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

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

3. PART 1
Background

4. 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.

5. PART 2
Purpose

6. 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.

7. PART 3
Methods

8. 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).

9. 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.

10. 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.

11. 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.

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

13. PART 4
Results

14. 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, and 5-9 age groups. ASIRW was higher for boys than for girls
ASIRW: Age-standardized incidence rate by world standard population.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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)
Incidence rate
Total
5.9*(1.6~10.3)
-0.1(-1.5~1.3)
1.8*( )
Boy
5.5*(2.6~8.4)
0.3(-0.6~1.3)
2.0*( )
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.

22. 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)
Total
5.9*(1.6~10.3)
-0.1(-1.5~1.3)
1.8*( )
Boy
5.5*(2.6~8.4)
0.3(-0.6~1.3)
2.0*( )
Leukemia
3.4*(2.4~4.3) —
Brain tumor
1.9*( )
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.

23. 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
-0.8(-1.8~0.2)
Boy
-1.1(-2.2~0.1)
Leukemia
-1.6(-3.5~0.3)
Brain tumor
1.7( )
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.

24. PART 5
Conclusions

25. 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.

26. Thank You!