# Population-Based Evidence of Familial Clustering in Pulmonary Carcinoid Tumors: Insights From the Utah Population Database

## TL;DR

This study finds that pulmonary carcinoid tumors cluster in families, suggesting a heritable component beyond known syndromes.

## Contribution

The study provides population-based evidence of familial clustering in pulmonary carcinoid tumors outside of MEN1 syndrome.

## Key findings

- Significant excess relatedness was found in parent-offspring and avuncular pairs.
- Relative risks were elevated for first- and second-degree relatives.
- 61 high-risk pedigrees were identified with more cases than expected.

## Abstract

Background: Pulmonary carcinoid tumors are rare neuroendocrine neoplasms. While gastrointestinal carcinoids have established familial clustering, the heritable component of pulmonary carcinoids, particularly outside of multiple endocrine neoplasia type 1 (MEN1) syndrome, remains poorly defined. Utah's unique linked genealogy-cancer registry enables population-based assessment of familial risk.

Methods: We used the Utah Population Database (UPDB) linked to the Utah Cancer Registry (a Surveillance, Epidemiology, and End Results (SEER) registry) to identify individuals diagnosed with pulmonary carcinoid tumors (International Classification of Diseases for Oncology, Third Edition (ICD-O-3), histology codes 8240, 8249). The Genealogical Index of Familiality (GIF) test evaluated excess pairwise relatedness compared with 1,000 matched control sets. Relative risks (RRs) were estimated for first-, second-, and third-degree relatives, with expected cases based on cohort-specific incidence rates.

Results: A total of 232 pulmonary carcinoid cases with ≥3 generations of genealogy were identified. The GIF test demonstrated significant excess relatedness (GIF: 5.36 vs. 2.65; p=0.002), with excess in parent-offspring and avuncular pairs. RRs were significantly elevated for first-degree relatives (RR: 5.78; 95% CI: 1.03-18.21; p=0.048) and second-degree relatives (RR: 12.91; 95% CI: 6.42-23.29; p<0.0001), but not third-degree relatives. We identified 61 high-risk pedigrees with significantly more cases than expected. Incidence rates of pulmonary carcinoid were similar in Utah (0.8%) and the rest of SEER (0.7%), despite markedly lower overall lung cancer incidence in Utah.

Conclusions: Our findings demonstrate the significant familial clustering of pulmonary carcinoid tumors in a large, population-based resource, supporting a potential heritable contribution independent of MEN1 syndrome. These results justify further genetic and environmental investigations in high-risk pedigrees to identify susceptibility loci and modifiable exposures.