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Semeraro M, Fouquet C, Vial Y, Amiel J, Galmiche L, Cretolle C, Blanc T, Jolaine V, Garcelon N, Entz-Werle N, Pellier I, Vérité C, Sophie Taque, Coulomb A, Petit A, Corradini N, Bouazza N, Lacour B, Clavel J, Brugières L, Bourdeaut F, Sarnacki S. Pediatric Tumors and Developmental Anomalies: A French Nationwide Cohort Study. J Pediatr 2023; 259:113451. [PMID: 37169337 DOI: 10.1016/j.jpeds.2023.113451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/17/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To assess the associations between congenital abnormalities and pediatric malignancies and evaluate the potential underlying molecular basis by collecting information on pediatric patients with cancer and congenital abnormalities. STUDY DESIGN Tumeur Et Développement is a national, prospective, and retrospective multicenter study recording data of children with cancer and congenital abnormalities. When feasible, blood and tumoral samples are collected for virtual biobanking. RESULTS From June 2013 to December 2019, 679 associations between pediatric cancers and congenital abnormalities were recorded. The most represented cancers were central nervous system tumors (n = 139; 20%), leukemia and myelodysplastic syndromes (n = 123; 18.1%), and renal tumors (n = 101; 15%). Congenital abnormalities were not related to any known genetic disorder in 66.5% of cases. In this group, the most common anomaly was intellectual disability (22.3%), followed by musculoskeletal (14.2%) and genitourinary anomalies (12.4%). Intellectual disability was mostly associated with hematologic malignancies. Embryonic tumors (neuroblastoma, Wilms tumor, and rhabdomyosarcoma) were associated with consistent abnormalities, sometimes with a close anatomical neighborhood between the abnormality and the neoplasm. CONCLUSIONS In the first Tumeur Et Développement analysis, 3 major themes have been identified: (1) germline mutations with or without known cancer predisposition, (2) postzygotic events responsible for genomic mosaicism, (3) coincidental associations. New pathways involved in cancer development need to be investigated to improve our understanding of childhood cancers.
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Affiliation(s)
- Michaela Semeraro
- Centre d'Investigation Clinique-Unité de Recherche Clinique, Hôpital Universitaire Necker Enfants-Malades, AP-HP Centre - Université Paris Cité, Paris, France; Université de Paris Cité, Paris, France; Equipe d'Accueil 7323, Université de Paris, Paris, France.
| | - Cyrielle Fouquet
- Départment de Pédiatrie, Unité d'onco-hématologie pédiatrique, Hôpital Pellegrin, Bordeaux, France
| | - Yoann Vial
- Université de Paris Cité, Paris, France; Département de génétique, CHU Paris-Hôpital Robert Debré, Paris, France
| | - Jeanne Amiel
- Université de Paris Cité, Paris, France; Laboratoire 408 Embryologie et génétique des malformations, INSERM UMR-1163, Institut Imagine, Paris, France
| | - Louise Galmiche
- Départment de Pédiatrie, Service Anatomie Pathologique, Hôpital Necker Enfants Malades, Paris, France
| | - Célia Cretolle
- Départment de Pédiatrie, Service de Chirurgie viscérale pédiatrique, Hôpital Universitaire Necker Enfants-Malades, GH Paris Centre, Paris, France
| | - Thomas Blanc
- Université de Paris Cité, Paris, France; Départment de Pédiatrie, Service de Chirurgie viscérale pédiatrique, Hôpital Universitaire Necker Enfants-Malades, GH Paris Centre, Paris, France
| | - Valérie Jolaine
- Centre d'Investigation Clinique-Unité de Recherche Clinique, Hôpital Universitaire Necker Enfants-Malades, AP-HP Centre - Université Paris Cité, Paris, France
| | - Nicolas Garcelon
- Départment de Pédiatrie, UMR 1163, Imagine Institute, Université de Paris, Paris, France
| | - Natacha Entz-Werle
- Départment de Pédiatrie, CHRU Hautepierre Strasbourg, Service de Pédiatrie Onco-Hématologie, Strasbourg, France
| | - Isabelle Pellier
- Hematology-Oncology-Immunology Department, CHU Angers, Angers, France
| | - Cécile Vérité
- Départment de Pédiatrie, Unité d'onco-hématologie pédiatrique, Hôpital Pellegrin, Bordeaux, France
| | - Sophie Taque
- Départment de Pédiatrie, Hôpital Universitaire de Rennes, Rennes, France
| | - Aurore Coulomb
- Department of Pathology, AP-HP, Armand Trousseau Hospital, Paris, France
| | - Arnaud Petit
- Department of Onco-Haematology, AP-HP, Armand Trousseau Hospital, Paris, France
| | - Nadège Corradini
- Department of Pediatric Oncology, Institut d'hématologie et d'oncologie pédiatrique, Lyon, France
| | - Naim Bouazza
- Université de Paris Cité, Paris, France; Clinical Research Unit, Tarnier Hospital, Paris, France
| | - Brigitte Lacour
- INSERM UMRS1018, Paris-Sud University, Villejuif, France; National Registry of Childhood Hematopoietic Malignancies, Villejuif, France
| | - Jacqueline Clavel
- INSERM UMRS1018, Paris-Sud University, Villejuif, France; National Registry of Childhood Hematopoietic Malignancies, Villejuif, France
| | - Laurence Brugières
- Child and Adolescent Cancer Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Franck Bourdeaut
- Université de Paris Cité, Paris, France; Laboratoire de Recherche Translationnelle en Oncologie Pédiatrique, INSERM U830, Institut Curie, Paris, France
| | - Sabine Sarnacki
- Université de Paris Cité, Paris, France; Départment de Pédiatrie, Service de Chirurgie viscérale pédiatrique, Hôpital Universitaire Necker Enfants-Malades, GH Paris Centre, Paris, France
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Luke B, Brown MB, Wantman E, Schymura MJ, Browne ML, Fisher SC, Forestieri NE, Rao C, Nichols HB, Yazdy MM, Gershman ST, Sacha CR, Williams M, Ethen MK, Canfield MA, Doody KJ, Eisenberg ML, Baker VL, Williams C, Sutcliffe AG, Richard MA, Lupo PJ. The risks of birth defects and childhood cancer with conception by assisted reproductive technology. Hum Reprod 2022; 37:2672-2689. [PMID: 36112004 PMCID: PMC9960485 DOI: 10.1093/humrep/deac196] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/04/2022] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Is there an association between fertility status, method of conception and the risks of birth defects and childhood cancer? SUMMARY ANSWER The risk of childhood cancer had two independent components: (i) method of conception and (ii) presence, type and number of birth defects. WHAT IS KNOWN ALREADY The rarity of the co-occurrence of birth defects, cancer and ART makes studying their association challenging. Prior studies have indicated that infertility and ART are associated with an increased risk of birth defects or cancer but have been limited by small sample size and inadequate statistical power, failure to adjust for or include plurality, differences in definitions and/or methods of ascertainment, lack of information on ART treatment parameters or study periods spanning decades resulting in a substantial historical bias as ART techniques have improved. STUDY DESIGN, SIZE, DURATION This was a population-based cohort study linking ART cycles reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) from 1 January 2004 to 31 December 2017 that resulted in live births in 2004-2018 in Massachusetts and North Carolina and live births in 2004-2017 in Texas and New York. A 10:1 sample of non-ART births were chosen within the same time period as the ART birth. Non-ART siblings were identified through the ART mother's information. Children from non-ART births were classified as being born to women who conceived with ovulation induction or IUI (OI/IUI) when there was an indication of infertility treatment on the birth certificate, and the woman did not link to the SART CORS; all others were classified as being naturally conceived. PARTICIPANTS/MATERIALS, SETTING, METHODS The study population included 165 125 ART children, 31 524 non-ART siblings, 12 451 children born to OI/IUI-treated women and 1 353 440 naturally conceived children. All study children were linked to their respective State birth defect registries to identify major defects diagnosed within the first year of life. We classified children with major defects as either chromosomal (i.e. presence of a chromosomal defect with or without any other major defect) or nonchromosomal (i.e. presence of a major defect but having no chromosomal defect), or all major defects (chromosomal and nonchromosomal), and calculated rates per 1000 children. Logistic regression models were used to generate adjusted odds ratios (AORs) and 95% CIs of the risk of birth defects by conception group (OI/IUI, non-ART sibling and ART by oocyte source and embryo state) with naturally conceived children as the reference, adjusted for paternal and maternal ages; maternal race and ethnicity, education, BMI, parity, diabetes, hypertension; and for plurality, infant sex and State and year of birth. All study children were also linked to their respective State cancer registries. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs of cancer by birth defect status (including presence of a defect, type and number of defects), and conception group. MAIN RESULTS AND THE ROLE OF CHANCE A total of 29 571 singleton children (2.0%) and 3753 twin children (3.5%) had a major birth defect (chromosomal or nonchromosomal). Children conceived with ART from autologous oocytes had increased risks for nonchromosomal defects, including blastogenesis, cardiovascular, gastrointestinal and, for males only, genitourinary defects, with AORs ranging from 1.22 to 1.85; children in the autologous-fresh group also had increased risks for musculoskeletal (AOR 1.28, 95% CI 1.13, 1.45) and orofacial defects (AOR 1.40, 95% CI 1.17, 1.68). Within the donor oocyte group, the children conceived from fresh embryos did not have increased risks in any birth defect category, whereas children conceived from thawed embryos had increased risks for nonchromosomal defects (AOR 1.20, 95% CI 1.03, 1.40) and blastogenesis defects (AOR 1.74, 95% CI 1.14, 2.65). The risk of cancer was increased among ART children in the autologous-fresh group (HR 1.31, 95% CI 1.08, 1.59) and non-ART siblings (1.34, 95% CI 1.02, 1.76). The risk of leukemia was increased among children in the OI/IUI group (HR 2.15, 95% CI 1.04, 4.47) and non-ART siblings (HR 1.63, 95% CI 1.02, 2.61). The risk of central nervous system tumors was increased among ART children in the autologous-fresh group (HR 1.68, 95% CI 1.14, 2.48), donor-fresh group (HR 2.57, 95% CI 1.04, 6.32) and non-ART siblings (HR 1.84, 95% CI 1.12, 3.03). ART children in the autologous-fresh group were also at increased risk for solid tumors (HR 1.39, 95% CI 1.09, 1.77). A total of 127 children had both major birth defects and cancer, of which 53 children (42%) had leukemia. The risk of cancer had two independent components: (i) method of conception (described above) and (ii) presence, type and number of birth defects. The presence of nonchromosomal defects increased the cancer risk, greater for two or more defects versus one defect, for all cancers and each type evaluated. The presence of chromosomal defects was strongly associated with cancer risk (HR 8.70 for all cancers and HR 21.90 for leukemia), further elevated in the presence of both chromosomal and nonchromosomal defects (HR 21.29 for all cancers, HR 64.83 for leukemia and HR 4.71 for embryonal tumors). Among the 83 946 children born from ART in the USA in 2019 compared to their naturally conceived counterparts, these risks translate into an estimated excess of 761 children with major birth defects, 31 children with cancer and 11 children with both major birth defects and cancer. LIMITATIONS, REASONS FOR CAUTION In the SART CORS database, it was not possible to differentiate method of embryo freezing (slow freezing versus vitrification), and data on ICSI were only available in the fresh embryo ART group. In the OI/IUI group, it was not possible to differentiate type of non-ART treatment utilized, and in both the ART and OI/IUI groups, data were unavailable on duration of infertility. Since OI/IUI is underreported on the birth certificate, some OI/IUI children were likely included among the naturally conceived children, which will decrease the difference between all the groups and the naturally conceived children. WIDER IMPLICATIONS OF THE FINDINGS The use of ART is associated with increased risks of major nonchromosomal birth defects. The presence of birth defects is associated with greater risks for cancer, which adds to the baseline risk in the ART group. Although this study does not show causality, these findings indicate that children conceived with ART, non-ART siblings, and all children with birth defects should be monitored more closely for the subsequent development of cancer. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by grant R01 HD084377 from the National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Child Health and Human Development, or the National Institutes of Health, nor any of the State Departments of Health which contributed data. M.L.E. reports consultancy for Ro, Hannah, Dadi, Sandstone and Underdog; presidency of SSMR; and SMRU board member. The remaining authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Barbara Luke
- Correspondence address. Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, 965 Wilson Road, East Fee Hall, Room 628, East Lansing, MI 48824, USA. Tel: +1-517-353-1678; Fax: +1-517-353-1663; E-mail:
| | - Morton B Brown
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Maria J Schymura
- New York State Department of Health, New York State Cancer Registry, Albany, NY, USA,Department of Epidemiology and Biostatistics, School of Public Health, University of Albany, Rensselaer, NY, USA
| | - Marilyn L Browne
- Department of Epidemiology and Biostatistics, School of Public Health, University of Albany, Rensselaer, NY, USA,New York State Department of Health, Birth Defects Registry, Albany, NY, USA
| | - Sarah C Fisher
- New York State Department of Health, Birth Defects Registry, Albany, NY, USA
| | - Nina E Forestieri
- North Carolina Department of Health and Human Services, Birth Defects Monitoring Program, State Center for Health Statistics, Raleigh, NC, USA
| | - Chandrika Rao
- North Carolina Central Cancer Registry, Raleigh, NC, USA
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mahsa M Yazdy
- Massachusetts Department of Public Health, Massachusetts Center for Birth Defects Research and Prevention, Boston, MA, USA
| | - Susan T Gershman
- Massachusetts Department of Public Health, Massachusetts Cancer Registry, Office of Data Management and Outcomes Assessment, Boston, MA, USA
| | - Caitlin R Sacha
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Melanie Williams
- Texas Department of State Health Services, Cancer Epidemiology and Surveillance Branch, Texas Health and Human Services, Austin, TX, USA
| | - Mary K Ethen
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, TX, USA
| | - Mark A Canfield
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, TX, USA
| | | | - Michael L Eisenberg
- Division of Male Reproductive Medicine and Surgery, Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carrie Williams
- Policy, Practice, and Population Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Alastair G Sutcliffe
- Policy, Practice, and Population Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Melissa A Richard
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
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Pediatric neurological cancer incidence and trends in the United States, 2000–2018. Cancer Causes Control 2022; 33:687-699. [DOI: 10.1007/s10552-021-01535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
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Morsy S, Hieu TH, Ghozy S, Tran L, Huy NT. Mortality in cancer patients with congenital anomalies across different age groups: trend analysis and prognostic risk factors.. [DOI: 10.1101/2021.11.20.21266629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
AbstractPurposeCongenital anomalies are one of the causes of the high mortality rate in children diagnosed with cancer. However, there is a gap of evidence of the rate of cancer mortality in older patients who had congenital anomalies. The study, therefore, aimed to investigate the epidemiology of cancer mortality in those patients.MethodsData were retrieved for patients with cancer and died due to congenital causes throughout 43 years from Surveillance, Epidemiology, and End Results program SEER. The age of patients was divided into nine groups each is formed of 10 years interval. Joinpoint analysis was used to calculate the trends of Cancer mortality and Cox proportional hazard ratio to identify the mortality risk factors.ResultsWe have included 2682 patients with death associated with congenital malformation. The mortality of cancer patients due to congenital anomalies greatly enhanced in the last years with the overall average annual percent was 3.8%. Interestingly, congenital anomalies had less mortality risk than other causes reported in SEER. Moreover, age, sex, radiation, chemotherapy, and behavior of tumor were significantly associated with higher survival in patients with congenital anomalies.ConclusionsCancer patients with congenital anomalies had less mortality risk than patients with other diseases reported in SEER. The mortality rates decreased recently, with the most mortality in the bone marrow and prostate tumors.Implications for Cancer SurvivorsCongenital anomalies are considered the least studied diseases in cancer patients. In this study, we studied how congenital anomalies did not increase the risk for cancer. However, our analysis implied the congenital anomalies in the male reproductive system were associated with the highest risk of cancer.
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Neurodevelopmental Consequences of Pediatric Cancer and Its Treatment: The Role of Sleep. Brain Sci 2020; 10:brainsci10070411. [PMID: 32630162 PMCID: PMC7408401 DOI: 10.3390/brainsci10070411] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Abstract
Cognitive impairment is frequent in pediatric cancer, and behavioral and psychological disturbances often also affect children who have survived cancer problems. Furthermore, pediatric tumors are also often associated with sleep disorders. The interrelationship between sleep disorders, neurodevelopmental disorders and pediatric cancer, however, is still largely unexplored. In this narrative review we approach this important aspect by first considering studies on pediatric cancer as a possible cause of neurodevelopmental disorders and then describing pediatric cancer occurring as a comorbid condition in children with neurodevelopmental disorders. Finally, we discuss the role of sleep disorders in children with cancer and neurodevelopmental disorders. Even if the specific literature approaching directly the topic of the role of sleep in the complex relationship between pediatric cancer and neurodevelopmental disorders was found to be scarce, the available evidence supports the idea that in-depth knowledge and correct management of sleep disorders can definitely improve the health and quality of life of children with cancer and of their families.
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Schraw JM, Desrosiers TA, Nembhard WN, Langlois PH, Meyer RE, Canfield MA, Rasmussen SA, Chambers TM, Spector LG, Plon SE, Lupo PJ. Cancer diagnostic profile in children with structural birth defects: An assessment in 15,000 childhood cancer cases. Cancer 2020; 126:3483-3492. [PMID: 32469081 DOI: 10.1002/cncr.32982] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Birth defects are established risk factors for childhood cancer. Nonetheless, cancer epidemiology in children with birth defects is not well characterized. METHODS Using data from population-based registries in 4 US states, this study compared children with cancer but no birth defects (n = 13,111) with children with cancer and 1 or more nonsyndromic birth defects (n = 1616). The objective was to evaluate cancer diagnostic characteristics, including tumor type, age at diagnosis, and stage at diagnosis. RESULTS Compared with the general population of children with cancer, children with birth defects were diagnosed with more embryonal tumors (26.6% vs 18.7%; q < 0.001), including neuroblastoma (12.5% vs 8.2%; q < 0.001) and hepatoblastoma (5.0% vs 1.3%; q < 0.001), but fewer hematologic malignancies, including acute lymphoblastic leukemia (12.4% vs 24.4%; q < 0.001). In age-stratified analyses, differences in tumor type were evident among children younger than 1 year and children 1 to 4 years old, but they were attenuated among children 5 years of age or older. The age at diagnosis was younger in children with birth defects for most cancers, including leukemia, lymphoma, astrocytoma, medulloblastoma, ependymoma, embryonal tumors, and germ cell tumors (all q < 0.05). CONCLUSIONS The results indicate possible etiologic heterogeneity in children with birth defects, have implications for future surveillance efforts, and raise the possibility of differential cancer ascertainment in children with birth defects. LAY SUMMARY Scientific studies suggest that children with birth defects are at increased risk for cancer. However, these studies have not been able to determine whether important tumor characteristics, such as the type of tumor diagnosed, the age at which the tumor is diagnosed, and the degree to which the tumor has spread at the time of diagnosis, are different for children with birth defects and children without birth defects. This study attempts to answer these important questions. By doing so, it may help scientists and physicians to understand the causes of cancer in children with birth defects and diagnose cancer at earlier stages when it is more treatable.
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Affiliation(s)
- Jeremy M Schraw
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas
| | - Tania A Desrosiers
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Wendy N Nembhard
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Peter H Langlois
- Birth Defects Epidemiology and Surveillance Branch, Department of State Health Services, Austin, Texas
| | - Robert E Meyer
- Department of Maternal and Child Health, University of North Carolina, Chapel Hill, North Carolina.,State Center for Health Statistics, North Carolina Division of Public Health, Raleigh, North Carolina
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Department of State Health Services, Austin, Texas
| | - Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.,Department of Epidemiology, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville, Florida
| | - Tiffany M Chambers
- Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Logan G Spector
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Sharon E Plon
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Philip J Lupo
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Ostrom QT, Fahmideh MA, Cote DJ, Muskens IS, Schraw JM, Scheurer ME, Bondy ML. Risk factors for childhood and adult primary brain tumors. Neuro Oncol 2019; 21:1357-1375. [PMID: 31301133 PMCID: PMC6827837 DOI: 10.1093/neuonc/noz123] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Primary brain tumors account for ~1% of new cancer cases and ~2% of cancer deaths in the United States; however, they are the most commonly occurring solid tumors in children. These tumors are very heterogeneous and can be broadly classified into malignant and benign (or non-malignant), and specific histologies vary in frequency by age, sex, and race/ethnicity. Epidemiological studies have explored numerous potential risk factors, and thus far the only validated associations for brain tumors are ionizing radiation (which increases risk in both adults and children) and history of allergies (which decreases risk in adults). Studies of genetic risk factors have identified 32 germline variants associated with increased risk for these tumors in adults (25 in glioma, 2 in meningioma, 3 in pituitary adenoma, and 2 in primary CNS lymphoma), and further studies are currently under way for other histologic subtypes, as well as for various childhood brain tumors. While identifying risk factors for these tumors is difficult due to their rarity, many existing datasets can be leveraged for future discoveries in multi-institutional collaborations. Many institutions are continuing to develop large clinical databases including pre-diagnostic risk factor data, and developments in molecular characterization of tumor subtypes continue to allow for investigation of more refined phenotypes. Key Point 1. Brain tumors are a heterogeneous group of tumors that vary significantly in incidence by age, sex, and race/ethnicity.2. The only well-validated risk factors for brain tumors are ionizing radiation (which increases risk in adults and children) and history of allergies (which decreases risk).3. Genome-wide association studies have identified 32 histology-specific inherited genetic variants associated with increased risk of these tumors.
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Affiliation(s)
- Quinn T Ostrom
- Department of Medicine, Section of Epidemiology and Population Sciences, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Maral Adel Fahmideh
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Solna, Karolinska Institutet, and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - David J Cote
- Channing Division of Network Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Computational Neuroscience Outcomes Center, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ivo S Muskens
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jeremy M Schraw
- Department of Medicine, Section of Epidemiology and Population Sciences, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Michael E Scheurer
- Department of Pediatrics, Section of Hematology-Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Melissa L Bondy
- Department of Medicine, Section of Epidemiology and Population Sciences, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
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Wong-Siegel JR, Johnson KJ, Gettinger K, Cousins N, McAmis N, Zamarione A, Druley TE. Congenital neurodevelopmental anomalies in pediatric and young adult cancer. Am J Med Genet A 2017; 173:2670-2679. [PMID: 28851129 PMCID: PMC5639360 DOI: 10.1002/ajmg.a.38387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/09/2017] [Accepted: 07/14/2017] [Indexed: 01/19/2023]
Abstract
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.
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Affiliation(s)
- Jeannette R Wong-Siegel
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri
| | - Kimberly J Johnson
- Brown School Masters of Public Health Program, Washington University in St. Louis, Saint Louis, Missouri
| | - Katie Gettinger
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri
| | - Nicole Cousins
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri.,Brown School Masters of Public Health Program, Washington University in St. Louis, Saint Louis, Missouri
| | - Nicole McAmis
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri
| | - Ashley Zamarione
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri
| | - Todd E Druley
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri
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