The Effects of Breastfeeding on Retinoblastoma Development: Results from an International Multicenter Retinoblastoma Survey

Abstract

The protective effects of breastfeeding on various childhood malignancies have been established but an association has not yet been determined for retinoblastoma (RB). We aimed to further investigate the role of breastfeeding in the severity of nonhereditary RB development, assessing relationship to (1) age at diagnosis, (2) ocular prognosis, measured by International Intraocular RB Classification (IIRC) or Intraocular Classification of RB (ICRB) group and success of eye salvage, and (3) extraocular involvement. Analyses were performed on a global dataset subgroup of 344 RB patients whose legal guardian(s) consented to answer a neonatal questionnaire. Patients with undetermined or mixed feeding history, family history of RB, or sporadic bilateral RB were excluded. There was no statistically significant difference between breastfed and formula-fed groups in (1) age at diagnosis (p = 0.20), (2) ocular prognosis measures of IIRC/ICRB group (p = 0.62) and success of eye salvage (p = 0.16), or (3) extraocular involvement shown by International Retinoblastoma Staging System (IRSS) at presentation (p = 0.74), lymph node involvement (p = 0.20), and distant metastases (p = 0.37). This study suggests that breastfeeding neither impacts the sporadic development nor is associated with a decrease in the severity of nonhereditary RB as measured by age at diagnosis, stage of disease, ocular prognosis, and extraocular spread. A further exploration into the impact of diet on children who develop RB is warranted.

Global retinoblastoma studies: A review

“…The type of studies included focused group discussions, surveys, retrospective, prospective studies, and mixed method studies. Some studies were brought forward by dedicated groups such as Retinoblastoma International Collaborative Study Group, 8 Global Retinoblastoma Study Group, [9][10][11][12][13][14][15][16][17][18][19] American Academy of Ophthalmology-Ocular Oncology Taskforce (AAO-OOT), [20][21][22][23][24][25] Children's Oncology Group (COG), 26 and Global Health Research Group. 27,28 Overall, participating centres were located in Africa, Asia, Australia, North America, South America, and Europe; and from lowerincome, lower-middle-income, higher-middle-income, and high-income countries based on the nation's gross domestic product (GDP).…”

“…Breastfeeding has been shown to have a protective effect against various paediatric cancers such as neuroblastoma, but evidence of its impact on RB is limited 33 . On surveying 344 guardians of breastfed and formula‐fed infants with RB from 10 countries, no protective effect from breastfeeding was established and there were no differences between the two groups in terms of age at presentation, disease stage, or outcomes 12 …”

“…33 On surveying 344 guardians of breastfed and formula-fed infants with RB from 10 countries, no protective effect from breastfeeding was established and there were no differences between the two groups in terms of age at presentation, disease stage, or outcomes. 12…”