Childhood brain tumors (CBT) are the leading cause of cancer death in children; their risk factors are still largely unknown. Since most CBTs are diagnosed before five years of age, prenatal exposure and early postnatal factors may be involved in their etiology. We investigated the association between CBT and parental occupational exposure to engine exhausts in an Australian population-based case-control study. Parents of 306 cases and 950 controls completed detailed occupational histories. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for both maternal and paternal exposure in key time periods. Increased risks were observed for maternal exposure to diesel exhaust any time before the child's birth (OR 2.03, 95% CI 1.09-3.81) and paternal exposure around the time of the child's conception (OR 1.62, 95% CI 1.12-2.34). No clear associations with other engine exhausts were found. Our results suggest that parental occupational exposure to diesel exhaust may increase the risk of CBT. Malignant brain tumors are the leading cause of cancer mortality in children. 1,2 Despite decades of research, risk factors for childhood brain tumors (CBT) are largely unknown. Associations with some genetic syndromes and ionizing radiation have been established, but these account for only a small percentage of cases. 1-3 Since most CBT occur before five years of age, prenatal exposure and early postnatal factors may be involved in their etiology.Paternal employment in industries involving exposures to polycyclic aromatic hydrocarbons (PAH) was first suggested as a risk factor for CBT in 1974 and has been observed in several studies since. 1,4,5 PAH are formed during incomplete burning of organic substances (e.g. fuel or tobacco). Few studies have assessed maternal exposures. There is some evidence for genetic and epigenetic mechanisms following preconceptional and in utero exposures. 1,6 We investigated the association between CBT and parental occupational exposure to engine exhausts in our nation-wide Australian case-control study of CBT (Aus-CBT).
Material and Methods
Study populationIncident cases (aged 0-14 years) were identified through all ten pediatric oncology centers in Australia. Patients were diagnosed between 2005 and 2010. Three controls, frequency matched by age, sex and state of residence, were recruited for each brain tumor case. The control group consisted of two subgroups. The first group of controls was recruited specifically for the Aus-CBT study, by random digit dialing, in 2007-2010. The second set comprised controls from the Australian childhood acute lymphoblastic leukemia (Aus-ALL) study, 7 to increase statistical power at no additional cost. These controls were selected in 2005-2006 by the same method. Written informed consent was obtained from all parents and Ethics approval was granted by all participating hospitals.We were notified of 794 CBT cases, of whom 64 were ineligible (36 with no English-speaking parent, 23 non-residents and five with no biological parent available). Of the 730 el...