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

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          Abstract

          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.

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          Most cited references31

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          Selective Discrimination against Female Children in Rural Punjab, India

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            Childhood cancer epidemiology in low-income countries.

            Global studies of childhood cancer provide clues to cancer etiology, facilitate prevention and early diagnosis, identify biologic differences, improve survival rates in low-income countries (LIC) by facilitating quality improvement initiatives, and improve outcomes in high-income countries (HIC) through studies of tumor biology and collaborative clinical trials. Incidence rates of cancer differ between various ethnic groups within a single country and between various countries with similar ethnic compositions. Such differences may be the result of genetic predisposition, early or delayed exposure to infectious diseases, and other environmental factors. The reported incidence of childhood leukemia is lower in LIC than in more prosperous countries. Registration of childhood leukemia requires recognition of symptoms, rapid access to primary and tertiary medical care (a pediatric cancer unit), a correct diagnosis, and a data management infrastructure. In LIC, where these services are lacking, some children with leukemia may die before diagnosis and registration. In this environment, epidemiologic studies would seem to be an unaffordable luxury, but in reality represent a key element for progress. Hospital-based registries are both feasible and essential in LIC, and can be developed using available training programs for data managers and the free online Pediatric Oncology Networked Data Base (www.POND4kids.org), which allows collection, analysis, and sharing of data.
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              Childhood cancers in Chennai, India, 1990-2001: incidence and survival.

              Childhood cancers (age at diagnosis: 0-14 years) comprise a variety of malignancies, with incidence varying worldwide by age, sex, ethnicity and geography, that provide insights into cancer etiology. A total of 1,334 childhood cancers registered in population-based cancer registry, Chennai, India, during 1990-2001 and categorized by International Classification of Childhood Cancer norms formed the study material. Cases included for survival analysis were 1,274 (95.5%). Absolute survival was calculated by actuarial method. Cox proportional hazard model was used to elicit the prognostic factors for survival. The age-standardized rates for all childhood cancers together were 127 per million boys and 88 per million girls. A decreasing trend in incidence rates with increasing 5-year age groups was observed in both sexes. The top 5 childhood cancers were the same among boys and girls: leukemias, lymphomas, central nervous system neoplasms, retinoblastomas and renal tumors. The highest 5-year absolute survival was observed in Hodgkin's disease (65%) followed by Wilm's tumor (64%), retinoblastomas (48%), non-Hodgkin's lymphomas (47%), osteosarcomas (44%), acute lymphoid leukemia and astrocytoma (39%). Multifactorial analysis of age at diagnosis and sex showed no differences in the risk of dying for all childhood cancers. Completeness of treatment and type of hospital combination emerged as a prognostic factor for survival for all childhood cancers together (p < 0.001), acute lymphoid leukemia (p < 0.001) and non-Hodgkin's lymphoma (p = 0.04). A Childhood Cancer Registry with high-resolution data collection is advocated for in-depth analysis of variation in incidence and survival. (c) 2008 Wiley-Liss, Inc.
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                Author and article information

                Journal
                Br J Cancer
                Br. J. Cancer
                British Journal of Cancer
                Nature Publishing Group
                0007-0920
                1532-1827
                26 June 2012
                10 May 2012
                : 107
                : 1
                : 183-188
                Affiliations
                [1 ]Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
                [2 ]Institute of Health and Society, Newcastle University, Sir James Spence Institute , Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
                Author notes
                Article
                bjc2012191
                10.1038/bjc.2012.191
                3389403
                22576590
                99df7eaa-e805-4dc6-ac00-085f38169ede
                Copyright © 2012 Cancer Research UK

                From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/

                History
                : 15 December 2011
                : 12 April 2012
                : 13 April 2012
                Categories
                Epidemiology

                Oncology & Radiotherapy
                childhood,health inequalities,low-income countries,middle-income countries,epidemiology

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