Targeted maternal screening for a cancer-linked virus could prevent cases of a rare but aggressive leukemia in high-risk populations in the United States, according to new national data.
The study, published in JAMA Oncology, focuses on adult T-cell leukemia/lymphoma (ATLL), an aggressive malignancy caused by infection with human T-cell leukemia virus type 1 (HTLV-1). Infection typically occurs early in life, most often through mother-to-child transmission during breastfeeding, but cancer may not develop until decades later.
Analysis of more than 3,200 cases across US cancer registries showed that incidence is not evenly distributed. Among non-Hispanic Caribbean-born individuals, rates were around 30 times higher than in US- or Canada-born populations, reaching levels comparable to established endemic regions.
The data also point to geographic clustering within the US. Florida and New York, in particular, having large Caribbean-born populations, had disproportionately high ATLL incidence rates.
The findings highlight a diagnostic gap as well as a prevention opportunity. HTLV-1 testing is not routinely performed when patients present with T-cell lymphomas, meaning ATLL may be misclassified as peripheral T-cell lymphoma not otherwise specified. Sensitivity analyses in the study suggest that correcting for this misclassification could substantially increase estimated incidence, indicating that cases are being under-recognized.
Accurate identification of ATLL requires linking clinical presentation with viral testing, which is not standard practice in many settings. Without this, opportunities for early intervention and family-level risk assessment may be missed.
The proposed strategy — targeted maternal screening based on country of origin — shifts the diagnostic focus upstream. Identifying HTLV-1 infection during pregnancy could enable interventions to prevent transmission, such as modified infant feeding practices, thereby reducing lifetime cancer risk.
With five-year survival below 25 percent, ATLL remains difficult to treat once established. The study suggests that integrating viral testing into diagnostic pathways and prenatal care could improve case detection, refine disease classification, and support prevention strategies that reduce future disease burden.
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