Long-term projections of childhood cancer incidence and prevalence in Ontario, Canada until 2040

Background — The prevalence of childhood cancer continues to rise due to increases in cancer incidence and advances in treatment, leading to better survival. We generated epidemiologic projections for childhood cancer, by cancer type, in Ontario, Canada, until 2040.

Methods — We used the Pediatric Oncology Microsimulation Model for Prevalence (POSIM-Prev) to simulate incident and prevalent cases of childhood cancer across historical (1970–2019) and future (2020–2040) time periods. The model was utilized to estimate annual population-level projections of incidence (counts and crude rates per million children), overall survival rates, and limited-duration prevalence (counts and crude rates per 100,000 population) for 14 types of childhood cancer between 2020 and 2040.

Results — Across future years, crude incidence rates are projected to increase for 10 cancer types in Ontario, with the largest growth expected for non-Hodgkin lymphomas. Crude prevalence rates are projected to rise between 2020 and 2040 for 13 cancer types and remain stable for bone tumors. While individuals diagnosed with lymphoid leukemia will continue to comprise the largest proportion of overall prevalence during this period, the largest relative increases in prevalence are estimated for those diagnosed with hepatic tumors and acute myeloid leukemia. By 2040, the percentage of prevalent individuals, by malignancy, who are expected to reach late adulthood (aged 60+) ranges from 4% (hepatic tumors) to 19% (bone tumors).

Conclusion — Further increases in incidence and improvements in survival for several pediatric cancer types will contribute to substantially higher prevalence by 2040, with a projected shift toward older subpopulations.