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Evidence for a delay in diagnosis of Wilms’ tumour in the UK compared with Germany: implications for primary care for children
  1. Kathy Pritchard-Jones1,
  2. Norbert Graf2,
  3. Harm van Tinteren3,
  4. Alan Craft4
    1. 1University College London Institute of Child Health, London, UK
    2. 2Department of Paediatric Oncology/Hematology, Saarland University Hospital Homburg, Homburg, Germany
    3. 3Head Biometrics Department, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
    4. 4Department of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK
    1. Correspondence to Professor Kathy Pritchard-Jones, University College London Institute of Child Health, 30 Guilford Street, London, UK; k.pritchard-jones{at}


    The UK has a longstanding system of general practice which provides the vast majority of primary care, including that for children. It acts as a 'gatekeeper' to more specialist care. Parents may also use accident and emergency departments as their first point of medical contact for their children. Outcomes in the UK for many conditions in children appear to be worse than in comparable European countries where there is direct access to care by paediatricians. We have therefore looked at pathways to diagnosis and compared outcomes in the childhood kidney cancer, Wilms' tumour, which has been treated in the UK and Germany within the same clinical trial for over a decade. We find that Wilms' tumours are significantly larger in volume and have a more advanced tumour stage at diagnosis in the UK compared to Germany. There is a small (∼3%) difference in event free and overall survival between the two countries. Our data suggest that the system of primary care for children in the UK is less likely to result in the incidental finding of an abdominal mass in a child with no or vague symptoms. This may be a reason for the poorer outcome.

    • Routes to diagnosis
    • Outcomes research
    • Oncology

    This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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