Global Retinoblastoma Study Group IMPORTANCE Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.OBJECTIVES To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. DESIGN, SETTING, AND PARTICIPANTSA total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. MAIN OUTCOMES AND MEASURESAge at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. RESULTSThe cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI,, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI,). CONCLUSIONS AND RELEVANCEThis study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

Bangladesh is known as a predominantly male-dominated society with traditional and religious beliefs that restrict women's mobility and participation in economic and social activities. This article is based on national rural representative household-level data collected in 1987 and 2000 from 62 villages in Bangladesh jointly conducted by the International Rice Research Institute and Bangladesh Institute of Development Studies. First, this article depicts patterns of women's work and analyzes the factors that infl uence the gender division of labor. Second, a women empowerment index is developed from the 2000 survey data on intra-household decision-making in different spheres, and its relationship with women's work is then explored. The persistent gender division of labor in rural Bangladesh has been found to be associated with both economic and socio-cultural factors. Rural economic activities within the household were found to have a weak impact on women's empowerment.The major policy implications emerging from the study are (1) enabling and improving the quality of women's education is necessary to increase their participation in marketing activities, for which the gender disparity in earnings is less; and (2) developing desirable social and institutional infrastructures that enable women's mobility outside the home to participate in economic and social activities, and reduce the burden of their domestic work.

Pakistan is categorised as a lower-middle-income country, with population estimated at 197 million in 2017 by the World Bank. 1 Although Pakistan is a populous country, there is a dearth of oncologists or dedicated facilities that deal specifically with cancer diagnosis or management. 2 This is compounded by the fact that cancer registration has never been taken seriously in the country in more than 70 years of existence, and enough efforts have not been made to establish populationbased cancer registries in the region. Except for the population-based data from the Karachi Cancer Registry (KCR), 3 which was published by the International Agency for Research on Cancer (IARC) in 2007, the data reported from few other centres is institutional and does not represent the population of the region. Even the KCR data represented merely 1.7 million population of the Karachi South district, accounting for nearly 1% of the population of the country. The government's total expenditure on health is 2.6% of the GDP, and healthcare delivery is quite complex, with a large part of the population being served through a mixed health system via multiple health providers. 4 The Punjab Cancer Registry was established in 2005 and the reporting of cancer cases was initiated under a mutual agreement between various centres. 5 During the early phase of the Registry, enough information could not be collected. Later, reports on its 3-year data (2010-2012) were published. 6,7 The current study is a comprehensive, retrospective study over an extended six-year period (2010)(2011)(2012)(2013)(2014)(2015) reporting the cancer incidence rates within the population of Lahore.

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Background: The relationship between lag time and outcomes in retinoblastoma (RB) is unclear. In this study, we aimed to study the effect of lag time between onset of symptoms and diagnosis of retinoblastoma (RB) in countries based on their national-income and analyse its effect on the outcomes. Methods: We performed a prospective study of 692 patients from 11 RB centres in 10 countries from 1 January 2019 to 31 December 2019. Results: The following factors were significantly different among different countries based on national-income level: age at diagnosis of RB (p = 0.001), distance from home to nearest primary healthcare centre (p = 0.03) and mean lag time between detection of first symptom to visit to RB treatment centre (p = 0.0007). After adjusting for country income, increased lag time between onset of symptoms and diagnosis of RB was associated with higher chances of an advanced tumour at presentation (p < 0.001), higher chances of high-risk histopathology features (p = 0.003), regional lymph node metastasis (p < 0.001), systemic metastasis (p < 0.001) and death (p < 0.001). Conclusions: There is a significant difference in the lag time between onset of signs and symptoms and referral to an RB treatment centre among countries based on national income resulting in significant differences in the presenting features and clinical outcomes.