title: Autoimmune diseases in Adult Life after Childhood Cancer in Scandinavia (ALiCCS).
abstract: The pattern of autoimmune diseases in childhood cancer survivors has not been investigated previously. We estimated the risk for an autoimmune disease after childhood cancer in a large, population-based setting with outcome measures from comprehensive, nationwide health registries.
  
  
  
  From the national cancer registries of Denmark, Iceland and Sweden, we identified 20 361 1-year survivors of cancer diagnosed before the age of 20 between the start of cancer registration in the 1940s and 1950s through 2008; 125 794 comparison subjects, matched by age, gender and country, were selected from national population registers. Study subjects were linked to the national hospital registers. Standardised hospitalisation rate ratios (SHRRs) and absolute excess risks (AERs) were calculated.
  
  
  
  Childhood cancer survivors had a significantly increased SHRR of 1.4 (95% CI 1.3 to 1.5) of all autoimmune diseases combined, corresponding to an AER of 67 per 100 000 person-years. The SHRRs were significantly increased for autoimmune haemolytic anaemia (16.3), Addison's disease (13.9), polyarteritis nodosa (5.8), chronic rheumatic heart disease (4.5), localised scleroderma (3.6), idiopathic thrombocytopenic purpura (3.4), Hashimoto's thyroiditis (3.1), pernicious anaemia (2.7), sarcoidosis (2.2), Sjögren's syndrome (2.0) and insulin-dependent diabetes mellitus (1.6). The SHRRs for any autoimmune disease were significantly increased after leukaemia (SHRR 1.6), Hodgkin's lymphoma (1.6), renal tumours (1.6) and central nervous system neoplasms (1.4).
  
  
  
  Childhood cancer survivors are at increased risk for certain types of autoimmune diseases. These findings underscore the need for prolonged follow-up of these survivors.
authors.affiliation: Department of Clinical Sciences, Pediatric Oncology and Hematology, Skåne University Hospital, Lund University, Lund, Sweden.
authors.forename: Anna Sällfors
authors.initials: AS
authors.lastname: Holmqvist
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Jørgen H
authors.initials: JH
authors.lastname: Olsen
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Mellemkjaer
authors.affiliation: Department of Clinical Sciences, Pediatric Oncology and Hematology, Skåne University Hospital, Lund University, Lund, Sweden.
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Garwicz
authors.affiliation: Department of Clinical Sciences, Pediatric Oncology and Hematology, Skåne University Hospital, Lund University, Lund, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Hjorth
authors.affiliation: Department of Clinical Sciences, Pediatric Oncology and Hematology, Skåne University Hospital, Lund University, Lund, Sweden.
authors.forename: Christian
authors.initials: C
authors.lastname: Moëll
authors.affiliation: Department of Rheumatology, Skåne University Hospital, Lund, Sweden Department of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Månsson
authors.affiliation: Icelandic Cancer Registry, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors.forename: Laufey
authors.initials: L
authors.lastname: Tryggvadottir
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Hasle
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Jeanette Falck
authors.initials: JF
authors.lastname: Winther
mesh_terms: D000293:Adolescent; D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000706:statistics & numerical data*; D001327:Autoimmune Diseases / Q000453:epidemiology* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D012042:Registries; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: Autoimmune Diseases; Autoimmunity; Epidemiology