Post on 23-Dec-2015
Childhood leukaemia in Great Britain: trends in incidence, survival and ‘cure’
Anjali Shah
UK Association of Cancer Registries conference
30 September 2004
Malignant disease in childrenMalignant disease in childrenEngland and Wales, 1981-1990England and Wales, 1981-1990
International Incidence of Childhood Cancer, vol 2, 1999
Type No. %
Leukaemia 3,705 33
Brain, spinal cord 2,549 22
Lymphoma 1,134 10
Neuroblastoma 797 7
Soft tissue 776 7
Other (kidney, …) 2,391 21
Total 11,352 100
Types of leukaemia in childrenTypes of leukaemia in childrenEngland and Wales, 1981-1990England and Wales, 1981-1990
International Incidence of Childhood Cancer, vol 2, 1999
Type No. %
Acute lymphoid 2,959 80
Acute myeloid 596 16
Chronic myeloid 88 2
Other 62 2
Total 3,705 100
Objectives
To examine long-term trends in:
- Relative survival
- ‘Cure’
- Incidence and mortality
Leukaemia categories 1901-2000International Classification of Diseases
From ICDContent Categoriesrev.
1901– 1Not defined ─
1911– 2-3Leukaemia 1
1931– 4-5Leukaemia, aleukaemia 2
1950– 6-7Lymphatic, myeloid, monocytic 5
1968– 8Acute, chronic 13
1979–2000 9 Subacute 25
WHO, International Classification of Diseases
Leukaemia incidence, mortality and survival trendsLeukaemia incidence, mortality and survival trendsEngland and Wales, 1911 to 2000England and Wales, 1911 to 2000
0
10
20
30
40
50
60
70
80
1911-1915
1916 1921 1926 1931 1936 1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996-2000
Calendar period of diagnosis (incidence, survival) or of death
An
nu
al
rate
pe
r m
illi
on
0
10
20
30
40
50
60
70
80
90
100
Fiv
e-y
ea
r s
urv
iva
l (%
)
Mortality
Incidence
Survival
Leukaemia incidence and mortality trendsLeukaemia incidence and mortality trendsEngland and Wales, 1911 to 2000 – England and Wales, 1911 to 2000 – by sexby sex
Leukaemia incidence and mortality trendsLeukaemia incidence and mortality trendsEngland and Wales, 1911 to 2000: England and Wales, 1911 to 2000: 1-4 years1-4 years
Incidence
Mortality
1993-97
1971-74
1988-92
1983-87
1979-82
1975-78
Childhood leukaemia survival by period of diagnosisChildhood leukaemia survival by period of diagnosisGreat Britain, 1971 to 1997Great Britain, 1971 to 1997
1993-97
1988-92
Childhood ALL survival by period of diagnosisChildhood ALL survival by period of diagnosisGreat Britain, 1971 to 1997Great Britain, 1971 to 1997
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5
Years since diagnosis
Rel
ativ
e su
rviv
al (
%)
0
10
20
30
40
50
60
70
80
90
100
1993-97
1988-92
1983-87
1979-82
1975-78
1971-74
1993-97
Childhood AML survival by period of diagnosisChildhood AML survival by period of diagnosisGreat Britain, 1971 to 1997Great Britain, 1971 to 1997
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5
Years since diagnosis
Rea
ltiv
e su
rviv
al (
%)
0
10
20
30
40
50
60
70
80
90
100
1993-97
1988-92
1983-87
1979-82
1975-78
1971-74
“cured” patients
Relative survival and population ‘cure’
‘Cured’ patients
“cured” patients
Relative survival and population ‘cure’
‘Cured’ patients
Tm
“cured” patients
Relative survival and population ‘cure’
‘Cured’ patients
Tm Tc
1993-97
Childhood leukaemia ‘cure’ by sexChildhood leukaemia ‘cure’ by sexGreat Britain, 1971 to 1997Great Britain, 1971 to 1997
0
10
20
30
40
50
60
70
80
Period of diagnosis
Pe
rce
nta
ge
of
pa
tie
nts
'cu
red
'
Girls
Boys
1993-97
Childhood leukaemia ‘cure’ by type of leukaemiaChildhood leukaemia ‘cure’ by type of leukaemiaGreat Britain, 1971 to 1997Great Britain, 1971 to 1997
ALL
ANLL
0
10
20
30
40
50
60
70
80
1971-74 1975-78 1979-82 1983-87 1988-92 1993-97
Period of diagnosis
Per
cent
age
of c
hild
ren
'cur
ed'
ALL
AML
1993-97
Time to ‘cure’ by type of leukaemiaTime to ‘cure’ by type of leukaemiaGreat Britain, 1971 to 1997Great Britain, 1971 to 1997
ALL
ANLL
ALL
AML
0
2
4
6
8
10
12
14
16
18
1971-74 1975-78 1979-82 1983-87
Period of diagnosis
Tim
e t
o 'c
ure
' (y
ea
rs)
ALL
AML
Summary
• Incidence has increased by 20% between 1971 and 2000
by 24% in 1-4 year olds
• Survival has increased from 31% in 1971 to 77% in 1997
• It is possible to estimate ‘cure’ by period analysis
• ‘Cure’ is estimated to have increased to 71%
Acknowledgements
• Office for National Statistics
• Childhood Cancer Research Group
• Clinical Trials Service Unit
Funding• Foundation for Children with Leukaemia