{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:27:55Z","timestamp":1791764875045,"version":"4.3.4"},"reference-count":116,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T00:00:00Z","timestamp":1642032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006529","name":"Federal Office for Radiation Protection","doi-asserted-by":"publisher","award":["3620S92412"],"award-info":[{"award-number":["3620S92412"]}],"id":[{"id":"10.13039\/501100006529","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Leukemia is the most common type of cancer among children and adolescents worldwide. The aim of this umbrella review was (1) to provide a synthesis of the environmental risk factors for the onset of childhood acute lymphoblastic leukemia (ALL) by exposure window, (2) evaluate their strength of evidence and magnitude of risk, and as an example (3) estimate the prevalence in the German population, which determines the relevance at the population level. Relevant systematic reviews and pooled analyses were identified and retrieved through PubMed, Web of Science databases and lists of references. Only two risk factors (low doses of ionizing radiation in early childhood and general pesticide exposure during maternal preconception\/pregnancy) were convincingly associated with childhood ALL. Other risk factors including extremely low frequency electromagnetic field (ELF-MF), living in proximity to nuclear facilities, petroleum, benzene, solvent, and domestic paint exposure during early childhood, all showed some level of evidence of association. Maternal consumption of coffee (high consumption\/&gt;2 cups\/day) and cola (high consumption) during pregnancy, paternal smoking during the pregnancy of the index child, maternal intake of fertility treatment, high birth weight (\u22654000 g) and caesarean delivery were also found to have some level of evidence of association. Maternal folic acid and vitamins intake, breastfeeding (\u22656 months) and day-care attendance, were inversely associated with childhood ALL with some evidence. The results of this umbrella review should be interpreted with caution; as the evidence stems almost exclusively from case-control studies, where selection and recall bias are potential concerns, and whether the empirically observed association reflect causal relationships remains an open question. Hence, improved exposure assessment methods including accurate and reliable measurement, probing questions and better interview techniques are required to establish causative risk factors of childhood leukemia, which is needed for the ultimate goal of primary prevention.<\/jats:p>","DOI":"10.3390\/cancers14020382","type":"journal-article","created":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T10:57:37Z","timestamp":1642071457000},"page":"382","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":84,"title":["Environmental Risk Factors for Childhood Acute Lymphoblastic Leukemia: An Umbrella Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4953-4949","authenticated-orcid":false,"given":"Felix M.","family":"Onyije","sequence":"first","affiliation":[{"name":"Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC\/WHO), 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6498-2259","authenticated-orcid":false,"given":"Ann","family":"Olsson","sequence":"additional","affiliation":[{"name":"Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC\/WHO), 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Baaken","sequence":"additional","affiliation":[{"name":"Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Langenbeckstra\u03b2e 1, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9982-3300","authenticated-orcid":false,"given":"Friederike","family":"Erdmann","sequence":"additional","affiliation":[{"name":"Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC\/WHO), 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France"},{"name":"Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Langenbeckstra\u03b2e 1, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Stanulla","sequence":"additional","affiliation":[{"name":"Pediatric Hematology and Oncology, Hannover Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1009-259X","authenticated-orcid":false,"given":"Daniel","family":"Wollschl\u00e4ger","sequence":"additional","affiliation":[{"name":"Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Langenbeckstra\u03b2e 1, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Sch\u00fcz","sequence":"additional","affiliation":[{"name":"Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC\/WHO), 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/S1470-2045(17)30186-9","article-title":"International incidence of childhood cancer, 2001\u20132010: A population-based registry study","volume":"18","author":"Colombet","year":"2017","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/S1470-2045(19)30339-0","article-title":"The global burden of childhood and adolescent cancer in 2017: An analysis of the Global Burden of Disease Study 2017","volume":"20","author":"Force","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_3","unstructured":"Erdmann, F., Kaatsch, P., Grabow, D., and Spix, C. 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