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Peckham-Gregory EC, Boff LM, Schraw JM, Spector LG, Linabery AM, Erhardt EB, Ribeiro KB, Allen CE, Scheurer ME, Lupo PJ. Role of non-chromosomal birth defects on the risk of developing childhood Hodgkin lymphoma: A Children's Oncology Group study. Pediatr Blood Cancer 2024; 71:e30822. [PMID: 38146016 DOI: 10.1002/pbc.30822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Non-chromosomal birth defects are an important risk factor for several childhood cancers. However, these associations are less clear for Hodgkin lymphoma (HL). Therefore, we sought to more fully elucidate the association between non-chromosomal birth defects and HL risk. PROCEDURE Information on cases (n = 517) diagnosed with HL (ages of 0-14) at Children's Oncology Group Institutions for the period of 1989-2003 was obtained. Control children without a history of cancer (n = 784) were identified using random digit dialing and individually matched to cases on sex, race/ethnicity, age, and geographic location. Parents completed comprehensive interviews and answered questions including whether their child had been born with a non-chromosomal birth defect. To test the association between birth defects and HL risk, conditional logistic regression was applied to generate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS Children born with any non-chromosomal birth defect were not more likely to be diagnosed with HL at 0-14 years of age (aOR: 0.91; 95% CI: 0.69-1.21). No associations were detected between major or minor birth defects and HL (aOR: 1.34; 95% CI: 0.67-2.67 and aOR: 0.88; 95% CI: 0.57-1.34, respectively). Similarly, no association was observed for children born with any birth defect and EBV-positive HL (aOR: 0.57; 95% CI: 0.25-1.26). CONCLUSIONS Previous assessments of HL in children with non-chromosomal birth defects have been limited. Using data from the largest case-control study of HL in those <15 years of age, we did not observe strong associations between being born with a birth defect and HL risk.
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Affiliation(s)
- Erin C Peckham-Gregory
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Feigin Center, Houston, Texas, USA
- Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
| | - Lucas Maschietto Boff
- Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
- Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Jeremy M Schraw
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Feigin Center, Houston, Texas, USA
- Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
| | - Logan G Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota, USA
| | - Amy M Linabery
- Department of Pediatrics, Neuroscience Institute, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Erik B Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Karina B Ribeiro
- Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Carl E Allen
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Feigin Center, Houston, Texas, USA
| | - Michael E Scheurer
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Feigin Center, Houston, Texas, USA
- Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Feigin Center, Houston, Texas, USA
- Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
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Hasan MS, Ganni E, Liu A, Guo L, Mackie AS, Kaufman JS, Marelli AJ. CanCHD Study of Hematopoietic Cancers in Children With and Without Genetic Syndromes. J Am Heart Assoc 2024; 13:e026604. [PMID: 38156460 PMCID: PMC10863797 DOI: 10.1161/jaha.122.026604] [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: 04/29/2022] [Accepted: 10/23/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Individuals with genetic syndromes can manifest both congenital heart disease (CHD) and cancer attributable to possible common underlying pathways. To date, reliable risk estimates of hematopoietic cancer (HC) among children with CHD based on large population-based data remain scant. This study sought to quantify the risk of HC by the presence of genetic syndrome among children with CHD. METHODS AND RESULTS Data sources were the Canadian CHD database, a nationwide database on CHD (1999-2017), and the CCR (Canadian Cancer Registry). Standardized incidence ratios were calculated for comparing HC incidences in children with CHD with the general pediatric population. A modified Kaplan-Meier curve was used to estimate the cumulative incidence of HC with death as a competing risk. A total of 143 794 children (aged 0-17 years) with CHD were followed up from birth to age 18 years for 1 314 603 person-years. Of them, 8.6% had genetic syndromes, and 898 HC cases were observed. Children with known syndromes had a substantially higher risk of incident HC than the general pediatric population (standardized incidence ratio, 13.4 [95% CI, 11.7-15.1]). The cumulative incidence of HC was 2.44% (95% CI, 2.11-2.76) among children with a syndrome and 0.79% (95% CI, 0.72-0.87) among children without a syndrome. Acute myeloid leukemia had a higher cumulative incidence during early childhood than acute lymphoblastic leukemia. CONCLUSIONS This is the first large population-based analysis documenting that known genetic syndromes in children with CHD are a significant predictor of HC. The finding could be essential in informing risk-stratified policy recommendations for cancer surveillance in children with CHD.
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Affiliation(s)
- Mohammad Sazzad Hasan
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Elie Ganni
- McGill Adult Unit for Congenital Heart Disease ExcellenceMcGill University Health CentreMontrealQuebecCanada
| | - Aihua Liu
- McGill Adult Unit for Congenital Heart Disease ExcellenceMcGill University Health CentreMontrealQuebecCanada
| | - Liming Guo
- McGill Adult Unit for Congenital Heart Disease ExcellenceMcGill University Health CentreMontrealQuebecCanada
| | - Andrew S. Mackie
- Division of Cardiology, Stollery Children’s Hospital and Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | - Jay S. Kaufman
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Ariane J. Marelli
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
- McGill Adult Unit for Congenital Heart Disease ExcellenceMcGill University Health CentreMontrealQuebecCanada
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Richard MA, Yang W, Sok P, Li M, Carmichael SL, von Behren J, Reynolds P, Fisher PG, Collins RT, Hobbs CA, Luke B, Shaw GM, Lupo PJ. Differential newborn DNA methylation among individuals with complex congenital heart defects and childhood lymphoma. Birth Defects Res 2022; 114:1434-1439. [PMID: 36226634 DOI: 10.1002/bdr2.2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/07/2022] [Accepted: 09/25/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is emerging evidence that children with complex congenital heart defects (CHDs) are at increased risk for childhood lymphoma, but the mechanisms underlying this association are unclear. Thus, we sought to evaluate the role of DNA methylation patterns on "CHD-lymphoma" associations. METHODS From >3 million live births (1988-2004) in California registry linkages, we obtained newborn dried bloodspots from eight children with CHD-lymphoma through the California BioBank. We performed case-control epigenome-wide association analyses (EWAS) using two comparison groups with reciprocal discovery and validation to identify differential methylation associated with CHD-lymphoma. RESULTS After correction for multiple testing at the discovery and validation stages, individuals with CHD-lymphoma had differential newborn methylation at six sites relative to two comparison groups. Our top finding was significant in both EWAS and indicates PPFIA1 cg25574765 was hypomethylated among individuals with CHD-lymphoma (mean beta = 0.04) relative to both unaffected individuals (mean beta = 0.93, p = 1.5 × 10-12 ) and individuals with complex CHD (mean beta = 0.95, p = 3.8 × 10-8 ). PPFIA1 encodes a ubiquitously expressed liprin protein in one of the most commonly amplified regions in many cancers (11q13). Further, cg25574765 is a proposed marker of pre-eclampsia, a maternal CHD risk factor that has not been fully evaluated for lymphoma risk in offspring, and the tumor microenvironment that may drive immune cell malignancies. CONCLUSIONS We identified associations between molecular changes present in the genome at birth and risk of childhood lymphoma among those with CHD. Our findings also highlight novel perinatal exposures that may underlie methylation changes in CHD predisposing to lymphoma.
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Affiliation(s)
- Melissa A Richard
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Wei Yang
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Pagna Sok
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Ming Li
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, Indiana, USA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Julie von Behren
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Paul G Fisher
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Neurology, Stanford University School of Medicine, Palo Alto, California, USA
| | - R Thomas Collins
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Charlotte A Hobbs
- Rady Children's Institute for Genomic Medicine, San Diego, California, USA
| | - Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Congenital Heart Disease and the Risk of Cancer: An Update on the Genetic Etiology, Radiation Exposure Damage, and Future Research Strategies. J Cardiovasc Dev Dis 2022; 9:jcdd9080245. [PMID: 36005409 PMCID: PMC9409914 DOI: 10.3390/jcdd9080245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 01/27/2023] Open
Abstract
Epidemiological studies have shown an increased prevalence of cancer in patients with congenital heart disease (CHD) as compared with the general population. The underlying risk factors for the acquired cancer risk remain poorly understood, and shared genetic anomalies and cumulative radiation exposure from repeated imaging and catheterization procedures may be contributing factors. In the present review, we provide an update on the most recent literature regarding the associations between CHD and cancer, with a particular focus on genetic etiology and radiation exposure from medical procedures. The current evidence indicates that children with CHD may be a high-risk population, already having the first genetic “hit”, and, consequently, may have increased sensitivity to ionizing radiation from birth or earlier. Future research strategies integrating biological and molecular measures are also discussed in this article.
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Yet Kwong Horman J, Schultz M. An Unexpected Occurrence of Malignancy in a Patient After a Fontan Operation. Cureus 2022; 14:e26160. [PMID: 35891831 PMCID: PMC9302605 DOI: 10.7759/cureus.26160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/05/2022] Open
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Ferrero P, Piazza I, Giamberti A, Chessa M. Oncogenesis in patients with congenital heart disease: A possible role of the neural crest. Ann Pediatr Cardiol 2022; 15:273-275. [PMID: 36589641 PMCID: PMC9802619 DOI: 10.4103/apc.apc_213_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/31/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Patients with congenital heart disease (CHD) seem to have a higher risk for specific malignancies. We hypothesize a pathogenetic link between particular congenital heart defects and cancer originating from specific cellular lineages. We report a series of patients, followed in two high-volume referral centers, with CHD involving neural crest-derived structures who developed cancer later in life. Fourteen patients (five female) developed neoplasia with a cellular origin embryologically linked to the neural crest between 2010 and 2020. If confirmed on larger datasets, this observation might support the hypothesis of common embryogenetic pathway suggesting tailored surveillance of a specific subset of patients.
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Affiliation(s)
- Paolo Ferrero
- ACHD UNIT, Pediatric and Adult Congenital Heart Centre, IRCCS – Policlinico San Donato, San Donato Milanese, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, ERN GUARD-Heart, Milan, Italy
| | - Isabelle Piazza
- EAS, Emergency department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Giamberti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, ERN GUARD-Heart, Milan, Italy
- Congenital Cardiac Surgery Unit, IRCCS - Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Massimo Chessa
- ACHD UNIT, Pediatric and Adult Congenital Heart Centre, IRCCS – Policlinico San Donato, San Donato Milanese, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, ERN GUARD-Heart, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
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7
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Kampitsi CE, Mogensen H, Feychting M, Tettamanti G. The relationship between congenital heart disease and cancer in Swedish children: A population-based cohort study. PLoS Med 2022; 19:e1003903. [PMID: 35213531 PMCID: PMC8880823 DOI: 10.1371/journal.pmed.1003903] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/05/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Birth defects have been consistently associated with elevated childhood cancer risks; however, the relationship between congenital heart disease (CHD) and childhood cancer remains conflicting. Considering the increasing patient population with CHD after improvements in their life expectancies, insights into this relationship are particularly compelling. Thus, we aimed to determine the relationship between CHD and cancer in Swedish children. METHODS AND FINDINGS All individuals registered in the Swedish Medical Birth Register (MBR) between 1973 and 2014 were included in this population-based cohort study (n = 4,178,722). Individuals with CHD (n = 66,892) were identified from the MBR and National Patient Register, whereas cancer diagnoses were retrieved from the Swedish Cancer Register. The relationship between CHD and childhood cancer (<20 years at diagnosis) was evaluated using Cox proportional hazards regression models. We observed increased risks of cancer overall, leukemia, lymphoma, and hepatoblastoma in children with CHD, but after adjustment for Down syndrome, only the increased lymphoma (hazard ratio (HR) = 1.64, 95% confidence interval (CI) 1.11 to 2.44) and hepatoblastoma (HR = 3.94, 95% CI 1.83 to 8.47) risk remained. However, when restricting to CHD diagnoses from the MBR only, i.e., those diagnosed around birth, the risk for childhood cancer overall (HR = 1.45, 95% CI 1.23 to 1.71) and leukemia (HR = 1.41, 95% CI 1.08 to 1.84) was more pronounced, even after controlling for Down syndrome. Finally, a substantially elevated lymphoma risk (HR = 8.13, 95% CI 4.06 to 16.30) was observed in children with complex CHD. Limitations of the study include the National Patient Register not being nationwide until 1987, in addition to the rareness of the conditions under study providing limited power for analyses on the rarer cancer subtypes. CONCLUSIONS We found associations between CHD and childhood lymphomas and hepatoblastomas not explained by a diagnosis of Down syndrome. Stronger associations were observed in complex CHD.
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Affiliation(s)
- Christina-Evmorfia Kampitsi
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Giorgio Tettamanti
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Martinez HR, Beasley GS, Goldberg JF, Absi M, Ryan KA, Guerrier K, Joshi VM, Johnson JN, Morin CE, Hurley C, Morrison RR, Rai P, Hankins JS, Bishop MW, Triplett BM, Ehrhardt MJ, Pui CH, Inaba H, Towbin JA. Pediatric Cardio-Oncology Medicine: A New Approach in Cardiovascular Care. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121200. [PMID: 34943396 PMCID: PMC8699848 DOI: 10.3390/children8121200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 12/11/2022]
Abstract
Survival for pediatric patients diagnosed with cancer has improved significantly. This achievement has been made possible due to new treatment modalities and the incorporation of a systematic multidisciplinary approach for supportive care. Understanding the distinctive cardiovascular characteristics of children undergoing cancer therapies has set the underpinnings to provide comprehensive care before, during, and after the management of cancer. Nonetheless, we acknowledge the challenge to understand the rapid expansion of oncology disciplines. The limited guidelines in pediatric cardio-oncology have motivated us to develop risk-stratification systems to institute surveillance and therapeutic support for this patient population. Here, we describe a collaborative approach to provide wide-ranging cardiovascular care to children and young adults with oncology diseases. Promoting collaboration in pediatric cardio-oncology medicine will ultimately provide excellent quality of care for future generations of patients.
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Affiliation(s)
- Hugo R. Martinez
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
- Correspondence:
| | - Gary S. Beasley
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Jason F. Goldberg
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Mohammed Absi
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Kaitlin A. Ryan
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Karine Guerrier
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Vijaya M. Joshi
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Jason N. Johnson
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Cara E. Morin
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Caitlin Hurley
- Division of Critical Care Medicine, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (C.H.); (R.R.M.)
- Department of Bone Marrow Transplantation & Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Ronald Ray Morrison
- Division of Critical Care Medicine, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (C.H.); (R.R.M.)
| | - Parul Rai
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (P.R.); (J.S.H.)
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (P.R.); (J.S.H.)
| | - Michael W. Bishop
- Division of Solid Tumor, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Brandon M. Triplett
- Department of Bone Marrow Transplantation & Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Matthew J. Ehrhardt
- Division of Cancer Survivorship, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Ching-Hon Pui
- Division of Leukemia/Lymphoma, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (C.-H.P.); (H.I.)
| | - Hiroto Inaba
- Division of Leukemia/Lymphoma, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (C.-H.P.); (H.I.)
| | - Jeffrey A. Towbin
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
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Patel J, Schraw JM, Lupo PJ, Mian A, Nembhard WN. Cancer Risk by Attained Age among Children with Birth Defects in Arkansas. Cancer Epidemiol 2020; 68:101796. [PMID: 32827802 DOI: 10.1016/j.canep.2020.101796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/28/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Few studies have evaluated associations between birth defects and risk of pediatric cancers by age of attainment. Therefore, we assessed the risk of cancer among children with and without birth defects by age at attainment. METHODS We examined cancer risk in children ≤14 years with and without birth defects born between 1996 and 2011 by linking data from the Arkansas Reproductive Health Monitoring System, Arkansas Central Cancer Registry, and birth certificates. Age of attainment for cancer was calculated as person-years from birth to cancer diagnosis, death, or end of study period, whichever occurred first. Using Cox proportional hazards models, we evaluated associations by attained age groups (<1, 1-4, 5-9, and 10-14 years) between: (1) groups of birth defects (any, chromosomal, and non-chromosomal) and any cancer; (2) non-chromosomal birth defects by organ system and any cancer; and (3) non-chromosomal birth defects and subtypes of cancer. RESULTS In the cohort of 629,086 children, 23,341 (3.7%) children had birth defects and 1,037 (0.2%) children had cancer. For children with non-chromosomal birth defects, specifically cardiovascular and genitourinary, highest risk of any cancer was observed in first year of life (Hazard Ratio [HR] 18.5; 95% confidence interval [CI] 10.1-33.8). For children with chromosomal birth defects, increased cancer risk was observed among those 1-4 years-old (HR 20.0; 95% CI 8.3-48.4). CONCLUSION Overall, cancer risk among children with birth defects was highest among those <5 years-old. Our findings, consistent with previous studies, may inform surveillance strategies for children with birth defects.
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Affiliation(s)
- Jenil Patel
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR USA; Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of PublicHealth, University of Arkansas for Medical Science, Little Rock, AR USA.
| | - Jeremy M Schraw
- Department of Pediatrics, Baylor College of Medicine, Houston, TX USA; Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX USA.
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX USA; Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX USA.
| | - Amir Mian
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR USA.
| | - Wendy N Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR USA; Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of PublicHealth, University of Arkansas for Medical Science, Little Rock, AR USA; Arkansas Children's Research Institute, Little Rock, AR USA.
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10
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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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11
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Gurvitz M. Increasing Evidence for and a Word of Caution About an Association Between Cancer and Congenital Heart Disease. JAMA Netw Open 2019; 2:e196756. [PMID: 31276174 DOI: 10.1001/jamanetworkopen.2019.6756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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