title: Mortality and cancer incidence among individuals with Down syndrome.
abstract: BACKGROUND
  Individuals with Down syndrome (DS) have a predisposition to leukemia and possibly other cancers and excess mortality from other conditions, but information on the magnitude of risk associated with specific cancers or causes of death is sparse.
  
  
  METHODS
  Mortality experience and cancer incidence were evaluated in a combined cohort of 4872 individuals with a hospital discharge diagnosis of DS in Sweden (1965-1993) or Denmark (1977-1989) by linkage to national cancer and vital statistics registries. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were estimated by comparison with age, sex, and calendar-year expected values.
  
  
  RESULTS
  Individuals with DS had an increased risk of incident acute lymphocytic (SIR, 24.2; 95% confidence interval [CI], 15.2-36.6; n = 22) and acute nonlymphocytic (SIR, 28.2; 95% CI, 15.7-48.3; n = 14) leukemias. Risks of testicular cancer (SIR, 3.7; 95% CI, 1.0-9.4; n = 4) and liver cancer (SIR, 6.0; 95% CI, 1.2-17.5; n = 3) were also elevated. Individuals with DS also experienced elevated mortality attributed to stomach cancer (SMR, 6.4; 95% CI, 1.7-16.4; n = 4), dementia and Alzheimer disease (SMR, 54.1; 95% CI, 27.9-94.4), epilepsy (SMR, 30.4; 95% CI, 13.9-57.7), ischemic heart disease (SMR, 3.9; 95% CI, 2.7-5.4), other heart disease (SMR, 16.5; 95% CI, 11.0-23.7), cerebrovascular disease (SMR, 6.0; 95% CI, 3.5-9.6), infectious diseases (SMR, 12.0; 95% 6.0-21.4), and congenital anomalies (SMR, 25.8; 95% CI, 21.0-31.4).
  
  
  CONCLUSIONS
  Individuals with DS have a substantially increased risk of mortality due to specific causes and may have an elevated risk of other incident cancers in addition to leukemia. These results provide clues regarding chromosome 21 gene involvement in diseases that complicate DS and are important for disease detection and care of affected individuals.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-7238, USA. dhill@mail.nih.gov
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Hill
authors.forename: Gloria
authors.initials: G
authors.lastname: Gridley
authors.forename: Sven
authors.initials: S
authors.lastname: Cnattingius
authors.forename: Lene
authors.initials: L
authors.lastname: Mellemkjaer
authors.forename: Martha
authors.initials: M
authors.lastname: Linet
authors.forename: Hans-Olof
authors.initials: HO
authors.lastname: Adami
authors.forename: Jorgen H
authors.initials: JH
authors.lastname: Olsen
authors.forename: Olof
authors.initials: O
authors.lastname: Nyren
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Fraumeni
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002891:Chromosomes, Human, Pair 21; D003718:Denmark / Q000453:epidemiology; D004314:Down Syndrome / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007938:Leukemia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology* / Q000235:genetics / Q000401:mortality; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology