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Nethery RC, Vega S, Frazier AL, Laden F. Mobile Source Benzene Regulations and Risk of Childhood and Young Adult Hematologic Cancers in Alaska: A Quasi-experimental Study. Epidemiology 2023; 34:385-388. [PMID: 36715968 PMCID: PMC10074683 DOI: 10.1097/ede.0000000000001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND We aimed to evaluate the impact of the EPA's Mobile Source Air Toxics rules (MSAT), which targeted benzene emissions, on childhood and young adult leukemia and lymphoma incidence in Alaska. METHODS MSAT was implemented in 2011 and produced a dramatic decline in ambient benzene in Alaska. Due to previous benzene-related regulations enacted in the continental United States, MSAT had relatively modest impacts in other states. This created quasi-experimental conditions leveraged in this study. Using 2-year state-level incidence rates of childhood and young adult leukemia and lymphoma for each US state 2001-2018, we examined MSAT-attributable changes in incidence by applying a difference-in-differences approach. RESULTS We found evidence of a substantial reduction associated with MSAT in incidence of childhood and young adult lymphoma (-1.23 [-1.84, -0.62] cases per 100,000), but not in leukemia (-0.13 [-0.77, 0.51] cases per 100,000). CONCLUSIONS Our findings are consistent with the hypothesis that MSAT, which reduced benzene levels in Alaska, led to a decline in lymphoma incidence in children and young adults.
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Affiliation(s)
- Rachel C Nethery
- From the Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sofia Vega
- From the Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - A Lindsay Frazier
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | - Francine Laden
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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Onyije FM, Olsson A, Baaken D, Erdmann F, Stanulla M, Wollschläger D, Schüz J. Environmental Risk Factors for Childhood Acute Lymphoblastic Leukemia: An Umbrella Review. Cancers (Basel) 2022; 14:382. [PMID: 35053543 PMCID: PMC8773598 DOI: 10.3390/cancers14020382] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 02/05/2023] Open
Abstract
Leukemia is the most common type of cancer among children and adolescents worldwide. The aim of this umbrella review was (1) to provide a synthesis of the environmental risk factors for the onset of childhood acute lymphoblastic leukemia (ALL) by exposure window, (2) evaluate their strength of evidence and magnitude of risk, and as an example (3) estimate the prevalence in the German population, which determines the relevance at the population level. Relevant systematic reviews and pooled analyses were identified and retrieved through PubMed, Web of Science databases and lists of references. Only two risk factors (low doses of ionizing radiation in early childhood and general pesticide exposure during maternal preconception/pregnancy) were convincingly associated with childhood ALL. Other risk factors including extremely low frequency electromagnetic field (ELF-MF), living in proximity to nuclear facilities, petroleum, benzene, solvent, and domestic paint exposure during early childhood, all showed some level of evidence of association. Maternal consumption of coffee (high consumption/>2 cups/day) and cola (high consumption) during pregnancy, paternal smoking during the pregnancy of the index child, maternal intake of fertility treatment, high birth weight (≥4000 g) and caesarean delivery were also found to have some level of evidence of association. Maternal folic acid and vitamins intake, breastfeeding (≥6 months) and day-care attendance, were inversely associated with childhood ALL with some evidence. The results of this umbrella review should be interpreted with caution; as the evidence stems almost exclusively from case-control studies, where selection and recall bias are potential concerns, and whether the empirically observed association reflect causal relationships remains an open question. Hence, improved exposure assessment methods including accurate and reliable measurement, probing questions and better interview techniques are required to establish causative risk factors of childhood leukemia, which is needed for the ultimate goal of primary prevention.
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Affiliation(s)
- Felix M. Onyije
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (A.O.); (F.E.); (J.S.)
| | - Ann Olsson
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (A.O.); (F.E.); (J.S.)
| | - Dan Baaken
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany; (D.B.); (D.W.)
| | - Friederike Erdmann
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (A.O.); (F.E.); (J.S.)
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany; (D.B.); (D.W.)
| | - Martin Stanulla
- Pediatric Hematology and Oncology, Hannover Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany;
| | - Daniel Wollschläger
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany; (D.B.); (D.W.)
| | - Joachim Schüz
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (A.O.); (F.E.); (J.S.)
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Lavigne E, Lima I, Hatzopoulou M, Van Ryswyk K, van Donkelaar A, Martin RV, Chen H, Stieb DM, Crighton E, Burnett RT, Weichenthal S. Ambient ultrafine particle concentrations and incidence of childhood cancers. ENVIRONMENT INTERNATIONAL 2020; 145:106135. [PMID: 32979813 DOI: 10.1016/j.envint.2020.106135] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ambient air pollution has been associated with childhood cancer. However, little is known about the possible impact of ambient ultrafine particles (<0.1 μm) (UFPs) on childhood cancer incidence. OBJECTIVE This study aimed to evaluate the association between prenatal and childhood exposure to UFPs and development of childhood cancer. METHODS We conducted a population-based cohort study of within-city spatiotemporal variations in ambient UFPs across the City of Toronto, Canada using 653,702 singleton live births occurring between April 1, 1998 and March 31, 2017. Incident cases of 13 subtypes of paediatric cancers among children up to age 14 were ascertained using a cancer registry. Associations between ambient air pollutant concentrations and childhood cancer incidence were estimated using random-effects Cox proportional hazards models. We investigated both single- and multi-pollutant models accounting for co-exposures to PM2.5 and NO2. RESULTS A total of 1,066 childhood cancers were identified. We found that first trimester exposure to UFPs (Hazard Ratio (HR) per 10,000/cm3 increase = 1.13, 95% CI: 1.03-1.22) was associated with overall cancer incidence diagnosed before 6 years of age after adjusting for PM2.5, NO2, and for personal and neighborhood-level covariates. Association between UFPs and overall cancer incidence exhibited a linear shape. No statistically significant associations were found for specific cancer subtypes. CONCLUSION Ambient UFPs may represent a previously unrecognized risk factor in the aetiology of cancers in children. Our findings reinforce the importance of conducting further research on the effects of UFPs given their high prevalence of exposure in urban areas.
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Affiliation(s)
- Eric Lavigne
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - Isac Lima
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marianne Hatzopoulou
- Department of Civil Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Keith Van Ryswyk
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada; Harvard-Smithsonian Centre for Astrophysics, Cambridge, MA, USA; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada; Harvard-Smithsonian Centre for Astrophysics, Cambridge, MA, USA; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Hong Chen
- Population Studies Division, Health Canada, Ottawa, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - David M Stieb
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Population Studies Division, Health Canada, Vancouver, British Columbia, Canada
| | - Eric Crighton
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard T Burnett
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Population Studies Division, Health Canada, Ottawa, Ontario, Canada
| | - Scott Weichenthal
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Turner MC, Andersen ZJ, Baccarelli A, Diver WR, Gapstur SM, Pope CA, Prada D, Samet J, Thurston G, Cohen A. Outdoor air pollution and cancer: An overview of the current evidence and public health recommendations. CA Cancer J Clin 2020; 70:10.3322/caac.21632. [PMID: 32964460 PMCID: PMC7904962 DOI: 10.3322/caac.21632] [Citation(s) in RCA: 267] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/24/2022] Open
Abstract
Outdoor air pollution is a major contributor to the burden of disease worldwide. Most of the global population resides in places where air pollution levels, because of emissions from industry, power generation, transportation, and domestic burning, considerably exceed the World Health Organization's health-based air-quality guidelines. Outdoor air pollution poses an urgent worldwide public health challenge because it is ubiquitous and has numerous serious adverse human health effects, including cancer. Currently, there is substantial evidence from studies of humans and experimental animals as well as mechanistic evidence to support a causal link between outdoor (ambient) air pollution, and especially particulate matter (PM) in outdoor air, with lung cancer incidence and mortality. It is estimated that hundreds of thousands of lung cancer deaths annually worldwide are attributable to PM air pollution. Epidemiological evidence on outdoor air pollution and the risk of other types of cancer, such as bladder cancer or breast cancer, is more limited. Outdoor air pollution may also be associated with poorer cancer survival, although further research is needed. This report presents an overview of outdoor air pollutants, sources, and global levels, as well as a description of epidemiological evidence linking outdoor air pollution with cancer incidence and mortality. Biological mechanisms of air pollution-derived carcinogenesis are also described. This report concludes by summarizing public health/policy recommendations, including multilevel interventions aimed at individual, community, and regional scales. Specific roles for medical and health care communities with regard to prevention and advocacy and recommendations for further research are also described.
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Affiliation(s)
- Michelle C. Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada
| | - Zorana J. Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Baccarelli
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, United States
| | - W. Ryan Diver
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia, United States
| | - Susan M. Gapstur
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia, United States
| | - C. Arden Pope
- Department of Economics, Brigham Young University, Provo, Utah, United States
| | - Diddier Prada
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, United States
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Jonathan Samet
- Colorado School of Public Health, Aurora, Colorado, United States
| | - George Thurston
- New York University School of Medicine, New York, New York, United States
| | - Aaron Cohen
- Health Effects Institute, Boston, Massachusetts, United States
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States
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Abstract
BACKGROUND Many studies have analyzed the association between traffic-related air pollution and risk of childhood leukemia, but the results are inconsistent. Therefore, we performed this meta-analysis to investigate the association between traffic-related air pollution and risk of childhood leukemia. METHODS PubMed, Cochrane, and Embase databases were searched by the index words to identify eligible case-control studies, and relevant literature sources were also searched. The latest research was performed in September 2017. Odds ratio (OR) along with 95% confidence interval (95% CI) were used to analyzed the main outcomes. RESULTS Twenty-one case-control studies were included in the meta-analysis. The results indicated that in the studies of overall traffic density (OR: 1.01, 95% CI: 0.98-1.04), high traffic density (OR: 1.04, 95% CI: 0.91-1.17), moderate exposure to NO2 (OR: 1.02, 95% CI: 0.93-1.10), and benzene (OR: 1.04, 95% CI: 0.71-1.37), the risks of childhood leukemia incidence were higher in the case group than the control group, but no significant difference was found. In other analysis, no significant difference was observed in the risk of childhood leukemia in the 2 groups. CONCLUSIONS Current evidence suggests that childhood leukemia is associated with traffic density, and moderate exposure to NO2 and benzene. However, more high-quality studies are required to confirm the conclusions.
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Filippini T, Hatch EE, Rothman KJ, Heck JE, Park AS, Crippa A, Orsini N, Vinceti M. Association between Outdoor Air Pollution and Childhood Leukemia: A Systematic Review and Dose-Response Meta-Analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:46002. [PMID: 31017485 PMCID: PMC6785230 DOI: 10.1289/ehp4381] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 05/28/2023]
Abstract
BACKGROUND A causal link between outdoor air pollution and childhood leukemia has been proposed, but some older studies suffer from methodological drawbacks. To the best of our knowledge, no systematic reviews have summarized the most recently published evidence and no analyses have examined the dose-response relation. OBJECTIVE We investigated the extent to which outdoor air pollution, especially as resulting from traffic-related contaminants, affects the risk of childhood leukemia. METHODS We searched all case-control and cohort studies that have investigated the risk of childhood leukemia in relation to exposure either to motorized traffic and related contaminants, based on various traffic-related metrics (number of vehicles in the closest roads, road density, and distance from major roads), or to measured or modeled levels of air contaminants such as benzene, nitrogen dioxide, 1,3-butadiene, and particulate matter. We carried out a meta-analysis of all eligible studies, including nine studies published since the last systematic review and, when possible, we fit a dose-response curve using a restricted cubic spline regression model. RESULTS We found 29 studies eligible to be included in our review. In the dose-response analysis, we found little association between disease risk and traffic indicators near the child's residence for most of the exposure range, with an indication of a possible excess risk only at the highest levels. In contrast, benzene exposure was positively and approximately linearly associated with risk of childhood leukemia, particularly for acute myeloid leukemia, among children under 6 y of age, and when exposure assessment at the time of diagnosis was used. Exposure to nitrogen dioxide showed little association with leukemia risk except at the highest levels. DISCUSSION Overall, the epidemiologic literature appears to support an association between benzene and childhood leukemia risk, with no indication of any threshold effect. A role for other measured and unmeasured pollutants from motorized traffic is also possible. https://doi.org/10.1289/EHP4381.
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Affiliation(s)
- Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elizabeth E. Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kenneth J. Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Julia E. Heck
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Andrew S. Park
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nicola Orsini
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Transplacental exposure to carcinogens and risks to children: evidence from biomarker studies and the utility of omic profiling. Arch Toxicol 2019; 93:833-857. [PMID: 30859261 DOI: 10.1007/s00204-019-02428-3] [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: 12/14/2018] [Accepted: 03/04/2019] [Indexed: 12/12/2022]
Abstract
The factors underlying the increasing rates and the geographic variation of childhood cancers are largely unknown. Epidemiological studies provide limited evidence for a possible role in the etiology of certain types of childhood cancer of the exposure of pregnant women to environmental carcinogens (e.g., tobacco smoke and pesticides); however, such evidence is inadequate to allow definitive conclusions. Complementary evidence can be obtained from biomarker-based population studies. Such studies have demonstrated that, following exposure of pregnant mothers, most environmental carcinogens reach the fetus and, in many cases, induce therein genotoxic damage which in adults is known to be associated with increased cancer risk, implying that environmental carcinogens may contribute to the etiology of childhood cancer. During recent years, intermediate disease biomarkers, obtained via omic profiling, have provided additional insights into the impact of transplacental exposures on fetal tissues which, in some cases, are also compatible with a precarcinogenic role of certain in utero exposures. Here we review the epidemiological and biomarker evidence and discuss how further research, especially utilizing high-density profiling, may allow a better evaluation of the links between in utero environmental exposures and cancer in children.
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Seifi M, Niazi S, Johnson G, Nodehi V, Yunesian M. Exposure to ambient air pollution and risk of childhood cancers: A population-based study in Tehran, Iran. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 646:105-110. [PMID: 30053660 DOI: 10.1016/j.scitotenv.2018.07.219] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/05/2018] [Accepted: 07/16/2018] [Indexed: 05/21/2023]
Abstract
The relationship between air pollution and childhood cancer is inconclusive. We investigated the associations between exposure to ambient air pollution and childhood cancers in Tehran, Iran. This project included children between 1 and 15 years-of-age with a cancer diagnosis by the Center for the Control of Non Communicable Disease (n = 161) during 2007 to 2009. Controls were selected randomly within the city using a Geographic Information System (GIS) (n = 761). The cases were geocoded based on exact home addresses. Air pollution exposure of cases and random controls were estimated by a previously developed Land Use Regression (LUR) model for the 2010 calendar year. The annual mean concentrations of Particulate Matter ≤ 10 μm (PM10), nitrogen dioxide (NO2) and sulfur dioxide (SO2) in the locations of cancer cases were 101.97 μg/m3, 49.42 ppb and 38.92 ppb respectively, while in the random control group, respective mean exposures were 98.63 μg/m3, 45.98 ppb and 38.95 ppb. A logistic regression model was used to find the probability of childhood cancer per unit increase in PM10, NO2 and SO2. We observed a positive association between exposures to PM10 with childhood cancers. We did, however, observe a positive, but not statistically significant association between NO2 exposure and childhood cancer. Our study is the first to highlight an association between air pollution exposure and childhood cancer risk in Iran, however these findings require replication through future studies.
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Affiliation(s)
- Morteza Seifi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadegh Niazi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; International Laboratory for Air Quality and Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Graham Johnson
- International Laboratory for Air Quality and Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Vahideh Nodehi
- Department of geography, Kharazmi University, Tehran, Iran
| | - Masud Yunesian
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran.
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9
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Lavigne É, Bélair MA, Do MT, Stieb DM, Hystad P, van Donkelaar A, Martin RV, Crouse DL, Crighton E, Chen H, Brook JR, Burnett RT, Weichenthal S, Villeneuve PJ, To T, Cakmak S, Johnson M, Yasseen AS, Johnson KC, Ofner M, Xie L, Walker M. Maternal exposure to ambient air pollution and risk of early childhood cancers: A population-based study in Ontario, Canada. ENVIRONMENT INTERNATIONAL 2017; 100:139-147. [PMID: 28108116 DOI: 10.1016/j.envint.2017.01.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/15/2016] [Accepted: 01/06/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND There are increasing concerns regarding the role of exposure to ambient air pollution during pregnancy in the development of early childhood cancers. OBJECTIVE This population based study examined whether prenatal and early life (<1year of age) exposures to ambient air pollutants, including nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters ≤2.5μm (PM2.5), were associated with selected common early childhood cancers in Canada. METHODS 2,350,898 singleton live births occurring between 1988 and 2012 were identified in the province of Ontario, Canada. We assigned temporally varying satellite-derived estimates of PM2.5 and land-use regression model estimates of NO2 to maternal residences during pregnancy. Incident cases of 13 subtypes of pediatric cancers among children up to age 6 until 2013 were ascertained through administrative health data linkages. Associations of trimester-specific, overall pregnancy and first year of life exposures were evaluated using Cox proportional hazards models, adjusting for potential confounders. RESULTS A total of 2044 childhood cancers were identified. Exposure to PM2.5, per interquartile range increase, over the entire pregnancy, and during the first trimester was associated with an increased risk of astrocytoma (hazard ratio (HR) per 3.9μg/m3=1.38 (95% CI: 1.01, 1.88) and, HR per 4.0μg/m3=1.40 (95% CI: 1.05-1.86), respectively). We also found a positive association between first trimester NO2 and acute lymphoblastic leukemia (ALL) (HR=1.20 (95% CI: 1.02-1.41) per IQR (13.3ppb)). CONCLUSIONS In this population-based study in the largest province of Canada, results suggest an association between exposure to ambient air pollution during pregnancy, especially in the first trimester and an increased risk of astrocytoma and ALL. Further studies are required to replicate the findings of this study with adjustment for important individual-level confounders.
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Affiliation(s)
- Éric Lavigne
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | | | - Minh T Do
- Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - David M Stieb
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada; Population Studies Division, Health Canada, Vancouver, British Columbia, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel L Crouse
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Eric Crighton
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, Ontario, Canada
| | - Hong Chen
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jeffrey R Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Air Quality Research Division, Environment Canada, Downsview, Ontario, Canada
| | | | - Scott Weichenthal
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Paul J Villeneuve
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sabit Cakmak
- Population Studies Division, Health Canada, Ottawa, Ontario, Canada
| | - Markey Johnson
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | - Abdool S Yasseen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Better Outcomes Registry and Network Ontario, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kenneth C Johnson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marianna Ofner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Global Health and Guideline Division, Public Health Agency of Canada, Toronto, Ontario, Canada
| | - Lin Xie
- Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Mark Walker
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Better Outcomes Registry and Network Ontario, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
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10
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Carlos-Wallace FM, Zhang L, Smith MT, Rader G, Steinmaus C. Parental, In Utero, and Early-Life Exposure to Benzene and the Risk of Childhood Leukemia: A Meta-Analysis. Am J Epidemiol 2016; 183:1-14. [PMID: 26589707 DOI: 10.1093/aje/kwv120] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 04/27/2015] [Indexed: 02/06/2023] Open
Abstract
Benzene is an established cause of adult leukemia, but whether it is associated with childhood leukemia remains unclear. We conducted a meta-analysis in which we reviewed the epidemiologic literature on this topic and explored causal inference, bias, and heterogeneity. The exposure metrics that we evaluated included occupational and household use of benzenes and solvents, traffic density, and traffic-related air pollution. For studies of occupational and household product exposure published from 1987 to 2014, the summary relative risk for childhood leukemia was 1.96 (95% confidence interval (CI): 1.53, 2.52; n = 20). In these studies, the summary relative risk was higher for acute myeloid leukemia (summary relative risk (sRR) = 2.34, 95% CI: 1.72, 3.18; n = 6) than for acute lymphoblastic leukemia (sRR = 1.57; 95% CI: 1.21, 2.05; n = 14). The summary relative risk was higher for maternal versus paternal exposure, in studies that assessed benzene versus all solvents, and in studies of gestational exposure. In studies of traffic density or traffic-related air pollution published from 1999 to 2014, the summary relative risk was 1.48 (95% CI: 1.10, 1.99; n = 12); it was higher for acute myeloid leukemia (sRR = 2.07; 95% CI: 1.34, 3.20) than for acute lymphoblastic leukemia (sRR = 1.49; 95% CI: 1.07, 2.08) and in studies that involved detailed models of traffic pollution (sRR = 1.70; 95% CI: 1.16, 2.49). Overall, we identified evidence of associations between childhood leukemia and several different potential metrics of benzene exposure.
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García-Pérez J, López-Abente G, Gómez-Barroso D, Morales-Piga A, Romaguera EP, Tamayo I, Fernández-Navarro P, Ramis R. Childhood leukemia and residential proximity to industrial and urban sites. ENVIRONMENTAL RESEARCH 2015; 140:542-53. [PMID: 26025512 DOI: 10.1016/j.envres.2015.05.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/08/2015] [Accepted: 05/13/2015] [Indexed: 05/26/2023]
Abstract
BACKGROUND Few risk factors for the childhood leukemia are well established. While a small fraction of cases of childhood leukemia might be partially attributable to some diseases or ionizing radiation exposure, the role of industrial and urban pollution also needs to be assessed. OBJECTIVES To ascertain the possible effect of residential proximity to both industrial and urban areas on childhood leukemia, taking into account industrial groups and toxic substances released. METHODS We conducted a population-based case-control study of childhood leukemia in Spain, covering 638 incident cases gathered from the Spanish Registry of Childhood Tumors and for those Autonomous Regions with 100% coverage (period 1990-2011), and 13,188 controls, individually matched by year of birth, sex, and autonomous region of residence. Distances were computed from the respective subject's residences to the 1068 industries and the 157 urban areas with ≥10,000 inhabitants, located in the study area. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance to industrial and urban pollution sources were calculated, with adjustment for matching variables. RESULTS Excess risk of childhood leukemia was observed for children living near (≤2.5 km) industries (OR=1.31; 95%CI=1.03-1.67) - particularly glass and mineral fibers (OR=2.42; 95%CI=1.49-3.92), surface treatment using organic solvents (OR=1.87; 95%CI=1.24-2.83), galvanization (OR=1.86; 95%CI=1.07-3.21), production and processing of metals (OR=1.69; 95%CI=1.22-2.34), and surface treatment of metals (OR=1.62; 95%CI=1.22-2.15) - , and urban areas (OR=1.36; 95%CI=1.02-1.80). CONCLUSIONS Our study furnishes some evidence that living in the proximity of industrial and urban sites may be a risk factor for childhood leukemia.
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Affiliation(s)
- Javier García-Pérez
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Gonzalo López-Abente
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Diana Gómez-Barroso
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
| | - Antonio Morales-Piga
- Rare Disease Research Institute (IIER), Carlos III Institute of Health, Madrid, Spain; Consortium for Biomedical Research in Rare Diseases (CIBERER), Madrid, Spain.
| | - Elena Pardo Romaguera
- Spanish Registry of Childhood Tumors (RETI-SEHOP), University of Valencia, Valencia, Spain.
| | - Ibon Tamayo
- Public Health Division of Gipuzkoa, BIODonostia Research Institute, Department of Health of the Regional Government of the Basque Country, Donostia, Spain.
| | - Pablo Fernández-Navarro
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Rebeca Ramis
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
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Filippini T, E. Heck J, Malagoli C, Del Giovane C, Vinceti M. A review and meta-analysis of outdoor air pollution and risk of childhood leukemia. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, ENVIRONMENTAL CARCINOGENESIS & ECOTOXICOLOGY REVIEWS 2015; 33:36-66. [PMID: 25803195 PMCID: PMC4586078 DOI: 10.1080/10590501.2015.1002999] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Leukemia is the most frequent malignant disease affecting children. To date, the etiology of childhood leukemia remains largely unknown. Few risk factors (genetic susceptibility, infections, ionizing radiation, etc.) have been clearly identified, but they appear to explain only a small proportion of cases. Considerably more uncertain is the role of other environmental risk factors, such as indoor and outdoor air pollution. We sought to summarize and quantify the association between traffic-related air pollution and risk of childhood leukemia, and further examined results according to method of exposure assessment, study quality, leukemia subtype, time period, and continent where studies took place. After a literature search yielded 6 ecologic and 20 case-control studies, we scored the studies based on the Newcastle-Ottawa Scale. The studies assessed residential exposure to pollutants from motorized traffic by computing traffic density in the neighboring roads or vicinity to petrol stations, or by using measured or modeled nitrogen dioxide and benzene outdoor air levels. Because heterogeneity across studies was observed, random-effects summary odds ratios (OR) and 95% confidence intervals (CI) were reported. Whenever possible we additionally conducted stratified analyses comparing acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Limiting the analysis to high-quality studies (Newcastle-Ottawa Scale ≥ 7), those using traffic density as the exposure assessment metric showed an increase in childhood leukemia risk in the highest exposure category (OR = 1.07, 95% CI 0.93-1.24). However, we observed evidence of publication bias. Results for NO2 exposure and benzene showed an OR of 1.21 (95% CI 0.97-1.52) and 1.64 (95% CI 0.91-2.95) respectively. When stratifying by leukemia type, the results based upon NO2 were 1.21 (95% CI 1.04-1.41) for ALL and 1.06 (95% CI 0.51-2.21) for AML; based upon benzene were 1.09 (95% CI 0.67-1.77) for ALL and 2.28 (95% CI 1.09-4.75) for AML. Estimates were generally higher for exposures in the postnatal period compared to the prenatal period, and for European studies compared to North American studies. Overall, our results support a link between ambient exposure to traffic pollution and childhood leukemia risk, particularly due to benzene.
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Affiliation(s)
- Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research
Center (CREAGEN), University of Modena and Reggio Emilia, Modena, Italy
- Department of Diagnostic, Clinical, and Public Health Medicine,
University of Modena and Reggio Emilia, Modena, Italy
| | - Julia E. Heck
- Department of Epidemiology, Fielding School of Public Health,
University of California, Los Angeles, California
| | - Carlotta Malagoli
- Environmental, Genetic and Nutritional Epidemiology Research
Center (CREAGEN), University of Modena and Reggio Emilia, Modena, Italy
- Department of Diagnostic, Clinical, and Public Health Medicine,
University of Modena and Reggio Emilia, Modena, Italy
| | - Cinzia Del Giovane
- Department of Diagnostic, Clinical, and Public Health Medicine,
University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research
Center (CREAGEN), University of Modena and Reggio Emilia, Modena, Italy
- Department of Diagnostic, Clinical, and Public Health Medicine,
University of Modena and Reggio Emilia, Modena, Italy
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