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Heart disease risk higher in cancer survivors.

Compared with their healthy siblings, survivors of childhood cancers have a substantially increased risk of developing heart disease in early adulthood, new findings from the Childhood Cancer Survivor Study show.

The investigators analyzed data from 14,358 5-year survivors of eight childhood cancers and 3,899 sibling controls. Increased risk in survivors ranged from 5 times more likely to suffer a heart attack to 10 times more likely to have atherosclerosis at an early age.

Anthracycline exposure and radiation to the heart also increased the risk of heart disease in early adulthood when exposed survivors were compared with survivors who had not received anthracycline drugs or radiation to the heart. Compared with survivors not given these treatments, the relative risk of heart failure, for example, was 4.1 in survivors exposed to more than 250 mg/[m.sup.2] of anthracycline and 2.0 in those who had radiation to the heart.

The data were presented at the annual meeting of the American Society of Clinical Oncology (ASCO). An abstract was posted on the society's Web site ( and discussed by Dr. Daniel A. Mulrooney, lead author, during a press briefing Webcast.

Survivors in the study had been diagnosed with leukemia, central nervous system tumors, Hodgkin's or non-Hodgkin's lymphoma, renal tumors, neuroblastoma, soft-tissue sarcoma, or bone cancer between 1970 and 1986 before reaching 21 years of age. Their mean age was 7.8 years at diagnosis, and 27.5 years at follow-up.

After adjustment for age, gender, race, sociodemographic factors, and smoking status, survivors were more likely than were their siblings to report heart failure (relative risk 5.7), myocardial infarction (RR 4.9), atherosclerosis (RR 10), pericardial and valvular disease (RR 6.3 and 4.8, respectively), and coronary angiography (RR 8.2), reported Dr. Mulrooney of the University of Minnesota, Minneapolis.

"We found that 5-year survivors of childhood cancers are at elevated risk of early cardiovascular disease," he said, noting that cardiac toxicity can occur years following the cancer diagnosis, and that incidence increases steadily over time.

"Cardiovascular monitoring of early childhood cancer survivors should begin early and be lifelong," he concluded.

Dr. Richard L. Schilsky, president-elect of ASCO and professor of medicine at the University of Chicago, said the findings add to the increasing knowledge of the effects of childhood cancer on later health outcomes, and that they underscore the need for appropriate monitoring of survivors.

Previous studies have shown childhood cancer treatments have consequences on bone health, fertility, thyroid health, and mental health, and that survivors are also at increased risk of developing another malignancy. These findings have become increasingly important given the improvements in cancer treatments--and thus the increasing number of childhood cancer survivors. Currently there are more than 11 million cancer survivors in the United States; among them, about 270,000 are survivors of childhood cancers, Dr. Mulrooney said.

"So what's particularly important in all of this for patients and their physicians to keep in mind is that being a cancer survivor is a very special diagnosis in many ways, and carries with it a responsibility to understand the long-term consequences of cancer treatment and to monitor patients appropriately for health problems that might develop," Dr. Schilsky said.

ASCO is currently developing a care planning tool for oncologists to provide to patients who transfer their care, he noted.
Relative Risk of Adverse Cardiac Events Increased With Radiation
to the Heart

 1.0 Survivors not exposed (control)

Atherosclerosis 5.3
Valvular disease 2.8
Coronary angiography 2.2
Pericardial disease 2.2
Heart failure 2.0
Myocardial infarction 1.9

Notes: Based on an approximate 20-year follow-up of 14,358 5-year
survivors of childhood cancer. Adjusted for age, gender, race,
sociodemographic factors, and smoking status.

Source: Dr. Mulrooney

Note: table made from bar graph
Higher Relative Risk for Adverse Cardiac Events in Childhood
Cancer Survivors

 1.0 Sibling controls (n = 3,899)

Atherosclerosis 10.0
Coronary angiography 8.2
Pericardial disease 6.3
Heart failure 5.7
Myocardial infarction 4.9
Valvular disease 4.8

Notes: Based on an approximate 20-year follow-up of 14,358 5-year
survivors of childhood cancer. Cancer Adjusted for age, gender race,
socicdemographic factors, and moking status.

Source: Dr. Mulrconey

Note: table made from bar graph
Relative Ralative Risk of Cardiac Disease With Anthracycline
Exposure > 250 mg/[m.sup.2]

 1.0 Survivors not exposed (control)
Heart failur 4.1
Pericardial disease 1.9
Valvular disease 1.8

Notes: Based on an approximate 20-year follow-up of 14,358 5-year
survivors of childhood cancer. Adjusted for age, gender, race,
sociodemographic factors, and smoking status.

Source: Dr.Mulrooney.

Note: table made from bar graph


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Title Annotation:Cardiovascular Medicine
Author:Worcester, Sharon
Publication:Internal Medicine News
Geographic Code:1USA
Date:Jul 15, 2008
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