Childhood cancer survival in Europe: an overview

Other articles in this issue of the European Journal of Cancer have describ ed population-based survival analyses of specific types of childhood cancer included in the EUROCARE database, diagnosed since 1979. The present paper summarises the relevant estimates and comments on intercountry differences , focusing on possible distortions in the intercountry comparisons based on data produced by the cancer registries. Potential biases include a lack of exhaustiveness of both case ascertainment and follow-up for living status and also a lack of consistency in the use of classification of the childhoo d cancer types. Nevertheless, despite such biases, consistent differences a re observed between European countries in the probability of survival follo wing the diagnosis of a paediatric cancer. In most cases, poor population-b ased survival rates are probably explained by inadequacies in the adoption and implementation of therapeutic protocols that have been proved to be eff ective. In some instances, the cause of unsatisfactory estimates was the in clusion of a sizeable proportion of children with cancer in clinical trials which were found to be ineffective. A regression analysis of incidence, mo rtality and survival rates during 1978-1989 over the whole EUROCARE databas e strongly indicates that the prognostic improvements over time are real an d cannot be attributed to changes in diagnostic procedures. (C) 2001 Elsevi er Science Ltd. All rights reserved.