Cancer risk in individuals with autism spectrum disorder

Q Liu; W Yin; J J Meijsen; A Reichenberg; J R Gådin; A J Schork; H-O Adami; A Kolevzon; S Sandin; F Fang

doi:10.1016/j.annonc.2022.04.006

Cancer risk in individuals with autism spectrum disorder

Ann Oncol. 2022 Jul;33(7):713-719. doi: 10.1016/j.annonc.2022.04.006. Epub 2022 Apr 14.

Authors

Q Liu¹, W Yin², J J Meijsen³, A Reichenberg⁴, J R Gådin³, A J Schork³, H-O Adami⁵, A Kolevzon⁶, S Sandin⁷, F Fang²

Affiliations

¹ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: qianwei.liu@ki.se.
² Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
³ Institute for Biological Psychiatry, Mental Health Services Snct. Hans, Roskilde, Denmark.
⁴ Department of Psychiatry, Ichan School of Medicine at Mount Sinai, New York, USA; Seaver Autism Center for Research and Treatment at Mount Sinai, New York, USA.
⁵ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.
⁶ Department of Psychiatry, Ichan School of Medicine at Mount Sinai, New York, USA; Seaver Autism Center for Research and Treatment at Mount Sinai, New York, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA.
⁷ Department of Psychiatry, Ichan School of Medicine at Mount Sinai, New York, USA; Seaver Autism Center for Research and Treatment at Mount Sinai, New York, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

PMID: 35430370
DOI: 10.1016/j.annonc.2022.04.006

Abstract

Background: Whether individuals with autism spectrum disorders (ASDs) have a higher-than-expected risk of cancer remains unknown.

Patients and methods: We carried out a population-based cohort study including 2.3 million individuals live-born to mothers from Nordic countries during 1987-2013 in Sweden with follow-up through 2016 (up to age 30 years). Individuals with ASD were ascertained through the Swedish National Patient Register. We estimated the relative risk of cancer in relation to ASD by odds ratios (ORs) and associated 95% confidence intervals (CIs) derived from logistic regression, after detailed adjustment for potential confounders. We also carried out a sibling comparison to address familial confounding and a genetic correlation analysis using the genome-wide association study summary statistics to address confounding due to potential polygenetic pleiotropy between ASD and cancer.

Results: We observed an overall increased risk of any cancer among individuals with ASD (OR 1.3, 95% CI 1.2-1.5), compared with individuals without ASD. The association for any cancer was primarily noted for narrowly defined autistic disorder (OR 1.7, 95% CI 1.3-2.1) and ASD with comorbid birth defects (OR 2.1, 95% CI 1.5-2.9) or both birth defects and intellectual disability (ID; OR 4.8, 95% CI 3.4-6.6). An association was also suggested for ASD with comorbid ID (OR 1.4; 95% CI 0.9-2.1), but was not statistically significant. ASD alone (i.e. without comorbid ID or birth defects) was not associated with an increased risk of any cancer (OR 1.0, 95% CI 0.8-1.2). Sibling comparison and genetic correlation analysis showed little evidence for familial confounding or confounding due to polygenetic pleiotropy between ASD and cancer.

Conclusions: ASD per se is not associated with an increased risk for cancer in early life. The increased cancer risk among individuals with ASD is likely mainly attributable to co-occurring ID and/or birth defects in ASD.

Keywords: autism spectrum disorder; cancer; epidemiology; population-based.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Autism Spectrum Disorder* / epidemiology
Cohort Studies
Genome-Wide Association Study
Humans
Intellectual Disability*
Logistic Models
Neoplasms* / epidemiology