Risk of second primary lung cancer among cancer survivors stratified by the site of first primary cancer and the lung cancer screening eligibility status

Personal history of cancer is an independent risk factor for developing lung cancer. However, it is not considered in the current US lung cancer screening (LCS) guidelines. In this study, we assessed the risk of developing lung cancer among cancer survivors across 24 different sites of first primary cancer stratified by their LCS eligibility status. Using data from the Patient History Database at the University of Texas MD Anderson Cancer Center, we calculated and compared the cumulative incidence of second primary lung cancer, the overall and the LCS eligibility status-specific, stratified by the site of first primary cancer among cancer survivors. We found that among lung, head and neck (H&N), bladder, cervical, breast, and prostate cancer survivors, the risks of second primary lung cancer were statistically significantly higher compared to the overall risk among all cancer survivors (i.e., all cancer sites combined). Risk ratios (RR) ranged between 1.14 (95%CI:1.00-1.28, p = 0.0431) among prostate cancer survivors to 2.9 (95%CI:2.58-3.26, p < 0.001) among H&N cancer survivors. Other than first primary lung cancer (RR: 1.33; 95%CI:1.14-1.57; p < 0.001), H&N (RR: 1.73; 95%CI:1.45-2.05; p < 0.001) and bladder (RR: 1.32; 95%CI:1-1.74; p = 0.0483) cancer survivors, who were non-eligible for LCS, had significantly higher lung cancer risk than all cancer survivors. In conclusion, H&N, bladder, cervical, breast, and prostate cancer survivors have a high risk of developing second primary lung cancer. Specifically, personal history of H&N and bladder cancer, even among non-eligible for LCS individuals, remain at a sufficiently high risk, which warrants further consideration as an independent eligibility factor for LCS guidelines.