Phototherapy, a common treatment for hemolytic disease of the fetus and newborn (HDFN), is associated with a small increase in risk of cancer, according to a recently published study in Frontiers in Pediatrics.
Phototherapy is the most common treatment for neonatal hyperbilirubinemia, a condition in which bilirubin levels in a newborn’s blood rise dangerously high. If left untreated, this buildup can lead to severe brain damage known as bilirubin-induced neurologic dysfunction (BIND) or kernicterus, including hearing loss, developmental delays, and other lifelong impairments.
To prevent this, physicians use phototherapy to convert bilirubin into a water-soluble form that can be excreted. Although this treatment is effective and considered safe, recent research has raised concerns about its long-term effects.
Over the past few years, animal and laboratory studies have suggested that phototherapy might cause DNA damage. Observational studies in humans have followed, some hinting at a potential link between phototherapy and childhood cancers. However, evidence has been inconsistent. Previous meta-analyses on the topic were limited by small study numbers or excluded data without sufficient explanation, leaving the question unresolved.
To address this, the authors conducted an updated and comprehensive systematic review and meta-analysis that included over 6.6 million data points across 15 studies from 1995 to 2022. These studies evaluated cancer risk in individuals exposed to neonatal phototherapy, tracking outcomes from infancy to 31 years of age.
The analysis revealed that newborns who underwent phototherapy had a 24% higher odds of developing cancer later in life compared to those who didn’t.Blood cancers showed the strongest association, with a 40% increase in odds, followed by an 18% increase for solid organ cancers. However, no significant risk was found for skin cancers.
Although these results point to a small but consistent cancer risk, the authors emphasized that the benefits of phototherapy still outweigh the potential risks.Untreated hyperbilirubinemia remains a major risk factor for severe and often irreversible neurologic damage.
The researchers also noted that many included studies lacked adjustment for key confounding factors, such as prematurity or severity of hyperbilirubinemia, which could have influenced both the need for phototherapy and cancer risk.
“Phototherapy for neonatal hyperbilirubinemia was associated with a small increased risk of cancer up to age 31 years,” the authors concluded.”This association must be balanced by the well-understood risk of Bilirubin-Induced Neurologic Dysfunction,”
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