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Original article
Incidence of second and higher order smoking-related primary cancers following lung cancer: a population-based cohort study
  1. Matthew E Barclay1,
  2. Georgios Lyratzopoulos1,2,3,
  3. Fiona M Walter1,
  4. Sarah Jefferies4,
  5. Michael D Peake3,5,
  6. Robert C Rintoul6,7
  1. 1 The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
  2. 2 Department of Behavioural Science and Health, Epidemiology of Cancer Healthcare & Outcomes, University College London, London, UK
  3. 3 Public Health England (PHE), National Cancer Registration and Analysis Service (NCRAS), London, UK
  4. 4 Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  5. 5 Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
  6. 6 Department of Oncology, University of Cambridge, Cambridge, UK
  7. 7 Department of Thoracic Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Robert C Rintoul, Department of Oncology, University of Cambridge, Cambridge CB2 0RE, UK; robert.rintoul{at}


Background Lung cancer 5-year survival has doubled over 15 years. Although the risk of second primary cancer is recognised, quantification over time is lacking. We describe the incidence of second and higher order smoking-related primary cancers in lung cancer survivors, identifying high-incidence groups and how incidence changes over time from first diagnosis.

Methods Data on smoking-related primary cancers (lung, laryngeal, head and neck, oesophageal squamous cell carcinoma and bladder) diagnosed in England between 2000 and 2014 were obtained from Public Health England National Cancer Registration and Analysis Service. We calculated absolute incidence rates and standardised incidence rate ratios, both overall and for various subgroups of second primary cancer for up to 10 years from the initial diagnosis of lung cancer, using Poisson regression.

Results Elevated incidence of smoking-related second primary cancer persists for at least 10 years from first lung cancer diagnosis with those aged 50 and 79 at first diagnosis at particularly high risk. The most frequent type of second malignancy was lung cancer although the highest standardised incidence rate ratios were for oesophageal squamous cell carcinoma (2.4) and laryngeal cancers (2.8) and consistently higher in women than in men. Over the last decade, the incidence of second primary lung cancer has doubled.

Conclusion Lung cancer survivors have increased the incidence of subsequent lung, laryngeal, head and neck and oesophageal squamous cell carcinoma for at least a decade from the first diagnosis. Consideration should be given to increasing routine follow-up from 5 years to 10 years for those at highest risk, alongside surveillance for other smoking-related cancers.

  • lung cancer
  • clinical epidemiology
  • non-small cell lung cancer

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  • Contributors RCR conceived the study and MEB, GL, FMW, SJ and RCR designed it. MEB performed statistical analyses and wrote the first draft. All authors contributed to revisions and approved the final manuscript. The guarantor (RCR) accepts full responsibility for the work, had access to the data and controlled decision to publish.

  • Funding This study was supported the Early Diagnosis programme Cancer Research UK Cambridge Centre. FMW is supported by an NIHR Clinician Scientist award. GL is supported by a Cancer Research UK award (Advanced Clinician Scientist Fellowship C18081/A18180). RCR is part funded by the Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Centre.

  • Disclaimer The funder had no input into the study design, collection, analysis or interpretation of the data, in the writing of the report or in the decision to submit the paper for publication.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.