Fertility treatment and childhood cancer risk a systematic meta analysis

Capsule:
In this systematic meta-analysis of both cohort and case-control studies, published through September 2012, we found an increased risk for cancer among children born after fertility treatment.

Authors:
Marie Hargreave, M.Sc., Allan Jensen, M.Sc., Ph.D., Anita Toender, M.Sc., Klaus Kaae Andersen, M.Sc., Ph.D., Susanne Krüger Kjaer, M.D., D.M.Sc.

Volume 100, Issue 1, Pages 150-161, July 2013

Abstract:

Objective:
To clarify the association between fertility treatment and the risk for cancer in children.

Design:
Meta-analysis.

Setting:
None.

Patient(s):
Twenty-five cohort and case-control studies involving children born after fertility treatment as the exposure of interest and cancer as the outcome.

Intervention(s):
None.

Main Outcome Measure(s):
Medline was searched through September 2012 to identify relevant studies. The study-specific estimates for each cancer outcome were combined into a pooled relative risk (RR) with 95% confidence interval (CI) by a meta-analytic approach.

Result(s):
We found that children born after fertility treatment were at increased risk for all cancers (RR = 1.33; 95% CI, 1.08–1.63) and for hematological cancers (RR = 1.59; 95% CI, 1.32–1.91), central nervous system/neural cancers (RR = 1.88; 95% CI, 1.02–3.46), and other solid cancers (RR = 2.19; 95% CI, 1.26–3.80). For specific cancer types, we found increased risks for leukemias (RR = 1.65; 95% CI, 1.35–2.01), neuroblastomas (RR = 4.04; 95% CI, 1.24–13.18), and retinoblastomas (RR = 1.62; 95% CI, 1.12–2.35) associated with fertility treatment.

Conclusion(s):
The results of the largest meta-analysis on this topic to date indicate an association between fertility treatment and cancer in offspring. However, our results do not rule out that factors related to underlying subfertility, rather than the procedure itself, are the most important predisposing factors for childhood cancer.

  • Lauren Johnson

    Congratulations to the authors on completion of this meta-analysis. This study addresses an important research question that warrants further investigation. I appreciate the way the authors fully described their methods, acknowledged limitations of the research, and provided a thoughtful and thorough discussion of the findings. As the authors state in the discussion, the results of this study should be interpreted with caution since 1) The study does not provide evidence of a causal relationship between
    fertility treatments and childhood cancer, 2) The study design does not allow
    for a comprehensive assessment of confounders, and 3) The attributable risk calculated in this analysis is small (one case for every 4,236 women.) Future prospective studies with appropriate controls are needed before definitive conclusions can be drawn.

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