Subsequent primary invasive and in situ cancers after diagnosis of cervical cancer by race/ethnicity

A86 Background: Women diagnosed with cervical cancer tend to have specific risk factors for developing a cancer later in life: infection with the Human Papillomavirus (HPV), history of smoking, and/or treatment with radiation therapy. Recent licensure of an HPV vaccine protecting against HPV 16 and 18 has raised the issue of whether current racial/ethnic disparities in cervical cancer will improve or worsen. Since the HPV vaccine has the ability to impact more than one HPV-related cancer in the same individual, we examine whether there are racial/ethnic differences in developing subsequent primary cancers (invasive and in situ) after an initial invasive cervical cancer diagnosis.
 Methods: Using the SEER 13 Cancer Registry data (1992-2004), we identified 23,059 women with invasive cervical cancer and observed subsequent malignancies (including some in situ) in that cohort during 4.75 mean person-years of follow-up. We focused on HPV-associated cancers (vaginal, vulvar, anal, rectal, and oropharyngeal). Subsequent cancers were considered if they were diagnosed 2 or more months after initial diagnosis of the first cancer. Observed (O) subsequent cancers were compared with those expected (E) based on age-/race-/year-/site-specific rates in the SEER population. The standardized incidence ratio (SIR) represent 9O / E9. All reported SIRs were considered significant if p Results: After a primary cervical cancer diagnosis, there is significant elevated risk for invasive vaginal, vulvar, and rectal cancers (SIRs = 29.9, 5.7, 2.2 respectively). The significantly elevated risk for subsequent vaginal cancer by race was 48.5 for Asian Pacific Islander (API), 34.5 for Blacks, and 25.7 for Whites. When assessed by ethnicity, Hispanic and Non-Hispanic women had significantly elevated SIRs for subsequent vulvar and rectal cancers (Hispanic=9.7, 3.9 respectively, Non-Hispanic=6.1, 1.9, respectively). The significant elevated risk for in situ vaginal cancer was observed by race, SIRs for API was 91.4, Blacks 52.8, and Whites 49.4 respectively and ethnicity (SIR= 55.7 for Hispanics and 52.4 for nonHispanics).
 Conclusions: Using a population-based cancer registry, there are important racial/ethnic differences in development of subsequent HPV-associated in situ and invasive cancers after a cervical cancer diagnosis. The results have implications for the potential impact of the HPV vaccine on the same individual in different racial/ethnic groups.