Abstract
BackgroundParental smoking and exposure of the mother or the child to environmental tobacco smoke (ETS) as risk factors for Acute non-Lymphocytic Leukemia (AnLL) were investigated.MethodsIncident cases of childhood AnLL were enrolled in 14 Italian Regions during 1998–2001. We estimated odds ratios (OR) and 95% confidence intervals (95%CI) conducting logistic regression models including 82 cases of AnLL and 1,044 controls. Inverse probability weighting was applied adjusting for: age; sex; provenience; birth order; birth weight; breastfeeding; parental educational level age, birth year, and occupational exposure to benzene.ResultsPaternal smoke in the conception period was associated with AnLL (OR for ≥11 cigarettes/day = 1.79, 95% CI 1.01–3.15; P trend 0.05). An apparent effect modification by maternal age was identified: only children of mothers aged below 30 presented increased risks. We found weak statistical evidence of an association of AnLL with maternal exposure to ETS (OR for exposure>3 hours/day = 1.85, 95%CI 0.97–3.52; P trend 0.07). No association was observed between AnLL and either maternal smoking during pregnancy or child exposure to ETS.ConclusionsThis study is consistent with the hypothesis that paternal smoke is associated with AnLL. We observed statistical evidence of an association between maternal exposure to ETS and AnLL, but believe bias might have inflated our estimates.
Highlights
IntroductionAcute leukemia is the most common childhood cancer; acute lymphoblastic leukemia (ALL) accounts for 75–80% of total cases of childhood leukemia, acute non-lymphocytic leukemia (AnLL) for about 20%. [1] Established risk factors, such as exposure to ionizing radiations and genetic syndromes, explain no more than 10% of cases; [2] Suggested risk factors include: car exhaust fumes, pesticides, non-ionizing radiation, pets, antiepileptic drugs, maternal alcohol consumption, maternal illicit drug use (cannabis sativa), maternal age, paternal age, breast feeding, birth order, chemical contamination in drinking water, both viral and bacterial infections, and parental cigarette smoking. [3,4,5] Alongside occupational exposure to benzene, [6] active tobacco smoking is an established risk for adult myeloid leukemia. [7] According to the International Agency for Research on Cancer (IARC), the available body of evidence suggests a consistent association of childhood leukemia with preconception and with combined paternal and maternal smoking. [7] studies on maternal tobacco smoking often showed modest increases in risk, or null or inverse associations. [7] Only one study was included on second hand smoke and leukemia (namely chronic lymphocytic leukemia) reporting a positive association. [7] Most of the evidence on the relationship between cigarette smoking and childhood leukemia regards ALL, [8], while there is scant evidence for Acute non-Lymphocytic Leukemia (AnLL). [7,9] As shown in supplemental Table S1, several studies highlighted that paternal smoking around the time of conception is a risk factor for childhood ALL
[7] Most of the evidence on the relationship between cigarette smoking and childhood leukemia regards acute lymphoblastic leukemia (ALL), [8], while there is scant evidence for Acute non-Lymphocytic Leukemia (AnLL). [7,9] As shown in supplemental Table S1, several studies highlighted that paternal smoking around the time of conception is a risk factor for childhood ALL
The entire sample of controls, mainly consisting of subjects matched to ALL cases, has a different age distribution compared to AnLL cases and their matched controls
Summary
Acute leukemia is the most common childhood cancer; acute lymphoblastic leukemia (ALL) accounts for 75–80% of total cases of childhood leukemia, acute non-lymphocytic leukemia (AnLL) for about 20%. [1] Established risk factors, such as exposure to ionizing radiations and genetic syndromes, explain no more than 10% of cases; [2] Suggested risk factors include: car exhaust fumes, pesticides, non-ionizing radiation, pets, antiepileptic drugs, maternal alcohol consumption, maternal illicit drug use (cannabis sativa), maternal age, paternal age, breast feeding, birth order, chemical contamination in drinking water, both viral and bacterial infections, and parental cigarette smoking. [3,4,5] Alongside occupational exposure to benzene, [6] active tobacco smoking is an established risk for adult myeloid leukemia. [7] According to the International Agency for Research on Cancer (IARC), the available body of evidence suggests a consistent association of childhood leukemia with preconception and with combined paternal and maternal smoking. [7] studies on maternal tobacco smoking often showed modest increases in risk, or null or inverse associations. [7] Only one study was included on second hand smoke and leukemia (namely chronic lymphocytic leukemia) reporting a positive association. [7] Most of the evidence on the relationship between cigarette smoking and childhood leukemia regards ALL, [8], while there is scant evidence for AnLL. [7,9] As shown in supplemental Table S1, several studies highlighted that paternal smoking around the time of conception is a risk factor for childhood ALL. [7,9] As shown in supplemental Table S1, several studies highlighted that paternal smoking around the time of conception is a risk factor for childhood ALL. A meta-analysis of heavy paternal smoking (20+ cigarettes/day) highlighted a substantial increase in the risk of childhood leukemia (OR 1.44, 95%CI 1.24– 1.68) [8]. Our aim was to investigate parental cigarette consumption and second-hand smoke exposure as risk factors for childhood AnLL, using data collected in a large case-control study primarily designed to evaluate the role of physical agents (including electromagnetic fields), parental occupation and environmental exposure in childhood hematopoietic malignancies. Parental smoking and exposure of the mother or the child to environmental tobacco smoke (ETS) as risk factors for Acute non-Lymphocytic Leukemia (AnLL) were investigated
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