The objective of the European Childhood Leukaemia-Lymphoma Incidence Study (ECLIS) is to investigate trends in incidence rates of childhood leukaemia and lymphoma in Europe, in relation to the exposure to radiation which resulted from the accident at the Chernobyl nuclear power plant in April 1986. In this first report, the incidence of leukaemia in children aged 0-14 is presented from cancer registries in 20 European countries for the period 1980-1988. Risk of leukaemia in 1987-1988 (8-32 months post-accident) relative to that before 1986, is compared with estimated average dose of radiation received by the population in 30 geographic areas. The observed changes in incidence do not relate to exposure. The period of follow-up is so far rather brief, and the study is planned to continue for at least 10 years.
INTRODUCTION: Data on the survival of all incident cases collected by population-based cancer registries make it possible to evaluate the overall performance of diagnostic and therapeutic actions on cancer in those populations. EUROCARE-3 is the third round of the EUROCARE project, the largest cancer registry population based collaborative study on survival in European cancer patients. The EUROCARE-3 study analysed the survival of cancer patients diagnosed from 1990 to 1994 and followed-up to 1999. Sixty-seven cancer registries of 22 European countries characterised by differing health systems participated in the study. This paper includes essays providing brief overviews of the state and evolution of the health systems of the considered countries and comments on the relation between cancer survival in Europe and some European macro-economic and health system indicators, in the 1990s. OVERVIEW OF THE EUROPEAN HEALTH SYSTEMS: The European health systems underwent a great deal of reorganisation in the last decade; a general tendency being to facilitate expanding involvement of the private sector in health care, a process which occurred mainly in the eastern countries (i.e. the Czech Republic, Estonia, Poland, Slovakia and Slovenia). In contrast, organisational changes in the northern European countries (i.e. Denmark, Iceland, Finland and Sweden) tended to confirm the established public sector systems. Other countries, including the UK and some southern European countries (i.e. England, Scotland, Wales, Malta and Italy) have reduced the public role while the systems remain basically public, at least at present. Our findings clearly suggest that cancer survival (all cancer combined) is related to macro-economic variables such as the gross domestic product (GDP), the total national (public and private) expenditure on health (TNEH) and the total public expenditure on health (TPEH). We found, however, that survival is related to wealth (GDP), but only up to a certain level, after which survival continues to be related to the level of health investment (both TNEH and TPEH). According to the Organisation for Economic Co-operation and Development (OECD), the TNEH increased during the 1990s in all EUROCARE-3 countries, while the ratio of TPEH to TNEH reduced in all countries except Portugal. CONCLUSIONS: Cancer survival depends on the widespread application of effective diagnosis and treatment modalities, but our enquiry suggests that the availability of these depends on macro-economic determinants, including health and public health investment. Analysis of the relationship between health system organisation and cancer outcome is complicated and requires more information than is at present available. To describe cancer and cancer management in Europe, the European Cancer Health Indicator Project (EUROCHIP) has proposed a list of indicators that have to be adopted to evaluate the effects on outcome of proposed health system modifications.
Thyroid cancers are rare in childhood with between 0.4 and 1.5 cases per million, 2--3 times as frequent in girls as in boys. However, following the Chernobyl accident, a remarkable incidence increase was observed in children exposed to radioactive iodine fall-out. Survival after thyroid cancer in childhood is thus of interest. In the EUROCARE II study, excluding most of Eastern Europe, a total of 165 childhood thyroid cancers were reported during the period 1978--1989, of which 134 were aged 10--14 years. The childhood cancer registry in England and Wales contributed 39% of the cases, and another 24% came from the Nordic countries, the rest from other parts of west, south, east and central Europe. The 5-year survival was for both genders combined 97% (95% confidence interval (CI): 93--99), 98% (95% CI: 91--100) for boys and 97% (95% CI: 91--99) for girls, with no significant difference between the genders. Survival was high during the entire study period, and variations influenced by the small numbers. As for adults, long-term follow-up beyond 10--20 years is needed to clearly demonstrate excess mortality as a consequence of the cancer.
Remarkable increases in lung cancer risk have recently been observed in the Central European (CE) area. This study examines the patterns of lung cancer mortality rates and cigarette sales in 1965-1989 in four CE countries with a total population of 64.2 million and 31,000 deaths from lung cancer in the last year under study. The patterns of increases in cigarette sales during the 1960s and 1970s were different by country, and, in the 1980s, the consumption in Hungary and Poland exceeded 3,000 pieces of cigarettes/year per adult (age 15 years and older). Among men, the lung cancer death rates in 1989 for the Czech Republic (75.8/100,000, age-adjusted to the world standard), Hungary (74.0), Poland (69.4) and Slovakia 68.7) ranked among the highest in Europe, the trends by country largely reflecting the varied prevalence and duration of smoking in previous decades. The age-adjusted lung cancer death rates for females of the same countries (9.3, 14.4, 9.4, and 6.8/100,000, respectively) were still much lower than in the most afflicted Western countries (Scotland, USA, Canada, England, Denmark), however, rapidly increasing. In more recent birth cohorts, there was some decline in lung cancer mortality rates among men, but not among women; these trends in young adult life are known to spread to older age groups in future years, and, therefore, have been suggested to predict future changes in older age groups. Hence, an increasing trend in lung cancer mortality can be predicted for the female population of the four countries under study which will continue probably well beyond the turn of the century. In most of these countries, the current increasing trend in men can be expected to reach a plateau (and later a decline) sooner than in women. This outlook underlines the urgent need for comprehensive lung cancer prevention with control of smoking in women as a priority.