Early-life distress may increase neuroblastoma risk
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Distress in the prenatal and neonatal period of development are associated with an increased risk of developing neuroblastoma in the first year of life, but not in subsequent years, according to a report in the International Journal of Cancer.
Neuroblastoma is a cancer that involves embryonic nerve cells of the sympathetic nervous system. It usually metastases quickly and is seen primarily in young children and infants.
The natural history of this cancer suggests that there may be biological differences between tumors that spontaneously regress and undergo benign transformation, which are usually diagnosed before 1 year, and the aggressive type that do not respond to treatment and are usually diagnosed after 1 year of age, Dr. Elizabeth Bluhm from Washington Hospital Center, Washington, DC, told Reuters Health.
“It is not altogether surprising to find different risk factors for the different manifestations of neuroblastoma, but we were disappointed not to identify factors for the more aggressive cases,” she said.
Bluhm and her colleagues used safety data from the Swedish Medical Birth Register and records from the Swedish National Cancer Register and Death Register to investigate prenatal and perinatal risk factors for neuroblastoma.
Maternal anemia in pregnancy was associated with an increased risk of neuroblastoma, especially for cases diagnosed before age 1, the authors report, whereas maternal hypertension in pregnancy was associated with a significantly decreased risk of neuroblastoma overall.
After further analysis, low 1-minute Apgar score and maternal anemia were each independently associated with an increased risk of tumors arising before 1 year of age. Neither neonatal respiratory distress nor congenital abnormalities were associated with neuroblastoma.
The investigators were unable to identify any prenatal or perinatal risk factors for cases diagnosed over the age of 1 year.
“The association we found with maternal anemia, which is likely related to lack of iron and/or folate intake during pregnancy, echoes earlier reports of a decreased risk of neuroblastoma in children whose mothers took prenatal vitamins and a lower population-wide incidence of neuroblastoma in Canada following grain fortification with folate,” Bluhm said.
This association with maternal anemia and neonatal respiratory distress supports the hypothesis that a lack of oxygen within the cells is involved in the process of tumor induction of this cancer.
“Further studies of risk factors for later-onset neuroblastoma are still in the planning phases,” she added.
SOURCE: International Journal of Cancer, December 15, 2008.
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