Anna Sällfors Holmqvist1, Jørgen H Olsen2, Klaus Kaae Andersen2, Sofie de Fine Licht2, Lars Hjorth3, Stanislaw Garwicz3, Christian Moëll3, Harald Anderson4, Finn Wesenberg5, Laufey Tryggvadottir6, Nea Malila7, John D Boice8, Henrik Hasle9, Jeanette Falck Winther2. 1. Paediatric Oncology and Haematology, Skåne University Hospital, Department of Clinical Sciences, Lund University, Lund, Sweden. Electronic address: anna.sallfors-holmqvist@med.lu.se. 2. Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark. 3. Paediatric Oncology and Haematology, Skåne University Hospital, Department of Clinical Sciences, Lund University, Lund, Sweden. 4. Department of Cancer Epidemiology, Lund University, Lund, Sweden. 5. Cancer Registry of Norway, Department of Paediatric Medicine, Oslo University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway. 6. Icelandic Cancer Registry, Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 7. Finnish Cancer Registry, Helsinki, Finland. 8. Vanderbilt University, Department of Medicine, Vanderbilt-Ingram Cancer Centre, Nashville, TN, USA; National Council on Radiation Protection and Measurements, Bethesda, MD, USA. 9. Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark.
Abstract
AIM: An increased risk for diabetes mellitus (DM) adds significantly to the burden of late complications in childhood cancer survivors. Complications of DM may be prevented by using appropriate screening. It is, therefore, important to better characterise the reported increased risk for DM in a large population-based setting. MATERIALS AND METHODS: From the national cancer registries of the five Nordic countries, a cohort of 32,903 1-year survivors of cancer diagnosed before the age of 20 between start of cancer registration in the 1940s and 1950s through 2008 was identified; 212,393 comparison subjects of the same age, gender and country were selected from national population registers. Study subjects were linked to the national hospital registers. Absolute excess risks (AERs) and standardised hospitalisation rate ratios (SHRRs) were calculated. RESULTS: DM was diagnosed in 496 childhood cancer survivors, yielding an overall SHRR of 1.6 (95% confidence interval (CI), 1.5-1.8) and an AER of 43 per 100,000 person-years, increasing from approximately 20 extra cases of DM in ages 0-19 to more than 100 extra cases per 100,000 person-years in ages > or =50. The relative risks for DM were significantly increased after Wilms' tumour (SHRR, 2.9), leukaemia (2.0), CNS neoplasms (1.8), germ-cell neoplasms (1.7), malignant bone tumours (1.7) and Hodgkin's lymphoma (1.6). The risk for DM type 2 was slightly higher than that for type 1. CONCLUSION: Childhood cancer survivors are at increased risk for DM, with absolute risks increasing throughout life. These findings underscore the need for preventive interventions and prolonged follow-up of childhood cancer survivors.
AIM: An increased risk for diabetes mellitus (DM) adds significantly to the burden of late complications in childhood cancer survivors. Complications of DM may be prevented by using appropriate screening. It is, therefore, important to better characterise the reported increased risk for DM in a large population-based setting. MATERIALS AND METHODS: From the national cancer registries of the five Nordic countries, a cohort of 32,903 1-year survivors of cancer diagnosed before the age of 20 between start of cancer registration in the 1940s and 1950s through 2008 was identified; 212,393 comparison subjects of the same age, gender and country were selected from national population registers. Study subjects were linked to the national hospital registers. Absolute excess risks (AERs) and standardised hospitalisation rate ratios (SHRRs) were calculated. RESULTS:DM was diagnosed in 496 childhood cancer survivors, yielding an overall SHRR of 1.6 (95% confidence interval (CI), 1.5-1.8) and an AER of 43 per 100,000 person-years, increasing from approximately 20 extra cases of DM in ages 0-19 to more than 100 extra cases per 100,000 person-years in ages > or =50. The relative risks for DM were significantly increased after Wilms' tumour (SHRR, 2.9), leukaemia (2.0), CNS neoplasms (1.8), germ-cell neoplasms (1.7), malignant bone tumours (1.7) and Hodgkin's lymphoma (1.6). The risk for DM type 2 was slightly higher than that for type 1. CONCLUSION: Childhood cancer survivors are at increased risk for DM, with absolute risks increasing throughout life. These findings underscore the need for preventive interventions and prolonged follow-up of childhood cancer survivors.
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