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Childhood cancer rate up, but deaths down
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Published in the Asbury Park Press
By REGINA MC ENERY
HEALTH WRITER
A STATEWIDE report spanning 17 years has found that pediatric cancer, already the subject of an intensive probe in Toms River, occurs at slightly higher rates in New Jersey than in the United States.
But the data, released yesterday by the State Cancer Registry, also reflect the remarkable strides that have been made arresting a disease once viewed with dread and still the second leading cause -- after accidents -- of death among those under age 15.
While the rate of childhood cancer has been rising, on average, about eight-tenths of a percent per year since 1973, mortality rates have declined by about one-third during that time, national surveys indicate. Yesterday's report measured data for the years 1979 to 1995 for infants to age 14.
The declines in mortality are largely due to earlier detection and an arsenal of chemotherapeutic drugs that began to be used more than a decade ago, oncologists said.
Experts saw few surprises in the report's findings, which offer a county-by-county breakdown of overall childhood cancer incidence, as well as a laundry list of specific types of tumors, including the three leaders: leukemia, central nervous system tumors and lymphomas. Together, they account for about 60 percent of all childhood cancers in New Jersey and the United States.
Locally, Ocean County ranked fourth and Monmouth County eighth among the state's 21 counties in total childhood cancer incidence; both were above the state rate of 14.3 per 100,000. The overall childhood cancer rate for Ocean County was 16 per 100,000 children; for Monmouth, it was 15.3.
For leukemia, Ocean ranked eighth and Monmouth ninth. But for central nervous system tumors, Ocean County led the state, while Monmouth ranked fourth.
Epidemiologists have known for some time that pediatric cancers are rising, a trend attributed in part to better diagnostic techniques and more accurate record-keeping by registries.
"Between 1973 and 1994, the incidence of brain tumors in the United States in children has been reported to have gone up 35 percent. That is huge," said Dr. Barton A. Kamen, who joined the Cancer Institute of New Jersey last month as its director of Pediatric Hematology-Oncology. "If you look at the analysis, it looks like there was a gigantic (spike) in 1985, the time when the country became flooded with MRI scanners. So at least some of the apparent increase in rates is due to an increased rate of detection."
Why New Jersey's numbers are higher than the national average, though, is unclear.
"I think New Jersey reflects the overall higher incidence in the Northeast," said Dr. Eddy A. Bresnitz, the state epidemiologist and assistant commissioner of health, who compiled the report. "Why it is higher, I don't really know."
Dr. Lawrence Ettinger, director of Pediatric Hematology-Oncology at St. Peter's University Medical Center in New Brunswick, said the slight fluctuation might be nothing more than a statistical fluke. If New Jersey had a disproportionately high percentage of white children or black children, it might skew the results, because the report didn't adjust for race, and epidemiological surveys have shown that childhood cancer occurs more frequently in white children than black ones.
The report is largely an update of a study five years ago that also documented slight but steady increases in pediatric cancer from year to year. Among the new findings:
· For white children, incidence rates were slightly higher in New Jersey than in the United States, while among black children the incidence was slightly below the national rate.
· Leukemia, central nervous system tumors and lymphomas occurred most frequently in children, perhaps because they prey upon areas of the body that expand rapidly during childhood. Such explosive activity raises the window of opportunity for tragic cellular mistakes.
· In New Jersey, the incidence rate for all childhood cancers over the 17-year period was 14.3 per 100,000 population, compared to 13.6 among U.S. children. In New Jersey, the rate peaked once in 1983, apparently due to an increase in the incidence of leukemias. It peaked again in 1991, when brain cancer, leukemia and non-Hodgkin's lymphoma rose. Despite this, New Jersey's overall rate was not significantly higher than the national average.
· Childhood cancer mortality rates in both New Jersey and the United States declined from 4.3 per 100,000 in 1979-81 to 2.9 per 100,000 in 1993-95.
Linda Gillick, a Toms River mother who helped push state and federal agencies to investigate elevated rates of pediatric cancer in her community, said she hoped the report would prompt more research. "This is an indicator of why it is so important for us to pursue what causes childhood cancer, because this is not going to go away until we find out why," said Gillick.
Kamen said it is premature to call the elevated rates of cancer in Toms River a cluster.
"The jury is out on whether it is due to chance or whether it is real," said Kamen. "I feel very badly for the kids, but I don't know that we can call it a cluster yet. Causation is difficult to prove."
To see the full report, visit the health department's Web site at www.state.nj.us/health/
Source: Asbury Park Press
Published: April 17, 1999
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