In public health, the possible changes in risks from the past lead to a wish to know the future development,

aimed to plan and determine budget priorities and necessary health services.13 Few investigations have studied the trend of leukemia in Brazilian children and adolescents. In a study conducted in Fortaleza,14 there was a decreasing trend in mortality from leukemia. In the present investigation, the same pattern was found for an overall analysis of all leukemias in both genders. However, when leukemia was analyzed by specific subgroups, the behavior was shown to be different. While leukemias here classified as “other types” showed a decrease in mortality in all age groups (Fig. 2), the lymphoid leukemias BAY 73-4506 showed an increasing trend in the age group 15-19 years (Fig. 3). When considering only the gender, the pattern also changed: the mortality rates from leukemias in males and females showed an increasing trend. Studies CP-690550 price performed in Latin American countries (Brazil, Chile, and the Dominican Republic) showed a decrease in the mortality trend. This behavior can be explained by the improvement in cancer diagnostic techniques and increasingly effective chemotherapy

protocols, procedures that directly reflect the improved disease prognosis.15 The present study showed an increasing mortality trend at ages 15-19 years for lymphoid leukemias, for both genders. The Latin-American study15 discusses this difference by asserting that protocols for the treatment of adolescents and young adults are not adequate for this age group, since patients sometimes are treated as adults and sometimes as pediatric patients, and that special physical and psychological needs for this age group are not recognized. This inappropriate treatment is demonstrated as differences in survival between the age groups. It is necessary to recognize the differences in the biological characteristics of the disease, which will lead to further advances in lymphoid leukemia therapeutic protocols for older children (older than 10 years). The toxicity and mortality associated

with treatment have been discussed in specific studies on leukemia, which can influence the increased rates of mortality in certain groups. There selleck screening library have been reports that intensive chemotherapy in patients with acute lymphoid leukemia leads to severe neutropenia, exposing patients to infections that can cause death (41% of deaths in a sample were related to septic shock).16 Estimates have described that deaths related to acute lymphoid leukemia treatment in less developed countries range between 11% and 20%; for acute myeloid leukemia, it may reach 33%.17 The lack of information about data quality and possible migration of cases, as well as the heterogeneity of Brazilian rates, are limitations of the study and need to be considered when assessing the conclusions.