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Screening for a second cancer: Know your risks, how to manage them

Network - Spring 2013

By Mary Brolley

Once you’ve been treated for one type of cancer, it doesn’t seem fair that you should have to worry about getting another type.   

But hard as it may be to think about getting a second cancer, it’s important to be aware of your risks.

That’s because, all things being equal, cancer survivors are more likely than others to get another cancer, says Therese Bevers, M.D., professor in MD Anderson’s Department of Clinical Cancer Prevention.

Though it’s a difficult topic, Bevers wants survivors to speak to their oncologists and primary care physicians about their risks of developing another cancer.

First, let’s define our terms. A second primary cancer is not a recurrence. It’s the development of a new type of cancer in someone with a history of cancer.

Because it affects quality of life and long-term survival, getting a second primary cancer is one of the most serious events in a survivor’s life.

A caution against ‘tunnel vision’

Bevers says that too often, survivors and their oncologists are so focused on checkups and diagnostic tests to spot a recurrence that they don’t consider their risks for other cancers.

“I call it tunnel vision,” she says. “I understand why it happens, but it’s important that we address it. Cancer survivors still need screenings for other types of cancer.”

Why are cancer survivors more likely to get a second cancer?

One factor — though rare — is genetics. If you have an inherited tendency to contract cancer (such as the BRCA1 or BRCA2 genes, or Lynch syndrome), you could get a second primary cancer that develops along the same genetic pathway.

Another may relate to lifestyle factors. If you smoke, drink more alcohol than recommended or are overweight or obese, you’re more likely to develop another cancer than someone with none of these risk factors.

Therese Bevers, M.D.

And some cancers develop as a result of treatments for the initial cancer. The so-called iatrogenic, or treatment-related, effects of radiation and chemotherapy on the development of later cancers are becoming more evident as cancer survivors live longer, says Bevers.

“We’re seeing more second primaries caused by treatments of the first cancer, and it’s a serious concern,” she says.

“However, it’s important to understand that the patient wouldn’t be here today if he or she hadn’t had the initial treatment.” 

Essentially, second primaries are a consequence of the success of the cancer treatment.

What you can do: vigilance and lifestyle changes

Cancer survivors worried about getting a second type of cancer can make lifestyle changes to improve their health.

Those who smoke can get help to quit. Those who are overweight or obese can get nutritional counseling to make better food choices and join a support group to get to a healthier weight.

Other recommendations are to limit alcohol consumption and increase physical activity.

Besides these proactive measures, Bevers lists strategies like chemoprevention, such as when breast cancer survivors take Tamoxifen, and prophylactic, or preventive, surgeries to prevent the development of cancer for those with a very high risk of second primaries due to a genetic predisposition.

As for screening, Bevers recommends asking your oncologist or primary care physician for guidance about your risks. The more we learn about cancer survivors and their experience, the more we can predict which screenings will be most effective.

Bevers is hopeful that, as the number of cancer survivors continues to grow, physicians and survivors will work in tandem to manage the risks of recurrence and second primaries.

Marisa Ramirez

Marisa Ramirez, a seven-year survivor of cervical cancer, is all too aware of her risks.

“Thinking I could get another type of cancer is a little unnerving,” she says. “Because cancer knows how to find me. It knows where I live.”

Ramirez has changed her lifestyle drastically since her diagnosis and treatment. She became a vegetarian seven years ago and is vigilant about age-appropriate screenings.

“You feel out of control when you’re diagnosed,” she says. “This is a way to be more in control.”

© 2014 The University of Texas MD Anderson Cancer Center