Judicious DICER1 testing and surveillance imaging facilitates early diagnosis and cure of pleuropulmonary blastoma

Pleuropulmonary blastoma (PPB) and Sertoli-Leydig cell tumor (SLCT) are both associated with germline mutations in DICER1. In this brief report, a maternal history of SLCT led to identification of a deleterious DICER1 mutation in the patient and her asymptomatic infant. Radiographic screening revealed a large Type I PPB, which was completely resected. Identification of DICER1 mutation carriers and imaging of children at risk for PPB may allow detection of PPB in its earliest and most curable form, leading to increased likelihood of surgical cure and decreased risks of treatment-related late effects.

Adolescent physical activity and inactivity: a prospective study of risk of benign breast disease in young women

In previous investigations of adolescent activity recalled in adulthood, modest reductions in risk of benign breast disease (BBD) and premenopausal breast cancer were seen with moderate-strenuous activity during high school. We therefore investigated physical activity, walking, and recreational inactivity (watching TV-videos, playing computer-videogames) reported by adolescent girls in relation to their subsequent risk for BBD as young women. The Growing Up Today Study includes 9,039 females, 9-15 years at study initiation (1996), who completed questionnaires annually through 2001, then in 2003, 2005, 2007, 2010 and 2013. Annual surveys (1996-2001) obtained data on physical and sedentary activities during the past year. Beginning in 2005, women (≥18 years) reported whether they had ever been diagnosed with BBD confirmed by breast biopsy (n = 133 cases, to 11/01/2013). Logistic regression (adjusted for baseline adiposity and age; additional factors in multivariable-adjusted models) estimated associations between adolescent activities (moderate-vigorous, walking, METS, inactivity) and biopsy-confirmed BBD in young women. Girls who walked the most had significantly lower risk of BBD (multivariable-adjusted OR = 0.61, ≥30 vs ≤15 min/day; p = .049). We observed no evidence that inactivity (≥3 vs <2 h/day OR = 1.02, p = .92) or METS (top vs bottom tertile OR = 1.19, p = .42) were associated with BBD. Accounting for factors including family history, childhood adiposity, and other activities and inactivities, adolescent girls who walked the most were at lower risk for BBD. We found no evidence that high moderate-vigorous activity might reduce risk, nor did we observe any association with inactivity. Continued follow-up will re-evaluate these findings as more BBD cases, and ultimately breast cancer, are diagnosed.

Adolescents and young adults with a "rare" cancer: getting past semantics to optimal care for patients with germ cell tumors

Because the tumors of adolescence and young adulthood (AYA) are distinct from those that occur earlier and later in life, the most common tumors in this age group are termed “rare.” We offer a collaborative, cross-disciplinary, evidence-based approach, advocated and funded by civil society, to advance the field of germ cell tumor and potentially to apply to other rare AYA tumors.

Disparities in depressive distress by sexual orientation in emerging adults: the roles of attachment and stress paradigms

Lesbian, gay, and bisexual (BI) youth have elevated rates of depression compared to heterosexuals. We proposed and examined a theoretical model to understand whether attachment and stress paradigms explain disparities in depressive distress by sexual orientation, using the longitudinal Growing Up Today Study (GUTS) and Nurses' Health Study II (NHSII). GUTS participants eligible for this analysis reported sexual orientation, childhood gender nonconforming behaviors (GNBs), attachment to mother (all in 2005), and depressive symptoms (in 2007). Mothers of the GUTS participants who are the NHSII participants reported attitudes toward homosexuality (in 2004) and maternal affection (in 2006). The sample had 6,122 participants. Of GUTS youth (M = 20.6 years old in 2005; 64.4 % female), 1.7 % were lesbian/gay (LG), 1.7 % bisexual (BI), 10.0 % mostly heterosexual (MH), and 86.7 % completely heterosexual (CH). After adjusting for demographic characteristics and sibling clustering, LGs, BIs, and MHs reported more depressive distress than CHs. This relation was partially mediated (i.e., explained) for LGs, BIs, and MHs relative to CHs by less secure attachment. A conditional relation (i.e., interaction) indicated that BIs reported more distress than CHs as GNBs increased for BIs; no comparable relation was found for LGs versus CHs. Sibling comparisons found that sexual minorities (LGs, BIs, and MHs) reported more depressive distress, less secure attachment, and more childhood GNBs than CH siblings; the mothers reported less affection for their sexual-minority than CH offspring. The findings suggest that attachment and childhood gender nonconformity differentially pattern depressive distress by sexual orientation. Attachment and related experiences are more problematic for sexual minorities than for their CH siblings.

Increase in the incidence of differentiated thyroid carcinoma in children, adolescents, and young adults: a population-based study

OBJECTIVE

To investigate trends in incidence of differentiated thyroid carcinomas among children and adolescents and young adults.

STUDY DESIGN

In this ecological time-trends study, we selected cases of differentiated thyroid carcinomas (1984-2010) in patients <30 years from Surveillance, Epidemiology, and End Results 9 cancer registries by using International Classification of Diseases for Oncology, 3rd edition, codes for papillary and follicular cancers. Patients with multiple other primary diseases before differentiated thyroid carcinomas were excluded. SEER*Stat software, version 8.0.4 (National Cancer Institute, Bethesda, Maryland) was used to calculate age-standardized rates (estimated per 1,000,000/persons) and annual percentage changes (APCs) were calculated by the Joinpoint model (Joinpoint software, version 4.0.4; National Cancer Institute).

RESULTS

Rates ranged from 2.77 (1990) to 9.63 (2009) and from 18.35 (1987) to 50.99 (2009), for male and female subjects, respectively. A significant increasing trend in incidence was observed for both male (APC 3.44; 95% CI 2.60-4.28) and female (APC 3.81; 95% CI 3.38-4.24) patients. When a stratified analysis on the basis of tumor size was performed, significant increasing trends were noted for the following categories: <0.5 cm (females: APC 5.09, 95% CI 3.54-6.65), 0.5-0.9 cm (females: APC 8.45, 95% CI 7.09-9.82), 1.0-1.9 cm (males: APC 5.09, 95% CI 3.20-7.01; females: APC 3.42, 95% CI 2.78-4.07), and ≥2 cm (males: APC 2.62, 95% CI 1.64-3.60; females: APC 2.96, 95% CI 2.34-3.59).

CONCLUSIONS

Incidence rates for differentiated thyroid carcinomas are increasing among children and adolescents and young adults in the US. The increasing trends for larger tumors rules out diagnostic scrutiny as the only explanation for the observed results. Environmental, dietary, and genetic influences should be investigated.

Adolescent carotenoid intake and benign breast disease

BACKGROUND

Carotenoids may reduce risk of benign breast disease (BBD), an independent risk factor for breast cancer, through antioxidative or antiproliferative mechanisms. Exposure to carotenoids may be most important during adolescence when breast tissue is still developing. We examined adolescent carotenoid intake in relation to BBD in young women.

METHODS

In 6593 adolescent girls in the prospective Growing Up Today Study cohort, intakes of α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin, and lycopene were assessed by using the means from food-frequency questionnaires in 1996, 1997, and 1998. Girls reported biopsy-confirmed BBD on questionnaires in 2005, 2007, and 2010 (n = 122). We conducted logistic regression of energy-adjusted carotenoid intakes in relation to BBD, adjusted for age, family history of breast cancer or BBD, age at menarche, nulliparity, alcohol intake, BMI, and physical activity.

RESULTS

Mean (SD) age at baseline was 12.0 (1.6) years. β-Carotene intake was inversely associated with BBD; comparing the highest to lowest quartile, the multivariate-adjusted odds ratio was 0.58 (95% confidence interval: 0.34-1.00; P-trend = .03). α-Carotene and lutein/zeaxanthin were also inversely associated with BBD, but the associations were not statistically significant.

CONCLUSIONS

Adolescent carotenoid intake may be associated with lower BBD risk; these findings warrant further study.

Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring

IMPORTANCE

The etiology of the increasing childhood prevalence of peanut or tree nut (P/TN) allergy is unknown.

OBJECTIVE

To examine the association between peripregnancy consumption of P/TN by mothers and the risk of P/TN allergy in their offspring.

DESIGN, SETTING, AND PARTICIPANTS

Prospective cohort study. The 10,907 participants in the Growing Up Today Study 2, born between January 1, 1990, and December 31, 1994, are the offspring of women who previously reported their diet during, or shortly before or after, their pregnancy with this child as part of the ongoing Nurses' Health Study II. In 2006, the offspring reported physician-diagnosed food allergy. Mothers were asked to confirm the diagnosis and to provide available medical records and allergy test results. Two board-certified pediatricians, including a board-certified allergist/immunologist, independently reviewed each potential case and assigned a confirmation code (eg, likely food allergy) to each case. Unadjusted and multivariable logistic regression analyses were used to evaluate associations between peripregnancy consumption of P/TN by mothers and incident P/TN allergy in their offspring.

EXPOSURE

Peripregnancy consumption of P/TN.

MAIN OUTCOMES AND MEASURES

Physician-diagnosed P/TN allergy in offspring.

RESULTS

Among 8205 children, we identified 308 cases of food allergy (any food), including 140 cases of P/TN allergy. The incidence of P/TN allergy in the offspring was significantly lower among children of the 8059 nonallergic mothers who consumed more P/TN in their peripregnancy diet (≥ 5 times vs <1 time per month: odds ratio = 0.31; 95% CI, 0.13-0.75; P(trend) = .004). By contrast, a nonsignificant positive association was observed between maternal peripregnancy P/TN consumption and risk of P/TN allergy in the offspring of 146 P/TN-allergic mothers (P(trend) = .12). The interaction between maternal peripregnancy P/TN consumption and maternal P/TN allergy status was statistically significant (P(interaction) = .004).

CONCLUSIONS AND RELEVANCE

Among mothers without P/TN allergy, higher peripregnancy consumption of P/TN was associated with lower risk of P/TN allergy in their offspring. Our study supports the hypothesis that early allergen exposure increases tolerance and lowers risk of childhood food allergy.

Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors: report from the Children's Oncology Group

PURPOSE

To determine whether overall survival (OS) can be preserved for patients with stage I pediatric malignant ovarian germ cell tumor (MOGCT) with an initial strategy of surveillance after surgical resection.

PATIENTS AND METHODS

Between November 2003 and July 2011, girls age 0 to 16 years with stage I MOGCT were enrolled onto Children's Oncology Group study AGCT0132. Required histology included yolk sac, embryonal carcinoma, or choriocarcinoma. Surveillance included measurement of serum tumor markers and radiologic imaging at defined intervals. In those with residual or recurrent disease, chemotherapy with compressed PEB (cisplatin, etoposide, and bleomycin) was initiated every 3 weeks for three cycles (cisplatin 33 mg/m(2) on days 1 to 3, etoposide 167 mg/m(2) on days 1 to 3, bleomycin 15 U/m(2) on day 1). Survivor functions for event-free survival (EFS) and OS were estimated using the Kaplan-Meier method.

RESULTS

Twenty-five girls (median age, 12 years) with stage I MOGCT were enrolled onto AGCT0132. Twenty-three patients had elevated alpha-fetoprotein (AFP) at diagnosis. Predominant histology was yolk sac. After a median follow-up of 42 months, 12 patients had evidence of persistent or recurrent disease (4-year EFS, 52%; 95% CI, 31% to 69%). Median time to recurrence was 2 months. All patients had elevated AFP at recurrence; six had localized disease, two had metastatic disease, and four had tumor marker elevation only. Eleven of 12 patients experiencing relapse received successful salvage chemotherapy (4-year OS, 96%; 95% CI, 74% to 99%).

CONCLUSION

Fifty percent of patients with stage I pediatric MOGCT can be spared chemotherapy; treatment for those who experience recurrence preserves OS. Further study is needed to identify the factors that predict recurrence and whether this strategy can be extended successfully to older adolescents and young adults.

Pilot study of cisplatin, etoposide, bleomycin, and escalating dose cyclophosphamide therapy for children with high risk germ cell tumors: a report of the children's oncology group (COG)

BACKGROUND

To establish the maximum tolerated dose (MTD) and toxicity profile of cyclophosphamide with cisplatin, etoposide, and bleomycin (C-PEB) in children with high-risk malignant germ cell tumors (HR-MGCT).

PROCEDURE

Eligibility criteria included untreated patients ≤ 21 years of age with stage III/IV extragonadal, extra cranial MGCT. Patients received four cycles (repeated every 3 weeks) of cisplatin (20 mg/m(2) /day × 5 days), etoposide (100 mg/m(2) /day × 5 days), and bleomycin (15 mg/m(2) on Day 1) with escalating doses of cyclophosphamide on Day 1, assigned at the time of enrollment (1.2, 1.8, or 2.4 g/m(2)). Patients with complete response had therapy discontinued. Patients with residual disease underwent second-look surgery, those with pathologic evidence of residual MGCT or whose markers had not normalized received two more cycles. All other patients had protocol therapy stopped.

RESULTS

Nineteen patients were enrolled between July 2004 and August 2007. Three patients were non-evaluable. Sixteen patients completed four cycles. Eleven had complete response, one had progressive disease and four had partial response. All four with partial response underwent second look surgery followed by two more cycles. Only one patient, on dose 1.8 g/m(2), experienced dose-limiting toxicity (DLT) during the first cycle of therapy (grade 3 hyperglycemia). The 4-year EFS and OS (± standard deviation) were 74 ± 7% and 89 ± 10%, respectively.

CONCLUSION

The addition of cyclophosphamide to the standard PEB regimen (cisplatin, etoposide, and bleomycin) is feasible and well-tolerated at all dose levels used on this study.

Vegetable protein and vegetable fat intakes in pre-adolescent and adolescent girls, and risk for benign breast disease in young women

Previous investigations, of adolescent diet recalled in adulthood, found lower risk for benign breast disease (BBD) with higher intakes of vegetable fat and nuts during high school. We investigate whether vegetable protein and fat, derived from diets reported during pre-adolescence and adolescence, are associated with subsequent risk for BBD in young women. The Growing Up Today Study includes 9,039 females, 9-15 years in 1996, who completed questionnaires annually through 2001, and then in 2003, 2005, 2007, and 2010. Food frequency questionnaires (1996-2001) obtained intake data on a variety of foods. Beginning in 2005, women (18-30 years) reported whether they had ever been diagnosed with BBD that was confirmed by breast biopsy (n = 112 cases). Logistic regression estimated associations between intakes of vegetable protein and fat and biopsy-confirmed BBD. Those individual foods that were the largest contributors of protein and fat in this cohort were also investigated. In analyses of intakes from 1996 through 1998, when our cohort was youngest, vegetable fat (OR = 0.72/(10 gm/day), 95 % CI 0.53-0.98; p = 0.04) was inversely associated with BBD risk. The greatest sources of vegetable fat and protein in these girls were peanut butter, peanuts, nuts, beans (beans, lentils, and soybeans), and corn. A daily serving of any one of these was associated with lower risk (OR = 0.32/(serv/day), 95 % CI 0.13-0.79; p = 0.01). Peanut butter (and nuts) at age 11 years was inversely associated with risk (p = 0.01). In analyses of intakes at age 14 years, vegetable protein was associated with lower BBD risk (OR = 0.64/(10 gm/day), 95 % CI 0.43-0.95; p = 0.03). A daily serving at 14 years of any one of the foods was associated with lower risk (OR = 0.34, 95 % CI 0.16-0.75; p = 0.01), as was peanut butter (and nuts) (p = 0.02). Girls with a family history of breast cancer had significantly lower risk if they consumed these foods or vegetable fat. In conclusion, consumption of vegetable protein, fat, peanut butter, or nuts by older girls may help reduce their risk of BBD as young women.

DNA methylation analysis reveals distinct methylation signatures in pediatric germ cell tumors

Background

Aberrant DNA methylation is a prominent feature of many cancers, and may be especially relevant in germ cell tumors (GCTs) due to the extensive epigenetic reprogramming that occurs in the germ line during normal development.

Methods

We used the Illumina GoldenGate Cancer Methylation Panel to compare DNA methylation in the three main histologic subtypes of pediatric GCTs (germinoma, teratoma and yolk sac tumor (YST); N = 51) and used recursively partitioned mixture models (RPMM) to test associations between methylation pattern and tumor and demographic characteristics. We identified genes and pathways that were differentially methylated using generalized linear models and Ingenuity Pathway Analysis. We also measured global DNA methylation at LINE1 elements and evaluated methylation at selected imprinted loci using pyrosequencing.

Results

Methylation patterns differed by tumor histology, with 18/19 YSTs forming a distinct methylation class. Four pathways showed significant enrichment for YSTs, including a human embryonic stem cell pluripotency pathway. We identified 190 CpG loci with significant methylation differences in mature and immature teratomas (q < 0.05), including a number of CpGs in stem cell and pluripotency-related pathways. Both YST and germinoma showed significantly lower methylation at LINE1 elements compared with normal adjacent tissue while there was no difference between teratoma (mature and immature) and normal tissue. DNA methylation at imprinted loci differed significantly by tumor histology and location.

Conclusion

Understanding methylation patterns may identify the developmental stage at which the GCT arose and the at-risk period when environmental exposures could be most harmful. Further, identification of relevant genetic pathways could lead to the development of new targets for therapy.

Influence of hormonal contraceptive use and health beliefs on sexual orientation disparities in Papanicolaou test use

OBJECTIVES

Reproductive health screenings are a necessary part of quality health care. However, sexual minorities underutilize Papanicolaou (Pap) tests more than heterosexuals do, and the reasons are not known. Our objective was to examine if less hormonal contraceptive use or less positive health beliefs about Pap tests explain sexual orientation disparities in Pap test intention and utilization.

METHODS

We used multivariable regression with prospective data gathered from 3821 females aged 18 to 25 years in the Growing Up Today Study (GUTS).

RESULTS

Among lesbians, less hormonal contraceptive use explained 8.6% of the disparities in Pap test intention and 36.1% of the disparities in Pap test utilization. Less positive health beliefs associated with Pap testing explained 19.1% of the disparities in Pap test intention. Together, less hormonal contraceptive use and less positive health beliefs explained 29.3% of the disparities in Pap test intention and 42.2% of the disparities in Pap test utilization.

CONCLUSIONS

Hormonal contraceptive use and health beliefs, to a lesser extent, help to explain sexual orientation disparities in intention and receipt of a Pap test, especially among lesbians.

Evaluation of the necessity of bilateral bone marrow aspirates and biopsies for the diagnosis of metastatic disease in pediatric patients with solid tumors

10054

Background: Standard practice for staging solid tumors has been to perform bilateral bone marrow aspirates (BMA) and biopsies (BMB). However, the diagnostic yield of performing all 4 tests has not been thoroughly evaluated. This study evaluated the concordance between test types (aspirate and biopsy) and sites (right and left) to evaluate whether one type or one side would be sufficient. Methods: All patients with solid tumors who underwent a diagnostic bilateral bone marrow biopsy and aspirate performed between 2006 and 2011 at Children’s Hospital Boston were identifed in a search of hematopathology records.. Kappa coeffcients were estimated. Results: A search of the hematopathology data records revealed a total of 112 patients who had had a diagnostic bilateral BMA and BMB including patients with neuroblastoma (n=70 ), Ewing’s Sarcoma (n=11), rhabdomyosarcoma (n=25), retinoblastoma (n=5), and undifferentiated sarcoma (n=1). 73% (n=82) of the patients were negative for all tests; 27% (n=30) had at least one positive test. The results between right and left and aspirate and biopsy were highly correlated.(Kappa statistics: BMA and BMB (0.85); BMA-left and BMB-left (0.82); BMA-right and BMB-right (0.84); BMA-left and BMA-right (0.77); BMB-left and BMB-right (0.95). All 4 tests were positive in 63%, 3 tests positive in 10%, 2 tests positive in 13% and one test positive in 13%. The distribution of positive results did not differ by disease. Among 11 patients with less than 4 positive tests, 10 would have been diagnosed correctly with bilateral aspirates; only one patient (neuroblastoma) had positive results on biopsy only. In this patient, neither aspirate had spicules and was therefore likely an inadequate specimen. Conclusions: Bone marrow biopsy may not be essential for accurate diagnosis of metastatic disease in pediatric solid tumor patients. Further confirmation of these findings in a larger sample is warranted.

Socioeconomic status and incidence of pediatric embryonal tumors in the United States

10036

Background: Of the 13,000 children diagnosed with cancer each year in the United States (US), the embryonal solid tumors, neuroblastoma (NB), retinoblastoma (RB), Wilms tumors (WT), hepatoblastoma (HB), rhabdomyosarcomas (RMS) and germ cell tumors (GCT), account for over 30% of the cases. Social disparities in cancer are well studied for adults, but few studies have focused on children, mostly for leukemia. The aim of this study is to evaluate the differences in incidence of rare cancers according to socioeconomic status (SES). Methods: Cases aged 0-19 were identified from the Surveillance Epidemiology and End Results (SEER) cancer registries from 1992-2009. Using data from the US 2000 Census, the county of residence of the cases was categorized above or below the national average for SES measures including: % persons with< high school education, % persons below poverty, % persons unemployed and % households with > 1 person/room. Age standardized rates per million (ASR), rate ratios (RR) and 95% confidence intervals (CI) were obtained. The findings were validated using cases from the National Program of Cancer Registries (NPCR) from 1999-2009, analyzed with the same SES variables. Results: Among cases identified in SEER, rates of NB and WT are higher in counties with upper SES measures whereas RB and GCT occurred more frequently in counties with lower SES measures. No association was found between SES and rates of HB and RMS. The results were reproducible with NPCR cases. For instance, ASR of NB is lower (SEER: 5.86; NPCR: 7.48) in counties where >19.6% of the population had not completed high school and higher (SEER: 8.41; NPCR: 8.47) in counties where ≤19.6% had not achieved a high school degree. (SEER: RR=0.69; 95%CI=0.62-0.77; NPCR: RR=0.88; 95%CI=0.84-0.93). Analysis of NB rates according to poverty, unemployment and crowding showed consistent results, with higher rates in counties with higher SES. Conclusions: The findings are suggestive of a relation between SES and cancer susceptibility that may be connected to environment and lifestyle. Understanding the role of contributing causes demands further studies to evaluate why cancer rates vary across cultural and ethnic groups as well as the magnitude of specific SE aspects.

Birth and maternal characteristics, and childhood cancer in the United States: An ecological study

10061

Background: Childhood cancer is rare, yet it represents a major cause of mortality in this age group. Its etiology is largely unknown. The aim of this study was to identify associations between pre- and perinatal characteristics and cancer development in children below age 5. Methods: We developed an ecological study correlating birth information and childhood cancer incidence in 0-4 year old at the State level. The following variables were analyzed: birth weight (BW), preterm birth, maternal age, plurality, maternal smoking, chronic hypertension (CH), diabetes mellitus (DM), pregnancy associated hypertension (PH) and eclampsia. Birth characteristics were obtained from Centers for Disease Control and Prevention (CDC) database (1995-2009), and childhood cancer incidence data from the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology and End Results (SEER) program (1999-2009). Spearman correlation coefficients were calculated with SAS 9.2 (Cary, NC). Bonferroni correction was applied for multiple comparisons, ie, only results with p£0.01 were considered significant. Results: Acute lymphoid leukemia (ALL) (r=0.47, p <0.001), astrocytoma (AST) (r=0.59, p <0.001), neuroblastoma (NB) (r=0.48, p <0.001) and rhabdomyosarcoma (RMS) (r=0.51, p=0.003) were positively correlated with high BW (>4000g). ALL (r=0.46, p <0.001) was also positively correlated with advanced maternal age (40+ years). Moreover, a positive correlation was found between plurality and NB (r=0.50, p <0.001). Regarding maternal conditions, the following positive correlations were identified: DM with AST (r=0.40, p=0.009), NB (r=0.38, p=0.01) and WT (r=0.38, p=0.01). Conclusions: Well established correlations were replicated and new associations were suggested (e.g., AST and DM). In spite of the limitation of an ecological approach, this study provided new hypotheses to be explored in further analytical studies based on individual data.

Elevated risk of second malignant neoplasms in pediatric germ cell tumor patients

10010

Background: The probability of cure is very high for children with germ cell tumors (GCT), but late effects from cisplatinum can be quite significant. In addition to the immediate effects of oto-, neuro and nephrotoxicity, data from men treated for testicular cancer shows that the rate of second malignant neoplasm (SMN) is doubled and that a man treated before age 20 has a 50% chance of SMN by age 75. This study was designed to assess the risk of SMN among individuals treated for malignant GCT during childhood. Methods: We included all patients 0-19 years old with a primary diagnosis of malignant GCT registered in the Surveillance, Epidemiology and End Results (SEER) in the period 1973-2008. We analyzed tumors occurring at least 12 months after the first primary. Standardized incidence ratios (SIR) and 95% confidence intervals (CI) were calculated using SEER Stat, version 8.0.1. Results: The cohort comprised 1997 patients (798 women and 1,199 men); 86.3% had primary gonadal tumors (91% in men and 79.5% in women). The median age at diagnosis of the primary malignancy was 17 years (17 for males ; 15 for females), and for second malignancies was 27 (27 for males; 30 for females). Fifty eight SMNs were observed (21 in females; 37 in males). Among women, higher risk was observed to developing breast cancer (n=5; SIR=1.29; 95% CI= 0.42-3.02), thyroid cancer (n=5; SIR= 3.40; 95% CI= 1.1-7.93) and brain cancer (n=3; SIR= 9.19; 95% CI=1.89-26.85). Twenty-seven out of 37 second primary tumors observed in men were contralateral testicular tumors, conferring a 16.2 fold higher risk of developing this neoplasm (95% CI= 10.67-23.58). When the analysis excluded testis as a second site, a higher risk was noted for the development of pancreatic cancer (SIR=19.06; 95% CI=2.31-68.83) and leukemia (SIR=3.55; 95% CI=0.43-12.81). Conclusions: Rates of SMN are elevated in both men and women treated as children for pediatric germ cell tumors. Men need to be made aware of risk in contralateral testicle. The rates of SMN may continue to rise with longer follow up. The attribution of treatment type to risk of SMNs is not possible due to the lack of this information in SEER database.

Impact of socioeconomic status on extent of disease at diagnosis and cancer and ocular outcomes in retinoblastoma: A population-based analysis

10011

Background: The strong correlation between early diagnosis and improved outcomes has been consistently reported for retinoblastoma; extent of disease and eye preservation are associated with delayed diagnosis. In this study, we aimed to analyze the impact of socioeconomic status (SES) and ethnicity on extent on disease and cancer and ocular outcomes. Methods: All retinoblastoma cases (0-9 years) recorded in 18 SEER registries between 2000-2009 were included. The county-based disparity variables analyzed included poverty level, education attainment, language isolation, crowding, and percentage of immigrants. The cut-off values were defined as the median values for the cohort of patients. We also analyzed the impact of gender, race, and ethnicity. We tested for the association between SES and ethnicity with the percentage of extraocular disease and enucleation. Relative survival was calculated using Ederer II method; estimates were compared using Z-score. Results: We identified 753 cases. Percentage of extraocular cases was consistently higher in US counties with low SES indicators: higher vs. lower poverty status (29.3% vs. 22.1%, p=0.028); lower vs. higher education attainment (30.6% vs. 22.7%, p=0.003); higher vs. lower crowding (33.2% vs. 18.1%, p<0.001); higher vs. lower language isolation (32.2% vs. 19.3%, p<0.001); higher vs. lower percentage of immigrants (30.1% vs. 21.4%, p=0.008). Hispanic patients had significantly higher percentage of extraocular disease (35.2% vs. 20.9%, p<0.001). Poor ocular outcomes, reflected by high percentage of enucleation, were associated with counties with low education attainment (p=0.025), and with Hispanic origin (p=0.019). Decreased survival was associated with language isolation (p=0.016), but not with Hispanic origin or other SES indicators. Conclusions: Our study highlights significant disparities in the care and outcome of children with retinoblastoma. A low SES negatively impacts extent of disease, presumably by limiting access to primary care and delaying diagnosis. Hispanic patients have more advanced disease and higher enucleation rates, although survival is not significantly different.

Preadolescent and adolescent risk factors for benign breast disease

PURPOSE

It is well established that exposures during childhood and adolescence affect breast cancer risk much later in life. Recently, studies have begun to evaluate whether early life exposures might also impact the risk of developing benign breast disease (BBD). A diagnosis of proliferative BBD independent of other breast cancer risk factors also increases the subsequent risk of breast cancer; therefore, understanding how to decrease the incidence of BBD may have important implications for primary breast cancer prevention.

METHODS

We reviewed several studies from prospective cohort studies that have investigated the relationship between risk factors during childhood and adolescence, such as anthropometric and reproductive characteristics as well as diet and other behaviors, and subsequent risk of BBD.

RESULTS

Higher intake of vegetable oils, nuts, vitamin E, and fiber and lower consumption of animal fat, red meat, and alcohol are associated with reduced risk of BBD. Childhood weight and adolescent body mass index are inversely associated with BBD risk, whereas a greater peak height velocity during adolescence is associated with a higher risk of BBD. There was no association between age of menarche and risk of BBD.

CONCLUSION

Early life exposures and behaviors appear to impact BBD risk. The current body of evidence further supports the importance of a life-course approach to breast cancer prevention.