Introduction Cervical cancer is the fourth most common cancer in women worldwide. This study aims to determine whether a history of cervical cancer is associated with an increased risk of a second primary (SP) compared to women without a history of cervical cancer.

Methods Using the SEER database from 2000-2020, we calculated multiple primary standardized incidence ratios (MP-SIRs) across race/ethnicity in cervical cancer patients. Included in the analyses were non-Hispanic Whites (Whites), non-Hispanic Blacks (Blacks), non-Hispanic Asian/Pacific Islanders (APIs), and Hispanic Whites (Hispanics). We examined MP-SIRs for the following malignancies: all sites, all solid tumors, colon and rectum, lung and bronchus, breast, female genital system, urinary system, thyroid, and hematopoietic cancers. Demographic and clinical characteristics were compared across SP status (none vs. any) in all cervical cancer patients to determine which factors were associated with risk of SP.

Results Included in the analyses were 58,414 women with a history of primary cervical cancer, of whom 3,747 (6.4%) developed SP. Of these 3,747 patients, 2,129 were White, 549 Black, 317 API, and 752 Hispanic. The MP-SIRs in all sites combined was significantly higher in all races (p<0.05), with Blacks having the highest MP-SIR at 1.79 (95% CI: 1.64-1.94) compared to 1.40 (95% CI 1.34-1.46) in Whites, 1.46 (95% CI 1.30-1.63) in APIs and 1.25 (95% 1.17-1.35) in Hispanics. The most marked increases in risk of a SP were cancers of the colon and rectum, lung and bronchus, female genital system, and urinary system. Characteristics associated with increased risk of a SP included older age at diagnosis (p<0.01), not having a surgical resection (p=0.02), undergoing radiotherapy (p<0.001), and a longer interval between diagnosis and treatment (p=0.02).

Conclusion/Implications There is a significant association with black ethnicity and risk of developing a SP cancer in cervical cancer patients, highlighting the importance of optimizing screening and careful monitoring for SP.