Second primary cancer after in situ and invasive cervical cancer

The Swedish Family-Cancer Database was used to analyze 9,426 second primary cancers in 117,830 subjects diagnosed with in situ and 17,556 subjects wit h invasive cervical cancer from the years 1958-1996. We calculated standard ized incidence ratios (SIRs) from age and period-specific rates for all wom en. SIRs were elevated after both in situ and invasive cervical cancer fur cancers of the upper aerodigestive trace, anus, pancreas, lung, other femal e genitals, and urinary bladder. Anus and other female genitals, known targ ets of human papilloma virus, showed SIRs exceeding 3.0 and 10 or more with in the year of diagnosis of cervical cancer, probably implying the effects of diagnostic intensity or transient faltering of host immunosurveillance. Among the remaining sites, smoking appeared to be the major cause, but for urinary bladder cancer it only explained one-half of the excess; human papi lloma virus infection, possibly through immunosuppression, could account fo r the remaining excess. Although urinary bladder cancer showed a relatively small SIR compared with anal cancer, because it is more common, the number of attributable cases was about equal for the two sites. Invasive cervical cancer showed an SIR of 2.3 after in situ cancer. On follow-up, we also ob served increased SIRs at many radiosensitive sites 10 or more years after d iagnosis of invasive cervical cancer.