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Summary The European Childhood Leukaemia-Lymphoma Incidence Study (ECLIS) is designed to address concerns about a possible increase in the risk of cancer in Europe following the nuclear accident in Chernobyl in 1986. This paper reports results of surveillance of childhood leukaemia in cancer registry populations from 1980 up to the end of 1991. There was a slight increase in the incidence of childhood leukaemia in Europe during this period, but the overall geographical pattern of change bears no relation to estimated exposure to radiation resulting from the accident. We conclude that at this stage of follow-up any changes in incidence consequent upon the Chernobyl accident remain undetectable against the usual background rates. Our results are consistent with current estimates of the leukaemogenic risk of radiation exposure, which, outside the immediate vicinity of the accident, was small.

Summary Breast cancer is the second most common cancer among women in Madras and southern India after cervix cancer. The Madras Metropolitan Tumour Registry (MMTR), a population-based cancer registry, collects data on the outcome of cancer diagnosis by both active and passive methods. A total of 2080 cases of invasive female breast cancer were registered in MMTR during 1982-89. Of these, 98 (4.7%) cases were registered on the basis of death certificate information only (DCO), and there was no follow-up information for 235 (11.3%). These were excluded, leaving 1747 (84%) for survival analysis. The mean follow-up time was 43 months. The overall Kaplan-Meier observed survival rates at 1, 3 and 5 years were 80%, 58% and 48% respectively; the corresponding figures for relative survival were 81%, 61% and 51%. A multifactorial analysis of prognostic factors using a proportional hazards model showed statistically significant differences in survival for subjects in different categories of age at diagnosis, marital status, educational level and clinical extent of disease. Increasing age at diagnosis was associated with decreased survival. Single women displayed poorer survival (37.4%) at 5 years than those married and living with spouses (50.0%). The survival rate among those who had more than 12 years of education was higher (70%) at 5 years than that of illiterate subjects (47%). An inverse relationship was seen between survival rates and clinical extent of disease. The need for research to determine feasible public health approaches, allied to coordinated treatment facilities to control breast cancer in India, is emphasized.

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Thailand is one of the few developing countries for which population-based cancer survival data are available. Using clinical follow-up information and reply-paid postal enquiries, 10,333 residents of Khon Kaen province registered with cancer in the period 1985-1992 were followed-up to the end of 1993. The sites of the most common cancers in the province were liver (5-year relative survival rate 9.2%), cervix (60.1%), lung (15.4%), breast (48.1%) and large bowel (41.9%). Results for Khon Kaen were compared with age-standardized survival data for the US and Scotland. Survival was consistently higher for US whites compared to Khon Kaen residents for those cancers whose prognosis is associated with early diagnosis (breast, cervix and large bowel) or the availability of intensive therapy (leukaemia and lymphoma). The main implication of these results for cancer control in Thailand is that the interventions of greatest potential benefit are those designed to promote early detection. More than one-third of all cancers in Thailand are liver tumours: primary prevention through control of hepatitis-B infection and liver fluke infestation is the only effective strategy for their control.

Population‐based cancer registries from Algeria, China, Costa Rica, Cuba, India, the Philippines, and Thailand are collaborating with the International Agency for Research on Cancer in a study of cancer survival in developing countries. Comparisons with the SEER program results of the National Cancer Institute in the United States, and the EUROCARE study of survival in European countries revealed considerable differences in the survival of patients with certain tumors associated with intensive chemotherapeutic treatment regimes (Hodgkin's disease and testicular tumors), more modest differences in the survival of patients with tumors for which early diagnosis and treatment confer an improved prognosis (carcinomas of the large bowel, breast, and cervix), and only slight differences for tumors associated with poor prognosis (carcinomas of the stomach, pancreas, and lung). With limited resources to meet the challenge of the increasing incidence of cancer expected in the next few decades, health authorities in developing countries should be aware of the importance of investing in a range of cancer control activities, including primary prevention and early detection programs as well as treatment. Cancer 1996; 78:2461‐4.

A case of congenital tracheo-oesophageal fistula without oesophageal atresia in an adult is presented. Surgical repair via a right thoracotomy was successfully undertaken. The 13 previously reported cases in English publications are reviewed.The majority of tracheo-oesophageal fistulae are diagnosed immediately after birth or during infancy. These are brought to light because of the lifethreatening complications of oesophageal atresia and inhalation of secretions. The purpose of this paper is to report a case of congenital tracheo-oesophageal fistula in an adult. Case reportTwo subsequent bronchoscopies have been performed for recurrence of cough. On each occasion, part of a silk stitch was found at the repair site and removed.There has been no recurrence of the fistula and the patient is well. She eats a normal diet without difficulty. DiscussionA 50-year-old woman presented in May 1977 with a history of chronic cough. She stated that episodes of coughing were worse when she dined out and were associated more with swallowing liquids than solids. She had a history of recurrent mild chest infections as a child. A barium swallow performed 25 years previously had been reported as normal but these films were not available.Clinical examination revealed no abnormality. A barium swallow on this occasion revealed a fistula on the right side of the oesophagus communicating with the trachea. This was best demonstrated with the patient lying on her right side and partially prone.The barium passed into the right main bronchus and into the anterior segment of the right upper lobe ( figure).A bronchoscopy revealed that the fistula was directed caudally towards the oesophagus. The tracheal opening was 5 cm proximal to the carina. Oesophagoscopy failed to show the oesophageal opening.In June 1977, via a right thoracotomy, the fistula was divided and oversewn and mediastinal tissue was interposed at the site of closure.

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