الفهرس 
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Abstract
Childhood cancer represents nearly 1 to 4% of all cases affected with cancers and it is considered the 2nd cause of childhood death in developed countries. A global study found that in children aged zero to fourteen, the ASR was 140.6/million person-years. In Egypt, the crude Egyptian national incidence rates on children aged 0-15 years old was 132.9. ICD-O classified childhood cancer into 12 major groups. The prevalence of childhood malignancies varies by age groups and exposure to different risk factors.
Aim of the study:
This study was done to determine the risk factors of childhood cancer in children attending Minia oncology center.
Subjects and methods:
The study is an observational analytical case control study had been conducted in the Minia Oncology Center, Minia governorate, Egypt, from January to November 2020. A total (n= 192 ) child included in the study; ninety- six cases of childhood cancer included and a matched control with the same age and sex had been randomly selected for each case.
Official permissions were obtained from Public health and Preventive Medicine department, Minia University administration, and the scientific ethical committee of the collage. An approval was taken from Minia oncology center.
Data was collected from mothers of children by face-to-face interviews with cases in the Minia oncology center and controls in the household setting using a multi-component questionnaire; Sociodemographic data, socioeconomic status, history of disease of cases, environmental and dietary factors.
Results:
The study included ninety-six children diagnosed with cancer were included fifty-one males (53.1%) and forty-five females (46.9%), with a mean age of 9.08±4.97 years. One age and sex matched control was chosen for each case.
The most frequent type of cancer was leukemia (27.1%), followed by lymphoma (26%). About 15.6% were bone tumors, and 10.4% were brain and spinal tumors. The least frequent tumors were retinoblastoma and unspecified malignant neoplasms 2.1% and 1%, respectively. Leukemia and lymphoma were higher in males than females, while brain and spinal tumors, kidney tumors and retinoblastoma were higher in females than males.
According to age groups, leukemia was the highest percentage in children under five years and in age group from five to ten years old; (31.9%, 40%) respectively, while lymphoma represented 38.3% which was the highest percentage in children more than ten years.
Nearly 92.7% of cases were rural residents vs. control group (80.2%); p value = 0.01. Lower level of maternal and paternal education among cases, with a statistically significant differences observed; (p value= 0.01, 0.005) respectively. Parental consanguinity was higher among cases than controls (62.5 % vs. 20.8 %; P < 0.001). As regard child birth order, monthly income and family history of cancer, there were no differences.
Regarding early childhood feeding, there was a significant association exclusivity of breastfeeding and childhood cancer. About 71.8% of cases were not exclusively breastfed compared to 52.4% of control but there were no statistically significant differences were detected as regard breast feeding initiation, type of lactation and duration of lactation.
Margarine used in cooking, either eaten by the child or mother during pregnancy and preservative food, showed a link to increased cancer risk (p values= 0.001, 0.022) respectively. There were 87.5% of mothers of children affected with cancer used artificial ghee during pregnancy vs. 61.5% of mothers of healthy children (p value < 0.001). Maternal folic acid supplementation during pregnancy was significantly increased in control group (25%) compared to cases (3.1%).
Pesticides exposure among children who diagnosed with cancer was 37.5% compared to 21.9% in controls (p value = 0.018) and there was 35.4% of mothers of cases exposed to pesticides during pregnancy vs. 9.4% in controls (p value < 0.001).
The mean hours of daily exposure to smart phones was 5.67±3.21 hours/ day in cases compared to 4.23±2.81 hours/ day in controls and showed a significant association with cancer risk (p value = 0.009).
Finally, the regression model found that child age was inversely associated with the occurrence of cancer. Whereas, infrequent use of vegetables and fruits had higher odds of cancer occurrence compared to children who consumed fruits and vegetables frequently. Consanguinity linked to higher risk of cancer. In addition, children exposed to more hours of cell phone have higher odd of having cancer. Other factors as child sex, parents’ education and occupation, exposure to pesticides and consumption of foods containing preservatives, etc. showed no significant association with cancer.
Recommendations:
This study highlights the need for:
• Public health interventions as screening programs for early detection of childhood cancer.
• Strategies for accurate registration of childhood cancer cases in Egypt.
• Further studies to determine the possible risk factors of childhood cancer, starting from preconception period for parents through the period of pregnancy and what the mother is exposed to.
• Genetic studies to determine genes that may be the cause of many types of childhood cancer.
• Raising awareness of the importance of consuming vegetables and fruits frequently and avoiding margarine use in cooking.
• Health education of mothers about the dangerous effect of children exposure to mobile cell phones.
• Raising awareness about the potential harms of consanguineous marriage.
• On the light of the results of this study, a risk prediction model is made for further validation to can be used as a screening tool to detect high-risk cancer individuals.