American Journal of Epidemiology Advance Access published online on December 12, 2007
American Journal of Epidemiology, doi:10.1093/aje/kwm339
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Original Contribution |
Risk of Childhood Leukemia Associated with Vaccination, Infection, and Medication Use in Childhood
The Cross-Canada Childhood Leukemia Study
1 Cancer Control Research Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
2 Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada
3 Department of Statistics, Simon Fraser University, Vancouver, British Columbia, Canada
4 Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
Correspondence to Mary McBride, Cancer Control Research Program, British Columbia Cancer Agency, Cancer Research Center, 2-107, 675 West 10th Avenue, Vancouver, BC, Canada V5Z 1L3 (e-mail: mmcbride{at}bccrc.ca).
Received for publication May 22, 2007. Accepted for publication October 23, 2007.
Current hypotheses consonant with the peak in leukemia incidence in early childhood point to an infectious etiology. The authors examined the effect of postnatal exposures predicted to affect early immune functioning, including childhood vaccinations, illness, medication use, and breastfeeding patterns. Children 0–15 years of age diagnosed with leukemia from 1990 to 1994 and resident within principal cities across Canada were eligible for inclusion. Through pediatric oncology centers and population-based cancer registries, 399 cases were ascertained at the time of diagnosis. For each participating case, an age-, gender-, and area-matched control was randomly selected from government health insurance rolls. Risk factor information was obtained through personal interviews with each child's parents or guardians. Conditional logistic regression was used to calculate odds ratios, with adjustment for potential confounders. Use of immunosuppressant medication by the index child led to a deficit of risk (odds ratio = 0.37, 95% confidence interval: 0.16, 0.84), while vitamin intake was positively associated with leukemia (odds ratio = 1.66, 95% confidence interval: 1.18, 2.33). Breastfeeding for more than 6 months was also protective (p < 0.05). Results persisted for cases diagnosed with acute lymphoblastic leukemia and for children diagnosed at 1–5 years of age. These findings suggest a role for early immunologic challenge in the expression of childhood leukemia.
breast feeding; case-control studies; infection; leukemia, lymphocytic, acute, L1; risk factors; vaccination
Abbreviations: ALL, acute lymphoblastic leukemia; BCG, Bacillus Calmette-Guérin; CI, confidence interval; DTP, diphtheria, tetanus, and pertussis; MMR, measles, mumps, and rubella; OR, odds ratio
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  D. A. Hanauer and S. W. Choi RE: "RISK OF CHILDHOOD LEUKEMIA ASSOCIATED WITH VACCINATION, INFECTION, AND MEDICATION USE IN CHILDHOOD: THE CROSS-CANADA CHILDHOOD LEUKEMIA STUDY" Am. J. Epidemiol., August 1, 2008; 168(3): 353 - 353. [Full Text] [PDF]
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A. C. MacArthur and M. L. McBride THE FIRST TWO AUTHORS REPLY Am. J. Epidemiol., August 1, 2008; 168(3): 353 - 354. [Full Text] [PDF]
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