Childhood cancer - mainly curable so where next?

More than 70% of childhood cancer is now curable with best modern therapy. The treatment is expensive but in terms of cost per life year saved, USD 17 50, compares very favourably with other major health interventions. The rat e of improvement in survival is stowing down. New, "designer", treatments a re needed and, better still, prevention. The causes of childhood cancer are beginning to emerge. The origin for many is probably in utero and may be i nitiated by dietary and other environmental exposures perhaps in susceptibl e individuals. However, one of the great challenges for the future must be to extend the benefits of modern treatment to the 80% of the world's childr en who currently have little or no access to it in economically disadvantag ed and emerging nations. The International Paediatric Oncology Society (SIO P) is leading the way in bringing hope for children with cancer worldwide. In India, with the support of the WHO, there is a "train the trainers" prog ramme. In Africa, pilot studies of cost-effective treatments for Burkitt's lymphoma are producing gratifying results in Malawi and there are several e xamples of twinning programmes between major centres in developed and less well-developed countries. Conclusions: The future for children with cancer is bright. Most are curabl e and prevention may be just over the horizon.