Câncer infantojuvenil: tendência de incidência no município de São Paulo (1997-2015)

Abstract

INTRODUCTION: Although rare, cancer in children and adolescents are the leading cause of death both in Brazil and worldwide. In 2020, 279,419 new cases of childhood and adolescent cancer were projected worldwide. In Brazil, 7,930 new cases are estimated between 2023 and 2025. Evaluating the incidence of cancers in childhood and adolescence enables the understanding of the most common neoplasms for these age groups, as well as, through the detection of geographical and temporal variations, generating hypotheses about possible risk factors. OBJECTIVE: Describe the incidence and analyze the temporal tendency of cancer incidence rates in these groups, between the ages of 0 and 19, in the municipality of São Paulo, from 1997 to 2015. METHODOLOGY: It is a time series study that used data obtained from the São Paulo Population-Based Cancer Registry (PBCR-SP). We selected all confirmed cases of cancer in children and adolescents aged 0 to 19 years residing in the municipality of São Paulo, which could be classified according to the International Classification of Childhood Cancer (ICCC-3), from 1997 to 2015. Crude and standardized incidence rates were calculated by sex and age. Temporal trends in standardized incidence rates by main diagnostic group and sex were obtained using the Joinpoint regression model. RESULTS: Childhood and adolescent cancer in São Paulo showed a high incidence rate (189.6 per million), more pronounced in males (205.3 per million) and in the age group between 15 and 19 (233.8 per million). Leukemias were the most common type of cancer (42.9 per million), followed by lymphomas (26.6 per million) and tumors in the central nervous system (23.0 per million). Solid cancers represented the majority of the cases (63.3%), with tumors of the central nervous system being the most incident among them. The group of other malignant epithelial neoplasms and malignant melanomas had a large occurrence in the sample (19.2 per million), especially in females (24.3 per million). The analysis of the temporal trend of childhood and adolescent cancer incidence showed stability from 1997 to 2015. Leukemias showed a decreasing trend in incidence rates from 1997 to 2015 (APC= -3.0). Lymphomas showed a decreasing trend throughout the period (APC= -1.63), as did tumors of the central nervous system (APC= -3.46). CONCLUSION: The fact that lymphomas are the second most frequent childhood and adolescent neoplasm, and the high rates of the group of other malignant and unspecified neoplasms, demonstrate a behavior similar to that of countries with low/medium Human Development Index (HDI), despite São Paulo's high HDI, possibly reflecting the inequalities found in its territory. The analyses of temporal trends in incidence rates demonstrated, depending on the type of cancer, several possible causes, reflecting a higher probability of multifactorial causes. The results indicate the importance of continuous surveillance of data, early and correct diagnosis for cancer in these groups, and the importance of population-based cancer registers as a tool with relevant role in health care planning, development of public policies, and evaluation of health services.