INCREASED RISK OF 2ND MALIGNANT NEOPLASMS OUTSIDE RADIATION-FIELDS INPATIENTS WITH CERVICAL-CARCINOMA

Background. The relative risk of second primary cancers was evaluated in 125 women with International Federation of Gynecology and Obstetric s (FIGO) Stages I and II cervical carcinoma treated radically with rad iation therapy between January 1980 and December 1990. Methods. Medica l records of patients were reviewed to evaluate the incidence of secon d malignant neoplasms. Only tumors histologically proven were scored. The annual 5-year age-specific cancer incidence data per 100,000 white women in the years 1981-1985 were obtained from the National Cancer I nstitute's Surveillance, Epidemiology and End Results database. The re lative risks were calculated as the ratio of observed-to-expected numb ers of second cancers, using person-years at risk accumulated for each individual in the study. Results. During the follow-up time (through December 1992), 10 women whose median age was 65.5 years at the time c ervical cancer was diagnosed were found to have 11 second primary canc ers. Nine of these cancers were metachronous with regard to cervical c ancer and included breast (4), lung (2), myeloma (1), non-Hodgkin's ly mphoma (1) and vulva (1). The metachronous tumors were diagnosed at a median age of 74 years and at median follow-up time of 34 months. Two of the cancers were synchronous with cervical cancer and included blad der (1) and thyroid (1). All of the second tumors were located outside radiation fields. None of the patients with second tumors received ch emotherapy during treatment for cervical carcinoma. The relative risk of developing a second cancer of any type was 2.31 (95% confidence int erval [CI] = 1.15-4.13), whereas the relative risk of developing a met achronous breast cancer was 2.64 (95% CI = 0.72-6.75). Conclusions. An increased risk of second primary cancers developing was observed amon g 125 patients with FIGO Stages I and II cervical carcinoma, which may suggest an abnormal genetic background and/or a common etiology for t he initial and second tumors. The increased risk of breast cancer occu rring as a second primary is in contrast with previously published stu dies reporting a decreased risk of breast cancer in survivors of cervi cal cancer.