Cancer Risk Among 21st Century Blood Transfusion Recipients

Tienyu Owen YANG, University of Oxford, United Kingdom

1 Nuffield Department of Population Health, University of Oxford, Oxford, UK

Some carcinogenic infectious agents, such as hepatitis viruses, are known to be transmissible by blood transfusion. In most countries transfused blood is intensively screened for hepatitis B and C, HIV, and HTLV1 viruses. In the UK, high-sensitivity nucleic acid amplification tests for hepatitis C were introduced in 1999 and it was thought that this would reduce, and possibly eliminate, transfusion-related liver cancer. Here we report cancer incidence among 21st century transfusion recipients in a prospective study of one million UK women.
Overall 11,274 women without prior cancer or precancerous conditions, such as hepatitis, had a first hospital record of one or more blood transfusions in 2000 or later; 1648 of them were diagnosed with cancer during follow-up to 1 January 2014. Cox regression yielded relative risks (RRs) for 11 site-specific cancers, with age as the underlying variable and adjusting for year of birth, region, socioeconomic status, height, smoking, body mass index, and alcohol consumption. Because some women may have had preclinical cancer at the time of blood transfusion, the first 5 years follow-up after transfusion was excluded from the analyses.
Five or more years (mean 8 years) after blood transfusion, there were significant excess risks for liver cancer (adjusted RR= 2.63, 95%CI 1.45-4.78) and for non-Hodgkin lymphoma (adjusted RR=1.74, 95%CI 1.21-2.51). The reasons the transfusions were done in all the women who developed these cancers appear unrelated to the cancer: for example, a third of the transfusions were associated with hip or knee replacement surgery.
In this cohort of UK women, 21st century blood transfusions are still associated with excess risks of liver cancer and non-Hodgkin lymphoma. The role of infectious agents, other than those for which there is routine screening, needs to be considered.
Funding Source
UK Medical Research Council and Cancer Research UK