Pediatric cancer rates after universal folic acid flour fortification in ontario

Sandy G. Grupp, Mark L. Greenberg, Joel G. Ray, Usoa Busto, Krista L. Lanctôt, Irena Nulman, Gideon Koren

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36 Scopus citations


Following the introduction of mandatory Canadian folic acid flour fortification in mid-1997, the incidence of selected childhood cancers that declined in Ontario prior to and subsequent to this public policy initiative was examined. A population-based cohort study of all incident cases of childhood malignancy in Ontario between the years 1985 and 2006 was conducted. Participants were identified from a database provided by the Pediatric Oncology Group of Ontario and included children 0 to 4 years of age and 5 to 9 years of age who were diagnosed with cancer. Among children aged 0 to 4 years, the incidence rate of Wilms' tumor declined from 1.94 to 1.43 per 100 000 (incidence rate ratio 0.74, 95% confidence interval, 0.57-0.95). No significant change was seen in the prefortification vs postfortification time periods for acute lymphoblastic leukemia, brain cancers, or embryonal cancers among the 0- to 4-year or 5- to 9-year age groups. There was an approximately 30% reduction in risk of Wilms' tumor following introduction of the initiative. This corroborates a recent case-control study from Germany. These data may also provide some reassurance that universal flour fortification does not heighten the risk of pediatric cancer.

Original languageEnglish
Pages (from-to)60-65
Number of pages6
JournalJournal of Clinical Pharmacology
Issue number1
StatePublished - Jan 2011
Externally publishedYes


  • Clinical pharmacology
  • clinical trials
  • geriatrics
  • pharmacokinetics and drug metabolism
  • pharmacology


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