Foreword

Article Outline

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The incidence of infant leukemia has risen ∼2% each year over the past 20 years. We now understand that the genetic changes linked to infant leukemia begin in the womb and many scientists hypothesize that this increase may be associated with in utero environmental exposures that can alter genes.

One focus of attention has been maternal dietary exposures. Women are “eating for two” during pregnancy and epidemiologic studies in recent years have associated certain compounds found in coffee, tea, chocolate, and soy products with alterations in one specific gene and infant leukemia. In this issue, Dr. Patrick A. Zweidler-McKay from the Children’s Cancer Hospital at the University of Texas M. D. Anderson Cancer Center and Dr. Joanne M. Hilden from Peyton Manning Children’s Hospital at St. Vincent provide a comprehensive review, including a description of the data regarding specific components of the maternal diet and infant leukemia. They report recent progress in treatment and prevention, although much remains to be done.

After reading this article, I learned a great deal about how genes and environment interact in infant leukemia. The amount that we understand about gene-environment interactions for other childhood conditions is still relatively small. We look to the National Children’s Study to improve our knowledge of how the environment affects children’s health. This study will examine the effects of environmental influences on the health and development of more than 100,000 children across the United States, following them from before birth until age 21. Although there will not be enough cases of infant leukemia in the study to further evaluate the hypotheses in this article (only 5 cases would be expected in 100,000 births), the National Children’s Study should be able to further elucidate genetic and environmental risk factors for more common diseases. A broad definition of “environment” is being used, and the study will include a wide range of biological, physical, genetic, social, cultural and other factors. The National Children’s Study promises to be a rich resource for answering questions related to children’s health and the environment. With better understanding of how genes and environment interact, we should be able to improve prevention efforts for diseases that are on the increase.