title: Outcomes for children and adolescents with cancer: challenges for the twenty-first century.
abstract: OBJECTIVE
  This report provides an overview of current childhood cancer statistics to facilitate analysis of the impact of past research discoveries on outcome and provide essential information for prioritizing future research directions.
  
  
  METHODS
  Incidence and survival data for childhood cancers came from the Surveillance, Epidemiology, and End Results 9 (SEER 9) registries, and mortality data were based on deaths in the United States that were reported by states to the Centers for Disease Control and Prevention by underlying cause.
  
  
  RESULTS
  Childhood cancer incidence rates increased significantly from 1975 through 2006, with increasing rates for acute lymphoblastic leukemia being most notable. Childhood cancer mortality rates declined by more than 50% between 1975 and 2006. For leukemias and lymphomas, significantly decreasing mortality rates were observed throughout the 32-year period, though the rate of decline slowed somewhat after 1998. For remaining childhood cancers, significantly decreasing mortality rates were observed from 1975 to 1996, with stable rates from 1996 through 2006. Increased survival rates were observed for all categories of childhood cancers studied, with the extent and temporal pace of the increases varying by diagnosis.
  
  
  CONCLUSIONS
  When 1975 age-specific death rates for children are used as a baseline, approximately 38,000 childhood malignant cancer deaths were averted in the United States from 1975 through 2006 as a result of more effective treatments identified and applied during this period. Continued success in reducing childhood cancer mortality will require new treatment paradigms building on an increased understanding of the molecular processes that promote growth and survival of specific childhood cancers.
authors.affiliation: Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD 20892, USA. Malcolm.Smith@NIH.GOV
authors.forename: Malcolm A
authors.initials: MA
authors.lastname: Smith
authors.forename: Nita L
authors.initials: NL
authors.lastname: Seibel
authors.forename: Sean F
authors.initials: SF
authors.lastname: Altekruse
authors.forename: Lynn A G
authors.initials: LA
authors.lastname: Ries
authors.forename: Danielle L
authors.initials: DL
authors.lastname: Melbert
authors.forename: Maura
authors.initials: M
authors.lastname: O'Leary
authors.forename: Franklin O
authors.initials: FO
authors.lastname: Smith
authors.forename: Gregory H
authors.initials: GH
authors.lastname: Reaman
mesh_terms: D000293:Adolescent; D002648:Child; D005544:Forecasting; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
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