The burden of childhood cancers in the South Asian Association for Regional Cooperation (SAARC) Region: a population-based, cross-sectional GLOBOCAN 2022 analysis
Jul 2026· The Lancet Regional Health - Southeast Asia· Vol 52, pp. 100815· 0 citations· 61 references
Medicine
TL;DR
SAARC childhood cancer patterns reflect both population size and health system capacity, with a preponderance of leukemia and marked mortality-to-incidence ratio disparities across countries, especially for CNS cancers.
Abstract
Summary Background Countries of the South Asian Association for Regional Cooperation (SAARC) are home to approximately 600 million children aged 0–14 years, representing a quarter of the global child population. We report incidence and mortality for childhood cancers among South Asia's eight nations to inform priority setting for research, programming for health services, and policy for childhood cancers. Methods Incidence and mortality of new childhood cancer diagnoses for all cancers combined and for selected leading cancer types were retrieved from GLOBOCAN 2022 database of Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Age-standardized incidence rates (ASR) and mortality-to-incidence ratios (MIR) were calculated, together with statistical examination of cross-country variation in diagnostic structure and mortality patterns. Findings In SAARC nations, 37,716 new childhood cancer diagnoses and 17,698 deaths were estimated in 2022. India contributed 68.8% of subregional cases (25,939), and Pakistan contributed 20.8% (7841). Age-standardized incidence rates differed and were greatest in Sri Lanka (10.4/100,000) and Pakistan (10.1) and lowest in Bhutan (2.3) and Bangladesh (3.7). Age-standardized mortality rates ranged from 1.1/100,000 in Bhutan to 5.2/100,000 in Afghanistan (SAARC-wide ASMR 3.5/100,000). Boys represented 57% of cases overall, with the proportion varying across countries. Leukemia was the most common cancer in all countries (35–50%), followed by central nervous system (CNS) tumors (approximately 12% of cases). MIR ranged from 0.30 (Sri Lanka) to 0.57 (Afghanistan). Interpretation SAARC childhood cancer patterns reflect both population size and health system capacity, with a preponderance of leukemia and marked mortality-to-incidence ratio disparities across countries, especially for CNS cancers. There is a need to have subregional cooperation to address gaps in cancer registration, equitable access to specialty care, and continuity of treatment. Funding ECD is funded in part through the 10.13039/100000892Prostate Cancer Foundation Young Investigator Award. SM, SLW, CBJ, and ECD are funded in part through the Cancer Center Support Grant from the 10.13039/100000054National Cancer Institute (P30 CA008748).
Summary Background Cancer registries in Latin America continue to face challenges related to coverage, under-registration, and data quality. We evaluated childhood cancer epidemiology in Chile from 2007 to 2023, assessed the quality of the National Childhood Cancer Registry (RENCI) according to International Agency for Research on Cancer (IARC) standards, and described the childhood cancer control policy context. Methods We analysed 8821 incident cases in children aged 0–14 years registered in RENCI and classified according to ICD-O-3.2 and ICCC-3. Incidence and mortality rates were age-standardised using the Segi world standard population. Mortality and years of potential life lost (YPLL) were estimated using national mortality data (2002–2021). Trends were assessed using Joinpoint regression and five-year observed survival using the Kaplan–Meier method. Registry quality was evaluated according to IARC criteria. Findings Incidence increased from 137.4 to 143.0 per million (AAPC 1.36, 95% CI 0.5–2.4), with leukaemias remaining the most common cancer type (58.6 per million), followed by central nervous system tumours (24.8) and lymphomas (12.7). Five-year survival improved from 71.4% (95% CI 69.6–73.8) in 2007–2011 to 80.5% (95% CI 76.4–83.9) in 2020–2023. Mortality declined from 36.3 to 25.7 per million between 2002 and 2021 (AAPC –0.57, 95% CI –1.5 to 0.4). RENCI achieved 100% national coverage, an MV% of 93.5%, and a DCO% of 0.7%. Interpretation This study describes the implementation and operation of a national population-based childhood cancer registry in a middle-income country and reports its epidemiological findings. Key findings include increasing incidence, improved survival in recent cohorts, and a non-significant downward trend in mortality. These results offer practical insights for other low- and middle-income countries seeking to strengthen childhood cancer surveillance systems. The descriptive nature of the study and the temporal (non-causal) associations observed should be considered when interpreting the findings. Funding National Childhood Cancer Registry (RENCI) of the Ministry of Health of Chile.
Patricia Cerda, Kelly Núñez, M. Paredes et al.· The Lancet Regional Health -...· 0 citations
Abstract Childhood cancer represents an increasingly recognized priority in global health, with the World Health Organization’s Global Initiative for Childhood Cancer aiming to achieve 60% survival for six index cancers by 2030. In Nigeria, leukemia and lymphoma constitute a substantial proportion of pediatric malignancies, yet outcomes remain dramatically poorer than in high-income countries. This review examines the current state of childhood leukemia and lymphoma in Nigeria, synthesizing available epidemiological data, discussing unique biological features, and analyzing the multifactorial challenges that perpetuate poor survival. Treatment abandonment exceeds 37%, mortality approaches 32%, and critical infrastructure gaps—including limited radiotherapy access, absence of bone marrow transplantation, and inadequate diagnostic capacity—compound the problem. The WHO’s interventions through the Global Initiative and technical support for registry development offer frameworks for progress. Future perspectives emphasize the necessity of population-based cancer registries, expanded health insurance coverage, investment in regional diagnostic and treatment centers, and sustainable financing mechanisms to bridge the survival gap.
O. Izuegbuna· Pediatric Hematology & Oncol...· 0 citations
Light is shed on the prevalence of cancer in Somalia and the dire need for accessible and affordable oncology services in Somalia and the urgent to need to establish national or population-based cancer registries to determine cancer incidence, identify risk factors, and create national plan for cancer prevention, control, and treatment.
Population-based cancer registries are essential tools for monitoring the burden of childhood cancer and guiding evidence-based public health policies. In pediatric oncology, long-term registry data are particularly valuable for evaluating survival trends, identifying inequities, and informing health system strengthening. The Argentina Oncopediatric Registry (ROHA), established in 2000, provides a unique framework for evaluating long-term trends in childhood cancer incidence, survival, and mortality.
We analyzed population-based data from ROHA for children aged 0–14 years diagnosed with cancer(2000-2022).Incidence was calculated using age-standardized rates (ASR). Overall survival(OS) was estimated using standard survival analysis techniques and evaluated by calendar period, tumor group, geographic region, and Human Development Index (HDI). National mortality data were obtained from the National Statistical Office. Adolescents aged 15–19 years were excluded due to incomplete registry coverage.
During the study period, 31,241 childhood cancer cases were registered, corresponding to an incidence ASR of 131 cases/million children per year, which remained stable over time. Five-year OS improved substantially, increasing from 59.7% in 2000–2004 to approximately 70% in the most recent period. The largest survival gains were observed for leukemias and central nervous system tumors. However, improvements slowed in recent years, and marked disparities persist by tumor type, geographic region, and Human Development Index level. The national age-standardized childhood cancer mortality rate per 100,000 children was 3.73 in 2021–2022 and showed a declining trend over the study period, consistent with improvements in overall survival.
Over the past 25 years, Argentina has achieved meaningful progress in childhood cancer survival while maintaining stable incidence rates. Argentina's survival estimates are among the highest reported in Latin America; however, important regional and socioeconomic disparities persist. Integrating high-quality registry data with national cancer policies, social protection mechanisms, and strategies to strengthen clinical support—through the Childhood and Adolescent Cancer Protection Law and the Unique Pediatric Oncology Certificate—offers a model to improve equity, quality of care, and outcomes in Argentina and similar middle-income settings.
Florencia Moreno, M. Chaplin, Mariana Nana et al.· Frontiers in Cancer Control...· 0 citations
Childhood leukemia remains a critical global public health challenge, contributing significantly to disability and premature mortality. Despite progress in healthcare, comprehensive estimates of its burden across geographic and sociodemographic strata remain essential for formulating evidence-based interventions. Utilizing data from the Global Burden of Diseases 2021, this cross-sectional study analyzed leukemia incidence, deaths, and disability-adjusted life years (DALYs) among children aged 0 to 14 across 204 countries and territories from 1990 to 2021. Stratified analyses by region, nation, age, sex, leukemia type, and Sociodemographic Index (SDI) were conducted, with estimated annual percentage changes calculated to assess trends. In 2021, childhood leukemia caused 58,785 incident cases (95% uncertainty interval [UI], 43,200–73,139), 27,861 deaths, and 2,341,610 DALYs globally, corresponding to an incidence rate of 4.37 per 100,000 (95% UI, 3.51–5.46). From 1990 to 2021, global incidence and death rates declined by a total of 0.23% (95% UI, −0.44% to −0.11%) and 0.52% (95% UI, −0.64% to −0.35%), respectively. However, the low-SDI region exhibited rising incidence, mortality, and DALY rates. Australasia experienced the largest incidence increase (estimated annual percentage change: 0.67%, 95% confidence interval, 0.23%–1.11%). Nationally, San Marino reported the highest incidence (13.79 per 100,000; 95% UI, 8.03–21.07), while Tokelau had the highest mortality (7.92 per 100,000; 95% UI, 4.36–13.32) and DALY rates (116.39 per 100,000; 95% UI, 86.46–139.97). Despite global reductions in childhood leukemia burden over 3 decades, persistent disparities across SDI subgroups and regions underscore unmet needs in low-resource settings. Precision epidemiology and context-specific strategies are imperative to mitigate inequities and optimize prevention and care.
BACKGROUND
Despite global elimination initiatives, cervical cancer remains a major public health burden across Asia. We aimed to assess regional and age-specific trends in cervical cancer burden using data from the Global Burden of Disease Study (GBD) 2023.
METHODS
We analyzed GBD 2023 to estimate the burden of cervical cancer across 34 Asian countries from 1990 to 2023. Age-standardized incidence rate (ASIR), mortality rate (ASMR), and DALY rate (ASDR) were assessed by region and Socio-demographic Index (SDI), while age-specific rates were evaluated for females aged 15-49, 50-69, and ≥70 years. Cervical cancer was defined as malignant neoplasm of the cervix, and burden attributable to unsafe sex and tobacco use was estimated using population-attributable fractions derived from exposure data and relative risks. Estimates are presented as means with 95% uncertainty intervals (UIs).
RESULTS
In 2023, South Asia exhibited the highest cervical cancer burden, with an ASIR of 22.07 (95% UI, 14.68-33.20) per 100,000 population, whereas High-income Asia Pacific had the lowest ASIR at 11.89 (9.94-14.37). A similar pattern was observed for ASDR: South Asia had the highest rate at 377.19 (95% UI, 255.79-558.38) per 100,000 population, while High-income Asia Pacific exhibited the lowest rate at 96.04 (84.08-109.75). From 1990 to 2023, ASIR and ASDR generally declined across Asia, although substantial regional disparities persisted. Across all five regions, the relative contribution of females aged 15-49 years to cervical cancer burden increased, while that of older age groups generally decreased; however, the absolute incidence rates among females aged 15-49 years increased only in Southeast Asia and High-income Asia Pacific. Cervical cancer burden attributable to unsafe sex showed the highest DALY rate among females aged 50-69 years and the highest mortality rate among those aged 70 years or older. Overall, cervical cancer burden exhibited an inverse association with SDI.
CONCLUSION
Cervical cancer remains a substantial burden in low-SDI Asian countries, with an increasing relative contribution among females aged 15-49 years. Age-specific and context-specific prevention strategies are urgently needed to reduce inequalities and accelerate elimination efforts in Asia.
Seohyun Shin, Dongjin Yeo, Hyunjee Kim et al.· European Journal of Obstetri...· 0 citations