Lympho-hematopoietic malignancies risk after exposure to low dose ionizing radiation during cardiac catheterization in childhood

Abalo, Kossi; Malekzadeh‐Milani, Sophie; Hascoët, Sébastien; Dreuil, Serge; Feuillet, Tiphaine; Damon, Cécilia; Bouvaist, Hélène; Bouzguenda, Ivan; Cohen, Sarah; Dauphin, Claire; Filippo, Sylvie Di; Douchin, Stéphanie; Godart, François; Guérin, Patrice; Helms, Pauline; Karsenty, Clément; Lefort, Bruno; Mauran, Pierre; Ovaert, Caroline; Piéchaud, Jean-François; Thambo, Jean-Benoît; Lee, Choonsik; Little, Mark P.; Bonnet, Damien; Bernier, Marie‐Odile; Rage, Estelle

doi:10.1007/s10654-023-01010-7

Cited by 4 publications

(1 citation statement)

References 47 publications

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“…The origins and the risk factors contributing to the acquired cancer risk in CHD remain largely elusive, and exposure to ionizing radiation (IR) from X-ray examinations and fluoroscopically guided cardiac catheterization (cath) procedures is considered a potentially relevant factor [ 3 – 9 ], particularly in patients receiving repetitive and cumulative radiation doses during early life [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

The burden of radiation exposure in congenital heart disease: the Italian cohort profile and bioresource collection in HARMONIC project

Campolo,

Annoni,

Vignati

et al. 2024

Ital J Pediatr

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Background The European-funded Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Pediatrics (HARMONIC) project aims to improve knowledge on the effects of medical exposure to ionizing radiation (IR) received during childhood. One of its objectives is to build a consolidated European cohort of pediatric patients who have undergone cardiac catheterization (Cath) procedures, with the goal of enhancing the assessment of long-term radiation-associated cancer risk. The purpose of our study is to provide a detailed description of the Italian cohort contributing to the HARMONIC project, including an analysis of cumulative IR exposure, reduction trend over the years and an overview of the prospective collection of biological samples for research in this vulnerable population. Methods In a single-center retrospective cohort study, a total of 584 patients (323 males) with a median age of 6 (2–13) years, referred at the Pediatric Cardiology in Niguarda Hospital from January 2015 to October 2023, were included. Biological specimens from a subset of 60 patients were prospectively collected for biobanking at baseline, immediately post-procedure and after 12 months. Results Two hundred fifty-nine (44%) patients were under 1 year old at their first procedure. The median KAP/weight was 0.09 Gy·cm2/kg (IQR: 0.03–0.20), and the median fluoroscopy time was 8.10 min (IQR: 4.00–16.25). KAP/weight ratio showed a positive correlation with the fluoroscopy time (Spearman’s rho = 0.679, p < 0.001). Significant dose reduction was observed either after implementation of an upgraded technology system and a radiation training among staff. The Italian cohort includes 1858 different types of specimens for Harmonic biobank, including blood, plasma, serum, clot, cell pellet/lymphocytes, saliva. Conclusions In the Italian Harmonic cohort, radiation dose in cardiac catheterization varies by age and procedure type. An institution’s radiological protection strategy has contributed to a reduction in radiation dose over time. Biological samples provide a valuable resource for future research, offering an opportunity to identify potential early biomarkers for health surveillance and personalized risk assessment.

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Section: Introductionmentioning

confidence: 99%

The burden of radiation exposure in congenital heart disease: the Italian cohort profile and bioresource collection in HARMONIC project

Campolo,

Annoni,

Vignati

et al. 2024

Ital J Pediatr

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Outcomes after cancer diagnosis in children and adult patients with congenital heart disease in Sweden: a registry-based cohort study

Karazisi,

Dellborg,

Mellgren

et al. 2024

BMJ Open

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ObjectivePatients with congenital heart disease (CHD) have an increased cancer risk. The aim of this study was to determine cancer-related mortality in CHD patients compared with non-CHD controls, compare ages at cancer diagnosis and death, and explore the most fatal cancer diagnoses.DesignRegistry-based cohort study.Setting and participantsCHD patients born between 1970 and 2017 were identified using Swedish Health Registers. Each was matched by birth year and sex with 10 non-CHD controls. Included were those born in Sweden with a cancer diagnosis.ResultsCancer developed in 758 out of 67814 CHD patients (1.1%), with 139 deaths (18.3%)—of which 41 deaths occurred in patients with genetic syndromes. Cancer was the cause of death in 71.9% of cases. Across all CHD patients, cancer accounted for 1.8% of deaths. Excluding patients with genetic syndromes and transplant recipients, mortality risk between CHD patients with cancer and controls showed no significant difference (adjusted HR 1.17; 95% CI 0.93 to 1.49). CHD patients had a lower median age at cancer diagnosis—13.0 years (IQR 2.9–30.0) in CHD versus 24.6 years (IQR 8.6–35.1) in controls. Median age at death was 15.1 years (IQR 3.6–30.7) in CHD patients versus 18.5 years (IQR 6.1–32.7) in controls. The top three fatal cancer diagnoses were ill-defined, secondary and unspecified, eye and central nervous system tumours and haematological malignancies.ConclusionsCancer-related deaths constituted 1.8% of all mortalities across all CHD patients. Among CHD patients with cancer, 18.3% died, with cancer being the cause in 71.9% of cases. Although CHD patients have an increased cancer risk, their mortality risk post-diagnosis does not significantly differ from non-CHD patients after adjustements and exclusion of patients with genetic syndromes and transplant recipients. However, CHD patients with genetic syndromes and concurrent cancer appear to be a vulnerable group.

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Risk of Cancer in Patients with Congenital Heart Disease: A Systematic Review and Meta-Analysis

Ren,

Feng,

Luo

et al. 2024

Cardiology

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Introduction There has been remarkable progress in both diagnosis and treatment of patients with congenital heart disease (CHD), with an increasing number of survivors. Whether patients with CHD are more likely to develop cancer is still a controversial issue. This study aimed to quantitatively estimate the association between patients with CHD and the risk of developing cancer through meta-analysis. Methods Web of Science, PubMed, and Embase databases were searched from inception to September 2023 to identify potentially relevant case-control studies and cohort studies that reported risk estimates and confidence intervals. RevMan software was used to analyze the pooled effect size and test for heterogeneity. The random effect and fixed effect models were applied to the study period. Egger's test was performed to examine publication bias. Results We analyzed six studies, consisting of 2 case-control studies and 4 cohort studies comprising 276,124 participants. The overall pooled hazard risk for cancer in patients with CHD was 1.71 (95% CI: 1.28-2.28; P<0.01), with significant heterogeneity (I2=97%, P<0.01). The quantitative analysis of studies indicates that patients with CHD have an increased risk of developing cancer, even after adjusting for chromosomal disorders. Conclusions Our study highlights the importance of controlling modifiable factors in cancer prevention and emphasizes the need for health education for patients with CHD in primary care. Given the limited number of studies included in this analysis, further research is needed to accurately quantify the cancer risk of exposed versus unexposed CHD.

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Lympho-hematopoietic malignancies risk after exposure to low dose ionizing radiation during cardiac catheterization in childhood

Cited by 4 publications

References 47 publications

The burden of radiation exposure in congenital heart disease: the Italian cohort profile and bioresource collection in HARMONIC project

The burden of radiation exposure in congenital heart disease: the Italian cohort profile and bioresource collection in HARMONIC project

Outcomes after cancer diagnosis in children and adult patients with congenital heart disease in Sweden: a registry-based cohort study

Risk of Cancer in Patients with Congenital Heart Disease: A Systematic Review and Meta-Analysis

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