American Journal of Epidemiology Vol. 150, No. 9: 930-938
Copyright © 1999 by The Johns Hopkins University School of Hygiene and Public Health
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Hormone and Fertility Drug Use and the Risk of Neuroblastoma: A Report from the Children's Cancer Group and the Pediatric Oncology Group
1Department of Epidemiology, School of Public Health, University of North Carolina Chapel Hill, NC
2Department of Family Medicine and Clinical Epidemiology, School of Medicine, University of Pittsburgh Pittsburgh, PA
3Pediatric Oncology Group Statistical Office, University of Florida Gainesville, FL
4Department of Health Policy and Epidemiology, University of Florida Gainesville, FL
5Operations Office, Children's Cancer Group Arcadia, CA
6Children's Cancer Group Neuroblastoma Reference Laboratory, Children's Hospital of Los Angeles Los Angeles, CA
7Department of Experimental Oncology, St. Jude Children's Research Hospital Memphis, TN
8Children's Memorial Hospital Chicago, IL
9Department of Pediatrics, Northwestern University Chicago, IL
10Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham Birmingham, AL
11Department of Epidemiology, The University of Texas, M.D. Anderson Cancer Center Houston, TX
Reprint requests to Dr. Andrew F. Olshan, Children's Cancer Group, P.O. Box 60012, Arcadia, CA 91066-6012.
Previous epidemiologic studies have suggested an association between maternal sex hormone use during pregnancy, including infertility medication, and an increased risk of neuroblastoma in the offspring. The authors conducted a case-control interview study from 1992 to 1996 that included 504 children less than 19 years of age whose newly diagnosed neuroblastoma was identified by two national collaborative clinical trials groups in the United States and Canada, the Children' Cancer Group and the Pediatric Oncology Group. Controls, matched to cases on age, were identified by random digit dialing. No association was found for use of oral contraceptives before or during pregnancy (first trimester odds ratio (OR) = 1.0, 95% confidence interval (CI): 0.5, 2.1). The odds ratio was slightly elevated for history of infertility (OR = 1.4, 95% CI: 0.9, 2.1) and ever use of any infertility medication (OR = 1.2. 95% CI: 0.7, 2.2). Specifically, ever use of clomiphene was associated with a 1.6-fold increased risk (95% CI: 0.8, 3.0) but not periconceptionally or during the index pregnancy. A suggestive pattern was found for gender of the offspring, with an increased risk for males but not for females after exposure to oral contraceptives or clomiphene. This study did not find consistent and large increased risks for maternal use of hormones, but the suggestion of an association for male offspring requires further consideration. Am J Epidemiol 1999;150:930-8.
child; fertility agents; hormones; neuroblastoma; pregnancy; sex
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