Incidence of subsequent pancreatic adenocarcinoma in patients with a history of nonpancreatic primary cancers

Abstract

Background Several environmental risk factors are known to predispose to pancreas cancer and up to 15% of pancreatic cancers have an inherited component. Understanding metachronous cancer associations can modify pancreas cancer risk. We sought to investigate the association of non-pancreatic cancers with subsequent pancreatic adenocarcinoma. Methods We used data from the U.S. Surveillance, Epidemiology, and End-Results (SEER) registries to identify 1,618,834 individuals with a primary malignancy and subsequent pancreatic adenocarcinoma (n=4,013). We calculated standardized incidence ratios as an approximation of relative risk (RR) for occurrence of pancreatic adenocarcinoma after another primary malignancy. Results Among patients diagnosed with a first primary malignancy at ages 20-49, the risk of subsequent pancreatic adenocarcinoma was increased among patients with cancers of the ascending colon (RR 4.62, 95%CI 1.86-9.52), hepatic flexure (5.42, 1.12-15.84), biliary system (13.14, 4.27-30.66), breast (1.32, 1.09-1.59), uterine cervix (1.61, 1.02-2.41), testes (2.78, 1.83-4.05) and hematopoietic system (1.83, 1.28-2.53). Among patients with a first malignancy at ages 50-64, the risk was increased after cancers of the stomach (1.88, 1.13-2.93), hepatic flexure (2.25, 1.08-4.13), lung and bronchus (1.46, 1.16-1.82), pharynx (2.26, 1.13-4.04) and bladder (1.24, 1.03-1.48). Among patients with a primary cancer after age 65, the risk was increased after cancers of the stomach (1.79, 1.23-2.53), hepatic flexure (1.76, 1.06-2.75), biliary system (2.35, 1.17-4.20), and uterus (1.23, 1.03-2.47). Conclusions This population-based dataset suggests that pancreatic adenocarcinoma is associated with certain primary cancers. Genetic predisposition, common environmental and behavioral risk factors may all contribute to this observation. Specific tumor associations will guide future risk-stratification efforts.

The impact of a history of cancer on pancreatic ductal adenocarcinoma survival

“…The association between nonpancreatic cancers and subsequent pancreatic cancer had also been addressed by previous studies. 8,9,15 The excess risk of multiple malignancies might reflect a genetic predisposition and similar environmental factors. 16,17 Up to 15% of pancreatic cancers have a genetic predisposition, such as mutations in Partner and Localiser of BRCA2 (PALB2), Ataxia telangiectasia mutated (ATM), BRCA2 and other hereditary cancer syndromes.…”

“…7 According to a previous study, antecedent cancer history (colon cancer, biliary system and uterus malignancies) directly increases risk of subsequent PDAC. 8,9 Genetic predisposition and common environmental risk factors together may contribute to this phenomenon. [10][11][12] With increased numbers of cancer survivors, further understanding of the relative risk of developing secondary PDAC might contribute to better prognosis of this population.…”

Trends in Racial Disparities in Pancreatic Cancer Surgery

“…All patients aged ≥18 years with a malignant tumor of the pancreas were included. We then excluded patients with nonadenocarcinoma tumors which were identified using SEER ICD-O- 3 8 Patients with race other than white or black, including those with unknown race, were excluded from the analyses as were patients with pancreatic cancer noted only on the autopsy/death certificate. Patients with distant metastatic disease were also excluded as they are not candidates for potentially curative tumor resection.…”

Creation of gastric conduit free-graft with intraoperative perfusion imaging during pancreaticoduodenectomy in a patient post esophagectomy

“…The most important risk factor commonly shared between esophageal cancer and a second primary is smoking. On the other hand in a study using the SEER registries performed by Amin et al it is advocated that there is higher incidence of pancreatic cancer following some malignancies associated with certain genetic syndromes, after tobacco-related malignancies, cancers treated with radiation, and possibly other environmental factors, such as Helicobacter pylori infection [5] .…”