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U.S. childhood cancer survival, 1973-1987
1Genetic Epidemiology Branch, National Cancer Institute, Bethesda, Maryland.
Insights
Pediatric cancer survival rates improved significantly between 1973-1987, especially for hematopoietic tumors like acute lymphocytic leukemia (ALL). However, survival rates for some childhood cancers have plateaued since the late 1970s, requiring further investigation.
Area of Science:
- Pediatric Oncology
- Cancer Epidemiology
- Survival Analysis
Background:
- Childhood cancer survival rates have historically varied, with significant disparities based on tumor type, sex, and race.
- Population-based data are crucial for assessing the real-world impact of treatment advancements on pediatric cancer outcomes.
Purpose of the Study:
- To analyze trends in 5-year relative survival rates for common pediatric tumors using Surveillance, Epidemiology, and End-Results (SEER) data from 1973-1987.
- To identify specific pediatric cancer types with the greatest survival improvements and investigate factors influencing these trends.
Main Methods:
- Utilized SEER data covering 1973-1987 for pediatric tumors (ages 0-14).
- Analyzed 5-year relative survival rates, stratifying by tumor type, sex, race, and stage at diagnosis.
- Compared survival trends across different time periods (1973-1977, 1983-1987, and 1978-1982).
Main Results:
- Significant survival increases observed for hematopoietic tumors, including acute lymphocytic leukemia (ALL) and Burkitt's lymphoma.
- Solid tumors demonstrated a steady, albeit less steep, increase in survival rates.
- A plateau in survival rates was noted for acute leukemia, astrocytoma, medulloblastoma, and osteosarcoma starting from the 1978-1982 period.
- Females generally had better survival rates, except for Hodgkin's disease.
- Black children with leukemia exhibited lower survival rates compared to white children.
- Earlier diagnosis stage did not correlate with improved survival for solid tumors.
Conclusions:
- While substantial progress has been made in pediatric cancer survival, particularly for leukemias and lymphomas, recent trends indicate a concerning flattening for several tumor types.
- Disparities in survival based on race and sex persist, highlighting the need for targeted interventions.
- Further research and follow-up are warranted to understand and address the observed plateau in survival rates for specific pediatric cancers.
Abstract:
The surveillance, epidemiology, and end-results (SEER) data on 5-year relative survival rates (1973-1987) for the most common pediatric tumors (ages 0-14) were analyzed. The SEER data are population based, so the observed progress in survival from childhood cancer represents the real impact that development in cancer treatment had on the population followed by the registry. The greatest increase in survival rate from 1973 until 1987 has been achieved in hematopoietic tumors such as acute lymphocytic leukemia (ALL), in which survival increased from 47.6% (1973-1977) to 60.8% (1983-1987), and Burkitt's lymphoma in which survival increased from 27.6% (1973-1977) to 68.7% (1983-1987). Solid tumors showed a less steep, but steady increase in survival rates. Flattening in the survival rates since 1978-1982 has been observed for acute leukemia, astrocytoma, medulloblastoma, and osteosarcoma. Females have better survival rates for most pediatric tumors, except Hodgkin's disease. Analysis of race of childhood leukemia confirmed that black children have worse survival than white. When solid tumors were analyzed by stage at presentation, there was no indication that diagnosis in earlier stages of disease accounted for the improved survival. Observed flattening in the survival rates since 1978-1982 of leukemia and some solid tumors warrants further follow-up.