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Abstract

  1. Top of page
  2. Abstract
  3. Materials and Methods
  4. Results
  5. Discussion
  6. Acknowledgments
  7. Disclosure Statement
  8. References
  9. Supporting Information

(Cancer Sci 2010; 101: 787–792)

Mortality for childhood cancer has declined in Osaka, as well as all over Japan, since the 1970s, but whether this decline can be explained by trends of incidence or survival of childhood cancer has not been examined. A total of 5960 malignant tumors diagnosed between 1973 and 2001 in children <15 years of age were registered at the Osaka Cancer Registry in Japan. The time trends for childhood cancer were analyzed over 29 years for incidence and 20 years for survival. Leukemia was the most common among childhood cancer for both sexes and accounted for one-third of all cases. The age-standardized annual incidence rate of all tumors was highest in 1988–1992: 155.1 per million for males and 135.9 for females. Five-year survival for all tumors improved from 50.1% in 1978–1982 to 73.0% in 1993–1997 for males and from 52.3% to 76.3% for females. Thus, the constant decline in mortality in childhood cancer was primarily due to improved survival between the 1970s and 1980s and reduced incidence after the 1990s.

Cancer is the second-highest cause of death for children <15 years of age in Japan, following accident as unintentional injury.(1) According to Vital Statistics, mortality rates for childhood cancer all over Japan have declined consistently since the beginning of 1970s for both sexes and it is similar to Osaka.(1,2) However, no studies have systematically examined trends for incidence and survival of childhood cancer to explain this mortality decline in Japan. In the USA, the Surveillance Epidemiology and End Result (SEER) program publishes annual reports on mortality, incidence, and survival.(3) Europe has large-scale registries such as the Automated Childhood Cancer Information System Project (ACCIS) and the EUROCARE study which reports incidence and survival periodically.(4–6) However, mortality data for individual countries is not available. Information on mortality, incidence, and survival has been exceptionally available from Britain.(7) An important question is to what degree the decline in the mortality from childhood cancer reflects incidence and survival trends. Marugame et al. have reported on the incidence of childhood cancer from 1993 to 2001, using the data of 15 population-based cancer registries in Japan, but long-term trends have not been examined.(8) In Japan there is no nationwide cancer registry, although a large population is needed to monitor childhood trends of cancer. The Osaka Cancer Registry is one of the few registries in the world that has a long history and covers a large-enough population to monitor trends of childhood cancer. Ajiki et al. described incidence trends for childhood cancer based on 12 major cancer classifications from 1971 to 1988 by using data from the Osaka Cancer Registry.(9) They also reported trends for survival from cancer between 1975 and 1994.(10) However, they treated incidence and survival separately, and did not focus on the effects of these two factors on mortality trends. This article reports incidence trends for childhood cancer in Osaka from 1973 to 2001 and survival trends from 1978 to 1997 to clarify whether the continuous decline in cancer mortality between 1973 and 2001 was caused by trends for incidence, survival, or both.

Materials and Methods

  1. Top of page
  2. Abstract
  3. Materials and Methods
  4. Results
  5. Discussion
  6. Acknowledgments
  7. Disclosure Statement
  8. References
  9. Supporting Information

The incidence data were obtained from the Osaka Cancer Registry, which covers all communities in Osaka Prefecture. The population in Osaka Prefecture was 8.8 million at the 2000 census, which accounts for 7% of the total Japanese population, and the analysis of incidence included childhood cancer cases diagnosed between 1973 and 2001. The data on survival was collected from patients diagnosed in 1975 for all communities except for Osaka City, which is the biggest city in Osaka Prefecture and includes a quarter of its population, and we completed the 5-year follow-up for the cases diagnosed until 1997. Although the survival data for Osaka City was available from 1993, for the analysis in this study it was not used to examine long-term trends in the defined population of Osaka Prefecture excluding Osaka City. Compared with the data for incidence trends, the analysis of survival covered approximately 3500 childhood cancer cases (82%) diagnosed between 1978 and 1997.

The Osaka Cancer Registry gathers information from reports from (1) medical institutions in Osaka Prefecture; (2) death records of inhabitants of Osaka Prefecture mentioning neoplasms; (3) autopsy records of medical institutions in Osaka Prefecture (originally compiled in the Autopsy Records of the Japanese Society of Pathology); (4) information on cancer cases in Osaka Prefecture extracted from the Nationwide Registry of Childhood Cancer of the Society for Protection of Children with Cancer; (5) records of cancer patients in Osaka Prefecture extracted from the Childhood Cancer Registry of the Committee for Malignant Tumors of the Japanese Society for Pediatric Surgeons; and (6) information from application forms used in the Research Project for Pediatric Chronic Severe Diseases.(11)

For the analysis of incidence, cases were children <15 years of age who were diagnosed with neoplasms defined by the International Classification of Childhood Cancers second revision (ICCC-2) between 1973 and 2001, and for analysis of survival, those diagnosed between 1978 and 1997.(12) Secondary or more neoplasms were included in the analysis of incidence but not in that of survival.

To examine trends for the incidence of all tumors and all tumors excluding neuroblastoma, joinpoint analysis was performed and the annual percent change (APC) was calculated from the joinpoint model by the Joinpoint 3.3 package (US National Cancer Institute, Bethesda, MD, USA)(13,14). In each diagnostic group, the annual number of the patients was so small that we need to examined the number of cases in six periods (1973–1977, 1978–1982, 1983–1987, 1988–1992, 1993–1997, and 1998–2001), where the joinpoint analysis was not conducted because of the small number of observations.

The number of cases was expressed in six periods. Incidence rates were calculated with the direct method as the number of cases per million person-years. Age-standardized rates (ASR) were calculated from age-specific incidence rates (for age groups <1, 1–4, 5–9, and 10–14 years) using the world standard population in 1970 and expressed in the six periods. Age-specific rates were expressed for two time periods, the first 15 years (1973–1987) and the following 14 years (1988–2001). The average change in incidence rate over time was modeled using Poisson regression, and expressed as the average annual percentage change (AAPC) for all tumors between 1973–1987 and 1988–2001 in age-specific rates. In order to rule out the effect of the introduction of nationwide mass screening for neuroblastoma from 1985, a calculation excluding neuroblastoma cases was added to each analysis. The P-values and 95% confidence intervals (CI) of the trend tests were also calculated.

The distribution of the number of cases used for the analysis of survival was expressed in 5-year periods: 1978–1982, 1983–1987, 1988–1992, and 1993–1997. The data of prognoses was obtained through a magnetic death file of vital statistics and resident cards.(9) Observed survival rates and 95% CIs were calculated with the Kaplan–Meier method. Death Certificate Only (DCO) cases were excluded from the survival analyses. Relative survival was not used since mortality from competing causes of death is low and our analyses indicated that the difference between observed and relative survival was at most 0.3%. Changes in survival among the four periods were tested by log-rank test for trend followed by calculation of the corresponding P-values.

The annual number of deaths by cancer, stratified for sex, was derived from reports from the Osaka Cancer Registry.(2) Mortality was calculated and joinpoint analysis was performed by sex. APC was calculated from the joinpoint model.

SAS software for Windows (version 9.1; SAS Institute Inc., Cary, NC, USA) was used for all statistical analyses.

Results

  1. Top of page
  2. Abstract
  3. Materials and Methods
  4. Results
  5. Discussion
  6. Acknowledgments
  7. Disclosure Statement
  8. References
  9. Supporting Information

Analyses for incidence are based on 5960 cases diagnosed between 1973 and 2001. Malignant tumors with a 5th-digit morphology behavior code of 3 according to the International Classification of Diseases for Oncology accounted for 98% of all childhood cancer cases (5822/5960), and the remaining cases were non-malignant tumors occurring in the central nervous system (120 cases; 2.0%), intracranial germ cell tumors (18; 0.3%). DCO cases accounted for 3.5% of the total for 1973–2001, 4.0% for 1973–1987, and 2.7% for 1988–2001. No difference was observed in the distributions of major diagnostic groups between the DCO cases and the other reported cases, except for central nervous system tumors: 34.0%vs 31.4% for leukemia, 9.6%vs 9.9% for lymphoma, 32.1%vs 19.2% for central nervous system tumors, and 3.8%vs 9.8% for sympathetic nervous system tumors. The majority (83.9%) of the tumors were microscopically confirmed for the entire study period, and the proportion increased from 80.6% for 1973–1987 to 88.7% for 1988–2001.

Figure 1 shows the trends of incidence, survival, and mortality of all tumors from 1973 to 2001 by sex. The trends of ASR for all tumors increased, and the peak was identified in 1988 for males and 1992 for females. In order to rule out the effect of mass screening for neuroblastomas initiated in 1985, the trends for ASR for all tumors excluding neuroblastomas were also examined. ASRs for all tumors excluding neuroblastoma showed the same trends except for the shift of the peaks from 1988 to 1987 for males and from 1992 to 1986 for females. The trends of mortality steadily decreased for both sexes with an APC of −3.7% since 1977 for males and −3.3 to −5.1% during the time period for females.

image

Figure 1.  Trends for incidence, 5-year survival, and mortality of all childhood cancer in Osaka, Japan. Age-standardized rates (ASRs) of all tumors (observation; black point and fitted; black line), ASR of all tumors excluding neuroblastoma (observation; cross mark and fitted; dashed line), mortality (observation; black point and fitted; dotted line) and 5-year survival (black square) and 95% CI. The annual percent changes (APCs) are indicated in the graph. *< 0.05.

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Figure 2 and Table S2 presents the sex-specific trends in the age-standardized rate (ASR) of childhood cancer incidence by diagnostic group. Leukemia in males and females showed the highest frequency for the whole period, followed by central nervous system tumors, except for the excess in sympathetic nervous system tumors in 1993–1997 in males and 1988–1997 in females. Childhood cancer was more common among males than females with a male-to-female ratio of 1.27 (Table S1). This ratio was particularly high for lymphomas (1.69) and renal tumors (1.70) and slightly higher for retinoblastomas (1.10), malignant bone tumors (1.05), and epithelial tumors (1.02). The cases in the four major diagnostic groups (leukemia, lymphoma, central nervous system tumors, and sympathetic nervous system tumors) accounted for approximately 70% of all tumors for both sexes.

image

Figure 2.  Trends for age-standardized rates (ASRs) of childhood cancer by diagnostic groups in Osaka, Japan, from 1973 to 2001. Central nervous system (CNS) (inline image), germ-cell tumor (inline image), hepatic tumor (inline image), leukemia (inline image), lymphoma (inline image), malignant bone tumor (inline image), renal tumor (inline image), retinoblastoma (inline image), soft tissue tumor (inline image in the middle), sympathetic nervous system tumor (inline image).

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The incidence rates for sympathetic nervous system tumors increased until 1993–1997 for males and until 1988–1992 for females, and then declined. For males, the incidence rates for leukemias, lymphomas, and malignant bone tumors increased until 1983–1987 and showed no consistent trends. ASRs for germ-cell tumors and hepatic tumors declined from 1988–1992 to 1998–2001. For females, the incidence rates for lymphomas, germ-cell tumors, and soft tissue tumors increased until 1983–1987 and then declined.

Age-specific incidence rates for all tumors were highest in the 0-year age group, followed by the 1–4-year age group for both sexes (Table 1). This trend was similar to the incidence rates for all tumors excluding neuroblastomas for both sexes. For the other diagnostic groups, higher rates in the 0- and 1–4-year age groups and lower rates for the 5–14-year age groups were observed for leukemias, sympathetic nervous system tumors, retinoblastomas, renal tumors, hepatic tumors, and germ-cell tumors in both sexes. Incidence rates for malignant bone tumors increased with age for both sexes. Age-specific rates for all tumors in the 0-year old increased substantially from 1973–1987 to 1988–2001, primarily due to the increased rate of neuroblastoma. AAPCs for all tumors for the various age groups ranged from 2.0% to 3.1% between 1973 and 1989 and from −0.4% to −4.2% between 1988 and 2001 for males, and from 1.2% to 3.7% and −1.8% to −2.9% for females.

Table 1.   Sex- and age-specific rate and average annual percent change of childhood cancer in Osaka, Japan, from 1973 to 2001 by period
ClassificationMalesFemales
Age-specific rateAge-specific rate
0 year1–4 years5–9 years10–14 years0 year1–4 years5–9 years10–14 years
73–8788–200173–8788–200173–8788–200173–8788–200173–8788–200173–8788–200173–8788–200173–8788–2001
  1. *< 0.05; **< 0.01; ***< 0.001. AAPC, average annual percentage change.

I. Leukemia50.056.665.663.038.538.325.130.849.353.951.856.429.027.824.623.8
II. Lymphoma13.86.516.013.611.817.815.915.715.78.411.311.48.46.97.98.5
III. Central nervous   system tumors57.442.028.431.324.221.525.117.135.935.323.723.121.919.017.618.8
IV. Sympathetic   nervous   system tumors33.0179.418.219.24.44.11.41.437.0175.115.513.02.63.91.00.3
V. Retinoblastoma26.622.610.77.60.61.60.20.031.410.19.59.70.81.00.00.0
VI. Renal tumors33.019.49.710.81.31.60.41.712.38.46.88.80.80.31.00.9
VII. Hepatic tumors9.619.45.03.21.01.91.82.012.316.84.25.90.80.70.80.6
VIII. Malignant bone    tumors2.14.81.51.63.42.87.812.01.10.00.51.33.44.39.910.3
IX. Soft-tissue   sarcomas22.319.46.09.24.67.24.95.025.815.15.07.63.45.23.97.3
X. Germ-cell tumors36.227.512.58.83.15.37.86.213.523.64.75.15.44.911.411.5
XI. Epithelial tumors2.10.01.20.01.30.92.75.32.20.01.10.41.01.63.74.1
XII. Unspecified    tumors7.48.12.73.62.50.31.41.411.23.43.20.81.01.01.92.1
All tumors293.5405.6177.5172.096.7103.294.498.4247.7350.1137.2143.578.776.683.788.1
All tumorsexcludingneuroblastoma260.5226.2159.3152.892.399.193.097.0210.7175.1121.7130.576.072.682.787.8
AAPC (%) for all tumors3.1−4.22.0−0.42.0−2.72.6−1.41.2−1.83.7−2.31.8−2.91.9−2.1
95% confidence interval(0.3–5.9)*(−7.1–−1.2)**(0.3–3.8)*(−2.7–1.9) *(−0.1–4.1)(−5.3–−0.1)*(0.4–4.8)*(−3.9–1.2)(−1.8–4.3)(−5.1–1.5)(1.7–5.8)***(−4.8–0.3)(−0.6–4.2)(−6.0–0.2)(−0.4–4.3)(−4.8–0.7)

The distribution of cases used for survival analysis was expressed by tumor group over 5-year periods (Table S3). A total of 3460 childhood cancer cases diagnosed during 1978–1997 were used for the survival analysis. DCO cases numbered 47 (1.4%) between 1978 and 1987 with 22 cases between 1978 and 1982. Central nervous system tumors, leukemias, and lymphomas accounted for more than half of the DCO cases in every period.

Figure 3 illustrates trends for sex-specific 5-year survival rates in each diagnostic group in 5-year periods. Survival improved significantly over the four survey periods for all tumor groups. Overall survival for all tumors increased from 50% (95% CI: 46–55) to 74% (95% CI: 70–79) for males, and from 52% (95% CI: 47–58) to 77% (95% CI: 73–82) for females. These trends did not change for all tumors excluding neuroblastomas. Survival for all tumors excluding neuroblastomas was slightly higher (at most 2%) during 1978–1982 and 1983–1988 and slightly lower (at most 2%) during 1988–1992 and 1993–1998 than survival for all tumors for both sexes. Improvement in survival was statistically significant for leukemias, lymphomas, sympathetic nervous system tumors, germ cell tumors, all tumors excluding neuroblastomas, and all tumors. Central nervous system tumors and some other minor diagnostic groups showed no significant changes in survival.

image

Figure 3.  Trends for age-standardized rates (ASRs) of childhood cancer by diagnostic groups in Osaka, Japan, from 1978 to 1997. Central nervous system (CNS) (inline image), germ-cell tumor (inline image), hepatic tumor (inline image), leukemia (inline image), lymphoma (inline image), malignant bone tumor (inline image), renal tumor (inline image), retinoblastoma (inline image), soft tissue tumor (inline image in the middle), sympathetic nervous system tumor (inline image).

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Discussion

  1. Top of page
  2. Abstract
  3. Materials and Methods
  4. Results
  5. Discussion
  6. Acknowledgments
  7. Disclosure Statement
  8. References
  9. Supporting Information

The data presented here from the large-scale and long-term cancer registry in Osaka showed a unique trend in the incidence of total childhood cancer: an increase until 1988 with an APC of 1.5% for males and until 1992 with an APC of 1.7% for females, and then successive decrease with declining APCs of −2.0% for males and −1.9% for females. These trends did not change when neuroblastomas were excluded from this analysis.

As for survival, we have found an approximately 50–75% increase for the periods 1978–1982 and 1993–1997 for both sexes. The trend for mortality in Osaka was similar to that in all over Japan (Fig. 1).(15) These findings indicate that the continuous decline in mortality from childhood cancer throughout the period 1973–2001 was due to substantial improvement in survival in spite of an increase in incidence between the 1970s and 1980s, and a stable survival but declining incidence after the 1990s. Mortality and survival in our study showed similar trends to those in the USA and European countries, although these countries reported a continuous increase in the incidence of childhood cancer between the 1970s and 1990s.(3,4,7)

The reason why the total childhood incidence in Osaka increased but has declined since 1998 for males and 1992 for females is unknown. That decline is unlikely due to a systematic drift for collecting data. If systematic drift occurs, the trends would be similar regardless of diagnostic grouping. However, the incidence of. leukemia, retinoblastoma, central nervous system in males, and hepatic tumors in females did not decline over time, while other tumors such as sympathetic nervous system tumors and germ-cell tumors declined from the middle of the study period for both sexes, a tendency which is not seen in other areas such as the USA and Europe.(3,4) Moreover, the incidence of sympathetic nervous system tumors declined in spite of continuous and vigorous national screening and accurate detection of neuroblastoma. There is a concern that data came mostly from the Research Project for Pediatric Chronic Severe Diseases, which is originally for subvention of treatment costs. However, this research project has been conducted vigorously and the possibility of the systematic drift of detection may be small.

The proportion of DCO cases in the registry used for this study was 3.5% throughout the study period, higher than the percentages in other registries in the USA and Europe, which according to the SEER and ACCIS project was <1% in almost all European areas.(3,4) The distribution among diagnostic groups between DCO and other cases did not differ substantially except for central nervous system tumors, which consists of various morphological types in the present study.

The screening for neuroblastomas in 6-month-old infants from 1985 to 2003 resulted in an increase of almost six times the incidence of neuroblastomas among infants in 1988–2001 compared to 1973–1987. The ASR for neuroblastomas tripled but the ASR for all tumors increased by only 10% because 0-year infants accounted for only approximately 5–7% of all incident cases. Although our reports covered the period until 2001, this screening was stopped in 2004 after two reports that screening for neuroblasotomas among infants had no effects on mortality.(16,17)

The survival of childhood cancer patients in the leukemia and other diagnostic groups in Osaka markedly improved between 1978 and 1992, probably due to earlier diagnosis and more effective therapies.(3,18) The introduction of mass screening for neuroblastomas had no effect on the total tumor survival rates, since the rates excluding and including neuroblastomas were similar.

Survival for the major diagnostic groups in 1993–1997 in our study was generally lower than that in the USA and UK.(3,5) The 5-year survival for leukemias, for example, was 73% for males and 76% for females in Osaka, 80% in the USA, and 76% in the UK. The exception is the higher 5-year survival rate for neuroblastomas in our study (86%) compared with that in the USA (69%) and UK (57%), probably due to over-diagnosis resulting from nationwide mass screening.(19,20)

In conclusion, our study has clarified the trends for incidence, survival, and mortality of childhood cancer in Japan. The constant decline in mortality from childhood cancer was primarily due to the improvement in survival during the 1970s and 1980s, and the reduction in incidence after the 1990s.

Acknowledgments

  1. Top of page
  2. Abstract
  3. Materials and Methods
  4. Results
  5. Discussion
  6. Acknowledgments
  7. Disclosure Statement
  8. References
  9. Supporting Information

This study was supported in part by a Grant-in Aid for Cancer Research (14-2) from the Ministry of Health, Labour and Welfare of Japan. Authors appreciate Ms Miho Imanaka for her assistance with making graphs.

References

  1. Top of page
  2. Abstract
  3. Materials and Methods
  4. Results
  5. Discussion
  6. Acknowledgments
  7. Disclosure Statement
  8. References
  9. Supporting Information
  • 1
    Statistics and Information Department, Minister’s Secretariat, Ministry of Health, Labour and Welfare. Vital Statistics of Japan 2005. Tokyo: Health and Welfare Statistics Association, 2007. (In Japanese.)
  • 2
    Osaka Prefectural Department of Public Health and Welfare, Osaka Medical Association, Osaka Medical Center for Cancer and Cardiovascular Diseases. Annual Report of Osaka Cancer Registry No.71 – Cancer Incidence and Medical Care in Osaka in 2004 and the Survival in 2000. OPDPHW, 2008. (In Japanese.)
  • 3
    Ries MelbertD, KrapchoM, eds. SEER Cancer Statistics Review, 1975–2004. Bethesda, MD: National Cancer Institute. [Cited 22 Dec 2009.] Available from URL: http://seer.cancer.gov/csr/1975_2004/.
  • 4
    Kaatsch P, Steliarova-Foucher E, Crocetti E, Magnani C, Spix C, Zambon P. Time trends of cancer incidence in European children (1978–1997): report from the Automated Childhood Cancer Information System project. Eur J Cancer 2006; 42: 196171.
  • 5
    Magnani C, Pastore P, Coebergh JW, Viscomi S, Spix C, Steliarova-Foucher E. Trends in survival after childhood cancer in Europe, 1978–1997: reports from the Automated Childhood Cancer Information System project (ACCIS). Eur J Cancer 2006; 42: 19812005.
  • 6
    Gatta G, Gorazziari I, Magnani C et al. Childhood cancer survival in Europe. Ann Oncol 2003; 14: 11927.
  • 7
    Cancer Research UK. Childhood Cancer Statistics Trends, 2001. [Cited 22 Dec 2009.] Available from URL: http://info.cancerresearchuk.org/cancerstats/childhoodcancer/trends/?a=5441.
  • 8
    Marugame T, Katanoda K, Matsuda T et al. The Japan Cancer Surveillance Report: incidence of childhood, bone, penis, and testis cancers. Jpn J Clin Oncol 2007; 37: 31923.
  • 9
    Ajiki W, Hanai A, Tsukuma H, Hiyama T, Fujimoto I. Incidence of childhood cancer in Osaka, Japan, 1971–1988: reclassification of registered cases by Birch’s scheme using information on clinical diagnosis, histology and primary site. Jpn J Cancer Res 1994; 85: 13946.
  • 10
    Ajiki W, Tsukuma H, Oshima A. Survival rates of childhood cancer patients in Osaka, Japan. Jpn J Clin Oncol 2004; 34: 504.
  • 11
    Ajiki W, Tsukuma H, Oshima A. The Source of Registration of Childhood Cancer in Osaka Cancer Registry In. JACR Monograph NO.8. Osaka: Japanese Association of Cancer Registries, 2003. (In Japanese.)
  • 12
    Kramarova E, Stiller CA. The international classification of childhood cancer. Int J Cancer 1996; 68: 75965.
  • 13
    Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation Tests for joinpoint regression with applications to cancer rates. Stat Med 2000; 19: 335516.
  • 14
    National Cancer Institute. Joinpoint Regression Program ver 3.3 [Cited 22 Dec 2009.] Available from URL: http://srab.cancer.gov/joinpoint/
  • 15
    Yang L, Fujimoto J, Qiu D, Saskamoto N. Childhood cancer in Japan: focusing on trend in mortality from 1970 to 2006. Annals of Oncology 2009; 20: 16674.
  • 16
    Woods WG, Gao RN, Shuster JJ et al. Screening of infants and mortality due to neuroblastoma. NEJM 2002; 346: 10416.
  • 17
    Schilling FH, Spix C, Berthold F et al. Neuroblastoma screening at one year of age. NEJM 2002; 346: 104753.
  • 18
    Rubnits JE, Pui CH. Recent advances in the treatment and understanding of childhood acute lymphoblastic leukemia. Cancer Treat Rev 2003; 29: 3144.
  • 19
    Ajiki W, Tsukuma H, Ohshima A, Kawa K. Effects of mass screening for neuroblastoma on incidence, mortality, and survival rates in Osaka, Japan. Cancer Causes Control 1998; 9: 6316.
  • 20
    Honjo S, Doran HE, Stiller CA et al. Neuroblastoma trends in Osaka, Japan, and Great Britain 1970–1994, in relation to screening. Int J Cancer 2003; 103: 53843.

Supporting Information

  1. Top of page
  2. Abstract
  3. Materials and Methods
  4. Results
  5. Discussion
  6. Acknowledgments
  7. Disclosure Statement
  8. References
  9. Supporting Information

Table S1. Sex-specific trends in incident cases of childhood cancer in Osaka, Japan, from 1973 to 2001.

Table S2. Sex-specific trends in age-standardized incidence rate and average annual percent changes of childhood cancer in Osaka, Japan, from 1973 to 2001.

Table S3. Sex-specific 5-year survival rates (%) of childhood cancer in Osaka, Japan, from 1978 to 1997.

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