Global cancer statistics for children: Two decades of change and projections to 2050

Abstract

Reliable, contemporary estimates of the global childhood cancer burden remain scarce, particularly in the post‐coronavirus disease 2019 (COVID‐19) era. By using data from the Global Burden of Disease 2021 and Global Cancer Observatory 2022 projects, the authors evaluated the childhood cancer burden at global, regional, and national levels, characterizing temporal and projected trends, and analyzed the data according to disparities by geography and socioeconomic development. From 2000 to 2021, the age‐standardized incidence rate (ASIR) and the age‐standardized mortality rate (ASMR) of childhood cancer declined overall (average annual percent change, −0.88 and −2.13, respectively), especially during the COVID‐19 pandemic. During this period, the disparities in childhood cancer burden were mainly concentrated in countries/territories with a lower Sociodemographic Index. In 2022, an estimated 202,164 new cases and 77,182 deaths from childhood cancer occurred worldwide (ASIR and ASMR, 10.3 and 3.9 per 100,000 children, respectively). Countries/territories with higher a Human Development Index (HDI) had a higher incidence (ASIR, 8.0 [low HDI] vs. 15.3 [very high HDI] per 100,000), whereas those with a lower HDI had higher mortality (ASMR, 4.4 [low HDI] vs. 2.8 [very high HDI] per 100,000). Analyses indicated that, by 2050, there will be 204,925 projected new cases and 78,210 deaths globally, with increases only in low HDI countries/territories, exacerbating existing health inequities. Childhood cancer remains a global health challenge, with notable geographic and socioeconomic disparities. These data serve as the impetus for governments and policymakers to prioritize resources and equitable access to interventions, particularly in regions with lower levels of development, while addressing health care vulnerabilities exposed by global crises like the COVID‐19 pandemic.

INTRODUCTION

Despite its relative rarity compared with other illnesses, childhood cancer is the dominant cause of disease‐related death among children worldwide. ¹ , ² , ³ Thanks to ongoing medical advancements, childhood cancer is curable for a majority of patients, particularly when essential diagnosis, treatment, and supportive care services are available. ⁴ , ⁵ However, significant disparities in childhood cancer outcomes persist between high‐income countries (HICs) and low‐income and middle‐income countries (LMICs). ⁶ , ⁷ , ⁸ , ⁹ Over the past few decades, the prognoses for childhood cancers have substantially improved, with 5‐year survival rates exceeding 80% in most HICs. ¹⁰ , ¹¹ Although LMICs account for greater than 80% of the global childhood cancer burden, the improvement in survival outcomes is less marked. ¹² , ¹³ Critical barriers, such as insufficient health care infrastructure, shortage of specialized medical professionals, and limited access to essential medications, severely hinder effective childhood cancer treatment in LMICs. This inequity obstructs progress toward worldwide progress, such as the goals outlined in the United Nations 2030 Agenda for Sustainable Development (https://sdgs.un.org/2030agenda, February 17, 2026).

In response to these challenges, the World Health Organization (WHO) launched the Global Initiative for Childhood Cancer in 2018, with the objective of enhancing cancer outcomes for children worldwide. ¹⁴ The Global Initiative for Childhood Cancer aims to narrow the survival gap between HICs and LMICs by 2030, with the objective that at least 60% of children with cancer globally will survive after diagnosis. ¹⁵

In this article, we examine the temporal trends of childhood cancer burden worldwide in the last 2 decades (from 2000 to 2021) using data from the Global Burden of Disease (GBD) 2021 project, and we compare the reported incidence and mortality of childhood cancer during the coronavirus disease 2019 (COVID‐19) pandemic (from 2019 to 2021) with the indicators predicted by the Bayesian age‐period‐cohort (BAPC) model to reveal potential underdiagnosis linked to health care disruptions during the pandemic. By using data from the Global Cancer Observatory (GLOBOCAN) 2022 project, we describe the contemporary epidemiology of global childhood cancer burden in 2022, focusing on incidence and mortality patterns, as well as their geographic and socioeconomic variations. We also report the projected childhood cancer burden by 2050. By highlighting geographic and socioeconomic disparities of childhood cancer, these findings can inform targeted cancer control strategies on a global scale.

MATERIALS AND METHODS

Data sources and definitions

Data on global childhood cancer burden, encompassing all available cancer types, were obtained from the GBD 2021 (https://vizhub.healthdata.org/gbd‐results/, December 26, 2025) and GLOBOCAN 2022 (https://gco.iarc.fr/today/en, December 26, 2025) projects. The underlying methodologies and data sources for both estimates have been described in detail in previous publications and are publicly accessible through the respective online platforms. ¹⁶ , ¹⁷ Because publicly available, de‐identified, population‐level data were used, our study did not require institutional review board approval or informed consent.

This study defined childhood cancer as malignancies diagnosed in patients younger than 15 years, consistent with the classifications used by the WHO and the American Cancer Society. Malignant neoplasms were classified following the International Classification of Diseases, Tenth Revision, with detailed crosswalks to the GBD and GLOBOCAN classifications provided in Table S1. The GLOBOCAN 2022 database encompassed 36 malignancy groups (34 categorized and two uncategorized), compared with 13 malignant neoplasm groups (12 categorized and one uncategorized) in GBD 2021. Whereas GLOBOCAN provided only incidence and mortality estimates, GBD provided more comprehensive outcome indicators comprising incidence, prevalence, mortality, disability‐adjusted life‐years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). Geographically, GLOBOCAN covered 185 countries/territories across 21 regions versus the GBD project's broader coverage of 204 countries/territories spanning 21 regions (see Tables S2 and S3).

For socioeconomic development assessment, GBD used the Sociodemographic Index (SDI), comprising fertility rates in women younger than 25 years, educational attainment in persons aged 15 years and older, and lag‐adjusted per capita income. ¹⁸ GLOBOCAN used the Human Development Index (HDI; https://hdr.undp.org/data‐center/human‐development‐index, December 26, 2025), which incorporates life expectancy, educational level, and gross national income.

Health system metrics (including a gender inequality index, the Universal Health Coverage index, physicians per 1000 population, nurses and midwives per 10,000 population, gross domestic product per capita [adjusted to 2022 US dollars], current health expenditure [CHE] per capita [adjusted to 2022 US dollars], domestic general government health expenditure [GGHE‐D; adjusted to 2022 US dollars], CHE as a percentage of gross domestic product, out‐of‐pocket spending as a percentage of CHE, GGHE‐D as a percentage of CHE, availability of public pathology services, availability of public tertiary cancer centers, availability of a population‐based cancer registry, and radiotherapy units per 1,000,000 population) were obtained from the United Nations Development Program (https://hdr.undp.org/, December 26, 2025), the Global Health Observatory (https://www.who.int/data/gho, December 26, 2025), the World Bank (https://data.worldbank.org/, December 26, 2025), and the Directory of Radiotherapy Centers (https://dirac.iaea.org/, December 26, 2025).

Statistical analysis

We report the absolute numbers and age‐standardized rates (ASRs) for childhood cancer incidence, prevalence, mortality, and DALYs at the global, regional, and national levels based on GBD 2021 and GLOBOCAN 2022 estimates. The truncated ASR per 100,000 children was calculated according to the following formula:

$$\frac{{\sum }_{i=1}^A{a}_i{w}_i}{{\sum }_{i=1}^A{w}_i}\times 100,000,$$

where a _i represents the age‐specific rate for the i‐th age group, w _i represents the corresponding weight in the standard population, and A represents the total number of age groups.

The ASRs for GBD 2021 were estimated based on the GBD 2021 standard population, whereas the ASRs for GLOBOCAN 2022 were estimated based on the world standard population proposed by Segi (see Table S4). ¹⁹ Temporal trends in the ASRs were evaluated by using the average annual percent change (AAPC) calculated through Joinpoint regression analysis (version 5.2.0; National Cancer Institute). The AAPC summarizes long‐term trends as a weighted average of the annual percent change (APC). Trends were considered statistically significant if the APC or AAPC slope differed from zero in two‐sided tests; trends were categorized as increasing or decreasing accordingly and as stable if they were nonsignificant.

To assess geographic and developmental disparities, the associations between country‐level ASRs, mortality‐to‐incidence ratios (MIRs), and the socioeconomic indicators were explored through scatterplots with LOWESS (locally weighted scatterplot smoothing) regression analysis, followed by Spearman correlation analysis. MIRs were adopted to convert cancer incidence information into mortality estimates with spatiotemporal Gaussian process regression analysis, thereby maximizing data availability in locations where mortality information is scarce. ¹² By using frontier analysis, the empirical relation between childhood cancer burden and socioeconomic development was evaluated. This nonparametric approach identifies a frontier curve representing the lowest observed ASRs achievable at each SDI level across countries or regions. The curve serves as a data‐driven benchmark for optimal outcomes under current global conditions. Countries substantially above the frontier may have greater potential for reducing childhood cancer burden, whereas countries near or on the frontier are considered to perform relatively well given their developmental context.

Absolute and relative inequality in childhood cancer burden was quantified by using the slope index of inequality (SII) and the concentration index (CI). The SII was calculated through regression analysis of age‐standardized DALYs and the SDI, using the midpoint of the cumulative population distribution ranked by SDI. Changes in health inequality were analyzed by comparing the data from 2000 to 2021. To reduce the influence of outliers, in the current study, we used a robust regression model. To calculate the CI, the cumulative fraction of age‐standardized DALYs was matched with the cumulative population distribution ranked by SDI, and the area under the Lorenz curve was numerically integrated. A negative SII or CI value indicates a higher burden in countries/territories with lower SDI, and a larger absolute value of the SII or CI indicates greater inequality.

Given the potential impact of the COVID‐19 pandemic on cancer diagnosis, the childhood cancer burden during the pandemic was projected using the BAPC model based on data preceding the pandemic (i.e., up to 2019) from the GBD 2021 project. This model was established through the BAPC package in R (R Foundation for Statistical Computing), ²⁰ and used integrated nested Laplace approximations to directly estimate the posterior marginal distributions. The integrated nested Laplace approximation was further used to extrapolate future values by capturing age, period, and cohort effects. Model fitting was conducted without reliance on Markov chain Monte Carlo methods to avoid convergence issues commonly associated with Markov chain Monte Carlo–based Bayesian estimation.

To evaluate the associations between MIRs and 15 socioeconomic and health system metrics, univariable linear regression models were established. Only variables with p < .00333 (Bonferroni correction, α = .05 [15 comparisons]) were included in the initial multivariable regression model. Multicollinearity was evaluated by variation inflation factor (VIF) analysis. Variables with VIF >10 were removed from the final model. Model performance was evaluated using coefficient of determination (R²) and adjusted R² statistics. Standardized coefficients were calculated for both univariable and multivariable linear regression models to facilitate the comparison of effect sizes across predictors with different scales. We used the refit method using the effect size package in R, which involves re‐fitting the models after applying Z‐score standardization (mean ± standard deviation, 0 ± 1) to both the outcome and the predictor variables. Robust standard errors (HC3; a heteroskedasticity‐consistent estimator) were used to account for potential heteroscedasticity. Diagnostic checks were performed, including residual analysis, normality assessment, leverage examination, and collinearity verification.

The projected number of new childhood cancer cases and deaths by 2050 was estimated by applying sex‐specific incidence and mortality rates from GLOBOCAN 2022 to population projections from the United Nations World Population Prospects 2019 revision (https://www.un.org/development/desa/pd/news/world‐population‐prospects‐2019‐0, December 26, 2025). Additional methodological details and guidance for interpreting the projection outputs are available from the Cancer Tomorrow project (https://gco.iarc.fr/tomorrow/en/, December 26, 2025).

Microsoft Excel 2016 (Microsoft Corporation) was used for data extraction and management; whereas all data processing, statistical analyses, and visualizations were performed in R software, version 4.5.1.

RESULTS

Temporal trends of global childhood cancer burden from 2000 to 2021

According to the GBD 2021 project, from 2000 to 2021, both the number of new cases and the number of prevalent childhood cancer cases demonstrated a nonlinear pattern—first declining, then rising, and declining again—whereas the number of deaths demonstrated a continuous downward trend over time (Figure 1A–C). In parallel, the age‐standardized incidence, prevalence, and mortality rates (age‐standardized incidence rate [ASIR], age‐standardized prevalence rate [ASPR], and age‐standardized mortality rate [ASMR], respectively) of childhood cancer revealed overall declining trends, with AAPCs of −0.88, −0.14, and −2.13, respectively (Figure 1D–F). Specifically, the ASIR and ASPR declined between 2000 and 2002, increased between 2003 and 2018, and experienced a marked reduction during the COVID‐19 pandemic (2019–2021). The ASMR progressively reduced from 2000 to 2021, especially during the COVID‐19 pandemic. This temporal pattern was almost consistent with the fluctuations observed in the ASIR, ASPR, and ASMR for leukemia and for brain and central nervous system (CNS) tumors (see Figure S1A–C and Table S5). Notably, all cancer types exhibited negative AAPCs for the ASIR, ASPR, and ASMR during the COVID‐19 pandemic; however, these declines were not statistically significant, likely because of the limited observation window (see Figure S1D–F). This pattern may partly reflect pandemic‐related disruptions in diagnosis and reporting rather than true epidemiologic changes.

FIGURE 1.

Temporal trends in the incidence, prevalence, and mortality of childhood cancer worldwide from 2000 to 2021. (A−C) Trends in the number of new cases, prevalence, and deaths from childhood cancer in different world regions from 2000 to 2021. (D−F) Temporal trends in the age‐standardized incidence rate, the age‐standardized prevalence rate, and the age‐standardized mortality rate of childhood cancer worldwide from 2000 to 2021. Asterisks indicate p < .05. AAPC indicates average annual percent change; APC, annual percent change. Data source: Global Burden of Disease, 2021.

Figure 2A illustrates the trends of global YLLs, YLDs, and DALYs attributed to childhood cancer between 2000 and 2021. The number of childhood cancer‐caused YLLs and DALYs declined globally during this period, whereas the number of childhood cancer‐caused YLDs declined between 2000 and 2004, increased between 2005 and 2019, and declined between 2020 and 2021. Overall, age‐standardized DALYs from childhood cancer declined globally between 2000 and 2021 (Figure 2B,C), indicating that the global burden of childhood cancer tended to decline over time. To assess the absolute and relative inequality in the global burden of childhood cancer associated with the SDI, the SII and CI values for age‐standardized DALYs were calculated. The SII values were −252.05 (95% CI, −314.02, −190.08) in 2000 and −233.96 (95% CI, −278.04, −189.87) in 2021 (Figure 2D), whereas the CIs were −0.13 (95% CI, −0.16, −0.10) in 2000 and −0.15 (95% CI, −0.19, −0.12) in 2021 (Figure 2E). This reflects the finding that the global burden of childhood cancer was disproportionately concentrated in lower SDI countries/territories from 2000 to 2021. In addition, the absolute inequality in childhood cancer burden was improved, but the relative inequality was worsened during this period.

FIGURE 2.

Temporal trends in DALYs of childhood cancer worldwide from 2000 to 2021. (A) Trends in the number of YLLs, YLDs, and DALYs for different childhood cancer types at the global level from 2000 to 2021. (B) Trends in age‐standardized DALYs with SDI at the global level from 2000 to 2021. The color gradient represents the progression of years. The frontier curve represents the lowest observed age‐standardized DALYs achievable at each SDI level. (C) Changes in age‐standardized DALYs in different countries across different SDI levels between 2000 and 2021. Each dot represents a specific country. (D) Scatterplot of age‐standardized DALYs by SDI ranking with robust linear model fits in 2000, 2011, and 2021. (E) Concentration curves depict the distribution of age‐standardized DALYs by SDI ranking in 2000, 2011, and 2021. CI indicates concentration index; CNS, central nervous system; DALYs, disability‐adjusted life‐years; SDI, Sociodemographic Index; SII, slope index of inequality; YLDs, years lived with disability; YLLs, years of life lost. Data source: Global Burden of Disease, 2021.

The unequal concerns about childhood cancer during COVID‐19

The number of new cases, prevalence, deaths, and DALYs of childhood cancer all showed a marked reduction from 2019 to 2021, which represents the time most affected by the COVID‐19 pandemic. To assess the effect of the COVID‐19 pandemic on childhood cancer, we used the BAPC model to calculate the expected childhood cancer burden in 2021. The statistically reported ASIR, ASPR, ASMR, and age‐standardized DALYs were lower than the BAPC model‐predicted values in most countries/territories in 2021, especially in countries/territories with middle, high‐middle, and high SDI levels (Figure 3A and Table 1), indicating that childhood cancer was underdiagnosed and that deaths attributable to childhood cancer were not reported during the COVID‐19 pandemic. Notably, for most childhood cancer types, girls experienced a more pronounced percentage decrease in the statistically reported ASIR, ASPR, and ASMR than the model‐predicted values compared with boys (Figure 3B). The exception was Hodgkin lymphoma, in which boys experienced a more pronounced percentage decrease in the statistically reported ASIR, ASPR, and ASMR than the model‐predicted values compared with girls.

FIGURE 3.

The unequal concerns about childhood cancer during the coronavirus disease 2019 pandemic. (A) Global maps present the percentage changes in reported and predicted age‐standardized rates of incidence, prevalence, mortality, and DALYs of childhood cancer in 2021 worldwide (percentage change = [reported statistically value − model‐predicted value]/model‐predicted value). (B) Percentage changes in reported and predicted age‐standardized rates of incidence, prevalence, and mortality of different childhood cancer types, for boys and girls separately and combined. ASDR indicates age‐standardized disability‐adjusted life years rate; ASIR, age‐standardized incidence rate; ASMR, age‐standardized mortality rate; ASPR, age‐standardized prevalence rate; BCNST, brain and central nervous system tumors; DALYs, disability‐adjusted life‐years; EYEC, eye cancer; HL, Hodgkin lymphoma; KIDC, kidney cancer; LC, liver cancer; LEUK, leukemia; NA, not applicable/not available; NBPNT, neuroblastoma and other peripheral nervous cell tumors; NHL, non‐Hodgkin lymphoma; OMN, other malignant neoplasms; PC, percentage change; STS, soft tissue and other extraosseous sarcomas. Data source: Global Burden of Disease, 2021.

TABLE 1.

Reported and predicted age‐standardized rates of childhood cancer incidence, prevalence, mortality, and disability‐adjusted life‐years and their percentage changes in 2021, worldwide, based on Global Burden of Disease 2021 data.

	SDI level
	Low	Low‐middle	Middle	High‐middle	High
ASIR per 100,000
Reported	8.0	7.2	9.7	14.3	12.7
Predicted	8.1	7.7	11.5	17.8	14.1
PC, %	−2.2	−6.1	−15.9	−19.8	−10.2
ASPR per 100,000
Reported	42.3	38.4	60.2	104.3	97.5
Predicted	43.1	40.9	74.3	132.5	109.0
PC, %	−1.8	−6.1	−18.9	−21.3	−10.6
ASMR per 100,000
Reported	5.5	4.4	3.8	3.2	2.1
Predicted	5.6	4.6	4.1	3.5	2.2
PC, %	−2.3	−5.8	−8.4	−10.2	−7.6
ASDR per 100,000
Reported	467.0	367.7	317.5	272.4	178.3
Predicted	477.3	390.4	348.2	305.3	194.3
PC, %	−2.1	−5.8	−8.8	−10.8	−8.2

Abbreviations: ASDR, age‐standardized disability‐adjusted life‐years rate; ASIR, age‐standardized incidence rate; ASMR, age‐standardized mortality rate; ASPR, age‐standardized prevalence rate; DALYs, disability‐adjusted life‐years; GBD, Global Burden of Disease; PC, percentage change; SDI, Sociodemographic Index.

Global burden of childhood cancer in 2022

Table 2 presents the number of new cases and deaths, the ASIR, and the ASMR for childhood cancer worldwide in 2022. There were 202,164 new cancer cases and 77,182 cancer‐related deaths in children younger than 15 years worldwide in 2022, with an ASIR of 10.3 per 100,000 children and an ASMR of 3.9 per 100,000 children. According to the GLOBOCAN 2022 project, the most prevalent and fatal childhood cancers globally in 2022 were leukemia (64,566 new cases and 23,833 deaths), other specified cancers (42,766 new cases and 16,713 deaths), brain and CNS tumors (24,677 new cases and 12,249 deaths), non‐Hodgkin lymphoma (17,615 new cases and 6590 deaths), and kidney cancer (12,505 new cases and 4716 deaths). The ASIRs for leukemia, other specified cancers, brain and CNS tumors, non‐Hodgkin lymphoma, and kidney cancer were 3.33, 2.2, 1.25, 0.89, and 0.68 per 100,000 children, respectively, whereas the ASMRs were 1.21, 0.86, 0.62, 0.33, and 0.25 per 100,000 children, respectively.

TABLE 2.

Estimated number and age‐standardized rates of new cases and deaths in children (with all‐age statistics in parentheses) in 2022 by cancer type and sex, worldwide, based on Global Cancer Observatory 2022 data.

Cancer site	Incidence (all‐age statistics)						Mortality (all‐age statistics)
	No.			ASR			No.			ASR
	Both	Males	Females	Both	Males	Females	Both	Males	Females	Both	Males	Females
All cancers	202,164 (19,976,499)	114,689 (10,311,610)	87,475 (9,664,889)	10.33 (196.90)	11.40 (212.60)	9.20 (186.30)	77,182 (9,743,832)	44,498 (5,430,284)	32,684 (4,313,548)	3.90 (91.70)	4.40 (109.80)	3.40 (76.90)
Leukemia	64,566 (487,294)	37,511 (278,120)	27,055 (209,174)	3.33 (5.26)	3.75 (6.23)	2.88 (4.38)	23,833 (305,405)	14,113 (173,289)	9720 (132,116)	1.21 (3.09)	1.39 (3.70)	1.02 (2.55)
Brain and central nervous system	24,677 (321,731)	13,658 (173,699)	11,019 (148,032)	1.25 (3.47)	1.35 (3.88)	1.15 (3.09)	12,249 (248,500)	6813 (139,823)	5436 (108,677)	0.62 (2.59)	0.67 (3.05)	0.57 (2.16)
Non‐Hodgkin lymphoma	17,615 (553,389)	11,355 (311,375)	6260 (242,014)	0.89 (5.57)	1.11 (6.64)	0.65 (4.58)	6590 (250,679)	4191 (143,740)	2399 (106,939)	0.33 (2.38)	0.41 (2.95)	0.25 (1.88)
Kidney	12,505 (434,840)	6396 (277,800)	6109 (157,040)	0.68 (4.42)	0.68 (5.92)	0.68 (3.04)	4716 (155,953)	2435 (100,343)	2281 (55,610)	0.25 (1.46)	0.26 (2.04)	0.25 (0.95)
Hodgkin lymphoma	7853 (82,469)	5311 (48,774)	2542 (33,695)	0.37 (0.95)	0.49 (1.14)	0.24 (0.77)	2067 (22,733)	1522 (13,674)	545 (9059)	0.10 (0.24)	0.14 (0.31)	0.05 (0.18)
Liver and intrahepatic bile ducts	4642 (866,136)	2647 (600,676)	1995 (265,460)	0.25 (8.57)	0.28 (12.67)	0.22 (4.76)	2332 (758,725)	1390 (521,826)	942 (236,899)	0.13 (7.37)	0.15 (10.90)	0.11 (4.13)
Ovary	3122 (324,603)	—	3122 (324,603)	0.30 (6.65)	—	0.30 (6.65)	760 (206,956)	—	760 (206,956)	0.07 (3.97)	—	0.07 (3.97)
Thyroid	2638 (821,214)	690 (206,485)	1948 (614,729)	0.12 (9.12)	0.06 (4.59)	0.18 (13.64)	302 (47,507)	113 (17,241)	189 (30,266)	0.01 (0.44)	0.01 (0.35)	0.02 (0.53)
Testis	2502 (72,040)	2502 (72,040)	—	0.25 (1.69)	0.25 (1.69)	—	410 (9068)	410 (9068)	—	0.04 (0.21)	0.04 (0.21)	—
Nonmelanoma skin cancer	1402 (1,234,533)	846 (744,785)	556 (489,748)	0.07 (10.37)	0.08 (14.05)	0.06 (7.47)	363 (69,416)	215 (39,688)	148 (29,728)	0.02 (0.59)	0.02 (0.77)	0.01 (0.45)
Nasopharynx	1395 (120,434)	1021 (86,289)	374 (34,145)	0.07 (1.31)	0.09 (1.92)	0.04 (0.73)	497 (734,82)	354 (54,104)	143 (19,378)	0.02 (0.77)	0.03 (1.18)	0.01 (0.39)
Lip, oral cavity	1103 (389,846)	611 (268,999)	492 (120,847)	0.05 (4.00)	0.06 (5.80)	0.05 (2.29)	366 (188,438)	200 (130,808)	166 (57,630)	0.02 (1.92)	0.02 (2.81)	0.02 (1.07)
Colorectum	1094 (1,926,425)	587 (1,069,446)	507 (856,979)	0.05 (18.35)	0.05 (21.94)	0.05 (15.16)	213 (904,019)	145 (499,775)	68 (404,244)	0.01 (8.05)	0.01 (9.86)	0.01 (6.50)
Kaposi sarcoma	1086 (35,813)	791 (24,620)	295 (11,193)	0.05 (0.41)	0.07 (0.56)	0.03 (0.26)	642 (16,169)	460 (10,629)	182 (5540)	0.03 (0.19)	0.04 (0.25)	0.02 (0.13)
Salivary glands	756 (55,083)	347 (30,963)	409 (24,120)	0.04 (0.56)	0.03 (0.66)	0.04 (0.49)	188 (23,942)	86 (13,989)	102 (9953)	0.01 (0.23)	0.01 (0.29)	0.01 (0.18)
Melanoma of skin	745 (331,722)	361 (179,953)	384 (151,769)	0.04 (3.22)	0.03 (3.66)	0.04 (2.88)	102 (58,667)	49 (33,160)	53 (25,507)	0.00 (0.53)	0.00 (0.65)	0.01 (0.43)
Tracheal, bronchus, and lung	733 (2,480,675)	453 (1,572,045)	280 (908,630)	0.04 (23.62)	0.04 (32.07)	0.03 (16.24)	319 (1,817,469)	204 (1,233,241)	115 (584,228)	0.02 (16.76)	0.02 (24.77)	0.01 (9.79)
Stomach	590 (968,784)	384 (627,458)	206 (341,326)	0.03 (9.18)	0.04 (12.79)	0.02 (6.00)	231 (660,175)	180 (427,575)	51 (232,600)	0.01 (6.09)	0.02 (8.57)	0.01 (3.93)
Bladder	461 (614,298)	329 (471,293)	132 (143,005)	0.02 (5.58)	0.03 (9.31)	0.01 (2.38)	142 (220,596)	98 (165,672)	44 (54,924)	0.01 (1.82)	0.01 (3.11)	0.00 (0.80)
Oropharynx	258 (106,400)	171 (86,339)	87 (20,061)	0.01 (1.10)	0.02 (1.87)	0.01 (0.39)	25 (52,305)	14 (42,818)	11 (9487)	0.00 (0.53)	0.00 (0.91)	0.00 (0.18)
Breast	233 (229,6840)	—	233 (2,296,840)	0.02 (46.82)	—	0.02 (46.82)	42 (666,103)	—	42 (666,103)	0.00 (12.65)	—	0.00 (12.65)
Pancreas	217 (510,992)	109 (269,709)	108 (241,283)	0.01 (4.69)	0.01 (5.45)	0.01 (3.98)	50 (467,409)	20 (247,589)	30 (219,820)	0.00 (4.21)	0.00 (4.95)	0.00 (3.53)
Prostate	180 (1,467,854)	180 (1,467,854)	—	0.02 (29.42)	0.02 (29.42)	—	24 (397,430)	24 (397,430)	—	0.00 (7.27)	0.00 (7.27)	—
Multiple myeloma	170 (187,952)	85 (103,805)	85 (84,147)	0.01 (1.79)	0.01 (2.12)	0.01 (1.51)	119 (121,388)	80 (66,966)	39 (54,422)	0.01 (1.11)	0.01 (1.33)	0.00 (0.92)
Larynx	169 (189,191)	103 (165,794)	66 (23,397)	0.01 (1.91)	0.01 (3.51)	0.01 (0.45)	51 (103,359)	32 (90,384)	19 (12,975)	0.00 (1.01)	0.00 (1.88)	0.00 (0.23)
Esophagus	157 (511,054)	112 (365,225)	45 (145,829)	0.01 (4.97)	0.01 (7.58)	0.00 (2.62)	74 (445,391)	48 (318,433)	26 (126,958)	0.00 (4.26)	0.00 (6.54)	0.00 (2.22)
Vagina	149 (18,819)	—	149 (18,819)	0.02 (0.36)	—	0.02 (0.36)	42 (8240)	—	42 (8240)	0.00 (0.15)	—	0.00 (0.15)
Cervix uteri	107 (662,301)	—	107 (662,301)	0.01 (14.12)	—	0.01 (14.12)	26 (348,874)	—	26 (348,874)	0.00 (7.08)	—	0.00 (7.08)
Vulva	105 (47,336)	—	105 (47,336)	0.01 (0.83)	—	0.01 (0.83)	22 (18,579)	—	22 (18,579)	0.00 (0.30)	—	0.00 (0.30)
Penis	83 (37,700)	83 (37,700)	—	0.01 (0.79)	0.01 (0.79)	—	10 (13,738)	10 (13,738)	—	0.00 (0.28)	0.00 (0.28)	—
Hypopharynx	68 (86,257)	48 (72,077)	20 (14,180)	0.00 (0.89)	0.00 (1.55)	0.00 (0.29)	17 (40,902)	13 (34,564)	4 (6338)	0.00 (0.41)	0.00 (0.73)	0.00 (0.12)
Corpus uteri	31 (420,368)	—	31 (420,368)	0.00 (8.37)	—	0.00 (8.37)	3 (97,723)	—	3 (97,723)	0.00 (1.72)	—	0.00 (1.72)
Mesothelioma	14 (30,633)	3 (21,410)	11 (9223)	0.00 (0.28)	0.00 (0.42)	0.00 (0.16)	2 (25,371)	2 (18,082)	0 (7289)	0.00 (0.22)	0.00 (0.35)	0.00 (0.13)
Gallbladder	11 (122,491)	6 (43,538)	5 (78,953)	0.00 (1.15)	0.00 (0.88)	0.00 (1.41)	4 (89,055)	3 (31,406)	1 (57,649)	0.00 (0.83)	0.00 (0.63)	0.00 (1.02)
Other specified cancers	42,766 (704,447)	23,711 (390,243)	19,055 (314,204)	2.20 (7.29)	2.38 (8.45)	2.02 (6.26)	16,713 (401,598)	9320 (222,441)	7393 (179,157)	0.86 (3.96)	0.94 (4.68)	0.78 (3.32)
Unspecified sites	7961 (454,535)	4278 (243,096)	3683 (211,439)	0.41 (4.48)	0.43 (5.10)	0.39 (3.94)	3636 (408,468)	1954 (218,788)	1682 (189,680)	0.19 (3.83)	0.19 (4.46)	0.18 (3.29)

Abbreviation: ASR, age‐standardized rate.

The global geographic distribution of new cases and deaths in 2022 is illustrated in Figure 4A. Approximately one half of all new cases and deaths occurred in Asia in 2022. Australia/New Zealand reported the highest incidence (ASIR, 19.8 per 100,000 children), followed by Northern America (ASIR, 18.2 per 100,000), and Southern Europe (ASIR, 16.4 per 100,000); whereas Micronesia/Polynesia had the lowest incidence (ASIR, 3.8 per 100,000), followed by Western Africa (ASIR, 6.6 per 100,000), and South Central Asia (ASIR, 7.8 per 100,000; Figure 4B; see Table S6). The highest mortality was reported in South‐Eastern Asia and Melanesia (both ASMRs, 5.2 per 100,000 children), whereas the lowest mortality was recorded in Micronesia/Polynesia (ASMR, 0.56 per 100,000), followed by Northern America, Northern Europe, and Australia/New Zealand (all ASMRs, 2.1 per 100,000). There was notable variation in the ASIR and ASMR rankings of childhood cancer types among different world regions, but leukemia was the childhood cancer with the highest ASIR globally, except in regions like Northern, Eastern, Middle, and Western Africa, where other specified cancers were most common (see Figure S2A–D).

FIGURE 4.

Estimated incidence and mortality of childhood cancer worldwide in 2022. (A) Global maps present the number of new cases and deaths from childhood cancer in 185 countries or territories in 2022. (B) The number of new cases and deaths, the ASIR, and the ASMR of childhood cancer in 2022 by world regions. The country or territory with the highest number of new cases and deaths in each region is illustrated. ASIR, age‐standardized incidence rate; ASMR indicates age‐standardized mortality rate; CNS, central nervous system; NA, not applicable/not available. Data source: Global Cancer Observatory, 2022.

The incidence and mortality of childhood cancer showed remarkable disparities across the four HDI levels (Figure 5A). As HDI increased, the ASIR progressively increased, with the highest ASIR in countries/territories with very‐high HDI (15.3 per 100,000 children) and the lowest ASIR in countries/territories with low HDI (8.0 per 100,000; Figure 5B). Inversely, the highest ASMR was found in countries/territories with low HDI (4.4 per 100,000 children), whereas the lowest ASMR was found in countries/territories with very‐high HDI (2.8 per 100,000; Figure 5C). Similar trends were evident when data were further stratified by sex, but boys had higher ASIRs and ASMRs than girls globally. Figure 5D illustrates the correlations of the ASIR, ASMR, and MIR with the HDI. The HDI was positively correlated with the ASIR (R = 0.54; p < .001), indicating that, with increasing HDI levels, the ASIR of childhood cancer increased. Inversely, both the ASMR and the MIR were negatively associated with the HDI (ASMR, R = −0.51 [p < .001]; MIR, R = −0.81 [p < .001]), with progressively lower rates observed as the HDI increased. The CIs for ASIR, ASMR, and MIR according to the HDI were 0.12 (95% CI, 0.09–0.14), −0.16 (95% CI, −0.2, −0.12), and −0.27 (95% CI, −0.3, −0.23), respectively (Figure 5E), indicating that higher HDI countries/territories had a markedly increased ASIR of childhood cancer, whereas lower HDI countries/territories exhibited disproportionately higher ASMRs and MIRs. The combination of these results likely reflects the inequities between LMICs and HICs in terms of early detection, timely diagnosis, and access to comprehensive management for childhood cancer.

FIGURE 5.

Global childhood cancer burden by HDI level in 2022. (A) Estimated number of new cases and deaths in 2022 by HDI. (B, C) Estimated age‐standardized incidence and mortality of childhood cancer in 2022 by HDI and sex. (D) Correlations of country‐level ASIR, ASMR, and MIR with HDI. Each dot represents a country, with the dot size indicating ASIR, ASMR, and MIR in that country. (E) Concentration curves depict the distribution of ASIR, ASMR, and MIR by HDI ranking. ASIR, age‐standardized incidence rate; ASMR indicates age‐standardized mortality rate; CI, concentration index; CNS, central nervous system; HDI, Human Development Index; MIR, mortality‐to‐incidence ratio. Data source: Global Cancer Observatory, 2022.

Univariable analysis demonstrated that all 15 socioeconomic and health system indicators were significantly associated with the MIR of childhood cancer (all p < .001; Figure 6A). Variables that met the Bonferroni‐corrected significance threshold (p < .00333) were included in the initial multivariable linear regression model (R² = 0.703). VIF analysis identified substantial multicollinearity for CHE per capita, the HDI, and GGHE‐D per capita (VIF: 24.63, 17.78, and 12.25, respectively), and these variables were sequentially removed until all remaining indicators demonstrated acceptable collinearity (VIF <10). In the final model (R² = 0.663), a higher gender inequality index was independently associated with a higher MIR, whereas a higher percentage of GGHE‐D in CHE was independently associated with a lower MIR. No other indicators remained statistically significant (Figure 6B).

FIGURE 6.

Associations between socioeconomic and health system metrics and the MIR of childhood cancer worldwide in 2022. (A) Univariable linear regression analysis associating socioeconomic and health system metrics with the MIR. (B) Multivariate linear regression analysis associating socioeconomic and health system metrics with the MIR after removing variables that had significant multicollinearity (R² = 0.663; adjusted R² = 0.635). CHE indicates current health expenditure; GDP, gross domestic product; GGHE‐D, domestic general government health expenditure; MIR, mortality‐to‐incidence ratio; OOP, out‐of‐pocket health expenditure; USD, US dollars; UHC, universal health coverage. Data source: Global Cancer Observatory, 2022.

Future global burden of childhood cancer by 2050

We project that there will be 204,925 new cancer cases and 78,210 cancer‐related deaths among children in 2050 (Table 3; see Table S7). Leukemia will remain the most prevalent and fatal childhood cancer globally, with 65,403 new cases and 24,134 deaths. Asia will remain the greatest contributor to new childhood cancer cases and deaths (Figure 7A,B). Low HDI countries/territories are expected to have the highest number of new cases and deaths, whereas very‐high HDI countries/territories will have the lowest number of new cases and deaths (Figure 7C).

TABLE 3.

Estimated number of new cases and deaths of children by cancer type and sex in 2050, worldwide, based on projections from Global Cancer Observatory 2022.

Cancer site	Incidence						Mortality
	Both		Boys		Girls		Both		Boys		Girls
	No. of new cases	Change, %	No. of new cases	Change, %	No. of new cases	Change, %	No. of deaths	Change, %	No. of deaths	Change, %	No. of deaths	Change, %
All cancers	204,925	1.37	115,120	0.38	89,804	2.66	78,210	1.33	44,660	0.36	33,550	2.65
Leukemia	65,403	1.30	37,645	0.36	27,758	2.60	24,134	1.26	14,160	0.33	9975	2.62
Brain and central nervous system	25,004	1.33	13,701	0.31	11,303	2.58	12,404	1.27	68,31	0.26	5573	2.52
Non‐Hodgkin lymphoma	17,811	1.11	11,385	0.26	6426	2.65	6666	1.15	4202	0.26	2464	2.71
Kidney	12,703	1.58	6434	0.59	6269	2.62	4789	1.55	2448	0.53	2340	2.59
Hodgkin lymphoma	7932	1.01	5318	0.13	2614	2.83	2082	0.73	1523	0.07	559	2.57
Liver and intrahepatic bile ducts	4716	1.59	2666	0.72	2050	2.76	2368	1.54	1400	0.72	968	2.76
Ovary	3213	2.91	—	—	3213	2.91	783	3.03	—	—	783	3.03
Thyroid	2702	2.43	693	0.43	2009	3.13	308	1.99	114	0.89	195	3.17
Testis	2518	0.64	2518	0.64	—	—	413	0.73	413	0.73	—	—
Nonmelanoma skin cancer	1421	1.36	849	0.35	572	2.88	368	1.38	216	0.47	152	2.70
Nasopharynx	1412	1.22	1026	0.49	385	2.94	503	1.21	356	0.57	148	3.50
Lip, oral cavity	1118	1.36	613	0.33	506	2.85	371	1.37	201	0.50	171	3.01
Colorectum	1112	1.65	589	0.34	523	3.16	216	1.41	146	0.69	70	2.94
Kaposi sarcoma	1098	1.11	794	0.38	303	2.71	650	1.25	462	0.43	187	2.75
Salivary glands	768	1.59	348	0.29	420	2.69	191	1.60	86	0.00	105	2.94
Melanoma of skin	757	1.61	362	0.28	395	2.86	104	1.96	49	0.00	55	3.77
Trachea, bronchus, and lung	743	1.36	455	0.44	288	2.86	323	1.25	205	0.49	118	2.61
Stomach	597	1.19	385	0.26	212	2.91	234	1.30	181	0.56	52	1.96
Bladder	466	1.08	331	0.61	136	3.03	144	1.41	98	0.00	45	2.27
Oropharynx	261	1.16	172	0.58	89	2.30	25	0.00	14	0.00	11	0.00
Breast	240	3.00	—	—	240	3.00	43	2.38	—	—	43	2.38
Pancreas	221	1.84	110	0.92	111	2.78	51	2.00	20	0.00	31	3.33
Prostate	181	0.56	181	0.56	—	—	24	0.00	24	0.00	—	—
Multiple myeloma	173	1.76	85	0.00	87	2.35	120	0.84	80	0.00	40	2.56
Larynx	171	1.18	103	0.00	68	3.03	51	0.00	32	0.00	19	0.00
Esophagus	159	1.27	113	0.89	46	2.22	75	1.35	48	0.00	27	3.85
Vagina	153	2.68	—	—	153	2.68	43	2.38	—	—	43	2.38
Cervix uteri	110	2.80	—	—	110	2.80	27	3.85	—	—	27	3.85
Vulva	108	2.86	—	—	108	2.86	23	4.55	—	—	23	4.55
Penis	83	0.00	83	0.00			10	0.00	10	0.00	—	—
Hypopharynx	68	0.00	48	0.00	20	0.00	17	0.00	13	0.00	4	0.00
Corpus uteri	32	3.23	—	—	32	3.23	3	0.00	—	—	3	0.00
Mesothelioma	14	0.00	3	0.00	11	0.00	2	0.00	2	0.00	0	—
Gallbladder	11	0.00	6	0.00	5	0.00	4	0.00	3	0.00	1	0.00
Other specified cancers	43,364	1.40	23,806	0.40	19,558	2.64	16,951	1.42	9361	0.44	7590	2.66
Unspecified sites	8078	1.47	4297	0.44	3781	2.66	3689	1.46	1962	0.41	1727	2.68

FIGURE 7.

Prediction of the global childhood cancer burden in 2050. (A) Global maps show the estimated number of new cases and deaths from childhood cancer around the world in 2050. (B) Estimated number of new cases and deaths from childhood cancer in 2050 by world region. (C) Estimated number of new cases and deaths from childhood cancer in 2050 by HDI level. CNS indicates central nervous system; HDI, Human Development Index; NA, not applicable/not available. Data source: Projections from Global Cancer Observatory, 2022.

From 2022 to 2050, new cases and deaths of childhood cancer globally are projected to increase by 1.37% and 1.33%, respectively (Table 3). Although the number of new cases and deaths among girls will be lower than that among boys, the relative increases among girls will be higher (Table 3; see Figure S3). Most African regions (Eastern, Middle, Western, and Northern Africa), Western Asia, and Melanesia are expected to have absolute and relative increases in new cases and deaths, with decreases in other regions (Figure 8A,B). Medium, high, and very‐high HDI countries/territories are expected to have absolute and relative decreases in new cancer cases and deaths among children (Figure 8C). Conversely, absolute and relative increases in new cases and deaths of childhood cancer will occur in low HDI countries/territories, with increases of 44.9% and 44.8%, respectively, from 2022 to 2050.

FIGURE 8.

Projected changes in global childhood cancer burden from 2022 to 2050. (A) Global maps show changes in the number of new cases and deaths from childhood cancer around the world between 2022 and 2050. (B) Absolute and relative changes in the number of new cases and deaths between 2022 and 2050 by world regions. (C) Absolute and relative changes in the number of new cases and deaths between 2022 and 2050 by HDI level. HDI indicates Human Development Index; NA, not applicable/not available. Data source: Projections from Global Cancer Observatory, 2022.

DISCUSSION

To our knowledge, this population‐based study provides one of the first comprehensive and up‐to‐date global overviews of childhood cancer burden in the post‐COVID era and forecasts the future burden by 2050 by using estimates from two well established global cancer databases. We demonstrate a significant childhood cancer burden with considerable geographic and socioeconomic variations. Overall, the global incidence of childhood cancer declined from 2000 to 2021, with a particularly notable reduction during the COVID‐19 pandemic, whereas mortality significantly decreased across most world regions and cancer types. Although environmental and lifestyle factors may influence these changing patterns, as well as individuals not pursuing regular care during the pandemic, resulting in the potential for delayed diagnosis and thus lower overall incidence of new cancers diagnosed, the evolving epidemiological landscape also reflects advancements in health care and emerging challenges. Our study enhances the epidemiological evidence on the cancer burden among this population, providing detailed profiles and novel insights into future trends.

Unlike adult cancer, the etiology of childhood cancer remains poorly understood, and only a limited number of cases can be prevented. From 2000 to 2021, the ASIR and ASMR of childhood cancer declined overall (AAPC, −0.88 and −2.13, respectively), especially during the COVID‐19 pandemic. We quantified the cross‐country disparities in the childhood cancer burden and evaluated the temporal trends from 2000 to 2021. Although the age‐standardized DALYs of childhood cancer worldwide showed a declining trend from 2000 to 2021, the SII and CI indicators revealed that the burden of childhood cancer was mainly concentrated in lower SDI countries/territories during this period. These findings revealed an imbalance in the progress of childhood cancer early diagnosis and treatment across countries/territories with various levels of SDI from 2000 to 2021, underscoring the importance of addressing the disparities.

Previous research has highlighted significant disruptions and delays in childhood cancer care during the COVID‐19 pandemic. ²¹ , ²² However, the data remain insufficient to determine the full extent of cancer underdiagnosis or to identify which specific types of cancer have been most affected at the population level. This study demonstrates the substantial influence of the pandemic on global childhood cancer diagnosis, as evidenced by an unexpected and steep decline in the incidence during this period (AAPC of the ASIR, −6.63), with girls experiencing more pronounced underdiagnosis than boys for most childhood cancer types according to the model prediction. Our results are consistent with previous research suggesting the global variability in diagnostic delays for childhood cancer. ²³ Although it might be expected that the frequency of delays and disruptions in cancer care would be higher in LMICs because of limited baseline capacity for delivering essential health services, a previous study demonstrated that the decrease in new childhood cancer cases was not significantly influenced by country income status. ²² Indeed, our findings revealed that the model‐predicted, age‐standardized incidence, prevalence, and DALY rates were higher than the statistically reported values, which were more pronounced in countries/territories with higher SDI levels, underscoring the vulnerability of health care systems in HICs despite their typically abundant health care resources. As nations recover from the pandemic, it is essential to mitigate these disruptions by implementing strategies that ensure continuity of cancer care, such as expanding telehealth services and enhancing community outreach programs. ²⁴ , ²⁵ Further studies should investigate the long‐term effect of these disruptions on childhood cancer survival rates and overall quality of life, particularly among vulnerable populations.

We observed that the cancer ASIR in children younger than 15 years was 10.3 per 100,000 children in 2022 worldwide, marking a decline from 14.1 per 100,000 reported in the International Incidence of Childhood Cancer, Volume 3, ²⁶ which covered the period from 2001 to 2010. ⁹ Previous reports have suggested that variations in environmental and lifestyle risk factors may contribute to these shifting patterns in childhood cancer. ²⁷ , ²⁸ , ²⁹ , ³⁰ Maternal smoking and prenatal exposure to antibiotics, painkillers, neurologic medications, benzene, drugs, and alcohol are strongly associated with leukemia, brain tumors, hepatoblastoma, and neuroblastoma. ³¹ Moreover, childhood exposure to both natural and artificial ionizing radiation, as well as infections such as the human immunodeficiency virus and Epstein–Barr virus, significantly elevates the risk of cancers like lymphoma and leukemia. A critical avenue for future research is to explore the effect of maternal and childhood lifestyle changes and environmental exposures on childhood cancer incidence. Gaining a deeper understanding of these connections could help shape prevention strategies, particularly in rapidly urbanizing regions where shifts in lifestyle and environment are pronounced. However, changes in childhood cancer incidence are likely influenced by a complex interplay of genetic, environmental, and health care access factors, emphasizing the necessity for targeted research.

In 2022, our analysis revealed a positive relation between the ASIR of childhood cancer and the HDI as well as inverse relations between the ASMR and the MIR and HDI. We also reported that countries/territories with lower HDI had a disproportionately higher mortality burden despite a lower incidence, revealing the pronounced socioeconomic disparities in the burden of childhood cancer. To alleviate the childhood cancer burden and achieve equity in health outcomes, timely and effective strategies for preventing and managing childhood cancer are warranted, especially in countries with lower levels of development. A decreased gender inequality index and an increased percentage of GGHE‐D in CHE were independently associated with improved childhood cancer outcomes. Gender inequality hinders girls' access to health services. In 2022, boys had higher ASIR and ASMR of childhood cancer than girls. According to the political commitment in the United Nations 2030 Agenda for Sustainable Development, more attention should be paid to girls who have cancer during diagnosis, treatment, and prognosis. Many families, especially in resource‐constrained regions, are at risk of experiencing catastrophic health expenditure because of a costly cancer diagnosis and care for their children. Consequently, children may fail to receive timely diagnosis and suffer from delayed treatment, or even abandon treatment. Our data suggest that increasing the percentage of domestic government health expenditure in the total health expenditure may improve childhood cancer outcomes.

It is projected that, by 2050, there will be the highest absolute number of new cases and deaths in low HDI countries/territories, increasing by 44.9% and 44.8%, respectively, compared with 2022. Conversely, in medium, high, and very‐high HDI countries/territories, the number of new cases and deaths will decline. This reflects a likelihood that the inequality in the burden of childhood cancer will still persist and even intensify in 2050. These disparities are likely exacerbated by systemic barriers, such as inadequate health care infrastructure and a shortage of specialized medical professionals in LMICs. ³ The burden of childhood cancer in these regions underscores broader health inequities that must be addressed through comprehensive health care reforms, including increased investment in pediatric oncology services and the establishment of training programs for health care professionals. ³ , ³² Our findings underscore the urgent need for policymakers to enhance resource allocation and implement targeted interventions, particularly in regions with low levels of human development.

This study benefits from a robust methodology that integrates data from multiple reputable cancer databases. Methodological advancements and the inclusion of additional cancer registry data have resulted in more accurate and reliable estimates in both GBD 2021 and GLOBOCAN 2022, allowing for a comprehensive analysis of the global burden of childhood cancer. The geodemographic comparisons and temporal analyses provide valuable insights into the evolving and future landscape of childhood cancer. However, several important limitations should be acknowledged. First, the study relies on population‐based cancer registry data, which may not fully capture the true burden of childhood cancer, particularly in regions with underdeveloped or incomplete cancer registries. Furthermore, even when registries do exist, they might still significantly underestimate the true incidence, because children with cancer might not be diagnosed. Cultural and socioeconomic factors, such as treatment refusal and abandonment, might also lead to underreporting or inaccuracies. Therefore, caution is warranted when interpreting GBD 2021 and GLOBOCAN 2022 estimates. Sustained investment in high‐quality, population‐based cancer registries and vital registration systems is of crucial importance for planning, monitoring, and evaluating childhood cancer control programs. Second, the GLOBOCAN and GBD data comprise a large proportion of uncategorized childhood cancers. This is because both are presented based on International Classification of Diseases site codes, which do not cover the major categories of childhood cancers. When estimating the burden of childhood cancer, the International Classification of Childhood Cancer classification system would be more appropriate. ¹³ However, simply using this classification to eliminate the proportion of uncategorized childhood cancers in the GLOBOCAN and GBD data is not feasible because of the relatively small number of childhood cancer cases and the relatively large number of diverse, rare cancer types. Thus, in future research, it will be necessary to carefully evaluate how categories are grouped, particularly for unspecified and other specified cancers. Third, although the HDI and SDI serve as useful proxies for socioeconomic development, they are limited in their ability to account for other critical health determinants, such as cultural factors, local health care infrastructure, and policy differences, all of which can significantly affect childhood cancer outcomes. Future research should focus on developing more nuanced and comprehensive indicators that can reflect the full spectrum of factors affecting childhood cancer. This may include integrating qualitative assessments of health care access, patient and family experiences, and the effect of health care policies, which would provide a deeper understanding of the barriers to effective cancer care in diverse settings.

CONCLUSION

This study provides a comprehensive analysis of the past, current, and future burden of childhood cancer globally, highlighting that childhood cancer remains a significant global health challenge, disproportionately affecting resource‐limited populations and revealing considerable geographic and socioeconomic disparities. Our findings highlight the continued need for high‐quality, population‐based cancer registries, targeted policy intervention measures, and improved health care systems. As we strive to meet the WHO's Global Initiative for Childhood Cancer targets, it is crucial for policymakers to prioritize childhood cancer within the broader context of public health, aligning it with efforts to reduce health disparities. The need is urgent to expand high‐quality, population‐based cancer registries to more accurately and equitably estimate the global childhood cancer burden, thus informing planning and resource allocation. Collaborative efforts between governments, international organizations, and health care providers are essential to enhance resource distribution and bolster capacity‐building efforts in LMICs. In addition, there is an urgent need for innovative care models that can improve treatment accessibility and support for children with cancer, particularly in underserved regions, such as telehealth in collaboration with local, cross‐regional, or international expert groups, to complement on‐site continuing education. ³³ By promoting a strong commitment to health care equity, we can ensure that every child, regardless of geographic or socioeconomic status, receives the necessary care, thereby shaping a healthier future for children globally.

Author Contributions

Jianxing He, Min Kang, Wenhua Liang, Chengzhi Zhou, and Nanshan Zhong: Study decision. Wangzhong Li, Shanzhou Huang, Qiyue Chen, Ting Wang, and Guanming Lu: writing—review and editing. Wangzhong Li, Xing Niu, Qiong Song, Yilin Xu, Ke Mo, Chunhui Cui, Run Zhang, Wei Du, Feiying He, and Lei Shi: Data collection. Yan Lin, Qiu Wei, Li Jiang, Yongsheng Chen, Baiyang Song, Huijuan Zhang, Zhenli Fu, Wenjing Liao, Jiancong Sun, Wenhui Guan, and Weitao Zhuang: Data analysis. Jianxing He and Min Kang: Resources. All authors reviewed and approved the manuscript.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Supporting information

Table S1

Table S2

Table S3

Table S4

Table S5

Table S6

Table S7

Supplementary material

Figure S1

Figure S2

Figure S3

DATA AVAILABILITY STATEMENT

The data used to support the findings of this study are included in the Supporting Information files.