Cancer Mortality In Italy Research Articles

Insights from Explainable Artificial Intelligence of Pollution and Socioeconomic Influences for Respiratory Cancer Mortality in Italy.

Respiratory malignancies, encompassing cancers affecting the lungs, the trachea, and the bronchi, pose a significant and dynamic public health challenge. Given that air pollution stands as a significant contributor to the onset of these ailments, discerning the most detrimental agents becomes imperative for crafting policies aimed at mitigating exposure. This study advocates for the utilization of explainable artificial intelligence (XAI) methodologies, leveraging remote sensing data, to ascertain the primary influencers on the prediction of standard mortality rates (SMRs) attributable to respiratory cancer across Italian provinces, utilizing both environmental and socioeconomic data. By scrutinizing thirteen distinct machine learning algorithms, we endeavor to pinpoint the most accurate model for categorizing Italian provinces as either above or below the national average SMR value for respiratory cancer. Furthermore, employing XAI techniques, we delineate the salient factors crucial in predicting the two classes of SMR. Through our machine learning scrutiny, we illuminate the environmental and socioeconomic factors pertinent to mortality in this disease category, thereby offering a roadmap for prioritizing interventions aimed at mitigating risk factors.

MSR45 Evaluation of the Future Impact of Immuno-Oncology Introduction on Cancer Mortality in Italy

MSR45 Evaluation of the Future Impact of Immuno-Oncology Introduction on Cancer Mortality in Italy

Cancer mortality associated with low education in Italy.

This study provides a nationwide representative quantification of the impact of educational inequalities on cancer mortality in Italy. The study is based on prevalence data and mortality rate ratios according to levels of education obtained from the Italian 2011 census cohort, including >35 million individuals aged 30-74. We estimated the population attributable fraction (PAF) and the number of cancer deaths associated with low education (below university degree) in Italy by sex. PAFs for low levels of education were 29.1% among men and 13.3% among women, corresponding to 22,271 cancer deaths associated with low education in men and 7456 in women in 2019. PAFs by cancer site in men were: 53.0% for upper aerodigestive tract (UADT), 44.6% for liver, 41.3% for stomach, 41.3% for lung, 37.0% for bladder, 18.5% for colorectal, 9.8% for prostate and 9.1% for pancreatic cancers. PAFs in women were: 44.5% for cervical, 36.1% for UADT, 34.9% for stomach and 13.9% for colorectal cancers. The cancer sites with the highest number of deaths associated with low education were lung among men (7902/22,271, 35.5%) and colorectum among women (780/7456, 10.5%). About a quarter of cancer deaths in 2019 in Italy may be prevented by reducing the socioeconomic determinants that contribute to educational disparities in cancer mortality.

Epidemiologic transition of lung cancer mortality in Italy by sex, province of residence and birth cohort (1920-1929 to 1960-1969).

Space-time analysis of mortality risk is useful to evaluate the epidemiologic transitions at the subnational level. In our study, we analysed the death certificate records for lung cancer in Italy in 1995-2016, obtained from the Italian National Institute of Statistics. Our objective was to investigate the spatial-temporal evolution of lung cancer mortality by sex and province of residence (n = 107) using the birth cohort as relevant time axis. We built Bayesian space-time models with space-time interactions. Among males (n = 554 829), mortality peaked in the 1920-1929 cohort, followed by a generalised decline. Among females (n = 158 619), we found novel original evidence for a peak in the 1955-1964 cohort, equivalent to a 35-year delay, with a downward trend being observed thereafter. Over time, the documented north-south decreasing mortality gradient has been replaced by a west-east decreasing gradient. Naples has become the province at highest risk in Italy, both among males and females. This pattern is consistent with an epidemiologic transition of risk factors for lung cancer to the south-west of the country and raises concern, because 5-year age-standardised net survival from the disease in this geographic area is lower than in northern and central Italy. The variability of mortality rates among provinces has changed over time, with an increasing homogeneity for males and an opposite trend for females in the more recent birth cohorts. These unprecedented observations provide evidence for a profound spatio-temporal transition of lung cancer mortality in Italy.

A ten-year (2009–2018) database of cancer mortality rates in Italy

In Italy, approximately 400.000 new cases of malignant tumors are recorded every year. The average of annual deaths caused by tumors, according to the Italian Cancer Registers, is about 3.5 deaths and about 2.5 per 1,000 men and women respectively, for a total of about 3 deaths every 1,000 people. Long-term (at least a decade) and spatially detailed data (up to the municipality scale) are neither easily accessible nor fully available for public consultation by the citizens, scientists, research groups, and associations. Therefore, here we present a ten-year (2009–2018) database on cancer mortality rates (in the form of Standardized Mortality Ratios, SMR) for 23 cancer macro-types in Italy on municipal, provincial, and regional scales. We aim to make easily accessible a comprehensive, ready-to-use, and openly accessible source of data on the most updated status of cancer mortality in Italy for local and national stakeholders, researchers, and policymakers and to provide researchers with ready-to-use data to perform specific studies.

The spatial association between environmental pollution and long-term cancer mortality in Italy

Tumours are nowadays the second world‑leading cause of death after cardiovascular diseases. During the last decades of cancer research, lifestyle and random/genetic factors have been blamed for cancer mortality, with obesity, sedentary habits, alcoholism, and smoking contributing as supposed major causes. However, there is an emerging consensus that environmental pollution should be considered one of the main triggers. Unfortunately, all this preliminary scientific evidence has not always been followed by governments and institutions, which still fail to pursue research on cancer's environmental connections. In this unprecedented national-scale detailed study, we analyzed the links between cancer mortality, socio-economic factors, and sources of environmental pollution in Italy, both at wider regional and finer provincial scales, with an artificial intelligence approach. Overall, we found that cancer mortality does not have a random or spatial distribution and exceeds the national average mainly when environmental pollution is also higher, despite healthier lifestyle habits. Our machine learning analysis of 35 environmental sources of pollution showed that air quality ranks first for importance concerning the average cancer mortality rate, followed by sites to be reclaimed, urban areas, and motor vehicle density. Moreover, other environmental sources of pollution proved to be relevant for the mortality of some specific cancer types. Given these alarming results, we call for a rearrangement of the priority of cancer research and care that sees the reduction and prevention of environmental contamination as a priority action to put in place in the tough struggle against cancer.

Pancreatic cancer mortality in Italy (1981–2015): a population-based study on geographic distribution and temporal trends

Pancreatic cancer mortality in Italy (1981–2015): a population-based study on geographic distribution and temporal trends

Cancer mortality in Italy, 2008, and predictions for 2012.

This report provides up-to-date data and statistics for cancer mortality in Italy in 2008, and predicts the figures and rates for selected cancer sites for 2012. Cancer death certifications (for 30 sites) and resident population estimates in 2008 stratified by sex and age were obtained from the World Health Organization (WHO) database (WHOSIS). Mortality rates were age-standardized on the world standard population. Cancer deaths registered in Italy in 2008 were 172,783 (97,773 men and 75,010 women), corresponding to age-standardized death rates of 144.1/100,000 men and 84.3/100,000 women. The projected cancer deaths in 2012 are 178,000 (100,000 men, 78,000 women) and the corresponding rates 132,5/100,000 men and 80.5/100,000 women. The favorable trend in lung cancer mortality among men was confirmed, with rates of 37.7/100,000 in 2008 (all ages) and 33.3 for 2012. Other tobacco-related cancers also declined in men but not in women, including pancreatic cancer, whose rates tended to level off over the last 3 years. The fall in female cancer mortality rates continues to be led by favorable trends in breast cancer (16.1/100,000 in 2007 and 15.2 in 2012), intestinal cancer, stomach cancer and uterine cancer. However, the female lung cancer mortality was still rising with 7743 deaths in 2008 (9.5/100,000), and lung cancer is predicted to become the second cause of female cancer mortality by 2012 (8,500 deaths, 9.8/100,000). Reduced tobacco and alcohol consumption are largely responsible for the favorable trends in cancer mortality in men. Advances in treatment and management accounted for the reduced mortality from colorectal cancer, breast cancer, leukemias and a few other cancers, as well as improved diagnosis for colorectal, cervical and breast cancer. The rising epidemic of tobacco-related deaths in women indicates the need for targeted tobacco-control strategies.

Blockade of Surface Alpha-Enolase (ENO1) as a Novel Immunotherapeutic Approach in Pancreatic Cancer

In 2010 in Italy, there were 175,046 cancer deaths, with total mortality rates, respectively for men and women, of 138 and 83/100,000 [1]. Total cancer mortality in Italy has been declining since the 1980s in men and earlier in women [1], similarly to most European countries [2] and the United States [3]. However, some rising trends have also been observed, notably for female lung cancer and pancreatic cancer in both sexes [1]. Although the incidence of pancreatic cancer is relative low compared to other tumor types such as breast, lung and prostate cancer, in pancreatic cancer the mortality is almost equal to the incidence level, with 41,780 and 40,560 deaths predicted in Europe and USA respectively [2,4]. For this reason, PDA is the 4th leading cause of cancer deaths in the Western Countries [1,2,4]. Despite the efforts of clinicians and scientists, pancreatic cancer has the worst prognosis of all major malignancies, with a 5-year survival rate of 8% [4].

Cancer Mortality in Italy, 2008, and Predictions for 2012

This report provides up-to-date data and statistics for cancer mortality in Italy in 2008, and predicts the figures and rates for selected cancer sites for 2012. Cancer death certifications (for 30 sites) and resident population estimates in 2008 stratified by sex and age were obtained from the World Health Organization (WHO) database (WHOSIS). Mortality rates were age-standardized on the world standard population. Cancer deaths registered in Italy in 2008 were 172,783 (97,773 men and 75,010 women), corresponding to age-standardized death rates of 144.1/100,000 men and 84.3/100,000 women. The projected cancer deaths in 2012 are 178,000 (100,000 men, 78,000 women) and the corresponding rates 132,5/100,000 men and 80.5/100,000 women. The favorable trend in lung cancer mortality among men was confirmed, with rates of 37.7/100,000 in 2008 (all ages) and 33.3 for 2012. Other tobacco-related cancers also declined in men but not in women, including pancreatic cancer, whose rates tended to level off over the last 3 years. The fall in female cancer mortality rates continues to be led by favorable trends in breast cancer (16.1/100,000 in 2007 and 15.2 in 2012), intestinal cancer, stomach cancer and uterine cancer. However, the female lung cancer mortality was still rising with 7743 deaths in 2008 (9.5/100,000), and lung cancer is predicted to become the second cause of female cancer mortality by 2012 (8,500 deaths, 9.8/100,000). Reduced tobacco and alcohol consumption are largely responsible for the favorable trends in cancer mortality in men. Advances in treatment and management accounted for the reduced mortality from colorectal cancer, breast cancer, leukemias and a few other cancers, as well as improved diagnosis for colorectal, cervical and breast cancer. The rising epidemic of tobacco-related deaths in women indicates the need for targeted tobacco-control strategies.

Cancer Mortality in Italy, 2003

This report provides data and statistics for cancer mortality in Italy in 2003, updating previous work on the issue. Cancer death certification numbers by cause and estimates of the resident population in 2003, stratified by sex and quinquennium of age, were obtained from the World Health Organization database. In 2003, cause of death encoding was changed from the 9th to the 10th Revision of the International Classification of Diseases (ICD). All cancers and groups of cancers, classified according to the 10th revision of the ICD, were grouped into 30 categories, besides other and unspecified sites. Mortality rates were age-standardized on the world standard population in five-year age groups up to 80-84 years and 85+. The total number of cancer deaths in Italy was 167,144 in 2003 (96,127 men and 71,017 women), with age-standardized death rates of 160.63 and 89.32 per 100,000 inhabitants, respectively. Lung cancer mortality in men confirmed the favorable trend, with rates of 43.72/100,000 and 51.68/100,000 in the all ages and truncated groups, respectively. Most other tobacco-related cancers were also declining in men but not in women. Cancers of the female breast and uterus (cervix and corpus) continue to decrease, with overall rates of 17.11/100,000 and 3.71/100,000. Declines were also observed in stomach and testis cancers. A few cancer sites such as prostate and multiple myeloma appeared to rise, but these trends were mainly due to the ICD change and the stricter age-standardization categories (80-84 and 85+ instead of 80+). Trends in cancer mortality remained favorable for most major cancer sites, mainly in men for tobacco-related cancers. Due to the classification changes brought about by the change of ICD and the stricter age standardization, the present mortality rates should only be compared to previous ones with due caution.

Cancer Mortality in Italy, 1970–2002

To update previous work on Italian cancer mortality. WHO data were used to calculate death rates for 30 cancer sites for 2002. Trends were analyzed with joinpoint regression over the 1970-2002 period. Total cancer deaths for 2002 in Italy were 163,070 (93,398 men, 69,672 women). Male cancer mortality rose until 1988 and since then has had a 1.4% yearly fall. The first cause of cancer death in males was lung cancer, accounting for 28% of deaths. The decrease in mortality from male lung cancer came about the end of the 1980's (estimated annual percentage change, EAPC, -1.26 from 1989 to 1993 and -2.32 thereafter) and was the main reason for the favorable trends in total male cancer mortality, reflecting the change in smoking prevalence in Italian males. Female total cancer mortality trends have also been favorable, with an overall yearly drop of 1.1% since 1992. The most frequent causes of cancer deaths in females were breast and colorectal cancers, accounting for 16% and 14% of cancer deaths, and both showed declining trends (EAPC, -1.80 since 1992 and -1.51 from 1993 for breast and colorectal cancers, respectively). Female lung cancer has been on the rise (EAPC, 0.82 since 1987) for the last decades due to the rise in cigarette smoking since the 1970's in Italian females. Mortality from the most common cancers in Italy showed a favorable trend over recent years, the maintenance and potential improvement of which would require a strategy focusing on the control of tobacco and alcohol consumption, nutrition and diet. Early diagnosis for selected neoplasms can also have a relevant impact, together with advancements in treatments.

Magnitude of asbestos-related lung cancer mortality in Italy

An ecological study, based on a data set containing all lung and pleural cancer deaths in each Italian municipality in the period 1980–2001, was performed. The pleural to lung cancer ratio was estimated to be 1 : 1 and 3% (around 700) of all male lung cancer deaths were found to be asbestos-related.

P.59 Bayesian geographical analysis at municipalitylevel on oropharyngeal cancer mortality in Italy, 1980–2000

P.59 Bayesian geographical analysis at municipalitylevel on oropharyngeal cancer mortality in Italy, 1980–2000

The rise and fall in primary liver cancer mortality in Italy

Primary liver cancer (PLC) is the fifth most common cancer site in the world, and the fourth cause of cancer mortality I-4. Hepatocellular carcinoma accounts for 85 to 90% of cases in most countries, while colangiocarcinoma, hepatoblastoma and angiosarcoma account for a small proportion of cases. Incidence and mortality from PLC have an extremely wide geographic variation, since 80% of cases arise in developing countries, particularly in South East Asia and Sub-S&u-an Africa i 4 Even within Europe, an over lo-fold . variation has been observed in liver cancer mortality 5 6. In the early 1990’s, Italy had the second highest liver cancer mortality rates in males, after Hungary, and the third in females, after Bulgaria and Hungary. For both sexes, the lowest PLC rates were in the UK, Scandinavia and Greece 5-7. Upward trends in incidence and mortality from PLC over the last three decades have been reported not only from Italy 5-7, but also from Japan 8, the UK9 lo France ” and the USA 12. These rises were observed in males and females,‘in blacks and whites in the USA, in younger and elderly populations, indicating that they cannot be totally accounted for by increased diagnosis and certification of the disease. It has been indicated that the increased prevalence of hepatitis C virus (HCV) may, in part, be responsible of upward trends 13-16. Changes in the incidence and mortality from liver cirrhosis may also play a role, since PLC generally arises in the cirrhotic liver I7 lx. Mortality from cirrhosis has, in fact, declined in Italy, as in several other developed countries I9 20, but there are indications that its incidence has increased or, at least, has not shown a comparable decrease thus leading to an increased prevalence of the disease. Improvement in the survival rate of cirrhotic patients, due to reduced alcohol consumption and better cure of complications of the disease, may have increased the likelihood of PLC occurrence in those patients 2 s ‘* 19. In contrast, in several of the developing countries in Asia including Chinese and Indian populations downward trends in liver cancer incidence and mortality have been recorded over the last two decades. This has been related to a decreased prevalence of hepatitis B virus (HBV) infections in these populations 2 I3 16. In the light of the different incidence and mortality from PLC worldwide, we examined trends in age-specific and age-standardized liver cancer mortality in Italy over the period 1970-98. Numbers of death certifications from PLC (International Classification of Diseases, ICD, 9 Revision to 155.0) were derived from official death certifications provided by the Italian National Institute of Statistics (ISTAT) in strata of sex and 5-year age groups. Estimates of the resident population were obtained from the same source. Age-specific (for each five-year age group and calendar period) and agestandardized (on the world standard population) death certification rates were derived from the matrix of certified deaths and resident population 21. Figure 1 shows trends in age-standardized death certification rates in males at all ages and selected age groups. The corresponding trends in females are shown in Figure 2. In males, overall age-standardized mortality from PLC rose from about 3/100,000 in the early 1970’s, to reach 9.2/100,000 in 1994, and decreased thereafter to 6.0 in 1998. In females, overall PLC mortality rates were 22.5/100,000 between 1970 and 1994, but dropped to 1.7 in 1998. The fall between 1996 and 1998 was, therefore, 30% in males and 23% in females. The falls were, if anything, greater in middle age (35 to 64 years, -36% for

Cancer Mortality in Italy, 1998

This short report provides data and statistics of cancer mortality in Italy in 1998, updating previous work on the issue. The material and methods of this report are similar to those previously described. Briefly, cancer death certification numbers by cause and estimates of the resident population in 1998, stratified by sex and quinquennia of age, were abstracted from data provided by the Istituto Nazionale di Statistica (ISTAT). All cancers or groups of cancers, classified according to the standard International Classification of Diseases (ICD), Ninth Revision, were grouped in 31 categories, besides total cancer mortality and other and unspecified sites. We grouped together all intestinal sites, melanomas and non-melanomatous skin neoplasms, all uterine neoplasms (cervix and corpus), all neoplasms of the brain and nerves (benign and malignant), all leukemias, and all non-Hodgkin's lymphomas. Eight tables were produced, including the following statistics: 1) number of deaths, crude and age-standardized death certification rates, and percentages of all cancer deaths for population at all ages and truncated 35-64 years (Table 1 for males and Table 2 for females). Two different standards were used: i) the 1971 Italian census population, corrected for census undercount and subdivided into 16 quinquennia of age from 0-4 to 75-79, plus 80 and over, and ii) the world standard population, for purposes of comparison with other countries; 2) age-specific death certification rates for each sex and quinquennium of age from 0-4 to 75-79, plus 80 and over (Table 3 for males and Table 4 for females); 3) total number of registered deaths for each cancer or group of cancers, sex and age group (Table 5 for males and Table 6 for females); 4) percentage of all cancer deaths for each sex and age group (Table 7 for males and Table 8 for females). A few comments are included, mainly in order to assist reading and interpretation of data for major cancer sites, and to recall underlying long-term tendencies. Any inference should in any case be based on age-standardized rates, and, essentially, on detailed inspection of age-specific rates.

Cancer mortality in Italy, 1997: quantifying the fall in rates in women and men.

To update data and statistics on cancer death certification in Italy to 1997. Data and statistics for 1997 subdivided into 31 cancer sites are presented. Trends in age-standardized rates for major cancer sites are plotted from 1955 to 1997. The age-standardized (world standard) death certification rates from all neoplasms steadily declined from the peak of 199.2/100,000 males in 1988 to 174.7 in 1997 and for females from 102.5 to 93.0. The decline was larger in truncated rates, by about 26% for males since 1983 and by 24% for females since the top rate of the early 1960's. A major component of the favorable trend in males was lung cancer, which showed a 16% decline from the peak of 1987-88, to reach 50.6/100,000 in 1997, corresponding to about 5,000 avoided deaths. The decline in lung cancer was about 34% at age 35 to 64. For females, in contrast, both the absolute number of lung cancer deaths and the age-standardized rate of 7.9/100,000 were among the highest values ever registered, reflecting the different pattern of spread of the tobacco-related lung cancer epidemic in the two sexes. Intestinal cancer rates were stable for males but declined by approximately 10% for females, mostly in middle age, as did breast cancer mortality. Among neoplasms showing favorable trends, there were other tobacco-related neoplasms in men, plus the continuing fall in stomach and cervix uteri. Upward trends were observed for non Hodgkin's lymphomas. The fall in cancer mortality observed over the last decade in Italy is attributable to a decline in lung and other tobacco-related neoplasms in males, together with a persistent fall in stomach and uterine (cervical) cancer. In women, there were also recent falls in intestinal and breast cancer rates, and declines in both sexes in rarer neoplasms influenced by therapeutic advancements.

Olive oil consumption and cancer mortality in Italy. A correlation study.

Total dietary fat and animal fat intakes are frequently positively associated with site specific cancer mortality, the most common association being found with cancer of the breast, colon and prostate. Results from epidemiological studies are, however, controversial with respect to the relationship between total dietary fat consumption and breast cancer risk; there is more agreement that a high fat diet is associated with prostate cancer.1 KeywordsBreast Cancer RiskCancer MortalityItalian National InstituteItalian AreaTotal Cancer MortalityThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Cancer mortality in Italy, 1994, and an overview of trends from 1955 to 1994.

Data and statistics are presented on cancer death certification in Italy, updating previous publications covering the period 1955-1993. Data for 1994 and the quinquennium 1990-94 subdivided into 30 cancer sites are presented in 8 tables, including age- and sex-specific absolute and percentage frequencies of cancer deaths, and crude, age-specific and age-standardized rates, at all ages and truncated for the 35-64 year age group. Trends in age-standardized rates for major cancer sites are plotted from 1955 to 1994. The age-standardized (world standard) death certification rates from all neoplasms steadily declined from the peak of 199.2/100,000 males in 1988 to 186.3 in 1994, and in females from 102.5 in 1989 to 98.6 in 1994. Ever larger was the decline in truncated rates, for males from the peak of 275.1/100,000 in 1983 to 223.2 (-19%) in 1994, and for females from 151.6/100,000 in 1987 to 136.4 (-10%). A major component of the favourable cancer mortality trends in males was lung cancer (accounting for 31,000 deaths in both sexes combined in 1994), whose overall age-standardized rates declined from 60.3 in 1987-89 to 54.6/100,000 males in 1994 (-9%), and from the peak of 96.7 in 1983 at ages 35 to 64 to 72.7 in 1994 (-25%). In contrast, female lung cancer rates have remained stable from 1992 onwards, but have increased from 7.2 to 7.7 at all ages and from 10.6 to 11.0 at age 35-64 between 1985-89 and 1990-94. These different trends in the two sexes reflect the patterns and trends in smoking among Italian males and females. Cancer mortality trends in Italy over the period 1990-94 were relatively favourable, mainly reflecting the decline in lung cancer rates in males, together with the persistent declines in gastric cancer in both sexes and in cervix uteri for women. Continuous advancements were registered for neoplasms amenable to treatment, essentially testicular cancer, Hodgkin's disease and childhood leukaemias. The major unfavourable trends were observed for non Hodgkin's lymphomas, and require therefore further monitoring, besides a clearer understanding of their determinants. Italy maintains an intermediate level of cancer mortality on a European scale, suggesting that further progress is possible, mostly for tobacco-related neoplasms in males.

Cancer Mortality in Italy, 1993

Data and statistics are presented on cancer death certification for 1993 in Italy, updating previous publications covering the period 1955-1992. Data for 1993 subdivided into 30 cancer sites are presented in 8 tables, including age- and sex-specific absolute and percentage frequencies of cancer deaths, and crude, age-specific and age-standardized rates, at all ages and truncated for the 35-64 year age group. Age-adjusted death certification rates (on the world standard population) for all neoplasms declined from 189.8 in 1992 (and a peak of 199.2 in 1986) to 187.8/100,000 males in 1993, and remained stable around 100,000 females. The favorable trends were even larger in middle and younger age males, but not in children below age 15, whose overall age-standardized cancer mortality rates increased for the fourth subsequent year. Lung cancer was the leading site of cancer mortality, with over 30,900 deaths. For the fifth subsequent year, its rates in males declined, to reach 56.0/100,000. The decline in lung cancer rates is now established in Italian males and is substantial in middle age, whereas the rise in female lung cancer rates seems to have leveled off over the last few years. Rates for other major cancer sites (intestines, stomach, female breast, prostate, pancreas, leukemias and lymphomas) were stable, but some decrease was apparent also in 1993 for Hodgkin's disease. Italian cancer mortality rates in 1993 were moderately favorable in males, due to the leveling of the tobacco-related epidemic, whereas no appreciable change was registered in females. The persisting unfavorable trends in childhood cancer mortality should be investigated.