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Epidemiology of Acute Lymphoblastic Leukaemia

Epidemiology of Acute Lymphoblastic Leukaemia . Eve Roman. Numbers of cases and rates by age and sex, all leukaemias combined, UK. Number of cases by age, all persons, selected leukaemias, UK. Numbers and proportions of leukaemias by type, UK. Childhood cancer: more developed countries.

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Epidemiology of Acute Lymphoblastic Leukaemia

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  1. Epidemiology of Acute Lymphoblastic Leukaemia Eve Roman

  2. Numbers of cases and rates by age and sex, all leukaemias combined, UK

  3. Number of cases by age, all persons, selected leukaemias, UK

  4. Numbers and proportions of leukaemias by type, UK

  5. Childhood cancer: more developed countries 26,864 new cases each year leukaemia CNS NHL other kidney Hodgkin’s ovary

  6. Childhood cancer: less developed countries 133,867 new cases each year leukaemia NHL CNS kidney other Hodgkin’s liver

  7. Epidemiology Study of the distribution and determinants of disease/states of health in human populations Exposure Health Susceptibility Early Biological effect Altered structure/ function Internal Dose Effective Dose

  8. ALL in infants, children and adults Infants Children Adults Philadelphia chromosome Hyperdiploidy TEL-AML1 gene fusion MLL gene fusion Others

  9. United Kingdom Childhood Cancer Study(UKCCS) Management committee chaired by Professor Sir Richard Doll FRS 1992-2004 Professor Nick Day FRS 2004 -

  10. UKCCS: Main areas of study

  11. Study population • Children (≤ 15 years) registered for primary care with a General Practitioner (GP) Cases - ascertained from multiple sources:- • Treating/referring hospitals • Cross-checks with cancer registries Controls – selected from primary care population registers and individually matched to cases on:- • date of birth • sex • region of residence

  12. Registration (cases & controls) Diagnostics (cases) Birth Certificates Interview Census Biological samples (cases) Radon & Gamma Maternity notes EMF/ELF Primary care records UKCCS Data

  13. Diagnostics (cases) Biological samples (cases) Diagnostics and biological samples Diagnostics (cases) Diagnostics (cases) Diagnostics - multiple sources including: - Treatment trials Cytogenetics databases (routine & specialist) Histopathological review (solid tumours) Individual clinical records Biological samples Pre-treatment Remission Biological samples (cases) Biological samples (cases)

  14. Diagnostics (cases) Biological samples (cases) Diagnostics and biological samples Diagnostics (cases) Diagnostics (cases) Biological samples (cases) Biological samples (cases)

  15. Registration (cases & controls) Diagnostics (cases) Birth Certificates Interview Census Biological samples (cases) Maternity notes Primary care records UKCCS Data The study provides no evidence that exposure to magnetic fields associated with electricity supply in the UK increases risks for childhood leukaemia, cancers of the central nervous system, or any other childhood cancer.

  16. Registration (cases & controls) Diagnostics (cases) Birth Certificates Interview Census Biological samples (cases) Maternity notes Primary care records UKCCS Data Our results are reassuring, in that they do not suggest any detectable public health risk of childhood malignancies in the UK population from radon exposure.

  17. “Greaves hypothesis” “…. the common subset of ALL peaking between two and five years of age may develop in response to infection in children who have been under-exposed to one or more common micro-organism in infancy……..

  18. Fertlization errors • Implantation errors • Fetal loss • Intra-uterine growth problems • Congenital anomaly • Child health e.g. • Immune function • Allergy • Development • Cancer • Adult health e.g. • Fertility • Heart disease • Cancer

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