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)
Open accessAbstract
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).
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Forty countries had complete national population coverage in CONCORD-2.
“In 40 countries, the data had 100% national population coverage.”
The CONCORD programme began worldwide monitoring of cancer survival in 2015.
“In 2015, the CONCORD programme established global surveillance of cancer survival for the first time,6”
CONCORD-2 used central quality control and analysed individual records for 25,676,887 patients with one of 10 common cancers, which made up 63% of the 2009 global cancer burden.
“CONCORD-2 incorporated centralised quality control and analysis of individual data for 25,676,887 patients diagnosed with one of 10 common cancers that represented 63% of the global cancer burden in 2009.”
CONCORD-2 reported survival trends for 1995-2009 in 67 countries whose combined population was two-thirds (4.8 billion) of the world total.
“with publication of trends in survival over the 15-year period 1995–2009 among patients diagnosed with cancer in 67 countries that were home to two-thirds (4.8 billion) of the world’s population.”
CONCORD-2's 279 registries together covered 896 million people.
“The 279 population-based registries covered a combined total population of 896 million people.”
Net survival up to five years after diagnosis was estimated for both adults and children to ensure comparability of survival trends from 1995.
“To ensure comparability of survival trends from 1995,6 we estimated net survival up to five years after diagnosis for both adults and children.”
Record variables were checked for logical consistency against 20 criteria sets covering eligibility, definite errors and possible errors.
“The variables in each record were checked for logical coherence against 20 sets of criteria, including eligibility (e.g. age, tumour behaviour), definite errors (e.g. sex-site errors, invalid dates, impossible date sequence, missing vital status) and possible errors, including a wide range of inconsistencies between age, tumour site and morphology.6,28”
In some settings, especially South America, improved data quality is reflected in lower survival estimates than previously published, with fewer death-certificate-only registrations and more complete follow-up.
“In some cases, especially in South America, the improvement in data quality is reflected in survival estimates that are actually lower than those previously published,6 with fewer death-certificate-only registrations and more complete follow-up.”
In Canada, national coverage of cancer survival statistics was first achieved in CONCORD-2 with data from all 13 provinces and territories for 1995-2009, but several jurisdictions could not participate in CONCORD-3 because of legal or administrative difficulties linking their cancer registry with death records.
“In Canada, for example, national coverage of cancer survival statistics was achieved for the first time in CONCORD-2,6 with data from all 13 provinces and territories for 1995–2009, but several jurisdictions were unable to participate in CONCORD-3 because of legal or administrative difficulties in linking their cancer registry with death records.”
As in CONCORD-2, the authors could not use the proportion of in situ cancers to compare diagnostic activity for solid tumours.
“As in CONCORD-2,6 we were unable to use the proportion of in situ cancers to compare the intensity of diagnostic activity for solid tumours.”
Up to 2009, adult leukaemia survival in Asian populations was much lower than in Europe, North America and Oceania.
“Survival from the adult leukaemias up to 2009 in Asian populations was much lower than in Europe, North America and Oceania.6”
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Self-citation
- Authors
- Allemani, C., Weir, H. K., Carreira, H., Harewood, R., Spika, D., Wang, X.-S., Bannon, F., Ahn, J. V., Johnson, C. J., Bonaventure, A., Marcos-Gragera, R., Stiller, C., Azevedo e Silva, G., Chen, W.-Q., Ogunbiyi, O. J., Rachet, B., Soeberg, M. J., You, H., Matsuda, T., Bielska-Lasota, M., Storm, H., Tucker, T. C., & Coleman, M. P.
- Affiliations
- Cancer Research UK (GB)
- Centers for Disease Control and Prevention (US)
- Queen's University Belfast (GB)
- Public Health England (GB)
- University College Hospital, Ibadan (NG)
- Cancer Institute of New South Wales (AU)
- National Cancer Centre Japan (JP)
- Danish Cancer Society (DK)
- University of Kentucky (US)
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 385
- Issue
- 9972
- Pages
- 977-1010
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC4588097
- OpenAlex
- W2112657305
- Cited by
- 2,614
- References
- 113
- Citations by year
- 2026: 58 · 2025: 116 · 2024: 141 · 2023: 171 · 2022: 212 · 2021: 270 · 2020: 245 · 2019: 218 · 2018: 282 · 2017: 415 · 2016: 283 · 2015: 194 · 2014: 3 · 2013: 1
- FWCI
- 144.12
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- The Lancet (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Tampere University Institutional Repository (Tampere University) (publishedVersion, cc-by)
- Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Universitat de Girona Digital Repository (Universitat de Girona) (acceptedVersion, cc-by)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- Unicam Scientific Publications (University of Camerino) (submittedVersion, other-oa)
- HAL (submittedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- IRIS (submittedVersion)
- IRIS UniPA (University of Palermo) (submittedVersion, other-oa)
- Lund University Publications (Lund University) (submittedVersion)
- UTS ePRESS (University of Technology Sydney) (submittedVersion, cc-by)
- Research Portal (Queen's University Belfast) (submittedVersion, cc-by)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (submittedVersion, other-oa)
- SERVAL (Université de Lausanne) (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion, cc-by)
- Tampere University Institutional Repository (Tampere University) (submittedVersion, cc-by)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Funders
- U.S. Department of Health and Human Services
- World Bank Group
- New York City Department of Health and Mental Hygiene
- Pennsylvania Department of Health
- University of Kentucky (3049024672-12-568)
- Cancer Care Ontario
- London School of Hygiene and Tropical Medicine
- Ohio Department of Health
- ACT Government
- Cancer Research UK (C1336/ A16148, 16148, A16148, C1336, 18525)
- National Institute for Health and Care Research
- Cancer Institute NSW
- Universitat de València
- International Atomic Energy Agency
- Institut National Du Cancer
- Swiss Re
- Regione Toscana
- Swiss Cancer Research Foundation
- Partenariat Canadien Contre Le Cancer
- National Institutes of Health (CC999999)
- Centers for Disease Control and Prevention (12FED03123, ACO12036)
- BC Cancer Agency
- National Cancer Institute (P30CA177558)
- Topics
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
- Keywords
- cancer survival, net survival, population-based cancer registry, colon cancer, rectal cancer, breast cancer, prostate cancer, lung cancer, liver cancer, cervical cancer, ovarian cancer, pediatric leukemia, childhood cancer, survival trends, health system effectiveness, cancer control policy, cross-national comparison, registry data quality
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Neoplasms, Registries, Global Health, Survival Analysis, Age Distribution, Sex Distribution, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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