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Wheeler DC, Boyle J, Carli M, Ward MH, Metayer C. Neighborhood Deprivation, Indoor Chemical Concentrations, and Spatial Risk for Childhood Leukemia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3582. [PMID: 36834278 PMCID: PMC9968201 DOI: 10.3390/ijerph20043582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Leukemia is the most common childhood cancer in industrialized countries, and the increasing incidence trends in the US suggest that environmental exposures play a role in its etiology. Neighborhood socioeconomic status (SES) has been found to be associated with many health outcomes, including childhood leukemia. In this paper, we used a Bayesian index model approach to estimate a neighborhood deprivation index (NDI) in the analysis of childhood leukemia in a population-based case-control study (diagnosed 1999 to 2006) in northern and central California, with direct indoor measurements of many chemicals for 277 cases and 306 controls <8 years of age. We considered spatial random effects in the Bayesian index model approach to identify any areas of significantly elevated risk not explained by neighborhood deprivation or individual covariates, and assessed if groups of indoor chemicals would explain any elevated spatial risk areas. Due to not all eligible cases and controls participating in the study, we conducted a simulation study to add non-participants to evaluate the impact of potential selection bias when estimating NDI effects and spatial risk. The results in the crude model showed an odds ratio (OR) of 1.06 and 95% credible interval (CI) of (0.98, 1.15) for a one unit increase in the NDI, but the association became slightly inverse when adjusting for individual level covariates in the observed data (OR = 0.97 and 95% CI: 0.87, 1.07), as well as when using simulated data (average OR = 0.98 and 95% CI: 0.91, 1.05). We found a significant spatial risk of childhood leukemia after adjusting for NDI and individual-level covariates in two counties, but the area of elevated risk was partly explained by selection bias in simulation studies that included more participating controls in areas of lower SES. The area of elevated risk was explained when including chemicals measured inside the home, and insecticides and herbicides had greater effects for the risk area than the overall study. In summary, the consideration of exposures and variables at different levels from multiple sources, as well as potential selection bias, are important for explaining the observed spatial areas of elevated risk and effect estimates.
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Affiliation(s)
- David C. Wheeler
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, One Capitol Square, 830 East Main Street, Richmond, VA 23298, USA
| | - Joseph Boyle
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, One Capitol Square, 830 East Main Street, Richmond, VA 23298, USA
| | - Matt Carli
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, One Capitol Square, 830 East Main Street, Richmond, VA 23298, USA
| | - Mary H. Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Catherine Metayer
- School of Public Health, University of California Berkeley, Berkeley, CA 94704, USA
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Desai S, Guddati AK. Bimodal Age Distribution in Cancer Incidence. World J Oncol 2022; 13:329-336. [PMID: 36660209 PMCID: PMC9822681 DOI: 10.14740/wjon1424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/05/2022] [Indexed: 12/26/2022] Open
Abstract
Cancer is caused by accumulation of genetic changes which include activation of protooncogenes and loss of tumor suppressor genes. The age-specific incidence of cancer in general increases with advancing age. However, some cancers exhibit a bimodal distribution. Commonly recognized cancers with bimodal age distribution include acute lymphoblastic leukemia, osteosarcoma, Hodgkin's lymphoma, germ cell tumors and breast cancer. Delayed infection hypothesis has been used to provide explanation for the early childhood peak in leukemias and lymphomas, whereas the peak at an older age is associated with accumulation of protooncogenes and weakened immune system. Further genetic analysis and histopathological variations point to distinctly different cancers, varying genetically and histologically, which are often combined under a single category of cancers. Tumor characteristics and age distribution of these cancers varies also by population groups and has further implications on cancer screening methods. Although significant advances have been made to explain the bimodal nature of such cancers, the specific genetic mechanisms for each age distribution remain to be elucidated. Further distinction among the different cancer subtypes may lead to improvements in individual risk assessments, prevention and enhancement of treatment strategies.
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Affiliation(s)
- Shreya Desai
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | - Achuta K. Guddati
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA,Corresponding Author: Achuta Kumar Guddati, Division of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, GA 30909, USA.
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Shapoo NS, Masood A, Bhat JR, Bhatia AS, Shah IA, Ganai BA. CYP2D6 rs35742686 and rs3892097 Gene Polymorphisms and Childhood Acute Lymphoblastic Leukemia: Relation to Disease Susceptibility in Kashmiri Children. J Pediatr Genet 2022; 11:213-220. [DOI: 10.1055/s-0041-1723975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Abstract
CYP2D6 is one of the most widely investigated CYPs in relation to gene polymorphism. This study analyzed the relationship between CYP2D6 rs35742686 and rs3892097 single-nucleotide polymorphisms (SNPs) and potential risk factors in the development of acute lymphoblastic leukemia (ALL) in Kashmiri children. We recruited 300 cases and 600 controls for genotyping and risk factors assessment. Genotypes of rs35742686 and rs3892097 were analyzed by polymerase chain reaction-restriction fragment length polymorphism method. CYP2D6 expression analysis was done by quantitative reverse transcription polymerase chain reaction in ALL cases. Conditional logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI). High risk of ALL was observed in cases who carried the mutant genotypes of rs35742686 (OR = 18.15; 95% CI = 4.13–79.66, p < 0.0001) or rs3892097 (OR = 24.06; 95% CI = 10.23–56.53, p < 0.0001). Significant interaction was observed between rs35742686 and rs3892097 SNPs (P interaction = 0.001). The risk associated with the variant genotypes of rs35742686 and rs3892097 was retained in the cases whose fathers were smokers or had maternal X-ray exposure (p < 0.001). Relative messenger ribonucleic acid expression across genotypes was significantly decreased in cases carrying rs357426863 (*3/*3) (n-fold = 0.37 ± 0.156, p < 0.0079) and rs3892097 SNPs (*4/*4) (n-fold = 0.02 ± 0.0075, p < 0.0001) suggesting these two events are independent in ALL cases. The study concluded that rs35742686 and rs3892097 SNPs are significantly associated with ALL risk in Kashmiri children.
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Affiliation(s)
- Nidha Sadiq Shapoo
- Department of Biochemistry, University of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Akbar Masood
- Department of Biochemistry, University of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Javid R. Bhat
- Department of Clinical Haematology, Sher-e-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - A. S. Bhatia
- Department of Biochemistry, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Idrees A. Shah
- Department of Biochemistry, University of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Bashir A. Ganai
- Centre of Research for Development, University of Kashmir, Srinagar, Jammu and Kashmir, India
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Marcotte EL, Spector LG, Mendes-de-Almeida DP, Nelson HH. The Prenatal Origin of Childhood Leukemia: Potential Applications for Epidemiology and Newborn Screening. Front Pediatr 2021; 9:639479. [PMID: 33968846 PMCID: PMC8102903 DOI: 10.3389/fped.2021.639479] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/22/2021] [Indexed: 12/22/2022] Open
Abstract
Childhood leukemias are heterogeneous diseases with widely differing incident rates worldwide. As circulating tumors, childhood acute leukemias are uniquely accessible, and their natural history has been described in greater detail than for solid tumors. For several decades, it has been apparent that most cases of childhood acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) initiate in utero. Circumstantial evidence in support of this contention includes the young age of onset and high rate of concordance among identical twins. "Backtracking" of leukemic somatic mutations, particularly gene translocations, to cord blood and dried blood spots collected during the perinatal period has provided molecular proof of prenatal leukemogenesis. Detection of a patient's leukemia translocation in easily accessible birth samples, such as dried blood spots, is straightforward with the knowledge of their idiosyncratic breakpoints. However, to translate these findings into population-based screening and leukemia prevention requires novel methods able to detect translocations at all possible breakpoints when present in a low frequency of cells. Several studies have attempted to screen for leukemic translocations, mainly the common ETV6-RUNX1 translocation, in cord blood samples from healthy children. Most studies have reported finding translocations in healthy children, but estimates of prevalence have varied widely and greatly exceed the incidence of leukemia, leading to concerns that technical artifact or contamination produced an artificially inflated estimate of translocation prevalence at birth. New generation techniques that capture the presence of these translocations at birth have the potential to vastly increase our understanding of the epidemiology of acute leukemias. For instance, if leukemic translocations are present at birth in a far higher proportion of children than eventually develop acute leukemia, what are the exposures and somatic molecular events that lead to disease? And could children with translocations present at birth be targeted for prevention of disease? These questions must be answered before large-scale newborn screening for leukemia can occur as a public health initiative. Here, we review the literature regarding backtracking of acute leukemias and the prevalence of leukemic translocations at birth. We further suggest an agenda for epidemiologic research using new tools for population screening of leukemic translocations.
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Affiliation(s)
- Erin L. Marcotte
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Logan G. Spector
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Daniela P. Mendes-de-Almeida
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
- Department of Hematology, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Division of Molecular Carcinogenesis, Research Center, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Heather H. Nelson
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
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Erdmann F, Hvidtfeldt UA, Feychting M, Sørensen M, Raaschou-Nielsen O. Is the risk of childhood leukaemia associated with socioeconomic measures in Denmark? A nationwide register-based case-control study. Int J Cancer 2020; 148:2227-2240. [PMID: 33210292 DOI: 10.1002/ijc.33402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 01/11/2023]
Abstract
The aetiology of childhood leukaemia is poorly understood. Knowledge about differences in risk by socioeconomic status (SES) may enhance etiologic insights. We conducted a nationwide register-based case-control study to evaluate socioeconomic differences in the risk of childhood leukaemia in Denmark and to access whether associations varied by different measures of SES, time point of assessment, leukaemia type and age at diagnosis. We identified all cases of leukaemia in children aged 0 to 19 years, born and diagnosed between 1980 and 2013 from the Danish Cancer Registry (N = 1336) and sampled four individually matched controls per case (N = 5330). We used conditional logistic regression models for analysis. Medium and high level of parental education was associated with a higher risk of acute myeloid leukaemia (AML) in the offspring, mainly driven by children diagnosed at ages 0 to 4 years [odds ratio (OR) for high maternal education = 3.07; 95% confidence interval (CI): 1.44-6.55]. We also observed a modestly increased risk for lymphoid leukaemia (LL) in association with higher level of parental education, but only in children diagnosed at ages 5 to 19 years. Higher parental income was associated with an increased risk of LL but not AML among children aged 5 to 19 years at diagnosis (OR for high maternal income = 2.78; 95% CI: 1.32-5.89). Results for neighbourhood SES measures indicated null associations. Bias or under-ascertainment of cases among families with low income or basic education are unlikely to explain the observed socioeconomic differences. Future research addressing explicitly the underlying mechanisms of our results may help to enhance etiologic insights of the disease.
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Affiliation(s)
- Friederike Erdmann
- Division of Childhood Cancer Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mette Sørensen
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.,Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.,Department of Environmental Science, Aarhus University, Roskilde, Denmark
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Caesarean sections, prenatal and postnatal conditions and childhood acute lymphoblastic leukaemia: A case-control study in the State of São Paulo, Brazil. Cancer Epidemiol 2020; 69:101851. [PMID: 33186820 DOI: 10.1016/j.canep.2020.101851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Brazil has high rates of caesarean sections, which has been suggested as a risk factor for acute lymphoblastic leukaemia (ALL). In addition, some pre- and postnatal conditions have been identified as relevant in the etiology of ALL. OBJECTIVES Investigate the association of caesarean sections, pre- and postnatal conditions with childhood ALL in the State of São Paulo. METHODS Population-based case-control study including children that are below10 years old. Information on study variables was obtained through face to face interviews, through a questionnaire, and the State of São Paulo Declarations of Live Births database. The conditional and unconditional logistic regression approaches were used to calculate the odds ratio (OR) of the associations between caesarean sections, pre- and postnatal conditions with ALL, and 95 % confidence intervals (95 % CI). RESULTS We observed a weak and non-statistically significant risk for ALL among children exposed to caesarean sections (unconditional logistic regression OR 1.08; 95 % CI 0.70-1.66; conditional logistic regression OR 1.21; 95 % CI 0.72-2.02), but among children under 3 years old and born through a caesarean sections, the risk of ALL was greater (unconditional logistic regression OR 1.70; 95 % CI 0.69-4.21). A negative association for ALL was observed among children with mothers who reported 12 years of schooling or more (unconditional logistic regression OR 0.34; 95 % CI 0.16-0.69). CONCLUSIONS We found a tenuous suggestive association between caesarean sections and childhood ALL. The mother's high level of education showed an inverse association with ALL.
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Silva-Junior AL, Alves FS, Kerr MWA, Xabregas LA, Gama FM, Rodrigues MGA, Torres AS, Tarragô AM, Sampaio VS, Carvalho MPSS, Fraiji NA, Malheiro A, Costa AG. Acute lymphoid and myeloid leukemia in a Brazilian Amazon population: Epidemiology and predictors of comorbidity and deaths. PLoS One 2019; 14:e0221518. [PMID: 31437246 PMCID: PMC6705820 DOI: 10.1371/journal.pone.0221518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/08/2019] [Indexed: 01/07/2023] Open
Abstract
Introduction Leukemia is the most common cancer in children and has the highest rates of incidence in industrialized countries, followed by developing countries. This epidemiologic profile can mainly be attributed to the availability of diagnostic resources. In Brazil, leukemia diagnosis is a challenge due to financial viability, lack of hemovigilance services in isolated regions and the vast size of the territory. Its incidence in the state of Amazonas has been increasing since 2010. Therefore, this study aims to describe the epidemiological pattern and spatial distribution of patients with acute lymphoid leukemia and acute myeloid leukemia in Amazonas and identify the predictors of comorbidity and death. Materials and methods A retrospective cross-sectional study was carried out based on patients’ data which was obtained from the database of a referral center for the period of 2005 to 2015. Variables included age, gender, ethnicity, civil status, schooling, income, location of residence, subtype of leukemia, comorbidities, and date of death. The spatial distribution was performed using QGIS v.2.18. Stata software was used for univariable and multivariable logistic regression to evaluate the association between both comorbidities and death for all characteristic groups of ALL and AML. Results The group that was studied was composed of 577 ALL and 266 AML patients. For both, most patients were male, with a schooling period of 1–4 years, received<1 minimum wage, and lived mostly in Manaus, followed by the municipality of Tefé. There was no association between the development of comorbidities and analyzed variables in patients with ALL. AML patients that were >60 years old and with family history of the disease had the highest risk of developing comorbidities (OR = 5.06, p = 0.038; OR = 2.44, p = 0.041, respectively). Furthermore, patients with ALL and in the 41-50-year age group had a higher risk of death (OR = 31.12; p = 0.001). No association between death and explanatory variables were found in patients with AML. In addition, significant difference was observed in time to death (chi2 = 4,098.32, p = 0.000), with 50% of patients with AML dying within two years after diagnosis, whereas in ALL, this percentual of death only is reached in approximately 5 years. Conclusion Our study describes the data of patients with acute leukemia in Amazonas, a remote region in the north of Brazil. In addition, it highlights the importance of hemovigilance in an Amazon region state, while focusing on peripheral areas which don't have prevention, diagnosis and treatment tools for this disease.
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Affiliation(s)
- Alexander Leonardo Silva-Junior
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Fabíola Silva Alves
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Marlon Wendell Athaydes Kerr
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Lilyane Amorim Xabregas
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Fábio Magalhães Gama
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Maria Gabriela Almeida Rodrigues
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
| | - Alexandre Santos Torres
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
| | - Andréa Monteiro Tarragô
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Vanderson Souza Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - Maria Perpétuo Socorro Sampaio Carvalho
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Nelson Abrahim Fraiji
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Adriana Malheiro
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Allyson Guimarães Costa
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- * E-mail:
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Ologbenla A, Hu M, Hajizadeh M. Socioeconomic status and incidence of pediatric leukemia in Canada: 1992-2010. Cancer Epidemiol 2019; 61:14-22. [PMID: 31103934 DOI: 10.1016/j.canep.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/03/2019] [Accepted: 04/26/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Leukemia is the most common cancer among Canadian children, representing about a third of pediatric cancers in Canada and is responsible for about one-third of pediatric cancer deaths. Understanding the effect of socioeconomic status (SES) on pediatric leukemia incidence provides valuable information for cancer control and interventions in Canada. METHODS Using a linked data from the Canadian Cancer Registry (CCR), Canadian Census of Population (CCP) and National Household Survey (NHS) we aimed to quantify socioeconomic inequalities in the incidence of pediatric leukemia from 1992 to 2010. We used the concentration index (C) approach to quantify income- and education-related inequalities in the incidence of pediatric leukemia over time. RESULTS Though there were fluctuations in incidence over the study period, our results showed that the total incidence of pediatric leukemia in Canada was generally consistent from 1992 to 2010. Incidence rate of 47 per 1,000,000 as at 1992 rose to 57 per 1,000,000 in 2010. The estimated values of the C over the study period failed to show any significant association between pediatric leukemia incidence and household income or education status. CONCLUSIONS Although pediatric leukemia incidence is not rising significantly, it is not reducing significantly either. The incidence of pediatric leukemia showed no significant association with socioeconomic status. Future cancer control interventions should focus more on mitigating risk factors that are independent of socioeconomic status.
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Affiliation(s)
| | - Min Hu
- School of Health Administration, Dalhousie University, Halifax, Canada
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Precision medicine and health disparities: The case of pediatric acute lymphoblastic leukemia. Nurs Outlook 2019; 67:331-336. [PMID: 31279488 DOI: 10.1016/j.outlook.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/07/2019] [Accepted: 05/12/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Precision medicine has uncertain potential to address population health disparities. PURPOSE Case study of disparities in pediatric acute lymphoblastic leukemia (ALL). METHOD Literature-based evaluation of ALL in African American (AA) and European American (EA) children. FINDINGS AA children have a lower incidence of ALL than EA children, experience higher relapse rates, and are more likely to be diagnosed with poor prognostic indicators. Environmental risk exposures for ALL have small effect sizes; data are insufficient to determine their contribution to differences in incidence and prognosis. Differences in prevalence of gene variants associated with treatment response contribute to higher relapse rates in AA children. However, higher relapse rates were not seen in a care setting that eliminated out of pocket costs, used risk-directed therapy, and included rigorous case management. DISCUSSION Unequal access to effective treatment contributes to ALL disparities. Precision medicine can help to define effective treatment for diverse patient populations.
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Gilli IO, Joaquim AF, Tedeschi H, Dos Santos Aguiar S, Morcillo AM, Ghizoni E. Factors affecting diagnosis of primary pediatric central nervous system neoplasias in a developing country. Childs Nerv Syst 2019; 35:91-96. [PMID: 30250987 DOI: 10.1007/s00381-018-3958-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/19/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Understand the variables that could interfere with diagnosis and prompt treatment in CNS childhood cancer in Brazil, a developing country with continental dimensions. METHODS From 2005 to 2010, we retrospectively evaluated factors, which could represent a negative influence on the time period elapsing from the onset of symptoms until the diagnosis of the central nervous system (CNS) neoplasia in children and adolescents attended in our service. RESULTS Two hundred seventeen records were analyzed retrospectively. Factors of the households were evaluated, and this data was related to the time period elapsing from presentation of the first symptoms until the diagnosis of CNS neoplasia. The average time elapsed from the onset of the symptoms until seeking medical assistance was 96 days, and from medical assistance to patient referral to a reference service was 33 days. The symptoms which most contributed to a shorter delay in diagnosis were changes in gait and paresis, mother's occupation, father's education level, patient gender, and living in the state of São Paulo. Besides that, variables such as male gender, mother's education level, and lower patient age were associated with an early diagnosis time. CONCLUSION There is great difficulty in performing early diagnosis of CNS tumors, partly due to parent's inability to recognize signs and symptoms, and in part due to an educational deficit among healthcare professionals. Identification of measures that can minimize these causes of delay is fundamental to increasing the chance of cure and survival of these patients.
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Affiliation(s)
- Isadora Olenscki Gilli
- Childhood Hematological Investigations Center Dr. Domingos A. Boldrini., Dr. Gabriel Porto St., 1270 Cidade Universitária, Campinas, SP, 13083-210, Brazil.
| | - Andrei Fernandes Joaquim
- Division of Neurosurgery, Department of Neurology, University of Campinas, Tessalia Vieira de Camargo St., 126, Campinas, SP, 13083-887, Brazil
| | - Helder Tedeschi
- Childhood Hematological Investigations Center Dr. Domingos A. Boldrini., Dr. Gabriel Porto St., 1270 Cidade Universitária, Campinas, SP, 13083-210, Brazil.,Division of Neurosurgery, Department of Neurology, University of Campinas, Tessalia Vieira de Camargo St., 126, Campinas, SP, 13083-887, Brazil
| | - Simone Dos Santos Aguiar
- Center for Investigation in Pediatrics (CIPED), University of Campinas, Tessalia Vieira de Camargo St., 126, Campinas, SP, 13083-887, Brazil
| | - Andre Moreno Morcillo
- Center for Investigation in Pediatrics (CIPED), University of Campinas, Tessalia Vieira de Camargo St., 126, Campinas, SP, 13083-887, Brazil.,Department of Pediatrics, University of Campinas, Tessalia Vieira de Camargo St., 126, Campinas, SP, 13083-887, Brazil
| | - Enrico Ghizoni
- Childhood Hematological Investigations Center Dr. Domingos A. Boldrini., Dr. Gabriel Porto St., 1270 Cidade Universitária, Campinas, SP, 13083-210, Brazil.,Division of Neurosurgery, Department of Neurology, University of Campinas, Tessalia Vieira de Camargo St., 126, Campinas, SP, 13083-887, Brazil
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11
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Ye X, Torabi M, Lix LM, Mahmud SM. Time and spatial trends in lymphoid leukemia and lymphoma incidence and survival among children and adolescents in Manitoba, Canada: 1984-2013. PLoS One 2017; 12:e0175701. [PMID: 28430788 PMCID: PMC5400229 DOI: 10.1371/journal.pone.0175701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/30/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To test for time and spatial trends in lymphoid malignancies, including lymphoid leukemia (LL), Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL), in children and adolescents in the province of Manitoba, Canada. METHODS Incident cases diagnosed between 1984 and 2013 were identified from the Manitoba Cancer Registry. We assessed time trends in age-standardized incidence rates using joinpoint regression and in 5-year relative survival using Poisson regression model. Kulldorff's scan method was used to assess spatial variation and clustering. RESULTS Age-standardized incidence rates (per million person-years) in males and females were 34.0 (95% confidence interval [CI] 28.9-39.1) and 26.2 (95% CI 21.5-30.7) for LL, 10.5 (95% CI 7.7-13.3) and 12.5 (95% CI 9.4-15.7) for HL, 12.5 (95% CI 9.3-15.4) and 7.7 (95% CI 5.2-10.2) for NHL (except for Burkitt lymphomas), and 3.2 (95% CI 1.6-4.7) and 1.5 (95% CI 0.4-2.5) for Burkitt lymphomas. Age- and sex- standardized LL incidence rate increased 1.4% (95% CI 0.3%-2.5%) per year, while the changes for HL and NHL incidence rates were not statistically significant. There were geographic differences in age-standardized incidence rates for LL, HL, and NHL and spatial clusters were detected in southern part of the province. Five-year relative survival has improved over time and there was no difference between rural and urban areas. CONCLUSIONS Lymphoid leukemia incidence rate increased over time and varied by geographic area. Further research should examine the factors contributing to these trends.
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Affiliation(s)
- Xibiao Ye
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mahmoud Torabi
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salaheddin M. Mahmud
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
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12
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Marquant F, Goujon S, Faure L, Guissou S, Orsi L, Hémon D, Lacour B, Clavel J. Risk of Childhood Cancer and Socio-economic Disparities: Results of the French Nationwide Study Geocap 2002-2010. Paediatr Perinat Epidemiol 2016; 30:612-622. [PMID: 27555468 DOI: 10.1111/ppe.12313] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Socio-economic status is related to many life style and environmental factors, some of which have been suggested to influence the risk of childhood cancer. Studies requiring subject participation are usually hampered by selection of more educated parents. To prevent such bias, we used unselected nationwide Geographical Information System (GIS)-based registry data, to investigate the influence of socio-economic disparities on the risk of childhood cancer. METHODS The Geocap study included all French residents diagnosed with cancer aged up to 15 years over the period 2002-2010 (15 111 cases) and 45 000 contemporaneous controls representative of the childhood population. Area socio-economic characteristics used to calculate the European Deprivation Index (EDI) were based on census data collected on the fine scale of the Merged Islet for Statistical Information (IRIS). RESULTS Overall, the risk of acute lymphoblastic leukaemia (ALL) was lower in the most deprived quintile than in the other quintiles of EDI (ORQ5vs<Q5 0.80 (95% confidence interval (CI) 0.73, 0.88)). The odds ratio for all the other cancers taken together was close to the null (ORQ5vs<Q5 0.99 (95% CI 0.94, 1.04)). CONCLUSION Living in the most deprived areas was inversely associated with the risk of ALL in childhood. There was no indication that the risk of childhood cancer of any site could be increased by deprivation. Life style or environmental factors potentially underlying the association need further investigation.
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Affiliation(s)
- Fabienne Marquant
- Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of childhood and adolescent cancers research group (EPICEA), INSERM, UMR 1153, Paris Descartes University, Villejuif, France
| | - Stéphanie Goujon
- Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of childhood and adolescent cancers research group (EPICEA), INSERM, UMR 1153, Paris Descartes University, Villejuif, France.,French National Registry of Childhood Haematological Malignancies (NRCH), Villejuif, France
| | - Laure Faure
- Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of childhood and adolescent cancers research group (EPICEA), INSERM, UMR 1153, Paris Descartes University, Villejuif, France.,French National Registry of Childhood Haematological Malignancies (NRCH), Villejuif, France
| | - Sandra Guissou
- French National Registry of Childhood Solid Tumours (NRCST), Vandoeuvre-les-Nancy, France
| | - Laurent Orsi
- Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of childhood and adolescent cancers research group (EPICEA), INSERM, UMR 1153, Paris Descartes University, Villejuif, France
| | - Denis Hémon
- Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of childhood and adolescent cancers research group (EPICEA), INSERM, UMR 1153, Paris Descartes University, Villejuif, France
| | - Brigitte Lacour
- French National Registry of Childhood Solid Tumours (NRCST), Vandoeuvre-les-Nancy, France
| | - Jacqueline Clavel
- Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of childhood and adolescent cancers research group (EPICEA), INSERM, UMR 1153, Paris Descartes University, Villejuif, France.,French National Registry of Childhood Haematological Malignancies (NRCH), Villejuif, France
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13
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Acute lymphoblastic leukemia in low and middle-income countries: disease characteristics and treatment results. Curr Opin Oncol 2015; 26:650-5. [PMID: 25202926 DOI: 10.1097/cco.0000000000000125] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Acute lymphoblastic leukemia is the most common pediatric cancer. The cure rate of this disease is over 80% in developed countries utilizing protocols with very tolerable toxicity. Several factors contributed to this success, including the implementation of large collaborative clinical trials and the better understanding of disease biology allowing for risk-stratified treatment. We will review the current state of the treatment of acute lymphoblastic leukemia in low-income and medium-income countries. RECENT FINDINGS The picture differs from country to country, but recent advances have been made in many countries and the cure rates have improved significantly. Tackling problems such as access to care, abandonment of treatment and toxicity of protocols and the development of centers of excellence are critical for continued improvement. Twinning with programs in developed countries and the creation of regional collaborative groups will allow the implementation of risk-directed therapy and better supportive care. SUMMARY The experience in low-income countries shows that a structured approach to the treatment of acute lymphoblastic leukemia results in improved survival.
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14
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Adam M, Kuehni CE, Spoerri A, Schmidlin K, Gumy-Pause F, Brazzola P, Probst-Hensch N, Zwahlen M. Socioeconomic Status and Childhood Leukemia Incidence in Switzerland. Front Oncol 2015; 5:139. [PMID: 26175964 PMCID: PMC4485172 DOI: 10.3389/fonc.2015.00139] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/02/2015] [Indexed: 11/21/2022] Open
Abstract
Socioeconomic status (SES) discrepancies exist for child and adult cancer morbidity and are a major public health concern. In this Swiss population-based matched case–control study on the etiology of childhood leukemia, we selected the cases from the Swiss Childhood Cancer Registry diagnosed since 1991 and the controls randomly from census. We assigned eight controls per case from the 1990 and 2000 census and matched them by the year of birth and gender. SES information for both cases and controls was obtained from census records by probabilistic record linkage. We investigated the association of SES with childhood leukemia in Switzerland, and explored whether it varied with different definitions of socioeconomic status (parental education, living condition, area-based SES), time period, and age. In conditional logistic regression analyses of 565 leukemia cases and 4433 controls, we found no consistent evidence for an association between SES and childhood leukemia. The odds ratio comparing the highest with the lowest SES category ranged from 0.95 (95% CI: 0.71–1.26; Ptrend = 0.73) for paternal education to 1.37 (1.00–1.89; Ptrend = 0.064) for maternal education. No effect modification was found for time period and age at diagnosis. Based on this population-based study, which avoided participation and reporting bias, we assume the potential association of socioeconomic status and childhood leukemia if existing to be small. This study did not find evidence that socioeconomic status, of Switzerland or comparable countries, is a relevant risk factor or strong confounder in etiological investigations on childhood leukemia.
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Affiliation(s)
- Martin Adam
- Swiss Tropical and Public Health Institute , Basel , Switzerland ; University of Basel , Basel , Switzerland ; Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
| | - Adrian Spoerri
- Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
| | - Kurt Schmidlin
- Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
| | - Fabienne Gumy-Pause
- Haematology/Oncology Unit, Department of Paediatrics, University Hospital of Geneva , Geneva , Switzerland
| | - Pierluigi Brazzola
- Department of Paediatrics, Ospedale San Giovanni , Bellinzona , Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute , Basel , Switzerland ; University of Basel , Basel , Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland
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15
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Ribeiro KB, Degar B, Antoneli CBG, Rollins B, Rodriguez-Galindo C. Ethnicity, race, and socioeconomic status influence incidence of Langerhans cell histiocytosis. Pediatr Blood Cancer 2015; 62:982-7. [PMID: 25586293 DOI: 10.1002/pbc.25404] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/25/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disease, and its etiology is not well understood. Population-based studies may contribute to etiologic research by defining incidence patterns. This study was designed to evaluate the descriptive epidemiology of disseminated LCH in the United States, using data from population-based cancer registries. PROCEDURE We analyzed the incidence and survival of disseminated LCH in children and adolescents (0-19 years) from 18 SEER registries during 2000-2009. Age-standardized incidence rates (ASIR) per million and rate ratios (RR) were calculated by gender, race, ethnicity, age, and socioeconomic variables (crowding, rural/urban, education, and poverty) using the SEER*Stat software 8.0.1. Relative survival (RS) estimates were calculated using Ederer II method. RESULTS One hundred forty-five cases of disseminated LCH were recorded; ASIR was 0.70/million per year. Lower ASIR was observed for blacks (vs. whites) (RR = 0.41, 95% CI 0.18-0.81), while higher ASIR was noted for Hispanics (vs. non-Hispanics) (RR = 1.63, 95% CI 1.15-2.29). Risk of LCH was higher in crowded counties (RR = 1.84, 95% CI 1.31-2.58) and also in areas with low educational level (RR = 1.49, 95% CI 1.02-2.22). Five-year relative survival was 90.0% (95% CI 83.0-94.2). Important differences in survival were noted according to gender (male: RS = 96.0 vs. female: RS = 83.4%, P = 0.029) and age (<1 year: RS = 78.5, 1-4 years: RS = 95.6%, 5-19 years: RS = 100%, P = 0.004). CONCLUSIONS This population-based study shows significant variations in the incidence of disseminated LCH by race and ethnic group, as well as the influence of socioeconomic factors. These data may provide clues to causation and point toward the need for analytical epidemiologic studies.
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Affiliation(s)
- Karina Braga Ribeiro
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Department of Social Medicine, São Paulo, Brazil
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16
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Maia RDRP, Wünsch Filho V. Infection and childhood leukemia: review of evidence. Rev Saude Publica 2014; 47:1172-85. [PMID: 24626555 PMCID: PMC4206105 DOI: 10.1590/s0034-8910.2013047004753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 07/09/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze studies that evaluated the role of infections as well as indirect
measures of exposure to infection in the risk of childhood leukemia,
particularly acute lymphoblastic leukemia. METHODS A search in Medline, Lilacs, and SciELO scientific publication databases
initially using the descriptors "childhood leukemia" and "infection" and
later searching for the words "childhood leukemia" and "maternal infection
or disease" or "breastfeeding" or "daycare attendance" or "vaccination"
resulted in 62 publications that met the following inclusion criteria:
subject aged ≤ 15 years; specific analysis of cases diagnosed with acute
lymphoblastic leukemia or total leukemia; exposure assessment of mothers' or
infants' to infections (or proxy of infection), and risk of leukemia. RESULTS Overall, 23 studies that assessed infections in children support the
hypothesis that occurrence of infection during early childhood reduces the
risk of leukemia, but there are disagreements within and between studies.
The evaluation of exposure to infection by indirect measures showed evidence
of reduced risk of leukemia associated mainly with daycare attendance. More
than 50.0% of the 16 studies that assessed maternal exposure to infection
observed increased risk of leukemia associated with episodes of influenza,
pneumonia, chickenpox, herpes zoster, lower genital tract infection, skin
disease, sexually transmitted diseases, Epstein-Barr virus, and
Helicobacter pylori. CONCLUSIONS Although no specific infectious agent has been identified, scientific
evidence suggests that exposure to infections has some effect on childhood
leukemia etiology.
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17
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de Souza Reis R, de Camargo B, de Oliveira Santos M, de Oliveira JM, Azevedo Silva F, Pombo-de-Oliveira MS. Childhood leukemia incidence in Brazil according to different geographical regions. Pediatr Blood Cancer 2011; 56:58-64. [PMID: 21108440 DOI: 10.1002/pbc.22736] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Resource-rich countries tend to have a higher incidence of childhood acute lymphoblastic leukemia (ALL), whereas lower rates are seen in more deprived countries. This study describes the incidence of childhood acute leukemia in Brazil, an upper middle-income country, based on data from 16 population-based cancer registries (PBCRs). PROCEDURE Data were examined from 16 PBCRs in Brazilian cities located in five geographical regions during the period from 1997 to 2004. Incidence rates were analyzed according to gender, age, and type of leukemia. The Wilcoxon test was performed to evaluate for gender-age based difference between by leukemia type. RESULTS The median age-adjusted incidence rate (AAIR) of leukemia in children aged 0-14 years old was 53.3 per million. A different AAIR was found regarding ALL and myeloproliferative disorders (MPD) that ranged from 24.8 to 76.84 per 1,000,000 children. Manaus, although located in a poor area of Brazil, exhibited the highest AAIR (56.6 per million) of ALL. Goiania had the highest AAIR (24.5 per million) of MPD. The median age-specific incidence rate (ASIR) for the 16 Brazilian PBCRs demonstrated a marked peak in incidence of ALL at age 3 years old, in both genders. CONCLUSIONS This population-based study of childhood leukemia demonstrates that substantial regional differences exist regarding the incidence of acute leukemia in Brazil, which warrants further ecological study.
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Affiliation(s)
- Rejane de Souza Reis
- Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer, Rua dos Inválidos, Rio de Janeiro, Brazil
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18
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Azevedo-Silva F, Camargo BD, Pombo-de-Oliveira MS. Implications of infectious diseases and the adrenal hypothesis for the etiology of childhood acute lymphoblastic leukemia. Braz J Med Biol Res 2010; 43:226-9. [PMID: 20401428 DOI: 10.1590/s0100-879x2010007500011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 02/01/2010] [Indexed: 02/02/2023] Open
Abstract
Acute leukemia is the most frequent cancer in children. Recently, a new hypothesis was proposed for the pathogenesis of childhood acute lymphoblastic leukemia (ALL). The so-called 'adrenal hypothesis' emphasized the role of endogenous cortisol in the etiology of B-cell precursor ALL. The incidence peak of ALL in children between 3 to 5 years of age has been well documented and is consistent with this view. The adrenal hypothesis proposes that the risk of childhood B-cell precursor ALL is reduced when early childhood infections induce qualitative and quantitative changes in the hypothalamus-pituitary-adrenal axis. It suggests that the increased plasma cortisol levels would be sufficient to eliminate all clonal leukemic cells originating during fetal life. Because Brazil is a continental and tropical country, the exposure to infections is diversified with endemic viral and regionally non-viral infections, with some characteristics that support the recent adrenal hypothesis. Here we discuss this new hypothesis in terms of data from epidemiological studies and the possible implications of the diversity of infections occurring in Brazilian children.
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Affiliation(s)
- F Azevedo-Silva
- Centro de Pesquisa, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil
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19
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Koppen IJN, Hermans FJR, Kaspers GJL. Folate related gene polymorphisms and susceptibility to develop childhood acute lymphoblastic leukaemia. Br J Haematol 2010; 148:3-14. [DOI: 10.1111/j.1365-2141.2009.07898.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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zur Hausen H. Childhood leukemias and other hematopoietic malignancies: Interdependence between an infectious event and chromosomal modifications. Int J Cancer 2009; 125:1764-70. [DOI: 10.1002/ijc.24365] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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21
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Incidence of first primary central nervous system tumors in California, 2001-2005: children, adolescents and teens. J Neurooncol 2009; 94:263-73. [PMID: 19099198 PMCID: PMC2724634 DOI: 10.1007/s11060-009-9860-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 03/16/2009] [Indexed: 11/22/2022]
Abstract
This study used data from the California Cancer Registry to comprehensively examine first primary central nervous system tumors (PCNST) by the International Classification of Childhood Cancers (ICCC) diagnostic groups and to compare their incidence by age groups, sex, race/ethnicity, socioeconomic status and tumor behavior. The study period, 2001–2005, represents the first 5 years of benign PCNST data collection in the state. The age-adjusted incidence rates were 2.1 for malignant and 1.3 for benign per 100,000. Children younger than 5 years old had the highest incidence of malignant PCNST (2.6 per 100,000). Teens aged 15–19 had the highest incidence of benign PCNST (1.8 per 100,000). Age-specific incidence rates were nearly the same for Hispanics, non-Hispanic whites, and Asian/Pacific Islanders for malignant PCNST among children younger than 5 (2.6–2.7 per 100,000); non-Hispanic whites had the highest rates in the 5–14 year-old age group (2.5 per 100,000) and Asian/Pacific Islanders the highest among the 15–19 year old age group (2.3 per 100,000). We found no statistically significant differences in the incidence of malignant PCNST by race/ethnicity in any age group. Astrocytoma had the highest incidence for both malignant and benign histology in most age groups.
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