Affiliations of authors: X. O. Shu, M. Steinbuch, W. Q. Wen, J. P. Neglia, L. L. Robison, Division of Pediatric Epidemiology and Clinical Research, University of Minnesota, Minneapolis; M. S. Linet, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda MD; J. D. Buckley, Department of Preventive Medicine, University of Southern California, Los Angeles; J. D. Potter, Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA; G. H. Reaman, Department of Pediatric Hematology/Oncology, Children's National Medical Center, Washington, DC.
Correspondence to present address: Xiao Ou Shu, M.D., Ph.D., Department of Pediatrics, University of South Carolina School of Medicine, 15 Medicine Park, Suite 301, Columbia, SC 29203. Address reprint requests to: Xiao Ou Shu, M.D., Ph.D., Children's Cancer Group, P. O. Box 60012, Arcadia, CA 91066-6012.
Present address: M. Steinbuch, Medical Communications Department, Procter and Gamble Pharmaceuticals, Cincinnati, OH.
BACKGROUND: Breast-feeding is well known to have a protective effect against infection in infants. Although the long-term effects of breast-feeding on childhood cancer have not been studied extensively, a protective effect against childhood Hodgkin's disease and lymphoma has been suggested previously from small investigations. In this study, we tested the hypothesis that breast-feeding decreases the risk of childhood acute leukemia.
METHODS: A total of 1744 children with acute lymphoblastic leukemia (ALL) and 1879 matched control subjects, aged 1-14 years, and 456 children with acute myeloid leukemia (AML) and 539 matched control subjects, aged 1-17 years, were included in the analysis. Information regarding breast-feeding was obtained through telephone interviews with mothers. All leukemias combined, histologic type of leukemia (ALL versus AML), immunophenotype of ALL (early pre-B cell, pre-B cell, or T cell), and morphology of AML were assessed separately in the data analysis.
RESULTS: Ever having breast-fed was found to be associated with a 21% reduction in risk of childhood acute leukemias (odds ratio [OR] for all types combined = 0.79; 95% confidence interval [CI] = 0.70-0.91). A reduction in risk was seen separately for AML (OR = 0.77; 95% CI = 0.57-1.03) and ALL (OR = 0.80; 95% CI = 0.69-0.93). The inverse associations were stronger with longer duration of breast-feeding for total ALL and AML; for M0, M1, and M2 morphologic subtypes of AML; and for early pre-B-cell ALL.
CONCLUSION: In this study, breast-feeding was associated with a reduced risk of childhood acute leukemia. If confirmed in additional epidemiologic studies, our findings suggest that future epidemiologic and experimental efforts should be directed at investigating the anti-infective and/or immune-stimulatory or immune-modulating effects of breast-feeding on leukemogenesis in children.
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