Recent years, particularly after 2021, show a sustained increase in the incidence of childhood cancers, accompanied by regional differences in diagnostics, therapy, and survival rates.
This LabNews analysis summarizes current epidemiological developments, causes, disease burden, and the resulting challenges based on peer-reviewed studies and official statistics.
Epidemiological Development: Incidence and Prevalence
Annually, approximately 400,000 children and adolescents aged 0 to 19 years worldwide are diagnosed with cancer[4][6][11]. The most common childhood cancers are leukemias, brain tumors, lymphomas, and solid tumors such as neuroblastoma and Wilms' tumor[4][6]. Data from recent decades show a continuous increase in incidence. In the USA, the incidence rose from 14.23 cases per 100,000 children (1975–1979) to 18.89 per 100,000 in the period 2010–2019, corresponding to an average annual increase of 0.73%[1][3][10]. Current analyses from Europe, for example from Germany, also confirm an increase in age-standardized incidence rates by 8–12% depending on the diagnostic group[8].
A current global study on acute lymphoblastic leukemia (ALL), the most common childhood cancer, shows an increase in cases by 59% between 1990 and 2021, reaching 168,879 cases in 2021. The prevalence rate increased from 17.13 to 25.66 per 100,000 children[2]. For neuroblastoma, which accounts for about 8–10% of all pediatric malignancies, an increase in incidence by 30% to 5,560 cases worldwide in 2021 was observed between 1990 and 2021[5].
Mortality and Survival Rates
Despite the rising incidence, mortality from childhood cancers is declining in many regions. Age-adjusted cancer mortality decreased in the USA from 4.9 per 100,000 (1975–1979) to 2.3 per 100,000 (2010–2019)[3]. For ALL, global mortality decreased by 66.7% between 1990 and 2021 to 6,294 deaths annually[2]. The number of disability-adjusted life years (DALYs) lost due to cancer also decreased by 66% in the same period[2].
Survival rates show significant differences depending on the region and tumor type. In high-income countries, more than 80% of children with cancer are cured today, while in low- and middle-income countries (LMICs), less than 30% achieve a cure[4][11]. The 5-year survival rate for leukemias increased in the USA from 48.2% (1975–1979) to 85.1% (2010–2019)[3]. For lymphomas, an improvement from 72.9% to 94.2% was observed[3]. In contrast, survival rates for central nervous system tumors, bone tumors, and sarcomas remain significantly lower at around 60%[3].
The WHO estimates that in 2022, more than 275,000 children and adolescents worldwide were newly diagnosed with cancer, and over 105,000 died from the disease. Actual numbers are likely higher due to underdiagnosis in low-resource countries[6].
Causes for the increase in incidence
The reasons for the observed increase in childhood cancer incidence are multifactorial:
- Improved diagnostics and registration: Advances in medical imaging, molecular diagnostics, and the expansion of cancer registries lead to better case detection, especially in countries with previously limited diagnostics[2][3][10].
- Increasing environmental pollution: There is evidence that environmental factors such as air pollution, radiation exposure, and chemicals may increase the risk of cancer in children, although the exact mechanisms are not yet fully understood[10].
- Socioeconomic development: With increasing prosperity and better access to healthcare systems, more cases are identified and treated, influencing incidence statistics[2].
- Changes in lifestyle and demographic shifts: Changes in family planning, older parental age, and other demographic factors may also play a role[10].
Regional differences and global disparities
The development of incidence and mortality varies greatly worldwide. While high-income countries benefit from improved survival rates, the prognosis in LMICs remains poor[4][11]. The causes for this are:
- Lack of or delayed diagnosis
- Limited access to oncological care and medication (only 29% of low-income countries report general availability of cancer drugs, compared to 96% in high-income countries)[4]
- Treatment interruptions and deaths due to treatment toxicity or relapse
In countries like India, which led the world with 685 neuroblastoma cases in 2021, the challenges are particularly great[5]. The WHO initiative 'Global Initiative for Childhood Cancer' aims for a global survival rate of at least 60% by 2030, particularly through the expansion of cancer registries and the improvement of care in low-resource regions[6][11].
Disease burden and long-term consequences
In addition to mortality and incidence, the burden of disease caused by cancer (DALYs) is an important indicator. For ALL, the global DALY rate decreased from 269.96 to 86.13 per 100,000 children between 1990 and 2021[2]. Nevertheless, the burden remains high in countries with a low socioeconomic index, as progress in diagnostics and therapy is slower in these regions[2][5].
Long-term survivors of childhood cancer often face late effects, including secondary tumors, cardiovascular diseases, endocrine disorders, and psychosocial problems. The growing number of survivors presents global health systems with new challenges in follow-up care and rehabilitation.
Developments after 2021: Current Trends and Challenges
The latest available data up to 2021/2022 show that the trend of increasing incidence rates continues[2][3][5][10]. In the US, cancer incidence in children and adolescents increased annually by 0.8–1.3% between 2008 and 2018[10]. Increasing case numbers are also reported in other regions, such as Europe and Asia[8][5]. At the same time, mortality rates continue to decline in many countries, which is attributed to advances in diagnostics, therapy, and supportive care[2][3][7].
However, there are indications of a slowdown in mortality improvement in adolescents compared to younger children, particularly for certain tumor types such as ALL, non-Hodgkin lymphoma, and brain tumors[10]. This is attributed, among other factors, to differences in tumor biology, treatment protocols, and access to innovative therapies.
Outlook and Recommendations
The increasing number of childhood cancer cases worldwide requires a coordinated global response:
- Strengthening Cancer Registries: Improved data collection is essential for early detection of trends and enabling targeted interventions[6][11].
- Early Detection and Access to Therapy: Expanding diagnostic and therapeutic services, especially in LMICs, is crucial to increase survival rates and reduce the disease burden[2][4][11].
- Research on Causes and Prevention: There is a significant need for research into the causes of the increase, particularly concerning environmental factors and genetic predispositions[10].
- Long-term Follow-up: Care for long-term survivors must be improved to detect and treat late effects early.
Summary
The global increase in childhood cancer cases after 2021 is a complex, multifactorial phenomenon. While incidence rates continue to rise, particularly for leukemias and solid tumors such as neuroblastoma, mortality rates are significantly declining in many regions due to medical advances. However, considerable regional disparities exist, especially between high-income countries and LMICs, concerning survival chances and disease burden. The causes for the increase are diverse, ranging from improved diagnostics and environmental factors to socioeconomic developments. Sustainable improvement of the situation requires global efforts in early detection, therapy, research, and follow-up care[2][3][4][5][6][10][11].
Quellen:
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