Cancer Causes & Control

, Volume 30, Issue 5, pp 465–475 | Cite as

Second primary lung cancer in United States Cancer Survivors, 1992–2008

  • Nicholas M. DoninEmail author
  • Lorna Kwan
  • Andrew T. Lenis
  • Alexandra Drakaki
  • Karim Chamie
Original paper



Lung cancer is common and lethal, and can occur in survivors of previous cancers. We sought to describe the incidence and mortality attributable to second primary lung cancers (SPLC) among survivors of other cancers, and to identify survivors at highest risk.


We identified adults diagnosed with a localized malignancy from non-pulmonary cancer sites from surveillance, epidemiology, and end results (SEER) data from 1992 to 2008. We explored factors associated with the incidence and death from SPLC using bivariable and multivariable models. Finally, we compared standardized incidence rates for SPLC in our cohort with the control arm of the National Lung Screening Trial (NLST), a randomized lung cancer screening trial.


We identified 1,450,837 survivors of non-pulmonary cancers, of whom 25,472 developed SPLC at a mean (SD) follow-up of 5.7 (3.6) years. Over half (57%) of patients with SPLC died of the disease. Survivors of cancer of the hypopharynx, oropharynx, tonsil, and larynx, experienced SPLC at standardized incidence rates which greatly exceeded that observed in the control arm of the NLST (572/100,000 person-years). Additionally, survivors of bladder and esophageal cancer had rates that approached the NLST control arm rate. Increasing age and being divorced/widowed/separated were independent risk factors for SPLC in most primary cancer types.


The incidence of SPLC in survivors of certain primary cancers greatly exceeds the rate observed in the control arm of the NLST. Further study could help determine if screening for lung cancer in these cancer survivors could prevent death from lung cancer.


SEER program Lung neoplasms Second primary neoplasms Epidemiology Survivors Screening 



This work was supported in part by the STOP Cancer Foundation and the Flax Family Foundation (KC).

Compliance with ethical standards

Conflict of interest

All authors report no financial conflicts of interest.

Informed consent

Dr. Nicholas M. Donin and Dr. Karim Chamie take ultimate responsibility for the integrity of the content contained herein.

Supplementary material

10552_2019_1161_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 18 KB)


  1. 1.
    Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66:7–30CrossRefGoogle Scholar
  2. 2.
    Miller KD et al (2016) Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 66:271–289CrossRefGoogle Scholar
  3. 3.
    Curtis RE et al (2006) New malignancies among cancer survivors: SEER cancer registries, 1973–2000. National Cancer Institute, Bethesda, (NIH Publ. No. 05-5302) Google Scholar
  4. 4.
    Donin N et al (2016) Risk of second primary malignancies among cancer survivors in the United States, 1992 through 2008. Cancer 122:3075–3086CrossRefGoogle Scholar
  5. 5.
    Torre LA, Siegel RL, Jemal A (2016) Lung cancer statistics. Adv Exp Med Biol 893:1–19CrossRefGoogle Scholar
  6. 6.
    Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER cancer statistics review, 1975–2013, National Cancer Institute. Bethesda, MD,, based on November 2015 SEER data submission, posted to the SEER web site, April 2016. Accessed 3 Mar 2017
  7. 7.
    Team TNLSTR (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395–409CrossRefGoogle Scholar
  8. 8.
    National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health (2014) The health consequences of smoking—50 Years of progress: a report of the surgeon general. (Centers for Disease Control and Prevention (US))Google Scholar
  9. 9.
    Percy C, Van Holten V, Muir C (1990) International classification of diseases for oncology, 2nd edition. World Health Organization, Washington, D.C.Google Scholar
  10. 10.
    Baris D et al (2009) A case-control study of smoking and bladder cancer risk: emergent patterns over time. J Natl Cancer Inst 101:1553–1561CrossRefGoogle Scholar
  11. 11.
    Health CO on S. and. Smoking and Tobacco Use; Surgeon General’s Reports (2004) Complete report. Smoking and tobacco use available at: Accessed 28 Nov 2016
  12. 12.
    Cohen EEW et al (2016) American cancer society head and neck cancer survivorship care guideline. CA Cancer J Clin 66:203–239CrossRefGoogle Scholar
  13. 13.
    Wood DE (2015) National comprehensive cancer network (NCCN) clinical practice guidelines for lung cancer screening. Thorac Surg Clin 25:185–197CrossRefGoogle Scholar
  14. 14.
    Tammemägi MC et al (2014) Evaluation of the lung cancer risks at which to screen ever- and never-smokers: screening rules applied to the PLCO and NLST cohorts. PLoS Med 11:e1001764CrossRefGoogle Scholar
  15. 15.
    Kovalchik SA et al (2013) Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med 369:245–254CrossRefGoogle Scholar
  16. 16.
    Tammemägi MC et al (2013) Selection criteria for lung-cancer screening. N Engl J Med 368:728–736CrossRefGoogle Scholar
  17. 17.
    NHIS—National Health Interview Survey Homepage (2016) Available at: Accessed 13 Dec 2016
  18. 18.
    Corrao MA, Guindon GE, Cokkinides V, Sharma N (2000) Building the evidence base for global tobacco control. Bull World Health Organ 78:884–890Google Scholar
  19. 19.
  20. 20.
    Kuo JC-L, Raley RK (2016) Diverging patterns of union transition among cohabitors by race-ethnicity and education: trends and marital intentions. Demography 53:921–935CrossRefGoogle Scholar
  21. 21.
    Botteman MF, Pashos CL, Redaelli A, Laskin B, Hauser R (2003) The health economics of bladder cancer: a comprehensive review of the published literature. PharmacoEcon 21:1315–1330CrossRefGoogle Scholar
  22. 22.
    Rink M et al (2013) Impact of smoking and smoking cessation on oncologic outcomes in primary non-muscle-invasive bladder cancer. Eur Urol 63:724–732CrossRefGoogle Scholar
  23. 23.
    Do K-A et al (2004) Longitudinal study of smoking patterns in relation to the development of smoking-related secondary primary tumors in patients with upper aerodigestive tract malignancies. Cancer 101:2837–2842CrossRefGoogle Scholar
  24. 24.
    Bjurlin MA et al (2013) Brief smoking cessation intervention: a prospective trial in the urology setting. J Urol 189:1843–1849CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nicholas M. Donin
    • 1
    • 3
    Email author
  • Lorna Kwan
    • 1
  • Andrew T. Lenis
    • 1
  • Alexandra Drakaki
    • 2
    • 3
  • Karim Chamie
    • 1
    • 3
  1. 1.Department of Urology, David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  2. 2.Department of Medicine, Division of Hematology & Oncology, David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  3. 3.Jonsson Comprehensive Cancer CenterUniversity of CaliforniaLos AngelesUSA

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