A research team at The Hospital for Sick Children (HSC) and the University of Toronto (U of T) has shown that folic acid food fortification has resulted in a 60 per cent reduction in the incidence of neuroblastoma, a deadly childhood cancer. This research is reported in the September 2003 issue of the journal Clinical Pharmacology & Therapeutics.
"Our research indicates that this is the first paediatric cancer that can be prevented through maternal diet," said Dr. Gideon Koren, the study's principal investigator, director of HSC's Motherisk Program, a senior scientist in the HSC Research Institute, and a professor of Paediatrics, Pharmacology, Pharmacy and Medicine and Medical Genetics at U of T. "The role of folic acid in preventing neural tube defects such as spina bifida was already known. This study also suggests a link between folic acid and neuroblastoma."
Neuroblastoma is the second most common paediatric tumour and the most prevalent solid tumour that occurs outside of the brain in children under the age of five, affecting one in every 6,000 to 7,000 children in North America. Because this cancer develops in utero, neuroblastoma is the most commonly diagnosed malignant tumour of infancy. The aggressive nature of this tumour also makes it the most common cause of cancer-related death among children one to four years old.
When a number of Sick Kids oncologists noticed a decline in new neuroblastoma diagnoses, they sought to investigate the cause. In this study, the researchers looked at the incidence of neuroblastoma in Ontario, using the Pediatric Oncology Group of Ontario (POGO) registry, before and after the mandatory folic acid food fortification program. In 1997, Canada began fortifying flour with folic acid to aid in the prevention of neural tube defects. The POGO registry is a database that captures information on 95 per cent of all paediatric cancers in Ontario, which is submitted by the five major paediatric oncology centres in the province.
"This study shows the benefit of a population-based approach to studying childhood cancer, as we can look at trends and possible prevention strategies," said Dr. Mark Greenberg, a senior staff oncologist at Sick Kids, holder of the Pediatric Oncology Group of Ontario (POGO) Chair in Childhood Cancer Control, and a professor of Paediatrics and Surgery at U of T.
The research team also looked at the effect maternal folic acid intake had on infant acute lymphoblastic leukemia and hepablastoma, two childhood cancers that also have embryonal origins. However, no decline in these cancers was noted after the folic acid food fortification program was introduced.
"We need to investigate further the role of metabolism in the formation and prevention of neuroblastoma and other cancers that develop in utero. We will also look at whether folic acid has an impact on neuroblastoma after the cancer has already developed," added Dr. Koren.
Other members of the research team included Amy French, the study's lead author, a U of T graduate student, and the recipient of a National Sciences and Engineering Research Council of Canada scholarship and the ASCPT Presidential Student Award, Drs. Ron Grant, Sheila Weitzman, and Lillian Sung, all from The Hospital for Sick Children, and Dr. Joel Ray and Marian Vermeulen from Sunnybrook and Women's College Health Sciences Centre.
This research was supported by The Hospital for Sick Children Foundation.
The Hospital for Sick Children, affiliated with the University of Toronto, is Canada's most research-intensive hospital and the largest centre dedicated to improving children's health in the country. Its mission is to provide the best in family-centred, compassionate care, to lead in scientific and clinical advancement, and to prepare the next generation of leaders in child health. For more information, please visit www.sickkids.ca.