Folic acid food enrichment potentially protective against childhood cancers

The new research, published online May 22 in the journal Pediatrics, shows fortification does not appear to be causing childhood cancer rates to increase, and also finds a notable decrease in two types of childhood cancer.

This study was led by Amy Linabery, Ph.D., postdoctoral fellow in the University of Minnesota's Division of Pediatric Epidemiology and Clinical Research, and Kimberly Johnson, Ph.D., assistant professor in the Brown School at Washington University in St. Louis, and co-authored by Julie Ross, Ph.D., professor and director of the Division of Pediatric Epidemiology and Clinical Research at the University of Minnesota. Funding was provided by the National Institutes of Health (NIH) and the Children's Cancer Research Fund, Minneapolis.

Grain product fortification began in 1996, after the FDA determined prenatal folic acid could benefit infants by reducing the occurrence of neural tube defects (such as spina bifida) and wanted to expand the benefits to all newborns. The population-level study by Linabery and colleagues compared data for incidence of childhood cancers before and after fortification began, using statistics from the National Cancer Institute (NCI) between 1986 and 2008; more than 8,000 cancer cases were evaluated.

"We were looking to see if rates for childhood cancers dropped following the fortification mandate," said Linabery. "We were also watching closely to see if any cancers appeared to increase during the same time frame."

While some cancers appeared unaffected by the fortification, others showed a notable decrease following the FDA mandate. Specifically, both Wilms tumor, the most common type of kidney cancer in children, and primitive neuroectodermal tumor (PNET), a type of brain tumor, saw a significant decrease in occurrence following the start of grain product fortification. No cancers appeared to rise in response to fortification according to the analyzed data.

The lack of rising cancer rates suggests that the folic acid fortification does not appear to cause unintended harm for children. Linabery also points out the primary benefit of folic acid in preventing neural tube defects, adding to the case for continued fortification.

There is much more research to be done. Linabery says, "These results help generate further hypotheses regarding folic acid's potential impact in cancer biology. The data we found on Wilms tumor and PNET in children warrants a closer investigation to determine the role of folic acid in possibly preventing these diseases."