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Abstract

Title: Epidemiology of leukemia: overview and patterns of occurrence.
Author: Linet MS, Devesa SS
Journal: In: Leukemia 7th ed (Henderson E, Lister TA, Greaves MF, eds ),Philadelphia: WB Saunders :131-151
Year: 2002
Month: None

Abstract: Clues to the etiology of the leukemias may be obtained by comparing rates for total leukemia and specific subtypes among populations. Patterns and trends in mortality reveal differences by race within the U.S., and higher rates among males than females, although there has been a convergence of rates within gender. Age-specific U.S. mortality has shown dramatic declines for children of both races since the early 1960s, a less rapid decline among young adults, little change among middle-aged adults, and an increase among the elderly of both races. Overall, 5-year relative survival from all forms of leukemia combined (and for each major subtype) has improved significantly rising from 34.4% to 43.1% in regions covered by the U.S. Surveillance Epidemiology and End Results program registries. For childhood acute lymphoblastic leukemia, there are differences in survival by race (generally poorer for other racial groups in the U.S., particularly for American Indians, than for whites), gender (generally poorer for males than females), and age (worse for those younger than age 5 and older than age 10, compared with those ages 5-9). Among the four major leukemia cell types, prognosis is poorest for patients diagnosed with AML as adults. Wtihin virtually all populations internationally, total leukemia age-adjusted incidence rates are higher for males than for females, and higher in white populations in North American, Australia, and New Zealand; lowest rates occur in Japanese, Chinese, and Indians. Among the major subtypes, variation is greatest for chronic lymphocytic leukemia, and least for chronic myeloid leukemia. Over time, incidence has changed little in U.S. whites for total leukemia, whereas incidence rose in the 1970s and early 1980s, then declined slowly among African-Americans. For acute lymphoblastic leukemia, age-standardized incidence rose between the mid-1970s through 1990, then leveled off in all four race groups, whereas chronic lymphocytic leukemia has declined in all four gender-race groups in the U.S. during 1975-1996. For acute myeloid leukemia, rates were stable for adults ages 15-64 during 1975-96, whereas rates declined in the elderly in parallel with a dramatic increase in myelodysplastic syndromes. Age-standardized rates for chronic myeloid leukemia have declined slowly over time among whites; rates rose among African-Americans from 1975-84, then declined steadily. The pattern for age-specific rates differs by subtype, with a U-shaped pattern seen for acute lymphoblastic leukemia, absence of chronic lymphocytic leukemia among those under age 30, but an exponential increase after age 30 years, an S-shaped increase with age for acute myeloid leukemia (with higher rates in infancy among whites than African-Americans, higher rates in childhood among African-Americans than in whites, similar rates by race and sex in young and middle-aged adults, and higher rates among males of both races than females among the elderly), and a linear increase with age for chronic myeloid leukemia, with higher rates among African-Americans than among whites in most age groups except the juvenile myelomonocytic leukemia and chronic myeloid leukemia among the elderly.