International variation in childhood cancer mortality rates from 2001 to 2015: Comparison of trends in the International Cancer Benchmarking Partnership countries

Lesley Smith, Charles A. Stiller, Joanne F. Aitken, Lisa L. Hjalgrim, Tom Johannesen, Paivi Lahteenmaki, Martin G. McCabe, Robert Phillips, Kathy Pritchard-Jones, Eva Steliarova-Foucher, Jeanette F. Winther, Ryan R. Woods, Adam W. Glaser, Richard G. Feltbower*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Despite improved survival rates, cancer remains one of the most common causes of childhood death. The International Cancer Benchmarking Partnership (ICBP) showed variation in cancer survival for adults. We aimed to assess and compare trends over time in cancer mortality between children, adolescents and young adults (AYAs) and adults in the six countries involved in the ICBP: United Kingdom, Denmark, Australia, Canada, Norway and Sweden. Trends in mortality between 2001 and 2015 in the six original ICBP countries were examined. Age standardised mortality rates (ASR per million) were calculated for all cancers, leukaemia, malignant and benign central nervous system (CNS) tumours, and non-CNS solid tumours. ASRs were reported for children (age 0-14 years), AYAs aged 15 to 39 years and adults aged 40 years and above. Average annual percentage change (AAPC) in mortality rates per country were estimated using Joinpoint regression. For all cancers combined, significant temporal reductions were observed in all countries and all age groups. However, the overall AAPC was greater for children (−2.9; 95% confidence interval = −4.0 to −1.7) compared to AYAs (−1.8; −2.1 to −1.5) and adults aged >40 years (−1.5; −1.6 to −1.4). This pattern was mirrored for leukaemia, CNS tumours and non-CNS solid tumours, with the difference being most pronounced for leukaemia: AAPC for children −4.6 (−6.1 to −3.1) vs AYAs −3.2 (−4.2 to −2.1) and over 40s −1.1 (−1.3 to −0.8). AAPCs varied between countries in children for all cancers except leukaemia, and in adults over 40 for all cancers combined, but not in subgroups. Improvements in cancer mortality rates in ICBP countries have been most marked among children aged 0 to 14 in comparison to 15 to 39 and over 40 year olds. This may reflect better care, including centralised service provision, treatment protocols and higher trial recruitment rates in children compared to older patients.

Original languageEnglish
Pages (from-to)28-37
Number of pages10
JournalInternational Journal of Cancer
Issue number1
Publication statusAccepted/In press - 2021

Bibliographical note

Funding Information:
This work was supported by the Candlelighters Trust who had no influence on the content of this manuscript, grant number RG.EPID.111259. Richard G. Feltbower confirms that he had full access to the data in the study and has final responsibility for the decision to submit for publication. We thank the Australian Childhood Cancer Registry and Danny Youlden in particular for support in providing data.

Publisher Copyright:
© 2021 UICC


  • childhood cancer
  • epidemiology
  • mortality trends


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