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Impact of family history of cancer on risk and mortality of second cancers in patients with prostate cancer

Prostate Cancer and Prostatic Diseasesvolume 22pages143149 (2019) | Download Citation



Survival rates are increasing in patients with prostate cancer, and second primary cancers (SPCs) are becoming more common in these patients. However, the etiology and clinical consequences of SPCs are not well-known. We define the impact of family history on SPC and causes of mortality in these patients.

Patients and methods

A nation-wide cohort study based on the Swedish Family-Cancer Database covering 4.4 million men and 80,449 prostate cancers diagnosed between 1990 and 2015. Relative risks (RRs) and cumulative incidence for SPCs and for familial SPC were calculated for prostate cancer patients.


SPC was diagnosed in 6,396 men and more than a third of these patients had a first-degree family history of any cancer; the familial risk was 1.37 (95% CI: 1.27–1.40), compared to 1.10 (1.08–1.16), without a family history. Cumulative incidence by the age of 83 years reached 21% for prostate cancer alone, 28% in those with SPC, and 35% in patients with SPC and family history. Family history was associated with the risk of seven specific SPCs, including colorectal, lung, kidney, bladder and skin (both melanoma and squamous cell) cancers, and leukemia. Colorectal and lung cancers were common SPCs, and family history doubled the risk of these SPCs. In patients with SPC, half of all causes of death were due to SPC and only 12.77% were due to prostate cancer. Most deaths in SPC were caused by lung and colorectal cancers.


SPCs were an important cause of death in patients with prostate cancer and family history was an important risk factor for SPCs. Prevention of SPC should be essential when prostate cancer survival rates are being improved and this could start by conducting a thorough assessment of family history at the time of prostate cancer diagnosis.

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We are grateful for Patrick Reilly for language editing. This project was supported by grants from the German Cancer Aid, the Swedish Research Council (2014-2517, 2014-10134, and 2016-01176), and ALF funding from Region Skane, Sweden.

Author contributions

The study was designed by KH, OH, SC. KS, and JS were responsible for data acquisition. Data analysis was done by SC, KH, and AF. All authors interpreted the data. The first draft of the report was written by KH. The decision to submit the report for publication was made by all the authors. All authors contributed to the review of the manuscript.

Author information


  1. Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany

    • Subhayan Chattopadhyay
    • , Asta Försti
    •  & Kari Hemminki
  2. Department of Abdominal Surgery and Urology, Helsinki University Hospital, Helsinki, Finland

    • Otto Hemminki
  3. Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland

    • Otto Hemminki
  4. Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden

    • Asta Försti
    • , Kristina Sundquist
    • , Jan Sundquist
    •  & Kari Hemminki
  5. Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA

    • Kristina Sundquist
    •  & Jan Sundquist
  6. Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Izumo, Japan

    • Kristina Sundquist
    •  & Jan Sundquist


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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Kari Hemminki.

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