title: Risk of Cerebrovascular Events in 178 962 Five-Year Survivors of Cancer Diagnosed at 15 to 39 Years of Age: The TYACSS (Teenage and Young Adult Cancer Survivor Study).
abstract: BACKGROUND
  Survivors of teenage and young adult cancer are at risk of cerebrovascular events, but the magnitude of and extent to which this risk varies by cancer type, decade of diagnosis, age at diagnosis, and attained age remains uncertain. This is the largest-ever cohort study to evaluate the risks of hospitalization for a cerebrovascular event among long-term survivors of teenage and young adult cancer.
  
  
  METHODS
  The population-based TYACSS (Teenage and Young Adult Cancer Survivor Study) (N=178,962) was linked to Hospital Episode Statistics data for England to investigate the risks of hospitalization for a cerebrovascular event among 5-year survivors of cancer diagnosed when 15 to 39 years of age. Observed numbers of first hospitalizations for cerebrovascular events were compared with that expected from the general population using standardized hospitalization ratios (SHRs) and absolute excess risks per 10 000 person-years. Cumulative incidence was calculated with death considered a competing risk.
  
  
  RESULTS
  Overall, 2782 cancer survivors were hospitalized for a cerebrovascular event-40% higher than expected (SHR=1.4, 95% confidence interval, 1.3-1.4). Survivors of central nervous system (CNS) tumors (SHR=4.6, 95% confidence interval, 4.3-5.0), head and neck tumors (SHR=2.6, 95% confidence interval, 2.2-3.1), and leukemia (SHR=2.5, 95% confidence interval, 1.9-3.1) were at greatest risk. Males had significantly higher absolute excess risks than females (absolute excess risks =7 versus 3), especially among head and neck tumor survivors (absolute excess risks =30 versus 11). By 60 years of age, 9%, 6%, and 5% of CNS tumor, head and neck tumor, and leukemia survivors, respectively, had been hospitalized for a cerebrovascular event. Beyond 60 years of age, every year, 0.4% of CNS tumor survivors were hospitalized for a cerebral infarction (versus 0.1% expected), whereas at any age, every year, 0.2% of head and neck tumor survivors were hospitalized for a cerebral infarction (versus 0.06% expected).
  
  
  CONCLUSIONS
  Survivors of a CNS tumor, head and neck tumor, and leukemia are particularly at risk of hospitalization for a cerebrovascular event. The excess risk of cerebral infarction among CNS tumor survivors increases with attained age. For head and neck tumor survivors, this excess risk remains high across all ages. These groups of survivors, particularly males, should be considered for surveillance of cerebrovascular risk factors and potential pharmacological interventions for cerebral infarction prevention.
authors.affiliation: From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.).
authors.forename: Chloe J
authors.initials: CJ
authors.lastname: Bright
authors.affiliation: From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.).
authors.forename: Mike M
authors.initials: MM
authors.lastname: Hawkins
authors.affiliation: From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.).
authors.forename: Joyeeta
authors.initials: J
authors.lastname: Guha
authors.affiliation: From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.).
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Henson
authors.affiliation: From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.).
authors.forename: David L
authors.initials: DL
authors.lastname: Winter
authors.affiliation: From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.).
authors.forename: Julie S
authors.initials: JS
authors.lastname: Kelly
authors.affiliation: From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.).
authors.forename: Richard G
authors.initials: RG
authors.lastname: Feltbower
authors.affiliation: From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.).
authors.forename: Marlous
authors.initials: M
authors.lastname: Hall
authors.affiliation: From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.).
authors.forename: David J
authors.initials: DJ
authors.lastname: Cutter
authors.affiliation: From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.).
authors.forename: Angela B
authors.initials: AB
authors.lastname: Edgar
authors.affiliation: From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.).
authors.forename: Clare
authors.initials: C
authors.lastname: Frobisher
authors.affiliation: From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.). r.c.reulen@bham.ac.uk.
authors.forename: Raoul C
authors.initials: RC
authors.lastname: Reulen
mesh_terms: D000293:Adolescent; D000328:Adult; D016543:Central Nervous System Neoplasms / Q000150:complications* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology* / Q000473:pathology; D017741:Survivors; D013997:Time Factors; D055815:Young Adult
keywords: cerebrovascular disease; strokes; teenage and young adult cancer