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

Abstract

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.

Conflict of interest statement

Conflicts of interest

We declare no conflicts of interest.

Copyright © 2018 Elsevier Ltd. All rights reserved.

Figures

Figure 1. Participating countries and regions: world (adults)

Registries in smaller countries are shown in boxes, at different scales. See web-figures 1.1–1.29 for regional maps, and web-figure 1.30 for world map for childhood cancers.

Figure 2. Global distribution of age-standardised five-year net survival (%) for adults (15–99 years) diagnosed during 2010–2014 with colon cancer or breast cancer (women) and children (0–14 years) diagnosed with acute lymphoblastic leukaemia: continent and country

Survival estimates for each country are ranked from highest to lowest within each continent. Where data were available for more than one registry in a given country, the survival estimates are derived by pooling the data for that country, but excluding data from registries for which the estimates are considered less reliable (see text). See web-figures 2.1–2.18 for all 18 cancers included in CONCORD-3, and for each calendar period 2000–2004, 2005–2009, 2010–2014. *Data with 100% coverage of the national population. †National estimate not age-standardised. §National estimate flagged as less reliable because the only available estimates are from a registry or registries in this category (see text).

Figure 3. 20-year trends in age-standardised five-year net survival (%) for women (15–99 years) with breast cancer,* by calendar period of diagnosis (1995–1999, 2000–2004, 2005–2009 and 2010–2014), continent (or continental region) and country

Estimates for women diagnosed during 1995–1999 are taken from the analyses for CONCORD-2. Where data were available for more than one registry in a given country, the survival estimates are derived by pooling the data for that country, excluding data from registries for which the survival estimates are considered less reliable (see text). *See web-figures 3.1–3.18 for other cancers. §Continent or continental region with one or more national estimates flagged as less reliable. Standard ISO abbreviations for country names: Algeria - DZA; Argentina - ARG; Australia - AUS; Austria - AUT; Belgium - BEL; Brazil - BRA; Bulgaria - BGR; Canada - CAN; Chile - CHL; China - CHN; Colombia - COL; Costa Rica - CRI; Croatia - HRV; Cuba - CUB; Cyprus - CYP; Czech Republic - CZE; Denmark - DNK; Ecuador - ECU; Estonia - EST; Finland - FIN; France - FRA; Germany - DEU; Gibraltar - GIB; Guadeloupe - GLP; Hong Kong SAR - HKG; Iceland - ISL; India - IND; Ireland - IRL; Israel - ISR; Italy - ITA; Japan - JPN; Jordan - JOR; Kuwait - KWT; Latvia - LVA; Lithuania - LTU; Malaysia - MYS; Malta - MLT; Martinique - MTQ; Mauritius - MUS; Mongolia - MNG; Morocco - MAR; Netherlands - NLD; New Zealand - NZL; Nigeria - NGA; Norway - NOR; Peru - PER; Poland - POL; Portugal - PRT; Puerto Rico - PRI; Qatar - QAT; Republic of Korea - KOR; Romania - ROU; Russian Federation - RUS; Singapore - SGP; Slovakia - SVK; Slovenia - SVN; South Africa - ZAF; Spain - ESP; Sweden - SWE; Switzerland - CHE; Taiwan - TWN; Thailand - THA; Turkey - TUR; United Kingdom of Great Britain and Northern Ireland - GBR; United States of America - USA

Figure 4. Global range of breast cancer* survival among 296 cancer registry populations in 64 countries: age-standardised five-year net survival (%) estimates for 6,420,288 women diagnosed during 2000–2014, by continent and calendar period of diagnosis

*See web-figure 4 for other cancers. Each box-plot shows the range of survival estimates among all cancer registries for which suitable estimates could be obtained for patients diagnosed in each calendar period, in each continent. The number of registries included in each box-plot is shown in parentheses. Survival estimates considered less reliable are not included (see text). The vertical line inside each box represents the median survival estimate among all contributing registries (the central value in the range, or 50th centile). The box covers the inter-quartile range (IQR) between the lower and upper quartiles (25th and 75th centiles). Where there are only a few widely scattered estimates, the median may be close to the lower or upper quartile. The extreme limits of the box-plot are 1.5*IQR below the lower quartile and 1.5*IQR above the upper quartile. Open circles indicate „outlier‟ values, outside this range.

Text-figure 1. Recruitment of cancer registries

*Of the 400 operational registries invited; all other percentages refer to the number of registries at the top of each column. The number of countries excluded (black boxes) refers to those for which exclusions affected the only participating cancer registry or registries.