Incidence and Mortality of Childhood Cancer in China National Cancer Center of China

Contents 1. Background 2. Purpose 3. Methods 4. Results 5. Conclusions

PART 1 Background

Background Cancer has become the leading cause of death in China. National Cancer Registration and Follow-up Program was launched by the Ministry of Health in 2008. To date, a national cancer surveillance network has been built in China and cancer registration has been carried out in all provinces. National Cancer Center (NCC) is responsible for collecting, evaluating and publishing national cancer statistics of China. In 2015, the national cancer surveillance network has expanded to 501 cancer registries, providing cancer registry data with high quality and national representativeness.

PART 2 Purpose

Purpose To reveal the patterns of childhood cancer in China in 2015 To reveal the trends of childhood cancer in China from 2000 to 2015.

PART 3 Methods

Methods 368 registries submitted cancer registry data with high quality in 2015. All cancer registries covered 387,872,825 populations, accounting for 28.22% of the national population in 2015. Cancer cases were coded according to the International Classification of Diseases for Oncology, 3rd edition (ICD-O-3) and the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10).

Methods NCC assessed the validity, reliability, completeness and comparability of all cancer registry data based on the quality control criteria of “Guideline for Chinese Cancer Registration” by NCC and criteria by International Agency for Research on Cancer/International Association of Cancer Registries (IARC/IACR). A series of indexes were taken into consideration, including the mortality to incidence (M/I) ratio, the percentage of cases morphologically verified (MV), the percentage of death certificate-only cases (DCO), the percentage of the diagnosis of unknown basis (UB) and the stability of cancer trends over years.

Methods Cancer registry data for children between 0-14 years old were extracted. National Bureau of Statistics of the People’s Republic of China provided national population data of 2015 stratified by area (urban/rural) and gender. We estimated the age-specific population of 2015 according to the population structure of the fifth and sixth National Population Census, which provided the whole population data of 2000 and 2010 by age group (0-, 1-4, 5-9,10-14 years). The change of age-specific death probabilities between the two Census data was calculated and the age-specific death probabilities of 2015 were estimated under the assumption of linear interpolation and extrapolation.

Methods Data from 22 registries with successive cancer registry data were used for trend analysis from 2000 to 2015. The age-standardized rates were calculated using the world Segi’s population.

Methods Fgure 1. Map of the 368 contributing cancer registries and geographic regions in China (the dots are locations of the cancer registries)

PART 4 Results

Results Table 1 Incidence of childhood cancer in China, 2015 Area Gender 0~   1~ 5~ 10~14 0~14 No. Rate (1/106) ASIRW All areas All 2186 149.2 7263 125.9 5694 81.2 6166 91.3 21309 101.5 103.2 Boy 1180 150.1 4363 140.9 3468 92.1 3443 94.7 12454 110.4 112.5 Girl 1006 148.2 2900 108.6 2226 68.6 2722 87.2 8855 91.1 92.5 Urban areas 1297 173.5 3977 135.1 2836 79.1 3200 92.3 11310 105.3 107.6 656 165.0 2461 157.2 1646 86.3 1801 97.5 6562 114.8 117.6 641 183.2 1516 110.0 1190 71.0 1400 4747 94.4 96.2 Rural areas 889 123.9 3287 116.4 2858 83.4 2965 90.2 10000 98.7 524 134.8 1902 124.3 1823 98.0 1642 91.9 5892 105.9 107.2 365 111.0 1384 107.0 1036 66.1 1323 88.2 4108 87.6 88.7 In 2015, 21,300 childhood cancer cases were diagnosed, including 12,500 boys and 8,800 girls. The age-standardized incidence rate by world standard population (ASIRW) was 103.2/1,000,000. ASIRW was highest in age group below 1 year old, followed by 1-4, 10-14 and 5-9 age groups. ASIRW was higher for boys than for girls ASIRW: Age-standardized incidence rate by world standard population.

Results Table 2 Incidence of top 5 common cancer types of childhood cancer in China, 2015 No. Boy   Girl Cancer Site CR (1/106) 1 leukemia 5304 47.0 3607 37.1 2 brain tumor 2232 19.8 1389 14.3 3 lymphoma 1052 9.3 bone tumor 527 5.4 4 614 489 5.0 5 kidney cancer 373 3.3 299 3.1 The 5 most common cancer types were leukemia, brain tumor, lymphoma, bone tumor and kidney cancer. CR: crude rate.

Results Incidence rate (1×106) Incidence rate (1×106) Lymphoma and bone tumor became more common as age increased, while leukemia, brain tumor and kidney cancer followed the inverse pattern. years of age years of age A B Figure 1 Incidence rates of top 5 common childhood cancer types in China by gender and age, 2015; (A) Boy; (B) Girl.

Table 3 Mortality of childhood cancer in China, 2015 Results Table 3 Mortality of childhood cancer in China, 2015 Area Gender 0~   1~ 5~ 10~14 0~14 No. Rate (1/106) ASMRW All areas All 888 60.6 2698 46.8 2679 38.2 2516 37.2 8781 41.8 42.3 Boy 454 57.7 1521 49.1 1646 43.7 1365 37.6 4986 44.2 44.7 Girl 434 64.0 1177 44.1 1033 31.8 1151 36.9 3796 39.1 39.6 Urban areas 521 69.8 1447 1402 1324 4693 44.3 232 58.4 827 52.8 826 43.3 685 37.1 2570 44.9 45.6 289 82.7 620 576 34.3 639 39.4 2124 42.2 42.8 Rural areas 367 51.1 1251 1278 37.3 1192 36.3 4088 39.9 40.2 222 56.9 694 45.3 820 680 38.1 2416 43.4 145 557 43.1 458 29.2 512 34.1 1672 35.7 36.1 8,800 childhood cancer deaths were reported in 2015, including 5,000 boys and 3800 girls. The age-standardized mortality rate by world standard population (ASMRW) was 42.3/1,000,000. ASMRW decreased as age increased. ASMRW was higher for boys than for girls ASIRW: Age-standardized mortality rate by world standard population.

Results Table 4 Mortality of top 5 common cancer types of childhood cancer in China, 2015 No. Boy   Girl Cancer Site CR (1/106) 1 leukemia 2026 18.0 1582 16.3 2 brain tumor 1194 10.6 946 9.7 3 lymphoma 396 3.5 bone tumor 224 2.3 4 liver cancer 195 1.7 156 1.6 5 133 1.2 127 1.3 he 5 most common causes of cancer deaths were leukemia, brain tumor, lymphoma, liver cancer and bone tumor. CR: crude rate.

Results Mortality rate (1×106) Mortality rate (1×106) ASMRW for bone tumor increased with age, while ASMRWs for leukemia, brain tumor and liver cancers followed the inverse pattern. ASMRW for lymphoma remained stable across age groups. years of age years of age A B Figure 2 Mortality rates for top 5 common childhood cancer types in China by gender and age, 2015; (A) Boy; (B) Girl.

Results Incidence rate (1×106) Mortality rate (1×106) rates showed fluctuaion trends. A B Figure 3 Incidence and mortality rates for childhood cancer in China from 2000 to 2015; (A) Incidence rates; (B) Mortality rates.

Results Table 5 Changing trend of childhood cancer incidence and mortality in China from 2000 to 2015 Gender Trend1 Trend2 AAPC Years APC (95%CI) 2000-2015 Incidence rate Total 2000-2005 5.9*(1.6~10.3)   2005-2015 -0.1(-1.5~1.3) 1.8*(0.3-3.4) Boy 5.5*(2.6~8.4) 0.3(-0.6~1.3) 2.0*(1.0-3.0) Girl 1.2(-0.2~3.6) — Mortality rate -0.8(-1.8~0.2) -1.1(-2.2~0.1) -0.4(-2.1~1.3) from 2000 to 2015, incidence rate for boys and both sexes increased significantly APC: annual percent change. AAPC: average annual percent change.

Results  Table 6 Changing trend of childhood cancer incidence in China by sex and cancer site from 2000 to 2015 Gender Cancer Site Trend1 Trend2 AAPC Years APC (95%CI) 2000-2015 Total 2000-2005 5.9*(1.6~10.3)   2005-2015 -0.1(-1.5~1.3) 1.8*(0.3-3.4) Boy 5.5*(2.6~8.4) 0.3(-0.6~1.3) 2.0*(1.0-3.0) Leukemia 3.4*(2.4~4.3) — Brain tumor 1.9*(0.5-3.4) Lymphoma -1.7(-3.7~0.4) Liver cancer -0.6(-2.8~1.7) Bone tumor -1.3(-3.8~1.3) Kidney tumor 1.9(-0.8~4.7) Girl 1.2(-0.2~3.6) 2.0*(0.2~3.9) 0.7(-1.8~3.4) -3.1(-6.8~0.7) 3.3(-2.6~9.5) 10.5*(0.9~21.0) -8.6*(-14.7~-2.1) 2.4(-2.7~7.7) 2.1(-0.9~5.2) From 2000 to 2015, incidences for leukemia and brain tumor in boys increased significantly, while incidence for leukemia in girls increased significantly. APC: annual percent change. AAPC: average annual percent change.

Results Table 7 Changing trend of childhood cancer mortality in China by sex and cancer site from 2000 to 2015 ICD-10 Site Years APC (95%CI) Total 2000-2015 -0.8(-1.8~0.2) Boy -1.1(-2.2~0.1)   Leukemia -1.6(-3.5~0.3) Brain tumor 1.7(-0.8-4.3) Lymphoma -7.2*(-11.9~-2.4) Liver cancer -2.3(-5.4~0.8) Bone tumor -5.9(-12.1~0.8) Girl -0.4(-2.1~1.3) -1.5(-4.0~1.1) -0.5(-2.4~1.4) -5.1(-10.4~0.5) Mortality for lymphoma in boys decreased significantly. APC: annual percent change. AAPC: average annual percent change.

PART 5 Conclusions

Conclusions ASIRW for childhood cancer was higher for boys than for girls. ASIRW for childhood cancer was higher in urban areas than in rural areas. Leukemia is the major life threatening cancer for children between 0-14 years old. The uptrends of leukemia and brain tumor incidences suggested urgent needs for further studies and childhood cancer prevention and control plans.

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