STEP 1: Prevention and early detection

This step outlines recommendations for the prevention and early detection of Chronic lymphocytic leukaemia.

Evidence shows that not smoking, avoiding or limiting alcohol intake, eating a healthy diet, maintaining a healthy body weight, being physically active, being sun smart and avoiding exposure to oncoviruses or carcinogens may help reduce cancer risk (Cancer Council Australia 2018).

The cause of CLL is unknown, and there are currently no effective prevention strategies.

The risk factors for developing CLL include:

  • older age – 83 per cent of all people diagnosed with CLL are 60 years of age or older (AIHW 2021)
  • sex – CLL is more common in males than females (AIHW 2021)
  • family history – people with a first-degree relative (parent, sibling or child) with CLL or other lymphoproliferative disorder have a six- to nine-fold increased risk of developing CLL (Eichhorst et al. 2021), but the underlying genetic cause is unclear and there is no available screening test for genetic predisposition
  • race/ethnicity – CLL is more common in Caucasians and less common in people of Asian descent (including South Asian, East Asian and Southeast Asian) (Kawamata et 2013; Miranda-Filho

et al. 2018; Wu et al. 2010; Yang et al. 2021).

Exposure to chemicals such as Agent Orange, a herbicide used in the Vietnam War, is associated with developing lymphoproliferative disorders generally. Any potential causative link to CLL specifically has not been definitively established, and research is ongoing (Chang et al. 2015; DVA 2020; Frumkin 2003; McBride et al. 2013; Mescher et al. 2018).

While there is no evidence linking lifestyle changes to reduced risk of CLL, it is important to encourage people to reduce modifiable risk factors for other types of cancer and health conditions. This includes providing advice on regular screening, skin checks, sun-safe behaviours (Kleinstern et al. 2016; 2020), preventing or reducing obesity, and support to quit smoking.

This is particularly important since people with CLL have an increased risk of developing other cancers including lung and upper aerodigestive cancers such as pharyngeal and oesophageal cancer, as well as skin cancers.

Neither genetic nor medical screening is warranted for family members of people with CLL.

Although family history of a lymphoproliferative disorder is associated with increased risk of developing CLL (Brown 2008; Goldin et al. 2004), the disease is polygenic and no specific causative genes have been identified. As such, there are no tests that can screen for inherited genetic markers.

Patients should understand that any ‘genetic testing’ recommended by their doctor will identify changes in CLL cells that can help inform prognosis and guide treatment but cannot identify genes or genetic changes that are inherited or passed on. There is no evidence to support any kind

of genetic screening among family members, including direct-to-consumer genetic testing.

CLL is usually slow growing, and in most cases it is picked up early during routine blood tests for unrelated conditions. There is currently no established benefit from early detection.

Routine screening for CLL is not currently recommended in either the general population or in relatives of people with CLL.