Assisted Reproductive Technology & Risk of Childhood Cancer

描述（由申请人提供）：在过去的二十年里，由于几个原因，包括高龄生育和保险覆盖率的增加，辅助生殖技术（ART）的使用在美国稳步上升。研究报告了辅助妊娠与自然妊娠的不良围产期结局风险显著高于自然妊娠，包括过度早产、低出生体重和出生缺陷。抗逆转录病毒治疗和/或不孕症可能影响其他产前疾病的发病率，如儿童癌症。此外，在接受抗逆转录病毒治疗的儿童中，诸如贝克维斯-魏德曼综合征和安吉尔曼综合征等印记疾病的患病率有所上升；其中一些疾病反过来又大大增加了发生在儿童早期的几种胚胎癌的风险。一些关于辅助生殖和儿童癌症的队列、病例对照和病例系列研究报告了无效结果，尽管所有这些研究都受到样本量小的限制，无法区分特定的癌症类型。一项专门针对肝母细胞瘤的研究发现，使用不孕症治疗或辅助生殖与患病风险增加9倍相关。利用辅助生殖技术协会（SART）以及20个州和纽约市的出生和癌症登记处的资源，我们建议进行迄今为止最大的ART和儿童癌症风险的研究。SART根据1992年联邦生育成功率和认证法案（PL 102-493）的规定，为美国提供ART服务的项目建立了一个持续的国家数据库。截至2006年（可获得数据的最近年份），这包括来自483家诊所的138,198个抗逆转录病毒治疗周期的综合数据（包括足以用于联系的标识符），这些周期在一年内导致41,343例怀孕和54,656例婴儿。我们建议将SART数据库2004-2013年的数据与20个州和纽约市的出生和癌症登记处联系起来，其中包括ART出生人数最多的五个州（加利福尼亚、纽约、伊利诺伊、新泽西和马萨诸塞州），以创建一个约3000万儿童的队列，其中包括超过467,000名通过ART受孕的儿童，以评估辅助生殖与儿童癌症风险之间的关系。本研究的具体目的是比较辅助受孕儿童的儿童癌症发病率与一般人群的发病率。

DESCRIPTION (provided by applicant): Use of assisted reproductive technology (ART) has risen steadily in the United States during the past two decades due to several reasons, including childbearing at older maternal ages and increasing insurance coverage. Studies have reported significantly higher risks of adverse perinatal outcomes in assisted- versus spontaneous-conception pregnancies, including an excess of prematurity, low birthweight, and birth defects. ART and/or infertility may influence the incidence of other conditions with prenatal origins, such as childhood cancer. In addition, the prevalence of imprinting disorders such as Beckwith-Wiedemann and Angelman syndromes is elevated among children conceived by ART; some of these disorders, in turn, drastically raise the risk of several embryonal cancers that occur in early childhood. Several cohort, case-control, and case- series studies of assisted reproduction and childhood cancer have reported null results, although all were limited by small sample size and could not differentiate specific cancer types. One study that focused specifically on hepatoblastoma found that use of infertility treatment or assisted reproduction was associated with a nine-fold increased risk of disease. Using the resources of the Society for Assisted Reproductive Technology (SART) and the birth and cancer registries in 20 States and New York City, we propose to conduct the largest study to date of ART and childhood cancer risk. SART maintains an ongoing national database of programs that provide ART services in the United States as mandated by the federal Fertility Success Rate and Certification Act of 1992 [PL 102-493]. As of 2006, the latest year of data available, this included comprehensive data (including identifiers sufficient for linkage) on 138,198 ART cycles from 483 clinics resulting in 41,343 pregnancies and 54,656 infants for a single year. We propose to link the data from the SART database from 2004-2013 to the birth and cancer registries of 20 states and New York City, including the five states with the highest numbers of ART births (California, New York, Illinois, New Jersey, and Massachusetts), to create a cohort of approximately 30 million children, including over 467,000 conceived by ART to evaluate the association between assisted reproduction and the risk for childhood cancer. The specific aim of this study is to compare the incidence of childhood cancer in children with assisted conception to that in the general population.