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.
Highlights
Some carcinogenic infectious agents are known to be transmissible by blood transfusion
In 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
Our aim here is to examine on cancer incidence associated with blood transfusions administered in 2000 or later in a large cohort of UK women, among whom we could exclude those with cancer or precancerous conditions at the time of or before the transfusion, and among whom we could adjust for known risk factors for cancer, including smoking and alcohol consumption
Summary
Some carcinogenic infectious agents are known to be transmissible by blood transfusion. Our aim here is to examine on cancer incidence associated with blood transfusions administered in 2000 or later in a large cohort of UK women, among whom we could exclude those with cancer or precancerous conditions (e.g. hepatitis) at the time of or before the transfusion, and among whom we could adjust for known risk factors for cancer, including smoking and alcohol consumption. Conclusions: In 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.
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