Spina bifida has been reported to co-occur with pediatric cancer, but comprehensive evaluations remained elusive. We investigated this cooccurrence in two large, population-based studies in Taiwan (N=1900 cancer cases, 2,077,137 controls) and Denmark (N=5508 cases, 137,700 controls). Analyses in Denmark were restricted to the period before prenatal diagnostics became available ( 2004) and pregnancy terminations of fetuses with birth defects became more common. Using national patient and cancer registries, we linked spina bifida and cancer diagnoses among cases and non-cases. The risk of spina bifida among all cancer cases was increased and similar in Denmark [odds ratio (OR)=8.4, 95% confidence interval (CI) 5.1-13.8] and Taiwan (OR=8.5, 95% CI 4.0-17.8), particularly for central nervous system (CNS) tumors (Denmark: OR=16.3, 95% CI 8.1-33.0; Taiwan: OR=26.6, 95% CI 8.5, 83.1), including benign CNS tumors (Denmark: OR=41.5, 95% CI 21.2, 81.4). These findings suggest the need for comprehensive investigation of shared risk factors in the link between spina bifida and pediatric cancer.