Original research

Incidence of childhood cancer in Latin America and

the Caribbean: coverage, patterns, and time trends
Neimar de Paula Silva1, Murielle Colombet1, Florencia Moreno2, Friederike Erdmann3, Anastasia
Dolya1, Marion Piñeros1, Charles A Stiller4, Eva Steliarova-Foucher1, and the IICC-3 contributors

Suggested citation De Paula Silva N, Colombet M, Moreno F, Erdmann F, Dolya A, Piñeros M, et al. Incidence of childhood cancer in Latin America
and the Caribbean: coverage, patterns, and time trends. Rev Panam Salud Publica. 2024;48:e11. https://doi.org/10.26633/
RPSP.2024.11

ABSTRACT Objective. To provide a comprehensive overview of geographical patterns (2001–2010) and time trends
(1993–2012) of cancer incidence in children aged 0–19 years in Latin America and the Caribbean (LAC) and
interpret the findings in the context of global patterns.
Methods. Geographical variations in 2001–2010 and incidence trends over 1993–2012 in the population of LAC
younger than 20 years were described using the database of the third volume of the International Incidence of
Childhood Cancer study containing comparable data. Age-specific incidence per million person-years (ASR)
was calculated for population subgroups and age-standardized (WSR) using the world standard population.
Results. Overall, 36 744 unique cases were included in this study. In 2001–2010 the overall WSR in age 0–14
years was 132.6. The most frequent were leukemia (WSR 48.7), central nervous system neoplasms (WSR
23.0), and lymphoma (WSR 16.6). The overall ASR in age group 15–19 years was 152.3 with lymphoma rank-
ing first (ASR 30.2). Incidence was higher in males than in females, and higher in South America than in Central
America and the Caribbean. Compared with global data LAC incidence was lower overall, except for leukemia
and lymphoma at age 0–14 years and the other and unspecified tumors at any age. Overall incidence at age
0–19 years increased by 1.0% per year (95% CI [0.6, 1.3]) over 1993–2012. The included registries covered
16% of population aged 0–14 years and 10% of population aged 15–19 years.
Conclusions. The observed patterns provide a baseline to assess the status and evolution of childhood can-
cer occurrence in the region. Extended and sustained support of cancer registration is required to improve
representativeness and timeliness of data for childhood cancer control in LAC.

Keywords Neoplasms; incidence; child health; registries; public health surveillance; Latin America; Caribbean region.

With improved control of communicable diseases, childhood Geographical variations of cancer incidence indicate potential
cancer has gained relevance in low- and middle-income coun- etiological clues, implying further targeted studies. Incidence data
tries (LMIC) (1). Childhood cancers differ from those occurring are generated by population-based cancer registries, but these
in adults by biology, presentation, response to treatment, and are sparse in many LMIC, including in Latin America and the
epidemiology. The etiology of childhood cancers is poorly Caribbean (LAC) (3). The reported incidence is often lower in the
understood, which hampers their prevention. Causal evidence populations of LMIC than in the high-income countries (HIC) (3, 4).
links to certain genetic conditions, high dose ionizing radiation, LAC, with its 600 million inhabitants of Amerindian, Euro-
chemotherapy, and viral infections (2). pean, and African descendance, displays huge contrasts in

1
International Agency for Research on Cancer, Lyon, France   Eva Steliarova- 3
University Medical Center of the Johannes Gutenberg University Mainz,
Foucher, [email protected] Mainz, Germany
2
National Cancer Institute, Buenos Aires, Argentina 4
NHS England, Leeds, United Kingdom

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Original research De Paula Silva et al. • Childhood cancer in Latin America and the Caribbean

sociodemographic, economic, and epidemiological patterns. In of cases retrieved from a death certificate only, the proportion
2010, the size of national population ranged from 49 000 in Saint of cases with morphology not otherwise specified, and others.
Kitts and Nevis to almost 200 million in Brazil (5), the gross We constructed several datasets to utilize the maximum data
domestic product (GDP) per capita varied from 2 683 current available in each analysis.
international dollar (intl$) in Haiti to almost 31 000 intl$ in
Puerto Rico, while the life expectancy at birth ranged from Constitution of analytical datasets
46 years in Haiti to 79 in Costa Rica, and the childhood mortality
rate (under 5 years) varied from 6.4 per 1 000 live births in Cuba All registered cancers diagnosed in residents younger than
to 203.6 in Haiti according to the World Bank (databank.world- 20 years, obtained from the registries that provided data for each
bank.org). Existing social inequalities are magnified by rapid year of the entire decade 2001–2010, were eligible for inclusion
urbanization, internal and external migration, poverty, cor- in geographical analysis. Eligible pediatric registries covered
ruption, and violence (6), all of which contribute to distortions populations aged 0–14 years. The reference period 2001–2010
in decisions that affect cancer control in many LAC countries. contained the largest populations covered within LAC and
Cancer registration is often discontinued due to irregular fund- within the IICC-3 database.
ing and frequently changing policies (7). Geographical analyses for the age range 0–14 years were
Data generated by population-based cancer registries are conducted using a pediatric dataset, which contained data from
vital for understanding of cancer burden and its control, and eligible pediatric registries, complemented by data from the eli-
their production requires sustained commitment and funding gible general registries that covered different, non-overlapping
(8, 9). Several LAC registries were established long ago and populations. The analyses for the age range 0–19 years and the
generate high-quality data, including Puerto Rico in 1954, age group 15–19 years were conducted using a general dataset,
Kingston and St. Andrew, Jamaica in 1958, and Cali, Colombia which included data only from the eligible general registries.
in 1962. Others were discontinued or were unable to supply To compare cancer incidence within LAC, we have grouped
comparable data to international studies due to suboptimal registries into two subregions, Central America and the Carib-
data quality (4, 10, 11). Although national cancer registration bean (CAC) and South America (SA), as per the United Nations
has developed in few countries, most registries have sub- (UN) definition of world regions (unstats.un.org/sdgs/
national coverage, meaning a lower informative potential indicators/regional-groups).
compared with national registries (12). LAC, however, boasts We also compared incidence observed in LAC with that of
two pediatric population-based cancer registries with national North America (NA), as the region representative of incidence
coverage of Argentina since 2000 (13) and Chile since 2007 (14). patterns in HIC, which hosts a large identifiable Hispanic popu-
On the other hand, the regional childhood cancer registry, lation with a similar genetic background to the LAC population.
started in Mexico City in 1996 (15), vanished with the retire- LAC incidence was also compared with the global figures
ment of its founder, due to the lack of sustained support. (which included LAC data) reported previously (3). Incidence
Using the most complete and up-to-date study, the Interna- time trends were investigated over two decades, 1993–2012.
tional Incidence of Childhood Cancer, volume 3 (IICC-3, iicc. We examined the evolution of the coverage of childhood
iarc.fr) (3, 11), we provide a unique comprehensive overview of population of LAC by population-based cancer registries as
geographical patterns (2001–2010) and time trends (1993–2012) reflected in the three IICC volumes (4, 10, 11) which included
of cancer incidence in children aged 0–19 years in LAC and four decades of comparable global data.
interpret the findings in the context of global patterns. We also
share our views on the need for further development so that the Statistical analyses
countries in the region could join the WHO Global Initiative for
Childhood Cancer (16). Age-specific rates (ASR) were computed for five age groups
(<1, 1–4, 5–9, 10–14, and 15–19 years) by dividing the number of
MATERIALS AND METHODS cancer cases by the number of person-years at risk in the corre-
sponding sex and age category. To enable comparisons between
Data sources and processing countries and world regions we adjusted overall incidence
rates for the age ranges of 0–14 and 0–19 years, using the world
Data were extracted from the database of individual cancer standard population distribution (19) in five-year age groups,
records of the IICC-3 study coordinated by the International and reported age-standardized rates (WSR). All incidence rates
Agency for Research on Cancer (3, 11). The LAC populations were expressed per million person-years at risk. We computed
covered by the registries contributing to the IICC-3 are shown the 95% confidence intervals (CI) of the incidence rates accord-
in Supplement, Figure S1. ing to standard methods (20). We assessed the male to female
Each cancer record contained information on sex, age, date (M/F) sex ratio as the quotient of the rate in males to that in
of birth, date of incidence, tumor sequence, site, morphology, females.
behavior, laterality, and most valid basis of diagnosis. Cancers, To assess incidence time trends, we fit linear regression mod-
originally coded by the registries according to the International els weighted by the ratio of the squares of age-standardized
Classification of Diseases for Oncology were first converted to rate and its standard error. The changes were reported as the
its third edition, first revision (17) and then to the International average annual percentage change (AAPC) and correspond-
Classification of Childhood Cancer – third edition, updated in ing 95% CI. Changes in trends during the study period were
2017 (ICCC-3) (18). Data included in the IICC-3 database were examined using Joinpoint software (21), allowing a maximum
quality controlled (3, 11). Quality indicators included the pro- of three break points and using the permutation test method (22)
portion of cases with microscopic verification, the proportion to select the final model. In the subsets where at least one

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De Paula Silva et al. • Childhood cancer in Latin America and the Caribbean Original research

joinpoint was identified, we reported the overall AAPC and the and for lymphoid leukemia, rhabdomyosarcoma, and gonadal
annual percentage change with 95% CI for each time segment. tumors in age group 15–19 years. Conversely, twice as many
The population coverage was calculated by dividing the females than males had thyroid carcinoma before age 15 years and
population covered by a registry in each IICC volume by the three times as many in age range 0–19 and age group 15–19 years.
national population of the same country, year, and age range. Females with renal tumors were registered twice as often as males
For the first two IICC volumes (4, 10) we used the average in the 15–19 years age group (Supplement, Figure S2 and Table S7).
annual population covered, while for the IICC-3 we used pop-
ulation covered in year 2010 or other closest available year (11). Geographical variations in incidence, 2001–2010
Countries with national cancer registries were assumed to have
100% coverage, using the population data provided by the Overall incidence for the age range 0–19 years was higher in
registries. National populations for the countries with subna- South America (SA) (WSR 146.8) than in Central America and
tional coverage were retrieved from the UN estimates (5) for the Caribbean (CAC) (WSR 131.6), mostly due to rates of lym-
the calendar years most frequently represented in each volume; phoid leukemia, and (gonadal) germ cell tumors in age group
i.e., 1975, 1985, and 2010. The UN population estimates for the 15–19 years (Supplement, Figures S3 and S4, Table S8). In chil-
entire LAC region and its subregions in each reference year dren aged 0–14 years incidence was higher in SA than in CAC
were used to calculate the overall coverage. for leukemia, CNS neoplasms, retinoblastoma, and rhabdomyo-
Unless stated otherwise, statistical analyses were performed sarcoma, while CAC showed higher incidence of non-Hodgkin
using Stata/IC, version 14.2 (StataCorp, stata.com). combined with Burkitt lymphoma and the group of carcinomas
and melanoma (Supplement, Figure S4 and Table S8). In each
RESULTS age category, CAC reported higher incidence of unspecified
tumors (group XII).
Location and characteristics of all registries contributing to The WSR for main diagnostic groups in the age range 0–14
IICC-3 (11) are shown in the Supplement (Figure S1, Tables years were compared between LAC, NA, and the world in Fig-
S1 and S2). Overall, 36 744 unique cancer cases, arising in ure 3. LAC had the highest incidence of lymphoma and other
276 million person-years, excluding geographical and temporal and unspecified tumors. In contrast, incidence of CNS neo-
overlap, were included in the analyses of incidence presented plasms, neuroblastoma, renal tumors, soft tissue sarcoma, and
below. other carcinomas and melanoma were the lowest. LAC inci-
dence of leukemia was intermediate between the global and the
Childhood cancer incidence in LAC, 2001–2010 NA rate. Incidence in age range 0–19 and age group 15–19 years
was lower in LAC than elsewhere except for other and unspec-
Overall WSR for the age range 0–14 years was 132.6, based on ified tumors (Supplement, Table S9).
24 556 cases and 191 million person-years, and it ranged from
less than 100 in Martinique and Jamaica to 152.8 in Colom- Incidence time trends in LAC for age 0–19 years,
bia. Overall WSR per million for the age range 0–19 years was 1993–2012
slightly higher (139.0), and it remained at almost the same level
as that for children under 15 years in Cuba (128.5) and in Jamaica Overall incidence increased by 1.0% per year on average
(81.2) due to their low rates in the 15–19 years age group. The with 95% CI (0.6, 1.3) (Figure 4 and Supplement, Table S10).
highest rate in the age group 15–19 years was observed in Chile Incidence increased for CNS neoplasms (AAPC = 1.8%), reti-
(182.1). The pediatric cancer registries showed intermediate noblastoma (1.7), hepatic tumors (4.9), bone tumors (1.4), germ
WSR of 130.1 in Argentina and 133.8 in Mexico City (Table 1). cell tumors (2.0), and the group of carcinomas and melanoma
Using only data from general cancer registries, the incidence (2.9); some changes were driven by a subpopulation defined
rate for the age range 0–14 years was 135.1 per million (95% CI by region or sex. For example, the AAPC of 4.3 in females
[132.5, 137.7]), based on 11 099 cases. Incidence for all eligible with retinoblastoma in SA influenced the AAPC of 1.7% for
registries is shown in Supplement, Table S3. the entire LAC. SA and CAC showed opposite trends of other
Figure 1 shows the ASR for main diagnostic groups by age, and unspecified tumors, with a sharp decrease of 7.7% (95% CI
(see also Supplement, Table S4). Leukemia was the most com- [–9.6, –5.7]) per year in SA and a strong increase of 4.9% (95%
mon diagnostic group in age 0–14 years, with the peak ASR CI [1.5, 8.4]) per year in CAC (Supplement, Table S10). Joinpoint
at 73.5 in age 1–4 years. Among children younger than 1 year, analysis revealed breaks in incidence time trends in some pop-
neuroblastoma (ASR 30.7) was almost as common as leukemia. ulations. In LAC, the time segments with variable time trends
Incidence of central nervous system (CNS) neoplasms was sta- include those for leukemia in males and for other and unspec-
ble before age 10 years (ASR around 24), after which it declined ified tumors in females. Variations were seen among females
slightly. Incidence of lymphoma increased with age, from 7.8 at in CAC for lymphoma, germ cell tumors, and other carcino-
age under 1 year to 30.2 in age 15–19 years, in which it ranked mas and melanoma and in the group of other and unspecified
first. The other most common were other carcinomas and mel- tumors (Supplement, Figure S5).
anoma (ASR 30.0), and leukemia (ASR 27.6). Incidence rates
for diagnostic groups and selected subgroups are compared in Evolution of the registration coverage in LAC
Figure 2 by age (see also Supplement, Tables S5A and S5B and
Tables S6A and S6B). Coverage of the LAC population aged 0–14 years by inter-
Overall incidence was higher in males than in females (M/F nationally comparable data included in the three volumes of
= 1.2). The M/F ratio was 2 or higher for lymphoma in age 0–14 IICC has improved from 6.5% in 1975 to 16.4% in 2010, with a
years, for non-Hodgkin & Burkitt lymphoma in age 0–19 years, drop in 1985 (5.6%). The coverage of the population aged 15–19

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TABLE 1. Overview of cancer incidence in children diagnosed in Latin America and the Caribbean, 2001–2010

Pediatric dataset General dataset

Age 0–14 years Age 0–19 years Age 15–19 years
Country, registry N Person-years WSR per million 95% CI N Person-years WSR per million 95% CI N Person-years ASR per million 95% CI
(thousands) (thousands) (thousands)
Overall 24 556 191 186 132.6 130.9, 134.3 15 832 116 078 139.0 136.8, 141.2 4 733 31 070 152.3 148.0, 156.6
ARGENTINA, 12 941 102 433 130.1 127.8, 132.4 – – – – – – – –
pediatric
ARGENTINA, – – – – 521 4 184 126.2 115.3, 137.1 138 1 029 134.2 111.8, 156.6
Entre Rios
BRAZIL, 1 413 10 054 145.7 138.0, 153.4 2 098 14 019 151.8 145.2, 158.4 685 3 966 172.7 159.8, 185.6
4 registries
CHILE, 119 932 140.5 114.8, 166.2 182 1 278 149.9 127.5, 172.3 63 346 182.1 137.1, 227.1
Valdivia
COLOMBIA, 1 381 9 258 152.8 144.6, 161.0 1 925 12 517 156.0 148.9, 163.1 544 3 259 166.9 152.9, 180.9
3 registries
COSTA RICA 1 591 11 856 138.0 131.1, 144.9 2 341 16 142 146.3 140.3, 152.3 750 4 286 175.0 162.5, 187.5
CUBA 2 608 21 086 128.6 123.6, 133.6 3 652 29 238 128.5 124.2, 132.8 1 044 8 152 128.1 120.3, 135.9
ECUADOR, 1 355 10 285 136.1 128.8, 143.4 1 892 13 829 139.6 133.2, 146.0 537 3 544 151.5 138.7, 164.3
4 registries
FRANCE, 80 835 98.2 76.2, 120.2 126 1 138 110.2 90.5, 129.9 46 303 151.6 107.8, 195.4
Martinique
JAMAICA, 139 1 743 82.9 68.9, 96.9 187 2 379 81.2 69.3, 93.1 48 635 75.5 54.1, 96.9
Kingston & St.
Andrew
MEXICO, 899 6 902 133.8 125.0, 142.6 – – – – – – – –
Mexico City, pediatric
UNITED STATES, 988 8 216 124.3 116.4, 132.2 1 453 11 172 131.7 124.8, 138.6 465 2 956 157.3 143.0, 171.6
Puerto Rico
URUGUAY 1 042 7 588 143.0 134.2, 151.8 1 455 10 181 146.7 139.0, 154.4 413 2 593 159.3 143.9, 174.7
Note: N, number of cases; WSR, age-standardized rate (world standard) (19); CI, confidence interval; ASR, age-specific rate; – not applicable.
Source: IICC-3 (11).

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De Paula Silva et al. • Childhood cancer in Latin America and the Caribbean
De Paula Silva et al. • Childhood cancer in Latin America and the Caribbean Original research

FIGURE 1. Age-specific cancer incidence in children diagnosed in 2001–2010 in Latin America and the Caribbean

Note: Diagnostic groups are defined according to the International Classification of Childhood Cancer (ICCC-3) (18).
Source: IICC-3 (11).

years, which was included for the first time in IICC-3, was 9.8% income level, which has an impact on public health policies,
(Supplement, Table S11). including cancer registration. Low incidence of CNS neoplasms
may be linked to inadequate diagnostic technology or access
DISCUSSION to health care (23), while high rates of thyroid carcinoma in
HIC (France, Martinique; and United States of America, Puerto
In this comprehensive overview of childhood cancer incidence Rico) indicate a high level of medical vigilance, more affordable
in LAC, leukemia was the leading diagnostic group, followed by in affluent societies (24). The incidence variations thus likely
CNS neoplasms and lymphoma in children aged 0–14 years. Com- reflect disparities in health services, care pathways, outcomes,
pared with the world average, LAC was shown to have a higher and information systems, in addition to potential risk factors
incidence of lymphoma and of other and unspecified tumors and the role of which needs to be determined. The observed sex
intermediate rates of leukemia. In age range 0–19 years, incidence ratio variations are consistent with those observed on a global
was lower or similar to that in the compared populations for all scale (3).
diagnostic groups except for the unspecified tumors. We docu- The larger intraregional differences in incidence in the age
mented higher incidence in South America (SA) than in Central group 15–19 years compared with age range 0–14 years is influ-
America and the Caribbean (CAC), especially in age group 15–19 enced by the composition of the analytical datasets. The pediatric
years. Increasing incidence and the expanding registration cover- dataset covered larger populations and had therefore more stable
age mostly reflect the underlying changes in sociopolitical context. rates. The rates observed in pediatric cancer registries affected
the overall rates in age 0–14 years: the Argentinian national
Variations of childhood cancer incidence within LAC pediatric cancer registry contributed more than a half of the total
person-years. Although some underrepresentation of tumors
The incidence variations within LAC likely reflect variable common in older children, noted in pediatric cancer registries (12),
socioeconomic development of individual countries and their may draw down the combined rates, their quasi-complete

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Original research De Paula Silva et al. • Childhood cancer in Latin America and the Caribbean

FIGURE 2. Childhood cancer incidence estimates and their 95% confidence intervals in Latin America and the Caribbean,
2001–2010

Note: Diagnostic groups are defined according to the International Classification of Childhood Cancer (ICCC-3) (18).
Source: IICC-3 (11).

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De Paula Silva et al. • Childhood cancer in Latin America and the Caribbean Original research

FIGURE 3. Cancer incidence estimates and their 95% confidence intervals in children aged 0–14 years in populations included in
the IICC-3 study, 2001–2010

Note: Diagnostic groups are defined according to the International Classification of Childhood Cancer (ICCC-3) (18). World includes Latin America and the Caribbean.
Source: Source: IICC-3 (11).

FIGURE 4. Cancer incidence trends in children aged 0–19 years in Latin America and the Caribbean, 1993–2012

Note: The dots represent the observed values; the trend curves were obtained from Poisson model.
Source: IICC-3 (11).

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Original research De Paula Silva et al. • Childhood cancer in Latin America and the Caribbean

registration of cancers characteristic of (early) childhood pulls registries. Retinoblastoma is often diagnosed and treated in
the overall rate up. National coverage of high quality provides specialized (ophthalmology) clinics, which are sometimes
more reliable estimates than regional coverage because higher missed as data sources. The increase in incidence of hepatic
rates observed in urban areas even out with lower rates in rural tumors among males has been described; however, the reasons
areas. National registration is also more effective in using linked are unclear (33). The considerable increase in the incidence of
data sources, such as death certificates (12). bone tumors among males in SA may be the result of better
diagnosis and would be consistent with the decreasing trend of
Comparison of incidence in LAC with other world unspecified tumor types and no increase seen in females, who
regions also undergo growth spurt just before males.
Increase in the germ cell tumors incidence in males sug-
The low overall LAC incidence reflects the level of socioeco- gests environmental exposures, such as pollution or pesticides,
nomic development, as both tend to increase simultaneously (25). which have an anti-androgen effect (34), although the evidence
The low rates of CNS neoplasms, neuroblastoma, renal tumors, is ambiguous (35). The increasing incidence of other carcinomas
soft tissue sarcoma, and epithelial tumors and melanoma may and melanoma may be driven by a shift of diagnosis to an earlier
be explained by lagging diagnostic capacity in LAC and will age due to improved diagnostics (24) or changing exposures (2).
expectedly evolve over time toward those observed in NA. As the available data were sparse, continued surveillance is
This assumption is further supported by the high proportion needed to examine the evolution of these trends.
of unspecified cases in LAC, likely reflecting a suboptimal Finally, the opposed incidence trends of other and unspeci-
capacity to provide precise diagnosis or inability of registries fied tumors in the two compared LAC regions suggest the need
to obtain relevant records, although the absolute difference was for improved diagnosis or registration techniques, and access to
smaller than for other tumor groups. medical records in CAC.
LAC leads the average global incidence of lymphoma in the
age range 0–14 years. Lymphoma is the prominent group also Registration coverage in LAC
in African populations (4, 10, 11). In several LAC countries
children are exposed to endemic forms of viral infections by Of 91 invited population-based cancer registries, represent-
Epstein-Barr virus, Kaposi sarcoma herpesvirus, and human ing 27 LAC countries, 54 submitted data and 38 registries in
T-lymphotropic virus (HTLV-1), which may increase lymphoma 14 countries could contribute to IICC-3 (11). Among those
rates in children, including in Amerindian populations (26). included, 21 registries covered the entire decade 2001–2010.
The highest leukemia rates worldwide are observed in His- Several registries, contributing to the earlier IICC volumes (4, 10),
panic children in the United States of America (Supplement, were not included in IICC-3 because they had ceased to
Table S12) (3), which may be conditioned by the genome-wide exist, did not have resources to submit data, or did not pro-
Native American ancestry (27). However, the much lower rate vide comparable data. LAC countries need to expand cancer
in LAC, where the overwhelming majority are Hispanic, sug- registration coverage, and strengthen quality of childhood can-
gests that other environmental and sociodemographic factors cer data, in support of a childhood cancer control strategy (8).
may modulate this risk (28). An additional component of the Sharing data for research and surveillance is the best way to
differences in incidence between genetically comparable popu- improve data quality (3, 11).
lations living in different environments may be underdiagnosis
or underreporting of childhood leukemia (1) in LAC. Strengths and limitations

Incidence trends The strength of this study is its large coverage and comprehen-
sive underlying database which contains the most up-to-date
The observed overall increase in incidence of approximately internationally comparable and reliable information on child-
1% per year was documented in other studies over several hood cancer incidence in LAC. This data resource would benefit
decades, and decelerated recently in high-income settings from an update with more recent data, also embedding data on
(29, 30). The modestly growing incidence rates may indicate follow-up. Survival is the key outcome measure for the WHO
changes in exposures, such as changing maternal and birth Global Initiative for Childhood Cancer, which aims to achieve
characteristics (31), or environmental risk factors (2). Never- 60% survival of children with cancer by 2030 (16). The paucity
theless, improvements in the capacity to diagnose childhood of quality childhood cancer data in LAC is the limitation that
cancer may have contributed to the increasing incidence of highlights the need to scale up cancer registration.
the CNS neoplasms, as diagnostic computed tomography and
magnetic resonance imaging technology was introduced pro- Conclusion
gressively in LAC during the study period (32). Surprisingly,
the increasing incidence of CNS neoplasms in CAC was limited In this study we showed the importance of international
to males, which might indicate gender inequity in seeking care, collaboration, which allows standardized data validation, cus-
similar to that seen in Indian populations (11) or, potentially, a tomized data analyses, and context-sensitive interpretation of
sex-specific exposure factor. The increase in incidence of leu- global data. The LAC incidence rates likely reflect a combination
kemia over 1993–1998 in males, revealed in joinpoint analysis, of the status of diagnostic efficacy, completeness of registration,
may indicate sex-specific differences in seeking diagnosis (and and underlying risk factors. The slightly increasing incidence
treatment). rates suggest improvement in access to care and cancer regis-
The increasing incidence of retinoblastoma observed in tration, as well as changing exposures, as countries pursue their
SA may reflect an improved registration by general cancer overall socioeconomic development. Coverage of the childhood

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De Paula Silva et al. • Childhood cancer in Latin America and the Caribbean Original research

population of LAC by cancer registration is inadequate, and a Andrew). Mexico: A Fajardo-Gutiérrez (Children Cancer Regis-
long-term commitment is expected from governments to sup- try of Mexico City). Peru: E Payet (Metropolitan Lima Cancer
port production of data, to benefit current and future childhood Registry); PF Albújar (Trujillo Cancer Registry). United States of
cancer patients. America – Puerto Rico: DE Zavala Zegarra (Puerto Rico Central
Cancer Registry). Uruguay: E Barrios (National Cancer Registry
IICC-3 contributors. Editors: E Steliarova-Foucher, M of Uruguay).
Colombet, LA Gloeckler Ries, F Moreno, A Dolya, HY Shin, P
Hesseling, CA Stiller. Data providers: Argentina: F Moreno Author contributions. FM, FE, and ESF conceived the study.
(Argentinean Pediatric Oncology Hospital Registry); EA Laura NPS, FM, FE, and ESF designed the study. MC, FM, AD, CAS,
(Bahía Blanca Cancer Registry); MA Duarte (Chaco Tumor Pop- and ESF acquired the data. NPS, MC, and ESF analyzed the
ulation Registry "Dra Ana H. Rey"); M Alonso (Córdoba Cancer data. NPS, FM, FE, MP, CAS, and ESF interpreted the data/
Registry); MA Prince (Entre Ríos Provincial Population Can- results. NPS, FE, and ESF drafted the manuscript. NPS, MC,
cer Registry); MC Diumenjo (Provincial Registry of Tumors of FM, FE, AD, MP, CAS, and ESF critically reviewed the manu-
Mendoza); N Arias Ondicol (Neuquén Cancer Registry). Brazil: script. All authors approved the final version of the manuscript
CA Lima (Cancer Registry of Aracaju); GP Mundim Pena (Pop- and agree to be accountable for all aspects of the work. IICC-3
ulation-Based Cancer Registry of Belo Horizonte); C Asturian contributors participated in data acquisition, interpretation,
Laporte (Population-Based Cancer Registry of Curitiba); JC and critical review.
de Oliveira (Cancer Registry of Goiânia); JA Pontes de Aquino
(Cancer Registry of João Pessoa). Chile: C Vallebuona (National Acknowledgments. The authors acknowledge the cooperation
Registry of Childhood Cancer); JC Galaz (Cancer Registry of of all staff of the contributing cancer registries in Latin Amer-
the Region of Antofagasta); ME Umaña (Population-Based ica. The map in Figure S1 was drawn by Jérôme Vignat at the
Cancer Registry of the Province of Bío Bío); C Espinoza (Pop- Cancer Surveillance Branch of the International Agency for
ulation Cancer Registry of the Province of Concepción); SM Research on Cancer.
Vargas Gallagher (Region de Los Rios Cancer Registry).
Colombia: CJ Uribe (Cancer Registry of the Metropolitan Area Conflict of interest. None declared.
of Bucaramanga); LE Bravo (Cali Cancer Registry); NE Arias
Ortiz (Population-Based Cancer Registry of Manizales); MC Funding. International Incidence of Childhood Cancer volume 3
Yepez Chamorro (Cancer Registry of Pasto). Costa Rica: G Tor- was supported by the International Agency for Research on
res Alvarado (Costa Rica National Tumor Registry). Cuba: YH Cancer and the Union for International Cancer Control.
Galán Alvarez (Cuba National Cancer Registry). Ecuador: FC
Martinez Reyes (Cuenca Tumor Registry); J Tanca Campozano Disclaimer. Authors hold sole responsibility for the views
(Guayaquil Cancer Registry); JC Castillo Calvas (Loja Cancer expressed in the article, which may not necessarily reflect the
Registry); M Mendoza Alava (Manabí cancer registry); P Cueva opinion or policy of the RPSP/PAJPH and/or the Pan American
Ayala (Quito Cancer Registry). France – French Guiana: T Health Organization (PAHO). Where authors are identified as
Roué (French Guiana Cancer Registry); France – Guadeloupe: J personnel of the International Agency for Research on Cancer
Deloumeaux (General Cancer Registry of Guadeloupe); France (IARC)/World Health Organization (WHO), the authors alone
– Martinique: C Joachim (Martinique Cancer Registry). Hon- are responsible for the views expressed in this article and they
duras: F Duarte Muñoz (Francisco Morazán Cancer Registry). do not necessarily represent the decisions, policy, or views of
Jamaica: B Hanchard (Jamaica Cancer Registry, Kingston and St. IARC/WHO.

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De Paula Silva et al. • Childhood cancer in Latin America and the Caribbean Original research

Incidencia del cáncer infantil en América Latina y el Caribe: cobertura de los

registros, patrones y tendencias a lo largo del tiempo
RESUMEN Objetivo. Presentar un panorama integral de los patrones geográficos (2001 a 2010) y las tendencias a lo
largo del tiempo (1993 a 2012) de la incidencia de cáncer en la población infantil de 0 a 19 años en América
Latina y el Caribe e interpretar los resultados en el contexto de los patrones mundiales.
Métodos. Se describen las diferencias geográficas en el período 2001-2010 y las tendencias de la incidencia
entre 1993 y el 2012 correspondientes a la población menor de 20 años de América Latina y el Caribe, mediante
el empleo de la base de datos del tercer volumen del estudio de Incidencia Internacional del Cáncer Infantil,
(IICC, por su sigla en inglés), que contiene datos comparables. Se calculó la tasa de incidencia específica para
la edad (TEE) por millón de años-persona para los diversos subgrupos poblacionales y la tasa de incidencia
mundial estandarizada según la edad (TEM) utilizando la población estándar mundial.
Resultados. El estudio incluyó un total de 36 744 casos únicos. En el período del 2001 al 2010, la TEM general
en la franja etaria de 0 a 14 años fue de 132,6. Los cánceres más frecuentes fueron la leucemia (TEM 48,7), las
neoplasias del sistema nervioso central (TEM 23,0) y el linfoma (TEM 16,6). La TEE general en la franja etaria
de 15 a 19 años fue de 152,3, con el linfoma como cáncer más frecuente (TEE 30,2). La incidencia fue mayor
en el sexo masculino que en el femenino, y fue más alta en América del Sur que en Centroamérica y el Caribe.
En comparación con los datos mundiales, en América Latina y el Caribe la incidencia fue, en general, menor,
excepto en el caso de leucemia y el linfoma en la franja etaria de 0–14 años y los cánceres classificados como
otros tumores y tumores sin especificar en todas las edades. La incidencia general en la franja etaria de 0-19
años aumentó en un 1,0 % al año (IC del 95 % [0,6, 1,3]) entre 1993 y el 2012. La cobertura de los registros
incluidos fue de un 16% de la población de 0 a 14 años y de un 10% de la de 15 a 19 años.
Conclusiones. Los patrones observados proporcionan un valor de referencia para evaluar el estado y la
evolución de la incidencia del cáncer infantil en la Región. Es necesario contar con un apoyo mayor y más
sostenido para el registro del cáncer a fin de mejorar la representatividad y la oportunidad de los datos
relativos al control del cáncer infantil en América Latina y el Caribe.

Palabras clave Neoplasias; incidencia; salud infantil; sistema de registros; vigilancia en salud pública; América Latina; región
del Caribe.

Rev Panam Salud Publica 48, 2024 | https://journal.paho.org | https://doi.org/10.26633/RPSP.2024.11 11

Original research De Paula Silva et al. • Childhood cancer in Latin America and the Caribbean

Incidência de câncer infantil na América Latina e no Caribe: cobertura,

padrões e tendências temporais
RESUMO Objetivo. Apresentar uma visão abrangente dos padrões geográficos (2001 a 2010) e das tendências
temporais (1993 a 2012) da incidência de câncer em crianças e jovens de 0 a 19 anos na América Latina
e no Caribe (ALC) e interpretar os resultados no contexto de padrões mundiais.
Métodos. Foram descritas variações geográficas de 2001 a 2010 e tendências de incidência de 1993 a
2012 na população com menos de 20 anos da ALC usando informações comparáveis da base de dados
do terceiro volume do estudo International Incidence of Childhood Cancer. Foram calculadas taxas de
incidência específica por idade por milhão de pessoas-ano (ASR, na sigla em inglês) para subgrupos
populacionais e taxas padronizadas por idade usando a população padrão mundial (WSR, na sigla em
inglês).
Resultados. No total, foram incluídos 36 744 casos únicos. No período de 2001 a 2010, a WSR para todos
os tumores combinados na faixa etária de 0 a 14 anos foi de 132,6. Os diagnósticos mais frequentes foram
leucemia (WSR de 48,7), neoplasias do sistema nervoso central (WSR de 23,0) e linfoma (WSR de 16,6). A
ASR para todos os tumores combinados na faixa etária de 15 a 19 anos foi de 152,3, e a maior taxa foi a de
linfoma (ASR de 30,2). A incidência foi maior no sexo masculino do que no sexo feminino e maior na América
do Sul do que na América Central e no Caribe. De modo geral, em comparação com as estimativas mundiais,
a incidência na ALC foi menor, exceto para leucemia e linfoma entre 0 e 14 anos e para outros tumores e
tumores não especificados em qualquer idade. A taxa de incidência na faixa etária de 0 a 19 anos aumentou
em 1,0% ao ano (IC de 95% [0,6, 1,3]) entre 1993 e 2012. Os registros incluídos cobriam 16% da população
de 0 a 14 anos e 10% da população de 15 a 19 anos.
Conclusões. Os padrões observados servem de referência para avaliar o status e a evolução da ocorrência
de câncer infantil na região. É necessário garantir um apoio ampliado e consistente aos registros de câncer
para aprimorar a representatividade e a disponibilidade das informações em tempo adequado para o controle
do câncer infantil na ALC.

Palavras-chave Neoplasias; incidência; saúde da criança; sistema de registros; vigilância em saúde pública; América Latina;
região do Caribe.

12 Rev Panam Salud Publica 48, 2024 | https://journal.paho.org | https://doi.org/10.26633/RPSP.2024.11