Childhood cancer incidence and survival trends in Estonia (1970–2016): a nationwide population-based study

Abstract

Background: Childhood cancers represent a small proportion of all cancers but are still a major public health problem. The study analysed long-term trends in childhood cancer incidence and survival in Estonia in relation to societal and health care transition. Methods: Data on all malignant tumours, diagnosed in children aged 0-14 during 1970-2016, were derived from the Estonian Cancer Registry. Age-standardised (World standard) incidence rates were calculated by ICCC-3 site groups and joinpoint regression was used to estimate annual percentage change (APC) for incidence trends. Cohort and period approach were used to estimate 5-year survival. Internal age standardisation was applied. Results: A total of 1628 incident cancer cases were diagnosed during the study period and overall incidence increased significantly at a rate of 0.5% per year. Significant increases were seen for neuroblastoma and germ cell tumours, for lymphoid leukemias and some CNS sub-sites. At the same time, decline in incidence was seen in almost all subgroups of unspecified neoplasms. The overall 5-year survival improved from 24% in 1970-1979 to 73% in 2010-2016, with the largest changes occurring in the 1990s and 2000s. For many sites, survival increase thereafter has been marginal. Conclusion: In this first comprehensive population-based study of childhood cancer incidence and survival in Estonia, long-term trends are shown in the context of societal and health care changes. Even though the increasing incidence of some sites may, at least partially, be explained by improved diagnostics reflected in the decreased incidence of unspecified neoplasms, the overall cancer incidence in children seems to be rising. Rapid progress in diagnosis and care have improved childhood cancer survival immensely, but deficit in Estonia persists compared to other European countries. Results of the study accentuate the need for a more in-depth analysis of clinical data, but also for the prioritization of childhood cancer in Estonia, to ensure access to standard care and innovative treatments.

Pattern and Outcome of Childhood Cancer in Rivers State University Teaching Hospital

“…Burkitt's lymphoma was also the commonest type of lymphoma in Uyo [12] southern Nigeria, Kano [7] northern Nigeria and Ghana. [23] Contrary to the present study however, Non-Hodgkin's lymphoma was the commonest type of lymphoma in Ibadan [14] and Lagos, [15] western Nigeria whereas in Estonia, [17] Europe Hodgkin's lymphoma was the commonest type followed by Non-Hodgkin's lymphoma and Burkitt's lymphoma. These variations could also be as a result of ethnic and geographic variations and different levels of exposures to environmental toxins.…”

“…Males predominated in the present study with a M: F ratio of 3:1. Similar male predominance was documented in all other studies [7][8][9][10][12][13][14][15][16][17][18][19][20].…”

“…Acute lymphoblastic leukaemia (ALL) was the commonest type of leukaemia followed by acute myeloid leukaemia in the present study. This pattern was also observed in Zaria, [9] northern Nigeria, Lagos, [15] western Nigeria, Estonia, [17] Iran [18] and Namibia [22].…”

“…It was however much lower than the 23%, 25% and 51.3% reported by Schroeder et al, [25] Akinsete et al [15] and Ibrahim et al [7] in Tanzania, Lagos, western Nigeria and Kano, northern Nigeria respectively. Interestingly, the survival rate in Estonia [17] Europe was observed to increase from 23.8%…”

“…In India, [21] Leukaemia was also documented as the commonest malignancy followed by Lymphoma. Leukaemia being the commonest malignancy was also reported in Lagos [15] western Nigeria, Estonia, [17] United Kingdom, [20] Iran [18] and Namibia. [22] An earlier study in Port Harcourt [13] Nigeria however documented nephroblastoma as the commonest cancer implicated as also observed in Ethiopia.…”