Incidence of second and higher order smoking-related primary cancers following lung cancer: a population-based cohort study

Background Lung cancer five-year survival has doubled over fifteen years. Although the risk of second primary cancer is recognised, quantification over time is lacking. We describe the incidence of second and higher order smoking-related primary cancers in lung cancer survivors, identifying high-incidence groups and how incidence changes over time from first diagnosis. Methods Data on smoking-related primary cancers (lung, laryngeal, head and neck, oesophageal squamous carcinoma and bladder) diagnosed in England between 2000-2014 was obtained from Public Health England National Cancer Registration and Analysis Service. We calculated absolute incidence rates and standardised incidence rate ratios, both overall and for various sub-groups of second primary cancer for up to 10 years from initial diagnosis of lung cancer, using Poisson regression. Results Elevated incidence of smoking-related second primary cancer persists for at least ten years from first lung cancer diagnosis with those aged 50 and 79 at first diagnosis at particularly high risk. The most frequent type of second malignancy was lung cancer although the highest standardised incidence rate ratios were for oesophageal squamous carcinoma (2.4) and laryngeal cancers (2.8) and consistently higher in women than in men. Over the last decade the incidence of second primary lung cancer has doubled. Conclusion Lung cancer survivors have increased incidence of subsequent lung, laryngeal, head and neck and oesophageal squamous cell carcinoma for at least a decade from first diagnosis. Consideration should be given to increasing routine follow-up from 5 years to 10 years for those at highest risk, alongside surveillance for other smoking-related cancers.This study was supported the Early Diagnosis programme Cancer Research UK Cambridge Centre. FMW is supported by an NIHR Clinician Scientist award. GL is supported by a Cancer Research UK award (Advanced Clinician Scientist Fellowship C18081/A18180). RCR is part funded by the Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Centre