Pediatric cancers in the Eure department
In September 2019, the Normandy Regional Health Agency (ARS) was notified of a high number of childhood cancer cases among children living in two municipalities in the Eure department.
See also
Pediatric Leukemia in the Pont de l'Arche and Igoville Area: No Cases Reported Between 2020 and 2022 | Press Release (September 26, 2025)
In 2019, several cases of pediatric cancer were reported in an area comprising several municipalities in the Eure department (27). Following these reports, the Normandy Regional Health Agency referred the matter to Santé publique France.
Santé publique France Normandy conducted an epidemiological investigation to determine:
whether there is indeed a statistical excess of cancer cases in the observed population and within what geographic area;
and whether there is one or more local cause(s) for this cluster of cases other than chance, on which action can be taken.
An analysis conducted in 2020 revealed an excess of diagnosed leukemia cases over a 3-year period (2017–2019) among children under 15, compared to the expected number of cases calculated based on the national average incidence. No excess of cases was found for any other types of cancer.
The epidemiological analysis did not identify any risk factors common to the children. The environmental assessment based on previously available data did not identify any specific situation. The investigation report was published online in April 2022.
The leading hypothesis following this epidemiological investigation is that of a spatio-temporal cluster of leukemia cases linked to a random, non-uniform distribution of cases across a given geographic area and time period. To support this hypothesis, Santé publique France recommended continuing to monitor the occurrence of new cases of pediatric leukemia in the area and reassessing the situation three years later, using consolidated data from the National Registry of Childhood Cancers (RNCE).
The report published in 2025 showed no new cases of pediatric leukemia between 2020 and 2022, supporting the conclusions of the initial investigation report, namely those of a random fluctuation in the spatio-temporal distribution of the number of cases.
These findings bring an end to enhanced surveillance in this sector, with surveillance now being conducted nationally by the RNCE across the entire metropolitan territory.
Santé publique France’s contribution to advancing knowledge in environmental health, pediatric cancer, and health promotion in these fields
Santé publique France continues to contribute to improving knowledge through several national studies. Notably:
The national Géocap Agri study, conducted by Inserm-Epicea UMR 1153 in partnership with Santé publique France and funded by ANSES, examines the risk of childhood cancer in relation to residential proximity to certain types of agricultural crops. This study is part of Inserm’s Géocap program, which examines the risk of pediatric cancers based on mapped sources of environmental exposure (natural ionizing radiation, UV radiation, proximity to agricultural activities, and proximity to industrial zones, among others) present in the environment.
The response to the 2022 referral from the Directorate General for Health regarding the increase in the incidence of glioblastomas in metropolitan France, co-led by SpFrance and the National Cancer Institute, will be based on:
1/ a detailed analysis of incidence data from cancer registries regarding primary tumors of the central nervous system;
2/ the identification of epidemiological research avenues to consolidate knowledge on the trends and risk factors for these tumors. Regarding point (1), the pediatric component will be the subject of a specific study by the RNCE, with results expected in 2024.
The biomonitoring component of the ESTeban study aims to describe and estimate the population’s exposure levels to various environmental substances that impact health and to track these levels over time (through repeated surveys). Exposure results for several substances (e.g., lead, metals, pesticides, arsenic) were published in 2021 (link to publications).
The PESTIRIV study aims to determine whether there is a difference in pesticide exposure between people living near vineyards and those living far from any agricultural crops. This is a multi-site exposure study (6 regions selected) among residents living near agricultural crop areas (samples collected from 1,500 exposed individuals and 7,050 unexposed individuals) combined with environmental measurements of air (indoor and outdoor) and dust in living spaces, in partnership with ANSES. The full report is expected in 2024.
At the same time, Santé publique France is committed to promoting health and prevention in the fields of perinatal care and early childhood. In 2021, SpFrance and the Ministry of Solidarity and Health launched an information campaign on the critical period of the first 1,000 days of life, spanning from conception through the first two years of life. Resources for parents and professionals are available at 1000-premiers-jours.fr.
Current understanding of risk factors for pediatric cancers and ongoing research (Source: Jacqueline Clavel and Brigitte Lacour of the INSERM Research Team on the Epidemiology of Cancers in Children and Adolescents - RNCE)
At present, no environmental exposure has been established as a risk factor for childhood cancers under “normal” conditions. Unlike adult cancers, very few carcinomas develop in children, and the many environmental risk factors established in adults—related to occupational settings and lifestyle habits—do not apply to children. Ionizing
radiation is a recognized risk factor in environmental disaster situations. It is thus responsible for thyroid cancers among Ukrainian and Belarusian residents affected by the Chernobyl accident, and for all types of cancers among survivors of the bombings of Hiroshima and Nagasaki. The Epstein-Barr virus is a proven risk factor for nasopharyngeal cancer, Hodgkin’s lymphoma, and Burkitt’s lymphoma. In the latter case, in the sub-Saharan environment conducive to Anopheles mosquitoes, malaria acts as a cofactor.
A great deal of data has been gathered on other environmental exposures, though no firm conclusions have been reached. The rarity and diversity of childhood cancers, the need for significant contrasts in exposure to detect differences in risk between exposed and unexposed children, the difficulty of tracing exposure history back to the intrauterine period, and the absence of persistent exposure markers at the time of cancer diagnosis complicate the search for risk factors and necessitate research at the national or international level. The past 30 years have been productive and have allowed for the documentation of several hypotheses:
The role of low-dose ionizing radiation from natural sources (radon and telluric gamma radiation) is highly debated. No excess risk of leukemia has been observed in France over 30 years of observation, but doubts persist in some countries. It is much more difficult to study the risk of brain tumors, and even more so for other solid tumors, because these are highly varied and heterogeneous tumors with small sample sizes. Nevertheless, while it remains difficult to rule out the possibility of any cancer risk linked to these environmental exposures, current data suggest that such a risk, if it exists, can only be very moderate;
Residential exposure to pesticides, particularly during pregnancy, has been associated with an increased risk of childhood leukemia and brain tumors in numerous studies. This increase, on the order of 50%, has not, however, been established with certainty, as the data rely largely on the recollections of parents of both sick and healthy children. Research into biological markers of exposure that persist over several years, or any other objective indicator of exposure, would help shed light on the role of these frequent exposures;
Exposure to traffic and air pollution has been studied to a somewhat lesser extent. Current data suggest an increased risk of leukemia among the most exposed children, which needs to be confirmed and clarified. Data are much more limited and heterogeneous regarding tumors of the central nervous system and are very insufficient regarding other types of cancer;
Exposure to extremely low-frequency magnetic fields generated by high-voltage power lines has been implicated following the observation of a higher risk of leukemia among children living in the immediate vicinity of very high-voltage power lines. Recent epidemiological data are much less supportive of this association, which, moreover, has no biological basis.
Lifestyle factors, while not strictly environmental in nature, have often been linked to the risk of childhood cancer. For example, paternal tobacco use prior to conception is thought to increase the risk of leukemia. Conversely, certain factors such as extended breastfeeding, maternal preconception folic acid supplementation, and—for leukemias—early childhood infections and daycare attendance may have a protective effect.
Many questions remain, and they are the subject of very active French research https://rnce.inserm.fr/, https://programme-pediac.com/ and international research https://www.clic.ngo/.
FAQs on Pediatric Cancers
Pediatric cancers
There are approximately 1,700 new cases of pediatric cancer in children under the age of 15 each year in mainland France.
The most common cancers are leukemias (28%), tumors of the central nervous system (24%), and lymphomas (11%).
Generally speaking, the causes of childhood cancers remain largely unknown today, and scientists primarily rely on genetic, immune-infectious, or environmental hypotheses. Based on current knowledge, the causes of pediatric cancers are most likely multifactorial.
Risk factors with a high level of evidence include:
medical ionizing radiation used for therapeutic purposes and radiation from atomic explosions, which are implicated in the development of several types of cancer;
genetic predispositions (predisposing diseases or genetic susceptibility) in acute lymphoblastic leukemia;
the Epstein-Barr virus (EBV) in Burkitt’s lymphoma.
Other factors are debated in the scientific literature, with a level of scientific evidence that remains insufficient to date to draw conclusions regarding causality. The main ones are described below:
individual factors: birth weight, use of assisted reproductive technology, as well as parental smoking and high consumption of certain foods (tea and coffee);
infectious factors: exposure to EBV and herpes viruses for leukemia;
Drug exposures: antiretrovirals, anticancer drugs, and oral contraceptives for several types of cancer;
exposure to environmental factors: Physical: high-voltage power lines (leukemia); ultraviolet radiation (acute lymphoblastic leukemia); Chemical: air pollution linked to road traffic, particularly benzene (leukemia); polychlorinated biphenyls (leukemia); solvents and hydrocarbons during the father’s occupational exposure; pesticides (blood disorders, central nervous system tumors, and even embryonic tumors), through domestic exposure or due to parents’ occupational exposure.
Population mixing, which corresponds to the immuno-infectious hypothesis, has also been cited in publications to explain increases in the incidence of childhood leukemia following population influx into a previously isolated area. Finally, certain authors also cite protective factors, such as breastfeeding; early exposure to infectious agents; and the quality of the mother’s or child’s diet in terms of fruits, vegetables, and vitamins;
Monitoring of pediatric cancers
This surveillance system was established, in particular, in the context of investigations into clusters of pediatric cancer cases: leukemias around La Hague at the inception of the Childhood Hematologic Diseases Registry (1990), and cancers at the Franklin-Roosevelt School in Vincennes at the inception of the Childhood Solid Tumors Registry (2000). These two registries have merged into a single entity (the National Registry of Childhood Cancers, or RNCE) and have provided robust and comprehensive data on the subject, addressing the questions raised. They also enable research to improve understanding of these cancers, as studies can now be conducted on larger sample sizes at the national level.
In France, the surveillance of childhood and adolescent cancers is carried out by the National Registry of Childhood Cancers (RNCE), which records all cases of cancer in children under the age of 15 in metropolitan France, dating back to 1990 for hematologic malignancies and to 2000 for solid tumors. Since 2011, it has been extended to residents of the Overseas Departments (Martinique, Guadeloupe, French Guiana, Réunion) and to adolescents under the age of 18.
A registry is defined as a continuous and comprehensive collection of personal data pertaining to one or more health events within a geographically defined population, maintained for the purposes of surveillance, research, or evaluation by a team with the appropriate expertise.
The registries:
contribute to health surveillance by producing national reference rates on incidence and survival, and by studying geographical and temporal variations in incidence.
monitor cancer incidence in populations considered “at risk”: children who have undergone specific treatments (antiretrovirals, radiation therapy, etc.). They contribute to the investigation of clusters of cancer cases reported in a geographic area.
also support cancer research conducted within the INSERM team on the epidemiology of childhood and adolescent cancers led by J. Clavel (EPICEA, CRESS, UMR-S1153). For example:
The GEOCAP program (GEOlocalized Study of Pediatric Cancers), whose objective is to study the role of environmental exposures in the occurrence of cancers in children under 15 years of age (road traffic and exposure to emitted pollutants, high-voltage power lines and electromagnetic fields, proximity to nuclear sites, natural ionizing radiation, UV radiation, etc.).
The ESCALE and ESTELLE studies, which examine the influence on childhood cancer risk of the course of pregnancy, the child’s characteristics at birth, the child’s environment in utero or during childhood (linked to the parents’ occupation or lifestyle), and genetic predispositions…
The MOBI-KIDS study investigates a link between exposure to radiofrequency radiation from cell phones and the occurrence of brain tumors in young people.
Cancer case clusters
A “spatio-temporal cluster” is a group of people with the same disease or symptoms within a specific geographic area and over a given period of time, where the number of cases relative to the population is unusually high.
Such a cluster may occur within a community due to various, and possibly interrelated, causes of genetic, environmental, infectious, occupational, or lifestyle origin. If no cause is identified, the role of chance cannot be ruled out, given the statistical distribution of cases over time and space and the possibility that the number of cases perceived as abnormal falls within this distribution and is simply an extreme outlier.
The identification of a cluster, however, raises the public health question of whether there is one (or more) common cause(s) that explains the clustering of disease cases over time and space.
As for the clusters reported to Santé publique France, they occur fairly frequently (several per year) and are systematically investigated based on the specific circumstances, with the assistance of the National Childhood Cancer Registry to identify confirmed cases.
Healthcare professionals have developed a specific protocol for investigating spatio-temporal clusters of disease cases, which is outlined in a methodological guide available on the Santé publique France website. This protocol calls for the collection of information on reported health issues and the environment in which they occurred.
The guiding scientific principle behind the investigation of a reported cluster is the notion that, if there is an “abnormal” clustering of people with the same disease, they should share exposure to one or more common causes, and that this exposure situation is not found in the rest of the population. Therefore, the epidemiological objectives of the response to a suspected cluster are to determine:
whether there is indeed an excess of cases in the observed population;
and, if such an excess exists, to determine whether there are one or more local causes for this cluster of cases, other than chance.
