Stage I Lung Cancer Survivorship: Risk of Second Malignancies and Need for Individualized Care Plan

Background:Survivors of stage I lung cancer are at increased risk of subsequent malignancies. Specific data on risk of subsequent malignancies are underreported in the literature. We studied the incidence of stage I lung cancer and the incidence of all second malignancies in survivors.Methods:Data from the Surveillance, Epidemiology and End Results 9 database were analyzed to calculate the incidence of stage I lung cancer and subsequent malignancies from 1998 to 2007. The risk of subsequent malignancies is reported as a standardized incidence ratio (observed incidence [O]/expected incidence [E]).Results:The incidence rate of stage I lung cancer increased slowly from 1988 (8, confidence interval [CI]: 7.6–8.4) to 2003 (9.2, CI: 8.9–9.6) and more rapidly from 2003 to 2007 (11.2, CI: 10.8–11.7). The risk of developing a second lung cancer is highest in the first year with the O/E at 6.78 (CI: 6.29–7.31) and continues to be high at 10 years (O/E 4.12; CI: 4.44–4.80). Laryngeal cancer has the highest incidence in the first year (O/E 9.78; CI: 7.51–12.51) and continues to be high at 10 years (O/E 3.55; CI: 1.77–6.34). For gastrointestinal cancers, there is increased risk of colon (O/E 1.33; CI: 1.22–1.44), esophagus (O/E 2.29; CI: 1.85–2.89), and stomach (O/E 1.43; CI: 1.15–1.75) cancers. The increased risk of bladder cancer (O/E 1.83; CI: 1.65–2.03) remains high even at 10 years after the diagnosis of stage I lung cancer.Conclusions:There is increasing incidence of stage I lung cancer. Survivors of stage I are at increased risk of certain second malignancies.