Methodology for evaluating the incidence of second primary cancers with application to smoking-relted cancers from the Surveillance, Epidmiology, and End Results (SEER) program Journal Article


Authors: Begg, C. B.; Zhang, Z. F.; Sun, M.; Herr, H. W.; Schantz, S. P.
Article Title: Methodology for evaluating the incidence of second primary cancers with application to smoking-relted cancers from the Surveillance, Epidmiology, and End Results (SEER) program
Abstract: The Surveillance, Epidemiology, and End Results (SEER) database is used to estimate the standardized incidence ratios (SIRs) of second primaries for all pairs of smoking-related cancers and to interpret the results in the context of our knowledge of the known effects of smoking on the incidence of each of the individual cancers. In evaluating the simultaneous incidence of two cancers, one must recognize the inherent duality of the two relevant SIRs linking the two cancers (e.g., A and B), namely, the SIRs of A following B and B following A. Under fairly general assumptions, the two SIRs are seen to be equal, and departures from equality suggest changes in risk status or the introduction of new risk factors after the Incidence of the first primary. Based on these observations, a methodological strategy is developed. The data reveal several clear patterns. First, short-term incidence is uniformly much greater than long-term incidence. Second, the SIRs are consistently much higher for women than for men, for every pair of cancers studied. Third, the magnitudes of the SIRs are generally high and often substantially higher than would be expected on the basis of the known risks of smoking. Exceptionally high SIRs are observed between kidney and bladder cancer and between head and neck and esophageal cancer. Various influences may affect these high observed SIRs, including artifactual influences such as diagnostic, surveillance, and misclassification biases, and the effect of different exposure prevalences on subsequent SIRs, which may to some extent explain the strong sex differences. However, these artifacts do not appear to explain the magnitude of the observed SIRs, especially the very strong associations between kidney and bladder cancer and between head and neck and esophageal cancer. It seems likely that other factors play a role, including, possibly, host susceptibility factors or additional common risk factors other than smoking. Although multiple primary cancers are rare, they represent an especially fruitful population for detailed epidemiologic study. Am J Epidemiol 1995;142:653-65. © 1995 by The Johns Hopkins University School of Hygiene and Public Health.
Keywords: cancer risk; united states; cancer incidence; neoplasms; incidence; lung cancer; smoking; bladder cancer; kidney; head and neck cancer; lung; seer program; cancer epidemiology; neoplasms, second primary; evaluation studies; esophagus cancer; mathematical computing; head and neck; esophagus; sex distribution; bladder; second primary; human; male; female; article; support, u.s. gov't, p.h.s.
Journal Title: American Journal of Epidemiology
Volume: 142
Issue: 6
ISSN: 0002-9262
Publisher: Oxford University Press  
Date Published: 1995-09-15
Start Page: 653
End Page: 665
Language: English
DOI: 10.1093/oxfordjournals.aje.a117689
PUBMED: 7653476
PROVIDER: scopus
DOI/URL:
Notes: Source: Scopus
Altmetric Score
MSK Authors
  1. Colin B Begg
    239 Begg
  2. Stimson P Schantz
    96 Schantz
  3. Harry W Herr
    407 Herr
  4. Zuo-Feng Zhang
    94 Zhang
  5. Ming Sun
    18 Sun