Worrying about a 'secondary cancer'

Most of us worry about our known cancer recurring, and some of us also worry about developing a second brand new cancer, sometimes called secondary cancers. Patients who have had breast cancer often are concerned about another cancer in the opposite breast, and others may ruminate about their risk for an unrelated kind of malignancy. Although we may feel that having had one cancer should mean that we have checked off that box and don't need to worry about another, the fact is that 1 in 6 people who are diagnosed with cancer have had a previous one.

Just as you could not prevent the first cancer, you can't prevent a second. If you carry a genetic mutation that increases the risk of certain cancers, you hopefully know about it and are following the guidelines for surveillance. The rest of us can just do what we can do: try to maintain healthy diets and weight, exercise regularly, and limit alcohol intake, don't smoke — and, of course, always fasten your seat belt.

Sometimes the treatment for the first cancer heightens the possibility of another. Remember that, at the time of diagnosis, the important and correct decision was to do whatever was necessary to treat that cancer. For all of us, the biggest risk was that first cancer, and it was important to treat it correctly even if those treatments carried some additional risk. Examples include radiation and some drugs used for chemotherapy. Your doctors will talk with you, if your risks are higher, about any screening tests that you should receive. All of us need to follow the usual guidelines about mammograms and colonoscopies.

The statistic is that one to three percent of cancer survivors develop a second cancer that is different from the first. Many more people, after treatment, live long and healthy lives without another cancer problem. These numbers are quite reassuring, but, since we have all fallen on the wrong side of the statistics with the first diagnosis, we never feel completely reassured about future health.

There are a few groups of patients who are at higher risk of secondary cancers. People who have specific and rare genetic conditions or mutations will be aware of their situation and will have careful conversations with their doctors about how to manage their ongoing health care. Another group is people who had cancer before age 15. It is vital that they keep complete health records and histories, talk with their doctors about their past cancers, and maintain a heightened awareness of possible problems. Finally, all of us face an increased risk of cancer as we age. The good news for many of us could be that we live long enough to have to worry.