Abstract
Aim: To explore the validity and strength of evidence on the
association between environmental factors and risk of developing
childhood (0-14 years) cancer. Methods: An umbrella review was
conducted including systematic reviews and meta-analyses of
observational epidemiological studies that examined the association of
any environmental exposure of either parent or child with any type of
childhood cancer. PubMed and Scopus databases were searched until April
2020. Based on predefined criteria, the evidence was graded into strong,
highly suggestive, suggestive or weak. Results: 509
meta-analyses explored environmental exposures and risk of developing 10
different types of childhood cancer. Only 2.4% of the associations were
considered to have highly suggestive evidence inferred by strongly
statistically significant results. These associations were confined to
increased risk of overall leukemia, especially acute lymphoblastic
leukemia (ALL), in relation to high birthweight, paternal smoking and
exposure to pesticides, particularly insecticides. By contrast, maternal
multivitamin supplementation during pregnancy (summary odds ratio
[OR]: 0.64, 95% confidence intervals [CI]: 0.52, 0.80) and
breastfeeding for more than 6 months (summary OR: 0.76, 95%CI: 0.68,
0.84) were supported by highly suggestive evidence for decreased risk of
ALL. There was also highly suggestive evidence for increased risk of
central nervous system (CNS) tumors, especially astrocytoma, in relation
to high birthweight, as well as increased risk of testicular cancer in
relation to testicular microlithiasis and isolated cryptorchidism.
Conclusions: The present findings provide evidence that
exposure to seven maternal/neonatal factors significantly affects the
risk of childhood leukemia, CNS tumors and testicular cancer. Further
evidence from sufficiently powered studies and large consortia with
uniform reporting of analyses is needed to allow firmer conclusions to
be drawn.