Affiliations of authors: F. Levi, L. Randimbison, V.-C. Te, Vaud Cancer Registry and Cancer Epidemiology Unit, University Institute of Social and Preventive Medicine, Lausanne, Switzerland; C. La Vecchia, Istituto di Ricerche Farmacologiche "Mario Negri," and Istituto di Statistica Medica e Biometria, Università degli Studi, Milano, Italy.
Correspondence to: Fabio Levi, M.D., M.Sc., Registre vaudois des tumeurs, Institut universitaire de médecine sociale et preventive, CHUV-Falaises 1, CH-1011 Lausanne, Switzerland (e-mail: fabio.levi{at}inst.hospvd.ch).
Patients with a history of colorectal cancer are at increased risk of second primary colorectal cancer, with an overall excess risk of 1.5-fold to twofold compared with the general population (14).
On the basis of the large SEER1 database, Shureiqi et al. (4) reported that the standardized incidence ratio (SIR) of second colorectal primary cancer decreased with age at diagnosis, from 160 at age 2029 to 1.1 at age 80 or older. Since information on this issue is limited (1,5,6), we exploited data from the Swiss Cancer Registry of Vaud for 1974 through 1999. The registry covers a population of 601 000 inhabitants in 1990; it is tumor-based, and multiple primary cancers in the same person are registered separately. Both passive and active follow-up are recorded (2,3).
A total of 6579 subjects with primary colorectal cancer (excluding anorectal and anal primary cancers) were registered and followed for a mean follow-up of 4.3 years. Overall, 90 second primary colorectal cancers were observed versus 61.6 expected, corresponding to an SIR of 1.5 (95% confidence interval = 1.2 to 1.8). The SIRs, however, substantially declined with age at diagnosis, being 38.3 at age 3039, 7.6 at age 4049, 2.2 at age 5059, and 1.2 at age 60 or older (Table 1). In contrast, no pattern of risk was observed with time since diagnosis of the first primary cancer; the SIR was 1.4 at less than 1 year, 1.3 at 14 years, and 1.7 at 5 years or more since diagnosis.
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NOTES
1 Editor's note: SEER is a set of geographically defined, population-based, central cancer registries in the United States, operated by local nonprofit organizations under contract to the National Cancer Institute (NCI). Registry data are submitted electronically without personal identifiers to the NCI on a biannual basis, and the NCI makes the data available to the public for scientific research.
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