Rahman Md Morshadur, Hayen Andrew, Olynyk John K, Cust Anne E, Irving David O, Karki Surendra
School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia.
Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia.
Vox Sang. 2024 Dec;119(12):1234-1244. doi: 10.1111/vox.13734. Epub 2024 Sep 19.
Several studies have suggested that blood donors have lower risk of gastrointestinal and breast cancers, whereas some have indicated an increased risk of haematological cancers. We examined these associations by appropriately adjusting the 'healthy donor effect' (HDE).
We examined the risk of gastrointestinal/colorectal, breast and haematological cancers in regular high-frequency whole blood (WB) donors using the Sax Institute's 45 and Up Study data linked with blood donation and other health-related data. We calculated 5-year cancer risks, risk differences and risk ratios. To mitigate HDE, we used 5-year qualification period to select the exposure groups, and applied statistical adjustments using inverse probability weighting, along with other advanced doubly robust g-methods.
We identified 2867 (42.4%) as regular high-frequency and 3888 (57.6%) as low-frequency donors. The inverse probability weighted 5-year risk difference between high and low-frequency donors for gastrointestinal/colorectal cancer was 0.2% (95% CI, -0.1% to 0.5%) with a risk ratio of 1.25 (0.83-1.68). For breast cancer, the risk difference was -0.2% (-0.9% to 0.4%), with a risk ratio of 0.87 (0.48-1.26). Regarding haematological cancers, the risk difference was 0.0% (-0.3% to 0.5%) with a risk ratio of 0.97 (0.55-1.40). Our doubly robust estimators targeted minimum loss-based estimator (TMLE) and sequentially doubly robust (SDR) estimator, yielded similar results, but none of the findings were statistically significant.
After applying methods to mitigate the HDE, we did not find any statistically significant differences in the risk of gastrointestinal/colorectal, breast and haematological cancers between regular high-frequency and low-frequency WB donors.
多项研究表明,献血者患胃肠道癌和乳腺癌的风险较低,而另一些研究则表明其患血液系统癌症的风险增加。我们通过适当调整“健康献血者效应”(HDE)来研究这些关联。
我们利用萨克斯研究所的45岁及以上研究数据,该数据与献血及其他健康相关数据相链接,研究了定期高频全血(WB)献血者患胃肠道/结直肠癌、乳腺癌和血液系统癌症的风险。我们计算了5年癌症风险、风险差异和风险比。为减轻HDE,我们使用5年资格期来选择暴露组,并采用逆概率加权进行统计调整,以及其他先进的双重稳健g方法。
我们将2867名(42.4%)确定为定期高频献血者,3888名(57.6%)为低频献血者。高频和低频献血者之间胃肠道/结直肠癌的逆概率加权5年风险差异为0.2%(95%CI,-0.1%至0.5%),风险比为1.25(0.83 - 1.68)。对于乳腺癌,风险差异为-0.2%(-0.9%至0.4%),风险比为0.87(0.48 - 1.26)。关于血液系统癌症,风险差异为0.0%(-0.3%至0.5%),风险比为0.97(0.55 - 1.40)。我们的双重稳健估计量,即基于最小损失的目标估计量(TMLE)和顺序双重稳健(SDR)估计量,得出了相似的结果,但所有结果均无统计学意义。
在应用减轻HDE的方法后,我们未发现定期高频和低频WB献血者在患胃肠道/结直肠癌、乳腺癌和血液系统癌症的风险上存在任何统计学显著差异。