Clarifying Lung Cancer Risk Among Colorectal Cancer Survivors
Principal Investigator
Name
Juan Wisnivesky
Degrees
M.D., DrPH
Institution
Icahn School of Medicine at Mount Sinai
Position Title
Professor
About this CDAS Project
Study
PLCO
(Learn more about this study)
Project ID
PLCO-2036
Initial CDAS Request Approval
Mar 23, 2026
Title
Clarifying Lung Cancer Risk Among Colorectal Cancer Survivors
Summary
Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer-related death in the United States after lung cancer.1 With advances in detection and treatment, there is a rapidly growing population of CRC survivors. As of January 2025, more than 1.4 million CRC survivors live in the United States, with this number projected to continue increasing.2 Secondary cancers are now a major clinical issue for this growing survivor population. CRC survivors are estimated to have a 16% increased risk of developing lung cancer compared to the general population with lung cancer being the second most common site for second primary malignancy.3 The lung is the most common site of metastatic recurrence in rectal cancer specifically, occurring in up to 69% of patients with distant relapse.
Despite the National Lung Screening Trial (NLST) showing that lung cancer screening with the use of low-dose computed tomography (LDCT) resulted in a 20% reduction in mortality from lung cancer19, the current LC screening guidelines were established for the general population, without consideration of prior cancer survivorship. Participants with cancer diagnosis < 5 years have been excluded from prior randomized trials (RCT). But the effective lung cancer screening eligibility criteria among CRC survivors may differ from criteria for the general healthy population. Although most patients with stage I-II BC have a
relatively good prognosis and survival, BC survivors’ benefit/risk ratio from LC screening is likely to differ substantially due to a number of factors including competing risks of death (from cancer recurrence or non-colorectal cancer comorbid conditions). As a result, early harms of LC screening and limited life expectancy due to these competing risks would complicate LC screening regimen selection among CRC survivors and result in considerable practice variability. To our knowledge, no randomized data or consistent observational results exist so far to help guide surveillance imagining for LC screening among CRC survivors. Therefore, better understanding of lung cancer incidence adjusted for major lung cancer risk factors (including smoking, COPD status, and receipt of chemotherapy or radiotherapy) is important for quantifying the benefits of lung cancer screening in this population.
The project aims to explore the joint effects of cigarette smoking and radiotherapy (RT) on LC risk by using a multi-racial and ethnic BC survivor population and further modify PLCOm2012 LC risk model to aid in detecting a second primary lung cancer among CRC survivor earlier in the course of the disease. Smoking patterns and smoking cessation, CRC history, CRC stage and grade, time elapse since CRC Diagnosis date till the 2nd primary LC diagnosis and Radiotherapy treatment will be incorporated for secondary lung cancer risk prediction and survival analysis. Additionally, we will estimate noncancer mortality rates for CRC survivors to understand competing risks of death for this group.
Aims
Aims:
1. Using PLCO lung cancer screening cohort to quantify the unadjusted and adjusted incidence rate of second primary lung cancer in colorectal cancer survivors.
2. Recalculate PLCOm2012 risk score accounting for smoking history, CRC history, CRC stage, receipt of radiotherapy and other previously established PLCOm2012 predictors.
3. Estimate the rate of non-lung cancer and non-colorectal cancer mortality among colorectal cancer survivors in PLCO.
References:
1. Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA Cancer J Clin. 2025;75(1):10-45. doi:10.3322/caac.21871
2. Wagle NS, Nogueira L, Devasia TP, Mariotto AB, Yabroff KR, Islami F, et al. Cancer treatment and survivorship statistics, 2025. CA Cancer J Clin. 2025;75(4):308-340. doi:10.3322/caac.70011
3. Robertson D, Ng SK, Baade PD, Lam AK. Risk of extracolonic second primary cancers following a primary colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis. 2022;37(3):541-551. doi:10.1007/s00384-022-04105-x
Collaborators
Juan Wisnivesky Icahn School of Medicine at Mount Sinai
DANIELA SOLIS Icahn School of Medicine at Mount Sinai
Keith Sigel Icahn School of Medicine at Mount Sinai
Pranav Gwalani Icahn School of Medicine at Mount Sinai
Dana Cavanaugh Icahn School of Medicine at Mount Sinai