title: Distinctive Cancer Associations in Patients With Neurofibromatosis Type 1.
abstract: The current study was designed to determine the risk of cancer in patients with neurofibromatosis type 1 (NF1) by cancer type, age, and sex with unprecedented accuracy to be achieved by combining two total population-based registers.
  
  
  
  A population-based series of patients with NF1 (N = 1,404; 19,076 person-years) was linked to incident cancers recorded in the Finnish Cancer Registry and deaths recorded in the national Population Register Centre between 1987 and 2012. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were calculated for selected cancer types. Survival of the patients with cancer with and without NF1 was compared.
  
  
  
  In malignant peripheral nerve sheath tumors and CNS tumors, the cancers traditionally associated with NF1, we observed SIRs of 2,056 (95% CI, 1,561 to 2,658), and 37.5 (95% CI, 30.2 to 46.0), respectively, and SMRs of 2,301 (95% CI, 1,652 to 3,122) and 30.2 (95% CI, 19.1 to 45.2), respectively. We found an unequivocally increased risk for breast cancer. In particular, SIR was 11.1 (95% CI, 5.56 to 19.5) for breast cancer in women with NF1 age < 40 years; the overall SMR for breast cancer was 5.20 (95% CI, 2.38 to 9.88). Particularly high overall SIRs were observed in patients with NF1 age < 15 years: women, 87.6 (95% CI, 58.6 to 125); men, 45.6 (95% CI, 28.4 to 68.5). An estimated lifetime cancer risk for patients with NF1 was 59.6%. The 5-year survival of patients with cancer and NF1, excluding nervous tissue cancers, was worse than that of comparable patients with cancers without NF1 (54.0% v 67.5%; P = .01).
  
  
  
  Our results emphasize the general cancer proclivity of patients with NF1. These findings should translate to clinical practices to determine clinical interventions and focused follow-up of patients with NF1.
authors.affiliation: Elina Uusitalo, Roope A. Kallionpää, Jussi Leppävirta, Heli Ylä-Outinen, Sirkku Peltonen, and Juha Peltonen, University of Turku; Jussi Leppävirta, Heli Ylä-Outinen, and Sirkku Peltonen, Turku University Hospital, Turku; Matti Rantanen, Eero Pukkala, and Janne Pitkäniemi, Finnish Cancer Registry; Minna Pöyhönen and Janne Pitkäniemi, University of Helsinki; Minna Pöyhönen, Helsinki University Hospital, Helsinki; Eero Pukkala, University of Tampere, Tampere, Finland; and Vincent M. Riccardi, The Neurofibromatosis Institute, La Crescenta, CA.
authors.forename: Elina
authors.initials: E
authors.lastname: Uusitalo
authors.affiliation: Elina Uusitalo, Roope A. Kallionpää, Jussi Leppävirta, Heli Ylä-Outinen, Sirkku Peltonen, and Juha Peltonen, University of Turku; Jussi Leppävirta, Heli Ylä-Outinen, and Sirkku Peltonen, Turku University Hospital, Turku; Matti Rantanen, Eero Pukkala, and Janne Pitkäniemi, Finnish Cancer Registry; Minna Pöyhönen and Janne Pitkäniemi, University of Helsinki; Minna Pöyhönen, Helsinki University Hospital, Helsinki; Eero Pukkala, University of Tampere, Tampere, Finland; and Vincent M. Riccardi, The Neurofibromatosis Institute, La Crescenta, CA.
authors.forename: Matti
authors.initials: M
authors.lastname: Rantanen
authors.affiliation: Elina Uusitalo, Roope A. Kallionpää, Jussi Leppävirta, Heli Ylä-Outinen, Sirkku Peltonen, and Juha Peltonen, University of Turku; Jussi Leppävirta, Heli Ylä-Outinen, and Sirkku Peltonen, Turku University Hospital, Turku; Matti Rantanen, Eero Pukkala, and Janne Pitkäniemi, Finnish Cancer Registry; Minna Pöyhönen and Janne Pitkäniemi, University of Helsinki; Minna Pöyhönen, Helsinki University Hospital, Helsinki; Eero Pukkala, University of Tampere, Tampere, Finland; and Vincent M. Riccardi, The Neurofibromatosis Institute, La Crescenta, CA.
authors.forename: Roope A
authors.initials: RA
authors.lastname: Kallionpää
authors.affiliation: Elina Uusitalo, Roope A. Kallionpää, Jussi Leppävirta, Heli Ylä-Outinen, Sirkku Peltonen, and Juha Peltonen, University of Turku; Jussi Leppävirta, Heli Ylä-Outinen, and Sirkku Peltonen, Turku University Hospital, Turku; Matti Rantanen, Eero Pukkala, and Janne Pitkäniemi, Finnish Cancer Registry; Minna Pöyhönen and Janne Pitkäniemi, University of Helsinki; Minna Pöyhönen, Helsinki University Hospital, Helsinki; Eero Pukkala, University of Tampere, Tampere, Finland; and Vincent M. Riccardi, The Neurofibromatosis Institute, La Crescenta, CA.
authors.forename: Minna
authors.initials: M
authors.lastname: Pöyhönen
authors.affiliation: Elina Uusitalo, Roope A. Kallionpää, Jussi Leppävirta, Heli Ylä-Outinen, Sirkku Peltonen, and Juha Peltonen, University of Turku; Jussi Leppävirta, Heli Ylä-Outinen, and Sirkku Peltonen, Turku University Hospital, Turku; Matti Rantanen, Eero Pukkala, and Janne Pitkäniemi, Finnish Cancer Registry; Minna Pöyhönen and Janne Pitkäniemi, University of Helsinki; Minna Pöyhönen, Helsinki University Hospital, Helsinki; Eero Pukkala, University of Tampere, Tampere, Finland; and Vincent M. Riccardi, The Neurofibromatosis Institute, La Crescenta, CA.
authors.forename: Jussi
authors.initials: J
authors.lastname: Leppävirta
authors.affiliation: Elina Uusitalo, Roope A. Kallionpää, Jussi Leppävirta, Heli Ylä-Outinen, Sirkku Peltonen, and Juha Peltonen, University of Turku; Jussi Leppävirta, Heli Ylä-Outinen, and Sirkku Peltonen, Turku University Hospital, Turku; Matti Rantanen, Eero Pukkala, and Janne Pitkäniemi, Finnish Cancer Registry; Minna Pöyhönen and Janne Pitkäniemi, University of Helsinki; Minna Pöyhönen, Helsinki University Hospital, Helsinki; Eero Pukkala, University of Tampere, Tampere, Finland; and Vincent M. Riccardi, The Neurofibromatosis Institute, La Crescenta, CA.
authors.forename: Heli
authors.initials: H
authors.lastname: Ylä-Outinen
authors.affiliation: Elina Uusitalo, Roope A. Kallionpää, Jussi Leppävirta, Heli Ylä-Outinen, Sirkku Peltonen, and Juha Peltonen, University of Turku; Jussi Leppävirta, Heli Ylä-Outinen, and Sirkku Peltonen, Turku University Hospital, Turku; Matti Rantanen, Eero Pukkala, and Janne Pitkäniemi, Finnish Cancer Registry; Minna Pöyhönen and Janne Pitkäniemi, University of Helsinki; Minna Pöyhönen, Helsinki University Hospital, Helsinki; Eero Pukkala, University of Tampere, Tampere, Finland; and Vincent M. Riccardi, The Neurofibromatosis Institute, La Crescenta, CA.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Riccardi
authors.affiliation: Elina Uusitalo, Roope A. Kallionpää, Jussi Leppävirta, Heli Ylä-Outinen, Sirkku Peltonen, and Juha Peltonen, University of Turku; Jussi Leppävirta, Heli Ylä-Outinen, and Sirkku Peltonen, Turku University Hospital, Turku; Matti Rantanen, Eero Pukkala, and Janne Pitkäniemi, Finnish Cancer Registry; Minna Pöyhönen and Janne Pitkäniemi, University of Helsinki; Minna Pöyhönen, Helsinki University Hospital, Helsinki; Eero Pukkala, University of Tampere, Tampere, Finland; and Vincent M. Riccardi, The Neurofibromatosis Institute, La Crescenta, CA.
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
authors.affiliation: Elina Uusitalo, Roope A. Kallionpää, Jussi Leppävirta, Heli Ylä-Outinen, Sirkku Peltonen, and Juha Peltonen, University of Turku; Jussi Leppävirta, Heli Ylä-Outinen, and Sirkku Peltonen, Turku University Hospital, Turku; Matti Rantanen, Eero Pukkala, and Janne Pitkäniemi, Finnish Cancer Registry; Minna Pöyhönen and Janne Pitkäniemi, University of Helsinki; Minna Pöyhönen, Helsinki University Hospital, Helsinki; Eero Pukkala, University of Tampere, Tampere, Finland; and Vincent M. Riccardi, The Neurofibromatosis Institute, La Crescenta, CA.
authors.forename: Janne
authors.initials: J
authors.lastname: Pitkäniemi
authors.affiliation: Elina Uusitalo, Roope A. Kallionpää, Jussi Leppävirta, Heli Ylä-Outinen, Sirkku Peltonen, and Juha Peltonen, University of Turku; Jussi Leppävirta, Heli Ylä-Outinen, and Sirkku Peltonen, Turku University Hospital, Turku; Matti Rantanen, Eero Pukkala, and Janne Pitkäniemi, Finnish Cancer Registry; Minna Pöyhönen and Janne Pitkäniemi, University of Helsinki; Minna Pöyhönen, Helsinki University Hospital, Helsinki; Eero Pukkala, University of Tampere, Tampere, Finland; and Vincent M. Riccardi, The Neurofibromatosis Institute, La Crescenta, CA.
authors.forename: Sirkku
authors.initials: S
authors.lastname: Peltonen
authors.affiliation: Elina Uusitalo, Roope A. Kallionpää, Jussi Leppävirta, Heli Ylä-Outinen, Sirkku Peltonen, and Juha Peltonen, University of Turku; Jussi Leppävirta, Heli Ylä-Outinen, and Sirkku Peltonen, Turku University Hospital, Turku; Matti Rantanen, Eero Pukkala, and Janne Pitkäniemi, Finnish Cancer Registry; Minna Pöyhönen and Janne Pitkäniemi, University of Helsinki; Minna Pöyhönen, Helsinki University Hospital, Helsinki; Eero Pukkala, University of Tampere, Tampere, Finland; and Vincent M. Riccardi, The Neurofibromatosis Institute, La Crescenta, CA. juhpel@utu.fi.
authors.forename: Juha
authors.initials: J
authors.lastname: Peltonen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000401:mortality; D009456:Neurofibromatosis 1 / Q000453:epidemiology* / Q000401:mortality; D012042:Registries; D012306:Risk