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Journal ArticleDOI

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)

TL;DR: The aim was 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.
About: This article is published in The Lancet.The article was published on 2015-03-14 and is currently open access. It has received 1866 citations till now. The article focuses on the topics: Cancer registry & Cancer.

Summary (4 min read)

Introduction

  • The global burden of cancer is growing, particularly in countries of low and middle income.
  • The need to implement eff ective strategies of primary prevention is urgent.
  • The International Cancer Benchmarking Partnership published survival estimates for four common cancers for patients diagnosed during 1995–2007 in six highincome countries.
  • The authors aim is to analyse progress toward the overarching goal in the Union for International Cancer Control’s World Cancer Declaration 2013: “there will be major reductions in premature deaths from cancer and improvements in quality of life and cancer survival”.

Cancer registries

  • The authors identifi ed population-based cancer registries that were operational in 2009 and had either published reports on survival or were known to follow up registered cancer patients to establish their vital status.
  • Many registries had met quality criteria for inclusion in either the quinquennial compendium Cancer Incidence in Five Continents,15,16 published by the International Association of Cancer Registries (IACR) and the International Agency for Research on Cancer (IARC), or similar compendia; other registries were established more recently.
  • The authors invited all these registries to contribute data for patients diagnosed during all or part of the 15-year period 1995–2009, including data on their vital status at least 5 years after diagnosis, or at Dec 31, 2009, or a later year.
  • Of 395 registries invited, 306 (77%) agreed to participate: of these, 24 (8%) did not submit data, either because of resource constraints (n=4), legal constraints (1) or reversal of the original decision (3), or because they could not provide complete follow-up data (6) or did not respond to further communication (10).
  • They comprised cancers of the stomach, colon, rectum, liver, lung, breast , cervix, ovary, and prostate in adults (age 15–99 years), and leukaemia in adults, and precursor-cell acute lymphoblastic leukaemia in children (age 0–14 years).

Ethics approval

  • The authors obtained approval for CONCORD-2 from the Ethics and Confi dentiality Committee of the UK’s statutory National Information Governance Board (now the Health Research Authority; ECC 3-04(i)/2011) and the National Health Service (NHS) research ethics service (southeast; 11/LO/0331).
  • The authors obtained separate statutory or ethics approval (or both) in more than 40 other jurisdictions to secure the release of data.
  • The authors gave every registry a set of unique numeric codes for the name of every fi le; these codes have no meaning outside the CONCORD-2 study.
  • The authors developed a fi le transmission utility deploying 256-bit advanced encryption security, with random, strong, one-time passwords that were generated automatically at the point of data transmission but sent separately, thus eliminating the need for email or telephone exchanges to confi rm passwords.
  • The authors also provided free access to a similar commercial utility (HyperSend; Covisint, Detroit, MI, USA) that complies with US federal law on the secure transmission of sensitive health data.

Protocol

  • The authors fi nalised the protocol (in which they defi ned the data structure, fi le transmission procedures, and statistical analyses) after a 2-day meeting in Cork, Ireland, in September, 2012, with 90 members of the CONCORD Working Group from 48 countries (the protocol was revised by October, 2012).
  • Vol 385 March 14, 2015 979 translated the protocol into Chinese , Portuguese, and Spanish, and other native speakers did back-translation to check the translation against the English original.
  • The authors defi ned countries, states, and world regions by their UN names and codes (as of 2007).
  • In consultation with specialists in the cancer registrybased project on haematologic malignancies group,20 the authors selected subtypes of adult leukaemia from nine morphology groups,21 excluding myelodysplastic and myeloproliferative neoplasms such as chronic myeloid leukaemia .
  • The authors included patients who were diagnosed with two or more primary cancers at diff erent index sites during 1995–2009 in the analyses for each cancer—eg, colon cancer in 2000, breast cancer in 2005.

Quality control

  • The quality and completeness of cancer registration data can aff ect both incidence and survival estimates and, thus, the reliability of international comparisons.
  • The authors developed a suite of quality control programs,27 extending the checks used in the fi rst CONCORD study,6 cross-checked with those used in the EUROCARE study,28 IARC/IACR tools for cancer registries,29 and WHO’s classifi cation of tumours.
  • The authors applied these checks systematically in three phases and sent registries a detailed report on how to revise and resubmit their data, if needed, after every phase.
  • When the authors identifi ed errors in classifi cation, coding, or pathological assignment, they asked registries to correct and resubmit their data.
  • The proportion of tumour records with morphological verifi cation or non-specifi c morphology; distributions of the day and month of birth, diagnosis, and last known vital status; and proportions of patients who died within 30 days, were reported as lost to follow-up, or were censored within 5 years of diagnosis, also known as Finally, the authors analysed.

Follow-up for vital status

  • Cancer registries use various methods to ascertain the vital status (alive, dead, emigrated, lost to follow-up) of registered cancer patients.
  • In countries with limited administrative infrastructure, so-called active follow-up can be used to establish vital status via direct contact with the patient, the family, or a local authority (eg, a village headman), or by home visit.
  • Cancer registrations are updated with the vital status and the date of last known vital status.
  • These methods are typically summarised as passive follow-up.
  • It also means that 5-year survival estimates for more recently diagnosed patients cannot be obtained, even with the period approach.

Statistical analysis

  • Most registries submitted data for patients diagnosed from 1995 to 2009, with follow-up to 2009 or later; some registries only began operation after 1995 or provided data for less than 15 years.
  • The authors were able to estimate 5-year survival using the cohort approach for patients diagnosed in 1995–99 and 2000–04, because in most datasets, all patients had been followed up for at least 5 years.
  • Net survival can be interpreted as the proportion of cancer patients who survive up to that time, after eliminating other causes of www.thelancet.com.
  • For 172 registries, the authors obtained raw data from either the registry, the relevant national statistical authority, or the Human Mortality Database.37.
  • The authors then created life tables for every calendar year from 1997 to 2009 by linear interpolation between the 1996 and 2010 life tables.

Europe

  • For patients diagnosed with colon cancer during 2005–09, age-standardised 5-year net survival was 50–59% in many countries, although it did surpass 60% in North America, Oceania, 12 European countries, and a few countries in Central and South America and Asia .
  • Survival was very high (70% or more) in Cyprus, Iceland, and Qatar, and high (60–69%) in South Korea, North America, Oceania, and nine European countries .
  • For women diagnosed during 2005–09, age-standardised 5-year net survival from breast cancer was 80% or higher in 34 countries around the world (table 4, fi gures 2 to 4).

America (Central and South)

  • For adults diagnosed with leukaemia during 2005–09, age-standardised 5-year net survival was 50–60% in 21 countries in North America, west Asia, Europe, and Oceania .
  • 5-year survival in Argentina, Ecuador, and Slovakia was in the range 60–79%, with little or no change over time.

Discussion

  • With CONCORD-2, the authors have initiated worldwide surveillance of trends in cancer survival.
  • Vol 385 March 14, 2015 1001 global range in 5-year survival from ten cancers in adults and acute lymphoblastic leukaemia in children is very wide.
  • In North America and Oceania, population coverage was higher than 80% and the same registries generally provided data for the entire period 1995–2009 : survival for most cancers was high on a global scale, with a fairly narrow range in estimates between registries.
  • To maintain the breadth of global surveillance of survival, the authors retained some datasets that seemed less suitable for international comparison than all other estimates, but they fl agged these survival estimates to inform interpretation.
  • Other registries, not all of them in low-income countries, were prevented from participating by scant resources either to follow up registered patients for vital status or to prepare data for submission.

Contributors

  • All authors contributed to writing the fi nal report and approved the version to be published.
  • All members of the CONCORD Working Group had access to the results at all steps of data preparation, quality control, and analyses, and contributed to interpretation of the fi ndings.

CONCORD Working Group

  • S Eser, CI Yakut (Izmir Cancer Registry), also known as Turkey.
  • Oceania—Australia: E Chalker, L Newman (Australian Capital Territory Cancer Registry); D Baker, MJ Soeberg (NSW Central Cancer Registry); C Scott (Queensland Cancer Registry); BC Stokes, A Venn (Tasmanian Cancer Registry); H Farrugia, GG Giles (Victorian Cancer Registry); T Threlfall (Western Australian Cancer Registry); D Currow*, H You (Cancer Institute NSW); New Zealand: C Lewis, SA Miles (New Zealand Cancer Registry).

Acknowledgments

  • 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).
  • The authors 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.

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Journal ArticleDOI
TL;DR: Many of the estimated cancer cases and deaths can be prevented through reducing the prevalence of risk factors, while increasing the effectiveness of clinical care delivery, particularly for those living in rural areas and in disadvantaged populations.
Abstract: With increasing incidence and mortality, cancer is the leading cause of death in China and is a major public health problem. Because of China's massive population (1.37 billion), previous national incidence and mortality estimates have been limited to small samples of the population using data from the 1990s or based on a specific year. With high-quality data from an additional number of population-based registries now available through the National Central Cancer Registry of China, the authors analyzed data from 72 local, population-based cancer registries (2009-2011), representing 6.5% of the population, to estimate the number of new cases and cancer deaths for 2015. Data from 22 registries were used for trend analyses (2000-2011). The results indicated that an estimated 4292,000 new cancer cases and 2814,000 cancer deaths would occur in China in 2015, with lung cancer being the most common incident cancer and the leading cause of cancer death. Stomach, esophageal, and liver cancers were also commonly diagnosed and were identified as leading causes of cancer death. Residents of rural areas had significantly higher age-standardized (Segi population) incidence and mortality rates for all cancers combined than urban residents (213.6 per 100,000 vs 191.5 per 100,000 for incidence; 149.0 per 100,000 vs 109.5 per 100,000 for mortality, respectively). For all cancers combined, the incidence rates were stable during 2000 through 2011 for males (+0.2% per year; P = .1), whereas they increased significantly (+2.2% per year; P < .05) among females. In contrast, the mortality rates since 2006 have decreased significantly for both males (-1.4% per year; P < .05) and females (-1.1% per year; P < .05). Many of the estimated cancer cases and deaths can be prevented through reducing the prevalence of risk factors, while increasing the effectiveness of clinical care delivery, particularly for those living in rural areas and in disadvantaged populations.

13,073 citations

Journal ArticleDOI
TL;DR: In this paper, the authors assess the burden of 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus, and evaluate cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods.
Abstract: Importance The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required. Objective To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus. Evidence Review Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition. Findings In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, −1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territories, and the average annual age-standardized death rates decreased within that timeframe in 143 of 195 countries or territories. Conclusions and Relevance Large disparities exist between countries in cancer incidence, deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments for noncommunicable disease and cancer control.

4,621 citations

Journal ArticleDOI
TL;DR: 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, while for many cancers, Denmark is closing the survival gap with the other Nordic countries.

2,756 citations

Journal ArticleDOI
Christina Fitzmaurice1, Christina Fitzmaurice2, Daniel Dicker1, Daniel Dicker2, Amanda W Pain2, Hannah Hamavid2, Maziar Moradi-Lakeh2, Michael F. MacIntyre2, Michael F. MacIntyre3, Christine Allen2, Gillian M. Hansen2, Rachel Woodbrook2, Charles D.A. Wolfe2, Randah R. Hamadeh4, Ami R. Moore5, A. Werdecker6, Bradford D. Gessner, Braden Te Ao, Brian J. McMahon7, Chante Karimkhani8, Chuanhua Yu9, Graham S Cooke10, David C. Schwebel11, David O. Carpenter12, David M. Pereira13, Denis Nash, Dhruv S. Kazi14, Diego De Leo15, Dietrich Plass16, Kingsley N. Ukwaja17, George D. Thurston, Kim Yun Jin18, Edgar P. Simard19, Edward J Mills20, Eun-Kee Park21, Ferrán Catalá-López22, Gabrielle deVeber, Carolyn C. Gotay23, Gulfaraz Khan24, H. Dean Hosgood25, Itamar S. Santos26, Janet L Leasher27, Jasvinder A. Singh28, James Leigh12, Jost B. Jonas29, Juan R. Sanabria30, Justin Beardsley31, Justin Beardsley32, Kathryn H. Jacobsen33, Ken Takahashi34, Richard C. Franklin, Luca Ronfani35, Marcella Montico36, Luigi Naldi36, Marcello Tonelli, Johanna M. Geleijnse37, Max Petzold38, Mark G. Shrime39, Mark G. Shrime40, Mustafa Z. Younis41, Naohiro Yonemoto42, Nicholas J K Breitborde, Paul S. F. Yip43, Farshad Pourmalek44, Paulo A. Lotufo24, Alireza Esteghamati27, Graeme J. Hankey45, Raghib Ali46, Raimundas Lunevicius33, Reza Malekzadeh47, Robert P. Dellavalle45, Robert G. Weintraub48, Robert G. Weintraub49, Robyn M. Lucas50, Robyn M. Lucas51, Roderick J Hay52, David Rojas-Rueda, Ronny Westerman, Sadaf G. Sepanlou53, Sandra Nolte, Scott B. Patten54, Scott Weichenthal37, Semaw Ferede Abera55, Seyed-Mohammad Fereshtehnejad56, Ivy Shiue57, Tim Driscoll58, Tim Driscoll59, Tommi J. Vasankari29, Ubai Alsharif, Vafa Rahimi-Movaghar54, Vasiliy Victorovich Vlassov45, W. S. Marcenes60, Wubegzier Mekonnen61, Yohannes Adama Melaku62, Yuichiro Yano56, Al Artaman63, Ismael Campos, Jennifer H MacLachlan41, Ulrich O Mueller, Daniel Kim53, Matias Trillini64, Babak Eshrati65, Hywel C Williams66, Kenji Shibuya67, Rakhi Dandona68, Kinnari S. Murthy69, Benjamin C Cowie69, Azmeraw T. Amare, Carl Abelardo T. Antonio70, Carlos A Castañeda-Orjuela71, Coen H. Van Gool, Francesco Saverio Violante, In-Hwan Oh72, Kedede Deribe73, Kjetil Søreide74, Kjetil Søreide62, Luke D. Knibbs75, Luke D. Knibbs76, Maia Kereselidze77, Mark Green78, Rosario Cardenas79, Nobhojit Roy80, Taavi Tillmann57, Yongmei Li81, Hans Krueger82, Lorenzo Monasta24, Subhojit Dey36, Sara Sheikhbahaei, Nima Hafezi-Nejad45, G Anil Kumar45, Chandrashekhar T Sreeramareddy69, Lalit Dandona83, Haidong Wang2, Haidong Wang69, Stein Emil Vollset2, Ali Mokdad84, Ali Mokdad75, Joshua A. Salomon2, Rafael Lozano41, Theo Vos2, Mohammad H. Forouzanfar2, Alan D. Lopez2, Christopher J L Murray51, Mohsen Naghavi2 
University of Washington1, Institute for Health Metrics and Evaluation2, Iran University of Medical Sciences3, King's College London4, Arabian Gulf University5, University of North Texas6, Auckland University of Technology7, Alaska Native Tribal Health Consortium8, Columbia University9, Wuhan University10, Imperial College London11, University of Alabama at Birmingham12, University at Albany, SUNY13, City University of New York14, University of California, San Francisco15, Griffith University16, Environment Agency17, New York University18, Southern University College19, Emory University20, University of Ottawa21, Kosin University22, University of Toronto23, University of British Columbia24, United Arab Emirates University25, Albert Einstein College of Medicine26, University of São Paulo27, Nova Southeastern University28, University of Sydney29, Heidelberg University30, Case Western Reserve University31, Cancer Treatment Centers of America32, University of Oxford33, George Mason University34, James Cook University35, University of Trieste36, University of Calgary37, Wageningen University and Research Centre38, University of Gothenburg39, University of the Witwatersrand40, Harvard University41, Jackson State University42, University of Arizona43, University of Hong Kong44, Tehran University of Medical Sciences45, University of Western Australia46, Aintree University Hospitals NHS Foundation Trust47, University of Colorado Denver48, Veterans Health Administration49, Royal Children's Hospital50, University of Melbourne51, Australian National University52, University of Marburg53, Charité54, Health Canada55, College of Health Sciences, Bahrain56, Karolinska Institutet57, Northumbria University58, University of Edinburgh59, National Research University – Higher School of Economics60, Queen Mary University of London61, Addis Ababa University62, Northwestern University63, Northeastern University64, Mario Negri Institute for Pharmacological Research65, Arak University of Medical Sciences66, University of Nottingham67, University of Tokyo68, Public Health Foundation of India69, University of Groningen70, University of the Philippines Manila71, University of Bologna72, Kyung Hee University73, Brighton and Sussex Medical School74, University of Bergen75, Stavanger University Hospital76, University of Queensland77, National Centre for Disease Control78, University of Sheffield79, Universidad Autónoma Metropolitana80, University College London81, Genentech82, Universiti Tunku Abdul Rahman83, Norwegian Institute of Public Health84
TL;DR: To estimate mortality, incidence, years lived with disability, years of life lost, and disability-adjusted life-years for 28 cancers in 188 countries by sex from 1990 to 2013, the general methodology of the Global Burden of Disease 2013 study was used.
Abstract: Importance Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies. Objective To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013. Evidence Review The general methodology of the Global Burden of Disease (GBD) 2013 study was used. Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios. Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources. The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates. Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs. Findings In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs. Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million). Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths. For men, TBL cancer was the leading cause of DALYs (24.9 million). For women, breast cancer was the leading cause of DALYs (13.1 million). Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3). Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries. Conclusions and Relevance Cancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990. The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments. The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation.

2,375 citations

Journal ArticleDOI
TL;DR: This work presents the results of a meta-analysis conducted at the 2016 European Oncology and Radiotherapy Guidelines Working Group (ESMO) workshop on breast cancer diagnosis and prognosis of women with atypical central giant cell granuloma (CGM) who have previously had surgery.

2,274 citations

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Frequently Asked Questions (13)
Q1. What have the authors contributed in "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)" ?

Allemani et al. this paper presented a global comparison of cancer survival in low and middle income countries. 

Projections of the future burden of cancer106 are based on the same cancer incidence data. However, if cancer registration is to develop further in support of the 25 × 25 goals and in the evaluation of clinical care,111 WHO and the UN will need to address the growing legal and procedural diffi culties in obtaining primary health data and in accessing them for research. 

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. 

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 defi ciencies in the management of a largely curable disease. 

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. 

The authors aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the eff ectiveness of health systems, and to inform global policy on cancer control. 

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. 

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. 

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. 

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. 

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. 

The authors looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. 

The authors 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.