Incidence of Malignancy in Children After Cardiac Catheterization Within the First 8 Years of Life Between 1999 and...

Background/Objectives: Children with congenital heart disease are exposed to ionizing radiation, which may induce cancer. This study aimed to reassess cancer risk after cardiac catheterization (CC) between 1999 and 2013, with follow-up until 15 years of age, cancer diagnosis, or death. Methods: We studied 2762 children who underwent at least one CC before eight years of age between 1999 and 2013. Cancer diagnoses were obtained from the German Childhood Cancer Registry. For patients with tumors and 60 randomly selected control patients, cumulative effective radiation doses (Deff) were calculated. Results: During 344.80 person-years of follow-up, ten patients developed cancer, whereas 5.3 cases were expected (standardized incidence ratio [SIR] 1.88; 95% CI 0.90-3.46; p = 0.0449). Eight tumors occurred in patients who underwent CC during the first year of life, compared with 3.5 expected (SIR 2.26; 95% CI 0.98-4.46; p = 0.0282). Patients with cancer had a median of 2.0 (1-11) CCs and a median D_eff of 14.6 mSv (2.4-94.3) compared with 1.0 (1-10) CCs and 9.7 mSv (0.7-171.5) in controls. Neither parameter differed significantly. No specific malignancy was predominant. Conclusion: Cardiac catheterization early in life remains associated with an increased cancer risk; however, compared with our previously published 1980-1998 cohort, a reduction in risk was observed.