What can we learn from geographical comparisons of childhood cancer survival?

Abstract

With improvements in treatment for childhood cancer, comparisons of survival rates between countries have become important to inform future health policies and treatment strategies. Population-based cancer registry data are viewed as the gold standard for such comparisons, but even these have potential confounding factors. Here, we review the interpretation of recent geographical comparisons of childhood cancer survival from the viewpoint of the British Isles, a region with a 45-year record of national population-based cancer registration and a national childhood cancer clinical trials organisation in place for nearly 30 years. Using national data on referral patterns to tertiary paediatric oncology centres, we explore some of the reasons for lower survival rates in the past for some tumour groups and anticipate continued improvement in the next decade. Participation in international clinical trials coincided with rapid gains in survival for hepatoblastoma. This exemplifies the potential benefits of international collaborative clinical research, particularly for rare subgroups.

Figure 1

Five-year actuarial cumulative survival for all childhood cancers, by European region and period of diagnosis (source: Magnani et al, 2006) Trends in survival after childhood cancer in Europe, 1978–1997: the ACCIS project. Eur J Cancer 42:1981–2005). For details of the countries included in each of the regions, see main text. Reproduced with the permission of the European Journal of Cancer.

Figure 2

Actuarial 5-year cumulative survival for all childhood cancers diagnosed in Great Britain (England, Wales, Scotland) during the period 1971–2000. Source: Stiller C (2007) Childhood Cancer in Britain: Incidence, Survival and Mortality, Oxford University Press: Oxford, UK.

Figure 3

Actuarial 5-year cumulative survival for specified childhood cancers diagnosed in Great Britain during the period 1971–2000. Source: Stiller C (2007) Childhood Cancer in Britain: Incidence, Survival and Mortality, Oxford University Press: Oxford, UK.