H Krueger, D McLean and D Williams
It was with some surprise, and not a little alarm to read that as a group, Second Primary Cancers (SPC) comprise approximately one sixth of all malignancies. This startling statistic, and the title itself, hooks one into thinking that what is contained within these pages is going to be of vital relevance. It is therefore a disappointment that the book does not live up to these expectations. The authors have delivered a good summary of the issues, including important clarity around definitions of SPC and provide a fairly straightforward way of looking up which SPCs are most common for specific types of primary cancers.
The incidence of SPC is related in part to the great successes achieved through the use of chemotherapy and radiotherapy in the treatment of many malignancies. This is so both because people have sufficient longevity for an SPC to arise and ironically because some of the treatments are clearly indicated as causative of SPCs themselves. The definition of an SPC is not as straightforward as one might think and this monograph does provide a useful discourse on the various issues that have arisen. Management may depend on whether the cancer is regarded as a recurrence or a new primary.
The importance of accurately describing and defining SPC is made in chapter 3, which makes the argument that we can’t prevent them if we don’t have a clear idea what they are. The contributing factors to SPCs are identified as: genetic predisposition that led to the first primary; treatments that may themselves cause new cancers through DNA damage and; behaviours of people such as smoking or exposure to sunlight that provide a sustained increase to risk of a second cancer. In all three cases strategies could be put in place to reduce the burden of SPC and could make a significant impact on cancer incidence as a whole. It is therefore a shame that the brevity of the book does not allow greater discourse on this topic and prevention strategies are dealt with in a cursory and not particularly useful manner.
It would also have been very useful to have had a more clear discourse around the concerns that adjuvant therapies aimed at reducing risk of recurrence may in fact cause a large number of SPCs, and in particular how the risks may be presented to patients considering such treatments. But perhaps that will require a separate monograph itself.
In conclusion, this book does not really live up to its title and as a result will not find a place in the busy schedule of the majority of clinicians, basic researchers or allied health professionals. This is a great shame as the prevention of SPC is indeed an issue of major importance.