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2018 ; 33
(4
): 393-401
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Cancer incidence among children and young adults who have undergone x-ray guided
cardiac catheterization procedures
#MMPMID29349586
Harbron RW
; Chapple CL
; O'Sullivan JJ
; Lee C
; McHugh K
; Higueras M
; Pearce MS
Eur J Epidemiol
2018[Apr]; 33
(4
): 393-401
PMID29349586
show ga
Children and young adults with heart disease appear to be at increased risk of
developing cancer, although the reasons for this are unclear. A cohort of 11,270
individuals, who underwent cardiac catheterizations while aged ? 22 years in the
UK, was established from hospital records. Radiation doses from cardiac
catheterizations and CT scans were estimated. The cohort was matched with the NHS
Central Register and NHS Transplant Registry to determine cancer incidence and
transplantation status. Standardized incidence ratios (SIR) with associated
confidence intervals (CI) were calculated. The excess relative risk (ERR) of
lymphohaematopoietic neoplasia was also calculated using Poisson regression. The
SIR was raised for all malignancies (2.32, 95% CI 1.65, 3.17), lymphoma (8.34,
95% CI 5.22, 12.61) and leukaemia (2.11, 95% CI 0.82, 4.42). After censoring
transplant recipients, post-transplant, the SIR was reduced to 0.90 (95% CI 0.49,
1.49) for all malignancies. All lymphomas developed post-transplant. The SIR for
all malignancies developing 5 years from the first cardiac catheterization
(2 years for leukaemia/lymphoma) remained raised (3.01, 95% CI 2.09, 4.19) but
was again reduced after censoring transplant recipients (0.98, 95% CI 0.48,
1.77). The ERR per mGy bone marrow dose for lymphohaematopoietic neoplasia was
reduced from 0.541 (95% CI 0.104, 1.807) to 0.018 (95% CI - 0.002, 0.096) where
transplantation status was accounted for as a time-dependent background risk
factor. In conclusion, transplantation appears to be a large contributor to
elevated cancer rates in this patient group. This is likely to be mainly due to
associated immunosuppression, however, radiation exposure may also be a
contributing factor.