Risk factors for acute myeloid leukemia (AML)
A risk factor is something that increases the risk of developing cancer. It could be a behaviour, substance or condition. Most cancers are the result of many risk factors. But sometimes acute myelogenous leukemia (AML) develops in people who don’t have any of the risk factors described below.
The risk of developing AML increases with age. The average age at diagnosis is 65 years. Slightly more men than women develop AML.
Some people with certain genetic conditions have a higher than average risk for AML. Talk to your doctor about your risk. If you have a genetic condition that increases the risk of AML, you may need to visit your doctor more often to check for AML. Your doctor will recommend what tests you should have and how often you should have them.
Risk factors are generally listed in order from most to least important. But in most cases, it is impossible to rank them with absolute certainty.
Risk factors
Radiation therapy and chemotherapy
There is convincing evidence that the following factors increase your risk for AML.
Genetic syndromes
Genetic syndromes are groups of symptoms caused by a change, or mutation, in one or more genes. They are passed from parents to children. Having certain genetic syndromes can increase the risk of developing AML, especially childhood AML.
The following genetic syndromes are linked with a higher risk for AML. Other genetic syndromes may also increase the risk.
Down syndrome is a condition caused by an extra (third) copy of chromosome 21. It causes different birth defects, intellectual disability, a characteristic facial appearance and poor muscle tone in infancy. People with Down syndrome have a higher risk of developing several medical conditions, including childhood leukemia.
Fanconi anemia is a condition that affects the bone marrow so that it doesn’t make enough healthy red blood cells, white blood cells and platelets. People with Fanconi anemia have a higher risk of developing leukemia.
Bloom syndrome is a condition caused by a large number of abnormal chromosomes. People with Bloom syndrome are usually smaller than average and have a high-pitched voice and a characteristic facial appearance. People with Bloom syndrome have a high risk of developing different types of cancer, including AML.
Ataxia-telangiectasia (AT) is a rare condition that affects the nervous system, immune system and other body systems. People with AT have problems with walking, balance and coordination. They often have a weakened immune system and a higher risk of developing cancer, particularly lymphoma and leukemia.
Neurofibromatosis type 1 (von Recklinghausen disease) is a condition that causes tumours to start in nerve tissue. These tumours form in the skin, just under the skin and in cranial and spinal cord nerves. People with neurofibromatosis type 1 have a higher risk of developing certain cancers, including leukemia.
Shwachman-Diamond syndrome is a condition that affects many parts of the body, including the bone marrow, pancreas and skeletal system. People with Shwachman-Diamond syndrome often have low levels of red blood cells, white blood cells and platelets. This causes more frequent infections, fatigue, weakness and easy bruising or bleeding. People with Shwachman-Diamond syndrome also have a higher risk of developing AML.
Congenital dyskeratosis is a condition that causes abnormally shaped fingernails and toenails, a lacy rash on the face and chest, white patches in the mouth and often bone marrow failure. People with congenita dyskeratosis have a risk for myelodysplastic syndromes (MDS) and cancers such as leukemia.
Kostmann syndrome is also known as severe congenital neutropenia. It is a condition that causes very low white blood cell counts. People with Kostmann syndrome have a higher risk for infections, myelodysplastic syndromes (MDS) and cancers such as leukemia.
Wiskott-Aldrich syndrome is a condition that affects blood cells and cells of the immune system. People with Wiskott-Aldrich syndrome have fewer platelets, which can cause easy bruising and bleeding. They also have a higher risk for infection because some immune cells, such as T cells and B cells, do not work properly. People with Wiskott-Aldrich syndrome have a higher risk of developing some types of cancer, such as leukemia.
Li-Fraumeni syndrome is a rare condition that greatly increases the risk of developing several types of cancer, including breast cancer, osteosarcoma, soft tissue sarcomas, brain cancer and leukemia.
Klinefelter syndrome is a condition caused by an extra copy of the X chromosome in males. It affects male sexual development and increases the risk for leukemia.
High levels of radiation
Coming into contact with high levels of radiation – for example, radiation from nuclear reactor accidents – is a risk factor for AML.
Smoking
About 20% of AML cases are linked to tobacco smoke. This may be because there is benzene in tobacco.
Previous radiation therapy and chemotherapy
Radiation therapy given in the past to treat cancer or other health conditions increases the risk of leukemia. Certain chemotherapy drugs or drug combinations given in the past to treat cancer also increase the risk. Having had both radiation therapy and chemotherapy to treat cancer increases the risk more than having had the individual treatments alone.
Breathing in benzene
Benzene is found in unleaded gasoline and is used by the chemical industry. People may breathe in benzene at work, in the general environment or by using certain products.
Certain blood disorders
People with a history of the following blood disorders have a higher risk of developing AML:
Myelodysplastic syndrome (MDS) is a group of disorders that affect the bone marrow so it does not make enough healthy mature blood cells. It is the blood disorder that is most commonly linked to the risk of AML.
Chronic myelogenous leukemia (CML) eventually transforms into AML. But not everyone with AML has CML first.
Myeloproliferative disorders affect the bone marrow and cause large numbers of abnormal red blood cells, white blood cells or platelets to build up in the bone marrow and blood. Chronic myeloproliferative disorders that increase the risk of developing AML include polycythemia vera, essential thrombocytopenia and idiopathic myelofibrosis.
Possible risk factors
The following factors have been linked with AML, but there is not enough evidence to show for sure that they are risk factors. More research is needed to clarify the role of these factors for AML.
- obesity or overweight
- breathing in formaldehyde
- working in farming or agriculture
Questions to ask your healthcare team
To make the decisions that are right for you, ask your healthcare team questions about risks.