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Racial and ethnic differences in risk of second primary cancers among breast cancer survivors

  • Epidemiology
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Abstract

Disparities exist in breast cancer (BC) outcomes between racial and ethnic groups in the United States. Reasons for these disparities are multifactorial including differences in genetics, stage at presentation, access to care, and socioeconomic factors. Less is documented on racial/ethnic differences in subsequent risk of second primary cancers (SPC). The purpose of this study is to evaluate the risk of SPC among different racial/ethnic groups of women with BC. We conducted a retrospective cohort study of 134,868 Non-Hispanic White, 17,484 Black, 18,034 Hispanic, and 19,802 Asian/Pacific Islander (API) women with stages I–III BC in twelve Surveillance, Epidemiology and End Results Program registries between 2001 and 2010. Standardized incidence ratios (SIR), 95 % confidence intervals (CI), and absolute excess risks were calculated by comparing incidence of SPC in the cohort to incidence in the general population for specific cancer sites by race/ethnicity and stratified by index BC characteristics. All women were at increased risks of second primary BC and acute myeloid leukemia (AML), with higher risk among more advanced stage index BC. Black and API women had higher SIRs for AML [4.86 (95 % CI 3.05–7.36) and 5.00 (95 % CI 3.26–7.32)], respectively] which remained elevated among early-stage (I) BC cases. Women with a history of invasive BC have increased risk of SPC, most notable for second primary BC and AML. These risks for secondary cancers differ by race/ethnicity. Studies evaluating possible genetic and biobehavioral mechanisms underlying these differences are warranted. Strategies for BC adjuvant treatment and survivorship care may require further individualization with consideration given to race/ethnicity.

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Acknowledgments

The authors would like to express their gratitude to Dr. Eric P. Winer for his guidance and comments on revisions of this manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This work was supported by the National Institutes of Health (R25 CA094880) Cancer Prevention Training Grant in Nutrition, Exercise and Genetics at the University of Washington and the Carter Disparities Fund at Boston Medical Center. E.H.L. was supported by the 2014–2016 UIC/Takeda Fellowship in Health Economics and Outcomes Research.

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Authors and Affiliations

  1. Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 South Wood Street M/C 871, Chicago, IL, 60612, USA

    Gregory S. Calip & Ernest H. Law

  2. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA, 98109, USA

    Gregory S. Calip

  3. Department of Epidemiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA

    Gregory S. Calip

  4. Boston Medical Center Section of Hematology Oncology, Boston University, 725 Albany Street, Boston, MA, 02118, USA

    Naomi Y. Ko

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  1. Gregory S. Calip
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Correspondence to Gregory S. Calip.

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Calip, G.S., Law, E.H. & Ko, N.Y. Racial and ethnic differences in risk of second primary cancers among breast cancer survivors. Breast Cancer Res Treat 151, 687–696 (2015). https://doi.org/10.1007/s10549-015-3439-7

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