TABLE 4. Risk Factors (Known, Suggestive, Limited) Associated With Childhood Germ Cell Tumors, Carcinomas and Other Malignant Epithelial Tumors, and Retinoblastoma

Exposure or Characteristic Germ Cell Tumors

Carcinomas and Other Malignant Epithelial Tumors

Retinoblastoma

Known

 Gender Type M:F Age-adjusted incidence Type M:F Age-adjusted incidence Type M:F Age-adjusted incidence
 All germ cell  1.1  10.1 per million  All carcinomas  0.5  14.1 per million  All retinoblastoma  1.0  2.8 per million
 Gonadal  1.5  6.1  Thyroid carcinoma  0.2  5.0
 Testicular  8.1  Malignant melanoma  0.6  4.5
 Ovarian  5.3
 Age peak 15–19 y 15–19 y Infancy
 Race W:B = 1.5 W:B = 1.5 W:B = 0.9
 Other Cryptorchidism Thyroid carcinoma Parent with a history of bilateral retinoblastoma
 Ionizing radiation exposure during childhood from  environmental and medical sources
 Inherited cancer susceptibility syndromes (familial  polyposis multiple endocrine neoplasia types I, II-A, II-B)
Malignant melanoma
 Ultraviolet sunlight exposure
 Number of nevi and dysplastic nevi
Suggestive High maternal hormone levels during pregnancy Thyroid carcinoma 13q deletion syndrome
Family history of germ cell tumor  Hormonal factors
Hernia  Benign thyroid diseases
Preterm birth
Limited Viral infections Paternal occupation including military, metal
High birth weight  manufacturing and welding, machining, or related
Prenatal radiographic exposure  occupation
Parental occupation including health care, aircraft industry (paternal), and other work involving exposure to x-rays (paternal) or solvents (maternal)
Constitutional chromosome abnormalities (Klinefelter syndrome)

M:F indicates male-to-female ratio of incidence; W:B, white-to-black ratio of incidence.