Trends and inequalities in cancer survival world-wide

The survival of all patients diagnosed with cancer in a country or region – population-based survival – is a key measure of the overall effectiveness of the national or regional health system in managing cancer. Population-based survival estimates are designed for public health surveillance, and to inform strategic policy-making on how to improve cancer management.

CONCORD is the research programme for the surveillance of population-based cancer survival trends and inequalities world-wide. It currently involves almost 600 collaborators.

CONCORD was designed to compare survival in five continents. The first CONCORD study¹ included data from 101 population-based cancer registries in 31 countries world-wide on 2 million patients diagnosed 1990-94 with cancer of the breast, bowel or prostate, with follow-up to 1999.

In 2015, the second cycle of the CONCORD programme (CONCORD-2) established global surveillance of long-term trends in cancer survival. ² It provided estimates of 5-year net survival for 26 million adults (15-99 years) diagnosed during 1995-2009 with a cancer of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary or prostate, or leukaemia, and for 75,000 children (0-14 years) diagnosed with acute lymphoblastic leukaemia, with follow-up to 2009, with data from 279 cancer registries in 67 countries around the world.

The third cycle of the CONCORD programme³ extended surveillance to 2014. CONCORD-3 included 5 additional cancers (oesophagus, pancreas, melanoma, brain and lymphoma): 322 cancer registries in 71 countries contributed data for a total of 37.5 million patients.

From 2017, the Organisation for Economic Co-operation and Development has included survival estimates from the CONCORD programme for 48 countries in its Health at a Glance publications. These estimates will now become the de facto standard for international cancer survival comparisons, and they will be crucial for the comparative evaluation of health systems performance in all OECD Member States.

VENUSCANCER, embedded in the CONCORD programme, is examining in much greater depth why these enormous differences in five-year net survival still persist for women’s cancers in 2010-2014 (breast cancer: from 66% in India to 91% in the United States; cervical cancer: 52% Ecuador vs. 77% Korea; ovarian cancer: 16% India vs. 57% Costa Rica). It will enable us to quantify the extent to which differences in stage at diagnosis or approaches to treatment can explain the differences in survival between high- and low-income countries.

The overall aim of this study is to provide actionable evidence for health policy that is designed to reduce the burden of women’s cancers world-wide.

Results from the CONCORD programme and the VENUSCANCER project will be presented and discussed during the seminar.

1.  Coleman MP, Quaresma M, Berrino F, et al. Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol 2008; 9: 730-56.

2.  Allemani C, Weir HK, Carreira H, et al. 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). Lancet 2015; 385: 977–1010.

3.  Allemani C, Matsuda T, Di Carlo V, et al. 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. Lancet 2018; 391: 1023-75.