Although cancer in children is rare, it is the leading cause of death by disease past infancy among children in the United States. In 2018, it is estimated that 15,590 children and adolescents ages 0 to 19 will be diagnosed with cancer and 1,780 will die of the disease in the United States (1). Among children ages 0 to 14 years, it is estimated that, in 2018, 10,590 will be diagnosed with cancer and 1,180 will die of the disease (1). Among adolescents ages 15 to 19 years, about 5000 will be diagnosed with cancer and about 600 will die of the disease.
Overall, among children and adolescents (ages 0 to 19) in the United States, the most common types of cancer are leukemias, brain and central nervous system tumors, and lymphomas. Among children (ages 0 to 14 years), the most common types of cancer are leukemias, followed by brain and other central nervous system tumors, lymphomas, soft tissue sarcomas (of which half are rhabdomyosarcoma), neuroblastoma, and kidney tumors (1). Among adolescents (ages 15 to 19 years), the most common types of cancer are brain and other central nervous system tumors and lymphomas, followed by leukemias, gonadal (testicular and ovarian) germ cell tumors, thyroid cancer, and melanoma (1).
As of January 1, 2015 (the most recent date for which data exist), approximately 429,000 survivors of childhood and adolescent cancer (diagnosed at ages 0 to 19 years) were alive in the United States (2). The number of survivors will continue to increase, given that the incidence of childhood cancer has been rising slightly in recent decades and that survival rates overall are improving.
The overall outlook for children and adolescents with cancer has improved greatly over the last half-century. In the mid-1970s, 58% of children (ages 0 to 14 years) and 68% of adolescents (ages 15 to 19 years) diagnosed with cancer survived at least 5 years (1). In 2008–2014, 83.4% of children and 84.6% of adolescents diagnosed with cancer survived at least 5 years (2).
Although survival rates for most childhood cancers have improved in recent decades, the improvement has been especially dramatic for a few cancers, particularly acute lymphoblastic leukemia, which is the most common childhood cancer. Improved treatments introduced beginning in the 1960s and 1970s raised the 5-year survival rate for children diagnosed with acute lymphoblastic leukemia at ages 0 to 14 years from 57% in 1975 to 92% in 2012 (3). The 5-year survival rate for children diagnosed with non-Hodgkin lymphoma at ages 0 to 14 years has also increased dramatically, from 43% in 1975 to 91% in 2012 (3).
Because of these survival improvements, in more recent years brain cancer has replaced leukemia as the leading cause of cancer death among children (4).
By contrast, survival rates remain very low for some cancer types, for some age groups, and for some cancers within a site. For example, half of children with diffuse intrinsic pontine glioma (a type of brain tumor) survive less than 1 year from diagnosis (5). Among children with Wilms tumor (a type of kidney cancer), older children (those diagnosed between ages 10 and 16 years) have lower 5-year survival rates than younger children (6). For soft tissue sarcomas, 5-year survival rates in 2008–2014 among children and adolescents ages 0 to 19 years ranged from 65% (rhabdomyosarcoma) to 95% (chondrosarcoma) (7), but children with sarcomas who present with metastatic disease have much lower 5-year survival rates. And the 5-year survival rate for acute lymphoblastic leukemia in 2008-2014 was 91% for children younger than 15 years, compared with 74% for adolescents ages 15 to 19 years (7).
Some evidence suggests that adolescents and young adults with acute lymphoblastic leukemia may have better outcomes if they are treated with pediatric treatment regimens than if they receive adult treatment regimens (8). The improvement in 5-year survival rates for 15- to 19-year-olds with acute lymphoblastic leukemia may reflect greater use of these pediatric treatment regimens.
The cancer mortality rate—the number of deaths due to cancer per 100,000 people per year—among children and adolescents ages 0 to 19 years declined by more than 50% from 1975 to 2015 (2). Specifically, the mortality rate was 5.1 per 100,000 children and adolescents in 1975 and 2.3 per 100,000 children and adolescents in 2015. However, despite the overall decrease in mortality, approximately 1,800 children and adolescents still die of cancer each year in the United States, indicating that new advances and continued research to identify effective treatments are required to further reduce childhood cancer mortality.
Between 1999 and 2014, the cancer death rate dropped the most for 1- to-4-year-olds (a 26% drop), followed by that for 15- to 19-year-olds (a 22% drop), 10- to 14-year-olds (a 19% drop), and 5- to 9-year-olds (a 14% drop) (4).