Cancer in the families of children with soft tissue sarcoma

The cancer experience among 754 first-degree relatives (mothers, fathers, and siblings) of a population-based series of 177 children with soft tissue sarcoma is reported. The current study represents an extension of our earlier work in which the authors found an excess of breast cancer in the mothers of 143 of these children. There were 40 cancers among all first-degree relatives, compared with 24.82 expected (relative risk [RR] 1.61, P = 0.006). There was no excess in fathers, but an excess of borderline significance was seen in mothers (RR 1.67, P = 0.0545), and a significant excess in siblings (RR 4.55, P = 0.0002), mainly due to carcinoma of the breast and pediatric tumors. Results of a step forward Cox multivariate analysis identified three variables in the index child which were independently associated with high cancer risk in relatives, as follows: age younger than 24 months at diagnosis; histologic type, embryonal rhabdomyosarcoma or other and unspecified soft tissue sarcoma; and male sex. It was possible, therefore, to identify a subgroup of children whose relatives are at high risk of early onset cancer (RR in this group 10.14). The pattern of cancers is consistent with the Li-Fraumeni syndrome. The authors conclude that a marked proportion of childhood soft tissue sarcoma has a genetic basis.     

Cancer among children of parents with autoimmune diseases

Many different aetiologies for childhood cancer have been suggested, but few are well established. One is that parental autoimmune disease is linked with susceptibility for haematopoietic malignancies in their offspring during childhood. The present study is the first to investigate this hypothesis using a follow-up design. A cohort of 53,811 children of more than 36,000 patients diagnosed with a systemic, organ-specific or suspected autoimmune disease were followed up for cancer incidence in the Danish Cancer Registry during 1968-1993. The parents were identified through the National Registry of Patients, while their children were traced in the Central Population Register. Cancer incidence among the offspring was compared with that in the corresponding childhood population of Denmark. In total, 115 cancers were observed among children aged 0-19 years, yielding a non-significant standardized incidence ratio of 1.07. Lymphomas contributed 21 cases to the overall number of tumours, 60% more than expected (95% confidence interval (CI) 1.0-2.4); leukaemia contributed 37 cases representing an excess of 30% (95% CI 0.9-1.8). Our results give some support to the hypothesis that parental autoimmune disease is associated with childhood lymphoma and leukaemia.     

Cancer chemotherapy reduces plasma total antioxidant capacity in children with malignancies

The sum of endogenous and food-derived antioxidants provides an estimate of the total antioxidant capacity (TAC) of the extracellular fluids, while corrected TAC (cTAC) is an estimation of the exogenously provided antioxidants. Similar values for TAC and cTAC were observed between cancer free children and children with malignancy at diagnosis. Antineoplastic treatment induced a significant decrease of TAC and cTAC during chemotherapy. Additionally to the dietary factors, this might be attributed to the antineoplastic drugs as shown by the significant increase of ROS after administration of chemotherapeutic agents both in vitro and in vivo. According to our preliminary results TAC and cTAC returned to normal after the end of therapy.     

Cancer among Hispanic children in California, 1988-1994: comparison with non-Hispanic white children.

BACKGROUND: There has been a perception that California Hispanic children have an unusually high cancer incidence rate, but to the authors' knowledge the only information regarding cancer rates in this population has been the tabular data published in reports issued by the California Department of Health Services. The California Cancer Registry has collected data regarding all cancers diagnosed in California since 1988. METHODS: Data regarding all invasive cancers diagnosed in California Hispanic children age <15 years during the 7-year period 1988-1994 were analyzed. Cancers were grouped according to the International Classification for Childhood Cancers. Age-adjusted and age specific incidence rates were compared with the corresponding incidence rates among non-Hispanic white children. RESULTS: Based on available demographic information, the overall incidence rate of cancer was approximately 7% lower among California children classified as Hispanic than among non-Hispanic white children. Hispanic children had higher incidence rates of lymphoid leukemia and gonadal germ cell tumors and a lower incidence rate of astrocytomas and carcinomas than non-Hispanic white children. CONCLUSIONS: These data do not confirm the perception that California Hispanic children have an unusually high cancer incidence rate but there were notable differences between Hispanic and non-Hispanic white children with regard to the incidence rates of certain cancers. The perception may be due in part to the fact that childhood malignancies represented 3.1% of all cancers diagnosed among Hispanics but only 0.5% of all cancers diagnosed among non-Hispanic whites. This is explained by the lower incidence rate of cancer among California Hispanic adults than among non-Hispanic white adults and the difference in the age distribution of the two populations.     

Cancer rehabilitation for children: a model with potential

The dramatic improvements in the treatment of children's cancers has lead to the identification of a growing need for the development of comprehensive rehabilitation programes. These programmes should include help in learning to live with cancer, and maximize levels of independence for the child with cancer and their family. In this paper, the author will demonstrate the potential for childhood cancer rehabilitation, highlighting factors already in place and those areas that could benefit from development.     

Cancer risk in second degree relatives of children with soft tissue sarcoma

The risk of cancer in the second degree relatives of a population-based series of children with soft tissue sarcoma was studied in relation to (i) various characteristics in these relatives, (ii) certain clinical features in the index children previously identified as risk factors for cancer in their first degree relatives. Overall there was a non-significant deficit of cancers in the second degree relatives (RR = 0.88) and cancer risk was unrelated to type or site of cancer, type of relative, or to risk factors in the index case. The findings indicate that although the families investigated may include a proportion with the Li-Fraumeni cancer family syndrome, the increased cancer risk already reported in the first degree relatives does not extent to second degree relatives in general.     

Cancer risks among relatives of children with Hodgkin and non-Hodgkin lymphoma

A role for genetic susceptibility in the aetiology of childhood lymphomas was investigated in 454 families of children with histologically confirmed Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) from Northwest England. Cancers in parents were obtained from the UK National Health Service Central Register and in other close relatives by interview with the parents. The cancer incidence among relatives was compared with expected incidence based on cancer registry data for England. There were 197 cancers in relatives (SIR 1.0 95% CI 0.8-1.1). In families of children with HL, there was an excess of HL in the first degree relatives (SIR 5.8 95% CI 1.2-16.9). Excesses of HL diagnosed under population median age (SIR 4.1 95% CI 1.1-10.6) were seen among all relatives and relatives of children who were below the median age at diagnosis (SIR 5.5 95% CI 1.1-16.0). In families of children with NHL, there were non-significant excesses of central nervous system (CNS) tumours in the first degree relatives (SIR 2.9 95% CI 0.8-7.4) and in the second and third degree relatives (SIR 1.5). There were significant excesses of CNS tumours diagnosed under the population median age (SIR 2.8 95% CI 1.1-5.8) in all relatives. Excess CNS tumours were also seen among relatives of children below the median age at diagnosis (SIR 3.2 95% CI 1.1-7.6). In conclusion, genetic susceptibility in some families of children with lymphoma might be operating, but aetiologies in HL and NHL appear to be different. Possible interpretations of our findings, in the context of putative genetic and infectious aetiologies, are discussed.     

Cancer in children and adolescents in Europe: developments over 20 years and future challenges

This special issue contains 18 articles describing population-based analyses of incidence and survival for cancer among children and adolescents in Europe over the period 1978-1997. The analyses were derived from the large database of the ACCIS project (Automated Childhood Cancer Information System), which was built through collaboration of 62 population-based cancer registries in 19 European countries. Data on 88,465 cancers in children and 15,369 in adolescents (age 15-19 yrs) were included in the various analyses, making this the largest database on cancer in these age-groups in the world. National data were grouped into five European regions to allow comparisons of incidence and survival, for all cancers and by tumour type, including analysis of trends in both over time. This overview paper focuses on the comparability of the data from multiple registries and describes the potential confounding factors. Age-standardised annual incidence rates of many, but not all, cancers in children and adolescents are clearly rising. There are geographical differences in survival for the majority of tumour types. Survival rates increased for nearly all types of cancer in children and adolescents. The implications of these findings for aetiological factors and treatment delivery for cancer in children and adolescents are discussed.