Felix M. Onyije

Introduction: Retinoblastoma, hepatoblastoma, germ cell tumors, bone tumors, and soft tissue tumors are rare types of childhood cancer. Identifying modifiable risk factors is essential to inform primary prevention. This review aimed to systematically examine literature and synthesize risk factors for childhood rare cancers. Methods: PubMed, Web of Science, and Embase databases were searched using lists of keywords and MeSH terms related to parental and childhood exposures. Studies were included if they were case–control or cohort studies of children under the age of 20 years at diagnosis and reported relative risks (RRs) with 95% confidence intervals (95% CIs). Pooled effect sizes (ES) and CIs for risk factors were estimated using random-effects models. Results: A total of 75 eligible articles from Asia, Europe, Latin America, North America, and Oceania reported cases of rare childhood cancers diagnosed between 1953 and 2021. Birth weight 4,000 g was not associated with any of the studied cancer types. Assisted reproductive technology (ES 2.82, 95% CI 1.82–4.39), Caesarean section (ES 1.47, 95% CI 1.20–1.79), and parental age >35 years (mothers ES 1.97, 95% CI 1.45–2.68; fathers ES 1.33, 95% CI 0.99–1.79) were observed to be associated with hepatoblastoma. Paternal smoking during preconception/pregnancy was associated with an increased risk of hepatoblastoma (ES = 1.58, 95% CI 1.18–2.12). Paternal occupational exposure to pesticides during preconception/pregnancy was associated with an increased risk of retinoblastoma (ES = 1.55, 95% CI 1.09–2.21). For some other exposures, we found several raised ES but with very wide CIs. Discussion: We identified only a few modifiable risk factors for certain childhood cancers, notably paternal smoking for hepatoblastoma and paternal occupational exposure to pesticides for retinoblastoma. Larger studies for rare childhood cancers are needed, with international collaboration to increase sample sizes.

Introduction: Neuroblastoma (NB) is the most common extracranial tumor in children. Synthesizing and elucidating modifiable risk factors is fundamental to inform primary prevention of NB. The objective is to review literature and synthesize risk factors for NB.Methods: PubMed, Web of Science, and Embase databases were searched using lists of key words and MeSH terms related to exposures and risk of NB. Studies were included if they were case-control or cohort studies of children under the age of 20 years at diagnosis and reported Relative Risks (RRs) with 95% confidence intervals (CIs). Pooled effect sizes (ES) and 95% CIs for risk factors associated with NB were estimated using random-effects models.Results: We included 50 eligible studies from Asia, Europe, and North America, and Oceania on cases of NB diagnosed between 1964 and 2016. We observed associations for maternal occupational exposure to pesticides during preconception/pregnancy (ES 1.62, CI 1.04–2.54), high birthweight [(>4,000 g) ES 1.21, CI 1.02–1.42], and Cesarean section (ES 1.14, CI 1.00–1.30) and the risk of NB. Parental smoking showed a weak association, while breastfeeding ≥6 months (ES 0.50, CI 0.30–0.84) was inversely associated with NB. Birth characteristics such as low birthweight (<2,500 g), small and large-for-gestational age, gestation age 40 weeks, and assisted reproductive technology were not associated with NB. Similarly, no associations were suggested for parental age, gestational diabetes, and pre-eclampsia. Maternal alcohol consumption during preconception/pregnancy, maternal intake of vitamin and folic acid during pregnancy, paternal occupational exposure to extremely low-frequency magnetic fields (ELF-MF), and maternal X-ray exposure during pregnancy were also not associated with the risk of NB. Paternal occupational and child's postnatal exposure to pesticides were also not associated with NB.Discussion: This systematic review and meta-analysis suggest that maternal occupational exposure to pesticides during preconception/pregnancy, high birthweight, Cesarean section, and breastfeeding (beneficial) were associated with the risk of NB, but all associations were rather modest in strength. Synthesizing of these risk factors are needed to inform whether there are avenues for primary prevention of NB.

Air pollution contributes significantly to morbidity and mortality globally. The Niger Delta Region of Nigeria flares the second largest amount of natural gas in the world, with residents of oil-producing communities bearing the burden of outdoor pollution that may have adverse effects on their health and well-being. Our study aimed to investigate the haematological indices of residents of a selected gas-flaring site. We conducted a cross-sectional study, wherein a total of eighty adults aged 24 to 73 years were recruited from communities located within a radius of approximately 5 to 10 km from the gas-flaring facility. Blood specimens were collected from consenting participants and analysed for various haematological parameters, including Red Blood Cell (RBC) count, Packed Cell Volume (PCV), Haemoglobin (HB), Mean Cell Haemoglobin (MCH), platelet count (PLT), White Blood Cell (WBC) count, neutrophil (NEU), lymphocytes (LYMs), and Monocyte + Basophil + Eosinophil (MXD). The analysis was performed using an automated Sysmex KX21N haematological analyser. Overall, there was a significant decrease in RBC counts (p < 0.001) and a significant elevation in WBCs (p < 0.001) among people residing within a 5 km radius compared to those residing within a 10 km radius. About 42.5% of males residing within a 5 Km radius exhibited low RBC counts in contrast to only 15% of males residing within a 10 km radius. The WBC levels were found to be significantly higher (p < 0.001) than the reference range among both males and females residing within a 5 km radius compared to those residing at a distance of 10 km. In the female population, 15% of individuals residing within a 5 km and 10 Km radius exhibited RBC levels below the reference category, while 7.5% showed RBC levels above the reference range. Exposure to gas flaring may alter haematological indices. It is, therefore, recommended that a comprehensive longitudinal study be conducted among residents of oil-producing communities and workers at gas-flaring facilities in the Niger Delta region of Nigeria to assess the potential environmental and health implications of their exposure to chemical pollutants.

Background Previous studies investigating risk factors for childhood lymphoma have shown inconsistent results. This systematic review and meta-analysis aimed to synthesize the available evidence on the risk of childhood lymphoma and its subtypes Non-Hodgkin's Lymphoma (NHL) and Hodgkin's Lymphoma (HL) for various potential and modifiable risk factors and to provide meta effect sizes . Methods Peer-reviewed scientific articles were identified, retrieved and screened through PubMed, Web of Science (WOS) and EMBASE databases and included studies that 1) were case-control or cohort studies and provided Relative Risk (RR) estimates (such as Odds Ratio (OR)), Hazard Ratio (HR), Standardized Mortality Ratio (SMR), Mortality Rate Ratio (MRR), Standard Incidence Ratio (SIR) or Incidence Rate (IRR)) with 95% confidence intervals (CI), 2) reported effect estimates for specific exposure time window: pre-conceptional, prenatal or postnatal, and 3) reported lymphoma risks for children under 20 years of age at diagnosis were assessed using the Joanna Briggs Institute critical appraisal (JBI) tools. A total of 69 studies (35 case-control studies and 34 cohort studies including nested or registry-based case-control studies) were included. After assessing articles for quality using the JBI tool, case-control studies achieved a higher mean score (86.6%) compared to cohort studies (73.6%). Meta-analyses with the random effects model were performed overall and separately by study design and reported using pooled effect sizes (ES) with corresponding 95% CIs. Results In the case-control studies, younger maternal age (≤25 years) was associated with a higher risk of HL (ES=1.81; 95%CI: 1.25-2.63) and lymphoma (ES=1.48; 95%CI: 1.17-1.86), while in the combined analysis, children with younger fathers (<=25 years) had a lower risk of developing lymphoma (ES=0.79; 95%CI: 0.65-0.96). Parental smoking before and during pregnancy was associated with a higher risk of NHL and lymphoma, while in case-control studies, NHL risk was associated with prenatal maternal (ES=1.43; 95%CI:1.08-1.88) and paternal (ES=1.56; 95%CI:1.09-2.24) smoking of 1-10 cigarettes per day. Maternal prenatal insecticide (ES=1.97; 95%CI:1.42-2.73) and pesticide (ES=1.67; 95%CI=1.21-2.32) exposure were associated with a higher risk of NHL and lymphoma, respectively, in case-control studies. In the combined analysis, breastfeeding for ≤6 months was associated with a higher risk of NHL (n=7, ES=1.34;95%CI:1.04-1.74), and lymphoma (ES=1.39;95%CI:0.99-1.97). Gestational age, gestational size, caesarean section, and low birthweight (<2,500 gram) were not associated with childhood lymphoma, based on few cohort studies. Moderate heterogeneity was observed for short gestational age (<37 weeks) and low birthweight (4,000 gram) resulted in an elevated meta effect size for 2 cohort studies with low heterogeneity, while a reduced meta effect size for 2 case-control studies with no heterogeneity. Conclusion Although there was a limitation in the number of studies assessing childhood lymphoma risk, the findings of the current study provided information on the association between modifiable risk factors, such as parental smoking and maternal prenatal exposure to pesticides and insecticides, and the risk of childhood lymphoma and its subtypes. While there are inherent biases in observational studies that may have influenced our findings, they should therefore be interpreted with caution. Keywords Lymphoma; Children; Exposure; Aetiology

Importance: Effective communication between patients and health care teams is essential in the health care setting for delivering optimal cancer care and increasing cancer awareness. While the significance of communication in health care is widely acknowledged, the topic is largely understudied within African settings.Objective: To assess how the medical language of cancer and oncology translates into African languages and what these translations mean within their cultural context.Design, Setting, and Participants: In this multinational survey study in Africa, health professionals, community health workers, researchers, and scientists involved in cancer care and research and traditional healers were invited to participate in an online survey on a voluntary basis through online platforms. The survey provided 16 cancer and oncologic terms used in cancer diagnosis and treatment (eg, cancer, radiotherapy) to participants, mostly health care workers, who were asked to provide these terms in their local languages (if the terms existed) followed by a direct or close translation of the meaning in English. The survey was open from February to April 2023.Main Outcomes and Measures: Patterns of meaning that recurred across languages were identified using thematic analysis of 16 English-translated terms categorized into 5 themes (neutral, negative, positive, phonetic or borrowed, and unknown).Results: A total of 107 responses (response rate was unavailable given the open and widespread distribution strategy) were collected from 32 countries spanning 44 African languages, with most participants (63 [59%]) aged 18 to 40 years; 54 (50%) were female. Translations for cancer were classified as phonetic or borrowed (34 [32%]), unknown (30 [28%]), neutral (24 [22%]), and negative (19 [18%]), with the latter category including universal connotations of fear, tragedy, incurability, and fatality. Similar elements connoting fear or tragedy were found in translations of terms such as malignant, chronic, and radiotherapy. The term radiotherapy yielded a high percentage of negative connotations (24 [22%]), with a prevailing theme of describing the treatment as being burned or burning with fire, heat, or electricity, which may potentially hinder treatment.Conclusions and Relevance: In this survey study of cancer communication and the translation of oncology terminology in African languages, the findings suggest that the terminology may contribute to fear, health disparities, and barriers to care and pose communication difficulties for health professionals. The results reinforce the need for culturally sensitive cancer terminology for improving cancer awareness and communication.

Synthesized evidence for childhood acute lymphoblastic leukemia