Childhood Cancer Incidence Rates Research Articles

A province-wide childhood malignancy profiles in Indonesia (2010-2019): Yogyakarta Pediatric Cancer Registry

Background The global burden of childhood cancer is poorly quantified, but it is estimated that 80% of all children with cancer live in low- and middle-income countries with cure rates of childhood cancer far lower than in high-income nations.
 Objective To describe the Yogyakarta Region pediatric cancer profile from 2010-2019 and compare it to that of a 2000-2009 study in the same setting.
 Methods This retrospective study of childhood cancer was conducted in patients aged £18 years and diagnosed in Dr. Sardjito General Hospital from 2010 to 2019. Pediatric cancer patient data were collected from hospital hardcopy and electronic medical records. An estimated annual average incidence rate of childhood cancer was calculated and the number of patients by their regions of origin were visualized. The number of childhood malignancies recorded is also compared by the number found in 2000-2009 study.
 Results There were 1,839 new cases registered in Yogyakarta Pediatric Cancer Registry during the study period. The mean age at diagnosis was 6.3 years and male-to-female ratio was 1.4: 1.0. Fifty-six% of cancers were diagnosed in the 0-5-years age group. The most common diagnosis category was leukemia, which accounted for 60% of all childhood malignancies. The three most common diagnoses were acute lymphoblastic leukemia (44%), acute myeloid leukemia (12%), and retinoblastoma (7%). The annual average incidence rates of leukemia and solid tumors were 26.8 and 17.5 per million, respectively. The number of patients registered in 2000-2009 study was 1,124 case. Therefore, there was an increase of 63.6% in the number of childhood malignancies registered in 2010-2019 compared to the 2000-2009 study.
 Conclusion There is an increase in the number of childhood malignancies registered in 2010-2019 compared to the 2000-2009 study. The number of patients referred to our hospital increased, indicating a more inclusive registry, better referral system, and better access to health care facility.

The systematic analysis and 10-year prediction on disease burden of childhood cancer in China.

BackgroundThere is a lack of in-depth analysis regarding the disease burden of childhood cancer in China. Indeed, this is the first time the topic has been addressed in detail. Drawing on population-based data for the past 30 years, this study systematically analyzes the composition and long-term trend of this disease burden in China.MethodsGBD 2019 contained population-based data from 1990 to 2019 and was prepared using Microsoft Excel 2016. We used AAPC and ARIMA models for trend analysis and prediction formulation.ResultsIn 2019, there were 45,601 new cases, 9,156 cancer deaths, and 782,530 DALYs in China. From 1990 to 2019, leukemia, together with brain and CNS cancer, invariably ranked highest in terms of new cases, cancer deaths, and DALYs. Leukemia accounted for more than 50%, but decreased over time. By contrast, the proportions for brain and CNS cancer increased. There were significant decreases in the overall incidence, mortality, and DALY rates in China, but these were still higher than the corresponding global average levels. Considering all types of childhood cancer, the incidence rate of testicular cancer showed the biggest increase, and the mortality and DALY rates of leukemia showed the largest decrease. In terms of different age groups, the overall incidence rate of childhood cancers increased in 0 to 4 age group, but it decreased in 5 to 14 age groups. The overall mortality and DALY rates of childhood cancers decreased in all four age groups. Over the next 10 years, the overall incidence rate of childhood cancer will increase, but the overall mortality and DALY rates will decrease. The increase in malignant skin melanoma will comprise the largest rise in the incidence, while the decrease for leukemia will be the largest fall in the incidence, cancer deaths, and DALYs.ConclusionThe disease burden of all childhood cancers in China remains highly serious, especially for certain types of cancer and certain age groups. China should focus more emphatically on the incidence of childhood cancer in future, and it must consistently strengthen investment in the relevant research and medical resources to reduce the disease burden in this field.

Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study

Despite the substantial burden caused by childhood cancer globally, childhood cancer incidence obtained in a nationwide childhood cancer registry and the accessibility of relevant health services are still unknown in China. We comprehensively assessed the most up-to-date cancer incidence in Chinese children and adolescents, nationally, regionally, and in specific population subgroups, and also examined the association between cancer incidence and socioeconomic inequality in access to health services. In this national cross-sectional study, we used data from the National Center for Pediatric Cancer Surveillance, the nationwide Hospital Quality Monitoring System, and public databases to cover 31 provinces, autonomous regions, and municipalities in mainland China. We estimated the incidence of cancer among children (aged 0-14 years) and adolescents (aged 15-19 years) in China through stratified proportional estimation. We classified regions by socioeconomic status using the human development index (HDI). Incidence rates of 12 main groups, 47 subgroups, and 81 subtypes of cancer were reported and compared by sex, age, and socioeconomic status, according to the third edition of the International Classification of Childhood Cancer. We also quantified the geographical and population density of paediatric oncologists, pathology workforce, diagnoses and treatment institutions of paediatric cancer, and paediatric beds. We used the Gini coefficient to assess equality in access to these four health service indicators. We also calculated the proportions of cross-regional patients among new cases in our surveillance system. We estimated the incidence of cancer among children (aged 0-14 years) and adolescents (aged 15-19 years) in China from Jan 1, 2018, to Dec 31, 2020. An estimated 121 145 cancer cases were diagnosed among children and adolescents in China between 2018 and 2020, with world standard age-standardised incidence rates of 122·86 (95% CI 121·70-124·02) per million for children and 137·64 (136·08-139·20) per million for adolescents. Boys had a higher incidence rate of childhood cancer (133·18 for boys vs 111·21 for girls per million) but a lower incidence of adolescent cancer (133·92 for boys vs 141·79 for girls per million) than girls. Leukaemias (42·33 per million) were the most common cancer group in children, whereas malignant epithelial tumours and melanomas (30·39 per million) surpassed leukaemias (30·08 per million) in adolescents as the cancer with the highest incidence. The overall incidence rates ranged from 101·60 (100·67-102·51) per million in very low HDI regions to 138·21 (137·14-139·29) per million in high HDI regions, indicating a significant positive association between the incidence of childhood and adolescent cancer and regional socioeconomic status (p<0·0001). The incidence in girls showed larger variation (48·45% from the lowest to the highest) than boys (36·71% from lowest to highest) in different socioeconomic regions. The population and geographical densities of most health services also showed a significant positive correlation with HDI levels. In particular, the geographical density distribution (Gini coefficients of 0·32-0·47) had higher inequalities than population density distribution (Gini coefficients of 0·05-0·19). The overall proportion of cross-regional patients of childhood and adolescent cancer was 22·16%, and the highest proportion occurred in retinoblastoma (56·54%) and in low HDI regions (35·14%). Our study showed that the burden of cancer in children and adolescents in China is much higher than previously nationally reported from 2000 to 2015. The distribution of the accessibility of health services, as a social determinant of health, might have a notable role in the socioeconomic inequalities in cancer incidence among Chinese children and adolescents. With regards to achieving the Sustainable Development Goals, policy approaches should prioritise increasing the accessibility of health services for early diagnosis to improve outcomes and subsequently reduce disease burdens, as well as narrowing the socioeconomic inequalities of childhood and adolescent cancer. National Major Science and Technology Projects of China, National Natural Science Foundation of China, Chinese Academy of Engineering Consulting Research Project, Wu Jieping Medical Foundation, Beijing Municipal Administration of Hospitals Incubating Program.

Using data to improve care: childhood cancer in China

The last decades have seen substantial improvements in childhood cancer treatment, with cure rates of more than 80%.1 Although these statistics represent hope for families, they are only relevant to those treated in high-income countries. Cure rates are far lower in low-income and middle-income countries (LMICs), where more than 80% of children with cancer reside.2 This survival gap is one of the starkest inequalities in global child health. In this context, Xin Ni and colleagues3 established childhood cancer incidence rates across China by leveraging new health services databases that approach population-level coverage, including national hospital-based childhood cancer registries coordinated by the National Center for Pediatric Cancer Surveillance.

Cancers Among Adolescents and Young Adults in Maine 2001-2017: A Descriptive Analysis and Model for Future Studies.

Purpose: Maine has had a high age-adjusted incidence rate of cancer and a high incidence rate of childhood cancer. However, it is unknown if Maine adolescents and young adults (AYAs) have a higher-than-expected cancer incidence rate. Methods: Based on the International Classification of Diseases of Oncology, Third Edition (ICD-0-3) classification system, we obtained the incidence rates of AYA cancers by state, sex, race, and ethnicity from 2001 to 2017 using CDC WONDER. Overall, all cancer rates and age-adjusted incidence rates for specific cancers were compared and ranked by state. Results: Maine had a similar overall age-adjusted cancer incidence rate among non-Hispanic white AYAs compared with the national rate from 2001 to 2017. Among non-Hispanic white AYA cancers of the respiratory system, lung and bronchial cancers, uterine cancer, female breast cancer, thyroid cancer, lymphomas, and Hodgkin's lymphoma were significantly greater in Maine than the state with the lowest incidence rate for that cancer. Specifically, Maine was ranked as one of the top 10 states for the highest incidence rate of lung cancer, uterine cancer, Hodgkin's lymphoma, thyroid cancer (males only), and female breast cancer. Conclusion: Although the cancer incidence rate among AYAs in Maine was not significantly higher than the national average, Maine AYAs had a significantly higher incidence of lung cancer, uterine cancer, Hodgkin's lymphoma, thyroid cancer, and breast cancer. This information may direct future studies to identify regional cancer risk factors in Maine, which may account for this elevated rate. The described methodology is an innovative approach to identifying states with high cancer rates and directing future studies.

Global, regional, and national childhood cancer burden, 1990–2019: An analysis based on the Global Burden of Disease Study 2019

IntroductionCancer is the leading cause of death among children. ObjectivesWe report on the latest estimates of the burden of cancer among children at the global, regional, and national levels from 1990 to 2019. MethodsBased on the Global Burden of Disease Study 2019, children’s cancer data were analyzed by sex, age, year, and location. Age-standardized rates were used to compare the burdens among regions and nations. Joinpoint analysis was applied to assess the temporal trend of the global childhood cancer burden. ResultsIn 2019, 291,319 (95% uncertainty interval [UI], 254,239 to 331,993) new cases and 98,834 (86,124 to 113,581) deaths from childhood cancer were documented globally. Further, 8,302,464 (7,230,447 to 9,555,118) DALYs and 1,806,630 (1,567,808 to 2,089,668) prevalent cases were recorded in the same year. Age-standardized incidence and prevalence rates of childhood cancer were greatest in higher SDI settings and increased most significantly in Australasia and Southern Latin America over the last 30 years. However, although age-standardized death and DALY rates of childhood cancer have remarkably decreased in all regions since 1990, countries with a lower SDI showed the highest rates in 2019, particularly in countries in Eastern Sub-Saharan Africa. Among all cancers, leukemia has shown the largest decrease in burden since 1990. Despite this, leukemia was still the most common cancer and the leading cause of death among children in 2019, followed by brain and central nervous system cancer. ConclusionsOn a global scale, the childhood cancer burden has significantly fallen over the last 30 years, but is still higher in lower SDI countries. Effective interventions and collaborations among nations should be facilitated to improve healthcare among children with cancer in countries with lower SDI.

Patterns and Trends of Childhood Cancer Incidence (0–14 Years) in Delhi, India: 1990–2014

To investigate the patterns and temporal trends of childhood cancer incidence (0-14 years) in Delhi from 1990 to 2014. The new childhood cancer cases diagnosed between 1990 and 2014 were extracted from the Delhi population-based cancer registry (PBCR). Joinpoint regression analysis was performed to assess the temporal behaviour of new childhood cancer. The magnitude of temporal trend was assessed by estimated annual percentage changes (EAPCs). The Delhi PBCR registered 12,637 cases (8484 boys and 4153 girls) during 1990-2014. The overall childhood cancer was twice in boys than girls (5.62% vs. 2.78%). The age-standardised incidence rates (ASIRs) of childhood cancer adjusted to the WHO World standard population distribution (year 2000) was 163 per one million in boys and 92 per one million in girls; median age at diagnosis being 6 and 7 years, respectively. Five-top childhood cancer sites was leukaemia, lymphoma, central nervous system (CNS), bone and retinoblastoma. A decreasing linear trend in proportion of new childhood cancer cases to total all age-group cancer was observed in both sexes during this period. The percentage increase in childhood cancer is similar in both sexes from 1990-94 to 2010-14 (97% vs. 93%). Increasing trend in ASIRs of childhood cancer was observed. The new childhood cancer cases observed increasing trend during 1990 to 2014. Boys had nearly double the number of childhood cancer cases than girls while population ratio of boys and girls during the same period was 1.14:1.

Abstract A04: Childhood cancer incidence among specific Asian and Pacific Islander populations in the U.S.

Abstract Background: We sought to explore variation in childhood cancer incidence rates among specific Asian and Pacific Islander (API) groups. Despite high genetic diversity in this region of the world, API groups in the United States are often combined into a single race/ethnic group. Methods: The Surveillance, Epidemiology, and End Results (SEER) Detailed Asian/Pacific Islander (2000-Centered) data was used for this analysis. Cancer diagnoses occurring between January 1998 to December 2002 from 14 SEER registries were included. Detailed racial/ethnic population data from the 2000 census was used to calculate incidence rates for individual races with at least 500,000 individuals. We also combined this data into groups based on geographic regions and genetic similarity, which included East Asia (China, Japan, Korea; n=377 cases), Southeast Asia (Vietnam, Laos, Cambodia; n=136 cases), Asian Indian/Pakistan (n=163 cases), Oceania (Guam, Samoa, Tonga; n=29 cases), and the Philippines (n=199 cases). Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated comparing each API regional group to non-Hispanic Whites (NHW), and each API regional group to East Asians. Results: Incidence rates among detailed Asian and Pacific Islander groups varied. Acute lymphoblastic leukemia (ALL) was significantly lower in children of SE Asian (IRR 0.59, 95% CI 0.42, 0.82) and Filipino (IRR 0.73, 95% CI 0.57, 1.00) descent compared to non-Hispanic Whites. Acute myeloid leukemia (AML) was more common among children from Oceania compared to NHW (IRR 3.44, 95% CI 1.63, 7.28). Central nervous system (CNS) cancers were less common among East Asian (IRR 0.74, 95% CI 0.58, 0.96), SE Asian (IRR 0.45, 95% CI 0.28, 0.73), and Filipino (IRR 0.48, 95% CI 0.32, 0.72) children compared to NHW. When comparing the incidence of cancers among API regions, few clear patterns emerged. The incidence of AML in children from Oceania was nearly four times that in East Asians (IRR 3.88, 95% CI 1.64, 9,.11), though roughly the same among all other regions. The incidence rates of ALL (IRR 0.63, 95% CI 0.41, 0.97) and malignant gonadal germ cell tumors (IRR 0.29 95% CI 0.08, 0.97) were lower in SE Asians compared to East Asians. Lymphoma was twice as common in Asian Indians/Pakistani children compared to East Asians (IRR 2.13, 95% CI 1.33, 2.29). Conclusions: The variation observed in cancer incidence patterns among these groups is important and may indicate differences in underlying etiology and/or exposure patterns. These findings highlight possible disparities in cancer incidence between specific API groups. Citation Format: Kristin J. Moore, Aubrey K. Hubbard, Lindsay A. Williams, Logan G. Spector. Childhood cancer incidence among specific Asian and Pacific Islander populations in the U.S. [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr A04.

Global frequency and distribution of head and neck cancer in pediatrics, a systematic review.

Incidence and mortality rates of childhood cancer represent a global public health issue, however, the worldwide prevalence of head and neck cancer in pediatric patients (HNCPP) is still unknown. Therefore, this study aimed to describe the frequency and distribution of HNCPP worldwide. A specific search strategy was performed using MEDLINE, Scopus, and EMBASE to include studies based on hospital records, national cancer registries, and pathology files. Studies quality was assessed using the risk of bias checklist of the Joanna Briggs Institute Critical Appraisal. Nineteen publications (15,970 cases) were included. Global frequency ranged from 0.25 % to 15 %. Male patients older than 10 years of age were most affected by lymphomas, followed by carcinomas and sarcomas. Non-Hodgkin lymphoma, Hodgkin lymphoma, rhabdomyosarcoma, thyroid carcinoma, and nasopharyngeal carcinoma were the main histopathological subtypes. Neck/lymph nodes were anatomical hotspots. This HNCPP global overview may guide secondary prevention strategies and future etiological studies.

The incidence of childhood cancer in Australia, 1983-2015, and projections to 2035.

ObjectivesTo describe changes in childhood cancer incidence in Australia, 1983–2015, and to estimate projected incidence to 2035.Design, settingPopulation‐based study; analysis of Australian Childhood Cancer Registry data for the 20 547 children under 15 years of age diagnosed with cancer in Australia between 1983 and 2015.Main outcome measuresIncidence rate changes during 1983–2015 were assessed by joinpoint regression, with rates age‐standardised to the 2001 Australian standard population. Incidence projections to 2035 were estimated by age‐period‐cohort modelling.ResultsThe overall age‐standardised incidence rate of childhood cancer increased by 34% between 1983 and 2015, increasing by 1.2% (95% CI, +0.5% to +1.9%) per annum between 2005 and 2015. During 2011–2015, the mean annual number of children diagnosed with cancer in Australia was 770, an incidence rate of 174 cases (95% CI, 169–180 cases) per million children per year. The incidence of hepatoblastoma (annual percentage change [APC], +2.3%; 95% CI, +0.8% to +3.8%), Burkitt lymphoma (APC, +1.6%; 95% CI, +0.4% to +2.8%), osteosarcoma (APC, +1.1%; 95%, +0.0% to +2.3%), intracranial and intraspinal embryonal tumours (APC, +0.9%; 95% CI, +0.4% to +1.5%), and lymphoid leukaemia (APC, +0.5%; 95% CI, +0.2% to +0.8%) increased significantly across the period 1983–2015. The incidence rate of childhood melanoma fell sharply between 1996 and 2015 (APC, –7.7%; 95% CI, –10% to –4.8%). The overall annual cancer incidence rate is conservatively projected to rise to about 186 cases (95% CI, 175–197 cases) per million children by 2035 (1060 cases per year).ConclusionsThe incidence rates of several childhood cancer types steadily increased during 1983–2015. Although the reasons for these rises are largely unknown, our findings provide a foundation for health service planning for meeting the needs of children who will be diagnosed with cancer until 2035.

Association Between Fertility Treatment and Cancer Risk in Children

An increasing number of children worldwide are born after the use of fertility treatment, although it remains unclear whether the treatment affects the risk of childhood cancer and whether any associations observed are due to the use of specific drugs, the use of specific procedures, or the underlying infertility. To examine the association between different types of fertility treatments and cancer risk in children. A retrospective cohort study based on Danish population-based registry data and the Danish Infertility Cohort (individual record linkage) that included 1 085 172 children born in Denmark between January 1, 1996, and December 31, 2012, linked with parental information. There were a total of 2217 children diagnosed with cancer (follow-up occurred during 1996-2015). Maternal fertility treatment during the index pregnancy, including the use of fertility drugs (clomiphene [n = 33 835], gonadotropins [n = 57 136], gonadotropin-releasing hormone analogs [n = 38 653], human chorionic gonadotropin [n = 68 181], progesterone [n = 41 628], and estrogen [n = 16 948]) and assisted reproductive technology (in vitro fertilization [n = 19 448], intracytoplasmic sperm injection [n = 13 417], and frozen embryo transfer [n = 3356]). Each exposure was examined separately and compared with children born to fertile women. Hazard ratios and incidence rate differences for childhood cancer. After 12.2 million person-years of follow-up (mean, 11.3 years), the incidence rate of childhood cancer was 17.5 per 100 000 for children born to fertile women (n = 910 291) and 44.4 per 100 000 for children born after the use of frozen embryo transfer (n = 3356). Compared with children born to fertile women, the use of frozen embryo transfer was associated with an elevated risk of childhood cancer (14 cancer cases; hazard ratio, 2.43 [95% CI, 1.44 to 4.11]; incidence rate difference, 26.9 [95% CI, 2.8 to 51.0] per 100 000), mainly due to an increased risk of leukemia (5 cancer cases; incidence rate, 14.4 per 100 000; hazard ratio, 2.87 [95% CI, 1.19 to 6.93]; incidence rate difference, 10.1 [95% CI, -4.0 to 24.2] per 100 000) and sympathetic nervous system tumors (<5 cancer cases; hazard ratio, 7.82 [95% CI, 2.47 to 24.70]). There were no statistically significant associations with the use of the other types of fertility treatment examined. Among children born in Denmark, the use of frozen embryo transfer, compared with children born to fertile women, was associated with a small but statistically significant increased risk of childhood cancer; this association was not found for the use of other types of fertility treatment examined.

Feasibility of fertility preservation in pre-pubertal males scheduled to receive chemotherapy

Overall incidence rates of childhood cancer vary between 50-200/million children across the world. Childhood cancer survival rates are high, as are the late effects of gonadotoxic agents, such as infertility, in cancer survivors. While cryopreservation of sperm in adults is widely used, cryopreservation of testicular tissue in pre-pubertal boys has only recently been applied as a means to help preserve future fertility in pre-pubertal boys with cancer. The objective of this study is to present our experience of pre-pubertal pre-chemo fertility preservation. We reviewed all pre-pubertal patients who underwent pre-chemo fertility preservation at a large cancer center for feasibility and safety. All pre-pubertal pre-chemotherapy patients who underwent fertility preservation using testicular sperm extraction (TESE) were analyzed. Parents were informed that: the procedure was experimental, given that it is unknown if the tissue will be of use in the future; the procedure had to be performed under an anesthetic for another procedure (infusion port, bone marrow aspirates); the procedure would not be covered by insurance. A unilateral window technique was utilized as most patients were to undergo chemotherapy within 48 hours of TESE. Safety data including rates of infection, hematoma development or delay in chemotherapy initiation were recorded. A total of 22 pre-pubertal males had a mean age of 7.613 years constituted the study population. Mean FSH level was 6.9±6.3 (range 0.3-15.4) iU/ml. Most (71%) were Tanner stage 1, mean testicular volume 3.6±1.9. The most common childhood cancers in this cohort were sarcomas (55%), immune deficiencies (23%), and leukemias (14%). The procedure took an average of 22 . The tissue was sent to the sperm bank where it was cryopreserved. Viability testing on the first 10 specimens revealed healthy testicular tissue. No wound infections or scrotal hematomas occurred postoperatively. All patients were able to commence chemotherapy on schedule, usually within 24 hours or less of the fertility procedure. Fertility preservation in pre-pubertal pre-chemotherapy patients is a safe and feasible operation.

PD34-11 DEFINING THE FEASIBILITY OF FERTILITY PRESERVATION IN PRE-PUBERTAL MALES SCHEDULED TO UNDERGO CHEMOTHERAPY

INTRODUCTION AND OBJECTIVES:Overall incidence rates of childhood cancer vary between 50-200/million children across the world. Childhood cancer survival rates are high, as are the late effects of g...

Spatial and temporal variations of childhood cancers: Literature review and contribution of the French national registry.

BackgroundSignificant increases in childhood cancer incidence since the 1970s have been consistently reported worldwide, but the persistence of the increase on recent periods is discussed. No conclusion can be drawn concerning the spatial variations of childhood cancer, either. This study is an in‐depth investigation of the spatial and temporal variations of childhood cancer in France. An extensive review of all the studies published since 2000 on those issues is provided.MethodsThe study included 25 877 cases of childhood cancer registered nationwide over 2000‐2014. The spatial heterogeneity (overdispersion, autocorrelation, overall heterogeneity) was tested, on two geographic scales, and two spatial scan methods were used to detect clusters of cases. The annual average percent change (AAPC) in incidence rate was estimated with Poisson regression models, and joinpoint analyses were considered.ResultsGlioma and non‐Hodgkin lymphoma cases exhibited some spatial heterogeneity and two large clusters were detected. Overall, the incidence rate of childhood cancer was stable over 2000‐2014 (AAPC = −0.1% [−0.3%; 0.2%]). A log‐linear positive trend was significantly evidenced for gliomas other than pilocytic astrocytomas (AAPC = 1.8% [0.9%; 2.7%]), with some suggestion of a leveling‐off at the end of the period, while Burkitt lymphoma and germ cell tumor incidence rates decreased (AAPC = −2.2% [−3.8%; −0.5%] and AAPC = −1.9% [−3.4%; −0.3%], respectively). No spatial heterogeneity or significant time variation was evidenced for other cancers.ConclusionSeveral types of childhood cancer displayed some spatial heterogeneity and two large clusters were detected, the origins of which are to be investigated and might include differences in case ascertainment. Overall, the results do not support a sustained increase in incidence rates of childhood cancer in recent years.

Childhood cancer incidence and survival in Thailand: A comprehensive population-based registry analysis, 1990-2011.

Southeast Asia is undergoing a transition from infectious to chronic diseases, including a dramatic increase in adult cancers. Childhood cancer research in Thailand has focused predominantly on leukemias and lymphomas or only examined children for a short period of time. This comprehensive multisite study examined childhood cancer incidence and survival rates in Thailand across all International Classification of Childhood Cancer (ICCC) groups over a 20-year period. Cancer cases diagnosed in children ages 0-19years (n=3574) from 1990 to 2011 were extracted from five provincial population-based Thai registries, covering approximately 10% of the population. Descriptive statistics of the quality of the registries were evaluated. Age-standardized incidence rates (ASRs) were calculated using the Segi world standard population, and relative survival was computed using the Kaplan-Meier method. Changes in incidence and survival were analyzed using Joinpoint Regression and reported as annual percent changes (APC). The ASR of all childhood cancers during the study period was 98.5 per million person-years with 91.0 per million person-years in 1990-2000 and 106.2 per million person-years in 2001-2011. Incidence of all childhood cancers increased significantly (APC=1.2%, P<0.01). The top three cancer groups were leukemias, brain tumors, and lymphomas. The 5-year survival for all childhood cancers significantly improved from 39.4% in 1990-2000 to 47.2% in 2001-2011 (P<0.01). Both childhood cancer incidence and survival rates have increased, suggesting improvement in the health care system as more cases are identified and treated. Analyzing childhood cancer trends in low- and middle-income countries can improve understanding of cancer etiology and pediatric health care disparities.

Incidence of childhood cancer in Costa Rica, 2000–2014: An international perspective

BackgroundEstimating childhood cancer incidence globally is hampered by a lack of reliable data from low- and middle-income countries. Costa Rica is one of the few middle-income countries (MIC) with a long-term high quality nationwide population-based cancer registry. MethodsData on incident cancers in children aged under 15 years reported to the Costa Rica National Cancer Registry between 2000 and 2014 were analyzed by diagnostic group, age, sex, and geographical region and compared with incidence data for Hispanic and Non-Hispanic White (NHW) children in California, USA. ResultsDuring the 15-year period, 2396 cases of childhood cancer were reported in Costa Rica, resulting in an overall age-standardized incidence rate (ASR) of 140/million. Most frequent cancer types were leukemias (40.5%), malignant central nervous system (CNS) tumors (13.9%), and lymphomas (12.7%). The observed ASR of lymphoid leukemia (46.9/million) ranked high globally. Low rates were found for most solid tumors including malignant CNS tumors, sympathetic nervous system tumors, and soft tissue sarcomas. There was almost no change in incidence rates over time, while geographical variations were observed within Costa Rica. The overall cancer rate in Costa Rica was lower compared to NHW (176.1/million) and Hispanic (161.7/million) children in California. ConclusionBased on the longstanding registration system, the childhood cancer incidence rates were similar to those observed in other Latin American countries. While a degree of under-ascertainment of cases cannot be excluded, the markedly high leukemia rates, in particular of the lymphoid sub-type deserves further study in this population.

Evaluation of prooxidant-antioxidant balance in in vitro fertilization-conceived mice.

ObjectiveConcerns about the safety of assisted reproductive technology (ART) have been raised, as some studies have shown elevated incidence rates of childhood cancer, asthma, allergies, and other diseases in ART-conceived babies. Findings regarding the health of ART-conceived babies are controversial. The present study was conducted to evaluate the prooxidant-antioxidant balance (PAB) in in vitro fertilization (IVF)-conceived mice in comparison to naturally conceived offspring.MethodsMice (6–8 weeks) were divided into two groups (IVF-conceived and naturally conceived) matched by sex, age, weight, and litter size. A 1-mL blood sample was taken and the sera were separated. The oxidant-antioxidant balance was evaluated using a fast and reliable PAB assay. The results were expressed as mean±standard deviation.ResultsThe mean PAB values (HK units) in the IVF-conceived and naturally conceived groups were 59.70±22.30 and 54.70±18.22, respectively (p=0.82).ConclusionSince free radicals contribute to several pathological conditions and antioxidants play an important protective role against oxidative stress, evaluating the oxidant-antioxidant balance is very important. Although the results of this study showed that the quality of the defense mechanism against free radicals was not significantly different between the IVF-conceived and naturally conceived mice, other parameters of metabolic dysfunction need to be measured.

Childhood Cancer in Basrah, Iraq During 2012-2016: Incidence and Mortality

Background:Worldwide, childhood cancer is rare. In addition, a distinct variation in both incidence and type distribution was reported between countries.Aim:To estimate the incidence and mortality rates of childhood cancer in Basrah, Iraq during 2012-2016.Methods:This registry based descriptive study included children aged 0-14 years with primary cancer who were newly diagnosed in Basrah during 2012-2016. The types of malignant tumors were classified according to International Classification of Childhood Cancer, Version 3 (ICCC-3). The overall and specific incidence and mortality rates by age and sex were calculated per 100,000 population.Results:A total of 723 new cases of childhood cancer were registered during the five- year study period, with a male to-female ratio of 1.2/1. Children aged <4 years accounted for 43.1% of patients. The overall incidence rate was 13.74/100,000, and the age standardized incidence rate (ASIR) was 13.87/100,000. Boys showed higher incidence rate than girls (14.78 vs. 12.66/100,000). Leukemia was the most common type of childhood cancer accounting for 35.4%, followed by lymphoma (17.8%), and central nervous system tumors 11.9%. The overall cancer-specific mortality rate was 6.04/100,000 and the ASMR was 6.08/100,000 children.Conclusion:The incidence rate of childhood cancer in Basrah as well as the cancer type distribution was comparable to that reported for developing countries.

Do pregnancy characteristics contribute to rising childhood cancer incidence rates in the United States?

Since 1975, childhood cancer incidence rates have gradually increased in the United States; however, few studies have conducted analyses across time to unpack this temporal rise. The aim of this study was to test the hypothesis that increasing cancer incidence rates are due to secular trends in pregnancy characteristics that are established risk factors for childhood cancer incidence including older maternal age, higher birthweight, and lower birth order. We also considered temporal trends in sociodemographic characteristics including race/ethnicity and poverty. We conducted a time series county-level ecologic analysis using linked population-based data from Surveillance, Epidemiology, and End Results cancer registries (1975-2013), birth data from the National Center for Health Statistics (1970-2013), and sociodemographic data from the US Census (1970-2010). We estimated unadjusted and adjusted average annual percent changes (AAPCs) in incidence of combined (all diagnoses) and individual types of cancer among children, ages 0-4 years, from Poisson mixed models. There was a statistically significant unadjusted temporal rise in incidence of combined childhood cancers (AAPC=0.71%; 95% CI=0.55-0.86), acute lymphoblastic leukemia (0.78%; 0.49-1.07), acute myeloid leukemia (1.86%; 1.13-2.59), central nervous system tumors (1.31%; 0.94-1.67), and hepatoblastoma (2.70%; 1.68-3.72). Adjustment for county-level maternal age reduced estimated AAPCs between 8% (hepatoblastoma) and 55% (combined). However, adjustment for other county characteristics did not attenuate AAPCs, and AAPCs remained significantly above 0% in models fully adjusted for county-level characteristics. Although rising maternal age may account for some of the increase in childhood cancer incidence over time, other factors, not considered in this analysis, may also contribute to temporal trends.

Cancer of childhood in sub-Saharan Africa.

Measurement of incidence rates of childhood cancer in Africa is difficult. The study ‘Cancer of Childhood in sub Saharan Africa’ brings together results from 16 population-based registries which, as members of the African Cancer Registry Network (AFCRN), have been evaluated as achieving adequate coverage of their target population. The cancers are classified according to the third revision of the International Classification of Childhood Cancer (ICCC-3) and recorded rates in Africa are compared with those in childhood populations in the UK, France, and the USA.It is clear that, in many centres, lack of adequate diagnostic and treatment facilities leads to under-diagnosis (and enumeration) of leukaemias and brain cancers. However, for several childhood cancers, incidence rates in Africa are higher than those in high-income countries. This applies to infection-related cancers such as Kaposi sarcoma, Burkitt lymphoma, Hodgkin lymphoma and hepatocellular carcinoma, and also to two common embryonal cancers - retinoblastoma and nephroblastoma. These (and other) observations are unlikely to be artefact, and are of considerable interest when considering possible aetiological factors, including ethnic differences in risk (and hence genetic/familial antecedents).The data reported are the most extensive so far available on the incidence of cancer in sub Saharan Africa, and clearly indicate the need for more resources to be devoted to cancer registration, especially in the childhood age range, as part of an overall programme to improve the availability of diagnosis and treatment of this group of cancers, many of which have—potentially—an excellent prognosis.