Seasonal variations in the diagnosis of childhood cancer in the United States

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Summary

Seasonal trends in month of diagnosis have been reported for childhood acute lymphoblastic leukaemia (ALL) and non-Hodgkin’s lymphoma (NHL). This seasonal variation has been suggested to represent an underlying viral aetiology for these malignancies. Some studies have shown the highest frequency of diagnoses in the summer months, although this has been inconsistent. Data from the Children’s Cancer Group and the Pediatric Oncology Group were analysed for seasonal incidence patterns. A total of 20 949 incident cancer cases diagnosed in the USA from 1 January 1989 through 31 December 1991 were available for analyses. Diagnosis-specific malignancies available for evaluation included ALL, acute myeloid leukaemia (AML), Hodgkin’s disease, NHL, rhabdomyosarcoma, neuroblastoma, retinoblastoma, osteosarcoma, Wilms’ tumour, retinoblastoma, Ewings’ sarcoma, central nervous system (CNS) tumours and hepatoblastoma. Overall, there was no statistically significant seasonal variation in the month of diagnosis for all childhood cancers combined. For diagnosis-specific malignancies, there was a statistically significant seasonal variation for ALL (P = 0.01; peak in summer), rhabdomyosarcoma (P = 0.03; spring/summer) and hepatoblastoma (P = 0.01; summer); there was no seasonal variation in the diagnosis of NHL. When cases were restricted to latitudes greater than 40° (‘north’), seasonal patterns were apparent only for ALL and hepatoblastoma. Notably, 33% of hepatoblastoma cases were diagnosed in the summer months. In contrast, for latitudes less than 40° (‘south’), only CNS tumours demonstrated a seasonal pattern (P = 0.002; winter). Although these data provide modest support for a summer peak in the diagnosis of childhood ALL, any underlying biological mechanisms that account for these seasonal patterns are likely complex and in need of more definitive studies.

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  • 16 November 2011

    This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication

References

  1. Badrinath, P, Day, NE & Stockton, D (1997). Seasonality in the diagnosis of acute lymphocytic leukaemia. Br J Cancer 75: 1711–1713.

  2. Bjelke, E (1964). Leukemia in children and young adults in Norway. Cancer 17: 248–255.

  3. Bleyer, WA (1990). The impact of childhood cancer on the United States and the world. CA Can J Clin 40: 355–367.

  4. Edwards, JH (1961). The recognition and estimation of cyclic trends. Ann Hum Genet Lond 25: 83–87.

  5. Fekety, FR & Carey, JJH (1969). Season and the onset of acute childhood leukemia. Maryland State Med J 11: 73–77.

  6. Fraumeni, JF (1963). Seasonal variation in leukaemia incidence (letter to the editor). Br Med J 2: 1408–1409.

  7. Gilman, EA, Sorahan, T, Lancashire, RJ, Lawrence, GM & Cheng, KK (1998). Seasonality in the presentation of acute lymphoid leukaemia (letter to the editor). Br J Cancer 77: 677–678.

  8. Greaves, MF (1997). Aetiology of acute leukaemia. Lancet 349: 1–5.

  9. Gunz, FW & Spears, GFS (1968). Distribution of acute leukaemia in time and space. Studies in New Zealand. Br Med J 4: 604–608.

  10. Hall, AJ & Peckham, CS (1997). Infections in childhood and pregnancy as a cause of adult disease – methods and examples. Br Med Bull 53: 10–23.

  11. Harris, RE & Al-Rashid, R (1984). Seasonal variation in the incidence of childhood acute lymphocytic leukemia in Nebraska. Nebraska Med J 6: 192–198.

  12. Harris, RE, Harrell, FE, Jr, Patil, KD & Al-Rashid, R (1987). The seasonal risk of pediatric/juvenile acute lymphocytic leukemia in the United States. J Chron Dis 40: 915–923.

  13. Hayes, DM (1961). The seasonal incidence of acute leukemia. Cancer 14: 1301–1305.

  14. Kinlen, LJ (1995). Epidemiological evidence for an infective basis in childhood leukaemia. Br J Cancer 71: 1–5.

  15. Knox, G (1964). Epidemiology of childhood leukaemia in Northumberland and Durham. Brit J Prev Soc Med 18: 17–24.

  16. Lanzkowsky, P (1964). Variation in leukaemia incidence (letter to the editor). Br Med J 1: 910.

  17. Lee, JAH (1962). Seasonal variation in the clinical onset of leukaemia in young people. Br Med J 1: 1737–1738.

  18. Lee, JAH (1963). Seasonal variation in leukaemia incidence (letter to the editor). Br Med J 2: 623.

  19. Mainwaring, D (1966). Epidemiology of acute leukaemia of childhood in the Liverpool area. Brit J Prev Soc Med 20: 189–194.

  20. Meltzer, AA, Annegers, JF & Spitz, MR (1996). Month of birth and incidence of acute lymphoblastic leukemia in children. Leuk Lymph 23: 85–92.

  21. Mueller, N (1991). An epidemiologist’s view of the new molecular biology findings in Hodgkin’s disease. Ann Oncol 2: 23–27.

  22. Roger, JH (1977). A significance test for cyclic trends in incidence data. Biometrika 64: 152–155.

  23. Ross, JA, Severson, RK, Pollock, BH, Neglia, JP, Woods, WG & Hammond, GD (1993). Pediatric cancer in the United States. A preliminary report of a collaborative study of the Children’s Cancer Group and the Pediatric Oncology Group. Cancer 71: 3415–3421.

  24. Ross, JA, Davies, SM, Potter, JD & Robison, LL (1994). Epidemiology of childhood leukemia with a focus on infants. Epidemiol Rev 16: 243–272.

  25. Ross, JA, Severson, RK, Pollock, BH & Robison, LL (1996). Childhood cancer in the United States. A geographical analysis of cases from the Pediatric Cooperative Clinical Trials Groups. Cancer 77: 201–207.

  26. Smith, MA, Simon, R, Strickler, HD, McQuillan, G, Ries, LA & Linet, M (1998). Evidence that childhood acute lymphoblastic leukemia is associated with an infectious agent linked to hygiene conditions. Cancer Causes Control 9: 285–298.

  27. Stark, CR & Mantel, N (1967). Temporal-spatial distribution of birth dates for Michigan children with leukemia. Cancer Res 27: 1749–1755.

  28. Stewart, AM & Kneale, GW (1982). The immune system and cancers of foetal origin. Cancer Immunol Immunother 14: 110–116.

  29. Swensen, AR, Ross, JA, Severson, RK, Pollock, BH & Robison, LL (1997). The age peak in childhood acute lymphoblastic leukemia. Exploring the potential relationship with socioeconomic status. Cancer 79: 2045–2051.

  30. Till, MM, Hardisty, RM, Pike, MC & Doll, R (1967). Childhood leukaemia in greater London: a search for evidence of clustering. Br Med J 3: 755–758.

  31. Thorne, R, Hunt, LP & Mott, MG (1998). Seasonality in the diagnosis of childhood acute lymphoblastic leukaemia (letter to the editor). Br J Cancer 77: 678.

  32. Van Steensel-Moll, HA, Valkenburg, HA, Vandenbroucke, JP & Van Zanen, GE (1983). Time space distribution of childhood leukaemia in the Netherlands. J Epidemiol Comm Health 37: 145–148.

  33. Walker, AM & Van Noord, PAH (1982). No seasonality in the diagnosis of acute leukemia in the United States. J Natl Cancer Inst 69: 1283–1287.

  34. Westerbeek, RMC, Blair, V, Eden, OB, Stevens, RF, Will, AM, Taylor, GM & Birch, JM (1998). Seasonal variations in the onset of childhood leukaemia and lymphoma. Br J Cancer 78: 119–124.

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Correspondence to J A Ross.

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From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/

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Ross, J., Severson, R., Swensen, A. et al. Seasonal variations in the diagnosis of childhood cancer in the United States. Br J Cancer 81, 549–553 (1999) doi:10.1038/sj.bjc.6690729

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Keywords

  • seasonality
  • childhood cancer
  • leukaemia
  • infection

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