Introduction - This Battle Which I Must Fight: Cancer in Canada's Children and Teenagers

Introduction

Children and teenagers represent approximately one-quarter of the Canadian population. Canadian children are much less likely to contract infectious diseases, suffer from malnutrition, or die in their first year of life than children in developing countries. With universal access to quality health care and programs to encourage healthy lifestyles, the majority of Canadian children and teenagers lead safe, healthy lives. Nevertheless, they still face serious challenges. Low birth weight is a determining factor in about two-thirds of all deaths among newborns. After infancy and below the age of 20 years, the two major causes of death in young Canadians are accidents and cancer.

The aim in writing this book was not to produce a textbook on cancer in the young, but rather to present the most current information on this disease in Canada.* This book is an overview of the concepts central to the treatment and emotional impact of cancer in early life. Because the ultimate goal of curing a child with cancer includes not only saving a life, but also facilitating a quality existence, this book devotes considerable attention to the psychosocial aspects of cancer in the young.

In this book, the terms children and childhood refer to the entire age range from birth to 19 years, thereby including older teenagers, many of whom have special needs and are not treated in pediatric institutions. The numbers cited pertain to all of the types of cancers seen in young people, including those that are rare. However, the rare cancers are not discussed in as much detail as the more common cancers. The reader is directed to the recommended readings for information on the rare cancers.

Except where indicated, all data (numbers) are Canadian and cover the years 1985 to 1992. Considerable technical work is involved in the collection, classification, analysis and presentation of information on cancer in Canada's children and teenagers. A separate document to accompany this book contains descriptions of these aspects.

The numbers here may not match numbers used in prior publications on childhood cancer because of the extensive case-finding and data verification undertaken for this book. The incidence data were obtained directly from provincial and territorial cancer registries. Funding from Health Canada and assistance from pediatric oncologists across Canada greatly aided the collection of this information. Despite this, certain inaccuracies may be present. One role of the Canadian Childhood Cancer Surveillance and Control Program will be to correct any misinformation and to produce accurate incidence and mortality reports. Since this program has only just been implemented, the data herein are the best available.

Selected references are provided, as well as an appendix containing tabulations of the frequencies of the various types of cancer in the young and incidence, mortality and survival rates. Other appendices contain the addresses of organizations that help individuals and families cope with cancer in a young person, as well as a list of printed and audiovisual materials relating to cancer in children and teenagers. Some readers may encounter a considerable amount of unfamiliar and detailed terminology. They are directed to the glossary at the back of the book for definitions of terms.

Progress made in treating cancer in the young is one of the undisputed success stories in modern medicine. As recently as 40 years ago, few children survived cancer; today, approximately three-quarters are considered cured. It is hoped that this book will strengthen the perception that there is much room for optimism. This book is also about courage. The words and drawings of young cancer patients communicate much about cancer beyond its science and numbers.

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