Cancer risk among 21st century blood transfusion recipients

Abstract

BackgroundSome carcinogenic viruses are known to be transmissible by blood transfusion. Intensive viral screening of transfused blood now exists in most countries. In the UK, high-sensitivity nucleic acid amplification tests for hepatitis C virus were introduced in 1999 and it was thought that this would reduce, and possibly eliminate, transfusion-related liver cancer. We aimed to investigate cancer risk in recipients of blood transfusion in 2000 or after.MethodsA total of 1.3 million UK women recruited in 1998 on average were followed for hospital records of blood transfusion and for cancer registrations. After excluding women with cancer or precancerous conditions before or at the time of transfusion, Cox regression yielded adjusted relative risks of 11 site-specific cancers for women with compared to without prior blood transfusion.ResultsDuring follow up, 11 274 (0.9%) women had a first recorded transfusion in 2000 or after, and 1648 (14.6%) of them were subsequently diagnosed with cancer, a mean 6.8 years after the transfusion. In the first 5 years after transfusion there were significant excesses for most site-specific cancers examined, presumably because some had preclinical cancer. However, 5 or more years (mean 8 years) after blood transfusion, there were significant excess risks only for liver cancer (adjusted relative risk = 2.63, 95%CI 1.45–4.78) and for non-Hodgkin lymphoma (adjusted relative risk = 1.74, 1.21–2.51). When analyses were restricted to those undergoing hip or knee replacement surgery, the commonest procedure associated with transfusion, these relative risks were not materially altered.ConclusionsIn a large cohort of UK women, transfusions in the 21st century were associated with long-term increased risks of liver cancer and non-Hodgkin lymphoma. Some of these malignancies may have been caused by carcinogenic agents that are not currently screened for in transfused blood.

Blood transfusion history and risk of non-Hodgkin lymphoma: an InterLymph pooled analysis

“…This raises concerns of either reverse causality (lymphoma causing anemia) or confounding by indication of medical conditions associated with both risk of transfusion and NHL. In the Million Women Study [21], history of blood transfusion after 2000 (modern era of intense viral screening) was ascertained from electronic hospital records. In that study, there was also an elevated risk of NHL <5 years after transfusion (RR=4.69; 95% CI 3.79-5.82).…”

<p>Blood Transfusion and the Risk of Cancer in the US Population: Is There an Association?</p>

“…13,21 Other causes should be considered including lifestyle habits of alcohol, smoking, and the presence of occult cancer foci. 8,12,22 In another study, the increased cancer risk was mainly attributed to the transfer of carcinogenic infectious agents like EBV, HIV, and HCV. This explains why there was an increased risk for specific cancers, such as lymphoma and liver cancer.…”

“…13 All studies that investigated the risk of cancer after blood transfusion found that there is a temporal dependent risk association. [11][12][13][14][15]20 The risk decreases over time and after a specific period, there was no risk of cancer. This was explained as a reverse causation relationship and that the increased risk of cancer after transfusion does not necessarily mean that the transfusion is the cause of cancer.…”

Új korszak és új szempontok a transzfúziós kórokozó-átvitel kockázatában, különös tekintettel a rendszeres plazmaeredetű készítményre szoruló haemophiliás betegekre

“…5 éven túl azonban szignifikánsan több májcarcinomát (1,45×-es rizikó), kissé több myelomát és nagyobb számú non-Hodgkinlymphomát (1,74×-es rizikónövekedés) találtak. Ha kizárólag a csípőprotézis miatt transzfundáltakat nézték, ez az arány akkor is ugyanennyi volt [27].…”