title: Geographic Variation in Cancer Incidence among Children and Adolescents in Taiwan (1995-2009).
abstract: BACKGROUND
  Evidence from our recent study suggested that the overall trend for cancer incidence in children and adolescents has been increasing in Taiwan.
  
  
  METHODS
  To analyze geographic variations in this trend, cancer frequencies and incidence rates of disease groups were quantified according to geographic areas among 12,633 patients aged <20 years during 1995-2009 by using the population-based Taiwan Cancer Registry. Three geographic levels were defined, namely county or city, region (Northern, Central, Southern, and Eastern Taiwan), and local administrative area (special municipality, provincial city, county-administered city, township, and aboriginal area).
  
  
  RESULTS
  Of the regions, Northern Taiwan had the highest incidence rate at 139.6 per million person-years, followed by Central (132.8), Southern (131.8), and Eastern (128.4) Taiwan. Significantly higher standardized rate ratios (SRRs) were observed in Northern Taiwan (SRR = 1.06, 95% confidence interval [CI] = 1.02-1.10) and at the township level (SRR = 1.07, 95% CI = 1.03-1.11). Of the cities or counties, New Taipei City yielded the highest SRR (1.08), followed by Taipei City (SRR = 1.07). A comparison of the rates in the four regions and the remainder of Taiwan according to cancer type revealed that only the rate of neuroblastomas in Eastern Taiwan was significantly low. Trend analysis showed that the most significant increase in incidence rate was observed at the township level, with an annual percent change of 1.8% during the 15-year study period.
  
  
  CONCLUSIONS
  The high rate of childhood cancer in Northern Taiwan and at the township level deserves further attention. The potential impacts of environmental factors on the upward trend of childhood cancer incidence rate in townships warrant further investigation.
authors.affiliation: Division of Pediatric Hematology and Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Life Science, National Taiwan Normal University, Taipei, Taiwan.
authors.forename: Giun-Yi
authors.initials: GY
authors.lastname: Hung
authors.affiliation: Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Jiun-Lin
authors.initials: JL
authors.lastname: Horng
authors.affiliation: Division of Pediatric Hematology and Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Life Science, National Taiwan Normal University, Taipei, Taiwan.
authors.forename: Hsiu-Ju
authors.initials: HJ
authors.lastname: Yen
authors.affiliation: Division of Pediatric Hematology and Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Chih-Ying
authors.initials: CY
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000473:pathology; D012042:Registries; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult