Multiple primary versions can arise by themselves, experts say. Researchers look into past treatments, environments and genetics as the culprits.
By Marlene Cimons April 14 at 12:00 PM Noelle Johnson, 42, was diagnosed with her first cancer — a soft tissue sarcoma under her right arm — in 1999 when she was 21. In 2013, her physicians found six different cancers in her breasts. In the years that followed, surgeons discovered and removed numerous masses they deemed “premalignant” from her ovary, her uterus, her leg, arm and chest wall, aiming to get them out before they turned cancerous.
Experts believe that many of these additional primary tumors are the result of earlier treatments for initial cancers that often occur in childhood. Radiation and chemotherapy, while successful in knocking out the first disease, also cause DNA damage. This can prompt new cancers to develop later, among them lymphomas, leukemias, and those of the breast, thyroid or soft tissues.
In 2013, after undergoing a double mastectomy — and before the later masses were found — genetic testing showed she had Li-Fraumeni Syndrome , an inherited familial predisposition to a wide range of specific and often rare cancers, particularly in children and young adults.
Hereditary factors The failure of many physicians to take a family history is one reason it is underreported, she adds. Cancers among closely related family members — especially at a young age — are an important clue. Johnson’s mother, for example, who died at 50, suffered from leiomyosarcoma, an aggressive cancer of the smooth muscle tissue. “Doctors often don’t think about the possibility of an underlying genetic predisposition,” Nichols says.
“It’s not just rare variants that we should be thinking about with multiple cancers, but common variants, possibly many of them,” says Lindsay Morton, a scientist in NCI’s division of cancer epidemiology and genetics.
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