All EHP content is accessible to individuals with disabilities. A fully accessible (Section 508–compliant) HTML version of this article is available at http://dx.doi.org/10.1289/ehp.1306761. Research | Children’s Health Childhood Cancer and Traffic-Related Air Pollution Exposure in Pregnancy and Early Life Julia E. Heck, 1 Jun Wu, 2 Christina Lombardi, 1 Jiaheng Qiu, 3 Travis J. Meyers, 1 Michelle Wilhelm, 1 Myles Cockburn, 4 and Beate Ritz 1 1 Department of Epidemiology, School of Public Health, University of California, Los Angeles, Los Angeles, California, USA; 2 Program in Public Health and Department of Epidemiology, University of California, Irvine, Irvine, California, USA; 3 Department of Biostatistics, School of Public Health, University of California, Los Angeles, Los Angeles, California, USA; 4 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA B ackground : The literature on traffic-related air pollution and childhood cancers is inconclusive, and little is known on rarer cancer types. O bjectives : We sought to examine associations between childhood cancers and traffic-related p ollution exposure. M ethods : The present study included children < 6 years of age identified in the California Cancer Registry (born 1998–2007) who could be linked to a California birth certificate (n = 3,590). Controls were selected at random from California birthrolls (n = 80,224). CAlifornia LINE Source Dispersion Modeling, version 4 (CALINE4) was used to generate estimates of local traffic exposures for each trimester of pregnancy and in the first year of life at the address indicated on the birth certificate. We checked our findings by additionally examining associations with particulate matter (≤ 2.5 μm in aerodynamic diameter; PM 2.5 ) pollution measured by community-based air pollution monitors, and with a simple measure of traffic density. R esults : With unconditional logistic regression, a per interquartile range increase in exposure to traffic-related pollution during the first trimester (0.0538 ppm carbon monoxide, estimated using CALINE4) was associated with acute lymphoblastic leukemia [ALL; first trimester odds ratio (OR) = 1.05; 95% CI: 1.01, 1.10]; germ cell tumors (OR = 1.16; 95% CI: 1.04, 1.29), particularly teratomas (OR = 1.26; 95% CI: 1.12, 1.41); and retinoblastoma (OR = 1.11; 95% CI: 1.01, 1.21), particularly bilateral retinoblastoma (OR = 1.16; 95% CI: 1.02, 1.33). Retinoblastoma was also associated with average PM 2.5 concentrations during pregnancy, and ALL and teratomas were asso- ciated with traffic density near the child’s residence at birth. C onclusions : We estimated weak associations between early exposure to traffic pollution and several childhood cancers. Because this is the first study to report on traffic pollution in relation to retinoblastoma or germ cell tumors, and both cancers are rare, these findings require replication in other studies. C itation : Heck JE, Wu J, Lombardi C, Qiu J, Meyers TJ, Wilhelm M, Cockburn M, Ritz B. 2013. Childhood cancer and traffic-related air pollution exposure in pregnancy and early life. Environ Health Perspect 121:1385–1391; http://dx.doi.org/10.1289/ehp.1306761 Introduction Motor vehicle emissions are a major source of ambient air pollution in the United States and elsewhere. In a recent meeting, the International Agency for Research on Cancer (IARC) classified diesel exhaust as carcinogenic and gasoline exhaust as possibly carcinogenic to humans (Benbrahim-Tallaa et al. 2012). Traffic exhaust contains carbon monoxide, nitrogen oxides, and toxic air con- taminants such as benzene, formaldehyde, 1,3‑butadiene, and nitroarenes. Particulate components of traffic exhaust include met- als, elemental carbon, organic carbon, and sulphate. A number of these components have been classified as established or sus- pected carcinogens in occupational settings (IARC 2012). The literature on traffic-related air pol- lution and childhood cancers has been equivocal, likely for several reasons, includ- ing variation in exposure assessment methods and time periods of exposure. In addition, because of small numbers of cases, disparate cancer types were grouped as a single out- come. Many studies have used simple proxy measures of exposure such as rates of neigh- borhood car ownership, gas station density, or residential proximity to roads, gas stations, or car repair shops (Abdul Rahman et al. 2008; Alexander et al. 1996; Brosselin et al. 2009; Harrison et al. 1999; Nordlinder and Jarvholm 1997; Reynolds et al. 2002; Steffen et al. 2004; Weng et al. 2009). Other stud- ies have classified exposure based on traffic density (Harrison et al. 1999; Langholz et al. 2002; Pearson et al. 2000; Reynolds et al. 2001, 2002, 2004; Savitz and Feingold 1989; Visser et al. 2004; Von Behren et al. 2008). Only a few studies have classified exposure based on measurements of air pollutants from air monitors (Amigou et al. 2011; Weng et al. 2008) or sophisticated air pollution modeling strategies that consider more factors that influ- ence exhaust levels such as chemical reactions of pollutants, background pollution levels, land use, or weather (Crosignani et al. 2004; Feychting et al. 1998; Raaschou-Nielsen Environmental Health Perspectives • volume 121 | number 11-12 | November-December 2013 et al. 2001; Vinceti et al. 2012). In a previ- ous study that compared different ways of measuring traffic-related air pollution expo- sures in relation to birth outcomes, Wu et al. (2011) showed that traffic density yields lower effect estimates than those generated in more complex models. The literature is also limited in scope because most studies have reported only on leukemias, central nervous system (CNS) tumors, or all childhood cancer types com- bined, and few have had sufficient sample sizes to stratify by cancer subtypes or estimate associations with rarer tumors. Further, most studies assessed exposure using the child’s address at the time of diagnosis, study entry, or death, and are therefore best interpreted as estimating associations with traffic exposure during childhood. Because the pathogenesis of at least some childhood cancers is likely to begin in utero, these studies may not capture an important exposure period for early child- hood cancers (Greaves and Wiemels 2003; Lafiura et al. 2007). We a priori hypothesized that because of the fetus’s greater vulnerability to environ- mental toxins, exposures during the preg- nancy period would be most relevant for childhood cancer risk (Selevan et al. 2000). To our knowledge, six studies have examined associations between childhood cancers and exposures during pregnancy. Two reported that living near gas stations or auto repair garages was associated with acute lympho- blastic leukemia (ALL) and acute myeloid leukemia (AML) (Brosselin et al. 2009) or with all leukemias combined (Steffen et al. 2004). Of studies that evaluated traffic den- sity near the child’s residence, two reported Address correspondence to J. Heck, Department of Epidemiology, Box 951772, 650 Charles E. Young Dr., Los Angeles, CA 90095-1772 USA. Telephone: (310) 825-8579. E-mail: jeheck@ucla.edu We thank A. Park for his assistance with the manuscript. This study was supported by grants from the National Institute of Environmental Health Sciences (R21ES018960, R21ES019986, P30ES007048) and the National Cancer Institute (R25CA087949). The authors declare they have no actual or potential competing financial interests. Received: 5 March 2013; Accepted: 9 September 2013; Advance Publication: 10 September 2013; Final Publication: 1 December 2013.