Studies of cancer incidence patterns and trends can provide useful measures of health burden and possible disease etiology, which can aid the planning of cancer care services. This report aims to characterize trends in incidence of childhood cancer, and to assess the implications of these trends by generating incidence projections to 2015. Cancer incidence data were obtained from the database of the Pediatric Oncology Group of Ontario (POGO), which has registered all cancer cases in Ontario since 1985. Annual incidence rates were calculated with census-based population estimates for the 1986–2001 period. Poisson regression models were used to analyze trends, and to calculate projected numbers of cases up to the year 2015. From 1986 to 2001, 5,163 cancer cases occurred among children aged 0–14. Leukemia, CNS tumors and lymphomas were the most common cancers. The number of incident cases increased by 14%, from 296 in 1986 to 336 in 2001. For all cancers, average annual age-standardized rates increased from 147 per million in 1991 to 157 per million in 2001. Over the next 15 years, the 0–14 year population is expected to decrease from 2.28 million in 2000 to 2.13 million in 2015. A marginally statistically significant trend in incidence was projected for all cancers combined (0.5% increase per year p < 0.10) and a statistically significant increase for lymphomas, (1.2% per year 95% CI = 0.0–3.9%). During this period, the number of cases of leukemia and CNS tumors is expected to remain relatively stable. The number of cases of all cancers is expected to increase by 8%, from the average of 320 in 1995 to ∼347 in 2015. Understanding of these projections will facilitate health care resource planning. © 2005 Wiley-Liss, Inc.