Pediatric cancer incidence and survival in the United States (1973-2003)

65 Over 12,000 children are newly diagnosed with malignancy each year in the United States. Cancer is the leading cause of disease-related mortality in children between the ages of 1-19 years. Unfortunately, the etiology of most childhood cancers is unknown. Recent reports from Europe suggest that both pediatric cancer incidence and survival has been increasing over the last several decades. We examined population-based incidence and survival data from the Surveillance, Epidemiology, and End Results (SEER) program to provide updated information regarding United States incidence and survival trends. Data were obtained on incident cancers diagnosed in children under the age of 20 years from nine SEER registries during the period 1973-2003. Frequencies, age-adjusted incidence rates, annual percent change (APC) in incidence rates, and 5-year relative survival rates across three 6-year cohorts were evaluated. A total of 33,471 malignant neoplasms were identified, for an overall incidence rate of 152/1,000,000 person-years. For all cancers combined, there was a significant average annual increase (APC=0.6%; 95% Confidence Interval (CI): 0.4%-0.8%). Incidence rates increased significantly for acute lymphoblastic leukemia (0.9%), central nervous system tumors (1.1%), hepatoblastoma (2.9%), osteosarcoma (0.7%), germ cell tumors (0.9%), thyroid carcinoma (1.2%), and malignant melanoma (1.8%). Incidence rates decreased significantly for Hodgkin disease (-0.7%) and other leukemias (-3.6%). Five-year survival rates increased significantly for all histologic subtypes combined (50% in 1973-1978 to 78% in 1993-1998). The highest 5-year survival rates (1993-1998) were observed among children with retinoblastoma and thyroid carcinoma (98%) while the lowest rates were observed in children with acute myeloid leukemia (41%). Importantly, survival rates continue to improve for nearly all cancers examined. The greatest increases in survival occurred for ependymomas (+37%) and non-Hodgkin lymphoma (+35%). Our results confirm that incidence rates for pediatric cancers continue to increase over time, while survival rates are also increasing. Increasing trends in pediatric cancer incidence rates, along with the paucity of information regarding underlying causes, necessitate an ongoing need for surveillance and etiologic studies. Further, improvements in survival have produced an expanding population of childhood cancer survivors who are at risk for adverse physical and psychosocial effects and who require long-term follow-up care. Supported by NIH T32 CA099936 and the Children’s Cancer Research Fund.