Systematic review and meta-analysis of cancer risk in children….ppt

Systematic Review and Meta-analysis of Cancer Risk in Children Born after Assisted Reproduction Dr Carrie Williams Mr Andrew Constantine Dr Alastair Sutcliffe Why is it worth investigating if children born after Assisted Reproductive Technology (ART) might be at an increased risk of cancer? Rising ART usage Over 4 Million people Worldwide Over 150,000 people UK Serious Outcome 1 in 500 UK children will develop some form of cancer by 14 years Cancer is the leading cause of death from disease in children aged 1-14 years (UK) 1/5 of all deaths aged 1-14 years Cancer Research UK December 2010 ART, Epigentics Carcinogenesis Increased numbers of children born after ART with imprinting disorders Largely due to epigenetic defects Aberrant DNA methylation implicated in carcinogenesis Objective To assess current published evidence investigating: - Risk of cancer In children born after assisted reproductive technologies (ART) Compared to risk in spontaneously conceived children Search- 21/10/2010 MEDLINE EMBASE Cancer* AND Assisted Reproductive Technology* Abstracts Reviewed (2 authors) Relevant Primary Research Articles Identified Hand search of Bibliographies Study Selection Study quality reviewed (2 reviewers) Classified by design Observational cohort studies identified Children born after ART (Exposure) Diagnosed with All cancer (Outcome) Overlapping studies excluded Registry based, population cohort studies included in final meta-analysis Results Over 4000 results 60 relevant primary articles identified 28 Case reports 4 include only children born after maternal hormonal treatment 24 include only children born after ART 11 Case- control studies 21 Cohort studies 24 Case Reports28 Children, 29 Cancers Cohort Studies 21 Cohort studies identified 8 = Excluded for overlapping data 2= Included children born after maternal hormonal treatment only 11 Studies identified 9 population based Cohort studies using registry data Forest Plot A