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.