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America's Children and the Environment, Third Edition (ACE3)

Childhood Cancer

Indicator H4 graph

Download high-resolution JPEG file of this graph | Data Tables for this Topic (PDF) (3pp, 184K, About PDF)

Data characterization

  • Cancer incidence data for this indicator are obtained from a database of 13 regional tumor registries located throughout the country, maintained by the National Cancer Institute.
  • The population covered by the 13 registries is comparable to the general U.S. population regarding poverty and education, but is more urban and has more foreign-born persons.
  • Cancer mortality data for this indicator are obtained from a database of all death certificates in the United States; cause of death is recorded on the death certificates.
  • The age-adjusted annual incidence of cancer ranged from 153 to 161 cases per million children between 1992 and 1994 and from 172 to 175 cases per million children between 2007 and 2009. This increasing trend from 1992-2009 was statistically significant.
  • Childhood cancer mortality decreased from 33 deaths per million children in 1992 to 24 deaths per million children in 2009, a statistically significant decreasing trend.
  • Childhood cancer incidence and mortality rates were generally higher for boys than for girls. In 2007-2009, rates of cancer incidence and mortality for boys were 183 cases per million and 26 deaths per million, compared with 163 cases per million and 22 deaths per million for girls. These differences by sex were statistically significant for cancer incidence (after adjustment for age and race/ethnicity) and cancer mortality. (See Tables H4a and H4b (PDF). (3pp, 184K, About PDF))
  • In 2007-2009, the difference in cancer incidence between boys and girls was not consistent for all races/ethnicities. No statistically significant difference in cancer incidence by sex was seen among Black non-Hispanic children or Asian or Pacific Islander non-Hispanic children. Among American Indian and Alaska Native non-Hispanic children, cancer incidence was greater for girls than for boys, although this difference was not statistically significant. Cancer incidence was greater for boys than for girls and statistically significant (after adjustment for age) among White non-Hispanic children and Hispanic children. (See Tables H4a (PDF). (3pp, 184K, About PDF))
  • In 2007-2009, childhood cancer incidence was highest among White non-Hispanic children at 188 cases per million. Hispanic children had an incidence rate of 169 cases per million, Asian and Pacific Islander non-Hispanic children had an incidence rate of 152 cases per million, American Indian and Alaska Native non-Hispanic children had an incidence rate of 137 cases per million, and Black non-Hispanic children had an incidence rate of 133 cases per million. (See Tables H4a (PDF). (3pp, 184K, About PDF))
    • The cancer incidence rate for White non-Hispanic children was statistically significantly higher than the rates of each of the other race/ethnicity categories after accounting for differences by age and sex. The cancer incidence rate for Black non-Hispanic children was also statistically significantly lower than the rates for Hispanic children and Asian and Pacific Islander non-Hispanic children after adjustment for differences by age and sex. The cancer incidence rate for Asian and Pacific Islander non-Hispanic was also statistically significantly lower than the rate for Hispanic children after adjustment for differences by age and sex. The remaining differences between race/ethnicity groups were not statistically significant.
  • Childhood cancer incidence rates vary by age. In 2007-2009, children under 5 and those of ages 15 to 19 years experienced the highest incidence rates of cancer at approximately 208 and 232 cases per million, respectively. Children ages 5 to 9 years and 10 to 14 years had lower incidence rates at 117 and 139 cases per million, respectively. These differences among age groups were statistically significant. (See Tables H4c (PDF). (3pp, 184K, About PDF))

Indicator H5 graph

Download high-resolution JPEG file of this graph | Data Tables for this Topic (PDF) (3pp, 184K, About PDF)

Data characterization

  • Data for this indicator are obtained from a database of 13 regional tumor registries located throughout the country, maintained by the National Cancer Institute.
  • The population covered by the 13 registries is comparable to the general U.S. population regarding poverty and education, but is more urban and has more foreign-born persons.
  • Leukemia, which includes acute lymphoblastic leukemia and acute myeloid leukemia, was the most common cancer diagnosis for children from 2004-2006, representing 28% of total cancer cases. Incidence of acute lymphoblastic (lymphocytic) leukemia was 30 cases per million in 1992-1994 and 35 cases per million in 2004-2006. The rate of acute myeloid (myelogenous) leukemia was 7 cases per million in 1992-1994 and 9 cases per million in 2004-2006.
    • The increasing trend for incidence of acute lymphoblastic leukemia was statistically significant after accounting for differences by age, sex, and race/ethnicity. The trend for acute myeloid leukemia was not statistically significant.
  • Central nervous system tumors represented 18% of childhood cancers in 2004-2006. The incidence of central nervous system tumors was 27 cases per million in 2004-2006, with no statistically significant trend for 1992-2006.
  • Lymphomas, which include Hodgkin's lymphoma, non-Hodgkin's lymphoma, and Burkitt's lymphoma, represented 14% of childhood cancers in 2004-2006. Incidence of Hodgkin's lymphoma was 12 cases per million in 1992-1994 and 11 per million in 2004-2006. There were approximately 7 cases of non-Hodgkin's lymphoma per million children in 1992-1994 and 9 per million in 2004-2006. Incidence of Burkitt's lymphoma remained constant from 1992-2006 (2 cases per million children). The increasing trend in the incidence rate of non-Hodgkin's lymphoma was statistically significant, while there was no statistically significant trend in the incidence rate of Hodgkin's lymphoma or Burkitt's lymphoma.
  • Between the years 1992 and 2006, increasing trends in the incidence of soft tissue sarcomas, malignant melanomas, and hepatoblastomas were statistically significant, as was the decreasing trend in the incidence of Wilms' tumor (tumors of the kidney). There was no statistically significant trend in the incidence rate of thyroid carcinomas, other and unspecified carcinomas, germ cell tumors, osteosarcomas, Ewing's sarcomas, or neuroblastomas.
    • The increasing trend in the incidence rate of hepatoblastomas was statistically significant after accounting for differences by age, sex, and race/ethnicity.
  • Different types of cancer affect children at different ages. The incidence of neuroblastomas and Wilms' tumor (tumors of the kidney) was highest for young children (ages 0 to 4 years). Leukemias occur in all age groups, but the incidence is highest among 0- to 4-year-olds. The incidence of Hodgkin's and non-Hodgkin's lymphomas, thyroid carcinomas, malignant melanomas, other and unspecified carcinomas, germ cell tumors, and osteosarcomas was higher in those 15 to 19 years old. Differences among age groups were statistically significant for each of these cancer types. (See Tables H5a (PDF). (3pp, 184K, About PDF))

 

About the Childhood Cancer Indicators

Indicators H4 and H5 present information about new childhood cancer cases and deaths caused by childhood cancer. The data are from various cancer tumor registries in specific geographic regions around the country as well as a national database of vital statistics that collects data on numbers and causes of all deaths each year.

  • Indicator H4 presents cancer incidence and mortality for children ages 0 to 19 years from 1992-2009.
  • Indicator H5 presents cancer incidence for children ages 0 to 19 years, by type, in 1992-2006.

Cancer in childhood is rare compared with cancer in adulthood, but still causes more deaths than any factor, other than injuries, among children from infancy to age 15 years. The annual incidence of childhood cancer has increased slightly over the last 30 years; however, mortality has declined significantly for many cancers due largely to improvements in treatment.

The causes of cancer in children are poorly understood, though in general it is thought that different forms of cancer have different causes. According to scientists at the National Cancer Institute, established risk factors for the development of childhood cancer include family history, specific genetic syndromes (such as Down syndrome), high levels of radiation, and certain pharmaceutical agents used in chemotherapy. A number of studies suggest that environmental contaminants may play a role in the development of childhood cancers. The majority of these studies have focused on pesticides and solvents, such as benzene. According to the President’s Cancer Panel, “the true burden of environmentally induced cancer has been grossly underestimated.”

Indicators H4 and H5 present data on childhood cancer incidence and mortality from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program.

More information about childhood cancer and Indicators H4 and H5 is provided in the Childhood Cancer section of America's Children and the Environment, Third Edition (PDF) (17 pp, 983K, About PDF).

Related Links

National Cancer Institute (NCI): Childhood Cancer

National Cancer Institute (NCI): Cancer Incidence and Survival Among Children and Adolescents: United States SEER Program 1975-1995

National Cancer Institute (NCI): Reducing Environmental Cancer Risk - What We Can Do Now

National Cancer Institute (NCI): SEER Cancer Statistics Review

National Institute of Environmental Health Sciences (NIEHS): Cancer for Integrative Research on Childhood Leukemia and the Environment (CIRCLE)


Summary of Methods - Childhood Cancer

The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program collects and publishes data on cancer incidence, survival, and prevalence. SEER obtains its cancer case data from population-based cancer registries that currently cover a total of 17 geographical areas in the United States and one quarter of the population. SEER obtains its cancer mortality data from a national database of vital statistics that collects data on numbers and causes of all deaths each year.

Indicator H4 uses the SEER data to present childhood cancer incidence and mortality for children ages 0 to 19 years. Indicator H5 uses the SEER data to present the number of childhood cancer cases reported for children ages 0 to 19 years, stratified by type. The incidence rate is age-adjusted, meaning that each year's incidence calculation uses the age distribution of children from the year 2000. Some types of childhood cancers are very rare, and as such the yearly incidence is particularly low and variable. Due to this fact, Indicator H5 shows the incidence of individual childhood cancers in groupings of three years.

Detailed Methods for Indicators H4 and H5 (PDF) (20 pp, 266K, About PDF)

Metadata for National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program (PDF) (2 pp, 86K, About PDF)

 

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