β-Hemoglobinopathies and Early Onset of Cancers in Adulthood: Epidemiology in Southeastern Asia and Brunei with Emphasis for Prevention and Treatment

Despite occurring with lesser incidence in comparison with Western countries, breast cancers (BC) manifest at earlier ages than in the Western World than in Southeast Asia, where thalassemias and hemoglobinopathies are highly prevalent. Cord blood analyses in Singapore revealed that Malays have higher rates of HbE and β-thalassemia than Chinese and Indians. Among Southeast Asian populations, Malays have a worse prognosis for BC with early age of onset. Peculiarly, Brunei has lowest cancer mortality rates among ASEAN countries, yet neurological cancers had the highest percentage of young adult patients. 11p15.5 genomic region includes β-globin genes in the order of 5′-ε–γG–γA–δ–β-3′ and genes which associate with pathogenesis of early age breast cancers and brain tumors such as IGF-2, SLC22A18, H19/Wilms tumor-2, ILK, TSSC3/PHLDA2, p57kip2/CDKN1C, and HRAS. β-Globin genes and tumor-proneness genes at 11p15.5 may possess haplotype interactions and proval of this hypothesis would be important for cancer prediction and prevention. In subjects with thalassemia trait (as shown by rapid and economical tests), cancer screenings may be intensified. The lack of an association in other World regions where hemoglobinopathies are prevalent (such as Middle Asia and Africa) may be due to the different types of hemoglobin mutations leading different types and levels of hemorphins, the splicing products of hemoglobins which regulate immunity.