Childhood Cancer among Twins and Higher Order Multiples

Abstract

Although several studies have found no change or a decreased risk of childhood cancer in twins, few have controlled for potential confounders such as birth weight. We examined the association of birth plurality and childhood cancer in pooled data from five U.S. states (California, Minnesota, New York, Texas, and Washington) using linked birth-cancer registry data. The data, excluding children with Down syndrome or who died before 28 days of life, included 17,672 cases diagnosed from 1980 to 2004 at ages 28 days to 14 years and 57,966 controls with all cases and controls born from 1970 to 2004. Analyses were restricted to children weighing V4,000 g at birth. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using unconditional logistic regression adjusting for sex, gestational age, birth weight, birth order, maternal age, maternal race, state of birth, and birth year. Children who were multiples had no difference in risk of cancer overall (OR, 0.93; 95% CI, 0.82-1.07), but a borderline reduced risk of Wilms' tumor (OR, 0.65; 95% CI, 0.39-1.09). For children diagnosed <2 y of age there was a reduced risk of Wilms' tumor (OR, 0.27; 95% CI, 0.09-0.86) and neuroblastoma (OR, 0.46; 95% CI,) and an increased risk of fibrosarcoma (OR, 5.81; 95% CI,). Higher-order multiple birth (triplets or higher) was not associated with childhood cancer. Our analysis suggests that mechanisms other than birth weight and gestational age may influence the lower risk of Wilms' tumor and neuroblastoma in multiple births. (Cancer Epidemiol Biomarkers Prev 2009;18(1):162-8)

Case-control study of birth characteristics and the risk of hepatoblastoma

“…Studies of multiples prior to 1980, when the use of fertility treatments became more widespread, observed no association or a decreased risk for childhood cancers in multiples compared to singletons [47,48]. A more recent study, which includes some of the same cases from our study, reported an increased risk of hepatoblastoma among twins in crude analyses (OR=2.6); after adjustment for birthweight no relation remained (OR=0.9) [49]. …”

Possible risk for cancer among children born following assisted reproductive technology in Israel

“…On the other hand, Inskip et al 28 found that the incidence of childhood cancer in twins was less frequent than expected. In addition, Puumala et al 29 found that multiple births were not a risk factor for overall cancer.…”

Cancer Risk among Children Born after Assisted Conception

“…7 Children from multiple births, including those born after assisted conception, are at significantly lower risk than are singletons. 31,38,39 The previously identified potential mediating factors of low birth weight and premature delivery 7 were explored in our study. However, it was not possible to adjust for respiratory diagnoses, shown previously to have a possible effect on cancer risk among children conceived after assisted conception, 7 or to investigate this potential association systematically.…”