Decline in US Childhood Cancer Mortality

Miller, Robert W.

doi:10.1001/jama.1984.03340360033025

Cited by 49 publications

(7 citation statements)

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“…Similar analyses conducted on US data [11], for instance, showed a 50% decrease for leukaemias, 32% for non-Hodgkin's lymphoma, 80% for Hodgkin's disease, 50% for bone sarcoma, 68% for kidney cancer and 31% for all other neoplasms. In Britain, the overall fall in childhood cancer mortality approached 30% between 1961 and 1975 [12], and further improvement in survival rates from most can cer sites (with the only exception of fibrosarcoma) was observed for cases registered in the second half of the 1970s [Stiller C.A., unpublished data from the Nation al Cancer Registration Schemes in England, Wales, and Scotland], Survival rates from the Province of Turin [13] (in the Northwest of Italy), where a population-based registry of cancer in children has been in operation since 1965 [14], were similar to those from other West ern countries for leukaemias and lymphomas, but considerably lower for other neoplasms, particularly for those requiring radiotherapy or surgical treatment.…”

Section: Discussionsupporting

confidence: 56%

Decline of Childhood Cancer Mortality in Italy, 1955–1980

Vecchia

Decarli

1988

Oncology

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The decline in childhood cancer mortality in Italy from 1955 to 1980 has been evaluated through (1) comparison of age-specific and age-standardized (0–14 years) rates for the periods 1955–1960 and 1979–1980 and (2) computation of expected numbers of deaths by application of the age-specific rates for the period 1955 1960 to the population structure of subsequent periods. Certified mortality fell by 35% for leukaemias, 90% for Hodgkin’s disease, 30% for non-Hodgkin’s lymphomas, 40% for bone sarcomas, 30% for kidney (Wilms’) tumours, 65% for retinoblastoma. No clear trend was reported for other neoplasms, including neuroblastoma. About 300 cancer deaths per year were avoided in the period 1979–1980 compared with the expected number based on the 1955–1960 rates (170 for leukaemias alone). Although clearly encouraging, these trends are substantially less favourable than those from several other developed countries. It is therefore likely that several dozen other deaths from childhood cancer could be avoided each year through earlier (or more accurate) application of effective therapies, particularly for neoplasms requiring radiotherapy or surgical treatment.

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Section: Discussionsupporting

confidence: 56%

Decline of Childhood Cancer Mortality in Italy, 1955–1980

Vecchia

Decarli

1988

Oncology

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“…The better outlook for children with cancer is reflected in the national mortality data, the death rates from neoplasms in children aged 1-14 years being 84-4, 62 5, and 43-3 per million in 1965, 1975, and 1985 respectively.2" 12 A similar decline in mortality from childhood cancer has recently been reported in the United States. 13 Data on mortality therefore no longer adequately reflect the extent of the problem of cancer in childhood, and high quality data on incidence are required for planning health services.…”

Section: Discussionmentioning

confidence: 99%

Improvements in survival from childhood cancer: results of a population based survey over 30 years

Birch

Marsden²,

Jones³

et al. 1988

BMJ

130

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Survival from cancer of children whose cancer was diagnosed during the 30 years 1954-83 was analysed. The study was population based with nearly 3000 cases covering about 30 million child years at risk. When survival during the three decades 1954-63, 1964-73, and 1974-83 was compared striking improvements were observed. For ali childhood cancer five year survival increased from 21% in the first decade to 49% in the third decade. During the first and third decades five year survival rates for acute lymphocytic leukaemia increased from 2% to 47%, Hodgkin's disease from 44% to 91%, non-Hodgkin's lymphoma from 18% to 45%, Wilms's tumour from 31% to 85%, and germ celi tumours from 10% to 64%. Twenty patients developed second primary tumours, but otherwise there were few late deaths. Less than 1% of children who survived without a relapse for 10 years subsequently died of their initial cancer.

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“…More effective treatment for the primary cancer and prolonged survival over the recent years 12 may have resulted in an increased frequency of brain metastases in the pediatric population. Improvement in neuroimaging techniques may also have led to improved detection and earlier diagnosis of brain metastasis, with greater certainty in both groups.…”

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confidence: 99%

Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center

Suki¹,

Abdulla²,

Ding³

et al. 2014

PED

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Object Metastasis to the brain is frequent in adult cancer patients but rare among children. Advances in primary tumor treatment and the associated prolonged survival are said to have increased the frequency of brain metastasis in children. The authors present a series of cases of brain metastases in children diagnosed with a solid primary cancer, evaluate brain metastasis trends, and describe tumor type, patterns of occurrence, and prognosis. Methods Patients with brain metastases whose primary cancer was diagnosed during childhood were identified in the 1990–2012 Tumor Registry at The University of Texas M.D. Anderson Cancer Center. A review of their hospital records provided demographic data, history, and clinical data, including primary cancer sites, number and location of brain metastases, sites of extracranial metastases, treatments, and outcomes. Results Fifty-four pediatric patients (1.4%) had a brain metastasis from a solid primary tumor. Sarcomas were the most common (54%), followed by melanoma (15%). The patients' median ages at diagnosis of the primary cancer and the brain metastasis were 11.37 years and 15.03 years, respectively. The primary cancer was localized at diagnosis in 48% of patients and disseminated regionally in only 14%. The primary tumor and brain metastasis presented synchronously in 15% of patients, and other extracranial metastases were present when the primary cancer was diagnosed. The remaining patients were diagnosed with brain metastasis after initiation of primary cancer treatment, with a median presentation interval of 17 months after primary cancer diagnosis (range 2–77 months). At the time of diagnosis, the brain metastasis was the first site of systemic metastasis in only 4 (8%) of the 51 patients for whom data were available. Up to 70% of patients had lung metastases when brain metastases were found. Symptoms led to the brain metastasis diagnosis in 65% of cases. Brain metastases were single in 60% of cases and multiple in 35%; 6% had only leptomeningeal disease. The median Kaplan-Meier estimates of survival after diagnoses of primary cancer and brain metastasis were 29 months (95% CI 24–34 months) and 9 months (95% CI 6–11 months), respectively. Untreated patients survived for a median of 0.9 months after brain metastasis diagnosis (95% CI 0.3–1.5 months). Those receiving treatment survived for a median of 8 months after initiation of therapy (95% CI 6–11 months). Conclusions The results of this study challenge the current notion of an increased incidence of brain metastases among children with a solid primary cancer. The earlier diagnosis of the primary cancer, prior to its dissemination to distant sites (especially the brain), and initiation of presumably more effective treatments may support such an observation. However, although the actual number of cases may not be increasing, the prognosis after the diagnosis of a brain metastasis remains poor regardless of the management strategy.

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Decline in US Childhood Cancer Mortality

Cited by 49 publications

References 0 publications

Decline of Childhood Cancer Mortality in Italy, 1955–1980

Decline of Childhood Cancer Mortality in Italy, 1955–1980

Improvements in survival from childhood cancer: results of a population based survey over 30 years

Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center

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