas as well as pheochromocytoma.

Cancer of the Thymus

The thymus is the site of maturation for T lymphocytes,

which play a central role in adaptive immunity. The

thymus is large in childhood and begins to atrophy in

adolescence, although it maintains some activity

throughout life (Douek et al, 1998). Malignant neoplasms of the thymus are rare (0.3 incident cases per

100,000 person-years) and occur slightly more often in

men than women (Ries et al, 2004). The median age at

diagnosis is 55.3 years. The most common histologic

type is thymoma (85% of cases), a tumor of thymic

epithelial cells frequently accompanied by a rich infiltrate of T lymphocytes. Although these tumors can be

benign, SEER identifies only malignant thymomas

(Engels and Pfeiffer, 2003). Carcinoid tumors make up

another 4% of thymic malignancies, while no other histologic type constitutes more than 1% of cases. The

mainstay of therapy for thymoma is surgery, with

radiotherapy often given as adjuvant therapy or given

alone when surgical resection is not possible (Hejna et

al, 1999). Adjuvant chemotherapy is sometimes administered (Hejna et al, 1999). Overall survival is poor, with

a relative 5-year survival rate of only 65.3%. Although

the causes of thymic neoplasms are unknown, thymoma

is frequently associated with autoimmune diseases,

most notably myasthenia gravis and pure red cell

aplasia (Müller-Hermelink and Marx, 2000).

Results and Discussion

For 963 individuals surviving at least 2 months with

a thymic malignancy, the overall risk of subsequent

cancer was significantly elevated (O/E=1.53, O=91,

95% CI=1.23-1.88, EAR=60). Restricting analysis to the

815 patients with thymoma did not change the relative

risk (O/E=1.54), which was similar in males and

females. The cumulative incidence of any second cancer

following thymus cancer was 12.7% at 15 years (95%

CI=10.0%-15.7%).

Among all subjects, the risk for non-Hodgkin lymphoma (NHL) was elevated (O/E=4.81, O=10), consistent with previous surveys (Souadjian et al, 1968; Welsh

et al, 2000), but a reciprocal relationship (O/E=0.64)

was not seen. Altered immune function associated with

thymoma may predispose to NHL, or the lymphoma

excess may artifactually result from initial misclassification of thymoma (Ritter and Wick, 1999). Although all

cases of NHL arose in patients treated with radiotherapy,

the relevance of this finding is not clear.

A modest increase in cancers of the digestive tract

was noted (O/E=1.84, O=24). However, no specific site

entirely accounted for this finding, which also has been

suggested in clinical surveys (Souadjian et al, 1968;

Welsh et al, 2000; Pan et al, 2001). Risks for cancer of the

liver and biliary tract were also increased (O/E=3.73).

All 4 cases occurred in males (O/E=5.65), and 3 of

them were hepatocellular carcinomas, which have been

described previously as a new malignancy following

thymoma (Welsh et al, 2000; Pan et al, 2001). Risk of soft

tissue sarcoma was also elevated among individuals

with thymoma (O/E=9.00), based on 2 cases (malignant

fibrous histiocytoma and liposarcoma) at sites distant

from the thymus. It is noteworthy that an elevated risk

for malignant fibrous histiocytoma following thymoma

has been described previously (Masaoka et al, 1994);

the increased occurrence is possibly the result of shared

susceptibility factors or perhaps chemotherapy (Zahm

et al, 1996). Although the overall risk of subsequent

cancers was elevated only among the 68% of patients

receiving radiotherapy (O/E=1.72), there was no apparent radiotherapy effect for malignancies of tissues

receiving substantial radiation doses (bone marrow,

lung, and esophagus) (Travis et al, 2003).

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NEW MALIGNANCIES FOLLOWING CANCER OF THE THYROID AND OTHER ENDOCRINE GLANDS 379
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THYROID AND OTHER

ENDOCRINE GLANDS
Thyroid

Both Sexes

Table 15.1.1: Characteristics of patients with an initial cancer of the thyroid, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 7,406 100.0 22,050 100.0 29,456 100.0

Initial treatment

Any radiation 3,196 43.2 8,022 36.4 11,218 38.1

With surgery 3,010 40.6 7,776 35.3 10,786 36.6

Without surgery 186 2.5 246 1.1 432 1.5

No radiation 4,210 56.8 14,028 63.6 18,238 61.9

With surgery 3,945 53.3 13,392 60.7 17,337 58.9

Without surgery 265 3.6 636 2.9 901 3.1

Race

White 6,364 85.9 18,214 82.6 24,578 83.4

Black 311 4.2 1,225 5.6 1,536 5.2

Other 683 9.2 2,433 11.0 3,116 10.6

Unknown 48 0.6 178 0.8 226 0.8

Age at 1st primary cancer diagnosis, years

< 30 1,020 13.8 4,601 20.9 5,621 19.1

30–49 3,033 41.0 10,021 45.4 13,054 44.3

50–69 2,574 34.8 5,391 24.4 7,965 27.0

70–79 603 8.1 1,439 6.5 2,042 6.9

> 80 176 2.4 598 2.7 774 2.6

Number of patients with one or more

primary cancers

One primary cancer only 6,737 91.0 20,717 94.0 27,454 93.2

1st and 2nd cancers 604 8.2 1,213 5.5 1,817 6.2

1st, 2nd, and 3rd cancers 53 0.7 105 0.5 158 0.5

1st, 2nd, 3rd, and additional cancers 12 0.2 15 0.1 27 0.1

Other statistics

Median age at 1st cancer diagnosis 47.6 — 42.0 — 43.3 —

Median year of 1st cancer diagnosis 1990.0 — 1990.4 — 1990.3 —

Median person-years at risk 7.4 — 8.0 — 7.9 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 97.5 — 98.3 — 98.0

1st, 2nd, and additional cancers — 96.4 — 98.0 — 97.5

1st cancer only — 2.1 — 1.2 — 1.5

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.

NEW MALIGNANCIES FOLLOWING CANCER OF THE THYROID AND OTHER ENDOCRINE GLANDS 381
All subsequent cancers 160 1.26* 619 1.17* 590 1.11* 845 1.04 2,214 1,999.67 1.11* 7.64

All excluding same site 141 1.13 611 1.18* 584 1.12* 828 1.03 2,164 1,969.87 1.10* 6.92

Buccal cavity, pharynx 2 0.65 9 0.71 9 0.74 17 0.99 37 45.08 0.82 -0.29

Lip 0 0.00 0 0.00 0 0.00 1 0.60 1 4.50 0.22 -0.12

Tongue 2 3.07 0 0.00 2 0.76 1 0.26 5 9.82 0.51 -0.17

Salivary gland 0 0.00 4 3.09 3 2.41 6 3.29* 13 4.68 2.78* 0.30

Mouth 0 0.00 2 0.58 3 0.90 4 0.85 9 12.34 0.73 -0.12

Nasopharynx 0 0.00 0 0.00 0 0.00 3 3.07 3 2.71 1.11 0.01

Tonsil 0 0.00 1 0.79 0 0.00 1 0.58 2 4.52 0.44 -0.09

Oropharynx 0 0.00 1 3.03 0 0.00 0 0.00 1 1.18 0.84 -0.01

Hypopharynx 0 0.00 1 0.91 1 0.95 1 0.69 3 3.86 0.78 -0.03

Digestive system 30 1.24 97 0.97 104 1.03 143 0.92 374 380.23 0.98 -0.22

Esophagus 2 1.93 2 0.47 2 0.47 3 0.46 9 16.02 0.56 -0.25

Stomach 7 2.91* 11 1.12 13 1.36 12 0.87 43 35.54 1.21 0.27

Small intestine 1 2.61 4 2.49 2 1.22 2 0.74 9 6.34 1.42 0.09

Colon 9 0.84 51 1.14 56 1.24 66 0.94 182 171.05 1.06 0.39

Rectum, rectosigmoid junction 6 1.39 11 0.62 14 0.80 31 1.19 62 65.57 0.95 -0.13

Anus, anal canal 1 3.10 2 1.47 1 0.72 0 0.00 4 5.27 0.76 -0.05

Liver 0 0.00 5 1.40 4 1.11 5 0.85 14 13.91 1.01 0.00

Gallbladder 0 0.00 1 0.60 1 0.60 1 0.40 3 6.24 0.48 -0.12

Bile ducts, other biliary 2 3.86 0 0.00 2 0.89 4 1.06 8 8.71 0.92 -0.03

Pancreas 2 0.69 9 0.75 8 0.65 17 0.88 36 46.59 0.77 -0.38

Respiratory system 17 0.94 66 0.87 64 0.83 109 0.89 256 293.36 0.87* -1.33

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 3 2.66 3 2.88 1.04 0.00

Larynx 1 0.89 5 1.09 1 0.23 3 0.48 10 16.32 0.61 -0.23

Lung, bronchus 15 0.90 60 0.85 62 0.86 101 0.88 238 273.33 0.87* -1.26

Female breast 27 1.01 156 1.38* 140 1.21* 207 1.14 530 437.35 1.21* 4.36

Female genital system 12 0.96 43 0.84 53 1.06 57 0.78 165 186.45 0.88 -1.01

Cervix uteri 1 0.41 7 0.72 5 0.58 8 0.79 21 30.99 0.68 -0.47

Corpus uteri 3 0.54 16 0.69 29 1.27 25 0.71 73 86.60 0.84 -0.64

Ovary 5 1.39 18 1.20 17 1.14 15 0.67 55 55.82 0.99 -0.04

Vagina 1 6.76 0 0.00 0 0.00 1 1.07 2 2.30 0.87 -0.01

Vulva 1 2.37 1 0.57 1 0.55 3 1.03 6 6.93 0.87 -0.04

Male genital system 17 1.37 81 1.57* 74 1.42* 97 1.15 269 200.86 1.34* 10.02

Prostate 16 1.34 74 1.48* 74 1.46* 93 1.12 257 195.83 1.31* 9.00

Testis 0 0.00 4 2.98 0 0.00 3 3.09 7 3.73 1.88 0.48

Urinary system 10 1.35 41 1.34 42 1.35 66 1.35* 159 118.15 1.35* 1.46

Urinary bladder 4 0.86 16 0.83 16 0.83 26 0.85 62 73.64 0.84 -0.41

Kidney parenchyma 5 2.19 23 2.40* 21 2.16* 35 2.24* 84 37.22 2.26* 1.67

Renal pelvis, other urinary 1 2.13 2 1.03 5 2.59 5 1.70 13 7.29 1.78 0.20

Ureter 1 6.73 0 0.00 0 0.00 2 2.16 3 2.30 1.31 0.03

Bone, joints 0 0.00 2 2.76 0 0.00 4 4.72* 6 2.40 2.50 0.13

Soft tissue including heart 1 1.59 5 1.96 3 1.23 4 1.12 13 9.20 1.41 0.14

Kaposi sarcoma 1 2.81 0 0.00 0 0.00 0 0.00 1 4.60 0.22 -0.13

Melanoma of skin 8 1.91 25 1.43 19 1.12 26 1.07 78 62.98 1.24 0.54

Eye, orbit 0 0.00 1 1.20 2 2.52 0 0.00 3 2.99 1.00 0.00

Brain, central nervous system 2 1.21 12 1.77 12 1.85 11 1.21 37 24.00 1.54* 0.46

Thyroid 19 8.37* 8 0.88 6 0.74 17 1.65 50 29.80 1.68* 0.72

Lymphatic, hematopoietic 10 1.06 56 1.44* 50 1.29 63 1.05 179 146.86 1.22* 1.15

Hodgkin lymphoma 2 2.69 6 2.12 4 1.74 2 0.80 14 8.36 1.67 0.20

Non-Hodgkin lymphoma 6 1.36 14 0.76 19 1.01 32 1.06 71 71.83 0.99 -0.03

Myeloma 2 1.46 13 2.27* 9 1.55 8 0.86 32 22.21 1.44 0.35

Leukemia 0 0.00 23 1.93* 18 1.53 21 1.18 62 44.45 1.39* 0.63

Acute lymphocytic 0 0.00 0 0.00 4 7.72* 0 0.00 4 1.90 2.10 0.07

Chronic lymphocytic 0 0.00 3 0.73 8 1.93 8 1.24 19 15.71 1.21 0.12

Acute non-lymphocytic 0 0.00 15 3.43* 3 0.70 2 0.30 20 16.31 1.23 0.13

Chronic myeloid 0 0.00 2 1.12 2 1.15 5 1.94 9 6.53 1.38 0.09

Thyroid

Both Sexes

Table 15.1.2: Risk of subsequent primary cancers after cancer of the thyroid, both sexes,

SEER 1973-2000.

382 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

THYROID

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 29,456 26,797 19,112 12,302 29,456

Person-years in interval 23,251 90,780 77,456 89,094 280,581

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR]  10,000. EAR for female cancers is based on 212,594 PYR and for male cancers on 67,987 PYR.
Thyroid

Both Sexes, Long-term Follow-up

Table 15.1.3: Risk of subsequent primary cancers after cancer of the thyroid, both sexes,

long-term follow-up, SEER 1973-2000.

All subsequent cancers 1,369 1.16* 417 1.06 256 0.97 172 1.10 2,214 1,999.67 1.11* 7.64

All excluding same site 1,336 1.15* 411 1.06 247 0.94 170 1.10 2,164 1,969.87 1.10* 6.92

Buccal cavity, pharynx 20 0.72 9 1.05 5 0.91 3 0.97 37 45.08 0.82 -0.29

Lip 0 0.00 1 1.21 0 0.00 0 0.00 1 4.50 0.22 -0.12

Tongue 4 0.67 0 0.00 1 0.81 0 0.00 5 9.82 0.51 -0.17

Salivary gland 7 2.45 3 3.34 2 3.42 1 2.92 13 4.68 2.78* 0.30

Mouth 5 0.66 3 1.27 0 0.00 1 1.18 9 12.34 0.73 -0.12

Nasopharynx 0 0.00 1 1.97 1 3.27 1 6.15 3 2.71 1.11 0.01

Tonsil 1 0.36 0 0.00 1 1.79 0 0.00 2 4.52 0.44 -0.09

Oropharynx 1 1.37 0 0.00 0 0.00 0 0.00 1 1.18 0.84 -0.01

Hypopharynx 2 0.83 1 1.36 0 0.00 0 0.00 3 3.86 0.78 -0.03

Digestive system 231 1.03 77 1.03 37 0.74 29 0.95 374 380.23 0.98 -0.22

Esophagus 6 0.63 2 0.64 0 0.00 1 0.77 9 16.02 0.56 -0.25

Stomach 31 1.42 8 1.17 1 0.23 3 1.16 43 35.54 1.21 0.27

Small intestine 7 1.92 1 0.79 0 0.00 1 1.80 9 6.34 1.42 0.09

Colon 116 1.15 30 0.89 22 0.97 14 1.01 182 171.05 1.06 0.39

Rectum, rectosigmoid junction 31 0.78 18 1.41 8 0.96 5 1.01 62 65.57 0.95 -0.13

Anus, anal canal 4 1.30 0 0.00 0 0.00 0 0.00 4 5.27 0.76 -0.05

Liver 9 1.12 5 1.82 0 0.00 0 0.00 14 13.91 1.01 0.00

Gallbladder 2 0.53 0 0.00 1 1.25 0 0.00 3 6.24 0.48 -0.12

Bile ducts, other biliary 4 0.81 2 1.14 1 0.81 1 1.27 8 8.71 0.92 -0.03

Pancreas 19 0.70 10 1.09 3 0.48 4 1.03 36 46.59 0.77 -0.38

Respiratory system 147 0.86 53 0.91 31 0.78 25 1.03 256 293.36 0.87* -1.33

Nose, nasal cavity, ear 0 0.00 3 5.34* 0 0.00 0 0.00 3 2.88 1.04 0.00

Larynx 7 0.69 0 0.00 1 0.50 2 1.80 10 16.32 0.61 -0.23

Lung, bronchus 137 0.86 49 0.90 29 0.78 23 1.01 238 273.33 0.87* -1.26

Female breast 323 1.26* 96 1.08 68 1.16 43 1.28 530 437.35 1.21* 4.36

Female genital system 108 0.95 32 0.88 16 0.68 9 0.69 165 186.45 0.88 -1.01

Cervix uteri 13 0.62 4 0.71 2 0.65 2 1.43 21 30.99 0.68 -0.47

Corpus uteri 48 0.93 17 1.00 5 0.44 3 0.45 73 86.60 0.84 -0.64

Ovary 40 1.19 6 0.54 6 0.83 3 0.75 55 55.82 0.99 -0.04

Vagina 1 0.73 1 2.19 0 0.00 0 0.00 2 2.30 0.87 -0.01

Vulva 3 0.75 1 0.72 1 1.05 1 1.74 6 6.93 0.87 -0.04

Male genital system 172 1.48* 49 1.25 29 1.01 19 1.12 269 200.86 1.34* 10.02

Prostate 164 1.46* 46 1.20 28 0.99 19 1.13 257 195.83 1.31* 9.00

Testis 4 1.45 2 3.42 1 3.59 0 0.00 7 3.73 1.88 0.48

Urinary system 93 1.35* 30 1.29 17 1.06 19 1.93* 159 118.15 1.35* 1.46

Urinary bladder 36 0.83 15 1.04 7 0.71 4 0.65 62 73.64 0.84 -0.41

Kidney parenchyma 49 2.27* 14 1.89* 8 1.56 13 4.20* 84 37.22 2.26* 1.67

Renal pelvis, other urinary 8 1.84 1 0.71 2 2.11 2 3.38 13 7.29 1.78 0.20

Ureter 1 0.73 0 0.00 1 3.36 1 5.36 3 2.30 1.31 0.03

Bone, joints 2 1.29 2 4.63 2 7.47 0 0.00 6 2.40 2.50 0.13

Soft tissue including heart 9 1.60 2 1.14 1 0.87 1 1.49 13 9.20 1.41 0.14

Kaposi sarcoma 1 0.32 0 0.00 0 0.00 0 0.00 1 4.60 0.22 -0.13

Melanoma of skin 52 1.35* 13 1.08 10 1.28 3 0.66 78 62.98 1.24 0.54

Eye, orbit 3 1.64 0 0.00 0 0.00 0 0.00 3 2.99 1.00 0.00

Brain, central nervous system 26 1.74* 3 0.66 3 1.03 5 3.07 37 24.00 1.54* 0.46

Thyroid 33 1.69* 6 1.10 9 2.79* 2 1.21 50 29.80 1.68* 0.72

Lymphatic, hematopoietic 116 1.33* 29 1.01 22 1.14 12 1.03 179 146.86 1.22* 1.15

Hodgkin lymphoma 12 2.04* 0 0.00 0 0.00 2 5.45 14 8.36 1.67 0.20

Non-Hodgkin lymphoma 39 0.93 15 1.05 9 0.92 8 1.34 71 71.83 0.99 -0.03

Myeloma 24 1.86* 5 1.13 2 0.66 1 0.54 32 22.21 1.44 0.35

Leukemia 41 1.54* 9 1.04 11 1.91 1 0.29 62 44.45 1.39* 0.63

Acute lymphocytic 4 3.28 0 0.00 0 0.00 0 0.00 4 1.90 2.10 0.07

Chronic lymphocytic 11 1.19 2 0.64 6 2.85* 0 0.00 19 15.71 1.21 0.12

Acute non-lymphocytic 18 1.85* 0 0.00 1 0.47 1 0.77 20 16.31 1.23 0.13

Chronic myeloid 4 1.01 3 2.36 2 2.42 0 0.00 9 6.53 1.38 0.09

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 29,456 12,302 7,352 3,793 29,456

Person-years in interval 191,487 48,565 27,293 13,236 280,581

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR]  10,000. EAR for female cancers is based on 212,594 PYR and for male cancers on 67,987 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE THYROID AND OTHER ENDOCRINE GLANDS 383
All subsequent cancers 107 1.29* 408 1.18* 389 1.10 564 1.02 1,468 1,337.02 1.10* 6.16

All excluding same site 91 1.13 402 1.18* 384 1.11* 552 1.01 1,429 1,311.00 1.09* 5.55

Buccal cavity, pharynx 0 0.00 6 0.96 4 0.64 12 1.30 22 23.20 0.95 -0.06

Lip 0 0.00 0 0.00 0 0.00 1 1.83 1 1.29 0.77 -0.01

Tongue 0 0.00 0 0.00 1 0.71 0 0.00 1 5.26 0.19 -0.20

Salivary gland 0 0.00 2 2.44 1 1.27 5 4.32* 8 2.96 2.70* 0.24

Mouth 0 0.00 1 0.51 2 1.02 4 1.36 7 7.32 0.96 -0.02

Nasopharynx 0 0.00 0 0.00 0 0.00 2 3.73 2 1.46 1.37 0.03

Tonsil 0 0.00 1 1.72 0 0.00 0 0.00 1 2.12 0.47 -0.05

Oropharynx 0 0.00 1 6.75 0 0.00 0 0.00 1 0.56 1.80 0.02

Hypopharynx 0 0.00 1 2.47 0 0.00 0 0.00 1 1.50 0.67 -0.02

Digestive system 18 1.21 59 0.95 68 1.06 96 0.93 241 243.69 0.99 -0.13

Esophagus 0 0.00 2 1.16 2 1.13 0 0.00 4 6.81 0.59 -0.13

Stomach 5 3.95* 6 1.15 9 1.72 4 0.50 24 19.68 1.22 0.20

Small intestine 1 4.12 2 1.94 1 0.93 2 1.09 6 4.19 1.43 0.09

Colon 5 0.71 33 1.12 35 1.15 46 0.94 119 115.98 1.03 0.14

Rectum, rectosigmoid junction 3 1.19 6 0.57 8 0.75 24 1.46 41 40.21 1.02 0.04

Rectum 2 1.20 5 0.72 5 0.71 19 1.73* 31 26.58 1.17 0.21

Anus, anal canal 0 0.00 2 1.94 0 0.00 0 0.00 2 4.09 0.49 -0.10

Liver 0 0.00 2 1.21 1 0.58 4 1.35 7 6.74 1.04 0.01

Gallbladder 0 0.00 0 0.00 1 0.72 1 0.48 2 5.17 0.39 -0.15

Bile ducts, other biliary 2 6.22 0 0.00 2 1.38 3 1.19 7 5.64 1.24 0.06

Pancreas 2 1.08 5 0.64 8 0.98 10 0.74 25 31.28 0.80 -0.30

Respiratory system 12 1.28 34 0.84 33 0.76 67 0.90 146 168.34 0.87 -1.05

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 2 2.80 2 1.77 1.13 0.01

Larynx 1 2.82 2 1.33 0 0.00 0 0.00 3 5.76 0.52 -0.13

Lung, bronchus 10 1.12 31 0.81 33 0.80 64 0.89 138 160.33 0.86 -1.05

Female breast 27 1.01 156 1.38* 140 1.21* 207 1.14 530 437.35 1.21* 4.36

Female genital system 12 0.96 43 0.84 53 1.06 57 0.78 165 186.45 0.88 -1.01

Cervix uteri 1 0.41 7 0.72 5 0.58 8 0.79 21 30.99 0.68 -0.47

Corpus uteri 3 0.54 16 0.69 29 1.27 25 0.71 73 86.60 0.84 -0.64

Ovary 5 1.39 18 1.20 17 1.14 15 0.67 55 55.82 0.99 -0.04

Vagina 1 6.76 0 0.00 0 0.00 1 1.07 2 2.30 0.87 -0.01

Vulva 1 2.37 1 0.57 1 0.55 3 1.03 6 6.93 0.87 -0.04

Urinary system 5 1.55 23 1.69* 20 1.40 32 1.33 80 55.16 1.45* 1.17

Urinary bladder 3 1.69 8 1.07 6 0.77 11 0.84 28 30.25 0.93 -0.11

Kidney parenchyma 2 1.66 15 2.92* 11 2.03* 20 2.19* 48 20.89 2.30* 1.28

Renal pelvis, other urinary 0 0.00 0 0.00 3 2.84 1 0.58 4 4.03 0.99 0.00

Ureter 0 0.00 0 0.00 0 0.00 1 1.93 1 1.21 0.82 -0.01

Bone, joints 0 0.00 0 0.00 0 0.00 3 5.07* 3 1.64 1.83 0.06

Soft tissue including heart 0 0.00 3 1.79 2 1.23 3 1.24 8 6.12 1.31 0.09

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.02

Melanoma of skin 6 2.18 16 1.39 11 0.98 15 0.95 48 41.20 1.17 0.32

Eye, orbit 0 0.00 1 1.89 2 3.89 0 0.00 3 1.94 1.55 0.05

Brain, central nervous system 0 0.00 11 2.55* 8 1.90 8 1.32 27 15.62 1.73* 0.54

Thyroid 16 8.08* 6 0.75 5 0.70 12 1.34 39 26.02 1.50* 0.61

Lymphatic, hematopoietic 9 1.54 37 1.52* 36 1.46* 34 0.86 116 94.17 1.23* 1.03

Hodgkin lymphoma 2 3.93 3 1.55 4 2.57 1 0.60 10 5.67 1.76 0.20

Non-Hodgkin lymphoma 6 2.18 12 1.03 12 0.98 20 0.99 50 46.94 1.07 0.14

Myeloma 1 1.17 8 2.23 6 1.60 5 0.81 20 14.36 1.39 0.27

Leukemia 0 0.00 14 1.98* 14 1.96* 8 0.71 36 27.20 1.32 0.41

Acute lymphocytic 0 0.00 0 0.00 4 11.72* 0 0.00 4 1.26 3.18 0.13

Chronic lymphocytic 0 0.00 3 1.32 5 2.10 3 0.77 11 9.11 1.21 0.09

Acute non-lymphocytic 0 0.00 9 3.26* 3 1.09 0 0.00* 12 10.52 1.14 0.07

Chronic myeloid 0 0.00 1 0.91 2 1.84 3 1.83 6 4.09 1.47 0.09

Thyroid

Females

Table 15.1.4: Risk of subsequent primary cancers after cancer of the thyroid, females,

SEER 1973-2000.

384 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

THYROID

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 22,050 20,168 14,442 9,402 22,050

Person-years in interval 17,467 68,539 58,736 67,852 212,594

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR]  10,000.
Thyroid

Males

Table 15.1.5: Risk of subsequent primary cancers after cancer of the thyroid, males,

SEER 1973-2000.

All subsequent cancers 53 1.20 211 1.17* 201 1.14 281 1.07 746 662.65 1.13* 12.26

All excluding same site 50 1.14 209 1.16* 200 1.14 276 1.06 735 658.87 1.12* 11.20

Buccal cavity, pharynx 2 1.25 3 0.47 5 0.84 5 0.63 15 21.88 0.69 -1.01

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 3.21 0.00 -0.47

Tongue 2 6.21 0 0.00 1 0.82 1 0.59 4 4.56 0.88 -0.08

Salivary gland 0 0.00 2 4.21 2 4.40 1 1.50 5 1.72 2.91 0.48

Mouth 0 0.00 1 0.67 1 0.73 0 0.00 2 5.02 0.40 -0.44

Nasopharynx 0 0.00 0 0.00 0 0.00 1 2.27 1 1.26 0.80 -0.04

Tonsil 0 0.00 0 0.00 0 0.00 1 1.12 1 2.39 0.42 -0.20

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -0.09

Hypopharynx 0 0.00 0 0.00 1 1.55 1 1.18 2 2.36 0.85 -0.05

Digestive system 12 1.28 38 1.00 36 0.98 47 0.90 133 136.54 0.97 -0.52

Esophagus 2 3.20 0 0.00 0 0.00 3 0.83 5 9.22 0.54 -0.62

Stomach 2 1.76 5 1.09 4 0.93 8 1.37 19 15.87 1.20 0.46

Small intestine 0 0.00 2 3.46 1 1.77 0 0.00 3 2.15 1.40 0.13

Colon 4 1.08 18 1.18 21 1.42 20 0.94 63 55.07 1.14 1.17

Rectum, rectosigmoid junction 3 1.68 5 0.70 6 0.88 7 0.73 21 25.36 0.83 -0.64

Anus, anal canal 1 12.39 0 0.00 1 3.20 0 0.00 2 1.18 1.70 0.12

Liver 0 0.00 3 1.56 3 1.59 1 0.35 7 7.17 0.98 -0.02

Gallbladder 0 0.00 1 3.30 0 0.00 0 0.00 1 1.06 0.94 -0.01

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 0.80 1 3.08 0.33 -0.31

Pancreas 0 0.00 4 0.93 0 0.00* 7 1.19 11 15.32 0.72 -0.63

Respiratory system 5 0.58 32 0.91 31 0.92 42 0.89 110 125.02 0.88 -2.21

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 1 2.41 1 1.11 0.90 -0.02

Larynx 0 0.00 3 0.97 1 0.35 3 0.78 7 10.56 0.66 -0.52

Lung, bronchus 5 0.64 29 0.91 29 0.95 37 0.86 100 112.99 0.89 -1.91

Male breast 0 0.00 1 2.88 0 0.00 1 1.97 2 1.28 1.57 0.11

Male genital system 17 1.37 81 1.57* 74 1.42* 97 1.15 269 200.86 1.34* 10.02

Prostate 16 1.34 74 1.48* 74 1.46* 93 1.12 257 195.83 1.31* 9.00

Testis 0 0.00 4 2.98 0 0.00 3 3.09 7 3.73 1.88 0.48

Urinary system 5 1.20 18 1.06 22 1.32 34 1.36 79 62.98 1.25 2.36

Urinary bladder 1 0.35 8 0.68 10 0.87 15 0.87 34 43.39 0.78 -1.38

Kidney parenchyma 3 2.78 8 1.80 10 2.31* 15 2.31* 36 16.33 2.20* 2.89

Renal pelvis, other urinary 1 4.40 2 2.17 2 2.28 4 3.23 9 3.26 2.76* 0.84

Ureter 1 13.25 0 0.00 0 0.00 1 2.44 2 1.08 1.85 0.13

Bone, joints 0 0.00 2 8.47 0 0.00 1 3.89 3 0.76 3.96 0.33

Soft tissue including heart 1 4.56 2 2.27 1 1.22 1 0.86 5 3.08 1.62 0.28

Kaposi sarcoma 1 3.00 0 0.00 0 0.00 0 0.00 1 4.24 0.24 -0.48

Melanoma of skin 2 1.39 9 1.52 8 1.39 11 1.27 30 21.78 1.38 1.21

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 1.05 0.00 -0.15

Brain, central nervous system 2 3.27 1 0.41 4 1.76 3 0.98 10 8.39 1.19 0.24

Thyroid 3 10.30* 2 1.76 1 0.99 5 3.71* 11 3.78 2.91* 1.06

Lymphatic, hematopoietic 1 0.28 19 1.30 14 0.99 29 1.42 63 52.68 1.20 1.52

Hodgkin lymphoma 0 0.00 3 3.37 0 0.00 1 1.22 4 2.69 1.49 0.19

Non-Hodgkin lymphoma 0 0.00 2 0.29 7 1.06 12 1.22 21 24.89 0.84 -0.57

Myeloma 1 1.91 5 2.34 3 1.44 3 0.96 12 7.85 1.53 0.61

Leukemia 0 0.00 9 1.87 4 0.86 13 1.97* 26 17.25 1.51 1.29

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -0.09

Chronic lymphocytic 0 0.00 0 0.00 3 1.69 5 1.95 8 6.60 1.21 0.21

Acute non-lymphocytic 0 0.00 6 3.72* 0 0.00 2 0.89 8 5.80 1.38 0.32

Chronic myeloid 0 0.00 1 1.45 0 0.00 2 2.14 3 2.45 1.23 0.08

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 7,406 6,629 4,670 2,900 7,406

Person-years in interval 5,784 22,241 18,721 21,242 67,987

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR]  10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE THYROID AND OTHER ENDOCRINE GLANDS 385
All subsequent cancers 28 3.06* 70 1.49* 85 1.33* 214 1.29* 397 286.20 1.39* 8.16

All excluding same site 18 2.18* 67 1.55* 82 1.37* 202 1.26* 369 272.05 1.36* 7.14

Buccal cavity, pharynx 0 0.00 1 1.15 2 1.54 8 2.13 11 6.09 1.81 0.36

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.03

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 1.43 0.00 -0.11

Salivary gland 0 0.00 1 4.47 1 4.00 4 8.34* 6 1.00 5.99* 0.37

Mouth 0 0.00 0 0.00 1 3.71 3 3.36 4 1.35 2.97 0.20

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -0.05

Tonsil 0 0.00 0 0.00 0 0.00 1 2.04 1 0.70 1.42 0.02

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.01

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.02

Digestive system 1 1.79 6 1.86 6 1.14 28 1.48 41 28.02 1.46* 0.96

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 1.04 0.00 -0.08

Stomach 1 14.60 1 2.59 2 3.48 3 1.86 7 2.64 2.65* 0.32

Small intestine 0 0.00 0 0.00 0 0.00 1 1.91 1 0.82 1.21 0.01

Colon 0 0.00 3 2.36 3 1.48 13 1.77 19 10.87 1.75* 0.60

Rectum, rectosigmoid junction 0 0.00 0 0.00 1 0.91 7 1.75 8 5.85 1.37 0.16

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.88 0.00 -0.06

Liver 0 0.00 2 12.78* 0 0.00 0 0.00 2 1.36 1.47 0.05

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.03

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 2.40 1 0.61 1.65 0.03

Pancreas 0 0.00 0 0.00 0 0.00 3 1.43 3 2.90 1.03 0.01

Respiratory system 2 7.13 1 0.55 3 0.85 17 1.07 23 21.46 1.07 0.11

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 1 4.31 1 0.42 2.38 0.04

Larynx 1 46.10 0 0.00 0 0.00 1 0.93 2 1.51 1.33 0.04

Lung, bronchus 1 4.31 1 0.64 3 0.96 15 1.04 20 19.35 1.03 0.05

Female breast 5 2.16 17 1.23 36 1.64* 77 1.35* 135 94.96 1.42* 3.76

Female genital system 3 1.90 11 1.42 7 0.72 15 0.69 36 40.58 0.89 -0.43

Cervix uteri 0 0.00 4 1.09 4 1.04 4 0.76 12 13.58 0.88 -0.15

Corpus uteri 0 0.00 3 2.12 2 0.85 5 0.60 10 12.34 0.81 -0.22

Ovary 2 4.48 4 1.80 1 0.34 4 0.59 11 12.33 0.89 -0.13

Vagina 1 82.39* 0 0.00 0 0.00 0 0.00 1 0.34 2.91 0.06

Vulva 0 0.00 0 0.00 0 0.00 1 1.53 1 1.20 0.83 -0.02

Male genital system 1 4.40 3 3.06 3 2.64 11 1.56 18 9.38 1.92* 2.96

Prostate 0 0.00 0 0.00 3 9.91* 9 1.46 12 6.53 1.84 1.88

Testis 0 0.00 3 3.30 0 0.00 2 2.50 5 2.74 1.83 0.78

Urinary system 1 4.86 1 0.84 3 1.56 13 1.89* 18 10.18 1.77* 0.58

Urinary bladder 0 0.00 0 0.00 2 2.23 4 1.18 6 4.95 1.21 0.08

Kidney parenchyma 1 9.89 1 1.69 1 1.04 9 2.81* 12 4.86 2.47* 0.53

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.03

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.01

Bone, joints 0 0.00 0 0.00 0 0.00 2 6.14 2 0.85 2.35 0.08

Soft tissue including heart 0 0.00 1 1.81 0 0.00 1 0.96 2 2.30 0.87 -0.02

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 3.05 0.00 -0.22

Melanoma of skin 3 2.82 7 1.40 5 0.88 12 1.23 27 21.45 1.26 0.41

Eye, orbit 0 0.00 0 0.00 1 7.70 0 0.00 1 0.55 1.81 0.03

Brain, central nervous system 1 3.33 6 4.44* 4 2.74 5 1.89 16 5.75 2.78* 0.75

Thyroid 10 11.42* 3 0.78 3 0.79 12 2.13* 28 14.15 1.98* 1.02

Lymphatic, hematopoietic 1 0.94 12 2.50* 11 2.04* 11 0.94 35 22.94 1.53* 0.89

Hodgkin lymphoma 1 2.54 4 2.64 2 1.66 2 1.63 9 4.33 2.08 0.34

Non-Hodgkin lymphoma 0 0.00 3 1.51 6 2.32 6 0.96 15 11.22 1.34 0.28

Myeloma 0 0.00 0 0.00 0 0.00 1 0.84 1 1.62 0.62 -0.05

Leukemia 0 0.00 5 4.31* 3 2.25 2 0.66 10 5.76 1.74 0.31

Acute lymphocytic 0 0.00 0 0.00 1 5.93 0 0.00 1 0.64 1.56 0.03

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.99 0.00 -0.07

Acute non-lymphocytic 0 0.00 4 7.15* 1 1.64 0 0.00 5 2.49 2.00 0.18

Chronic myeloid 0 0.00 0 0.00 1 3.53 1 1.81 2 1.15 1.74 0.06

Thyroid

Both Sexes, <40 Years of Age

Table 15.1.6: Risk of subsequent primary cancers after cancer of the thyroid, both sexes,

<40 years of age, SEER 1973-2000.

386 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

THYROID

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 12,547 11,824 8,982 6,153 12,547

Person-years in interval 10,126 41,362 37,459 46,810 135,756

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR]  10,000. EAR for female cancers is based on 106,643 PYR and for male cancers on 29,113 PYR.
Thyroid

Both Sexes, 40-49 Years of Age

Table 15.1.7: Risk of subsequent primary cancers after cancer of the thyroid, both sexes,

40-49 years of age, SEER 1973-2000.

All subsequent cancers 16 1.03 99 1.33* 107 1.19 201 1.00 423 381.73 1.11* 6.96

All excluding same site 13 0.87 97 1.34* 105 1.19 198 0.99 413 374.87 1.10 6.43

Buccal cavity, pharynx 1 2.63 2 1.03 1 0.41 2 0.42 6 9.48 0.63 -0.59

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.71 0.00 -0.12

Tongue 1 12.11 0 0.00 1 1.82 1 0.91 3 2.15 1.40 0.14

Salivary gland 0 0.00 1 4.65 0 0.00 0 0.00 1 0.93 1.08 0.01

Mouth 0 0.00 1 2.02 0 0.00 0 0.00 1 2.54 0.39 -0.26

Nasopharynx 0 0.00 0 0.00 0 0.00 1 3.55 1 0.69 1.45 0.05

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 1.12 0.00 -0.19

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.04

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.80 0.00 -0.14

Digestive system 2 1.19 15 1.67 11 0.88 26 0.76 54 57.25 0.94 -0.55

Esophagus 0 0.00 1 2.66 1 1.74 0 0.00 2 2.69 0.74 -0.12

Stomach 1 5.70 1 1.15 2 1.82 0 0.00 4 4.95 0.81 -0.16

Small intestine 0 0.00 1 4.29 1 3.46 0 0.00 2 1.23 1.62 0.13

Colon 1 1.54 7 1.99 2 0.40 12 0.82 22 23.80 0.92 -0.30

Rectum, rectosigmoid junction 0 0.00 4 2.12 2 0.76 5 0.79 11 11.21 0.98 -0.04

Anus, anal canal 0 0.00 1 4.11 0 0.00 0 0.00 1 1.14 0.88 -0.02

Liver 0 0.00 0 0.00 1 1.92 2 1.39 3 2.44 1.23 0.09

Gallbladder 0 0.00 0 0.00 0 0.00 1 1.92 1 0.86 1.16 0.02

Bile ducts, other biliary 0 0.00 0 0.00 1 3.99 1 1.33 2 1.22 1.64 0.13

Pancreas 0 0.00 0 0.00 1 0.69 4 0.96 5 6.78 0.74 -0.30

Respiratory system 1 0.75 8 1.05 13 1.11 19 0.57* 41 54.01 0.76 -2.19

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.09

Larynx 0 0.00 1 1.74 0 0.00 1 0.52 2 3.42 0.58 -0.24

Lung, bronchus 1 0.84 7 1.01 13 1.22 18 0.58* 39 49.89 0.78 -1.84

Female breast 3 0.51 37 1.38 31 1.08 59 1.21 130 109.94 1.18 4.47

Female genital system 3 1.38 9 0.88 11 0.96 17 0.85 40 43.78 0.91 -0.84

Cervix uteri 1 1.64 1 0.42 0 0.00 1 0.45 3 7.19 0.42 -0.93

Corpus uteri 0 0.00 4 0.98 6 1.13 11 1.04 21 20.77 1.01 0.05

Ovary 1 1.47 3 0.94 4 1.14 3 0.50 11 13.34 0.82 -0.52

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.10

Vulva 1 15.68 0 0.00 1 3.39 0 0.00 2 1.23 1.62 0.17

Male genital system 0 0.00 3 1.77 3 0.86 17 0.86 23 25.20 0.91 -1.53

Prostate 0 0.00 3 2.16 3 0.91 16 0.82 22 24.40 0.90 -1.67

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.42

Urinary system 1 1.74 4 1.32 10 2.37* 23 1.99* 38 19.39 1.96* 3.14

Urinary bladder 0 0.00 1 0.66 1 0.45 10 1.49 12 10.75 1.12 0.21

Kidney parenchyma 1 3.66 3 2.16 8 4.44* 12 2.85* 24 7.68 3.12* 2.75

Renal pelvis, other urinary 0 0.00 0 0.00 1 5.18 1 1.62 2 0.96 2.08 0.18

Ureter 0 0.00 0 0.00 0 0.00 1 5.32 1 0.27 3.74 0.12

Bone, joints 0 0.00 0 0.00 0 0.00 1 5.28 1 0.46 2.16 0.09

Soft tissue including heart 0 0.00 0 0.00 3 6.65* 2 2.44 5 1.81 2.77 0.54

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.77 0.00 -0.13

Melanoma of skin 1 1.11 8 2.12 8 2.21 4 0.70 21 13.99 1.50 1.18

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.10

Brain, central nervous system 0 0.00 3 2.61 6 4.79* 3 1.33 12 4.92 2.44* 1.19

Thyroid 3 5.46* 2 0.92 2 1.07 3 1.32 10 6.86 1.46 0.53

Lymphatic, hematopoietic 1 0.97 6 1.23 6 1.03 16 1.19 29 25.13 1.15 0.65

Hodgkin lymphoma 1 9.61 1 2.51 1 2.91 0 0.00 3 1.32 2.28 0.28

Non-Hodgkin lymphoma 0 0.00 0 0.00 3 0.97 9 1.29 12 13.22 0.91 -0.21

Myeloma 0 0.00 3 5.60* 0 0.00 1 0.47 4 3.55 1.13 0.08

Leukemia 0 0.00 2 1.49 2 1.23 6 1.58 10 7.04 1.42 0.50

Acute lymphocytic 0 0.00 0 0.00 1 10.62 0 0.00 1 0.36 2.75 0.11

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 3 2.08 3 2.36 1.27 0.11

Acute non-lymphocytic 0 0.00 2 3.79 1 1.68 0 0.00 3 2.59 1.16 0.07

Chronic myeloid 0 0.00 0 0.00 0 0.00 2 3.75 2 1.12 1.79 0.15

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,128 5,671 4,004 2,545 6,128

Person-years in interval 4,903 19,205 16,123 19,091 59,323

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR]  10,000. EAR for female cancers is based on 44,929 PYR and for male cancers on 14,394 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE THYROID AND OTHER ENDOCRINE GLANDS 387
All subsequent cancers 64 1.05 323 1.20* 308 1.07 389 0.96 1,084 1,024.08 1.06 8.41

All excluding same site 60 0.99 320 1.20* 307 1.07 387 0.96 1,074 1,016.62 1.06 8.05

Buccal cavity, pharynx 1 0.57 4 0.55 4 0.58 7 0.88 16 23.93 0.67 -1.11

Lip 0 0.00 0 0.00 0 0.00 1 1.08 1 2.50 0.40 -0.21

Tongue 1 2.66 0 0.00 1 0.68 0 0.00 2 5.11 0.39 -0.44

Salivary gland 0 0.00 2 3.47 1 1.73 2 2.48 5 2.10 2.39 0.41

Mouth 0 0.00 1 0.49 1 0.52 1 0.44 3 6.74 0.45 -0.52

Nasopharynx 0 0.00 0 0.00 0 0.00 2 5.58 2 1.20 1.66 0.11

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 2.34 0.00 -0.33

Oropharynx 0 0.00 1 4.61 0 0.00 0 0.00 1 0.69 1.44 0.04

Hypopharynx 0 0.00 0 0.00 1 1.41 1 1.36 2 2.37 0.84 -0.05

Digestive system 15 1.33 43 0.83 62 1.07 80 0.90 200 209.93 0.95 -1.39

Esophagus 2 3.36 0 0.00 0 0.00 3 0.82 5 9.63 0.52 -0.65

Stomach 3 2.82 4 0.83 8 1.49 7 0.87 22 19.31 1.14 0.38

Small intestine 1 5.30 3 3.59 0 0.00 1 0.74 5 3.28 1.52 0.24

Colon 3 0.63 22 0.99 38 1.47* 35 0.84 98 94.38 1.04 0.51

Rectum, rectosigmoid junction 4 1.82 5 0.51 8 0.78 19 1.36 36 36.20 0.99 -0.03

Anus, anal canal 1 6.23 1 1.43 0 0.00 0 0.00 2 2.54 0.79 -0.08

Liver 0 0.00 1 0.51 1 0.46 3 0.94 5 7.74 0.65 -0.38

Gallbladder 0 0.00 0 0.00 1 1.06 0 0.00 1 3.37 0.30 -0.33

Bile ducts, other biliary 1 4.50 0 0.00 1 0.81 2 0.90 4 4.71 0.85 -0.10

Pancreas 0 0.00 7 1.11 5 0.69 9 0.79 21 26.29 0.80 -0.74

Respiratory system 8 0.77 50 1.07 37 0.73 66 0.97 161 175.79 0.92 -2.07

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 2 3.59 2 1.46 1.37 0.08

Larynx 0 0.00 4 1.31 1 0.35 1 0.33 6 9.74 0.62 -0.52

Lung, bronchus 8 0.84 45 1.04 35 0.74 61 0.95 149 164.19 0.91 -2.13

Female breast 9 0.72 77 1.46* 57 1.09 66 0.97 209 185.74 1.13 4.63

Female genital system 4 0.67 19 0.77 30 1.28 23 0.81 76 82.41 0.92 -1.28

Cervix uteri 0 0.00 2 0.69 1 0.42 3 1.28 6 8.37 0.72 -0.47

Corpus uteri 2 0.61 6 0.45* 17 1.34 7 0.47* 32 44.26 0.72 -2.44

Ovary 2 1.20 10 1.44 11 1.62 8 0.93 31 24.03 1.29 1.39

Vagina 0 0.00 0 0.00 0 0.00 1 2.24 1 1.09 0.92 -0.02

Vulva 0 0.00 1 1.44 0 0.00 2 1.45 3 3.03 0.99 -0.01

Male genital system 8 1.25 46 1.49* 53 1.41* 61 1.11 168 129.68 1.30* 18.18

Prostate 8 1.27 44 1.44* 53 1.42* 60 1.10 165 128.59 1.28* 17.27

Testis 0 0.00 1 6.84 0 0.00 1 14.73 2 0.35 5.71 0.78

Urinary system 3 0.81 30 1.78* 24 1.29 28 1.01 85 66.76 1.27* 2.56

Urinary bladder 1 0.44 13 1.25 11 0.93 10 0.55 35 42.73 0.82 -1.08

Kidney parenchyma 2 1.62 15 2.80* 10 1.79 14 1.85* 41 19.71 2.08* 2.99

Renal pelvis, other urinary 0 0.00 2 1.91 3 2.49 4 2.16 9 4.32 2.08 0.66

Ureter 0 0.00 0 0.00 0 0.00 1 1.65 1 1.40 0.71 -0.06

Bone, joints 0 0.00 2 7.91 0 0.00 0 0.00 2 0.86 2.33 0.16

Soft tissue including heart 1 4.03 2 1.91 0 0.00 1 0.66 4 3.86 1.04 0.02

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -0.08

Melanoma of skin 4 2.54 7 1.09 5 0.81 7 0.85 23 22.39 1.03 0.09

Eye, orbit 0 0.00 1 2.40 1 2.48 0 0.00 2 1.44 1.39 0.08

Brain, central nervous system 1 1.35 2 0.64 1 0.33 3 0.77 7 10.83 0.65 -0.54

Thyroid 4 6.13* 3 1.21 1 0.48 2 0.89 10 7.46 1.34 0.36

Lymphatic, hematopoietic 4 0.98 27 1.49 25 1.25 34 1.11 90 73.03 1.23 2.38

Hodgkin lymphoma 0 0.00 0 0.00 1 1.65 0 0.00 1 2.16 0.46 -0.16

Non-Hodgkin lymphoma 3 1.51 6 0.68 8 0.82 16 1.06 33 35.77 0.92 -0.39

Myeloma 1 1.48 7 2.28 8 2.30 5 0.94 21 12.55 1.67* 1.19

Leukemia 0 0.00 14 2.52* 8 1.30 13 1.35 35 22.55 1.55* 1.75

Acute lymphocytic 0 0.00 0 0.00 2 10.44* 0 0.00 2 0.68 2.94 0.19

Chronic lymphocytic 0 0.00 3 1.35 4 1.61 5 1.34 12 8.90 1.35 0.43

Acute non-lymphocytic 0 0.00 7 3.64* 0 0.00 2 0.57 9 8.02 1.12 0.14

Chronic myeloid 0 0.00 2 2.65 1 1.24 2 1.57 5 3.02 1.66 0.28

Thyroid

Both Sexes, 50-69 Years of Age

Table 15.1.8: Risk of subsequent primary cancers after cancer of the thyroid, both sexes,

50-69 years of age, SEER 1973-2000.

388 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

THYROID

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 7,965 7,141 4,976 3,106 7,965

Person-years in interval 6,247 23,854 19,956 21,209 71,266

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR]  10,000. EAR for female cancers is based on 50,185 PYR and for male cancers on 21,081 PYR.
Thyroid

Both Sexes, ≥70 Years of Age

Table 15.1.9: Risk of subsequent primary cancers after cancer of the thyroid, both sexes,

≥70 years of age, SEER 1973-2000.

All subsequent cancers 52 1.27 127 0.93 90 1.03 41 0.96 310 307.67 1.01 1.64

All excluding same site 50 1.22 127 0.94 90 1.03 41 0.96 308 306.34 1.01 1.17

Buccal cavity, pharynx 0 0.00 2 0.79 2 1.31 0 0.00 4 5.57 0.72 -1.11

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -0.59

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 1.12 0.00 -0.79

Salivary gland 0 0.00 0 0.00 1 5.31 0 0.00 1 0.65 1.53 0.24

Mouth 0 0.00 0 0.00 1 2.10 0 0.00 1 1.72 0.58 -0.50

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.14

Tonsil 0 0.00 1 5.83 0 0.00 0 0.00 1 0.35 2.86 0.46

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.09

Hypopharynx 0 0.00 1 5.04 0 0.00 0 0.00 1 0.39 2.55 0.43

Digestive system 12 1.12 33 0.91 25 1.01 9 0.67 79 85.03 0.93 -4.23

Esophagus 0 0.00 1 0.84 1 1.34 0 0.00 2 2.66 0.75 -0.46

Stomach 2 1.82 5 1.35 1 0.40 2 1.52 10 8.64 1.16 0.95

Small intestine 0 0.00 0 0.00 1 3.49 0 0.00 1 1.00 1.00 0.00

Colon 5 0.98 19 1.08 13 1.05 6 0.87 43 42.00 1.02 0.71

Rectum, rectosigmoid junction 2 1.21 2 0.37 3 0.86 0 0.00 7 12.31 0.57 -3.73

Anus, anal canal 0 0.00 0 0.00 1 5.04 0 0.00 1 0.71 1.41 0.20

Liver 0 0.00 2 1.88 2 2.95 0 0.00 4 2.37 1.69 1.14

Gallbladder 0 0.00 1 1.41 0 0.00 0 0.00 1 1.66 0.60 -0.46

Bile ducts, other biliary 1 3.99 0 0.00 0 0.00 0 0.00 1 2.18 0.46 -0.83

Pancreas 2 1.51 2 0.45 2 0.65 1 0.58 7 10.62 0.66 -2.55

Respiratory system 6 0.99 7 0.36* 11 0.95 7 1.46 31 42.11 0.74 -7.80

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.32

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.65 0.00 -1.16

Lung, bronchus 5 0.87 7 0.38* 11 1.00 7 1.53 30 39.90 0.75 -6.95

Female breast 10 1.64 25 1.24 16 1.21 5 0.70 56 46.71 1.20 8.57

Female genital system 2 0.75 4 0.46 5 0.92 2 0.69 13 19.68 0.66 -6.17

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 1.85 0.00 -1.71

Corpus uteri 1 0.75 3 0.71 4 1.61 2 1.68 10 9.23 1.08 0.71

Ovary 0 0.00 1 0.38 1 0.58 0 0.00 2 6.12 0.33 -3.80

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.40

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 1.47 0.00 -1.35

Male genital system 8 1.45 29 1.61* 15 1.50 8 2.60* 60 36.59 1.64* 68.88

Prostate 8 1.46 27 1.51 15 1.51 8 2.63* 58 36.31 1.60* 63.82

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.10

Urinary system 5 1.73 6 0.62 5 0.80 2 0.67 18 21.81 0.83 -2.68

Urinary bladder 3 1.50 2 0.30 2 0.45 2 0.95 9 15.22 0.59 -4.37

Kidney parenchyma 1 1.48 4 1.79 2 1.43 0 0.00 7 4.96 1.41 1.43

Renal pelvis, other urinary 1 4.59 0 0.00 1 2.14 0 0.00 2 1.64 1.22 0.26

Ureter 1 13.48 0 0.00 0 0.00 0 0.00 1 0.55 1.82 0.32

Bone, joints 0 0.00 0 0.00 0 0.00 1 32.20 1 0.23 4.39 0.54

Soft tissue including heart 0 0.00 2 3.83 0 0.00 0 0.00 2 1.23 1.62 0.54

Kaposi sarcoma 1 38.28 0 0.00 0 0.00 0 0.00 1 0.24 4.22 0.54

Melanoma of skin 0 0.00 3 1.36 1 0.67 3 3.83 7 5.14 1.36 1.31

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.27

Brain, central nervous system 0 0.00 1 0.87 1 1.45 0 0.00 2 2.50 0.80 -0.35

Thyroid 2 10.28* 0 0.00 0 0.00 0 0.00 2 1.33 1.50 0.47

Lymphatic, hematopoietic 4 1.23 11 0.99 8 1.07 2 0.51 25 25.75 0.97 -0.53

Hodgkin lymphoma 0 0.00 1 3.99 0 0.00 0 0.00 1 0.55 1.83 0.32

Non-Hodgkin lymphoma 3 2.05 5 1.00 2 0.59 1 0.57 11 11.62 0.95 -0.43

Myeloma 1 1.72 3 1.53 1 0.77 1 1.54 6 4.49 1.34 1.06

Leukemia 0 0.00 2 0.52 5 1.88 0 0.00 7 9.10 0.77 -1.47

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.15

Chronic lymphocytic 0 0.00 0 0.00 4 4.01* 0 0.00 4 3.45 1.16 0.38

Acute non-lymphocytic 0 0.00 2 1.47 1 1.07 0 0.00 3 3.20 0.94 -0.14

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.25 0.00 -0.88

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,816 2,161 1,150 498 2,816

Person-years in interval 1,975 6,359 3,918 1,983 14,236

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR]  10,000. EAR for female cancers is based on 10,837 PYR and for male cancers on 3,399 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE THYROID AND OTHER ENDOCRINE GLANDS 389
Adrenal Gland

Both Sexes

Table 15.2.1: Characteristics of patients with an initial cancer of the adrenal gland excluding neuroblastoma,

both sexes, SEER 1973-2000.

390 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ADRENAL GLAND

Number of patients with 1st primary cancer

Total 389 100.0 422 100.0 811 100.0

Initial treatment

Any radiation 82 21.1 55 13.0 137 16.9

With surgery 41 10.5 37 8.8 78 9.6

Without surgery 41 10.5 18 4.3 59 7.3

No radiation 307 78.9 367 87.0 674 83.1

With surgery 221 56.8 286 67.8 507 62.5

Without surgery 86 22.1 81 19.2 167 20.6

Race

White 334 85.9 359 85.1 693 85.5

Black 26 6.7 36 8.5 62 7.6

Other 28 7.2 27 6.4 55 6.8

Unknown 1 0.3 0 0.0 1 0.1

Age at 1st primary cancer diagnosis, years

< 30 43 11.1 66 15.6 109 13.4

30–49 118 30.3 103 24.4 221 27.3

50–69 167 42.9 180 42.7 347 42.8

70–79 52 13.4 58 13.7 110 13.6

> 80 9 2.3 15 3.6 24 3.0

Number of patients with one or more

primary cancers

One primary cancer only 357 91.8 401 95.0 758 93.5

1st and 2nd cancers 28 7.2 21 5.0 49 6.0

1st, 2nd, and 3rd cancers 4 1.0 0 0.0 4 0.5

1st, 2nd, 3rd, and additional cancers 0 0.0 0 0.0 0 0.0

Other statistics

Median age at 1st cancer diagnosis 55.4 — 54.3 — 54.6 —

Median year of 1st cancer diagnosis 1987.2 — 1989.0 — 1988.2 —

Median person-years at risk 1.1 — 1.7 — 1.6 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 93.8 — 90.5 — 92.5

1st, 2nd, and additional cancers — 93.8 — 90.5 — 92.5

1st cancer only — 6.3 — 0.0 — 3.8

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Adrenal Gland

Both Sexes

Table 15.2.2: Risk of subsequent primary cancers after cancer of the adrenal gland excluding neuroblastoma,

both sexes, SEER 1973-2000.

All subsequent cancers 12 3.01* 18 1.59 13 1.49 14 1.65 57 32.47 1.76* 71.36

All excluding same site 12 3.01* 18 1.59 12 1.38 14 1.66 56 32.46 1.73* 68.49

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.85 0.00 -2.46

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.30

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.52

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.21

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.66

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.11

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.26

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.07

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.25

Digestive system 2 2.46 1 0.44 3 1.73 4 2.39 10 6.49 1.54 10.22

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.99

Stomach 0 0.00 1 4.62 0 0.00 0 0.00 1 0.61 1.64 1.14

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.31

Colon 0 0.00 0 0.00 1 1.28 2 2.66 3 2.89 1.04 0.31

Rectum, rectosigmoid junction 1 6.71 0 0.00 0 0.00 1 3.55 2 1.14 1.76 2.51

Anus, anal canal 0 0.00 0 0.00 1 49.39 0 0.00 1 0.08 13.05 2.69

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.67

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.25

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.39

Pancreas 1 10.10 0 0.00 0 0.00 1 4.79 2 0.80 2.50 3.49

Respiratory system 2 2.87 7 3.57* 2 1.34 1 0.69 12 5.59 2.15* 18.65

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 1 81.24* 1 0.05 20.90 2.77

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -1.08

Lung, bronchus 2 3.13 7 3.88* 2 1.45 0 0.00 11 5.16 2.13* 17.00

Female breast 1 1.71 3 1.70 0 0.00 1 0.88 5 4.74 1.05 1.36

Female genital system 0 0.00 0 0.00 1 1.90 0 0.00 1 2.02 0.49 -5.40

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -1.41

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 1.00 0.00 -5.30

Ovary 0 0.00 0 0.00 1 6.25 0 0.00 1 0.60 1.66 2.09

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.14

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.41

Male genital system 3 5.11* 4 2.43 1 0.68 3 1.91 11 5.27 2.09* 37.11

Prostate 3 5.24* 4 2.49 1 0.69 3 1.93 11 5.18 2.12* 37.71

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.39

Urinary system 1 3.57 2 2.55 3 4.86 2 3.18 8 2.31 3.46* 16.56

Urinary bladder 1 5.50 2 3.97 2 4.96 1 2.41 6 1.50 3.99* 13.08

Kidney parenchyma 0 0.00 0 0.00 1 5.61 1 5.56 2 0.67 2.99 3.87

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.40

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.13

Bone, joints 0 0.00 0 0.00 0 0.00 1 115.19* 1 0.04 28.56 2.81

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.40

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.22

Melanoma of skin 2 19.37* 0 0.00 1 4.34 0 0.00 3 0.87 3.44 6.19

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.14

Brain, central nervous system 1 19.91 0 0.00 0 0.00 0 0.00 1 0.38 2.64 1.81

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.82

Lymphatic, hematopoietic 0 0.00 1 1.20 1 1.55 2 3.14 4 2.41 1.66 4.63

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 1 39.86 1 0.11 9.33 2.60

Non-Hodgkin lymphoma 0 0.00 0 0.00 1 3.29 0 0.00 1 1.13 0.88 -0.39

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -1.16

Leukemia 0 0.00 1 3.75 0 0.00 1 5.03 2 0.77 2.61 3.59

Acute lymphocytic 0 0.00 0 0.00 0 0.00 1 131.92* 1 0.03 28.90 2.81

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.86

Acute non-lymphocytic 0 0.00 1 11.12 0 0.00 0 0.00 1 0.26 3.82 2.15

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.31

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 811 485 238 128 811

Person-years in interval 492 1,316 868 762 3,437

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR]  10,000. EAR for female cancers is based on 1,894 PYR and for male cancers on 1,543 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE THYROID AND OTHER ENDOCRINE GLANDS 391
All subsequent cancers 4 2.14 6 1.07 5 1.22 6 1.62 21 15.27 1.37 30.23

All excluding same site 4 2.14 6 1.07 5 1.22 6 1.62 21 15.27 1.38 30.27

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -1.41

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.08

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.32

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.16

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.46

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.07

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.13

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.04

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.10

Digestive system 0 0.00 0 0.00 2 2.42 1 1.34 3 3.01 1.00 -0.05

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.49

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -1.18

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.27

Colon 0 0.00 0 0.00 1 2.46 0 0.00 1 1.46 0.68 -2.45

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 1 8.81 1 0.48 2.07 2.73

Rectum 0 0.00 0 0.00 0 0.00 1 13.14 1 0.32 3.16 3.61

Anus, anal canal 0 0.00 0 0.00 1 79.42* 0 0.00 1 0.05 21.33 5.03

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.39

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.32

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.34

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -2.12

Respiratory system 1 4.01 2 2.60 0 0.00 1 1.83 4 2.15 1.86 9.78

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 1 198.47* 1 0.02 49.64 5.17

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.38

Lung, bronchus 1 4.22 2 2.73 0 0.00 0 0.00 3 2.05 1.46 5.02

Female breast 1 1.71 3 1.70 0 0.00 1 0.88 5 4.74 1.05 1.36

Female genital system 0 0.00 0 0.00 1 1.90 0 0.00 1 2.02 0.49 -5.40

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -1.41

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 1.00 0.00 -5.30

Ovary 0 0.00 0 0.00 1 6.25 0 0.00 1 0.60 1.66 2.09

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.14

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.41

Urinary system 0 0.00 1 4.08 1 5.34 1 5.88 3 0.68 4.40 12.24

Urinary bladder 0 0.00 1 7.38 1 9.49 0 0.00 2 0.38 5.26 8.55

Kidney parenchyma 0 0.00 0 0.00 0 0.00 1 15.79 1 0.25 3.96 3.95

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.26

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.08

Bone, joints 0 0.00 0 0.00 0 0.00 1 245.25* 1 0.02 59.50 5.19

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.35

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 -0.02

Melanoma of skin 2 44.43* 0 0.00 1 9.98 0 0.00 3 0.37 8.10* 13.88

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.12

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.90

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -1.06

Lymphatic, hematopoietic 0 0.00 0 0.00 0 0.00 1 3.64 1 1.11 0.90 -0.57

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 1 87.92* 1 0.05 20.95 5.03

Non-Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -2.87

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -1.01

Leukemia 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -1.72

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.09

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.62

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.63

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.24

Adrenal Gland

Females

Table 15.2.3: Risk of subsequent primary cancers after cancer of the adrenal gland excluding neuroblastoma,

females, SEER 1973-2000.

392 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ADRENAL GLAND

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 422 266 132 72 422

Person-years in interval 263 727 484 420 1,894

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR]  10,000.
Adrenal Gland

Males

Table 15.2.4: Risk of subsequent primary cancers after cancer of the adrenal gland excluding neuroblastoma,

males, SEER 1973-2000.

All subsequent cancers 8 3.78* 12 2.10* 8 1.74 8 1.68 36 17.20 2.09* 121.86

All excluding same site 8 3.78* 12 2.10* 7 1.52 8 1.68 35 17.19 2.04* 115.42

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -3.76

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.57

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.77

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.27

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.90

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.16

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.41

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.12

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.42

Digestive system 2 4.44 1 0.84 1 1.11 3 3.22 7 3.48 2.01 22.82

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -1.61

Stomach 0 0.00 1 7.29 0 0.00 0 0.00 1 0.39 2.59 3.98

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.36

Colon 0 0.00 0 0.00 0 0.00 2 5.12 2 1.43 1.40 3.70

Rectum, rectosigmoid junction 1 11.42 0 0.00 0 0.00 0 0.00 1 0.65 1.53 2.25

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.19

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -1.01

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.16

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.45

Pancreas 1 19.18 0 0.00 0 0.00 1 9.31 2 0.40 5.00 10.37

Respiratory system 1 2.23 5 4.20* 2 2.20 0 0.00 8 3.44 2.32* 29.53

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.18

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -1.94

Lung, bronchus 1 2.48 5 4.66* 2 2.43 0 0.00 8 3.11 2.58* 31.72

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.22

Male genital system 3 5.11* 4 2.43 1 0.68 3 1.91 11 5.27 2.09* 37.11

Prostate 3 5.24* 4 2.49 1 0.69 3 1.93 11 5.18 2.12* 37.71

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.39

Urinary system 1 5.01 1 1.86 2 4.65 1 2.18 5 1.63 3.07 21.86

Urinary bladder 1 7.29 1 2.71 1 3.35 1 3.12 4 1.12 3.56 18.64

Kidney parenchyma 0 0.00 0 0.00 1 9.10 0 0.00 1 0.42 2.40 3.78

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.56

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.19

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.12

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.47

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.47

Melanoma of skin 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -3.25

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.17

Brain, central nervous system 1 36.00 0 0.00 0 0.00 0 0.00 1 0.21 4.80 5.13

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.52

Lymphatic, hematopoietic 0 0.00 1 2.29 1 2.93 1 2.77 3 1.30 2.30 11.01

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.39

Non-Hodgkin lymphoma 0 0.00 0 0.00 1 6.48 0 0.00 1 0.59 1.69 2.65

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -1.35

Leukemia 0 0.00 1 6.72 0 0.00 1 8.29 2 0.44 4.52 10.10

Acute lymphocytic 0 0.00 0 0.00 0 0.00 1 241.65* 1 0.02 54.45 6.36

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -1.15

Acute non-lymphocytic 0 0.00 1 20.95 0 0.00 0 0.00 1 0.14 6.99 5.55

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.39

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 389 219 106 56 389

Person-years in interval 229 589 383 342 1,543

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR]  10,000.

NEW MALIGNANCIES FOLLOWING CANCER OF THE THYROID AND OTHER ENDOCRINE GLANDS 393
Thymus

Both Sexes

Table 15.3.1: Characteristics of patients with an initial cancer of the thymus, both sexes,

SEER 1973-2000.

394 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

THYMUS

Number of patients with 1st primary cancer

Total 545 100.0 418 100.0 963 100.0

Initial treatment

Any radiation 372 68.3 286 68.4 658 68.3

With surgery 259 47.5 191 45.7 450 46.7

Without surgery 113 20.7 95 22.7 208 21.6

No radiation 173 31.7 132 31.6 305 31.7

With surgery 117 21.5 90 21.5 207 21.5

Without surgery 56 10.3 42 10.0 98 10.2

Race

White 385 70.6 287 68.7 672 69.8

Black 63 11.6 64 15.3 127 13.2

Other 96 17.6 62 14.8 158 16.4

Unknown 1 0.2 5 1.2 6 0.6

Age at 1st primary cancer diagnosis, years

< 30 47 8.6 30 7.2 77 8.0

30–49 181 33.2 116 27.8 297 30.8

50–69 236 43.3 176 42.1 412 42.8

70–79 65 11.9 72 17.2 137 14.2

> 80 16 2.9 24 5.7 40 4.2

Number of patients with one or more

primary cancers

One primary cancer only 496 91.0 386 92.3 882 91.6

1st and 2nd cancers 43 7.9 30 7.2 73 7.6

1st, 2nd, and 3rd cancers 5 0.9 1 0.2 6 0.6

1st, 2nd, 3rd, and additional cancers 1 0.2 1 0.2 2 0.2

Other statistics

Median age at 1st cancer diagnosis 53.5 — 57.2 — 55.3 —

Median year of 1st cancer diagnosis 1990.0 — 1991.2 — 1990.5 —

Median person-years at risk 3.8 — 3.5 — 3.7 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 100.0 — 96.9 — 98.8

1st, 2nd, and additional cancers — 100.0 — 96.9 — 98.8

1st cancer only — 0.0 — 0.0 — 0.0

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Thymus

Both Sexes

Table 15.3.2: Risk of subsequent primary cancers after cancer of the thymus, both sexes,

SEER 1973-2000.

All subsequent cancers 9 1.30 34 1.45* 30 1.79* 18 1.46 91 59.55 1.53* 59.59

All excluding same site 9 1.30 34 1.45* 30 1.79* 18 1.46 91 59.52 1.53* 59.65

Buccal cavity, pharynx 0 0.00 0 0.00 2 4.47 0 0.00 2 1.62 1.23 0.72

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.36

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.63

Salivary gland 0 0.00 0 0.00 2 54.22* 0 0.00 2 0.14 14.76* 3.53

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.42 0.00 -0.79

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.20

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.31

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.09

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.33

Digestive system 2 1.31 8 1.55 8 2.18 6 2.23 24 13.04 1.84* 20.77

Esophagus 0 0.00 0 0.00 1 4.97 2 14.98* 3 0.71 4.23 4.34

Stomach 0 0.00 2 3.42 3 7.61* 0 0.00 5 1.43 3.50* 6.77

Small intestine 1 44.70 0 0.00 0 0.00 0 0.00 1 0.20 5.04 1.52

Colon 0 0.00 2 0.92 3 1.90 3 2.50 8 5.59 1.43 4.56

Rectum, rectosigmoid junction 0 0.00 3 3.38 0 0.00 0 0.00 3 2.21 1.36 1.50

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.25

Liver 0 0.00 1 4.10 1 5.84 1 8.47 3 0.60 4.97 4.54

Gallbladder 1 47.11 0 0.00 0 0.00 0 0.00 1 0.17 5.81 1.57

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.56

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 1.56 0.00 -2.96

Respiratory system 2 1.64 4 0.96 4 1.37 5 2.43 15 10.38 1.45 8.76

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.18

Larynx 0 0.00 1 3.39 1 5.10 0 0.00 2 0.70 2.86 2.46

Lung, bronchus 2 1.79 3 0.78 3 1.11 5 2.62 13 9.56 1.36 6.52

Female breast 1 1.22 4 1.50 1 0.53 0 0.00 6 6.69 0.90 -3.02

Female genital system 0 0.00 1 0.85 1 1.24 1 1.88 3 2.87 1.04 0.55

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -1.73

Corpus uteri 0 0.00 0 0.00 1 2.54 1 3.81 2 1.40 1.43 2.60

Ovary 0 0.00 1 2.95 0 0.00 0 0.00 1 0.84 1.18 0.68

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.19

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.52

Male genital system 2 1.68 4 0.93 5 1.57 4 1.57 15 11.21 1.34 12.73

Prostate 2 1.71 4 0.95 5 1.60 4 1.59 15 11.03 1.36 13.34

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.36

Urinary system 0 0.00 2 1.16 1 0.81 1 1.03 4 4.42 0.90 -0.80

Urinary bladder 0 0.00 1 0.89 1 1.23 1 1.52 3 2.92 1.03 0.16

Kidney parenchyma 0 0.00 1 2.03 0 0.00 0 0.00 1 1.24 0.81 -0.45

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.51

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.16

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.11

Soft tissue including heart 0 0.00 1 9.90 1 14.25 0 0.00 2 0.25 7.89 3.31

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.27

Melanoma of skin 0 0.00 1 1.85 1 2.64 0 0.00 2 1.39 1.44 1.15

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.15

Brain, central nervous system 0 0.00 0 0.00 1 5.75 0 0.00 1 0.63 1.58 0.69

Thyroid 0 0.00 2 10.58* 0 0.00 0 0.00 2 0.45 4.46 2.94

Lymphatic, hematopoietic 2 3.89 7 4.02* 5 4.02* 1 1.06 15 4.45 3.37* 20.00

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.32

Non-Hodgkin lymphoma 2 8.42 3 3.72 4 6.86* 1 2.21 10 2.08 4.81* 15.01

Myeloma 0 0.00 1 3.32 0 0.00 0 0.00 1 0.77 1.30 0.44

Leukemia 0 0.00 3 5.36* 1 2.53 0 0.00 4 1.43 2.80 4.88

Acute lymphocytic 0 0.00 0 0.00 1 76.15 0 0.00 1 0.05 20.57 1.80

Chronic lymphocytic 0 0.00 1 4.79 0 0.00 0 0.00 1 0.54 1.87 0.88

Acute non-lymphocytic 0 0.00 2 10.20* 0 0.00 0 0.00 2 0.50 3.99 2.84

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.39

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 963 788 414 182 963

Person-years in interval 725 2,272 1,400 881 5,278

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR]  10,000. EAR for female cancers is based on 2,302 PYR and for male cancers on 2,976 PYR.

NEW MALIGNANCIES FOLLOWING CANCER OF THE THYROID AND OTHER ENDOCRINE GLANDS 395

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 397

Synopsis

The risk of subsequent primary cancer was evaluated

in more than 100,000 patients diagnosed with Hodgkin

lymphoma (HL), non-Hodgkin lymphoma (NHL), or

myeloma between 1973 and 2000. The overall risk of

new cancer was significantly increased among 2-month

survivors of HL (O/E=2.22,1 O=1,336, EAR=49 per 10,000

person-years) and NHL (O/E=1.14,1 O=5,490, EAR=19),

but not among 2-month survivors of myeloma

(O/E=0.98,1 O=1,216). Subsequent cancer risk increased

with time to reach 3-fold and 1.5-fold among 20-year

survivors of HL and NHL, respectively. The relative

risk of developing a new neoplasm was significantly

increased among patients with HL in all age groups,

whereas increased risk for a subsequent cancer was

restricted to NHL patients diagnosed before age 70

years. Excluding sex-specific sites, lung cancer accounted for the largest excess of subsequent cancer after HL

and NHL, likely reflecting the effects of radiotherapy,

chemotherapy, and tobacco use. Women given radiotherapy for HL had a significantly increased 3-fold risk

of breast cancer and risk remained significantly elevated in 20-year survivors. The increased risk of breast

cancer was restricted to women treated for HL before

age 40 years. Radiotherapy for HL contributed to the

increased risk of subsequent primary cancers of the

salivary gland, thyroid, stomach, uterine corpus, bone,

and soft tissue. Radiotherapy as well as chemotherapy

was associated with an elevated risk of bladder cancer

following NHL. Excess acute non-lymphocytic

leukemias following HL, NHL, and myeloma were

most likely due to the effects of alkylating agent

chemotherapy. Immune dysfunction may have played a

role in the significantly elevated risks of malignant

melanoma and lip cancer among both HL and NHL

survivors. Increased reciprocal risks of HL and NHL

may reflect the lymphoid etiology of both malignancies, misclassification, immune defects, or the role of

Epstein-Barr virus, an etiologic agent in subtypes of

both lymphomas. The significantly elevated risk of

Kaposi sarcoma following both HL and NHL suggested

an effect of human immunodeficiency virus (HIV)

infection or immune defects, which are shared risk

factors for all three cancers. Human papillomavirus

infection probably contributed to the excess anal cancers seen following HL and subgroups of NHL.

Hodgkin Lymphoma

Hodgkin lymphoma (HL) accounts for only 0.5% of estimated incident cancers in the U.S. (Jemal et al, 2005), but

it is the third most common malignancy in persons

younger than 20 years of age. In developed countries, the

incidence rates for HL peak between the ages of 15 and

34 years and again after age 55 years, a bimodal distribution suggesting 2 distinct etiologic entities (Mueller,

1996). Incidence rates for HL are 25% higher in males

than females and 21% higher in whites than blacks.

Radiotherapy and chemotherapy, alone or in combination, constitute standard treatment, which is determined

largely by disease stage (Yung and Linch, 2003). Radiotherapy most frequently consists of mantle, inverted-Y, 

or pelvic fields. Since the 1970s, the use of radiotherapy

in HL has diminished, particularly in the treatment of

early-stage disease, and radiation field size and dose

have decreased (Yahalom, 2002). In the late 1970s,

mechlorethamine-containing combination chemotherapy

(e.g., mechlorethamine, vincristine, procarbazine, and

prednisone) began to be replaced by chemotherapy

regimens associated with fewer adverse sequelae (e.g.,

doxorubicin, bleomycin, vinblastine, and dacarbazine).

Improvements in treatment over the past 30 years have

resulted in a 13% increase in 5-year survival rates since

the 1970s, with current 5- and 10-year relative survival

rates of 85.3% and 78.4%, respectively. Death rates were

50% higher in males than females and similar in whites

and blacks. Overall, HL accounts for an estimated 0.2%

of cancer deaths in the U.S. (Jemal et al, 2005).

LYMPHOMA AND MYELOMA

Chapter 16

New Malignancies Following Hodgkin

Lymphoma, Non-Hodgkin Lymphoma,

and Myeloma

Graça M. Dores, Timothy R. Coté, Lois B. Travis

1Observed-to-expected ratios for Hodgkin lymphoma, non-Hodgkin

lymphoma, and myeloma exclude subsequent primary Hodgkin

lymphoma, non-Hodgkin lymphoma, and myeloma, respectively.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated as

[(O-E)/PYR]10,000).

Author affiliations: Graça M. Dores, Division of Cancer Prevention,

NCI, NIH, DHHS; Timothy R. Coté, Division of Cancer Control and

Population Sciences, NCI, NIH, DHHS; Lois B. Travis, Division of

Cancer Epidemiology and Genetics, NCI, NIH, DHHS. Present

address for Dr. Coté: D.C. Department of Health, Centers for

Disease Control and Prevention, DHHS, Washington, DC.
The etiology of HL is largely unknown, although

reported risk factors include higher maternal educational or socioeconomic status, smaller sibship size, certain

occupational exposures (e.g., woodworking), immunodeficiency, and possibly genetic influences (Mueller,

1996). Evidence linking Epstein-Barr virus (EBV) with

HL appears most convincing for the mixed cellularity

type, especially in children and the elderly (Yung and

Linch, 2003).

Results and Discussion

Among 17,516 2-month survivors of HL, 1,336 subsequent cancers were observed (O/E=2.22 excluding subsequent HL, 95% CI=2.10-2.34, EAR=49 per 10,000 person-years). The cumulative incidence of second cancer

following HL in the presence of the competing risk of

death due to other causes was 16.1% at 25 years (95%

CI=15.0%-17.3%) (Figure 16.1). The risk of developing a

new malignancy did not differ by race. Overall relative

risk of subsequent cancer was higher in females

(O/E=2.60, EAR=56) than males (O/E=1.96, EAR=43);

however, excluding sex-specific cancer sites, the excess

absolute risk of subsequent cancer was lower for females

(O/E=2.93, EAR=35) than males (O/E=2.42, EAR=46).

The relative risk of developing a new malignant neoplasm was significantly increased among HL patients of

all ages at diagnosis, with the highest relative risk seen

among those diagnosed at younger ages, but with the

largest excess absolute risk occurring among those diagnosed at ages 40-59 years (EAR=106) (Figure 16.2). Significantly elevated relative risks were observed in each

time interval following HL diagnosis and increased in

magnitude to 3-fold (O/E=3.24) among 20-year survivors (P trend <0.0001). Confirming previous studies,

we found significant excesses of non-Hodgkin lymphoma (NHL), malignant melanoma, and leukemia, as

well as cancers of the lip, tongue, salivary gland, stomach, colon, liver, lung, female breast, thyroid, bone, and

soft tissue (Metayer et al, 2000; Dong and Hemminki,

2001; van Leeuwen and Travis, 2001; Dores et al, 2002).

New findings included significant 2- to 7-fold excesses

for Kaposi sarcoma (KS) as well as cancers of the anus,

uterine corpus, and ureter. Risk of prostate cancer was

significantly decreased.

Excluding sex-specific sites, lung cancer accounted for

the largest excess of subsequent neoplasms occurring

after HL. Significantly elevated risks were observed in

both sexes and among all age groups. Overall increased

risks of lung cancer were apparent in both irradiated and

nonirradiated patients, consistent with several analytic

studies implicating either radiotherapy or chemotherapy

(Swerdlow et al, 2001; Travis et al, 2002). In the largest

investigation to date, alkylating agent chemotherapy

used to treat HL was associated with a dose-dependent

increase in lung cancer risk, with significant excesses

beginning 1-4 years after treatment and continuing for

up to 15 years (Travis et al, 2002). Risk also rose with

increasing radiation dose to the lung, starting 5-9 years

after treatment and persisting for more than 20 years.

Smoking appeared to multiply all treatment-associated

risks. Nearly all HL patients who developed lung cancer

were smokers (Travis et al, 2002), although few studies

have linked tobacco use with HL (Briggs et al, 2002).

Women treated with radiotherapy for HL experienced

a significant 3-fold increase in the risk of breast cancer,

which persisted among 20-year survivors (O/E=5.46).

Significantly elevated risks were confined to females

treated at ages younger than 20 years and 20-39 years,

consistent with the increased sensitivity of the breast to

ionizing radiation exposure at young ages (Preston et al,

2002). Our findings are consistent with the elevated

breast cancer risk described in previous surveys of HL,

398 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LYMPHOMA AND MYELOMA

1

2

3

4

5

6

7

8

10

9

20 20-39 40-59 60

0

20

40

60

80

100

120

20 20-39 40-59 60

Age at diagnosis of Hodgkin lymphoma (years)

O/E

EAR (per 10,000 person-years)

3.34*

1.21*

2.23*

36 38 45

8.91* 106

Figure 16.2: Observed-to-expected ratio (O/E) and excess

absolute risk (EAR) of subsequent primary cancers after

Hodgkin lymphoma, both sexes, SEER 1973-2000.

*P <0.05.

Notes: All subsequent cancers excluding Hodgkin lymphoma. EAR = Excess number of

subsequent cancers per 10,000 person-years. Observed number of subsequent cancers are

128, 435, 480 and 293, for age groups <20, 20-39, 40-59 and 60 years, respectively.

Years after initial cancer diagnosis

Cumulative incidence (%)

0

5

10

15

20

0 5 10 15 20 25

All second cancers*

Female breast†

Lung and bronchus

Leukemia

Figure 16.1: Cumulative incidence of developing a second

cancer among patients with Hodgkin lymphoma, both sexes,

SEER 1973-2000.

* Cumulative incidence for all second cancers at 25 years is 14.1% for males and 

18.9% for females.

† Female breast cancer curve is based on female Hodgkin lymphoma patients only.
NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 399

LYMPHOMA AND MYELOMA

other medically irradiated populations, and atomic bomb

survivors (Travis et al, 2003). In a large international

study of young women treated for HL, breast cancer risk

increased with increasing radiation dose to the breast,

reaching an 8-fold increase in risk at a dose higher than

40 Gy; radiation-related risk persisted for more than 25

years (Travis et al, 2003). In contrast, the risk of breast

cancer decreased with increasing number of cycles of

alkylating agents, with corollary findings implicating

treatment-induced ovarian failure (Travis et al, 2003; van

Leeuwen et al, 2003).

Leukemias accounted for the third largest absolute

number of subsequent primary cancers in our series,

with acute non-lymphocytic leukemia (ANLL) constituting 80% of leukemia cases and associated with a significantly elevated 19-fold risk. The risk of subsequent

ANLL was highest within the first 10 years after diagnosis of HL, and an elevated risk persisted in the 10-14 and

15-19 year time intervals. Previous studies of HL have

attributed excess leukemias primarily to either initial or

salvage treatment with alkylating agent chemotherapy

(especially mechlorethamine and procarbazine) (van

Leeuwen and Travis, 2001). Radiotherapy alone for HL

appears associated with little or no increased risk of

leukemia, and the risk following combination radiation

and chemotherapy does not seem to exceed the risk after

chemotherapy alone (van Leeuwen and Travis, 2001).

Based on small numbers, the risks of acute lymphocytic

leukemia and chronic myelogenous leukemia (CML)

were also significantly elevated in our series. These types

of leukemia have been linked previously to prior

chemotherapy and radiation exposure (van Leeuwen and

Travis, 2001).

The increased risks of cancers of the salivary gland,

thyroid, stomach, uterine corpus, bone, and soft tissue

appeared related to treatment. Radiation is an established

risk factor for salivary gland cancer (Land et al, 1996),

especially mucoepidermoid tumors, which constituted

67% of salivary neoplasms in our series, compared with

24% in the general population. The thyroid also is an

established site for radiogenic cancer, particularly when

exposure occurs prior to age 20 years (Ron et al, 1995). In

our series, significantly increased risks of thyroid cancer

were limited to patients younger than 40 years of age at

HL diagnosis, although some studies have described elevated risks in older HL patients, albeit based on small

numbers (van Leeuwen and Travis, 2001; Dores et al,

2002). Some surveys—but not all—have found significant

excesses of stomach cancer following HL, with the

largest risk following both chemotherapy and radiotherapy (van Leeuwen and Travis, 2001). Significant excesses

of uterine corpus cancer in our series were evident

among 10-year survivors of HL who initially received

radiation, consistent with the location of the uterus in

pelvic radiotherapy fields. Similar increases in the risk of

uterine corpus cancer have been observed among longterm survivors of cervical cancer treated with radiotherapy (Boice et al, 1988). The excess we observed for

bone cancer is consistent with the increased risks associated with radiotherapy and chemotherapy for childhood

cancer (Hawkins et al, 1996; van Leeuwen and Travis,

2001). In previous studies of HL among children and

adults, significantly increased risks of sarcomas of bone

and soft tissue have been reported (Metayer et al, 2000;

van Leeuwen and Travis, 2001; Dores et al, 2002).

The increased risk of NHL following HL may be due,

at least in part, to the cellular immune dysfunction that is

evident prior to the diagnosis of HL and that may persist

for years (Poppema, 1996). In addition, misclassification

of HL as NHL and the derivation of HL and NHL from

common lymphoid precursors may contribute to the

association. Immunologic susceptibility to human papillomavirus (HPV) infection may account for excess cancers of the tongue and anus in our series (Herrero et al,

2003). Defective immune mechanisms may underlie the

elevated risks of malignant melanoma and lip cancer in

our study, as well as in other immunosuppressed populations (Frisch et al, 2001), although heightened medical

surveillance may play a role.

A significantly elevated risk of KS was restricted to 

the first 5 years after HL diagnosis. Because KS and 

NHL are acquired immune deficiency syndrome (AIDS)-

defining cancers, the excess of both malignancies that we

observed among HL survivors may be influenced by

underlying human immunodeficiency virus (HIV) infection, which is also known to increase the risk of HL. In

addition, although human herpesvirus-8 is the causal

agent in KS, the risk of KS among HIV-infected individuals (Goedert, 2000), as well as organ transplant

recipients (Schwartz, 2001), increases with the level of

immune suppression.

The significantly increased 2-fold risk of liver cancer

following HL in our study may reflect hepatitis C virus

(HCV) infection acquired through transfusion of blood

products before effective screening measures were available. Eighty-nine percent of hepatocellular carcinomas

(O=9) were detected in patients diagnosed with HL

prior to 1992, when second-generation testing for HCV

was instituted.

Non-Hodgkin Lymphoma

NHL is the seventh most frequent cancer in the U.S., constituting an estimated 4.1% of new malignant neoplasms

(Jemal et al, 2005). The incidence of NHL has increased

significantly in the last few decades, but reasons for this

increase remain unclear (Groves et al, 2000; Evans and

Hancock, 2003). Between 1975 and 2000 the overall incidence rate of NHL in the SEER Program increased by

more than 70%. Incidence rates for NHL are 48% higher

in males than females and 38% higher in whites than

blacks. Standard treatment options for NHL include

radiotherapy and/or chemotherapy and are based largely

on stage and histology (Evans and Hancock, 2003).

Therapeutic regimens have recently been expanded to

include monoclonal antibodies, biologic response modifiers, and antimicrobial agents (Evans and Hancock,

2003). The 5-year relative survival rate for patients with
NHL is 59.1%. Between 1996 and 2000 death rates were

52% higher in males than females and 53% higher in

whites than blacks. Overall, NHL accounts for an estimated 3.4% of cancer deaths in the U.S. (Jemal et al, 2005).

Risk factors for NHL likely vary by histologic type

and may include acquired and congenital immunodeficiency states, selected viral infections (HIV, EBV, HCV),

pesticides and other agricultural exposures, lifestyle factors (diet, tobacco, hair dyes), and genetic susceptibility

(Groves et al, 2000; Evans and Hancock, 2003).

Results and Discussion

Overall, 5,490 subsequent cancers were observed among

73,958 2-month survivors of NHL, reflecting an overall

14% elevated risk compared with the general population

(O/E=1.14 excluding subsequent NHL, 95% CI=1.11-1.17,

EAR=19). Second cancer incidence reached 12.3% within

25 years (95% CI=11.9%-12.7%) (Figure 16.3). The risk of

developing a new malignancy did not differ significantly

by race or gender. Subsequent cancer risk was significantly elevated in patients of ages less than 30, 30-49, and

50-69 years at NHL diagnosis, with the highest relative

risk seen among those diagnosed under age 30 years, but

with the largest excess absolute risk occurring among

those ages 30-49 years (EAR=35) (Figure 16.4).

The relative risk of all new cancers increased with time

since diagnosis to 1.47 among 20-year survivors of NHL

(P trend <0.0001). Significantly increased risks of new

malignancies were observed for malignant melanoma,

KS, HL, and ANLL, as well as cancers of the buccal

cavity, lip, salivary gland, mouth, lung, vagina, urinary

bladder, kidney, and bone. Significant deficits were

reported for cancers of the female breast and prostate, as

well as for myeloma and chronic lymphocytic leukemia

(CLL). (Patients diagnosed with myeloma or CLL following NHL are presumed not to have developed a new second primary, according to SEER rules.) An earlier survey

of the SEER database reported a reciprocally elevated

risk of cutaneous melanoma and NHL (Goggins et al,

2001). In addition, our results corroborate findings in

other previous surveys of NHL, which have reported

significant excesses of cutaneous melanoma, KS, HL,

ANLL, and cancers of the buccal cavity, lip, lung, urinary

bladder, and kidney, as well as significant deficits of

breast and prostate cancers (Travis et al, 1991, 1992, 1993;

Brennan et al, 2000, 2005; Cannon et al, 2000; Dong and

Hemminki, 2001).

Lung cancer accounted for the largest excess of subsequent cancers after NHL in both sexes, with overall

increased risks noted in some—but not all—prior surveys (Travis et al, 1991, 1993; Brennan et al, 2000, 2005;

Dong and Hemminki, 2001). A general upswing in the

risk of lung cancer with time since NHL diagnosis was

observed in our study, with 70% excesses among 20-year

survivors (P trend <0.01). Given the overlap in treatment

used for NHL and HL, similar therapeutic agents, as well

as smoking, are likely involved in the lung cancer excesses seen after both tumors (Travis et al, 2002). In addition,

tobacco use probably contributes to the excess risks

observed for cancers of the lip, mouth, urinary bladder,

and kidney, and may increase the risk of the follicular

subtype of NHL (Stagnaro et al, 2001; Morton et al, 2005).

Significant excesses of ANLL were restricted to the

first 15 years after NHL diagnosis, as reported in prior

surveys (Travis et al, 1993). Previous studies have documented the leukemogenic effects of radiotherapy and

alkylating agent chemotherapy for NHL, in particular,

mechlorethamine, procarbazine, and chlorambucil

(Travis et al, 1994, 1996). Radiotherapy for NHL appeared

related to the increased risks for bladder cancers and

bone sarcomas in our series. Among patients who initially

received radiotherapy, significantly increased risks of

bladder cancer were confined to 10-year survivors

400 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LYMPHOMA AND MYELOMA

Years after initial cancer diagnosis

Cumulative incidence (%)

0

5

10

15

20

0 5 10 15 20 25

All second cancers

Lung and bronchus

Urinary system

Leukemia

Figure 16.3: Cumulative incidence of developing a second

cancer among patients with non-Hodgkin lymphoma, both

sexes, SEER 1973-2000.

Age at diagnosis of non-Hodgkin lymphoma (years)

O/E

EAR (per 10,000 person-years)

1.0

1.5

2.0

2.5

3.0

3.5

30 30-49 50-69 70 30 30-49 50-69 70

35

13

-9

26

-15

-10

-5

0

5

10

15

20

25

30

35

40

1.82*

0.96

1.17*

2.93*

-1.5

-3.0

Figure 16.4: Observed-to-expected ratio (O/E) and excess

absolute risk (EAR) of subsequent primary cancers after

non-Hodgkin lymphoma, both sexes, SEER 1973-2000.

*P <0.05.

Notes: All subsequent cancers excluding non-Hodgkin lymphoma. EAR = Excess number of

subsequent cancers per 10,000 person-years. Observed number of subsequent cancers are

59, 631, 2,956 and 1,844, for age groups <30, 30-49, 50-69 and 70 years, respectively.
(O/E=2.25), a pattern consistent with previous studies of

NHL (Travis et al, 1995) and with other surveys of radiogenic bladder cancer (UNSCEAR, 2000). In patients

treated with chemotherapy, elevated risks of bladder

cancer were noted in the follow-up intervals 5-9 years

and 10 or more years after diagnosis, possibly due to

treatment with cyclophosphamide, a known bladder carcinogen (Travis et al, 1995). In a previous analytic study

of NHL patients, cyclophosphamide increased the risk of

bladder cancer in a dose-dependent manner and had an

additional effect when combined with radiotherapy

(Travis et al, 1995).

The immunosuppressive state associated with NHL

(Evans and Hancock, 2003) may contribute to the

increased risks observed for cutaneous melanoma, HL,

and lip cancer (Frisch et al, 2001; Goggins et al, 2001).

Although diagnostic misclassification of HL and NHL

may affect risk estimates, one population-based study of

NHL in which histopathological materials for all cases

were independently reviewed revealed a significant

3-fold excess of HL (Travis et al, 1992). EBV infection, an

established cofactor in several subtypes of NHL and HL,

may contribute to the 5-fold increased risk of HL in our

study. The elevated 13-fold risk of KS, based on 113 cases,

probably reflects underlying HIV infection in some NHL

patients, particularly because significant excesses were

not evident prior to 1980 (the pre-HIV era). Individuals

with AIDS have a 150- to 200-fold increased risk of NHL,

which is associated with the degree of immune suppression (Goedert, 2000). In a reciprocal fashion, the significantly increased risks of NHL following HL, KS, and

malignant melanoma in the SEER database point to the

role of shared etiologic factors, possibly immune-related.

Based on small numbers, significantly increased risks

of vaginal cancers were limited to women diagnosed

with NHL at ages 50-69 years, and excesses of anal cancers were limited to males diagnosed at ages 30-49 years.

Vaginal and anal cancers have been linked to HPV infection and occur excessively in persons with HIV infection.

A significant deficit of prostate cancer was restricted to

the period from 2 to 12 months after NHL and likely

reflects the residual effect of detecting cases with screening within 2 months of diagnosis of NHL. The significantly increased 4-fold risk of kidney cancer observed

between 2 and 12 months after NHL diagnosis suggests a

role for medical surveillance; the subsequent increase in

risk 5-9 years after NHL diagnosis was unrelated to initial treatment and may reflect medical surveillance or

chance observation.

Myeloma

Myeloma accounts for an estimated 1.2% of all cancers in

the U.S. and 2% of all cancer deaths (Jemal et al, 2005).

The incidence of myeloma rises sharply with age, with

only 8% of cases reported to the SEER Program in

patients younger than age 50 years. Males are approximately 50% more likely to be diagnosed with myeloma

than females, and blacks have a 2-fold higher incidence

compared with whites. For more than 30 years, the standard treatment for myeloma has consisted of intermittent

courses of melphalan and prednisone, although chemotherapy that includes cyclophosphamide, vinca alkaloids,

anthracyclines, and nitrosoureas has also been used

(Barlogie et al, 2004). Radiation therapy may provide

potentially curative treatment for patients with localized

disease (solitary plasmacytoma), but radiation is otherwise generally reserved for palliation of skeletal lesions.

Immunomodulatory agents, monoclonal antibodies, and

autologous and allogeneic bone marrow transplantation

are among the newer treatment options (Barlogie et al,

2004). The 5-year relative survival rate for patients with

myeloma is 31.9%. Between 1996 and 2000, death rates

were 47% higher in males than females and twice as high

in blacks as in whites.

The etiology of myeloma remains largely unexplained.

Studies in atomic bomb survivors and individuals

exposed to therapeutic and diagnostic radiation have

reported an effect of radiation, but the studies are inconsistent (Herrington et al, 1996). Occupational exposures,

such as benzene, herbicides, and pesticides, have also

been associated with myeloma (Herrington et al, 1996).

Results and Discussion

Among 23,838 patients who survived 2 months or more

following a diagnosis of myeloma, the overall risk of

developing a subsequent primary cancer was not

increased (O/E=0.98 excluding subsequent myeloma,

O=1,216, 95% CI=0.93-1.04). Approximately 6.1% (95%

CI=5.8%-6.5%) of myeloma patients developed a second

cancer within 20 years. The increased risk of developing

a new malignancy was limited to individuals diagnosed

with myeloma at ages younger than 70 years (O/E=1.09,

EAR=12); subsequent cancer risk did not differ by gender, race, or initial therapy. Significantly elevated risks

were noted for KS, ANLL, and CML, while significant

deficits were observed for CLL as well as cancers of the

buccal cavity and pharynx, esophagus, female breast,

and prostate. The increased risks for KS and leukemia are

consistent with earlier surveys, but we did not observe

the significant excesses of NHL or bladder cancer reported previously (Cannon et al, 2000; Finnish Leukaemia

Group, 2000; Dong and Hemminki, 2001).

Leukemias accounted for the largest cancer excesses

following a diagnosis of myeloma, with ANLL constituting 80% of leukemia cases. Risks for ANLL were significantly elevated 1-4, 5-9, and 10-14 years after initial

diagnosis, consistent with previous surveys (Finnish

Leukaemia Group, 2000; Dong and Hemminki, 2001).

Increased risks of ANLL likely reflect treatment for

myeloma with alkylating agents, which are often given

for 6 to 12 months or longer (Barlogie et al, 2004). The

significantly increased 2.5-fold risk of CML that we

observed is likely due to the antecedent chemotherapy

and/or radiotherapy, in accord with prior studies (van

Leeuwen and Travis, 2001).

A significantly increased risk of KS was observed, as

was reported in another large survey (Cannon et al, 2000),

although an excess of myeloma following KS was not

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 401

LYMPHOMA AND MYELOMA
402 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

noted in the SEER data. Whether human herpesvirus-8,

the etiologic agent of KS, may be associated with some

cases of myeloma is not clear (Berenson and Vescio, 1999;

Tarte et al, 1999). The significantly increased risk of kidney cancer was confined to the 1-year period following

the diagnosis of myeloma, which suggests a surveillance

effect.

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LYMPHOMA AND MYELOMA
Hodgkin Lymphoma

Both Sexes

Table 16.1.1: Characteristics of patients with an initial Hodgkin lymphoma, both sexes,

SEER 1973-2000.

404 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

HODGKIN LYMPHOMA

Number of patients with 1st primary cancer

Total 9,769 100.0 7,747 100.0 17,516 100.0

Initial treatment

Any radiation 4,825 49.4 4,376 56.5 9,201 52.5

With surgery 1,208 12.4 1,070 13.8 2,278 13.0

Without surgery 3,617 37.0 3,306 42.7 6,923 39.5

No radiation 4,944 50.6 3,371 43.5 8,315 47.5

With surgery 998 10.2 697 9.0 1,695 9.7

Without surgery 3,946 40.4 2,674 34.5 6,620 37.8

Race

White 8,662 88.7 6,914 89.2 15,576 88.9

Black 801 8.2 593 7.7 1,394 8.0

Other 252 2.6 204 2.6 456 2.6

Unknown 54 0.6 36 0.5 90 0.5

Age at 1st primary cancer diagnosis, years

< 30 4,019 41.1 3,713 47.9 7,732 44.1

30–49 3,243 33.2 2,165 27.9 5,408 30.9

50–69 1,801 18.4 1,099 14.2 2,900 16.6

70–79 529 5.4 516 6.7 1,045 6.0

> 80 177 1.8 254 3.3 431 2.5

Number of patients with one or more

primary cancers

One primary cancer only 9,101 93.2 7,188 92.8 16,289 93.0

1st and 2nd cancers 618 6.3 507 6.5 1,125 6.4

1st, 2nd, and 3rd cancers 49 0.5 46 0.6 95 0.5

1st, 2nd, 3rd, and additional cancers 1 0.0 6 0.1 7 0.0

Other statistics

Median age at 1st cancer diagnosis 33.8 — 30.8 — 32.3 —

Median year of 1st cancer diagnosis 1987.5 — 1988.1 — 1987.8 —

Median person-years at risk 6.5 — 7.1 — 6.7 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 97.8 — 97.3 — 97.6

1st, 2nd, and additional cancers — 97.6 — 96.6 — 97.1

1st cancer only — 1.9 — 2.1 — 2.0

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Hodgkin Lymphoma

Both Sexes

Table 16.1.2: Risk of subsequent primary cancers after Hodgkin lymphoma, both sexes,

SEER 1973-2000.

HODGKIN LYMPHOMA

All subsequent cancers 76 1.40* 325 1.74* 338 2.11* 598 2.88* 1,337 608.94 2.20* 48.59

All excluding same site 76 1.41* 324 1.75* 338 2.13* 598 2.90* 1,336 603.01 2.22* 48.92

Buccal cavity, pharynx 1 0.61 15 2.70* 19 4.15* 21 3.70* 56 17.44 3.21* 2.57

Lip 1 4.14 3 3.89 4 6.82* 1 1.59 9 2.23 4.04* 0.45

Tongue 0 0.00 3 2.61 4 4.03* 7 5.32* 14 3.78 3.70* 0.68

Salivary gland 0 0.00 3 5.78* 5 11.25* 10 17.58* 18 1.68 10.72* 1.09

Mouth 0 0.00 3 2.11 3 2.63 1 0.74 7 4.34 1.61 0.18

Nasopharynx 0 0.00 0 0.00 1 4.57 0 0.00 1 0.83 1.21 0.01

Tonsil 0 0.00 1 1.72 0 0.00 1 1.38 2 1.97 1.01 0.00

Oropharynx 0 0.00 0 0.00 2 16.13* 0 0.00 2 0.48 4.21 0.10

Hypopharynx 0 0.00 1 1.91 0 0.00 1 2.05 2 1.59 1.26 0.03

Digestive system 10 0.91 34 0.95 40 1.37 92 2.61* 176 111.19 1.58* 4.33

Esophagus 0 0.00 1 0.52 3 1.86 5 2.40 9 6.18 1.46 0.19

Stomach 2 1.75 6 1.65 4 1.39 22 6.64* 34 10.97 3.10* 1.54

Small intestine 0 0.00 3 5.18* 0 0.00 2 2.77 5 1.98 2.52 0.20

Colon 5 1.03 13 0.83 20 1.59 33 2.23* 71 47.89 1.48* 1.54

Rectum, rectosigmoid junction 1 0.50 7 1.07 4 0.76 2 0.31 14 20.22 0.69 -0.41

Anus, anal canal 0 0.00 0 0.00 2 5.09 5 8.64* 7 1.52 4.59* 0.37

Liver 0 0.00 1 0.78 2 1.80 7 4.50* 10 4.31 2.32* 0.38

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.32 0.00 -0.09

Bile ducts, other biliary 1 4.55 0 0.00 0 0.00 2 2.55 3 2.33 1.29 0.04

Pancreas 1 0.76 3 0.71 5 1.46 11 2.64* 20 13.16 1.52 0.46

Respiratory system 10 1.13 62 2.08* 76 3.11* 103 3.47* 251 92.74 2.71* 10.56

Nose, nasal cavity, ear 0 0.00 1 3.28 0 0.00 1 3.11 2 0.97 2.05 0.07

Larynx 0 0.00 3 1.30 2 1.07 7 3.14* 12 7.09 1.69 0.33

Lung, bronchus 10 1.25 56 2.07* 72 3.25* 95 3.52* 233 84.27 2.76* 9.93

Female breast 5 0.82 16 0.74 33 1.65* 136 4.54* 190 77.61 2.45* 16.55

Female genital system 0 0.00 15 1.42 14 1.52 34 2.78* 63 35.08 1.80* 4.11

Cervix uteri 0 0.00 3 1.27 2 0.89 6 2.20 11 7.94 1.39 0.45

Corpus uteri 0 0.00 5 1.15 8 2.26 19 3.94* 32 14.03 2.28* 2.64

Ovary 0 0.00 6 1.93 3 1.07 8 2.09 17 10.62 1.60 0.94

Vagina 0 0.00 0 0.00 0 0.00 1 7.42 1 0.42 2.40 0.09

Vulva 0 0.00 0 0.00 1 2.89 0 0.00 1 1.33 0.75 -0.05

Male genital system 10 1.15 25 0.82 20 0.75 25 0.69 80 102.07 0.78* -2.69

Prostate 10 1.23 21 0.75 19 0.78 23 0.68 73 94.47 0.77* -2.62

Testis 0 0.00 4 1.78 1 0.49 1 0.49 6 6.87 0.87 -0.11

Urinary system 3 0.75 14 1.03 16 1.41 22 1.53 55 43.24 1.27 0.78

Urinary bladder 1 0.37 8 0.89 12 1.64 12 1.34 33 27.91 1.18 0.34

Kidney parenchyma 2 1.85 4 1.05 3 0.89 7 1.49 16 12.98 1.23 0.20

Renal pelvis, other urinary 0 0.00 2 2.52 1 1.62 3 4.34 6 2.35 2.55 0.24

Ureter 0 0.00 2 7.93 0 0.00 3 14.34* 5 0.73 6.81* 0.28

Bone, joints 0 0.00 3 6.80* 0 0.00 5 13.72* 8 1.27 6.28* 0.45

Soft tissue including heart 2 6.28 3 2.62 9 9.12* 17 13.94* 31 3.67 8.44* 1.82

Kaposi sarcoma 7 16.68* 6 3.26* 2 1.00 1 0.42 16 6.63 2.41* 0.63

Melanoma of skin 3 1.58 13 1.73 12 1.65 15 1.49 43 26.70 1.61* 1.09

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 1.08 0.00 -0.07

Brain, central nervous system 0 0.00 6 1.94 4 1.50 1 0.31 11 9.80 1.12 0.08

Thyroid 1 1.30 4 1.30 4 1.37 23 6.07* 32 10.55 3.03* 1.43

Lymphatic, hematopoietic 24 5.07* 97 5.87* 82 5.79* 79 4.51* 282 52.94 5.33* 15.29

Hodgkin lymphoma 0 0.00 1 0.48 0 0.00 0 0.00 1 5.93 0.17* -0.33

Non-Hodgkin lymphoma 19 9.32* 41 5.60* 29 4.38* 55 6.23* 144 24.80 5.81* 7.95

Myeloma 1 1.62 3 1.46 1 0.58 3 1.36 8 6.59 1.21 0.09

Leukemia 4 2.65 52 10.29* 52 12.58* 21 4.27* 129 15.61 8.26* 7.57

Acute lymphocytic 0 0.00 2 5.56 2 7.24 3 10.49* 7 1.03 6.82* 0.40

Chronic lymphocytic 0 0.00 1 0.60 3 2.21 1 0.61 5 5.18 0.96 -0.01

Acute non-lymphocytic 2 3.83 43 24.27* 43 29.46* 14 8.07* 102 5.49 18.59* 6.44

Chronic myeloid 1 4.49 1 1.31 2 3.08 3 3.82 7 2.42 2.89* 0.31

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 17,516 15,494 10,454 6,496 17,516

Person-years in interval 13,638 50,563 41,692 43,953 149,847

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 67,933 PYR and for male cancers on 81,914 PYR.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 405
All subsequent cancers 739 1.84* 279 2.59* 206 3.19* 113 3.22* 1,337 608.94 2.20* 48.59

All excluding same site 738 1.86* 279 2.61* 206 3.21* 113 3.24* 1,336 603.01 2.22* 48.92

Buccal cavity, pharynx 35 2.97* 6 2.02 12 6.85* 3 3.13 56 17.44 3.21* 2.57

Lip 8 5.00* 1 2.86 0 0.00 0 0.00 9 2.23 4.04* 0.45

Tongue 7 2.84* 2 2.99 5 12.15* 0 0.00 14 3.78 3.70* 0.68

Salivary gland 8 7.21* 2 6.69 6 34.21* 2 21.09* 18 1.68 10.72* 1.09

Mouth 6 2.01 0 0.00 1 2.42 0 0.00 7 4.34 1.61 0.18

Nasopharynx 1 1.79 0 0.00 0 0.00 0 0.00 1 0.83 1.21 0.01

Tonsil 1 0.80 0 0.00 0 0.00 1 7.30 2 1.97 1.01 0.00

Oropharynx 2 6.30 0 0.00 0 0.00 0 0.00 2 0.48 4.21 0.10

Hypopharynx 1 0.91 1 3.83 0 0.00 0 0.00 2 1.59 1.26 0.03

Digestive system 84 1.11 38 2.04* 39 3.63* 15 2.55* 176 111.19 1.58* 4.33

Esophagus 4 0.98 2 1.86 2 3.09 1 2.76 9 6.18 1.46 0.19

Stomach 12 1.57 8 4.51* 9 8.96* 5 9.36* 34 10.97 3.10* 1.54

Small intestine 3 2.38 0 0.00 1 4.39 1 7.62 5 1.98 2.52 0.20

Colon 38 1.15 18 2.27* 11 2.46* 4 1.68 71 47.89 1.48* 1.54

Rectum, rectosigmoid junction 12 0.87 1 0.30 1 0.52 0 0.00 14 20.22 0.69 -0.41

Anus, anal canal 2 2.12 1 3.51 3 16.18* 1 9.22 7 1.52 4.59* 0.37

Liver 3 1.09 3 3.90 3 6.15* 1 3.35 10 4.31 2.32* 0.38

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.32 0.00 -0.09

Bile ducts, other biliary 1 0.65 0 0.00 2 8.23 0 0.00 3 2.33 1.29 0.04

Pancreas 9 1.00 4 1.82 6 4.69* 1 1.43 20 13.16 1.52 0.46

Respiratory system 148 2.35* 48 3.07* 34 3.74* 21 4.23* 251 92.74 2.71* 10.56

Nose, nasal cavity, ear 1 1.53 0 0.00 0 0.00 1 19.01 2 0.97 2.05 0.07

Larynx 5 1.03 6 5.07* 0 0.00 1 2.72 12 7.09 1.69 0.33

Lung, bronchus 138 2.41* 42 2.96* 34 4.11* 19 4.20* 233 84.27 2.76* 9.93

Female breast 54 1.13 59 3.99* 50 5.20* 27 4.88* 190 77.61 2.45* 16.55

Female genital system 29 1.27 17 2.70* 9 2.34* 8 3.83* 63 35.08 1.80* 4.11

Cervix uteri 5 0.96 3 1.98 1 1.20 2 5.29 11 7.94 1.39 0.45

Corpus uteri 13 1.41 10 4.20* 5 3.27* 4 4.39* 32 14.03 2.28* 2.64

Ovary 9 1.32 4 2.05 3 2.48 1 1.52 17 10.62 1.60 0.94

Vagina 0 0.00 0 0.00 0 0.00 1 46.17 1 0.42 2.40 0.09

Vulva 1 1.17 0 0.00 0 0.00 0 0.00 1 1.33 0.75 -0.05

Male genital system 55 0.84 13 0.71 7 0.61 5 0.79 80 102.07 0.78* -2.69

Prostate 50 0.83 11 0.64 7 0.65 5 0.82 73 94.47 0.77* -2.62

Testis 5 1.04 1 0.81 0 0.00 0 0.00 6 6.87 0.87 -0.11

Urinary system 33 1.14 8 1.07 7 1.58 7 2.84* 55 43.24 1.27 0.78

Urinary bladder 21 1.11 4 0.85 4 1.47 4 2.66 33 27.91 1.18 0.34

Kidney parenchyma 9 1.09 3 1.27 2 1.34 2 2.34 16 12.98 1.23 0.20

Renal pelvis, other urinary 3 1.81 1 2.67 1 4.84 1 9.10 6 2.35 2.55 0.24

Ureter 2 3.81 1 8.69 1 16.19 1 30.89 5 0.73 6.81* 0.28

Bone, joints 3 3.30 2 9.85* 1 9.13 2 38.56* 8 1.27 6.28* 0.45

Soft tissue including heart 14 5.71* 8 12.36* 5 13.25* 4 20.50* 31 3.67 8.44* 1.82

Kaposi sarcoma 15 3.52* 1 0.66 0 0.00 0 0.00 16 6.63 2.41* 0.63

Melanoma of skin 28 1.68* 7 1.35 5 1.59 3 1.78 43 26.70 1.61* 1.09

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 1.08 0.00 -0.07

Brain, central nervous system 10 1.51 1 0.58 0 0.00 0 0.00 11 9.80 1.12 0.08

Thyroid 9 1.33 10 4.97* 9 7.64* 4 6.68* 32 10.55 3.03* 1.43

Lymphatic, hematopoietic 203 5.73* 50 5.37* 18 3.34* 11 3.94* 282 52.94 5.33* 15.29

Hodgkin lymphoma 1 0.23 0 0.00 0 0.00 0 0.00 1 5.93 0.17* -0.33

Non-Hodgkin lymphoma 89 5.57* 33 7.17* 12 4.33* 10 6.90* 144 24.80 5.81* 7.95

Myeloma 5 1.14 1 0.88 2 2.92 0 0.00 8 6.59 1.21 0.09

Leukemia 108 10.10* 16 6.06* 4 2.67 1 1.28 129 15.61 8.26* 7.57

Acute lymphocytic 4 5.40* 2 12.29* 0 0.00 1 25.58 7 1.03 6.82* 0.40

Chronic lymphocytic 4 1.13 1 1.15 0 0.00 0 0.00 5 5.18 0.96 -0.01

Acute non-lymphocytic 88 23.45* 11 11.83* 3 5.71* 0 0.00 102 5.49 18.59* 6.44

Chronic myeloid 4 2.44 2 4.70 1 4.15 0 0.00 7 2.42 2.89* 0.31

Hodgkin Lymphoma

Both Sexes, Long-term Follow-up

Table 16.1.3: Risk of subsequent primary cancers after Hodgkin lymphoma, both sexes,

long-term follow-up, SEER 1973-2000.

406 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

HODGKIN LYMPHOMA

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 17,516 6,496 3,704 1,716 17,516

Person-years in interval 105,894 25,015 13,081 5,856 149,847

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 67,933 PYR and for male cancers on 81,914 PYR.
Hodgkin Lymphoma

Females

Table 16.1.4: Risk of subsequent primary cancers after Hodgkin lymphoma, females,

SEER 1973-2000.

HODGKIN LYMPHOMA

All subsequent cancers 27 1.29 126 1.77* 145 2.30* 320 3.80* 618 239.29 2.58* 55.75

All excluding same site 27 1.31 125 1.78* 145 2.33* 320 3.82* 617 236.89 2.60* 55.95

Buccal cavity, pharynx 0 0.00 4 3.20 8 7.67* 10 7.70* 22 3.97 5.54* 2.65

Lip 0 0.00 0 0.00 1 15.60 0 0.00 1 0.24 4.17 0.11

Tongue 0 0.00 0 0.00 0 0.00 3 9.71* 3 0.90 3.34 0.31

Salivary gland 0 0.00 1 5.27 4 23.87* 6 28.55* 11 0.62 17.72* 1.53

Mouth 0 0.00 2 5.03 2 6.22 1 2.57 5 1.23 4.06* 0.55

Nasopharynx 0 0.00 0 0.00 1 20.17 0 0.00 1 0.19 5.29 0.12

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.05

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.01

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.03

Digestive system 6 1.46 12 0.94 12 1.15 31 2.51* 61 39.58 1.54* 3.15

Esophagus 0 0.00 0 0.00 0 0.00 1 2.97 1 1.09 0.92 -0.01

Stomach 2 6.18 1 1.02 0 0.00 6 6.71* 9 2.98 3.02* 0.89

Small intestine 0 0.00 3 14.60* 0 0.00 0 0.00 3 0.71 4.20 0.34

Colon 3 1.48 5 0.80 8 1.58 14 2.39* 30 19.20 1.56* 1.59

Rectum, rectosigmoid junction 0 0.00 2 0.94 1 0.58 1 0.48 4 6.64 0.60 -0.39

Rectum 0 0.00 2 1.43 0 0.00 1 0.71 3 4.40 0.68 -0.21

Anus, anal canal 0 0.00 0 0.00 1 5.43 2 7.32 3 0.72 4.17 0.34

Liver 0 0.00 0 0.00 1 4.18 0 0.00 1 0.91 1.10 0.01

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.82 0.00 -0.12

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 3.53 1 0.85 1.17 0.02

Pancreas 1 1.93 1 0.62 1 0.76 4 2.57 7 5.00 1.40 0.30

Respiratory system 5 2.20 14 1.82 26 3.89* 31 3.49* 76 25.50 2.98* 7.43

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.05

Larynx 0 0.00 1 3.50 0 0.00 1 3.16 2 0.93 2.15 0.16

Lung, bronchus 5 2.32 11 1.51 26 4.11* 30 3.56* 72 24.16 2.98* 7.04

Female breast 5 0.82 16 0.74 33 1.65* 136 4.54* 190 77.61 2.45* 16.55

Female genital system 0 0.00 15 1.42 14 1.52 34 2.78* 63 35.08 1.80* 4.11

Cervix uteri 0 0.00 3 1.27 2 0.89 6 2.20 11 7.94 1.39 0.45

Corpus uteri 0 0.00 5 1.15 8 2.26 19 3.94* 32 14.03 2.28* 2.64

Ovary 0 0.00 6 1.93 3 1.07 8 2.09 17 10.62 1.60 0.94

Vagina 0 0.00 0 0.00 0 0.00 1 7.42 1 0.42 2.40 0.09

Vulva 0 0.00 0 0.00 1 2.89 0 0.00 1 1.33 0.75 -0.05

Urinary system 0 0.00 4 1.42 3 1.25 5 1.61 12 9.18 1.31 0.42

Urinary bladder 0 0.00 2 1.26 2 1.52 4 2.46 8 5.02 1.59 0.44

Kidney parenchyma 0 0.00 1 0.99 1 1.10 0 0.00 2 3.51 0.57 -0.22

Renal pelvis, other urinary 0 0.00 1 4.69 0 0.00 1 5.29 2 0.64 3.12 0.20

Ureter 0 0.00 1 15.76 0 0.00 1 18.92 2 0.19 10.70* 0.27

Bone, joints 0 0.00 2 12.45* 0 0.00 4 27.84* 6 0.48 12.58* 0.81

Soft tissue including heart 0 0.00 2 4.73 6 16.18* 7 15.32* 15 1.37 10.96* 2.01

Kaposi sarcoma 0 0.00 1 37.17 0 0.00 1 36.05 2 0.09 22.99* 0.28

Melanoma of skin 0 0.00 3 1.00 6 1.99 4 0.97 13 10.89 1.19 0.31

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.06

Brain, central nervous system 0 0.00 2 1.87 1 1.07 0 0.00 3 3.43 0.87 -0.06

Thyroid 1 1.90 3 1.40 3 1.45 21 7.86* 28 7.41 3.78* 3.03

Lymphatic, hematopoietic 10 5.91* 47 8.20* 28 5.74* 26 4.40* 111 18.21 6.09* 13.66

Hodgkin lymphoma 0 0.00 1 1.15 0 0.00 0 0.00 1 2.41 0.42 -0.21

Non-Hodgkin lymphoma 5 6.88* 19 7.66* 8 3.65* 16 5.49* 48 8.32 5.77* 5.84

Myeloma 1 4.38 1 1.38 1 1.63 3 3.99 6 2.32 2.59 0.54

Leukemia 4 7.88* 26 15.70* 19 13.85* 7 4.28* 56 5.17 10.83* 7.48

Acute lymphocytic 0 0.00 1 8.42 1 10.61 1 9.76 3 0.35 8.57* 0.39

Chronic lymphocytic 0 0.00 1 1.99 2 4.97 0 0.00 3 1.54 1.94 0.21

Acute non-lymphocytic 2 10.41* 23 35.51* 15 27.55* 5 7.61* 45 2.04 22.04* 6.32

Chronic myeloid 1 13.39 0 0.00 1 4.58 1 3.76 3 0.81 3.70 0.32

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 7,747 6,922 4,746 2,962 7,747

Person-years in interval 6,070 22,688 19,023 20,152 67,933

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 407
All subsequent cancers 49 1.47* 199 1.72* 193 1.98* 278 2.26* 719 369.65 1.95* 42.65

All excluding same site 49 1.48* 199 1.74* 193 2.00* 278 2.27* 719 366.13 1.96* 43.08

Buccal cavity, pharynx 1 0.80 11 2.55* 11 3.11* 11 2.51* 34 13.48 2.52* 2.51

Lip 1 4.58 3 4.31 3 5.75* 1 1.81 8 1.99 4.02* 0.73

Tongue 0 0.00 3 3.43 4 5.29* 4 3.97* 11 2.88 3.81* 0.99

Salivary gland 0 0.00 2 6.08 1 3.61 4 11.15* 7 1.06 6.61* 0.73

Mouth 0 0.00 1 0.98 1 1.22 0 0.00 2 3.11 0.64 -0.13

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -0.08

Tonsil 0 0.00 1 2.13 0 0.00 1 1.65 2 1.62 1.23 0.05

Oropharynx 0 0.00 0 0.00 2 19.84* 0 0.00 2 0.39 5.17 0.20

Hypopharynx 0 0.00 1 2.23 0 0.00 1 2.39 2 1.36 1.47 0.08

Digestive system 4 0.58 22 0.95 28 1.50 61 2.67* 115 71.61 1.61* 5.30

Esophagus 0 0.00 1 0.64 3 2.27 4 2.29 8 5.09 1.57 0.36

Stomach 0 0.00 5 1.88 4 1.92 16 6.62* 25 7.98 3.13* 2.08

Small intestine 0 0.00 0 0.00 0 0.00 2 4.33 2 1.27 1.58 0.09

Colon 2 0.71 8 0.85 12 1.59 19 2.13* 41 28.69 1.43* 1.50

Rectum, rectosigmoid junction 1 0.75 5 1.13 3 0.84 1 0.23 10 13.58 0.74 -0.44

Anus, anal canal 0 0.00 0 0.00 1 4.78 3 9.83* 4 0.80 4.98* 0.39

Liver 0 0.00 1 1.01 1 1.15 7 5.60* 9 3.40 2.65* 0.68

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.06

Bile ducts, other biliary 1 7.33 0 0.00 0 0.00 1 2.00 2 1.48 1.35 0.06

Pancreas 0 0.00 2 0.76 4 1.90 7 2.68* 13 8.16 1.59 0.59

Respiratory system 5 0.76 48 2.17* 50 2.82* 72 3.46* 175 67.25 2.60* 13.15

Nose, nasal cavity, ear 0 0.00 1 4.76 0 0.00 1 4.57 2 0.67 3.01 0.16

Larynx 0 0.00 2 0.99 2 1.23 6 3.13* 10 6.16 1.62 0.47

Lung, bronchus 5 0.85 45 2.27* 46 2.90* 65 3.50* 161 60.11 2.68* 12.32

Male breast 0 0.00 1 4.54 0 0.00 1 3.95 2 0.72 2.76 0.16

Male genital system 10 1.15 25 0.82 20 0.75 25 0.69 80 102.07 0.78* -2.69

Prostate 10 1.23 21 0.75 19 0.78 23 0.68 73 94.47 0.77* -2.62

Testis 0 0.00 4 1.78 1 0.49 1 0.49 6 6.87 0.87 -0.11

Urinary system 3 0.95 10 0.93 13 1.46 17 1.51 43 34.06 1.26 1.09

Urinary bladder 1 0.46 6 0.82 10 1.66 8 1.09 25 22.89 1.09 0.26

Kidney parenchyma 2 2.55 3 1.07 2 0.81 7 2.05 14 9.46 1.48 0.55

Renal pelvis, other urinary 0 0.00 1 1.72 1 2.23 2 3.98 4 1.71 2.34 0.28

Ureter 0 0.00 1 5.30 0 0.00 2 12.79* 3 0.55 5.48* 0.30

Bone, joints 0 0.00 1 3.56 0 0.00 1 4.53 2 0.80 2.51 0.15

Soft tissue including heart 2 9.98* 1 1.38 3 4.87 10 13.12* 16 2.30 6.95* 1.67

Kaposi sarcoma 7 17.00* 5 2.76 2 1.01 0 0.00 14 6.54 2.14* 0.91

Melanoma of skin 3 2.59 10 2.23* 6 1.41 11 1.86 30 15.81 1.90* 1.73

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.69 0.00 -0.08

Brain, central nervous system 0 0.00 4 1.97 3 1.74 1 0.49 8 6.37 1.26 0.20

Thyroid 0 0.00 1 1.07 1 1.18 2 1.79 4 3.14 1.27 0.10

Lymphatic, hematopoietic 14 4.61* 50 4.63* 54 5.82* 53 4.57* 171 34.72 4.92* 16.64

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 3.53 0.00 -0.43

Non-Hodgkin lymphoma 14 10.68* 22 4.54* 21 4.75* 39 6.60* 96 16.48 5.82* 9.71

Myeloma 0 0.00 2 1.50 0 0.00 0 0.00 2 4.27 0.47 -0.28

Leukemia 0 0.00 26 7.66* 33 11.95* 14 4.26* 73 10.44 6.99* 7.64

Acute lymphocytic 0 0.00 1 4.15 1 5.49 2 10.91* 4 0.68 5.92* 0.41

Chronic lymphocytic 0 0.00 0 0.00 1 1.05 1 0.86 2 3.64 0.55 -0.20

Acute non-lymphocytic 0 0.00 20 17.79* 28 30.60* 9 8.35* 57 3.45 16.54* 6.54

Chronic myeloid 0 0.00 1 1.94 1 2.32 2 3.85 4 1.61 2.48 0.29

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 9,769 8,572 5,708 3,534 9,769

Person-years in interval 7,568 27,875 22,669 23,801 81,914

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Hodgkin Lymphoma

Males

Table 16.1.5: Risk of subsequent primary cancers after Hodgkin lymphoma, males,

SEER 1973-2000.

408 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

HODGKIN LYMPHOMA

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Hodgkin Lymphoma

Both Sexes, <20 Years of Age

Table 16.1.6: Risk of subsequent primary cancers after Hodgkin lymphoma, both sexes,

<20 years of age, SEER 1973-2000.

HODGKIN LYMPHOMA

All subsequent cancers 0 0.00 14 6.37* 22 6.77* 92 9.34* 128 15.70 8.15* 37.59

All excluding same site 0 0.00 14 7.64* 22 7.76* 92 9.84* 128 14.36 8.91* 38.04

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 3 15.48* 3 0.30 9.98* 0.90

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.01

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.02

Salivary gland 0 0.00 0 0.00 0 0.00 3 65.63* 3 0.08 35.81* 0.98

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.02

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.01

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Digestive system 0 0.00 0 0.00 1 8.96 11 16.76* 12 0.84 14.34* 3.74

Esophagus 0 0.00 0 0.00 0 0.00 1 48.56 1 0.02 42.89 0.33

Stomach 0 0.00 0 0.00 0 0.00 4 56.94* 4 0.09 44.94* 1.31

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.01

Colon 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.10

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 1 7.27 1 0.17 5.98 0.28

Anus, anal canal 0 0.00 0 0.00 0 0.00 1 31.64 1 0.03 28.80 0.32

Liver 0 0.00 0 0.00 0 0.00 1 28.30 1 0.06 17.28 0.32

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Pancreas 0 0.00 0 0.00 1 144.42* 2 39.21* 3 0.06 47.52* 0.98

Respiratory system 0 0.00 0 0.00 0 0.00 3 10.11* 3 0.39 7.74* 0.87

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.01

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.01

Lung, bronchus 0 0.00 0 0.00 0 0.00 3 12.97* 3 0.28 10.90* 0.91

Female breast 0 0.00 0 0.00 3 21.10* 39 23.49* 42 1.83 22.94* 27.61

Female genital system 0 0.00 1 5.99 1 3.00 2 1.75 4 1.67 2.39 1.60

Cervix uteri 0 0.00 0 0.00 0 0.00 1 1.76 1 0.80 1.26 0.14

Corpus uteri 0 0.00 0 0.00 0 0.00 1 6.29 1 0.18 5.55 0.56

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.40

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Vulva 0 0.00 0 0.00 1 132.36* 0 0.00 1 0.05 21.66 0.66

Male genital system 0 0.00 1 4.45 0 0.00 0 0.00 1 1.38 0.72 -0.25

Prostate 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.02

Testis 0 0.00 1 4.53 0 0.00 0 0.00 1 1.34 0.75 -0.22

Urinary system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.13

Urinary bladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.06

Kidney parenchyma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.06

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Bone, joints 0 0.00 3 30.44* 0 0.00 2 26.00* 5 0.28 18.14* 1.58

Soft tissue including heart 0 0.00 1 11.89 3 33.37* 4 25.61* 8 0.35 22.92* 2.56

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.68 0.00 -0.23

Melanoma of skin 0 0.00 0 0.00 3 7.07* 3 2.41 6 1.93 3.11* 1.36

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.01

Brain, central nervous system 0 0.00 0 0.00 2 9.57* 0 0.00 2 0.84 2.39 0.39

Thyroid 0 0.00 1 4.53 1 2.88 12 15.00* 14 1.40 10.00* 4.22

Lymphatic, hematopoietic 0 0.00 7 9.78* 7 8.69* 9 5.99* 23 3.18 7.24* 6.64

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.35 0.00 -0.45

Non-Hodgkin lymphoma 0 0.00 2 13.52* 2 9.51* 6 8.86* 10 1.07 9.39* 2.99

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.01

Leukemia 0 0.00 5 25.08* 5 27.98* 3 9.94* 13 0.73 17.78* 4.11

Acute lymphocytic 0 0.00 1 10.56 0 0.00 0 0.00 1 0.25 4.04 0.25

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Acute non-lymphocytic 0 0.00 4 51.64* 5 62.54* 3 22.83* 12 0.31 39.22* 3.91

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.04

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,614 2,486 1,898 1,365 2,614

Person-years in interval 2,124 8,714 8,118 10,916 29,872

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 14,548 PYR and for male cancers on 15,324 PYR.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 409
All subsequent cancers 16 3.23* 66 2.72* 78 2.46* 276 3.80* 436 133.60 3.26* 36.04

All excluding same site 16 3.46* 65 2.82* 78 2.54* 276 3.84* 435 130.28 3.34* 36.32

Buccal cavity, pharynx 1 9.33 3 5.34* 5 5.88* 14 5.95* 23 3.87 5.94* 2.28

Lip 1 61.83 1 12.37 1 9.52 0 0.00 3 0.41 7.29* 0.31

Tongue 0 0.00 0 0.00 0 0.00 6 10.06* 6 0.95 6.33* 0.60

Salivary gland 0 0.00 2 16.45* 3 22.20* 6 24.51* 11 0.53 20.83* 1.25

Mouth 0 0.00 0 0.00 1 5.81 0 0.00 1 0.81 1.24 0.02

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.03

Tonsil 0 0.00 0 0.00 0 0.00 1 2.62 1 0.55 1.83 0.05

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.01

Hypopharynx 0 0.00 0 0.00 0 0.00 1 6.27 1 0.21 4.78 0.09

Digestive system 1 3.14 2 1.13 5 1.74 29 3.12* 37 14.26 2.59* 2.71

Esophagus 0 0.00 0 0.00 0 0.00 1 1.69 1 0.80 1.25 0.02

Stomach 0 0.00 0 0.00 3 9.48* 11 12.71* 14 1.43 9.80* 1.50

Small intestine 0 0.00 0 0.00 0 0.00 1 3.63 1 0.45 2.20 0.07

Colon 1 7.95 1 1.46 1 0.94 7 2.10 10 5.20 1.92 0.57

Rectum, rectosigmoid junction 0 0.00 1 3.01 0 0.00 0 0.00 1 2.89 0.35 -0.22

Anus, anal canal 0 0.00 0 0.00 1 9.18 2 7.03 3 0.47 6.38* 0.30

Liver 0 0.00 0 0.00 0 0.00 2 3.72 2 0.79 2.53 0.14

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.01

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 5.05 1 0.30 3.32 0.08

Pancreas 0 0.00 0 0.00 0 0.00 3 2.91 3 1.49 2.01 0.18

Respiratory system 0 0.00 0 0.00 11 5.77* 40 5.36* 51 10.54 4.84* 4.82

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 1 7.71 1 0.24 4.10 0.09

Larynx 0 0.00 0 0.00 1 5.11 1 1.37 2 1.04 1.92 0.11

Lung, bronchus 0 0.00 0 0.00 8 4.97* 38 5.80* 46 9.09 5.06* 4.40

Female breast 0 0.00 4 1.00 7 1.05 79 4.86* 90 27.59 3.26* 16.00

Female genital system 0 0.00 4 1.53 5 1.53 24 3.91* 33 12.56 2.63* 5.24

Cervix uteri 0 0.00 2 1.50 1 0.69 5 2.92 8 4.78 1.68 0.83

Corpus uteri 0 0.00 0 0.00 2 3.03 11 5.21* 13 3.22 4.04* 2.51

Ovary 0 0.00 2 2.66 2 2.06 7 3.59* 11 3.83 2.88* 1.84

Vagina 0 0.00 0 0.00 0 0.00 1 18.68 1 0.11 9.32 0.23

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.10

Male genital system 0 0.00 2 1.11 2 1.10 7 1.06 11 10.68 1.03 0.07

Prostate 0 0.00 0 0.00 1 3.29 6 1.14 7 5.66 1.24 0.30

Testis 0 0.00 2 1.16 1 0.67 1 0.80 4 4.90 0.82 -0.20

Urinary system 0 0.00 2 2.47 1 0.76 8 1.92 11 6.43 1.71 0.54

Urinary bladder 0 0.00 0 0.00 0 0.00 4 1.85 4 3.33 1.20 0.08

Kidney parenchyma 0 0.00 2 5.62 1 1.67 3 1.61 6 2.88 2.08 0.37

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 7.10 1 0.22 4.49 0.09

Ureter 0 0.00 0 0.00 0 0.00 1 32.05 1 0.05 21.77 0.11

Bone, joints 0 0.00 0 0.00 0 0.00 2 10.69* 2 0.56 3.55 0.17

Soft tissue including heart 0 0.00 1 2.63 5 12.96* 11 18.79* 17 1.44 11.79* 1.85

Kaposi sarcoma 5 17.67* 3 2.14 2 1.22 1 0.59 11 5.03 2.19* 0.71

Melanoma of skin 0 0.00 5 1.72 4 1.17 6 1.08 15 12.52 1.20 0.30

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.04

Brain, central nervous system 0 0.00 1 1.04 1 0.99 0 0.00 2 3.75 0.53 -0.21

Thyroid 1 2.56 3 1.75 3 1.71 10 4.29* 17 6.19 2.75* 1.29

Lymphatic, hematopoietic 8 9.40* 34 9.22* 27 6.82* 37 5.36* 106 15.40 6.88* 10.80

Hodgkin lymphoma 0 0.00 1 0.81 0 0.00 0 0.00 1 3.31 0.30 -0.28

Non-Hodgkin lymphoma 7 21.64* 15 9.50* 7 3.50* 26 6.78* 55 7.74 7.11* 5.63

Myeloma 0 0.00 0 0.00 0 0.00 2 3.35 2 0.86 2.32 0.14

Leukemia 1 5.47 18 22.74* 20 23.18* 9 5.46* 48 3.49 13.77* 5.31

Acute lymphocytic 0 0.00 0 0.00 0 0.00 3 21.30* 3 0.43 6.99* 0.31

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.07

Acute non-lymphocytic 1 11.99 16 45.35* 18 49.90* 6 10.08* 41 1.39 29.45* 4.72

Chronic myeloid 0 0.00 0 0.00 1 4.97 0 0.00 1 0.74 1.34 0.03

Hodgkin Lymphoma

Both Sexes, 20-39 Years of Age

Table 16.1.7: Risk of subsequent primary cancers after Hodgkin lymphoma, both sexes,

20-39 years of age, SEER 1973-2000.

410 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

HODGKIN LYMPHOMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 8,620 8,065 5,834 3,783 8,620

Person-years in interval 6,958 27,369 23,804 25,775 83,906

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 39,010 PYR and for male cancers on 44,896 PYR.
Hodgkin Lymphoma

Both Sexes, 40-59 Years of Age

Table 16.1.8: Risk of subsequent primary cancers after Hodgkin lymphoma, both sexes,

40-59 years of age, SEER 1973-2000.

HODGKIN LYMPHOMA

All subsequent cancers 20 1.62 131 2.41* 143 2.39* 186 2.08* 480 216.25 2.22* 106.15

All excluding same site 20 1.63 131 2.42* 143 2.40* 186 2.08* 480 215.46 2.23* 106.47

Buccal cavity, pharynx 0 0.00 6 2.58 11 4.89* 4 1.63 21 7.60 2.76* 5.39

Lip 0 0.00 1 4.04 2 8.47 1 3.58 4 0.82 4.85* 1.28

Tongue 0 0.00 2 3.94 4 8.03* 1 1.84 7 1.67 4.20* 2.15

Salivary gland 0 0.00 0 0.00 1 6.63 1 5.04 2 0.54 3.68 0.59

Mouth 0 0.00 1 1.62 2 3.43 1 1.62 4 1.97 2.03 0.82

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.14

Tonsil 0 0.00 1 3.29 0 0.00 0 0.00 1 0.94 1.06 0.02

Oropharynx 0 0.00 0 0.00 2 28.13* 0 0.00 2 0.24 8.39 0.71

Hypopharynx 0 0.00 1 4.21 0 0.00 0 0.00 1 0.81 1.24 0.08

Digestive system 1 0.46 13 1.33 22 2.01* 41 2.48* 77 39.39 1.95* 15.13

Esophagus 0 0.00 1 1.40 3 3.78 3 2.70 7 2.77 2.52* 1.70

Stomach 0 0.00 3 2.99 1 0.94 6 3.91* 10 3.84 2.61* 2.48

Small intestine 0 0.00 3 15.20* 0 0.00 1 3.35 4 0.75 5.34* 1.31

Colon 1 1.24 4 1.08 10 2.31* 18 2.60* 33 15.78 2.09* 6.93

Rectum, rectosigmoid junction 0 0.00 2 1.00 3 1.35 1 0.33 6 7.69 0.78 -0.68

Anus, anal canal 0 0.00 0 0.00 1 6.47 2 10.26* 3 0.55 5.48* 0.99

Liver 0 0.00 0 0.00 1 2.07 4 5.53* 5 1.73 2.90 1.32

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.15

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.77 0.00 -0.31

Pancreas 0 0.00 0 0.00 3 2.31 5 2.50 8 4.72 1.69 1.32

Respiratory system 3 1.35 38 3.75* 40 3.50* 49 2.98* 130 40.23 3.23* 36.13

Nose, nasal cavity, ear 0 0.00 1 9.36 0 0.00 0 0.00 1 0.36 2.76 0.26

Larynx 0 0.00 1 0.99 1 0.96 4 3.30 6 3.50 1.72 1.01

Lung, bronchus 3 1.53 36 4.00* 39 3.81* 45 2.99* 123 36.27 3.39* 34.91

Female breast 2 1.05 4 0.53 11 1.60 14 1.67 31 24.67 1.26 7.18

Female genital system 0 0.00 3 0.94 7 2.43 8 2.31 18 10.37 1.74* 8.65

Cervix uteri 0 0.00 1 1.86 1 2.61 0 0.00 2 1.40 1.43 0.68

Corpus uteri 0 0.00 2 1.29 5 3.40* 7 3.75* 14 5.27 2.66* 9.89

Ovary 0 0.00 0 0.00 1 1.16 1 0.96 2 3.09 0.65 -1.24

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.12

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.35

Male genital system 0 0.00 9 1.33 6 0.57 11 0.50* 26 40.59 0.64* -9.10

Prostate 0 0.00 9 1.40 6 0.58 10 0.46* 25 39.73 0.63* -9.20

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.35

Urinary system 2 2.20 6 1.46 7 1.50 12 1.72 27 16.68 1.62* 4.15

Urinary bladder 0 0.00 4 1.64 5 1.73 6 1.32 15 10.42 1.44 1.84

Kidney parenchyma 2 5.91 1 0.68 2 1.29 4 1.93 9 5.44 1.66 1.43

Renal pelvis, other urinary 0 0.00 1 5.07 0 0.00 2 5.59 3 0.82 3.65 0.88

Ureter 0 0.00 1 18.44 0 0.00 2 17.36* 3 0.25 12.07* 1.11

Bone, joints 0 0.00 0 0.00 0 0.00 1 12.96 1 0.25 4.00 0.30

Soft tissue including heart 1 12.82 0 0.00 1 3.65 2 5.91 4 0.99 4.03* 1.21

Kaposi sarcoma 2 18.17* 2 5.77 0 0.00 0 0.00 4 0.75 5.32* 1.31

Melanoma of skin 2 3.37 7 2.97* 3 1.39 5 1.99 17 7.63 2.23* 3.77

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.15

Brain, central nervous system 0 0.00 2 2.18 1 1.18 1 1.03 4 2.97 1.35 0.41

Thyroid 0 0.00 0 0.00 0 0.00 1 1.86 1 2.02 0.50 -0.41

Lymphatic, hematopoietic 7 6.78* 35 8.09* 31 7.00* 28 4.49* 101 16.02 6.30* 34.20

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -0.32

Non-Hodgkin lymphoma 6 11.46* 15 6.89* 12 5.47* 21 6.94* 54 7.92 6.82* 18.54

Myeloma 1 7.57 2 3.35 1 1.48 1 0.94 5 2.47 2.03 1.02

Leukemia 0 0.00 18 14.26* 18 13.44* 6 3.08* 42 4.84 8.67* 14.95

Acute lymphocytic 0 0.00 1 16.73 2 35.92* 0 0.00 3 0.19 15.59* 1.13

Chronic lymphocytic 0 0.00 0 0.00 1 1.81 1 1.24 2 1.94 1.03 0.02

Acute non-lymphocytic 0 0.00 14 34.91* 14 33.37* 3 4.59 31 1.57 19.75* 11.84

Chronic myeloid 0 0.00 1 5.30 0 0.00 2 7.70 3 0.68 4.40 0.93

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,453 2,990 1,846 1,016 3,453

Person-years in interval 2,673 9,362 6,946 5,866 24,847

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 8,826 PYR and for male cancers on 16,021 PYR.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 411
All subsequent cancers 40 1.09 114 1.08 95 1.45* 44 1.24 293 243.39 1.20* 44.21

All excluding same site 40 1.10 114 1.08 95 1.45* 44 1.25 293 242.91 1.21* 44.64

Buccal cavity, pharynx 0 0.00 6 2.28 3 2.11 0 0.00 9 5.67 1.59 2.96

Lip 0 0.00 1 2.27 1 4.18 0 0.00 2 0.96 2.09 0.93

Tongue 0 0.00 1 1.96 0 0.00 0 0.00 1 1.10 0.91 -0.09

Salivary gland 0 0.00 1 4.42 1 7.21 0 0.00 2 0.52 3.82 1.32

Mouth 0 0.00 2 2.87 0 0.00 0 0.00 2 1.51 1.32 0.43

Nasopharynx 0 0.00 0 0.00 1 21.15 0 0.00 1 0.19 5.29 0.72

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.47 0.00 -0.42

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.14

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.50

Digestive system 8 0.94 19 0.78 12 0.79 11 1.26 50 56.70 0.88 -5.97

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 2.58 0.00 -2.30

Stomach 2 2.29 3 1.24 0 0.00 1 1.19 6 5.61 1.07 0.35

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.74 0.00 -0.66

Colon 3 0.77 8 0.71 9 1.25 8 1.86 28 26.60 1.05 1.24

Rectum, rectosigmoid junction 1 0.66 4 0.95 1 0.40 0 0.00 6 9.47 0.63 -3.09

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.47 0.00 -0.42

Liver 0 0.00 1 1.33 1 2.13 0 0.00 2 1.74 1.15 0.23

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -0.74

Bile ducts, other biliary 1 5.73 0 0.00 0 0.00 1 4.54 2 1.24 1.61 0.68

Pancreas 1 0.97 3 1.03 1 0.54 1 0.92 6 6.88 0.87 -0.78

Respiratory system 7 1.09 24 1.29 25 2.26* 11 2.01 67 41.59 1.61* 22.65

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.30

Larynx 0 0.00 2 1.68 0 0.00 2 7.68 4 2.51 1.59 1.33

Lung, bronchus 7 1.18 20 1.16 25 2.43* 9 1.74 61 38.64 1.58* 19.93

Female breast 3 0.85 8 0.80 12 1.88 4 1.10 27 23.52 1.15 6.27

Female genital system 0 0.00 7 1.53 1 0.36 0 0.00 8 10.48 0.76 -4.47

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.97 0.00 -1.75

Corpus uteri 0 0.00 3 1.25 1 0.72 0 0.00 4 5.37 0.75 -2.47

Ovary 0 0.00 4 3.01 0 0.00 0 0.00 4 3.11 1.28 1.60

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.33

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -1.05

Male genital system 10 1.41 13 0.60 12 0.87 7 1.02 42 49.42 0.85 -13.08

Prostate 10 1.42 12 0.56* 12 0.88 7 1.03 41 49.04 0.84 -14.18

Testis 0 0.00 1 27.77 0 0.00 0 0.00 1 0.07 13.99 1.64

Urinary system 1 0.34 6 0.70 8 1.51 2 0.69 17 19.74 0.86 -2.45

Urinary bladder 1 0.48 4 0.66 7 1.87 2 0.95 14 13.97 1.00 0.03

Kidney parenchyma 0 0.00 1 0.51 0 0.00 0 0.00 1 4.48 0.22 -3.10

Renal pelvis, other urinary 0 0.00 1 1.77 1 2.90 0 0.00 2 1.30 1.54 0.63

Ureter 0 0.00 1 5.18 0 0.00 0 0.00 1 0.44 2.28 0.50

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.17

Soft tissue including heart 1 7.60 1 2.64 0 0.00 0 0.00 2 0.89 2.25 0.99

Kaposi sarcoma 0 0.00 1 13.87 0 0.00 0 0.00 1 0.17 5.89 0.74

Melanoma of skin 1 1.49 1 0.50 2 1.60 1 1.42 5 4.63 1.08 0.33

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.30

Brain, central nervous system 0 0.00 3 2.96 0 0.00 0 0.00 3 2.25 1.33 0.67

Thyroid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.94 0.00 -0.84

Lymphatic, hematopoietic 9 3.34* 21 2.69* 17 3.43* 5 1.74 52 18.34 2.84* 30.00

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.48 0.00 -0.43

Non-Hodgkin lymphoma 6 5.17* 9 2.63* 8 3.62* 2 1.56 25 8.08 3.09* 15.08

Myeloma 0 0.00 1 0.73 0 0.00 0 0.00 1 3.23 0.31 -1.99

Leukemia 3 3.06 11 3.93* 9 5.13* 3 2.95 26 6.55 3.97* 17.33

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.14

Chronic lymphocytic 0 0.00 1 0.88 2 2.83 0 0.00 3 2.65 1.13 0.32

Acute non-lymphocytic 1 3.07 9 9.57* 6 10.01* 2 5.65 18 2.22 8.11* 14.06

Chronic myeloid 1 7.76 0 0.00 1 4.28 1 7.08 3 0.87 3.44 1.90

Hodgkin Lymphoma

Both Sexes, ≥60 Years of Age

Table 16.1.9: Risk of subsequent primary cancers after Hodgkin lymphoma, both sexes,

≥60 years of age, SEER 1973-2000.

412 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

HODGKIN LYMPHOMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,829 1,953 876 332 2,829

Person-years in interval 1,884 5,118 2,824 1,397 11,222

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 5,549 PYR and for male cancers on 5,672 PYR.
Hodgkin Lymphoma

Both Sexes, Radiotherapy

Table 16.1.10: Risk of subsequent primary cancers after Hodgkin lymphoma, both sexes,

with initial radiotherapy, SEER 1973-2000.

HODGKIN LYMPHOMA

All subsequent cancers 25 1.13 140 1.65* 190 2.37* 419 3.45* 774 308.38 2.51* 50.06

All excluding same site 25 1.15 139 1.66* 190 2.41* 419 3.48* 773 304.71 2.54* 50.35

Buccal cavity, pharynx 1 1.51 6 2.39 15 6.59* 15 4.49* 37 8.79 4.21* 3.03

Lip 1 10.11 0 0.00 2 6.89 0 0.00 3 1.09 2.74 0.20

Tongue 0 0.00 1 1.93 4 8.08* 4 5.07* 9 1.93 4.65* 0.76

Salivary gland 0 0.00 2 7.97 4 17.00* 10 28.79* 16 0.90 17.82* 1.62

Mouth 0 0.00 2 3.13 2 3.54 0 0.00 4 2.16 1.85 0.20

Nasopharynx 0 0.00 0 0.00 1 8.74 0 0.00 1 0.44 2.28 0.06

Tonsil 0 0.00 0 0.00 0 0.00 1 2.28 1 1.01 0.99 0.00

Oropharynx 0 0.00 0 0.00 2 33.58* 0 0.00 2 0.23 8.62 0.19

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.75 0.00 -0.08

Digestive system 1 0.23 14 0.90 18 1.33 58 3.02* 91 52.61 1.73* 4.13

Esophagus 0 0.00 1 1.25 1 1.38 4 3.56 6 2.86 2.09 0.34

Stomach 0 0.00 3 1.90 3 2.27 17 9.62* 23 5.12 4.50* 1.92

Small intestine 0 0.00 2 7.81 0 0.00 0 0.00 2 0.99 2.02 0.11

Colon 1 0.53 5 0.74 9 1.53 20 2.52* 35 22.44 1.56* 1.35

Rectum, rectosigmoid junction 0 0.00 3 1.05 2 0.80 2 0.56 7 9.75 0.72 -0.30

Anus, anal canal 0 0.00 0 0.00 0 0.00 3 8.32* 3 0.81 3.71 0.24

Liver 0 0.00 0 0.00 2 3.91 3 3.44 5 2.07 2.42 0.32

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -0.07

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 2.35 1 1.10 0.91 -0.01

Pancreas 0 0.00 0 0.00 1 0.63 6 2.66 7 6.17 1.13 0.09

Respiratory system 5 1.46 19 1.49 46 4.05* 73 4.49* 143 43.83 3.26* 10.66

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 1 5.26 1 0.50 2.01 0.05

Larynx 0 0.00 0 0.00 0 0.00 3 2.41 3 3.40 0.88 -0.04

Lung, bronchus 5 1.62 17 1.47 45 4.37* 69 4.67* 136 39.70 3.43* 10.35

Female breast 3 1.11 10 0.93 17 1.50 110 5.42* 140 45.13 3.10* 21.09

Female genital system 0 0.00 7 1.29 10 1.87 25 3.01* 42 20.49 2.05* 4.78

Cervix uteri 0 0.00 2 1.44 1 0.69 5 2.52 8 5.15 1.55 0.63

Corpus uteri 0 0.00 2 0.96 5 2.62 14 4.42* 21 7.72 2.72* 2.95

Ovary 0 0.00 3 1.87 3 1.86 5 1.92 11 6.23 1.77 1.06

Vagina 0 0.00 0 0.00 0 0.00 1 11.79 1 0.23 4.41 0.17

Vulva 0 0.00 0 0.00 1 5.30 0 0.00 1 0.73 1.37 0.06

Male genital system 5 1.55 15 1.20 5 0.43* 13 0.70 38 45.97 0.83 -1.66

Prostate 5 1.73 12 1.08 5 0.48 12 0.71 34 41.42 0.82 -1.54

Testis 0 0.00 3 2.38 0 0.00 1 0.71 4 4.20 0.95 -0.04

Urinary system 0 0.00 5 0.85 7 1.31 16 2.01* 28 20.73 1.35 0.78

Urinary bladder 0 0.00 3 0.78 4 1.18 7 1.45 14 13.12 1.07 0.09

Kidney parenchyma 0 0.00 1 0.59 2 1.21 6 2.18 9 6.52 1.38 0.27

Renal pelvis, other urinary 0 0.00 1 2.93 1 3.51 3 8.20* 5 1.09 4.59* 0.42

Ureter 0 0.00 1 9.38 0 0.00 3 27.79* 4 0.33 12.04* 0.39

Bone, joints 0 0.00 2 8.18 0 0.00 3 12.35* 5 0.76 6.61* 0.46

Soft tissue including heart 1 6.79 1 1.72 8 14.68* 13 16.93* 23 2.04 11.28* 2.25

Kaposi sarcoma 0 0.00 2 2.07 1 0.82 1 0.61 4 4.00 1.00 0.00

Melanoma of skin 0 0.00 7 1.80 8 1.92 11 1.67 26 15.55 1.67* 1.12

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.06

Brain, central nervous system 0 0.00 4 2.56 2 1.35 1 0.49 7 5.47 1.28 0.16

Thyroid 0 0.00 2 1.13 2 1.09 18 6.73* 22 6.68 3.29* 1.65

Lymphatic, hematopoietic 9 4.43* 39 4.97* 46 6.26* 47 4.50* 141 27.68 5.09* 12.18

Hodgkin lymphoma 0 0.00 1 0.82 0 0.00 0 0.00 1 3.67 0.27 -0.29

Non-Hodgkin lymphoma 7 8.23* 18 5.29* 17 4.98* 36 6.73* 78 13.02 5.99* 6.99

Myeloma 0 0.00 2 2.28 1 1.27 2 1.67 5 3.10 1.61 0.20

Leukemia 2 3.16 18 7.67* 28 13.46* 9 3.18* 57 7.89 7.22* 5.28

Acute lymphocytic 0 0.00 0 0.00 1 6.07 2 10.65* 3 0.61 4.94 0.26

Chronic lymphocytic 0 0.00 0 0.00 2 3.16 0 0.00 2 2.45 0.82 -0.05

Acute non-lymphocytic 1 4.46 15 17.85* 21 27.98* 7 6.92* 44 2.83 15.57* 4.43

Chronic myeloid 1 10.44 1 2.74 2 5.90 0 0.00 4 1.27 3.16 0.29

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 9,201 8,561 6,269 4,227 9,201

Person-years in interval 7,390 29,180 26,048 30,391 93,009

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 44,979 PYR and for male cancers on 48,029 PYR.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 413
All subsequent cancers 51 1.58* 185 1.81* 148 1.84* 179 2.08* 563 300.56 1.87* 46.17

All excluding same site 51 1.60* 185 1.83* 148 1.86* 179 2.09* 563 298.30 1.89* 46.57

Buccal cavity, pharynx 0 0.00 9 2.95* 4 1.74 6 2.57 19 8.65 2.20* 1.82

Lip 0 0.00 3 7.12* 2 6.76 1 3.65 6 1.13 5.29* 0.86

Tongue 0 0.00 2 3.17 0 0.00 3 5.70* 5 1.85 2.71 0.55

Salivary gland 0 0.00 1 3.73 1 4.78 0 0.00 2 0.78 2.56 0.21

Mouth 0 0.00 1 1.28 1 1.73 1 1.78 3 2.18 1.38 0.15

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.07

Tonsil 0 0.00 1 3.10 0 0.00 0 0.00 1 0.96 1.04 0.01

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.04

Hypopharynx 0 0.00 1 3.34 0 0.00 1 4.61 2 0.83 2.40 0.21

Digestive system 9 1.34 20 0.98 22 1.42 34 2.13* 85 58.59 1.45* 4.65

Esophagus 0 0.00 0 0.00 2 2.26 1 1.04 3 3.31 0.91 -0.05

Stomach 2 2.87 3 1.46 1 0.65 5 3.24* 11 5.85 1.88 0.91

Small intestine 0 0.00 1 3.10 0 0.00 2 6.58 3 0.99 3.03 0.35

Colon 4 1.35 8 0.90 11 1.63 13 1.90* 36 25.45 1.41 1.86

Rectum, rectosigmoid junction 1 0.82 4 1.08 2 0.72 0 0.00 7 10.46 0.67 -0.61

Anus, anal canal 0 0.00 0 0.00 2 10.44* 2 9.19* 4 0.72 5.59* 0.58

Liver 0 0.00 1 1.36 0 0.00 4 5.86* 5 2.25 2.22 0.48

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.70 0.00 -0.12

Bile ducts, other biliary 1 7.40 0 0.00 0 0.00 1 2.80 2 1.23 1.62 0.13

Pancreas 1 1.24 3 1.24 4 2.17 5 2.61 13 6.98 1.86 1.06

Respiratory system 5 0.92 43 2.52* 30 2.30* 30 2.24* 108 48.91 2.21* 10.40

Nose, nasal cavity, ear 0 0.00 1 6.07 0 0.00 0 0.00 1 0.48 2.10 0.09

Larynx 0 0.00 3 2.30 2 2.04 4 4.06* 9 3.68 2.44* 0.94

Lung, bronchus 5 1.01 39 2.52* 27 2.27* 26 2.12* 97 44.57 2.18* 9.22

Female breast 2 0.59 6 0.56 16 1.84* 26 2.70* 50 32.48 1.54* 7.63

Female genital system 0 0.00 8 1.56 4 1.03 9 2.30* 21 14.59 1.44 2.79

Cervix uteri 0 0.00 1 1.03 1 1.26 1 1.35 3 2.79 1.08 0.09

Corpus uteri 0 0.00 3 1.33 3 1.84 5 3.03 11 6.31 1.74 2.04

Ovary 0 0.00 3 1.99 0 0.00 3 2.46 6 4.39 1.37 0.70

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.08

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.26

Male genital system 5 0.91 10 0.56 15 1.01 12 0.68 42 56.10 0.75 -4.16

Prostate 5 0.96 9 0.53 14 1.00 11 0.65 39 53.05 0.74 -4.15

Testis 0 0.00 1 1.02 1 1.29 0 0.00 2 2.66 0.75 -0.20

Urinary system 3 1.22 9 1.17 9 1.50 6 0.94 27 22.51 1.20 0.79

Urinary bladder 1 0.61 5 0.98 8 2.04 5 1.21 19 14.79 1.28 0.74

Kidney parenchyma 2 3.07 3 1.41 1 0.58 1 0.51 7 6.46 1.08 0.09

Renal pelvis, other urinary 0 0.00 1 2.21 0 0.00 0 0.00 1 1.26 0.79 -0.05

Ureter 0 0.00 1 6.87 0 0.00 0 0.00 1 0.40 2.49 0.11

Bone, joints 0 0.00 1 5.08 0 0.00 2 16.44* 3 0.52 5.79* 0.44

Soft tissue including heart 1 5.84 2 3.53 1 2.26 4 8.85* 8 1.63 4.90* 1.12

Kaposi sarcoma 7 31.37* 4 4.57* 1 1.27 0 0.00 12 2.63 4.57* 1.65

Melanoma of skin 3 2.98 6 1.66 4 1.29 4 1.16 17 11.16 1.52 1.03

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.09

Brain, central nervous system 0 0.00 2 1.31 2 1.70 0 0.00 4 4.34 0.92 -0.06

Thyroid 1 2.79 2 1.53 2 1.83 5 4.48* 10 3.87 2.58* 1.08

Lymphatic, hematopoietic 15 5.55* 58 6.68* 36 5.29* 32 4.53* 141 25.25 5.58* 20.36

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 2.26 0.00 -0.40

Non-Hodgkin lymphoma 12 10.11* 23 5.87* 12 3.75* 19 5.46* 66 11.79 5.60* 9.54

Myeloma 1 2.63 1 0.85 0 0.00 1 1.00 3 3.49 0.86 -0.09

Leukemia 2 2.29 34 12.57* 24 11.69* 12 5.75* 72 7.72 9.33* 11.31

Acute lymphocytic 0 0.00 2 12.52* 1 8.96 1 10.20 4 0.42 9.54* 0.63

Chronic lymphocytic 0 0.00 1 1.05 1 1.38 1 1.35 3 2.74 1.10 0.05

Acute non-lymphocytic 1 3.36 28 30.06* 22 31.03* 7 9.69* 58 2.66 21.80* 9.74

Chronic myeloid 0 0.00 0 0.00 0 0.00 3 9.44* 3 1.16 2.60 0.32

Hodgkin Lymphoma

Both Sexes, No Radiotherapy

Table 16.1.11: Risk of subsequent primary cancers after Hodgkin lymphoma, both sexes,

without initial radiotherapy, SEER 1973-2000.

414 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

HODGKIN LYMPHOMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 8,315 6,933 4,185 2,269 8,315

Person-years in interval 6,249 21,383 15,644 13,562 56,838

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 22,953 PYR and for male cancers on 33,884 PYR.
Hodgkin Lymphoma

Both Sexes, Long-term Follow-up, Radiotherapy

Table 16.1.12: Risk of subsequent primary cancers after Hodgkin lymphoma, both sexes, long-term follow-up,

with initial radiotherapy, SEER 1973-2000.

HODGKIN LYMPHOMA

All subsequent cancers 355 1.90* 177 2.96* 155 3.95* 87 3.88* 774 308.38 2.51* 50.06

All excluding same site 354 1.92* 177 2.99* 155 3.98* 87 3.91* 773 304.71 2.54* 50.35

Buccal cavity, pharynx 22 4.04* 4 2.43 8 7.41* 3 4.88 37 8.79 4.21* 3.03

Lip 3 4.06 0 0.00 0 0.00 0 0.00 3 1.09 2.74 0.20

Tongue 5 4.37* 2 5.31 2 7.75 0 0.00 9 1.93 4.65* 0.76

Salivary gland 6 10.90* 2 11.45* 6 53.80* 2 32.66* 16 0.90 17.82* 1.62

Mouth 4 2.91 0 0.00 0 0.00 0 0.00 4 2.16 1.85 0.20

Nasopharynx 1 3.67 0 0.00 0 0.00 0 0.00 1 0.44 2.28 0.06

Tonsil 0 0.00 0 0.00 0 0.00 1 11.04 1 1.01 0.99 0.00

Oropharynx 2 14.10* 0 0.00 0 0.00 0 0.00 2 0.23 8.62 0.19

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.75 0.00 -0.08

Digestive system 33 0.99 23 2.40* 25 4.08* 10 2.85* 91 52.61 1.73* 4.13

Esophagus 2 1.15 2 3.69 1 2.72 1 4.66 6 2.86 2.09 0.34

Stomach 6 1.79 4 4.44* 8 14.33* 5 16.26* 23 5.12 4.50* 1.92

Small intestine 2 3.50 0 0.00 0 0.00 0 0.00 2 0.99 2.02 0.11

Colon 15 1.03 11 2.72* 7 2.80* 2 1.44 35 22.44 1.56* 1.35

Rectum, rectosigmoid junction 5 0.81 1 0.56 1 0.88 0 0.00 7 9.75 0.72 -0.30

Anus, anal canal 0 0.00 1 6.02 2 16.63* 0 0.00 3 0.81 3.71 0.24

Liver 2 1.68 0 0.00 3 10.43* 0 0.00 5 2.07 2.42 0.32

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.62 0.00 -0.07

Bile ducts, other biliary 0 0.00 0 0.00 1 7.26 0 0.00 1 1.10 0.91 -0.01

Pancreas 1 0.26 3 2.69 2 2.78 1 2.39 7 6.17 1.13 0.09

Respiratory system 70 2.54* 32 3.96* 27 5.20* 14 4.66* 143 43.83 3.26* 10.66

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 1 30.12 1 0.50 2.01 0.05

Larynx 0 0.00 3 4.82 0 0.00 0 0.00 3 3.40 0.88 -0.04

Lung, bronchus 67 2.69* 29 3.96* 27 5.73* 13 4.76* 136 39.70 3.43* 10.35

Female breast 30 1.21 41 4.36* 46 6.87* 23 5.46* 140 45.13 3.10* 21.09

Female genital system 17 1.40 11 2.72* 7 2.61* 7 4.42* 42 20.49 2.05* 4.78

Cervix uteri 3 0.95 2 1.87 1 1.60 2 6.79 8 5.15 1.55 0.63

Corpus uteri 7 1.54 7 4.83* 4 3.88* 3 4.36 21 7.72 2.72* 2.95

Ovary 6 1.65 2 1.59 2 2.37 1 2.00 11 6.23 1.77 1.06

Vagina 0 0.00 0 0.00 0 0.00 1 64.71 1 0.23 4.41 0.17

Vulva 1 2.33 0 0.00 0 0.00 0 0.00 1 0.73 1.37 0.06

Male genital system 25 0.91 5 0.56 5 0.82 3 0.86 38 45.97 0.83 -1.66

Prostate 22 0.90 4 0.50 5 0.89 3 0.91 34 41.42 0.82 -1.54

Testis 3 1.07 1 1.21 0 0.00 0 0.00 4 4.20 0.95 -0.04

Urinary system 12 0.94 6 1.53 4 1.56 6 4.11* 28 20.73 1.35 0.78

Urinary bladder 7 0.84 2 0.82 2 1.30 3 3.52 14 13.12 1.07 0.09

Kidney parenchyma 3 0.80 3 2.31 1 1.10 2 3.66 9 6.52 1.38 0.27

Renal pelvis, other urinary 2 2.77 1 5.28 1 8.73 1 16.10 5 1.09 4.59* 0.42

Ureter 1 4.46 1 17.63 1 29.86 1 56.30 4 0.33 12.04* 0.39

Bone, joints 2 3.89 1 7.62 1 13.33 1 27.30 5 0.76 6.61* 0.46

Soft tissue including heart 10 7.86* 5 12.78* 4 16.25* 4 30.71* 23 2.04 11.28* 2.25

Kaposi sarcoma 3 1.26 1 0.99 0 0.00 0 0.00 4 4.00 1.00 0.00

Melanoma of skin 15 1.67 4 1.22 5 2.34 2 1.72 26 15.55 1.67* 1.12

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.06

Brain, central nervous system 6 1.74 1 0.95 0 0.00 0 0.00 7 5.47 1.28 0.16

Thyroid 4 1.00 8 5.83* 7 8.20* 3 6.69* 22 6.68 3.29* 1.65

Lymphatic, hematopoietic 94 5.46* 28 5.25* 11 3.29* 8 4.51* 141 27.68 5.09* 12.18

Hodgkin lymphoma 1 0.39 0 0.00 0 0.00 0 0.00 1 3.67 0.27 -0.29

Non-Hodgkin lymphoma 42 5.47* 21 7.89* 8 4.58* 7 7.47* 78 13.02 5.99* 6.99

Myeloma 3 1.58 0 0.00 2 5.15 0 0.00 5 3.10 1.61 0.20

Leukemia 48 9.48* 7 4.81* 1 1.11 1 2.09 57 7.89 7.22* 5.28

Acute lymphocytic 1 2.39 1 9.62 0 0.00 1 36.71 3 0.61 4.94 0.26

Chronic lymphocytic 2 1.29 0 0.00 0 0.00 0 0.00 2 2.45 0.82 -0.05

Acute non-lymphocytic 37 20.39* 6 11.50* 1 3.15 0 0.00 44 2.83 15.57* 4.43

Chronic myeloid 4 5.00* 0 0.00 0 0.00 0 0.00 4 1.27 3.16 0.29

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 9,201 4,227 2,589 1,257 9,201

Person-years in interval 62,618 16,813 9,303 4,274 93,009

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 44,979 PYR and for male cancers on 48,029 PYR.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 415
All subsequent cancers 384 1.79* 102 2.12* 51 2.01* 26 2.05* 563 300.56 1.87* 46.17

All excluding same site 384 1.81* 102 2.14* 51 2.02* 26 2.06* 563 298.30 1.89* 46.57

Buccal cavity, pharynx 13 2.06* 2 1.52 4 5.96* 0 0.00 19 8.65 2.20* 1.82

Lip 5 5.82* 1 6.23 0 0.00 0 0.00 6 1.13 5.29* 0.86

Tongue 2 1.51 0 0.00 3 19.56* 0 0.00 5 1.85 2.71 0.55

Salivary gland 2 3.57 0 0.00 0 0.00 0 0.00 2 0.78 2.56 0.21

Mouth 2 1.24 0 0.00 1 6.19 0 0.00 3 2.18 1.38 0.15

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.07

Tonsil 1 1.48 0 0.00 0 0.00 0 0.00 1 0.96 1.04 0.01

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.04

Hypopharynx 1 1.62 1 8.02 0 0.00 0 0.00 2 0.83 2.40 0.21

Digestive system 51 1.20 15 1.66 14 3.04* 5 2.12 85 58.59 1.45* 4.65

Esophagus 2 0.85 0 0.00 1 3.59 0 0.00 3 3.31 0.91 -0.05

Stomach 6 1.39 4 4.58* 1 2.24 0 0.00 11 5.85 1.88 0.91

Small intestine 1 1.46 0 0.00 1 11.04 1 20.95 3 0.99 3.03 0.35

Colon 23 1.24 7 1.79 4 2.04 2 2.02 36 25.45 1.41 1.86

Rectum, rectosigmoid junction 7 0.91 0 0.00 0 0.00 0 0.00 7 10.46 0.67 -0.61

Anus, anal canal 2 4.02 0 0.00 1 15.35 1 29.50 4 0.72 5.59* 0.58

Liver 1 0.64 3 8.13* 0 0.00 1 8.80 5 2.25 2.22 0.48

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.70 0.00 -0.12

Bile ducts, other biliary 1 1.14 0 0.00 1 9.50 0 0.00 2 1.23 1.62 0.13

Pancreas 8 1.58 1 0.93 4 7.17* 0 0.00 13 6.98 1.86 1.06

Respiratory system 78 2.20* 16 2.12* 7 1.80 7 3.57* 108 48.91 2.21* 10.40

Nose, nasal cavity, ear 1 2.90 0 0.00 0 0.00 0 0.00 1 0.48 2.10 0.09

Larynx 5 1.85 3 5.34* 0 0.00 1 7.06 9 3.68 2.44* 0.94

Lung, bronchus 71 2.20* 13 1.88* 7 1.97 6 3.34* 97 44.57 2.18* 9.22

Female breast 24 1.05 18 3.34* 4 1.37 4 3.03 50 32.48 1.54* 7.63

Female genital system 12 1.12 6 2.67 2 1.72 1 1.98 21 14.59 1.44 2.79

Cervix uteri 2 0.98 1 2.24 0 0.00 0 0.00 3 2.79 1.08 0.09

Corpus uteri 6 1.29 3 3.23 1 2.01 1 4.48 11 6.31 1.74 2.04

Ovary 3 0.95 2 2.87 1 2.73 0 0.00 6 4.39 1.37 0.70

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.08

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.26

Male genital system 30 0.78 8 0.84 2 0.37 2 0.70 42 56.10 0.75 -4.16

Prostate 28 0.78 7 0.78 2 0.38 2 0.72 39 53.05 0.74 -4.15

Testis 2 0.99 0 0.00 0 0.00 0 0.00 2 2.66 0.75 -0.20

Urinary system 21 1.30 2 0.57 3 1.62 1 0.99 27 22.51 1.20 0.79

Urinary bladder 14 1.31 2 0.87 2 1.69 1 1.54 19 14.79 1.28 0.74

Kidney parenchyma 6 1.33 0 0.00 1 1.73 0 0.00 7 6.46 1.08 0.09

Renal pelvis, other urinary 1 1.07 0 0.00 0 0.00 0 0.00 1 1.26 0.79 -0.05

Ureter 1 3.32 0 0.00 0 0.00 0 0.00 1 0.40 2.49 0.11

Bone, joints 1 2.52 1 13.90 0 0.00 1 65.61 3 0.52 5.79* 0.44

Soft tissue including heart 4 3.39 3 11.73* 1 7.63 0 0.00 8 1.63 4.90* 1.12

Kaposi sarcoma 12 6.37* 0 0.00 0 0.00 0 0.00 12 2.63 4.57* 1.65

Melanoma of skin 13 1.69 3 1.57 0 0.00 1 1.90 17 11.16 1.52 1.03

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.09

Brain, central nervous system 4 1.26 0 0.00 0 0.00 0 0.00 4 4.34 0.92 -0.06

Thyroid 5 1.82 2 3.12 2 6.18 1 6.66 10 3.87 2.58* 1.08

Lymphatic, hematopoietic 109 5.99* 22 5.52* 7 3.41* 3 2.94 141 25.25 5.58* 20.36

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 2.26 0.00 -0.40

Non-Hodgkin lymphoma 47 5.66* 12 6.18* 4 3.91* 3 5.84* 66 11.79 5.60* 9.54

Myeloma 2 0.80 1 1.80 0 0.00 0 0.00 3 3.49 0.86 -0.09

Leukemia 60 10.65* 9 7.60* 3 5.01* 0 0.00 72 7.72 9.33* 11.31

Acute lymphocytic 3 9.34* 1 16.98 0 0.00 0 0.00 4 0.42 9.54* 0.63

Chronic lymphocytic 2 1.00 1 2.38 0 0.00 0 0.00 3 2.74 1.10 0.05

Acute non-lymphocytic 51 26.31* 5 12.24* 2 9.60* 0 0.00 58 2.66 21.80* 9.74

Chronic myeloid 0 0.00 2 11.01* 1 10.88 0 0.00 3 1.16 2.60 0.32

Hodgkin Lymphoma

Both Sexes, Long-term Follow-up, No Radiotherapy

Table 16.1.13: Risk of subsequent primary cancers after Hodgkin lymphoma, both sexes, long-term follow-up,

without initial radiotherapy, SEER 1973-2000.

416 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

HODGKIN LYMPHOMA

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 8,315 2,269 1,115 459 8,315

Person-years in interval 43,275 8,202 3,778 1,582 56,838

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 22,953 PYR and for male cancers on 33,884 PYR.
Non-Hodgkin Lymphoma

NON-HODGKIN LYMPHOMA

Both Sexes

Table 16.2.1: Characteristics of patients with an initial non-Hodgkin lymphoma, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 39,861 100.0 34,097 100.0 73,958 100.0

Initial treatment

Any radiation 11,287 28.3 9,737 28.6 21,024 28.4

With surgery 2,933 7.4 2,830 8.3 5,763 7.8

Without surgery 8,354 21.0 6,907 20.3 15,261 20.6

No radiation 28,574 71.7 24,360 71.4 52,934 71.6

With surgery 6,473 16.2 6,013 17.6 12,486 16.9

Without surgery 22,101 55.4 18,347 53.8 40,448 54.7

Race

White 34,949 87.7 30,384 89.1 65,333 88.3

Black 2,573 6.5 1,854 5.4 4,427 6.0

Other 2,149 5.4 1,691 5.0 3,840 5.2

Unknown 190 0.5 168 0.5 358 0.5

Age at 1st primary cancer diagnosis, years

< 30 2,823 7.1 1,440 4.2 4,263 5.8

30–49 9,113 22.9 4,959 14.5 14,072 19.0

50–69 16,442 41.2 13,348 39.1 29,790 40.3

70–79 8,089 20.3 9,048 26.5 17,137 23.2

> 80 3,394 8.5 5,302 15.5 8,696 11.8

Number of patients with one or more

primary cancers

One primary cancer only 36,828 92.4 31,944 93.7 68,772 93.0

1st and 2nd cancers 2,761 6.9 1,982 5.8 4,743 6.4

1st, 2nd, and 3rd cancers 244 0.6 155 0.5 399 0.5

1st, 2nd, 3rd, and additional cancers 28 0.1 16 0.0 44 0.1

Other statistics

Median age at 1st cancer diagnosis 61.0 — 67.0 — 63.8 —

Median year of 1st cancer diagnosis 1990.6 — 1990.0 — 1990.4 —

Median person-years at risk 2.5 — 3.0 — 2.7 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 95.2 — 95.4 — 95.3

1st, 2nd, and additional cancers — 94.8 — 94.9 — 94.8

1st cancer only — 3.8 — 3.9 — 3.8

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 417

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 743 1.08* 2,191 1.07* 1,548 1.19* 1,195 1.26* 5,677 4,996.09 1.14* 19.31

All excluding same site 719 1.08* 2,124 1.07* 1,496 1.19* 1,151 1.26* 5,490 4,818.52 1.14* 19.04

Buccal cavity, pharynx 24 1.35 56 1.09 51 1.64* 39 1.85* 170 121.53 1.40* 1.37

Lip 5 1.87 9 1.19 11 2.48* 6 2.05 31 17.60 1.76* 0.38

Tongue 1 0.28 14 1.34 11 1.71 9 2.04 35 24.85 1.41 0.29

Salivary gland 3 1.92 6 1.29 7 2.38 6 2.76* 22 11.32 1.94* 0.30

Mouth 9 1.90 14 1.02 13 1.56 9 1.62 45 32.42 1.39* 0.36

Nasopharynx 0 0.00 4 1.96 2 1.65 2 2.51 8 4.77 1.68 0.09

Tonsil 2 1.21 2 0.41 2 0.69 5 2.62 11 11.28 0.98 -0.01

Oropharynx 1 2.05 0 0.00 0 0.00 0 0.00 1 3.35 0.30 -0.07

Hypopharynx 2 1.15 5 0.99 4 1.34 1 0.52 12 11.66 1.03 0.01

Digestive system 139 0.90 455 1.00 296 1.04 238 1.17* 1,128 1,097.36 1.03 0.87

Esophagus 8 1.11 11 0.52* 13 0.97 13 1.34 45 51.65 0.87 -0.19

Stomach 16 1.04 46 1.04 37 1.37 21 1.12 120 105.37 1.14 0.41

Small intestine 3 1.41 6 0.94 7 1.68 4 1.27 20 15.83 1.26 0.12

Colon 66 0.93 222 1.06 141 1.06 123 1.29* 552 507.05 1.09 1.27

Rectum, rectosigmoid junction 22 0.82 84 1.08 47 0.98 27 0.82 180 185.07 0.97 -0.14

Anus, anal canal 0 0.00 9 2.03 2 0.70 2 0.96 13 10.85 1.20 0.06

Liver 7 1.38 11 0.74 11 1.15 6 0.84 35 36.71 0.95 -0.05

Gallbladder 1 0.44 3 0.46 2 0.49 2 0.71 8 15.70 0.51 -0.22

Bile ducts, other biliary 2 0.60 11 1.10 6 0.92 9 1.79 28 24.88 1.13 0.09

Pancreas 11 0.59 50 0.91 28 0.81 30 1.20 119 132.99 0.89 -0.40

Respiratory system 135 1.16 425 1.23* 312 1.44* 222 1.43* 1,094 833.08 1.31* 7.40

Nose, nasal cavity, ear 1 0.98 3 1.00 5 2.66 2 1.50 11 7.24 1.52 0.11

Larynx 11 1.45 24 1.09 19 1.44 6 0.69 60 51.46 1.17 0.24

Lung, bronchus 123 1.15 398 1.25* 288 1.43* 214 1.48* 1,023 772.27 1.32* 7.11

Female breast 45 0.57* 193 0.80* 145 0.92 122 1.06 505 591.64 0.85* -5.04

Female genital system 30 0.84 92 0.87 64 0.96 58 1.24 244 255.07 0.96 -0.64

Cervix uteri 3 0.76 6 0.53 3 0.45 6 1.38 18 26.45 0.68 -0.49

Corpus uteri 11 0.60 49 0.90 33 0.98 32 1.36 125 129.62 0.96 -0.27

Ovary 12 1.15 29 0.92 15 0.74 14 0.96 70 76.71 0.91 -0.39

Vagina 2 3.69 2 1.24 3 2.92 2 2.71 9 3.92 2.30* 0.30

Vulva 2 1.20 5 0.99 10 2.99* 3 1.18 20 12.60 1.59 0.43

Male genital system 89 0.71* 345 0.93 226 0.94 168 0.93 828 919.07 0.90* -5.04

Prostate 88 0.72* 338 0.92 222 0.93 168 0.94 816 906.97 0.90* -5.03

Testis 0 0.00 3 1.11 2 1.28 0 0.00 5 6.32 0.79 -0.07

Urinary system 91 1.69* 159 1.00 147 1.45* 136 1.83* 533 388.38 1.37* 4.10

Urinary bladder 34 0.92 111 1.02 104 1.50* 105 2.06* 354 266.58 1.33* 2.48

Kidney parenchyma 56 4.20* 39 0.98 39 1.52* 23 1.22 157 97.81 1.61* 1.68

Renal pelvis, other urinary 1 0.29 9 0.90 4 0.65 8 1.82 22 24.00 0.92 -0.06

Ureter 0 0.00 1 0.30 2 0.98 2 1.40 5 7.91 0.63 -0.08

Bone, joints 2 3.08 5 2.63 5 4.28* 4 4.90* 16 4.53 3.53* 0.33

Soft tissue including heart 0 0.00 12 1.47 11 2.11* 4 1.03 27 20.02 1.35 0.20

Kaposi sarcoma 64 48.45* 36 9.75* 10 4.42* 3 2.00 113 8.78 12.87* 2.96

Melanoma of skin 22 1.39 84 1.74* 53 1.68* 30 1.23 189 120.07 1.57* 1.95

Eye, orbit 2 1.93 2 0.66 2 1.07 0 0.00 6 7.25 0.83 -0.04

Brain, central nervous system 9 1.23 22 1.02 8 0.59 16 1.68 55 51.90 1.06 0.09

Thyroid 12 2.93* 14 1.15 8 1.05 4 0.73 38 29.41 1.29 0.24

Lymphatic, hematopoietic 52 0.99 200 1.28* 153 1.53* 95 1.29* 500 382.79 1.31* 3.32

Hodgkin lymphoma 3 1.58 29 5.34* 12 3.69* 17 7.70* 61 12.79 4.77* 1.37

Non-Hodgkin lymphoma 24 1.01 67 0.93 52 1.11 44 1.25 187 177.56 1.05 0.27

Myeloma 4 0.46 13 0.50* 11 0.67 7 0.58 35 63.05 0.56* -0.80

Leukemia 21 1.16 91 1.71* 78 2.32* 27 1.11 217 129.39 1.68* 2.48

Acute lymphocytic 1 1.82 0 0.00 2 1.99 0 0.00 3 3.86 0.78 -0.02

Chronic lymphocytic 2 0.28 11 0.52* 7 0.53 5 0.53 25 51.13 0.49* -0.74

Acute non-lymphocytic 11 1.80 59 3.27* 54 4.70* 18 2.13* 142 44.14 3.22* 2.77

Chronic myeloid 4 1.62 11 1.52 8 1.75 2 0.60 25 17.63 1.42 0.21

Non-Hodgkin Lymphoma

Both Sexes

Table 16.2.2: Risk of subsequent primary cancers after non-Hodgkin lymphoma, both sexes,

SEER 1973-2000.

418 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

NON-HODGKIN LYMPHOMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 73,958 54,226 26,404 11,779 73,958

Person-years in interval 51,532 149,798 90,252 61,113 352,695

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 171,844 PYR and for male cancers on 180,851 PYR.
Non-Hodgkin Lymphoma

Both Sexes, Long-term Follow-up

Table 16.2.3: Risk of subsequent primary cancers after non-Hodgkin lymphoma, both sexes,

long-term follow-up, SEER 1973-2000.

NON-HODGKIN LYMPHOMA

All subsequent cancers 4,482 1.11* 763 1.25* 307 1.22* 125 1.46* 5,677 4,996.09 1.14* 19.31

All excluding same site 4,339 1.11* 732 1.24* 298 1.23* 121 1.47* 5,490 4,818.52 1.14* 19.04

Buccal cavity, pharynx 131 1.30* 28 2.03* 11 2.03* 0 0.00 170 121.53 1.40* 1.37

Lip 25 1.70* 6 3.11* 0 0.00 0 0.00 31 17.60 1.76* 0.38

Tongue 26 1.27 6 2.08 3 2.61 0 0.00 35 24.85 1.41 0.29

Salivary gland 16 1.75 2 1.44 4 6.89* 0 0.00 22 11.32 1.94* 0.30

Mouth 36 1.34 8 2.18 1 0.70 0 0.00 45 32.42 1.39* 0.36

Nasopharynx 6 1.51 1 1.90 1 4.95 0 0.00 8 4.77 1.68 0.09

Tonsil 6 0.64 3 2.38 2 4.08 0 0.00 11 11.28 0.98 -0.01

Oropharynx 1 0.36 0 0.00 0 0.00 0 0.00 1 3.35 0.30 -0.07

Hypopharynx 11 1.13 1 0.78 0 0.00 0 0.00 12 11.66 1.03 0.01

Digestive system 890 1.00 137 1.04 72 1.34* 29 1.56* 1,128 1,097.36 1.03 0.87

Esophagus 32 0.76 10 1.61 3 1.17 0 0.00 45 51.65 0.87 -0.19

Stomach 99 1.14 13 1.07 7 1.44 1 0.61 120 105.37 1.14 0.41

Small intestine 16 1.26 2 1.00 2 2.35 0 0.00 20 15.83 1.26 0.12

Colon 429 1.04 71 1.16 37 1.47* 15 1.73 552 507.05 1.09 1.27

Rectum, rectosigmoid junction 153 1.01 12 0.56* 7 0.82 8 2.76* 180 185.07 0.97 -0.14

Anus, anal canal 11 1.26 0 0.00 2 3.58 0 0.00 13 10.85 1.20 0.06

Liver 29 0.98 6 1.33 0 0.00 0 0.00 35 36.71 0.95 -0.05

Gallbladder 6 0.47 2 1.10 0 0.00 0 0.00 8 15.70 0.51 -0.22

Bile ducts, other biliary 19 0.96 5 1.58 3 2.19 1 2.02 28 24.88 1.13 0.09

Pancreas 89 0.82 16 0.99 10 1.50 4 1.73 119 132.99 0.89 -0.40

Respiratory system 872 1.29* 141 1.41* 58 1.42* 23 1.66* 1,094 833.08 1.31* 7.40

Nose, nasal cavity, ear 9 1.52 1 1.16 1 2.84 0 0.00 11 7.24 1.52 0.11

Larynx 54 1.26 2 0.35 3 1.36 1 1.41 60 51.46 1.17 0.24

Lung, bronchus 809 1.29* 138 1.48* 54 1.41* 22 1.70* 1,023 772.27 1.32* 7.11

Female breast 383 0.80* 74 1.00 38 1.24 10 0.94 505 591.64 0.85* -5.04

Female genital system 186 0.89 42 1.39 11 0.89 5 1.19 244 255.07 0.96 -0.64

Cervix uteri 12 0.54* 4 1.39 2 1.79 0 0.00 18 26.45 0.68 -0.49

Corpus uteri 93 0.88 24 1.58* 5 0.81 3 1.42 125 129.62 0.96 -0.27

Ovary 56 0.90 9 0.96 3 0.78 2 1.51 70 76.71 0.91 -0.39

Vagina 7 2.20 1 2.10 1 5.11 0 0.00 9 3.92 2.30* 0.30

Vulva 17 1.69 3 1.87 0 0.00 0 0.00 20 12.60 1.59 0.43

Male genital system 660 0.89* 109 0.93 42 0.86 17 1.09 828 919.07 0.90* -5.04

Prostate 648 0.89* 109 0.94 42 0.87 17 1.10 816 906.97 0.90* -5.03

Testis 5 0.96 0 0.00 0 0.00 0 0.00 5 6.32 0.79 -0.07

Urinary system 397 1.26* 82 1.73* 34 1.72* 20 2.89* 533 388.38 1.37* 4.10

Urinary bladder 249 1.15* 62 1.90* 27 1.99* 16 3.36* 354 266.58 1.33* 2.48

Kidney parenchyma 134 1.70* 16 1.32 5 0.99 2 1.14 157 97.81 1.61* 1.68

Renal pelvis, other urinary 14 0.71 4 1.41 2 1.73 2 5.00 22 24.00 0.92 -0.06

Ureter 3 0.46 2 2.16 0 0.00 0 0.00 5 7.91 0.63 -0.08

Bone, joints 12 3.23* 2 3.80 1 4.65 1 13.47 16 4.53 3.53* 0.33

Soft tissue including heart 23 1.42 1 0.41 2 1.93 1 2.72 27 20.02 1.35 0.20

Kaposi sarcoma 110 15.12* 3 2.92 0 0.00 0 0.00 113 8.78 12.87* 2.96

Melanoma of skin 159 1.66* 22 1.43 4 0.61 4 1.64 189 120.07 1.57* 1.95

Eye, orbit 6 1.01 0 0.00 0 0.00 0 0.00 6 7.25 0.83 -0.04

Brain, central nervous system 39 0.92 9 1.46 5 2.01 2 2.36 55 51.90 1.06 0.09

Thyroid 34 1.42 4 1.14 0 0.00 0 0.00 38 29.41 1.29 0.24

Lymphatic, hematopoietic 405 1.31* 69 1.46* 16 0.81 10 1.45 500 382.79 1.31* 3.32

Hodgkin lymphoma 44 4.16* 11 7.60* 3 5.24* 3 16.01* 61 12.79 4.77* 1.37

Non-Hodgkin lymphoma 143 1.00 31 1.38 9 0.95 4 1.19 187 177.56 1.05 0.27

Myeloma 28 0.55* 5 0.65 1 0.31 1 0.90 35 63.05 0.56* -0.80

Leukemia 190 1.81* 22 1.41 3 0.46 2 0.89 217 129.39 1.68* 2.48

Acute lymphocytic 3 0.95 0 0.00 0 0.00 0 0.00 3 3.86 0.78 -0.02

Chronic lymphocytic 20 0.48* 3 0.49 1 0.40 1 1.18 25 51.13 0.49* -0.74

Acute non-lymphocytic 124 3.48* 15 2.78* 2 0.88 1 1.24 142 44.14 3.22* 2.77

Chronic myeloid 23 1.61* 2 0.93 0 0.00 0 0.00 25 17.63 1.42 0.21

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 73,958 11,779 5,002 1,800 73,958

Person-years in interval 291,582 39,961 15,837 5,315 352,695

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 171,844 PYR and for male cancers on 180,851 PYR.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 419
All subsequent cancers 258 0.92 852 1.00 676 1.22* 556 1.36* 2,342 2,090.46 1.12* 14.64

All excluding same site 249 0.92 828 1.01 651 1.22* 533 1.36* 2,261 2,010.36 1.12* 14.59

Buccal cavity, pharynx 2 0.40 14 0.93 20 2.09* 8 1.17 44 36.42 1.21 0.44

Lip 0 0.00 0 0.00 2 2.89 2 3.81 4 2.61 1.53 0.08

Tongue 0 0.00 4 1.21 6 2.82* 2 1.32 12 8.06 1.49 0.23

Salivary gland 0 0.00 3 1.79 5 4.63* 0 0.00 8 4.12 1.94 0.23

Mouth 2 1.15 3 0.58 4 1.20 3 1.26 12 12.65 0.95 -0.04

Nasopharynx 0 0.00 2 3.36 1 2.67 0 0.00 3 1.43 2.09 0.09

Tonsil 0 0.00 0 0.00 1 1.28 1 1.94 2 3.00 0.67 -0.06

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.89 0.00 -0.05

Hypopharynx 0 0.00 2 1.99 1 1.60 0 0.00 3 2.38 1.26 0.04

Digestive system 61 0.92 188 0.95 145 1.13 123 1.30* 517 486.76 1.06 1.76

Esophagus 2 1.14 2 0.38 4 1.15 6 2.31 14 13.15 1.06 0.05

Stomach 6 1.16 19 1.26 15 1.56 15 2.18* 55 36.79 1.50* 1.06

Small intestine 0 0.00 2 0.72 3 1.60 0 0.00 5 7.01 0.71 -0.12

Colon 32 0.96 99 1.00 76 1.17 69 1.44* 276 245.43 1.12 1.78

Rectum, rectosigmoid junction 10 0.96 31 1.00 25 1.28 10 0.72 76 74.70 1.02 0.08

Rectum 7 1.03 25 1.24 16 1.24 6 0.65 54 49.17 1.10 0.28

Anus, anal canal 0 0.00 3 1.15 0 0.00 1 0.79 4 6.45 0.62 -0.14

Liver 3 2.15 1 0.24 4 1.42 1 0.46 9 10.65 0.85 -0.10

Gallbladder 1 0.65 2 0.45 2 0.72 1 0.52 6 10.70 0.56 -0.27

Bile ducts, other biliary 1 0.69 4 0.91 4 1.35 4 1.71 13 11.16 1.16 0.11

Pancreas 5 0.58 25 0.97 11 0.65 15 1.18 56 64.15 0.87 -0.47

Respiratory system 43 1.19 144 1.27* 129 1.70* 97 1.66* 413 283.63 1.46* 7.53

Nose, nasal cavity, ear 0 0.00 1 0.87 1 1.32 0 0.00 2 2.85 0.70 -0.05

Larynx 0 0.00 6 1.72 4 1.80 2 1.28 12 8.42 1.43 0.21

Lung, bronchus 43 1.24 137 1.27* 124 1.70* 95 1.70* 399 271.65 1.47* 7.41

Female breast 45 0.57* 193 0.80* 145 0.92 122 1.06 505 591.64 0.85* -5.04

Female genital system 30 0.84 92 0.87 64 0.96 58 1.24 244 255.07 0.96 -0.64

Cervix uteri 3 0.76 6 0.53 3 0.45 6 1.38 18 26.45 0.68 -0.49

Corpus uteri 11 0.60 49 0.90 33 0.98 32 1.36 125 129.62 0.96 -0.27

Ovary 12 1.15 29 0.92 15 0.74 14 0.96 70 76.71 0.91 -0.39

Vagina 2 3.69 2 1.24 3 2.92 2 2.71 9 3.92 2.30* 0.30

Vulva 2 1.20 5 0.99 10 2.99* 3 1.18 20 12.60 1.59 0.43

Urinary system 28 2.07* 35 0.85 38 1.40 51 2.49* 152 102.32 1.49* 2.89

Urinary bladder 8 0.99 25 1.02 27 1.68* 41 3.38* 101 60.65 1.67* 2.35

Kidney parenchyma 19 4.41* 6 0.45* 11 1.24 6 0.89 42 33.25 1.26 0.51

Renal pelvis, other urinary 1 0.87 4 1.17 0 0.00 4 2.46 9 8.42 1.07 0.03

Ureter 0 0.00 1 0.94 0 0.00 2 4.01 3 2.61 1.15 0.02

Bone, joints 2 7.50 0 0.00 4 7.93* 2 5.49 8 1.93 4.14* 0.35

Soft tissue including heart 0 0.00 4 1.19 3 1.36 2 1.20 9 8.34 1.08 0.04

Kaposi sarcoma 0 0.00 1 3.05 4 18.04* 0 0.00 5 0.82 6.06* 0.24

Melanoma of skin 11 2.00 30 1.75* 22 1.94* 9 1.03 72 42.69 1.69* 1.71

Eye, orbit 1 2.36 1 0.80 0 0.00 0 0.00 2 3.02 0.66 -0.06

Brain, central nervous system 1 0.34 8 0.90 3 0.53 7 1.72 19 21.53 0.88 -0.15

Thyroid 6 2.37 10 1.30 5 1.03 3 0.85 24 18.59 1.29 0.31

Lymphatic, hematopoietic 20 0.92 86 1.31* 76 1.75* 44 1.34 226 163.88 1.38* 3.61

Hodgkin lymphoma 1 1.42 11 5.28* 6 4.61* 6 6.64* 24 4.99 4.81* 1.11

Non-Hodgkin lymphoma 9 0.87 24 0.75 25 1.17 23 1.40 81 80.11 1.01 0.05

Myeloma 3 0.82 9 0.81 5 0.68 3 0.55 20 27.54 0.73 -0.44

Leukemia 7 1.01 42 2.03* 40 2.96* 12 1.19 101 51.24 1.97* 2.90

Acute lymphocytic 1 4.81 0 0.00 1 2.46 0 0.00 2 1.54 1.30 0.03

Chronic lymphocytic 1 0.37 5 0.62 3 0.57 3 0.78 12 19.77 0.61 -0.45

Acute non-lymphocytic 3 1.23 31 4.22* 28 5.82* 8 2.19 70 18.24 3.84* 3.01

Chronic myeloid 1 1.06 4 1.41 4 2.16 0 0.00 9 7.02 1.28 0.12

Non-Hodgkin Lymphoma

Females

Table 16.2.4: Risk of subsequent primary cancers after non-Hodgkin lymphoma, females,

SEER 1973-2000.

420 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

NON-HODGKIN LYMPHOMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 34,097 25,711 12,979 5,881 34,097

Person-years in interval 24,158 72,195 44,679 30,813 171,844

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Non-Hodgkin Lymphoma

Males

Table 16.2.5: Risk of subsequent primary cancers after non-Hodgkin lymphoma, males,

SEER 1973-2000.

NON-HODGKIN LYMPHOMA

All subsequent cancers 485 1.18* 1,339 1.11* 872 1.16* 639 1.18* 3,335 2,905.62 1.15* 23.74

All excluding same site 470 1.18* 1,296 1.12* 845 1.16* 618 1.18* 3,229 2,808.17 1.15* 23.27

Buccal cavity, pharynx 22 1.73* 42 1.15 31 1.44 31 2.18* 126 85.11 1.48* 2.26

Lip 5 2.15 9 1.38 9 2.40* 4 1.66 27 14.98 1.80* 0.66

Tongue 1 0.41 10 1.40 5 1.17 7 2.41 23 16.79 1.37 0.34

Salivary gland 3 2.98 3 1.01 2 1.07 6 4.39* 14 7.20 1.94* 0.38

Mouth 7 2.33 11 1.28 9 1.80 6 1.88 33 19.77 1.67* 0.73

Nasopharynx 0 0.00 2 1.38 1 1.19 2 3.76 5 3.34 1.50 0.09

Tonsil 2 1.63 2 0.56 1 0.48 4 2.87 9 8.27 1.09 0.04

Oropharynx 1 2.74 0 0.00 0 0.00 0 0.00 1 2.46 0.41 -0.08

Hypopharynx 2 1.43 3 0.75 3 1.27 1 0.67 9 9.28 0.97 -0.02

Digestive system 78 0.88 267 1.04 151 0.96 115 1.05 611 610.60 1.00 0.02

Esophagus 6 1.09 9 0.56 9 0.91 7 0.99 31 38.50 0.81 -0.41

Stomach 10 0.98 27 0.93 22 1.26 6 0.51 65 68.58 0.95 -0.20

Small intestine 3 2.46 4 1.11 4 1.74 4 2.37 15 8.82 1.70 0.34

Colon 34 0.90 123 1.13 65 0.96 54 1.14 276 261.62 1.05 0.80

Rectum, rectosigmoid junction 12 0.74 53 1.13 22 0.78 17 0.89 104 110.37 0.94 -0.35

Anus, anal canal 0 0.00 6 3.29* 2 1.76 1 1.22 9 4.40 2.05 0.25

Liver 4 1.09 10 0.93 7 1.04 5 1.01 26 26.06 1.00 0.00

Gallbladder 0 0.00 1 0.47 0 0.00 1 1.15 2 4.99 0.40 -0.17

Bile ducts, other biliary 1 0.53 7 1.26 2 0.56 5 1.86 15 13.72 1.09 0.07

Pancreas 6 0.60 25 0.87 17 0.97 15 1.22 63 68.83 0.92 -0.32

Respiratory system 92 1.15 281 1.21* 183 1.30* 125 1.29* 681 549.45 1.24* 7.27

Nose, nasal cavity, ear 1 1.55 2 1.08 4 3.55 2 2.58 9 4.40 2.05 0.25

Larynx 11 1.71 18 0.97 15 1.37 4 0.56 48 43.04 1.12 0.27

Lung, bronchus 80 1.10 261 1.24* 164 1.27* 119 1.34* 624 500.63 1.25* 6.82

Male breast 0 0.00 3 1.32 2 1.41 2 1.94 7 5.49 1.27 0.08

Male genital system 89 0.71* 345 0.93 226 0.94 168 0.93 828 919.07 0.90* -5.04

Prostate 88 0.72* 338 0.92 222 0.93 168 0.94 816 906.97 0.90* -5.03

Testis 0 0.00 3 1.11 2 1.28 0 0.00 5 6.32 0.79 -0.07

Urinary system 63 1.56* 124 1.05 109 1.47* 85 1.58* 381 286.06 1.33* 5.25

Urinary bladder 26 0.90 86 1.01 77 1.45* 64 1.65* 253 205.93 1.23* 2.60

Kidney parenchyma 37 4.10* 33 1.24 28 1.67* 17 1.40 115 64.56 1.78* 2.79

Renal pelvis, other urinary 0 0.00 5 0.76 4 1.01 4 1.45 13 15.58 0.83 -0.14

Ureter 0 0.00 0 0.00 2 1.48 0 0.00 2 5.30 0.38 -0.18

Bone, joints 0 0.00 5 4.54* 1 1.50 2 4.43 8 2.60 3.08* 0.30

Soft tissue including heart 0 0.00 8 1.66 8 2.67* 2 0.91 18 11.68 1.54 0.35

Kaposi sarcoma 64 52.78* 35 10.41* 6 2.94* 3 2.25 108 7.95 13.58* 5.53

Melanoma of skin 11 1.07 54 1.74* 31 1.53* 21 1.34 117 77.38 1.51* 2.19

Eye, orbit 1 1.63 1 0.56 2 1.85 0 0.00 4 4.23 0.95 -0.01

Brain, central nervous system 8 1.83 14 1.10 5 0.64 9 1.66 36 30.38 1.19 0.31

Thyroid 6 3.84* 4 0.88 3 1.09 1 0.51 14 10.82 1.29 0.18

Lymphatic, hematopoietic 32 1.03 114 1.26* 77 1.36* 51 1.24 274 218.91 1.25* 3.05

Hodgkin lymphoma 2 1.67 18 5.38* 6 3.08* 11 8.44* 37 7.79 4.75* 1.61

Non-Hodgkin lymphoma 15 1.11 43 1.08 27 1.07 21 1.11 106 97.46 1.09 0.47

Myeloma 1 0.20 4 0.27* 6 0.65 4 0.60 15 35.52 0.42* -1.13

Leukemia 14 1.25 49 1.51* 38 1.89* 15 1.05 116 78.15 1.48* 2.09

Acute lymphocytic 0 0.00 0 0.00 1 1.67 0 0.00 1 2.32 0.43 -0.07

Chronic lymphocytic 1 0.22 6 0.46* 4 0.49 2 0.35 13 31.35 0.41* -1.01

Acute non-lymphocytic 8 2.17 28 2.61* 26 3.90* 10 2.08 72 25.90 2.78* 2.55

Chronic myeloid 3 1.96 7 1.59 4 1.47 2 1.01 16 10.62 1.51 0.30

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 39,861 28,515 13,425 5,898 39,861

Person-years in interval 27,374 77,603 45,574 30,299 180,851

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 421
All subsequent cancers 7 6.57* 25 5.95* 16 3.18* 19 1.67* 67 21.69 3.09* 15.38

All excluding same site 6 6.08* 23 5.92* 13 2.79* 17 1.60 59 20.17 2.93* 13.18

Buccal cavity, pharynx 0 0.00 0 0.00 1 9.46 1 3.18 2 0.52 3.82 0.50

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.02

Tongue 0 0.00 0 0.00 0 0.00 1 12.60 1 0.12 8.26 0.30

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.03

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.03

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.02

Tonsil 0 0.00 0 0.00 1 160.32* 0 0.00 1 0.06 17.94 0.32

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Digestive system 0 0.00 1 4.86 0 0.00 3 2.62 4 1.71 2.34 0.78

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.02

Stomach 0 0.00 0 0.00 0 0.00 1 8.53 1 0.19 5.37 0.28

Small intestine 0 0.00 0 0.00 0 0.00 1 25.78 1 0.06 16.43 0.32

Colon 0 0.00 1 12.93 0 0.00 0 0.00 1 0.62 1.62 0.13

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.11

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.02

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.04

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.01

Pancreas 0 0.00 0 0.00 0 0.00 1 8.85 1 0.15 6.58 0.29

Respiratory system 0 0.00 1 12.61 1 7.10 1 1.40 3 0.96 3.14 0.69

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.01

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.03

Lung, bronchus 0 0.00 1 20.66 1 9.61 1 1.64 3 0.77 3.89 0.76

Female breast 0 0.00 0 0.00 2 3.14 6 2.47 8 3.43 2.33* 4.12

Female genital system 0 0.00 1 2.59 0 0.00 0 0.00 1 2.01 0.50 -0.91

Cervix uteri 0 0.00 1 4.83 0 0.00 0 0.00 1 0.89 1.13 0.10

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.34

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -0.57

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.05

Male genital system 0 0.00 0 0.00 1 2.14 0 0.00 1 1.88 0.53 -0.48

Prostate 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.14

Testis 0 0.00 0 0.00 1 2.18 0 0.00 1 1.60 0.62 -0.33

Urinary system 0 0.00 0 0.00 0 0.00 1 2.01 1 0.76 1.32 0.08

Urinary bladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.13

Kidney parenchyma 0 0.00 0 0.00 0 0.00 1 4.18 1 0.36 2.78 0.22

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Bone, joints 0 0.00 1 11.64 1 14.21 0 0.00 2 0.25 7.96 0.59

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.13

Kaposi sarcoma 5 98.15* 4 16.22* 1 2.76 0 0.00 10 1.15 8.71* 3.00

Melanoma of skin 0 0.00 3 6.36* 2 3.44 1 0.92 6 2.25 2.66 1.27

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.02

Brain, central nervous system 1 12.16 0 0.00 0 0.00 1 2.86 2 0.96 2.08 0.35

Thyroid 0 0.00 2 5.90 2 5.52 1 1.79 5 1.35 3.71* 1.24

Lymphatic, hematopoietic 1 3.60 10 10.50* 5 5.36* 4 2.71 20 3.64 5.50* 5.55

Hodgkin lymphoma 0 0.00 4 10.65* 1 3.12 1 3.00 6 1.14 5.25* 1.65

Non-Hodgkin lymphoma 1 12.59 2 6.40 3 7.89* 2 2.67 8 1.52 5.26* 2.20

Myeloma 0 0.00 0 0.00 1 74.16 0 0.00 1 0.09 11.24 0.31

Leukemia 0 0.00 4 15.55* 0 0.00 1 3.07 5 0.89 5.65* 1.40

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.09

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.02

Acute non-lymphocytic 0 0.00 4 41.37* 0 0.00 1 7.66 5 0.35 14.48* 1.58

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.06

Non-Hodgkin Lymphoma

Both Sexes, <30 Years of Age

Table 16.2.6: Risk of subsequent primary cancers after non-Hodgkin lymphoma, both sexes,

<30 years of age, SEER 1973-2000.

422 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

NON-HODGKIN LYMPHOMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,263 3,217 1,997 1,256 4,263

Person-years in interval 3,058 9,828 8,031 8,545 29,463

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 11,090 PYR and for male cancers on 18,373 PYR.
Non-Hodgkin Lymphoma

Both Sexes, 30-49 Years of Age

Table 16.2.7: Risk of subsequent primary cancers after non-Hodgkin lymphoma, both sexes,

30-49 years of age, SEER 1973-2000.

NON-HODGKIN LYMPHOMA

All subsequent cancers 93 4.21* 151 1.68* 161 1.71* 260 1.66* 665 362.91 1.83* 37.29

All excluding same site 88 4.22* 139 1.63* 154 1.71* 250 1.66* 631 346.90 1.82* 35.07

Buccal cavity, pharynx 1 1.18 5 1.44 8 2.24 9 1.88 23 12.70 1.81* 1.27

Lip 0 0.00 0 0.00 1 3.11 1 2.26 2 1.20 1.67 0.10

Tongue 0 0.00 1 1.26 3 3.59 2 1.77 6 2.95 2.03 0.38

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 1.08 0.00 -0.13

Mouth 0 0.00 2 2.38 2 2.24 2 1.66 6 3.14 1.91 0.35

Nasopharynx 0 0.00 1 4.28 0 0.00 1 4.29 2 0.74 2.71 0.16

Tonsil 1 8.16 1 1.97 0 0.00 3 4.77 5 1.78 2.81 0.40

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.04

Hypopharynx 0 0.00 0 0.00 2 6.39 0 0.00 2 1.09 1.83 0.11

Digestive system 1 0.34 17 1.34 17 1.17 42 1.60* 77 56.31 1.37* 2.55

Esophagus 0 0.00 1 1.25 0 0.00 5 2.90 6 3.66 1.64 0.29

Stomach 1 3.06 1 0.76 1 0.72 5 2.22 8 5.30 1.51 0.33

Small intestine 0 0.00 1 2.90 1 2.78 0 0.00 2 1.35 1.48 0.08

Colon 0 0.00 6 1.30 4 0.74 16 1.53 26 21.59 1.20 0.54

Rectum, rectosigmoid junction 0 0.00 3 1.16 5 1.65 5 0.96 13 11.38 1.14 0.20

Anus, anal canal 0 0.00 4 12.36* 1 3.17 1 2.29 6 1.16 5.18* 0.60

Liver 0 0.00 1 1.47 0 0.00 1 0.82 2 2.81 0.71 -0.10

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.07

Bile ducts, other biliary 0 0.00 0 0.00 2 7.10 3 5.45* 5 1.14 4.40* 0.48

Pancreas 0 0.00 0 0.00 3 1.77 6 1.91 9 6.59 1.37 0.30

Respiratory system 5 2.05 19 1.69* 35 2.53* 60 2.30* 119 53.56 2.22* 8.08

Nose, nasal cavity, ear 0 0.00 1 5.43 0 0.00 1 4.13 2 0.65 3.07 0.17

Larynx 0 0.00 1 0.87 3 2.25 2 0.97 6 4.80 1.25 0.15

Lung, bronchus 5 2.37 17 1.72* 32 2.61* 57 2.41* 111 47.90 2.32* 7.79

Female breast 6 1.24 5 0.25* 19 0.99 31 1.24 61 68.60 0.89 -2.22

Female genital system 4 2.13 7 0.92 15 2.04* 17 1.72* 43 26.74 1.61* 4.75

Cervix uteri 2 3.35 2 0.99 1 0.69 3 2.42 8 5.31 1.51 0.78

Corpus uteri 2 3.34 2 0.71 8 2.49* 8 1.58 20 11.68 1.71* 2.43

Ovary 0 0.00 3 1.27 1 0.44 4 1.34 8 8.21 0.97 -0.06

Vagina 0 0.00 0 0.00 1 14.79 1 9.76 2 0.25 7.86 0.51

Vulva 0 0.00 0 0.00 4 19.27* 1 3.37 5 0.78 6.40* 1.23

Male genital system 0 0.00 8 1.41 11 1.24 21 0.78 40 42.75 0.94 -0.59

Prostate 0 0.00 4 0.95 9 1.12 21 0.79 34 39.35 0.86 -1.14

Testis 0 0.00 2 1.45 1 1.41 0 0.00 3 2.97 1.01 0.01

Urinary system 8 6.29* 6 1.10 13 2.09* 32 2.89* 59 24.07 2.45* 4.31

Urinary bladder 1 1.52 3 1.04 9 2.62* 22 3.32* 35 13.61 2.57* 2.64

Kidney parenchyma 7 12.39* 1 0.42 4 1.57 8 2.02 20 9.45 2.12* 1.30

Renal pelvis, other urinary 0 0.00 2 9.24* 0 0.00 2 4.09 4 1.00 3.98* 0.37

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.03

Bone, joints 1 15.43 3 14.01* 1 6.03 2 10.91* 7 0.63 11.14* 0.79

Soft tissue including heart 0 0.00 2 2.77 2 3.31 0 0.00 4 2.26 1.77 0.21

Kaposi sarcoma 49 70.76* 28 15.14* 6 5.93* 2 4.07 85 4.05 21.01* 9.99

Melanoma of skin 4 2.37 13 2.14* 10 1.93 7 1.16 34 18.99 1.79* 1.85

Eye, orbit 0 0.00 0 0.00 1 4.95 0 0.00 1 0.74 1.36 0.03

Brain, central nervous system 1 1.84 3 1.53 0 0.00 3 1.44 7 6.31 1.11 0.09

Thyroid 2 2.82 5 2.05 1 0.54 0 0.00 8 6.78 1.18 0.15

Lymphatic, hematopoietic 8 3.47* 26 3.06* 20 2.54* 26 2.29* 80 30.04 2.66* 6.17

Hodgkin lymphoma 1 3.21 4 4.28* 2 3.25 7 13.26* 14 2.39 5.86* 1.43

Non-Hodgkin lymphoma 5 3.97* 12 2.61* 7 1.65 10 1.69 34 16.01 2.12* 2.22

Myeloma 0 0.00 1 1.26 0 0.00 1 0.60 2 3.57 0.56 -0.19

Leukemia 2 3.59 9 4.17* 11 5.22* 8 2.46* 30 8.07 3.72* 2.71

Acute lymphocytic 0 0.00 0 0.00 1 7.49 0 0.00 1 0.49 2.03 0.06

Chronic lymphocytic 0 0.00 1 1.77 2 2.85 1 0.79 4 2.66 1.51 0.17

Acute non-lymphocytic 2 9.57* 7 9.11* 8 11.38* 7 6.52* 24 2.75 8.71* 2.62

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.34 0.00 -0.17

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 14,072 10,546 5,970 3,067 14,072

Person-years in interval 9,923 31,329 21,636 18,127 81,016

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 34,275 PYR and for male cancers on 46,741 PYR.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 423
All subsequent cancers 317 1.20* 1,067 1.13* 893 1.17* 772 1.19* 3,049 2,621.79 1.16* 26.44

All excluding same site 307 1.20* 1,039 1.13* 865 1.17* 745 1.20* 2,956 2,533.45 1.17* 26.16

Buccal cavity, pharynx 12 1.39 24 0.85 29 1.50* 26 1.92* 91 69.67 1.31* 1.32

Lip 2 1.92 4 1.15 7 2.77* 3 1.51 16 9.05 1.77* 0.43

Tongue 0 0.00 7 1.19 7 1.73 6 2.16 20 14.54 1.38 0.34

Salivary gland 1 1.71 3 1.47 4 2.55 5 3.67* 13 5.55 2.34* 0.46

Mouth 6 2.62 4 0.54 7 1.37 7 1.95 24 18.45 1.30 0.34

Nasopharynx 0 0.00 2 1.67 0 0.00 1 2.13 3 2.81 1.07 0.01

Tonsil 1 1.05 1 0.33 1 0.53 2 1.77 5 6.97 0.72 -0.12

Oropharynx 1 3.67 0 0.00 0 0.00 0 0.00 1 2.13 0.47 -0.07

Hypopharynx 0 0.00 2 0.63 2 0.95 1 0.76 5 7.54 0.66 -0.16

Digestive system 56 1.09 190 1.02 160 1.04 151 1.10 557 528.47 1.05 1.77

Esophagus 4 1.26 5 0.46 8 0.96 6 0.90 23 29.13 0.79 -0.38

Stomach 6 1.20 16 0.90 16 1.12 11 0.88 49 49.45 0.99 -0.03

Small intestine 2 2.47 4 1.37 4 1.68 3 1.43 13 8.20 1.59 0.30

Colon 22 1.03 90 1.13 81 1.19 83 1.29* 276 232.99 1.18* 2.66

Rectum, rectosigmoid junction 12 1.18 38 1.07 29 1.05 16 0.72 95 95.68 0.99 -0.04

Anus, anal canal 0 0.00 4 1.86 1 0.61 1 0.77 6 5.71 1.05 0.02

Liver 2 1.01 6 0.86 7 1.24 4 0.82 19 19.54 0.97 -0.03

Gallbladder 0 0.00 1 0.44 0 0.00 2 1.07 3 6.74 0.45 -0.23

Bile ducts, other biliary 1 1.02 3 0.82 2 0.63 4 1.20 10 11.15 0.90 -0.07

Pancreas 6 0.96 22 0.97 11 0.59 20 1.18 59 64.51 0.91 -0.34

Respiratory system 74 1.45* 262 1.45* 199 1.42* 145 1.30* 680 483.01 1.41* 12.19

Nose, nasal cavity, ear 0 0.00 2 1.43 5 4.79* 1 1.16 8 3.73 2.14 0.26

Larynx 5 1.22 18 1.34 12 1.31 4 0.67 39 32.61 1.20 0.40

Lung, bronchus 69 1.49* 242 1.47* 182 1.40* 140 1.34* 633 445.56 1.42* 11.60

Female breast 22 0.68 100 0.88 66 0.75* 64 0.89 252 305.38 0.83* -6.76

Female genital system 8 0.51* 48 0.90 32 0.83 30 1.02 118 137.29 0.86 -2.44

Cervix uteri 0 0.00 2 0.37 1 0.29 1 0.45 4 12.81 0.31* -1.12

Corpus uteri 2 0.23* 27 0.91 18 0.85 18 1.16 65 75.01 0.87 -1.27

Ovary 5 1.14 15 0.99 8 0.70 10 1.10 38 39.96 0.95 -0.25

Vagina 1 5.74 2 3.24 2 3.92 1 2.13 6 1.77 3.39* 0.54

Vulva 0 0.00 1 0.61 3 2.06 0 0.00 4 5.07 0.79 -0.14

Male genital system 36 0.79 161 0.91 139 0.89 131 0.97 467 513.21 0.91* -5.59

Prostate 35 0.78 160 0.91 138 0.89 131 0.98 464 508.89 0.91* -5.43

Testis 0 0.00 1 1.50 0 0.00 0 0.00 1 1.40 0.71 -0.05

Urinary system 43 2.18* 84 1.18 97 1.66* 92 1.79* 316 200.68 1.57* 7.14

Urinary bladder 14 1.10 58 1.24 68 1.74* 72 2.02* 212 134.26 1.58* 4.81

Kidney parenchyma 29 4.97* 24 1.18 27 1.72* 14 1.11 94 54.42 1.73* 2.45

Renal pelvis, other urinary 0 0.00 2 0.47 2 0.57 6 1.92 10 12.00 0.83 -0.12

Ureter 0 0.00 0 0.00 0 0.00 2 1.93 2 3.97 0.50 -0.12

Bone, joints 0 0.00 1 1.16 3 4.81 2 4.28 6 2.21 2.72 0.23

Soft tissue including heart 0 0.00 7 2.00 6 2.23 3 1.26 16 9.59 1.67 0.40

Kaposi sarcoma 9 33.81* 4 5.15* 2 4.27 1 2.73 16 1.88 8.52* 0.87

Melanoma of skin 8 1.18 39 1.68* 31 1.78* 21 1.45 99 61.83 1.60* 2.30

Eye, orbit 1 2.28 1 0.67 0 0.00 0 0.00 2 3.87 0.52 -0.12

Brain, central nervous system 7 2.15 11 1.00 5 0.62 11 1.80 34 28.41 1.20 0.35

Thyroid 5 2.67 4 0.67 4 1.01 3 1.10 16 14.54 1.10 0.09

Lymphatic, hematopoietic 22 1.21 87 1.33* 84 1.56* 54 1.10 247 186.37 1.33* 3.75

Hodgkin lymphoma 1 1.37 14 6.04* 6 3.82* 8 7.01* 29 5.76 5.04* 1.44

Non-Hodgkin lymphoma 10 1.16 28 0.90 28 1.10 27 1.16 93 88.34 1.05 0.29

Myeloma 1 0.33 3 0.27* 6 0.65 5 0.60 15 31.62 0.47* -1.03

Leukemia 10 1.72 42 1.98* 44 2.51* 14 0.87 110 60.65 1.81* 3.05

Acute lymphocytic 1 5.32 0 0.00 1 2.05 0 0.00 2 1.71 1.17 0.02

Chronic lymphocytic 1 0.41 7 0.79 3 0.41 2 0.31 13 25.07 0.52* -0.75

Acute non-lymphocytic 4 2.12 30 4.29* 33 5.53* 9 1.58 76 20.57 3.70* 3.43

Chronic myeloid 2 2.57 3 1.09 4 1.77 2 0.93 11 7.94 1.39 0.19

Non-Hodgkin Lymphoma

Both Sexes, 50-69 Years of Age

Table 16.2.8: Risk of subsequent primary cancers after non-Hodgkin lymphoma, both sexes,

50-69 years of age, SEER 1973-2000.

424 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

NON-HODGKIN LYMPHOMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 29,790 23,540 12,338 5,779 29,790

Person-years in interval 21,789 67,636 43,148 28,981 161,555

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 78,918 PYR and for male cancers on 82,637 PYR.
Non-Hodgkin Lymphoma

Both Sexes, ≥70 Years of Age

Table 16.2.9: Risk of subsequent primary cancers after non-Hodgkin lymphoma, both sexes,

≥70 years of age, SEER 1973-2000.

NON-HODGKIN LYMPHOMA

All subsequent cancers 326 0.81* 948 0.94 478 1.08 144 1.06 1,896 1,989.70 0.95* -11.62

All excluding same site 318 0.82* 923 0.95 464 1.09 139 1.07 1,844 1,918.01 0.96 -9.17

Buccal cavity, pharynx 11 1.33 27 1.36 13 1.59 3 1.24 54 38.64 1.40* 1.90

Lip 3 1.94 5 1.35 3 1.91 2 4.24 13 7.29 1.78 0.71

Tongue 1 0.64 6 1.61 1 0.66 0 0.00 8 7.23 1.11 0.09

Salivary gland 2 2.26 3 1.33 3 2.82 1 2.65 9 4.58 1.96 0.55

Mouth 3 1.34 8 1.47 4 1.73 0 0.00 15 10.75 1.40 0.53

Nasopharynx 0 0.00 1 1.68 2 8.54 0 0.00 3 1.15 2.60 0.23

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 2.47 0.00 -0.31

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.86 0.00 -0.11

Hypopharynx 2 2.82 3 1.86 0 0.00 0 0.00 5 3.00 1.66 0.25

Digestive system 82 0.82 247 0.97 119 1.01 42 1.08 490 510.86 0.96 -2.59

Esophagus 4 1.03 5 0.52 5 1.23 2 1.60 16 18.79 0.85 -0.35

Stomach 9 0.89 29 1.15 20 1.76* 4 1.06 62 50.44 1.23 1.43

Small intestine 1 0.82 1 0.32 2 1.41 0 0.00 4 6.21 0.64 -0.27

Colon 44 0.91 125 1.00 56 0.95 24 1.20 249 251.86 0.99 -0.35

Rectum, rectosigmoid junction 10 0.63 43 1.09 13 0.76 6 1.15 72 77.67 0.93 -0.70

Anus, anal canal 0 0.00 1 0.51 0 0.00 0 0.00 1 3.91 0.26 -0.36

Liver 5 1.72 4 0.55 4 1.27 1 1.07 14 14.25 0.98 -0.03

Gallbladder 1 0.61 2 0.48 2 1.04 0 0.00 5 8.39 0.60 -0.42

Bile ducts, other biliary 1 0.43 8 1.32 2 0.66 2 1.79 13 12.56 1.04 0.06

Pancreas 5 0.41* 28 0.91 14 0.99 3 0.62 50 61.74 0.81 -1.46

Respiratory system 56 0.89 143 0.93 77 1.23 16 0.96 292 295.56 0.99 -0.44

Nose, nasal cavity, ear 1 1.80 0 0.00 0 0.00 0 0.00 1 2.82 0.35 -0.23

Larynx 6 1.87 5 0.67 4 1.49 0 0.00 15 13.96 1.07 0.13

Lung, bronchus 49 0.83 138 0.96 73 1.23 16 1.01 276 278.04 0.99 -0.25

Female breast 17 0.41* 88 0.82 58 1.17 21 1.29 184 214.23 0.86* -6.36

Female genital system 18 1.01 36 0.80 17 0.86 11 1.71 82 89.03 0.92 -1.48

Cervix uteri 1 0.64 1 0.26 1 0.63 2 3.94 5 7.43 0.67 -0.51

Corpus uteri 7 0.80 20 0.91 7 0.76 6 2.22 40 42.56 0.94 -0.54

Ovary 7 1.29 11 0.79 6 0.94 0 0.00 24 27.91 0.86 -0.82

Vagina 1 2.85 0 0.00 0 0.00 0 0.00 1 1.88 0.53 -0.18

Vulva 2 1.70 4 1.26 3 1.81 2 2.96 11 6.69 1.65 0.91

Male genital system 53 0.68* 176 0.93 75 0.99 16 0.85 320 361.22 0.89* -12.45

Prostate 53 0.68* 174 0.93 75 1.00 16 0.85 318 358.47 0.89* -12.23

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.10

Urinary system 40 1.22 69 0.84 37 1.01 11 0.98 157 162.88 0.96 -0.73

Urinary bladder 19 0.80 50 0.84 27 1.01 11 1.33 107 118.33 0.90 -1.40

Kidney parenchyma 20 2.89* 14 0.81 8 1.09 0 0.00 42 33.58 1.25 1.04

Renal pelvis, other urinary 1 0.45 5 0.90 2 0.82 0 0.00 8 10.97 0.73 -0.37

Ureter 0 0.00 1 0.54 2 2.48 0 0.00 3 3.67 0.82 -0.08

Bone, joints 1 3.31 0 0.00 0 0.00 0 0.00 1 1.45 0.69 -0.06

Soft tissue including heart 0 0.00 3 0.78 3 1.66 1 1.64 7 7.79 0.90 -0.10

Kaposi sarcoma 1 3.21 0 0.00 1 2.39 0 0.00 2 1.71 1.17 0.04

Melanoma of skin 10 1.39 29 1.57* 10 1.18 1 0.35 50 37.01 1.35* 1.61

Eye, orbit 1 1.86 1 0.76 1 1.79 0 0.00 3 2.58 1.16 0.05

Brain, central nervous system 0 0.00 8 0.95 3 0.86 1 1.04 12 16.22 0.74 -0.52

Thyroid 5 3.51* 3 0.87 1 0.70 0 0.00 9 6.74 1.34 0.28

Lymphatic, hematopoietic 21 0.66 77 0.95 44 1.17 11 0.90 153 162.75 0.94 -1.21

Hodgkin lymphoma 1 1.34 7 3.88* 3 4.04 1 4.87 12 3.50 3.43* 1.05

Non-Hodgkin lymphoma 8 0.57 25 0.70 14 0.84 5 0.94 52 71.69 0.73* -2.44

Myeloma 3 0.55 9 0.64 4 0.63 1 0.50 17 27.78 0.61* -1.34

Leukemia 9 0.77 36 1.21 23 1.67* 4 0.86 72 59.78 1.20 1.52

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.39 0.00 -0.17

Chronic lymphocytic 1 0.22 3 0.26* 2 0.38 2 1.13 8 23.35 0.34* -1.90

Acute non-lymphocytic 5 1.25 18 1.76* 13 2.76* 1 0.64 37 20.47 1.81* 2.05

Chronic myeloid 2 1.28 8 1.98 4 2.08 0 0.00 14 8.19 1.71 0.72

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 25,833 16,923 6,099 1,677 25,833

Person-years in interval 16,761 41,004 17,437 5,459 80,661

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 47,561 PYR and for male cancers on 33,100 PYR.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 425
All subsequent cancers 202 1.13 583 1.07 452 1.19* 439 1.30* 1,676 1,441.52 1.16* 21.49

All excluding same site 192 1.11 563 1.07 434 1.19* 417 1.28* 1,606 1,390.23 1.16* 19.78

Buccal cavity, pharynx 6 1.28 13 0.92 14 1.50 14 1.82 47 35.77 1.31 1.03

Lip 1 1.40 3 1.45 2 1.51 3 2.78 9 5.18 1.74 0.35

Tongue 0 0.00 0 0.00 4 2.09 2 1.24 6 7.31 0.82 -0.12

Salivary gland 0 0.00 0 0.00 2 2.35 3 3.87 5 3.27 1.53 0.16

Mouth 3 2.38 5 1.32 2 0.80 3 1.49 13 9.55 1.36 0.32

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.48 0.00 -0.14

Tonsil 1 2.28 1 0.76 1 1.16 2 2.83 5 3.32 1.50 0.15

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.98 0.00 -0.09

Hypopharynx 0 0.00 3 2.20 2 2.23 0 0.00 5 3.43 1.46 0.14

Digestive system 32 0.79 124 1.02 80 0.96 87 1.21 323 317.92 1.02 0.47

Esophagus 0 0.00 1 0.18* 3 0.78 6 1.73 10 14.76 0.68 -0.44

Stomach 4 0.97 16 1.33 11 1.38 8 1.19 39 30.91 1.26 0.74

Small intestine 2 3.69 2 1.19 2 1.67 3 2.71 9 4.52 1.99 0.41

Colon 13 0.70 54 0.97 36 0.93 42 1.26 145 146.30 0.99 -0.12

Rectum, rectosigmoid junction 3 0.42 25 1.19 15 1.06 9 0.76 52 54.09 0.96 -0.19

Anus, anal canal 0 0.00 2 1.67 0 0.00 2 2.74 4 3.15 1.27 0.08

Liver 5 3.78* 3 0.75 2 0.72 0 0.00 10 10.72 0.93 -0.07

Gallbladder 0 0.00 2 1.10 0 0.00 1 1.03 3 4.62 0.65 -0.15

Bile ducts, other biliary 1 1.14 3 1.13 2 1.06 3 1.70 9 7.18 1.25 0.17

Pancreas 4 0.82 15 1.02 8 0.79 13 1.48 40 38.43 1.04 0.14

Respiratory system 32 1.07 108 1.18 94 1.48* 76 1.37* 310 240.31 1.29* 6.39

Nose, nasal cavity, ear 1 3.68 0 0.00 0 0.00 1 2.10 2 2.12 0.94 -0.01

Larynx 5 2.54 7 1.18 6 1.53 1 0.31 19 15.04 1.26 0.36

Lung, bronchus 26 0.95 101 1.19 88 1.50* 74 1.44* 289 222.52 1.30* 6.09

Female breast 13 0.61 70 1.06 45 0.96 49 1.25 177 173.73 1.02 0.62

Female genital system 10 1.01 24 0.81 22 1.09 22 1.37 78 75.88 1.03 0.40

Cervix uteri 0 0.00 2 0.60 0 0.00 2 1.27 4 8.13 0.49 -0.78

Corpus uteri 5 0.99 14 0.92 14 1.37 12 1.50 45 38.53 1.17 1.22

Ovary 3 1.05 6 0.69 5 0.82 7 1.41 21 22.69 0.93 -0.32

Vagina 1 6.75 0 0.00 1 3.27 1 4.02 3 1.15 2.61 0.35

Vulva 1 2.20 1 0.72 2 2.01 0 0.00 4 3.68 1.09 0.06

Male genital system 28 0.93 82 0.87 75 1.12 55 0.83 240 257.09 0.93 -3.04

Prostate 28 0.95 81 0.88 74 1.13 55 0.84 238 253.29 0.94 -2.72

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 2.13 0.00 -0.38

Urinary system 21 1.53 33 0.79 35 1.20 52 1.96* 141 111.35 1.27* 2.72

Urinary bladder 8 0.85 22 0.77 21 1.06 41 2.25* 92 76.25 1.21 1.44

Kidney parenchyma 13 3.82* 10 0.95 12 1.62 8 1.18 43 28.14 1.53* 1.36

Renal pelvis, other urinary 0 0.00 1 0.37 2 1.10 3 1.92 6 6.96 0.86 -0.09

Ureter 0 0.00 0 0.00 1 1.66 2 3.91 3 2.30 1.30 0.06

Bone, joints 0 0.00 3 5.68* 3 8.43* 4 13.36* 10 1.36 7.35* 0.79

Soft tissue including heart 0 0.00 1 0.45 6 3.94* 2 1.45 9 5.84 1.54 0.29

Kaposi sarcoma 22 60.44* 6 5.85* 1 1.38 1 1.64 30 2.72 11.01* 2.50

Melanoma of skin 8 1.97 26 2.03* 10 1.09 15 1.71 59 34.89 1.69* 2.21

Eye, orbit 0 0.00 1 1.21 1 1.80 0 0.00 2 2.13 0.94 -0.01

Brain, central nervous system 4 2.08 5 0.85 2 0.49 6 1.74 17 15.31 1.11 0.16

Thyroid 6 5.27* 7 2.02 3 1.28 1 0.49 17 8.97 1.89* 0.74

Lymphatic, hematopoietic 14 1.02 55 1.32 40 1.37 36 1.38 145 110.60 1.31* 3.15

Hodgkin lymphoma 0 0.00 7 4.52* 4 3.92* 5 5.95* 16 3.95 4.06* 1.11

Non-Hodgkin lymphoma 10 1.62 20 1.05 18 1.32 22 1.77* 70 51.29 1.36* 1.72

Myeloma 1 0.45 3 0.44 2 0.42 2 0.47 8 18.00 0.44* -0.92

Leukemia 3 0.63 25 1.76* 16 1.64 7 0.81 51 37.37 1.36* 1.25

Acute lymphocytic 0 0.00 0 0.00 1 3.28 0 0.00 1 1.15 0.87 -0.01

Chronic lymphocytic 0 0.00 2 0.36 2 0.52 0 0.00 4 14.70 0.27* -0.98

Acute non-lymphocytic 2 1.25 16 3.31* 10 2.99* 6 2.01 34 12.76 2.67* 1.95

Chronic myeloid 0 0.00 3 1.55 3 2.26 0 0.00 6 5.10 1.18 0.08

Non-Hodgkin Lymphoma

Both Sexes, Radiotherapy

Table 16.2.10: Risk of subsequent primary cancers after non-Hodgkin lymphoma, both sexes,

with initial radiotherapy, SEER 1973-2000.

426 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

NON-HODGKIN LYMPHOMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 21,024 15,192 7,852 4,008 21,024

Person-years in interval 14,563 42,961 28,435 23,133 109,093

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 52,891 PYR and for male cancers on 56,202 PYR.
Non-Hodgkin Lymphoma

Both Sexes, No Radiotherapy

Table 16.2.11: Risk of subsequent primary cancers after non-Hodgkin lymphoma, both sexes,

without initial radiotherapy, SEER 1973-2000.

NON-HODGKIN LYMPHOMA

All subsequent cancers 541 1.06 1,608 1.07* 1,096 1.18* 756 1.23* 4,001 3,554.57 1.13* 18.33

All excluding same site 527 1.07 1,561 1.08* 1,062 1.19* 734 1.25* 3,884 3,428.29 1.13* 18.71

Buccal cavity, pharynx 18 1.38 43 1.15 37 1.69* 25 1.87* 123 85.76 1.43* 1.53

Lip 4 2.03 6 1.09 9 2.89* 3 1.62 22 12.42 1.77* 0.39

Tongue 1 0.38 14 1.84* 7 1.55 7 2.49 29 17.54 1.65* 0.47

Salivary gland 3 2.60 6 1.77 5 2.39 3 2.14 17 8.04 2.11* 0.37

Mouth 6 1.73 9 0.90 11 1.89 6 1.69 32 22.86 1.40 0.38

Nasopharynx 0 0.00 4 2.75 2 2.41 2 4.04 8 3.29 2.43* 0.19

Tonsil 1 0.82 1 0.28 1 0.50 3 2.49 6 7.96 0.75 -0.08

Oropharynx 1 2.78 0 0.00 0 0.00 0 0.00 1 2.37 0.42 -0.06

Hypopharynx 2 1.57 2 0.55 2 0.96 1 0.83 7 8.23 0.85 -0.05

Digestive system 107 0.94 331 1.00 216 1.07 151 1.14 805 779.44 1.03 1.05

Esophagus 8 1.48 10 0.64 10 1.05 7 1.13 35 36.89 0.95 -0.08

Stomach 12 1.06 30 0.93 26 1.37 13 1.09 81 74.46 1.09 0.27

Small intestine 1 0.63 4 0.85 5 1.68 1 0.49 11 11.31 0.97 -0.01

Colon 53 1.01 168 1.10 105 1.12 81 1.31* 407 360.75 1.13* 1.90

Rectum, rectosigmoid junction 19 0.97 59 1.04 32 0.95 18 0.85 128 130.98 0.98 -0.12

Anus, anal canal 0 0.00 7 2.16 2 1.00 0 0.00 9 7.70 1.17 0.05

Liver 2 0.53 8 0.73 9 1.33 6 1.32 25 25.99 0.96 -0.04

Gallbladder 1 0.60 1 0.21 2 0.70 1 0.55 5 11.07 0.45 -0.25

Bile ducts, other biliary 1 0.40 8 1.09 4 0.86 6 1.83 19 17.70 1.07 0.05

Pancreas 7 0.51 35 0.87 20 0.82 17 1.04 79 94.55 0.84 -0.64

Respiratory system 103 1.19 317 1.25* 218 1.42* 146 1.47* 784 592.77 1.32* 7.85

Nose, nasal cavity, ear 0 0.00 3 1.37 5 3.77* 1 1.17 9 5.12 1.76 0.16

Larynx 6 1.07 17 1.06 13 1.40 5 0.91 41 36.42 1.13 0.19

Lung, bronchus 97 1.22 297 1.27* 200 1.40* 140 1.51* 734 549.75 1.34* 7.56

Female breast 32 0.56* 123 0.71* 100 0.91 73 0.96 328 417.91 0.78* -7.56

Female genital system 20 0.78 68 0.89 42 0.91 36 1.17 166 179.19 0.93 -1.11

Cervix uteri 3 1.07 4 0.49 3 0.65 4 1.44 14 18.32 0.76 -0.36

Corpus uteri 6 0.46* 35 0.90 19 0.81 20 1.29 80 91.09 0.88 -0.93

Ovary 9 1.19 23 1.01 10 0.71 7 0.73 49 54.02 0.91 -0.42

Vagina 1 2.54 2 1.71 2 2.77 1 2.04 6 2.77 2.16 0.27

Vulva 1 0.82 4 1.10 8 3.41* 3 1.76 16 8.92 1.79* 0.60

Male genital system 61 0.64* 263 0.95 151 0.87 113 0.98 588 661.97 0.89* -5.93

Prostate 60 0.64* 257 0.94 148 0.86 113 1.00 578 653.68 0.88* -6.07

Testis 0 0.00 3 1.60 2 1.96 0 0.00 5 4.18 1.19 0.07

Urinary system 70 1.74* 126 1.07 112 1.55* 84 1.76* 392 277.04 1.41* 4.72

Urinary bladder 26 0.94 89 1.11 83 1.68* 64 1.96* 262 190.33 1.38* 2.94

Kidney parenchyma 43 4.33* 29 0.99 27 1.48 15 1.23 114 69.67 1.64* 1.82

Renal pelvis, other urinary 1 0.39 8 1.10 2 0.46 5 1.77 16 17.04 0.94 -0.04

Ureter 0 0.00 1 0.41 1 0.70 0 0.00 2 5.61 0.36 -0.15

Bone, joints 2 4.23 2 1.46 2 2.46 0 0.00 6 3.17 1.89 0.12

Soft tissue including heart 0 0.00 11 1.84 5 1.36 2 0.80 18 14.18 1.27 0.16

Kaposi sarcoma 42 43.88* 30 11.25* 9 5.86* 2 2.24 83 6.05 13.71* 3.16

Melanoma of skin 14 1.19 58 1.64* 43 1.92* 15 0.96 130 85.18 1.53* 1.84

Eye, orbit 2 2.63 1 0.45 1 0.76 0 0.00 4 5.12 0.78 -0.05

Brain, central nervous system 5 0.93 17 1.08 6 0.64 10 1.65 38 36.60 1.04 0.06

Thyroid 6 2.03 7 0.80 5 0.95 3 0.87 21 20.44 1.03 0.02

Lymphatic, hematopoietic 38 0.98 145 1.27* 113 1.59* 59 1.23 355 272.19 1.30* 3.40

Hodgkin lymphoma 3 2.20 22 5.67* 8 3.59* 12 8.78* 45 8.84 5.09* 1.48

Non-Hodgkin lymphoma 14 0.79 47 0.89 34 1.03 22 0.96 117 126.28 0.93 -0.38

Myeloma 3 0.46 10 0.53* 9 0.77 5 0.64 27 45.05 0.60* -0.74

Leukemia 18 1.34 66 1.69* 62 2.60* 20 1.27 166 92.02 1.80* 3.04

Acute lymphocytic 1 2.49 0 0.00 1 1.43 0 0.00 2 2.71 0.74 -0.03

Chronic lymphocytic 2 0.38 9 0.58 5 0.53 5 0.81 21 36.43 0.58* -0.63

Acute non-lymphocytic 9 1.99 43 3.25* 44 5.41* 12 2.19* 108 31.38 3.44* 3.15

Chronic myeloid 4 2.19 8 1.51 5 1.54 2 0.92 19 12.53 1.52 0.27

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 52,934 39,034 18,552 7,771 52,934

Person-years in interval 36,968 106,837 61,817 37,979 243,602

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 118,953 PYR and for male cancers on 124,649 PYR.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 427
All subsequent cancers 1,237 1.12* 260 1.28* 122 1.28* 57 1.46* 1,676 1,441.52 1.16* 21.49

All excluding same site 1,189 1.12* 244 1.25* 117 1.28* 56 1.49* 1,606 1,390.23 1.16* 19.78

Buccal cavity, pharynx 33 1.17 10 2.11* 4 1.90 0 0.00 47 35.77 1.31 1.03

Lip 6 1.46 3 4.51 0 0.00 0 0.00 9 5.18 1.74 0.35

Tongue 4 0.70 2 2.03 0 0.00 0 0.00 6 7.31 0.82 -0.12

Salivary gland 2 0.80 1 2.15 2 9.19* 0 0.00 5 3.27 1.53 0.16

Mouth 10 1.33 3 2.40 0 0.00 0 0.00 13 9.55 1.36 0.32

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.48 0.00 -0.14

Tonsil 3 1.15 0 0.00 2 10.22* 0 0.00 5 3.32 1.50 0.15

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.98 0.00 -0.09

Hypopharynx 5 1.84 0 0.00 0 0.00 0 0.00 5 3.43 1.46 0.14

Digestive system 236 0.96 41 0.93 30 1.51* 16 1.95* 323 317.92 1.02 0.47

Esophagus 4 0.35* 4 1.93 2 2.05 0 0.00 10 14.76 0.68 -0.44

Stomach 31 1.28 4 0.97 4 2.17 0 0.00 39 30.91 1.26 0.74

Small intestine 6 1.76 1 1.52 2 6.36 0 0.00 9 4.52 1.99 0.41

Colon 103 0.91 20 0.98 12 1.30 10 2.65* 145 146.30 0.99 -0.12

Rectum, rectosigmoid junction 43 1.02 4 0.55 2 0.62 3 2.29 52 54.09 0.96 -0.19

Anus, anal canal 2 0.83 0 0.00 2 9.77* 0 0.00 4 3.15 1.27 0.08

Liver 10 1.23 0 0.00 0 0.00 0 0.00 10 10.72 0.93 -0.07

Gallbladder 2 0.55 1 1.66 0 0.00 0 0.00 3 4.62 0.65 -0.15

Bile ducts, other biliary 6 1.11 2 1.92 1 1.99 0 0.00 9 7.18 1.25 0.17

Pancreas 27 0.91 5 0.94 5 2.05 3 2.98 40 38.43 1.04 0.14

Respiratory system 234 1.27* 38 1.13 30 1.94* 8 1.26 310 240.31 1.29* 6.39

Nose, nasal cavity, ear 1 0.61 0 0.00 1 7.58 0 0.00 2 2.12 0.94 -0.01

Larynx 18 1.53 0 0.00 1 1.13 0 0.00 19 15.04 1.26 0.36

Lung, bronchus 215 1.26* 38 1.22 28 1.94* 8 1.35 289 222.52 1.30* 6.09

Female breast 128 0.95 32 1.33 11 1.02 6 1.39 177 173.73 1.02 0.62

Female genital system 56 0.94 17 1.71 4 0.92 1 0.59 78 75.88 1.03 0.40

Cervix uteri 2 0.31 2 2.01 0 0.00 0 0.00 4 8.13 0.49 -0.78

Corpus uteri 33 1.08 10 2.01 1 0.46 1 1.17 45 38.53 1.17 1.22

Ovary 14 0.79 5 1.63 2 1.47 0 0.00 21 22.69 0.93 -0.32

Vagina 2 2.23 0 0.00 1 14.78 0 0.00 3 1.15 2.61 0.35

Vulva 4 1.41 0 0.00 0 0.00 0 0.00 4 3.68 1.09 0.06

Male genital system 185 0.97 33 0.85 13 0.66 9 1.13 240 257.09 0.93 -3.04

Prostate 183 0.97 33 0.86 13 0.67 9 1.15 238 253.29 0.94 -2.72

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 2.13 0.00 -0.38

Urinary system 89 1.05 33 2.09* 10 1.33 9 2.79* 141 111.35 1.27* 2.72

Urinary bladder 51 0.88 26 2.40* 8 1.55 7 3.14* 92 76.25 1.21 1.44

Kidney parenchyma 35 1.64* 5 1.24 2 1.04 1 1.23 43 28.14 1.53* 1.36

Renal pelvis, other urinary 3 0.56 2 2.12 0 0.00 1 5.52 6 6.96 0.86 -0.09

Ureter 1 0.56 2 6.40 0 0.00 0 0.00 3 2.30 1.30 0.06

Bone, joints 6 5.65* 2 10.97* 1 12.05 1 29.37 10 1.36 7.35* 0.79

Soft tissue including heart 7 1.57 0 0.00 2 5.12 0 0.00 9 5.84 1.54 0.29

Kaposi sarcoma 29 13.72* 1 2.50 0 0.00 0 0.00 30 2.72 11.01* 2.50

Melanoma of skin 44 1.69* 11 2.15* 2 0.79 2 1.74 59 34.89 1.69* 2.21

Eye, orbit 2 1.20 0 0.00 0 0.00 0 0.00 2 2.13 0.94 -0.01

Brain, central nervous system 11 0.93 3 1.43 2 2.10 1 2.56 17 15.31 1.11 0.16

Thyroid 16 2.30* 1 0.82 0 0.00 0 0.00 17 8.97 1.89* 0.74

Lymphatic, hematopoietic 109 1.29* 26 1.66* 7 0.95 3 0.97 145 110.60 1.31* 3.15

Hodgkin lymphoma 11 3.54* 3 5.77* 1 4.31 1 11.29 16 3.95 4.06* 1.11

Non-Hodgkin lymphoma 48 1.24 16 2.16* 5 1.42 1 0.66 70 51.29 1.36* 1.72

Myeloma 6 0.44* 2 0.78 0 0.00 0 0.00 8 18.00 0.44* -0.92

Leukemia 44 1.53* 5 0.96 1 0.41 1 1.00 51 37.37 1.36* 1.25

Acute lymphocytic 1 1.12 0 0.00 0 0.00 0 0.00 1 1.15 0.87 -0.01

Chronic lymphocytic 4 0.35* 0 0.00 0 0.00 0 0.00 4 14.70 0.27* -0.98

Acute non-lymphocytic 28 2.87* 4 2.24 1 1.19 1 2.78 34 12.76 2.67* 1.95

Chronic myeloid 6 1.53 0 0.00 0 0.00 0 0.00 6 5.10 1.18 0.08

Non-Hodgkin Lymphoma

Both Sexes, Long-term Follow-up, Radiotherapy

Table 16.2.12: Risk of subsequent primary cancers after non-Hodgkin lymphoma, both sexes, long-term follow-up,

with initial radiotherapy, SEER 1973-2000.

428 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

NON-HODGKIN LYMPHOMA

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 21,024 4,008 1,901 794 21,024

Person-years in interval 85,959 14,293 6,366 2,474 109,093

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 52,891 PYR and for male cancers on 56,202 PYR.
Non-Hodgkin Lymphoma

Both Sexes, Long-term Follow-up, No Radiotherapy

Table 16.2.13: Risk of subsequent primary cancers after non-Hodgkin lymphoma, both sexes, long-term follow-up,

without initial radiotherapy, SEER 1973-2000.

NON-HODGKIN LYMPHOMA

All subsequent cancers 3,245 1.10* 503 1.23* 185 1.18* 68 1.45* 4,001 3,554.57 1.13* 18.33

All excluding same site 3,150 1.11* 488 1.24* 181 1.20* 65 1.44* 3,884 3,428.29 1.13* 18.71

Buccal cavity, pharynx 98 1.35* 18 1.98* 7 2.11 0 0.00 123 85.76 1.43* 1.53

Lip 19 1.80* 3 2.37 0 0.00 0 0.00 22 12.42 1.77* 0.39

Tongue 22 1.49 4 2.11 3 4.27 0 0.00 29 17.54 1.65* 0.47

Salivary gland 14 2.11* 1 1.08 2 5.51 0 0.00 17 8.04 2.11* 0.37

Mouth 26 1.35 5 2.07 1 1.13 0 0.00 32 22.86 1.40 0.38

Nasopharynx 6 2.15 1 2.96 1 8.26 0 0.00 8 3.29 2.43* 0.19

Tonsil 3 0.44 3 3.63 0 0.00 0 0.00 6 7.96 0.75 -0.08

Oropharynx 1 0.50 0 0.00 0 0.00 0 0.00 1 2.37 0.42 -0.06

Hypopharynx 6 0.85 1 1.20 0 0.00 0 0.00 7 8.23 0.85 -0.05

Digestive system 654 1.01 96 1.09 42 1.24 13 1.25 805 779.44 1.03 1.05

Esophagus 28 0.91 6 1.44 1 0.63 0 0.00 35 36.89 0.95 -0.08

Stomach 68 1.09 9 1.12 3 0.99 1 1.11 81 74.46 1.09 0.27

Small intestine 10 1.08 1 0.74 0 0.00 0 0.00 11 11.31 0.97 -0.01

Colon 326 1.09 51 1.24 25 1.56* 5 1.02 407 360.75 1.13* 1.90

Rectum, rectosigmoid junction 110 1.00 8 0.56 5 0.94 5 3.14* 128 130.98 0.98 -0.12

Anus, anal canal 9 1.42 0 0.00 0 0.00 0 0.00 9 7.70 1.17 0.05

Liver 19 0.89 6 2.00 0 0.00 0 0.00 25 25.99 0.96 -0.04

Gallbladder 4 0.43 1 0.82 0 0.00 0 0.00 5 11.07 0.45 -0.25

Bile ducts, other biliary 13 0.90 3 1.41 2 2.30 1 3.60 19 17.70 1.07 0.05

Pancreas 62 0.79 11 1.02 5 1.19 1 0.77 79 94.55 0.84 -0.64

Respiratory system 638 1.29* 103 1.55* 28 1.10 15 2.00* 784 592.77 1.32* 7.85

Nose, nasal cavity, ear 8 1.88 1 1.76 0 0.00 0 0.00 9 5.12 1.76 0.16

Larynx 36 1.16 2 0.53 2 1.51 1 2.75 41 36.42 1.13 0.19

Lung, bronchus 594 1.30* 100 1.61* 26 1.09 14 1.99* 734 549.75 1.34* 7.56

Female breast 255 0.75* 42 0.84 27 1.35 4 0.63 328 417.91 0.78* -7.56

Female genital system 130 0.88 25 1.23 7 0.87 4 1.59 166 179.19 0.93 -1.11

Cervix uteri 10 0.64 2 1.07 2 2.91 0 0.00 14 18.32 0.76 -0.36

Corpus uteri 60 0.79 14 1.37 4 0.99 2 1.58 80 91.09 0.88 -0.93

Ovary 42 0.95 4 0.63 1 0.40 2 2.53 49 54.02 0.91 -0.42

Vagina 5 2.19 1 3.12 0 0.00 0 0.00 6 2.77 2.16 0.27

Vulva 13 1.80 3 2.74 0 0.00 0 0.00 16 8.92 1.79* 0.60

Male genital system 475 0.87* 76 0.98 29 0.99 8 1.04 588 661.97 0.89* -5.93

Prostate 465 0.86* 76 0.99 29 1.00 8 1.05 578 653.68 0.88* -6.07

Testis 5 1.40 0 0.00 0 0.00 0 0.00 5 4.18 1.19 0.07

Urinary system 308 1.34* 49 1.55* 24 1.96* 11 2.98* 392 277.04 1.41* 4.72

Urinary bladder 198 1.26* 36 1.66* 19 2.26* 9 3.56* 262 190.33 1.38* 2.94

Kidney parenchyma 99 1.72* 11 1.36 3 0.96 1 1.06 114 69.67 1.64* 1.82

Renal pelvis, other urinary 11 0.77 2 1.06 2 2.76 1 4.57 16 17.04 0.94 -0.04

Ureter 2 0.43 0 0.00 0 0.00 0 0.00 2 5.61 0.36 -0.15

Bone, joints 6 2.26 0 0.00 0 0.00 0 0.00 6 3.17 1.89 0.12

Soft tissue including heart 16 1.37 1 0.61 0 0.00 1 4.97 18 14.18 1.27 0.16

Kaposi sarcoma 81 15.70* 2 3.19 0 0.00 0 0.00 83 6.05 13.71* 3.16

Melanoma of skin 115 1.65* 11 1.07 2 0.49 2 1.55 130 85.18 1.53* 1.84

Eye, orbit 4 0.94 0 0.00 0 0.00 0 0.00 4 5.12 0.78 -0.05

Brain, central nervous system 28 0.92 6 1.47 3 1.95 1 2.18 38 36.60 1.04 0.06

Thyroid 18 1.06 3 1.31 0 0.00 0 0.00 21 20.44 1.03 0.02

Lymphatic, hematopoietic 296 1.32* 43 1.36 9 0.73 7 1.84 355 272.19 1.30* 3.40

Hodgkin lymphoma 33 4.41* 8 8.63* 2 5.88 2 20.23* 45 8.84 5.09* 1.48

Non-Hodgkin lymphoma 95 0.92 15 1.00 4 0.67 3 1.61 117 126.28 0.93 -0.38

Myeloma 22 0.59* 3 0.58 1 0.49 1 1.63 27 45.05 0.60* -0.74

Leukemia 146 1.91* 17 1.63 2 0.49 1 0.81 166 92.02 1.80* 3.04

Acute lymphocytic 2 0.88 0 0.00 0 0.00 0 0.00 2 2.71 0.74 -0.03

Chronic lymphocytic 16 0.53* 3 0.73 1 0.64 1 2.14 21 36.43 0.58* -0.63

Acute non-lymphocytic 96 3.71* 11 3.05* 1 0.70 0 0.00 108 31.38 3.44* 3.15

Chronic myeloid 17 1.64 2 1.39 0 0.00 0 0.00 19 12.53 1.52 0.27

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 52,934 7,771 3,101 1,006 52,934

Person-years in interval 205,623 25,668 9,471 2,841 243,602

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 118,953 PYR and for male cancers on 124,649 PYR.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 429
Myeloma

Both Sexes

Table 16.3.1: Characteristics of patients with an initial myeloma, both sexes,

SEER 1973-2000.

430 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

MYELOMA

Number of patients with 1st primary cancer

Total 12,419 100.0 11,419 100.0 23,838 100.0

Initial treatment

Any radiation 3,852 31.0 3,193 28.0 7,045 29.6

With surgery 368 3.0 209 1.8 577 2.4

Without surgery 3,484 28.1 2,984 26.1 6,468 27.1

No radiation 8,567 69.0 8,226 72.0 16,793 70.4

With surgery 138 1.1 88 0.8 226 0.9

Without surgery 8,429 67.9 8,138 71.3 16,567 69.5

Race

White 9,904 79.7 8,993 78.8 18,897 79.3

Black 1,875 15.1 1,912 16.7 3,787 15.9

Other 607 4.9 489 4.3 1,096 4.6

Unknown 33 0.3 25 0.2 58 0.2

Age at 1st primary cancer diagnosis, years

< 30 30 0.2 20 0.2 50 0.2

30–49 1,112 9.0 782 6.8 1,894 7.9

50–69 6,108 49.2 4,773 41.8 10,881 45.6

70–79 3,587 28.9 3,639 31.9 7,226 30.3

> 80 1,582 12.7 2,205 19.3 3,787 15.9

Number of patients with one or more

primary cancers

One primary cancer only 11,710 94.3 10,977 96.1 22,687 95.2

1st and 2nd cancers 660 5.3 424 3.7 1,084 4.5

1st, 2nd, and 3rd cancers 48 0.4 18 0.2 66 0.3

1st, 2nd, 3rd, and additional cancers 1 0.0 0 0.0 1 0.0

Other statistics

Median age at 1st cancer diagnosis 67.6 — 70.3 — 68.9 —

Median year of 1st cancer diagnosis 1989.1 — 1988.7 — 1989.0 —

Median person-years at risk 2.0 — 2.0 — 2.0 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 86.7 — 87.3 — 87.0

1st, 2nd, and additional cancers — 86.5 — 87.3 — 86.8

1st cancer only — 7.2 — 5.2 — 6.4

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Myeloma

Both Sexes

Table 16.3.2: Risk of subsequent primary cancers after myeloma, both sexes,

SEER 1973-2000.

MYELOMA

All subsequent cancers 250 0.88 626 0.93 252 1.17* 91 1.10 1,219 1,255.85 0.97 -5.19

All excluding same site 250 0.90 624 0.94 251 1.18* 91 1.12 1,216 1,238.01 0.98 -3.10

Buccal cavity, pharynx 4 0.56 9 0.54 5 0.98 1 0.57 19 30.84 0.62* -1.67

Lip 1 0.95 0 0.00 0 0.00 0 0.00 1 4.30 0.23 -0.46

Tongue 0 0.00 3 0.90 1 0.97 0 0.00 4 6.13 0.65 -0.30

Salivary gland 0 0.00 1 0.69 1 2.19 0 0.00 2 2.68 0.75 -0.10

Mouth 2 1.04 2 0.44 1 0.73 1 2.12 6 8.28 0.72 -0.32

Nasopharynx 0 0.00 1 1.57 0 0.00 0 0.00 1 1.18 0.85 -0.03

Tonsil 0 0.00 1 0.63 2 4.09 0 0.00 3 2.92 1.03 0.01

Oropharynx 1 4.86 0 0.00 0 0.00 0 0.00 1 0.90 1.11 0.01

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 3.25 0.00 -0.46

Digestive system 59 0.89 154 0.99 64 1.31* 18 0.97 295 288.87 1.02 0.86

Esophagus 1 0.30 5 0.63 0 0.00 1 1.03 7 14.87 0.47* -1.11

Stomach 3 0.43 18 1.10 6 1.18 2 1.04 29 30.38 0.95 -0.19

Small intestine 1 1.13 5 2.31 2 2.80 0 0.00 8 4.06 1.97 0.55

Colon 33 1.10 60 0.85 38 1.69* 10 1.17 141 131.87 1.07 1.28

Rectum, rectosigmoid junction 5 0.46 28 1.10 8 1.02 5 1.81 46 47.05 0.98 -0.15

Anus, anal canal 0 0.00 2 1.46 0 0.00 0 0.00 2 2.54 0.79 -0.08

Liver 4 1.85 8 1.54 0 0.00 0 0.00 12 9.69 1.24 0.32

Gallbladder 0 0.00 0 0.00 1 1.49 0 0.00 1 4.07 0.25 -0.43

Bile ducts, other biliary 2 1.48 5 1.55 2 1.91 0 0.00 9 6.03 1.49 0.42

Pancreas 9 1.11 22 1.15 7 1.16 0 0.00 38 35.63 1.07 0.33

Respiratory system 31 0.64* 110 0.94 36 0.97 15 1.07 192 216.47 0.89 -3.44

Nose, nasal cavity, ear 0 0.00 0 0.00 1 3.29 0 0.00 1 1.80 0.56 -0.11

Larynx 0 0.00 7 0.92 4 1.69 2 2.43 13 14.08 0.92 -0.15

Lung, bronchus 31 0.69* 103 0.96 31 0.90 13 1.00 178 200.06 0.89 -3.10

Female breast 23 0.82 53 0.78 14 0.65 5 0.58 95 126.32 0.75* -9.16

Female genital system 8 0.61 30 0.97 7 0.74 4 1.11 49 56.94 0.86 -2.32

Cervix uteri 0 0.00 4 1.09 1 0.93 0 0.00 5 6.74 0.74 -0.51

Corpus uteri 7 1.06 15 0.97 3 0.64 2 1.12 27 28.50 0.95 -0.44

Ovary 1 0.27 8 0.90 2 0.72 1 0.92 12 16.50 0.73 -1.32

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 1.03 0.00 -0.30

Vulva 0 0.00 2 1.35 0 0.00 1 5.16 3 2.76 1.09 0.07

Male genital system 43 0.77 93 0.68* 32 0.71* 15 0.83 183 255.75 0.72* -19.74

Prostate 42 0.76 92 0.68* 32 0.71 15 0.83 181 253.46 0.71* -19.66

Testis 1 5.81 0 0.00 0 0.00 0 0.00 1 0.69 1.44 0.08

Urinary system 29 1.33 54 1.05 28 1.72* 10 1.66 121 95.65 1.27* 3.57

Urinary bladder 17 1.13 34 0.96 21 1.89* 8 1.97 80 65.68 1.22 2.02

Kidney parenchyma 11 2.07* 15 1.17 6 1.44 2 1.26 34 23.85 1.43 1.43

Renal pelvis, other urinary 1 0.71 5 1.51 1 0.98 0 0.00 7 6.11 1.14 0.12

Ureter 0 0.00 3 2.81 0 0.00 0 0.00 3 1.96 1.53 0.15

Bone, joints 0 0.00 1 1.86 1 6.14 0 0.00 2 0.99 2.03 0.14

Soft tissue including heart 1 0.93 2 0.78 0 0.00 0 0.00 3 4.74 0.63 -0.24

Kaposi sarcoma 2 6.39 1 1.36 1 4.25 1 13.01 5 1.36 3.67* 0.51

Melanoma of skin 9 1.75 15 1.20 6 1.47 3 2.00 33 23.23 1.42 1.38

Eye, orbit 1 2.68 0 0.00 1 3.83 0 0.00 2 1.59 1.26 0.06

Brain, central nervous system 5 1.91 6 0.96 1 0.52 1 1.48 13 11.46 1.13 0.22

Thyroid 3 2.26 5 1.59 0 0.00 1 2.81 9 5.81 1.55 0.45

Lymphatic, hematopoietic 22 1.05 78 1.57* 53 3.34* 16 2.64* 169 92.48 1.83* 10.77

Hodgkin lymphoma 2 3.19 0 0.00 0 0.00 1 7.19 3 2.62 1.14 0.05

Non-Hodgkin lymphoma 11 1.24 22 1.03 14 2.02* 4 1.50 51 39.88 1.28 1.56

Myeloma 0 0.00* 2 0.21* 1 0.32 0 0.00 3 17.84 0.17* -2.09

Leukemia 9 1.22 54 3.12* 38 7.01* 11 5.45* 112 32.14 3.49* 11.24

Acute lymphocytic 0 0.00 2 4.42 0 0.00 1 19.79 3 0.84 3.58 0.30

Chronic lymphocytic 0 0.00 0 0.00* 1 0.46 0 0.00 1 12.89 0.08* -1.67

Acute non-lymphocytic 6 2.44 42 7.21* 34 18.53* 8 11.52* 90 10.82 8.32* 11.15

Chronic myeloid 3 2.98 6 2.54 1 1.34 1 3.51 11 4.40 2.50* 0.93

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 23,838 17,427 4,717 1,046 23,838

Person-years in interval 16,572 38,645 11,751 4,079 71,047

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 34,191 PYR and for male cancers on 36,856 PYR.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 431
All subsequent cancers 93 0.89 244 0.97 87 1.09 36 1.12 460 468.83 0.98 -2.58

All excluding same site 93 0.90 244 0.98 87 1.11 36 1.14 460 461.50 1.00 -0.44

Buccal cavity, pharynx 0 0.00 2 0.45 1 0.73 1 1.89 4 8.16 0.49 -1.22

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.16

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 1.78 0.00 -0.52

Salivary gland 0 0.00 1 2.11 0 0.00 0 0.00 1 0.88 1.14 0.03

Mouth 0 0.00 1 0.65 0 0.00 1 5.37 2 2.86 0.70 -0.25

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.09

Tonsil 0 0.00 0 0.00 1 8.59 0 0.00 1 0.71 1.41 0.09

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.16

Digestive system 21 0.79 66 1.04 28 1.39 6 0.74 121 118.60 1.02 0.70

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 3.45 0.00 -1.01

Stomach 1 0.45 9 1.71 2 1.20 1 1.56 13 9.82 1.32 0.93

Small intestine 0 0.00 1 1.14 2 6.95 0 0.00 3 1.65 1.82 0.39

Colon 12 0.90 29 0.91 18 1.78* 4 0.99 63 59.37 1.06 1.06

Rectum, rectosigmoid junction 2 0.49 10 1.04 3 1.02 1 0.89 16 17.71 0.90 -0.50

Rectum 2 0.75 9 1.44 2 1.04 0 0.00 13 11.56 1.12 0.42

Anus, anal canal 0 0.00 2 2.59 0 0.00 0 0.00 2 1.44 1.39 0.16

Liver 1 1.75 2 1.44 0 0.00 0 0.00 3 2.62 1.14 0.11

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 2.63 0.00 -0.77

Bile ducts, other biliary 2 3.62 1 0.75 1 2.27 0 0.00 4 2.51 1.59 0.44

Pancreas 3 0.84 12 1.40 2 0.73 0 0.00 17 15.98 1.06 0.30

Respiratory system 11 0.82 27 0.81 9 0.83 5 1.08 52 62.23 0.84 -2.99

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.65 0.00 -0.19

Larynx 0 0.00 0 0.00 0 0.00 1 7.42 1 1.98 0.51 -0.29

Lung, bronchus 11 0.86 27 0.85 9 0.86 4 0.90 51 59.44 0.86 -2.47

Female breast 23 0.82 53 0.78 14 0.65 5 0.58 95 126.32 0.75* -9.16

Female genital system 8 0.61 30 0.97 7 0.74 4 1.11 49 56.94 0.86 -2.32

Cervix uteri 0 0.00 4 1.09 1 0.93 0 0.00 5 6.74 0.74 -0.51

Corpus uteri 7 1.06 15 0.97 3 0.64 2 1.12 27 28.50 0.95 -0.44

Ovary 1 0.27 8 0.90 2 0.72 1 0.92 12 16.50 0.73 -1.32

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 1.03 0.00 -0.30

Vulva 0 0.00 2 1.35 0 0.00 1 5.16 3 2.76 1.09 0.07

Urinary system 6 1.17 11 0.89 7 1.77 1 0.61 25 23.12 1.08 0.55

Urinary bladder 5 1.63 4 0.54 4 1.71 1 1.05 14 13.73 1.02 0.08

Kidney parenchyma 1 0.62 4 1.01 2 1.55 0 0.00 7 7.43 0.94 -0.13

Renal pelvis, other urinary 0 0.00 3 2.83 1 3.01 0 0.00 4 1.97 2.03 0.59

Ureter 0 0.00 2 6.27 0 0.00 0 0.00 2 0.59 3.38 0.41

Bone, joints 0 0.00 0 0.00 1 15.06 0 0.00 1 0.40 2.49 0.17

Soft tissue including heart 1 2.40 2 1.99 0 0.00 0 0.00 3 1.87 1.60 0.33

Kaposi sarcoma 0 0.00 0 0.00 1 27.95 0 0.00 1 0.20 4.91 0.23

Melanoma of skin 3 1.82 4 1.00 1 0.77 1 1.90 9 7.48 1.20 0.45

Eye, orbit 1 6.97 0 0.00 0 0.00 0 0.00 1 0.61 1.63 0.11

Brain, central nervous system 2 1.99 1 0.41 1 1.32 1 3.41 5 4.47 1.12 0.15

Thyroid 0 0.00 4 2.13 0 0.00 1 4.41 5 3.48 1.44 0.44

Lymphatic, hematopoietic 12 1.46 37 1.87* 16 2.52* 10 3.85* 75 36.97 2.03* 11.12

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 1 16.89 1 0.98 1.02 0.01

Non-Hodgkin lymphoma 8 2.15 9 0.99 3 1.02 1 0.82 21 16.94 1.24 1.19

Myeloma 0 0.00 0 0.00* 0 0.00 0 0.00 0 7.33 0.00* -2.14

Leukemia 4 1.51 28 4.45* 13 6.55* 8 10.03* 53 11.72 4.52* 12.07

Acute lymphocytic 0 0.00 2 11.72* 0 0.00 0 0.00 2 0.32 6.28 0.49

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 4.58 0.00* -1.34

Acute non-lymphocytic 2 2.18 22 10.00* 13 18.65* 7 24.46* 44 4.10 10.73* 11.67

Chronic myeloid 2 5.47 3 3.45 0 0.00 1 9.00 6 1.62 3.70* 1.28

Myeloma

Females

Table 16.3.3: Risk of subsequent primary cancers after myeloma, females,

SEER 1973-2000.

432 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

MYELOMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 11,419 8,305 2,299 513 11,419

Person-years in interval 7,885 18,532 5,658 2,117 34,191

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Myeloma

Males

Table 16.3.4: Risk of subsequent primary cancers after myeloma, males,

SEER 1973-2000.

MYELOMA

All subsequent cancers 157 0.88 382 0.90* 165 1.22* 55 1.09 759 787.02 0.96 -7.60

All excluding same site 157 0.89 380 0.91 164 1.23* 55 1.11 756 776.51 0.97 -5.56

Buccal cavity, pharynx 4 0.75 7 0.57 4 1.07 0 0.00 15 22.68 0.66 -2.09

Lip 1 1.07 0 0.00 0 0.00 0 0.00 1 3.75 0.27 -0.75

Tongue 0 0.00 3 1.27 1 1.36 0 0.00 4 4.35 0.92 -0.10

Salivary gland 0 0.00 0 0.00 1 3.24 0 0.00 1 1.80 0.56 -0.22

Mouth 2 1.56 1 0.34 1 1.12 0 0.00 4 5.42 0.74 -0.39

Nasopharynx 0 0.00 1 2.15 0 0.00 0 0.00 1 0.86 1.16 0.04

Tonsil 0 0.00 1 0.83 1 2.68 0 0.00 2 2.22 0.90 -0.06

Oropharynx 1 6.27 0 0.00 0 0.00 0 0.00 1 0.70 1.43 0.08

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 2.69 0.00 -0.73

Digestive system 38 0.97 88 0.96 36 1.25 12 1.15 174 170.27 1.02 1.01

Esophagus 1 0.39 5 0.81 0 0.00 1 1.37 7 11.42 0.61 -1.20

Stomach 2 0.42 9 0.81 4 1.16 1 0.78 16 20.56 0.78 -1.24

Small intestine 1 1.89 4 3.12 0 0.00 0 0.00 5 2.41 2.07 0.70

Colon 21 1.26 31 0.79 20 1.62 6 1.33 78 72.50 1.08 1.49

Rectum, rectosigmoid junction 3 0.44 18 1.13 5 1.03 4 2.43 30 29.33 1.02 0.18

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 1.10 0.00 -0.30

Liver 3 1.89 6 1.58 0 0.00 0 0.00 9 7.07 1.27 0.52

Gallbladder 0 0.00 0 0.00 1 4.26 0 0.00 1 1.43 0.70 -0.12

Bile ducts, other biliary 0 0.00 4 2.12 1 1.65 0 0.00 5 3.52 1.42 0.40

Pancreas 6 1.32 10 0.95 5 1.51 0 0.00 21 19.64 1.07 0.37

Respiratory system 20 0.57* 83 1.00 27 1.03 10 1.07 140 154.24 0.91 -3.86

Nose, nasal cavity, ear 0 0.00 0 0.00 1 5.19 0 0.00 1 1.15 0.87 -0.04

Larynx 0 0.00 7 1.06 4 1.97 1 1.45 12 12.10 0.99 -0.03

Lung, bronchus 20 0.62* 76 1.00 22 0.92 9 1.05 127 140.62 0.90 -3.69

Male breast 1 2.94 0 0.00 0 0.00 0 0.00 1 1.50 0.67 -0.14

Male genital system 43 0.77 93 0.68* 32 0.71* 15 0.83 183 255.75 0.72* -19.74

Prostate 42 0.76 92 0.68* 32 0.71 15 0.83 181 253.46 0.71* -19.66

Testis 1 5.81 0 0.00 0 0.00 0 0.00 1 0.69 1.44 0.08

Urinary system 23 1.39 43 1.10 21 1.70* 9 2.05 96 72.52 1.32* 6.37

Urinary bladder 12 1.00 30 1.07 17 1.93* 7 2.25 66 51.95 1.27 3.81

Kidney parenchyma 10 2.72* 11 1.24 4 1.40 2 1.91 27 16.43 1.64* 2.87

Renal pelvis, other urinary 1 1.03 2 0.89 0 0.00 0 0.00 3 4.15 0.72 -0.31

Ureter 0 0.00 1 1.34 0 0.00 0 0.00 1 1.37 0.73 -0.10

Bone, joints 0 0.00 1 3.13 0 0.00 0 0.00 1 0.58 1.71 0.11

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 2.87 0.00 -0.78

Kaposi sarcoma 2 7.45 1 1.59 0 0.00 1 16.06 4 1.16 3.45 0.77

Melanoma of skin 6 1.72 11 1.29 5 1.80 2 2.06 24 15.75 1.52 2.24

Eye, orbit 0 0.00 0 0.00 1 6.19 0 0.00 1 0.98 1.02 0.01

Brain, central nervous system 3 1.86 5 1.31 0 0.00 0 0.00 8 6.99 1.14 0.27

Thyroid 3 5.56* 1 0.79 0 0.00 0 0.00 4 2.33 1.71 0.45

Lymphatic, hematopoietic 10 0.79 41 1.37 37 3.89* 6 1.74 94 55.51 1.69* 10.44

Hodgkin lymphoma 2 5.01 0 0.00 0 0.00 0 0.00 2 1.64 1.22 0.10

Non-Hodgkin lymphoma 3 0.58 13 1.05 11 2.75* 3 2.08 30 22.95 1.31 1.91

Myeloma 0 0.00 2 0.36 1 0.55 0 0.00 3 10.51 0.29* -2.04

Leukemia 5 1.06 26 2.36* 25 7.28* 3 2.46 59 20.41 2.89* 10.47

Acute lymphocytic 0 0.00 0 0.00 0 0.00 1 34.76 1 0.52 1.93 0.13

Chronic lymphocytic 0 0.00 0 0.00* 1 0.72 0 0.00 1 8.31 0.12* -1.98

Acute non-lymphocytic 4 2.59 20 5.52* 21 18.46* 1 2.45 46 6.71 6.85* 10.66

Chronic myeloid 1 1.56 3 2.01 1 2.13 0 0.00 5 2.78 1.80 0.60

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 12,419 9,122 2,418 533 12,419

Person-years in interval 8,687 20,114 6,093 1,962 36,856

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 433
All subsequent cancers 93 0.87 327 1.04 174 1.27* 80 1.18 674 624.11 1.08 10.88

All excluding same site 93 0.88 325 1.05 173 1.28* 80 1.20 671 615.76 1.09* 12.05

Buccal cavity, pharynx 2 0.56 7 0.72 2 0.54 1 0.66 12 18.52 0.65 -1.42

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 2.02 0.00 -0.44

Tongue 0 0.00 2 0.99 1 1.29 0 0.00 3 3.84 0.78 -0.18

Salivary gland 0 0.00 1 1.51 0 0.00 0 0.00 1 1.30 0.77 -0.07

Mouth 1 1.04 1 0.39 0 0.00 1 2.50 3 4.92 0.61 -0.42

Nasopharynx 0 0.00 1 2.37 0 0.00 0 0.00 1 0.80 1.25 0.04

Tonsil 0 0.00 1 0.91 1 2.49 0 0.00 2 2.07 0.96 -0.02

Oropharynx 1 8.35 0 0.00 0 0.00 0 0.00 1 0.61 1.63 0.08

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 2.19 0.00 -0.48

Digestive system 18 0.84 63 1.00 34 1.22 16 1.12 131 126.90 1.03 0.90

Esophagus 0 0.00 2 0.46 0 0.00 1 1.20 3 8.56 0.35 -1.21

Stomach 2 0.90 5 0.77 2 0.71 2 1.39 11 12.93 0.85 -0.42

Small intestine 0 0.00 4 3.89* 1 2.19 0 0.00 5 2.07 2.41 0.64

Colon 8 0.91 23 0.87 20 1.67* 8 1.25 59 53.58 1.10 1.18

Rectum, rectosigmoid junction 3 0.75 14 1.22 6 1.25 5 2.25 28 22.47 1.25 1.21

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 1.37 0.00 -0.30

Liver 1 1.16 4 1.58 0 0.00 0 0.00 5 5.08 0.98 -0.02

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 1.48 0.00 -0.32

Bile ducts, other biliary 0 0.00 1 0.87 1 1.88 0 0.00 2 2.36 0.85 -0.08

Pancreas 3 1.13 10 1.27 4 1.16 0 0.00 17 15.80 1.08 0.26

Respiratory system 13 0.61 67 1.09 32 1.24 14 1.16 126 120.30 1.05 1.24

Nose, nasal cavity, ear 0 0.00 0 0.00 1 5.28 0 0.00 1 0.92 1.09 0.02

Larynx 0 0.00 7 1.47 4 2.17 2 2.69 13 9.12 1.43 0.85

Lung, bronchus 13 0.68 60 1.07 27 1.14 12 1.07 112 109.98 1.02 0.44

Female breast 10 0.83 31 0.92 10 0.72 4 0.56 55 67.02 0.82 -5.88

Female genital system 3 0.50 17 1.06 4 0.65 4 1.33 28 31.19 0.90 -1.56

Cervix uteri 0 0.00 2 0.95 0 0.00 0 0.00 2 3.99 0.50 -0.97

Corpus uteri 2 0.63 9 1.06 2 0.62 2 1.30 15 16.39 0.92 -0.68

Ovary 1 0.62 5 1.13 1 0.56 1 1.11 8 8.72 0.92 -0.35

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.21

Vulva 0 0.00 1 2.05 0 0.00 1 7.45 2 1.00 1.99 0.49

Male genital system 10 0.52* 45 0.73* 23 0.77 15 0.98 93 126.29 0.74* -13.11

Prostate 10 0.53* 45 0.74* 23 0.77 15 0.99 93 124.97 0.74* -12.59

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.23

Urinary system 14 1.84* 30 1.33 18 1.81* 8 1.66 70 44.95 1.56* 5.46

Urinary bladder 10 2.07 18 1.24 12 1.85 7 2.20 47 29.01 1.62* 3.92

Kidney parenchyma 4 1.72 10 1.49 5 1.75 1 0.73 20 13.25 1.51 1.47

Renal pelvis, other urinary 0 0.00 2 1.48 1 1.69 0 0.00 3 2.68 1.12 0.07

Ureter 0 0.00 1 2.37 0 0.00 0 0.00 1 0.84 1.20 0.04

Bone, joints 0 0.00 1 3.52 1 8.98 0 0.00 2 0.55 3.67 0.32

Soft tissue including heart 1 2.38 2 1.67 0 0.00 0 0.00 3 2.36 1.27 0.14

Kaposi sarcoma 2 11.75* 1 2.31 0 0.00 1 17.53 4 0.82 4.89* 0.69

Melanoma of skin 4 1.68 11 1.63 5 1.80 2 1.62 22 13.14 1.67* 1.93

Eye, orbit 0 0.00 0 0.00 1 5.82 0 0.00 1 0.84 1.19 0.03

Brain, central nervous system 2 1.61 2 0.58 1 0.73 1 1.72 6 6.63 0.90 -0.14

Thyroid 2 2.69 2 1.01 0 0.00 1 3.19 5 3.77 1.33 0.27

Lymphatic, hematopoietic 7 0.96 41 1.91* 42 4.46* 12 2.51* 102 42.91 2.38* 12.89

Hodgkin lymphoma 1 3.22 0 0.00 0 0.00 1 8.35 2 1.54 1.30 0.10

Non-Hodgkin lymphoma 4 1.22 8 0.83 10 2.35* 2 0.93 24 19.31 1.24 1.02

Myeloma 0 0.00 2 0.48 1 0.54 0 0.00 3 8.35 0.36 -1.17

Leukemia 2 0.87 31 4.52* 31 10.25* 9 5.92* 73 13.71 5.32* 12.93

Acute lymphocytic 0 0.00 1 4.78 0 0.00 1 25.20 2 0.41 4.87 0.35

Chronic lymphocytic 0 0.00 0 0.00 1 0.81 0 0.00 1 5.64 0.18* -1.01

Acute non-lymphocytic 2 2.68 25 11.10* 28 27.57* 6 11.34* 61 4.54 13.43* 12.32

Chronic myeloid 0 0.00 3 3.18 0 0.00 1 4.69 4 1.89 2.11 0.46

Myeloma

Both Sexes, <70 Years of Age

Table 16.3.5: Risk of subsequent primary cancers after myeloma, both sexes,

<70 years of age, SEER 1973-2000.

434 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

MYELOMA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 12,825 10,131 3,267 842 12,825

Person-years in interval 9,391 24,221 8,714 3,514 45,840

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 20,449 PYR and for male cancers on 25,391 PYR.
Myeloma

Both Sexes, ≥70 Years of Age

Table 16.3.6: Risk of subsequent primary cancers after myeloma, both sexes,

≥70 years of age, SEER 1973-2000.

MYELOMA

All subsequent cancers 157 0.89 299 0.83* 78 0.99 11 0.73 545 631.73 0.86* -34.41

All excluding same site 157 0.90 299 0.84* 78 1.00 11 0.75 545 622.25 0.88* -30.65

Buccal cavity, pharynx 2 0.56 2 0.28 3 2.11 0 0.00 7 12.33 0.57 -2.11

Lip 1 1.50 0 0.00 0 0.00 0 0.00 1 2.28 0.44 -0.51

Tongue 0 0.00 1 0.76 0 0.00 0 0.00 1 2.29 0.44 -0.51

Salivary gland 0 0.00 0 0.00 1 5.51 0 0.00 1 1.38 0.73 -0.15

Mouth 1 1.04 1 0.52 1 2.51 0 0.00 3 3.36 0.89 -0.14

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.15

Tonsil 0 0.00 0 0.00 1 11.32 0 0.00 1 0.85 1.17 0.06

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.11

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.06 0.00 -0.42

Digestive system 41 0.92 91 0.99 30 1.42 2 0.47 164 161.98 1.01 0.80

Esophagus 1 0.55 3 0.83 0 0.00 0 0.00 4 6.31 0.63 -0.92

Stomach 1 0.21 13 1.32 4 1.76 0 0.00 18 17.45 1.03 0.22

Small intestine 1 1.84 1 0.88 1 3.86 0 0.00 3 1.99 1.51 0.40

Colon 25 1.18 37 0.83 18 1.72* 2 0.94 82 78.29 1.05 1.47

Rectum, rectosigmoid junction 2 0.29 14 1.00 2 0.66 0 0.00 18 24.58 0.73 -2.61

Anus, anal canal 0 0.00 2 3.01 0 0.00 0 0.00 2 1.16 1.72 0.33

Liver 3 2.32 4 1.51 0 0.00 0 0.00 7 4.61 1.52 0.95

Gallbladder 0 0.00 0 0.00 1 2.94 0 0.00 1 2.59 0.39 -0.63

Bile ducts, other biliary 2 2.06 4 1.93 1 1.95 0 0.00 7 3.67 1.91 1.32

Pancreas 6 1.10 12 1.06 3 1.16 0 0.00 21 19.82 1.06 0.47

Respiratory system 18 0.65 43 0.78 4 0.35* 1 0.53 66 96.17 0.69* -11.97

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.88 0.00 -0.35

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 4.96 0.00* -1.97

Lung, bronchus 18 0.70 43 0.83 4 0.38* 1 0.56 66 90.08 0.73* -9.55

Female breast 13 0.81 22 0.65* 4 0.52 1 0.69 40 59.30 0.67* -14.05

Female genital system 5 0.70 13 0.88 3 0.93 0 0.00 21 25.75 0.82 -3.45

Cervix uteri 0 0.00 2 1.28 1 2.91 0 0.00 3 2.75 1.09 0.18

Corpus uteri 5 1.46 6 0.86 1 0.70 0 0.00 12 12.11 0.99 -0.08

Ovary 0 0.00 3 0.67 1 1.00 0 0.00 4 7.78 0.51 -2.75

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.43

Vulva 0 0.00 1 1.01 0 0.00 0 0.00 1 1.76 0.57 -0.55

Male genital system 33 0.90 48 0.64* 9 0.59 0 0.00 90 129.46 0.70* -34.42

Prostate 32 0.88 47 0.64* 9 0.59 0 0.00 88 128.50 0.68* -35.32

Testis 1 27.30 0 0.00 0 0.00 0 0.00 1 0.12 8.30 0.77

Urinary system 15 1.06 24 0.83 10 1.57 2 1.68 51 50.70 1.01 0.12

Urinary bladder 7 0.69 16 0.76 9 1.93 1 1.13 33 36.67 0.90 -1.45

Kidney parenchyma 7 2.35 5 0.82 1 0.77 1 4.36 14 10.60 1.32 1.35

Renal pelvis, other urinary 1 1.04 3 1.53 0 0.00 0 0.00 4 3.43 1.17 0.23

Ureter 0 0.00 2 3.10 0 0.00 0 0.00 2 1.13 1.77 0.35

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.17

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 2.38 0.00 -0.94

Kaposi sarcoma 0 0.00 0 0.00 1 12.95 0 0.00 1 0.54 1.84 0.18

Melanoma of skin 5 1.82 4 0.69 1 0.77 1 3.79 11 10.09 1.09 0.36

Eye, orbit 1 4.64 0 0.00 0 0.00 0 0.00 1 0.75 1.33 0.10

Brain, central nervous system 3 2.18 4 1.43 0 0.00 0 0.00 7 4.83 1.45 0.86

Thyroid 1 1.71 3 2.55 0 0.00 0 0.00 4 2.05 1.95 0.77

Lymphatic, hematopoietic 15 1.10 37 1.31 11 1.71 4 3.12 67 49.57 1.35* 6.91

Hodgkin lymphoma 1 3.15 0 0.00 0 0.00 0 0.00 1 1.09 0.92 -0.03

Non-Hodgkin lymphoma 7 1.25 14 1.19 4 1.49 2 3.86 27 20.57 1.31 2.55

Myeloma 0 0.00 0 0.00* 0 0.00 0 0.00 0 9.49 0.00* -3.76

Leukemia 7 1.38 23 2.20* 7 2.92* 2 4.03 39 18.42 2.12* 8.16

Acute lymphocytic 0 0.00 1 4.11 0 0.00 0 0.00 1 0.43 2.34 0.23

Chronic lymphocytic 0 0.00 0 0.00* 0 0.00 0 0.00 0 7.25 0.00* -2.88

Acute non-lymphocytic 4 2.33 17 4.76* 6 7.33* 2 12.10* 29 6.27 4.62* 9.02

Chronic myeloid 3 4.41 3 2.11 1 3.00 0 0.00 7 2.51 2.79* 1.78

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 11,013 7,296 1,450 204 11,013

Person-years in interval 7,181 14,424 3,037 565 25,207

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 13,742 PYR and for male cancers on 11,465 PYR.

NEW MALIGNANCIES FOLLOWING HODGKIN LYMPHOMA, NON-HODGKIN LYMPHOMA, AND MYELOMA 435

NEW MALIGNANCIES FOLLOWING LEUKEMIA 437

Synopsis

The risk of subsequent primary cancer was assessed in

more than 46,000 individuals diagnosed with any of

the 4 major leukemias between 1973 and 2000. The

overall risk of subsequent cancers was significantly

increased among survivors of chronic lymphocytic

leukemia (CLL) (O/E=1.19,1 O=2,718, EAR=38 per

10,000 person-years), chronic myeloid leukemia (CML)

(O/E=1.16,1 O=334, EAR=19), and acute lymphocytic

leukemia (ALL) (O/E=1.55,1 O=66, EAR=5), but not

acute myeloid leukemia (O/E=0.94,1 O=157). The risk

of a new malignancy was notably high among children

diagnosed with ALL (O/E=5.01,1 O=36, EAR=7), with

statistically significant increased risks seen for cancers

of the salivary gland, brain and other central nervous

system, thyroid, and bone, based on small numbers.

Much of the excess was likely related to treatment

with radiotherapy at a young age, although familial

cancer syndromes could have played a small role.

Immune dysfunction, which is an intrinsic part of

CLL, may have contributed to the significantly

increased incidence for subsequent cancers of the lip,

larynx, and lung, as well as subsequent cutaneous

melanoma, Hodgkin lymphoma, and Kaposi sarcoma

seen in these patients. Excess new malignancies of the

oral cavity, lung, and colon (females only) and nonHodgkin lymphoma were seen following CML for

reasons that are unclear.

Leukemia

The leukemias are a heterogeneous group of malignancies

constituting 2.5% of incident cancer cases and 4.0% of cancer deaths (Jemal et al, 2005). Leukemias are classified by

lineage into 2 main groups, myeloid and lymphoid, and

further subdivided into acute and chronic forms. All 4

major subtypes of leukemia originate from a common

stem cell that normally divides and differentiates into subtypes of cells that play an important role in immune function. The hematologic malignancies of each lineage arise

from genetic changes that occur at some point along the

differentiation pathway of this stem cell, and each has its

own unique pattern of disease presentation.

The etiology is largely unknown for all 4 major subtypes of leukemia. Ionizing radiation has been shown 

to cause excesses of each leukemia subtype except

chronic lymphocytic leukemia (CLL) (Preston et al, 1994),

whereas chemotherapeutic agents (alkylating agents,

topoisomerase II inhibitors) and the organic solvent benzene have been associated with acute myeloid leukemia

(AML) (Hayes et al, 1997). Most studies of environmental

and occupational exposures and leukemia have shown

inconsistent results in both children and adults. Epidemiologic evidence suggests a weak association between

smoking and leukemia, particularly AML (Kane et al,

1999). Some investigators have linked childhood acute

lymphocytic leukemia (ALL) to various risk factors, such

as parental exposures (Shu et al, 1999; Schüz et al, 2000),

infectious agents (Kinlen and Balkwill, 2001), and high

birth weight (Hjalgrim et al, 2004).

Genetic factors contribute also to the etiology of

leukemia, especially in familial aggregation of CLL

(Ishibe et al, 2001). Approximately 5% of acute leukemia

has been related to genetic syndromes, such as Down

syndrome, ataxia telangiectasia, neurofibromatosis type 1,

Li-Fraumeni syndrome, Fanconi anemia, and other bone

marrow failure disorders (Lindor and Greene, 1998).

Overall risks presented below for each leukemia subtype exclude observed and expected numbers of subsequent leukemia of the same lineage (i.e., myeloid or lymphoid) as the first primary leukemia, because according

to SEER abstracting rules, new leukemia diagnoses of the

same lineage are not considered new, separate primaries.

Acute Leukemias

ALL is the most common childhood leukemia; more than

60% of all ALL cases occur in children and adolescents

younger than 17 years of age. In contrast, AML is typically diagnosed in adulthood, and pediatric patients constitute less than 10% of the total. Survival among children

with ALL has improved greatly since the 1970s due to

advances in treatment, with current relative survival

rates reaching 84.9% at 5 years and 78.1% at 10 years. In

contrast, adults with ALL have a poor prognosis: 29.6%

relative survival at 5 years. Substantially lower 5-year

relative survival rates are seen for AML: 50.9% for children and 17.4% for adults. Patients with acute leukemia

LEUKEMIA

Chapter 17

New Malignancies Following Leukemia

Naoko Ishibe, Rochelle E. Curtis

1Observed-to-expected ratios for acute and chronic lymphocytic

leukemia exclude subsequent lymphocytic leukemias; those for acute

and chronic myeloid leukemia exclude subsequent myeloid leukemias.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated

as [(O-E)/PYR]10,000).

Author affiliations: Naoko Ishibe and Rochelle E. Curtis, Division of

Cancer Epidemiology and Genetics, NCI, NIH, DHHS.
are usually treated for curative intent with chemotherapy

relying heavily on antimetabolites and anthracyclines

(Hoelzer et al, 2002). With ALL, and to a lesser extent

AML, cranial or craniospinal irradiation has been used to

prevent or treat central nervous system (CNS) involvement. (Treatment with cranial radiotherapy has been

reportable to the SEER Program since its inception, but

cranial irradiation given for prophylaxis was not recorded in registry databases until 1988.) Current efforts to

reduce the late sequelae of cranial irradiation have led to

wider use of intrathecal chemotherapy alone for lowerrisk patients. Younger ALL/AML patients with a poor

prognosis or those who fail conventional treatment may

be considered for bone marrow transplantation.

Results and Discussion

Acute Lymphocytic Leukemia

The overall risk of subsequent primary cancer was

significantly increased among the 7,246 ALL patients

who survived 2 months or more (O/E=1.55, O=66, 95%

CI=1.20-1.98, EAR=5 per 10,000 person-years). The

cumulative incidence of developing a second cancer following ALL, adjusted for the competing risk of death

due to other causes, was 2.3% (95% CI=1.4%-3.6%) at 25

years. The increase in risk of developing a new malignancy was confined to pediatric patients (ages <17 years,

O/E=5.01, 95% CI=3.51-6.93, EAR=7); no elevation in risk

was observed among older patients (ages ≥17 years,

O/E=0.85, 95% CI=0.57-1.21). Among children with ALL,

significantly increased relative risks were observed for

new cancers of the salivary gland, small intestine, brain

and other CNS, thyroid, and bone, based on small numbers. The risk of a new malignancy among pediatric ALL

patients was increased 3-fold compared to expected values among those surviving 1 to 5 years and then rose to

5-fold among those surviving 5 years or more. Females

and males appeared to have similar risks. These results

are consistent with previous studies of childhood ALL,

which have reported increased risks of subsequent cancers ranging from 4- to 14-fold, with significant elevations noted for cancers of the brain, thyroid, buccal cavity

(especially salivary gland), and bone, as well as for AML

(Neglia et al, 1991, 2001; Kimball Dalton et al, 1998;

Bhatia et al, 2002; Pui et al, 2003).

We observed an overall 10-fold increase in risk of

developing a subsequent malignancy of the brain/CNS

among children with ALL, rising to 17-fold among longterm survivors (≥5 years). Gliomas (O=7) and primitive

neuroectodermal tumors (O=2) were the most frequent

cell types. Most of the patients developing subsequent

brain/CNS tumors (7 out of 11) were known to have

received initial radiation treatment for ALL, and 9 of the

brain cancers occurred among ALL patients diagnosed at

5 years of age or younger. These findings resemble those

of previous studies of childhood ALL showing a marked

increase in risk of subsequent brain/CNS tumors following cranial irradiation at doses of 18 to 24 Gy (Walter

et al, 1998). The especially high risks seen among very

young children in our series and other studies (Neglia et

al, 1991; Walter et al, 1998) indicate that the developing

brain is particularly susceptible to the carcinogenic

effects of radiation.

Treatment of ALL with cranial irradiation during

childhood may also account for the excess cancers of the

thyroid, salivary gland, and bone, since the patterns over

time for these subsequent cancers are consistent with a

radiation effect. Thyroid tissue is highly radiosensitive

(Thompson et al, 1994; Ron et al, 1995), and an excess of

thyroid cancer has been reported after head and neck

radiotherapy during childhood (de Vathaire et al, 1999).

Similarly, radiation exposure is associated with excess

tumors of the salivary gland (Land et al, 1996), and bone

cancer is well documented as a second cancer following

radiotherapy for childhood cancer (Hawkins et al, 1996;

Le Vu et al, 1998). Three of the 4 bone tumors in the current study were located in the skull or shoulder/upper

limb, sites that may have received direct or scatter radiation. In addition, genetic susceptibility may have played

a role, since brain tumors, bone sarcomas, and acute

leukemia are part of the constellation of tumors seen in

Li-Fraumeni syndrome (Hisada et al, 1998; Lindor and

Greene, 1998).

Data from clinical trials have shown an increased risk

of subsequent AML following treatment for ALL with

topoisomerase II inhibitors (etoposide, teniposide) since

their introduction in the mid-1980s (Pui et al, 1991).

Although only 1 case of subsequent AML was observed

among pediatric ALL patients, we found a 15-fold significantly increased risk among older ALL patients, based on

4 cases.

Acute Myeloid Leukemia

The number of new malignancies observed among the

11,169 individuals diagnosed with AML did not differ

from that expected based on general population rates

(O/E=0.94, O=157, 95% CI=0.79-1.09). Approximately 

3% of patients developed a second cancer within 20 years

of initial diagnosis (cumulative incidence=2.2%, 

CI=1.8%-2.7%). Subsequent cancer risks appeared similar

among males and females and did not differ significantly

by race or follow-up period. Although significantly

increased risks were detected for subsequent kidney and

thyroid cancers, the elevations in risk were limited to the

first year after AML diagnosis, suggesting an effect of

increased medical surveillance during this period.

Pediatric AML patients in our series appeared at

increased risk of subsequent cancers, although the risk

was not statistically significant (O/E=3.51, O=3). A previous study of childhood AML found a 10-fold elevation

in the risk of second cancers following conventional

treatment, based on 5 cases (Leung et al, 2001). The risks

were substantially higher (48-fold) in a survey of 1,100

children undergoing allogeneic bone marrow transplantation for AML, with excesses of lymphoma and

melanoma of the skin, and cancers of the tongue, salivary gland, brain/CNS, bone, soft tissue, and thyroid

(Socié et al, 2000).

438 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

LEUKEMIA
NEW MALIGNANCIES FOLLOWING LEUKEMIA 439

LEUKEMIA

Chronic Leukemias

CLL is typically a disease of older adults; its median age

at onset is 70 years. In contrast, incidence rates for

chronic myeloid leukemia (CML) begin increasing in

adolescence, rise rapidly in young adulthood, and reach

a peak at older ages. In general, age-adjusted incidence

rates of leukemia tend to be higher for males than

females; however, the sex difference is most pronounced

for CLL and CML (Jemal et al, 2005). CLL is generally

indolent, with 5- and 10-year relative survival rates of

72.7% and 52.9%, respectively. Prognosis for CML varies

by age at diagnosis, with more favorable 5-year survival

rates under age 55 years (56.1%) compared to older ages

(24.2%). Patients with CLL and CML typically receive

palliative treatment, but low-risk CLL patients may

remain untreated until the disease progresses. Chemotherapy for CLL usually includes alkylating agents

(chlorambucil, cyclophosphamide) and more recently

nucleoside analogues (e.g., fludarabine) (Kipps, 2000).

Frontline chemotherapy for CML includes busulfan,

hydroxyurea, and interferon α, although the recent introduction of GleevecTM (imatinib mesylate) has revolutionized the treatment of CML (Garcia-Manero et al, 2003).

Bone marrow transplantation is frequently considered as

a treatment option for younger CML patients.

Results and Discussion

Chronic Lymphocytic Leukemia

A 19% elevation in risk of subsequent primary cancers

was observed among 19,631 patients who survived

2 months or more following a diagnosis of CLL

(O/E=1.19, O=2,718, 95% CI=1.15-1.24, EAR=38). An

estimated 17% of patients developed a second cancer

within 25 years of follow-up (cumulative incidence=16.7%,

CI=16.1%-17.4%). An 80% increase in risk was seen

among CLL patients diagnosed at less than 50 years of

age, and then risk declined at older ages (Figure 17.1).

Both relative and absolute risks of new cancers were

higher among blacks (O/E=1.41, EAR=82) than whites

(O/E=1.19, EAR=37). The risk was greatest during the

first 5 years of follow-up and then diminished. Significantly heightened risks were observed for subsequent

cancers of the lip, salivary gland, nose and nasal cavity,

larynx, lung, colon, rectum (females), and kidney, as

well as cutaneous melanoma, Hodgkin lymphoma, and

Kaposi sarcoma. Significantly decreased risks were seen

for new malignancies of the bile ducts and of the corpus

uteri. Our findings are consistent with previous surveys

of CLL patients (Mellemgaard et al, 1994; Wiernik 2004),

including 2 earlier SEER analyses (Travis et al, 1992;

Hisada et al, 2001) that reported increased risks for subsequent cancers of the lung, as well as Hodgkin lymphoma, Kaposi sarcoma, and melanoma of the skin.

CLL transformation to large B-cell non-Hodgkin lymphoma, known as Richter’s syndrome, is not reportable

to SEER (Robak, 2004).

Cancers of the respiratory tract are the most common

new cancers seen after a diagnosis of CLL (Mellemgaard

et al, 1994; Hisada et al, 2001). In our survey, 50-60%

increased risks of subsequent cancers of the lung were

observed in all follow-up periods. Excess cancers of the

larynx were confined to long-term survivors. Reasons 

for these excesses are not entirely clear but may be

related to the combined effects of cigarette smoking

(Parekh et al, 1999), immunologic impairment (Bartik

et al, 1998; Sgambati et al, 2001), and treatment with

alkylating agents (Travis et al, 2002) or nucleoside analogues (Robak et al, 2004).

Immune alterations probably contributed to the excess

risks reported for lip cancer, as well as for melanoma of

the skin, Hodgkin lymphoma, and Kaposi sarcoma, as

these malignancies occur excessively in other immunocompromised groups, such as transplant recipients

(Curtis et al, 1997; Euvrard et al, 2003) and Hodgkin

lymphoma patients (Dores et al, 2002). Infections with

Epstein-Barr virus and human herpesvirus 8 may

account for Hodgkin lymphoma and Kaposi sarcoma,

respectively, in the setting of immunosuppression. However, some cases of Hodgkin lymphoma after CLL may

represent a Hodgkin variant of Richter’s syndrome

(Ohno et al, 1998).

The risk of subsequent primary cancer has been

reported to be higher in patients with familial CLL as

compared with nonfamilial CLL, particularly at younger

ages (Ishibe et al, 2001). Thus the nearly 2-fold increased

risk of subsequent cancers seen among CLL patients

diagnosed under age 50 years, with excesses of cancers

of the lip and lung, as well as melanoma of the skin 

and AML, may be related in part to an underlying

genetic susceptibility.

The excess of kidney cancers was confined to the first

year of follow-up, likely due to increased medical surveillance during the initial diagnostic work-up. The

elevated risks of new cancers of the colon, rectum, and

50 50-59 60-69 70 50 50-59 60-69 70

Age at diagnosis of chronic lymphocytic leukemia (years)

O/E

EAR (per 10,000 person-years)

1.44*

1.08*

1.20*

58

44

21

42

1.83*

1.00

1.25

1.50

1.75

2.00

0

5

10

15

20

25

30

35

40

45

50

55

60

65

Figure 17.1: Observed-to-expected ratio (O/E) and excess

absolute risk (EAR) of subsequent primary cancers after

chronic lymphocytic leukemia, both sexes, SEER 1973-2000.

*P <0.05.

Notes: All subsequent cancers excluding lymphocytic leukemias. EAR = Excess number of

subsequent cancers per 10,000 person-years. Observed number of subsequent cancers are

86, 456, 976 and 1,200, for age groups <50, 50-59, 60-69 and 70 years, respectively.
salivary gland that were observed in the current CLL

cohort, but not in earlier surveys of the SEER Program,

may provide etiologic clues for future studies.

Chronic Myeloid Leukemia

There was a 16% increased risk for all subsequent primary cancers combined among the 8,005 patients who

survived 2 months or more after a diagnosis of CML

(O/E=1.16, O=334, 95% CI=1.04-1.29, EAR=19). The

cumulative incidence of developing a new malignancy

at 15 years was 4.8% (CI=4.3%-5.4%). Females had a 30%

elevation in the risk of subsequent cancers, whereas no

excess was observed among males. No discernible pattern in risk was evident over time since initial diagnosis.

Significantly increased risks were observed for new primary cancers of the oral cavity and lung and for nonHodgkin lymphoma in both sexes combined, as well as

for cancers of the colon among females but not males.

Because little is known of the etiology of CML, the reasons for these associations are unclear. Secondary ALL

appeared more frequently than expected in this cohort,

based on 7 cases, but this may represent a transformation of the original CML to a lymphoblastic phase

(Garcia-Manero et al, 2003).

Among younger CML patients who were potential

candidates for bone marrow transplantation, there was

a 5-fold significantly increased risk of subsequent malignancies involving a variety of sites, including 2 lymphomas. Although the effects of bone marrow transplantation could not be evaluated in our study, previous

transplant studies of CML have reported increased risks

for lymphomas and solid tumors (Socié et al, 2001).

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NEW MALIGNANCIES FOLLOWING LEUKEMIA 441

LEUKEMIA
Acute Lymphocytic Leukemia

Both Sexes

Table 17.1.1: Characteristics of patients with an initial acute lymphocytic leukemia, both sexes,

SEER 1973-2000.

442 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ACUTE LYMPHOCYTIC

LEUKEMIA

Number of patients with 1st primary cancer

Total 4,205 100.0 3,041 100.0 7,246 100.0

Initial treatment

Any radiation 1,221 29.0 819 26.9 2,040 28.2

With surgery 5 0.1 1 0.0 6 0.1

Without surgery 1,216 28.9 818 26.9 2,034 28.1

No radiation 2,984 71.0 2,222 73.1 5,206 71.8

With surgery 9 0.2 1 0.0 10 0.1

Without surgery 2,975 70.7 2,221 73.0 5,196 71.7

Race

White 3,523 83.8 2,511 82.6 6,034 83.3

Black 275 6.5 235 7.7 510 7.0

Other 389 9.3 278 9.1 667 9.2

Unknown 18 0.4 17 0.6 35 0.5

Age at 1st primary cancer diagnosis, years

< 30 3,274 77.9 2,359 77.6 5,633 77.7

30–49 415 9.9 275 9.0 690 9.5

50–69 335 8.0 256 8.4 591 8.2

70–79 133 3.2 89 2.9 222 3.1

> 80 48 1.1 62 2.0 110 1.5

Number of patients with one or more

primary cancers

One primary cancer only 4,171 99.2 3,013 99.1 7,184 99.1

1st and 2nd cancers 31 0.7 27 0.9 58 0.8

1st, 2nd, and 3rd cancers 3 0.1 1 0.0 4 0.1

1st, 2nd, 3rd, and additional cancers 0 0.0 0 0.0 0 0.0

Other statistics

Median age at 1st cancer diagnosis 9.9 — 7.8 — 8.8 —

Median year of 1st cancer diagnosis 1988.9 — 1989.0 — 1989.0 —

Median person-years at risk 3.3 — 4.0 — 3.6 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 100.0 — 96.4 — 98.4

1st, 2nd, and additional cancers — 100.0 — 96.4 — 98.4

1st cancer only — 0.0 — 3.6 — 1.6

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Acute Lymphocytic Leukemia

Both Sexes

Table 17.1.2: Risk of subsequent primary cancers after acute lymphocytic leukemia, both sexes,

SEER 1973-2000.

ACUTE LYMPHOCYTIC

LEUKEMIA

All subsequent cancers 7 0.80 19 1.24 19 2.10* 21 1.98* 66 43.79 1.51* 4.77

All excluding same site 7 0.82 19 1.28 19 2.17* 21 2.02* 66 42.46 1.55* 5.06

Buccal cavity, pharynx 0 0.00 1 2.55 1 4.61 3 12.44* 5 1.09 4.61* 0.84

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.03

Tongue 0 0.00 0 0.00 0 0.00 1 20.09 1 0.22 4.63 0.17

Salivary gland 0 0.00 1 22.87 1 30.31 1 21.91 3 0.14 20.78* 0.61

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.05

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.02

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.02

Oropharynx 0 0.00 0 0.00 0 0.00 1 253.03* 1 0.03 39.48 0.21

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.02

Digestive system 3 1.76 1 0.37 0 0.00 2 1.42 6 7.31 0.82 -0.28

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.08

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.75 0.00 -0.16

Small intestine 1 39.84 1 23.74 0 0.00 0 0.00 2 0.12 16.72* 0.40

Colon 1 1.35 0 0.00 0 0.00 0 0.00 1 3.18 0.31 -0.47

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 1 4.08 1 1.29 0.78 -0.06

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.02

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.07

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.02

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.03

Pancreas 1 5.00 0 0.00 0 0.00 0 0.00 1 0.84 1.19 0.03

Respiratory system 1 0.75 2 0.94 3 2.72 0 0.00 6 5.55 1.08 0.10

Nose, nasal cavity, ear 0 0.00 0 0.00 1 63.21 0 0.00 1 0.08 13.00 0.20

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.08

Lung, bronchus 1 0.82 2 1.04 2 2.00 0 0.00 5 5.02 1.00 0.00

Female breast 0 0.00 0 0.00 1 1.23 1 1.01 2 4.15 0.48 -1.03

Female genital system 0 0.00 0 0.00 1 2.37 0 0.00 1 2.21 0.45 -0.58

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.24

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.78 0.00 -0.37

Ovary 0 0.00 0 0.00 1 6.49 0 0.00 1 0.76 1.32 0.12

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.01

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.04

Male genital system 1 0.66 4 1.53 0 0.00 1 0.58 6 7.43 0.81 -0.55

Prostate 1 0.70 4 1.66 0 0.00 1 0.83 6 6.41 0.94 -0.16

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.96 0.00 -0.37

Urinary system 1 1.51 2 1.79 0 0.00 1 1.69 4 2.97 1.35 0.22

Urinary bladder 1 2.39 1 1.43 0 0.00 1 2.57 3 1.90 1.58 0.24

Kidney parenchyma 0 0.00 1 2.75 0 0.00 0 0.00 1 0.92 1.09 0.02

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.03

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.01

Bone, joints 1 27.66 0 0.00 1 7.39 2 14.33* 4 0.44 9.12* 0.76

Soft tissue including heart 0 0.00 2 11.24* 1 7.97 0 0.00 3 0.55 5.44* 0.53

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.09

Melanoma of skin 0 0.00 0 0.00 0 0.00 2 2.66 2 1.90 1.05 0.02

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.03

Brain, central nervous system 0 0.00 1 1.66 7 17.96* 3 7.83* 11 1.61 6.85* 2.02

Thyroid 0 0.00 1 4.43 2 10.08* 5 10.17* 8 1.01 7.90* 1.50

Lymphatic, hematopoietic 0 0.00 5 2.58 1 0.79 0 0.00 6 5.74 1.05 0.06

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.09 0.00 -0.24

Non-Hodgkin lymphoma 0 0.00 1 1.56 0 0.00 0 0.00 1 1.98 0.51 -0.21

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.09

Leukemia 0 0.00 4 4.48* 1 2.04 0 0.00 5 2.25 2.22 0.59

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.94 0.00 -0.20

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.07

Acute non-lymphocytic 0 0.00 4 18.07* 1 6.96 0 0.00 5 0.65 7.70* 0.93

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.04

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 7,246 5,822 3,119 1,886 7,246

Person-years in interval 5,338 16,550 12,144 12,533 46,564

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 20,836 PYR and for male cancers on 25,728 PYR.

NEW MALIGNANCIES FOLLOWING LEUKEMIA 443
All subsequent cancers 1 0.32 7 1.27 11 3.39* 10 2.32* 29 16.25 1.78* 6.12

All excluding same site 1 0.32 7 1.32 11 3.50* 10 2.36* 29 15.78 1.84* 6.34

Buccal cavity, pharynx 0 0.00 0 0.00 1 17.60 1 13.54 2 0.28 7.17 0.83

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.03

Salivary gland 0 0.00 0 0.00 1 76.41 0 0.00 1 0.06 17.26 0.45

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.04

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.01

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Oropharynx 0 0.00 0 0.00 0 0.00 1 .† 1 0.01 175.46* 0.48

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Digestive system 0 0.00 0 0.00 0 0.00 0 0.00 0 2.50 0.00 -1.20

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.03

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.10

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.02

Colon 0 0.00 0 0.00 0 0.00 0 0.00 0 1.18 0.00 -0.57

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.19

Rectum 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.13

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.02

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.04

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.02

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.03

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.15

Respiratory system 0 0.00 1 1.83 1 3.49 0 0.00 2 1.47 1.36 0.25

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.01

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.03

Lung, bronchus 0 0.00 1 1.96 1 3.73 0 0.00 2 1.37 1.46 0.30

Female breast 0 0.00 0 0.00 1 1.23 1 1.01 2 4.15 0.48 -1.03

Female genital system 0 0.00 0 0.00 1 2.37 0 0.00 1 2.21 0.45 -0.58

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.24

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.78 0.00 -0.37

Ovary 0 0.00 0 0.00 1 6.49 0 0.00 1 0.76 1.32 0.12

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.01

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.04

Urinary system 1 6.88 1 4.20 0 0.00 0 0.00 2 0.62 3.24 0.66

Urinary bladder 1 13.99 0 0.00 0 0.00 0 0.00 1 0.30 3.37 0.34

Kidney parenchyma 0 0.00 1 8.72 0 0.00 0 0.00 1 0.28 3.54 0.34

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.02

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.08

Soft tissue including heart 0 0.00 1 14.18 1 19.90 0 0.00 2 0.22 9.12* 0.85

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Melanoma of skin 0 0.00 0 0.00 0 0.00 2 5.46 2 0.79 2.55 0.58

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.03

Brain, central nervous system 0 0.00 1 4.44 4 26.20* 3 20.81* 8 0.61 13.20* 3.55

Thyroid 0 0.00 0 0.00 1 7.01 3 7.81* 4 0.74 5.39* 1.56

Lymphatic, hematopoietic 0 0.00 3 4.56 0 0.00 0 0.00 3 2.00 1.50 0.48

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.22

Non-Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.29

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.07

Leukemia 0 0.00 3 9.30* 0 0.00 0 0.00 3 0.80 3.74 1.06

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.18

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.04

Acute non-lymphocytic 0 0.00 3 36.58* 0 0.00 0 0.00 3 0.24 12.28* 1.32

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.03

Acute Lymphocytic Leukemia

Females

Table 17.1.3: Risk of subsequent primary cancers after acute lymphocytic leukemia, females,

SEER 1973-2000.

444 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ACUTE LYMPHOCYTIC

LEUKEMIA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,041 2,454 1,396 868 3,041

Person-years in interval 2,237 7,216 5,524 5,859 20,836

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. †O/E > 500. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.)

primary cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per

10,000 person-years = [(O-E)/PYR] 10,000.
Acute Lymphocytic Leukemia

Males

Table 17.1.4: Risk of subsequent primary cancers after acute lymphocytic leukemia, males,

SEER 1973-2000.

ACUTE LYMPHOCYTIC

LEUKEMIA

All subsequent cancers 6 1.08 12 1.22 8 1.38 11 1.74 37 27.54 1.34 3.68

All excluding same site 6 1.11 12 1.26 8 1.42 11 1.78 37 26.68 1.39 4.01

Buccal cavity, pharynx 0 0.00 1 3.36 0 0.00 2 11.96* 3 0.81 3.72 0.85

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.05

Tongue 0 0.00 0 0.00 0 0.00 1 28.61 1 0.16 6.28 0.33

Salivary gland 0 0.00 1 36.37 0 0.00 1 40.95 2 0.09 23.13* 0.74

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.07

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.02

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.03

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.03

Digestive system 3 2.73 1 0.56 0 0.00 2 2.12 6 4.81 1.25 0.46

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.11

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.54 0.00 -0.21

Small intestine 1 61.54 1 36.32 0 0.00 0 0.00 2 0.08 25.74* 0.75

Colon 1 2.23 0 0.00 0 0.00 0 0.00 1 2.00 0.50 -0.39

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 1 6.00 1 0.89 1.13 0.04

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.02

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.09

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.01

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.04

Pancreas 1 8.13 0 0.00 0 0.00 0 0.00 1 0.53 1.90 0.18

Respiratory system 1 1.01 1 0.63 2 2.45 0 0.00 4 4.08 0.98 -0.03

Nose, nasal cavity, ear 0 0.00 0 0.00 1 100.67* 0 0.00 1 0.05 20.19 0.37

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.13

Lung, bronchus 1 1.13 1 0.71 1 1.37 0 0.00 3 3.64 0.82 -0.25

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.02

Male genital system 1 0.66 4 1.53 0 0.00 1 0.58 6 7.43 0.81 -0.55

Prostate 1 0.70 4 1.66 0 0.00 1 0.83 6 6.41 0.94 -0.16

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.96 0.00 -0.37

Urinary system 0 0.00 1 1.13 0 0.00 1 2.12 2 2.35 0.85 -0.14

Urinary bladder 0 0.00 1 1.70 0 0.00 1 3.03 2 1.60 1.25 0.15

Kidney parenchyma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -0.25

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.05

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.02

Bone, joints 1 41.97 0 0.00 1 12.03 2 22.27* 4 0.28 14.44* 1.45

Soft tissue including heart 0 0.00 1 9.31 0 0.00 0 0.00 1 0.33 3.01 0.26

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.16

Melanoma of skin 0 0.00 0 0.00 0 0.00 0 0.00 0 1.11 0.00 -0.43

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.03

Brain, central nervous system 0 0.00 0 0.00 3 12.66* 0 0.00 3 1.00 3.00 0.78

Thyroid 0 0.00 1 13.79 1 17.99 2 18.61* 4 0.27 14.80* 1.45

Lymphatic, hematopoietic 0 0.00 2 1.57 1 1.20 0 0.00 3 3.74 0.80 -0.29

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.64 0.00 -0.25

Non-Hodgkin lymphoma 0 0.00 1 2.23 0 0.00 0 0.00 1 1.38 0.72 -0.15

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.10

Leukemia 0 0.00 1 1.75 1 3.17 0 0.00 2 1.45 1.38 0.21

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.58 0.00 -0.22

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.10

Acute non-lymphocytic 0 0.00 1 7.18 1 10.96 0 0.00 2 0.41 4.94 0.62

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.05

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,205 3,368 1,723 1,018 4,205

Person-years in interval 3,100 9,333 6,621 6,674 25,728

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING LEUKEMIA 445
All subsequent cancers 1 1.65 6 3.19* 13 7.87* 16 4.06* 36 8.08 4.45* 7.10

All excluding same site 1 2.21 6 4.09* 13 8.95* 16 4.19* 36 7.19 5.01* 7.33

Buccal cavity, pharynx 0 0.00 1 41.12 1 31.65 2 25.86* 4 0.14 28.84* 0.98

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Tongue 0 0.00 0 0.00 0 0.00 1 69.87 1 0.02 50.83 0.25

Salivary gland 0 0.00 1 119.23* 1 77.72* 1 37.53 3 0.05 60.63* 0.75

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.01

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Digestive system 0 0.00 1 19.21 0 0.00 1 6.36 2 0.27 7.44 0.44

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Small intestine 0 0.00 1 .† 0 0.00 0 0.00 1 0.01 113.27* 0.25

Colon 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.02

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.01

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.01

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 0.00

Respiratory system 0 0.00 0 0.00 1 48.54 0 0.00 1 0.12 8.07 0.22

Nose, nasal cavity, ear 0 0.00 0 0.00 1 207.29* 0 0.00 1 0.02 47.24 0.25

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Lung, bronchus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.01

Female breast 0 0.00 0 0.00 0 0.00 1 5.37 1 0.19 5.13 0.45

Female genital system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.25

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.08

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.01

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.13

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.01

Male genital system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.28

Prostate 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.27

Urinary system 0 0.00 0 0.00 0 0.00 1 13.64 1 0.25 3.97 0.19

Urinary bladder 0 0.00 0 0.00 0 0.00 1 25.87 1 0.06 18.06 0.24

Kidney parenchyma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.05

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Bone, joints 1 49.21 0 0.00 1 8.20 2 15.50* 4 0.37 10.79* 0.92

Soft tissue including heart 0 0.00 1 9.70 1 11.92 0 0.00 2 0.35 5.66 0.42

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.03

Melanoma of skin 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.15

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.02

Brain, central nervous system 0 0.00 1 2.46 7 24.61* 3 10.36* 11 1.10 9.98* 2.52

Thyroid 0 0.00 1 23.62 1 11.06 5 12.78* 7 0.53 13.18* 1.64

Lymphatic, hematopoietic 0 0.00 1 1.26 1 1.59 0 0.00 2 2.70 0.74 -0.18

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.80 0.00 -0.20

Non-Hodgkin lymphoma 0 0.00 1 7.27 0 0.00 0 0.00 1 0.60 1.66 0.10

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 0.00

Leukemia 0 0.00 0 0.00 1 3.43 0 0.00 1 1.29 0.77 -0.07

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.89 0.00 -0.23

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00

Acute non-lymphocytic 0 0.00 0 0.00 1 13.52 0 0.00 1 0.31 3.18 0.17

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.02

Acute Lymphocytic Leukemia

Both Sexes, <17 Years of Age

Table 17.1.5: Risk of subsequent primary cancers after acute lymphocytic leukemia, both sexes,

<17 years of age, SEER 1973-2000.

446 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ACUTE LYMPHOCYTIC

LEUKEMIA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,811 4,370 2,684 1,666 4,811

Person-years in interval 3,821 13,598 10,605 11,304 39,328

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. †O/E > 500. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.)

primary cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per

10,000 person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 18,065 PYR and for male cancers on 21,264 PYR.
Acute Lymphocytic Leukemia

Both Sexes, ≥17 Years of Age

Table 17.1.6: Risk of subsequent primary cancers after acute lymphocytic leukemia, both sexes,

≥17 years of age, SEER 1973-2000.

ACUTE LYMPHOCYTIC

LEUKEMIA

All subsequent cancers 6 0.74 13 0.96 6 0.81 5 0.75 30 35.70 0.84 -7.88

All excluding same site 6 0.75 13 0.97 6 0.82 5 0.76 30 35.27 0.85 -7.28

Buccal cavity, pharynx 0 0.00 0 0.00 0 0.00 1 6.11 1 0.95 1.06 0.07

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.20

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.20 0.00 -0.27

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.13

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.32

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.07

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.13

Oropharynx 0 0.00 0 0.00 0 0.00 1 262.50* 1 0.02 40.42 1.35

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.11

Digestive system 3 1.79 0 0.00 0 0.00 1 0.80 4 7.04 0.57 -4.21

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.48

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 0.72 0.00 -1.00

Small intestine 1 40.28 0 0.00 0 0.00 0 0.00 1 0.11 9.02 1.23

Colon 1 1.35 0 0.00 0 0.00 0 0.00 1 3.12 0.32 -2.92

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 1 4.66 1 1.25 0.80 -0.35

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.11

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.37

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.12

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.21

Pancreas 1 5.01 0 0.00 0 0.00 0 0.00 1 0.83 1.21 0.24

Respiratory system 1 0.75 2 0.95 2 1.85 0 0.00 5 5.43 0.92 -0.59

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.08

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.53

Lung, bronchus 1 0.82 2 1.04 2 2.02 0 0.00 5 4.97 1.01 0.04

Female breast 0 0.00 0 0.00 1 1.24 0 0.00 1 3.96 0.25 -10.67

Female genital system 0 0.00 0 0.00 1 2.83 0 0.00 1 1.76 0.57 -2.75

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -1.27

Corpus uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.76 0.00 -2.73

Ovary 0 0.00 0 0.00 1 9.37 0 0.00 1 0.53 1.90 1.71

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.08

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.25

Male genital system 1 0.67 4 1.55 0 0.00 1 0.78 6 6.84 0.88 -1.88

Prostate 1 0.70 4 1.66 0 0.00 1 0.84 6 6.41 0.94 -0.91

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.87

Urinary system 1 1.62 2 1.96 0 0.00 0 0.00 3 2.72 1.10 0.39

Urinary bladder 1 2.40 1 1.45 0 0.00 0 0.00 2 1.84 1.08 0.21

Kidney parenchyma 0 0.00 1 3.68 0 0.00 0 0.00 1 0.72 1.38 0.38

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.21

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.07

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.09

Soft tissue including heart 0 0.00 1 13.36 0 0.00 0 0.00 1 0.20 5.06 1.11

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.40

Melanoma of skin 0 0.00 0 0.00 0 0.00 2 6.89 2 1.30 1.54 0.97

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.08

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.70

Thyroid 0 0.00 0 0.00 1 9.27 0 0.00 1 0.48 2.08 0.72

Lymphatic, hematopoietic 0 0.00 4 3.49 0 0.00 0 0.00 4 3.03 1.32 1.34

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.29 0.00 -0.40

Non-Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 1.38 0.00 -1.90

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.56

Leukemia 0 0.00 4 10.94* 0 0.00 0 0.00 4 0.96 4.16* 4.20

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.08

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.46

Acute non-lymphocytic 0 0.00 4 31.29* 0 0.00 0 0.00 4 0.33 11.95* 5.07

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.20

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 2,435 1,452 435 220 2,435

Person-years in interval 1,516 2,951 1,540 1,229 7,236

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 2,771 PYR and for male cancers on 4,465 PYR.

NEW MALIGNANCIES FOLLOWING LEUKEMIA 447
Acute Myeloid Leukemia

Both Sexes

Table 17.2.1: Characteristics of patients with an initial acute myeloid leukemia, both sexes,

SEER 1973-2000.

448 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ACUTE MYELOID LEUKEMIA

Number of patients with 1st primary cancer

Total 6,080 100.0 5,089 100.0 11,169 100.0

Initial treatment

Any radiation 296 4.9 254 5.0 550 4.9

With surgery 4 0.1 2 0.0 6 0.1

Without surgery 292 4.8 252 5.0 544 4.9

No radiation 5,784 95.1 4,835 95.0 10,619 95.1

With surgery 12 0.2 14 0.3 26 0.2

Without surgery 5,772 94.9 4,821 94.7 10,593 94.8

Race

White 5,152 84.7 4,285 84.2 9,437 84.5

Black 429 7.1 420 8.3 849 7.6

Other 486 8.0 374 7.3 860 7.7

Unknown 13 0.2 10 0.2 23 0.2

Age at 1st primary cancer diagnosis, years

< 30 924 15.2 872 17.1 1,796 16.1

30–49 1,106 18.2 1,008 19.8 2,114 18.9

50–69 2,201 36.2 1,534 30.1 3,735 33.4

70–79 1,318 21.7 1,020 20.0 2,338 20.9

> 80 531 8.7 655 12.9 1,186 10.6

Number of patients with one or more

primary cancers

One primary cancer only 5,987 98.5 5,028 98.8 11,015 98.6

1st and 2nd cancers 91 1.5 59 1.2 150 1.3

1st, 2nd, and 3rd cancers 2 0.0 2 0.0 4 0.0

1st, 2nd, 3rd, and additional cancers 0 0.0 0 0.0 0 0.0

Other statistics

Median age at 1st cancer diagnosis 61.5 — 59.8 — 60.9 —

Median year of 1st cancer diagnosis 1989.0 — 1989.0 — 1989.0 —

Median person-years at risk 0.6 — 0.7 — 0.7 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 87.1 — 90.2 — 88.3

1st, 2nd, and additional cancers — 87.1 — 90.2 — 88.3

1st cancer only — 12.9 — 9.8 — 11.7

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Acute Myeloid Leukemia

Both Sexes

Table 17.2.2: Risk of subsequent primary cancers after acute myeloid leukemia, both sexes,

SEER 1973-2000.

ACUTE MYELOID LEUKEMIA

All subsequent cancers 61 1.05 54 0.85 20 0.82 23 0.96 158 169.81 0.93 -5.35

All excluding same site 61 1.06 53 0.84 20 0.83 23 0.97 157 167.91 0.94 -4.94

Buccal cavity, pharynx 0 0.00 2 1.17 2 3.18 1 1.73 5 4.48 1.12 0.24

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.27

Tongue 0 0.00 0 0.00 0 0.00 1 7.84 1 0.92 1.08 0.03

Salivary gland 0 0.00 1 6.59 1 16.89 0 0.00 2 0.40 4.98 0.72

Mouth 0 0.00 1 2.27 1 6.18 0 0.00 2 1.16 1.73 0.38

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.10

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.21

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.12 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.20

Digestive system 8 0.63 14 1.05 3 0.62 4 0.83 29 35.61 0.81 -3.00

Esophagus 0 0.00 2 3.01 0 0.00 1 4.02 3 1.79 1.68 0.55

Stomach 1 0.75 0 0.00 1 2.01 0 0.00 2 3.70 0.54 -0.77

Small intestine 1 5.72 1 5.07 0 0.00 0 0.00 2 0.53 3.74 0.66

Colon 4 0.71 8 1.37 1 0.47 1 0.48 14 15.72 0.89 -0.78

Rectum, rectosigmoid junction 2 0.89 1 0.42 0 0.00 0 0.00 3 6.24 0.48 -1.47

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.17

Liver 0 0.00 0 0.00 1 5.06 2 9.19* 3 1.35 2.22 0.75

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.22

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.77 0.00 -0.35

Pancreas 0 0.00 2 1.26 0 0.00 0 0.00 2 4.26 0.47 -1.02

Respiratory system 11 1.11 10 0.96 2 0.53 1 0.27 24 27.90 0.86 -1.77

Nose, nasal cavity, ear 1 11.46 0 0.00 0 0.00 0 0.00 1 0.26 3.91 0.34

Larynx 1 1.44 0 0.00 0 0.00 0 0.00 1 1.89 0.53 -0.40

Lung, bronchus 9 0.98 10 1.04 2 0.57 1 0.29 22 25.66 0.86 -1.66

Female breast 2 0.34 2 0.25* 4 1.08 4 1.22 12 20.94 0.57 -8.10

Female genital system 1 0.36 2 0.56 1 0.64 3 2.23 7 9.24 0.76 -2.03

Cervix uteri 0 0.00 0 0.00 0 0.00 2 9.75* 2 1.39 1.44 0.55

Corpus uteri 0 0.00 1 0.59 1 1.38 0 0.00 2 4.40 0.45 -2.17

Ovary 1 1.26 0 0.00 0 0.00 1 2.39 2 2.74 0.73 -0.67

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.12

Vulva 0 0.00 1 7.02 0 0.00 0 0.00 1 0.38 2.61 0.56

Male genital system 17 1.51 9 0.81 1 0.27 3 0.68 30 30.56 0.98 -0.50

Prostate 16 1.44 9 0.83 1 0.28 3 0.70 29 29.80 0.97 -0.72

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.50

Urinary system 8 1.75 7 1.49 3 1.81 2 1.20 20 12.59 1.59 3.36

Urinary bladder 0 0.00 4 1.27 3 2.81 1 0.93 8 8.43 0.95 -0.20

Kidney parenchyma 7 6.19* 3 2.36 0 0.00 1 2.00 11 3.40 3.24* 3.44

Renal pelvis, other urinary 1 3.48 0 0.00 0 0.00 0 0.00 1 0.76 1.32 0.11

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.25 0.00 -0.11

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.10

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.78 0.00 -0.35

Kaposi sarcoma 0 0.00 1 4.37 0 0.00 0 0.00 1 0.57 1.75 0.19

Melanoma of skin 1 0.73 2 1.14 0 0.00 0 0.00 3 4.67 0.64 -0.76

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.26 0.00 -0.12

Brain, central nervous system 1 1.55 1 1.28 0 0.00 0 0.00 2 2.03 0.99 -0.01

Thyroid 6 14.65* 0 0.00 1 3.29 0 0.00 7 1.60 4.37* 2.45

Lymphatic, hematopoietic 3 0.68 3 0.61 2 1.03 4 2.14 12 13.10 0.92 -0.50

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.73 0.00 -0.33

Non-Hodgkin lymphoma 2 1.04 1 0.45 1 1.08 2 2.22 6 5.98 1.00 0.01

Myeloma 0 0.00 1 1.32 0 0.00 1 3.44 2 2.04 0.98 -0.02

Leukemia 1 0.65 1 0.61 1 1.68 1 1.76 4 4.35 0.92 -0.16

Acute lymphocytic 0 0.00 0 0.00 1 26.33 0 0.00 1 0.23 4.42 0.35

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 1 5.04 1 1.59 0.63 -0.27

Acute non-lymphocytic 0 0.00 1 1.79 0 0.00 0 0.00 1 1.50 0.67 -0.22

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.61 0.00 -0.28

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 11,169 4,932 1,219 560 11,169

Person-years in interval 5,822 8,753 4,175 3,323 22,073

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 11,036 PYR and for male cancers on 11,037 PYR.

NEW MALIGNANCIES FOLLOWING LEUKEMIA 449
All subsequent cancers 19 0.93 22 0.84 11 0.94 11 1.05 63 68.86 0.91 -5.31

All excluding same site 19 0.94 22 0.85 11 0.95 11 1.06 63 68.13 0.92 -4.65

Buccal cavity, pharynx 0 0.00 1 2.15 2 9.90* 0 0.00 3 1.21 2.49 1.63

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.07

Tongue 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.24

Salivary gland 0 0.00 0 0.00 1 38.30 0 0.00 1 0.15 6.68 0.77

Mouth 0 0.00 1 6.56 1 15.27 0 0.00 2 0.40 5.02 1.45

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.05

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.10

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.03 0.00 -0.03

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.07

Digestive system 4 0.88 9 1.67 1 0.44 1 0.48 15 14.29 1.05 0.65

Esophagus 0 0.00 2 13.64* 0 0.00 0 0.00 2 0.39 5.11 1.46

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 0 1.19 0.00 -1.07

Small intestine 1 15.66 1 12.47 0 0.00 0 0.00 2 0.22 9.13* 1.61

Colon 3 1.33 4 1.53 0 0.00 1 0.99 8 6.96 1.15 0.95

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 0 0.00 0 2.30 0.00 -2.08

Rectum 0 0.00 0 0.00 0 0.00 0 0.00 0 1.51 0.00 -1.37

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.19

Liver 0 0.00 0 0.00 1 17.25 0 0.00 1 0.34 2.95 0.60

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.29

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.29

Pancreas 0 0.00 2 2.91 0 0.00 0 0.00 2 1.84 1.09 0.14

Respiratory system 4 1.58 2 0.62 1 0.68 1 0.75 8 8.54 0.94 -0.49

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.08

Larynx 1 11.63 0 0.00 0 0.00 0 0.00 1 0.29 3.47 0.64

Lung, bronchus 3 1.24 2 0.66 1 0.71 1 0.79 7 8.14 0.86 -1.03

Female breast 2 0.34 2 0.25* 4 1.08 4 1.22 12 20.94 0.57 -8.10

Female genital system 1 0.36 2 0.56 1 0.64 3 2.23 7 9.24 0.76 -2.03

Cervix uteri 0 0.00 0 0.00 0 0.00 2 9.75* 2 1.39 1.44 0.55

Corpus uteri 0 0.00 1 0.59 1 1.38 0 0.00 2 4.40 0.45 -2.17

Ovary 1 1.26 0 0.00 0 0.00 1 2.39 2 2.74 0.73 -0.67

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.12

Vulva 0 0.00 1 7.02 0 0.00 0 0.00 1 0.38 2.61 0.56

Urinary system 1 1.07 3 2.61 0 0.00 1 2.15 5 3.05 1.64 1.76

Urinary bladder 0 0.00 2 3.05 0 0.00 1 3.82 3 1.75 1.71 1.13

Kidney parenchyma 1 3.22 1 2.49 0 0.00 0 0.00 2 1.07 1.88 0.85

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.24 0.00 -0.22

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.07

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.09

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.29

Kaposi sarcoma 0 0.00 1 118.35* 0 0.00 0 0.00 1 0.02 42.67 0.88

Melanoma of skin 0 0.00 1 1.45 0 0.00 0 0.00 1 1.83 0.55 -0.75

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.10

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 0.80 0.00 -0.72

Thyroid 4 15.55* 0 0.00 0 0.00 0 0.00 4 1.09 3.66 2.63

Lymphatic, hematopoietic 1 0.64 1 0.51 1 1.14 1 1.25 4 5.17 0.77 -1.06

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.27

Non-Hodgkin lymphoma 1 1.39 1 1.10 0 0.00 0 0.00 2 2.44 0.82 -0.40

Myeloma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.82 0.00 -0.75

Leukemia 0 0.00 0 0.00 1 3.85 1 4.22 2 1.60 1.25 0.36

Acute lymphocytic 0 0.00 0 0.00 1 56.38 0 0.00 1 0.10 10.48 0.82

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 1 12.67 1 0.55 1.80 0.40

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.53

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.20

Acute Myeloid Leukemia

Females

Table 17.2.3: Risk of subsequent primary cancers after acute myeloid leukemia, females,

SEER 1973-2000.

450 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

ACUTE MYELOID LEUKEMIA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,089 2,338 640 300 5,089

Person-years in interval 2,709 4,362 2,212 1,754 11,036

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Acute Myeloid Leukemia

Males

Table 17.2.4: Risk of subsequent primary cancers after acute myeloid leukemia, males,

SEER 1973-2000.

ACUTE MYELOID LEUKEMIA

All subsequent cancers 42 1.12 32 0.85 9 0.72 12 0.89 95 100.94 0.94 -5.39

All excluding same site 42 1.13 31 0.84 9 0.73 12 0.90 94 99.78 0.94 -5.24

Buccal cavity, pharynx 0 0.00 1 0.81 0 0.00 1 2.45 2 3.27 0.61 -1.15

Lip 0 0.00 0 0.00 0 0.00 0 0.00 0 0.53 0.00 -0.48

Tongue 0 0.00 0 0.00 0 0.00 1 11.30 1 0.65 1.53 0.31

Salivary gland 0 0.00 1 10.61 0 0.00 0 0.00 1 0.25 3.97 0.68

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.76 0.00 -0.69

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.15

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.31

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.09

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.36 0.00 -0.32

Digestive system 4 0.49 5 0.63 2 0.77 3 1.11 14 21.33 0.66 -6.64

Esophagus 0 0.00 0 0.00 0 0.00 1 5.21 1 1.40 0.72 -0.36

Stomach 1 1.04 0 0.00 1 3.25 0 0.00 2 2.52 0.79 -0.47

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.32 0.00 -0.29

Colon 1 0.29 4 1.23 1 0.97 0 0.00 6 8.76 0.68 -2.50

Rectum, rectosigmoid junction 2 1.32 1 0.68 0 0.00 0 0.00 3 3.94 0.76 -0.85

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.15

Liver 0 0.00 0 0.00 0 0.00 2 12.18* 2 1.01 1.98 0.90

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.16

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.41

Pancreas 0 0.00 0 0.00 0 0.00 0 0.00 0 2.42 0.00 -2.19

Respiratory system 7 0.94 8 1.10 1 0.43 0 0.00 16 19.36 0.83 -3.04

Nose, nasal cavity, ear 1 16.79 0 0.00 0 0.00 0 0.00 1 0.16 6.10 0.76

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.61 0.00 -1.45

Lung, bronchus 6 0.89 8 1.22 1 0.48 0 0.00 15 17.53 0.86 -2.29

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.17

Male genital system 17 1.51 9 0.81 1 0.27 3 0.68 30 30.56 0.98 -0.50

Prostate 16 1.44 9 0.83 1 0.28 3 0.70 29 29.80 0.97 -0.72

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.56 0.00 -0.50

Urinary system 7 1.93 4 1.13 3 2.60 1 0.83 15 9.53 1.57 4.95

Urinary bladder 0 0.00 2 0.80 3 3.83 0 0.00 5 6.68 0.75 -1.52

Kidney parenchyma 6 7.32* 2 2.30 0 0.00 1 3.03 9 2.33 3.86* 6.04

Renal pelvis, other urinary 1 4.77 0 0.00 0 0.00 0 0.00 1 0.52 1.91 0.43

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.16

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.12

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.42

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.50

Melanoma of skin 1 1.10 1 0.94 0 0.00 0 0.00 2 2.85 0.70 -0.77

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.14

Brain, central nervous system 1 2.40 1 2.12 0 0.00 0 0.00 2 1.23 1.63 0.70

Thyroid 2 13.14* 0 0.00 1 11.90 0 0.00 3 0.51 5.91* 2.26

Lymphatic, hematopoietic 2 0.71 2 0.68 1 0.94 3 2.81 8 7.92 1.01 0.07

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.43 0.00 -0.39

Non-Hodgkin lymphoma 1 0.83 0 0.00 1 1.99 2 3.90 4 3.53 1.13 0.42

Myeloma 0 0.00 1 2.22 0 0.00 1 6.04 2 1.22 1.64 0.71

Leukemia 1 0.96 1 0.97 0 0.00 0 0.00 2 2.74 0.73 -0.67

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.12

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.04 0.00 -0.94

Acute non-lymphocytic 0 0.00 1 2.95 0 0.00 0 0.00 1 0.91 1.10 0.08

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.38 0.00 -0.35

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 6,080 2,594 579 260 6,080

Person-years in interval 3,113 4,391 1,963 1,569 11,037

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING LEUKEMIA 451
Chronic Lymphocytic Leukemia

Both Sexes

Table 17.3.1: Characteristics of patients with an initial chronic lymphocytic leukemia, both sexes,

SEER 1973-2000.

452 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CHRONIC LYMPHOCYTIC

LEUKEMIA

Number of patients with 1st primary cancer

Total 11,528 100.0 8,103 100.0 19,631 100.0

Initial treatment

Any radiation 285 2.5 171 2.1 456 2.3

With surgery 8 0.1 4 0.0 12 0.1

Without surgery 277 2.4 167 2.1 444 2.3

No radiation 11,243 97.5 7,932 97.9 19,175 97.7

With surgery 130 1.1 71 0.9 201 1.0

Without surgery 11,113 96.4 7,861 97.0 18,974 96.7

Race

White 10,560 91.6 7,460 92.1 18,020 91.8

Black 705 6.1 494 6.1 1,199 6.1

Other 162 1.4 97 1.2 259 1.3

Unknown 101 0.9 52 0.6 153 0.8

Age at 1st primary cancer diagnosis, years

< 30 7 0.1 9 0.1 16 0.1

30–49 804 7.0 345 4.3 1,149 5.9

50–69 5,567 48.3 3,049 37.6 8,616 43.9

70–79 3,360 29.1 2,616 32.3 5,976 30.4

> 80 1,790 15.5 2,084 25.7 3,874 19.7

Number of patients with one or more

primary cancers

One primary cancer only 9,842 85.4 7,313 90.3 17,155 87.4

1st and 2nd cancers 1,527 13.2 726 9.0 2,253 11.5

1st, 2nd, and 3rd cancers 148 1.3 59 0.7 207 1.1

1st, 2nd, 3rd, and additional cancers 11 0.1 5 0.1 16 0.1

Other statistics

Median age at 1st cancer diagnosis 68.3 — 72.4 — 70.0 —

Median year of 1st cancer diagnosis 1987.9 — 1988.0 — 1987.9 —

Median person-years at risk 4.4 — 4.8 — 4.6 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 92.0 — 89.6 — 91.2

1st, 2nd, and additional cancers — 91.6 — 89.2 — 90.8

1st cancer only — 4.9 — 6.1 — 5.3

Males Females Total

Characteristics No. % No. % No. %

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
Chronic Lymphocytic Leukemia

Both Sexes

Table 17.3.2: Risk of subsequent primary cancers after chronic lymphocytic leukemia, both sexes,

SEER 1973-2000.

CHRONIC LYMPHOCYTIC

LEUKEMIA

All subsequent cancers 353 1.26* 1,228 1.22* 728 1.13* 409 1.05 2,718 2,314.31 1.17* 35.06

All excluding same site 353 1.28* 1,228 1.24* 728 1.15* 409 1.07 2,718 2,284.29 1.19* 37.67

Buccal cavity, pharynx 9 1.24 29 1.15 15 1.00 8 0.99 61 55.73 1.09 0.46

Lip 4 3.07 7 1.60 6 2.35 4 2.91 21 9.62 2.18* 0.99

Tongue 1 0.72 3 0.62 1 0.34 1 0.63 6 10.82 0.55 -0.42

Salivary gland 2 3.16 5 2.20 3 2.06 2 2.21 12 5.26 2.28* 0.59

Mouth 2 1.05 6 0.90 2 0.51 1 0.47 11 14.67 0.75 -0.32

Nasopharynx 0 0.00 2 2.50 1 2.16 0 0.00 3 1.73 1.73 0.11

Tonsil 0 0.00 1 0.45 1 0.79 0 0.00 2 4.73 0.42 -0.24

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.50 0.00 -0.13

Hypopharynx 0 0.00 4 1.60 0 0.00 0 0.00 4 5.40 0.74 -0.12

Digestive system 74 1.13 259 1.11 166 1.13 89 1.01 588 533.47 1.10* 4.74

Esophagus 2 0.65 8 0.73 11 1.62 3 0.75 24 24.77 0.97 -0.07

Stomach 10 1.47 29 1.23 18 1.27 8 0.99 65 52.58 1.24 1.08

Small intestine 1 1.21 4 1.33 2 1.01 1 0.80 8 7.05 1.13 0.08

Colon 34 1.12 125 1.15 87 1.25* 42 0.99 288 251.10 1.15* 3.20

Rectum, rectosigmoid junction 13 1.15 41 1.03 25 1.03 23 1.66* 102 89.28 1.14 1.10

Anus, anal canal 1 1.86 1 0.52 1 0.80 1 1.34 4 4.47 0.89 -0.04

Liver 1 0.52 5 0.72 2 0.45 1 0.36 9 15.99 0.56 -0.61

Gallbladder 2 2.12 6 1.83 1 0.49 2 1.68 11 7.45 1.48 0.31

Bile ducts, other biliary 0 0.00 2 0.40 2 0.61 1 0.46 5 11.79 0.42* -0.59

Pancreas 9 1.14 29 1.04 16 0.91 7 0.66 61 64.00 0.95 -0.26

Respiratory system 76 1.59* 278 1.63* 183 1.70* 94 1.50* 631 389.15 1.62* 21.00

Nose, nasal cavity, ear 2 4.89 3 2.08 4 4.44* 0 0.00 9 3.28 2.74* 0.50

Larynx 4 1.24 14 1.24 16 2.40* 5 1.46 39 24.60 1.59* 1.25

Lung, bronchus 69 1.57* 259 1.64* 163 1.63* 89 1.52* 580 360.30 1.61* 19.08

Female breast 14 0.59* 92 1.06 50 0.86 31 0.85 187 205.54 0.91 -3.69

Female genital system 7 0.64 32 0.82 15 0.60* 14 0.94 68 90.06 0.76* -4.39

Cervix uteri 0 0.00 4 1.03 1 0.45 1 0.87 6 8.40 0.71 -0.48

Corpus uteri 2 0.36 16 0.80 7 0.56 3 0.40 28 45.59 0.61* -3.50

Ovary 4 1.25 7 0.60 6 0.79 7 1.49 24 27.04 0.89 -0.61

Vagina 0 0.00 0 0.00 0 0.00 1 3.69 1 1.59 0.63 -0.12

Vulva 1 1.70 5 2.31 1 0.69 2 2.05 9 5.18 1.74 0.76

Male genital system 71 1.22 214 1.01 133 0.96 63 0.75* 481 491.50 0.98 -1.62

Prostate 70 1.22 210 1.00 132 0.96 61 0.73* 473 487.22 0.97 -2.19

Testis 1 5.57 1 1.74 0 0.00 0 0.00 2 1.15 1.74 0.13

Urinary system 42 1.79* 100 1.19 48 0.89 35 1.07 225 193.82 1.16* 2.71

Urinary bladder 20 1.20 68 1.14 31 0.81 27 1.15 146 138.13 1.06 0.68

Kidney parenchyma 18 3.46* 23 1.22 15 1.23 6 0.82 62 43.56 1.42* 1.60

Renal pelvis, other urinary 4 2.65 9 1.69 2 0.60 2 1.02 17 12.13 1.40 0.42

Ureter 2 4.00 5 2.82 0 0.00 0 0.00 7 4.04 1.73 0.26

Bone, joints 0 0.00 1 1.22 1 2.01 0 0.00 2 1.83 1.09 0.02

Soft tissue including heart 3 2.83 6 1.59 4 1.67 1 0.66 14 8.73 1.60 0.46

Kaposi sarcoma 4 12.63* 4 3.74* 4 6.47* 0 0.00 12 2.33 5.14* 0.84

Melanoma of skin 18 3.25* 52 2.53* 31 2.25* 27 3.05* 128 48.68 2.63* 6.89

Eye, orbit 1 2.44 3 2.09 1 1.12 0 0.00 5 3.26 1.54 0.15

Brain, central nervous system 4 1.51 11 1.16 8 1.33 1 0.29 24 21.67 1.11 0.20

Thyroid 4 3.45 6 1.46 1 0.40 0 0.00 11 9.21 1.19 0.16

Lymphatic, hematopoietic 11 0.52* 83 1.09 43 0.88 27 0.88 164 176.80 0.93 -1.11

Hodgkin lymphoma 1 1.57 16 7.39* 10 7.90* 8 11.76* 35 4.75 7.37* 2.63

Non-Hodgkin lymphoma 7 0.78 44 1.34 23 1.05 13 0.93 87 77.74 1.12 0.80

Myeloma 2 0.55 12 0.92 7 0.84 3 0.58 24 30.23 0.79 -0.54

Leukemia 1 0.13* 11 0.39* 3 0.17* 3 0.28* 18 64.09 0.28* -4.00

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.61 0.00 -0.14

Chronic lymphocytic 0 0.00 0 0.00* 0 0.00* 0 0.00* 0 26.03 0.00* -2.26

Acute non-lymphocytic 1 0.39 7 0.76 2 0.34 2 0.55 12 21.29 0.56* -0.81

Chronic myeloid 0 0.00 3 0.81 1 0.43 0 0.00 4 8.59 0.47 -0.40

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 19,631 17,177 9,454 3,718 19,631

Person-years in interval 15,136 52,327 30,981 16,698 115,142

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 50,255 PYR and for male cancers on 64,887 PYR.

NEW MALIGNANCIES FOLLOWING LEUKEMIA 453
All subsequent cancers 2,309 1.20* 291 1.09 97 1.01 21 0.85 2,718 2,314.31 1.17* 35.06

All excluding same site 2,309 1.21* 291 1.10 97 1.02 21 0.86 2,718 2,284.29 1.19* 37.67

Buccal cavity, pharynx 53 1.11 6 1.05 2 1.04 0 0.00 61 55.73 1.09 0.46

Lip 17 2.06* 4 4.15* 0 0.00 0 0.00 21 9.62 2.18* 0.99

Tongue 5 0.54 0 0.00 1 2.63 0 0.00 6 10.82 0.55 -0.42

Salivary gland 10 2.29* 2 3.28 0 0.00 0 0.00 12 5.26 2.28* 0.59

Mouth 10 0.80 0 0.00 1 1.95 0 0.00 11 14.67 0.75 -0.32

Nasopharynx 3 2.00 0 0.00 0 0.00 0 0.00 3 1.73 1.73 0.11

Tonsil 2 0.49 0 0.00 0 0.00 0 0.00 2 4.73 0.42 -0.24

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.50 0.00 -0.13

Hypopharynx 4 0.85 0 0.00 0 0.00 0 0.00 4 5.40 0.74 -0.12

Digestive system 499 1.12* 62 1.03 23 1.05 4 0.68 588 533.47 1.10* 4.74

Esophagus 21 1.01 1 0.36 2 2.02 0 0.00 24 24.77 0.97 -0.07

Stomach 57 1.28 5 0.89 3 1.51 0 0.00 65 52.58 1.24 1.08

Small intestine 7 1.21 1 1.18 0 0.00 0 0.00 8 7.05 1.13 0.08

Colon 246 1.18* 27 0.93 11 1.04 4 1.38 288 251.10 1.15* 3.20

Rectum, rectosigmoid junction 79 1.05 20 2.07* 3 0.90 0 0.00 102 89.28 1.14 1.10

Anus, anal canal 3 0.80 1 1.96 0 0.00 0 0.00 4 4.47 0.89 -0.04

Liver 8 0.60 0 0.00 1 1.42 0 0.00 9 15.99 0.56 -0.61

Gallbladder 9 1.44 2 2.45 0 0.00 0 0.00 11 7.45 1.48 0.31

Bile ducts, other biliary 4 0.42 0 0.00 1 1.75 0 0.00 5 11.79 0.42* -0.59

Pancreas 54 1.01 5 0.69 2 0.75 0 0.00 61 64.00 0.95 -0.26

Respiratory system 537 1.65* 74 1.70* 14 0.91 6 1.52 631 389.15 1.62* 21.00

Nose, nasal cavity, ear 9 3.27* 0 0.00 0 0.00 0 0.00 9 3.28 2.74* 0.50

Larynx 34 1.61* 5 2.03 0 0.00 0 0.00 39 24.60 1.59* 1.25

Lung, bronchus 491 1.63* 69 1.70* 14 0.97 6 1.61 580 360.30 1.61* 19.08

Female breast 156 0.92 22 0.89 7 0.76 2 0.76 187 205.54 0.91 -3.69

Female genital system 54 0.72* 11 1.08 2 0.54 1 0.97 68 90.06 0.76* -4.39

Cervix uteri 5 0.69 1 1.23 0 0.00 0 0.00 6 8.40 0.71 -0.48

Corpus uteri 25 0.66* 1 0.20 1 0.54 1 1.96 28 45.59 0.61* -3.50

Ovary 17 0.76 6 1.89 1 0.84 0 0.00 24 27.04 0.89 -0.61

Vagina 0 0.00 1 5.44 0 0.00 0 0.00 1 1.59 0.63 -0.12

Vulva 7 1.67 2 3.09 0 0.00 0 0.00 9 5.18 1.74 0.76

Male genital system 418 1.03 45 0.77 16 0.77 2 0.45 481 491.50 0.98 -1.62

Prostate 412 1.02 43 0.74* 16 0.78 2 0.45 473 487.22 0.97 -2.19

Testis 2 1.93 0 0.00 0 0.00 0 0.00 2 1.15 1.74 0.13

Urinary system 190 1.18* 22 0.98 12 1.46 1 0.46 225 193.82 1.16* 2.71

Urinary bladder 119 1.04 17 1.06 9 1.52 1 0.63 146 138.13 1.06 0.68

Kidney parenchyma 56 1.55* 5 0.99 1 0.55 0 0.00 62 43.56 1.42* 1.60

Renal pelvis, other urinary 15 1.48 0 0.00 2 4.09 0 0.00 17 12.13 1.40 0.42

Ureter 7 2.07 0 0.00 0 0.00 0 0.00 7 4.04 1.73 0.26

Bone, joints 2 1.29 0 0.00 0 0.00 0 0.00 2 1.83 1.09 0.02

Soft tissue including heart 13 1.80 1 0.99 0 0.00 0 0.00 14 8.73 1.60 0.46

Kaposi sarcoma 12 5.99* 0 0.00 0 0.00 0 0.00 12 2.33 5.14* 0.84

Melanoma of skin 101 2.54* 15 2.52* 9 3.96* 3 4.68 128 48.68 2.63* 6.89

Eye, orbit 5 1.83 0 0.00 0 0.00 0 0.00 5 3.26 1.54 0.15

Brain, central nervous system 23 1.27 1 0.41 0 0.00 0 0.00 24 21.67 1.11 0.20

Thyroid 11 1.41 0 0.00 0 0.00 0 0.00 11 9.21 1.19 0.16

Lymphatic, hematopoietic 137 0.94 17 0.82 10 1.29 0 0.00 164 176.80 0.93 -1.11

Hodgkin lymphoma 27 6.64* 5 10.51* 3 18.31* 0 0.00 35 4.75 7.37* 2.63

Non-Hodgkin lymphoma 74 1.16 9 0.96 4 1.12 0 0.00 87 77.74 1.12 0.80

Myeloma 21 0.84 1 0.29 2 1.54 0 0.00 24 30.23 0.79 -0.54

Leukemia 15 0.28* 2 0.27* 1 0.37 0 0.00 18 64.09 0.28* -4.00

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.61 0.00 -0.14

Chronic lymphocytic 0 0.00* 0 0.00 0 0.00 0 0.00 0 26.03 0.00* -2.26

Acute non-lymphocytic 10 0.57 1 0.40 1 1.07 0 0.00 12 21.29 0.56* -0.81

Chronic myeloid 4 0.56 0 0.00 0 0.00 0 0.00 4 8.59 0.47 -0.40

Chronic Lymphocytic Leukemia

Both Sexes, Long-term Follow-up

Table 17.3.3: Risk of subsequent primary cancers after chronic lymphocytic leukemia, both sexes,

long-term follow-up, SEER 1973-2000.

454 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CHRONIC LYMPHOCYTIC

LEUKEMIA

Years after first primary cancer diagnosis

<10 years 10-14 years 15-19 years ≥20 years Total

Number starting interval 19,631 3,718 1,361 409 19,631

Person-years in interval 98,444 11,690 3,985 1,023 115,142

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 50,255 PYR and for male cancers on 64,887 PYR.
Chronic Lymphocytic Leukemia

Females

Table 17.3.4: Risk of subsequent primary cancers after chronic lymphocytic leukemia, females,

SEER 1973-2000.

CHRONIC LYMPHOCYTIC

LEUKEMIA

All subsequent cancers 99 1.10 393 1.19* 218 0.99 150 1.07 860 779.49 1.10* 16.02

All excluding same site 99 1.11 393 1.21* 218 1.01 150 1.08 860 769.88 1.12* 17.93

Buccal cavity, pharynx 3 1.89 4 0.70 2 0.53 0 0.00 9 13.37 0.67 -0.87

Lip 0 0.00 0 0.00 1 3.26 0 0.00 1 1.09 0.92 -0.02

Tongue 0 0.00 1 0.80 0 0.00 0 0.00 1 2.91 0.34 -0.38

Salivary gland 1 5.63 0 0.00 0 0.00 0 0.00 1 1.52 0.66 -0.10

Mouth 2 3.52 1 0.48 1 0.75 0 0.00 4 4.81 0.83 -0.16

Nasopharynx 0 0.00 1 5.25 0 0.00 0 0.00 1 0.44 2.29 0.11

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 1.01 0.00 -0.20

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.06

Hypopharynx 0 0.00 1 2.75 0 0.00 0 0.00 1 0.83 1.21 0.03

Digestive system 28 1.18 109 1.27* 64 1.12 37 1.01 238 203.33 1.17* 6.90

Esophagus 0 0.00 0 0.00 1 0.68 0 0.00 1 5.22 0.19 -0.84

Stomach 6 3.15* 12 1.78 8 1.85 2 0.75 28 15.64 1.79* 2.46

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 2.63 0.00 -0.52

Colon 12 0.99 59 1.34* 40 1.36 24 1.26 135 104.77 1.29* 6.02

Rectum, rectosigmoid junction 3 0.82 15 1.14 11 1.30 7 1.36 36 30.38 1.18 1.12

Rectum 2 0.83 12 1.39 10 1.80 6 1.75 30 19.97 1.50* 2.00

Anus, anal canal 1 3.65 0 0.00 0 0.00 0 0.00 1 2.39 0.42 -0.28

Liver 1 2.28 2 1.24 0 0.00 0 0.00 3 3.90 0.77 -0.18

Gallbladder 1 1.75 5 2.47 0 0.00 2 2.64 8 4.63 1.73 0.67

Bile ducts, other biliary 0 0.00 0 0.00 1 0.78 1 1.11 2 4.55 0.44 -0.51

Pancreas 4 1.31 10 0.89 3 0.40 1 0.20 18 26.75 0.67 -1.74

Respiratory system 21 1.93* 66 1.61* 39 1.36 32 1.67* 158 99.62 1.59* 11.62

Nose, nasal cavity, ear 1 8.16 0 0.00 2 6.58 0 0.00 3 1.07 2.80 0.38

Larynx 0 0.00 3 2.46 1 1.26 0 0.00 4 2.81 1.42 0.24

Lung, bronchus 20 1.93* 62 1.58* 36 1.31 32 1.73* 150 95.47 1.57* 10.85

Female breast 14 0.59* 92 1.06 50 0.86 31 0.85 187 205.54 0.91 -3.69

Female genital system 7 0.64 32 0.82 15 0.60* 14 0.94 68 90.06 0.76* -4.39

Cervix uteri 0 0.00 4 1.03 1 0.45 1 0.87 6 8.40 0.71 -0.48

Corpus uteri 2 0.36 16 0.80 7 0.56 3 0.40 28 45.59 0.61* -3.50

Ovary 4 1.25 7 0.60 6 0.79 7 1.49 24 27.04 0.89 -0.61

Vagina 0 0.00 0 0.00 0 0.00 1 3.69 1 1.59 0.63 -0.12

Vulva 1 1.70 5 2.31 1 0.69 2 2.05 9 5.18 1.74 0.76

Urinary system 9 1.97 24 1.42 14 1.23 8 1.07 55 40.27 1.37* 2.93

Urinary bladder 4 1.41 14 1.35 11 1.58 6 1.30 35 24.82 1.41 2.03

Kidney parenchyma 3 2.24 6 1.21 3 0.88 1 0.44 13 12.00 1.08 0.20

Renal pelvis, other urinary 2 4.98 4 2.73 0 0.00 1 1.61 7 3.46 2.02 0.70

Ureter 1 7.97 2 4.35 0 0.00 0 0.00 3 1.08 2.78 0.38

Bone, joints 0 0.00 1 3.42 0 0.00 0 0.00 1 0.68 1.48 0.06

Soft tissue including heart 0 0.00 2 1.56 1 1.17 1 1.77 4 3.05 1.31 0.19

Kaposi sarcoma 2 45.42* 2 12.08* 2 17.53* 0 0.00 6 0.40 14.99* 1.11

Melanoma of skin 7 4.60* 10 1.77 9 2.34* 6 2.33 32 13.60 2.35* 3.66

Eye, orbit 0 0.00 1 2.05 1 3.24 0 0.00 2 1.12 1.78 0.17

Brain, central nervous system 0 0.00 1 0.31 2 0.94 1 0.76 4 7.49 0.53 -0.70

Thyroid 0 0.00 1 0.46 1 0.73 0 0.00 2 4.93 0.41 -0.58

Lymphatic, hematopoietic 1 0.14* 26 0.97 11 0.61 13 1.08 51 64.22 0.79 -2.63

Hodgkin lymphoma 0 0.00 4 5.70* 2 4.53 4 15.30* 10 1.60 6.23* 1.67

Non-Hodgkin lymphoma 0 0.00 17 1.37 5 0.58 5 0.86 27 30.20 0.89 -0.64

Myeloma 1 0.78 2 0.43 3 0.96 3 1.48 9 11.11 0.81 -0.42

Leukemia 0 0.00 3 0.33* 1 0.17* 1 0.26 5 21.30 0.23* -3.24

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.55 0.00 -0.11

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 8.45 0.00* -1.68

Acute non-lymphocytic 0 0.00 3 0.98 1 0.49 0 0.00 4 7.32 0.55 -0.66

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 2.88 0.00 -0.57

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 8,103 7,140 4,076 1,736 8,103

Person-years in interval 6,270 22,125 13,810 8,051 50,255

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING LEUKEMIA 455
All subsequent cancers 254 1.34* 835 1.24* 510 1.21* 259 1.05 1,858 1,534.82 1.21* 49.81

All excluding same site 254 1.36* 835 1.25* 510 1.22* 259 1.06 1,858 1,514.40 1.23* 52.95

Buccal cavity, pharynx 6 1.06 25 1.28 13 1.15 8 1.38 52 42.36 1.23 1.49

Lip 4 3.40 7 1.78 5 2.22 4 3.41 20 8.53 2.34* 1.77

Tongue 1 0.96 2 0.55 1 0.47 1 0.91 5 7.91 0.63 -0.45

Salivary gland 1 2.19 5 3.07 3 2.92 2 3.17 11 3.74 2.94* 1.12

Mouth 0 0.00 5 1.09 1 0.38 1 0.77 7 9.86 0.71 -0.44

Nasopharynx 0 0.00 1 1.64 1 2.92 0 0.00 2 1.30 1.54 0.11

Tonsil 0 0.00 1 0.57 1 1.01 0 0.00 2 3.72 0.54 -0.27

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.19 0.00 -0.18

Hypopharynx 0 0.00 3 1.40 0 0.00 0 0.00 3 4.58 0.66 -0.24

Digestive system 46 1.09 150 1.02 102 1.14 52 1.01 350 330.14 1.06 3.06

Esophagus 2 0.81 8 0.92 10 1.87 3 0.98 23 19.55 1.18 0.53

Stomach 4 0.81 17 1.01 10 1.02 6 1.10 37 36.94 1.00 0.01

Small intestine 1 1.87 4 2.07 2 1.64 1 1.36 8 4.42 1.81 0.55

Colon 22 1.20 66 1.02 47 1.18 18 0.77 153 146.33 1.05 1.03

Rectum, rectosigmoid junction 10 1.31 26 0.98 14 0.88 16 1.84* 66 58.90 1.12 1.09

Anus, anal canal 0 0.00 1 1.07 1 1.74 1 3.16 3 2.09 1.44 0.14

Liver 0 0.00 3 0.57 2 0.60 1 0.50 6 12.09 0.50 -0.94

Gallbladder 1 2.69 1 0.79 1 1.34 0 0.00 3 2.81 1.07 0.03

Bile ducts, other biliary 0 0.00 2 0.64 1 0.50 0 0.00 3 7.24 0.41 -0.65

Pancreas 5 1.04 19 1.14 13 1.29 6 1.05 43 37.25 1.15 0.89

Respiratory system 55 1.49* 212 1.63* 144 1.82* 62 1.42* 473 289.53 1.63* 28.27

Nose, nasal cavity, ear 1 3.49 3 3.02 2 3.35 0 0.00 6 2.21 2.71 0.58

Larynx 4 1.38 11 1.09 15 2.55* 5 1.69 35 21.78 1.61* 2.04

Lung, bronchus 49 1.46* 197 1.66* 127 1.75* 57 1.41* 430 264.83 1.62* 25.46

Male breast 1 2.79 3 2.38 2 2.56 0 0.00 6 2.86 2.10 0.48

Male genital system 71 1.22 214 1.01 133 0.96 63 0.75* 481 491.50 0.98 -1.62

Prostate 70 1.22 210 1.00 132 0.96 61 0.73* 473 487.22 0.97 -2.19

Testis 1 5.57 1 1.74 0 0.00 0 0.00 2 1.15 1.74 0.13

Urinary system 33 1.75* 76 1.13 34 0.80 27 1.06 170 153.55 1.11 2.54

Urinary bladder 16 1.15 54 1.10 20 0.64* 21 1.11 111 113.31 0.98 -0.36

Kidney parenchyma 15 3.88* 17 1.22 12 1.37 5 0.99 49 31.57 1.55* 2.69

Renal pelvis, other urinary 2 1.81 5 1.29 2 0.85 1 0.74 10 8.67 1.15 0.20

Ureter 1 2.67 3 2.28 0 0.00 0 0.00 4 2.96 1.35 0.16

Bone, joints 0 0.00 0 0.00 1 3.23 0 0.00 1 1.15 0.87 -0.02

Soft tissue including heart 3 4.24 4 1.61 3 1.95 0 0.00 10 5.68 1.76 0.67

Kaposi sarcoma 2 7.34 2 2.22 2 3.97 0 0.00 6 1.93 3.10* 0.63

Melanoma of skin 11 2.74* 42 2.83* 22 2.22* 21 3.34* 96 35.08 2.74* 9.39

Eye, orbit 1 3.67 2 2.10 0 0.00 0 0.00 3 2.13 1.41 0.13

Brain, central nervous system 4 2.25 10 1.58 6 1.54 0 0.00 20 14.17 1.41 0.90

Thyroid 4 7.26* 5 2.57 0 0.00 0 0.00 9 4.28 2.10 0.73

Lymphatic, hematopoietic 10 0.72 57 1.16 32 1.04 14 0.75 113 112.58 1.00 0.06

Hodgkin lymphoma 1 2.29 12 8.20* 8 9.71* 4 9.55* 25 3.14 7.95* 3.37

Non-Hodgkin lymphoma 7 1.24 27 1.32 18 1.36 8 0.98 60 47.54 1.26 1.92

Myeloma 1 0.42 10 1.19 4 0.77 0 0.00 15 19.12 0.78 -0.63

Leukemia 1 0.18 8 0.42* 2 0.17* 2 0.29 13 42.79 0.30* -4.59

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.06 0.00 -0.16

Chronic lymphocytic 0 0.00 0 0.00* 0 0.00* 0 0.00 0 17.58 0.00* -2.71

Acute non-lymphocytic 1 0.58 4 0.65 1 0.26 2 0.87 8 13.97 0.57 -0.92

Chronic myeloid 0 0.00 3 1.20 1 0.65 0 0.00 4 5.71 0.70 -0.26

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 11,528 10,037 5,378 1,982 11,528

Person-years in interval 8,866 30,203 17,171 8,647 64,887

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Chronic Lymphocytic Leukemia

Males

Table 17.3.5: Risk of subsequent primary cancers after chronic lymphocytic leukemia, males,

SEER 1973-2000.

456 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CHRONIC LYMPHOCYTIC

LEUKEMIA

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
Chronic Lymphocytic Leukemia

Both Sexes, <50 Years of Age

Table 17.3.6: Risk of subsequent primary cancers after chronic lymphocytic leukemia, both sexes,

<50 years of age, SEER 1973-2000.

CHRONIC LYMPHOCYTIC

LEUKEMIA

All subsequent cancers 9 3.66* 20 1.62 19 1.39 38 2.00* 86 47.59 1.81* 43.17

All excluding same site 9 3.70* 20 1.63 19 1.40 38 2.02* 86 47.04 1.83* 43.79

Buccal cavity, pharynx 0 0.00 1 1.73 2 3.33 1 1.60 4 1.92 2.08 2.34

Lip 0 0.00 0 0.00 1 17.07 1 16.04 2 0.20 10.18* 2.03

Tongue 0 0.00 0 0.00 1 7.27 0 0.00 1 0.44 2.28 0.63

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.16

Mouth 0 0.00 1 6.79 0 0.00 0 0.00 1 0.49 2.04 0.57

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.09 0.00 -0.10

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.27 0.00 -0.30

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.06

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.19 0.00 -0.21

Digestive system 1 2.70 0 0.00 0 0.00 7 2.11 8 8.01 1.00 -0.02

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.59 0.00 -0.66

Stomach 0 0.00 0 0.00 0 0.00 1 3.33 1 0.79 1.27 0.24

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.18 0.00 -0.20

Colon 1 7.59 0 0.00 0 0.00 3 2.27 4 3.04 1.31 1.07

Rectum, rectosigmoid junction 0 0.00 0 0.00 0 0.00 0 0.00 0 1.63 0.00 -1.83

Anus, anal canal 0 0.00 0 0.00 0 0.00 1 20.89 1 0.14 7.03 0.96

Liver 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.41

Gallbladder 0 0.00 0 0.00 0 0.00 1 32.79 1 0.07 14.42 1.05

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.17

Pancreas 0 0.00 0 0.00 0 0.00 1 2.51 1 0.96 1.04 0.05

Respiratory system 3 8.66* 6 3.07* 8 3.32* 9 2.60* 26 8.17 3.18* 20.04

Nose, nasal cavity, ear 0 0.00 1 36.08 0 0.00 0 0.00 1 0.09 11.00 1.02

Larynx 1 25.75 0 0.00 0 0.00 0 0.00 1 0.80 1.25 0.22

Lung, bronchus 2 6.67 5 2.94 8 3.77* 9 2.88* 24 7.25 3.31* 18.82

Female breast 0 0.00 1 0.49 2 1.01 1 0.50 4 6.47 0.62 -8.66

Female genital system 0 0.00 0 0.00 1 1.27 0 0.00 1 2.56 0.39 -5.46

Cervix uteri 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -1.55

Corpus uteri 0 0.00 0 0.00 1 2.70 0 0.00 1 1.19 0.84 -0.65

Ovary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.79 0.00 -2.75

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.02 0.00 -0.08

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.26

Male genital system 2 13.74* 1 1.03 2 1.22 8 1.89 13 6.99 1.86 9.94

Prostate 1 10.47 1 1.24 2 1.30 8 1.92 12 6.61 1.81 8.91

Testis 1 21.96 0 0.00 0 0.00 0 0.00 1 0.31 3.26 1.15

Urinary system 1 5.83 0 0.00 1 0.95 3 2.04 5 3.61 1.39 1.57

Urinary bladder 0 0.00 0 0.00 0 0.00 2 2.20 2 2.11 0.95 -0.12

Kidney parenchyma 1 13.83 0 0.00 1 2.48 1 2.02 3 1.34 2.23 1.86

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.17

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -0.05

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.07 0.00 -0.08

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.32

Kaposi sarcoma 0 0.00 1 5.33 0 0.00 0 0.00 1 0.40 2.51 0.68

Melanoma of skin 0 0.00 3 3.82 1 1.44 4 5.91* 8 2.34 3.42* 6.37

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.10 0.00 -0.11

Brain, central nervous system 1 16.46 1 3.67 0 0.00 0 0.00 2 0.83 2.42 1.32

Thyroid 1 16.29 0 0.00 0 0.00 0 0.00 1 0.67 1.49 0.37

Lymphatic, hematopoietic 0 0.00 5 4.23* 1 0.86 4 2.94 10 3.95 2.53* 6.80

Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 2 34.55* 2 0.28 7.21 1.94

Non-Hodgkin lymphoma 0 0.00 3 4.75 0 0.00 2 2.90 5 2.06 2.43 3.30

Myeloma 0 0.00 1 7.89 0 0.00 0 0.00 1 0.51 1.97 0.55

Leukemia 0 0.00 1 3.18 1 3.08 0 0.00 2 1.11 1.80 1.00

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.06 0.00 -0.07

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.41 0.00 -0.46

Acute non-lymphocytic 0 0.00 1 9.60 1 9.92 0 0.00 2 0.36 5.62 1.85

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.19

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 1,165 1,088 712 345 1,165

Person-years in interval 933 3,597 2,577 1,791 8,897

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 2,854 PYR and for male cancers on 6,044 PYR.

NEW MALIGNANCIES FOLLOWING LEUKEMIA 457
All subsequent cancers 42 2.19* 139 1.48* 137 1.39* 138 1.27* 456 320.18 1.42* 56.06

All excluding same site 42 2.22* 139 1.50* 137 1.41* 138 1.28* 456 316.50 1.44* 57.58

Buccal cavity, pharynx 2 2.28 3 0.78 4 1.23 3 1.20 12 10.48 1.14 0.63

Lip 0 0.00 1 2.34 2 5.14 1 2.84 4 1.26 3.16 1.13

Tongue 1 5.39 0 0.00 0 0.00 1 1.90 2 2.23 0.90 -0.09

Salivary gland 1 19.21 0 0.00 1 4.63 1 4.48 3 0.72 4.14 0.94

Mouth 0 0.00 1 0.95 1 1.17 0 0.00 2 2.78 0.72 -0.32

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.39 0.00 -0.16

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 1.17 0.00 -0.48

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.14

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 1.19 0.00 -0.49

Digestive system 6 1.64 20 1.11 15 0.81 24 1.14 65 61.25 1.06 1.55

Esophagus 0 0.00 0 0.00 0 0.00 2 1.67 2 4.10 0.49 -0.87

Stomach 1 2.66 1 0.55 2 1.15 1 0.54 5 5.77 0.87 -0.32

Small intestine 0 0.00 1 3.21 0 0.00 0 0.00 1 1.02 0.98 -0.01

Colon 2 1.43 10 1.41 8 1.04 12 1.27 32 25.62 1.25 2.63

Rectum, rectosigmoid junction 3 3.95 5 1.35 3 0.81 4 1.09 15 11.84 1.27 1.30

Anus, anal canal 0 0.00 1 4.25 0 0.00 0 0.00 1 0.73 1.38 0.11

Liver 0 0.00 1 1.47 0 0.00 0 0.00 1 2.30 0.43 -0.54

Gallbladder 0 0.00 0 0.00 0 0.00 1 4.02 1 0.63 1.58 0.15

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 1.20 0.00 -0.50

Pancreas 0 0.00 1 0.46 2 0.90 4 1.54 7 7.43 0.94 -0.18

Respiratory system 12 3.01* 44 2.25* 52 2.64* 35 1.77* 143 63.03 2.27* 33.01

Nose, nasal cavity, ear 0 0.00 0 0.00 2 13.24* 0 0.00 2 0.50 4.00 0.62

Larynx 0 0.00 0 0.00 3 1.81 3 2.46 6 5.17 1.16 0.34

Lung, bronchus 12 3.40* 44 2.52* 47 2.63* 32 1.74* 135 57.21 2.36* 32.11

Female breast 2 0.92 7 0.73 8 0.87 10 0.92 27 31.77 0.85 -5.30

Female genital system 2 1.84 3 0.63 1 0.23 5 1.10 11 14.69 0.75 -4.10

Cervix uteri 0 0.00 1 1.80 0 0.00 0 0.00 1 1.47 0.68 -0.52

Corpus uteri 2 3.38 1 0.38 0 0.00 2 0.80 5 8.12 0.62 -3.47

Ovary 0 0.00 0 0.00 1 0.81 3 2.17 4 4.21 0.95 -0.23

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.19

Vulva 0 0.00 1 8.68 0 0.00 0 0.00 1 0.45 2.21 0.61

Male genital system 3 1.19 18 1.15 29 1.38 24 0.93 74 64.84 1.14 6.02

Prostate 3 1.22 17 1.11 29 1.40 24 0.94 73 64.12 1.14 5.84

Testis 0 0.00 1 6.75 0 0.00 0 0.00 1 0.31 3.20 0.45

Urinary system 5 3.31* 8 1.08 8 1.03 10 1.15 31 25.42 1.22 2.30

Urinary bladder 2 2.18 4 0.86 3 0.59 8 1.35 17 16.62 1.02 0.16

Kidney parenchyma 3 5.82* 4 1.67 5 2.19 1 0.45 13 7.42 1.75 2.30

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 1 2.00 1 1.38 0.73 -0.16

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.18

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.13

Soft tissue including heart 0 0.00 1 2.47 0 0.00 0 0.00 1 1.24 0.81 -0.10

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.35 0.00 -0.15

Melanoma of skin 4 5.88* 10 3.35* 5 1.87 11 4.22* 30 8.95 3.35* 8.69

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.52 0.00 -0.21

Brain, central nervous system 1 3.28 1 0.75 2 1.70 0 0.00 4 3.91 1.02 0.04

Thyroid 1 5.50 3 4.14 0 0.00 0 0.00 4 1.97 2.03 0.84

Lymphatic, hematopoietic 3 2.09 9 1.34 5 0.75 10 1.29 27 22.58 1.20 1.83

Hodgkin lymphoma 0 0.00 3 9.44* 0 0.00 2 9.94* 5 0.85 5.91* 1.71

Non-Hodgkin lymphoma 3 4.36 6 1.88 4 1.26 5 1.35 18 10.75 1.67 2.99

Myeloma 0 0.00 0 0.00 1 0.89 1 0.76 2 3.73 0.54 -0.71

Leukemia 0 0.00 0 0.00 0 0.00 2 0.79 2 7.25 0.28* -2.17

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.09

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 3.10 0.00 -1.28

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 1 1.14 1 2.34 0.43 -0.55

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.94 0.00 -0.39

Chronic Lymphocytic Leukemia

Both Sexes, 50-59 Years of Age

Table 17.3.7: Risk of subsequent primary cancers after chronic lymphocytic leukemia, both sexes,

50-59 years of age, SEER 1973-2000.

458 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CHRONIC LYMPHOCYTIC

LEUKEMIA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,103 2,889 1,925 932 3,103

Person-years in interval 2,487 9,618 6,996 5,127 24,227

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 9,002 PYR and for male cancers on 15,226 PYR.
Chronic Lymphocytic Leukemia

Both Sexes, 60-69 Years of Age

Table 17.3.8: Risk of subsequent primary cancers after chronic lymphocytic leukemia, both sexes,

60-69 years of age, SEER 1973-2000.

CHRONIC LYMPHOCYTIC

LEUKEMIA

All subsequent cancers 108 1.52* 417 1.33* 286 1.10 165 0.92 976 823.07 1.19* 39.34

All excluding same site 108 1.54* 417 1.34* 286 1.12 165 0.93 976 813.29 1.20* 41.85

Buccal cavity, pharynx 2 0.87 14 1.56 6 0.98 4 1.14 26 20.90 1.24 1.31

Lip 1 3.01 3 2.20 2 1.98 2 3.09 8 3.35 2.39* 1.20

Tongue 0 0.00 2 1.11 0 0.00 0 0.00 2 4.17 0.48 -0.56

Salivary gland 0 0.00 2 3.12 1 1.92 1 2.52 4 1.71 2.35 0.59

Mouth 1 1.66 3 1.30 1 0.64 1 1.09 6 5.38 1.11 0.16

Nasopharynx 0 0.00 2 6.50 0 0.00 0 0.00 2 0.67 2.97 0.34

Tonsil 0 0.00 0 0.00 1 1.88 0 0.00 1 1.89 0.53 -0.23

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.63 0.00 -0.16

Hypopharynx 0 0.00 2 1.89 0 0.00 0 0.00 2 2.31 0.87 -0.08

Digestive system 16 1.10 65 1.02 64 1.19 38 0.94 183 172.95 1.06 2.58

Esophagus 2 2.19 4 1.06 7 2.47 1 0.55 14 9.35 1.50 1.20

Stomach 3 2.07 8 1.28 5 0.98 2 0.54 18 16.52 1.09 0.38

Small intestine 1 4.86 0 0.00 2 2.57 1 1.75 4 2.48 1.62 0.39

Colon 3 0.49 27 0.97 32 1.30 17 0.86 79 78.21 1.01 0.20

Rectum, rectosigmoid junction 6 2.11 14 1.15 10 1.05 14 2.20* 44 30.88 1.42* 3.38

Anus, anal canal 0 0.00 0 0.00 1 2.09 0 0.00 1 1.54 0.65 -0.14

Liver 0 0.00 2 0.90 1 0.55 0 0.00 3 5.81 0.52 -0.72

Gallbladder 0 0.00 1 1.36 0 0.00 0 0.00 1 2.10 0.48 -0.28

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 1 1.00 1 3.59 0.28 -0.67

Pancreas 1 0.57 8 1.03 6 0.92 2 0.41 17 20.92 0.81 -1.01

Respiratory system 33 2.26* 117 1.89* 75 1.57* 37 1.25 262 153.56 1.71* 27.89

Nose, nasal cavity, ear 1 9.29 0 0.00 0 0.00 0 0.00 1 1.11 0.90 -0.03

Larynx 2 1.69 8 1.75 6 2.00 2 1.34 18 10.26 1.75* 1.99

Lung, bronchus 29 2.19* 108 1.91* 69 1.56* 35 1.26 241 141.83 1.70* 25.51

Female breast 4 0.67 25 0.99 21 1.00 13 0.86 63 67.45 0.93 -2.80

Female genital system 1 0.32 10 0.81 4 0.43 5 0.81 20 30.90 0.65* -6.86

Cervix uteri 0 0.00 1 0.86 1 1.32 0 0.00 2 2.68 0.75 -0.43

Corpus uteri 0 0.00 5 0.73 2 0.39 1 0.32 8 16.85 0.47* -5.57

Ovary 0 0.00 2 0.58 1 0.36 3 1.55 6 8.98 0.67 -1.87

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.28

Vulva 1 11.27 2 4.80 0 0.00 1 2.51 4 1.32 3.04 1.69

Male genital system 24 1.60* 77 1.07 52 0.82 25 0.61* 178 190.90 0.93 -5.61

Prostate 24 1.62* 76 1.06 52 0.83 23 0.57* 175 189.54 0.92 -6.32

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.30 0.00 -0.13

Urinary system 10 1.74 36 1.41 18 0.84 14 0.90 78 68.38 1.14 2.47

Urinary bladder 4 1.03 27 1.54* 14 0.93 11 0.97 56 47.86 1.17 2.09

Kidney parenchyma 4 2.66 6 0.94 3 0.59 2 0.60 15 16.29 0.92 -0.33

Renal pelvis, other urinary 2 5.66 3 1.88 1 0.75 1 1.06 7 4.23 1.65 0.71

Ureter 2 16.72* 1 1.84 0 0.00 0 0.00 3 1.44 2.09 0.40

Bone, joints 0 0.00 1 3.87 1 5.11 0 0.00 2 0.64 3.13 0.35

Soft tissue including heart 0 0.00 2 1.91 1 1.15 0 0.00 3 2.84 1.05 0.04

Kaposi sarcoma 0 0.00 0 0.00 3 20.90* 0 0.00 3 0.48 6.23* 0.65

Melanoma of skin 7 4.57* 18 2.74* 12 2.27* 8 2.07 45 17.25 2.61* 7.14

Eye, orbit 1 8.86 0 0.00 1 2.77 0 0.00 2 1.18 1.70 0.21

Brain, central nervous system 1 1.22 5 1.48 3 1.18 0 0.00 9 8.31 1.08 0.18

Thyroid 0 0.00 1 0.73 1 1.04 0 0.00 2 3.23 0.62 -0.32

Lymphatic, hematopoietic 6 1.25 24 1.12 17 0.92 12 0.85 59 58.94 1.00 0.02

Hodgkin lymphoma 1 5.71 5 7.30* 4 8.20* 4 13.37* 14 1.65 8.50* 3.18

Non-Hodgkin lymphoma 4 1.86 11 1.14 12 1.43 5 0.77 32 26.68 1.20 1.37

Myeloma 1 1.18 5 1.32 0 0.00 2 0.83 8 10.27 0.78 -0.58

Leukemia 0 0.00 3 0.41 1 0.16* 1 0.20 5 20.34 0.25* -3.95

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.50 0.00 -0.13

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 8.49 0.00* -2.18

Acute non-lymphocytic 0 0.00 2 0.83 1 0.46 1 0.58 4 6.85 0.58 -0.73

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 2.64 0.00 -0.68

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 5,513 5,083 3,230 1,450 5,513

Person-years in interval 4,384 16,629 11,219 6,645 38,877

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 15,891 PYR and for male cancers on 22,986 PYR.

NEW MALIGNANCIES FOLLOWING LEUKEMIA 459
All subsequent cancers 194 1.04 652 1.12* 286 1.05 68 0.83 1,200 1,123.48 1.07* 17.74

All excluding same site 194 1.05 652 1.13* 286 1.07 68 0.85 1,200 1,107.45 1.08* 21.45

Buccal cavity, pharynx 5 1.26 11 0.93 3 0.59 0 0.00 19 22.43 0.85 -0.80

Lip 3 3.49 3 1.18 1 0.91 0 0.00 7 4.81 1.46 0.51

Tongue 0 0.00 1 0.47 0 0.00 0 0.00 1 3.98 0.25 -0.69

Salivary gland 1 2.35 3 2.21 1 1.48 0 0.00 5 2.69 1.86 0.53

Mouth 1 0.96 1 0.32 0 0.00 0 0.00 2 6.02 0.33 -0.93

Nasopharynx 0 0.00 0 0.00 1 7.88 0 0.00 1 0.59 1.71 0.10

Tonsil 0 0.00 1 1.29 0 0.00 0 0.00 1 1.40 0.71 -0.09

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.47 0.00 -0.11

Hypopharynx 0 0.00 2 2.08 0 0.00 0 0.00 2 1.72 1.16 0.06

Digestive system 51 1.08 174 1.17* 87 1.21 20 0.86 332 291.25 1.14* 9.45

Esophagus 0 0.00 4 0.71 4 1.58 0 0.00 8 10.73 0.75 -0.63

Stomach 6 1.21 20 1.31 11 1.55 4 1.79 41 29.51 1.39 2.66

Small intestine 0 0.00 3 1.74 0 0.00 0 0.00 3 3.37 0.89 -0.09

Colon 28 1.23 88 1.20 47 1.30 10 0.84 173 144.22 1.20* 6.67

Rectum, rectosigmoid junction 4 0.52 22 0.94 12 1.13 5 1.59 43 44.94 0.96 -0.45

Anus, anal canal 1 3.00 0 0.00 0 0.00 0 0.00 1 2.07 0.48 -0.25

Liver 1 0.80 2 0.51 1 0.55 1 1.87 5 7.50 0.67 -0.58

Gallbladder 2 2.68 5 2.11 1 0.86 0 0.00 8 4.65 1.72 0.78

Bile ducts, other biliary 0 0.00 2 0.59 2 1.13 0 0.00 4 6.84 0.59 -0.66

Pancreas 8 1.43 20 1.13 8 0.93 0 0.00 36 34.70 1.04 0.30

Respiratory system 28 0.97 111 1.27* 48 1.27 13 1.29 200 164.40 1.22* 8.25

Nose, nasal cavity, ear 1 3.89 2 2.47 2 5.09 0 0.00 5 1.58 3.16* 0.79

Larynx 1 0.63 6 1.30 7 3.96* 0 0.00 14 8.37 1.67 1.30

Lung, bronchus 26 0.97 102 1.24* 39 1.09 13 1.37 180 154.00 1.17* 6.03

Female breast 8 0.52 59 1.17 19 0.74 7 0.82 93 99.85 0.93 -3.04

Female genital system 4 0.60 19 0.89 9 0.86 4 1.18 36 41.92 0.86 -2.63

Cervix uteri 0 0.00 2 1.02 0 0.00 1 3.56 3 3.80 0.79 -0.36

Corpus uteri 0 0.00 10 0.99 4 0.85 0 0.00 14 19.43 0.72 -2.41

Ovary 4 1.98 5 0.76 4 1.20 1 0.89 14 13.07 1.07 0.41

Vagina 0 0.00 0 0.00 0 0.00 1 11.63 1 0.95 1.05 0.02

Vulva 0 0.00 2 1.24 1 1.11 1 2.77 4 3.34 1.20 0.29

Male genital system 42 1.04 118 0.96 50 0.95 6 0.46* 216 228.77 0.94 -6.19

Prostate 42 1.05 116 0.95 49 0.94 6 0.46 213 226.95 0.94 -6.76

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.11

Urinary system 26 1.63* 56 1.12 21 0.90 8 1.13 111 96.41 1.15 3.38

Urinary bladder 14 1.19 37 1.00 14 0.80 6 1.13 71 71.53 0.99 -0.12

Kidney parenchyma 10 3.21* 13 1.34 6 1.36 2 1.56 31 18.51 1.67* 2.90

Renal pelvis, other urinary 2 1.87 6 1.81 1 0.66 0 0.00 9 6.37 1.41 0.61

Ureter 0 0.00 4 3.61 0 0.00 0 0.00 4 2.12 1.89 0.44

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.81 0.00 -0.19

Soft tissue including heart 3 4.30 3 1.35 3 2.77 1 2.75 10 4.37 2.29* 1.31

Kaposi sarcoma 4 23.63* 3 5.48* 1 3.57 0 0.00 8 1.10 7.26* 1.60

Melanoma of skin 7 2.23 21 2.06* 13 2.55* 4 2.32 45 20.15 2.23* 5.76

Eye, orbit 0 0.00 3 3.94 0 0.00 0 0.00 3 1.46 2.06 0.36

Brain, central nervous system 1 0.68 4 0.88 3 1.47 1 1.76 9 8.62 1.04 0.09

Thyroid 2 3.51 2 1.14 0 0.00 0 0.00 4 3.34 1.20 0.15

Lymphatic, hematopoietic 2 0.14* 45 0.96 20 0.88 1 0.14* 68 91.33 0.74* -5.41

Hodgkin lymphoma 0 0.00 8 7.61* 6 13.26* 0 0.00 14 1.98 7.08* 2.79

Non-Hodgkin lymphoma 0 0.00* 24 1.23 7 0.72 1 0.32 32 38.24 0.84 -1.45

Myeloma 1 0.39 6 0.74 6 1.55 0 0.00 13 15.72 0.83 -0.63

Leukemia 1 0.17* 7 0.39* 1 0.11* 0 0.00 9 35.39 0.25* -6.12

Acute lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -0.19

Chronic lymphocytic 0 0.00 0 0.00* 0 0.00 0 0.00 0 14.03 0.00* -3.25

Acute non-lymphocytic 1 0.53 4 0.66 0 0.00 0 0.00 5 11.75 0.43* -1.56

Chronic myeloid 0 0.00 3 1.22 1 0.83 0 0.00 4 4.84 0.83 -0.19

Chronic Lymphocytic Leukemia

Both Sexes, ≥70 Years of Age

Table 17.3.9: Risk of subsequent primary cancers after chronic lymphocytic leukemia, both sexes,

≥70 years of age, SEER 1973-2000.

460 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CHRONIC LYMPHOCYTIC

LEUKEMIA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 9,850 8,117 3,587 991 9,850

Person-years in interval 7,333 22,483 10,190 3,135 43,140

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 22,508 PYR and for male cancers on 20,632 PYR.
Chronic Myeloid Leukemia

CHRONIC MYELOID LEUKEMIA

Both Sexes

Table 17.4.1: Characteristics of patients with an initial chronic myeloid leukemia, both sexes,

SEER 1973-2000.

Number of patients with 1st primary cancer

Total 4,520 100.0 3,485 100.0 8,005 100.0

Initial treatment

Any radiation 235 5.2 154 4.4 389 4.9

With surgery 3 0.1 1 0.0 4 0.0

Without surgery 232 5.1 153 4.4 385 4.8

No radiation 4,285 94.8 3,331 95.6 7,616 95.1

With surgery 31 0.7 18 0.5 49 0.6

Without surgery 4,254 94.1 3,313 95.1 7,567 94.5

Race

White 3,822 84.6 2,958 84.9 6,780 84.7

Black 414 9.2 337 9.7 751 9.4

Other 270 6.0 177 5.1 447 5.6

Unknown 14 0.3 13 0.4 27 0.3

Age at 1st primary cancer diagnosis, years

< 30 406 9.0 241 6.9 647 8.1

30–49 1,015 22.5 689 19.8 1,704 21.3

50–69 1,633 36.1 1,165 33.4 2,798 35.0

70–79 948 21.0 728 20.9 1,676 20.9

> 80 518 11.5 662 19.0 1,180 14.7

Number of patients with one or more

primary cancers

One primary cancer only 4,341 96.0 3,347 96.0 7,688 96.0

1st and 2nd cancers 168 3.7 133 3.8 301 3.8

1st, 2nd, and 3rd cancers 11 0.2 4 0.1 15 0.2

1st, 2nd, 3rd, and additional cancers 0 0.0 1 0.0 1 0.0

Other statistics

Median age at 1st cancer diagnosis 61.9 — 64.6 — 63.1 —

Median year of 1st cancer diagnosis 1988.5 — 1988.1 — 1988.3 —

Median person-years at risk 1.9 — 2.2 — 2.0 —

Percent histologically confirmed*

Both 1st and 2nd cancers — 93.9 — 87.0 — 90.9

1st, 2nd, and additional cancers — 93.3 — 87.0 — 90.5

1st cancer only — 5.0 — 8.0 — 6.3

Males Females Total

Characteristics No. % No. % No. %

NEW MALIGNANCIES FOLLOWING LEUKEMIA 461

*Percent histologically confirmed among patients who developed a subsequent primary cancer.
All subsequent cancers 74 1.03 191 1.19* 48 1.04 21 1.56 334 291.80 1.14* 17.29

All excluding same site 74 1.04 191 1.21* 48 1.06 21 1.57 334 288.51 1.16* 18.63

Buccal cavity, pharynx 7 3.69* 3 0.72 3 2.58 2 6.07 15 7.54 1.99* 3.05

Lip 0 0.00 2 3.18 1 6.44 0 0.00 3 1.14 2.63 0.76

Tongue 2 5.48 1 1.21 0 0.00 1 14.12 4 1.50 2.66 1.02

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.68 0.00 -0.28

Mouth 4 8.02* 0 0.00 1 3.26 1 11.82 6 1.99 3.02* 1.64

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.31 0.00 -0.13

Tonsil 0 0.00 0 0.00 1 8.53 0 0.00 1 0.72 1.39 0.12

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.21 0.00 -0.08

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.73 0.00 -0.30

Digestive system 19 1.14 39 1.09 7 0.71 5 1.77 70 65.29 1.07 1.93

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 3.17 0.00 -1.30

Stomach 3 1.70 5 1.37 0 0.00 1 3.83 9 6.61 1.36 0.98

Small intestine 1 4.62 0 0.00 1 6.64 0 0.00 2 0.91 2.20 0.45

Colon 8 1.05 21 1.28 5 1.10 2 1.54 36 29.92 1.20 2.49

Rectum, rectosigmoid junction 2 0.70 6 0.98 1 0.60 1 2.13 10 11.13 0.90 -0.46

Anus, anal canal 0 0.00 1 2.96 0 0.00 0 0.00 1 0.62 1.62 0.16

Liver 0 0.00 3 2.57 0 0.00 0 0.00 3 2.13 1.41 0.36

Gallbladder 1 4.14 1 1.96 0 0.00 0 0.00 2 0.93 2.16 0.44

Bile ducts, other biliary 1 2.86 0 0.00 0 0.00 0 0.00 1 1.39 0.72 -0.16

Pancreas 3 1.51 2 0.46 0 0.00 1 2.93 6 7.85 0.76 -0.76

Respiratory system 12 0.99 43 1.61* 7 0.92 1 0.46 63 48.56 1.30 5.91

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.18

Larynx 0 0.00 1 0.56 0 0.00 0 0.00 1 3.24 0.31 -0.92

Lung, bronchus 12 1.08 41 1.66* 7 1.00 1 0.50 61 44.76 1.36* 6.65

Female breast 9 1.28 17 0.98 1 0.17* 2 1.23 29 31.76 0.91 -2.49

Female genital system 1 0.31 8 1.02 3 1.22 2 3.08 14 14.19 0.99 -0.17

Cervix uteri 0 0.00 2 1.98 2 6.53 0 0.00 4 1.82 2.20 1.97

Corpus uteri 1 0.63 3 0.78 1 0.83 2 6.39 7 6.98 1.00 0.02

Ovary 0 0.00 3 1.31 0 0.00 0 0.00 3 4.17 0.72 -1.05

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.20

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.67 0.00 -0.61

Male genital system 9 0.64 28 0.93 9 1.11 2 0.77 48 54.96 0.87 -5.21

Prostate 9 0.65 27 0.91 9 1.14 2 0.79 47 54.01 0.87 -5.25

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.43

Urinary system 5 0.87 17 1.36 3 0.86 2 1.93 27 22.81 1.18 1.72

Urinary bladder 4 0.99 10 1.16 2 0.85 1 1.44 17 15.76 1.08 0.51

Kidney parenchyma 1 0.74 6 1.95 1 1.08 1 3.54 9 5.63 1.60 1.38

Renal pelvis, other urinary 0 0.00 1 1.27 0 0.00 0 0.00 1 1.43 0.70 -0.17

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.47 0.00 -0.19

Bone, joints 0 0.00 0 0.00 0 0.00 1 71.38 1 0.28 3.51 0.29

Soft tissue including heart 0 0.00 2 3.02 0 0.00 0 0.00 2 1.21 1.65 0.32

Kaposi sarcoma 0 0.00 1 2.59 0 0.00 0 0.00 1 0.73 1.38 0.11

Melanoma of skin 2 1.30 4 1.09 1 0.83 0 0.00 7 6.81 1.03 0.08

Eye, orbit 0 0.00 1 4.25 1 14.85 0 0.00 2 0.43 4.68 0.64

Brain, central nervous system 0 0.00 2 1.19 0 0.00 0 0.00 2 3.06 0.65 -0.43

Thyroid 3 7.29* 2 1.99 0 0.00 0 0.00 5 1.85 2.70 1.29

Lymphatic, hematopoietic 7 1.27 18 1.47 8 2.24 3 2.82 36 22.39 1.61* 5.57

Hodgkin lymphoma 1 4.71 0 0.00 2 13.59* 0 0.00 3 0.89 3.38 0.87

Non-Hodgkin lymphoma 2 0.84 14 2.57* 1 0.60 2 3.97 19 9.97 1.91* 3.70

Myeloma 2 2.14 1 0.48 1 1.70 0 0.00 4 3.75 1.07 0.10

Leukemia 2 1.00 3 0.70 4 3.40 1 2.90 10 7.78 1.28 0.91

Acute lymphocytic 1 16.46 3 22.31* 2 49.98* 1 82.48* 7 0.25 28.30* 2.77

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 3.05 0.00 -1.25

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 2.61 0.00 -1.07

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 1.09 0.00 -0.45

Chronic Myeloid Leukemia

Both Sexes

Table 17.4.2: Risk of subsequent primary cancers after chronic myeloid leukemia, both sexes,

SEER 1973-2000.

462 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CHRONIC MYELOID LEUKEMIA

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 8,005 5,879 1,699 371 8,005

Person-years in interval 5,618 13,333 4,214 1,250 24,415

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000. EAR for female cancers is based on 11,071 PYR and for male cancers on 13,344 PYR.
Chronic Myeloid Leukemia

Females

Table 17.4.3: Risk of subsequent primary cancers after chronic myeloid leukemia, females,

SEER 1973-2000.

CHRONIC MYELOID LEUKEMIA

All subsequent cancers 30 1.18 87 1.42* 21 1.07 6 1.11 144 111.63 1.29* 29.24

All excluding same site 30 1.19 87 1.44* 21 1.08 6 1.12 144 110.41 1.30* 30.34

Buccal cavity, pharynx 1 2.21 1 0.92 1 2.91 0 0.00 3 1.98 1.52 0.93

Lip 0 0.00 0 0.00 1 43.81 0 0.00 1 0.14 7.29 0.78

Tongue 1 10.20 1 4.23 0 0.00 0 0.00 2 0.43 4.64 1.42

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.21

Mouth 0 0.00 0 0.00 0 0.00 0 0.00 0 0.68 0.00 -0.62

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.07

Tonsil 0 0.00 0 0.00 0 0.00 0 0.00 0 0.17 0.00 -0.15

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.05 0.00 -0.04

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.13 0.00 -0.12

Digestive system 7 1.11 25 1.72* 4 0.92 2 1.68 38 26.39 1.44* 10.49

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 0.72 0.00 -0.65

Stomach 1 1.92 2 1.73 0 0.00 0 0.00 3 2.09 1.44 0.82

Small intestine 0 0.00 0 0.00 0 0.00 0 0.00 0 0.37 0.00 -0.33

Colon 3 0.94 15 2.05* 4 1.83 1 1.65 23 13.30 1.73* 8.76

Rectum, rectosigmoid junction 0 0.00 3 1.32 0 0.00 0 0.00 3 4.10 0.73 -1.00

Rectum 0 0.00 1 0.68 0 0.00 0 0.00 1 2.69 0.37 -1.52

Anus, anal canal 0 0.00 1 5.38 0 0.00 0 0.00 1 0.34 2.93 0.59

Liver 0 0.00 1 3.41 0 0.00 0 0.00 1 0.53 1.87 0.42

Gallbladder 1 6.65 1 3.01 0 0.00 0 0.00 2 0.60 3.32 1.26

Bile ducts, other biliary 1 7.47 0 0.00 0 0.00 0 0.00 1 0.56 1.77 0.39

Pancreas 1 1.23 2 1.06 0 0.00 1 6.35 4 3.44 1.16 0.51

Respiratory system 3 1.00 19 2.49* 4 1.54 0 0.00 26 13.93 1.87* 10.91

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.15 0.00 -0.14

Larynx 0 0.00 1 3.98 0 0.00 0 0.00 1 0.46 2.19 0.49

Lung, bronchus 3 1.05 17 2.34* 4 1.62 0 0.00 24 13.28 1.81* 9.68

Female breast 9 1.28 17 0.98 1 0.17* 2 1.23 29 31.76 0.91 -2.49

Female genital system 1 0.31 8 1.02 3 1.22 2 3.08 14 14.19 0.99 -0.17

Cervix uteri 0 0.00 2 1.98 2 6.53 0 0.00 4 1.82 2.20 1.97

Corpus uteri 1 0.63 3 0.78 1 0.83 2 6.39 7 6.98 1.00 0.02

Ovary 0 0.00 3 1.31 0 0.00 0 0.00 3 4.17 0.72 -1.05

Vagina 0 0.00 0 0.00 0 0.00 0 0.00 0 0.22 0.00 -0.20

Vulva 0 0.00 0 0.00 0 0.00 0 0.00 0 0.67 0.00 -0.61

Urinary system 3 2.45 6 2.06 0 0.00 0 0.00 9 5.32 1.69 3.33

Urinary bladder 2 2.69 3 1.72 0 0.00 0 0.00 5 3.17 1.58 1.65

Kidney parenchyma 1 2.66 3 3.24 0 0.00 0 0.00 4 1.70 2.35 2.07

Renal pelvis, other urinary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.44 0.00 -0.40

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.14 0.00 -0.12

Bone, joints 0 0.00 0 0.00 0 0.00 0 0.00 0 0.11 0.00 -0.10

Soft tissue including heart 0 0.00 0 0.00 0 0.00 0 0.00 0 0.46 0.00 -0.42

Kaposi sarcoma 0 0.00 1 37.81 0 0.00 0 0.00 1 0.05 20.80 0.86

Melanoma of skin 1 2.04 0 0.00 0 0.00 0 0.00 1 2.29 0.44 -1.17

Eye, orbit 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.15

Brain, central nervous system 0 0.00 0 0.00 0 0.00 0 0.00 0 1.15 0.00 -1.04

Thyroid 1 4.10 1 1.61 0 0.00 0 0.00 2 1.14 1.75 0.77

Lymphatic, hematopoietic 4 2.01 7 1.48 4 2.67 0 0.00 15 8.65 1.73 5.74

Hodgkin lymphoma 1 14.16 0 0.00 1 17.81 0 0.00 2 0.31 6.39 1.52

Non-Hodgkin lymphoma 0 0.00 6 2.72 0 0.00 0 0.00 6 4.05 1.48 1.77

Myeloma 2 5.75 0 0.00 0 0.00 0 0.00 2 1.50 1.33 0.45

Leukemia 1 1.50 1 0.65 3 6.50* 0 0.00 5 2.79 1.79 2.00

Acute lymphocytic 1 48.88 1 20.55 1 65.31 0 0.00 3 0.09 33.81* 2.63

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.06 0.00 -0.96

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 0.98 0.00 -0.88

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.40 0.00 -0.36

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 3,485 2,605 804 169 3,485

Person-years in interval 2,456 6,087 2,002 526 11,071

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.

NEW MALIGNANCIES FOLLOWING LEUKEMIA 463
All subsequent cancers 44 0.94 104 1.05 27 1.02 15 1.86* 190 180.17 1.05 7.37

All excluding same site 44 0.95 104 1.06 27 1.04 15 1.88* 190 178.10 1.07 8.92

Buccal cavity, pharynx 6 4.16* 2 0.65 2 2.45 2 8.36 12 5.57 2.16* 4.82

Lip 0 0.00 2 3.62 0 0.00 0 0.00 2 1.00 2.00 0.75

Tongue 1 3.75 0 0.00 0 0.00 1 19.83 2 1.07 1.87 0.70

Salivary gland 0 0.00 0 0.00 0 0.00 0 0.00 0 0.45 0.00 -0.34

Mouth 4 11.74* 0 0.00 1 5.28 1 18.68 6 1.31 4.59* 3.52

Nasopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.23 0.00 -0.17

Tonsil 0 0.00 0 0.00 1 11.52 0 0.00 1 0.55 1.83 0.34

Oropharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.16 0.00 -0.12

Hypopharynx 0 0.00 0 0.00 0 0.00 0 0.00 0 0.60 0.00 -0.45

Digestive system 12 1.16 14 0.65 3 0.54 3 1.84 32 38.90 0.82 -5.17

Esophagus 0 0.00 0 0.00 0 0.00 0 0.00 0 2.45 0.00 -1.84

Stomach 2 1.62 3 1.20 0 0.00 1 5.64 6 4.52 1.33 1.11

Small intestine 1 7.41 0 0.00 1 11.86 0 0.00 2 0.54 3.68 1.09

Colon 5 1.12 6 0.66 1 0.43 1 1.45 13 16.62 0.78 -2.71

Rectum, rectosigmoid junction 2 1.07 3 0.77 1 1.01 1 3.46 7 7.03 1.00 -0.02

Anus, anal canal 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.21

Liver 0 0.00 2 2.29 0 0.00 0 0.00 2 1.59 1.26 0.31

Gallbladder 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.24

Bile ducts, other biliary 0 0.00 0 0.00 0 0.00 0 0.00 0 0.83 0.00 -0.62

Pancreas 2 1.70 0 0.00 0 0.00 0 0.00 2 4.42 0.45 -1.81

Respiratory system 9 0.99 24 1.25 3 0.60 1 0.69 37 34.64 1.07 1.77

Nose, nasal cavity, ear 0 0.00 0 0.00 0 0.00 0 0.00 0 0.28 0.00 -0.21

Larynx 0 0.00 0 0.00 0 0.00 0 0.00 0 2.78 0.00 -2.08

Lung, bronchus 9 1.09 24 1.38 3 0.66 1 0.76 37 31.48 1.18 4.14

Male breast 0 0.00 0 0.00 0 0.00 0 0.00 0 0.34 0.00 -0.26

Male genital system 9 0.64 28 0.93 9 1.11 2 0.77 48 54.96 0.87 -5.21

Prostate 9 0.65 27 0.91 9 1.14 2 0.79 47 54.01 0.87 -5.25

Testis 0 0.00 0 0.00 0 0.00 0 0.00 0 0.57 0.00 -0.43

Urinary system 2 0.44 11 1.15 3 1.17 2 2.58 18 17.49 1.03 0.38

Urinary bladder 2 0.60 7 1.01 2 1.10 1 1.85 12 12.59 0.95 -0.44

Kidney parenchyma 0 0.00 3 1.40 1 1.64 1 5.14 5 3.93 1.27 0.81

Renal pelvis, other urinary 0 0.00 1 1.84 0 0.00 0 0.00 1 0.98 1.02 0.01

Ureter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.33 0.00 -0.25

Bone, joints 0 0.00 0 0.00 0 0.00 1 114.91* 1 0.17 5.76 0.62

Soft tissue including heart 0 0.00 2 4.89 0 0.00 0 0.00 2 0.75 2.67 0.94

Kaposi sarcoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.68 0.00 -0.51

Melanoma of skin 1 0.96 4 1.64 1 1.29 0 0.00 6 4.52 1.33 1.11

Eye, orbit 0 0.00 1 6.89 1 25.17 0 0.00 2 0.26 7.56 1.30

Brain, central nervous system 0 0.00 2 1.91 0 0.00 0 0.00 2 1.91 1.05 0.07

Thyroid 2 11.91* 1 2.60 0 0.00 0 0.00 3 0.71 4.23 1.72

Lymphatic, hematopoietic 3 0.85 11 1.46 4 1.93 3 4.69 21 13.74 1.53 5.44

Hodgkin lymphoma 0 0.00 0 0.00 1 10.99 0 0.00 1 0.57 1.74 0.32

Non-Hodgkin lymphoma 2 1.37 8 2.48* 1 1.07 2 6.78 13 5.92 2.20* 5.31

Myeloma 0 0.00 1 0.81 1 3.05 0 0.00 2 2.25 0.89 -0.19

Leukemia 1 0.75 2 0.73 1 1.40 1 4.67 5 5.00 1.00 0.00

Acute lymphocytic 0 0.00 2 23.31* 1 40.48 1 127.75* 4 0.16 25.22* 2.88

Chronic lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.99 0.00 -1.49

Acute non-lymphocytic 0 0.00 0 0.00 0 0.00 0 0.00 0 1.63 0.00 -1.22

Chronic myeloid 0 0.00 0 0.00 0 0.00 0 0.00 0 0.69 0.00 -0.52

Years after first primary cancer diagnosis

<1 year 1-4 years 5-9 years ≥10 years Total

Number starting interval 4,520 3,274 895 202 4,520

Person-years in interval 3,162 7,246 2,212 724 13,344

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

Chronic Myeloid Leukemia

Males

Table 17.4.4: Risk of subsequent primary cancers after chronic myeloid leukemia, males,

SEER 1973-2000.

464 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CHRONIC MYELOID LEUKEMIA

*P < 0.05. Notes: See Appendices for definitions of cancer sites and “all excluding same site.” Abbreviations: O = observed number of subsequent (2nd, 3rd, etc.) primary

cancers; E = expected number of subsequent primary cancers; O/E = ratio of observed to expected cancers; PYR = person-years at risk; EAR = excess absolute risk per 10,000

person-years = [(O-E)/PYR] 10,000.
NEW MALIGNANCIES FOLLOWING CHILDHOOD CANCER 465

Synopsis

The incidence of subsequent primary cancers was evaluated in a cohort of 23,819 2-month survivors of childhood cancer diagnosed at ages less than 18 years during

1973-2000 and followed for an average of 8.3 years. The

most common types of childhood cancers were

leukemias, lymphomas, cancers of the central nervous

system (CNS), and bone and soft tissue sarcomas.

Childhood cancer survivors were at more than 6-fold

increase in risk of developing a new cancer relative to

the general population (O/E=6.07, O=352, EAR=15 per

10,000 person-years), and the cumulative incidence of

second cancers after 25 years was 3.5%. Most common

were subsequent primary cancers of the female breast,

brain, bone, thyroid gland, and soft tissue, as well as

melanoma of the skin and acute non-lymphocytic

leukemia (ANLL). The greatest risks of subsequent

cancers occurred among patients previously diagnosed

with Ewing sarcoma (O/E=14.84, EAR=44), Hodgkin

lymphoma (O/E=9.55, EAR=39), primitive neuroectodermal tumor of the CNS (O/E=12.54, EAR=26), and

retinoblastoma (O/E=14.71, EAR=24). Risk of second

solid cancers was significantly higher among persons

whose initial treatment for childhood cancer included

radiotherapy, whereas the excess of subsequent ANLL

was more closely related to chemotherapy. Childhood

cancer survivors are at markedly increased risk of

developing a variety of new primary cancers compared

with the general population, but the magnitude of

excess risk and specific types of second cancers vary

widely by type of first cancer.

Childhood Cancers 

Childhood cancers are a heterogeneous group of diseases

that vary widely in incidence, age at diagnosis, type of

treatment, survival, and, most probably, etiology.

Leukemia, lymphoma, and central nervous system (CNS)

tumors account for nearly 60% of the total number of

cases. In 1998, an estimated 12,400 children younger than

age 20 years were diagnosed with cancer, and 2,500 children died due to their cancer (Ries et al, 1999). Incidence

rates for most, but not all, types of childhood cancer are

higher among males than females and among whites

than blacks (Ries et al, 1999, 2004). Because of dramatic

improvements in the therapy for many types of childhood cancers, survival is far better today than it was 30

or 40 years ago, and the population of long-term childhood cancer survivors is growing. Current 5-year relative

survival rates for childhood acute lymphocytic leukemia

(ALL), Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), germ cell tumors, Wilms tumor, and

retinoblastoma range between 70% and 93% (Ries et al,

1999). Treatment gains have been less dramatic for acute

non-lymphocytic leukemia (ANLL), CNS cancer, neuroblastoma first diagnosed at age 5 years or older, Ewing

sarcoma, and rhabdomyosarcoma (Ries et al, 1999, 2004).

Five-year survival rates for most types of childhood cancers are somewhat better in whites than in blacks (Ries et

al, 1999).

Treatment regimens have varied widely by type of

first cancer and have changed over time. Historically,

radiation was commonly used as part of initial therapy

for CNS cancers, HL, rhabdomyosarcoma, and Ewing

sarcoma; it was used much less often for osteosarcoma,

fibrosarcoma, and germ cell cancers. Multidrug

chemotherapy regimens, including alkylating agents,

were introduced in the 1960s and modified during the

ensuing decades (Friedman and Meadows, 1999; Ebb et

al, 2005; Weinstein and Tarbell, 2005). As the medical

community came to better understand the adverse late

effects of radiation, it sought ways to lower radiation

exposures without compromising survival. These included reducing the usage of prophylactic CNS irradiation in

patients with ALL, avoiding or deferring the use of cranial radiotherapy in very young children with brain

tumors, and reducing dose and field size in children with

HL (Pollack, 1994; Kalapurakal and Thomas, 1997;

Shusterman and Meadows, 2000; Donaldson, 2002;

Bhatia, 2003; Bhatia et al, 2003). In light of the leukemogenic effects of alkylating agents (Tucker et al, 1987a),

there have been parallel efforts to identify new drugs

that are equally or more effective with less associated

toxicity (Friedman and Meadows, 1999). 

The etiology of childhood cancers is largely unknown.

For very-early-age-at-onset cancers, such as retinoblastoma, neuroblastoma, Wilms tumor, and ALL of infancy,

Chapter 18

CHILDHOOD CANCER

New Malignancies Following Childhood Cancer 

Peter D. Inskip, Lynn A. G. Ries, Randi J. Cohen, Rochelle E. Curtis

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.)

primary cancers; O/E=ratio of observed to expected cancers;

CI=confidence interval; PYR=person-years at risk; EAR=excess

absolute risk (excess cancers per 10,000 person-years, calculated as

[(O-E)/PYR]10,000).

Author affiliations: Peter D. Inskip, Randi J. Cohen, and Rochelle E.

Curtis, Division of Cancer Epidemiology and Genetics, NCI, NIH,

DHHS; Lynn A. G. Ries, Division of Cancer Control and Population

Sciences, NCI, NIH, DHHS.
prenatal exposures or genetic factors may play predominant roles. Ionizing radiation is known to induce

leukemia, sarcomas, and CNS cancers but probably

explains only a small minority of childhood tumors

(Inskip, 1999). Congenital anomalies have been associated with Wilms tumor and leukemia, while infectious

agents and immune factors may be related to certain

types of leukemia and lymphoma (Ries et al, 1999). 

A strong genetic component has been identified in

retinoblastoma, while leukemia, CNS cancer, and bone

and soft tissue sarcomas may arise as part of the

Li-Fraumeni familial cancer syndrome (Malkin et al,

1992; Hisada et al, 1998; Eng and Maher, 1999; Nichols

et al, 2001). In addition, leukemia, CNS cancer, and soft

tissue sarcoma occur in association with neurofibromatosis type 1 (Heyn et al, 1993; Eng and Maher, 1999).

Results and Discussion

Characteristics of Study Population 

A total of 23,819 children (age <18 years) with cancer

who survived 2 or more months following diagnosis

were observed for an average of 8.3 years (median, 5.8

years) (Table 18.A). There were 12,951 5-year survivors,

8,424 10-year survivors, and 2,637 20-year survivors. ALL

was the most common type of first cancer, accounting for

21% of the total, while cancers of the CNS accounted for

an additional 18%. Fifty-four percent of the study population was male and 46% female, but there was a female

predominance among cases of retinoblastoma, Wilms

tumor, fibrosarcoma, cutaneous melanoma, and carcinomas. Eighty-one percent of the cohort was white, 10%

black, and 9% other or of unknown race. Blacks were

overrepresented among cases with osteosarcoma,

retinoblastoma, soft tissue sarcoma, and Wilms tumor

466 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CHILDHOOD CANCER

Notes: Includes children surviving 2 months or more after diagnosis.

Abbreviations: DX=diagnosis; PYR=person-years at risk; RT=initial radiation; CNS=central nervous system; PNET=primitive neuroectodermal tumor.

*Categories and ordering based on International Classification of Childhood Cancer (ICCC) (Kramarova and Stiller, 1996).

†Also includes neurofibrosarcoma.

‡Does not include Kaposi sarcoma.

§Includes intracranial and intraspinal germ cell tumors, other or unspecified nongonadal germ cell tumors, gonadal germ cell tumors, gonadal carcinomas, other or

unspecified malignant gonadal tumors.

||Includes adrenocortical carcinoma (N=38), thyroid carcinoma (N=592), nasopharyngeal carcinoma (N=77), malignant melanoma (N=466), skin carcinoma other than

melanoma (N=3), and other or unspecified carcinoma (N=430).

¶Includes Burkitt lymphoma (N=335), unspecified lymphoma (N=143), miscellaneous lymphoreticular cancers (N=55), other tumors of sympathetic nervous system

(N=55), non-central nervous system PNET (N=48), renal carcinoma (N=53), hepatoblastoma (N=191), hepatic carcinoma (N=61), and other or unspecified cancers

(N=159).

Table 18.A: Descriptive characteristics of persons diagnosed with different histopathologic types of childhood cancer, both sexes, SEER

1973-2000.

Number Median Initial therapy (%)

Histopathologic type* Total Female Male Age at DX PYR RT Surgery

All first cancers 23,819 10,964 12,855 8.2 5.8 38.1 49.6

Leukemia 6,440 2,833 3,607 5.2 4.8 26.6 0.3

Acute lymphocytic 4,905 2,122 2,783 4.8 5.8 29.4 0.2

Acute non-lymphocytic 1,007 498 509 8.5 1.5 13.8 0.7

Hodgkin lymphoma 1,744 838 906 15.1 10.4 64.2 23.1

Non-Hodgkin lymphoma 1,038 322 716 12.1 5.7 39.4 23.6

Brain, CNS 4,344 1,948 2,396 7.6 4.8 57.3 75.4

Ependymoma 374 151 223 4.2 3.4 63.4 94.4

Astrocytoma 2,242 1,059 1,183 8.8 6.5 45.6 78.6

PNET (brain, CNS) 859 327 532 6.4 3.5 81.3 92.9

Neuroblastoma 1,461 691 770 1.6 4.0 31.6 64.1

Retinoblastoma 581 301 280 1.3 8.2 27.5 88.1

Wilms tumor 1,188 625 563 3.2 8.8 49.9 95.4

Bone, joints 1,352 584 768 13.7 4.0 27.7 68.4

Osteosarcoma 752 337 415 13.9 3.9 6.5 80.5

Ewing sarcoma 479 198 281 13.3 3.4 62.0 46.6

Soft tissue sarcoma 1,759 807 952 10.3 5.9 45.4 76.6

Rhabdomyosarcoma 769 309 460 6.6 4.8 64.5 62.3

Fibrosarcoma† 448 237 211 12.8 9.0 17.9 92.4

Other‡ 538 259 279 12.5 4.5 41.3 84.0

Germ cell tumors§ 1,206 601 605 14.6 7.0 21.7 86.2

Carcinomas/epithelial|| 1,606 1,017 589 15.5 9.3 24.5 89.9

Other ¶ 1,100 397 703 7.9 3.6 26.1 47.5
NEW MALIGNANCIES FOLLOWING CHILDHOOD CANCER 467

CHILDHOOD CANCER

relative to their frequency in the cohort as a whole (data

not shown). The median age at diagnosis was less than 

5 years for retinoblastoma, neuroblastoma, Wilms tumor,

ALL, and ependymoma; 5 to 9 years for ANLL, astrocytoma, primitive neuroectodermal tumor (PNET), and

rhabdomyosarcoma; and 10 to 16 years for lymphoma,

bone sarcoma, fibrosarcoma, germ cell tumors, various

carcinomas, and melanoma. Patients diagnosed at very

young ages often were followed into adolescence, and

those diagnosed as teenagers were often followed into

early adulthood. The maximum age at the end of followup was 44 years. Radiation was part of the initial course

of therapy for a high proportion (>60%) of patients with

HL, PNET, Ewing sarcoma, and rhabdomyosarcoma but

rarely was given for osteosarcoma, fibrosarcoma, ANLL,

or germ cell cancers. Initial treatment commonly included surgery, except for leukemia and lymphoma.

Overall Results

During the period of follow-up, 352 new primary cancers

were diagnosed in 327 individuals. This represents a

more than 6-fold increase in incidence relative to the general population (O/E=6.07, 95% CI=5.45-6.74, EAR=15

per 10,000 person-years) (Table 18.B), which is similar to

risks reported for 3 other large cohorts from North America (Neglia et al, 2001), Great Britain (Jenkinson et al,

2004), and Nordic countries (Olsen et al, 1993) for contemporaneous periods. Eighteen childhood cancer

patients developed 2 new malignancies, and 3 developed

3 or more new malignancies. Risks were similar for

females (O/E=5.80, O=176, EAR=15) and males

(O/E=6.36, O=176, EAR=15) but were somewhat higher

for blacks (O/E=8.38, O=33, EAR=16) than whites

(O/E=5.72, O=287, EAR=14). Subsequent cancer risks

varied by age at diagnosis of the first cancer; however,

patterns depended on type of first cancer and latency (or

attained age). For all new cancers combined, the relative

risk increased over the first 10 years following diagnosis

of the initial cancer to nearly 8-fold and then decreased

to less than 4-fold among 20-year survivors (Table 18.B).

In contrast, the excess absolute risk increased with time,

from 7 excess cancers per 10,000 person-years in the first

year of follow-up to 26 among persons surviving more

than 20 years. The cumulative incidence of developing a

second cancer at 25 years, adjusted for the competing

risk of death due to other causes, was 3.5% (95%

CI=3.0%-4.1%) (Figure 18.1). In comparison, the 25-year

cumulative competing risk of death, based on all deaths

excluding deaths among patients with a second cancer,

was 37.6% (95% CI=36.7%-38.5%). Most of the deaths

due to other causes were attributed to the first cancer

(data not shown). 

Numerous types of subsequent primary cancers

occurred significantly more often than expected among

childhood cancer patients, and the patterns of excess risk

for specific cancer sites changed over time (Table 18.B).

The most common types were cancers of the female

breast, brain/CNS, bone, thyroid gland, and soft tissue,

as well as melanoma and ANLL. Significantly high rates

also were noted for new malignancies of the buccal cavity, digestive system, respiratory system, testis, urinary

tract, eye, and CNS other than brain, as well as NHL.

Relative and excess absolute risks for specific types of

cancer generally were similar for males and females,

with some exceptions (data not shown). The excess of

urinary tract cancers occurred exclusively among males.

The relative and excess absolute risks for ANLL and the

relative (but not absolute) risk for thyroid cancer were

higher among males than females, whereas the relative

and absolute risks of subsequent bone cancer were

higher in females. 

Elevated O/E ratios for some new primary cancers

(notably ANLL, melanoma, and cancers of the female and

male genital tracts) were apparent within the first 5 years

after diagnosis of the first cancer (Table 18.B). For other

cancers (including those of the buccal cavity, stomach,

female breast, urinary tract, soft tissues, and cranial

nerves or spinal cord), the relative risk appeared greater

for long-term survivors. In particular, there was a lateemerging excess of stomach cancer, 15 or more years after

initial therapy. Observed-to-expected ratios for NHL and

cancers of the bone, brain, and thyroid gland varied erratically with time. The relative risks for all latency intervals

combined were similar for new primary solid cancers and

leukemia, but the absolute risk was decidedly higher for

subsequent solid cancers (Table 18.B). Solid cancers

accounted for 81% of all subsequent cancers, and the temporal change in risk since initial diagnosis resembled that

for all subsequent cancers combined. For subsequent

leukemia, both the O/E and EAR peaked between 1 and 5

years after the first cancer, and no cases were observed 15

or more years after initial diagnosis. As childhood cancer

survivors mature to the ages at which cancer incidence

rates in the population increase sharply, it remains to be

Years after initial cancer diagnosis

Cumulative incidence (%)

0 5 10 15 20 25

0

5

10

15

20

25

30

35

40

All second cancers

Deaths

Figure 18.1: Cumulative incidence of developing a second

cancer and cumulative probability of death due to competing

causes among children with any primary cancer, SEER 1973-

2000.

Note: The competing cause of death is based on all deaths excluding deaths among

patients with a second cancer.
seen whether the excess cancer risk will broaden to

include the common adult carcinomas and increase in

proportion to the background risk. 

The patterns of excess risk over time in the SEER

cohort are similar to those observed in previous studies

of multiple primary cancers in children (Little et al, 1991,

1998a; Olsen et al, 1993; de Vathaire et al, 1999a; Jenkinson

et al, 2004). The wave-like temporal pattern for excess

leukemia fits the pattern commonly observed following

acute exposure to leukemogens and strongly suggests an

effect of treatment. A decreasing relative risk for solid

cancers with increasing follow-up time may reflect

increases in background incidence rates unrelated to the

initial childhood cancer or its treatment. However, part of

Notes: EAR for female sites is based on 94,789 PYR and for male sites on 101,795 PYR.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; E=expected number of subsequent primary cancers; O/E=ratio of observed to

expected cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000).

*P <0.05.

†Ten of 25 subsequent melanomas occurred among children with an initial melanoma.

Table 18.B: Risk of subsequent primary cancers following childhood cancer (ages 0-17 years), by time since diagnosis of first cancer,

both sexes.

468 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CHILDHOOD CANCER

Years after first primary cancer diagnosis

<1 yr 1-4 yr 5-9 yr 10-14 yr 15-19 yr ≥20 yr Total

Number starting interval 23,819 20,415 12,951 8,424 5,234 2,637 23,819

Person-years in interval 18,350 63,463 52,583 33,856 19,330 9,003 196,585

Subsequent primary cancer O O/E O O/E O O/E O O/E O O/E O O/E O E O/E EAR

All subsequent cancers 16 5.39* 83 7.74* 92 7.83* 72 5.77* 57 4.98* 32 3.71* 352 58.00 6.07* 14.96

All solid cancers 13 7.46* 53 8.15* 75 9.52* 63 6.77* 54 5.93* 27 3.70* 285 41.84 6.81* 12.37

Buccal cavity, pharynx 0 0.00 2 11.83* 4 18.19* 6 25.32* 4 18.73* 1 5.54 17 1.06 16.06* 0.81

Tongue 0 0.00 1 60.15 0 0.00 1 23.32 1 21.94 0 0.00 3 0.18 16.38* 0.14

Salivary gland 0 0.00 1 16.08 2 24.68* 3 36.97* 2 32.79* 0 0.00 8 0.34 23.37* 0.39

Digestive system 1 9.77 4 12.94* 5 15.29* 4 8.30* 8 12.95* 3 4.65 25 2.48 10.07* 1.15

Stomach 0 0.00 0 0.00 0 0.00 0 0.00 3 41.78* 3 43.34* 6 0.25 23.61* 0.29

Small intestine 0 0.00 1 148.04* 1 79.34* 1 49.82 0 0.00 0 0.00 3 0.09 32.79* 0.15

Colon 1 106.96* 1 19.66 0 0.00 0 0.00 1 4.42 0 0.00 3 0.79 3.78 0.11

Rectum, rectosigmoid junction 0 0.00 0 0.00 3 60.24* 0 0.00 0 0.00 0 0.00 3 0.43 7.02* 0.13

Pancreas 0 0.00 1 68.97 1 43.38 0 0.00 3 70.63* 0 0.00 5 0.16 30.31* 0.25

Respiratory system 0 0.00 1 6.21 3 17.72* 2 10.20* 1 4.16 1 3.37 8 1.11 7.19* 0.35

Nose, nasal cavity, ear 0 0.00 0 0.00 2 65.46* 0 0.00 0 0.00 0 0.00 2 0.13 15.08* 0.09

Lung, bronchus 0 0.00 1 22.20 1 13.86 2 18.65* 1 6.01 0 0.00 5 0.64 7.82* 0.22

Female breast 0 0.00 0 0.00 2 8.92* 13 18.42* 16 12.38* 8 4.64* 39 3.99 9.78* 3.69

Female genital system 1 12.85 4 9.06* 3 3.55 1 0.80 1 0.78 0 0.00 10 4.91 2.04 0.54

Cervix uteri 0 0.00 1 11.19 1 3.19 0 0.00 0 0.00 0 0.00 2 2.11 0.95 -0.01

Corpus uteri 0 0.00 0 0.00 0 0.00 1 12.54 1 8.14 0 0.00 2 0.41 4.87 0.17

Ovary 1 17.63 2 6.95 1 2.35 0 0.00 0 0.00 0 0.00 4 2.03 1.97 0.21

Male genital system 1 10.45 5 9.08* 5 4.76* 0 0.00 1 0.95 0 0.00 12 4.59 2.61* 0.73

Testis 1 11.34 5 9.49* 4 3.88* 0 0.00 1 0.97 0 0.00 11 4.48 2.46* 0.64

Urinary system 0 0.00 2 4.66 1 4.25 1 4.44 4 15.82* 0 0.00 8 1.58 5.07* 0.33

Urinary bladder 0 0.00 0 0.00 0 0.00 0 0.00 2 16.19* 0 0.00 2 0.52 3.82 0.08

Kidney parenchyma 0 0.00 2 5.46 0 0.00 1 9.83 2 16.29* 0 0.00 5 1.03 4.86* 0.20

Melanoma of skin† 5 61.74* 3 5.72* 6 5.54* 5 3.41* 3 2.10 3 2.85 25 5.63 4.44* 0.99

Eye, orbit 1 11.54 1 5.61 1 22.88 1 30.01 0 0.00 0 0.00 4 0.39 10.16* 0.18

Brain 2 4.20 7 4.43* 14 11.27* 6 7.25* 2 3.84 1 3.5 32 4.93 6.49* 1.38

Other central nervous system 0 0.00 2 12.83* 2 18.70* 2 29.27* 0 0.00 2 88.13* 8 0.45 17.90* 0.38

Thyroid 1 11.04 4 7.24* 8 7.90* 11 9.16* 3 2.78 3 4.1 30 4.67 6.43* 1.29

Bone, joints 1 6.84 12 20.94* 11 20.20* 7 19.40* 2 11.85* 2 32.04* 35 1.86 18.86* 1.69

Osteosarcoma 0 0.00 8 26.71* 7 25.06* 5 28.24* 1 14.40 0 0.00 21 0.92 22.79* 1.02

Chondrosarcoma 1 117.72* 1 27.45 2 43.48* 2 41.33* 1 24.69 0 0.00 7 0.20 34.78* 0.35

Soft tissue including heart 0 0.00 5 8.99* 10 21.35* 4 10.72* 8 31.38* 2 14.39* 29 1.97 14.75* 1.38

(Neuro)Fibrosarcoma 0 0.00 2 17.80* 7 57.01* 2 19.57* 4 55.20* 1 25.07 16 0.48 33.43* 0.79

Non-Hodgkin lymphoma 2 10.95* 3 4.03 4 4.64* 1 1.10 3 3.59 3 5.39* 16 4.09 3.91* 0.61

Hodgkin lymphoma 0 0.00 2 1.72 2 1.29 0 0.00 0 0.00 0 0.00 4 5.58 0.72 -0.08

Leukemia 0 0.00 24 10.87* 9 6.63* 5 6.32* 0 0.00 0 0.00 38 5.88 6.46* 1.63

Acute lymphocytic 0 0.00 3 1.89 3 3.73 2 5.94 0 0.00 0 0.00 8 3.50 2.29 0.23

Acute non-lymphocytic 0 0.00 19 38.66* 6 14.31* 3 9.44* 0 0.00 0 0.00 28 1.72 16.28* 1.34

Chronic myeloid 0 0.00 2 23.78* 0 0.00 0 0.00 0 0.00 0 0.00 2 0.47 4.24 0.08
the decrease in relative risk in later follow-up intervals

may reflect underascertainment of new cancers among

long-term survivors. An estimated 14% of childhood cancer cases are lost to follow-up by SEER (Ries et al, 1999).

In addition, new primary cancers occurring among persons who moved outside of geographic areas covered by

SEER registries would not be recorded in SEER files. 

Childhood cancer patients whose initial treatment

included radiotherapy were at higher risk of developing

a new cancer than those not given radiotherapy (Table

18.C). Subsequent cancer sites showing the greatest

increased risk following radiotherapy among 5-year survivors included breast, brain, bone and soft tissue, thyroid gland, digestive system (especially stomach and

pancreas), and lung. Because subsequent courses of

radiotherapy were often given for several types of initial

cancer (particularly HL), and because prophylactic

craniospinal irradiation for ALL was not coded as radiation treatment until 1988, some of the persons classified

in the “no radiation” group probably did receive radiation. This would imply that actual differences in O/E

ratios for the irradiated and nonirradiated groups are

greater than indicated in Table 18.C, for some types of

subsequent cancers. Previous epidemiologic studies have

documented excesses of cancers of the female breast,

thyroid gland, brain and CNS, salivary gland, bone, and

stomach associated with radiotherapy during childhood

(Tucker et al, 1987a,b, 1991; Ron et al, 1988, 1995; Neglia

et al, 1991; Newton et al, 1991; Hancock et al, 1993; Bhatia

et al, 1996; Hawkins et al, 1996; Kuttesch et al, 1996;

Wong et al, 1997; Karlsson et al, 1998; Le Vu et al, 1998;

Little et al, 1998b; Schneider et al, 1998; Walter et al, 1998;

de Vathaire et al, 1999b; Garwicz et al, 2000; Metayer et

al, 2000; Bhatia and Sklar, 2002; Sigurdson et al, 2005). 

The O/E ratios for ANLL and cancer of the buccal

cavity differed little by radiotherapy history, while the

O/E ratios for cancers of the female and male genital

tract and for cutaneous melanoma were higher among

persons not known to have received radiation. Chemotherapy likely was more important than radiotherapy in

causing subsequent ANLL. At least 23 of the 28 ANLL

cases were known to have received chemotherapy for

their childhood cancer. Chemotherapy probably contributed to the increased risks of other subsequent cancers, because previous studies have linked alkylating

agents with second primary bone and soft tissue sarcomas (Tucker et al, 1987b; Newton et al, 1991; Hawkins

et al, 1996; Le Vu et al, 1998), lung cancer (Kaldor et al,

1992; Swerdlow et al, 1992; Travis et al, 2002), and bladder cancer (Travis et al, 1995). Melanoma has not been

clearly linked to radiotherapy or chemotherapy, although

a recent small study of childhood cancer survivors

reported increased risks associated with radiation doses

greater than 15 Gy or treatment with alkylating agents

and spindle inhibitors combined (Guérin et al, 2003). 

The largest relative risks for all types of subsequent

cancers combined were seen among patients with initial

diagnoses of Ewing sarcoma, retinoblastoma, and PNET,

while the largest absolute risks were seen following

Ewing sarcoma, HL, and PNET (Table 18.D). The cumulative incidence of second cancer at 25 years after HL was

11.8% (95% CI=9.1%-14.9%), decidedly higher than for

most other types of childhood cancers (Figure 18.2).

(Because of the small numbers of second cancers, PNET

is grouped with other brain and CNS cancers, and Ewing

sarcoma with other bone sarcomas.) Patients with Ewing

sarcoma, HL, and PNET were frequently treated with

both radiotherapy and chemotherapy. Patients diagnosed

with lymphomas, bone sarcomas, and carcinomas plus

melanomas also tended to be older, and to have attained

ages at which background incidence rates for many cancers are higher. The high relative risk of cancer in

patients with retinoblastoma probably reflects the combination of genetic predisposition to multiple cancers, sensitivity to radiogenic cancer, and very low background

cancer risk in the general population during the early

years of life. Overall, females and males had similar

excess risks of subsequent cancer after most types of first

cancer (Table 18.D). However, risks following HL and

fibrosarcoma were higher in females, and risks following

a first Wilms tumor, retinoblastoma, carcinoma, or

ependymoma were higher among males. A large part of

the sex difference in subsequent cancer after HL can be

explained by the occurrence of radiation-related breast

cancer (discussed later in this chapter).

The EAR for new primary solid cancers was higher

among persons whose first cancer was diagnosed

between the ages of 10 and 17 years than at younger ages

(Table 18.E); however, it was difficult to separate the

effects of age at initial cancer diagnosis from the effects

related to the type of first cancer, its treatment, and time

since initial diagnosis (or attained age). HL rarely occurs

before the age of 10 years, but it accounted for a large

part of the excess risk for the group aged 10-17 years 

NEW MALIGNANCIES FOLLOWING CHILDHOOD CANCER 469

CHILDHOOD CANCER

Years after initial cancer diagnosis

Cumulative incidence (%)

0 5 10 15 20 25

Other

0

5

10

15

HL

Bone/STS CNS

ALL

Figure 18.2: Cumulative incidence of developing a second

cancer among children with selected first primary cancers:

Hodgkin lymphoma (HL), bone and soft tissue sarcomas

(Bone/STS), brain and other central nervous system cancers

(CNS), acute lymphocytic leukemia (ALL) and other cancer

sites (Other).
Table 18.C: Risk of subsequent primary cancers following childhood cancer (ages 0-17 years), by time since diagnosis of first cancer

and by initial treatment with radiation, both sexes.

470 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CHILDHOOD CANCER

Years after first primary cancer diagnosis

<1 yr 1-4 yr 5-9 yr 10-14 yr 15-19 yr ≥20 yr Total

Radiation, no. pts 9,063 7,670 4,940 3,607 2,492 1,359 9,063

Radiation, PYR 6,971 23,726 21,142 15,269 9,629 4,695 81,432

No radiation, no. pts 13,905 12,054 7,577 4,530 2,555 1,172 13,905

No radiation, PYR 10,764 37,596 29,691 17,405 8,998 3,857 108,311

Subsequent primary cancer O O/E O O/E O O/E O O/E O O/E O O/E O E O/E EAR

All subsequent cancers

Any radiation 4 3.69 37 9.39* 56 11.69* 43 7.67* 36 6.50* 21 5.02* 197 25.14 7.84* 21.10

No radiation 12 6.72* 41 6.41* 34 5.21* 28 4.38* 16 2.94* 11 2.79* 142 30.48 4.66* 10.30

All solid cancers

Any radiation 2 3.17 23 9.68* 45 14.06* 38 9.16* 34 7.77* 18 5.13* 160 18.24 8.77* 17.41

No radiation 11 10.44* 27 6.94* 29 6.62* 24 5.01* 16 3.67* 9 2.68* 116 21.83 5.31* 8.69

Buccal cavity, pharynx

Any radiation 0 0.00 2 30.97* 1 11.15 1 9.47 3 29.07* 0 0.00 7 0.47 15.03* 0.80

No radiation 0 0.00 0 0.00 3 24.52* 5 40.81* 1 9.82 1 12.37 10 0.55 18.25* 0.87

Salivary gland

Any radiation 0 0.00 1 42.37 1 31.06 0 0.00 2 67.91* 0 0.00 4 0.15 27.13* 0.47

No radiation 0 0.00 0 0.00 1 21.75 3 70.11* 0 0.00 0 0.00 4 0.18 22.03* 0.35

Digestive system

Any radiation 1 29.01 1 9.46 3 22.73* 2 9.45* 5 17.19* 2 6.59 14 1.08 12.99* 1.59

No radiation 0 0.00 2 10.40* 2 10.94* 2 7.95 3 9.95* 1 3.35 10 1.29 7.74* 0.80

Stomach

Any radiation 0 0.00 0 0.00 0 0.00 0 0.00 2 60.12* 2 61.83* 4 0.11 35.89* 0.48

No radiation 0 0.00 0 0.00 0 0.00 0 0.00 1 28.08 1 30.81 2 0.13 15.24* 0.17

Pancreas

Any radiation 0 0.00 1 191.15* 1 112.06* 0 0.00 3 151.26* 0 0.00 5 0.07 69.36* 0.61

No radiation 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.08 0.00 -0.01

Respiratory system

Any radiation 0 0.00 1 16.81 1 14.10 2 22.51* 1 8.81 1 7.45 6 0.48 12.38* 0.68

No radiation 0 0.00 0 0.00 2 21.78* 0 0.00 0 0.00 0 0.00 2 0.57 3.48 0.13

Lung, bronchus

Any radiation 0 0.00 1 56.44 0 0.00 2 42.30* 1 13.05 0 0.00 4 0.28 14.20* 0.46

No radiation 0 0.00 0 0.00 1 25.56 0 0.00 0 0.00 0 0.00 1 0.32 3.09 0.06

Female breast

Any radiation 0 0.00 0 0.00 2 22.91* 11 37.47* 11 19.21* 5 6.71* 29 1.71 16.91* 7.14

No radiation 0 0.00 0 0.00 0 0.00 2 5.21 5 7.48* 3 3.44 10 2.08 4.81* 1.48

Female genital system

Any radiation 0 0.00 0 0.00 1 2.99 1 1.85 1 1.67 0 0.00 3 2.14 1.40 0.22

No radiation 1 21.97 4 15.49* 2 4.18 0 0.00 0 0.00 0 0.00 7 2.56 2.73* 0.83

Male genital system

Any radiation 0 0.00 0 0.00 1 2.22 0 0.00 1 1.86 0 0.00 2 2.15 0.93 -0.03

No radiation 1 18.03 5 16.03* 4 7.19* 0 0.00 0 0.00 0 0.00 10 2.24 4.46* 1.41

Urinary system

Any radiation 0 0.00 0 0.00 1 10.74 0 0.00 1 8.28 0 0.00 2 0.64 3.12 0.17

No radiation 0 0.00 1 3.66 0 0.00 1 8.65 1 8.25 0 0.00 3 0.87 3.44 0.20

Melanoma of skin

Any radiation 0 0.00 1 4.93 1 2.25 1 1.52 3 4.28 0 0.00 6 2.57 2.34 0.42

No radiation 5 107.52* 2 6.68 5 8.41* 4 5.34* 0 0.00 3 6.48* 19 2.82 6.74* 1.49

Brain, CNS

Any radiation 1 5.19 4 6.40* 12 22.54* 5 12.41* 2 7.16 3 18.88* 27 2.19 12.32* 3.05

No radiation 1 3.14 5 4.75* 4 5.18* 2 4.34 0 0.00 0 0.00 12 3.00 4.00* 0.83

Thyroid

Any radiation 0 0.00 2 9.48* 5 12.33* 7 13.27* 0 0.00 3 8.12* 17 2.08 8.18* 1.83

No radiation 1 19.31 1 3.14 3 5.29* 4 6.36* 3 5.83* 0 0.00 12 2.41 4.99* 0.89
at first diagnosis. For this age group, O/E ratios for

subsequent solid cancers were similar among patients

with HL and those with other forms of cancer through

the first 10 years of follow-up; only among patients who

survived more than 10 years was the O/E clearly higher

for those diagnosed with HL. This temporal pattern

may be explained by the frequent use of extended field

radiotherapy in HL patients and a latency period of 10

years or more before most radiation-related solid cancers begin to appear. The excess of subsequent leukemia

occurred entirely within the first 15 years of follow-up,

regardless of age at diagnosis and type of the first cancer

(Table 18.E).

Risks of Specific Subsequent Primary Cancers

by Type of First Primary Cancer

Acute Lymphocytic Leukemia

Children diagnosed with ALL had a nearly 5-fold relative

risk of developing a new cancer (O/E=4.70, O=39); however, the overall excess absolute risk (EAR=8) was low

compared with risks following most other childhood cancers (Tables 18.D and 18.F). The relative risk grew to 8-fold

for the 5- to 9-year follow-up interval, then declined. 

Most of the absolute excess was due to subsequent cancers of the salivary glands, brain and other CNS, bone,

and thyroid gland, with the temporal patterns of relative

risk generally consistent with a radiation effect. Previous

studies of ALL have found that cranial irradiation, given

to prevent or treat CNS involvement, is related to a particularly high risk of subsequent primary brain cancer, as

well as new cancers of the head and neck (Neglia et al,

1991; Bhatia et al, 2002; Bhatia, 2003), whereas excess

leukemias have been linked to the use of epipodophyllotoxins (Pui et al, 1989, 2003). It is possible that

genetic predisposition related to neurofibromatosis type

1 or Li-Fraumeni syndrome played a role in the excess

cancer incidence after ALL (Hisada et al, 1998; Eng and

Maher, 1999).

Hodgkin Lymphoma 

In our survey, HL was the initial cancer associated with

87 of the 352 new primary cancers following childhood

cancers (O/E=9.55, EAR=39) (Tables 18.D and 18.G). A

strong increasing trend over time was apparent, with the

EAR rising to more than 90 among children surviving 

15 years or more (data not shown). Risks were higher

among females, mainly due to a notably high risk of

breast cancer (O/E=24.61, EAR=23) (Table 18.G). In addition, significantly elevated risks of more than 9-fold were

seen for subsequent cancers of the salivary gland, stomach, pancreas, lung, bone, soft tissue, and thyroid gland,

as well as for ANLL and NHL, based on smaller numbers. Radiotherapy clearly contributed to the excess risk

of solid cancers among 5-year survivors. The increased

risk of breast cancer after mantle radiotherapy for HL is

well established (Tucker et al, 1988; Hancock et al, 1993;

van Leeuwen et al, 1994a, 2000, 2003; Bhatia et al, 1996,

2003; Travis et al, 1996, 2003; Metayer et al, 2000). Radiation also may have contributed to the increases seen for

Notes: EAR for female sites is based on 38,218 (any radiation) and 53,447 (no radiation) PYR, and for male sites on 43,214 (any radiation) and 54,864 (no radiation)

PYR. Patients with unknown treatment, unknown radiation, or no known treatment were excluded (N=851, O=13).

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; E=expected number of subsequent primary cancers; O/E=ratio of observed to

expected cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000); pts=patients;

CNS=central nervous system.

*P <0.05.

NEW MALIGNANCIES FOLLOWING CHILDHOOD CANCER 471

CHILDHOOD CANCER

Table 18.C: Continued.

Bone, joints

Any radiation 0 0.00 8 35.36* 8 34.82* 5 30.09* 1 11.85 1 30.39 23 0.80 28.83* 2.73

No radiation 1 12.13 4 12.26* 3 10.08* 2 10.94* 1 12.76 1 37.89 12 0.99 12.07* 1.02

Soft tissue including heart

Any radiation 0 0.00 3 15.17* 8 42.94* 2 12.04* 4 31.91* 2 27.90* 19 0.81 23.48* 2.23

No radiation 0 0.00 2 5.90 1 3.76 2 10.32* 2 16.64* 0 0.00 7 1.09 6.45* 0.55

Hodgkin lymphoma

Any radiation 0 0.00 1 2.13 2 3.05 0 0.00 0 0.00 0 0.00 3 2.51 1.20 0.06

No radiation 0 0.00 1 1.55 0 0.00 0 0.00 0 0.00 0 0.00 1 2.85 0.35 -0.17

Non-Hodgkin lymphoma

Any radiation 2 27.79* 1 3.48 2 5.65 0 0.00 2 4.90 2 7.15 9 1.81 4.97* 0.88

No radiation 0 0.00 2 4.65 2 4.19 1 2.17 0 0.00 1 4.12 6 2.11 2.85* 0.36

Acute lymphocytic leukemia

Any radiation 0 0.00 2 3.71 2 6.48 1 6.60 0 0.00 0 0.00 5 1.30 3.85* 0.45

No radiation 0 0.00 1 1.00 1 2.12 1 5.73 0 0.00 0 0.00 3 2.09 1.44 0.08

Acute non-lymphocytic leukemia

Any radiation 0 0.00 8 44.63* 3 17.69* 1 6.97 0 0.00 0 0.00 12 0.72 16.66* 1.39

No radiation 0 0.00 10 33.92* 2 8.51 2 12.26* 0 0.00 0 0.00 14 0.94 14.93* 1.21

Years after first primary cancer diagnosis

<1 yr 1-4 yr 5-9 yr 10-14 yr 15-19 yr ≥20 yr Total

Subsequent primary cancer O O/E O O/E O O/E O O/E O O/E O O/E O E O/E EAR
cancers of the digestive system, thyroid, lung, bone, and

soft tissue among long-term survivors, as observed in

other HL study populations (Tucker et al, 1988; van

Leeuwen et al, 1994a; Metayer et al, 2000; Dores et al,

2002; Travis et al, 2002). The high relative risk for subsequent ANLL, reaching an increase of 75-fold during the

first 15 years of follow-up, is consistent with previous

studies linking excess ANLL following HL to treatment

with alkylating agents (Tucker et al, 1987a, 1988; Kaldor

et al, 1990; Swerdlow et al, 1992, 1997; van Leeuwen et al,

1994a,b). Misclassification of the original HL or depressed

cell-mediated immunity associated with HL (Slivnick et

al, 1990) may be related to the excess of NHL. Recent

trends toward use of lower radiation doses, smaller radiation fields, and less toxic chemotherapy may reduce the

risk of new malignancies in the future (Moppett et al,

2001; Donaldson, 2002).

Non-Hodgkin Lymphoma

The risk of developing a new malignancy following

childhood NHL (O/E=5.11, O=13, EAR=13) was decidedly lower than that for HL (Table 18.G). However, significantly elevated risks were seen for ANLL and cancers of

the female breast and thyroid, based on small numbers

of cases. For breast cancer, the excess was confined to

15-year survivors (O/E=29.62) and is probably related

to initial treatment with radiation. Radiation is no

longer part of standard therapy for many patients with

childhood NHL (Kalapurakal and Thomas, 1997). The

increased risk of ANLL among NHL survivors within

the first 5 years after initial diagnosis appears related to

treatment with chemotherapy, including alkylating

agents and/or epipodophyllotoxins (Hawkins et al, 1992;

Travis et al, 1994a; Leung et al, 2001). The excess thyroid

cancer occurred within the first 5 years after diagnosis of

NHL and may reflect increased detection due to close

medical surveillance.

Central Nervous System Cancers

Relative and excess absolute risks of developing a new

cancer were highest following a first PNET (O/E=12.54,

O=15, EAR=26), intermediate following ependymoma

472 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CHILDHOOD CANCER

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; E=expected number of subsequent primary cancers; O/E=ratio of observed to

expected cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000); CNS=central nervous

system; PNET=primitive neuroectodermal tumor.

*P <0.05.

†Also includes neurofibrosarcoma.

‡Includes adrenocortical carcinoma (N=38), thyroid carcinoma (N=592), nasopharyngeal carcinoma (N=77), malignant melanoma (N=466), skin carcinoma other than

melanoma (N=3), and other or unspecified carcinoma (N=430).

§Includes Burkitt lymphoma (N=335), unspecified lymphoma (N=143), miscellaneous lymphoreticular cancers (N=55), other tumors of sympathetic nervous system

(N=55), non-CNS PNET (N=48), renal carcinoma (N=53), hepatoblastoma (N=191), hepatic carcinoma (N=61), and other or unspecified cancers (N=159).

Table 18.D: Risk of subsequent primary cancers of all types combined following childhood cancer (ages 0-17 years), by type of first

cancer, both sexes.

Females Males Total

Number starting interval 10,964 12,855 23,819

Person-years in interval 94,789 101,795 196,584

Type of first cancer O O/E EAR O O/E EAR O E O/E EAR

All first cancers 176 5.80* 15.37 176 6.36* 14.57 352 58.00 6.07* 14.96

Leukemia 20 4.23* 6.93 26 4.78* 8.05 46 10.17 4.52* 7.53

Acute lymphocytic 18 4.80* 7.83 21 4.61* 7.60 39 8.30 4.70* 7.70

Acute non-lymphocytic 1 1.69 1.74 2 4.65 8.28 3 1.02 2.93 4.66

Hodgkin lymphoma 59 11.74* 56.72 28 6.86* 22.82 87 9.11 9.55* 38.95

Non-Hodgkin lymphoma 4 4.74* 12.43 9 5.29* 12.85 13 2.54 5.11* 12.72

Brain, CNS 21 5.00* 11.53 35 7.76* 17.28 56 8.71 6.43* 14.68

Ependymoma 0 0.00 -2.63 4 14.47* 28.68 4 0.51 7.79* 15.86

Astrocytoma 11 4.11* 9.40 16 5.66* 12.84 27 5.50 4.91* 11.25

PNET (brain, CNS) 6 10.56* 23.83 9 14.32* 26.91 15 1.20 12.54* 25.61

Neuroblastoma 7 7.87* 12.06 4 4.10* 5.72 11 1.87 5.90* 8.82

Retinoblastoma 6 11.60* 17.59 9 17.92* 30.17 15 1.02 14.71* 23.56

Wilms tumor 5 4.07* 5.81 9 8.56* 14.32 14 2.28 6.14* 9.73

Bone, joints 13 7.08* 23.87 13 8.46* 23.36 26 3.37 7.71* 23.61

Osteosarcoma 5 4.46* 14.36 5 6.08* 15.87 10 1.94 5.14* 15.10

Ewing sarcoma 7 13.79* 42.74 8 15.90* 45.92 15 1.01 14.84* 44.39

Soft tissue including heart 16 6.80* 19.78 12 5.10* 12.12 28 4.71 5.95* 15.67

Rhabdomyosarcoma 5 7.88* 18.19 6 6.81* 14.40 11 1.52 7.26* 15.93

Fibrosarcoma† 7 7.95* 25.32 2 2.74 5.79 9 1.61 5.59* 16.03

Other 4 4.90* 15.53 4 5.45* 14.89 8 1.55 5.16* 15.20

Germ cell tumors 8 3.50* 9.87 9 4.68* 13.34 17 4.21 4.04* 11.53

Carcinomas/epithelial‡ 15 2.67* 8.33 15 6.06* 20.85 30 8.10 3.71* 12.69

Other § 2 2.44 4.16 7 6.32* 12.82 9 1.93 4.67* 9.52
NEW MALIGNANCIES FOLLOWING CHILDHOOD CANCER 473

(O/E=7.79, O=4, EAR=16), and lowest following an astrocytoma (O/E=4.91, O=27, EAR=11) (Table 18.D). This

result parallels the use of radiation to treat the primary

tumor (Tables 18.A and 18.H). Risk of subsequent CNS

cancer (mostly brain cancer) was significantly increased

following a first CNS cancer, with the excesses among

those surviving 5 or more years, possibly related to

radiotherapy. In the absence of radiotherapy, chemotherapy has not been related to subsequent primary CNS

tumors (Little et al, 1998b; Garwicz et al, 2000). However,

chemotherapy, which was commonly used for childhood

brain cancer (Black, 1991a,b; Pollack, 1994), is likely to

account for the excess of leukemia. It is noteworthy that

the only 2 cases of subsequent chronic myelogenous

leukemia observed in the entire cohort of childhood cancer survivors occurred among patients diagnosed previously with astrocytoma. Craniospinal radiation fields

were more commonly used for PNETs than for astrocytomas because of the greater tendency of PNETs to

spread throughout the CNS (Black, 1991a,b; Pollack,

1994; Fine et al, 2005), so that radiation exposure covered

more extensive volumes of tissue. In a prior study of second cancers in PNET (medulloblastoma) patients, which

partially overlapped with the present study, excesses of

ALL were seen, along with cancers of the salivary glands,

uterine cervix, CNS, and thyroid gland, with a majority

of the solid cancers arising in or near the radiation fields

(Goldstein et al, 1997). In the present study, bone and soft

tissue sarcomas were increased following astrocytoma,

possibly due to a combination of treatment and genetic

susceptibility (Inskip, 2003). Recent trends in the treatment of childhood CNS cancer include less use of cranial

radiotherapy and greater use of chemotherapy (Moppett

et al, 2001). 

Bone Sarcoma

The large risk of subsequent cancer following Ewing sarcoma (O/E=14.84, O=15, EAR=44) was due mostly to

new cancers of the bone, soft tissue, and breast, as well as

ANLL (Table 18.I). Several studies of Ewing sarcoma

have reported an increased risk of subsequent osteosarcoma and soft tissue sarcomas related to high radiation

doses (41-60 Gy) and alkylating agents (Suit, 1975; Tucker

et al, 1987b; Travis et al, 1994b; Hawkins et al, 1996;

Kuttesch et al, 1996; Le Vu et al, 1998). Notably high risks

of leukemia have been associated with multiagent

chemotherapy for Ewing sarcoma (Dunst et al, 1998). A

similar constellation of excess cancers was observed after

osteosarcoma in our survey (Table 18.I), although relative

and absolute risks (O/E=5.14, O=10, EAR=15) were lower

than for Ewing sarcoma. The risk of subsequent breast

cancer was increased markedly among patients with

CHILDHOOD CANCER

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; E=expected number of subsequent primary cancers; O/E=ratio of observed to

expected cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000).

*P <0.05.

Table 18.E: Risk of subsequent primary solid cancers and leukemia following a first childhood cancer, by age at first cancer diagnosis,

type of first cancer (Hodgkin lymphoma, other) and years after first primary cancer diagnosis, both sexes.

Years after first primary cancer diagnosis 

Age at <1 yr 1-4 yr 5-9 yr 10-14 yr 15-19 yr ≥20 yr Total

diagnosis of

first cancer (yr) First cancer O O/E O O/E O O/E O O/E O O/E O O/E O E O/E EAR

Subsequent primary solid cancer

<5 Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.04 0.00 -1.19

Other 2 2.73 11 5.66* 21 17.58* 17 14.92* 12 10.31* 2 2.06 65 7.14 9.10* 8.43

All 1st cancers 2 2.72 11 5.64* 21 17.50* 17 14.85* 12 10.24* 2 2.04 65 7.18 9.05* 8.38

5-9 Hodgkin lymphoma 0 0.00 1 25.71 0 0.00 1 12.04 1 11.99 0 0.00 3 0.33 9.13* 12.36

Other 1 4.71 11 14.22* 6 6.37* 11 9.67* 3 2.52 1 1.11 33 5.16 6.39* 7.51

All 1st cancers 1 4.52 12 14.77* 6 5.98* 12 9.83* 4 3.14 1 1.05 36 5.49 6.56* 7.78

10-17 Hodgkin lymphoma 0 0.00 6 8.24* 11 8.98* 13 8.12* 22 13.66* 10 7.31* 62 6.66 9.31* 31.62

Other 10 15.18* 24 7.97* 37 8.13* 21 3.94* 16 3.17* 14 3.50* 122 22.50 5.42* 14.04

All 1st cancers 10 12.69* 30 8.03* 48 8.46* 34 4.90* 38 5.70* 24 4.47* 184 29.16 6.31* 17.52

Subsequent leukemia

<5 Hodgkin lymphoma 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.01 0.00 -0.34

Other 0 0.00 7 5.96* 2 3.44 2 7.05 0 0.00 0 0.00 11 2.71 4.06* 1.21

All 1st cancers 0 0.00 7 5.95* 2 3.43 2 7.01 0 0.00 0 0.00 11 2.72 4.05* 1.20

5-9 Hodgkin lymphoma 0 0.00 0 0.00 2 127.20* 1 92.46* 0 0.00 0 0.00 3 0.06 50.62* 13.60

Other 0 0.00 2 5.48 1 4.11 0 0.00 0 0.00 0 0.00 3 1.00 2.99 0.54

All 1st cancers 0 0.00 2 5.22 3 11.58* 1 6.32 0 0.00 0 0.00 6 1.06 5.65* 1.26

10-17 Hodgkin lymphoma 0 0.00 2 17.44* 2 19.71* 2 26.80* 0 0.00 0 0.00 6 0.42 14.43* 3.19

Other 0 0.00 13 24.43* 2 4.85 0 0.00 0 0.00 0 0.00 15 1.69 8.90* 1.88

All 1st cancers 0 0.00 15 23.19* 4 7.79* 2 5.75 0 0.00 0 0.00 21 2.10 9.99* 2.14
Ewing sarcoma or osteosarcoma, probably due in part to

thoracic radiotherapy for lung metastases, although

genetic predisposition may have played a role. A recent

study showed that breast cancer incidence was increased

among survivors of bone or soft tissue sarcoma who did

not receive chest radiotherapy, and that a family history

of sarcoma was predictive of breast cancer risk among

childhood cancer survivors (Kenney et al, 2004).

Germline mutations in p53, which underlie most cases of

Li-Fraumeni syndrome, have been found in up to 3% of

children with osteosarcomas (McIntyre et al, 1994).

Unlike osteosarcoma, Ewing sarcoma is not considered

part of Li-Fraumeni syndrome.

Soft Tissue Sarcoma

Six-fold increased risks of subsequent cancers were

observed among children with soft tissue sarcoma, with

28 new cancers observed among 27 children (O/E=5.95)

(Table 18.D). Significant elevations in risk were seen

among children with rhabdomyosarcoma (O/E=7.26,

O=11, EAR=16), fibromatous neoplasms (O/E=5.59, O=9,

EAR=16), and other soft tissue sarcomas (O/E=5.16,

O=8, EAR=15) (Table 18.J). Excesses were found for subsequent ANLL, melanoma, bone and soft tissue sarcomas, and cancers of the female breast and buccal cavity.

A more detailed analysis of SEER data found that combined modality treatment with radiation and chemotherapeutic agents was associated with a significantly higher

risk of subsequent malignancies than initial treatment

with surgery alone, with risks being especially high for

subsequent ANLL, melanoma, breast cancer, and sarcomas (Cohen et al, 2005). Our results are consistent with

clinical surveys of second cancers following combined

modality treatment for childhood rhabdomyosarcoma

(Heyn et al, 1993, 1994). In these trials, the observed

excess of ANLL was attributed to therapy with alkylating agents and topoisomerase II inhibitors (doxorubicin,

etoposide). Previous studies have shown that germline

mutations in p53 occur in up to 10% of children with

soft tissue sarcomas (Hartley et al, 1993) and that genetic

susceptibility greatly increases the risk of second cancers

among children treated for soft tissue sarcomas (Heyn et

al, 1993; Kenney et al, 2004).

Retinoblastoma

Retinoblastoma patients had a high relative risk of developing a new cancer (O/E=14.71, O=15, EAR=24) (Table

18.K). Risks were greater among those who received

radiation as part of their initial treatment (O/E=44.08,

O=12) than among those who did not (O/E=4.2, O=3).

The risks of subsequent cancer were most pronounced

for cancers of the bone, soft tissue, and eye/orbit, as well

as ALL, consistent with the exceptional risks of second

cancer reported among children with familial or bilateral

retinoblastoma (Draper et al, 1986; Eng et al, 1993; Wong

et al, 1997; Kleinerman et al, 2005). Although subsequent

cancer risks are elevated in heritable cases both with and

without exposure to radiotherapy, the relative risks of

sarcomas associated with radiotherapy are substantially

higher for heritable than for nonheritable (sporadic)

cases, indicating gene-environment interaction (Wong et

al, 1997; Moll et al, 2001; Fletcher et al, 2004; Kleinerman

et al, 2005). The array of second cancers reported after

retinoblastoma includes cancers of the nasal cavity, brain,

474 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CHILDHOOD CANCER

Notes: Number of patients (PYR at risk in interval) for <5, 5-9, and ≥10 time intervals are: 4,905 (17,699), 2,723 (10,742), and 1,688 (11,403), respectively.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; E=expected number of subsequent primary cancers; O/E=ratio of observed to

expected cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000); CNS=central nervous

system.

*P <0.05.

†Radiotherapy data are known to be incomplete for patients with acute leukemia because cranial irradiation given to prevent CNS involvement was not reportable to

SEER before 1988.

Table 18.F: Risk of subsequent primary cancers among 4,905 children (ages 0-17 years) diagnosed with acute lymphocytic leukemia,

by years after diagnosis of initial cancer, both sexes.

Years after first primary cancer diagnosis

<5 yr 5-9 yr ≥10 yr Total

Subsequent primary cancer O O/E O O/E O O/E O E O/E EAR

All subsequent cancers 7 2.73* 14 8.16* 18 4.47* 39 8.30 4.70* 7.70

Any radiation† 1 1.28 8 12.31* 5 2.3 14 3.60 3.89* 6.93

All solid cancers 6 4.08* 13 12.31* 17 5.78* 36 5.47 6.58* 7.66

Any radiation† 1 2.25 8 19.88* 5 3.13* 14 2.45 5.72* 7.70

Buccal cavity, pharynx 1 31.99 1 30.54 2 25.34* 4 0.14 27.98* 0.97

Salivary gland 1 95.60* 1 75.88 1 36.99 3 0.05 59.20* 0.74

Digestive system 1 12.83 0 0.00 1 6.17 2 0.28 7.19 0.43

Brain, CNS 1 1.87 7 24.27* 3 10.22* 11 1.12 9.86* 2.48

Thyroid 1 18.27 2 20.97* 5 12.58* 8 0.55 14.61* 1.87

Bone, joints 1 8.06 1 8.12 2 15.41* 4 0.38 10.61* 0.91

Osteosarcoma 0 0.00 0 0.00 2 31.18* 2 0.19 10.33* 0.45

Soft tissue including heart 1 6.98 1 11.69 0 0.00 2 0.36 5.56 0.41

Melanoma of skin 0 0.00 0 0.00 2 4.25 2 0.62 3.20 0.35

Other 1 0.65 2 2.10 3 1.27 6 4.86 1.24 0.29
NEW MALIGNANCIES FOLLOWING CHILDHOOD CANCER 475

pineal gland, uterine corpus, female breast, lung, and

bladder, as well as melanoma (Kleinerman et al, 2005).

However, these tumors were not observed in our study

(except for 1 case of nasal cavity cancer), possibly due to

the young attained age of the population.

Neuroblastoma

A nearly 6-fold elevation in subsequent cancer risk was

observed among children with neuroblastoma

(O/E=5.90, O=11, EAR=9), with the highest risks among

those surviving 10 or more years (Table 18.K). Significantly elevated risks were seen for subsequent cancers of

the kidney, digestive system, and thyroid gland,

although based on small numbers. In a European cohort

of 544 children who survived 5 or more years after

neuroblastoma, the most common new malignancies

involved the thyroid (O=5) and breast (O=3), with risks

associated with radiotherapy but not chemotherapy

(Rubino et al, 2003). The absence of breast cancer in our

study may be related to the early onset of neuroblastoma,

as most of the cohort has not yet reached the ages at

which breast cancer tends to occur. It has been suggested

that neuroblastoma patients may be prone to thyroid

cancer independent of treatment (de Vathaire et al, 1992,

1999b), but this remains unclear.

Wilms Tumor

Risk of a new primary cancer was increased approximately 6-fold among children with Wilms tumor, who

were followed for an average of 10 years (O/E=6.14,

O=14, EAR=10) (Table 18.K). One-half of the new cancers consisted of soft tissue sarcoma, cancer of the urinary system (1 bladder and 1 kidney), or ANLL. In a

study of 5,278 Wilms tumor patients diagnosed between

CHILDHOOD CANCER

Notes: Number of patients (PYR in interval) for <5, 5-9, 10-14, and ≥15 time intervals are 1,744 (7,181), 1,261 (5,390), 910 (3,807), and 605 (3,620), respectively, for

Hodgkin lymphoma; and 1,038 (3,450), 557 (2,285), 367 (1,445), and 205 (1,041), respectively, for non-Hodgkin lymphoma.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; E=expected number of subsequent primary cancers; O/E=ratio of observed to

expected cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000); CNS=central nervous

system.

*P <0.05.

Table 18.G: Risk of subsequent primary cancers among children (ages 0-17 years) diagnosed with lymphoma, by years after diagnosis

of initial cancer, both sexes.

Years after first primary cancer diagnosis

<5 yr 5-9 yr 10-14 yr ≥15 yr Total

Subsequent primary cancer O O/E O O/E O O/E O O/E O E O/E EAR

First primary cancer: Hodgkin lymphoma (N=1,744) 

All subsequent cancers 11 7.55* 18 9.93* 20 9.33* 38 10.29* 87 9.11 9.55* 38.95

Any radiation 5 5.18* 14 10.80* 16 9.84* 33 11.36* 68 6.79 10.01* 42.74

All solid cancers 7 7.66* 11 8.51* 14 8.28* 33 10.53* 65 7.03 9.25* 28.99

Any radiation 3 4.96 9 9.73* 12 9.33* 29 11.74* 53 5.29 10.03* 33.32

Salivary gland 0 0.00 0 0.00 0 0.00 2 119.77* 2 0.05 39.47* 0.97

Digestive system 0 0.00 1 17.97 0 0.00 6 23.16* 7 0.44 15.87* 3.28

Stomach 0 0.00 0 0.00 0 0.00 4 146.34* 4 0.05 85.31* 1.98

Pancreas 0 0.00 1 262.44* 0 0.00 1 50.12 2 0.03 63.45* 0.98

Lung, bronchus 0 0.00 0 0.00 2 98.12* 1 11.03 3 0.13 22.26* 1.43

Female breast 0 0.00 2 38.01* 8 48.00* 13 18.43* 23 0.93 24.61* 23.19

Female genital 1 10.55 1 6.11 0 0.00 1 2.26 3 0.95 3.17 2.16

Bones, joints 3 32.88* 0 0.00 0 0.00 2 81.25* 5 0.20 25.06* 2.40

Osteosarcoma 2 42.17* 0 0.00 0 0.00 0 0.00 2 0.09 22.17* 0.95

Soft tissue including heart 1 15.42 2 34.69* 0 0.00 3 54.88* 6 0.22 26.76* 2.89

Fibrosarcoma 0 0.00 2 114.29* 0 0.00 2 121.01* 4 0.07 60.53* 1.97

Melanoma of skin 0 0.00 2 9.00* 1 3.45 1 2.14 4 1.10 3.65 1.45

Brain, CNS 0 0.00 2 15.30* 0 0.00 0 0.00 2 0.54 3.70 0.73

Thyroid 1 8.18 1 5.17 3 14.09* 3 9.98* 8 0.83 9.65* 3.59

Non-Hodgkin lymphoma 2 18.63* 2 16.75* 0 0.00 5 19.82* 9 0.63 14.33* 4.19

Acute non-lymphocytic leukemia 2 34.52* 4 77.57* 3 75.77* 0 0.00 9 0.19 46.19* 4.40

Other 1 1.75 1 1.45 3 4.14 1 1.11 6 2.89 2.08 1.56

First primary cancer: Non-Hodgkin lymphoma (N=1,038) 

All subsequent cancers 8 13.68* 2 3.40 0 0.00 3 3.91 13 2.54 5.11* 12.72

All solid cancers 3 8.56* 1 2.53 0 0.00 3 4.92 7 1.80 3.89* 6.33

Female breast 0 0.00 0 0.00 0 0.00 2 29.62* 2 0.10 20.75* 7.49

Thyroid 2 72.64* 0 0.00 0 0.00 0 0.00 2 0.18 11.26* 2.22

Hodgkin lymphoma 2 26.34* 0 0.00 0 0.00 0 0.00 2 0.28 7.25 2.10

Acute non-lymphocytic leukemia 2 74.65* 0 0.00 0 0.00 0 0.00 2 0.07 26.74* 2.34

Other 2 4.41 2 4.62 0 0.00 1 1.72 5 1.92 2.61 3.75
476 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

1969 and 1991, abdominal irradiation and treatment of

relapse with etoposide were associated with an

increased risk of second cancer, with 7 of 43 second

cancers being ANLL (Breslow et al, 1995; Shearer et al,

2001). Since Wilms tumor tends to occur at a very young

age, relatively few survivors in the present study were

followed into adulthood. 

Germ Cell, Trophoblastic, or Other Gonadal Cancers

In this study, the most common first primary tumors in

this category were cancer of the ovary (70%) among

females and cancers of the testis (64%) and pineal gland

(14%) among males. The risk of subsequent cancer was

increased approximately 4-fold (O/E=3.50 in females and

4.68 in males) (Tables 18.D and 18.K). Among females,

this was attributable mainly to 3 cases of cancer of the

reproductive system (O/E=7.23), 2 of which arose in the

contralateral ovary. The increased risk of subsequent cancer among males was attributable to 7 cases of contralateral testicular cancer (O/E=19.06), consistent with the

tendency to bilateral disease reported in the literature

(Buetow, 1995).

CHILDHOOD CANCER

Notes: Includes children surviving 2 or more months after diagnosis. Number of patients (PYR in interval) for <5, 5-9, and ≥10 time intervals are 2,242 (7,828), 1,304

(5,259), and 842 (6,026), respectively, for astrocytoma; and 859 (2,570), 351 (1,382), and 212 (1,439), respectively, for PNET.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; E=expected number of subsequent primary cancers; O/E=ratio of observed to

expected cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000); PNET=primitive

neuroectodermal tumor; CNS=central nervous system.

*P <0.05.

†O/E >500.00.

TABLE 18.H: Risk of subsequent cancers among children (ages 0-17 years) diagnosed with central nervous system cancer, by years

after diagnosis of initial cancer, both sexes.

Years after first primary cancer diagnosis

<5 yr 5-9 yr ≥10 yr Total

Subsequent primary cancer O O/E O O/E O O/E O E O/E EAR

First primary cancer: Astrocytoma (N=2,242) 

All subsequent cancers 14 11.43* 6 5.25* 7 2.23 27 5.50 4.91* 11.25

All radiation 9 17.51* 5 8.96* 3 1.63 17 2.92 5.83* 15.07

All solid cancers 10 13.72* 6 8.00* 6 2.46 22 3.92 5.61* 9.46

All radiation 6 19.72* 5 13.60* 3 2.09 14 2.11 6.64* 12.72

Digestive system 1 30.11 1 33.30 0 0.00 2 0.22 8.91* 0.93

Bone, joints 3 40.71* 1 16.60 0 0.00 4 0.19 20.97* 1.99

Soft tissue including heart 1 15.21 2 40.83* 0 0.00 3 0.19 15.75* 1.47

Melanoma of skin 1 19.63 0 0.00 1 2.52 2 0.55 3.65 0.76

Brain, CNS 4 18.41* 1 7.54 2 11.49* 7 0.52 13.36* 3.39

Brain 3 15.16* 0 0.00 1 6.20 4 0.48 8.32* 1.84

Other CNS 1 51.48 1 93.22* 1 77.58* 3 0.04 69.70* 1.55

Non-Hodgkin lymphoma 1 11.18 0 0.00 1 4.33 2 0.41 4.90 0.83

Leukemia 3 11.38* 0 0.00 0 0.00 3 0.55 5.49* 1.28

Chronic myelogenous leukemia 2 209.41* 0 0.00 0 0.00 2 0.05 43.52* 1.02

Other 0 0.00 1 1.82 3 1.59 4 2.87 1.39 0.59

First primary cancer: PNET of CNS (N=859) 

All subsequent cancers 3 8.02* 8 32.79* 4 6.92* 15 1.20 12.54* 25.61

Any radiation 2 6.26 8 35.80* 4 7.39* 14 1.08 12.91* 26.59

All solid cancers 2 9.27* 6 39.39* 4 9.14* 12 0.81 14.90* 20.77

Any radiation 2 10.86* 6 42.99* 4 9.80* 12 0.73 16.39* 23.20

Digestive system 1 94.88* 1 167.57* 1 35.66 3 0.04 67.35* 5.48

Pancreas 1 † 0 0.00 1 † 2 0.00 † 3.71

Bones, soft tissues 0 0.00 2 68.37* 0 0.00 2 0.10 19.29* 3.52

Brain, CNS 1 13.23 1 28.48 3 83.12* 5 0.15 34.06* 9.00

Brain 1 14.53 1 31.08 1 30.06 3 0.13 22.34* 5.32

Other CNS 0 0.00 0 0.00 2 † 2 0.01 159.71* 3.69

Leukemia 1 10.38 2 55.47* 0 0.00 3 0.17 18.00* 5.26

Acute lymphocytic leukemia 0 0.00 2 88.26* 0 0.00 2 0.11 18.40* 3.51

Other 0 0.00 2 14.53* 0 0.00 2 0.73 2.72 2.35
NEW MALIGNANCIES FOLLOWING CHILDHOOD CANCER 477

CHILDHOOD CANCER

Notes: Number of patients (PYR in interval) for <5, 5-9, and ≥10 time intervals are 752 (2,385), 346 (1,393), and 217 (1,556), respectively, for osteosarcoma; and 479

(1,510), 205 (791), and 114 (851), respectively, for Ewing sarcoma.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; E=expected number of subsequent primary cancers; O/E=ratio of observed to

expected cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000).

*P <0.05.

†O/E >500.00.

Table 18.I: Risk of subsequent cancers among children (ages 0-17 years) diagnosed with bone sarcomas, by years after diagnosis of

initial cancer, both sexes.

Years after first primary cancer diagnosis

<5 yr 5-9 yr ≥10 yr Total

Subsequent primary cancer O O/E O O/E O O/E O E O/E EAR

First primary cancer: Osteosarcoma (N=752) 

All subsequent cancers 3 7.15* 0 0.00 7 6.28* 10 1.94 5.14* 15.10

All solid cancers 2 7.71 0 0.00 7 7.62* 9 1.46 6.15* 14.13

Female breast 0 0.00 0 0.00 3 16.93* 3 0.19 15.96* 10.41

Bone and soft tissue sarcoma 1 18.69 0 0.00 2 64.43* 3 0.11 26.50* 5.41

Soft tissue 0 0.00 0 0.00 2 96.81* 2 0.06 35.15* 3.64

Other 2 5.49 0 0.00 2 2.21 4 1.64 2.44 4.42

First primary cancer: Ewing sarcoma (N=479)

All subsequent cancers 3 11.40* 6 27.53* 6 11.33* 15 1.01 14.84* 44.39

Any radiation 1 6.27 6 45.94* 4 10.47* 11 0.67 16.37* 50.47

All solid cancers 1 6.26 4 26.80* 6 14.14* 11 0.73 15.00* 32.58

Any radiation 1 10.38 4 45.16* 4 13.03* 9 0.49 18.29* 41.58

Female breast 0 0.00 0 0.00 2 38.51* 2 0.06 35.79* 12.80

Bone, joints 1 51.22 1 110.44* 1 152.34* 3 0.04 85.37* 9.41

Osteosarcoma 1 99.91* 1 226.58* 1 403.59* 3 0.02 177.51* 9.47

Soft tissue including heart 0 0.00 3 381.44* 1 92.13* 4 0.03 126.37* 12.59

Fibrosarcoma 0 0.00 2 † 0 0.00 2 0.01 245.58* 6.32

Acute non-lymphocytic leukemia 2 171.82* 1 135.86* 0 0.00 3 0.03 105.37* 9.43

Other 0 0.00 1 5.25 2 4.44 3 0.86 3.49 6.80
478 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

CHILDHOOD CANCER

Notes: Number of patients (PYR in interval) for <5, 5-9, and ≥10 time intervals are 769 (2,484), 386 (1,587), and 263 (1,882), respectively, for persons with

rhabdomyosarcoma; 448 (1,715), 301 (1,278), and 215 (1,615), respectively, for persons with fibrosarcoma (or neurofibrosarcoma); and 538 (1,763), 265 (1,079), and 172

(1,401), respectively, for those with other soft tissue sarcomas.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; E=expected number of subsequent primary cancers; O/E=ratio of observed to

expected cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000).

*P <0.05.

Table 18.J: Risk of subsequent cancers among children (ages 0-17 years) diagnosed with soft tissue sarcomas, by years after diagnosis

of initial cancer, both sexes.

Years after first primary cancer diagnosis

<5 yr 5-9 yr ≥10 yr Total

Subsequent primary cancer O O/E O O/E O O/E O E O/E EAR

First primary cancer: Rhabdomyosarcoma (N=769)

All subsequent cancers 3 8.05* 1 3.42 7 8.23* 11 1.52 7.26* 15.93

Any radiation 2 8.64 0 0.00 5 10.25* 7 0.90 7.76* 16.48

All solid cancers 1 4.59 1 5.40 6 9.26* 8 1.05 7.61* 11.67

Any radiation 1 7.41 0 0.00 4 11.00* 5 0.61 8.14* 11.85

Bone, soft tissue 1 24.80 1 31.89 2 46.25* 4 0.11 34.81* 6.53

Bone, joints 1 51.51 1 56.13 1 49.75 3 0.06 52.33* 4.94

Female breast 0 0.00 0 0.00 2 29.28* 2 0.07 27.91* 8.04

Acute non-lymphocytic leukemia 2 107.83* 0 0.00 0 0.00 2 0.05 40.20* 3.28

Other 0 0.00 0 0.00 3 4.17 3 1.28 2.34 2.89

First primary cancer: Fibrosarcoma (N=448)

All subsequent cancers 4 13.32* 3 8.93* 2 2.05 9 1.61 5.59* 16.03

Any radiation 2 44.35* 3 65.48* 2 21.87* 7 0.18 38.38* 120.84

All solid cancers 3 16.15* 2 8.59 2 2.56 7 1.20 5.83* 12.58

Any radiation 1 34.98 2 60.57* 2 27.38* 5 0.13 37.14* 86.24

Bone, soft tissue 1 29.30 2 81.01* 0 0.00 3 0.09 32.38* 6.31

Bone, joints 1 54.34 1 80.50* 0 0.00 2 0.04 45.69* 4.25

Female genital system 1 57.71 0 0.00 1 9.27 2 0.16 12.90* 7.64

Other 2 8.04 1 3.55 1 1.20 4 1.36 2.93 5.72

First primary cancer: Other soft tissue sarcomas (N=538)

All subsequent cancers 2 6.50 1 3.47 5 5.24* 8 1.55 5.16* 15.20

Any radiation 2 16.88* 0 0.00 5 13.58* 7 0.59 11.85* 40.61

All solid cancers 1 5.29 1 5.03 5 6.42* 7 1.17 6.00* 13.75

Any radiation 1 13.84 0 0.00 5 16.54* 6 0.45 13.47* 35.19

Buccal cavity, pharynx 0 0.00 0 0.00 2 103.43* 2 0.03 65.19* 4.64

Melanoma of skin 1 56.22 0 0.00 1 8.59 2 0.16 12.24* 4.33

Other 1 3.52 1 3.94 2 2.44 4 1.36 2.95 6.23
Table 18.K: Risk of subsequent cancers among children (ages 0-17 years) diagnosed with retinoblastoma, neuroblastoma, Wilms

tumor, and germ cell tumors, by years after diagnosis of initial cancer, both sexes.

NEW MALIGNANCIES FOLLOWING CHILDHOOD CANCER 479

CHILDHOOD CANCER

Notes: Number of patients (PYR in interval) for <5, 5-9, and ≥10 time intervals are 581 (2,279), 381 (1,570), and 261 (2,085), respectively, for persons with

retinoblastoma; 1,461 (4,489), 676 (2,696), and 419 (3,168), respectively, for those with neuroblastoma; 1,188 (4,650), 794 (3,346), and 549 (4,051), respectively, for

persons with Wilms tumor; and 1,206 (4,470), 740 (2,964), and 477 (3,662), respectively, for persons with germ cell tumors.

Abbreviations: O=observed number of subsequent (2nd, 3rd, etc.) primary cancers; E=expected number of subsequent primary cancers; O/E=ratio of observed to

expected cancers; PYR=person-years at risk; EAR=excess absolute risk (excess cancers per 10,000 person-years, calculated as [(O-E)/PYR]10,000).

*P <0.05.

†O/E >500.00.

Years after first primary cancer diagnosis

<5 yr 5-9 yr ≥10 yr Total

Subsequent primary cancer O O/E O O/E O O/E O E O/E EAR

First primary cancer: Retinoblastoma (N=581) 

All subsequent cancers 4 10.55* 7 40.05* 4 8.59* 15 1.02 14.71* 23.56

Any radiation 3 26.04* 5 100.99* 4 37.22* 12 0.27 44.08* 72.45

All solid cancers 3 13.46* 6 60.84* 3 9.60* 12 0.63 18.93* 19.16

Any radiation 2 29.18* 5 179.69* 3 41.42* 10 0.17 59.24* 60.74

Bone and soft tissue 1 32.35 4 187.97* 3 63.52* 8 0.10 80.47* 13.32

Bone 1 166.88* 4 331.57* 0 0.00 5 0.04 114.35* 8.35

Soft tissue 0 0.00 0 0.00 3 139.13* 3 0.06 53.86* 4.96

Eye 1 45.85 1 † 0 0.00 2 0.02 81.09* 3.33

Acute lymphocytic leukemia 1 9.50 1 25.40 1 39.49 3 0.17 17.65* 4.77

Other 1 4.53 1 8.88 0 0.00 2 0.73 2.76 2.15

First primary cancer: Neuroblastoma (N=1,461) 

All subsequent cancers 3 3.86 2 6.23 6 7.81* 11 1.87 5.90* 8.82

Any radiation 0 0.00 2 21.02* 3 8.23* 5 0.67 7.49* 12.28

All solid cancers 2 4.39 2 10.99* 6 11.41* 10 1.16 8.59* 8.54

Any radiation 0 0.00 2 37.21* 3 11.90* 5 0.43 11.72* 12.96

Digestive system 0 0.00 0 0.00 3 124.97* 3 0.07 45.32* 2.83

Brain, CNS 1 6.44 1 12.44 0 0.00 2 0.31 6.36 1.63

Thyroid 0 0.00 1 130.58* 1 14.37 2 0.08 24.65* 1.85

Kidney 1 14.30 0 0.00 2 314.79* 3 0.09 33.60* 2.81

Other 1 1.96 0 0.00 0 0.00 1 1.31 0.76 -0.30

First primary cancer: Wilms tumor (N=1,188)

All subsequent cancers 5 7.35* 1 2.31 8 6.87* 14 2.28 6.14* 9.73

Any radiation 2 6.40 0 0.00 4 5.35* 6 1.28 4.69* 7.49

All solid cancers 1 2.52 1 3.91 8 9.69* 10 1.48 6.77* 7.07

Any radiation 0 0.00 0 0.00 4 7.41* 4 0.85 4.70* 5.00

Bone, soft tissue 1 15.89 0 0.00 4 43.79* 5 0.21 23.66* 3.97

Soft tissue 1 23.80 0 0.00 3 66.77* 4 0.11 36.14* 3.23

Urinary system 0 0.00 0 0.00 2 98.08* 2 0.09 22.15* 1.59

Acute non-lymphocytic leukemia 3 83.80* 0 0.00 0 0.00 3 0.09 32.06* 2.41

Other 1 1.90 1 2.93 2 1.97 4 1.88 2.12 1.76

First primary cancer: Germ cell tumors (N=1,206) 

All subsequent cancers 8 8.99* 6 6.80* 3 1.23 17 4.21 4.04* 11.53

All solid cancers 8 14.19* 6 9.59* 3 1.51 17 3.17 5.36* 12.46

Female breast 0 0.00 0 0.00 2 6.02 2 0.36 5.53 2.83

Female genital system 1 19.74 2 25.80* 0 0.00 3 0.41 7.23* 4.46

Ovary 1 29.68 1 27.27 0 0.00 2 0.16 12.28* 3.17

Testis 5 71.67* 2 19.68* 0 0.00 7 0.37 19.06* 12.51

Other 2 2.62 2 2.95 1 0.62 5 3.06 1.63 1.75
480 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

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CHILDHOOD CANCER
APPENDIX 1: CUMULATIVE INCIDENCE OF DEVELOPING A SECOND CANCER 483

APPENDIX 1

Notes: See Appendices for definitions of cancer sites. The competing cause of death is based on all deaths excluding deaths among patients with a second cancer.

Deaths

Salivary gland

All second cancers

Deaths

Lip

All second cancers

Deaths

Oral and pharynx

All second cancers

Deaths

Liver

All second cancers

Deaths

Stomach

All second cancers

Deaths

Esophagus

All second cancers

Deaths

Nasopharynx

All second cancers

Deaths

Small intestine

All second cancers

Deaths

Gallbladder

All second cancers

0

10

20

30

40

50

60

70

80

90

100

Cumulative incidence (%)

Years after initial cancer diagnosis

0

10

20

30

40

50

60

70

80

90

100

0 5 10 15 20 25 0 5 10 15 20 25 0 5 10 15 20 25

60

80

90

100

20

30

40

50

10

0

70

Appendix 1: Cumulative incidence of developing a second cancer and cumulative probability of

death due to competing causes, by site of initial cancer, SEER 1973–2000.
484 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

APPENDIX 1

Notes: See Appendices for definitions of cancer sites. The competing cause of death is based on all deaths excluding deaths among patients with a second cancer.

Other biliary tract Pancreas Colon

Lung and bronchus

Rectum Anus Nasal cavities

Larynx Mesothelioma

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Cumulative incidence (%)

Years after initial cancer diagnosis

0 5 10 15 20 25 0 5 10 15 20 25 0 5 10 15 20 25

Appendix 1: Cumulative incidence of developing a second cancer and cumulative probability of

death due to competing causes, by site of initial cancer, SEER 1973–2000.
APPENDIX 1: CUMULATIVE INCIDENCE OF DEVELOPING A SECOND CANCER 485

Notes: See Appendices for definitions of cancer sites. The competing cause of death is based on all deaths excluding deaths among patients with a second cancer.

Female breast Male breast Cervix uteri

Prostate

Vulva Vagina Corpus uteri

Ovary Testis

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Cumulative incidence (%)

Years after initial cancer diagnosis

0 5 10 15 20 25 0 5 10 15 20 25 0 5 10 15 20 25

Appendix 1: Cumulative incidence of developing a second cancer and cumulative probability of

death due to competing causes, by site of initial cancer, SEER 1973–2000.

APPENDIX 1
486 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

APPENDIX 1

Notes: See Appendices for definitions of cancer sites. The competing cause of death is based on all deaths excluding deaths among patients with a second cancer.

Penis Bladder Kidney parenchyma

Melanoma of the skin

Renal pelvis and ureter Bone Soft tissues

Kaposi sarcoma (1980–2000) Ocular melanoma

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Cumulative incidence (%)

Years after initial cancer diagnosis

0 5 10 15 20 25 0 5 10 15 20 25 0 5 10 15 20 25

Appendix 1: Cumulative incidence of developing a second cancer and cumulative probability of

death due to competing causes, by site of initial cancer, SEER 1973–2000.
APPENDIX 1: CUMULATIVE INCIDENCE OF DEVELOPING A SECOND CANCER 487

APPENDIX 1

Notes: See Appendices for definitions of cancer sites. The competing cause of death is based on all deaths excluding deaths among patients with a second cancer.

Eye (non-melanoma) Brain and other CNS Thyroid

Myeloma

Thymus Adrenal gland Hodgkin lymphoma

Non-Hodgkin lymphoma Acute lymphocytic leukemia

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Deaths

All second cancers

Cumulative incidence (%)

Years after initial cancer diagnosis

0 5 10 15 20 25 0 5 10 15 20 25 0 5 10 15 20 25

Appendix 1: Cumulative incidence of developing a second cancer and cumulative probability of

death due to competing causes, by site of initial cancer, SEER 1973–2000.
488 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

APPENDIX 1

Notes: See Appendices for definitions of cancer sites. The competing cause of death is based on all deaths excluding deaths among patients with a second cancer.

Deaths

All second cancers

Acute myeloid leukemia Chronic lymphocytic leukemia Chronic myeloid leukemia

0

10

20

30

40

50

60

70

80

90

100

Deaths

All second cancers

Deaths

All second cancers

Cumulative incidence (%)

Years after initial cancer diagnosis

0 5 10 15 20 25 0 5 10 15 20 25 0 5 10 15 20 25

Appendix 1: Cumulative incidence of developing a second cancer and cumulative probability of

death due to competing causes, by site of initial cancer, SEER 1973–2000.
APPENDIX 2: CANCER SITE AND HISTOLOGY DEFINITIONS 489

APPENDIX 2

Appendix 2.A: Initial primary cancer site definitions.

Cancer site name SEER site recode ICD-O-2 site code ICD-O-2 histology (type)

Lip 20010 C000-C009 All histologies excluding 9050-9055, 9140, 9590-9989 

Oral and pharynx 20020, 20040, 20050, C019-C069, C090-C109, All histologies excluding 9050-9055, 9140, 9590-9989

20070, 20080, 20090 C129-C139

Tongue 20020 C019-C029 All histologies excluding 9050-9055, 9140, 9590-9989 

Gum and mouth 20040, 20050 C030-C069 All histologies excluding 9050-9055, 9140, 9590-9989 

Tonsil 20070 C090-C099 All histologies excluding 9050-9055, 9140, 9590-9989 

Oropharynx 20080 C100-C109 All histologies excluding 9050-9055, 9140, 9590-9989 

Hypopharynx 20090 C129-C139 All histologies excluding 9050-9055, 9140, 9590-9989 

Salivary gland 20030 C079-C089 All histologies excluding 9050-9055, 9140, 9590-9989 

Nasopharynx 20060 C110-C119 All histologies excluding 9050-9055, 9140, 9590-9989 

Esophagus 21010 C150-C159 All histologies excluding 9050-9055, 9140, 9590-9989

Stomach 21020 C160-C169 All histologies excluding 9050-9055, 9140, 9590-9989

Small intestine 21030 C170-C179 All histologies excluding 9050-9055, 9140, 9590-9989

Liver 21071, 21072 C220-C221 All histologies excluding 9050-9055, 9140, 9590-9989

Gallbladder 21080 C239 All histologies excluding 9050-9055, 9140, 9590-9989

Other biliary tract 21090 C240-C249 All histologies excluding 9050-9055, 9140, 9590-9989

Pancreas 21100 C250-C259 All histologies excluding 9050-9055, 9140, 9590-9989

Colon 21041-21049 C180-C189, C260 All histologies excluding 9050-9055, 9140, 9590-9989

Rectum 21051-21052 C199, C209 All histologies excluding 9050-9055, 9140, 9590-9989

Anus 21060 C210-C212, C218 All histologies excluding 9050-9055, 9140, 9590-9989

Lung and bronchus 22030 C340-C349 All histologies excluding 9050-9055, 9140, 9590-9989

Larynx 22020 C320-C329 All histologies excluding 9050-9055, 9140, 9590-9989

Nasal cavities 22010 C300-C301, C310-C319 All histologies excluding 9050-9055, 9140, 9590-9989

Mesothelioma 36010 Any site 9050-9055

Breast, females 26000* C500-C509, Sex=Female All histologies excluding 9050-9055, 9140, 9590-9989

Breast, males 26000* C500-C509, Sex=Male All histologies excluding 9050-9055, 9140, 9590-9989

Cervix uteri 27010 C530-C539 All histologies excluding 9050-9055, 9140, 9590-9989

Vagina 27050 C529 All histologies excluding 9050-9055, 9140, 9590-9989

Vulva 27060 C510-C519 All histologies excluding 9050-9055, 9140, 9590-9989

Corpus uteri 27020 C540-C549 All histologies excluding 9050-9055, 9140, 9590-9989

Ovary 27040 C569 All histologies excluding 9050-9055, 9140, 9590-9989

Prostate 28010 C619 All histologies excluding 9050-9055, 9140, 9590-9989

Testis 28020 C620-C629 All histologies excluding 9050-9055, 9140, 9590-9989

Penis 28030 C600-C609 All histologies excluding 9050-9055, 9140, 9590-9989

Bladder 29010 C670-C679 All histologies excluding 9050-9055, 9140, 9590-9989

Kidney parenchyma 29020* C649, age at diagnosis >18 All histologies excluding 9050-9055, 9140, 9590-9989

Renal pelvis and ureter 29020*, 29030 C659, C669 All histologies excluding 9050-9055, 9140, 9590-9989

Bone 23000 C400-C419 All histologies excluding 9050-9055, 9140, 9590-9989

Soft tissues 24000 C380, C470-C479, C490-C499 All histologies excluding 9050-9055, 9140, 9590-9989

Kaposi sarcoma 36020 Any site 9140

Melanoma of skin 25010 C440-C449 8720-8790

Ocular melanoma 30000* C690-C699 8720-8790

Eye (non-melanoma) 30000* C690-C699 All histologies excluding 8720-8799, 9050-9055, 9140,

9510-9512, 9590-9989

Retinoblastoma 30000* C690-C699 9510-9512

Brain and other CNS 31010, 31040 C700-C729 All histologies excluding 9050-9055, 9140, 9590-9989

Thyroid 32010 C739 All histologies excluding 9050-9055, 9140, 9590-9989

Thymus 32020* C379 All histologies excluding 9050-9055, 9140, 9590-9989

Adrenal gland 32020* C740-C749 All histologies excluding 9050-9055, 9140, 9490, 9500, 9590-9989

Hodgkin lymphoma 33011-33012 Any site 9650-9667

Non-Hodgkin lymphoma 33041-33042 Any site 9590-9595, 9670-9677, 9680-9688, 9690-9698, 9700-9717, 9823, 9827

Myeloma 34000 Any site 9731-9732

Acute lymphocytic leukemia 35011 Any site 9821, 9826, 9828

Acute myeloid leukemia 35021 Any site 9840-9841, 9861, 9866, 9867, 9871-9874, 9910

Chronic lymphocytic leukemia 35012 C420, C421, C424 9823

Chronic myeloid leukemia 35022 Any site 9863, 9868

Childhood cancers — Any site, age at Any histology

diagnosis <17

* SEER site recodes with a star (*) indicate that the cancer site grouping is based not only on the SEER site recode but on the given ICD-O-2 codes, sex, age, and/or histologic type.
APPENDIX 2

Appendix 2.B: Subsequent primary cancer site definitions.

Subsequent primary cancer SEER site recode ICD-O-2 site code ICD-O-2 histology (type)

All subsequent cancers 20010-25010, Any site All histologies excluding non-melanoma skin (i.e., excluding

26000-37000 ICD-O-2 site C440-C449 with the following histologies

8000-8004, 8010-8045, 8050-8082, 8090-8110, 8720-8790) 

Buccal cavity, pharynx 20010-20100 C000-C009, C019-C069, C079-C119, All histologies excluding 9050-9055, 9140, 9590-9989

C129-C140, C142-C148

Lip 20010 C000-C009 All histologies excluding 9050-9055, 9140, 9590-9989 

Tongue 20020 C019-C029 All histologies excluding 9050-9055, 9140, 9590-9989 

Salivary gland 20030 C079-C089 All histologies excluding 9050-9055, 9140, 9590-9989 

Mouth 20040, 20050 C030-C069 All histologies excluding 9050-9055, 9140, 9590-9989 

Nasopharynx 20060 C110-C119 All histologies excluding 9050-9055, 9140, 9590-9989 

Tonsil 20070 C090-C099 All histologies excluding 9050-9055, 9140, 9590-9989 

Oropharynx 20080 C100-C109 All histologies excluding 9050-9055, 9140, 9590-9989 

Hypopharynx 20090 C129-C139 All histologies excluding 9050-9055, 9140, 9590-9989 

Digestive system 21010-21130 C150-C189, C199, C209-C212, All histologies excluding 9050-9055, 9140, 9590-9989

C218, C220-C221, C239-C260,

C268-C269, C480-C482, C488

Esophagus 21010 C150-C159 All histologies excluding 9050-9055, 9140, 9590-9989

Stomach 21020 C160-C169 All histologies excluding 9050-9055, 9140, 9590-9989

Small intestine 21030 C170-C179 All histologies excluding 9050-9055, 9140, 9590-9989

Colon 21041-21049 C180-C189, C260 All histologies excluding 9050-9055, 9140, 9590-9989

Rectum, rectosigmoid junction 21051-21052 C199, C209 All histologies excluding 9050-9055, 9140, 9590-9989

Rectum 21052 C209 All histologies excluding 9050-9055, 9140, 9590-9989

Anus, anal canal 21060 C210-C212, C218 All histologies excluding 9050-9055, 9140, 9590-9989

Liver 21071 C220 All histologies excluding 9050-9055, 9140, 9590-9989

Gallbladder 21080 C239 All histologies excluding 9050-9055, 9140, 9590-9989

Bile ducts, other biliary 21072, 21090 C221, C240-C249 All histologies excluding 9050-9055, 9140, 9590-9989

Pancreas 21100 C250-C259 All histologies excluding 9050-9055, 9140, 9590-9989

Respiratory system 22010-22030, C300-C301, C310-C329, C339-C349, All histologies excluding 9050-9055, 9140, 9590-9989

22050-22060 C381-C384, C388, C390, C398-C399

Nose, nasal cavity, ear 22010 C300-C301, C310-C319 All histologies excluding 9050-9055, 9140, 9590-9989

Larynx 22020 C320-C329 All histologies excluding 9050-9055, 9140, 9590-9989

Lung, bronchus 22030 C340-C349 All histologies excluding 9050-9055, 9140, 9590-9989

Female breast 26000* C500-C509, Sex=Female All histologies excluding 9050-9055, 9140, 9590-9989

Male breast 26000* C500-C509, Sex=Male All histologies excluding 9050-9055, 9140, 9590-9989

Female genital system 27010-27070 C510-C519, C529-C549, C559, All histologies excluding 9050-9055, 9140, 9590-9989

C569-C589

Cervix uteri 27010 C530-C539 All histologies excluding 9050-9055, 9140, 9590-9989

Corpus uteri 27020 C540-C549 All histologies excluding 9050-9055, 9140, 9590-9989

Ovary 27040 C569 All histologies excluding 9050-9055, 9140, 9590-9989

Vagina 27050 C529 All histologies excluding 9050-9055, 9140, 9590-9989

Vulva 27060 C510-C519 All histologies excluding 9050-9055, 9140, 9590-9989

Male genital system 28010-28040 C600-C609, C619-C639 All histologies excluding 9050-9055, 9140, 9590-9989

Prostate 28010 C619 All histologies excluding 9050-9055, 9140, 9590-9989

Testis 28020 C620-C629 All histologies excluding 9050-9055, 9140, 9590-9989

Urinary system 29010-29040 C649, C659, C669-C689 All histologies excluding 9050-9055, 9140, 9590-9989

Urinary bladder 29010 C670-C679 All histologies excluding 9050-9055, 9140, 9590-9989

Kidney parenchyma 29020* C649 All histologies excluding 9050-9055, 9140, 9590-9989

Renal pelvis, other urinary 29020*, 29030, 29040 C659, C669, C680-C689 All histologies excluding 9050-9055, 9140, 9590-9989

Ureter 29030 C669 All histologies excluding 9050-9055, 9140, 9590-9989

Bone, joints 23000 C400-C419 All histologies excluding 9050-9055, 9140, 9590-9989

Soft tissue including heart 24000 C380, C470-C479, C490-C499 All histologies excluding 9050-9055, 9140, 9590-9989

Kaposi sarcoma 36020 Any site 9140

Melanoma of skin 25010 C440-C449 8720-8790

Eye, orbit 30000 C690-C699 All histologies excluding 9050-9055, 9140, 9590-9989

Brain, central nervous system 31010, 31040 C700-C729 All histologies excluding 9050-9055, 9140, 9590-9989

Thyroid 32010 C739 All histologies excluding 9050-9055, 9140, 9590-9989

Lymphatic, hematopoietic 33011-35043 Any site 9590-9595, 9650-9667, 9670-9677, 9680-9688, 9690-9698,

9700-9717, 9731-9732, 9800-9804, 9820-9828, 9830,

9840-9842, 9850, 9860-9864, 9866-9868, 9870-9874, 9880,

9890-9894, 9900, 9910, 9930-9932, 9940-9941

Hodgkin lymphoma 33011-33012 Any site 9650-9667

Non-Hodgkin lymphoma 33041-33042 Any site 9590-9595, 9670-9677, 9680-9688, 9690-9698, 9700-9717,

9823, 9827

Myeloma 34000 Any site 9731-9732

Leukemia 35011-35043 Any site 9800-9804, 9820-9828, 9830, 9840-9842, 9850, 9860-9864,

9866-9868, 9870-9874, 9880, 9890-9894, 9900, 9910,

9930-9932, 9940-9941

Acute lymphocytic 35011 Any site 9821, 9826, 9828

Chronic lymphocytic 35012 C420, C421, C424 9823

Acute non-lymphocytic 35021, 35023*, Any site 9801, 9802, 9840-9842, 9861, 9862, 9866, 9867, 9871-9874,

35031, 35041, 35043* 9891, 9892, 9910, 9931, 9932

Chronic myeloid 35022 Any site 9863, 9868

* SEER site recodes with a star (*) indicate that the cancer site grouping is based not only on the SEER site recode but also on the given ICD-O-2 codes, sex, and/or histologic type.

490 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 
APPENDIX 2: CANCER SITE AND HISTOLOGY DEFINITIONS 491

APPENDIX 2

Appendix 2.C: All subsequent cancers excluding same-site definitions.

First primary site All subsequent cancers excluding same-site definition

Lip All subsequent cancers excluding cancer of the lip

Oral and pharynx All subsequent cancers excluding cancers of the oral cavity and pharynx

Tongue All subsequent cancers excluding cancer of the tongue

Gum and mouth All subsequent cancers excluding cancers of the gum and mouth 

Tonsil All subsequent cancers excluding cancer of the tonsil

Oropharynx All subsequent cancers excluding cancer of the oropharynx

Hypopharynx All subsequent cancers excluding cancer of the hypopharynx

Salivary gland All subsequent cancers excluding cancer of the salivary gland 

Nasopharynx All subsequent cancers excluding cancer of the nasopharynx 

Esophagus All subsequent cancers excluding cancer of the esophagus 

Stomach All subsequent cancers excluding cancer of the stomach 

Small intestine All subsequent cancers excluding cancer of the small intestine 

Liver All subsequent cancers excluding cancer of the liver 

Gallbladder All subsequent cancers excluding cancer of the gallbladder

Other biliary tract All subsequent cancers excluding cancer of the other biliary tract 

Pancreas All subsequent cancers excluding cancer of the pancreas 

Colon All subsequent cancers excluding cancers of the colon, rectum and anus

Rectum All subsequent cancers excluding cancers of the colon, rectum and anus

Anus All subsequent cancers excluding cancer of the anus 

Lung and bronchus All subsequent cancers excluding cancers of the lung and bronchus

Larynx All subsequent cancers excluding cancer of the larynx 

Nasal cavities All subsequent cancers excluding cancer of the nasal cavities

Mesothelioma All subsequent cancers excluding mesothelioma

Breast, females All subsequent cancers excluding cancer of the breast, females

Breast, males All subsequent cancers excluding cancer of the breast, males

Cervix uteri All subsequent cancers excluding cancer of the cervix uteri 

Vagina All subsequent cancers excluding cancer of the vagina

Vulva All subsequent cancers excluding cancer of the vulva

Corpus uteri All subsequent cancers excluding cancers of the female genital system

Ovary All subsequent cancers excluding cancers of the female genital system

Prostate All subsequent cancers excluding cancer of the prostate

Testis All subsequent cancers excluding cancer of the testis

Penis All subsequent cancers excluding cancer of the penis

Bladder All subsequent cancers excluding cancers of the renal pelvis, ureter, bladder and other urinary

Kidney parenchyma All subsequent cancers excluding cancer of the kidney parenchyma

Renal pelvis and ureter All subsequent cancers excluding cancers of the renal pelvis, ureter, bladder and other urinary

Bone All subsequent cancers excluding cancer of the bone 

Soft tissues All subsequent cancers excluding cancer of the soft tissues 

Kaposi sarcoma All subsequent cancers excluding Kaposi sarcoma

Melanoma of skin All subsequent cancers excluding melanoma of skin 

Ocular melanoma All subsequent cancers excluding ocular melanoma

Eye (non-melanoma) All subsequent cancers excluding cancer of the eye (non-melanoma)

Brain and other CNS All subsequent cancers excluding cancers of the brain and other central nervous system

Thyroid All subsequent cancers excluding cancer of the thyroid

Thymus All subsequent cancers excluding cancer of the thymus

Adrenal gland All subsequent cancers excluding cancer of the adrenal gland

Hodgkin lymphoma All subsequent cancers excluding Hodgkin lymphoma

Non-Hodgkin lymphoma All subsequent cancers excluding non-Hodgkin lymphoma 

Myeloma All subsequent cancers excluding myeloma 

Acute lymphocytic leukemia All subsequent cancers excluding lymphocytic leukemia*

Acute myeloid leukemia All subsequent cancers excluding non-lymphocytic leukemia**

Chronic lymphocytic leukemia All subsequent cancers excluding lymphocytic leukemia*

Chronic myeloid leukemia All subsequent cancers excluding non-lymphocytic leukemia**

* Definition of lymphocytic leukemia is ICD-O-2 histology (type): 9820, 9821, 9822, 9823, 9824, 9825, 9826, 9828, 9850, 9940-

9941.

** Definition of non-lymphocytic leukemia is ICD-O-2 histology (type): 9800, 9803-9804, 9830, 9840, 9841, 9860-9861, 9863-

9864, 9866-9868, 9870, 9871-9874, 9880, 9890-9891, 9893, 9894, 9900, 9910, 9930 and ICD-O-2 site C420, C421, C424,

and ICD-O-2 histology (type) 9827.
492 NEW MALIGNANCIES AMONG CANCER SURVIVORS: SEER CANCER REGISTRIES, 1973–2000 

APPENDIX 2

Appendix 2.D: Histology/primary site group definitions.

Chapter number Site and histology name ICD-O-2 histology/primary site codes

4 Esophagus, squamous cell carcinoma 8010, 8012, 8051-8052, 8070-8075, 8082, 8094, 8120

4 Esophagus, adenocarcinoma 8140, 8144-8145, 8200, 8210-8211, 8260-8263, 8310,

8430, 8480-8481, 8490, 8550, 8560, 8570

4 Stomach, cardia C160

4 Stomach, excluding cardia C161-C166, C168, C169

4 Small intestine, adenocarcinoma 8140-8141, 8144, 8150, 8210-8211, 8260-8263,

8480-8481, 8490, 8550, 8560, 8570

6 Lung and bronchus, small cell carcinoma 8041-8045

6 Lung and bronchus, non-small cell carcinoma 8000-8040, 8046-9989

7 Female breast, infiltrating ductal carcinoma, NOS* 8500

7 Female breast, lobular carcinoma 8520

10 Testis, testicular seminoma 9060-9063

10 Testis, testicular non-seminoma 9070-9071, 9073, 9080-9085, 9100-9102

* Not Otherwise Specified.