Residential Proximity to Gasoline Stations and Risk of Childhood Leukemia

Trends in childhood leukemia incidence in urban countries and their relation to environmental factors, including space weather

Leukemia is the most common cancer in children. Its incidence has been increasing worldwide since 1910th, suggesting the presence of common sources of the disease, most likely related to people's lifestyle and environment. Understanding the relationship between childhood leukemia and environmental conditions is critical to preventing the disease. This discussion article examines established potentially-carcinogenic environmental factors, such as vehicle emissions and fires, alongside space weather-related parameters like cosmic rays and the geomagnetic field. To discern the primary contributor, we analyze trends and annual variations in leukemia incidence among 0-14-year-olds in the United States, Canada, Australia, and Russia from 1990 to 2018. Comparisons are drawn with the number of vehicles (representing gasoline emissions) and fire-affected land areas (indicative of fire-related pollutants), with novel data for Russia introduced for the first time. While childhood leukemia incidence is rising in all countries under study, the rate of increase in Russia is twice that of other nations, possibly due to a delayed surge in the country's vehicle fleet compared to others. This trend in Russia may offer insights into past leukemia levels in the USA, Canada, and Australia. Our findings highlight vehicular emissions as the most substantial environmental hazard for children among the factors examined. We also advocate for the consideration of potential modulation of carcinogenic effects arising from variations in cosmic ray intensity, as well as the protective role of the geomagnetic field. To support the idea, we provide examples of potential space weather effects at both local and global scales. The additional analysis includes statistical data from 49 countries and underscores the significance of the magnetic field dip in the South Atlantic Anomaly in contributing to a peak in childhood leukemia incidence in Peru, Ecuador and Chile. We emphasize the importance of collectively assessing all potentially carcinogenic factors for the successful future predictions of childhood leukemia risk in each country.

Childhood cancer and residential proximity to petrol stations: a nationwide registry-based case-control study in Switzerland and an updated meta-analysis

PURPOSE

Benzene is a known carcinogen for adult leukemia. Exposure to benzene through parental occupation and the use of household products has been associated with childhood leukemia (CL). Ambient benzene has also been associated with CL and central nervous system (CNS) tumors. We aimed to investigate whether the higher ambient levels of benzene in proximity of petrol stations are associated with a greater risk of childhood cancers, leukemia, and CNS tumors.

METHODS

We identified children diagnosed with cancer at age 0-15 years during 1985-2015 from the Swiss Childhood Cancer Registry and selected 10 age and sex-matched controls per case from national censuses. We calculated the distance from children's home to the nearest petrol station using precise geocodes. We estimated odds ratios using conditional logistic regression adjusting for ambient levels of NO₂, distance to highways, level of urbanization, and presence of a cantonal cancer registry. In addition, we ran a meta-analysis pooling current results for CL with those of previous studies.

RESULTS

We identified 6129 cases, of which 1880 were leukemias and 1290 CNS tumors. 24 cases lived within 50 m from a petrol station. The adjusted odds ratio of a cancer diagnosis for children thus exposed compared to unexposed children (> 500 m) was 1.29 (0.84-1.98) for all cancers combined, 1.08 (0.46-2.51) for leukemia, and 1.30 (0.51-3.35) for CNS tumors. During 2000-2015, when exposure assessment was more precise, the adjusted odds ratio for any cancer diagnosis was 1.77 (1.05-2.98). The summary relative risk estimate for CL in the meta-analysis including four studies was 2.01 (1.25-3.22).

CONCLUSIONS

Our study provides weak support for an increased risk of childhood cancers among children living close to petrol stations. A meta-analysis including our study suggests an increased risk for CL.

Benzene emissions from gas station clusters: a new framework for estimating lifetime cancer risk

PURPOSE

During gas station operation, unburned fuel can be released to the environment through distribution, delivery, and storage. Due to the toxicity of fuel compounds, setback distances have been implemented to protect the general population. However, these distances treat gasoline sales volume as a categorical variable and only account for the presence of a single gas station and not clusters, which frequently occur. This paper introduces a framework for recommending setback distances for gas station clusters based on estimated lifetime cancer risk from benzene exposure.

METHODS

Using the air quality dispersion model AERMOD, we simulated levels of benzene released to the atmosphere from single and clusters of generic gas stations and the associated lifetime cancer risk under meteorological conditions representative of Albany, New York.

RESULTS

Cancer risk as a function of distance from gas station(s) and as a continuous function of total sales volume can be estimated from an equation we developed. We found that clusters of gas stations have increased cancer risk compared to a single station because of cumulative emissions from the individual gas stations. For instance, the cancer risk at 40 m for four gas stations each dispensing 1 million gal/year is 9.84 × 10^-6 compared to 2.45 × 10^-6 for one gas station.

CONCLUSION

The framework we developed for estimating cancer risk from gas station(s) could be adopted by regulatory agencies to make setback distances a function of sales volume and the number of gas stations in a cluster, rather than on a sales volume category.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40201-020-00601-w.

Challenging the concept of de novo acute myeloid leukemia: Environmental and occupational leukemogens hiding in our midst

Myeloid neoplasms like acute myeloid leukemia (AML) originate from genomic disruption, usually in a multi-step fashion. Hematopoietic stem/progenitor cell acquisition of abnormalities in vital cellular processes, when coupled with intrinsic factors such as germline predisposition or extrinsic factors such as the marrow microenvironment or environmental agents, can lead to requisite pre-leukemic clonal selection, expansion and evolution. Several of these entities have been invoked as "leukemogens." The known leukemogens are numerous and are found in the therapeutic, occupational and ambient environments, however they are often difficult to implicate for individual patients. Patients treated with particular chemotherapeutic agents or radiotherapy accept a calculated risk of therapy-related AML. Occupational exposures to benzene, dioxins, formaldehyde, electromagnetic and particle radiation have been associated with an increased risk of AML. Although regulatory agencies have established acceptable exposure limits in the workplace, accidental exposures and even ambient exposures to leukemogens are possible. It is plausible that inescapable exposure to non-anthropogenic ambient leukemogens may be responsible for many cases of non-inherited de novo AML. In this review, we discuss the current understanding of leukemogens as they relate to AML, assess to what extent the term "de novo" leukemia is meaningful, and describe the potential to identify and characterize new leukemogens.

The association between residential proximity to brownfield sites and high-traffic areas and measures of immunity

The mechanisms by which neighborhood environmental exposures influence health are poorly understood, although immune system dysregulation represents a potential biological pathway. While many neighborhood exposures have been investigated, there is little research on residential proximity to brownfield waste. Using biomarker data from 262 participants in the Detroit Neighborhood Health Study, we estimated the association between proximity to brownfields and heavy traffic and signal joint T-cell receptor excision circles (sjTRECs, a measure of naive T-cell production), C-reactive protein (CRP, a measure of systemic inflammation), and interleukin-6 (IL-6, a pro-inflammatory cytokine). We assessed residential proximity ≤200 m from brownfields and highways on all three biomarkers using multivariate regression. We demonstrated that living ≤200 m from a brownfield site was associated with a 0.30 (95% CI = 0.59, 0.02, p = 0.04) log_e-unit decrease in sjTRECs per million whole blood cells, as well as non-significantly elevated levels of CRP and IL-6. Heavy traffic was not associated with any biomarker. Persons living in close proximity to brownfield sites had significantly lower naive T-cell production, suggesting accelerated immune aging. Decreased T-cell production associated with brownfield proximity may be caused by toxicant exposure in brownfield sites, or may serve as a marker of other neighborhood stressors.

A clandestine culprit with critical consequences: Benzene and acute myeloid leukemia

While most clinicians recognize adult therapy-related leukemias following cytotoxic chemotherapy and radiation, environmental regulatory agencies evaluate exposure to "safe levels" of leukemogenic compounds. Benzene represents the most notorious leukemogenic chemical. Used in the production of ubiquitous items such as plastics, lubricants, rubbers, dyes, and pesticides, benzene may be responsible for the higher risk of acute myeloid leukemia (AML) among automobile, janitorial, construction, and agricultural workers. It is possible that ambient benzene may contribute to many cases of "de novo" AML not arising out of germline predispositions. In this appraisal of the available literature, we evaluate and discuss the association between chronic, low-dose and ambient exposure to environmental benzene and the development of adult AML.

Estimating policy-relevant health effects of ambient heat exposures using spatially contiguous reanalysis data

BACKGROUND

Regional National Weather Service (NWS) heat advisory criteria in New York State (NYS) were based on frequency of heat events estimated by sparse monitoring data. These may not accurately reflect temperatures at which specific health risks occur in large geographic regions. The objectives of the study were to use spatially resolved temperature data to characterize health risks related to summertime heat exposure and estimate the temperatures at which excessive risk of heat-related adverse health occurs in NYS. We also evaluated the need to adjust current heat advisory threshold and messaging based on threshold temperatures of multiple health outcomes.

METHODS

We assessed the effect of multi-day lag exposure for maximum near-surface air temperature (Tmax) and maximum Heat Index derived from the gridded National Land Data Assimilation System (NLDAS) reanalysis dataset on emergency department (ED) visits/ hospitalizations for heat stress, dehydration, acute kidney failure (AKF) and cardiovascular diseases (CVD) using a case-crossover analysis during summers of 2008-2012. We assessed effect modification using interaction terms and stratified analysis. Thresholds were estimated using piecewise spline regression.

RESULTS

We observed an increased risk of heat stress (Risk ratio (RR) = 1.366, 95% confidence interval (CI): 1.347, 1.386) and dehydration (RR = 1.024, 95% CI: 1.021, 1.028) for every 1 °C increase in Tmax on the day of exposure. The highest risk for AKF (RR = 1.017, 95% CI: 1.014, 1.021) and CVD (RR = 1.001, 95% CI: 1.000, 1.002) were at lag 1 and 4 respectively. The increased risk of heat-health effects persists up to 6 days. Rural areas of NYS are at as high a risk of heat-health effects as urban areas. Heat-health risks start increasing at temperatures much lower than the current NWS criteria.

CONCLUSION

Reanalysis data provide refined exposure-response functions for health research, in areas with sparse monitor observations. Based on this research, rural areas in NYS had similar risk for health effects of heat. Heat advisories in New York City (NYC) had been reviewed and lowered previously. As such, the current NWS heat advisory threshold was lowered for the upstate region of New York and surrounding areas. Enhanced outreach materials were also developed and disseminated to local health departments and the public.

Vent pipe emissions from storage tanks at gas stations: Implications for setback distances

At gas stations, fuel vapors are released into the atmosphere from storage tanks through vent pipes. Little is known about when releases occur, their magnitude, and their potential health consequences. Our goals were to quantify vent pipe releases and examine exceedance of short-term exposure limits to benzene around gas stations. At two US gas stations, we measured volumetric vent pipe flow rates and pressure in the storage tank headspace at high temporal resolution for approximately three weeks. Based on the measured vent emission and meteorological data, we performed air dispersion modeling to obtain hourly atmospheric benzene levels. For the two gas stations, average vent emission factors were 0.17 and 0.21 kg of gasoline per 1000 L dispensed. Modeling suggests that at one gas station, a 1-hour Reference Exposure Level (REL) for benzene for the general population (8 ppb) was exceeded only closer than 50 m from the station's center. At the other gas station, the REL was exceeded on two different days and up to 160 m from the center, likely due to non-compliant bulk fuel deliveries. A minimum risk level for intermediate duration (>14-364 days) benzene exposure (6 ppb) was exceeded at the elevation of the vent pipe opening up to 7 and 8 m from the two gas stations. Recorded vent emission factors were >10 times higher than estimates used to derive setback distances for gas stations. Setback distances should be revisited to address temporal variability and pollution controls in vent emissions.

Maternal exposure to gasoline and exhaust increases the risk of childhood leukaemia in offspring - a prospective study in the Norwegian Mother and Child Cohort Study

BACKGROUND

In the prospective population-based Norwegian Mother and Child Cohort Study (MoBa), comprising 113 754 offspring, we investigated the association between parental exposure to "gasoline or exhaust", as a proxy for benzene exposure, and childhood leukaemia.

METHODS

Around gestational week 17, mothers and fathers responded to a questionnaire on exposure to various agents during the last 6 months and 6 months  pre-conception, respectively. Benzene exposure was assessed through self-reported exposure to "gasoline or exhaust". Cases of childhood leukaemia (n = 70) were identified through linkage with the Cancer Registry of Norway. Risk was estimated by hazard ratios (HRs) with 95% confidence intervals (95%CI), comparing offspring from exposed and unexposed parents using a Cox regression model.

RESULTS

Maternal exposure to "gasoline or exhaust" was associated with an increased risk of childhood leukaemia (HR = 2.59; 95%CI: 1.03, 6.48) and acute lymphatic leukaemia (HR = 2.71; 95%CI: 0.97, 7.58). There was an increasing risk for higher exposure (p value for trend = 0.032 and 0.027). The association did not change after adjustment for maternal smoking.

CONCLUSION

In spite of rather few cases, the findings in this prospective study, with the exposure metric defined a priori, support previous observations relating maternal exposure to benzene from gasoline and other petroleum-derived sources and the subsequent development of childhood leukaemia in the offspring.

Steinmaus and Smith Respond to "Proximity to Gasoline Stations and Childhood Leukemia"

Benzene is an established cause of adult leukemia, but its role in childhood leukemia is less clear. In a recent meta-analysis, we identified associations of childhood leukemia with occupational and household product benzene exposure and traffic-related pollution. Residential proximity to gasoline stations or automobile repair facilities may be another source of benzene, and in 3 studies assessing these sources, we identified a summary relative risk of 1.59 (95% confidence interval: 0.70, 3.62). Although not statistically significant, this summary relative risk was of a magnitude similar to that of our other positive findings. In this issue of the Journal (Am J Epidemiol 2017;185(1):5-7), Dr. Infante suggested that meta-analyses of studies on childhood leukemia and proximity to gasoline stations should involve some criteria that differ from those we used. These suggested criteria involved combining leukemia subtypes, excluding automobile repair facilities, and using nonleukemia cancers as control subjects. We redid our meta-analysis using these new criteria and obtained a summary relative risk of 2.42 (95% confidence interval: 1.51, 3.89). Overall, although this result should be interpreted in light of the relatively small sample size (3 studies) and its post-hoc nature, it provides additional new evidence for associations of childhood leukemia with both residential proximity to gasoline stations and exposure to benzene.