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Meta-Analysis
. 2021 Apr 13;19(1):90.
doi: 10.1186/s12916-021-01950-5.

Breastfeeding and the risk of childhood cancer: a systematic review and dose-response meta-analysis

Qing Su #  1 , Xiaohui Sun #  1 , Liwen Zhu #  2 , Qin Yan  1 , Peiwen Zheng  3 , Yingying Mao  4 , Ding Ye  5
Affiliations
Meta-Analysis

Breastfeeding and the risk of childhood cancer: a systematic review and dose-response meta-analysis

Qing Su et al. BMC Med. .

Abstract

Background: The aim of this study was to quantitatively summarize the available evidence on the association of breastfeeding with the risk of childhood cancer.

Methods: A literature search of PubMed and Embase databases was performed to identify eligible observational studies published from inception to July 17, 2020. The categorical and dose-response meta-analysis was conducted by pooling relative risk (RR) or odds ratio (OR) estimates with 95% confidence intervals (CIs). Potential sources of heterogeneity were detected by meta-regression and stratification analysis. Sensitivity analysis and publication bias test were also carried out.

Results: Forty-five articles involving 475,579 individuals were included in the meta-analysis. Among the thirty-three studies on the association between breastfeeding and risk of childhood leukemia, the pooled risk estimates were 0.77 (95% CI, 0.65-0.91) and 0.77 (95% CI 0.63-0.94) for ever versus non/occasional breastfeeding and longest versus shortest breastfeeding duration group, respectively. There was clear indication for non-linear dose-response relationship between breastfeeding duration and the risk of childhood leukemia (P non-linear < 0.001). The most protective effect (OR, 0.66, 95% CI 0.62-0.70) was observed at a breastfeeding duration of 9.6 months. Four studies examined, the association between breastfeeding and risk of childhood neuroblastoma, and significant inverse associations were consistently observed in both the comparisons of ever breastfeeding versus non/occasional breastfeeding (OR = 0.59, 95% CI 0.44-0.81) and longest versus shortest breastfeeding (OR = 0.61, 95% CI 0.44-0.83). However, no associations of breastfeeding with risk of other cancers were found.

Conclusions: Our study supports a protective role of breastfeeding on the risk of childhood leukemia, also suggesting a non-linear dose-response relationship. Further studies are warranted to confirm the association between breastfeeding and risk of childhood neuroblastoma.

Keywords: Breastfeeding; Childhood cancer; Dose-response; Meta-analysis.

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Conflict of interest statement

The authors have declared no conflict of interests.

Figures

Fig. 1
Fig. 1
Forest plots for pooled risk estimates and the corresponding 95% confidence intervals (CIs) of childhood leukemia risk for a breastfeeding vs. non/occasional breastfeeding and b longest vs. shortest breastfeeding duration
Fig. 2
Fig. 2
Risk estimates (solid line) and the corresponding 95% CIs (dash lines) for the dose-response relationship between breastfeeding and the risk of childhood leukemia
Fig. 3
Fig. 3
Forest plots for pooled risk estimates and the corresponding 95% confidence intervals (CIs) of childhood lymphoma risk for a breastfeeding vs. non/occasional breastfeeding and b longest vs. shortest breastfeeding duration
Fig. 4
Fig. 4
Forest plots for pooled risk estimates and the corresponding 95% confidence intervals (CIs) of the risk of childhood brain tumors for a breastfeeding vs. non/occasional breastfeeding and b longest vs. shortest breastfeeding duration
See this image and copyright information in PMC

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