Risk of cerebrovascular disease among 13 457 five‐year survivors of childhood cancer: A population‐based cohort study

Research output: Contribution to journalArticlepeer-review


  • Joyeeta Guha
  • Chloe J. Bright
  • Katherine E. Henson
  • Richard G. Feltbower
  • Marlous Hall
  • Julie S. Kelly
  • David L. Winter
  • Michelle Kwok‐williams
  • Roderick Skinner
  • David J. Cutter
  • Clare Frobisher
  • Mike M. Hawkins

Colleges, School and Institutes

External organisations

  • Institute for Data Analytics, University of Leeds, Leeds, Yorkshire, UK.
  • Leeds Cancer CentreLeeds Teaching Hospitals NHS Trust Leeds UK
  • Newcastle University
  • Clinical Trial Service Unit (CTSU), Nuffield Department of Population HealthUniversity of Oxford Oxford UK
  • Department of Paediatric and Adolescent Haematology/Oncology, and Children's Haemopoietic Stem Cell Transplant UnitGreat North Children's Hospital Newcastle upon Tyne UK


Survivors of childhood cancer treated with cranial irradiation are at risk of cerebrovascular disease (CVD), but the risks beyond age 50 are unknown. In all, 13457 survivors of childhood cancer included in the population‐based British Childhood Cancer Survivor Study cohort were linked to Hospital Episode Statistics data for England. Risk of CVD related hospitalisation was quantified by standardised hospitalisation ratios (SHRs), absolute excess risks and cumulative incidence. Overall, 315 (2.3%) survivors had been hospitalised at least once for CVD with a 4‐fold risk compared to that expected (95% confidence interval [CI]: 3.7‐4.3). Survivors of a central nervous system (CNS) tumour and leukaemia treated with cranial irradiation were at greatest risk of CVD (SHR = 15.6, 95% CI: 14.0‐17.4; SHR = 5.4; 95% CI: 4.5‐6.5, respectively). Beyond age 60, on average, 3.1% of CNS tumour survivors treated with cranial irradiation were hospitalised annually for CVD (0.4% general population). Cumulative incidence of CVD increased from 16.0% at age 50 to 26.0% at age 65 (general population: 1.4‐4.2%). In conclusion, among CNS tumour survivors treated with cranial irradiation, the risk of CVD continues to increase substantially beyond age 50 up to at least age 65. Such survivors should be: counselled regarding this risk; regularly monitored for hypertension, dyslipidaemia and diabetes; advised on life‐style risk behaviours. Future research should include the recall for counselling and brain MRI to identify subgroups that could benefit from pharmacological or surgical intervention and establishment of a case‐control study to comprehensively determine risk‐factors for CVD.


Original languageEnglish
JournalInternational Journal of Cancer
Early online date19 Jul 2020
Publication statusE-pub ahead of print - 19 Jul 2020


  • cancer survivorship, cohort, epidemiology, late effects