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SEER update of incidence and trends in pediatric malignancies: acute lymphoblastic leukemia
Dawn Elizabeth McNeil1, Timothy R Coté, Limin Clegg
1Division of Cancer Epidemiology and Genetics, Genetic Epidemiology Branch, National Cancer Institute/NIH, EPS Room 7125, 6120 Executive Boulevard, MSC 7236, Rockville, MD 20892-7236, USA. mcneile@mail.nih.gov
Insights
Childhood acute lymphoblastic leukemia (ALL) incidence has risen, with higher rates in White and Hispanic children. Survival rates vary by race, with Black males under 4 years facing the poorest outcomes.
Area of Science:
- Pediatric Oncology
- Epidemiology of Childhood Cancers
- Hematologic Malignancies
Background:
- Acute lymphoblastic leukemia (ALL) is the most frequent childhood cancer.
- Incidence peaks in 2-3 year olds, is more common in White children and boys in the USA.
Purpose of the Study:
- To analyze trends in childhood ALL incidence and survival rates in the USA.
- To identify demographic disparities in ALL occurrence and outcomes.
Main Methods:
- Utilized the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database.
- Reviewed 5,379 cases of ALL in individuals under 20 years of age from 1973 to 1998.
Main Results:
- Overall ALL incidence increased from 1973-1977 to 1993-1998.
- Rates were significantly higher in White compared to Black children, and highest in Hispanic children.
- Five-year survival rates were better for White children than Black children, with the poorest survival among Black males.
Conclusions:
- Childhood ALL incidence has increased over a 25-year period.
- Significant racial and ethnic disparities exist in ALL incidence and survival.
- The poor survival in Black males under 4 may be linked to ALL subtypes, not socioeconomic factors.
Background:
Acute lymphoblastic leukemia (ALL) represents the most common malignancy of childhood. Its incidence peaks in children just before school entry age; i.e., in 2-3 year olds. It is known to be more common in white children in the USA; the incidence is also higher in boys than girls.
Procedure:
We reviewed the 5,379 cases of ALL among persons under 20 years of age in the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database.
Results:
The overall incidence of ALL was 26/10(6) person-years between 1973 and 1998, but increased from 19/10(6) person-years in 1973-77 to 28/10(6) person-years in 1993-98 (P < 0.0001). Rates were 44% higher among Whites compared to Blacks (27/10(6) person-years vs. 15/10(6) person-years, P < 0.0001). In 1992-1998, the incidence rate for Hispanics was 43/10(6) person-years, significantly higher than non-Hispanics (28/10(6), P < 0.0001). White children with ALL had better 5-year survival rates than Black children with ALL (71% vs. 58%, P < 0.0001), and 5-year survival was poorest among black males.
Conclusions:
ALL incidence has increased over the examined 25-year period. The rate in US whites is higher than that of US Blacks, and the rates in the Hispanic subgroup are the highest of all. While the median survival period is now more than 10 years overall, the 5-year survival rate remains poor for Black males under 4 years of age. Socioeconomic factors do not account for this difference, which may relate to ALL subtype distribution.