METHODS. Using 1975Using -2001 data from the Surveillance, Epidemiology, and End Results (SEER) Program, we assembled 262,600 index cases of colorectal carcinoma to assess the occurrence of subsequent primary cancers in 13 noncolonic sites. Observed (O) subsequent cancers were compared with those expected (E) based on age-/sex-/race-/year-/site-specific rates in the SEER population. The standardized incidence ratio (SIR) and the absolute excess risk (AER) represent 'O 7 E' and 'O -E,' respectively.
RESULTS.Colorectal carcinoma patients had significantly elevated SIRs for small gut, stomach (males), kidney, and corpus uteri cancers, ranging from 1.13 for stomach cancer in males to 3.45 for small gut cancer in females. Elevated SIRs for additional sites were seen in certain population subgroups: pancreas and ovary in persons aged <50 years, and prostate in black males. The excess burden, as assessed by AER, was notable for prostate cancer in black males and for corpus uteri cancer in females aged <50 years (26.5 and 9.5 cancers per 10,000 personyears, respectively), and it persisted beyond 5 years of follow-up.CONCLUSIONS. Although significantly elevated SIRs were found for several cancers, the excess burden was notable only for cancer of the prostate in black males and of the corpus uteri in females under age 50. KEYWORDS: colorectal neoplasms, second primary neoplasms, uterine neoplasms, ovarian neoplasms, stomach neoplasms, gastrointestinal neoplasms, pancreatic neoplasms, prostatic neoplasms, kidney neoplasms, breast neoplasms.M ore effective screening and treatment regimens, coupled with more cancer diagnoses because of an aging population, have resulted in increasing numbers of cancer survivors who are at risk for subsequent cancers. 1 In 2002, there were an estimated 1.1 million colorectal cancer survivors in the United States. 2 The increased risk of a second primary cancer among colorectal cancer patients, when compared with the risk of persons without colorectal cancer, may result from environmental or genetic factors shared between the two cancers or from treatment effects. 3,4 However, it is possible that the intensive medical follow-up of colorectal cancer patients may produce an artifactual association. 3,4 A unidirectional altered risk of a given cancer following colorectal cancer suggests a treat- We appreciate the in-kind support from all the contributors to this monograph and also are grateful for the contributions of Jessica King for the preparation of analytic files and to Faruque Ahmed for his leadership of the colorectal cancer monograph project.