Childhood Cancer Rates Across the U.S., State by State, 2003–2014

Each year about 15,000 Americans under 20 are diagnosed with cancer. Earlier national studies compared the four U.S. Census regions but gave no state-level figures. A CDC team — David A. Siegel, Jun Li, S. Jane Henley, Reda J. Wilson, Natasha Buchanan Lunsford, Eric Tai and Elizabeth A. Van Dyne — filled that gap with data from United States Cancer Statistics (USCS) for 2003–2014.

The data

USCS combines CDC's National Program of Cancer Registries and the National Cancer Institute's SEER program. The study drew on population-based registries in every state and D.C. that met USCS quality criteria, covering more than 99% of the U.S. population; only Nevada was left out, because its 2011 data fell short. It counted first primary malignant cancers only, not recurrences, grouped by the International Classification of Childhood Cancer. Rates are per 1 million people under 20, age-adjusted to the 2000 U.S. standard population.

The national picture

• 171,432 new cases, a rate of 173.7 per million.
• Most common types: leukemias (45.7 per million), brain tumors (30.9) and lymphomas (26.2).
• Rates were highest in males, in children aged 0–4 and teens aged 15–19, and in white children, consistent with past reports.

By region

Rates per million, age-adjusted. White, Black, AI/AN and API are non-Hispanic. Source: CDC, MMWR.

The Northeast led across every age group and among white and Black children; for Hispanic children the South was highest. Leukemia rates were highest in the West, lymphoma and brain tumor rates in the Northeast.

Wealth and cities

These county comparisons exclude Kansas, Minnesota and Nevada.

By state

State rates ranged from 145.2 to 205.5 per million — highest in New Hampshire (205.5), D.C. (194.0) and New Jersey (192.3), lowest in South Carolina (149.3) and Mississippi (145.2).

Rates also varied from state to state within each cancer type.

Incidence by state and cancer type, 2003–2014. Credit: CDC, MMWR.

Why rates might differ

The authors list several possible reasons:

1. Exposures to cancer-causing chemicals — in air pollution, secondhand smoke, food or drinking water — or to radiation.
2. Genetics, such as how common cancer-predisposition genes are in a population.
3. Race and ethnicity. Hispanic children have the highest rate of acute lymphoblastic leukemia, the most common childhood leukemia, so states with more Hispanic residents may see more of it.
4. Detection and access to care, which can drive rates of some cancers, such as thyroid carcinoma.

Age, economic status and rural or urban setting may matter too. Adult cancer rates are also highest in the Northeast, and adult rates vary between rural and urban areas, partly perhaps because of obesity or smoking — which may or may not explain the pattern in children.

Earlier studies, built on single states, SEER registries (covering 9%–28% of the population) or other data sets, may have differed partly because of this geographic variation. A 2016 Delaware study, for instance, examined childhood cancer by demographic group and ZIP Code; national data give every state a standard yardstick and could prompt similar investigations.

Limitations

• Nevada's absence makes the findings less representative.
• Diagnosis and reporting differ by state. Early adopters of electronic pathology reporting may catch more cases and so report higher rates.
• Race and ethnicity can be misrecorded. American Indians, Alaska Natives and Hispanics may be undercounted among cases, lowering their rates, while census counts may miss children and Hispanics, raising them.

What the numbers are for

Five-year survival for childhood cancer is above 80%, and most survivors need specialist follow-up for life. State data by cancer type and age can help registries check their reporting and diagnostic standards, help planners and clinicians tackle barriers to care — especially where pediatric oncology centers are far away — plan survivorship care, help clinical trial organizers predict enrollment, and guide research into why incidence varies. Continued surveillance will be needed to confirm the patterns and follow them over time.

Sources

Based on Siegel DA, Li J, Henley SJ, et al., "Geographic Variation in Pediatric Cancer Incidence — United States, 2003–2014," MMWR, Centers for Disease Control and Prevention; a work of the United States government in the public domain.