Children and adolescents who survive cancer have a significantly higher risk of developing heart disease as young adults.

The findings show that young adult survivors of childhood cancer are at risk for a variety of cardiovascular complications related to their cancer therapy, such as heart failure, myocardial infarction, pericardial disease and heart valve abnormalities - as late as 30 years after therapy.

They also show that this risk is apparent at lower exposures to anthracyclines ( drugs used in chemotherapy ) and radiation therapy than previously thought.

Researchers at University of Minnesota ( U.S. ), compared data from 14,358 five year cancer survivors taking part in the Childhood Cancer Survivor Study with 3,899 siblings of cancer survivors.

The cancer survivors were diagnosed between 1970 and 1986, before the age of 21. They had one of the following cancers: leukaemia, brain cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma, kidney cancer, neuroblastoma, soft tissue sarcoma, or bone cancer.

The participants or their parents completed questionnaires about their health, medical conditions, and surgical procedures since diagnosis.

Survivors of cancer were significantly more likely than siblings to report congestive heart failure ( hazard ratio, HR=5.9; P<0.001 ), myocardial infarction ( HR=5.0; P<0.001 ), pericardial disease ( HR=6.3; P<0.001 ), or valvular abnormalities ( HR=4.8; P<0.001).

Exposure to 250 mg/m2 or more of anthracyclines increased the relative hazard of congestive heart failure, pericardial disease, and valvular abnormalities by two to five times compared with survivors who had not been exposed to anthracyclines.

Cardiac radiation exposure of 1500 centigray or more increased the relative hazard of congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities by twofold to sixfold compared to non-irradiated survivors.

The cumulative incidence of adverse cardiac outcomes in cancer survivors continued to increase up to 30 years after diagnosis.

UK guidelines recommend routine cardiac screening every five years, but many survivors currently receive no follow-up, they say. With the number of adult survivors steadily rising, they suggest a network of specialists that collaborate across age boundaries is needed to optimise the care pathways for patients with complex problems.

Source: British Medical Journal, 2009

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