Pandemic-era increases in late-stage pediatric cancer diagnoses, 2020-2022

COVID-19 pandemic-related disruptions may have altered pediatric cancer detection in the United States. Using the National Childhood Cancer Registry, we compared observed incidence rates among individuals aged 0-17 years during 2020-2022 with expected rates with 95% credible intervals (CrIs) derived from pre-pandemic trends. Rates were evaluated overall and by race/ethnicity, cancer site, and stage-at-diagnosis. Among 27 996 cancers diagnosed in 2020-2022, total incidence was 17.44 per 100 000, similar to the expected rate of 17.39 (95% CrI = 16.80-17.98). Annual patterns showed an incidence reduction in 2020, followed by modestly higher-than-expected rates in 2021-2022. Pandemic-era late-stage incidence was significantly higher than expected, however (10.58 vs 10.19 per 100 000). Overall, pediatric cancer incidence during the COVID-19 pandemic matched expectations, but late-stage diagnoses increased, underscoring the need to restore timely evaluation and maintain diagnostic access during health-system disruptions.