Cancer

Persons with Down syndrome generally have a lower risk of developing solid tumor cancers, except for testicular cancer (Hasle, 2016). However, the risk of leukemia is higher than in people without Down syndrome.

Marlow et al. (2021) studied 3.9 million children born from 1996 to 2016 in healthcare systems in the US and Canada. Leukemia was diagnosed in 124 of the 4401 children (0.028%) with Down syndrome.
Here's the breakdown of the incidences of the different types of leukemia in children with down syndrome within different ages:

• Acute myeloid leukemia (AML) = 1405/100,000 at age 4 and unchanged at age 14.
  
• In children with Down syndrome, acute lymphoid leukemia was 1059/100,000 at age 4 but greater with age 14 at 1714/100 000.
  
• Children with Down syndrome had a greater risk of AML before age 5 years than other children. The most significant hazard ratios were for megakaryoblast leukemia before age 5 years (HR 1500).
  
• Children with Down syndrome had a greater risk of acute lymphoid leukemia than other children regardless of age (Marlow et al., 2021).

Survival statistics

Children with Down syndrome who develop AML with treatment have a survival rate of 80%. This is much higher than the 35% survival rate of non-Down syndrome children with similar leukemic subtypes. The survival rate of children with Down syndrome is approximately 80% (Caldwell et al., 2014).

According to the American Cancer Society, the survival rate with treatment for all children who develop acute lymphoid leukemia is about 90%. https://www.cancer.org/cancer/leukemia-in-children/detection-diagnosis-staging/survival-rates.html

Nurses caring for these children should include reporting any signs of early leukemia to the primary health care provider, including:

• fatigue over a 2–6-week period
• fever
• pallor
• easy bruising or hemorrhages
• joint or bone pain
• life-threatening systemic infection or hemorrhage

Caldwell, J. T., Ge, Y. & Taub, J. W. (2014). Prognosis and management of acute myeloid leukemia in patients with Down syndrome. Expert review of hematology, 7(6), 831–840. https://doi.org/10.1586/17474086.2014.959923.

Hasle, H., Friedman, J.M., Olsen, J.H. & Rasmussen, S. A. (2016). Low risk of solid tumors in persons with Down syndrome. Genetics in medicine. 18(11), 1151-1157.

Marlow, E. C., Ducore, J., Kwan, M. L., Weinmann, S., Smith-Bindman, R. & Miglioretti, D. L. (2021). Leukemia Risk in a Cohort of 3.9 Million Children with and without Down Syndrome. Journal of Pediatrics. https://www.jpeds.com/article/S0022-3476(21)00212-2/fulltext

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