Cancer surveillance series: Recent trends in childhood cancer incidence and mortality in the United States

Background: Public concern about possible increases in childhood cancer inc idence in the United States led us to examine recent incidence and mortalit y patterns. Methods: Cancers diagnosed in 14540 children under age 15 years from 1975 through 1995 and reported to nine population-based registries in the National Cancer Institute's Surveillance, Epidemiology, and End Result s Program mere investigated. Age-adjusted incidence was analyzed according to anatomic site and histologic categories of the International Classificat ion of Childhood Cancer. Age-adjusted U.S, mortality rates were calculated. Trends in rates were evaluated by use of standard regression methods. Resu lts: A modest rise in the incidence of leukemia, the most common childhood cancer, was largely due to an abrupt increase from 1983 to 1984; rates have decreased slightly since 1989, For brain and other central nervous system (CNS) cancers, incidence rose modestly, although statistically significantl y (two-sided P = .020), largely from 1983 through 1986, A few rare childhoo d cancers demonstrated upward trends (e.g., the 40% of skin cancers designa ted as dermatofibrosarcomas, adrenal neuroblastomas, and retinoblastomas, t he latter two in infants only), In contrast, incidence decreased modestly b ut statistically significantly for Hodgkin's disease (two-sided P = .037). Mortality rates declined steadily for all major childhood cancer categories , although less rapidly for brain/CNS cancers. Conclusions: There was no su bstantial change in incidence for the major pediatric cancers, and rates ha ve remained relatively stable since the mid-1980s, The modest increases tha t were observed for brain/CNS cancers, leukemia, and infant neuroblastoma w ere confined to the mid-1980s, The patterns suggest that the increases like ly reflected diagnostic improvements or reporting changes. Dramatic decline s in childhood cancer mortality represent treatment-related improvements in survival.