Chemotherapy response of the primary tumor is a prognostic factor in patients with ET with ppm. Strategies of treatment intensification warrant further evaluation.

The Northern Region Young Persons’ Malignant Disease Registry records information on young people under 25 years old diagnosed with cancer in the Northern Region of England. Incidence and survival rates were calculated for children and young adults diagnosed with cancer between 1968 and 1995. There were 2099 (M:F 1.28:1) children (age 0–14 years) and 2217 (M:F 1.23:1) young adults (15–24 years) diagnosed with a first cancer between 1968 and 1995. The age-standardized rate (ASR) for childhood cancer was 121 per million 0 to 14 year-olds per year. For young adults the ASR was 175 per million 15 to 24 year-olds, per year. Incidence of childhood cancer increased over time at a rate of 12 extra cases per million children, per decade ( P < 0.001). In young adults incidence rates increased by 16 extra cases per million 15 to 24 year-olds, per decade ( P < 0.001). For childhood cancer 5-year survival was 42% for those diagnosed 1968–1977, 57% for 1978–1987 and 71% (95% CI 67–75) for 1988–1995. Survival for young adults over the three periods was 45%, 62% and 73% (95% CI 70–78) respectively. The cumulative risk of developing cancer before the age of 25 is 1 in 285. Over the 28-year period there were significant improvements in survival and modest increases in incidence in both children and young adults. © 2000 Cancer Research Campaign

While risk for CMS in men is compounded by early life disadvantage, promotion of a healthier adult lifestyle and a reduction in the number of people taking up smoking would appear to be the public health interventions most likely to reduce the prevalence of CMS in middle age.

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results are not independent. Those for the present paper, however, are based on more cases, and the method of analysis is entirely different and, in particular, does not use the controls from the other studies. Although (with some minor and possibly questionable exceptions) the results of the present analyses are not significant and there is no suggestion of a doubling of the risk of malignant disease arising from the use of intramuscular vitamin K, the findings for childhood leukaemia are compatible with an increased risk of around 20-30%, as, by using the same argument as at the end of the section on statistical methods, it can be shown that an individual relative risk of 1.25 gives a risk ratio of 1.14, and such values occur in table 3. These largely negative results are in agreement with those from our own casecontrol study and with most of the other papers on this subject, the results and implications of which are discussed in the accompanying paper by Passmore et al. 3 Various colleagues are thanked in the accompanying paper. We are very grateful to Dr Hey and the members of the Scottish Neonatal Network for providing carefully validated information on numbers of births and vitamin K prophylaxis policies in Scottish hospitals.Contributors: SJP and GD initiated the study and designed the protocol. PB was responsible for setting up and manipulating computer databases. Statistical analyses were carried out by GD and MK. The paper was written jointly by SJP and GD, who are guarantors for the paper.Funding: This work was funded by the Department of Health; the views expressed in this publication are those of the authors and not necessarily those of the Department of Health.Conflict of interest: None. Results: There was no association between the administration of vitamin K and the development of all childhood cancers (unadjusted odds ratio 0.89; 95% confidence interval 0.69 to 1.15) or for all acute lymphoblastic leukaemia (1.20; 0.75 to 1.92), but there was a raised odds ratio for acute lymphoblastic leukaemia developing 1-6 years after birth (1.79; 1.02 to 3.15). No such association was seen in a separate cohort-based study not dependent on case note retrieval in which the rates of acute lymphoblastic leukaemia in children born in hospital units where all babies received vitamin K were compared with those born in units where less than a third received prophylaxis. Conclusions: It is not possible, on the basis of currently published evidence, to refute the suggestion that neonatal intramuscular vitamin K administration increases the risk of early childhood leukaemia. Any Key messages+ Intramuscular vitamin K given to babies is known to be effective in the prevention of vitamin K deficiency bleeding but it has been suggested that these preparations, or one of their constituents, may increase the risk of childhood cancer + Most studies have not shown a significant association between childhood cancer and vitamin K but are unable to exclude the possibility that its use increases the risk of childhood cancer ...

Background:Cancer is the second most common cause of death in children in the developed world. The study investigated patterns and trends in survival from childhood cancer in patients from northern England diagnosed 1968–2005.Methods:Five-year survival was analysed using Kaplan–Meier estimation for four successive time periods. Cox regression analysis was used to explore associations with age and demographic factors.Results:The study included 2958 cases (1659 males and 1299 females). Five-year survival for all cancers improved significantly from 39% in 1968–1977 to 79% in 1998–2005 (P<0.001). Five-year survival for leukaemia increased from 24% to 81% (P<0.001), lymphoma from 46% to 87% (P<0.001), central nervous system tumours from 43% to 73% (P<0.001), bone tumours from 21% to 75% (P<0.001), soft tissue sarcoma from 30% to 58% (P<0.001) and germ cell tumours from 59% to 97% (P<0.001). Survival was worse for cases of acute lymphoblastic leukaemia (P<0.001) and astrocytoma (P<0.001) aged 10–14 years compared with 0–4-year olds.Conclusion:There were marked improvements in survival over a 38-year time span. Future work should examine factors that could influence further improvement in survival such as diagnosis delays.