Background: Childhood cancer (CC) is a leading cause of death among
children aged 0-19 years worldwide. Each year, 400,000 new cases of CC
are diagnosed globally. Given the between-country differences in CC
incidence rates, types and trends, this study aimed to identify possible
risk factors for CC in Armenia. Methods: We used a case-control study
design by enrolling participants from the only specialized pediatric
hematology and oncology center in Armenia. Cases included patients ≤14
years old diagnosed and treated with a malignant disease between
2017-2020 in the centre. Controls included patients diagnosed and
treated in the center during the same period for a non-malignant
disease. We conducted telephone interviews with mothers of cases and
controls. Independent risk factors of cancer were identified using
multivariable logistic regression analysis. Results: Overall, 234
participants (117 cases, 117 controls) were included in the study. Based
on the fitted model, maternal usage of folic acid during pregnancy was
protective against CC, almost twice decreasing its odds (OR=0.54; 95%
CI: 0.31-0.94). On the contrary, experiencing horrifying/terrifying
event(s) during pregnancy (OR=2.19; 95% CI: 1.18-4.07) and having
induced abortions before getting pregnant with the given child (OR=2.94;
95% CI: 1.45-5.96) were associated with higher odds for a child to
develop cancer. Conclusion: This study identified three important
modifiable risk factors for CC in Armenia, all related to the period of
pregnancy. The findings indicate the importance of education on stress
reduction during pregnancy, the use of folic acid prior to and during
pregnancy, and avoidance of induced abortions.
Risk Factors of Childhood Cancer in Armenia: A Case-Control Study