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Indian Journal of Cancer, Vol. 47, No. 4, October-December, 2010, pp. 473-474 Letter to Editor Trend of reported cases of retinoblastoma under five hospital based cancer registries S Sachdeva Ophthalmology Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Nirman Bhawan,New Delhi-110 108, India Correspondence Address: Code Number: cn10111 PMID: 21131767 DOI: 10.4103/0019-509X.73554 Sir, Neoplasm in children (0-14 years) is a rare entity as compared with adult cancer and contributes to 5-7% of the total cancer burden in India. Population-based Cancer Registries in India have reported the top 5 childhood cancers as leukemia, lymphoma, central nervous system neoplasm, retinoblastoma, and renal tumors with similar proportion among boys and girls. Retinoblastoma is a common primary intraocular malignancy of childhood, though overall a rare malignancy. Indian Council of Medical Research (ICMR), as a nodal agency, initiated the National Cancer Registry Program (NCRP) in 1981 with a network of cancer registries across the country. Reports of ICMR was reviewed and consolidated for an arbitrary 10-year time frame (I) 1984-1993 and time frame (II) 1994-2003 to draw some meaningful conclusions. [1] Reported new cases of childhood cancer (0-14 years) and retinoblastoma under 5 national hospital-based registries (Mumbai, Bangalore, Chennai, Thiruvanthapuram, and Dibrugarh) were extracted and entered into a MS excel master sheet. Proportion (%) and male-to-female ratio of retinoblastoma were determined among childhood cancer cases and statistical analysis was carried out using STATA (version 9, Stata Corp LP, Texas, USA) to determine any significant trend during the reference period. It was observed that the proportion of retinoblastoma detected among childhood cancer cases varied from 4.04% at Thiruvanthapuram to 11.67% at Dibrugarh during 1984-1993 and 3.59% at Mumbai to 15.6% at Dibrugarh during 1994-2003, respectively [Table - 1]. An upward trend was noticed in detection of the absolute number of childhood cancers under all the cancer registries in the time frame II except for Dibrugarh. In contrast, the proportion of retinoblastoma was found to be lower in all the cancer registries except Dibrugarh. Among all the cancer registries, difference in the proportion among male and female retinoblastoma cases vs non-retinoblastoma cases was found to be statistically significant (P < 0.001) only at Mumbai for both the time frames. The male-to-female ratio among the retinoblastoma cases was slightly more than one in all the cancer registries except for Thiruvanthapuram (0.93) during 1984-1993, whereas it was unity in Dibrugarh. Similarly, gender-based trend among retinoblastoma was also found to be statistically significant only at Mumbai. For males, P value was determined to be less than 0.001, whereas for females it was less than 0.05 on considering both the time frames. Admission policy and level of resources differ among the institutions; however, it can be concluded that no significant trend was noticed for retinoblastoma under hospital-based national cancer registries except in Mumbai for the period under review. The male-to-female ratio was slightly more than 1, similar to as reported in literature. In Europe, North America, and Australia, retinoblastoma accounts for 2-4% of the total childhood cancers and the relative frequency is similar in Asia. In contrast, it accounts for 10-15% of childhood cancers in African countries. [2] Globally, annual incidence is recorded to be about 8-11 cases per million children younger than 5 years. [3] Most of the studies report an estimate of 01 case of retinoblastoma between 14,000 and 34,000 live births independent of race or sex. [4] It is diagnosed at an average age of 15-24 months, with 90% of diagnosis reported before 5 years of age. Review of literature points toward slightly male preponderance (M:F ≥ 1) except few studies with higher female reporting. [5] There is little evidence suggesting any significant change in the incidence of retinoblastoma over time in any part of the world. With the advent of technology, better treatment protocol, availability of expertise and infrastructure, current survival rates for retinoblastoma exceed 95%; however, individual visual outcome and survival are dependent on early detection and appropriate referral, especially in developing countries. References
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