Childhood and Adolescent Cancer Burden in 2024 and Projections to 2050

BACKGROUND: In recent decades, significant improvements have been made in the treatment of many childhood and adolescent cancers (patients ages 0-19 years), yet outcomes remain strikingly inequitable worldwide. We quantified the 2024 global burden of childhood and adolescent cancer by Human Development Index (HDI) and projected trends to 2050. METHODS: We used GLOBOCAN 2024 to estimate numbers of children and adolescents diagnosed with cancer and who died from cancer in 186 countries, overall and for four key cancer types (leukemia, brain and central nervous system [CNS] tumors, non-Hodgkin lymphoma [NHL], and kidney cancer). Age-standardized incidence and mortality rates (ASIR, ASMR) were calculated using the Segi-Doll world standard and stratified by sex, UN region, and four-tier HDI. Projections to 2050 applied 2024 age-specific rates to UN World Population Prospects demographic estimates, assuming constant rates over time. RESULTS: In 2024, excluding non-melanoma skin cancer, an estimated 277,023 children and adolescents were diagnosed with cancer and 102,056 died from cancer. Leukemia accounted for 27.8% of diagnoses and 33.9% of deaths, followed by CNS tumors (11.1% of diagnoses; 17.3% of deaths), NHL (8.2%; 6.9%), and kidney cancers (4.7%; 2.5%). Hematological malignancies represented the largest diagnostic category across all HDI levels, accounting for 36.8-46.4% of incident cases and 35.9-49.5% of deaths. Very high-HDI countries had the highest ASIRs but the lowest ASMRs, whereas low- and medium-HDI settings accounted for 57% of deaths in 2024. By 2050, incident cancers are projected to increase by 35.2% and deaths by 34.8% in low-HDI countries, while very high- and high-HDI countries are projected to experience relative declines in both incidence and mortality. Approximately 52% of diagnoses and 65% of deaths are expected in low- and medium-HDI countries, with more than 35% of deaths occurring in low-HDI settings alone. INTERPRETATION: Although significant advances have improved outcomes of many childhood and adolescent cancers, substantial global disparities in cancer burden persist. Underdiagnosis, limited diagnostic infrastructure, constrained workforces, and weak cancer registration systems likely lead to underestimation of the true burden. Under the assumption of constant incidence and mortality rates, an increasing share of childhood and adolescent cancer cases and deaths is projected to occur in low- and medium-HDI countries, underscoring the need for equitable investments in diagnosis, treatment, survivorship, and cancer registration. Contextualized implementation of the WHO Global Initiative for Childhood Cancer, including earlier diagnosis, reliable access to essential therapies, survivorship care, and strengthened registries, is essential to ensure that all children, regardless of geography, have a chance to survive cancer and thrive.