Geographic Variation in Pediatric Cancer Incidence - United States, 2003-2014

Abstract

Approximately 15,000 persons aged <20 years receive a cancer diagnosis each year in the United States (1). National surveillance data could provide understanding of geographic variation in occurrence of new cases to guide public health planning and investigation (2,3). Past research on pediatric cancer incidence described differences by U.S. Census region but did not provide state-level estimates (4). To adequately describe geographic variation in cancer incidence among persons aged <20 years in the United States, CDC analyzed data from United States Cancer Statistics (USCS) during 2003-2014 and identified 171,432 cases of pediatric cancer during this period (incidence = 173.7 cases per 1 million persons). The cancer types with the highest incidence rates were leukemias (45.7), brain tumors (30.9), and lymphomas (26.2). By U.S. Census region, pediatric cancer incidence was highest in the Northeast (188.0) and lowest in the South (168.0), whereas by state (including the District of Columbia [DC]), rates were highest in New Hampshire, DC, and New Jersey. Among non-Hispanic whites (whites) and non-Hispanic blacks (blacks), pediatric cancer incidence was highest in the Northeast, and the highest rates among Hispanics were in the South. The highest rates of leukemia were in the West, and the highest rates of lymphoma and brain tumors were in the Northeast. State-based differences in pediatric cancer incidence could guide interventions related to accessing care (e.g., in states with large distances to pediatric oncology centers), clinical trial enrollment, and state or regional studies designed to further explore variations in cancer incidence.

FIGURE

Age-adjusted incidence of cancer among persons aged <20 years, by U.S. state and ICCC type — United States, 2003–2014 Sources: CDC’s National Program of Cancer Registries; National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Abbreviation: ICCC = International Classification of Childhood Cancer. * Rates are per 1 million persons and age-adjusted to the 2000 U.S. standard population. ^† Cases included all malignant cancers (with behavior code = 3) as grouped by the ICCC. ^§ Solid tumors (Groups IV–XI) include neuroblastoma and other peripheral nervous cell tumors, retinoblastoma, renal tumors, hepatic tumors, malignant bone tumors, soft tissue and other extraosseous sarcomas, germ cell and trophoblastic tumors and neoplasms of gonads, and other malignant epithelial neoplasms and melanomas. The ICCC group total map includes 258 cases not classified by ICCC. ^¶ Incidence data are compiled from cancer registries that meet the data quality criteria for all years 2003–2014 (covering >99% of the U.S. population). Nevada is excluded. Registry-specific data quality information is available at https://www.cdc.gov/cancer/npcr/uscs/pdf/uscs-2014-technical-notes.pdf.