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Smoking Cessation after Successful Treatment of Small-Cell Lung Cancer Is Associated with Fewer Smoking-related Second Primary Cancers
- Gary E. Richardson, MD;
- Margaret A. Tucker, MD;
- David J. Venzon, PhD;
- R. Ilona Linnoila, MD;
- Ruby Phelps;
- John C. Phares, MD;
- Margaret Edison, RN;
- Daniel C. Ihde, MD; and
- Bruce E. Johnson, MD
- From the National Cancer Institute, National Naval Medical Center, and Uniformed Services University of the Health Sciences, Bethesda, Maryland. Requests for Reprints: Bruce E. Johnson, MD, National Cancer Institute-Navy Medical Oncology Branch, Building 8, Room 5101, National Naval Medical Center, Bethesda, MD 20889-5101.
Abstract
Objective: To determine the incidence of second primary cancers developing in patients surviving free of cancer for 2 or more years after treatment for small-cell lung cancer and to assess the potential effect of smoking cessation.
Design: Retrospective review of 540 patients from a single institution with a median follow-up of 6.1 years.
Setting: A single government institution (the National Cancer Institute).
Patients: Consecutive sample of 540 patients with histologically confirmed small-cell lung cancer treated from 1973 through 1989 on therapeutic clinical trials.
Measurements: The relative risk for second primary cancers and death were calculated in patients who remained free of cancer for 2 years after initiation of therapy. The relation of these end points to smoking history was also determined.
Results: Fifty-five patients (10%) were free of cancer 2 years after initiation of therapy. Eighteen of these patients developed one or more second primary cancers, including 13 who developed second primary non-small-cell lung cancer. The risk for any second primary cancer compared with that in the general population was increased four times (relative risk, 4.4; 95% CI, 2.5-7.2), with a relative risk of a second primary non-small-cell lung cancer of 16 (CI, 8.4-27). Forty-three patients discontinued smoking within 6 months of starting treatment for small-cell lung cancer, and 12 continued to smoke. In those who stopped smoking at time of diagnosis, the relative risk of a second lung cancer was 11 (CI, 4.4 to 23), whereas, in those who continued to smoke, it was 32 (CI, 12 to 69).
Conclusions: Patients with small-cell lung cancer who survive cancer-free for more than 2 years have a significantly increased risk for development of a second primary smoking-related cancer. Cigarette smoking cessation after successful therapy is associated with a decrease in risk for a second smoking-related primary cancer.
- Copyright 2004 by the American College of Physicians
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