***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The introduction of new treatments for esophageal cancer including surgery , chemotherapy , radiotherapy , or a combination of these modalities has not only improved patient survival , but may also increase the risk of the second primary cancers . The available evidence is conflicting with most risk estimates based on sparse numbers . Here we estimated st and ardized incidence ratios ( SIRs ) of second cancer among 24,557 esophageal cancer survivors ( at least 2 months ) in the Surveillance , Epidemiology , and End Results ( SEER ) Program between 1973 and 2007 , who had been followed up for median 6.5 years ( range 2 months-29.3 years ) .  Second cancer risk was statistically significantly elevated ( SIR = 1.34 , 95 % confidence interval [CI]= 1.25 - 1.42 ) among the survivors compared with the general population ; the SIRs for cancers of oral and pharynx , stomach , small intestine , larynx , lung and bronchus , thyroid and prostate cancer were 8.64 ( 95 % CI = 7.36 - 10.07 ) , 2.87 ( 95 % CI = 2.10 - 3.82 ) , 3.80 ( 95 % CI = 1.82 - 7.00 ) , 3.19 ( 95 % CI = 2.12 - 4.61 ) , 1.68 ( 95 % CI = 1.46 - 1.93 ) , 2.50 ( 95 % CI = 1.25 - 4.47 ) , and 0.77 ( 95 % CI = 0.65 - 0.90 ) , respectively . Radiotherapy  raised cancer risk of larynx ( SIR = 3.98 , 95 % CI = 2.43 - 6.14 ) and thyroid ( SIR = 3.57 , 95 % CI = 1.54 - 7.03 ) among all esophageal cancer survivors . For patients who had 5 - 9 years of follow up after radiotherapy , the SIR for lung cancer was 3.46 ( 95 % CI = 2.41 - 4.82 ) . Patients with esophageal cancer are at increased risks of second cancers of oral and pharynx , larynx , lung , and thyroid , while at a decreased risk for prostate cancer . These findings indicate that  radiotherapy for esophageal cancer patients may increase risk of developing second cancers of larynx , lung , and thyroid . Thus , r and omized clinical trials to address the association of radiotherapy and the risk of secondary cancer are warranted We studied the risk of the development of acute myeloid leukemia ( AML ) during initial remission in 733 consecutive children with acute lymphoid leukemia ( ALL ) who were treated with intensive chemotherapy .  This complication was identified according to st and ard morphologic and cytochemical criteria in 13 patients 1.2 to 6 years ( median , 3.0 ) after the diagnosis of ALL . At three years of follow-up , the cumulative risk of secondary AML during the first bone marrow remission was 1.6 percent ( 95 percent confidence limits , 0.7 and 3.5 percent ) ; at six years , it was 4.7 percent ( 2 and 10 percent ) . The development of secondary AML was much more likely among patients with a T-cell than a non-T-cell immunophenotype ( cumulative risk , 19.1 percent [ 6 and 47 percent ] at six years ) . Sequential cytogenetic studies in 10 patients revealed entirely different karyotypes in 9 , suggesting the induction of a second neoplasm . In eight of these patients , the blast cells had abnormalities of the 11q23 chromosomal region , which has been associated with malignant transformation of a pluripotential stem cell . There was no evidence of loss of DNA from chromosome 5 or 7 , a karyotypic change commonly observed in cases of AML secondary to treatment with alkylating agents , irradiation , or both . We conclude that there is a substantial risk of AML in patients who receive intensive treatment for ALL , especially in those with a T-cell immunophenotype , and that 11q23 chromosomal abnormalities may be important in the pathogenesis of this complication IMPORTANCE Screening for lung cancer has the potential to reduce mortality , but in addition to detecting aggressive tumors , screening will also detect indolent tumors that otherwise may not cause clinical symptoms . These overdiagnosis cases represent an important potential harm of screening because they incur additional cost , anxiety , and morbidity associated with cancer treatment . OBJECTIVE To estimate overdiagnosis in the National Lung Screening Trial ( NLST ) . DESIGN , SETTING , AND PARTICIPANTS We used data from the NLST , a r and omized trial comparing screening using low-dose computed tomography ( LDCT ) vs chest radiography ( CXR )  among 53 452 persons at high risk for lung cancer observed for 6.4 years , to estimate the excess number of lung cancers in the LDCT arm of the NLST compared with the CXR arm . MAIN OUTCOMES AND MEASURES We calculated 2 measures of overdiagnosis : the probability that a lung cancer detected by screening with  LDCT is an overdiagnosis ( PS ) , defined as the excess lung cancers detected by LDCT divided by all lung cancers detected by screening in the LDCT arm ; and the number of cases that were considered overdiagnosis relative to the number of persons needed to screen to prevent 1 death from lung cancer . RESULTS During follow-up , 1089 lung cancers were reported in the LDCT arm and 969 in the CXR arm of the NLST . The probability is 18.5 % ( 95 % CI , 5.4%-30.6 % ) that any lung cancer detected by screening with LDCT was an overdiagnosis , 22.5 % ( 95 % CI , 9.7%-34.3 % ) that a non-small cell lung cancer detected by LDCT was an overdiagnosis , and 78.9 % ( 95 % CI , 62.2%-93.5 % ) that a bronchioalveolar lung cancer detected by LDCT was an overdiagnosis . The number of cases of overdiagnosis found among the 320 participants who would need to be screened in the NLST to prevent 1 death from lung cancer  was 1.38 . CONCLUSIONS AND RELEVANCE More than 18 % of all lung cancers detected by LDCT in the NLST seem to be indolent , and overdiagnosis should be considered when describing the risks of LDCT screening for lung cancer 
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Conclusion Overall , the risk of developing MPCs appears to have increased since the 1980s when considering studies of all primary cancer sites combined from the USA and Australia but not from Europe .