Occupational exposure to pesticides towards the danger of childhood leukemia in China

Leukemias are neoplastic disorders of white blood cells marked by genetic and chromosomal abnormalities that prevent blood cells to achieve their ultimate functional form. Leukemia accounts for around 30% of total malignant tumors and is common in children around the world. Acute leukemia constitutes approximately 95% of leukemias and Acute Lymphoblastic Leukemia (ALL) is the most frequently reported pediatric leukemia, with approximately 80% of total leukemia cases in children. The incidence rate of ALL between 1991 and 1994 was 59 events per million children aged below 5 years. The highest incidence rate was observed in children aged 2-6 years, with >80 events occurring each year per million children aged 3-4 years, and the rate declined with age. Based on this pattern, researchers believe that leukemia development occurs after both the first chromosomal translocation, which usually occurs during embryofetal development, and the second mutation, which occurs post-birth. The etiology of ALL in children is considered different from that in adults and although ALL is common in children, it is rarer than most adult cancers. This makes ALL difficult to study epidemiologically and very few definitive likelihood factors are established, such as chemotherapeutic agents, ionizing radiations, and genetic/chromosomal abnormalities. Based on limited evidence that is currently available, it is hypothesized that childhood acute leukemia may be a consequence of interactions between genetic predisposition and environmental factors including chemotherapeutic agents and pesticides.

Data on carcinogenic potential of pesticide use are limited, and the association between the higher occurrence of pediatric leukemia and maternal exposure to residential or occupational pesticides is highly debated. In a Seattle-based study, higher urine concentrations of dimethyl and diethyl dialkylphosphate, organophosphorus pesticide metabolites, were reported in children whose parents were exposed to either garden or indoor pesticides. Several studies have reported gestational exposure of pesticides to be the cause of various malignancies, including leukemia, Wilms’ tumor, neuroblastoma, Ewing’s sarcoma, soft-tissue sarcoma, non-Hodgkin’s lymphoma, in children. Although these surveys lack conclusive evidence owing to non-specific pesticide exposure information, low number of participants, and potential for case-response bias, the risks reported by them are of greater magnitude than those noted for adults exposed to pesticides. This calls for attention to a possibility of children being more disposed to the carcinogenicity of pesticides. Children in China, especially those living around treated agricultural lands, are overexposed to pesticide drift through ground application, overspray, or off-gassing. We aimed to analyze the correlation between pesticide exposure in children and childhood acute leukemia.

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