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Cancer incidence among children and young adults who have undergone x-ray guided cardiac catheterization procedures

Lookup NU author(s): Dr Richard Harbron, Dr Claire-Louise Chapple, Dr John O'Sullivan, Dr Manuel Higueras, Professor Mark PearceORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


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 cardiaccatheterizations while aged ≤22 years in the UK, was established from hospital records. Radiationdoses from cardiac catheterizations and CT scans were estimated. The cohort was matched with theNHS Central Register and NHS Transplant Registry to determine cancer incidence and transplantationstatus. Standardized incidence ratios (SIR) with associated confidence intervals (CI) were calculated.The excess relative risk (ERR) of haematological neoplasia was also calculated using Poissonregression. 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, posttransplant,the SIR was reduced to 0.90 (95% CI: 0.49, 1.49) for all malignancies. All lymphomasdeveloped post-transplant. The SIR for all malignancies developing 5 years from the first cardiaccatheterization (2 years for leukaemia/lymphoma) remained raised (3.01, 95% CI: 2.09, 4.19) but wasagain reduced after censoring transplant recipients (0.98, 95% CI: 0.48, 1.77). The ERR per mGybone marrow dose for haematological neoplasia was reduced from 0.541 (95% CI: 0.104, 1.807) to0.018 (95% CI: -0.002, 0.096) where transplantation status was accounted for as a time-dependentbackground risk factor. In conclusion, transplantation appears to be a large contributor to elevatedcancer rates in this patient group. This is likely to be mainly due to associated immunosuppression,however, radiation exposure may also be a contributing factor.

Publication metadata

Author(s): Harbron RW, Chapple CL, O'Sullivan JJ, Lee C, McHugh K, Higueras M, Pearce MS

Publication type: Article

Publication status: Published

Journal: European Journal of Epidemiology

Year: 2018

Volume: 33

Issue: 4

Pages: 393-401

Print publication date: 01/04/2018

Online publication date: 18/01/2018

Acceptance date: 06/01/2018

Date deposited: 12/01/2018

ISSN (print): 0393-2990

ISSN (electronic): 1573-7284

Publisher: Springer


DOI: 10.1007/s10654-018-0357-0


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Funder referenceFunder name
PG/15/1/31217British Heart Foundation