1. Epidemiology of Childhood Cancer: Incidence, Survival and Mortality Pediatric Resident Education Series

2. Childhood Cancer Purpose is to describe the incidence and survival of various types of cancer in kids and how these parameters are affected by: Age Race / Ethnicity Gender

3. Childhood Cancer General Statistics: Approximately 12,400 new diagnoses/year < 20 yo  0-14 = 8,700  15-19 = 3,700 Thus, incidence is 150 per million children < 20 yo newly diagnosed with cancer each year, or 1/ 7,000 The probability of a newborn developing cancer by age 20 is between 0.3 – 0.32%, or ~ 1/300 1,500-1,600 deaths/year in children < 15 years of age

4. Overall Trends Incidence relatively stable Mortality declining

5. Age Specific Incidence Rates for Childhood Cancers

6. Age Specific Incidence Rates for Childhood Cancers Incidence rate similar for youngest (< 5 yr) and oldest (15-19 yr) age groups But… histologies (or types of cancer) are different in these groups

7. Incidence distribution by histology children 15 yrs

8. Age Specific Incidence Rates for Childhood Cancers

9. Most common cancer < 15 yrs – leukemia > 15 yrs – lymphoma Second most common < 10 yrs – CNS tumors 10-14 yrs – lymphoma > 15 yrs – leukemia

10. Distribution of Specific Cancer Diagnoses for Children and Adolescents

11. Incidence of Cancers is Influenced by Race/Ethnicity

12. Incidence of Cancers is Influenced by Race/Ethnicity – US data 1990-95 In adults, incidence of cancer more common in blacks than whites For children, cancer was less common in blacks than whites Incidence for Hispanic & Asian/Pacific islanders intermediate between blacks and whites American Indians had the lowest incidence of any group

13. Incidence of Cancers is Influenced by Race/Ethnicity

14. Incidence of cancer influenced by gender Generally higher in males than females Some histologies show gender predisposition Age may also influence sex distribution e.g. Hodgkins Age < 15 yrs male > female Age > 15 yrs female > male

15. Trend in Survival Rates for Childhood Cancer – overall & specific

16. Trend in Survival Rates for Specific Childhood Cancers

17. Trend in Survival Rates for Specific Childhood Cancers – influence of age

18. Leading Causes of Death in Children < 14 y/o in the USA 1997

19. Leading Causes of Death in Adolescents in the USA 1997

20. The converse of survival... Overall Mortality rate decreasing

21. Distribution by Cause of Cancer Death Overall distribution of incidence by cancer type

22. Mortality Rates for Childhood Cancers

23. Age-specific cancer mortality… Related to incidence and type of cancer in the age groups

24. Age-specific cancer mortality…

26. Summary Cancers of children represent a diverse group of diagnoses with a distinctive age-incidence pattern The incidence of cancer among children has remained essentially stable over several decades The mortality rates for all cancer types have decreased dramatically over the last several decades

28. Credits Information and tables, for the most part, taken from the SEER monograph on Childhood Cancer Cancer Incidence and Survival Among Children and Adolescents: United States SEER Program 1975-1995 http://seer.cancer.gov/publications/childhood/ http://seer.cancer.gov/publications/childhood/ Other tables taken from Gurney JG & Bondy ML, “Epidemiology of Childhood Cancer”, in Principles and Practice of Pediatric Oncology, 5 th ed, Pizzo PA and Poplack DA, eds, LWW, 2005. http://www.lww.com/static/docs/product/samplechapter s/0-7817-5492-5_Chapter%201.pdf http://www.lww.com/static/docs/product/samplechapter s/0-7817-5492-5_Chapter%201.pdf Michael Kelly MD PhD Anne Warwick MD MPH