Grace E. Holmes

Genetic Disease in Offspring of Long-Term Survivors of Childhood and Adolescent Cancer

Numerous case series have addressed the concern that cancer therapy may damage germ cells, leading to clinical disease in offspring of survivors. None has documented an increased risk. However, the methodological problems of small series make it difficult to draw firm conclusions regarding the potential of cancer treatments to damage the health of future offspring. We conducted a large interview study of adult survivors of childhood cancer treated before 1976. Genetic disease occurred in 3.4% of 2,198 offspring of survivors, compared with 3.1% of 4,544 offspring of controls (P=.33; not significant); there were no statistically significant differences in the proportion of offspring with cytogenetic syndromes, single-gene defects, or simple malformations. A comparison of survivors treated with potentially mutagenic therapy with survivors not so treated showed no association with sporadic genetic disease (P=.49). The present study provides reassurance that cancer treatment using older protocols does not carry a large risk for genetic disease in offspring conceived many years after treatment. With 80% power to detect an increase as small as 40% in the rate of genetic disease in offspring, this study did not do so. However, we cannot rule out the possibility that new therapeutic agents or specific combinations of agents at high doses may damage germ cells.

Anal cancer in women.

We studied predisposing factors in 56 women with anal cancer, comparing them with 56 matched controls drawn from the population. A detailed pretested questionnaire was administered to each study subject in a structured interview and blood was drawn for detection of herpes simplex virus antibodies by radioimmunoassay. Pathologic material from cases was obtained and evidence of human papilloma virus infection was sought. By univariate analyses we found associations between anal cancer and positive herpes simplex virus 2 titer (p = 0.0017), cigarette smoking (p = 0.0028), previous positive or questionable cervical Papanicolaou smear (p = 0.0124), and increasing number of sexual partners (p = 0.0224). By the multivariate technique of logistic regression there were independent and significant associations with cigarette smoking (p = 0.0126), previous use of hemorrhoid preparations (p = 0.0149), and history of disturbed bowel habits for greater than 1 mo (p = 0.0273). Anal cancer in women is a rare disease associated with cigarette smoking and sexual experience. Its association with previous anorectal disease is unclear and deserving of further study.

The availability of insurance to long‐time survivors of childhood cancer

The authors identified 100 adults who survived cancer who were diagnosed and treated in childhood between 1945 and 1975. Using standardized interviews, each survivor and matched same‐sex sibling was asked about life and health including questions about insurance. Compared with their same‐sex siblings, childhood cancer survivors had significantly more difficulty in securing life insurance (P < 0.001), in having life insurance in force (P < 0.004), and in obtaining health insurance because of health reasons (P < 0.001). Survivors were significantly less likely than siblings to be covered by health insurance (P < 0.04). Cure of childhood cancer has become more common, allowing thousands of survivors to enter adult life. This study suggests that childhood cancer survivors have an unmet need in respect to life and health insurance.

Maternal care vs. economic wealth and the health of newborns: Bishkek, Kyrgyz Republic and Kansas City, USA

Abstract This paper focuses on a narrow aspect of the demographic and health crisis in the former Soviet Union, examining the extent to which maternal behavior can compensate for poverty and poor medical conditions. Using sister hospital data form Bishkek, Kyrgyzstan and Kansas City, USA covering nearly 1,500 live births, the paper finds that Kyrgyzstani women are partially successful in compensating by taking better care of themselves and their newborn children. Moreover, ethnicity within Kyrgyzstan has no apparent impact on maternal behavior. Careful behavior, however, does not remove all disadvantages, and targeted interventions are still greatly needed.

The Death of Young King Edward VI

Measles virus suppresses host immunity to tuberculosis, as may some types of live measles-virus vaccine.1 Tuberculosis and measles remain important factors in childhood morbidity and mortality, par...

High-Risk Children Referred to an Early-Intervention Developmental Program:

Early-intervention programs for infants with developmental disabilities or with high-risk factors for such problems were first established in the United States more than 20 years ago. The benefits of such programs are generally recognized. This study describes the presenting problems of 698 children referred to an early-intervention program over a 15-year period (1975-1989). Medical condition groups rather than specific diagnoses are considered. The developmental progress of 464 children who attended the program for at least 6 months was determined by comparing their admission and discharge developmental quotients (DQ). Admission trends over time are noted and the value of intervention programs for young children with disabilities is discussed.

Childhood Cancer Survivors: Attained Adult Heights: Compared with Sibling Controls

As part of a large collaborative study, the authors administered a pretested questionnaire to 62 childhood and adolescent cancer survivors and 62 same-sex sibling controls. The authors requested information regarding attained adult height on the questionnaire. Mean adult height of survivors (172.2 cm) was less than that of controls (174.1 cm), at a borderline significant difference of p = 0.0757. Multivariate analysis examined four potential, independent variables as possible predictors of this difference. The presence of brain tumor (vs. nonbrain tumor) (p < .0001) and diagnosis at an early age (≤ 8 years vs. 9-15 years) (p = .05) were factors significantly related to the differential; sex of patient and type of therapy were not. Our findings thus identify malignancy site and age at diagnosis as important predictors of adult height in childhood and adolescent cancer survivors.

The KIDS Chart-Reply

In Reply .—We have carefully read the letter from Knobloch and Malone. They seem to have misunderstood the purpose of the KIDS chart as a simple screening tool. As stated, the KIDS chart is to be used as a screening mechanism to detect developmental delays. As such, it does not make diagnoses, much less differential diagnoses. Rather, it screens for deficiencies in several areas of development to alert the thoughtful clinician and prompt further and more comprehensive testing. Clear differences were demonstrated between our populations with normal and delayed development, and it is possible for delays in development of an individual infant to be detected early with this chart. We appreciate their pointing out that the Michigan Developmental Programming for Infants and Young Children is indeed a validated rather than a standardized profile, as was stated in our article. Lengthy, detailed lists of questions and items in ponderous, time-consuming developmental

Pregnancy Outcome of Patients Treated for Hodgkinʼs Disease. A Controlled Study

Normal reproduction prosepcts for Hodgkins disease patients are unknown. This study compares the outcome of 93 pregnancies in 48 patients with 228 pregnancies in 69 sibling controls. No statistically significant differences for spontaneous abortions or abnormal offspring were noted comparing all patients with all controls or 35 irradiated patients with all controls. Pregnancy outcome of 13 patients who received both irradiation and chemotherapy prior to pregnancy appeared to be compromised compared to controls. Wives of male patients in this category were more likely to have spontnaeous abortions than wives of male controls; female patients in this category were significantly more likely to produce abnormal offspring than were female controls (p = 0.047). In this series of patients therapeutic irradiation alone did not appear to jeoparadize posttreatment reproduction in fertile Hodgkins disease patients but in the smaller group of patients who received both irradiation and chemotherapy the reproduction picture was statistically not as good.