Sex-specific incidence and temporal trends in solid tumours in young people from Northern England, 1968

1471-2407-8-89 1471-2407 Research article Sex-specific incidence and temporal trends in solid tumours in young people from Northern England, 1968–2005 Magnanti L Brooke Brooke.Magnanti@ncl.ac.uk Dorak M Tevfik m.t.dorak@Humigen.org Parker Louise Louise.Parker@iwk.nshealth.ca Craft W Alan A.W.Craft@ncl.ac.uk James W Peter P.W.James@ncl.ac.uk McNally JQ Richard Richard.McNally@ncl.ac.uk

School of Clinical Medical Sciences (Child Health), Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK

IWK Health Centre, Dalhousie University, Halifax, Nova Scotia B3K 6R8, Canada

School of Clinical Medical Sciences (Child Health) and Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK

BMC Cancer 1471-2407 2008 8 1 89 http://www.biomedcentral.com/1471-2407/8/89 18387183 10.1186/1471-2407-8-89 13 9 2007 03 4 2008 03 4 2008 2008 Magnanti et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

This study examined sex-specific patterns and temporal trends in the incidence of solid tumours in the Northern Region of England from 1968 to 2005. This updates earlier analyses from the region where sex was not considered in depth. Sex-specific analyses were carried out to determine whether sex differences might provide clues to aetiology.

Methods

Details of 3576 cases, aged 0–24 years, were obtained from a specialist population-based cancer registry. There were 1843 males (886 aged 0–14 years and 957 aged 15–24 years) and 1733 females (791 aged 0–14 years and 942 aged 15–24 years). Age-standardized incidence rates (per million population) were calculated. Linear regression was used to analyze temporal trends in incidence and annual percentage changes were estimated. Analyses were stratified by sex and by age-group.

Results

There were marked differences in incidence patterns and trends between males and females and also between age-groups. For males central nervous system (CNS) tumours formed the largest proportion of under-15 cases and germ cell tumours was the largest group in the 15–24's, whilst for females CNS tumours dominated in the under-15's and carcinomas in the older group. For 0–14 year olds there were male-specific increases in the incidence of rhabdomyosarcoma (2.4% per annum; 95% CI: 0.2%–4.5%) and non-melanotic skin cancer (9.6%; 95% CI: 0.0%–19.2%) and female-specific increases for sympathetic nervous system tumours (2.2%; 95% CI: 0.4%–3.9%), gonadal germ cell tumours (8.6%; 95% CI: 4.3%–12.9%) and non-gonadal germ cell tumours (5.4%; 95% CI: 2.8%–7.9%). For 15–24 year olds, there were male-specific increases in gonadal germ cell tumours (1.9%; 95% CI: 0.3%–3.4%), non-gonadal germ cell tumours (4.4%; 95% CI: 1.1%–7.7%) and non-melanotic skin cancer (4.7%; 95% CI: 0.5%–8.9%) and female-specific increases for osteosarcoma (3.5%; 95% CI: 0.5%–6.5%), thyroid cancer (2.8%; 95% CI: 0.1%–5.6%) and melanoma (4.6%; 95% CI: 2.2%–7.1%).

Conclusion

This study has highlighted notable differences between the sexes in incidence patterns and trends for solid tumours. Some of these sex-specific differences could have been obscured if males and females had been analysed together. Furthermore, they suggest aetiological differences or differential susceptibility to environmental factors between males and females.

Background

Sex-related differences in incidence of childhood cancer are well-established and consistent worldwide 1234. Sex of the patient can also play a role in efficiency of diagnosis and treatment 5. Therefore it is important to include both male and female results in reported trends, even for childhood and young persons' cancers.

Unfortunately this has not always been done. For instance, a recent paper reported solid tumour rates in north-west Italy over a similar time period of 1967–2001 6. Sex ratios have been given where the incidence rates were reported. However, in calculating the annual average percentage rate change the sexes have been combined. Other papers have also reported overall and not sex-specific results 7. This may have obscured sex-specific temporal trends, especially over an extended time period.

Previous studies from the Northern Region of England have assessed the incidence of solid tumours diagnosed in 0 – 24 year olds during the periods 1968 – 1982 and 1968 – 1995 89. Another study from the Northern region has focused specifically on the 15–24 age group 10. These studies have found that the overall incidence of solid tumours is rising in the area. This is a trend which is in agreement with a number of other studies from other parts of Europe and elsewhere in the world 711121314.

The present study updates the previous analyses from the Northern Region of England and, more specifically examines sex-specific trends in the incidence of individual diagnostic groups. It was hypothesized that diagnostic groups that show only marginal or non-statistically significant results when the sexes are pooled would show more distinct and significant results when examined by sex.

The aim of this study was to determine whether there were sex-specific trends in the incidence of solid tumours in the Northern Region of England. It is well known that cancer patterns are substantially different between children and the group comprising adolescents and young adults. Thus, analyses were stratified by age-group (0 – 14 year olds and 15 – 24 year olds).

Methods

Study Subjects

All cases of solid tumours in 0 – 24 year olds diagnosed in the Northern Region of England during the period 1968 – 2005 were obtained from the Northern Region Young Persons' Malignant Disease Registry (NRYPMDR). The NRYPMDR is a specialist cancer registry covering the counties of Northumberland, Tyne and Wear, Durham, Teesside and Cumbria (excluding Barrow-in-Furness). All cases of malignant disease in the region occurring in residents aged under-25 are reported to the registry. The entire region contains about 17% of the under-25 population of England. Tyne and Wear is the 6^thlargest conurbation in the country and the largest population centre in the study area. The population of the Northern Region is ethnically homogeneous, with fewer than 2% from ethnic minorities 151617. Less than 3% born of its population was born outside of the UK, the lowest of any region in England and Scotland, and is similar to Wales 18.

Cases aged 0–14 years have been collected prospectively since 1968. Cases aged 15–24 years have been collected retrospectively for cases diagnosed during 1968–1985 and prospectively since 1985. Cases are identified from multiple sources. Consultants throughout the region notify the registry of any malignancies in children and young adults. Death certificates and hospital admissions are regularly examined. Data are thoroughly cross-checked with regional and national cancer registries at regular intervals. This ensures that information is highly accurate and complete. The same rigorous procedures were applied to the retrospective collection of data on 15–24 year olds for the period 1968–1985. Overall, it has been estimated that ascertainment of cases in 0–24 year olds is greater than 98% 919. The International Classification of Diseases for Oncology (ICDO-2) was used for coding of morphology and primary site of diagnosis 20. Cases were grouped using a modification of the International Classification of Childhood Cancer (ICCC) 21.

Statistical Methods

Incidence rates per million population were calculated based on mid-year population estimates for the study region obtained from the Office for National Statistics. Age-standardized rates (ASRs) and 95% confidence intervals (CIs) were calculated based on a standard world population 22. ASRs (and 95% CIs) were calculated separately for males and females in childhood (aged 0–14) and adolescence/young adulthood (aged 15–24). This was done for the entire study period (1968–2005) and also for three shorter time periods (1968–1980, 1981–1993, 1994–2005) to assess temporal variation. Temporal trends in annual ASRs were analysed using a linear regression model that included year as a covariate. Furthermore, a significance test for a male/female difference in trend was obtained by including covariates year, sex and the interaction term year* sex in a linear regression model. Statistical significance was taken as P < 0.05.

Results

There were a total of 3576 cases of primary solid tumour diagnosed during the period 1968–2005. 1843 were in males, of whom 886 were aged 0–14 and 957 were aged 15–24. 1733 were in females, of whom 791 were aged 0–14 and 942 were aged 15–24. Overall numbers of cases and age-standardized rates (per million population) with 95% confidence intervals (CIs) by diagnosis, age-group and sex, are given for the entire time period (1968–2005) in Table 1. Solid tumours in males aged 0–14 years were dominated by central nervous system (CNS) tumours (43.1%), with soft tissue sarcomas (14.3%) and sympathetic nervous system tumours (11.5%) being the next most predominant groups, whilst for males aged 15–24 germ cell tumours (30.5%), CNS tumours (23.4%) and carcinomas (23.1%) were the largest diagnostic groups. 27.6% of the male carcinomas in the 15–24 year old group were melanomas. For females aged 0–14 years CNS tumours (39.1%), sympathetic nervous system tumours (12.0%) and renal tumours (10.7%) were the three most common types of solid tumour. However, females aged 15–24 years presented a contrasting spectrum to males from this age-group. Carcinomas (50.1%) dominated the diagnoses, followed by CNS tumours (17.5%) and germ cell tumours (13.5%) in these ages. Carcinomas in females aged 15–24 years included large proportions of melanomas (31.4%) and thyroid cancer (12.9%). A large proportion of the carcinomas (18.0%) were also tumours in the genital and other reproductive areas, and 8.9% of carcinomas were breast tumours.

Table 1

Numbers of cases and age-standardized rates (per million population) with 95% confidence intervals (CIs) by diagnosis, age-group and sex, 1968–2005

Ages 0–14

Ages 15–24

No.

Rate (95% CI)

No.

Rate (95% CI)

CNS tumours

382

31.7 (28.5,35.0)

224

27.3 (23.7,30.9)

309

27.6 (24.4,30.7)

165

20.2 (17.1,23.3)

Ependymomas

4.6 (3.3,5.8)

2.6 (1.6,3.9)

2.0 (1.2,3.1)

0.8 (0.3,1.6)

Astrocytomas

137

11.1 (9.2,12.9)

9.3 (7.2,11.4)

126

11.2 (9.2,13.1)

6.6 (4.8,8.4)

PNET

6.7 (5.2,8.2)

1.6 (0.8,2.7)

4.2 (3.0,5.4)

0.9 (0.4,1.8)

Other gliomas

2.9 (1.9,3.8)

4.3 (2.9,5.8)

3.0 (2.0,4.0)

3.2 (2.1,4.7)

Sympathetic nervous system tumours

102

9.8 (7.9,11.7)

1.1 (0.5,2.1)

9.7 (7.8,11.7)

1.1 (0.5,2.2)

Retinoblastoma

3.9 (2.6,5.1)

5.4 (3.9,6.8)

Renal tumours

6.8 (5.2,8.4)

0.9 (0.4,1.8)

8.7 (6.9,10.6)

0.8 (0.3,1.7)

Hepatoblastomas

0.7 (0.3,1.5)

1.0 (0.5,1.9)

0.2 (0.0,0.8)

Bone tumours

4.7 (3.5,5.8)

114

14.2 (11.6,16.8)

4.3 (3.2,5.5)

8.3 (6.3,10.3)

Osteosarcoma

2.4 (1.6,3.3)

7.5 (5.6,9.5)

2.8 (1.9,3.8)

4.9 (3.4,6.5)

Ewing's sarcoma

2.1 (1.4,3.0)

4.5 (3.0,5.9)

1.3 (0.7,2.1)

2.0 (1.2,3.3)

Soft tissue sarcomas

127

11.0 (9.1,13.0)

10.9 (8.6,13.2)

6.2 (4.8,7.7)

11.7 (9.3,14.0)

Rhabdomyosarcoma

6.8 (5.3,8.4)

1.8 (1.0,3.0)

3.6 (2.5,4.7)

2.7 (1.6,4.1)

Other

4.2 (3.0,5.4)

9.1 (7.1,11.2)

2.6 (1.7,3.5)

9.0 (6.9,11.1)

Germ cell tumours

5.2 (3.8,6.6)

292

34.8 (30.8,38.8)

5.5 (4.1,6.9)

127

15.4 (12.7,18.1)

Gonadal

3.2 (2.1,4.3)

260

31.0 (27.2,34.7)

1.4 (0.8,2.2)

10.4 (8.2,12.6)

Non-gonadal

2.0 (1.3,3.0)

3.8 (2.5,5.2)

4.1 (2.9,5.4)

5.0 (3.5,6.6)

Carcinomas

2.9 (2.0,3.9)

221

26.4 (22.9,29.9)

4.5 (3.3,5.7)

472

56.5 (51.4,61.6)

Thyroid

0.7 (0.3,1.3)

2.8 (1.7,4.1)

0.7 (0.3,1.4)

7.4 (5.6,9.3)

Melanoma

0.5 (0.2,1.1)

7.4 (5.5,9.2)

1.4 (0.8,2.3)

148

17.9 (15.0,20.7)

Skin

0.3 (0.1,0.7)

4.6 (3.1,6.0)

0.3 (0.1,0.7)

5.2 (3.6,6.7)

Breast

0.1 (0.0,0.7)

4.9 (3.4,6.4)

Genital/other reproductive

0.1 (0.0,0.6)

9.9 (7.8,12.0)

Lung and bronchial

0.1 (0.0,0.4)

0.8 (0.3,1.7)

0.1 (0.0,0.5)

0.6 (0.2,1.4)

Colorectal

2.3 (1.4,3.6)

0.1 (0.0,0.5)

1.1 (0.5,2.0)

TOTAL

886

76.8 (71.7,81.9)

957

115.7 (108.3,123.0)

791

73.0 (67.8,78.1)

942

114.3 (107.0,121.6)

The results of the analyses of trends are shown in Tables 2 and 3. For 0–14 year olds, there were overall statistically significant increases for both sexes. There was also an increase in incidence for both male and female CNS tumours in 0–14 year olds (males: 1.5% per year; 95% CI: 0.5–2.5 and females: 1.2% per year; 95% CI: 0.2%–2.2%). This was due to increases in the incidence of astrocytoma (males: 3.1% per year; 95% CI: 1.7%–4.6% and females: 4.4% per year; 95% CI: 2.3%–6.6%). There were a number of sex-specific incidence trends for 0–14 year olds. Male-specific increases were observed for rhabdomyosarcoma (average annual increase of 2.4%, 95% CI: 0.2%–4.5%), carcinomas overall (3.2% per year, 95% CI: 0.1%–6.3%) and non-melanotic skin cancer (9.6% per year, 95% CI: 0.0%–19.2%). There were female-specific increases for sympathetic nervous system tumours (2.2% per year; 95% CI: 0.4%–3.9%), gonadal germ cell tumours (8.6% per year; 95% CI: 4.3%–12.9%) and non-gonadal germ cell tumours (5.4% per year; 95% CI: 2.8%–7.9%).

Table 2

Numbers of cases aged 0–14 years, age-standardized rates (per million population) and 95% CIs, average annual percentage rate changes and 95% CIs, by diagnosis, sex and time period and test for sex-difference in temporal trend (P-value)

1968–1980

1981–1993

1994–2005

% Ann. Inc

M/F diff

CNS tumours

Male

134

28.5 (23.6,33.4)

115

29.9 (24.4,35.4)

133

38.4 (31.8,45.0)

1.5 (0.5,2.5)

0.74

Female

116

26.2 (21.3,31.0)

25.1 (19.9,30.3)

102

32.7 (26.3,39.2)

1.2 (0.2,2.2)

Ependymomas

Male

4.3 (2.5,6.8)

4.7 (2.7,7.5)

4.9 (2.8,8.0)

0.7 (-1.7,3.2)

0.61

Female

2.4 (1.2,4.5)

1.6 (0.6,3.5)

1.9 (0.6,4.5)

-0.5 (-4.6,3.6)

Astrocytomas

Male

7.9 (5.4,10.5)

11.1 (7.8,14.4)

15.5 (11.3,19.6)

3.1 (1.7,4.6)

0.33

Female

8.1 (5.4,10.8)

7.9 (5.3,11.4)

19.5 (14.5,24.5)

4.4 (2.3,6.6)

PNET

Male

7.5 (4.9,10.0)

4.4 (2.5,7.2)

8.1 (5.3,11.8)

0.6 (-1.6,2.9)

0.86

Female

3.8 (2.1,6.1)

4.3 (2.4,7.1)

4.7 (2.5,7.8)

0.9 (-1.7,3.6)

Other gliomas

Male

2.9 (1.5,5.0)

2.6 (1.2,4.7)

3.1 (1.5,5.6)

0.7 (-2.4,3.9)

0.42

Female

3.4 (1.9,5.6)

2.6 (1.2,4.9)

2.9 (1.4,5.4)

-1.0 (-3.7,1.7)

Sympathetic nervous system tumours

Male

7.4 (4.8,10.0)

12.6 (8.9,16.4)

9.6 (6.3,14.0)

0.9 (-0.5,2.4)

0.29

Female

6.9 (4.5,10.2)

10.3 (6.8,13.8)

13.3 (8.9,17.6)

2.2 (0.4,3.9)

Retinoblastoma

Male

4.2 (2.4,6.8)

3.6 (1.9,6.3)

3.6 (1.7,6.6)

-0.3 (-3.6,3.1)

0.42

Female

7.2 (4.7,10.5)

5.4 (3.1,8.6)

2.7 (1.1,5.6)

-2.1 (-5.0,0.8)

Renal tumours

Male

6.8 (4.5,9.9)

5.1 (3.0,8.0)

9.0 (5.8,13.3)

0.5 (-1.5,2.6)

0.86

Female

8.3 (5.3,11.2)

8.8 (5.9,12.7)

9.4 (6.1,13.9)

0.3 (-1.5,2.1)

Hepatoblastomas

Male

0.3 (0.0,1.5)

0.3 (0.0,1.7)

1.9 (0.6,4.4)

7.3 (-0.2,14.9)

0.18

Female

1.3 (0.4,3.0)

0.6 (0.1,2.3)

1.2 (0.2,3.4)

0.5 (-5.5,6.6)

Bone tumours

Male

5.3 (3.4,7.2)

4.0 (2.3,6.4)

4.6 (2.7,7.3)

0.3 (-2.1,2.7)

0.58

Female

4.1 (2.5,6.3)

5.1 (3.1,7.8)

3.8 (2.1,6.4)

-0.7 (-3.3,1.9)

Osteosarcoma

Male

3.1 (1.9,5.0)

1.9 (0.8,3.8)

2.0 (0.9,3.9)

-0.9 (-4.3,2.6)

0.80

Female

3.1 (1.8,5.1)

2.9 (1.5,5.0)

2.5 (1.1,4.7)

-1.5 (-4.2,1.3)

Ewing's sarcoma

Male

2.2 (1.1,3.8)

2.0 (0.9,3.9)

2.0 (0.9,4.0)

0.3 (-2.4,3.0)

0.94

Female

0.8 (0.2,2.2)

2.2 (1.0,4.2)

0.8 (0.2,2.4)

0.1 (-4.9,5.1)

Soft tissue sarcomas

Male

9.6 (6.7,12.4)

12.5 (8.9,16.2)

11.2 (7.5,14.9)

1.3 (-0.2,2.8)

0.70

Female

6.0 (4.0,8.7)

5.8 (3.6,8.8)

7.0 (4.4,10.7)

0.8 (-1.2,2.9)

Rhabdomyosarcoma

Male

5.4 (3.4,8.1)

7.2 (4.7,10.6)

8.3 (5.3,12.3)

2.4 (0.2,4.5)

0.09

Female

4.3 (2.5,6.7)

2.7 (1.3,5.1)

3.7 (1.7,6.7)

-0.4 (-2.7,1.9)

Other

Male

4.2 (2.6,6.4)

5.3 (3.2,8.2)

2.9 (1.4,5.2)

-0.4 (-2.9,2.1)

0.19

Female

1.7 (0.8,3.3)

3.1 (1.6,5.4)

3.4 (1.7,5.9)

2.5 (-1.1,6.0)

Germ cell tumours

Male

4.4 (2.5,7.0)

5.1 (3.0,8.1)

6.5 (4.0,10.2)

2.1 (-0.7,4.8)

0.02

Female

1.8 (0.7,3.5)

5.7 (3.5,8.9)

10.6 (6.9,14.4)

6.2 (4.1,8.3)

Gonadal

Male

3.4 (1.8,5.8)

3.9 (2.1,6.6)

2.1 (0.8,4.6)

-1.1 (-4.9,2.7)

0.001

Female

0.4 (0.0,1.3)

0.5 (0.1,1.8)

4.0 (2.1,6.7)

8.6 (4.3,12.9)

Non-gonadal

Male

1.0 (0.3,2.5)

1.2 (0.4,2.9)

4.4 (2.4,7.5)

7.2 (2.6,11.8)

0.50

Female

1.4 (0.5,3.1)

5.2 (3.1,8.3)

6.6 (3.9,10.5)

5.4 (2.8,7.9)

Carcinomas

Male

2.0 (1.0,3.7)

3.0 (1.6,5.1)

4.2 (2.3,6.9)

3.2 (0.1,6.3)

0.31

Female

3.8 (2.2,6.1)

5.0 (3.0,7.7)

5.0 (2.9,8.0)

1.1 (-1.5,3.7)

Thyroid

Male

0.4 (0.0,1.3)

0.5 (0.1,1.7)

1.3 (0.4,3.0)

5.9 (-0.4,12.2)

0.07

Female

0.9 (0.2,2.4)

0.7 (0.1,2.0)

0.6 (0.1,2.0)

-1.8 (-7.1,3.4)

Melanoma

Male

0.3 (0.0,1.2)

0.7 (0.1,2.0)

0.6 (0.1,2.3)

4.3 (-2.8,11.4)

0.81

Female

0.7 (0.1,2.2)

2.1 (0.9,4.1)

1.6 (0.5,3.7)

3.1 (-2.7,9.0)

Skin

Male

0.4 (0.1,1.5)

0.5 (0.1,1.9)

9.6 (0.0,19.2)

0.46

Female

0.5 (0.1,1.6)

0.5 (0.1,1.8)

4.5 (-4.8,13.8)

Breast

Male

Female

Genital/other reproductive

Male

Female

0.3 (0.0,1.8)

2.9 (-15.1,20.9)

Lung and bronchial

Male

0.2 (0.0,1.1)

-12.1 (-25.9,1.6)

0.12

Female

0.2 (0.0,1.0)

0.3 (0.0,1.4)

2.8 (-9.6,15.2)

Colorectal

Male

Female

0.2 (0.0,1.0)

0.3 (0.0,1.4)

2.5 (-9.9,14.8)

TOTAL

Male

314

68.6 (60.8,76.3)

283

76.1 (67.1,85.0)

289

89.0 (78.6,99.4)

1.3 (0.7,1.9)

0.84

Female

277

65.4 (57.6,73.2)

256

71.8 (62.9,80.7)

258

85.7 (75.0,96.3)

1.2 (0.5,2.0)

Figures are counts, ASRs with 95% CIs, Annual Percentage Change in ASR with 95% CIs (estimated from linear regression model) and p value for testing M/F difference in trend (obtained from year *sex interaction term in linear regression model)

Table 3

Numbers of cases aged 15–24 years, age-standardized rates (per million population) and 95% CIs, average annual percentage rate changes and 95% CIs, by diagnosis, sex and time period and test for sex-difference in temporal trend (P-value)

1968–1980

1981–1993

1994–2005

% Ann Inc

M/F diff

CNS tumours

Male

29.0 (22.9,35.1)

28.4 (22.3,34.5)

23.6 (17.3,30.0)

-0.5 (-1.9,0.8)

0.60

Female

19.8 (14.7,24.8)

20.2 (15.1,25.4)

20.8 (14.9,26.8)

0.0 (-1.5,1.5)

Ependymomas

Male

2.7 (1.2,5.3)

3.4 (1.6,6.3)

1.3 (0.3,3.9)

-2.1 (-5.5,1.4)

0.19

Female

0.7 (0.1,2.5)

0.4 (0.0,2.1)

1.3 (0.3,3.9)

3.2 (-3.9,10.3)

Astrocytomas

Male

9.4 (6.2,13.6)

8.6 (5.6,12.7)

10.2 (6.5,15.3)

0.4 (-1.9,2.7)

0.71

Female

7.0 (4.4,10.8)

5.8 (3.4,9.3)

7.1 (4.0,11.5)

-0.2 (-2.4,2.0)

PNET

Male

2.6 (1.1,5.2)

1.0 (0.2,2.9)

0.9 (0.1,3.2)

-2.8 (-7.9,2.2)

0.99

Female

1.4 (0.4,3.5)

0.7 (0.1,2.5)

0.5 (0.0,2.6)

-2.9 (-8.8,3.1)

Other gliomas

Male

4.6 (2.5,7.8)

5.6 (3.3,9.0)

2.2 (0.7,5.2)

-1.4 (-4.4,1.5)

0.99

Female

3.6 (1.8,6.5)

3.6 (1.7,6.7)

2.2 (0.7,5.1)

-1.4 (-5.3,2.4)

Sympathetic nervous system tumours

Male

0.3 (0.0,1.8)

2.1 (0.8,4.6)

0.9 (0.1,3.2)

1.5 (-4.1,7.0)

0.71

Female

0.7 (0.1,2.4)

1.1 (0.2,3.1)

1.9 (0.5,4.8)

3.1 (-3.4,9.7)

Retinoblastoma

Male

Female

Renal tumours

Male

0.3 (0.0,1.8)

1.0 (0.2,2.9)

1.7 (0.5,4.3)

2.8 (-4.0,9.6)

0.32

Female

1.0 (0.2,3.0)

0.9 (0.2,2.7)

0.4 (0.0,2.4)

-1.8 (-7.9,4.3)

Hepatoblastomas

Male

Female

0.3 (0.0,1.8)

0.3 (0.0,1.7)

-4.4 (-16.0,7.3)

Bone tumours

Male

12.1 (8.2,16.1)

17.7 (12.8,22.6)

12.6 (8.4,18.3)

0.2 (-1.7,2.0)

0.15

Female

6.4 (3.9,10.0)

7.9 (4.9,11.9)

11.6 (7.5,17.1)

2.2 (0.2,4.2)

Osteosarcoma

Male

6.8 (4.2,10.6)

8.2 (5.2,12.3)

7.7 (4.5,12.3)

0.1 (-2.6,2.8)

0.10

Female

3.4 (1.6,6.2)

4.3 (2.2,7.5)

7.9 (4.6,12.7)

3.5 (0.5,6.5)

Ewing's sarcoma

Male

3.0 (1.4,5.7)

7.0 (4.3,10.8)