Falling risk of heart disease among survivors of childhood cancer

Large scale investigations have indicated substantial premature mortality among adult survivors of childhood cancer. In one cohort from Britain, 30% of participants who had survived childhood cancer for at least five years died by 45 years of diagnosis; just 6% were expected to have died.1 Beyond 45 years, most excess deaths in this cohort were caused by new primary cancers (51%) and cardiovascular disease (26%).1 Consequently, efforts to reduce long term mortality have focused on reducing exposure to the most toxic aspects of anticancer treatment, including radiotherapy. Several studies have evaluated the success of these efforts, considering specific causes of death,2 subsequent primary cancers,3 and chronic health conditions.4 A linked study by Mulrooney and colleagues (doi:10.1136/bmj.l6794) adds to this evidence base.

Using data from the Childhood Cancer Survivor Study (CCSS), based in the United States and Canada, the authors explored whether changes in anticancer treatment …