Skip to main content
NCBI home page
Public Health Reports logoLink to Public Health Reports
. 2004 Nov-Dec;119(6):521–535. doi: 10.1016/j.phr.2004.09.002

Breastfeeding and the risk of childhood leukemia: a meta-analysis.

Marilyn L Kwan 1, Patricia A Buffler 1, Barbara Abrams 1, Vincent A Kiley 1
PMCID: PMC1497668  PMID: 15504444

Abstract

OBJECTIVE: The authors used a meta-analytic technique to (1) quantify the evidence of an association between duration of breastfeeding and risk of childhood acute lymphoblastic leukemia (ALL) or acute myeloblastic leukemia (AML), (2) assess the influence of socioeconomic status (SES) on any such associations, and (3) discuss the implications of these findings for the evaluation of whether breastfeeding reduces the risk of childhood leukemia. METHODS: A fixed effects model was employed to systematically combine the results of 14 case-control studies addressing the effect of short-term (< or = 6 months) and long-term (>6 months) breastfeeding on the risk of childhood ALL and/or AML. Subgroup analyses of studies that did and did not adjust for SES were also performed. RESULTS: A significant, negative association was observed between long-term breastfeeding and both ALL risk (odds ratio [OR]=0.76; 95% confidence interval [CI] 0.68, 0.84) and AML risk (OR=0.85; 95% CI 0.73, 0.98). Short-term breastfeeding was similarly protective for ALL and AML. Results for studies that adjusted and did not adjust for SES were not significantly different from the results for the 14 studies combined. CONCLUSIONS: This meta-analysis showed that both short-term and long-term breastfeeding reduced the risk of childhood ALL and AML, suggesting that the protective effect of breastfeeding might not be limited to ALL as earlier hypothesized. Potential bias introduced by different participation rates for case and control samples that differed in SES can be minimized by implementing larger case-control studies with SES-matched, population-based controls.

Full Text

The Full Text of this article is available as a PDF (2.0 MB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Begg C. B., Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994 Dec;50(4):1088–1101. [PubMed] [Google Scholar]
  2. Bener A., Denic S., Galadari S. Longer breast-feeding and protection against childhood leukaemia and lymphomas. Eur J Cancer. 2001 Jan;37(2):234–238. doi: 10.1016/s0959-8049(00)00339-7. [DOI] [PubMed] [Google Scholar]
  3. Davis M. K. Breastfeeding and chronic disease in childhood and adolescence. Pediatr Clin North Am. 2001 Feb;48(1):125-41, ix. doi: 10.1016/s0031-3955(05)70289-3. [DOI] [PubMed] [Google Scholar]
  4. Davis M. K. Review of the evidence for an association between infant feeding and childhood cancer. Int J Cancer Suppl. 1998;11:29–33. [PubMed] [Google Scholar]
  5. Davis M. K., Savitz D. A., Graubard B. I. Infant feeding and childhood cancer. Lancet. 1988 Aug 13;2(8607):365–368. doi: 10.1016/s0140-6736(88)92835-8. [DOI] [PubMed] [Google Scholar]
  6. DerSimonian R., Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986 Sep;7(3):177–188. doi: 10.1016/0197-2456(86)90046-2. [DOI] [PubMed] [Google Scholar]
  7. Dockerty J. D., Skegg D. C., Elwood J. M., Herbison G. P., Becroft D. M., Lewis M. E. Infections, vaccinations, and the risk of childhood leukaemia. Br J Cancer. 1999 Jul;80(9):1483–1489. doi: 10.1038/sj.bjc.6690548. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Golding J., Paterson M., Kinlen L. J. Factors associated with childhood cancer in a national cohort study. Br J Cancer. 1990 Aug;62(2):304–308. doi: 10.1038/bjc.1990.283. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Goldman A. S. The immune system of human milk: antimicrobial, antiinflammatory and immunomodulating properties. Pediatr Infect Dis J. 1993 Aug;12(8):664–671. doi: 10.1097/00006454-199308000-00008. [DOI] [PubMed] [Google Scholar]
  10. Greaves M. Molecular genetics, natural history and the demise of childhood leukaemia. Eur J Cancer. 1999 Dec;35(14):1941–1953. doi: 10.1016/s0959-8049(99)00296-8. [DOI] [PubMed] [Google Scholar]
  11. Greenland S. Quantitative methods in the review of epidemiologic literature. Epidemiol Rev. 1987;9:1–30. doi: 10.1093/oxfordjournals.epirev.a036298. [DOI] [PubMed] [Google Scholar]
  12. Hardell L., Dreifaldt A. C. Breast-feeding duration and the risk of malignant diseases in childhood in Sweden. Eur J Clin Nutr. 2001 Mar;55(3):179–185. doi: 10.1038/sj.ejcn.1601142. [DOI] [PubMed] [Google Scholar]
  13. Hartley A. L., Birch J. M., McKinney P. A., Blair V., Teare M. D., Carrette J., Mann J. R., Stiller C. A., Draper G. J., Johnston H. E. The Inter-Regional Epidemiological Study of Childhood Cancer (IRESCC): past medical history in children with cancer. J Epidemiol Community Health. 1988 Sep;42(3):235–242. doi: 10.1136/jech.42.3.235. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Huttly S. R., Barros F. C., Victora C. G., Beria J. U., Vaughan J. P. Do mothers overestimate breast feeding duration? An example of recall bias from a study in southern Brazil. Am J Epidemiol. 1990 Sep;132(3):572–575. doi: 10.1093/oxfordjournals.aje.a115693. [DOI] [PubMed] [Google Scholar]
  15. Infante-Rivard C., Fortier I., Olson E. Markers of infection, breast-feeding and childhood acute lymphoblastic leukaemia. Br J Cancer. 2000 Dec;83(11):1559–1564. doi: 10.1054/bjoc.2000.1495. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Jourdan-Da Silva N., Perel Y., Méchinaud F., Plouvier E., Gandemer V., Lutz P., Vannier J. P., Lamagnére J. L., Margueritte G., Boutard P. Infectious diseases in the first year of life, perinatal characteristics and childhood acute leukaemia. Br J Cancer. 2004 Jan 12;90(1):139–145. doi: 10.1038/sj.bjc.6601384. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kaatsch P., Kaletsch U., Meinert R., Miesner A., Hoisl M., Schüz J., Michaelis J. German case control study on childhood leukaemia--basic considerations, methodology and summary of the results. Klin Padiatr. 1998 Jul-Aug;210(4):185–191. doi: 10.1055/s-2008-1043877. [DOI] [PubMed] [Google Scholar]
  18. Kramer M. S., Chalmers B., Hodnett E. D., Sevkovskaya Z., Dzikovich I., Shapiro S., Collet J. P., Vanilovich I., Mezen I., Ducruet T. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA. 2001 Jan 24;285(4):413–420. doi: 10.1001/jama.285.4.413. [DOI] [PubMed] [Google Scholar]
  19. Lancashire R. J., Sorahan T., OSCC Breastfeeding and childhood cancer risks: OSCC data. Br J Cancer. 2003 Apr 7;88(7):1035–1037. doi: 10.1038/sj.bjc.6600881. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Li Ruowei, Ogden Cynthia, Ballew Carol, Gillespie Cathleen, Grummer-Strawn Laurence. Prevalence of exclusive breastfeeding among US infants: the Third National Health and Nutrition Examination Survey (Phase II, 1991-1994). Am J Public Health. 2002 Jul;92(7):1107–1110. doi: 10.2105/ajph.92.7.1107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Linet M. S., Ries L. A., Smith M. A., Tarone R. E., Devesa S. S. Cancer surveillance series: recent trends in childhood cancer incidence and mortality in the United States. J Natl Cancer Inst. 1999 Jun 16;91(12):1051–1058. doi: 10.1093/jnci/91.12.1051. [DOI] [PubMed] [Google Scholar]
  22. Magnani C., Pastore G., Terracini B. Infant feeding and childhood cancer. Lancet. 1988 Nov 12;2(8620):1136–1136. doi: 10.1016/s0140-6736(88)90548-x. [DOI] [PubMed] [Google Scholar]
  23. Martinez G. A., Krieger F. W. 1984 milk-feeding patterns in the United States. Pediatrics. 1985 Dec;76(6):1004–1008. [PubMed] [Google Scholar]
  24. Mathur G. P., Gupta N., Mathur S., Gupta V., Pradhan S., Dwivedi J. N., Tripathi B. N., Kushwaha K. P., Sathy N., Modi U. J. Breastfeeding and childhood cancer. Indian Pediatr. 1993 May;30(5):651–657. [PubMed] [Google Scholar]
  25. McKinney P. A., Cartwright R. A., Saiu J. M., Mann J. R., Stiller C. A., Draper G. J., Hartley A. L., Hopton P. A., Birch J. M., Waterhouse J. A. The inter-regional epidemiological study of childhood cancer (IRESCC): a case control study of aetiological factors in leukaemia and lymphoma. Arch Dis Child. 1987 Mar;62(3):279–287. doi: 10.1136/adc.62.3.279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. McKinney P. A., Juszczak E., Findlay E., Smith K., Thomson C. S. Pre- and perinatal risk factors for childhood leukaemia and other malignancies: a Scottish case control study. Br J Cancer. 1999 Aug;80(11):1844–1851. doi: 10.1038/sj.bjc.6690609. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Murray L., McCarron P., Bailie K., Middleton R., Davey Smith G., Dempsey S., McCarthy A., Gavin A. Association of early life factors and acute lymphoblastic leukaemia in childhood: historical cohort study. Br J Cancer. 2002 Feb 1;86(3):356–361. doi: 10.1038/sj.bjc.6600012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Mwanda O. W. Cancers in children younger than age 16 years in Kenya. East Afr Med J. 1999 Jan;76(1):3–9. [PubMed] [Google Scholar]
  29. Norris J. M., Scott F. W. A meta-analysis of infant diet and insulin-dependent diabetes mellitus: do biases play a role? Epidemiology. 1996 Jan;7(1):87–92. doi: 10.1097/00001648-199601000-00015. [DOI] [PubMed] [Google Scholar]
  30. Perrillat F., Clavel J., Auclerc M. F., Baruchel A., Leverger G., Nelken B., Philippe N., Schaison G., Sommelet D., Vilmer E. Day-care, early common infections and childhood acute leukaemia: a multicentre French case-control study. Br J Cancer. 2002 Apr 8;86(7):1064–1069. doi: 10.1038/sj.bjc.6600091. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Perrillat Florence, Clavel Jacqueline, Jaussent Isabelle, Baruchel André, Leverger Guy, Nelken Brigitte, Philippe Noël, Schaison Gérard, Sommelet Danièle, Vilmer Etienne. Breast-feeding, fetal loss and childhood acute leukaemia. Eur J Pediatr. 2002 Apr;161(4):235–237. doi: 10.1007/s00431-001-0906-4. [DOI] [PubMed] [Google Scholar]
  32. Petridou E., Trichopoulos D., Kalapothaki V., Pourtsidis A., Kogevinas M., Kalmanti M., Koliouskas D., Kosmidis H., Panagiotou J. P., Piperopoulou F. The risk profile of childhood leukaemia in Greece: a nationwide case-control study. Br J Cancer. 1997;76(9):1241–1247. doi: 10.1038/bjc.1997.541. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Rosenbaum P. F., Buck G. M., Brecher M. L. Early child-care and preschool experiences and the risk of childhood acute lymphoblastic leukemia. Am J Epidemiol. 2000 Dec 15;152(12):1136–1144. doi: 10.1093/aje/152.12.1136. [DOI] [PubMed] [Google Scholar]
  34. Ross J. A., Potter J. D., Robison L. L. Infant leukemia, topoisomerase II inhibitors, and the MLL gene. J Natl Cancer Inst. 1994 Nov 16;86(22):1678–1680. doi: 10.1093/jnci/86.22.1678. [DOI] [PubMed] [Google Scholar]
  35. Schwartzbaum J. A., George S. L., Pratt C. B., Davis B. An exploratory study of environmental and medical factors potentially related to childhood cancer. Med Pediatr Oncol. 1991;19(2):115–121. doi: 10.1002/mpo.2950190209. [DOI] [PubMed] [Google Scholar]
  36. Schüz J., Kaletsch U., Meinert R., Kaatsch P., Michaelis J. Association of childhood leukaemia with factors related to the immune system. Br J Cancer. 1999 May;80(3-4):585–590. doi: 10.1038/sj.bjc.6690395. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Scott J. A., Aitkin I., Binns C. W., Aroni R. A. Factors associated with the duration of breastfeeding amongst women in Perth, Australia. Acta Paediatr. 1999 Apr;88(4):416–421. doi: 10.1080/08035259950169800. [DOI] [PubMed] [Google Scholar]
  38. Shore R. E., Gardner M. J., Pannett B. Ethylene oxide: an assessment of the epidemiological evidence on carcinogenicity. Br J Ind Med. 1993 Nov;50(11):971–997. doi: 10.1136/oem.50.11.971. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Shu X. O., Clemens J., Zheng W., Ying D. M., Ji B. T., Jin F. Infant breastfeeding and the risk of childhood lymphoma and leukaemia. Int J Epidemiol. 1995 Feb;24(1):27–32. doi: 10.1093/ije/24.1.27. [DOI] [PubMed] [Google Scholar]
  40. Shu X. O., Linet M. S., Steinbuch M., Wen W. Q., Buckley J. D., Neglia J. P., Potter J. D., Reaman G. H., Robison L. L. Breast-feeding and risk of childhood acute leukemia. J Natl Cancer Inst. 1999 Oct 20;91(20):1765–1772. doi: 10.1093/jnci/91.20.1765. [DOI] [PubMed] [Google Scholar]
  41. Slattery M. L., Edwards S. L., Caan B. J., Kerber R. A., Potter J. D. Response rates among control subjects in case-control studies. Ann Epidemiol. 1995 May;5(3):245–249. doi: 10.1016/1047-2797(94)00113-8. [DOI] [PubMed] [Google Scholar]
  42. Smulevich V. B., Solionova L. G., Belyakova S. V. Parental occupation and other factors and cancer risk in children: I. Study methodology and non-occupational factors. Int J Cancer. 1999 Dec 10;83(6):712–717. doi: 10.1002/(sici)1097-0215(19991210)83:6<712::aid-ijc2>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  43. Tuttle C. R., Dewey K. G. Potential cost savings for Medi-Cal, AFDC, food stamps, and WIC programs associated with increasing breast-feeding among low-income Hmong women in California. J Am Diet Assoc. 1996 Sep;96(9):885–890. doi: 10.1016/s0002-8223(96)00241-6. [DOI] [PubMed] [Google Scholar]
  44. Villalpando S., Hamosh M. Early and late effects of breast-feeding: does breast-feeding really matter? Biol Neonate. 1998;74(2):177–191. doi: 10.1159/000014022. [DOI] [PubMed] [Google Scholar]
  45. Wade J. C., Johnson D. E., Bustamante C. I. Monotherapy for empiric treatment of fever in granulocytopenic cancer patients. Am J Med. 1986 May 30;80(5C):85–95. [PubMed] [Google Scholar]
  46. Wiemels J. L., Cazzaniga G., Daniotti M., Eden O. B., Addison G. M., Masera G., Saha V., Biondi A., Greaves M. F. Prenatal origin of acute lymphoblastic leukaemia in children. Lancet. 1999 Oct 30;354(9189):1499–1503. doi: 10.1016/s0140-6736(99)09403-9. [DOI] [PubMed] [Google Scholar]
  47. van Duijn C. M., van Steensel-Moll H. A., van der Does-vd Berg A., van Wering E. R., van Zanen G. E., Valkenburg H. A., Rammeloo J. A. Infant feeding and childhood cancer. Lancet. 1988 Oct 1;2(8614):796–797. doi: 10.1016/s0140-6736(88)92445-2. [DOI] [PubMed] [Google Scholar]
  48. van Steensel-Moll H. A., Valkenburg H. A., van Zanen G. E. Childhood leukemia and infectious diseases in the first year of life: a register-based case-control study. Am J Epidemiol. 1986 Oct;124(4):590–594. doi: 10.1093/oxfordjournals.aje.a114431. [DOI] [PubMed] [Google Scholar]

Articles from Public Health Reports are provided here courtesy of SAGE Publications

RESOURCES