Spatial clustering of childhood leukaemia in Switzerland: A nationwide study.

Konstantinoudis, Garyfallos; Kreis, Christian; Ammann, Roland A; Niggli, Felix; Kuehni, Claudia E; Spycher, Ben D; Swiss Paediatric Oncology, Group; Swiss National Cohort, Study Group (2017). Spatial clustering of childhood leukaemia in Switzerland: A nationwide study. International journal of cancer, 141(7), pp. 1324-1332. Wiley-Blackwell 10.1002/ijc.30832

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The aetiology of childhood leukaemia remains largely unknown. Several hypotheses involve environmental exposures that could implicate spatial clustering of cases. The evidence from previous clustering studies is inconclusive. Most of them used areal data and thus had limited spatial resolution. We investigated whether childhood leukaemia tends to cluster in space using exact geocodes of place of residence both at the time of birth or diagnosis. We included 1,871 leukaemia cases diagnosed between 1985 and 2015 at age 0-15 years from the Swiss Childhood Cancer Registry. For each case, we randomly sampled 10 age and sex matched controls from national censuses closest in time. We used the difference of k-functions, Cuzick-Edwards' test and Tango's index for point data to assess spatial clustering and Kulldorff's circular scan to detect clusters. We separately investigated acute lymphoid leukaemia (ALL), acute myeloid leukaemia (AML), different age groups at diagnosis (0-4, 5-15 years) and adjusted for multiple testing. After adjusting for multiple testing, we found no evidence of spatial clustering of childhood leukaemia neither around time of birth (p = 0.52) nor diagnosis (p = 0.51). Individual tests indicated spatial clustering for leukaemia diagnosed at age 5-15 years, p k-functions = 0.05 and p Cuzick-Edwards' = 0.04 and a cluster of ALL cases diagnosed at age 0-4 years in a small rural area (p = 0.05). This study provides little evidence of spatial clustering of childhood leukaemia in Switzerland and highlights the importance of accounting for multiple testing in clustering studies.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Konstantinoudis, Garyfallos, Kreis, Christian, Ammann, Roland, Kühni, Claudia, Spycher, Ben


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services








Anette van Dorland

Date Deposited:

11 Jul 2017 13:26

Last Modified:

05 Dec 2022 15:06

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

cancer registry; childhood cancer; acute lymphoid leukaemia; point patterns; spatial clusters




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