Is spontaneous mutation the major 'cause' of childhood acute lymphoblastic leukaemia? The paucity of evidence for environmental and genetic factors in acute lymphoblastic leukaemia

Abstract

Acute lymphoblastic leukemia (ALL) in children has an annual incidence rate of around two to three cases per 10 5 age-matched population in Europe and the U.S.A. Although it is rare compared with the common cancers of adults, ALL is the major paediatric cancer in developed societies. Despite substantial advances in the treatment of ALL and understanding of its biology the aetiology of this disease remains enigmatic. Doubtless the very rarity of childhood leukaemia has been a major impediment to epidemiological studies which might provide clues to causality. Nevertheless, a substantial number of environmental, genetic (inherited) or immunological factors are reported to be associated with the occurrence of ALL. Most of these correlates are, however, rather weak, controversial or as yet unsubstantiated. A few that are more striking and potentially important are discussed.