SETIL: Italian multicentric epidemiological case/control study on risk factors for childhood leukaemia, non hodgkin lymphoma and neuroblastoma: study population and prevalence of risk factors in Italy
Magnani C, Mattioli S, Miligi L, Ranucci A, Rondelli R, Salvan A, Bisanti L, Masera G, Rizzari C, Zambon P, Cannizzaro S, Gafà L, Luzzatto L, Benvenuti A, Michelozzi P, Kirchmayer U, Cocco P, Biddau P, Galassi C, Celentano E, Guarino E, Assennato G, de Nichilo G, Merlo D, Bocchini V, Pannelli F, Mosciatti P, Minelli L, Chiavarini M, Cuttini M, Casotto V, Torregrossa M, Valenti R, Forastiere F, Haupt R, Lagorio S, Risica S, Polichetti A. SETIL: Italian multicentric epidemiological case¿control study on risk factors for childhood leukaemia, non hodgkin lymphoma and neuroblastoma: study population and prevalence of risk factors in Italy. Ital J Pediatr. 2014 Dec 24;40(1):1. [Epub ahead of print].
Aetiology of childhood leukaemia and childhood neoplasm is poorly understood. Information on the prevalence of risk factors in the childhood population is limited. SETIL is a population based case¿control study on childhood leukaemia, conducted with two companion studies on non-Hodgkin Lymphoma (NHL) and neuroblastoma. The study relies on questionnaire interviews and 50 Hz magnetic field (ELF-MF) indoor measurements. This paper discusses the SETIL study design and includes descriptive information.
The study was carried out in 14 Italian regions (78.3% of Italian population aged 0-10). It included leukaemia, NHL and neuroblastoma cases incident in 0-10 year olds in 1998-2001, registered by the Italian Association of Paediatric Haematology and Oncology (AIEOP) (accrual over 95% of estimated incidence). Two controls for each leukaemia case were randomly sampled from the Local Health Authorities rolls, matched by gender, birthdate and residence. The same controls were used in NHL and neuroblastoma studies. Parents were interviewed at home on: physical agents (ELF-MF and ionizing radiation), chemicals (smoking, solvents, traffic, insecticides), occupation, medical and personal history of children and parents, infectious diseases, immunizations and associated factors. Occupational exposure was collected using job specific modules. ELF-MF was measured in the main rooms (spot measurement) and close to child's bed (48 hours measurement).
The study included: 683 leukaemia cases (87% ALL, 13% AnLL), 97 NHL, 155 neuroblastomas, and 1044 controls.ELF-MF long term measurements were obtained for 61.1% of controls and 81.6% of leukaemia cases; 8.8% of controls were exposed at over 0.1 microTesla (uT), 3.5% and 2.1% at respectively over 0.2 and 0.3 uT. 25% of controls' fathers had smoked over 10 cigarettes/day during the year of conception, varying according to education and region. Maternal smoking was less common (71.4% did not smoke in pregnancy). Maternal passive smoking during pregnancy was reported by 31.2% of controls; the child's passive smoking for 28.6%. Occupational exposure to solvents was estimated in 18.3% of controls' fathers and 7.7% of mothers. Contact with public was more frequent among mothers (36.1%) than fathers (23.4%).
SETIL represents a data source on exposure of Italian children to a broad array of potential carcinogenic factors.
Our results showed that the exposure of Italian children to cancer risk factors is not negligible, consistently with other countries of Western life style and industrial economy. Even if the association of common risk factors such as smoking with childhood leukemia is debated, they clearly represent risk factors for other diseases in childhood, such as asthma and acute respiratory illnesses. SETIL study results on prevalence of exposure indicate the need to take a stronger stance to reduce it, as it directly concern a large proportion of parents and indirectly affect their children. Large size population based case control studies are a major resource for providing information on prevalence of exposure, as shown in this report. The Italian case/control study on childhood leukaemia, NHL and neuroblastoma (SETIL study) represents a useful source of data to estimate the prevalence of exposure of Italian children to a broad array of potential carcinogenic factors.
Joel M. Moskowitz, Ph.D., Director
Center for Family and Community Health
School of Public Health
University of California, Berkeley
Electromagnetic Radiation Safety
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