Olsen J H, Boice J D, Seersholm N, Bautz A, Fraumeni J F
Division for Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
N Engl J Med. 1995 Dec 14;333(24):1594-9. doi: 10.1056/NEJM199512143332403.
Certain types of cancer in children and young adults have been linked with an increased risk of cancer in close relatives. However, the relation between childhood cancer and familial risk remains to be fully assessed in population-based studies.
We conducted a nationwide study in Denmark of 11,380 parents of children with cancer. The children were identified from records in the Danish Cancer Registry; their parents were identified from population registers. The occurrence and rate of cancer in the parents were determined with use of the Cancer Registry's files and compared with national incidence rates for various categories of tumor.
Overall, 1445 cancers were diagnosed in the parents, as compared with 1496 expected from national incidence rates, to yield standardized incidence ratios of 1.0 (95 percent confidence interval, 0.9 to 1.0) for all parents, 1.0 for mothers, and 0.9 for fathers. The lower rate of cancer among fathers reflected their lower standardized incidence ratio for lung cancer (0.8; 95 percent confidence interval, 0.6 to 0.9), as calculated from 144 observations.
Genetic determinants are important in several types of childhood cancer, but the genetic susceptibility to tumors does not generally extend to the parents of children with cancer, nor do the patterns of incidence point to the influence of shared environmental factors. Thus, cancer in children should not be viewed as a general marker for an increased risk of cancer in the patients' parents.
儿童和青年的某些类型癌症与近亲患癌风险增加有关。然而,在基于人群的研究中,儿童癌症与家族风险之间的关系仍有待全面评估。
我们在丹麦对11380名患癌儿童的父母进行了一项全国性研究。这些儿童通过丹麦癌症登记处的记录确定;他们的父母通过人口登记处确定。利用癌症登记处的档案确定父母的癌症发生情况和发病率,并与各类肿瘤的全国发病率进行比较。
总体而言,父母中诊断出1445例癌症,而根据全国发病率预计为1496例,所有父母的标准化发病率为1.0(95%置信区间为0.9至1.0),母亲为1.0,父亲为0.9。父亲患癌率较低反映出他们肺癌的标准化发病率较低(0.8;95%置信区间为0.6至0.9),这是根据144例观察结果计算得出的。
遗传因素在几种儿童癌症类型中很重要,但对肿瘤的遗传易感性一般不会延伸到患癌儿童的父母,发病率模式也未表明存在共同环境因素的影响。因此,儿童癌症不应被视为患者父母患癌风险增加的一般标志。