Evolution of Cancer Incidence in Children after Cardiac Catheterization: Comparison of the Years 1980–1998 and 1999–2013

Background: Ionizing radiation may lead to procarcinogenic effects. Children with congenital heart disease (CHD) are exposed to substantial radiation during cardiac catheterization (CC), mostly early in life. Clinical studies assessing the risk of cancer in children exposed to radiation during CC are scarce and report conflicting results. Theoretical risk calculations from published studies estimate a low cancer risk. This study should assess the risk of cancer for children who underwent cardiac catheterization in 1980-1998 and 1998-2013.

Method: This is a retrospective, single-center study. The first cohort in the era 1980–1998 included 2,770 infants, who underwent CC in their first year of life, while the second cohort (era 1998–2013) included 2,765 children with CC in the first 8 years of age. The second cohort was divided into two subgroups (1,688 patients with first CC in first year of life and 1,074 patients with first CC between age 1 and 8). Catheterization and patient data were retrieved from clinical database and were cross-matched with the database of the German Childhood Cancer Registry (GCCR). For all patients, identified as having developed a malignant tumor, the type of cancer, time of diagnosis and associated chromosomal disorder was assessed. Cumulative effective doses were calculated for each tumor patient and for 120 randomly selected control patients without cancer.

Results: In the first cohort 24,472.5 person-years could be evaluated and 16 infants developed a tumor, while 3.64 were expected (standardized incidence ratio [SIR]: 4.4, 95% CI: 2.5–7.2, p < 0.001). Four of 16 tumor patients had trisomy 21. The median cumulative effective dose in children with a tumor and in controls were 43.0 mSv (0.8–242.3 mSv) and 29.0 mSv (2.0–750.0 mSv), respectively (p > 0.1). In the second cohort, 34,480 person-years were analyzed and 10 children developed a tumor, while 5.32 were expected (SIR: 1.88; 95% CI: 0.90–3.46; p = 0.0449). Eight of 10 had their first CC in the first year of life, while 3.54 were expected (SIR: 2.26; CI: 0.98–4.46; p = 0.0282). Median effective doses in the ten children with a tumor and in controls were 14.59 mSv (2.4–94.28 mSv) and 9.97 mSv (0.7–171.45 mSv), respectively (p > 0.1).

Conclusion: Cardiac catheterization in the first years of life is still associated with a significantly increased cancer risk in a population with CHD. Cancer risk from 1980 to present time, however, is declining.

Publication History

Article published online:
28 January 2023