Cancer Rates in Kids: Looking Behind the Numbers
Cancer Rates in Kids: Looking Behind the Numbers
Medscape: Renal cancers in adults have been associated with obesity, though not causally linked to it. Was that same association found in children?
Dr Siegel: As is true in thyroid cancer, other studies have associated renal carcinoma with obesity. Future research is needed to explore the question of whether this association with obesity is causal and real. There are a number of researchers exploring why obesity is related to cancers overall. There is a potential biological link between cancer and obesity.
Medscape: Were there other notable changes in incidence overall (region, sex, age, etc.) in renal carcinoma or other cancer types?
Dr Siegel: It's important to note that we found that the overall cancer rate is not changing for the most common types of pediatric cancer: leukemia, brain cancer, and lymphoma. It is encouraging that these were not increasing.
There were a number of trends identified when we looked at region, race, ethnicity, sex, and age. With a study like this, it is important to realize that the numbers in the subgroups are smaller than the overall numbers, so it is hard to make sound conclusions on one study of one short time period. These are findings that need to be examined in future studies. The longer the time period, the more confident we can be in determining whether these other changes are real.
For example, within the subgroup of African American children, we did find that Hodgkin lymphoma was increasing as was kidney cancer overall. These two areas are important to study because they may have contributed to the overall increase in cancer in African American children.
Medscape: What about changes for any other cancer types?
Dr Siegel: We also found a significant decrease in the rate of melanomas. This is in contrast to other studies that have found increasing rates of melanomas looking at a longer time period, two to three decades. We are encouraged by the finding of decreased melanomas because it is possible that it is related to better public health measures, such as sunscreen usage and decreased use of tanning beds. But we do emphasize this important caveat: In our study methodology, cancers that were diagnosed in the outpatient setting were added back into the registry late. Therefore, in the latter years of the study, our confidence that we collected all of the cases is decreased. So we want to track the melanoma incidence in another 5 years. That would be very important to further flesh this out. The potential exists that the decreased melanoma finding is a methodological artifact. One other note: Nonmelanoma skin carcinomas were a separate group, and the numbers there were too small to make any conclusion.
Medscape: What are the implications of your findings for primary care? Would you suggest any changes in monitoring children? How should this data affect parent—and patient—education?
Dr Siegel: It can be concerning to see a cancer increase in any demographic group, sex, age, race, ethnicity, or location. But I want to emphasize, both for families and pediatric healthcare providers, that the rate overall is still very low, and cancer in children is relatively rare, with a rate of less than 1 in 5800 per year. The relative changes are small, and it is still very unlikely for any child to develop cancer. It is important, when a parent has a concern, that the pediatrician or family practice doctor is available to answer those questions and to follow up as needed if what seems to be a pretty benign condition doesn't resolve in the way that we initially think it might.
So, I would say that the overall way to approach an individual patient may not change that much, and clinicians should have the discussion about the things we do know work for prevention. This study didn't look at the specifics of these issues, but we know that the human papilloma virus (HPV) vaccine is helpful in preventing cervical cancer. We do know that sunscreen is important. I would emphasize as much as possible to continue the measures that we know do work, and to support research going forward that will help us answer these questions over the long term.
Our findings are only possible because of countless healthcare workers who have created and maintained high-quality cancer surveillance systems. That is really how we are able to have some of these answers. It is important to support the continued use of cancer surveillance systems that will be helpful in guiding researchers to understand the driving forces in the future.
Renal Cancer and Obesity
Medscape: Renal cancers in adults have been associated with obesity, though not causally linked to it. Was that same association found in children?
Dr Siegel: As is true in thyroid cancer, other studies have associated renal carcinoma with obesity. Future research is needed to explore the question of whether this association with obesity is causal and real. There are a number of researchers exploring why obesity is related to cancers overall. There is a potential biological link between cancer and obesity.
Medscape: Were there other notable changes in incidence overall (region, sex, age, etc.) in renal carcinoma or other cancer types?
Dr Siegel: It's important to note that we found that the overall cancer rate is not changing for the most common types of pediatric cancer: leukemia, brain cancer, and lymphoma. It is encouraging that these were not increasing.
There were a number of trends identified when we looked at region, race, ethnicity, sex, and age. With a study like this, it is important to realize that the numbers in the subgroups are smaller than the overall numbers, so it is hard to make sound conclusions on one study of one short time period. These are findings that need to be examined in future studies. The longer the time period, the more confident we can be in determining whether these other changes are real.
For example, within the subgroup of African American children, we did find that Hodgkin lymphoma was increasing as was kidney cancer overall. These two areas are important to study because they may have contributed to the overall increase in cancer in African American children.
Medscape: What about changes for any other cancer types?
Dr Siegel: We also found a significant decrease in the rate of melanomas. This is in contrast to other studies that have found increasing rates of melanomas looking at a longer time period, two to three decades. We are encouraged by the finding of decreased melanomas because it is possible that it is related to better public health measures, such as sunscreen usage and decreased use of tanning beds. But we do emphasize this important caveat: In our study methodology, cancers that were diagnosed in the outpatient setting were added back into the registry late. Therefore, in the latter years of the study, our confidence that we collected all of the cases is decreased. So we want to track the melanoma incidence in another 5 years. That would be very important to further flesh this out. The potential exists that the decreased melanoma finding is a methodological artifact. One other note: Nonmelanoma skin carcinomas were a separate group, and the numbers there were too small to make any conclusion.
Should Practice Change?
Medscape: What are the implications of your findings for primary care? Would you suggest any changes in monitoring children? How should this data affect parent—and patient—education?
Dr Siegel: It can be concerning to see a cancer increase in any demographic group, sex, age, race, ethnicity, or location. But I want to emphasize, both for families and pediatric healthcare providers, that the rate overall is still very low, and cancer in children is relatively rare, with a rate of less than 1 in 5800 per year. The relative changes are small, and it is still very unlikely for any child to develop cancer. It is important, when a parent has a concern, that the pediatrician or family practice doctor is available to answer those questions and to follow up as needed if what seems to be a pretty benign condition doesn't resolve in the way that we initially think it might.
So, I would say that the overall way to approach an individual patient may not change that much, and clinicians should have the discussion about the things we do know work for prevention. This study didn't look at the specifics of these issues, but we know that the human papilloma virus (HPV) vaccine is helpful in preventing cervical cancer. We do know that sunscreen is important. I would emphasize as much as possible to continue the measures that we know do work, and to support research going forward that will help us answer these questions over the long term.
Our findings are only possible because of countless healthcare workers who have created and maintained high-quality cancer surveillance systems. That is really how we are able to have some of these answers. It is important to support the continued use of cancer surveillance systems that will be helpful in guiding researchers to understand the driving forces in the future.
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