Risk of neuroblastoma, maternal characteristics and perinatal exposures: the SETIL study

Abstract

Purpose: Neuroblastoma (NB) is the most common extra-cranial paediatric solid tumour. Incidence peaks in infancy, suggesting a role of in-utero and neonatal exposures but its aetiology is largely unknown. The aim of the present study is to evaluate the association between maternal characteristics and perinatal factors with the risk of NB, using data from the SETIL database. Methods: SETIL is a large Italian population-based case-control study established to evaluate several potential cancer risk factors in 0-10 year olds. Information about maternal characteristics, reproductive history, environmental and occupational exposures during pregnancy, as well as newborns' characteristics were obtained using a structured questionnaire. Extremely low frequency magnetic field (ELF-MF) home exposure was measured. The study included 1044 healthy controls and 153 NB cases, diagnosed between 1998 and 2001. Results: A twofold risk was associated to exposure in pregnancy to chemical products for domestic work and to hair dye. The risk associated with the latter was higher among 0-17 month old children (OR = 5.5, 95%CI: 1.0-29.3). Risk was increased for children whose mothers had suffered work related exposure in the preconception period to solvents (OR = 2.0 95%CI: 1.0-4.1) and in particular to aromatic hydrocarbons (OR = 9.2, 95%CI: 2.4-34.3). No association was observed with ELF-MF exposure. A higher risk was found among children with congenital malformations (OR = 4.9, 95%CI: 1.8-13.6) or neurofibromatosis (2 cases and 0 controls, p = 0.016). Conclusions: Our study suggests maternal exposure to hair dyes and aromatic hydrocarbons plays a role and deserves further investigation. The association with congenital malformations might also be explained by over-diagnosis. External exposure, in particular during and before pregnancy might contribute to NB occurrence.

AI evidence extraction

Main findings

In this Italian population-based case-control study (153 neuroblastoma cases; 1044 controls), no association was observed between measured extremely low frequency magnetic field (ELF-MF) home exposure during pregnancy and neuroblastoma risk. Increased risks were reported for several non-EMF exposures (e.g., maternal hair dye use, domestic chemical products, and preconception occupational exposure to solvents/aromatic hydrocarbons) and for congenital malformations/neurofibromatosis.

Outcomes measured

• Neuroblastoma risk (odds ratios)
• Association with maternal characteristics and perinatal factors
• ELF-MF home exposure and neuroblastoma risk

Limitations

• Exposure information for many factors was obtained via structured questionnaire (potential recall/misclassification)
• Details of ELF-MF measurement protocol and exposure levels are not provided in the abstract
• Case numbers for some subgroups/exposures appear small (e.g., neurofibromatosis; wide confidence intervals for hair dye in 0–17 months)
• Observational case-control design (susceptible to confounding)

Suggested hubs

• occupational-exposure (0.55)
  Assessed maternal occupational exposures (e.g., solvents, aromatic hydrocarbons) in relation to childhood cancer risk.

{
    "study_type": "case_control",
    "exposure": {
        "band": "ELF",
        "source": "home exposure (measured)",
        "frequency_mhz": null,
        "sar_wkg": null,
        "duration": "during pregnancy"
    },
    "population": "Italian children aged 0–10 years (neuroblastoma cases and healthy controls); maternal characteristics and perinatal exposures assessed",
    "sample_size": 1197,
    "outcomes": [
        "Neuroblastoma risk (odds ratios)",
        "Association with maternal characteristics and perinatal factors",
        "ELF-MF home exposure and neuroblastoma risk"
    ],
    "main_findings": "In this Italian population-based case-control study (153 neuroblastoma cases; 1044 controls), no association was observed between measured extremely low frequency magnetic field (ELF-MF) home exposure during pregnancy and neuroblastoma risk. Increased risks were reported for several non-EMF exposures (e.g., maternal hair dye use, domestic chemical products, and preconception occupational exposure to solvents/aromatic hydrocarbons) and for congenital malformations/neurofibromatosis.",
    "effect_direction": "no_effect",
    "limitations": [
        "Exposure information for many factors was obtained via structured questionnaire (potential recall/misclassification)",
        "Details of ELF-MF measurement protocol and exposure levels are not provided in the abstract",
        "Case numbers for some subgroups/exposures appear small (e.g., neurofibromatosis; wide confidence intervals for hair dye in 0–17 months)",
        "Observational case-control design (susceptible to confounding)"
    ],
    "evidence_strength": "low",
    "confidence": 0.7800000000000000266453525910037569701671600341796875,
    "peer_reviewed_likely": "yes",
    "keywords": [
        "neuroblastoma",
        "case-control",
        "pregnancy",
        "perinatal exposures",
        "maternal characteristics",
        "ELF-MF",
        "extremely low frequency magnetic fields",
        "home exposure",
        "occupational exposure",
        "hair dye",
        "aromatic hydrocarbons",
        "solvents"
    ],
    "suggested_hubs": [
        {
            "slug": "occupational-exposure",
            "weight": 0.5500000000000000444089209850062616169452667236328125,
            "reason": "Assessed maternal occupational exposures (e.g., solvents, aromatic hydrocarbons) in relation to childhood cancer risk."
        }
    ]
}

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