Second primary cancers related to smoking and treatment of small-cell lung cancer

Margaret A. Tucker, Nevin Murray, Edward G. Shaw, David S. Ettinger, Mack Mabry, Martin H. Huber, Ronald Feld, Frances A. Shepherd, David H. Johnson, Stefan C. Grant, Joseph Aisner, Bruce E. Johnson

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190 Scopus citations


Background: An increased risk of second primary cancers has been reported in patients who survive small-cell carcinoma of the lung. The treatment's contribution to the development of second cancers is difficult to assess, in part because the number of long-term survivors seen at any one institution is small. We designed a multi-institution study to investigate the risk among survivors of developing second primary cancers other than small-cell lung carcinoma. Methods: Demographic, smoking, and treatment information were obtained from the medical records of 611 patients who had been cancer free for more than 2 years after therapy for histologically proven small-cell lung cancer, and personyears of follow-up were cumulated. Population-based rates of cancer incidence and mortality were used to estimate the expected number of cancers or deaths. The actuarial risk of second cancers was estimated by the Kaplan-Meier method. Results: Relative to the general population, the risk of all second cancers among these patients (mostly non-small-cell cancers of the lung) was increased 3.5-fold. Second lung cancer risk was increased 13-fold among those who received chest irradiation in comparison to a sevenfold increase among nonirradiated patients. It was higher in those who continued smoking, with evidence of an interaction between chest irradiation and continued smoking (relative risk = 21). Patients treated with various forms of combination chemotherapy had comparable increases in risk (9.4- to 13-fold, overall), except for a 19- fold risk increase among those treated with alkylating agents who continued smoking. Implications: Because of their substantially increased risk, survivors should stop smoking and may consider entering trials of secondary chemoprevention.

Original languageEnglish (US)
Pages (from-to)1782-1788
Number of pages7
JournalJournal of the National Cancer Institute
Issue number23
StatePublished - Dec 3 1997

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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