Familial risk and heritability of cancer among twins in nordic countries

Lorelei A. Mucci, Jacob B. Hjelmborg, Jennifer R. Harris, Kamila Czene, David J. Havelick, Thomas Scheike, Rebecca E. Graff, Klaus Holst, Sören Möller, Robert H. Unger, Christina McIntosh, Elizabeth Nuttall, Ingunn Brandt, Kathryn L. Penney, Mikael Hartman, Peter Kraft, Giovanni Parmigiani, Kaare Christensen, Markku Koskenvuo, Niels V. Holm & 9 others Kauko Heikkilä, Eero Pukkala, Axel Skytthe, Hans Olov Adami, Jaakko Kaprio, Julia Isaeva, Thomas Nilsen, Tellervo Korhonen, Ulrich Halekoh

Research output: Contribution to journalArticle

Abstract

Importance: Estimates of familial cancer risk from population-based studies are essential components of cancer risk prediction. Objective: To estimate familial risk and heritability of cancer types in a large twin cohort. Design, Setting, and Participants: Prospective study of 80 309 monozygotic and 123 382 same-sex dizygotic twin individuals (N = 203 691) within the population-based registers of Denmark, Finland, Norway, and Sweden. Twins were followed up a median of 32 years between 1943 and 2010. There were 50 990 individuals who died of any cause, and 3804 who emigrated and were lost to follow-up. EXPOSURES Shared environmental and heritable risk factors among pairs of twins. Main Outcomes and Measures: The main outcome was incident cancer. Time-to-event analyses were used to estimate familial risk (risk of cancer in an individual given a twin's development of cancer) and heritability (proportion of variance in cancer risk due to interindividual genetic differences) with follow-up via cancer registries. Statistical models adjusted for age and follow-up time, and accounted for censoring and competing risk of death. Results: A total of 27 156 incident cancers were diagnosed in 23 980 individuals, translating to a cumulative incidence of 32%. Cancer was diagnosed in both twins among 1383 monozygotic (2766 individuals) and 1933 dizygotic (2866 individuals) pairs. Of these, 38%of monozygotic and 26%of dizygotic pairs were diagnosed with the same cancer type. There was an excess cancer risk in twins whose co-twin was diagnosed with cancer, with estimated cumulative risks that were an absolute 5%(95% CI, 4%-6%) higher in dizygotic (37%; 95% CI, 36%-38%) and an absolute 14%(95% CI, 12%-16%) higher in monozygotic twins (46%; 95% CI, 44%-48%) whose twin also developed cancer compared with the cumulative risk in the overall cohort (32%). For most cancer types, there were significant familial risks and the cumulative risks were higher in monozygotic than dizygotic twins. Heritability of cancer overall was 33%(95% CI, 30%-37%). Significant heritability was observed for the cancer types of skin melanoma (58%; 95% CI, 43%-73%), prostate (57%; 95% CI, 51%-63%), nonmelanoma skin (43%; 95% CI, 26%-59%), ovary (39%; 95% CI, 23%-55%), kidney (38%; 95% CI, 21%-55%), breast (31%; 95% CI, 11%-51%), and corpus uteri (27%; 95% CI, 11%-43%). Conclusions and Relevance: In this long-term follow-up study among Nordic twins, there was significant excess familial risk for cancer overall and for specific types of cancer, including prostate, melanoma, breast, ovary, and uterus. This information about hereditary risks of cancers may be helpful in patient education and cancer risk counseling.

Original languageEnglish (US)
Pages (from-to)68-76
Number of pages9
JournalJournal of the American Medical Association
Volume315
Issue number1
DOIs
StatePublished - Jan 5 2016
Externally publishedYes

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Scandinavian and Nordic Countries
Neoplasms
Dizygotic Twins
Monozygotic Twins
Uterus
Registries
Ovary
Melanoma
Breast

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Mucci, L. A., Hjelmborg, J. B., Harris, J. R., Czene, K., Havelick, D. J., Scheike, T., ... Halekoh, U. (2016). Familial risk and heritability of cancer among twins in nordic countries. Journal of the American Medical Association, 315(1), 68-76. https://doi.org/10.1001/jama.2015.17703

Familial risk and heritability of cancer among twins in nordic countries. / Mucci, Lorelei A.; Hjelmborg, Jacob B.; Harris, Jennifer R.; Czene, Kamila; Havelick, David J.; Scheike, Thomas; Graff, Rebecca E.; Holst, Klaus; Möller, Sören; Unger, Robert H.; McIntosh, Christina; Nuttall, Elizabeth; Brandt, Ingunn; Penney, Kathryn L.; Hartman, Mikael; Kraft, Peter; Parmigiani, Giovanni; Christensen, Kaare; Koskenvuo, Markku; Holm, Niels V.; Heikkilä, Kauko; Pukkala, Eero; Skytthe, Axel; Adami, Hans Olov; Kaprio, Jaakko; Isaeva, Julia; Nilsen, Thomas; Korhonen, Tellervo; Halekoh, Ulrich.

In: Journal of the American Medical Association, Vol. 315, No. 1, 05.01.2016, p. 68-76.

Research output: Contribution to journalArticle

Mucci, LA, Hjelmborg, JB, Harris, JR, Czene, K, Havelick, DJ, Scheike, T, Graff, RE, Holst, K, Möller, S, Unger, RH, McIntosh, C, Nuttall, E, Brandt, I, Penney, KL, Hartman, M, Kraft, P, Parmigiani, G, Christensen, K, Koskenvuo, M, Holm, NV, Heikkilä, K, Pukkala, E, Skytthe, A, Adami, HO, Kaprio, J, Isaeva, J, Nilsen, T, Korhonen, T & Halekoh, U 2016, 'Familial risk and heritability of cancer among twins in nordic countries', Journal of the American Medical Association, vol. 315, no. 1, pp. 68-76. https://doi.org/10.1001/jama.2015.17703
Mucci LA, Hjelmborg JB, Harris JR, Czene K, Havelick DJ, Scheike T et al. Familial risk and heritability of cancer among twins in nordic countries. Journal of the American Medical Association. 2016 Jan 5;315(1):68-76. https://doi.org/10.1001/jama.2015.17703
Mucci, Lorelei A. ; Hjelmborg, Jacob B. ; Harris, Jennifer R. ; Czene, Kamila ; Havelick, David J. ; Scheike, Thomas ; Graff, Rebecca E. ; Holst, Klaus ; Möller, Sören ; Unger, Robert H. ; McIntosh, Christina ; Nuttall, Elizabeth ; Brandt, Ingunn ; Penney, Kathryn L. ; Hartman, Mikael ; Kraft, Peter ; Parmigiani, Giovanni ; Christensen, Kaare ; Koskenvuo, Markku ; Holm, Niels V. ; Heikkilä, Kauko ; Pukkala, Eero ; Skytthe, Axel ; Adami, Hans Olov ; Kaprio, Jaakko ; Isaeva, Julia ; Nilsen, Thomas ; Korhonen, Tellervo ; Halekoh, Ulrich. / Familial risk and heritability of cancer among twins in nordic countries. In: Journal of the American Medical Association. 2016 ; Vol. 315, No. 1. pp. 68-76.
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abstract = "Importance: Estimates of familial cancer risk from population-based studies are essential components of cancer risk prediction. Objective: To estimate familial risk and heritability of cancer types in a large twin cohort. Design, Setting, and Participants: Prospective study of 80 309 monozygotic and 123 382 same-sex dizygotic twin individuals (N = 203 691) within the population-based registers of Denmark, Finland, Norway, and Sweden. Twins were followed up a median of 32 years between 1943 and 2010. There were 50 990 individuals who died of any cause, and 3804 who emigrated and were lost to follow-up. EXPOSURES Shared environmental and heritable risk factors among pairs of twins. Main Outcomes and Measures: The main outcome was incident cancer. Time-to-event analyses were used to estimate familial risk (risk of cancer in an individual given a twin's development of cancer) and heritability (proportion of variance in cancer risk due to interindividual genetic differences) with follow-up via cancer registries. Statistical models adjusted for age and follow-up time, and accounted for censoring and competing risk of death. Results: A total of 27 156 incident cancers were diagnosed in 23 980 individuals, translating to a cumulative incidence of 32{\%}. Cancer was diagnosed in both twins among 1383 monozygotic (2766 individuals) and 1933 dizygotic (2866 individuals) pairs. Of these, 38{\%}of monozygotic and 26{\%}of dizygotic pairs were diagnosed with the same cancer type. There was an excess cancer risk in twins whose co-twin was diagnosed with cancer, with estimated cumulative risks that were an absolute 5{\%}(95{\%} CI, 4{\%}-6{\%}) higher in dizygotic (37{\%}; 95{\%} CI, 36{\%}-38{\%}) and an absolute 14{\%}(95{\%} CI, 12{\%}-16{\%}) higher in monozygotic twins (46{\%}; 95{\%} CI, 44{\%}-48{\%}) whose twin also developed cancer compared with the cumulative risk in the overall cohort (32{\%}). For most cancer types, there were significant familial risks and the cumulative risks were higher in monozygotic than dizygotic twins. Heritability of cancer overall was 33{\%}(95{\%} CI, 30{\%}-37{\%}). Significant heritability was observed for the cancer types of skin melanoma (58{\%}; 95{\%} CI, 43{\%}-73{\%}), prostate (57{\%}; 95{\%} CI, 51{\%}-63{\%}), nonmelanoma skin (43{\%}; 95{\%} CI, 26{\%}-59{\%}), ovary (39{\%}; 95{\%} CI, 23{\%}-55{\%}), kidney (38{\%}; 95{\%} CI, 21{\%}-55{\%}), breast (31{\%}; 95{\%} CI, 11{\%}-51{\%}), and corpus uteri (27{\%}; 95{\%} CI, 11{\%}-43{\%}). Conclusions and Relevance: In this long-term follow-up study among Nordic twins, there was significant excess familial risk for cancer overall and for specific types of cancer, including prostate, melanoma, breast, ovary, and uterus. This information about hereditary risks of cancers may be helpful in patient education and cancer risk counseling.",
author = "Mucci, {Lorelei A.} and Hjelmborg, {Jacob B.} and Harris, {Jennifer R.} and Kamila Czene and Havelick, {David J.} and Thomas Scheike and Graff, {Rebecca E.} and Klaus Holst and S{\"o}ren M{\"o}ller and Unger, {Robert H.} and Christina McIntosh and Elizabeth Nuttall and Ingunn Brandt and Penney, {Kathryn L.} and Mikael Hartman and Peter Kraft and Giovanni Parmigiani and Kaare Christensen and Markku Koskenvuo and Holm, {Niels V.} and Kauko Heikkil{\"a} and Eero Pukkala and Axel Skytthe and Adami, {Hans Olov} and Jaakko Kaprio and Julia Isaeva and Thomas Nilsen and Tellervo Korhonen and Ulrich Halekoh",
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TY - JOUR

T1 - Familial risk and heritability of cancer among twins in nordic countries

AU - Mucci, Lorelei A.

AU - Hjelmborg, Jacob B.

AU - Harris, Jennifer R.

AU - Czene, Kamila

AU - Havelick, David J.

AU - Scheike, Thomas

AU - Graff, Rebecca E.

AU - Holst, Klaus

AU - Möller, Sören

AU - Unger, Robert H.

AU - McIntosh, Christina

AU - Nuttall, Elizabeth

AU - Brandt, Ingunn

AU - Penney, Kathryn L.

AU - Hartman, Mikael

AU - Kraft, Peter

AU - Parmigiani, Giovanni

AU - Christensen, Kaare

AU - Koskenvuo, Markku

AU - Holm, Niels V.

AU - Heikkilä, Kauko

AU - Pukkala, Eero

AU - Skytthe, Axel

AU - Adami, Hans Olov

AU - Kaprio, Jaakko

AU - Isaeva, Julia

AU - Nilsen, Thomas

AU - Korhonen, Tellervo

AU - Halekoh, Ulrich

PY - 2016/1/5

Y1 - 2016/1/5

N2 - Importance: Estimates of familial cancer risk from population-based studies are essential components of cancer risk prediction. Objective: To estimate familial risk and heritability of cancer types in a large twin cohort. Design, Setting, and Participants: Prospective study of 80 309 monozygotic and 123 382 same-sex dizygotic twin individuals (N = 203 691) within the population-based registers of Denmark, Finland, Norway, and Sweden. Twins were followed up a median of 32 years between 1943 and 2010. There were 50 990 individuals who died of any cause, and 3804 who emigrated and were lost to follow-up. EXPOSURES Shared environmental and heritable risk factors among pairs of twins. Main Outcomes and Measures: The main outcome was incident cancer. Time-to-event analyses were used to estimate familial risk (risk of cancer in an individual given a twin's development of cancer) and heritability (proportion of variance in cancer risk due to interindividual genetic differences) with follow-up via cancer registries. Statistical models adjusted for age and follow-up time, and accounted for censoring and competing risk of death. Results: A total of 27 156 incident cancers were diagnosed in 23 980 individuals, translating to a cumulative incidence of 32%. Cancer was diagnosed in both twins among 1383 monozygotic (2766 individuals) and 1933 dizygotic (2866 individuals) pairs. Of these, 38%of monozygotic and 26%of dizygotic pairs were diagnosed with the same cancer type. There was an excess cancer risk in twins whose co-twin was diagnosed with cancer, with estimated cumulative risks that were an absolute 5%(95% CI, 4%-6%) higher in dizygotic (37%; 95% CI, 36%-38%) and an absolute 14%(95% CI, 12%-16%) higher in monozygotic twins (46%; 95% CI, 44%-48%) whose twin also developed cancer compared with the cumulative risk in the overall cohort (32%). For most cancer types, there were significant familial risks and the cumulative risks were higher in monozygotic than dizygotic twins. Heritability of cancer overall was 33%(95% CI, 30%-37%). Significant heritability was observed for the cancer types of skin melanoma (58%; 95% CI, 43%-73%), prostate (57%; 95% CI, 51%-63%), nonmelanoma skin (43%; 95% CI, 26%-59%), ovary (39%; 95% CI, 23%-55%), kidney (38%; 95% CI, 21%-55%), breast (31%; 95% CI, 11%-51%), and corpus uteri (27%; 95% CI, 11%-43%). Conclusions and Relevance: In this long-term follow-up study among Nordic twins, there was significant excess familial risk for cancer overall and for specific types of cancer, including prostate, melanoma, breast, ovary, and uterus. This information about hereditary risks of cancers may be helpful in patient education and cancer risk counseling.

AB - Importance: Estimates of familial cancer risk from population-based studies are essential components of cancer risk prediction. Objective: To estimate familial risk and heritability of cancer types in a large twin cohort. Design, Setting, and Participants: Prospective study of 80 309 monozygotic and 123 382 same-sex dizygotic twin individuals (N = 203 691) within the population-based registers of Denmark, Finland, Norway, and Sweden. Twins were followed up a median of 32 years between 1943 and 2010. There were 50 990 individuals who died of any cause, and 3804 who emigrated and were lost to follow-up. EXPOSURES Shared environmental and heritable risk factors among pairs of twins. Main Outcomes and Measures: The main outcome was incident cancer. Time-to-event analyses were used to estimate familial risk (risk of cancer in an individual given a twin's development of cancer) and heritability (proportion of variance in cancer risk due to interindividual genetic differences) with follow-up via cancer registries. Statistical models adjusted for age and follow-up time, and accounted for censoring and competing risk of death. Results: A total of 27 156 incident cancers were diagnosed in 23 980 individuals, translating to a cumulative incidence of 32%. Cancer was diagnosed in both twins among 1383 monozygotic (2766 individuals) and 1933 dizygotic (2866 individuals) pairs. Of these, 38%of monozygotic and 26%of dizygotic pairs were diagnosed with the same cancer type. There was an excess cancer risk in twins whose co-twin was diagnosed with cancer, with estimated cumulative risks that were an absolute 5%(95% CI, 4%-6%) higher in dizygotic (37%; 95% CI, 36%-38%) and an absolute 14%(95% CI, 12%-16%) higher in monozygotic twins (46%; 95% CI, 44%-48%) whose twin also developed cancer compared with the cumulative risk in the overall cohort (32%). For most cancer types, there were significant familial risks and the cumulative risks were higher in monozygotic than dizygotic twins. Heritability of cancer overall was 33%(95% CI, 30%-37%). Significant heritability was observed for the cancer types of skin melanoma (58%; 95% CI, 43%-73%), prostate (57%; 95% CI, 51%-63%), nonmelanoma skin (43%; 95% CI, 26%-59%), ovary (39%; 95% CI, 23%-55%), kidney (38%; 95% CI, 21%-55%), breast (31%; 95% CI, 11%-51%), and corpus uteri (27%; 95% CI, 11%-43%). Conclusions and Relevance: In this long-term follow-up study among Nordic twins, there was significant excess familial risk for cancer overall and for specific types of cancer, including prostate, melanoma, breast, ovary, and uterus. This information about hereditary risks of cancers may be helpful in patient education and cancer risk counseling.

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