Cancer: age of diagnosis may influence heart disease death risk

Cancer: age of diagnosis may influence heart disease death risk

New research suggests that the age at which cancer is diagnosed can influence the risk of death from heart disease among survivors.

The researchers found survivors whose cancer was diagnosed at ages 15-19 years had 4.2 times higher risk of death from heart disease.

The large population-based study of cancer survivors - led by a team from the University of Birmingham in the United Kingdom - is published in the journal Circulation.

Heart disease is one of a number of cardiovascular diseases - conditions that affect the heart and blood vessels. These conditions have one thing in common - they are related to atherosclerosis, a process where plaque builds up in the walls of arteries.

As atherosclerosis progresses, the plaque buildup narrows the arteries - making it harder for the blood to flow properly - and thereby raising the risk of blood clots, which can lead to heart attacks and strokes.

Other types of cardiovascular disease include heart failure (where the heart is not pumping blood as well as it should), arrhythmia (abnormal rhythm of the heart), and heart valve problems (for instance, where valves of the heart do not open enough or do not close properly).

In their paper, the authors remark that heart disease is an acknowledged health risk among cancer survivors who have been treated with cancer drugs that can weaken the heart muscle.

Heart disease is known, for example, to be the leading cause of treatment-related, non-tumor deaths among survivors of childhood cancer, breast cancer, and Hodgkin lymphoma (cancer of the lymphatic system).

Important to know risks for heart disease

However, survivors of teenage and young adult cancer are not a well-researched group; there is little comprehensive knowledge of their long-term health risks, particularly of heart disease, note the researchers.

  • Heart disease kills 17.5 million people each year - nearly a third of all deaths worldwide
  • More than three quarters of deaths from heart disease occur in low- and middle-income countries
  • Tobacco use, an unhealthy diet, and physical inactivity raise risk of heart attacks and strokes.

Learn more about heart disease

It is important for doctors to know what these risks might be, "because it helps them focus the most intensive follow-up care on those most at risk," says senior study author Mike Hawkins, epidemiology professor and director of the Centre for Childhood Cancer Survivor Studies at Birmingham. He also notes:

"It is important for survivors because it empowers them by providing them with their long-term chances of a specific side effect of cancer treatment."

For their study, the team examined data on over 200,000 participants in the Teenage and Young Adult Cancer Survivor Study (TYACSS) who had survived at least 5 years after diagnosis, and who were first diagnosed with cancer from ages 15-39.

When they analyzed the data, the researchers discovered that 6 percent of deaths were due to heart disease.

They also found survivors whose cancer was diagnosed at ages 15-19 years had 4.2 times higher risk of death from heart disease than same-sex counterparts of similar age in the general population.

However, for survivors whose cancer was diagnosed later - at ages 35-39 years - the raised risk was not as high (1.2 times higher).

Heart disease death risk varies with different cancers

When the researchers looked at risks across different cancers, they found some stark contrasts. Compared with the number expected from the same-sex, similarly aged general population, the risk of death from heart disease among survivors diagnosed at ages 15-39 was 3.8 times higher for Hodgkin lymphoma, 2.7 times higher for acute myeloid leukemia, and 2 times higher for genitourinary cancers (other than bladder cancer).

Death from heart disease risk was also higher for survivors diagnosed at ages 15-39 of other cancers, including non-Hodgkin lymphoma (1.7 times higher), lung cancer (1.7), leukemia other than acute myeloid (1.6), central nervous system tumor (1.4), cervical cancer (1.3), and breast cancer (1.2).

The team also found contrasts within each type of cancer. For example, in the case of Hodgkin lymphoma, they found 6.9 percent of survivors diagnosed at ages 15-19 years had died of heart disease by age 55. This compares with only 2 percent of those diagnosed at ages 35-39 years, and under 1 percent of same-sex and similarly aged counterparts in the general population.

When they looked at survivors of Hodgkin lymphoma aged over 60, they found nearly 28 percent more deaths from heart disease than among same-sex and similarly aged counterparts in the general population.

The researchers conclude the findings offer some new clues on the potential harm that cancer treatments given to teenagers and young adults can cause to the heart and blood vessels. They suggest:

"The evidence here provides an initial basis for developing evidence-based follow-up guidelines."

However, they also note their investigation did not look in detail at exposure to different types of cancer treatment, for instance, radiotherapy and chemotherapy.

Survivors of cancer diagnosed in teenage and young adulthood are internationally acknowledged to be an understudied population. With the advantage of long-standing cancer registration for the U.K. population, we were in a position to undertake the largest study to date, which has the advantage of being population-based and benefits from lengthy follow-up after diagnosis."

Prof. Mike Hawkins

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Section Issues On Medicine: Disease