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Song I, Yoo EH, Jung I, Oh JK, Kim SY. Role of geographic characteristics in the spatial cluster detection of cancer: Evidence in South Korea, 1999-2013. ENVIRONMENTAL RESEARCH 2023; 236:116841. [PMID: 37549782 DOI: 10.1016/j.envres.2023.116841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Identification of high-risk areas of cancer, referred to as spatial clusters, can inform targeted policies for cancer control. Although cancer cluster detection could be affected by various geographic characteristics including sociodemographic and environmental factors which impacts could also vary over time, studies accounting for such influence remain limited. This study aims to assess the role of geographic characteristics in the spatial cluster detection for lung and stomach cancer over an extended period. METHODS We obtained sex-specific age-standardized incidence and mortality rates of lung and stomach cancer as well as geographic characteristics across 233 districts in South Korea for three five-year periods between 1999 and 2013. We classified geographic characteristics of each district into four categories: demography, socioeconomic status, behaviors, and physical environments. Specifically, we quantified physical environments using measures of greenness, concentrations of particulate matter and nitrogen dioxide, and air pollution emissions. Finally, we conducted cluster detection analyses using weighted normal spatial scan statistics with the residuals from multiple regression analyses performed with the four progressive sets of geographic attributes. RESULTS We found that the size of clusters reduced as we progressively adjusted for geographic covariates. Among the four categories, physical environments had the greatest impact on the reduction or disappearance of clusters particularly for lung cancer consistently over time. Whereas older population affected a decrease of lung cancer clusters in the early period, the contribution of education was large in the recent period. The impact was less clear in stomach cancer than lung cancer. CONCLUSION Our findings highlight the importance of geographic characteristics in explaining the existing cancer clusters and identifying new clusters, which jointly provides practical guidance to cancer control.
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Affiliation(s)
- Insang Song
- Department of Geography, University of Oregon, Eugene, OR, 97403, USA
| | - Eun-Hye Yoo
- Department of Geography, The State University of New York at Buffalo, NY, 14261, USA
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jin-Kyoung Oh
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center of Korea, Goyang, Gyeonggi-do, 10408, Republic of Korea
| | - Sun-Young Kim
- Department of Cancer AI and Digital Health, Graduate School of Cancer Science and Policy, National Cancer Center of Korea, Goyang, Gyeonggi-do, 10408, Republic of Korea.
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Ziyaee S, Akbari ME, Azizmohammad Looha M, Rahimi F, Khodakarim S. Spatiotemporal variations in childhood lymphoma cancer incidence and its survival rate in Iran, 2005-2015: a cross-sectional study. BMJ Paediatr Open 2023; 7:e001802. [PMID: 37344003 DOI: 10.1136/bmjpo-2022-001802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/25/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Childhood lymphoma is the second leading cause of cancer in children under 15 years of age in Iran. The aim of this study was to investigate the spatial and time variations in lymphoma incidence as well as the children's survival time in Iran. METHOD This cross-sectional study was conducted using lymphoma cases (children under 14 years of age) from 2005 to 2015, and the data were obtained from the National Cancer Registry Center. The frequency, age-standardised incidence rate (ASIR), spatial clustering in national level and the survival rate (1 year and 5 years) using Kaplan-Meier method were evaluated. We used Spatial and Temporal Scan statistics software in order to detect statistically significant clusters in spatial analysis. RESULTS A total number of 746 girls and 1610 boys were diagnosed with lymphoma during a 10-year period. ASIRs (per 100 000 people) for girls ranged from 0 in Ilam to 3.47 in Yasuj, and it ranged from 0.19 in Ilam to 5.91 in Yazd for boys from 2005 to 2015. Spatial analysis result showed a large statistically significant cluster (the most likely cluster) for both boys (relative risk (RR)=2.37) and girls (RR=2.49) located in the northwest of Iran. Fortunately, survival rate for both boys and girls was over 95.5%. CONCLUSION Lymphoma incidence rates had heterogeneous geographical distribution, and some significant clusters were identified which strengthens the role of possible aetiological factors, and further studies are needed to clarify this ambiguity. Fortunately, the survival rate of this cancer in Iran was good and it was similar to the high-income countries.
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Affiliation(s)
- Samaneh Ziyaee
- Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical sciences, Tehran, Iran
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Esmaeil Akbari
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mehdi Azizmohammad Looha
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Forough Rahimi
- Departments of English Language, School of Paramedical Science, Shiraz University of Medical, Shiraz, Iran (the Islamic Republic of)
| | - Soheila Khodakarim
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran (the Islamic Republic of)
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Bamouni S, Hémon D, Faure L, Clavel J, Goujon S. Residential proximity to croplands at birth and childhood leukaemia. Environ Health 2022; 21:103. [PMID: 36303166 PMCID: PMC9615229 DOI: 10.1186/s12940-022-00909-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022]
Abstract
Background Domestic and parental occupational pesticide exposures are suspected of involvement in the occurrence of childhood acute leukaemia (AL), but the role of exposure to agricultural activities is little known. In a previous ecological study conducted in France, we observed an increase in acute lymphoblastic leukaemia (ALL) incidence rate with increasing viticulture density in the municipalities of residence at diagnosis. Objectives This study aimed to test the hypothesis that residential proximity to croplands at birth increases the risk of childhood AL, with a particular focus on vineyards. Methods We identified all the primary AL cases diagnosed before the age of 15 years in the cohorts of children born in the French municipalities between 1990 and 2015. We estimated crop densities in each municipality of residence at birth using agricultural census data, for ten crop types. Variations in standardized incidence ratios (SIR) were evaluated with Poisson regression models, for all AL, ALL and acute myeloid leukaemia (AML), separately. Results Among the 19,809,700 children born and residing in mainland France at birth in 1990–2015, 8,747 AL cases (7,236 ALL and 1,335 AML) were diagnosed over the period. We did not evidence any statistically significant positive association between total crop density or any specific crop density in the municipality of residence at birth and all AL, ALL or AML. Interestingly, we observed a higher ALL incidence rate in the municipalities with the highest viticulture densities (SIR = 1.25 95%CI [1.01–1.54]). Adjusting for the main potential confounders did not change the results. Conclusion Our study does not support the hypothesis that residential proximity to croplands, particularly vineyards, around birth plays a role in childhood leukaemia. The slightly higher ALL incidence rate in children born in the municipalities with the highest viticulture densities may reflect the previously-observed association at diagnosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12940-022-00909-0.
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Affiliation(s)
- Sophie Bamouni
- Inserm, UMR 1153 Center of Research in Epidemiology and StatisticS (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), 16 avenue Paul Vaillant Couturier, Hôpital Paul Brousse - Bât Leriche/porte 45, F-94807, Villejuif Cedex, France. .,Université Paris Cité, Paris, France.
| | - Denis Hémon
- Inserm, UMR 1153 Center of Research in Epidemiology and StatisticS (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), 16 avenue Paul Vaillant Couturier, Hôpital Paul Brousse - Bât Leriche/porte 45, F-94807, Villejuif Cedex, France.,Université Paris Cité, Paris, France
| | - Laure Faure
- Inserm, UMR 1153 Center of Research in Epidemiology and StatisticS (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), 16 avenue Paul Vaillant Couturier, Hôpital Paul Brousse - Bât Leriche/porte 45, F-94807, Villejuif Cedex, France.,Université Paris Cité, Paris, France.,French National Registry of Childhood Haematological Malignancies (RNHE), F-94807, Villejuif, France
| | - Jacqueline Clavel
- Inserm, UMR 1153 Center of Research in Epidemiology and StatisticS (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), 16 avenue Paul Vaillant Couturier, Hôpital Paul Brousse - Bât Leriche/porte 45, F-94807, Villejuif Cedex, France.,Université Paris Cité, Paris, France.,French National Registry of Childhood Haematological Malignancies (RNHE), F-94807, Villejuif, France
| | - Stéphanie Goujon
- Inserm, UMR 1153 Center of Research in Epidemiology and StatisticS (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), 16 avenue Paul Vaillant Couturier, Hôpital Paul Brousse - Bât Leriche/porte 45, F-94807, Villejuif Cedex, France.,Université Paris Cité, Paris, France.,French National Registry of Childhood Haematological Malignancies (RNHE), F-94807, Villejuif, France
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Loizou L, Demetriou A, Erdmann F, Borkhardt A, Brozou T, Sharp L, McNally R. Patterns and temporal trends in the incidence of childhood and adolescence cancer in Cyprus 1998-2017: A population-based study from the Cyprus Paediatric Oncology Registry. Cancer Epidemiol 2022; 80:102239. [PMID: 35994888 DOI: 10.1016/j.canep.2022.102239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/22/2022] [Accepted: 08/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite its rarity, cancer in children and adolescents (CAC) is a major health issue worldwide. The lack of appropriate cancer registries is an obstacle for defining its incidence and survival, and informing cancer control. As in Cyprus, CAC epidemiology has not previously been comprehensively examined, we determined incidence rates and temporal trends of cancer in the 0-19 age group during 1998-2017. METHODS We established the population based Paediatric Oncology Registry of Cyprus (PORCY) for the period 1998-2017. World age standardised incidence rate per million children and adolescents per year (ASRW) were calculated and time trends were assessed using Joinpoint regression analysis. Comparisons were made with other countries using the International Incidence of Childhood Cancer, third volume. RESULTS For all cancers combined, for ages 0-19-years, ASRW was 203.54 (95% CI 189.49, 217.59) one of the highest rates globally. The most frequent CAC were leukaemias followed by lymphomas, specified epithelial neoplasms and central nervous system tumours, differing to what is described in most other countries. For all cancers, both combined and individual types, except thyroid carcinoma (where incidence was rising), no significant temporal variation was found. CONCLUSIONS To inform cancer control activities, we conducted the first ever population-based epidemiological study of childhood and adolescent cancer (0-19 years) in Cyprus. The striking findings indicate high overall incidence rates that are among the world's highest, a higher frequency of lymphomas and thyroid cancer than brain tumours, and rising incidence for thyroid, but not for other, cancers. These novel findings, will help the formulation of hypotheses to provide explanation for the high rates for all CAC in Cyprus and may contribute to the global efforts for improving prevention of cancer in this age group.
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Affiliation(s)
- Loizos Loizou
- University of Nicosia Medical School, Cyprus; Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
| | - Anna Demetriou
- National Cancer Registry, Health Monitoring Unit, Ministry of Health, Cyprus.
| | - Friederike Erdmann
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
| | - Arndt Borkhardt
- Department of Paediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine University Dusseldorf, Dusseldorf, Germany.
| | - Triantafyllia Brozou
- Department of Paediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine University Dusseldorf, Dusseldorf, Germany.
| | - Linda Sharp
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
| | - Richard McNally
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
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Zhao Y, Sun P, Xiao J, Jin L, Ma N, Li Z, Feng G, Huang H, Deziel NC, Ma X, Ni X, Zhang Y. International patterns and trends of childhood and adolescent cancer, 1978-2012. JOURNAL OF THE NATIONAL CANCER CENTER 2022; 2:78-89. [PMID: 39034956 PMCID: PMC11256536 DOI: 10.1016/j.jncc.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background This study aimed to provide a detailed analysis of the temporal trends of cancer incidence rates for individuals aged 0-19 years in selected regions globally from 1978 to 2012. Methods Data were obtained from Volumes V-XI of Cancer Incidence in Five Continents (CI5), published by the International Agency for Research on Cancer. A total of 53 registries in 23 regions from the Americas, Asia, Europe, and Oceania that contained information on cancer incidence throughout 1978-2012 (35 years) were included in this study. Joinpoint regression was used for the analysis of trends. Results Most regions showed increasing trends in overall childhood cancer among children (aged 0-14 years) and adolescents (aged 15-19 years). Nearly all regions showed rising trends in childhood and adolescent leukemia incidence rates, whereas the incidence of lymphoma among children generally decreased. Only France, Australia, and New Zealand showed decreasing trends for malignant central nervous system (CNS) tumors among adolescents. Kidney cancer and bone cancer incidence rates remained stable for most regions. The incidence of thyroid cancer among adolescents increased in most regions and that of testicular cancer decreased in approximately one-half of the regions studied. Conclusion The international temporal trends of cancer incidents among children and adolescents are varied by region, cancer type, age group, and gender, and have changed over time.
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Affiliation(s)
- Yawen Zhao
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Peiyuan Sun
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingyuan Xiao
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Lan Jin
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Ning Ma
- Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhe Li
- National Center for Pediatric Cancer Surveillance, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Guoshuang Feng
- Center for Bigdata Research, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Huang Huang
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nicole C. Deziel
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- National Center for Pediatric Cancer Surveillance, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Center for Bigdata Research, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yawei Zhang
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Joseph N, Kolok AS. Assessment of Pediatric Cancer and Its Relationship to Environmental Contaminants: An Ecological Study in Idaho. GEOHEALTH 2022; 6:e2021GH000548. [PMID: 35310467 PMCID: PMC8917512 DOI: 10.1029/2021gh000548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 05/31/2023]
Abstract
The primary aim of this study was to determine the degree to which a multivariable principal component model based on several potentially carcinogenic metals and pesticides could explain the county-level pediatric cancer rates across Idaho. We contend that human exposure to environmental contaminants is one of the reasons for increased pediatric cancer incidence in the United States. Although several studies have been conducted to determine the relationship between environmental contaminants and carcinogenesis among children, research gaps exist in developing a meaningful association between them. For this study, pediatric cancer data was provided by the Cancer Data Registry of Idaho, concentrations of metals and metalloids in groundwater were collected from the Idaho Department of Water Resources, and pesticide use data were collected from the United States Geological Survey. Most environmental variables were significantly intercorrelated at an adjusted P-value <0.01 (97 out of 153 comparisons). Hence, a principal component analysis was employed to summarize those variables to a smaller number of components. An environmental burden index (EBI) was constructed using these principal components, which categorized the environmental burden profiles of counties into low, medium, and high. EBI was significantly associated with pediatric cancer incidence (P-value <0.05). The rate ratio of high EBI profile to low EBI profile for pediatric cancer incidence was estimated as 1.196, with lower and upper confidence intervals of 1.061 and 1.348, respectively. A model was also developed in the study using EBI to estimate the county-level pediatric cancer incidence in Idaho (Nash-Sutcliffe Efficiency = 0.97).
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Affiliation(s)
- Naveen Joseph
- Idaho Water Resources Research InstituteUniversity of IdahoMoscowIDUSA
| | - Alan S. Kolok
- Idaho Water Resources Research InstituteUniversity of IdahoMoscowIDUSA
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Berlivet J, Hémon D, Cléro É, Ielsch G, Laurier D, Faure L, Clavel J, Goujon S. Residential exposure to natural background radiation at birth and risk of childhood acute leukemia in France, 1990-2009. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2021; 233:106613. [PMID: 33895630 DOI: 10.1016/j.jenvrad.2021.106613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/26/2021] [Accepted: 04/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The role of natural background radiation (NBR) in childhood acute leukemia (AL) remains unclear. Several large record based studies have recently reported heterogeneous results. Differences in exposure assessment timing may explain this heterogeneity. OBJECTIVES In a previous ecological study we did not observe any association between childhood AL incidence in France and NBR exposure at the time of diagnosis. With the same methodology, the present study focused on NBR exposure at the time of birth. Based on data from the French national registry of childhood cancer, we analyzed all AL together, and lymphoblastic and myeloid AL, separately. METHODS We included 6,059 childhood AL cases born and diagnosed in mainland France between 1990 and 2009. NBR levels in municipalities of residence at birth were estimated by cokriging models, using NBR measurements and precise geological data. The incidence rate ratio (IRR) per unit variation of exposure was estimated with Poisson regression models, with adjustment for socio-demographic indicators and ultraviolet radiation levels. NBR exposures were considered at the time of birth, and cumulatively from birth to diagnosis. We also estimated a total NBR dose to red-bone marrow (RBM). RESULTS There was no evidence for an association between NBR exposure at birth and childhood AL incidence, neither overall (gamma radiation: IRR = 0.99 (0.94,1.05) per 50 nSv/h; radon: IRR = 0.97 (0.91,1.03) per 100 Bq/m3) nor for the main AL types. The conclusions were similar with the cumulative exposures, and the total RBM dose. CONCLUSIONS The study was based on high quality incidence data, large numbers of AL cases, and validated models of NBR exposure assessment. In all, the results further support the hypothesis that NBR are not associated to childhood AL in France.
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Affiliation(s)
- Justine Berlivet
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Paris University, Villejuif, F-94807, France
| | - Denis Hémon
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Paris University, Villejuif, F-94807, France
| | - Énora Cléro
- Institute for Radiological Protection and Nuclear Safety (IRSN), Health and Environment Division, Fontenay-aux-Roses, F-92262, France
| | - Geraldine Ielsch
- Institute for Radiological Protection and Nuclear Safety (IRSN), Health and Environment Division, Fontenay-aux-Roses, F-92262, France
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), Health and Environment Division, Fontenay-aux-Roses, F-92262, France
| | - Laure Faure
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Paris University, Villejuif, F-94807, France; French National Registry of Childhood Hematological Malignancies (RNHE), Villejuif, F-94807, France
| | - Jacqueline Clavel
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Paris University, Villejuif, F-94807, France; French National Registry of Childhood Hematological Malignancies (RNHE), Villejuif, F-94807, France
| | - Stéphanie Goujon
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Paris University, Villejuif, F-94807, France; French National Registry of Childhood Hematological Malignancies (RNHE), Villejuif, F-94807, France.
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Manrique-Hernández EF, Rojas Díaz MP, Rodriguez-Villamizar LA. Clustering of non-leukemia childhood cancer in Colombia: a nationwide study. F1000Res 2021; 10:86. [PMID: 34249334 PMCID: PMC8261763 DOI: 10.12688/f1000research.27766.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Childhood cancer is considered one the most important causes of death in children and adolescents, despite having a low incidence in this population. Spatial analysis has been previously used for the study of childhood cancer to study the geographical distribution of leukemias. This study aimed to identify the presence of space-time clusters of childhood of cancer excluding leukemia in Colombia between 2014 and 2017. Methods: All incident cancer cases (excluding leukemia) in children under the age of 15 years that had been confirmed by the National Surveillance System of Childhood Cancer between 2014 and 2017 were included. Kulldorf's circular scan test was used to identify clusters using the municipality of residence as the spatial unit of analysis and the year of diagnosis as the temporal unit of analysis. A sensitivity analysis was conducted with different upper limit parameters for the at-risk population in the clusters. Results: A total of 2006 cases of non-leukemia childhood cancer were analyzed, distributed in 432 out of 1,122 municipalities with a mean annual incidence rate of 44 cases per million children under the age of 15. Central nervous system (CNS) tumors were the most frequent type. Two space-time clusters were identified in the central and southwest regions of the country. In the analysis for CNS tumors, a spatial cluster was identified in the central region of the country. Conclusions: The distribution of non-leukemia childhood cancer seems to have a clustered distribution in some Colombian regions that may suggest infectious or environmental factors associated with its incidence although heterogeneity in access to diagnosis cannot be discarded.
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Affiliation(s)
- Edgar F. Manrique-Hernández
- Public Health Department, School of Medicine, Universidad Industrial de Santander. Bucaramanga, Santander, Colombia
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Monthly variation in diagnosis of acute lymphoblastic leukemia and survival outcome in children and adults: 15-year trends at a single center. Hematol Transfus Cell Ther 2021; 44:314-320. [PMID: 33422491 PMCID: PMC9477782 DOI: 10.1016/j.htct.2020.10.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/07/2020] [Accepted: 10/28/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The date of acute lymphoblastic leukemia (ALL) diagnosis has been studied regarding potential etiologic roles with contrasting results and the issue remains controversial. The principal aim of this study was to analyze monthly variation of ALL diagnosis in a large homogenous Hispanic Latin American cohort over 15 years; its association with survival rates was also assessed. METHODS Clinical files and electronic records of 501 consecutive patients of all ages with ALL in northeastern Mexico over the years of 2004-2018 were scrutinized. Patients were divided into children ≤18 and adults >18 years. The Chi-square heterogeneity analysis was used to test for non-uniform variation. The Poisson regression analysis was used to fit sinusoidal (harmonic) models to the data, using the month of diagnosis as a covariate in a separate model. RESULTS During the study period 363 children (72.5%) and 138 adults (27.5%) (p < 0.001) were diagnosed with ALL. Heterogeneity across the months of diagnosis was confirmed (p = 0.019) and the Poisson regression analysis confirmed a significant monthly variation (p < 0.001) (95% CI, 3.024-3.745), a higher annual peak being observed in the month of March (p = 0.002), followed by a second peak in October (p = 0.026). The five-year OS for children was 68.2% (95% CI, 67.64-68.74) and for adults, 43.7% (95% CI, 42.67-44.71) (p < 0.001). No significant association between the month of diagnosis and OS was found (p = 0.789). CONCLUSION The monthly variation of ALL diagnosis was documented; these results confirm the heterogeneous behavior of the disease and appear to be consistent with an interplay of environmental and biologic factors. Further studies are needed to examine putative candidate agents.
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Coste A, Goujon S, Faure L, Hémon D, Clavel J. Agricultural crop density in the municipalities of France and incidence of childhood leukemia: An ecological study. ENVIRONMENTAL RESEARCH 2020; 187:109517. [PMID: 32438101 DOI: 10.1016/j.envres.2020.109517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Pesticide exposure is suspected to play a role in the etiology of childhood leukemia (AL). Various sources of exposure have been explored, but few studies have investigated the risk of childhood AL in relation to residential exposure to agricultural pesticides. Since around 50% of France is agricultural land, with marked pesticide use, France is a suitable location to investigate for an association. We aimed to analyze the association between the agricultural crop density in the municipalities of France and the incidence of childhood AL between 1990 and 2014. METHODS 11,487 cases of AL diagnosed in children aged 0-14 years were registered by the French National Registry of Childhood Hematological Malignancies over 1990-2014. National agricultural census data for 1990, 2000 and 2010 were used to estimate the densities of the most common crops in France. The incidence of AL was estimated in the 35,512 municipalities, by age and gender, and 3 observation periods, and expressed as the standardized incidence ratio (SIR). RESULTS We observed a moderate log-linear association between viticulture density and the incidence of AL, with a 3% increase in SIR for a 10% increase in viticulture density (SIRR = 1.03; 95%CI [1.00-1.06]). The association remained for lymphoblastic AL but not for myeloid AL. The association was stable after stratification by geographic area, age and period, and after adjustment on UV radiation and a French deprivation index. No consistent association was observed for other crop types. DISCUSSION This nationwide study shows a moderate increase in incidence of childhood AL in municipalities where viticulture is common. Future individual studies are needed to know whether this observation is confirmed and related to particular use of pesticides.
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Affiliation(s)
- Astrid Coste
- Inserm, UMR 1153 Centre of Research in Epidemiology and StatisticS (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France; Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland.
| | - Stéphanie Goujon
- Inserm, UMR 1153 Centre of Research in Epidemiology and StatisticS (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France.
| | - Laure Faure
- Inserm, UMR 1153 Centre of Research in Epidemiology and StatisticS (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France; French National Registry of Childhood Hematological,Malignancies, France
| | - Denis Hémon
- Inserm, UMR 1153 Centre of Research in Epidemiology and StatisticS (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France
| | - Jacqueline Clavel
- Inserm, UMR 1153 Centre of Research in Epidemiology and StatisticS (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France; French National Registry of Childhood Hematological,Malignancies, France
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11
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Konstantinoudis G, Schuhmacher D, Ammann RA, Diesch T, Kuehni CE, Spycher BD. Bayesian spatial modelling of childhood cancer incidence in Switzerland using exact point data: a nationwide study during 1985-2015. Int J Health Geogr 2020; 19:15. [PMID: 32303231 PMCID: PMC7165384 DOI: 10.1186/s12942-020-00211-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/11/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The aetiology of most childhood cancers is largely unknown. Spatially varying environmental factors such as traffic-related air pollution, background radiation and agricultural pesticides might contribute to the development of childhood cancer. This study is the first investigation of the spatial disease mapping of childhood cancers using exact geocodes of place of residence. METHODS We included 5947 children diagnosed with cancer in Switzerland during 1985-2015 at 0-15 years of age from the Swiss Childhood Cancer Registry. We modelled cancer risk using log-Gaussian Cox processes and indirect standardisation to adjust for age and year of diagnosis. We examined whether the spatial variation of risk can be explained by modelled ambient air concentration of NO2, modelled exposure to background ionising radiation, area-based socio-economic position (SEP), linguistic region, duration in years of general cancer registration in the canton or degree of urbanisation. RESULTS For all childhood cancers combined, the posterior median relative risk (RR), compared to the national level, varied by location from 0.83 to 1.13 (min to max). Corresponding ranges were 0.96 to 1.09 for leukaemia, 0.90 to 1.13 for lymphoma, and 0.82 to 1.23 for central nervous system (CNS) tumours. The covariates considered explained 72% of the observed spatial variation for all cancers, 81% for leukaemia, 82% for lymphoma and 64% for CNS tumours. There was weak evidence of an association of CNS tumour incidence with modelled exposure to background ionising radiation (RR per SD difference 1.17; 0.98-1.40) and with SEP (1.6; 1.00-1.13). CONCLUSION Of the investigated diagnostic groups, childhood CNS tumours showed the largest spatial variation. The selected covariates only partially explained the observed variation of CNS tumours suggesting that other environmental factors also play a role.
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Affiliation(s)
- Garyfallos Konstantinoudis
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
- Epidemiology and Biostatistics Department, School of Public Health, Imperial College London, London, UK.
| | - Dominic Schuhmacher
- Institute for Mathematical Stochastics, University of Göttingen, Göttingen, Germany
| | - Roland A Ammann
- Department of Paediatrics Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tamara Diesch
- Division of Paediatric Oncology/Haematology, University Children's Hospital Basel, Basel, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Ben D Spycher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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12
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Berlivet J, Hémon D, Cléro É, Ielsch G, Laurier D, Guissou S, Lacour B, Clavel J, Goujon S. Ecological association between residential natural background radiation exposure and the incidence rate of childhood central nervous system tumors in France, 2000-2012. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2020; 211:106071. [PMID: 31600676 DOI: 10.1016/j.jenvrad.2019.106071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/01/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND High-dose ionizing radiation is an established risk factor for childhood central nervous system tumors (CNST) but the role of low doses remains debated. In particular, there are few studies of natural background radiation (NBR, gamma radiation and radon) and childhood CNST, and their results are inconclusive. OBJECTIVES This study aimed to investigate the ecological association between NBR exposure and childhood CNST incidence in France, considering childhood CNST overall and by subgroups. METHODS Incidence data were provided by the French national registry of childhood cancers, which has high completeness. We included 5471 childhood CNST cases registered over the period 2000-2012, and their municipality of residence at diagnosis was recorded. Municipality NBR exposures were estimated by cokriging models, using NBR measurements and additional geographic data. The incidence rate ratio (IRR) per unit variation of exposure was estimated with Poisson regression models. NBR exposures were considered at the time of diagnosis, and cumulatively from birth to diagnosis. In an exploratory analysis, the total brain dose due to NBR was used. RESULTS Overall, there was no association between NBR exposure and childhood CNST incidence (IRR = 1.03 (0.98,1.09) per 50 nSv/h for gamma radiation, and IRR = 1.02 (0,96,1.07) per 100 Bq/m3 for radon). An association was suggested between pilocytic astrocytomas and gamma radiation (IRR = 1.12 (1.00,1.24) per 50 nSv/h) but not with radon (IRR = 1.07 (0.95,1.20) per 100 Bq/m3). Upward trends for this CNST subtype were also suggested with the cumulative exposures to gamma radiation and the total brain dose. NBR exposure was not associated with other CNST subgroups (ependymomas, embryonal tumors, and gliomas other than pilocytic astrocytomas). Adjustment for socio-demographic factors did not change the findings. CONCLUSIONS Our study was based on high quality incidence data, large numbers of CNST cases, and validated models of NBR exposure assessment. Results suggest an association between gamma radiation, as a component of NBR, and pilocytic astrocytomas incidence in France.
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Affiliation(s)
- Justine Berlivet
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France.
| | - Denis Hémon
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France
| | - Énora Cléro
- Institut de Radioprotection et de Sûreté Nucléaire, IRSN, PSE-SANTE/SESANE, Fontenay aux Roses, F-92262, France
| | - Géraldine Ielsch
- Institut de Radioprotection et de Sûreté Nucléaire, IRSN, PSE-ENV/SEREN, Fontenay aux Roses, F-92262, France
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire, IRSN, PSE-SANTE/SESANE, Fontenay aux Roses, F-92262, France
| | - Sandra Guissou
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France; CHU Nancy, French National Registry of Childhood Solid Tumors (RNTSE), Faculté de Médecine, Vandoeuvre-lès-Nancy, F-54500, France
| | - Brigitte Lacour
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France; CHU Nancy, French National Registry of Childhood Solid Tumors (RNTSE), Faculté de Médecine, Vandoeuvre-lès-Nancy, F-54500, France
| | - Jacqueline Clavel
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France; French National Registry of Childhood Hematological Malignancies (RNHE), Villejuif, F-94807, France
| | - Stéphanie Goujon
- Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA), Villejuif, F-94807, France; Paris Descartes University, Sorbonne Paris Cité, France; French National Registry of Childhood Hematological Malignancies (RNHE), Villejuif, F-94807, France
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13
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Genin M, Fumery M, Occelli F, Savoye G, Pariente B, Dauchet L, Giovannelli J, Vignal C, Body-Malapel M, Sarter H, Gower-Rousseau C, Ficheur G. Fine-scale geographical distribution and ecological risk factors for Crohn's disease in France (2007-2014). Aliment Pharmacol Ther 2020; 51:139-148. [PMID: 31588597 DOI: 10.1111/apt.15512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/14/2019] [Accepted: 09/09/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Geographical variations in Crohn's disease (CD) suggest that the environment has a role in the pathogenesis of this condition. AIMS To describe the spatial distribution and the clustering of CD cases in France, and to assess the relationship between the prevalence of CD and environmental risk factors. METHODS We identified all patients with CD included in the French hospital discharge database from 2007 to 2014. Age- and gender-smoothed standardised prevalence ratios over this period were computed for 5610 spatial units. An ecological regression analysis was used to assess the relationship between the risk of CD and ecological variables (health care, latitude, socio-economic deprivation, urbanisation, proportion of agricultural surfaces and density of industries). Local spatial clusters of high-CD prevalence were searched for using elliptic spatial scan statistics and characterised in a hierarchical ascendant classification based on the same ecological variables. RESULTS About 129 089 patients with CD were identified, yielding a crude prevalence of 203 per 100 000 inhabitants. The overall spatial heterogeneity was statistically significant (P < .001). An elevated risk of CD was found to be significantly associated with high-social deprivation (relative risk [95% confidence interval] = 1.05 [1.02-1.08]) and high urbanisation (1.09 [1.04-1.14]). Sixteen significant spatial clusters of high-CD prevalence were identified; there were no common ecological variables. CONCLUSIONS The geographical distribution of CD prevalence in France is not uniform, and is associated with high levels of social deprivation and urbanisation. Larger ecological databases integrating more detailed environmental and clinical information are needed.
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Affiliation(s)
- Michaël Genin
- EA2694 - Santé Publique: épidémiologie et qualité des soins, University of Lille, Lille, France.,Department of Methodology and Biostatistics, Maison régionale de la Recherche Clinique, CHU Lille, Lille, France
| | - Mathurin Fumery
- Gastroenterology Unit, Epimad Registry, Amiens University Hospital, Amiens, France
| | - Florent Occelli
- EA 4483, Faculté de Pharmacie de Lille, Université Lille Nord de France, Lille, France
| | - Guillaume Savoye
- Gastroenterology Unit, Epimad Registry, Rouen University Hospital, Rouen, France
| | - Benjamin Pariente
- Gastroenterology Unit, Epimad Registry, Lille University Hospital, Lille, France
| | - Luc Dauchet
- Univ. Lille , U116 7 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Jonathan Giovannelli
- Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison régionale de la Recherche Clinique, Lille University Hospital, Lille, France
| | - Cécile Vignal
- Inserm, LIRIC UMR 995, Lille University, Lille, France
| | | | - Hélène Sarter
- Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison régionale de la Recherche Clinique, Lille University Hospital, Lille, France.,Inserm, LIRIC UMR 995, Lille University, Lille, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison régionale de la Recherche Clinique, Lille University Hospital, Lille, France.,Inserm, LIRIC UMR 995, Lille University, Lille, France
| | - Grégoire Ficheur
- EA2694 - Santé Publique: épidémiologie et qualité des soins, University of Lille, Lille, France.,Department of Methodology and Biostatistics, Maison régionale de la Recherche Clinique, CHU Lille, Lille, France
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14
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Goujon S, Kyrimi E, Faure L, Guissou S, Hémon D, Lacour B, Clavel J. Spatial and temporal variations of childhood cancers: Literature review and contribution of the French national registry. Cancer Med 2018; 7:5299-5314. [PMID: 30230715 PMCID: PMC6198217 DOI: 10.1002/cam4.1774] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/19/2018] [Accepted: 08/21/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Significant increases in childhood cancer incidence since the 1970s have been consistently reported worldwide, but the persistence of the increase on recent periods is discussed. No conclusion can be drawn concerning the spatial variations of childhood cancer, either. This study is an in-depth investigation of the spatial and temporal variations of childhood cancer in France. An extensive review of all the studies published since 2000 on those issues is provided. METHODS The study included 25 877 cases of childhood cancer registered nationwide over 2000-2014. The spatial heterogeneity (overdispersion, autocorrelation, overall heterogeneity) was tested, on two geographic scales, and two spatial scan methods were used to detect clusters of cases. The annual average percent change (AAPC) in incidence rate was estimated with Poisson regression models, and joinpoint analyses were considered. RESULTS Glioma and non-Hodgkin lymphoma cases exhibited some spatial heterogeneity and two large clusters were detected. Overall, the incidence rate of childhood cancer was stable over 2000-2014 (AAPC = -0.1% [-0.3%; 0.2%]). A log-linear positive trend was significantly evidenced for gliomas other than pilocytic astrocytomas (AAPC = 1.8% [0.9%; 2.7%]), with some suggestion of a leveling-off at the end of the period, while Burkitt lymphoma and germ cell tumor incidence rates decreased (AAPC = -2.2% [-3.8%; -0.5%] and AAPC = -1.9% [-3.4%; -0.3%], respectively). No spatial heterogeneity or significant time variation was evidenced for other cancers. CONCLUSION Several types of childhood cancer displayed some spatial heterogeneity and two large clusters were detected, the origins of which are to be investigated and might include differences in case ascertainment. Overall, the results do not support a sustained increase in incidence rates of childhood cancer in recent years.
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Affiliation(s)
- Stéphanie Goujon
- Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA)UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS)InsermVillejuifFrance
- Sorbonne Paris CitéParis Descartes UniversityParisFrance
- French National Registry of Childhood Hematological Malignancies (RNHE)VillejuifFrance
| | - Evangelia Kyrimi
- Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA)UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS)InsermVillejuifFrance
- Sorbonne Paris CitéParis Descartes UniversityParisFrance
| | - Laure Faure
- Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA)UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS)InsermVillejuifFrance
- Sorbonne Paris CitéParis Descartes UniversityParisFrance
- French National Registry of Childhood Hematological Malignancies (RNHE)VillejuifFrance
| | - Sandra Guissou
- Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA)UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS)InsermVillejuifFrance
- Sorbonne Paris CitéParis Descartes UniversityParisFrance
- French National Registry of Childhood Solid Tumors (RNTSE)Faculté de MédecineCHU NancyVandoeuvre‐lès‐NancyFrance
| | - Denis Hémon
- Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA)UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS)InsermVillejuifFrance
- Sorbonne Paris CitéParis Descartes UniversityParisFrance
| | - Brigitte Lacour
- Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA)UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS)InsermVillejuifFrance
- Sorbonne Paris CitéParis Descartes UniversityParisFrance
- French National Registry of Childhood Solid Tumors (RNTSE)Faculté de MédecineCHU NancyVandoeuvre‐lès‐NancyFrance
| | - Jacqueline Clavel
- Epidémiologie des Cancers de l'enfant et de l'adolescent Team (EPICEA)UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS)InsermVillejuifFrance
- Sorbonne Paris CitéParis Descartes UniversityParisFrance
- French National Registry of Childhood Hematological Malignancies (RNHE)VillejuifFrance
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