Cancer epidemiology and health policy
Sol Levine, Abraham M. Lilienfeld in Epidemiology and Health Policy, 1987
Biologically, a primary prevention strategy has greatest appeal for those cancers with poor survival and unfavorable natural history, such as lung cancer. Screening programs seem reasonable for those cancers with a favorable natural history (that is long period of localized growth compatible with a long detectable pre-clinical period), effective therapy for early disease, but with poor overall survival, such as melanoma. To circumvent the low prevalence and poor predictive value of each cancer site, high risk groups which might have a prevalence rate of up to 100 times the general population are targeted for screening programs. Squamous cell cancers of the head and neck region, which develop in heavy smokers and drinkers, exemplify this approach. Childhood leukemia represents a disease with unknown etiologies and unfavorable natural history, for which we are unable to devise primary and secondary prevention strategies. Fortunately, therapeutic advances have resulted in marked improvements in long-term survival; successful rehabilitation and elimination of workplace prejudice towards cancer survivors have now become problems for national policy with these patients.
New Perspectives on the Epidemiology of Hematological Malignancies and Related Disorders
Peter G. Shields in Cancer Risk Assessment, 2005
While it has been hypothesized that children of radiation workers are at an increased risk of ALL (179), risks are probably very small or not increased. A large record linkage U.K. study revealed a small increase in childhood leukemia and NHL of children of nuclear workers, but no dose–response trend (180). There was no association in a case-control record linkage study in Ontario, Canada (181). Small clusters of childhood leukemia cases in geographical proximity to nuclear plants in the United Kingdom in the mid-1980s prompted large surveys, which revealed excess leukemia and lymphoma in persons under age 25 living near nuclear fuel reprocessing or weapons production plants (particularly the Sellafield and Dounreay plants) (182), but no excess among populations residing close to nuclear plants generating electricity (183–185). Environmental radiation levels measured in proximity to Sellafield and other nuclear facilities were too low to be etiologically related.
What happens in Leukemias, Lymphomas, and Myelomas?
Tariq I Mughal, John M Goldman, Sabena T Mughal in Understanding Leukemias, Lymphomas, and Myelomas, 2017
In 2003, at a time when considerable enthusiasm was being generated for the potential success of “gene therapy” in the treatment of a rare immunodeficiency disorder (called severe combined immunodeficiency), it was observed that although 9 of the 10 infants treated were apparently cured, two infants developed a leukemia. Subsequent research into this showed how a viral vector, used for the gene therapy, could have been responsible. This finding has major implications for future gene therapy protocols and supports the role of some viruses in leukemogenesis. The risk of developing childhood leukemia appears to be increased when there is inadequate priming of the infant’s naive immune system, continuing susceptibility to infections and suppression of normal bone marrow activity, for example, due to a viral infection. These phenomena may provide the second and additional postnatal events, in keeping with Mel Greaves’s hypothesis (chap. 1), which are often required for a precancerous cell to become an overt cancer cell.
Gestational age and childhood leukemia: A meta-analysis of epidemiologic studies
Published in Hematology, 2018
Yang-Feng Wang, Li-Qun Wu, Yi-Ni Liu, Yong-Yi Bi, Hong Wang
Childhood leukemia has become the most common cancer type of childhood [1], but only a few cases can be explained by known risk factors, such as Down’s syndrome, ionizing radiation and benzene. A growing amount of evidence indicating that childhood leukemia, representing the clonal proliferation of transformed hemopoietic cells driven by mutations, is initiated in utero [2,3]. In this respect, birth characteristics initiated in utero, as birth weight and gestational age, may have important roles in the leukemogenic process. The meta-analysis [4] suggested that high birth weight was a factor that has been implicated in an increased risk of all types of leukemia, while low birth weight enhanced the risk of developing acute myeloid leukemia (AML). In addition, preterm birth infants, who were given birth before 37 completed gestational weeks, are usually born with immature organs and thus are known to be more likely to suffer from respiratory distress syndrome, neurologic morbidities and chronic diseases in their later life [5–7]. Postterm infants, born after 41 completed gestational weeks, are more likely to suffer from abnormal growth, asphyxia and neurologic diseases over their life courses [7,8]. Accordingly, it is interesting to investigate whether gestational age has an influence on the development of childhood leukemia and its subtypes, acute lymphocytic leukemia (ALL) and AML.
Polymorphisms of inflammation-related genes and susceptibility to childhood leukemia: evidence from a meta-analysis of 16 published studies
Published in Hematology, 2023
Qiuping Zeng, Haoyan Ren, Cui Liu, Ting Liu, Yongwu Xie, Xiufu Tang
Some limitations should be acknowledged to explain the results. First, the number of included studies for most of the polymorphic loci (except of IL-10) was small, which may lead to an underestimation or overestimation of their associations with childhood leukemia. Second, only ALL cases were investigated in our included studies. Whether there were associations of CXCL12 rs1801157, TLR6 rs5743810, IL-10 rs1800871, rs1800872 and MIF rs75562 with childhood AML patients, was unclear. Third, the associations of these SNPs with patients’ prognoses were also unknown. Fourth, it is generally believed that childhood leukemia is a disease resulting from complex interactions between genetic and environmental factors. However, our pooled results were calculated only based on the primary data which were not adjusted by environmental factors because of lacking relevant data. Therefore, more well-designed studies (including sex – and age-matched controls, different ethnic backgrounds or environmental exposures) with larger sample sizes are still needed to further validate the associations of SNPs in various inflammation-related genes and the vulnerability to childhood leukemia.
Summary of Radiation Research Society Online 66th Annual Meeting, Symposium on “Epidemiology: Updates on epidemiological low dose studies,” including discussion
Published in International Journal of Radiation Biology, 2021
Cato M. Milder, Gerald M. Kendall, Aryana Arsham, Helmut Schöllnberger, Richard Wakeford, Harry M. Cullings, Mark P. Little
A number of national record-based studies of childhood cancer and natural background radiation have been undertaken. These have been reviewed by Mazzei-Abba et al. (2020). Since that review further studies have been published by Berlivet et al. (2020) and Nikkilä et al. (2020). Results from these studies have been mixed. The results of five studies of childhood leukemia and natural background radiation have been compared (Kendall et al. 2021; Mazzei-Abba et al. 2020). Two studies, from Great Britain (GB) (Kendall et al. 2013) and from Switzerland (Spycher et al. 2015), found positive associations between radiation dose and cancer incidence and were statistically significant. The study from Germany (Spix et al. 2017) found a positive association, but was not significant; that from Finland (Nikkilä et al. 2016) found a negative association, and was also not significant. Nevertheless, the results of these four studies appear broadly similar, given the uncertainties that must be expected, and the small size of the some of the studies. The fifth study, set in France (Demoury et al. 2017) appears different, not so much because of its central estimate of risk (a relative risk 1.00, so no association between leukemia rates and gamma-ray doses), but because of its exceptionally (and puzzlingly) tight confidence interval 0.99 − 1.01, while the distribution of gamma dose rates is much as in the GB study (Kendall et al. 2013). With these results it is hard to draw firm conclusions. More studies and perhaps pooled studies of those that have been published will hopefully make the picture clearer.
Related Knowledge Centers
- Blood Cell
- Childhood Cancer
- White Blood Cell
- Leukemia
- Bone Marrow
- Cancer
- Acute Lymphoblastic Leukemia
- Acute Myeloid Leukemia
- Tumors of The Hematopoietic & Lymphoid Tissues
- Chronic Condition