The Odds of Having Second Cancers

Have you experienced a second cancer? 

Many of us assume that, once we have experienced cancer, checked off that life box, we can move on. It is upsetting to acknowledge that we can develop a second, unrelated to the first, cancer. It is even more upsetting to learn that our odds of this happening are fairly high. (And a disclaimer here: odds that seem high to one person may seem not so high to another. We have different thresholds on this one.)

While this is not exactly welcome information, it is important. The statistic is that 25% of patients over 65 and 11% of younger people who are diagnosed with cancer have had a previous cancer diagnosis. My non-medical brain tells me something like: "Well, since our bodies figured out how to make cancer once, it makes sense that they might do it again." I am sure that our doctors would explain it in a more scientific way, but that seems to be the bottom line. The positive addition might be: "And, since we were treated once and are doing OK, that is likely to be the case again." Not honestly sure if that is accurate, but it is comforting.

Since I fall into this group, I am weirdly reassured to have a lot of company. My first breast cancer was in 1993 when I was in my early 40s, and the second (a new primary) was in 2005. Last year when I passed the 12-year anniversary of Breast Cancer #2, I took a semi sigh of relief. And then, of course, I immediately became superstitious and tried to take it back.

The number of cancer survivors in the United States is growing and expected to reach 26 million by 2040. The good news, of course, is that many of us are surviving after cancer, but this does put a lot of people at risk for a second diagnosis.

Some people who carry a gene mutation are already aware that they are at higher risk of second (or even third) cancers. Some of those people are advised to follow a careful course of screening and observation, trying to catch any new malignancy early. If you have a family history that suggests a gene mutation may be part of your heritage, it would be smart to meet with a genetic counselor. At the BIDMC Cancer Center, there is a Cancer Genetics and Prevention program that is very helpful.

For most of us, the recommendation is the same as for the general population: annual mammograms , usually starting at 40 although this is controversial, and colonoscopies, starting at 50, at a schedule that is determined by the results of each test. You may have seen some of the advertisements for full body scans, rarely covered by insurance, to find early cancers. Cancer doctors don’t recommend this, reminding us of the risks of radiation, and the likelihood that risks outweigh possible benefits. Unfortunately, cancer prevention doesn’t give us much opportunity to be pro-active in the ways that one can to reduce the risk of heart disease or diabetes. 

The answer is the usual advice to stick with the prescribed follow up with your cancer doctors, and to pay attention to lifestyle choices: exercise, weight control, a healthy diet, and limited alcohol.  I would add don’t smoke and fasten your seat belt. While none of these things will prevent cancer, they will improve our odds and keep as as healthy as possible—whatever we have to face.