Cancer Causes & Control

, Volume 3, Issue 4, pp 383–387 | Cite as

Neonatal exposure to protoporphyrin-activating lighting as a contributing cause of childhood acute lymphocytic leukemia

  • Shmuel A. Ben-Sasson
  • Devra Lee Davis
Hypothesis

Abstract

While being a relatively rare disease, acute lymphocytic leukemia (ALL) is the leading form of cancer in children in the developed world today. ALL sharply peaks in incidence at ages three to four years. In the United States there have been persistent, unexplained increases in incidence of ALL in the past two decades. We hypothesize that exposure to photosensitizing lighting immediately after birth may be a contributing cause of ALL. Fluorescent lamps and other light sources with strong illumination, around 400 nanometers, are protoporphyrin-activating. Activation of protoporphyrin produces superoxides and free radicals that can induce breaks in DNA. In newborn nurseries in the US, the intensity of lighting has increased five-to 10-fold over the past two decades. Thus, protoporphyrin-activating light may be a contributing cause of childhood ALL. Additional retrospective and prospective studies should be undertaken of the relationship between exposure of newborns to protoporphyrin-activating illumination and the development of childhood ALL, along with in vitro studies of the hematologic effects of fluorescent lighting. Protoporphyrin-activating lighting is clearly not the sole determinant of ALL, but it could be a completely preventable cause. Inexpensive plastic filters could reduce these exposures substantially.

Key words

ALL leukemia lighting nurseries porphyria protoporphyrins 

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References

  1. 1.
    US National Cancer Institute. Cancer Statistics Review 1973–1987. Bethesda, MD, USA: National Institutes of Health, 1990.Google Scholar
  2. 2.
    Campana, D, Janossy, G. Proliferation of normal and malignant human immature lymphoid cells. Blood 1988; 71: 1201–10.Google Scholar
  3. 3.
    Ichimaru, M, Ohkita, T, Ishimaru, T. Leukemia, multiple myeloma and malignant lymphoma. In: Shigematsu, I, Kagan, A, eds. Cancer in Atomic Bomb Survivors. New York: Plenum Press, 1986; Gann Monograph on Cancer Research, No. 32: 113–28.Google Scholar
  4. 4.
    Stewart, AM, Kneale, GW. Age-distribution of cancers caused by obstetric X-rays and their relevance to cancer latent period. Lancet 1970; ii: 4–8.Google Scholar
  5. 5.
    Smith, PG, Doll, R. Mortality among patients with ankylosing spondylitis after a single treatment course with X-rays. Br Med J 1982; 284: 449–60.Google Scholar
  6. 6.
    Pinkel, D, Nefzger, D. Some epidemiological features of childhood leukemia in the Buffalo, NY area. Cancer 1959; 12: 351–8.Google Scholar
  7. 7.
    Elliott, E, Githens, JH, Saunders, LH. The influence of socioeconomic factors on the incidence of childhood leukemia. Am J Dis Child Soc Trans 1961; 102: 483–4.Google Scholar
  8. 8.
    Fasal, E, Jackson, EW, Klauber, MR. Birth characteristics and leukemias in childhood. JNCI 1971; 47: 501–9.Google Scholar
  9. 9.
    McWhirter, WR. The relationship of incidence of childhood lymphoblastic leukaemia to social class. Br J Cancer 1982; 46: 640–5.Google Scholar
  10. 10.
    Birch, JM, Swindell, R, Marsden, HB, Morris Jones, PH. Childhood leukaemia in North West England 1954–1977: epidemiology, incidence and survival. Br J Cancer 1981; 43: 324–9.Google Scholar
  11. 11.
    Van, Steensel-Moll, HA, Valkenburg, HA, Van, Zanen, GE. Childhood leukemia and parental occupation: A register-based case-control study. Am J Epidemiol 1985; 121: 216–24.Google Scholar
  12. 12.
    Burbank, F, Fraumeni, JF Jr. US cancer mortality: non-white predominance. JNCI 1972; 49: 649–59.Google Scholar
  13. 13.
    Rosenthal, P, Rimm, IJ, Umiel, T, et al. Ontogeny of human hematopoietic cells: analysis utilizing monoclonal antibodies. J Immunol 1983; 131: 232–7.Google Scholar
  14. 14.
    Foon, KA, Schroff, RW, Gale, RP. Surface markers on leukemia and lymphoma cells: recent advances. Blood 1982; 60: 1–19.Google Scholar
  15. 15.
    Kamps, WA, Cooper, MD. Microenvironmental studies of pre-B and B cell development in human and mouse fetuses. J Immunol 1982; 129: 526–31.Google Scholar
  16. 16.
    Broxmeyer, HE, Douglas, GW, Hangoc, G, et al. Human umbilical cord blood as a potential source of transplantable hematopoietic stem/progenitor cells. Proc Natl Acad Sci 1989; 86: 3828–32.Google Scholar
  17. 17.
    Eales, L. Liver involvement in erythropoietic protoporphyria (EP). Int J Biochem 1980; 12: 915–23.Google Scholar
  18. 18.
    Malik, Z, Djaldetti, M. Destruction of erythroleukemia, myelocytic leukemia and Burkitt lymphoma cells by photoactivated protoporphyrin. Int J Cancer 1980; 26: 495–500.Google Scholar
  19. 19.
    Kappas, A, Sassa, S, Anderson, KE. The porphyrias. In: Stanbury, JB, Wyngaarden, JB, Fredrickson, DS, goldstein, JL et al, eds. The Metabolic Basis of Inherited Disease, 5th edn, New York: McGraw-Hill, 1983: 1301–84.Google Scholar
  20. 20.
    Magnus, IA. Dermatological Photobiology: Clinical and Experimental Aspects. Oxford: Blackwell Scientific Publications, 1976: 41–53, 236–59.Google Scholar
  21. 21.
    Spikes, JD. Photobiology of porphyrins. Prog Clin Biol Res 1984; 170: 19–39.Google Scholar
  22. 22.
    Buettner, GR, Oberley, LW. Superoxide formation by protoporphyrin as seen by spin trapping. FEBS Lett 1979; 98: 18–20.Google Scholar
  23. 23.
    Evensen, JF, Moan, J. Photodynamic action and chromosomal damage: A comparison of haematoporphyrin derivative (HpD) and light with X-irradiation. Br J Cancer 1982; 45: 456–65.Google Scholar
  24. 24.
    Kessel, D. Components of hematoporphyrin derivatives and their tumor-localizing capacity. Cancer Res 1982; 42: 1703–6.Google Scholar
  25. 25.
    Gottuso, MA, Oski, BF, Oski, FA. Free erythrocyte porphyrins in cord blood. J Pediatr 1978; 92: 810–2.Google Scholar
  26. 26.
    Heese, HD, Dempster, WS, Pocock, F. Free erythrocyte protoporphyrin levels in the first year of life. S Afr Med J 1983; 64: 237–9.Google Scholar
  27. 27.
    McDonagh, AF, Falma, LA, Lightner, DA, Blue light and bilirubin excretion. Science 1980; 208: 145–51.Google Scholar
  28. 28.
    Sideris, EG, Papageorgiou, GC, Charalampous, SC, et al. A spectrum response study on single strand DNA breaks, sister chromatid exchanges, and lethality induced by phototherapy lights. Pediatr Res 1987; 15: 1019–23.Google Scholar
  29. 29.
    Hopkinson RG. Lighting and lighting devices. In: The Encyclopedia Britannica, 15th edn, 1974; 10: 957–65.Google Scholar
  30. 30.
    Glass, P, Avery, GB, Subramanian, KN, et al. Effect of bright light in the hospital nursery on the incidence of retinopathy of prematurity. N Engl J Med 1985; 313: 401–4.Google Scholar
  31. 31.
    Everett, MA, Yeargers, E, Sayre, RM, et al. Penetration of epidermis by ultraviolet rays. Photochem Photobiol 1966; 5: 533–42.Google Scholar
  32. 32.
    Dougherty, TJ, Lawrence, G, Kaufman, JH, et al. Photoradiation in the treatment of recurrent breast carcinoma. JNCI 1979; 62: 231–7.Google Scholar
  33. 33.
    Magnus, IA, Janousek, V, Jones, K. The effect of environmental lighting on porphyrin metabolism in the rat. Nature 1974; 250: 504–5.Google Scholar
  34. 34.
    Le, Beau, MM, Rowley, JD. Chromosomal abnormalities in leukemia and lymphoma: clinical and biological significance. Adv Hum Genet 1986; 15: 1–54.Google Scholar
  35. 35.
    Roos, D, Weening, RS, Voetman, AA, et al. Protection of phagocytic leukocytes by endogenous glutathione: Studies in a family with glutathione reductase deficiency. Blood 1979; 53: 851–66.Google Scholar
  36. 36.
    Babior, BM. Oxygen-dependent microbial killing by phagocytes (first of two parts). N Engl J Med 1978; 298: 659–68.Google Scholar
  37. 37.
    Perianin, A, Labro-Bryskier, MT, Marquetty, C, et al. Glutathione reductase and nitroblue tetrazolium reduction deficiencies in neutrophils of patients with primary idiopathic myelofibrosis. Clin Exp Immunol 1984; 57: 244–8.Google Scholar
  38. 38.
    Bentfeld, ME, Nichols, BA, Bainton, DF. Ultrastructural localization of peroxidase in leukocytes of rat bone marrow and blood. Anat Rec 1977; 187: 219–40.Google Scholar
  39. 39.
    Arrick, BA, Nathan, CF. Glutathione metabolism as a determinant of therapeutic efficacy: a review. Cancer Res 1984; 44: 4224–32.Google Scholar
  40. 40.
    Gustafsson, G, Kreuger, A. Incidence of childhood leukemia in Sweden 1975–1980. Acta Paediatr Scand 1982; 71: 887–92.Google Scholar
  41. 41.
    Baijal, E, Roworth, M, Walker, D, et al. An investigation of apparent leukaemia clusters in Fife by validation of cancer register data and a case-control study. Public Health 1989; 103: 91–7.Google Scholar
  42. 42.
    Van, Steensel-Moll, HA, Van, Duijn, CM, Valkenburg, HA, Van, Zanen, GE. Predominance of hospital deliveries among children with acute lymphocytic leukemia: speculations about neonatal exposure to fluorescent light (Comment), 1992. Cancer Causes Control 1992; 3: 389–390.Google Scholar
  43. 43.
    Zack, M, Adami, HO, Ericson, A. Maternal and perinatal risk factors for childhood leukemia. Cancer Res 1991; 51: 3696–701.Google Scholar

Copyright information

© Rapid Communications of Oxford Ltd 1992

Authors and Affiliations

  • Shmuel A. Ben-Sasson
  • Devra Lee Davis

There are no affiliations available

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