Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Nov 15;134(20):1519-1531.
doi: 10.1161/CIRCULATIONAHA.116.022514. 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

Katherine E Henson  1 , Raoul C Reulen  1 , David L Winter  1 , Chloe J Bright  1 , Miranda M Fidler  1 , Clare Frobisher  1 , Joyeeta Guha  1 , Kwok F Wong  1 , Julie Kelly  1 , Angela B Edgar  1 , Martin G McCabe  1 , Jeremy Whelan  1 , David J Cutter  1 , Sarah C Darby  1 , Mike M Hawkins  2
Affiliations

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

Katherine E Henson et al. Circulation. .

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.

Keywords: adolescent; cardiac deaths; epidemiology; heart diseases; mortality; neoplasms.

PubMed Disclaimer

Figures

Figure.
Figure.
Cardiac mortality according to attained age. Cumulative mortality from cardiac disease among 5-year survivors of Hodgkin lymphoma according to attained age by age at cancer diagnosis. HL indicate Hodgkin lymphoma.
See this image and copyright information in PMC

References

    1. Thomas DM, Albritton KH, Ferrari A. Adolescent and young adult oncology: an emerging field. J Clin Oncol. 2010;28:4781–4782. doi: 10.1200/JCO.2010.30.5128. - PubMed
    1. Desandes E, Lacour B, Belot A, Molinie F, Delafosse P, Tretarre B, Velten M, Sauleau EA, Woronoff AS, Guizard AV, Ganry O, Bara S, Grosclaude P, Troussard X, Bouvier V, Brugieres L, Clavel J. Cancer incidence and survival in adolescents and young adults in France, 2000-2008. Pediatr Hematol Oncol. 2013;30:291–306. doi: 10.3109/08880018.2012.762569. - PubMed
    1. Pollock BH, Birch JM. Registration and classification of adolescent and young adult cancer cases. Pediatr Blood Cancer. 2008;50(5)(suppl):1090–1093. doi: 10.1002/pbc.21462. - PubMed
    1. Stock W, La M, Sanford B, Bloomfield CD, Vardiman JW, Gaynon P, Larson RA, Nachman J Children’s Cancer Group; Cancer and Leukemia Group B studies. What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children’s Cancer Group and Cancer and Leukemia Group B studies. Blood. 2008;112:1646–1654. doi: 10.1182/blood-2008-01-130237. - PMC - PubMed
    1. Coccia PF, Altman J, Bhatia S, Borinstein SC, Flynn J, George S, Goldsby R, Hayashi R, Huang MS, Johnson RH, Beaupin LK, Link MP, Oeffinger KC, Orr KM, Pappo AS, Reed D, Spraker HL, Thomas DA, von Mehren M, Wechsler DS, Whelan KF, Zebrack BJ, Sundar H, Shead DA. Adolescent and young adult oncology. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2012;10:1112–1150. - PubMed