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Welcome to PSR's Environmental Health Policy Institute, where we ask questions -- then we ask the experts to answer them. Join us as physicians, health professionals, and environmental health experts share their ideas, inspiration, and analysis about toxic chemicals and environmental health policy.

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Is Make-A-Wish All We Have to Offer? Perinatal Prevention of Childhood Cancers

By Joanne L. Perron, MD FACOG

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 cancer?”

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 childhood cancer.

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.

Comments

J Hohmeister, MS, APRN said ..

Your comments are well stated. The exposures are all too common. Not only should all perinatal providers be educating their clients about home exposures, but we should pressure businesses to reduce exposures to children and or pregnant families: no children should be allowed in the Home and Garden section of stores or farms where pesticides are stored or sold..look at the customers walking through these areas where product has spilled from torn bags, then track all this home and into the yards, into the kitchen where children of course are widely exposed be playing or crawling on the floors etc... These products need regulation. There should be regulations within towns to warn neighbors of applications... I give my organic/non-toxic talk to all of my perinatal patients, but most of the time I do not feel that there is enough support by other providers to reinforce the message to reduce the use and exposures of household chemicals...

June 29, 2011
Dorothy Peterson said ..

Right on! Your information is very readable. Write whenever you can. I hope to teach by example - home garden using compost and organics. Thank you for your input.

June 16, 2011

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