Time from incident primary cancer until recurrence or second primary cancer: Risk factors and impact in general practice

Eur J Cancer Care (Engl). 2019 Sep;28(5):e13123. doi: 10.1111/ecc.13123. Epub 2019 Jun 24.


Objective: Specialised follow-up care after cancer treatment is changing towards increased involvement of general practice. To ensure timely detection of new cancer events, knowledge is warranted on the timing of cancer recurrence (CR) and second primary cancer (SPC), including risk factors for CR.

Methods: This population-based register study included 67,092 patients diagnosed with malignant melanoma, bladder, lung, ovarian, endometrial, colorectal and breast cancer in Denmark in 2008-2016. The time from primary cancer to CR or SPC and risk factors for prolonged time to CR were analysed and stratified on sex and primary cancer type.

Results: Cancer recurrence proportions ranged from 6% to 35%. The risk of CR increased profoundly within the first 3 years and then levelled off, except for breast cancer. A total of 3%-6% of patients had SPC, with monotonously increasing cumulative incidence proportions. Besides primary tumour characteristics, lower educational level, living alone and comorbidity were associated with earlier CR. For example, in female malignant melanoma, HRs and 95% confidence intervals were 0.47 (0.37-0.61) for high educational level, 1.40 (1.16-1.68) for living alone and 2.38 (1.53-3.70) for high comorbidity.

Conclusion: The results may inform stratified risk assessment in decision of frequency, location and duration of post-cancer follow-up care.

Keywords: cancer survivors; care transition; primary health care; recurrence; second primary neoplasms.

MeSH terms

  • Aftercare*
  • Aged
  • Breast Neoplasms / pathology
  • Breast Neoplasms / therapy
  • Cancer Survivors
  • Colorectal Neoplasms / pathology
  • Colorectal Neoplasms / therapy
  • Comorbidity
  • Denmark / epidemiology
  • Disease-Free Survival
  • Educational Status
  • Endometrial Neoplasms / pathology
  • Endometrial Neoplasms / therapy
  • Female
  • General Practice
  • Humans
  • Incidence
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy
  • Male
  • Melanoma / pathology
  • Melanoma / therapy
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology*
  • Neoplasms / pathology
  • Neoplasms / therapy*
  • Neoplasms, Second Primary / epidemiology*
  • Ovarian Neoplasms / pathology
  • Ovarian Neoplasms / therapy
  • Proportional Hazards Models
  • Registries
  • Residence Characteristics
  • Sex Factors
  • Skin Neoplasms / pathology
  • Skin Neoplasms / therapy
  • Time Factors
  • Urinary Bladder Neoplasms / pathology
  • Urinary Bladder Neoplasms / therapy

Supplementary concepts

  • Melanoma, Cutaneous Malignant