Cancer survival varies widely between countries according to a worldwide study published online today in Lancet Oncology.* More than 100 investigators contributed to the study.
And while the USA has the highest 5-year survival rate for prostate cancer than any of the 31 countries studied, cancer survival in black men and women is systematically and substantially lower than in white men and women.
Until now, direct comparisons of cancer patient survival between rich and poor countries have not generally been available. The CONCORD study is, to the authors' knowledge, the first worldwide analysis of cancer survival, with standard quality-control procedures and identical analytic methods for all datasets. It provides directly comparable data on 1.9 million adult cancer patients (aged between 15 and 99) from 101 cancer registries in 31 countries on 5 continents. The study covers cancers of the breast (women), colon, rectum and prostate, which comprise a majority of all newly diagnosed cancers in adults. The study includes analyses of cancer survival in 16 states and 6 metropolitan areas in the USA, covering 42% of the population – four times as many as in previous studies.
Five-year relative survival for breast cancer (women) ranged from 80% or higher in North America, Sweden, Japan, Finland and Australia to less than 60% in Brazil and Slovakia, and below 40% in Algeria. Survival for white women in the USA (84.7%) was 14% higher than for black women (70.9%).
For colorectal cancer, five-year survival was higher in North America, Japan, Australia and some western European countries and lower in Algeria, Brazil and in eastern European countries. Survival for white patients in the USA was 10% higher than for black patients (60% compared with 50%).
For prostate cancer, 5-year survival was higher in the USA (92%) than in all 30 of the other participating countries. However, there was a 7% difference in survival between black and white men (92% compared with 85.8%).
Michel P Coleman, Professor of Epidemiology and Vital Statistics at the London School of Hygiene & Tropical Medicine, and lead author of the study, comments: 'The differences in cancer survival between countries and between black and white men and women in the USA are large and consistent across geographic areas. Most of the wide variation in survival is likely to be due to differences in access to diagnostic and treatment services, and factors such as tumour biology, state at diagnosis or compliance with treatment may also be significant.
'Population-based cancer registries are increasingly important in monitoring cancer control efforts, and in evaluating cancer survival. We hope that the information provided here will facilitate better comparison between rich and poor countries, and eventually enable joint evaluation of international trends in cancer incidence, survival and mortality'.
Notes for editors:
*Published online 17 July 2008 www.thelancet.com/oncology DOI10.1016/S1470-2045(08)70179-7
Professor Michel Coleman, Cancer Research UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine T) (currently in Bulgaria) +359 887 542 854 E) michel.coleman@lshtm.ac.uk
Cancer survival in five continents: a worldwide population-based study (CONCORD)
Michel P Coleman, Manuela Quaresma, Franco Berrino, Jean-Michel Lutz, Roberta De Angelis, Riccardo Capocaccia, Paolo Baili, Bernard Rachet, Gemma Gatta, Timo Hakulinen, Andrea Micheli, Milena Sant, Hannah K Weir, J Mark Elwood, Hideaki Tsukuma, Sergio Koifman, Gulnar Azevedo e Silva, Silvia Francisci, Mariano Santaquilani, Arduino Verdecchia, Hans H Storm, John L Young, the CONCORD Working Group. CONCORD Working Group
AFRICA: Algeria: M Hamdi Chérif (Sétif Cancer Registry, Sétif); AMERICA, CENTRAL AND SOUTH: Brazil: N Mahayri, DC Moreira Filho (Cancer Registry of Campinas, Campinas SP); MP Curado (Cancer Registry of Goiânia, Goiás GO); S Koifman* (National School of Public Health, Rio de Janeiro); G Azevedo e Silva* (Rio de Janeiro State University); Cuba: L Fernandes Garrote (National Cancer Registry, Havana); AMERICA, NORTH: Canada: AJ Coldman, M McBride (British Columbia Cancer Registry, Vancouver); A Demers*, E Kliewer, D Turner (Manitoba Cancer Registry, Winnipeg); R Dewar (Nova Scotia Cancer Registry, Halifax); E Holowaty, L Marrett, D Mishri (Ontario Cancer Registry, Toronto); J Tonita (Saskatchewan Cancer Registry, Saskatchewan); J Hatcher, Y Mao (Health Canada, Ottawa); A-M Ugnat, C Waters (Case Surveillance Division, Ottawa); USA: JL Young* (Metro Atlanta Cancer Registry, Atlanta GA); HK Weir* (Centers for Disease Control and Prevention, Atlanta GA); WE Wright, D Yin (California State Cancer Registry, Sacramento CA); D Deapen (Los Angeles County Cancer Surveillance Program, Los Angeles CA); D West (Greater Bay Area Cancer Registry, San Francisco CA); K Bol, R Bott, J Finch (Colorado Central Cancer Registry, Denver CO); A Polednak (Connecticut Tumor Registry, Hartford CT); J MacKinnon (Florida Tumor Registry, Miami FL); MT Goodman (Hawaii Tumor Registry, Honolulu HI); S Carson, C Johnson (Cancer Data Registry of Idaho, Boise ID); CF Lynch (State Health Registry of Iowa, Iowa City IO); V Chen (Louisiana Tumor Registry, New Orleans LA); G Copeland (Michigan Tumor Registry, Lansing MI); J Graff (Metropolitan Detroit Cancer Surveillance System, Detroit MI); V Filos, S Frederick (Nebraska Cancer Registry, Lincoln NE); B Kohler (New Jersey State Cancer Registry, Trenton NJ); C Wiggins (New Mexico Tumor Registry, Albuquerque NM); CC McLaughlin, MJ Schymura (New York State Cancer Registry, Albany NY); J Fulton, D Rousseau (Rhode Island Cancer Registry, Providence RI); M Potts, S Schwartz (Cancer Surveillance System of Western Washington, Seattle WA): R Dibble, N Stroup (Utah Cancer Registry, Salt Lake City UT); J Brockhouse, J Grandpré (Wyoming Cancer Surveillance Program, Cheyenne WY); ASIA: Japan: M Fujita (Fukui Cancer Registry, Fukui); W Ajiki, H Tsukuma* (Osaka Cancer Registry, Osaka); T Matsuda (Yamagata Cancer Registry, Yamagata); EUROPE: Austria: W Oberaigner (Tyrol Cancer Registry, Innsbruck); Czech Republic: J Holub (West Bohemia Cancer Registry, Prague); Denmark: HH Storm (Danish Cancer Society, Department of Cancer Prevention and Documentation, Copenhagen); Estonia: T Aareleid, M Rahu (Estonian Cancer Registry, Tallinn); Finland: T Hakulinen* (Finnish Cancer Registry, Helsinki); France: G Hédelin, M Velten (Bas-Rhin Cancer Registry, Strasbourg); G Launoy, J Macé-Lesech (Calvados Digestive Cancer Registry, Caen); G Chaplain (Côte d'Or Gynaecologic Registry, Dijon), J Faivre (Côte d'Or Digestive Tract Registry, Dijon); M Colonna (Isère Cancer Registry, Meylan); Germany: H Ziegler (Saarland Cancer Registry, Saarbrucken); Iceland: L Tryggvadóttir (Icelandic Cancer Registry, Reykjavik); Ireland: H Comber (National Cancer Registry of Ireland, Cork); Italy: S Ferretti (Ferrara Cancer Registry, Ferrara); M Vercelli (Liguria Cancer Registry, Genova); F Albertoni, E Conti, F Pannozzo (Latina Cancer Registry, Rome); F Pannelli, S Vitarelli (Macerata Cancer Registry, Camerino); C Allemani, P Baili, F Berrino*, L Ciccolallo, G Gatta*, A Micheli*, M Sant* (National Cancer Institute, Milan); ME Artioli, M Federico, M Ponz de Leon (Modena Cancer Registry, Modena); V De Lisi, L Serventi (Parma Cancer Registry, Parma); L Gafà, R Tumino (Ragusa Cancer Registry, Ragusa); F Falcini (Romagna Cancer Registry, Forli); R Capocaccia*, R De Angelis, S Francisci, M Santaquilani, A Verdecchia* (Istituto Superiore di Sanità, Rome); M Budroni, R Cesaraccio (Sassari Cancer Registry, Sassari); S Patriarca, R Zanetti (Torino Cancer Registry, Torino); E Crocetti, E Paci (Tuscany Cancer Registry, Firenze); P Contiero, P Crosignani, G Tagliabue (Lombardy Cancer Registry, Varese); S Guzzinati, P Zambon (Venetian Cancer Registry, Padova); Malta: M Dalmas (Malta National Cancer Registry, Valletta); Netherlands: O Visser (Amsterdam Cancer Registry, Amsterdam); R Otter, M Schaapveld (North Netherlands Cancer Registry, Groningen); JW Coebergh (South Netherlands Cancer Registry, Eindhoven); Norway: A Andersen, F Langmark (Cancer Registry of Norway, Oslo); Poland: J Rachtan (Krakow Cancer Registry, Krakow); M Bielska-Lasota, Z Wronkoski, M Zwierko (Warsaw Cancer Registry, Warsaw); Portugal: AM da Costa Miranda (Southern Portugal Cancer Registry, Lisbon); Slovakia: M Obšitniková, I Pleško (National Cancer Registry of Slovakia, Bratislava); Slovenia: V Pompe-Kirn, M Primic-Žakelj (Cancer Registry of Slovenia, Ljubljana); Spain: I Izarzugaza (Basque Country Cancer Registry, Vitoria-Gasteiz); C Martinez Garcia, MJ Sánchez-Pérez (Granada Cancer Registry, Granada); I Garau (Mallorca Cancer Registry, Palma de Mallorca); MD Chirlaque, C Navarro Sanchez (Murcia Cancer Registry, Murcia); E Ardanaz, C Moreno (Navarra Cancer Registry, Pamplona); J Galceran (Tarragona Cancer Registry, Reus); Sweden: TA Alvegård, L Barlow (Cancer Registry of Sweden, Stockholm); Switzerland: G Jundt (Basel Cancer Registry, Basel); J-M Lutz*, M Ussel (Geneva Cancer Registry, Geneva); H Frick (Graubunden-Glarus Cancer Registry, Chur); S Ess (St Gall-Appenzell Cancer Registry, St Gallen); I Konzelmann (Valais Cancer Registry, Sion); UK - England: T Davies, S Godward, J Rashbass (Eastern Cancer Registration and Information Centre, Cambridge); N Cooper, MJ Quinn (National Cancer Registry, Office for National Statistics, London); MP Coleman*, M Quaresma, B Rachet (London School of Hygiene and Tropical Medicine, London); L Shack, EMI Williams (Merseyside and Cheshire Cancer Registry, Liverpool): M Roche (Oxford Cancer Intelligence Unit, Oxford); H Møller (South Thames Cancer Registry, London); J Smith, J Verne (South West Cancer Intelligence Service, Bristol); H Botha, D Meechan (Trent Cancer Registry, Sheffield); G Lawrence (West Midlands Cancer Intelligence Unit, Birmingham); D Forman (Northern and Yorkshire Cancer Registry and Information Service, Leeds); UK - Northern Ireland: A Gavin (Northern Ireland Cancer Registry, Belfast); UK - Scotland: R Black, DH Brewster (Scottish Cancer Intelligence Unit, Edinburgh); UK - Wales: J Steward (Welsh Cancer Intelligence and Surveillance Unit, Cardiff); OCEANIA: Australia: JM Elwood* (Australian Capital Territory Cancer Registry, Canberra); F Sitas (New South Wales Central Cancer Registry, Sydney); J Condon (Northern Territory Cancer Registry, Casuarina); J Aitken (Queensland Cancer Registry, Brisbane); David Roder (South Australian Cancer Registry, Adelaide); A Venn (Tasmanian Cancer Registry, Hobart); G Giles* (Victorian Cancer Registry, Carlton); T Threlfall (Western Australian Cancer Registry, East Perth).
* CONCORD Steering Committee
Journal
The Lancet Oncology