Mellemkjaer Lene, Friis Søren, Olsen Jørgen H, Scélo Ghislaine, Hemminki Kari, Tracey Elizabeth, Andersen Aage, Brewster David H, Pukkala Eero, McBride Mary L, Kliewer Erich V, Tonita Jon M, Kee-Seng Chia, Pompe-Kirn Vera, Martos Carmen, Jonasson Jon G, Boffetta Paolo, Brennan Paul
Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
Int J Cancer. 2006 May 1;118(9):2285-92. doi: 10.1002/ijc.21651.
A large number of women survive a diagnosis of breast cancer. Knowledge of their risk of developing a new primary cancer is important not only in relation to potential side effects of their cancer treatment, but also in relation to the possibility of shared etiology with other types of cancer. A cohort of 525,527 women with primary breast cancer was identified from 13 population-based cancer registries in Europe, Canada, Australia and Singapore, and followed for second primary cancers within the period 1943-2000. We used cancer incidence rates of first primary cancer for the calculation of standardized incidence ratios (SIRs) of second primary cancer. Risk of second primary breast cancer after various types of nonbreast cancer was also computed. For all second cancer sites combined, except contralateral breast cancer, we found a SIR of 1.25 (95% CI = 1.24-1.26) on the basis of 31,399 observed cases after first primary breast cancer. The overall risk increased with increasing time since breast cancer diagnosis and decreased by increasing age at breast cancer diagnosis. There were significant excesses of many different cancer sites; among these the excess was larger than 150 cases for stomach (SIR = 1.35), colorectal (SIR = 1.22), lung (SIR = 1.24), soft tissue sarcoma (SIR = 2.25), melanoma (SIR = 1.29), non-melanoma skin (SIR = 1.58), endometrium (SIR = 1.52), ovary (SIR = 1.48), kidney (SIR = 1.27), thyroid gland (SIR = 1.62) and leukaemia (SIR = 1.52). The excess of cancer after a breast cancer diagnosis is likely to be explained by treatment for breast cancer and by shared genetic or environmental risk factors, although the general excess of cancer suggests that there may be additional explanations such as increased surveillance and general cancer susceptibility.
大量女性在被诊断出患有乳腺癌后存活下来。了解她们患新发原发性癌症的风险不仅对于其癌症治疗的潜在副作用很重要，而且对于与其他类型癌症存在共同病因的可能性也很重要。从欧洲、加拿大、澳大利亚和新加坡的13个基于人群的癌症登记处中识别出一组525,527名原发性乳腺癌女性，并在1943年至2000年期间对她们进行随访，观察是否发生第二原发性癌症。我们使用第一原发性癌症的发病率来计算第二原发性癌症的标准化发病比（SIR）。还计算了各类非乳腺癌后发生第二原发性乳腺癌的风险。对于所有合并的第二癌症部位，除了对侧乳腺癌外，在第一原发性乳腺癌后的31,399例观察病例的基础上，我们发现SIR为1.25（95%置信区间 = 1.24 - 1.26）。总体风险随着自乳腺癌诊断以来时间的增加而增加，并随着乳腺癌诊断时年龄的增加而降低。有许多不同的癌症部位存在显著超额风险；其中，胃癌（SIR = 1.35）、结直肠癌（SIR = 1.22）、肺癌（SIR = 1.24）、软组织肉瘤（SIR = 2.25）、黑色素瘤（SIR = 1.29）、非黑色素瘤皮肤癌（SIR = 1.58）、子宫内膜癌（SIR = 1.52）、卵巢癌（SIR = 1.48）、肾癌（SIR = 1.27）、甲状腺癌（SIR = 1.62）和白血病（SIR = 1.52）的超额病例数超过150例。乳腺癌诊断后癌症风险的增加可能是由乳腺癌治疗以及共同的遗传或环境风险因素所解释的，尽管癌症总体超额风险表明可能还有其他解释，如监测增加和一般癌症易感性增加。
