Journal of Surgical Oncology 44:62-65 (1990)
Married Couples and Cancer NATAL10 WALACH, MD From the Department of Oncology, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler School of Medicine, Tel Aviv University, lsrael
The occurrence of cancer in 46 couples related only by marriage and treated in a regional hospital is reported. Twenty-four pairs had tumors of the same histopathologic type. Three couples had the same tumors with similar histology: brain (astrocytoma), urinary bladder (transitional cell carcinoma), and lung (adenocarcinoma). The possible significance of environmental, nutritional, and contamination factors are emphasized. although this is a probably coincidental phenomenon. KEY WORDS:environmental factors, coincidental phenomena, histology
INTRODUCTION Cancer in married couples is rare. Etiologic factors associated with cancer include heredity, race, sex, age, endocrine status, environment, nutrition, physical and chemical substance exposure, ionizing radiation, and organisms, including parasites and viruses [ 11. Although married couples are, in general, unrelated genetically and are intimately associated in the home environtnent during adult life, little research has been done to investigate this particular environmental association of cancer 121. An 8 year prospective study was performed in a regional hospital to identify married couples with cancer in both partners. MATERIAL AND METHODS During the period between January, 1978, and December, 1985, all cancer patients referred to the Department of Oncology at the Assaf Harofeh Medical Center, were interviewed about their partner’s condition and past history of cancer. During this period, 2,312 patients were admitted and 46 couples were identified. Among the total of 92 patients included in this study, 72 were diagnosed and treated during this 8 year period: 20 were treated before the year 1978. At least one of the partners was referred during the study period (1978-1985). Diagnosis was made on the basis of histopathologic examination from tissues removed. Information was obtained directly from patients. relatives, medical files, and the Ministry of Interior for details such as dates of birth, marriage, and death, especially for patients diagnosed before the year 1978. Details of patient’s history, organ 0 1990 Wiley-Liss, Inc.
involvement, and type of cancer are summarized in Table 1.
RESULTS The 46 couples had lived together for an average period of 36 years (range 12-54 years) before the first cancer was diagnosed. The mean time interval between the diagnosis of cancer in the married couples was 6.8 years, with a range of 1-26 years. Age of the patients ranged between 38 and 80 years, with a mean of 63.8 years. The mean age for females was 59.8 and for males 67.8 years. Two males had double tumors. In couple 7, the husband suffered from tumors in the nasopharynx and colon, and in couple 10 the husband suffered from tumors in the urinary bladder and colon. In both cases the patients died from the tumors of the colon. In three couples, cancer involved the same organ system, with the same histology. In couple 9, both patients suffered from brain tumors and the histology was astrocytoma grade IV. In couple 36, husband and wife suffered from urinary bladder tumors. The histology was transitional cell carcinoma. In couple 42, the patients suffered from lung tumors, with identical histology (adenocarcinoma) .
Accepted for publication June 5 , 1989 Address reprint requests to Natalio Walach. MD, Department of Oncology, Assaf Harofeh Medical Center, Zerifin 70300. Israel.
Married Couples and Cancer
631
TABLE 1. Cancer in Married Couples Cancer Couple
I
Sex
F M F M F M F M F M F M
I929 1903 1913 1909 I908 li 907 1913 11914 1916 1913 1923 I923 1922 1921
F M F M F M
1918 1906 1918 I920 1915 I908
F
1919 I906 1915 1912 1917 I91 1 1912 1902 1916 1912 I91 1 I907 1913 1913 1925 1923 1910 1909 1919 1903 1932 1927 1913 I908 1921 1918 1914 1913 1941 1937 1919 1913 1906 1906 I940 1933
F M
73 4 5
6 7
8 9
10
11
M
12 13 I4
IS
F M F M F M F M
16 17 18 19
F M F M F M F
M 20 21 22 23 24 25
F M F M F M F M F M F
M 26 27 28
Birth (year)
F M F M F
M
Marriage (year) 1946 1929 1930 I948 1934 1945 1940
1936 1939 1935
1937 1932 1934 1938 1945 1932 1937 1944 1930 1937 1966 1937 1940 I940 1958 1938 1930 1961
Appearance ( year) 1980 1977 I976 1979 1976 1980 1974 1978 1954 I978 1974 1979 I98 1 1975 1958 1978 1980 1979 1976 1980 1975 1980 1978 1982 1975 1981 I979 I980 I980 1981 1979 1982 1978 1982 I966 I978 1982 1978 1984 1981 1978 1983 1983 1980 1981 1983 1984 I969 1981 I984 1983 1984 1977 1983 1978 1983
Location
Histology (type)”
Uterus Lung Breast Pancreas Breast Lung Brain U. bladder Breast U . bladder Breast Colon Stomach Nasopharynx (colon 1985) Breast Colon Brain Brain Breast U . bladder (colon 1982) Cervix U. bladder Liver Gallbladder Breast Prostate Pancreas U. bladder Breast Colon Pancreas Lung Breast Bone (metastatic) Breast Kidney Colon Larynx Breast Larynx Breast Colon Uterus Skin Brain Colon Breast Stomach Breast U. bladder Colon Lung Lymph nodes Pharynx Breast Skin
Adenoca Adenoca Adenoca Adenoca Adenoca Sq. cell Astroc ytoma Transit. cell Adenoca Transit. cell Adenoca Adenoca Lymphoma Lymphoepithelioma (adenoca) Adenoca Adenoca Astrocytoma gr IV Astrocytoma gr IV Adenoca Transit. cell (adenoca) Sq. cell Transit. cell Adenoca Adenoca Adenoca Adenoca Adenoca Transit. cell Adenoca Adenoca Adenoca Adenoca Adenoca Clear cell Adenoca Clear cell Adenoca Sq. cell Adenoca Sq. cell Adenoca Adenoca Adenoca Mycosis fungoides Astrocytoma Adenoca Adenoca Adenoca Adenoca Transit, cell Adenoca Adenoca Lymphoma Sq. cell Adenoca Sq. cell
.
F~II~w-uP Well Dead Well Dead Dead Dead Dead Well Well Well Dead Dead Dead Dead Dead Dead Dead Dead Well
( 1977)
(1980) (1979) (1981) ( 1979)
(1980) (1981) (1981) ( 1985) (1981) ( 1 980) (1981) ( 1979)
Dead ( 1984) Dead (1977) Dead (1981) Dead (1979) Dead (1983) Well Dead (1983) Dead (1980) Dead ( 1982) Well Well Dead (1981) Dead (1982) Dead ( 1980) Dead (1983) Well Dead ( 1979) Well Well Well Well Dead (1 970) Well Well Dead ( I98:!) Dead (1982) Well Well Dead (I970) Well Well Dead ( 198fi) Dead (1 985) Dead ( 1979) Dead (1984) Well Well (con11 I? uvd)
64
Walach
TABLE I. Cancer in Married Couples (Continued) Cancer Couple 29 30 31 32 33 34
Sex
Birth (year)
F
1909 I908 1929 1929 1927
M F M F M
F M F M F F
M 36
39
F M F M F M F
40
M F
37 38
41 42 43 44 45 46
M F M F M F M F M F M F
1930 1952
1921
I947
1906 1903 1914
1923
1911
1933
1916 I904 1919 1914 1915 1913 1922 1906 1916 1911 1 YO8 1906 1931 1908 1916 1910 1924 1YO9
M 35
Marriage (year)
1934 1937 1936 1939 1937 1946 I947 1939 I943
I926
1926 1932 1924 1909 1907 1 908 1907
M
1951
1947 1929 1930
Appearance ( year)
Location
1984 I98 I 1983 1985 1982 1984 1975 1983 1970 1984 1958 I984 1972 1985 1982 1985 1985 1980 I975 1985 1985 1978 I979 1980 1982 1983 1985 1970 I967 1985 1978 1985 1985 1978 1985 1984
Maxilla Skin Skin Stomach Breast U. bladder Ovary Colon Breast Colon Breast Prostate Uterus Colon U. bladder U. bladder Ovary Proatate Breast Liver Breast Stomach Colon U . bladder Ovary Stomach Lung Lung Cervix Lung Breast Lung Lymph nodes Lung Breast Lung
Histology (type)d Melanoma Sq. cell Melanoma Adenoca Adenoca Transit. cell Aden oca Adenoca Adenoca Adenoca Adenoca Adenoca Adenoca Adenoca Transit. cell Transit. cell Adenoca Adenoca Adenoca Melanoma Adenoca Adenoca Adenoca Transit. cell Adenoca Adenoca Adenoca Adenoca Sq. cell. Sq. cell. Adenoca Sq. cell. Lymphoma Sq. cell. Adenoca Adenoca
FOIIOW-UP Well Well Well Well Well Well Well Dead ( 1984) Dead ( 1973) Well Dead (1958) Well Well Well Well Dead (1985) Well Well Well Dead (1985) Well Well Well Well Dead (1985) Well Dead ( 1986) Dead (1970) Dead ( 1968) Well Well Well Well Dead (1979) Well Dead ( 1985)
~
"Abbreviations: Adenoca. adenocarcinoma: Sq. cell, squamous cell carcinoma; Transit. cell. transitional cell carcinoma; Clear cell, clear cell carcinoma.
In 32 couples the cancer appeared first in the wives. and in 14 couples it appeared first in the husbands. Twenty-two patients suffered from breast carcinoma, 2 1 patients from gastrointestinal cancer, 10 patients from lung cancer, 13 patients from tumors in the genitourinary tract, and eight from lymphoma. Other tumors were metastatic of unknown origin, nasopharynx, and skin. Histology revealed 56 adenocarcinomas, 10 squamous cell carcinomas, nine transitional cell carcinomas, four astrocytonias, three melanomas, three lymphomas, and two clear cell carcinomas. Couples with the same histology had 21 adenocarcinomas, one astrocytoma, one squamous cell carcinoma, and one transitional cell carcinoma.
DISCUSSION The incidence of cancer in married couples is not high. In 1973 we reported 15 couples identified among 20,000 cancer patients [ 3 ] . Martinez [4] and Graham et al. [51 observed an increase in carcinoina of the cervix among wives of patients with penile carcinoma. Other malignancies such as lymphomas [6], colon carcinoma [7], breast cancer [8], and astrocytoma [9,10] have also been reported in married couples. Husbands and wives have contact of a more intimate nature than other adults. This intimacy may last for many years, during which time they share the identical home environment and are equally subject to such factors as climate, diet, and sanitation, which can influence their
Married Couples and Cancer
health. Cox and Mackay [ 1 I ] , in their review of psychological factors and cancer etiology, point out that specific variables such as marital status, socioeconomic status, stress, and social support interact with each other as a host environment complex. These factors could exacerbate the effects of known carcinogens, such as cigarette smoking and alcohol consumption. It is likely that these factors act synergistically to produce a promoter effect in the process of transformation and growth of malignant cells rather than acting independently. Onuigbo [ 121 describes the accepted theories prevalent during the nineteenth century regarding the occurrence of cancer in married couples, which stressed the importance of the contagiousness of cancer. Payan [I] reported on 19 married couples found among 2,512 charts of patients; two pairs suffered from carcinoma involving the same organs, one couple with carcinoma of the breast and one couple with transitional cell carcinoma of the bladder. Enck [13], in a 24 year retrospective review of 3,333 cases of cancer, found 46 couples with cancer. In three couples, cancer involved the same organ system: colon and rectum, testicle and ovary. and lung. Russ and ScanIon [ I41 accumulated data on 1 1 married couples having histologically identical malignant tumors, two couples with melanoma, two couples with kidney tumors, three couples with breast carcinoma, one couple with fibrosarcoma, one couple with floor of the mouth tumor (squamous cell carcinoma), one couple with colon and rectal tumors, and one couple with carcinoma of the nasopharynx. In our prospective study, we present 46 married couples sufferring from cancer; both partners in three couples suffered from the same tumor, with similar histology. The significance of our observations is unclear and most probably constitutes a coincidental phenomenon, a medical curiosity, since the patients were in the fourth to
65
eighth decades of life, when a high incidence of cancer occurs anyway. Still, further analysis of more data could help explain this observation, because environmental, nutritional, and contamination factors are shared by the couples for an extended period and could be contributing factors to the pathogenesis of cancer.
REFERENCES 1. Payan HM: Cancer in married couples. South Med J 72:17-19.
1979. 2. Chen WY, Crittenden LB, Mantel N, Cameron WR: Site distriibution of cancer deaths in husband-wife and sibling pairs. J Natl Cancer Inst 27:875-892, 1961. 3. Walach N, Horn Y: The incidence of cancer in married couples (Letter to the editor). J Am Med Assoc 226:201, 1973. 4. Martinez I: Relationship of squarnous cell carcinoma of the cervix uteri to squamous cell carcinoma of the penis. Cancer 24:777780, 1969. 5. Graham S, Priore R , Graham M, Browne R, Burnett W, West D: Genital cancer in wives of penile cancer patients. Cancer 44: 1870-1874. 1979. 6. Offit K, Maris NT. Hellinan G , Rotterdam HZ: Consecutive lyniphoma with monoclonal gamniopathy in a married couple. Cancer 57:277-281, 1986. 7. Jensen OM, Sigtryggsson P. Nguyen-Dinh X, Bolander A M , Vercelli M, MacLennan R: Large bowel cancer in married cow ples in Sweden: A follow up study. Lancet 1:1161-1163, 1980. 8. Wetchler BB, Simon B: Carcinoma of the breast occurring in a husband and wife. A brief communication. Mount Sinai J Med 42:205-206, 1975. 9. Griffin TW, Smith TW, Levy BS. Recht LD: Synchronous occurrence of glioblastoma multiforme in a husband and wife. J Neurooncol 4:75-78. 1986. 10. Tupchong L. Levison DA. Jones AE: Concommitant conjugal gliomas with similar histologic features. Cancer 55:864-860, 1985. 11. Cox T, Mackay C: Psychosocial factors and psychophysiological mechanisms in the etiology and development of cancers. Soc Sci Med 16:381-396. 1982. 12. Ontiigbo WIB: Historical notes on cancer in married couples. Netherlands J Surg 36:112-1 15, 1984. 13. Enck RE: Cancer in married couples. Military Med 144:603-605. 1979. 14. Russ JE. Scanlon EF: Identical cancers in husband and wife. Surg Gynecol Obstet 150:664-666. 1980.
Married Couples and Cancer NATAL10 WALACH, MD From the Department of Oncology, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler School of Medicine, Tel Aviv University, lsrael
The occurrence of cancer in 46 couples related only by marriage and treated in a regional hospital is reported. Twenty-four pairs had tumors of the same histopathologic type. Three couples had the same tumors with similar histology: brain (astrocytoma), urinary bladder (transitional cell carcinoma), and lung (adenocarcinoma). The possible significance of environmental, nutritional, and contamination factors are emphasized. although this is a probably coincidental phenomenon. KEY WORDS:environmental factors, coincidental phenomena, histology
INTRODUCTION Cancer in married couples is rare. Etiologic factors associated with cancer include heredity, race, sex, age, endocrine status, environment, nutrition, physical and chemical substance exposure, ionizing radiation, and organisms, including parasites and viruses [ 11. Although married couples are, in general, unrelated genetically and are intimately associated in the home environtnent during adult life, little research has been done to investigate this particular environmental association of cancer 121. An 8 year prospective study was performed in a regional hospital to identify married couples with cancer in both partners. MATERIAL AND METHODS During the period between January, 1978, and December, 1985, all cancer patients referred to the Department of Oncology at the Assaf Harofeh Medical Center, were interviewed about their partner’s condition and past history of cancer. During this period, 2,312 patients were admitted and 46 couples were identified. Among the total of 92 patients included in this study, 72 were diagnosed and treated during this 8 year period: 20 were treated before the year 1978. At least one of the partners was referred during the study period (1978-1985). Diagnosis was made on the basis of histopathologic examination from tissues removed. Information was obtained directly from patients. relatives, medical files, and the Ministry of Interior for details such as dates of birth, marriage, and death, especially for patients diagnosed before the year 1978. Details of patient’s history, organ 0 1990 Wiley-Liss, Inc.
involvement, and type of cancer are summarized in Table 1.
RESULTS The 46 couples had lived together for an average period of 36 years (range 12-54 years) before the first cancer was diagnosed. The mean time interval between the diagnosis of cancer in the married couples was 6.8 years, with a range of 1-26 years. Age of the patients ranged between 38 and 80 years, with a mean of 63.8 years. The mean age for females was 59.8 and for males 67.8 years. Two males had double tumors. In couple 7, the husband suffered from tumors in the nasopharynx and colon, and in couple 10 the husband suffered from tumors in the urinary bladder and colon. In both cases the patients died from the tumors of the colon. In three couples, cancer involved the same organ system, with the same histology. In couple 9, both patients suffered from brain tumors and the histology was astrocytoma grade IV. In couple 36, husband and wife suffered from urinary bladder tumors. The histology was transitional cell carcinoma. In couple 42, the patients suffered from lung tumors, with identical histology (adenocarcinoma) .
Accepted for publication June 5 , 1989 Address reprint requests to Natalio Walach. MD, Department of Oncology, Assaf Harofeh Medical Center, Zerifin 70300. Israel.
Married Couples and Cancer
631
TABLE 1. Cancer in Married Couples Cancer Couple
I
Sex
F M F M F M F M F M F M
I929 1903 1913 1909 I908 li 907 1913 11914 1916 1913 1923 I923 1922 1921
F M F M F M
1918 1906 1918 I920 1915 I908
F
1919 I906 1915 1912 1917 I91 1 1912 1902 1916 1912 I91 1 I907 1913 1913 1925 1923 1910 1909 1919 1903 1932 1927 1913 I908 1921 1918 1914 1913 1941 1937 1919 1913 1906 1906 I940 1933
F M
73 4 5
6 7
8 9
10
11
M
12 13 I4
IS
F M F M F M F M
16 17 18 19
F M F M F M F
M 20 21 22 23 24 25
F M F M F M F M F M F
M 26 27 28
Birth (year)
F M F M F
M
Marriage (year) 1946 1929 1930 I948 1934 1945 1940
1936 1939 1935
1937 1932 1934 1938 1945 1932 1937 1944 1930 1937 1966 1937 1940 I940 1958 1938 1930 1961
Appearance ( year) 1980 1977 I976 1979 1976 1980 1974 1978 1954 I978 1974 1979 I98 1 1975 1958 1978 1980 1979 1976 1980 1975 1980 1978 1982 1975 1981 I979 I980 I980 1981 1979 1982 1978 1982 I966 I978 1982 1978 1984 1981 1978 1983 1983 1980 1981 1983 1984 I969 1981 I984 1983 1984 1977 1983 1978 1983
Location
Histology (type)”
Uterus Lung Breast Pancreas Breast Lung Brain U. bladder Breast U . bladder Breast Colon Stomach Nasopharynx (colon 1985) Breast Colon Brain Brain Breast U . bladder (colon 1982) Cervix U. bladder Liver Gallbladder Breast Prostate Pancreas U. bladder Breast Colon Pancreas Lung Breast Bone (metastatic) Breast Kidney Colon Larynx Breast Larynx Breast Colon Uterus Skin Brain Colon Breast Stomach Breast U. bladder Colon Lung Lymph nodes Pharynx Breast Skin
Adenoca Adenoca Adenoca Adenoca Adenoca Sq. cell Astroc ytoma Transit. cell Adenoca Transit. cell Adenoca Adenoca Lymphoma Lymphoepithelioma (adenoca) Adenoca Adenoca Astrocytoma gr IV Astrocytoma gr IV Adenoca Transit. cell (adenoca) Sq. cell Transit. cell Adenoca Adenoca Adenoca Adenoca Adenoca Transit. cell Adenoca Adenoca Adenoca Adenoca Adenoca Clear cell Adenoca Clear cell Adenoca Sq. cell Adenoca Sq. cell Adenoca Adenoca Adenoca Mycosis fungoides Astrocytoma Adenoca Adenoca Adenoca Adenoca Transit, cell Adenoca Adenoca Lymphoma Sq. cell Adenoca Sq. cell
.
F~II~w-uP Well Dead Well Dead Dead Dead Dead Well Well Well Dead Dead Dead Dead Dead Dead Dead Dead Well
( 1977)
(1980) (1979) (1981) ( 1979)
(1980) (1981) (1981) ( 1985) (1981) ( 1 980) (1981) ( 1979)
Dead ( 1984) Dead (1977) Dead (1981) Dead (1979) Dead (1983) Well Dead (1983) Dead (1980) Dead ( 1982) Well Well Dead (1981) Dead (1982) Dead ( 1980) Dead (1983) Well Dead ( 1979) Well Well Well Well Dead (1 970) Well Well Dead ( I98:!) Dead (1982) Well Well Dead (I970) Well Well Dead ( 198fi) Dead (1 985) Dead ( 1979) Dead (1984) Well Well (con11 I? uvd)
64
Walach
TABLE I. Cancer in Married Couples (Continued) Cancer Couple 29 30 31 32 33 34
Sex
Birth (year)
F
1909 I908 1929 1929 1927
M F M F M
F M F M F F
M 36
39
F M F M F M F
40
M F
37 38
41 42 43 44 45 46
M F M F M F M F M F M F
1930 1952
1921
I947
1906 1903 1914
1923
1911
1933
1916 I904 1919 1914 1915 1913 1922 1906 1916 1911 1 YO8 1906 1931 1908 1916 1910 1924 1YO9
M 35
Marriage (year)
1934 1937 1936 1939 1937 1946 I947 1939 I943
I926
1926 1932 1924 1909 1907 1 908 1907
M
1951
1947 1929 1930
Appearance ( year)
Location
1984 I98 I 1983 1985 1982 1984 1975 1983 1970 1984 1958 I984 1972 1985 1982 1985 1985 1980 I975 1985 1985 1978 I979 1980 1982 1983 1985 1970 I967 1985 1978 1985 1985 1978 1985 1984
Maxilla Skin Skin Stomach Breast U. bladder Ovary Colon Breast Colon Breast Prostate Uterus Colon U. bladder U. bladder Ovary Proatate Breast Liver Breast Stomach Colon U . bladder Ovary Stomach Lung Lung Cervix Lung Breast Lung Lymph nodes Lung Breast Lung
Histology (type)d Melanoma Sq. cell Melanoma Adenoca Adenoca Transit. cell Aden oca Adenoca Adenoca Adenoca Adenoca Adenoca Adenoca Adenoca Transit. cell Transit. cell Adenoca Adenoca Adenoca Melanoma Adenoca Adenoca Adenoca Transit. cell Adenoca Adenoca Adenoca Adenoca Sq. cell. Sq. cell. Adenoca Sq. cell. Lymphoma Sq. cell. Adenoca Adenoca
FOIIOW-UP Well Well Well Well Well Well Well Dead ( 1984) Dead ( 1973) Well Dead (1958) Well Well Well Well Dead (1985) Well Well Well Dead (1985) Well Well Well Well Dead (1985) Well Dead ( 1986) Dead (1970) Dead ( 1968) Well Well Well Well Dead (1979) Well Dead ( 1985)
~
"Abbreviations: Adenoca. adenocarcinoma: Sq. cell, squamous cell carcinoma; Transit. cell. transitional cell carcinoma; Clear cell, clear cell carcinoma.
In 32 couples the cancer appeared first in the wives. and in 14 couples it appeared first in the husbands. Twenty-two patients suffered from breast carcinoma, 2 1 patients from gastrointestinal cancer, 10 patients from lung cancer, 13 patients from tumors in the genitourinary tract, and eight from lymphoma. Other tumors were metastatic of unknown origin, nasopharynx, and skin. Histology revealed 56 adenocarcinomas, 10 squamous cell carcinomas, nine transitional cell carcinomas, four astrocytonias, three melanomas, three lymphomas, and two clear cell carcinomas. Couples with the same histology had 21 adenocarcinomas, one astrocytoma, one squamous cell carcinoma, and one transitional cell carcinoma.
DISCUSSION The incidence of cancer in married couples is not high. In 1973 we reported 15 couples identified among 20,000 cancer patients [ 3 ] . Martinez [4] and Graham et al. [51 observed an increase in carcinoina of the cervix among wives of patients with penile carcinoma. Other malignancies such as lymphomas [6], colon carcinoma [7], breast cancer [8], and astrocytoma [9,10] have also been reported in married couples. Husbands and wives have contact of a more intimate nature than other adults. This intimacy may last for many years, during which time they share the identical home environment and are equally subject to such factors as climate, diet, and sanitation, which can influence their
Married Couples and Cancer
health. Cox and Mackay [ 1 I ] , in their review of psychological factors and cancer etiology, point out that specific variables such as marital status, socioeconomic status, stress, and social support interact with each other as a host environment complex. These factors could exacerbate the effects of known carcinogens, such as cigarette smoking and alcohol consumption. It is likely that these factors act synergistically to produce a promoter effect in the process of transformation and growth of malignant cells rather than acting independently. Onuigbo [ 121 describes the accepted theories prevalent during the nineteenth century regarding the occurrence of cancer in married couples, which stressed the importance of the contagiousness of cancer. Payan [I] reported on 19 married couples found among 2,512 charts of patients; two pairs suffered from carcinoma involving the same organs, one couple with carcinoma of the breast and one couple with transitional cell carcinoma of the bladder. Enck [13], in a 24 year retrospective review of 3,333 cases of cancer, found 46 couples with cancer. In three couples, cancer involved the same organ system: colon and rectum, testicle and ovary. and lung. Russ and ScanIon [ I41 accumulated data on 1 1 married couples having histologically identical malignant tumors, two couples with melanoma, two couples with kidney tumors, three couples with breast carcinoma, one couple with fibrosarcoma, one couple with floor of the mouth tumor (squamous cell carcinoma), one couple with colon and rectal tumors, and one couple with carcinoma of the nasopharynx. In our prospective study, we present 46 married couples sufferring from cancer; both partners in three couples suffered from the same tumor, with similar histology. The significance of our observations is unclear and most probably constitutes a coincidental phenomenon, a medical curiosity, since the patients were in the fourth to
65
eighth decades of life, when a high incidence of cancer occurs anyway. Still, further analysis of more data could help explain this observation, because environmental, nutritional, and contamination factors are shared by the couples for an extended period and could be contributing factors to the pathogenesis of cancer.
REFERENCES 1. Payan HM: Cancer in married couples. South Med J 72:17-19.
1979. 2. Chen WY, Crittenden LB, Mantel N, Cameron WR: Site distriibution of cancer deaths in husband-wife and sibling pairs. J Natl Cancer Inst 27:875-892, 1961. 3. Walach N, Horn Y: The incidence of cancer in married couples (Letter to the editor). J Am Med Assoc 226:201, 1973. 4. Martinez I: Relationship of squarnous cell carcinoma of the cervix uteri to squamous cell carcinoma of the penis. Cancer 24:777780, 1969. 5. Graham S, Priore R , Graham M, Browne R, Burnett W, West D: Genital cancer in wives of penile cancer patients. Cancer 44: 1870-1874. 1979. 6. Offit K, Maris NT. Hellinan G , Rotterdam HZ: Consecutive lyniphoma with monoclonal gamniopathy in a married couple. Cancer 57:277-281, 1986. 7. Jensen OM, Sigtryggsson P. Nguyen-Dinh X, Bolander A M , Vercelli M, MacLennan R: Large bowel cancer in married cow ples in Sweden: A follow up study. Lancet 1:1161-1163, 1980. 8. Wetchler BB, Simon B: Carcinoma of the breast occurring in a husband and wife. A brief communication. Mount Sinai J Med 42:205-206, 1975. 9. Griffin TW, Smith TW, Levy BS. Recht LD: Synchronous occurrence of glioblastoma multiforme in a husband and wife. J Neurooncol 4:75-78. 1986. 10. Tupchong L. Levison DA. Jones AE: Concommitant conjugal gliomas with similar histologic features. Cancer 55:864-860, 1985. 11. Cox T, Mackay C: Psychosocial factors and psychophysiological mechanisms in the etiology and development of cancers. Soc Sci Med 16:381-396. 1982. 12. Ontiigbo WIB: Historical notes on cancer in married couples. Netherlands J Surg 36:112-1 15, 1984. 13. Enck RE: Cancer in married couples. Military Med 144:603-605. 1979. 14. Russ JE. Scanlon EF: Identical cancers in husband and wife. Surg Gynecol Obstet 150:664-666. 1980.
