Yu Guo-Pei, Schantz Stimson P, Neugut Alfred I, Zhang Zuo-Feng
Biostatistics and Epidemiology Service, The New York Eye and Ear Infirmary, 310 East 14th street, New York, NY 10003, USA.
Cancer Causes Control. 2006 May;17(4):411-20. doi: 10.1007/s10552-005-0338-y.
To determine incidences and time trends of second cancers among female breast cancer patients.
Using data of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, we designed three inception cohorts: 1975-1977 (n=25,920), 1983-1985 (n=32,722) and 1991-1993 (n=40,819), and analyzed their incidences of second cancers during the first 8 years after initial breast cancer diagnosis.
Between the 1970s and the 1990s, the incidence rate of malignant second cancer significantly increased among female breast cancer patients, of which second non-Hodgkin's lymphoma and kidney cancer increased by about 150%, while second cancers of the thyroid, uterine corpus and skin melanoma increased 80%, and cancer of the lung increased 50%. The patterns of trend of second cancers were somewhat similar to those of the general population except for second endometrial cancer at all ages and second leukemia and skin melanoma among young patients aged 20-49. In the 1990s, the risk ratios (RR) of all sites cancer were found to be 5.5 (95% CI=5.0-6.1) for age 20-49, 1.3 (1.3-1.4) for age 50-64, and 1.2 (1.1-1.2) for age 65 and over, comparing breast cancer patients to general population. Additionally, radiotherapy slightly increased the risks of second leukemia (RR=1.8, 1.2-2.8), and second endometrial (RR=1.3, 1.0-1.6) and breast (RR=1.2, 1.1-1.3) cancers.
The fixed inception cohort method is valid for analyzing cancer registry-based second cancer data. By this method, we found that the incidence of second cancer has substantially increased among female breast cancer patients over the past 25 years. Observed changes in incidence may partially reflect the effect of treatments. Because the absolute number of affected patients is small, however, the breast cancer treatments have remained safe for most patients.
确定女性乳腺癌患者中第二原发癌的发病率及时间趋势。
利用美国国立癌症研究所监测、流行病学和最终结果（SEER）项目的数据，我们设计了三个起始队列：1975 - 1977年（n = 25,920）、1983 - 1985年（n = 32,722）和1991 - 1993年（n = 40,819），并分析了她们在初次乳腺癌诊断后的前8年中第二原发癌的发病率。
在20世纪70年代至90年代期间，女性乳腺癌患者中恶性第二原发癌的发病率显著上升，其中第二非霍奇金淋巴瘤和肾癌增加了约150%，而甲状腺、子宫体和皮肤黑色素瘤的第二原发癌增加了80%，肺癌增加了50%。除了各年龄段的第二子宫内膜癌以及20 - 49岁年轻患者中的第二白血病和皮肤黑色素瘤外，第二原发癌的趋势模式与普通人群的模式有些相似。在20世纪90年代，与普通人群相比，乳腺癌患者中20 - 49岁所有部位癌症的风险比（RR）为5.5（95%CI = 5.0 - 6.1），50 - 64岁为1.3（1.3 - 1.4），65岁及以上为1.2（1.1 - 1.2）。此外，放疗略微增加了第二白血病（RR = 1.8，1.2 - 2.8）、第二子宫内膜癌（RR = 1.3，1.0 - 1.6）和第二乳腺癌（RR = 1.2，1.1 - 1.3）的风险。
固定起始队列方法对于分析基于癌症登记的第二原发癌数据是有效的。通过这种方法，我们发现过去25年中女性乳腺癌患者中第二原发癌的发病率大幅上升。观察到的发病率变化可能部分反映了治疗的影响。然而，由于受影响患者的绝对数量较少，乳腺癌治疗对大多数患者来说仍然是安全的。
