Risk of neuroblastoma, birth‐related characteristics, congenital malformations and perinatal exposures: A pooled analysis of the ESCALE and ESTELLE French studies (SFCE)

Abstract

Neuroblastoma (NB), an embryonic tumour arising from neural crest cells, is the most common malignancy among infants. The aetiology of NB is largely unknown. We conducted a pooled analysis to explore whether there is an association between NB and preconception and perinatal factors using data from two French national population-based case-control studies. The mothers of 357 NB cases and 1783 controls younger than 6 years, frequency-matched by age and gender, responded to a telephone interview that focused on demographic, socioeconomic and perinatal characteristics, childhood environment, life-style and maternal reproductive history. Unconditional logistic regression was used to estimate pooled odds ratios and 95% confidence intervals. After controlling for matching variables, study of origin and potential confounders, being born either small (OR 1.4 95% CI 1.0-2.0) or large (OR 1.5 95% CI 1.1-2.2) for gestational age and, among children younger than 18 months, having congenital malformations (OR 3.6 95% CI 1.3-8.9), were significantly associated with NB. Inverse associations were observed with breastfeeding (OR 0.7 95% CI 0.5-1.0) and maternal use of any supplements containing folic acid, vitamins or minerals (OR 0.5 95% CI 0.3-0.9) during the preconception period. Our findings reinforce the hypothesis that fetal growth anomalies and congenital malformations may be associated with an increased risk of NB. Further investigations are needed in order to clarify the role of folic acid supplementation and breastfeeding, given their potential importance in NB prevention.

Factors related to pregnancy and birth and the risk of childhood brain tumours: The ESTELLE and ESCALE studies (SFCE, France)

“…The distribution by study, age at diagnosis and malignancy status are shown in Supporting Information Table 1. In total, 437 (85.7%) of the tumours were malignant and 73 were nonmalignant, the majority of which were astrocytomas (51) or other gliomas (20).…”

“…Low folate levels at this time may be associated with increased DNA methylation, thereby suppressing expression of genes, such as OTX2, which are implicated in neural crest development in the critical first week following fertilisation. 17 While there may be a protective association between breastfeeding and childhood cancer overall, 18 acute lymphoblastic leukemia, 18,19 and neuroblastoma, 18,20 previous publications 19,[21][22][23][24] have found no such association with CBT. However, as other factors related to the early priming of the immune system, that is, allergy 25 and asthma, [25][26][27] have been associated with decreased risk, a protective association is still plausible.…”

Congenital neurodevelopmental anomalies in pediatric and young adult cancer

“…Increased risks for subsequent CNS, neuroblastoma, germ cell, and rhabdomyosarcoma tumors among children with congenital anomalies have been previously reported, as well as specific risks for those with a neurological, circulatory, genitourinary, digestive, and musculoskeletal abnormality (Agha et al, ; Altmann et al, ; Bjorge et al, ; Botto et al, ; Carozza et al, ; Fisher et al, ; Narod et al, ; Rios et al, ). However, few studies have provided specific anomaly/tumor subtype comparisons (Baptiste et al, ; Birch et al, ; Durmaz et al, ; Gold et al, ; Hall et al, ; Johnson, Annegers, Frankowski, Spitz, & Buffler, ; Rankin et al, ; Sun, Overvad, & Olsen, ).…”

“…Multiple linkage studies have reported a prevalence of 2–3% of children with congenital anomalies in the general population (Hoyert et al, ; Yoon et al, ). Several large‐scale epidemiologic studies have provided substantial evidence of an association between congenital anomalies and cancer risk in children (Agha et al, ; Altmann, Halliday, & Giles, ; Bjorge, Cnattingius, Lie, Tretli, & Engeland, ; Botto et al, ; Carozza, Langlois, Miller, & Canfield, ; Hall, Ritz, Cockburn, Davidson, & Heck, ; Janitz et al, ; Mili, Khoury et al, ); Narod, Hawkins, Robertson, & Stiller, ; Rankin, Silf, Pearce, Parker, & Ward Platt, ; Rios et al, ; Windham, Bjerkedal, & Langmark, ). Studies have demonstrated significant associations specifically between neurological congenital anomalies and pediatric cancer (Altmann et al, ; Bjorge et al, ; Botto et al, ; Carozza et al, ; Narod et al, ), with some suggesting a specific link between neurological malformations and central nervous system tumors (Agha et al, ; Altmann et al, ; Bjorge et al, ; Narod et al, ).…”

Parental smoking, maternal alcohol consumption during pregnancy and the risk of neuroblastoma in children. A pooled analysis of the ESCALE and ESTELLE French studies

“…The ESCALE and ESTELLE studies were two separate nationwide population‐based case–control studies conducted by the same investigators in France. The study designs have been previously described elsewhere . Both studies included cases of NB, lymphoma, leukaemia and malignant brain tumour.…”