Starting date: March 2023
Work Programme
The Childhood Cancer Awareness and Research Evidence Team (CCARE) was set up to highlight childhood cancer research across IARC and to support the WHO Global Initiative for Childhood Cancer (GICC). The GICC strives for the goal of increasing the survival rate of children with cancer globally to at least 60% by 2030 while reducing their suffering and improving their quality of life.
The objectives of CCARE are:
- to improve communication within IARC and seek synergies in research on childhood cancer;
- to streamline the dissemination of knowledge on childhood cancer generated at IARC; and
- to support the GICC by providing scientific evidence for global action.
To achieve these goals, the team members meet regularly within IARC and with WHO partners. IARC’s expertise in research on childhood cancer is built through the following projects.
- International Incidence of Childhood Cancer (IICC): Childhood cancer data, collected by population-based cancer registries around the world, are processed, analysed, and periodically disseminated through the IICC series, which is a unique resource on childhood cancer incidence. The latest volume (IICC-3) was supported by the Union for International Cancer Control (UICC).
- International Classification of Childhood Cancer (ICCC): This is a standardized system that categorizes paediatric cancer types according to the WHO Classification of Paediatric Tumours and the International Classification of Diseases for Oncology (ICD-O) into three-level categories. The ICCC facilitates consistent reporting of cancer statistics in childhood populations on an international level.
- Targeting Childhood Cancer through the Global Initiative for Cancer Registry Development (ChildGICR): The development of childhood cancer registration in low- and middle-income countries is supported through implementation in target countries, an educational programme, and implementation research. This project is conducted in collaboration with St. Jude Children’s Research Hospital (USA), which also supports the project financially.
- Cancer Risk in Childhood Cancer Survivors (CRICCS): This project leverages international quality-assured data collected by population-based cancer registries. The objectives of CRICCS are to estimate the number of childhood cancer survivors in a population, to understand the risk of development of second cancers among childhood cancer survivors, and to develop guidelines for population-based cancer registries to study childhood cancer survivorship. This project is supported by Children with Cancer UK.
- Childhood Cancer – Epidemiology, Research, and Omics (CICERO): This new multidisciplinary project examines several complementary aspects of childhood cancer research. One part of the project is dedicated to studies of childhood cancer in Africa, in particular completeness of ascertainment, understanding referral patterns, survival, and treatment completion. This will be complemented by defining molecular profiles of childhood cancer cases in Africa using epigenomics methodology. Another part of CICERO is dedicated to the development and dissemination of indicators of the burden of childhood cancer and encompasses incidence, survival, prevalence, mortality, and financial impact. The CICERO project is supported by the Ministry of Health, Welfare and Sport of the Government of the Netherlands.
- Childhood Cancer and Leukemia International Consortium (CLIC): Founded in 2007 with a focus on leukaemia, this consortium facilitates collaboration among more than 20 case–control studies on the etiology of childhood cancer, conducted on all continents. In more than 25 publications, IARC has mostly been leading the research on environmental causes, in particular parental occupational exposures before conception or during pregnancy and domestic exposures such as pesticides and paint. CLIC is currently expanding to include studies on childhood brain tumours.
- Global Acute Leukaemia/Lymphoma network (GALnet): This is a research consortium in which expertise acquired in high-income countries is transferred to paediatric oncology units based in low- and middle-income countries to increase their participation in international research projects. The consortium has contributed to the understanding of childhood cancer and improved awareness, detection, diagnosis, and treatment in different parts of the world.
- Childhood cancer in relation to radiofrequency electromagnetic fields from television and radio broadcast transmitters (CIRE-RF): This is a registry-based case–control study in France in which residential information from previous case–control studies is linked with estimates of environmental exposure to radiofrequency electromagnetic fields obtained from official sources. This is the newest in the portfolio of studies investigating the unresolved question of whether exposure to electric, magnetic, or electromagnetic fields increases the risk of certain childhood cancers.
- Childhood Leukaemia and Environmental Risk Factors (CLERF): In this pilot study, conducted in Germany, IARC explored the feasibility of recruiting patients with leukaemia, enrolled in European clinical trials, for etiological research on gene–environment interactions. On the basis of these findings, a standardized protocol of recruitment, applicable to most European countries, can be developed.
- COVID-19 and Childhood Cancer: This project looks at the impact of the COVID-19 pandemic on the occurrence of childhood cancer, using data from the German Childhood Cancer Registry. The pandemic may have had an impact on risk, referral, delayed diagnosis, and/or treatment.
- The Environment and Child Health International Consortium (ECHIG) has been established to strengthen the collaboration and coordinate the activities of the birth cohorts from China, Denmark, France, Japan, and Norway, among others. ECHIG actively works on harmonization of study methods and data, including infant health outcomes, biomarkers, and environmental measurements.
- The Environmental Hazards and Prevention of Acute Lymphoblastic Leukaemia in Children (ENV-ALL) project aims to investigate the associations between maternal exposure to various persistent chemicals (per- and polyfluoroalkyl substances; PFAS) during pregnancy and the presence of pre-leukaemic clones at birth, which could lead to a higher risk of developing acute lymphoblastic leukaemia during childhood. The ultimate goal is to produce new scientific evidence for primary prevention strategies so that fewer children in France, in Europe, and around the globe develop this most common childhood cancer.
- EpiChildCan: This project aims to identify epigenetic markers of early-life factors and precursors of childhood cancer and its predisposing phenotypes. With a focus on leukaemia/lymphoma and brain cancer, the project spans critical stages of childhood cancer development while backtracking its origin to the birth period. Epigenetic mechanisms are then integrated with genomics and transcriptomics to derive multi-omics cancer driver genes affecting the course of the disease. Such an innovative approach, including follow-up from birth to the clinic, cannot be implemented without international collaboration. Resources amassed in large, unique, and complementary networks of prospective and retrospective studies are combined to tackle this challenge with a scale, design, and uniqueness beyond the reach of any single country. The derived evidence is then triangulated from multiple angles, including epidemiology, clinical, organoid, and animal models. This work is supported by the French National Cancer Institute, the World Cancer Research Fund International, the IARC Postdoctoral Fellowship Programme, the Marie Curie Actions-People-COFUND, and Children with Cancer UK. This project benefits from access to the rich resources of the International Childhood Cancer Cohort Consortium (I4C).
- WpCigCAD: This project aims to establish a molecular diary of tobacco forms in early and adult life to map mechanisms of cancer. The project currently focuses on cigarette and waterpipe smoking while setting a research framework that can be expanded to other tobacco forms. This framework triangulates evidence from state-of-the-art molecular and data science (including AI) tools applied in birth studies, adult cohorts, clinical samples, and cell and animal models, as well as bioengineered smoking robots that mimic the smoking operandi in humans. This work is supported by the French National Cancer Institute and the French Institute for Public Health Research, the IARC Postdoctoral Fellowship Programme, and the Medical Practice Plan (American University of Beirut) in Lebanon.
- International Lifestyle Behaviour and Biobanking Programme in Paediatric Oncology: This project is a collaboration between IARC and the International Initiative for Pediatrics and Nutrition (IIPAN) that aims to develop an information resource for studying the impact of nutrition and other lifestyle factors on health outcomes in children and adolescents with cancer. The two studies under the IIPAN–IARC collaboration are the InterNatIonal CHildhood Leukemia Microbiome/MEtabolome Cohort (NICHE) and the Southern European Prospective Investigation into Childhood Cancer and Nutrition (EPICkids). Understanding the role of nutrition status will help improve survival of children and adolescents with cancer. Recruitment of patients and data collection are under way by personnel trained at collaborating IIPAN sites in several countries, using standard operating procedures.
- Determinants of Late Diagnosis and Delayed Treatment of Cancer (DEDICA): This study aims to evaluate the determinants of late diagnosis and delayed treatment of childhood cancers and how the elimination of these challenges can contribute towards the improvement of cancer control strategy. On the basis of the perceptions of patients with cancer, the study will investigate which determinants of socioeconomic status and the health system affect the time to diagnosis and the time to treatment initiation and completion.
- The IARC Monographs programme identifies the causes of human cancer. Agents that are known or suspected to cause different types of cancer (including childhood cancers) are identified in the list of classifications by cancer site. Agents accorded priority for evaluation are listed in the report of the Advisory Group to Recommend Priorities for the IARC Monographs and include agents linked to the risk of childhood cancer. The Advisory Group to Recommend Priorities for the IARC Monographs during 2025–2029 recommended several agents to be evaluated with high priority that are relevant for childhood cancer etiology (i.e. some pesticides, infectious, lifestyle, and physical agents, and pharmaceuticals). Chemotherapeutic agents that are commonly used to treat childhood cancers (platinum-based anthracyclines) are also on the high-priority list because their use may elucidate the risk of second cancer in childhood cancer survivors.
- South-ROCK: In this project, the current paediatric oncology research consortia active in southern regions of France, centred around Lyon and Marseille, have set up an integrated centre of excellence in paediatric oncology research, called Research on Cancer for Kids (ROCK), in which IARC participates. The main themes of this large consortium are the therapeutic exploitation of alterations in developmental pathways in paediatric tumours, adapting care approaches to the developing bodies of children and adolescents with cancer, and implications of characterizing the role of environmental factors for the prevention of paediatric cancers.
Team Composition
Team Leaders:
Dr Eva Steliarova-Foucher, Cancer Surveillance Branch (CSU) and Dr Akram Ghantous, Epigenomics and Mechanisms Branch (EGM)
Emails: steliarovae@iarc.who.int; ghantousa@iarc.who.int
Secretary: Dr Neimar de Paula Silva (Postdoctoral Scientist, CSU)
Team members:
Dr Andre Carvalho (Scientist, EPR)
Dr Inge Huybrechts (Scientist, NME)
Dr Rita Khoueiry (Scientist, EGM)
Dr Zisis Kozlakidis (Head, LSB)
Dr Michele Matta (Scientist, ENV)
Dr Ann Olsson (Scientist, ENV)
Dr Elisa Pasqual (Scientist, ESC)
Dr Ljubica Zupunski (Scientist, ENV)
Early-career scientists:
Dr Shiny Manohar (IARC Postdoctoral Fellow, NME)
Dr Farah Nassar (Postdoctoral Scientist, EGM)
Director’s representatives:
Dr Véronique Chajès (Programme Officer, DIR)
Mr Clément Chauvet (Strategic Engagement and Resource Mobilization Officer, DIR)
Senior advisors:
Dr Freddie Bray (Branch Head, CSU)
Dr Joachim Schüz (Branch Head, ENV)
Dr Zdenko Herceg (Branch Head, EGM)
Dr Mary Schubauer-Berigan (Branch Head, ESC)
Key publications
- Forjaz G, Kohler B, Coleman MP, Steliarova-Foucher E, Negoita S, Guidry Auvil JM, et al. (2025). Making the case for an International Childhood Cancer Data Partnership. J Natl Cancer Inst. djaf003. https://doi.org/10.1093/jnci/djaf003 PMID:39799506
- Radhakrishnan V, Jothi A, Mary R, Veeraiah S, Sudhakar R, Selvam P, et al. (2024). Assessment of barriers and enablers for implementing a population-based childhood cancer registry in Chennai, India. Pediatr Blood Cancer. e31500. https://doi.org/10.1002/pbc.31500 PMID:39739444
- Ghantous A, Nusslé SG, Nassar FJ, Spitz N, Novoloaca A, Krali O, et al. (2024). Epigenome-wide analysis across the development span of pediatric acute lymphoblastic leukemia: backtracking to birth. Mol Cancer. 23(1):238. https://doi.org/10.1186/s12943-024-02118-4 PMID:39443995
- Onyije FM, Dolatkhah R, Olsson A, Bouaoun L, Schüz J (2024). Environmental risk factors of Wilms tumour: a systematic review and meta-analysis. EJC Paediatr Oncol. https://doi.org/10.1016/j.ejcped.2024.100178 PMID:39678930
- Ritter J, de Bragança J, Auste C, Mendez A, Cohen PD, Fajardo AF, et al. (2024). Novel framework of financial hardship in childhood cancer: incorporating stakeholder perspectives. JCO Glob Oncol. 10(10):e2400093. https://doi.org/10.1200/GO.24.00093 PMID:39208390
- de Paula Silva N, Gini A, Dolya A, Colombet M, Soerjomataram I, Youlden D, et al.; CRICCS consortium (2024). Prevalence of childhood cancer survivors in Europe: a scoping review. EJC Paediatr Oncol. https://doi.org/10.1016/j.ejcped.2024.100155 PMID:38915419
- Moreira DC, Znaor A, Santana VM, Dolya A, Fox Irwin L, Bhakta N, et al. (2024). Expanding the global capacity for childhood cancer registration: the ChildGICR Masterclass. JCO Glob Oncol. 10(10):e2300334. https://doi.org/10.1200/GO.23.00334 PMID:38905577
- Maroui MA, Odongo GA, Mundo L, Manara F, Mure F, Fusil F, et al. (2024). Aflatoxin B1 and Epstein-Barr virus-induced CCL22 expression stimulates B cell infection. Proc Natl Acad Sci U S A. 121(16):e2314426121. https://doi.org/10.1073/pnas.2314426121 PMID:38574017
- Choudhary P, Monasso GS, Karhunen V, Ronkainen J, Mancano G, Howe CG, et al. (2024). Maternal educational attainment in pregnancy and epigenome-wide DNA methylation changes in the offspring from birth until adolescence. Mol Psychiatry. 29(2):348–58. https://doi.org/10.1038/s41380-023-02331-5 PMID:38052982
- de Paula Silva N, Colombet M, Moreno F, Erdmann F, Dolya A, Piñeros M, et al.; IICC-3 contributors (2024). Incidence of childhood cancer in Latin America and the Caribbean: coverage, patterns, and time trends. Rev Panam Salud Publica. 48:e11. https://doi.org/10.26633/RPSP.2024.11 PMID:38410357
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