- ALL —
- acute lymphoblastic leukemia
- HICs —
- high-income countries
- LMICs —
- low- and middle-income countries
Although morbidity from childhood cancer is second only to unintentional injuries in high-income countries, in low-income countries, it hardly hits the radar screen compared with death from pneumonia, diarrhea, malaria, neonatal sepsis, preterm birth, and neonatal asphyxia. Nevertheless, the extraordinary progress made in treating childhood cancer in high-income countries brings into harsh focus the mammoth disparities that exist in impoverished areas of the world. As the capacity to diagnose and treat childhood cancer improves in low- and middle-income countries, the ability to improve outcomes for the more common diseases benefits as well. The authors have summarized the issues related to childhood cancer care with thoughtful attention to how children everywhere can gain from the advances in medical science in high-income nations.
Jay E. Berkelhamer
Childhood cancer is a relatively rare disease, and most cases occur in the low- and middle-income countries (LMICs) where nearly 90% of the world’s children live.1,2 In low-income countries, childhood cancer mortality is low compared with childhood mortality from other causes (eg, infectious disease). However, as mortality rates from other causes decreased by 49% worldwide from 1990 to 2013 for children aged under 5 years, so the relative importance of childhood cancer has increased.2,3
Although no etiologic agent or trigger is identifiable for most childhood cancers, there are some well-described associations with infectious diseases. The incidence of Burkitt lymphoma is much higher in malaria-endemic regions, Kaposi sarcoma is almost always associated with HIV infection, and hepatocellular carcinoma is more frequent in areas with a high prevalence of hepatitis B infection.1,2 Public health measures to reduce these infectious diseases will also lower childhood cancer mortality.
There are 3 standard modalities …
Address correspondence to Trijn Israels, MD, PhD, Pediatric Oncology, VU University Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands 1081 HV. E-mail: