Medline ® Abstracts for References 38-40

BACKGROUND: Myelodysplastic syndromes (MDS) became reportable to the Surveillance, Epidemiology, and End Results (SEER) Program (the United States cancer surveillance program) in 2001. This provided the first opportunity to examine the incidence and survival of patients with MDS in the United States using a large, population-based database.

METHODS: The SEER 17 regions public-use database (November 2005 submission) was accessed to obtain data on the frequency, incidence, and survival of patients with MDS. Geographic areas were selected for inclusion in the SEER Program based on their ability to operate and maintain a high-quality, population-based cancer reporting system and for their epidemiologically significant population subgroups.

RESULTS: SEER data from 2001 through 2003 indicated that the risk of MDS increased with age, and approximately 86% of MDS cases were diagnosed in individuals aged>or =60 years (median age at diagnosis = 76 years). Men had a significantly higher incidence rate than women (4.5 vs 2.7 per 100,000 per year). Among racial groups, white individuals had the highest incidence rate. In 2003, approximately 10,300 incident cases of MDS were diagnosed in the United States. The survival of MDS patients was poor, with an observed 3-year survival rate of only 35% (5-year survival data were not available at the time of the current report). Male patients and patients who were diagnosed at an older age had significantly worse survival. MDS survival also varied by clinical subtype, and the survival of patients who had refractory anemia was somewhat worse than reported previously. The availability of descriptive epidemiologic data on MDS can be used now to facilitate much needed research on the etiology and outcome of MDS.

CONCLUSIONS: The current results indicated that>10,000 incident cases of MDS are diagnosed annually in the United States, and the survival of patients with MDS is poor. The availability of descriptive epidemiologic data on MDS can be used now to facilitate much needed research on the etiology and outcomes of MDS.

Although most haematologists perceive a rising prevalence and incidence of myelodysplastic syndromes (MDS), reliable epidemiological data on these disorders are largely lacking. The bone marrow register of the University of Düsseldorf allowed us to assess among other epidemiological features the incidence of MDS, which was compared to that of acute myeloid leukaemia (AML). Among a total of 18,416 different patients registered between 1975 and 1990, 584 cases of MDS (3.2%) and 506 cases of AML (2.8%) were identified. Over the study period, the percentage of newly diagnosed MDS rose from 1.3% to 4.5%, while there was no upward trend for AML. Among all patients undergoing bone marrow biopsy, the proportion of those over 60 years of age increased from 41.9% in 1975 to 54.1% in 1990. We found a strong correlation between the proportion of elderly patients and the relative frequency of MDS diagnoses. Thirty-one patients (5.3%) were classified as a secondary MDS because of previous treatment with cytotoxic chemotherapy and/or irradiation for a variety of malignancies. Twelve patients were identified in whom occupational exposure to organic solvents could not be ruled out. For calculating age-specific incidence rates, the analysis was confined to the town district of Düsseldorf (575,000 inhabitants), because exact demographical data were available for this population. In the last quinquennium of the study period (1986-90), myelodysplastic syndromes were more frequent than AML in the age group 50-70 years (4.9 v 1.8/100,000/year). In patients over 70, the incidence of MDS was more than 3 times that of AML (22.8 v 6.7/100,000). In this group, men had a higher incidence of MDS (33.9/100,000) than women (18/100,000). Crude annual incidence (all age groups) was also higher for MDS (4.1/100,000) than for AML (2.1/100,000) in recent years. We conclude that MDS are relatively common haematological neoplasias. The rising incidence in recent years is probably not due to changes in aetiological factors, but may reflect increased awareness on the part of physicians and extended use of diagnostic procedures in elderly patients.

Reporting of myelodysplastic syndromes (MDSs) and chronic myeloproliferative disorders (CMDs) to population-based cancer registries in the United States was initiated in 2001. In this first analysis of data from the North American Association of Central Cancer Registries (NAACCR), encompassing 82% of the US population, we evaluated trends in MDS and CMD incidence, estimated case numbers for the entire United States, and assessed trends in diagnostic recognition and reporting. Based on more than 40 000 observations, average annual age-adjusted incidence rates of MDS and CMD for 2001 through 2003 were 3.3 and 2.1 per 100,000, respectively. Incidence rates increased with age for both MDS and CMD (P<.05) and were highest among whites and non-Hispanics. Based on follow-up data through 2004 from the Surveillance, Epidemiology, and End Results (SEER) Program, overall relative 3-year survival rates for MDS and CMD were 45% and 80%, respectively, with males experiencing poorer survival than females. Applying the observed age-specific incidence rates to US Census population estimates, approximately 9700 patients with MDS and 6300 patients with CMD were estimated for the entire United States in 2004. MDS incidence rates significantly increased with calendar year in2001 through 2004, and only 4% of patients were reported to registries by physicians' offices. Thus, MDS disease burden in the United States may be underestimated.