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Paltiel O, Lemeshow S, Phillips GS, Tikellis G, Linet MS, Ponsonby AL, Magnus P, Håberg SE, Olsen SF, Granström C, Klebanoff M, Golding J, Herceg Z, Ghantous A, Hirst JE, Borkhardt A, Ward MH, Holst Søegaard S, Dwyer T. The association between birth order and childhood leukemia may be modified by paternal age and birth weight. Pooled results from the International Childhood Cancer Cohort Consortium (I4C). Int J Cancer 2019; 144:26-33. [PMID: 30098208 DOI: 10.1002/ijc.31635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 04/12/2018] [Accepted: 04/27/2018] [Indexed: 01/14/2023]
Abstract
The "delayed infection hypothesis" states that a paucity of infections in early childhood may lead to higher risks of childhood leukemia (CL), especially acute lymphoblastic leukemia (ALL). Using prospectively collected data from six population-based birth cohorts we studied the association between birth order (a proxy for pathogen exposure) and CL. We explored whether other birth or parental characteristics modify this association. With 2.2 × 106 person-years of follow-up, 185 CL and 136 ALL cases were ascertained. In Cox proportional hazards models, increasing birth order (continuous) was inversely associated with CL and ALL; hazard ratios (HR) = 0.88, 95% confidence interval (CI): (0.77-0.99) and 0.85: (0.73-0.99), respectively. Being later-born was associated with similarly reduced hazards of CL and ALL compared to being first-born; HRs = 0.78: 95% CI: 0.58-1.05 and 0.73: 0.52-1.03, respectively. Successive birth orders were associated with decreased CL and ALL risks (P for trend 0.047 and 0.055, respectively). Multivariable adjustment somewhat attenuated the associations. We found statistically significant and borderline interactions between birth weight (p = 0.024) and paternal age (p = 0.067), respectively, in associations between being later-born and CL, with the lowest risk observed for children born at <3 kg with fathers aged 35+ (HR = 0.18, 95% CI: 0.06-0.50). Our study strengthens the theory that increasing birth order confers protection against CL and ALL risks, but suggests that this association may be modified among subsets of children with different characteristics, notably advanced paternal age and lower birth weight. It is unclear whether these findings can be explained solely by infectious exposures.
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Affiliation(s)
- Ora Paltiel
- Braun School of Public Health and Community Medicine and Department of Hematology, Hadassah-Hebrew University, Jerusalem, Israel
| | - Stanley Lemeshow
- College of Public Health, The Ohio State University, Columbus, OH
| | - Gary S Phillips
- Statistical consultant, Department of Biomedical Informatics, The Ohio State University, Center for Biostatistics, Retired
| | - Gabriella Tikellis
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, Royal Childrens Hospital, University of Melbourne, Melbourne, Australia
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Sjurdur F Olsen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Charlotta Granström
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Mark Klebanoff
- The Research Institute at Nationwide Children's Hospital, Departments of Pediatrics, Obstetrics and Gynecology, and Epidemiology, The Ohio State University, Columbus, OH
| | - Jean Golding
- Centre for Child and Adolescent Health, University of Bristol, Bristol, United Kingdom
| | - Zdenko Herceg
- Epigenetics Group, International Agency for Research on Cancer, Lyon, France
| | - Akram Ghantous
- Epigenetics Group, International Agency for Research on Cancer, Lyon, France
| | - Jane Elizabeth Hirst
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, Oxford, United Kingdom
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Mary H Ward
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Signe Holst Søegaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Terence Dwyer
- The George Institute for Global Health, Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
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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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Li J, Vestergaard M, Obel C, Cnattingus S, Gissler M, Ahrensberg J, Olsen J. Antenatal maternal bereavement and childhood cancer in the offspring: a population-based cohort study in 6 million children. Br J Cancer 2012; 107:544-8. [PMID: 22759879 PMCID: PMC3405225 DOI: 10.1038/bjc.2012.288] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Prenatal stress may increase the susceptibility to childhood cancer by affecting immune responses and hormonal balance. We examined whether antenatal stress following maternal bereavement increased the risk of childhood cancer. Methods: All children born in Denmark from 1968 to 2007 (N=2 743 560) and in Sweden from 1973 to 2006 (N=3 400 212) were included in this study. We compared cancer risks in children born to women who lost a first-degree relative (a child, spouse, a parent, or a sibling) the year before pregnancy or during pregnancy with cancer risks in children of women who did not experience such bereavement. Results: A total of 9795 childhood cancer cases were observed during follow-up of 68 360 707 person years. Children born to women who lost a child or a spouse, but not those who lost other relatives, had an average 30% increased risk of any cancer (hazard ratio (HR) 1.30, 95% confidence interval (CI) 0.96–1.77). The HRs were the highest for non-Hodgkin disease (512 cases in total, HR 3.40, 95% CI 1.51–7.65), hepatic cancer (125 cases in total, HR 5.51, 95% CI 1.34–22.64), and testicular cancer (86 cases in total, HR 8.52, 95% CI 2.03–37.73). Conclusion: Our data suggest that severe antenatal stress following maternal bereavement, especially due to loss of a child or a spouse, is associated with an increased risk of certain childhood cancers in the offspring, such as hepatic cancer and non-Hodgkin disease, but not with childhood cancer in general.
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Affiliation(s)
- J Li
- Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Alle 2, DK 8000 Aarhus C, Denmark.
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Li J, Cnattingus S, Gissler M, Vestergaard M, Obel C, Ahrensberg J, Olsen J. The 5-minute Apgar score as a predictor of childhood cancer: a population-based cohort study in five million children. BMJ Open 2012; 2:bmjopen-2012-001095. [PMID: 22874628 PMCID: PMC3425910 DOI: 10.1136/bmjopen-2012-001095] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The aetiology of childhood cancer remains largely unknown but recent research indicates that uterine environment plays an important role. We aimed to examine the association between the Apgar score at 5 min after birth and the risk of childhood cancer. DESIGN Nationwide population-based cohort study. SETTING Nationwide register data in Denmark and Sweden. STUDY POPULATION All live-born singletons born in Denmark from 1978 to 2006 (N=1 771 615) and in Sweden from 1973 to 2006 (N=3 319 573). Children were followed up from birth to 14 years of age. MAIN OUTCOME MEASURES Rates and HRs for all childhood cancers and for specific childhood cancers. RESULTS A total of 8087 children received a cancer diagnosis (1.6 per 1000). Compared to children with a 5-min Apgar score of 9-10, children with a score of 0-5 had a 46% higher risk of cancer (adjusted HR 1.46, 95% CI 1.15 to 1.89). The potential effect of low Apgar score on overall cancer risk was mostly confined to children diagnosed before 6 months of age. Children with an Apgar score of 0-5 had higher risks for several specific childhood cancers including Wilms' tumour (HR 4.33, 95% CI 2.42 to 7.73). CONCLUSIONS A low 5 min Apgar score was associated with a higher risk of childhood cancers diagnosed shortly after birth. Our data suggest that environmental factors operating before or during delivery may play a role on the development of several specific childhood cancers.
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Affiliation(s)
- Jiong Li
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Sven Cnattingus
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland/Nordic School of Public Health, Gothenburg, Sweden
| | - Mogens Vestergaard
- Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Carsten Obel
- Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Program for Mental Child Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jette Ahrensberg
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, USA
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Spycher BD, Feller M, Zwahlen M, Röösli M, von der Weid NX, Hengartner H, Egger M, Kuehni CE. Childhood cancer and nuclear power plants in Switzerland: a census-based cohort study. Int J Epidemiol 2011; 40:1247-60. [PMID: 21750009 PMCID: PMC3204210 DOI: 10.1093/ije/dyr115] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies on childhood cancer and nuclear power plants (NPPs) produced conflicting results. We used a cohort approach to examine whether residence near NPPs was associated with leukaemia or any childhood cancer in Switzerland. METHODS We computed person-years at risk for children aged 0-15 years born in Switzerland from 1985 to 2009, based on the Swiss censuses 1990 and 2000 and identified cancer cases from the Swiss Childhood Cancer Registry. We geo-coded place of residence at birth and calculated incidence rate ratios (IRRs) with 95% confidence intervals (CIs) comparing the risk of cancer in children born <5 km, 5-10 km and 10-15 km from the nearest NPP with children born >15 km away, using Poisson regression models. RESULTS We included 2925 children diagnosed with cancer during 21 117 524 person-years of follow-up; 953 (32.6%) had leukaemia. Eight and 12 children diagnosed with leukaemia at ages 0-4 and 0-15 years, and 18 and 31 children diagnosed with any cancer were born <5 km from a NPP. Compared with children born >15 km away, the IRRs (95% CI) for leukaemia in 0-4 and 0-15 year olds were 1.20 (0.60-2.41) and 1.05 (0.60-1.86), respectively. For any cancer, corresponding IRRs were 0.97 (0.61-1.54) and 0.89 (0.63-1.27). There was no evidence of a dose-response relationship with distance (P > 0.30). Results were similar for residence at diagnosis and at birth, and when adjusted for potential confounders. Results from sensitivity analyses were consistent with main results. CONCLUSIONS This nationwide cohort study found little evidence of an association between residence near NPPs and the risk of leukaemia or any childhood cancer.
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Affiliation(s)
- Ben D Spycher
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Martin Feller
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Marcel Zwahlen
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Martin Röösli
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Nicolas X von der Weid
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Heinz Hengartner
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Matthias Egger
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Claudia E Kuehni
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
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McNally RJQ. Are early infectious exposures involved in the etiology of childhood CNS tumors? Expert Rev Neurother 2010; 10:1663-1665. [DOI: 10.1586/ern.10.157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Early life patterns of common infection: a latent class analysis. Eur J Epidemiol 2010; 25:875-83. [PMID: 20976529 PMCID: PMC3898516 DOI: 10.1007/s10654-010-9518-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 10/12/2010] [Indexed: 01/07/2023]
Abstract
Early life infection has been implicated in the aetiology of many chronic diseases, most often through proxy measures. Data on ten infectious symptoms were collected by parental questionnaire when children were 6 months old as part of the Avon Longitudinal Study of Parents and Children, United Kingdom. A latent class analysis was used to identify patterns of infection and their relationship to five factors commonly used as proxies: sex, other children in the home, maternal smoking, breastfeeding and maternal education. A total of 10,032 singleton children were included in the analysis. Five classes were identified with differing infectious disease patterns and children were assigned to the class for which they had a highest probability of membership based on their infectious symptom profile: ‘general infection’ (n = 1,252, 12.5%), ‘gastrointestinal’ (n = 1,902, 19.0%), ‘mild respiratory’ (n = 3,560, 35.5%), ‘colds/ear ache’ (n = 462, 4.6%) and ‘healthy’ (n = 2,856, 28.5%). Females had a reduced risk of being in all infectious classes, other children in the home were associated with an increased risk of being in the ‘general infection’, ‘mild respiratory’ or ‘colds/ear ache’ class. Breastfeeding reduced the risk of being in the ‘general infection’ and ‘gastrointestinal’ classes whereas maternal smoking increased the risk of membership. Higher maternal education was associated with an increased risk of being in the ‘mild respiratory’ group. Other children in the home had the greatest association with infectious class membership. Latent class analysis provided a flexible method of investigating the relationship between multiple symptoms and demographic and lifestyle factors.
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Von Behren J, Spector LG, Mueller BA, Carozza SE, Chow EJ, Fox EE, Horel S, Johnson KJ, McLaughlin C, Puumala SE, Ross JA, Reynolds P. Birth order and risk of childhood cancer: a pooled analysis from five US States. Int J Cancer 2010; 128:2709-16. [PMID: 20715170 DOI: 10.1002/ijc.25593] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 07/09/2010] [Indexed: 11/08/2022]
Abstract
The causes of childhood cancers are largely unknown. Birth order has been used as a proxy for prenatal and postnatal exposures, such as frequency of infections and in utero hormone exposures. We investigated the association between birth order and childhood cancers in a pooled case-control dataset. The subjects were drawn from population-based registries of cancers and births in California, Minnesota, New York, Texas and Washington. We included 17,672 cases <15 years of age who were diagnosed from 1980 to 2004 and 57,966 randomly selected controls born 1970-2004, excluding children with Down syndrome. We calculated odds ratios and 95% confidence intervals using logistic regression, adjusted for sex, birth year, maternal race, maternal age, multiple birth, gestational age and birth weight. Overall, we found an inverse relationship between childhood cancer risk and birth order. For children in the fourth or higher birth order category compared to first-born children, the adjusted OR was 0.87 (95% CI: 0.81, 0.93) for all cancers combined. When we examined risks by cancer type, a decreasing risk with increasing birth order was seen in the central nervous system tumors, neuroblastoma, bilateral retinoblastoma, Wilms tumor and rhabdomyosarcoma. We observed increased risks with increasing birth order for acute myeloid leukemia but a slight decrease in risk for acute lymphoid leukemia. These risk estimates were based on a very large sample size, which allowed us to examine rare cancer types with greater statistical power than in most previous studies, however the biologic mechanisms remain to be elucidated.
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Affiliation(s)
- Julie Von Behren
- Cancer Prevention Institute of California, Berkeley, CA 94704, USA.
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Schmidt LS, Kamper-Jørgensen M, Schmiegelow K, Johansen C, Lähteenmäki P, Träger C, Stokland T, Grell K, Gustafson G, Kogner P, Sehested A, Schüz J. Infectious exposure in the first years of life and risk of central nervous system tumours in children: analysis of birth order, childcare attendance and seasonality of birth. Br J Cancer 2010; 102:1670-5. [PMID: 20461079 PMCID: PMC2883153 DOI: 10.1038/sj.bjc.6605679] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: An infective, mostly viral basis has been found in different human cancers. To test the hypothesis of a possible infectious aetiology for central nervous system (CNS) tumours in children, we investigated the associations with proxy measures of exposure to infectious disease. Methods: In a large case–control study nested in the populations of Denmark, Norway, Sweden, and Finland of 4.4 million children, we studied the association of birth order and seasonal variation of birth with subsequent risk for CNS tumours. We identified 3983 children from the national cancer registries, and information on exposure was obtained from the high-quality national administrative health registries. We investigated the association between childcare attendance during the first 2 years of life and the risk for CNS tumours in a subset of Danish children with CNS tumours, using information from the Danish Childcare database. Results: We observed no association between birth order and risk of CNS tumours overall (odds ratio (OR) for second born or later born vs first born, 1.03; 95% confidence interval (CI), 0.96–1.10) or by histological subgroup, and children with CNS tumours did not show a seasonal variation of birth that was distinct from that of the background population. Childcare attendance compared with homecare showed a slightly increased OR (1.29; 95% CI, 0.90–1.86) for CNS tumours, with the highest risk observed in children attending a crèche. The strongest association was observed for embryonal CNS tumours. We found no effect of age at enrolment or duration of enrolment in childcare. Conclusion: These results do not support the hypothesis that the burden of exposure to infectious disease in early childhood has an important role in the aetiology of paediatric CNS tumours.
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Affiliation(s)
- L S Schmidt
- Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
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Cancer incidence in the vicinity of Finnish nuclear power plants: an emphasis on childhood leukemia. Cancer Causes Control 2009; 21:587-95. [PMID: 20037792 PMCID: PMC2839478 DOI: 10.1007/s10552-009-9488-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 12/05/2009] [Indexed: 11/05/2022]
Abstract
The objective of this paper was to study cancer incidence, especially leukemia in children (<15 years), in the vicinity of Finnish nuclear power plants (NPPs). We used three different approaches: ecological analysis at municipality level, residential cohorts defined from census data, and case–control analysis with individual residential histories. The standardized incidence ratio of childhood leukemia for the seven municipalities in the vicinity of NPPs was 1.0 (95% CI 0.6, 1.6) compared to the rest of Finland. The two cohorts defined by censuses of 1980 and 1990 gave rate ratios of 1.0 (95% CI 0.3, 2.6) and 0.9 (95% CI 0.2, 2.7), respectively, for childhood leukemia in the population residing within 15 km from the NPPs compared to the 15–50 km zone. The case–control analysis with 16 cases of childhood leukemia and 64 matched population-based controls gave an odds ratio for average distance between residence and NPP in the closest 5–9.9 km zone of 0.7 (95% CI 0.1, 10.4) compared to ≥30 km zone. Our results do not indicate an increase in childhood leukemia and other cancers in the vicinity of Finnish NPPs though the small sample size limits the strength of conclusions. The conclusion was the same for adults.
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