RE: WEBSITE: Form Submission

["Ken Campbell" <KCampbell@lrf....uk>]

Dear Jan,

Thank you for your email. It was not our case that there is definitive
evidence of no increase in childhood leukaemia in the last 100 years.
Rather we would state that there is no robust evidence which shows that
there has been a marked increase in the last 20-30 years and that
evidence for the first half of the 20th Century is so unreliable that
one cannot know the magnitude of any increase. 

As was pointed out in the commentary, data up to the 1960s is based on
mortality reports since childhood leukaemia was almost 100% fatal in
that period. It has been suggested that such mortality data should be
regarded as reliable. As I hope I made clear, this is untenable;
throughout almost all of this period there was a high background rate of
infectious deaths in early childhood and no means available to
differentiate the comparatively very small numbers of leukaemia deaths
which may have been contained within that group. It should be mentioned
that the same problem exists within any society today in which there is
a high rate of childhood deaths due to infection and limited access to
sophisticated diagnostic facilities. By the time of diagnosis, even in
developed countries, most children with leukaemia have suffered several
bouts of infection - in countries where facilities for treatment of
infection are limited, most such children would die with a clinical
diagnosis of infection but no suspicion of their underlying leukaemia.

Improvements in diagnostic facilities and in treatment of paediatric
infections led to the capacity to diagnose leukaemia in children - this
alone would account for most, if not all, of the apparent dramatic
increase in cases seen from 1900 to 1950. When we consider data being
produced from the 1960s onwards there are very significant developments
in the capacity to accurately diagnose and classify childhood leukaemia.
There is also clear evidence, the example of the COMARE report being
cited in the commentary, that this has led to a significant number of
cases being accurately described now as leukaemia which had been
misclassified as lymphoma. As also specifically cited in the commentary,
direct comparison of the results of the (proactive) Data Collection
Study with the (passive) National Registry of Childhood Tumours showed
that significant numbers of cases were being missed by the latter.

Taken collectively, these factors mean that much, and possibly all, of
the reported increase may be due to such missed diagnoses,
misclassifications and failed registrations. As each of these three
strands has improved, cases will have been included which were
previously missed. It is possible that there may be a real on-going
increase but the crucial point is that, if this does exist, it is at a
very low rate and there is no justification for alarmist claims.

As regards the specific paper by Milham and Ossiander, I am indeed
familiar with this paper. A crucial flaw in the paper is its failure to
acknowledge that the hypotheses of Kinlen and Greaves, cited but
dismissed in the paper, would predict exactly the phenomenon described
by Milham. The rural locations were late to achieve electrification
because they were isolated (immunological isolation in infancy) and,
unless we are to understand the locals installed their own electrical
facilities, there will have been an influx of migrant workers bringing
novel infections. In the absence of evidence in his paper that he has
seriously considered these potential confounders, Milham's paper cannot
be regarded as strong evidence.

A very recent paper has offered strong support for the
infection/immunity mechanisms as a cause of childhood leukaemia. An
international comparison of incidence of childhood leukaemia and
childhood diabetes has shown a strong correlation between these
biologically distinct conditions and between them and markers of wealth
and affluence. The most plausible common factor is the "hygiene
hypothesis", that a reduced rate of early exposure to infection may
predispose to the development of apparently unconnected conditions.

International parallels in leukaemia and diabetes epidemiology. Arch Dis
Child. 2004 Jan;89(1):54-6.  PMID: 14709508

In  closing, I would just point out that nothing in my commentary could
be seen as novel. Although not extensively referenced its content is
based on widely published material and, as such, I would not submit it
to any journal, even Medical Hypotheses, as I would deem it simply a
restatement of mainstream opinion. As regards the suggestion that
nothing can be done to diminish the risk of childhood leukaemia, I would
point out that it has already been shown that folate supplementation
during pregnancy reduces the risk, as does early socialization and
mixing with other infants. It is quite likely, based on known biological
features that it may not be possible to reduce the incidence; the major
exception to this assumption would be if, as Professor Kinlen has
hypothesized, there is one infection responsible for triggering most or
all cases, in which case vaccination might be feasible.

While not minimizing the significance of every single case to the
affected family, it must be remembered that childhood leukaemia is,
thankfully, a rare disease. This means that expending huge resources on
unproven suspected risk factors (such as resiting power facilities or
phone masts), may use up money which would save many more children from
harm if used, for example, to reduce the much greater road traffic death
and injury toll. 

I hope that you find this helpful. 

Ken Campbell, MSc (Clin Onc)
Clinical Information Officer

t:   020 7269 9060 
f:   020 7242 1488
e:  kcampbell@lrf....uk

Leukaemia Research Fund, 43 Great Ormond Street, London WC1N 3JJ
Registered charity 216032, a company limited by guarantee 738089

For legal and ethical reasons and because we have no medically qualified
staff in this office, we are unable to give individual advice.
No advice or information provided on this site should be considered a
substitute for advice from a qualified medical practitioner.



> -> Your Name: Jan Hollan
> 
> -> Your Email Address: hollan@ped....cz
> 
> -> Your Feedback: I appreciate that an opinion by Ken Campbell {that
> children leukaemia incidence has been not rising within the last
> hundred years) has been published on your site. However, it gives no
> references, seems to be just a quickly formulated personal opinion. Or
> is it an opinion of Leukaemia Research, when it is offered on the
> information&education page? 
> 
> Constancy of incidence would mean there are hardly any influences we
> could avoid, and reducing the incidence of children leukaemia is
> difficult to achieve. 
> 
> This is a serious claim and would deserve at least publishing within
> Medical Hypotheses. 
> 
> I recommend it would also analyze a paper by Milham and Ossiander,
> which found very differing incidences in areas with differing degree
> of electrification in the US (
> http://www.feb.se/EMFguru/Research/Childhood.pdf ).
>  
> with best regards,
>  jenik hollan
> 
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> 
> 
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