Italian cancer figures--report 2008. 1. Childhood cancer.

Aim: This study provides updated results on cancer incidence and survival in children and adolescents in Italy, based on data collected by the Italian network of Cancer Registries (AIRTUM). We also present time trends of incidence, survival and mortality, estimates of the number of incident cases expected in the next 15 years in Italy and the results of the hospital based registry run by the Italian Association of Paediatric Haematology and Oncology (AIEOP). Method: Data were collected by the population based cancer registries in the AIEOP network, referring to incidence in 1998-2002. Quality was high: microscopic diagnosis was available for 87.4% in age 0 - 14 and 92.5% in age 15-19 years; DCO cases were 0.3% overall; the proportion of cases coded in classes 11 (carcinoma) and 12 (unspecified) of the ICCC classification was 6.7% in age 0-14 and 24.8% in age 15-19. Mortality : incidence ratio was 19.0% in age 0-14 and 18.8% in age 15-19. Results for paediatric cancer are presented in 20 specific sections (10 for the major and 9 for the minor ICCC categories plus one for the total) accompanied by one paper on incidence and one paper on survival. Results regarding adolescents are all condensed in one paper. We present incidence rates and cumulative survival by age, gender, and area and, for trend analyses, also by period. Indices and their 95% confidence intervals are presented as graphs or tables. Registries are grouped in analyses by area according to their location in Northern, Central and Southern Italy. Age classes are defined as customary (0, 1-4, 5-9, 10-14 years as paediatric age and 15-19 as adolescence). Analyses of incidence trends include those registries with at least two years of observation in each of the 5 years periods considered and were conducted using Poisson regression models. Survival analyses were carried on using non parametric Kaplan Meier estimates. The expected numbers of cases were computed from the incidence rates measured by cancer registries and the projections of population size provided by ISTAT for the next 15 years. The AIEOP data base provided the number of cases registered in the AIEOP clinical centres. Results: Incidence of paediatric neoplasm in 1998-2002 was 175.4 per million-year in age 0-14 and 269.7 in age 15-19 years. Differences among geographical areas were limited. Statistically significant increasing trends were observed for some tumour types in paediatric age, the most relevant being: leukaemia (APC=+1.6%), lymphoma (APC=+4.6%) and CNS neoplasm (APC=+2.0%). In period 1998-2002, the AIEOP centres recorded 5,616 new cases. The survival analyses showed an improved prognosis for most neoplasm. Cumulative survival percent at 5 years from diagnosis for cases incident in 1998-2002 was 78% for neoplasm in paediatric age and 82% in adolescent age. Mortality analyses showed a marked reduction from 1970. The expected number of incident cases in paediatric age is 8,132, 8,672 e 8,944, in 2001-05, 2006-10 e 2011-15 periods, respectively. In adolescents corresponding figures are 3,974, 3,892 and 3,752. Comments: These data present descriptive cancer epidemiology in children and adolescents in Italy. Data were provided by the extensive data collection run by Italian population based Cancer Registries, both specialized and general. Registry data are complemented by mortality data and by hospital-based AIEOP registry data. Results indicate high incidence rates compared internationally and an increasing incidence trend. Positive results were provided regarding prognosis and mortality both in paediatric and adolescent age. These results are useful both for the clinician and for the health service planner. Results refer to an unselected population and therefore provide an unbiased information on the complex interaction between incidence and diagnostic-therapeutic options provided by the Italian Health Service.