1 Cancer Month 0, 2021 Original Article Childhood Cancer Mortality Trends in the Americas and Australasia: An Update to 2017 Matteo Malvezzi, PhD 1 ; Claudia Santucci, ScD 1 ; Gianfranco Alicandro, PhD 2 ; Greta Carioli, PhD 1 ; Paolo Boffetta, MD 3,4 ; Karina Braga Ribeiro, DDS, PhD 5,6 ; Fabio Levi, MD 7 ; Carlo La Vecchia, MD 1 ; Eva Negri, ScD 1 ; and Paola Bertuccio, PhD 8 BACKGROUND: Marked reductions in childhood cancer mortality occurred over the last decades in high-income countries and, to a lesser degree, in middle-income countries. This study aimed to monitor mortality trends in the Americas and Australasia, focusing on areas showing unsatisfactory trends. METHODS: Age-standardized mortality rates per 100,000 children (aged 0-14 years) from 1990 to 2017 (or the last available calendar year) were computed for all neoplasms and 8 leading childhood cancers in countries from the Americas and Australasia, using data from the World Health Organization database. A joinpoint regression was used to identify changes in slope of mortality trends for all neoplasms, leukemia, and neoplasms of the central nervous system (CNS) for major countries. RESULTS: Over the last decades, childhood cancer mortality continued to decrease by approximately 2% to 3% per year in Australasian countries (ie, Japan, Korea, and Australia), by approximately 1.5% to 2% in North America and Chile, and 1% in Argentina. Other Latin American countries did not show any substantial decrease. Leukemia mortality declined in most countries, whereas less favorable trends were registered for CNS neoplasms, particularly in Latin America. Around 2016, death rates from all neoplasms were 4 to 6 per 100,000 boys and 3 to 4 per 100,000 girls in Latin America, and 2 to 3 per 100,000 boys and approximately 2 per 100,000 girls in North America and Australasia. CONCLUSIONS: Childhood cancer mortality trends declined steadily in North America and Australasia, whereas they were less favorable in most Latin American countries. Priority must be given to closing the gap by providing high-quality care for all chil- dren with cancer worldwide. Cancer 2021;0:1-12. © 2021 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modi- fications or adaptations are made. LAY SUMMARY: • Advances in childhood cancer management have substantially improved the burden of these neoplasms over the past 40 years, par- ticularly in high-income countries. • This study aimed to monitor recent trends in America and Australasia using mortality data from the World Health Organization. • Trends in childhood cancer mortality continued to decline in high-income countries by approximately 2% to 3% per year in Japan, Korea, and Australia, and 1% to 2% in North America. • Only a few Latin American countries showed favorable trends, including Argentina, Chile, and Mexico, whereas other countries with limited resources still lagged behind. KEYWORDS: America, Asia, cancer, childhood, mortality, Oceania, trends. INTRODUCTION Cancer is among the top 10 leading causes of death among children worldwide. 1,2 Over 200,000 new cases and 70,000 cancer deaths at age 0 to 14 years were estimated in 2018 worldwide. Of these, over 80% occurred in low- and middle- income countries, where specialized pediatric centers are located in major cities only, resources are limited, and standards of care cannot be guaranteed. 2-7 Restricted access to care for children living in rural areas often results in delayed diagno- sis, high toxicity, and treatment discontinuation with unfavorable effects that undermine the achievement of the high- survival rates observed in high-income countries. 3,8-10 Despite the advances in early diagnosis and treatment of pediatric cancers, substantial differences in mortality between high-income and low-/middle-income countries persist. 8,11-14 Childhood cancer mortality trends showed Corresponding Author: Paola Bertuccio, PhD, Department of Biomedical and Clinical Sciences L. Sacco, Università degli Studi di Milano, Via Vanzetti 5, 20122 Milan, Italy (paola.bertuccio@unimi.it). 1 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; 2 Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; 3 Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York; 4 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; 5 Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil; 6 Department of Pediatric Oncology, Hospital Santa Marcelina/TUCCA, São Paulo, Brazil; 7 Department of Epidemiology and Health Services Research, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland; 8 Department of Biomedical and Clinical Sciences L. Sacco, Università degli Studi di Milano, Milan, Italy Additional supporting information may be found in the online version of this article. DOI: 10.1002/cncr.33642, Received: November 16, 2020; Revised: March 19, 2021; Accepted: April 26, 2021, Published online Month 00, 2021 in Wiley Online Library (wileyonlinelibrary.com)