Articulo Concord 2

Articles
Global surveillance of cancer survival 19952009:

analysis of individual data for 25 676 887 patients from
279 population-based registries in 67 countries (CONCORD-2)
Claudia Allemani, Hannah K Weir, Helena Carreira, Rhea Harewood, Devon Spika, Xiao-Si Wang, Finian Bannon, Jane V Ahn, Christopher J Johnson,
Audrey Bonaventure, Rafael Marcos-Gragera, Charles Stiller, Gulnar Azevedo e Silva, Wan-Qing Chen, Olufemi J Ogunbiyi, Bernard Rachet,
Matthew J Soeberg, Hui You, Tomohiro Matsuda, Magdalena Bielska-Lasota, Hans Storm, Thomas C Tucker, Michel P Coleman,
and the CONCORD Working Group*
Summary
Background Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer Published Online
survival by central analysis of population-based registry data, as a metric of the eectiveness of health systems, and to November 26, 2014
http://dx.doi.org/10.1016/
inform global policy on cancer control. S0140-6736(14)62038-9
See Online/Comment
Methods Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for http://dx.doi.org/10.1016/
257 million adults (age 1599 years) and 75 000 children (age 014 years) diagnosed with cancer during 19952009 S0140-6736(14)62251-0
and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast *Members listed at end of report
(women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control Cancer Research UK Cancer
procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted Survival Group, Department of
Non-Communicable Disease
for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic
Epidemiology, London School
origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. of Hygiene & Tropical Medicine,
London, UK (C Allemani PhD,
Findings 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For H Carreira MPH,
R Harewood MSc, D Spika MSc,
patients diagnosed during 200509, survival for colon and rectal cancer reached 60% or more in 22 countries around
X-S Wang PhD, J V Ahn MSc,
the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer A Bonaventure MD,
remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 1519% B Rachet FFPH,
in North America, and as low as 79% in Mongolia and Thailand. Striking rises in 5-year survival from prostate Prof M P Coleman FFPH);
Division of Cancer Prevention
cancer have occurred in many countries: survival rose by 1020% between 199599 and 200509 in 22 countries in
and Control, Centers for Disease
South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria Control and Prevention,
and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year Atlanta, GA, USA (H K Weir PhD);
survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between Northern Ireland Cancer
Registry, Centre for Public
199599 and 200509 have generally been slight. For women diagnosed with ovarian cancer in 200509, 5-year
Health, Queens University
survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach Belfast, Belfast, UK
cancer in 200509 was high (5458%) in Japan and South Korea, compared with less than 40% in other countries. By (F Bannon PhD); Cancer Data
contrast, 5-year survival from adult leukaemia in Japan and South Korea (1823%) is lower than in most other Registry of Idaho, Boise, ID,
USA (C J Johnson MPH); Unitat
countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as dEpidemiologia i Registre de
high as 90% in Canada and four European countries, which suggests major deciencies in the management of a Cncer de Girona, Departament
largely curable disease. de Salut, Institut dInvestigaci
Biomdica de Girona, Girona,
Spain (R Marcos-Gragera PhD);
Interpretation International comparison of survival trends reveals very wide dierences that are likely to be attributable South East Knowledge and
to dierences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer Intelligence Team, Public
survival should become an indispensable source of information for cancer patients and researchers and a stimulus Health England, Oxford, UK
for politicians to improve health policy and health-care systems. (C Stiller MSc); Department of
Epidemiology, Universidade do
Estado do Rio de Janeiro,
Funding Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Rio de Janeiro, RJ, Brazil
Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease (Prof G Azevedo e Silva MD);
Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, National Oce for Cancer
Prevention and Control and
Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA). National Central Cancer
Registry, National Cancer
Copyright Allemani et al. Open Access article distributed under the terms of CC BY. Center, Beijing, China
(W-Q Chen PhD); Ibadan Cancer
Registry, University City College
Introduction urgent.1,2 Prevention is crucial but long term. If WHOs Hospital, Ibadan, Nigeria
The global burden of cancer is growing, particularly in global target of a 25% reduction in deaths from cancer (Prof O J Ogunbiyi FWACP);
countries of low and middle income. The need to and other non-communicable diseases in people aged New South Wales Central
Cancer Registry, Australian
implement eective strategies of primary prevention is 3069 years is to be achieved by 2025 (referred to as
www.thelancet.com Published online November 26, 2014 http://dx.doi.org/10.1016/S0140-6736(14)62038-9 1

Articles
Technology Park 25 25),3 we will need not only more eective prevention We invited all these registries to contribute data for
(M J Soeberg PhD), and Cancer (to reduce incidence) but also more eective health patients diagnosed during all or part of the 15-year
Institute NSW
(H You MAppStats), Sydney,
systems (to improve survival).4 period 19952009, including data on their vital status at
NSW, Australia; In the rst international comparison of cancer survival, least 5 years after diagnosis, or at Dec 31, 2009, or a
Population-Based Cancer a transatlantic study of patients diagnosed during later year. Of 395 registries invited, 306 (77%) agreed to
Registry Section, Division of 194554, survival for 12 cancers in three US states was participate: of these, 24 (8%) did not submit data, either
Surveillance, Center for Cancer
Control and Information
typically higher than in six European countries.5 In 2008, because of resource constraints (n=4), legal constraints
Services, National Cancer a global comparison of population-based cancer survival (1) or reversal of the original decision (3), or because
Center, Tokyo, Japan (CONCORD) showed very wide variations in survival they could not provide complete follow-up data (6) or
(T Matsuda PhD); Department from cancers of the breast (women), colon, rectum, and did not respond to further communication (10).
of Health Promotion and
Postgraduate Education,
prostate.6 That analysis included 19 million adults We excluded three registries because they provided data
National Institute of Public (age 1599 years) diagnosed with cancer during 199094 that did not adhere to the protocol and could not be
Health and National Institute and followed up until 1999 from 31 countries (16 with rectied, leaving 279 participating registries (71% of
of Hygiene, Warsaw, Poland
100% population coverage) on ve continents. those invited).
(Prof M Bielska-Lasota MD);
Cancer Prevention and Three large international comparisons of cancer Among the cancers suggested by participating registries,
Documentation, Danish Cancer survival have been published since 2008. The European the ten we prioritised for study (referred to as index sites)
Society, Copenhagen, Denmark cancer registry study on survival (EUROCARE)-5 accounted collectively for almost two-thirds of the
(H Storm MD); and Kentucky
provided survival estimates for all cancers for patients estimated global cancer burden in 2008, both in developed
Cancer Registry, University of
Kentucky, Lexington, KY, USA diagnosed during 200007 in 29 countries in Europe.7 In and developing countries.4 They comprised cancers of the
(Prof T C Tucker PhD) SurvCan (cancer survival in Africa, Asia, the Caribbean, stomach, colon, rectum, liver, lung, breast (women),
Correspondence to: and Central America), relative survival estimates were cervix, ovary, and prostate in adults (age 1599 years), and
Prof M P Coleman, Cancer reported for patients diagnosed during 19902001 in leukaemia in adults, and precursor-cell acute lympho-
Research UK Cancer Survival 12 low-income and middle-income countries.8 The blastic leukaemia in children (age 014 years).
Group, Department of
Non-Communicable Disease
International Cancer Benchmarking Partnership
Epidemiology, London School of published survival estimates for four common cancers Ethics approval
Hygiene & Tropical Medicine, for patients diagnosed during 19952007 in six high- We obtained approval for CONCORD-2 from the Ethics
London WC1E 7HT, UK
income countries.9 These three studies dier with respect and Condentiality Committee of the UKs statutory
concord@lshtm.ac.uk
to geographic and population coverage, calendar period, National Information Governance Board (now the Health
and analytical methods and do not enable worldwide Research Authority; ECC 3-04(i)/2011) and the National
comparison of cancer survival. Health Service (NHS) research ethics service (southeast;
Surveillance of cancer survival is seen as important by 11/LO/0331). We obtained separate statutory or ethics
national and international agencies, cancer patient approval (or both) in more than 40 other jurisdictions to
advocacy groups, departments of health, politicians, and secure the release of data. Registries in all other
research agencies. Cancer survival research is being used jurisdictions obtained their own ethics approval locally.
to formulate cancer control strategies,9 to prioritise cancer We applied strict security constraints to the
control measures,10 and to assess both the eectiveness11,12 transmission of data les. We gave every registry a set of
and cost-eectiveness13 of those strategies. unique numeric codes for the name of every le; these
We designed CONCORD-2 to initiate long-term codes have no meaning outside the CONCORD-2 study.
worldwide surveillance of cancer survival on the broadest All data elds were numeric or coded. We developed a
possible basis. Our aim is to analyse progress toward the le transmission utility deploying 256-bit advanced
overarching goal in the Union for International Cancer encryption security, with random, strong, one-time
Controls World Cancer Declaration 2013: there will be passwords that were generated automatically at the point
major reductions in premature deaths from cancer and of data transmission but sent separately, thus eliminating
improvements in quality of life and cancer survival.14 the need for email or telephone exchanges to conrm
passwords. We also provided free access to a similar
Methods commercial utility (HyperSend; Covisint, Detroit, MI,
Cancer registries USA) that complies with US federal law on the secure
We identied population-based cancer registries that were transmission of sensitive health data.
operational in 2009 and had either published reports on
survival or were known to follow up registered cancer Protocol
For the protocol see http:// patients to establish their vital status. Many registries had We nalised the protocol (in which we dened the data
www.lshtm.ac.uk/eph/ncde/ met quality criteria for inclusion in either the quinquennial structure, le transmission procedures, and statistical
cancersurvival/research/concord/
compendium Cancer Incidence in Five Continents,15,16 analyses) after a 2-day meeting in Cork, Ireland, in
protocol/index.html
published by the International Association of Cancer September, 2012, with 90 members of the CONCORD
Registries (IACR) and the International Agency for Working Group from 48 countries (the protocol was
Research on Cancer (IARC), or similar compendia; other revised by October, 2012). English poses a communication
registries were established more recently. barrier in many countries; therefore, native speakers
2 www.thelancet.com Published online November 26, 2014 http://dx.doi.org/10.1016/S0140-6736(14)62038-9

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translated the protocol into Chinese (Mandarin),

Topography or morphology codes* Description
Portuguese, and Spanish, and other native speakers did
back-translation to check the translation against the Stomach C160C166, C168C169 Stomach
English original. We made the protocol available in all Colon C180C189, C199 Colon and rectosigmoid junction
four languages. We held protocol workshops in Argentina Rectum C209, C210C212, C218 Rectum, anus, and anal canal
(for Spanish-speaking South American researchers), Liver C220C221 Liver and intrahepatic bile ducts
Brazil, China, India, Japan, Puerto Rico, Russia, and the Lung C340C343, C348C349 Lung and bronchus
USA (for North America), which we followed up with Breast C500C506, C508C509 Breast
(women)
conference calls and online seminars. We responded to
Cervix C530C531, C538C539 Cervix uteri
telephone or email queries in Chinese, English, French,
Ovary C480C482, C569, C570C574, C577C579 Ovary, fallopian tube, and uterine
Italian, Portuguese, and Spanish.
ligaments, other and unspecied
We dened countries, states, and world regions by female genital organs, peritoneum
their UN names and codes (as of 2007).17 Only Cuba and and retroperitoneum
Puerto Rico provided data from the Caribbean and Prostate C619 Prostate gland
Central America so we grouped them with South Leukaemia 9670, 9687, 9727, 9728, 9729, 9800, 9801, 9805, Leukaemia
America as America (Central and South). We wrote this (adults) 9820, 9823, 9826, 9832, 9833, 9835, 9836, 9837,
9840, 9860, 9861, 9866, 9867, 9870, 9871, 9872,
Article and prepared the maps without prejudice to the 9873, 9874, 9891, 9895, 9896, 9897, 9910, 9920,
status, boundaries, or name of any country, territory, or 9930, 9931, 9940, 9984, 9987
region. We have shortened some names for convenience Leukaemia 9727, 9728, 9729, 9835, 9836, 9837 Precursor-cell acute lymphoblastic
(eg, Korea for South Korea), which does not have any (children) leukaemia
political signicance. We created world maps and
*International Classication of Diseases for Oncology, 3rd edn (ICD-O-3).19 We dened solid tumours with topography
27 regional maps in ArcGIS version 10, using digital (anatomical site) codes. Includes peritoneum and retroperitoneum (C480C482), where ovarian cancers of
boundaries (shapeles) of countries and subnational high-grade serous morphology are frequently detected; also includes the fallopian tube, uterine ligaments, and adnexa
regions from the Database of Global Administrative (C570C574), and other and unspecied female genital organs (C577C579). We dened adult leukaemia subtypes
with morphology codes in HAEMACARE groups 6, 11, 15, 17, 18, 19, 20, 21, and 22 (appendix p 2).20 The six
Areas (GADM 2.0).18 We obtained national populations morphology codes used to dene precursor-cell acute lymphoblastic leukaemia (referred to as acute lymphoblastic
for 2009 from the UN Population Database17 or national leukaemia) in children are those in HAEMACARE group 15 only.
authorities (Canada, Portugal, and the UK) and
Table 1: Denition of malignant diseases
subnational populations from the relevant registries.
We dened solid tumours by anatomical site
(topography) and leukaemia by morphology (table 1). For survival analyses, we included only invasive primary
We coded topography and morphology according to the malignant diseases (ICD-O-3 behaviour code 3). To
International Classication of Diseases for Oncology facilitate quality control and comparisons of the intensity
(3rd edn; ICD-O-3).19 For ovarian cancer, we included the of early diagnostic and screening activity, however, we
fallopian tube, uterine ligaments, and adnexa, and the asked registries to submit data for all solid tumours at
peritoneum and retroperitoneum, where high-grade each index site, including those that were benign
serous ovarian carcinomas are often detected. (behaviour code 0), of uncertain or borderline malignancy
We excluded Kaposis sarcoma and solid tumours with (1), or in situ (2).
lymphoma morphology. We asked registries to submit full dates (day, month,
The classication of leukaemias and lymphomas has year) for birth, diagnosis, and death or last known vital
changed since the mid-1990s. To minimise dierences in status, both for quality control and to enable comparable
the range of leukaemia subtypes included in our analyses, estimation of survival.23 When the day of diagnosis or the
we asked registries to provide data for all haemopoietic day or month of birth or last known vital status were
malignant diseases in adults and children, as dened by missing, we developed an algorithm to standardise the
the ICD-O-3 morphology code range 95909989. imputation of missing dates for all populations (details
In consultation with specialists in the cancer registry- available on request). Participating registries completed a
based project on haematologic malignancies detailed questionnaire on their methods of operation,
(HAEMACARE) group,20 we selected subtypes of adult including data denitions, data collection procedures,
leukaemia from nine morphology groups,21 excluding coding of anatomical site, morphology and behaviour,
myelodysplastic and myeloproliferative neoplasms such the tracing of registered cancer patients to ascertain their
as chronic myeloid leukaemia (appendix p 2). Precursor- vital status, and how tumour records are linked with data See Online for appendix
cell acute lymphoblastic leukaemia is the most common on vital status.
form of leukaemia in children; we included We included patients who were diagnosed with two or
HAEMACARE group 15a relatively homogeneous more primary cancers at dierent index sites during
group comprising precursor-cell lymphoblastic 19952009 in the analyses for each cancereg, colon
lymphoma and precursor-cell lymphoblastic leukaemia cancer in 2000, breast cancer in 2005. We measured
(B-cell, T-cell, and not otherwise specied), and we refer survival from the date of diagnosis until the date of death,
to these six entities as acute lymphoblastic leukaemia.22 or loss to follow-up, or censoring. When two or more

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primary malignant diseases occurred at the same index administrative infrastructure, so-called active follow-up
site during 19952009, we included the rst cancer only. can be used to establish vital status via direct contact with
We retained the most complete record for patients with the patient, the family, or a local authority (eg, a village
synchronous primary cancers in the same organ. headman), or by home visit. Many registries in both
North American registries dene multiple primary high-income and low-income countries also seek
cancers under the rules of the Surveillance, Epidemiology information from the hospital or the treating clinician in
and End Results (SEER) programme,24 whereas registries hospital or primary care.
in the European Network of Cancer Registries (ENCR) Most registries link their database with a regional or
and elsewhere generally use the rules of the IACR,25 national index of deaths, using identiers such as name,
which are more conservative. The North American sex, date of birth, and identity number. Tumour records
Association of Central Cancer Registries (NAACCR) that match to a death record are updated with the date of
prepared a program to enable all North American death. Many registries also use other ocial databases
registries to recode their entire incidence databases to (eg, hospital and primary care databases, social insurance,
the IACR multiple primary rules, before their datasets health insurance, drivers licences, and electoral registers)
for 19952009 were extracted for CONCORD-2. to establish the date on which a patient was last known or
believed to have been alive, to have migrated within the
Quality control country, or to have emigrated to another country. Cancer
The quality and completeness of cancer registration data registrations are updated with the vital status and the
can aect both incidence and survival estimates and, date of last known vital status. These methods are
thus, the reliability of international comparisons.26 typically summarised as passive follow-up.
We developed a suite of quality control programs,27 Some registries receive information on the vital status
extending the checks used in the rst CONCORD study,6 of all registered patients on an almost continuous basis,
cross-checked with those used in the EUROCARE or at least every month or every 3 months. Other registries
study,28 IARC/IACR tools for cancer registries,29 and seek to trace the vital status of patients registered in a
WHOs classication of tumours.22,3032 We applied these particular calendar year only, 1 year or even 5 years after
checks systematically in three phases and sent registries the end of that year: this approach can increase the
a detailed report on how to revise and resubmit their proportion of patients lost to follow-up. It also means that
data, if needed, after every phase. 5-year survival estimates for more recently diagnosed
First, we sent registries a protocol adherence report patients cannot be obtained, even with the period
that showed, for every cancer, the proportion of tumour approach.
records that were coded in compliance with the protocol. We asked all 279 participating registries how they
Second, we checked the data in every tumour record for ascertained the vital status of registered cancer patients.
logical coherence against 20 sets of criteria, including Of 243 registries that responded to the question,
eligibility (eg, age, tumour behaviour), denite errors 147 (60%) stated that they used only passive follow-up,
(eg, sex-site errors and invalid dates or date sequence), 92 (38%) that they used both passive and active follow-up,
and possible errors including a wide range of and four (2%) only active follow-up.
inconsistencies between age, tumour site, and
morphology.27 We sent registries exclusion reports that Statistical analysis
showed, for every index cancer and calendar period, the Most registries submitted data for patients diagnosed
number of tumour records in each category of denite or from 1995 to 2009, with follow-up to 2009 or later; some
possible error, the number of tumours registered from a registries only began operation after 1995 or provided
death certicate only or detected at autopsy, and the data for less than 15 years. We were able to estimate
number of patients whose data could be included 5-year survival using the cohort approach for patients
in survival analyses. When we identied errors in diagnosed in 199599 and 200004, because in most
classication, coding, or pathological assignment, datasets, all patients had been followed up for at least
we asked registries to correct and resubmit their data. 5 years. We used the period approach33 to estimate 5-year
Finally, we analysed: the proportion of tumour records survival for patients diagnosed during 200509, because
with morphological verication or non-specic 5 years of follow-up data were not available for all patients
morphology; distributions of the day and month of birth, (appendix p 174).
diagnosis, and last known vital status; and proportions of We estimated net survival up to 5 years after diagnosis
patients who died within 30 days, were reported as lost to for both adults and children. Net survival represents the
follow-up, or were censored within 5 years of diagnosis. cumulative probability that the cancer patients would
have survived a given time, say 5 years or more after
Follow-up for vital status diagnosis, in the hypothetical situation that the cancer
Cancer registries use various methods to ascertain the was the only possible cause of death. Net survival can be
vital status (alive, dead, emigrated, lost to follow-up) of interpreted as the proportion of cancer patients who
registered cancer patients. In countries with limited survive up to that time, after eliminating other causes of

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death (background mortality). We used the recently smoothing, for each calendar year. For 172 registries,
developed Pohar Perme estimator34 of net survival imple- we obtained raw data from either the registry, the
mented with the program stns35 in Stata version 13.36 This relevant national statistical authority, or the Human
estimator takes unbiased account of the fact that older Mortality Database.37 We derived life tables for 1996 and
patients are more likely than younger patients to die 2010 if possible, each centred on three calendar years of
from causes other than cancerie, that the competing data (eg, 199597, 200911) to increase the robustness of
risks of death are higher for elderly cancer patients. the rates. We modelled raw mortality rates with Poisson
To control for the wide dierences in background regression and exible functions to obtain smoothed
mortality between participating jurisdictions and over complete life tables extended up to age 99 years. We then
time, we constructed 6514 life tables of all-cause mortality created life tables for every calendar year from 1997 to
in the general population of each country or the territory 2009 by linear interpolation between the 1996 and 2010
covered by each participating registry, by age (single life tables.38 Rather than extrapolate, we used the 1996
year), sex, and calendar year of death, and by race or life table for 1995.
ethnic origin in Israel (Arab, Jewish), Malaysia (Chinese, 62 of 279 registries provided abridged mortality rates,
Malay, Indian), New Zealand (Mori, non-Mori), and the or complete mortality rates that were not smoothed.
USA (Black, White). The method of life table construction We used the Ewbank relational model39 with three or
depended on whether we received raw data (numbers of four parameters to interpolate (if abridged) and smooth
deaths and populations) or mortality rates, and on the mortality rates for the registry territory against a
whether the raw data or the mortality rates were by single high-quality smooth life table for a country with a similar
year of age (so-called complete) or by 5-year or 10-year pattern of mortality by age. We could not obtain reliable
age group (abridged). We checked the life tables by data on all-cause mortality for 24 registries. We took
examination of age-sex-mortality rates, life expectancy at national life tables published by the UN Population
birth (appendix p 175), the probability of death in the age Division40 and interpolated and extended them to
bands 1559 years, 6084 years, and 8599 years and, age 99 years with the Elandt-Johnson method.41
where necessary, the model residuals. For each country and registry, we present estimates of
Of the 279 participating registries, 21 provided age-standardised net survival for each cancer at 5 years
complete life tables that did not need interpolation or after diagnosis. We report cumulative survival probabilities
National coverage
Regional coverage
Regional territory (no data)
0 5000 10 000 km
No coverage
Cuba Jordan The Gambia
Israel Hong Kong
Puerto Rico Gibraltar Malta Cyprus Qatar Mauritius Taiwan
Figure 1: Participating countries and regions (adults)

National registries in smaller countries are shown in boxes at dierent scales. 28 regional maps and a world map for childhood acute lymphoblastic leukaemia are in
the appendix (pp 11240).

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as percentages. For adults, we used the International 1 682 081 (59%) records were for an in situ cancer, mostly
Cancer Survival Standard (ICSS) weights, with age at of the cervix, breast, colon, or prostate. The proportions of
diagnosis categorised into ve groups: 1544 years, in situ cancer are not comparable directly because some
4554 years, 5564 years, 6574 years, and 7599 years for registries do not record in situ cancer, others did not
eight solid tumours and leukaemia in adults; and submit data for index sites in which in situ malignant
1554 years, 5564 years, 6574 years, 7584 years, and disease is common, and screening programmes in which
8599 years for prostate cancer.42 For children, we in situ cancers are frequently detected were introduced in
estimated survival for the age groups 04 years, 59 years, some countries during 19952009. The variation between
and 1014 years; we obtained age-standardised estimates continents is still of interest: for example, a little over 1%
by assigning equal weights to the three age-specic of cervical cancers in African registries were in situ,
estimates.43 We derived CIs for both unstandardised and compared with 20% in Central and South American
age-standardised survival estimates assuming a normal registries and 81% in Oceania. For breast cancer in situ,
distribution, truncated to the range 0100. We derived SEs the variation was from 01% in African registries to 16%
with the Greenwood method44 to construct the CIs in North American registries and about 45% in other
We did not estimate survival if fewer than ten patients regions of the world (appendix pp 363). Patients with
were available for analysis. If between ten and 49 patients in situ cancer were not included in survival analyses.
were available for analysis in a given calendar period We excluded a further 360 773 (13%) patients either
(199599, 200004, 200509), we merged data for because their year of birth, month or year of diagnosis, or
two consecutive periods. For less common cancers in the year of last vital status were unknown, or because the
smallest populations, we sometimes needed to merge data tumour was not primary invasive malignant disease
for all three periods. When between ten and 49 patients in (behaviour code 3) or the morphology was that of Kaposis
total were available, we only estimated survival for all ages sarcoma or lymphoma in a solid organ, or for other
combined. If 50 or more patients were available, reasons (table 2). The proportion of patients with an
we attempted survival estimation for each age group. If an unknown date of last vital status ranged from 0% to 40%
age-specic estimate could not be obtained, we merged or more for some cancers in some African registries.
data for adjacent age groups and assigned the combined Proportions are presented in the appendix (pp 363) for
estimate to both age groups. If two or more age-specic each registry, for all cancers combined, and for each
estimates could not be obtained, we present only the cancer separately.
unstandardised estimate for all ages combined. Of 26 642 591 patients eligible for inclusion in the
survival analyses, 905 841 (34%) were excluded because
Role of the funding sources their cancer was registered from a death certicate only
The funders had no role in study design, data collection, or discovered at autopsy (table 2), and 59 863 (02%) were
data analysis, data interpretation, or writing of the report. excluded for other reasons, including denite errors
The corresponding author had full access to all data in (eg, unknown vital status or sex, sex-site error, or invalid
the study and had nal responsibility for the decision to dates or sequence of dates) or possible errors (eg, apparent
submit for publication. inconsistencies between age, cancer site, and morphology)
for which the record was not later conrmed as correct by
Results the relevant registry.
279 cancer registries from 67 countries provided data for Of 25 676 887 patients available for survival analyses
this study (gure 1; appendix pp 11240). Nine African (964% of those eligible), pathological evidence of
countries took part (ten registries), eight countries were malignant disease (histological, cytological, or haema-
in Central and South America (27 registries), Canada and tological ndings) was available for 23 338 015 patients
the USA comprised North America (57 registries), for all cancers combined (911%; table 2), ranging from
16 countries were in Asia (50 registries), 30 European 831% in Asian registries, 855% in African registries,
countries participated (128 registries), and New Zealand and 874% in Central and South American registries to
and Australia represented Oceania (seven registries). For 9095% in Europe, Oceania, and North America. The
countries with less than 100% coverage of the population, range of pathological evidence at a national level was very
the country name is used for brevity in the text (eg, Libya, wide, from 15% in The Gambia, 36% in Mongolia, and
the USA), but a more accurate term is used in the tables 66% in Chinese registries, up to 99% or more in Belgium,
(eg, Libya [Benghazi], US registries). Some registries Mauritius, and Sweden. For 938 703 (37%) patients,
provided data for only part of their territory. morphological features were poorly specied (eg,
We examined records for 28 685 445 patients diagnosed malignant neoplasm or tumour, ICD-O-3 codes
with cancer of the stomach, colon, rectum, liver, lung, 80008005): this proportion also varied widely, from
breast (women), cervix, ovary, and prostate in adults around 1% in North American registries to 17% for all
(age 1599 years), leukaemia in adults, and precursor-cell African registries combined and as high as 59% in
acute lymphoblastic leukaemia in children (age 014 years) The Gambia. Data for every registry are shown in the
during the period 19952009 (table 2). Of these, appendix (pp 363).

Articles
Calendar Patients Ineligible patients Eligible Exclusions|| Available for Data quality indicators
period submitted patients (n) analysis (n)
(n)
In situ Other DCO (%) Other (%) MV (%) Non-specic Lost to Censored
(%) (%) morphology follow- (%)
(%) up (%)
Africa 23 325 02% 395% 14 048 14% 96% 12 509 855% 170% 102% 288%
Algerian registries 19952009 6919 <01% 58% 6515 03% 174% 5358 938% 123% 00% 215%
Lesotho (childhood) 19952009 22 00% 00% 22 00% 00% 22 1000% 00% 00% 118%
Libya (Benghazi) 20032005 1698 00% 04% 1692 89% 05% 1533 844% 165% 00% 324%
Mali (Bamako) 19952009 1007 00% 783% 219 50% 23% 203 586% 414% 837% 64%
Mauritius* 20052005 855 00% 06% 850 00% 09% 842 1000% 241% 00% NA
Nigeria (Ibadan) 19982007 2192 21% 601% 830 06% 36% 795 708% 00% 89% 651%
South Africa (Eastern Cape) 19982007 2404 00% 29% 2335 01% 44% 2230 705% 328% 457% 251%
The Gambia* 19951997 387 00% 101% 348 09% 103% 309 152% 589% 32% 142%
Tunisia (Central) 19952007 7841 01% 841% 1237 NA 16% 1217 991% 10% 07% 512%
America (Central and South) 467 456 30% 80% 416 140 137% 07% 356 173 874% 77% 01% 29%
Argentinian registries 19952009 40 482 50% 76% 35 377 111% 05% 31 244 979% 37% <01% 146%
Brazilian registries 19952009 119 423 54% 200% 89 067 95% 05% 80 113 928% 71% 02% 17%
Chilean registries 19982008 8920 82% 07% 8121 107% 05% 7213 903% 41% 05% 00%
Colombian registries 19952009 36 140 15% 57% 33 550 57% 08% 31 365 885% 120% <01% 195%
Cuba* 19982006 120 748 03% 21% 117 883 237% 03% 89 576 706% 117% 00% 00%
Ecuadorian registries 19952009 35 395 13% 57% 32 924 97% 43% 28 314 920% 37% 00% <01%
Puerto Rico* 20002009 81 886 39% 45% 74 937 67% 03% 69 745 972% 14% 00% 00%
Uruguay* 20022009 24 462 04% 03% 24 281 234% 00% 18 603 806% 209% 00% 00%
America (North) 12 233 257 60% 13% 11 340 569 18% 02% 11 109 332 948% 13% 08% <01%
Canada* 19952009 1 392 677 43% 06% 1 324 227 18% 05% 1 294 159 887% 15% 00% <01%
US registries 19952009 10 840 580 62% 14% 10 016 342 18% 02% 9 815 173 956% 13% 09% <01%
Asia 3 581 339 33% 09% 3 432 472 44% 02% 3 274 733 831% 114% 07% 26%
Chinese registries 19952009 241 044 01% 13% 237 656 16% <01% 233 736 664% 387% 35% 01%
Cyprus* 20042009 9986 28% 27% 9437 86% 02% 8609 987% 21% 00% 01%
Hong Kong* 19972006 6184 00% 00% 6184 00% 02% 6169 996% <01% 90% 85%
Indian registries 19952009 11 732 00% 15% 11 551 27% 01% 11 235 818% 97% 229% 99%
Indonesia (Jakarta) 20052007 3830 00% 181% 3138 13% 02% 3091 754% 230% 00% NA
Israel* 19952009 202 745 61% 20% 186 266 32% 02% 179 921 942% 64% 00% 00%
Japanese registries 19952009 1 065 707 37% 10% 1 015 315 133% <01% 879 341 864% 99% 00% 36%
Jordan* 20002009 19 191 00% 06% 19 081 <01% 09% 18 896 993% 15% 549% 00%
Korea* 19952009 1 191 749 00% 08% 1 182 442 <01% 01% 1 180 925 825% 89% 00% 00%
Malaysia (Penang) 19952009 15 842 00% 25% 15 447 24% 18% 14 800 920% 98% 00% <01%
Mongolia* 20052009 13 415 18% 06% 13 096 <01% 45% 12 510 357% 12% 169% NA
Qatar* 20022009 780 08% 01% 773 27% 04% 749 900% 64% 00% 51%
Saudi Arabia* 19952008 24 216 14% 01% 23 876 26% 101% 20 860 952% 16% 00% 613%
Taiwan* 19952009 662 906 92% <01% 601 480 00% 01% 600 934 831% 96% 00% 00%
Thai registries 19952009 47 263 14% 07% 46 279 40% 01% 44 406 585% 384% 01% 234%
Turkey (Izmir) 19952009 64 749 33% 34% 60 451 30% 02% 58 551 929% 21% <01% 307%
Europe 11 449 869 65% 10% 10 584 050 45% 02% 10 086 145 897% 35% 03% 04%
Austria * 19952009 353 194 69% 06% 326 730 01% 09% 323 432 976% 25% 00% 00%
Belarus (childhood) 19952009 726 00% 00% 726 00% 00% 726 999% 00% 28% 00%
Belgium* 20042009 256 073 87% 06% 232 152 <01% 02% 231 734 987% 15% 11% 00%
Bulgaria* 19952009 255 768 <01% 02% 255 158 112% <01% 226 566 814% 13% 01% 00%
Croatia* 19982009 148 131 00% 01% 148 031 60% <01% 139 147 849% 04% 00% 00%
Czech Republic* 19952009 469 330 64% 13% 433 523 79% 09% 395 462 908% 19% 00% 00%
Denmark* 19952009 251 533 00% 02% 250 931 04% 00% 249 943 932% 80% 01% 00%
Estonia* 19952008 51 544 14% 11% 50 283 38% 04% 48 193 890% 35% 04% 00%
(Table 2 continues on next page)

Articles
Calendar Patients Ineligible patients Eligible Exclusions|| Available for Data quality indicators
period submitted patients (n) analysis (n)
(n)
In situ Other DCO (%) Other (%) MV (%) Non-specic Lost to Censored
(%) (%) morphology follow- (%)
(%) up (%)
(Continued from previous page)
Finland* 19952009 235 156 65% 29% 213 137 23% <01% 208 129 961% 73% 01% 00%
French registries 19952009 227 210 <01% 03% 226 622 <01% 02% 226 234 963% 26% 39% 41%
German registries 19952009 1 668 355 40% 12% 1 582 464 135% 01% 1 367 345 949% 10% 03% 01%
Gibraltar* 19992009 665 138% 158% 468 NA 13% 462 857% 09% 00% 22%
Iceland* 19952009 10 805 00% 08% 10 722 02% 00% 10 704 972% 28% 00% 00%
Ireland* 19952009 169 818 149% 14% 142 134 24% 01% 138 602 910% 11% 00% 00%
Italian registries 19952009 877 272 27% 05% 849 556 21% 02% 830 162 875% 125% 08% 10%
Latvia* 19952009 78 334 01% 02% 78 141 61% 05% 72 992 815% 05% 00% 00%
Lithuania* 19952009 132 425 28% 05% 127 999 36% 00% 123 380 849% 20% 10% 00%
Malta* 19952009 11 630 00% 09% 11 526 26% 05% 11 173 963% 79% 00% <01%
Netherlands* 19952009 716 617 29% 09% 688 714 03% 03% 684 601 970% 31% 05% 00%
Norway* 19952009 202 823 00% 04% 202 016 08% 00% 200 334 955% 47% 02% 00%
Poland* 19952009 813 485 12% 02% 802 179 41% 04% 766 183 796% 05% 01% 00%
Portugal* 19982009 240 114 28% 27% 226 878 02% 02% 225 902 959% 33% 01% 14%
Romania (Cluj) 20062009 6900 39% 07% 6583 180% 20% 5264 930% 08% 00% NA
Russia (Arkhangelsk) 20002009 23 609 00% <01% 23 602 33% 07% 22 643 824% 35% 11% 00%
Slovakia* 20002007 92 942 00% 03% 92 655 99% <01% 83 449 953% 55% 00% 00%
Slovenia* 19952009 95 466 148% 25% 78 973 27% <01% 76 835 945% 59% 01% 00%
Spanish registries 19952009 338 249 39% 24% 317 154 26% 03% 308 081 915% 54% 02% 08%
Sweden* 19952009 395 792 00% <01% 395 744 NA 00% 395 744 989% 21% 02% 00%
Swiss registries 19952009 151 879 69% 04% 140 737 17% 01% 138 125 952% 29% 32% 60%
UK* 19952009 3 174 024 145% 14% 2 668 512 35% 01% 2 574 598 833% 34% <01% 01%
Oceania 930 199 75% 06% 855 312 18% 02% 837 995 920% 42% 00% 41%
Australian registries 19952009 766 090 91% 07% 691 260 14% 02% 680 295 919% 34% 00% 50%
New Zealand* 19952009 164 109 00% <01% 164 052 33% 06% 157 700 926% 76% 00% 00%
Total 28 685 445 59% 13% 26 642 591 34% 02% 25 676 887 911% 37% 06% 07%
NA=not available. *100% coverage of the national population. 100% coverage of the national population for childhood leukaemia only. South Korea. In situ malignant disease (ICD-O-3 behaviour code 2):
some registries do not register in situ cancers, other registries did not submit them. Other: records with incomplete data; or tumours that are benign (behaviour code 0), of uncertain behaviour (1), metastatic
from another organ (6), or unknown if primary or metastatic (9); or patients falling outside the age range 014 years (children) or 1599 years (adults); or other conditions. ||DCO=tumours registered from a
death certicate only or detected solely at autopsy. Other: vital status or sex unknown; or invalid sequence of dates; or inconsistency of sex-site, site-morphology, age-site, age-morphology, or
age-site-morphology. MV=microscopically veried. Non-specic morphology (solid tumours only): ICD-O-3 morphology code in the range 80008005. Censored: patients diagnosed during 19952004, with
last known vital status alive but less than 5 years of follow-up.
Table 2: Data quality indicators for patients diagnosed during 19952009, by continent and country (all cancers combined)
Morphological conrmation for each cancer varied (pp 6480). 100% coverage of the national population
widely between continents and countries. Overall, 482% was provided by 40 countries. Population coverage in
of liver cancers had morphological data available Australia was 91%, and in the USA it was 83%. In the
compared with 844% of lung cancers, at least 90% of remaining 25 countries, population coverage ranged
other solid tumours and adult leukaemia, and 99% from 05% to 47%. In China, 21 participating registries
of childhood acute lymphoblastic leukaemia (appendix covered 377 million people (28% of 135 billion total
pp 363). Morphological conrmation was available for population), whereas the four registries in India covered
100% of acute lymphoblastic leukaemias in all the 59 million people (05% of 119 billion total population).
specialist childhood cancer registries, including the China and India apart, data from 254 registries covered
national registries in Lesotho and Belarus. 37% of the combined population of 23 billion people in
The 279 participating cancer registries represented 65 countries.
an estimated total population of about 896 210 000 people Life expectancy at birth in 2009 varied widely between
in 2009, or 186% of the combined national popula- the 279 registry populations: for females, the range was
tions of the 67 countries (48 billion total population; 4687 years and for males it was 4581 years (appendix,
table 3); details by registry are provided in the appendix p 175). Life expectancy rose slightly from 1995 to 2009 in

Articles
Population covered Stomach Colon Rectum Liver Lung Breast|| Cervix Ovary Prostate Leukaemia Total
(n) (n) (n) (n) (n) (n) (n) (n) (n) (n) (n)
n % Adults Children
Africa
Total 15 983 791 58% 830 958 756 445 1833 3202 2357 346 1 085 592 105 12 509
Algerian 2 099 478 58% 551 406 343 177 908 1582 514 153 364 327 33 5358
registries
Lesotho 756 000 1000% 22 22
(childhood)
Libya 1 582 160 265% 87 225 105 61 317 352 57 68 153 93 15 1533
(Benghazi)
Mali 902 723 134% 203 203
(Bamako)
Mauritius* 1 226 840 1000% 65 81 65 23 84 290 93 52 58 31 842
Nigeria 1 853 300 12% 70 108 315 263 39 795
(Ibadan)
South Africa 1 094 303 22% 54 40 38 98 216 372 1168 46 198 2230
(Eastern
Cape)
The Gambia* 1 628 330 1000% 21 85 21 33 149 309
Tunisia 4 840 657 461% 52 136 97 1 287 370 61 27 49 102 35 1217
(central)
America (Central and South)
Total 43 562 690 132% 24 610 43 552 10 405 4076 51 054 111 382 26 389 10 022 64 579 4960 5144 356 173
Argentinian 5 123 973 128% 1742 4172 1308 14 2463 9886 2189 1076 4883 15 3496 31 244
registries
Brazilian 11 012 413 57% 3689 3457 1681 672 4192 52 198 3209 1203 8292 1117 403 80 113
registries
Chilean 931 477 55% 1333 614 270 181 878 1174 562 229 1653 257 62 7 213
registries
Colombian 3 139 671 69% 4773 2439 741 3135 8346 3795 1352 6177 170 437 31 365
registries
Cuba* 11 288 830 1000% 5026 11 393 25 654 18 757 10 726 3551 14 372 97 .. 89 576
Ecuadorian 4 987 086 338% 4821 1880 907 815 1698 5627 3957 1207 5333 1484 585 28 314
registries
Puerto Rico* 3 718 810 1000% 3226 11 930 3115 1653 5222 15 394 1951 1404 23 869 1820 161 69 745
Uruguay* 3 360 430 1000% 7667 3124 7812 18 603
America (North)
Total 291 101 829 848% 289 269 1 533 456 428 293 201 342 2 532 324 2 493 295 175 743 302 513 2 689 226 432 639 31 232 11 109 332
Canada* 33 628 600 1000% 43 996 194 803 49 333 21 124 305 723 286 173 20 651 25 874 289 868 53 175 3439 1 294 159
US registries 257 473 229 832% 245 273 1 338 653 378 960 180 218 2 226 601 2 207 122 155 092 276 639 2 399 358 379 464 27 793 9 815 173
Asia
Total 219 911 285 69% 680 012 405 348 229 351 465 575 594 333 414 619 139 621 71 388 194 319 70 615 9552 3 274 733
Chinese 37 688 165 28% 47 580 17 894 15 261 37 555 65 320 27 667 5251 5316 5597 6025 270 233 736
registries
Cyprus* 819 100 1000% 407 1330 375 104 1150 2482 150 265 1936 376 34 8609
Hong Kong* 3 707 500 1000% 3792 2377 6169
Indian 5 877 408 05% 1942 147 138 242 1746 2691 2960 631 128 426 184 11 235
registries
Indonesia 9 607 787 40% 67 229 142 301 406 1004 459 235 137 97 14 3091
(Jakarta)
Israel* 7 273 800 1000% 10 161 34 810 9595 2291 23 739 49 458 2887 5928 30 921 9339 792 179 921
Japanese 37 172 726 292% 230 800 139 071 63 269 81 085 154 292 97 409 17 249 17 221 65 114 12 784 1047 879 341
registries
Jordan* 6 181 310 1000% 1217 2653 1069 303 2 518 6674 373 691 1457 1451 490 18 896
Korea* 48 164 970 1000% 324 913 118 155 87 349 183 659 197 382 118 602 61 815 20 394 42 921 21 970 3 765 1 180 925

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(n) (n) (n) (n) (n) (n) (n) (n) (n) (n) (n)
n % Adults Children
Malaysia 1 458 900 53% 1125 1931 1011 877 2784 3803 1227 719 740 424 159 14 800
(Penang)
Mongolia* 2 672 220 1000% 2532 354 60 6358 1196 392 1178 264 39 113 24 12 510
Qatar* 1 564 080 1000% 41 109 39 65 90 248 31 31 56 39 749
Saudi Arabia * 26 796 380 1000% 1707 2515 1238 3165 2094 5179 734 954 1473 1801 20 860
Taiwan* 23 119 772 1000% 51 506 78 146 45 212 133 440 111 317 82 264 35 308 13 036 36 455 12 239 2011 600 934
Thai registries 3 938 859 59% 1337 3198 1827 14 840 8382 5770 4722 1607 1120 1275 328 44 406
Turkey (Izmir) 3 868 308 54% 4677 4806 2766 1290 21 917 10 976 1485 1719 6225 2256 434 58 551
Europe
Total 301 311 488 465% 621 585 1 487 141 691 181 210 272 1 983 228 2 281 321 245 190 373 542 1 836 205 330 922 25 558 10 086 145
Austria* 8 371 710 1000% 21 262 45 039 23 989 9368 51 467 70 149 7140 12 357 71 407 10 570 684 323 432
Belarus 1 387 671 1000% 726 726
(childhood)
Belgium* 10 862 440 1000% 8180 33 007 14 454 3050 43 212 57 203 3851 5783 55 141 7447 406 231 734
Bulgaria* 7 446 200 1000% 21 072 31 599 20 332 5164 45 999 49 420 15 317 11 643 18 612 6859 549 226 566
Croatia* 4 349 930 1000% 12 341 19 816 12 240 4063 33 037 26 912 4389 5885 14 885 5227 352 139 147
Czech 10 486 430 1000% 24 175 73 556 31 175 8062 80 304 77 632 15 605 17 702 54 772 12 479 395 462
Republic*
Denmark* 5 524 430 1000% 8014 36 668 19 769 4035 56 379 59 135 6104 9328 41 162 8806 543 249 943
Estonia* 1 302 970 1000% 6093 6159 3097 876 9975 8201 2317 2296 7060 2038 81 48 193
Finland* 5 343 930 1000% 10 911 22 300 11 548 4129 30 317 54 675 2353 7714 57 012 6576 594 208 129
French 11 563 608 184% 10 890 36 315 14 723 8996 30 470 52 334 3549 5835 47 893 9508 5721 226 234
registries
German 36 511 217 439% 83 205 204 411 107 477 27 951 232 433 323 100 31 607 44 569 265 955 44 460 2177 1 367 345
registries
Gibraltar* 29 253 1000% 32 73 17 5 61 176 11 13 63 11 462
Iceland* 313 800 1000% 532 1333 509 130 2053 2371 223 366 2813 346 28 10 704
Ireland* 4 410 420 1000% 6952 20 706 8813 1564 25 042 31 160 3232 4933 30 060 5669 471 138 602
Italian 23 238 302 386% 67 401 139 202 40 810 42 965 153 997 181 654 10 400 23 787 135 881 32 057 2008 830 162
registries
Latvia* 2 112 340 1000% 9476 8380 5236 1376 15 713 13 617 3016 4533 8994 2555 96 72 992
Lithuania* 3 101 970 1000% 14 672 11 677 8578 1944 22 425 19 047 7179 6392 26 047 5120 299 123 380
Malta* 422 870 1000% 687 1693 722 141 1866 3238 160 549 1662 399 56 11 173
Netherlands* 16 561 280 1000% 31 142 109 467 41 810 4788 144 869 176 885 10 292 21 021 120 745 22 549 1033 684 601
Norway* 4 835 630 1000% 8765 33 809 15 840 1789 32 745 38 651 4573 7660 50 016 5962 524 200 334
Poland* 38 193 590 1000% 60 115 93 762 60 178 15 018 225 554 151 046 39 367 39 430 79 083 2630 766 183
Portugal* 10 776 872 1000% 25 315 39 016 18 641 3647 27 423 47 868 6861 4977 46 210 5530 414 225 902
Romania 677 942 31% 535 618 275 161 1028 1073 458 213 655 240 8 5264
(Cluj)
Russia 1 246 204 09% 5006 2927 1840 225 5220 3654 1005 1078 1331 357 22 643
(Arkhangelsk)
Slovakia* 5 425 040 1000% 6767 16 002 7521 1295 15 545 15 859 4349 3564 8914 3407 226 83 449
Slovenia* 2 044 250 1000% 6864 11 173 6409 1658 15 976 15 240 2827 2837 11 025 2673 153 76 835
Spanish 10 002 689 219% 22 326 54 275 18 868 12 105 58 048 57 242 5316 8948 58 421 11 541 991 308 081
registries
Sweden* 9 310 300 1000% 15 320 50 722 29 449 7543 46 744 90 168 6780 12 999 121 681 13 451 887 395 744
Swiss 3 666 300 474% 5901 18 300 7457 4072 23 183 33 550 1924 4579 32 976 5514 669 138 125
registries
UK* 61 791 900 1000% 127 634 365 136 159 404 34 152 552 143 620 061 44 985 102 551 465 729 96 941 5862 2 574 598

Articles
(n) (n) (n) (n) (n) (n) (n) (n) (n) (n) (n)
n % Adults Children
Oceania
Total 24 339 214 923% 29 290 142 612 53 875 12 739 131 489 183 109 12 925 21 491 213 853 33 860 2752 837 995
Australian 20 016 274 908% 23 821 114 778 44 152 10 583 108 025 148 633 10 219 16 899 173 796 27 162 2227 680 295
registries
New Zealand* 4 322 940 100% 5469 27 834 9723 2156 23 464 34 476 2706 4592 40 057 6698 525 157 700
Worldwide
Total 894 710 154 186% 1 645 596 3 613 067 1 413 861 894 449 5 294 261 5 486 928 602 225 779 302 4 999 267 873 588 74 343 25 676 887
*100% coverage of the national population. 100% coverage of the national population for childhood leukaemia only. South Korea. Data are from the UN Population Division for 2009, national authorities
40
in Canada, Portugal, and the UK, or the cancer registry. ||In female patients.
Table 3: Population coverage and number of patients diagnosed during 19952009, by continent and country
most populations, but in some countries it changed (1819%). Survival was less than 10% in Gibraltar and
substantially between the earliest and latest years for Libya, but those two estimates are based on fewer than
which data were available, from a decline of 69 years in 100 cases (table 4; appendix pp 6480). In most
South Africa and Lesotho (attributable largely to HIV/ countries, survival from stomach cancer remained in
AIDS),45 to an increase of 6 years or more in Estonia, the narrow range of 2530% from 199599 to 200509.
Latvia (for male patients), and South Korea, and in some Very large increases were seen in South Korea (from
regions of Brazil (male patients), China, and Germany 33% to 58%) and China (from 15% to 31%), but survival
(male patients; data not shown). rose by less than 10% in some countries on all
Whenever possible, ndings are presented for continents (appendix p 153). Survival from stomach
patients diagnosed during 199599, 200004, and cancer fell by 617% in Brazil, Cyprus, Malaysia,
200509, by continent, country, and registry (gures 2 Thailand, and Turkey, declines that were not seen for
to 4; appendix pp 3173). When data were available for most other cancers in these registries. We could not
more than one registry in a given country, survival assess survival trends for stomach cancer in African
estimates were derived by pooling data for that country, countries. The range of 5-year survival estimates for
excluding data from registries for which estimates were stomach cancer in 200509 varied widely between
judged less reliable (gures 2 and 3). Survival estimates registries in Africa, Asia, and Central and South
were agged as less reliable if a higher than usual America (appendix p 164).
proportion of patients was excluded from analyses Data for colon cancer are available for 3 613 067 patients
because their cancer was registered from the death (table 3). 191 registries in 48 countries contributed data
certicate only, or had an unknown date for last vital for 199599, 244 registries in 58 countries provided
status, or because not all deaths were ascertained. Less data for 200004, and 242 registries in 61 countries
reliable estimates are not always outliers in the global had data for 200509 (appendix pp 6480). For patients
distribution, but when they are, they have been omitted diagnosed with colon cancer during 200509,
from this discussion. Less reliable estimates are also age-standardised 5-year net survival was 5059% in
excluded from the distribution of survival among many countries, although it did surpass 60% in
registries in each continent (gure 4). North America, Oceania, 12 European countries, and a
Data for stomach cancer are available for few countries in Central and South America and Asia
1 645 596 patients. 191 registries in 48 countries (table 4; appendix p 143). 5-year net survival from colon
contributed data for 199599, 241 registries in cancer was 4049% in Argentina, Bulgaria, Chile,
56 countries provided data for 200004, and Colombia, Latvia, and Russia, and it was less than 40%
241 registries in 59 countries provided data for 200509 in India, Indonesia, and Mongolia. In most countries,
(table 3; appendix pp 6480). For patients diagnosed 5-year survival from colon cancer increased from
during 200509, age-standardised 5-year net survival 199599 to 200509, but it fell in Argentina and Cyprus
for stomach cancer was very high in South Korea (table 4; appendix p 154). Pooled 5-year survival estimates
(58%), Japan (54%), and Mauritius (41%; table 4; for Canada and the USA were already high (57% and 61%,
appendix p 142). 5-year survival from stomach cancer respectively) for patients diagnosed with colon cancer in
was 3039% in Austria, Belgium, China, Germany, 199599, but they increased to 63% and 65%,
Iceland, Italy, Portugal, Switzerland, and Taiwan. respectively, for individuals diagnosed during 200509.
5-year survival in Denmark, Malta, Poland, and the UK Data were generally available from the same registries
was lower than in most other European countries throughout the period 19952009 in North America and

Articles
Breast cancer (women)

199599 200004 200509
Mauritius* Mauritius* Mauritius*
Libya Libya Libya
Tunisia Tunisia Tunisia
Algeria Algeria Algeria
South Africa South Africa South Africa
The Gambia* The Gambia* The Gambia*
Mali Mali Mali
Brazil Brazil Brazil
Ecuador Ecuador Ecuador
Puerto Rico* Puerto Rico* Puerto Rico*
Cuba* Cuba* Cuba*
Chile Chile Chile
Argentina Argentina Argentina
Colombia Colombia Colombia
USA USA USA
Canada* Canada* Canada*
Cyprus* Cyprus* Cyprus*
Israel * Israel* Israel*
Qatar* Qatar* Qatar*
Japan Japan Japan
Korea* Korea* Korea*
Taiwan* Taiwan* Taiwan*
China China China
Turkey Turkey Turkey
Indonesia Indonesia Indonesia
Thailand Thailand Thailand
Malaysia Malaysia Malaysia
India India India
Mongolia* Mongolia* Mongolia*
Jordan* Jordan* Jordan*
Saudi Arabia* Saudi Arabia* Saudi Arabia*
France France France
Finland* Finland* Finland*
Sweden* Sweden* Sweden*
Italy Italy Italy
Norway* Norway* Norway*
Switzerland Switzerland Switzerland
Belgium* Belgium* Belgium*
Iceland* Iceland* Iceland*
Germany Germany Germany
Netherlands* Netherlands* Netherlands*
Gibraltar* Gibraltar* Gibraltar*
Spain Spain Spain
Portugal* Portugal* Portugal*
Austria* Austria* Austria*
Denmark* Denmark* Denmark*
UK* UK* UK*
Slovenia* Slovenia* Slovenia*
Ireland* Ireland* Ireland*
Czech Republic* Czech Republic* Czech Republic*
Croatia* Croatia* Croatia*
Malta* Malta* Malta*
Romania Romania Romania
Poland* Poland* Poland*
Bulgaria* Bulgaria* Bulgaria*
Estonia* Estonia* Estonia*
Lithuania* Lithuania* Lithuania*
Slovakia* Slovakia* Slovakia*
Latvia* Latvia* Latvia*
Russia Russia Russia
Australia Australia Australia
New Zealand* New Zealand* New Zealand*
0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100
5-year net survival (%) 5-year net survival (%) 5-year net survival (%)
Figure 2: Global distribution of age-standardised 5-year net survival for women diagnosed with breast cancer during 199599, 200004, and 200509, by continent and country
Age-standardised 5-year net survival estimates for other cancers are presented in the appendix (pp 14151). Survival estimates for every country are ranked from highest to lowest within every
continent; for ease of reference, the ranking for 200509 is used for 199599 and 200004. 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 agged as less reliable because the only estimate or estimates available are from a registry or registries in this category.
Oceania, where survival from colon cancer was either contributed data for 200509 (appendix pp 6480).
stable or improving, and the range of estimates was For patients diagnosed with cancer of the rectum
narrow (appendix p 165). High outlier values for during 200509, age-standardised 5-year net survival
200509 are for Yukon (Canada; 78%, a merged estimate was in the range 5059% in many countries. Survival
based on 109 cases) and Australian Capital Territory was very high (70% or more) in Cyprus, Iceland, and
(Australia; 74%, based on 247 cases; appendix pp 64111). Qatar, and high (6069%) in South Korea,
Data for rectal cancer are available for 1 413 861 patients North America, Oceania, and nine European countries
(table 3). 188 registries in 46 countries provided data for (table 4; appendix p 144). Survival from rectal cancer
199599, 240 registries in 57 countries had data available was very low in India (29%). During 19952009, survival
for 200004, and 238 registries in 60 countries from rectal cancer increased in most countries, but it

Articles

Africa (north) Africa (south, east, and west) America (Central and South) America (North)
100 BRA
ECU USA
5-year net survival (%)
MUS PRI CAN

80 LBY CUB
CHL
TUN ARG
60 DZA COL
ZAF
40
20
GMB MLI
0
Asia (west) Asia (south) Asia (east) Europe (north)

100 FIN
CYP SWE
JPN
ISR NOR
KOR
80 SAU
QAT
TUR
IDN TWN ISL
THA CHN DNK
MYS GBR
IRL
60 IND
MNG EST
LTU
JOR LVA
40
20
0
Europe (west) Europe (south) Europe (east) Oceania

100 ITA
FRA GIB AUS
CHE ESP CZE NZL

80 BEL
DEU
PRT ROU
SVN POL
NLD HRV BGR
AUT SVK
60 MLT
RUS
40
20
0
199599 200004 200509 199599 200004 200509 199599 200004 200509 199599 200004 200509
Figure 3: Trends in age-standardised 5-year net survival for women diagnosed with breast cancer during 199599, 200004, and 200509, by continent or
region and country
Trends in age-standardised 5-year net survival for other cancers are presented in the appendix (pp 15262). 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 agged as less reliable.
was stable or even falling in Argentina, Brazil, Chile, Estonia, Finland, India, Malta, Mongolia, Norway, Russia,
India (Karunagappally), Malaysia, and Uruguay Slovenia, Thailand, and the UK. Estimates judged less
(appendix p 155). reliable were mostly very similar to those that were robust.
Data for liver cancer are available for 894 449 patients 5-year survival from liver cancer increased between
(table 3). 189 registries in 46 countries contributed data for 199599 and 200509 in the two countries in North
199599, 236 registries in 54 countries provided data for America, four countries in Asia, and 13 European
200004, and 236 registries in 57 countries had data countries. Survival declined in Thailand from 16% to 8%
available for 200509 (appendix pp 6480). However, (based on 14 800 cases). The high survival estimate for
international comparisons are more limited for liver Mauritius (53%) is a national gure, but it is based on only
cancer than for other malignant diseases because 23 cases and is not age-standardised.
estimates from 20 countries were agged as less reliable, Data for lung cancer are available for 5 294 261 patients
mainly because of a high proportion of cancer registrations (table 3). 190 registries in 48 countries provided data for
from a death certicate only (appendix pp 2428). 199599, 240 registries in 57 countries contributed data
Age-standardised 5-year net survival from liver cancer was for 200004, and 240 registries in 60 countries had data
generally low (1020%) in most countries, both in the available for 200509 (appendix pp 6480).
developed and developing world, throughout the period Age-standardised 5-year net survival from lung cancer
19952009 (table 4; appendix p 145). Survival only reached was typically low, in the range 1020% for most
20% or more for patients diagnosed during 200509 in geographical areas, both in the developed and developing
some east Asian countries (Japan, South Korea, and world (table 4, appendix pp 146 and 168). The general
Taiwan), where a steady rise in survival from liver cancer pattern is very similar to that of liver cancer. International
has been seen since 199599. Even for 200509, survival variation in survival is less striking than for cancers with
was still very low (less than 10%) in Colombia, Denmark, good prognosis, but dierences are still noticeable.

Articles

Africa 199599 (1)
200004 (1)
200509 (3)
America (Central and South) 199599 (7)

200004 (14)
200509 (14)
America (North) 199599 (45)

200004 (50)
200509 (50)
Asia 199599 (14)

200004 (31)
200509 (38)
Europe 199599 (94)

200004 (111)
200509 (104)
Oceania 199599 (7)

200004 (7)
200509 (7)
0 10 20 30 40 50 60 70 80 90 100
5-year age-standardised net survival (%)
Figure 4: Global range of age-standardised 5-year net survival estimates for women diagnosed with breast cancer in 228 cancer registry patients
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 15 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 16373).
For patients diagnosed during 200509, 5-year survival 78% to 87%), Colombia (from 66% to 76%), and Ecuador
from lung cancer was higher than 20% in only three (from 69% to 83%; gure 3). Survival also rose in Algeria
countries: Japan (30%), Israel (24%), and Mauritius (from 17% to 60%), but this trend is less reliable. We were
(37%). The survival estimate for Mauritius is based on unable to assess survival trends in most other African
only 84 cases diagnosed in 2005 (appendix pp 6480). countries. The very low survival estimate for breast cancer
Survival from lung cancer was very low (less than 10%) in in Mali (136%; Bamako) is not age-standardised and is a
Bulgaria, Lithuania, Mongolia, and Thailand, and only pooled estimate based on 203 women diagnosed during
2% in Libya (Benghazi; based on 317 patients diagnosed 19952004. These women represent only a small proportion
during 200305). Between 199599 and 200509, survival of all those registered with breast cancer in this period; for
from lung cancer rose by 7% in Israel and Japan, most women, obtaining information on their vital status
and it increased in China (from 8% to 18%), India proved impossible. In North America and Oceania, survival
(Karunagappally; from 4% to 10%; appendix pp 81111) from breast cancer was high, with a fairly narrow range
and South Korea (from 10% to 19%). Rises of 24% were between registries (8489%) and with stable or slightly
noted in Colombia, North America, and Europe. Survival improving survival seen up to 200509. Survival also rose
from lung cancer fell from 19% to 10% in Turkey (Izmir), in Europe but was generally lower than in North America
but this reduction could be attributable to improvement and Oceania and with a much wider geographic range
in data quality. Smaller decreases (24%) were seen in (gure 4).
Cyprus, Croatia, Malaysia, and Lithuania. Data for cervical cancer are available for 602 225 women
Data for breast cancer are available for 5 486 928 women (table 3). 192 registries in 51 countries provided data for
(table 3). 193 registries in 49 countries provided data for 199599, 244 registries in 58 countries contributed data
199599, 245 registries in 57 countries had data available for for 200004, and 244 registries in 61 countries provided
200004, and 243 registries in 59 countries contributed data data for 200509 (appendix pp 6480). The global range
for 200509 (appendix pp 6480). Most survival estimates in 5-year net survival from cervical cancer is very wide,
were judged reliable. For women diagnosed during particularly in Africa, Central and South America, and
200509, age-standardised 5-year net survival from breast Asia (table 4; appendix p 169). For women diagnosed with
cancer was 80% or higher in 34 countries around the world cancer of the cervix during 200509, age-standardised
(table 4, gures 2 to 4). However, breast cancer survival was 5-year net survival was 70% or higher in Iceland,
lower than 70% in Malaysia (68%) and India (60%) and very Mauritius, Norway, South Korea, and Taiwan; the
low in Mongolia (57%) and South Africa (53%). Between estimate for Qatar is also above 70% but is based on
199599 and 200509, survival from breast cancer increased only 16 cases and is not age-standardised (table 4;
in Central and South America, particularly in Brazil (from appendix p 147). In 34 of 61 countries around the world,

Articles
Stomach Colon Rectum Liver Lung Breast Cervix Ovary Prostate Leukaemia ALL
(adult) (children)
Africa
Algerian registries
199599 51 108 79 60 171 234 139 440 212
(2082) (79136) (40118) (3980) (138203) (180289) (79199) (343538) (101324)
200004 176 486 412 179 82 295 595 429 555 323
(116237) (336636) (325498) (115244) (46119) (253336) (515675) (208649) (506603) (221425)
200509 103 572 455 175 148 598 551 418 585 136 541
(67140) (456689) (363548) (117234) (112184) (486711) (498604) (222614) (512659) (67205) (313768)
Lesotho (childhood)
199599
200004
200509 395
(164627)
Libya (Benghazi)
199599
200004
200509 30 307 505 02 22 766 394 221 414 62 701
(0076) (210405) (332679) (0008) (0736) (555977) (285504) (103339) (273556) (14110) (434969)
Mali (Bamako)
199599
200004 136
(00301)
200509
Mauritius*
199599
200004
200509 407 555 689 526 372 874 867 827 773 572
(243570) (410701) (486892) (289763) (244500) (781967) (779956) (6381000) (610935) (374769)
Nigeria (Ibadan)
199599
200004 936 974
(837 (8951000)
1000)
200509 01 460 960 910 827
(0004) (184736) (904 (8181000) (5981000)
1000)
South Africa
(Eastern Cape)
199599 715 370
(514916) (247494)
200004 379 630 853
(211547) (542718) (6001000)
200509 102 190 534 549 909 1000
(00229) (00384) (355713) (415683) (6781000) (8551000)
The Gambia*
199599 03 45 300 119 195
(0010) (0288) (36564) (00247) (110280)
200004
200509
Tunisia (central)
199599 69 856
(09129) (715997)
200004 150 767
(43257) (668867)
200509 490 676 785 103 684 424 478 1000 265 501
(279702) (574778) (646924) (00206) (645722) (257590) (252705) (10001000) (150379) (260742)

Articles
(adult) (children)
America (Central and South)
Argentinian
registries
199599 459
(350568)
200004 192 460 444 208 755 520 268 850 646
(149236) (420500) (344543) (163252) (705805) (465575) (177359) (755944) (622670)
200509 160 406 310 242 119 766 506 297 866 900 669
(129192) (345467) (233387) (16467) (96142) (714819) (467545) (237358) (806926) (6801000) (644693)
Brazilian registries
199599 331 559 547 159 186 782 602 351 834 343 719
(247415) (486633) (453641) (71247) (112260) (735828) (550654) (260443) (787882) (162524) (589848)
200004 282 581 528 179 137 869 675 413 930 301 687
(242322) (542620) (466591) (123236) (94180) (843895) (640710) (346481) (905955) (163439) (605770)
200509 249 582 559 116 180 874 611 318 961 203 658
(212286) (544619) (502617) (75157) (128232) (848900) (574649) (255382) (939984) (110297) (577740)
Chilean registries
199599 134 390 733 419 697
(77191) (245536) (582885) (309530) (583812)
200004 164 364 417 45 62 768 555 296 812 103
(127201) (283445) (322512) (1476) (24100) (697840) (491619) (201392) (750875) (48158)
200509 180 433 377 79 63 771 509 322 887 161 664
(143217) (349517) (279475) (20138) (22104) (704838) (443575) (192451) (835938) (84239) (513815)
Colombian registries
199599 154 292 37 61 657 506 273 671 409
(131178) (248337) (0077) (4280) (610703) (468545) (205341) (631711) (315503)
200004 177 423 43 90 704 568 330 805 196 493
(152202) (379467) (1473) (68112) (670739) (533602) (270390) (776834) (78314) (401584)
200509 166 433 53 90 761 593 311 786 201 538
(139192) (388479) (2285) (66114) (722800) (554632) (254368) (754818) (82320) (439636)
Cuba*
199599 262 458 218 728 664 354 545
(232292) (432483) (205232) (701755) (632696) (307400) (515576)
200004 238 441 141 733 619 347 476
(220256) (427456) (134148) (719748) (602637) (319375) (458493)
200509 262 464 182 777 640 398 561 596
(231293) (440488) (170194) (754799) (612667) (355442) (532590) (466727)
Ecuadorian registries
199599 401 615 455 162 345 689 597 352 763 295 636
(349454) (521710) (346565) (92232) (222469) (629749) (545650) (273431) (707819) (223367) (534738)
200004 285 699 483 153 378 796 585 447 909 360 642
(257313) (584815) (386580) (100205) (269487) (745846) (537633) (352542) (865953) (281440) (549736)
200509 319 682 526 177 287 832 617 470 924 335 626
(291346) (577787) (443610) (123232) (220354) (792872) (568665) (371570) (887960) (263407) (537716)
Puerto Rico*
199599
200004 268 603 543 122 148 826 609 345 975 341 788
(243293) (587619) (512573) (94150) (132164) (811841) (572646) (305386) (965985) (300382) (698877)
200509 286 609 578 92 158 830 593 348 977 302 801
(260312) (594623) (547608) (71112) (142174) (816845) (557629) (308388) (968986) (269335) (711890)
Uruguay*
199599
200004 565 530 125
(541590) (490571) (109140)
200509 534 494 91
(505563) (456532) (79103)

Articles
(adult) (children)
America (North)
Canada*
199599 211 568 565 121 151 837 662 365 875 468 858
(204219) (563573) (554575) (112131) (148153) (833841) (648675) (353377) (871879) (459478) (834882)
200004 231 601 605 154 156 853 675 355 910 524 910
(223239) (596606) (596615) (145164) (154159) (849857) (661688) (344366) (907914) (515532) (890929)
200509 248 628 628 177 173 858 668 375 917 552 906
(240256) (624633) (619637) (168187) (171176) (855862) (654681) (363386) (914920) (544560) (886927)
US registries
199599 221 605 600 85 152 860 642 389 932 445 831
(218225) (603607) (596604) (8288) (151153) (858861) (636647) (385392) (930933) (442449) (821840)
200004 258 637 631 119 166 879 636 396 964 488 866
(255262) (635639) (627634) (117122) (165167) (878881) (631641) (393400) (963965) (485491) (858874)
200509 291 647 640 152 187 886 628 409 972 518 877
(287294) (645649) (636643) (149155) (186188) (885887) (623633) (405412) (970973) (515521) (869884)
Asia
Chinese registries
199599 153 335 289 24 75 538 401 410 629 47 109
(122183) (283388) (239339) (1632) (5793) (443632) (300502) (269551) (452806) (1975) (15202)
200004 290 512 480 109 181 780 561 426 558 182 500
(281299) (494530) (462499) (102117) (175188) (755805) (520601) (383470) (505611) (157208) (397602)
200509 313 546 532 125 175 809 599 389 638 212 611
(304321) (531560) (516549) (118133) (169180) (791827) (572627) (364413) (596681) (191234) (513708)
Cyprus*
199599
200004 429 684 184 887
(288570) (605763) (123245) (809965)
200509 263 581 702 98 154 906 645 432 931 613 832
(199326) (487674) (610793) (24171) (122186) (856955) (556735) (343522) (890972) (534692) (697967)
Hong Kong*
199599 687 470
(658717) (410530)
200004 721 533
(699743) (488579)
200509 694 529
(659729) (458600)
Indian registries
199599 212 44 481 491 232 73
(61362) (1969) (372589) (394589) (88377) (09137)
200004 93 332 407 18 98 553 474 357
(42144) (230434) (245570) (0040) (38158) (422685) (360589) (200514)
200509 187 373 294 43 96 604 458 139 581 60 647
(93282) (267480) (175413) (0094) (47145) (465743) (349567) (68210) (383778) (03116) (501792)
Indonesia (Jakarta)
199599
200004
200509 184 281 580 199 122 777 651 399 435 398 443
(00405) (188373) (383778) (43355) (11233) (653902) (558743) (270528) (11859) (201594) (134753)
Israel*
199599 265 600 568 82 173 809 625 389 850 437 823
(248283) (588612) (546590) (60104) (163183) (798819) (587662) (363414) (834866) (415459) (765881)
200004 293 662 625 147 207 855 658 405 919 545 847
(275310) (651673) (605646) (119176) (197217) (845865) (624692) (382428) (908930) (524567) (800895)
200509 286 694 666 142 238 867 659 420 940 504 850
(269303) (683704) (645686) (116167) (228249) (858877) (626693) (397444) (930950) (484524) (805894)

Articles
(adult) (children)
Japanese registries
199599 517 614 566 214 229 818 657 263 657 121 775
(512522) (607621) (555576) (195233) (215243) (808829) (641673) (242284) (634679) (100142) (724826)
200004 536 622 578 264 285 842 651 331 834 179 778
(532541) (616627) (570587) (243285) (275295) (835848) (639664) (313348) (824845) (165194) (728828)
200509 540 644 603 270 301 847 663 373 868 189 811
(536545) (639649) (596611) (255284) (291310) (841853) (652675) (356389) (860877) (176203) (768854)
Jordan*
199599
200004 482 530 263 229 77 576 171 172 355 69 151
(317648) (401658) (118409) (52406) (43112) (464688) (31310) (69275) (238472) (00158) (64238)
200509 288 481 214 171 44 431 103 80 274 71 164
(146430) (350613) (96332) (32311) (2068) (312550) (00218) (29132) (163385) (00163) (68260)
Korea*
199599 328 425 516 108 96 767 737 421 637 154 629
(325331) (419431) (505528) (104113) (9499) (744789) (728746) (396446) (615659) (139170) (601657)
200004 410 604 608 152 152 796 700 433 758 188 728
(408413) (598611) (600615) (149156) (149155) (781810) (695706) (415451) (744773) (176200) (703754)
200509 579 660 659 201 185 827 771 442 822 234 771
(575582) (654666) (652666) (198205) (182188) (814840) (764778) (426458) (811833) (222246) (747795)
Malaysia (Penang)
199599 343 524 483 103 151 648 546 447 624 160 773
(279407) (461587) (384582) (57149) (121180) (568729) (486605) (300593) (520728) (36284) (655892)
200004 265 479 387 192 131 711 584 425 578 252 687
(209321) (427531) (321452) (121263) (106156) (643780) (530637) (303546) (483673) (134371) (565810)
200509 242 533 425 133 107 678 552 429 664 121 694
(196288) (487579) (363487) (93174) (86127) (624733) (502602) (336521) (578749) (74169) (574815)
Mongolia*
199599
200004
200509 151 306 159 85 66 565 595 521 396 356 343
(126176) (225388) (09308) (69100) (4191) (461668) (533658) (397645) (172619) (237475) (119568)
Qatar*
199599
200004
200509 273 682 778 41 132 853 855 372 553 528
(118427) (482881) (583973) (00103) (32232) (668 (716993) (101642) (472634) (296760)
1000)
Saudi Arabia*
199599 336 433 610 235 213 709 622 494 648 614
(208463) (319547) (831000) (155315) (85341) (566853) (506738) (316673) (539758) (471757)
200004 441 490 593 160 129 784 656 530 653 509
(318563) (378602) (731000) (108212) (73185) (683885) (568744) (382679) (558748) (414604)
200509
Taiwan*
199599 361 562 562 171 133 772 754 442 697 243 634
(352370) (552571) (550574) (166176) (128138) (754790) (745763) (410474) (675719) (223263) (594673)
200004 358 571 581 195 116 807 745 443 760 223 718
(350366) (563578) (571591) (191199) (113120) (794821) (736754) (420466) (743777) (207239) (681755)
200509 364 595 605 222 143 824 740 456 779 229 779
(355372) (588602) (595614) (218226) (139147) (811836) (730750) (435478) (765793) (214243) (745813)
Thai registries
199599 185 437 349 156 319 659 550 557 513 97 512
(97274) (340534) (227471) (120192) (202436) (503816) (488613) (361754) (308717) (34160) (395629)
200004 153 522 357 105 97 729 577 473 647 172 589
(111196) (474571) (302412) (92118) (83112) (637820) (544610) (374571) (564729) (122223) (492686)

Articles
(adult) (children)
200509 124 504 397 78 81 713 559 411 577 135 551
(90158) (462546) (347446) (6788) (7092) (658768) (527591) (332490) (507647) (95175) (455646)
Turkey (Izmir)
199599 325 543 475 118 192 728 592 407 774 315 637
(258391) (483604) (404546) (65171) (157227) (676780) (510675) (326488) (693855) (230401) (542733)
200004 200 504 468 192 110 815 634 460 802 364 691
(168232) (468540) (424512) (142241) (97123) (784845) (584685) (381540) (760844) (303425) (609772)
200509 171 529 453 142 101 786 609 390 806 331 731
(149192) (499559) (415490) (104180) (91110) (760812) (563654) (333448) (776836) (288374) (661802)
Europe
Austria*
199599 295 571 548 87 141 787 623 422 847 398 859
(283307) (560581) (535562) (75100) (135147) (778795) (603644) (407438) (838856) (377419) (806912)
200004 300 602 598 110 156 814 654 404 898 433 898
(287313) (593612) (585611) (98122) (150163) (806822) (633674) (389420) (891905) (415451) (853942)
200509 331 630 621 129 179 829 660 416 905 458 911
(317345) (621640) (608634) (116143) (173186) (821837) (638682) (400432) (898912) (441476) (869952)
Belarus (childhood)
199599 747
(694799)
200004 784
(729839)
200509 883
(836930)
Belgium*
199599
200004 279 640 623 199 153 848 660 425 920 575 802
(251308) (623656) (598648) (155244) (143163) (835861) (620700) (393457) (907933) (542607) (698906)
200509 334 646 647 196 166 854 652 430 926 594 897
(319348) (638654) (635660) (177216) (161172) (847860) (631672) (412447) (919932) (577610) (861933)
Bulgaria*
199599 112 395 310 47 59 680 467 277 452 212 580
(102122) (380410) (294326) (3360) (5266) (665695) (449485) (257298) (425478) (190234) (505655)
200004 111 438 369 38 57 712 494 329 497 241 633
(102119) (426450) (355383) (2748) (5064) (700725) (478510) (309349) (473520) (219262) (554712)
200509 129 470 408 50 63 739 530 354 534 250 710
(120138) (458482) (393423) (3863) (5671) (727751) (514546) (335372) (511558) (229271) (642777)
Croatia*
199599 240 501 446 132 165 775 681 375 614 386
(217263) (476527) (415476) (98165) (151179) (750799) (642721) (329422) (568660) (343428)
200004 216 498 465 116 152 751 656 391 677 372 776
(203229) (484512) (448483) (98134) (145160) (737764) (630683) (367414) (655699) (348396) (708844)
200509 213 520 482 122 136 779 653 368 751 376 859
(200226) (507533) (465499) (104140) (129143) (766793) (627680) (346391) (732771) (353399) (800918)
Czech Republic*
199599 166 453 386 47 85 727 613 326 646 428
(157176) (444461) (374399) (3757) (8190) (717737) (598627) (311340) (630661) (408449)
200004 218 514 469 55 109 778 622 345 756 468
(207229) (506522) (457481) (4465) (104114) (770786) (607638) (332359) (744769) (450486)
200509 232 549 503 72 123 800 645 366 831 461
(220243) (541557) (491515) (6084) (118129) (792808) (630661) (353380) (821841) (443478)
Denmark*
199599 138 482 476 26 80 758 631 312 464 454 856
(123153) (471494) (460492) (1635) (7585) (748768) (609654) (295330) (445483) (432475) (794918)
200004 153 521 538 44 96 807 632 332 640 512 845
(137169) (509532) (522553) (3157) (91101) (798816) (608656) (315349) (625655) (491533) (789901)
200509 179 559 584 61 113 820 648 373 772 568 872
(162195) (548570) (569598) (4477) (107119) (811829) (623672) (354392) (759785) (546590) (815929)

Articles
(adult) (children)
Estonia*
199599 200 497 377 54 82 623 582 282 559 374
(182219) (468526) (340413) (2879) (7095) (593652) (544621) (250313) (513606) (329420)
200004 223 488 465 56 109 704 629 313 671 435
(203244) (461515) (430501) (2883) (96123) (678730) (590668) (279348) (637704) (392478)
200509 228 517 489 87 119 724 667 387 732 384 626
(205252) (487546) (449529) (51123) (103135) (696752) (626708) (346428) (699765) (341427) (520733)
Finland*
199599 270 587 546 69 110 828 662 391 793 451 824
(254286) (572602) (525567) (5188) (102117) (817839) (626698) (368414) (779806) (425477) (763884)
200004 259 612 598 72 118 865 681 409 900 476 847
(243276) (598626) (579618) (5588) (110126) (855874) (646716) (390428) (891909) (453500) (780914)
200509 252 629 629 79 123 868 653 449 932 507 819
(235269) (615643) (611648) (6296) (115132) (859877) (617690) (429469) (923940) (484529) (753885)
French registries
199599 257 572 544 111 128 837 663 335 794 546 829
(242272) (561582) (528560) (98125) (122135) (829846) (639688) (316354) (781807) (526566) (810848)
200004 273 597 570 135 139 865 605 398 894 589 884
(258288) (586607) (554586) (123148) (133145) (857873) (577633) (377419) (886902) (572606) (868900)
200509 277 598 568 144 136 869 589 390 905 592 892
(253302) (582614) (545591) (126162) (127146) (857880) (539638) (359422) (894916) (566618) (877908)
German registries
199599 228 487 519 65 116 812 647 377 771 429 867
(215242) (475499) (507531) (4882) (110122) (806818) (633660) (362391) (756785) (409449) (835899)
200004 300 621 602 105 151 841 648 399 893 501 873
(292307) (616627) (596609) (90120) (147154) (837844) (637659) (389410) (887898) (489513) (846899)
200509 316 646 621 144 162 853 649 397 912 536 918
(308323) (641651) (615627) (129160) (158165) (849856) (639659) (387407) (907916) (525546) (898937)
Gibraltar*
199599
200004 824
(703944)
200509 94 579 578 202 844 630 593 674 440
(00220) (438719) (270886) (72333) (734955) (238 (257929) (540807) (70811)
1000)
Iceland*
199599 239 541 517 143 830 636 304 748 391
(174304) (479602) (428607) (114172) (779881) (510762) (211396) (687808) (302480)
200004 342 608 722 16 145 881 707 341 795 566
(261423) (549668) (638807) (0037) (115174) (835928) (618796) (269414) (748841) (456676)
200509 323 651 765 110 150 853 731 386 835 544 841
(243403) (596706) (683846) (48171) (119182) (807899) (618843) (300472) (794875) (431657) (700983)
Ireland*
199599 176 508 481 68 95 731 589 281 698 473 798
(157194) (492524) (456505) (3898) (86103) (715747) (545633) (257306) (678718) (442504) (729867)
200004 187 536 515 118 103 777 581 296 842 549 831
(169206) (521551) (494537) (89147) (94111) (764791) (544619) (273320) (830854) (522576) (769894)
200509 227 586 561 128 129 800 559 322 884 564 853
(207247) (572600) (539583) (100156) (120138) (787813) (526593) (298346) (873895) (539590) (791915)
Italian registries
199599 311 575 533 115 129 828 644 361 791 470 828
(304318) (569581) (523544) (108122) (126133) (823833) (628661) (350372) (782800) (458481) (797859)
200004 320 601 567 155 140 855 671 379 886 473 830
(313326) (596606) (558576) (148162) (137144) (851859) (656686) (369389) (881891) (463483) (799861)
200509 324 632 595 179 147 862 683 392 897 467 877
(317332) (627637) (585604) (172187) (143150) (857866) (667699) (381403) (892902) (456477) (849905)

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(adult) (children)
Latvia*
199599 213 409 341 72 121 641 529 306 519 446
(197229) (385433) (311370) (4499) (108133) (617666) (492566) (280332) (478560) (404489)
200004 207 424 364 72 138 698 517 357 653 431
(190225) (401448) (336392) (43100) (126151) (675721) (480554) (329386) (622685) (389472)
200509 228 453 386 64 162 711 554 356 739 545 750
(210246) (430477) (356415) (4088) (149176) (689734) (519590) (329384) (710768) (495594) (643858)
Lithuania*
199599 244 480 403 54 100 653 532 332 518 366 595
(227261) (452507) (374432) (2384) (87113) (626680) (505559) (297368) (485552) (336397) (494696)
200004 256 516 447 95 83 703 570 330 812 395 726
(240272) (494539) (422472) (62129) (7492) (683723) (545595) (305356) (790834) (368422) (635817)
200509 260 515 483 113 77 721 613 358 924 447 696
(243277) (494537) (458509) (73152) (6887) (702741) (588638) (331386) (906941) (419474) (591801)
Malta*
199599 175 493 498 109 713 588 342 686 386 ..
(119231) (431554) (409588) (80138) (671755) (447729) (259426) (610761) (307464)
200004 155 576 514 108 93 763 528 379 827 242 ..
(107202) (524627) (439590) (45171) (63123) (724802) (379676) (302455) (769886) (168317)
200509 180 560 481 95 108 763 631 331 848 190 725
(128232) (512608) (410552) (65124) (80136) (727799) (493769) (272390) (799897) (128253) (595854)
Netherlands*
199599 190 554 555 82 124 800 639 387 774 469 ..
(181198) (547561) (543566) (6798) (121128) (794806) (620657) (375399) (765783) (454483)
200004 195 577 577 97 122 835 657 373 827 484 845
(186204) (570583) (567588) (82113) (119126) (830841) (638676) (360385) (820834) (471498) (808881)
200509 214 601 620 126 148 850 665 381 858 518 859
(205224) (595607) (610630) (108143) (144151) (845855) (646684) (368393) (852864) (505531) (827892)
Norway*
199599 211 559 578 56 107 815 667 367 738 446 791
(194229) (546572) (561595) (3478) (100115) (803826) (641694) (347388) (725751) (419473) (714868)
200004 220 584 617 74 117 841 706 402 824 489 877
(202239) (572596) (601633) (5197) (109124) (830851) (678735) (382423) (814835) (463515) (823931)
200509 241 618 646 95 150 859 714 403 863 536 897
(221261) (606629) (630662) (69122) (141158) (849870) (686743) (383424) (854872) (510562) (844949)
Poland*
199599 142 400 367 79 114 669 500 306 543 441 ..
(132151) (387413) (353382) (6593) (109119) (654683) (484515) (288324) (521565) (389494)
200004 157 457 428 92 117 723 517 328 685 445 ..
(151162) (451464) (420435) (84101) (114120) (716729) (509526) (319337) (676694) (404485)
200509 186 501 469 104 134 741 530 343 741 490 ..
(180192) (495507) (461476) (95113) (131137) (735747) (521539) (335352) (734749) (452527)
Portugal*
199599 266 488 460 77 104 749 540 339 813 400 665
(245287) (467509) (432488) (47107) (91117) (728769) (500580) (298381) (792834) (353447) (515814)
200004 297 563 542 134 104 814 603 394 872 412 806
(288306) (554573) (529555) (115152) (98110) (805824) (584621) (372417) (862881) (389435) (747865)
200509 326 603 582 156 128 834 615 406 894 436 868
(316335) (594612) (570595) (136175) (121134) (825843) (597632) (384429) (885902) (413458) (807929)
Romania (Cluj)
199599
200004
200509 221 584 468 23 162 750 691 405 795 412
(176265) (521647) (387550) (0344) (135190) (691809) (631751) (309501) (727864) (327498)

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(adult) (children)
Russia (Arkhangelsk)
199599 .. .. .. .. ..
200004 218 355 278 74 147 624 566 372 639 341
(192244) (323388) (238317) (31118) (126169) (581666) (511622) (312432) (549730) (256426)
200509 199 406 304 94 157 706 549 404 696 420
(175223) (373438) (262345) (43145) (136179) (664749) (491606) (342466) (621772) (319522)
Slovakia*
199599
200004 202 497 434 51 96 740 616 348 626 411 789
(188216) (485510) (416452) (3468) (89104) (725756) (592640) (323374) (603649) (383438) (716862)
200509 197 499 440 53 107 721 588 339 660 372 782
(179214) (483515) (416463) (3174) (97117) (703739) (560616) (309369) (632688) (341403) (695870)
Slovenia*
199599 201 451 405 30 85 713 629 334 611 443 831
(183220) (429473) (377433) (1446) (7694) (692735) (595664) (298369) (577644) (398488) (725938)
200004 256 531 484 38 97 783 673 378 727 399 861
(236277) (512551) (459509) (2253) (89106) (765802) (638707) (344412) (702753) (362436) (745976)
200509 267 560 552 52 114 802 689 375 781 379 757
(246288) (539580) (527577) (3370) (104123) (785820) (654725) (344406) (761802) (344414) (638876)
Spanish registries
199599 251 520 490 102 102 778 617 353 737 485 738
(240262) (511530) (474505) (90114) (97107) (768787) (594640) (334371) (723750) (465505) (683793)
200004 253 561 552 143 115 822 634 381 846 507 815
(242264) (552569) (538566) (131154) (110120) (813830) (611657) (362399) (838855) (489525) (769861)
200509 273 593 576 158 126 837 652 384 871 520 833
(261285) (584601) (562590) (146171) (121131) (828845) (629676) (366402) (863879) (502539) (791874)
Sweden*
199599 212 554 579 53 122 838 650 408 754 485 850
(199225) (544565) (566592) (4364) (116129) (831845) (629671) (392424) (745762) (468503) (805895)
200004 210 594 596 68 133 856 666 428 861 550 868
(196223) (585604) (584608) (5680) (127140) (849863) (644688) (412444) (855867) (533567) (826909)
200509 232 625 620 111 156 862 678 435 892 592 855
(217246) (616635) (609632) (95127) (149164) (855869) (656700) (419451) (887898) (575608) (809901)
Swiss registries
199599 236 545 538 90 130 787 635 350 760 517 856
(214258) (528563) (512564) (70111) (121139) (774800) (595675) (324376) (742777) (487547) (803908)
200004 282 614 589 118 145 840 638 357 859 560 873
(259306) (599629) (566613) (99137) (136155) (828851) (597680) (331383) (847870) (533588) (825922)
200509 304 633 638 136 165 855 654 377 880 581 884
(280329) (619648) (615661) (116157) (156175) (844866) (611696) (353402) (870890) (556607) (838930)
UK*
199599 145 481 491 67 73 742 580 328 682 424 791
(141149) (477485) (486497) (6174) (7275) (739745) (571588) (322333) (677687) (417431) (770812)
200004 165 514 539 81 85 787 591 345 803 453 859
(160169) (511518) (534545) (7587) (8487) (784789) (582600) (340350) (800807) (446459) (842877)
200509 185 538 566 93 96 811 602 364 832 474 891
(180190) (535542) (561571) (8799) (9498) (809814) (593611) (359370) (829835) (467480) (876907)
5-year survival was in the range 6069%. In general, cervical cancer is stable or has increased slightly in most
cervical cancer survival was 50% or higher in all other countries (appendix p 158). For example, in Central and
countries, except for Libya (Benghazi, 39%) and India South America, survival was stable at around 60% in
(Karunagappally, 46%). Survival estimates for northeast Brazil, Cuba, Ecuador, and Puerto Rico. In the 10 years
India (Guwahati, 32%; Sikkim, 53%) are agged as less between 199599 and 200509, 5-year net survival
reliable because up to 30% of women could not be traced increased from 42% to 51% in Chile and from 46% to
despite active follow-up (appendix pp 3943). Survival for 51% in Argentina. In France, the decline in survival

Articles
(adult) (children)
Oceania
Australian registries
199599 259 603 599 132 137 846 699 361 837 475 826
(248270) (597610) (589610) (118146) (133142) (840852) (683716) (348374) (831842) (462487) (795857)
200004 278 631 638 143 148 864 684 370 868 510 860
(268289) (625637) (629647) (131154) (144152) (859869) (666703) (357383) (863872) (498521) (833886)
200509 279 642 642 147 150 862 671 375 885 511 886
(267290) (636648) (633651) (135160) (146155) (856868) (651691) (362388) (881889) (500523) (859914)
New Zealand*
199599 222 608 570 116 122 795 643 358 808 477 826
(200243) (595621) (548593) (85146) (113131) (782808) (608679) (330385) (796820) (450504) (760892)
200004 246 609 598 129 114 823 676 387 885 602 858
(224268) (596621) (578619) (103155) (106122) (811835) (640712) (360413) (876894) (579624) (799917)
200509 267 616 608 174 124 837 639 338 887 580 893
(243290) (604628) (588628) (146202) (116133) (825849) (602676) (313362) (877896) (556603) (838948)
Data are net survival estimates (%) with 95% CI. Italics denote survival estimates that are not age-standardised. When too few patients were available for analysis in any calendar period, data were merged and the survival
estimates are underlined. Follow-up was shorter than 5 years for six registries: Libya (Benghazi); The Gambia; Argentina (Mendoza); China (Lianyungang); Indonesia (Jakarta); and Colombia (Manizales: stomach, colon,
breast, cervix, and prostate). ALL=acute lymphoblastic leukaemia. *100% coverage of the national population. 100% coverage of the national population for childhood leukaemia only. South Korea. Survival estimate
considered less reliable.
Table 4: 5-year age-standardised net survival for adults (aged 1599 years) diagnosed with one of ten common malignant diseases and children (aged 014 years) with ALL, by continent,
country, and calendar period of diagnosis
between 199599 and 200004 (from 66% to 61%) was 47%), Estonia (from 28% to 39%), and Japan (from 26%
based on around 1700 women in each period; the survival to 37%), and by 510% in Bulgaria, Denmark, France,
estimate for women diagnosed during 200509 (59%) Hong Kong, Iceland, Latvia, and Portugal (appendix
includes data for only 139 women from two registries p 159). More modest increases (24%) were seen in
(Calvados, 76%; Loire-Atlantique, 49%); the other several countries in South America, Asia, and Europe.
registries could not provide follow-up data for women We were unable to assess any trend in Africa because of
diagnosed with cervical cancer after 2004 (appendix scant reliable data covering the entire period 19952009.
pp 6480). The striking increase in 5-year survival from For women diagnosed with ovarian cancer since 2000,
cervical cancer in China (from 40% to 60%) should be data were available from 60 registries in Asia and Central
interpreted with caution: the estimate for 199599 is and South America (appendix p 170). The range in 5-year
based on data for only 71 women in Changle, Jiashan, survival was very wide. The range is much narrower for
and Zhongshan, whereas the estimates for 200004 the 160 registries in Europe, North America, and Oceania
(56%) and 200509 (60%) are based on data for more that provided data for the same period.
than 1200 women (18 registries) and 3900 women Data for prostate cancer are available for 4 999 267 men
(21 registries), respectively (appendix pp 64111). (table 3). 189 registries in 48 countries contributed data
Data for ovarian cancer are available for 779 302 women for 199599, 241 registries in 57 countries provided
(table 3). 191 registries in 48 countries contributed data data for 200004, and 240 registries in 60 countries
for 199599, 243 registries in 57 countries had data had data for 200509 (appendix pp 6480). Among the
available for 200004, and 241 registries in 61 countries 61 countries that provided data on prostate cancer, the
provided data for 200509 (appendix pp 6480). For range in age-standardised 5-year net survival is very
women diagnosed with ovarian cancer during 200509, wide, from less than 40% to greater than 95%. For men
age-standardised 5-year net survival was 40% or higher in diagnosed during 200509, survival was 90% or higher
Ecuador, the USA, nine countries in Asia, and in Austria, Belgium, Brazil, Canada, Cyprus, Ecuador,
eight countries in Europe (table 4; appendix p 148). Finland, France, Germany, Israel, Italy, Lithuania, Puerto
Survival in other countries was mostly in the range Rico, and the USA (table 4; appendix p 149). In the USA,
3040%, except for Libya (22%). The high survival where widespread prostate-specic antigen (PSA) testing
estimate for Gibraltar (59%) is based on data for only was introduced around 1990, 5-year survival has been
13 women; it is not age-standardised and the CI is wide higher than 90% since 199599. Prostate cancer survival
(table 4); similarly, the very high estimate for Mauritius was 8089% in 19 countries in Central and South
(83%) is based on 52 women diagnosed in 2005. 5-year America, Asia, Europe, and Oceania. In 18 other
survival for ovarian cancer rose by more than 10% countries, survival ranged widely (5079%), but in Libya
between 199599 and 200509 in Ecuador (from 35% to and Mongolia it was 4041%. Striking and persistent

Articles
increases in prostate cancer survival were seen in many mortality in childhood. Survival was less than 50% in
countries between 199599 and 200509 (appendix Indonesia, Mongolia, and Lesotho, although these
p 160). Survival rose by 1020% in 22 countries in estimates are based on very small numbers. The range of
Central and South America, Asia, and Europe; smaller survival estimates for childhood acute lymphoblastic
increases (less than 10%) were seen in 15 countries. leukaemia in Central and South America (16 registries)
Data for leukaemia in adults are available for and Asia (23 registries) is much lower than the range in
873 588 patients (table 3). 185 registries in 47 countries North America (48 registries), Europe (83 registries), and
provided data for 199599, 234 registries in 56 countries Oceania (seven registries; appendix p 173). 5-year survival
contributed data for 200004, and 232 registries in for childhood acute lymphoblastic leukaemia rose by 10%
60 countries provided data for 200509 (appendix or more between 199599 and 200509 in Belarus,
pp 6480). For adults diagnosed with leukaemia during Belgium, Bulgaria, China, Colombia, Lithuania, Norway,
200509, age-standardised 5-year net survival was Portugal, South Korea, Spain, Taiwan, and the UK. The
5060% in 21 countries in North America, west Asia, estimate of 11% from China for 199599 is based on only
Europe, and Oceania (table 4; appendix p 150). The 23 children, but the increase from 50% for 200004 to 61%
estimate in Mauritius (57%) is based on 31 patients for 200509 is more reliable. Increases in survival of up to
diagnosed in 2005; it is not age-standardised and has a 9% were seen in 16 other countries. 5-year survival in
wide CI. Similarly, the estimate for Cuba (60%) is based Argentina, Ecuador, and Slovakia was in the range 6079%,
on only 97 patients diagnosed during 19982006. 5-year with little or no change over time. Survival seemed to fall
net survival from adult leukaemia is generally much in Brazil (from 72% to 66%), Malaysia (from 77% to 69%),
lower in the 15 participating Asian countries than in and Slovenia (from 8386% in 19952004 to 76% for
other regions of the world (appendix pp 16373). With a 200509). Survival trends could not be assessed in Africa.
few exceptions, survival seems to be low in east Asia (eg,
from 19% in Japan to 23% in South Korea and Taiwan), Discussion
high in west Asia (eg, from 33% in Turkey to 53% in With CONCORD-2, we have initiated worldwide
Qatar), with a mixed picture in other Asian countries (eg, surveillance of trends in cancer survival. In the rst
from 7% in Jordan to 40% in Indonesia). Survival CONCORD study,6 comparable estimates of cancer
estimates for adult leukaemia from Jordan, India, and survival worldwide were provided: the study included
Saudi Arabia might be less reliable for international 19 million patients diagnosed with breast, colorectal, or
comparison, but the overall pattern of leukaemia survival prostate cancer during 199094 and followed up to 1999 in
in Asia is still informative. Survival increases of 1016% 31 countries (panel). CONCORD-2 extends coverage to
for adult leukaemia were seen in China, Denmark, 257 million patients diagnosed with an invasive primary
Germany, Iceland, Latvia, Sweden, and New Zealand. cancer during the 15-year period 19952009 in 67 countries.
Smaller rises of 59% were noted in North America, The ten index cancers represent about two-thirds of
Israel, Japan, South Korea, and ten European countries. the overall cancer burden in both low-income and high-
In Malta, 5-year survival fell from 39% in 199599 (based income countries.4 Individual patient data provided by
on 142 adults) to 19% for 200509 (128 adults; appendix p 279 population-based cancer registries were prepared with
161). This pattern is surprising, because data quality is standardised quality-control procedures and subjected to
very high (appendix pp 5458) and survival trends for all centralised analysis with the latest statistical methods.
solid tumours seem to be normal. Smaller declines were The ndings do not cover all countries, but they provide
seen in several countries, such as Slovakia (from 41% to at least some population-based cancer survival estimates
37%) and Slovenia (from 44% to 38%). for 67 countries (26 of low or middle income) that are
Data for acute lymphoblastic leukaemia in children are home to two-thirds of the worlds population, including
available for 74 343 patients (table 3). 173 registries in national data for 40 countries. The estimates are derived
42 countries contributed data for 199599, 215 registries in from analysis of raw data on the survival of individual
50 countries provided data for 200004, and 213 registries cancer patients up to 5 years after diagnosis. Until now,
in 53 countries provided data for 200509. In Romania for comparison of global or continental survival,
(Cluj), data were only available for eight children and researchers generally needed to interpret scattered
survival was not estimated. Of 53 countries, 32 provided reports produced with diverse cancer denitions,
data with 100% national population coverage. The quality-control criteria, and survival estimators, for
geographic range in survival for acute lymphoblastic dierent calendar periods, and age-standardised to
leukaemia in children was very wide. For patients dierent sets of weights.46 More speculative comparisons
diagnosed during 200509, age-standardised 5-year net have been based on modelling of mortality-incidence
survival was 90% or higher in Austria, Belgium, Canada, ratios, sometimes with data from neighbouring regions
Germany, and Norway and 8089% in 21 countries on or countries,47 with all the attendant assumptions.48
various continents (table 4; appendix p 151). In many Even after adjustment for the wide international
countries, however, 5-year net survival is still lower than variation in levels of mortality from other causes, and
60%, even after adjustment for the very high background with due allowance for variation in quality of data, the

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global range in 5-year survival from ten cancers in adults

and acute lymphoblastic leukaemia in children is very Panel: Research in context
wide. For most cancers, survival in Africa, Asia, and Systematic review
Central and South America is lower, and the range in In the rst global comparison of population-based cancer survival (CONCORD),6 wide
survival much wider, than in Europe, North America, variations in survival from cancers of the breast (women), colon, rectum, and prostate
and Oceania. The wider range is only partly attributable were reported among 19 million adults diagnosed during 199094 and followed up to
to the fact that not all cancer registries could provide data 1999 in 31 countries (16 countries had national coverage). More recent studies have
covering the 15 years from 1995 to 2009; for example, diered with respect to geographic and population coverage, calendar period, and
many of the Chinese registries contributed data for analytical methods, and they do not enable worldwide comparison of survival trends.79
200004 but not 200509. In North America and Oceania, With CONCORD-2, we have extended coverage to 257 million cancer patients diagnosed
population coverage was higher than 80% and the same during the 15-year period 19952009 in one of 67 countries (26 of low or middle
registries generally provided data for the entire period income), of which 40 countries had national coverage.
19952009 (gure 4; appendix pp 16373): survival for
most cancers was high on a global scale, with a fairly Interpretation
narrow range in estimates between registries. The ten index cancers we selected for analysis represent two-thirds of the overall cancer
5-year net survival from stomach cancer is generally in burden in both low-income and high-income countries. 5-year survival from colon, rectal,
the range 2530%, but it is very high (5060%) in Japan, and breast cancers has increased in most developed countries. Liver and lung cancer
South Korea, and, to a lesser extent, Taiwan. High remain lethal in both developing and developed countries. Striking increases in prostate
survival from stomach cancer in Japan,49 South Korea,50 cancer survival have occurred in many countries, but trends vary widely. The range in
and Taiwan51 is well known, and is likely to be attributable cervical and ovarian cancer survival is very wide, but improvements have been slight. In
to intensive diagnostic activity, early stage at diagnosis, east Asia, stomach cancer survival is very high, suggesting lessons could be learnt,
and radical surgery. Survival varies according to sub-site, whereas survival for adult and childhood leukaemia is remarkably low. The global range in
morphological type, and stage. Types of cancer with survival from precursor-cell acute lymphoblastic leukaemia in children is very wide,
better prognosis might also be more common in Japan suggesting major deciencies in the management of what is now a largely curable
and South Korea, but the striking worldwide dierences disease. The ndings of our study can be used to assess the extent to which investment in
in survival suggest important lessons could be learnt health-care systems is improving their eectiveness.
from these countries about diagnosis and treatment.
5-year survival has risen for colon and rectal cancers in disease and cirrhosis and are not amenable to surgery.61
most developed countries and regions, including North Overall completeness of registration is low, but the
America, Europe, Oceania, and parts of east Asia (South incidence of liver cancer is comparable with that of other
Korea and urban areas in China); increases in breast west African populations.62 Data from the national cancer
cancer survival have also been noted in these regions and registry for The Gambia, set up in 1986 to support the
in parts of Central and South America. These trends are IARCs Gambia Hepatitis Intervention Study,63 have been
likely to be attributable to earlier diagnosis, reduction in analysed previously,64 but more recent data were
postoperative mortality,52 and more eective treatment.53,54 unavailable, so we cleaned and analysed them here
For rectal cancer, preoperative radiotherapy and total alongside all other datasets, with permission from IARC.
mesorectal excision reduce local recurrence and extend The global range in 5-year survival from cervical cancer
survival,5557 which could account for improvements is very wide, from less than 40% to more than 70%. The
noted in Canada, Finland, the Netherlands, Norway, overall decline in survival from 66% to 61% in France
Sweden, and the USA, where survival was already high between 199599 and 200004 was seen in all nine
(5560%) for patients diagnosed in 199599 and rose registries (appendix p 105). The decrease might be
further for those diagnosed during 200509 (6265%). attributable to removal of less aggressive tumours by
These trends accord with those reported from the more intensive cervical screening for preinvasive
Netherlands,58 Scotland, the Nordic countries,59 and lesions.65,66 Survival from cervical cancer in the Nordic
elsewhere in Europe.60 countries was stable or rose slightly over the same
Liver and lung cancer remain lethal in both developing period.67 By comparison, lower survival in low-income
and developed countries, with 5-year survival generally and middle-income countries is striking, since invasive
lower than 20%, indicating that most patients are still cervical cancer is potentially curable with early detection
diagnosed when they are inoperable. Primary prevention by screening and appropriate surgery.68
aimed at reducing tobacco and alcohol consumption, and 5-year survival from ovarian cancer is generally in the
prevention of chronic hepatitis, will be especially range 3040% in most parts of the world, but the overall
important for these cancers. The very low survival estimate range is much wider. Diversity in international survival
for liver cancer in The Gambia (5%) is based on a sample might be attributable partly to variations in the proportion
of only 85 patients diagnosed during 199597 who were of tumours classied as type I (typically early-stage and
followed up for less than 5 years, to the end of 1998; it is slow-growing) and type II (typically late-stage and
not age-standardised, but it is unlikely to be far wrong: aggressive).69 Dierences in stage at diagnosis and
patients in The Gambia tend to present with very advanced treatment are also likely to be important.70 Dierential

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classication of borderline and invasive tumours might these exclusions will have biased survival estimates
also contribute. Overall, however, worldwide survival upwards. Thus, the proportion of cancer registrations
trends show very little improvement between 199599 from a death certicate only was typically higher in
and 200509 (appendix p 158). This nding accords with countries where survival is low. This leads to exclusion
the absence of improvement reported from many from analysis of a group of patients who tend to have
developed countries.7,9 low survival,80 leading to overestimation of the level of
Striking increases in 5-year survival from prostate survival in that population. This bias would tend to
cancer have occurred in many countries, but global reduce international dierences.
trends varied widely. Examples include three northern Various indications suggest that the data submitted by
European countries, all with nationwide cancer some registries were not exhaustive, either because there
registration. 5-year survival in Lithuania jumped from were fewer cancer patients than expected or because the
52% for men diagnosed during 199599 to 92% for full range of haemopoietic malignant diseases was not
those diagnosed during 200509. The rise in Latvia was represented in some of the leukaemia datasets. The
from 52% to 74%: access to health care in these smaller number of cancer registrations in Poland for
countries has improved, and opportunistic PSA 199599 reects a national strike of doctors in 1997, but
screening began in 2000.71 In Denmark, survival rose we have little reason to suppose this type of
from 46% to 77% over the same period, having been incompleteness would bias survival estimates.
stable at 40% throughout the period 198294,72 during Pathological conrmation of diagnosis was available
which time survival increased rapidly in the other four for more than 90% of cancers included in the analyses
Nordic countries.73 The Danish Urology Society advised (985% for childhood acute lymphoblastic leukaemia),
against PSA testing in asymptomatic men in the early and less than 4% of malignant diseases were assigned to
1990s,74 but this advice is now followed less widely. a non-specic morphology code. Nevertheless, consider-
By contrast, survival in North America and Oceania was able variation was noted, and pathological evidence was
already very high in the late 1990s, and increases since much less complete for some populations in low-income
then have been much smaller. In Africa, we were and middle-income countries (table 2; appendix pp 363).
unable to assess a trend. Several registries reported high proportions of intestinal-
Survival from both adult and childhood leukaemia in type adenocarcinoma in the colon and rectum: this
east Asia is surprisingly low. The low survival for adult morphological type was originally described (in 1965) for
leukaemia in Japan, South Korea, and Taiwan is especially carcinoma of the stomach81 and is included in ICD-O-3
surprising, because survival from solid tumours is (M8144). A similar issue arose with cholangiocarcinoma
generally high. Could ethnic or genetic factors play a part? (M8160) coded as arising in the liver (ICD-O-3 site code
This possibility has been suggested in a recent comparison C22.0) rather than the intrahepatic bile duct (C22.1). If we
of survival from chronic lymphocytic leukaemia between were told that pathologists frequently use these terms for
Taiwan and the USA.75 Leukaemia survival is also low in malignant disease of the large bowel or liver, respectively,
China, but haematological malignant diseases have we included the patients in our analyses.
received low priority in cancer control there, with limited The distribution of cancers within an organ by anatomic
access to health insurance and chemotherapy,76 and sub-site or morphological type can dier between
medical resources in rural areas are poor.77 populations, so any dierences in survival by sub-site or
The global range in 5-year survival from acute morphological features could aect comparisons of overall
lymphoblastic leukaemia in children is very wide, from survival. We will address the eect on survival of these
less than 60% in several countries to 90% or higher in dierences in biology with more detailed analyses,
Austria, Belgium, Canada, Germany, and Norway. This particularly for cancers of the stomach, lung, and ovary.
nding conrms that major deciencies are present in Leukaemia comprises a broad and heterogeneous group of
the management of what is now a largely curable disease.78 diseases. We excluded chronic myeloid leukaemia; survival
Failure to start or complete treatment, usually for nancial for other major groups will be investigated in more detail.
reasons, is an important contributor to the survival decit Premalignant and small malignant lesions can be
in developing countries.79 detected more frequently in countries with mass
Standardised quality controls were applied system- screening programmes or intensive early diagnostic
atically to all datasets. Detailed discussions were held activity, particularly for cancers of the breast, cervix,
with every registry to identify and correct any errors or colon, rectum, and prostate. Dierences in tumour stage
artifacts in the data. Many registries resubmitted their at diagnosis can contribute to international variations in
data after correction, which greatly improved data overall survival between low-income countries.8 Wide
quality and comparability. The overall proportion of dierences in tumour stage at diagnosis and
eligible tumours excluded from analysis was low stage-specic survival have also been recorded among
(36%), but it was much higher for some registries and high-income countries.59,70,8284 High-resolution studies of
varied widely between cancers. For some populations, tumour stage at diagnosis, treatment, and adherence to
mostly in low-income and middle-income countries, guidelines have helped account for international

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dierences in survival.55,8587 The comparability of data quality and completeness of data and follow-up can be
gathered routinely on cancer stage remains poor easier to achieve in small or island populations than in
in developed countries,88 even though the TNM large urban populations.
classication89 has been available for more than 60 years. For robust international comparison of cancer survival,
We will examine in more detail the extent to which dierences and trends in background mortality according
available data on tumour stage can explain the very wide to age, sex, region, and ethnic origin must be taken into
global dierences in survival reported by us here. account. In the populations covered by these data, the
We imputed the day of diagnosis in data from registries range in background mortality was very wide, measured by
that only record (or were only allowed to submit) the life expectancy at birth (4687 years in females and
month and year of diagnosis. A few of those registries 4581 years in males), and by the change in life expectancy
also submitted survival time in days; our imputation between 1995 and 2009 (appendix p 175), and in other
achieved similar results. The eect on short-term survival metrics such as the probability of death in middle age (data
of minor variations in the date of diagnosis is generally not shown). We created more than 6500 complete life
small90 and cannot account for the very wide international tables of background mortality to capture these dierences.
dierences in 5-year survival.91 For children with cancer, usual practice is to present the
Loss to follow-up of cancer patients in registries using observed probability of survival, including all causes of
active follow-up varied widely, but most registries also death,97 rather than net survival, because mortality from
used several passive follow-up techniques. Dierences other causes is typically very low, at least in developed
between the databases used for passive follow-up can countries. Here, however, we have estimated net survival
aect survival estimates.92,93 When information for all for children with acute lymphoblastic leukaemia because,
deaths is incomplete or inaccessible from administrative among the 53 countries for which data could be analysed,
systems, active follow-up by the registry augments mortality from other causes in childhood varied very widely.
completeness of ascertainment of vital status, particularly In 2002, infant mortality ranged from less than one death
in low-income and middle-income countries.94 Some per 1000 population to more than 120 deaths per 1000 popu-
registries did not have the resources to follow up all their lation (in some African populations); under-5 mortality
patients for vital status. Others could not provide ranged from less than one death per 1000 population to
follow-up data for at least 5 years after diagnosis for all more than 200 deaths per 1000 population; and the overall
their patients; for those registries, we have presented probability of death before age 15 years ranged from
survival at 3 or 4 years if possible. one death per 1000 population to more than 250 per
If age-specic (and thus age-standardised) survival 1000 population (data not shown). For a worldwide
estimates could not be produced, non-standardised comparison of survival from childhood acute lymphoblastic
estimates for all ages combined were presented. leukaemia, it seemed especially important to eliminate the
In some analyses, data had to be pooled across two or eect of this wide variation in background mortality
three calendar periods, restricting presentation of between countries and over time.
survival trends. For some countries or regions with very Net survival was age-standardised in most estimates
small populations, no survival estimate could be made for both adults and children. Age standardisation
at all for less common cancers, because very few minimises the risk of reporting international dierences
patients were available for analysis. or trends in cancer survival that are attributable solely to
We used a rigorously enforced protocol, with centralised international dierences or changes over time in the age
data evaluation and analysis to enhance comparability, distribution of cancer patients.42
but international survival comparisons should still be We included both rst and higher order cancers in our
interpreted with caution. Data quality varies widely:95,96 analyses. The eect of multiple primary cancers on overall
we provided detailed indices of data quality at country survival is typically only 12%,98 but the proportion of such
and registry level (table 2; appendix pp 363), which cancers in a given population is aected by the set of rules
should be taken into account. Not all countries could used to dene them99 and by the longevity of the registry.100
provide data for 200509. Also, the range in size between Some participating registries began operation in the 1950s
the smallest and largest populations included in this whereas others only started after 2000. In long-established
report is greater than 1000-fold, both for registries with registries, 10% or more of patients might be registered
national coverage (eg, Gibraltar includes 29 000 people with more than one cancer.101 This proportion is lower in
and the UK covers 618 million people) and those with newer registries, because a second cancer will typically be
regional coverage (eg, Nunavut in Canada represents registered as the patients rst. Restriction to rst primaries
33 000 people whereas California in the USA includes can also aect international comparison of survival trends,
370 million people). These dierences are reected in because the number of long-term survivors at high risk of
the numbers of patients and the width of CIs around another cancer is increasing, particularly in high-income
survival estimates. However, lack of precision because of countries.102 Exclusion of second cancers would, therefore,
small numbers does not necessarily imply that the tend to bias international survival comparisons in favour
survival estimates are incorrect or unreliable: high of wealthier countries.103 The rules for dening multiple

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primary cancers dier between North America and the National health-care systems must manage all cancer
rest of the world,24,25 but in a novel step, data from registries patients, however they are diagnosed, even if some patients
in North America were rst converted to IACR denitions might not have been diagnosed before widespread
used elsewhere, before being submitted for analysis. This adoption of new diagnostic techniques or screening
alteration will have minimised any eect on international programmes. In a given country, incidence and survival
survival comparisons presented here. estimates reect current approaches to prevention,
To maintain the breadth of global surveillance of diagnosis, and treatment.6 Coherent assessment of
survival, we retained some datasets that seemed less preventive and health-care strategies, therefore, requires
suitable for international comparison than all other that all cancer patients are included, no matter how they
estimates, but we agged these survival estimates to are diagnosed, in both incidence and survival estimates.
inform interpretation. The number of agged estimates Projections of the future burden of cancer106 are based on
is larger than in the rst CONCORD study6 because more the same cancer incidence data.
registries are from low-income countries and the data Some cancer registries followed up their patients for
cover a much longer period. Residual errors and artifacts the rst time so they could participate in CONCORD-2.
in data undoubtedly exist, but they are unlikely to account Other registries, not all of them in low-income countries,
for global patterns and trends in cancer survival. were prevented from participating by scant resources
We used an unbiased estimator of net survival.104 To our either to follow up registered patients for vital status or to
knowledge, this is the rst time this estimator has been prepare data for submission. This decit underscores the
used for an international comparison. We used the period continued fragility, low coverage, and scarcity of
approach33 to estimate survival up to 5 years after diagnosis resources for cancer registries.4,107,108 In many countries,
for patients diagnosed during 200509 (appendix p 174). even the basic infrastructure of a civil registration system
This approach oers reliable prediction of the eventual and vital statistics is decient.109 This absence is especially
survival of recently diagnosed patients who have not all severe in Africa, where several participating countries
been followed up for 5 years.105 have also been subject to civil or military conict within
A small part of the global range in survival could be the past 1015 years and where, with few exceptions,
attributable to dierences in the intensity of diagnostic assessment of recent survival trends from available data
activity. The introduction of new diagnostic techniques in was almost impossible.
wealthier countries, such as PSA testing for prostate Cancer registries are crucial to our understanding of
cancer, has led to more patients being diagnosed at an the global cancer burden,107 and they need to be funded
early stage of disease, typically with a good prognosis, thus and equipped to gather, analyse, and publish incidence
inating both incidence and survival. We were not able to and survival data at national or regional level. Worldwide
use the proportion of in situ cancers for international monitoring of cancer incidence has been done since the
comparison of the intensity of diagnostic activity for 1960s, with centralised data collection and standardised
cancers of the colon, rectum, breast, cervix, or prostate. methods in Cancer Incidence in Five Continents.16 IARCs
Some registries do not collect data for in situ tumours, Global Initiative for Cancer Registry Development is an
whereas some registries that do collect this information important stimulus to promote high-quality data
did not include these data in their submissions. In poorer collection and cancer registration in low-income and
countries, by contrast, many patients still die undiagnosed middle-income countries.108
or untreated.68 Both WHO3 and the UN110 have recognised cancer as a
For some cancers, both incidence and survival in worldwide public health issue of growing concern.
countries with the most intensive diagnostic activity could However, if cancer registration is to develop further in
be inated slightly by overdiagnosis, but the eect on the support of the 25 25 goals and in the evaluation of
global range of survival estimates is probably small. clinical care,111 WHO and the UN will need to address
Equally, in the poorest countries, under-registration of the growing legal and procedural diculties in
cancer patients with the worst prognosis might lead to obtaining primary health data and in accessing them for
underestimation of incidence and overestimation of research. For example, legislation now at the nal stage
survival. Even though some survival estimates in of discussion in the European Union would make
low-income and middle-income countries might be too cancer registration and most forms of public health
high for this reason, it is striking that for cancers of the research either impossible or illegal in 28 European
colon, rectum, lung, and breast, and particularly for countries.112,113
leukaemia in adults and children, the range of estimates The CONCORD programme at the London School of
in Africa and Central and South America for patients Hygiene & Tropical Medicine (LSHTM) represents the
diagnosed during 200509 is still much lower than in establishment of worldwide surveillance of cancer
North America and Oceania during 199599, 10 years survival by centralised quality control and analysis of
earlier (gure 4; appendix pp 16373). As reported population-based registry data, as a comparative metric
elsewhere,68 these patterns strongly suggest inadequate of the eectiveness of health systems. It will provide part
access to early diagnosis and optimum treatment. of the evidence base for global policy on cancer control

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and should contribute to the overarching goal of the Contributors

World Cancer Declaration 201314 and, more broadly, to CA, HKW, RM-G, CS, GAS, BR, HS, TCT and MPC drafted the protocol;
CA, HKW, GAS, W-QC, OJO, MJS, HY, TM, MB-L, TCT, and MPC
the revolution in metrics for global health.114 obtained statutory and ethics approvals; HKW, FB, CJJ, RM-G, CS, GAS,
At a national level, cancer outcomes are aected by the W-QC, OJO, MJS, HY, TM, MB-L, HS, and TCT contributed to data
organisation and funding of access to health services.115 acquisition; CA, DS, FB, MPC and BR prepared the life tables; CA, HC,
Improvements in cancer survival have been reported RH, DS, X-SW, FB, JVA, AB, BR, and MPC had access to all raw data;
CA, HC, RH, DS, X-SW, FB, JVA, CJJ, AB, and MPC did the data
after major political and economic changes in Estonia,116 preparation, quality control and analyses, and checked the results; CA
Lithuania,117 and Germany.118 In turn, low survival has and MPC drafted the report. All authors contributed to writing the nal
aected the development of cancer strategy in countries report and approved the version to be published. All members of the
such as Algeria,119 Brazil,120,121 Mexico,122 China, India, and CONCORD Working Group had access to the results at all steps of data
preparation, quality control, and analyses, and contributed to
Russia,123 and in many wealthier countries.4 interpretation of the ndings.
Some of the conclusions drawn from these analyses
CONCORD Working Group
are similar to those for patients diagnosed 2025 years AfricaAlgeria: S Bouzbid (Registre du Cancer dAnnaba);
ago.6 The ndings of this study can be used to assess the M Hamdi-Chrif*, Z Zaidi (Registre du Cancer de Stif); Gambia: E Bah,
extent to which investment in health-care systems is R Swaminathan (National Cancer Registry); Lesotho: SH Nortje, CD Stefan
(Childrens Haematology Oncology Clinics - Lesotho); Libya: MM El Mistiri
improving their eectiveness. We will examine survival
(Benghazi Cancer Registry); Mali: S Bayo, B Malle (Kankou Moussa
trends and dierentials in relation to health economic University); Mauritius: SS Manraj, R Sewpaul-Sungkur (Mauritius Cancer
indicators to assess why improvements in survival are so Registry); Nigeria: A Fabowale, OJ Ogunbiyi* (Ibadan Cancer Registry);
slow and unequal. South Africa: D Bradshaw, NIM Somdyala (Eastern Cape Province Cancer
Registry); Sudan: M Abdel-Rahman (University of Khartoum); Tunisia:
Most of the wide global range in cancer survival is
L Jaidane, M Mokni (Registre du Cancer du Centre Tunisien).
probably attributable to inequity in access to optimum America (Central and South)Argentina: I Kumcher, F Moreno
diagnostic and treatment services,6 both in rich124126 and (National Childhood Cancer Registry); MS Gonzlez, E Laura (Registro
poor127,128 countries. Availability of linear accelerators varies Regional de Tumores del Sur de la Provincia de Buenos Aires); FV Pugh,
ME Torrent (Chubut Cancer Registry); B Carballo Quintero, R Fita
more than ten-fold worldwide, from one machine per
(Registro de Tumores de Crdoba); D Garcilazo, PL Giacciani (Entre Rios
500 000 population to less than one per ve million people, Cancer Registry); MC Diumenjo, WD Laspada (Registro Provincial de
and more than 30 countries in Africa and Asia have no Tumores de Mendoza); MA Green, MF Lanza (Registro de Cncer de
radiotherapy service at all.129 Cancer survival in Europe has Santa Fe); SG Ibaez (Tierra del Fuego Cancer Registry); Brazil:
CA Lima, E Lobo (Registro de Cncer de Base Populacional de Aracaju);
been associated with gross national product, total national C Daniel, C Scandiuzzi (Cancer Registry of Distrito Federal);
expenditure on health and investment in health technology PCF De Souza (Registro de Cncer de Base Populacional de Cuiab);
(eg, CT scanners, radiotherapy units),130 and with K Del Pino, C Laporte (Registro de Curitiba); MP Curado, JC de Oliveira
suboptimum allocation of available resources.86 The global (Registro de Goinia); CLA Veneziano, DB Veneziano (Registro de
Cncer de Base Populacional de Jahu); TS Alexandre, AS Verdugo
economic cost of cancer from premature death and lost (Registro de Cncer de So Paulo); S Koifman* (National School of
productivity was estimated at US$895 billion in 2008, Public Health); G Azevedo e Silva* (University of Rio de Janeiro); Chile:
excluding direct treatment costs estimated at $300 billion.131 JC Galaz, JA Moya (Registro Poblacional de Cncer Region de
Even in wealthy countries, the rapidly growing costs of Antofagasta); DA Herrmann, AM Jofre (Registro Poblacional Region de
Los Rios); Colombia: CJ Uribe (Registro Poblacional de Cncer Area
cancer treatment have raised concerns about the growing Metropolitana de Bucaramanga); LE Bravo (Cali Cancer Registry);
use of tests, imaging, and treatments that are expensive G Lopez Guarnizo (Registro Poblacional de Cncer Manizales);
but have marginal value.132 At the same time, closing the DM Jurado, MC Yepes (Registro Poblacional de Cncer del Municipio de
richpoor divide in access to cancer treatment has been Pasto); Cuba: YH Galn, P Torres (Registro Nacional de Cncer de
Cuba); Ecuador: F Martnez-Reyes (Cuenca Tumor Registry); L Jaramillo,
described as an equity imperative.133,134 The ndings R Quinto (Guayaquil Cancer Registry); P Cueva, J Ypez (Quito Cancer
reported here conrm the global divide in outcomes. Registry); Puerto Rico: CR Torres-Cintrn, G Tortolero-Luna (Puerto Rico
The rst international study of cancer survival was Central Cancer Registry); Uruguay: R Alonso, E Barrios (Registro
published 50 years ago.5 In the same year, Nacional de Cncer).
America (North)Canada: C Russell, L Shack (Alberta Cancer Registry);
Alexander Langmuir, founder of the US Centers for AJ Coldman, RR Woods (British Columbia Cancer Registry); G Noonan,
Disease Control and Preventions epidemic intelligence D Turner* (Manitoba Cancer Registry); E Kumar, B Zhang
service, commented on national outbreaks of infectious (New Brunswick Provincial Cancer Registry); FR McCrate, S Ryan
disease: good surveillance does not necessarily ensure (Newfoundland Cancer Registry); H Hannah (Northwest Territories
Cancer Registry); RAD Dewar, M MacIntyre (Nova Scotia Surveillance
the making of the right decisions, but it reduces the and Epidemiology Unit); A Lalany, M Ruta (Nunavut Department of
chances of wrong ones.135 His view applies today to Health and Social Services); L Marrett, DE Nishri* (Ontario Cancer
non-communicable diseases such as cancer, for which Registry); KA Vriends (Prince Edward Island Cancer Registry);
C Bertrand, R Louchini (Registre Qubcois du Cancer); KI Robb,
long-term surveillance of incidence, mortality, and
H Stuart-Panko (Saskatchewan Cancer Registry); S Demers, S Wright
survival is increasingly important. Survival is a key metric (Yukon Government); USA: J George, X Shen (Alabama Statewide
of overall progress in cancer control.4 Continuous Cancer Registry); JT Brockhouse, DK OBrien (Alaska Cancer Registry);
worldwide surveillance of cancer survival should become L Almon, JL Young* (Metropolitan Atlanta Registry); J Bates (California
State Cancer Registry); R Rycroft (Colorado Central Cancer Registry);
both an indispensable source of information for cancer
L Mueller, C Phillips (Connecticut Tumor Registry); H Ryan, J Walrath
patients and researchers and a stimulus for politicians to (Delaware Cancer Registry); A Schwartz, F Vigneau (Metropolitan Detroit
improve health policy and health-care systems.

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Cancer Surveillance System); JA MacKinnon, B Wohler (Florida Cancer Turkey: S Eser, CI Yakut (Izmir Cancer Registry).
Data System); R Bayakly, KC Ward (Georgia Comprehensive Cancer EuropeAustria: M Hackl, N Zielonke (Austrian National Cancer
Registry); K Davidson-Allen, S Glaser (Greater Bay Area Cancer Registry); Registry); H Mhlbck, W Oberaigner (Tyrol Cancer Registry);
D West (Cancer Registry of Greater California); MD Green, M Pieros* (IAEA, PACT Programme); Belarus: AA Zborovskaya
BY Hernandez (Hawaii Tumor Registry); CJ Johnson (Cancer Data (Belarus Childhood Cancer Subregistry); Belgium: K Henau,
Registry of Idaho); CF Lynch, KM McKeen (State Health Registry of L Van Eycken (Belgian Cancer Registry); Bulgaria: N Dimitrova,
Iowa); B Huang, TC Tucker* (Kentucky Cancer Registry); D Deapen, Z Valerianova (Bulgarian National Cancer Registry); Croatia: M ekerija,
L Liu (Los Angeles Cancer Surveillance Program); MC Hsieh, XC Wu A Znaor (Croatian National Cancer Registry); Czech Republic: M Zvolsk
(Louisiana Tumor Registry); K Stern (Maryland Cancer Registry); (Czech National Cancer Registry); Denmark: G Engholm, H Storm*
ST Gershman, RC Knowlton (Massachusetts Cancer Registry); (Danish Cancer Society); Estonia: T Aareleid, M Mgi (Estonian Cancer
G Copeland, G Spivak (Michigan State Cancer Surveillance Program); Registry); Finland: N Malila, K Sepp (Cancer Society of Finland); France:
DB Rogers (Mississippi Cancer Registry); D Lemons, LL Williamson M Velten (Bas-Rhin General Cancer Registry); E Cornet, X Troussard
(Montana Central Tumor Registry); M Hood, H Jerry (Nebraska Cancer (Registre Rgional des Hmopathies Malignes de Basse Normandie);
Registry); GM Hosain, JR Rees (New Hampshire State Cancer Registry); AM Bouvier, J Faivre (Burgundy Digestive Cancer Registry); AV Guizard
KS Pawlish, A Stroup (New Jersey State Cancer Registry); C Key, (Calvados General Cancer Registry); V Bouvier, G Launoy (Calvados
C Wiggins (New Mexico Tumor Registry); AR Kahn, MJ Schymura Digestive Cancer Registry); P Arveux (Cte-dOr Gynaecologic Cancer
(New York State Cancer Registry); G Leung, C Rao (North Carolina Registry); M Maynadi, M Mounier (Cte-dOr Haematopoietic
Central Cancer Registry); L Giljahn, B Warther (Ohio Cancer Incidence Malignancies Registry); AS Worono (Doubs and Belfort Territory
Surveillance System); A Pate (Oklahoma Central Cancer Registry); General Cancer Registry); M Daoulas (Finistre Cancer Registry); J Clavel
M Patil, DK Shipley (Oregon State Cancer Registry); M Esterly, RD Otto (National Registry of Childhood Haematopoietic Malignancies);
(Pennsylvania Cancer Registry); JP Fulton, DL Rousseau (Rhode Island S Le Guyader-Peyrou, A Monnereau (Gironde Haematopoietic
Cancer Registry); TA Janes, SM Schwartz (Seattle Cancer Surveillance Malignancies Registry); B Trtarre (Hrault General Cancer Registry);
System); SW Bolick, DM Hurley (South Carolina Central Cancer M Colonna (Isre General Cancer Registry); S Delacour-Billon, F Molini
Registry); RA Tenney, MA Whiteside (Tennessee Cancer Registry); (Loire-Atlantique-Vende Cancer Registry); S Bara, D Degr (Manche
A Hakenewerth, MA Williams (Texas Cancer Registry); K Herget, General Cancer Registry); O Ganry, B Laptre-Ledoux (Somme General
C Sweeney (Utah Cancer Registry); J Martin, S Wang (Virginia Cancer Cancer Registry); P Grosclaude (Tarn General Cancer Registry); JM Lutz*
Registry); MG Harrelson, MB Keitheri Cheteri (Washington State Cancer (Grenoble); A Belot, J Estve (Hospices Civils de Lyon); D Forman*
Registry); AG Hudson (West Virginia Cancer Registry); R Borchers, (International Agency for Research on Cancer); F Sassi (Organisation for
L Stephenson (Wisconsin Department of Health Services); JR Espinoza Economic Co-operation and Development); Germany: R Stabenow
(Wyoming Cancer Surveillance Program); HK Weir* (Centers for Disease (Common Cancer Registry of the Federal States); A Eberle (Bremen
Control and Prevention); BK Edwards* (National Cancer Institute). Cancer Registry); A Nennecke (Hamburg Cancer Registry); J Kieschke,
AsiaChina: N Wang, L Yang (Beijing Cancer Registry); JS Chen E Sirri (Epidemiological Cancer Registry of Lower Saxony); H Kajueter
(Changle City Cancer Registry); GH Song (Cixian Cancer Registry); (North Rhine Westphalia Cancer Registry); K Emrich, SR Zeissig
XP Gu (Dafeng County Center for Disease Control and Prevention); (Rhineland Palatinate Cancer Registry); B Holleczek (Saarland Cancer
P Zhang (Dalian Centers for Disease Prevention and Control); HM Ge Registry); N Eisemann, A Katalinic (Schleswig-Holstein Cancer Registry);
(Donghai County Center for Disease Prevention and Control); DL Zhao H Brenner (German Cancer Research Center); Gibraltar: RA Asquez,
(Feicheng County); JH Zhang (Ganyu Center for Disease Prevention and V Kumar (Gibraltar Cancer Registry); Iceland: EJ lafsdttir,
Control); FD Zhu (Guanyun Cancer Registry); JG Tang (Haimen Cancer L Tryggvadttir (Icelandic Cancer Registry); Ireland: H Comber, PM
Registry); Y Shen (Haining City Cancer Registry); J Wang (Jianhu Cancer Walsh (National Cancer Registry); H Sundseth* (European Institute of
Registry); QL Li (Jiashan County Cancer Registry); SP Yang (Jintan Womens Health); Italy: T Dal Cappello, G Mazzoleni (Registro Tumori
Cancer Registry); JM Dong, WW Li (Lianyungang Center for Disease Alto Adige); A Giacomin (Registro Tumori Biella); M Castaing, S Sciacca
Prevention and Control); LP Cheng (Henan Province Central Cancer (Integrated Cancer Registry of Catania-Messina-Siracusa-Enna); A Sutera
Registry); JG Chen (Qidong County Cancer Registry); QH Huang (Sihui (Registro Tumori Catanzaro); M Corti, G Gola (Registro Tumori della
Cancer Registry); SQ Huang (Taixing Cancer Registry); GP Guo (Cancer Provincia di Como); S Ferretti (Registro Tumori della Provincia di
Institute of Yangzhong City); K Wei (Zhongshan City Cancer Registry); Ferrara); D Serraino, A Zucchetto (Registro Tumori del Friuli Venezia
WQ Chen*, H Zeng (National Central Cancer Registry China); Cyprus: Giulia); R Lillini, M Vercelli (Registro Tumori Regione Liguria); S Busco,
AV Demetriou, P Pavlou (Cyprus Cancer Registry); Hong Kong: F Pannozzo (Registro Tumori della Provincia di Latina); S Vitarelli
WK Mang, KC Ngan (Hong Kong Cancer Registry); India: (Registro Tumori della Provincia di Macerata); P Ricci (Registro Tumori
R Swaminathan (Chennai Cancer Registry); AC Kataki, M Krishnatreya Mantova); V Pascucci (Registro Tumori Marche Childhood); M Autelitano
(Guwahati Cancer Registry); PA Jayalekshmi, P Sebastian (Registro Tumori Milano); C Cirilli, M Federico (Registro Tumori della
(Karunagappally Cancer Registry); SD Sapkota, Y Verma (Population Provincia di Modena); M Fusco, MF Vitale (Registro Tumori della ASL
Based Cancer Registry, Sikkim); A Nandakumar* (National Centre for Napoli 3 sud); M Usala (Nuoro Cancer Registry); R Cusimano, F Vitale
Disease Informatics and Research; National Cancer Registry (Registro Tumori Palermo); M Michiara, P Sgargi (Registro Tumori della
Programme); Indonesia: E Suzanna (Jakarta Cancer Registry); Israel: Provincia di Parma); C Sacerdote (Piedmont Childhood Cancer Registry);
L Keinan-Boker, BG Silverman (Israel National Cancer Registry); Japan: R Tumino (Registro Tumori della Provincia di Ragusa); L Mangone
H Ito (Aichi Cancer Registry); M Hattori (Fukui Cancer Registry); (Registro Tumori Reggio Emilia); F Falcini (Registro Tumori della
H Sugiyama, M Utada (Hiroshima Prefecture Cancer Registry); Romagna); L Cremone (Registro Tumori Salerno); M Budroni,
K Katayama, S Natsui (Kanagawa Cancer Registry); T Matsuda*, R Cesaraccio (Registro Tumori della Provincia di Sassari); A Madeddu,
Y Nishino (Miyagi Prefectural Cancer Registry); T Koike (Niigata F Tisano (Registro Tumori Siracusa); S Maspero, R Tessandori (Registro
Prefecture Cancer Registry); A Ioka, K Nakata (Osaka Cancer Registry); Tumori della Provincia di Sondrio); G Candela, T Scuderi (Registro
K Kosa (Saga Prefectural Cancer Registry); I Oki (Tochigi Prefectural Tumori Trapani); S Pier (Registro Tumori Trento); S Rosso, R Zanetti
Cancer Registry); A Shibata (Yamagata Cancer Registry); Jordan: O Nimri (Registro Tumori Piemonte Citt di Torino); A Caldarella, E Crocetti
(Jordan National Cancer Registry); Malaysia: A Ab Manan, N Bhoo Pathy (Registro Tumori della Regione Toscana); F La Rosa, F Stracci (Registro
(Penang Cancer Registry); Mongolia: C Ochir, S Tuvshingerel (Cancer Tumori Umbro di Popolazione); P Contiero, G Tagliabue (Registro
Registry of Mongolia); Qatar: AM Al Khater, MM El Mistiri (Qatar Tumori Lombardia, Provincia di Varese); P Zambon (Registro Tumori
Cancer Registry); Saudi Arabia: H Al-Eid (Saudi National Cancer Veneto); P Baili, F Berrino*, G Gatta, M Sant* (National Cancer
Registry); South Korea: KW Jung, YJ Won (Korea Central Cancer Institute); R Capocaccia*, R De Angelis, A Verdecchia* (National Centre
Registry); S Park (University of Yonsei); Taiwan: CJ Chiang, MS Lai for Epidemiology); Latvia: E Liepina, A Maurina (Latvian Cancer
(Taiwan Cancer Registry); Thailand: K Suwanrungruang, S Wiangnon Registry); Lithuania: G Smailyte (Lithuanian Cancer Registry); Malta:
(Khon Kaen Provincial Registry); K Daoprasert, D Pongnikorn (Lampang D Agius, N Calleja (Malta National Cancer Registry); Netherlands:
Cancer Registry); SL Geater, H Sriplung (Songkhla Cancer Registry); S Siesling (Comprehensive Cancer Centre of the Netherlands); Norway:

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S Larnningen, B Mller (The Cancer Registry of Norway); Poland: Janeiro); Renata Abraho (LSHTM); Helena Carreira (LSHTM); and
A Dyzmann-Sroka, M Trojanowski (Greater Poland Cancer Registry); Manuela Quaresma (LSHTM). We thank colleagues at LSHTM who gave
S Gd, R Myk (Cancer Registry of Kielce); M Grdalska-Lampart, help and advice: Natalia Sanz (CONCORD programme manager),
AU Radziszewska (Podkarpackie Cancer Registry); J Didkowska, Camille Maringe, Andy Sloggett, Sarah Walters, Laura Woods,
U Wojciechowska (National Cancer Registry); J Baszczyk, K Kpska Manuela Quaresma, Hakim Miah, Yuki Alencar, and Tanisha Lewis.
(Lower Silesian Cancer Registry); M Bielska-Lasota (National Institute of We also thank: Chris Johnson (Cancer Data Registry of Idaho),
Public Health); Portugal: G Forjaz, RA Rego (Registo Oncolgico Amy Kahn (New York State Cancer Registry), Ron Dewar (Cancer Care
Regional dos Aores); J Bastos (Registo Oncolgico Regional do Centro); Nova Scotia), and Jennifer Stevens (US National Cancer Institute) for the
L Antunes, MJ Bento (Registo Oncolgico Regional do Norte); program to convert NAACCR data structures to meet the CONCORD
AM da Costa Miranda, A Mayer-da-Silva (Registo Onclogico Regional do protocol; Angela Mariotto (US National Cancer Institute) for US mortality
Sul); Romania: D Coza, AI Todescu (Cancer Institute I. Chiricuta); data; and Giovanni Luca Lo Magno (Caltanissetta, Italy) for the program
Russia: A Krasilnikov, M Valkov (Arkhangelsk Regional Cancer Registry); to convert Stata output into Word les. Finally, we thank Gabriela Abriata
Slovakia: J Adamcik, C Safaei Diba (National Cancer Registry of Slovakia); (Instituto Nacional del Cncer, Argentina); Magnus Lindelow (World
Slovenia: M Primic akelj, T agar (Cancer Registry of Republic of Bank, Brazil); Heather Bryant (Canadian Partnership Against Cancer);
Slovenia); J Stare (University of Ljubljana); Spain: E Almar, A Mateos Brendan Hanley (Yukon Government); Carlotta Buzzoni (Registro
(Registro de Cncer de Albacete); MV Argelles, JR Quirs (Registro de Tumori della Regione Toscana and AIRTum, Italy); Andrea Micheli
Tumores del Principado de Asturias); J Bidaurrazaga, N Larraaga (Italian National Cancer Institute); Roberto Zanetti (International
(Basque Country Cancer Registry); JM Daz Garca, AI Marcos (Registro Association of Cancer Registries); Santa Pildava (Latvian Cancer
de Cncer de Cuenca); R Marcos-Gragera, ML Vilardell Gil (Registre de Registry); Vladimir Stevanovic (New Zealand Ministry of Health);
Cncer de Girona); E Molina, MJ Snchez (Registro de Cncer de Jose Maria Martin-Moreno (University of Valencia); Diego Salmern
Granada); M Ramos Montserrat (Mallorca Cancer Registry); MD (Murcia Cancer Registry); Alojz Peterle (European Parliament);
Chirlaque, C Navarro (Murcia Cancer Registry); E Ardanaz (Registro de Louise Abela (LSHTM); Liam Crosby (LSHTM); Daniel Ryan (Swiss Re);
Cncer de Navarra); S Felipe Garcia, R Peris-Bonet (Registro Nacional de and Marcus Plescia (CDC). CONCORD has been endorsed by the
Tumores Infantiles); J Galceran (Tarragona Cancer Registry); Sweden: following agencies: Asociacin Espaola contra el Cncer (Madrid,
S Khan, M Lambe (Swedish Cancer Registry); Switzerland: B Camey Spain); Association of European Cancer Leagues (Brussels, Belgium);
(Registre Fribourgeois des Tumeurs); C Bouchardy, M Usel (Geneva British Embassy in Algiers (Algeria); Canadian Association of Provincial
Cancer Registry); SM Ess, C Hermann (Cancer Registry Grisons and Cancer Agencies (Toronto, Canada); Canadian Council of Cancer
Glarus; Cancer Registry of St Gallen-Appenzell); FG Levi, Registries (Toronto, Canada); Danish Cancer Society (Copenhagen,
M Maspoli-Conconi (Registre Neuchtelois des Tumeurs); CE Kuehni, Denmark); European CanCer Organisation (Brussels, Belgium);
VR Mitter (Swiss Childhood Cancer Registry); A Bordoni, A Spitale European Institute for Womens Health (Dublin, Ireland); Institut
(Registro Tumori Cantone Ticino); A Chiolero, I Konzelmann (Registre National du Cancer (Paris, France); IARC (Lyon, France); International
Valaisan des Tumeurs); SI Dehler, RI Laue (Krebsregister Kanton Atomic Energy Agency (Vienna, Austria); International Network for
Zrich); United Kingdom: D Meechan, J Poole (East Midlands); D Cancer Treatment and Research (Brussels, Belgium); Israel Centre for
Greenberg, J Rashbass (East of England); E Davies, K Linklater (London); Disease Control (Tel-Hashomer, Israel); Jolanta Kwaniewskas
E Morris (North East); T Moran (North West); F Bannon, A Gavin Foundation (Warsaw, Poland); Members of the European Parliament
(Northern Ireland Cancer Registry); RJ Black, DH Brewster (Scottish Against Cancer (Brussels, Belgium); Center for Global Health (National
Cancer Registry); M Roche (South East); S McPhail, J Verne (South West); Cancer Institute, USA); Consumer Liaison Group (National Institute for
M Murphy, C Stiller* (National Registry of Childhood Tumours); Health Research, UK); National Institute for Cancer Epidemiology and
DW Huws, C White (Welsh Cancer Intelligence & Surveillance Unit); Registration (Zurich, Switzerland); NAACCR (Chicago, USA);
G Lawrence (West Midlands); C Brook, J Wilkinson (Yorkshire and the Organisation for Economic Co-operation and Development (Paris,
Humber); P Finan (Leeds General Inrmary); JV Ahn, C Allemani*, France); Union for International Cancer Control (Geneva, Switzerland);
A Bonaventure, H Carreira, MP Coleman*, R Harewood, B Rachet*, WHO Regional Oce for Europe (Copenhagen, Denmark); and the
N Sanz, D Spika, XS Wang (London School of Hygiene & Tropical World Bank (Washington, DC, USA). The ndings, interpretation, and
Medicine); R Stephens* (National Cancer Research Institute, London); conclusions in this report are those of the authors and do not necessarily
J Butler (Royal Marsden Hospital); M Peake (University of Leicester). represent the opinions or ocial position of the funding sources or of the
OceaniaAustralia: E Chalker, L Newman (Australian Capital Territory British Columbia Cancer Agency, Cancer Care Ontario, Maryland Cancer
Cancer Registry); D Baker, MJ Soeberg (NSW Central Cancer Registry); Registry, New Hampshire Department of Health and Human Services,
C Scott (Queensland Cancer Registry); BC Stokes, A Venn (Tasmanian New York City Department of Health and Mental Hygiene, Pennsylvania
Cancer Registry); H Farrugia, GG Giles (Victorian Cancer Registry); Department of Health, Ohio Department of Health, West Virginia Cancer
T Threlfall (Western Australian Cancer Registry); D Currow*, H You Registry, the CDC, or the Health Directorate of the Australian Capital
(Cancer Institute NSW); New Zealand: C Lewis, SA Miles (New Zealand Territory.
Cancer Registry).
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Global surveillance of cancer survival 19952009:

www.thelancet.com Published online November 26, 2014 http://dx.doi.org/10.1016/S0140-6736(14)62038-9 1

2 www.thelancet.com Published online November 26, 2014 http://dx.doi.org/10.1016/S0140-6736(14)62038-9

translated the protocol into Chinese (Mandarin),

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Figure 1: Participating countries and regions (adults)

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8 www.thelancet.com Published online November 26, 2014 http://dx.doi.org/10.1016/S0140-6736(14)62038-9

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10 www.thelancet.com Published online November 26, 2014 http://dx.doi.org/10.1016/S0140-6736(14)62038-9

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Breast cancer (women)

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Breast cancer (women)

MUS PRI CAN

Asia (west) Asia (south) Asia (east) Europe (north)

Europe (west) Europe (south) Europe (east) Oceania

CHE ESP CZE NZL

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Breast cancer (women)

America (Central and South) 199599 (7)

America (North) 199599 (45)

Asia 199599 (14)

Europe 199599 (94)

Oceania 199599 (7)

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global range in 5-year survival from ten cancers in adults

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26 www.thelancet.com Published online November 26, 2014 http://dx.doi.org/10.1016/S0140-6736(14)62038-9

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28 www.thelancet.com Published online November 26, 2014 http://dx.doi.org/10.1016/S0140-6736(14)62038-9

and should contribute to the overarching goal of the Contributors

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30 www.thelancet.com Published online November 26, 2014 http://dx.doi.org/10.1016/S0140-6736(14)62038-9

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