title: Childhood Leukemia: A Preventable Disease.
abstract: In contrast to most pediatric cancers, there is a growing body of literature, nationally and internationally, that has implicated the role of several environmental indoor and outdoor hazards in the etiology of childhood leukemia. For example, exposures to solvents, traffic, pesticides, and tobacco smoke have consistently demonstrated positive associations with the risk of developing childhood leukemia. Intake of vitamins and folate supplementation during the preconception period or pregnancy has been demonstrated to have a protective effect. Despite the strength of these findings, the dissemination of this knowledge to clinicians has been limited. Some children may be more vulnerable than others as documented by the high and increasing incidence of childhood leukemia in Hispanics. To protect children's health, it is prudent to establish programs to alter exposure to those factors with well-established associations with leukemia risk rather than to suspend judgment until no uncertainty remains. This is particularly true because other serious health outcomes (both negative and positive) have been associated with the same exposures. We draw from historical examples to put in perspective the arguments of association versus causation, as well as to discuss benefits versus risks of immediate and long-term preventive actions.
authors.affiliation: School of Public Health, University of California, Berkeley, Berkeley, California; cmetayer@berkeley.edu.
authors.forename: Catherine
authors.initials: C
authors.lastname: Metayer
authors.affiliation: School of Medicine, Stanford University, Stanford, California; and.
authors.forename: Gary
authors.initials: G
authors.lastname: Dahl
authors.affiliation: Department of Epidemiology and Biostatistics, and.
authors.forename: Joe
authors.initials: J
authors.lastname: Wiemels
authors.affiliation: Western States Pediatric Environmental Health Specialty Unit, University of California, San Francisco, San Francisco, California.
authors.forename: Mark
authors.initials: M
authors.lastname: Miller
mesh_terms: D000397:Air Pollution / Q000009:adverse effects*; D001942:Breast Feeding; D002648:Child; D004781:Environmental Exposure / Q000009:adverse effects / Q000517:prevention & control; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000209:etiology / Q000517:prevention & control*; D010575:Pesticides / Q000009:adverse effects*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D012307:Risk Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects
chemical_list: D010575:Pesticides; D014028:Tobacco Smoke Pollution; D005492:Folic Acid