Epidemiology of second primary cancer in France based on data from cancer registries (K2-France)

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1 Epidemiology of second primary cancer in France based on data from cancer registries (K2-France) Jérémie Jégu, Michel Velten and the K2-France Working Group Colloque «La prévention tertiaire en cancérologie : Quels enjeux pour la santé des patients? Quels défis à relever?» 24/03/2016, Paris

2 Context Early detection Improvement of treatments 28.8 million cancer survivors worldwide 3 million in France These patients face an increased risk of new malignancies Ferlay et al. 2013, Colonna et al

3 O/E (SIR): relative risk of second cancer among cancer survivors compared with the general population United States Curtis et al O/E = 1.14 Denmark Storm et al O/E = 0.91 Sweden Dong et al O/E = 1.44 Finland Sankila et al O/E = 1.12 Red: O/E > 1 (p<0.05) Blue: O/E 1 Japan Tabuchi et al O/E = 1.21 Utada et al O/E = 1.10 Queensland, Australia Youlden et al O/E =1.27 France O/E =? Switzerland Levi et al O/E = 1.21 Italy AIRTUM Working Group 2013 O/E = 1.10 Victoria, Australia Karahalios et al O/E (male)= 1.03 O/E (female)= 1.26

4 K2-France study Objective: to assess the incidence of second primary cancer in France Nationwide collaborative project gathering data from 10 cancer registries Historic cohort Patients with a 1 st cancer diagnosed between 1989 and 2004 Isère Bas-Rhin Tarn Follow-up until December 31 st, 2007 Hérault Doubs Second Primary Cancer (SPC): 1 st subsequent primary cancer Somme Calvados (RD) occurring > 2 months after 1 st cancer diagnosis in a different subsite as the first primary Manche Basse- Normandie Calvados (RG) Jégu et al

5 Number of 1 st primary cancers General population 1 st cancer incidence rate in the general population Number of Person-Years at Risk (PYR) among cancer survivors Observed number (O) of 2 nd primary cancers Expected number (E) of 2 nd primary cancers Standardized Incidence Ratio SIR=O/E Excess Absolute Risk EAR= O/PYR E/PYR Multivariate Poisson regression models used to model SIRs and EARs

6 Results 289,967 patients with a 1 st cancer 1.4 million PYR (Median follow-up: 4 years) 21,226 SPC Observed (15,555 Expected) (excluding SPC occurring in the same subsite as the first primary cancer) Cancer survivors presented a 36% higher risk of SPC SIR =1.36 (95% CI: ) EAR of 39.4 excess cancers per 10,000 PYR

7 The risk new malignancies differed widely according to patient characteristics SIR EAR* Gender Male Female Age at first cancer diagnosis 44 y y-54 y y-64 y y-74 y y Year of first cancer diagnosis Follow-up 2 m-<1 y y-<2 y y-<4 y y-<6 y y-<8 y y-<10 y y *Number of excess cancers per 10,000 person-years at risk. Males Females SIR EAR* SIR EAR* First cancer site (only main cancer sites are presented) Head and neck Oesophagus Colorectum Larynx Lung, bronchus and trachea Breast Prostate Bladder Kidney *Number of excess cancers per 10,000 person-years at risk.

8 Male patients with a first tobacco- or alcohol-related cancer presented a very high risk of tobacco- or alcohol- related SPC First cancer site Second cancer site SIR EAR* Head and neck Lung Head and neck** Oesophagus Larynx Oesophagus Head and neck Lung Larynx Lung Head and neck Bladder Oesophagus Bladder Lung *Number of excess cancers per 10,000 person-years at risk. **SPC occurring in a different subsite

9 Discussion Lifestyle habits Host factors Environmental exposures 1st cancer 1 st cancer treatments Lifestyle habits Environmental exposures 2 nd cancer Host factors Wood et al. 2012, Curtis et al. 2006, Jegu et al. 2014

10 United States Curtis et al O/E = 1.14 Denmark Storm et al O/E = 0.91 Sweden Dong et al O/E = 1.44 Finland Sankila et al O/E = 1.12 Red: O/E > 1 (p<0.05) Blue: O/E 1 Japan Tabuchi et al O/E = 1.21 Utada et al O/E = 1.10 Queensland, Australia Youlden et al O/E =1.27 France O/E = 1.36 The risk of SPC is high in France Switzerland Levi et al O/E = 1.21 Italy AIRTUM Working Group 2013 O/E = 1.10 Victoria, Australia Karahalios et al O/E (male)= 1.03 O/E (female)= 1.26

11 Important contribution of cancers related to alcohol and tobacco in France Alcohol consumption (l per capita) Smoking (daily smokers %) France US Contribution to the excess SPCs France: 50% US: 35% OECD website, Curtis et al. 2006, Jégu et all. 2014

12 Among male patients with a first tobacco- or alcohol-related cancer, the risk of SPC is higher in France than in the US SIR (in males) EAR (in males) First cancer site France US France US Head and neck Oesophagus* Larynx* Lung* *All excluding same site Primary prevention Early detection of SPCs Tertiary prevention Demark et al. 2006

13 K2-France study Further developments

14 Collaborative research projects

15 Muller et al. 2015

16 Update of the database Cases diagnosed , with a follow-up until June cancer registries (+2) Objectives: study SPC incidence, trends, impact on survival Funding: INCa Started Nov 2015

17 K2-France Working Group: Registre des cancers du Bas-Rhin, Registre général des tumeurs du Calvados, Registre des tumeurs digestives du Calvados, Registre des hémopathies malignes de Côte-d'Or, Registre des hémopathies malignes de Basse-Normandie, Registre des tumeurs du Doubs et du Territoire de Belfort, Registre des tumeurs de l'hérault, Registre des cancers de l Isère, Registre des cancers de Lille et de sa région, Registre des cancers de Loire-Atlantique et de Vendée, Registre des cancers de la Manche, Registre des cancers de la Somme, Registre des cancers du Tarn With the collaboration of: Service de biostatistique, hospices civils de Lyon We are grateful to all the Pathologists, Public hospitals, Private hospitals and General Practitioners for their contribution The K2-France study was supported by the Institut de Recherche en Santé Publique (IReSP) in the framework of the French Cancer Plan LESP website: Contact - jeremie.jegu@unistra.fr Acknowledgments

18 Bibliography (1) AIRTUM Working Group. Italian cancer figures, report 2013: Multiple tumours. Epidemiol. Prev. 2013;37: Colonna M, Mitton N, Bossard N, Belot A, Grosclaude P, $author.lastname $author firstname. Total and partial cancer prevalence in the adult French population in BMC Cancer. 2015;15:153 Curtis RE, Freedman DM, Ron E, Ries LAG, Hacker DG, Edwards BK, et al. New Malignancies Among Cancer Survivors: SEER Cancer Registries, NIH Publ. Bethesda, MD: National Cancer Institute Demark-Wahnefried W, Pinto BM, Gritz ER. Promoting health and physical function among cancer survivors: potential for prevention and questions that remain. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2006;24: Dong C, Hemminki K. Second primary neoplasms in 633,964 cancer patients in Sweden, Int. J. Cancer Jul 15;93(2): Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon Fr. Int. Agency Res. Cancer [cited 2014 Oct 23]. Available from: Jégu J, Colonna M, Daubisse-Marliac L, Trétarre B, Ganry O, Guizard A-V, Bara S, Troussard X, Bouvier V, Woronoff A-S, Velten M. The effect of patient characteristics on second primary cancer risk in France. BMC Cancer 2014, 14:94. Karahalios E, English D, Thursfield V, Simpson J, Farrugia H, Giles G. Second Primary Cancers in Victoria. Melbourne: Victorian Cancer Registry, Cancer Epidemiology Centre, Cancer Council Victoria; 2009 Aug. Levi F, Randimbison L, Te VC, Rolland-Portal I, Franceschi S, La Vecchia C. Multiple primary cancers in the Vaud Cancer Registry, Switzerland, Br. J. Cancer Feb;67(2):391 5.

19 Bibliography (2) Muller J, Grosclaude P, Lapôtre-Ledoux B, Woronoff A-S, Guizard A-V, Bara S, et al. Trends of the risk of second primary cancer among bladder cancer survivors: a population-based cohort of 10,047 patients. BJU Int Oct 15. Storm HH, Lynge E, Osterlind A, Jensen OM. Multiple primary cancers in Denmark ; influence of possible underreporting and suggested risk factors. Yale J Biol Med Oct;59(5): Sankila R, Pukkala E, Teppo L. Risk of subsequent malignant neoplasms among 470,000 cancer patients in Finland, Int. J. Cancer Feb 8;60(4): Tabuchi T, Ito Y, Ioka A, Miyashiro I, Tsukuma H. Incidence of metachronous second primary cancers in Osaka, Japan: update of analyses using population-based cancer registry data. Cancer Sci Jun;103(6): Utada M, Ohno Y, Hori M, Soda M. Incidence of multiple primary cancers and interval between first and second primary cancers. Cancer Sci. 2014;105: Wood ME, Vogel V, Ng A, Foxhall L, Goodwin P, Travis LB. Second Malignant Neoplasms: Assessment and Strategies for Risk Reduction. J. Clin. Oncol. 2012;30: Youlden D, Baade P. The relative risk of second primary cancers in Queensland, Australia: a retrospective cohort study. BMC Cancer. 2011;11(1):83.

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