Case control study on childhood leukaemia in Lower Saxony
 

In two municipalities in Lower Saxony statistically valid clusters were observed, which attracted great public interest. Committees were set up to initiate a large variety of on-the-spot-investigations. Finally, it was decided to conduct a case control study throughout Lower Saxony to explore potential risk factors which might explain the observed clusters. A limited number of already established and currently discussed hypotheses was chosen for investigation. The study was based on patients registrated at the German Children's Cancer Registry (GCCR). For each child with leukemia diseased between 1988 and 1993 two population-based controls (local and state controls) and one tumour control were selected. Data were collected by means of a questionnaire self-administered by the parents and a telephone interview. In addition, measurements of electromagnetic fields and radon were performed and inspections of the child's birth record were made for the purpose of confirming a potential association between parenteral vitamin K prophylaxis and leukemia or tumours. 425 parents of diseased children and 610 of non-diseased children were asked for participation. The rates of response were 82% for families with diseased and 71% for families with non-diseased children. In total, 781 parents participated in the study. The most important results are as follows: The Greaves' hypothesis was supported by the following results: In children diseased with leukemia, vaccinations were less frequent, virus-related infections occurred more rarely, these children were more frequently first-born children and more frequently breast-feed, and they possibly had fewer contacts with other children in infancy. Our data do not show a significant association between parenteral vitamin K prophylaxis and leukemia or tumours. Measurements of electromagnetic fields show a weak association between high-level exposure and an increased risk of developing leukemias. Children who were X-rayed more than four times or were born prematurely and had received intensive care treatment show a positive association with occurrence of leukemia, but the number of these patients was very small and these factors are not independent. The only potential job-related hazard was paternal exposure to plastic and resin fumes. The incidence of miscarriages and abortions was increased in mothers of children with leukemia. Our study did not confirm the hypotheses, that leukemia is associated with gestational age, with consumption of alcohol, nicotine, and medicaments during pregnancy. Nor was any association detected with exposure to wood preservatives and insecticides or with a high socio-economic status. The number of patients living in municipalities with increased incidence of leukemia was too small to show statistically valid results. However, it is noteworthy that some of the above-mentioned risk factors were observed also in these children. One of the purposes of the finished case control study which is described below was to validate and complete these results.

KAATSCH, P., KALETSCH, U., KRUMMENAUER, F., MEINERT, R., MIESNER, A., HAAF, G., MICHAELIS, J.
Case Control Study on Childhood Leukemia in Lower Saxony, Germany - Basic considerations, methodology, and summary of results. Klin. Pädiatr. 208, 179-185, 1996.
 

Further publications:

KALETSCH, U., HAAF, G., KAATSCH, P., KRUMMENAUER, F., MEINERT, R., MIESNER, A., MICHAELIS, J.
Fallkontrollstudie zu den Ursachen von Leukämien bei Kindern in Niedersachsen, Technischer Bericht des Instituts für Medizinische Statistik und Dokumentation der Universität Mainz, 1995.

KAATSCH, P., KALETSCH, U., KRUMMENAUER F., MEINERT, R., MIESNER, A., MICHAELIS, J.
Kindliche Leukämie und deren Ursachen - eine niedersächsische Fallkontrollstudie. S. 71 - 75 in Heinemann, G., Pfob, H. (Hrsg.): Strahlenbiologie und Strahlenschutz: Moderne Entwicklungen und Tendenzen in der Strahlenbiologie, Publikationsreihe Fortschritte im Strahlenschutz, Verlag TÜV Rheinland, Köln, 1996.

MEINERT, R., KAATSCH, P., KALETSCH, U., KRUMMENAUER, F., MIESNER, A., MICHAELIS, J.
Childhood leukaemia and exposure to pesticides - Results of a case control study in Northern Germany. Eur. J. Cancer, 32A, 1943 - 1948, 1996.
Abstract

MICHAELIS, J., SCHÜZ, J., MEINERT, R., MENGER, M., GRIGAT, J.-P., KAATSCH, P., KALETSCH, U., MIESNER, A., STAMM, A., BRINKMANN, K., KÄRNER, H.
Childhood leukemia and electromagnetic fields: results of a population-based case-control study. Cancer, Causes and Control 8, 167-174, 1997
Abstract

MIESNER, A., HOISL, M., KAATSCH, P., KALETSCH, U., MEINERT, R., MICHAELIS, J.
Gibt es anamnestische Faktoren, die das Leukämierisiko von Kindern erhöhen? (Ergebnisse einer Fallkontrollstudie in Niedersachsen), S. 504-508 in Muche, R., Büchele, G., Harder, D., Gaus, W. (Hrsg.), Medizinische Informatik, Biometrie und Epidemiologie GMDS ’97, MMV Medizinverlag München 1997.

MICHAELIS, J., VON KRIES, R.
Case control study in Lower Saxony on vitamin K prophylaxis and childhood cancer. p 317-320 in Sutor, A. H., Hathaway, W. E. (eds.): Vitamin K in Infancy. Stuttgart, New York 1995.

VON KRIES, R., GÖBEL, U., HACHMEISTER, A., KALETSCH, U., MICHAELIS, J.
Vitamin K and childhood cancer: a population based case-control study in Lower Saxony, Germany. BMJ 313, 1996, 199-203.
Abstract