Abstract
BackgroundChildhood cancers represent a small proportion of all cancers but are still a major public health problem. The study analysed long-term trends in childhood cancer incidence and survival in Estonia in relation to societal and health care transition.MethodsData on all malignant tumours, diagnosed in children aged 0–14 during 1970–2016, were derived from the Estonian Cancer Registry. Age-standardised (World standard) incidence rates were calculated by ICCC-3 site groups and joinpoint regression was used to estimate annual percentage change (APC) for incidence trends. Cohort and period approach were used to estimate 5-year survival. Internal age standardisation was applied.ResultsA total of 1628 incident cancer cases were diagnosed during the study period and overall incidence increased significantly at a rate of 0.5% per year. Significant increases were seen for neuroblastoma and germ cell tumours, for lymphoid leukemias and some CNS sub-sites. At the same time, decline in incidence was seen in almost all subgroups of unspecified neoplasms. The overall 5-year survival improved from 24% in 1970–1979 to 73% in 2010–2016, with the largest changes occurring in the 1990s and 2000s. For many sites, survival increase thereafter has been marginal.ConclusionIn this first comprehensive population-based study of childhood cancer incidence and survival in Estonia, long-term trends are shown in the context of societal and health care changes. Even though the increasing incidence of some sites may, at least partially, be explained by improved diagnostics reflected in the decreased incidence of unspecified neoplasms, the overall cancer incidence in children seems to be rising. Rapid progress in diagnosis and care have improved childhood cancer survival immensely, but deficit in Estonia persists compared to other European countries. Results of the study accentuate the need for a more in-depth analysis of clinical data, but also for the prioritization of childhood cancer in Estonia, to ensure access to standard care and innovative treatments.
Highlights
Childhood cancers represent a small proportion of all cancers but are still a major public health problem
Incidence The number of cases, incidence rates, trends described by annual percentage change (APC) are presented in Table 2 by ICCC-3 site groups
No joinpoints were found for the main ICCC-3 site groups, APC over the whole study period is presented in the table
Summary
Childhood cancers represent a small proportion of all cancers but are still a major public health problem. The study analysed long-term trends in childhood cancer incidence and survival in Estonia in relation to societal and health care transition. In Estonia, childhood cancer is the third leading cause and the main disease-related cause of death in children under the age of 15. Estonia has witnessed societal and political transition during the past decades and has moved from the Soviet health care system into a more modern and centralised system that has brought along. The aim of the study was a) to analyse long-term childhood cancer incidence and survival trends in Estonia by sex, age and site group, b) to examine these trends in the context of the advances in cancer treatment through changes in the political order and in the health care system
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