EPA's Report on the Environment: External Review Draft
Childhood Cancer Incidence
Note to reviewers of this draft revised ROE: This indicator reflects data through 2009. EPA anticipates updating this indicator in 2014.
The term “cancer” is used to characterize diseases in which abnormal cells divide without control. A cancerous cell loses its ability to regulate its own growth, control cell division, and communicate with other cells. If left unchecked, cancer cells can invade nearby tissues and can spread through the bloodstream and lymphatic system to other parts of the body (NCI, 2004). The cellular changes caused by cancer cells are complex and occur over a period of time. This may be accelerated in children. The classification of cancers in children differs from the classification used for adult cancers. The International Classification of Childhood Cancer classifies childhood cancer based on tumor morphology rather than, as for adults, the site of the tumor (Stellarova-Foucher et al., 2005).
As stated by NCI (2008), “The causes of childhood cancers are largely unknown. A few conditions, such as Down syndrome, other specific chromosomal and genetic abnormalities, and ionizing radiation exposures, explain a small percentage of cases.” Environmental exposures have long been suspected of increasing the risk of certain childhood cancers. Researchers continue to examine environmental influences on childhood cancer (
This indicator presents incidence rates for childhood cancers from 1973 to 2009 using data collected through the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. The SEER Program collects and publishes cancer incidence and survival data from 18 population-based cancer registries, including state, central, metropolitan, and Alaska Native registries, which cover approximately 28 percent of the U.S. population (NCI, 2011).
What the Data Show
In general, overall childhood (ages 0-19 years) cancer incidence for the U.S. has increased slightly between 1973 and 2009 (Exhibit 1), increasing over time from an age-adjusted incidence rate of 13.8 per 100,000 in 1973 to a high of 17.6 per 100,000 in 2005. In 2009, the age-adjusted incidence rate was 17.3 per 100,000. From 1973 to 2009, males generally had higher childhood cancer incidence rates than females. In 2009, females and males age 0-19 years had overall incidence rates of 16.8 and 17.7 cases per 100,000, respectively. Whites consistently had higher rates than blacks from 1973 to 2009. In 2009, whites and blacks had overall incidence rates of 18.3 and 12.8 cases per 100,000, respectively (Exhibit 1).
Exhibit 2 presents the age-adjusted incidence rates for the top five cancers among children 0-19 years of age in 2009, and shows incidence rate trends for these five cancers between 1973 and 2009. In general, there are no clearly identifiable temporal trends in rates among any of the top five cancers over the reported time period. In 2009, leukemia continued to be the most frequently diagnosed cancer in children age 0-19 years (4.0 cases per 100,000) followed by brain and other nervous system cancers (3.2 cases per 100,000). The incidence rates of Hodgkin’s lymphoma and non-Hodgkin’s lymphoma are very similar, with rates of 1.3 and 1.4 cases per 100,000, respectively (2009). Cancer of the bones and joints was the fifth most common childhood cancer in 2009, with a rate of 1.1 cases per 100,000.
- SEER data cover approximately 28 percent of the U.S. population, though it is designed to be representative of the entire U.S. population.
- Incidence data generated from SEER are updated annually. There may be changes in the numerator (e.g., revised counts of newly identified cases) or denominator (e.g., revised population counts) numbers that result in small changes in the overall incidence rates for the same year, depending on when a query is run within the SEER database. For example, the SEER database queried in 2009 generating incidence rates for the year 2000 may provide different incidence rates than the database queried in 2008 for the year 2000.
Cancer incidence data for this indicator were obtained by querying the National Cancer Institute’s SEER Program database through its Cancer Query System (CanQues) (
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