Childhood cancer incidence in Canada: demographic and geographic variation of temporal trends (1992–2010)

Lin Xie, MSc; Jay Onysko, MA; Howard Morrison, PhD

https://doi.org/10.24095/hpcdp.38.3.01

This original quantitative research article has been peer reviewed.

Author reference:

Public Health Agency of Canada, Ottawa, Ontario, Canada

Correspondence: Lin Xie, Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, AL 6807A, Ottawa, ON  K1A 0K9; Tel: 613-513-6357; Fax: 613-960-0944; Email: lin.xie@canada.ca

Abstract

Introduction: Surveillance of childhood cancer incidence trends can inform etiologic research, policy and programs. This study presents the first population-based report on demographic and geographic variations in incidence trends of detailed pediatric diagnostic groups in Canada.

Methods: The Canadian Cancer Registry data were used to calculate annual age-standardized incidence rates (ASIRs) from 1992 to 2010 among children less than 15 years of age by sex, age and region for the 12 main diagnostic groups and selected subgroups of the International Classification of Childhood Cancer (ICCC), 3rd edition. Temporal trends were examined by annual percent changes (APCs) using Joinpoint regression.

Results: The ASIRs of childhood cancer among males increased by 0.5% (95% confidence interval (CI) = 0.2–0.9) annually from 1992 to 2010, whereas incidence among females increased by 3.2% (CI = 0.4–6.2) annually since 2004 after an initial stabilization. The largest overall increase was observed in children aged 1–4 years (APC = 0.9%, CI = 0.4–1.3). By region, the overall rates increased the most in Ontario from 2006 to 2010 (APC = 5.9%, CI = 1.9–10.1), and increased non-significantly in the other regions from 1992 to 2010. Average annual ASIRs for all cancers combined from 2006 to 2010 were lower in the Prairies (149.4 per million) and higher in Ontario (170.1 per million). The ASIRs increased for leukemias, melanoma, carcinoma, thyroid cancer, ependymomas and hepatoblastoma for all ages, and neuroblastoma in 1–4 year olds. Astrocytoma decreased in 10–14 year olds (APC = −2.1%, CI = −3.7 to −0.5), and among males (APC = −2.4%, CI = −4.6 to −0.2) and females (APC = −3.7%, CI = −5.8 to −1.6) in Ontario over the study period.

Conclusion: Increasing incidence trends for all cancers and selected malignancies are consistent with those reported in other developed countries, and may reflect the changes in demographics and etiological exposures, and artefacts of changes in cancer coding, diagnosis and reporting. Significant decreasing trend for astrocytoma in late childhood was observed for the first time.

Keywords: childhood cancer, ICCC, age-standardized incidence rate, annual percent change

Highlights

  • Childhood cancer incidence increased by 0.5% annually from 1992 to 2010 among males, and increased by 3.2% from 2004 to 2010 among females.
  • The overall increase was observed in the most recent decade, and among children aged 1–4.
  • The overall incidence tended to increase in each region from 1992 to 2010. The rates were lower in the Prairies and higher in Ontario from 2006 to 2010.
  • Significant increases were observed for leukemias, melanoma, carcinoma, thyroid cancer, ependymomas and hepatoblastoma for all ages combined, and neuroblastoma in children aged 1–4.
  • Astrocytoma incidence decreased among children aged 10–14 years.
  • The findings can help inform etiologic research, public health policy and programs.

Introduction

While cancer in children is rare and represents less than 1% of all new cancer cases in Canada, it is the most common cause of death (following accidents) among children >1 year of age in Canada.Footnote 1,Footnote 2 Although treatment advances have increased the overall five-year survival rate from 71% to 83% over the last three decades, childhood cancer has a lifelong health, psychosocial, and financial impact on children and their families.Footnote 1,Footnote 3 Patients who survive five years remain at risk of recurrence or progression of their primary cancer and are at an increased risk of developing subsequent malignancies, chronic diseases, and functional impairments as a result of treatment.

A Statistics Canada report has documented a statistically significant increase of 0.4% per year in overall incidence of pediatric cancers from 1992 to 2010 at the national level.Footnote 4 In recent years, the possibility that the incidence rates of certain pediatric malignancies are increasing has become a topic of public and scientific concern.Footnote 5,Footnote 6,Footnote 7,Footnote 8 Reasons for such changes are not yet understood. Surveillance of cancer incidence trends may provide insight to develop new hypotheses for future etiologic studies, and may inform the need for health services in particular populations. However, the recent temporal trends in incidence have not been examined in detail by pediatric diagnostic groups or in regional contexts. This study presents detailed recent population-based data on demographic and geographic variations in childhood cancer incidence trends in Canada.

Methods

Data sources

The cancer incidence data were extracted from the Canadian Cancer Registry (CCR),Footnote 9 except for Quebec where, from 2008 to 2010, data were obtained in a summary format from the province directly. The incidence data are collected by the provincial and territorial cancer registries, which report data annually to the CCR at Statistics Canada. The CCR is a dynamic, person-oriented, population-based database with cases newly diagnosed from 1992 onward.

Cancer diagnoses were coded according to topography, morphology and behaviour using the International Classification of Diseases for Oncology, Third Edition (ICD-O-3)Footnote 10 and were converted to the International Classification of Childhood Cancer, Third Edition (ICCC-3).Footnote 11,Footnote 12 All primary malignancies diagnosed during the period 1992 through 2010 among those aged 0–14 years were included. The ICCC-3 includes non-malignant intracranial and intraspinal tumours in categories III and X. In accordance with this classification, non-malignant central nervous system (CNS) tumours were also included as a separate analysis.

Population estimates for Canada and the provinces/territories used in the calculation of incidence rates were based on quinquennial censuses conducted from 1991 to 2011. We used intercensal estimates prepared by Statistics Canada for the years between these censuses.Footnote 13

Statistical analysis

Cancer incidence counts and population estimates were summarized by age group (<1 [infants], 1–4, 5–9, and 10–14 [late childhood] years), year of diagnosis, sex, and geographical region at diagnosis (British Columbia, the Prairie provinces [Alberta, Saskatchewan and Manitoba], Ontario, Quebec, the Atlantic provinces [New Brunswick, Prince Edward Island, Nova Scotia, and Newfoundland and Labrador], and the Territories [Yukon, Northwest Territories and Nunavut]). Given that the number of cancer cases was too small to provide stable estimates for some cancers for each of the Prairie provinces, the Atlantic provinces or the Territories, aggregated regions were created for analysis. Rates for each category were calculated by dividing the number of cases in each category by the corresponding population figure. These age-specific rates were standardized to the 2011 Canadian population, using the direct method, to obtain age-standardized incidence rates (ASIRs) per million children.

Joinpoint Regression Program, which is a statistical software for the analysis of trends, was used to identify changes in the trends of annual age-standardized incidence rates of selected cancers over the period from 1992 to 2010.Footnote 14 The response variable was the natural logarithm of the ASIR, and the independent variable was the year of cancer diagnosis. Separate analyses were run by cancer type, sex, age and region. The annual percent change (APC) in cancer incidence rates was calculated by fitting a piecewise linear regression model, assuming a constant rate of change in the logarithm of the annual ASIR in each segment.Footnote 15 The estimated slope from this model was then transformed back to represent an annual percentage increase or decrease in the rate. The test of APC is based on asymptotic t-test. The APC was considered statistically significant if its 95% confidence interval (CI) did not include zero (p < 0.05). The connecting points of the linear segments are referred to as changepoints or joinpoints. The models incorporated estimated standard errors of the ASIRs. To reduce the likelihood of reporting spurious changes in trends, we used a minimum of five observations from a joinpoint to either end of the data and a minimum of four observations between joinpoints. Statistical significance in changes of the trends (joinpoints) was determined using Monte Carlo permutation tests with the Bonferroni adjustment to control the over-fitting probability of the multiple tests (the overall significance level was 0.05).

To ensure confidentiality and limit the possibility of residual disclosure, in keeping with CCR reporting requirements, incidence counts presented in the tables and Figure 1 have been randomly rounded either up or down to a multiple of 5. As a result, when these data are grouped, the totals may not equal the sums of individual values. ASIRs were derived using the actual counts. The ASIRs and APCs are not reported when the corresponding rounded counts are less than 30. In addition, the extended classifications of lymphoid leukemias, except for precursor cell lymphoblastic leukemia, are not presented, as the cases in these subgroups originally coded in ICD-O-2 do not have the required information to be converted to ICD-O-3.Footnote 10 Also, the results by region are only reported for the 12 major diagnostic categories and the subtypes with significant APCs.

Figure 1: Distribution of new cancer cases diagnosed in children less than 15 years of age by sex and age groups, Canada, 2006-2010
Figure 1

Data sources: Canadian Cancer Registry (CCR) database at Statistics Canada and Quebec Cancer Registry (2008-2010).
Note: The rates were standardized to the 2011 Canadian population for all ages combined.

Figure 1 - Text Description

This figure summarizes the distribution of primary cancers for Canada from 2006 to 2010 by age groups for males and females combined and separately. During this period, an average of 910 new diagnoses each year; i.e., a total of 4550 new cases, were reported among children 14 years and under in Canada: 2440 (53.6%) in males and 2110 (46.4%) in females, which amounts to a male:female ratio of 1.2:1.

Overall, the most com­mon childhood cancers diagnosed from 2006 to 2010 were leukemias (32.3%), CNS tumors (18.9%), and lymphomas (11.1%). Next most common were neuroblastoma (7.8%), soft tissue sarcoma (6.5%), and renal tumors (5.2%). The distribution of the most frequent childhood cancers was generally the same for males and females, except lymphomas were more common in males (13.6% compared to 8.2% ), and carcinomas (especially thy­roid carcinoma) were more common in females (6.1% vs. 3.2%).

Around half of children’s cancer cases (47.4%) were diagnosed among those under the age of five years. The age-specific incidence rates in children aged less than 5 years were around twice those of their older counterparts. The highest incidence was observed in infants under the age of one year and generally declined with age. Patterns of diagnoses varied considerably by age group. In infants, neuroblastoma formed the most commonly diagnosed cancers and accounted for nearly a third of all cases (26.4%), followed by leukemias (19.6%) and CNS tumours (11.7%). The embryonal tumors of neuroblastoma, retinoblastoma, and nephroblastoma jointly accounted for 42.6% of all diagnoses in infants. Leukemias prevailed among 1–4 year olds, accounting for 42.4% of all diagnoses, while in 5–9 year olds and 10–14 year olds, lymphomas and bone tumours became increasingly common (lymphomas: 12.2% and 21.0%; bone cancers: 5.4 % and 9.5%, respectively). Also in children aged 10–14 years, leukemias (21.5%) and CNS tumours (19.0%) predominated.

Results

Since the completeness of non-malignant CNS tumor data collection varied by province (data not shown), which may have an impact on comparisons across region and time (see Discussion), the results addressed in this section for all cancers combined and CNS tumors are based on malignancies only, whereas results of the best fit joinpoint regression models for these two categories including non-malignant CNS tumors are also provided in Tables 1–5.

Table 1. Annual percent changes (APC) of age standardized incidence rates (ASIRs)Table 1 - Footnote a (per million) of selected ICCC diagnoses by sex, Canada, 1992–2010
Total cases % (including
non-malignancies)
% (malignancies
 only)
Average
annual cases
Average
ASIR
APC Year 95% CI p-value
Both sexes combined
All childhood cancers (malignancies only) 16955 97.54 100.00 890 155.71 0.45 1992–2010 0.08 to 0.81 0.02
All childhood cancers including non-malignancies brain 17380 100.00 102.52 915 159.55 0.40 1992–2010 0.08 to 0.73 0.02
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 5485 31.57 32.36 285 50.74 0.64 1992–2010 0.08 to 1.20 0.03
I(A) Lymphoid leukemias
4305 24.78 25.41 225 39.86 0.61 1992–2010 0.09 to 1.13 0.02
Lymphoid leukemias, precursor cell leukemias
4075 23.45 24.04 215 37.68 0.02 1992–2010 -0.78 to 0.83 0.95
I(B) Acute myeloid leukemias
755 4.36 4.47 40 6.98 -0.49 1992–2010 -2.20 to 1.25 0.56
I(C) Chronic myeloproliferative diseases
140 0.81 0.83 10 1.29 0.01 1992–2010 -2.63 to 2.71 1.00
I(D) Myelodysplastic syndrome and other myeloproliferative diseases
85 0.48 0.49 5 0.78 4.06 1992–2010 -0.08 to 8.36 0.05
I(E) Unspecified and other specified leukemias
200 1.13 1.16 10 1.84 17.13 1992–2001 6.18 to 29.21 < 0.01
-31.47 2001–2004 Table 1 - Footnote 0.45
18.36 2004–2010 0.99 to 38.72 0.04
Lymphomas and reticuloendothelial neoplasms 1905 10.94 11.22 100 17.01 0.48 1992–2010 -0.35 to 1.32 0.24
II(A) Hodgkin lymphomas
715 4.10 4.21 35 6.28 0.34 1992–2010 -1.00 to 1.70 0.60
II(B) Non-Hodgkin lymphomas (except Burkitt lymphoma)
600 3.45 3.53 35 5.39 0.14 1992–2010 -1.58 to 1.89 0.86
II(C) Burkitt lymphoma
270 1.55 1.59 15 2.41 -2.54 1992–2010 -5.82 to 0.85 0.13
II(D) Miscellaneous lymphoreticular neoplasms
130 0.75 0.77 5 1.22 -0.40 1992–2006 -5.98 to 5.52 0.88
38.05 2006–2010 7.48 to 77.31 0.02
II(E) Unspecified lymphomas
190 1.09 1.12 10 1.71 3.41 1992–2010 0.72 to 6.18 0.02
CNS and miscellaneous intracranial and intraspinal neoplasms 3345 19.22 19.71 175 30.41 0.13 1992–2010 -0.46 to 0.71 0.65
III(A) Ependymomas and choroid plexus tumor
325 1.86 1.91 15 3.02 2.25 1992–2010 0.23 to 4.31 0.03
III(B) Astrocytomas
1505 8.64 8.86 80 13.59 -0.97 1992–2010 -2.10 to 0.16 0.09
III(C) Intracranial and intraspinal embryonal tumors
805 4.61 4.73 45 7.33 -0.45 1992–2010 -1.77 to 0.89 0.49
III(D) Other gliomas
475 2.72 2.79 25 4.29 1.27 1992–2010 -0.82 to 3.41 0.22
III(E) Other specified intracranial and intraspinal neoplasms
45 0.25 0.26 5 0.40 11.39 1992–2010 7.70 to 15.20 < 0.01
III(F) Unspecified intracranial and intraspinal neoplasms
195 1.13 1.16 10 1.79 2.37 1992–2010 -2.96 to 7.98 0.37
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 3770 21.69 22.23 195 34.25 -0.03 1992–2010 -0.51 to 0.45 0.89
III(A) Ependymomas and choroid plexus tumor including non-malignancies
360 2.07 2.12 15 3.34 1.58 1992–2010 -0.22 to 3.42 0.08
III(B) Astrocytomas including non-malignancies
1545 8.90 9.12 85 13.98 -0.98 1992–2010 -2.04 to 0.09 0.07
III(C) Intracranial and intraspinal embryonal tumors including non-malignancies
805 4.61 4.73 40 7.33 -0.45 1992–2010 -1.77 to 0.89 0.49
III(D) Other gliomas including non-malignancies
475 2.73 2.80 25 4.29 1.29 1992–2010 -0.80 to 3.43 0.21
III(E) Other specified intracranial and intraspinal neoplasms including non-malignancies
320 1.85 1.90 20 2.89 1.88 1992–2010 -1.08 to 4.93 0.20
III(F) Unspecified intracranial and intraspinal neoplasms including non-malignancies
265 1.52 1.56 15 2.42 0.25 1992–2010 -4.24 to 4.95 0.91
Neuroblastoma and other peripheral nervous cell tumors 1260 7.26 7.44 65 12.03 0.74 1992–2010 -0.45 to 1.95 0.21
IV(A) Neuroblastoma and ganglioneuroblastoma
1245 7.15 7.33 65 11.86 0.83 1992–2010 -0.30 to 1.98 0.14
Retinoblastoma 430 2.47 2.54 25 4.13 0.30 1992–2010 -1.66 to 2.30 0.75
Renal tumours 950 5.47 5.60 50 8.90 -0.68 1992–2010 -2.07 to 0.73 0.32
VI(A) Nephroblastoma and other nonepithelial renal tumors
895 5.16 5.29 50 8.42 -0.71 1992–2010 -2.16 to 0.77 0.33
VI(B) Renal carcinomas
30 0.18 0.19 5 0.28 -5.27 1992–2010 -9.53 to -0.81 0.02
Hepatic tumours 260 1.49 1.53 15 2.47 1.35 1992–2010 -0.13 to 2.86 0.07
VII(A) Hepatoblastoma
210 1.23 1.26 10 2.07 2.42 1992–2010 0.44 to 4.42 0.02
VII(B) Hepatic carcinomas
35 0.21 0.22 5 0.33 -3.00 1992–2010 -7.92 to 2.18 0.23
Malignant bone tumours 760 4.39 4.50 40 6.76 -0.50 1992–2010 -1.66 to 0.66 0.37
VIII(A) Osteosarcomas
380 2.19 2.24 20 3.35 -0.89 1992–2010 -2.61 to 0.85 0.29
VIII(C) Ewing tumor and related sarcomas of bone
300 1.73 1.77 15 2.66 0.63 1992–2010 -1.27 to 2.57 0.49
VIII(D) Other specified malignant bone tumors
30 0.17 0.18 0 0.27 -3.39 1992–2010 -7.70 to 1.12 0.13
VIII(E) Unspecified malignant bone tumors
35 0.22 0.22 5 0.34 -0.89 1992–2010 -5.83 to 4.31 0.72
Soft tissue and other extraosseous sarcomas 1060 6.08 6.23 55 9.60 -0.08 1992–2010 -1.46 to 1.31 0.90
IX(A) Rhabdomyosarcomas
530 3.04 3.12 30 4.83 -0.52 1992–2010 -2.37 to 1.36 0.56
IX(B) Fibrosarcomas, peripheral nerve sheath tumors, and other fibrous neoplasms
100 0.57 0.58 5 0.91 0.41 1992–2010 -3.51 to 4.49 0.83
IX(D) Other specified soft tissue sarcomas
305 1.75 1.79 15 2.73 0.25 1992–2010 -2.18 to 2.74 0.83
IX(E) Unspecified soft tissue sarcomas
125 0.71 0.73 5 1.13 0.40 1992–2010 -3.38 to 4.33 0.83
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 555 3.19 3.27 30 5.05 -0.38 1992–2010 -1.64 to 0.90 0.54
X(A) Intracranial and intraspinal germ cell tumors
155 0.91 0.94 10 1.42 1.91 1992–2010 -0.88 to 4.79 0.17
X(B) Malignant extracranial and extragonadal germ cell tumors
130 0.76 0.78 10 1.26 1.20 1992–2010 -1.12 to 3.57 0.29
X(C) Malignant gonadal germ cell tumors
230 1.33 1.36 10 2.07 -2.25 1992–2010 -4.42 to -0.03 0.05
Other malignant epithelial neoplasms and malignant melanomas 670 3.86 3.95 35 5.99 2.45 1992–2010 0.23 to 4.72 0.03
XI(A) Adrenocortical carcinomas
35 0.20 0.20 5 0.32 4.22 1992–2010 -0.95 to 9.66 0.10
XI(B) Thyroid carcinomas
260 1.49 1.53 10 2.29 4.20 1992–2010 1.37 to 7.11 0.01
XI(D) Malignant melanomas
155 0.87 0.89 5 1.36 2.68 1992–2010 0.08 to 5.35 0.04
XI(F) Other and unspecified carcinomas
205 1.19 1.22 10 1.85 -0.84 1992–2010 -3.73 to 2.13 0.56
Other and unspecified malignant neoplasms 280 1.61 1.65 15 2.61 2.78 1992–2010 -0.02 to 5.65 0.05
XII(A) Other specified malignant tumors
35 0.21 0.22 5 0.35 15.83 1992–1999 5.45 to 27.22 0.01
-10.31 1999–2006 -33.63 to 21.19 0.44
32.16 2006–2010 12.48 to 55.27 < 0.01
XII(B) Other unspecified malignant tumors
245 1.40 1.43 10 2.26 1.68 1992–2010 -1.42 to 4.88 0.27
Males
All childhood cancers (malignancies only) 9135 97.36 100.00 480 163.68 0.52 1992–2010 0.16 to 0.88 0.01
All childhood cancers including non-malignancies brain 9380 100.00 102.72 495 168.01 0.45 1992–2010 0.09 to 0.81 0.02
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 3000 32.03 32.90 160 54.26 0.82 1992–2010 0.03 to 1.62 0.04
I(A) Lymphoid leukemias
2420 25.80 26.50 125 43.73 0.82 1992–2010 0.05 to 1.60 0.04
Lymphoid leukemias, precursor cell leukemias
2280 24.31 24.97 120 41.14 0.19 1992–2010 -0.76 to 1.16 0.68
I(B) Acute myeloid leukemias
375 3.99 4.10 20 6.74 -0.50 1992–2010 -2.71 to 1.75 0.64
I(C) Chronic myeloproliferative diseases
75 0.80 0.82 5 1.35 -0.43 1992–2010 -4.02 to 3.28 0.80
I(D) Myelodysplastic syndrome and other myeloproliferative diseases
45 0.50 0.51 0 0.86 7.68 1992–2010 2.51 to 13.11 0.01
I(E) Unspecified and other specified leukemias
90 0.94 0.96 5 1.58 0.97 1992–2010 -4.92 to 7.24 0.74
Lymphomas and reticuloendothelial neoplasms 1260 13.46 13.82 70 22.04 0.51 1992–2010 -0.50 to 1.53 0.30
II(A) Hodgkin lymphomas
415 4.45 4.57 25 7.18 0.61 1992–2010 -1.39 to 2.66 0.53
II(B) Non-Hodgkin lymphomas (except Burkitt lymphoma)
400 4.28 4.39 20 7.03 0.47 1992–2010 -1.32 to 2.30 0.59
II(C) Burkitt lymphoma
230 2.42 2.49 15 3.94 -2.72 1992–2010 -6.22 to 0.90 0.13
II(D) Miscellaneous lymphoreticular neoplasms
90 0.95 0.97 5 1.63 6.82 1992–2010 2.15 to 11.71 0.01
II(E) Unspecified lymphomas
130 1.36 1.40 10 2.25 3.29 1992–2010 0.50 to 6.15 0.02
CNS and miscellaneous intracranial and intraspinal neoplasms 1795 19.13 19.65 95 31.86 0.12 1992–2010 -0.85 to 1.11 0.79
III(A) Ependymomas and choroid plexus tumor
185 1.96 2.02 10 3.32 1.71 1992–2010 -0.81 to 4.29 0.17
III(B) Astrocytomas
770 8.18 8.40 40 13.56 -0.83 1992–2010 -2.71 to 1.09 0.37
III(C) Intracranial and intraspinal embryonal tumors
480 5.16 5.30 25 8.62 -0.38 1992–2010 -1.96 to 1.23 0.62
III(D) Other gliomas
240 2.55 2.62 10 4.23 0.99 1992–2010 -1.77 to 3.82 0.46
III(F) Unspecified intracranial and intraspinal neoplasms
100 1.07 1.10 5 1.78 1.95 1992–2010 -2.46 to 6.56 0.37
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 2040 21.77 22.36 105 36.19 -0.12 1992–2010 -0.93 to 0.69 0.75
III(A) Ependymomas and choroid plexus tumor including non-malignancies
205 2.20 2.26 10 3.70 0.94 1992–2010 -1.62 to 3.56 0.45
III(B) Astrocytomas including non-malignancies
795 8.48 8.71 45 14.05 -0.83 1992–2010 -2.61 to 0.98 0.34
III(C) Intracranial and intraspinal embryonal tumors including non-malignancies
485 5.16 5.30 25 8.62 -0.38 1992–2010 -1.96 to 1.23 0.62
III(D) Other gliomas including non-malignancies
240 2.56 2.63 10 4.25 1.02 1992–2010 -1.70 to 3.81 0.44
III(E) Other specified intracranial and intraspinal neoplasms including non-malignancies
170 1.86 1.91 10 3.04 -0.17 1992–2010 -3.67 to 3.45 0.92
III(F) Unspecified intracranial and intraspinal neoplasms including non-malignancies
145 1.52 1.57 10 2.53 -1.41 1992–2010 -4.66 to 1.94 0.38
Neuroblastoma and other peripheral nervous cell tumors 650 6.94 7.13 35 12.15 1.37 1992–2010 0.15 to 2.60 0.03
IV(A) Neuroblastoma and ganglioneuroblastoma
645 6.86 7.04 35 12.01 1.36 1992–2010 0.14 to 2.60 0.03
Retinoblastoma 215 2.30 2.37 10 4.04 -1.30 1992–2010 -3.76 to 1.23 0.29
Renal tumours 425 4.53 4.65 25 7.80 -0.25 1992–2010 -2.38 to 1.93 0.81
VI(A) Nephroblastoma and other nonepithelial renal tumors
400 4.24 4.36 20 7.33 -0.36 1992–2010 -2.60 to 1.94 0.74
Hepatic tumours 160 1.73 1.77 5 3.00 2.18 1992–2010 0.01 to 4.40 0.05
VII(A) Hepatoblastoma
130 1.41 1.45 10 2.47 3.22 1992–2010 0.60 to 5.91 0.02
Malignant bone tumours 390 4.16 4.27 20 6.74 0.11 1992–2010 -1.86 to 2.12 0.91
VIII(A) Osteosarcomas
195 2.04 2.09 10 3.29 -1.52 1992–2010 -4.19 to 1.22 0.25
VIII(C) Ewing tumor and related sarcomas of bone
160 1.70 1.74 10 2.76 2.28 1992–2010 -0.81 to 5.47 0.14
Soft tissue and other extraosseous sarcomas 565 6.05 6.21 25 10.02 -0.84 1992–2010 -2.46 to 0.82 0.30
IX(A) Rhabdomyosarcomas
290 3.13 3.22 15 5.22 -0.87 1992–2010 -2.96 to 1.26 0.40
IX(B) Fibrosarcomas, peripheral nerve sheath tumors, and other fibrous neoplasms
50 0.53 0.55 5 0.90 0.12 1992–2010 -4.22 to 4.65 0.96
IX(D) Other specified soft tissue sarcomas
155 1.66 1.71 5 2.72 -1.02 1992–2010 -4.58 to 2.66 0.56
IX(E) Unspecified soft tissue sarcomas
70 0.71 0.73 5 1.18 0.16 1992–2010 -3.19 to 3.62 0.92
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 255 2.72 2.79 10 4.58 -0.49 1992–2010 -2.41 to 1.46 0.60
X(A) Intracranial and intraspinal germ cell tumors
110 1.17 1.20 5 1.92 1.89 1992–2010 -1.80 to 5.72 0.30
X(B) Malignant extracranial and extragonadal germ cell tumors
45 0.50 0.51 0 0.88 1.15 1992–2010 -4.30 to 6.91 0.67
X(C) Malignant gonadal germ cell tumors
90 0.93 0.95 5 1.57 -4.02 1992–2010 -6.71 to -1.24 0.01
Other malignant epithelial neoplasms and malignant melanomas 270 2.87 2.95 15 4.70 1.61 1992–2010 -1.37 to 4.69 0.27
XI(B) Thyroid carcinomas
75 0.77 0.79 5 1.24 2.88 1992–2010 -1.05 to 6.98 0.14
XI(D) Malignant melanomas
75 0.84 0.87 5 1.38 3.19 1992–2010 -0.89 to 7.44 0.12
XI(F) Other and unspecified carcinomas
95 1.03 1.06 5 1.71 -0.22 1992–2010 -4.22 to 3.94 0.91
Other and unspecified malignant neoplasms 135 1.45 1.49 10 2.49 3.86 1992–2010 -0.55 to 8.46 0.08
XII(B) Other unspecified malignant tumors
120 1.28 1.31 5 2.19 2.31 1992–2010 -2.24 to 7.08 0.30
Females
All childhood cancers (malignancies only) 7820 97.75 100.00 415 147.32 -0.72 1992–2004 -1.71 to 0.29 0.15
3.23 2004–2010 0.35 to 6.20 0.03
All childhood cancers including non-malignancies brain 8000 100.00 102.30 420 150.65 0.35 1992–2010 -0.22 to 0.92 0.22
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 2480 31.02 31.74 130 47.04 0.43 1992–2010 -0.32 to 1.19 0.24
I(A) Lymphoid leukemias
1885 23.58 24.13 100 35.79 0.36 1992–2010 -0.57 to 1.30 0.43
Lymphoid leukemias, precursor cell leukemias
1795 22.45 22.96 95 34.04 -0.18 1992–2010 -1.31 to 0.96 0.74
I(B) Acute myeloid leukemias
380 4.80 4.91 25 7.22 -0.50 1992–2010 -2.55 to 1.60 0.62
I(C) Chronic myeloproliferative diseases
70 0.82 0.84 5 1.22 0.71 1992–2010 -3.90 to 5.55 0.75
I(D) Myelodysplastic syndrome and other myeloproliferative diseases
40 0.45 0.46 0 0.70 1.65 1992–2010 -3.05 to 6.59 0.48
I(E) Unspecified and other specified leukemias
105 1.36 1.39 5 2.10 16.69 1992–2001 2.75 to 32.52 0.02
-34.96 2001–2004 Table 1 - Footnote 0.45
27.43 2004–2010 4.88 to 54.84 0.02
Lymphomas and reticuloendothelial neoplasms 640 8.00 8.18 35 11.72 0.31 1992–2010 -1.08 to 1.72 0.64
II(A) Hodgkin lymphomas
295 3.70 3.78 15 5.34 -0.25 1992–2010 -1.88 to 1.41 0.75
II(B) Non-Hodgkin lymphomas (except Burkitt lymphoma)
200 2.47 2.53 10 3.66 -0.61 1992–2010 -3.66 to 2.53 0.68
II(C) Burkitt lymphoma
40 0.54 0.55 0 0.79 -1.13 1992–2010 -5.41 to 3.34 0.59
II(D) Miscellaneous lymphoreticular neoplasms
40 0.51 0.52 5 0.79 4.57 1992–2010 0.72 to 8.57 0.02
II(E) Unspecified lymphomas
65 0.77 0.79 0 1.14 3.29 1992–2010 -1.97 to 8.83 0.21
CNS and miscellaneous intracranial and intraspinal neoplasms 1545 19.34 19.78 80 28.89 0.07 1992–2010 -0.96 to 1.10 0.89
III(A) Ependymomas and choroid plexus tumor
140 1.75 1.79 5 2.70 2.99 1992–2010 0.60 to 5.43 0.02
III(B) Astrocytomas
735 9.19 9.40 40 13.62 -1.19 1992–2010 -2.76 to 0.39 0.13
III(C) Intracranial and intraspinal embryonal tumors
315 3.97 4.07 15 5.97 -0.57 1992–2010 -2.84 to 1.76 0.61
III(D) Other gliomas
235 2.92 2.99 15 4.34 0.88 1992–2010 -1.98 to 3.81 0.53
III(E) Other specified intracranial and intraspinal neoplasms
25 0.30 0.31 0 0.45 11.38 1992–2010 5.49 to 17.60 < 0.01
III(F) Unspecified intracranial and intraspinal neoplasms
95 1.20 1.23 5 1.80 58.43 1992–1996 Table 1 - Footnote 0.03
-16.38 1996–2001 -40.10 to 16.75 0.25
65.74 2001–2004 Table 1 - Footnote 0.28
-28.95 2004–2010 -40.97 to -14.47 < 0.01
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 1730 21.58 22.08 90 32.22 0.03 1992–2010 -0.96 to 1.04 0.95
III(A) Ependymomas and choroid plexus tumor including non-malignancies
155 1.92 1.97 10 2.96 2.37 1992–2010 0.27 to 4.51 0.03
III(B) Astrocytomas including non-malignancies
750 9.39 9.60 40 13.91 -1.21 1992–2010 -2.71 to 0.32 0.11
III(C) Intracranial and intraspinal embryonal tumors including non-malignancies
315 3.97 4.07 20 5.97 -0.57 1992–2010 -2.84 to 1.76 0.61
III(D) Other gliomas including non-malignancies
235 2.92 2.99 15 4.34 0.88 1992–2010 -1.98 to 3.81 0.53
III(E) Other specified intracranial and intraspinal neoplasms including non-malignancies
150 1.85 1.89 10 2.74 4.03 1992–2010 0.08 to 8.14 0.05
III(F) Unspecified intracranial and intraspinal neoplasms including non-malignancies
120 1.52 1.56 5 2.29 8.90 1992–2005 1.10 to 17.31 0.03
-31.76 2005–2010 -57.68 to 10.04 0.11
Neuroblastoma and other peripheral nervous cell tumors 610 7.62 7.80 35 11.91 0.04 1992–2010 -1.62 to 1.74 0.96
IV(A) Neuroblastoma and ganglioneuroblastoma
595 7.49 7.66 30 11.71 0.22 1992–2010 -1.38 to 1.85 0.77
Retinoblastoma 215 2.67 2.74 10 4.23 2.23 1992–2010 -0.63 to 5.16 0.12
Renal tumours 525 6.56 6.71 30 10.05 -0.85 1992–2010 -2.43 to 0.75 0.28
VI(A) Nephroblastoma and other nonepithelial renal tumors
500 6.24 6.38 25 9.56 -0.76 1992–2010 -2.48 to 0.99 0.37
Hepatic tumours 100 1.21 1.24 5 1.92 0.29 1992–2010 -3.04 to 3.75 0.86
VII(A) Hepatoblastoma
85 1.02 1.05 5 1.64 1.58 1992–2010 -2.13 to 5.44 0.39
Malignant bone tumours 375 4.66 4.77 15 6.77 -1.21 1992–2010 -2.76 to 0.37 0.13
VIII(A) Osteosarcomas
190 2.36 2.42 10 3.42 -0.43 1992–2010 -2.60 to 1.79 0.68
VIII(C) Ewing tumor and related sarcomas of bone
140 1.76 1.80 5 2.55 -0.63 1992–2010 -2.96 to 1.77 0.59
Soft tissue and other extraosseous sarcomas 490 6.11 6.25 25 9.17 0.82 1992–2010 -0.66 to 2.33 0.26
IX(A) Rhabdomyosarcomas
235 2.94 3.00 10 4.42 -0.12 1992–2010 -2.14 to 1.94 0.90
IX(B) Fibrosarcomas, peripheral nerve sheath tumors, and other fibrous neoplasms
50 0.61 0.63 5 0.92 0.58 1992–2010 -3.10 to 4.39 0.75
IX(D) Other specified soft tissue sarcomas
150 1.85 1.89 10 2.75 2.07 1992–2010 -0.45 to 4.65 0.10
IX(E) Unspecified soft tissue sarcomas
60 0.71 0.73 0 1.07 0.86 1992–2010 -4.36 to 6.37 0.74
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 300 3.74 3.82 20 5.55 -0.35 1992–2010 -2.58 to 1.93 0.75
X(A) Intracranial and intraspinal germ cell tumors
50 0.61 0.63 0 0.89 3.43 1992–2010 -0.58 to 7.59 0.09
X(B) Malignant extracranial and extragonadal germ cell tumors
85 1.06 1.09 5 1.67 1.10 1992–2010 -1.49 to 3.75 0.39
X(C) Malignant gonadal germ cell tumors
145 1.80 1.84 10 2.60 -1.39 1992–2010 -4.72 to 2.06 0.40
Other malignant epithelial neoplasms and malignant melanomas 405 5.01 5.13 20 7.34 2.93 1992–2010 0.56 to 5.36 0.02
XI(B) Thyroid carcinomas
185 2.34 2.39 10 3.40 4.85 1992–2010 1.80 to 7.99 < 0.01
XI(D) Malignant melanomas
75 0.90 0.92 5 1.34 1.27 1992–2010 -2.84 to 5.57 0.53
XI(F) Other and unspecified carcinomas
110 1.36 1.39 5 1.99 -0.80 1992–2010 -4.17 to 2.68 0.63
Other and unspecified malignant neoplasms 145 1.80 1.84 5 2.73 1.46 1992–2010 -1.48 to 4.50 0.31
XII(B) Other unspecified malignant tumors
125 1.54 1.57 5 2.34 1.00 1992–2010 -2.56 to 4.69 0.57
Data sources: Canadian Cancer Registry (CCR) database at Statistics Canada and Quebec Cancer Registry (2008-2010).
Table 2. Annual percent changes (APC) of age standardized incidence rates (ASIRs)Table 2 - Footnote a (per million) of selected ICCC diagnoses by age, Canada, 1992–2010
Total cases % (including
non-malignancies)
% (malignancies
 only)
Average
annual cases
Average
ASIR
APC Year 95% CI p-value
Age <1 year
All childhood cancers (malignancies only) 1705 98.10 100.00 85 248.64 -0.16 1992–2010 -1.21 to 0.90 0.75
All childhood cancers including non-malignancies brain 1735 100.00 101.94 95 253.47 -0.20 1992–2010 -1.23 to 0.84 0.69
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 340 19.38 19.75 20 49.23 -0.27 1992–2010 -1.95 to 1.44 0.74
I(A) Lymphoid leukemias
125 7.15 7.29 5 18.22 -1.83 1992–2010 -4.62 to 1.04 0.19
Lymphoid leukemias, precursor cell leukemias
120 6.81 6.94 5 17.30 -2.54 1992–2010 -5.45 to 0.46 0.09
I(B) Acute myeloid leukemias
110 6.40 6.53 5 16.19 -2.06 1992–2010 -4.49 to 0.43 0.10
I(C) Chronic myeloproliferative diseases
35 2.13 2.18 0 5.37 -0.10 1992–2010 -4.01 to 3.97 0.96
I(E) Unspecified and other specified leukemias
45 2.60 2.65 5 6.67 0.97 1992–2010 -4.41 to 6.66 0.71
Lymphomas and reticuloendothelial neoplasms 55 3.17 3.23 5 8.05 -2.81 1992–2010 -6.55 to 1.08 0.14
II(D) Miscellaneous lymphoreticular neoplasms
35 1.90 1.94 0 4.78 -4.43 1992–2010 -8.14 to -0.58 0.03
CNS and miscellaneous intracranial and intraspinal neoplasms 185 10.78 10.99 10 27.33 0.41 1992–2010 -2.29 to 3.18 0.75
III(A) Ependymomas and choroid plexus tumor
35 2.02 2.06 0 5.15 5.60 1992–2010 1.94 to 9.38 < 0.01
III(B) Astrocytomas
60 3.69 3.76 5 9.26 -0.24 1992–2010 -4.22 to 3.91 0.90
III(C) Intracranial and intraspinal embryonal tumors
50 2.88 2.94 0 7.40 -1.01 1992–2010 -5.92 to 4.15 0.68
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 220 12.69 12.93 10 32.16 0.19 1992–2010 -1.64 to 2.06 0.83
III(A) Ependymomas and choroid plexus tumor including non-malignancies
40 2.25 2.29 5 5.73 5.04 1992–2010 1.20 to 9.03 0.01
III(B) Astrocytomas including non-malignancies
65 3.81 3.88 5 9.57 -0.16 1992–2010 -4.06 to 3.90 0.94
III(C) Intracranial and intraspinal embryonal tumors including non-malignancies
50 2.88 2.94 5 7.40 -1.01 1992–2010 -5.92 to 4.15 0.68
III(F) Unspecified intracranial and intraspinal neoplasms including non-malignancies
30 1.90 1.94 0 4.78 -5.87 1992–2010 -8.37 to -3.30 < 0.01
Neuroblastoma and other peripheral nervous cell tumors 445 25.61 26.10 25 64.56 -14.00 1992–1996 -28.97 to 4.13 0.11
2.78 1996–2010 -0.50 to 6.17 0.09
IV(A) Neuroblastoma and ganglioneuroblastoma
440 25.55 26.04 25 64.41 -14.22 1992–1996 -29.13 to 3.83 0.11
2.86 1996–2010 -0.43 to 6.25 0.08
Retinoblastoma 150 8.59 8.76 5 21.70 -0.60 1992–2010 -4.08 to 3.02 0.73
Renal tumours 130 7.38 7.52 5 18.89 0.38 1992–2010 -2.72 to 3.58 0.80
VI(A) Nephroblastoma and other nonepithelial renal tumors
120 6.98 7.11 5 17.86 0.65 1992–2010 -2.34 to 3.74 0.65
Hepatic tumours 60 3.58 3.64 5 9.16 1.95 1992–2010 -3.15 to 7.31 0.44
VII(A) Hepatoblastoma
60 3.46 3.53 0 8.85 1.93 1992–2010 -3.02 to 7.12 0.43
Soft tissue and other extraosseous sarcomas 110 6.29 6.41 5 15.93 0.40 1992–2010 -2.95 to 3.87 0.81
IX(A) Rhabdomyosarcomas
30 1.79 1.82 5 4.53 -4.82 1992–2010 -9.23 to -0.19 0.04
IX(B) Fibrosarcomas, peripheral nerve sheath tumors, and other fibrous neoplasms
30 1.85 1.88 0 4.70 0.73 1992–2010 -4.53 to 6.27 0.78
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 105 6.00 6.11 5 15.20 1.86 1992–2010 -1.38 to 5.21 0.25
X(B) Malignant extracranial and extragonadal germ cell tumors
65 3.81 3.88 5 9.71 3.44 1992–2010 0.17 to 6.82 0.04
X(C) Malignant gonadal germ cell tumors
30 1.56 1.59 5 3.87 -0.28 1992–2010 -5.42 to 5.15 0.91
Other malignant epithelial neoplasms and malignant melanomas 50 2.88 2.94 5 7.34 1.03 1992–2010 -3.63 to 5.92 0.65
XI(F) Other and unspecified carcinomas
30 1.73 1.76 5 4.36 -2.09 1992–2010 -6.45 to 2.47 0.34
Other and unspecified malignant neoplasms 70 4.15 4.23 0 10.52 -5.42 1992–2010 -10.35 to -0.21 0.04
XII(B) Other unspecified malignant tumors
65 3.81 3.88 5 9.63 -6.47 1992–2010 -11.68 to -0.96 0.02
Age 1 to 4 years
All childhood cancers (malignancies only) 6165 98.69 100.00 325 219.32 0.89 1992–2010 0.44 to 1.34 < 0.01
All childhood cancers including non-malignancies brain 6245 100.00 101.33 325 222.24 0.87 1992–2010 0.42 to 1.32 < 0.01
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 2640 42.27 42.83 135 93.95 0.82 1992–2010 -0.10 to 1.74 0.08
I(A) Lymphoid leukemias
2265 36.25 36.73 120 80.59 0.92 1992–2010 0.09 to 1.76 0.03
Lymphoid leukemias, precursor cell leukemias
2160 34.63 35.09 115 76.82 0.43 1992–2010 -0.61 to 1.49 0.39
I(B) Acute myeloid leukemias
260 4.13 4.19 15 9.15 -0.11 1992–2010 -2.80 to 2.65 0.93
I(D) Myelodysplastic syndrome and other myeloproliferative diseases
30 0.43 0.44 0 0.98 17.66 1992–2002 8.49 to 27.61 < 0.01
-7.10 2002–2010 -20.03 to 7.91 0.31
I(E) Unspecified and other specified leukemias
65 1.04 1.05 0 2.32 2.60 1992–2010 -2.41 to 7.86 0.29
Lymphomas and reticuloendothelial neoplasms 300 4.77 4.83 15 10.63 2.22 1992–2010 -0.03 to 4.52 0.05
II(B) Non-Hodgkin lymphomas (except Burkitt lymphoma)
130 2.05 2.08 5 4.59 3.03 1992–2010 -0.39 to 6.56 0.08
II(C) Burkitt lymphoma
60 0.94 0.96 5 2.08 -2.82 1992–2010 -5.91 to 0.36 0.08
II(D) Miscellaneous lymphoreticular neoplasms
50 0.82 0.83 5 1.82 6.91 1992–2010 2.31 to 11.73 0.01
II(E) Unspecified lymphomas
35 0.54 0.55 0 1.23 2.09 1992–2010 -2.89 to 7.34 0.40
CNS and miscellaneous intracranial and intraspinal neoplasms 1070 17.11 17.34 55 38.10 1.20 1992–2010 -0.09 to 2.51 0.07
III(A) Ependymomas and choroid plexus tumor
170 2.69 2.73 10 5.97 1.59 1992–2010 -0.70 to 3.94 0.16
III(B) Astrocytomas
415 6.61 6.70 20 14.70 0.52 1992–2010 -1.59 to 2.67 0.61
III(C) Intracranial and intraspinal embryonal tumors
290 4.64 4.70 15 10.32 1.20 1992–2010 -1.22 to 3.68 0.31
III(D) Other gliomas
135 2.15 2.17 5 4.80 1.46 1992–2010 -1.37 to 4.38 0.29
III(F) Unspecified intracranial and intraspinal neoplasms
55 0.88 0.89 5 1.98 1.15 1992–2010 -4.95 to 7.65 0.70
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 1155 18.43 18.67 65 41.02 1.06 1992–2010 -0.22 to 2.35 0.10
III(A) Ependymomas and choroid plexus tumor including non-malignancies
170 2.79 2.82 10 6.18 1.77 1992–2010 -0.57 to 4.16 0.13
III(B) Astrocytomas including non-malignancies
425 6.76 6.85 20 15.03 0.50 1992–2010 -1.53 to 2.57 0.61
III(C) Intracranial and intraspinal embryonal tumors including non-malignancies
290 4.64 4.70 15 10.32 1.20 1992–2010 -1.22 to 3.68 0.31
III(D) Other gliomas including non-malignancies
135 2.15 2.17 10 4.80 1.46 1992–2010 -1.37 to 4.38 0.29
III(E) Other specified intracranial and intraspinal neoplasms including non-malignancies
55 0.90 0.91 0 2.02 1.12 1992–2010 -2.63 to 5.02 0.54
III(F) Unspecified intracranial and intraspinal neoplasms including non-malignancies
75 1.20 1.22 5 2.68 -0.52 1992–2010 -5.58 to 4.81 0.84
Neuroblastoma and other peripheral nervous cell tumors 620 9.97 10.11 35 22.22 1.62 1992–2010 0.20 to 3.05 0.03
IV(A) Neuroblastoma and ganglioneuroblastoma
620 9.88 10.01 30 22.01 1.66 1992–2010 0.28 to 3.07 0.02
Retinoblastoma 260 4.18 4.23 10 9.26 0.85 1992–2010 -1.56 to 3.32 0.47
Renal tumours 555 8.84 8.96 25 19.53 -0.86 1992–2010 -2.50 to 0.80 0.29
VI(A) Nephroblastoma and other nonepithelial renal tumors
540 8.61 8.73 30 19.04 -0.88 1992–2010 -2.62 to 0.89 0.31
Hepatic tumours 145 2.34 2.37 5 5.21 2.83 1992–2010 0.04 to 5.70 0.05
VII(A) Hepatoblastoma
135 2.18 2.21 5 4.87 3.73 1992–2010 1.10 to 6.43 0.01
Malignant bone tumours 60 1.02 1.04 5 2.27 -0.89 1992–2010 -4.79 to 3.18 0.65
VIII(C) Ewing tumor and related sarcomas of bone
35 0.61 0.62 5 1.35 1.67 1992–2010 -3.41 to 7.03 0.50
Soft tissue and other extraosseous sarcomas 280 4.48 4.54 15 9.90 -4.09 1992–2003 -8.31 to 0.33 0.07
8.78 2003–2010 -0.57 to 19.01 0.06
IX(A) Rhabdomyosarcomas
215 3.41 3.46 10 7.51 -5.42 1992–2004 -10.76 to 0.24 0.06
15.86 2004–2010 -1.97 to 36.94 0.08
IX(D) Other specified soft tissue sarcomas
40 0.64 0.65 5 1.44 -1.06 1992–2010 -5.28 to 3.34 0.61
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 110 1.71 1.74 10 3.78 -1.74 1992–2010 -4.81 to 1.43 0.26
X(B) Malignant extracranial and extragonadal germ cell tumors
45 0.75 0.76 0 1.66 -1.78 1992–2010 -4.77 to 1.30 0.24
X(C) Malignant gonadal germ cell tumors
35 0.61 0.62 0 1.33 -4.20 1992–2010 -10.68 to 2.75 0.21
Other malignant epithelial neoplasms and malignant melanomas 50 0.77 0.78 0 1.71 6.00 1992–2010 0.61 to 11.69 0.03
Other and unspecified malignant neoplasms 75 1.22 1.23 5 2.75 3.90 1992–2010 -0.81 to 8.83 0.10
XII(B) Other unspecified malignant tumors
60 1.01 1.02 5 2.28 2.71 1992–2010 -3.05 to 8.81 0.34
Age 5 to 9 years
All childhood cancers (malignancies only) 4335 97.31 100.00 225 118.00 0.37 1992–2010 -0.01 to 0.76 0.05
All childhood cancers including non-malignancies brain 4460 100.00 102.77 235 121.22 0.36 1992–2010 0.00 to 0.73 0.05
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 1485 33.30 34.22 80 40.42 0.85 1992–2010 -0.14 to 1.86 0.09
I(A) Lymphoid leukemias
1235 27.70 28.46 65 33.62 0.60 1992–2010 -0.45 to 1.66 0.25
Lymphoid leukemias, precursor cell leukemias
1165 26.06 26.78 60 31.57 -0.14 1992–2010 -1.27 to 1.01 0.80
I(B) Acute myeloid leukemias
160 3.57 3.66 10 4.33 0.50 1992–2010 -2.89 to 4.01 0.76
I(E) Unspecified and other specified leukemias
45 1.08 1.11 0 1.31 31.75 1992–1999 -2.28 to 77.63 0.07
-2.34 1999–2010 -10.19 to 6.20 0.55
Lymphomas and reticuloendothelial neoplasms 540 12.13 12.47 30 14.71 0.10 1992–2010 -1.40 to 1.62 0.89
II(A) Hodgkin lymphomas
135 2.96 3.04 5 3.59 -1.62 1992–2010 -4.65 to 1.50 0.29
II(B) Non-Hodgkin lymphomas (except Burkitt lymphoma)
210 4.69 4.82 15 5.66 -0.59 1992–2010 -3.02 to 1.90 0.62
II(C) Burkitt lymphoma
110 2.44 2.51 5 2.95 -0.41 1992–2010 -3.84 to 3.14 0.81
II(E) Unspecified lymphomas
65 1.46 1.50 5 1.77 2.78 1992–2010 -1.89 to 7.67 0.23
CNS and miscellaneous intracranial and intraspinal neoplasms 1140 25.57 26.27 60 30.95 -0.24 1992–2010 -1.38 to 0.92 0.67
III(A) Ependymomas and choroid plexus tumor
60 1.35 1.38 5 1.62 -1.11 1992–2010 -5.38 to 3.36 0.60
III(B) Astrocytomas
530 11.89 12.21 30 14.39 -0.85 1992–2010 -2.44 to 0.77 0.28
III(C) Intracranial and intraspinal embryonal tumors
290 6.53 6.71 15 7.87 -0.67 1992–2010 -3.01 to 1.73 0.56
III(D) Other gliomas
190 4.19 4.31 10 5.09 0.93 1992–2010 -2.26 to 4.23 0.55
III(F) Unspecified intracranial and intraspinal neoplasms
55 1.28 1.31 5 1.56 14.98 1992–2005 5.25 to 25.61 < 0.01
-32.87 2005–2010 -55.39 to 1.03 0.06
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 1260 28.26 29.04 65 34.18 -0.24 1992–2010 -1.34 to 0.88 0.66
III(A) Ependymomas and choroid plexus tumor including non-malignancies
70 1.53 1.57 5 1.84 -2.04 1992–2010 -6.20 to 2.30 0.33
III(B) Astrocytomas including non-malignancies
550 12.27 12.61 25 14.84 -0.81 1992–2010 -2.38 to 0.78 0.30
III(C) Intracranial and intraspinal embryonal tumors including non-malignancies
290 6.53 6.71 15 7.87 -0.67 1992–2010 -3.01 to 1.73 0.56
III(D) Other gliomas including non-malignancies
185 4.19 4.31 10 5.09 0.93 1992–2010 -2.26 to 4.23 0.55
III(E) Other specified intracranial and intraspinal neoplasms including non-malignancies
100 2.15 2.21 5 2.60 17.06 1992–2001 4.32 to 31.35 0.01
-4.60 2001–2010 -13.20 to 4.85 0.30
III(F) Unspecified intracranial and intraspinal neoplasms including non-malignancies
70 1.59 1.64 5 1.94 11.58 1992–2005 2.22 to 21.81 0.02
-34.00 2005–2010 -60.57 to 10.46 0.11
Neuroblastoma and other peripheral nervous cell tumors 150 3.41 3.50 10 4.14 -0.32 1992–2010 -2.89 to 2.31 0.80
IV(A) Neuroblastoma and ganglioneuroblastoma
150 3.34 3.43 5 4.06 -0.01 1992–2010 -2.61 to 2.67 1.00
Renal tumours 220 4.84 4.98 15 5.83 -0.83 1992–2010 -3.55 to 1.97 0.54
VI(A) Nephroblastoma and other nonepithelial renal tumors
205 4.60 4.72 10 5.54 -0.97 1992–2010 -3.77 to 1.91 0.48
Malignant bone tumours 225 4.98 5.12 10 6.03 -0.95 1992–2010 -4.17 to 2.38 0.55
VIII(A) Osteosarcomas
105 2.33 2.40 5 2.84 -0.75 1992–2010 -4.41 to 3.04 0.68
VIII(C) Ewing tumor and related sarcomas of bone
95 2.20 2.26 5 2.66 -1.26 1992–2010 -6.25 to 3.99 0.61
Soft tissue and other extraosseous sarcomas 295 6.71 6.89 15 8.15 0.15 1992–2010 -1.72 to 2.05 0.87
IX(A) Rhabdomyosarcomas
170 3.79 3.89 10 4.59 0.00 1992–2010 -1.82 to 1.85 1.00
IX(D) Other specified soft tissue sarcomas
85 1.86 1.91 5 2.26 -0.16 1992–2010 -4.18 to 4.03 0.94
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 70 1.59 1.64 5 1.93 1.65 1992–2010 -2.95 to 6.47 0.47
X(A) Intracranial and intraspinal germ cell tumors
35 0.76 0.78 0 0.93 16.29 1992–1999 2.48 to 31.96 0.02
-10.62 1999–2006 -23.06 to 3.83 0.13
18.51 2006–2010 -7.47 to 51.80 0.16
X(C) Malignant gonadal germ cell tumors
35 0.76 0.78 0 0.91 -1.20 1992–2010 -6.37 to 4.26 0.64
Other malignant epithelial neoplasms and malignant melanomas 120 2.69 2.77 5 3.28 3.24 1992–2010 -0.06 to 6.65 0.05
XI(B) Thyroid carcinomas
55 1.23 1.27 0 1.51 3.19 1992–2010 -0.33 to 6.84 0.07
XI(D) Malignant melanomas
35 0.74 0.76 0 0.92 6.13 1992–2010 3.16 to 9.19 < 0.01
Other and unspecified malignant neoplasms 55 1.19 1.22 0 1.46 2.07 1992–2010 -1.70 to 5.98 0.27
XII(B) Other unspecified malignant tumors
45 1.03 1.06 0 1.26 0.63 1992–2010 -3.58 to 5.03 0.76
Age 10 to 14 years
All childhood cancers (malignancies only) 4750 96.09 100.00 250 122.57 0.17 1992–2010 -0.54 to 0.88 0.62
All childhood cancers including non-malignancies brain 4945 100.00 104.06 260 127.53 0.08 1992–2010 -0.57 to 0.72 0.80
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 1025 20.74 21.59 50 26.47 0.36 1992–2010 -0.85 to 1.57 0.54
I(A) Lymphoid leukemias
685 13.84 14.41 35 17.67 0.09 1992–2010 -1.06 to 1.25 0.87
Lymphoid leukemias, precursor cell leukemias
630 12.81 13.33 30 16.38 -0.54 1992–2010 -2.10 to 1.04 0.48
I(B) Acute myeloid leukemias
230 4.65 4.84 10 5.95 -0.34 1992–2010 -2.87 to 2.26 0.78
I(C) Chronic myeloproliferative diseases
50 1.03 1.07 0 1.31 3.27 1992–2010 -1.35 to 8.11 0.16
I(E) Unspecified and other specified leukemias
40 0.79 0.82 5 1.01 4.39 1992–2010 -1.28 to 10.38 0.12
Lymphomas and reticuloendothelial neoplasms 1010 20.40 21.23 55 26.00 0.36 1992–2010 -0.94 to 1.68 0.56
II(A) Hodgkin lymphomas
555 11.21 11.67 30 14.29 0.82 1992–2010 -0.87 to 2.53 0.32
II(B) Non-Hodgkin lymphomas (except Burkitt lymphoma)
250 5.02 5.22 15 6.41 -1.06 1992–2010 -4.20 to 2.17 0.49
II(C) Burkitt lymphoma
100 2.06 2.15 5 2.63 -4.35 1992–2010 -9.35 to 0.94 0.10
II(E) Unspecified lymphomas
85 1.70 1.77 5 2.16 5.25 1992–2010 2.30 to 8.28 < 0.01
CNS and miscellaneous intracranial and intraspinal neoplasms 945 19.13 19.90 50 24.40 -0.77 1992–2010 -1.98 to 0.45 0.20
III(A) Ependymomas and choroid plexus tumor
60 1.23 1.28 0 1.56 5.11 1992–2010 1.45 to 8.91 0.01
III(B) Astrocytomas
495 10.02 10.43 25 12.80 -2.07 1992–2010 -3.67 to -0.45 0.02
III(C) Intracranial and intraspinal embryonal tumors
170 3.46 3.60 10 4.43 -2.34 1992–2010 -4.64 to 0.02 0.05
III(D) Other gliomas
140 2.83 2.95 5 3.62 0.69 1992–2010 -2.82 to 4.34 0.69
III(F) Unspecified intracranial and intraspinal neoplasms
65 1.30 1.35 5 1.63 4.34 1992–2010 0.19 to 8.67 0.04
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 1135 23.03 23.97 60 29.36 -1.02 1992–2010 -2.31 to 0.28 0.12
III(A) Ependymomas and choroid plexus tumor including non-malignancies
80 1.60 1.66 5 2.02 3.82 1992–2010 0.37 to 7.38 0.03
III(B) Astrocytomas including non-malignancies
510 10.34 10.76 25 13.22 -2.11 1992–2010 -3.69 to -0.50 0.01
III(C) Intracranial and intraspinal embryonal tumors including non-malignancies
170 3.46 3.60 10 4.43 -2.34 1992–2010 -4.64 to 0.02 0.05
III(D) Other gliomas including non-malignancies
145 2.85 2.97 10 3.64 0.73 1992–2010 -2.70 to 4.28 0.66
III(E) Other specified intracranial and intraspinal neoplasms including non-malignancies
150 3.04 3.16 10 3.86 -0.30 1992–2010 -3.85 to 3.38 0.86
III(F) Unspecified intracranial and intraspinal neoplasms including non-malignancies
85 1.74 1.81 5 2.20 1.79 1992–2010 -1.93 to 5.65 0.33
Neuroblastoma and other peripheral nervous cell tumors 40 0.85 0.88 5 1.08 -1.01 1992–2010 -4.58 to 2.68 0.56
IV(A) Neuroblastoma and ganglioneuroblastoma
35 0.67 0.70 0 0.85 -0.01 1992–2010 -4.72 to 4.92 0.99
Renal tumours 55 1.09 1.14 0 1.39 -1.32 1992–2010 -5.91 to 3.50 0.56
VI(A) Nephroblastoma and other nonepithelial renal tumors
35 0.67 0.70 0 0.85 -0.32 1992–2010 -5.27 to 4.89 0.90
Hepatic tumours 30 0.55 0.57 5 0.70 -5.02 1992–2010 -8.68 to -1.21 0.01
Malignant bone tumours 475 9.55 9.94 25 12.18 -0.30 1992–2010 -1.59 to 1.01 0.64
VIII(A) Osteosarcomas
260 5.32 5.54 15 6.79 -0.56 1992–2010 -2.90 to 1.85 0.63
VIII(C) Ewing tumor and related sarcomas of bone
160 3.30 3.43 10 4.19 1.39 1992–2010 -0.94 to 3.78 0.23
Soft tissue and other extraosseous sarcomas 370 7.45 7.75 15 9.49 -0.54 1992–2010 -3.05 to 2.04 0.66
IX(A) Rhabdomyosarcomas
115 2.35 2.44 5 3.00 -1.54 1992–2010 -5.18 to 2.23 0.40
IX(B) Fibrosarcomas, peripheral nerve sheath tumors, and other fibrous neoplasms
35 0.73 0.76 0 0.93 -0.81 1992–2010 -4.85 to 3.41 0.69
IX(D) Other specified soft tissue sarcomas
155 3.20 3.33 10 4.07 -1.03 1992–2010 -4.40 to 2.45 0.54
IX(E) Unspecified soft tissue sarcomas
55 1.17 1.22 0 1.50 1.80 1992–2010 -2.11 to 5.86 0.35
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 270 5.50 5.73 15 7.03 -0.80 1992–2010 -3.31 to 1.78 0.52
X(A) Intracranial and intraspinal germ cell tumors
100 2.04 2.13 5 2.62 -0.16 1992–2010 -3.37 to 3.15 0.92
X(C) Malignant gonadal germ cell tumors
130 2.67 2.78 10 3.41 -0.61 1992–2010 -3.81 to 2.71 0.70
Other malignant epithelial neoplasms and malignant melanomas 455 9.15 9.52 25 11.67 1.72 1992–2010 -0.77 to 4.27 0.16
XI(B) Thyroid carcinomas
190 3.93 4.09 15 5.01 3.47 1992–2010 -0.37 to 7.47 0.07
XI(D) Malignant melanomas
95 1.92 2.00 5 2.45 -1.34 1992–2010 -4.01 to 1.41 0.32
XI(F) Other and unspecified carcinomas
135 2.73 2.84 10 3.49 -0.28 1992–2010 -3.78 to 3.34 0.87
Other and unspecified malignant neoplasms 80 1.60 1.66 5 2.03 7.20 1992–2010 3.71 to 10.80 < 0.01
XII(B) Other unspecified malignant tumors
70 1.38 1.43 5 1.75 7.52 1992–2010 3.84 to 11.32 < 0.01
Data sources: Canadian Cancer Registry (CCR) database at Statistics Canada and Quebec Cancer Registry (2008-2010).
Table 3. Annual percent changes (APC) of age standardized incidence rates (ASIRs)Table 3 - Footnote a  (per million) of selected ICCC diagnosis categories by geographic region, males and females combined, Canada, 1992–2010
Total cases % (including
non-malignancies)
% (malignancies
 only)
Average
annual cases
Average
ASIR
APC Year 95% CI p-value
British Columbia
All childhood cancers (malignancies only) 2030 96.26 100.00 105 152.22 0.23 1992–2010 -0.80 to 1.27 0.65
All childhood cancers including non-malignancies brain 2110 100.00 103.89 110 158.01 0.32 1992–2010 -0.67 to 1.31 0.51
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 695 32.92 34.20 40 52.82 0.33 1992–2010 -1.14 to 1.83 0.64
Lymphomas and reticuloendothelial neoplasms 220 10.37 10.78 10 15.81 1.03 1992–2010 -1.92 to 4.06 0.48
CNS and miscellaneous intracranial and intraspinal neoplasms 380 18.00 18.70 20 28.30 0.43 1992–2010 -1.29 to 2.18 0.61
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 460 21.74 22.59 25 34.09 0.79 1992–2010 -0.87 to 2.47 0.33
Neuroblastoma and other peripheral nervous cell tumors 155 7.34 7.63 5 12.19 2.44 1992–2010 -0.11 to 5.06 0.06
Retinoblastoma 50 2.32 2.41 5 3.87 -1.54 1992–2010 -4.88 to 1.92 0.36
Renal tumours 110 5.07 5.27 5 8.15 -1.32 1992–2010 -3.89 to 1.32 0.30
Hepatic tumours 35 1.61 1.67 0 2.61 9.86 1992–1999 -0.72 to 21.56 0.06
-32.48 1999–2002 -71.72 to 61.22 0.33
43.69 2002–2005 Table 3 - Footnote 0.37
-14.53 2005–2010 -29.37 to 3.43 0.09
Malignant bone tumours 115 5.45 5.66 5 8.18 -1.12 1992–2010 -4.46 to 2.34 0.50
Soft tissue and other extraosseous sarcomas 135 6.30 6.55 5 9.74 -0.69 1992–2010 -3.58 to 2.29 0.63
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 75 3.55 3.69 5 5.44 -2.11 1992–2010 -6.51 to 2.49 0.34
Other malignant epithelial neoplasms and malignant melanomas 60 2.98 3.10 5 4.56 0.49 1992–2010 -3.65 to 4.79 0.81
Prairies
All childhood cancers (malignancies only) 2885 94.97 100.00 155 141.12 0.35 1992–2010 -0.39 to 1.10 0.33
All childhood cancers including non-malignancies brain 3040 100.00 105.30 160 148.50 0.26 1992–2010 -0.47 to 1.00 0.47
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 945 31.16 32.81 50 46.71 0.84 1992–2010 -0.55 to 2.25 0.22
Lymphomas and reticuloendothelial neoplasms 325 10.73 11.30 15 15.64 1.86 1992–2010 -0.17 to 3.94 0.07
II(B) Non-Hodgkin lymphomas (except Burkitt lymphoma)
115 3.82 4.02 5 5.60 4.81 1992–2010 1.58 to 8.14 0.01
CNS and miscellaneous intracranial and intraspinal neoplasms 610 20.04 21.10 30 29.47 -0.09 1992–2010 -1.49 to 1.33 0.90
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 760 25.07 26.40 40 36.85 -0.39 1992–2010 -1.69 to 0.92 0.53
Neuroblastoma and other peripheral nervous cell tumors 205 6.68 7.03 10 10.22 0.17 1992–2010 -1.43 to 1.79 0.83
Retinoblastoma 75 2.44 2.56 5 3.71 -0.31 1992–2010 -4.14 to 3.68 0.87
Renal tumours 185 6.02 6.34 10 9.10 -1.65 1992–2010 -4.29 to 1.07 0.22
Hepatic tumours 55 1.68 1.77 0 2.57 3.48 1992–2010 -1.25 to 8.44 0.14
Malignant bone tumours 125 4.15 4.37 10 5.98 1.25 1992–2010 -1.90 to 4.50 0.42
VIII(C) Ewing tumor and related sarcomas of bone
45 1.55 1.63 0 2.23 4.14 1992–2010 0.72 to 7.68 0.02
Soft tissue and other extraosseous sarcomas 175 5.69 5.99 5 8.40 -0.12 1992–2010 -2.68 to 2.52 0.92
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 105 3.49 3.67 5 5.12 -0.68 1992–2010 -3.56 to 2.28 0.63
X(C) Malignant gonadal germ cell tumors
40 1.32 1.39 0 1.93 -5.85 1992–2010 -9.49 to -2.06 0.01
Other malignant epithelial neoplasms and malignant melanomas 80 2.67 2.81 0 3.87 -1.39 1992–2010 -5.45 to 2.85 0.49
OntarioTable 3 - Footnote b
All childhood cancers (malignancies only) 6655 100.00 100.00 350 157.62 -0.05 1992–2006 -0.67 to 0.56 0.85
5.91 2006–2010 1.90 to 10.08 0.01
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 2110 31.69 31.69 110 50.12 0.78 1992–2010 -0.34 to 1.92 0.16
I(A) Lymphoid leukemias
1675 25.17 25.17 90 39.87 1.33 1992–2010 0.24 to 2.44 0.02
Lymphoid leukemias, precursor cell leukemias
1480 22.29 22.29 80 35.26 1.12 1992–2000 -2.78 to 5.17 0.55
-13.91 2000–2004 -29.82 to 5.62 0.14
14.23 2004–2010 7.50 to 21.37 < 0.01
I(C) Chronic myeloproliferative diseases
30 0.45 0.45 0 0.70 -9.02 1992–2010 -13.48 to -4.33 < 0.01
I(E) Unspecified and other specified leukemias
90 1.40 1.40 5 2.21 18.50 1992–2001 5.61 to 32.96 0.01
-12.68 2001–2010 -22.51 to -1.59 0.03
Lymphomas and reticuloendothelial neoplasms 775 11.63 11.63 40 17.91 0.64 1992–2010 -0.83 to 2.12 0.37
II(D) Miscellaneous lymphoreticular neoplasms
65 0.98 0.98 0 1.55 7.59 1992–2010 3.09 to 12.29 < 0.01
II(E) Unspecified lymphomas
155 2.28 2.28 5 3.50 4.34 1992–2010 1.27 to 7.51 0.01
CNS and miscellaneous intracranial and intraspinal neoplasms 1340 20.14 20.14 70 31.49 -1.40 1992–2004 -2.82 to 0.05 0.06
4.99 2004–2010 0.96 to 9.18 0.02
III(A) Ependymomas and choroid plexus tumor
115 1.68 1.68 5 2.69 3.33 1992–2010 0.68 to 6.05 0.02
III(B) Astrocytomas
575 8.65 8.65 30 13.47 -5.90 1992–2004 -7.96 to -3.80 < 0.01
5.65 2004–2010 -1.56 to 13.39 0.12
III(D) Other gliomas
185 2.76 2.76 5 4.32 4.52 1992–2010 2.34 to 6.74 < 0.01
III(F) Unspecified intracranial and intraspinal neoplasms
145 2.16 2.16 5 3.35 12.13 1992–2005 3.76 to 21.17 0.01
-21.74 2005–2010 -40.25 to 2.51 0.07
Neuroblastoma and other peripheral nervous cell tumors 445 6.67 6.67 25 10.94 1.85 1992–2010 -0.35 to 4.09 0.09
Retinoblastoma 165 2.43 2.43 10 4.03 1.10 1992–2010 -1.26 to 3.52 0.34
Renal tumours 350 5.29 5.29 15 8.45 -0.63 1992–2010 -2.40 to 1.17 0.47
Hepatic tumours 105 1.59 1.59 5 2.60 1.15 1992–2010 -2.01 to 4.42 0.46
Malignant bone tumours 285 4.28 4.28 15 6.58 -0.90 1992–2010 -3.02 to 1.28 0.39
Soft tissue and other extraosseous sarcomas 395 5.93 5.93 25 9.32 0.28 1992–2010 -1.49 to 2.08 0.75
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 205 3.06 3.06 10 4.82 1.46 1992–2010 -0.88 to 3.85 0.21
Other malignant epithelial neoplasms and malignant melanomas 290 4.33 4.33 15 6.66 3.85 1992–2010 1.07 to 6.71 0.01
XI(B) Thyroid carcinomas
110 1.65 1.65 10 2.49 6.34 1992–2010 2.98 to 9.81 < 0.01
Other and unspecified malignant neoplasms 195 2.96 2.96 10 4.69 2.17 1992–2010 -2.01 to 6.54 0.29
XII(B) Other unspecified malignant tumors
180 2.70 2.70 10 4.27 65.13 1992–1996 5.53 to 158.41 0.03
-2.18 1996–2010 -6.07 to 1.87 0.26
Quebec
All childhood cancers (malignancies only) 4140 96.60 100.00 220 168.59 0.13 1992–2010 -0.53 to 0.79 0.69
All childhood cancers including non-malignancies brain 4290 100.00 103.52 225 174.36 0.05 1992–2010 -0.60 to 0.71 0.87
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 1310 30.54 31.61 70 53.70 0.57 1992–2010 -0.52 to 1.67 0.29
I(D) Myelodysplastic syndrome and other myeloproliferative diseases
35 0.77 0.80 0 1.38 18.53 1992–2004 4.42 to 34.55 0.01
-12.36 2004–2010 -24.97 to 2.35 0.09
Lymphomas and reticuloendothelial neoplasms 460 10.72 11.10 25 18.16 -1.06 1992–2010 -2.97 to 0.90 0.27
CNS and miscellaneous intracranial and intraspinal neoplasms 770 17.88 18.51 40 31.01 0.50 1992–2010 -0.75 to 1.77 0.41
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 910 21.28 22.03 45 36.78 2.58 1992–2005 1.19 to 3.99 < 0.01
-10.14 2005–2010 -16.05 to -3.83 < 0.01
III(F) Unspecified intracranial and intraspinal neoplasms including non-malignancies
80 1.84 1.91 5 3.14 -14.70 1992–2001 -25.16 to -2.77 0.02
47.35 2001–2004 Table 3 - Footnote 0.55
-33.06 2004–2010 -54.59 to -1.34 0.04
Neuroblastoma and other peripheral nervous cell tumors 385 8.97 9.29 20 16.08 -1.27 1992–2010 -3.56 to 1.08 0.27
Retinoblastoma 115 2.66 2.75 5 4.79 -0.20 1992–2010 -3.46 to 3.17 0.90
Renal tumours 235 5.57 5.77 15 10.01 0.08 1992–2010 -2.61 to 2.85 0.95
Hepatic tumours 45 1.10 1.13 5 1.99 4.06 1992–2010 -0.33 to 8.64 0.07
Malignant bone tumours 185 4.31 4.46 5 7.21 -4.88 1992–2002 -8.45 to -1.16 0.01
6.19 2002–2010 0.39 to 12.32 0.04
Soft tissue and other extraosseous sarcomas 265 6.25 6.47 15 10.78 0.04 1992–2010 -2.27 to 2.41 0.97
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 130 3.05 3.16 10 5.31 -1.21 1992–2010 -4.90 to 2.63 0.51
X(B) Malignant extracranial and extragonadal germ cell tumors
35 0.77 0.80 0 1.41 9.46 1992–2004 2.62 to 16.75 0.01
-26.73 2004–2010 -40.96 to -9.06 0.01
Other malignant epithelial neoplasms and malignant melanomas 180 4.22 4.37 10 7.20 3.47 1992–2010 0.40 to 6.63 0.03
XI(B) Thyroid carcinomas
75 1.72 1.79 5 2.94 8.21 1992–2010 3.61 to 13.02 < 0.01
Other and unspecified malignant neoplasms 60 1.33 1.38 0 2.36 1.09 1992–2010 -4.07 to 6.53 0.67
Atlantic provinces
All childhood cancers (malignancies only) 1180 96.00 100.00 60 152.27 0.34 1992–2010 -0.90 to 1.59 0.57
All childhood cancers including non-malignancies brain 1225 100.00 104.16 65 158.19 0.23 1992–2010 -1.01 to 1.49 0.70
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 410 33.44 34.83 20 53.90 0.90 1992–2010 -1.20 to 3.05 0.38
Lymphomas and reticuloendothelial neoplasms 120 9.71 10.11 5 14.72 1.38 1992–2010 -1.47 to 4.30 0.33
CNS and miscellaneous intracranial and intraspinal neoplasms 230 18.68 19.46 10 28.77 8.63 1992–1998 -1.07 to 19.29 0.08
-6.38 1998–2010 -10.19 to -2.40 < 0.01
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 280 22.68 23.62 15 34.69 10.74 1992–1998 1.84 to 20.43 0.02
-7.22 1998–2010 -10.52 to -3.79 < 0.01
Neuroblastoma and other peripheral nervous cell tumors 75 5.87 6.12 5 10.12 2.22 1992–2010 -0.60 to 5.11 0.12
Retinoblastoma 30 2.45 2.55 0 4.19 55.50 1992–1996 Table 3 - Footnote 0.23
-30.80 1996–2002 -44.84 to -13.17 0.01
163.12 2002–2006 Table 3 - Footnote 0.04
-55.12 2006–2010 -71.86 to -28.43 < 0.01
Renal tumours 65 5.22 5.44 5 8.81 1.27 1992–2010 -2.62 to 5.32 0.51
Malignant bone tumours 50 4.00 4.16 5 5.91 3.84 1992–2010 -1.65 to 9.64 0.16
Soft tissue and other extraosseous sarcomas 90 7.01 7.31 5 10.77 0.07 1992–2010 -4.28 to 4.62 0.97
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 35 3.10 3.23 0 4.88 -0.87 1992–2010 -3.88 to 2.23 0.56
Other malignant epithelial neoplasms and malignant melanomas 50 4.32 4.50 0 6.43 0.63 1992–2010 -2.27 to 3.61 0.66
Territories
All childhood cancers (malignancies only) 55 98.21 100.00 5 106.35 0.51 1992–2010 -2.90 to 4.04 0.76
All childhood cancers including non-malignant CNS tumors 55 100.00 101.82 5 108.15 0.53 1992–2010 -2.88 to 4.07 0.75
Data sources: Canadian Cancer Registry (CCR) database at Statistics Canada and Quebec Cancer Registry (2008-2010).
Table 4. Annual percent changes (APC) of age standardized incidence rates (ASIRs)Table 4 - Footnote a  (per million) of selected ICCC diagnosis categories by geographic region, males, Canada, 1992–2010
Total cases % (including
non-malignancies)
% (malignancies
 only)
Average
annual cases
Average
ASIR
APC Year 95% CI p-value
British Columbia
All childhood cancers (malignancies only) 1095 96.21 100.00 55 158.93 0.41 1992–2010 -1.06 to 1.90 0.56
All childhood cancers including non-malignancies brain 1135 100.00 103.94 60 165.02 0.53 1992–2010 -0.90 to 1.98 0.45
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 380 33.66 34.98 20 56.45 0.94 1992–2010 -0.84 to 2.74 0.28
Lymphomas and reticuloendothelial neoplasms 150 13.04 13.55 10 20.83 2.72 1992–2010 -0.77 to 6.32 0.12
CNS and miscellaneous intracranial and intraspinal neoplasms 190 16.92 17.58 10 27.64 -0.24 1992–2010 -2.61 to 2.18 0.83
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 235 20.70 21.52 10 33.73 0.48 1992–2010 -2.05 to 3.08 0.70
Neuroblastoma and other peripheral nervous cell tumors 70 6.17 6.41 5 10.70 3.71 1992–2010 -0.41 to 8.00 0.08
Retinoblastoma 30 2.47 2.56 5 4.26 -3.92 1992–2010 -6.78 to -0.97 0.01
Renal tumours 60 5.02 5.22 0 8.48 0.68 1992–2010 -2.70 to 4.19 0.68
Malignant bone tumours 55 4.85 5.04 0 7.64 -1.88 1992–2010 -7.61 to 4.22 0.52
Soft tissue and other extraosseous sarcomas 70 5.99 6.23 5 9.66 -0.62 1992–2010 -4.66 to 3.59 0.76
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 40 3.52 3.66 0 5.72 -4.24 1992–2010 -8.65 to 0.37 0.07
Other malignant epithelial neoplasms and malignant melanomas 30 2.29 2.38 5 3.68 0.15 1992–2010 -4.13 to 4.63 0.94
Prairies
All childhood cancers (malignancies only) 1580 95.13 100.00 85 150.77 0.85 1992–2010 -0.09 to 1.79 0.07
All childhood cancers including non-malignancies brain 1660 100.00 105.12 85 158.35 0.76 1992–2010 -0.12 to 1.64 0.09
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 535 32.35 34.01 30 51.70 1.54 1992–2010 -0.40 to 3.52 0.11
Lymphomas and reticuloendothelial neoplasms 210 12.75 13.40 15 19.78 1.16 1992–2010 -1.15 to 3.52 0.31
II(B) Non-Hodgkin lymphomas (except Burkitt lymphoma)
75 4.45 4.68 0 6.91 3.84 1992–2010 0.29 to 7.51 0.04
CNS and miscellaneous intracranial and intraspinal neoplasms 335 19.96 20.99 15 31.36 0.99 1992–2010 -0.72 to 2.74 0.24
III(C) Intracranial and intraspinal embryonal tumors
75 4.63 4.87 5 7.27 -18.75 1992–1996 -43.00 to 15.83 0.23
6.34 1996–2010 0.33 to 12.71 0.04
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 410 24.83 26.11 20 38.94 0.64 1992–2010 -0.80 to 2.10 0.36
III(C) Intracranial and intraspinal embryonal tumors including non-malignancies
80 4.63 4.87 5 7.27 -18.75 1992–1996 -43.00 to 15.83 0.23
6.34 1996–2010 0.33 to 12.71 0.04
Neuroblastoma and other peripheral nervous cell tumors 100 6.01 6.32 5 9.84 1.04 1992–2010 -1.98 to 4.15 0.48
Retinoblastoma 30 1.98 2.09 0 3.27 -2.99 1992–2010 -7.49 to 1.73 0.20
Renal tumours 90 5.29 5.56 5 8.50 -3.27 1992–2010 -6.35 to -0.09 0.04
Hepatic tumours 35 2.10 2.21 0 3.43 4.34 1992–2010 -0.78 to 9.71 0.09
Malignant bone tumours 65 3.67 3.86 5 5.67 1.32 1992–2010 -2.64 to 5.45 0.50
Soft tissue and other extraosseous sarcomas 95 5.65 5.94 5 8.87 -1.35 1992–2010 -4.96 to 2.40 0.45
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 50 2.89 3.03 0 4.55 -2.61 1992–2010 -6.80 to 1.76 0.22
Other malignant epithelial neoplasms and malignant melanomas 40 2.22 2.34 0 3.44 1.75 1992–2010 -2.90 to 6.62 0.44
OntarioTable 4 - Footnote b
All childhood cancers (malignancies only) 3585 100.00 100.00 190 165.70 1.55 1992–2002 0.45 to 2.66 0.01
-5.12 2002–2005 -17.46 to 9.05 0.42
5.00 2005–2010 1.87 to 8.23 < 0.01
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 1150 32.11 32.11 60 53.46 0.89 1992–2010 -0.06 to 1.84 0.06
I(A) Lymphoid leukemias
935 26.05 26.05 45 43.43 1.36 1992–2010 0.28 to 2.45 0.02
Lymphoid leukemias, precursor cell leukemias
820 22.93 22.93 45 38.16 1.28 1992–2001 -2.63 to 5.34 0.49
-18.31 2001–2004 -50.22 to 34.07 0.39
13.60 2004–2010 5.26 to 22.61 < 0.01
Lymphomas and reticuloendothelial neoplasms 505 14.06 14.06 25 22.79 1.15 1992–2010 -0.76 to 3.09 0.22
II(E) Unspecified lymphomas
100 2.79 2.79 5 4.51 4.46 1992–2010 1.69 to 7.30 < 0.01
CNS and miscellaneous intracranial and intraspinal neoplasms 730 20.31 20.31 40 33.34 0.26 1992–2010 -1.07 to 1.61 0.68
III(B) Astrocytomas
285 8.01 8.01 15 13.09 -2.42 1992–2010 -4.58 to -0.22 0.03
III(D) Other gliomas
90 2.51 2.51 5 4.14 4.71 1992–2010 1.01 to 8.54 0.02
Neuroblastoma and other peripheral nervous cell tumors 250 6.89 6.89 10 11.87 1.30 1992–2010 -1.16 to 3.83 0.28
Retinoblastoma 80 2.26 2.26 0 3.92 -1.36 1992–2010 -5.10 to 2.53 0.47
Renal tumours 150 4.13 4.13 10 7.00 -0.15 1992–2010 -2.75 to 2.53 0.91
Hepatic tumours 65 1.84 1.84 5 3.13 3.58 1992–2010 0.32 to 6.94 0.03
VII(A) Hepatoblastoma
55 1.48 1.48 5 2.54 5.80 1992–2010 2.68 to 9.02 < 0.01
Malignant bone tumours 145 4.02 4.02 5 6.47 -0.71 1992–2010 -3.66 to 2.32 0.62
Soft tissue and other extraosseous sarcomas 220 6.19 6.19 10 10.17 -0.74 1992–2010 -3.30 to 1.89 0.56
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 85 2.48 2.48 5 4.14 1.31 1992–2010 -2.62 to 5.39 0.50
Other malignant epithelial neoplasms and malignant melanomas 115 3.18 3.18 5 5.16 1.36 1992–2010 -2.09 to 4.93 0.42
XI(B) Thyroid carcinomas
35 0.86 0.86 0 1.36 5.68 1992–2010 1.91 to 9.58 0.01
Other and unspecified malignant neoplasms 95 2.54 2.54 5 4.25 1.20 1992–2010 -4.34 to 7.06 0.66
Quebec
All childhood cancers (malignancies only) 2230 95.92 100.00 115 177.37 0.14 1992–2010 -0.63 to 0.92 0.71
All childhood cancers including non-malignancies brain 2325 100.00 104.25 125 184.65 -0.05 1992–2010 -0.79 to 0.70 0.89
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 715 30.63 31.93 35 56.99 0.14 1992–2010 -1.49 to 1.80 0.86
I(C) Chronic myeloproliferative diseases
30 1.25 1.30 0 2.35 5.96 1992–2010 1.38 to 10.75 0.01
Lymphomas and reticuloendothelial neoplasms 320 13.57 14.15 20 24.37 -1.80 1992–2010 -3.96 to 0.40 0.10
CNS and miscellaneous intracranial and intraspinal neoplasms 425 18.08 18.85 20 33.30 0.35 1992–2010 -1.50 to 2.24 0.69
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 515 22.16 23.11 25 40.59 2.06 1992–2004 0.14 to 4.01 0.04
-7.38 2004–2010 -12.91 to -1.50 0.02
III(E) Other specified intracranial and intraspinal neoplasms including non-malignancies
55 2.28 2.37 0 4.05 -13.60 1992–2000 -22.56 to -3.60 0.01
14.61 2000–2006 -2.67 to 34.97 0.09
-47.06 2006–2010 -73.25 to 4.77 0.06
III(F) Unspecified intracranial and intraspinal neoplasms including non-malignancies
50 2.10 2.19 5 3.78 -7.94 1992–2010 -12.27 to -3.41 < 0.01
Neuroblastoma and other peripheral nervous cell tumors 195 8.29 8.64 10 15.87 0.38 1992–2010 -2.10 to 2.93 0.75
Retinoblastoma 60 2.58 2.69 5 4.89 -0.92 1992–2010 -4.05 to 2.32 0.55
Renal tumours 105 4.38 4.57 5 8.40 0.97 1992–2010 -3.36 to 5.50 0.65
Hepatic tumours 30 1.29 1.34 0 2.49 2.12 1992–2010 -2.37 to 6.81 0.34
Malignant bone tumours 100 4.17 4.34 5 7.38 0.99 1992–2010 -1.95 to 4.02 0.49
Soft tissue and other extraosseous sarcomas 140 6.01 6.27 10 10.93 -0.58 1992–2010 -3.89 to 2.85 0.72
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 60 2.66 2.78 5 4.94 1.02 1992–2010 -2.55 to 4.73 0.56
Other malignant epithelial neoplasms and malignant melanomas 70 2.92 3.05 5 5.28 2.62 1992–2010 -2.05 to 7.51 0.26
Other and unspecified malignant neoplasms 30 1.33 1.39 5 2.54 4.58 1992–2010 0.13 to 9.23 0.04
Atlantic provinces
All childhood cancers (malignancies only) 615 95.49 100.00 35 154.99 0.06 1992–2010 -1.81 to 1.96 0.95
All childhood cancers including non-malignancies brain 645 100.00 104.72 35 161.76 -0.12 1992–2010 -2.08 to 1.89 0.90
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 210 33.13 34.69 10 54.85 1.61 1992–2010 -1.38 to 4.68 0.27
Lymphomas and reticuloendothelial neoplasms 80 12.29 12.87 5 19.19 1.72 1992–2010 -2.17 to 5.77 0.37
CNS and miscellaneous intracranial and intraspinal neoplasms 120 18.20 19.06 5 28.53 -2.78 1992–2010 -5.99 to 0.54 0.09
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 145 22.71 23.78 5 35.30 12.16 1992–1997 -5.79 to 33.52 0.18
-7.45 1997–2010 -12.19 to -2.45 0.01
Neuroblastoma and other peripheral nervous cell tumors 40 6.22 6.51 5 10.96 0.35 1992–2010 -3.31 to 4.15 0.84
Malignant bone tumours 30 4.67 4.89 5 7.12 1.69 1992–2010 -4.36 to 8.13 0.57
Soft tissue and other extraosseous sarcomas 45 6.53 6.84 5 10.22 -24.40 1992–1998 -37.07 to -9.17 0.01
21.86 1998–2006 0.80 to 47.31 0.04
-25.26 2006–2010 -49.89 to 11.46 0.14
Territories
All childhood cancers (malignancies only) 25 100.00 100.00 0 95.99 0.42 1992–2010 -3.46 to 4.45 0.82
All childhood cancers including non-malignant CNS tumors 25 100.00 100.00 0 95.99 0.42 1992–2010 -3.46 to 4.45 0.82
Data sources: Canadian Cancer Registry (CCR) database at Statistics Canada and Quebec Cancer Registry (2008-2010).
Table 5. Annual percent changes (APC) of age standardized incidence rates (ASIRs)Table 5 - Footnote a  (per million) of selected ICCC diagnosis categories by geographic region, females, Canada, 1992–2010
Total cases % (including
non-malignancies)
% (malignancies
 only)
Average
annual cases
Average
ASIR
APC Year 95% CI p-value
British Columbia
All childhood cancers (malignancies only) 940 96.31 100.00 50 145.09 -0.07 1992–2010 -1.56 to 1.43 0.92
All childhood cancers including non-malignancies brain 975 100.00 103.83 50 150.57 0.00 1992–2010 -1.50 to 1.52 1.00
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 310 32.07 33.30 20 48.97 -0.57 1992–2010 -2.78 to 1.70 0.60
I(B) Acute myeloid leukemias
50 5.02 5.21 5 7.50 -17.65 1992–1996 -37.50 to 8.50 0.15
38.45 1996–1999 Table 5 - Footnote 0.38
-10.68 1999–2010 -16.27 to -4.72 < 0.01
Lymphomas and reticuloendothelial neoplasms 70 7.27 7.55 5 10.49 -1.96 1992–2010 -6.17 to 2.43 0.35
CNS and miscellaneous intracranial and intraspinal neoplasms 190 19.26 20.00 10 29.01 0.95 1992–2010 -1.80 to 3.77 0.48
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 220 22.95 23.83 15 34.49 0.93 1992–2010 -1.73 to 3.67 0.47
Neuroblastoma and other peripheral nervous cell tumors 85 8.71 9.04 5 13.76 1.44 1992–2010 -2.01 to 5.01 0.40
Renal tumours 50 5.12 5.32 0 7.80 -2.06 1992–2010 -6.62 to 2.73 0.37
Malignant bone tumours 60 6.15 6.38 5 8.75 -1.80 1992–2010 -5.81 to 2.37 0.37
Soft tissue and other extraosseous sarcomas 65 6.66 6.91 5 9.83 0.67 1992–2010 -3.22 to 4.73 0.72
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 35 3.59 3.72 5 5.14 2.86 1992–2010 -2.08 to 8.04 0.24
Other malignant epithelial neoplasms and malignant melanomas 40 3.79 3.94 5 5.48 0.30 1992–2010 -4.31 to 5.14 0.89
Prairies
All childhood cancers (malignancies only) 1305 94.77 100.00 70 130.92 -0.24 1992–2010 -1.18 to 0.72 0.61
All childhood cancers including non-malignancies brain 1375 100.00 105.52 75 138.09 -0.35 1992–2010 -1.31 to 0.62 0.45
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 410 29.72 31.37 20 41.42 -0.02 1992–2010 -1.47 to 1.46 0.98
Lymphomas and reticuloendothelial neoplasms 110 8.28 8.74 5 11.28 3.50 1992–2010 0.26 to 6.84 0.04
II(B) Non-Hodgkin lymphomas (except Burkitt lymphoma)
45 3.05 3.22 0 4.21 6.03 1992–2010 1.64 to 10.61 0.01
CNS and miscellaneous intracranial and intraspinal neoplasms 280 20.13 21.24 15 27.47 -1.38 1992–2010 -3.43 to 0.72 0.18
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 350 25.36 26.76 15 34.64 -1.62 1992–2010 -3.76 to 0.56 0.13
Neuroblastoma and other peripheral nervous cell tumors 100 7.49 7.90 5 10.61 -1.29 1992–2010 -4.42 to 1.93 0.40
Retinoblastoma 45 2.98 3.14 0 4.18 -1.50 1992–2010 -4.86 to 1.99 0.37
Renal tumours 95 6.90 7.29 5 9.73 -0.07 1992–2010 -3.92 to 3.94 0.97
Malignant bone tumours 65 4.72 4.98 5 6.30 0.64 1992–2010 -4.14 to 5.66 0.79
Soft tissue and other extraosseous sarcomas 75 5.74 6.06 0 7.92 1.72 1992–2010 -1.76 to 5.33 0.32
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 60 4.22 4.45 0 5.73 -4.00 1992–2005 -8.39 to 0.60 0.08
11.42 2005–2010 -7.78 to 34.62 0.24
Other malignant epithelial neoplasms and malignant melanomas 40 3.20 3.37 0 4.32 -4.46 1992–2010 -8.19 to -0.59 0.03
OntarioTable 5 - Footnote b
All childhood cancers (malignancies only) 3070 100.00 100.00 165 149.15 -0.48 1992–2006 -1.82 to 0.87 0.45
8.96 2006–2010 0.15 to 18.56 0.05
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 960 31.21 31.21 50 46.64 0.58 1992–2010 -1.29 to 2.48 0.53
Lymphoid leukemias, precursor cell leukemias
665 21.54 21.54 35 32.22 10.41 1992–1996 -8.74 to 33.58 0.28
-8.94 1996–2004 -16.60 to -0.57 0.04
14.42 2004–2010 3.53 to 26.46 0.01
I(E) Unspecified and other specified leukemias
45 1.50 1.50 5 2.26 17.14 1992–1999 1.88 to 34.69 0.03
-5.28 1999–2010 -10.93 to 0.73 0.08
Lymphomas and reticuloendothelial neoplasms 270 8.79 8.79 15 12.79 -0.41 1992–2010 -2.34 to 1.56 0.66
CNS and miscellaneous intracranial and intraspinal neoplasms 615 19.95 19.95 35 29.54 0.34 1992–2010 -1.17 to 1.86 0.64
III(A) Ependymomas and choroid plexus tumor
50 1.56 1.56 5 2.38 -4.60 1992–2003 -11.72 to 3.08 0.21
17.38 2003–2010 3.29 to 33.38 0.02
III(B) Astrocytomas
285 9.40 9.40 15 13.86 -3.74 1992–2010 -5.84 to -1.59 < 0.01
III(C) Intracranial and intraspinal embryonal tumors
100 3.29 3.29 5 4.91 4.01 1992–2010 1.83 to 6.24 < 0.01
III(D) Other gliomas
95 3.06 3.06 5 4.52 3.26 1992–2010 0.62 to 5.98 0.02
III(F) Unspecified intracranial and intraspinal neoplasms
75 2.41 2.41 5 3.54 15.32 1992–2005 6.45 to 24.93 < 0.01
-36.13 2005–2010 -57.62 to -3.75 0.03
Neuroblastoma and other peripheral nervous cell tumors 195 6.41 6.41 10 9.97 2.50 1992–2010 -0.51 to 5.60 0.10
Retinoblastoma 80 2.64 2.64 5 4.15 3.98 1992–2010 0.91 to 7.15 0.01
Renal tumours 205 6.64 6.64 15 9.98 10.47 1992–1998 0.76 to 21.12 0.04
-19.07 1998–2002 -38.41 to 6.33 0.12
7.57 2002–2010 1.47 to 14.05 0.02
VI(A) Nephroblastoma and other nonepithelial renal tumors
180 5.92 5.92 10 8.91 12.18 1992–1998 0.83 to 24.81 0.04
-20.40 1998–2002 -42.21 to 9.65 0.15
8.81 2002–2010 1.69 to 16.43 0.02
Hepatic tumours 40 1.30 1.30 0 2.04 -1.61 1992–2010 -6.45 to 3.48 0.51
Malignant bone tumours 140 4.59 4.59 5 6.70 -1.37 1992–2010 -3.93 to 1.26 0.28
Soft tissue and other extraosseous sarcomas 170 5.63 5.63 10 8.43 1.43 1992–2010 -0.58 to 3.48 0.15
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 115 3.74 3.74 10 5.54 1.28 1992–2010 -1.79 to 4.45 0.40
X(B) Malignant extracranial and extragonadal germ cell tumors
35 1.11 1.11 0 1.74 4.76 1992–2010 0.38 to 9.34 0.03
Other malignant epithelial neoplasms and malignant melanomas 175 5.66 5.66 10 8.23 5.25 1992–2010 1.67 to 8.97 0.01
XI(B) Thyroid carcinomas
75 2.57 2.57 5 3.69 7.33 1992–2010 2.42 to 12.47 0.01
Other and unspecified malignant neoplasms 105 3.45 3.45 5 5.14 2.82 1992–2010 -1.04 to 6.83 0.14
Quebec
All childhood cancers (malignancies only) 1910 97.40 100.00 100 159.41 0.12 1992–2010 -0.73 to 0.99 0.76
All childhood cancers including non-malignancies brain 1965 100.00 102.67 105 163.57 0.18 1992–2010 -0.68 to 1.04 0.67
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 600 30.43 31.24 30 50.25 1.06 1992–2010 -0.30 to 2.43 0.12
Lymphomas and reticuloendothelial neoplasms 145 7.34 7.54 5 11.64 0.39 1992–2010 -3.03 to 3.93 0.82
CNS and miscellaneous intracranial and intraspinal neoplasms 345 17.64 18.11 15 28.61 0.60 1992–2010 -1.48 to 2.73 0.55
III(C) Intracranial and intraspinal embryonal tumors
75 3.87 3.98 5 6.24 -4.69 1992–2010 -8.61 to -0.61 0.03
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 395 20.23 20.77 25 32.77 0.92 1992–2010 -1.54 to 3.44 0.44
III(C) Intracranial and intraspinal embryonal tumors including non-malignancies
75 3.87 3.98 0 6.24 -4.69 1992–2010 -8.61 to -0.61 0.03
Neuroblastoma and other peripheral nervous cell tumors 195 9.79 10.05 10 16.30 -16.35 1992–1997 -28.80 to -1.73 0.03
2.01 1997–2010 -2.54 to 6.78 0.37
Retinoblastoma 55 2.75 2.83 0 4.68 1.03 1992–2010 -3.59 to 5.87 0.65
Renal tumours 135 6.98 7.17 10 11.71 -1.30 1992–2010 -3.55 to 1.00 0.25
Malignant bone tumours 90 4.49 4.60 5 7.02 -2.39 1992–2010 -5.30 to 0.60 0.11
Soft tissue and other extraosseous sarcomas 130 6.52 6.70 5 10.63 0.83 1992–2010 -1.51 to 3.24 0.47
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 65 3.52 3.61 5 5.69 -2.02 1992–2010 -6.55 to 2.73 0.37
Other malignant epithelial neoplasms and malignant melanomas 110 5.76 5.91 5 9.22 3.63 1992–2010 0.25 to 7.12 0.04
XI(B) Thyroid carcinomas
50 2.70 2.77 5 4.32 8.43 1992–2010 3.96 to 13.09 < 0.01
Other and unspecified malignant neoplasms 30 1.33 1.36 0 2.19 26.90 1992–1996 -4.07 to 67.87 0.09
-66.08 1996–1999 Table 5 - Footnote 0.98
88.43 1999–2003 Table 5 - Footnote 0.39
-13.52 2003–2010 -29.24 to 5.70 0.13
Atlantic provinces
All childhood cancers (malignancies only) 565 96.57 100.00 30 149.37 0.42 1992–2010 -1.69 to 2.58 0.68
All childhood cancers including non-malignancies brain 585 100.00 103.55 30 154.41 0.35 1992–2010 -1.67 to 2.41 0.72
Leukemias, myeloproliferative diseases, and myelodysplastic diseases 195 33.79 34.99 15 52.90 0.30 1992–2010 -2.58 to 3.27 0.83
I(B) Acute myeloid leukemias
35 6.52 6.75 0 10.43 14.42 1992–2003 4.23 to 25.60 0.01
-13.02 2003–2010 -24.21 to -0.17 0.05
Lymphomas and reticuloendothelial neoplasms 40 6.86 7.10 5 10.02 -0.94 1992–2010 -4.82 to 3.09 0.62
CNS and miscellaneous intracranial and intraspinal neoplasms 115 19.21 19.89 10 29.00 -0.32 1992–2010 -4.18 to 3.69 0.87
CNS and miscellaneous intracranial and intraspinal neoplasms including non-malignancies 130 22.64 23.45 5 34.04 -0.49 1992–2010 -4.13 to 3.29 0.79
Neuroblastoma and other peripheral nervous cell tumors 35 5.49 5.68 5 9.25 -38.68 1992–1996 -57.57 to -11.37 0.01
71.74 1996–1999 Table 5 - Footnote 0.46
2.00 1999–2010 -5.28 to 9.83 0.57
Renal tumours 35 6.17 6.39 0 10.08 -0.16 1992–2010 -3.71 to 3.51 0.92
Soft tissue and other extraosseous sarcomas 45 7.55 7.82 0 11.35 2.60 1992–2010 -2.42 to 7.88 0.29
Other malignant epithelial neoplasms and malignant melanomas 30 5.15 5.33 5 7.50 4.07 1992–2010 -0.19 to 8.52 0.06
Territories
All childhood cancers (malignancies only) 30 96.77 100.00 0 117.51 -1.43 1992–2010 -6.31 to 3.72 0.56
All childhood cancers including non-malignant CNS tumors 35 100.00 103.33 5 121.20 -1.33 1992–2010 -6.34 to 3.96 0.60
Data sources: Canadian Cancer Registry (CCR) database at Statistics Canada and Quebec Cancer Registry (2008-2010).

Recent incidence counts and rates (2006–2010)

Figure 1 summarizes the distribution of primary cancers for Canada from 2006 to 2010 by age groups for males and females combined and separately. During this period, an average of 910 new diagnoses each year; i.e., a total of 4550 new cases, were reported among children 14 years and under in Canada: 2440 (53.6%) in males and 2110 (46.4%) in females, which amounts to a male:female ratio of 1.2:1. The average annual ASIR was 163.4 per million children, with males having a higher rate than females (170.9 vs. 155.5 per 106 children). Average annual ASIRs for all cancers combined from 2006 to 2010 were lower in the Prairies (149.4 per 106) and higher in Ontario (170.1 per 106) (Figure 2).

Figure 2: Average annual age-standardized incidence rates (ASIRs) (per million) of all cancers combined and most common cancers (%) by region, age < 15, Canada, 2006-2010
Figure 2

Data sources: Canadian Cancer Registry (CCR) database at Statistics Canada and Quebec Cancer Registry (2008-2010).
Notes:

  1. The pie charts represent the percentage distribution of new cancer cases in each region.
  2. The ASIRs were standardized to the 2011 Canadian population.
Figure 2 - Text Description

In this figure presenting a map of Canada, we can see the average annual age-standardized incidence rates (ASIRs) (per million) of all cancers combined and most common cancers by region. Average annual ASIRs for all cancers combined from 2006 to 2010 were lower in the Prairies (149.4 per 106) and higher in Ontario (170.1 per 106). The top 5 most common cancers (leukemias, CNS, lymphomas, neuroblastoma and soft tissues) were similarly distributed within each region, with some variations in proportions and ranking in the Atlantic region, possibly due to Type I error from the small population in the region.

While most adult cancers are carcinomas, childhood cancers show much histologic and biologic diversity, and are mainly not of epithelial origin. Overall, the most common childhood cancers diagnosed from 2006 to 2010 were leukemias (32.3%), CNS tumors (18.9%), and lymphomas (11.1%) (Figure 1). Next most common were neuroblastoma (7.8%), soft tissue sarcoma (6.5%), and renal tumors (5.2%). The top 5 most common cancers were similarly distributed within each region, with some variations in proportions and ranking in the Atlantic region (Figure 2), possibly due to Type I error from the small population in the region. The distribution of the most frequent childhood cancers was generally the same for males and females, except lymphomas were more common in males (13.6% compared to 8.2% ), and carcinomas (especially, thyroid carcinoma) were more common in females (6.1% vs. 3.2%) (Figure 1).

Around half of children’s cancer cases (47.4%) were diagnosed among those under the age of five years (Figure 1). The age-specific incidence rates in children aged less than 5 years were around twice those of their older counterparts. The highest incidence was observed in infants under the age of one year and generally declined with age. Patterns of diagnoses varied considerably by age group. In infants, neuroblastoma formed the most commonly diagnosed cancers and accounted for nearly a third of all cases (26.4%), followed by leukemias (19.6%) and CNS tumours (11.7%). The embryonal tumors of neuroblastoma, retinoblastoma, and nephroblastoma jointly accounted for 42.6% of all diagnoses in infants. Leukemias prevailed among 1–4 year olds, accounting for 42.4% of all diagnoses, while in 5–9 year olds and 10–14 year olds, lymphomas and bone tumours became increasingly common (lymphomas: 12.2% and 21.0%; bone cancers: 5.4 % and 9.5%, respectively). Also in children aged 10–14 years, leukemias (21.5%) and CNS tumours (19.0%) predominated.

Overall temporal trends (1992–2010)

Trends varied greatly by cancer type, although the small numbers of some types may have resulted in extensive random fluctuations in rates even when the trend was statistically significant. The incidence rates of childhood cancer increased by an average of 0.4% per year (95% CI = 0.1–0.8), from 154.8 per million children in 1992 to 169.7 per million in 2010 (Table 1). Leukemia overall and lymphoid leukemia specifically had an equally increase from 1992 through 2010 (APC = 0.6%, CI = 0.1–1.2). Lymphoid leukemia is the most common type in children, accounting for nearly four-fifths (78.5%) of all leukemias and as such largely determined the incidence pattern for leukemia overall. Rates which increased by at least 2% annually over the study period included: unspecified lymphomas (APC = 3.4%; CI = 0.7–6.2), ependymomas (APC = 2.3%, CI = 0.2–4.3), hepatoblastoma (APC = 2.4%, CI = 0.4–4.4), carcinoma (APC = 2.5%, CI = 0.2–4.7), thyroid cancer (APC = 4.2, CI = 1.4–7.1) and melanoma (APC = 2.7%, CI = 0.1–5.4). The data suggested a decrease for malignant gonadal germ cell tumors (APC = −2.3%, CI = −4.4 to −0.03). Figure 3 highlights the trends for all cancers combined and the most common five cancers in children under 15 years of age.

Figure 3: Age-standardized incidence rates (ASIRs) for all cancers combined and top five most common cancers in children under 15 years of age, Canada, 1992-2010
Figure 3

Data sources: Canadian Cancer Registry (CCR) database at Statistics Canada and Quebec Cancer Registry (2008-2010).
Abbreviations: ASIR, age-standardized incidence rate; CNS, central nervous system.
Note: The ASIRs were standardized to the 2011 Canadian population.

Figure 3 - Text Description

This figure highlights the trends for all cancers combined by sex and the most common five cancers in children under 15 years of age. The incidence rates of childhood cancer increased by an average of 0.4% per year (95% CI = 0.1– 0.8), from 154.8 per million children in 1992 to 169.7 per million in 2010. The trend for all cancers combined among males (APC = 0.5%, CI = 0.2–0.9) paralleled the increase observed overall. A break in trend was observed for all cancers combined among females; the rate increased by 3.2% per year (CI = 0.4–6.2) from 2004 to 2010, which followed an initial period of stable rates. Leukemia increased by 0.6% annually from 1992 through 2010 (CI = 0.1–1.2). The incidence rates for CNS tumors, lymphomas, neuroblastomas, and soft tissue sarcomas have remained stable.

Trends by sex

The trends for all cancers combined (APC = 0.5%, CI = 0.2–0.9) and leukemias (APC = 0.8%, CI = 0.03–1.6) among males paralleled the increases observed overall (Table 1). A break in trend was observed for all cancers combined among females; the rate increased by 3.2% per year (CI = 0.4–6.2) from 2004 to 2010, which followed an initial period of stable rates. Positive trends were also observed for other hematologic malignancies over the entire period: miscellaneous lymphoreticular neoplasms in both males (APC = 6.8%, CI = 2.2–11.7) and females (APC = 4.6%, CI = 0.7–8.6), and unspecified lymphomas among males (APC = 3.3%, CI = 0.5–6.2). Some embryonal tumors demonstrated increasing trends in males. An increase occurred for neuroblastoma overall in males (APC = 1.4%, CI = 0.2–2.6), as did its subgroup of neuroblastoma and ganglioneuroblastoma (IV(A)) which comprised nearly all male neuroblastoma cases. Hepatoblastoma constituted four-fifths (81.3%) of all hepatic cancer cases in males; rates of hepatoblastoma increased by 3.2% per year (CI = 0.6–5.9), and drove the increase of 2.2% per year for hepatic cancers overall (CI = 0.01–4.4).

While incidence rates for CNS tumors have remained stable, some of its divisions showed significant changes. Notably, ependymomas increased among females (APC = 3.0%, CI = 0.6–5.4), echoing the rate transition of this disease overall. Incidence of carcinoma among females increased (APC = 2.9%, CI = 0.6–5.4), as did its subgroup of thyroid cancer (APC = 4.9%, CI = 1.8–8.0). For malignant gonadal germ cell tumors, the rate in males decreased (APC = −4.0%, CI = −6.7 to −1.2), with a non-significant less rapid decline in rates noted in females (APC = −1.4%, CI = −4.7 to 2.1).

Trends by age group

The overall increasing trend for all cancers combined was suggested among children aged 1–4 years (APC = 0.9%, CI = 0.4–1.3), whereas the rates appeared stable in other age groups (Table 2). Specifically, the incidence rate of lymphoid leukemias increased among children aged 1–4 years (APC = 0.9%, CI = 0.1–1.8).

Astrocytoma formed the largest subgroup of all CNS tumors, constituting more than two-fifths (45.0%) of the total. The incidence proportion of astrocytoma increased with age, from 32.4% in infants to 52.4% in late childhood. The rates of astrocytoma decreased by 2.1% annually among children aged 10–14 years (CI = −3.7 to −0.5) and appeared stable in the under-tens over the entire study period. In line with the trend observed overall and in females, the rates of ependymomas increased in infants and late childhood (APC = 5.6%, CI = 1.9–9.4 and APC = 5.1%, CI = 1.5–8.9, respectively), although the rates were based on small numbers of cases.

Several types of embryonal tumors demonstrate age difference in incidence trends. The rates increased by 1.6% per year (CI = 0.2–3.1) for neuroblastoma overall and equally for neuroblastoma and ganglioneuroblastoma (IV(A)) for children ages 1–4 years. Hepatoblastoma comprised nearly all hepatic cancer cases in children under 5 years of age. In children aged 1–4 years, rates of hepatoblastoma increased by 3.7% per year (CI = 1.1–6.4).

Trends by geographic area

Trends by geographic area are presented for both sexes combined (Table 3) and individually (Table 4 and 5). The rates of all cancers combined increased the most in Ontario from 2006 (APC = 5.9%, CI = 1.9–10.1) after a preceding stable period, and increased non-significantly in the other regions from 1992 to 2010. Positive trends in Ontario were noted for both sexes: while the trend among females was very similar to those observed overall, increases in trends in males occurred between 1992 and 2002 (APC = 1.6%, CI = 0.5–2.7), and more rapidly between 2005 and 2010 (APC = 5.0%, CI = 1.9–8.2). 

Some lymphohematopoietic malignancies demonstrated increasing trends in Ontario and the Prairies: lymphoid leukemias among males (APC = 1.4%, CI = 0.3–2.5) and among all children (APC = 1.3%, CI = 0.2–2.4), and unspecified lymphomas (APC = 4.3%, CI = 1.3–7.5) in Ontario; as well as lymphomas in females (APC = 3.5%, CI = 0.3–6.8), and non-Hodgkin lymphomas (except Burkitt lymphoma) in males and females combined (APC = 4.8%, CI = 1.6–8.1) and separately (males: APC = 3.8%, CI = 0.3–7.5; females: APC = 6.0%, CI = 1.6–10.6) in the Prairies. Two joinpoints suggest shifts in the direction of the trend for a subgroup of lymphoid leukemia, precursor cell lymphoblastic leukemia in Ontario for both sexes individually and combined: an early non-significant rise and a recent significant more rapid increase since 2004.

Amphi-directional incidence trends of CNS tumors were noted in some regions. Rates of CNS tumors in Ontario decreased non-significantly by 1.4% per year from 1992 to 2004 (CI = −2.8 to 0.1), and subsequently increased significantly by 5.0% per year from 2004 to 2010 (CI = 1.0–9.2). In comparison, the rates in the Atlantic region displayed a reverse trend. The ASIRs of CNS tumors in the Atlantic region were the highest in the country during 2002–2004 and then dropped to the lowest in 2005, and 2007–2010 (data not shown). Incidence of astrocytoma in Ontario decreased consistently over the study horizon in males (APC = −2.4%, CI = −4.6 to −0.2) and females (APC = −3.7%, CI = −5.8 to −1.6), while increases were observed for ependymomas (APC = 3.3%, CI = 0.7–6.1), intracranial and intraspinal embryonal tumors among females (APC = 4.0%, CI = 1.8–6.2), and other gliomas in males and females combined (APC = 4.5%, CI = 2.3–6.7) and separately (males: APC = 4.7%, CI = 1.0–8.5; females: APC = 3.3%, CI = 0.6–6.0).

Significant changes were also observed for other embryonal tumors in central Canada. Neuroblastoma in females in Quebec decreased significantly by 16.4% per year from 1992 to 1997, but increased non-significantly by 2% thereafter. For neuroblastoma in males in Quebec, a joinpoint was not suggested for the best fitted model, but an one-joinpoint model showed a similar but non-significant trend as that in females: the rates dropped by 7.0% (CI = −22.6 to 11.7) per year during 1992–1997, and then rose by 2.6% (CI = −2.1 to 7.5) (data not shown). Retinoblastoma increased by 4% annually (CI = 0.9–7.2) over the entire period in females in Ontario. Two breaks in trend show that there have been early (in the 1990s) and recent (since 2002), significant increases in the incidence of nephroblastomas in females in Ontario, and a corresponding trend was evident in renal tumors as a whole. There is a suggestion, however, that renal tumors among males decreased by 3.3% per year (CI = −6.4 to −0.1) in the Prairies.

The increases were similar for carcinoma in Ontario and Quebec, mainly driven by the increases in thyroid cancers more specifically among females. Bone cancer in Quebec decreased by 4.9% (CI = −8.5 to −1.2) per year from 1992 to 2002 for males and females combined and increased by 6.2% (CI = 0.4–12.3) thereafter. 

Discussion

Our study found that the incidence rates of childhood cancer increased by an average of 0.4% per year from 1992 to 2010. Similar increases have been documented in the United States,Footnote 5 Australia,Footnote 6 in European countries,Footnote 7 in Asian nations,Footnote 8 and internationally.Footnote 16 A study using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program indicated that the overall cancer incidence rates increased non-significantly by 0.4% per year between 1992 and 2004 in the US,Footnote 5 consistent with our change magnitude. The non-significant increase was updated to continue (APC = 0.3%, CI = −0.1 to 0.7) during 2001–2009 based on data which provided greater population coverage.Footnote 17 Considering the findings on all cancers combined from Ellison et al. who examined the top 5 most common cancers at the national level over the same time frame,Footnote 4 our study had comparable results for males and both sexes combined; however, it also revealed a recent substantial increase among females.

For the period from 2001 to 2010, our study showed an annual increase in overall rates of 1.5% (CI = 0.6–2.4), driven mainly by the increase in cancer rates in females (APC = 2.5%, CI = 1.2–3.8) (data not shown). The overall trend in females is due in large part to the rate increases in leukemias (APC = 2.3%, CI = 0.5–4.2), lymphomas (APC = 1.8%, CI = −1.9 to 5.6), neuroblastoma (APC = 3.7%, CI = −0.8 to 8.5), soft tissue sarcoma (APC = 3.9%, CI = −0.8 to 8.8), and most pronouncedly in thyroid cancer (APC = 10.4%, CI = 3.4–17.8) (data not shown). Regarding an earlier period (1985–1992), Health Canada reported that the incidence rates for all cancers combined in children and teenagers aged under 20 tended to increase slightly.Footnote 18

Broad similarities in the increase of ASIRs for some cancers raise questions as to the potential for common etiologies, given the etiology of pediatric cancer is largely unknown. Several hypotheses have been put forward to explain the trends. The changes may partially be artefacts of changes in classification, increased use of advanced diagnostic technology, and improved cancer reporting. The overall increases were confined to 1992–1999 and 2003–2010, mirrored trends in leukemias, lymphomas, soft tissue sarcoma, and CNS tumors (data not shown). The increases which occurred in 1992–1999 coincided with the introduction of ICCC in 1996 and the increased use of magnetic resonance imaging (MRI) during 1990–2001, whereas the increase which occurred in 2003–2010 coincided with the introduction of ICD-O-3 in 2001 and the increased use of molecular tests to supplement pathological diagnosis in an attempt to improve the precision and objectivity of the histopathological diagnosis. The incidence trends in children have also been associated with changes in environmental exposures or gene-environment interactions, parental lifestyle, changes in birth weight, or changes in social structures.Footnote 7

The observed increased incidence trends could, in part, be explained as an artefact of increases in survival. Prognosis has been improving in the last three decades as a result of more accurate diagnoses and improved treatment strategies. Research has shown that risk for subsequent malignant neoplasms is higher for childhood cancer survivors than is the risk for cancer in people of the same age in the general population.Footnote 19 Our data show that the percentage of second or third cancers increased from 0.7% in 1992 to 4.1% in 2006 (with an interruption in 2004), and then dropped sharply in males; as it did in females but with a smaller increase (data not shown). These increases of subsequent malignant neoplasms in Canada coincide with the magnitude and significance of the increases in the overall incidence trends.

Risk of pediatric cancer has been linked to maternal age at birth. A large US case–control study reported an increase of 8% in overall childhood cancer risk for each quinquennial increase in maternal age, with similar increases for most of the frequent cancers.Footnote 20 Maternal age could also be a marker for unknown environmental exposures which may have changed over time.Footnote 6 As in most developed countries, the average maternal ages at both first and all childbirths have risen since the mid-1970s in Canada.Footnote 21 During our study period, the average age at all childbirths increased from 27.9 years in 1992 to 30.1 years in 2010.Footnote 21 The rise of maternal age might have contributed to the incidence increase, but the extent to which this might occur is unknown.

Childhood cancer is characterized by heterogeneity, different cancers likely have different etiologies. To follow up our findings, it would be useful to identify the tumour types and population groups that were specifically affected by these trends. The strongest increase of ASIRs for all cancers combined is seen in children aged 1–4 years. The rise is driven, in large part, by an increase in leukemia, which is the most common cancer (accounting for a third of all cancers) in children. Ontario experienced the most pronounced increase from 2006 to 2010 for all cancers combined, and for leukemia, subgroups of lymphomas, CNS tumors, embryonal tumors, carcinoma and thyroid cancer. While demographic and/or etiologic differences could potentially exist between the geographic regions, the variation in cancer registry practices could also explain the geographical differences in cancer incidence.

Leukemia overall and lymphoid leukemia specifically had an equally significant increase. The incidence rate of lymphoid leukemia also increased significantly in those aged 1–4 years. Similar increases in leukemia have been reported in other developed countries.Footnote 5,Footnote 6,Footnote 22 Previous studies have shown that ionizing radiation, certain genetic disorders, high birth weight, cytotoxic alkylating agents, parental age, parental smoking, prenatal and postnatal pesticide exposures, residential traffic-related air pollution and prenatal exposure to infectious agents such as John Cunningham virus have been associated with leukemia in children.Footnote 23,Footnote 24,Footnote 25,Footnote 26,Footnote 27 Fetuses and young children might be more susceptible to the exposures because of their underdeveloped detoxification mechanisms or higher intake rates relative to their body weight compared with older children. There is considerable evidence of a positive association between improving socioeconomic status and a peak incidence of precursor B-cell acute lymphoblastic leukemia (ALL) in children aged 2–3.Footnote 28 It has also been suggested that aberrant immune response to delayed infection by unknown agents may play a role in conversion of preleukemic clones into overt precursor B-cell ALL.Footnote 23 Precursor cell lymphoblastic leukemia increased non-significantly by 0.4% per year (CI = −0.6 to 1.5) among Canadian children aged 1–4 years from 1992 to 2010 (Table 2), whereas a significant increase of the disease in Ontario was confined to 2004–2010 (Table 3). A Canadian spatial study found that areas with a higher proportion of immigrants had higher childhood leukemia incidence rates.Footnote 29 The proportion of immigrants in Canada steadily increased from 16.1% of the total population in 1991 to 18.4% in 2001 and 20.6% in 2011.Footnote 30 The percentage of immigrants who settled in Ontario was over 50% from 1992 to 2006,Footnote 31 with the proportion of immigrants increasing from 25.6% of the total provincial population in 1996, to 26.8% in 2001 and 28.3% in 2006.Footnote 32 The increased immigrant population may play a role in the observed increases in cancer incidence. However this association is from a single study.

The stable rate of CNS tumors was also observed in the US for similar reporting periods (1992–2004Footnote 5 and 1987–2009Footnote 33). The increase of CNS tumors in the US confined to 2000–2010 is comparable to the Ontario trend.Footnote 22 Also, a significant change in rate was found for non-malignant brain tumors in the US population. It has been suggested that the increase is likely attributable to changes in the detection and reporting of these diseases.Footnote 34 The recent increase of CNS tumors in Ontario may reflect the increased use of molecular markers to supplement pathological diagnosis.

The International Agency for Research on Cancer (IARC) stated that X-radiation and gamma-radiation, forms of ionizing radiation, are the only established risk factors for CNS cancers.Footnote 35 IARC also groups radiofrequency non-ionizing radiation from telecommunications as a possible cause of CNS malignancies, with limited evidence.Footnote 35,Footnote 36 Genetic and hereditary conditions are associated with an increased risk. Changes in environmental and medical exposures or gene-environment interactions, such as ionizing radiation and pesticides have been linked to the recent increases in incidence of CNS tumors.Footnote 37 A Canadian study found a positive association between astrocytoma and maternal exposure to residential air pollution.Footnote 24

Our study shows that incidence of hepatoblastoma has risen 2.4% per year between 1992 and 2010. An annual increase of 4% was observed in the US between 1992 and 2004.Footnote 5 Although few causes of hepatoblastoma have been established, several clues have emerged. StudiesFootnote 38,Footnote 39,Footnote 40 have found a strong association between hepatoblastoma and very low birth weight (VLBW) (< 1500 g), suggesting an iatrogenic etiology. Risk of hepatoblastoma was elevated 20-fold in Children with VLBW, and doubled in children with moderately low birth weight (1500–2500 g).Footnote 38 It has been previously noted that the rise in hepatoblastoma corresponds to the increase in the frequency of low or very low weight births in the US.Footnote 41 The Public Health Agency of Canada reported that the low birth weight rate generally increased from 2001 to 2010 in Canada.Footnote 42 Furthermore, the survival rate of low birth weight babies in Canada has increased with improved neonatal care. These together may, in part, account for the increased trend in hepatoblastoma in this study.

As presented in our data, neuroblastoma is the most common pediatric cancer diagnosed in infants,Footnote 43 accounting for 26.4% of all diagnoses in Canada. It is the third most frequent cancer in children 1–4 year olds, accounting for 10.5% of all cases (Figure 1). The incidence of neuroblastoma increased significantly in children 1–4 year olds during 1992–2010, similar to patterns observed in Europe.Footnote 43 Increased use of advanced diagnostic techniques, detecting latent or asymptomatic tumours, may have contributed to the observed increase in incidence.Footnote 44 The large declines in neuroblastoma in Quebec noted in the 1992–1997 period reflects the ending of a large screening trial in 1994 which resulted in the identification of many cases of neuroblastoma which may otherwise never have been clinically detected.Footnote 45

The rapid increase of pediatric thyroid cancer was confirmed by other studies.Footnote 17,Footnote 46 Siegel et al. reported that thyroid cancer incidence rates increased by 4.9% per year (CI = 3.2–6.6) among US children and adolescents (less than 20 years of age) during 2001–2009.Footnote 17 Previous studies have also revealed increased rates of thyroid cancers among adults in Canada and other countries.Footnote 1,Footnote 47,Footnote 48 It is unknown if causes for the increase in thyroid carcinomas in children are the same as those in adults. Increased use of advanced diagnostic technologies has contributed to the detection of small, subclinical thyroid tumors.Footnote 49 More frequent use of imaging to diagnose benign thyroid diseases, which are more common in females than males, may explain the more increase of thyroid cancer in females.Footnote 49 On the other hand, it has been shown that exposure to radiation by increased use of CT scansFootnote 50 may increase risk of thyroid cancer.Footnote 51,Footnote 52 There is also evidence of a positive association between obesity and adult thyroid cancer risk.Footnote 53,Footnote 54 The increased obesity prevalence among the pediatric populationFootnote 55,Footnote 56,Footnote 57 may be responsible for some of the increases in thyroid cancer.

The annual significant decrease of 2.1% in astrocytoma incidence among children aged 10–14 years is similar to the non-significant decrease (APC = −1.9, CI = −4.4 to 0.8) in the same age group between 1992 and 2004 observed in the US.Footnote 5 The decrease of astrocytoma could be partially explained by improvements in diagnosis and classification with implementation of the ICD-O-3 in 2001. As per ICD-O-3, pilocytic astrocytomas are coded as uncertain/borderline tumors (morphological code 9421/1), and thus, were excluded from analysis of the malignant cases. In addition, the decrease of astrocytomas not otherwise specified (NOS) suggests improvements in precise diagnostic classification of CNS tumors.Footnote 33 Declining incidence trends for malignant gonadal germ cell tumors accords with the reduction in prevalence of congenital anomalies.Footnote 20,Footnote 58

Strengths and limitations

Our findings should be interpreted in the context of study limitations and strengths. Although the provincial and territorial cancer registries strive to find and define new cancer cases according to the national standard, reporting procedures and completeness remain inconsistent across the registries.Footnote 1 The incidence of some cancers in Quebec, particularly for those that rely more heavily on pathological diagnosis, are underestimated as a result of the registry’s dependence on hospitalization data during the study period. Although all provincial and territorial cancer registries now record cancers according to the SEER rules for multiple primaries, not all registries were able to report according to the new requirements beginning in 2007.Footnote 9

Cancer incidence may be under-reported in some provinces due to missing information on “death certificate only” (DCO) cases or incomplete linkage of cancer data with vital statistics information for the data used in this study. The number of DCO cases from 2008 to 2010 in Newfoundland and Labrador (NL) was estimated based on 2007 data. NL has recently implemented death clearance processes to improve case ascertainment and have also improved the case reporting from areas that previously under-registered cases. In Quebec, DCO cases were incompletely recorded before 2000. The number of DCO cases for 2010 in Quebec was calculated as the average of 2005 to 2009 data. Ontario did not report DCO cases for 2008 to 2010. Their number of DCO cases for these three years was estimated by averaging the DCO cases in 2003 to 2007. The number of DCO cases is below 2% of total new cases.

Non-malignant brain tumors are not routinely captured or reported to CCR, and these cases in CCR are underreported based on our analysis (data not shown). Inclusion of benign brain tumors in the analysis could result in an artefact when comparing incidence across time and geographic area, given the incompleteness of the data collection. For example, the analysis based on the dataset comprising non-malignant along with malignant CNS tumors did not detect the statistically significant break in the ASIR trend for all cancers combined in females. Another example is that the addition of a preponderance of non-malignant cases (86%) to the total of other specified intracranial and intraspinal neoplasms (III(E)) resulted in a significant joinpoint trend in the 5–9 year age group (Table 2).

A Type I error may have biased the results for the diagnostic groups with only a small number of cases. Multiple tests were performed with adjustment to control the overall over-fitting error probability of 0.05; because of small numbers, random fluctuations in rates may erroneously show as significant certain trends. Therefore, trends involving a small number of cases and those with wide confidence intervals should be interpreted critically. For example, the increase of non-Hodgkin lymphomas (except Burkitt lymphoma) among females in the Prairies involved a small number of cases (45) between 1992 and 2010. Some significant findings show significance that is close to the cut-off of 0.05, e.g. decreasing malignant gonadal germ cell tumors, and increasing hepatic cancers in males. These trends should be further validated.

The increases of all cancers and selected malignancies varied in magnitude and significance among regions. The statistical significance achieved in Ontario may be a reflection of the size of its population.

Differences in trends by tumor type, sex, age, and region were described in this study but the relationships among the trends were not tested statistically. The results therefore may include spurious associations.

The principal strength of CCR is the complete population coverage and high data quality. Our analysis provides current trends in childhood cancer incidence, and to our knowledge represents the first report for the detailed diagnostic groups in demographic and geographic context.

Conclusion

In summary, overall incidence rates of childhood cancer have slowly increased since 1992. Statistically significant increases were observed in several malignancies such as leukemia, unspecified lymphoma, ependymoma, hepatoblastoma, thyroid and melanoma. The differences in the temporal trends were also registered by sex, age, and geographic area. The rates for all cancers combined increased the most in Ontario, and increased non-significantly in the other regions from 1992 to 2010. Another new finding is that astrocytoma incidence decreased significantly among children aged 10–14 years. Given the limited understanding of pediatric cancer etiology, this study underscores the value of surveillance in creating opportunities to seek insights into the factors driving incidence trends. This knowledge may ultimately help inform public health policy and programs.

Acknowledgements

We acknowledge the collaboration between the provincial and territorial cancer registries and the Health Statistics Division of Statistics Canada for providing the Canadian Cancer Registry data. We thank the Quebec Cancer Registry for providing their aggregate data for 2008 to 2010. We thank Mr. Robert Semenciw, formerly from the Public Health Agency of Canada (PHAC), for providing expert advice on cancer surveillance, and reviewing the manuscript. We thank Dr. Dianne Zakaria of PHAC for discussions on analysis method, and Dr. Shiliang Liu for discussions on risk factors. We also thank Ms. Judy Snider for reviewing the manuscript.

Conflicts of interest

The authors declare no conflicts of interest.

Author contributions and statement

All authors contributed to study design, interpretation of the data, and drafting and/or revising the paper. LX performed the analysis.

The content and views expressed in this article are those of the authors and do not necessarily reflect those of the Government of Canada.

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