Cancer Causes & Control

, Volume 23, Issue 8, pp 1297–1305 | Cite as

Cancer in childhood, adolescence, and young adults: a population-based study of changes in risk of cancer death during four decades in Norway

  • Sara GhaderiEmail author
  • Rolv Terje Lie
  • Dag Moster
  • Ellen Ruud
  • Astri Syse
  • Finn Wesenberg
  • Tone Bjørge
Original paper



Cancer is one of the most common causes of death among young individuals. The purpose of this study was to explore the risk of early death (the first five years after diagnosis) among children (0–14 years), adolescents (15–19 years), and young adults (20–24 years) with cancer in Norway, born during 1965–1985.


The overall and cancer-specific early deaths were explored by linking population-based national registers (including the Cancer Registry of Norway and the Cause of Death Registry) that include the entire population of Norway (approximately 1.3 million individuals). Hazard and sub-hazard ratios were estimated using Cox regression analyses and competing risk models.


A total of 5,828 individuals were diagnosed with cancer (56.3 % males). During follow-up, 1,415 individuals died from cancer (60.2 % males) within five years after diagnosis. The hazard ratio (HR) of overall death of the cancer patients relative to the general population decreased from 1965 (from HR, 385.8 (95 % confidence interval (CI): 335.3, 443.4) in 1965-74 to HR, 19.7 (CI: 9.3, 41.5) in 2005-09). Over all, there were fewer cancer-related deaths among female compared with male patients (sub-hazard ratio (SHR), 0.83 (CI: 0.74, 0.92)). Except for all hematopoietic malignancies, adolescents and young adult patients had lower risk of cancer death than children.


The difference in risk of cancer and overall deaths between the cancer patients and the general population has been substantially reduced since 1965.


Childhood cancer Adolescents and young adults Early cancer death Norway 



Acute lymphatic leukemia


Acute myelogenic leukemia


95 % confidence interval


Central nervous system


Cancer Registry of Norway


International Classification of Diseases-7


Hazard ratio


Sub-hazard ratio



This work was supported by the Norwegian Cancer Society.

Conflict of interest

The authors declare no conflict of interest.


  1. 1.
    Gonzalez JR, Fernandez E, de Toledo JS et al (2004) Trends in childhood cancer incidence and mortality in Catalonia, Spain, 1975–1998. Eur J Cancer Prev 13(1):47–51PubMedCrossRefGoogle Scholar
  2. 2.
    Bosetti C, Bertuccio P, Chatenoud L, Negri E, Levi F, La VC (2010) Childhood cancer mortality in Europe, 1970–2007. Eur J Cancer 46(2):384–394PubMedCrossRefGoogle Scholar
  3. 3.
    Lawless SC, Verma P, Green DM, Mahoney MC (2007) Mortality experiences among 15+ year survivors of childhood and adolescent cancers. Pediatr Blood Cancer 48(3):333–338PubMedCrossRefGoogle Scholar
  4. 4.
    Desandes E (2007) Survival from adolescent cancer. Cancer Treat Rev 33(7):609–615PubMedCrossRefGoogle Scholar
  5. 5.
    Helgestad J, Madsen B (2005) Survival of children with cancer. Tidsskr Nor Laegeforen 125(18):2491–2492PubMedGoogle Scholar
  6. 6.
    Moller TR, Garwicz S, Barlow L et al (2001) Decreasing late mortality among 5-year survivors of cancer in childhood and adolescence: a population-based study in the Nordic countries. J Clin Oncol 19(13):3173–3181PubMedGoogle Scholar
  7. 7.
    Zuccolo L, Pastore G, Maule M et al (2004) Time trends of childhood cancer mortality rates: a report from the Childhood Cancer Registry of Piedmont, Italy, 1971–1998. Pediatr Blood Cancer 43(7):788–791PubMedCrossRefGoogle Scholar
  8. 8.
    Chatenoud L, Bertuccio P, Bosetti C, Levi F, Negri E, La VC (2010) Childhood cancer mortality in America, Asia, and Oceania, 1970 through 2007. Cancer 116(21):5063–5074PubMedCrossRefGoogle Scholar
  9. 9.
    Yaris N, Mandiracioglu A, Buyukpamukcu M (2004) Childhood cancer in developing countries. Pediatr Hematol Oncol 21(3):237–253PubMedCrossRefGoogle Scholar
  10. 10.
    Gatta G, Capocaccia R, De AR, Stiller C, Coebergh JW (2003) Cancer survival in European adolescents and young adults. Eur J Cancer 39(18):2600–2610PubMedCrossRefGoogle Scholar
  11. 11.
    NORDCAN (2009) Association of the Nordic Cancer RegistriesGoogle Scholar
  12. 12.
    SEER (2011) National cancer instituteGoogle Scholar
  13. 13.
    Cancer in Norway (2008) (2009) Cancer incidence, mortality, survival and prevalence in Norway. Kreftregisteret, OsloGoogle Scholar
  14. 14.
    World Health Organization (WHO). (2011) ICD systemsGoogle Scholar
  15. 15.
    Larsen IK, Smastuen M, Johannesen TB et al (2009) Data quality at the Cancer Registry of Norway: an overview of comparability, completeness, validity and timeliness. Eur J Cancer 45(7):1218–1231PubMedCrossRefGoogle Scholar
  16. 16.
    Health Statistics (2002) Atlas on mortality in the European Union: data 1994–1996. Office for Official Publications of the European Communities, LuxembourgGoogle Scholar
  17. 17.
    Lau B, Cole SR, Gange SJ (2009) Competing risk regression models for epidemiologic data. Am J Epidemiol 170(2):244–256PubMedCrossRefGoogle Scholar
  18. 18.
    Smith MA, Seibel NL, Altekruse SF et al (2010) Outcomes for children and adolescents with cancer: challenges for the twenty-first century. J Clin Oncol 28(15):2625–2634PubMedCrossRefGoogle Scholar
  19. 19.
    Ward EM, Thun MJ, Hannan LM, Jemal A (2006) Interpreting cancer trends. Ann N Y Acad Sci 1076:29–53PubMedCrossRefGoogle Scholar
  20. 20.
    Yang L, Fujimoto J, Qiu D, Sakamoto N (2009) Childhood cancer in Japan: focusing on trend in mortality from 1970 to 2006. Ann Oncol 20(1):166–174PubMedCrossRefGoogle Scholar
  21. 21.
    Gatta G, Zigon G, Capocaccia R et al (2009) Survival of European children and young adults with cancer diagnosed 1995–2002. Eur J Cancer 45(6):992–1005PubMedCrossRefGoogle Scholar
  22. 22.
    Baade PD, Youlden DR, Valery PC et al (2010) Trends in incidence of childhood cancer in Australia, 1983–2006. Br J Cancer 102(3):620–626PubMedCrossRefGoogle Scholar
  23. 23.
    Gatta G, Capocaccia R, Stiller C, Kaatsch P, Berrino F, Terenziani M (2005) Childhood cancer survival trends in Europe: a EUROCARE Working Group study. J Clin Oncol 23(16):3742–3751PubMedCrossRefGoogle Scholar
  24. 24.
    Kaatsch P (2010) Epidemiology of childhood cancer. Cancer Treat Rev 36(4):277–285Google Scholar
  25. 25.
    Pui CH (1995) Childhood leukemias. N Engl J Med 332(24):1618–1630PubMedCrossRefGoogle Scholar
  26. 26.
    McBride ML, Rogers PC, Sheps SB et al (2010) Childhood, adolescent, and young adult cancer survivors research program of British Columbia: objectives, study design, and cohort characteristics. Pediatr Blood Cancer 55(2):324–330PubMedCrossRefGoogle Scholar
  27. 27.
    Fernandez CV, Barr RD (2006) Adolescents and young adults with cancer: an orphaned population. Paediatr Child Health 11(2):103–106PubMedGoogle Scholar
  28. 28.
    Yang CP, Hung IJ, Jaing TH, Chang WH (2006) Cancers in infancy: percent distribution and incidence rates. Acta Paediatr Taiwan 47(6):273–277PubMedGoogle Scholar
  29. 29.
    Tai E, Pollack LA, Townsend J, Li J, Steele CB, Richardson LC (2010) Non-Hodgkin lymphoma survival among adolescents. Arch Pediatr Adolesc Med 164(8):779–780PubMedCrossRefGoogle Scholar
  30. 30.
    Hampton T (2005) Cancer treatment’s trade-off: years of added life can have long-term costs. JAMA 294(2):167–168PubMedCrossRefGoogle Scholar
  31. 31.
    Armstrong GT, Liu Q, Yasui Y et al (2009) Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. J Clin Oncol 27(14):2328–2338PubMedCrossRefGoogle Scholar
  32. 32.
    Garwicz S, Moller T, Olsen JH, Sankila R (2004) Nordic studies on late effects of treatment of cancer in childhood and adolescence. Acta Oncol 43(7):682–683Google Scholar
  33. 33.
    Nathan PC, Greenberg ML, Ness KK et al (2008) Medical care in long-term survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol 26(27):4401–4409PubMedCrossRefGoogle Scholar
  34. 34.
    Shah A, Stiller CA, Kenward MG, Vincent T, Eden TO, Coleman MP (2008) Childhood leukaemia: long-term excess mortality and the proportion ‘cured’. Br J Cancer 99(1):219–223PubMedCrossRefGoogle Scholar
  35. 35.
    Nathan PC, Ford JS, Henderson TO et al (2009) Health behaviors, medical care, and interventions to promote healthy living in the Childhood Cancer Survivor Study cohort. J Clin Oncol 27(14):2363–2373PubMedCrossRefGoogle Scholar
  36. 36.
    Kahalley LS, Robinson LA, Tyc VL et al (2012) Risk factors for smoking among adolescent survivors of childhood cancer: A report from the childhood cancer survivor study. Pediatr Blood Cancer 58(3):428–434Google Scholar
  37. 37.
    Reulen RC, Winter DL, Frobisher C et al (2010) Long-term cause-specific mortality among survivors of childhood cancer. JAMA 304(2):172–179PubMedCrossRefGoogle Scholar
  38. 38.
    Prasad PK, Signorello LB, Friedman DL, Boice JD Jr, Pukkala E (2012) Long-term non-cancer mortality in pediatric and young adult cancer survivors in Finland. Pediatr Blood Cancer 58(3):421–427PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Sara Ghaderi
    • 1
    Email author
  • Rolv Terje Lie
    • 1
    • 2
  • Dag Moster
    • 1
    • 3
    • 4
  • Ellen Ruud
    • 5
  • Astri Syse
    • 6
  • Finn Wesenberg
    • 5
  • Tone Bjørge
    • 1
    • 2
  1. 1.Department of Public Health and Primary Health CareUniversity of BergenBergenNorway
  2. 2.Medical Birth Registry of NorwayNorwegian Institute of Public HealthBergenNorway
  3. 3.Department of Clinical MedicineUniversity of BergenBergenNorway
  4. 4.Department of PediatricsHaukeland University HospitalBergenNorway
  5. 5.Section for Pediatric Hematology and Oncology, Women and Children’s Division, Department of Pediatrics MedicineOslo University HospitalOsloNorway
  6. 6.Department of ResearchCancer Registry of NorwayOsloNorway

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