Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.


Timeliness of diagnosis and treatment: the challenge of childhood cancers

A Correction to this article was published on 16 September 2021

This article has been updated


Cancer represents an important cause of disease-related death in children worldwide. Improved treatment and understanding of the ways in which cancer manifests has allowed for a greater prospect of survival in children of all ages. However, variation in childhood cancer experience exists based on factors at the individual, community and systems levels. Throughout the cancer care continuum these factors may influence the access and timeliness of care a child receives, leading to delays in diagnosis and treatment. The pejorative designation ‘delay in diagnosis and treatment’ is better characterised as lag time, representing an interval that is thought to influence survival and overall outcome. In recent decades, work has been done to expedite early childhood cancer diagnosis through the creation of screening and education-based programmes. Although systematic cancer screening in children poses risks and fails to achieve the goal of early diagnosis, a case has been made for risk-based surveillance that has been shown to improve outcome and reduce occurrence of advanced stage disease in targeted populations. The components of lag time are examined separately and individually. This review highlights the challenges of early diagnosis in childhood cancers and describes important contributors in the cancer care continuum.

This is a preview of subscription content

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1: Estimated incidence (numbers of cases, dark grey bars) of and mortality (numbers of deaths, light grey bars) from common paediatric cancers according to age group.
Fig. 2: Lag time in diagnosis and treatment according to patient, physician and healthcare system influences across the cancer treatment continuum.

Data availability

The datasets analyzed during the current study are available from the GLOBOCAN and SEER data repositories at and

Change history


  1. 1.

    Steliarova‐Foucher E, Stiller C, Lacour B, Kaatsch P. International classification of childhood cancer. Cancer. 2005;103:1457–67.

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Steliarova-Foucher E, Colombet M, Ries LA, Moreno F, Dolya A, Bray F, et al. International incidence of childhood cancer, 2001–10: a population-based registry study. Lancet Oncol. 2017;18:719–31.

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Stewart BW, Wild CP. World Cancer Report 2014. Lyon: The International Agency for Research on Cancer; 2014.

  4. 4.

    Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, Brenner H, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol. 2017;3:524–48.

    PubMed  PubMed Central  Google Scholar 

  5. 5.

    Ward ZJ, Yeh JM, Bhakta N, Frazier AL, Atun R. Estimating the total incidence of global childhood cancer: a simulation-based analysis. Lancet Oncol. 2019;20:483–93.

    Google Scholar 

  6. 6.

    Rodriguez-Galindo C, Friedrich P, Alcasabas P, Antillon F, Banavali S, Castillo L, et al. Toward the cure of all children with cancer through collaborative efforts: pediatric oncology as a global challenge. J Clin Oncol. 2015;33:3065.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. 7.

    De Camargo B, De Andrea MLM, Franco EL. Catching up with history: treatment of Wilms’ tumor in a developing country. Med Pediatr Oncol. 1987;15:270–6.

    PubMed  PubMed Central  Google Scholar 

  8. 8.

    Bhakta N, Force LM, Allemani C, Atun R, Bray F, Coleman MP, et al. Childhood cancer burden: a review of global estimates. Lancet Oncol. 2019;20:e42–e53.

    PubMed  PubMed Central  Google Scholar 

  9. 9.

    Gupta S, Howard SC, Hunger SP, Antillon FG, Metzger ML, Israels T, et al. Treating Childhood Cancer in Low- and Middle-Income Countries. In: H Gelband, P Jha, R Sankaranarayanan, S Horton, editors. Cancer: Disease Control Priorities, 3rd edition (Volume 3). Washington (DC): The International Bank for Reconstruction and Development/The World Bank; 2015 Nov 1. Chapter 7. 2015. Available from:

  10. 10.

    Abramson DH, Beaverson K, Sangani P, Vora RA, Lee TC, Hochberg HM, et al. Screening for retinoblastoma: presenting signs as prognosticators of patient and ocular survival. Pediatrics. 2003;112:1248–55.

    Google Scholar 

  11. 11.

    Erwenne CM, Franco EL. Age and lateness of referral as determinants of extra-ocular retinoblastoma. Ophthalmic Paediatr Genet. 1989;10:179–84.

    CAS  Google Scholar 

  12. 12.

    Neal R, Tharmanathan P, France B, Din N, Cotton S, Fallon-Ferguson J, et al. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer. 2015;112:S92–S107.

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Kaatsch P. Epidemiology of childhood cancer. Cancer Treat Rev. 2010;36:277–85.

    Google Scholar 

  14. 14.

    Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, et al. Global Cancer Observatory: Cancer Today. Lyon: International Agency for Research on Cancer; 2020. Accessed 21 July 2021.

  15. 15.

    Howlader N, Noone A, Krapcho M, Miller D, Brest A, Yu M, et al. SEER Cancer Statistics Review, 1975–2018. Bethesda: National Cancer Institute. Accessed 21 July 2021.

  16. 16.

    Dimaras H, Kimani K, Dimba EA, Gronsdahl P, White A, Chan HS, et al. Retinoblastoma. Lancet. 2012;379:1436–46.

    Google Scholar 

  17. 17.

    Murray CJ. Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ. 1994;72:429.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Force LM, Abdollahpour I, Advani SM, Agius D, Ahmadian E, Alahdab F, et al. The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017. Lancet Oncol. 2019;20:1211–25.

    Google Scholar 

  19. 19.

    Benson JR, Jatoi I, Keisch M, Esteva FJ, Makris A, Jordan VC, et al. Early breast cancer. Lancet. 2009;373:1463–79.

    Google Scholar 

  20. 20.

    Franco EL, Duarte-Franco E, Rohan TE. Evidence-based policy recommendations on cancer screening and prevention. Cancer Detect Prev. 2002;26:350–61.

    Google Scholar 

  21. 21.

    Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570–95.

    CAS  Google Scholar 

  22. 22.

    Pollock BH, Krischer JP, Vietti TJ. Interval between symptom onset and diagnosis of pediatric solid tumors. J Pediatr. 1991;119:725–32.

    CAS  Google Scholar 

  23. 23.

    Stiller CA. Epidemiology and genetics of childhood cancer. Oncogene. 2004;23:6429–44.

    CAS  Google Scholar 

  24. 24.

    Wilson JMG, Jungner G. Principles and practice of screening for disease. In: Public health papers; no. 34. Geneva: World Health Organization; 1968.

  25. 25.

    Tota JE, Isidean SD, Franco EL. Defining benchmarks for tolerable risk thresholds in cancer screening: Impact of HPV vaccination on the future of cervical cancer screening. Int J Cancer. 2020;147:3305–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Woods WG, Tuchman M, Robison LL, Bernstein M, Leclerc J-M, Brisson LC, et al. A population-based study of the usefulness of screening for neuroblastoma. Lancet. 1996;348:1682–7.

    CAS  Google Scholar 

  27. 27.

    Sawada T, Nakata T, Takasugi N, Maeda K, Hanawa Y, Shimizu K, et al. Mass screening for neuroblastoma in infants in Japan: interim report of a mass screening study group. Lancet. 1984;324:271–3.

    Google Scholar 

  28. 28.

    Schilling FH, Spix C, Berthold F, Erttmann R, Fehse N, Hero B, et al. Neuroblastoma screening at one year of age. N Engl J Med. 2002;346:1047–53.

    Google Scholar 

  29. 29.

    Soderstrom L, Woods WG, Bernstein M, Robison LL, Tuchman M, Lemieux B, et al. Health and economic benefits of well-designed evaluations: some lessons from evaluating neuroblastoma screening. J Natl Cancer Inst. 2005;97:1118–24.

    Google Scholar 

  30. 30.

    Woods WG, Gao R-N, Shuster JJ, Robison LL, Bernstein M, Weitzman S, et al. Screening of infants and mortality due to neuroblastoma. N Engl J Med. 2002;346:1041–6.

    PubMed  PubMed Central  Google Scholar 

  31. 31.

    Schilling FH, Spix C, Berthold F, Erttmann R, Sander J, Treuner J, et al. Children may not benefit from neuroblastoma screening at 1 year of age. Updated results of the population based controlled trial in Germany. Cancer Lett. 2003;197:19–28.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Yamamoto K, Hanada R, Kikuchi A, Ichikawa M, Aihara T, Oguma E, et al. Spontaneous regression of localized neuroblastoma detected by mass screening. J Clin Oncol. 1998;16:1265–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Brodeur G, Look A, Shimada H, Hamilton V, Maris J, Hann H, et al. Biological aspects of neuroblastomas identified by mass screening in Quebec. Med Pediatr Oncol. 2001;36:157–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Barrette S, Bernstein ML, Leclerc J-M, Champagne MA, Samson Y, Brossard J, et al. Treatment complications in children diagnosed with neuroblastoma during a screening program. J Clin Oncol. 2006;24:1542–5.

    PubMed  PubMed Central  Google Scholar 

  35. 35.

    Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102:605–13.

    PubMed  PubMed Central  Google Scholar 

  36. 36.

    Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L, et al. Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med. 2016;375:614–7.

    Google Scholar 

  37. 37.

    Tsuda T, Tokinobu A, Yamamoto E, Suzuki E. Thyroid cancer detection by ultrasound among residents ages 18 years and younger in Fukushima, Japan: 2011 to 2014. Epidemiology. 2016;27:316.

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Vaccarella S, Dal Maso L, Laversanne M, Bray F, Plummer M, Franceschi S, et al. The impact of diagnostic changes on the rise in thyroid cancer incidence: a population-based study in selected high-resource countries. Thyroid. 2015;25:1127–36.

    Google Scholar 

  39. 39.

    Davies L, Morris LG, Haymart M, Chen AY, Goldenberg D, Morris J, et al. American Association of Clinical Endocrinologists and American College of Endocrinology disease state clinical review: the increasing incidence of thyroid cancer. Endocr Pract. 2015;21:686–96.

    PubMed  PubMed Central  Google Scholar 

  40. 40.

    Dimaras H, Corson TW, Cobrinik D, White A, Zhao J, Munier FL, et al. Retinoblastoma. Nat Rev Dis Prim. 2015;1:1–23.

    Google Scholar 

  41. 41.

    Committee on Practice Ambulatory Medicine. Eye examination in infants, children, and young adults by pediatricians. Pediatrics. 2003;111:902–7.

    Google Scholar 

  42. 42.

    Skalet AH, Gombos DS, Gallie BL, Kim JW, Shields CL, Marr BP, et al. Screening children at risk for retinoblastoma: consensus report from the American Association of Ophthalmic Oncologists and Pathologists. Ophthalmology. 2018;125:453–8.

    Google Scholar 

  43. 43.

    Antoneli CBG, Steinhorst F, de Cássia Braga Ribeiro K, Novaes PER, Chojniak MM, Arias V, et al. Extraocular retinoblastoma: a 13‐year experience. Cancer. 2003;98:1292–8.

    Google Scholar 

  44. 44.

    Leander C, Fu LC, Pena A, Howard SC, Rodriguez‐Galindo C, Wilimas JA, et al. Impact of an education program on late diagnosis of retinoblastoma in Honduras. Pediatr Blood Cancer. 2007;49:817–9.

    PubMed  PubMed Central  Google Scholar 

  45. 45.

    Antoneli CBG, Steinhorst F, Ribeiro KDCB, Chojniak MM, Novaes PER, Arias V, et al. The pediatrician’s ability to recognize the presenting signs and symptoms of retinoblastoma. Rev da Assocçao Médica Brasileira. 2004;50:400–2.

    Google Scholar 

  46. 46.

    Nathan PC, Ness KK, Mahoney MC, Li Z, Hudson MM, Ford JS, et al. Screening and surveillance for second malignant neoplasms in adult survivors of childhood cancer: a report from the childhood cancer survivor study. Ann Intern Med. 2010;153:442–51.

    PubMed  PubMed Central  Google Scholar 

  47. 47.

    Landier W, Bhatia S, Eshelman DA, Forte KJ, Sweeney T, Hester AL, et al. Development of risk-based guidelines for pediatric cancer survivors: The Children’s Oncology Group long-term follow-up guidelines from the Children’s Oncology Group Late Effects Committee and Nursing Discipline. J Clin Oncol. 2004;22:4979–90.

    PubMed  PubMed Central  Google Scholar 

  48. 48.

    Yan AP, Chen Y, Henderson TO, Oeffinger KC, Hudson MM, Gibson TM, et al. Adherence to surveillance for second malignant neoplasms and cardiac dysfunction in childhood cancer survivors: a childhood cancer survivor study. J Clin Oncol. 2020;38:1711–22.

    PubMed  PubMed Central  Google Scholar 

  49. 49.

    Smith R, Cokkinides V, von Eschenbach A, Levin B, Cohen C, Runowicz C. American Cancer Society Guidelines for the Early Detection of Cancer. CA Cancer J Clin. 2002;52:8–22.

    PubMed  PubMed Central  Google Scholar 

  50. 50.

    Institute of Medicine and National Research Council. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: The National Academies Press; 2006.

  51. 51.

    American College of Surgeons. Important information regarding CoC survivorship care plan standard. 2021.

  52. 52.

    Halton J, Walker E, Greenberg M, Greenberg C. Physician workforce in pediatric oncology: A pediatric oncology group of Ontario (POGO) exercise in establishing the appropriate physician ratio. Pediatr Blood Cancer. 2007;48:626–626.

    Google Scholar 

  53. 53.

    Halton JM, Hand J, Byron P, Strother D, Blanchette V, C17 Council of Canadian Pediatric Hematology Oncology, T. D. et al. Establishing physician to patient ratios and predicting workforce needs for Canadian pediatric hematology‐oncology programs. Pediatr Blood Cancer. 2013;60:564–9.

    Google Scholar 

  54. 54.

    Centre for Surveillance and Applied Research, Public Health Agency of Canada. Cancer in Young People in Canada Data Tool. 2020 Edition. Public Health Infobase. Ottawa (ON): Public Health Agency of Canada, 2020.

  55. 55.

    Dixon SB, Bjornard KL, Alberts NM, Armstrong GT, Brinkman TM, Chemaitilly W, et al. Factors influencing risk‐based care of the childhood cancer survivor in the 21st century. CA Cancer J Clin. 2018;68:133–52.

    Google Scholar 

  56. 56.

    Kratz CP, Achatz MI, Brugieres L, Frebourg T, Garber JE, Greer M-LC, et al. Cancer screening recommendations for individuals with Li-Fraumeni syndrome. Clin Cancer Res. 2017;23:e38–e45.

    CAS  Google Scholar 

  57. 57.

    Ballinger ML, Best A, Mai PL, Khincha PP, Loud JT, Peters JA, et al. Baseline surveillance in Li-Fraumeni syndrome using whole-body magnetic resonance imaging: a meta-analysis. JAMA Oncol. 2017;3:1634–9.

    Google Scholar 

  58. 58.

    Chompret AS, Abel A, Stoppa-Lyonnet D, Brugières L, Pagès S, Feunteun J, et al. Sensitivity and predictive value of criteria for p53 germline mutation screening. J Med Genet. 2001;38:43.

    CAS  PubMed  PubMed Central  Google Scholar 

  59. 59.

    Brodeur GM, Nichols KE, Plon SE, Schiffman JD, Malkin D. Pediatric cancer predisposition and surveillance: an overview, and a tribute to Alfred G. Knudson Jr. Clin Cancer Res. 2017;23:e1–e5.

    PubMed  PubMed Central  Google Scholar 

  60. 60.

    Samuel N, Villani A, Fernandez CV, Malkin D. Management of familial cancer: sequencing, surveillance and society. Nat Rev Clin Oncol. 2014;11:723–31.

    Google Scholar 

  61. 61.

    Green DM. The evolution of treatment for Wilms tumor. J Pediatr Surg. 2013;48:14–9.

    Google Scholar 

  62. 62.

    Barr RD. “Delays” in diagnosis: a misleading concept, yet providing opportunities for advancing clinical care. J Pediatr Hematol Oncol. 2014;36:169–72.

    Google Scholar 

  63. 63.

    Worden JW, Weisman AD. Psychosocial components of lagtime in cancer diagnosis. J Psychosom Res. 1975;19:69–79.

    CAS  Google Scholar 

  64. 64.

    National Patient Safety Agency. Delayed diagnosis of cancer: Thematic review. London: National Reporting and Learning Service, 2010.

  65. 65.

    Hanna TP, King WD, Thibodeau S, Jalink M, Paulin GA, Harvey-Jones E, et al. Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ. 2020;371:m4087.

  66. 66.

    Brasme J-F, Morfouace M, Grill J, Martinot A, Amalberti R, Bons-Letouzey C, et al. Delays in diagnosis of paediatric cancers: a systematic review and comparison with expert testimony in lawsuits. Lancet Oncol. 2012;13:e445–e459.

    Google Scholar 

  67. 67.

    Dang‐Tan T, Franco EL. Diagnosis delays in childhood cancer: a review. Cancer. 2007;110:703–13.

    Google Scholar 

  68. 68.

    Dobson CM, Russell AJ, Rubin GP. Patient delay in cancer diagnosis: what do we really mean and can we be more specific? BMC Health Serv Res. 2014;14:1–6.

    Google Scholar 

  69. 69.

    Purkayastha D, O’Hara C, Moran, T. Routes to diagnosis: investigating the different pathways for cancer referrals in England for teenagers and young adults. London: National Cancer Intelligence Network; 2013.

  70. 70.

    Armstrong L. It’s not about the bike: My journey back to life. Penguin; 2001.

  71. 71.

    Diorio C, Lam CG, Ladas EJ, Njuguna F, Afungchwi GM, Taromina K, et al. Global use of traditional and complementary medicine in childhood cancer: a systematic review. J Glob Oncol. 2017;3:791–800.

    PubMed  PubMed Central  Google Scholar 

  72. 72.

    Fern LA, Birch R, Whelan J, Cooke M, Sutton S, Neal RD, et al. Why can’t we improve the timeliness of cancer diagnosis in children, teenagers, and young adults? BMJ. 2013;347:f6493.

    PubMed  PubMed Central  Google Scholar 

  73. 73.

    Walker DA. Helping GPs to diagnose children’s cancer. Br J Gen Pract. 2021;71:151–2.

    PubMed  PubMed Central  Google Scholar 

  74. 74.

    Leal‐Leal CA, Dilliz‐Nava H, Flores‐Rojo M, Robles‐Castro J. First contact physicians and retinoblastoma in Mexico. Pediatr Blood Cancer. 2011;57:1109–12.

    PubMed  PubMed Central  Google Scholar 

  75. 75.

    Yousef YA, AlNawaiseh T, AlJabari R, Muhsen S, Al-Nawaiseh I. Retinoblastoma awareness among first contact physicians in Jordan. Ophthalmic Genet. 2019;40:191–5.

    PubMed  PubMed Central  Google Scholar 

  76. 76.

    Piramal Foundation. A cancer screening program for rural Telangana. 2021.

  77. 77.

    Nair MK, Varghese C, Mathew B, Sankaranarayanan R. Prevention and early detection of oral, breast and cervical cancers: a practical approach in Indian context. J Indian Med Assoc. 1993;91:94–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  78. 78.

    Noronha V, Tsomo U, Jamshed A, Hai M, Wattegama S, Baral R, et al. A fresh look at oncology facts on south central Asia and SAARC countries. South Asian J Cancer. 2012;1:1.

    PubMed  PubMed Central  Google Scholar 

  79. 79.

    Wright JG, Menaker RJ. Waiting for children’s surgery in Canada: the Canadian Paediatric Surgical Wait Times project. CMAJ. 2011;183:E559–E564.

    PubMed  PubMed Central  Google Scholar 

  80. 80.

    Improving outcomes in children and young people with cancer. London: NICE: 2005.

  81. 81.

    Barraclough KNew. NICE guidance on referral for cancer. BMJ. 2015;351:h3640.

    Google Scholar 

  82. 82.

    Neal R, Din N, Hamilton W, Ukoumunne O, Carter B, Stapley S, et al. Comparison of cancer diagnostic intervals before and after implementation of NICE guidelines: analysis of data from the UK General Practice Research Database. Br J Cancer. 2014;110:584–92.

    CAS  Google Scholar 

  83. 83.

    Shanmugavadivel D, Liu J-F, Murphy L, Wilne S, Walker D. Accelerating diagnosis for childhood brain tumours: an analysis of the HeadSmart UK population data. Arch Dis Child. 2020;105:355–62.

    Google Scholar 

  84. 84.

    Abdelkhalek E, Sherief L, Kamal N, Soliman R. Factors associated with delayed cancer diagnosis in egyptian children. Clin Med Insights Pediatr. 2014;8: S16413.

  85. 85.

    Berhane A, Hailu T, Mulugeta A. Determinants of delayed diagnosis among pediatric cancer patients from Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia. BMC Pediatr. 2019;19:1–8.

    Google Scholar 

  86. 86.

    Venkatasai JP, Srinivasamaharaj S, Sneha LM, Scott JX, Baby AK, Rajan M. Pediatric hematological malignancy: identification of issues involved in the road to diagnosis. South Asian J Cancer. 2017;6:028–30.

    Google Scholar 

  87. 87.

    Verma N, Bhattacharya S. Time to diagnosis and treatment of childhood cancer. Indian J Pediatr. 2020;87:641–3.

  88. 88.

    Handayani K, Sitaresmi M, Supriyadi E, Widjajanto P, Susilawati D, Njuguna F, et al. Delays in diagnosis and treatment of childhood cancer in Indonesia. Pediatr Blood Cancer. 2016;63:2189–96.

    CAS  PubMed  PubMed Central  Google Scholar 

  89. 89.

    Buckle GC, Collins JP, Sumba PO, Nakalema B, Omenah D, Stiffler K, et al. Factors influencing time to diagnosis and initiation of treatment of endemic Burkitt Lymphoma among children in Uganda and western Kenya: a cross-sectional survey. Infect Agents Cancer. 2013;8:1–16.

    Google Scholar 

  90. 90.

    Njuguna F, Martijn H, Langat S, Musimbi J, Muliro H, Skiles J, et al. Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya. Pediatr Hematol Oncol. 2016;33:186–99.

    CAS  Google Scholar 

  91. 91.

    Chukwu B, Ezenwosu O, Ikefuna A, Emodi I. Diagnostic delay in pediatric cancer in Enugu, Nigeria: a prospective study. Pediatr Hematol Oncol. 2015;32:164–71.

    CAS  Google Scholar 

  92. 92.

    Stefan DC, Siemonsma F. Delay and causes of delay in the diagnosis of childhood cancer in Africa. Pediatr Blood Cancer. 2011;56:80–5.

    Google Scholar 

  93. 93.

    Fabian ID, Abdallah E, Abdullahi SU, Abdulqader RA, Boubacar SA, Ademola-Popoola DS, et al. Global retinoblastoma presentation and analysis by national income level. JAMA Oncol. 2020;6:685–95.

    Google Scholar 

  94. 94.

    Kaliki S, Ji X, Zou Y, Rashid R, Sultana S, Taju Sherief S, et al. Lag time between onset of first symptom and treatment of retinoblastoma: an international collaborative study of 692 patients from 10 countries. Cancers. 2021;13:1956.

    PubMed  PubMed Central  Google Scholar 

  95. 95.

    Kivelä T. The epidemiological challenge of the most frequent eye cancer: retinoblastoma, an issue of birth and death. Br J Opthalmol. 2009;93:1129–31.

    Google Scholar 

  96. 96.

    Rodriguez-Galindo C, Friedrich P, Morrissey L, Frazier L. Global challenges in pediatric oncology. Curr Opin Pediatr. 2013;25:3–15.

    Google Scholar 

  97. 97.

    Lam CG, Howard SC, Bouffet E, Pritchard-Jones K. Science and health for all children with cancer. Science. 2019;363:1182–6.

    CAS  Google Scholar 

Download references


We are grateful to Dr. Ligia Fu (Hospital Escuela, Tegucigalpa, Honduras), Dr. Carlos Rodriguez-Galindo (St. Jude Children’s Research Hospital, Memphis TN, United States), Dr. Kathy Pritchard-Jones (International Society of Paediatric Oncology, London, United Kingdom), Kathy Brodeur-Robb and Dr. Leah Young (C17 Children’s Cancer and Blood Disorders, Canada) and Dr. Lorna Fern (University College London, United Kingdom) for valuable suggestions and advice.


CM received an MSc. stipend from the Division of Cancer Epidemiology, McGill University. The other authors received no specific funding for this work.

Author information




All authors contributed to the conceptualisation, writing and editing of the manuscript. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Eduardo L. Franco.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: Due to an error in the legend of figure 1

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mullen, C.J.R., Barr, R.D. & Franco, E.L. Timeliness of diagnosis and treatment: the challenge of childhood cancers. Br J Cancer (2021).

Download citation


Quick links