NEUROBLASTOMA IN EUROPE - DIFFERENCES IN THE PATTERN OF DISEASE IN THE UK

Background Neuroblastoma is a major contributor to childhood cancer mo rtality, but its prognosis varies with age and stage of disease, and s ome tumours regress spontaneously. Urinary screening programmes or cli nical examination may detect the disease before symptoms appear, but t he benefit of early diagnosis is uncertain. We examined the incidence, pattern, and presentation of neuroblastoma in four European countries . Method Population-based incidence rates were derived for France, Aus tria, Germany, and the UK. Age, sex, and stage distribution were analy sed by Mantel-Haenszel techniques and Poisson regression. The proporti on of incidental diagnoses (cases without symptoms found at routine he alth checks or during investigation of other disorders) and mortality rates were also compared. Findings Between 1987 and 1991, 1672 cases o f neuroblastoma were diagnosed in children under 15 years old (France, 624; Austria, 69;Germany, 493; UK, 486). Age-standardised annual inci dence was significantly lower in the UK (10.1/million) than in France (12.5) and Germany (11.4). In the UK a deficit of low-stage disease in infants was accompanied by an excess of stage IV in older children. T he UK had significantly fewer incidental diagnoses (8%) than Austria ( 27%) and Germany (34%). UK mortality rates were significantly higher t han German or French rates. Interpretation In the UK, neuroblastoma di agnosis is delayed, possibly because of a less rigorous system of heal th checks for children. Although some overdiagnosis occurs in mainland Europe, our data suggest that in the UK some low-stage cases, undetec ted in infancy, may later present as advanced disease. This finding ha s implications for screening programmes and organisation of routine su rveillance of infant health in the UK.