Second Cancers Among 40 576 Testicular Cancer Patients: Focus on Long-term Survivors

Background: Although second primary cancers are a leading cause of death among men with testicular cancer, few studies have quantifi ed risks among long-term survivors. Methods: Within 14 population-based tumor registries in Europe and North America (1943–2001), we identifi ed 40 576 1-year sur-vivors of testicular cancer and ascertained data on any new incident solid tumors among these patients. We used Poisson regression analysis to model relative risks (RRs) and excess ab-solute risks (EARs) of second solid cancers. All statistical tests were two-sided. Results: A total of 2285 second solid cancers were reported in the cohort. The relative risk and EAR decreased with increasing age at testicular cancer diagnosis ( P <.001); the EAR increased with attained age ( P <.001) but the excess RR decreased. Among 10-year survivors diagnosed with testicular cancer at age 35 years, the risk of developing a second solid tumor was increased (RR = 1.9, 95 % confi dence interval [CI] = 1.8 to 2.1). Risk remained statistically signifi cantly ele-vated for 35 years (RR = 1.7, 95 % CI = 1.5 to 2.0; P <.001). We observed statistically signifi cantly elevated risks, for the fi rst time, for cancers of the pleura (malignant mesothelioma; RR = 3.4, 95 % CI = 1.7 to 5.9) and esophagus (RR = 1.7, 95 % CI = 1.0 to 2.6). Cancers of the lung (RR = 1.5, 95 % CI = 1.2 to 1.7)