Lisa Signorello, Sc.D.

A large, retrospective study of the children of childhood cancer survivors who were treated with radiation therapy and/or some forms of chemotherapy found that the offspring do not have an increased risk for birth defects compared to children of cancer survivors who did not receive these treatments.

The findings provide reassurance that increased risks of birth defects are unlikely for the children of childhood cancers survivors and can help guide family planning choices for those survivors.

The study, led by Vanderbilt-Ingram Cancer Center investigators, was published online December 12 in the Journal of Clinical Oncology.

“We hope this study will become part of the arsenal of information used by the physicians of childhood cancer survivors if reproductive worries arise,” said lead author Lisa Signorello, Sc.D., associate professor of Medicine at Vanderbilt and senior epidemiologist at the International Epidemiology Institute in Rockville, Md. “Childhood cancer survivors face real reproductive concerns, including unknowns related to the effects of therapy. But, hopefully this study will provide some reassurance that their children are unlikely to be at increased risk for genetic defects stemming from their earlier treatment.”

Childhood cancer patients frequently receive aggressive, life-saving radiation and chemotherapy treatments that can affect their ability to have children. For girls, radiation to the pelvis – and the resulting damage to the uterus – has been associated with a risk for miscarriage and preterm birth, and effects on the ovaries can lead to infertility.

Radiotherapy and chemotherapy with alkylating agents can damage DNA. Previous studies have not determined whether genetic damage from a parent’s treatment could be passed down to their offspring. Genetic-based birth defects are rare in the general population (about 3 percent), and while previous research indicated little or no increased risk for birth defects among the offspring, the studies were relatively small in size and lacked detailed information about radiation and chemotherapy treatments.

In the current study, investigators used information from the Childhood Cancer Survivor Study, a large retrospective study of treatment and outcomes in more than 20,000 childhood cancer survivors diagnosed between 1970 and 1986. Signorello and her colleagues examined data from 4,699 children of 1,128 men and 1,627 women who were 5-year childhood cancer survivors. The survivors reported their children’s health problems through questionnaires, and investigators also examined medical records, focusing on survivors’ history of radiation to the testes or ovaries and chemotherapy with alkylating agents.

Of the survivors, 63 percent (1,736) had received radiation for their cancer as children, and 44 percent of men (496) and 50 percent of women (810) had received chemotherapy with alkylating agents. Overall, 2.7 percent (129) of the survivors’ children had at least one birth defect, such as Down syndrome, abnormally short stature (achondroplasia) or cleft lip. Researchers found that three percent of children of mothers exposed to radiation or treated with alkylating chemotherapy agents had a genetic birth defect, compared to 3.5 percent of children of cancer survivors who did not have such exposures.

Only 1.9 percent of children of male cancer survivors who received these DNA-damaging treatments were reported to have such birth defects, compared to 1.7 percent of children of male survivors who did not have this type of chemotherapy or radiation. The researchers concluded that children of cancer survivors were not at higher risk for birth defects stemming from parents’ exposure to chemotherapy and/or radiation.

The researchers noted that a strength of their study is the comparison they made to the children of other cancer survivors and not to the children of people randomly sampled from the general population. The investigators determined that the prevalence of birth defects among the cancer survivors’ children was similar to what has been reported in the general population.

“The possibility of birth defects in offspring has been a lingering concern among cancer survivors because it’s hard to address,” Signorello said. “It took years to validate the parents’ self-reported outcomes, and to assemble and use the medical records of radiation and chemotherapy treatment exposures to allow us to quantify their exposure doses. These are the strongest results to date.”

In order to help raise awareness, informative videos will be posted to the Web site and feature Vanderbilt-Ingram Cancer Center physicians and staff. More research is crucial to improve as well as find better treatment options for these two cancers that tend to be caught at a late stage. Events are also scheduled throughout the month, and we hope that you will join us in raising awareness for lung cancer and pancreatic cancer. Here are ways for you to get involved:

• Paint Nashville Purple to kick off pancreatic cancer awareness month tonight at the Roundabout on Demonbreun and hear the Cancer Center’s Dr. Jordan Berlin speak.
• Metro Nashville Council and State of Tennessee announces November as Tennessee Lung Cancer Awareness month at tonight’s meeting.
• Join us on Nov. 2 at 10 a.m. for “Wellness Wednesday” as Karen Dyer, exercise physiologist, discusses Gentle Movement Exercise and Rehabilitation. This FREE educational series is for those currently undergoing treatment as well as those who have finished, and it does not matter where you received your treatment. Everyone who has been touched by cancer is welcome.
• Walk with us by joining our team for the LUNGevity Foundation’s Breathe Deep 5K at Centennial Park on Nov. 5.
• Celebrate with us on Nov. 5 from 6-8 p.m. for the Breathe Hope: Celebrating Lung Cancer Survivors and their Caregivers, a free educational event for lung cancer survivors (on-therapy or post-treatment) and their caregivers. You will learn about advancements in lung cancer research and clinical care from Vanderbilt-Ingram experts as well as enjoy hors d’oeuvres, desserts and cocktails. Please RSVP if you would like to attend.

If you can’t participate in any of these events, there are other ways for you to get involved in the fight against cancer by volunteering and/or donating.

Dr. Carlos Arteaga with research advocates, Pam Martin and Lynne Cargen (left to right).

As a 15-year breast cancer survivor, Lynne Cargen continues her fight against cancer as a research advocate at Vanderbilt-Ingram Cancer Center. She works with Carlos Arteaga, M.D. and his team of researchers in the Specialized Program of Research Excellence (SPORE) in Breast Cancer.

Cargen said that she has been committed to raising awareness and becoming an advocate for breast cancer since her diagnosis in 1996. “Dr. Arteaga’s invitation to become an advocate in the Breast SPORE provided me with the opportunity to direct my passion as a cancer advocate directly toward the research process,” she noted. “As a research advocate, it is the shared goal to partner with scientists to add the survivors perspective to the research process.”

Cancer survivors are not the only individuals participating in the Cancer Center’s research advocacy program. Caregivers, family members, health professionals and community members are also contributing to the research process and outcomes for future patients.

There are three main objectives for those participating as a research advocate. First one is to provide Vanderbilt-Ingram’s researchers an expanded perspective, since the research advocates are the ones who have personally experienced or been touched by cancer. Second is to help refine the nature of research questions, improve the choice of research tools and enhance outcomes so that research is meaningful and relevant to patients. The last objective is to assist in the development of patient oriented resources and tools for clinical trials.

For those interested in becoming research advocates, Cargen encourages you to educate yourself about your disease and the research process. “Through building education programs and reaching out to the community, we hope to dispel many of the myths of clinical trials and research.”

Please contact Jane Kennedy, manager of patient advocacy, at 615-936-1072 to learn more about Vanderbilt-Ingram’s research advocacy program.

Anne Washburn, M.P.H.

Anne Washburn, M.P.H., associate director of Patient and Community Education for Vanderbilt-Ingram Cancer Center, will receive an award for her support of the Sisters Network Inc.

The group is a national survivorship organization committed to increasing local and national attention to the devastating impact that breast cancer has in the African-American community.

Washburn will be honored with the ESTHER (Effective Service Through Health Education and Resources) Award for her role as a community partner with the organization during the Sisters Network Survivorship Gala.

The “Spirit of a Survivor” program will be held Saturday, Oct. 8, at 3 p.m., at the Nashville Airport Marriott, 600 Marriott Drive. VICC is one of the sponsors of this event.

“I am so pleased to be recognized on behalf of VICC for our efforts to eliminate health disparities, especially in the African-American community,” said Washburn, who also serves as administrative director for Vanderbilt’s REACH for Survivorship program.

“VICC continues to work closely with the local affiliate of Sisters Network on survivorship and community education initiatives.”

Ingrid Mayer, M.D., associate professor of Medicine and clinical director of Vanderbilt’s Breast Cancer Program, will serve as a special guest speaker during the program.

Tickets for the gala are $50. For more information about the event, call 299-5574, email nashvilletn@sistersnetworkinc.org or visit www.sistersnetworkinc.org.