A Review and Meta-Analysis of Outdoor Air Pollution and Risk of Childhood Leukemia

Abstract

Leukemia is the most frequent malignant disease affecting children. To date, the etiology of childhood leukemia remains largely unknown. Few risk factors (genetic susceptibility, infections, ionizing radiation, etc.) have been clearly identified, but they appear to explain only a small proportion of cases. Considerably more uncertain is the role of other environmental risk factors, such as indoor and outdoor air pollution. We sought to summarize and quantify the association between traffic-related air pollution and risk of childhood leukemia, and further examined results according to method of exposure assessment, study quality, leukemia subtype, time period and continent where studies took place. After a literature search yielded 6 ecologic and 20 case-control studies, we scored the studies based upon the Newcastle-Ottawa Scale. The studies assessed residential exposure to pollutants from motorized traffic by computing traffic density in the neighboring roads or vicinity to petrol stations, or by using measured or modeled nitrogen dioxide and benzene outdoor air levels. Because heterogeneity across studies was observed, random-effects summary odds ratios (OR) and 95% confidence intervals (CI) were reported. Whenever possible we additionally conducted stratified analyses comparing acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Limiting the analysis to high-quality studies (Newcastle-Ottawa Scale ≥ 7), those using traffic density as the exposure assessment metric showed an increase in childhood leukemia risk in the highest exposure category (OR=1.07, 95% CI 0.93 – 1.24). However, we observed evidence of publication bias. Results for NO2 exposure and benzene showed an OR of 1.21 (95% CI 0.97 – 1.52) and 1.64 (95% CI 0.91 – 2.95) respectively. When stratifying by leukemia type, the results based upon NO2 were 1.21 (95% CI 1.04 – 1.41) for ALL and 1.06 (95% CI 0.51 – 2.21) for AML; based upon benzene were 1.09 (95% CI 0.67 – 1.77) for ALL and 2.28 (95% CI 1.09 – 4.75) for AML. Estimates were generally higher for exposures in the postnatal period compared to the prenatal period, and for European studies compared to North American studies. Overall, our results support a link between ambient exposure to traffic pollution and childhood leukemia risk, particularly due to benzene.

Childhood cancer and residential exposure to highways: a nationwide cohort study

“…No evidence of an association between traffic related pollutants and leukaemia was found in a recent Italian study [12]. 13 Among studies that investigated leukaemia by age groups, those that found positive associations with traffic related pollution in all children -consistent with our study -found stronger associations in the age group 0-4 years [10,28]. However, studies that found no evidence of association for leukaemia in all children found no such evidence in young children if these were investigated [12,31].…”

“…A recent review and meta-analysis of previous studies on traffic related pollution and childhood leukaemia suggests increased risks with exposure at diagnosis or longest place of residence, but not with exposure at birth [13]. However, there was evidence of publication bias.…”

Childhood Leukemia: A Preventable Disease

“…59, 60 Associations were observed for ambient exposures early in life and, to a lesser extent, before birth. The independent contribution of particulate matter (PM10) has been suggested in the development of leukemia.…”

In vivo micronucleus test as a biomarker of genotoxicity in free-range goats from suspected contaminated environment

“…This has thus resulted in the utilization of different biomarkers to assess the pathogenic and health impact of environmental pollution (Briggs, 2003). Some of the health problems associated with exposure to these pollutants include immunosuppression; increase the incidence of disease, reduced life expectancy, reproductive loss and cancers (Filippini et al, 2015). Aside the many global health impacts of environmental pollution, different meta-analysis and systematic review of evidence-based studies have also shown the correlation and association between cancer risk (and prevalence) and diverse environmental risk factors.…”