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Spatial clustering of childhood cancers in Switzerland: a nationwide study

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Abstract

Purpose

Childhood cancers are rare and little is known about their etiology. Potential risk factors include environmental exposures that might implicate spatial variation of cancer risk. Previous studies of spatial clustering have mainly focused on childhood leukemia. We investigated spatial clustering of different childhood cancers in Switzerland using exact geocodes of place of residence.

Methods

We included 6,034 cancer cases diagnosed at age 0–15 years during 1985–2015 from the Swiss Childhood Cancer Registry. Age and sex-matched controls (10 per case) were randomly sampled from the national censuses (1990, 2000, 2010). Geocodes of place of residence were available at birth and diagnosis for both cases and controls. We used the difference in k-functions and Cuzick–Edwards test to assess global clustering and Kulldorff’s circular scan to detect individual clusters. We also carefully adjusted for multiple testing.

Results

After adjusting for multiple testing, we found no evidence of spatial clustering of childhood cancers neither at birth (p = 0.43) nor diagnosis (p = 0.13). Disregarding multiple testing, results of individual tests indicated spatial clustering of all childhood cancers combined (p < 0.01), childhood lymphoma (p = 0.01), due to Hodgkin lymphoma (HL) (p = 0.02) at diagnosis, and embryonal tumors of the central nervous system (CNS) at birth and diagnosis, respectively (p = 0.05 and p = 0.02).

Conclusions

This study provides weak evidence of spatial clustering of childhood cancers. Evidence was strongest for HL and embryonal CNS tumors, adding to the current literature that these cancers cluster in space.

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Change history

  • 05 December 2019

    Garyfallos Konstantinoudis’s ORCiD ID was originally incorrectly listed alongside Ben D. Spycher’s name, this has since been corrected

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Acknowledgments

This work was supported by Swiss Cancer Research (4012-08-2016, 3515-08-2014, 3049-08-2012), the Swiss Federal Office of Public Health (08.001616, 10.002946, 12.008357), and the Swiss Cancer League (02224-03-2008). BD Spycher was supported by a Swiss National Science Foundation fellowship (PZ00P3_147987). The work of the Swiss Childhood Cancer Registry is supported by the Swiss Pediatric Oncology Group (http://www.spog.ch), Schweizerische Konferenz der kantonalen Gesundheitsdirektorinnen und – direktoren (http://www.gdk-cds.ch), Swiss Cancer Research (http://www.krebsforschung.ch), Kinderkrebshilfe Schweiz (http://www.kinderkrebshilfe.ch), and the National Institute of Cancer Epidemiology and Registration (http://www.nicer.org). We thank the Swiss Federal Statistical Office for providing mortality and census data and for the support which made the Swiss National Cohort and this study possible. This work was supported by the Swiss National Science Foundation (Grant Nos. 3347CO-108806, 33CS30_134273, and 33CS30_148415).

The members of the Swiss Pediatric Oncology Group Scientific Committee

R. A. Ammann (Bern), M. Ansari (Geneva), M. Beck Popovic (Lausanne), P. Brazzola (Bellinzona), J. Greiner (St. Gallen), M. Grotzer (Zurich), H. Hengartner (St Gallen), T. Kuehne (Basel), K. Leibundgut (Bern), C. Kuehni (Bern), F. Niggli (Zurich), C. Reimann (Lucerne), K. Scheinemann (Aarau), N. von der Weid (Basel).

The members of the Swiss National Cohort Study Group

M. Egger (Chairman of the Executive Board), A. Spoerri and M. Zwahlen (all Bern), M. Puhan (Chairman of the Scientific Board), M. Bopp (both Zurich), N. Künzli (Basel), F. Paccaud (Lausanne), and M. Oris (Geneva).

Author information

Authors and Affiliations

  1. Faculty of Medicine, Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland

    Garyfallos Konstantinoudis, Christian Kreis, Claudia E. Kuehni & Ben D. Spycher

  2. Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Roland A. Ammann, Claudia E. Kuehni & Ben D. Spycher

  3. Department of Oncology, University Children’s Hospital Zurich, Zurich, Switzerland

    Felix Niggli

Authors
  1. Garyfallos Konstantinoudis
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  2. Christian Kreis
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  3. Roland A. Ammann
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  4. Felix Niggli
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  5. Claudia E. Kuehni
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  6. Ben D. Spycher
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Consortia

Swiss Paediatric Oncology Group

  • R. A. Ammann
  • , M. Ansari
  • , M. Beck Popovic
  • , E. Bergstraesser
  • , P. Brazzola
  • , J. Greiner
  • , M. Grotzer
  • , H. Hengartner
  • , T. Kuehne
  • , K. Leibundgut
  • , F. Niggli
  • , C. Reimann
  • , K. Scheinemann
  •  & N. von der Weid

Swiss National Cohort Study Group

  • M. Egger
  • , A. Spoerri
  • , M. Zwahlen
  • , M. Puhan
  • , M. Bopp
  • , N. Künzli
  • , F. Paccaud
  •  & M. Oris

Corresponding author

Correspondence to Ben D. Spycher.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

Ethics approval was granted through the Ethics Committee of the Canton of Bern to the SCCR on 22 July 2014 (KEK-BE: 166/2014).

Additional information

The members of Swiss Pediatric Oncology Group Scientific Committee and Swiss National Cohort Study Group are listed in ‘Acknowledgment.’

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Konstantinoudis, G., Kreis, C., Ammann, R.A. et al. Spatial clustering of childhood cancers in Switzerland: a nationwide study. Cancer Causes Control 29, 353–362 (2018). https://doi.org/10.1007/s10552-018-1011-6

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