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Introduction: What is the disease? Why is it important? Why did you select it to study? Purpose of project: State in one clear sentence the goal/objective of your report Person: Describe the disease by person (review in your textbook concepts and variables related to person) Place: Describe the disease by place (review in your textbook concepts and variables related to place) Time: Describe the disease by time (review in your textbook concepts and variables related to time) Summary: Summarize the salient/major points of the descriptive epidemiology of the disease you studied.

Abbi Schwartz Dancy Guzman 10/1/20 Chronic myeloid leukemia

Chronic myeloid leukemia (CML) is cancer that starts in cells that form blood located in the bone marrow. This then invades and infects the blood. It is important to understand the early signs of CML in order to detect it early and treat the cancer. The reason that we chose this disease is because we both are interested in the health fields and wanted to take this opportunity to learn more about a topic we hadn't really heard about. The goal of this report is to inform what chronic myeloid leukemia is and how to detect it early on. PERSON The ratio between men and women is pretty similar, but there does seem to be a slight increase in the male population in regard to diagnosing cases of CML. About 8,450 new people will be diagnosed with CML (4,970 in men and 3,480 in women). The ratio still factors into death rates, as males are slightly higher. About 1,130 people will die of CML (670 men and 460 women). CML generally is diagnosed in mid-late life stages. The average age of diagnosis of CML is 64 years. Almost half of cases are diagnosed in people 65 and older. Chronic myeloid leukemia mainly affects adults, and rarely any children. There are several key signs that can help in early detection of CML. The symptoms, unfortunately, are vague and can be partially caused by other illnesses. Some symptoms include, weakness, fatigue, night sweats, weight loss, fever, bone pain, enlarged spleen, feeling full after eating a small amount of food, and pain in the belly. If any of these symptoms are noticed, they should be consulted with a doctor to direct if they are symptoms of CML, or another illness. These symptoms of CML happen because the body's leukemia cells are replacing the bone marrow's regular blood making cells. Thus, a person with CML does not make enough red blood cells, platelets, and correct white blood cells. If a person has a shortage of red blood cells, it is known as anemia. Some symptoms of this can include tiredness, weakness, and shortness of breath. If a person has a shortage of normal white blood cells, it is known as leukopenia. A person with leukopenia has an increased risk of infection, due to their white blood cells not protecting them against an infection the way a normal white blood cell would. If a person has a low level of normal neutrophils, that is known as neutropenia. People that are neutropenic are at

a higher risk of contracting a serious bacterial infection due to their neutrophils being lower. The neutrophils are a specific type of white blood cell that assists in fighting off infections from bacteria. If the person had a shortage of blood platelets, then they have thrombocytopenia. The symptoms of this are easy bruising, easy bleeding, many nosebleeds, and bleeding gums. This can be due to their platelets not working correctly and thus making it easier to bleed and bruise. PLACE and TIME Between1998 and 2002, a reported 19,262 males and 12,428 females were diagnosed with CML. In a study conducted by the International Agency for Research on Cancer’s, patterns of age at diagnosis and incidence by geography and socioeconomic status were examined. Results from this study showed that the incidence of early and late onset CML differed by region. Africa and Asia presented with the highest youngest median age of diagnosis for males and females (42 and 47 years). While Oceania had the highest median age at diagnosis (72 years for males and females). As seen in Figure 1, a significant age-specific interaction was evident by region. As seen in males, the incidence of early-onset of CML ranged from .33 per 100,000 in Africa to 0.59 per 100,000 in south/Central America while the incidence of late-incidence of CML ranged from 1.77 per 100,000 in Africa to 6.70 per 100,000 in Oceania.

The interaction between geography and age may be an indicator for some sort of exposure that is currently unknown. The regional differences in age at diagnosis and incidence on the contrary, demonstrates that there is an environmental factor impacting the pattern of CML. Such patterns may include agriculture, occupational or socioeconomic exposures. Another hypothesis may be that a genetic component is triggered from an environmental exposure that caused the translocation of the chromosome 9 and 22.

Furthermore, according to the National Cancer Institute, the rates for new cases of chronic myeloid leukemia is 1.9 per 100,00 men and women per year. Thus far the rates of CML have been rising on average 1.2% each year between 2008 -2017. While the death rates have been declining on average 1.0% between 2009 and 2018. The 5-year relative survival for this disease, as seen in Figure 1, is seen to steadily increase overtime as newfound research and treatments have been implemented over the years. The estimated new cases for this disease are 8,450 of which 1,130 are estimated to die.

Figure 1

Work cited “Key Statistics for Chronic Myeloid Leukemia.” American Cancer Society, www.cancer.org/cancer/chronic-myeloid-leukemia/about/statistics.html. “Chronic Myeloid Leukemia - Cancer Stat Facts.” SEER, seer.cancer.gov/statfacts/html/cmyl.html. Mendizabal, A. M., Younes, N., & Levine, P. H. (2016). Geographic and income variations in age at diagnosis and incidence of chronic myeloid leukemia. International journal of hematology, 103(1), 70-78....