Commentary - Trends in the risk of second primary cancer among bladder cancer survivors: a population-based cohort of 10 047 patients - Beyond the Abstract

Bladder cancer (BCa) is the 6th most diagnosed cancer in men and 19th in women worldwide1. Among those that survive through BCa, there is an increase risk of developing a second primary cancer (SPC) when compared with the general population2. These SPC are frequently located in the lungs, head, or neck, which suggests this abnormality is tobacco-related3. In fact, data shows risk of BCa among current smokers relative to non-smokers in the US increased 4.06 times from 1963 to 19874. The aim of this study was to determine whether the risk of SPC among subjects diagnosed with BCa has changed over the past years.

The study collected data from 10 French population-based cancer registries to create a cohort for patients diagnosed with a first invasive ≥T BCa between 1989 and 2004, and then followed up until 2007. Patients who had history of previous cancers, carcinoma in situ and Ta disease, and synchronous cancers were excluded from the study; only invasive T1 stage cancers were included. A total of 10,047 patient’s data were used in the study. A SPC in the study was defined as the first subsequent primary cancer occurring at least 2 months after a BCa diagnosis. Both the standardized incidence ratios (SIRs) and excess absolute risk (EAR) were calculated, combining with gender, age, period of BCa diagnosis and follow-up. For statistical analysis, a Multivariate Poisson regression models were used to assess the direct effect of the period of BCa diagnosis on SPC risk.

The results of the study showed that the risk of SPC of any sites after a first BCa significantly increased by 60% compared with general population (SIR 1.60 95% CI 1.51-1.68). Men and younger patients presented higher risks of SPC, and overall risk of SPC was higher during the first year after BCa diagnosis than in later years. SPC were mainly found in the lungs, head, neck, and prostate sites in men with BCa, while for women, they were only localized in the lung. In the multivariate analysis, after adjusting for gender and age, the results showed a significant increase in the risk of SPC of the lung over the calendar year of BCa diagnosis. This was not observed for the head or prostate.

The high frequency of SPCs observed in the study shows the influence of aetiological and treatment related factors, specifically cigarette smoking5. The data suggests that high prevalence of smoking among patients BCa contributed to the significant increase of SPC, mainly in the lungs for both genders. The study also found that patients diagnosed with BCa have a higher risk of developing a lung that those in previous years, consistent with Freedman et al.4 In conclusion, the study suggests a correlation between smoking and higher risks of disease recurrence. These findings provide further support and evidence for the need to promote tobacco smoking cessation interventions in patients with BCa.

Authors: Joris Muller, Pascale Grosclaude, Benedicte Lapotre-Ledoux, Anne-Sophie Woronoff§, Anne-Valerie Guizard, Simona Bara, Marc Colonna, Xavier Troussard, Veronique Bouvier, Brigitte Tretarre, Michel Velten, and Jeremie Jegu

Affiliations: Bas-Rhin Cancer Registry, EA 3430, FMTS, University of Strasbourg, Department of Public Health, University Hospital of Strasbourg, Strasbourg, Tarn Cancer Registry, Albi, Francim: Reseau francais des registres des cancers, Toulouse, Somme Cancer Registry, Department of Hygiene and Public Health, University Hospital of Amiens, Amiens, Doubs and Belfort Territory Cancer Registry, University Hospital of Besancon, Besancon, Calvados General Cancer Registry, Cancers & Preventions, U 1086 Inserm, Francois Baclesse Centre, Caen, Manche Cancer Registry, Cotentin Hospital, Cherbourg-Octeville, Isere Cancer Registry, University Hospital of Grenoble, Grenoble, Basse-Normandie Haematological Malignancies Cancer Registry, University Hospital of Caen, Calvados Digestive Cancer Registry, Cancers & Preventions, U 1086 Inserm, Francois Baclesse Centre, Caen, Herault Cancer Registry, Research Center, Montpellier , and Department of Epidemiology and Biostatistics, Paul Strauss Center, Strasbourg, France

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