Cancer Declaration (Figure 3). Figure 3: CONCORD programme fits UICC World Cancer Declaration goals
The Organisation for Economic Co-operation and
Development (www.oecd.org), Paris, endorses the • To provide information on world-wide survival trends since
the 1990s (goal 11).
CONCORD programme, which will provide cancer survival
• To help measure the cancer burden and the impact of cancer
information for 30 of its 34 Member States (Figure 4). control interventions (goal 2).
• To help dispel myths about the inevitability of death from
CONCORD-2 study: Global trends in cancer survival cancer (goal 5).
since 1995 • To provide training opportunities for cancer professionals
CONCORD was the first world-wide study to provide direct (goal 9).
comparisons of cancer survival between high-income and low-
... and UICC high-priority health policies:
income countries, using standard quality control criteria and
the same analytic method for all data sets3. It provided • to bridge gaps in worldwide cancer surveillance.
estimates of five-year survival for 1.9 million adults (aged 15– • to increase the number of health professionals with
99 years) diagnosed during 1990–94 and followed up to expertise in cancer control.
1999. Individual tumour records were supplied by 101
population-based cancer registries in 31 countries on five Figure 4: Organisation of Economic Co-operation and Development
(OECD) endorses CONCORD
continents. Sixteen of the 31 countries provided data with
national coverage. Global variation was wide: 5-year relative “ ... [the first CONCORD study] has contributed to a sea-
change in how national policy makers are using international
survival for breast (women), colorectal and prostate cancers
comparisons to improve their health systems”.
was generally higher in North America, Australia and Japan,
and in northern, western and southern Europe, and lower or “... [OECD considers the] proposals for a CONCORD-2 study,
much lower in Algeria, Brazil, and eastern Europe. with its objective of producing data on cancer survival trends
CONCORD-2 will quantify international differences and up to 2009 for 10 major cancers, to be extremely important.
trends in survival since 1995 in 50 or more countries on all five We are excited by the prospect of being able to use your data
to address the contribution of health system characteristics
continents. It will include 10 common malignancies: cancers of
in explaining international differences in cancer survival. This
the stomach, colon, rectum, liver, lung, breast (women), ovary, is one of the tasks which our Member countries have given
cervix and prostate in adults (15-99 years), and leukaemia in us for the next few years.”
adults and children (0-14 years). These 10 cancers represent
63% of all new cancer cases and deaths, both in developed and
developing38 regions of the world (Table 1). The proportions as the programme develops.
for individual cancers differ widely between rich and poor By 2013, CONCORD-2 will start to provide regular
countries: whereas prostate cancer comprises 22% of new information on world-wide cancer survival trends.
cases among men in high-income countries, the proportion is
only 7% in low- and middle-income countries, while liver Inequalities in survival and avoidable premature
cancer comprises 9% of cancers in LMIC but only 2% in high- deaths
income countries. Equal treatment for a given cancer should yield equal
Of 350 population-based cancer registries invited to outcome, regardless of race39, geography or socio-economic
participate, over 220 registries in 60 countries have status40. Racial, ethnic and socio-economic differences in
registered their intent to contribute data. Participation from survival can reflect differences in access to optimal health
low- and middle-income countries is expected to include 26 of services for population groups within a country41,42.
these countries: 8 in Africa, 8 in Central and South America, 7 The wider public health impact of cancer survival disparities
of the 13 Asian countries and 3 of the 24 in Europe. About half can also contribute to the formulation of health strategy43, and
the countries will contribute national data (100% population these aspects will be examined in the CONCORD programme
coverage). where data are available. Thus, estimates of avoidable
Most registries have indicated they will provide data for premature cancer deaths in Britain since the mid-1990s,
patients diagnosed during all or part of the period 1995-2009. derived from the persistent UK survival deficit identified in the
The end of follow-up will be 31 December 2009, or a later year EUROCARE studies44, have become central to the initiative for
if adequate data are available from most registries. Data from earlier diagnosis in the UK45
more recent years of diagnosis and follow-up will be accepted International, regional and socio-economic disparities in
62 CANCER CONTROL 2013