Is Make-A-Wish All We Have to Offer? Perinatal Prevention of Childhood Cancers
June 16, 2011
This essay is in response to: What are we learning about the relationship between environmental toxicants and cancer? How should our regulatory system respond to this information?
As a cancer survivor, I have been asked to do many cancer
benefit fashion shows. As an unapologetic lover of fashion and bling, I always
accept the invitations. While I underwent
countless surgeries and received the Dementor’s Kiss of chemotherapy, at least
it didn’t happen when I was a kid. At least I got to ride my Stingray bike,
practice handstands, swim all summer at Zuma beach, and slurp Slurpees until
the sun went down and the fireflies came out; blissful experiences that kids
with childhood cancer and suppressed immune systems won’t have. At these fashion shows, I see the brave and
sweet faces that everyone declares heroes and I ask myself, “Why has it become
routine to hear through the grapevine that somebody’s little love bug has
Childhood cancer affected over 10,000 kids between the ages
of 0-14 in 2010. The incidence of childhood cancers peaked in 2002-2003. Acute
leukemia is the most common childhood cancer. Due to improved treatment
regimens, the 80% survival rate is truly something to celebrate.
But what about the cost to society? Pediatric leukemia
hospitalizations in 2005 cost $474.8 million. More importantly, what about the intangible costs to the family
supporting their child and to the child who loses the fun part of childhood? Is
Make-A-Wish all we have to offer?
Despite being alive, survivorship isn’t all peaches and cream.
There are some serious and long-term sequelae to cancer treatment as a youngster such as neurocognitive dysfunction, cardiovascular
disease, infertility and gonadal dysfunction, psychosocial problems, endocrine dysfunction, and the development of subsequent cancers. Obviously there are continued healthcare costs, loss
of productivity costs, and serious quality of life issues for survivors of
There is a strong body of epidemiological evidence that pesticide
exposure in early life, including the fetal period, is associated with adverse child health outcomes, with the evidence for early life pesticide exposures and childhood
cancer particularly robust. According to Infante-Rivard and Weichenthal, “one can
confidently state that there is at least some association between pesticide
exposure and childhood cancer. Furthermore...recent epidemiological studies
suggest that this relationship may be causal due to the repeated finding of
pesticide exposures significantly increasing the risk of childhood cancer.”
Additional systematic reviews and meta-analyses have found positive
associations between maternal prenatal occupational and residential pesticide
exposures and childhood leukemia (see here, here, and here).
At some point soon, I hope that the paradigm expands from treatment
of childhood cancers such as acute leukemia to protecting the in-utero
environment from toxic contaminations such as pesticides. However, paradigms
can only be shifted after persistent education occurs to fuel the groundswell
of change. Education and training of health care professionals, especially
those who provide preconception care, should include: 1) How to take an
exposure history, 2) Identifying potential harmful chemical exposures, and 3)
Prevention of future exposures and mitigation of current exposures.
For the average motivated parent-to-be, avoidance of
pesticides during the preconception and perinatal periods is achievable, but
these folks need the information from trusted providers. Just as practitioners take
exposure histories and recommend avoidance of smoking, drugs, alcohol, and
infectious agents such Listeriosis and Toxoplasmosis to promote good
birth outcomes, they should also recommend eliminating exposures to pesticides
in homes, food, pets, lice shampoo, yards, and recreation areas. Furthermore, since DEET is not recommended for those under 2 years of age, would that include the fetus,
especially since studies have looked at outcomes of usage during pregnancy only
up until age 1?
“Carnation, Lily, Lily, Rose” by John Singer Sargent (source
Surprisingly, there are not public health communications,
either from governmental or non-profit agencies, about the associations between
perinatal pesticides exposures and risk of childhood cancers, even though the
incidence (10,000/year) is much higher than the number who contract congenital
toxoplasmosis infection (3500/year) or women who contract Listeriosis during
pregnancy (2500/year). The knowledge that perinatal pesticide exposures may
damage the underdeveloped immune system of a fetus and lead to childhood cancer
is important information for parents so they can avoid these products during
critical times of their child’s development.
If coffee vendors warn about the dangers of spilling and
holding hot coffee, why aren’t pesticide manufacturers of products used by the
average consumer placing prominent warnings
to the public about the dangers of exposure to their product during the
perinatal period? Should this be mandated by the US EPA or required by law? If
I ruled the world, a stroke of my pen would make it so. In the meantime, my
contribution is to translate the science for clinicians and educate them about
the hazards of perinatal pesticide and other toxicant exposures on the
developing fetus so that future kids can experience a childhood like it is
meant to be and develop into happy, productive, and healthy adults who can
still find time to be a kid now and then.