Incidence trends of vestibular schwannomas in Denmark, Finland, Norway and Sweden in 1987-2007.

BACKGROUND: The reported incidence rates of vestibular schwannomas (VS) vary substantially, but it is unclear as to what extent the variation reflects differences in risk or recording practices. Our aim was to describe the incidence rates of VS in Denmark, Finland, Norway and Sweden between 1987 and 2007. METHODS: Comprehensive data were available from all registries only for the period from 1987 to 2007. An analysis of a longer time period (1965-2007) was conducted with the Norwegian and Swedish data. RESULTS: The average age-standardised incidence rates during 1987-2007 varied from 6.1 per 1,000,000 person-years (95% confidence interval (CI), 5.4-6.7) among Finnish men to 11.6 (95% CI, 10.4-12.7) in Danish men, and from 6.4 per 1,000,000 person-years (95% CI, 5.7-7.0) among Swedish women to 11.6 (95% CI, 10.5-12.8) among Danish women. An overall annual increase of 3.0% (95% CI 2.1-3.9) was observed when all countries and both sexes were combined, with considerable differences between countries. However, the practices of both reporting and coding VS cases varied markedly between countries and over time, which poses a challenge for interpretation of the results. CONCLUSION: The overall incidence of VS increased in all the four Nordic countries combined between 1987 and 2007, with marked differences between countries. However, the incidence rates more or less stabilised in the late 1990s, showing relatively constant incidence rates and even some decline after 2000.

Chronic lymphocytic leukaemia patients have a high risk of Merkel-cell polyomavirus DNA-positive Merkel-cell carcinoma.

BACKGROUND: Immunosuppression and Merkel-cell polyomavirus (MCPyV) infection may have a role in the pathogenesis of Merkel-cell carcinoma (MCC), a rare neuroendocrine carcinoma of the skin. METHODS: We studied incidence of chronic lymphocytic leukaemia (CLL) and MCC from the files of the Finnish Cancer Registry and the largest hospital of Finland, Helsinki University Central Hospital, from 1979 to 2006. Presence of MCPyV DNA in MCCs was investigated by quantitative PCR. RESULTS: We identified 4164 patients diagnosed with CLL and 172 diagnosed with MCC. Six patients diagnosed with both diseases were found; CLL was the first diagnosis in four cases and MCC in two. The standardised incidence ratio (SIR) for CLL after the diagnosis of MCC was highly elevated, 17.9 (95% confidence interval (CI), 2.2-64.6; P<0.001), and the SIR for MCC after the diagnosis of CLL was also elevated, 15.7 (3.2-46.0, P<0.01). Merkel-cell polyomavirus DNA was present in all five MCCs with tumour tissue available for analysis. CONCLUSIONS: We conclude that patients diagnosed with CLL have a substantially increased risk for MCC, and vice versa. Merkel-cell polyomavirus DNA is frequently present in MCCs that occur in CLL patients. Immunosuppression related with CLL and viral infection might explain the association between CLL and MCC.

Is the incidence of meningiomas underestimated? A regional survey.

We assessed the undercount of meningiomas in a population-based cancer registry. A comprehensive material was formed by compiling hospital sources with the Finnish Cancer Registry database. The completeness of each source ranged 62-69%. The corrected age-standardised meningioma incidence was 2.9/100,000 for men and 13.0/100,000 for women, a third higher than the cancer registry figures.

Geographical comparison of cancer survival in European children (1988-1997): report from the Automated Childhood Cancer Information System project.

The aim of this study was to assess regional survival differences among childhood cancer patients in Europe. For this exercise, the Automated Childhood Cancer Information System (ACCIS) database was utilised. Survival data from 54 population-based cancer registries on 49,651 childhood cancer patients aged 0-14 years and diagnosed in 1988-1997 were analysed using life-table method. Overall, the 5-year survival was 72% among all patients, varying from 62% to 77% between the five geographical regions. The East region generally had lower survival rates than the rest of Europe. The geographical differences indicate the need for more co-ordination, systematisation and standardisation in diagnosis, referral and the treatment of childhood cancers in Europe. Increase of resources is necessary to improve the lower survival in the East region. Continuing data collection on a European level will facilitate monitoring of population-based survival of childhood cancer patients.

Cancer in patients with ataxia-telangiectasia and in their relatives in the nordic countries.

BACKGROUND: Epidemiologic studies of the families of patients with ataxia-telangiectasia (A-T), a recessive genetic neurologic disorder caused by mutation of the ATM gene, suggest that heterozygous carriers of an ATM mutation are at increased risk of cancer. A population-based study of cancer incidence in A-T families with unbiased selection and tracing of relatives would confirm this hypothesis. METHODS: We conducted a study in the Nordic countries of 1218 blood relatives of 56 A-T patients from 50 families. The relatives were identified from population registries, and the occurrence of cancer was determined from cancer registry files in each country and compared with national incidence rates. All statistical tests were two-sided. RESULTS: Among the 56 patients with A-T, we observed six cases of cancer (four leukemias and two non-Hodgkin's lymphomas) compared with 0.16 expected, yielding a standardized incidence ratio (SIR) of 37 (95% confidence interval [CI] = 13 to 80). Among the 1218 relatives, 150 cancers were recorded, with 126 expected (SIR = 1.19; 95% CI = 1.01 to 1.40). Invasive breast cancer occurred in 21 female relatives of A-T patients (SIR = 1.54; 95% CI = 0.95 to 2.36), including five of the 50 mothers (all of whom are obligate ATM mutation carriers) (SIR = 7.1; 95% CI = 2.3 to 17). Relatives who were less likely to be carriers of a mutant ATM allele had no increase or only a modest, statistically nonsignificant increase in the risk of breast cancer. There was no evidence of increased risk for cancer at any other site. CONCLUSIONS: We confirmed the previously recognized high risk of lymphoma and leukemia in A-T patients. Our data are also consistent with an increased risk of breast cancer among blood relatives of A-T patients. The epidemiologic findings suggest, however, that, even if ATM mutations are responsible for some breast cancer cases, ATM is a relatively weak genetic risk factor for the disease.

Decreasing late mortality among five-year survivors of cancer in childhood and adolescence: a population-based study in the Nordic countries.

PURPOSE: To assess the risk of death in patients who survive more than 5 years after diagnosis of childhood cancer and to evaluate causes of death in fatal cases. PATIENTS AND METHODS: This was a population-based study in the five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) using data of the nationwide cancer registries and the cause-of-death registries. The study cohort included 13,711 patients who were diagnosed with cancer before the age of 20 years between 1960 and 1989 and who survived at least 5 years from diagnosis. By December 31, 1995, 1,422 patients had died, and death certificates were assessed in 1,402. Standardized mortality ratios (SMRs) for validated causes of death were calculated based on 156,046 patient-years at risk. RESULTS: The overall SMR was 10.8 (95% confidence interval [CI], 10.3 to 11.5), mainly due to high excess mortality from the primary cancer. SMR for second cancer was 4.9 (95% CI, 3.9 to 5.9) and was 3.1 (95% CI, 2.8 to 3.5) for noncancer death. The pattern of causes of death varied markedly between different groups of primary cancer diagnoses and was highly dependent on time passed since diagnosis. Overall late mortality was significantly lower in patients treated during the most recent period of time, 1980 to 1989, compared with those treated from 1960 to 1979 (hazard ratio, 0.61; 95% CI, 0.54 to 0.70), and there was no increase in rates of death due to cancer treatment. CONCLUSION: Long-term survivors of childhood cancer had an increased mortality rate, mainly dying from primary cancers. However, modern treatments have reduced late cancer mortality without increasing the rate of therapy-related deaths.

Risk of subsequent malignant neoplasms among 1,641 Hodgkin's disease patients diagnosed in childhood and adolescence: a population-based cohort study in the five Nordic countries. Association of the Nordic Cancer Registries and the Nordic Society of Pediatric Hematology and Oncology.

PURPOSE: To assess the risk of subsequent malignant neoplasms among Hodgkin's disease patients diagnosed before 20 years of age in the five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden). PATIENTS AND METHODS: There were 1,641 Hodgkin's disease patients identified through the national cancer registries since the 1940s or 1950s. The patients were monitored for 17,000 person-years until the end of 1991. Expected figures were derived from the age-specific incidence rates in each country and standardized incidence ratios (SIR) were calculated. RESULTS: A total of 62 subsequent neoplasms were diagnosed (SIR, 7.7; 95% confidence interval [CI], 5.9 to 9.9). The overall cumulative risk of subsequent neoplasms was 1.9% at the 10-year follow-up point, 6.9% at 20 years, and 18% at 30 years. There were 26 subsequent neoplasms among males (SIR, 6.5; 95% CI, 4.3 to 9.6) and 36 among females (SIR, 8.9; 95% CI, 6.2 to 12), of which 16 were breast cancers (SIR, 17; 95% CI, 9.9 to 28). High risks were seen for thyroid cancer (SIR, 33; 95% CI, 15 to 62), for secondary leukemia (SIR, 17; 95% CI, 6.9 to 35), and for non-Hodgkin's lymphoma (SIR, 15; 95% CI, 4.9 to 35). The relative risk increased from 3.3 (95% CI, 1.2 to 7.1) for Hodgkin's disease patients diagnosed in the 1940s and 1950s to 15 (95% CI, 7.4 to 27) in the 1980s. The highest risk of secondary leukemia (SIR, 68; 95% CI, 18 to 174) was seen among those diagnosed with Hodgkin's disease in the 1980s. CONCLUSION: Patients who survive Hodgkin's disease at a young age are at very high relative risk of subsequent malignant neoplasms throughout their lives. In particular, the high relative risk of breast cancer following Hodgkin's disease in the teenage years calls for enhanced activity for early diagnosis.

A genetic epidemiological study of hereditary prostate cancer (HPC) in Finland: frequent HPCX linkage in families with late-onset disease.

Several predisposition loci for hereditary prostate cancer (HPC) have been suggested, including HPC1 at 1q24-q25 (OMIM #601518) and HPCX at Xq27-q28 (OMIM #300147). Genetically homogeneous populations, such as that of Finland, and distinct subsets of families may help to minimize the genetic heterogeneity that complicates the genetic dissection of complex traits. Here, the role of the HPC1, and HPCX loci in a series of Finnish prostate cancer families was studied, especially in subgroups of families defined by age, number of affected cases, and the mode of disease transmission. DNA samples were collected from 57 Finnish HPC families with at least two living prostate cancer patients. Linkage analysis was carried out with 39 microsatellite markers for the HPC1 region and 22 markers for the HPCX region. The maximum two-point LOD score for the HPCX was 2.05 (marker DXS1205, at theta = 0.14), whereas HPC1 LOD scores were all negative. In HOMOG3R analyses, significant evidence of heterogeneity was observed. Subgroup analyses performed to explore the nature of this heterogeneity indicated that families with no male-to-male (NMM) transmission and a late age of diagnosis (>65 years) accounted for most of the HPCX-linked cases. The maximum HPCX LOD score in this subgroup was 3.12 (theta = 0.001). Nonparametric sibling pair analyses gave a peak LOD score of 3.04 (P < 0.000093) for the NMM transmission subgroup. No subgroup showed any positivity for HPC1. This study suggests that the HPCX-linked prostate cancer families represent a distinct subgroup characterized by NMM transmission of disease and late age of diagnosis.

Characterization of ATM mutations in 41 Nordic families with ataxia telangiectasia.

The Ataxia Telangiectasia Mutation (ATM) gene is mutated in the rare recessive syndrome Ataxia Telangiectasia (AT), which is characterized by cerebellar degeneration, immunodeficiency, and cancer predisposition. In this study, 41 AT families from Denmark, Finland, Norway, and Sweden were screened for ATM mutations. The protein truncation test (PTT), fragment length and heteroduplex analyses of large (0.8-1.2 kb) cDNA fragments were used. In total, 67 of 82 (82%) of the disease-causing alleles were characterized. Thirty-seven unique mutations were detected of which 25 have not previously been reported. The mutations had five different consequences for the ATM transcript: mutations affecting splicing (43%); frameshift mutations (32%); nonsense mutations (16%); small in-frame deletions (5%); and one double substitution (3%). In 28 of the probands mutations were found in both alleles, in 11 of the probands only one mutated allele was detected, and no mutations were detected in two Finnish probands. One-third of the probands (13) were homozygous, whereas the majority of the probands (26) were compound heterozygote with at least one identified allele. Ten alleles were found more than once; one Norwegian founder mutation constituted 57% of the Norwegian alleles. Several sequence variants were identified, none of them likely to be disease-causing. Some of them even involved partial skipping of exons, leading to subsequent truncation of the ATM protein.

Population-based analysis of sporadic and type 2 neurofibromatosis-associated meningiomas and schwannomas.

OBJECTIVE: To estimate the incidence of meningiomatosis and schwannomatosis, and their familial occurrences and relation to type 2 neurofibromatosis (NF2) in a well-defined population. METHODS: Patients with histologically verified intracranial, spinal, or peripheral schwannomas or meningiomas, who were residents of the Helsinki University Hospital catchment area (population, 1,713,000) from January 1, 1985, to December 31, 1995, were included in the study. The Population Register Center was used to identify relatives of all the patients, and their data were linked further to the Finnish Cancer Registry to find NF2-related tumors. Detailed pedigrees were constructed for the patients with NF2, schwannomatosis, meningiomatosis, patients with relatives with histologically verified schwannomas or meningiomas, and patients younger than 25 years of age at the time of diagnosis. RESULTS: Approximately 3% (12 of 455) of the schwannoma patients had multiple schwannomas in association with NF2, and 2% (11 of 455) had schwannomatosis without NF2. Two of the patients with schwannomatosis (2 of 11) had familial schwannomatosis. Approximately 1% (7 of 823) of the patients with meningioma had multiple meningiomas in association with NF2, and 4% (29 of 823) had meningiomatosis without NF2. No families with meningiomatosis were found among the 823 patients with meningioma studied. The birth occurrence of NF2 was 1 in 87,410. CONCLUSIONS: The current diagnostic criteria of type 2 neurofibromatosis (NF2) seem valid because NF2 patients were differentiated rather easily from patients with sporadic schwannomatosis and meningiomatosis. Familial meningiomatosis, if it truly exists, is very rare, and familial schwannomatosis is uncommon.

Survival trends for neuroblastoma patients in Finland: negative reflections on screening.

Based on 257 neuroblastoma patients in the age group 0-14 years and reported to the Finnish Cancer Registry, the 5-year cumulative survival rates have improved from 15% in the 1950s to 57% in 1980-1986. The potential benefit of screening for neuroblastoma was assessed on the basis of these nationwide survival trends. It is likely that any decrease in the overall neuroblastoma mortality due to screening would be small, because the survival rates of the Finnish neuroblastoma patients are already, even without screening, similar to those in Japan, which has a nationwide public health policy to screen for neuroblastoma.

Breast cancer incidence and mortality trends in 16 European countries.

Trends in the incidence of and mortality from breast cancer result from a variety of influences including screening programmes, such as those introduced in several European countries in the late 1980s. Incidence and mortality rates for 16 European countries are analysed. Incidence increased in all countries. The estimated annual percent change (EAPC) varied from 0.8 to 2.8% in prescreening years in 6 'screened' countries and from 1.2 to 3.0% in 10 'non-screened' countries. Screening related temporary increases were visible. Earlier mortality trends were maintained in the most recent decade in Estonia (EAPC +1.8%) and Sweden (-1.2%). In other countries, previously increasing trends changed. Trends flattened in Finland, Denmark, France, Italy and Norway (EAPC 0.0 to -0.3%), while they declined in England and Wales (-3.1%), Scotland (-2.0%), and The Netherlands (-1.0%), all of which have national screening programmes, and in Slovakia (-1.1%), Spain (-0.7%), and Switzerland (-1.1%). In some countries with screening programmes, declines in mortality started before screening was introduced, and declines also occurred in non-screened age groups and in some countries without national screening programmes. This suggests that the major determinants of the observed trends vary among the countries and may include earlier detection through screening in countries where this has been introduced, but also improvements in therapy, in countries with or without screening.

Estimates of cancer incidence and mortality in Europe in 1995.

Cancer incidence and mortality estimates for 1995 are presented for the 38 countries in the four United Nations-defined areas of Europe, using World Health Organization mortality data and published estimates of incidence from national cancer registries. Additional estimation was required where national incidence data was not available, and the method involved incorporating the high quality incidence and mortality data available from the expanding number of population-based cancer registries in Europe. There were an estimated 2.6 million new cases of cancer in Europe in 1995, representing over one-quarter of the world burden of cancer. The corresponding number of deaths from cancer was approximately 1.6 million. After adjusting for differing population age structures, overall incidence rates in men were highest in the Western European countries (420.9 per 100,000), with only Austria having a rate under 400. Eastern European men had the second highest rates of cancer (414.2), with extremely high rates being observed in Hungary (566.6) and in the Czech Republic (480.5). The lowest male all-cancer rate by area was observed in the Northern European countries, with fairly low rates seen in Sweden (356.6) and the UK (377.8). In contrast to men, the highest rates in women were observed in Northern Europe (315.9) and were particularly high in Denmark (396.2) and the other Nordic countries excepting Finland. The rates of cancer in Eastern European women were lower than in the other three areas, although as with men, female rates were very high in Hungary (357.2) and in the Czech Republic (333.6). There was greater disparity in the mortality rates within Europe--generally, rates were highest in Eastern European countries, notably in Hungary, reflecting a combination of poorer cancer survival rates and a higher incidence of the more lethal neoplasms, notably cancer of the lung. Lung cancer, with an estimated 377,000 cases, was the most common cancer in Europe in 1995. Rates were particularly high in much of Eastern Europe reflecting current and past tobacco smoking habits of many of its inhabitants. Together with cancers of colon and rectum (334,000), and female breast (321,000), the three cancers represented approximately 40% of new cases in Europe. In men, the most common primary sites were lung (22% of all cancer cases), colon and rectum (12%) and prostate (11%), and in females, breast (26%), colon and rectum (14%) and stomach (7%). The number of deaths is determined by survival, as well as incidence; by far the most common cause of death was lung cancer (330,000)--about one-fifth of the total number of cancer deaths in Europe in 1995. Deaths from cancers of the colon and rectum (189,000) ranked second, followed by deaths from stomach cancer (152,000), which due to poorer survival ranked higher than breast cancer (124,000). Lung cancer was the most common cause of death from cancer in men (29%). Breast cancer was the leading cause of death in females (17%). Cancer registries are a unique source of information on cancer incidence and survival, and are used here with national mortality to demonstrate the very substantial burden of cancer in Europe, and the scope for prevention. Despite some provisos about data quality, the general patterns which emerge in Europe verify the role of past exposures and interventions, and more importantly, firmly establish the need for cancer control measures which target specific populations. In particular, there is a clear urgency to combat the ongoing tobacco epidemic, now prevalent in much of Europe, particularly in the Eastern countries.

Endothelial and epithelial expression of sialyl Lewis(x) in squamous carcinoma of the tongue.

In this retrospective study we describe the immunohistochemical expression pattern of sLe(x) epitopes in endothelial and epithelial cells of 59 squamous carcinomas of the tongue, and relate this to the relative survival rates of the patients. Endothelial sLe(x) expression was significantly elevated in malignant lesions compared to normal tissues, but did not have any prognostic value for the relative survival rate. In contrast, epithelial sLe(x) expression was decreased in carcinomas compared to normal tongue. The patients whose carcinoma showed only moderate epithelial HECA-452 reactivity had a significantly better relative survival rate than the patients with tumor specimens with neglible or very high HECA-452 reactivity. The epithelial staining with the two other anti-sLe(x) antibodies (CSLEX-1 and 2F3) did not correlate with the survival rates of tongue carcinoma patients.

Factors affecting operative and excess long-term mortality in 935 patients with intracranial meningioma.

Between 1953 and 1980, a total of 935 patients underwent surgery for intracranial meningioma in the Department of Neurosurgery of the Helsinki University Hospital. The patients were followed up until death or the end of the year 1987. The cumulative observed survival rate was 91% at 3 months, 89% at 1 year, and 63% at 15 years. The relative survival rate, that is, the ratio of the the observed and the expected rates, was 91% at 3 months, 89% at 1 year, and 78% at 15 years. Significant risk factors for operative mortality (7%) for the 652 patients operated on from 1966 to 1980 were poor preoperative clinical condition, absence of epilepsy, old age, incomplete tumor removal, pulmonary embolism, and an intracranial hematoma requiring evacuation. For those 828 patients who survived the first postoperative year, the factors predicting an excess risk of death for up to 15 years were incomplete tumor removal, poor pre- and postoperative clinical condition, anaplasia of the tumor, and hyperostosis. Patients whose tumors were not completely removed had a 4.2-fold relative excess risk of death as compared with patients whose tumors were completely removed, and patients who had malignant tumors had a 4.6-fold risk as compared with those who had benign tumors.

Long-term outcome after removal of spinal schwannoma: a clinicopathological study of 187 cases.

Are spinal schwannomas as benign as we think? To what extent do patients recover? Are patients prone to develop late complications such as cystic myelopathy or symptomatic spinal deformity? Is their life expectancy compromised? In an effort to answer these questions, the authors analyzed the long-term outcome for 187 patients from one neurosurgical department with surgically treated spinal schwannoma. Median follow-up period was 12.9 years (2454 patient years). One-fifth of the patients considered themselves free of symptoms at follow-up examination. The most common late complaint was local pain (46%), followed by radiating pain (43%), paraparesis (31%), radicular deficit (28%), sensory deficit due to a spinal cord lesion (27%), and difficulty voiding (19%). Late complications occurred in 21% of the patient population, including cystic myelopathy (2%), spinal arachnoiditis (6%), spinal deformity (6%), and troublesome pain (7%). Life expectancy of the patients corresponded to that of the general population.

Long-term outcome after removal of spinal neurofibroma.

Spinal neurofibromas are uncommon, comprising approximately 3% of all spinal tumors. They occur both sporadically and in association with neurofibromatosis 1 (NF1; von Recklinghausen's disease). This study presents the clinical characteristics of 32 patients who underwent surgery for symptomatic spinal neurofibromas. Twenty-two of these patients showed clinical signs of NF1. The patients were typically younger (median age 31 years) than those with spinal schwannomas. The tumors were located mainly in the cervical region and tended to grow both extra- and intradurally. Patients with NF1 were prone to develop new spinal neurofibromas. A life-table analysis showed a reduced survival rate for these patients compared to that of the general population.

Long-term survival in idiopathic membranous glomerulonephritis: can the course be clinically predicted?

72 adult patients with idiopathic membranous glomerulonephritis (iMGN), 92% having proteinuria 3 g/24 h or more, were studied for the clinical evolution of the disease and factors which might be involved in the development of chronic renal insufficiency (CRI). At 10 years, 46% were in complete or partial remission, 4% had the nephrotic syndrome (NS), 26% had some degree of CRI, and 24% were dead or started on dialysis. The actuarial patient and kidney survival rates were 80% and 64%, respectively at 10 years. Patient survival rate was not affected by gender, age (after adjustment for age- and sex-matched population) or the severity of NS at diagnosis. 20 patients showed CRI and apart from the more frequent (p < 0.05) presence of CRI at diagnosis, no clinical features discriminated them from those having intact renal function. Furthermore, no clinical factors at diagnosis predicted the final renal function among the 72 patients. However, it appeared that the evolution of clinical status of iMGN was rapid CRI appearing 1.4 (median, range from 0 to 15.1) years after the diagnosis. At one and two years, renal function correlated significantly (r = 0.54, p < 0.0001 at two years) with the final renal function. What is more, the type of the evolution of proteinuria over the first two years gave valuable information on the eventual deterioration of renal function. Patients having stable non-nephrotic grade proteinuria and those in whom NS disappeared, had excellent renal outcome while those in particular showing an increased severity of NS had poor prognosis in terms of renal survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Cancer risk among health care personnel in Finland, 1971-1980.

Standardized incidence ratios were calculated for the assessment of cancer risk among Finnish health care personnel in 1971-1980. The overall relative cancer risk among the men was low when compared with that of all economically active men, mainly due to the low relative risk of lung cancer. The cancer risk of female health care personnel was increased when compared with that of all economically active women. The relative risk of breast cancer among registered nurses was high, being twice that of practical nurses, who had an average risk. In contrast, the risk of lymphomas, leukemia, and primary liver carcinoma was low among registered nurses and high among practical nurses. Although specific occupational exposures could not be assessed, the results did not imply any alarming major hazards related to health care work itself.

Evaluation of various treatments for carcinoma of the mandibular region.

Cancers of the mandibular region show the lowest survival rates of all oral cancers. In order to compare the effect of five different modes of treatment (including surgery and/or radiotherapy), a series of 159 patients was analysed. When adjustments were made for age, sex and tumour stage in a log-linear multivariate analysis, no differences between treatments in the 5-year relative survival rates (RSR) could be demonstrated for stage I and II tumours. In stage III and IV tumours, radiation treatment alone resulted in poor survival. Between the other four treatments, all including surgery, no statistically significant differences in the 5-year relative survival rates were found. Radiation therapy as an element in combination therapy may have postponed a recurrence but did not affect the 5-year survival rate. For advanced tumours, mostly responsible for the low overall 5-year RSR, higher survival rates can possibly be achieved by improving surgical treatment of the primary lesion and the neck. At present, however, only earlier diagnosis might significantly increase the survival rates.