Heidy Medina, Ph.D. in
Epidemiology candidate

“With almost 9 million female cancer survivors in the US, patients with prior cancer diagnoses are often unfortunately excluded from clinical trials due to many concerns. For this exact reason, population-based studies such as this one are an important source of evidence due to its inclusivity,” said Heidy Medina.

The study utilized data from the Florida Cancer Data System to analyze the survival outcomes of patients with ECSPs and first primary ECs. A total of 45,593 diagnosed cases of endometrial cancer between 2005 and 2016 from the statewide cancer registry were analyzed. Of the 45,593 cases, 2,879 cases were clinically independent ECSPs and 42,714 cases were first primary ECs.

Medina and co-authors of the study employed Kaplan-Meier and Cox regression statistical methods to determine the cause-specific survival analysis. After adjusting for sociodemographic and tumor-related characteristics, the statistical analysis showed that ECSPs have improved survival in relation to first primary ECs.

Additionally, the study demonstrated that the two most common primary cancer sites for ECSPs were breast cancer (BC) and colorectal cancer (CRC). ECSPs that followed breast cancer as a first primary had a lower risk of EC-specific death compared to first primary ECs. ECSPs that followed colorectal cancer as a first primary had the same survival as first primary ECs, but worse survival compared to ECSPs following BC. Results also show that repeated chemotherapy treatment on subsequent cancers does not impact survival.

Overall, the research findings emphasize the importance of healthcare surveillance and follow-up for a previous primary cancer, which is evidenced in the improved survival outcomes of ECSPs compared to EC as a first primary. Routine ongoing gynecological surveillance among the general population could potentially mitigate current racial/ethnic health disparities that exist for EC as a first primary. The evidence also highlights ECSPs with a first primary CRC as a population of interest due to their worse prognosis.

Further research on second primary cancers is needed to generate additional insights on effective cancer prevention and treatment, particularly due to the complex nature of ECSPs. Lastly, the study recommends aligning registry definitions of second primary cancers with clinically independent second primaries in order to better understand their root causes and develop strategies to effectively manage successive cancers.

“We found that 6% of all EC cases in Florida were second primaries, therefore highlighting the importance of cancer control and primary prevention efforts as well as effective clinical management among disproportionately affected populations,” added Heidy Medina.

Co-authors of the paper include Matthew P. Schlumbrecht, M.D., associate professor and co-director of cancer prevention and control at the Sylvester Comprehensive Cancer Center’s Division of Gynecologic Oncology; Frank J. Penedo, Ph.D., professor, associate director for cancer survivorship and translational behavioral sciences, and director of the Sylvester Comprehensive Cancer Center’s cancer survivorship program; and Paulo S. Pinheiro, Ph.D., research associate professor of epidemiology at the University of Miami Miller School of Medicine’s Department of Public Health Sciences and member of the Sylvester Comprehensive Cancer Center.

Written by Veronica Bustabad

Published on March 30, 2022