Ho Katherine, Brandt Carolyn, Li Jessica, Datta Geetanjali, Moore Justin X, Veiga Lene H S, Gierach Gretchen L, de González Amy Berrington, Vo Jacqueline B, Ramin Cody
Division of Population Sciences, Cedars-Sinai Cancer Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Cancer Causes Control. 2025 Sep 4. doi: 10.1007/s10552-025-02054-8.
BACKGROUND: Breast cancer survivors have an increased risk of second primary cancers (SPCs), the role of county-level socioeconomic status and rurality-factors that may influence access to treatment, surveillance, and preventive care-remains understudied. METHODS: We identified 721,957 women with localized/regional first primary breast cancer who survived ≥ 1 year in 17 Surveillance, Epidemiology, and End Results registries (2000-2018). We used Cox regression to assess associations between county-level median household income (proxy for socioeconomic status), rurality, and their joint effects on invasive SPC risk, adjusting for demographic and clinical factors. We examined risk for all SPCs, non-breast SPCs, and the three most common SPC sites (breast, lung/bronchus, colorectal). Models were further stratified by index breast cancer characteristics. RESULTS: During 6.1 median years of follow-up, 65,954 survivors developed an SPC (42,400 non-breast; 23,554 breast, 8,338 lung/bronchus, 5,442 colorectal). Survivors from lower-income counties had higher SPC risk (< $50,000 vs. ≥ $75,000: HR = 1.07, 95% CI = 1.04-1.10), driven by lung/bronchus (HR = 1.32, 95% CI = 1.23-1.42) and colorectal cancers (HR = 1.19, 95% CI = 1.09-1.31). Lung/bronchus cancer risk was stronger among younger (age < 50: HR = 1.95, 95% CI = 1.59-2.39, age ≥ 50: HR = 1.20, 95% CI = 1.12-1.28; p interaction < 0.001) and Estrogen Receptor (ER)-negative survivors (ER negative: HR = 1.50, 95% CI = 1.31-1.72; ER positive: HR = 1.21, 95% CI = 1.12-1.30; p interaction = 0.02). Survivors from rural counties had higher SPC risk compared with most urban counties (HR range:1.07-1.12), especially for lung/bronchus cancer in younger (age < 50: HR = 1.66, 95% CI = 1.34-2.05, age ≥ 50: HR = 1.13, 95% CI = 1.06-1.21; p interaction = 0.001) and ER-negative survivors (ER negative: HR = 1.45, 95% CI = 1.26-1.67; ER positive: HR = 1.11, 95% CI = 1.03-1.20; p interaction = 0.001). Survivors in rural/lower-income counties had the highest SPC risk compared with urban/higher-income counties (HR-range: 1.20-1.23), particularly for lung/bronchus cancer (HR = 1.57, 95% CI = 1.10-2.23). CONCLUSION: Studies are needed to understand factors driving the impact of socioeconomic status and rurality (e.g., access to care) on SPC risk to inform preventive strategies for breast cancer survivors.
背景：乳腺癌幸存者患第二原发性癌症（SPC）的风险增加，县级社会经济地位和农村因素（可能影响治疗、监测和预防保健的可及性）的作用仍未得到充分研究。 方法：我们在17个监测、流行病学和最终结果登记处（2000 - 2018年）中确定了721,957名患有局限性/区域性原发性乳腺癌且存活≥1年的女性。我们使用Cox回归来评估县级家庭收入中位数（社会经济地位的代理指标）、农村地区及其对浸润性SPC风险的联合影响，并对人口统计学和临床因素进行了调整。我们研究了所有SPC、非乳腺癌SPC以及三个最常见的SPC部位（乳房、肺/支气管、结肠直肠）的风险。模型根据索引乳腺癌特征进一步分层。 结果：在中位随访6.1年期间，65,954名幸存者发生了SPC（42,400例非乳腺癌；23,554例乳腺癌、8,338例肺/支气管癌、5,442例结肠直肠癌）。来自低收入县的幸存者患SPC的风险更高（<50,000美元与≥75,000美元相比：HR = 1.07，95%CI = 1.04 - 1.10），主要由肺/支气管癌（HR = 1.32，95%CI = 1.23 - 1.42）和结肠直肠癌（HR = 1.19，95%CI = 1.
Cochrane Database Syst Rev. 2012-8-15
Cochrane Database Syst Rev. 2022-9-26
JAMA Netw Open. 2025-6-2
JNCI Cancer Spectr. 2024-9-2
JAMA Oncol. 2024-6-1
J Rural Health. 2024-3
Zotero 插件