© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 12, 1051-1058,
June 16, 1999
© 1999 Oxford University Press
REPORTS |
Cancer Surveillance Series: Recent Trends in Childhood Cancer Incidence and Mortality in the United States
Affiliations of authors: M. S. Linet, R. E. Tarone, S. S. Devesa (Division of Cancer Epidemiology and Genetics), L. A. G. Ries (Division of Cancer Control and Population Sciences), M. A. Smith (Division of Cancer Treatment and Diagnosis), National Cancer Institute, Bethesda, MD.
Correspondence to: Martha S. Linet, M.D., National Institutes of Health, Executive Plaza South, Rm. 7054, MSC 7238, Bethesda, MD 20892-7238 (e-mail: linetm{at}epndce.nci.nih.gov)
BACKGROUND: Public concern about possible increases in childhood cancer incidence in the United States led us to examine recent incidence and mortality patterns. METHODS: Cancers diagnosed in 14 540 children under age 15 years from 1975 through 1995 and reported to nine population-based registries in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program were investigated. Age-adjusted incidence was analyzed according to anatomic site and histologic categories of the International Classification of Childhood Cancer. Age-adjusted U.S. mortality rates were calculated. Trends in rates were evaluated by use of standard regression methods. RESULTS: A modest rise in the incidence of leukemia, the most common childhood cancer, was largely due to an abrupt increase from 1983 to 1984; rates have decreased slightly since 1989. For brain and other central nervous system (CNS) cancers, incidence rose modestly, although statistically significantly (two-sided P = .020), largely from 1983 through 1986. A few rare childhood cancers demonstrated upward trends (e.g., the 40% of skin cancers designated as dermatofibrosarcomas, adrenal neuroblastomas, and retinoblastomas, the latter two in infants only). In contrast, incidence decreased modestly but statistically significantly for Hodgkin's disease (two-sided P = .037). Mortality rates declined steadily for all major childhood cancer categories, although less rapidly for brain/CNS cancers. CONCLUSIONS: There was no substantial change in incidence for the major pediatric cancers, and rates have remained relatively stable since the mid-1980s. The modest increases that were observed for brain/CNS cancers, leukemia, and infant neuroblastoma were confined to the mid-1980s. The patterns suggest that the increases likely reflected diagnostic improvements or reporting changes. Dramatic declines in childhood cancer mortality represent treatment-related improvements in survival.
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