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Blood transfusions and the subsequent risk of cancers in the United States elderly

Authors

  • Regina Riedl,

    1. Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
    2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
    3. Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
    4. Information Management Services, Rockville, Maryland
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  • Eric A. Engels,

    1. Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
    2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
    3. Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
    4. Information Management Services, Rockville, Maryland
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  • Joan L. Warren,

    1. Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
    2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
    3. Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
    4. Information Management Services, Rockville, Maryland
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  • Andrea Berghold,

    1. Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
    2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
    3. Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
    4. Information Management Services, Rockville, Maryland
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  • Winnie Ricker,

    1. Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
    2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
    3. Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
    4. Information Management Services, Rockville, Maryland
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  • Ruth M. Pfeiffer

    Corresponding author
    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
    2. Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
    3. Information Management Services, Rockville, Maryland
    • Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
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  • This research was supported by the Intramural Research Program of the National Institute of Health, Division of Cancer Epidemiology and Genetics.

Address reprint requests to: Ruth M. Pfeiffer, PhD, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, HHS, 6120 Executive Boulevard, EPS/RM 8030, Bethesda, MD 20892-7244; e-mail: pfeiffer@mail.nih.gov.

Abstract

Background

Blood transfusions are common in older adults and also may modulate the immune system. However, the impact of transfusion on cancer risk in the elderly has not been studied.

Study Design and Methods

Cancer risk after blood transfusion was evaluated in a US population-based case–control study using 552,951 elderly cases identified from cancer registries and 100,000 frequency-matched controls. Transfusions received 0 to 12, 13 to 30, and 31 to 48 months before cancer diagnosis or selection date were identified using Medicare claims. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression models. A Bonferroni correction adjusted for multiple testing.

Results

Transfusions received 0 to 12 months before cancer diagnosis and/or selection were associated with significantly elevated risk of cancer overall (OR, 2.05; 95% CI, 1.95-2.16) and cancer of the stomach; cancer of the colon; cancer of the liver, kidney, renal pelvis, and/or ureter; lymphoma; myeloma; and leukemia. No significant associations for cancer overall were observed for the two earlier intervals. No site was associated with transfusions received 13 to 30 or 31 to 48 months before diagnosis and/or selection. Nonetheless, overall cancer risk increased with the number of transfused periods (p-trend < 0.0001).

Conclusion

Risk of overall cancer and specific sites was elevated 0 to 12 months after blood transfusion and associated with multiple transfusions, possibly due to reverse causation, that is, incipient cancers or cancer precursors causing anemia.

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