The incidence and risk of developing a second primary esophageal cancer in patients with oral and pharyngeal carcinoma: a population-based study in Taiwan over a 25 year period

Abstract

BackgroundThe incidence of oral and pharyngeal (including oral cavity, oropharynx and hypopharynx) carcinoma increases rapidly in Asia and South Pacific because of betel quid chewing. Thus far, large-scale epidemiological studies are not available yet to stratify these patients by their risks of developing a second primary cancer in the digestive tract including esophagus, stomach, colon, and rectum.MethodsA population-based study was conducted using the database from the Taiwan National Cancer Registry for the period 1979-2003. We quantified standardized incidence ratios (SIRs) and cumulative incidence of second primary cancers among 33,787 patients with initial diagnoses of oral and pharyngeal carcinoma.ResultsAmong these four digestive tract organs, the esophagus was the only site of second cancer with excess risk in patients with oral and pharyngeal carcinoma. The incidence and risk of developing a second primary esophageal cancer differed by the site of the primary index tumor, most frequently seen in hypopharyngeal cancer (71/4,218 = 1.68%, SIR = 22.76, 95% CI 17.77-28.70), followed by oropharyngeal cancer (30/3,403 = 0.88%, SIR = 14.29, 95% CI 9.64-20.39) and the least in oral cavity cancer (99/26,166 = 0.38%, SIR = 5.57, 95% CI 4.53-6.78). In addition, the risk was extraordinarily high for patients with a follow-up interval ≤ 1 year and those with first primary cancer diagnosed at age ≤50. These patients may justify more close surveillance.ConclusionThe present study represents the first population-based study in Asia attempting to stratify the patients of oral and pharyngeal carcinoma by their risk of developing a second esophageal cancer. It helps identify patients at high risk and tailor the application of intense follow-up surveillance to the estimated risk in each individual case.

Effect of Routine Esophageal Screening in Patients With Head and Neck Cancer

“…According to a previous study, 7 the risk of developing a second primary esophageal cancer was extraordinarily high for patients with a follow-up interval of less than 1 year. In the present study, after completion of treatment, all patients with HNSCC received regular esophageal follow-up evaluation at least once every 6 months for 3 years.…”

“…Following completion of treatment, all patients with HNSCC were advised to undergo regular esophageal follow-up assessment at least every 6 months for 3 years. 7 The patients included in the study were divided into 5 categories based on tumor location (nasal cavity, oral cavity, oropharynx, larynx, or hypopharynx). The prevalences and odds ratios (ORs) of second primary ESCC were analyzed based on HNSCC location.…”

Second primary esophageal or lung cancer in patients with head and neck carcinoma in Taiwan: incidence and risk in relation to primary index tumor site

“…In Taiwan, 17% adult males chewing betel quid, oral and pharyngeal carcinoma has become the malignancy with the fastest increasing incidence (Ko et al 1995). In the past 20 years, its age-standardized incidence rate has increased from 6.04 per 100,000 men in 1986 to 26.36 in 2000, and 32.4 in 2005, strikingly higher than the incidences of the United States and Canada (16 and 13 per 100,000 men in 2004, respectively) (Lee et al 2009). …”

Incidence and Patterns of Second Primary Malignancies Following Oral Cavity Cancers in a Prevalent Area of Betel-nut Chewing: A Population-based Cohort of 26 166 Patients in Taiwan

“…In Taiwan, .3700 new cases of oral cavity cancers occur every year, and for all stages and sites combined, 81% of oral cavity cancer patients survive at least 1 year and the 5-year and 10-year survival rates are 50 and 40%, respectively (25). This survival time is sufficient for survivors to develop second primary cancers.…”