Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-30T23:32:03.206Z Has data issue: false hasContentIssue false
  • English
  • Français

Cancer risk among patients with congenital heart defects: a nationwide follow-up study

Published online by Cambridge University Press:  18 January 2013

Morten Olsen ,
Ester Garne ,
Claus Sværke ,
Lars Søndergaard ,
Henrik Nissen ,
Henrik Ø. Andersen ,
Vibeke E. Hjortdal ,
Søren P. Johnsen  and
Jørgen Videbæk
Morten Olsen*
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Ester Garne
Affiliation:
Department of Paediatrics, Hospital Lillebaelt, Kolding, Denmark
Claus Sværke
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Lars Søndergaard
Affiliation:
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Heart Centre, Copenhagen, Denmark
Henrik Nissen
Affiliation:
Department of Cardiology, Odense University Hospital, Odense, Denmark
Henrik Ø. Andersen
Affiliation:
Department of Cardiothoracic Surgery, Rigshospitalet – Copenhagen University Hospital, Heart Centre, Copenhagen, Denmark
Vibeke E. Hjortdal
Affiliation:
Department of Cardiothoracic Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
Søren P. Johnsen
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Jørgen Videbæk
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
*
Correspondence to: Dr M. Olsen, MD, PhD, Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark. Tel: +4589424811; Fax: +4589424801; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

We aimed to assess cancer risk in congenital heart defect patients, with and without Down's syndrome, compared with the general population.

Methods

We identified all patients born and diagnosed with congenital heart defects from 1977 to 2008 using the Danish National Registry of Patients, covering all Danish hospitals. We compared cancer incidence in the congenital heart defect cohort with that expected in the general population (∼5.5 million) using the Danish Cancer Registry, and computed age- and gender-standardised incidence ratios.

Results

We identified 15,905 congenital heart defect patients, contributing a total of 151,172 person-years at risk; the maximum length of follow-up was 31 years (median 8 years). In all, 53 patients were diagnosed with cancer, including 30 female and 23 male patients (standardised incidence ratio = 1.63; 95% confidence interval: 1.22–2.13). Risks were increased for leukaemia, brain tumours, and basal cell carcinoma. After excluding 801 patients with Down's syndrome, the standardised incidence ratio was 1.19 (95% confidence interval: 0.84–1.64). In the subgroup of 5660 non-Down's syndrome patients undergoing cardiac surgery or catheter-based interventions, the standardised incidence ratio was 1.45 (95% confidence interval: 0.86–2.29).

Conclusion

The overall risk of cancer among congenital heart defect patients without Down's syndrome was not statistically significantly elevated. Cancer risk in the congenital heart defect cohort as a whole, including patients with Down's syndrome, was increased compared with the general population, although the absolute risk was low. Studies with longer follow-up and more information on radiation doses are needed to further examine a potential cancer risk associated with diagnostic radiation exposure.

Keywords

Long-term prognosispopulation-based data.
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 1 , February 2014 , pp. 40 - 46
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Nieminen, H, Jokinen, E, Sairanen, H. Causes of late deaths after pediatric cardiac surgery: a population-based study. J Am Coll Cardiol 2007; 50: 1263–1271.Google Scholar
2. Khairy, P, Ionescu-Ittu, R, Mackie, AS, Abrahamowicz, M, Pilote, L, Marelli, AJ. Changing mortality in congenital heart disease. J Am Coll Cardiol 2010; 56: 1149–1157.Google Scholar
3. Opotowsky, AR, Siddiqi, OK, Webb, GD. Trends in hospitalizations for adults with congenital heart disease in the U.S. J Am Coll Cardiol 2009; 54: 460–467.CrossRefGoogle ScholarPubMed
4. Andreassi, MG. Radiation risk from pediatric cardiac catheterization: friendly fire on children with congenital heart disease. Circulation 2009; 120: 1847–1849.CrossRefGoogle ScholarPubMed
5. Jongmans, MC, van der Burgt, I, Hoogerbrugge, PM, et al. Cancer risk in patients with Noonan syndrome carrying a PTPN11 mutation. Eur J Hum Genet 2011; 19: 870–874.CrossRefGoogle ScholarPubMed
6. Alter, BP. Cancer in Fanconi anemia, 1927–2001. Cancer 2003; 97: 425–440.CrossRefGoogle ScholarPubMed
7. Hasle, H, Clemmensen, IH, Mikkelsen, M. Risks of leukaemia and solid tumours in individuals with Down's syndrome. Lancet 2000; 355: 165–169.Google Scholar
8. Bacher, K, Bogaert, E, Lapere, R, De Wolf, D, Thierens, H. Patient-specific dose and radiation risk estimation in pediatric cardiac catheterization. Circulation 2005; 111: 83–89.Google Scholar
9. Hoffmann, A, Engelfriet, P, Mulder, B. Radiation exposure during follow-up of adults with congenital heart disease. Int J Cardiol 2007; 118: 151–153.Google Scholar
10. Rajaraman, P, Simpson, J, Neta, G, et al. Early life exposure to diagnostic radiation and ultrasound scans and risk of childhood cancer: case–control study. BMJ 2011; 342: d472.Google Scholar
11. Beels, L, Bacher, K, De Wolf, D, Werbrouck, J, Thierens, H. gamma-H2AX foci as a biomarker for patient X-ray exposure in pediatric cardiac catheterization: are we underestimating radiation risks? Circulation 2009; 120: 1903–1909.CrossRefGoogle ScholarPubMed
12. Modan, B, Keinan, L, Blumstein, T, Sadetzki, S. Cancer following cardiac catheterization in childhood. Int J Epidemiol 2000; 29: 424–428.Google Scholar
13. McLaughlin, JR, Kreiger, N, Sloan, MP, Benson, LN, Hilditch, S, Clarke, EA. An historical cohort study of cardiac catheterization during childhood and the risk of cancer. Int J Epidemiol 1993; 22: 584–591.Google Scholar
14. Olsen, M, Videbæk, J, Johnsen, SP. The danish register of congenital heart disease. Scand J Public Health 2011; 39: 50–53.Google Scholar
15. Hasle, H. Pattern of malignant disorders in individuals with Down's syndrome. Lancet Oncol 2001; 2: 429–436.Google Scholar
16. UNSCEAR report 2006, vol. I Annex A. The United Nations Scientific Committee on the Effects of Atomic Radiation. http://www.unscear.org/docs/reports/2006/07-82087_Report_Annex_A_2006_Web_corr.pdf.Google Scholar
17. Ron, E, Modan, B, Boice, JD, et al. Tumors of the brain and nervous system after radiotherapy in childhood. N Engl J Med 1988; 319: 1033–1039.CrossRefGoogle ScholarPubMed
18. Pearce, MS, Salotti, JA, Little, MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet 2012; 380: 499–505.Google Scholar
19. Storm, HH, Michelsen, EV, Clemmensen, IH, Pihl, J. The Danish Cancer Registry – history, content, quality and use. Dan Med Bull 1997; 44: 535–539.Google Scholar
20. Seguchi, S, Aoyama, T, Koyama, S, Kawaura, C, Fujii, K. Evaluation of exposure dose to patients undergoing catheter ablation procedures – a phantom study. Eur Radiol 2008; 18: 2559–2567.Google Scholar
21. Kleinerman, RA. Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatr Radiol 2006; 36 (Suppl 2): 121–125.Google Scholar
22. Ait-Ali, L, Andreassi, MG, Foffa, I, Spadoni, I, Vano, E, Picano, E. Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease. Heart 2010; 96: 269–274.Google Scholar
23. Shilnikova, NS, Preston, DL, Ron, E, et al. Cancer mortality risk among workers at the Mayak nuclear complex. Radiat Res 2003; 159: 787–798.Google Scholar
24. Boothroyd, A, McDonald, E, Moores, BM, Sluming, V, Carty, H. Radiation exposure to children during cardiac catheterization. Br J Radiol 1997; 70: 180–185.Google Scholar
25. Waldman, JD, Rummerfield, PS, Gilpin, EA, Kirkpatrick, SE. Radiation exposure to the child during cardiac catheterization. Circulation 1981; 64: 158–163.CrossRefGoogle Scholar
26. Jepsen, B, Jepsen, P, Johnsen, SP, Espersen, GT, Sørensen, HT. Validity of diagnoses of cardiac malformations in a Danish population-based hospital-discharge registry. Int J Risk Saf Med 2006; 18: 77–81.Google Scholar
27. Sørensen, HT, Mellemkjær, L, Skriver, MV, et al. Fever of unknown origin and cancer: a population-based study. Lancet Oncol 2005; 6: 851–855.CrossRefGoogle ScholarPubMed
28. Healthcare in Denmark. http://www.sum.dk/Aktuelt/Publikationer/Publikationer/UK_Healthcare_in_DK.aspx.Google Scholar
Supplementary material: File

Olsen Supplementary Material

Appendix

Download Olsen Supplementary Material(File)
File 42.5 KB