August 8th, 2022 by Tyler Scott | NAACCReview Home Leave a comment

Judy Rees, BM, BCh, MPH, PhD

Director, NH State Cancer Registry; Associate Director for Community Outreach and Engagement, Dartmouth Cancer Center; Associate Professor, Department of Epidemiology

 Geisel School of Medicine at Dartmouth College


Background: In a 2018 descriptive study, cancer incidence in children (age 0-19) in diagnosis years 2003-2014 was reported as being highest in New Hampshire and in the Northeast region. (David A. Siegel, MD, MPH, of the Centers for Disease Control and Prevention (CDC).1

Methods: Using the Cancer in North America (CiNA) analytic file, we tested the hypotheses that incidence rates in the Northeast were higher than those in other regions of the United States either overall or by race/ethnicity group, and that rates in New Hampshire were higher than the Northeast region as a whole.

Results: In 2003-2014, pediatric cancer incidence was significantly higher in the Northeast than other regions of the United States overall and among non-Hispanic Whites and Blacks, but not among Hispanics and other racial minorities. However, there was no significant variability in incidence in the states within the Northeast overall or by race/ethnicity subgroup. Overall, statistically significantly higher incidence was seen in the Northeast for lymphomas (RR 1.15; 99% CI 1.10-1.19), central nervous system neoplasms (RR 1.12; 99% CI 1.07-1.16), and neuroblastoma (RR 1.13; 99% CI 1.05-1.21).

Conclusion: Pediatric cancer incidence is statistically significantly higher in the Northeast than in the rest of the United States, but within the Northeast, states have comparable incidence. Differences in cancer subtypes by ethnicity merit further investigation.

Impact: Our analyses clarify and extend previous reports by statistically confirming the hypothesis that the Northeast has the highest pediatric cancer rates in the country, by providing similar comparisons stratified by race/ethnicity, and by assessing variability within the Northeast.


Rees JR, Weiss JE, Riddle BL, Craver K, Zens MS, Celaya MO, Peacock JL. Pediatric Cancer by Race, Ethnicity and Region in the United States. Cancer Epidemiol Biomarkers Prev. 2022 Jul 21:EPI-22-0317. doi: 10.1158/1055-9965.EPI-22-0317. Epub ahead of print. PMID: 35861625.


We thank NAACCR for use of the analytical file and for the NAACCR Institutional Review Board approval of our study protocol.


1.  Siegel DA, Li J, Henley SJ, Wilson, RJ, Lunsford, NB, Tai, E, et al. Geographic Variation in Pediatric Cancer Incidence – United States, 2003-2014. MMWR Morb Mortal Wkly Rep 2018;67:707-13.




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