Background

There is little evidence about childhood cancer burden in the WHO Eastern Mediterranean region (EMR). We aimed to provide an estimate of childhood cancer burden in the EMR, examine the connection between age-standardised mortality rate and level of income (gross domestic product [GDP] per capita), and reflect on the current status of childhood cancer registration in the EMR.

Methods

Using the GLOBOCAN 2020 data from the Cancer Surveillance Unit of the International Agency for Research on Cancer, we extracted data for childhood cancer (at ages 0–14 years) incidence, prevalence, and mortality for 22 countries in the EMR, the EMR as a whole, and other WHO regions, and categorised by main cancer types. Childhood cancers were classified according to the 10th revision of the International Classification of Diseases. We also searched MEDLINE, Google Scholar, and the grey literature between May 17 and Aug 2, 2021, for English-language articles and reports about the status of childhood cancer registration in the EMR. We further examined the connection between age-standardised mortality rate and GDP per capita for the 22 countries in the EMR.

Findings

The total estimated number of incident childhood cancer cases in the EMR was 23 847 in 2020, with an age-standardised incidence rate of 10·1 per 100 000 children at risk, ranging from 7·3 per 100 000 children at risk in Pakistan to 13·8 per 100 000 children at risk in Iran. The estimated number of incident cases was 7451 (age-standardised incidence rate 3·10 per 100 000 children at risk) for leukaemia, 3006 (1·30 per 100 000 children at risk) for brain and CNS tumours, 2222 (0·92 per 100 000 children at risk) for non-Hodgkin lymphoma, 1569 (0·67 per 100 000 children at risk) for kidney cancers, and 1420 (0·58 per 100 000 children at risk) for Hodgkin lymphoma. In 2020, the number of total estimated childhood cancer deaths in the EMR was 10 535, with an age-standardised mortality rate of 4·4 (per 100 000 children at risk, ranging from 0·8 per 100 000 children at risk in Qatar to 7·2 per 100 000 children at risk in Somalia. A negative correlation was found between countries’ GDP per capita (income level) and mortality rates (r=–0·77, p<0·0001). The scarcity of data and quality of cancer registries in EMR countries prevented further analysis.

Interpretation

Given the variable quality and coverage of cancer registries in EMR countries, these findings are likely to be underestimates. Nevertheless, these data, especially the high mortality rates, reflect a need for effective national childhood cancer plans in line with the WHO Global Initiative for Childhood Cancer to improve survival.

Funding

Friends of Cancer Patients.

中文翻译：

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世卫组织东地中海区域儿童癌症（0-14 岁）的估计发病率、患病率、死亡率和登记：对 GLOBOCAN 2020 数据的分析

背景

几乎没有证据表明世卫组织东地中海地区 (EMR) 的儿童癌症负担。我们旨在提供 EMR 中儿童癌症负担的估计，检查年龄标准化死亡率与收入水平（人均国内生产总值 [GDP]）之间的联系，并反映儿童癌症登记的现状电子病历。

方法

使用来自国际癌症研究机构癌症监测部门的 GLOBOCAN 2020 数据，我们提取了 EMR 中 22 个国家的儿童癌症（0-14 岁）发病率、流行率和死亡率数据，EMR 作为整个区域和其他 WHO 区域，并按主要癌症类型分类。儿童癌症根据国际疾病分类第 10 版进行分类。我们还在 2021 年 5 月 17 日至 8 月 2 日期间搜索了 MEDLINE、Google Scholar 和灰色文献，以查找有关 EMR 中儿童癌症登记状态的英文文章和报告。我们进一步研究了 EMR 中 22 个国家的年龄标准化死亡率与人均 GDP 之间的联系。

发现

到 2020 年，EMR 中估计的儿童癌症病例总数为 23 847 例，年龄标准化发病率为每 10 万高危儿童 10·1 例，范围从巴基斯坦每 10 万高危儿童 7·3 例到在伊朗，每 100 000 名儿童中有 13·8 名处于危险之中。估计发生白血病的病例数为 7451 例（年龄标准化发病率为 3·10/10 万有风险的儿童），3006 例（每 10 万有风险的儿童中有 1·30 例）脑和中枢神经系统肿瘤，2222 例（0·92每 100 000 名有风险的儿童）患有非霍奇金淋巴瘤，1569 人（每 100 000 名有风险的儿童 0·67）患有肾癌，1420 人（每 10 万有风险的儿童 0·58 人）患有霍奇金淋巴瘤。2020 年，EMR 中估计的儿童癌症死亡总数为 10 535 人，年龄标准化死亡率为 4·4（每 100 000 名处于危险中的儿童，从卡塔尔每 100 000 名面临风险的儿童 0·8 到索马里每 100 000 名面临风险的儿童 7·2 不等。发现各国人均 GDP（收入水平）与死亡率（r =–0·77, p<0·0001)。EMR 国家癌症登记数据和质量的稀缺性阻碍了进一步的分析。

解释

鉴于 EMR 国家癌症登记的质量和覆盖范围参差不齐，这些发现可能被低估了。尽管如此，这些数据，尤其是高死亡率，反映出需要根据世卫组织儿童癌症全球倡议制定有效的国家儿童癌症计划以提高生存率。

资金

癌症患者的朋友。