Abstract 4665: Pre-diagnostic smoking, alcohol and obesity and risk of second primary cancer in female keratinocyte carcinoma survivors
Authors: Park Sang Min , Li Tricia , Wu Shaowei , Li Wen-Qing , Qureshi Abrar A. , Cho Eunyoung 
Published: August 2015

Abstract
BACKGROUND:
Several studies have suggested a positive association between personal history of keratinocyte carcinoma and risk of subsequent cancer at other sites. Although smoking, alcohol, and obesity are well-known risk factors for first cancers, few studies evaluate the role of these risk factors in the development of second primary cancers (SPCs) in keratinocyte carcinoma survivors.
METHODS:
In the Nurses’ Health Study (NHS), 20,020 female keratinocyte carcinoma survivors were identified from a cohort of 115,711 women from June 1884 to June 2010. Incident SPC (all cancer combined and major individual cancers, including lung, colorectal, breast, non-Hodgkin, melanoma, endometrial, ovary, and bladder) were assessed throughout follow-up until June 2012. Cox proportional hazards models were used to calculate the relative risks (RRs) of SPC associated with pre-diagnosis smoking history, alcohol consumption, and body mass index (BMI). We also compared these estimates to those for first cancers in the cohort.
RESULTS:
During 239,029 person years’ follow-up, we recorded 3,365 SPC cases. Compared with nonsmokers, smokers with at least 25 cigarettes/d before keratinocyte carcinoma diagnosis had a significantly elevated SPC risk for lung cancer (RR, 24.48; 95% CI, 15.93 to 37.62) and colorectal cancer (RR, 2.36; 95% CI, 1.33 to 4.19) in dose-dependent manner (test for trend P&lt;0.01). We found positive linear trends for the relationship between higher BMI and risk for breast cancer, endometrial cancer and all-combined SPC (test for trend P&lt;0.01). Keratinocyte carcinoma survivors who reported drinking at least 30 g of alcohol/d had a marginally higher risk of SPC than non-alcohol drinkers (RR, 1.17; 95% CI, 0.99 to 1.39), while there was a J-shape association between alcohol consumption and risk of second primary colorectal cancer. When we compared the magnitude of the association between heavy smoking (≥25 cigarettes/day) and any cancer risk among those with keratinocyte carcinoma vs. none, the RR for keratinocyte carcinoma survivors (2.29; 95% CI, 1.97 to 2.66) slightly exceed that for participants without keratinocyte carcinoma (RR, 1.94; 95% CI, 1.79 to 2.10).
CONCLUSIONS:
Our study found that prediagnostic smoking and obesity were associated with overall SPCs and for several individual sites among keratinocyte carcinoma survivors. These findings suggest that more thorough surveillance and screening for SPCs is needed for the keratinocyte carcinoma survivors with these risk factors. Further research is needed to understand the long-term impact of smoking cessation and healthy weight management among cancer survivors.
Citation Format: Sang Min Park, Tricia Li, Shaowei Wu, Wen-Qing Li, Abrar A. Qureshi, Eunyoung Cho. Pre-diagnostic smoking, alcohol and obesity and risk of second primary cancer in female keratinocyte carcinoma survivors. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4665. doi:10.1158/1538-7445.AM2015-4665