The Incidence and 5-years Relative Survival Rate of Cancer among People Younger than 25 Years in the US, 2000 to 2020: a SEER-retrospective study

The Incidence and 5-years Relative Survival Rate of Cancer among People Younger than 25 Years in the US, 2000 to 2020: a SEER-retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Incidence and 5-years Relative Survival Rate of Cancer among People Younger than 25 Years in the US, 2000 to 2020: a SEER-retrospective study Xiao Chengqi, Min Ji, Dongmei Lai This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4472499/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract A growing number of children, adolescents, and young adults (CAYA) are suffering from cancer and are surviving after treatment. However, the incidence and long-term overall survival patterns for CAYA cancer survivors over the past 20 years have been underreported. Data from 17 Surveillance, Epidemiology, and End Results (SEER) registries in the United States were analyzed to identify cancer cases in individuals under the age of 25 from 2000 to 2020. A joinpoint regression model was used to analyze the trend of cancer incidence and 5-year survival rate in CAYA. Additionally, we examined the temporal trends of age-standardized cancer incidence and 5-year survival rate from 2000 to 2020. Between 2000 and 2020, there were 129,384 CAYA patients under the age of 25 with cancer (67,873 males and 61,511 females) in the USA. The overall age-standardized incidence rate (ASIR) of CAYA cancer was 19.26 per 100,000 in 2000 and 21.47 per 100,000 in 2020. The incidence rate of CAYA cancer increased over time, with males having a higher incidence rate than females. The most common cancer types were leukemia, lymphoma, brain and other nervous system cancer, endocrine system cancer, and male genital system cancer, which together accounted for more than 60% of CAYA cancer cases. The overall 5-year relative survival rate of CAYA cancer increased from 80.40% (95% CI, 78.84%-81.87%) in 2000 to 87.80% (95% CI, 86.65%-88.86%) in 2015. The 5-year relative survival rate of females under the age of 25 was higher than that of males (89.86% vs. 85.58%). Due to their long life expectancy, CAYA cancer survivors are at particular risk of long-term sequelae from the cancer itself or the therapy applied, especially late sequelae related to reproduction. These issues remain problematic for cancer survivors after entering adulthood, highlighting the need for more efforts and strategies to be directed towards fertility protection for young cancer survivors. Children adolescents and young adults Cancer incidence 5-year relative survival rate Cancer survivors Fertility protection Figures Figure 1 Figure 2 Introduction According to statistics from the World Health Organization (WHO), approximately 400,000 children and adolescents (0–19 years old) worldwide are diagnosed with cancer every year[ 1 ]. In the United States, more than 15,000 children and adolescents were diagnosed with cancer in 2023[ 2 ]. Early detection and intervention for various cancers have contributed to improved survival rates[ 3 ]. In high-income countries, the 5-year survival rates for children, adolescents, and young adults (CAYA) diagnosed at age 25 or younger have exceeded 80%, indicating that CAYA are surviving cancer more frequently today than in the past[ 4 ]. With the advancement of cancer research, the concept of early-onset cancer has emerged, often defined as cancers diagnosed in adults under 50 years of age[ 5 ]. Recent efforts have focused on evaluating the incidence patterns of specific types of early-onset cancers[ 6 ]. Despite being classified as early-onset cancer, survivors of cancer in CAYA have unique characteristics and face challenges regarding reproductive health. However, a comprehensive overview of recent patterns of CAYA cancer in the US over the past 20 years has not been reported. This study utilized population-based data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program to characterize temporal patterns in the incidence of CAYA cancers in the US from 2000 to 2020. The primary objective was to characterize the temporal patterns in CAYA cancer overall and by organ system. The secondary objective was to assess temporal patterns in CAYA cancer stratified by sex, age group, and race and ethnicity. These results can provide scientific evidence for cancer preventive strategies in CAYA cancer patients regarding their future risk for long-term sequelae, especially in terms of fertility prospects. Methods We obtained the data from the SEER, which is publicly accessible ( https://seer.cancer.gov/ ). SEER is supported by the Surveillance Research Program (SRP) and Population Sciences (DCCPS). Since these data were freely available, the study was exempted from institutional review, and no consent form was required. Data from 17 SEER registries (Incidence-SEER 17 Registries 2000–2020) were used to identify cancer cases in individuals younger than 25 years from January 1, 2000, to December 31, 2020. These 17 SEER registries cover approximately 26.5% of the U.S. population based on the 2020 census, including San Francisco-Oakland SMSA, Connecticut, Hawaii, Iowa, New Mexico, Seattle (Puget Sound), Utah, Atlanta (Metropolitan), San Jose-Monterey, Los Angeles, Alaska Natives, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, New Jersey, and Greater Georgia[ 7 ]. SEER STAT software 8.4.2 was utilized to estimate cross-sectional incidence rates and the 20-year mean annual percentage change (APC) in incidence rates, as well as the 5-year relative survival rate, stratified by sex (male and female), race (American Indian/Alaska Native, Asian or Pacific Islander, Black, White, Unknown), and age groups (0, 1–4, 5–9, 10–14, 15–19, 20–24). The SEER program uses the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) to classify cancer sites. Bar charts were used to compare changes in cancer incidence between 2000 and 2020 and 5-year relative survival rates between 2000 and 2015. A forest plot was used to show the 20-year APC stratified by sex, race, age, and cancer site. A joinpoint regression model was established to simulate the trend of cancer incidence and 5-year survival rate in CAYA. P-value less than 0.05 was considered statistically significant. R 4.3.2 was employed to create bar charts, forest plots, and charts showing changes in cancer incidence and survival rates. The R package included ggplot2, splines, rms, stringr, reshape2, forcats, and forestplot. Result Sociodemographic Characteristics of Cancers among People Younger than 25 Years From 2000 to 2020 Between 2000 and 2020, the SEER 17 data file included 129,384 CAYA patients younger than 25 years with cancer in the USA, with 67,873 (52.46%) being male and 61,511 (47.54%) female. Table 1 presents the overall counts of CAYA cancers diagnosed during this period, stratified by age, sex, and race. More than 50% of CAYA cancer patients were aged 14–25 years old, and 79.26% were White. Additionally, the gender ratio was consistent across all age and race groups (Table 1 ). Table 1 Sociodemographic Characteristics of CAYA Cancers among People Younger than 25 Years From 2000 to 2020a Sex group (%) Total Male Female Overall Age, years 129384 67873 (52.46%) 61511 (47.54%) 0 5654 (4.37%) 2985 (52.79%) 2669 (47.21%) 1 ~ 4 20254 (15.65%) 10965 (54.14%) 9289 (45.86%) 5 ~ 9 14755 (11.40%) 8138 (55.15%) 6617 (44.85%) 10 ~ 14 17137 (13.25%) 9092 (53.05%) 8045 (46.95%) 15 ~ 19 27444 (21.21%) 14653 (53.39%) 12791 (46.61%) 20 ~ 24 44140 (34.12%) 22040 (49.93%) 22100 (50.07%) Race American Indian/Alaska Native 1343 (1.04%) 712 (53.02%) 631 (46.98%) Asian or Pacific Islander 10295 (7.96%) 5304 (51.52%) 4991 (48.48%) Black 12914 (9.98%) 6494 (50.29%) 6420 (49.71%) White 102554(79.26%) 54239 (53.89%) 48315 (47.11%) Unknown 2278 (1.76%) 1124 (49,34%) 1154 (50.66%) a Data extracted from the Surveillance, Epidemiology and End Results Database 17 Registry, November 2022 (2000–2020), linked by county Incidence of Cancers among People Younger than 25 years from 2000 to 2020 As shown in Table 2 and eFig 1 in the supplement, the age-standardized incidence rate (ASIR) of cancer among individuals younger than 25 years was 19.26 cases per 100,000 individuals in 2000 and 21.47 cases per 100,000 individuals in 2020. The overall incidence of CAYA cancer increased significantly, with an annual percentage change (APC) of 0.72% (95% CI, 0.49%-0.96%; P < 0.001). From 2000 to 2020, the ASIR of cancer among individuals younger than 25 years increased in Asian or Pacific Islander individuals (APC 1.23%; 95% CI, 0.76%-1.70%; P < 0.001), Black individuals (APC 0.61%; 95% CI, 0.18–1.04%; P = 0.008), and White individuals (APC 0.68%; 95% CI, 0.42–0.94%; P < 0.001), and decreased in American Indian/Alaska Native individuals (APC, -0.60%; 95% CI, -1.58%-0.39%; P = 0.22). The ASIR of cancer among individuals younger than 25 years increased notably in the age groups of 10 to 14 (APC, 1.29%; 95% CI, 0.90%-1.67%; P < 0.001), 15 to 19 (APC, 0.99%; 95% CI, 0.75%-1.23%; P < 0.001), and 20 to 24 (APC, 0.61%; 95% CI, 0.34%-0.88%; P < 0.001). Table 2 Incidence of cancers among people younger than 25 from 2000 to 2020 Incidence (ASIR per 100 000 people) Characteristic 2000 2020 APC (95% CI) P value Overall 5253 ( 19.26 ) 6021 ( 21.47 ) 0.72 ( 0.49 to 0.96 ) <0.001 Sex Male 2750 ( 19.62 ) 3156 ( 22.02 ) 0.70 ( 0.47 to 0.93 ) <0.001 Female 2503 ( 18.89 ) 2865 ( 20.89 ) 0.75 ( 0.45 to 1.04 ) <0.001 Race American Indian/Alaska Native 54 ( 11.92 ) 68 ( 10.86 ) -0.60 (-1.58 to 0.39) 0.22 Asian or Pacific Islander 335 ( 14.10 ) 556 ( 17.21 ) 1.23 ( 0.76 to 1.70 ) <0.001 Black 452 ( 12.17 ) 653 ( 16.07 ) 0.61 ( 0.18 to 1.04 ) 0.008 White 4367 ( 21.07 ) 4543 ( 22.59 ) 0.68 ( 0.42 to 0.94 ) <0.001 Unknown 45 ( —— ) 201 ( —— ) —— —— Age,years 0 241 ( 22.57 ) 246 ( 24.62 ) 0.08 (-0.46 to 0.62 ) 0.77 1 ~ 4 870 ( 20.39 ) 904 ( 21.68 ) 0.26 (-0.09 to 0.61 ) 0.13 5 ~ 9 669 ( 11.73 ) 652 ( 11.93 ) 0.74 ( 0.28 to 1.20 ) 0.003 10 ~ 14 679 ( 12.12 ) 825 ( 14.75 ) 1.29 ( 0.90 to 1.67 ) <0.001 15 ~ 19 1098 ( 20.14 ) 1352 ( 24.20 ) 0.99 ( 0.75 to 1.23 ) <0.001 20 ~ 24 1696 ( 32.63 ) 2042 ( 35.45 ) 0.61 ( 0.34 to 0.88 ) <0.001 a P value of APC from 2000 to 2020. Abbreviations: APC, annual percentage change; ASIR, age-standardized incidence rate. The incidence of cancer among individuals younger than 25 years has increased in both males (APC, 0.70%; 95% CI, 0.47%-0.93%; P < 0.001) and females (APC, 0.75%; 95% CI, 0.45%-1.04%; P < 0.001). The trends in the incidence rate of cancer increased from 2000 to 2015 and decreased after 2015, but the incidence rate of cancer in 2020 was still higher than that in 2000 among individuals younger than 25 years. Grouped by sex, both males and females followed a similar trend, with the incidence rate of cancer higher in males than in females (Fig. 1 ). Leading causes of cancer among People Younger than 25 years from 2000 to 2020 The total number of cancer cases among individuals younger than 25 years was 5,253 in 2000 and 6,021 in 2020. The leading causes of CAYA cancer during these 20 years were similar. Leukemia/lymphoma was the most common cancer in the USA in 2000 (1,902 cases) and in 2020 (2,094 cases), followed by brain and other nervous system cancer in 2000 (791 cases) and in 2020 (710 cases), endocrine system cancer in 2000 (466 cases) and in 2020 (696 cases), and male genital system cancer in 2000 (362 cases) and in 2020 (468 cases), accounting for 67.02% in 2000 and 65.45% in 2020 of total cancer cases, respectively. There is a gender difference in the leading cause of CAYA cancer in 2020. The top 5 cancers in males included leukemia, lymphoma, male genital system cancer, nervous system cancer, and endocrine system cancer, accounting for 75.4% of total cancer cases in males in 2020, whereas the most common cancers in females were leukemia, endocrine system cancer, lymphoma, nervous system cancer, and digestive system cancer, accounting for 63.75% of total new cancer cases in females (eTable 1). In addition, the incidence of cancers in the digestive system (APC, 5.44%; 95%CI, 4.46%-6.43%; P<0.001), male genital system(especially testicular cancer,APC,1.02%;; 95%CI,0.60–1.44%,;P<0.001), endocrine system(especially thyroid cancer, APC, 2.60%; 95%CI, 2.01%-3.19%;P<0.001) and leukemia(APC, 0.57%; 95%CI, 0.31%-0.84%;P<0.001) increased most significantly. Instead, the incidence of cancer in skin excluding basal and squamous cancer (APC, -3.03%; 95%CI, -3.73% to -2.33%;P<0.001) and female genital system (especially cervical cancer, APC, -0.65%; 95%CI, -1.14% to -0.15%;P = 0.01) declined obviously(Table 3 , eTable2&eFig 2). Table 3 Incidence of cancers stratified by cancer site among people younger than 25 from 2000 to 2020 Incidence (ASIR per 100 000 cancers) Organ system 2000 2020 APC (95% CI) P value All Sites 5253 (19.26) 6021 (21.47) 0.72 ( 0.49 to 0.96 ) <0.001 Oral Cavity and Pharynx 73 (0.27) 90 (0.32) 0.32 (-0.64 to 1.30 ) 0.49 Digestive System 164 (0.60) 431 (1.52) 5.44 ( 4.46 to 6.43 ) <0.001 Respiratory System 82 (0.30) 79 (0.28) -0.29 (-1.24 to 0.68 ) 0.54 Bones and Joints 206 (0.76) 241 (0.87) 0.11 (-0.57 to 0.79 ) 0.75 Soft Tissue including Heart 314 (1.15) 299 (1.08) -0.08 (-0.62 to 0.45 ) 0.75 Skin excluding Basal and Squamous 357 (1.31) 182 (0.62) -3.03 (-3.73 to -2.33 ) <0.001 Breast 36 (0.13) 45 (0.15) 0.93 (-0.26 to 2.14 ) 0.12 Female Genital System 173 (0.63) 191 (0.66) -0.65 (-1.14 to -0.15 ) 0.01 Male Genital System 362 (1.32) 468 (1.59) 1.02 ( 0.60 to 1.44 ) <0.001 Urinary System 180 (0.66) 202 (0.74) 0.68 ( 0.13 to 1.23 ) 0.02 Eye and Orbit 92 (0.34) 70 (0.26) -0.40 (-1.21 to 0.42 ) 0.32 Brain and Other Nervous System 791 (2.90) 710 (2.60) -0.13 (-0.52 to 0.25 ) 0.48 Endocrine System 466 (1.71) 696 (2.43) 2.60 ( 2.01 to 3.19 ) <0.001 Lymphoma 838 (3.08) 922 (3.24) 0.33 ( 0.06 to 0.60 ) 0.02 Myeloma 1(0.00) 3 (0.01) 0.54 (-4.55 to 5.90 ) 0.83 Leukemia 1064 (3.90) 1172 (4.30) 0.57 ( 0.31 to 0.84 ) <0.001 Kaposi Sarcoma 4 (0.01) 9 (0.03) 1.64 (-1.87 to 5.28 ) 0.34 Miscellaneous 50 (0.18) 210 (0.76) 5.43 ( 3.63 to 7.25 ) <0.001 a P value of APC from 2000 to 2020. Abbreviations: APC, annual percentage change; ASIR,age-standardized incidence rate 5-year Relative Survival Rate of Cancers among People Younger than 25 From 2000 to 2015 For both sexes combined, the overall 5-year relative survival rate of cancer among individuals younger than 25 years increased from 80.40% (95% CI, 78.84%-81.87%) in 2000 to 87.80% (95% CI, 86.65%-88.86%) in 2015. Both males and females saw an increase in the 5-year relative survival rate, with females younger than 25 years reaching a 5-year relative survival rate of 89.86% in 2015, higher than that of males (85.58%) (Table 5, Fig. 2 ). The 5-year relative survival rate of cancer for all races younger than 25 years was higher than in 2000, but the survival rate for Blacks was relatively low. For all age groups younger than 25 years, the 5-year survival rate has been increasing from 2000 to 2015, but the rate for the 0–1 years age group is lower than for other age groups (Table 5, eFig 3). Table 5 5-year relative survival rate of cancers among people younger than 25 from 2000 to 2015. 5 Year Relative Survival Rate (%)(95%CI) Characteristic 2000 2015 Overall 80.40 (78.84 to 81.87) 87.80 (86.65 to 88.86) Sex Male 80.40(78.84 to 81.87) 85.58 (83.90 to 87.28) Female 82.48 (80.31 to 84.43) 89.86 (88.34 to 91.20) Race American Indian/Alaska Native 57.09 (37.55 to 72.56) 91.96 (68.57 to 98.15)a Asian or Pacific Islander 76.94 (69.85 to 82.57) 85.44 (80.73 to 89.07) Black 72.85 (66.50 to 78.20) 78.58 (73.58 to 82.75) White 81.68 (79.99 to 83.23) 88.78 (87.52 to 89.92) Unknown 85.15 (67.42 to 93.66) 97.59 (89.79 to 99.45)a Age, year 0 ~ 1 74.64 (68.48 to 79.78) 80.84 (75.27 to 84.70) 1 ~ 4 82.68 (79.99 to 85.05) 87.63 (85.36 to 89.57)a 5 ~ 9 78.51 (75.17 to 81.46) 86.95 (84.34 to 89.15) 10 ~ 14 80.76 (77.53 to 83.57)a 85.93 (83.41 to 88.09) 15 ~ 19 77.47 (74.82 to 79.88) 86.92 (85.00 to 88.62) 20 ~ 24 82.32 (80.36 to 84.11)a 86.37 (86.89 to 89.69)a Confidence interval: Log(-Log()) Transformation. The level is 95%. a, the relative cumulative survival increased from a prior interval and has been adjusted As mentioned above, for both sexes combined, the leading causes of cancer among individuals younger than 25 in the USA included leukemia/lymphoma, brain and other nervous system cancer, endocrine system cancer, and male genital system cancer. In 2015, the 5-year relative survival rate of leukemia (72.53%, 95% CI, 67.54%-76.89%), lymphoma (93.38%, 95% CI, 91.02%-95.13%), brain and other nervous system cancers (79.07%, 95% CI, 73.53%-83.58%), endocrine system cancers (98.98%, 95% CI, 97.61%-99.56%), and male genital system cancers (94.89%, 95% CI, 92.10%-96.71%) increased dramatically compared with 2000. Moreover, the 5-year relative survival rate of female reproductive system tumors also increased significantly (87.51%, 95% CI, 80.79–92.00%) (Table 6 , eFig 4). Comparatively, CAYA cancers with lower survival rates in 2015 included respiratory system cancer (63.16%, 95% CI, 47.91–75.06%), bone and joint cancer (65.23%, 95% CI, 56.36–72.73%), and Kaposi Sarcoma (68.26%, 95% CI, 39.54–85.46%) (Table 4). Additionally, cranial nerves/other nervous system cancer in males and liver/intrahepatic bile duct cancer in females had low survival rates, at 50.2% (95% CI, 18.4–76.3%) and 50.0% (95% CI, 20.8–73.6%), respectively (eTable 1). Table 6 5-year relative survival rate of cancers stratified by cancer site among people younger than 25 from 2000 to 2015 5 Year Relative Survival Rate (%) (95%CI) Organ system 2000 2015 All Sites 80.40 (78.84 to 81.87) 87.80 (86.65 to 88.86) Oral Cavity and Pharynx 80.37 (67.03 to 88.75) 98.02 (84.83 to 99.76)a Digestive System 57.65 (44.94 to 68.44) 81.02 (75.63 to 85.53) Respiratory System 64.31 (49.76 to 75.64) 63.16 (47.91 to 75.06) Bones and Joints 61.48 (51.04 to 70.34) 65.23 (56.36 to 72.73) Soft Tissue including Heart 69.18 (61.09 to 75.92) 74.14 (66.35 to 80.39) Skin excluding Basal and Squamous 95.71 (92.58 to 97.54) 98.83 (95.59 to 99.69)a Breast 80.50 (63.12 to 90.92) 80.60 (66.74 to 89.13) Female Genital System 81.76 (74.47 to 87.14) 87.51 (80.79 to 92.00) Male Genital System 93.00 (89.61 to 95.31) 94.89 (92.10 to 96.71) Urinary System 80.60 (63.11 to 90.39) 87.91 (74.77 to 94.45) Eye and Orbit —— —— Brain and Other Nervous System 69.98 (63.42 to 75.60) 79.07 (73.53 to 83.58) Endocrine System 95.53 (92.51 to 97.35) 98.98 (97.61 to 99.56) Lymphoma 84.86 (81.65 to 87.56) 93.38 (91.02 to 95.13) Myeloma —— 75.01 (12.79 to 96.06) Leukemia 50.48 (44.21 to 56.41) 72.53 (67.54 to 76.89) Kaposi Sarcoma 66.79 (5.34 to 94.59) 68.26 (39.54 to 85.46) Miscellaneous 40.17 (19.37 to 60.24) 86.31 (75.90 to 92.45) a, the width of the confidence interval is more than 25% lager than if the normal approximation was applied NHL, non-Hodgkin lymphoma; NOS, not otherwise specified. Discussion In this population-based study, data from 17 SEER registries in the United States were collected to analyze cancer cases in individuals under the age of 25 from 2000 to 2020. To our knowledge, this is the first report on the incidence and long-term overall survival patterns for CAYA cancer survivors in the past 20 years in the USA. The overall age-standardized incidence rate (ASIR) of CAYA cancer was 19.26 per 100,000 in 2000 and 21.47 per 100,000 in 2020. The trends in the incidence rate of CAYA cancer increased, with the incidence rate in males higher than that in females. Additionally, the overall 5-year relative survival rate of CAYA cancer increased from 80.40% (95% CI, 78.84%-81.87%) in 2000 to 87.80% (95% CI, 86.65%-88.86%) in 2015, with the 5-year relative survival rate for females under 25 years reaching 89.86%, higher than that for males (85.58%). Previous studies on cancer incidence have often focused on early-onset cancers, typically under the age of 50[ 6 ]. Among individuals under 50 years old, breast, thyroid, and colon and/or rectum cancers are more common than other sites[ 6 ]. However, breast and thyroid cancers are not common in individuals younger than 25, whereas leukemia, lymphoma, brain and other nervous system cancers, male genital system cancers, and digestive system cancers are more prevalent, accounting for more than 50% of all sites in CAYA individuals. This suggests that there are different characteristics of tumor onset in CAYA individuals. In the following Table 6 , we summarized the incidence and survival rates of common cancers among individuals of different ages and regions. In recent years, the common sites of CAYA tumors have changed compared to before, with the blood system, nervous system, and male genital system becoming more common. Moreover, there are differences in common cancers between different age groups and regions. For example, in individuals aged 15 to 39 years, breast cancer is common, but not in those younger than 25 years old (Table 7 ). Table 7 Comparative of common cancer and survival rates in CAYA cancer patients. (Supplement data) Author Data source Publication year Investigation period Region Age range Common cancer Survival rate Beatriz de Camargo et al.[ 8 ] PBCR 2010 1991–2004 Brazil 0 to 19 years Male: Leukemia, Lymphoma, CNS tumors; —— Meerim Park et al.[ 9 ] KCCR 2016 1993–2016 Korea 15 to 39 years Thyroid carcinoma, Carcinoma of Gastrointestinal Tract, Carcinoma of Breast, Carcinoma of Genitourinary Tract; Thyroid carcinoma (100.1%), Carcinoma of Gastrointestinal Tract (69.7%), Carcinoma of Breast (100.5%), Carcinoma of Genitourinary Tract (92.8%);b Annalisa Trama et al.[ 10 ] EUROCARE-5 2016 2000–2007 Europe 15 to 39 years Male: Germ cell tumours, trophoblastic tumours, and neoplasms of gonads, Malignant melanomas, Hodgkin lymphomas; Female: Breast carcinomas, Female genital tract carcinomas, Malignant melanomas; Male: Germ cell tumours, trophoblastic tumours, and neoplasms of gonads (94·9%), Malignant melanomas(84.0%), Hodgkin lymphomas (91.8%);b Female: Breast carcinomas (83.5%), Female genital tract carcinomas (81.6%), Malignant melanomas (91.9%);b Alyssa R. Scott et al.[ 11 ] the SEER Database 18 registry research data 2020 1973–2015 the US 15 to 39 years Male: Germ Cell and Trophoblastic Neoplasms of Gonads, Melanoma, Non-Hodgkin lymphoma; Female: Breast, Thyroid carcinoma, Carcinoma of the Cervix and Uterus; —— Chengqi Xiao et al. the SEER Database 17 registry research data —— 2000–2020 the US 0 to 25 years Leukemia, Lymphoma, Brain and other nervous system, Male genital system, Digestive system; Leukemia (72.53%), Lymphoma (93.38%), Brain and other nervous system (79.07%), Male genital system (94.89%), Digestive system (81.02%);c The SEER Database: Surveillance, Epidemiology, and End Results Database; EUROCARE: European Cancer Registry Based Study on Survival and Care of Cancer Patients; Korea National Cancer Incidence database in the Korea Central Cancer Registry; CNS, central nervous system; PBCR: The Brazilian Population-Based Cancer Registry; a, 5-relative survival rate, 2012–2016; b, relative survival rate, population weighted; c, 5-relative survival rate,2016. Table 6 . Comparative of common cancer and survival rate among younger people. In our study, we observed that leukemia, lymphoma, brain and other nervous system cancers, endocrine system cancers, and male genital system cancers were the top five cancer types, collectively accounting for more than 60% of all CAYA cancer cases. Additionally, there was a notable increase in digestive system cancers, while the incidence of skin cancers excluding basal and squamous cell carcinoma, as well as female genital system cancers, declined. Various factors are associated with cancer in CAYA individuals, including intrauterine radiation exposure[ 12 ], transplacental exposure to environmental carcinogens[ 13 ] smoking, exposure to environmental tobacco smoke[ 14 ], and inherited genetic factors[ 15 ]. The use of colonoscopy has been beneficial for screening colorectal cancer[ 16 ]. The advancement of auxiliary examination techniques such as ultrasound, CT, and MRI, along with the application of puncture biopsy, has led to a rapid increase in the incidence of thyroid cancer, although concerns about overdiagnosis exist[ 17 , 18 ]. Public health efforts targeting melanoma have resulted in a decline in its incidence among CAYA individuals[ 19 , 20 ]. The significant decrease in the incidence of cervical cancer can be attributed to the widespread use of the HPV vaccine[ 18 , 21 ]. However, some cancers, like osteosarcoma, have not seen significant treatment breakthroughs[ 22 ], leading to minimal changes in survival rates. The overall 5-year relative survival rate of CAYA cancer increased from 80.40% (95% CI, 78.84%-81.87%) in 2000 to 87.80% (95% CI, 86.65%-88.86%) in 2015. With advancements in treatment technology, such as genome-based and immunologic-based treatments, the cure rate of cancer in CAYA individuals has improved[ 23 , 24 ]. The higher survival rates have led to an increase in CAYA cancer survivors, who face dual challenges transitioning from precancerous states to survivors and from childhood or adolescence to adulthood[ 25 ]. Apart from cancer affecting their growth[ 26 ], two-thirds of CAYA survivors are at a particular risk of long-term sequelae from the cancer itself or the therapies used[ 27 ]. Compared to healthy individuals, adolescent and young adult (AYA) cancer survivors are at a higher risk of poor health-related quality of life due to a higher burden of total chronic health conditions (CHCs)[ 28 ]. Lager epigenetic age accelerations were measured among children and adolescent cancer survivors associated with early-onset obesity, morbidity burden in general, and late mortality[ 29 ]. Children and adolescent cancer survivors, especially those from low- and middle-income backgrounds, are more likely to experience physical late effects, including hypothyroidism, metabolic syndrome, gonadal dysfunction, cardiac dysfunction, and even secondary primary cancer[ 30 , 31 ]. Psychological problems are also more severe in young cancer patients[ 32 ]. Additionally, CAYA cancer survivors are at risk of delayed cancer diagnosis[ 33 ]. Collectively, these individuals require more psychological and social support[ 34 ]. Common cancer treatments such as radiotherapy and chemotherapy can impair reproductive health and fertility[ 35 – 40 ]. Compared to healthy individuals, cancer survivors are 80% more likely to experience diminished fertility after cancer treatments[ 41 ]. Female cancer survivors are particularly vulnerable to fertility damage due to the destruction of ovarian function[ 42 ]. Premature ovarian insufficiency (POI), which impacts fertility and estrogen production, can occur in about 30% of cases within 2 years after cancer diagnosis[ 43 ]. POI can manifest as acute ovarian failure (AOF) in the years following cancer treatment, leading to either the cessation of menstruation or the failure to achieve natural menarche. POI can also result in premature menopause after cancer treatment, leading not only to infertility but also to premature aging of the body. The risk of AOF and POI depends on factors such as age, cyclophosphamide equivalent dose (CED), and the quantity of radiation (RT). For example, with a high CED, the risk of AOF is greater than 5% for individuals aged 1–20 with a dose to the least affected ovary (LAO) of less than 2 Gy, and the risk of POI by age 20 approaches 100%[ 44 ]. Children born to female cancer survivors are at an increased risk of being born preterm and with low birth weight[ 45 , 46 ]. Similarly, some male cancer survivors experience reduced sperm count and azoospermia due to treatments such as high cumulative radiation[ 37 , 47 ]. For instance, when the mean testicular dose exceeds 1 Gy, the rate of oligospermia increases to over 90% at 12 months[ 48 ]. These cancer survivors often experience mental depression due to the damage to their reproductive function, which can be particularly severe in females compared to males[ 49 ]. Therefore, the reproductive health of young cancer survivors is a critical aspect of their overall well-being that cannot be ignored. Oncofertility focuses on addressing the intersection of oncology and reproductive medicine to preserve or restore the reproductive function of cancer survivors[ 50 ]. Fertility preservation (FP) involves specific medical interventions to protect the fertility of individuals at risk of infertility due to their disease or its treatment. This can include cryopreservation of oocytes, embryos, ovarian tissue, sperm, and testicular tissue[ 51 ]. The gold standards of FP in female cancer patients are oocyte and embryo vitrification. With the advancements in assisted reproductive technology (ART), an increasing number of female cancer survivors have been able to have offspring[ 52 ]. Other FP techniques for females include ovarian tissue cryopreservation[ 53 , 54 ], in vitro maturation (IVM) [ 55 ] and stem cell regeneration [ 56 ]. Stem cells currently under study for FP include embryonic stem cells (ESCs)[ 57 ], human pluripotent stem cells (hPSCs)[ 58 ] and mesenchymal stem cells (MSCs).Further, MSCs contained human amniotic epithelial cells (hAECs)[ 59 ], umbilical cord mesenchymal stem cells (UC-MSCs)[ 60 ], human placenta-derived mesenchymal stem cell (hPMSC)[ 61 ]. Anti-Müllerian hormone (AMH) decreased or undetectable after treatment in cancer survivors can be regard as an indicator of ovarian function[ 62 ]. For male cancer patients, the FP gold standard is sperm cryopreservation, with cryopreservation of testicular tissue and in vitro spermatogenesis as complementary options[ 52 ]. Spermatogonial stem cells (SSCs), which have the ability to self-renew and differentiate, are considered an ideal tissue for cryopreservation[ 63 ]. Additionally, raising awareness among young cancer survivors about the potential long-term reproductive effects of cancer treatment is a priority in current care.[ 64 ]. Therefore, more efforts should be focused on FP for young cancer survivors to help preserve their fertility and improve their quality of life after cancer treatment. To our knowledge, this is the first report on the cancer incidence and survival rates among individuals younger than 25 years old in the USA over the past 20 years. However, this study has some limitations. Firstly, the majority of participants were White, whereas some reports suggest that the incidence and prognosis of certain cancers are related to race[ 65 – 67 ]. Secondly, the study did not consider the impact of the coronavirus disease 2019 (COVID-19) pandemic, as there was a lag in statistical data. Some studies have indicated that COVID-19 may affect the incidence and survival rates of cancer[ 68 , 69 ]. Finally, our study was based on the SEER database, and as cancer incidence can vary by region, further research is needed to explore the incidence and survival of cancer in individuals under 25 years old globally. Conclusion The incidence of cancer among individuals under 25 years old is increasing in the United States, and the 5-year relative survival rate has also improved compared to previous years. It is crucial for public health and medical services to prioritize the care of CAYA cancer survivors to prevent late sequelae related to reproduction. Declarations Author Contribution The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Chengqi Xiao, Dongmei Lai and Min Ji. The first draft of the manuscript was written by Chengqi Xiao and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgments This study was funded by the National Natural Science Foundation of China (82271664), the Research Projects of Shanghai Municipal Health Committee (202240345); the interdisciplinary program of Shanghai Jiao Tong University (YG2022ZD028), Shanghai Key Laboratory of Embryo Original Diseases (Shelab2022ZD01). References Organisation, W.H. 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Drechsel, K.C.E., et al., Reproductive ability in survivors of childhood, adolescent, and young adult Hodgkin lymphoma: a review. Hum Reprod Update, 2023. 29(4): p. 486-517. Yumura, Y., et al., Fertility and sexual dysfunction in young male cancer survivors. Reprod Med Biol, 2022. 21(1): p. e12481. Brant, A., et al., Effects of Chemo- and Radiation Therapy on Microsurgical Testicular Sperm Extraction for Men with Nonobstructive Azoospermia. J Urol, 2022. 208(3): p. 676-683. van den Berg, M.H., et al., Treatment-related fertility impairment in long-term female childhood, adolescent and young adult cancer survivors: investigating dose-effect relationships in a European case-control study (PanCareLIFE). Hum Reprod, 2021. 36(6): p. 1561-1573. Roshandel, R., et al., Female reproductive function after treatment of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer, 2021. 68(4): p. e28894. Patterson, P., et al., Emerging issues among adolescent and young adult cancer survivors. Semin Oncol Nurs, 2015. 31(1): p. 53-9. Stern, E., et al., Hypothalamic-pituitary-gonadal function, pubertal development, and fertility outcomes in male and female medulloblastoma survivors: a single-center experience. Neuro Oncol, 2023. 25(7): p. 1345-1354. Garrido Colino, C., et al., Primary ovarian insufficiency in cancer survivors: Keys to optimal management. An Pediatr (Engl Ed), 2023. 99(6): p. 385-392. Milano, M.T., et al., Comparison of Risks of Late Effects From Radiation Therapy in Children Versus Adults: Insights From the QUANTEC, HyTEC, and PENTEC Efforts. Int J Radiat Oncol Biol Phys, 2023. Everhøj, C., et al., Effects of early maternal cancer and fertility treatment on the risk of adverse birth outcomes. EClinicalMedicine, 2022. 46: p. 101369. Anderson, C., et al., Risk of adverse birth outcomes after adolescent and young adult cancer. JNCI Cancer Spectr, 2023. Jahnukainen, K., et al., Testicular function and fertility preservation in male cancer patients. Best Pract Res Clin Endocrinol Metab, 2011. 25(2): p. 287-302. Baliga, S., et al., Testicular Dysfunction in Male Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys, 2023. Lehmann, V., et al., Fertility-related knowledge and reproductive goals in childhood cancer survivors: short communication. Hum Reprod, 2017. 32(11): p. 2250-2253. Woodruff, T.K., The Oncofertility Consortium--addressing fertility in young people with cancer. Nat Rev Clin Oncol, 2010. 7(8): p. 466-75. Sauerbrun-Cutler, M.T., et al., The Status of Fertility Preservation (FP) Insurance Mandates and Their Impact on Utilization and Access to Care. J Clin Med, 2024. 13(4). Medrano, J.V., et al., Basic and Clinical Approaches for Fertility Preservation and Restoration in Cancer Patients. Trends Biotechnol, 2018. 36(2): p. 199-215. Canosa, S., et al., Innovative Strategies for Fertility Preservation in Female Cancer Survivors: New Hope from Artificial Ovary Construction and Stem Cell-Derived Neo-Folliculogenesis. Healthcare (Basel), 2023. 11(20). Corkum, K.S., et al., Fertility and hormone preservation and restoration for female children and adolescents receiving gonadotoxic cancer treatments: A systematic review. J Pediatr Surg, 2019. 54(11): p. 2200-2209. Segers, I., et al., In vitro maturation (IVM) of oocytes recovered from ovariectomy specimens in the laboratory: a promising "ex vivo" method of oocyte cryopreservation resulting in the first report of an ongoing pregnancy in Europe. J Assist Reprod Genet, 2015. 32(8): p. 1221-31. Silvestris, E., et al., Human Ovarian Cortex biobanking: A Fascinating Resource for Fertility Preservation in Cancer. Int J Mol Sci, 2020. 21(9). Bahrehbar, K., et al., Human embryonic stem cell-derived mesenchymal stem cells improved premature ovarian failure. World J Stem Cells, 2020. 12(8): p. 857-878. Yamashiro, C., et al., Generation of human oogonia from induced pluripotent stem cells in vitro. Science, 2018. 362(6412): p. 356-360. Wang, F., et al., Human amniotic epithelial cells can differentiate into granulosa cells and restore folliculogenesis in a mouse model of chemotherapy-induced premature ovarian failure. Stem Cell Res Ther, 2013. 4(5): p. 124. Ding, L., et al., Transplantation of UC-MSCs on collagen scaffold activates follicles in dormant ovaries of POF patients with long history of infertility. Sci China Life Sci, 2018. 61(12): p. 1554-1565. Yin, N., et al., Restoring Ovarian Function With Human Placenta-Derived Mesenchymal Stem Cells in Autoimmune-Induced Premature Ovarian Failure Mice Mediated by Treg Cells and Associated Cytokines. Reprod Sci, 2018. 25(7): p. 1073-1082. Lie Fong, S., et al., Anti-müllerian hormone as a marker of ovarian function in women after chemotherapy and radiotherapy for haematological malignancies. Hum Reprod, 2008. 23(3): p. 674-8. Kubota, H. and R.L. Brinster, Spermatogonial stem cells. Biol Reprod, 2018. 99(1): p. 52-74. Holme, I.K., et al., Sexual Problems as Late Effects: Awareness and Information Needs Among 1870 Long-term Norwegian Childhood, Adolescent, and Young Adult Cancer Survivors (The NOR-CAYACS Study). J Adolesc Young Adult Oncol, 2023. Sozio, S.J., et al., Prognosis of South Asian Buccal Mucosa Cancer Patients in the United States: Association of Race with Overall Survival. Asian Pac J Cancer Prev, 2024. 25(1): p. 241-248. Tan, S.H., et al., Identification of phenomic data in the pathogenesis of cancers of the gastrointestinal (GI) tract in the UK biobank. Sci Rep, 2024. 14(1): p. 1997. Zheng, S., E.D. Donnelly, and J.B. Strauss, Race, Prevalence of POLE and POLD1 Alterations, and Survival Among Patients With Endometrial Cancer. JAMA Netw Open, 2024. 7(1): p. e2351906. de Andrade-Lima, A.L.M., et al., The Infection Profile and Survival of Children and Adolescents With COVID-19 Undergoing Cancer Treatment: A Cohort Study. Pediatr Infect Dis J, 2023. 42(7): p. 614-619. Guével, E., et al., Impact of the COVID-19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study. Cancer Med, 2023. 12(22): p. 20918-20929. Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial.docx Cite Share Download PDF Status: Under Review Version 1 posted Editor assigned by journal 25 May, 2024 Submission checks completed at journal 25 May, 2024 First submitted to journal 24 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4472499","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":306644593,"identity":"2713e377-f13f-4a5b-8228-ce9897a90b3f","order_by":0,"name":"Xiao Chengqi","email":"","orcid":"","institution":"The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University","correspondingAuthor":false,"prefix":"","firstName":"Xiao","middleName":"","lastName":"Chengqi","suffix":""},{"id":306644594,"identity":"ec912125-2717-4b3e-a836-10144c0bdb03","order_by":1,"name":"Min Ji","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Ji","suffix":""},{"id":306644595,"identity":"29f02c34-2af3-4643-a65d-20cc19a09ce6","order_by":2,"name":"Dongmei Lai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYBACPgbGBgkwi5n5GJhmYyeghQ2hhS2NgSEBKMJMUAsDA0QLA48ZWAsDQS3shxtvfNxRG83PzvPtwccf2+T5mBkYP3zMwaOFJ7HZcuaZ47kzm3m3G85IuG3YxszALDlzGz6HJbZJ87Ydy91wmHebNE/CbUagFjZmXnxa+B9CtOw/zPMMpMWesBYJsC01uRuYedhAWhKJ0PIQ6Je2A7kzDrOZSc5Iu53cxszYjNcv/PzpD298bKvL7e8//Ezig81t2/ntzQc/fMSjBQoOI3MYGwiqB4I6YhSNglEwCkbBSAUAGIhLNfK+U00AAAAASUVORK5CYII=","orcid":"","institution":"The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University","correspondingAuthor":true,"prefix":"","firstName":"Dongmei","middleName":"","lastName":"Lai","suffix":""}],"badges":[],"createdAt":"2024-05-24 12:36:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4472499/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4472499/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58151009,"identity":"009dc755-7654-4139-87e6-9e52a47f4719","added_by":"auto","created_at":"2024-06-11 20:09:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":196163,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe trend in incidence rate of cancer from 2000 to 2020 among people younger than 25.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ea. The incidence rate of cancer from 2000 to 2020 among people younger than 25.\u003c/p\u003e\n\u003cp\u003eb. The incidence rate of cancer from 2000 to 2020 among people younger than 25, stratified by sex.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4472499/v1/74b6382da597ebdccd2ce442.png"},{"id":58151008,"identity":"46a1d79e-b027-4bf7-a9bc-90e986aa5f20","added_by":"auto","created_at":"2024-06-11 20:09:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":162436,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe change of 5-year relative survival rate of cancers among people younger than 25 years from 2000 to 2015.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ea. The change of 5-year relative survival rate of cancers among people younger than 25 years from 2000 to 2015.\u003c/p\u003e\n\u003cp\u003eb. The change of 5-year relative survival rate of cancers among people than younger 25 years from 2000 to 2015, stratified by sex.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4472499/v1/66f06b9720e23632327a697d.png"},{"id":58152273,"identity":"817aac49-549a-4a86-aa83-30674cf62be7","added_by":"auto","created_at":"2024-06-11 20:17:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1102378,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4472499/v1/1b60a28a-4ea1-4de8-9dd3-6a20becf085a.pdf"},{"id":58151010,"identity":"ddb885f8-2925-4262-9cf7-db5b3b0a8382","added_by":"auto","created_at":"2024-06-11 20:09:38","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":693372,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-4472499/v1/1b44f369f05d765e23168891.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Incidence and 5-years Relative Survival Rate of Cancer among People Younger than 25 Years in the US, 2000 to 2020: a SEER-retrospective study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to statistics from the World Health Organization (WHO), approximately 400,000 children and adolescents (0\u0026ndash;19 years old) worldwide are diagnosed with cancer every year[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In the United States, more than 15,000 children and adolescents were diagnosed with cancer in 2023[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Early detection and intervention for various cancers have contributed to improved survival rates[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In high-income countries, the 5-year survival rates for children, adolescents, and young adults (CAYA) diagnosed at age 25 or younger have exceeded 80%, indicating that CAYA are surviving cancer more frequently today than in the past[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith the advancement of cancer research, the concept of early-onset cancer has emerged, often defined as cancers diagnosed in adults under 50 years of age[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recent efforts have focused on evaluating the incidence patterns of specific types of early-onset cancers[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Despite being classified as early-onset cancer, survivors of cancer in CAYA have unique characteristics and face challenges regarding reproductive health. However, a comprehensive overview of recent patterns of CAYA cancer in the US over the past 20 years has not been reported.\u003c/p\u003e \u003cp\u003eThis study utilized population-based data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program to characterize temporal patterns in the incidence of CAYA cancers in the US from 2000 to 2020. The primary objective was to characterize the temporal patterns in CAYA cancer overall and by organ system. The secondary objective was to assess temporal patterns in CAYA cancer stratified by sex, age group, and race and ethnicity. These results can provide scientific evidence for cancer preventive strategies in CAYA cancer patients regarding their future risk for long-term sequelae, especially in terms of fertility prospects.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe obtained the data from the SEER, which is publicly accessible (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://seer.cancer.gov/\u003c/span\u003e\u003cspan address=\"https://seer.cancer.gov/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). SEER is supported by the Surveillance Research Program (SRP) and Population Sciences (DCCPS). Since these data were freely available, the study was exempted from institutional review, and no consent form was required. Data from 17 SEER registries (Incidence-SEER 17 Registries 2000\u0026ndash;2020) were used to identify cancer cases in individuals younger than 25 years from January 1, 2000, to December 31, 2020. These 17 SEER registries cover approximately 26.5% of the U.S. population based on the 2020 census, including San Francisco-Oakland SMSA, Connecticut, Hawaii, Iowa, New Mexico, Seattle (Puget Sound), Utah, Atlanta (Metropolitan), San Jose-Monterey, Los Angeles, Alaska Natives, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, New Jersey, and Greater Georgia[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSEER STAT software 8.4.2 was utilized to estimate cross-sectional incidence rates and the 20-year mean annual percentage change (APC) in incidence rates, as well as the 5-year relative survival rate, stratified by sex (male and female), race (American Indian/Alaska Native, Asian or Pacific Islander, Black, White, Unknown), and age groups (0, 1\u0026ndash;4, 5\u0026ndash;9, 10\u0026ndash;14, 15\u0026ndash;19, 20\u0026ndash;24). The SEER program uses the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) to classify cancer sites. Bar charts were used to compare changes in cancer incidence between 2000 and 2020 and 5-year relative survival rates between 2000 and 2015. A forest plot was used to show the 20-year APC stratified by sex, race, age, and cancer site. A joinpoint regression model was established to simulate the trend of cancer incidence and 5-year survival rate in CAYA. P-value less than 0.05 was considered statistically significant. R 4.3.2 was employed to create bar charts, forest plots, and charts showing changes in cancer incidence and survival rates. The R package included ggplot2, splines, rms, stringr, reshape2, forcats, and forestplot.\u003c/p\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eSociodemographic Characteristics of Cancers among People Younger than 25 Years From 2000 to 2020\u003c/h2\u003e\n \u003cp\u003eBetween 2000 and 2020, the SEER 17 data file included 129,384 CAYA patients younger than 25 years with cancer in the USA, with 67,873 (52.46%) being male and 61,511 (47.54%) female. Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the overall counts of CAYA cancers diagnosed during this period, stratified by age, sex, and race. More than 50% of CAYA cancer patients were aged 14\u0026ndash;25 years old, and 79.26% were White. Additionally, the gender ratio was consistent across all age and race groups (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSociodemographic Characteristics of CAYA Cancers among People Younger than 25 Years From 2000 to 2020a\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eSex group (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall Age, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e129384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67873 (52.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61511 (47.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5654 (4.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2985 (52.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2669 (47.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026thinsp;~\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20254 (15.65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10965 (54.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9289 (45.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u0026thinsp;~\u0026thinsp;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14755 (11.40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8138 (55.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6617 (44.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026thinsp;~\u0026thinsp;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17137 (13.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9092 (53.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8045 (46.95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026thinsp;~\u0026thinsp;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27444 (21.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14653 (53.39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12791 (46.61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u0026thinsp;~\u0026thinsp;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44140 (34.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22040 (49.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22100 (50.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmerican Indian/Alaska Native\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1343 (1.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e712 (53.02%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e631 (46.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAsian or Pacific Islander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10295 (7.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5304 (51.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4991 (48.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12914 (9.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6494 (50.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6420 (49.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102554(79.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54239 (53.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48315 (47.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2278 (1.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1124 (49,34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1154 (50.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003ea Data extracted from the Surveillance, Epidemiology and End Results Database 17 Registry, November 2022 (2000\u0026ndash;2020), linked by county\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eIncidence of Cancers among People Younger than 25 years from 2000 to 2020\u003c/h2\u003e\n \u003cp\u003eAs shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and eFig 1 in the supplement, the age-standardized incidence rate (ASIR) of cancer among individuals younger than 25 years was 19.26 cases per 100,000 individuals in 2000 and 21.47 cases per 100,000 individuals in 2020. The overall incidence of CAYA cancer increased significantly, with an annual percentage change (APC) of 0.72% (95% CI, 0.49%-0.96%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n \u003cp\u003eFrom 2000 to 2020, the ASIR of cancer among individuals younger than 25 years increased in Asian or Pacific Islander individuals (APC 1.23%; 95% CI, 0.76%-1.70%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Black individuals (APC 0.61%; 95% CI, 0.18\u0026ndash;1.04%; P\u0026thinsp;=\u0026thinsp;0.008), and White individuals (APC 0.68%; 95% CI, 0.42\u0026ndash;0.94%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and decreased in American Indian/Alaska Native individuals (APC, -0.60%; 95% CI, -1.58%-0.39%; P\u0026thinsp;=\u0026thinsp;0.22). The ASIR of cancer among individuals younger than 25 years increased notably in the age groups of 10 to 14 (APC, 1.29%; 95% CI, 0.90%-1.67%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), 15 to 19 (APC, 0.99%; 95% CI, 0.75%-1.23%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and 20 to 24 (APC, 0.61%; 95% CI, 0.34%-0.88%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eIncidence of cancers among people younger than 25 from 2000 to 2020\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eIncidence (ASIR per 100 000 people)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAPC (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5253 ( 19.26 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6021 ( 21.47 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72 ( 0.49 to 0.96 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2750 ( 19.62 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3156 ( 22.02 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70 ( 0.47 to 0.93 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2503 ( 18.89 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2865 ( 20.89 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75 ( 0.45 to 1.04 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmerican Indian/Alaska Native\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 ( 11.92 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68 ( 10.86 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.60 (-1.58 to 0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAsian or Pacific Islander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e335 ( 14.10 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e556 ( 17.21 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.23 ( 0.76 to 1.70 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e452 ( 12.17 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e653 ( 16.07 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61 ( 0.18 to 1.04 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4367 ( 21.07 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4543 ( 22.59 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.68 ( 0.42 to 0.94 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 ( \u0026mdash;\u0026mdash; )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e201 ( \u0026mdash;\u0026mdash; )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge,years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e241 ( 22.57 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e246 ( 24.62 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.08 (-0.46 to 0.62 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026thinsp;~\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e870 ( 20.39 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e904 ( 21.68 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.26 (-0.09 to 0.61 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u0026thinsp;~\u0026thinsp;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e669 ( 11.73 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e652 ( 11.93 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.74 ( 0.28 to 1.20 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026thinsp;~\u0026thinsp;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e679 ( 12.12 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e825 ( 14.75 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.29 ( 0.90 to 1.67 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026thinsp;~\u0026thinsp;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1098 ( 20.14 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1352 ( 24.20 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99 ( 0.75 to 1.23 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u0026thinsp;~\u0026thinsp;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1696 ( 32.63 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2042 ( 35.45 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61 ( 0.34 to 0.88 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003ea P value of APC from 2000 to 2020.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eAbbreviations: APC, annual percentage change; ASIR, age-standardized incidence rate.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eThe incidence of cancer among individuals younger than 25 years has increased in both males (APC, 0.70%; 95% CI, 0.47%-0.93%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and females (APC, 0.75%; 95% CI, 0.45%-1.04%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The trends in the incidence rate of cancer increased from 2000 to 2015 and decreased after 2015, but the incidence rate of cancer in 2020 was still higher than that in 2000 among individuals younger than 25 years. Grouped by sex, both males and females followed a similar trend, with the incidence rate of cancer higher in males than in females (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eLeading causes of cancer among People Younger than 25 years from 2000 to 2020\u003c/h3\u003e\n\u003cp\u003eThe total number of cancer cases among individuals younger than 25 years was 5,253 in 2000 and 6,021 in 2020. The leading causes of CAYA cancer during these 20 years were similar. Leukemia/lymphoma was the most common cancer in the USA in 2000 (1,902 cases) and in 2020 (2,094 cases), followed by brain and other nervous system cancer in 2000 (791 cases) and in 2020 (710 cases), endocrine system cancer in 2000 (466 cases) and in 2020 (696 cases), and male genital system cancer in 2000 (362 cases) and in 2020 (468 cases), accounting for 67.02% in 2000 and 65.45% in 2020 of total cancer cases, respectively. There is a gender difference in the leading cause of CAYA cancer in 2020. The top 5 cancers in males included leukemia, lymphoma, male genital system cancer, nervous system cancer, and endocrine system cancer, accounting for 75.4% of total cancer cases in males in 2020, whereas the most common cancers in females were leukemia, endocrine system cancer, lymphoma, nervous system cancer, and digestive system cancer, accounting for 63.75% of total new cancer cases in females (eTable 1).\u003c/p\u003e\n\u003cp\u003eIn addition, the incidence of cancers in the digestive system (APC, 5.44%; 95%CI, 4.46%-6.43%; P\u0026lt;0.001), male genital system(especially testicular cancer,APC,1.02%;; 95%CI,0.60\u0026ndash;1.44%,;P\u0026lt;0.001), endocrine system(especially thyroid cancer, APC, 2.60%; 95%CI, 2.01%-3.19%;P\u0026lt;0.001) and leukemia(APC, 0.57%; 95%CI, 0.31%-0.84%;P\u0026lt;0.001) increased most significantly. Instead, the incidence of cancer in skin excluding basal and squamous cancer (APC, -3.03%; 95%CI, -3.73% to -2.33%;P\u0026lt;0.001) and female genital system (especially cervical cancer, APC, -0.65%; 95%CI, -1.14% to -0.15%;P\u0026thinsp;=\u0026thinsp;0.01) declined obviously(Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, eTable2\u0026amp;eFig 2).\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eIncidence of cancers stratified by cancer site among people younger than 25 from 2000 to 2020\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eIncidence (ASIR per 100 000 cancers)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrgan system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAPC (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAll Sites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5253 (19.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6021 (21.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72 ( 0.49 to 0.96 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOral Cavity and Pharynx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73 (0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90 (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.32 (-0.64 to 1.30 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDigestive System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e164 (0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e431 (1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.44 ( 4.46 to 6.43 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRespiratory System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82 (0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79 (0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.29 (-1.24 to 0.68 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBones and Joints\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e206 (0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e241 (0.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.11 (-0.57 to 0.79 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSoft Tissue including Heart\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e314 (1.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e299 (1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.08 (-0.62 to 0.45 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSkin excluding Basal and Squamous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e357 (1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e182 (0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.03 (-3.73 to -2.33 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 (0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93 (-0.26 to 2.14 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale Genital System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e173 (0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e191 (0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.65 (-1.14 to -0.15 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale Genital System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e362 (1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e468 (1.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02 ( 0.60 to 1.44 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrinary System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e180 (0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e202 (0.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.68 ( 0.13 to 1.23 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEye and Orbit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92 (0.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70 (0.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.40 (-1.21 to 0.42 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrain and Other Nervous System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e791 (2.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e710 (2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.13 (-0.52 to 0.25 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndocrine System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e466 (1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e696 (2.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.60 ( 2.01 to 3.19 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymphoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e838 (3.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e922 (3.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33 ( 0.06 to 0.60 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMyeloma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54 (-4.55 to 5.90 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeukemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1064 (3.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1172 (4.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57 ( 0.31 to 0.84 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKaposi Sarcoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.64 (-1.87 to 5.28 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiscellaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e210 (0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.43 ( 3.63 to 7.25 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003ea P value of APC from 2000 to 2020.\u003c/p\u003e\n \u003cp\u003eAbbreviations: APC, annual percentage change; ASIR,age-standardized incidence rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e5-year Relative Survival Rate of Cancers among People Younger than 25 From 2000 to 2015\u003c/h2\u003e\n \u003cp\u003eFor both sexes combined, the overall 5-year relative survival rate of cancer among individuals younger than 25 years increased from 80.40% (95% CI, 78.84%-81.87%) in 2000 to 87.80% (95% CI, 86.65%-88.86%) in 2015. Both males and females saw an increase in the 5-year relative survival rate, with females younger than 25 years reaching a 5-year relative survival rate of 89.86% in 2015, higher than that of males (85.58%) (Table 5, Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The 5-year relative survival rate of cancer for all races younger than 25 years was higher than in 2000, but the survival rate for Blacks was relatively low. For all age groups younger than 25 years, the 5-year survival rate has been increasing from 2000 to 2015, but the rate for the 0\u0026ndash;1 years age group is lower than for other age groups (Table\u0026nbsp;5, eFig 3).\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e5-year relative survival rate of cancers among people younger than 25 from 2000 to 2015.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e5 Year Relative Survival Rate (%)(95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.40 (78.84 to 81.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.80 (86.65 to 88.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.40(78.84 to 81.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.58 (83.90 to 87.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.48 (80.31 to 84.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89.86 (88.34 to 91.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmerican Indian/Alaska Native\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.09 (37.55 to 72.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.96 (68.57 to 98.15)a\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAsian or Pacific Islander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.94 (69.85 to 82.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.44 (80.73 to 89.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.85 (66.50 to 78.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.58 (73.58 to 82.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.68 (79.99 to 83.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88.78 (87.52 to 89.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.15 (67.42 to 93.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97.59 (89.79 to 99.45)a\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026thinsp;~\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.64 (68.48 to 79.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.84 (75.27 to 84.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026thinsp;~\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.68 (79.99 to 85.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.63 (85.36 to 89.57)a\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u0026thinsp;~\u0026thinsp;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.51 (75.17 to 81.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.95 (84.34 to 89.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026thinsp;~\u0026thinsp;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.76 (77.53 to 83.57)a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.93 (83.41 to 88.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026thinsp;~\u0026thinsp;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.47 (74.82 to 79.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.92 (85.00 to 88.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u0026thinsp;~\u0026thinsp;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.32 (80.36 to 84.11)a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.37 (86.89 to 89.69)a\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eConfidence interval: Log(-Log()) Transformation. The level is 95%.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003ea, the relative cumulative survival increased from a prior interval and has been adjusted\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eAs mentioned above, for both sexes combined, the leading causes of cancer among individuals younger than 25 in the USA included leukemia/lymphoma, brain and other nervous system cancer, endocrine system cancer, and male genital system cancer. In 2015, the 5-year relative survival rate of leukemia (72.53%, 95% CI, 67.54%-76.89%), lymphoma (93.38%, 95% CI, 91.02%-95.13%), brain and other nervous system cancers (79.07%, 95% CI, 73.53%-83.58%), endocrine system cancers (98.98%, 95% CI, 97.61%-99.56%), and male genital system cancers (94.89%, 95% CI, 92.10%-96.71%) increased dramatically compared with 2000. Moreover, the 5-year relative survival rate of female reproductive system tumors also increased significantly (87.51%, 95% CI, 80.79\u0026ndash;92.00%) (Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e, eFig 4).\u003c/p\u003e\n \u003cp\u003eComparatively, CAYA cancers with lower survival rates in 2015 included respiratory system cancer (63.16%, 95% CI, 47.91\u0026ndash;75.06%), bone and joint cancer (65.23%, 95% CI, 56.36\u0026ndash;72.73%), and Kaposi Sarcoma (68.26%, 95% CI, 39.54\u0026ndash;85.46%) (Table\u0026nbsp;4). Additionally, cranial nerves/other nervous system cancer in males and liver/intrahepatic bile duct cancer in females had low survival rates, at 50.2% (95% CI, 18.4\u0026ndash;76.3%) and 50.0% (95% CI, 20.8\u0026ndash;73.6%), respectively (eTable 1).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e5-year relative survival rate of cancers stratified by cancer site among people younger than 25 from 2000 to 2015\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e5 Year Relative Survival Rate (%) (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrgan system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAll Sites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.40 (78.84 to 81.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.80 (86.65 to 88.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOral Cavity and Pharynx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.37 (67.03 to 88.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98.02 (84.83 to 99.76)a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDigestive System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.65 (44.94 to 68.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.02 (75.63 to 85.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRespiratory System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.31 (49.76 to 75.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.16 (47.91 to 75.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBones and Joints\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.48 (51.04 to 70.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.23 (56.36 to 72.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSoft Tissue including Heart\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.18 (61.09 to 75.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.14 (66.35 to 80.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSkin excluding Basal and Squamous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.71 (92.58 to 97.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98.83 (95.59 to 99.69)a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.50 (63.12 to 90.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.60 (66.74 to 89.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale Genital System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.76 (74.47 to 87.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.51 (80.79 to 92.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale Genital System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93.00 (89.61 to 95.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.89 (92.10 to 96.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrinary System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.60 (63.11 to 90.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.91 (74.77 to 94.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEye and Orbit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrain and Other Nervous System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.98 (63.42 to 75.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.07 (73.53 to 83.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndocrine System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.53 (92.51 to 97.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98.98 (97.61 to 99.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymphoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84.86 (81.65 to 87.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93.38 (91.02 to 95.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMyeloma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.01 (12.79 to 96.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeukemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.48 (44.21 to 56.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.53 (67.54 to 76.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKaposi Sarcoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.79 (5.34 to 94.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.26 (39.54 to 85.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiscellaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.17 (19.37 to 60.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.31 (75.90 to 92.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003ea, the width of the confidence interval is more than 25% lager than if the normal approximation was applied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eNHL, non-Hodgkin lymphoma; NOS, not otherwise specified.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this population-based study, data from 17 SEER registries in the United States were collected to analyze cancer cases in individuals under the age of 25 from 2000 to 2020. To our knowledge, this is the first report on the incidence and long-term overall survival patterns for CAYA cancer survivors in the past 20 years in the USA. The overall age-standardized incidence rate (ASIR) of CAYA cancer was 19.26 per 100,000 in 2000 and 21.47 per 100,000 in 2020. The trends in the incidence rate of CAYA cancer increased, with the incidence rate in males higher than that in females. Additionally, the overall 5-year relative survival rate of CAYA cancer increased from 80.40% (95% CI, 78.84%-81.87%) in 2000 to 87.80% (95% CI, 86.65%-88.86%) in 2015, with the 5-year relative survival rate for females under 25 years reaching 89.86%, higher than that for males (85.58%).\u003c/p\u003e \u003cp\u003ePrevious studies on cancer incidence have often focused on early-onset cancers, typically under the age of 50[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Among individuals under 50 years old, breast, thyroid, and colon and/or rectum cancers are more common than other sites[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, breast and thyroid cancers are not common in individuals younger than 25, whereas leukemia, lymphoma, brain and other nervous system cancers, male genital system cancers, and digestive system cancers are more prevalent, accounting for more than 50% of all sites in CAYA individuals. This suggests that there are different characteristics of tumor onset in CAYA individuals. In the following Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e6\u003c/span\u003e, we summarized the incidence and survival rates of common cancers among individuals of different ages and regions. In recent years, the common sites of CAYA tumors have changed compared to before, with the blood system, nervous system, and male genital system becoming more common. Moreover, there are differences in common cancers between different age groups and regions. For example, in individuals aged 15 to 39 years, breast cancer is common, but not in those younger than 25 years old (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative of common cancer and survival rates in CAYA cancer patients. (Supplement data)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eData source\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePublication year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInvestigation period\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAge range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommon cancer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurvival rate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeatriz de Camargo et al.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePBCR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1991\u0026ndash;2004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 to 19 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMale:\u003c/p\u003e \u003cp\u003eLeukemia, Lymphoma, CNS tumors;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeerim Park et al.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKCCR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1993\u0026ndash;2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 to 39 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eThyroid carcinoma, Carcinoma of Gastrointestinal Tract, Carcinoma of Breast, Carcinoma of Genitourinary Tract;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eThyroid carcinoma (100.1%),\u003c/p\u003e \u003cp\u003eCarcinoma of Gastrointestinal Tract (69.7%),\u003c/p\u003e \u003cp\u003eCarcinoma of Breast (100.5%),\u003c/p\u003e \u003cp\u003eCarcinoma of Genitourinary Tract (92.8%);b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnnalisa Trama et al.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEUROCARE-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2000\u0026ndash;2007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEurope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 to 39 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMale:\u003c/p\u003e \u003cp\u003eGerm cell tumours, trophoblastic tumours, and neoplasms of gonads, Malignant melanomas, Hodgkin lymphomas;\u003c/p\u003e \u003cp\u003eFemale:\u003c/p\u003e \u003cp\u003eBreast carcinomas, Female genital tract carcinomas, Malignant melanomas;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMale:\u003c/p\u003e \u003cp\u003eGerm cell tumours, trophoblastic tumours, and neoplasms of gonads (94\u0026middot;9%), \u003c/p\u003e \u003cp\u003eMalignant melanomas(84.0%), \u003c/p\u003e \u003cp\u003eHodgkin lymphomas (91.8%);b\u003c/p\u003e \u003cp\u003eFemale:\u003c/p\u003e \u003cp\u003eBreast carcinomas (83.5%),\u003c/p\u003e \u003cp\u003eFemale genital tract carcinomas (81.6%),\u003c/p\u003e \u003cp\u003eMalignant melanomas (91.9%);b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlyssa R. Scott et al.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ethe SEER Database 18 registry research data\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1973\u0026ndash;2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ethe US\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 to 39 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMale:\u003c/p\u003e \u003cp\u003eGerm Cell and Trophoblastic Neoplasms of Gonads, Melanoma, Non-Hodgkin lymphoma;\u003c/p\u003e \u003cp\u003eFemale:\u003c/p\u003e \u003cp\u003eBreast, Thyroid carcinoma, Carcinoma of the Cervix and Uterus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChengqi Xiao et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ethe SEER Database 17 registry research data\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2000\u0026ndash;2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ethe US\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 to 25 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLeukemia, Lymphoma, Brain and other nervous system, Male genital system, Digestive system;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLeukemia (72.53%),\u003c/p\u003e \u003cp\u003eLymphoma (93.38%),\u003c/p\u003e \u003cp\u003eBrain and other nervous system (79.07%),\u003c/p\u003e \u003cp\u003eMale genital system (94.89%),\u003c/p\u003e \u003cp\u003eDigestive system (81.02%);c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eThe SEER Database: Surveillance, Epidemiology, and End Results Database; EUROCARE: European Cancer Registry Based Study on Survival and Care of Cancer Patients; Korea National Cancer\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eIncidence database in the Korea Central Cancer Registry; CNS, central nervous system; PBCR: The Brazilian Population-Based Cancer Registry;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ea, 5-relative survival rate, 2012\u0026ndash;2016; b, relative survival rate, population weighted; c, 5-relative survival rate,2016.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e6\u003c/span\u003e. Comparative of common cancer and survival rate among younger people.\u003c/p\u003e \u003cp\u003eIn our study, we observed that leukemia, lymphoma, brain and other nervous system cancers, endocrine system cancers, and male genital system cancers were the top five cancer types, collectively accounting for more than 60% of all CAYA cancer cases. Additionally, there was a notable increase in digestive system cancers, while the incidence of skin cancers excluding basal and squamous cell carcinoma, as well as female genital system cancers, declined. Various factors are associated with cancer in CAYA individuals, including intrauterine radiation exposure[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], transplacental exposure to environmental carcinogens[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] smoking, exposure to environmental tobacco smoke[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and inherited genetic factors[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The use of colonoscopy has been beneficial for screening colorectal cancer[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The advancement of auxiliary examination techniques such as ultrasound, CT, and MRI, along with the application of puncture biopsy, has led to a rapid increase in the incidence of thyroid cancer, although concerns about overdiagnosis exist[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Public health efforts targeting melanoma have resulted in a decline in its incidence among CAYA individuals[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The significant decrease in the incidence of cervical cancer can be attributed to the widespread use of the HPV vaccine[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, some cancers, like osteosarcoma, have not seen significant treatment breakthroughs[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], leading to minimal changes in survival rates.\u003c/p\u003e \u003cp\u003eThe overall 5-year relative survival rate of CAYA cancer increased from 80.40% (95% CI, 78.84%-81.87%) in 2000 to 87.80% (95% CI, 86.65%-88.86%) in 2015. With advancements in treatment technology, such as genome-based and immunologic-based treatments, the cure rate of cancer in CAYA individuals has improved[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe higher survival rates have led to an increase in CAYA cancer survivors, who face dual challenges transitioning from precancerous states to survivors and from childhood or adolescence to adulthood[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Apart from cancer affecting their growth[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], two-thirds of CAYA survivors are at a particular risk of long-term sequelae from the cancer itself or the therapies used[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Compared to healthy individuals, adolescent and young adult (AYA) cancer survivors are at a higher risk of poor health-related quality of life due to a higher burden of total chronic health conditions (CHCs)[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLager epigenetic age accelerations were measured among children and adolescent cancer survivors associated with early-onset obesity, morbidity burden in general, and late mortality[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Children and adolescent cancer survivors, especially those from low- and middle-income backgrounds, are more likely to experience physical late effects, including hypothyroidism, metabolic syndrome, gonadal dysfunction, cardiac dysfunction, and even secondary primary cancer[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Psychological problems are also more severe in young cancer patients[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Additionally, CAYA cancer survivors are at risk of delayed cancer diagnosis[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Collectively, these individuals require more psychological and social support[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCommon cancer treatments such as radiotherapy and chemotherapy can impair reproductive health and fertility[\u003cspan additionalcitationids=\"CR36 CR37 CR38 CR39\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Compared to healthy individuals, cancer survivors are 80% more likely to experience diminished fertility after cancer treatments[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Female cancer survivors are particularly vulnerable to fertility damage due to the destruction of ovarian function[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Premature ovarian insufficiency (POI), which impacts fertility and estrogen production, can occur in about 30% of cases within 2 years after cancer diagnosis[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. POI can manifest as acute ovarian failure (AOF) in the years following cancer treatment, leading to either the cessation of menstruation or the failure to achieve natural menarche. POI can also result in premature menopause after cancer treatment, leading not only to infertility but also to premature aging of the body. The risk of AOF and POI depends on factors such as age, cyclophosphamide equivalent dose (CED), and the quantity of radiation (RT). For example, with a high CED, the risk of AOF is greater than 5% for individuals aged 1\u0026ndash;20 with a dose to the least affected ovary (LAO) of less than 2 Gy, and the risk of POI by age 20 approaches 100%[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Children born to female cancer survivors are at an increased risk of being born preterm and with low birth weight[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Similarly, some male cancer survivors experience reduced sperm count and azoospermia due to treatments such as high cumulative radiation[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. For instance, when the mean testicular dose exceeds 1 Gy, the rate of oligospermia increases to over 90% at 12 months[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. These cancer survivors often experience mental depression due to the damage to their reproductive function, which can be particularly severe in females compared to males[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Therefore, the reproductive health of young cancer survivors is a critical aspect of their overall well-being that cannot be ignored.\u003c/p\u003e \u003cp\u003eOncofertility focuses on addressing the intersection of oncology and reproductive medicine to preserve or restore the reproductive function of cancer survivors[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Fertility preservation (FP) involves specific medical interventions to protect the fertility of individuals at risk of infertility due to their disease or its treatment. This can include cryopreservation of oocytes, embryos, ovarian tissue, sperm, and testicular tissue[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. The gold standards of FP in female cancer patients are oocyte and embryo vitrification. With the advancements in assisted reproductive technology (ART), an increasing number of female cancer survivors have been able to have offspring[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Other FP techniques for females include ovarian tissue cryopreservation[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], in vitro maturation (IVM) [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e] and stem cell regeneration [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Stem cells currently under study for FP include embryonic stem cells (ESCs)[\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], human pluripotent stem cells (hPSCs)[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] and mesenchymal stem cells (MSCs).Further, MSCs contained human amniotic epithelial cells (hAECs)[\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e], umbilical cord mesenchymal stem cells (UC-MSCs)[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], human placenta-derived mesenchymal stem cell (hPMSC)[\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Anti-M\u0026uuml;llerian hormone (AMH) decreased or undetectable after treatment in cancer survivors can be regard as an indicator of ovarian function[\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. For male cancer patients, the FP gold standard is sperm cryopreservation, with cryopreservation of testicular tissue and in vitro spermatogenesis as complementary options[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Spermatogonial stem cells (SSCs), which have the ability to self-renew and differentiate, are considered an ideal tissue for cryopreservation[\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. Additionally, raising awareness among young cancer survivors about the potential long-term reproductive effects of cancer treatment is a priority in current care.[\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. Therefore, more efforts should be focused on FP for young cancer survivors to help preserve their fertility and improve their quality of life after cancer treatment.\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first report on the cancer incidence and survival rates among individuals younger than 25 years old in the USA over the past 20 years. However, this study has some limitations. Firstly, the majority of participants were White, whereas some reports suggest that the incidence and prognosis of certain cancers are related to race[\u003cspan additionalcitationids=\"CR66\" citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. Secondly, the study did not consider the impact of the coronavirus disease 2019 (COVID-19) pandemic, as there was a lag in statistical data. Some studies have indicated that COVID-19 may affect the incidence and survival rates of cancer[\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. Finally, our study was based on the SEER database, and as cancer incidence can vary by region, further research is needed to explore the incidence and survival of cancer in individuals under 25 years old globally.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe incidence of cancer among individuals under 25 years old is increasing in the United States, and the 5-year relative survival rate has also improved compared to previous years. It is crucial for public health and medical services to prioritize the care of CAYA cancer survivors to prevent late sequelae related to reproduction.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Chengqi Xiao, Dongmei Lai and Min Ji. The first draft of the manuscript was written by Chengqi Xiao and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eThis study was funded by the National Natural Science Foundation of China (82271664), the Research Projects of Shanghai Municipal Health Committee (202240345); the interdisciplinary program of Shanghai Jiao Tong University (YG2022ZD028), Shanghai Key Laboratory of Embryo Original Diseases (Shelab2022ZD01).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOrganisation, W.H. \u003cem\u003eImproving the childhood cancer cure rate.\u003c/em\u003e 2021 [cited 2021; Available from: https://www.who.int/news-room/fact-sheets/detail/cancer-in-children.\u003c/li\u003e\n\u003cli\u003eCancerSociety, A. \u003cem\u003eCancer Facts \u0026amp; Figures 2023\u003c/em\u003e. 2023; Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2023/2023-cancer-facts-and-figures.pdf.\u003c/li\u003e\n\u003cli\u003eWelch, H.G., B.S. 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Strauss, \u003cem\u003eRace, Prevalence of POLE and POLD1 Alterations, and Survival Among Patients With Endometrial Cancer.\u003c/em\u003e JAMA Netw Open, 2024. 7(1): p. e2351906.\u003c/li\u003e\n\u003cli\u003ede Andrade-Lima, A.L.M., et al., \u003cem\u003eThe Infection Profile and Survival of Children and Adolescents With COVID-19 Undergoing Cancer Treatment: A Cohort Study.\u003c/em\u003e Pediatr Infect Dis J, 2023. 42(7): p. 614-619.\u003c/li\u003e\n\u003cli\u003eGu\u0026eacute;vel, E., et al., \u003cem\u003eImpact of the COVID-19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study.\u003c/em\u003e Cancer Med, 2023. 12(22): p. 20918-20929.\u003cstrong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cancer-survivorship","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcsu","sideBox":"Learn more about [Journal of Cancer Survivorship](https://www.springer.com/journal/11764)","snPcode":"11764","submissionUrl":"https://submission.nature.com/new-submission/11764/3","title":"Journal of Cancer Survivorship","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Children, adolescents and young adults, Cancer incidence, 5-year relative survival rate, Cancer survivors, Fertility protection","lastPublishedDoi":"10.21203/rs.3.rs-4472499/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4472499/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA growing number of children, adolescents, and young adults (CAYA) are suffering from cancer and are surviving after treatment. However, the incidence and long-term overall survival patterns for CAYA cancer survivors over the past 20 years have been underreported. Data from 17 Surveillance, Epidemiology, and End Results (SEER) registries in the United States were analyzed to identify cancer cases in individuals under the age of 25 from 2000 to 2020. A joinpoint regression model was used to analyze the trend of cancer incidence and 5-year survival rate in CAYA. Additionally, we examined the temporal trends of age-standardized cancer incidence and 5-year survival rate from 2000 to 2020.\u003c/p\u003e \u003cp\u003eBetween 2000 and 2020, there were 129,384 CAYA patients under the age of 25 with cancer (67,873 males and 61,511 females) in the USA. The overall age-standardized incidence rate (ASIR) of CAYA cancer was 19.26 per 100,000 in 2000 and 21.47 per 100,000 in 2020. The incidence rate of CAYA cancer increased over time, with males having a higher incidence rate than females. The most common cancer types were leukemia, lymphoma, brain and other nervous system cancer, endocrine system cancer, and male genital system cancer, which together accounted for more than 60% of CAYA cancer cases. The overall 5-year relative survival rate of CAYA cancer increased from 80.40% (95% CI, 78.84%-81.87%) in 2000 to 87.80% (95% CI, 86.65%-88.86%) in 2015. The 5-year relative survival rate of females under the age of 25 was higher than that of males (89.86% vs. 85.58%).\u003c/p\u003e \u003cp\u003eDue to their long life expectancy, CAYA cancer survivors are at particular risk of long-term sequelae from the cancer itself or the therapy applied, especially late sequelae related to reproduction. These issues remain problematic for cancer survivors after entering adulthood, highlighting the need for more efforts and strategies to be directed towards fertility protection for young cancer survivors.\u003c/p\u003e","manuscriptTitle":"The Incidence and 5-years Relative Survival Rate of Cancer among People Younger than 25 Years in the US, 2000 to 2020: a SEER-retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 20:09:34","doi":"10.21203/rs.3.rs-4472499/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2024-05-25T10:10:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-25T10:10:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cancer Survivorship","date":"2024-05-24T12:33:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cancer-survivorship","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcsu","sideBox":"Learn more about [Journal of Cancer Survivorship](https://www.springer.com/journal/11764)","snPcode":"11764","submissionUrl":"https://submission.nature.com/new-submission/11764/3","title":"Journal of Cancer Survivorship","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"7f319d11-eef3-498e-a2be-420a1e69a818","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-06-11T20:09:34+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-11 20:09:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4472499","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4472499","identity":"rs-4472499","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}