In utero exposure to female hormones and germ cell tumors in children


  • Participating institutions are: University of South Alabama, Mobile, AL; University of Arkansas, Little Rock, AR; Phoenix Children's Hospital, Phoenix, AZ; British Columbia's Children's Hospital, Vancouver, BC, Canada; Children's Hospital of Los Angeles, Los Angeles, CA; Children's Hospital of Oakland, Oakland, CA; Children's Hospital of Orange County, Orange, CA; City of Hope National Medical Center, Duarte, CA; Kaiser Permanente Medical Group, Inc., Northern CA, Oakland, CA; Loma Linda University Cancer Institute, Loma Linda, CA; Santa Barbara Cottage Hospital, Santa Barbara, CA; Southern California Permanente Medical Group, Downey, CA; University of California, San Francisco School of Medicine, San Francisco, CA; University of California, Los Angeles School of Medicine, Los Angeles, CA; Harbor/University of California, Medical Center, Torrance, CA; The Children's Hospital, Denver, Denver, CO; Children's National Medical Center, D.C., Washington, DC; Children's Healthcare of Atlanta at Egleston, Atlanta, GA; Raymond Blank Children's Hospital, Des Moines, IA; University of Iowa Hospitals & Clinics, Iowa City, IA; Southern Illinois University School of Medicine, Springfield, IL; University of Illinois, Chicago, IL; Clarian Health, Indianapolis, IN; Indiana University, Riley Children's Hospital, Indianapolis, IN; Kosair Children's Hospital, Louisville, KY; Dana Farber Cancer Institute/Children's Hospital of Boston, Boston, MA; C.S. Mott Children's Hospital, Ann Arbor, MI; DeVos Children's Hospital, Grand Rapids, MI; Kalamazoo Community Clinical Oncology Program, Kalamazoo, MI; Michigan State University, Lansing, MI; Mayo Clinic and Foundation, Rochester, MN; The Children's Mercy Hospital, Kansas City, MO; University of North Carolina at Chapel Hill, Chapel Hill, NC; Janeway Child Health Center, St Johns, NL, Canada; University of Medical and Dentistry of New Jersey, New Brunswick, NJ; Izaak Walton Killam Children's Hospital, Halifax, NS; Canada; Sunrise Children's Hospital, Sunrise Hospital and Med Center, Las Vegas, NV; Albany Medical Center, Albany, NY; Montefiore Medical Center, New York, NY; New York University Medical Center, New York, NY; SUNY Health Science Center at Brooklyn, Brooklyn, NY; Children's Hospital Medical Center, Akron, Akron, OH; Children's Hospital of Columbus, Columbus, OH; Children's Medical Center, Dayton, Dayton, OH; Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Mercy Children's Hospital, Toledo, OH; Rainbow Babies and Children's Hospital, Cleveland, OH; Children's East Ontario, Ottawa, ON; Canada; Children's Hospital of Western Ontario, London, ON; Canada; Emanuel Hospital—Health Care, Portland, OR; Children's Hospital of Philadelphia, Philadelphia, PA; Children's Hospital of Pittsburgh, Pittsburgh, PA; Penn State Children's Hospital, Hershey, PA; South Carolina Cancer Center, Columbia, SC; Dakota Midwest Cancer Institute, Sioux Falls, SD; Allain Blair Cancer Centre, Regina, SK; Canada; Saskatoon Cancer Center, Saskatoon, SK; Canada; East Tennessee Children's Hospital, Knoxville, TN; Vanderbilt University, Nashville, TN; Columbia Medical Center—West, El Paso, TX; M.D. Anderson Cancer Center, Houston, TX; Scott & White, Temple, TX; Southwest Texas Methodist Hospital, San Antonio, TX; Texas Tech University, Health Science Center, Amarillo, TX; Primary Children's Medical Center, Salt Lake City, UT; Children's Hospital, King's Daughters, Norfolk, VA; Children's Hospital & Regional Medical Center, Seattle, Seattle, WA; Deaconess Medical Center, Spokane, WA; Group Health Cooperative of Puget Sound, Redmond, WA; Bellin Memorial Hospital, Green Bay, WI; Marshfield Clinic, Marshfield, WI; Oregon Health Sciences University, Portland, OR; Medical Center of Delaware—Alfred I. Dupont Institute, Wilmington, DE; Atlantic Health System, Morristown, NJ; University of Minnesota, Minneapolis, MN; Childrens Hospital & Clinics Minneapolis & St Paul, Minneapolis & St Paul, MN; Children's Hospital Central California, Madera, CA; Sioux Valley Children's Specialty Clinics, Sioux Falls, SD; The Children's Hospital at The Cleveland Clinic, Cleveland, OH; MeritCare Medical Group DBA Roger Maris Cancer Center, Fargo, ND.



Maternal exposure to exogenous female hormones during pregnancy has been implicated as a risk factor for malignant germ cell tumors (GCTs) in the offspring in some epidemiologic studies of testicular and ovarian carcinoma in adults.


From 1996 to 2002, 278 children younger than 15 years of age with malignant GCTs and 423 healthy controls, frequency-matched for geographic location, age, and sex were enrolled in a case–control study to investigate whether in utero exposure to female hormones is associated with the risk of malignant GCT in children. Cases were recruited from 84 institutions in the U.S. and controls were enrolled through random digit dialing. Information was obtained through telephone interview with the biological mothers of the subjects and through blinded review of the mothers' medical records.


Neither self-reported (odds ratio [OR] = 1.15; 95% confidence interval [CI], 0.63, 2.12) nor medical chart based (OR = 1.14; 95% CI, 0.75, 1.73) maternal exposure to exogenous female hormones was related to malignant GCT risk. Pregnancy-related conditions that may have altered serum levels of circulating female hormones were also unrelated to the risk of GCT in the offspring.


This study failed to provide strong evidence to support the hypothesis that maternal exposure to exogenous female hormones during pregnancy increases the risk of GCT in the offspring. Cancer 2006. © 2006 American Cancer Society.