First Report of National Estimates of the Incidence of Myelodysplastic Syndromes and Chronic Myeloproliferative Disorders from the U.S. SEER Program.
Dana E. Rollison, PhD1,
Matthew Hayat, PhD2,*,
Martyn Smith, PhD4,*,
Sara S. Strom, PhD5,*,
William D. Merritt, PhD3,*,
Lynn Ries, MS2,*,
Brenda K. Edwards, PhD2,* and
Alan F. List, MD1
1 Interdisciplinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL; 2 Surveillance Research Program, National Cancer Institute (NCI), Bethesda, MD; 3 Cancer Therapy Evaluation Program, NCI, Bethesda, MD; 4 Molecular Epidemiology and Toxicology Laboratory, UC Berkeley, Berkeley, CA and 5 Epidemiology, MD Anderson Cancer Center, Houston, TX.
BACKGROUND: Incidence rates for myelodysplastic syndromes (MDS)and chronic myeloproliferative disorders (CMD) in the UnitedStates were unavailable prior to the addition of these stemcell malignancies to the National Cancer Institutes Surveillance,Epidemiology, and End Results (SEER) Program and other centralcancer registries in 2001. Description of national incidencerates for 20012003 will provide an important baselinefor future studies of secular trends and allow for the examinationof rates by selected demographic factors to define risk profilesof these malignancies in the American population.
METHODS: Incidence rates of MDS and CMD were calculated for18 SEER areas between 20012003. These rates were stratifiedby disease subtype using the FAB classification (including chronicmyelomonocytic leukemia [CMML]) with the addition of the WHOdeletion 5q category, sex, age at diagnosis and race. Basedon the observed SEER incidence rates, counts were estimatedfor the entire U.S. population.
RESULTS: In 2003, 2,538 cases of MDS and 1,421 cases of CMDwere observed for all 18 SEER areas combined. Similar numbersof cases were observed in 2001 and 2002. Age-adjusted incidencerates for 20012003 were significantly higher among malesthan females for MDS (4.5 per 100,000 in males vs. 2.7 per 100,000in females, p <0.0001) and CMD (2.4 per 100,000 in malesvs. 1.7 per 100,000 in females, p<0.0001). This gender ratedifference was observed consistently across all disease subtypes,including refractory anemia (2.0 per 100,000 in males vs. 1.2per 100,000 in females (p<0.0001). Incidence rates were significantlyassociated with age at diagnosis for both MDS (p=0.01) and CMD(p=0.001), and were highest among White, non-Hispanics (2.4per 100,000 for CMD; 4.2 per 100,000 for MDS). An estimatednational total of 14,648 cases of MDS (including CMML) and CMDwere diagnosed in 2003, with overall incidence rates for MDSand CMD of 3.1 and 1.9 per 100,000, respectively. The MDS incidencerate for the U.S. is remarkably similar to those previouslyreported from European countries including England and Wales(3.6 per 100,000), Germany (4.1 per 100,000), Sweden (3.6 per100,000) and France (3.2 per 100,000). Estimated incidence ratesin the U.S. were greater among men than women for all diseases,including CMML (0.40 per 100,000 in males versus 0.3 per 100,000in females, p< 0.0001). Disease incidence increased withage for MDS, CMD, and CMML, although the increase was greatestfor MDS, with an approximate five-fold difference in estimatedrates for those diagnosed at ages 6069 years vs. 80 yearsand older (7.4 per 100,000 vs. 36.3 per 100,000). The increasein MDS incidence with age was greater for males than females,whereas the age-related increase in CMD and CMML incidence wassimilar across sexes. Rates of CMD, MDS and CMML were all estimatedto be highest among White, non-Hispanics.
CONCLUSION: Male sex and advanced age are important risk factorsfor the development of CMD and MDS. Diagnostic recording differencesmay underestimate the total annual U.S. MDS and CMD case burden.Future prevention intervention and disease causality studiesof MDS and CMD should target high-risk groups.
* Corresponding author
Disclosure: No relevant conflicts of interest to declare.