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Benítez L, Castro-Barquero S, Crispi F, Youssef L, Crovetto F, Fischer U, Kameri E, Bueno C, Camos M, Menéndez P, Heinäniemi M, Borkhardt A, Gratacós E. Maternal Lifestyle and Prenatal Risk Factors for Childhood Leukemia: A Review of the Existing Evidence. Fetal Diagn Ther 2024; 51:395-410. [PMID: 38710162 DOI: 10.1159/000539141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/12/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Acute leukemia is the most common pediatric cancer, with an incidence peak at 2-5 years of age. Despite the medical advances improving survival rates, children suffer from significant side effects of treatments as well as its high social and economic impact. The frequent prenatal origin of this developmental disease follows the two-hit carcinogenesis model established in the 70s: a first hit in prenatal life with the creation of genetic fusion lesions or aneuploidy in hematopoietic progenitor/stem cells, and usually a second hit in the pediatric age that converts the preleukemic clone into clinical leukemia. Previous research has mostly focused on postnatal environmental factors triggering the second hit. SUMMARY There is scarce evidence on prenatal risk factors associated with the first hit. Mainly retrospective case-control studies suggested several environmental and lifestyle determinants as risk factors. If these associations could be confirmed, interventions focused on modifying prenatal factors might influence the subsequent risk of leukemia during childhood and reveal unexplored research avenues for the future. In this review, we aim to comprehensively summarize the currently available evidence on prenatal risk factors for the development of childhood leukemia. According to the findings of this review, parental age, ethnicity, maternal diet, folate intake, alcohol consumption, X-ray exposure, pesticides, perinatal infections, and fetal growth may have a significant role in the appearance of preleukemic lesions during fetal life. Other factors such as socioeconomic status, consumption of caffeinated beverages, and smoking consumption have been suggested with inconclusive evidence. Additionally, investigating the association between prenatal factors and genetic lesions associated with childhood leukemia at birth is crucial. Prospective studies evaluating the link between lifestyle factors and genetic alterations could provide indirect evidence supporting new research avenues for leukemia prevention. Maternal diet and lifestyle factors are modifiable determinants associated with adverse perinatal outcomes that could be also related to preleukemic lesions. KEY MESSAGES Parental age, ethnicity, maternal diet, folate intake, alcohol consumption, X-ray exposure, pesticides, perinatal infections, and fetal growth may have a significant role in the appearance of preleukemic lesions during fetal life. Dedicating efforts to studying maternal lifestyle during pregnancy and its association with genetic lesions leading to childhood leukemia could lead to novel prevention strategies.
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Affiliation(s)
- Leticia Benítez
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain,
| | - Sara Castro-Barquero
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Fàtima Crispi
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Lina Youssef
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Josep Carreras Leukemia Research Institute and Department of Biomedicine, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Francesca Crovetto
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ute Fischer
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Düsseldorf, Germany
| | - Ersen Kameri
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Clara Bueno
- Stem Cell Biology, Developmental Leukemia and Immunotherapy Group, Josep Carreras Leukemia Research Institute, Barcelona, Spain
- RICORS-TERAV Network, ISCIII, Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), ISCIII, Barcelona, Spain
| | - Mireia Camos
- Department of Pediatric Oncology and Hematology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Pablo Menéndez
- Stem Cell Biology, Developmental Leukemia and Immunotherapy Group, Josep Carreras Leukemia Research Institute, Barcelona, Spain
- RICORS-TERAV Network, ISCIII, Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), ISCIII, Barcelona, Spain
- Department of Biomedicine, School of Medicine, University of Barcelona, Barcelona, Spain
- Instituciò Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Merja Heinäniemi
- Institute of Biomedicine, School of Medicine, University of Finland, Kuopio, Finland
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Düsseldorf, Germany
| | - Eduard Gratacós
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Duarte-Rodríguez DA, Flores-Lujano J, McNally RJQ, Pérez-Saldivar ML, Jiménez-Hernández E, Martín-Trejo JA, Espinoza-Hernández LE, Medina-Sanson A, Paredes-Aguilera R, Merino-Pasaye LE, Velázquez-Aviña MM, Torres-Nava JR, Espinosa-Elizondo RM, Amador-Sánchez R, Dosta-Herrera JJ, Mondragón-García JA, González-Ulibarri JE, Martínez-Silva SI, Espinoza-Anrubio G, Paz-Bribiesca MM, Salcedo-Lozada P, Landa-García RÁ, Ramírez-Colorado R, Hernández-Mora L, Santamaría-Ascencio M, López-Loyola A, Godoy-Esquivel AH, García-López LR, Anguiano-Ávalos AI, Mora-Rico K, Castañeda-Echevarría A, Rodríguez-Jiménez R, Cibrian-Cruz JA, Solís-Labastida KA, Cárdenas-Cardos R, López-Santiago N, Flores-Villegas LV, Peñaloza-González JG, González-Ávila AI, Sánchez-Ruiz M, Rivera-Luna R, Rodríguez-Villalobos LR, Hernández-Pérez F, Olvera-Durán JÁ, García-Cortés LR, Mata-Rocha M, Sepúlveda-Robles OA, Bekker-Méndez VC, Jiménez-Morales S, Meléndez-Zajgla J, Rosas-Vargas H, Vega E, Núñez-Enríquez JC, Mejía-Aranguré JM. Evidence of spatial clustering of childhood acute lymphoblastic leukemia cases in Greater Mexico City: report from the Mexican Inter-Institutional Group for the identification of the causes of childhood leukemia. Front Oncol 2024; 14:1304633. [PMID: 38420017 PMCID: PMC10899509 DOI: 10.3389/fonc.2024.1304633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/11/2024] [Indexed: 03/02/2024] Open
Abstract
Background A heterogeneous geographic distribution of childhood acute lymphoblastic leukemia (ALL) cases has been described, possibly, related to the presence of different environmental factors. The aim of the present study was to explore the geographical distribution of childhood ALL cases in Greater Mexico City (GMC). Methods A population-based case-control study was conducted. Children <18 years old, newly diagnosed with ALL and residents of GMC were included. Controls were patients without leukemia recruited from second-level public hospitals, frequency-matched by sex, age, and health institution with the cases. The residence address where the patients lived during the last year before diagnosis (cases) or the interview (controls) was used for geolocation. Kulldorff's spatial scan statistic was used to detect spatial clusters (SCs). Relative risks (RR), associated p-value and number of cases included for each cluster were obtained. Results A total of 1054 cases with ALL were analyzed. Of these, 408 (38.7%) were distributed across eight SCs detected. A relative risk of 1.61 (p<0.0001) was observed for the main cluster. Similar results were noted for the remaining seven ones. Additionally, a proximity between SCs, electrical installations and petrochemical facilities was observed. Conclusions The identification of SCs in certain regions of GMC suggest the possible role of environmental factors in the etiology of childhood ALL.
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Affiliation(s)
- David Aldebarán Duarte-Rodríguez
- División de Desarrollo de la Investigación en Salud, Coordinación de Investigación en Salud, Centro Médico Nacional (CMN) “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Janet Flores-Lujano
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (UMAE), Hospital de Pediatría, Centro Médico Nacional (CMN) “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Richard J. Q. McNally
- Population Health Sciences Institute, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - María Luisa Pérez-Saldivar
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (UMAE), Hospital de Pediatría, Centro Médico Nacional (CMN) “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Elva Jiménez-Hernández
- Servicio de Oncología, Hospital Pediátrico “Moctezuma”, Secretaría de Salud de la Ciudad de Mexico (SEDESA), Ciudad de Mexico, Mexico
| | - Jorge Alfonso Martín-Trejo
- Servicio de Hematología, Unidad Médica de Alta Especialidad Hospital de Pediatría, Centro Médico Nacional (CMN) “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Laura Eugenia Espinoza-Hernández
- Servicio de Hematología, Unidad Médica de Alta Especialidad Hospital de Pediatría, Centro Médico Nacional (CMN) “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Aurora Medina-Sanson
- Departamento de Hemato-Oncología, Hospital Infantil de Mexico “Federico Gómez”, Secretaría de Salud (SS), Ciudad de Mexico, Mexico
| | | | - Laura Elizabeth Merino-Pasaye
- Servicio de Hematología Pediátrica, Centro Médico Nacional (CMN) “20 de Noviembre”, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE), Ciudad de Mexico, Mexico
| | | | - José Refugio Torres-Nava
- Servicio de Oncología, Hospital Pediátrico “Moctezuma”, Secretaría de Salud de la Ciudad de Mexico (SEDESA), Ciudad de Mexico, Mexico
| | | | - Raquel Amador-Sánchez
- Servicio de Hematología Pediátrica, Hospital General Regional (HGR) No 1 “Dr Carlos MacGregor Sánchez Navarro” Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Juan José Dosta-Herrera
- Servicio de Cirugía Pediátrica, Hospital General “Gaudencio González Garza”, Centro Médico Nacional (CMN) “La Raza”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Javier Anastacio Mondragón-García
- Servicio de Cirugía Pediátrica, Hospital General Regional (HGR) No 1 “Dr Carlos MacGregor Sánchez Navarro” Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | | | - Sofía Irene Martínez-Silva
- Hospital Pediátrico de Iztapalapa, Secretaría de Salud de la Ciudad de Mexico (SEDESA), Ciudad de Mexico, Mexico
| | - Gilberto Espinoza-Anrubio
- Servicio de Pediatría, Hospital General Zona (HGZ) No 8 “Dr Gilberto Flores Izquierdo”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | | | - Perla Salcedo-Lozada
- Hospital General de Ecatepec “Las Américas”, Instituto de Salud del Estado de Mexico (ISEM), Ecatepec de Morelos, Mexico
| | | | - Rosario Ramírez-Colorado
- Hospital Pediátrico “La Villa”, Secretaría de Salud de la Ciudad de Mexico (SEDESA), Ciudad de Mexico, Mexico
| | - Luis Hernández-Mora
- Hospital Pediátrico “San Juan de Aragón”, Secretar´ıa de Salud de la Ciudad de Mexico (SEDESA), Ciudad de Mexico, Mexico
| | - Marlene Santamaría-Ascencio
- Servicio de Pediatría, Hospital General Regional (HGR) No 72 “Lic. Vicente Santos Guajardo”, Instituto Mexicano del Seguro Social (IMSS), Tlalnepantla de Baz, Mexico
| | - Anselmo López-Loyola
- Servicio de Cirugía Pediátrica, Hospital General Zona (HGZ) No. 32, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Arturo Hermilo Godoy-Esquivel
- Servicio de Cirugía Pediátrica, Hospital Pediátrico de Moctezuma, Secretaría de Salud de la Ciudad de Mexico (SEDESA), Ciudad de Mexico, Mexico
| | - Luis Ramiro García-López
- Servicio de Pediatría, Hospital Pediátrico de Tacubaya, Secretaría de Salud de la Ciudad de Mexico (SEDESA), Ciudad de Mexico, Mexico
| | - Alison Ireri Anguiano-Ávalos
- Urgencias Pediátricas, Hospital General Zona (HGZ) No 47, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Karina Mora-Rico
- Servicio de Cirugía Pediátrica, Hospital Regional “1° Octubre”, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE), Instituto Politécnico Nacional 1669, Revolución Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Alejandro Castañeda-Echevarría
- Servicio de Pediatría, Hospital General Regional (HGR) No. 25 Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Roberto Rodríguez-Jiménez
- Servicio de Pediatría, Hospital General de Zona con Medicina Familiar (HGZMF) No. 29, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - José Alberto Cibrian-Cruz
- Servicio de Cirugía Pediátrica, Hospital General Zona (HGZ) No. 27, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Karina Anastacia Solís-Labastida
- Servicio de Hematología, Unidad Médica de Alta Especialidad Hospital de Pediatría, Centro Médico Nacional (CMN) “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Rocío Cárdenas-Cardos
- Servicio de Oncología, Instituto Nacional de Pediatr´ıa (INP), SS, Ciudad de Mexico, Mexico
| | - Norma López-Santiago
- Servicio de Hematología, Instituto Nacional de Pediatría (INP), SS, Ciudad de Mexico, Mexico
| | - Luz Victoria Flores-Villegas
- Servicio de Hematología Pediátrica, Centro Médico Nacional (CMN) “20 de Noviembre”, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE), Ciudad de Mexico, Mexico
| | - José Gabriel Peñaloza-González
- Servicio de Onco-Pediatría, Hospital Juárez de Mexico, SS, Instituto Politécnico Nacional 5160, Ciudad de Mexico, Mexico
| | - Ana Itamar González-Ávila
- Servicio de Hematología Pediátrica, Hospital General Regional (HGR) No 1 “Dr Carlos MacGregor Sánchez Navarro” Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Martin Sánchez-Ruiz
- Hospital General de Ecatepec “Las Américas”, Instituto de Salud del Estado de Mexico (ISEM), Ecatepec de Morelos, Mexico
| | - Roberto Rivera-Luna
- Servicio de Oncología, Instituto Nacional de Pediatr´ıa (INP), SS, Ciudad de Mexico, Mexico
| | - Luis Rodolfo Rodríguez-Villalobos
- Servicio de Pediatría, Hospital Pediátrico de Tacubaya, Secretaría de Salud de la Ciudad de Mexico (SEDESA), Ciudad de Mexico, Mexico
| | - Francisco Hernández-Pérez
- Urgencias Pediátricas, Hospital General Zona (HGZ) No 47, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Jaime Ángel Olvera-Durán
- Servicio de Cirugía Pediátrica, Hospital Regional “1° Octubre”, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE), Instituto Politécnico Nacional 1669, Revolución Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Luis Rey García-Cortés
- Delegación Regional Estado de Mexico Oriente, Instituto Mexicano del Seguro Social (IMSS), Naucalpan de Juárez, Mexico
| | - Minerva Mata-Rocha
- Laboratorio de Biología Molecular, Unidad Me´dica de Alta Especialidad (UMAE), Hospital de Pediatría, Centro Me´dico Nacional (CMN) “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Omar Alejandro Sepúlveda-Robles
- Laboratorio de Biología Molecular, Unidad Me´dica de Alta Especialidad (UMAE), Hospital de Pediatría, Centro Me´dico Nacional (CMN) “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Vilma Carolina Bekker-Méndez
- Unidad de Investigación Médica en Inmunología e Infectología, Hospital de Infectología “Dr Daniel Méndez Hernández”, Centro Me´dico Nacional (CMN) “La Raza”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Silvia Jiménez-Morales
- Laboratory of Innovation and Precision Medicine, Nucleus A. Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de Mexico, Mexico
| | - Jorge Meléndez-Zajgla
- Laboratorio de Genómica Funcional del Cáncer, Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de Mexico, Mexico
| | - Haydée Rosas-Vargas
- Unidad de Investigación Médica en Genética Humana, Unidad Me´dica de Alta Especialidad (UMAE), Hospital de Pediatría, Centro Me´dico Nacional (CMN) “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Elizabeth Vega
- Instituto de Ciencias de la Atmósfera y Cambio Climático, Universidad Nacional Autónoma de Mexico (UNAM), Ciudad de Mexico, Mexico
| | - Juan Carlos Núñez-Enríquez
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (UMAE), Hospital de Pediatría, Centro Médico Nacional (CMN) “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
- División de Investigación en Salud, Unidad Me´dica de Alta Especialidad (UMAE) Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Centro Me´dico Nacional (CMN) “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico
| | - Juan Manuel Mejía-Aranguré
- Laboratorio de Genómica Funcional del Cáncer, Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de Mexico, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de Mexico (UNAM), Ciudad de Mexico, Mexico
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Maternal antibiotics exposure during pregnancy and the risk of acute lymphoblastic leukemia in childhood: a systematic review and meta-analysis. Eur J Pediatr 2022; 181:471-478. [PMID: 34535829 DOI: 10.1007/s00431-021-04247-0] [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: 06/09/2021] [Revised: 08/17/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
Many epidemiological studies have assessed the association between maternal antibiotic exposure during pregnancy and childhood acute lymphoblastic leukemia (ALL), while reaching inconsistent conclusions. In order to clarify the association, the publications in English that provided information about maternal antibiotic exposure during pregnancy and ALL risk in offspring in the PubMed, Embase, and Web of Science databases were systematically reviewed and we performed a meta-analysis using the random-effect models. Results of pooled analysis showed that maternal antibiotic intake during pregnancy is not associated with childhood ALL risk (pooled odds ratio 1.07, 95% confidence interval 0.98-1.18) without significant heterogeneity (I2 = 13.7%, P = 0.310). This finding was consistent across subgroups stratified by type of study design, measurement method, sample size, study quality, and pregnancy stage. Our findings suggest that maternal antibiotic consumption during pregnancy was not associated with ALL risk in progeny. Further investigations are needed to confirm the results and assess any risk differences of ALL by types of antibiotics.Conclusions: Our findings suggest that maternal antibiotics consumption during pregnancy was not associated with ALL risk in progeny. Further investigations are needed to confirm the results and assess any risk differences of ALL by types of antibiotics. What is Known: • It is not unusual for pregnant woman to receive antibiotics for local or systematic use during pregnancy. • The conclusions regarding the associations between maternal antibiotics use during pregnancy and childhood ALL risk were inconsistent. What is New: • Maternal antibiotics consumption during pregnancy was not associated with the increased ALL risk in offspring. • Further laboratory evidences are needed to confirm the results.
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Hauer J, Fischer U, Borkhardt A. Toward prevention of childhood ALL by early-life immune training. Blood 2021; 138:1412-1428. [PMID: 34010407 PMCID: PMC8532195 DOI: 10.1182/blood.2020009895] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/21/2021] [Indexed: 11/21/2022] Open
Abstract
B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is the most common form of childhood cancer. Chemotherapy is associated with life-long health sequelae and fails in ∼20% of cases. Thus, prevention of leukemia would be preferable to treatment. Childhood leukemia frequently starts before birth, during fetal hematopoiesis. A first genetic hit (eg, the ETV6-RUNX1 gene fusion) leads to the expansion of preleukemic B-cell clones, which are detectable in healthy newborn cord blood (up to 5%). These preleukemic clones give rise to clinically overt leukemia in only ∼0.2% of carriers. Experimental evidence suggests that a major driver of conversion from the preleukemic to the leukemic state is exposure to immune challenges. Novel insights have shed light on immune host responses and how they shape the complex interplay between (1) inherited or acquired genetic predispositions, (2) exposure to infection, and (3) abnormal cytokine release from immunologically untrained cells. Here, we integrate the recently emerging concept of "trained immunity" into existing models of childhood BCP-ALL and suggest future avenues toward leukemia prevention.
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Affiliation(s)
- Julia Hauer
- National Center for Tumor Diseases (NCT), Dresden, Germany
- Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ute Fischer
- Department for Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; and
- German Cancer Consortium (DKTK), partnering site Essen/Düsseldorf, Germany
| | - Arndt Borkhardt
- Department for Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; and
- German Cancer Consortium (DKTK), partnering site Essen/Düsseldorf, Germany
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Cobaleda C, Vicente-Dueñas C, Sanchez-Garcia I. Infectious triggers and novel therapeutic opportunities in childhood B cell leukaemia. Nat Rev Immunol 2021; 21:570-581. [PMID: 33558682 DOI: 10.1038/s41577-021-00505-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 01/30/2023]
Abstract
B cell acute lymphoblastic leukaemia (B-ALL) is the most common form of childhood cancer. Although treatment has advanced remarkably in the past 50 years, it still fails in ~20% of patients. Recent studies revealed that more than 5% of healthy newborns carry preleukaemic clones that originate in utero, but only a small percentage of these carriers will progress to overt B-ALL. The drivers of progression are unclear, but B-ALL incidence seems to be increasing in parallel with the adoption of modern lifestyles. Emerging evidence shows that a major driver for the conversion from the preleukaemic state to the B-ALL state is exposure to immune stressors, such as infection. Here, we discuss our current understanding of the environmental triggers and genetic predispositions that may lead to B-ALL, highlighting lessons from epidemiology, the clinic and animal models, and identifying priority areas for future research.
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Affiliation(s)
- Cesar Cobaleda
- Immune System Development and Function Unit, Centro de Biología Molecular Severo Ochoa, CSIC and Universidad Autónoma de Madrid, Madrid, Spain.
| | | | - Isidro Sanchez-Garcia
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain. .,Experimental Therapeutics and Translational Oncology Program, Instituto de Biología Molecular y Celular del Cáncer, CSIC and Universidad de Salamanca, Salamanca, Spain.
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McNally RJ, Jones JH, Shaikh MG, Donaldson MD, Blakey K, Cheetham TD. Congenital Hypothyroidism: Space-Time Clustering of Thyroid Dysgenesis Indicates a Role for Environmental Factors in Disease Etiology. Thyroid 2021; 31:876-883. [PMID: 33183175 PMCID: PMC8215409 DOI: 10.1089/thy.2020.0005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: The etiology of most cases of congenital hypothyroidism (CHT) due to thyroid dysgenesis (DG) is unknown. If transient environmental factors can impact on thyroid gland development, then clustering of cases in time and/or space may occur, and this would be more likely in thyroid DG than dyshormonogenesis (DHG). Methods: The newborn screening program for CHT in Scotland is linked to a central database that includes case details such as postcode. The etiology of CHT is investigated in many cases of CHT using scintigraphy and/or ultrasonography. We looked for evidence of a change in CHT incidence with year of birth and according to season of the year. We then undertook space-time clustering analysis (using a method based on K-functions, with nearest neighbor thresholds) of CHT in Scotland between 1979 and 2015. We also looked for evidence of overall changes associated with sex and area-based birth density. Results: Of 531 cases with CHT during the study period, 290 cases had been categorized as DG (n = 229) or DHG (n = 61) following more detailed investigation. The incidence of CHT increased with year of birth and was in part linked to changing methodology, but there was no seasonality. There was no evidence of overall space-time clustering (p = 0.06), but there was evidence of clustering in babies with DG (p = 0.007). This picture appeared to be most closely linked to underlying thyroid gland hypoplasia rather than thyroid gland agenesis or ectopia. There was significant space-time clustering for both males and females, but clustering was restricted to lesser birth density areas. There was also evidence of clustering for unknown cases (p < 0.001). Clustering of these cases was restricted to females but was present for cases from both greater and lesser birth density areas. There was no evidence of clustering in cases of DHG. Conclusions: These data suggest that an unidentified environmental factor or factors may be involved in the etiology of thyroid DG in Scotland. The variation in CHT incidence observed internationally may reflect environmental as well as genetic factors.
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Affiliation(s)
- Richard J.Q. McNally
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | | | | | - Malcolm D.C. Donaldson
- Section of Child Health, Royal Hospital for Children, University of Glasgow School of Medicine, Glasgow, United Kingdom
| | - Karen Blakey
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Tim D. Cheetham
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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7
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Bamouni S, Hémon D, Faure L, Clavel J, Goujon S. Seasonal variations in childhood leukaemia incidence in France, 1990-2014. Cancer Causes Control 2021; 32:693-704. [PMID: 33829352 DOI: 10.1007/s10552-021-01421-5] [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: 07/10/2020] [Accepted: 03/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Several studies have addressed the potential seasonality of childhood acute leukaemia (AL) without conclusive results. Using data from the National Registry of Childhood Cancers over 1990-2014 in mainland France, we investigated the seasonal variations in childhood AL taken together, and lymphoblastic (ALL) and myeloid (AML) leukaemia separately. METHODS Assuming constant variations over 1990-2014, we used a Poisson regression model to evaluate variations in standardized incidence ratios (SIRs) by month of birth or diagnosis. A scan method for temporal cluster detection was used to identify windows of several consecutive months with high or low SIR. The yearly reproducibility of the observed monthly variations was then evaluated. RESULTS We included 11,528 AL, of which 9493 ALL and 1,843 AML. No seasonal variation was detected for ALL. With a clear seasonal pattern, differences in AML incidence rates were evidenced between January-April and May-December birth periods (SIR = 0.85, 95% CI 0.77-0.94 and SIR = 1.07, 95% CI 1.01-1.14, respectively). AML incidence variations by month of diagnosis were less clear-cut. CONCLUSION Based on a large number of cases from a high-quality registry, we did not evidence any seasonality in ALL incidence rates but evidenced seasonal variations in AML incidence rates by month of birth.
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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 - Bat 15/16, 94807, Villejuif Cedex, France. .,Université de Paris, 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 - Bat 15/16, 94807, Villejuif Cedex, France.,Université de Paris, 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 - Bat 15/16, 94807, Villejuif Cedex, France.,Université de Paris, Paris, France.,French National Registry of Childhood Hematological Malignancies (RNHE), 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 - Bat 15/16, 94807, Villejuif Cedex, France.,Université de Paris, Paris, France.,French National Registry of Childhood Hematological Malignancies (RNHE), 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 - Bat 15/16, 94807, Villejuif Cedex, France.,Université de Paris, Paris, France.,French National Registry of Childhood Hematological Malignancies (RNHE), 94807, Villejuif, France
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8
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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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9
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Rodriguez-Villamizar LA, Moreno-Corzo FE, Valbuena-Garcia AM, Uribe Pérez CJ, Brome Bohórquez MR, García García HI, Bravo LE, Ortiz Martínez RG, Niederbacher Velásquez J, Osornio-Vargas AR. Childhood Leukemia in Small Geographical Areas and Proximity to Industrial Sources of Air Pollutants in Three Colombian Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7925. [PMID: 33137878 PMCID: PMC7662935 DOI: 10.3390/ijerph17217925] [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] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/24/2020] [Accepted: 10/24/2020] [Indexed: 01/08/2023]
Abstract
Acute leukemia is the most common childhood cancer and has been associated with exposure to environmental carcinogens. This study aimed to identify clusters of acute childhood leukemia (ACL) cases and analyze their relationship with proximity to industrial sources of air pollution in three capital cities in Colombia during 2000-2015. Incident ACL cases were obtained from the population cancer registries for the cities of Bucaramanga, Cali, and Medellín. The inventory of industrial sources of emissions to the air was obtained from the regional environmental authorities and industrial conglomerates were identified. The Kulldorf's circular scan test was used to detect city clusters and to identify clusters around industrial conglomerates. Multivariable spatial modeling assessed the effect of distance and direction from the industrial conglomerates controlling for socioeconomic status. We identified industrials sectors within a buffer of 1 km around industrial conglomerates related to the ACL clusters. Incidence rates showed geographical heterogeneity with low spatial autocorrelation within cities. The spatio-temporal tests identified one cluster in each city. The industries located within 1 km around the ACL clusters identified in the three cities represent different sectors. Exposure to air pollution from industrial sources might be contributing to the incidence of ACL cases in urban settings in Colombia.
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Affiliation(s)
| | - Feisar Enrique Moreno-Corzo
- Public Health Observatory of Santander, Fundación Oftalmológica de Santander, Floridablanca 681003, Colombia; (F.E.M.-C.); (R.G.O.M.)
| | - Ana María Valbuena-Garcia
- Department of Public Health, Universidad Industrial de Santander, Bucaramanga 680002, Colombia;
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá 110111, Colombia
| | - Claudia Janeth Uribe Pérez
- Population Based Cancer Registry of the Metropolitan Area of Bucaramanga, Universidad Autónoma de Bucaramanga, Bucaramanga 681003, Colombia;
| | | | | | - Luis Eduardo Bravo
- Population Based Cancer Registry of Cali, Universidad del Valle, Cali 760043, Colombia;
| | - Rafael Gustavo Ortiz Martínez
- Public Health Observatory of Santander, Fundación Oftalmológica de Santander, Floridablanca 681003, Colombia; (F.E.M.-C.); (R.G.O.M.)
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10
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Martig DS, Williamson CM, Xu X, Sukov WR, Greipp PT, Hoppman NL, Baughn LB, Ketterling RP, Peterson JF. Siblings with ETV6/RUNX1-positive B-lymphoblastic leukemia: A single site experience and review of the literature. Ann Diagn Pathol 2020; 48:151588. [PMID: 32836179 DOI: 10.1016/j.anndiagpath.2020.151588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022]
Abstract
Siblings diagnosed with B-lymphoblastic leukemia (B-ALL) that share the same driver abnormality have been rarely described in the literature. Herein, we report three pairs of siblings (one non-identical pair, one maternal half-sibling pair, and one identical pair) all diagnosed with ETV6/RUNX1-positive B-ALL. Considering that ETV6/RUNX1 fusion is thought to represent a prenatal event and necessitates additional genomic alterations to result in leukemia, siblings of patient's with known ETV6/RUNX1-positive B-ALL may be at increased risk of ETV6/RUNX1-positive B-ALL due to common exposures (environmental or infectious) or shared germline polymorphisms.
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Affiliation(s)
- Daniel S Martig
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Cynthia M Williamson
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Xinjie Xu
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - William R Sukov
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Patricia T Greipp
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Nicole L Hoppman
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Linda B Baughn
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Rhett P Ketterling
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America; Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Jess F Peterson
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America.
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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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Konstantinoudis G, Schuhmacher D, Rue H, Spycher BD. Discrete versus continuous domain models for disease mapping. Spat Spatiotemporal Epidemiol 2020; 32:100319. [PMID: 32007284 DOI: 10.1016/j.sste.2019.100319] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 03/04/2019] [Accepted: 10/22/2019] [Indexed: 12/23/2022]
Abstract
The main goal of disease mapping is to estimate disease risk and identify high-risk areas. Such analyses are hampered by the limited geographical resolution of the available data. Typically the available data are counts per spatial unit and the common approach is the Besag-York-Mollié (BYM) model. When precise geocodes are available, it is more natural to use Log-Gaussian Cox processes (LGCPs). In a simulation study mimicking childhood leukaemia incidence using actual residential locations of all children in the canton of Zürich, Switzerland, we compare the ability of these models to recover risk surfaces and identify high-risk areas. We then apply both approaches to actual data on childhood leukaemia incidence in the canton of Zürich during 1985-2015. We found that LGCPs outperform BYM models in almost all scenarios considered. Our findings suggest that there are important gains to be made from the use of LGCPs in spatial epidemiology.
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Affiliation(s)
| | | | - Håvard Rue
- CEMSE Division, King Abdullah University of Science and Technology, Saudi Arabia.
| | - Ben D Spycher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
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13
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Maternal Infection in Pregnancy and Childhood Leukemia: A Systematic Review and Meta-analysis. J Pediatr 2020; 217:98-109.e8. [PMID: 31810630 PMCID: PMC7605597 DOI: 10.1016/j.jpeds.2019.10.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/13/2019] [Accepted: 10/17/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To summarize the published evidence regarding the association between maternal infection during pregnancy and childhood leukemia. STUDY DESIGN In this systematic review and meta-analysis (PROSPERO number, CRD42018087289), we searched PubMed and Embase to identify relevant studies. We included human studies that reported associations of at least one measure of maternal infection during pregnancy with acute lymphoblastic leukemia (ALL) or all childhood leukemias in the offspring. One reviewer extracted the data first using a standardized form, and the second reviewer independently checked the data for accuracy. Two reviewers used the Newcastle-Ottawa Scale to assess the quality of included studies. We conducted random effects meta-analyses to pool the ORs of specific type of infection on ALL and childhood leukemia. RESULTS This review included 20 studies (ALL, n = 15; childhood leukemia, n = 14) reported in 32 articles. Most (>65%) included studies reported a positive association between infection variables and ALL or childhood leukemia. Among specific types of infection, we found that influenza during pregnancy was associated with higher risk of ALL (pooled OR, 3.64; 95% CI, 1.34-9.90) and childhood leukemia (pooled OR, 1.77; 95% CI, 1.01-3.11). Varicella (pooled OR, 10.19; 95% CI, 1.98-52.39) and rubella (pooled OR, 2.79; 95% CI, 1.16-6.71) infections were also associated with higher childhood leukemia risk. CONCLUSIONS Our findings suggest that maternal infection during pregnancy may be associated with a higher risk of childhood leukemia.
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14
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Rodriguez-Villamizar LA, Rojas Díaz MP, Acuña Merchán LA, Moreno-Corzo FE, Ramírez-Barbosa P. Space-time clustering of childhood leukemia in Colombia: a nationwide study. BMC Cancer 2020; 20:48. [PMID: 31959128 PMCID: PMC6971926 DOI: 10.1186/s12885-020-6531-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leukemia is the most common cancer in childhood. The estimated incidence rate of childhood leukemia in Colombia is one of the highest in America and little is known about its spatial distribution. PURPOSE To explore the presence of space-time clustering of childhood leukemia in Colombia. METHODS We included children less than 15 years of age with confirmed diagnosis of acute leukemia reported to the national surveillance system for cancer between 2009 and 2017. Kulldorff's spatio-temporal scan statistics were used with municipality and year of diagnosis as units for spatial and temporal analysis. RESULTS There were 3846 cases of childhood leukemia between 2009 and 2017 with a specific mean incidence rate of 33 cases per million person-years in children aged 0-14 years. We identified five spatial clusters of childhood leukemia in different regions of the country and specific time clustering during the study period. CONCLUSION Childhood leukemia seems to cluster in space and time in some regions of Colombia suggesting a common etiologic factor or conditions to be studied.
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Affiliation(s)
| | | | - Lizbeth Alexandra Acuña Merchán
- Ministerio de Salud y Protección Social, Cuenta de Alto Costo- Fondo Colombiano de Enfermedades de Alto Costo, Avenida 45 103-34 Of. 802, Bogota, Colombia
| | - Feisar Enrique Moreno-Corzo
- Observatorio de Salud Pública de Santander, Fundación Oftalmológica de Santander, Avenida El Bosque 23-60, Floridablanca, Colombia
| | - Paula Ramírez-Barbosa
- Ministerio de Salud y Protección Social, Cuenta de Alto Costo- Fondo Colombiano de Enfermedades de Alto Costo, Avenida 45 103-34 Of. 802, Bogota, Colombia
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15
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Cao Y, Lu J, Lu J. Paternal Smoking Before Conception and During Pregnancy Is Associated With an Increased Risk of Childhood Acute Lymphoblastic Leukemia: A Systematic Review and Meta-Analysis of 17 Case-Control Studies. J Pediatr Hematol Oncol 2020; 42:32-40. [PMID: 31743318 PMCID: PMC6924935 DOI: 10.1097/mph.0000000000001657] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/03/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Current evidence regarding the association between paternal smoking before conception or during pregnancy and the risk of childhood acute lymphoblastic leukemia (ALL) are inconsistent. We aimed to systematically summarize the current evidence regarding this potential association. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE), we systematically retrieved PubMed, Embase, Web of Science, and Scopus, screened relevant literature, and assessed the methodologic quality of the included studies. We calculated the pooled estimates using random-effects models. We assessed statistical heterogeneity by I values and χ tests for the Cochrane Q statistic. We further investigate the dose-response relation using 2-stage nonlinear models. RESULTS A total of 17 case-control studies were identified, and the synthesized risk ratios (RRs) for smoking before conception (RR=1.15, 95% confidence interval: 1.04-1.27) and during pregnancy (RR=1.20, 95% confidence interval: 1.12-1.28) were both statistically significant. Moreover, the dose-response analysis showed a positive association as well. CONCLUSION Current evidence from observational studies suggests the association between paternal smoking before conception or during pregnancy and the increased risk of childhood ALL, which needs to be confirmed in prospective studies.
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Affiliation(s)
- Yue Cao
- Departments of Science and Technology
| | - Jing Lu
- Department of Pediatrics, West China Women’s and Children’s Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jing Lu
- Pharmacy, West China Hospital
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16
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Ye X, Monchka BA, Righolt CH, Mahmud SM. Maternal use of antibiotics and cancer incidence risk in offspring: A population-based cohort study in Manitoba, Canada. Cancer Med 2019; 8:5367-5372. [PMID: 31310456 PMCID: PMC6718549 DOI: 10.1002/cam4.2412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022] Open
Abstract
Several epidemiological studies have found an association between maternal antibiotics use during pregnancy and increased risk of certain cancer types, although conclusions differ between studies. We examined this association in a cohort study including 262 116 mother‐child pairs of Manitoba births between 1996 and 2013. Maternal antibiotics use during prepregnancy (6 months prior to pregnancy) and pregnancy periods was assessed. Children's cancer incidence was tracked up to the end of the follow‐up period (December 2015). We calculated incidence rate and used Cox regression to estimate adjusted hazard ratios (HRs). Antibiotics use during pregnancy was not associated with overall cancer (HR = 1.1, 95% confidence interval 0.9‐1.4), leukemias (1.3, 0.9‐1.8), or acute lymphocytic leukemia (1.1, 0.7‐1.6). The association between antibiotics use and overall cancer risk differed by trimester: 1.5 (1.1‐1.9) in the first, 0.8 (0.6‐1.0) in the second, and 1.1 (0.8‐1.5) in the third trimester. Further research is necessary to confirm the association between first‐trimester exposure and cancer risk after a better controlling of confounding factors.
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Affiliation(s)
- Xibiao Ye
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada.,School of Health Information Science, University of Victoria, British Columbia, Canada
| | - Barret A Monchka
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada.,George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada.,College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada.,George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
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17
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Amoon AT, Arah OA, Kheifets L. The sensitivity of reported effects of EMF on childhood leukemia to uncontrolled confounding by residential mobility: a hybrid simulation study and an empirical analysis using CAPS data. Cancer Causes Control 2019; 30:901-908. [PMID: 31144088 DOI: 10.1007/s10552-019-01189-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/22/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Residential mobility is considered as a potential source of confounding in studies assessing environmental exposures, including in studies of electromagnetic field (EMF) exposures and childhood leukemia. METHODS We present a hybrid simulation study where we simulate a synthetic dataset based on an existing study and use it to assess the sensitivity of EMF-leukemia associations to different scenarios of uncontrolled confounding by mobility under two major hypotheses of the infectious etiology of childhood leukemia. We then used the findings to conduct sensitivity analysis and empirically offset the potential bias due to unmeasured mobility in the California Power Line Study dataset. RESULTS As expected, the stronger the assumed relationship between mobility and exposure and outcome, the greater the potential bias. However, no scenario created a bias strong enough to completely explain away previously observed associations. CONCLUSIONS We conclude that uncontrolled confounding by residential mobility had some impact on the estimated effect of EMF exposures on childhood leukemia, but that it was unlikely to be the primary explanation behind previously observed largely consistent, but unexplained associations.
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Affiliation(s)
- Aryana T Amoon
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E. Young Drive South, Los Angeles, CA, 90095-1772, USA.
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E. Young Drive South, Los Angeles, CA, 90095-1772, USA.,Department of Statistics, UCLA College of Letters and Science, Los Angeles, CA, USA
| | - Leeka Kheifets
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E. Young Drive South, Los Angeles, CA, 90095-1772, USA
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18
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Ologbenla A, Hu M, Hajizadeh M. Socioeconomic status and incidence of pediatric leukemia in Canada: 1992-2010. Cancer Epidemiol 2019; 61:14-22. [PMID: 31103934 DOI: 10.1016/j.canep.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/03/2019] [Accepted: 04/26/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Leukemia is the most common cancer among Canadian children, representing about a third of pediatric cancers in Canada and is responsible for about one-third of pediatric cancer deaths. Understanding the effect of socioeconomic status (SES) on pediatric leukemia incidence provides valuable information for cancer control and interventions in Canada. METHODS Using a linked data from the Canadian Cancer Registry (CCR), Canadian Census of Population (CCP) and National Household Survey (NHS) we aimed to quantify socioeconomic inequalities in the incidence of pediatric leukemia from 1992 to 2010. We used the concentration index (C) approach to quantify income- and education-related inequalities in the incidence of pediatric leukemia over time. RESULTS Though there were fluctuations in incidence over the study period, our results showed that the total incidence of pediatric leukemia in Canada was generally consistent from 1992 to 2010. Incidence rate of 47 per 1,000,000 as at 1992 rose to 57 per 1,000,000 in 2010. The estimated values of the C over the study period failed to show any significant association between pediatric leukemia incidence and household income or education status. CONCLUSIONS Although pediatric leukemia incidence is not rising significantly, it is not reducing significantly either. The incidence of pediatric leukemia showed no significant association with socioeconomic status. Future cancer control interventions should focus more on mitigating risk factors that are independent of socioeconomic status.
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Affiliation(s)
| | - Min Hu
- School of Health Administration, Dalhousie University, Halifax, Canada
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Kreis C, Doessegger E, Lupatsch JE, Spycher BD. Space-time clustering of childhood cancers: a systematic review and pooled analysis. Eur J Epidemiol 2018; 34:9-21. [PMID: 30446850 PMCID: PMC6326085 DOI: 10.1007/s10654-018-0456-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 10/23/2018] [Indexed: 12/28/2022]
Abstract
The aetiology of childhood cancers remains largely unknown. Space–time clustering of cases might imply an aetiological role of infections. We aimed to review the evidence of space–time clustering of specific childhood cancers. We searched Medline and Embase for population-based studies that covered a pre-defined study area, included cases under 20 years of age and were published before July 2016. We extracted all space–time clustering tests and calculated the proportion of positive tests per diagnostic group. In a pooled analysis, we performed a Knox test of the number of pairs of cases close to each other in time and space pooled across studies. 70 studies met our eligibility criteria, 32 of which reported Knox tests. For leukaemia, the proportion of positive tests was higher than expected by chance at both time of diagnosis (26%) and birth (11%). The pooled analysis showed strong evidence of clustering at diagnosis for children aged 0–5 years for a spatial and temporal lag of 5 km and 6 months, respectively (p < 0.001). The evidence was mixed for lymphoma and tumours of the central nervous system. The current study suggests that leukaemia cases cluster in space–time due to an aetiological factor affecting children under 5 years of age. The observed pattern of clustering of young children close to time of diagnosis is compatible with Greaves’ delayed-infections-hypothesis.
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Affiliation(s)
- Christian Kreis
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Eliane Doessegger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Judith E Lupatsch
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Ben D Spycher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
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20
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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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21
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Kendall GM, Bithell JF, Bunch KJ, Draper GJ, Kroll ME, Murphy MFG, Stiller CA, Vincent TJ. Childhood cancer research in oxford III: The work of CCRG on ionising radiation. Br J Cancer 2018; 119:771-778. [PMID: 30131551 PMCID: PMC6173777 DOI: 10.1038/s41416-018-0182-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/26/2018] [Accepted: 06/20/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND High doses of ionising radiation are a known cause of childhood cancer and great public and professional interest attaches to possible links between childhood cancer and lower doses, particularly of man-made radiation. This paper describes work done by the Childhood Cancer Research Group (CCRG) on this topic METHODS: Most UK investigations have made use of the National Registry of Childhood Tumours and associated controls. Epidemiological investigations have included national incidence and mortality analyses, geographical investigations, record linkage and case-control studies. Dosimetric studies use biokinetic and dosimetric modelling. RESULTS This paper reviews the work of the CCRG on the association between exposure to ionising radiation and childhood cancer, 1975-2014. CONCLUSION The work of CCRG has been influential in developing understanding of the causes of 'clusters' of childhood cancer and the risks arising from exposure to ionising radiation both natural and man-made. Some clusters around nuclear installations have certainly been observed, but ionising radiation does not seem to be a plausible cause. The group's work has also been instrumental in discounting the hypothesis that paternal preconception irradiation was a cause of childhood cancers and has demonstrated an increased leukaemia risk for children exposed to higher levels of natural gamma-ray radiation.
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Affiliation(s)
- Gerald M Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - John F Bithell
- Department of Statistics, University of Oxford, 24-29 St Giles', Oxford, OX1 3LB, UK
| | - Kathryn J Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Gerald J Draper
- Department of Statistics, University of Oxford, 24-29 St Giles', Oxford, OX1 3LB, UK
| | - Mary E Kroll
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Michael F G Murphy
- Nuffield Department of Women's and Reproductive Health John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, Chancellor Court, Oxford Business Park South, Oxford, OX4 2GX, UK
| | - Tim J Vincent
- Formerly of Childhood Cancer Research Group, University of Oxford, Oxford, UK
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22
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Kehm RD, Spector LG, Poynter JN, Vock DM, Osypuk TL. Socioeconomic Status and Childhood Cancer Incidence: A Population-Based Multilevel Analysis. Am J Epidemiol 2018; 187:982-991. [PMID: 29036606 DOI: 10.1093/aje/kwx322] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/18/2017] [Indexed: 12/19/2022] Open
Abstract
The etiology of childhood cancers remains largely unknown, especially regarding environmental and behavioral risk factors. Unpacking the association between socioeconomic status (SES) and incidence may offer insight into such etiology. We tested associations between SES and childhood cancer incidence in a population-based case-cohort study (source cohort: Minnesota birth registry, 1989-2014). Cases, ages 0-14 years, were linked from the Minnesota Cancer Surveillance System to birth records through probabilistic record linkage. Controls were 4:1 frequency matched on birth year (2,947 cases and 11,907 controls). We tested associations of individual-level (maternal education) and neighborhood-level (census tract composite index) SES using logistic mixed models. In crude models, maternal education was positively associated with incidence of acute lymphoblastic leukemia (odds ratio (OR) = 1.10, 95% confidence interval (CI): 1.02, 1.19), central nervous system tumors (OR = 1.12, 95% CI: 1.04, 1.21), and neuroblastoma (OR = 1.15, 95% CI: 1.02, 1.30). Adjustment for established risk factors-including race/ethnicity, maternal age, and birth weight-substantially attenuated these positive associations. Similar patterns were observed for neighborhood-level SES. Conversely, higher maternal education was inversely associated with hepatoblastoma incidence (adjusted OR = 0.70, 95% CI: 0.51, 0.98). Overall, beyond the social patterning of established demographic and pregnancy-related exposures, SES is not strongly associated with childhood cancer incidence.
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Affiliation(s)
- Rebecca D Kehm
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
| | - Logan G Spector
- University of Minnesota, Division of Epidemiology and Clinical Research, Department of Pediatrics, Minneapolis, Minnesota
| | - Jenny N Poynter
- University of Minnesota, Division of Epidemiology and Clinical Research, Department of Pediatrics, Minneapolis, Minnesota
| | - David M Vock
- University of Minnesota School of Public Health, Division of Biostatistics, Minneapolis, Minnesota
| | - Theresa L Osypuk
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
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23
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Konstantinoudis G, Kreis C, Ammann RA, Niggli F, Kuehni CE, Spycher BD. Spatial clustering of childhood cancers in Switzerland: a nationwide study. Cancer Causes Control 2018; 29:353-362. [PMID: 29442212 DOI: 10.1007/s10552-018-1011-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/07/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE Childhood cancers are rare and little is known about their etiology. Potential risk factors include environmental exposures that might implicate spatial variation of cancer risk. Previous studies of spatial clustering have mainly focused on childhood leukemia. We investigated spatial clustering of different childhood cancers in Switzerland using exact geocodes of place of residence. METHODS We included 6,034 cancer cases diagnosed at age 0-15 years during 1985-2015 from the Swiss Childhood Cancer Registry. Age and sex-matched controls (10 per case) were randomly sampled from the national censuses (1990, 2000, 2010). Geocodes of place of residence were available at birth and diagnosis for both cases and controls. We used the difference in k-functions and Cuzick-Edwards test to assess global clustering and Kulldorff's circular scan to detect individual clusters. We also carefully adjusted for multiple testing. RESULTS After adjusting for multiple testing, we found no evidence of spatial clustering of childhood cancers neither at birth (p = 0.43) nor diagnosis (p = 0.13). Disregarding multiple testing, results of individual tests indicated spatial clustering of all childhood cancers combined (p < 0.01), childhood lymphoma (p = 0.01), due to Hodgkin lymphoma (HL) (p = 0.02) at diagnosis, and embryonal tumors of the central nervous system (CNS) at birth and diagnosis, respectively (p = 0.05 and p = 0.02). CONCLUSIONS This study provides weak evidence of spatial clustering of childhood cancers. Evidence was strongest for HL and embryonal CNS tumors, adding to the current literature that these cancers cluster in space.
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Affiliation(s)
- Garyfallos Konstantinoudis
- Faculty of Medicine, Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Christian Kreis
- Faculty of Medicine, Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Roland A Ammann
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Felix Niggli
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Claudia E Kuehni
- Faculty of Medicine, Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.,Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ben D Spycher
- Faculty of Medicine, Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland. .,Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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24
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Shim KS, Kim MH, Shim CN, Han M, Lim IS, Chae SA, Yun SW, Lee NM, Yi DY, Kim H. Seasonal trends of diagnosis of childhood malignant diseases and viral prevalence in South Korea. Cancer Epidemiol 2017; 51:118-124. [PMID: 29127946 PMCID: PMC7102810 DOI: 10.1016/j.canep.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/17/2017] [Accepted: 11/01/2017] [Indexed: 12/02/2022]
Abstract
The present study analyzed the diagnosis pattern of childhood malignant diseases using public health data and viral surveillance data in Korea. The number of newly diagnosis showed the highest monthly average in January, and the lowest in September. Seasonal trends were apparent in acute myeloid leukemia, Non-Hodgkin’s lymphoma, acute lymphoblastic leukemia and germ cell tumors. In winter, significantly more patients were diagnosed with acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma, and Hodgkin’s lymphoma than in other seasons. There was a temporal correlation with the diagnostic trends of several diseases and the prevalence of recent human parainfluenza virus.
Background Several studies have reported a seasonal trend in the diagnosis of childhood cancer suggesting seasonal factors such as infection. The present study aimed to analyze the diagnosis pattern of childhood malignant diseases using public health data, and to compare this pattern with seasonal viral infection trends. Method Using the open data source of the Health Insurance Review and Assessment Service, we extracted data regarding all patients under 21 years of age and who had any cancer, aplastic anemia or myelodysplastic syndrome between September 2009 and December 2013. The positive detection rates of 11 viruses was collected from the surveillance data of Korea Centers for Disease Control and Prevention, and seasonality analysis were conducted with both data. Results In total, 9085 patients were diagnosed with malignant disease during the study period; there were about 175 new cases per month on average. Monthly stacked time series by year showed an apparent seasonal variation with the highest monthly average in January as 236, and the lowest in September as 120. In winter, significantly more patients were diagnosed with acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma, and Hodgkin’s lymphoma than in other seasons. There was a temporal correlation with the diagnostic trends of several diseases and the prevalence of recent human parainfluenza virus. Conclusion This study tentatively suggests that the diagnosis of childhood malignancy follows a seasonal trend in Korea, and has a possible correlation with viral prevalence in several diseases. Further long-term analysis of epidemiological data is needed to explore possible causality.
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Affiliation(s)
- Kyu Seok Shim
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Min Hyung Kim
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Choong Nam Shim
- Department of Internal Medicine, Nasaret International Hospital, Incheon, Republic of Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In Seok Lim
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea; College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Soo Ahn Chae
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea; College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Sin Weon Yun
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea; College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Na Mi Lee
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Dae Yong Yi
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea; College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hyery Kim
- College of Medicine, Chung-Ang University, Seoul, Republic of Korea; Department of Pediatrics, Asan Medical Center, Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Hwee J, Tait C, Sung L, Kwong JC, Sutradhar R, Pole JD. A systematic review and meta-analysis of the association between childhood infections and the risk of childhood acute lymphoblastic leukaemia. Br J Cancer 2017; 118:127-137. [PMID: 29065105 PMCID: PMC5765221 DOI: 10.1038/bjc.2017.360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 01/02/2023] Open
Abstract
Background: To determine whether childhood infections were associated with the development of childhood acute lymphoblastic leukaemia (ALL). Methods: We included studies that assessed any infection in childhood prior to the diagnosis of ALL in children aged 0–19 years compared to children without cancer. The primary analysis synthesised any infection against the odds of ALL, and secondary analyses assessed the frequency, severity, timing of infections, and specific infectious agents against the odds of ALL. Subgroup analyses by data source were investigated. Results: In our primary analysis of 12 496 children with ALL and 2 356 288 children without ALL from 38 studies, we found that any infection was not associated with ALL (odds ratio (OR)=1.10, 95% CI: 0.95–1.28). Among studies with laboratory-confirmed infections, the presence of infections increased the odds of ALL by 2.4-fold (OR=2.42, 95% CI: 1.54–3.82). Frequency, severity, and timing of infection were not associated with ALL. Conclusions: The hypothesis put forward by Greaves and others about an infectious aetiology are neither confirmed nor refuted and the overall evidence remains inadequate for good judgement. The qualitative difference in the subgroup effects require further study, and future research will need to address the challenges in measuring infectious exposures.
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Affiliation(s)
- Jeremiah Hwee
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada
| | - Christopher Tait
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.,Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada.,Public Health Ontario, Toronto, ON, Canada.,Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, Canada
| | - Jason D Pole
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada.,Pediatric Oncology Group of Ontario, 480 University Avenue, Suite 1014, Toronto, ON, Canada
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Cazzaniga G, Bisanti L, Randi G, Deandrea S, Bungaro S, Pregliasco F, Perotti D, Spreafico F, Masera G, Valsecchi MG, Biondi A, Greaves M. Possible role of pandemic AH1N1 swine flu virus in a childhood leukemia cluster. Leukemia 2017; 31:1819-1821. [PMID: 28446785 PMCID: PMC5542028 DOI: 10.1038/leu.2017.127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Giovanni Cazzaniga
- Centro Ricerca Tettamanti, Clinica Pediatrica Università di Milano Bicocca, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy
| | - Luigi Bisanti
- Servizio di Epidemiologia, Azienda Sanitaria Locale di Milano, Milano, Italy
| | - Giorgia Randi
- Servizio di Epidemiologia, Azienda Sanitaria Locale di Milano, Milano, Italy
| | - Silvia Deandrea
- Servizio di Epidemiologia, Azienda Sanitaria Locale di Milano, Milano, Italy
| | - Silvia Bungaro
- Centro Ricerca Tettamanti, Clinica Pediatrica Università di Milano Bicocca, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy
| | - Fabrizio Pregliasco
- Dipartimento di Scienze Biomediche per la Salute - Università degli Studi di Milano, Milano, Italy
| | - Daniela Perotti
- Department of Preventive and Predictive Medicine, Unit of Molecular Bases of Genetic Risk and Genetic Testing, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - Filippo Spreafico
- Pediatric Oncology Unit, Hematology and Pediatric Onco-Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giuseppe Masera
- Clinica Pediatrica Università di Milano Bicocca, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Andrea Biondi
- Clinica Pediatrica Università di Milano Bicocca, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy
| | - Mel Greaves
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
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Cárceles-Álvarez A, Ortega-García JA, López-Hernández FA, Orozco-Llamas M, Espinosa-López B, Tobarra-Sánchez E, Alvarez L. Spatial clustering of childhood leukaemia with the integration of the Paediatric Environmental History. ENVIRONMENTAL RESEARCH 2017; 156:605-612. [PMID: 28454012 PMCID: PMC5685499 DOI: 10.1016/j.envres.2017.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/30/2017] [Accepted: 04/16/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Leukaemia remains the most common type of paediatric cancer and its aetiology remains unknown, but considered to be multifactorial. It is suggested that the initiation in utero by relevant exposures and/or inherited genetic variants and, other promotional postnatal exposures are probably required to develop leukaemia. This study aimed to map the incidence and analyse possible clusters in the geographical distribution of childhood acute leukaemia during the critical periods and to evaluate the factors that may be involved in the aetiology by conducting community and individual risk assessments. MATERIALS AND METHODS We analysed all incident cases of acute childhood leukaemia (<15 years) diagnosed in a Spanish region during the period 1998-2013. At diagnosis, the addresses during pregnancy, early childhood and diagnosis were collected and codified to analyse the spatial distribution of acute leukaemia. Scan statistical test methodology was used for the identification of high-incidence spatial clusters. Once identified, individual and community risk assessments were conducted using the Paediatric Environmental History. RESULTS A total of 158 cases of acute leukaemia were analysed. The crude rate for the period was 42.7 cases per million children. Among subtypes, acute lymphoblastic leukaemia had the highest incidence (31.9 per million children). A spatial cluster of acute lymphoblastic leukaemia was detected using the pregnancy address (p<0.05). The most common environmental risk factors related with the aetiology of acute lymphoblastic leukaemia, identified by the Paediatric Environmental History were: prenatal exposure to tobacco (75%) and alcohol (50%); residential and community exposure to pesticides (62.5%); prenatal or neonatal ionizing radiation (42.8%); and parental workplace exposure (37.5%) CONCLUSIONS: Our study suggests that environmental exposures in utero may be important in the development of childhood leukaemia. Due to the presence of high-incidence clusters using pregnancy address, it is necessary to introduce this address into the childhood cancer registers. The Paediatric Environmental History which includes pregnancy address and a careful and comprehensive evaluation of the environmental exposures will allow us to build the knowledge of the causes of childhood leukaemia.
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Affiliation(s)
- Alberto Cárceles-Álvarez
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environment and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain
| | - Juan A Ortega-García
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environment and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain.
| | | | - Mayra Orozco-Llamas
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environment and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain
| | - Blanca Espinosa-López
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environment and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain
| | - Esther Tobarra-Sánchez
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environment and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain
| | - Lizbeth Alvarez
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environment and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain
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Ortega-García JA, López-Hernández FA, Cárceles-Álvarez A, Fuster-Soler JL, Sotomayor DI, Ramis R. Childhood cancer in small geographical areas and proximity to air-polluting industries. ENVIRONMENTAL RESEARCH 2017; 156:63-73. [PMID: 28319819 PMCID: PMC5685507 DOI: 10.1016/j.envres.2017.03.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/02/2017] [Accepted: 03/06/2017] [Indexed: 05/13/2023]
Abstract
AIM Pediatric cancer has been associated with exposure to certain environmental carcinogens. The purpose of this work is to analyse the relationship between environmental pollution and pediatric cancer risk. METHOD We analysed all incidences of pediatric cancer (<15) diagnosed in a Spanish region during the period 1998-2015. The place of residence of each patient and the exact geographical coordinates of main industrial facilities was codified in order to analyse the spatial distribution of cases of cancer in relation to industrial areas. Focal tests and focused Scan methodology were used for the identification of high-incidence-rate spatial clusters around the main industrial pollution foci. RESULTS The crude rate for the period was 148.0 cases per 1,000,0000 children. The incidence of pediatric cancer increased significantly along the period of study. With respect to spatial distribution, results showed significant high incidence around some industrial pollution foci group and the Scan methodology identify spatial clustering. We observe a global major incidence of non Hodgkin lymphomas (NHL) considering all foci, and high incidence of Sympathetic Nervous System Tumour (SNST) around Energy and Electric and organic and inorganic chemical industries foci group. In the analysis foci to foci, the focused Scan test identifies several significant spatial clusters. Particularly, three significant clusters were identified: the first of SNST was around energy-generating chemical industries (2 cases versus the expected 0.26), another of NHL was around residue-valorisation plants (5 cases versus the expected 0.91) and finally one cluster of Hodgkin lymphoma around building materials (3 cases versus the expected 2.2) CONCLUSION: Results suggest a possible association between proximity to certain industries and pediatric cancer risk. More evidences are necessary before establishing the relationship between industrial pollution and pediatric cancer incidence.
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Affiliation(s)
- Juan A Ortega-García
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environmental and Human Health (A5), Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain.
| | | | - Alberto Cárceles-Álvarez
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environmental and Human Health (A5), Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain
| | - José L Fuster-Soler
- Oncology & Hematology Section, Pediatrics Department, Clinical University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Diana I Sotomayor
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environmental and Human Health (A5), Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain
| | - Rebeca Ramis
- Environmental Epidemiology and Cancer Unit, National Centre for Epidemiology, Instituto de Salud Carlos III - ISCIII, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
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Konstantinoudis G, Kreis C, Ammann RA, Niggli F, Kuehni CE, Spycher BD. Spatial clustering of childhood leukaemia in Switzerland: A nationwide study. Int J Cancer 2017; 141:1324-1332. [DOI: 10.1002/ijc.30832] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/24/2017] [Accepted: 05/31/2017] [Indexed: 12/18/2022]
Affiliation(s)
| | - Christian Kreis
- Institute of Social and Preventive Medicine (ISPM), Faculty of Medicine, University of Bern Switzerland
| | - Roland A. Ammann
- Department of Paediatrics InselspitalBern University Hospital, University of Bern Switzerland
| | - Felix Niggli
- Department of Oncology, University Children's Hospital Zurich Switzerland
| | - Claudia E. Kuehni
- Institute of Social and Preventive Medicine (ISPM), Faculty of Medicine, University of Bern Switzerland
| | - Ben D. Spycher
- Institute of Social and Preventive Medicine (ISPM), Faculty of Medicine, University of Bern Switzerland
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Wang L, Gomez SL, Yasui Y. Racial and Ethnic Differences in Socioeconomic Position and Risk of Childhood Acute Lymphoblastic Leukemia. Am J Epidemiol 2017; 185:1263-1271. [PMID: 28369160 DOI: 10.1093/aje/kww164] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/29/2016] [Indexed: 11/14/2022] Open
Abstract
Racial and ethnic differences in associations between socioeconomic position (SEP) and risk of childhood acute lymphoblastic leukemia (ALL) were investigated using data from population-based cancer registries in the Surveillance, Epidemiology, and End Results Program in the United States. The study included 8,383 ALL cases diagnosed at age ≤19 years in 2000-2010. Census tract-level composite SEP index in quintiles was assigned based on residence at the time of diagnosis. Incidence rate ratios and 95% confidence intervals associated with SEP and race/ethnicity, adjusted for sex, age, and year of diagnosis, were estimated using Poisson regression models. The incidence rate of childhood ALL was negatively associated with SEP among Hispanics but was positively associated among children of other races/ethnicities. As compared with the lowest SEP, the adjusted incidence rate ratios for children with the highest SEP were 1.29 (95% confidence interval (CI): 1.15, 1.44) for non-Hispanic whites, 1.67 (95% CI: 1.20, 2.34) for non-Hispanic blacks, 1.57 (95% CI: 1.17, 2.09) for Asians/Pacific Islanders, 2.33 (95% CI: 0.93, 5.83) for American Indians/Alaska Natives, and 0.70 (95% CI: 0.60, 0.81) for Hispanics. The findings of a reverse association in Hispanics need to be confirmed and further explained in future studies using different measures of SEP.
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Affiliation(s)
- Linwei Wang
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (Linwei Wang, Yutaka Yasui)
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California (Scarlett Lin Gomez)
- Division of Epidemiology, Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California (Scarlett Lin Gomez)
- Stanford Cancer Institute, Stanford, California (Scarlett Lin Gomez)
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (Linwei Wang, Yutaka Yasui)
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Can changes in population mixing and socio-economic deprivation in Cumbria, England explain changes in cancer incidence around Sellafield? Spat Spatiotemporal Epidemiol 2017; 21:25-36. [PMID: 28552185 DOI: 10.1016/j.sste.2017.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 02/14/2017] [Accepted: 02/21/2017] [Indexed: 11/23/2022]
Abstract
Previously excesses in incident cases of leukaemia and non-Hodgkin lymphoma have been observed amongst young people born or resident in Seascale, Cumbria. These excesses have not been seen more recently. It is postulated that the former apparent increased risk was related to 'unusual population mixing', which is not present in recent years. This study investigated changes in measures of population mixing from 1951-2001. Comparisons were made between three specified areas. Area-based measures were calculated (migration, commuting, deprivation, population density). All areas have become more affluent, although Seascale was consistently the most affluent. Seascale has become less densely populated, with less migration into the ward and less diversity with respect to migrants' origin. There have been marked changes in patterns of population mixing throughout Cumbria. Lesser population mixing has been observed in Seascale in recent decades. Changes in pattern and nature of population mixing may explain the lack of recent excesses.
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Kreis C, Lupatsch JE, Niggli F, Egger M, Kuehni CE, Spycher BD. Space-Time Clustering of Childhood Leukemia: Evidence of an Association with ETV6-RUNX1 (TEL-AML1) Fusion. PLoS One 2017; 12:e0170020. [PMID: 28129329 PMCID: PMC5271308 DOI: 10.1371/journal.pone.0170020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/26/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Many studies have observed space-time clustering of childhood leukemia (CL) yet few have attempted to elicit etiological clues from such clustering. We recently reported space-time clustering of CL around birth, and now aim to generate etiological hypotheses by comparing clustered and nonclustered cases. We also investigated whether the clustering resulted from many small aggregations of cases or from a few larger clusters. METHODS We identified cases of persons born and diagnosed between 1985 and 2014 at age 0-15 years from the Swiss Childhood Cancer Registry. We determined spatial and temporal lags that maximized evidence of clustering based on the Knox test and classified cases born within these lags from another case as clustered. Using logistic regression adjusted for child population density, we determined whether clustering status was associated with age at diagnosis, immunophenotype, cytogenetic subtype, perinatal and socioeconomic characteristics, and pollution sources. RESULTS Analyses included 1,282 cases of which 242 were clustered (born within 1 km and 2 years from another case). Of all investigated characteristics only the t(12;21)(p13;q22) translocation (resulting in ETV6-RUNX1 fusion) differed significantly in prevalence between clustered and nonclustered cases (40% and 25%, respectively; adjusted OR 2.54 [1.52-4.23]; p = 0.003). Spatio-temporal clustering was driven by an excess of aggregations of two or three children rather than by a few large clusters. CONCLUSION Our findings suggest ETV6-RUNX1 is associated with space-time clustering of CL and are consistent with an infection interacting with that oncogene in early life leading to clinical leukemia.
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Affiliation(s)
- Christian Kreis
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Judith E. Lupatsch
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Felix Niggli
- University Children's Hospital Zurich, Zurich, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 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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Ford AM, Greaves M. ETV6-RUNX1 + Acute Lymphoblastic Leukaemia in Identical Twins. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 962:217-228. [PMID: 28299660 DOI: 10.1007/978-981-10-3233-2_14] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute leukaemia is the major subtype of paediatric cancer with a cumulative risk of 1 in 2000 for children up to the age of 15 years. Childhood acute lymphoblastic leukaemia (ALL) is a biologically and clinically diverse disease with distinctive subtypes; multiple chromosomal translocations exist within the subtypes and each carries its own prognostic relevance. The most common chromosome translocation observed is the t(12;21) that results in an in-frame fusion between the first five exons of ETV6 (TEL) and almost the entire coding region of RUNX1 (AML1).The natural history of childhood ALL is almost entirely clinically silent and is well advanced at the point of diagnosis. It has, however, been possible to backtrack this process through molecular analysis of appropriate clinical samples: (i) leukaemic clones in monozygotic twins that are either concordant or discordant for ALL; (ii) archived neonatal blood spots or Guthrie cards from individuals who later developed leukaemia; and (iii) stored, viable cord blood cells.Here, we outline our studies on the aetiology and pathology of childhood ALL that provide molecular evidence for a monoclonal, prenatal origin of ETV6-RUNX1+ leukaemia in monozygotic identical twins. We provide mechanistic support for the concept that altered patterns of infection during early childhood can deliver the necessary promotional drive for the progression of ETV6-RUNX1+ pre-leukaemic cells into a postnatal overt leukaemia.
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Affiliation(s)
- Anthony M Ford
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK.
| | - Mel Greaves
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK
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Moschovi M, Adamaki M, Vlahopoulos SA. Progress in Treatment of Viral Infections in Children with Acute Lymphoblastic Leukemia. Oncol Rev 2016; 10:300. [PMID: 27471584 PMCID: PMC4943096 DOI: 10.4081/oncol.2016.300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/29/2016] [Indexed: 02/08/2023] Open
Abstract
In children, the most commonly encountered type of leukemia is acute lymphoblastic leukemia (ALL). An important source of morbidity and mortality in ALL are viral infections. Even though allogeneic transplantations, which are often applied also in ALL, carry a recognized risk for viral infections, there are multiple factors that make ALL patients susceptible to viral infections. The presence of those factors has an influence in the type and severity of infections. Currently available treatment options do not guarantee a positive outcome for every case of viral infection in ALL, without significant side effects. Side effects can have very serious consequences for the ALL patients, which include nephrotoxicity. For this reason a number of strategies for personalized intervention have been already clinically tested, and experimental approaches are being developed. Adoptive immunotherapy, which entails administration of ex vivo grown immune cells to a patient, is a promising approach in general, and for transplant recipients in particular. The ex vivo grown cells are aimed to strengthen the immune response to the virus that has been identified in the patients' blood and tissue samples. Even though many patients with weakened immune system can benefit from progress in novel approaches, a viral infection still poses a very significant risk for many patients. Therefore, preventive measures and supportive care are very important for ALL patients.
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Affiliation(s)
- Maria Moschovi
- Hematology-Oncology Unit, First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital , Athens, Greece
| | - Maria Adamaki
- Hematology-Oncology Unit, First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital , Athens, Greece
| | - Spiros A Vlahopoulos
- Hematology-Oncology Unit, First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital , Athens, Greece
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35
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Harrison A, Fletcher-Groves S, Gordon-Strachan G, Thame M. Factors Affecting the Choice and Desire to Exclusively Breastfeed in Jamaica: A Cross-Sectional Study at 6 Weeks Postpartum. J Hum Lact 2016; 32:292-300. [PMID: 26138917 DOI: 10.1177/0890334415593540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 06/01/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Exclusive breastfeeding rates (EBRs) may be influenced by sociodemographic and sociocultural factors, including maternal age, socioeconomic status, education, and breastfeeding knowledge. The EBR in Jamaica has been low and declining, leaving a need for better determination of the specific local contributory factors. OBJECTIVES This study aimed to better elucidate the factors that influence mothers exclusively breastfeeding, including antenatal intentions to breastfeed, mothers' knowledge of the benefits of breastfeeding, and mothers' infant feeding practices in general, inclusive of breastfeeding, formula feeding, and complementary feeding. METHODS A cross-sectional survey was conducted using a 52-item interviewer-administered questionnaire with mothers attending their 6-week postnatal clinic visit. Sociodemographic data were collected on all participants as well as data regarding participants' breastfeeding knowledge, attitudes, and practices. Statistical analyses were done using χ(2) tests, t tests, and risk analyses. RESULTS Two hundred participants were interviewed; the mean ± SD age of participants was 26.2 ± 6.46 years (range, 15-46 years). The EBR in this study sample was 32%. Sociodemographic factors, including maternal age and socioeconomic status, as well as antenatal and postnatal breastfeeding sessions, did not significantly affect the likelihood of exclusively breastfeeding at 6 weeks postpartum. The only factor significantly associated with the EBR was mothers' belief that exclusively breastfeeding was able to ensure infant satiety. CONCLUSION Antenatal and postnatal breastfeeding sessions should place more emphasis on dispelling maternal myths and misperceptions regarding signs of satiety and hunger in infants and reinforcing the knowledge that breast milk alone is sufficient for the first 6 months of life.
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Affiliation(s)
- Abigail Harrison
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
| | - Shani Fletcher-Groves
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
| | | | - Minerva Thame
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
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Ornelles DA, Gooding LR, Dickherber ML, Policard M, Garnett-Benson C. Limited but durable changes to cellular gene expression in a model of latent adenovirus infection are reflected in childhood leukemic cell lines. Virology 2016; 494:67-77. [PMID: 27085068 PMCID: PMC4946252 DOI: 10.1016/j.virol.2016.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 12/12/2022]
Abstract
Mucosal lymphocytes support latent infections of species C adenoviruses. Because infected lymphocytes resist re-infection with adenovirus, we sought to identify changes in cellular gene expression that could inhibit the infectious process. The expression of over 30,000 genes was evaluated by microarray in persistently infected B-and T-lymphocytic cells. BBS9, BNIP3, BTG3, CXADR, SLFN11 and SPARCL1 were the only genes differentially expressed between mock and infected B cells. Most of these genes are associated with oncogenesis or cancer progression. Histone deacetylase and DNA methyltransferase inhibitors released the repression of some of these genes. Cellular and viral gene expression was compared among leukemic cell lines following adenovirus infection. Childhood leukemic B-cell lines resist adenovirus infection and also show reduced expression of CXADR and SPARCL. Thus adenovirus induces limited changes to infected B-cell lines that are similar to changes observed in childhood leukemic cell lines.
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Affiliation(s)
- D A Ornelles
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - L R Gooding
- Emory University School of Medicine, Department of Microbiology and Immunology, Atlanta, GA 30322, United States
| | - M L Dickherber
- Department of Biology, Georgia State University, Atlanta, GA 30303, United States
| | - M Policard
- Department of Biology, Georgia State University, Atlanta, GA 30303, United States
| | - C Garnett-Benson
- Department of Biology, Georgia State University, Atlanta, GA 30303, United States.
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Reis RDS, Santos MDO, de Camargo B, Oliveira JFP, Thuler LCS, Pombo-de-Oliveira MS. Early childhood leukemia incidence trends in Brazil. Pediatr Hematol Oncol 2016; 33:83-93. [PMID: 26925506 DOI: 10.3109/08880018.2015.1130763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Incidence rates of childhood leukemia vary between different regions of the world. The objective of this study was to test possible trends in incidence rate of early childhood leukemia (children <5 years old at the diagnosis) in Brazil. Data from 18 population-based cancer registries (PBCRs) were analyzed (period 1999-2010). The analysis consisted of frequencies, age-adjusted incidence rates, and joinpoint regression results, including annual average percent change (AAPC) in incidence rates and 95% confidence intervals (CIs). The median age-adjusted incidence rate (AAIR) of overall early childhood leukemia was 61 per million. The AAIR for acute lymphoid leukemia (ALL) was 44 per million and nonlymphoid acute leukemia (NLAL) was 14 per million. The median ALL/NLAL ratio was 3.0, suggesting higher incidence rate of NLAL in these settings. The joinpoint analysis demonstrated increased leukemia incidence rate in João Pessoa (AAPC = 20; 95% CI: 3.5, 39.4) and Salvador (AAPC = 8.68; 95% CI: 1.0, 16.9), respectively, whereas incidence rate in São Paulo PBCR decreased (AAPC = -4.02%; 95% CI: -6.1%, -1.9%). Correlation between ALL AAIR and selected variables of socioeconomic (SES) factors was not observed. Increased AAIR regionally overtime was observed. However, the interpretation for such phenomenon should be cautious because it might reflect the access to health care, diagnosis procedures, and improvement of PBCR´s quality. The observed trend supports the necessity of further ecological studies.
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Affiliation(s)
- Rejane de Souza Reis
- a Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro , Brazil
| | - Marceli de Oliveira Santos
- a Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro , Brazil
| | - Beatriz de Camargo
- b Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro , Brazil
| | - Julio Fernando Pinto Oliveira
- a Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro , Brazil
| | | | - Maria S Pombo-de-Oliveira
- b Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro , Brazil
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38
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Residential mobility and the risk of childhood leukemia. Cancer Causes Control 2016; 27:433-43. [DOI: 10.1007/s10552-016-0720-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
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Kreis C, Grotzer M, Hengartner H, Spycher BD. Space-time clustering of childhood cancers in Switzerland: A nationwide study. Int J Cancer 2016; 138:2127-35. [PMID: 26650335 DOI: 10.1002/ijc.29955] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/11/2015] [Accepted: 11/23/2015] [Indexed: 11/09/2022]
Abstract
The aetiology of childhood cancers remains largely unknown. It has been hypothesized that infections may be involved and that mini-epidemics thereof could result in space-time clustering of incident cases. Most previous studies support spatio-temporal clustering for leukaemia, while results for other diagnostic groups remain mixed. Few studies have corrected for uneven regional population shifts which can lead to spurious detection of clustering. We examined whether there is space-time clustering of childhood cancers in Switzerland identifying cases diagnosed at age <16 years between 1985 and 2010 from the Swiss Childhood Cancer Registry. Knox tests were performed on geocoded residence at birth and diagnosis separately for leukaemia, acute lymphoid leukaemia (ALL), lymphomas, tumours of the central nervous system, neuroblastomas and soft tissue sarcomas. We used Baker's Max statistic to correct for multiple testing and randomly sampled time-, sex- and age-matched controls from the resident population to correct for uneven regional population shifts. We observed space-time clustering of childhood leukaemia at birth (Baker's Max p = 0.045) but not at diagnosis (p = 0.98). Clustering was strongest for a spatial lag of <1 km and a temporal lag of <2 years (Observed/expected close pairs: 124/98; p Knox test = 0.003). A similar clustering pattern was observed for ALL though overall evidence was weaker (Baker's Max p = 0.13). Little evidence of clustering was found for other diagnostic groups (p > 0.2). Our study suggests that childhood leukaemia tends to cluster in space-time due to an etiologic factor present in early life.
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Affiliation(s)
- Christian Kreis
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Heinz Hengartner
- Children's Hospital Eastern Switzerland, St. Gallen, Switzerland
| | - Ben Daniel Spycher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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40
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Lin JN, Lin CL, Lin MC, Lai CH, Lin HH, Yang CH, Sung FC, Kao CH. Risk of leukaemia in children infected with enterovirus: a nationwide, retrospective, population-based, Taiwanese-registry, cohort study. Lancet Oncol 2015; 16:1335-43. [DOI: 10.1016/s1470-2045(15)00060-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/09/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
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Martín-Lorenzo A, Hauer J, Vicente-Dueñas C, Auer F, González-Herrero I, García-Ramírez I, Ginzel S, Thiele R, Constantinescu SN, Bartenhagen C, Dugas M, Gombert M, Schäfer D, Blanco O, Mayado A, Orfao A, Alonso-López D, Rivas JDL, Cobaleda C, García-Cenador MB, García-Criado FJ, Sánchez-García I, Borkhardt A. Infection Exposure is a Causal Factor in B-cell Precursor Acute Lymphoblastic Leukemia as a Result of Pax5-Inherited Susceptibility. Cancer Discov 2015; 5:1328-43. [PMID: 26408659 DOI: 10.1158/2159-8290.cd-15-0892] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/17/2015] [Indexed: 11/16/2022]
Abstract
UNLABELLED Earlier in the past century, infections were regarded as the most likely cause of childhood B-cell precursor acute lymphoblastic leukemia (pB-ALL). However, there is a lack of relevant biologic evidence supporting this hypothesis. We present in vivo genetic evidence mechanistically connecting inherited susceptibility to pB-ALL and postnatal infections by showing that pB-ALL was initiated in Pax5 heterozygous mice only when they were exposed to common pathogens. Strikingly, these murine pB-ALLs closely resemble the human disease. Tumor exome sequencing revealed activating somatic, nonsynonymous mutations of Jak3 as a second hit. Transplantation experiments and deep sequencing suggest that inactivating mutations in Pax5 promote leukemogenesis by creating an aberrant progenitor compartment that is susceptible to malignant transformation through accumulation of secondary Jak3 mutations. Thus, treatment of Pax5(+/-) leukemic cells with specific JAK1/3 inhibitors resulted in increased apoptosis. These results uncover the causal role of infection in pB-ALL development. SIGNIFICANCE These results demonstrate that delayed infection exposure is a causal factor in pB-ALL. Therefore, these findings have critical implications for the understanding of the pathogenesis of leukemia and for the development of novel therapies for this disease.
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Affiliation(s)
- Alberto Martín-Lorenzo
- Experimental Therapeutics and Translational Oncology Program, Instituto de Biología Molecular y Celular del Cáncer, CSIC/Universidad de Salamanca, Campus M. de Unamuno s/n, Salamanca, Spain. Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Julia Hauer
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich-Heine University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Carolina Vicente-Dueñas
- Experimental Therapeutics and Translational Oncology Program, Instituto de Biología Molecular y Celular del Cáncer, CSIC/Universidad de Salamanca, Campus M. de Unamuno s/n, Salamanca, Spain. Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Franziska Auer
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich-Heine University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Inés González-Herrero
- Experimental Therapeutics and Translational Oncology Program, Instituto de Biología Molecular y Celular del Cáncer, CSIC/Universidad de Salamanca, Campus M. de Unamuno s/n, Salamanca, Spain. Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Idoia García-Ramírez
- Experimental Therapeutics and Translational Oncology Program, Instituto de Biología Molecular y Celular del Cáncer, CSIC/Universidad de Salamanca, Campus M. de Unamuno s/n, Salamanca, Spain. Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Sebastian Ginzel
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich-Heine University Dusseldorf, Medical Faculty, Dusseldorf, Germany. Department of Computer Science, Bonn-Rhein-Sieg University of Applied Sciences, Sankt Augustin, Germany
| | - Ralf Thiele
- Department of Computer Science, Bonn-Rhein-Sieg University of Applied Sciences, Sankt Augustin, Germany
| | - Stefan N Constantinescu
- Ludwig Institute for Cancer Research Brussels and Université catholique de Louvain, de Duve Institute, Brussels, Belgium
| | | | - Martin Dugas
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Michael Gombert
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich-Heine University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Daniel Schäfer
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich-Heine University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Oscar Blanco
- Departamento de Anatomía Patológica, Universidad de Salamanca, Salamanca, Spain
| | - Andrea Mayado
- Servicio de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Alberto Orfao
- Servicio de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Diego Alonso-López
- Bioinformatics Unit, Cancer Research Center (CSIC-USAL), Salamanca, Spain
| | - Javier De Las Rivas
- Bioinformatics Unit, Cancer Research Center (CSIC-USAL), Salamanca, Spain. Bioinformatics and Functional Genomics Research Group, Cancer Research Center (CSIC-USAL), Salamanca, Spain
| | - César Cobaleda
- Centro de Biología Molecular Severo Ochoa; CSIC/Universidad Autónoma de Madrid; Campus de Cantoblanco, Madrid, Spain
| | | | | | - Isidro Sánchez-García
- Experimental Therapeutics and Translational Oncology Program, Instituto de Biología Molecular y Celular del Cáncer, CSIC/Universidad de Salamanca, Campus M. de Unamuno s/n, Salamanca, Spain. Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich-Heine University Dusseldorf, Medical Faculty, Dusseldorf, Germany.
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Spector LG. Enterovirus infection and childhood leukaemia: an association? Lancet Oncol 2015; 16:1278-9. [PMID: 26321215 DOI: 10.1016/s1470-2045(15)00194-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 07/18/2015] [Accepted: 07/22/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Logan G Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
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Gradel KO, Kaerlev L. Antibiotic use from conception to diagnosis of child leukaemia as compared to the background population: A nested case-control study. Pediatr Blood Cancer 2015; 62:1155-61. [PMID: 25790083 DOI: 10.1002/pbc.25477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/16/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND The role of infection in the aetiology of childhood leukaemia is unknown. We used prescriptions of antibiotics from Danish pharmacies as a proxy measure for the occurrence of infections. PROCEDURE We investigated the association between exposure to antibiotics, from conception to leukaemia diagnosis, and the risk of leukaemia. Incident cases of leukaemia among children in Denmark, 1995-2008, with mothers having their earliest conception date in 1995, were individually matched to population controls by age, sex and municipality. Conditional logistic regression analyses assessed antibiotic redemptions in different time periods from conception up to 6 months before the diagnoses of all leukaemia types, acute lymphoblastic leukaemia [ALL] and ALL in 2- to 5-year-old children, adjusting for several potential confounders. RESULTS A total of 120/360 (33.3%) leukaemia mothers and 1,081/3,509 (30.8%) control mothers redeemed antibiotics during pregnancy (P = 0.32). For children, the equivalent numbers were 276 (76.7%) and 2,665 (75.9%) (P = 0.76). Histograms of antibiotic redemptions showed no temporal differences between leukaemia mothers/children and controls, which was confirmed in adjusted regression analyses (OR [95% CI]: 1.02 [0.75-1.38]). Only antibiotics redeemed during the first year after birth differed from this (OR [95% CI] for ALL diagnosed in 2- to 5-year-old children: 0.46 [0.31-0.66]). CONCLUSIONS In this hypothesis generating study, the similar amount and pattern of antibiotic redemptions in children with and without leukaemia indicate that infections play a minor role in the aetiology of childhood leukaemia. However, less antibiotic redemptions during the first year of life conform to Greaves' 'delayed infection hypothesis'.
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Affiliation(s)
- Kim Oren Gradel
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Linda Kaerlev
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
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Adam M, Kuehni CE, Spoerri A, Schmidlin K, Gumy-Pause F, Brazzola P, Probst-Hensch N, Zwahlen M. Socioeconomic Status and Childhood Leukemia Incidence in Switzerland. Front Oncol 2015; 5:139. [PMID: 26175964 PMCID: PMC4485172 DOI: 10.3389/fonc.2015.00139] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/02/2015] [Indexed: 11/21/2022] Open
Abstract
Socioeconomic status (SES) discrepancies exist for child and adult cancer morbidity and are a major public health concern. In this Swiss population-based matched case–control study on the etiology of childhood leukemia, we selected the cases from the Swiss Childhood Cancer Registry diagnosed since 1991 and the controls randomly from census. We assigned eight controls per case from the 1990 and 2000 census and matched them by the year of birth and gender. SES information for both cases and controls was obtained from census records by probabilistic record linkage. We investigated the association of SES with childhood leukemia in Switzerland, and explored whether it varied with different definitions of socioeconomic status (parental education, living condition, area-based SES), time period, and age. In conditional logistic regression analyses of 565 leukemia cases and 4433 controls, we found no consistent evidence for an association between SES and childhood leukemia. The odds ratio comparing the highest with the lowest SES category ranged from 0.95 (95% CI: 0.71–1.26; Ptrend = 0.73) for paternal education to 1.37 (1.00–1.89; Ptrend = 0.064) for maternal education. No effect modification was found for time period and age at diagnosis. Based on this population-based study, which avoided participation and reporting bias, we assume the potential association of socioeconomic status and childhood leukemia if existing to be small. This study did not find evidence that socioeconomic status, of Switzerland or comparable countries, is a relevant risk factor or strong confounder in etiological investigations on childhood leukemia.
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Affiliation(s)
- Martin Adam
- Swiss Tropical and Public Health Institute , Basel , Switzerland ; University of Basel , Basel , Switzerland ; Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
| | - Adrian Spoerri
- Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
| | - Kurt Schmidlin
- Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
| | - Fabienne Gumy-Pause
- Haematology/Oncology Unit, Department of Paediatrics, University Hospital of Geneva , Geneva , Switzerland
| | - Pierluigi Brazzola
- Department of Paediatrics, Ospedale San Giovanni , Bellinzona , Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute , Basel , Switzerland ; University of Basel , Basel , Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
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Crump C, Sundquist J, Sieh W, Winkleby MA, Sundquist K. Perinatal risk factors for acute myeloid leukemia. Eur J Epidemiol 2015; 30:1277-85. [PMID: 26113060 DOI: 10.1007/s10654-015-0063-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 06/18/2015] [Indexed: 02/06/2023]
Abstract
Infectious etiologies have been hypothesized for acute leukemias because of their high incidence in early childhood, but have seldom been examined for acute myeloid leukemia (AML). We conducted the first large cohort study to examine perinatal factors including season of birth, a proxy for perinatal infectious exposures, and risk of AML in childhood through young adulthood. A national cohort of 3,569,333 persons without Down syndrome who were born in Sweden in 1973-2008 were followed up for AML incidence through 2010 (maximum age 38 years). There were 315 AML cases in 69.7 million person-years of follow-up. We found a sinusoidal pattern in AML risk by season of birth (P < 0.001), with peak risk among persons born in winter. Relative to persons born in summer (June-August), incidence rate ratios for AML were 1.72 (95 % CI 1.25-2.38; P = 0.001) for winter (December-February), 1.37 (95 % CI 0.99-1.90; P = 0.06) for spring (March-May), and 1.27 (95 % CI 0.90-1.80; P = 0.17) for fall (September-November). Other risk factors for AML included high fetal growth, high gestational age at birth, and low maternal education level. These findings did not vary by sex or age at diagnosis. Sex, birth order, parental age, and parental country of birth were not associated with AML. In this large cohort study, birth in winter was associated with increased risk of AML in childhood through young adulthood, possibly related to immunologic effects of early infectious exposures compared with summer birth. These findings warrant further investigation of the role of seasonally varying perinatal exposures in the etiology of AML.
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Affiliation(s)
- Casey Crump
- Department of Medicine, Stanford University, 1265 Welch Road, MSOB X212, Stanford, CA, 94305-5411, USA.
| | - Jan Sundquist
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Lund University, Building 28, floor 11, Jan Waldenströms gata 35, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Weiva Sieh
- Department of Health Research and Policy, Stanford University, HRP Redwood Building, T254B, Stanford, CA, 94305-5405, USA
| | - Marilyn A Winkleby
- Stanford Prevention Research Center, Stanford University, Medical School Office Building, 251 Campus Drive, Room X318, Stanford, CA, 94305-5411, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Lund University, Building 28, floor 11, Jan Waldenströms gata 35, Skåne University Hospital, SE-205 02, Malmö, Sweden
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Does primary biliary cirrhosis cluster in time? Spat Spatiotemporal Epidemiol 2015; 14-15:1-8. [PMID: 26530818 DOI: 10.1016/j.sste.2015.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 06/01/2015] [Accepted: 06/09/2015] [Indexed: 11/24/2022]
Abstract
The aetiology of primary biliary cirrhosis (PBC) is not well established. Previously we found evidence of space-time clustering and seasonal variation in the date of diagnosis, suggesting a possible role for a transient or seasonally varying environmental factor. We examined whether a temporally varying environmental agent may be involved by analysing population-based PBC data from northeast England over 1987-2003. Using an adaptation of a method proposed by Potthoff and Whittinghill, we found significant temporal variation by date of diagnosis at the level of aggregation of one year. However, there was no evidence for general irregular (non-seasonal) temporal clustering within periods less than a year. These results provide little support for the involvement of agents occurring in geographically widespread mini-epidemics, but--taken together with studies of spatial and spatio-temporal clustering--do not preclude the role of more localised sporadic mini-epidemics. Future research should seek to elicit putative environmental agents.
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Ramis R, Gómez-Barroso D, Tamayo I, García-Pérez J, Morales A, Pardo Romaguera E, López-Abente G. Spatial analysis of childhood cancer: a case/control study. PLoS One 2015; 10:e0127273. [PMID: 25992892 PMCID: PMC4439051 DOI: 10.1371/journal.pone.0127273] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/14/2015] [Indexed: 11/18/2022] Open
Abstract
Background Childhood cancer was the leading cause of death among children aged 1-14 years for 2012 in Spain. Leukemia has the highest incidence, followed by tumors of the central nervous system (CNS) and lymphomas (Hodgkin lymphoma, HL, and Non-Hodgkin’s lymphoma, NHL). Spatial distribution of childhood cancer cases has been under concern with the aim of identifying potential risk factors. Objective The two objectives are to study overall spatial clustering and cluster detection of cases of the three main childhood cancer causes, looking to increase etiological knowledge. Methods We ran a case-control study. The cases were children aged 0 to 14 diagnosed with leukemia, lymphomas (HL and NHL) or CNS neoplasm in five Spanish regions for the period 1996-2011. As a control group, we used a sample from the Birth Registry matching every case by year of birth, autonomous region of residence and sex with six controls. We geocoded and validated the address of the cases and controls. For our two objectives we used two different methodologies. For the first, for overall spatial clustering detection, we used the differences of K functions from the spatial point patterns perspective proposed by Diggle and Chetwynd and the second, for cluster detection, we used the spatial scan statistic proposed by Kulldorff with a level for statistical significance of 0.05. Results We had 1062 cases of leukemia, 714 cases of CNS, 92 of HL and 246 of NHL. Accordingly we had 6 times the number of controls, 6372 controls for leukemia, 4284 controls for CNS, 552 controls for HL and 1476 controls for NHL. We found variations in the estimated empirical D(s) for the different regions and cancers, including some overall spatial clustering for specific regions and distances. We did not find statistically significant clusters. Conclusions The variations in the estimated empirical D(s) for the different regions and cancers could be partially explained by the differences in the spatial distribution of the population; however, according to the literature, we cannot discard environmental hazards or infections agents in the etiology of these cancers.
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Affiliation(s)
- Rebeca Ramis
- Environmental Epidemiology and Cancer Unit, National Centre for Epidemiology, Instituto de Salud Carlos III - ISCIII, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
- * E-mail:
| | - Diana Gómez-Barroso
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
| | - Ibon Tamayo
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, BIODonostia Research Institute, Department of Health of the regional Government of the Basque Country, Donostia, Spain
| | - Javier García-Pérez
- Environmental Epidemiology and Cancer Unit, National Centre for Epidemiology, Instituto de Salud Carlos III - ISCIII, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
| | - Antonio Morales
- Rare Disease Research Institute (Instituto de Investigación de Enfermedades Raras-IIER), Instituto de Salud Carlos III - ISCIII, Madrid, Spain
- Consortium for Biomedical Research in Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras-CIBERER), Madrid, Spain
| | - Elena Pardo Romaguera
- Registro Español de Tumores Infantiles (RETI-SEHOP), Universidad de Valencia, Valencia, Spain
| | - Gonzalo López-Abente
- Environmental Epidemiology and Cancer Unit, National Centre for Epidemiology, Instituto de Salud Carlos III - ISCIII, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
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Ernst SA, Günther K, Frambach T, Zeeb H. Prenatal recruitment of participants for a birth cohort study including cord blood collection: results of a feasibility study in Bremen, Germany. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2015; 13:Doc04. [PMID: 25908931 PMCID: PMC4397994 DOI: 10.3205/000208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 04/07/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prospective birth cohort studies comprising follow up of children from pregnancy or birth over a long period of time, and collecting various biological samples at different times through the life-course offer a promising approach to enhance etiologic knowledge of various diseases. Especially for those where early lifetime exposures and conditions are thought to play an important role. The collection and storage of biological samples is a critical component in epidemiological studies, notably for research regarding prenatal exposures to various environmental factors as well as for DNA extraction. Our feasibility study for a birth cohort within the scope of etiology of childhood leukemia with prospective sampling of mothers and their future newborns aimed to investigate the willingness of pregnant women to participate in a birth cohort study involving collection of blood and umbilical cord blood samples. The overall aim was to develop practice-based research recommendations for a possible German birth cohort study. METHODS The study was conducted in Bremen, Germany, between January 2012 and March 2013. Pregnant women were eligible for recruitment if (i) their expected date of delivery was during the study recruitment phase (September 2012-February 2013), (ii) they planned to give birth at the cooperating hospital's obstetric unit and (iii) their knowledge of the German language was sufficient to understand study materials, details of participation and to fill out the prenatal self-administered questionnaire. Maternal blood and umbilical cord blood samples to be used for later research activities were collected and stored at a stem cell bank already collaborating with the hospital. 22 primary care gynecologists were invited to enroll pregnant women for the study and cooperation with one hospital was established. Expectant women were recruited during the last trimester of pregnancy, either during one of their prenatal care visits at their primary care gynecologist or later on in hospital by the attending obstetricians or project staff. RESULTS Of the 22 invited primary care gynecologists requested to enroll pregnant women for the study, 8 gynecologists actually collaborated. A total of 200 eligible women were invited to participate in the study, 48 (24%) of whom agreed. 34 women were enrolled by primary care gynecologists, with one gynecologist enrolling 26 women. Twelve of 14 women recruited via hospitals were enrolled by study staff. A total of 41 women consented to the collection of umbilical cord blood and maternal blood samples, and samples could be stored for 54% of them. Reason for non-participation were the uncertainty whether or not the full study would be conducted and the fact that the participants were not willing to decide for their children whether or not genetic information (cord blood) can be stored for research purposes. CONCLUSION Enrolling parents in a birth cohort study that includes biosampling is a challenge, but participation can be improved through close collaboration with primary care gynecologists and maternity hospitals. Cord blood collection may impede participation, especially when maternity hospitals offer an alternative option for cord blood donation.
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Affiliation(s)
| | - Kathrin Günther
- Leibniz-Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | | | - Hajo Zeeb
- Leibniz-Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
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49
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Kerr JR, Mattey DL. The role of parvovirus B19 and the immune response in the pathogenesis of acute leukemia. Rev Med Virol 2015; 25:133-55. [DOI: 10.1002/rmv.1830] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Jonathan R. Kerr
- Escuela de Medicina y Ciencias de la Salud; Universidad del Rosario; Bogotá D.C. Colombia
| | - Derek L. Mattey
- Staffordshire Rheumatology Centre and University of Keele; Haywood Hospital; Stoke on Trent United Kingdom
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50
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Crump C, Sundquist J, Sieh W, Winkleby MA, Sundquist K. Perinatal and familial risk factors for acute lymphoblastic leukemia in a Swedish national cohort. Cancer 2014; 121:1040-7. [PMID: 25417823 DOI: 10.1002/cncr.29172] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/08/2014] [Accepted: 11/10/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Perinatal factors including high birth weight have been found to be associated with acute lymphoblastic leukemia (ALL) in case-control studies. However, to the best of our knowledge, these findings have seldom been examined in large population-based cohort studies, and the specific contributions of gestational age and fetal growth remain unknown. METHODS The authors conducted a national cohort study of 3,569,333 individuals without Down syndrome who were born in Sweden between 1973 and 2008 and followed for the incidence of ALL through 2010 (maximum age, 38 years) to examine perinatal and familial risk factors. RESULTS There were 1960 ALL cases with 69.7 million person-years of follow-up. After adjusting for potential confounders, risk factors for ALL included high fetal growth (incidence rate ratio [IRR] per additional 1 standard deviation, 1.07; 95% confidence interval [95% CI], 1.02-1.11 [P =.002]; and IRR for large vs appropriate for gestational age, 1.22; 95% CI, 1.06-1.40 [P =.005]), first-degree family history of ALL (IRR, 7.41; 95% CI, 4.60-11.95 [P<.001]), male sex (IRR, 1.20; 95% CI, 1.10-1.31 [P<.001]), and parental country of birth (IRR for both parents born in Sweden vs other countries, 1.13; 95% CI, 1.00-1.27 [P =.045]). These risk factors did not appear to vary by patient age at the time of diagnosis of ALL. Gestational age at birth, season of birth, birth order, multiple birth, parental age, and parental education level were not found to be associated with ALL. CONCLUSIONS In this large cohort study, high fetal growth was found to be associated with an increased risk of ALL in childhood through young adulthood, independent of gestational age at birth, suggesting that growth factor pathways may play an important long-term role in the etiology of ALL.
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Affiliation(s)
- Casey Crump
- Department of Medicine, Stanford University, Stanford, California
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