Abstract

Background

Cancer is a leading cause of death by disease among children and adolescents in the United States. This study updates cancer incidence rates and trends using the most recent and comprehensive US cancer registry data available.

Methods

We used data from US Cancer Statistics to evaluate counts, age-adjusted incidence rates, and trends among children and adolescents younger than 20 years of age diagnosed with malignant tumors between 2003 and 2019. We calculated the average annual percent change (APC) and APC using joinpoint regression. Rates and trends were stratified by demographic and geographic characteristics and by cancer type.

Results

With 248 749 cases reported between 2003 and 2019, the overall cancer incidence rate was 178.3 per 1 million; incidence rates were highest for leukemia (46.6), central nervous system neoplasms (30.8), and lymphoma (27.3). Rates were highest for males, children 0 to 4 years of age, Non-Hispanic White children and adolescents, those in the Northeast census region, the top 25% of counties by economic status, and metropolitan counties with a population of 1 million people or more. Although the overall incidence rate of pediatric cancer increased 0.5% per year on average between 2003 and 2019, the rate increased between 2003 and 2016 (APC = 1.1%), and then decreased between 2016 and 2019 (APC = –2.1%). Between 2003 and 2019, rates of leukemia, lymphoma, hepatic tumors, bone tumors, and thyroid carcinomas increased, while melanoma rates decreased. Rates of central nervous system neoplasms increased until 2017, and then decreased. Rates of other cancer types remained stable.

Conclusions

Incidence of pediatric cancer increased overall, although increases were limited to certain cancer types. These findings may guide future public health and research priorities.

Approximately 15 000 children and adolescents are diagnosed with cancer each year in the United States (1). Although pediatric cancer mortality has decreased over the past 40 years (2), cancer is still the leading disease-related cause of death among children and adolescents aged 1 to 19 years in the United States (3,4). The number of pediatric cancer survivors in the United States is growing and was estimated at 483 039 as of 2018 (5). Changes in pediatric cancer incidence rates may indicate shifts in clinical care or research needs both for patients and for survivors.

Past studies documented either stable or increasing rates of pediatric cancer in the United States (6,7) or trends that varied by cancer type (8-11). Many of these studies used older data or Surveillance, Epidemiology, and End Results (SEER) data, however, which covered 28% or less of the US population (2,7,12). US Cancer Statistics (USCS) combines data from the US Centers for Disease Control and Prevention’s National Program of Cancer Registries (NPCR) and the National Cancer Institute’s SEER program. USCS covers all 50 US states and the District of Columbia and can be used to assess recent pediatric cancer trends overall, by demographic group, and by cancer type. Because pediatric cancer incidence varies geographically in the United States (13-15), studies using high population coverage can account for regional differences in incidence and trends. This study describes overall counts, rates, and trends of pediatric cancer in the United States diagnosed from 2003 to 2019 by demographic group, geographic characteristic, and cancer type.

Methods

Data were obtained from the USCS analytic database (16). Population-based cancer registries that contribute to NPCR and SEER collected cases through medical record abstraction performed by cancer registrars. In our study, pediatric cancer included children (aged between 0-14 years) and adolescents (aged 15-19 years) who were diagnosed with a first primary malignant cancer, defined by behavior code = 3 [including pilocytic astrocytoma, as has been noted previously (17,18)] in the United States from 2003 to 2019. Data met USCS publication criteria during the study period (19,20); data from Nevada were excluded from the entire study because they did not meet publication criteria during the 2018-2019 period. The final dataset covered 99.1% of the US population. We characterized diagnoses by site and histology according to the rules and nomenclature of the International Classification of Diseases for Oncology, Third Edition (21,22) and grouped them according to the International Classification of Childhood Cancer (ICCC) (23,24). We used the USCS “race and origin recode” variable to define race and ethnicity and categorized results as Non-Hispanic American Indian or Alaska Native, Non-Hispanic Asian or Pacific Islander, Non-Hispanic Black (Black), Non-Hispanic White (White), and Hispanic or Latino (any race) (Hispanic). We analyzed economic status by county of residence at diagnosis and stratified by percentile, as defined by the Appalachian Regional Commission (25) but did not include data from Kansas and Minnesota because county-level data were not reported from those states. Rural-urban status was described by metropolitan and nonmetropolitan areas by population size using Beale codes (26).

Statistical analysis

Rates, which were reported per 1 million people, were calculated using SEER*Stat, version 8.4.0, software and age-adjusted to the 2000 US standard population (19 age groups—Census P25-1130). Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated based on reported sex using SEER*Stat software because of well-described differences in the incidence of pediatric cancer by sex. Two-sided, statistically significant IRRs were different at P <.05. Incidence trends were assessed using average annual percent change (AAPC) to describe a fixed interval and annual percent change (APC) to describe a single segment (6), calculated by Joinpoint, version 4.9.0.1, software; APC calculations allowed a maximum of 3 joinpoints. Two-sided statistically significant AAPC and APC were different from zero at P <.05. Statistically significant trends were described as increasing or decreasing; otherwise, trends were described as stable. Rates and trends were calculated overall and by sex, age, race and ethnicity, US Census region, economic status by county, rural-urban status, and cancer type (ICCC group). Rates and counts were suppressed for counts of fewer than 6 cases, and trends were calculated only if there were 6 or more cases in each calendar year during 2003 to 2019. Institutional review board review was not needed because this was a secondary analysis of deidentified data.

Results

From 2003 to 2019, 248 749 cases of pediatric cancer were reported in the United States, which represented an overall age-adjusted incidence rate of 178.3 cases per million (Table 1). Rates were higher for males (185.9) than for females (170.5), and rates were highest for infants (264.6) and children aged 0 to 4 years (230.7), followed by adolescents aged 15 to 19 years (221.1). Rates were highest for White children and adolescents (188.9) and lowest for Black children and adolescents (136.1). By US Census region, rates were highest in the Northeast (192.4) and lowest in the South (173.6). Rates were highest in the top 25% of counties by economic status (186.1) and were highest in metropolitan areas with populations of 1 million people or more (182.1).

Table 1.

Age-adjusted and age-specific incidence ratea of invasive cancer,b ages 0 to 19 years, and trends, by selected characteristics—United States,c 2003-2019

2003
2019
2003-2019
APC1 
APC2
CharacteristicCountRateCountRateCountRate (95% CI)AAPCd (95% CI)YearsAPCd (95% CI)YearsAPCd (95% CI)
Overall13 327164.514 381177.2248 749178.3 (177.6 to 179.0)0.5 (0.1 to 0.8)e2003-20161.1 (0.9 to 1.3)e2016-2019–2.1 (–3.8 to –0.3)e
Sex
 Male7040169.57557182.4132 557185.9 (184.9 to 186.9)0.4 (–0.1 to 0.8)2003-20161.0 (0.8 to 1.2)e2016-2019–2.5 (–4.6 to –0.2)e
 Female6287159.16824171.8116 192170.5 (169.5 to 171.5)0.6 (0.2 to 1.0)e2003-20161.1 (0.9 to 1.4)e2016-2019–1.6 (–3.8 to 0.7)
Age group, y
 0 to 149006149.49565159.3168 836164.0 (163.2 to 164.8)0.3 (0.0 to 0.7)2003-20161.1 (0.9 to 1.3)e2016-2019–3.0 (–4.9 to –1.0)e
 <1991251.4950254.917 690264.6 (260.7 to 268.5)0.1 (–0.5 to 0.8)2003-20151.1 (0.6 to 1.6)e2015-2019–2.8 (–5.4 to –0.1)e
 0 to 44187215.34160215.077 477230.7 (229.1 to 232.3)–0.1 (–0.5 to 0.4)2003-20150.9 (0.6 to 1.2)e2015-2019–2.9 (–4.6 to –1.2)e
 5-92175111.72390119.342 455125.3 (124.2 to 126.5)0.4 (–0.2 to 1.0)2003-20151.4 (1.0 to 1.9)e2015-2019–2.7 (–4.9 to –0.6)e
 10-142644124.43015146.248 904139.2 (138.0 to 140.4)1.1 (0.4 to 1.8)e2003-20171.5 (1.3 to 1.8)e2017-2019–1.7 (–7.3 to 4.2)
 15-194321209.24816230.679 913221.1 (219.6 to 222.6)0.8 (0.5 to 1.1)e2003-20190.8 (0.5 to 1.1)e
Race and ethnicityf
 American Indian or Alaska Native100117.0120152.72274159.9 (153.4 to 166.6)1.7 (0.4 to 3.0)e2003-20191.7 (0.4 to 3.0)e
 Asian or Pacific Islander451126.6725143.511 246152.2 (149.4 to 155.0)0.6 (–0.7 to 1.9)2003-20171.7 (1.1 to 2.3)e2017-2019–6.7 (–16.1 to 3.9)
 Black1609129.21639132.629 053136.1 (134.6 to 137.7)0.1 (–0.6 to 0.8)2003-20160.8 (0.4 to 1.2)e2016-2019–2.9 (–6.5 to 0.8)
 Hispanic (all races)2406157.73720183.755 066175.7 (174.2 to 177.2)0.9 (0.6 to 1.1)e2003-20190.9 (0.6 to 1.1)e
 White8588175.27847183.7147 314188.9 (188.0 to 189.9)0.4 (0.0 to 0.7)2003-20161.1 (0.8 to 1.3)e2016-2019–2.6 (–4.7 to –0.6)e
US Census regiong
 Midwest3056165.23040176.353 987176.9 (175.4 to 178.4)0.5 (–0.1 to 1.1)2003-20161.0 (0.7 to 1.4)e2016-2019–1.7 (–4.8 to 1.4)
 Northeast2604180.02495190.545 435192.4 (190.6 to 194.1)0.3 (–0.2 to 0.9)2003-20171.0 (0.7 to 1.2)e2017-2019–3.8 (–8.4 to 1.0)
 South4699160.05535173.791 624173.6 (172.5 to 174.8)0.5 (0.0 to 1.0)e2003-20161.2 (0.9 to 1.4)e2016-2019–2.3 (–4.7 to 0.2)
 West2968158.73311174.757 703177.1 (175.6 to 178.5)0.7 (0.4 to 1.0)e2003-20190.7 (0.4 to 1.0)e
County-level economic status, by percentile
 Top 25%4225172.54704184.680 092186.1 (184.8 to 187.4)0.5 (0.0 to 1.0)e2003-20161.0 (0.8 to 1.3)e2016-2019–1.8 (–4.3 to 0.7)
 Transitional7459162.77992175.4138 065175.7 (174.8 to 176.7)0.4 (0.0 to 0.8)e2003-20161.0 (0.7 to 1.2)e2016-2019–1.8 (–3.8 to 0.2)
 Bottom 25%1253152.31232161.022 991167.7 (165.5 to 169.9)0.5 (–0.5 to 1.5)2003-20161.7 (1.2 to 2.3)e2016-2019–4.7 (–9.6 to 0.5)
County-level rural-urban continuum
 Metropolitan areas ≥1 million population7296165.78129181.3139 232182.1 (181.1 to 183.1)0.5 (0.2 to 0.9)e2003-20151.1 (0.9 to 1.4)e2015-2019–1.2 (–2.4 to –0.1)e
 Metropolitan areas of 250 000 to <1 million population2878167.03085174.153 050175.9 (174.4 to 177.4)0.3 (–0.3 to 1.0)2003-20170.8 (0.5 to 1.1)e2017-2019–3.0 (–8.5 to 2.8)
 Metropolitan areas of <250 000 population1163157.41264171.221 708170.8 (168.5 to 173.0)0.7 (0.3 to 1.1)e2003-20190.7 (0.3 to 1.1)e
 Nonmetropolitan counties1974160.01896169.534 594172.0 (170.2 to 173.9)0.4 (–0.3 to 1.1)2003-20171.2 (0.9 to 1.5)e2017-2019–4.9 (–10.5 to 1.0)
2003
2019
2003-2019
APC1 
APC2
CharacteristicCountRateCountRateCountRate (95% CI)AAPCd (95% CI)YearsAPCd (95% CI)YearsAPCd (95% CI)
Overall13 327164.514 381177.2248 749178.3 (177.6 to 179.0)0.5 (0.1 to 0.8)e2003-20161.1 (0.9 to 1.3)e2016-2019–2.1 (–3.8 to –0.3)e
Sex
 Male7040169.57557182.4132 557185.9 (184.9 to 186.9)0.4 (–0.1 to 0.8)2003-20161.0 (0.8 to 1.2)e2016-2019–2.5 (–4.6 to –0.2)e
 Female6287159.16824171.8116 192170.5 (169.5 to 171.5)0.6 (0.2 to 1.0)e2003-20161.1 (0.9 to 1.4)e2016-2019–1.6 (–3.8 to 0.7)
Age group, y
 0 to 149006149.49565159.3168 836164.0 (163.2 to 164.8)0.3 (0.0 to 0.7)2003-20161.1 (0.9 to 1.3)e2016-2019–3.0 (–4.9 to –1.0)e
 <1991251.4950254.917 690264.6 (260.7 to 268.5)0.1 (–0.5 to 0.8)2003-20151.1 (0.6 to 1.6)e2015-2019–2.8 (–5.4 to –0.1)e
 0 to 44187215.34160215.077 477230.7 (229.1 to 232.3)–0.1 (–0.5 to 0.4)2003-20150.9 (0.6 to 1.2)e2015-2019–2.9 (–4.6 to –1.2)e
 5-92175111.72390119.342 455125.3 (124.2 to 126.5)0.4 (–0.2 to 1.0)2003-20151.4 (1.0 to 1.9)e2015-2019–2.7 (–4.9 to –0.6)e
 10-142644124.43015146.248 904139.2 (138.0 to 140.4)1.1 (0.4 to 1.8)e2003-20171.5 (1.3 to 1.8)e2017-2019–1.7 (–7.3 to 4.2)
 15-194321209.24816230.679 913221.1 (219.6 to 222.6)0.8 (0.5 to 1.1)e2003-20190.8 (0.5 to 1.1)e
Race and ethnicityf
 American Indian or Alaska Native100117.0120152.72274159.9 (153.4 to 166.6)1.7 (0.4 to 3.0)e2003-20191.7 (0.4 to 3.0)e
 Asian or Pacific Islander451126.6725143.511 246152.2 (149.4 to 155.0)0.6 (–0.7 to 1.9)2003-20171.7 (1.1 to 2.3)e2017-2019–6.7 (–16.1 to 3.9)
 Black1609129.21639132.629 053136.1 (134.6 to 137.7)0.1 (–0.6 to 0.8)2003-20160.8 (0.4 to 1.2)e2016-2019–2.9 (–6.5 to 0.8)
 Hispanic (all races)2406157.73720183.755 066175.7 (174.2 to 177.2)0.9 (0.6 to 1.1)e2003-20190.9 (0.6 to 1.1)e
 White8588175.27847183.7147 314188.9 (188.0 to 189.9)0.4 (0.0 to 0.7)2003-20161.1 (0.8 to 1.3)e2016-2019–2.6 (–4.7 to –0.6)e
US Census regiong
 Midwest3056165.23040176.353 987176.9 (175.4 to 178.4)0.5 (–0.1 to 1.1)2003-20161.0 (0.7 to 1.4)e2016-2019–1.7 (–4.8 to 1.4)
 Northeast2604180.02495190.545 435192.4 (190.6 to 194.1)0.3 (–0.2 to 0.9)2003-20171.0 (0.7 to 1.2)e2017-2019–3.8 (–8.4 to 1.0)
 South4699160.05535173.791 624173.6 (172.5 to 174.8)0.5 (0.0 to 1.0)e2003-20161.2 (0.9 to 1.4)e2016-2019–2.3 (–4.7 to 0.2)
 West2968158.73311174.757 703177.1 (175.6 to 178.5)0.7 (0.4 to 1.0)e2003-20190.7 (0.4 to 1.0)e
County-level economic status, by percentile
 Top 25%4225172.54704184.680 092186.1 (184.8 to 187.4)0.5 (0.0 to 1.0)e2003-20161.0 (0.8 to 1.3)e2016-2019–1.8 (–4.3 to 0.7)
 Transitional7459162.77992175.4138 065175.7 (174.8 to 176.7)0.4 (0.0 to 0.8)e2003-20161.0 (0.7 to 1.2)e2016-2019–1.8 (–3.8 to 0.2)
 Bottom 25%1253152.31232161.022 991167.7 (165.5 to 169.9)0.5 (–0.5 to 1.5)2003-20161.7 (1.2 to 2.3)e2016-2019–4.7 (–9.6 to 0.5)
County-level rural-urban continuum
 Metropolitan areas ≥1 million population7296165.78129181.3139 232182.1 (181.1 to 183.1)0.5 (0.2 to 0.9)e2003-20151.1 (0.9 to 1.4)e2015-2019–1.2 (–2.4 to –0.1)e
 Metropolitan areas of 250 000 to <1 million population2878167.03085174.153 050175.9 (174.4 to 177.4)0.3 (–0.3 to 1.0)2003-20170.8 (0.5 to 1.1)e2017-2019–3.0 (–8.5 to 2.8)
 Metropolitan areas of <250 000 population1163157.41264171.221 708170.8 (168.5 to 173.0)0.7 (0.3 to 1.1)e2003-20190.7 (0.3 to 1.1)e
 Nonmetropolitan counties1974160.01896169.534 594172.0 (170.2 to 173.9)0.4 (–0.3 to 1.1)2003-20171.2 (0.9 to 1.5)e2017-2019–4.9 (–10.5 to 1.0)
a

Rates are per 1 million people. Rates for ages <1 year, 5-9 years, 10-14 years, and 15-19 years are age specific, and the rates for ages 0 to 4 years, 0 to 14 years, and 0 to 19 years are age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Source: US Cancer Statistics. AAPC = average annual percent change; APC = annual percent change; CI = confidence interval.

b

Cases included all malignant cancers.

c

Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003–2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Characteristic values with other, missing, or blank results are not included in this table.

d

Trends were measured with APC or AAPC and rates and were considered to increase or decrease if P <.05 (2-sided); otherwise, trends were considered stable. AAPC was not calculated if case count was <6 cases in any 1 year.

e

Trends were significant at P <.05.

f

Race and ethnicity results were categorized as White, Black, American Indian or Alaska Native, and Asian or Pacific Islander (all Non-Hispanic) and Hispanic or Latino (any race) (Hispanic). Excludes 3796 cases of Non-Hispanic Unknown Race during 2003-2019, including 173 from 2003 and 330 from 2019.

Table 1.

Age-adjusted and age-specific incidence ratea of invasive cancer,b ages 0 to 19 years, and trends, by selected characteristics—United States,c 2003-2019

2003
2019
2003-2019
APC1 
APC2
CharacteristicCountRateCountRateCountRate (95% CI)AAPCd (95% CI)YearsAPCd (95% CI)YearsAPCd (95% CI)
Overall13 327164.514 381177.2248 749178.3 (177.6 to 179.0)0.5 (0.1 to 0.8)e2003-20161.1 (0.9 to 1.3)e2016-2019–2.1 (–3.8 to –0.3)e
Sex
 Male7040169.57557182.4132 557185.9 (184.9 to 186.9)0.4 (–0.1 to 0.8)2003-20161.0 (0.8 to 1.2)e2016-2019–2.5 (–4.6 to –0.2)e
 Female6287159.16824171.8116 192170.5 (169.5 to 171.5)0.6 (0.2 to 1.0)e2003-20161.1 (0.9 to 1.4)e2016-2019–1.6 (–3.8 to 0.7)
Age group, y
 0 to 149006149.49565159.3168 836164.0 (163.2 to 164.8)0.3 (0.0 to 0.7)2003-20161.1 (0.9 to 1.3)e2016-2019–3.0 (–4.9 to –1.0)e
 <1991251.4950254.917 690264.6 (260.7 to 268.5)0.1 (–0.5 to 0.8)2003-20151.1 (0.6 to 1.6)e2015-2019–2.8 (–5.4 to –0.1)e
 0 to 44187215.34160215.077 477230.7 (229.1 to 232.3)–0.1 (–0.5 to 0.4)2003-20150.9 (0.6 to 1.2)e2015-2019–2.9 (–4.6 to –1.2)e
 5-92175111.72390119.342 455125.3 (124.2 to 126.5)0.4 (–0.2 to 1.0)2003-20151.4 (1.0 to 1.9)e2015-2019–2.7 (–4.9 to –0.6)e
 10-142644124.43015146.248 904139.2 (138.0 to 140.4)1.1 (0.4 to 1.8)e2003-20171.5 (1.3 to 1.8)e2017-2019–1.7 (–7.3 to 4.2)
 15-194321209.24816230.679 913221.1 (219.6 to 222.6)0.8 (0.5 to 1.1)e2003-20190.8 (0.5 to 1.1)e
Race and ethnicityf
 American Indian or Alaska Native100117.0120152.72274159.9 (153.4 to 166.6)1.7 (0.4 to 3.0)e2003-20191.7 (0.4 to 3.0)e
 Asian or Pacific Islander451126.6725143.511 246152.2 (149.4 to 155.0)0.6 (–0.7 to 1.9)2003-20171.7 (1.1 to 2.3)e2017-2019–6.7 (–16.1 to 3.9)
 Black1609129.21639132.629 053136.1 (134.6 to 137.7)0.1 (–0.6 to 0.8)2003-20160.8 (0.4 to 1.2)e2016-2019–2.9 (–6.5 to 0.8)
 Hispanic (all races)2406157.73720183.755 066175.7 (174.2 to 177.2)0.9 (0.6 to 1.1)e2003-20190.9 (0.6 to 1.1)e
 White8588175.27847183.7147 314188.9 (188.0 to 189.9)0.4 (0.0 to 0.7)2003-20161.1 (0.8 to 1.3)e2016-2019–2.6 (–4.7 to –0.6)e
US Census regiong
 Midwest3056165.23040176.353 987176.9 (175.4 to 178.4)0.5 (–0.1 to 1.1)2003-20161.0 (0.7 to 1.4)e2016-2019–1.7 (–4.8 to 1.4)
 Northeast2604180.02495190.545 435192.4 (190.6 to 194.1)0.3 (–0.2 to 0.9)2003-20171.0 (0.7 to 1.2)e2017-2019–3.8 (–8.4 to 1.0)
 South4699160.05535173.791 624173.6 (172.5 to 174.8)0.5 (0.0 to 1.0)e2003-20161.2 (0.9 to 1.4)e2016-2019–2.3 (–4.7 to 0.2)
 West2968158.73311174.757 703177.1 (175.6 to 178.5)0.7 (0.4 to 1.0)e2003-20190.7 (0.4 to 1.0)e
County-level economic status, by percentile
 Top 25%4225172.54704184.680 092186.1 (184.8 to 187.4)0.5 (0.0 to 1.0)e2003-20161.0 (0.8 to 1.3)e2016-2019–1.8 (–4.3 to 0.7)
 Transitional7459162.77992175.4138 065175.7 (174.8 to 176.7)0.4 (0.0 to 0.8)e2003-20161.0 (0.7 to 1.2)e2016-2019–1.8 (–3.8 to 0.2)
 Bottom 25%1253152.31232161.022 991167.7 (165.5 to 169.9)0.5 (–0.5 to 1.5)2003-20161.7 (1.2 to 2.3)e2016-2019–4.7 (–9.6 to 0.5)
County-level rural-urban continuum
 Metropolitan areas ≥1 million population7296165.78129181.3139 232182.1 (181.1 to 183.1)0.5 (0.2 to 0.9)e2003-20151.1 (0.9 to 1.4)e2015-2019–1.2 (–2.4 to –0.1)e
 Metropolitan areas of 250 000 to <1 million population2878167.03085174.153 050175.9 (174.4 to 177.4)0.3 (–0.3 to 1.0)2003-20170.8 (0.5 to 1.1)e2017-2019–3.0 (–8.5 to 2.8)
 Metropolitan areas of <250 000 population1163157.41264171.221 708170.8 (168.5 to 173.0)0.7 (0.3 to 1.1)e2003-20190.7 (0.3 to 1.1)e
 Nonmetropolitan counties1974160.01896169.534 594172.0 (170.2 to 173.9)0.4 (–0.3 to 1.1)2003-20171.2 (0.9 to 1.5)e2017-2019–4.9 (–10.5 to 1.0)
2003
2019
2003-2019
APC1 
APC2
CharacteristicCountRateCountRateCountRate (95% CI)AAPCd (95% CI)YearsAPCd (95% CI)YearsAPCd (95% CI)
Overall13 327164.514 381177.2248 749178.3 (177.6 to 179.0)0.5 (0.1 to 0.8)e2003-20161.1 (0.9 to 1.3)e2016-2019–2.1 (–3.8 to –0.3)e
Sex
 Male7040169.57557182.4132 557185.9 (184.9 to 186.9)0.4 (–0.1 to 0.8)2003-20161.0 (0.8 to 1.2)e2016-2019–2.5 (–4.6 to –0.2)e
 Female6287159.16824171.8116 192170.5 (169.5 to 171.5)0.6 (0.2 to 1.0)e2003-20161.1 (0.9 to 1.4)e2016-2019–1.6 (–3.8 to 0.7)
Age group, y
 0 to 149006149.49565159.3168 836164.0 (163.2 to 164.8)0.3 (0.0 to 0.7)2003-20161.1 (0.9 to 1.3)e2016-2019–3.0 (–4.9 to –1.0)e
 <1991251.4950254.917 690264.6 (260.7 to 268.5)0.1 (–0.5 to 0.8)2003-20151.1 (0.6 to 1.6)e2015-2019–2.8 (–5.4 to –0.1)e
 0 to 44187215.34160215.077 477230.7 (229.1 to 232.3)–0.1 (–0.5 to 0.4)2003-20150.9 (0.6 to 1.2)e2015-2019–2.9 (–4.6 to –1.2)e
 5-92175111.72390119.342 455125.3 (124.2 to 126.5)0.4 (–0.2 to 1.0)2003-20151.4 (1.0 to 1.9)e2015-2019–2.7 (–4.9 to –0.6)e
 10-142644124.43015146.248 904139.2 (138.0 to 140.4)1.1 (0.4 to 1.8)e2003-20171.5 (1.3 to 1.8)e2017-2019–1.7 (–7.3 to 4.2)
 15-194321209.24816230.679 913221.1 (219.6 to 222.6)0.8 (0.5 to 1.1)e2003-20190.8 (0.5 to 1.1)e
Race and ethnicityf
 American Indian or Alaska Native100117.0120152.72274159.9 (153.4 to 166.6)1.7 (0.4 to 3.0)e2003-20191.7 (0.4 to 3.0)e
 Asian or Pacific Islander451126.6725143.511 246152.2 (149.4 to 155.0)0.6 (–0.7 to 1.9)2003-20171.7 (1.1 to 2.3)e2017-2019–6.7 (–16.1 to 3.9)
 Black1609129.21639132.629 053136.1 (134.6 to 137.7)0.1 (–0.6 to 0.8)2003-20160.8 (0.4 to 1.2)e2016-2019–2.9 (–6.5 to 0.8)
 Hispanic (all races)2406157.73720183.755 066175.7 (174.2 to 177.2)0.9 (0.6 to 1.1)e2003-20190.9 (0.6 to 1.1)e
 White8588175.27847183.7147 314188.9 (188.0 to 189.9)0.4 (0.0 to 0.7)2003-20161.1 (0.8 to 1.3)e2016-2019–2.6 (–4.7 to –0.6)e
US Census regiong
 Midwest3056165.23040176.353 987176.9 (175.4 to 178.4)0.5 (–0.1 to 1.1)2003-20161.0 (0.7 to 1.4)e2016-2019–1.7 (–4.8 to 1.4)
 Northeast2604180.02495190.545 435192.4 (190.6 to 194.1)0.3 (–0.2 to 0.9)2003-20171.0 (0.7 to 1.2)e2017-2019–3.8 (–8.4 to 1.0)
 South4699160.05535173.791 624173.6 (172.5 to 174.8)0.5 (0.0 to 1.0)e2003-20161.2 (0.9 to 1.4)e2016-2019–2.3 (–4.7 to 0.2)
 West2968158.73311174.757 703177.1 (175.6 to 178.5)0.7 (0.4 to 1.0)e2003-20190.7 (0.4 to 1.0)e
County-level economic status, by percentile
 Top 25%4225172.54704184.680 092186.1 (184.8 to 187.4)0.5 (0.0 to 1.0)e2003-20161.0 (0.8 to 1.3)e2016-2019–1.8 (–4.3 to 0.7)
 Transitional7459162.77992175.4138 065175.7 (174.8 to 176.7)0.4 (0.0 to 0.8)e2003-20161.0 (0.7 to 1.2)e2016-2019–1.8 (–3.8 to 0.2)
 Bottom 25%1253152.31232161.022 991167.7 (165.5 to 169.9)0.5 (–0.5 to 1.5)2003-20161.7 (1.2 to 2.3)e2016-2019–4.7 (–9.6 to 0.5)
County-level rural-urban continuum
 Metropolitan areas ≥1 million population7296165.78129181.3139 232182.1 (181.1 to 183.1)0.5 (0.2 to 0.9)e2003-20151.1 (0.9 to 1.4)e2015-2019–1.2 (–2.4 to –0.1)e
 Metropolitan areas of 250 000 to <1 million population2878167.03085174.153 050175.9 (174.4 to 177.4)0.3 (–0.3 to 1.0)2003-20170.8 (0.5 to 1.1)e2017-2019–3.0 (–8.5 to 2.8)
 Metropolitan areas of <250 000 population1163157.41264171.221 708170.8 (168.5 to 173.0)0.7 (0.3 to 1.1)e2003-20190.7 (0.3 to 1.1)e
 Nonmetropolitan counties1974160.01896169.534 594172.0 (170.2 to 173.9)0.4 (–0.3 to 1.1)2003-20171.2 (0.9 to 1.5)e2017-2019–4.9 (–10.5 to 1.0)
a

Rates are per 1 million people. Rates for ages <1 year, 5-9 years, 10-14 years, and 15-19 years are age specific, and the rates for ages 0 to 4 years, 0 to 14 years, and 0 to 19 years are age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Source: US Cancer Statistics. AAPC = average annual percent change; APC = annual percent change; CI = confidence interval.

b

Cases included all malignant cancers.

c

Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003–2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Characteristic values with other, missing, or blank results are not included in this table.

d

Trends were measured with APC or AAPC and rates and were considered to increase or decrease if P <.05 (2-sided); otherwise, trends were considered stable. AAPC was not calculated if case count was <6 cases in any 1 year.

e

Trends were significant at P <.05.

f

Race and ethnicity results were categorized as White, Black, American Indian or Alaska Native, and Asian or Pacific Islander (all Non-Hispanic) and Hispanic or Latino (any race) (Hispanic). Excludes 3796 cases of Non-Hispanic Unknown Race during 2003-2019, including 173 from 2003 and 330 from 2019.

The absolute count of pediatric cancers increased from 13 327 in 2003 to 14 381 in 2019, with a peak count of 15 624 cases in 2015 (Figure 1). Overall, pediatric cancer incidence rates increased from 2003 to 2019 (AAPC = 0.5%, 95% CI = 0.1 to 0.8) (Table 1). Rates increased for females, those 10 to 14 years of age and 15 to 19 years of age, American Indian or Alaska Native and Hispanic race and ethnicity groups, the South and West US Census regions, the top 75% of counties by economic status, and metropolitan areas with population of 1 million people or more or fewer than 250 000 people. From 2003 to 2019, overall rates increased until 2016 (APC = 1.1, 95% CI = 0.9 to 1.3), and then decreased (APC = –2.1%, 95% CI = –3.8 to –0.3). All study characteristics had an increase starting in 2003, with a first segment APC lasting at least 13 years; some study characteristics then had a second APC showing a decrease (eg, males; those 0-4 years of age and those 5-9 years of age) or stable trends (eg, females; those aged 10-14 years). Incidence rates for those aged 15 to 19 years increased during the entire study period (AAPC = 0.8%, 95% CI = 0.5 to 1.1). Although those 0 to 4 years of age had a higher rate than those in older age groups during the 2003-2019 period overall, the annual incidence rate for adolescents aged 15 to 19 years surpassed that of children 0 to 4 years of age in 2017 and subsequent years.

Counts and trends of invasive cancer, patients aged 0 to 19 years, and AAPC, overall, by sex, and by age—United States, 2003-2019. A) Counts overall and by sex, (B) rates overall and by sex, (C) rates by age, and (D) rates by race and ethnicity. Source: US Cancer Statistics. Rates are per 1 million people. Rates for patients younger than 1 year of age, 5-9 years of age, 10-14 years of age, and 15-19 years of age are age specific, and the rates for those aged 0 to 4 years and 0 to 19 years are age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Cases included all malignant cancers. Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003-2019 (covering 99.1% of the US population). Race and ethnicity were classified as Non-Hispanic American Indian or Alaska Native, Non-Hispanic Asian or Pacific Islander, Non-Hispanic Black (Black), Non-Hispanic White (White), and Hispanic or Latino (any race) (Hispanic). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Trends were estimated using joinpoint regression and measured with APC or AAPC and were considered to increase or decrease if P < .05 (2-sided); otherwise, trends were considered stable. *Indicates significant AAPC at P < .05. **Indicates significant APC at P < .05. Nonsignificant APC is not described in text in the figure. In panel A, markers depict observed counts; in panels B, C, and D, markers depict observed rates, and lines represent fitted rates calculated by joinpoint regression. AAPC = average annual percent change; APC = annual percent change.
Figure 1.

Counts and trends of invasive cancer, patients aged 0 to 19 years, and AAPC, overall, by sex, and by age—United States, 2003-2019. A) Counts overall and by sex, (B) rates overall and by sex, (C) rates by age, and (D) rates by race and ethnicity. Source: US Cancer Statistics. Rates are per 1 million people. Rates for patients younger than 1 year of age, 5-9 years of age, 10-14 years of age, and 15-19 years of age are age specific, and the rates for those aged 0 to 4 years and 0 to 19 years are age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Cases included all malignant cancers. Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003-2019 (covering 99.1% of the US population). Race and ethnicity were classified as Non-Hispanic American Indian or Alaska Native, Non-Hispanic Asian or Pacific Islander, Non-Hispanic Black (Black), Non-Hispanic White (White), and Hispanic or Latino (any race) (Hispanic). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Trends were estimated using joinpoint regression and measured with APC or AAPC and were considered to increase or decrease if P <.05 (2-sided); otherwise, trends were considered stable. *Indicates significant AAPC at P <.05. **Indicates significant APC at P < .05. Nonsignificant APC is not described in text in the figure. In panel A, markers depict observed counts; in panels B, C, and D, markers depict observed rates, and lines represent fitted rates calculated by joinpoint regression. AAPC = average annual percent change; APC = annual percent change.

The ICCC group leukemias, myeloproliferative diseases, and myelodysplastic diseases had the highest rate (46.6), followed by central nervous system (CNS) neoplasms (30.8) and lymphomas and reticuloendothelial neoplasms (27.3) (Table 2). Compared with females, incidence rates for several cancer types (eg, leukemias, CNS neoplasms, lymphoma) were significantly higher for males. The highest male-to-female IRR was for Burkitt lymphoma (3.91), and the lowest were for gonadal carcinoma (0.08) and thyroid carcinoma (0.22).

Table 2.

Age-adjusted incidence ratea of invasive cancer,b ages 0 to 19 years, average annual percent change between rates, and incidence rate ratios, by International Classification of Childhood Cancer group and sex—United States,c 2003-2019

Males and Females
Males
Females
Incidence rate ratio, males to females
ICCC groupNo.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)(95% CI)
Overall248 749178.30.5 (0.1 to 0.8)e132 557185.90.4 (–0.1 to 0.8)116 192170.50.6 (0.2 to 1.0)e1.09 (1.08 to 1.10)e
I Leukemias, myeloproliferative diseases, and myelodysplastic diseases64 57546.60.4 (0.0 to 0.8)e36 12950.90.3 (0 to 0.7)28 44642.00.7 (0.1 to 1.4)e1.21 (1.19 to 1.23)e
 I(a) Lymphoid leukemias46 68733.80.4 (0.0 to 0.8)e26 63037.60.4 (0 to 0.8)20 05729.70.5 (0.0 to 1.0)e1.27 (1.24 to 1.29)e
 I(b) Acute myeloid leukemias10 4747.5–0.2 (–0.6 to 0.2)54217.6–0.5 (–1.1 to 0.1)50537.40.2 (–0.4 to 0.7)1.02 (0.99 to 1.06)
 I(c) Chronic myeloproliferative diseases34402.5–0.7 (–2.8 to 1.5)18292.5–0.8 (–3.8 to 2.2)16112.40.6 (–1.3 to 2.6)1.08 (1.01 to 1.16)e
 I(d) Myelodysplastic syndrome and other myeloproliferative diseases18851.4–1.1 (–2.2 to 0.1)10631.5–1.1 (–2.8 to 0.7)8221.2–1.0 (–2.2 to 0.2)1.24 (1.13 to 1.36)e
 I(e) Unspecified and other specified leukemias20891.54.2 (3.1 to 5.4)e11861.73.7 (2.3 to 5.2)e9031.34.9 (3.2 to 6.5)e1.25 (1.15 to 1.37)e
II Lymphomas and reticuloendothelial neoplasms38 30827.31.2 (0.4 to 2.1)e23 02132.21.2 (0.3 to 2.0)e15 28722.30.9 (–0.4 to 2.1)1.44 (1.41 to 1.47)e
 II(a) Hodgkin lymphomas17 31912.3–0.1 (–0.4 to 0.2)926612.8–0.1 (–0.5 to 0.3)805311.6–0.1 (–0.7 to 0.5)1.10 (1.07 to 1.14)e
 II(b) Non-Hodgkin lymphomas (except Burkitt lymphoma)12 6009.01.2 (0.6 to 1.8)e803211.21.3 (0.7 to 1.9)e45686.71.0 (0.3 to 1.7)e1.68 (1.62 to 1.74)e
 II(c) Burkitt lymphoma33302.4–0.5 (–1.1 to 0.2)26763.8–0.4 (–1.1 to 0.3)6541.0–0.6 (–2.7 to 1.5)3.91 (3.59 to 4.27)e
 II(d) Miscellaneous lymphoreticular neoplasms46013.39.8 (1.1 to 19.3)e27563.911.1 (2.0 to 21.0)e18452.78.1 (–2.4 to 19.7)1.43 (1.35 to 1.51)e
 II(e) Unspecified lymphomas4580.3–1.7 (–6.2 to 3.0)2910.4–0.9 (–6.8 to 5.5)1670.2f1.66 (1.37 to 2.03)e
III CNS and miscellaneous intracranial and intraspinal neoplasms42 63030.8–1.7 (–2.7 to –0.6)e22 87332.3–1.6 (–2.8 to –0.5)e19 75729.2–1.7 (–3.1 to –0.3)e1.11 (1.09 to 1.13)e
 III(a) Ependymomas and choroid plexus tumor36182.6–0.1 (–1.1 to 0.8)20142.80.4 (–0.5 to 1.3)16042.4–0.3 (–7.4 to 7.3)1.20 (1.12 to 1.28)e
 III(b) Astrocytomas22 01515.9–1.3 (–3.1 to 0.5)11 49816.2–0.9 (–2.0 to 0.3)10 51715.6–1.5 (–3.9 to 1.0)1.04 (1.02 to 1.07)e
 III(c) Intracranial and intraspinal embryonal tumors79765.8–3.7 (–5.5 to –1.8)e47936.8–3.5 (–5.3 to –1.8)e31834.7–3.8 (–6.8 to –0.7)e1.44 (1.38 to 1.51)e
 III(d) Other gliomas74485.4–1.5 (–4.0 to 1.1)37495.3–1.9 (–3.7 to –0.1)e36995.50.3 (–1.0 to 0.6)0.97 (0.93 to 1.01)
 III(e) Other specified intracranial/intraspinal neoplasms9080.7–2.0 (–8.2 to 4.7)4780.7–0.4 (–2.5 to 1.8)4300.60.4 (–1.6 to 2.4)1.06 (0.93 to 1.21)
 III(f) Unspecified intracranial and intraspinal neoplasms6650.51.1 (–0.8 to 2.9)3410.51.7 (–0.4 to 3.8)3240.50.3 (–2.2 to 3.2)1.00 (0.86 to 1.17)
IV Neuroblastoma and other peripheral nervous cell tumors11 9078.60.4 (–0.1 to 0.9)62868.90.4 (–0.1 to 0.9)56218.30.4 (–0.2 to 1.0)1.07 (1.03 to 1.11)e
 IV(a) Neuroblastoma and ganglioneuroblastoma11 5758.40.4 (–0.1 to 0.8)61108.60.4 (–0.2 to 0.9)54658.10.4 (–0.2 to 1.0)1.07 (1.03 to 1.11)e
 IV(b) Other peripheral nervous cell tumors3320.21.0 (–1.6 to 3.6)1760.3f1560.2f1.08 (0.86 to 1.35)
V Retinoblastoma44243.2–0.4 (–1.4 to 0.6)22263.10.1 (–0.9 to 1.1)21983.20 (–1.0 to 0.1)0.97 (0.91 to 1.03)
VI Renal tumors95066.9–0.3 (–1.1 to 0.6)44466.30.1 (–0.7 to 0.9)50607.50.2 (–0.7 to 1.1)0.84 (0.81 to 0.87)e
 VI(a) Nephroblastoma and other nonepithelial renal tumors85836.2–0.4 (–1.2 to 0.5)39985.7–0.1 (–0.9 to 0.8)45856.80.1 (–0.7 to 1.0)0.83 (0.80 to 0.87)e
 VI(b) Renal carcinomas8750.61.3 (–0.3 to 2.9)4230.61.7 (–0.2 to 3.6)4520.71.0 (–0.7 to 2.7)0.90 (0.78 to 1.02)
 VI(c) Unspecified malignant renal tumors480.0f250.0f230.0f1.05 (0.57 to 1.93)
VII Hepatic tumors33822.41.6 (0.7 to 2.4)e19952.81.1 (0 to 2.3)13872.02.2 (1.1 to 3.2)e1.38 (1.28 to 1.48)e
 VII(a) Hepatoblastoma25221.81.9 (0.9 to 3.0)e15322.21.6 (0.2 to 3.0)e9901.52.5 (1.2 to 3.7)e1.48 (1.37 to 1.60)e
 VII(b) Hepatic carcinomas8220.60.4 (–0.8 to 1.5)4390.6–0.5 (–1.8 to 0.9)3830.61.4 (–0.7 to 3.6)1.10 (0.95 to 1.26)
 VII(c) Unspecified malignant hepatic tumors380.0f240.0f140.0ff
VIII Malignant bone tumors12 2138.70.5 (0.1 to 0.9)e69469.70.7 (–0.9 to 2.4)52677.80 (–0.5 to 0.5)1.25 (1.21 to 1.30)e
 VIII(a) Osteosarcomas67924.90.1 (–0.3 to 0.6)38765.40.8 (0.1 to 1.6)e29164.3–0.7 (–1.4 to –0.1)e1.26 (1.20 to 1.32)e
 VIII(b) Chondrosarcomas4630.30.2 (–2.0 to 2.4)2850.4–1.2 (–4.1 to 1.7)1780.3f1.52 (1.26 to 1.85)e
 VIII(c) Ewing tumor and related sarcomas of bone40312.90.8 (0.0 to 1.6)e23113.20.9 (–0.2 to 2.0)17202.50.6 (–0.4 to 1.7)1.28 (1.20 to 1.36)e
 VIII(d) Other specified malignant bone tumors6510.51.6 (–0.1 to 3.3)3150.41.7 (0 to 3.4)e3360.51.5 (–0.7 to 3.7)0.90 (0.77 to 1.05)
 VIII(e) Unspecified malignant bone tumors2760.21.5 (–0.6 to 3.6)1590.22.4 (–1.7 to 6.6)1170.2f1.29 (1.01 to 1.65)e
IX Soft tissue and other extraosseous sarcomas16 45711.80.1 (–0.2 to 0.4)898512.60.2 (–0.3 to 0.6)747211.00 (–0.5 to 0.4)1.15 (1.11 to 1.18)e
 IX(a) Rhabdomyosarcomas63814.6–0.1 (–0.9 to 0.7)36605.2–0.1 (–0.9 to 0.7)27214.0–0.1 (–1.3 to 1.2)1.28 (1.22 to 1.35)e
 IX(b) Fibrosarcomas, peripheral nerve and other fibrous16941.2–1.0 (–2.4 to 0.5)8831.2–0.6 (–2.0 to 0.8)8111.2–1.3 (–3.2 to 0.5)1.04 (0.94 to 1.14)
 IX(c) Kaposi sarcoma620.0f520.1f100.0ff
 IX(d) Other specified soft tissue sarcomas64824.60.0 (–0.4 to 0.4)33944.70.1 (–0.6 to 0.7)30884.5–0.1 (–0.6 to 0.5)1.05 (1.00 to 1.10)
 IX(e) Unspecified soft tissue sarcomas18381.31.9 (0.7 to 3.1)e9961.42.2 (1.0 to 3.4)e8421.21.2 (–0.9 to 3.5)1.13 (1.03 to 1.24)e
X Germ cell tumors, trophoblastic tumors neoplasms of gonads15 54911.00.1 (–0.4 to 0.6)978413.40.1 (–0.6 to 0.7)57658.40.2 (–0.3 to 0.7)1.59 (1.54 to 1.65)e
 X(a) Intracranial and intraspinal germ cell tumors23791.71.2 (0.1 to 2.3)e17232.40.9 (–0.2 to 2.1)6561.01.8 (–0.6 to 4.3)2.47 (2.26 to 2.71)e
 X(b) Extracranial and extragonadal germ cell tumors20001.4–0.3 (–1.2 to 0.6)8761.20.2 (–1.3 to 1.6)11241.7–0.7 (–1.6 to 0.3)0.74 (0.68 to 0.81)e
 X(c) Malignant gonadal germ cell tumors10 0727.1–0.2 (–0.8 to 0.5)70439.6–0.2 (–0.9 to 0.6)30294.4–0.1 (–0.7 to 0.5)2.17 (2.08 to 2.27)e
 X(d) Gonadal carcinomas6090.40.7 (–1.3 to 2.6)470.1f5620.80.7 (–1.4 to 2.8)0.08 (0.06 to 0.11)e
 X(e) Other and unspecified malignant gonadal tumors4890.42.1 (0.1 to 4.2)e950.1f3940.61.5 (–0.6 to 3.7)0.23 (0.18 to 0.29)e
XI Other malignant epithelial neoplasms and melanomas27 78219.62.6 (1.7 to 3.5)e894712.42.2 (1.3 to 3.0)e18 83527.23.0 (2.4 to 3.7)e0.45 (0.44 to 0.47)e
 XI(a) Adrenocortical carcinomas2880.20.7 (–2.1 to 3.6)1090.2f1790.3–0.5 (–3.5 to 2.5)0.58 (0.46 to 0.74)e
 XI(b) Thyroid carcinomas12 4598.84.2 (3.6 to 4.9)e23023.24.1 (2.7 to 5.6)e10 15714.74.2 (3.5 to 4.9)e0.22 (0.21 to 0.23)e
 XI(c) Nasopharyngeal carcinomas7440.5–1.8 (–3.8 to 0.3)5040.7–2.2 (–4.7 to 0.3)2400.4–0.5 (–2.8 to 1.9)2.00 (1.71 to 2.34)e
 XI(d) Malignant melanomas62474.4–4.1 (–4.9 to –3.3)e25643.6–4.1 (–5.4 to –2.8)e36835.3–4.2 (–5.2 to –3.2)e0.67 (0.63 to 0.70)e
 XI(e) Skin carcinomas1180.1f570.1f610.1f0.89 (0.61 to 1.31)
 XI(f) Other and unspecified carcinomas79265.65.4 (3.7 to 7.2)e34114.75.6 (3.5 to 7.9)e45156.55.2 (2.3 to 8.2)e0.72 (0.69 to 0.75)e
XII Other and unspecified malignant neoplasms11680.80.3 (–1.3 to 1.9)5090.7–1.2 (–9.4 to 7.8)6591.0–0.3 (–2.2 to 1.7)0.74 (0.66 to 0.83)e
 XII(a) Other specified malignant tumors5790.41.7 (–0.3 to 3.7)2490.42.3 (–0.3 to 5.1)3300.50.9 (–1.8 to 3.7)0.72 (0.61 to 0.85)e
 XII(b) Other unspecified malignant tumors5890.4–0.9 (–3.1 to 1.2)2600.40.2 (–3.0 to 0.6)3290.5–1.4 (–3.9 to 1.2)0.76 (0.64 to 0.90)e
Not classified by ICCC or in situ8480.619.6 (6.5 to 34.2)e4100.6f4380.719.4 (5.0 to 35.8)e0.90 (0.78 to 1.03)
Males and Females
Males
Females
Incidence rate ratio, males to females
ICCC groupNo.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)(95% CI)
Overall248 749178.30.5 (0.1 to 0.8)e132 557185.90.4 (–0.1 to 0.8)116 192170.50.6 (0.2 to 1.0)e1.09 (1.08 to 1.10)e
I Leukemias, myeloproliferative diseases, and myelodysplastic diseases64 57546.60.4 (0.0 to 0.8)e36 12950.90.3 (0 to 0.7)28 44642.00.7 (0.1 to 1.4)e1.21 (1.19 to 1.23)e
 I(a) Lymphoid leukemias46 68733.80.4 (0.0 to 0.8)e26 63037.60.4 (0 to 0.8)20 05729.70.5 (0.0 to 1.0)e1.27 (1.24 to 1.29)e
 I(b) Acute myeloid leukemias10 4747.5–0.2 (–0.6 to 0.2)54217.6–0.5 (–1.1 to 0.1)50537.40.2 (–0.4 to 0.7)1.02 (0.99 to 1.06)
 I(c) Chronic myeloproliferative diseases34402.5–0.7 (–2.8 to 1.5)18292.5–0.8 (–3.8 to 2.2)16112.40.6 (–1.3 to 2.6)1.08 (1.01 to 1.16)e
 I(d) Myelodysplastic syndrome and other myeloproliferative diseases18851.4–1.1 (–2.2 to 0.1)10631.5–1.1 (–2.8 to 0.7)8221.2–1.0 (–2.2 to 0.2)1.24 (1.13 to 1.36)e
 I(e) Unspecified and other specified leukemias20891.54.2 (3.1 to 5.4)e11861.73.7 (2.3 to 5.2)e9031.34.9 (3.2 to 6.5)e1.25 (1.15 to 1.37)e
II Lymphomas and reticuloendothelial neoplasms38 30827.31.2 (0.4 to 2.1)e23 02132.21.2 (0.3 to 2.0)e15 28722.30.9 (–0.4 to 2.1)1.44 (1.41 to 1.47)e
 II(a) Hodgkin lymphomas17 31912.3–0.1 (–0.4 to 0.2)926612.8–0.1 (–0.5 to 0.3)805311.6–0.1 (–0.7 to 0.5)1.10 (1.07 to 1.14)e
 II(b) Non-Hodgkin lymphomas (except Burkitt lymphoma)12 6009.01.2 (0.6 to 1.8)e803211.21.3 (0.7 to 1.9)e45686.71.0 (0.3 to 1.7)e1.68 (1.62 to 1.74)e
 II(c) Burkitt lymphoma33302.4–0.5 (–1.1 to 0.2)26763.8–0.4 (–1.1 to 0.3)6541.0–0.6 (–2.7 to 1.5)3.91 (3.59 to 4.27)e
 II(d) Miscellaneous lymphoreticular neoplasms46013.39.8 (1.1 to 19.3)e27563.911.1 (2.0 to 21.0)e18452.78.1 (–2.4 to 19.7)1.43 (1.35 to 1.51)e
 II(e) Unspecified lymphomas4580.3–1.7 (–6.2 to 3.0)2910.4–0.9 (–6.8 to 5.5)1670.2f1.66 (1.37 to 2.03)e
III CNS and miscellaneous intracranial and intraspinal neoplasms42 63030.8–1.7 (–2.7 to –0.6)e22 87332.3–1.6 (–2.8 to –0.5)e19 75729.2–1.7 (–3.1 to –0.3)e1.11 (1.09 to 1.13)e
 III(a) Ependymomas and choroid plexus tumor36182.6–0.1 (–1.1 to 0.8)20142.80.4 (–0.5 to 1.3)16042.4–0.3 (–7.4 to 7.3)1.20 (1.12 to 1.28)e
 III(b) Astrocytomas22 01515.9–1.3 (–3.1 to 0.5)11 49816.2–0.9 (–2.0 to 0.3)10 51715.6–1.5 (–3.9 to 1.0)1.04 (1.02 to 1.07)e
 III(c) Intracranial and intraspinal embryonal tumors79765.8–3.7 (–5.5 to –1.8)e47936.8–3.5 (–5.3 to –1.8)e31834.7–3.8 (–6.8 to –0.7)e1.44 (1.38 to 1.51)e
 III(d) Other gliomas74485.4–1.5 (–4.0 to 1.1)37495.3–1.9 (–3.7 to –0.1)e36995.50.3 (–1.0 to 0.6)0.97 (0.93 to 1.01)
 III(e) Other specified intracranial/intraspinal neoplasms9080.7–2.0 (–8.2 to 4.7)4780.7–0.4 (–2.5 to 1.8)4300.60.4 (–1.6 to 2.4)1.06 (0.93 to 1.21)
 III(f) Unspecified intracranial and intraspinal neoplasms6650.51.1 (–0.8 to 2.9)3410.51.7 (–0.4 to 3.8)3240.50.3 (–2.2 to 3.2)1.00 (0.86 to 1.17)
IV Neuroblastoma and other peripheral nervous cell tumors11 9078.60.4 (–0.1 to 0.9)62868.90.4 (–0.1 to 0.9)56218.30.4 (–0.2 to 1.0)1.07 (1.03 to 1.11)e
 IV(a) Neuroblastoma and ganglioneuroblastoma11 5758.40.4 (–0.1 to 0.8)61108.60.4 (–0.2 to 0.9)54658.10.4 (–0.2 to 1.0)1.07 (1.03 to 1.11)e
 IV(b) Other peripheral nervous cell tumors3320.21.0 (–1.6 to 3.6)1760.3f1560.2f1.08 (0.86 to 1.35)
V Retinoblastoma44243.2–0.4 (–1.4 to 0.6)22263.10.1 (–0.9 to 1.1)21983.20 (–1.0 to 0.1)0.97 (0.91 to 1.03)
VI Renal tumors95066.9–0.3 (–1.1 to 0.6)44466.30.1 (–0.7 to 0.9)50607.50.2 (–0.7 to 1.1)0.84 (0.81 to 0.87)e
 VI(a) Nephroblastoma and other nonepithelial renal tumors85836.2–0.4 (–1.2 to 0.5)39985.7–0.1 (–0.9 to 0.8)45856.80.1 (–0.7 to 1.0)0.83 (0.80 to 0.87)e
 VI(b) Renal carcinomas8750.61.3 (–0.3 to 2.9)4230.61.7 (–0.2 to 3.6)4520.71.0 (–0.7 to 2.7)0.90 (0.78 to 1.02)
 VI(c) Unspecified malignant renal tumors480.0f250.0f230.0f1.05 (0.57 to 1.93)
VII Hepatic tumors33822.41.6 (0.7 to 2.4)e19952.81.1 (0 to 2.3)13872.02.2 (1.1 to 3.2)e1.38 (1.28 to 1.48)e
 VII(a) Hepatoblastoma25221.81.9 (0.9 to 3.0)e15322.21.6 (0.2 to 3.0)e9901.52.5 (1.2 to 3.7)e1.48 (1.37 to 1.60)e
 VII(b) Hepatic carcinomas8220.60.4 (–0.8 to 1.5)4390.6–0.5 (–1.8 to 0.9)3830.61.4 (–0.7 to 3.6)1.10 (0.95 to 1.26)
 VII(c) Unspecified malignant hepatic tumors380.0f240.0f140.0ff
VIII Malignant bone tumors12 2138.70.5 (0.1 to 0.9)e69469.70.7 (–0.9 to 2.4)52677.80 (–0.5 to 0.5)1.25 (1.21 to 1.30)e
 VIII(a) Osteosarcomas67924.90.1 (–0.3 to 0.6)38765.40.8 (0.1 to 1.6)e29164.3–0.7 (–1.4 to –0.1)e1.26 (1.20 to 1.32)e
 VIII(b) Chondrosarcomas4630.30.2 (–2.0 to 2.4)2850.4–1.2 (–4.1 to 1.7)1780.3f1.52 (1.26 to 1.85)e
 VIII(c) Ewing tumor and related sarcomas of bone40312.90.8 (0.0 to 1.6)e23113.20.9 (–0.2 to 2.0)17202.50.6 (–0.4 to 1.7)1.28 (1.20 to 1.36)e
 VIII(d) Other specified malignant bone tumors6510.51.6 (–0.1 to 3.3)3150.41.7 (0 to 3.4)e3360.51.5 (–0.7 to 3.7)0.90 (0.77 to 1.05)
 VIII(e) Unspecified malignant bone tumors2760.21.5 (–0.6 to 3.6)1590.22.4 (–1.7 to 6.6)1170.2f1.29 (1.01 to 1.65)e
IX Soft tissue and other extraosseous sarcomas16 45711.80.1 (–0.2 to 0.4)898512.60.2 (–0.3 to 0.6)747211.00 (–0.5 to 0.4)1.15 (1.11 to 1.18)e
 IX(a) Rhabdomyosarcomas63814.6–0.1 (–0.9 to 0.7)36605.2–0.1 (–0.9 to 0.7)27214.0–0.1 (–1.3 to 1.2)1.28 (1.22 to 1.35)e
 IX(b) Fibrosarcomas, peripheral nerve and other fibrous16941.2–1.0 (–2.4 to 0.5)8831.2–0.6 (–2.0 to 0.8)8111.2–1.3 (–3.2 to 0.5)1.04 (0.94 to 1.14)
 IX(c) Kaposi sarcoma620.0f520.1f100.0ff
 IX(d) Other specified soft tissue sarcomas64824.60.0 (–0.4 to 0.4)33944.70.1 (–0.6 to 0.7)30884.5–0.1 (–0.6 to 0.5)1.05 (1.00 to 1.10)
 IX(e) Unspecified soft tissue sarcomas18381.31.9 (0.7 to 3.1)e9961.42.2 (1.0 to 3.4)e8421.21.2 (–0.9 to 3.5)1.13 (1.03 to 1.24)e
X Germ cell tumors, trophoblastic tumors neoplasms of gonads15 54911.00.1 (–0.4 to 0.6)978413.40.1 (–0.6 to 0.7)57658.40.2 (–0.3 to 0.7)1.59 (1.54 to 1.65)e
 X(a) Intracranial and intraspinal germ cell tumors23791.71.2 (0.1 to 2.3)e17232.40.9 (–0.2 to 2.1)6561.01.8 (–0.6 to 4.3)2.47 (2.26 to 2.71)e
 X(b) Extracranial and extragonadal germ cell tumors20001.4–0.3 (–1.2 to 0.6)8761.20.2 (–1.3 to 1.6)11241.7–0.7 (–1.6 to 0.3)0.74 (0.68 to 0.81)e
 X(c) Malignant gonadal germ cell tumors10 0727.1–0.2 (–0.8 to 0.5)70439.6–0.2 (–0.9 to 0.6)30294.4–0.1 (–0.7 to 0.5)2.17 (2.08 to 2.27)e
 X(d) Gonadal carcinomas6090.40.7 (–1.3 to 2.6)470.1f5620.80.7 (–1.4 to 2.8)0.08 (0.06 to 0.11)e
 X(e) Other and unspecified malignant gonadal tumors4890.42.1 (0.1 to 4.2)e950.1f3940.61.5 (–0.6 to 3.7)0.23 (0.18 to 0.29)e
XI Other malignant epithelial neoplasms and melanomas27 78219.62.6 (1.7 to 3.5)e894712.42.2 (1.3 to 3.0)e18 83527.23.0 (2.4 to 3.7)e0.45 (0.44 to 0.47)e
 XI(a) Adrenocortical carcinomas2880.20.7 (–2.1 to 3.6)1090.2f1790.3–0.5 (–3.5 to 2.5)0.58 (0.46 to 0.74)e
 XI(b) Thyroid carcinomas12 4598.84.2 (3.6 to 4.9)e23023.24.1 (2.7 to 5.6)e10 15714.74.2 (3.5 to 4.9)e0.22 (0.21 to 0.23)e
 XI(c) Nasopharyngeal carcinomas7440.5–1.8 (–3.8 to 0.3)5040.7–2.2 (–4.7 to 0.3)2400.4–0.5 (–2.8 to 1.9)2.00 (1.71 to 2.34)e
 XI(d) Malignant melanomas62474.4–4.1 (–4.9 to –3.3)e25643.6–4.1 (–5.4 to –2.8)e36835.3–4.2 (–5.2 to –3.2)e0.67 (0.63 to 0.70)e
 XI(e) Skin carcinomas1180.1f570.1f610.1f0.89 (0.61 to 1.31)
 XI(f) Other and unspecified carcinomas79265.65.4 (3.7 to 7.2)e34114.75.6 (3.5 to 7.9)e45156.55.2 (2.3 to 8.2)e0.72 (0.69 to 0.75)e
XII Other and unspecified malignant neoplasms11680.80.3 (–1.3 to 1.9)5090.7–1.2 (–9.4 to 7.8)6591.0–0.3 (–2.2 to 1.7)0.74 (0.66 to 0.83)e
 XII(a) Other specified malignant tumors5790.41.7 (–0.3 to 3.7)2490.42.3 (–0.3 to 5.1)3300.50.9 (–1.8 to 3.7)0.72 (0.61 to 0.85)e
 XII(b) Other unspecified malignant tumors5890.4–0.9 (–3.1 to 1.2)2600.40.2 (–3.0 to 0.6)3290.5–1.4 (–3.9 to 1.2)0.76 (0.64 to 0.90)e
Not classified by ICCC or in situ8480.619.6 (6.5 to 34.2)e4100.6f4380.719.4 (5.0 to 35.8)e0.90 (0.78 to 1.03)
a

Rates are per 1 million people and age-adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Source: US Cancer Statistics. AAPC = average annual percent change; CI = confidence interval; CNS = central nervous system; ICCC = International Classification of Childhood Cancer.

b

Cases included all malignant cancers.

c

Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003-2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Characteristic values with other, missing, or blank results are not included in this table.

d

Trends were measured with AAPC, and rates and were considered to increase or decrease if P <.05; otherwise, trends were considered stable. AAPC was not calculated if case count was <6 cases in any 1 year.

e

Difference was significant at P <.05 (2-sided).

f

Statistic could not be calculated because of low number of cases.

Table 2.

Age-adjusted incidence ratea of invasive cancer,b ages 0 to 19 years, average annual percent change between rates, and incidence rate ratios, by International Classification of Childhood Cancer group and sex—United States,c 2003-2019

Males and Females
Males
Females
Incidence rate ratio, males to females
ICCC groupNo.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)(95% CI)
Overall248 749178.30.5 (0.1 to 0.8)e132 557185.90.4 (–0.1 to 0.8)116 192170.50.6 (0.2 to 1.0)e1.09 (1.08 to 1.10)e
I Leukemias, myeloproliferative diseases, and myelodysplastic diseases64 57546.60.4 (0.0 to 0.8)e36 12950.90.3 (0 to 0.7)28 44642.00.7 (0.1 to 1.4)e1.21 (1.19 to 1.23)e
 I(a) Lymphoid leukemias46 68733.80.4 (0.0 to 0.8)e26 63037.60.4 (0 to 0.8)20 05729.70.5 (0.0 to 1.0)e1.27 (1.24 to 1.29)e
 I(b) Acute myeloid leukemias10 4747.5–0.2 (–0.6 to 0.2)54217.6–0.5 (–1.1 to 0.1)50537.40.2 (–0.4 to 0.7)1.02 (0.99 to 1.06)
 I(c) Chronic myeloproliferative diseases34402.5–0.7 (–2.8 to 1.5)18292.5–0.8 (–3.8 to 2.2)16112.40.6 (–1.3 to 2.6)1.08 (1.01 to 1.16)e
 I(d) Myelodysplastic syndrome and other myeloproliferative diseases18851.4–1.1 (–2.2 to 0.1)10631.5–1.1 (–2.8 to 0.7)8221.2–1.0 (–2.2 to 0.2)1.24 (1.13 to 1.36)e
 I(e) Unspecified and other specified leukemias20891.54.2 (3.1 to 5.4)e11861.73.7 (2.3 to 5.2)e9031.34.9 (3.2 to 6.5)e1.25 (1.15 to 1.37)e
II Lymphomas and reticuloendothelial neoplasms38 30827.31.2 (0.4 to 2.1)e23 02132.21.2 (0.3 to 2.0)e15 28722.30.9 (–0.4 to 2.1)1.44 (1.41 to 1.47)e
 II(a) Hodgkin lymphomas17 31912.3–0.1 (–0.4 to 0.2)926612.8–0.1 (–0.5 to 0.3)805311.6–0.1 (–0.7 to 0.5)1.10 (1.07 to 1.14)e
 II(b) Non-Hodgkin lymphomas (except Burkitt lymphoma)12 6009.01.2 (0.6 to 1.8)e803211.21.3 (0.7 to 1.9)e45686.71.0 (0.3 to 1.7)e1.68 (1.62 to 1.74)e
 II(c) Burkitt lymphoma33302.4–0.5 (–1.1 to 0.2)26763.8–0.4 (–1.1 to 0.3)6541.0–0.6 (–2.7 to 1.5)3.91 (3.59 to 4.27)e
 II(d) Miscellaneous lymphoreticular neoplasms46013.39.8 (1.1 to 19.3)e27563.911.1 (2.0 to 21.0)e18452.78.1 (–2.4 to 19.7)1.43 (1.35 to 1.51)e
 II(e) Unspecified lymphomas4580.3–1.7 (–6.2 to 3.0)2910.4–0.9 (–6.8 to 5.5)1670.2f1.66 (1.37 to 2.03)e
III CNS and miscellaneous intracranial and intraspinal neoplasms42 63030.8–1.7 (–2.7 to –0.6)e22 87332.3–1.6 (–2.8 to –0.5)e19 75729.2–1.7 (–3.1 to –0.3)e1.11 (1.09 to 1.13)e
 III(a) Ependymomas and choroid plexus tumor36182.6–0.1 (–1.1 to 0.8)20142.80.4 (–0.5 to 1.3)16042.4–0.3 (–7.4 to 7.3)1.20 (1.12 to 1.28)e
 III(b) Astrocytomas22 01515.9–1.3 (–3.1 to 0.5)11 49816.2–0.9 (–2.0 to 0.3)10 51715.6–1.5 (–3.9 to 1.0)1.04 (1.02 to 1.07)e
 III(c) Intracranial and intraspinal embryonal tumors79765.8–3.7 (–5.5 to –1.8)e47936.8–3.5 (–5.3 to –1.8)e31834.7–3.8 (–6.8 to –0.7)e1.44 (1.38 to 1.51)e
 III(d) Other gliomas74485.4–1.5 (–4.0 to 1.1)37495.3–1.9 (–3.7 to –0.1)e36995.50.3 (–1.0 to 0.6)0.97 (0.93 to 1.01)
 III(e) Other specified intracranial/intraspinal neoplasms9080.7–2.0 (–8.2 to 4.7)4780.7–0.4 (–2.5 to 1.8)4300.60.4 (–1.6 to 2.4)1.06 (0.93 to 1.21)
 III(f) Unspecified intracranial and intraspinal neoplasms6650.51.1 (–0.8 to 2.9)3410.51.7 (–0.4 to 3.8)3240.50.3 (–2.2 to 3.2)1.00 (0.86 to 1.17)
IV Neuroblastoma and other peripheral nervous cell tumors11 9078.60.4 (–0.1 to 0.9)62868.90.4 (–0.1 to 0.9)56218.30.4 (–0.2 to 1.0)1.07 (1.03 to 1.11)e
 IV(a) Neuroblastoma and ganglioneuroblastoma11 5758.40.4 (–0.1 to 0.8)61108.60.4 (–0.2 to 0.9)54658.10.4 (–0.2 to 1.0)1.07 (1.03 to 1.11)e
 IV(b) Other peripheral nervous cell tumors3320.21.0 (–1.6 to 3.6)1760.3f1560.2f1.08 (0.86 to 1.35)
V Retinoblastoma44243.2–0.4 (–1.4 to 0.6)22263.10.1 (–0.9 to 1.1)21983.20 (–1.0 to 0.1)0.97 (0.91 to 1.03)
VI Renal tumors95066.9–0.3 (–1.1 to 0.6)44466.30.1 (–0.7 to 0.9)50607.50.2 (–0.7 to 1.1)0.84 (0.81 to 0.87)e
 VI(a) Nephroblastoma and other nonepithelial renal tumors85836.2–0.4 (–1.2 to 0.5)39985.7–0.1 (–0.9 to 0.8)45856.80.1 (–0.7 to 1.0)0.83 (0.80 to 0.87)e
 VI(b) Renal carcinomas8750.61.3 (–0.3 to 2.9)4230.61.7 (–0.2 to 3.6)4520.71.0 (–0.7 to 2.7)0.90 (0.78 to 1.02)
 VI(c) Unspecified malignant renal tumors480.0f250.0f230.0f1.05 (0.57 to 1.93)
VII Hepatic tumors33822.41.6 (0.7 to 2.4)e19952.81.1 (0 to 2.3)13872.02.2 (1.1 to 3.2)e1.38 (1.28 to 1.48)e
 VII(a) Hepatoblastoma25221.81.9 (0.9 to 3.0)e15322.21.6 (0.2 to 3.0)e9901.52.5 (1.2 to 3.7)e1.48 (1.37 to 1.60)e
 VII(b) Hepatic carcinomas8220.60.4 (–0.8 to 1.5)4390.6–0.5 (–1.8 to 0.9)3830.61.4 (–0.7 to 3.6)1.10 (0.95 to 1.26)
 VII(c) Unspecified malignant hepatic tumors380.0f240.0f140.0ff
VIII Malignant bone tumors12 2138.70.5 (0.1 to 0.9)e69469.70.7 (–0.9 to 2.4)52677.80 (–0.5 to 0.5)1.25 (1.21 to 1.30)e
 VIII(a) Osteosarcomas67924.90.1 (–0.3 to 0.6)38765.40.8 (0.1 to 1.6)e29164.3–0.7 (–1.4 to –0.1)e1.26 (1.20 to 1.32)e
 VIII(b) Chondrosarcomas4630.30.2 (–2.0 to 2.4)2850.4–1.2 (–4.1 to 1.7)1780.3f1.52 (1.26 to 1.85)e
 VIII(c) Ewing tumor and related sarcomas of bone40312.90.8 (0.0 to 1.6)e23113.20.9 (–0.2 to 2.0)17202.50.6 (–0.4 to 1.7)1.28 (1.20 to 1.36)e
 VIII(d) Other specified malignant bone tumors6510.51.6 (–0.1 to 3.3)3150.41.7 (0 to 3.4)e3360.51.5 (–0.7 to 3.7)0.90 (0.77 to 1.05)
 VIII(e) Unspecified malignant bone tumors2760.21.5 (–0.6 to 3.6)1590.22.4 (–1.7 to 6.6)1170.2f1.29 (1.01 to 1.65)e
IX Soft tissue and other extraosseous sarcomas16 45711.80.1 (–0.2 to 0.4)898512.60.2 (–0.3 to 0.6)747211.00 (–0.5 to 0.4)1.15 (1.11 to 1.18)e
 IX(a) Rhabdomyosarcomas63814.6–0.1 (–0.9 to 0.7)36605.2–0.1 (–0.9 to 0.7)27214.0–0.1 (–1.3 to 1.2)1.28 (1.22 to 1.35)e
 IX(b) Fibrosarcomas, peripheral nerve and other fibrous16941.2–1.0 (–2.4 to 0.5)8831.2–0.6 (–2.0 to 0.8)8111.2–1.3 (–3.2 to 0.5)1.04 (0.94 to 1.14)
 IX(c) Kaposi sarcoma620.0f520.1f100.0ff
 IX(d) Other specified soft tissue sarcomas64824.60.0 (–0.4 to 0.4)33944.70.1 (–0.6 to 0.7)30884.5–0.1 (–0.6 to 0.5)1.05 (1.00 to 1.10)
 IX(e) Unspecified soft tissue sarcomas18381.31.9 (0.7 to 3.1)e9961.42.2 (1.0 to 3.4)e8421.21.2 (–0.9 to 3.5)1.13 (1.03 to 1.24)e
X Germ cell tumors, trophoblastic tumors neoplasms of gonads15 54911.00.1 (–0.4 to 0.6)978413.40.1 (–0.6 to 0.7)57658.40.2 (–0.3 to 0.7)1.59 (1.54 to 1.65)e
 X(a) Intracranial and intraspinal germ cell tumors23791.71.2 (0.1 to 2.3)e17232.40.9 (–0.2 to 2.1)6561.01.8 (–0.6 to 4.3)2.47 (2.26 to 2.71)e
 X(b) Extracranial and extragonadal germ cell tumors20001.4–0.3 (–1.2 to 0.6)8761.20.2 (–1.3 to 1.6)11241.7–0.7 (–1.6 to 0.3)0.74 (0.68 to 0.81)e
 X(c) Malignant gonadal germ cell tumors10 0727.1–0.2 (–0.8 to 0.5)70439.6–0.2 (–0.9 to 0.6)30294.4–0.1 (–0.7 to 0.5)2.17 (2.08 to 2.27)e
 X(d) Gonadal carcinomas6090.40.7 (–1.3 to 2.6)470.1f5620.80.7 (–1.4 to 2.8)0.08 (0.06 to 0.11)e
 X(e) Other and unspecified malignant gonadal tumors4890.42.1 (0.1 to 4.2)e950.1f3940.61.5 (–0.6 to 3.7)0.23 (0.18 to 0.29)e
XI Other malignant epithelial neoplasms and melanomas27 78219.62.6 (1.7 to 3.5)e894712.42.2 (1.3 to 3.0)e18 83527.23.0 (2.4 to 3.7)e0.45 (0.44 to 0.47)e
 XI(a) Adrenocortical carcinomas2880.20.7 (–2.1 to 3.6)1090.2f1790.3–0.5 (–3.5 to 2.5)0.58 (0.46 to 0.74)e
 XI(b) Thyroid carcinomas12 4598.84.2 (3.6 to 4.9)e23023.24.1 (2.7 to 5.6)e10 15714.74.2 (3.5 to 4.9)e0.22 (0.21 to 0.23)e
 XI(c) Nasopharyngeal carcinomas7440.5–1.8 (–3.8 to 0.3)5040.7–2.2 (–4.7 to 0.3)2400.4–0.5 (–2.8 to 1.9)2.00 (1.71 to 2.34)e
 XI(d) Malignant melanomas62474.4–4.1 (–4.9 to –3.3)e25643.6–4.1 (–5.4 to –2.8)e36835.3–4.2 (–5.2 to –3.2)e0.67 (0.63 to 0.70)e
 XI(e) Skin carcinomas1180.1f570.1f610.1f0.89 (0.61 to 1.31)
 XI(f) Other and unspecified carcinomas79265.65.4 (3.7 to 7.2)e34114.75.6 (3.5 to 7.9)e45156.55.2 (2.3 to 8.2)e0.72 (0.69 to 0.75)e
XII Other and unspecified malignant neoplasms11680.80.3 (–1.3 to 1.9)5090.7–1.2 (–9.4 to 7.8)6591.0–0.3 (–2.2 to 1.7)0.74 (0.66 to 0.83)e
 XII(a) Other specified malignant tumors5790.41.7 (–0.3 to 3.7)2490.42.3 (–0.3 to 5.1)3300.50.9 (–1.8 to 3.7)0.72 (0.61 to 0.85)e
 XII(b) Other unspecified malignant tumors5890.4–0.9 (–3.1 to 1.2)2600.40.2 (–3.0 to 0.6)3290.5–1.4 (–3.9 to 1.2)0.76 (0.64 to 0.90)e
Not classified by ICCC or in situ8480.619.6 (6.5 to 34.2)e4100.6f4380.719.4 (5.0 to 35.8)e0.90 (0.78 to 1.03)
Males and Females
Males
Females
Incidence rate ratio, males to females
ICCC groupNo.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)(95% CI)
Overall248 749178.30.5 (0.1 to 0.8)e132 557185.90.4 (–0.1 to 0.8)116 192170.50.6 (0.2 to 1.0)e1.09 (1.08 to 1.10)e
I Leukemias, myeloproliferative diseases, and myelodysplastic diseases64 57546.60.4 (0.0 to 0.8)e36 12950.90.3 (0 to 0.7)28 44642.00.7 (0.1 to 1.4)e1.21 (1.19 to 1.23)e
 I(a) Lymphoid leukemias46 68733.80.4 (0.0 to 0.8)e26 63037.60.4 (0 to 0.8)20 05729.70.5 (0.0 to 1.0)e1.27 (1.24 to 1.29)e
 I(b) Acute myeloid leukemias10 4747.5–0.2 (–0.6 to 0.2)54217.6–0.5 (–1.1 to 0.1)50537.40.2 (–0.4 to 0.7)1.02 (0.99 to 1.06)
 I(c) Chronic myeloproliferative diseases34402.5–0.7 (–2.8 to 1.5)18292.5–0.8 (–3.8 to 2.2)16112.40.6 (–1.3 to 2.6)1.08 (1.01 to 1.16)e
 I(d) Myelodysplastic syndrome and other myeloproliferative diseases18851.4–1.1 (–2.2 to 0.1)10631.5–1.1 (–2.8 to 0.7)8221.2–1.0 (–2.2 to 0.2)1.24 (1.13 to 1.36)e
 I(e) Unspecified and other specified leukemias20891.54.2 (3.1 to 5.4)e11861.73.7 (2.3 to 5.2)e9031.34.9 (3.2 to 6.5)e1.25 (1.15 to 1.37)e
II Lymphomas and reticuloendothelial neoplasms38 30827.31.2 (0.4 to 2.1)e23 02132.21.2 (0.3 to 2.0)e15 28722.30.9 (–0.4 to 2.1)1.44 (1.41 to 1.47)e
 II(a) Hodgkin lymphomas17 31912.3–0.1 (–0.4 to 0.2)926612.8–0.1 (–0.5 to 0.3)805311.6–0.1 (–0.7 to 0.5)1.10 (1.07 to 1.14)e
 II(b) Non-Hodgkin lymphomas (except Burkitt lymphoma)12 6009.01.2 (0.6 to 1.8)e803211.21.3 (0.7 to 1.9)e45686.71.0 (0.3 to 1.7)e1.68 (1.62 to 1.74)e
 II(c) Burkitt lymphoma33302.4–0.5 (–1.1 to 0.2)26763.8–0.4 (–1.1 to 0.3)6541.0–0.6 (–2.7 to 1.5)3.91 (3.59 to 4.27)e
 II(d) Miscellaneous lymphoreticular neoplasms46013.39.8 (1.1 to 19.3)e27563.911.1 (2.0 to 21.0)e18452.78.1 (–2.4 to 19.7)1.43 (1.35 to 1.51)e
 II(e) Unspecified lymphomas4580.3–1.7 (–6.2 to 3.0)2910.4–0.9 (–6.8 to 5.5)1670.2f1.66 (1.37 to 2.03)e
III CNS and miscellaneous intracranial and intraspinal neoplasms42 63030.8–1.7 (–2.7 to –0.6)e22 87332.3–1.6 (–2.8 to –0.5)e19 75729.2–1.7 (–3.1 to –0.3)e1.11 (1.09 to 1.13)e
 III(a) Ependymomas and choroid plexus tumor36182.6–0.1 (–1.1 to 0.8)20142.80.4 (–0.5 to 1.3)16042.4–0.3 (–7.4 to 7.3)1.20 (1.12 to 1.28)e
 III(b) Astrocytomas22 01515.9–1.3 (–3.1 to 0.5)11 49816.2–0.9 (–2.0 to 0.3)10 51715.6–1.5 (–3.9 to 1.0)1.04 (1.02 to 1.07)e
 III(c) Intracranial and intraspinal embryonal tumors79765.8–3.7 (–5.5 to –1.8)e47936.8–3.5 (–5.3 to –1.8)e31834.7–3.8 (–6.8 to –0.7)e1.44 (1.38 to 1.51)e
 III(d) Other gliomas74485.4–1.5 (–4.0 to 1.1)37495.3–1.9 (–3.7 to –0.1)e36995.50.3 (–1.0 to 0.6)0.97 (0.93 to 1.01)
 III(e) Other specified intracranial/intraspinal neoplasms9080.7–2.0 (–8.2 to 4.7)4780.7–0.4 (–2.5 to 1.8)4300.60.4 (–1.6 to 2.4)1.06 (0.93 to 1.21)
 III(f) Unspecified intracranial and intraspinal neoplasms6650.51.1 (–0.8 to 2.9)3410.51.7 (–0.4 to 3.8)3240.50.3 (–2.2 to 3.2)1.00 (0.86 to 1.17)
IV Neuroblastoma and other peripheral nervous cell tumors11 9078.60.4 (–0.1 to 0.9)62868.90.4 (–0.1 to 0.9)56218.30.4 (–0.2 to 1.0)1.07 (1.03 to 1.11)e
 IV(a) Neuroblastoma and ganglioneuroblastoma11 5758.40.4 (–0.1 to 0.8)61108.60.4 (–0.2 to 0.9)54658.10.4 (–0.2 to 1.0)1.07 (1.03 to 1.11)e
 IV(b) Other peripheral nervous cell tumors3320.21.0 (–1.6 to 3.6)1760.3f1560.2f1.08 (0.86 to 1.35)
V Retinoblastoma44243.2–0.4 (–1.4 to 0.6)22263.10.1 (–0.9 to 1.1)21983.20 (–1.0 to 0.1)0.97 (0.91 to 1.03)
VI Renal tumors95066.9–0.3 (–1.1 to 0.6)44466.30.1 (–0.7 to 0.9)50607.50.2 (–0.7 to 1.1)0.84 (0.81 to 0.87)e
 VI(a) Nephroblastoma and other nonepithelial renal tumors85836.2–0.4 (–1.2 to 0.5)39985.7–0.1 (–0.9 to 0.8)45856.80.1 (–0.7 to 1.0)0.83 (0.80 to 0.87)e
 VI(b) Renal carcinomas8750.61.3 (–0.3 to 2.9)4230.61.7 (–0.2 to 3.6)4520.71.0 (–0.7 to 2.7)0.90 (0.78 to 1.02)
 VI(c) Unspecified malignant renal tumors480.0f250.0f230.0f1.05 (0.57 to 1.93)
VII Hepatic tumors33822.41.6 (0.7 to 2.4)e19952.81.1 (0 to 2.3)13872.02.2 (1.1 to 3.2)e1.38 (1.28 to 1.48)e
 VII(a) Hepatoblastoma25221.81.9 (0.9 to 3.0)e15322.21.6 (0.2 to 3.0)e9901.52.5 (1.2 to 3.7)e1.48 (1.37 to 1.60)e
 VII(b) Hepatic carcinomas8220.60.4 (–0.8 to 1.5)4390.6–0.5 (–1.8 to 0.9)3830.61.4 (–0.7 to 3.6)1.10 (0.95 to 1.26)
 VII(c) Unspecified malignant hepatic tumors380.0f240.0f140.0ff
VIII Malignant bone tumors12 2138.70.5 (0.1 to 0.9)e69469.70.7 (–0.9 to 2.4)52677.80 (–0.5 to 0.5)1.25 (1.21 to 1.30)e
 VIII(a) Osteosarcomas67924.90.1 (–0.3 to 0.6)38765.40.8 (0.1 to 1.6)e29164.3–0.7 (–1.4 to –0.1)e1.26 (1.20 to 1.32)e
 VIII(b) Chondrosarcomas4630.30.2 (–2.0 to 2.4)2850.4–1.2 (–4.1 to 1.7)1780.3f1.52 (1.26 to 1.85)e
 VIII(c) Ewing tumor and related sarcomas of bone40312.90.8 (0.0 to 1.6)e23113.20.9 (–0.2 to 2.0)17202.50.6 (–0.4 to 1.7)1.28 (1.20 to 1.36)e
 VIII(d) Other specified malignant bone tumors6510.51.6 (–0.1 to 3.3)3150.41.7 (0 to 3.4)e3360.51.5 (–0.7 to 3.7)0.90 (0.77 to 1.05)
 VIII(e) Unspecified malignant bone tumors2760.21.5 (–0.6 to 3.6)1590.22.4 (–1.7 to 6.6)1170.2f1.29 (1.01 to 1.65)e
IX Soft tissue and other extraosseous sarcomas16 45711.80.1 (–0.2 to 0.4)898512.60.2 (–0.3 to 0.6)747211.00 (–0.5 to 0.4)1.15 (1.11 to 1.18)e
 IX(a) Rhabdomyosarcomas63814.6–0.1 (–0.9 to 0.7)36605.2–0.1 (–0.9 to 0.7)27214.0–0.1 (–1.3 to 1.2)1.28 (1.22 to 1.35)e
 IX(b) Fibrosarcomas, peripheral nerve and other fibrous16941.2–1.0 (–2.4 to 0.5)8831.2–0.6 (–2.0 to 0.8)8111.2–1.3 (–3.2 to 0.5)1.04 (0.94 to 1.14)
 IX(c) Kaposi sarcoma620.0f520.1f100.0ff
 IX(d) Other specified soft tissue sarcomas64824.60.0 (–0.4 to 0.4)33944.70.1 (–0.6 to 0.7)30884.5–0.1 (–0.6 to 0.5)1.05 (1.00 to 1.10)
 IX(e) Unspecified soft tissue sarcomas18381.31.9 (0.7 to 3.1)e9961.42.2 (1.0 to 3.4)e8421.21.2 (–0.9 to 3.5)1.13 (1.03 to 1.24)e
X Germ cell tumors, trophoblastic tumors neoplasms of gonads15 54911.00.1 (–0.4 to 0.6)978413.40.1 (–0.6 to 0.7)57658.40.2 (–0.3 to 0.7)1.59 (1.54 to 1.65)e
 X(a) Intracranial and intraspinal germ cell tumors23791.71.2 (0.1 to 2.3)e17232.40.9 (–0.2 to 2.1)6561.01.8 (–0.6 to 4.3)2.47 (2.26 to 2.71)e
 X(b) Extracranial and extragonadal germ cell tumors20001.4–0.3 (–1.2 to 0.6)8761.20.2 (–1.3 to 1.6)11241.7–0.7 (–1.6 to 0.3)0.74 (0.68 to 0.81)e
 X(c) Malignant gonadal germ cell tumors10 0727.1–0.2 (–0.8 to 0.5)70439.6–0.2 (–0.9 to 0.6)30294.4–0.1 (–0.7 to 0.5)2.17 (2.08 to 2.27)e
 X(d) Gonadal carcinomas6090.40.7 (–1.3 to 2.6)470.1f5620.80.7 (–1.4 to 2.8)0.08 (0.06 to 0.11)e
 X(e) Other and unspecified malignant gonadal tumors4890.42.1 (0.1 to 4.2)e950.1f3940.61.5 (–0.6 to 3.7)0.23 (0.18 to 0.29)e
XI Other malignant epithelial neoplasms and melanomas27 78219.62.6 (1.7 to 3.5)e894712.42.2 (1.3 to 3.0)e18 83527.23.0 (2.4 to 3.7)e0.45 (0.44 to 0.47)e
 XI(a) Adrenocortical carcinomas2880.20.7 (–2.1 to 3.6)1090.2f1790.3–0.5 (–3.5 to 2.5)0.58 (0.46 to 0.74)e
 XI(b) Thyroid carcinomas12 4598.84.2 (3.6 to 4.9)e23023.24.1 (2.7 to 5.6)e10 15714.74.2 (3.5 to 4.9)e0.22 (0.21 to 0.23)e
 XI(c) Nasopharyngeal carcinomas7440.5–1.8 (–3.8 to 0.3)5040.7–2.2 (–4.7 to 0.3)2400.4–0.5 (–2.8 to 1.9)2.00 (1.71 to 2.34)e
 XI(d) Malignant melanomas62474.4–4.1 (–4.9 to –3.3)e25643.6–4.1 (–5.4 to –2.8)e36835.3–4.2 (–5.2 to –3.2)e0.67 (0.63 to 0.70)e
 XI(e) Skin carcinomas1180.1f570.1f610.1f0.89 (0.61 to 1.31)
 XI(f) Other and unspecified carcinomas79265.65.4 (3.7 to 7.2)e34114.75.6 (3.5 to 7.9)e45156.55.2 (2.3 to 8.2)e0.72 (0.69 to 0.75)e
XII Other and unspecified malignant neoplasms11680.80.3 (–1.3 to 1.9)5090.7–1.2 (–9.4 to 7.8)6591.0–0.3 (–2.2 to 1.7)0.74 (0.66 to 0.83)e
 XII(a) Other specified malignant tumors5790.41.7 (–0.3 to 3.7)2490.42.3 (–0.3 to 5.1)3300.50.9 (–1.8 to 3.7)0.72 (0.61 to 0.85)e
 XII(b) Other unspecified malignant tumors5890.4–0.9 (–3.1 to 1.2)2600.40.2 (–3.0 to 0.6)3290.5–1.4 (–3.9 to 1.2)0.76 (0.64 to 0.90)e
Not classified by ICCC or in situ8480.619.6 (6.5 to 34.2)e4100.6f4380.719.4 (5.0 to 35.8)e0.90 (0.78 to 1.03)
a

Rates are per 1 million people and age-adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Source: US Cancer Statistics. AAPC = average annual percent change; CI = confidence interval; CNS = central nervous system; ICCC = International Classification of Childhood Cancer.

b

Cases included all malignant cancers.

c

Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003-2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Characteristic values with other, missing, or blank results are not included in this table.

d

Trends were measured with AAPC, and rates and were considered to increase or decrease if P <.05; otherwise, trends were considered stable. AAPC was not calculated if case count was <6 cases in any 1 year.

e

Difference was significant at P <.05 (2-sided).

f

Statistic could not be calculated because of low number of cases.

The highest rates of leukemia and CNS neoplasms were among children 0 to 4 years of age, and the highest rate of lymphoma was among adolescents (Figure 2). Some cancers were predominantly seen among children aged 0 to 4 years (eg, retinoblastoma and neuroblastoma) and some among children aged 10 to 14 years and adolescents (eg, thyroid carcinoma and malignant melanoma). By race and ethnicity, the rate for leukemia was highest among Hispanic children and adolescents (57.9), and the rates of lymphoma and CNS neoplasms were highest among White children and adolescents (29.2 and 35.1, respectively) (Table 3).

Rates of invasive cancer in patients aged 0 to 19 years, by ICCC group and age—United States, 2003-2019. Source: US Cancer Statistics. Rates are per 1 million people and age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Cases included all malignant cancers. Incidence data are compiled from cancer registries that meet the data quality criteria for all years 2003-2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. CNS = central nervous system; ICCC = International Classification of Childhood Cancer.
Figure 2.

Rates of invasive cancer in patients aged 0 to 19 years, by ICCC group and age—United States, 2003-2019. Source: US Cancer Statistics. Rates are per 1 million people and age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Cases included all malignant cancers. Incidence data are compiled from cancer registries that meet the data quality criteria for all years 2003-2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. CNS = central nervous system; ICCC = International Classification of Childhood Cancer.

Table 3.

Age-adjusted incidence ratea of invasive cancer,b aged 0 to 19 years, and average annual percent change between rates, by International Classification of Childhood Cancer group and race and ethnicityc—United States,d 2003-2019

American Indian or Alaska Native
Asian or Pacific Islander
Black
Hispanic (all races)
White
ICCC groupNo.RateAAPCe (95% CI)No.RateAAPCe (95% CI)No.RateAAPCe (95% CI)No.RateAAPCe (95% CI)No.RateAAPCe (95% CI)
I Leukemias, myeloproliferative diseases, and myelodysplastic diseases65746.71.1 (–0.8 to 3.1)337545.40.2 (–0.6 to 0.9)638730.10.3 (–0.3 to 0.9)18 39957.90.8 (–0.7 to 2.2)34 93145.60 (–0.3 to 0.4)
 I(a) Lymphoid leukemias45632.61.8 (–0.3 to 4.0)236231.60.2 (–0.9 to 1.2)379818.00.1 (–0.7 to 0.8)13 97743.91.0 (–1.1 to 3.0)25 53433.60 (–0.4 to 0.4)
 I(b) Acute myeloid leukemias1188.3f6258.50.3 (–1.8 to 2.4)14897.0–0.7 (–2.2 to 0.8)25828.2–0.1 (–0.7 to 0.5)55477.1–0.4 (–1.0 to 0.2)
 I(c) Chronic myeloproliferative diseases322.2f1732.4f5742.71.8 (–0.6 to 4.2)7592.5–0.8 (–2.5 to 1.0)18232.3–1.4 (–5.2 to 2.5)
 I(d) Myelodysplastic syndrome and other myeloproliferative diseases271.9f1121.5f2491.20.5 (–1.9 to 3.0)4571.4–0.1 (–1.6 to 1.5)10071.3–2.2 (–4.1 to –0.3)g
 I(e) Unspecified and other specified leukemias241.7f1031.4f2771.35.7 (2.6 to 8.9)g6242.03.0 (1.1 to 4.9)g10201.34.2 (2.7 to 5.8)g
II Lymphomas and reticuloendothelial neoplasms29520.63.1 (–0.4 to 6.6)171823.52.5 (1.1 to 3.9)g496223.00.6 (–0.2 to 1.4)754824.60.9 (-0.9 to 2.8)23 22829.21.4 (0.6 to 2.2)g
 II(a) Hodgkin lymphomas1047.1f5958.21.0 (–1.0 to 3.1)225410.40.1 (–0.9 to 1.0)308310.3–0.6 (–1.1 to –0.1)g11 09213.60.1 (–0.3 to 0.5)
 II(b) Non-Hodgkin lymphomas (except Burkitt lymphoma)976.8f6899.50.9 (–1.3 to 3.2)20669.60.7 (–0.4 to 1.9)25128.21.3 (0.5 to 2.1)g70158.91.2 (0.6 to 1.7)g
 II(c) Burkitt lymphoma342.4f1732.4f3051.4–1.9 (–4.4 to 0.7)4951.6–1.2 (–3.2 to 0.8)22813.0–0.2 (–1.1 to 0.6)
 II(d) Miscellaneous lymphoreticular neoplasms543.9f2463.3f2591.2f13494.18.0 (–7.2 to 25.7)26013.411.5 (4.3 to 19.2)g
 II(e) Unspecified lymphomas60.4f150.2f780.4f1090.4f2390.30.8 (–3.6 to 5.3)
III CNS and miscellaneous intracranial and intraspinal neoplasms38027.00.9 (–1.5 to 3.3)160721.8–1.9 (–5.8 to 2.3)524824.9–1.3 (–3.9 to 1.3)778024.5–2.0 (–3.5 to –0.5)g26 95135.1–1.6 (–2.9 to –0.2)g
 III(a) Ependymomas and choroid plexus tumor332.3f1602.1f4462.10.7 (–1.7 to 3.3)8262.6–1.5 (–3.0 to 0.1)21122.80.2 (–0.9 to 1.3)
 III(b) Astrocytomas19413.80.4 (–2.4 to 3.3)73810.00.5 (–1.4 to 2.6)256312.10.2 (–1.0 to 1.4)367111.7–1.0 (–2.5 to 0.6)14 47018.8–1.2 (–3.2 to 0.9)
 III(c) Intracranial and intraspinal embryonal tumors735.2f3975.30.1 (–2.5 to 2.7)8784.2–3.0 (–4.9 to –1.0)g16765.2–2.4 (–3.6 to –1.3)g48586.4–3.9 (–6.9 to –0.9)g
 III(d) Other gliomas604.3f2683.7–2.1 (–4.8 to 0.8)10314.9–1.3 (–6.0 to 3.6)13114.2–1.0 (–2.4 to 0.4)46586.0–1.3 (–4.4 to 1.8)
 III(e) Other specified intracranial/intraspinal neoplasms120.9f210.3f2221.1–1.5 (–3.7 to 0.7)1640.51.5 (–2.4 to 5.7)4750.60.2 (–1.8 to 2.3)
 III(f) Unspecified intracranial and intraspinal neoplasms80.6f230.3f1080.5f1320.4f3780.50.8 (–1.8 to 3.5)
IV Neuroblastoma and other peripheral nervous cell tumors936.7f5246.81.1 (–0.5 to 2.9)15407.3–0.5 (–1.6 to 0.6)19035.70.5 (–0.6 to 1.6)767110.30.6 (0.1 to 1.2)g
 IV(a) Neuroblastoma and ganglioneuroblastoma906.5f5156.71.2 (–0.4 to 3.0)14847.0–0.6 (–1.6 to 0.4)18395.40.5 (–0.6 to 1.6)747410.00.6 (0.1 to 1.1)g
 IV(b) Other peripheral nervous cell tumorshff90.1f560.3f640.2f1970.32.0 (–1.3 to 5.3)
V Retinoblastoma443.2f2613.41.0 (–1.4 to 3.6)7253.4–1.0 (–1.9 to –0.2)g11963.5–0.8 (–1.7 to 0.2)21212.9–0.5 (–2.6 to 1.7)
VI Renal tumors936.7f2833.7–0.1 (–2.4 to 2.3)18168.60.6 (–0.5 to 1.7)18085.50.8 (–0.4 to 2.1)53637.1–0.8 (–2.2 to 0.6)
 VI(a) Nephroblastoma and other nonepithelial renal tumors815.8f2463.2–0.8 (–3.4 to 1.8)15767.50.5 (–0.6 to 1.7)16575.00.7 (–0.5 to 1.9)48986.5–0.9 (–2.3 to 0.6)
 VI(b) Renal carcinomas110.8f320.4f2321.11.1 (–1.7 to 3.9)1420.5f4440.61.1 (–0.5 to 2.7)
 VI(c) Unspecified malignant renal tumorshffhff80.0f90.0f210.0f
VII Hepatic tumors412.9f2132.8–0.2 (–3.5 to 3.2)3931.92.8 (0.2 to 5.4)g9172.81.1 (–0.8 to 2.9)17692.31.4 (0.4 to 2.4)g
 VII(a) Hepatoblastoma352.5f1622.1f2751.34.2 (1.0 to 7.5)g7142.11.6 (–0.5 to 3.7)13001.71.5 (0.3 to 2.7)g
 VII(b) Hepatic carcinomas60.4f500.7f1100.5f1950.6f4510.61.2 (–0.7 to 3.2)
 VII(c) Unspecified malignant hepatic tumorshffhff80.0f80.0f180.0f
VIII Malignant bone tumors1137.9f5617.82.0 (–0.3 to 4.3)15297.1–0.4 (–1.2 to 0.4)25848.60.1 (–0.8 to 0.9)72799.20.6 (0.1 to 1.1)g
 VIII(a) Osteosarcomas614.2f3224.50.9 (–1.9 to 3.7)12125.6–0.6 (–1.6 to 0.5)15425.1–0.4 (–1.3 to 0.5)35824.50.3 (–0.3 to 1.0)
 VIII(b) Chondrosarcomashff140.2f600.3f860.3f2920.4–0.7 (–3.5 to 2.1)
 VIII(c) Ewing tumor and related sarcomas of bone402.8f1692.3f1240.6f7342.40.5 (–1.5 to 2.5)29183.70.9 (0.1 to 1.7)g
 VIII(d) Other specified malignant bone tumors70.5f460.6f760.4f1540.5f3560.51.2 (–1.7 to 4.1)
 VIII(e) Unspecified malignant bone tumorshff100.1f570.3f680.2f1310.2f
IX Soft tissue and other extraosseous sarcomas15410.8f6468.81.5 (–0.5 to 3.5)270212.60.1 (–0.9 to 1.1)344111.10.2 (–0.4 to 0.9)924111.8–0.2 (–0.6 to 0.3)
 IX(a) Rhabdomyosarcomas614.4f2483.31.9 (–0.2 to 4.1)10585.00.0 (–1.5 to 1.5)13394.2–0.3 (–1.6 to 1.1)35984.7–0.3 (–1.2 to 0.7)
 IX(b) Fibrosarcomas, peripheral nerve and other fibrous181.3f640.9f2741.3–2.0 (–4.5 to 0.6)3321.1–2.3 (–4.6 to 0.1)9661.2–0.5 (–2.5 to 1.4)
 IX(c) Kaposi sarcomahffhff380.2f130.0f100.0f
 IX(d) Other specified soft tissue sarcomas654.5f2623.62.0 (–1.3 to 5.5)10224.7–0.1 (–1.4 to 1.3)13914.60.7 (–0.2 to 1.7)36134.6–0.5 (–0.9 to –0.1)g
 IX(e) Unspecified soft tissue sarcomas100.7f711.0f3101.52.3 (–0.1 to 4.7)3661.22.6 (0.5 to 4.7)g10541.31.7 (–0.1 to 3.5)
X Germ cell tumors, trophoblastic tumors, and neoplasms of gonads1409.6f83811.4–0.2 (–1.4 to 1.1)13356.20.1 (–0.6 to 0.8)433814.40.8 (–0.3 to 1.9)869910.8–0.6 (–1.1 to 0.0)g
 X(a) Intracranial and intraspinal germ cell tumors141.0f2453.4–0.9 (–4.0 to 2.3)2271.14.2 (0.8 to 7.7)g5511.81.0 (–0.3 to 2.4)13211.70.7 (–0.8 to 2.2)
 X(b) Extracranial and extragonadal germ cell tumors181.3f1472.0–1.8 (–4.2 to 0.7)2741.3–0.9 (–2.8 to 1.0)4861.5–0.8 (–2.2 to 0.5)10351.4–0.3 (–2.0 to 1.5)
 X(c) Malignant gonadal germ cell tumors986.6f3975.40.0 (–1.9 to 2.0)6843.2–1.0 (–2.2 to 0.1)305410.21.1 (0.1 to 2.1)g57177.0–1.2 (–1.8 to –0.5)g
 X(d) Gonadal carcinomas70.5f410.6f520.2f1360.5f3680.51.4 (–1.0 to 4.0)
 X(e) Other and unspecified malignant gonadal tumorshff80.1f980.5f1110.4f2580.31.4 (–0.7 to 3.4)
XI Other malignant epithelial neoplasms and melanomas23916.34.1 (2.0 to 6.2)g113615.74.6 (3.3 to 6.0)g21319.81.4 (0.3 to 2.5)g470115.84.9 (4.2 to 5.7)g18 93423.32.4 (1.3 to 3.5)g
 XI(a) Adrenocortical carcinomashff120.2f190.1f630.2f1840.2f
 XI(b) Thyroid carcinomas1037.0f6899.56.0 (4.1 to 7.9)g6703.12.9 (1.2 to 4.7)g25858.75.1 (4.1 to 6.1)g821010.03.9 (3.2 to 4.7)g
 XI(c) Nasopharyngeal carcinomas100.7f530.73.9 (1.3 to 6.5)g3141.4–3.7 (–6.8 to –0.6)g1180.4f2400.3–1.6 (–3.9 to 0.8)
 XI(d) Malignant melanomas322.2f701.0f1090.5f4161.4–2.6 (–4.6 to –0.5)g53496.6–3.8 (–4.6 to –2.9)g
 XI(e) Skin carcinomashffhff240.1f160.1f670.1f
 XI(f) Other and unspecified carcinomas875.9f3074.23.9 (1.3 to 6.5)g9954.62.4 (0.6 to 4.1)g15035.15.8 (0.8 to 11.0)g48846.06.5 (4.3 to 8.8)g
XII Other and unspecified malignant neoplasms130.9f430.6f1950.9f2480.80.1 (–2.9 to 3.3)6380.80.5 (–1.3 to 2.3)
 XII(a) Other specified malignant tumors70.5f230.3f820.4f1200.4f3420.41.3 (–0.9 to 3.6)
 XII(b) Other unspecified malignant tumors60.4f200.3f1130.5f1280.4f2960.4–0.6 (–3.0 to 1.8)
Not classified by ICCC or in situ120.9f410.6f900.4f2030.6f4890.6f
American Indian or Alaska Native
Asian or Pacific Islander
Black
Hispanic (all races)
White
ICCC groupNo.RateAAPCe (95% CI)No.RateAAPCe (95% CI)No.RateAAPCe (95% CI)No.RateAAPCe (95% CI)No.RateAAPCe (95% CI)
I Leukemias, myeloproliferative diseases, and myelodysplastic diseases65746.71.1 (–0.8 to 3.1)337545.40.2 (–0.6 to 0.9)638730.10.3 (–0.3 to 0.9)18 39957.90.8 (–0.7 to 2.2)34 93145.60 (–0.3 to 0.4)
 I(a) Lymphoid leukemias45632.61.8 (–0.3 to 4.0)236231.60.2 (–0.9 to 1.2)379818.00.1 (–0.7 to 0.8)13 97743.91.0 (–1.1 to 3.0)25 53433.60 (–0.4 to 0.4)
 I(b) Acute myeloid leukemias1188.3f6258.50.3 (–1.8 to 2.4)14897.0–0.7 (–2.2 to 0.8)25828.2–0.1 (–0.7 to 0.5)55477.1–0.4 (–1.0 to 0.2)
 I(c) Chronic myeloproliferative diseases322.2f1732.4f5742.71.8 (–0.6 to 4.2)7592.5–0.8 (–2.5 to 1.0)18232.3–1.4 (–5.2 to 2.5)
 I(d) Myelodysplastic syndrome and other myeloproliferative diseases271.9f1121.5f2491.20.5 (–1.9 to 3.0)4571.4–0.1 (–1.6 to 1.5)10071.3–2.2 (–4.1 to –0.3)g
 I(e) Unspecified and other specified leukemias241.7f1031.4f2771.35.7 (2.6 to 8.9)g6242.03.0 (1.1 to 4.9)g10201.34.2 (2.7 to 5.8)g
II Lymphomas and reticuloendothelial neoplasms29520.63.1 (–0.4 to 6.6)171823.52.5 (1.1 to 3.9)g496223.00.6 (–0.2 to 1.4)754824.60.9 (-0.9 to 2.8)23 22829.21.4 (0.6 to 2.2)g
 II(a) Hodgkin lymphomas1047.1f5958.21.0 (–1.0 to 3.1)225410.40.1 (–0.9 to 1.0)308310.3–0.6 (–1.1 to –0.1)g11 09213.60.1 (–0.3 to 0.5)
 II(b) Non-Hodgkin lymphomas (except Burkitt lymphoma)976.8f6899.50.9 (–1.3 to 3.2)20669.60.7 (–0.4 to 1.9)25128.21.3 (0.5 to 2.1)g70158.91.2 (0.6 to 1.7)g
 II(c) Burkitt lymphoma342.4f1732.4f3051.4–1.9 (–4.4 to 0.7)4951.6–1.2 (–3.2 to 0.8)22813.0–0.2 (–1.1 to 0.6)
 II(d) Miscellaneous lymphoreticular neoplasms543.9f2463.3f2591.2f13494.18.0 (–7.2 to 25.7)26013.411.5 (4.3 to 19.2)g
 II(e) Unspecified lymphomas60.4f150.2f780.4f1090.4f2390.30.8 (–3.6 to 5.3)
III CNS and miscellaneous intracranial and intraspinal neoplasms38027.00.9 (–1.5 to 3.3)160721.8–1.9 (–5.8 to 2.3)524824.9–1.3 (–3.9 to 1.3)778024.5–2.0 (–3.5 to –0.5)g26 95135.1–1.6 (–2.9 to –0.2)g
 III(a) Ependymomas and choroid plexus tumor332.3f1602.1f4462.10.7 (–1.7 to 3.3)8262.6–1.5 (–3.0 to 0.1)21122.80.2 (–0.9 to 1.3)
 III(b) Astrocytomas19413.80.4 (–2.4 to 3.3)73810.00.5 (–1.4 to 2.6)256312.10.2 (–1.0 to 1.4)367111.7–1.0 (–2.5 to 0.6)14 47018.8–1.2 (–3.2 to 0.9)
 III(c) Intracranial and intraspinal embryonal tumors735.2f3975.30.1 (–2.5 to 2.7)8784.2–3.0 (–4.9 to –1.0)g16765.2–2.4 (–3.6 to –1.3)g48586.4–3.9 (–6.9 to –0.9)g
 III(d) Other gliomas604.3f2683.7–2.1 (–4.8 to 0.8)10314.9–1.3 (–6.0 to 3.6)13114.2–1.0 (–2.4 to 0.4)46586.0–1.3 (–4.4 to 1.8)
 III(e) Other specified intracranial/intraspinal neoplasms120.9f210.3f2221.1–1.5 (–3.7 to 0.7)1640.51.5 (–2.4 to 5.7)4750.60.2 (–1.8 to 2.3)
 III(f) Unspecified intracranial and intraspinal neoplasms80.6f230.3f1080.5f1320.4f3780.50.8 (–1.8 to 3.5)
IV Neuroblastoma and other peripheral nervous cell tumors936.7f5246.81.1 (–0.5 to 2.9)15407.3–0.5 (–1.6 to 0.6)19035.70.5 (–0.6 to 1.6)767110.30.6 (0.1 to 1.2)g
 IV(a) Neuroblastoma and ganglioneuroblastoma906.5f5156.71.2 (–0.4 to 3.0)14847.0–0.6 (–1.6 to 0.4)18395.40.5 (–0.6 to 1.6)747410.00.6 (0.1 to 1.1)g
 IV(b) Other peripheral nervous cell tumorshff90.1f560.3f640.2f1970.32.0 (–1.3 to 5.3)
V Retinoblastoma443.2f2613.41.0 (–1.4 to 3.6)7253.4–1.0 (–1.9 to –0.2)g11963.5–0.8 (–1.7 to 0.2)21212.9–0.5 (–2.6 to 1.7)
VI Renal tumors936.7f2833.7–0.1 (–2.4 to 2.3)18168.60.6 (–0.5 to 1.7)18085.50.8 (–0.4 to 2.1)53637.1–0.8 (–2.2 to 0.6)
 VI(a) Nephroblastoma and other nonepithelial renal tumors815.8f2463.2–0.8 (–3.4 to 1.8)15767.50.5 (–0.6 to 1.7)16575.00.7 (–0.5 to 1.9)48986.5–0.9 (–2.3 to 0.6)
 VI(b) Renal carcinomas110.8f320.4f2321.11.1 (–1.7 to 3.9)1420.5f4440.61.1 (–0.5 to 2.7)
 VI(c) Unspecified malignant renal tumorshffhff80.0f90.0f210.0f
VII Hepatic tumors412.9f2132.8–0.2 (–3.5 to 3.2)3931.92.8 (0.2 to 5.4)g9172.81.1 (–0.8 to 2.9)17692.31.4 (0.4 to 2.4)g
 VII(a) Hepatoblastoma352.5f1622.1f2751.34.2 (1.0 to 7.5)g7142.11.6 (–0.5 to 3.7)13001.71.5 (0.3 to 2.7)g
 VII(b) Hepatic carcinomas60.4f500.7f1100.5f1950.6f4510.61.2 (–0.7 to 3.2)
 VII(c) Unspecified malignant hepatic tumorshffhff80.0f80.0f180.0f
VIII Malignant bone tumors1137.9f5617.82.0 (–0.3 to 4.3)15297.1–0.4 (–1.2 to 0.4)25848.60.1 (–0.8 to 0.9)72799.20.6 (0.1 to 1.1)g
 VIII(a) Osteosarcomas614.2f3224.50.9 (–1.9 to 3.7)12125.6–0.6 (–1.6 to 0.5)15425.1–0.4 (–1.3 to 0.5)35824.50.3 (–0.3 to 1.0)
 VIII(b) Chondrosarcomashff140.2f600.3f860.3f2920.4–0.7 (–3.5 to 2.1)
 VIII(c) Ewing tumor and related sarcomas of bone402.8f1692.3f1240.6f7342.40.5 (–1.5 to 2.5)29183.70.9 (0.1 to 1.7)g
 VIII(d) Other specified malignant bone tumors70.5f460.6f760.4f1540.5f3560.51.2 (–1.7 to 4.1)
 VIII(e) Unspecified malignant bone tumorshff100.1f570.3f680.2f1310.2f
IX Soft tissue and other extraosseous sarcomas15410.8f6468.81.5 (–0.5 to 3.5)270212.60.1 (–0.9 to 1.1)344111.10.2 (–0.4 to 0.9)924111.8–0.2 (–0.6 to 0.3)
 IX(a) Rhabdomyosarcomas614.4f2483.31.9 (–0.2 to 4.1)10585.00.0 (–1.5 to 1.5)13394.2–0.3 (–1.6 to 1.1)35984.7–0.3 (–1.2 to 0.7)
 IX(b) Fibrosarcomas, peripheral nerve and other fibrous181.3f640.9f2741.3–2.0 (–4.5 to 0.6)3321.1–2.3 (–4.6 to 0.1)9661.2–0.5 (–2.5 to 1.4)
 IX(c) Kaposi sarcomahffhff380.2f130.0f100.0f
 IX(d) Other specified soft tissue sarcomas654.5f2623.62.0 (–1.3 to 5.5)10224.7–0.1 (–1.4 to 1.3)13914.60.7 (–0.2 to 1.7)36134.6–0.5 (–0.9 to –0.1)g
 IX(e) Unspecified soft tissue sarcomas100.7f711.0f3101.52.3 (–0.1 to 4.7)3661.22.6 (0.5 to 4.7)g10541.31.7 (–0.1 to 3.5)
X Germ cell tumors, trophoblastic tumors, and neoplasms of gonads1409.6f83811.4–0.2 (–1.4 to 1.1)13356.20.1 (–0.6 to 0.8)433814.40.8 (–0.3 to 1.9)869910.8–0.6 (–1.1 to 0.0)g
 X(a) Intracranial and intraspinal germ cell tumors141.0f2453.4–0.9 (–4.0 to 2.3)2271.14.2 (0.8 to 7.7)g5511.81.0 (–0.3 to 2.4)13211.70.7 (–0.8 to 2.2)
 X(b) Extracranial and extragonadal germ cell tumors181.3f1472.0–1.8 (–4.2 to 0.7)2741.3–0.9 (–2.8 to 1.0)4861.5–0.8 (–2.2 to 0.5)10351.4–0.3 (–2.0 to 1.5)
 X(c) Malignant gonadal germ cell tumors986.6f3975.40.0 (–1.9 to 2.0)6843.2–1.0 (–2.2 to 0.1)305410.21.1 (0.1 to 2.1)g57177.0–1.2 (–1.8 to –0.5)g
 X(d) Gonadal carcinomas70.5f410.6f520.2f1360.5f3680.51.4 (–1.0 to 4.0)
 X(e) Other and unspecified malignant gonadal tumorshff80.1f980.5f1110.4f2580.31.4 (–0.7 to 3.4)
XI Other malignant epithelial neoplasms and melanomas23916.34.1 (2.0 to 6.2)g113615.74.6 (3.3 to 6.0)g21319.81.4 (0.3 to 2.5)g470115.84.9 (4.2 to 5.7)g18 93423.32.4 (1.3 to 3.5)g
 XI(a) Adrenocortical carcinomashff120.2f190.1f630.2f1840.2f
 XI(b) Thyroid carcinomas1037.0f6899.56.0 (4.1 to 7.9)g6703.12.9 (1.2 to 4.7)g25858.75.1 (4.1 to 6.1)g821010.03.9 (3.2 to 4.7)g
 XI(c) Nasopharyngeal carcinomas100.7f530.73.9 (1.3 to 6.5)g3141.4–3.7 (–6.8 to –0.6)g1180.4f2400.3–1.6 (–3.9 to 0.8)
 XI(d) Malignant melanomas322.2f701.0f1090.5f4161.4–2.6 (–4.6 to –0.5)g53496.6–3.8 (–4.6 to –2.9)g
 XI(e) Skin carcinomashffhff240.1f160.1f670.1f
 XI(f) Other and unspecified carcinomas875.9f3074.23.9 (1.3 to 6.5)g9954.62.4 (0.6 to 4.1)g15035.15.8 (0.8 to 11.0)g48846.06.5 (4.3 to 8.8)g
XII Other and unspecified malignant neoplasms130.9f430.6f1950.9f2480.80.1 (–2.9 to 3.3)6380.80.5 (–1.3 to 2.3)
 XII(a) Other specified malignant tumors70.5f230.3f820.4f1200.4f3420.41.3 (–0.9 to 3.6)
 XII(b) Other unspecified malignant tumors60.4f200.3f1130.5f1280.4f2960.4–0.6 (–3.0 to 1.8)
Not classified by ICCC or in situ120.9f410.6f900.4f2030.6f4890.6f
a

Rates are per 1 million people and age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Source: US Cancer Statistics. AAPC = average annual percent change; CI = confidence interval; CNS = central nervous system; ICCC = International Classification of Childhood Cancer.

b

Cases included all malignant cancers.

c

Race and ethnicity results were categorized as White, Black, American Indian or Alaska Native, and Asian or Pacific Islander (all Non-Hispanic) and Hispanic or Latino (any race) (Hispanic).

d

Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003-2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Characteristic values with other, missing, or blank results are not included in this table.

e

Trends were measured with AAPC, and rates and were considered to increase or decrease if P <.05 (2-sided); otherwise, trends were considered stable. AAPC was not calculated if case count was <6 cases in any 1 year.

f

Statistic could not be calculated because of a low number of cases.

g

Trends were significant at P <.05.

h

Cell suppressed because there were <6 cases.

Table 3.

Age-adjusted incidence ratea of invasive cancer,b aged 0 to 19 years, and average annual percent change between rates, by International Classification of Childhood Cancer group and race and ethnicityc—United States,d 2003-2019

American Indian or Alaska Native
Asian or Pacific Islander
Black
Hispanic (all races)
White
ICCC groupNo.RateAAPCe (95% CI)No.RateAAPCe (95% CI)No.RateAAPCe (95% CI)No.RateAAPCe (95% CI)No.RateAAPCe (95% CI)
I Leukemias, myeloproliferative diseases, and myelodysplastic diseases65746.71.1 (–0.8 to 3.1)337545.40.2 (–0.6 to 0.9)638730.10.3 (–0.3 to 0.9)18 39957.90.8 (–0.7 to 2.2)34 93145.60 (–0.3 to 0.4)
 I(a) Lymphoid leukemias45632.61.8 (–0.3 to 4.0)236231.60.2 (–0.9 to 1.2)379818.00.1 (–0.7 to 0.8)13 97743.91.0 (–1.1 to 3.0)25 53433.60 (–0.4 to 0.4)
 I(b) Acute myeloid leukemias1188.3f6258.50.3 (–1.8 to 2.4)14897.0–0.7 (–2.2 to 0.8)25828.2–0.1 (–0.7 to 0.5)55477.1–0.4 (–1.0 to 0.2)
 I(c) Chronic myeloproliferative diseases322.2f1732.4f5742.71.8 (–0.6 to 4.2)7592.5–0.8 (–2.5 to 1.0)18232.3–1.4 (–5.2 to 2.5)
 I(d) Myelodysplastic syndrome and other myeloproliferative diseases271.9f1121.5f2491.20.5 (–1.9 to 3.0)4571.4–0.1 (–1.6 to 1.5)10071.3–2.2 (–4.1 to –0.3)g
 I(e) Unspecified and other specified leukemias241.7f1031.4f2771.35.7 (2.6 to 8.9)g6242.03.0 (1.1 to 4.9)g10201.34.2 (2.7 to 5.8)g
II Lymphomas and reticuloendothelial neoplasms29520.63.1 (–0.4 to 6.6)171823.52.5 (1.1 to 3.9)g496223.00.6 (–0.2 to 1.4)754824.60.9 (-0.9 to 2.8)23 22829.21.4 (0.6 to 2.2)g
 II(a) Hodgkin lymphomas1047.1f5958.21.0 (–1.0 to 3.1)225410.40.1 (–0.9 to 1.0)308310.3–0.6 (–1.1 to –0.1)g11 09213.60.1 (–0.3 to 0.5)
 II(b) Non-Hodgkin lymphomas (except Burkitt lymphoma)976.8f6899.50.9 (–1.3 to 3.2)20669.60.7 (–0.4 to 1.9)25128.21.3 (0.5 to 2.1)g70158.91.2 (0.6 to 1.7)g
 II(c) Burkitt lymphoma342.4f1732.4f3051.4–1.9 (–4.4 to 0.7)4951.6–1.2 (–3.2 to 0.8)22813.0–0.2 (–1.1 to 0.6)
 II(d) Miscellaneous lymphoreticular neoplasms543.9f2463.3f2591.2f13494.18.0 (–7.2 to 25.7)26013.411.5 (4.3 to 19.2)g
 II(e) Unspecified lymphomas60.4f150.2f780.4f1090.4f2390.30.8 (–3.6 to 5.3)
III CNS and miscellaneous intracranial and intraspinal neoplasms38027.00.9 (–1.5 to 3.3)160721.8–1.9 (–5.8 to 2.3)524824.9–1.3 (–3.9 to 1.3)778024.5–2.0 (–3.5 to –0.5)g26 95135.1–1.6 (–2.9 to –0.2)g
 III(a) Ependymomas and choroid plexus tumor332.3f1602.1f4462.10.7 (–1.7 to 3.3)8262.6–1.5 (–3.0 to 0.1)21122.80.2 (–0.9 to 1.3)
 III(b) Astrocytomas19413.80.4 (–2.4 to 3.3)73810.00.5 (–1.4 to 2.6)256312.10.2 (–1.0 to 1.4)367111.7–1.0 (–2.5 to 0.6)14 47018.8–1.2 (–3.2 to 0.9)
 III(c) Intracranial and intraspinal embryonal tumors735.2f3975.30.1 (–2.5 to 2.7)8784.2–3.0 (–4.9 to –1.0)g16765.2–2.4 (–3.6 to –1.3)g48586.4–3.9 (–6.9 to –0.9)g
 III(d) Other gliomas604.3f2683.7–2.1 (–4.8 to 0.8)10314.9–1.3 (–6.0 to 3.6)13114.2–1.0 (–2.4 to 0.4)46586.0–1.3 (–4.4 to 1.8)
 III(e) Other specified intracranial/intraspinal neoplasms120.9f210.3f2221.1–1.5 (–3.7 to 0.7)1640.51.5 (–2.4 to 5.7)4750.60.2 (–1.8 to 2.3)
 III(f) Unspecified intracranial and intraspinal neoplasms80.6f230.3f1080.5f1320.4f3780.50.8 (–1.8 to 3.5)
IV Neuroblastoma and other peripheral nervous cell tumors936.7f5246.81.1 (–0.5 to 2.9)15407.3–0.5 (–1.6 to 0.6)19035.70.5 (–0.6 to 1.6)767110.30.6 (0.1 to 1.2)g
 IV(a) Neuroblastoma and ganglioneuroblastoma906.5f5156.71.2 (–0.4 to 3.0)14847.0–0.6 (–1.6 to 0.4)18395.40.5 (–0.6 to 1.6)747410.00.6 (0.1 to 1.1)g
 IV(b) Other peripheral nervous cell tumorshff90.1f560.3f640.2f1970.32.0 (–1.3 to 5.3)
V Retinoblastoma443.2f2613.41.0 (–1.4 to 3.6)7253.4–1.0 (–1.9 to –0.2)g11963.5–0.8 (–1.7 to 0.2)21212.9–0.5 (–2.6 to 1.7)
VI Renal tumors936.7f2833.7–0.1 (–2.4 to 2.3)18168.60.6 (–0.5 to 1.7)18085.50.8 (–0.4 to 2.1)53637.1–0.8 (–2.2 to 0.6)
 VI(a) Nephroblastoma and other nonepithelial renal tumors815.8f2463.2–0.8 (–3.4 to 1.8)15767.50.5 (–0.6 to 1.7)16575.00.7 (–0.5 to 1.9)48986.5–0.9 (–2.3 to 0.6)
 VI(b) Renal carcinomas110.8f320.4f2321.11.1 (–1.7 to 3.9)1420.5f4440.61.1 (–0.5 to 2.7)
 VI(c) Unspecified malignant renal tumorshffhff80.0f90.0f210.0f
VII Hepatic tumors412.9f2132.8–0.2 (–3.5 to 3.2)3931.92.8 (0.2 to 5.4)g9172.81.1 (–0.8 to 2.9)17692.31.4 (0.4 to 2.4)g
 VII(a) Hepatoblastoma352.5f1622.1f2751.34.2 (1.0 to 7.5)g7142.11.6 (–0.5 to 3.7)13001.71.5 (0.3 to 2.7)g
 VII(b) Hepatic carcinomas60.4f500.7f1100.5f1950.6f4510.61.2 (–0.7 to 3.2)
 VII(c) Unspecified malignant hepatic tumorshffhff80.0f80.0f180.0f
VIII Malignant bone tumors1137.9f5617.82.0 (–0.3 to 4.3)15297.1–0.4 (–1.2 to 0.4)25848.60.1 (–0.8 to 0.9)72799.20.6 (0.1 to 1.1)g
 VIII(a) Osteosarcomas614.2f3224.50.9 (–1.9 to 3.7)12125.6–0.6 (–1.6 to 0.5)15425.1–0.4 (–1.3 to 0.5)35824.50.3 (–0.3 to 1.0)
 VIII(b) Chondrosarcomashff140.2f600.3f860.3f2920.4–0.7 (–3.5 to 2.1)
 VIII(c) Ewing tumor and related sarcomas of bone402.8f1692.3f1240.6f7342.40.5 (–1.5 to 2.5)29183.70.9 (0.1 to 1.7)g
 VIII(d) Other specified malignant bone tumors70.5f460.6f760.4f1540.5f3560.51.2 (–1.7 to 4.1)
 VIII(e) Unspecified malignant bone tumorshff100.1f570.3f680.2f1310.2f
IX Soft tissue and other extraosseous sarcomas15410.8f6468.81.5 (–0.5 to 3.5)270212.60.1 (–0.9 to 1.1)344111.10.2 (–0.4 to 0.9)924111.8–0.2 (–0.6 to 0.3)
 IX(a) Rhabdomyosarcomas614.4f2483.31.9 (–0.2 to 4.1)10585.00.0 (–1.5 to 1.5)13394.2–0.3 (–1.6 to 1.1)35984.7–0.3 (–1.2 to 0.7)
 IX(b) Fibrosarcomas, peripheral nerve and other fibrous181.3f640.9f2741.3–2.0 (–4.5 to 0.6)3321.1–2.3 (–4.6 to 0.1)9661.2–0.5 (–2.5 to 1.4)
 IX(c) Kaposi sarcomahffhff380.2f130.0f100.0f
 IX(d) Other specified soft tissue sarcomas654.5f2623.62.0 (–1.3 to 5.5)10224.7–0.1 (–1.4 to 1.3)13914.60.7 (–0.2 to 1.7)36134.6–0.5 (–0.9 to –0.1)g
 IX(e) Unspecified soft tissue sarcomas100.7f711.0f3101.52.3 (–0.1 to 4.7)3661.22.6 (0.5 to 4.7)g10541.31.7 (–0.1 to 3.5)
X Germ cell tumors, trophoblastic tumors, and neoplasms of gonads1409.6f83811.4–0.2 (–1.4 to 1.1)13356.20.1 (–0.6 to 0.8)433814.40.8 (–0.3 to 1.9)869910.8–0.6 (–1.1 to 0.0)g
 X(a) Intracranial and intraspinal germ cell tumors141.0f2453.4–0.9 (–4.0 to 2.3)2271.14.2 (0.8 to 7.7)g5511.81.0 (–0.3 to 2.4)13211.70.7 (–0.8 to 2.2)
 X(b) Extracranial and extragonadal germ cell tumors181.3f1472.0–1.8 (–4.2 to 0.7)2741.3–0.9 (–2.8 to 1.0)4861.5–0.8 (–2.2 to 0.5)10351.4–0.3 (–2.0 to 1.5)
 X(c) Malignant gonadal germ cell tumors986.6f3975.40.0 (–1.9 to 2.0)6843.2–1.0 (–2.2 to 0.1)305410.21.1 (0.1 to 2.1)g57177.0–1.2 (–1.8 to –0.5)g
 X(d) Gonadal carcinomas70.5f410.6f520.2f1360.5f3680.51.4 (–1.0 to 4.0)
 X(e) Other and unspecified malignant gonadal tumorshff80.1f980.5f1110.4f2580.31.4 (–0.7 to 3.4)
XI Other malignant epithelial neoplasms and melanomas23916.34.1 (2.0 to 6.2)g113615.74.6 (3.3 to 6.0)g21319.81.4 (0.3 to 2.5)g470115.84.9 (4.2 to 5.7)g18 93423.32.4 (1.3 to 3.5)g
 XI(a) Adrenocortical carcinomashff120.2f190.1f630.2f1840.2f
 XI(b) Thyroid carcinomas1037.0f6899.56.0 (4.1 to 7.9)g6703.12.9 (1.2 to 4.7)g25858.75.1 (4.1 to 6.1)g821010.03.9 (3.2 to 4.7)g
 XI(c) Nasopharyngeal carcinomas100.7f530.73.9 (1.3 to 6.5)g3141.4–3.7 (–6.8 to –0.6)g1180.4f2400.3–1.6 (–3.9 to 0.8)
 XI(d) Malignant melanomas322.2f701.0f1090.5f4161.4–2.6 (–4.6 to –0.5)g53496.6–3.8 (–4.6 to –2.9)g
 XI(e) Skin carcinomashffhff240.1f160.1f670.1f
 XI(f) Other and unspecified carcinomas875.9f3074.23.9 (1.3 to 6.5)g9954.62.4 (0.6 to 4.1)g15035.15.8 (0.8 to 11.0)g48846.06.5 (4.3 to 8.8)g
XII Other and unspecified malignant neoplasms130.9f430.6f1950.9f2480.80.1 (–2.9 to 3.3)6380.80.5 (–1.3 to 2.3)
 XII(a) Other specified malignant tumors70.5f230.3f820.4f1200.4f3420.41.3 (–0.9 to 3.6)
 XII(b) Other unspecified malignant tumors60.4f200.3f1130.5f1280.4f2960.4–0.6 (–3.0 to 1.8)
Not classified by ICCC or in situ120.9f410.6f900.4f2030.6f4890.6f
American Indian or Alaska Native
Asian or Pacific Islander
Black
Hispanic (all races)
White
ICCC groupNo.RateAAPCe (95% CI)No.RateAAPCe (95% CI)No.RateAAPCe (95% CI)No.RateAAPCe (95% CI)No.RateAAPCe (95% CI)
I Leukemias, myeloproliferative diseases, and myelodysplastic diseases65746.71.1 (–0.8 to 3.1)337545.40.2 (–0.6 to 0.9)638730.10.3 (–0.3 to 0.9)18 39957.90.8 (–0.7 to 2.2)34 93145.60 (–0.3 to 0.4)
 I(a) Lymphoid leukemias45632.61.8 (–0.3 to 4.0)236231.60.2 (–0.9 to 1.2)379818.00.1 (–0.7 to 0.8)13 97743.91.0 (–1.1 to 3.0)25 53433.60 (–0.4 to 0.4)
 I(b) Acute myeloid leukemias1188.3f6258.50.3 (–1.8 to 2.4)14897.0–0.7 (–2.2 to 0.8)25828.2–0.1 (–0.7 to 0.5)55477.1–0.4 (–1.0 to 0.2)
 I(c) Chronic myeloproliferative diseases322.2f1732.4f5742.71.8 (–0.6 to 4.2)7592.5–0.8 (–2.5 to 1.0)18232.3–1.4 (–5.2 to 2.5)
 I(d) Myelodysplastic syndrome and other myeloproliferative diseases271.9f1121.5f2491.20.5 (–1.9 to 3.0)4571.4–0.1 (–1.6 to 1.5)10071.3–2.2 (–4.1 to –0.3)g
 I(e) Unspecified and other specified leukemias241.7f1031.4f2771.35.7 (2.6 to 8.9)g6242.03.0 (1.1 to 4.9)g10201.34.2 (2.7 to 5.8)g
II Lymphomas and reticuloendothelial neoplasms29520.63.1 (–0.4 to 6.6)171823.52.5 (1.1 to 3.9)g496223.00.6 (–0.2 to 1.4)754824.60.9 (-0.9 to 2.8)23 22829.21.4 (0.6 to 2.2)g
 II(a) Hodgkin lymphomas1047.1f5958.21.0 (–1.0 to 3.1)225410.40.1 (–0.9 to 1.0)308310.3–0.6 (–1.1 to –0.1)g11 09213.60.1 (–0.3 to 0.5)
 II(b) Non-Hodgkin lymphomas (except Burkitt lymphoma)976.8f6899.50.9 (–1.3 to 3.2)20669.60.7 (–0.4 to 1.9)25128.21.3 (0.5 to 2.1)g70158.91.2 (0.6 to 1.7)g
 II(c) Burkitt lymphoma342.4f1732.4f3051.4–1.9 (–4.4 to 0.7)4951.6–1.2 (–3.2 to 0.8)22813.0–0.2 (–1.1 to 0.6)
 II(d) Miscellaneous lymphoreticular neoplasms543.9f2463.3f2591.2f13494.18.0 (–7.2 to 25.7)26013.411.5 (4.3 to 19.2)g
 II(e) Unspecified lymphomas60.4f150.2f780.4f1090.4f2390.30.8 (–3.6 to 5.3)
III CNS and miscellaneous intracranial and intraspinal neoplasms38027.00.9 (–1.5 to 3.3)160721.8–1.9 (–5.8 to 2.3)524824.9–1.3 (–3.9 to 1.3)778024.5–2.0 (–3.5 to –0.5)g26 95135.1–1.6 (–2.9 to –0.2)g
 III(a) Ependymomas and choroid plexus tumor332.3f1602.1f4462.10.7 (–1.7 to 3.3)8262.6–1.5 (–3.0 to 0.1)21122.80.2 (–0.9 to 1.3)
 III(b) Astrocytomas19413.80.4 (–2.4 to 3.3)73810.00.5 (–1.4 to 2.6)256312.10.2 (–1.0 to 1.4)367111.7–1.0 (–2.5 to 0.6)14 47018.8–1.2 (–3.2 to 0.9)
 III(c) Intracranial and intraspinal embryonal tumors735.2f3975.30.1 (–2.5 to 2.7)8784.2–3.0 (–4.9 to –1.0)g16765.2–2.4 (–3.6 to –1.3)g48586.4–3.9 (–6.9 to –0.9)g
 III(d) Other gliomas604.3f2683.7–2.1 (–4.8 to 0.8)10314.9–1.3 (–6.0 to 3.6)13114.2–1.0 (–2.4 to 0.4)46586.0–1.3 (–4.4 to 1.8)
 III(e) Other specified intracranial/intraspinal neoplasms120.9f210.3f2221.1–1.5 (–3.7 to 0.7)1640.51.5 (–2.4 to 5.7)4750.60.2 (–1.8 to 2.3)
 III(f) Unspecified intracranial and intraspinal neoplasms80.6f230.3f1080.5f1320.4f3780.50.8 (–1.8 to 3.5)
IV Neuroblastoma and other peripheral nervous cell tumors936.7f5246.81.1 (–0.5 to 2.9)15407.3–0.5 (–1.6 to 0.6)19035.70.5 (–0.6 to 1.6)767110.30.6 (0.1 to 1.2)g
 IV(a) Neuroblastoma and ganglioneuroblastoma906.5f5156.71.2 (–0.4 to 3.0)14847.0–0.6 (–1.6 to 0.4)18395.40.5 (–0.6 to 1.6)747410.00.6 (0.1 to 1.1)g
 IV(b) Other peripheral nervous cell tumorshff90.1f560.3f640.2f1970.32.0 (–1.3 to 5.3)
V Retinoblastoma443.2f2613.41.0 (–1.4 to 3.6)7253.4–1.0 (–1.9 to –0.2)g11963.5–0.8 (–1.7 to 0.2)21212.9–0.5 (–2.6 to 1.7)
VI Renal tumors936.7f2833.7–0.1 (–2.4 to 2.3)18168.60.6 (–0.5 to 1.7)18085.50.8 (–0.4 to 2.1)53637.1–0.8 (–2.2 to 0.6)
 VI(a) Nephroblastoma and other nonepithelial renal tumors815.8f2463.2–0.8 (–3.4 to 1.8)15767.50.5 (–0.6 to 1.7)16575.00.7 (–0.5 to 1.9)48986.5–0.9 (–2.3 to 0.6)
 VI(b) Renal carcinomas110.8f320.4f2321.11.1 (–1.7 to 3.9)1420.5f4440.61.1 (–0.5 to 2.7)
 VI(c) Unspecified malignant renal tumorshffhff80.0f90.0f210.0f
VII Hepatic tumors412.9f2132.8–0.2 (–3.5 to 3.2)3931.92.8 (0.2 to 5.4)g9172.81.1 (–0.8 to 2.9)17692.31.4 (0.4 to 2.4)g
 VII(a) Hepatoblastoma352.5f1622.1f2751.34.2 (1.0 to 7.5)g7142.11.6 (–0.5 to 3.7)13001.71.5 (0.3 to 2.7)g
 VII(b) Hepatic carcinomas60.4f500.7f1100.5f1950.6f4510.61.2 (–0.7 to 3.2)
 VII(c) Unspecified malignant hepatic tumorshffhff80.0f80.0f180.0f
VIII Malignant bone tumors1137.9f5617.82.0 (–0.3 to 4.3)15297.1–0.4 (–1.2 to 0.4)25848.60.1 (–0.8 to 0.9)72799.20.6 (0.1 to 1.1)g
 VIII(a) Osteosarcomas614.2f3224.50.9 (–1.9 to 3.7)12125.6–0.6 (–1.6 to 0.5)15425.1–0.4 (–1.3 to 0.5)35824.50.3 (–0.3 to 1.0)
 VIII(b) Chondrosarcomashff140.2f600.3f860.3f2920.4–0.7 (–3.5 to 2.1)
 VIII(c) Ewing tumor and related sarcomas of bone402.8f1692.3f1240.6f7342.40.5 (–1.5 to 2.5)29183.70.9 (0.1 to 1.7)g
 VIII(d) Other specified malignant bone tumors70.5f460.6f760.4f1540.5f3560.51.2 (–1.7 to 4.1)
 VIII(e) Unspecified malignant bone tumorshff100.1f570.3f680.2f1310.2f
IX Soft tissue and other extraosseous sarcomas15410.8f6468.81.5 (–0.5 to 3.5)270212.60.1 (–0.9 to 1.1)344111.10.2 (–0.4 to 0.9)924111.8–0.2 (–0.6 to 0.3)
 IX(a) Rhabdomyosarcomas614.4f2483.31.9 (–0.2 to 4.1)10585.00.0 (–1.5 to 1.5)13394.2–0.3 (–1.6 to 1.1)35984.7–0.3 (–1.2 to 0.7)
 IX(b) Fibrosarcomas, peripheral nerve and other fibrous181.3f640.9f2741.3–2.0 (–4.5 to 0.6)3321.1–2.3 (–4.6 to 0.1)9661.2–0.5 (–2.5 to 1.4)
 IX(c) Kaposi sarcomahffhff380.2f130.0f100.0f
 IX(d) Other specified soft tissue sarcomas654.5f2623.62.0 (–1.3 to 5.5)10224.7–0.1 (–1.4 to 1.3)13914.60.7 (–0.2 to 1.7)36134.6–0.5 (–0.9 to –0.1)g
 IX(e) Unspecified soft tissue sarcomas100.7f711.0f3101.52.3 (–0.1 to 4.7)3661.22.6 (0.5 to 4.7)g10541.31.7 (–0.1 to 3.5)
X Germ cell tumors, trophoblastic tumors, and neoplasms of gonads1409.6f83811.4–0.2 (–1.4 to 1.1)13356.20.1 (–0.6 to 0.8)433814.40.8 (–0.3 to 1.9)869910.8–0.6 (–1.1 to 0.0)g
 X(a) Intracranial and intraspinal germ cell tumors141.0f2453.4–0.9 (–4.0 to 2.3)2271.14.2 (0.8 to 7.7)g5511.81.0 (–0.3 to 2.4)13211.70.7 (–0.8 to 2.2)
 X(b) Extracranial and extragonadal germ cell tumors181.3f1472.0–1.8 (–4.2 to 0.7)2741.3–0.9 (–2.8 to 1.0)4861.5–0.8 (–2.2 to 0.5)10351.4–0.3 (–2.0 to 1.5)
 X(c) Malignant gonadal germ cell tumors986.6f3975.40.0 (–1.9 to 2.0)6843.2–1.0 (–2.2 to 0.1)305410.21.1 (0.1 to 2.1)g57177.0–1.2 (–1.8 to –0.5)g
 X(d) Gonadal carcinomas70.5f410.6f520.2f1360.5f3680.51.4 (–1.0 to 4.0)
 X(e) Other and unspecified malignant gonadal tumorshff80.1f980.5f1110.4f2580.31.4 (–0.7 to 3.4)
XI Other malignant epithelial neoplasms and melanomas23916.34.1 (2.0 to 6.2)g113615.74.6 (3.3 to 6.0)g21319.81.4 (0.3 to 2.5)g470115.84.9 (4.2 to 5.7)g18 93423.32.4 (1.3 to 3.5)g
 XI(a) Adrenocortical carcinomashff120.2f190.1f630.2f1840.2f
 XI(b) Thyroid carcinomas1037.0f6899.56.0 (4.1 to 7.9)g6703.12.9 (1.2 to 4.7)g25858.75.1 (4.1 to 6.1)g821010.03.9 (3.2 to 4.7)g
 XI(c) Nasopharyngeal carcinomas100.7f530.73.9 (1.3 to 6.5)g3141.4–3.7 (–6.8 to –0.6)g1180.4f2400.3–1.6 (–3.9 to 0.8)
 XI(d) Malignant melanomas322.2f701.0f1090.5f4161.4–2.6 (–4.6 to –0.5)g53496.6–3.8 (–4.6 to –2.9)g
 XI(e) Skin carcinomashffhff240.1f160.1f670.1f
 XI(f) Other and unspecified carcinomas875.9f3074.23.9 (1.3 to 6.5)g9954.62.4 (0.6 to 4.1)g15035.15.8 (0.8 to 11.0)g48846.06.5 (4.3 to 8.8)g
XII Other and unspecified malignant neoplasms130.9f430.6f1950.9f2480.80.1 (–2.9 to 3.3)6380.80.5 (–1.3 to 2.3)
 XII(a) Other specified malignant tumors70.5f230.3f820.4f1200.4f3420.41.3 (–0.9 to 3.6)
 XII(b) Other unspecified malignant tumors60.4f200.3f1130.5f1280.4f2960.4–0.6 (–3.0 to 1.8)
Not classified by ICCC or in situ120.9f410.6f900.4f2030.6f4890.6f
a

Rates are per 1 million people and age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Source: US Cancer Statistics. AAPC = average annual percent change; CI = confidence interval; CNS = central nervous system; ICCC = International Classification of Childhood Cancer.

b

Cases included all malignant cancers.

c

Race and ethnicity results were categorized as White, Black, American Indian or Alaska Native, and Asian or Pacific Islander (all Non-Hispanic) and Hispanic or Latino (any race) (Hispanic).

d

Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003-2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Characteristic values with other, missing, or blank results are not included in this table.

e

Trends were measured with AAPC, and rates and were considered to increase or decrease if P <.05 (2-sided); otherwise, trends were considered stable. AAPC was not calculated if case count was <6 cases in any 1 year.

f

Statistic could not be calculated because of a low number of cases.

g

Trends were significant at P <.05.

h

Cell suppressed because there were <6 cases.

Increasing AAPCs were observed for 5 of the 12 ICCC categories: leukemias, lymphomas, hepatic tumors, malignant bone tumors, and other malignant neoplasms and melanoma. Rates for CNS neoplasms decreased overall during the study period (Table 2) but increased until 2017 (APC = 0.5%, 95% CI = 0.1 to 0.9), and then decreased (APC = –15.6%, 95% CI = –23.1 to –7.4) (data not shown). Within ICCC group XI (other malignant neoplasms and melanomas), rates increased for thyroid carcinoma (AAPC = 4.2%, 95% CI = 3.6 to 4.9) and decreased for melanomas (AAPC = –4.1%, 95% CI = –4.9 to –3.3).

Comparing trends in incidence rates by cancer type for males and females, lymphoma increased in males but not in females, whereas leukemia increased in females but not in males (Table 2 and Figure 3). By race and ethnicity, White children and adolescents were the only group to have increases in neuroblastoma and bone tumors and decreases in germ cell tumors, and Black children and adolescents were the only group to have decreases in retinoblastoma (Table 3 and Figure 4). Comparing trends in cancer incidence rates by age, among other findings, increases were seen in leukemia among those aged 5 to 19 years and lymphoma among those aged younger than 1 year and 10 to 19 years and decreases were seen in CNS neoplasms among children aged 0 to 4 years and those 5 to 9 years of age. Bone tumor rates increased among children aged 10 to 14 years (Table 4).

Trends of pediatric cancer incidence by ICCC group and sex for patients aged 0 to 19 years—United States, 2003-2019. A) I Leukemia, (B) II Lymphoma, (C) III CNS neoplasms, (D) IV Neuroblastoma, (E) V Retinoblastoma, (F) VI Renal, (G) VII Hepatic, (H) VIII Bone tumors, (I) IX Soft tissue sarcoma, (J) X germ cell, (K) XI(b) Thyroid, and (L) XI(d) Melanoma. Source: US Cancer Statistics. Rates are per 1 million people and age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Cases included all malignant cancers. Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003-2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Trends were estimated using joinpoint regression and measured with AAPC; they were considered to increase or decrease if P < .05 (2-sided); otherwise, trends were considered stable. *Indicates significant AAPC at P < .05. Markers depict observed rates, and lines represent fitted rates calculated by joinpoint regression. AAPC = average annual percent change; CNS = central nervous system; ICCC = International Classification of Childhood Cancer.
Figure 3.

Trends of pediatric cancer incidence by ICCC group and sex for patients aged 0 to 19 years—United States, 2003-2019. A) I Leukemia, (B) II Lymphoma, (C) III CNS neoplasms, (D) IV Neuroblastoma, (E) V Retinoblastoma, (F) VI Renal, (G) VII Hepatic, (H) VIII Bone tumors, (I) IX Soft tissue sarcoma, (J) X germ cell, (K) XI(b) Thyroid, and (L) XI(d) Melanoma. Source: US Cancer Statistics. Rates are per 1 million people and age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Cases included all malignant cancers. Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003-2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Trends were estimated using joinpoint regression and measured with AAPC; they were considered to increase or decrease if P < .05 (2-sided); otherwise, trends were considered stable. *Indicates significant AAPC at P < .05. Markers depict observed rates, and lines represent fitted rates calculated by joinpoint regression. AAPC = average annual percent change; CNS = central nervous system; ICCC = International Classification of Childhood Cancer.

Trends of pediatric cancer incidence by ICCC group and race and ethnicity for patients aged 0 to 19 years—United States, 2003-2019. A) I Leukemia, (B) II Lymphoma, (C) III CNS neoplasms, (D) IV Neuroblastoma, (E) V Retinoblastoma, (F) VI Renal, (G) VII Hepatic, (H) VIII Bone tumors, (I) IX Soft tissue sarcoma, (J) X germ cell, (K) XI(b) Thyroid, and (L) XI(d) Melanoma. Source: US Cancer Statistics. Rates are per 1 million people and age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Cases included all malignant cancers. Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003-2019 (covering 99.1% of the US population). Race and ethnicity were classified as Non-Hispanic American Indian or Alaska Native, Non-Hispanic Asian or Pacific Islander, Non-Hispanic Black (Black), Non-Hispanic White (White), and Hispanic or Latino (any race) (Hispanic). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Markers depict observed rates, and lines represent fitted rates calculated by joinpoint regression. Trends were calculated only if there were 6 or more cases in each calendar year during 2003 to 2019. CNS = central nervous system; ICCC = International Classification of Childhood Cancer.
Figure 4.

Trends of pediatric cancer incidence by ICCC group and race and ethnicity for patients aged 0 to 19 years—United States, 2003-2019. A) I Leukemia, (B) II Lymphoma, (C) III CNS neoplasms, (D) IV Neuroblastoma, (E) V Retinoblastoma, (F) VI Renal, (G) VII Hepatic, (H) VIII Bone tumors, (I) IX Soft tissue sarcoma, (J) X germ cell, (K) XI(b) Thyroid, and (L) XI(d) Melanoma. Source: US Cancer Statistics. Rates are per 1 million people and age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Cases included all malignant cancers. Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003-2019 (covering 99.1% of the US population). Race and ethnicity were classified as Non-Hispanic American Indian or Alaska Native, Non-Hispanic Asian or Pacific Islander, Non-Hispanic Black (Black), Non-Hispanic White (White), and Hispanic or Latino (any race) (Hispanic). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Markers depict observed rates, and lines represent fitted rates calculated by joinpoint regression. Trends were calculated only if there were 6 or more cases in each calendar year during 2003 to 2019. CNS = central nervous system; ICCC = International Classification of Childhood Cancer.

Table 4.

Age-adjusted and age-specific incidence ratea of invasive cancer,b ages 0 to 19 years, and average annual percent change between rates, by International Classification of Childhood Cancer group and age group—United States,c 2003-2019

Age <1 y
Age 0 to 4 y
Age 5-9 y
Age 10-14 y
Age 15-19 y
ICCC groupNo.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)
I Leukemias, myeloproliferative diseases, and myelodysplastic diseases338150.6–0.5 (–1.2 to 0.3)27 68082.4–0.1 (–0.6 to 0.3)14 08741.60.5 (0.1 to 0.9)e11 12731.71.1 (0.5 to 1.7)e11 68132.30.9 (0.5 to 1.3)e
 I(a) Lymphoid leukemias124718.7–1.3 (–2.3 to –0.4)e21 55564.1–0.1 (–0.6 to 0.4)11 66834.50.5 (–0.1 to 1.0)743221.21.4 (0.7 to 2.1)e603216.71.1 (0.4 to 1.8)e
 I(b) Acute myeloid leukemias115417.30.1 (–1.0 to 1.1)380211.3–0.2 (–0.8 to 0.4)13814.1–0.4 (–1.3 to 0.5)22466.4–0.2 (–1.2 to 0.7)30458.4–0.3 (–1.4 to 0.8)
 I(c) Chronic myeloproliferative diseases3284.90.1 (–4.6 to 5.0)6301.9–0.2 (–3.8 to 3.5)3591.1–3.9 (–8.0 to 0.3)7222.10.2 (–1.7 to 2.1)17294.81.0 (0.2 to 1.8)e
 I(d) Myelodysplastic syndrome and other myeloproliferative diseases4366.50.2 (–2.9 to 3.5)9322.8–1.8 (–2.7 to –0.9)e2500.7–1.5 (–4.4 to 1.4)2950.8–1.0 (–3.8 to 2.0)4081.10.5 (–1.9 to 3.0)
 I(e) Unspecified and other specified leukemias2163.2–1.6 (–3.5 to 0.4)7612.32.4 (0.9 to 3.9)e4291.36.7 (4.2 to 9.3)e4321.25.4 (3.0 to 7.9)e4671.33.3 (1.5 to 5.1)e
II Lymphomas and reticuloendothelial neoplasms110516.57.2 (4.4 to 10.1)e470714.02.5 (–1.1 to 6.2)579317.11.6 (0.0 to 3.3)947427.01.8 (1.2 to 2.4)e18 33450.70.4 (0.1 to 0.8)e
 II(a) Hodgkin lymphomasfgg2550.8g13243.9–0.7 (–2.0 to 0.6)425112.10.3 (–0.4 to 1.0)11 48931.8–0.1 (–0.4 to 0.1)
 II(b) Non-Hodgkin lymphomas (except Burkitt lymphoma)1792.7g14264.20.7 (–0.4 to 1.8)23577.01.5 (0.5 to 2.5)e34249.81.5 (0.5 to 2.5)e539314.90.9 (0.0 to 1.8)e
 II(c) Burkitt lymphoma70.1g5631.7–0.6 (–2.1 to 0.9)10343.1–1.0 (–2.1 to 0.2)9492.70.2 (–1.2 to 1.5)7842.2–0.3 (–1.5 to 0.8)
 II(d) Miscellaneous lymphoreticular neoplasms90413.58.8 (4.6 to 13.2)e24167.27.0 (–1.0 to 15.6)10073.013.9 (0.9 to 28.6)e7562.2g4221.2g
 II(e) Unspecified lymphomas120.2g470.1g710.2g940.3g2460.70.9 (–1.9 to 3.7)
III CNS and miscellaneous intracranial and intraspinal neoplasms227134.0–1.2 (–2.4 to 0.1)14 01541.7–2.2 (–3.8 to –0.5)e11 47133.9–2.0 (–3.3 to –0.7)e935626.6–0.8 (–2.7 to 1.0)778821.6–1.3 (–4.0 to 1.3)
 III(a) Ependymomas and choroid plexus tumor3234.8–1.0 (–3.7 to 1.7)17295.20.4 (–1.1 to 2.0)7302.2–0.7 (–2.6 to 1.3)5831.71.2 (–0.7 to 3.1)5761.6–2.2 (–3.8 to –0.6)e
 III(b) Astrocytomas87813.1–1.5 (–3.6 to 0.6)663119.7–2.3 (–4.1 to –0.5)e569416.8–0.5 (–2.0 to 1.1)523414.9–0.1 (–1.7 to 1.5)445612.30.0 (–1.0 to 1.0)
 III(c) Intracranial and intraspinal embryonal tumors74111.1–1.4 (–3.5 to 0.6)348510.4–2.5 (–5.6 to 0.7)23306.9–3.4 (–6.7 to 0.1)13523.9–3.6 (–9.2 to 2.4)8092.2–3.0 (–5.3 to –0.6)e
 III(d) Other gliomas1832.7g16965.10.2 (–2.7 to 3.2)23557.0–2.5 (–7.0 to 2.3)18315.21.2 (–0.2 to 2.5)15664.30.8 (–0.9 to 2.4)
 III(e) Other specified intracranial/intraspinal neoplasms580.9g2550.80.1 (–2.9 to 3.1)2140.6–1.5 (–4.2 to 1.2)2040.6g2350.7–2.4 (–11.6 to 7.8)
 III(f) Unspecified intracranial and intraspinal neoplasms881.3g2190.70.9 (–2.4 to 4.3)1480.4g1520.40.2 (–3.3 to 3.8)1460.4g
IV Neuroblastoma and other peripheral nervous cell tumors396159.30.1 (–0.6 to 0.8)975829.10.0 (–0.5 to 0.5)13524.01.5 (–1.0 to 4.0)4781.40.6 (–1.4 to 2.6)3190.93.0 (0.9 to 5.2)e
 IV(a) Neuroblastoma and ganglioneuroblastoma394959.10.1 (–0.6 to 0.8)971329.00.0 (–0.5 to 0.6)13173.92.4 (1.2 to 3.7)e3761.10.4 (–2.0 to 2.8)1690.5g
 IV(b) Other peripheral nervous cell tumors120.2g450.1g350.1g1020.3g1500.4g
V Retinoblastoma199229.80.6 (–0.4 to 1.6)424212.7–0.3 (–1.4 to 0.7)1500.4g250.1g70.0g
VI Renal tumors105715.8–0.5 (–1.9 to 0.9)639419.0–0.9 (–1.8 to 0.0)19585.81.4 (0.3 to 2.5)e5111.51.8 (0.2 to 3.5)e6431.81.3 (–0.5 to 3.0)
 VI(a) Nephroblastoma and other nonepithelial renal tumors104215.6−0.7 (-2.0 to 0.7)634218.9–0.9 (–1.8 to 0.0)e18415.41.7 (0.5 to 2.8)e2760.82.0 (–0.8 to 4.9)1240.3g
 VI(b) Renal carcinomas80.1g290.1g1060.3g2290.71.4 (–0.9 to 3.8)5111.42.2 (–0.2 to 4.6)
 VI(c) Unspecified malignant renal tumors70.1g230.1g110.0g60.0g80.0g
VII Hepatic tumors86412.91.7 (0.1 to 3.4)e23797.11.7 (0.6 to 2.7)e2590.83.3 (1.3 to 5.3)e2880.80.4 (–2.5 to 3.4)4561.30.3 (–1.8 to 2.4)
 VII(a) Hepatoblastoma83912.61.9 (0.3 to 3.6)e22926.81.8 (0.7 to 2.9)e1500.4g660.2g140.0g
 VII(b) Hepatic carcinomas150.2g720.2g1010.3g2140.6g4351.20.1 (–1.9 to 2.2)
 VII(c) Unspecified malignant hepatic tumors100.2g150.0g80.0g80.0g70.0g
VIII Malignant bone tumors590.9g5111.50.6 (–1.5 to 2.8)19395.71.0 (0.0 to 2.1)473513.51.1 (0.5 to 1.6)e502813.9–0.4 (–1.0 to 0.2)
 VIII(a) Osteosarcomasfgg980.3g10103.00.5 (–0.6 to 1.7)28388.11.2 (0.4 to 2.1)e28467.9–1.1 (–1.9 to –0.2)e
 VIII(b) Chondrosarcomasfgg90.0g310.1g1440.4g2790.8–0.3 (–3.5 to 2.9)
 VIII(c) Ewing tumor and related sarcomas of bone360.5g3191.00.9 (–1.9 to 3.7)7522.21.4 (–0.6 to 3.4)14654.20.8 (0.1 to 1.4)e14954.10.5 (–0.7 to 1.8)
 VIII(d) Other specified malignant bone tumors80.1g520.2g1050.3g2010.6g2930.8–0.5 (–2.9 to 2.0)
 VIII(e) Unspecified malignant bone tumors100.2g330.1g410.1g870.3g1150.3g
IX Soft tissue and other extraosseous sarcomas118717.80.3 (–0.9 to 1.6)412312.30.5 (–0.2 to 1.2)27868.2–0.1 (–0.9 to 0.7)405211.50.2 (–0.4 to 0.9)549615.2–0.3 (–1.0 to 0.5)
 IX(a) Rhabdomyosarcomas3705.50.3 (–1.5 to 2.2)24177.20.3 (–0.6 to 1.3)14774.4–0.6 (–1.7 to 0.5)12573.60.1 (–1.2 to 1.5)12303.4–0.6 (–2.0 to 0.9)
 IX(b) Fibrosarcomas, peripheral nerve and other fibrous3294.90.0 (–3.0 to 3.1)4691.40.2 (–2.1 to 2.5)1940.6–1.2 (–4.1 to 1.9)3971.1–1.6 (–3.5 to 0.3)6341.8–1.2 (–3.4 to 1.0)
 IX(d) Other specified soft tissue sarcomash3565.30 (–2.3 to 2.2)9332.80.9 (–0.7 to 2.6)8302.50.2 (–1.4 to 1.9)18685.30.1 (–0.8 to 1.0)29138.1–0.4 (–1.3 to 0.6)
 IX(e) Unspecified soft tissue sarcomas1322.0g3040.90.3 (–3.4 to 4.3)2850.81.9 (–0.5 to 4.4)5301.52.4 (0.6 to 4.3)e7192.01.7 (0.0 to 3.3)
X Germ cell tumors, trophoblastic tumors, and neoplasms of gonads129919.4–0.3 (–1.7 to 1.2)21816.5–0.1 (–1.0 to 0.8)8522.51.2 (–0.4 to 2.9)26097.40.7 (–0.2 to 1.6)990727.4–0.3 (–1.5 to 0.9)
 X(a) Intracranial and intraspinal germ cell tumors1352.0g2060.61.2 (–3.1 to 5.7)3931.21.7 (–1.1 to 4.5)9272.61.2 (–0.2 to 2.5)8532.40.8 (–0.4 to 2.0)
 X(b) Extracranial and extragonadal germ cell tumors86913.00.2 (–1.3 to 1.7)12763.8–0.1 (–1.2 to 1.0)410.1g1170.3g5661.6–0.2 (–2.4 to 2.0)
 X(c) Malignant gonadal germ cell tumors2814.2–1.6 (–6.5 to 3.4)6692.0–1.0 (–3.4 to 1.4)3611.10.5 (–1.7 to 2.7)13593.90.5 (–0.6 to 1.6)768321.3–0.3 (–1.1 to 0.5)
 X(d) Gonadal carcinomasfgg60.0g130.0g920.3g4981.41.0 (–1.2 to 3.3)
 X(e) Other and unspecified malignant gonadal tumors120.2g240.1g440.1g1140.3g3070.90.5 (–1.7 to 2.7)
XI Other malignant epithelial neoplasms and melanomas3064.65.9 (2.5 to 9.5)e7922.42.3 (0.5 to 4.1)e14684.31.3 (–0.3 to 2.8)590316.83.6 (2.4 to 4.8)e19 61954.32.4 (1.2 to 3.7)e
 XI(a) Adrenocortical carcinomas310.5g1270.4g270.1g480.1g860.2g
 XI(b) Thyroid carcinomas180.3g880.3g4591.41.1 (–1.6 to 3.9)25377.23.8 (2.9 to 4.7)e937525.94.5 (3.8 to 5.2)e
 XI(c) Nasopharyngeal carcinomasfggfgg270.1g2320.7g4851.3–1.1 (–3.5 to 1.3)
 XI(d) Malignant melanomas1672.5g4431.32.2 (0.0 to 4.5)e4971.5–0.8 (–8.7 to 7.8)10713.1–3.4 (–4.9 to –1.9)e423611.7–5.4 (–6.2 to –4.6)e
 XI(e) Skin carcinomasfggfgg110.0g390.1g650.2g
 XI(f) Other and unspecified carcinomas881.3g1310.4g4471.34.5 (2.0 to 7.1)e19765.67.1 (3.9 to 10.4)e537214.95.0 (2.7 to 7.3)e
XII Other and unspecified malignant neoplasms1542.3g4411.32.7 (0.4 to 5.2)e1060.3g1790.5g4421.2–1.4 (–3.9 to 1.2)
 XII(a) Other specified malignant tumors781.2g2910.94.0 (1.2 to 6.8)e350.1g740.2g1790.5g
 XII(b) Other unspecified malignant tumors761.1g1500.5g710.2g1050.3g2630.7–1.9 (–4.8 to 1.0)
Not classified by ICCC or in situ540.8g2540.8g2340.7g1670.5g1930.5g
Age <1 y
Age 0 to 4 y
Age 5-9 y
Age 10-14 y
Age 15-19 y
ICCC groupNo.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)
I Leukemias, myeloproliferative diseases, and myelodysplastic diseases338150.6–0.5 (–1.2 to 0.3)27 68082.4–0.1 (–0.6 to 0.3)14 08741.60.5 (0.1 to 0.9)e11 12731.71.1 (0.5 to 1.7)e11 68132.30.9 (0.5 to 1.3)e
 I(a) Lymphoid leukemias124718.7–1.3 (–2.3 to –0.4)e21 55564.1–0.1 (–0.6 to 0.4)11 66834.50.5 (–0.1 to 1.0)743221.21.4 (0.7 to 2.1)e603216.71.1 (0.4 to 1.8)e
 I(b) Acute myeloid leukemias115417.30.1 (–1.0 to 1.1)380211.3–0.2 (–0.8 to 0.4)13814.1–0.4 (–1.3 to 0.5)22466.4–0.2 (–1.2 to 0.7)30458.4–0.3 (–1.4 to 0.8)
 I(c) Chronic myeloproliferative diseases3284.90.1 (–4.6 to 5.0)6301.9–0.2 (–3.8 to 3.5)3591.1–3.9 (–8.0 to 0.3)7222.10.2 (–1.7 to 2.1)17294.81.0 (0.2 to 1.8)e
 I(d) Myelodysplastic syndrome and other myeloproliferative diseases4366.50.2 (–2.9 to 3.5)9322.8–1.8 (–2.7 to –0.9)e2500.7–1.5 (–4.4 to 1.4)2950.8–1.0 (–3.8 to 2.0)4081.10.5 (–1.9 to 3.0)
 I(e) Unspecified and other specified leukemias2163.2–1.6 (–3.5 to 0.4)7612.32.4 (0.9 to 3.9)e4291.36.7 (4.2 to 9.3)e4321.25.4 (3.0 to 7.9)e4671.33.3 (1.5 to 5.1)e
II Lymphomas and reticuloendothelial neoplasms110516.57.2 (4.4 to 10.1)e470714.02.5 (–1.1 to 6.2)579317.11.6 (0.0 to 3.3)947427.01.8 (1.2 to 2.4)e18 33450.70.4 (0.1 to 0.8)e
 II(a) Hodgkin lymphomasfgg2550.8g13243.9–0.7 (–2.0 to 0.6)425112.10.3 (–0.4 to 1.0)11 48931.8–0.1 (–0.4 to 0.1)
 II(b) Non-Hodgkin lymphomas (except Burkitt lymphoma)1792.7g14264.20.7 (–0.4 to 1.8)23577.01.5 (0.5 to 2.5)e34249.81.5 (0.5 to 2.5)e539314.90.9 (0.0 to 1.8)e
 II(c) Burkitt lymphoma70.1g5631.7–0.6 (–2.1 to 0.9)10343.1–1.0 (–2.1 to 0.2)9492.70.2 (–1.2 to 1.5)7842.2–0.3 (–1.5 to 0.8)
 II(d) Miscellaneous lymphoreticular neoplasms90413.58.8 (4.6 to 13.2)e24167.27.0 (–1.0 to 15.6)10073.013.9 (0.9 to 28.6)e7562.2g4221.2g
 II(e) Unspecified lymphomas120.2g470.1g710.2g940.3g2460.70.9 (–1.9 to 3.7)
III CNS and miscellaneous intracranial and intraspinal neoplasms227134.0–1.2 (–2.4 to 0.1)14 01541.7–2.2 (–3.8 to –0.5)e11 47133.9–2.0 (–3.3 to –0.7)e935626.6–0.8 (–2.7 to 1.0)778821.6–1.3 (–4.0 to 1.3)
 III(a) Ependymomas and choroid plexus tumor3234.8–1.0 (–3.7 to 1.7)17295.20.4 (–1.1 to 2.0)7302.2–0.7 (–2.6 to 1.3)5831.71.2 (–0.7 to 3.1)5761.6–2.2 (–3.8 to –0.6)e
 III(b) Astrocytomas87813.1–1.5 (–3.6 to 0.6)663119.7–2.3 (–4.1 to –0.5)e569416.8–0.5 (–2.0 to 1.1)523414.9–0.1 (–1.7 to 1.5)445612.30.0 (–1.0 to 1.0)
 III(c) Intracranial and intraspinal embryonal tumors74111.1–1.4 (–3.5 to 0.6)348510.4–2.5 (–5.6 to 0.7)23306.9–3.4 (–6.7 to 0.1)13523.9–3.6 (–9.2 to 2.4)8092.2–3.0 (–5.3 to –0.6)e
 III(d) Other gliomas1832.7g16965.10.2 (–2.7 to 3.2)23557.0–2.5 (–7.0 to 2.3)18315.21.2 (–0.2 to 2.5)15664.30.8 (–0.9 to 2.4)
 III(e) Other specified intracranial/intraspinal neoplasms580.9g2550.80.1 (–2.9 to 3.1)2140.6–1.5 (–4.2 to 1.2)2040.6g2350.7–2.4 (–11.6 to 7.8)
 III(f) Unspecified intracranial and intraspinal neoplasms881.3g2190.70.9 (–2.4 to 4.3)1480.4g1520.40.2 (–3.3 to 3.8)1460.4g
IV Neuroblastoma and other peripheral nervous cell tumors396159.30.1 (–0.6 to 0.8)975829.10.0 (–0.5 to 0.5)13524.01.5 (–1.0 to 4.0)4781.40.6 (–1.4 to 2.6)3190.93.0 (0.9 to 5.2)e
 IV(a) Neuroblastoma and ganglioneuroblastoma394959.10.1 (–0.6 to 0.8)971329.00.0 (–0.5 to 0.6)13173.92.4 (1.2 to 3.7)e3761.10.4 (–2.0 to 2.8)1690.5g
 IV(b) Other peripheral nervous cell tumors120.2g450.1g350.1g1020.3g1500.4g
V Retinoblastoma199229.80.6 (–0.4 to 1.6)424212.7–0.3 (–1.4 to 0.7)1500.4g250.1g70.0g
VI Renal tumors105715.8–0.5 (–1.9 to 0.9)639419.0–0.9 (–1.8 to 0.0)19585.81.4 (0.3 to 2.5)e5111.51.8 (0.2 to 3.5)e6431.81.3 (–0.5 to 3.0)
 VI(a) Nephroblastoma and other nonepithelial renal tumors104215.6−0.7 (-2.0 to 0.7)634218.9–0.9 (–1.8 to 0.0)e18415.41.7 (0.5 to 2.8)e2760.82.0 (–0.8 to 4.9)1240.3g
 VI(b) Renal carcinomas80.1g290.1g1060.3g2290.71.4 (–0.9 to 3.8)5111.42.2 (–0.2 to 4.6)
 VI(c) Unspecified malignant renal tumors70.1g230.1g110.0g60.0g80.0g
VII Hepatic tumors86412.91.7 (0.1 to 3.4)e23797.11.7 (0.6 to 2.7)e2590.83.3 (1.3 to 5.3)e2880.80.4 (–2.5 to 3.4)4561.30.3 (–1.8 to 2.4)
 VII(a) Hepatoblastoma83912.61.9 (0.3 to 3.6)e22926.81.8 (0.7 to 2.9)e1500.4g660.2g140.0g
 VII(b) Hepatic carcinomas150.2g720.2g1010.3g2140.6g4351.20.1 (–1.9 to 2.2)
 VII(c) Unspecified malignant hepatic tumors100.2g150.0g80.0g80.0g70.0g
VIII Malignant bone tumors590.9g5111.50.6 (–1.5 to 2.8)19395.71.0 (0.0 to 2.1)473513.51.1 (0.5 to 1.6)e502813.9–0.4 (–1.0 to 0.2)
 VIII(a) Osteosarcomasfgg980.3g10103.00.5 (–0.6 to 1.7)28388.11.2 (0.4 to 2.1)e28467.9–1.1 (–1.9 to –0.2)e
 VIII(b) Chondrosarcomasfgg90.0g310.1g1440.4g2790.8–0.3 (–3.5 to 2.9)
 VIII(c) Ewing tumor and related sarcomas of bone360.5g3191.00.9 (–1.9 to 3.7)7522.21.4 (–0.6 to 3.4)14654.20.8 (0.1 to 1.4)e14954.10.5 (–0.7 to 1.8)
 VIII(d) Other specified malignant bone tumors80.1g520.2g1050.3g2010.6g2930.8–0.5 (–2.9 to 2.0)
 VIII(e) Unspecified malignant bone tumors100.2g330.1g410.1g870.3g1150.3g
IX Soft tissue and other extraosseous sarcomas118717.80.3 (–0.9 to 1.6)412312.30.5 (–0.2 to 1.2)27868.2–0.1 (–0.9 to 0.7)405211.50.2 (–0.4 to 0.9)549615.2–0.3 (–1.0 to 0.5)
 IX(a) Rhabdomyosarcomas3705.50.3 (–1.5 to 2.2)24177.20.3 (–0.6 to 1.3)14774.4–0.6 (–1.7 to 0.5)12573.60.1 (–1.2 to 1.5)12303.4–0.6 (–2.0 to 0.9)
 IX(b) Fibrosarcomas, peripheral nerve and other fibrous3294.90.0 (–3.0 to 3.1)4691.40.2 (–2.1 to 2.5)1940.6–1.2 (–4.1 to 1.9)3971.1–1.6 (–3.5 to 0.3)6341.8–1.2 (–3.4 to 1.0)
 IX(d) Other specified soft tissue sarcomash3565.30 (–2.3 to 2.2)9332.80.9 (–0.7 to 2.6)8302.50.2 (–1.4 to 1.9)18685.30.1 (–0.8 to 1.0)29138.1–0.4 (–1.3 to 0.6)
 IX(e) Unspecified soft tissue sarcomas1322.0g3040.90.3 (–3.4 to 4.3)2850.81.9 (–0.5 to 4.4)5301.52.4 (0.6 to 4.3)e7192.01.7 (0.0 to 3.3)
X Germ cell tumors, trophoblastic tumors, and neoplasms of gonads129919.4–0.3 (–1.7 to 1.2)21816.5–0.1 (–1.0 to 0.8)8522.51.2 (–0.4 to 2.9)26097.40.7 (–0.2 to 1.6)990727.4–0.3 (–1.5 to 0.9)
 X(a) Intracranial and intraspinal germ cell tumors1352.0g2060.61.2 (–3.1 to 5.7)3931.21.7 (–1.1 to 4.5)9272.61.2 (–0.2 to 2.5)8532.40.8 (–0.4 to 2.0)
 X(b) Extracranial and extragonadal germ cell tumors86913.00.2 (–1.3 to 1.7)12763.8–0.1 (–1.2 to 1.0)410.1g1170.3g5661.6–0.2 (–2.4 to 2.0)
 X(c) Malignant gonadal germ cell tumors2814.2–1.6 (–6.5 to 3.4)6692.0–1.0 (–3.4 to 1.4)3611.10.5 (–1.7 to 2.7)13593.90.5 (–0.6 to 1.6)768321.3–0.3 (–1.1 to 0.5)
 X(d) Gonadal carcinomasfgg60.0g130.0g920.3g4981.41.0 (–1.2 to 3.3)
 X(e) Other and unspecified malignant gonadal tumors120.2g240.1g440.1g1140.3g3070.90.5 (–1.7 to 2.7)
XI Other malignant epithelial neoplasms and melanomas3064.65.9 (2.5 to 9.5)e7922.42.3 (0.5 to 4.1)e14684.31.3 (–0.3 to 2.8)590316.83.6 (2.4 to 4.8)e19 61954.32.4 (1.2 to 3.7)e
 XI(a) Adrenocortical carcinomas310.5g1270.4g270.1g480.1g860.2g
 XI(b) Thyroid carcinomas180.3g880.3g4591.41.1 (–1.6 to 3.9)25377.23.8 (2.9 to 4.7)e937525.94.5 (3.8 to 5.2)e
 XI(c) Nasopharyngeal carcinomasfggfgg270.1g2320.7g4851.3–1.1 (–3.5 to 1.3)
 XI(d) Malignant melanomas1672.5g4431.32.2 (0.0 to 4.5)e4971.5–0.8 (–8.7 to 7.8)10713.1–3.4 (–4.9 to –1.9)e423611.7–5.4 (–6.2 to –4.6)e
 XI(e) Skin carcinomasfggfgg110.0g390.1g650.2g
 XI(f) Other and unspecified carcinomas881.3g1310.4g4471.34.5 (2.0 to 7.1)e19765.67.1 (3.9 to 10.4)e537214.95.0 (2.7 to 7.3)e
XII Other and unspecified malignant neoplasms1542.3g4411.32.7 (0.4 to 5.2)e1060.3g1790.5g4421.2–1.4 (–3.9 to 1.2)
 XII(a) Other specified malignant tumors781.2g2910.94.0 (1.2 to 6.8)e350.1g740.2g1790.5g
 XII(b) Other unspecified malignant tumors761.1g1500.5g710.2g1050.3g2630.7–1.9 (–4.8 to 1.0)
Not classified by ICCC or in situ540.8g2540.8g2340.7g1670.5g1930.5g
a

Rates are per 1 million people. Rates for ages <1 year, 5-9 years, 10-14 years, and 15-19 years are age specific, and the rates for ages 0 to 4 years are age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Source: US Cancer Statistics. AAPC = average annual percent change; CI = confidence interval; CNS = central nervous system; ICCC = International Classification of Childhood Cancer.

b

Cases included all malignant cancers.

c

Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003-2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Characteristic values with other, missing, or blank results are not included in this table.

d

Trends were measured with AAPC, and rates and were considered to increase or decrease if P <.05 (2-sided); otherwise, trends were considered stable. AAPC was not calculated if case count was <6 cases in any 1 year.

e

Trends were significant at P <.05.

f

Cell suppressed because there were <6 cases.

g

Statistic could not be calculated because of the low number of cases.

h

Includes IX(c) Kaposi sarcoma because of US Cancer Statistics complementary cell-suppression rules.

Table 4.

Age-adjusted and age-specific incidence ratea of invasive cancer,b ages 0 to 19 years, and average annual percent change between rates, by International Classification of Childhood Cancer group and age group—United States,c 2003-2019

Age <1 y
Age 0 to 4 y
Age 5-9 y
Age 10-14 y
Age 15-19 y
ICCC groupNo.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)
I Leukemias, myeloproliferative diseases, and myelodysplastic diseases338150.6–0.5 (–1.2 to 0.3)27 68082.4–0.1 (–0.6 to 0.3)14 08741.60.5 (0.1 to 0.9)e11 12731.71.1 (0.5 to 1.7)e11 68132.30.9 (0.5 to 1.3)e
 I(a) Lymphoid leukemias124718.7–1.3 (–2.3 to –0.4)e21 55564.1–0.1 (–0.6 to 0.4)11 66834.50.5 (–0.1 to 1.0)743221.21.4 (0.7 to 2.1)e603216.71.1 (0.4 to 1.8)e
 I(b) Acute myeloid leukemias115417.30.1 (–1.0 to 1.1)380211.3–0.2 (–0.8 to 0.4)13814.1–0.4 (–1.3 to 0.5)22466.4–0.2 (–1.2 to 0.7)30458.4–0.3 (–1.4 to 0.8)
 I(c) Chronic myeloproliferative diseases3284.90.1 (–4.6 to 5.0)6301.9–0.2 (–3.8 to 3.5)3591.1–3.9 (–8.0 to 0.3)7222.10.2 (–1.7 to 2.1)17294.81.0 (0.2 to 1.8)e
 I(d) Myelodysplastic syndrome and other myeloproliferative diseases4366.50.2 (–2.9 to 3.5)9322.8–1.8 (–2.7 to –0.9)e2500.7–1.5 (–4.4 to 1.4)2950.8–1.0 (–3.8 to 2.0)4081.10.5 (–1.9 to 3.0)
 I(e) Unspecified and other specified leukemias2163.2–1.6 (–3.5 to 0.4)7612.32.4 (0.9 to 3.9)e4291.36.7 (4.2 to 9.3)e4321.25.4 (3.0 to 7.9)e4671.33.3 (1.5 to 5.1)e
II Lymphomas and reticuloendothelial neoplasms110516.57.2 (4.4 to 10.1)e470714.02.5 (–1.1 to 6.2)579317.11.6 (0.0 to 3.3)947427.01.8 (1.2 to 2.4)e18 33450.70.4 (0.1 to 0.8)e
 II(a) Hodgkin lymphomasfgg2550.8g13243.9–0.7 (–2.0 to 0.6)425112.10.3 (–0.4 to 1.0)11 48931.8–0.1 (–0.4 to 0.1)
 II(b) Non-Hodgkin lymphomas (except Burkitt lymphoma)1792.7g14264.20.7 (–0.4 to 1.8)23577.01.5 (0.5 to 2.5)e34249.81.5 (0.5 to 2.5)e539314.90.9 (0.0 to 1.8)e
 II(c) Burkitt lymphoma70.1g5631.7–0.6 (–2.1 to 0.9)10343.1–1.0 (–2.1 to 0.2)9492.70.2 (–1.2 to 1.5)7842.2–0.3 (–1.5 to 0.8)
 II(d) Miscellaneous lymphoreticular neoplasms90413.58.8 (4.6 to 13.2)e24167.27.0 (–1.0 to 15.6)10073.013.9 (0.9 to 28.6)e7562.2g4221.2g
 II(e) Unspecified lymphomas120.2g470.1g710.2g940.3g2460.70.9 (–1.9 to 3.7)
III CNS and miscellaneous intracranial and intraspinal neoplasms227134.0–1.2 (–2.4 to 0.1)14 01541.7–2.2 (–3.8 to –0.5)e11 47133.9–2.0 (–3.3 to –0.7)e935626.6–0.8 (–2.7 to 1.0)778821.6–1.3 (–4.0 to 1.3)
 III(a) Ependymomas and choroid plexus tumor3234.8–1.0 (–3.7 to 1.7)17295.20.4 (–1.1 to 2.0)7302.2–0.7 (–2.6 to 1.3)5831.71.2 (–0.7 to 3.1)5761.6–2.2 (–3.8 to –0.6)e
 III(b) Astrocytomas87813.1–1.5 (–3.6 to 0.6)663119.7–2.3 (–4.1 to –0.5)e569416.8–0.5 (–2.0 to 1.1)523414.9–0.1 (–1.7 to 1.5)445612.30.0 (–1.0 to 1.0)
 III(c) Intracranial and intraspinal embryonal tumors74111.1–1.4 (–3.5 to 0.6)348510.4–2.5 (–5.6 to 0.7)23306.9–3.4 (–6.7 to 0.1)13523.9–3.6 (–9.2 to 2.4)8092.2–3.0 (–5.3 to –0.6)e
 III(d) Other gliomas1832.7g16965.10.2 (–2.7 to 3.2)23557.0–2.5 (–7.0 to 2.3)18315.21.2 (–0.2 to 2.5)15664.30.8 (–0.9 to 2.4)
 III(e) Other specified intracranial/intraspinal neoplasms580.9g2550.80.1 (–2.9 to 3.1)2140.6–1.5 (–4.2 to 1.2)2040.6g2350.7–2.4 (–11.6 to 7.8)
 III(f) Unspecified intracranial and intraspinal neoplasms881.3g2190.70.9 (–2.4 to 4.3)1480.4g1520.40.2 (–3.3 to 3.8)1460.4g
IV Neuroblastoma and other peripheral nervous cell tumors396159.30.1 (–0.6 to 0.8)975829.10.0 (–0.5 to 0.5)13524.01.5 (–1.0 to 4.0)4781.40.6 (–1.4 to 2.6)3190.93.0 (0.9 to 5.2)e
 IV(a) Neuroblastoma and ganglioneuroblastoma394959.10.1 (–0.6 to 0.8)971329.00.0 (–0.5 to 0.6)13173.92.4 (1.2 to 3.7)e3761.10.4 (–2.0 to 2.8)1690.5g
 IV(b) Other peripheral nervous cell tumors120.2g450.1g350.1g1020.3g1500.4g
V Retinoblastoma199229.80.6 (–0.4 to 1.6)424212.7–0.3 (–1.4 to 0.7)1500.4g250.1g70.0g
VI Renal tumors105715.8–0.5 (–1.9 to 0.9)639419.0–0.9 (–1.8 to 0.0)19585.81.4 (0.3 to 2.5)e5111.51.8 (0.2 to 3.5)e6431.81.3 (–0.5 to 3.0)
 VI(a) Nephroblastoma and other nonepithelial renal tumors104215.6−0.7 (-2.0 to 0.7)634218.9–0.9 (–1.8 to 0.0)e18415.41.7 (0.5 to 2.8)e2760.82.0 (–0.8 to 4.9)1240.3g
 VI(b) Renal carcinomas80.1g290.1g1060.3g2290.71.4 (–0.9 to 3.8)5111.42.2 (–0.2 to 4.6)
 VI(c) Unspecified malignant renal tumors70.1g230.1g110.0g60.0g80.0g
VII Hepatic tumors86412.91.7 (0.1 to 3.4)e23797.11.7 (0.6 to 2.7)e2590.83.3 (1.3 to 5.3)e2880.80.4 (–2.5 to 3.4)4561.30.3 (–1.8 to 2.4)
 VII(a) Hepatoblastoma83912.61.9 (0.3 to 3.6)e22926.81.8 (0.7 to 2.9)e1500.4g660.2g140.0g
 VII(b) Hepatic carcinomas150.2g720.2g1010.3g2140.6g4351.20.1 (–1.9 to 2.2)
 VII(c) Unspecified malignant hepatic tumors100.2g150.0g80.0g80.0g70.0g
VIII Malignant bone tumors590.9g5111.50.6 (–1.5 to 2.8)19395.71.0 (0.0 to 2.1)473513.51.1 (0.5 to 1.6)e502813.9–0.4 (–1.0 to 0.2)
 VIII(a) Osteosarcomasfgg980.3g10103.00.5 (–0.6 to 1.7)28388.11.2 (0.4 to 2.1)e28467.9–1.1 (–1.9 to –0.2)e
 VIII(b) Chondrosarcomasfgg90.0g310.1g1440.4g2790.8–0.3 (–3.5 to 2.9)
 VIII(c) Ewing tumor and related sarcomas of bone360.5g3191.00.9 (–1.9 to 3.7)7522.21.4 (–0.6 to 3.4)14654.20.8 (0.1 to 1.4)e14954.10.5 (–0.7 to 1.8)
 VIII(d) Other specified malignant bone tumors80.1g520.2g1050.3g2010.6g2930.8–0.5 (–2.9 to 2.0)
 VIII(e) Unspecified malignant bone tumors100.2g330.1g410.1g870.3g1150.3g
IX Soft tissue and other extraosseous sarcomas118717.80.3 (–0.9 to 1.6)412312.30.5 (–0.2 to 1.2)27868.2–0.1 (–0.9 to 0.7)405211.50.2 (–0.4 to 0.9)549615.2–0.3 (–1.0 to 0.5)
 IX(a) Rhabdomyosarcomas3705.50.3 (–1.5 to 2.2)24177.20.3 (–0.6 to 1.3)14774.4–0.6 (–1.7 to 0.5)12573.60.1 (–1.2 to 1.5)12303.4–0.6 (–2.0 to 0.9)
 IX(b) Fibrosarcomas, peripheral nerve and other fibrous3294.90.0 (–3.0 to 3.1)4691.40.2 (–2.1 to 2.5)1940.6–1.2 (–4.1 to 1.9)3971.1–1.6 (–3.5 to 0.3)6341.8–1.2 (–3.4 to 1.0)
 IX(d) Other specified soft tissue sarcomash3565.30 (–2.3 to 2.2)9332.80.9 (–0.7 to 2.6)8302.50.2 (–1.4 to 1.9)18685.30.1 (–0.8 to 1.0)29138.1–0.4 (–1.3 to 0.6)
 IX(e) Unspecified soft tissue sarcomas1322.0g3040.90.3 (–3.4 to 4.3)2850.81.9 (–0.5 to 4.4)5301.52.4 (0.6 to 4.3)e7192.01.7 (0.0 to 3.3)
X Germ cell tumors, trophoblastic tumors, and neoplasms of gonads129919.4–0.3 (–1.7 to 1.2)21816.5–0.1 (–1.0 to 0.8)8522.51.2 (–0.4 to 2.9)26097.40.7 (–0.2 to 1.6)990727.4–0.3 (–1.5 to 0.9)
 X(a) Intracranial and intraspinal germ cell tumors1352.0g2060.61.2 (–3.1 to 5.7)3931.21.7 (–1.1 to 4.5)9272.61.2 (–0.2 to 2.5)8532.40.8 (–0.4 to 2.0)
 X(b) Extracranial and extragonadal germ cell tumors86913.00.2 (–1.3 to 1.7)12763.8–0.1 (–1.2 to 1.0)410.1g1170.3g5661.6–0.2 (–2.4 to 2.0)
 X(c) Malignant gonadal germ cell tumors2814.2–1.6 (–6.5 to 3.4)6692.0–1.0 (–3.4 to 1.4)3611.10.5 (–1.7 to 2.7)13593.90.5 (–0.6 to 1.6)768321.3–0.3 (–1.1 to 0.5)
 X(d) Gonadal carcinomasfgg60.0g130.0g920.3g4981.41.0 (–1.2 to 3.3)
 X(e) Other and unspecified malignant gonadal tumors120.2g240.1g440.1g1140.3g3070.90.5 (–1.7 to 2.7)
XI Other malignant epithelial neoplasms and melanomas3064.65.9 (2.5 to 9.5)e7922.42.3 (0.5 to 4.1)e14684.31.3 (–0.3 to 2.8)590316.83.6 (2.4 to 4.8)e19 61954.32.4 (1.2 to 3.7)e
 XI(a) Adrenocortical carcinomas310.5g1270.4g270.1g480.1g860.2g
 XI(b) Thyroid carcinomas180.3g880.3g4591.41.1 (–1.6 to 3.9)25377.23.8 (2.9 to 4.7)e937525.94.5 (3.8 to 5.2)e
 XI(c) Nasopharyngeal carcinomasfggfgg270.1g2320.7g4851.3–1.1 (–3.5 to 1.3)
 XI(d) Malignant melanomas1672.5g4431.32.2 (0.0 to 4.5)e4971.5–0.8 (–8.7 to 7.8)10713.1–3.4 (–4.9 to –1.9)e423611.7–5.4 (–6.2 to –4.6)e
 XI(e) Skin carcinomasfggfgg110.0g390.1g650.2g
 XI(f) Other and unspecified carcinomas881.3g1310.4g4471.34.5 (2.0 to 7.1)e19765.67.1 (3.9 to 10.4)e537214.95.0 (2.7 to 7.3)e
XII Other and unspecified malignant neoplasms1542.3g4411.32.7 (0.4 to 5.2)e1060.3g1790.5g4421.2–1.4 (–3.9 to 1.2)
 XII(a) Other specified malignant tumors781.2g2910.94.0 (1.2 to 6.8)e350.1g740.2g1790.5g
 XII(b) Other unspecified malignant tumors761.1g1500.5g710.2g1050.3g2630.7–1.9 (–4.8 to 1.0)
Not classified by ICCC or in situ540.8g2540.8g2340.7g1670.5g1930.5g
Age <1 y
Age 0 to 4 y
Age 5-9 y
Age 10-14 y
Age 15-19 y
ICCC groupNo.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)No.RateAAPCd (95% CI)
I Leukemias, myeloproliferative diseases, and myelodysplastic diseases338150.6–0.5 (–1.2 to 0.3)27 68082.4–0.1 (–0.6 to 0.3)14 08741.60.5 (0.1 to 0.9)e11 12731.71.1 (0.5 to 1.7)e11 68132.30.9 (0.5 to 1.3)e
 I(a) Lymphoid leukemias124718.7–1.3 (–2.3 to –0.4)e21 55564.1–0.1 (–0.6 to 0.4)11 66834.50.5 (–0.1 to 1.0)743221.21.4 (0.7 to 2.1)e603216.71.1 (0.4 to 1.8)e
 I(b) Acute myeloid leukemias115417.30.1 (–1.0 to 1.1)380211.3–0.2 (–0.8 to 0.4)13814.1–0.4 (–1.3 to 0.5)22466.4–0.2 (–1.2 to 0.7)30458.4–0.3 (–1.4 to 0.8)
 I(c) Chronic myeloproliferative diseases3284.90.1 (–4.6 to 5.0)6301.9–0.2 (–3.8 to 3.5)3591.1–3.9 (–8.0 to 0.3)7222.10.2 (–1.7 to 2.1)17294.81.0 (0.2 to 1.8)e
 I(d) Myelodysplastic syndrome and other myeloproliferative diseases4366.50.2 (–2.9 to 3.5)9322.8–1.8 (–2.7 to –0.9)e2500.7–1.5 (–4.4 to 1.4)2950.8–1.0 (–3.8 to 2.0)4081.10.5 (–1.9 to 3.0)
 I(e) Unspecified and other specified leukemias2163.2–1.6 (–3.5 to 0.4)7612.32.4 (0.9 to 3.9)e4291.36.7 (4.2 to 9.3)e4321.25.4 (3.0 to 7.9)e4671.33.3 (1.5 to 5.1)e
II Lymphomas and reticuloendothelial neoplasms110516.57.2 (4.4 to 10.1)e470714.02.5 (–1.1 to 6.2)579317.11.6 (0.0 to 3.3)947427.01.8 (1.2 to 2.4)e18 33450.70.4 (0.1 to 0.8)e
 II(a) Hodgkin lymphomasfgg2550.8g13243.9–0.7 (–2.0 to 0.6)425112.10.3 (–0.4 to 1.0)11 48931.8–0.1 (–0.4 to 0.1)
 II(b) Non-Hodgkin lymphomas (except Burkitt lymphoma)1792.7g14264.20.7 (–0.4 to 1.8)23577.01.5 (0.5 to 2.5)e34249.81.5 (0.5 to 2.5)e539314.90.9 (0.0 to 1.8)e
 II(c) Burkitt lymphoma70.1g5631.7–0.6 (–2.1 to 0.9)10343.1–1.0 (–2.1 to 0.2)9492.70.2 (–1.2 to 1.5)7842.2–0.3 (–1.5 to 0.8)
 II(d) Miscellaneous lymphoreticular neoplasms90413.58.8 (4.6 to 13.2)e24167.27.0 (–1.0 to 15.6)10073.013.9 (0.9 to 28.6)e7562.2g4221.2g
 II(e) Unspecified lymphomas120.2g470.1g710.2g940.3g2460.70.9 (–1.9 to 3.7)
III CNS and miscellaneous intracranial and intraspinal neoplasms227134.0–1.2 (–2.4 to 0.1)14 01541.7–2.2 (–3.8 to –0.5)e11 47133.9–2.0 (–3.3 to –0.7)e935626.6–0.8 (–2.7 to 1.0)778821.6–1.3 (–4.0 to 1.3)
 III(a) Ependymomas and choroid plexus tumor3234.8–1.0 (–3.7 to 1.7)17295.20.4 (–1.1 to 2.0)7302.2–0.7 (–2.6 to 1.3)5831.71.2 (–0.7 to 3.1)5761.6–2.2 (–3.8 to –0.6)e
 III(b) Astrocytomas87813.1–1.5 (–3.6 to 0.6)663119.7–2.3 (–4.1 to –0.5)e569416.8–0.5 (–2.0 to 1.1)523414.9–0.1 (–1.7 to 1.5)445612.30.0 (–1.0 to 1.0)
 III(c) Intracranial and intraspinal embryonal tumors74111.1–1.4 (–3.5 to 0.6)348510.4–2.5 (–5.6 to 0.7)23306.9–3.4 (–6.7 to 0.1)13523.9–3.6 (–9.2 to 2.4)8092.2–3.0 (–5.3 to –0.6)e
 III(d) Other gliomas1832.7g16965.10.2 (–2.7 to 3.2)23557.0–2.5 (–7.0 to 2.3)18315.21.2 (–0.2 to 2.5)15664.30.8 (–0.9 to 2.4)
 III(e) Other specified intracranial/intraspinal neoplasms580.9g2550.80.1 (–2.9 to 3.1)2140.6–1.5 (–4.2 to 1.2)2040.6g2350.7–2.4 (–11.6 to 7.8)
 III(f) Unspecified intracranial and intraspinal neoplasms881.3g2190.70.9 (–2.4 to 4.3)1480.4g1520.40.2 (–3.3 to 3.8)1460.4g
IV Neuroblastoma and other peripheral nervous cell tumors396159.30.1 (–0.6 to 0.8)975829.10.0 (–0.5 to 0.5)13524.01.5 (–1.0 to 4.0)4781.40.6 (–1.4 to 2.6)3190.93.0 (0.9 to 5.2)e
 IV(a) Neuroblastoma and ganglioneuroblastoma394959.10.1 (–0.6 to 0.8)971329.00.0 (–0.5 to 0.6)13173.92.4 (1.2 to 3.7)e3761.10.4 (–2.0 to 2.8)1690.5g
 IV(b) Other peripheral nervous cell tumors120.2g450.1g350.1g1020.3g1500.4g
V Retinoblastoma199229.80.6 (–0.4 to 1.6)424212.7–0.3 (–1.4 to 0.7)1500.4g250.1g70.0g
VI Renal tumors105715.8–0.5 (–1.9 to 0.9)639419.0–0.9 (–1.8 to 0.0)19585.81.4 (0.3 to 2.5)e5111.51.8 (0.2 to 3.5)e6431.81.3 (–0.5 to 3.0)
 VI(a) Nephroblastoma and other nonepithelial renal tumors104215.6−0.7 (-2.0 to 0.7)634218.9–0.9 (–1.8 to 0.0)e18415.41.7 (0.5 to 2.8)e2760.82.0 (–0.8 to 4.9)1240.3g
 VI(b) Renal carcinomas80.1g290.1g1060.3g2290.71.4 (–0.9 to 3.8)5111.42.2 (–0.2 to 4.6)
 VI(c) Unspecified malignant renal tumors70.1g230.1g110.0g60.0g80.0g
VII Hepatic tumors86412.91.7 (0.1 to 3.4)e23797.11.7 (0.6 to 2.7)e2590.83.3 (1.3 to 5.3)e2880.80.4 (–2.5 to 3.4)4561.30.3 (–1.8 to 2.4)
 VII(a) Hepatoblastoma83912.61.9 (0.3 to 3.6)e22926.81.8 (0.7 to 2.9)e1500.4g660.2g140.0g
 VII(b) Hepatic carcinomas150.2g720.2g1010.3g2140.6g4351.20.1 (–1.9 to 2.2)
 VII(c) Unspecified malignant hepatic tumors100.2g150.0g80.0g80.0g70.0g
VIII Malignant bone tumors590.9g5111.50.6 (–1.5 to 2.8)19395.71.0 (0.0 to 2.1)473513.51.1 (0.5 to 1.6)e502813.9–0.4 (–1.0 to 0.2)
 VIII(a) Osteosarcomasfgg980.3g10103.00.5 (–0.6 to 1.7)28388.11.2 (0.4 to 2.1)e28467.9–1.1 (–1.9 to –0.2)e
 VIII(b) Chondrosarcomasfgg90.0g310.1g1440.4g2790.8–0.3 (–3.5 to 2.9)
 VIII(c) Ewing tumor and related sarcomas of bone360.5g3191.00.9 (–1.9 to 3.7)7522.21.4 (–0.6 to 3.4)14654.20.8 (0.1 to 1.4)e14954.10.5 (–0.7 to 1.8)
 VIII(d) Other specified malignant bone tumors80.1g520.2g1050.3g2010.6g2930.8–0.5 (–2.9 to 2.0)
 VIII(e) Unspecified malignant bone tumors100.2g330.1g410.1g870.3g1150.3g
IX Soft tissue and other extraosseous sarcomas118717.80.3 (–0.9 to 1.6)412312.30.5 (–0.2 to 1.2)27868.2–0.1 (–0.9 to 0.7)405211.50.2 (–0.4 to 0.9)549615.2–0.3 (–1.0 to 0.5)
 IX(a) Rhabdomyosarcomas3705.50.3 (–1.5 to 2.2)24177.20.3 (–0.6 to 1.3)14774.4–0.6 (–1.7 to 0.5)12573.60.1 (–1.2 to 1.5)12303.4–0.6 (–2.0 to 0.9)
 IX(b) Fibrosarcomas, peripheral nerve and other fibrous3294.90.0 (–3.0 to 3.1)4691.40.2 (–2.1 to 2.5)1940.6–1.2 (–4.1 to 1.9)3971.1–1.6 (–3.5 to 0.3)6341.8–1.2 (–3.4 to 1.0)
 IX(d) Other specified soft tissue sarcomash3565.30 (–2.3 to 2.2)9332.80.9 (–0.7 to 2.6)8302.50.2 (–1.4 to 1.9)18685.30.1 (–0.8 to 1.0)29138.1–0.4 (–1.3 to 0.6)
 IX(e) Unspecified soft tissue sarcomas1322.0g3040.90.3 (–3.4 to 4.3)2850.81.9 (–0.5 to 4.4)5301.52.4 (0.6 to 4.3)e7192.01.7 (0.0 to 3.3)
X Germ cell tumors, trophoblastic tumors, and neoplasms of gonads129919.4–0.3 (–1.7 to 1.2)21816.5–0.1 (–1.0 to 0.8)8522.51.2 (–0.4 to 2.9)26097.40.7 (–0.2 to 1.6)990727.4–0.3 (–1.5 to 0.9)
 X(a) Intracranial and intraspinal germ cell tumors1352.0g2060.61.2 (–3.1 to 5.7)3931.21.7 (–1.1 to 4.5)9272.61.2 (–0.2 to 2.5)8532.40.8 (–0.4 to 2.0)
 X(b) Extracranial and extragonadal germ cell tumors86913.00.2 (–1.3 to 1.7)12763.8–0.1 (–1.2 to 1.0)410.1g1170.3g5661.6–0.2 (–2.4 to 2.0)
 X(c) Malignant gonadal germ cell tumors2814.2–1.6 (–6.5 to 3.4)6692.0–1.0 (–3.4 to 1.4)3611.10.5 (–1.7 to 2.7)13593.90.5 (–0.6 to 1.6)768321.3–0.3 (–1.1 to 0.5)
 X(d) Gonadal carcinomasfgg60.0g130.0g920.3g4981.41.0 (–1.2 to 3.3)
 X(e) Other and unspecified malignant gonadal tumors120.2g240.1g440.1g1140.3g3070.90.5 (–1.7 to 2.7)
XI Other malignant epithelial neoplasms and melanomas3064.65.9 (2.5 to 9.5)e7922.42.3 (0.5 to 4.1)e14684.31.3 (–0.3 to 2.8)590316.83.6 (2.4 to 4.8)e19 61954.32.4 (1.2 to 3.7)e
 XI(a) Adrenocortical carcinomas310.5g1270.4g270.1g480.1g860.2g
 XI(b) Thyroid carcinomas180.3g880.3g4591.41.1 (–1.6 to 3.9)25377.23.8 (2.9 to 4.7)e937525.94.5 (3.8 to 5.2)e
 XI(c) Nasopharyngeal carcinomasfggfgg270.1g2320.7g4851.3–1.1 (–3.5 to 1.3)
 XI(d) Malignant melanomas1672.5g4431.32.2 (0.0 to 4.5)e4971.5–0.8 (–8.7 to 7.8)10713.1–3.4 (–4.9 to –1.9)e423611.7–5.4 (–6.2 to –4.6)e
 XI(e) Skin carcinomasfggfgg110.0g390.1g650.2g
 XI(f) Other and unspecified carcinomas881.3g1310.4g4471.34.5 (2.0 to 7.1)e19765.67.1 (3.9 to 10.4)e537214.95.0 (2.7 to 7.3)e
XII Other and unspecified malignant neoplasms1542.3g4411.32.7 (0.4 to 5.2)e1060.3g1790.5g4421.2–1.4 (–3.9 to 1.2)
 XII(a) Other specified malignant tumors781.2g2910.94.0 (1.2 to 6.8)e350.1g740.2g1790.5g
 XII(b) Other unspecified malignant tumors761.1g1500.5g710.2g1050.3g2630.7–1.9 (–4.8 to 1.0)
Not classified by ICCC or in situ540.8g2540.8g2340.7g1670.5g1930.5g
a

Rates are per 1 million people. Rates for ages <1 year, 5-9 years, 10-14 years, and 15-19 years are age specific, and the rates for ages 0 to 4 years are age adjusted to the 2000 US standard population (19 age groups—US Census P25-1130). Source: US Cancer Statistics. AAPC = average annual percent change; CI = confidence interval; CNS = central nervous system; ICCC = International Classification of Childhood Cancer.

b

Cases included all malignant cancers.

c

Incidence data are compiled from cancer registries that meet the data quality criteria for all years, 2003-2019 (covering 99.1% of the US population). Registry-specific data quality information is available at https://www.cdc.gov/cancer/uscs/technical_notes/criteria/index.htm. Characteristic values with other, missing, or blank results are not included in this table.

d

Trends were measured with AAPC, and rates and were considered to increase or decrease if P <.05 (2-sided); otherwise, trends were considered stable. AAPC was not calculated if case count was <6 cases in any 1 year.

e

Trends were significant at P <.05.

f

Cell suppressed because there were <6 cases.

g

Statistic could not be calculated because of the low number of cases.

h

Includes IX(c) Kaposi sarcoma because of US Cancer Statistics complementary cell-suppression rules.

Discussion

Approximately 15 000 new cases of pediatric cancer per year were reported for the period 2003 to 2019. Across this time frame, the 3 most common pediatric cancers were leukemia, CNS neoplasms, and lymphoma. Overall, we observed an increase in the counts and incidence rates of pediatric cancer from 2003 to 2019, but trend analysis showed an increase until 2016, followed by a decrease. Cancer types where rates increased overall included leukemia, lymphoma, hepatic tumors, bone tumors, and thyroid carcinoma, whereas rates decreased for melanoma. CNS neoplasm rates increased until 2017, followed by a decrease. Some of these increases and subsequent decreases could stem from patterns or changes in coding, diagnosis, and reporting of pediatric cancer. For some cancer types, further investigation is needed to better understand factors that may affect increases and decreases in trends.

We observed that 1054 more cases were reported in 2019 than in 2003, while the US population of those younger than 20 years of age increased by approximately 750 000 during that same time period (27). Past studies noted increasing rates of cancer among children younger than 15 years of age, such as from 2001 to 2017 in the United States (6) and between 1992 and 2010 in Canada (28), and an increasing trend for adolescents between 2007 and 2016 (29). The reasons for increasing rates of pediatric cancer overall are likely multifactorial. First, overall rates of cancer may have increased because of changes in cancer reporting over the past 2 decades, such as the increased use of electronic pathology reporting to cancer registries. Coding changes may account for some changes in trends in pediatric cancer, such as a 2008 World Health Organization redefinition of hemopoietic cancer codes (30), which may explain increases in pediatric lymphoma group II(d) (eg, changes in Langerhans cell histiocytosis coding likely affected trends among infants and older ages). Some increases or decreases in pediatric cancer rates could be secondary to changing trends in cancer risk factors related to preconception and pregnancy (eg, smoking, assisted reproductive technology), birth (eg, increasing maternal age, low birth weight), or childhood and adolescent life (eg, infection exposure, residential chemicals, radiation exposure, use of sunscreen) (31-34). Decreases in some risk factors [eg, decreases in US adult smoking trends (35)] may reduce risk for some cancers, whereas increases in other risk factors [eg, increasing maternal age (36)] may elevate risk for others. Decreasing incidence trends in the later years of this study may have resulted from reporting delays of recently diagnosed cases, which could lead to underestimating incidence in recent years (37).

The highest rates of pediatric cancer were among those aged 0 to 4 years and those 15 to 19 years, which is consistent with previous findings (13). Infants, a group that included cases diagnosed in utero, had a higher rate of cancer than other age groups in this study and a higher rate in this study than in previous data (38). For infants, the cancers with the highest incidence rates were neuroblastoma (59.3), leukemia (50.6), and CNS neoplasms (34.0), all of which had stable trends, although rates decreased for lymphoid leukemias. Increasing trends of cancer among adolescents in our study are consistent with previous data showing increases in this age group as well as in young adults aged 20 to 29 and 30 to 39 years (29). For adolescents, the most common ICCC cancer types were lymphoma (50.7), leukemia (32.3), germ cell tumors (27.4), thyroid carcinoma (25.9), and CNS neoplasms (21.6); of these, incidence rates for lymphoma, leukemia, and thyroid carcinoma increased, and rates for germ cell tumors and CNS neoplasms were stable. The reasons underlying these increases are likely multifactorial and could be related to changes in diagnosis and detection as well as to potential risk factors, including diet, obesity, and environmental exposures (39). Because clinical trial enrollment is lower among adolescents than among children because of barriers such as less frequent referrals and limited trial availability (40-42), increasing trends in this age group accentuate the importance of better understanding diagnosis patterns to improve clinical trial enrollment.

This study confirms past reports of pediatric cancer rates being highest in the Northeast compared with other US Census regions (13,14). Cancer among adults is highest in the Northeast, as well (43); regional variation in cancer could be related to demographic differences, differences in carcinogenic exposures, population-level genetic differences, or differences in access to care or cancer detection (13,14). Although the incidence rate of pediatric cancer overall was highest in the top 25% of counties by economic status, the association between socioeconomic status (SES) and pediatric cancer incidence has not been reported consistently, and definitions of SES may differ among studies; pediatric cancer incidence studies investigating potential associations between SES and race and ethnicity categories have produced varying results (14,44-48). In addition, detection bias for cancer based on SES may be possible (14). Differences in cancer incidence by rural-urban status have been described for some adult and pediatric cancers; researchers have investigated possible associations between SES status and exposures such as air pollution (10,49-51).

When evaluating the incidence of pediatric cancer by sex, rates were higher for males than for females (IRR = 1.09, 95% CI = 1.08 to 1.10), which was slightly lower than SEER data reported through 2015 (IRR = 1.19) (52). The male-to-female IRR for acute myeloid leukemia (1.02, 95% CI = 0.99 to 1.06) was lower than described in previous data; Williams et al. described male predominance of this cancer type (52). Male predominance of some cancer types may be the result of a combination of genetic, hormone-related, and immune-related mechanisms (52).

Cancer rates were highest among White children and adolescents, as has been reported previously (2,13,14). Differences in pediatric cancer incidence by race and ethnicity differed by cancer type. For example, leukemia was highest among Hispanic and lowest among Black children and adolescents, and lymphoma and CNS neoplasms were highest among White children and adolescents. Racial and ethnic disparities in pediatric cancer incidence have been reported previously across many different cancer types (47,48,53,54). Researchers have investigated differences in incidence by race and ethnicity through genome-wide association studies and investigations into epigenetics, gene-environment interactions, and exposures (31,48,54). For instance, researchers using genome-wide association studies have indicated greater frequency of pediatric cancer risk alleles among some ancestry groups (31,55).

By cancer type, increasing rates of leukemia (10), hepatic cancer (56,57), and thyroid cancer (58,59) and decreasing rates of melanoma (60,61) have been observed previously. Leukemia continues to be the most common pediatric cancer in the United States, and rates increased overall, for females, and for lymphoid leukemias; acute myeloid leukemia was stable. This study found stable rates of kidney tumors, which were previously found to be increasing, and increasing rates of bone tumors, which were previously noted to be stable between 2001 and 2009 (7). Some have hypothesized that the increasing rate of hepatoblastoma may be the result of the increasing number of children living with congenital anomalies, which appears to be an important risk factor for this malignancy (62). Increases in Ewing sarcoma, reported here and previously, may be the result of diagnostic changes, demographic changes, or changes related to specific risk factors (63). Increased detection may account, in part, for increases in incidence, such as for thyroid carcinoma. Increasing incidence of thyroid carcinoma may be a result of both overdiagnosis and true incidence increases secondary to other causes, such as environmental exposures (eg, ionizing radiation) (58,59). Decreases in melanoma could be related to reduced ultraviolet light exposure, possibly secondary to public health interventions such as increased sun protection during younger years (60,61,64).

This study found that pediatric CNS neoplasms decreased between 2003 and 2019, but rates increased until 2017, and then decreased. Past studies reported conflicting results for pediatric brain tumor trends, depending on the percentage population coverage, years included, and granularity of CNS neoplasm subtype studied (65-67). For CNS neoplasms, advances in radiologic imaging and biomarkers and molecular diagnosis may have led to increases of some subtypes (17,66). Decreases in pediatric CNS neoplasms in 2018 and 2019 are difficult to interpret and may reflect changes related to diagnosis and reporting. In addition, this decrease could represent late reporting of some CNS neoplasms (18), which could lead to underestimates in the most recent years of the study. Independent of diagnosis and reporting, established risk factors for pediatric CNS neoplasms include ionizing radiation and rare genetic syndromes; additional factors are being studied (68,69).

The strength of this study is its use of high-quality cancer registry data covering 99.1% of the US population during 2003 to 2019. This strength must be considered in the light of certain limitations, however. First, because this study did not use delay-adjusted data, it may underestimate rates of late-reported cancers, such as melanoma and CNS neoplasms, in later years of the study. Although delayed reporting to central cancer registries has improved over time (70), it is possible that data submissions to NPCR and SEER in 2020 and 2021, which included the first mostly complete reporting of cases diagnosed in 2018 and 2019, respectively, could have a higher proportion of late-reported cases or late completion of certain variables because of logistical challenges in reporting during the COVID-19 pandemic. Although a study of the National Cancer Database described no change in registrars’ ability to abstract same-year data in 2020 (71), delayed reporting of previous-year data was not evaluated. Second, our study did not include Nevada and did not include Kansas and Minnesota for economic status analysis. Third, although these data are considered high quality (no more than 5% of cases were missing information about race every year), this dataset did not include information about race for some cases; was not able to describe multiple races for individuals who reported more than 1 race; and was not restricted to Purchase/Referred Care Delivery Area counties that link with Indian Health Service data, meaning that rates in American Indian or Alaska Native populations could be underestimated (72). In addition, this study included only tumors with a malignant behavior code, meaning that nonmalignant brain tumors, which represent an annual incidence rate of 23 to 27 cases per million for children and adolescents (17,18), were not represented in rate and trend analyses; data about nonmalignant tumors are presented elsewhere (14,17,18,73).

Incidence count and rate changes of pediatric cancer are relevant to care capacity (eg, providers available, hospital space) related to cancer treatment, clinical trial enrollment, and long-term care needs. Increasing case counts of pediatric cancer, coupled with decreasing death rates and increasing survival (74), signify increasing numbers of survivors of childhood cancer in the United States. Survivors of childhood cancer often face long-term complications, including heart disease, infertility, and secondary cancers (2); many need continued follow-up as children, adolescents, and into adulthood (75). Continued surveillance can help guide potential interventions to improve treatment and survivor care and can help guide national measures to share pediatric cancer data, such as clinical and molecular data, that can be useful in research efforts and in developing interventions to increase clinical trial enrollment (76).

Data availability

The data that support the findings of this study are available on request by contacting [email protected]. The data are not publicly available because of privacy and legal restrictions. Information about accessing public use US Cancer Statistics can be found at https://www.cdc.gov/cancer/uscs/.

Author contributions

David A. Siegel, MD, MPH (Conceptualization; Formal analysis; Methodology; Writing—original draft; Writing—review & editing), Jessica B. King, MPH (Data curation; Methodology; Writing—original draft; Writing—review & editing), Philip J. Lupo, PhD, MPH (Writing—original draft; Writing—review & editing), Eric Durbin, DrPH, MS (Writing—original draft; Writing—review & editing), Eric Tai, MD, MS (Methodology; Writing—original draft; Writing—review & editing), Kathi Mills, BA (Writing—original draft; Writing—review & editing), Elizabeth Van Dyne, MD, MPH (Methodology; Writing—original draft; Writing—review & editing), Natasha Buchanan Lunsford, PhD (Methodology; Writing—original draft; Writing—review & editing), S. Jane Henley, MSPH (Conceptualization; Methodology; Writing—original draft; Writing—review & editing), Reda J. Wilson, MPH (Methodology; Writing—original draft; Writing—review & editing).

Funding

No funding was used for this study.

Conflicts of interest

Philip Lupo is a JNCI associate editor but was not involved in the editorial review of this manuscript. The authors have no other disclosures or conflicts to state.

Acknowledgement

State health departments and cancer registrars. Role of the funder is not applicable. An early version of this study was presented at the American Society of Pediatric Hematology/Oncology Conference in 2018 and the Centers for Disease Control and Prevention’s Epidemic Intelligence Service Conference in 2018; data in these past presentations covered 2001 to 2014.

The findings and conclusions are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Author notes

S. Jane Henley and Reda J. Wilson contributed equally to this work.

This work is written by (a) US Government employee(s) and is in the public domain in the US.