Second primary cancers in patients with nasopharyngeal carcinoma: A pooled analysis of 13 cancer registries

Objective: To study the risk of second primary cancers in nasopharyngeal carcinoma (NPC) patients and the risk of NPC as second primary cancer. Methods: We used data from the cancer registries from Singapore and from 12 low-incidence areas, including a total of 8,947 first occurring NPC cases, and 167 second occurring cases. We calculated standardized incidence ratios (SIRs) by comparing the second cancer incidence in NPC patients to the first primary cancer incidence in non-cancer population. We also calculated SIRs of second NPC after other primaries. Results: In Singapore, the risk of cancers of the lung (SIR = 0.42), stomach (SIR = 0.41), and colon (SIR = 0.23) was significantly decreased after NPC, whereas that of cancer of the tongue (SIR = 11.1) was significantly increased. In Australia, Canada, and Europe, the risk of non-Hodgkin's lymphoma (NHL) (SIR = 3.06), tongue cancer (SIR = 5.29), brain cancer (SIR = 3.89), myeloid leukemia (SIR = 3.85), and non-melanoma skin cancer (NMSC) (SIR = 3.47) was significantly increased after NPC. Incidences of second occurring NPCs following various primary cancers were not significantly altered compared to the incidence of first occurring NPCs. Conclusions: Immune suppression (NHL, NMSC), shared genetic factors (lung cancer, NHL, myeloid leukemia), and shared environmental risk factors (tongue and brain cancers) might explain the associations. Except for NHL, there was no evidence of association with other Epstein-Barr virus-related cancers.