Page 0064

EPIDEMIOLOGY

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

Index

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