Childhood leukaemia in Great Britain: trends in incidence, survival and ‘cure’ Anjali Shah UK Association of Cancer Registries conference 30 September.

Childhood leukaemia in Great Britain: trends in incidence, survival and ‘cure’

Anjali Shah

UK Association of Cancer Registries conference

30 September 2004

Malignant disease in childrenMalignant disease in childrenEngland and Wales, 1981-1990England and Wales, 1981-1990

International Incidence of Childhood Cancer, vol 2, 1999

Type No. %

Leukaemia 3,705 33

Brain, spinal cord 2,549 22

Lymphoma 1,134 10

Neuroblastoma 797 7

Soft tissue 776 7

Other (kidney, …) 2,391 21

Total 11,352 100

Types of leukaemia in childrenTypes of leukaemia in childrenEngland and Wales, 1981-1990England and Wales, 1981-1990

International Incidence of Childhood Cancer, vol 2, 1999

Type No. %

Acute lymphoid 2,959 80

Acute myeloid 596 16

Chronic myeloid 88 2

Other 62 2

Total 3,705 100

Objectives

To examine long-term trends in:

- Relative survival

- ‘Cure’

- Incidence and mortality

Leukaemia categories 1901-2000International Classification of Diseases

From ICDContent Categoriesrev.

1901– 1Not defined ─

1911– 2-3Leukaemia 1

1931– 4-5Leukaemia, aleukaemia 2

1950– 6-7Lymphatic, myeloid, monocytic 5

1968– 8Acute, chronic 13

1979–2000 9 Subacute 25

WHO, International Classification of Diseases

Leukaemia incidence, mortality and survival trendsLeukaemia incidence, mortality and survival trendsEngland and Wales, 1911 to 2000England and Wales, 1911 to 2000

0

10

20

30

40

50

60

70

80

1911-1915

1916 1921 1926 1931 1936 1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996-2000

Calendar period of diagnosis (incidence, survival) or of death

An

nu

al

rate

pe

r m

illi

on

0

10

20

30

40

50

60

70

80

90

100

Fiv

e-y

ea

r s

urv

iva

l (%

)

Mortality

Incidence

Survival

Leukaemia incidence and mortality trendsLeukaemia incidence and mortality trendsEngland and Wales, 1911 to 2000 – England and Wales, 1911 to 2000 – by sexby sex

Leukaemia incidence and mortality trendsLeukaemia incidence and mortality trendsEngland and Wales, 1911 to 2000: England and Wales, 1911 to 2000: 1-4 years1-4 years

Incidence

Mortality

1993-97

1971-74

1988-92

1983-87

1979-82

1975-78

Childhood leukaemia survival by period of diagnosisChildhood leukaemia survival by period of diagnosisGreat Britain, 1971 to 1997Great Britain, 1971 to 1997

1993-97

1988-92

Childhood ALL survival by period of diagnosisChildhood ALL survival by period of diagnosisGreat Britain, 1971 to 1997Great Britain, 1971 to 1997

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5

Years since diagnosis

Rel

ativ

e su

rviv

al (

%)

0

10

20

30

40

50

60

70

80

90

100

1993-97

1988-92

1983-87

1979-82

1975-78

1971-74

1993-97

Childhood AML survival by period of diagnosisChildhood AML survival by period of diagnosisGreat Britain, 1971 to 1997Great Britain, 1971 to 1997

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5

Years since diagnosis

Rea

ltiv

e su

rviv

al (

%)

0

10

20

30

40

50

60

70

80

90

100

1993-97

1988-92

1983-87

1979-82

1975-78

1971-74

“cured” patients

Relative survival and population ‘cure’

‘Cured’ patients

“cured” patients

Relative survival and population ‘cure’

‘Cured’ patients

Tm

“cured” patients

Relative survival and population ‘cure’

‘Cured’ patients

Tm Tc

1993-97

Childhood leukaemia ‘cure’ by sexChildhood leukaemia ‘cure’ by sexGreat Britain, 1971 to 1997Great Britain, 1971 to 1997

0

10

20

30

40

50

60

70

80

Period of diagnosis

Pe

rce

nta

ge

of

pa

tie

nts

'cu

red

'

Girls

Boys

1993-97

Childhood leukaemia ‘cure’ by type of leukaemiaChildhood leukaemia ‘cure’ by type of leukaemiaGreat Britain, 1971 to 1997Great Britain, 1971 to 1997

ALL

ANLL

0

10

20

30

40

50

60

70

80

1971-74 1975-78 1979-82 1983-87 1988-92 1993-97

Period of diagnosis

Per

cent

age

of c

hild

ren

'cur

ed'

ALL

AML

1993-97

Time to ‘cure’ by type of leukaemiaTime to ‘cure’ by type of leukaemiaGreat Britain, 1971 to 1997Great Britain, 1971 to 1997

ALL

ANLL

ALL

AML

0

2

4

6

8

10

12

14

16

18

1971-74 1975-78 1979-82 1983-87

Period of diagnosis

Tim

e t

o 'c

ure

' (y

ea

rs)

ALL

AML

Summary

• Incidence has increased by 20% between 1971 and 2000

by 24% in 1-4 year olds

• Survival has increased from 31% in 1971 to 77% in 1997

• It is possible to estimate ‘cure’ by period analysis

• ‘Cure’ is estimated to have increased to 71%

Acknowledgements

• Office for National Statistics

• Childhood Cancer Research Group

• Clinical Trials Service Unit

Funding• Foundation for Children with Leukaemia