Acute childhood leukaemia and environmental exposure to potential sources of benzene and other hydrocarbons; a case-control study

Refuelling of vehicles, the use of wood burners and the risk of acute lymphoblastic leukaemia in childhood

It is plausible that exposure of the parents before birth or of the child to sources of benzene increases the risk of childhood acute lymphoblastic leukaemia (ALL). The aim of this analysis was to investigate whether refuelling a vehicle with petrol before birth or burning wood to heat the home before or after the child's birth increased the risk of childhood ALL. Data from 389 cases and 876 frequency-matched controls were analysed using unconditional logistic regression, adjusting for study matching factors and potential confounders. The odds ratio (OR) for the mother ever refuelling a vehicle with petrol for non-occupational purposes before or during the pregnancy was 0.97 [95% confidence interval (CI) 0.69, 1.38]. The OR for the father for this exposure in the year before conception was 0.88 [95% CI 0.52, 1.48]. The OR for use of a closed wood burner to heat the home in the year before or during pregnancy was 1.41 [95% CI 1.02, 1.94] and 1.25 [95% CI 0.92, 1.70] after birth. We found no evidence that non-occupational refuelling a vehicle with petrol in the year before or during pregnancy increased the risk of ALL in the offspring. There was weak evidence that burning wood in a closed burner to heat the home increased the risk, but there was no dose-response relationship and chance could explain the finding.

Residential proximity to environmental hazards and adverse health outcomes

How living near environmental hazards contributes to poorer health and disproportionate health outcomes is an ongoing concern. We conducted a substantive review and critique of the literature regarding residential proximity to environmental hazards and adverse pregnancy outcomes, childhood cancer, cardiovascular and respiratory illnesses, end-stage renal disease, and diabetes. Several studies have found that living near hazardous wastes sites, industrial sites, cropland with pesticide applications, highly trafficked roads, nuclear power plants, and gas stations or repair shops is related to an increased risk of adverse health outcomes. Government agencies should consider these findings in establishing rules and permitting and enforcement procedures to reduce pollution from environmentally burdensome facilities and land uses.

Parental occupational exposure to exhausts, solvents, glues and paints, and risk of childhood leukemia

PURPOSE

It is unknown whether parental occupational exposure to chemicals before during and after pregnancy increases the risk of acute lymphoblastic leukemia (ALL) in the offspring. Few studies on this topic have assessed maternal exposures.

METHODS

In an Australian case-control study of ALL in children aged <15 years, parents were asked about tasks they undertook in each job using a set of job-specific modules (JSMs). An expert reviewed the likelihood of exposure to exhausts, solvents, glues, and paints. Exposure was examined in each job 2 years, 1 year and anytime before birth of the child, and up to 1 year after birth of child.

RESULTS

Solvent exposure was similar for case and control mothers in all time periods. More case mothers had moderate/high exposure to exhausts than control mothers anytime before the birth of the child (p = 0.010). Exposure to moderate or substantial levels of exhausts by mothers (OR = 1.97 95% CI 0.99-3.90) or fathers (OR = 1.37 95% CI 1.01-1.86) before the birth increased the risk of ALL in their offspring. Exposure to paints, pigments, glues, and resins was similar in case and control parents.

CONCLUSION

We found little evidence that parental occupational exposure to solvents, glues, and paints was associated with childhood ALL. There was some evidence ALL was associated with exhaust exposure.

Road traffic and childhood leukemia: the ESCALE study (SFCE)

BACKGROUND

Traffic is a source of environmental exposures, including benzene, which may be related to childhood leukemia.

OBJECTIVES

A national registry-based case-control study [ESCALE (Etude Sur les Cancers et les Leucémies de l'Enfant, Study on Environmental and Genetic Risk Factors of Childhood Cancers and Leukemia)] carried out in France was used to assess the effect of exposure to road traffic exhaust fumes on the risk of childhood leukemia.

METHODS

Over the study period, 2003-2004, 763 cases and 1,681 controls < 15 years old were included, and the controls were frequency matched with the cases on age and sex. The ESCALE data were collected by a standardized telephone interview of the mothers. Various indicators of exposure to traffic and pollution were determined using the geocoded addresses at the time of diagnosis for the cases and of interview for the controls. Indicators of the distance from, and density of, main roads and traffic nitrogen dioxide (NO(2)) concentrations derived from traffic emission data were used. Odds ratios (ORs) were estimated using unconditional regression models adjusted for potential confounders.

RESULTS

Acute leukemia (AL) was significantly associated with estimates of traffic NO(2) concentration at the place of residence > 27.7 µg/m(3) compared with NO(2) concentration < 21.9 µg/m(3) [OR=1.2; confidence interval (CI), 1.0-1.5] and with the presence of a heavy-traffic road within 500 m compared with the absence of a heavy-traffic road in the same area (OR=2.0; 95% CI, 1.0-3.6). There was a significant association between AL and a high density of heavy-traffic roads within 500 m compared with the reference category with no heavy-traffic road within 500 m (OR=2.2; 95% CI, 1.1-4.2), with a significant positive linear trend of the association of AL with the total length of heavy-traffic road within 500 m.

CONCLUSION

This study supports the hypothesis that living close to heavy-traffic roads may increase the risk of childhood leukemia.

Incidence of hematologic malignancies in Europe by morphologic subtype: results of the HAEMACARE project

Changing definitions and classifications of hematologic malignancies (HMs) complicate incidence comparisons. HAEMACARE classified HMs into groupings consistent with the latest World Health Organization classification and useful for epidemiologic and public health purposes. We present crude, age-specific and age-standardized incidence rates for European HMs according to these groupings, estimated from 66 371 lymphoid malignancies (LMs) and 21 796 myeloid malignancies (MMs) registered in 2000-2002 by 44 European cancer registries, grouped into 5 regions. Age-standardized incidence rates were 24.5 (per 100 000) for LMs and 7.55 for MMs. The commonest LMs were plasma cell neoplasms (4.62), small B-cell lymphocytic lymphoma/chronic lymphatic leukemia (3.79), diffuse B-cell lymphoma (3.13), and Hodgkin lymphoma (2.41). The commonest MMs were acute myeloid leukemia (2.96), other myeloproliferative neoplasms (1.76), and myelodysplastic syndrome (1.24). Unknown morphology LMs were commonest in Northern Europe (7.53); unknown morphology MMs were commonest in Southern Europe (0.73). Overall incidence was lowest in Eastern Europe and lower in women than in men. For most LMs, incidence was highest in Southern Europe; for MMs incidence was highest in the United Kingdom and Ireland. Differences in diagnostic and registration criteria are an important cause of incidence variation; however, different distribution of HM risk factors also contributes. The quality of population-based HM data needs further improvement.

A biomarker approach to estimate the daily intake of benzene in non-smoking and smoking individuals in Germany

Owing to its carcinogenic properties, benzene is one of the most important environmental air pollutants. We have applied a simple pharmacokinetic model to estimate the individual daily exposure of persons of the general population to benzene using their urinary excretion of S-phenylmercapturic acid as biomarker of exposure. On the basis of a non-representative convenience sample of the general population, spontaneous urine samples of 43 non-smoking persons, 13 persons with exposure to environmental tobacco smoke (ETS) (as determined by urinary cotinine) and 72 smokers were analyzed for S-phenylmercapturic acid, and benzene exposure was back calculated on the basis of the results. The pharmacokinetic model was based either on estimated daily urinary volume or creatinine excretion. Median daily exposure of non-smokers was calculated to be 47 microg/day (volume-based model) and 63 microg benzene/day (creatinine-based model). ETS-exposed persons had a slightly higher median daily exposure of 65 microg/day (volume-based model) and 72 microg benzene/day (creatinine-based model). The daily exposure of smokers was significantly higher with median values of 491 microg benzene/day (volume-based model) and 693 microg benzene/day (creatinine-based model). Our biomarker-based model gave plausible results for daily benzene exposure that were in good agreement with exposure estimations published earlier. As it is purely based on the determination of individual internal dose, our model provides a powerful tool for the risk assessment of environmental benzene.

Transplacental benzene exposure increases tumor incidence in mouse offspring: possible role of fetal benzene metabolism

Childhood cancer is the leading cause of disease-related death in children aged 1-14 years in Canada and the USA and it has been hypothesized that transplacental exposure to environmental carcinogens such as benzene may contribute to the etiology of these cancers. Our objectives were to determine if transplacental benzene exposure increased tumor incidence in mouse offspring and assess fetal benzene metabolism capability. Pregnant CD-1 and C57Bl/6N mice were given intraperitoneal injections of corn oil, 200 mg/kg, or 400 mg/kg benzene on gestational days 8, 10, 12 and 14. A significant increase in tumor incidence was observed in CD-1, but not C57BL/6N, 1-year-old offspring exposed transplacentally to 200 mg/kg benzene. Hepatic and hematopoietic tumors were predominantly observed in male and female CD-1 offspring, respectively. Female CD-1 offspring exposed transplacentally to 200 mg/kg benzene had significantly suppressed bone marrow CD11b(+) cells 1 year after birth, correlating with reduced colony-forming unit granulocyte/macrophage numbers in 2-day-old pups. CD-1 and C57Bl/6N maternal blood benzene levels and fetal liver benzene, t, t-muconic acid, hydroquinone and catechol levels were analyzed by gas chromatography/mass spectrometry. Significant strain-, gender- and dose-related differences were observed. Male CD-1 fetuses had high hydroquinone levels, whereas females had high catechol levels after maternal exposure to 200 mg/kg benzene. This is the first demonstration that transplacental benzene exposure can induce hepatic and hematopoietic tumors in mice, which may be dependent on fetal benzene metabolism capability.

A review of the potential association between childhood leukemia and benzene

Chronic exposure to high concentrations of benzene is an established cause of acute myeloid leukemia (AML) in occupationally exposed workers. Based on this association, it is not unreasonable to assume that children could also get AML if they were exposed to comparable levels of benzene. Fortunately, reports of such exposures and subsequent AML development in children are non-existent. However, the question of whether children can develop leukemia at far lower, environmental levels of benzene remains. The existing scientific evidence relevant to this question will be addressed in this review. While positive findings have been reported, the collective literature does not indicate that exposure to environmental levels of benzene is related to an increased risk of childhood leukemia. Our understanding of this important issue would be strengthened by additional studies that accurately characterize exposures as well as differentiate between the various forms of leukemias observed in children.

Leukaemia incidence in people living close to an oil refinery

OBJECTIVES

To assess the incidence of leukaemia in an area downwind of a large oil refinery emitting carcinogenic volatile organic compounds (VOCs) including benzene.

METHODS

Using a dispersion model and the prevailing wind direction, two parishes with about 5000 inhabitants were a priori considered to be exposed to VOCs from the refinery. Numbers of observed and expected leukaemia cases in 1975-2004 were calculated using regional sex- and age-specific incidence rates. In addition, five nearby parishes (12000 inhabitants), considered unaffected by the emissions, served as a local reference area. Based on emission data, dispersion modelling and VOC measurements, the refinery's contribution to the population's exposure to carcinogenic VOCs was estimated. Published "unit risks" for carcinogenic VOCs were used to estimate the expected excess leukaemia risk.

RESULTS

The incidence of leukaemia in the "exposed parishes" was significantly increased in 1975-2004 (33 cases v. 22 expected cases), owing to an increase in the last 10-year period, from 1995 to 2004 (19 cases v. 8.5 expected cases). The leukaemia incidence in the local control area was normal (50 cases v. 56 expected cases). The estimated contribution from the refinery to VOC concentrations was, however, only about 2 microg/m(3) (yearly average) for benzene, 2 microg/m(3) for ethylene, 0.5 microg/m(3) for 1,3-butadiene and 5 microg/m(3) for propene. Calculations of expected excess risk using published risk estimates would indicate a much lower excess risk in the exposed parishes.

CONCLUSIONS

Using risk estimates extrapolated from high-level exposure, we would not expect an increase of leukaemia at low exposure to VOC emissions. Nevertheless, the clear elevation of leukaemia in the priori selected, exposed parishes was remarkable. Our finding may reflect a causal association due to emissions, but it could also be due to unknown confounding, or chance.

In utero exposure to benzene disrupts fetal hematopoietic progenitor cell growth via reactive oxygen species

It is hypothesized that the increasing incidence of childhood leukemia may be due to in utero exposure to environmental pollutants, such as benzene, but the mechanisms involved remain unknown. We hypothesize that reactive oxygen species (ROS) contribute to the deregulation of fetal hematopoiesis caused by in utero benzene exposure. To evaluate this hypothesis, pregnant C57Bl/6N mice were exposed to benzene or polyethylene glycol-conjugated catalase (PEG-catalase) (antioxidative enzyme) and benzene. Colony formation assays on fetal liver cells were performed to measure erythroid and myeloid progenitor cell growth potential. The presence of ROS in CD117(+) fetal liver cells was measured by flow cytometric analysis. Oxidative cellular damage was assessed by Western blot analysis of 4-hydroxynonenol (4-HNE) and nitrotyrosine products, as well as reduced to oxidized glutathione ratios. Alterations in the redox-sensitive signaling pathway nuclear factor-kappa-light-chain-enhancer of activated B cells (NF-kappaB) were measured by Western blot analysis of Inhibitor of NF-kB-alpha (IkappaB-alpha) protein levels in fetal liver tissue. In utero exposure to benzene caused a significant increase in ROS production and significantly altered fetal liver erythroid and myeloid colony numbers but did not increase the levels of 4-HNE or nitrotyrosine products or alter reduced to oxidized glutathione ratios. However, in utero exposure to benzene did cause a significant decrease in fetal liver IkappaB-alpha protein levels, suggesting activation of the NF-kappaB pathway. Benzene-induced ROS formation, abnormal colony growth, and decreased IkappaB-alpha levels were all abrogated by pretreatment with PEG-catalase. These results suggest that ROS play a key role in the development of in utero-initiated benzene toxicity potentially through disruption of hematopoietic cell signaling pathways.

Prevalence of GSTT1, GSTM1 and NQO1 (609C>T) in Filipino children with ALL (acute lymphoblastic leukaemia)

In the present paper, we examined the incidence of polymorphic genes involved with the detoxification of exogenous chemicals, including carcinogens, namely GSTT1 (glutathione transferase theta1), GSTM1 (glutathione transferase micro1) and NQO1 (NAD(P)H:quinone oxidoreductase 1) in 60 Filipino paediatric patients with ALL (acute lymphoblastic leukaemia). We found a significantly high incidence of the GSTM1 null genotype in ALL children (71.7%) compared with 51.7% in the control group of children (P<0.05). The GSTT1 null genotype was observed in 35.0% and 33.3% of the ALL cases and the control subjects respectively, with no significant difference. Screening for NQO1 (609C>T) mutant alleles showed a high incidence of the NQO1 C/C genotype (NQO1 homozygous wild-type allele genotype) in 60.0% of ALL cases and was significantly higher than in the control group (23.3%) (P<0.01). These GSTM1 null and NQO1 wild-type genotypes are independently associated with the risk of ALL in Filipino patients. When these two genotypes, GSTM1 null and NQO1 C/C, were combined, the hazard rate for childhood leukaemia was significantly increased (P<0.001). We also noticed that the incidences of GSTM1 null mutations and the NQO1 C/C genotype were significantly higher among Filipinos. These findings suggest a possible role of the GSTM1 null and NQO1 C/C genotypes in the susceptibility of paediatric ALL cases in the Philippines.

Environmental factors and childhood acute leukemias and lymphomas

This review considers recent studies regarding the role of environmental factors in the etiology of childhood leukemia and lymphoma. Potential environmental risk factors identified for childhood leukemia include exposure to magnetic fields of more than 0.4 micro Tessla, exposure to pesticides, solvents, benzene and other hydrocarbons, maternal alcohol consumption (but only for certain genotypes), contaminated drinking water, infections, and high birth weight. The finding of space-time clustering and seasonal variation also supports a role for infections. There is little evidence linking childhood leukemia with lifetime exposure to ionizing radiation although fetal exposures to X-rays are associated with increased risk. Breast-feeding, consumption of fresh fruit and vegetables and having allergies all appear to be protective. Burkitt lymphoma (BL) is confined to areas of the world where malaria is endemic, with the additional involvement of the Epstein-Barr virus (EBV) as a co-factor. Environmental risk factors suggested for other types of non-Hodgkin lymphoma (NHL) include exposure to ionizing radiation (both lifetime and antenatal), pesticides, and, in utero exposure to cigarette smoke, benzene and nitrogen dioxide (via the mother). Hodgkin lymphoma (HL) is especially associated with higher levels of socioeconomic deprivation, but breast-feeding seems to confer lower risk. This is consistent with an infection or immune-response mediated etiology for HL.

The benzene metabolite para-benzoquinone is genotoxic in human, phorbol-12-acetate-13-myristate induced, peripheral blood mononuclear cells at low concentrations

Benzene is one of the most prominent occupational and environmental pollutants. The substance is a proven human carcinogen that induces hematologic malignancies in humans, probably at even low doses. Yet knowledge of the mechanisms leading to benzene-induced carcinogenesis is still incomplete. Benzene itself is not genotoxic. The generation of carcinogenic metabolites involves the production of oxidized intermediates such as catechol, hydroquinone and para-benzoquinone (p-BQ) in the liver. Further activation to the ultimate carcinogenic intermediates is most probably catalyzed by myeloperoxidase (MPO). Yet the products of the MPO pathway have not been identified. If an oxidized benzene metabolite such as p-BQ was actually the precursor for the ultimate carcinogenic benzene metabolite and further activation proceeds via MPO mediated reactions, it should be possible to activate p-BQ to a genotoxic compound in vitro. We tested this hypothesis with phorbol-12-acetate-13-myristate (PMA) activated peripheral blood cells exposed to p-BQ, using the cytokinesis-block micronucleus test. Addition of 20-28 ng/ml PMA caused a significant increase of micronuclei at low and non-cytotoxic p-BQ concentrations between 0.04 and 0.2 microg/ml (0.37-1.85 microM). Thus with PMA or p-BQ alone no reproducible elevation of micronuclei was seen up to toxic concentrations. PMA and p-BQ induce micronuclei when administered jointly. Our results add further support to the hypothesis that MPO is a key enzyme in the activation of benzene.

Childhood leukemia and traffic air pollution in Taiwan: petrol station density as an indicator

To investigate the relationship between traffic air pollution exposure and development of childhood leukemia (14 yr of age or younger), a matched case-control study was conducted using childhood deaths that occurred in Taiwan from 1996 through 2006. Data on all eligible childhood leukemia deaths were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. The control group consisted of children who died from causes other than neoplasms or diseases that were not associated with respiratory complications. The controls were pair matched to the cancer cases by gender, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each case. Data on the number of petrol stations in study municipalities were collected from the two major petroleum supply companies, Chinese Petroleum Corporation (CPC) and Formosa Petrochemical Corporation (FPCC). The petrol station density (per square kilometer) (PSD) for study municipalities was used as an indicator of a subject's exposure to benzene and other hydrocarbons present in evaporative losses of petrol or to air emissions from motor vehicles. The subjects were divided into tertiles according to PSD in their residential municipality. The results showed that there was a significant exposure-response relationship between PSD and the risk of leukemia development in young children after controlling for possible confounders. The findings of this study warrant further investigation of the role of traffic air pollution exposure in the etiology of childhood leukemia.

Chemical risk factors and childhood leukaemia: a review of recent studies

The search for chemical risks factors as determinants of childhood leukaemia has been ongoing for over two decades. Results of epidemiological studies, published from 1998 to the present, evaluating parental smoking, outdoor sources of pollution, indoor contaminants and chemicals from drinking water are reported. Overall, results were mostly negative. This may be due to the relatively small study sizes to detect environmental effects, usually measured imprecisely. Another reason may be that such effects, which may be revealed among the genetically susceptible, have rarely accounted for genetic susceptibility. The few studies that have are also reported here. Suggestions are made for work in the immediate future, which include pooling of data and of analyses, as well as carrying out in-depth reviews of studies with the goal of understanding the reasons for discrepant results.

Urinary biomarkers and low-level environmental benzene concentration: assessing occupational and general exposure

The categories of urban workers undergoing prolonged exposure to gasoline due to vehicle emissions, evaporation and traffic fumes are considered occupationally exposed to benzene, even if at low concentrations. The aim of this study was to evaluate the specificity of unmetabolized benzene excreted in urine (UBz) and S-phenylmercapturic acid (SPMA) as biomarkers of exposure to very low levels of benzene, and to study the impact of putative individual confounders like smoking and alcohol habits, co-exposure to other toxicants and body mass index on the exposure assessment. Environmental and biological monitoring of exposure to benzene were performed in 114 Urban Policemen. The mean value of UBz in non-smokers was significantly lower than in either groups of light to moderate smokers and heavy smokers (0.24, 1.82 and 2.82 microg L(-1), respectively). On the contrary, SPMA values did not discriminate exposure resulting from smoking habits. Moreover, the concentration of UBz in non-smokers appears to be correlated with environmental benzene concentration (BenzA) (R(2)=0.13, beta=0.37, p=0.002). On the other hand, no significant correlation was found between SPMA concentration (corrected for creatinine excretion and log transformed, LogSPMA) and LogBenzA (R(2)=0.003, beta=0.05, p=0.6). Our findings reinforce previous research on the use of unmetabolized urinary benzene as a specific and sensitive biomarker of low-level exposure to benzene and confirm that smoking habits strongly influence the excretion of UBz.

Childhood lymphohematopoietic cancer incidence and hazardous air pollutants in southeast Texas, 1995-2004

BACKGROUND

Cancer is the second leading cause of death among U.S. children with few known risk factors. There is increasing interest in the role of air pollutants, including benzene and 1,3-butadiene, in the etiology of childhood cancers.

OBJECTIVE

Our goal was to assess whether census tracts with the highest benzene or 1,3-butadiene ambient air levels have increased childhood lymphohematopoietic cancer incidence.

METHODS

Our ecologic analysis included 977 cases of childhood lymphohematopoietic cancer diagnosed from 1995-2004. We obtained the U.S. Environmental Protection Agency's 1999 modeled estimates of benzene and 1,3-butadiene for 886 census tracts surrounding Houston, Texas. We ran Poisson regression models by pollutant to explore the associations between pollutant levels and census-tract cancer rates. We adjusted models for age, sex, race/ethnicity, and community-level socioeconomic status (cSES).

RESULTS

Census tracts with the highest benzene levels had elevated rates of all leukemia [rate ratio (RR) = 1.37; 95% confidence interval (CI), 1.05, 1.78]. This association was higher for acute myeloid leukemia (AML) (RR = 2.02; 95% CI, 1.03-3.96) than for acute lymphocytic leukemia (ALL) (RR = 1.24; 95% CI, 0.92-1.66). Among census tracts with the highest 1,3-butadiene levels, we observed RRs of 1.40 (95% CI, 1.07-1.81), 1.68 (95% CI, 0.84-3.35), and 1.32 (95% CI, 0.98-1.77) for all leukemia, AML, and ALL, respectively. We detected no associations between benzene or 1,3-butadiene levels and lymphoma incidence. Results that examined joint exposure to benzene and 1,3-butadiene were similar to those that examined each pollutant separately.

CONCLUSIONS

Our ecologic analysis suggests an association between childhood leukemia and hazardous air pollution; further research using more sophisticated methodology is warranted.

Residential traffic density and childhood leukemia risk

BACKGROUND

Exposures to carcinogenic compounds from vehicle exhaust may increase childhood leukemia risk, and the timing of this exposure may be important.

METHODS

We examined the association between traffic density and childhood leukemia risk for three time periods: birth, time of diagnosis, and lifetime average, based on complete residential history in a case-control study. Cases were rapidly ascertained from participating hospitals in northern and central California between 1995 and 2002. Controls were selected from birth records, individually matched on age, sex, race, and Hispanic ethnicity. Traffic density was calculated by estimating total vehicle miles traveled per square mile within a 500-foot (152 meter) radius area around each address. We used conditional logistic regression analyses to account for matching factors and to adjust for household income.

RESULTS

We included 310 cases of acute lymphocytic leukemias (ALL) and 396 controls in our analysis. The odds ratio for ALL and residential traffic density above the 75th percentile, compared with subjects with zero traffic density, was 1.17 [95% confidence interval (95% CI), 0.76-1.81] for residence at diagnosis and 1.11 (95% CI, 0.70-1.78) for the residence at birth. For average lifetime traffic density, the odds ratio was 1.24 (95% CI, 0.74-2.08) for the highest exposure category.

CONCLUSIONS

Living in areas of high traffic density during any of the exposure time periods was not associated with increased risk of childhood ALL in this study.

Relationships between levels of volatile organic compounds in air and blood from the general population

The relationships between levels of volatile organic compounds (VOCs) in blood and air have not been well characterized in the general population where exposure concentrations are generally at parts per billion levels. This study investigates relationships between the levels of nine VOCs, namely, benzene, chloroform, 1,4-dichlorobenzene, ethylbenzene, methyl tert-butyl ether (MTBE), tetrachloroethene, toluene, and m-/p- and o-xylene, in blood and air from a stratified random sample of the general US population. We used data collected from 354 participants, including 89 smokers and 265 nonsmokers, aged 20-59 years, who provided samples of blood and air in the National Health and Nutrition Examination Survey (NHANES) 1999-2000. Demographic and physiological characteristics were obtained from self-reported information; smoking status was determined from levels of serum cotinine. Multiple linear regression models were used to investigate the relationships between VOC levels in air and blood, while adjusting for effects of smoking and demographic factors. Although levels of VOCs in blood were positively correlated with the corresponding air levels, the strength of association (R(2)) varied from 0.02 (ethylbenzene) to 0.68 (1,4-DCB). Also the blood-air relationships of benzene, toluene, ethylbenzene, and the xylenes (BTEX) were influenced by smoking, exposure-smoking interactions, and by gender, age, and BMI, whereas those of the other VOCs were not. Interestingly, the particular exposure-smoking interaction for benzene was different from those for toluene, ethylbenzene, and the xylenes. Whereas smokers retained more benzene in their blood at increasing exposure levels, they retained less toluene, ethylbenzene, and xylenes at increasing exposure levels. Investigators should consider interaction effects of exposure levels and smoking when exploring the blood-air relationships of the BTEX compounds in the general population.

Epidemiologic evidence of relationships between reproductive and child health outcomes and environmental chemical contaminants

This review summarizes the level of epidemiologic evidence for relationships between prenatal and/or early life exposure to environmental chemical contaminants and fetal, child, and adult health. Discussion focuses on fetal loss, intrauterine growth restriction, preterm birth, birth defects, respiratory and other childhood diseases, neuropsychological deficits, premature or delayed sexual maturation, and certain adult cancers linked to fetal or childhood exposures. Environmental exposures considered here include chemical toxicants in air, water, soil/house dust and foods (including human breast milk), and consumer products. Reports reviewed here included original epidemiologic studies (with at least basic descriptions of methods and results), literature reviews, expert group reports, meta-analyses, and pooled analyses. Levels of evidence for causal relationships were categorized as sufficient, limited, or inadequate according to predefined criteria. There was sufficient epidemiological evidence for causal relationships between several adverse pregnancy or child health outcomes and prenatal or childhood exposure to environmental chemical contaminants. These included prenatal high-level methylmercury (CH(3)Hg) exposure (delayed developmental milestones and cognitive, motor, auditory, and visual deficits), high-level prenatal exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs), and related toxicants (neonatal tooth abnormalities, cognitive and motor deficits), maternal active smoking (delayed conception, preterm birth, fetal growth deficit [FGD] and sudden infant death syndrome [SIDS]) and prenatal environmental tobacco smoke (ETS) exposure (preterm birth), low-level childhood lead exposure (cognitive deficits and renal tubular damage), high-level childhood CH(3)Hg exposure (visual deficits), high-level childhood exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) (chloracne), childhood ETS exposure (SIDS, new-onset asthma, increased asthma severity, lung and middle ear infections, and adult breast and lung cancer), childhood exposure to biomass smoke (lung infections), and childhood exposure to outdoor air pollutants (increased asthma severity). Evidence for some proven relationships came from investigation of relatively small numbers of children with high-dose prenatal or early childhood exposures, e.g., CH(3)Hg poisoning episodes in Japan and Iraq. In contrast, consensus on a causal relationship between incident asthma and ETS exposure came only recently after many studies and prolonged debate. There were many relationships supported by limited epidemiologic evidence, ranging from several studies with fairly consistent findings and evidence of dose-response relationships to those where 20 or more studies provided inconsistent or otherwise less than convincing evidence of an association. The latter included childhood cancer and parental or childhood exposures to pesticides. In most cases, relationships supported by inadequate epidemiologic evidence reflect scarcity of evidence as opposed to strong evidence of no effect. This summary points to three main needs: (1) Where relationships between child health and environmental exposures are supported by sufficient evidence of causal relationships, there is a need for (a) policies and programs to minimize population exposures and (b) population-based biomonitoring to track exposure levels, i.e., through ongoing or periodic surveys with measurements of contaminant levels in blood, urine and other samples. (2) For relationships supported by limited evidence, there is a need for targeted research and policy options ranging from ongoing evaluation of evidence to proactive actions. (3) There is a great need for population-based, multidisciplinary and collaborative research on the many relationships supported by inadequate evidence, as these represent major knowledge gaps. Expert groups faced with evaluating epidemiologic evidence of potential causal relationships repeatedly encounter problems in summarizing the available data. A major driver for undertaking such summaries is the need to compensate for the limited sample sizes of individual epidemiologic studies. Sample size limitations are major obstacles to exploration of prenatal, paternal, and childhood exposures during specific time windows, exposure intensity, exposure-exposure or exposure-gene interactions, and relatively rare health outcomes such as childhood cancer. Such research needs call for investments in research infrastructure, including human resources and methods development (standardized protocols, biomarker research, validated exposure metrics, reference analytic laboratories). These are needed to generate research findings that can be compared and subjected to pooled analyses aimed at knowledge synthesis.

Association of childhood leukemia with residential exposure to petrochemical air pollution in taiwan

To investigate the relationship between petrochemical air pollution and childhood leukemia (19 yr of age or younger), the authors conducted a matched case-control study using childhood deaths that occurred in Taiwan from 1995 through 2005. Data on all eligible childhood leukemia deaths were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. The control group consisted of children who died from causes other than neoplasms or diseases that were not associated with respiratory problems. The controls were pair matched to the cases by sex, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each case. The proportion of a municipality's total population employed in the petrochemical industry in a municipality was used as an indicator of a resident's exposure to air emissions from the petrochemical industry. The subjects were divided into three levels (< or =25th percentile; 25th-75th percentile; > 75th percentile) according to the levels of the index just described. After controlling for possible confounders, results showed that children who lived in the group of municipalities characterized by the highest levels of petrochemical air pollution had a statistically significant higher risk of developing leukemia than the group that lived in municipalities with the lowest petrochemical air pollution levels. The results of this study shed important light on the relationship between the Taiwan petrochemical industry and human health risks.

Benzene exposure in a sample of population residing in a district of Florence, Italy

OBJECTIVE

Personal exposure to airborne benzene is influenced by various outdoor and indoor sources. The first aim of this study was to assess the benzene exposure of a sample of urban inhabitants living in an inner-city neighborhood of Florence, Italy, excluding exposure from active smoking. The secondary objective was to differentiate the personal exposures according to personal usage patterns of the vehicles.

METHODS

A sample of 67 healthy non-smokers was monitored by passive samplers during two 4-weekday campaigns in winter and late spring. Simultaneously, benzene measurements were also taken for a subset of participants, inside and outside their houses. A 4-day time microenvironment activity diary was completed by each subject during each sampling period. Other relevant exposure data were collected by a questionnaire before the sampling. Additional data on urban ambient air benzene levels were also available from the public air quality network. The passive samplers, after automated thermal desorption, were analyzed by GC-FID.

RESULTS

Benzene personal exposure levels averaged 6.9 (SD=2.1) and 2.3 (SD=0.7) microg/m(3) in winter and spring, respectively. Outdoor and indoor levels showed high correlation in winter and poor in spring. In winter the highest benzene personal exposure levels were for people traveling by more public transport, followed by users of only car and by users of only bus respectively.

CONCLUSIONS

The time spent in-transport for work or leisure makes a major contribution to benzene exposure among Florentine non-smoking citizens. Indoor pollution and transportation means contribute significantly to individual exposure levels especially in winter season.

Childhood leukemia development and correlation with traffic air pollution in Taiwan using nitrogen dioxide as an air pollutant marker

To investigate the relationship between traffic air pollution and development of childhood leukemia (14 yr of age or younger), studies were conducted on a matched cancer case-control cohort using childhood deaths that occurred in Taiwan from 1995 through 2005. Data on all eligible childhood leukemia deaths were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. The control group consisted of children who died from causes other than neoplasms or from diseases that were not associated with respiratory complications. The controls were pair matched to the cases by gender, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each case. Air quality data for recorded concentrations of nitrogen dioxide (NO2) from study municipalities for 1995-2005 were obtained as an indicator of a subject's exposure to air emissions from motor vehicles. The subjects were divided into tertiles according to the levels of NO2 in their residential municipality. The results showed that there was a significant exposure-response relationship between exposure to traffic exhaust pollutants and the risk of leukemia among young children after controlling for possible confounders. The findings of this study warrant further investigation of the role of traffic air pollution in the etiology of childhood leukemia.

In utero-initiated cancer: the role of reactive oxygen species

It is becoming more evident that not only can drugs and environmental chemicals interfere with normal fetal development by causing structural malformations, such as limb defects, but that xenobiotic exposure during development can also cause biochemical and functional abnormalities that may ultimately lead to cancer later on in life. Fetal toxicity may be partly mediated by the embryonic bioactivation of xenobiotics to free radical intermediates that can lead to oxidative stress and potentially lead, in some cases, to carcinogenesis. Using a number of examples, this review will focus on the role of reactive oxygen species (ROS) in the mechanisms pertaining to in utero initiated cancers.

A critique of benzene exposure in the general population

Benzene risk assessment indicates that exposure to a time-weighted average (TWA) of 1-5 parts per million (ppm) benzene in ambient air for 40 years is associated with an increased risk of acute myeloid leukemia. Decreased white blood cell count, platelet count and other hematological indices have also been observed in persons exposed to as low as 1 ppm airborne benzene. Evidence from studies worldwide consistently shows elevated levels of benzene biomarkers that are equivalent to 0.1-2 ppm benzene in ambient air, or even higher in the general population without occupational exposure to benzene (including children). The public health significance of these observations depends on to what extent these levels reflect actual benzene exposure, and whether such exposures are life-long or at least occur frequently enough to pose a possible health threat. We reviewed the evidence and discussed possible explanations for these observations. It was concluded that while there is reason to suspect that benzene contributes significantly to elevated levels of biomarkers in the general population, there is growing concern that this cannot be definitively ascertained without concomitant consideration of the role of other factors such as metabolic polymorphisms and sources of biomarkers other than benzene, which have been insufficiently studied to date. Such studies are urgently needed for valid assessment of this potential public health problem.

Volatile organic compounds in human milk: methods and measurements

The present study was conducted to optimize methods for measurement of volatile organic compounds (VOCs) by use of headspace solid-phase microextraction (HS-SPME) and to provide a preliminary assessment of levels in human milk. MTBE (methyl tert-butyl ether), chloroform, benzene, and toluene were measured from two sources of milk: a North Carolina milk bank (n = 5) and multiple samples from three women within nonsmoking households in inner-city Baltimore, MD (n = 8). In Baltimore, indoor air VOC concentrations in the respective households were also measured by active sampling and thermal desorption gas chromatography/mass spectrometry in selective ion monitoring (GC/MS/SIM) over each of the 3 days of milk collection. By application of these optimized methods, we observed median VOC concentrations in Baltimore human milk of 0.09, 0.55, 0.12, and 0.46 ng/mL for MTBE, chloroform, benzene, and toluene, respectively. For benzene, toluene, and MTBE, milk levels trended with observed indoor air concentrations. On the basis of measured concentrations in air and milk, infant average daily dose by inhalation exceeded ingestion rates by 25-135-fold. Thus, VOC exposure from breast milk is vastly exceeded by that from indoor air in nonsmoking households. Accordingly, strategies to mitigate infant VOC exposure should focus on the indoor air inhalation pathway of exposure.

Trends in childhood cancer incidence: review of environmental linkages

Cancer in children is rare and accounts for about 1% of all malignancies. In the developed world, however, it is the commonest cause of disease-related deaths in childhood, carrying with it a great economic and emotional cost. Cancers are assumed to be multivariate, multifactorial diseases that occur when a complex and prolonged process involving genetic and environmental factors interact in a multistage sequence. This article explores the available evidence for this process, primarily from the environmental linkages perspective but including some evidence of the genetic factors.

Risk factors for increased BTEX exposure in four Australian cities

Benzene, toluene, ethylbenzene and xylenes (BTEX) are common volatile organic compounds (VOCs) found in urban airsheds. Elevated levels of VOCs have been reported in many airsheds at many locations, particularly those associated with industrial activity, wood heater use and heavy traffic. Exposure to some VOCs has been associated with health risks. There have been limited investigations into community exposures to BTEX using personal monitoring to elucidate the concentrations to which members of the community may be exposed and the main contributors to that exposure. In this cross sectional study we investigated BTEX exposure of 204 non-smoking, non-occupationally exposed people from four Australian cities. Each participant wore a passive BTEX sampler over 24h on five consecutive days in both winter and summer and completed an exposure source questionnaire for each season and a diary for each day of monitoring. The geometric mean (GM) and range of daily BTEX concentrations recorded for the study population were benzene 0.80 (0.04-23.8 ppb); toluene 2.83 (0.03-2120 ppb); ethylbenzene 0.49 (0.03-119 ppb); and xylenes 2.36 (0.04-697 ppb). A generalised linear model was used to investigate significant risk factors for increased BTEX exposure. Activities and locations found to increase personal exposure included vehicle repair and machinery use, refuelling of motor vehicles, being in an enclosed car park and time spent undertaking arts and crafts. A highly significant difference was found between the mean exposures in each of the four cities, which may be explained by differences in fuel composition, differences in the mix and density of industry, density of motor vehicles and air pollution meteorology.

Environmental hazards: evidence for effects on child health

The human fetus, child, and adult may experience adverse health outcomes from parental or childhood exposures to environmental toxicants. The fetus and infant are especially vulnerable to toxicants that disrupt developmental processes during relatively narrow time windows. This review summarizes knowledge of associations between child health and development outcomes and environmental exposures, including lead, methylmercury, polychlorinated biphenyls (PCBs), dioxins and related polyhalogenated aromatic hydrocarbons (PHAHs), certain pesticides, environmental tobacco smoke (ETS), aeroallergens, ambient air toxicants (especially particulate matter [PM] and ozone), chlorination disinfection by-products (DBPs), sunlight, power-frequency magnetic fields, radiofrequency (RF) radiation, residential proximity to hazardous waste disposal sites, and solvents. The adverse health effects linked to such exposures include fetal death, birth defects, being small for gestational age (SGA), preterm birth, clinically overt cognitive, neurologic, and behavioral abnormalities, subtle neuropsychologic deficits, childhood cancer, asthma, other respiratory diseases, and acute poisoning. Some environmental toxicants, notably lead, ionizing radiation, ETS, and certain ambient air toxicants, produce adverse health effects at relatively low exposure levels during fetal or child developmental time windows. For the many associations supported by limited or inadequate epidemiologic evidence, major sources of uncertainty include the limited number of studies conducted on specific exposure-outcome relationships and methodologic limitations. The latter include (1) crude exposure indices, (2) limited range of exposure levels, (3) small sample sizes, and (4) limited knowledge and control of potential confounders. Important knowledge gaps include the role of preconceptual paternal exposures, a topic much less studied than maternal or childhood exposures. Large longitudinal studies beginning before or during early pregnancy are urgently needed to accurately measure and assess the relative importance of parental and childhood exposures and evaluate relatively subtle health outcomes such as neuropsychologic and other functional deficits. Large case-control studies are also needed to assess the role of environmental exposures and their interactions with genetic factors in relatively uncommon outcomes such as specific types of birth defects and childhood cancers. There is also an urgent need to accelerate development and use of biomarkers of exposure and genetic susceptibility in epidemiologic studies. This review supports the priority assigned by international agencies to relationships between child health and air quality (indoor and outdoor), lead, pesticides, water contaminants, and ETS. To adequately address such priorities, governments and agencies must strengthen environmental health research capacities and adopt policies to reduce parental and childhood exposures to proven and emerging environmental threats.

Investigating the role of the aryl hydrocarbon receptor in benzene-initiated toxicity in vitro

Chronic occupational exposure to benzene has been correlated with aplastic aneamia and acute myelogenous leukemia, however mechanisms behind benzene toxicity remain unknown. Interestingly, benzene-initiated hematotoxicity is absent in mice lacking the aryl hydrocarbon receptor (AhR) suggesting an imperative role for this receptor in benzene toxicities. This study investigated two potential roles for the AhR in benzene toxicity using hepa 1c1c7 wild type and AhR deficient cells. Considering that many toxic effects of AhR ligands are dependent on AhR activation, our first objective was to determine if benzene, hydroquinone (HQ) or benzoquinone (BQ) could activate the AhR. Secondly, because the AhR regulates a number of enzymes involved in oxidative stress pathways, we sought to determine if the AhR had a role in HQ and BQ induced production of reactive oxygen species (ROS). Dual luciferase assays measuring dioxin response element (DRE) activation showed no significant change in DRE activity after exposure to benzene, HQ or BQ for 24h. Immunofluorescence staining showed cytosolic localization of the AhR after 2h incubations with benzene, HQ or BQ. Western blot analysis of cells exposed to benzene, HQ or BQ for 1, 12 and 24h did not demonstrate induction of CYP1A1 protein expression. Dichlorodihydrofluorescein staining of cells exposed to benzene, HQ or BQ revealed that the presence of the AhR did not affect BQ and HQ induced ROS production. These results indicate that the involvement of the AhR in benzene toxicity does not seem to be through classical activation of this receptor or through interference of oxidative stress pathways.

Childhood acute lymphocytic leukemia and perspectives on risk assessment of early-life stage exposures

Recognition that children are a potentially susceptible subpopulation has led to the development of child-specific sensitivity factors. Establishing reliable sensitivity factors in support of risk assessment of early-life stage exposures can be aided by evaluating studies that enhance our understanding both of the biological basis of disease processes and the potential role of environmental exposures in disease etiology. For these reasons, we evaluated childhood acute lymphocytic leukemia (ALL) studies from the point of view of mechanism and etiology. ALL is the most common form of childhood cancer proposed to result from a prenatal primary event and a postnatal second event. This multi-stage model is supported by the observation that chromosomal translocations/fusion genes (e.g., TEL-AML1) involved in producing ALL are detected at birth (prenatal event), and a postnatal event (e.g., TEL deletion) is required for disease manifestation. It appears that a proportion of ALL cases are the result of environmental exposures, in which case preconceptional, prenatal, and postnatal stages are likely to be critical exposure windows. To this end, we recognized postnatal infection-related risk factors as potential candidates associated with the ALL second event. Additionally, we discuss use of ALL-associated fusion genes and genetic polymorphisms, together or separately, as indicators of ALL susceptibility and increased risk. The possibility of using fusion genes alone as biomarkers of response is also discussed because they can serve as predictors of key events in the development of a mode of action (a sequence of key events, starting with interaction of an agent with a cell, ultimately resulting in cancer formation) for particular environmental exposures. Furthermore, we discuss use of an initiated animal model for ALL, namely transgenic mice with TEL-AML1 expression, for exploring mechanisms by which different classes of environmental exposures could be involved in inducing the postnatal step in ALL formation.

The effects of air pollution on the health of children

The present article is intended to inform paediatricians about the associations between ambient air pollution and adverse health outcomes in children within the context of current epidemiological evidence.The majority of the current literature pertains to adverse respiratory health outcomes, including asthma, other respiratory symptoms, and deficits in lung function and growth, as well as exposure to ambient levels of criteria air pollutants. In addition to the above, the present article highlights mortality, pregnancy outcomes, vitamin D deficiency and alteration in the immune system of children.Some of the data on the impact of improved air quality on children's health are provided, including the reduction of air pollution in former East Germany following the reunification of Germany, as well as the reduction in the rates of childhood asthma events during the 1996 Summer Olympics in Atlanta, Georgia, due to a reduction in local motor vehicle traffic. However, there are many other toxic air pollutants that are regularly released into the air. These pollutants, which are not regularly monitored and have not been adequately researched, are also potentially harmful to children.Significant morbidity and mortality is attributed to ambient air pollution, resulting in a significant economic cost to society. As Canada's cities grow, air pollution issues need to be a priority in order to protect the health of children and support sustainable development for future generations.

Environmental genotoxicants/carcinogens and childhood cancer: Bridgeable gaps in scientific knowledge

Cancer in children is a major concern in many countries. An important question is whether these childhood cancers are caused by something, or are just tragic random events. Causation of at least some children's cancers is suggested by direct and indirect evidence, including epidemiological data, and animal studies that predict early life sensitivity of humans to carcinogenic effects. Candidate risk factors include genotoxic agents (chemicals and radiation), but also diet/nutrition, and infectious agents/immune responses. With regard to likelihood of risks posed by genotoxicants, there are pros and cons. The biological properties of fetuses and infants are consistent with sensitivity to preneoplastic genotoxic damage. Recent studies of genetic polymorphisms in carcinogen-metabolizing enzymes confirm a role for chemicals. On the other hand, in numerous epidemiological studies, associations between childhood cancers and exposure to genotoxicants, including tobacco smoke, have been weak and hard to reproduce. Possibly, sensitive genetic or ontogenetic subpopulations, and/or co-exposure situations need to be discovered to allow identification of susceptible individuals and their risk factors. Among the critical knowledge gaps needing to be bridged to aid in this effort include detailed tissue and cellular ontogeny of carcinogen metabolism and DNA repair enzymes, and associations of polymorphisms in DNA repair enzymes with childhood cancers. Perinatal bioassays in animals of specific environmental candidates, for example, benzene, could help guide epidemiology. Genetically engineered animal models could be useful for identification of chemical effects on specific genes. Investigations of interactions between factors may be key to understanding risk. Finally, fathers and newborn infants should receive more attention as especially sensitive targets.

Analysis of mutagenic V(D)J recombinase mediated mutations at the HPRT locus as an in vivo model for studying rearrangements with leukemogenic potential in children

Pediatric acute lymphocytic leukemia (ALL) is a multifactorial malignancy with many distinctive developmentally specific features that include age specific acquisition of deletions, insertions and chromosomal translocations. The analysis of breakpoint regions involved in these leukemogenic genomic rearrangements has provided evidence that many are the consequence of V(D)J recombinase mediated events at both immune and non-immune loci. Hence, the direct investigation of in vivo genetic and epigenetic features in human peripheral lymphocytes is necessary to fully understand the mechanisms responsible for the specificity and frequency of these leukemogenic non-immune V(D)J recombinase events. In this review, I will present the utility of analyzing mutagenic V(D)J recombinase mediated genomic rearrangements at the HPRT locus in humans as an in vivo model system for understanding the mechanisms responsible for leukemogenic genetic alterations observed in children with leukemia.

Roads, railways, and childhood cancers

STUDY OBJECTIVES

To locate geographical sources of engine exhaust emissions in Great Britain and to link them with the birth addresses of children dying from cancer. To estimate the cancer initiating roles of nearby roads and railways and to measure effective ranges.

DESIGN

Birth and death addresses of all children born between 1955 and 1980 in Great Britain, and dying from leukaemia or other cancer during those years, were linked to locations of railway stations, bus stations, ferry terminals, railways, roads, canals, and rivers. Nearest distances to births and deaths were measured, and migration data relating to children who had moved house were analysed. Excesses of close to hazard birth addresses, compared with close to hazard death addresses, indicate a high prenatal or early postnatal risk of cancer initiation.

SETTING AND SUBJECTS

Child cancer birth and death addresses and their map references were extracted from an earlier inquiry. Map references of putative hazards were downloaded from the Ordnance Survey national digital map of Great Britain. These data are recorded to a precision of one metre and have ground accuracies around 20 metres.

MAIN RESULTS

Significant birth excesses were found within short distances of bus stations, railway stations, ferries, railways, and A,B class roads, with a relative risk of 2.1 within 100 m, tapering to neutral after 3.0 km. About 24% of child cancers were attributable to these joint birth proximities. Roads exerted the major effect.

CONCLUSIONS

Child cancer initiations are strongly determined by prenatal or early postnatal exposures to engine exhaust gases, probably through maternal inhalation and accumulation of carcinogens over many months. The main active substance is probably 1,3-butadiene.

Oil combustion and childhood cancers

STUDY OBJECTIVES

To identify specific toxic atmospheric emissions and their industrial sources in Great Britain. To link them with each other and with the birth addresses of children dying from cancer. To identify specific causal agents and sources.

DESIGN

Birth and death addresses of children dying from cancer were linked to emissions hotspots for specific chemicals: and to related source installations. Among those who moved house, distances from each address to the nearest hazard were compared. Relative excesses of close-to-hazard birth addresses showed high prenatal or early postnatal risks. Relative risks for individual and for combined exposures were measured.

SETTING AND SUBJECTS

Atmospheric emissions hotspots (UK, 2001) published as maps on the internet, were converted to coordinates. Industrial sites were identified through trade directories and map inspections. Child cancer addresses for 1955-80 births were extracted from an earlier inquiry and their postcodes converted to map references.

MAIN RESULTS

There were excess relative risks (RR) within 0.3 km of hotspots for carbon monoxide, PM10 particles, nitrogen oxides, 1,3-butadiene, benzene, dioxins, benzo(a)pyrene, and volatiles; and within 1.0 km of bus stations, hospitals, heavy transport centres, railways, and oil installations. Some excesses were attributable to mutual confounding, but 1,3-butadiene and carbon monoxide, mainly derived from engine exhausts, were powerful independent predictors. They were strongly reinforced when associated with bus stations, hospitals, railways, oil installations, and industrial transport centres; RR = 12.6 for joint <0.5 km exposure to bus stations and 1,3-butadiene.

CONCLUSIONS

Childhood cancers are strongly determined by prenatal or early postnatal exposures to oil based combustion gases, especially from engine exhausts. 1,3-butadiene, a known carcinogen, may be directly causal.

Household exposure to pesticides and risk of childhood acute leukaemia

OBJECTIVES

To investigate the relation between childhood acute leukaemia and household exposure to pesticides.

METHODS

The study included 280 incident cases of acute leukaemia and 288 controls frequency matched on gender, age, hospital, and ethnic origin. The data were obtained from standardised face to face interviews of the mothers with detailed questions on parental occupational history, home and garden insecticide use, and insecticidal treatment of pediculosis. Odds ratios were estimated using unconditional regression models including the stratification variables parental socioeconomic status and housing characteristics.

RESULTS

Acute leukaemia was observed to be significantly associated with maternal home insecticide use during pregnancy (OR = 1.8, 95% CI 1.2 to 2.8) and during childhood (OR = 1.7, 95% CI 1.1 to 2.4), with garden insecticide use (OR = 2.4, 95% CI 1.3 to 4.3), and fungicide use (OR = 2.5, 95% CI 1.0 to 6.2) during childhood. Insecticidal shampoo treatment of pediculosis was also associated with childhood acute leukaemia (OR = 1.9, 95% CI 1.2 to 3.3).

CONCLUSION

The results reported herein support the hypothesis that various types of insecticide exposure may be a risk factor for childhood acute leukaemia. The observed association with insecticidal shampoo treatment of pediculosis, which has never been investigated before, requires further study.

Air pollution and childhood cancer: A review of the epidemiological literature

The authors evaluated support in the literature for the hypothesis that ambient air pollution causes childhood cancer. The PubMed database was searched for original articles, which were reviewed for evidence of a relation with the main types of childhood cancer, using criteria including sample size, magnitude and precision of relative risk estimates, presence of a dose-response pattern and potential for bias. The hypothesis has been studied almost entirely with respect to traffic-related air pollution. Since derivation of the hypothesis from 2 case-control studies in Denver, USA, two further case-control studies have provided new positive evidence and 4 case-control and 7 ecological studies mainly negative evidence. The 4 case-control studies providing positive evidence were relatively small and tended to have more methodological limitations than those showing no association. Publication bias is possible. The weight of the epidemiological evidence indicates no increased risk for childhood cancer associated with exposure to traffic-related residential air pollution. Nevertheless, the limited number of studies, the methodological limitations of both positive and negative studies and the absence of consistency in the results obviate a firm conclusion of no effect. In particular, nondifferential misclassification of exposure might have masked true, weak associations.