Teen Cancer Means Early Heart Disease

Short Attention Span Summary

Cancer as a teen or young adult increases cardiac risk!
This is a large cohort of young people diagnosed with cancer in England and Wales with over 200,000 patients.  The risk of cardiac disease was highest in those diagnosed at a younger age, OR 4.2 if 15-19 years, compared to those 35-39 years, with OR 1.2.  Risk varied with the type of cancer.  Hodgkins was the worst for increasing risk of cardiac disease: ischemic, valvular, or cardiomyopathy.  Here is the list of cancers and the increase in odds of all forms of cardiac disease.  "Survivors of Hodgkin lymphoma, acute myeloid leukaemia, genitourinary cancers other than bladder cancer, non-Hodgkin lymphoma, lung cancer, leukaemia other than acute myeloid, central nervous system tumour, cervical cancer, and breast cancer experienced 3.8, 2.7, 2.0, 1.7, 1.7, 1.6, 1.4, 1.3 and 1.2 times the number of cardiac deaths expected from the general population, respectively."

Spoon Feed
If a young person presents with chest pain and has had prior treatment for cancer, his or her risk of cardiac disease is far greater than the baseline population.


Abstract

Circulation. 2016 Nov 15;134(20):1519-1531. Epub 2016 Nov 7.

Cardiac Mortality Among 200 000 Five-Year Survivors of Cancer Diagnosed at 15 to 39 Years of Age: The Teenage and Young Adult Cancer Survivor Study.

Henson KE1, Reulen RC1, Winter DL1, Bright CJ1, Fidler MM1, Frobisher C1, Guha J1, Wong KF1, Kelly J1, Edgar AB1, McCabe MG1, Whelan J1, Cutter DJ1, Darby SC1, Hawkins MM2.

Author information:

1From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D).

2From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D). m.m.hawkins@bham.ac.uk.

Abstract

BACKGROUND:

Survivors of teenage and young adult cancer are acknowledged as understudied. Little is known about their long-term adverse health risks, particularly of cardiac disease that is increased in other cancer populations where cardiotoxic treatments have been used.

METHODS:

The Teenage and Young Adult Cancer Survivor Study cohort comprises 200 945 5-year survivors of cancer diagnosed at 15 to 39 years of age in England and Wales from 1971 to 2006, and followed to 2014. Standardized mortality ratios, absolute excess risks, and cumulative risks were calculated.

RESULTS:

Two thousand sixteen survivors died of cardiac disease. For all cancers combined, the standardized mortality ratios for all cardiac diseases combined was greatest for individuals diagnosed at 15 to 19 years of age (4.2; 95% confidence interval, 3.4-5.2) decreasing to 1.2 (95% confidence interval, 1.1-1.3) for individuals aged 35 to 39 years (2P for trend <0.0001). Similar patterns were observed for both standardized mortality ratios and absolute excess risks for ischemic heart disease, valvular heart disease, and cardiomyopathy. Survivors of Hodgkin lymphoma, acute myeloid leukaemia, genitourinary cancers other than bladder cancer, non-Hodgkin lymphoma, lung cancer, leukaemia other than acute myeloid, central nervous system tumour, cervical cancer, and breast cancer experienced 3.8, 2.7, 2.0, 1.7, 1.7, 1.6, 1.4, 1.3 and 1.2 times the number of cardiac deaths expected from the general population, respectively. Among survivors of Hodgkin lymphoma aged over 60 years, almost 30% of the total excess number of deaths observed were due to heart disease.

CONCLUSIONS:

This study of over 200 000 cancer survivors shows that age at cancer diagnosis was critical in determining subsequent cardiac mortality risk. For the first time, risk estimates of cardiac death after each cancer diagnosed between the ages of 15 and 39 years have been derived from a large population-based cohort with prolonged follow-up. The evidence here provides an initial basis for developing evidence-based follow-up guidelines.

© 2016 The Authors.

PMCID: PMC5106083 Free PMC Article

PMID: 27821538 [PubMed - in process]