Epidemiology of Childhood Cancer: Incidence, Survival and Mortality

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Epidemiology of Childhood CancerIncidence,
Survival and Mortality

• Pediatric Resident
• Education Series

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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

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Childhood Cancer

• General Statistics
• Approximately 12,400 new diagnoses/year lt 20 yo
• 0-14 8,700
• 15-19 3,700
• Thus, incidence is 150 per million children lt 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 lt 15 years of
  age

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Overall Trends

• Incidence relatively stable
• Mortality declining

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Age Specific Incidence Rates for Childhood Cancers
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Age Specific Incidence Rates forChildhood Cancers

• Incidence rate similar for youngest (lt 5 yr) and
  oldest (15-19 yr) age groups
• But histologies (or types of cancer) are
  different in these groups

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Incidence distribution by histologychildren lt 5
yrs vs. gt 15 yrs
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Age Specific Incidence Rates forChildhood Cancers
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Age Specific Incidence Rates forChildhood Cancers

• Most common cancer
• lt 15 yrs leukemia
• gt 15 yrs lymphoma
• Second most common
• lt 10 yrs CNS tumors
• 10-14 yrs lymphoma
• gt 15 yrs leukemia

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Distribution of Specific Cancer Diagnoses for
Children and Adolescents
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Incidence of Cancers is Influenced by
Race/Ethnicity
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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

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Incidence of Cancers is Influenced by
Race/Ethnicity
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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 lt 15 yrs male gt female Age gt 15
yrs female gt male
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Trend in Survival Rates for Childhood Cancer
overall specific
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Trend in Survival Rates for Specific Childhood
Cancers
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Trend in Survival Rates for Specific Childhood
Cancers influence of age
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Leading Causes of Death in Children lt 14 y/o in
the USA
1997
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Leading Causes of Death in Adolescents in the USA
1997
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The converse of survival...

• Overall Mortality rate decreasing

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Distribution by Cause of Cancer Death

• Overall distribution of incidence by cancer type

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Mortality Rates for Childhood Cancers
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Age-specific cancer mortality

• Related to incidence and type of cancer in the
  age groups

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Age-specific cancer mortality
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Age-specific cancer mortality
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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

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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/samplechapt
  ers/0-7817-5492-5_Chapter201.pdf
• Michael Kelly MD PhDAnne Warwick MD MPH