title: Childhood Leukemia and Primary Prevention.
abstract: Leukemia is the most common pediatric cancer, affecting 3800 children per year in the United States. Its annual incidence has increased over the last decades, especially among Latinos. Although most children diagnosed with leukemia are now cured, many suffer long-term complications, and primary prevention efforts are urgently needed. The early onset of leukemia-usually before 5 years of age-and the presence at birth of "pre-leukemic" genetic signatures indicate that pre- and postnatal events are critical to the development of the disease. In contrast to most pediatric cancers, there is a growing body of literature-in the United States and internationally-that has implicated several environmental, infectious, and dietary risk factors in the etiology of childhood leukemia, mainly for acute lymphoblastic leukemia, the most common subtype. For example, exposures to pesticides, tobacco smoke, solvents, and traffic emissions have consistently demonstrated positive associations with the risk of developing childhood leukemia. In contrast, intake of vitamins and folate supplementation during the preconception period or pregnancy, breastfeeding, and exposure to routine childhood infections have been shown to reduce the risk of childhood leukemia. Some children may be especially vulnerable to these risk factors, as demonstrated by a disproportionate burden of childhood leukemia in the Latino population of California. The evidence supporting the associations between childhood leukemia and its risk factors-including pooled analyses from around the world and systematic reviews-is strong; however, the dissemination of this knowledge to clinicians has been limited. To protect children's health, it is prudent to initiate programs designed to alter exposure to well-established leukemia risk factors rather than to suspend judgment until no uncertainty remains. Primary prevention programs for childhood leukemia would also result in the significant co-benefits of reductions in other adverse health outcomes that are common in children, such as detriments to neurocognitive development.
authors.affiliation: Department of Epidemiology, School of Public Health, University of California, Berkeley, CA; Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA. Electronic address: toddpwhitehead@berkeley.edu.
authors.forename: Todd P
authors.initials: TP
authors.lastname: Whitehead
authors.affiliation: Department of Epidemiology, School of Public Health, University of California, Berkeley, CA; Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Metayer
authors.affiliation: Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Wiemels
authors.affiliation: Department of Epidemiology, School of Public Health, University of California, Berkeley, CA.
authors.forename: Amanda W
authors.initials: AW
authors.lastname: Singer
authors.affiliation: Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA; Western States Pediatric Environmental Health Specialty Unit, University of California, San Francisco, CA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Miller
mesh_terms: D002648:Child; D004032:Diet / Q000009:adverse effects; D004781:Environmental Exposure / Q000009:adverse effects / Q000517:prevention & control; D004785:Environmental Pollutants / Q000009:adverse effects; D006801:Humans; D007938:Leukemia / Q000209:etiology / Q000235:genetics / Q000517:prevention & control*; D009154:Mutation; D016273:Occupational Exposure / Q000009:adverse effects; D010575:Pesticides / Q000009:adverse effects; D011322:Primary Prevention / Q000379:methods*; D012307:Risk Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects
chemical_list: D004785:Environmental Pollutants; D010575:Pesticides; D014028:Tobacco Smoke Pollution