Pathogenic Germline Variants in 10,389 Adult Cancers

We conducted the largest investigation of predisposition variants in cancer to date, discovering 853 pathogenic or likely pathogenic variants in 8% of 10,389 cases from 33 cancer types. Twenty-one genes showed single or cross-cancer associations, including novel associations of SDHA in melanoma and PALB2 in stomach adenocarcinoma. The 659 predisposition variants and 18 additional large deletions in tumor suppressors, including ATM, BRCA1, and NF1, showed low gene expression and frequent (43%) loss of heterozygosity or biallelic two-hit events. We also discovered 33 such variants in oncogenes, including missenses in MET, RET, and PTPN11 associated with high gene expression. We nominated 47 additional predisposition variants from prioritized VUSs supported by multiple evidences involving case-control frequency, loss of heterozygosity, expression effect, and co-localization with mutations and modified residues. Our integrative approach links rare predisposition variants to functional consequences, informing future guidelines of variant classification and germline genetic testing in cancer.

Facilitators and Barriers for Advance Care Planning Among Ethnic and Racial Minorities in the U.S.: A Systematic Review of the Current Literature

Growing evidence suggests a low engagement in advance care planning (ACP) among ethnic minorities in the U.S. The purpose of this study was to synthesize findings from prior research about ACP among ethnic minorities. An extensive literature search was conducted using multiple electronic databases. After applying inclusion criteria, 26 studies were included. Four categories of facilitators and barriers to ACP were identified: (1) Socio-demographic factors, (2) health status, literacy and experiences, (3) cultural values, and (4) spirituality. Socio-demographic factors showed inconsistent findings regarding their association with ACP engagement. Worse health status and knowledge about ACP are common facilitators across ethnic minority groups, whereas mistrust toward the health care system was a barrier only for Blacks. Collectivistic cultural values influenced ACP engagement among Latinos and Asian Americans; however, spirituality/religion played an important role among Blacks. The implications for culturally competent approaches to promote ACP and future research directions are discussed.

Productive aging via volunteering: Does social cohesion influence level of engagement?

This study investigated whether neighborhood social cohesion influenced volunteer intensity over two years. The sample was drawn from Health and Retirement Study respondents who completed the 2010 or 2012 Psychosocial and Lifestyle Questionnaire (n = 12,929). Results showed that compared to nonvolunteers, a one-unit increase in neighborhood social cohesion increased the odds of moderate (OR: 1.07, p < .05) and high volunteering (OR: 1.10, p < .001). However, other productive roles, social contact, and education were significant in distinguishing high intensity from moderate volunteering while neighborhood social cohesion was not. Social workers should consider the neighborhood environment when recruiting volunteers.

Rural/urban residence and childhood and adolescent cancer survival in the United States

BACKGROUND

To the authors' knowledge, no previous study has examined the relationship between rural/urban residence and childhood or adolescent cancer survival in the United States. Using the Surveillance, Epidemiology, and End Results 18 registries database, the authors examined childhood and adolescent cancer survival by rural/urban residence as defined by Rural-Urban Continuum Codes (RUCCs).

METHODS

The authors obtained data from Surveillance, Epidemiology, and End Results 18 registries for individuals diagnosed at ages birth to 19 years with a first primary malignant cancer from 2000 through 2010. Rural/urban residence at the time of diagnosis was defined using both metropolitan/nonmetropolitan county classifications and individual RUCC categories. Cox proportional hazards regression was used to compute adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association between rural/urban residence and cancer survival. The authors also examined effect modification by age group, sex, race/ethnicity, and cancer type.

RESULTS

Among 41,879 cancer cases, approximately 54.7% were non-Hispanic white, 54.3% were male, and 90.4% lived in a metropolitan county. Individuals living in nonmetropolitan counties versus metropolitan counties had a similar risk of cancer death (HR,  1.03; 95% CI, 0.94-1.13) as did those living in nonmetropolitan rural counties with <2500 individuals nonadjacent to a metropolitan area versus those living in metropolitan counties of ≥1 million individuals (HR,  0.98; 95% CI, 0.71-1.37). Evidence for effect modification largely was absent.

CONCLUSIONS

The results of the current study suggest that childhood and adolescent cancer survival in the United States does not vary by rural/urban residence at the time of diagnosis as defined by RUCCs. The widespread availability of public health insurance for children and adolescents and a nationwide network of pediatric cancer providers may explain this finding.

Volunteering among First-Generation Asian Ethnic Groups Residing in California

This study was a cross-sectional investigation of volunteer activity among four distinct Asian ethnic subgroups-Chinese, Filipino, Korean, and Vietnamese-who have immigrated to the United States. Data from the 2011-2012 California Health Interview Survey (CHIS) were used with an analytic sample of Chinese (n = 547), Filipino (n = 229), Korean (n = 490), and Vietnamese (n = 546) adults 50 and older. A series of logistic regression models were estimated to examine differences and similarities across the four ethnic groups in volunteer activity. Consistent with previous studies, Asian immigrants with more years of education and those who became U.S. citizens were more likely to participate in volunteering. However, the correlates were not consistent within Asian ethnic subgroups. For example, education was not a significant factor for older Korean immigrants while it was a salient factor among other Asian subgroups. Results showed similarities and differences associated with volunteer participation among diverse ethnic subgroups. The findings underscored the importance of culture-specific information in creating inclusive opportunities for volunteering.

Use of reproducible research practices in public health: A survey of public health analysts

Objective

Use of reproducible research practices improves the quality of science and the speed of scientific development. We sought to understand use of reproducible research practices in public health and associated barriers and facilitators.

Methods

In late 2017, we surveyed members of the American Public Health Association Applied Public Health Statistics section and others; 247 of 278 who screened eligible answered the survey, and 209 answered every applicable question. The survey included questions about file management, code annotation and documentation, reproducibility of analyses, and facilitators and barriers of using reproducible practices.

Results

Just 14.4% of participants had shared code, data, or both. Many participants reported their data (33%) and code (43.2%) would be difficult for colleagues to find if they left their institution. Top reported barriers to using reproducible practices were data privacy (49.8%) and lack of time (41.7%). Participants suggested training (50.9%) and requirements by journals (44.4%) and funders (40.2%) to increase use of reproducible research practices.

Conclusions

Increasing use of reproducible research practices is important for public health and requires action from researchers, training programs, funders, and journals.

Characteristics of The Cancer Genome Atlas cases relative to U.S. general population cancer cases

Background

Despite anecdotal reports of differences in clinical and demographic characteristics of The Cancer Genome Atlas (TCGA) relative to general population cancer cases, differences have not been systematically evaluated.

Methods

Data from 11,160 cases with 33 cancer types were ascertained from TCGA data portal. Corresponding data from the Surveillance, Epidemiology, and End Results (SEER) 18 and North American Association of Central Cancer Registries databases were obtained. Differences in characteristics were compared using Student’s t, Chi-square, and Fisher’s exact tests. Differences in mean survival months were assessed using restricted mean survival time analysis and generalised linear model.

Results

TCGA cases were 3.9 years (95% CI 1.7–6.2) younger on average than SEER cases, with a significantly younger mean age for 20/33 cancer types. Although most cancer types had a similar sex distribution, race and stage at diagnosis distributions were disproportional for 13/18 and 25/26 assessed cancer types, respectively. Using 12 months as an end point, the observed mean survival months were longer for 27 of 33 TCGA cancer types.

Conclusions

Differences exist in the characteristics of TCGA vs. general population cancer cases. Our study highlights population subgroups where increased sample collection is warranted to increase the applicability of cancer genomic research results to all individuals.

Integrative omics analyses broaden treatment targets in human cancer

Background

Although large-scale, next-generation sequencing (NGS) studies of cancers hold promise for enabling precision oncology, challenges remain in integrating NGS with clinically validated biomarkers.

Methods

To overcome such challenges, we utilized the Database of Evidence for Precision Oncology (DEPO) to link druggability to genomic, transcriptomic, and proteomic biomarkers. Using a pan-cancer cohort of 6570 tumors, we identified tumors with potentially druggable biomarkers consisting of drug-associated mutations, mRNA expression outliers, and protein/phosphoprotein expression outliers identified by DEPO.

Results

Within the pan-cancer cohort of 6570 tumors, we found that 3% are druggable based on FDA-approved drug-mutation interactions in specific cancer types. However, mRNA/phosphoprotein/protein expression outliers and drug repurposing across cancer types suggest potential druggability in up to 16% of tumors. The percentage of potential drug-associated tumors can increase to 48% if we consider preclinical evidence. Further, our analyses showed co-occurring potentially druggable multi-omics alterations in 32% of tumors, indicating a role for individualized combinational therapy, with evidence supporting mTOR/PI3K/ESR1 co-inhibition and BRAF/AKT co-inhibition in 1.6 and 0.8% of tumors, respectively. We experimentally validated a subset of putative druggable mutations in BRAF identified by a protein structure-based computational tool. Finally, analysis of a large-scale drug screening dataset lent further evidence supporting repurposing of drugs across cancer types and the use of expression outliers for inferring druggability.

Conclusions

Our results suggest that an integrated analysis platform can nominate multi-omics alterations as biomarkers of druggability and aid ongoing efforts to bring precision oncology to patients.

Electronic supplementary material

The online version of this article (10.1186/s13073-018-0564-z) contains supplementary material, which is available to authorized users.

Abstract 1194: U.S. childhood and adolescent cancer survival between 1992 and 2013: An analysis of population-based data

Background

Monitoring cancer survival over time and across different demographic groups is an important part of cancer control. In the current study, our objective was to examine U.S. cancer survival patterns in childhood and adolescent cancer patients between different time periods and demographic groups.

Methods

Survival data for primary cancers diagnosed in individuals ≤ 19 years from 1992 to 2014 were obtained from the Surveillance, Epidemiology, and End Results 13 database. Five-year relative survival rates were estimated according to the cohort method using SEER*Stat software. Survival differences were examined for subgroups defined by diagnosis time period (1992-1994, 1995-1999, 2000-2004, 2005-2009), sex (male and female), age at diagnosis (&lt;1, 1-4, 5-9, 10-14, 15-19 years) and race/ethnicity (Non-Hispanic White, Non-Hispanic-Black, Hispanic, and Non-Hispanic Other). The annual percent change (APC) in 5-year relative survival was estimated using Joinpoint software. Finally, period survival analysis was also conducted using SEER*Stat software to provide the most up-to-date five-year relative survival predictions using data from cases diagnosed between 2007 and 2013.

Results

Five-year relative survival increased significantly for cancers overall (75.9% vs. 82.9 for 1992-1994 and 2005-2009 respectively, p&lt;0.001) and for half of the cancer subtypes. The largest improvements were observed for leukemias, myeloproliferative and myelodysplastic disease (+ 11.6%, p&lt;0.001) and lymphomas and reticuloendothelial neoplasms (+5.8%, p&lt;0.001). Significant improvement in relative survival over time was also observed for both sexes with APCs of 0.67 (males) and 0.51 (females), across all age groups with APCs of 0.68 (infants), 0.63 (1-4 years), 0.68 (10-14 years) and 0.65 (15-19 years) except 5-9 years (APC: 0.32), and all racial/ethnic groups with APCs of 0.61 (non-Hispanic White), 0.64 (Non-Hispanic Black), 0.51 (Hispanic), and 0.75 (Non-Hispanic Other). No statistically significant differences in the APCs were observed between sex, age, and race/ethnicity subgroups. However, survival disparities were apparent across age and race/ethnicity subgroups in period analyses, with infant and Hispanic, non-Hispanic Black and non-Hispanic Other cases having lower survival rates than older and non-Hispanic White cases (infant: 77.2% vs 1-4 years: 85.5%, 5-9 years: 84.1%, 10-14 years: 84.2% and 15-19 years: 84.0%; Non-Hispanic Black: 81.6%, Non-Hispanic Other: 81.2%, and Hispanic: 79.8% vs. Non-Hispanic White: 87.5%).

Conclusion

Our results indicate that childhood and adolescent cancer survival continues to improve for all demographic groups. However, persistent inferior survival rates in infants and in minority race/ethnicity groups reinforces the need for continued research that aims to eliminate childhood and adolescent cancer survival inequities.

Citation Format: Xiaoyan Wang, Kimberly J. Johnson. U.S. childhood and adolescent cancer survival between 1992 and 2013: An analysis of population-based data [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1194.

Parental age and risk of genetic syndromes predisposing to nervous system tumors: nested case-control study

Purpose

Phacomatoses are genetic syndromes that are associated with increased risk of developing nervous system tumors. Phacomatoses are usually inherited, but many develop de novo, with unknown etiology. In this population-based study, we investigated the effect of parental age on the risk of phacomatoses in offspring.

Patients and methods

The study was a population-based nested case–control study. All individuals born and residing in Sweden between January 1960 and December 2010 were eligible for inclusion. Using the Patient Register, 4625 phacomatosis cases were identified and further classified as familial or nonfamilial. Ten matched controls per case were randomly selected from the eligible population. Data were analyzed using conditional logistic regression. Analyses were conducted for neurofibromatosis alone (n=2089) and other phacomatoses combined (n=2536).

Results

Compared with offspring of fathers aged 25–29 years, increased risk estimates of nonfamilial neurofibromatosis were found for offspring of fathers aged 35–39 years (odds ratio [OR]=1.43 [95% CI 1.16–1.74]) and ≥40 years (OR =1.74 [95% CI 1.38–2.19]). For other nonfamilial phacomatoses, the risk estimate for offspring of fathers aged ≥40 years was OR =1.23 (95% CI 1.01–1.50). Paternal age was not associated with familial phacomatoses, and no consistent association was observed with maternal age.

Conclusion

The findings show a consistent increase in risk of de novo occurrence of phacomatoses predisposing to nervous system tumors in offspring with increasing paternal age, most pronounced for neurofibromatosis, while maternal age did not seem to influence the risk. These findings suggest an increasing rate of new mutations in the NF1 and NF2 genes in spermatozoa of older fathers.

Male Breast Cancer: An Updated Surveillance, Epidemiology, and End Results Data Analysis

BACKGROUND

Male breast cancer is rare and understudied compared with female breast cancer. A current comparison with female breast cancer could assist in bridging this gap. Although conflicting data have been reported on male and female survival outcomes, data from 1973 through 2005 in the Surveillance, Epidemiology, and End Results (SEER) program have demonstrated that the improvement in breast cancer survival in men has fallen behind that of women. As treatment for breast cancer has improved significantly, an updated analysis using a contemporary population is necessary.

MATERIALS AND METHODS

An analysis of SEER data from patients with a diagnosis of primary breast cancer from 2005 to 2010 were included. A Cox regression model was used to examine the association between sex and breast cancer mortality after controlling for prognostic factors, including age, race, marital status, disease stage, estrogen and progesterone receptor status, lymph node involvement, tumor grade, surgery, and geography. Subgroup analyses were performed by race and stage.

RESULTS

We included a total of 289,673 breast cancer cases (2054 men) with a diagnosis from 2005 to 2010. The 5-year survival rate for male patients was lower than that for female patients (82.8% vs. 88.5%). After controlling for other factors, the risk of death in men was 43% greater than that in women during the follow-up period (hazard ratio, 1.43; 95% confidence interval, 1.26-1.61). Similar results were noted in the race and stage subgroup analyses.

CONCLUSION

In recent years, male breast cancer patients have had worse survival outcomes compared with those of female patients.

Parental Age and Risk of Infant Leukaemia: A Pooled Analysis

BACKGROUND

Infant leukaemia (IL) is extremely rare with fewer than 150 cases occurring each year in the United States. Little is known about its causes. However, recent evidence supports a role of de novo mutations in IL aetiology. Parental age has been associated with several adverse outcomes in offspring, including childhood cancers. Given the role of older parental age in de novo mutations in offspring, we carried out an analysis of parental age and IL.

METHODS

We evaluated the relationship between parental age and IL in a case-control study using registry data from New York, Minnesota, California, Texas, and Washington. Records from 402 cases [219 acute lymphoblastic leukaemia (ALL), 131 acute myeloid leukaemia (AML), and 52 other] and 45 392 controls born during 1981-2004 were analysed. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by logistic regression. Estimates were adjusted for infant sex, birth year category, maternal race, state, and mutually adjusted for paternal or maternal age, respectively.

RESULTS

Infants with mothers' age ≥40 years had an increased risk of developing AML (OR 4.80, 95% CI 1.80, 12.76). In contrast, paternal age <20 was associated with increased risk of ALL (OR 3.69, 95% CI 1.62, 8.41).

CONCLUSION

This study demonstrates increased risk of infant ALL in relation to young paternal age. Given record linkage, there is little concern with recall or selection bias, although data are lacking on MLL gene status and other potentially important variables. Parent of origin effects, de novo mutations, and/or carcinogenic exposures may be involved in IL aetiology.

Congenital neurodevelopmental anomalies in pediatric and young adult cancer

Congenital anomalies that are diagnosed in at least 120,000 US infants every year are the leading cause of infant death and contribute to disability and pediatric hospitalizations. Several large-scale epidemiologic studies have provided substantial evidence of an association between congenital anomalies and cancer risk in children, suggesting potential underlying cancer-predisposing conditions and the involvement of developmental genetic pathways. Electronic medical records from 1,107 pediatric, adolescent, and young adult oncology patients were reviewed. The observed number (O) of congenital anomalies among children with a specific pediatric cancer subtype was compared to the expected number (E) of anomalies based on the frequency of congenital anomalies in the entire study population. The O/E ratios were tested for significance using Fisher's exact test. The Kaplan-Meier method was used to compare overall and neurological malignancy survival rates following tumor diagnosis. Thirteen percent of patients had a congenital anomaly diagnosis prior to their cancer diagnosis. When stratified by congenital anomaly subtype, there was an excess of neurological anomalies among children with central nervous system tumors (O/E = 1.56, 95%CI 1.13-2.09). Male pediatric cancer patients were more likely than females to have a congenital anomaly, particularly those <5 years of age (O/E 1.35, 95%CI 0.97-1.82). Our study provides additional insight into the association between specific congenital anomaly types and pediatric cancer development. Moreover, it may help to inform the development of new screening policies and support hypothesis-driven research investigating mechanisms underlying tumor predisposition in children with congenital anomalies.

Pediatric cancer risk in association with birth defects: A systematic review

BACKGROUND

Many epidemiological studies have examined associations between birth defects (BDs) and pediatric malignancy over the past several decades. Our objective was to conduct a systematic literature review of studies reporting on this association.

METHODS

We used librarian-designed searches of the PubMed Medline and Embase databases to identify primary research articles on pediatric neoplasms and BDs. English language articles from PubMed and Embase up to 10/12/2015, and in PubMed up to 5/12/2017 following an updated search, were eligible for inclusion if they reported primary epidemiological research results on associations between BDs and pediatric malignancies. Two reviewers coded each article based on the title and abstract to identify eligible articles that were abstracted using a structured form. Additional articles were identified through reference lists and other sources. Results were synthesized for pediatric cancers overall and for nine major pediatric cancer subtypes.

RESULTS

A total of 14,778 article citations were identified, of which 80 met inclusion criteria. Pediatric cancer risk was increased in most studies in association with BDs overall with some notable specific findings, including increased risks for CNS tumors in association with CNS abnormalities and positive associations between rib anomalies and several pediatric cancer types.

CONCLUSIONS

Some children born with BDs may be at increased risk for specific pediatric malignancy types. This work provides a foundation for future investigations that are needed to clarify specific BD types predisposing toward malignancy and possible underlying causes of both BDs and malignancy.

Blood biomarker analysis to differentiate between pseudo-progression and true disease progression in post-treatment glioblastoma

e13501

Background: Current standard treatment for patients with glioblastoma (GBM) includes glucocorticoid therapy, temozolomide (TMZ), and radiation (RT) which may result in lymphotoxic and immunosuppressive effects. MRI use is currently unreliable in differentiating true from pseudo-progression pathology. Recent studies have suggested that total lymphocyte count (TLC) and CD4 cell count are associated with clinical outcomes. Our objective was to investigate whether TLC or CD4 may help to differentiate treatment effect (pesudoprogression) from tumor progression. Methods: Patients were eligible for this retrospective study if they had 1) GBM diagnosed between February 2010 and July 2015, 2) series of cell counts and clinical follow-ups monitored at Washington University, and 3) tumor progression documented by MRI and pathology. The data were analyzed using descriptive statistics, chi-square tests, Kaplan-Meier survival curves, and progression-free survival. Results: A total of 728 charts were reviewed, of which 45adults met eligibility criteria. The median age and KPS scores were 58 years and 80, respectively. MGMT was detected in 33% of patients and 69% of patients had undergone a gross total resection. Median TLC at baseline was 1700 cells/mm3 (range 400-3100). After the completion of RT/TMZ, TLC dropped 41% to a median of 1000 cells/mm3 (range 200-2900). Median TLC was 1000 cells/mm3 (range 300-2900) at the first MRI documented progression. Patients underwent surgery for this MRI documented progression. Pathology revealed that 62% of patients had true tumor progression, 33% had mixed treatment effect and residual tumor, and 4% had necrosis. The median time from diagnosis to progression was 15 months. There were no statistically significant differences in overall survival or progression free survival found in patients with higher vs lower TLC at baseline, completion of RT/TMZ, and time of progression. Conclusions: These preliminary results do not indicate that TLC level in GBM patients can differentiate between true disease progression and pseudo-progression. A larger sample size that includes patients with CD4 data is needed to confirm these results.

Neurofibromatosis type 1

Neurofibromatosis type 1 is a complex autosomal dominant disorder caused by germline mutations in the NF1 tumour suppressor gene. Nearly all individuals with neurofibromatosis type 1 develop pigmentary lesions (café-au-lait macules, skinfold freckling and Lisch nodules) and dermal neurofibromas. Some individuals develop skeletal abnormalities (scoliosis, tibial pseudarthrosis and orbital dysplasia), brain tumours (optic pathway gliomas and glioblastoma), peripheral nerve tumours (spinal neurofibromas, plexiform neurofibromas and malignant peripheral nerve sheath tumours), learning disabilities, attention deficits, and social and behavioural problems, which can negatively affect quality of life. With the identification of NF1 and the generation of accurate preclinical mouse strains that model some of these clinical features, therapies that target the underlying molecular and cellular pathophysiology for neurofibromatosis type 1 are becoming available. Although no single treatment exists, current clinical management strategies include early detection of disease phenotypes (risk assessment) and biologically targeted therapies. Similarly, new medical and behavioural interventions are emerging to improve the quality of life of patients. Although considerable progress has been made in understanding this condition, numerous challenges remain; a collaborative and interdisciplinary approach is required to manage individuals with neurofibromatosis type1 and to develop effective treatments.

Integrated analysis of germline and somatic variants in ovarian cancer

We report the first large-scale exome-wide analysis of the combined germline-somatic landscape in ovarian cancer. Here we analyse germline and somatic alterations in 429 ovarian carcinoma cases and 557 controls. We identify 3,635 high confidence, rare truncation and 22,953 missense variants with predicted functional impact. We find germline truncation variants and large deletions across Fanconi pathway genes in 20% of cases. Enrichment of rare truncations is shown in BRCA1, BRCA2 and PALB2. In addition, we observe germline truncation variants in genes not previously associated with ovarian cancer susceptibility (NF1, MAP3K4, CDKN2B and MLL3). Evidence for loss of heterozygosity was found in 100 and 76% of cases with germline BRCA1 and BRCA2 truncations, respectively. Germline-somatic interaction analysis combined with extensive bioinformatics annotation identifies 222 candidate functional germline truncation and missense variants, including two pathogenic BRCA1 and 1 TP53 deleterious variants. Finally, integrated analyses of germline and somatic variants identify significantly altered pathways, including the Fanconi, MAPK and MLL pathways.

Factors Associated With Volunteering Among Racial/Ethnic Groups: Findings From the California Health Interview Survey

The present study investigated how volunteering was influenced by individual resources and social capital among four racial/ethnic groups of adults aged 50 and older. The data came from the California Health Interview Survey, a statewide sample that includes non-Hispanic Whites ( n = 18,927), non-Hispanic Asians ( n = 2,428), non-Hispanic Blacks ( n = 1,265), and Hispanics ( n = 3,799). Logistic regression models of volunteering were estimated to explore the effects of human and social capital within and across the racial/ethnic groups. Compared to Whites, racial/ethnic minority adults volunteered less. Although education was a significant predictor of volunteering across all groups, the findings indicated group-specific factors related to human and social capital. Results showed similarities and differences associated with volunteer participation among diverse racial/ethnic groups. The findings underscore the importance of understanding ways of creating inclusive opportunities for civic engagement among an increasingly diverse population.

Racial/Ethnic Differences in Pediatric Brain Tumor Diagnoses in Patients with Neurofibromatosis Type 1

OBJECTIVE

To evaluate evidence for differences in pediatric brain tumor diagnoses by race and ethnicity using a cross-sectional study design in individuals with neurofibromatosis type 1 (NF1).

STUDY DESIGN

Subjects with NF1 were ascertained from the NF1 Patient Registry Initiative and through a clinical record database of patients at a large academic medical center. Logistic regression was employed to calculate ORs and 95% CIs to analyze differences in the odds of brain tumor diagnosis by race (White, Black, Asian, other/unknown) and ethnic (Hispanic vs non-Hispanic) groups.

RESULTS

Data from a total of 1546, 629, and 2038 individuals who were ascertained from the NF1 Patient Registry Initiative, clinical records, and pooled datasets were analyzed, respectively. After adjusting for birth year, we observed a significantly reduced odds of brain tumor diagnoses in individuals self-identified or clinically reported as Black (OR = 0.13, 95% CI 0.05-0.31), Asian (OR = 0.15, 95% CI 0.04-0.64), and other/unknown (OR = 0.61, 95% CI 0.41-0.93) race compared with those with reported as White race. There was no significant difference in the odds of pediatric brain tumor diagnosis by Hispanic ethnicity.

CONCLUSIONS

Consistent with prior smaller studies, these data suggest that pediatric brain tumor diagnoses vary by race in individuals with NF1. Reasons underlying observed differences by race warrant further investigation.

Childhood brain tumor epidemiology: a brain tumor epidemiology consortium review

Childhood brain tumors are the most common pediatric solid tumor and include several histologic subtypes. Although progress has been made in improving survival rates for some subtypes, understanding of risk factors for childhood brain tumors remains limited to a few genetic syndromes and ionizing radiation to the head and neck. In this report, we review descriptive and analytical epidemiology childhood brain tumor studies from the past decade and highlight priority areas for future epidemiology investigations and methodological work that is needed to advance our understanding of childhood brain tumor causes. Specifically, we summarize the results of a review of studies published since 2004 that have analyzed incidence and survival in different international regions and that have examined potential genetic, immune system, developmental and birth characteristics, and environmental risk factors. Cancer Epidemiol Biomarkers Prev; 23(12); 2716-36. ©2014 AACR.

Age-related mutations associated with clonal hematopoietic expansion and malignancies

Several genetic alterations characteristic of leukemia and lymphoma have been detected in the blood of individuals without apparent hematological malignancies. The Cancer Genome Atlas (TCGA) provides a unique resource for comprehensive discovery of mutations and genes in blood that may contribute to the clonal expansion of hematopoietic stem/progenitor cells. Here, we analyzed blood-derived sequence data from 2,728 individuals from TCGA and discovered 77 blood-specific mutations in cancer-associated genes, the majority being associated with advanced age. Remarkably, 83% of these mutations were from 19 leukemia and/or lymphoma-associated genes, and nine were recurrently mutated (DNMT3A, TET2, JAK2, ASXL1, TP53, GNAS, PPM1D, BCORL1 and SF3B1). We identified 14 additional mutations in a very small fraction of blood cells, possibly representing the earliest stages of clonal expansion in hematopoietic stem cells. Comparison of these findings to mutations in hematological malignancies identified several recurrently mutated genes that may be disease initiators. Our analyses show that the blood cells of more than 2% of individuals (5-6% of people older than 70 years) contain mutations that may represent premalignant events that cause clonal hematopoietic expansion.

Abstract 1295: The association between asthma and pediatric brain tumors in neurofibromatosis type 1

Background. Neurofibromatosis type 1 (NF1) is a common hereditary cancer syndrome, affecting an estimated 1/2,500 people worldwide. NF1 increases the risk of several tumor types, including pediatric brain tumors that affect an estimated 10-20% of individuals. While established risk factors for pediatric brain tumor development in this population have not been elucidated, consistent evidence from non-syndromic populations suggests a strong inverse association between asthma and brain tumors. As such, the objective of this study was to test the hypothesis that asthma is inversely associated with pediatric brain tumors in the NF1 population.

Methods. In this analysis, we employed two data sources. The first dataset was assembled from the international NF1 Patient Registry Initiative (NPRI) (https://nf1registry.wustl.edu/) that enrolled individuals with NF1 over ∼2.5 years. Medical history data were collected through the online registry questionnaire. The second study used private health insurance claims data from 2006-2010 from Thompson Reuters MarketScan to assemble an NF1 group and their claims data on asthma- and brain tumor-related healthcare visits. Diagnoses were determined from ICD-9 codes. The NF1 group was defined by the presence of &gt;2 NF1-related outpatient claims &gt;30 days apart or one NF1-related inpatient claim. Within the NF1 group, individuals were classified as having asthma and/or brain tumors if they had &gt;2 claims for these conditions &gt;30 days apart. The study population for both data sources was limited to subjects who were &lt;18 years old at the time of NPRI or insurance enrollment. Unconditional logistic regression was employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between pediatric brain tumors and asthma for both datasets.

Results. A total of 409 individuals with NF1 were included in the analysis using NPRI data, resulting in 119 pediatric brain tumors. After adjusting for birth year, we observed an inverse association between pediatric brain tumors and asthma (OR=0.6; 95% CI 0.4-1.1). In the analysis using MarketScan data, the NF1 group included a total of 3,871 individuals &lt;18 years at the time of insurance enrollment, of which 397 had &gt;2 pediatric brain tumor-related claims. After controlling for number of months enrolled, birth year, and number of healthcare visits, subjects with brain tumor claims were significantly less likely to have asthma claims than those without brain tumor claims (OR=0.5; 95% CI 0.3-0.8).

Conclusions. Similar to findings from non-syndromic populations, the results from this study provide strong epidemiologic evidence for an inverse association between asthma and pediatric brain tumors in the NF1 population.

Acknowledgements. This work was supported by Alex's Lemonade Stand Foundation and NIH CTSA UL1 TR000448.

Citation Format: Kimberly J. Johnson, Nancy Mueller, Evelyn Sharkey, Qian Liu, David H. Gutmann. The association between asthma and pediatric brain tumors in neurofibromatosis type 1. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1295. doi:10.1158/1538-7445.AM2014-1295

Abstract 3438: Integrated analysis of germline and somatic variants in renal clear cell carcinoma

Each year in the United States, there are approximately 54,000 new cases of kidney and upper urinary tract cancers and 13,000 deaths. Renal clear cell carcinoma (RCC) is the most common type of kidney cancer comprising more than 75% of cases. It is known that certain genetic syndromes strongly increase risk for renal cell carcinoma including Von Hippel Lindau disease (VHL) that is caused by germline mutations in the VHL tumor suppressor gene. However, there are a large number of cases with familial RCC that are not explained by germline VHL mutations. Publically available data generated through large scale genomic sequencing projects such as The Cancer Genome Atlas (TCGA) provides new opportunities for identifying both known and novel germline cancer susceptibility variants. Moreover, the availability of matched tumor and normal genomic sequencing data from cancer patients (including RCCC) through TCGA allows for integrated analyses of germline and somatic interactions. Toward this end, we analyzed the TCGA exome sequencing data from 499 RCC cases. We employed GATK, VarScan, and Pindel tools to identify germline single nucleotide variants and indels and identified 10,492 candidate germline rare truncation variants (X truncation variants were in cancer genes). All the truncation candidates in commonly mutated cancer driver genes were manually reviewed, resulting in a total of 119 high confidence germline truncation variants in cancer genes. To date, we have identified one nonsense mutation in the VHL gene. In addition, there was one nonsense mutation and a frame-shift deletion in WRN and a nonsense and a splice-site mutation in BAP1, a recently identified RCC predisposition gene. Moreover, we also identified 6,079 candidate missense variants in known cancer driver genes, among a total of 179,066 rare missense variants. Future directions for this project will be to use the burden analysis to determine genes with significant enrichment for deleterious variants. We will also examine loss of heterozygosity patterns to evaluate germline somatic interactions.

Citation Format: Jiayin Wang, Charles Lu, Mingchao Xie, Piyush Tripathi, Michael McLellan, Feng Chen, Kimberly J. Johnson, Li Ding. Integrated analysis of germline and somatic variants in renal clear cell carcinoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3438. doi:10.1158/1538-7445.AM2014-3438

Neurofibromatosis type 1 and chronic neurological conditions in the United States: an administrative claims analysis

Purpose

Neurofibromatosis Type 1 (NF1) has been linked to several neurological conditions including: epilepsy, Parkinson's disease, headache, multiple sclerosis, and sleep disturbances, predominantly through case reports and series that lack comparison groups. Our objective was to assess whether specific neurological conditions occur more frequently in individuals with NF1 vs. those without NF1.

Methods

We used the 2006-2010 MarketScan Commercial Claims and Encounters database to examine associations between neurological conditions and NF1. The NF1 group was identified through ≥2 ICD-9-CM NF codes (237.70, 237.71) occurring ≥30 days apart or one inpatient NF code. A non-NF1 comparison group was frequency-matched to the NF1 group on age and enrollment length at a 10:1 ratio. Unconditional logistic regression was employed to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between NF and neurological conditions.

Results

Compared to the non-NF1 group (n=85,790), the NF1 group (n=8,579) had a significantly higher odds of health insurance claims for epilepsy (OR=7.3; 95% CI 6.4-8.3), Parkinson's disease (OR=3.1; 95% CI 1.3-7.5), headache (OR=2.9, 95% CI 2.6-3.1), multiple sclerosis (OR=1.9, 95% CI 1.2-2.9), and sleep disturbances/disorder (OR=1.4, 95% CI 1.2-3.6).

Conclusion

This large study provides strong evidence for positive associations between several neurological conditions and NF1.

Perigestational dietary folic acid deficiency protects against medulloblastoma formation in a mouse model of nevoid basal cell carcinoma syndrome

Hereditary nevoid basal cell carcinoma syndrome (NBCCS) is caused by PTCH1 gene mutations that result in diverse neoplasms including medulloblastoma (MB). Epidemiological studies report reduced pediatric brain tumor risks associated with maternal intake of prenatal vitamins containing folic acid (FA) and FA supplements specifically. We hypothesized that low maternal FA intake during the perigestational period would increase MB incidence in a transgenic NBCCS mouse model, which carries an autosomal dominant mutation in the Ptch1 gene. Female wild-type C57BL/6 mice (n = 126) were randomized to 1 of 3 diets with differing FA amounts: 0.3 mg/kg (low), 2.0 mg/kg (control), and 8.0 mg/kg (high) 1 mo prior to mating with Ptch1 (+/-) C57BL/6 males. Females were maintained on the diet until pup weaning; the pups were then aged for tumor development. Compared to the control group, offspring MB incidence was significantly lower in the low FA group (Hazard Ratio = 0.47; 95% confidence interval 0.27-0.80) at 1 yr. No significant difference in incidence was observed between the control and high FA groups. Low maternal perigestational FA levels may decrease MB incidence in mice genetically predisposed to tumor development. Our results could have implications for prenatal FA intake recommendations in the presence of cancer syndromes.

The emergence of a positive gerontology: from disengagement to social involvement

The latter part of the 20th century was a period characterized by a fundamental transition in scholarship on activity and the aging process. Theory emphasizing the inevitable decline of human capacity was gradually replaced with concepts stressing positive, multidimensional views of aging. In this article, we highlight the key contributors and trace the origins and overlapping themes of successful aging, productive aging, and civic engagement in later life: 3 examples of scholarship representing a "positive" gerontology. Rowe and Kahn's model of successful aging highlights the interplay between social engagement with life, health, and functioning for a positive aging experience. Productive aging, led by Robert Butler, recognizes the previously underappreciated participation of older adults in activities such as volunteering, paid work, and caregiving, and generates interest in the individual and societal barriers to and benefits of participation. Civic engagement in later life raises public awareness about the need to involve older adults in the community, creates opportunities for participation, and generates further interest in the mutual benefit of participation for community beneficiaries and participants. Successful aging, productive aging, and civic engagement represent important contributions to the field of gerontology through applications to policy, advocacy, and theory development.

Parental tobacco and alcohol use and risk of hepatoblastoma in offspring: a report from the children's oncology group

BACKGROUND

Hepatoblastoma is a rare pediatric liver tumor that has significantly increased in incidence over the last several decades. The International Agency for Research on Cancer (IARC) recently classified hepatoblastoma as a tobacco-related cancer. Parental alcohol use has shown no association. We examined associations between parental tobacco and alcohol use around the time of pregnancy and hepatoblastoma in a large case-control study.

METHODS

Maternal interviews were completed for 383 cases diagnosed in the United States during 2000-2008. Controls (n = 387) were identified through U.S. birth registries and frequency-matched to cases on birth weight, birth year, and region of residence. We used unconditional logistic regression to calculate ORs and 95% confidence intervals (CI) for associations between parental smoking and maternal drinking and offspring hepatoblastoma.

RESULTS

We found no association between hepatoblastoma and maternal smoking at any time (OR, 1.0; 95% CI, 0.7-1.4), within the year before pregnancy (OR, 1.1; 95% CI, 0.8-1.6), early in pregnancy (OR, 1.0; 95% CI, 0.7-1.6), or throughout pregnancy (OR, 0.9; 95% CI, 0.5-1.6). We observed marginally positive associations between hepatoblastoma and paternal smoking in the year before pregnancy (OR, 1.4; 95% CI, 1.0-2.0) and during pregnancy (OR, 1.4; 95% CI, 0.9-2.0). Maternal alcohol use was not associated with hepatoblastoma.

CONCLUSION

Our results do not provide evidence for an etiologic relationship between maternal smoking or drinking and hepatoblastoma, and only weak evidence for an association for paternal smoking in the year before pregnancy.

IMPACT

Our study provides limited support for hepatoblastoma as a tobacco-related cancer; however, it remains wise to counsel prospective parents on the merits of smoking cessation.

Second-trimester diagnosis of triploidy: a series of four cases

Triploidy occurs in 2 to 3% of conceptuses and accounts for approximately 20% of chromosomally abnormal first-trimester miscarriages. As such, triploidy is estimated to occur in 1 of 3,500 pregnancies at 12 weeks', 1 in 30,000 at 16 weeks', and 1 in 250,000 at 20 weeks' gestation. We present a series of four cases of second-trimester triploidy diagnosed at our center within a 1-year timeframe. This is remarkable, as the delivery volume at our institution is roughly 2,500/y. All patients were at least 19 weeks' gestation, with multiple abnormalities identified on prenatal ultrasound at 18 to 20 weeks' gestation; all fetuses had lethal anomalies, but anomalies were not consistent between cases. All patients elected for induction of labor before 24 weeks' gestational age. Two of the four cases had amniocentesis and chromosome analysis prior to delivery, and two cases had chromosome analysis performed on fetal tissue after delivery. All fetuses were examined following delivery. This case series demonstrates that the diagnosis of triploidy may not be obvious based on ultrasound and physical examination findings and highlights the importance of routine chromosome analysis on all prenatal diagnoses of multiple congenital anomalies prior to consideration of more complex genetic testing.

Incidence of childhood and adolescent melanoma in the United States: 1973-2009

OBJECTIVE

Childhood and adolescent melanoma is rare but has been increasing. To gain insight into possible reasons underlying this observation, we analyzed trends in melanoma incidence diagnosed between the ages of 0 and 19 years among US whites by gender, stage, age at diagnosis, and primary site. We also investigated incidence trends by UV-B exposure levels.

METHODS

By using Surveillance, Epidemiology, and End Results (SEER) program data (1973-2009), we calculated age-adjusted incidence rates (IRs), annual percent changes, and 95% confidence intervals for each category of interest. Incidence trends were also evaluated by using joinpoint and local regression models. SEER registries were categorized with respect to low or high UV-B radiation exposure.

RESULTS

From 1973 through 2009, 1230 children of white race were diagnosed with malignant melanoma. Overall, pediatric melanoma increased by an average of 2% per year (95% confidence interval, 1.4%-2.7%). Girls, 15- to 19-year-olds, and individuals with low UV-B exposure had significantly higher IRs than boys, younger children, and those living in SEER registries categorized as high UV-B. Over the study period, boys experienced increased IRs for melanoma on the face and trunk, and females on the lower limbs and hip. The only decreased incidence trend we observed was among 15- to 19-year-olds in the high UV-B exposure group from 1985 through 2009. Local regression curves indicated similar patterns.

CONCLUSIONS

These results may help elucidate possible risk factors for adolescent melanoma, but additional individual-level studies will be necessary to determine the reasons for increasing incidence trends.

Parent-of-origin in individuals with familial neurofibromatosis type 1 and optic pathway gliomas

Neurofibromatosis type 1 (NF1) is one of the most common autosomal dominant cancer syndromes worldwide. Individuals with NF1 have a wide variety of clinical features including a strongly increased risk for pediatric brain tumors. The etiology of pediatric brain tumor development in NF1 is largely unknown. Recent studies have highlighted the contribution of parent-of-origin effects to tumorigenesis in sporadic cancers and cancer predisposition syndromes; however, there is limited data on this effect for cancers arising in NF1. To increase our understanding of brain tumor development in NF1, we conducted a multi-center retrospective chart review of 240 individuals with familial NF1 who were diagnosed with a pediatric brain tumor (optic pathway glioma; OPG) to determine whether a parent-of-origin effect exists overall or by the patient's sex. Overall, 50 % of individuals with familial NF1 and an OPG inherited the NF1 gene from their mother. Similarly, by sex, both males and females were as likely to inherit the NF1 gene from their mother as from their father, with 52 % and 48 % of females and males with OPGs inheriting the NF1 gene from their mother. In conclusion, in contrast to findings from other studies of sporadic cancers and cancer predisposition syndromes, our results indicate no parent-of-origin effect overall or by patient sex for OPGs in NF1.

Abstract 4847: Efficacy of different recruitment methods for a neurofibromatosis type 1 online registry

Background. Neurofibromatosis Type 1 (NF1) is a hereditary cancer syndrome caused by a germline NF1 gene mutation. Affecting an estimated 70,000-100,000 Americans, cancer in individuals with NF1 is a leading cause of death. However, the factors that modify cancer risk in NF1 are largely unknown. To facilitate NF1 research aimed at defining epidemiologic and clinical cancer risk factors, we created an online patient registry (https://nf1registry.wustl.edu/). In the current study, we sought to evaluate different recruiting mechanisms and the characteristics of participants recruited by each mechanism.

Methods. Potential participants were alerted to the registry through three main mechanisms: (1) paid online advertising (Facebook and Google ads), (2) posting on government, academic, and advocacy group websites, and (3) healthcare provider-based recruiting through established NF1 Clinical Programs. Referral patterns were tracked through the online questionnaire that included a question about where the participant first heard about the registry. We compared the total number and characteristics of participants recruited through each method for the period of 4/17/2011-10/22/2012. Statistical significance of differences in participant characteristics between recruiting mechanisms were evaluated using ANOVA and chi-square tests.

Results. A total of 693 participants with self-reported NF1 participated in the registry during the study period. The most effective recruitment mechanism was paid online advertising that resulted in over half of the recruits (n=378), of which 75% responded to a Facebook ad. The second most effective method was postings on government, academic, and advocacy group websites (69 participants) followed by healthcare provider referrals (53 participants). The remainder of the participants reported hearing about the registry through a variety of other mechanisms. The mean age of participants was 30.7 years with the majority of participants reporting white race (72%) and female sex (62%). Age and sex were not significantly associated with the specific recruitment mechanism. However, there was a significant difference in referral patterns by race, with a higher percentage of Whites recruited by Facebook ads than other races and a higher percentage of other races reporting referral via a Google ad than Whites.

Conclusions. We found that the internet, especially Facebook advertising, provides a highly effective means for rapidly assembling large numbers of patients with a rare disease to an online registry for clinical research studies. Although participants were similarly recruited by all three recruitment mechanisms with respect to age and sex, referral patterns appear to differ by race.

Supported by: An American Cancer Society Institutional Research Grant, Alex's Lemonade Stand Foundation, and the St. Louis Children's Hospital Foundation

Citation Format: Kimberly J. Johnson, Nancy L. Mueller, David H. Gutmann. Efficacy of different recruitment methods for a neurofibromatosis type 1 online registry. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4847. doi:10.1158/1538-7445.AM2013-4847

Can MR imaging challenge the commonly accepted theory of the pathogenesis of solitary enchondroma of long bone?

OBJECTIVE

It has been widely postulated that enchondromas arise from cartilage remnants that have been displaced from the growth plate into the metaphysis. However, this theory remains unproven. Based on the common occurrence of enchondromas on routine knee MR imaging (2.9 %), one would expect to find displaced cartilage in the metaphysis of skeletally immature individuals on routine knee MR examinations if the above theory was to be supported.

MATERIALS AND METHODS

The electronic databases of a specialist orthopedic hospital and children's hospital were searched for skeletally immature patients who underwent MR imaging of the knee for a variety of indications. Individuals with Ollier disease or hereditary multiple exostoses were excluded. The MR images were subsequently reviewed by a musculoskeletal radiologist for evidence of displaced cartilage into the metaphysis.

RESULTS

We reviewed 240 MR examinations of the knee that were performed in 209 patients. There were 125 MR studies in male and 115 MR examinations in female patients (age range: 5 months-16 years; median age: 13 years). In 97.1 %, the growth plates around the knee demonstrated a regular appearance. Seven cases (2.9 %) in six patients showed cartilage extension from the growth plate into the metaphysis, which remained in continuity with the growth plate. There were no cases of displaced cartilage into the metaphysis on MRI.

CONCLUSIONS

Our study challenges the widely believed theory that enchondromas arise from displaced growth plate remnants.

Ionizing radiation and the risk of brain and central nervous system tumors: a systematic review

Although exposure to moderate-to-high doses of ionizing radiation is the only established environmental risk factor for brain and CNS tumors, it is not clear whether this relationship differs across tumor subtypes, by sex or age at exposure, or at the low-to-moderate range of exposure. This systematic review summarizes the epidemiologic evidence on the association between ionizing radiation exposure and risk of brain/CNS tumors. Articles included in this review estimated radiation exposure doses to the brain and reported excess relative risk (ERR) estimates for brain/CNS tumors. Eight cohorts were eligible for inclusion in the analysis. Average age at exposure ranged from 8 months to 26 years. Mean dose to the brain ranged from 0.07 to 10 Gy. Elevated risks for brain/CNS tumors were consistently observed in relation to ionizing radiation exposure, but the strength of this association varied across cohorts. Generally, ionizing radiation was more strongly associated with risk for meningioma compared with glioma. The positive association between ionizing radiation exposure and risk for glioma was stronger for younger vs older ages at exposure. We did not observe an effect modification on the risk for meningioma by sex, age at exposure, time since exposure, or attained age. The etiologic role of ionizing radiation in the development of brain/CNS tumors needs to be clarified further through additional studies that quantify the association between ionizing radiation and risk for brain/CNS tumors at low-to-moderate doses, examine risks across tumor subtypes, and account for potential effect modifiers.

Drawbacks and benefits associated with inter-organizational collaboration along the discovery-development-delivery continuum: a cancer research network case study

Background

The scientific process around cancer research begins with scientific discovery, followed by development of interventions, and finally delivery of needed interventions to people with cancer. Numerous studies have identified substantial gaps between discovery and delivery in health research. Team science has been identified as a possible solution for closing the discovery to delivery gap; however, little is known about effective ways of collaborating within teams and across organizations. The purpose of this study was to determine benefits and drawbacks associated with organizational collaboration across the discovery-development-delivery research continuum.

Methods

Representatives of organizations working on cancer research across a state answered a survey about how they collaborated with other cancer research organizations in the state and what benefits and drawbacks they experienced while collaborating. We used exponential random graph modeling to determine the association between these benefits and drawbacks and the presence of a collaboration tie between any two network members.

Results

Different drawbacks and benefits were associated with discovery, development, and delivery collaborations. The only consistent association across all three was with the drawback of difficulty due to geographic differences, which was negatively associated with collaboration, indicating that those organizations that had collaborated were less likely to perceive a barrier related to geography. The benefit, enhanced access to other knowledge, was positive and significant in the development and delivery networks, indicating that collaborating organizations viewed improved knowledge exchange as a benefit of collaboration. ‘Acquisition of additional funding or other resources’ and ‘development of new tools and methods’ were negatively significantly related to collaboration in these networks. So, although improved knowledge access was an outcome of collaboration, more tangible outcomes were not being realized. In the development network, those who collaborated were less likely to see ‘enhanced influence on treatment and policy’ and ‘greater quality or frequency of publications’ as benefits of collaboration.

Conclusion

With the exception of the positive association between knowledge transfer and collaboration and the negative association between geography and collaboration, the significant relationships identified in this study all reflected challenges associated with inter-organizational collaboration. Understanding network structures and the perceived drawbacks and benefits associated with collaboration will allow researchers to build and funders to support successful collaborative teams and perhaps aid in closing the discovery to delivery gap.

Childhood cancer incidence trends in association with US folic acid fortification (1986-2008)

OBJECTIVE

Epidemiologic evidence indicates that prenatal vitamin supplementation reduces risk for some childhood cancers; however, a systematic evaluation of population-based childhood cancer incidence trends after fortification of enriched grain products with folic acid in the United States in 1996-1998 has not been previously reported. Here we describe temporal trends in childhood cancer incidence in association with US folic acid fortification.

METHODS

Using Surveillance, Epidemiology, and End Results program data (1986-2008), we calculated incidence rate ratios and 95% confidence intervals to compare pre- and postfortification cancer incidence rates in children aged 0 to 4 years. Incidence trends were also evaluated by using joinpoint and loess regression models.

RESULTS

From 1986 through 2008, 8829 children aged 0 to 4 years were diagnosed with malignancies, including 3790 and 3299 in utero during the pre- and postfortification periods, respectively. Pre- and postfortification incidence rates were similar for all cancers combined and for most specific cancer types. Rates of Wilms tumor (WT), primitive neuroectodermal tumors (PNETs), and ependymomas were significantly lower postfortification. Joinpoint regression models detected increasing WT incidence from 1986 through 1997 followed by a sizable decline from 1997 through 2008, and increasing PNET incidence from 1986 through 1993 followed by a sharp decrease from 1993 through 2008. Loess curves indicated similar patterns.

CONCLUSIONS

These results provide support for a decrease in WT and possibly PNET incidence, but not other childhood cancers, after US folic acid fortification.

MLL gene rearrangements in infant leukemia vary with age at diagnosis and selected demographic factors: a Children's Oncology Group (COG) study

BACKGROUND

Infant leukemias have a high frequency of mixed lineage leukemia (MLL) gene rearrangements.

PROCEDURE

Using data from a large etiologic study, we evaluated the distribution of selected demographic factors among 374 infant leukemia cases by leukemic subtype, MLL status and diagnosis age.

RESULTS

Overall, 228 cases were MLL+. Compared to white infants, black infants were significantly less likely to have MLL+ leukemia. Further, there was a statistically significantly higher age at diagnosis for infants with t(9;11) translocations compared to all other translocation partners in both acute lymphoblastic leukemia and acute myeloid leukemia cases.

CONCLUSION

These patterns may provide important etiological insight into the biology of infant leukemia.

Medical conditions and risk of adult myeloid leukemia

PURPOSE

Although a few previous studies have reported positive associations between adult myeloid leukemia and a history of certain medical conditions, the etiology of most cases remains largely unknown. Our purpose was to examine associations between certain medical conditions and adult myeloid leukemia.

METHODS

Using logistic regression, we evaluated associations between 16 self-reported medical conditions and myeloid leukemia in a case-control study of 670 cases [including 420 acute myeloid leukemia (AML) and 186 chronic myelogenous leukemia (CML)] and 701 population-based controls.

RESULTS

We observed significant positive associations between AML and ulcerative colitis (odds ratio (OR) = 3.8; 95 % confidence interval (CI), 1.1-13) and between CML and peptic ulcer (OR = 2.0; 95% CI, 1.1-3.8). A personal cancer history increased both AML (OR = 2.6; 95% CI, 1.7-3.9) and CML (OR = 3.5; 95% CI, 2.0-5.8) risk even after excluding individuals who reported prior radiation and/or chemotherapy treatment.

CONCLUSION

Certain inflammatory medical conditions and a personal history of cancer, independent from therapy, are associated with an increased risk of myeloid leukemia.

Abstract 629: Childhood cancer incidence trends in association with folic acid fortification in the United States (1986-2008)

Folic acid plays a critical role in embryonic development and sufficient maternal prenatal folic acid consumption significantly reduces the incidence of congenital abnormalities in offspring. Epidemiological evidence supports the hypothesis that maternal prenatal folic acid supplementation lowers the risk of childhood cancer in offspring; however a systematic evaluation of population-based childhood cancer incidence trends following fortification of enriched grain products with folic acid in the U.S. in 1996-1998 has not been previously reported. Here we describe temporal trends in childhood cancer incidence in association with U.S. folic acid fortification. Using Surveillance, Epidemiology, and End Results program data (1986-2008) we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs) to compare pre- and post-fortification incidence rates in children aged 0-4 years. Using joinpoint and loess regression models, we looked for inflection points during this period where the incidence trend changed in magnitude and/or direction. From 1986-2008, 8,829 children aged 0-4 years were diagnosed with malignancies, including 3,790 and 3,299 in utero during the pre- and post-fortification periods, respectively. Pre- and post-fortification incidence rates were similar for all cancers combined (IRR=1.01, 95% CI: 0.96-1.06) and for most specific cancer types examined. Rates of ependymomas (IRR=0.70, 95% CI: 0.51-0.97), primitive neuroectodermal tumors (PNETs) (IRR=0.56, 95% CI: 0.37-0.84) and Wilms tumor (WT) (IRR=0.80, 95% CI: 0.68-0.95) were significantly lower post-fortification. Notably, a greater reduction in post-fortification incidence was observed for the latter two subtypes upon restricting the analysis to infants, in whom any true effect of folic acid is expected to be greater. Joinpoint regression models detected increasing PNET incidence from 1986-1993 (annual percent change, APC=11.5, 95% CI: -5.0-31.0) followed by a sharp decrease from 1993-2008 (APC=−7.4%, 95% CI: -12.1- -2.4), and increasing WT incidence from 1986-1997 (APC=2.2, 95% CI: -1.2-5.8) followed by a sizable decline from 1997-2008 (APC=−4.0%, 95% CI: -7.3- -0.6). Loess curves indicated similar patterns. These results provide support for decreases in PNET and WT incidence, but not other childhood cancers, following U.S. folic acid fortification. Ten years of data are now available post-fortification and any substantial changes in childhood cancer rates attributable to fortification should be evident. Drawing firm conclusions regarding the isolated effects of folic acid is difficult, however, as other temporal trends occurred during the time period examined. Alternative study designs are required to rule out other explanations and confirm causal relationships. Supported by NIH Grants T32 CA099936 and K05 CA157439, and Children's Cancer Research Fund, Minneapolis, MN. A.M. Linabery and K.J. Johnson contributed equally to this work.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 629. doi:1538-7445.AM2012-629

Abstract 5521: Development of a web-based patient registry and DNA repository for pediatric cancer research in individuals with neurofibromatosis type 1

Individuals with hereditary cancer syndromes represent unique study populations to elucidate the genetic, environmental, and clinical factors that influence cancer development and outcome. In this regard, research leveraging these populations has led to landmark discoveries that have advanced our understanding of cancer pathogenesis and prognosis. Neurofibromatosis type 1 (NF1) is one of the most common hereditary cancer syndromes, in which affected individuals are at risk for the development of several benign and malignant cancers. Despite the high frequency of tumorigenesis in this population, factors that predict tumor development and outcomes are poorly defined. To facilitate progress in this area, we have launched the NF1 Patient Registry Initiative (NPRI) and the NF1 Genome Project. The NPRI is a web-based patient-driven registry. Any individual with a NF1 diagnosis is eligible to participate. Participants provide contact information and complete a 30-45 minute questionnaire that captures demographic data, medical history, social history, and inquires whether they are interested in participating in future research studies and providing biological samples. Yearly reminders are sent requesting that participants update their information to allow for longitudinal study of outcomes in this population. From 5/17/2011-11/1/2011, 100 participants have provided contact information, of which 80% have completed the questionnaire. To date, participants include residents of 28 U.S. states and 11 countries spanning 6 continents. The mean age of the participants is 30 years (range 1-77 years), where fifty eight percent are female and 84% are white (race). Approximately half of all participants reported a family history of NF1 (46%). Fourteen pediatric brain cancers (diagnosed &lt;20 years) were reported with a mean diagnosis age of 4 years (range 1-10 years), fifty percent of whom are female. Ninety percent of participants indicated their willingness to be contacted in the future and to provide biological samples for research. The NF1 Genome Project is an initiative developed to collect genomic DNA samples from individuals with NF1 for genome-wide association studies (GWAS). Based on encouraging preliminary GWAS data, future sequencing-based investigations are planned to identify genetic risk modifiers of pediatric tumor susceptibility. To date, a total of 156 participants have provided DNA samples and clinical data. Together, the NPRI and NF1 Genome Project provide unprecedented and viable mechanisms for assembling patients with rare diseases from across the world to discover genomic and non-genomic factors that influence cancer development and progression in a model cancer predisposition syndrome. The insights gained from these studies will not only benefit individuals with NF1, but also serve as foundations for the study of other rare tumor syndromes.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5521. doi:1538-7445.AM2012-5521