FaCD Online Syndrome Fact Sheet

Last updated: 05 May 2008

Name: Anal Cancer, Multiple Primary Malignancies in Patients with

Tumor features

anal cancer
breast cancer
cervical cancer
lung/bronchial cancer
lymphoma, malignant (Non-Hodgkin and/or Hodgkin)
prostate cancer
small intestinal cancer
urinary bladder cancer
vaginal cancer
vulvar squamous cell cancer


Frisch et al. studied the occurrence of previous and subsequent cancer in a group of 831 Danish patients with anal cancer[1]. Multiple cancer occurred predominantly in cases diagnosed with anal cancer before age 60 yrs. Excess types of previous cancers were of the vulva/vagina (OR 15, 95% c.i. = 4.9-48), cervix (4.3, 2.7-6.9), lymphoma/leukemia (3.9, 1.5-10.4). Excess subsequent cancer was noted for lung (2.3, 1.3-3.7), bladder (2.3, 1-4.6), breast (2, 1.2-3.3), vulva/vagina (12.3, 4-28.7) and small intestine (10.8, 1.2-39).
Rabkin et al.[2] examined the incidence of second primary cancers occurring after anal cancer. Data from the Connecticut Tumor Registry for 1935-1988 and eight other US tumor registries for 1973-1988 were used. Patients with a primary diagnosis of anal cancer had relative risks for subsequent invasive and in situ cervical cancer of 1.3 (95% CI 0.2-4.5) and 3.4 (95% CI 0.9-8.8), respectively. Anal cancer was also associated with increased relative risks of subsequent lung (RR = 2.5) and prostate (RR = 1.8) cancers. Subsequent stuies have confirmed the association between anal and cervical cancer[3]. Both of these tumors are HPV infection related.

General aspects to consider with respect to multiple primary tumors:
- Shared genetic (immune response, metabolic/hormonal/DNA-repair pathways) or non-genetic (chemical carcinogens, radiation, viruses, life-style) risk factors
- Therapy (radiation, chemotherapy, hormonal,...) related effects
- Possible bias because of increased surveillance and autopsy findings.


[1] Frisch M, Olsen JH, Melbye M. Malignancies that occur before and after anal cancer: clues to their etiology. Am J Epidemiol 1994; 140(1):12-19.
[2] Rabkin CS, Biggar RJ, Melbye M, Curtis RE. Second primary cancers following anal and cervical carcinoma: evidence of shared etiologic factors. Am J Epidemiol 1992; 136(1):54-58.
[3] Chaturvedi AK, Engels EA, Gilbert ES, Chen BE, Storm H, Lynch CF, Hall P, Langmark F, Pukkala E, Kaijser M, Andersson M, Fosså SD, Joensuu H, Boice JD, Kleinerman RA, Travis LB. Second cancers among 104,760 survivors of cervical cancer: evaluation of long-term risk. Journal of the National Cancer Institute 2007; 99(21):1634-43.