1st Revision: Introduction
Overview of Leukaemia Leukaemia is a type of cancer that affects the blood and bone marrow. It occurs when the body produces abnormal white blood cells, which crowd healthy blood cells and impair the normal functioning of the immune system, interfering with the production of healthy blood cells.
Prevention is crucial when it comes to leukaemia, although it is not always possible to prevent the disease entirely. The causes of leukaemia are often complex and can involve a combination of genetic, environmental and lifestyle factors. However, there are certain measures individuals can take to reduce their risk:
- Avoid exposure to carcinogens: follow safety guidelines and protocols if you work in an industry that involves exposure to potentially harmful substances
- Maintain a healthy lifestyle: having a balanced diet and limiting the consumption of processed foods, carbonated drinks and red meat. Regular exercise and maintaining a healthy weight
- Protect against infections: some types of leukaemia, such as acute lymphoblastic leukaemia (ALL), have been associated with the Epstein-Barr virus and human T-cell leukaemia virus. Genetic counselling is important to prevent cancer1
Understanding Leukemia
Leukaemia is caused by the rapid production of white blood cells, which are responsible for fighting infections and diseases. These abnormal cells, known as leukaemia cells, do not function properly and accumulate in the bone marrow, crowding out healthy blood cells and impairing the usual production of red blood cells, white blood cells and platelets.
Risk factors for leukaemia:
- Genetic factors: certain genetic abnormalities, such as chromosomal mutations or inherited gene mutations, can increase the risk of developing leukaemia. For example, down syndrome and genetic disorders like Li-Fraumeni syndrome. Elevated incidence of leukaemia is linked to Fanconi anaemia2
- Radiation Exposure: high levels of ionisingradiation, such as those experienced during radiation therapy or nuclear accidents, have been linked to an increased risk of developing leukaemia
- Family history: leukaemia is more likely to strike people in the closest relatives, especially siblings or parents. This may indicate that certain people have a hereditary susceptibility to leukaemia
- Age and gender: The risk of developing leukaemia increases with age, with most cases occurring in older adults. However, certain types of leukaemia, such as ALL, are more common in children. Additionally, some types of leukaemia, such as CLL, are more common in men than in women
Regular medical check-ups, awareness of personal risk factors, and early detection are crucial for timely diagnosis and effective treatment of leukaemia. Lifestyle modifications including weight control, quitting smoking, managing hypercholesterolemia, and increased physical activity reduce the risk factors.3
Prevention strategies
While the exact causes of leukaemia can be complex and varied, certain carcinogens are identified as potential carcinogens linked to the development of leukaemia. Here are some common carcinogens associated with leukaemia:
- Benzene: is a chemical compound found in gasoline, tobacco smoke, solvents and various industrial products.4Prolonged exposure to high levels of benzene is known to increase the risk of developing leukaemia, particularly acute myeloid leukaemia (AML)
- Ionizing radiation: such as X-rays, gamma rays, and certain radioactive materials, havebeen linked to an increased risk of leukaemia
- Pesticides and herbicides: such as benzene hexachloride (BHC), chlordane and glyphosate, have been associated with an increased risk of leukaemia.5
Agricultural workers and individuals with frequent exposure to these chemicals may be at a higher risk - Formaldehyde: is a chemical commonly used in the manufacturing of certain building materials, household products and medical laboratories. Prolonged exposure to formaldehyde, particularly in occupational settings, has been linked to a higher incidence of leukemia, particularly myeloid leukemia6
Tips for reducing exposure
Carcinogens are an important step in minimizing the risk of developing various cancers, including leukemia. Here are some tips to help you reduce your exposure to carcinogens:
- Smoking: has been linked to a higher incidence of leukemia, particularly myeloid leukemia
- Minimize exposure to environmental pollutants: beingaware of your surroundings and minimising exposure to environmental pollutants such as air pollution, industrial emissions and chemical fumes. Stay informed about the air quality in your area and take necessary precautions, such as using air purifiers or avoiding outdoor activities during times of high pollution
- Practice safe food preparation: when cooking, grilling or barbecuing, be mindful of safe food preparation practices. Avoid charring or burning food, as this can create potentially carcinogenic compounds. Marinate meat before grilling and use lower heat settings to minimisethe formation of harmful substances
- Use safe household products: choose cleaning and personal care products that are free from potentially harmful chemicals. Look for products labelled as non-toxic, eco-friendly or fragrance-free. Consider using natural alternatives like vinegar and baking soda for cleaning
- Filter your drinking water: install a water filter to remove potential contaminants from your water. This can help reduce exposure to harmful substances like heavy metals and chemicals that may be present in tap water
- Be cautious with pesticides and herbicides: if you use pesticides or herbicides in your garden or home, follow safety instructions carefully. Consider natural alternatives or integrated pest management techniques to reduce reliance on chemicals
- Practice sun safety: protect your skin from excessive sun exposure by seeking shade, wearing protective clothing, and applying sunscreen with a high SPF regularly. Limiting sunburns and UV radiation exposure can help reduce the risk of skin cancer
Remember that while these tips can help reduce exposure to carcinogens, it's important to maintain overall good health , including regular medical check-ups, cancer screenings, and healthy lifestyle choices. Consult with healthcare professionals or environmental experts for specific guidance based on your circumstances and concerns.
Healthy lifestyle choices
Regular exercise
Patients during cancer treatment often complain about depression and tiredness which can lead to low cardiorespiratory activity and muscular dysfunction.7
While exercise alone cannot guarantee prevention, it is a valuable component of a healthy lifestyle. Here's how regular exercise can contribute to leukaemia prevention:
- Boosts the immune system: a strong immune system is crucial for identifying and eliminating cancerous cells before they can develop into leukaemia
- Reduces inflammation: regular exercise has anti-inflammatory effects, helping to reduce systemic inflammation in the body and potentially lowering the risk of developing leukaemia
- Enhances cardiovascular health: exercise promotes cardiovascular fitness and improves heart function. It enhances blood circulation, delivering oxygen and nutrients throughout the body, including the bone marrow where blood cells are produced. By supporting optimal blood flow, exercise can contribute to the healthy functioning of the bone marrow
- Manages stress: chronic stress has been associated with a negative impact on the immune system and may increase the risk of certain diseases, including cancer. Incorporating exercise into your routine can help manage stress and support a healthier immune system
- Promotes healthy hormone levels: regular exercise can help regulate hormone levels in the body, including those involved in cell growth and proliferation. Balanced hormone levels contribute to maintaining healthy cellular processes and reducing the risk of abnormal cell growth associated with cancer
Balanced diet and nutrition
A balanced diet can contribute to overall health and potentially reduce the risk of developing leukaemia. While there is no specific diet that can guarantee prevention, certain dietary choices and habits can support a healthy immune system and reduce the risk of cancer. Below are a couple of recommendations for a healthy diet that can discourage leukaemia:
- Eat a variety of fruits and vegetables: can help support a healthy immune system and provide protective compounds that may help prevent cancer
- Choose whole grains: fibres, vitamins, and minerals, and have been associated with a lower risk of certain types of cancer. They can also help maintain a healthy weight
- Include lean proteins: protein is important for cell growth and repair and choosing lean options can help reduce the intake of saturated fats
- Reduce red and processed meats: high intake of these meats has been linked with a higher chance of developing certain malignancies, including leukaemia
- Limit added sugars and refined carbohydrates: minimisingthe intake of sugary drinks, sweets, desserts and processed foods high in added sugars. Excessive sugar consumption can contribute to weight gain and inflammation, which may increase cancer risk
- Stay hydrated: water helps maintain overall health and supports various bodily functions, including digestion and detoxification
Limiting alcohol and quitting smoking
Limiting alcohol consumption and quitting smoking are crucial steps in reducing the risk of developing leukaemia. Here's why it is important to limit alcohol and quit smoking to prevent the occurrence of leukaemia:
- Alcohol and leukaemia: heavy alcohol consumption has been linked with a higher chance of leukaemia, particularly acute myeloid leukaemia (AML). Alcohol may affect the production of blood cells and impair the functioning of the immune system, making individuals more susceptible to developing leukaemia. To reduce the risk of leukaemia, it is advisable to limit alcohol consumption or
avoid it altogether. The American Cancer Society advises anyone who wants to consume alcohol to do so moderately. This entails a maximum of one beverage for ladies and two for males each day8 - Smoking and leukaemia: smoking tobacco is a significant risk factor for several types of cancer, including leukaemia. The chemicals present in tobacco smoke can enter the bloodstream and affect the bone marrow, where blood cells are produced
The best way to reduce the risk of leukaemia associated with smoking is to quit smoking altogether. Seek support from healthcare professionals, quit-smoking programs or support groups to increase your chances of successfully quitting.
Protecting against infections
Immunisationsand hygiene practices
Vaccines that are made to prevent leukaemia do not prevent the same way as modern vaccine therapy prevents diseases such as polio or measles. The therapeutic effect of these vaccines is to treat cancer that is already present or to reduce its growth potential.
Currently, the vaccines for leukaemia, lymphoma and myeloma are underdeveloped or are in clinical trials. Its goal is to modify the immune system to attack abnormal cancer cells.
The Centre for Disease Control and Prevention in the US CDC recommends influenza shots for cancer patients or survivors or any person who had direct contact with cancer patients every year.
The pneumococcal pneumonia vaccine is recommended for patients who recently had a blood cancer diagnosis. Ask your healthcare doctor for the immunization protocol.
Hygiene practices should be performed so that the infected person's immune system doesn't get compromised
Minimisingradiation exposure
Radiations can be a risk factor for leukaemia are nonionisingradiations and ionisingradiations. The nonionisingradiations are weak that can be emitted from a cell phone or PC. According to recent studies, brain tumour risk is a concern but its influence is relatively low.
- Ionising radiation is highly energisedto damage our DNA in cells. Also atomic bomb (Hiroshima and Nagasaki atomic bombings had increased the risk of leukaemia)10
- Nuclear hazards, radioactive iodine therapy used to treat hyperthyroidism or thyroid cancer had increased the risk of AML by 80% more than those who haven't received this treatment11
- Uranium being a radioactive material also increases the risk for leukaemia when exposed to tobacco-containing materials12
Role of genetics in leukaemia
Role of genetics in leukaemia varies with its types. It's not usually common in families but identical twins are an exception where any one sibling hasmore chances of disease development before one year13
Family history of AML increases therisk so diagnosis is important. As children with AML siblings have up to 4 times higher risk of disease development, meanwhile the risk in identical twins is around 20%14
Genetic counselling and testing
Counselling leukaemia patients or patients who had a risk factor for leukaemia is necessary to prevent cancer and offers several benefits:
- Early detection: testing can identify leukaemia at an early stage, increasing the chances of successful treatment
- Peace of mind: provide reassurance and alleviate anxiety for individuals with concerns about leukaemia
- Personalized risk assessment: helps assess individual risk factors, allowing for tailored recommendations for prevention and early detection
- Education and awareness: provide valuable information about leukaemia, its causes and preventive measures
- Support and coping strategies: offers emotional support and coping strategies for individuals diagnosed withleukaemia
- Access to resources: provides access to support groups, educational materials and specialist referrals
Overall, counsellingand testing empower individuals to make informed decisions, manage their health,and seek appropriate support.
Importance of check-ups and screenings
- Early detection: regular monitoring viaroutine physical examinations at an early stage helps in cancer diagnosis.15 Early detection increases the chances of successful treatment
- Prevention: some screenings, such as mammograms for breast cancer or colonoscopies for colorectal cancer, can detect pre-cancerous changes or abnormalities
- Risk assessment: check-ups provide an opportunity for healthcare professionals to assess an individuals personal and family medical history, lifestyle choices and potential risk factors for cancer
- Monitoring and follow-up: regular check-ups allow healthcare providers to monitor individuals over time and detect any changes or abnormalities that may require further investigation or treatment. They also provide an opportunity to discuss any new symptoms or concerns and receive appropriate guidance
Recognising leukaemia symptoms
Symptoms of leukaemia are often related to acute or chronic cancer h. Symptoms can lead to testing and diagnosis hence, diagnoses made are serendipitous.
Nonspecific symptoms occur such as body infection, weight loss, nausea, diarrhoea, vomiting, shortness of breath and easy bruising, both are common in AL and CL.
Other symptoms include cough, hypertension, and lymphadenopathy, which are much more common in CL, and fever, cold, flu gums, nose bleeds, and abdominal pain seen in AL patients.16
It's important for individuals undergoing cancer treatment to stay informed about their blood cell counts and communicate any changes or concerns to their healthcare team. Regular blood tests, as advised by the healthcare provider, help ensure the effectiveness and treatment safety, support and overall well-being during the cancer journey.
Summary
Leukaemia is a blood cancer caused by abnormal white blood cell production, impairing the immune system. Though prevention is not always possible, reducing risk involves avoiding harmful substances, maintaining a healthy lifestyle, and protecting against infections. Carcinogens like benzene and radiation should be minimized, while regular exercise, a balanced diet, and quitting smoking are essential. Genetic counseling and check-ups aid in early detection and informed decisions for better outcomes during cancer treatment. Promptly recognizing symptoms and staying informed through screenings are also crucial. While guarantees aren't possible, these measures can significantly lower the risk of leukaemia.
References
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- Zhang L, Freeman LEB, Nakamura J, Hecht SS, Vandenberg JJ, Smith MT, et al. Formaldehyde and leukemia: Epidemiology, potential mechanisms, and implications for risk assessment. Environ Mol Mutagen [Internet]. 2009 [cited 2023 Jun 7];NA-NA. Available from: https://onlinelibrary.wiley.com/doi/10.1002/em.20534
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- Lagunas-Rangel FA, Chávez-Valencia V, Gómez-Guijosa MÁ, Cortes-Penagos C. Acute myeloid leukemia—genetic alterations and their clinical prognosis. Int J Hematol Oncol Stem Cell Res [Internet]. 2017 Oct 1 [cited 2023 Jun 7];11(4):328–39. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767295/
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Hats off to Dr. Soha Farooq for yet another outstanding article, this time on leukemia! Your ability to break down complex medical information into understandable terms is truly praiseworthy. Your emphasis on lifestyle changes and dietary considerations alongside importance of checkups and screening is a game-changer!