Many children who survive cancer can look forward to moving on with their lives and returning to normality. Others may have late effects of their cancer or its treatment that can cause life long morbidity. In their linked retrospective cohort study of more than 14 000 adult survivors of childhood and adolescent cancers (doi:10.1136/bmj.b4606), Mulrooney and colleagues found that those treated between 1970 and 1986 are more likely than their siblings to report congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities in young adult life.1 Although they form a very small proportion of adult patients with cardiovascular disease, it is not known how they should be managed. Assessing the benefit and cost of any screening programme in the increasing population of survivors of childhood cancer (30 000 in the United Kingdom; personal communication, Charles Stiller, 2009) is a debate that has yet to be resolved.

Mulrooney and colleagues’ study confirms other published series by identifying a high risk of cardiac sequelae in certain subgroups of survivors of childhood cancer. Survivors were significantly more likely to report congestive heart failure (hazard ratio 5.9, 95% CI 3.4 to 9.6), myocardial infarction …