Academic journal article Environmental Health Perspectives

Household Exposure to Pesticides and Risk of Childhood Hematopoietic Malignancies: The ESCALE Study (SFCE)

Academic journal article Environmental Health Perspectives

Household Exposure to Pesticides and Risk of Childhood Hematopoietic Malignancies: The ESCALE Study (SFCE)

Article excerpt

Hematopoietic malignancies are the most common childhood cancers, with world age-standardized incidence rates of 43.1, 6.7, and 8.9 per million children in France for leukemia, Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL), respectively (Clavel et al. 2004). The etiology of those malignancies remains largely unknown. Some epidemiologic studies have suggested that pesticides might increase the risk of childhood hematopoietic malignancies (Daniels et al. 1997; Infante-Rivard and Scott Weichenthal 2007; Jurewicz and Hanke 2006; Nasterlack 2006, 2007; Zahm and Ward 1998). Furthermore, the International Agency for Research on Cancer (IARC) has classified the occupational spraying of insecticides as probably carcinogenic to humans (group 2A); adult lymphoma is one of the main cancers suspected (IARC 1991). Children can be exposed to pesticides in utero or during childhood through their parents' work, domestic use, or the general environment (residues in food, water, air, and soil). It is not clear which sources of pesticide exposure are the most important for children, and household pesticide exposure may be a major exposure for children (Bradman and Whyatt 2005; Grossman 1995). No French survey on household pesticide use is available, but surveys conducted in North America and the United Kingdom reported high rates of household use or storage of pesticides (Adgate et al. 2000; Grey etal. 2006).

This study investigated the relationship between household exposure to pesticides and the risks of childhood acute leukemia (AL), HL, and non-NHL, focusing on intrauterine exposures, using data generated by the French national population-based case--control study, ESCALE (Etude sur les cancers de l'enfant).

Patients and Methods

We conducted the ESCALE study in 2003 and 2004 to investigate the role of infectious, environmental, and genetic factors in four childhood neoplastic diseases (leukemia, lymphoma, neuroblastoma, and brain tumor).

Cases and controls ascertainment. Cases.The cases were identified directly by the investigators assigned to each French pediatric oncology hospital department, with the support of the French National Registry of Childhood Blood Malignancies (Clavel et al. 2004). For the cases to be eligible, leukemia or lymphoma was to have been newly diagnosed between 1 January 2003 and 31 December 2004. The cases were also required to be < 15 years of age and resident in France at the time of diagnosis. Cases who had been adopted, whose biological mother had died, whose mother did not speak French, or whose mother presented with a psychiatric disorder were not eligible. For ethical reasons, the children who had died or who were receiving hospital palliative care were not eligible. Of the 1,316 cases (938 AL, 171 HL, 207 NHL) of childhood hematopoietic malignancies identified during the study period, 1,182 (843 AL, 152 HL, 186 NHL) cases were eligible. The reasons for noneligibility were the child's death (34 AL, 3 HL, 7 NHL), hospital palliative care (7 AL, 1 HL, 1 NHL), biological mother's death (10 AL, 3NHL), non-French-speaking mother (29 AL, 11 HL, 8 NHL), or mother with serious psychiatric disorders (15AL, 4 HL, 2 NHL).

The participation rates were 91, 86, and 88% for acute leukemia, HL, and NHL, respectively.

Controls. The controls were randomly selected from the French population using a quota sampling method. A first sample of 60,000 addresses representative of the French population in terms of the 22 administrative regions and nine degrees of urbanization was randomly extracted from the French national telephone directory (plus randomly generated unlisted numbers). Then quotas were applied. The quotas were designed to make the controls similar to all the cases of all types of cancer in terms of age and sex, using the French National Registry of Childhood Blood Malignancies (Clavel et al. 2004) and the Regional Childhood Cancer Registries (Desandes et al. …

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