Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries

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Background: In 2015, the second cycle of the CONCORD programme established global surveillance of cancer survival as a metric of the effectiveness of health systems and to inform global policy on cancer control. CONCORD-3 updates the worldwide surveillance of cancer survival to 2014. Methods: CONCORD-3 includes individual records for 37·5 million patients diagnosed with cancer during the 15-year period 2000–14. Data were provided by 322 population-based cancer registries in 71 countries and territories, 47 of which provided data with 100% population coverage. The study includes 18 cancers or groups of cancers: oesophagus, stomach, colon, rectum, liver, pancreas, lung, breast (women), cervix, ovary, prostate, and melanoma of the skin in adults, and brain tumours, leukaemias, and lymphomas in both adults and children. Standardised quality control procedures were applied; errors were rectified by the registry concerned. We estimated 5-year net survival. Estimates were age-standardised with the International Cancer Survival Standard weights. Findings: For most cancers, 5-year net survival remains among the highest in the world in the USA and Canada, in Australia and New Zealand, and in Finland, Iceland, Norway, and Sweden. For many cancers, Denmark is closing the survival gap with the other Nordic countries. Survival trends are generally increasing, even for some of the more lethal cancers: in some countries, survival has increased by up to 5% for cancers of the liver, pancreas, and lung. For women diagnosed during 2010–14, 5-year survival for breast cancer is now 89·5% in Australia and 90·2% in the USA, but international differences remain very wide, with levels as low as 66·1% in India. For gastrointestinal cancers, the highest levels of 5-year survival are seen in southeast Asia: in South Korea for cancers of the stomach (68·9%), colon (71·8%), and rectum (71·1%); in Japan for oesophageal cancer (36·0%); and in Taiwan for liver cancer (27·9%). By contrast, in the same world region, survival is generally lower than elsewhere for melanoma of the skin (59·9% in South Korea, 52·1% in Taiwan, and 49·6% in China), and for both lymphoid malignancies (52·5%, 50·5%, and 38·3%) and myeloid malignancies (45·9%, 33·4%, and 24·8%). For children diagnosed during 2010–14, 5-year survival for acute lymphoblastic leukaemia ranged from 49·8% in Ecuador to 95·2% in Finland. 5-year survival from brain tumours in children is higher than for adults but the global range is very wide (from 28·9% in Brazil to nearly 80% in Sweden and Denmark). Interpretation: The CONCORD programme enables timely comparisons of the overall effectiveness of health systems in providing care for 18 cancers that collectively represent 75% of all cancers diagnosed worldwide every year. It contributes to the evidence base for global policy on cancer control. Since 2017, the Organisation for Economic Co-operation and Development has used findings from the CONCORD programme as the official benchmark of cancer survival, among their indicators of the quality of health care in 48 countries worldwide. Governments must recognise population-based cancer registries as key policy tools that can be used to evaluate both the impact of cancer prevention strategies and the effectiveness of health systems for all patients diagnosed with cancer. Funding: American Cancer Society; Centers for Disease Control and Prevention; Swiss Re; Swiss Cancer Research foundation; Swiss Cancer League; Institut National du Cancer; La Ligue Contre le Cancer; Rossy Family Foundation; US National Cancer Institute; and the Susan G Komen Foundation.

Original languageEnglish
Pages (from-to)1023-1075
Number of pages53
JournalThe Lancet
Issue number10125
StatePublished - Mar 17 2018

Bibliographical note

Funding Information:
This work was funded by the Centers for Disease Control and Prevention (Atlanta, GA, USA); Swiss Re (London, UK); Swiss Cancer Research foundation (Bern, Switzerland); Swiss Cancer League (Bern, Switzerland); Institut National du Cancer (Paris, France); La Ligue Contre le Cancer (Paris, France); Rossy Family Foundation (Montreal, QC, Canada); National Cancer Institute (Bethesda, MD, USA); American Cancer Society (Atlanta, GA, USA); Susan G Komen Foundation (Dallas, TX, USA). We gratefully acknowledge the cancer registry personnel who have recorded the diagnosis and outcome for every patient with cancer in their jurisdictions over many years: without their efforts, we would know very little about trends in the global cancer burden or the effectiveness of health systems in addressing it. The protocol was translated into Arabic by Mufid El Mistiri (Qatar Cancer Registry, Doha, Qatar) and Eiman Alawadhi (London School of Hygiene & Tropical Medicine [LSHTM], London, UK); into Chinese by Ning Wang, Shuo Liu (Beijing Cancer Registry, Beijing, China), Yannan Yuan (Beijing University Cancer Hospital, Beijing, China), and Chun-Ju Chiang (Taiwan Cancer Registry, Taipei, Taiwan); into French by Audrey Bonaventure and Michel Coleman (LSHTM); into Italian by Veronica Di Carlo, Cristina Renzi, and Claudia Allemani (LSHTM); into Japanese by Tomohiro Matsuda (National Cancer Centre, Tokyo, Japan), Mari Kajiwara, and Kayo Nakata (LSHTM); into Portuguese by Gulnar Azevedo e Silva (University of Rio de Janeiro State, Rio de Janeiro, Brazil); into Russian by Daria Dubovichenko and Mikhail Valkov (Arkhangelsk Cancer Registry, Arkhangelsk, Russia); and into Spanish by Gustavo Hernandez Suarez (National Cancer Institute, Bogotá, Colombia), Natalia Sanz (LSHTM), and Enrique Barrios (Cancer Registry of Uruguay, Montevideo, Uruguay). We are grateful for expert advice and ideas from many colleagues, including Marc Maynadié (Hémopathies Malignes de Côte d'Or, Dijon, France) for advice on the classification of haematological malignancies; Amy Kahn (New York State Cancer Registry, Albany, NY, USA), Ron Dewar (Cancer Care Nova Scotia, Halifax, NS, Canada) and Jennifer Stevens (National Cancer Institute, Bethesda, MD, USA) for the program to convert NAACCR data structures to meet the CONCORD protocol; Angela Mariotto (National Cancer Institute, Bethesda, MD, USA) for US mortality data, Reda Wilson (Centers for Disease Control and Prevention, Atlanta, GA, USA) for assistance with the National Program of Cancer Registries, and Giovanni Luca Lo Magno (Caltanissetta, Italy) for the program to convert Stata output into Microsoft Word files. We also thank Graciela Abriata (Instituto Nacional del Cáncer, Buenos Aires, Argentina); Cristian Herrera (Ministerio de Salud, Santiago, Chile); Daniel Salas Peraza (Ministerio de Salud, San José, Costa Rica); Noorlia Yahaya (Penang State Health Department, George Town, Malaysia); Niek Klazinga and Rie Fujisawa (OECD, Paris, France), and Steve Scoppa (Information Management Services, Calverton, MD, USA). We thank our LSHTM colleagues Natalia Sanz (CONCORD programme manager to March, 2017), Lisa Montel (CONCORD programme manager from April, 2017), Yuki Alencar (Cancer Survival Group coordinator), Adrian Turculeţ for maps and database management, and Hakim Miah for the CONCORD file transmission utility. We gratefully acknowledge endorsement of CONCORD by the following agencies: American Cancer Society (Atlanta, GA, USA); Asociación Española contra el Cáncer (Madrid, Spain); Association of European Cancer Leagues (Brussels, Belgium); Canadian Association of Provincial Cancer Agencies (Toronto, Canada); Canadian Council of Cancer Registries (Toronto, Canada); Childhood Cancer International (Nieuwegein, Netherlands); Children with Cancer UK (London, UK); Danish Cancer Society (Copenhagen, Denmark); European CanCer Organisation (Brussels, Belgium); European Cancer Patient Coalition (Brussels, Belgium); European Institute for Women's Health (Dublin, Ireland); European Society for Medical Oncology (Lugano, Switzerland); Fondation de France (Paris, France); International Agency for Research on Cancer (Lyon, France); International Atomic Energy Agency (Vienna, Austria); International Network for Cancer Treatment and Research (Brussels, Belgium); International SOS (Papua, Indonesia); Israel Centre for Disease Control (Tel-Hashomer, Israel); Jolanta Kwaśniewska's Foundation (Warsaw, Poland); Liga Argentina de Lucha contra el Cancer (Buenos Aires, Argentina); Members of the European Parliament Against Cancer (Brussels, Belgium); National Cancer Institute Center for Global Health (Bethesda MD, USA); National Cancer Research Institute Consumer Liaison Group (Leeds, UK); National Institute for Cancer Epidemiology and Registration (Zürich, Switzerland); NCD Asia Pacific Alliance (Tokyo, Japan); North American Association of Central Cancer Registries (Springfield, IL, USA); OECD (Paris, France); Société Internationale d'Oncologie Pédiatrique (Geneva, Switzerland); Union for International Cancer Control (Geneva, Switzerland); WHO Regional Office for Europe (Copenhagen, Denmark); and World Bank (Washington, DC, USA). The interpretation of the findings in this report, and the opinions, conclusions, and recommendations are those of the authors and do not necessarily reflect the views or official position of the British Columbia Cancer Agency or Cancer Care Ontario (Canada); the Centers for Disease Control and Prevention, the National Cancer Institute, Maryland Cancer Registry, New Hampshire Department of Health and Human Services, New York City Department of Health and Mental Hygiene, Ohio Department of Health, Pennsylvania Department of Health, West Virginia Cancer Registry, or the Susan G Komen Foundation (USA); the Health Directorate of the Australian Capital Territory, or the Institut National du Cancer (France). We are very grateful to Giulia Vivaldi for expert assistance with preparation of this Article.

Publisher Copyright:
© 2018 Elsevier Ltd

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  • Medicine (all)


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