Kashmir Study Finds Many Cancer Survivors Developing Second Primary Tumours | Kashmir Life

SRINAGAR: A major cancer study from Kashmir has revealed that a significant number of patients treated for cancer later develop a completely new and separate malignancy, with gastrointestinal cancers dominating the trend in the Valley’s high-risk population.

The five-year study, Dual Primary Malignancies in Kashmir: A Five-Year Analysis of Temporal Patterns, Gender-Specific Presentations and Treatment Outcomes in a High Gastrointestinal Cancer Risk Population, was conducted by researchers including Ubaid Jeelani, Mushood Ghulam Nabi and Gowher Ahmad Wagai at the Department of Radiation Oncology, Government Medical College Srinagar.

Researchers reviewed records of 5,731 cancer patients treated between January 2020 and December 2024 and identified 35 patients who developed “dual primary malignancies”, meaning two distinct cancers unrelated to metastasis or recurrence.

The study found an incidence rate of 0.611 percent, with 60 percent of cases being “synchronous” cancers detected simultaneously or within six months, while 40 percent were “metachronous”, appearing months or years later.

The researchers said the findings point towards a “growing challenge” among long-term cancer survivors in Kashmir.

“Over 80 percent of patients had at least one gastrointestinal tumour,” the paper noted, highlighting the Valley’s unusually high burden of GI cancers.

According to the study, gastrointestinal cancers accounted for 43 percent of first primary tumours and 40 percent of second malignancies. Researchers linked the trend to Kashmir’s dietary and environmental risk factors, including consumption of salt-preserved foods, smoked meats and widespread tobacco use.

“Prior research from Kashmir has documented an exceptionally high incidence of gastric cancer and other GI malignancies in the local population,” the study observed.

Among the 35 patients studied, males slightly outnumbered females overall, though women were more likely to present with synchronous cancers. The median age at diagnosis was 58 years, with most cases occurring in people aged between 41 and 70 years.

The study also documented striking cancer pairings. Four out of seven breast cancer patients later developed thyroid cancer, while some patients showed combinations of colon and endometrial cancers, patterns researchers said may indicate hereditary cancer syndromes such as Cowden or Lynch syndrome.

“One patient in our series had synchronous colon and endometrial carcinomas, a classic Lynch syndrome scenario,” the researchers wrote.

The interval between the first and second cancer ranged from 10 months to 19 years, with an average gap of nearly six years.

Despite the complexity of managing two separate cancers, the study reported that most patients underwent aggressive curative treatment. Nearly two-thirds of synchronous cases underwent surgeries for both tumours, while many others received chemotherapy, radiotherapy or hormonal therapy.

The researchers noted that improved cancer survival rates are now leading to more second primary cancers worldwide, but warned that resource limitations in Kashmir may mean many cases still go undetected.

The study stressed the need for lifelong surveillance of cancer survivors, greater use of advanced imaging such as PET-CT scans, and access to genetic testing to identify inherited cancer syndromes early.

“Second primary cancers pose a real and growing challenge, but one that can be mitigated by awareness, early detection, and advances in oncologic care,” the paper concluded.