A population-based study of familial central nervous system hemangioblastomas

Familial renal cell carcinoma from the Swedish Family-Cancer Database

BACKGROUND

Reliable data on familial risks are important for clinical counselling and cancer genetics.

OBJECTIVE

To evaluate familial risks for renal cell carcinomas (RCC) through parental and sibling probands in the largest available dataset.

DESIGN, SETTING, AND PARTICIPANTS

This study examined the Swedish Family-Cancer Database on 12.2 million individuals, which contains families with parents and offspring. Cancer data were retrieved from the Swedish Cancer Registry for the years 1961-2008, including 8513 patients with RCC.

MEASUREMENTS

Familial risk for offspring was defined through standardised incidence ratios (SIRs) and adjusted for many variables, including a proxy for smoking and obesity.

RESULTS AND LIMITATIONS

The familial risk for RCCs was 1.75 when a parent and 2.61 when a sibling was diagnosed with any kidney cancer. Also, RCCs were shown to be associated with prostate cancer (PCa) when parents or parents and siblings were diagnosed with PCa. Among siblings, the associations of RCC with melanoma, non-Hodgkin's lymphoma, and urinary bladder and papillary thyroid tumours were found. None of the results differed significantly after excluding the families with cancer pathognomonic of a von Hippel-Lindau (VHL) disease. Limitations of this study include the small number of familial cases (229 familial cases).

CONCLUSIONS

The present analysis showed a high familiarity for RCC, and recessive effects may be important for familial aggregation of RCC. As a novel association, offspring RCC was in excess when parents or parents and siblings were diagnosed with PCa. There is familial clustering beyond VHL and the recent low-risk gene that probably explains a small proportion of the observed familial clustering.

Renal cell carcinoma as first and second primary cancer: etiological clues from the Swedish Family-Cancer Database

PURPOSE

An increasing incidence and improved prognosis of kidney cancer have led to concern about second primary malignancies. The study of multiple primary malignancies is also important since the association of certain malignancies may guide the search for germline alterations and environmental risk factors. We evaluated bidirectional associations between renal cell carcinoma and other primary cancers.

MATERIALS AND METHODS

We studied 8,030 patients with renal cell carcinoma based on the Swedish Family-Cancer Database. The SIR of second cancer was calculated by comparing it to the rate of first cancers. Followup was started in 1993 and continued through 2006.

RESULTS

A total of 677 patients had second cancers after the first renal cell carcinoma, including 89 second renal cell carcinomas. In 776 patients renal cell carcinoma was diagnosed after another primary cancer. Histology concordant renal cell carcinoma pairs showed a SIR of 31.04 and 15.15 after clear cell and total renal cell carcinoma, respectively. The highest SIR of 132.46 was noted for synchronous contralateral clear cell renal cell carcinoma. A reciprocally increased risk of renal cell carcinoma was seen after lung, breast, prostate, bladder, thyroid gland, adrenal gland and nervous system cancer as well as after melanoma and nonHodgkin's lymphoma. Clear cell renal cell carcinoma was also in excess after brain hemangioblastoma with a SIR of 70.79.

CONCLUSIONS

High risk was found for histology concordant renal cell carcinoma pairs and contralateral renal cell carcinoma. Bidirectional associations of renal cell carcinoma with many other cancers may imply etiological sharing. von Hippel-Lindau syndrome may explain the excess of renal cell carcinoma after brain hemangioblastoma.

Familial risks in nervous-system tumours: a histology-specific analysis from Sweden and Norway

BACKGROUND

There are limited data available on tumour subtype-specific familial risks for nervous-system tumours. We aimed to provide such data at the population level.

METHODS

We used data from the nationwide Swedish and Norwegian databases on familial cancer to calculate standardised incidence ratios (SIRs) for the familial risk of developing a nervous-system tumour in offspring born after 1931 (Sweden) or 1900 (Norway) whose parents or siblings were probands.

FINDINGS

54 195 patients had nervous-system tumours, 22 331 of whom belonged to the offspring generation aged 0-72 years in Sweden and 0-51 years in Norway. Of 709 familial patients in the offspring generation, 438 (61.8%) had a parent affected by a nervous-system tumour (SIR 1.66; 95% CI 1.51-1.82), 236 (33.3%) had a sibling affected by a nervous-system tumour (SIR 2.01; 95% CI 1.76-2.28), and 35 (4.9%) belonged to families with a parent and at least two siblings affected by a nervous-system tumour (multiplex families; SIR 13.40; 95% CI 9.33-18.66). The SIR for glioma was 1.8 (1.5-2.0) when a parent was a proband, but increased to 11.2 (5.7-19.5) in multiplex families. Early-onset neurinoma and haemangioma showed high familial risks; with an SIR for neurinoma of 1.7 (1.4-2.2) for offspring of affected parents, 2.7 (2.0-3.5) for siblings, and 27.2 (13.5-48.8) for multiplex families, and an SIR for haemangioma of 2.4 (1.4-3.8) for offspring of affected parents. Histology-specific population-based familial risks were shown for meningioma (1.6 for offspring of affected parents; 95% CI 1.3-2.0), ependymoma (2.7 for young offspring <20 years; 1.1-5.5), medulloblastoma (4.1 for siblings; 1.7-8.1), and neuroblastoma (3.2 for siblings; 1.1-6.9).

INTERPRETATION

Our results suggest a complex genetic background for nervous-system tumours, which differs depending on the age of onset and histological subtype of the tumour. High sibling risks might suggest recessive inheritance. As the high-penetrant multiplex families only accounted for about 5% of familial nervous-system tumours, most familial cases are probably caused by low-penetrance genes.

FUNDING

The Nordic Cancer Union, Deutsche Krebshilfe, the Swedish Cancer Society, and the Swedish Council for Working Life and Social Research.

Familial blood vessel tumors and subsequent cancers

BACKGROUND

Population-based data on the familial risk for vascular tumors are largely lacking. Such data are important for clinical counseling and cancer genetics.

METHODS

We used the Swedish Family-Cancer Database to calculate standardized incidence ratios for specific subtypes of vascular tumors in offspring using parents as probands. In addition, risks for second cancers were analyzed.

RESULTS

Offspring hemangioblastoma in the nervous system was associated with parental kidney cancer and nervous system hemangioblastoma and hemangioma. Offspring nervous system hemangiopericytoma was associated with parental pituitary adenomas. Offspring angiosarcoma in the trunk and extremities was associated with maternal breast cancer. Second Kaposi's sarcoma, non-Hodgkin's lymphoma, Hodgkin's disease and myeloma were increased following primary skin Kaposi's sarcoma. Kidney and endocrine gland tumors and nervous system hemangioblastomas and hemangiomas were in excess following primary nervous system hemangioblastoma and hemangioma.

CONCLUSIONS

Our data showed that familial clustering of nervous system hemangioblastoma and hemangioma and the risks of subsequent cancers were primarily related to von-Hippel-Lindau disease. As a novel association, offspring nervous system hemangiopericytomas were in excess when parents were diagnosed with pituitary adenoma. Similarly, offspring angiosarcoma is associated with maternal breast cancer. Immunodeficiency may explain the excess of lymphoproliferative diseases after skin Kaposi's sarcoma.

Age-specific familial risks for renal cell carcinoma with evidence on recessive heritable effects

BACKGROUND

Systematic comparisons of mode of inheritance for renal cell carcinoma (RCC) have not been carried out. The occurrence of cancer in parents and offspring may be due to dominant causes, whereas cancer affecting only siblings may indicate a recessive causation. Environmental effects need to be excluded.

METHODS

The Swedish Family-Cancer Database includes all Swedes born after 1931 with their biologic parents, totaling 10.2 million persons. Cancer data were retrieved from the Swedish Cancer Registry from years 1961 to 2000, included 2415 cases of RCC in offspring and 18531 in parents. Standardized incidence ratios (SIRs) and 95% CI limits were calculated for offspring whose parents or sibling were diagnosed with RCC.

RESULTS

The SIRs for siblings for RCC depended on their age difference. SIR was 7.63 (95% CI 3.63-14.08) when the age difference was less than 3 years and compared to 3.43 (95% CI 1.77-6.02) for large age difference. SIRs for familial risk of RCC were 1.73 (95% CI 1.31-2.26) when a parent and 4.58 (95% CI 2.87-6.94) when a sibling had RCC. Age-specific analysis of familial RCC among siblings revealed maxima at ages 40 to 49 and 60 to 68 years.

CONCLUSION

The findings in the present study offer evidence on recessive effects in early onset RCC.

Association of brain tumours with other neoplasms in families

We used the nationwide Swedish Family-Cancer Database to analyse the association of histology-specific brain tumours with other cancers in family members. Among 0-68-year-old offspring, 9414 patients with brain tumours were identified from 1961 to 2000, of whom, 3387 parents were diagnosed with any primary neoplasm. Astrocytoma, meningioma and neurinoma were the main histological types. Increased standardised incidence ratios (SIRs) were found for brain tumours in association with cancers at sites that are known features in recognised syndromes, such as haemangioblastoma and renal cancer in von Hippel-Lindau disease. In addition, an association between astrocytoma and melanoma was recognised. Among as yet unknown clustering, neurinoma was associated with testicular cancer and myeloma; meningioma was associated with cervical cancer; astrocytoma was associated with prostate cancer; ependymoma was associated with breast cancer. Although some of these may feature a true tumour cluster, they need to be confirmed in another setting.

Genetic epidemiology of cancer: From families to heritable genes

A reliable determination of familial risks for cancer is important for clinical counseling, prevention and understanding cancer etiology. Family-based gene identification efforts may be targeted if the risks are well characterized and the mode of inheritance is identified. Medically verified data on familial risks have not been available for all types of cancer but they have become available through the use of the nationwide Swedish Family-Cancer Database, which includes all Swedes born in 1932 and later with their parents, totaling over 10 million individuals. Over 150 publications have emanated from this source. The familial risks of cancer have been characterized for all main cancers and the contribution of environmental and heritable effects to the familial aggregation has been assessed. Furthermore, the mode of inheritance has been deduced by comparing risks from parental and sibling probands. Examples are shown on familial clustering of cancers, for which heritable susceptibility genes are yet unknown, such as squamous cell carcinoma of the skin, intestinal carcinoids, thyroid papillary tumors, brain astrocytomas and pituitary adenomas. Some common cancers, such as lung and kidney cancers, appear to show an early-onset recessive component because familial risks among siblings are much higher than those in families where parents are probands. Many of the cancer sites showing high familial risks lack guidelines for clinical counseling or action level. In conclusion, we recommend that any future gene identification efforts, either using linkage or association designs, devise their strategies based on data from family studies. Clinical genetic counseling would benefit from reviewing established familial risks on all main types of cancer.

Kidney cancer in the Swedish Family Cancer Database: familial risks and second primary malignancies

BACKGROUND

Familial risks in kidney cancer and association with second primary malignancies were studied using the nationwide Swedish Family Cancer Database.

METHODS

Cancer data were retrieved from the Swedish Cancer Registry from years 1961 to 1998 and included 23,137 cases of kidney cancer. Standardized incidence ratios (SIRs) were used to measure the cancer risks.

RESULTS

Seventy-one families were identified where both a parent and an offspring had kidney cancer, giving a familial risk for offspring of 1.56 (1.22 to 1.95) and population attributable proportion of 0.78%. A risk for kidney cancer from an affected sibling was considerably higher with a SIR of 4.72 (2.28 to 9.20), giving an attributable proportion of 0.77%. The discordant tumor site that was associated with kidney cancer between two generations was hemangioblastoma of central nervous system. Discordant cancer sites that were associated with kidney cancer in siblings were ovaries, endocrine glands and pancreas. There was an over threefold increase of second primary malignancies of the urinary bladder, nervous system and endocrine gland in kidney cancer patients. The risks for second primary hemangioblastoma following kidney cancer or familial kidney cancer was 21.19 (6.69 to 43.83) and 1206 (114 to 3456), respectively.

CONCLUSIONS

The high ratio of sibling risk to offspring risk in kidney cancer may reflect a recessive susceptibility. The high risk for second primary cancers in the patients without family history is consistent with a polygenic model and variable degree of environmental modification.

Second primary neoplasms after 19281 endocrine gland tumours: aetiological links?

The nationwide Swedish Family-Cancer Database of 9.6 million individuals was used to analyse the development of second neoplasia after 6909 thyroid and 12697 other endocrine tumours. Tumour cases were retrieved from the Swedish Cancer Registry from 1958 to 1996. The risk of a second endocrine tumour was markedly increased compared with first endocrine tumour; e.g. the standardised incidence ratios (SIRs) were well over 10 for adrenal tumours after thyroid cancer, and vice versa. Familial risks were higher for the development of second compared with first neoplasms, and the SIRs for men were usually higher than those for women. Many increases between different endocrine glands can probably be ascribed to known cancer syndromes. Even cancers at some other sites were increased after the development of primary endocrine tumours. Notably, small intestinal carcinoids were increased after thyroid and other endocrine tumours, and brain menigiomas were increased after parathyroid and pituitary adenomas. These novel associations suggest shared risk factors for these sites. However, many endocrine tumours are benign and the diagnosis of the first tumour may increase the likelihood of a second diagnosis.