BACKGROUND: Survival rates for most major adult cancers are higher in the United States compared with the survival rates in Europe. The objective of this study was to determine whether transatlantic differences in survival also are present in childhood cancers. METHODS: The authors analyzed 16,148 European patients and 3476 patients in the United States who were diagnosed with malignant disease at age < 15 years during 1985-1989. The patients were obtained from 34 EUROCARE cancer registries in 17 countries and from 9 SEER registries in the United States. The authors considered the major 14 diagnostic categories of the International Classification of Childhood Cancers. To increase the power of comparisons, they also considered all childhood cancers together. Observed survival was calculated by actuarial methods. RESULTS: For all cancers combined, northern Europe had the highest 5-year survival rate at 75% (95% confidence interval [95%CI], 72-78%), and Eastern Europe had the lowest survival rate at 55% (95%CI, 52-58%). The survival rate in the United States was roughly comparable to the survival rates in Italy and other Western European countries at 70%. Northern Europe also had highest survival rate for patients with lymphoid leukemias (83%; 95%CI, 78-88%); whereas Germany, Italy, and the other Western European countries had survival rates similar to the average survival rate for patients in the United States (77%; 95%CI, 74-80%). The survival rate was 7-9% lower in Europe compared with the survival rate in United States for patients with neuroblastoma and Wilms tumors and 8% higher for patients with retinoblastoma (all significant). Small, nonsignificant differences were found for patients with osteosarcoma, ependymoma, and medulloblastoma (with a higher survival rate in the United States) and for patients with acute nonlymphocytic leukemia (with a higher survival rate in Europe). Very similar survival rates among the two populations were found for the other cancers. CONCLUSIONS: Unlike the survival of adults with cancer, the survival of children with cancer in Europe (except Eastern Europe) is very similar to that in the United States. Childhood cancers are generally more responsive to therapy than adult cancers, but these results also may reflect wide accessibility of these treatments for most patients. These results are relevant to the interpretation of differences in adult cancer survival.