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)

Karazisi, Christina; Dellborg, Mikael; Mellgren, Karin; Giang, Kok Wai; Skoglund, Kristofer; Eriksson, Peter; Mandalenakis, Zacharias

doi:10.1016/j.lanepe.2022.100407

Cited by 17 publications

(20 citation statements)

References 28 publications

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“…In previous studies, we demonstrated that the most common cancer types in CHD patients were largely similar to those in the control group, with the exclusion of patients with genetic syndromes and transplant recipients 4. In this study, the most frequent cancer diagnoses for both CHD patients and controls were haematological, ill-defined, secondary and unspecified sites, skin and eye and CNS tumours.…”

Section: Discussionsupporting

confidence: 57%

“…In previous studies, we have found that the overall cancer risk for CHD patients in Sweden is higher than in matched controls without CHD. Notably, this risk in children and young adults is more than double that of the matched controls 3 4. Some syndromes are known to have an increased risk of both CHD and cancer, such as Downs and 22q11-deletion syndrome 5 6.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have tried to find potential risk factors for cancer in CHD patients. Thymectomy at young age can be a possible risk factor 4 11. Heart transplantation is possible for CHD patients with end-stage circulatory failure 12.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

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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

Self Cite

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“…The risk of lymphoma was particularly elevated in children with complex CHD and that of leukemia in patients with Down syndrome [ 10 ]. Additionally, a recent Swedish register-based study confirmed the increased cancer risk in patients with CHD [ 15 ]. This study found that the risk of cancer in CHD was 23% higher compared to age- and sex-matched controls and remained 18% higher even when patients with syndromes and organ transplant recipients were excluded.…”

Section: Cancer Risk In Chd Patientsmentioning

confidence: 98%

“…This study found that the risk of cancer in CHD was 23% higher compared to age- and sex-matched controls and remained 18% higher even when patients with syndromes and organ transplant recipients were excluded. Importantly, younger patients (0–17 years of age) and those born in later cohorts (1990–2017) had more than a twofold increased total cancer risk, particularly of lymphoid or hematopoietic origin, compared with controls [ 15 ]. Furthermore, the risk of cancer in children with CHD who underwent cardiac surgery during the first year of life was almost twofold higher than in controls, supporting the notion that thymectomy or damage to the thymus gland by sternotomy during cardiac surgery may be responsible for the increased risk of cancer [ 15 , 16 ].…”

Section: Cancer Risk In Chd Patientsmentioning

confidence: 99%

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

Campolo

Annoni

Giaccardi³

et al. 2022

JCDD

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Epidemiological studies have shown an increased prevalence of cancer in patients with congenital heart disease (CHD) as compared with the general population. The underlying risk factors for the acquired cancer risk remain poorly understood, and shared genetic anomalies and cumulative radiation exposure from repeated imaging and catheterization procedures may be contributing factors. In the present review, we provide an update on the most recent literature regarding the associations between CHD and cancer, with a particular focus on genetic etiology and radiation exposure from medical procedures. The current evidence indicates that children with CHD may be a high-risk population, already having the first genetic “hit”, and, consequently, may have increased sensitivity to ionizing radiation from birth or earlier. Future research strategies integrating biological and molecular measures are also discussed in this article.

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Heart failure in patients with congenital heart disease after a cancer diagnosis

Karazisi,

Dellborg,

Mellgren

et al. 2024

ESC Heart Failure

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AimsIndividuals with congenital heart disease (CHD) are at an increased risk for cancer. As cancer survival rates improve, the prevalence of late side effects, such as heart failure (HF), is becoming more evident. This study aims to evaluate the risk of developing HF following a cancer diagnosis in patients with CHD, compared with those without CHD and with CHD patients who do not have cancer.MethodsCHD patients (n = 69 799) and randomly selected non‐CHD controls (n = 650 406), born in Sweden between 1952 and 2017, were identified from the Swedish National Health Registers and Total Population Register (excluding those with syndromes and transplant recipients). CHD patients who developed cancer (n = 1309) were propensity score‐matched with non‐CHD patients who developed cancer (n = 9425), resulting in a cohort of 1232 CHD patients with cancer and 2602 non‐CHD controls with cancer (after exclusion of individuals with HF prior to cancer diagnosis). In a separate analysis, CHD patients with cancer were propensity score‐matched with CHD patients without cancer (n = 68 490). A total of 1233 CHD patients with cancer and 2257 CHD patients without cancer were included in the study.ResultsAmong CHD patients with cancer, 73 (5.9%) developed HF during a mean follow‐up time of 8.5 ± 8.7. Comparatively, in the propensity‐matched control population, 29 (1.1%) non‐CHD cancer patients (mean follow‐up time of 7.3 ± 7.5) and 101 (4.5%) CHD patients without cancer (mean follow‐up time of 9.9 ± 9.2) developed HF. CHD patients exhibited a significantly higher risk of HF post‐cancer diagnosis compared with the non‐CHD control group [hazard ratio (HR) 4.39, 95% confidence interval (CI) 2.83–6.81], after adjusting for age at cancer diagnosis and comorbidities. In the analysis between CHD patients with cancer and those without cancer, the results indicated a significantly higher risk of developing HF in CHD patients with cancer (HR 1.53, 95% CI 1.13–2.07).ConclusionsCHD patients face a more than four‐fold increased risk of developing HF after a cancer diagnosis compared with cancer patients without CHD. Among CHD patients, the risk of HF is only modestly higher for those with cancer than for those without cancer. This suggests that the increased HF risk in CHD patients with cancer, relative to non‐CHD cancer patients, may be more attributable to CHD itself than to cancer treatment‐related side effects.

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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)

Cited by 17 publications

References 28 publications

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

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

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

Heart failure in patients with congenital heart disease after a cancer diagnosis

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