Dec. 20, 2004 Research from 19 European countries in this week's issue of THE LANCET documents how childhood cancer, while still rare, has been slowly increasing over the past 3 decades.
Cancer is rare before age 20 years. Eva Steliarova-Foucher (International Agency for Research on Cancer, Lyon, France) and colleagues used the large European database of childhood and adolescent cancer cases to estimate patterns and trends of incidence and survival within Europe.
The investigators obtained high-quality data from 63 European population-based cancer registries in 19 European countries. Analysis of 113,000 cancers in children and over 18,000 cancers in adolescents during the 1970s, 1980s, and 1990s showed how the incidence rates of cancer increased by around 1% for children and 1.5% for adolescents per year. The incidence rate by the 1990s was 140 per million for children and 157 per million for adolescents.
The increases were recorded for virtually all tumour types in children, while in adolescents the major changes were seen for carcinomas, lymphomas, soft tissue sarcomas, germ-cell and CNS tumours. Simultaneously, , survival of these patients increased substantially over the 3 decades studied, reaching 5-year actuarial survival of 75% for children in western Europe and 64% in eastern Europe; with similar findings for adolescents.
Dr Steliarova-Foucher comments: "Our results are clear evidence of an increase of cancer incidence in childhood and adolescence during the past decades, and of an acceleration of this trend. Geographical and temporal patterns suggest areas for further study into causes of these cancers, as well as provide an indicator of progress of public-health policy in Europe."
In an accompanying commentary (p 2074), Catherine Cole (Princess Margaret Hospital for Children, Perth, Australia) states: "Worldwide, most children with cancer live in developing countries. Despite 80% survival rates in the west, most children with cancer in developing countries will die for lack of medical care. Following the recommendations of the International Society of Paediatric Oncology to concentrate resources in specialised paediatric cancer units, there is an emphasis on assistance and twinning of units in developing (low-income) countries with established units in the west (resource-rich countries). These centres also provide cancer-registry expertise and are contributing to our knowledge of cancer incidence and epidemiology. The existence of the cooperative tumour registries and cooperative treatment groups in paediatric cancer is a credit to two generations of paediatric oncologists. The challenge now is to ensure equity of access to cancer care for all children…Centres of excellence should be developed in low-income countries to train staff. Finally, the group is seeking recognition from WHO and other international agencies, to ensure that the care of children with ALL (and other curable cancers) is deemed essential."
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