Journal of the National Cancer Institute
October 13, 2026 · via Europe PMC
Risk of second primary malignancies in older long-term survivors of breast, prostate, colon, and rectal cancer.
Kwaramba T, Westvold S, Long JB, +13 more, Dinan MA
AI summary — for doctors, generated from the abstract only
Roughly one in nine older long-term cancer survivors developed a late second primary cancer, most often non-screen-detectable tumors.
What was studied
SEER-Medicare retrospective cohort of 90,261 survivors of breast, prostate, colon or rectal cancer diagnosed at 66 or older who lived at least five years, analyzing late second primaries with restricted mean survival time regression.
Key findings
- 11.2% developed at least one late second primary
- Non-screen-detectable solid tumors made up 47.8% of late second cancers
- Prostate cancer survivors had the highest cumulative incidence over 8 years
- Common sites were lung after colorectal, bladder after prostate, and breast after breast cancer
Clinical relevance
Primary care and oncology clinicians should keep long-term survivorship surveillance in mind, as many second cancers are not covered by routine screening.
Who should care
Limitations
A Medicare claims-based cohort may lack detail on lifestyle factors and treatment, and the abstract is cut off before conclusions.
Keep screening and symptom vigilance going beyond five years and tailor to the index cancer.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
BACKGROUND
Cancer survivors face an increased risk of second primary malignancies (SPMs). Understanding SPM incidence and risk factors is crucial for long-term survivorship care.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
DOI
10.1093/jnci/djag383
PMID
42867138
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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