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)

Abstract

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).

Copyright © 2015 Allemani et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd. All rights reserved.

Figures

Figure 1. Participating countries and regions (adults)

National registries in smaller countries are shown in boxes at different scales. 28 regional maps and a world map for childhood acute lymphoblastic leukaemia are in the appendix (pp 112–40).

Figure 2. Global distribution of age-standardised 5-year net survival for women diagnosed with breast cancer during 1995–99, 2000–04, and 2005–09, by continent and country

Age-standardised 5-year net survival estimates for other cancers are presented in the appendix (pp 141–51). Survival estimates for every country are ranked from highest to lowest within every continent; for ease of reference, the ranking for 2005–09 is used for 1995–99 and 2000–04. Error bars represent 95% CIs. Grey bars represent African countries; red bars represent America (Central and South); light green bars represent America (North); purple bars represent Asian countries; blue bars represent European countries; and dark green bars represent Oceania. *100% coverage of the national population. †National estimate not age-standardised. §National estimate flagged as less reliable because the only estimate or estimates available are from a registry or registries in this category.

Figure 3. Trends in age-standardised 5-year net survival for women diagnosed with breast cancer during 1995–99, 2000–04, and 2005–09, by continent or region and country

Trends in age-standardised 5-year net survival for other cancers are presented in the appendix (pp 152–62). Countries have been grouped into 12 geographical regions. ARG=Argentina. AUS=Australia. AUT=Austria. BEL=Belgium. BGR=Bulgaria. BRA=Brazil. CAN=Canada. CHE=Switzerland. CHL=Chile. CHN=China. COL=Colombia. CUB=Cuba. CYP=Cyprus. CZE=Czech Republic. DEU=Germany. DNK=Denmark. DZA=Algeria. ECU=Ecuador. ESP=Spain. EST=Estonia. FIN=Finland. FRA=France. GBR=United Kingdom. GIB=Gibraltar. GMB=The Gambia. HRV=Croatia. IDN=Indonesia. IND=India. IRL=Ireland. ISL=Iceland. ISR=Israel. ITA=Italy. JOR=Jordan. JPN=Japan. KOR=South Korea. LBY=Libya. LTU=Lithuania. LVA=Latvia. MLI=Mali. MLT=Malta. MNG=Mongolia. MUS=Mauritius. MYS=Malaysia. NLD=Netherlands. NOR=Norway. NZL=New Zealand. POL=Poland. PRI=Puerto Rico. PRT=Portugal. QAT=Qatar. ROU=Romania. RUS=Russia. SAU=Saudi Arabia. SVK=Slovakia. SVN=Slovenia. SWE=Sweden. TWN=Taiwan. THA=Thailand. TUN=Tunisia. TUR=Turkey. USA=United States of America. ZAF=South Africa. §Continent or region with one or more national estimates flagged as less reliable.

Figure 4. Global range of age-standardised 5-year net survival estimates for women diagnosed with breast cancer in 228 cancer registries

Each box-plot shows the range of survival estimates among all those cancer registries for which suitable estimates could be obtained for patients diagnosed in a given 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. The vertical line inside each box denotes the median survival value, and the box shows the IQR between the lower and upper quartiles. The extreme limits of the box-plot are 1·5 times the IQR below the lower quartile and above the upper quartile. Open circles indicate outlier values, outside this range. Data for other cancers are presented in the appendix (pp 163–73).