Childhood Cancer:Incidence, Survival and Mortality

Pediatric Resident

Education Series

Childhood Cancer

Purpose is to describe the incidence and survival of various types of cancer in kids and how these parameters are affected by:

Age Race / Ethnicity Gender

Childhood Cancer

General Statistics: Approximately 12,400 new diagnoses/year < 20 yo

0-14 = 8,700 15-19 = 3,700

Thus, incidence is 150 per million children < 20 yo newly diagnosed with cancer each year, or 1/ 7,000

The probability of a newborn developing cancer by age 20 is between 0.3 – 0.32%, or ~ 1/300

1,500-1,600 deaths/year in children < 15 years of age

Overall Trends

Incidence relatively stable

Mortality declining

Age Specific Incidence Rates forChildhood Cancers

Age Specific Incidence Rates forChildhood Cancers

Incidence rate similar for youngest (< 5 yr) and oldest (15-19 yr) age groups

But… histologies (or types of cancer) are different in these groups

Incidence distribution by histologychildren < 5 yrs vs. > 15 yrs

Age Specific Incidence Rates forChildhood Cancers

Age Specific Incidence Rates forChildhood Cancers Most common cancer

< 15 yrs – leukemia > 15 yrs – lymphoma

Second most common < 10 yrs – CNS tumors 10-14 yrs – lymphoma > 15 yrs – leukemia

Distribution of Specific Cancer Diagnoses for Children and Adolescents

Incidence of Cancers is Influenced by Race/Ethnicity – US data 1990-95

In adults, incidence of cancer more common in blacks than whites

For children, cancer was less common in

blacks than whites Incidence for Hispanic &

Asian/Pacific islanders intermediate between blacks and whites

American Indians had the lowest incidence of any group

Incidence of Cancers is Influenced by Race/Ethnicity

Incidence of cancer influenced by gender

Generally higher in males than females

Some histologies show gender predisposition

Age may also influence sex distribution

e.g.Hodgkins

Age < 15 yrs

male > female

Age > 15 yrs

female > male

Trend in Survival Rates for Childhood Cancer – overall & specific

Trend in Survival Rates for Specific Childhood Cancers

Leading Causes of Death in Children < 14 y/o in the USA

1997

Leading Causes of Death in Adolescents in the USA

1997

The converse of survival...

Overall Mortality rate decreasing

Distribution by Cause of Cancer Death

Overall distribution of incidence by cancer type

LeukemiaCNSLymphomaNeuroblastomaWilmsBoneRetinoblastomaLiverSarcomaOther

Mortality Rates for Childhood Cancers

Age-specific cancer mortality…

Related to incidence and type of cancer in the age groups

Age-specific cancer mortality…

Age-specific cancer mortality…

Summary

Cancers of children represent a diverse group of diagnoses with a distinctive age-incidence pattern

The incidence of cancer among children has remained essentially stable over several decades

The mortality rates for all cancer types have decreased dramatically over the last several decades

Credits

Information and tables, for the most part, taken from the SEER monograph on Childhood Cancer Cancer Incidence and Survival Among Children and

Adolescents: United States SEER Program 1975-1995 http://seer.cancer.gov/publications/childhood/

Other tables taken from Gurney JG & Bondy ML, “Epidemiology of Childhood Cancer”, in Principles and Practice of Pediatric Oncology, 5th ed, Pizzo PA and Poplack DA, eds, LWW, 2005. http://www.lww.com/static/docs/product/samplechapter

s/0-7817-5492-5_Chapter%201.pdf

Michael Kelly MD PhDAnne Warwick MD MPH