Childhood cancer incidence in Zaragoza and Navarre (Spain): 1973-1987

Incidence and Survival Cancer Trends in Children and Adolescents in the Provinces of Florence and Prato (Central Italy), 1985–1997

Aims and background

The incidence of childhood and adolescent cancers has been increasing during the last decades in most Western countries. Improvements in cancer survival rates have also been observed according to the availability of more efficient therapies.

Methods and study design

A total of 518 cancer cases (age, 0–19 years) incident in the period 1985–1997 in the Tuscany Cancer Registry area, corresponding to the Provinces of Florence and Prato (Central Italy), were analyzed. Incidence rates and estimated annual percentage change were computed according to sex, 5-year age groups and diagnostic groups of the International Classification for Childhood Cancer. All patients were actively followed at 31.12.1998, and 5-year survival rates were computed for cases diagnosed in 1985–1990 and 1991–1997.

Results

Overall age-standardized incidence rates were 186.7/106 for males and 175.4 for females. In 1991–1997, standardized incident rates were 50.8 for leukemias, 44.6 for lymphomas, and 34.3 for CNS tumors. There was a marked increasing trend for lymphomas that grew at a yearly rate of +12.1% and less evident increasing tendency for leukemias, CNS tumors and carcinomas. The overall survival rate was 88% at one year, 78% at 3 years, and 74% at 5 years. A slight improving tendency in survival was evident over time.

Conclusions

The study pointed out that in the examined area, during 1985–1997, there was a significant increasing incidence trend for lymphomas. Survival rates were as high as in other Western countries – evidence of the high level of diagnostic and treatment services in the area.

Incidence and survival time trends for Spanish children and adolescents with leukaemia from 1983 to 2007

OBJECTIVE

We have analysed incidence and survival trends of children and adolescents with leukaemia registered in Spanish population-based cancer registries during the period 1983-2007.

METHODS

Childhood and adolescent leukaemia cases were drawn from the 11 Spanish population-based cancer registries. For survival, registries with data for the period 1991-2005 and follow-up until 31-12-2010 were included. Overall incidence trends were evaluated using joinpoint analysis. Observed survival rates were estimated using Kaplan-Meier, and trends were tested using the log-rank test.

RESULTS

Based on 2606 cases (2274 children and 332 adolescents), the overall age-adjusted incidence rate (ASRw) of leukaemia was 47.9 cases per million child-years in children and 23.8 in adolescents. The ASRw of leukaemia increased with an annual percentage change of 9.6 % (95 % CI: 2.2-17.6) until 1990 followed by a stabilisation of rates. In adolescents, incidence did not increase. Five-year survival increased from 66 % in 1991-1995 to 76 % in 2001-2005. By age, survival was dramatically lower in infants (0) and adolescents (15-19) than in the other age groups and no improvement was observed. In both children and adolescents, differences in 5-year survival rates among major subgroups of leukaemias were significant.

CONCLUSIONS

The increasing incidence trends observed in childhood leukaemias during the study period were confined to the beginning of the period. Remarkable improvements in survival have been observed in Spanish children with leukaemias. However, this improvement was not observed in infants and adolescents.

Temporal trends in the incidence rate of childhood cancer in Germany 1987-2004

The German Childhood Cancer Registry regularly presents graphs of childhood cancer incidence rates by period, but no systematic analysis. The Automated Childhood Cancer Information System-project found an increasing trend in Europe. Against this background we present the first detailed trend analysis of childhood (aged under 15) malignancies in Germany. We examined incidence rates separately in western Germany 1987-2004 and eastern Germany 1991-2004. We analyzed all malignancies, all main diagnostic groups and relevant subsets using an age-period-cohort model. Additionally we fitted fractional polynomials to assess the linearity of the drift. All malignancies combined (excluding Central Nervous System-tumors and neuroblastoma) show a significant trend: +0.7% in western and +1.1% per year in eastern Germany. The overall trend in Germany is mostly due to the significant increase in lymphoid leukemia, which increased significantly in western Germany (+0.7% per year) and significantly nonlinearly in eastern Germany (+3.3% per year until 1998, +0.8% since 1998), catching up from a level 20% below western Germany. This could be due to life style changes since the reunification in eastern Germany influencing early immune system training. We found no trends for acute non-lymphocytic leukemia and non-Hodgkin lymphoma. Hodgkin's disease shows a cohort effect in western Germany after reunification. Improved registration of CNS tumors led to an increase. Neuroblastoma yielded a period effect in western Germany due to screening. With the exception of germ cell tumors, further observations for solid tumor entities are in agreement with those reported for Europe.

Cancer incidence in the age range 0–34 years: Historical and actual status in Denmark

On the basis of 55 years of continuous cancer registration in Denmark, we present cancer incidence rates, time trends and birth cohort analyses for persons aged 0-34 years. The group of 40,750 cancer patients showed a substantial over-representation of males aged 1-24 years. The cancer pattern among young (15-34 years) men was dominated by testicular cancer (35%), lymphomas (14%) and tumors of the brain (13%), while the pattern among young women was governed by invasive cervical cancer (19%), malignant melanoma (15%) and cancer of the breast (12%). In this age range, a positive time trend was seen after 1970, equivalent to average annual percentage increases of 1.9% for men and 1.8% for women, due mainly to markedly increasing trends for testicular cancer, malignant melanoma, brain tumors, thyroid cancer, skin carcinomas and skin sarcoma among men, and for brain tumors, non-Hodgkin lymphoma, malignant melanoma, skin carcinomas and thyroid cancer among women. We saw no clear time trend for breast cancer among women. The cancer pattern among children (0-14 years) was similar to that reported for other white populations.

Incidence trends and projections for childhood cancer in Ontario

Studies of cancer incidence patterns and trends can provide useful measures of health burden and possible disease etiology, which can aid the planning of cancer care services. This report aims to characterize trends in incidence of childhood cancer, and to assess the implications of these trends by generating incidence projections to 2015. Cancer incidence data were obtained from the database of the Pediatric Oncology Group of Ontario (POGO), which has registered all cancer cases in Ontario since 1985. Annual incidence rates were calculated with census-based population estimates for the 1986-2001 period. Poisson regression models were used to analyze trends, and to calculate projected numbers of cases up to the year 2015. From 1986 to 2001, 5,163 cancer cases occurred among children aged 0-14. Leukemia, CNS tumors and lymphomas were the most common cancers. The number of incident cases increased by 14%, from 296 in 1986 to 336 in 2001. For all cancers, average annual age-standardized rates increased from 147 per million in 1991 to 157 per million in 2001. Over the next 15 years, the 0-14 year population is expected to decrease from 2.28 million in 2000 to 2.13 million in 2015. A marginally statistically significant trend in incidence was projected for all cancers combined (0.5% increase per year p < 0.10) and a statistically significant increase for lymphomas, (1.2% per year 95% CI = 0.0-3.9%). During this period, the number of cases of leukemia and CNS tumors is expected to remain relatively stable. The number of cases of all cancers is expected to increase by 8%, from the average of 320 in 1995 to approximately 347 in 2015. Understanding of these projections will facilitate health care resource planning.

Mortalidad por cáncer en niños y adolescentes de la Comunidad de Madrid, 1977-2001

INTRODUCTION

In the last few decades mortality from cancer among children and adolescents has not decreased homogeneously in industrialized countries. The aim of this study was to determine the epidemiological pattern and temporal trend of mortality from cancer in individuals aged less than 20 years old living in the Autonomous Community of Madrid from 1977 to 2001.

MATERIAL AND METHODS

Data on deaths from cancer among children and adolescents were obtained from Spain's National Institute of Statistics and from the Mortality Registry of Madrid. Populations were obtained from official publications of the Institute of Statistics of Madrid. Variables analyzed were sex, 5-year age groups, 5-year death periods and underlying cause of death. The epidemiological pattern was studied and a Poisson's regression model was used to analyze cancer mortality trends in children and adolescents from 1977 to 2001.

RESULTS

Cancer mortality among children and adolescents decreased by 41 % from 1977 to 2001. The decrease in mortality differed according to sex (46 % in boys and 33 % in girls) and type of cancer (leukemias: 38 %, non-Hodgkin's lymphomas: 58 %, malignant brain tumors: 45 %, malignant bone tumors: 19 %, ill-defined malignant tumors: 78 %). Moreover, the annual decrease was much greater in the last 5 years (4. 7 %) than during the entire period (2. 2 %).

CONCLUSIONS

Cancer mortality among children and adolescents decreased between 1977 and 2001 and our results are similar to those observed in other European and North American regions. To improve knowledge of the epidemiology of cancer among children and adolescents in the Autonomous Community of Madrid, future assessments including mortality, incidence, and survival indicators are required.

Trends in Childhood Cancer Incidence and Mortality in Catalonia, Spain, 1975–1998

Childhood cancer mortality has sharply declined in most economically developed countries over the last years, whereas no substantial changes in the incidence have been observed. In Catalonia (Spain), childhood cancer mortality showed a considerable decline until 1992, but incidence trends have not been analysed in this population. To assess both recent incidence and mortality trends in this population, we analysed childhood (0-14 years) cancer data from the population-based Tarragona Cancer Registry and from the Mortality Registry of Catalonia (Spain) from 1980 to 1998. All cancer mortality decreased by -2.6% annually in boys (95% confidence interval, 95% CI -3.7, -1.6) and -3.7% in girls (95% CI -4.9, -2.5). Mortality due to leukaemia decreased annually -3.0% in boys (95% CI -4.7, -1.4) and -4.4% in girls (95% CI -6.3, -2.4). Mortality for brain tumours showed a reduction of -3.2% in boys (95% CI -5.5, -0.9) and of -4.4% in girls (95% CI -6.3, -2.4). No significant trend in incidence rates, either in boys or in girls, was observed (annual per cent of change for all cancers -0.5%, 95% CI -3.5, 2.7, in boys and 1.7%, 95% CI -1.9, 5.5, in girls). These results suggest an improvement in both childhood cancer diagnosis and treatment, which may explain current higher childhood cancer survival rates.

[Childhood cancer in the Autonomous Community of Cantabria in Spain (1995-2000)]

BACKGROUND

Since 1980, the epidemiology of childhood cancer in Spain has been registered through the National Registry of Childhood Cancer. However, this registry does not include patients from Autonomous Community of Cantabria because there is no reporting clinical center. The absence of data on childhood cancer in this region justifies this study.

OBJECTIVES

To analyze the clinical presentation, diagnostic delay and incidence of childhood cancer in Cantabria.

METHODS

We performed a retrospective analysis of 89 children (aged 0-15 years) diagnosed with cancer in Cantabria from 1995-2000.

RESULTS

The annual incidence of childhood cancer in the region was 198.1 cases per million inhabitants with a predominance of males (53.9 %) and children aged less than 5 years (46.1 %). The most frequent cancers were leukemia (32.6 %) and brain tumors (23.6 %). The most frequent signs and symptoms were fever (29.2 %) and decreased appetite or fatigue (19.1 %). The mean delay in diagnosis for all tumors was 5.99 weeks and delays were longest for brain tumors. There was a direct statistical relationship between non-specific clinical presentation and diagnostic delay. A total of 20.2 % of all patients received treatment outside Cantabria.

CONCLUSIONS

The incidence of all childhood cancers and especially that of neuroblastoma was higher in Cantabria than in other areas of Spain. In general, the major difficulties in the diagnosis of childhood cancer are its low incidence and non-specific presenting symptoms. Specialized pediatric oncology units near to patients' homes should be created to avoid problems due to treatment outside the area of residence.

[Childhood cancer: a comparative analysis of incidence, mortality, and survival in Goiania (Brazil) and other countries]

Analysis of cancer incidence, mortality, and survival rates can yield geographic and temporal trends that are useful for planning and evaluating health interventions. This article reviews cancer incidence and mortality rates and respective trends around the world in children under 15 years old, as well as their 5-year survival rates in developed and developing countries. We conclude that even though increasing or stable childhood cancer incidence rates and decreasing mortality rates have been observed in developed countries, the trends remain unknown in developing countries. Data from the city of Goiania, Brazil, show stable childhood cancer incidence and mortality rates. Five-year survival rates (48%) in Goiania are similar to those seen in underdeveloped regions and lower than those reported in developed countries (64-70%).

Temporal increases in the incidence of childhood solid tumors seen in Northwest England (1954-1998) are likely to be real

BACKGROUND

There has been speculation that increasing trends in incidence of childhood central nervous system tumors and infant neuroblastoma in the United States have been due to diagnostic improvements or reporting changes. To investigate whether or not such trends could be explained in this way in the U.K., the authors used population-based data from Northwest England to analyze incidence trends in childhood solid tumors.

METHODS

Cases were diagnosed during 1954-1998 and were grouped according to a morphology-based classification scheme. More than 95% of diagnoses were based on special histopathologic review. Tissue sections were retained, and diagnoses were rereviewed to ensure consistency in classification throughout the time period. Age-, gender- and period-specific incidence rates were calculated. Analyses were performed with chi-square tests and Poisson regression.

RESULTS

There was an overall increase in the incidence of all childhood solid tumors of 0.9% each year. A temporal increase was found in childhood brain tumors characterized by, in particular, annual increases of 1% in pilocytic astrocytoma, 1% in primitive neuroectodermal tumors, and 2.3% in miscellaneous gliomas. The incidence of germ cell tumors increased at a rate of 2.6% each year.

CONCLUSIONS

These increases could not be attributed to changes in diagnostic practice, and it is unlikely that the increases were due to changes in reporting practice. Further, the restriction of the increases to certain groups, with stable rates in others, argued against the changes being artifactual. The authors concluded that the increases in incidence were likely to be real.

Lymphoma and lymphoid leukemia incidence in Florida children: ethnic and racial distribution

BACKGROUND

Incidence reports for pediatric lymphoma and lymphoid leukemia in Hispanic subpopulations in the United States are rare. The authors hypothesized that Florida's Hispanic children would have higher risks of lymphoma and lymphoid leukemia compared with non-Hispanic white children.

METHODS

All cases of lymphoid leukemia, Hodgkin, non-Hodgkin, and Burkitt lymphoma (SEER International Classification of Diseases for Oncology codes) in children (< 15 years) in the Florida Cancer Data System (FCDS) from 1985 to 1997 were studied. Cases were classified as: 1) white, 2) Hispanic, or 3) black, and stratified by age. Age-adjusted rates for the three race-ethnic groups were calculated. Rates for Hispanics and blacks were compared with whites as standardized rate ratios (SRR) with 95% confidence intervals.

RESULTS

Seven hundred thirty-one incident cases of pediatric lymphoma and 1231 cases of lymphoid leukemia were identified during the study period. For children with lymphoma, the SRR for Hispanics was 1.32 (95% CI, 1.20-1.44), and for blacks, the SRR was 0.68 (95% CI, 0.63-0.72. For lymphoid leukemia, the SRR for Hispanics was 1.29 (95% CI, 1.28-1.30), and for blacks, the SRR was 0.55 (95% CI, 0.54-0.56). Similar rates were found for the Hodgkin and non-Hodgkin subgroups.

CONCLUSIONS

Incidences of Hodgkin and non-Hodgkin lymphoma were significantly higher in Florida's Hispanic children, with 30% increased relative risks, compared with whites. Black children had significantly decreased incidences and risk. Results for lymphoid leukemia were similar. Incidence of lymphoma in Florida's Hispanic children (primarily Cuban and Central American origin) differed from similar reports from Texas and California, where Hispanics are primarily of Mexican origin.

Brain cancer incidence in the provinces of Zaragoza and Navarre (Spain): effect of age, period and birth cohort

Several studies have detected increases in malignant brain tumour incidence and mortality rates particularly among the elderly. We analyzed time trends in malignant brain tumors incidence in Zaragoza over the period 1973-1990 and Navarre over the period 1973-1991, two Spanish provinces that have been collecting data through their respective Cancer Registries for the last 20 years, using Poisson regression analysis of age, period of diagnosis and cohort. In general, age-adjusted rates showed a steady rise in both registries, except in the case of females in Navarre, for whom a decrease in risk was observed for the last period, 1988-1991. This increase is a reflection of the rise in incidence experienced by the elderly, since the cohorts successively register rates that are stable over time, and even downward in the case of females in Navarre. The risk run by generations born circa 1920-1930 was the highest encountered. Rates were higher in Navarre in both sexes and for all but the last period in females, when rates on the two registers stood level. Increasingly generalised use of CT scanning and magnetic resonance in the 1980s in Spain, coupled with better and more effective health care access for the elderly, are factors that may well have some bearing on these findings.

Malignant brain tumour mortality among children and adolescents: geographical distribution in Spain

Log-linear Poisson mixed models were used to study provincial malignant brain tumour (MBT) mortality among children and adolescents in Spain (1975-1992) in order to investigate the influence of specific socio-economic factors and to produce smoothed estimators of standardised mortality ratios (SMRs). Interdependence between geographical units was taken into account by including provinces as random effect terms nested with the corresponding Autonomous Region (Spain's administrative divisions). MBT mortality showed a positive association with three variables: non-cancer-related infant mortality; percentage of provincial land surface area devoted to agriculture; and industrial/construction activity. According to the final model, SMRs increased by 4% with every 10% rise in the area devoted to agriculture, with a 4% excess risk predicted for every increase in non-cancer-related infant mortality of 1 per 1000 person-years, and a 7% excess risk for contiguous categories of industrial/construction activity. By smoothing extreme values caused by random variability, the regression model yielded a reasonable estimation of SMRs. While infant mortality may be linked to the quality of medical care available, the relationship seen between MBT mortality and agricultural area accords with the excess risk reported for farmers' offspring. Finally, industrial activity might be regarded as a risk factor or as a marker of other conditions also associated with these tumours.