Counts, incidence rates, and trends of pediatric cancer in the United States, 2003-2019

Abstract

Background: Cancer is a leading cause of death by disease among children and adolescents in the United States. This study updates cancer incidence rates and trends using the most recent and comprehensive US cancer registry data available.

Methods: We used data from US Cancer Statistics to evaluate counts, age-adjusted incidence rates, and trends among children and adolescents younger than 20 years of age diagnosed with malignant tumors between 2003 and 2019. We calculated the average annual percent change (APC) and APC using joinpoint regression. Rates and trends were stratified by demographic and geographic characteristics and by cancer type.

Results: With 248 749 cases reported between 2003 and 2019, the overall cancer incidence rate was 178.3 per 1 million; incidence rates were highest for leukemia (46.6), central nervous system neoplasms (30.8), and lymphoma (27.3). Rates were highest for males, children 0 to 4 years of age, Non-Hispanic White children and adolescents, those in the Northeast census region, the top 25% of counties by economic status, and metropolitan counties with a population of 1 million people or more. Although the overall incidence rate of pediatric cancer increased 0.5% per year on average between 2003 and 2019, the rate increased between 2003 and 2016 (APC = 1.1%), and then decreased between 2016 and 2019 (APC = -2.1%). Between 2003 and 2019, rates of leukemia, lymphoma, hepatic tumors, bone tumors, and thyroid carcinomas increased, while melanoma rates decreased. Rates of central nervous system neoplasms increased until 2017, and then decreased. Rates of other cancer types remained stable.

Conclusions: Incidence of pediatric cancer increased overall, although increases were limited to certain cancer types. These findings may guide future public health and research priorities.

Figure 1.

Counts and trends of invasive cancer, patients aged 0 to 19years, and AAPC, overall, by sex, and by age—United States, 2003–2019. A) Counts overall and by sex, (B) rates overall and by sex, (C) rates by age, and (D) rates by race and ethnicity. Source: US Cancer Statistics. Rates are per 1 million people. Rates for patients younger than 1year of age, 5–9years of age, 10–14years of age, and 15–19years of age are age specific, and the rates for those aged 0 to 4years and 0 to 19years are age adjusted to the 2000 US standard population (19 age groups—US Census P25–1130). Cases included all malignant cancers. Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003–2019 (covering 99.1% of the US population). Race and ethnicity were classified as Non-Hispanic American Indian or Alaska Native, Non-Hispanic Asian or Pacific Islander, Non-Hispanic Black (Black), Non-Hispanic White (White), and Hispanic or Latino (any race) (Hispanic). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Trends were estimated using joinpoint regression and measured with APC or AAPC and were considered to increase or decrease if P < .05 (2-sided); otherwise, trends were considered stable. *Indicates significant AAPC at P < .05. **Indicates significant APC at P < .05. Nonsignificant APC is not described in text in the figure. In panel A, markers depict observed counts; in panels B, C, and D, markers depict observed rates, and lines represent fitted rates calculated by joinpoint regression. AAPC = average annual percent change; APC = annual percent change.

Figure 2.

Rates of invasive cancer in patients aged 0 to 19years, by ICCC group and age—United States, 2003–2019. Source: US Cancer Statistics. Rates are per 1 million people and age adjusted to the 2000 US standard population (19 age groups—US Census P25–1130). Cases included all malignant cancers. Incidence data are compiled from cancer registries that meet the data quality criteria for all years 2003–2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. CNS = central nervous system; ICCC = International Classification of Childhood Cancer.

Figure 3.

Trends of pediatric cancer incidence by ICCC group and sex for patients aged 0 to 19years—United States, 2003–2019. A) I Leukemia, (B) II Lymphoma, (C) III CNS neoplasms, (D) IV Neuroblastoma, (E) V Retinoblastoma, (F) VI Renal, (G) VII Hepatic, (H) VIII Bone tumors, (I) IX Soft tissue sarcoma, (J) X germ cell, (K) XI(b) Thyroid, and (L) XI(d) Melanoma. Source: US Cancer Statistics. Rates are per 1 million people and age adjusted to the 2000 US standard population (19 age groups—US Census P25–1130). Cases included all malignant cancers. Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003–2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Trends were estimated using joinpoint regression and measured with AAPC; they were considered to increase or decrease if P < .05 (2-sided); otherwise, trends were considered stable. *Indicates significant AAPC at P < .05. Markers depict observed rates, and lines represent fitted rates calculated by joinpoint regression. AAPC = average annual percent change; CNS = central nervous system; ICCC = International Classification of Childhood Cancer.

Figure 4.

Trends of pediatric cancer incidence by ICCC group and race and ethnicity for patients aged 0 to 19years—United States, 2003–2019. A) I Leukemia, (B) II Lymphoma, (C) III CNS neoplasms, (D) IV Neuroblastoma, (E) V Retinoblastoma, (F) VI Renal, (G) VII Hepatic, (H) VIII Bone tumors, (I) IX Soft tissue sarcoma, (J) X germ cell, (K) XI(b) Thyroid, and (L) XI(d) Melanoma. Source: US Cancer Statistics. Rates are per 1 million people and age adjusted to the 2000 US standard population (19 age groups—US Census P25–1130). Cases included all malignant cancers. Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003–2019 (covering 99.1% of the US population). Race and ethnicity were classified as Non-Hispanic American Indian or Alaska Native, Non-Hispanic Asian or Pacific Islander, Non-Hispanic Black (Black), Non-Hispanic White (White), and Hispanic or Latino (any race) (Hispanic). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Markers depict observed rates, and lines represent fitted rates calculated by joinpoint regression. Trends were calculated only if there were 6 or more cases in each calendar year during 2003 to 2019. CNS = central nervous system; ICCC = International Classification of Childhood Cancer.