Estimating the Proportion of Childhood Cancer Cases and Costs Attributable to the Environment in California.
OBJECTIVE
To estimate the proportion of cases and costs of the most common cancers among children aged 0 to 14 years (leukemia, lymphoma, and brain or central nervous system tumors) that were attributable to preventable environmental pollution in California in 2013.


METHODS
We conducted a literature review to identify preventable environmental hazards associated with childhood cancer. We combined risk estimates with California-specific exposure prevalence estimates to calculate hazard-specific environmental attributable fractions (EAFs). We combined hazard-specific EAFs to estimate EAFs for each cancer and calculated an overall EAF. Estimated economic costs included annual (indirect and direct medical) and lifetime costs.


RESULTS
Hazards associated with childhood cancer risks included tobacco smoke, residential exposures, and parental occupational exposures. Estimated EAFs for leukemia, lymphoma, and brain or central nervous system cancer were 21.3% (range = 11.7%-30.9%), 16.1% (range = 15.0%-17.2%), and 2.0% (range = 1.7%-2.2%), respectively. The combined EAF was 15.1% (range = 9.4%-20.7%), representing $18.6 million (range = $11.6 to $25.5 million) in annual costs and $31 million in lifetime costs.


CONCLUSIONS
Reducing environmental hazards and exposures in California could substantially reduce the human burden of childhood cancer and result in significant annual and lifetime savings.
Lauren Nelson is with the California Epidemiologic Investigation Service Fellowship Program, California Department of Public Health, Richmond. Jhaqueline Valle, Galatea King, Maxwell J. Richardson, and Eric M. Roberts are with the California Environmental Health Tracking Program, Richmond. Paul K. Mills is with the Fresno Medical Education and Research Program, University of California San Francisco, Fresno. Daniel Smith and Paul English are with the California Department of Public Health, Richmond.
Lauren
L
Nelson
Lauren Nelson is with the California Epidemiologic Investigation Service Fellowship Program, California Department of Public Health, Richmond. Jhaqueline Valle, Galatea King, Maxwell J. Richardson, and Eric M. Roberts are with the California Environmental Health Tracking Program, Richmond. Paul K. Mills is with the Fresno Medical Education and Research Program, University of California San Francisco, Fresno. Daniel Smith and Paul English are with the California Department of Public Health, Richmond.
Jhaqueline
J
Valle
Lauren Nelson is with the California Epidemiologic Investigation Service Fellowship Program, California Department of Public Health, Richmond. Jhaqueline Valle, Galatea King, Maxwell J. Richardson, and Eric M. Roberts are with the California Environmental Health Tracking Program, Richmond. Paul K. Mills is with the Fresno Medical Education and Research Program, University of California San Francisco, Fresno. Daniel Smith and Paul English are with the California Department of Public Health, Richmond.
Galatea
G
King
Lauren Nelson is with the California Epidemiologic Investigation Service Fellowship Program, California Department of Public Health, Richmond. Jhaqueline Valle, Galatea King, Maxwell J. Richardson, and Eric M. Roberts are with the California Environmental Health Tracking Program, Richmond. Paul K. Mills is with the Fresno Medical Education and Research Program, University of California San Francisco, Fresno. Daniel Smith and Paul English are with the California Department of Public Health, Richmond.
Paul K
PK
Mills
Lauren Nelson is with the California Epidemiologic Investigation Service Fellowship Program, California Department of Public Health, Richmond. Jhaqueline Valle, Galatea King, Maxwell J. Richardson, and Eric M. Roberts are with the California Environmental Health Tracking Program, Richmond. Paul K. Mills is with the Fresno Medical Education and Research Program, University of California San Francisco, Fresno. Daniel Smith and Paul English are with the California Department of Public Health, Richmond.
Maxwell J
MJ
Richardson
Lauren Nelson is with the California Epidemiologic Investigation Service Fellowship Program, California Department of Public Health, Richmond. Jhaqueline Valle, Galatea King, Maxwell J. Richardson, and Eric M. Roberts are with the California Environmental Health Tracking Program, Richmond. Paul K. Mills is with the Fresno Medical Education and Research Program, University of California San Francisco, Fresno. Daniel Smith and Paul English are with the California Department of Public Health, Richmond.
Eric M
EM
Roberts
Lauren Nelson is with the California Epidemiologic Investigation Service Fellowship Program, California Department of Public Health, Richmond. Jhaqueline Valle, Galatea King, Maxwell J. Richardson, and Eric M. Roberts are with the California Environmental Health Tracking Program, Richmond. Paul K. Mills is with the Fresno Medical Education and Research Program, University of California San Francisco, Fresno. Daniel Smith and Paul English are with the California Department of Public Health, Richmond.
Daniel
D
Smith
Lauren Nelson is with the California Epidemiologic Investigation Service Fellowship Program, California Department of Public Health, Richmond. Jhaqueline Valle, Galatea King, Maxwell J. Richardson, and Eric M. Roberts are with the California Environmental Health Tracking Program, Richmond. Paul K. Mills is with the Fresno Medical Education and Research Program, University of California San Francisco, Fresno. Daniel Smith and Paul English are with the California Department of Public Health, Richmond.
Paul
P
English
D000293:Adolescent; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects*; D004785:Environmental Pollutants / Q000633:toxicity*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000191:economics* / Q000453:epidemiology*; D015995:Prevalence; D012306:Risk; D012307:Risk Factors
D004785:Environmental Pollutants