Registration of cancer in girls remains lower than expected in countries with low/middle incomes and low female education rates.

BACKGROUND: A decade ago it was reported that childhood cancer incidence was higher in boys than girls in many countries, particularly those with low gross domestic product (GDP) and high infant mortality rate. Research suggests that socio-economic and cultural factors are likely to be responsible. This study aimed to investigate the association between cancer registration rate sex ratios and economic, social and healthcare-related factors using recent data (1998-2002). METHODS: For 62 countries, childhood (0-15 years) cancer registration rate sex ratios were calculated from Cancer Incidence in Five Continents Vol IX, and economic, social and healthcare indicator data were collated. RESULTS: Increased age standardised cancer registration rate sex ratio (M:F) was significantly associated with decreasing life expectancy (P=0.05), physician density (P=0.05), per capita health expenditure (P=0.05), GDP (P=0.01), education sex ratios (primary school enrolment sex ratio (P<0.01); secondary school enrolment sex ratio (P<0.01); adult literacy sex ratio (P<0.01)) and increasing proportion living on less than Int$1 per day (P=0.03). CONCLUSION: The previously described cancer registration sex disparity remains, particularly, in countries with poor health system indicators and low female education rates. We suggest that girls with cancer continue to go undiagnosed and that incidence data, particularly in low- and middle-income countries, should continue to be interpreted with caution

Incidence and survival of childhood bone cancer in northern England and the West Midlands, 1981–2002

There is a paucity of population-based studies examining incidence and survival trends in childhood bone tumours. We used high quality data from four population-based registries in England. Incidence patterns and trends were described using Poisson regression. Survival trends were analysed using Cox regression. There were 374 cases of childhood (ages 0–14 years) bone tumours (206 osteosarcomas, 144 Ewing sarcomas, 16 chondrosarcomas, 8 other bone tumours) registered in the period 1981–2002. Overall incidence (per million person years) rates were 2.63 (95% confidence interval (CI) 2.27–2.99) for osteosarcoma, 1.90 (1.58–2.21) for Ewing sarcoma and 0.21 (0.11–0.31) for chondrosarcoma. Incidence of Ewing sarcoma declined at an average rate of 3.1% (95% CI 0.6–5.6) per annum (P=0.04), which may be due to tumour reclassification, but there was no change in osteosarcoma incidence. Survival showed marked improvement over the 20 years (1981–2000) for Ewing sarcoma (hazard ratio (HR) per annum=0.95 95% CI 0.91–0.99; P=0.02). However, no improvement was seen for osteosarcoma patients (HR per annum=1.02 95% CI 0.98–1.05; P=0.35) over this time period. Reasons for failure to improve survival including potential delays in diagnosis, accrual to trials, adherence to therapy and lack of improvement in treatment strategies all need to be considered