Childhood Cancer Incidence Up, Mortality Down

Although the incidence of cancer in children and adolescents in the United States has increased slightly since 1975, mortality rates have decreased dramatically, according to a comprehensive report by American Cancer Society (ACS) researchers published in CA: A Cancer Journal for Clinicians.

Using data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries, the researchers found that cancer incidence rates increased by 0.6% annually between 1975 and 2010. The reasons for the increase remain unknown, according to the report.

Cancer remains the leading cause of death by disease among children younger than 14 in the United States. The authors estimate that the risk for being diagnosed with cancer before age 20 for a child born in the United States is about 0.35%, or about one in 285. The authors of the report estimate that 10,450 children (birth to 14 years old) and 5,330 adolescents (15 to19 years old) will be diagnosed with cancer in 2014, while 1,350 children and 610 adolescents will die from some type of the disease.

Since 1975, average death rates for all cancers combined dropped by more than 50% among children and adolescents, primarily due to improvements in treatment and care. The overall 5-year survival rate for a child diagnosed between 2003 and 2009 is 83%, up from 63% between 1975 and 1979.

One of the sharpest declines in mortality was observed in patients with acute lymphoblastic leukemia (ALL), the most commonly diagnosed cancer in children. The 5-year overall survival rate for ALL increased from 57% percent to 90%. However, for many solid tumors, the 5-year overall survival rate has remained virtually unchanged for the last 10-20 years.

“We've made tremendous progress in therapeutic treatment of childhood cancer for many, but not all, of the cancers that adolescents and children experience,” says Rebecca Kirch, JD, the director of Quality of Life and Survivorship at the ACS. However, combined statistics fail to capture the diversity of cancer experiences and expectations.

“When we aggregate, we're misleading people into thinking it's all a success story,” she says. For families facing a diagnosis of an untreatable type of cancer, the overall decrease in mortality provides little consolation. “We want to advance progress in all types of childhood cancer, and get them all up to the same level as ALL.”

The study also notes that children who survive at least 5 years still face increased risk of cancer later in life and may suffer recurrence, chronic disease, or side effects from either the disease itself or from toxic treatments like chemotherapy.

“Toxicity of treatments is a significant price to pay for progress,” says Kirch. The report notes that less-toxic therapies for some types of disease have lowered, but not eliminated, the risk for adverse events later in life. That's why the study's authors emphasize that childhood cancer survivors need to continue having regular checkups.