Thread by @MarkZobeck

How much #ChildhoodCancer is there in the world? What does that even mean? In this thread I’ll discuss some recent data to answer this q.

Short answer: There is (likely) much more than you thought!

(For the long answer see my recent podcast-ghccpod.com/gccp-edge1/) 1/14

First, credit where credit is due: these numbers come from research teams led by Dr. Jennifer Yeh and Zach Ward from @HarvardChanSPH, and Dr. @lisamforce and Dr. Bhakta from @StJude. I made the graphs using R (#rstat!) and @hadleywickham et al.'s #tidyverse packages. 2/14

Incidence: How many kids in the world get cancer each year? Previous estimates had it around 200k, but recent estimates put it closer to 400,000 children yearly! And 90% of kids live in LMICs – where treatment is often substandard or unavailable.
(thelancet.com/journals/lanon…) 3/14

Diagnosis: (LMIC = low- and middle-income countries for reference)
It is also estimated that many, many children who develop cancer are never diagnosed and this rate varies enormously by region, with highest rates of non-diagnosis in Africa, Oceania, and Asia 4/14

Diagnosis: If current trends continue, by 2030 a cumulative 3 million children who develop cancer will never be diagnosed. That’s the rough equivalent of 10 school buses filled with 55 kids each driving away and disappearing every single day for the next 15 years… 5/14

Mortality: Outcomes are very different in different regions on the world. Survival is much worse in low-resource countries. E.g. in North America an estimated 10% of kids do not survive a diagnosis of ALL, in Africa 78% of kids do not survive. (thelancet.com/journals/lanon…) 6/14

DALYs: Looking at childhood cancer from the perspective of disability-adjusted life years (who.int/healthinfo/glo… ) demonstrates that for all pediatric diseases, #ChildhoodCancer is the 9th largest cause of DALYs globally, and is 3rd in upper-middle income countries. 7/14

DALYs: Comparing #ChildhoodCancer to adult cancers, it is the 6th largest cause of DALYs globally. 8/14

DALYs: Consistent with the trends in non-diagnosis and survival, the countries with the largest number of DALYs from #ChildhoodCancer are in low-resource countries (thelancet.com/journals/lanon…) 9/14

Summary:
1. There are between 200-400k #childhoodcancer cases per year.
2. Most live in LMICs.
3. Kids in LMICs are much, much more likely to not be diagnosed and to not survive their cancers.
4. DALYs show that tho its rare, #childhoodcancer causes enormous dz burden 10/14

Perspective: These numbers help to demonstrate the most pressing issues in #ChildhoodCancer today are not biomedical (although these issues are important too!) but how to get the cures we already know about to the kids who need it! 11/14

There’s hope!: Despite the difficulties, many LMICs have made incredible improvements in care. In many places this isn’t a story of failure but of the incredible work done by committed people working in very difficult conditions!
(Shout out to @WorldSIOP PODC workng grps!) 12/14

There’s hope!: For examples Honduras, Vietnam, Mali, Paraguay, and Tanzania (and many other LMICs!) have made profound improvements in care in the last few years. (graph/data not mine - see this reference-onlinelibrary.wiley.com/doi/pdf/10.100…) 13/14

To conclude: #ChildhoodCancer is responsible for an enormous burden of suffering, and the most important factor for kids surviving is where they are born. While this is overwhelming, we know improvements in care and survival are possible but much works needs to be done! 14/14

Post script: Want to get find out more or involved? Ask me or check out these resources
who.int/cancer/childho…
ghccpod.com
siop-online.org
cancerpointe.com
childhoodcancerinternational.org
worldchildcancer.org

Post script 2: More great organizations (This is only a small fraction, mostly US based - feel free to comment with more links I'm missing!)
texaschildrens.org/departments/gl…
stjude.org/research/depar…
danafarberbostonchildrens.org/why-choose-us/…
sickkids.ca/globalchildhea…