Cumulative incidence of cancer after solid organ transplantation

Authors

  • Erin C. Hall MD, MPH,

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
    2. Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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  • Ruth M. Pfeiffer PhD,

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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  • Dorry L. Segev MD, PhD,

    1. Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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  • Eric A. Engels MD, MPH

    Corresponding author
    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
    • Corresponding author: Eric A. Engels, MD, MPH, Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, EPS 7076, Rockville, MD 20852; Fax: (301) 402-0817; engelse@exchange.nih.gov

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  • We gratefully acknowledge the support and assistance provided by individuals at the Health Resources and Services Administration (including Monica Lin), the Scientific Registry of Transplant Recipients (Ajay Israni, Bertram Kasiske, Paul Newkirk, and Jon Snyder), and the following cancer registries: the states of California (Christina Clarke), Colorado (Jack Finch), Connecticut (Lou Gonsalves), Georgia (Rana Bayakly), Hawaii (Marc Goodman), Iowa (Charles Lynch), Illinois (Lori Koch), Michigan (Glenn Copeland), New Jersey (Karen Pawlish, Xiaoling Niu), New York (Amy Kahn), North Carolina (Chandrika Rao), Texas (Melanie Williams), and Utah (Janna Harrell) as well as the Seattle-Puget Sound area of Washington (Margaret Madeleine). We also thank analysts at Information Management Services for programming support (David Castenson and Ruth Parsons).

  • The views expressed in this article are those of the authors and should not be interpreted to reflect the views or policies of the National Cancer Institute, the Health Resources and Services Administration, the Scientific Registry of Transplant Recipients, cancer registries, or their contractors.

Abstract

BACKGROUND

Solid organ transplantation recipients have elevated cancer incidence. Estimates of absolute cancer risk after transplantation can inform prevention and screening.

METHODS

The Transplant Cancer Match Study links the US transplantation registry with 14 state/regional cancer registries. The authors used nonparametric competing risk methods to estimate the cumulative incidence of cancer after transplantation for 2 periods (1987-1999 and 2000-2008). For recipients from 2000 to 2008, the 5-year cumulative incidence, stratified by organ, sex, and age at transplantation, was estimated for 6 preventable or screen-detectable cancers. For comparison, the 5-year cumulative incidence was calculated for the same cancers in the general population at representative ages using Surveillance, Epidemiology, and End Results data.

RESULTS

Among 164,156 recipients, 8520 incident cancers were identified. The absolute cancer risk was slightly higher for recipients during the period from 2000 to 2008 than during the period from 1987 to 1999 (5-year cumulative incidence: 4.4% vs 4.2%; P = .006); this difference arose from the decreasing risk of competing events (5-year cumulative incidence of death, graft failure, or retransplantation: 26.6% vs 31.9%; P < .001). From 2000 to 2008, the 5-year cumulative incidence of non-Hodgkin lymphoma was highest at extremes of age, especially in thoracic organ recipients (ages 0-34 years: range, 1.74%-3.28%; aged >50 years; range, 0.36%-2.22%). For recipients aged >50 years, the 5-year cumulative incidence was higher for colorectal cancer (range, 0.33%-1.94%) than for the general population at the recommended screening age (aged 50 years: range, 0.25%-0.33%). For recipients aged >50 years, the 5-year cumulative incidence was high for lung cancer among thoracic organ recipients (range, 1.16%-3.87%) and for kidney cancer among kidney recipients (range, 0.53%-0.84%). The 5-year cumulative incidence for prostate cancer and breast cancer was similar or lower in transplantation recipients than at the recommended ages of screening in the general population.

CONCLUSIONS

Subgroups of transplantation recipients have a high absolute risk of some cancers and may benefit from targeted prevention or screening. Cancer 2013;119:2300–2308. © 2013 American Cancer Society.

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