Association of Esophageal Adenocarcinoma With Other Subsequent Primary Cancers

PURPOSE: Esophageal adenocarcinoma shares risk factors such as obesity and smoking with other common cancers. The association of esophageal adenocarcinoma with other primary cancers has not been systematically evaluated. The authors used the Surveillance, Epidemiology and End-Results database of the National Cancer Institute to explore the association of esophageal adenocarcinoma with other primary cancers. PATIENTS AND METHODS: All adult patients with esophageal cancers, both adenocarcinoma and squamous cell carcinoma diagnosed between 1973 and 2001, were identified from the Surveillance, Epidemiology, and End-Results database, and standardized incidence rates were calculated for all subsequent primary cancers in these patients. The analysis was reversed to estimate the standardized incidence rate for subsequent primary esophageal cancer after a first primary cancer. RESULTS: In comparison with a standard population, patients with esophageal adenocarcinoma were at higher risk for the development of another subsequent cancer, specifically, cancers of the oral cavity and pharynx, lung and bronchus, and kidney and renal pelvis, and adenocarcinoma of the colon/rectum and pancreas. With squamous cell esophageal cancer, there was an association with tobacco-related cancers such as those of the oral cavity and pharynx, the lung and bronchus, and the breast. There was either no association or even a negative association of esophageal adenocarcinoma with other obesity-related cancers such as breast, uterine, and prostate cancers. CONCLUSIONS: Patients with esophageal adenocarcinoma and squamous cell carcinoma are at increased risk for the development of specific second primary cancers that share smoking as a common risk factor. Esophageal adenocarcinoma does not have a strong association with obesity-related cancers with respect to the relative risk for the development of subsequent primary cancers.