Abstract 5779: The association of instrument assisted deliveries and the development of childhood brain tumors: A matched case control study

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Abstract Background: Pediatric brain tumors are the second most common type of childhood cancer and have the highest mortality rate among all pediatric cancer types. New information on potentially preventative measures would be of great value. Previous studies have suggested that instrument-assisted delivery (forceps and vacuum) may be associated with an increased risk for childhood brain tumors. The goal of this study was to determine if there was an association of exposure to instrument-assisted deliveries with childhood brain tumors in Denmark. We additionally examined risk with emergency or planned cesarean section. Methods: This was a matched case-control study with childhood brain tumor cases in Denmark diagnosed from 1978-2013. Cases were identified from the Danish Cancer Registry. Birth outcomes, maternal procedures and covariates were obtained from the Danish Medical Births Register and the nationwide Hospital Register. A total of 3,698 brain tumor cases were recruited and 25 controls were matched to each case based on child's sex and birth year (N=89,554). We used conditional logistic regression to determine associations of delivery instruments types with various childhood brain tumors. Results: Compared to children birthed by spontaneous vaginal delivery, children who later developed ependymomas (N=136) had a greater likelihood of having been delivered by vacuum assisted deliveries (OR=1.69, 95% CI 1.01-2.83). An overall increased risk for cesarean section with any CNS tumor (OR= 1.20, 95% CI 1.06-1.36) dropped to 1.10 when we limited the age range to 4 or older (N=1,087). This suggests no clear increased risk for cancer with cesarean section, as there is a possibility that the CNS tumor was present before birth and influenced a larger head size, thus requiring a cesarean section. Planned cesarean and emergency cesarean section were not related to risk increases. While the use of forceps was rare in this population (1.2% in controls), we could not confirm previously reported associations with astrocytoma (OR=0.84), though there was a weak increase for ependymoma with wide confidence intervals (OR=2.69, 95% CI 0.77, 9.38). Conclusions: Based on objective data, the findings in our study suggest that there might be an association between vacuum assisted deliveries and ependymomas. Our data did not support a strong association of childhood brain tumors with cesarean sections. Citation Format: Karen Yeh, Johnni Hansen, Julia E. Heck. The association of instrument assisted deliveries and the development of childhood brain tumors: A matched case control study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5779.