Cancer in adolescents and young adults (AYA) in North Netherlands (1989–2003): Increased incidence, stable survival and high incidence of secondary tumors

Abstract

9538 Background: Lack of improvement in survival in AYA cancer patients as compared to children has led to increased awareness of this young population. We performed a population-based study of the incidence and survival of primary tumors and incidence of second tumors in patients 12–24 years, diagnosed in North Netherlands. Methods: Patients, diagnosed 1989–2003, classified according to Birch, were retrieved from the regional cancer registry and were divided into age groups (12–15, 16–19, 20–24). Age-specific incidence rates per 100,000 were calculated using population data from Statistics Netherlands. Three-year moving means of incidence were calculated for the three age groups. 5-years survival over time for males (M) and females (F) was calculated; difference in survival was assessed with log-rank test. Results: From 1989–2003 1,118 patients were diagnosed: lymphoma 22.9%, germ-cell malignancies 14.5%, melanoma 13.7%, carcinoma 12.7%, sarcoma 11.7%, CNS tumors 11.5%, leukaemia 10%. The total age-specific incidence rates per 100,000 were: M:13.4 (12–15 yrs), 26.9 (16–19 yrs), and 27.5 (20–24 yrs) and F:13.9, 20.7, 20.7. M/F ratio was 1.32. Between 1999–2003 a remarkable high incidence of Hodgkin's lymphoma in 16–19 yrs (M 9.4, F 7.6), germ cell malignancies 14.1 (M, 20–24), and melanoma 7.0 (F, 20–24) was found. The estimated annual percent change in incidence was 2.15% (p=0.001) overall. Multivariate analysis of the incidence showed a significant increase by age and year of diagnosis. The 5 years-survival was 0.80, 0.80 and 0.82 for the three age groups. Survival did not change significantly during the study period, except for a better survival for leukemias (p=0.04). With a follow-up of 8.7 years the relative risk of secondary tumors was 34.98 (23.06- 50.89; p<0.05). Conclusions: Between 1989 and 2003 the total incidence of cancer in AYA increased. Except for leukaemia survival was stable over time. No difference in survival between the age groups (12–15;16–19; 20–24) was found. From 1999–2003 a remarkable high incidence of Hodgkin's lymphomas (M, 16–19), germ cell malignancies (M, 20–24) and melanomas (F, 20–24) was observed. The relative risk of a secondary tumor in this young cohort was 35-fold increased. No significant financial relationships to disclose.