CDC study reveals overall increase in pediatric cancer incidence over 16 years
Overall incidence of pediatric cancer in the United States increased 0.5% annually on average between 2003 and 2019, according to a CDC study published in Journal of the National Cancer Institute.
The overall rate reflects an increase from 2003 to 2016, followed by a decrease from 2016 to 2019, U.S. Cancer Statistics data showed.
Researchers collected the data to assess age-adjusted incidence rates and trends among children and adolescents up to age 19 years diagnosed with a primary malignancy during the period.
“We have access to the USCS database that covers 99.1% of the U.S. population, and so we really wanted to describe pediatric incidence rates over the past 2 decades,” David A. Siegel, MD, MPH, a pediatric hematologist/oncologist and commander in the Commissioned Corps of the U.S. Public Health Service, told Healio. “The idea was that national high-quality data can help us better understand how to meet patient needs.”
Results showed an overall cancer incidence rate of 178.3 per 1 million, with 248,749 cases reported during the period. Cancers with the highest incidence rates included leukemia (46.6), central nervous system neoplasms (30.8) and lymphoma (27.3). Among patients, researchers observed the highest rates among males, children up to age 4 years, non-Hispanic white children and adolescents, and those who resided in the Northeast, the top 25% of counties by economic status, and metropolitan counties with a population of at least 1 million.
Siegel spoke with Healio about the trends his analysis identified and discussed what these findings might mean for the future of pediatric oncology care.
Healio: How did you conduct this study?
Siegel: We looked at pediatric ages, which we defined as aged zero to 19 years. We studied the period from 2003 to 2019 and looked at a few metrics: counts, which is the number of cases; rate, which is the number of cases per 1 million people; and trends, which assesses whether cancer is decreasing, increasing or staying the same. We looked at that by a few different variables, such as sex, age, race and ethnicity, geographic area, and cancer type.
Healio: What did you find?
Siegel: Overall, pediatric cancer is still very rare. We did find significant increases, but the increases were relatively small. We found increases in a few cancer types, including leukemia, lymphoma, hepatic tumors, bone tumors and thyroid cancer, but a decrease in melanoma. Brain tumors showed an interesting pattern — rates increased until 2017, then decreased.
Healio: What do you think these findings mean?
Siegel: There are many different reasons trends in cancer incidence could increase or decrease. One factor is coding changes. That’s how cancers are reported in these registries, and it makes a difference. For example, over the past couple of decades there has been increased use of electronic pathology reporting. It more easily sends the information from the pathologist to the cancer registries. There could also be changes in diagnostic patterns, how often physicians use MRIs to diagnose cancer, for example. Those all could impact some of the trends.
Risk factors could change, as well. For example, for melanoma, it’s likely that some of the public health interventions to reduce UV exposures contributed to the decrease in rates. On the flip side, we have seen an increase in hepatoblastoma, a type of liver cancer, in a few different studies. It could be that some risk factors related to this cancer have changed and may have contributed to the increase.
Healio: What do you expect to be the long-term implications of this study for the treatment of pediatric cancers?
Siegel: It is well-reported that survival rates for pediatric cancers are increasing and death rates are decreasing. That wasn’t part of this study, but it is very good news for pediatric cancer. The increases we saw are very small and, overall, pediatric cancer is still very rare. So, we are likely to have more cancer survivors, which is important because cancer survivors need long-term care. That’s important for physicians to keep in mind as they think about these questions going forward.
These data give some context for designing clinical trials that will improve outcomes and continue that improvement in survival over the next several years.
Healio: Is there anything else you’d like to mention?
Siegel: The CDC is working to improve the quality of this data. We use national data, but it takes about 2 years after cancer diagnosis to have a full report to share. So, CDC is working to make that data higher-quality and faster. One of the projects we’re working on is the Childhood Cancer STAR project. We are hoping the data can be used to rapidly improve treatment and interventions and determine how best to meet patient needs.
For more information:
David A. Siegel, MD, MPH, can be reached at Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mail Stop D-72, Atlanta, GA 30333.
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Siegel DA, et al. J Natl Cancer Inst. 2023;doi:10.1093/jnci/djad115.