Neuroblastoma, the most common extracranial solid tumor in children, contributes disproportionately to childhood cancer mortality and few risk factors have been identified. Our objective was to evaluate associations between parental and infant characteristics and neuroblastoma incidence.
Children born in Texas between January 1995 and December 2011 were eligible for the present study. Cases (N = 637) were diagnosed with neuroblastoma in Texas during the same period; controls (N = 6370) matched on year of birth were randomly selected from birth certificates that did not link to a record in the Texas Cancer Registry. We obtained data on birth and parental demographic/reproductive characteristics from birth certificates, and estimated odds ratios (OR) and 95% confidence intervals (CIs) for neuroblastoma using logistic regression.
Gestational age 34–36 weeks at birth was associated with neuroblastoma (OR 1.45, CI 1.09–1.90), whereas female sex was inversely associated (OR 0.68, CI 0.58–0.81). Relative to children of non-Hispanic White women, children of Hispanic (OR 0.53, CI 0.43–0.64) or non-Hispanic Black (OR 0.52, CI 0.38–0.71) women were at reduced odds of neuroblastoma. When maternal and paternal race/ethnicity were evaluated jointly, similar patterns were observed (two non-Hispanic Black parents: OR 0.55, 95%CI 0.36–0.79; two Hispanic parents: OR 0.53, 95%CI 0.41–0.67). Older maternal age was also positively associated with neuroblastoma (OR 1.41, CI 1.04–1.90 for 35–39 years; OR 1.62, CI 0.87–2.81 for ≥40 years, relative to 25–29 years).
Findings provide further evidence of racial/ethnic disparities in neuroblastoma incidence, determinants of which are unknown. In contrast to most published studies, we observed an association between maternal age and neuroblastoma. Further studies with more robust control for confounding are warranted.
- • Assessed childhood neuroblastoma in a large sample with prospective data collection.
- • Older maternal age was associated with neuroblastoma.
- • Hispanic/non-Hispanic Black children at lower risk than non-Hispanic White children.
Neuroblastoma is the most common extracranial solid tumor in children, and approximately 800 cases are diagnosed annually in the United States . Neuroblastoma is a heterogeneous disease, with nearly all patients with low- or intermediate-risk disease surviving, in contrast to the poor survival for patients with high-risk disease despite intense, multimodal therapy . Due to the aggressive and difficult to treat nature of high-risk neuroblastoma, it contributes disproportionately to childhood cancer mortality; whereas neuroblastoma constitutes 7% of cancer diagnoses in children, it is responsible for 12% of cancer-related deaths .
Because neuroblastoma can originate in utero and has a median age at diagnosis of just 17 months , epidemiologic investigations have focused on in utero exposures and birth characteristics. These studies suggest increased risk in children with birth defects , which may reflect shared developmental origins , and children whose mothers smoked tobacco or drank alcohol during pregnancy . Inverse associations between Hispanic and non-Hispanic Black race/ethnicity and risk of neuroblastoma have been reported . Limited evidence also exists to support associations with low birthweight, preterm birth, and lower birth order, whereas findings regarding maternal age, education, and chronic health conditions are generally null . Few studies have evaluated infertility treatment .
The paucity of modifiable risk factors for neuroblastoma, which may be partly attributable to small sample size (<200 cases) and retrospective parental reporting of exposures in past studies, limits prevention efforts. Therefore, our objective was to investigate associations of parental and infant characteristics with neuroblastoma using a registry linkage design, among a large and diverse sample of neuroblastoma cases from Texas.