Risk of neuroblastoma, maternal characteristics and perinatal exposures: The SETIL study Stefano Parodi a , Domenico Franco Merlo b , Alessandra Ranucci c , Lucia Miligi d , Alessandra Benvenuti d , Roberto Rondelli e , Corrado Magnani c, *, Riccardo Haupt f , on behalf of the SETIL Working Group 1 a Institute of Electronics, Computer and Telecommunication Engineering, National Research Council of Italy, Via De Marini 6, Genoa, Italy b Epidemiology, Biostatistics and Clinical Trials, IRCCS Azienda Ospedaliera Universitaria San Martino – IST, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy c Cancer Epidemiology Unit, Department of Translational Medicine, CPO Piemonte and University of Eastern Piedmont, Novara, Italy d Occupational and Environmental Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy e Paediatric Oncology-Haematology, Lalla Sera `gnoli, Policlinico S. Orsola-Malpighi, Bologna, Italy f Epidemiology and Biostatistics Unit, Istituto Giannina Gaslini, Genoa, Italy What is known? - Neuroblastoma is the most common extra-cranial paediatric malignancy. Incidence peaks in infancy, indicating a role of in- utero and neonatal exposures. Its aetiology is largely unknown: an increased risk was observed after parental exposure to chemicals, but evidence is limited. Cancer Epidemiology 38 (2014) 686–694 A R T I C L E I N F O Article history: Received 4 June 2014 Received in revised form 2 September 2014 Accepted 13 September 2014 Available online 1 October 2014 Keywords: Neuroblastoma Maternal characteristics Congenital malformations Neurofibromatosis Parental occupation ELF magnetic fields A B S T R A C T Purpose: Neuroblastoma (NB) is the most common extra-cranial paediatric solid tumour. Incidence peaks in infancy, suggesting a role of in-utero and neonatal exposures but its aetiology is largely unknown. The aim of the present study is to evaluate the association between maternal characteristics and perinatal factors with the risk of NB, using data from the SETIL database. Methods: SETIL is a large Italian population-based case-control study established to evaluate several potential cancer risk factors in 0–10 year olds. Information about maternal characteristics, reproductive history, environmental and occupational exposures during pregnancy, as well as newborns’ characteristics were obtained using a structured questionnaire. Extremely low frequency magnetic field (ELF-MF) home exposure was measured. The study included 1044 healthy controls and 153 NB cases, diagnosed between 1998 and 2001. Results: A twofold risk was associated to exposure in pregnancy to chemical products for domestic work and to hair dye. The risk associated with the latter was higher among 0–17 month old children (OR = 5.5, 95%CI: 1.0–29.3). Risk was increased for children whose mothers had suffered work related exposure in the preconception period to solvents (OR = 2.0 95%CI: 1.0–4.1) and in particular to aromatic hydrocarbons (OR = 9.2, 95%CI: 2.4–34.3). No association was observed with ELF-MF exposure. A higher risk was found among children with congenital malformations (OR = 4.9, 95%CI: 1.8–13.6) or neurofibromatosis (2 cases and 0 controls, p = 0.016). Conclusions: Our study suggests maternal exposure to hair dyes and aromatic hydrocarbons plays a role and deserves further investigation. The association with congenital malformations might also be explained by over-diagnosis. External exposure, in particular during and before pregnancy might contribute to NB occurrence. ß 2014 Elsevier Ltd. All rights reserved. Abbreviations: AIEOP, Italian Association of Paediatric Haematology and Oncology; CNS, central nervous system; ELF-MF, extremely low frequency magnetic fields; GP, general practitioner; JSQ, job specific questionnaire; NB, neuroblastoma; OR, odds ratio; SETIL, Italian Multicentric Epidemiological Study on Risk Factors of Childhood Leukaemia, non Hodgkin lymphoma and neuroblastoma. * Corresponding author at: Dipartimento di Medicina Traslazionale, Universita ` del Piemonte Orientale, V. Solaroli 17, 28100 Novara, Italy. Tel.: +39 0321 3732057; fax: +39 0321 620421. E-mail addresses: magnani@med.unipmn.it, corrado.magnani@med.unipmn.it (C. Magnani). 1 The members of The SETIL Working Group are mentioned in the ‘Acknowl- edgements’ section. Contents lists available at ScienceDirect Cancer Epidemiology The International Journal of Cancer Epidemiology, Detection, and Prevention jou r nal h o mep age: w ww.c an cer ep idem io log y.n et http://dx.doi.org/10.1016/j.canep.2014.09.007 1877-7821/ß 2014 Elsevier Ltd. All rights reserved.