6533b832fe1ef96bd129a2ee

RESEARCH PRODUCT

Wilms tumours diagnosed by routine physical examinations.

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Sir: The prognosis of stage I and -II Wilms tumours with favourable histology is good, reaching 97% (stage I) and 92% (stage II) 5 year disease-free survival rates [1]. With these figures in mind the question arises whether the overall prognosis of Wilms tumours could be improved by presymptomatic routine physical examinations in an attempt to avoid stage III to V primary diagnoses. In the Federal Republic of Germany six routine physical examinations (RPE) are offered to infants, and two additional ones to children between 12 and 48 months. The 1980-1987 German Wilms tumour study [1] listed 313 patients, 29 of whom (9%) were diagnosed by such routine examinations. As shown in Table 1, the RPE detection rate was higher in infancy than in childhood (33% vs 7.6%). Unfortunately, 7 of the 29 children (24.4%) detected through RPE had already stage I I I V tumours compared to 95/285 (33.3%) of conventionally diagnosed cases. This suggests that systematic early physical screening only slightly improves the overall prognosis of Wilms tumours in infancy and childhood.