The burden of childhood cancers in the South Asian Association for Regional Cooperation (SAARC) region: A GLOBOCAN 2022 analysis.

10022 Background: 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. Methods: Incidence and mortality of new childhood cancer diagnoses for all cancers combined and for selected leading diagnostic groups were retrieved from the 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 survival trends. Results: In SAARC nations, 37,716 new childhood cancer diagnoses and 17,700 deaths were estimated in 2022. India contributed 68.7% of subregional cases (25,939), and Pakistan contributed 20.8% (7,841). Age-standardized 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). Boys represented 60% of cases overall, with significant cross-country variation in sex distribution (χ²=18.0, p=0.012). Leukemia was the most common cancer in all countries (35–50%), followed by central nervous system (CNS) tumors. MIR ranged from 0.30 (Sri Lanka) to 0.57 (Afghanistan), reflecting extreme survival differences, with CNS tumors demonstrating disproportionately high mortality relative to incidence. Conclusions: SAARC childhood cancer trends reflect both population size influences and health system capacity, with a preponderance of leukemia but alarming survival gaps, particularly for CNS cancers. These findings highlight actionable priorities, including strengthening population-based childhood cancer registries, centralizing care pathways for CNS tumors, expanding standardized leukemia treatment protocols with abandonment-prevention strategies, and improving equitable access to specialty care through subregional collaboration.