Leukemia risk in children exposed to benzene and PM10 from vehicular traffic: a case–control study in an Italian population

Marco Vinceti, Kenneth J. Rothman, Catherine M. Crespi, Antonella Sterni, Andrea Cherubini, Luisa Guerra, Giuseppe Maffeis, Enrica Ferretti, Sara Fabbi, Sergio Teggi, Dario Consonni, Gianfranco De Girolamo, Alessandro Meggiato, Giovanni Palazzi, Paolo Paolucci, Carlotta Malagoli

Benzene, a recognized occupational leukemogen in adults, has been hypothesized to also increase the risk of childhood leukemia. We carried out a population-based case-control study in a northern Italy community involving 83 cases with acute childhood leukemia diagnosed in the years 1998-2009 and 332 matched controls. We assessed residential exposure to benzene and to particulate matter ≤10 μm (PM10) from motorized traffic using geocoded residences and detailed emission and dispersion modeling. Exposure to benzene, and to a lesser extent to PM10, appeared to be independently associated with an excess leukemia risk. When we stratified the study population by age and by leukemia subtype, the relative risk associated with benzene exposure was higher among children aged less than 5 years, and despite small numbers this relation appeared to be considerably stronger for acute myeloid leukemia than for acute lymphoblastic leukemia. Overall, these findings suggest that exposure to low levels of benzene released from motorized traffic may increase the risk of childhood leukemia, and suggest a possible independent effect of PM10, although unmeasured confounding due to other pollutants cannot be ruled out.