2ND MALIGNANT NEOPLASMS AMONG LONG-TERM SURVIVORS OF OVARIAN-CANCER

Second malignant neoplasms were evaluated among 32,251 women with ovar ian cancer, including 4,402 10-year survivors, within the nine populat ion-based registries of the Surveillance, Epidemiology, and End Result s Program of the National Cancer Institute (1973-1992) and the Connect icut Tumor Registry (1935-1972). Overall, 1,296 second cancers occurre d against 1,014 expected [observed/expected (O/E), 1.28; 95% confidenc e interval (CI), 1.21-1.35]. Sites contributing 25 or more excess canc ers included leukemia (O/E, 4.17; O, 111; 95% CI, 3.43-5.03) and malig nancies of colon (O/E, 1.33; O, 188; 95% CI, 1.15-1.51), rectum (O/E, 1.43; O, 76; 95% CI, 1.13-1.79), breast (O/E, 1.18; O, 404; 95%, CI 1. 07-1.30), and bladder (O/E, 2.07; O, 65; 95% CI, 1.59-2.63). Ocular me lanoma (O/E, 4.45; O, 8; 95% CI, 1.92-8.77) was also significantly inc reased. Second cancer risk was high during all follow-up intervals, an d cumulative risk at 20 years was 18.2%, compared with a population ex pected risk of 11.5%, Statistically significant relationships existed between serous adenocarcinoma of the ovary and breast cancer (O/E, 1.2 9; 95% CI, 1.06-1.56) and mucinous ovarian adenocarcinoma and rectal c ancer (O/E, 1.95; 95% CI, 1.09-3.22), Secondary leukemia appeared link ed with antecedent chemotherapy, whereas radiotherapy was associated w ith cancers of connective tissue, bladder, and possibly pancreas, Gene tic and reproductive factors predisposing to ovarian cancer may have c ontributed to the elevated risk of breast and colorectal neoplasms and possibly ocular melanoma, Thus, excess malignancies following ovarian cancer represent complications of curative therapies and/or underlyin g susceptibility states that have etiological and clinical ramificatio ns.