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IARC 60th Anniversary - 19-21 May 2026

Session : Childhood Cancer Research in Action: Bridging Population Science and Discovery

Maternal Smoking and Risk of Childhood Cancer in Population-Based Registry Data: A Report from the Childhood Cancer and Leukemia International Consort

DOMINGUES A. 2, SPECTOR L. 1, TETTAMANTI G. 3, FEYCHTING M. 3, NIKKILÄ A. 4, AUVINEN A. 4, ABUHAMED J. 4, SCHEURER M. 5, LUPO P. 5, HECK J. 6, HANSEN J. 7, MUELLER B. 8, NELSON H. 1, MACLEHOSE R. 9, MARCOTTE E. 1

1 University of Minnesota, Minneapolis, MN, United States; 2 University of Cincinnati, Cincinnati, OH , United States; 3 Karolinska Institute, Stockholm, Sweden; 4 Tampere University, Tampere, Finland; 5 Emory University, Atlanta, GA, United States; 6 University of North Texas, Denton, TX, United States; 7 Danish Cancer Society, Copenhagen, Denmark; 8 Fred Hutchinson Cancer Research Center, Seattle, WA, United States; 9 Tulane University, New Orleans, LA, United States

Background: Although tobacco is an established carcinogen and components of tobacco smoke have been observed to cross the placental membrane, past studies of maternal prenatal smoking and childhood cancer have resulted in mixed or null results. However, the majority of studies have relied on case-control methods and may be susceptible to selection biases and differential exposure misclassification.

Objectives: We aimed to elucidate the nature of the relationship between maternal prenatal smoking and childhood cancer through a pooled analysis of record-linkage studies with the incorporation of probabilistic bias methods. 

Methods: Data for this analysis came from existing population-based case-control record-linkage studies in the Childhood Cancer and Leukemia International Consortium, with studies from the United States, Sweden, Finland, and Denmark, including more than 20,000 cases and 300,000 controls with prospectively collected information on maternal smoking. We assessed the association between maternal prenatal smoking and International Classification of Childhood Cancer Third Edition (ICCC-3) defined childhood cancer using logistic regression, controlling for relevant confounders. Additionally, we conducted probabilistic bias analysis to investigate the effect of exposure misclassification using sensitivities and specificities from validation studies of self-reported smoking based on cotinine and other biomarkers.

Results: Both before and after bias adjustment, maternal smoking was not associated with the majority of investigated cancers including the most common cancers in children, such as acute lymphoblastic leukemia. Maternal prenatal smoking was associated with only one heterogeneous childhood cancer type: other and unspecified malignant tumors (Bias-adjusted OR: 1.68, 95% SI:1.34-2.09).

Conclusions: This analysis supports previous studies’ findings that maternal prenatal smoking has little impact on the risk of childhood cancer with the potential exception of some tumors included in the other and unspecified category.

Funding: This research was supported by the National Cancer Institute (T32 CA099936).

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Forest plot of bias adjusted and unadjusted associations between maternal smoking and childhood cancer as classified by ICCC-3