Kelly-Irving Michelle, Lepage Benoit, Dedieu Dominique, Lacey Rebecca, Cable Noriko, Bartley Melanie, Blane David, Grosclaude Pascale, Lang Thierry, Delpierre Cyrille
INSERM, U1027, Toulouse F-31300, France.
BMC Public Health. 2013 Aug 19;13:767. doi: 10.1186/1471-2458-13-767.
To analyse whether Adverse Childhood Experiences (ACE) are associated with an increased risk of cancer.
The National child development study (NCDS) is a prospective birth cohort study with data collected over 50 years. The NCDS included all live births during one week in 1958 (n=18558) in Great Britain. Self-reported cancer incidence was based on 444 participants reporting having had cancer at some point and 5694 reporting never having cancer. ACE was measured using reports of: 1) child in care, 2) physical neglect, 3) child's or family's contact with the prison service, 4) parental separation due to divorce, death or other, 5) family experience of mental illness & 6) family experience of substance abuse. The resulting variable had three categories, no ACEs/ one ACE/ 2+ACEs and was used to test for a relationship with cancer. Information on socioeconomic characteristics, pregnancy and birth were extracted as potential confounders. Information on adult health behaviours, socioeconomic environment, psychological state and age at first pregnancy were added to the models. Multivariate models were run using multiply-imputed data to account for missing data in the cohort.
The odds of having a cancer before 50 y among women increased twofold for those who had 2+ ACEs versus those with no ACEs, after adjusting for adult factors and early life confounders (OR: 2.1, 95% CI: 1.42-3.21, p<0.001).
These findings suggest that cancer risk may be influenced by exposure to stressful conditions and events early on in life. This is potentially important in furthering our understanding of cancer aetiology, and consequently in redirecting scientific research and developing appropriate prevention policies.
分析童年不良经历(ACE)是否与癌症风险增加相关。
全国儿童发展研究(NCDS)是一项前瞻性出生队列研究,收集了50多年的数据。NCDS纳入了1958年英国某一周内的所有活产儿(n = 18558)。自我报告的癌症发病率基于444名报告曾患癌症的参与者和5694名报告从未患癌症的参与者。ACE通过以下报告进行衡量:1)受照料儿童,2)身体忽视,3)儿童或家庭与监狱系统的接触,4)因离婚、死亡或其他原因导致的父母分居,5)家庭精神疾病经历和6)家庭药物滥用经历。所得变量有三个类别,无ACE/一个ACE/两个及以上ACE,并用于检验与癌症的关系。提取社会经济特征、怀孕和分娩方面的信息作为潜在混杂因素。将成人健康行为、社会经济环境、心理状态和首次怀孕年龄的信息添加到模型中。使用多重填补数据运行多变量模型以处理队列中的缺失数据。
在调整成人因素和早期生活混杂因素后,2个及以上ACE的女性在50岁前患癌症的几率是无ACE女性的两倍(OR:2.1,95%CI:1.42 - 3.21,p < 0.001)。
这些发现表明,癌症风险可能受到生命早期暴露于压力状况和事件的影响。这对于深化我们对癌症病因学的理解具有潜在重要性,进而有助于重新引导科学研究并制定适当的预防政策。