Worldwide comparison of survival from childhood leukaemia for 1995–2009, by subtype, age, and sex (CONCORD-2): a population-based study of individual data for 89 828 children from 198 registries in 53 countries

Background Global inequalities in access to health care are reflected in differences in cancer survival. The CONCORD programme was designed to assess worldwide differences and trends in population-based cancer survival. In this population-based study, we aimed to estimate survival inequalities globally for several subtypes of childhood leukaemia. Methods Cancer registries participating in CONCORD were asked to submit tumour registrations for all children aged 0-14 years who were diagnosed with leukaemia between Jan 1, 1995, and Dec 31, 2009, and followed up until Dec 31, 2009. Haematological malignancies were defined by morphology codes in the International Classification of Diseases for Oncology, third revision. We excluded data from registries from which the data were judged to be less reliable, or included only lymphomas, and data from countries in which data for fewer than ten children were available for analysis. We also excluded records because of a missing date of birth, diagnosis, or last known vital status. We estimated 5-year net survival (ie, the probability of surviving at least 5 years after diagnosis, after controlling for deaths from other causes [background mortality]) for children by calendar period of diagnosis (1995-99, 2000-04, and 2005-09), sex, and age at diagnosis (< 1, 1-4, 5-9, and 10-14 years, inclusive) using appropriate life tables. We estimated age-standardised net survival for international comparison of survival trends for precursor-cell acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML). Findings We analysed data from 89 828 children from 198 registries in 53 countries. During 1995-99, 5-year agestandardised net survival for all lymphoid leukaemias combined ranged from 10.6% (95% CI 3.1-18.2) in the Chinese registries to 86.8% (81.6-92.0) in Austria. International differences in 5-year survival for childhood leukaemia were still large as recently as 2005-09, when age-standardised survival for lymphoid leukaemias ranged from 52.4% (95% CI 42.8-61.9) in Cali, Colombia, to 91.6% (89.5-93.6) in the German registries, and for AML ranged from 33.3% (18.9-47.7) in Bulgaria to 78.2% (72.0-84.3) in German registries. Survival from precursor-cell ALL was very close to that of all lymphoid leukaemias combined, with similar variation. In most countries, survival from AML improved more than survival from ALL between 2000-04 and 2005-09. Survival for each type of leukaemia varied markedly with age: survival was highest for children aged 1-4 and 5-9 years, and lowest for infants (younger than 1 year). There was no systematic difference in survival between boys and girls. Interpretation Global inequalities in survival from childhood leukaemia have narrowed with time but remain very wide for both ALL and AML. These results provide useful information for health policy makers on the effectiveness of health-care systems and for cancer policy makers to reduce inequalities in childhood survival

A Letter from the Editor

I never had to go on a date to know I’m bad at them. My dry sarcasm never comes off funny, I spill down the front of myself more than the oldest woman at a nursing home and I consider smelling my date’s dinner the same as tasting it. The night before, I was talking to one of my best friends. I told him I was nervous and he told me something that every college student needs to know: “Every time you do something new, someone will tell you, ‘Relax, it’s not that bad, you’ll see.’ But you haven’t seen yet. You’ve never done it, and until you have you aren’t going to know it’s not that bad.”</p

A Letter from the Editor

I want to create awesome things with amazing people for the rest of my life. My friend called me to comment on the second best college town. She’s a collegiate correspondent for USA Today College and was writing a story about the best college towns in America: naturally, Ames was named No. 2 (don’t worry guys, we’ll kick Ithaca’s ass next year, like Cornell? Who cares?). She was interviewing me about what makes Ames so great; I started talking and immediately lost it. The realization that graduation is just around the corner, and with it my departure from Ames, got me so bummed.</p

Who Do You Think You Are? Richard Deyo

Surely one of the most well-known citizens of Ames, Richard Deyo separates himself with one key detail: no one knows him by name, but rather “skirt man” or “Santa.” We spent some time with Richard to get his full story, here’s the first glance. A question-and-answer column with Richard Deyo.</p

If the world were a village of 100 people...

Some "last-minute" statistics to make you think.</p

Stereotypes

Contains descriptions of stereotypes of various majors found at Iowa State.</p

Who Do You Think You Are? The Bible Man

We watched Keith Darrell preach his heart out, defend his beliefs against unruly passersby and snatched an interview with him during his recent visit to Iowa State. A question-and-answer column with Keith Darrell.</p

Veggies for One

Frozen veggies are not only cheaper than fresh produce, they also hold the same nutritional content and have a longer shelf life (obviously). So skip the cans and grab a variety of vegetable bags from the freezer aisle. This is a must-have for every college kitchen and these recipes will help you utilize them in single-person servings.</p

Smoke and Mirrors

The incessant beeping of an alarm clock begins at 6 a.m. each day. Molly* fills her backpack and heads to the campus office where she works until 10 a.m. when she switches over to classes. Come 2 p.m. she is free of lecture halls but has to either return to work or go to the library to do her homework for the night. Molly grabs dinner on her way home, walks into the house and tosses her backpack aside as she settles into the couch, flips on Netflix and announces, “I’m gonna get high.”</p