Elsevier

The Lancet

Volume 364, Issue 9451, 11–17 December 2004, Pages 2097-2105
The Lancet

Articles
Geographical patterns and time trends of cancer incidence and survival among children and adolescents in Europe since the 1970s (the ACCIS project): an epidemiological study

https://doi.org/10.1016/S0140-6736(04)17550-8Get rights and content

Summary

Background

Cancer is rare before age 20 years. We aimed to use the European database of childhood and adolescent cancer cases, within the Automated Childhood Cancer Information System project, to estimate patterns and trends of incidence and survival within Europe.

Methods

Comparable, high-quality data from 63 European population-based cancer registries consisted of 113000 tumours in children and 18 243 in adolescents diagnosed in 1970–99. Incidence rates and survival were compared by region (east vs west), period, and malignant disease.

Findings

In the 1990s, age-standardised incidence rates were 140 per million for children (0–14 years) and 157 per million for ages 0–19 years. Over the three decades, overall incidence increased by 1·0% per year (p<0·0001) in children (increases for most tumour types), and by 1·5% (p<0·0001) in adolescents (15–19 years; notable increases were recorded for carcinomas, lymphomas, and germ-cell tumours). Overall 5-year survival for children in the 1990s was 64% in the east and 75% in the west, with differences between regions for virtually all tumour groups; 5-year survival was much the same in adolescents. Survival has improved dramatically since the 1970s in children and adolescents, more so in the west than in the east.

Interpretation

Our results are clear evidence of an increase of cancer incidence in childhood and adolescence during the past decades, and of an acceleration of this trend. Geographical and temporal patterns suggest areas for further study into causes of these neoplasms, as well as providing an indicator of progress of public-health policy in Europe.

Introduction

In European populations, about 1% of all malignant neoplasms arise in patients younger than 20 years.1 This low frequency represents a major difficulty for studies of putative risk factors and clinical management, and is further accentuated by the many childhood tumour types that are uncommon in adults.

The Automated Childhood Cancer Information System (ACCIS) is a European Union funded project aiming at collection, presentation, and interpretation of data for cancer incidence and survival in children (aged 0–14 years) and adolescents (aged 15–19 years) in Europe. The ACCIS database contains data from 80 population-based cancer registries that cover about half the population aged 0–14 years and about a quarter aged 15–19 years living in the 35 participating countries.1 It covers 1·3 billion person-years, giving rise to over 160000 cases of childhood and adolescent cancer diagnosed from 1970 to 2001.

ACCIS provides a unique source of information for studies of causes of childhood cancer as well as for public-health purposes, by monitoring the patterns and trends of incidence and population-based survival in children and adolescents. We aimed to systematically analyse the ACCIS database with respect to aetiological research and public-health importance.

Section snippets

Procedures

Information was extracted from the ACCIS database about all malignant neoplasms, together with non-malignant tumours of the CNS, that were registered since the 1970s in patients younger than 20 years. A standard set of variables included basic demographic data (age, sex, and country or region of residence), information on the tumour (date of incidence, site, morphology, basis of diagnosis, grade, and laterality) and on follow-up (date of last contact and vital status). The underlying

Results

The overall average annual ASR for cancer in children in Europe in the 1990s was 140 per million, based on 48847 cases. The ASR for the age-range 0–19 years was 157 per million, and the age-specific rate for adolescents was 193 per million (n=7109). In children, the overall cancer incidence in the east (ASR 143 per million, n=7650) was slightly higher than that in the west (ASR 140 per million, n=41197); the IRR adjusted for age and sex was 1·05, (95% CI 1·03–1·08, p<0·0001). In adolescents,

Discussion

Our data provide strong evidence for an increase in incidence rates over time for virtually all neoplasms, continued improvement in survival, and a difference in survival between eastern and western Europe in children and adolescents. The registries in this study are members of European Network of Cancer Registries, and adhere to international standards of data collection and coding.12 Data were subjected to uniform checks, expert assessment, and centralised analysis. These safeguards, in

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