Increased Cancer Incidence Following up to 15 Years after Cardiac Catheterization in Infants under One Year between 1980 and 1998—A Single Center Observational Study

Abstract

Objective: To evaluate the incidence of cancer within the first 15 years of life in children who underwent cardiac catheterization under the age of one year. Methods: In this retrospective, single center study, 2770 infants (7.8% with trisomy 21) were studied. All infants underwent cardiac catheterization under one year of age between January 1980 and December 1998. Newly diagnosed cancer in the first 15 years of life was assessed through record linkage to the German Childhood Cancer Registry (GCCR). Cancer risk in study patients was compared to the GCCR population of children less than 15 years. Patients with trisomy 21 were compared to the Danish Cytogenic Register for trisomy 21. Effective radiation doses were calculated for each tumor patient and 60 randomly selected patients who did not develop cancer. Results: In total, 24,472.5 person-years were analyzed. Sixteen children developed cancer, while 3.64 were expected (standardized incidence ratio (SIR) = 4.4, 95% confidence interval (CI): 2.5–7.2, p < 0.001). There was no preferred cancer type. The observed incidence of leukemia and solid tumors in trisomy 21 was only slightly higher (1 in 476 py) than expected (1 in 609 py, p = 0.64). There was no direct relationship between the radiation dose and the incidence of cancer. Conclusion: Cardiac catherization in the first year of life was associated with a significantly increased cancer risk in a population with congenital heart disease.

Risk of cancer in young and older patients with congenital heart disease and the excess risk of cancer by syndromes, organ transplantation and cardiac surgery: Swedish health registry study (1930–2017)

“…There is also an ongoing discussion about the role of low-ionisation radiation and the risk for cancer in CHD patients. 10 , 11 , 29 Unfortunately, in this study, we had no data describing the amount of radiation to which the patients were exposed. One can argue that it is likely that patients who have undergone surgery have received more radiation.…”

“… 7 , 8 , 9 In our recent report, we found that the overall risk of cancer in children and young adult patients with CHD in Sweden was more than twice as high as that of matched controls without CHD, 7 similar to previous studies. 8 , 9 The cause of this association is likely multifactorial, and radiation exposure 9 , 10 , 11 and underlying syndromes 12 , 13 may be possible factors.…”

The HARMONIC project: Study design for assessment of cancer risks following cardiac fluoroscopy in childhood

“…A recent study of 11 270 children who received cardiac catheterisations in the UK [22] found an increased incidence of cancer, although this appeared to be largely associated with transplantation, rather than radiation exposure. Another recent study [19] reported 16 incident cases versus 3.64 expected among a cohort of 2770 German children exposed below age one year. All the above studies featured relatively small sample sizes, limiting power to detect excess risks at low doses.…”

Congenital Heart Disease and the Risk of Cancer: An Update on the Genetic Etiology, Radiation Exposure Damage, and Future Research Strategies

“…Several epidemiological studies have been conducted to assess the risk of cancer in children exposed to radiation during cardiac catheterization procedures [ 35 , 36 , 37 , 38 , 39 , 40 , 41 ], yielding conflicting and inconclusive results ( Table 3 ).…”