Blood donors are considered one of the healthiest populations. This study describes the epidemiology of cancer in a cohort of blood donors up to 20 years after blood donation. Records from donors who participated in the Retroviral Epidemiology Donor Study (REDS, 1991–2002) at Blood Centers of the Pacific (BCP), San Francisco, were linked to the California Cancer Registry (CCR, 1991–2010). Standardized incidence ratios (SIR) were estimated using standard US 2000 population, and survival analysis used to compare all-cause mortality among donors and a random sample of nondonors with cancer from CCR. Of 55,158 eligible allogeneic blood donors followed-up for 863,902 person-years, 4,236 (7.7%) primary malignant cancers were diagnosed. SIR in donors was 1.59 (95% CI = 1.54,1.64). Donors had significantly lower mortality (adjusted HR = 0.70, 95% CI = 0.66–0.74) compared with nondonor cancer patients, except for respiratory system cancers (adjusted HR = 0.93, 95% CI = 0.82–1.05). Elevated cancer incidence among blood donors may reflect higher diagnosis rates due to health seeking behavior and cancer screening in donors. A “healthy donor effect” on mortality following cancer diagnosis was demonstrated. This population-based database and sample repository of blood donors with long-term monitoring of cancer incidence provides the opportunity for future analyses of genetic and other biomarkers of cancer. 1. Introduction Blood donors are considered to be one of the healthiest populations due to donation eligibility requirements. Studies have suggested a lower incidence of cancer diagnosis and mortality in blood donors. Merk et al. and Edgren et al. estimated cancer incidence in Swedish donors and Swedish and Danish donors, respectively, and showed lower incidence of cancer—including hematological malignancies—in blood donors [1, 2]. These investigators also analyzed risk of cancer in longer-term blood donors relative to donation frequency and found no association between donation intensity and risk of cancer among blood donors [3]. We are unaware of any similar large-scale longitudinal study of cancer occurrence in the US blood donor population. Moreover, the Swedish and Danish studies did not retain samples from donors, in contrast to the existence of cryopreserved plasma and cellular sample repositories from a large number of US blood donors who consented to long-term outcome research studies in the past several decades. Establishment of a population-based database for long-term monitoring of cancer incidence and outcome among these US blood donors therefore
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