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Risk of Primary Neuroendocrine Pancreatic Tumor After a First Primary Cancer

A US Population-Based Study

Kamath, Geetanjali R., PhD*†; Kim, Michelle K., MD; Taioli, Emanuela, MD, PhD*†

doi: 10.1097/MPA.0000000000001232
Original Articles

Objective This study aimed to describe the relative and excess risk of pancreatic neuroendocrine tumor (NET) at least 6 months after the first primary cancer (FPC) among the US population.

Methods Surveillance, Epidemiology, and End-Results Program data were analyzed for patients diagnosed as having FPC from 2000 to 2015 (n = 4,008,092). Standardized incidence ratios, excess risk, and average time to diagnosis of a second primary pancreatic NET were reported by FPC site, stratified by sex and receipt of radiotherapy and chemotherapy.

Results Risk of pancreatic NET was significantly higher after FPC at any site, any solid tumor (standardized incidence ratios, 1.3; 95% confidence interval, 1.2–1.5), pancreas, thymus, small intestine, liver, stomach, kidney, lung, and female breast. Excess incidence of pancreatic NET was highest among those with FPC (especially NET) of the pancreas, bladder, thymus, and female breast; those who received radiotherapy/chemotherapy for bladder, melanoma, and stomach cancers; and those who received chemotherapy for uterine, cervical, prostate, and other genital cancers. Time to diagnosis was shortest after pancreatic, liver, lung, and stomach cancer.

Conclusions Cancer survivors have increased risk and excess incidence of primary pancreatic NET compared with the population, particularly for certain primary sites. High-risk patients should receive regular follow-up screenings, counseling to reduce carcinogen exposure, and lifestyle interventions.

From the *Department of Population Health Science and Policy and Institute for Translational Epidemiology,

Tisch Cancer Institute, and

Department of Internal Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY.

Received for publication July 2, 2018; accepted November 16, 2018.

Address correspondence to: Emanuela Taioli, MD, PhD, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York, NY 10029-5674 (e-mail:

This work was supported by a grant from the National Cancer Institute at the National Institutes of Health (P30 CA196521).

The authors declare no conflict of interest.

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