There may be nothing more traumatic for a parent than to be told that his or her child has cancer. This heartbreaking diagnosis is only the beginning of a multi-year struggle for survival that can lead to many questions, including “Why did this happen to my child?”
The Childhood Cancer & the Environment project has been developed by the Pediatric Environmental Health Specialty Unit (PEHSU) Network to help pediatric health care providers answer this and other questions from parents and caregivers. The Western States PEHSU heads up the project, now in its third year.
Factors that raise & lower cancer risk
Research in the last 25 years has greatly expanded our understanding of environmental risk factors for childhood cancer. These risk factors include exposure to pesticides, traffic-related air pollution, tobacco, and solvents. We also know more about protective factors.
You might be surprised to learn that attending a large daycare is a protective factor. Why would this, and other environmental stimuli, such as early exposure to household pets and farm animals, help protect children from developing childhood cancers? Researchers believe the answer is in the modulation and calming of the immune system as it reacts to early and common infections in childhood.
This type of information is important for pediatric and pediatric oncology providers to know.
Another environmental issue that may influence the risk of childhood cancer is climate change. In a recent paper by leaders in the Childhood Cancer & the Environment project (Climate change will impact childhood cancer risks, care and outcomes), the authors declare that, “the strong intersection between environmental pollution and climate change and their connections to childhood cancer are clear.”
Clinicians want information & training
Unfortunately, surveyed clinicians report that although they regularly get questions about environmental exposures, they have little or no training about this — and most are uncomfortable answering these questions. Only 6% said that they had been trained to take an environmental history. Fortunately, nearly all respond that they would like to know more.
They also want to know that the science supports a sound basis for including environmental risk factors in discussions, and they want clear action items that they can implement.
For example, research suggests an increased risk of hospitalization for respiratory illnesses in childhood cancer survivors exposed to higher levels of particulate air pollution. Learning how to provide guidance on the use of the air quality index and home HEPA filtration provides clinicians with a way to translate the research into daily practice in cancer survivorship clinics.
Education & tools drive change
Our Childhood Cancer project, in conjunction with PEHSU childhood cancer and the environment “champions” nationwide, has conducted a range of well-received educational events for health care professionals, from smaller workshops to webinars to large forums. The sessions include expert speakers who address the current and emerging science related to the environment and the risk of childhood cancers, including leukemia.
Results from the workshops for pediatric oncology providers have been very positive. Three months after the workshops, 86% said that their perceptions regarding environmental risks and childhood cancer changed because of the workshop, and 80% of attendees said that they already had made changes to their clinical practice.
One attendee said, “I have a lot more respect and consideration for parental concerns about environmental factors.” Another said, “For newly diagnosed patients, I do a more thorough history to look for environmental exposures and possible correlations between patients in similar areas.”
Community outreach for cancer prevention
We have also developed a suite of materials to educate community health workers and promotores de salud so they may further educate families on prevention strategies.
Materials include a “flip book” that health workers can use, with explanations on key factors on childhood cancer and the environment.
We believe it is vital that we reach out to communities with this information. The public also needs more information on the connections between childhood cancer and environmental risk factors.
The Children’s Environmental Health Network, along with others, are organizing the second Childhood Cancer Prevention Symposium February 10-13 at the Texas Children’s Neurological Research Institute in Houston, to bring together scientists, advocates, families, media, and the public to “discuss the latest advancements and strategies to prevent childhood cancer.” Renowned journalist Dan Fagin will keynote the 2 ½ day event. He is science and journalism professor at NYU and author of the bestselling book, awarded the Pulitzer Prize in 2014, Toms River: A Story of Science and Salvation.
Our web page on the Childhood Cancer & the Environment project has a wealth of free materials, as well as links to scientific and social media videos, and a free Continuing Education course for health professionals, with CE’s offered by the CDC (A Story of Health). You can also sign up for our free quarterly newsletter on the website.
Please join us for an upcoming webinar exploring this issue further; details and registration information will be available soon.
Dr. Mark Miller is an Associate Clinical Professor in the Division of Occupational and Environmental Medicine at the University of California San Francisco (UCSF). He is also the Director Emeritus of the Western States Pediatric Environmental Health Specialty Unit (WSPEHSU) at UCSF and the past director of the Children’s Environmental Health Center at California’s Environmental Protection Agency. He received his medical degree and completed a Pediatric residency at Michigan State University. He received his Masters in Public Health in Environmental Health Sciences from UC Berkeley and completed a residency with the California Department of Health Services in Preventive Medicine.
Maria Valenti has been an environmental health education leader for over three decades. She helped create and develop A Story of Health e-book, and has co-authored several environmental health publications including Generations at Risk: Reproductive Health & the Environment, In Harm’s Way: Toxic Threats to Child Development and Environmental Threats to Healthy Aging. She consults with the Western States Pediatric Environmental Health Specialty Unit, with a current focus on the Childhood Cancer & the Environment project. As the Executive Director of Greater Boston Physicians for Social Responsibility, she helped develop and manage national and multi-state environmental health education and training programs.