Cancer survivors need the right expert help to detect second cancers early

Cancer risk is significantly higher among cancer survivors. As many as 14 percent of all cancers diagnosed are second cancers — completely new cancers (not recurrences of the original cancer) that develop among cancer survivors. According to City of Hope’s Arti Hurria, M.D., and Ari M. VanderWalde, M.D., formerly of City of Hope and now at Amgen, these cancers happen most often among people diagnosed with their first cancer between ages 50 and 69, but they can happen among those in their 70s and beyond, too.

Certain first cancers are linked to a higher risk for specific other cancers. For example:

• Breast cancer – Higher risk for breast cancer in the other breast, as well as leukemia, sarcoma, melanoma and ovarian, uterine and lung cancers.
• Ovarian cancer – Higher risk for breast, colon, biliary tract and bladder cancer, as well as acute leukemia, melanoma in the eye and sarcoma.
• Prostate cancer – Higher risk of bladder, rectal, thyroid and small bowel (carcinoid) cancer.
• Colon cancer – Higher risk of small intestine, stomach, uterine, ovarian and cervical cancer, in addition to colorectal tumors.
• Hodgkin lymphoma – Higher risk of leukemia, non-Hodgkin lymphoma and cancers of the lung, breast, thyroid, salivary glands, uterus and gastrointestinal tract.

“The increased risk for these cancers comes from a variety of factors,” said Hurria, director of the Cancer and Aging Research Program at City of Hope. “These include the long-term effects of therapeutic radiation and chemotherapy, genetic factors and hormones.  Lifestyle factors that increase risk for one cancer, such as diet and obesity, often increase risk for others, as well.”

In the November issue of the journal The Oncologist, Hurria and VanderWalde urged primary care physicians and geriatricians to document their patients’ cancer and treatment history. While doctors have solid guidelines for screening cancer survivors at high risk of developing breast cancer, recommendations are incomplete for survivors of Hodgkin lymphoma and breast, ovarian, prostate and colon cancers, they said.

“We need better guidelines for screening among older adult survivors,” Hurria said. “But for now, the take-home message for older survivors is to make sure that you have shared all the details of your cancer experience, including your medications and course of treatment, with the physician who is coordinating your everyday care so that you can confidently focus on prevention and early detection of any future cancer.”

City of Hope’s Center for Cancer Survivorship offers specialized follow-up care for survivors of childhood cancer as well as breast and prostate cancer.