Epidemiology of childhood cancer

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Abstract

The present contribution reports childhood cancer incidence and survival rates as well as time trends and geographical variation. The report is based on the databases of population-based cancer registries which joined forces in cooperative projects such as Automated Childhood Cancer Information System (ACCIS) and EUROCARE.

According to these data, which refer to the International Classification of Childhood Cancer, leukemias, at 34%, brain tumors, at 23%, and lymphomas, at 12%, represent the largest diagnostic groups among the under 15-year-olds. The most frequent single diagnoses are: acute lymphoblastic leukemia, astrocytoma, neuroblastoma, non-Hodgkin lymphoma, and nephroblastoma. There is considerable variation between countries. Incidence rates range from 130 (British Isles) to 160 cases (Scandinavian countries) per million children. Incidence rates have shown an increase over time since the mid of the last century. In Europe, the yearly increase averages 1.1% for the 1978–1997 period and ranges from 0.6% for the leukemias to 1.8% for soft-tissue sarcomas. The probability of survival has risen considerably over the past decades, with the EUROCARE data showing an improvement of the relative risk of death by 8% when comparing the 2000–2002 time span to the 1995–1999 period. Regarding the years 1995–2002, the data show an overall 5-year survival probability of 81% for Europe and similar values for the USA.

The data presented here describe the cancer situation with a specific, European focus. They are drawn from population-based cancer registries that ensure excellent data quality, and as a consequence represent the most valid European population-based data existing at present. It is also apparent that not all countries have data available from nationwide childhood cancer registries, a situation which warrants further improvement.

Introduction

Cancer is the second commonest cause of death in children in the developed countries. Owing to highly specific diagnostic procedures and the introduction and continuous improvement of multimodal treatment strategies, the past decades have seen a welcome, marked rise in the probability of cure. Nevertheless, childhood cancer and its treatment have remained a challenge for patients, their families, and the oncologists caring for them, as well as from a public health viewpoint.

The present contribution provides information on the range of diagnoses, incidence and survival rates of childhood cancer as well as on time trends and geographical variation. The report draws mainly from findings generated in European cooperative projects where data from population-based cancer registries are pooled and are analyzed in a comprehensive manner.

Section snippets

Data sources

The data presented originate from different sources. Regarding Germany, this is the German Childhood Cancer Registry (GCCR), one of the largest pediatric cancer registries worldwide. The analyses pertaining to Europe have drawn from two cooperative projects, i.e. ACCIS and EUROCARE, where data from population-based cancer registries of European countries are merged. Data pertaining to the USA were obtained from the SEER program.

The German Childhood Cancer Registry (GCCR) was established at the

Diagnoses of childhood cancer

Table 2 gives the number of cases reported, percent values, median age, and sex ratio for each of the 12 main diagnostic groups and 47 diagnostic subgroups14 defined by ICCC-3. The leukemias (including myeloproliferative and myelodysplastic diseases) (34.1%), tumors of the central nervous system (CNS tumors, 22.6%), and lymphomas (including reticuloendothelial neoplasms) (11.5%) represent the largest diagnostic groups. The range of diagnoses is clearly different from the diagnoses seen in

Discussion

The incidence rate of cancer among children under 15 years of age is about 140 per million. Population-based cancer registries provide excellent means for observing the development in the cancer situation over extended periods of time. It is seen that the cancer incidence among children in the developed countries has risen steadily since the 1950s; this rise has been accompanied by a concurrent, marked improvement of prognosis. When changes like this are observed we are confronted with the

Conflict of interests

None declared.

Acknowledgements

The professional support by Susanna Siebert, GCCR, in producing the tables and figures and the scientific support by Claudia Spix, GCCR, are gratefully acknowledged. Special thanks to Eva Steliarova-Foucher (IARC), Lyon, who by her dedicated involvement in coordinating the ACCIS project has been instrumental in providing a reliable database on childhood cancer epidemiology in Europe. Many thanks as well to Gemma Gatta, Milano, for the childhood cancer specific analyses of the EUROCARE data. The

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