Abstract P3-01-04: Racial and ethnic disparities in the development of second primary solid tumor malignancies in breast cancer survivors

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Abstract Background: Cancer is the second most common cause of death in the United States and breast cancer (BC) is projected to be the most common cancer diagnosis in 2024. Further, BC, lung/bronchus, colorectal and pancreatic cancers are projected to contribute to nearly 50% of all cancer deaths. Prior SEER analysis of early-stage BC survivors demonstrated a statistically significant increase in the development of lung, tongue, salivary gland, gastric, colon and genitourinary cancers compared to the general population. However, very little is known about the racial differences in the development of second primary malignancies (SPM) in BC. Hence, we investigated the development of solid tumor SPM in BC survivors across different racial and ethnic groups. Methods: We conducted a retrospective analysis of the Surveillance, Epidemiology and End Results (SEER) 17 registries database and identified the cases diagnosed with BC as their primary malignancy between the years 2000 to 2021. These cases were followed for several years, and the standardized incidence ratios (SIR) for the development of SPMs in BC were calculated. The analysis was stratified by the following races and ethnicities: Non-Hispanic Whites (NHW), Non-Hispanic Blacks (NHB), Non-Hispanic American Indian/Non-Hispanic Alaska Native (NHAI/NHAN), Non-Hispanic Asian or Pacific Islander (NHAPI), Hispanic (H). Results: A total of 703991 NHW, 105014 NHB, 4712 NHAI/NHAN, 90295 NHAPI and 118500 H were included in the SPM analysis. The risk of developing solid tumor SPMs after BC was increased in all groups with SIR ranging from 1.14 in NHW to 1.83 in NHAI/NHAN (p<0.05). Within this, all groups had a statistically significant increased risk for developing second primary BC and endocrine malignancies, particularly thyroid cancer. The mean age for developing second primary BC ranges from 61.2 years (y) in Hispanics to 67.99 y in NHW. The total SIR for second primary BC was highest in NHBs (NHW – 1.31, NHB 2.07, NHAI/NHAN – 1.84, NHAPI 1.85, H – 1.58, p<0.05), which peaks (SIR: 2.61, p<0.05) at a latency of 10+ years after initial BC diagnosis. NHAPI were at the highest risk for development of thyroid cancer (SIR 2.22), followed by Hispanics (SIR 1.96), NHAI/NHAN (SIR 1.91), NHB (SIR 1.63) and NHW (1.4) (p<0.05). Further, there was a statistically significant increase in the risk for developing kidney and pancreatic cancers in various groups. The total SIR for kidney cancer was highest in NHAI/NHAN at 2.57, followed NHAPI at 1.55, NHB at 1.44, H at 1.4 and NHW at 1.1 (p<0.05)). Pancreatic cancer was relatively more common in BC survivors among NHAI/NHAN (SIR 1.76) and NHAPI (SIR 1.49) (p<0.05). NHAI/NHAN BC survivors seem to be particularly prone to developing SPMs with elevated SIRs such as – other oral cavity and pharynx (40.3), larynx (10.97), melanoma of skin (12.54), skin excluding basal and squamous (9.18), anus, anal canal and anorectum (5.48), cecum (2.86), colon, rectum and anus (1.79) and lung/bronchus (1.78) (all p<0.05). Interestingly, Hispanic BC survivors were more prone to stomach cancer with SIR 2.23 (p<0.05). There was also a higher incidence of salivary gland and soft tissues malignancies including the heart in all groups except NHAI/NHAN (p<0.05). Conclusion: There is a statistically significant increase in the development of solid tumor SPMs across all races and ethnicities, with a disproportionate increase in the NHAI/NHAN (head and neck, skin and GI cancers), NHAPI (thyroid, BC, kidney and pancreas) and NHB (BC) emphasizing the importance of survivorship care that is accessible to all races and ethnicities. Further, there is a need to tailor the survivorship practices to each race and ethnicity depending on their specific risk for certain malignancies. Citation Format: Kriti Ahuja, Malak Alharbi, Jayasree Krishnan, Zunairah Shah, Shipra Gandhi, Arya Mariam Roy. Racial and ethnic disparities in the development of second primary solid tumor malignancies in breast cancer survivors [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P3-01-04.

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