Deng Zhengyi, Visvanathan Kala
Stanford School of Medicine, Stanford, California.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Cancer Epidemiol Biomarkers Prev. 2025 Feb 6;34(2):246-259. doi: 10.1158/1055-9965.EPI-24-1009.
Breast cancer survivors face a higher risk of subsequent primary cancers. This study investigated the patterns of subsequent cancer risk according to time since breast cancer diagnosis.
Using data from the Surveillance, Epidemiology, and End Results Program (2000-2018), we identified a cohort of 771,681 breast cancer survivors. Standard incidence ratios (SIR) were calculated by comparing the observed with the expected number of subsequent cancers over different follow-up periods since breast cancer diagnosis. Analyses were conducted for multiple cancer types, stratified by hormone receptor status, treatment of the first breast cancer, age, and race/ethnicity.
Survivors experienced a 16% increased risk of subsequent cancer with the SIR continuing to increase with longer follow-up (SIR = 1.04, 1.22, and 1.31 for 12-59, 60-119, and ≥120 months). This trend was driven primarily by a subsequent breast cancer, particularly among women <50 years of age, those with initial hormone receptor-negative cancer, and racial/ethnic minorities. The patterns of subsequent non-breast cancer risk varied by type. An early-onset and sustained increased risk was observed for subsequent leukemia, thyroid cancer, soft-tissue sarcoma, melanoma, pancreatic cancer, and uterine cancer. A delayed increased risk was observed for subsequent esophageal, ovarian, oral cavity/pharyngeal, and lung cancers, whereas for small intestine, stomach, kidney, and colorectal cancers, there was a decrease after an initial increased risk.
Patterns in subsequent cancer risk since breast cancer diagnosis differ by cancer type and characteristics of the first breast cancer.
These findings can inform etiology and tailored approaches to screening and prevention of subsequent cancers.
乳腺癌幸存者面临后续原发性癌症的风险更高。本研究根据自乳腺癌诊断以来的时间调查了后续癌症风险模式。
利用监测、流行病学和最终结果计划（2000 - 2018年）的数据，我们确定了771,681名乳腺癌幸存者队列。通过比较自乳腺癌诊断以来不同随访期内观察到的后续癌症数量与预期数量来计算标准化发病率（SIR）。对多种癌症类型进行了分析，按激素受体状态、首次乳腺癌治疗、年龄和种族/族裔分层。
幸存者后续患癌风险增加了16%，SIR随着随访时间延长持续升高（12 - 59个月、60 - 119个月和≥120个月时的SIR分别为1.04、1.22和1.31）。这种趋势主要由后续乳腺癌驱动，特别是在年龄<50岁、初始激素受体阴性癌症患者以及种族/族裔少数群体中。后续非乳腺癌风险模式因类型而异。观察到后续白血病、甲状腺癌、软组织肉瘤、黑色素瘤、胰腺癌和子宫癌有早期发病且持续增加的风险。观察到后续食管癌、卵巢癌、口腔/咽喉癌和肺癌风险延迟增加，而对于小肠癌、胃癌、肾癌和结直肠癌，在初始风险增加后有所下降。
自乳腺癌诊断以来的后续癌症风险模式因癌症类型和首次乳腺癌的特征而异。
这些发现可为后续癌症的病因学以及筛查和预防的针对性方法提供信息。
