Melbourne School of Population and Global Health - Research Publications
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ItemAssociations between congenital malformations and childhood cancer. A register based case-control study(CHURCHILL LIVINGSTONE, 1998-11)This report describes a population-based case-control study that aimed to assess and quantify the risk of children with congenital malformations developing cancer. Three sources of data were used: the Victorian Cancer Register, the Victorian Perinatal Data Register (VPDR) and the Victorian Congenital Malformations/Birth Defects Register. Cases included all Victorian children born between 1984 and 1993 who developed cancer. Four controls per case, matched on birth date, were randomly selected from the VPDR. Record linkage between registers provided malformation data. A matched case-control analysis was undertaken. Of the 632 cancer cases, 570 (90.2%) were linked to the VPDR. The congenital malformation prevalence in children with cancer was 9.6% compared with 2.5% in the controls [odds ratio (OR) 4.5, 95% CI 3.1-6.7]. A strong association was found with chromosomal defects (OR=16.7, 95% CI 6.1-45.3), in particular Down's syndrome (OR=27.1, 95% CI 6.0-122). Most other birth defect groups were also associated with increased cancer risk. The increased risk of leukaemia in children with Down's syndrome was confirmed, and children with central nervous system (CNS) defects were found to be at increased risk of CNS tumours. The report confirms that children with congenital malformations have increased risks of various malignancies. These findings may provide clues to the underlying aetiology of childhood cancer, as congenital malformations are felt to be a marker of exposures or processes which may increase cancer risk. The usefulness of record linkage between accurate population-based registers in the epidemiological study of disease has also been reinforced.
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ItemHave increases in solar ultraviolet exposure contributed to the rise in incidence of non-Hodgkin's lymphoma?(NATURE PUBLISHING GROUP, 1996-04)The incidence of non-Hodgkin's lymphoma (NHL) has increased substantially in many countries over recent decades. The aetiology of this cancer is poorly understood, and this rise is largely unexplained. The incidence of NHL is known to increase markedly following immune suppression. In the light of evidence that exposure to ultraviolet radiation (UVR) may cause systemic immune suppression, part of the recent increase in NHL incidence may reflect population-based increases in UVR exposure. That such exposure increases have occurred is inferred from the widespread increases in skin cancer incidence in fair-skinned populations, especially malignant melanoma (MM), over recent decades. Epidemiological evidence presented here in support of the proposed UVR-NHL relationship includes the following: in Caucasian populations there is a moderate positive correlation between ambient UVR level, by latitude, and NHL incidence; there is also a positive correlation between time trends in MM incidence and NHL; there is some evidence that migration across latitude gradients induces concordant shifts in risks of NHL and MM. Data from two historical cancer patient registers show that, in individuals, these two cancers concurred a little more often than expected. These findings support recent suggestions that UVR-induced impairment of immune functioning contributes to the aetiology of NHL.
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ItemCERVICAL CYTOLOGY REPORTED AS NEGATIVE AND RISK OF ADENOCARCINOMA OF THE CERVIX - NO STRONG EVIDENCE OF BENEFIT(NATURE PUBLISHING GROUP, 1995-04)The relationship between negative cervical cytology reports and risk of adenocarcinoma of the cervix was evaluated in a case-control study of 113 cases and 452 controls. All cases and controls had received at least two negative cytology reports. There was no significant difference between the cases and controls in the number of negative cytology reports or in history of cervical abnormality; while a test for trend in the time since last negative cytology report was significant (P < 0.001), the estimated benefit was very modest. Although the estimates of relative protection were higher in women aged less than 35 years than in women aged 35-69 years, this difference was not statistically significant. These results suggest that cervical screening as practised in the 1970s and 1980s was much less effective in preventing adenocarcinoma than squamous carcinoma of the cervix.
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ItemBRCA1 mutations and other sequence variants in a population based sample of Australian women with breast cancer(CHURCHILL LIVINGSTONE, 1999-01)The frequency, in women with breast cancer, of mutations and other variants in the susceptibility gene, BRCA1, was investigated using a population-based case-control-family study. Cases were women living in Melbourne or Sydney, Australia, with histologically confirmed, first primary, invasive breast cancer, diagnosed before the age of 40 years, recorded on the state Cancer Registries. Controls were women without breast cancer, frequency-matched for age, randomly selected from electoral rolls. Full manual sequencing of the coding region of BRCA1 was conducted in a randomly stratified sample of 91 cases; 47 with, and 44 without, a family history of breast cancer in a first- or second-degree relative. All detected variants were tested in a random sample of 67 controls. Three cases with a (protein-truncating) mutation were detected. Only one case had a family history; her mother had breast cancer, but did not carry the mutation. The proportion of Australian women with breast cancer before age 40 who carry a germline mutation in BRCA1 was estimated to be 3.8% (95% CI 0.3-12.6%). Seven rare variants were also detected, but for none was there evidence of a strong effect on breast cancer susceptibility. Therefore, on a population basis, rare variants are likely to contribute little to breast cancer incidence.