Folic acid slashes neuroblastoma figures

Folic acid food fortification has more than halved the incidence in Canada of the deadly childhood cancer neuroblastoma, report researchers from The Hospital for Sick Children (HSC) and the University of Toronto.

Folic acid has already been shown to prevent neural tube defects but this is the first evidence to show a strong link between the vitamin and neuroblastoma, write the researchers in this month's Clinical Pharmacology & Therapeutics​.

"Our research indicates that this is the first paediatric cancer that can be prevented through maternal diet,"​ said Dr Gideon Koren, the study's principal investigator, a senior scientist in the HSC Research Institute, and a professor at the University of Toronto.

Neuroblastoma is the second most common paediatric tumour and the most prevalent solid tumour that occurs outside of the brain in children under the age of five. It affects one in every 6,000 to 7,000 children in North America and because it develops in utero, neuroblastoma is the most commonly diagnosed malignant tumour of infancy.

Oncologists at the Sick Kids​ hospital had noticed a decline in new neuroblastoma diagnoses. The researchers looked at the incidence of neuroblastoma in Ontario, using the Pediatric Oncology Group of Ontario (POGO) registry, (which contains information on 95 per cent of all paediatric cancers in Ontario) before and after the mandatory folic acid food fortification programme, begun in 1997 to help prevent neural tube defects.

The incidence of neuroblastoma dropped from 1.57 cases per 10,000 births before, to 0.62 cases per 10,000 births after folic acid fortification, representing a reduction of 60 per cent.

"This study shows the benefit of a population-based approach to studying childhood cancer, as we can look at trends and possible prevention strategies,"​ said Dr Mark Greenberg, a senior staff oncologist at Sick Kids and a professor of Paediatrics and Surgery at the University of Toronto.

The research team also looked at the effect maternal folic acid intake had on infant acute lymphoblastic leukaemia and hepablastoma, two childhood cancers that also have embryonal origins. However, no decline in these cancers was noted after the folic acid food fortification programme was introduced.

"We need to investigate further the role of metabolism in the formation and prevention of neuroblastoma and other cancers that develop in utero. We will also look at whether folic acid has an impact on neuroblastoma after the cancer has already developed,"​ added Dr Koren.

The US and Chile have also introduced mandatory fortification of flour with folic acid, but despite the success of the initiatives demonstrated by recent studies, European governments still resist pressure to follow the move. The UK's Food Standards Agency last year decided against fortification on the grounds that not enough was known about the potential adverse effects in the older population.