Pediatric cancer rates after universal folic acid flour fortification in Ontario.
Following the introduction of mandatory Canadian folic acid flour fortification in mid-1997, the incidence of selected childhood cancers that declined in Ontario prior to and subsequent to this public policy initiative was examined. A population-based cohort study of all incident cases of childhood malignancy in Ontario between the years 1985 and 2006 was conducted. Participants were identified from a database provided by the Pediatric Oncology Group of Ontario and included children 0 to 4 years of age and 5 to 9 years of age who were diagnosed with cancer. Among children aged 0 to 4 years, the incidence rate of Wilms' tumor declined from 1.94 to 1.43 per 100,000 (incidence rate ratio 0.74, 95% confidence interval, 0.57-0.95). No significant change was seen in the prefortification vs postfortification time periods for acute lymphoblastic leukemia, brain cancers, or embryonal cancers among the 0- to 4-year or 5- to 9-year age groups. There was an approximately 30% reduction in risk of Wilms' tumor following introduction of the initiative. This corroborates a recent case-control study from Germany. These data may also provide some reassurance that universal flour fortification does not heighten the risk of pediatric cancer.
Grupp
Sandy G
SG
Institute of Medical Science, University of Toronto, Hospital for Sick Children, Toronto, Canada.
Greenberg
Mark L
ML
Ray
Joel G
JG
Busto
Usoa
U
Lanctôt
Krista L
KL
Nulman
Irena
I
Koren
Gideon
G
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005492:Folic Acid / Q000008:administration & dosage* / Q000494:pharmacology; D005527:Food, Fortified; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000235:genetics / Q000517:prevention & control; D009369:Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D009864:Ontario / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D009396:Wilms Tumor / Q000453:epidemiology / Q000517:prevention & control
D005492:Folic Acid