Incidence of subsequent pancreatic adenocarcinoma in patients with a history of nonpancreatic primary cancers

• Published in: Cancer Vol. 118; no. 5; pp. 1244 - 1251
• Main Authors: Amin, Sunil, McBride, Russell B., Kline, Jennie K., Mitchel, Elana B., Lucas, Aimee L., Neugut, Alfred I., Frucht, Harold
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.03.2012; Wiley-Blackwell
• Subjects: Adenocarcinoma - epidemiology; Adenocarcinoma - genetics; Adult; Aged; and End Results Program; Biological and medical sciences; Environmental Exposure - statistics & numerical data; environmental risk factors; Epidemiology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Genetic Predisposition to Disease; Humans; Incidence; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical History Taking; Medical sciences; metachronous neoplasms; Middle Aged; Neoplasms - epidemiology; Neoplasms - genetics; Neoplasms - pathology; Neoplasms, Second Primary - epidemiology; Neoplasms, Second Primary - genetics; pancreas neoplasms; Pancreatic Neoplasms - epidemiology; Pancreatic Neoplasms - genetics; Risk Factors; SEER Program; Surveillance; Tumors; Young Adult; Human; pancreas neoplasms; Asynchronous; Program; metachronous neoplasms; Environmental factor; Malignant tumor; Epidemiology; Incidence; Cancerology; Health and environment; Surveillance; Pancreas cancer; Risk factor; Digestive diseases; environmental risk factors; Pancreas; and End Results Program; Pancreas adenocarcinoma; Cancer; Pancreatic disease; Primary cancer
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.26414

BACKGROUND: Several environmental risk factors are known to predispose individuals to pancreatic cancer, and up to 15% of pancreatic cancers have an inherited component. Understanding metachronous cancer associations can modify pancreas cancer risk. The objective of this study was to investigate the association of nonpancreatic cancers with subsequent pancreatic adenocarcinoma. METHODS: The authors used data from the US Surveillance, Epidemiology, and End Results (SEER) registries to identify 1,618,834 individuals who had a primary malignancy and subsequent pancreatic adenocarcinoma (n = 4013). Standardized incidence ratios were calculated as an approximation of relative risk (RR) for the occurrence of pancreatic adenocarcinoma after another primary malignancy. RESULTS: Among patients who were diagnosed with a first primary malignancy at ages 20 to 49 years, the risk of subsequent pancreatic adenocarcinoma was increased among patients who had cancers of the ascending colon (relative risk [RR], 4.62; 95% confidence interval [CI], 1.86‐9.52), hepatic flexure (RR, 5.42; 95% CI, 1.12‐15.84), biliary system (RR, 13.14; 95% CI, 4.27‐30.66), breast (RR, 1.32; 95% CI, 1.09‐1.59), uterine cervix (RR, 1.61; 95% CI, 1.02‐2.41), testes (RR, 2.78; 95% CI, 1.83‐4.05), and hematopoietic system (RR, 1.83; 95% CI, 1.28‐2.53). Among patients who had a first malignancy at ages 50 to 64 years, the risk was increased after cancers of the stomach (RR, 1.88; 95% CI, 1.13‐2.93), hepatic flexure (RR, 2.25; 95% CI, 1.08‐4.13), lung and bronchus (RR, 1.46; 95% CI, 1.16‐1.82), pharynx (RR, 2.26; 95% CI, 1.13‐4.04), and bladder (RR, 1.24; 95% CI, 1.03‐1.48). Among patients who had a primary cancer after age 65 years, the risk was increased after cancers of the stomach (RR, 1.79; 95% CI, 1.23‐2.53), hepatic flexure (RR, 1.76; 95% CI, 1.06‐2.75), biliary system (RR, 2.35; 95% CI, 1.17‐4.20), and uterus (RR, 1.23; 95% CI, 1.03‐1.47). CONCLUSIONS: The results from the current population‐based data set suggested that pancreatic adenocarcinoma is associated with certain primary cancers. Genetic predisposition and common environmental and behavioral risk factors all may contribute to this observation. Specific tumor associations will guide future risk‐stratification efforts. Cancer 2012. © 2011 American Cancer Society. Understanding metachronous cancer associations can modify pancreas cancer risk. Primary malignancies associated with certain environmental and genetic risk factors are associated with the development of pancreatic adenocarcinoma later in life.