[Dietetic factors associated with prostate cancer: protective effects of Mediterranean diet]. / Factores dietéticos asociados al cáncer de próstata. Beneficios de la dieta mediterránea.

OBJECTIVE: To review diet risk factors (RF) implied, more or less evidence-based, in the etiopathology of prostate carcinoma (PC), especially those that characterize the traditional Mediterranean diet (MD). MATERIAL AND METHODS: Literature review of PC related diet RF in MedLine, CancerLit, Science Citation Index y Embase. Search profiles were "Dietetic Factors/Nutritional Factors/Mediterranean Diet/Primary Prevention", and "Prostate Cancer". RESULTS: Diet RF are associated with 35% of cancer mortality and 10-12% of PC mortality. The main diet RF, implied in the development of PC but with a protective effect, which are considered characteristic of MD are: high daily ingestion of vegetarian products (cereals, legumes, dried and fresh fruits, tubers, vegetables..); olive oil as main lipid source; low intake of animal saturated fat, processed red meat, milk and dairy products; regular consumption of small fish; and low alcohol intake (wine with meals). The MD contains many phytoactive compounds (lycopene, lupeol, quercetin, genistein, carnosol, resveratrol, catechins, vitamins..) with PC protective effects. CONCLUSIONS: Diet RF have a role on prostatic carcinogenesis. Further epidemiologic studies with better designs are needed to clarify PC related diet RF. PC risk is reduced in persons on MD compared with those on Western diet. The preventive effect of MD is due to the great number and quality of phytochemicals with antioxidant and antinflammatory properties that contains.

[Constitutional risk factors in prostate cancer]. / Factores de riesgo constitucionales en el cáncer de próstata.

INTRODUCTION: The aim of this review is to update and divulge the main constitutional risk factors involved in the etiopathology of prostate cancer. MATERIALS AND METHODS: Bibliographic review of the scientific literature on the constitutional risk factors associated with prostate cancer between 1985 and 2010, obtained from MedLine, CancerLit, Science Citation Index and Embase. The search profiles were Risk Factors, Genetic Factors, Genetic Polymorphisms, Genomics, Etiology, Epidemiology, Hormonal Factors, Endocrinology, Primary Prevention and Prostate Cancer. RESULTS: The principal constitutional risk factors are: age (before the age of 50 years at least 0.7% of these neoplasms are diagnosed and between 75-85% are diagnosed after the age of 65 years), ethnic-racial and geographic (African Americans present the highest incidence rates, and the lowest are found in South East Asia), genetic, family and hereditary (family syndromes cover 13-26% of all prostate cancers, of which 5% are of autosomal dominant inheritance), hormonal (it is a hormone-dependent tumour), anthropometric (obesity increases the risk), perinatal, arterial hypertension and type 2 diabetes. CONCLUSIONS: Constitutional risk factors play a very important role in the etiopathology of prostate cancer, especially age, ethnic-racial-geographic factors and genetic-family factors. We cannot know what percentage of these neoplasms are a result of constitutional factors, because our knowledge of these factors is currently lacking.

[Non dietetic environmental risk factors in prostate cancer]. / Factores de riesgo ambientales no dietéticos en el cáncer de próstata.

INTRODUCTION: The aim is to update and disclose the main environmental risk factors, excluding dietary factors, involved in the etiopathology of prostate cancer. MATERIALS AND METHOD: Bibliographic review of the last 25 years of non-dietary environmental risk factors associated with prostate cancer between 1985 and 2010, obtained from MedLine, CancerLit, Science Citation Index and Embase. The search profiles were Environmental Risk Factors/Tobacco/Infectious-Inflammatory Factors/Pesticides/Vasectomy/Occupational Exposures/Chemoprevention Agents/Radiation and Prostate Cancer. RESULTS: While some non-dietary environmental risk factors increase the risk of acquiring the disease, others decrease it. Of the former, it is worth mentioning exposal to tobacco smoke, chronic infectious-inflammatory prostatic processes and occupational exposure to cadmium, herbicides and pesticides. The first factors that reduce the risk are the use of chemopreventive drugs (Finasterida, Dutasteride) and exposure to ultraviolet solar radiation. With the current data, a vasectomy does not influence the risk of developing the disease. CONCLUSIONS: The slow process of prostate carcinogenesis is the final result of the interaction of constitutional risk and environmental factors. Non-dietary environmental factors play an important role in the etiopathology of this disease. To appropriately assess the risk factors, extensive case studies that include all the possible variables must be analysed.

[Neonatal tumours and congenital malformations]. / Tumores neonatales y malformaciones congénitas.

INTRODUCTION: The association between pediatric cancer and congenital abnormalities is well known but, there is no exclusive data on the neonatal period and the underlying etiopathogenic mechanisms are unknown. OBJECTIVES: First, to analyze the frequency of neonatal tumours associated with congenital abnormalities; and second, to comment on the likely etiopathogenic hypotheses of a relationship between neonatal tumours and congenital abnormalities. MATERIALS AND METHOD: Historical series of neonatal tumours from La Fe University Children's Hospital in Valencia (Spain), from January 1990 to December 1999. Histological varieties of neonatal tumours and associated congenital abnormalities were described. A systematic review of the last 25 years was carried out using Medline, Cancerlit, Index Citation Science and Embase. The search profile used was the combination of "neonatal/congenital-tumors/cancer/neoplasms" and "congenital malformations/birth defects". RESULTS: 72 neonatal tumours were identified (2.8% of all pediatric cancers diagnosed in our hospital) and in 15 cases (20.8%) there was some associated malformation, disease or syndrome. The association between congenital abnormalities and neonatal tumours were: a) angiomas in three patients: two patients with congenital heart disease with a choanal stenosis, laryngomalacia; b) neuroblastomas in two patients: horseshoe kidney with vertebral anomalies and other with congenital heart disease; c) teratomas in two patients: one with cleft palate with vertebral anomalies and other with metatarsal varus; d) one tumour of the central nervous system with Bochdaleck hernia; e) heart tumours in four patients with tuberous sclerosis; f) acute leukaemia in one patient with Down syndrome and congenital heart disease; g) kidney tumour in one case with triventricular hydrocephaly, and h) adrenocortical tumour: hemihypertrophy. The publications included the tumours diagnosed in different pediatric periods and without unified criteria to classify the congenital abnormalities. Little data exist on the neonatal period and the majority are from medical institutions registers. The prevalence varies from 15 to 31.6%. To explain this association, the hypotheses are based on prenatal exposures (preconceptional and transplacental exposure), to mutagenic and carcinogenic risk factors. CONCLUSIONS: Neonatal tumours are more often associated to congenital abnormalities than other pediatric cancers. The inclusion and classification criteria needs to be unified to better understand the association between the neonatal tumours and congenital abnormalities. The environmental history in all neonatal tumours associated to congenital abnormalities, including the constitutional and environmental risk factors, will help to improve our knowledge of the underlying prenatal mechanisms and to an advance in its prevention.

[Risks factors for pediatric malignant liver tumors]. / Factores de riesgo para los tumores hepáticos malignos pediátricos.

OBJECTIVE: Pediatric Hepatic Malignancies (PHMs) are the result of the interaction between constitutional and environmental risk factors (RFs). We review the evidence on the main RFs associated to PHMs. METHOD: Systematic review of the literature published in the last 25 years on Medline, Embase, Cancerlit, Lilacs and SciElo using the following key words: "etiology/risk factor/epidemiology" and "malignant liver tumors/hepatic cancer" or "hepatoblastoma/hepatocarcionoma". RESULTS: PHMs account for 1 % of all pediatric malignancies. The main types, hepatoblastoma (HB) and hepatocarcionma (HCC) make up 98-99 % of PHM. The main constitutional RFs are: a) Beckwith-Wiedemann (BW) syndrome; b) isolated hemihyperplasia syndrome (IHS); c) adenomatous polyps of the colon; d) hemochromatosis; e) Hereditary Tyrosinemia Type 1; f) a -1-antitrypsin deficiency; g) porphyrias; h) cirrhosis; i) nonalcoholic steatosis; and j) primary sclerosing cholangitis. The main environmental RFs are: a) hepatitis B virus (HBV) and C virus (HCV); b) B1 aflatoxin (B1AF); c) ionizing radiation; d) alcohol; e) hormonal treatments; f) occupational exposure to pesticides, solvents, vinyl chloride and metals; g) smoking; h) arsenic; i) prematury and very low birth weight; and j) trematodes. CONCLUSIONS: The clinical, analytical and ultrasound screening facilitate the early diagnosis of HB in the previously mentioned genetic syndromes, particularly BW and IHS during the first years of life. HBV universal vaccination of newborns provides the biggest opportunity to prevent a substantial proportion of PHMs. Also systematic monitoring of HBV and HCV in blood, hemoderivates, donated organs and drug addicts, are very useful. Other effective measures are: the reduction/elimination of B(1)AF in food, zero alcohol intake during childhood and adolescence as well decreasing prenatal exposure to the tobacco, solvents, pesticides, vinyl chloride, metals, ionizing radiation and hormonal treatments.

[Neonatal tumors: clinical and therapeutic characteristics. Analysis of 72 patients in La Fe University Children's Hospital in Valencia (Spain)]. / Tumores neonatales: características clínicas y terapéuticas. Análisis de 72 casos del hospital infantil La Fe de Valencia.

BACKGROUND: Neonatal tumors, which represent only 1.5-2% of all pediatric tumors, have distinctive features. Their incidence is imprecise, as selection criteria vary and there are few published studies. OBJECTIVE: To analyze and disseminate findings on the histological, clinical, therapeutic and follow-up characteristics of neonatal tumors. MATERIAL AND METHODS: We performed a retrospective study of the clinical records of patients diagnosed with neonatal tumors in La Fe University Children's Hospital in Valencia (Spain) between January 1990 and December 1999. Hamartomas, flat and cavernous cutaneous hemangiomas, nevi, lipomas, subcutaneous fibroma, lymphangiomas, and epidermal cysts were excluded. A systematic review of the literature published in the previous 25 years was performed using Medline, Cancerlit, Index Citation Science, and Embase. The search profile combined neonatal or congenital and tumor or cancer or neoplasm. The most interesting studies, as well as the most relevant references contained in these studies and published before the search period, were selected. RESULTS: The clinical records of 72 patients with neonatal tumors (40 boys and 32 girls), representing 2.8% of all pediatric tumors, were reviewed. The most frequent tumors were hemangiomas (20.8%, 15 patients), neuroblastomas (16.7%, 12 patients), teratomas (12.5 %, 9 patients), and soft tissue tumors (9.7 %, 7 patients). Eighty-six percent of the patients were symptomatic during the first week of life. Although diagnosis was prenatal in 22.2 % of the patients, the most frequent findings on physical examination were identification of a mass or cutaneous lesion in 24 patients (33.3%) and an abdominal mass or hepatomegaly in 13 patients (18%). An associated disease, malformation or syndrome was found in 15 patients (20.8 %). Treatment included surgery (50% of patients) and drugs as monotherapy or coadjuvant therapy (13.9%). Thirteen patients received irradiation after the neonatal period. Spontaneous complete remission took place in six patients. Twenty patients died (27.8%). Mortality was highest in patients with central nervous system tumors or leukemias (83.3% and 75 % respectively). By contrast, none of the patients with hemangiomas or teratomas died. Mortality was low in patients with neuroblastoma (8.3%). At the time of the study, survival was 73 %, with a median follow-up of 8 years. CONCLUSIONS: Due to their biological features, neonatal tumors represent a distinctive subgroup in pediatric oncohematology. The concept of neonatal tumor should be unified to allow the results of different research groups to be analyzed and compared. Despite the methodological limitations found, the clinical, diagnostic, therapeutic, and follow-up characteristics of our patients are similar to those of other published series. The differences found could be explained by the diverse selection criteria employed.

[Risk factors associated with neonatal tumors. Experience of a pediatric environmental health specialty unit in Valencia (Spain)]. / Factores de riesgo asociados a los tumores neonatales. Experiencia de una unidad de salud medioambiental pediátrica (PEHSU-Valencia).

BACKGROUND: Neonatal tumors (NT) result from a variable combination of constitutional and environmental determinants. Multiple risk factors (RF) are involved in their development, although most are unknown. OBJECTIVE: To document the constitutional, environmental, preconceptional and transplacental RF associated with the development of NT with greater or lesser scientific evidence. PATIENTS AND METHODS: We investigated known RF in NT diagnosed at La Fe University Children's Hospital from January 1990 to December 1999, using a questionnaire completed by parents in a personal interview, either at the Pediatric Environmental Health Specialty Unit (PEHSU-Valencia) or at their home. RF associated with NT and childhood cancer were identified through a literature review of the last 25 years through Medline, Cancerlit, Science Citation Index, and Embase. RESULTS: The questionnaire was completed in 59 of 74 NT diagnosed during the period studied. All patients were Caucasians born in Spain. Constitutional-genetic factors were identified in 13.6 %: dominant hereditary syndromes in 5 (familial retinoblastoma in 1 and tuberous sclerosis in 4), and non-hereditary chromosomal syndromes in 3 (trisomy 21). Notable environmental factors were: a) ionizing radiation: preconceptional exposure in 32.2 % and in utero exposure in 6.8 %; b) non-ionizing radiation; 54.2 % reported preconceptional exposure and in utero exposure at home; c) pregnancy-related problems: infections in 13.6 % (8 patients) and a prior history of miscarriage in 20.3 %; d) drugs/chemicals administered during pregnancy: capillary dye in 42.4 %, daily facial make-up in 45.8 %, antacids in 30.5 %, acetaminophen in 34 %, hormone therapy in 10 %, cocaine and marijuana consumption in 11.7 %; e) tobacco: exposure to active smoking in 93.2 % of patients; f) alcohol: in utero exposure in 6.8 %; g) occupational exposure in parents: paternal in 49 % of cases (hydrocarbons in 15, metal in 3, chemical in 2, timber in 2, and agriculture in 7). Four were exposed to pesticides, 3 to solvents, and 3 to paints; and maternal in 12 cases (20 %): low frequency non-ionizing radiation in 6 (textile in 5, and railway in 1), 5 in the service sector (2 hairdressers, 3 cleaners), and 1 the in chemical industry. In another 6 there was exposure to solvents and paints (footwear industry). CONCLUSIONS: The hypotheses formulated in this observational study, which should be analyzed in future case-control and cohort studies, are: a) to scientifically document genetic-constitutional RF in the etiopathogenesis of NT; b) to determine the frequency and etiology of prior miscarriage and its possible association with NT; c) to determine the importance of active smoking before and during pregnancy as a RF for NT; d) to establish the importance of parental occupational exposure in the etiopathogenesis of NT; and e) to define more precisely the role of other physical and chemical RF in the development of NT. To determine and record the RF involved in the etiopathogenesis of NT, the environmental history should be documented in pediatric cancers. The identification of RF is one of the main objectives of Pediatric Environmental Health Specialty Units.

[Risk factors for pediatric malignant bone tumors]. / Factores de riesgo para los tumores óseos malignos pediátricos.

INTRODUCTION: Cancer is the result of the interaction of two kinds of determinants: genetic (endogenous) and environmental (exogenous). In the last few decades, pediatric oncology as a whole has progressed, including knowledge of malignant osseous tumors (MOT). Although advances have been made in diagnostic and therapeutic aspects, little progress has taken place in our knowledge of the risk factors involved in their etiopathogenesis. OBJECTIVE: This review has three objectives: a) to provide an update on MOT-related risk factors in the child and adult population; b) to disseminate knowledge of the main MOT-related risk factors among our colleagues in order to promote research into these factors, diagnosis and future prevention, and c) to request help from our colleagues in the Environment and Pediatric Cancer research project. MATERIAL AND METHODS: We performed a systematic review of the literature published in the last 30 years on risk factors implicated in the etiopathogenesis of MOT, using Medline, Cancerlit, Science Citation Index and Embase. The search profiles used were: pediatric/childhood malignant bone tumors, pediatric/ childhood bone cancer/neoplasm, osteosarcoma/bone sarcoma/Ewing's sarcoma and risk factors/etiology/epidemiology. The most interesting articles were selected and the most relevant references contained therein were retrieved. RESULTS: MOT represent 6-7 % of all pediatric neoplasms. The most frequent types are osteosarcoma (OS) and Ewing's sarcoma (ES), representing 56 % and 34 % respectively. OS-related risk factors are the following: a) previous osseous disease (Paget's disease); b) familial-genetic factors (hereditary retinoblastoma, Li-Fraumeni syndrome, Rothmund-Thompson syndrome, Bloom syndrome, familial OS, Diamond-Blackfan anemia); c) chemical factors (antineoplastic drugs); d) physical factors (ionizing radiation); e) biologic factors; f) parental occupation, and g) other factors (artificial osseous implants and traumatisms). ES-related risk factors are the following: a) ethnic-cultural (Caucasian race); b) genetic factors; c) parental occupation (herbicide, pesticide and fertilizer exposure); d) maternal obstetric history, and e) other factors (parental smoking and inguinal hernia). CONCLUSIONS: Most causes of MOT are unknown. Based on different levels of scientific evidence, the main factors implicated in the etiopathogenesis of OS are: Paget's disease, hereditary retinoblastoma, Li-Fraumeni syndrome, antineoplastic drugs, and ionizing radiation. The main factors related to ES are: Caucasian race, parental occupation, parental smoking, and surgery for inguinal hernia. The main obstacles to greater knowledge of MOT-related factors are: a) their multiple origin; b) the low prevalence in the population; c) lack of environmental health training in pediatrics, and d) the low public and private investment in this research field.

[Risk factors for neuroblastoma]. / Factores de riesgo para el neuroblastoma.

INTRODUCTION: NB is the most frequent pediatric cancer arising in the sympathetic nervous system and represents a serious healthcare challenge because: 1) it is the most frequent neoplasm in the first decades of life; 2) it biological behavior is unpredictable (spontaneous regression, maturation to ganglioneuroma, and localized and metastasized variants); and 3) little is known about most of the risk factors involved in its etiopathogenesis. The objective of this study was to disseminate knowledge of constitutional and environmental (physical, chemical, biological and social) risk factors linked to the development of neuroblastoma (NB), with various levels of scientific evidence. To seek collaboration among pediatricians in the research project "Environment and Pediatric Cancer". MATERIAL AND METHODS: We performed a systematic review of the literature published in the previous 25 years on risk factors for NB diagnosed in the first two decades of life, using Medline, the Science Citation Index and Embase. Search profiles were: "neuroblastoma/childhood sympathetic nervous system neoplasms and risk factors/etiology/epidemiology". The most interesting articles and the most relevant references contained therein were selected. RESULTS: With greater or lesser scientific evidence, the following risk factors increase the risk of developing NB: genetic factors; geographic factors; ethnic factors; socioeconomic factors; infectious factors; physical factors; parental occupational exposure; gestational factors; and perinatal and maternal factors. Preventive factors associated with a lower risk of developing NB are breastfeeding and intake of vitamin supplements during pregnancy. CONCLUSIONS: The main barriers to the identification of evidence-based risk factors involved in the development of NB are its complex biology and clinical course, its relative rarity and the difficulty of performing epidemiological studies. Research on constitutional and environmental factors involved in its etiopathogenesis should be stimulated. The best preventive strategy is to recommend breastfeeding for more than 6 months.

[Pediatric environmental health specialty units in Europe: from theory to practice]. / Unidades de salud medioambiental pediátrica en Europa: de la teoría a la acción.

BACKGROUND: The World Health Organization encourages the development of strategies to identify, increase awareness and solve problems of Pediatric Environmental Health (PEH) in units and centers of excellence. Pediatricians are in an excellent position to identify children at environmental risk, advise parents about the best way to reduce or prevent these risks, and recommend changes in health policies to politicians. OBJECTIVE: To inform pediatricians about the underlying principles and activities of pediatric environmental health specialty units (PEHSU) in Spain and Europe. To analyze up-to-date knowledge and the steps required for the development of PEH in Spain and Europe. MATERIAL AND METHODS: Review of the strategies, initiatives and examples of useful practices for national and international organizations involved in the development and implementation of PEH. Report of activities of PEHSUs. RESULTS: In Spain and Europe pediatricians do not receive training in PEH. PEHSUs are centers specialized in the diagnosis, treatment, and prevention of environmentally-related diseases. These centers are composed of multidisciplinary teams of health and other professionals, coordinated by pediatricians specialized in PEH, that have the study of environment-related pediatric problems as a common denominator. The activity of these units emphasizes teaching, research, scientific activity, the development of environmental history in pediatrics, diagnosis and treatment of the "pediatric environmental wound", assessment of risks in pediatrics, and specialization in the critical review of the literature on PEH to train pediatricians to be experts in environmental health. The activities and fields of PEHSU can be summarized as: medical care, training, research, and community health (school health). CONCLUSIONS: PEH should be considered by Ministries of Health and Pediatrics Associations as an important emergent area for current and future generations of pediatricians. Thus, it is necessary: a) to develop an integral plan for pediatric training in PEH; b) to actively seek funding and support to increase the presence of PEHSUs in Europe, and c) to create expert committees in PEH in National Associations of Pediatrics in Europe.

[Risk factors for Hodgkin's lymphomas]. / Factores de riesgo para los linfomas de Hodgkin.

OBJECTIVE: To divulge the risk factors associated with Hodgkin's lymphoma (HL) in children and adults among pediatricians. METHODS: We performed a literature review of the last 25 years through the Medline, IAR Cancer, and Cancerlit databases. The search profile was "HL risk factors". The most interesting papers, as well as those cited and published more than 25 years prior to the search, were selected. RESULTS: The following risk factors for HL were reported with greater or lesser evidence: a) genetic (variation in the HLA class II region); b) viral infections (Epstein-Barr virus); c) childhood environment and socio-economic status; d) congenital and acquired immunodeficiency; e) medical conditions and f) occupational exposure (the wood industry and its derivatives). CONCLUSIONS: The etiology of most HL is unknown. The most important risk factors are: 1) genetic; 2) Epstein-Barr virus (infectious mononucleosis); 3) congenital and acquired immunodeficiency; 4) occupational exposure (the wood industry).

[Risk factors for non-Hodgkin's lymphomas]. / Factores de riesgo para los linfomas no hodgkinianos.

OBJECTIVE: To divulge the risk factors for non-Hodgkin lymphomas (NHL) in children and adults among pediatricians. METHODS: We performed a literature review of articles published in the last 25 years through the Medline, IAR Cancer and Cancerlit databases. The search profile was "NHL risk factors". The most interesting papers, as well as the most relevant articles cited and published more than 25 years prior to the search, were selected. RESULTS: The following risk factors for the development of NHL were reported with greater or lesser evidence: socioeconomic status, family factors, immunodeficiencies, bacterial and viral infections, vaccinations and drugs, radiation,occupational exposure, exposure to animals, diet, and lifestyle. CONCLUSIONS: The etiology of most NHLs is unknown. The most important risk factors are: a) congenital and acquired immunodeficiency; b) viral (human T-cell leukemia virus type-I, Epstein-Barr virus, AIDS virus), and bacterial (Helicobacter pylori) infections; c) therapy with diphenylhydantoin and antineoplastic drugs, and d) exposure to pesticides and organic solvents.