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Öberg S, Sæter AH, Rosenberg J. The inheritance of groin hernias: an updated systematic review with meta-analyses. Hernia 2023; 27:1339-1350. [PMID: 36443569 DOI: 10.1007/s10029-022-02718-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this systematic review was to assess the inheritance of groin hernias. METHODS The primary outcome was to assess the inheritance based on the family history of groin hernias. We included studies that reported family history in patients with groin hernias, assessed the development of groin hernias in patients with a positive family history, or assessed the development of groin hernias in twins. Searches were conducted in PubMed, EMBASE, and Cochrane CENTRAL in November 2021. Results were synthesized narratively and with meta-analyses. RESULTS Twenty-two studies with unique participants were included. While two twin studies did not show convincing results of a genetic origin in children, database studies with low risk of bias showed that a positive history in parents or siblings increased the risk of inguinal hernia in children, and the risk was highest between mothers and daughters and between sisters. In adults, patients with inguinal hernia had higher odds of having a positive family history compared with patients without groin hernia (odds ratio 5.3, 95% confidence interval 3.3-8.7), and a nationwide study found the highest risk of inguinal hernia repair when a sister had been repaired compared with a brother. This study also found that having a sibling repaired for a groin hernia increased the risk of femoral hernia repair. CONCLUSION Despite studies being heterogeneous, there is overwhelming evidence that a positive family history is a risk factor for developing inguinal hernia in both children and adults, seemingly with a pronounced female-female inheritance pattern.
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Affiliation(s)
- S Öberg
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - A H Sæter
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Auger N, Del Giorgio F, Le-Nguyen A, Bilodeau-Bertrand M, Piché N. Maternal risk factors for paediatric inguinal hernia. Br J Surg 2021; 109:129-135. [PMID: 34669930 DOI: 10.1093/bjs/znab337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/22/2021] [Accepted: 08/30/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Risk factors for paediatric inguinal hernia are poorly understood. This longitudinal cohort study assessed whether children with a maternal history of inguinal hernia or connective tissue disorders have a higher risk of developing inguinal hernias before 13 years of age. METHODS The study included children followed up between birth and 13 years of age in Quebec, Canada, 2006-2019. Newborns whose mothers had inguinal hernias or connective tissue disorders were followed over time to identify future hospital admissions for inguinal hernia. Cox proportional hazards regression adjusted for patient characteristics was used to estimate hazard ratios (HRs) and 95 per cent confidence intervals for the association between maternal hernia or connective tissue disorders and future childhood hernias. Associations in girls and boys were examined separately. RESULTS The study included 786 322 children with 6 186 448 person-years of follow-up. There were 6861 children with inguinal hernias, corresponding to an incidence of 11.1 per 10 000 person-years. Children with a maternal history of inguinal hernia had 2.92 (95 per cent c.i. 2.39 to 3.58) times the risk of having inguinal hernias relative to children whose mothers had no such history. Children with a maternal history of connective tissue disorders had 1.30 (1.00 to 1.68) times the risk. Maternal hernias were strongly associated with risk of inguinal hernias in girls (HR 5.34, 3.82 to 7.47), whereas maternal connective tissue disorders were associated with inguinal hernias in boys (HR 1.35, 1.02 to 1.79). CONCLUSION Paediatric inguinal hernias may be associated with maternal inguinal hernias and connective tissue disorders, but the underlying reason for this relationship requires further investigation.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.,Institut national de santé publique du Québec, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal Quebec, Canada
| | - Francesca Del Giorgio
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal Quebec, Canada
| | - Annie Le-Nguyen
- Division of General Surgery, University of Montreal, Montreal, Quebec, Canada
| | | | - Nelson Piché
- Division of Paediatric Surgery, Sainte-Justine Hospital Centre for Children, University of Montreal, Montreal, Quebec, Canada
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Burcharth J, Pedersen M, Bisgaard T, Pedersen CB, Rosenberg J. Familial clustering and risk of groin hernia in children. BJS Open 2017; 1:46-49. [PMID: 29951605 PMCID: PMC5989964 DOI: 10.1002/bjs5.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 05/24/2017] [Indexed: 12/01/2022] Open
Abstract
Background The hypothesis was that groin hernias are hereditary. This study was undertaken to establish the degree of familial clustering of groin hernias on a nationwide scale. Methods A register‐based cohort was created consisting of all children in Denmark whose parents were born in 1970 or later by the use of the Danish Civil Registration System. Within this cohort, all groin hernia operations were identified. To establish the risk estimates associated with a positive family history of groin hernia operation, information on groin hernia operations in fathers, mothers and siblings was also assessed. Results In the cohort of 408 381 persons, a total of 4966 were operated on for groin hernia (incidence rate 2·12 per 1000 person‐years at risk). A person with a mother who had undergone surgery for a groin hernia had an increased risk of 2·89 (95 per cent c.i. 2·48 to 3·34) of having a groin hernia operation; a person with a father operated on for a groin hernia had an increased risk of 1·75 (1·58 to 1·94); and a person with a sibling operated on for a groin hernia had an increased risk of 2·54 (2·17 to 2·96). The strongest association was seen between mothers who had been operated on for groin hernia and their daughters (increased risk 6·01, 95 per cent c.i. 4·53 to 7·80), compared with the risk in girls who did not have a mother who had undergone surgery for groin hernia. Conclusion Groin hernias are clustered in families, with the strongest relationship seen between mothers and their daughters.
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Affiliation(s)
- J Burcharth
- Centre for Perioperative Optimization, Department of Surgery, Herlev Hospital University of Copenhagen Herlev Denmark
| | - M Pedersen
- National Centre for Register-based Research University of Aarhus Aarhus Denmark
| | - T Bisgaard
- Department of Surgical Gastroenterology, Hvidovre Hospital University of Copenhagen Hvidovre Denmark
| | - C B Pedersen
- National Centre for Register-based Research University of Aarhus Aarhus Denmark
| | - J Rosenberg
- Centre for Perioperative Optimization, Department of Surgery, Herlev Hospital University of Copenhagen Herlev Denmark
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4
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Pediatric Urology for the General Surgeon. Surg Clin North Am 2016; 96:545-65. [PMID: 27261794 DOI: 10.1016/j.suc.2016.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pediatric urology spans the neonatal period through the transition into early adulthood. There are a variety of common pediatric urologic conditions that overlap significantly with pediatric surgery. This article reviews the pertinent pathophysiology of a few key disease processes, including the pediatric inguinal hernia and/or hydrocele, cryptorchidism, and circumcision. General surgeons may find themselves in the position of managing these problems primarily, particularly in rural areas that may lack pediatric subspecialization. An understanding of the fundamentals can guide appropriate initial management. Additional focus is devoted to the management of genitourinary trauma to guide the general surgeon in more acute, emergent settings.
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Mihailov E, Nikopensius T, Reigo A, Nikkolo C, Kals M, Aruaas K, Milani L, Seepter H, Metspalu A. Whole-exome sequencing identifies a potential TTN mutation in a multiplex family with inguinal hernia. Hernia 2016; 21:95-100. [PMID: 27115767 PMCID: PMC5281683 DOI: 10.1007/s10029-016-1491-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/06/2016] [Indexed: 11/28/2022]
Abstract
Purpose Inguinal hernia repair is one of the most common procedures in general surgery. Males are seven times more likely than females to develop a hernia and have a 27 % lifetime ‘risk’ of inguinal hernia repair. Several studies have demonstrated that a positive family history is an important risk factor for the development of primary inguinal hernia, which indicates that genetic factors may play important roles in the etiology of the disease. So far, the contribution of genetic factors and underlying mechanisms for inguinal hernia remain largely unknown. The aim of this study was to investigate a multiplex Estonian family with inguinal hernia across four generations. Methods The whole-exome sequencing was carried out in three affected family members and subsequent mutation screening using Sanger sequencing was performed in ten family members (six affected and four unaffected). Results Whole-exome sequencing in three affected family members revealed a heterozygous missense mutation c.88880A>C (p.Lys29627Thr; RefSeq NM_001256850.1) in the highly conserved myosin-binding A-band of the TTN gene. Sanger sequencing demonstrated that this mutation cosegregated with the disease in this family and was not present in ethnically matched control subjects. Conclusion We report that missense variant in the A-band of TTN is the strongest candidate mutation for autosomal-dominant inguinal hernia with incomplete penetrance. Electronic supplementary material The online version of this article (doi:10.1007/s10029-016-1491-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Mihailov
- Estonian Genome Center, University of Tartu, 23b Riia Street, 51010, Tartu, Estonia.
| | - T Nikopensius
- Estonian Genome Center, University of Tartu, 23b Riia Street, 51010, Tartu, Estonia
| | - A Reigo
- Estonian Genome Center, University of Tartu, 23b Riia Street, 51010, Tartu, Estonia
| | - C Nikkolo
- Surgery Clinic, Tartu University Hospital, 8 Puusepa Street, 51014, Tartu, Estonia
| | - M Kals
- Estonian Genome Center, University of Tartu, 23b Riia Street, 51010, Tartu, Estonia
| | - K Aruaas
- Institute of Molecular and Cell Biology, University of Tartu, 23 Riia Street, 51010, Tartu, Estonia
| | - L Milani
- Estonian Genome Center, University of Tartu, 23b Riia Street, 51010, Tartu, Estonia
| | - H Seepter
- Surgery Clinic, Tartu University Hospital, 8 Puusepa Street, 51014, Tartu, Estonia
| | - A Metspalu
- Estonian Genome Center, University of Tartu, 23b Riia Street, 51010, Tartu, Estonia.,Institute of Molecular and Cell Biology, University of Tartu, 23 Riia Street, 51010, Tartu, Estonia
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Hernies inguinales et exposition professionnelle : revue de la littérature et étude descriptive de cas. ARCH MAL PROF ENVIRO 2014. [DOI: 10.1016/j.admp.2013.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Burcharth J, Pommergaard HC, Rosenberg J. The inheritance of groin hernia: a systematic review. Hernia 2013; 17:183-9. [PMID: 23423330 DOI: 10.1007/s10029-013-1060-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 02/08/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Groin hernia has been proposed to be hereditary; however, a clear hereditary pattern has not been established yet. The purpose of this review was to analyze studies evaluating family history and inheritance patterns and to investigate the possible heredity of groin hernias. METHODS A literature search in the MEDLINE and Embase databases was performed with the following search terms: genetics, heredity, multifactorial inheritance, inheritance patterns, sibling relations, family relations, and abdominal hernia. Only English human clinical or register-based studies describing the inheritance of groin hernias, family history of groin hernias, or familial accumulation of groin hernias were included. RESULTS Eleven studies evaluating 37,166 persons were included. The overall findings were that a family history of inguinal hernia was a significant risk factor for the development of a primary hernia. A family history of inguinal hernia showed a tendency toward increased hernia recurrence rate and significantly earlier recurrence. The included studies did not agree on the possible inheritance patterns differing between polygenic inheritance, autosomal dominant inheritance, and multifactorial inheritance. Furthermore, the studies did not agree on the degree of penetrance. CONCLUSION The literature on the inheritance of groin hernias indicates that groin hernia is most likely an inherited disease; however, neither the extent of familial accumulation nor a clear inheritance pattern has yet been found. In order to establish whether groin hernias are accumulated in certain families and to what extent, large register studies based on hernia repair data or clinical examinations are needed. Groin hernia repair (inguinal and femoral hernia) is among the most commonly performed gastrointestinal surgical procedures [1]. Emergency groin hernia surgery is associated with increased mortality, increased patient-related morbidity, and increased hospital stay compared with elective groin hernia procedures [2, 3]. Identifying patients at high risk of developing groin hernia would therefore provide the possibility of timely elective surgical intervention, thus reducing the rate of emergency procedures. It could also potentially make way for individualized surgical methods in the future.
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Affiliation(s)
- J Burcharth
- Department of Surgery, Center for Perioperative Optimization, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, DK, Copenhagen, Denmark.
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Davis-Dao C, Koh CJ, Hardy BE, Chang A, Kim SS, De Filippo R, Hwang A, Pike MC, Carroll JD, Coetzee GA, Vandenberg D, Siegmund K, Cortessis VK. Shorter androgen receptor CAG repeat lengths associated with cryptorchidism risk among Hispanic white boys. J Clin Endocrinol Metab 2012; 97:E393-9. [PMID: 22188741 DOI: 10.1210/jc.2011-2439] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Cryptorchidism is the most frequent congenital malformation among males, the major established risk factor for testicular germ cell tumors, and a presumed infertility risk factor. Androgens are essential for testicular descent, and functional genetic polymorphisms in the androgen receptor gene (AR) are postulated to influence cryptorchidism risk. OBJECTIVE The aim of the study was to investigate whether the CAG repeat length polymorphism in exon 1 of the AR is associated with cryptorchidism risk. DESIGN AND SETTING We conducted a family-based genotype-risk association study employing the transmission disequilibrium test for genotypic variants transmitted on the X-chromosome at a university-affiliated regional children's hospital. PARTICIPANTS We studied 127 Hispanic boys with persistent cryptorchidism and comorbidities described in detail and their biological mothers. INTERVENTION Genotypes defined by number of CAG repeats were measured for each member of participating son-mother pairs. MAIN OUTCOME MEASURE Associations between CAG tract length genotype and cryptorchidism risk were estimated using matched-pairs logistic regression. RESULTS Cryptorchidism risk was significantly associated with shorter CAG repeats [CAG≤19 vs. CAG≥20, odds ratio (OR)=0.44; 95% confidence interval (CI), 0.23-0.88]. This association was restricted to cryptorchidism with accompanying comorbidities, which was primarily hernia [CAG≤19 vs. CAG≥20, OR=0.35 (95% CI, 0.16-0.78)], and was strongest for bilateral cryptorchidism [CAG≤19 vs. CAG≥20, OR=0.09 (95% CI, 0.010-0.78)]. CONCLUSIONS Androgen receptor genotypes encoding moderate functional variation may influence cryptorchidism risk, particularly among boys with bilateral nondescent or congenital hernia, and may explain in part the elevated risk of testicular seminoma experienced by ex-cryptorchid boys. Mechanistic research is warranted to examine both classical and nonclassical mechanisms through which androgens may influence risk of cryptorchidism and related conditions.
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Affiliation(s)
- Carol Davis-Dao
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, 1441 Eastlake Avenue, MC-9175, Los Angeles, California 90033, USA
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Hendry PO, Paterson-Brown S, de Beaux A. Work related aspects of inguinal hernia: a literature review. Surgeon 2009; 6:361-5. [PMID: 19110825 DOI: 10.1016/s1479-666x(08)80009-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There is a traditional belief that that an inguinal hernia can be the result of increased intra-abdominal pressure (IAP) and therefore the development of a hernia may be attributed to single strenuous or recurrent strenuous events. As a result of this, litigation in this area is frequent. METHODS Medline was searched for English language publications using the keywords of 'hernia' or 'hernia AND recurrence' combined with 'work related', 'physical activity' and 'intra abdominal pressure'. The reference lists of appropriate papers identified on the original search were also checked to identify all related publications. RESULTS The search revealed 268 papers of which 59 were identified as appropriate to the subject of this review. Although publications in this area are scarce, from the literature available to date, there is no evidence to support the idea that single or recurrent strenuous events or early return to work related activity should result in the formation or recurrence of an inguinal hernia. CONCLUSION Although immediate pain at the time of an intensive or recurrent activity followed by a new diagnosis of a hernia supports a link between the activity and the hernia occurrence, it is likely that a congenital or acquired weakness in the connective tissue or muscles of the patient meant that hernia occurrence was almost inevitable. This may have significant implications regarding 'work related' hernia and its associated litigation.
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Affiliation(s)
- P O Hendry
- Department of Surgery, University of Edinburgh, Royal Infirmary, Edinburgh.
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Lau H, Fang C, Yuen WK, Patil NG. Risk factors for inguinal hernia in adult males: A case-control study. Surgery 2007; 141:262-6. [PMID: 17263984 DOI: 10.1016/j.surg.2006.04.014] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Revised: 04/13/2006] [Accepted: 04/17/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inguinal hernia is one of the most common surgical pathologies. Research studies on clinical factors predisposing a person for the development of inguinal hernia, however, remain scarce. The objective of the present study was to evaluate the risk factors for the development of inguinal hernia in adult males, using a case-control design in a hospital-based population. METHODS Between January 2002 and January 2004, a total of 1,418 male patients were recruited at the general surgical or hernia clinic of a University-affiliated teaching hospital. Patients were divided into case and control groups according to the presence of a primary inguinal hernia. Each patient was interviewed by a research assistant using a standardized questionnaire. Clinical data were studied by multivariate, logistic regression analyses to identify independent predictors of inguinal hernia in adult males. RESULTS Clinical factors associated with the presence of inguinal hernia included a higher work activity index (P = 0.03), a higher total activity index (P = 0.01), a positive family history of inguinal hernia (P < 0.01, odds ratio = 8.73), and chronic obstructive airway disease (P = 0.04, odds ratio = 2.04). After adjustments for the type of hernia, chronic obstructive airway disease was a risk factor only for direct hernia, whereas total activity index and family history of hernia remained significantly related to both direct and indirect hernias. On logistic regression analyses, positive family history of hernia was the only independent predictor for inguinal hernia. CONCLUSIONS Family history of hernia was the most important determinant factor for developing inguinal hernia in adult males. A male subject who has a positive family history of hernia is 8 times more likely to develop a primary inguinal hernia.
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Affiliation(s)
- Hung Lau
- Department of Surgery, University of Hong Kong Medical Center, Queen May Hospital & Tung Wah Hospital, Sheung Wan, Hong Kong.
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Valery PC, Holly EA, Sleigh AC, Williams G, Kreiger N, Bain C. Hernias and Ewing's sarcoma family of tumours: a pooled analysis and meta-analysis. Lancet Oncol 2005; 6:485-90. [PMID: 15992697 DOI: 10.1016/s1470-2045(05)70242-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ewing's sarcoma family of tumours has been associated with a history of hernia and with a parental occupation of farming. However, the causes of these tumours remain unknown. We therefore aimed to investigate the association between hernia and Ewing's sarcoma family of tumours. METHODS We did a pooled analysis of two case-control studies and a meta-analysis of three case-control studies of Ewing's sarcoma family of tumours that had adequate information on history of hernia. The primary endpoint was development of a tumour from the Ewing's sarcoma family. 138 patients with such a tumour and 574 controls were included in the pooled analysis, and 357 patients with these tumours and 745 controls were included in the meta-analysis. Risk was assessed by an odds ratio (OR) and 95% CI by use of multivariate analysis with unconditional logistic regression for the pooled analysis and random effects model for the meta-analysis. FINDINGS Pooled analysis showed that children with Ewing's sarcoma family of tumours were more likely to have had an umbilical hernia than were controls (odds ratio [OR] 3.3 [95% CI 1.3-8.0]). Meta-analysis showed that children with Ewing's sarcoma family of tumours were more likely to have had a hernia (3.2 [1.9-5.7]). INTERPRETATION Ewing's sarcoma family of tumours and hernias (particularly inguinal hernias) have common embryological pathways of neuroectodermal origin, and environmental factors, such as farming, might link the two entities.
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Affiliation(s)
- Patricia C Valery
- Division of Population and Clinical Sciences, Queensland Institute of Medical Research, Royal Brisbane Hospital, Queensland 4029, Australia.
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Valery PC, McWhirter W, Sleigh A, Williams G, Bain C. A national case-control study of Ewing's sarcoma family of tumours in Australia. Int J Cancer 2003; 105:825-30. [PMID: 12767069 DOI: 10.1002/ijc.11129] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Limited population-based epidemiologic information is available on Ewing's sarcoma family of tumours (ESFT), a rare group of neoplasms. Several associations have been noted on a few studies but results were not consistent, except for exposure to farming among cases and their parents. Here we present the non-farm findings of a nationwide case-control study of ESFT in children and young adults in Australia. The analysis included 106 persons with confirmed ESFT and 344 population-based controls selected randomly via telephone. Information was collected by interview (84% face to face). We found a strong and significant association of ESFT with hernias, in particular hernia repaired in hospital (OR = 5.6, 95% CI 1.3-6.4). Among other factors, there was a near doubling of risk for males, and male cases had their pubertal signs earlier (started shaving earlier) than male controls. There was also an increased risk of ESFT at higher levels of self-assessed exercise, but no other factor really stood out. For pregnancy-related factors, there was a tripling of risk for glandular fever, a doubling of risk for urinary tract infection and a near doubling of risk for X-rays during or just before pregnancy, but these estimates were not significant. In addition, there was a large number of inverse associations with medical conditions (specifically bone disorders), case exposure to medications, vaccinations and X-rays, with ultrasound during the pregnancy having the most certain effects. We conclude that, although the aetiology of ESFT remains obscure, overall there is strong evidence of an association with inguinal hernia; this can now be added to the farm-associated risk reported by others and us. The other associations reported here await replication and refinement in future studies.
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Affiliation(s)
- Patricia Casarolli Valery
- Population & Clinical Sciences Division, Queensland Institute of Medical Research, Brisbane, Australia.
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