Risk of second primary malignancies in older long-term survivors of breast, prostate, colon, and rectal cancer.

Authors

Tendai Kwaramba, Sarah Westvold, Jessica B Long, Terry Hyslop, Andrea Silber, Faiza Yasin, Rebecca Forman, Melissa Taylor, Shi-Yi Wang, Michael Leapman, Ira L Leeds, Michael Cecchini, Lisa P Spees, Stephanie B Wheeler, Cary P Gross, Kevin Oeffinger, Michaela A Dinan

Published in

Journal of the National Cancer Institute. Oct 13, 2026. Epub Oct 13, 2026.

Abstract

Cancer survivors face an increased risk of second primary malignancies (SPMs). Understanding SPM incidence and risk factors is crucial for long-term survivorship care.
This was a SEER-Medicare retrospective cohort study of breast, prostate, colon, or rectal cancer survivors diagnosed between 2003-2011 at age 66+ years who survived ≥5 years post-diagnosis. The primary outcome was a 'late' SPM, defined as invasive cancer occurring ≥5 years after initial diagnosis. Restricted mean survival time (RMST) regression was used to assess demographic, clinical, and treatment related factors associated with late SPMs. SPMs were categorized as hematologic, screen-detectable (breast, prostate, lung, colon, or rectal), or non-screen detectable solid tumors.
Of 90,261 long-term survivors, 11.2% (10,116) developed at least one late SPM. The cumulative incidence of late SPMs over 8 years was highest in prostate cancer survivors. Non-screen detectable cancers composed the largest proportion (47.8%) of 10,220 total late SPMs. The most common late SPM site was lung in colon (14.9%), and rectal (16.1%) cancer survivors, urinary bladder in prostate (17.0%), and new-primary breast cancers in breast cancer survivors (36.5%). In RMST regression, significant associations with demographic, index cancer, treatment, and clinical characteristics and late SPMs ranged from 3.6 months shorter to 4.4 months longer time without late SPM during the 8 years assessed.
Between 10-14% of older long-term cancer survivors developed a late SPM during 5-13 years after index cancer diagnosis. Over 40% of late SPMs were screen-detectable, highlighting the need for surveillance strategies beyond 5 years from index cancer diagnosis.

PMID:
42867138
Bibliographic data and abstract were imported from PubMed on 14 Oct 2026.

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