Original Article

Development of Multiple Primary Cancers in Lung Cancer Patients: Appalachian Versus Non-Appalachian Populations of Kentucky

Authors: Vira Pravosud, MS, MPH, Bin Huang, DrPH, Thomas Tucker, PhD, Nathan L. Vanderford, PhD, MBA

Abstract

Objectives: The aim of this study was to investigate whether patients with lung cancer in Appalachian Kentucky are more likely to develop multiple primary cancers than patients in non-Appalachian Kentucky. Additional analyses were conducted to identify other factors that may be associated with an increased hazard of developing multiple primary cancers in patients with lung cancer.

Methods: The data for this retrospective, population-based cohort study of 26,456 primary lung cancer patients were drawn from the Kentucky Cancer Registry. For inclusion in the study, patients must have been diagnosed between January 1, 2000 and December 31, 2013 and they must either have continually resided in Appalachian Kentucky or continually resided in non-Appalachian Kentucky. Cases were excluded if the patient was diagnosed as having additional primary cancers within 3 months of the initial diagnosis of primary lung cancer. The medical records for each case were examined to determine whether the patient was subsequently diagnosed as having additional primary cancers. The Cox proportional hazards model was then used to assess whether there was an association between the region in which the patients live and the likelihood of developing multiple primary cancers. Time to event was considered as the time from diagnosis to either death or development of a second primary cancer.

Results: The results presented here indicate that the risk of developing multiple primary cancers is the same for patients with lung cancer throughout Kentucky (hazard ratio [HR] 1.002, P = 0.9713). We found no evidence for a greater hazard in patients from Appalachia; however, additional analyses revealed several high-risk groups. Male patients and older patients had a significantly greater hazard of developing multiple primary cancers (HR 1.169, P = 0.012 and 1.015, P = 0.0001, respectively). In addition, patients who underwent surgery and those who were diagnosed initially as having an earlier stage of cancer also were more likely to develop multiple primary cancers (HR 1.446, P = 0.0003 and 0.684, P = 0.0015, respectively).

Conclusions: This is a negative study. Patients with primary lung cancer living in Appalachian Kentucky are not at a greater risk of developing multiple primary cancers than those residing in non-Appalachian Kentucky. High-risk groups identified in this study are male patients and older patients. The increased hazard seen in patients who underwent surgery or those who were diagnosed as having earlier stages of lung cancer are likely an artifact of these patients living longer and, therefore, having more time to develop additional primary cancers.

 

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. American Cancer Society. Key statistic for lung cancer. http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-key-statistics. Accessed April 20, 2016.
 
2. Centers for Disease Control and Prevention. Lung cancer. http://www.cdc.gov/cancer/lung/. Accessed April 20, 2016.
 
3. American Cancer Society. Cancer facts & figures 2015. http://oralcancerfoundation.org/wp-content/uploads/2016/03/Us_Cancer_Facts.pdf. Published 2015. Accessed April 20, 2016.
 
4. Kentucky Cancer Registry. Cancer of lung and bronchus, 2000-2013. Age-adjusted invasive cancer incidence rates in Kentucky 2013. http://cancer-rates.info/ky/. Accessed September 30, 2016.
 
5. Kentucky Cancer Registry. Cancer of lung and bronchus, 2000-2013. Age-adjusted cancer mortality rates in Kentucky 2012. http://cancer-rates.info/ky/. Accessed September 30, 2016.
 
6. Kentucky Cancer Registry. All sites. Age-adjusted mortality rates in Kentucky by Appalachian region, 2000-2013. http://cancer-rates.info/ky/. Accessed September 30, 2016.
 
7. Kentucky Cancer Registry. All sites. Age-adjusted cancer incidence rates in Kentucky by Appalachian region, 2000-2013. http://cancer-rates.info/ky/. Accessed September 30, 2016.
 
8. Curtis RE, Freedman DM, Ron E, et al , eds. New Malignancies Among Cancer Survivors: SEER Cancer Registries, 1973-2000. NIH Publ. No. 05-5302 Bethesda, MD: National Cancer Institute; 2006.
 
9. Koubková L, Hrstka R, Dobes P, et al. Second primary cancers -causes, incidence and the future. Klin Onkol 2014;27:11-17.
 
10. Bhaskarla A, Tang PC, Mashtare T, et al. Analysis of second primary lung cancers in the SEER database. J Surg Res 2010;162:1-6.
 
11. Chakraborty S, Hauke RJ, Bonthu N, et al. Increased incidence of a second lymphoproliferative malignancy in patients with multiple myeloma-a SEER based study. Anticancer Res 2012;32:4507-4515.
 
12. Chakraborty S, Tarantolo SR, Batra SK, et al. Incidence and prognostic significance of second primary cancers in renal cell carcinoma. Am J Clin Oncol 2013;36:132-142.
 
13. Hayat MJ, Howlader N, Reichman ME, et al. Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. Oncologist 2007;12:20-37.
 
14. Nielsen SF, Nordestgaard BG, Bojesen SE. Associations between first and second primary cancers: a population-based study. CMAJ 2012;184:E57-E69.
 
15. Nsouli-Maktabi HH, Henson DE, Younes N, et al. Second primary breast, endometrial, and ovarian cancers in black and white breast cancer survivors over a 35-year time span: effect of age. Breast Cancer Res Treat 2011;129:963-969.
 
16. Schoenberg NE, Huang B, Seshadri S, et al. Trends in cigarette smoking and obesity in Appalachian Kentucky. South Med J 2015;108:170-177.
 
17. Appalachian Translational Research Network. Appalachia & Appalachian health: quick facts. https://ccts.osu.edu/sites/default/files/Appalachia%20and%20Appalachian%20Health%20Overview%20UPDATED.pdf. Accessed April 20, 2016.
 
18. Martini N, Bains MS, Burt ME, et al. Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg 1995;109:120-129.
 
19. Vansteenkiste JF, De Belie B, Deneffe GJ, et al. Practical approach to patients presenting with multiple synchronous suspect lung lesions: a reflection on the current TNM classification based on 54 cases with complete follow-up. Lung Cancer 2001;34:169-175.
 
20. Zhang Y, Hu H, Wang R, et al. Synchronous non-small cell lung cancers: diagnostic yield can be improved by histologic and genetic methods. Ann Surg Oncol 2014;21:4369-4374.
 
21. Nakata M, Sawada S, Yamashita M, et al. Surgical treatments for multiple primary adenocarcinoma of the lung. Ann Thorac Surg 2004;78:1194-1199.
 
22. Rodrigues G, Choy H, Bradley J, et al. Definitive radiation therapy in locally advanced non-small cell lung cancer: executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based clinical practice guideline. Pract Radiat Oncol 2015;5:141-148.
 
23. Sawka AM, Thabane L, Parlea L, et al. Second primary malignancy risk after radioactive iodine treatment for thyroid cancer: a systematic review and meta-analysis. Thyroid 2009;19:451-457.
 
24. Fu JB, Kau TY, Severson RK, et al. Lung cancer in women: analysis of the national Surveillance, Epidemiology, and End Results database. Chest 2005;127:768-777.
 
25. Devesa SS, Bray F, Vizcaino AP, et al. International lung cancer trends by histologic type: male:female differences diminishing and adenocarcinoma rates rising. Int J Cancer 2005;117:294-299.
 
26. Centers for Disease Control and Prevention. State-specific prevalence of cigarette smoking and smokeless tobacco use among adults-United States. 2009. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5943a2.htm. Accessed April 20, 2016.
 
27. Kentucky Department for Public Health. State health assessment: a compilation on health status. http://chfs.ky.gov/nr/rdonlyres/cf31d71b-c7e3-4fa3-a8c7-713bea63f833/0/2013kystatehealthassessmentfinal52913.pdf. Published 2013. Accessed September 30, 2016.