Higher childhood cancer incidence rates are generally reported for high income countries although high quality information on descriptive patterns of childhood cancer incidence for low or middle income countries is limited, particularly in Sub-Saharan Africa. There is a need to quantify global differences by cancer types, and to investigate whether they reflect true incidence differences or can be attributed to under-diagnosis or under-reporting. For the first time, we describe childhood cancer data reported to the pathology report-based National Cancer Registry of South Africa in 2000–2006 and compare our results to incidence data from Germany, a high income country. The overall age-standardized incidence rate (ASR) for South Africa in 2000–2006 was 45.7 per million children. We observed substantial differences by cancer types within South Africa by racial group; ASRs tended to be 3–4-fold higher in South African Whites compared to Blacks. ASRs among both Black and White South Africans were generally lower than those from Germany with the greatest differences observed between the Black population in South Africa and Germany, although there was marked variation between cancer types. Age-specific rates were particularly low comparing South African Whites and Blacks with German infants. Overall, patterns across South African population groups and in comparison to Germans were similar for boys and girls. Genetic and environmental reasons may probably explain rather a small proportion of the observed differences. More research is needed to understand the extent to which under-ascertainment and under-diagnosis of childhood cancers drives differences in observed rates.What's new?
Reported geographical and racial differences in childhood cancer incidence contribute to hypotheses regarding the possible risk factors for the disease. Analysis of data from the National Cancer Registry of South Africa uncovered marked differences in childhood cancer incidence within South African populations, with significantly higher rates in Whites compared to Blacks. Compared to data from Germany (representing childhood cancer incidence in Western countries) lower rates were even found in South African Whites, with the greatest differences being noted for the Black population. Under-diagnosis and under-reporting may drive in part the observed patterns. These findings are highly informative for future policy making and improving access to health care services in South Africa.