Global surveillance of cancer survival 1995-2009: Analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2)

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Background Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. Methods Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75 000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. Findings 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. Interpretation International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems. Funding Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA).

Original languageEnglish
Pages (from-to)977-1010
Number of pages34
JournalThe Lancet
Issue number9972
StatePublished - Mar 14 2015

Bibliographical note

Funding Information:
This work was funded by the Canadian Partnership Against Cancer, Cancer Focus Northern Ireland, Cancer Institute New South Wales, Cancer Research UK (C1336/A16148), US Centers for Disease Control and Prevention (CDC; 12FED03123, ACO12036), Swiss Re, Swiss Cancer Research foundation, Swiss Cancer League, and the University of Kentucky (3049024672-12-568). We thank cancer registry personnel who have recorded diagnoses and outcomes for every cancer patient in their jurisdiction. We thank colleagues who translated the protocol into different languages: Gustavo Hernandez Suarez (Colombian National Cancer Institute); Marion Piñeros (International Atomic Energy Agency, Austria); Natalia Sanz (LSHTM); Yannan Yuan (Beijing University Cancer Hospital); Ning Wang (Beijing Cancer Registry); Xiao-Si Wang (LSHTM); Ruoran Li (LSHTM); Gulnar Azevedo e Silva (University of Rio de Janeiro); Renata Abrahão (LSHTM); Helena Carreira (LSHTM); and Manuela Quaresma (LSHTM). We thank colleagues at LSHTM who gave help and advice: Natalia Sanz (CONCORD programme manager), Camille Maringe, Andy Sloggett, Sarah Walters, Laura Woods, Manuela Quaresma, Hakim Miah, Yuki Alencar, and Tanisha Lewis. We also thank: Chris Johnson (Cancer Data Registry of Idaho), Amy Kahn (New York State Cancer Registry), Ron Dewar (Cancer Care Nova Scotia), and Jennifer Stevens (US National Cancer Institute) for the program to convert NAACCR data structures to meet the CONCORD protocol; Angela Mariotto (US National Cancer Institute) for US mortality data; and Giovanni Luca Lo Magno (Caltanissetta, Italy) for the program to convert Stata output into Word files. Finally, we thank Gabriela Abriata (Instituto Nacional del Cáncer, Argentina); Magnus Lindelow (World Bank, Brazil); Heather Bryant (Canadian Partnership Against Cancer); Brendan Hanley (Yukon Government); Carlotta Buzzoni (Registro Tumori della Regione Toscana and AIRTum, Italy); Andrea Micheli (Italian National Cancer Institute); Roberto Zanetti (International Association of Cancer Registries); Santa Pildava (Latvian Cancer Registry); Vladimir Stevanovic (New Zealand Ministry of Health); Jose Maria Martin-Moreno (University of Valencia); Diego Salmerón (Murcia Cancer Registry); Alojz Peterle (European Parliament); Louise Abela (LSHTM); Liam Crosby (LSHTM); Daniel Ryan (Swiss Re); and Marcus Plescia (CDC). CONCORD has been endorsed by the following agencies: Asociación Española contra el Cáncer (Madrid, Spain); Association of European Cancer Leagues (Brussels, Belgium); British Embassy in Algiers (Algeria); Canadian Association of Provincial Cancer Agencies (Toronto, Canada); Canadian Council of Cancer Registries (Toronto, Canada); Danish Cancer Society (Copenhagen, Denmark); European CanCer Organisation (Brussels, Belgium); European Institute for Women's Health (Dublin, Ireland); Institut National du Cancer (Paris, France); IARC (Lyon, France); International Atomic Energy Agency (Vienna, Austria); International Network for Cancer Treatment and Research (Brussels, Belgium); Israel Centre for Disease Control (Tel-Hashomer, Israel); Jolanta Kwaśniewska's Foundation (Warsaw, Poland); Members of the European Parliament Against Cancer (Brussels, Belgium); Center for Global Health (National Cancer Institute, USA); Consumer Liaison Group (National Institute for Health Research, UK); National Institute for Cancer Epidemiology and Registration (Zurich, Switzerland); NAACCR (Chicago, USA); Organisation for Economic Co-operation and Development (Paris, France); Union for International Cancer Control (Geneva, Switzerland); WHO Regional Office for Europe (Copenhagen, Denmark); and the World Bank (Washington, DC, USA). The findings, interpretation, and conclusions in this report are those of the authors and do not necessarily represent the opinions or official position of the funding sources or of the British Columbia Cancer Agency, Cancer Care Ontario, Maryland Cancer Registry, New Hampshire Department of Health and Human Services, New York City Department of Health and Mental Hygiene, Pennsylvania Department of Health, Ohio Department of Health, West Virginia Cancer Registry, the CDC, or the Health Directorate of the Australian Capital Territory.

Publisher Copyright:
© 2015 Allemani et al. Open Access article distributed under the terms of CC BY.

ASJC Scopus subject areas

  • Medicine (all)


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