Risk of Developing Subsequent Primary Colorectal Cancers Among Non‐Colorectal Cancer Survivors: Implications for Prevention and Screening
7 affiliations
- 1Department of Cancer Epidemiology and Prevention Research Cancer Care Alberta, Arthur Child Cancer Centre Calgary Alberta Canada
- 2Department of Oncology University of Calgary Calgary Alberta Canada
- 3Department of Community Health Sciences University of Calgary Calgary Alberta Canada
- 4Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services Calgary Alberta Canada
- 5Department of Medicine Cumming School of Medicine Calgary Alberta Canada
- 6Division of Hematology, Department of Medicine, Cumming School of Medicine University of Calgary Calgary Alberta Canada
- 7Screening Programs, Provincial Population and Public Health Alberta Health Services Calgary Alberta Canada
Abstract
Cancer survivors have an elevated risk of developing subsequent primary cancers, including colorectal cancer (CRC), and may benefit from tailored screening approaches to reduce incidence and morbidity. A retrospective cohort of adults diagnosed with cancer (excluding CRC) in Alberta, Canada from 2000 to 2021 who survived at least 6 months was used to investigate the incidence of CRC compared to the cancer‐free population. Incidence rate differences and standardized incidence ratios (SIRs) were used to characterize risk across first primary cancer sites, sexes, age groups, and survivorship periods, as well as according to CRC stage, histology, and subsite. Multivariable Fine‐Gray models were used to identify risk factors within site‐specific survivorship groups. Among 172,928 cancer survivors, 1812 were diagnosed with CRC during a median follow‐up of 4.9 years. Compared to the cancer‐free population, survivors had an elevated risk of CRC (SIR = 1.26, 95% CI: 1.20–1.32). The risk of CRC varied across first primary cancer sites but remained elevated among both short‐ and long‐term survivors. Cancer survivors were at an elevated risk of developing late stage (III/IV) CRC compared to the cancer‐free population with the highest risk in the proximal colon and among long‐term survivors (5+ years). Depending on the first primary cancer site, risk factors for subsequent CRC included older age at diagnosis, male sex, overweight/obese body mass index, earlier stage at diagnosis, and treatment type. These findings demonstrate the importance of improving adherence to CRC screening guidelines among cancer survivors. Greater research is needed to identify high‐risk survivorship groups who may require enhanced screening.
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BibTeX
@article{osullivan2026risk,
title = {{Risk of Developing Subsequent Primary Colorectal Cancers Among Non‐Colorectal Cancer Survivors: Implications for Prevention and Screening}},
author = {Dylan E. O'Sullivan and Robert J. Hilsden and Hannah Harsanyi and Matthew T. Warkentin and Kareem Jamani and Huiming Yang and Darren R. Brenner and Safiya Karim and Winson Y. Cheung and Yibing Ruan},
journal = {International Journal of Cancer},
year = {2026},
month = aug,
doi = {10.1002/ijc.70690},
url = {https://doi.org/10.1002/ijc.70690},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Risk of Developing Subsequent Primary Colorectal Cancers Among Non‐Colorectal Cancer Survivors: Implications for Prevention and Screening
AU - Dylan E. O'Sullivan
AU - Robert J. Hilsden
AU - Hannah Harsanyi
AU - Matthew T. Warkentin
AU - Kareem Jamani
AU - Huiming Yang
AU - Darren R. Brenner
AU - Safiya Karim
AU - Winson Y. Cheung
AU - Yibing Ruan
PY - 2026
DA - 2026/08/09
JO - International Journal of Cancer
DO - 10.1002/ijc.70690
UR - https://doi.org/10.1002/ijc.70690
AB - Cancer survivors have an elevated risk of developing subsequent primary cancers, including colorectal cancer (CRC), and may benefit from tailored screening approaches to reduce incidence and morbidity. A retrospective cohort of adults diagnosed with cancer (excluding CRC) in Alberta, Canada from 2000 to 2021 who survived at least 6 months was used to investigate the incidence of CRC compared to the cancer‐free population. Incidence rate differences and standardized incidence ratios (SIRs) were used to characterize risk across first primary cancer sites, sexes, age groups, and survivorship periods, as well as according to CRC stage, histology, and subsite. Multivariable Fine‐Gray models were used to identify risk factors within site‐specific survivorship groups. Among 172,928 cancer survivors, 1812 were diagnosed with CRC during a median follow‐up of 4.9 years. Compared to the cancer‐free population, survivors had an elevated risk of CRC (SIR = 1.26, 95% CI: 1.20–1.32). The risk of CRC varied across first primary cancer sites but remained elevated among both short‐ and long‐term survivors. Cancer survivors were at an elevated risk of developing late stage (III/IV) CRC compared to the cancer‐free population with the highest risk in the proximal colon and among long‐term survivors (5+ years). Depending on the first primary cancer site, risk factors for subsequent CRC included older age at diagnosis, male sex, overweight/obese body mass index, earlier stage at diagnosis, and treatment type. These findings demonstrate the importance of improving adherence to CRC screening guidelines among cancer survivors. Greater research is needed to identify high‐risk survivorship groups who may require enhanced screening.
SN - 0020-7136
SN - 1097-0215
ER -