Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, Executive Plaza South, Room 8022, Rockville, MD 20852, USA.
Cancer Epidemiol Biomarkers Prev. 2012 Dec;21(12):2159-66. doi: 10.1158/1055-9965.EPI-12-0910. Epub 2012 Oct 12.
Leukemia is a common cancer among U.S. adults but there are few established risk factors. If leukemia risks are substantially influenced by exposures that vary in prevalence across generations, then population incidence rates should vary significantly by birth cohort. However, prior studies have not examined leukemia birth cohort effects using contemporary data and methods.
We used incidence data from the National Cancer Institute's Surveillance, Epidemiology and End Results Program from 1992 through 2009 for adults 25-84 years old and age period cohort models to estimate incidence rate ratios according to birth cohort for acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), chronic myeloid leukemia (CML), and chronic lymphoid leukemia (CLL).
Leukemia incidence varied significantly between birth cohorts for each major leukemia type in men and women except female AMLs; changes on the order of 1% per birth year or 20% per generation were observed. The most significant birth cohort signatures were observed for CLLs and AMLs in men, which were decreasing and increasing, respectively, in cohorts born since 1946.
Our results support the hypothesis that adult leukemia risks are significantly modulated by environmental and lifestyle exposures.
A number of well-established (smoking, certain chemicals, radiation) and newly recognized (obesity) leukemia risk factors are modifiable; ultimately, efforts to promote healthy lifestyles might also help reduce incidence rates of adult leukemia.
白血病是美国成年人中常见的癌症，但目前仅有少数已确定的风险因素。如果白血病的风险受到代际间流行程度不同的暴露因素的显著影响，那么人群发病率应该会根据出生队列有显著差异。然而，之前的研究并没有使用当代数据和方法来研究白血病的出生队列效应。
我们使用了美国国家癌症研究所的监测、流行病学和最终结果计划（Surveillance, Epidemiology and End Results Program）在 1992 年至 2009 年期间 25-84 岁成年人的数据，以及年龄时期队列模型，根据出生队列来估计急性髓系白血病（AML）、急性淋巴细胞白血病（ALL）、慢性髓系白血病（CML）和慢性淋巴细胞白血病（CLL）的发病率比值。
除了女性急性髓性白血病（AML）外，每种主要白血病类型在男性和女性中的发病率在不同出生队列之间存在显著差异；观察到每出生一年变化约 1%或每代变化 20%。在男性中，CLL 和 AML 的出生队列特征最为显著，自 1946 年以来出生的队列中，CLL 的发病率呈下降趋势，AML 的发病率呈上升趋势。
我们的结果支持了这样一种假设，即成年白血病的风险受到环境和生活方式暴露的显著调节。
一些已确立的（吸烟、某些化学物质、辐射）和新发现的（肥胖）白血病风险因素是可以改变的；最终，促进健康生活方式的努力也可能有助于降低成年白血病的发病率。
