The burden of childhood cancers in the South Asian Association for Regional Cooperation (SAARC) Region: a population-based, cross-sectional GLOBOCAN 2022 analysis.

Countries of the South Asian Association for Regional Cooperation (SAARC) are home to approximately 600 million children aged 0-14 years, representing a quarter of the global child population. We report incidence and mortality for childhood cancers among South Asia's eight nations to inform priority setting for research, programming for health services, and policy for childhood cancers. Incidence and mortality of new childhood cancer diagnoses for all cancers combined and for selected leading cancer types were retrieved from GLOBOCAN 2022 database of Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Age-standardized incidence rates (ASR) and mortality-to-incidence ratios (MIR) were calculated, together with statistical examination of cross-country variation in diagnostic structure and mortality patterns. In SAARC nations, 37,716 new childhood cancer diagnoses and 17,698 deaths were estimated in 2022. India contributed 68.8% of subregional cases (25,939), and Pakistan contributed 20.8% (7841). Age-standardized incidence rates differed and were greatest in Sri Lanka (10.4/100,000) and Pakistan (10.1) and lowest in Bhutan (2.3) and Bangladesh (3.7). Age-standardized mortality rates ranged from 1.1/100,000 in Bhutan to 5.2/100,000 in Afghanistan (SAARC-wide ASMR 3.5/100,000). Boys represented 57% of cases overall, with the proportion varying across countries. Leukemia was the most common cancer in all countries (35-50%), followed by central nervous system (CNS) tumors (approximately 12% of cases). MIR ranged from 0.30 (Sri Lanka) to 0.57 (Afghanistan). SAARC childhood cancer patterns reflect both population size and health system capacity, with a preponderance of leukemia and marked mortality-to-incidence ratio disparities across countries, especially for CNS cancers. There is a need to have subregional cooperation to address gaps in cancer registration, equitable access to specialty care, and continuity of treatment. ECD is funded in part through the Prostate Cancer Foundation Young Investigator Award. SM, SLW, CBJ, and ECD are funded in part through the Cancer Center Support Grant from the National Cancer Institute (P30 CA008748).