【原】母亲死于乳腺宫颈癌对儿童的影响

　　乳腺癌和宫颈癌是影响低收入和中等收入国家育龄女性的两种常见癌症，也是主要的致死癌症。既往大样本人群研究已经表明，无论低收入和还是高收入国家，母亲已故的儿童与母亲尚在的儿童相比，死亡风险较高。

　　2018年11月1日，美国癌症学会《癌症》在线发表纽约大学、佛罗里达大学、康奈尔大学、世界卫生组织国际癌症研究机构的研究报告，推算了不同国家母亲死于乳腺癌或宫颈癌的儿童死亡率，并且建立了这些癌症所致死亡负担的综合评定方法。

　　该研究建立了乳腺癌、宫颈癌或其他原因所致女性死亡风险的蒙特卡罗统计学模拟方法，发现10岁之前母亲已故与母亲尚在的儿童相比，所有原因所致风险增加。通过统计学模拟，量化了亚洲孟加拉国、非洲布基纳法索、欧洲丹麦女性死于宫颈癌或乳腺癌对其儿童死亡率的影响，作为基准分析，随后将分析扩展至其他非洲国家。

　　结果，母亲死于乳腺癌和宫颈癌的儿童死亡率：

• 孟加拉国：增加2.2%

• 布基纳法索：增加14.0%

• 丹麦：增加0.02%

• 其他非洲国家：增加24.2%～29.9%

　　因此，该研究首次推算了母亲死于癌症对儿童死亡率的影响，该模型的推算结果表明，有必要对该相关性开展进一步调查，并且突显了育龄女性充分获得癌症预防和治疗的意义。

Cancer. 2018 Nov 1. [Epub ahead of print]

Estimating child mortality associated with maternal mortality from breast and cervical cancer.

Raymond B. Mailhot Vega, Onyinye D. Balogun, Omar F. Ishaq, Freddie Bray, Ophira Ginsburg, Silvia C. Formenti.

New York University School of Medicine, New York, New York; University of Florida Proton Therapy Institute, New York, New York; Weill Cornell Medical College, New York, New York; International Agency for Research on Cancer, Lyon, France; New York University Langone Medical Center, New York, New York.

It has been demonstrated in different geographic and socioeconomic settings that children of mothers who die have a higher risk of death compared with children who have living mothers. The model estimates in this study identify an increment in comprehensive cancer deaths when including child death estimates of up to 30% in certain African countries, and the predicted results call for further investigation and underscore the relevance of adequate access to prevention and treatment among women of childbearing age.

BACKGROUND: Large-scale population studies demonstrate an association between mothers' deaths and child mortality in both lower and higher income countries. The authors estimated children's deaths in association with mothers' deaths from breast or cervical cancer, 2 common cancers in low-income and middle-income countries affecting women of reproductive age, to develop a comprehensive assessment of the death burden of these cancers.

METHODS: A Monte Carlo simulation model was devised whereby women were at risk of dying from breast cancer, cervical cancer, or another cause. Compared with children who have living mothers, children of women who die before they reached age 10 years have an elevated risk of death from all causes. Therefore, simulations were conducted, and the impact of mothers' deaths from cervical and breast cancer on associated child mortality was quantified for Bangladesh, Burkina Faso, and Denmark (benchmark analysis), then the analyses were extended to all African countries.

RESULTS: Benchmark estimates of child deaths associated with mothers' deaths from breast and cervical cancer resulted in an increment in cancer-related mortality of approximately 2% in Bangladesh, 14% in Burkina Faso, and less than 1% in Denmark. The model predicted an increment in comprehensive cancer deaths when including child death estimates by as high as 30% in certain African countries.

CONCLUSIONS: To the authors' knowledge, this is the first study to estimate the impact of a mother's death from cancer on child mortality. The model's estimates call for further investigation into this correlation and underscore the relevance of adequate access to prevention and treatment among women of childbearing age.

KEYWORDS: breast cancer; cervical cancer; global health; mothers and cancer population health

DOI: 10.1002/cncr.31780