Lactancia materna y riesgo de cancer infantil

Lactancia materna

―XL CONGRESO MÉDICO NACIONAL―
y riesgo de
cáncer pediátrico
―RESEÑA DE LA EVIDENCIA―

29-30-31 octubre 2009

Lactancia materna y riesgo de cáncer pediátrico

1. Efecto de la lactancia materna en
la morbilidad infantil.
Dr. Frank Cajina Gómez

la mortalidad infantil.

el desarrollo intelectual y motor.

las enfermedades crónicas.

la salud materna.

6. Beneficios económicos de la
lactancia materna.

7. Bibliografía y Cuadros.

Junio 2002


Children who are artificially fed or breastfed for only 6 months or less, are at an
increased risk of developing cancer before age 15. The risk of artificially fed
children was 1-8 times that of long-term breastfed children, and the risk for
short term feeders was 1-9 times that of long term breast feeders.

Davis, MK. Infant Feeding and Childhood Cancer. The Lancet 1988 August ;332 (8607):365-368.

Los niños que son alimentados artificialmente o amamantados por sólo 6 me-
ses o menos, están en un riesgo aumentado de desarrollar cáncer antes de los
15 años de edad. El riesgo de los niños alimentados artificialmente fue de 1-8
veces que los amamantados a largo plazo, y el riesgo para los alimentados a
corto plazo fue de 1-9 veces que los alimentados con pecho a largo plazo.

Greaves MF.
Speculations on the cause of childhood acute lymphoblastic leukemia.
Leukemia 1988; 2: 120–125.


EVIDENCIA
RESEÑA DE LA


RESEÑA DE LA EVIDENCIA

Lactancia materna y cáncer infantil.
Autores, Métodos Resultados significativos Conclusión
año y lugar
Mathur GP, Between April 1991 The duration of total breast feeding was Estos resultados sugieren que la
et al (1993 and June 1992 in significantly longer for controls than cases (10 LM tiene un efecto protector
May) India, physicians months vs. 8 months; p .05). The difference
compared data on between mean duration of exclusive breast contra el cáncer infantil. Además,
Kanpur, 99 childhood feeding between cases and controls was estos indican que la LME
India. cancer cases with significant (4.6 months vs. 3.2 months; p .001). proporciona efectos inmunológicos
data on 90 sex, Controls were more likely to have undergone a más beneficiosos que la LM
age, and hospital longer duration of total breast feeding and
matched controls to exclusive breast feeding than were lymphoma complementada con la
examine the cases (10 months vs. 6.15 months; p .01 and 4.6 alimentación artificial. La alta tasa
relationship months vs. 3 months; p .001, respectively). 58% of LME en la India puede explicar la
between duration of lymphoma cases had non-Hodgkins lymphoma. baja incidencia de cáncer infantil
total breast feeding When the researchers compared other cancer
and exclusive groups and controls, no significant difference (p.ej, alrededor de 6/100,000 vs.
breast feeding and between the 2 groups existed in respect to total 18/100,000 en Israel).
childhood cancer. breast feeding and exclusive breast feeding

Mathur GP, Gupta N, Mathur S, Gupta V, Pradhan S, Dwivedi JN, Tripathi BN, Kushwaha KP, Sathy N, Modi UJ, et al.
Breastfeeding and childhood cancer. Indian Pediatr. 1993 May;30(5):651-7.



Lactancia materna y riesgo de leucemia aguda infantil.
año y lugar
Shu XO, et Data from a After adjustment for potentially Aunque promover ni apoya fuerte ni
al. (1995 population-based confounding variables, a slight, although refuta la hipótesis del estudio, estos
Feb) case-control study non-significant, reduction in risk of
People's of childhood cancer lymphoma was observed among children datos sugieren que si la LM reduce
Republic of in Shanghai, who were breastfed as infants versus realmente el riesgo de linfoma, su efecto
China including 82 those who were not (odds ratio [OR] = protector entre niños chinos es
lymphoma cases 0.69; 95% CI: 0.3-1.7). The reduction was probablemente modesto en la magnitud
and 159 acute somewhat greater for children who had
leukaemia cases been breastfed longer and appeared to y concentración en ciertos subgrupos
and their age- and pertain primarily to Hodgkin's disease and definidos por la prolongación de la LM,
sex-matched to cases diagnosed before the age of 6 la edad del diagnóstico y el subtipo
community years. As expected, there was no histológico del cáncer.
controls, were reduction in risk of acute leukaemia
analysed. associated with breastfeeding.

Shu XO, Clemens J, Zheng W, Ying DM, Ji BT, Jin F. Infant breastfeeding and the risk of childhood lymphoma and leukaemia.
Int J Epidemiol. 1995 Feb;24(1):27-32.



Lactancia materna y riesgo de leucemia aguda infantil.
año y lugar
Shu XO, et A total of 1744 Ever having breast-fed was found to be En este estudio, la LM estuvo asociada con un
al. (1999 children with associated with a 21% reduction in risk riesgo reducido de leucemia aguda infantil.
Oct) ALL and 1879 of childhood acute leukemias (odds ratio
Minneapoli matched [OR] for all types combined = 0.79; 95% De ser confirmado en estudios
s, USA. control confidence interval [CI] = 0.70-0.91). A epidemiológicos adicionales, nuestros
subjects, aged reduction in risk was seen separately for hallazgos sugieren que el futuro
1-14 years, and AML (OR = 0.77; 95% CI = 0.57-1.03) epidemiológico y los esfuerzos
456 children and ALL (OR = 0.80; 95% CI = 0.69-
with AML and 0.93). The inverse associations were experimentales debieran ser dirigidos a la
539 matched stronger with longer duration of breast- investigación de los efectos antiinfeciosos y/o
control feeding for total ALL and AML; for M0, inmunoestimuladores o inmunomoduladores
subjects, aged M1, and M2 morphologic subtypes of de la LM en la leucomogénesis en niños.
1-17 years. AML; and for early pre-B-cell ALL.

ALL: acute lymphoblastic leukemia.
AML: acute myeloid leukemia

Shu XO, Linet MS, Steinbuch M, Wen WQ, Buckley JD, Neglia JP, Potter JD, Reaman GH, Robison LL. Breast-feeding and
risk of childhood acute leukemia. J Natl Cancer Inst. 1999 Oct 20;91(20):1765-72.



Lactancia materna prolongada y

protección contra leucemia y linfomas infantiles.
año y lugar
Bener A, et A case-control The median duration of breast-feeding among patients was La duración de la LM por más
al. (2001 study significantly shorter than among controls, 7 (range 0-23) and de 6 meses puede proteger
Jan) United comprising 117 10 (range 0-20) months, respectively (P<0.0001). Breast-
Arab patients, aged feeding of 0-6 months' duration, when compared with feeding contra leucemia aguda y
Emirates. 2-14 years, with of longer than 6 months, was associated with increased odds linfomas infantiles.
ALL, HL and ratios (OR) for ALL (OR=2.47, 95% confidence interval (CI)
NHL, as well as 1.17-5.25), HL (OR=3.75, 95% CI 0.80-18.69), NHL
117 controls (OR=4.06, 95% CI 0.82-22.59), and overall (OR=2.79, 95% CI
matched for 1.54-5.05). In multivariate analysis, breast-feeding duration
age, sex and continues to be an independent predictor of lymphoid
ethnicity. malignancies (P=0.015).

HL: Hodgkin's lymphoma
NHL: non-Hodgkin's lymphoma

Bener A, Denic S, Galadari S. Longer breast-feeding and protection against childhood leukaemia and lymphomas. Eur J
Cancer. 2001 Jan;37(2):234-8.



Lactancia materna y neuroblastoma, EEUU y Canadá.
año y lugar
Daniels JL, Maternal reports of breast- Children with neuroblastoma were La LM estuvo asociada inversamente
et al. (2002 feeding were compared less likely to have breast-fed than con neuroblastoma y debería ser
Jun) USA y among 393 children six control children (odds ratio (OR) =
Canada. months or older who had 0.6; 95% confidence interval (CI) = promocionada entre las madres
neuroblastoma and were 0.5-0.9). The association between sanas. La investigación adicional
identified through the breast-feeding and neuroblastoma sobre los posibles mecanismos de de
Children's Cancer Group and increased with breast-feeding esta asociación deberían
the Pediatric Oncology Group duration (0-3 months OR = 0.7, CI =
and 376 age-matched case- 0.4-1.0; 13+ months OR = 0.5, CI = garantizarse.
control study. 0.3-0.9).

Daniels JL, Olshan AF, Pollock BH, Shah NR, Stram DO. Breast-feeding and neuroblastoma, USA and Canada. Cancer
Causes Control. 2002 Jun;13(5):401-5.



Lactancia materna y el riesgo de leucemia infantil: un meta-análisis.
año y lugar
Kwan ML, A fixed effects model was A significant, negative Este meta-análisis mostró que tanto la LM a
et al. (2004 employed to association was observed corto plazo como a largo plazo redujo el
Nov-Dec) systematically combine between long-term
the results of 14 case- breastfeeding and both ALL risk riesgo de ALL y AML infantil, sugiriendo que
California, control studies addressing (odds ratio [OR]=0.76; 95% el efecto protector de la LM no pude
USA. the effect of short-term (< confidence interval [CI] 0.68, limitarse a ALL como se suponía antes. La
or = 6 months) and long- 0.84) and AML risk (OR=0.85; tendencia potencial introducida por tasas
term (>6 months) 95% CI 0.73, 0.98). Short-term
breastfeeding on the risk breastfeeding was similarly de participación diferentes para casos y
of childhood ALL and/or protective for ALL and AML. control muestra que la diferencia en el SES
AML. Subgroup analyses Results for studies that adjusted puede minimizarse implementando
of studies that did and did and did not adjust for SES were estudios de casos y controles más grandes
not adjust for SES were not significantly different from
also performed. the results for the 14 studies comparando el SES, basados en la
combined. población.
SES: socioeconomic status

Kwan ML, Buffler PA, Abrams B, Kiley VA. Breastfeeding and the risk of childhood leukemia: a meta-analysis. Public Health
Rep. 2004 Nov-Dec;119(6):521-35.



Revisión de estudios de casos y

controles relacionados con la LM y reducción del riesgo de leucemia infantil.
año y lugar
Guise JM, We sought studies providing data We reviewed 111 citations to identify Hay pocos estudios de alta calidad que
regarding the association of 32 potentially eligible full-text articles.
et al. (2005 breastfeeding and occurrence of Of the 10 studies reviewed, only 4 were examinan el potencial de un efecto
Nov) childhood leukemia. Studies were sufficient to provide at least fair-quality protector de la LM para la leucemia
Oregon, identified by using Medline, HHS evidence regarding the association
Blueprint for Action on between maternal breastfeeding and infantil. Además, los pocos estudios que
USA. Breastfeeding, US Department of childhood leukemia. Studies conflicted existen discrepan en cuanto a la
Health and Human Services Office regarding the protective effect of
on Women's Health, Cochrane breastfeeding on childhood leukemia. asociación. Se estima que los EEUU
Database of Systematic Reviews, In the 2 largest and highest quality gastan 1.4 billones de dólares
National Centre for Reviews and studies, breastfeeding was associated
Dissemination, reference lists, and with a significant risk reduction in one anualmente para el tratamiento de la
national experts. Methodologic study with longer breastfeeding leucemia infantil. Los pacientes, los
quality was evaluated for each duration, reflecting greater protection,
study by using criteria from the US and a nonsignificant but suggestive clínicos, y los creadores de política no
Preventive Services Task Force difference in the other. Taken together, tienen los datos que ellos necesitan para
and the National Health Service half of the studies associated
Centre for Reviews and breastfeeding with a lower risk of acute tomar decisiones en cuanto a esta
Dissemination. lymphocytic leukemia. medida preventiva potencial importante.

Guise JM, Austin D, Morris CD. Review of case-control studies related to breastfeeding and reduced risk of childhood
leukemia. Pediatrics. 2005 Nov;116(5):e724-31.



Lactancia materna y cáncer infantil: una RS con meta-análisis.
año y lugar
Martin RM, We undertook a Forty-nine publications were potentially relevant; Haber sido amamantado está asociado
systematic review of of these, 26 provided odds ratio estimates for at
et al. (2005 published studies least one childhood cancer outcome and were inversamente con ALL, HL y
Dec) Bristol, investigating the included in metaanalyses. Overall, 92% of the neuroblastoma en la infancia, pero las
United association between studies were case-control studies, 85% relied on
breast-feeding and long-term recall of feeding history, only 8% explicaciones no causales son posibles.
Kingdom. childhood cancers using examined breast-feeding exclusivity and control Incluso de ser causal, la importancia
Medline (1966 to June response rates were under 80% in over half.
2004), supple-mented Metaanalyses suggested lower risks associated para la salud pública de estas
with auto alerts and with having been breast-fed of 9% (95% CI = 2- asociaciones puede ser pequeña.
manual searches. 16%) for ALL, 24% (3-40%) for HL and 41% (22-
Analyses are based on 56%) for neuroblastoma, with little between-study Nuestras estimaciones sugieren que el
odds ratios for specific heterogeneity. The estimates for HL and aumento de la LM de un 50% a un 100%
cancers among those neuroblastoma, however, were driven by single
ever breast-fed studies. There was little evidence that breast- prevendría en la mayor parte el 5% de
compared with those feeding was associated with acute casos de leucemia aguda y linfoma
never breast-fed, pooled nonlymphoblastic leukemia, NHL, central nervous
using random-effects system cancers, malignant germ cell tumors, infantiles.
models. juvenile bone tumors, or other solid cancers.
ALL: acute lymphoblastic leukemia. HL: Hodgkin's lymphoma. NHL: non-Hodgkin's lymphoma

Martin RM, Gunnell D, Owen CG, Smith GD. Breast-feeding and childhood cancer: A systematic review with metaanalysis. Int
J Cancer. 2005 Dec 20;117(6):1020-31.



Duración de la lactancia materna

y leucemia aguda y linfoma infantiles en una muestra de niños turcos.
año y lugar
Altinkaynak We investigated this The median duration of breast-feeding among patients was Nuestras conclusiones
S, et al. issue in a case-control shorter than that of controls (10 vs 12 months). Patients with sugieren que la LM por
(2006 May) study comprising 137 ALL and AML had shorter mean breast-feeding duration
patients, aged 1 to 16 compared with healthy children (P = 0.001 and P < 0.001, más de 6 meses es
Erzurum, years, with acute respectively). The shortest mean breast-feeding duration protectora contra
Turkey lymphocytic leukemia was noted in the children with AML. Breast-feeding for a malignidades linfoides
(ALL), acute myeloid duration of 0 to 6 months, when compared with feeding of en la infancia,
leukemia (AML), longer than 6 months, was associated with increased odds
Hodgkin or non-Hodgkin ratios (ORs) for ALL [OR = 2.44, 95% confidence interval (CI) especialmente para
lymphoma, in addition to = 1.17-5.10], AML (OR = 6.67, 95% CI = 1.32-33.69), AML y ALL.
146 controls matched for Hodgkin lymphoma (OR = 3.33, 95% CI = 0.60-18.54), non-
age and sex. Hodgkin lymphoma (OR = 1.90, 95% CI = 0.68-5.34) and
overall (OR = 2.54, 95% CI = 1.51-4.26).

Altinkaynak S, Selimoglu MA, Turgut A, Kilicaslan B, Ertekin V. Breast-feeding duration and childhood acute leukemia and
lymphomas in a sample of Turkish children. J Pediatr Gastroenterol Nutr. 2006 May;42(5):568-72.



Lactancia materna y turmor de Wilms:

un informe del Grupo de Oncología Pediátrica
año y lugar
COG, Sadd- We used data from a large case- Breast-feeding was associated with a Los resultados de este estudio
lemire S, et control study in the United States reduced risk of Wilms tumor [adjusted son sugestivos de una
al. (2006 and Canada. Cases were children odds ratio (OR) = 0.7; 95%
Jun) North under age 16 years who were confidence interval (CI) = 0.5-0.9]. asociación entre LM y una
Carolina, diagnosed with Wilms tumor from Longer duration did not provide any reducción en el riesgo de tumor
USA 1999 to 2002 and were participating additional reduction in risk. When de Wilms, pero la investigación
in the National Wilms Tumor Study. stratified by maternal education, adicional es necesaria para
Controls were identified by random- breast-feeding lowered risk among
digit dialing and were age and children whose mothers had less than confirmar esta relación.
region matched to cases. Mothers of a college education (OR = 0.6; 95%
501 cases and 480 controls CI = 0.4-0.8) but not for mothers who
provided information on breast- had a college degree or more (OR =
feeding by telephone interviews. 1.1; 95% CI = 0.6-1.9).

Children's Oncology Group, Saddlemire S, Olshan AF, Daniels JL, Breslow NE, Bunin GR, Ross JA. Breast-feeding and
Wilms tumor: a report from the Children's Oncology Group. Cancer Causes Control. 2006 Jun;17(5):687-93.



Relación entre lactancia materna y leucemia infantil. Un meta-análisis.
año y lugar
AHRQ We identified four systematic We used a random-effects model to combine Se concluye que existe
Publication reviews or meta-analyses that SES-adjusted odds ratios of ALL in relation to asociación entre una
No 07-E007. examined the relationship short-term (≤ 6 months) and long-term (> 6
(April 2007) between breastfeeding and months) breastfeeding from UKCCS103, historia de lactancia
USA childhood leukemia. We have CCG107study, and Dockerty 1999 (Table 17). materna de una duración
elected to describe in details only Rosenbaum 2000 was excluded from mínima de 6 meses y una
the Guise 2005 systematic review the analysis because the duration of reducción en el riesgo de
and Kwan 2004meta-analysis breastfeeding was not reported. The results from
because they superseded the our meta-analysis suggest that long-term ALL y AML.
Beral 2001 meta-analysis and breastfeeding is associated with a reduction in
Davis 1998 systematic review. the risk of ALL (OR 0.80; 95%CI 0.71 - 0.91).

acute lymphocytic leukemia (ALL)
acute myelogenous leukemia (AML)

Evidence Report/Technology Assessment. Number 153. Breastfeeding and Maternal and Infant Health
Outcomes in Developed Countries. Relationship between Childhood Leukemia and Breastfeeding. Agency for Healthcare
Research and Quality U.S. Department of Health and Human Services and Tufts-New England Medical Center Evidence-
Based Practice Center Boston, Massachusetts. AHRQ Publication No. 07-E007. April 2007.



Lactancia materna exclusiva y cáncer pediátrico.
año y lugar
Ortega- Maternal reports of full The mean duration of full La LM estuvo asociada inversamente con
García JA, breastfeeding, breastfeeding for cases were 8.43 and cáncer pediátrico, la protección aumenta
et al (Jan- collected through 11.25 weeks for controls. Cases had
Feb 2008) personal interviews been significantly more often bottle-fed con la duración de la lactancia exclusiva.
Spain. using the Paediatric than controls (odds ratio (OR) 1.8; Es necesaria la investigación adicional
Environmental History, 95% confidence interval (CI) 1.1–2.8). sobre los mecanismos posibles de esta
were compared among Cases were significantly less breastfed asociación. Mientras tanto, la LM debe
187 children 6 months for at least 2 months (OR
of age or older who 0.5; 95% CI 0.3–0.8), for at least 4 ser promocionada entre las madres.
had PC and 187 age- months (OR 0.5; 95% CI 0.3–0.8), and
matched control for 24 weeks or more (OR 0.5; 95% CI
siblings. 0.2–0.9).

Juan A Ortega-García, Josep Ferrís-Tortajada, Alberto M Torres-Cantero, Offie P Soldin, Encarna Pastor Torres, Jose L
Fuster-Soler, Blanca Lopez-Ibor and Luis Madero-López. Full breastfeeding and paediatric cancer. J Paediatr Child Health 44
(2008) 10–13.



¿La lactancia materna prolongada

reduce el riesgo de leucemia y linfomas infantiles?
año y lugar
Bener A, et The study group The mean age+/-SD of cases was 5.44+/- 3.29 years and of control subjects El presente estudio confirma
comprised of 169 5.51+/-3.62 years. The male/female ratio was 1.73. Overall, the mean
al (April patients with acute
number of months of breastfeeding in the male patients and controls was 9.1 que una mayor duración de la
lymphocytic leukemia
2008) (ALL), Hodgkin's (HL) (95% confidence interval [CI] 7.9-10.4) and 12.1 (95% CI 11.0-13.4), LM tiene un efecto protector
Qatar. and non-Hodgkin's
lymphoma (NHL), age
respectively (P<0.001), and in the female patients and controls 8.4 (95% CI contra ALL y HL. Los factores
=or<15 years, and
6.9-10.1) and 11.5 (95% CI 10.0-13.0), respectively (P<0.01). In 103 ALL adicionales que se encuentran
169 healthy controls, patients, a shorter period of breastfeeding (0-6 months duration), was
matched to patients associated with increased odds ratio (OR) for males (OR=3.1, 95% CI 1.4- asociados con un riesgo
by age and sex.
Mothers of all study
6.8) and females (OR=2.2, 95% CI 0.8-6.32) as compared to breastfeeding elevado de neoplasia linfoide
subjects provided
longer than 6 months. In 103 ALL patients, 32 HL and 34 NHL patients, there fueron edad y nivel educativo
information via were no statistically significant differences in the duration of breastfeeding
telephone about the between the male and female patients and their respective controls. In bajos de la madre. Todos estos
history of multivariate analysis, statistically significant risk factors for the development factores pueden estar
breastfeeding and of childhood lymphoid malignancy were: a shorter duration of breastfeeding,
parameters seen as relacionados con un mayor
lower age and level of education of mother and higher income, larger size of
proxies for viral
infection. accommodation and birth order in the family.
riesgo de infecciones en la
infancia temprana.
acute lymphocytic leukemia (ALL); Hodgkin's lymphoma (HL)

Bener A, Hoffmann GF, Afify Z, Rasul K, Tewfik I. Does prolonged breastfeeding reduce the risk for childhood leukemia and
lymphomas? Minerva Pediatr. 2008 Apr;60(2):155-61.



July 2009
Childhood cancer. Several studies have examined associations between formula-feeding and childhood
leukemia, based on the hypothesis that immunoactive factors in breast milk may prevent viral infections
implicated in leukemia pathogenesis. Two meta-analyses found a 1.3-fold higher risk of acute lymphoblastic
leukemia among formula-fed children, compared with children who were breast-fed for greater than 6
months. Kwan et al. found a 1.2-fold higher risk of acute myeloid leukemia among formula-fed infants,
compared with infants breast-fed ≥6 months.

―Semana Mundial de la Lactancia Materna 2009―

"Lactancia Materna: una respuesta vital en emergencias".

Lactancia materna y riesgo de cancer infantil

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