Health - Childhood Cancer

More ACE Indicators

Cancer in childhood is rare compared with cancer in adulthood, but still causes more deaths than any factor, other than injuries, among children ages 0 to 15 years.

On this page: 

Indicators

Cancer incidence and mortality for children ages 0 to 19 years, 1992-2018 (Indicator H4)

Web update: 2022

Click to open in new window | Tips for selecting and filtering data (pdf) (455.91 KB)  | Download in Excel

Data Tables for this Topic

Data characterization

  • Cancer incidence data for this indicator are obtained from a database of 13 regional tumor registries located throughout the United States, maintained by the National Cancer Institute.
  • The population covered by the 13 registries is comparable to the general U.S. population regarding poverty and education, but is more urban and has more foreign-born persons.
  • Cancer mortality data for this indicator are obtained from a database of all death certificates in the United States; cause of death is recorded on the death certificates.
  • The age-adjusted annual incidence of cancer ranged from 154 to 161 cases per million children between 1992 and 1994 and from 186 to 193 cases per million children between 2016 and 2018.
    • This increasing trend from 1992-2018 was statistically significant.
  • Childhood cancer mortality decreased from 33 deaths per million children ages 0 to 19 years in 1992 to 22 deaths per million children ages 0 to 19 years in 2018, a statistically significant decreasing trend.
  • Childhood cancer incidence and mortality rates were generally higher for boys than for girls. In 2016-2018, rates of cancer incidence and mortality for boys were 199 cases per million and 25 deaths per million, compared with 177 cases per million and 20 deaths per million for girls.
    • Differences by sex were statistically significant for cancer incidence and cancer mortality. (See Tables H4a and H4b.)
  • In 2016-2018, cancer incidence rates were consistently higher for boys than girls in each race/ethnicity group. The difference was statistically significant for White non-Hispanic children, Black non-Hispanic children, and Hispanic children (after adjustment for age). The differences were not statistically significant for other race/ethnicity groups. (See Table H4a.)
  • In 2016-2018, cancer mortality rates were consistently higher for boys than girls in each race/ethnicity group. The difference was statistically significant for each race/ethnicity group (after adjustment for age). (See Table H4b.)
  • In 2016-2018, childhood cancer incidence rates were highest among White non-Hispanic children ages 0 to 19 years at 200 cases per million. American Indian or Alaskan Native non-Hispanic children had an incidence rate of 176 cases per million, Asian and Pacific Islander (API) non-Hispanic children had an incidence rate of 174 cases per million, Hispanic children had an incidence rate of 181 cases per million, and Black non-Hispanic children had an incidence rate of 151 cases per million (See Table H4a.)
    • The cancer incidence rate for White non-Hispanic children was statistically significantly higher than the rates of Black non-Hispanic, API non-Hispanic, and Hispanic children after accounting for differences by age and sex. The cancer incidence rate for Black non-Hispanic children was statistically significantly lower than the rates of API non-Hispanic and Hispanic children after accounting for differences by age and sex. The remaining differences between race/ethnicity groups were not statistically significant.
  • Childhood cancer incidence rates vary by age. In 2016-2018, children under 5 years and those ages 15 to 19 years experienced the highest incidence rates of cancer at approximately 231 and 241 cases per million, respectively. Children ages 5 to 9 years and 10 to 14 years had lower incidence rates at 127 and 158 cases per million, respectively.
    • These differences among age groups were statistically significant. (See Table H4c.)

Cancer incidence for children ages 0 to 19 years, by type, 1997-2018 (Indicator H5)

Web update: 2022

Click to open in new window | Tips for selecting and filtering data (pdf) (455.91 KB)  | Download in Excel

Data Tables for this Topic

Data characterization

  • Data for this indicator are obtained from a database of 13 regional tumor registries located throughout the country, maintained by the National Cancer Institute.
  • The population covered by the 13 registries is comparable to the general U.S. population regarding poverty and education, but is more urban and has more foreign-born persons.
  • Leukemia, which includes acute lymphoblastic leukemia and acute myeloid leukemia, was the most common cancer diagnosis for children ages 0 to 19 years from 2017-2018, representing 30% of total cancer cases. Incidence of acute lymphoblastic (lymphocytic) leukemia was 30 cases per million in 1993-1994 and 35 cases per million in 2017-2018. The rate of acute myeloid (myelogenous) leukemia was 7.2 cases per million in 1993-1994 and 9.3 cases per million in 2017-2018.
    • The increasing trend for incidence of acute lymphoblastic leukemia was statistically significant after accounting for differences by age, sex, and race/ethnicity. The trend for acute myeloid leukemia was not statistically significant.
  • Central nervous system tumors represented 19% of childhood cancers in 2017-2018. The incidence of central nervous system tumors was 28.3 cases per million in 1993-1994 and 28.4 cases per million in 2017-2018 and ranged from 26.0 to 32.4 cases per million.
  • Lymphomas, which include Hodgkin's lymphoma and non-Hodgkin's lymphoma, represented 15% of childhood cancers in 2017-2018. Incidence of Hodgkin's lymphoma was 12.0 cases per million in 1993-1994 and 11.8 cases per million in 2017-2018. There were approximately 7.6 cases of non-Hodgkin's lymphoma per million children ages 0 to 19 years in 1993-1994 and 10.3 cases per million in 2017-2018.
    • The increasing trend in the incidence rate of non-Hodgkin's lymphoma was statistically significant after accounting for differences in age, sex, and race/ethnicity. There was no statistically significant trend in the incidence rates of Hodgkin’s lymphoma.
  • Between 1993 and 2018, decreasing trends in the incidence of neuroblastoma and of other and unspecified carcinomas were statistically significant. For Ewing’s sarcoma there was a statistically significant increasing trend, but the trend was not consistent. There were no other statistically significant trends.  
  • Different types of cancer affect children at different ages. The incidence of neuroblastomas and Wilms' tumor was highest for young children (ages 0 to 4 years). Leukemias occur in all age groups, but the incidence is highest among 0- to 4-year-olds. The incidence of Hodgkin's and non-Hodgkin's lymphomas, thyroid carcinoma, soft tissue sarcomas, other and unspecified carcinomas, and Ewing’s sarcoma was higher in those 15 to 19 years old. Differences among age groups were statistically significant for neuroblastomas, Wilms’ tumor, leukemias, and Hodgkin’s lymphoma. (See Table H5a.)

About the Childhood Cancer Indicators

Indicators H4 and H5 present information about new childhood cancer cases and deaths caused by childhood cancer. The data are from various cancer tumor registries in specific geographic regions around the United States as well as a national database of vital statistics that collects data on numbers and causes of all deaths each year.

Cancer in childhood is rare compared with cancer in adulthood, but still causes more deaths than any factor, other than injuries, among children ages 0 to 15 years. The annual incidence of childhood cancer has increased slightly over the last 30 years; however, mortality has declined significantly for many cancers due largely to improvements in treatment.

The causes of cancer in children are poorly understood, though in general it is thought that different forms of cancer have different causes. According to scientists at the National Cancer Institute, established risk factors for the development of childhood cancer include family history, specific genetic syndromes (such as Down syndrome), high levels of radiation, and certain pharmaceutical agents used in chemotherapy. A number of studies suggest that environmental contaminants may play a role in the development of childhood cancers. The majority of these studies have focused on pesticides and solvents, such as benzene. According to the President’s Cancer Panel, “the true burden of environmentally induced cancer has been grossly underestimated.”

Indicators H4 and H5 present data on childhood cancer incidence and mortality from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program.

More information about childhood cancer and Indicators H4 and H5 is provided in the Childhood Cancer section of America's Children and the Environment, Third Edition (pdf) (1.07 MB) .

Methods - Childhood Cancer

The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program collects and publishes data on cancer incidence, survival, and prevalence. SEER obtains its cancer case data from population-based cancer registries that currently cover a total of 17 geographical areas in the United States and one quarter of the population. SEER obtains its cancer mortality data from a national database of vital statistics that collects data on numbers and causes of all deaths each year.

Indicator H4 uses the SEER data to present childhood cancer incidence and mortality for children ages 0 to 19 years. Indicator H5 uses the SEER data to present the number of childhood cancer cases reported for children ages 0 to 19 years, stratified by type. The incidence rate is age-adjusted, meaning that each year's incidence calculation uses the age distribution of children from the year 2000. Some types of childhood cancers are very rare, and as such the yearly incidence is particularly low and variable. Due to this fact, Indicator H5 shows the incidence of individual childhood cancers in groupings of four years.

Related Links

Contact Us to ask a question, provide feedback, or report a problem.
Last updated on July 15, 2024