Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)

A icles www. helance .com Vol 385 Ma ch 14, 2015 977 Global su eillance o cance su i al 1995–2009: analysis o indi idual da a o 25 676 887 pa ien s om 279 popula ion-based egis ies in 67 coun ies (CONCORD-2) Claudia Allemani, Hannah K Wei , Helena Ca ei a, Rhea Ha ewood, De on Spika, Xiao-Si Wang, Finian Bannon, Jane V Ahn, Ch is ophe J Johnson, Aud ey Bona en u e, Ra ael Ma cos-G age a, Cha les S ille , Gulna Aze edo e Sil a, Wan-Qing Chen, Olu emi J Ogunbiyi, Be na d Rache , Ma hew J Soebe g, Hui You, Tomohi o Ma suda, Magdalena Bielska-Laso a, Hans S o m, Thomas C Tucke , Michel P Coleman, and he CONCORD Wo king G oup* Summa y Backg ound Wo ldwide da a o cance su i al a e sca ce. We aimed o ini ia e wo ldwide su eillance o cance su i al by cen al analysis o popula ion-based egis y da a, as a me ic o he eff ec i eness o heal h sys ems, and o in o m global policy on cance con ol. Me hods Indi idual umou eco ds we e submi ed by 279 popula ion-based cance egis ies in 67 coun ies o 25·7 million adul s (age 15–99 yea s) and 75 000 child en (age 0–14 yea s) diagnosed wi h cance du ing 1995–2009 and ollowed up o Dec 31, 2009, o la e . We looked a cance s o he s omach, colon, ec um, li e , lung, b eas (women), ce ix, o a y, and p os a e in adul s, and adul and childhood leukaemia. S anda dised quali y con ol p ocedu es we e applied; e o s we e co ec ed by he egis y conce ned. We es ima ed 5-yea ne su i al, adjus ed o backg ound mo ali y in e e y coun y o egion by age (single yea ), sex, and calenda yea , and by ace o e hnic o igin in some coun ies. Es ima es we e age-s anda dised wi h he In e na ional Cance Su i al S anda d weigh s. Findings 5-yea su i al om colon, ec al, and b eas cance s has inc eased s eadily in mos de eloped coun ies. Fo pa ien s diagnosed du ing 2005–09, su i al o colon and ec al cance eached 60% o mo e in 22 coun ies a ound he wo ld; o b eas cance , 5-yea su i al ose o 85% o highe in 17 coun ies wo ldwide. Li e and lung cance emain le hal in all na ions: o bo h cance s, 5-yea su i al is below 20% e e ywhe e in Eu ope, in he ange 15–19% in No h Ame ica, and as low as 7–9% in Mongolia and Thailand. S iking ises in 5-yea su i al om p os a e cance ha e occu ed in many coun ies: su i al ose by 10–20% be ween 1995–99 and 2005–09 in 22 coun ies in Sou h Ame ica, Asia, and Eu ope, bu su i al s ill a ies widely a ound he wo ld, om less han 60% in Bulga ia and Thailand o 95% o mo e in B azil, Pue o Rico, and he USA. Fo ce ical cance , na ional es ima es o 5-yea su i al ange om less han 50% o mo e han 70%; egional a ia ions a e much wide , and imp o emen s be ween 1995–99 and 2005–09 ha e gene ally been sligh . Fo women diagnosed wi h o a ian cance in 2005–09, 5-yea su i al was 40% o highe only in Ecuado , he USA, and 17 coun ies in Asia and Eu ope. 5-yea su i al o s omach cance in 2005–09 was high (54–58%) in Japan and Sou h Ko ea, compa ed wi h less han 40% in o he coun ies. By con as , 5-yea su i al om adul leukaemia in Japan and Sou h Ko ea (18–23%) is lowe han in mos o he coun ies. 5-yea su i al om childhood acu e lymphoblas ic leukaemia is less han 60% in se e al coun ies, bu as high as 90% in Canada and ou Eu opean coun ies, which sugges s majo defi ciencies in he managemen o a la gely cu able disease. In e p e a ion In e na ional compa ison o su i al ends e eals e y wide diff e ences ha a e likely o be a ibu able o diff e ences in access o ea ly diagnosis and op imum ea men . Con inuous wo ldwide su eillance o cance su i al should become an indispensable sou ce o in o ma ion o cance pa ien s and esea che s and a s imulus o poli icians o imp o e heal h policy and heal h-ca e sys ems. Funding Canadian Pa ne ship Agains Cance (To on o, Canada), Cance Focus No he n I eland (Bel as , UK), Cance Ins i u e New Sou h Wales (Sydney, Aus alia), Cance Resea ch UK (London, UK), Cen e s o Disease Con ol and P e en ion (A lan a, GA, USA), Swiss Re (London, UK), Swiss Cance Resea ch ounda ion (Be n, Swi ze land), Swiss Cance League (Be n, Swi ze land), and Uni e si y o Ken ucky (Lexing on, KY, USA). Copy igh ©Allemani e al. Open Access a icle dis ibu ed unde he e ms o CC BY. In oduc ion The global bu den o cance is g owing, pa icula ly in coun ies o low and middle income. The need o implemen eff ec i e s a egies o p ima y p e en ion is u gen .1,2 P e en ion is c ucial bu long e m. I WHO’s global a ge o a 25% educ ion in dea hs om cance and o he non-communicable diseases in people aged 30–69 yea s is o be achie ed by 2025 ( e e ed o as Lance 2015; 385: 977–1010 Published Online No embe 26, 2014 h p://dx.doi.o g/10.1016/ S0140-6736(14)62038-9 See Commen page 926 This online publica ion has been co ec ed. The co ec ed e sion fi s appea ed a helance .com on Dec 8, 2014 See Online/Commen h p://dx.doi.o g/10.1016/ S0140-6736(14)62251-0 *Membe s lis ed a end o epo Cance Resea ch UK Cance Su i al G oup, Depa men o Non-Communicable Disease Epidemiology, London School o Hygiene & T opical Medicine, London, UK (C Allemani PhD, H Ca ei a MPH, R Ha ewood MSc, D Spika MSc, X-S Wang PhD, J V Ahn MSc, A Bona en u e MD, B Rache FFPH, P o M P Coleman FFPH); Di ision o Cance P e en ion and Con ol, Cen e s o Disease Con ol and P e en ion, A lan a, GA, USA (H K Wei PhD); No he n I eland Cance Regis y, Cen e o Public Heal h, Queen’s Uni e si y Bel as , Bel as , UK (F Bannon PhD); Cance Da a Regis y o Idaho, Boise, ID, USA (C J Johnson MPH); Uni a d’Epidemiologia i Regis e de Cànce de Gi ona, Depa amen de Salu , Ins i u d’In es igació Biomèdica de Gi ona, Gi ona, Spain (R Ma cos-G age a PhD); Sou h Eas Knowledge and In elligence Team, Public Heal h England, Ox o d, UK (C S ille MSc); Depa men o Epidemiology, Uni e sidade do Es ado do Rio de Janei o, Rio de Janei o, RJ, B azil (P o G Aze edo e Sil a MD); Na ional Offi ce o Cance P e en ion and Con ol and Na ional Cen al Cance Regis y, Na ional Cance A icles 978 www. helance .com Vol 385 Ma ch 14, 2015 25 × 25),3 we will need no only mo e eff ec i e p e en ion ( o educe incidence) bu also mo e eff ec i e heal h sys ems ( o imp o e su i al).4 In he fi s in e na ional compa ison o cance su i al, a ansa lan ic s udy o pa ien s diagnosed du ing 1945–54, su i al o 12 cance s in h ee US s a es was ypically highe han in six Eu opean coun ies.5 In 2008, a global compa ison o popula ion-based cance su i al (CONCORD) showed e y wide a ia ions in su i al om cance s o he b eas (women), colon, ec um, and p os a e.6 Tha analysis included 1·9 million adul s (age 15–99 yea s) diagnosed wi h cance du ing 1990–94 and ollowed up un il 1999 om 31 coun ies (16 wi h 100% popula ion co e age) on fi e con inen s. Th ee la ge in e na ional compa isons o cance su i al ha e been published since 2008. The Eu opean cance egis y s udy on su i al (EUROCARE)-5 p o ided su i al es ima es o all cance s o pa ien s diagnosed du ing 2000–07 in 29 coun ies in Eu ope.7 In Su Can (cance su i al in A ica, Asia, he Ca ibbean, and Cen al Ame ica), ela i e su i al es ima es we e epo ed o pa ien s diagnosed du ing 1990–2001 in 12 low-income and middle-income coun ies.8 The In e na ional Cance Benchma king Pa ne ship published su i al es ima es o ou common cance s o pa ien s diagnosed du ing 1995–2007 in six high- income coun ies.9 These h ee s udies diff e wi h espec o geog aphic and popula ion co e age, calenda pe iod, and analy ical me hods and do no enable wo ldwide compa ison o cance su i al. Su eillance o cance su i al is seen as impo an by na ional and in e na ional agencies, cance pa ien ad ocacy g oups, depa men s o heal h, poli icians, and esea ch agencies. Cance su i al esea ch is being used o o mula e cance con ol s a egies,9 o p io i ise cance con ol measu es,10 and o assess bo h he eff ec i eness11,12 and cos -eff ec i eness13 o hose s a egies. We designed CONCORD-2 o ini ia e long- e m wo ldwide su eillance o cance su i al on he b oades possible basis. Ou aim is o analyse p og ess owa d he o e a ching goal in he Union o In e na ional Cance Con ol’s Wo ld Cance Decla a ion 2013: “ he e will be majo educ ions in p ema u e dea hs om cance and imp o emen s in quali y o li e and cance su i al”.14 Me hods Cance egis ies We iden ifi ed popula ion-based cance egis ies ha we e ope a ional in 2009 and had ei he published epo s on su i al o we e known o ollow up egis e ed cance pa ien s o es ablish hei i al s a us. Many egis ies had me quali y c i e ia o inclusion in ei he he quinquennial compendium Cance Incidence in Fi e Con inen s,15,16 published by he In e na ional Associa ion o Cance Regis ies (IACR) and he In e na ional Agency o Resea ch on Cance (IARC), o simila compendia; o he egis ies we e es ablished mo e ecen ly. We in i ed all hese egis ies o con ibu e da a o pa ien s diagnosed du ing all o pa o he 15-yea pe iod 1995–2009, including da a on hei i al s a us a leas 5 yea s a e diagnosis, o a Dec 31, 2009, o a la e yea . O 395 egis ies in i ed, 306 (77%) ag eed o pa icipa e: o hese, 24 (8%) did no submi da a, ei he because o esou ce cons ain s (n=4), legal cons ain s (1) o e e sal o he o iginal decision (3), o because hey could no p o ide comple e ollow-up da a (6) o did no espond o u he communica ion (10). We excluded h ee egis ies because hey p o ided da a ha did no adhe e o he p o ocol and could no be ec ifi ed, lea ing 279 pa icipa ing egis ies (71% o hose in i ed). Among he cance s sugges ed by pa icipa ing egis ies, he en we p io i ised o s udy ( e e ed o as index si es) accoun ed collec i ely o almos wo- hi ds o he es ima ed global cance bu den in 2008, bo h in de eloped and de eloping coun ies.4 They comp ised cance s o he s omach, colon, ec um, li e , lung, b eas (women), ce ix, o a y, and p os a e in adul s (age 15–99 yea s), and leukaemia in adul s, and p ecu so -cell acu e lympho- blas ic leukaemia in child en (age 0–14 yea s). E hics app o al We ob ained app o al o CONCORD-2 om he E hics and Confi den iali y Commi ee o he UK’s s a u o y Na ional In o ma ion Go e nance Boa d (now he Heal h Resea ch Au ho i y; ECC 3-04(i)/2011) and he Na ional Heal h Se ice (NHS) esea ch e hics se ice (sou heas ; 11/LO/0331). We ob ained sepa a e s a u o y o e hics app o al (o bo h) in mo e han 40 o he ju isdic ions o secu e he elease o da a. Regis ies in all o he ju isdic ions ob ained hei own e hics app o al locally. We applied s ic secu i y cons ain s o he ansmission o da a fi les. We ga e e e y egis y a se o unique nume ic codes o he name o e e y fi le; hese codes ha e no meaning ou side he CONCORD-2 s udy. All da a fi elds we e nume ic o coded. We de eloped a fi le ansmission u ili y deploying 256-bi ad anced enc yp ion secu i y, wi h andom, s ong, one- ime passwo ds ha we e gene a ed au oma ically a he poin o da a ansmission bu sen sepa a ely, hus elimina ing he need o email o elephone exchanges o confi m passwo ds. We also p o ided ee access o a simila comme cial u ili y (Hype Send; Co isin , De oi , MI, USA) ha complies wi h US ede al law on he secu e ansmission o sensi i e heal h da a. P o ocol We fi nalised he p o ocol (in which we defi ned he da a s uc u e, fi le ansmission p ocedu es, and s a is ical analyses) a e a 2-day mee ing in Co k, I eland, in Sep embe , 2012, wi h 90 membe s o he CONCORD Wo king G oup om 48 coun ies ( he p o ocol was e ised by Oc obe , 2012). English poses a communica ion ba ie in many coun ies; he e o e, na i e speake s Cen e , Beijing, China (W-Q Chen PhD); Ibadan Cance Regis y, Uni e si y Ci y College Hospi al, Ibadan, Nige ia (P o O J Ogunbiyi FWACP); New Sou h Wales Cen al Cance Regis y, Aus alian Technology Pa k (M J Soebe g PhD), and Cance Ins i u e NSW (H You MAppS a s), Sydney, NSW, Aus alia; Popula ion-Based Cance Regis y Sec ion, Di ision o Su eillance, Cen e o Cance Con ol and In o ma ion Se ices, Na ional Cance Cen e , Tokyo, Japan (T Ma suda PhD); Depa men o Heal h P omo ion and Pos g adua e Educa ion, Na ional Ins i u e o Public Heal h and Na ional Ins i u e o Hygiene, Wa saw, Poland (P o M Bielska-Laso a MD); Cance P e en ion and Documen a ion, Danish Cance Socie y, Copenhagen, Denma k (H S o m MD); and Ken ucky Cance Regis y, Uni e si y o Ken ucky, Lexing on, KY, USA (P o T C Tucke PhD) Co espondence o: P o M P Coleman, Cance Resea ch UK Cance Su i al G oup, Depa men o Non-Communicable Disease Epidemiology, London School o Hygiene & T opical Medicine, London WC1E 7HT, UK [email p o ec ed] Fo he p o ocol see h p:// www.lsh m.ac.uk/eph/ncde/ cance su i al/ esea ch/conco d/ p o ocol/index.h ml A icles www. helance .com Vol 385 Ma ch 14, 2015 979 ansla ed he p o ocol in o Chinese (Manda in), Po uguese, and Spanish, and o he na i e speake s did back- ansla ion o check he ansla ion agains he English o iginal. We made he p o ocol a ailable in all ou languages. We held p o ocol wo kshops in A gen ina ( o Spanish-speaking Sou h Ame ican esea che s), B azil, China, India, Japan, Pue o Rico, Russia, and he USA ( o No h Ame ica), which we ollowed up wi h con e ence calls and online semina s. We esponded o elephone o email que ies in Chinese, English, F ench, I alian, Po uguese, and Spanish. We defi ned coun ies, s a es, and wo ld egions by hei UN names and codes (as o 2007).17 Only Cuba and Pue o Rico p o ided da a om he Ca ibbean and Cen al Ame ica so we g ouped hem wi h Sou h Ame ica as Ame ica (Cen al and Sou h). We w o e his A icle and p epa ed he maps wi hou p ejudice o he s a us, bounda ies, o name o any coun y, e i o y, o egion. We ha e sho ened some names o con enience (eg, Ko ea o Sou h Ko ea), which does no ha e any poli ical signifi cance. We c ea ed wo ld maps and 27 egional maps in A cGIS e sion 10, using digi al bounda ies (shapefi les) o coun ies and subna ional egions om he Da abase o Global Adminis a i e A eas (GADM 2.0).18 We ob ained na ional popula ions o 2009 om he UN Popula ion Da abase17 o na ional au ho i ies (Canada, Po ugal, and he UK) and subna ional popula ions om he ele an egis ies. We defi ned solid umou s by ana omical si e ( opog aphy) and leukaemia by mo phology ( able 1). We coded opog aphy and mo phology acco ding o he In e na ional Classifi ca ion o Diseases o Oncology (3 d edn; ICD-O-3).19 Fo o a ian cance , we included he allopian ube, u e ine ligamen s, and adnexa, and he pe i oneum and e ope i oneum, whe e high-g ade se ous o a ian ca cinomas a e o en de ec ed. We excluded Kaposi’s sa coma and solid umou s wi h lymphoma mo phology. The classifi ca ion o leukaemias and lymphomas has changed since he mid-1990s. To minimise diff e ences in he ange o leukaemia sub ypes included in ou analyses, we asked egis ies o p o ide da a o all haemopoie ic malignan diseases in adul s and child en, as defi ned by he ICD-O-3 mo phology code ange 9590–9989. In consul a ion wi h specialis s in he cance egis y- based p ojec on haema ologic malignancies (HAEMACARE) g oup,20 we selec ed sub ypes o adul leukaemia om nine mo phology g oups,21 excluding myelodysplas ic and myelop oli e a i e neoplasms such as ch onic myeloid leukaemia (appendix p 2). P ecu so - cell acu e lymphoblas ic leukaemia is he mos common o m o leukaemia in child en; we included HAEMACARE g oup 15—a ela i ely homogeneous g oup comp ising p ecu so -cell lymphoblas ic lymphoma and p ecu so -cell lymphoblas ic leukaemia (B-cell, T-cell, and no o he wise specifi ed), and we e e o hese six en i ies as acu e lymphoblas ic leukaemia.22 Fo su i al analyses, we included only in asi e p ima y malignan diseases (ICD-O-3 beha iou code 3). To acili a e quali y con ol and compa isons o he in ensi y o ea ly diagnos ic and sc eening ac i i y, howe e , we asked egis ies o submi da a o all solid umou s a each index si e, including hose ha we e benign (beha iou code 0), o unce ain o bo de line malignancy (1), o in si u (2). We asked egis ies o submi ull da es (day, mon h, yea ) o bi h, diagnosis, and dea h o las known i al s a us, bo h o quali y con ol and o enable compa able es ima ion o su i al.23 When he day o diagnosis o he day o mon h o bi h o las known i al s a us we e missing, we de eloped an algo i hm o s anda dise he impu a ion o missing da es o all popula ions (de ails a ailable on eques ). Pa icipa ing egis ies comple ed a de ailed ques ion nai e on hei me hods o ope a ion, including da a defi ni ions, da a collec ion p ocedu es, coding o ana omical si e, mo phology and beha iou , he acing o egis e ed cance pa ien s o asce ain hei i al s a us, and how umou eco ds a e linked wi h da a on i al s a us. We included pa ien s who we e diagnosed wi h wo o mo e p ima y cance s a diff e en index si es du ing 1995–2009 in he analyses o each cance —eg, colon cance in 2000, b eas cance in 2005. We measu ed su i al om he da e o diagnosis un il he da e o dea h, o loss o ollow-up, o censo ing. When wo o mo e See Online o appendix Topog aphy o mo phology codes* Desc ip ion S omach C16·0–C16·6, C16·8–C16·9 S omach Colon C18·0–C18·9, C19·9 Colon and ec osigmoid junc ion Rec um C20·9, C21·0–C21·2, C21·8 Rec um, anus, and anal canal Li e C22·0–C22·1 Li e and in ahepa ic bile duc s Lung C34·0–C34·3, C34·8–C34·9 Lung and b onchus B eas (women) C50·0–C50·6, C50·8–C50·9 B eas Ce ix C53·0–C53·1, C53·8–C53·9 Ce ix u e i O a y† C48·0–C48·2, C56·9, C57·0–C57·4, C57·7–C57·9 O a y, allopian ube, and u e ine ligamen s, o he and unspecifi ed emale geni al o gans, pe i oneum and e ope i oneum P os a e C61·9 P os a e gland Leukaemia (adul s)‡ 9670, 9687, 9727, 9728, 9729, 9800, 9801, 9805, 9820, 9823, 9826, 9832, 9833, 9835, 9836, 9837, 9840, 9860, 9861, 9866, 9867, 9870, 9871, 9872, 9873, 9874, 9891, 9895, 9896, 9897, 9910, 9920, 9930, 9931, 9940, 9984, 9987 Leukaemia Leukaemia (child en)‡ 9727, 9728, 9729, 9835, 9836, 9837 P ecu so -cell acu e lymphoblas ic leukaemia *In e na ional Classifi ca ion o Diseases o Oncology, 3 d edn (ICD-O-3).19 We defi ned solid umou s wi h opog aphy (ana omical si e) codes. †Includes pe i oneum and e ope i oneum (C48·0–C48·2), whe e o a ian cance s o high-g ade se ous mo phology a e equen ly de ec ed; also includes he allopian ube, u e ine ligamen s, and adnexa (C57·0–C57·4), and o he and unspecifi ed emale geni al o gans (C57·7–C57·9). ‡We defi ned adul leukaemia sub ypes wi h mo phology codes in HAEMACARE g oups 6, 11, 15, 17, 18, 19, 20, 21, and 22 (appendix p 2).20 The six mo phology codes used o defi ne p ecu so -cell acu e lymphoblas ic leukaemia ( e e ed o as acu e lymphoblas ic leukaemia) in child en a e hose in HAEMACARE g oup 15 only. Table 1: Defi ni ion o malignan diseases A icles 980 www. helance .com Vol 385 Ma ch 14, 2015 p ima y malignan diseases occu ed a he same index si e du ing 1995–2009, we included he fi s cance only. We e ained he mos comple e eco d o pa ien s wi h synch onous p ima y cance s in he same o gan. No h Ame ican egis ies defi ne mul iple p ima y cance s unde he ules o he Su eillance, Epidemiology and End Resul s (SEER) p og amme,24 whe eas egis ies in he Eu opean Ne wo k o Cance Regis ies (ENCR) and elsewhe e gene ally use he ules o he IACR,25 which a e mo e conse a i e. The No h Ame ican Associa ion o Cen al Cance Regis ies (NAACCR) p epa ed a p og am o enable all No h Ame ican egis ies o ecode hei en i e incidence da abases o he IACR mul iple p ima y ules, be o e hei da ase s o 1995–2009 we e ex ac ed o CONCORD-2. Quali y con ol The quali y and comple eness o cance egis a ion da a can aff ec bo h incidence and su i al es ima es and, hus, he eliabili y o in e na ional compa isons.26 We de eloped a sui e o quali y con ol p og ams,27 ex ending he checks used in he fi s CONCORD s udy,6 c oss-checked wi h hose used in he EUROCARE s udy,28 IARC/IACR ools o cance egis ies,29 and WHO’s classifi ca ion o umou s.22,30–32 We applied hese checks sys ema ically in h ee phases and sen egis ies a de ailed epo on how o e ise and esubmi hei da a, i needed, a e e e y phase. Fi s , we sen egis ies a p o ocol adhe ence epo ha showed, o e e y cance , he p opo ion o umou eco ds ha we e coded in compliance wi h he p o ocol. Second, we checked he da a in e e y umou eco d o logical cohe ence agains 20 se s o c i e ia, including eligibili y (eg, age, umou beha iou ), defi ni e e o s (eg, sex-si e e o s and in alid da es o da e sequence), and possible e o s including a wide ange o inconsis encies be ween age, umou si e, and mo phology.27 We sen egis ies exclusion epo s ha showed, o e e y index cance and calenda pe iod, he numbe o umou eco ds in each ca ego y o defi ni e o possible e o , he numbe o umou s egis e ed om a dea h ce ifi ca e only o de ec ed a au opsy, and he numbe o pa ien s whose da a could be included in su i al analyses. When we iden ifi ed e o s in classifi ca ion, coding, o pa hological assignmen , we asked egis ies o co ec and esubmi hei da a. Finally, we analysed: he p opo ion o umou eco ds wi h mo phological e ifi ca ion o non-specifi c mo phology; dis ibu ions o he day and mon h o bi h, diagnosis, and las known i al s a us; and p opo ions o pa ien s who died wi hin 30 days, we e epo ed as los o ollow-up, o we e censo ed wi hin 5 yea s o diagnosis. Follow-up o i al s a us Cance egis ies use a ious me hods o asce ain he i al s a us (ali e, dead, emig a ed, los o ollow-up) o egis e ed cance pa ien s. In coun ies wi h limi ed adminis a i e in as uc u e, so-called ac i e ollow-up can be used o es ablish i al s a us ia di ec con ac wi h he pa ien , he amily, o a local au ho i y (eg, a illage headman), o by home isi . Many egis ies in bo h high-income and low-income coun ies also seek in o ma ion om he hospi al o he ea ing clinician in hospi al o p ima y ca e. Mos egis ies link hei da abase wi h a egional o na ional index o dea hs, using iden ifi e s such as name, sex, da e o bi h, and iden i y numbe . Tumou eco ds ha ma ch o a dea h eco d a e upda ed wi h he da e o dea h. Many egis ies also use o he offi cial da abases (eg, hospi al and p ima y ca e da abases, social insu ance, heal h insu ance, d i e s’ licences, and elec o al egis e s) o es ablish he da e on which a pa ien was las known o belie ed o ha e been ali e, o ha e mig a ed wi hin he coun y, o o ha e emig a ed o ano he coun y. Cance egis a ions a e upda ed wi h he i al s a us and he da e o las known i al s a us. These me hods a e ypically summa ised as passi e ollow-up. Some egis ies ecei e in o ma ion on he i al s a us o all egis e ed pa ien s on an almos con inuous basis, o a leas e e y mon h o e e y 3 mon hs. O he egis ies seek o ace he i al s a us o pa ien s egis e ed in a pa icula calenda yea only, 1 yea o e en 5 yea s a e he end o ha yea : his app oach can inc ease he p opo ion o pa ien s los o ollow-up. I also means ha 5-yea su i al es ima es o mo e ecen ly diagnosed pa ien s canno be ob ained, e en wi h he pe iod app oach. We asked all 279 pa icipa ing egis ies how hey asce ained he i al s a us o egis e ed cance pa ien s. O 243 egis ies ha esponded o he ques ion, 147 (60%) s a ed ha hey used only passi e ollow-up, 92 (38%) ha hey used bo h passi e and ac i e ollow-up, and ou (2%) only ac i e ollow-up. S a is ical analysis Mos egis ies submi ed da a o pa ien s diagnosed om 1995 o 2009, wi h ollow-up o 2009 o la e ; some egis ies only began ope a ion a e 1995 o p o ided da a o less han 15 yea s. We we e able o es ima e 5-yea su i al using he coho app oach o pa ien s diagnosed in 1995–99 and 2000–04, because in mos da ase s, all pa ien s had been ollowed up o a leas 5 yea s. We used he pe iod app oach33 o es ima e 5-yea su i al o pa ien s diagnosed du ing 2005–09, because 5 yea s o ollow-up da a we e no a ailable o all pa ien s (appendix p 174). We es ima ed ne su i al up o 5 yea s a e diagnosis o bo h adul s and child en. Ne su i al ep esen s he cumula i e p obabili y ha he cance pa ien s would ha e su i ed a gi en ime, say 5 yea s o mo e a e diagnosis, in he hypo he ical si ua ion ha he cance was he only possible cause o dea h. Ne su i al can be in e p e ed as he p opo ion o cance pa ien s who su i e up o ha ime, a e elimina ing o he causes o A icles www. helance .com Vol 385 Ma ch 14, 2015 981 dea h (backg ound mo ali y). We used he ecen ly de eloped Poha Pe me es ima o 34 o ne su i al imple- men ed wi h he p og am s ns35 in S a a e sion 13.36 This es ima o akes unbiased accoun o he ac ha olde pa ien s a e mo e likely han younge pa ien s o die om causes o he han cance —ie, ha he compe ing isks o dea h a e highe o elde ly cance pa ien s. To con ol o he wide diff e ences in backg ound mo ali y be ween pa icipa ing ju isdic ions and o e ime, we cons uc ed 6514 li e ables o all-cause mo ali y in he gene al popula ion o each coun y o he e i o y co e ed by each pa icipa ing egis y, by age (single yea ), sex, and calenda yea o dea h, and by ace o e hnic o igin in Is ael (A ab, Jewish), Malaysia (Chinese, Malay, Indian), New Zealand (Māo i, non-Māo i), and he USA (Black, Whi e). The me hod o li e able cons uc ion depended on whe he we ecei ed aw da a (numbe s o dea hs and popula ions) o mo ali y a es, and on whe he he aw da a o he mo ali y a es we e by single yea o age (so-called comple e) o by 5-yea o 10-yea age g oup (ab idged). We checked he li e ables by examina ion o age-sex-mo ali y a es, li e expec ancy a bi h (appendix p 175), he p obabili y o dea h in he age bands 15–59 yea s, 60–84 yea s, and 85–99 yea s and, whe e necessa y, he model esiduals. O he 279 pa icipa ing egis ies, 21 p o ided comple e li e ables ha did no need in e pola ion o smoo hing, o each calenda yea . Fo 172 egis ies, we ob ained aw da a om ei he he egis y, he ele an na ional s a is ical au ho i y, o he Human Mo ali y Da abase.37 We de i ed li e ables o 1996 and 2010 i possible, each cen ed on h ee calenda yea s o da a (eg, 1995–97, 2009–11) o inc ease he obus ness o he a es. We modelled aw mo ali y a es wi h Poisson eg ession and fl exible unc ions o ob ain smoo hed comple e li e ables ex ended up o age 99 yea s. We hen c ea ed li e ables o e e y calenda yea om 1997 o 2009 by linea in e pola ion be ween he 1996 and 2010 li e ables.38 Ra he han ex apola e, we used he 1996 li e able o 1995. 62 o 279 egis ies p o ided ab idged mo ali y a es, o comple e mo ali y a es ha we e no smoo hed. We used he Ewbank ela ional model39 wi h h ee o ou pa ame e s o in e pola e (i ab idged) and smoo h he mo ali y a es o he egis y e i o y agains a high-quali y smoo h li e able o a coun y wi h a simila pa e n o mo ali y by age. We could no ob ain eliable da a on all-cause mo ali y o 24 egis ies. We ook na ional li e ables published by he UN Popula ion Di ision40 and in e pola ed and ex ended hem o age 99 yea s wi h he Eland -Johnson me hod.41 Fo each coun y and egis y, we p esen es ima es o age-s anda dised ne su i al o each cance a 5 yea s a e diagnosis. We epo cumula i e su i al p obabili ies Figu e 1: Pa icipa ing coun ies and egions (adul s) Na ional egis ies in smalle coun ies a e shown in boxes a diff e en scales. 28 egional maps and a wo ld map o childhood acu e lymphoblas ic leukaemia a e in he appendix (pp 112–40). Na ional co e age Regional co e age Regional e i o y (no da a) No co e age 5000 10 000 km0 Cuba Pue o Rico Gib al a Mal a Cyp us Is ael Jo dan Qa a Mau i ius Hong Kong The Gambia Taiwan A icles 982 www. helance .com Vol 385 Ma ch 14, 2015 as pe cen ages. Fo adul s, we used he In e na ional Cance Su i al S anda d (ICSS) weigh s, wi h age a diagnosis ca ego ised in o fi e g oups: 15–44 yea s, 45–54 yea s, 55–64 yea s, 65–74 yea s, and 75–99 yea s o eigh solid umou s and leukaemia in adul s; and 15–54 yea s, 55–64 yea s, 65–74 yea s, 75–84 yea s, and 85–99 yea s o p os a e cance .42 Fo child en, we es ima ed su i al o he age g oups 0–4 yea s, 5–9 yea s, and 10–14 yea s; we ob ained age-s anda dised es ima es by assigning equal weigh s o he h ee age-specifi c es ima es.43 We de i ed CIs o bo h uns anda dised and age-s anda dised su i al es ima es assuming a no mal dis ibu ion, unca ed o he ange 0–100. We de i ed SEs wi h he G eenwood me hod44 o cons uc he CIs We did no es ima e su i al i ewe han en pa ien s we e a ailable o analysis. I be ween en and 49 pa ien s we e a ailable o analysis in a gi en calenda pe iod (1995–99, 2000–04, 2005–09), we me ged da a o wo consecu i e pe iods. Fo less common cance s in he smalles popula ions, we some imes needed o me ge da a o all h ee pe iods. When be ween en and 49 pa ien s in o al we e a ailable, we only es ima ed su i al o all ages combined. I 50 o mo e pa ien s we e a ailable, we a emp ed su i al es ima ion o each age g oup. I an age-specifi c es ima e could no be ob ained, we me ged da a o adjacen age g oups and assigned he combined es ima e o bo h age g oups. I wo o mo e age-specifi c es ima es could no be ob ained, we p esen only he uns anda dised es ima e o all ages combined. Role o he unding sou ces The unde s had no ole in s udy design, da a collec ion, da a analysis, da a in e p e a ion, o w i ing o he epo . The co esponding au ho had ull access o all da a in he s udy and had fi nal esponsibili y o he decision o submi o publica ion. Resul s 279 cance egis ies om 67 coun ies p o ided da a o his s udy (fi gu e 1; appendix pp 112–40). Nine A ican coun ies ook pa ( en egis ies), eigh coun ies we e in Cen al and Sou h Ame ica (27 egis ies), Canada and he USA comp ised No h Ame ica (57 egis ies), 16 coun ies we e in Asia (50 egis ies), 30 Eu opean coun ies pa icipa ed (128 egis ies), and New Zealand and Aus alia ep esen ed Oceania (se en egis ies). Fo coun ies wi h less han 100% co e age o he popula ion, he coun y name is used o b e i y in he ex (eg, Libya, he USA), bu a mo e accu a e e m is used in he ables (eg, Libya [Benghazi], US egis ies). Some egis ies p o ided da a o only pa o hei e i o y. We examined eco ds o 28 685 445 pa ien s diagnosed wi h cance o he s omach, colon, ec um, li e , lung, b eas (women), ce ix, o a y, and p os a e in adul s (age 15–99 yea s), leukaemia in adul s, and p ecu so -cell acu e lymphoblas ic leukaemia in child en (age 0–14 yea s) du ing he pe iod 1995–2009 ( able 2). O hese, 1 682 081 (5·9%) eco ds we e o an in si u cance , mos ly o he ce ix, b eas , colon, o p os a e. The p opo ions o in si u cance a e no compa able di ec ly because some egis ies do no eco d in si u cance , o he s did no submi da a o index si es in which in si u malignan disease is common, and sc eening p og ammes in which in si u cance s a e equen ly de ec ed we e in oduced in some coun ies du ing 1995–2009. The a ia ion be ween con inen s is s ill o in e es : o example, a li le o e 1% o ce ical cance s in A ican egis ies we e in si u, compa ed wi h 20% in Cen al and Sou h Ame ican egis ies and 81% in Oceania. Fo b eas cance in si u, he a ia ion was om 0·1% in A ican egis ies o 16% in No h Ame ican egis ies and abou 4–5% in o he egions o he wo ld (appendix pp 3–63). Pa ien s wi h in si u cance we e no included in su i al analyses. We excluded a u he 360 773 (1·3%) pa ien s ei he because hei yea o bi h, mon h o yea o diagnosis, o yea o las i al s a us we e unknown, o because he umou was no p ima y in asi e malignan disease (beha iou code 3) o he mo phology was ha o Kaposi’s sa coma o lymphoma in a solid o gan, o o o he easons ( able 2). The p opo ion o pa ien s wi h an unknown da e o las i al s a us anged om 0% o 40% o mo e o some cance s in some A ican egis ies. P opo ions a e p esen ed in he appendix (pp 3–63) o each egis y, o all cance s combined, and o each cance sepa a ely. O 26 642 591 pa ien s eligible o inclusion in he su i al analyses, 905 841 (3·4%) we e excluded because hei cance was egis e ed om a dea h ce ifi ca e only o disco e ed a au opsy ( able 2), and 59 863 (0·2%) we e excluded o o he easons, including defi ni e e o s (eg, unknown i al s a us o sex, sex-si e e o , o in alid da es o sequence o da es) o possible e o s (eg, appa en inconsis encies be ween age, cance si e, and mo phology) o which he eco d was no la e confi med as co ec by he ele an egis y. O 25 676 887 pa ien s a ailable o su i al analyses (96·4% o hose eligible), pa hological e idence o malignan disease (his ological, cy ological, o haema- ological fi ndings) was a ailable o 23 338 015 pa ien s o all cance s combined (91·1%; able 2), anging om 83·1% in Asian egis ies, 85·5% in A ican egis ies, and 87·4% in Cen al and Sou h Ame ican egis ies o 90–95% in Eu ope, Oceania, and No h Ame ica. The ange o pa hological e idence a a na ional le el was e y wide, om 15% in The Gambia, 36% in Mongolia, and 66% in Chinese egis ies, up o 99% o mo e in Belgium, Mau i ius, and Sweden. Fo 938 703 (3·7%) pa ien s, mo phological ea u es we e poo ly specifi ed (eg, malignan neoplasm o umou , ICD-O-3 codes 8000–8005): his p opo ion also a ied widely, om a ound 1% in No h Ame ican egis ies o 17% o all A ican egis ies combined and as high as 59% in The Gambia. Da a o e e y egis y a e shown in he appendix (pp 3–63). A icles www. helance .com Vol 385 Ma ch 14, 2015 983 Calenda pe iod Pa ien s submi ed (n) Ineligible pa ien s¶ Eligible pa ien s (n) Exclusions|| A ailable o analysis (n) Da a quali y indica o s†† In si u (%) O he (%) DCO (%) O he (%) MV (%) Non-specifi c mo phology (%) Los o ollow- up (%) Censo ed (%) A ica 23 325 0·2% 39·5% 14 048 1·4% 9·6% 12 509 85·5% 17·0% 10·2% 28·8% Alge ian egis ies 1995–2009 6919 <0·1% 5·8% 6515 0·3% 17·4% 5358 93·8% 12·3% 0·0% 21·5% Leso ho (childhood)† 1995–2009 22 0·0% 0·0% 22 0·0% 0·0% 22 100·0% 0·0% 0·0% 11·8% Libya (Benghazi) 2003–2005 1698 0·0% 0·4% 1692 8·9% 0·5% 1533 84·4% 16·5% 0·0% 32·4% Mali (Bamako) 1995–2009 1007 0·0% 78·3% 219 5·0% 2·3% 203 58·6% 41·4% 83·7% 6·4% Mau i ius* 2005–2005 855 0·0% 0·6% 850 0·0% 0·9% 842 100·0% 24·1% 0·0% NA Nige ia (Ibadan) 1998–2007 2192 2·1% 60·1% 830 0·6% 3·6% 795 70·8% 0·0% 8·9% 65·1% Sou h A ica (Eas e n Cape) 1998–2007 2404 0·0% 2·9% 2335 0·1% 4·4% 2230 70·5% 32·8% 45·7% 25·1% The Gambia* 1995–1997 387 0·0% 10·1% 348 0·9% 10·3% 309 15·2% 58·9% 3·2% 14·2% Tunisia (Cen al) 1995–2007 7841 0·1% 84·1% 1237 NA 1·6% 1217 99·1% 1·0% 0·7% 51·2% Ame ica (Cen al and Sou h) 467 456 3·0% 8·0% 416 140 13·7% 0·7% 356 173 87·4% 7·7% 0·1% 2·9% A gen inian egis ies 1995–2009 40 482 5·0% 7·6% 35 377 11·1% 0·5% 31 244 97·9% 3·7% <0·1% 14·6% B azilian egis ies 1995–2009 119 423 5·4% 20·0% 89 067 9·5% 0·5% 80 113 92·8% 7·1% 0·2% 1·7% Chilean egis ies 1998–2008 8920 8·2% 0·7% 8121 10·7% 0·5% 7213 90·3% 4·1% 0·5% 0·0% Colombian egis ies 1995–2009 36 140 1·5% 5·7% 33 550 5·7% 0·8% 31 365 88·5% 12·0% <0·1% 19·5% Cuba* 1998–2006 120 748 0·3% 2·1% 117 883 23·7% 0·3% 89 576 70·6% 11·7% 0·0% 0·0% Ecuado ian egis ies 1995–2009 35 395 1·3% 5·7% 32 924 9·7% 4·3% 28 314 92·0% 3·7% 0·0% <0·1% Pue o Rico* 2000–2009 81 886 3·9% 4·5% 74 937 6·7% 0·3% 69 745 97·2% 1·4% 0·0% 0·0% U uguay* 2002–2009 24 462 0·4% 0·3% 24 281 23·4% 0·0% 18 603 80·6% 20·9% 0·0% 0·0% Ame ica (No h) 12 233 257 6·0% 1·3% 11 340 569 1·8% 0·2% 11 109 332 94·8% 1·3% 0·8% <0·1% Canada* 1995–2009 1 392 677 4·3% 0·6% 1 324 227 1·8% 0·5% 1 294 159 88·7% 1·5% 0·0% <0·1% US egis ies 1995–2009 10 840 580 6·2% 1·4% 10 016 342 1·8% 0·2% 9 815 173 95·6% 1·3% 0·9% <0·1% Asia 3 581 339 3·3% 0·9% 3 432 472 4·4% 0·2% 3 274 733 83·1% 11·4% 0·7% 2·6% Chinese egis ies 1995–2009 241 044 0·1% 1·3% 237 656 1·6% <0·1% 233 736 66·4% 38·7% 3·5% 0·1% Cyp us* 2004–2009 9986 2·8% 2·7% 9437 8·6% 0·2% 8609 98·7% 2·1% 0·0% 0·1% Hong Kong* 1997–2006 6184 0·0% 0·0% 6184 0·0% 0·2% 6169 99·6% <0·1% 9·0% 8·5% Indian egis ies 1995–2009 11 732 0·0% 1·5% 11 551 2·7% 0·1% 11 235 81·8% 9·7% 22·9% 9·9% Indonesia (Jaka a) 2005–2007 3830 0·0% 18·1% 3138 1·3% 0·2% 3091 75·4% 23·0% 0·0% NA Is ael* 1995–2009 202 745 6·1% 2·0% 186 266 3·2% 0·2% 179 921 94·2% 6·4% 0·0% 0·0% Japanese egis ies 1995–2009 1 065 707 3·7% 1·0% 1 015 315 13·3% <0·1% 879 341 86·4% 9·9% 0·0% 3·6% Jo dan* 2000–2009 19 191 0·0% 0·6% 19 081 <0·1% 0·9% 18 896 99·3% 1·5% 54·9% 0·0% Ko ea*‡ 1995–2009 1 191 749 0·0% 0·8% 1 182 442 <0·1% 0·1% 1 180 925 82·5% 8·9% 0·0% 0·0% Malaysia (Penang) 1995–2009 15 842 0·0% 2·5% 15 447 2·4% 1·8% 14 800 92·0% 9·8% 0·0% <0·1% Mongolia* 2005–2009 13 415 1·8% 0·6% 13 096 <0·1% 4·5% 12 510 35·7% 1·2% 16·9% NA Qa a * 2002–2009 780 0·8% 0·1% 773 2·7% 0·4% 749 90·0% 6·4% 0·0% 5·1% Saudi A abia* 1995–2008 24 216 1·4% 0·1% 23 876 2·6% 10·1% 20 860 95·2% 1·6% 0·0% 61·3% Taiwan* 1995–2009 662 906 9·2% <0·1% 601 480 0·0% 0·1% 600 934 83·1% 9·6% 0·0% 0·0% Thai egis ies 1995–2009 47 263 1·4% 0·7% 46 279 4·0% 0·1% 44 406 58·5% 38·4% 0·1% 23·4% Tu key (Izmi ) 1995–2009 64 749 3·3% 3·4% 60 451 3·0% 0·2% 58 551 92·9% 2·1% <0·1% 30·7% Eu ope 11 449 869 6·5% 1·0% 10 584 050 4·5% 0·2% 10 086 145 89·7% 3·5% 0·3% 0·4% Aus ia * 1995–2009 353 194 6·9% 0·6% 326 730 0·1% 0·9% 323 432 97·6% 2·5% 0·0% 0·0% Bela us (childhood)† 1995–2009 726 0·0% 0·0% 726 0·0% 0·0% 726 99·9% 0·0% 2·8% 0·0% Belgium* 2004–2009 256 073 8·7% 0·6% 232 152 <0·1% 0·2% 231 734 98·7% 1·5% 1·1% 0·0% Bulga ia* 1995–2009 255 768 <0·1% 0·2% 255 158 11·2% <0·1% 226 566 81·4% 1·3% 0·1% 0·0% C oa ia* 1998–2009 148 131 0·0% 0·1% 148 031 6·0% <0·1% 139 147 84·9% 0·4% 0·0% 0·0% Czech Republic* 1995–2009 469 330 6·4% 1·3% 433 523 7·9% 0·9% 395 462 90·8% 1·9% 0·0% 0·0% Denma k* 1995–2009 251 533 0·0% 0·2% 250 931 0·4% 0·0% 249 943 93·2% 8·0% 0·1% 0·0% Es onia* 1995–2008 51 544 1·4% 1·1% 50 283 3·8% 0·4% 48 193 89·0% 3·5% 0·4% 0·0% (Table 2 con inues on nex page) A icles 984 www. helance .com Vol 385 Ma ch 14, 2015 Mo phological confi ma ion o each cance a ied widely be ween con inen s and coun ies. O e all, 48·2% o li e cance s had mo phological da a a ailable compa ed wi h 84·4% o lung cance s, a leas 90% o o he solid umou s and adul leukaemia, and 99% o childhood acu e lymphoblas ic leukaemia (appendix pp 3–63). Mo phological confi ma ion was a ailable o 100% o acu e lymphoblas ic leukaemias in all he specialis childhood cance egis ies, including he na ional egis ies in Leso ho and Bela us. The 279 pa icipa ing cance egis ies ep esen ed an es ima ed o al popula ion o abou 896 210 000 people in 2009, o 18·6% o he combined na ional popula- ions o he 67 coun ies (4·8 billion o al popula ion; able 3); de ails by egis y a e p o ided in he appendix (pp 64–80). 100% co e age o he na ional popula ion was p o ided by 40 coun ies. Popula ion co e age in Aus alia was 91%, and in he USA i was 83%. In he emaining 25 coun ies, popula ion co e age anged om 0·5% o 47%. In China, 21 pa icipa ing egis ies co e ed 37·7 million people (2·8% o 1·35 billion o al popula ion), whe eas he ou egis ies in India co e ed 5·9 million people (0·5% o 1·19 billion o al popula ion). China and India apa , da a om 254 egis ies co e ed 37% o he combined popula ion o 2·3 billion people in 65 coun ies. Li e expec ancy a bi h in 2009 a ied widely be ween he 279 egis y popula ions: o emales, he ange was 46–87 yea s and o males i was 45–81 yea s (appendix, p 175). Li e expec ancy ose sligh ly om 1995 o 2009 Calenda pe iod Pa ien s submi ed (n) Ineligible pa ien s¶ Eligible pa ien s (n) Exclusions|| A ailable o analysis (n) Da a quali y indica o s†† In si u (%) O he (%) DCO (%) O he (%) MV (%) Non-specifi c mo phology (%) Los o ollow- up (%) Censo ed (%) (Con inued om p e ious page) Finland* 1995–2009 235 156 6·5% 2·9% 213 137 2·3% <0·1% 208 129 96·1% 7·3% 0·1% 0·0% F ench egis ies† 1995–2009 227 210 <0·1% 0·3% 226 622 <0·1% 0·2% 226 234 96·3% 2·6% 3·9% 4·1% Ge man egis ies 1995–2009 1 668 355 4·0% 1·2% 1 582 464 13·5% 0·1% 1 367 345 94·9% 1·0% 0·3% 0·1% Gib al a * 1999–2009 665 13·8% 15·8% 468 NA 1·3% 462 85·7% 0·9% 0·0% 2·2% Iceland* 1995–2009 10 805 0·0% 0·8% 10 722 0·2% 0·0% 10 704 97·2% 2·8% 0·0% 0·0% I eland* 1995–2009 169 818 14·9% 1·4% 142 134 2·4% 0·1% 138 602 91·0% 1·1% 0·0% 0·0% I alian egis ies 1995–2009 877 272 2·7% 0·5% 849 556 2·1% 0·2% 830 162 87·5% 12·5% 0·8% 1·0% La ia* 1995–2009 78 334 0·1% 0·2% 78 141 6·1% 0·5% 72 992 81·5% 0·5% 0·0% 0·0% Li huania* 1995–2009 132 425 2·8% 0·5% 127 999 3·6% 0·0% 123 380 84·9% 2·0% 1·0% 0·0% Mal a* 1995–2009 11 630 0·0% 0·9% 11 526 2·6% 0·5% 11 173 96·3% 7·9% 0·0% <0·1% Ne he lands* 1995–2009 716 617 2·9% 0·9% 688 714 0·3% 0·3% 684 601 97·0% 3·1% 0·5% 0·0% No way* 1995–2009 202 823 0·0% 0·4% 202 016 0·8% 0·0% 200 334 95·5% 4·7% 0·2% 0·0% Poland* 1995–2009 813 485 1·2% 0·2% 802 179 4·1% 0·4% 766 183 79·6% 0·5% 0·1% 0·0% Po ugal* 1998–2009 240 114 2·8% 2·7% 226 878 0·2% 0·2% 225 902 95·9% 3·3% 0·1% 1·4% Romania (Cluj) 2006–2009 6900 3·9% 0·7% 6583 18·0% 2·0% 5264 93·0% 0·8% 0·0% NA Russia (A khangelsk) 2000–2009 23 609 0·0% <0·1% 23 602 3·3% 0·7% 22 643 82·4% 3·5% 1·1% 0·0% Slo akia* 2000–2007 92 942 0·0% 0·3% 92 655 9·9% <0·1% 83 449 95·3% 5·5% 0·0% 0·0% Slo enia* 1995–2009 95 466 14·8% 2·5% 78 973 2·7% <0·1% 76 835 94·5% 5·9% 0·1% 0·0% Spanish egis ies 1995–2009 338 249 3·9% 2·4% 317 154 2·6% 0·3% 308 081 91·5% 5·4% 0·2% 0·8% Sweden* 1995–2009 395 792 0·0% <0·1% 395 744 NA 0·0% 395 744 98·9% 2·1% 0·2% 0·0% Swiss egis ies 1995–2009 151 879 6·9% 0·4% 140 737 1·7% 0·1% 138 125 95·2% 2·9% 3·2% 6·0% UK* 1995–2009 3 174 024 14·5% 1·4% 2 668 512 3·5% 0·1% 2 574 598 83·3% 3·4% <0·1% 0·1% Oceania 930 199 7·5% 0·6% 855 312 1·8% 0·2% 837 995 92·0% 4·2% 0·0% 4·1% Aus alian egis ies 1995–2009 766 090 9·1% 0·7% 691 260 1·4% 0·2% 680 295 91·9% 3·4% 0·0% 5·0% New Zealand* 1995–2009 164 109 0·0% <0·1% 164 052 3·3% 0·6% 157 700 92·6% 7·6% 0·0% 0·0% To al 28 685 445 5·9% 1·3% 26 642 591 3·4% 0·2% 25 676 887 91·1% 3·7% 0·6% 0·7% NA=no a ailable. *100% co e age o he na ional popula ion. †100% co e age o he na ional popula ion o childhood leukaemia only. ‡Sou h Ko ea. ¶In si u malignan disease (ICD-O-3 beha iou code 2): some egis ies do no egis e in si u cance s, o he egis ies did no submi hem. O he : eco ds wi h incomple e da a; o umou s ha a e benign (beha iou code 0), o unce ain beha iou (1), me as a ic om ano he o gan (6), o unknown i p ima y o me as a ic (9); o pa ien s alling ou side he age ange 0–14 yea s (child en) o 15–99 yea s (adul s); o o he condi ions. ||DCO= umou s egis e ed om a dea h ce ifi ca e only o de ec ed solely a au opsy. O he : i al s a us o sex unknown; o in alid sequence o da es; o inconsis ency o sex-si e, si e-mo phology, age-si e, age-mo phology, o age-si e-mo phology. †† MV=mic oscopically e ifi ed. Non-specifi c mo phology (solid umou s only): ICD-O-3 mo phology code in he ange 8000–8005. Censo ed: pa ien s diagnosed du ing 1995–2004, wi h las known i al s a us “ali e” bu less han 5 yea s o ollow-up. Table 2: Da a quali y indica o s o pa ien s diagnosed du ing 1995–2009, by con inen and coun y (all cance s combined) A icles www. helance .com Vol 385 Ma ch 14, 2015 985 Popula ion co e ed¶ S omach (n) Colon (n) Rec um (n) Li e (n) Lung (n) B eas || (n) Ce ix (n) O a y (n) P os a e (n) Leukaemia (n) To al (n) n% Adul s Child en A ica To al 15 983 791 5·8% 830 958 756 445 1833 3202 2357 346 1 085 592 105 12 509 Alge ian egis ies 2 099 478 5·8% 551 406 343 177 908 1582 514 153 364 327 33 5358 Leso ho (childhood)† 756 000 100·0% ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 22 22 Libya (Benghazi) 1 582 160 26·5% 87 225 105 61 317 352 57 68 153 93 15 1533 Mali (Bamako) 902 723 13·4% ·· ·· ·· ·· ·· 203 ·· ·· ·· ·· ·· 203 Mau i ius* 1 226 840 100·0% 65 81 65 23 84 290 93 52 58 31 ·· 842 Nige ia (Ibadan) 1 853 300 1·2% ·· 70 108 ·· ·· ·· 315 ·· 263 39 ·· 795 Sou h A ica (Eas e n Cape) 1 094 303 2·2% 54 40 38 98 216 372 1168 46 198 ·· ·· 2230 The Gambia* 1 628 330 100·0% 21 ·· ·· 85 21 33 149 ·· ·· ·· ·· 309 Tunisia (cen al) 4 840 657 46·1% 52 136 97 1 287 370 61 27 49 102 35 1217 Ame ica (Cen al and Sou h) To al 43 562 690 13·2% 24 610 43 552 10 405 4076 51 054 111 382 26 389 10 022 64 579 4960 5144 356 173 A gen inian egis ies† 5 123 973 12·8% 1742 4172 1308 14 2463 9886 2189 1076 4883 15 3496 31 244 B azilian egis ies 11 012 413 5·7% 3689 3457 1681 672 4192 52 198 3209 1203 8292 1117 403 80 113 Chilean egis ies 931 477 5·5% 1333 614 270 181 878 1174 562 229 1653 257 62 7 213 Colombian egis ies 3 139 671 6·9% 4773 2439 ·· 741 3135 8346 3795 1352 6177 170 437 31 365 Cuba* 11 288 830 100·0% 5026 11 393 ·· ·· 25 654 18 757 10 726 3551 14 372 97 .. 89 576 Ecuado ian egis ies 4 987 086 33·8% 4821 1880 907 815 1698 5627 3957 1207 5333 1484 585 28 314 Pue o Rico* 3 718 810 100·0% 3226 11 930 3115 1653 5222 15 394 1951 1404 23 869 1820 161 69 745 U uguay* 3 360 430 100·0% ·· 7667 3124 ·· 7812 ·· ·· ·· ·· ·· ·· 18 603 Ame ica (No h) To al 291 101 829 84·8% 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* 33 628 600 100·0% 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 egis ies 257 473 229 83·2% 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 To al 219 911 285 6·9% 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 egis ies 37 688 165 2·8% 47 580 17 894 15 261 37 555 65 320 27 667 5251 5316 5597 6025 270 233 736 Cyp us* 819 100 100·0% 407 1330 375 104 1150 2482 150 265 1936 376 34 8609 Hong Kong* 3 707 500 100·0% ·· ·· ·· ·· ·· ·· 3792 2377 ·· ·· ·· 6169 Indian egis ies 5 877 408 0·5% 1942 147 138 242 1746 2691 2960 631 128 426 184 11 235 Indonesia (Jaka a) 9 607 787 4·0% 67 229 142 301 406 1004 459 235 137 97 14 3091 Is ael* 7 273 800 100·0% 10 161 34 810 9595 2291 23 739 49 458 2887 5928 30 921 9339 792 179 921 Japanese egis ies 37 172 726 29·2% 230 800 139 071 63 269 81 085 154 292 97 409 17 249 17 221 65 114 12 784 1047 879 341 Jo dan* 6 181 310 100·0% 1217 2653 1069 303 2 518 6674 373 691 1457 1451 490 18 896 Ko ea*‡ 48 164 970 100·0% 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 (Table 3 con inues on nex page) A icles 992 www. helance .com Vol 385 Ma ch 14, 2015 S omach Colon Rec um Li e Lung B eas Ce ix O a y P os a e Leukaemia (adul ) ALL (child en) (Con inued om p e ious page) Ame ica (Cen al and Sou h) A gen inian egis ies† 1995–99 ·· ·· ·· ·· ·· ·· 45·9 (35·0–56·8) ·· ·· ·· ·· 2000–04 19·2§ (14·9–23·6) 46·0§ (42·0–50·0) 44·4 (34·4–54·3) ·· 20·8§ (16·3–25·2) 75·5 (70·5–80·5) 52·0 (46·5–57·5) 26·8 (17·7–35·9) 85·0 (75·5–94·4) ·· 64·6 (62·2–67·0) 2005–09 16·0§ (12·9–19·2) 40·6§ (34·5–46·7) 31·0 (23·3–38·7) 24·2§ (1·6–46·7) 11·9§ (9·6–14·2) 76·6 (71·4–81·9) 50·6 (46·7–54·5) 29·7 (23·7–35·8) 86·6 (80·6–92·6) 90·0§ (68·0–100·0) 66·9 (64·4–69·3) B azilian egis ies 1995–99 33·1 (24·7–41·5) 55·9 (48·6–63·3) 54·7 (45·3–64·1) 15·9§ (7·1–24·7) 18·6 (11·2–26·0) 78·2 (73·5–82·8) 60·2 (55·0–65·4) 35·1 (26·0–44·3) 83·4 (78·7–88·2) 34·3§ (16·2–52·4) 71·9 (58·9–84·8) 2000–04 28·2 (24·2–32·2) 58·1 (54·2–62·0) 52·8 (46·6–59·1) 17·9§ (12·3–23·6) 13·7 (9·4–18·0) 86·9 (84·3–89·5) 67·5 (64·0–71·0) 41·3 (34·6–48·1) 93·0 (90·5–95·5) 30·1§ (16·3–43·9) 68·7 (60·5–77·0) 2005–09 24·9 (21·2–28·6) 58·2 (54·4–61·9) 55·9 (50·2–61·7) 11·6§ (7·5–15·7) 18·0 (12·8–23·2) 87·4 (84·8–90·0) 61·1 (57·4–64·9) 31·8 (25·5–38·2) 96·1 (93·9–98·4) 20·3§ (11·0–29·7) 65·8 (57·7–74·0) Chilean egis ies 1995–99 13·4§ (7·7–19·1) 39·0 (24·5–53·6) ·· ·· ·· 73·3 (58·2–88·5) 41·9 (30·9–53·0) ·· 69·7 (58·3–81·2) ·· ·· 2000–04 16·4 (12·7–20·1) 36·4 (28·3–44·5) 41·7 (32·2–51·2) 4·5§ (1·4–7·6) 6·2 (2·4–10·0) 76·8 (69·7–84·0) 55·5 (49·1–61·9) 29·6 (20·1–39·2) 81·2 (75·0–87·5) 10·3 (4·8–15·8) ·· 2005–09 18·0 (14·3–21·7) 43·3 (34·9–51·7) 37·7 (27·9–47·5) 7·9§ (2·0–13·8) 6·3 (2·2–10·4) 77·1 (70·4–83·8) 50·9 (44·3–57·5) 32·2 (19·2–45·1) 88·7 (83·5–93·8) 16·1 (8·4–23·9) 66·4 (51·3–81·5) Colombian egis ies 1995–99 15·4 (13·1–17·8) 29·2 (24·8–33·7) ·· 3·7 (0·0–7·7) 6·1 (4·2–8·0) 65·7 (61·0–70·3) 50·6 (46·8–54·5) 27·3 (20·5–34·1) 67·1 (63·1–71·1) ·· 40·9 (31·5–50·3) 2000–04 17·7 (15·2–20·2) 42·3 (37·9–46·7) ·· 4·3 (1·4–7·3) 9·0 (6·8–11·2) 70·4 (67·0–73·9) 56·8 (53·3–60·2) 33·0 (27·0–39·0) 80·5 (77·6–83·4) 19·6 (7·8–31·4) 49·3 (40·1–58·4) 2005–09 16·6 (13·9–19·2) 43·3 (38·8–47·9) ·· 5·3 (2·2–8·5) 9·0 (6·6–11·4) 76·1 (72·2–80·0) 59·3 (55·4–63·2) 31·1 (25·4–36·8) 78·6 (75·4–81·8) 20·1 (8·2–32·0) 53·8 (43·9–63·6) Cuba* 1995–99 26·2§ (23·2–29·2) 45·8§ (43·2–48·3) ·· ·· 21·8§ (20·5–23·2) 72·8 (70·1–75·5) 66·4 (63·2–69·6) 35·4 (30·7–40·0) 54·5§ (51·5–57·6) ·· ·· 2000–04 23·8§ (22·0–25·6) 44·1§ (42·7–45·6) ·· ·· 14·1§ (13·4–14·8) 73·3 (71·9–74·8) 61·9 (60·2–63·7) 34·7 (31·9–37·5) 47·6§ (45·8–49·3) ·· ·· 2005–09 26·2§ (23·1–29·3) 46·4§ (44·0–48·8) ·· ·· 18·2§ (17·0–19·4) 77·7 (75·4–79·9) 64·0 (61·2–66·7) 39·8 (35·5–44·2) 56·1§ (53·2–59·0) 59·6 (46·6–72·7) ·· Ecuado ian egis ies 1995–99 40·1§ (34·9–45·4) 61·5 (52·1–71·0) 45·5 (34·6–56·5) 16·2§ (9·2–23·2) 34·5§ (22·2–46·9) 68·9 (62·9–74·9) 59·7 (54·5–65·0) 35·2 (27·3–43·1) 76·3 (70·7–81·9) 29·5 (22·3–36·7) 63·6 (53·4–73·8) 2000–04 28·5§ (25·7–31·3) 69·9 (58·4–81·5) 48·3 (38·6–58·0) 15·3§ (10·0–20·5) 37·8§ (26·9–48·7) 79·6 (74·5–84·6) 58·5 (53·7–63·3) 44·7 (35·2–54·2) 90·9 (86·5–95·3) 36·0 (28·1–44·0) 64·2 (54·9–73·6) 2005–09 31·9§ (29·1–34·6) 68·2 (57·7–78·7) 52·6 (44·3–61·0) 17·7§ (12·3–23·2) 28·7§ (22·0–35·4) 83·2 (79·2–87·2) 61·7 (56·8–66·5) 47·0 (37·1–57·0) 92·4 (88·7–96·0) 33·5 (26·3–40·7) 62·6 (53·7–71·6) Pue o Rico* 1995–99 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2000–04 26·8 (24·3–29·3) 60·3 (58·7–61·9) 54·3 (51·2–57·3) 12·2§ (9·4–15·0) 14·8§ (13·2–16·4) 82·6 (81·1–84·1) 60·9 (57·2–64·6) 34·5 (30·5–38·6) 97·5 (96·5–98·5) 34·1 (30·0–38·2) 78·8 (69·8–87·7) 2005–09 28·6 (26·0–31·2) 60·9 (59·4–62·3) 57·8 (54·7–60·8) 9·2§ (7·1–11·2) 15·8§ (14·2–17·4) 83·0 (81·6–84·5) 59·3 (55·7–62·9) 34·8 (30·8–38·8) 97·7 (96·8–98·6) 30·2 (26·9–33·5) 80·1 (71·1–89·0) U uguay* 1995–99 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2000–04 ·· 56·5§ (54·1–59·0) 53·0 (49·0–57·1) ·· 12·5§ (10·9–14·0) ·· ·· ·· ·· ·· ·· 2005–09 ·· 53·4§ (50·5–56·3) 49·4 (45·6–53·2) ·· 9·1§ (7·9–10·3) ·· ·· ·· ·· ·· ·· (Table 4 con inues on nex page) A icles www. helance .com Vol 385 Ma ch 14, 2015 993 S omach Colon Rec um Li e Lung B eas Ce ix O a y P os a e Leukaemia (adul ) ALL (child en) (Con inued om p e ious page) Ame ica (No h) Canada* 1995–99 21·1 (20·4–21·9) 56·8 (56·3–57·3) 56·5 (55·4–57·5) 12·1 (11·2–13·1) 15·1 (14·8–15·3) 83·7 (83·3–84·1) 66·2 (64·8–67·5) 36·5 (35·3–37·7) 87·5 (87·1–87·9) 46·8 (45·9–47·8) 85·8 (83·4–88·2) 2000–04 23·1 (22·3–23·9) 60·1 (59·6–60·6) 60·5 (59·6–61·5) 15·4 (14·5–16·4) 15·6 (15·4–15·9) 85·3 (84·9–85·7) 67·5 (66·1–68·8) 35·5 (34·4–36·6) 91·0 (90·7–91·4) 52·4 (51·5–53·2) 91·0 (89·0–92·9) 2005–09 24·8 (24·0–25·6) 62·8 (62·4–63·3) 62·8 (61·9–63·7) 17·7 (16·8–18·7) 17·3 (17·1–17·6) 85·8 (85·5–86·2) 66·8 (65·4–68·1) 37·5 (36·3–38·6) 91·7 (91·4–92·0) 55·2 (54·4–56·0) 90·6 (88·6–92·7) US egis ies 1995–99 22·1 (21·8–22·5) 60·5 (60·3–60·7) 60·0 (59·6–60·4) 8·5 (8·2–8·8) 15·2 (15·1–15·3) 86·0 (85·8–86·1) 64·2 (63·6–64·7) 38·9 (38·5–39·2) 93·2 (93·0–93·3) 44·5 (44·2–44·9) 83·1 (82·1–84·0) 2000–04 25·8 (25·5–26·2) 63·7 (63·5–63·9) 63·1 (62·7–63·4) 11·9 (11·7–12·2) 16·6 (16·5–16·7) 87·9 (87·8–88·1) 63·6 (63·1–64·1) 39·6 (39·3–40·0) 96·4 (96·3–96·5) 48·8 (48·5–49·1) 86·6 (85·8–87·4) 2005–09 29·1 (28·7–29·4) 64·7 (64·5–64·9) 64·0 (63·6–64·3) 15·2 (14·9–15·5) 18·7 (18·6–18·8) 88·6 (88·5–88·7) 62·8 (62·3–63·3) 40·9 (40·5–41·2) 97·2 (97·0–97·3) 51·8 (51·5–52·1) 87·7 (86·9–88·4) Asia Chinese egis ies 1995–99 15·3 (12·2–18·3) 33·5 (28·3–38·8) 28·9 (23·9–33·9) 2·4 (1·6–3·2) 7·5 (5·7–9·3) 53·8 (44·3–63·2) 40·1 (30·0–50·2) 41·0 (26·9–55·1) 62·9 (45·2–80·6) 4·7 (1·9–7·5) 10·9 (1·5–20·2) 2000–04 29·0 (28·1–29·9) 51·2 (49·4–53·0) 48·0 (46·2–49·9) 10·9 (10·2–11·7) 18·1 (17·5–18·8) 78·0 (75·5–80·5) 56·1 (52·0–60·1) 42·6 (38·3–47·0) 55·8 (50·5–61·1) 18·2 (15·7–20·8) 50·0 (39·7–60·2) 2005–09 31·3 (30·4–32·1) 54·6 (53·1–56·0) 53·2 (51·6–54·9) 12·5 (11·8–13·3) 17·5 (16·9–18·0) 80·9 (79·1–82·7) 59·9 (57·2–62·7) 38·9 (36·4–41·3) 63·8 (59·6–68·1) 21·2 (19·1–23·4) 61·1 (51·3–70·8) Cyp us* 1995–99 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2000–04 42·9 (28·8–57·0) 68·4 (60·5–76·3) ·· ·· 18·4 (12·3–24·5) 88·7 (80·9–96·5) ·· ·· ·· ·· ·· 2005–09 26·3 (19·9–32·6) 58·1 (48·7–67·4) 70·2 (61·0–79·3) 9·8§ (2·4–17·1) 15·4 (12·2–18·6) 90·6 (85·6–95·5) 64·5 (55·6–73·5) 43·2 (34·3–52·2) 93·1 (89·0–97·2) 61·3 (53·4–69·2) 83·2 (69·7–96·7) Hong Kong* 1995–99 ·· ·· ·· ·· ·· ·· 68·7 (65·8–71·7) 47·0 (41·0–53·0) ·· ·· ·· 2000–04 ·· ·· ·· ·· ·· ·· 72·1 (69·9–74·3) 53·3 (48·8–57·9) ·· ·· ·· 2005–09 ·· ·· ·· ·· ·· ·· 69·4 (65·9–72·9) 52·9 (45·8–60·0) ·· ·· ·· Indian egis ies 1995–99 21·2 (6·1–36·2) ·· ·· ·· 4·4 (1·9–6·9) 48·1 (37·2–58·9) 49·1 (39·4–58·9) 23·2§ (8·8–37·7) ·· 7·3§ (0·9–13·7) ·· 2000–04 9·3 (4·2–14·4) 33·2 (23·0–43·4) 40·7 (24·5–57·0) 1·8 (0·0–4·0) 9·8 (3·8–15·8) 55·3 (42·2–68·5) 47·4 (36·0–58·9) ·· 35·7 (20·0–51·4) ·· ·· 2005–09 18·7 (9·3–28·2) 37·3 (26·7–48·0) 29·4 (17·5–41·3) 4·3 (0·0–9·4) 9·6 (4·7–14·5) 60·4 (46·5–74·3) 45·8 (34·9–56·7) 13·9§ (6·8–21·0) 58·1 (38·3–77·8) 6·0§ (0·3–11·6) 64·7 (50·1–79·2) Indonesia (Jaka a) 1995–99 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2000–04 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2005–09 18·4 (0·0–40·5) 28·1 (18·8–37·3) 58·0 (38·3–77·8) 19·9 (4·3–35·5) 12·2§ (1·1–23·3) 77·7 (65·3–90·2) 65·1§ (55·8–74·3) 39·9§ (27·0–52·8) 43·5 (1·1–85·9) 39·8 (20·1–59·4) 44·3 (13·4–75·3) Is ael* 1995–99 26·5 (24·8–28·3) 60·0 (58·8–61·2) 56·8 (54·6–59·0) 8·2§ (6·0–10·4) 17·3 (16·3–18·3) 80·9 (79·8–81·9) 62·5 (58·7–66·2) 38·9 (36·3–41·4) 85·0 (83·4–86·6) 43·7 (41·5–45·9) 82·3 (76·5–88·1) 2000–04 29·3 (27·5–31·0) 66·2 (65·1–67·3) 62·5 (60·5–64·6) 14·7§ (11·9–17·6) 20·7 (19·7–21·7) 85·5 (84·5–86·5) 65·8 (62·4–69·2) 40·5 (38·2–42·8) 91·9 (90·8–93·0) 54·5 (52·4–56·7) 84·7 (80·0–89·5) 2005–09 28·6 (26·9–30·3) 69·4 (68·3–70·4) 66·6 (64·5–68·6) 14·2§ (11·6–16·7) 23·8 (22·8–24·9) 86·7 (85·8–87·7) 65·9 (62·6–69·3) 42·0 (39·7–44·4) 94·0 (93·0–95·0) 50·4 (48·4–52·4) 85·0 (80·5–89·4) (Table 4 con inues on nex page) A icles 994 www. helance .com Vol 385 Ma ch 14, 2015 S omach Colon Rec um Li e Lung B eas Ce ix O a y P os a e Leukaemia (adul ) ALL (child en) (Con inued om p e ious page) Japanese egis ies 1995–99 51·7 (51·2–52·2) 61·4 (60·7–62·1) 56·6 (55·5–57·6) 21·4 (19·5–23·3) 22·9 (21·5–24·3) 81·8 (80·8–82·9) 65·7 (64·1–67·3) 26·3 (24·2–28·4) 65·7 (63·4–67·9) 12·1 (10·0–14·2) 77·5 (72·4–82·6) 2000–04 53·6 (53·2–54·1) 62·2 (61·6–62·7) 57·8 (57·0–58·7) 26·4 (24·3–28·5) 28·5 (27·5–29·5) 84·2 (83·5–84·8) 65·1 (63·9–66·4) 33·1 (31·3–34·8) 83·4 (82·4–84·5) 17·9 (16·5–19·4) 77·8 (72·8–82·8) 2005–09 54·0 (53·6–54·5) 64·4 (63·9–64·9) 60·3 (59·6–61·1) 27·0 (25·5–28·4) 30·1 (29·1–31·0) 84·7 (84·1–85·3) 66·3 (65·2–67·5) 37·3 (35·6–38·9) 86·8 (86·0–87·7) 18·9 (17·6–20·3) 81·1 (76·8–85·4) Jo dan* 1995–99 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2000–04 48·2§ (31·7–64·8) 53·0§ (40·1–65·8) 26·3§ (11·8–40·9) 22·9§ (5·2–40·6) 7·7§ (4·3–11·2) 57·6§ (46·4–68·8) 17·1§ (3·1–31·0) 17·2§ (6·9–27·5) 35·5§ (23·8–47·2) 6·9§ (0·0–15·8) 15·1§ (6·4–23·8) 2005–09 28·8§ (14·6–43·0) 48·1§ (35·0–61·3) 21·4§ (9·6–33·2) 17·1§ (3·2–31·1) 4·4§ (2·0–6·8) 43·1§ (31·2–55·0) 10·3§ (0·0–21·8) 8·0§ (2·9–13·2) 27·4§ (16·3–38·5) 7·1§ (0·0–16·3) 16·4§ (6·8–26·0) Ko ea*‡ 1995–99 32·8 (32·5–33·1) 42·5 (41·9–43·1) 51·6 (50·5–52·8) 10·8 (10·4–11·3) 9·6 (9·4–9·9) 76·7 (74·4–78·9) 73·7 (72·8–74·6) 42·1 (39·6–44·6) 63·7 (61·5–65·9) 15·4 (13·9–17·0) 62·9 (60·1–65·7) 2000–04 41·0 (40·8–41·3) 60·4 (59·8–61·1) 60·8 (60·0–61·5) 15·2 (14·9–15·6) 15·2 (14·9–15·5) 79·6 (78·1–81·0) 70·0 (69·5–70·6) 43·3 (41·5–45·1) 75·8 (74·4–77·3) 18·8 (17·6–20·0) 72·8 (70·3–75·4) 2005–09 57·9 (57·5–58·2) 66·0 (65·4–66·6) 65·9 (65·2–66·6) 20·1 (19·8–20·5) 18·5 (18·2–18·8) 82·7 (81·4–84·0) 77·1 (76·4–77·8) 44·2 (42·6–45·8) 82·2 (81·1–83·3) 23·4 (22·2–24·6) 77·1 (74·7–79·5) Malaysia (Penang) 1995–99 34·3 (27·9–40·7) 52·4 (46·1–58·7) 48·3 (38·4–58·2) 10·3 (5·7–14·9) 15·1 (12·1–18·0) 64·8 (56·8–72·9) 54·6 (48·6–60·5) 44·7 (30·0–59·3) 62·4 (52·0–72·8) 16·0 (3·6–28·4) 77·3 (65·5–89·2) 2000–04 26·5 (20·9–32·1) 47·9 (42·7–53·1) 38·7 (32·1–45·2) 19·2 (12·1–26·3) 13·1 (10·6–15·6) 71·1 (64·3–78·0) 58·4 (53·0–63·7) 42·5 (30·3–54·6) 57·8 (48·3–67·3) 25·2 (13·4–37·1) 68·7 (56·5–81·0) 2005–09 24·2 (19·6–28·8) 53·3 (48·7–57·9) 42·5 (36·3–48·7) 13·3 (9·3–17·4) 10·7 (8·6–12·7) 67·8 (62·4–73·3) 55·2 (50·2–60·2) 42·9 (33·6–52·1) 66·4 (57·8–74·9) 12·1 (7·4–16·9) 69·4 (57·4–81·5) Mongolia* 1995–99 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2000–04 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2005–09 15·1 (12·6–17·6) 30·6 (22·5–38·8) 15·9 (0·9–30·8) 8·5 (6·9–10·0) 6·6 (4·1–9·1) 56·5 (46·1–66·8) 59·5 (53·3–65·8) 52·1 (39·7–64·5) 39·6 (17·2–61·9) 35·6 (23·7–47·5) 34·3 (11·9–56·8) Qa a * 1995–99 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2000–04 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2005–09 27·3 (11·8–42·7) 68·2 (48·2–88·1) 77·8 (58·3–97·3) 4·1 (0·0–10·3) 13·2 (3·2–23·2) 85·3 (66·8– 100·0) 85·5 (71·6–99·3) 37·2 (10·1–64·2) 55·3 (47·2–63·4) 52·8 (29·6–76·0) ·· Saudi A abia* 1995–99 33·6§ (20·8–46·3) 43·3§ (31·9–54·7) 61·0§ (8·3–100·0) 23·5§ (15·5–31·5) 21·3§ (8·5–34·1) 70·9§ (56·6–85·3) 62·2§ (50·6–73·8) 49·4§ (31·6–67·3) 64·8§ (53·9–75·8) 61·4§ (47·1–75·7) ·· 2000–04 44·1§ (31·8–56·3) 49·0§ (37·8–60·2) 59·3§ (7·3– 100·0) 16·0§ (10·8–21·2) 12·9§ (7·3–18·5) 78·4§ (68·3–88·5) 65·6§ (56·8–74·4) 53·0§ (38·2–67·9) 65·3§ (55·8–74·8) 50·9§ (41·4–60·4) ·· 2005–09 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· Taiwan* 1995–99 36·1 (35·2–37·0) 56·2 (55·2–57·1) 56·2 (55·0–57·4) 17·1 (16·6–17·6) 13·3 (12·8–13·8) 77·2 (75·4–79·0) 75·4 (74·5–76·3) 44·2 (41·0–47·4) 69·7 (67·5–71·9) 24·3 (22·3–26·3) 63·4 (59·4–67·3) 2000–04 35·8 (35·0–36·6) 57·1 (56·3–57·8) 58·1 (57·1–59·1) 19·5 (19·1–19·9) 11·6 (11·3–12·0) 80·7 (79·4–82·1) 74·5 (73·6–75·4) 44·3 (42·0–46·6) 76·0 (74·3–77·7) 22·3 (20·7–23·9) 71·8 (68·1–75·5) 2005–09 36·4 (35·5–37·2) 59·5 (58·8–60·2) 60·5 (59·5–61·4) 22·2 (21·8–22·6) 14·3 (13·9–14·7) 82·4 (81·1–83·6) 74·0 (73·0–75·0) 45·6 (43·5–47·8) 77·9 (76·5–79·3) 22·9 (21·4–24·3) 77·9 (74·5–81·3) Thai egis ies 1995–99 18·5 (9·7–27·4) 43·7 (34·0–53·4) 34·9 (22·7–47·1) 15·6 (12·0–19·2) 31·9 (20·2–43·6) 65·9 (50·3–81·6) 55·0 (48·8–61·3) 55·7 (36·1–75·4) 51·3 (30·8–71·7) 9·7 (3·4–16·0) 51·2 (39·5–62·9) 2000–04 15·3 (11·1–19·6) 52·2 (47·4–57·1) 35·7 (30·2–41·2) 10·5 (9·2–11·8) 9·7 (8·3–11·2) 72·9 (63·7–82·0) 57·7 (54·4–61·0) 47·3 (37·4–57·1) 64·7 (56·4–72·9) 17·2 (12·2–22·3) 58·9 (49·2–68·6) (Table 4 con inues on nex page) A icles www. helance .com Vol 385 Ma ch 14, 2015 995 S omach Colon Rec um Li e Lung B eas Ce ix O a y P os a e Leukaemia (adul ) ALL (child en) (Con inued om p e ious page) 2005–09 12·4 (9·0–15·8) 50·4 (46·2–54·6) 39·7 (34·7–44·6) 7·8 (6·7–8·8) 8·1 (7·0–9·2) 71·3 (65·8–76·8) 55·9 (52·7–59·1) 41·1 (33·2–49·0) 57·7 (50·7–64·7) 13·5 (9·5–17·5) 55·1 (45·5–64·6) Tu key (Izmi ) 1995–99 32·5 (25·8–39·1) 54·3 (48·3–60·4) 47·5 (40·4–54·6) 11·8 (6·5–17·1) 19·2 (15·7–22·7) 72·8 (67·6–78·0) 59·2 (51·0–67·5) 40·7 (32·6–48·8) 77·4 (69·3–85·5) 31·5 (23·0–40·1) 63·7 (54·2–73·3) 2000–04 20·0 (16·8–23·2) 50·4 (46·8–54·0) 46·8 (42·4–51·2) 19·2 (14·2–24·1) 11·0 (9·7–12·3) 81·5 (78·4–84·5) 63·4 (58·4–68·5) 46·0 (38·1–54·0) 80·2 (76·0–84·4) 36·4 (30·3–42·5) 69·1 (60·9–77·2) 2005–09 17·1 (14·9–19·2) 52·9 (49·9–55·9) 45·3 (41·5–49·0) 14·2 (10·4–18·0) 10·1 (9·1–11·0) 78·6 (76·0–81·2) 60·9 (56·3–65·4) 39·0 (33·3–44·8) 80·6 (77·6–83·6) 33·1 (28·8–37·4) 73·1 (66·1–80·2) Eu ope Aus ia* 1995–99 29·5 (28·3–30·7) 57·1 (56·0–58·1) 54·8 (53·5–56·2) 8·7 (7·5–10·0) 14·1 (13·5–14·7) 78·7 (77·8–79·5) 62·3 (60·3–64·4) 42·2 (40·7–43·8) 84·7 (83·8–85·6) 39·8 (37·7–41·9) 85·9 (80·6–91·2) 2000–04 30·0 (28·7–31·3) 60·2 (59·3–61·2) 59·8 (58·5–61·1) 11·0 (9·8–12·2) 15·6 (15·0–16·3) 81·4 (80·6–82·2) 65·4 (63·3–67·4) 40·4 (38·9–42·0) 89·8 (89·1–90·5) 43·3 (41·5–45·1) 89·8 (85·3–94·2) 2005–09 33·1 (31·7–34·5) 63·0 (62·1–64·0) 62·1 (60·8–63·4) 12·9 (11·6–14·3) 17·9 (17·3–18·6) 82·9 (82·1–83·7) 66·0 (63·8–68·2) 41·6 (40·0–43·2) 90·5 (89·8–91·2) 45·8 (44·1–47·6) 91·1 (86·9–95·2) Bela us (childhood)† 1995–99 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 74·7 (69·4–79·9) 2000–04 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 78·4 (72·9–83·9) 2005–09 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 88·3 (83·6–93·0) Belgium* 1995–99 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2000–04 27·9 (25·1–30·8) 64·0 (62·3–65·6) 62·3 (59·8–64·8) 19·9 (15·5–24·4) 15·3 (14·3–16·3) 84·8 (83·5–86·1) 66·0 (62·0–70·0) 42·5 (39·3–45·7) 92·0 (90·7–93·3) 57·5 (54·2–60·7) 80·2 (69·8–90·6) 2005–09 33·4 (31·9–34·8) 64·6 (63·8–65·4) 64·7 (63·5–66·0) 19·6 (17·7–21·6) 16·6 (16·1–17·2) 85·4 (84·7–86·0) 65·2 (63·1–67·2) 43·0 (41·2–44·7) 92·6 (91·9–93·2) 59·4 (57·7–61·0) 89·7 (86·1–93·3) Bulga ia* 1995–99 11·2§ (10·2–12·2) 39·5 (38·0–41·0) 31·0 (29·4–32·6) 4·7§ (3·3–6·0) 5·9 (5·2–6·6) 68·0 (66·5–69·5) 46·7 (44·9–48·5) 27·7 (25·7–29·8) 45·2 (42·5–47·8) 21·2 (19·0–23·4) 58·0 (50·5–65·5) 2000–04 11·1§ (10·2–11·9) 43·8 (42·6–45·0) 36·9 (35·5–38·3) 3·8§ (2·7–4·8) 5·7 (5·0–6·4) 71·2 (70·0–72·5) 49·4 (47·8–51·0) 32·9 (30·9–34·9) 49·7 (47·3–52·0) 24·1 (21·9–26·2) 63·3 (55·4–71·2) 2005–09 12·9§ (12·0–13·8) 47·0 (45·8–48·2) 40·8 (39·3–42·3) 5·0§ (3·8–6·3) 6·3 (5·6–7·1) 73·9 (72·7–75·1) 53·0 (51·4–54·6) 35·4 (33·5–37·2) 53·4 (51·1–55·8) 25·0 (22·9–27·1) 71·0 (64·2–77·7) C oa ia* 1995–99 24·0 (21·7–26·3) 50·1 (47·6–52·7) 44·6 (41·5–47·6) 13·2§ (9·8–16·5) 16·5 (15·1–17·9) 77·5 (75·0–79·9) 68·1 (64·2–72·1) 37·5 (32·9–42·2) 61·4 (56·8–66·0) 38·6 (34·3–42·8) ·· 2000–04 21·6 (20·3–22·9) 49·8 (48·4–51·2) 46·5 (44·8–48·3) 11·6§ (9·8–13·4) 15·2 (14·5–16·0) 75·1 (73·7–76·4) 65·6 (63·0–68·3) 39·1 (36·7–41·4) 67·7 (65·5–69·9) 37·2 (34·8–39·6) 77·6 (70·8–84·4) 2005–09 21·3 (20·0–22·6) 52·0 (50·7–53·3) 48·2 (46·5–49·9) 12·2§ (10·4–14·0) 13·6 (12·9–14·3) 77·9 (76·6–79·3) 65·3 (62·7–68·0) 36·8 (34·6–39·1) 75·1 (73·2–77·1) 37·6 (35·3–39·9) 85·9 (80·0–91·8) Czech Republic* 1995–99 16·6 (15·7–17·6) 45·3 (44·4–46·1) 38·6 (37·4–39·9) 4·7§ (3·7–5·7) 8·5§ (8·1–9·0) 72·7 (71·7–73·7) 61·3 (59·8–62·7) 32·6 (31·1–34·0) 64·6 (63·0–66·1) 42·8 (40·8–44·9) ·· 2000–04 21·8 (20·7–22·9) 51·4 (50·6–52·2) 46·9 (45·7–48·1) 5·5§ (4·4–6·5) 10·9 (10·4–11·4) 77·8 (77·0–78·6) 62·2 (60·7–63·8) 34·5 (33·2–35·9) 75·6 (74·4–76·9) 46·8 (45·0–48·6) ·· 2005–09 23·2 (22·0–24·3) 54·9 (54·1–55·7) 50·3 (49·1–51·5) 7·2§ (6·0–8·4) 12·3 (11·8–12·9) 80·0 (79·2–80·8) 64·5 (63·0–66·1) 36·6 (35·3–38·0) 83·1 (82·1–84·1) 46·1 (44·3–47·8) ·· Denma k* 1995–99 13·8 (12·3–15·3) 48·2 (47·1–49·4) 47·6 (46·0–49·2) 2·6 (1·6–3·5) 8·0 (7·5–8·5) 75·8 (74·8–76·8) 63·1 (60·9–65·4) 31·2 (29·5–33·0) 46·4 (44·5–48·3) 45·4 (43·2–47·5) 85·6 (79·4–91·8) 2000–04 15·3 (13·7–16·9) 52·1 (50·9–53·2) 53·8 (52·2–55·3) 4·4 (3·1–5·7) 9·6 (9·1–10·1) 80·7 (79·8–81·6) 63·2 (60·8–65·6) 33·2 (31·5–34·9) 64·0 (62·5–65·5) 51·2 (49·1–53·3) 84·5 (78·9–90·1) 2005–09 17·9 (16·2–19·5) 55·9 (54·8–57·0) 58·4 (56·9–59·8) 6·1 (4·4–7·7) 11·3 (10·7–11·9) 82·0 (81·1–82·9) 64·8 (62·3–67·2) 37·3 (35·4–39·2) 77·2 (75·9–78·5) 56·8 (54·6–59·0) 87·2 (81·5–92·9) (Table 4 con inues on nex page) A icles 996 www. helance .com Vol 385 Ma ch 14, 2015 S omach Colon Rec um Li e Lung B eas Ce ix O a y P os a e Leukaemia (adul ) ALL (child en) (Con inued om p e ious page) Es onia* 1995–99 20·0 (18·2–21·9) 49·7 (46·8–52·6) 37·7 (34·0–41·3) 5·4 (2·8–7·9) 8·2 (7·0–9·5) 62·3 (59·3–65·2) 58·2 (54·4–62·1) 28·2 (25·0–31·3) 55·9 (51·3–60·6) 37·4 (32·9–42·0) ·· 2000–04 22·3 (20·3–24·4) 48·8 (46·1–51·5) 46·5 (43·0–50·1) 5·6 (2·8–8·3) 10·9 (9·6–12·3) 70·4 (67·8–73·0) 62·9 (59·0–66·8) 31·3 (27·9–34·8) 67·1 (63·7–70·4) 43·5 (39·2–47·8) ·· 2005–09 22·8 (20·5–25·2) 51·7 (48·7–54·6) 48·9 (44·9–52·9) 8·7 (5·1–12·3) 11·9 (10·3–13·5) 72·4 (69·6–75·2) 66·7 (62·6–70·8) 38·7 (34·6–42·8) 73·2 (69·9–76·5) 38·4 (34·1–42·7) 62·6 (52·0–73·3) Finland* 1995–99 27·0 (25·4–28·6) 58·7 (57·2–60·2) 54·6 (52·5–56·7) 6·9 (5·1–8·8) 11·0 (10·2–11·7) 82·8 (81·7–83·9) 66·2 (62·6–69·8) 39·1 (36·8–41·4) 79·3 (77·9–80·6) 45·1 (42·5–47·7) 82·4 (76·3–88·4) 2000–04 25·9 (24·3–27·6) 61·2 (59·8–62·6) 59·8 (57·9–61·8) 7·2 (5·5–8·8) 11·8 (11·0–12·6) 86·5 (85·5–87·4) 68·1 (64·6–71·6) 40·9 (39·0–42·8) 90·0 (89·1–90·9) 47·6 (45·3–50·0) 84·7 (78·0–91·4) 2005–09 25·2 (23·5–26·9) 62·9 (61·5–64·3) 62·9 (61·1–64·8) 7·9 (6·2–9·6) 12·3 (11·5–13·2) 86·8 (85·9–87·7) 65·3 (61·7–69·0) 44·9 (42·9–46·9) 93·2 (92·3–94·0) 50·7 (48·4–52·9) 81·9 (75·3–88·5) F ench egis ies† 1995–99 25·7 (24·2–27·2) 57·2 (56·1–58·2) 54·4 (52·8–56·0) 11·1 (9·8–12·5) 12·8 (12·2–13·5) 83·7 (82·9–84·6) 66·3 (63·9–68·8) 33·5 (31·6–35·4) 79·4 (78·1–80·7) 54·6 (52·6–56·6) 82·9 (81·0–84·8) 2000–04 27·3 (25·8–28·8) 59·7 (58·6–60·7) 57·0 (55·4–58·6) 13·5 (12·3–14·8) 13·9 (13·3–14·5) 86·5 (85·7–87·3) 60·5 (57·7–63·3) 39·8 (37·7–41·9) 89·4 (88·6–90·2) 58·9 (57·2–60·6) 88·4 (86·8–90·0) 2005–09 27·7 (25·3–30·2) 59·8 (58·2–61·4) 56·8 (54·5–59·1) 14·4 (12·6–16·2) 13·6 (12·7–14·6) 86·9 (85·7–88·0) 58·9 (53·9–63·8) 39·0 (35·9–42·2) 90·5 (89·4–91·6) 59·2 (56·6–61·8) 89·2 (87·7–90·8) Ge man egis ies 1995–99 22·8 (21·5–24·2) 48·7 (47·5–49·9) 51·9 (50·7–53·1) 6·5 (4·8–8·2) 11·6 (11·0–12·2) 81·2 (80·6–81·8) 64·7 (63·3–66·0) 37·7 (36·2–39·1) 77·1 (75·6–78·5) 42·9 (40·9–44·9) 86·7 (83·5–89·9) 2000–04 30·0 (29·2–30·7) 62·1 (61·6–62·7) 60·2 (59·6–60·9) 10·5 (9·0–12·0) 15·1 (14·7–15·4) 84·1 (83·7–84·4) 64·8 (63·7–65·9) 39·9 (38·9–41·0) 89·3 (88·7–89·8) 50·1 (48·9–51·3) 87·3 (84·6–89·9) 2005–09 31·6 (30·8–32·3) 64·6 (64·1–65·1) 62·1 (61·5–62·7) 14·4 (12·9–16·0) 16·2 (15·8–16·5) 85·3 (84·9–85·6) 64·9 (63·9–65·9) 39·7 (38·7–40·7) 91·2 (90·7–91·6) 53·6 (52·5–54·6) 91·8 (89·8–93·7) Gib al a * 1995–99 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2000–04 ·· ·· ·· ·· ·· 82·4 (70·3–94·4) ·· ·· ·· ·· ·· 2005–09 9·4 (0·0–22·0) 57·9 (43·8–71·9) 57·8 (27·0–88·6) ·· 20·2 (7·2–33·3) 84·4 (73·4–95·5) 63·0 (23·8– 100·0) 59·3 (25·7–92·9) 67·4 (54·0–80·7) 44·0 (7·0–81·1) ·· Iceland* 1995–99 23·9 (17·4–30·4) 54·1 (47·9–60·2) 51·7 (42·8–60·7) ·· 14·3 (11·4–17·2) 83·0 (77·9–88·1) 63·6 (51·0–76·2) 30·4 (21·1–39·6) 74·8 (68·7–80·8) 39·1 (30·2–48·0) ·· 2000–04 34·2 (26·1–42·3) 60·8 (54·9–66·8) 72·2 (63·8–80·7) 1·6 (0·0–3·7) 14·5 (11·5–17·4) 88·1 (83·5–92·8) 70·7 (61·8–79·6) 34·1 (26·9–41·4) 79·5 (74·8–84·1) 56·6 (45·6–67·6) ·· 2005–09 32·3 (24·3–40·3) 65·1 (59·6–70·6) 76·5 (68·3–84·6) 11·0 (4·8–17·1) 15·0 (11·9–18·2) 85·3 (80·7–89·9) 73·1 (61·8–84·3) 38·6 (30·0–47·2) 83·5 (79·4–87·5) 54·4 (43·1–65·7) 84·1 (70·0–98·3) I eland* 1995–99 17·6 (15·7–19·4) 50·8 (49·2–52·4) 48·1 (45·6–50·5) 6·8 (3·8–9·8) 9·5 (8·6–10·3) 73·1 (71·5–74·7) 58·9 (54·5–63·3) 28·1 (25·7–30·6) 69·8 (67·8–71·8) 47·3 (44·2–50·4) 79·8 (72·9–86·7) 2000–04 18·7 (16·9–20·6) 53·6 (52·1–55·1) 51·5 (49·4–53·7) 11·8 (8·9–14·7) 10·3 (9·4–11·1) 77·7 (76·4–79·1) 58·1 (54·4–61·9) 29·6 (27·3–32·0) 84·2 (83·0–85·4) 54·9 (52·2–57·6) 83·1 (76·9–89·4) 2005–09 22·7 (20·7–24·7) 58·6 (57·2–60·0) 56·1 (53·9–58·3) 12·8 (10·0–15·6) 12·9 (12·0–13·8) 80·0 (78·7–81·3) 55·9 (52·6–59·3) 32·2 (29·8–34·6) 88·4 (87·3–89·5) 56·4 (53·9–59·0) 85·3 (79·1–91·5) I alian egis ies 1995–99 31·1 (30·4–31·8) 57·5 (56·9–58·1) 53·3 (52·3–54·4) 11·5 (10·8–12·2) 12·9 (12·6–13·3) 82·8 (82·3–83·3) 64·4 (62·8–66·1) 36·1 (35·0–37·2) 79·1 (78·2–80·0) 47·0 (45·8–48·1) 82·8 (79·7–85·9) 2000–04 32·0 (31·3–32·6) 60·1 (59·6–60·6) 56·7 (55·8–57·6) 15·5 (14·8–16·2) 14·0 (13·7–14·4) 85·5 (85·1–85·9) 67·1 (65·6–68·6) 37·9 (36·9–38·9) 88·6 (88·1–89·1) 47·3 (46·3–48·3) 83·0 (79·9–86·1) 2005–09 32·4 (31·7–33·2) 63·2 (62·7–63·7) 59·5 (58·5–60·4) 17·9 (17·2–18·7) 14·7 (14·3–15·0) 86·2 (85·7–86·6) 68·3 (66·7–69·9) 39·2 (38·1–40·3) 89·7 (89·2–90·2) 46·7 (45·6–47·7) 87·7 (84·9–90·5) (Table 4 con inues on nex page) A icles www. helance .com Vol 385 Ma ch 14, 2015 997 S omach Colon Rec um Li e Lung B eas Ce ix O a y P os a e Leukaemia (adul ) ALL (child en) (Con inued om p e ious page) La ia* 1995–99 21·3 (19·7–22·9) 40·9 (38·5–43·3) 34·1 (31·1–37·0) 7·2§ (4·4–9·9) 12·1 (10·8–13·3) 64·1 (61·7–66·6) 52·9 (49·2–56·6) 30·6 (28·0–33·2) 51·9 (47·8–56·0) 44·6 (40·4–48·9) ·· 2000–04 20·7 (19·0–22·5) 42·4 (40·1–44·8) 36·4 (33·6–39·2) 7·2§ (4·3–10·0) 13·8 (12·6–15·1) 69·8 (67·5–72·1) 51·7 (48·0–55·4) 35·7 (32·9–38·6) 65·3 (62·2–68·5) 43·1 (38·9–47·2) ·· 2005–09 22·8 (21·0–24·6) 45·3 (43·0–47·7) 38·6 (35·6–41·5) 6·4§ (4·0–8·8) 16·2 (14·9–17·6) 71·1 (68·9–73·4) 55·4 (51·9–59·0) 35·6 (32·9–38·4) 73·9 (71·0–76·8) 54·5 (49·5–59·4) 75·0 (64·3–85·8) Li huania* 1995–99 24·4 (22·7–26·1) 48·0 (45·2–50·7) 40·3 (37·4–43·2) 5·4§ (2·3–8·4) 10·0 (8·7–11·3) 65·3 (62·6–68·0) 53·2 (50·5–55·9) 33·2 (29·7–36·8) 51·8 (48·5–55·2) 36·6 (33·6–39·7) 59·5 (49·4–69·6) 2000–04 25·6 (24·0–27·2) 51·6 (49·4–53·9) 44·7 (42·2–47·2) 9·5§ (6·2–12·9) 8·3 (7·4–9·2) 70·3 (68·3–72·3) 57·0 (54·5–59·5) 33·0 (30·5–35·6) 81·2 (79·0–83·4) 39·5 (36·8–42·2) 72·6 (63·5–81·7) 2005–09 26·0 (24·3–27·7) 51·5 (49·4–53·7) 48·3 (45·8–50·9) 11·3§ (7·3–15·2) 7·7 (6·8–8·7) 72·1 (70·2–74·1) 61·3 (58·8–63·8) 35·8 (33·1–38·6) 92·4 (90·6–94·1) 44·7 (41·9–47·4) 69·6 (59·1–80·1) Mal a* 1995–99 17·5 (11·9–23·1) 49·3 (43·1–55·4) 49·8 (40·9–58·8) ·· 10·9 (8·0–13·8) 71·3 (67·1–75·5) 58·8 (44·7–72·9) 34·2 (25·9–42·6) 68·6 (61·0–76·1) 38·6 (30·7–46·4) .. 2000–04 15·5 (10·7–20·2) 57·6 (52·4–62·7) 51·4 (43·9–59·0) 10·8 (4·5–17·1) 9·3 (6·3–12·3) 76·3 (72·4–80·2) 52·8 (37·9–67·6) 37·9 (30·2–45·5) 82·7 (76·9–88·6) 24·2 (16·8–31·7) .. 2005–09 18·0 (12·8–23·2) 56·0 (51·2–60·8) 48·1 (41·0–55·2) 9·5 (6·5–12·4) 10·8 (8·0–13·6) 76·3 (72·7–79·9) 63·1 (49·3–76·9) 33·1 (27·2–39·0) 84·8 (79·9–89·7) 19·0 (12·8–25·3) 72·5 (59·5–85·4) Ne he lands* 1995–99 19·0 (18·1–19·8) 55·4 (54·7–56·1) 55·5 (54·3–56·6) 8·2 (6·7–9·8) 12·4 (12·1–12·8) 80·0 (79·4–80·6) 63·9 (62·0–65·7) 38·7 (37·5–39·9) 77·4 (76·5–78·3) 46·9 (45·4–48·3) .. 2000–04 19·5 (18·6–20·4) 57·7 (57·0–58·3) 57·7 (56·7–58·8) 9·7 (8·2–11·3) 12·2 (11·9–12·6) 83·5 (83·0–84·1) 65·7 (63·8–67·6) 37·3 (36·0–38·5) 82·7 (82·0–83·4) 48·4 (47·1–49·8) 84·5 (80·8–88·1) 2005–09 21·4 (20·5–22·4) 60·1 (59·5–60·7) 62·0 (61·0–63·0) 12·6 (10·8–14·3) 14·8 (14·4–15·1) 85·0 (84·5–85·5) 66·5 (64·6–68·4) 38·1 (36·8–39·3) 85·8 (85·2–86·4) 51·8 (50·5–53·1) 85·9 (82·7–89·2) No way* 1995–99 21·1 (19·4–22·9) 55·9 (54·6–57·2) 57·8 (56·1–59·5) 5·6 (3·4–7·8) 10·7 (10·0–11·5) 81·5 (80·3–82·6) 66·7 (64·1–69·4) 36·7 (34·7–38·8) 73·8 (72·5–75·1) 44·6 (41·9–47·3) 79·1 (71·4–86·8) 2000–04 22·0 (20·2–23·9) 58·4 (57·2–59·6) 61·7 (60·1–63·3) 7·4 (5·1–9·7) 11·7 (10·9–12·4) 84·1 (83·0–85·1) 70·6 (67·8–73·5) 40·2 (38·2–42·3) 82·4 (81·4–83·5) 48·9 (46·3–51·5) 87·7 (82·3–93·1) 2005–09 24·1 (22·1–26·1) 61·8 (60·6–62·9) 64·6 (63·0–66·2) 9·5 (6·9–12·2) 15·0 (14·1–15·8) 85·9 (84·9–87·0) 71·4 (68·6–74·3) 40·3 (38·3–42·4) 86·3 (85·4–87·2) 53·6 (51·0–56·2) 89·7 (84·4–94·9) Poland* 1995–99 14·2 (13·2–15·1) 40·0 (38·7–41·3) 36·7 (35·3–38·2) 7·9§ (6·5–9·3) 11·4 (10·9–11·9) 66·9 (65·4–68·3) 50·0 (48·4–51·5) 30·6 (28·8–32·4) 54·3 (52·1–56·5) 44·1 (38·9–49·4) .. 2000–04 15·7 (15·1–16·2) 45·7 (45·1–46·4) 42·8 (42·0–43·5) 9·2§ (8·4–10·1) 11·7 (11·4–12·0) 72·3 (71·6–72·9) 51·7 (50·9–52·6) 32·8 (31·9–33·7) 68·5 (67·6–69·4) 44·5 (40·4–48·5) .. 2005–09 18·6 (18·0–19·2) 50·1 (49·5–50·7) 46·9 (46·1–47·6) 10·4§ (9·5–11·3) 13·4 (13·1–13·7) 74·1 (73·5–74·7) 53·0 (52·1–53·9) 34·3 (33·5–35·2) 74·1 (73·4–74·9) 49·0 (45·2–52·7) .. Po ugal* 1995–99 26·6 (24·5–28·7) 48·8 (46·7–50·9) 46·0 (43·2–48·8) 7·7 (4·7–10·7) 10·4 (9·1–11·7) 74·9 (72·8–76·9) 54·0 (50·0–58·0) 33·9 (29·8–38·1) 81·3 (79·2–83·4) 40·0 (35·3–44·7) 66·5 (51·5–81·4) 2000–04 29·7 (28·8–30·6) 56·3 (55·4–57·3) 54·2 (52·9–55·5) 13·4 (11·5–15·2) 10·4 (9·8–11·0) 81·4 (80·5–82·4) 60·3 (58·4–62·1) 39·4 (37·2–41·7) 87·2 (86·2–88·1) 41·2 (38·9–43·5) 80·6 (74·7–86·5) 2005–09 32·6 (31·6–33·5) 60·3 (59·4–61·2) 58·2 (57·0–59·5) 15·6 (13·6–17·5) 12·8 (12·1–13·4) 83·4 (82·5–84·3) 61·5 (59·7–63·2) 40·6 (38·4–42·9) 89·4 (88·5–90·2) 43·6 (41·3–45·8) 86·8 (80·7–92·9) Romania (Cluj) 1995–99 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2000–04 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2005–09 22·1§ (17·6–26·5) 58·4§ (52·1–64·7) 46·8 (38·7–55·0) 2·3§ (0·3–4·4) 16·2§ (13·5–19·0) 75·0 (69·1–80·9) 69·1 (63·1–75·1) 40·5§ (30·9–50·1) 79·5 (72·7–86·4) 41·2 (32·7–49·8) ·· (Table 4 con inues on nex page) A icles 998 www. helance .com Vol 385 Ma ch 14, 2015 5-yea su i al was in he ange 60–69%. In gene al, ce ical cance su i al was 50% o highe in all o he coun ies, excep o Libya (Benghazi, 39%) and India (Ka unagappally, 46%). Su i al es ima es o no heas India (Guwaha i, 32%; Sikkim, 53%) a e fl agged as less eliable because up o 30% o women could no be aced despi e ac i e ollow-up (appendix pp 39–43). Su i al o ce ical cance is s able o has inc eased sligh ly in mos coun ies (appendix p 158). Fo example, in Cen al and Sou h Ame ica, su i al was s able a a ound 60% in B azil, Cuba, Ecuado , and Pue o Rico. In he 10 yea s be ween 1995–99 and 2005–09, 5-yea ne su i al inc eased om 42% o 51% in Chile and om 46% o 51% in A gen ina. In F ance, he decline in su i al S omach Colon Rec um Li e Lung B eas Ce ix O a y P os a e Leukaemia (adul ) ALL (child en) (Con inued om p e ious page) Russia (A khan gelsk) 1995–99 ·· ·· ·· ·· .. .. .. .. .. ·· ·· 2000–04 21·8 (19·2–24·4) 35·5 (32·3–38·8) 27·8 (23·8–31·7) 7·4 (3·1–11·8) 14·7 (12·6–16·9) 62·4 (58·1–66·6) 56·6 (51·1–62·2) 37·2 (31·2–43·2) 63·9 (54·9–73·0) 34·1 (25·6–42·6) ·· 2005–09 19·9 (17·5–22·3) 40·6 (37·3–43·8) 30·4 (26·2–34·5) 9·4 (4·3–14·5) 15·7 (13·6–17·9) 70·6 (66·4–74·9) 54·9 (49·1–60·6) 40·4 (34·2–46·6) 69·6 (62·1–77·2) 42·0 (31·9–52·2) ·· Slo akia* 1995–99 ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· ·· 2000–04 20·2 (18·8–21·6) 49·7 (48·5–51·0) 43·4 (41·6–45·2) 5·1§ (3·4–6·8) 9·6§ (8·9–10·4) 74·0 (72·5–75·6) 61·6 (59·2–64·0) 34·8 (32·3–37·4) 62·6 (60·3–64·9) 41·1 (38·3–43·8) 78·9 (71·6–86·2) 2005–09 19·7 (17·9–21·4) 49·9 (48·3–51·5) 44·0 (41·6–46·3) 5·3§ (3·1–7·4) 10·7§ (9·7–11·7) 72·1 (70·3–73·9) 58·8 (56·0–61·6) 33·9 (30·9–36·9) 66·0 (63·2–68·8) 37·2 (34·1–40·3) 78·2 (69·5–87·0) Slo enia* 1995–99 20·1 (18·3–22·0) 45·1 (42·9–47·3) 40·5 (37·7–43·3) 3·0 (1·4–4·6) 8·5 (7·6–9·4) 71·3 (69·2–73·5) 62·9 (59·5–66·4) 33·4 (29·8–36·9) 61·1 (57·7–64·4) 44·3 (39·8–48·8) 83·1 (72·5–93·8) 2000–04 25·6 (23·6–27·7) 53·1 (51·2–55·1) 48·4 (45·9–50·9) 3·8 (2·2–5·3) 9·7 (8·9–10·6) 78·3 (76·5–80·2) 67·3 (63·8–70·7) 37·8 (34·4–41·2) 72·7 (70·2–75·3) 39·9 (36·2–43·6) 86·1 (74·5–97·6) 2005–09 26·7 (24·6–28·8) 56·0 (53·9–58·0) 55·2 (52·7–57·7) 5·2 (3·3–7·0) 11·4 (10·4–12·3) 80·2 (78·5–82·0) 68·9 (65·4–72·5) 37·5 (34·4–40·6) 78·1 (76·1–80·2) 37·9 (34·4–41·4) 75·7 (63·8–87·6) Spanish egis ies† 1995–99 25·1 (24·0–26·2) 52·0 (51·1–53·0) 49·0 (47·4–50·5) 10·2 (9·0–11·4) 10·2 (9·7–10·7) 77·8 (76·8–78·7) 61·7 (59·4–64·0) 35·3 (33·4–37·1) 73·7 (72·3–75·0) 48·5 (46·5–50·5) 73·8 (68·3–79·3) 2000–04 25·3 (24·2–26·4) 56·1 (55·2–56·9) 55·2 (53·8–56·6) 14·3 (13·1–15·4) 11·5 (11·0–12·0) 82·2 (81·3–83·0) 63·4 (61·1–65·7) 38·1 (36·2–39·9) 84·6 (83·8–85·5) 50·7 (48·9–52·5) 81·5 (76·9–86·1) 2005–09 27·3 (26·1–28·5) 59·3 (58·4–60·1) 57·6 (56·2–59·0) 15·8 (14·6–17·1) 12·6 (12·1–13·1) 83·7 (82·8–84·5) 65·2 (62·9–67·6) 38·4 (36·6–40·2) 87·1 (86·3–87·9) 52·0 (50·2–53·9) 83·3 (79·1–87·4) Sweden* 1995–99 21·2 (19·9–22·5) 55·4 (54·4–56·5) 57·9 (56·6–59·2) 5·3 (4·3–6·4) 12·2 (11·6–12·9) 83·8 (83·1–84·5) 65·0 (62·9–67·1) 40·8 (39·2–42·4) 75·4 (74·5–76·2) 48·5 (46·8–50·3) 85·0 (80·5–89·5) 2000–04 21·0 (19·6–22·3) 59·4 (58·5–60·4) 59·6 (58·4–60·8) 6·8 (5·6–8·0) 13·3 (12·7–14·0) 85·6 (84·9–86·3) 66·6 (64·4–68·8) 42·8 (41·2–44·4) 86·1 (85·5–86·7) 55·0 (53·3–56·7) 86·8 (82·6–90·9) 2005–09 23·2 (21·7–24·6) 62·5 (61·6–63·5) 62·0 (60·9–63·2) 11·1 (9·5–12·7) 15·6 (14·9–16·4) 86·2 (85·5–86·9) 67·8 (65·6–70·0) 43·5 (41·9–45·1) 89·2 (88·7–89·8) 59·2 (57·5–60·8) 85·5 (80·9–90·1) Swiss egis ies† 1995–99 23·6 (21·4–25·8) 54·5 (52·8–56·3) 53·8 (51·2–56·4) 9·0 (7·0–11·1) 13·0 (12·1–13·9) 78·7 (77·4–80·0) 63·5 (59·5–67·5) 35·0 (32·4–37·6) 76·0 (74·2–77·7) 51·7 (48·7–54·7) 85·6 (80·3–90·8) 2000–04 28·2 (25·9–30·6) 61·4 (59·9–62·9) 58·9 (56·6–61·3) 11·8 (9·9–13·7) 14·5 (13·6–15·5) 84·0 (82·8–85·1) 63·8 (59·7–68·0) 35·7 (33·1–38·3) 85·9 (84·7–87·0) 56·0 (53·3–58·8) 87·3 (82·5–92·2) 2005–09 30·4 (28·0–32·9) 63·3 (61·9–64·8) 63·8 (61·5–66·1) 13·6 (11·6–15·7) 16·5 (15·6–17·5) 85·5 (84·4–86·6) 65·4 (61·1–69·6) 37·7 (35·3–40·2) 88·0 (87·0–89·0) 58·1 (55·6–60·7) 88·4 (83·8–93·0) UK* 1995–99 14·5 (14·1–14·9) 48·1 (47·7–48·5) 49·1 (48·6–49·7) 6·7 (6·1–7·4) 7·3 (7·2–7·5) 74·2 (73·9–74·5) 58·0 (57·1–58·8) 32·8 (32·2–33·3) 68·2 (67·7–68·7) 42·4 (41·7–43·1) 79·1 (77·0–81·2) 2000–04 16·5 (16·0–16·9) 51·4 (51·1–51·8) 53·9 (53·4–54·5) 8·1 (7·5–8·7) 8·5 (8·4–8·7) 78·7 (78·4–78·9) 59·1 (58·2–60·0) 34·5 (34·0–35·0) 80·3 (80·0–80·7) 45·3 (44·6–45·9) 85·9 (84·2–87·7) 2005–09 18·5 (18·0–19·0) 53·8 (53·5–54·2) 56·6 (56·1–57·1) 9·3 (8·7–9·9) 9·6 (9·4–9·8) 81·1 (80·9–81·4) 60·2 (59·3–61·1) 36·4 (35·9–37·0) 83·2 (82·9–83·5) 47·4 (46·7–48·0) 89·1 (87·6–90·7) (Table 4 con inues on nex page) A icles www. helance .com Vol 385 Ma ch 14, 2015 999 be ween 1995–99 and 2000–04 ( om 66% o 61%) was based on a ound 1700 women in each pe iod; he su i al es ima e o women diagnosed du ing 2005–09 (59%) includes da a o only 139 women om wo egis ies (Cal ados, 76%; Loi e-A lan ique, 49%); he o he egis ies could no p o ide ollow-up da a o women diagnosed wi h ce ical cance a e 2004 (appendix pp 64–80). The s iking inc ease in 5-yea su i al om ce ical cance in China ( om 40% o 60%) should be in e p e ed wi h cau ion: he es ima e o 1995–99 is based on da a o only 71 women in Changle, Jiashan, and Zhongshan, whe eas he es ima es o 2000–04 (56%) and 2005–09 (60%) a e based on da a o mo e han 1200 women (18 egis ies) and 3900 women (21 egis ies), espec i ely (appendix pp 64–111). Da a o o a ian cance a e a ailable o 779 302 women ( able 3). 191 egis ies in 48 coun ies con ibu ed da a o 1995–99, 243 egis ies in 57 coun ies had da a a ailable o 2000–04, and 241 egis ies in 61 coun ies p o ided da a o 2005–09 (appendix pp 64–80). Fo women diagnosed wi h o a ian cance du ing 2005–09, age-s anda dised 5-yea ne su i al was 40% o highe in Ecuado , he USA, nine coun ies in Asia, and eigh coun ies in Eu ope ( able 4; appendix p 148). Su i al in o he coun ies was mos ly in he ange 30–40%, excep o Libya (22%). The high su i al es ima e o Gib al a (59%) is based on da a o only 13 women; i is no age-s anda dised and he CI is wide ( able 4); simila ly, he e y high es ima e o Mau i ius (83%) is based on 52 women diagnosed in 2005. 5-yea su i al o o a ian cance ose by mo e han 10% be ween 1995–99 and 2005–09 in Ecuado ( om 35% o 47%), Es onia ( om 28% o 39%), and Japan ( om 26% o 37%), and by 5–10% in Bulga ia, Denma k, F ance, Hong Kong, Iceland, La ia, and Po ugal (appendix p 159). Mo e modes inc eases (2–4%) we e seen in se e al coun ies in Sou h Ame ica, Asia, and Eu ope. We we e unable o assess any end in A ica because o scan eliable da a co e ing he en i e pe iod 1995–2009. Fo women diagnosed wi h o a ian cance since 2000, da a we e a ailable om 60 egis ies in Asia and Cen al and Sou h Ame ica (appendix p 170). The ange in 5-yea su i al was e y wide. The ange is much na owe o he 160 egis ies in Eu ope, No h Ame ica, and Oceania ha p o ided da a o he same pe iod. Da a o p os a e cance a e a ailable o 4 999 267 men ( able 3). 189 egis ies in 48 coun ies con ibu ed da a o 1995–99, 241 egis ies in 57 coun ies p o ided da a o 2000–04, and 240 egis ies in 60 coun ies had da a o 2005–09 (appendix pp 64–80). Among he 61 coun ies ha p o ided da a on p os a e cance , he ange in age-s anda dised 5-yea ne su i al is e y wide, om less han 40% o g ea e han 95%. Fo men diagnosed du ing 2005–09, su i al was 90% o highe in Aus ia, Belgium, B azil, Canada, Cyp us, Ecuado , Finland, F ance, Ge many, Is ael, I aly, Li huania, Pue o Rico, and he USA ( able 4; appendix p 149). In he USA, whe e widesp ead p os a e-specifi c an igen (PSA) es ing was in oduced a ound 1990, 5-yea su i al has been highe han 90% since 1995–99. P os a e cance su i al was 80–89% in 19 coun ies in Cen al and Sou h Ame ica, Asia, Eu ope, and Oceania. In 18 o he coun ies, su i al anged widely (50–79%), bu in Libya and Mongolia i was 40–41%. S iking and pe sis en S omach Colon Rec um Li e Lung B eas Ce ix O a y P os a e Leukaemia (adul ) ALL (child en) (Con inued om p e ious page) Oceania Aus alian egis ies 1995–99 25·9 (24·8–27·0) 60·3 (59·7–61·0) 59·9 (58·9–61·0) 13·2 (11·8–14·6) 13·7 (13·3–14·2) 84·6 (84·0–85·2) 69·9 (68·3–71·6) 36·1 (34·8–37·4) 83·7 (83·1–84·2) 47·5 (46·2–48·7) 82·6 (79·5–85·7) 2000–04 27·8 (26·8–28·9) 63·1 (62·5–63·7) 63·8 (62·9–64·7) 14·3 (13·1–15·4) 14·8 (14·4–15·2) 86·4 (85·9–86·9) 68·4 (66·6–70·3) 37·0 (35·7–38·3) 86·8 (86·3–87·2) 51·0 (49·8–52·1) 86·0 (83·3–88·6) 2005–09 27·9 (26·7–29·0) 64·2 (63·6–64·8) 64·2 (63·3–65·1) 14·7 (13·5–16·0) 15·0 (14·6–15·5) 86·2 (85·6–86·8) 67·1 (65·1–69·1) 37·5 (36·2–38·8) 88·5 (88·1–88·9) 51·1 (50·0–52·3) 88·6 (85·9–91·4) New Zealand* 1995–99 22·2 (20·0–24·3) 60·8 (59·5–62·1) 57·0 (54·8–59·3) 11·6 (8·5–14·6) 12·2 (11·3–13·1) 79·5 (78·2–80·8) 64·3 (60·8–67·9) 35·8 (33·0–38·5) 80·8 (79·6–82·0) 47·7 (45·0–50·4) 82·6 (76·0–89·2) 2000–04 24·6 (22·4–26·8) 60·9 (59·6–62·1) 59·8 (57·8–61·9) 12·9 (10·3–15·5) 11·4 (10·6–12·2) 82·3 (81·1–83·5) 67·6 (64·0–71·2) 38·7 (36·0–41·3) 88·5 (87·6–89·4) 60·2 (57·9–62·4) 85·8 (79·9–91·7) 2005–09 26·7 (24·3–29·0) 61·6 (60·4–62·8) 60·8 (58·8–62·8) 17·4 (14·6–20·2) 12·4 (11·6–13·3) 83·7 (82·5–84·9) 63·9 (60·2–67·6) 33·8 (31·3–36·2) 88·7 (87·7–89·6) 58·0 (55·6–60·3) 89·3 (83·8–94·8) Da a a e ne su i al es ima es (%) wi h 95% CI. I alics deno e su i al es ima es ha a e no age-s anda dised. When oo ew pa ien s we e a ailable o analysis in any calenda pe iod, da a we e me ged and he su i al es ima es a e unde lined. Follow-up was sho e han 5 yea s o six egis ies: Libya (Benghazi); The Gambia; A gen ina (Mendoza); China (Lianyungang); Indonesia (Jaka a); and Colombia (Manizales: s omach, colon, b eas , ce ix, and p os a e). ALL=acu e lymphoblas ic leukaemia. *100% co e age o he na ional popula ion. †100% co e age o he na ional popula ion o childhood leukaemia only. ‡Sou h Ko ea. §Su i al es ima e conside ed less eliable. Table 4: 5-yea age-s anda dised ne su i al o adul s (aged 15–99 yea s) diagnosed wi h one o en common malignan diseases and child en (aged 0–14 yea s) wi h ALL, by con inen , coun y, and calenda pe iod o diagnosis A icles 1000 www. helance .com Vol 385 Ma ch 14, 2015 inc eases in p os a e cance su i al we e seen in many coun ies be ween 1995–99 and 2005–09 (appendix p 160). Su i al ose by 10–20% in 22 coun ies in Cen al and Sou h Ame ica, Asia, and Eu ope; smalle inc eases (less han 10%) we e seen in 15 coun ies. Da a o leukaemia in adul s a e a ailable o 873 588 pa ien s ( able 3). 185 egis ies in 47 coun ies p o ided da a o 1995–99, 234 egis ies in 56 coun ies con ibu ed da a o 2000–04, and 232 egis ies in 60 coun ies p o ided da a o 2005–09 (appendix pp 64–80). Fo adul s diagnosed wi h leukaemia du ing 2005–09, age-s anda dised 5-yea ne su i al was 50–60% in 21 coun ies in No h Ame ica, wes Asia, Eu ope, and Oceania ( able 4; appendix p 150). The es ima e in Mau i ius (57%) is based on 31 pa ien s diagnosed in 2005; i is no age-s anda dised and has a wide CI. Simila ly, he es ima e o Cuba (60%) is based on only 97 pa ien s diagnosed du ing 1998–2006. 5-yea ne su i al om adul leukaemia is gene ally much lowe in he 15 pa icipa ing Asian coun ies han in o he egions o he wo ld (appendix pp 163–73). Wi h a ew excep ions, su i al seems o be low in eas Asia (eg, om 19% in Japan o 23% in Sou h Ko ea and Taiwan), high in wes Asia (eg, om 33% in Tu key o 53% in Qa a ), wi h a mixed pic u e in o he Asian coun ies (eg, om 7% in Jo dan o 40% in Indonesia). Su i al es ima es o adul leukaemia om Jo dan, India, and Saudi A abia migh be less eliable o in e na ional compa ison, bu he o e all pa e n o leukaemia su i al in Asia is s ill in o ma i e. Su i al inc eases o 10–16% o adul leukaemia we e seen in China, Denma k, Ge many, Iceland, La ia, Sweden, and New Zealand. Smalle ises o 5–9% we e no ed in No h Ame ica, Is ael, Japan, Sou h Ko ea, and en Eu opean coun ies. In Mal a, 5-yea su i al ell om 39% in 1995–99 (based on 142 adul s) o 19% o 2005–09 (128 adul s; appendix p 161). This pa e n is su p ising, because da a quali y is e y high (appendix pp 54–58) and su i al ends o all solid umou s seem o be no mal. Smalle declines we e seen in se e al coun ies, such as Slo akia ( om 41% o 37%) and Slo enia ( om 44% o 38%). Da a o acu e lymphoblas ic leukaemia in child en a e a ailable o 74 343 pa ien s ( able 3). 173 egis ies in 42 coun ies con ibu ed da a o 1995–99, 215 egis ies in 50 coun ies p o ided da a o 2000–04, and 213 egis ies in 53 coun ies p o ided da a o 2005–09. In Romania (Cluj), da a we e only a ailable o eigh child en and su i al was no es ima ed. O 53 coun ies, 32 p o ided da a wi h 100% na ional popula ion co e age. The geog aphic ange in su i al o acu e lymphoblas ic leukaemia in child en was e y wide. Fo pa ien s diagnosed du ing 2005–09, age-s anda dised 5-yea ne su i al was 90% o highe in Aus ia, Belgium, Canada, Ge many, and No way and 80–89% in 21 coun ies on a ious con inen s ( able 4; appendix p 151). In many coun ies, howe e , 5-yea ne su i al is s ill lowe han 60%, e en a e adjus men o he e y high backg ound mo ali y in childhood. Su i al was less han 50% in Indonesia, Mongolia, and Leso ho, al hough hese es ima es a e based on e y small numbe s. The ange o su i al es ima es o childhood acu e lymphoblas ic leukaemia in Cen al and Sou h Ame ica (16 egis ies) and Asia (23 egis ies) is much lowe han he ange in No h Ame ica (48 egis ies), Eu ope (83 egis ies), and Oceania (se en egis ies; appendix p 173). 5-yea su i al o childhood acu e lymphoblas ic leukaemia ose by 10% o mo e be ween 1995–99 and 2005–09 in Bela us, Belgium, Bulga ia, China, Colombia, Li huania, No way, Po ugal, Sou h Ko ea, Spain, Taiwan, and he UK. The es ima e o 11% om China o 1995–99 is based on only 23 child en, bu he inc ease om 50% o 2000–04 o 61% o 2005–09 is mo e eliable. Inc eases in su i al o up o 9% we e seen in 16 o he coun ies. 5-yea su i al in A gen ina, Ecuado , and Slo akia was in he ange 60–79%, wi h li le o no change o e ime. Su i al seemed o all in B azil ( om 72% o 66%), Malaysia ( om 77% o 69%), and Slo enia ( om 83–86% in 1995–2004 o 76% o 2005–09). Su i al ends could no be assessed in A ica. Discussion Wi h CONCORD-2, we ha e ini ia ed wo ldwide su eillance o ends in cance su i al. In he fi s CONCORD s udy,6 compa able es ima es o cance su i al wo ldwide we e p o ided: he s udy included 1·9 million pa ien s diagnosed wi h b eas , colo ec al, o p os a e cance du ing 1990–94 and ollowed up o 1999 in 31 coun ies (panel). CONCORD-2 ex ends co e age o 25·7 million pa ien s diagnosed wi h an in asi e p ima y cance du ing he 15-yea pe iod 1995–2009 in 67 coun ies. The en index cance s ep esen abou wo- hi ds o he o e all cance bu den in bo h low-income and high- income coun ies.4 Indi idual pa ien da a p o ided by 279 popula ion-based cance egis ies we e p epa ed wi h s anda dised quali y-con ol p ocedu es and subjec ed o cen alised analysis wi h he la es s a is ical me hods. The fi ndings do no co e all coun ies, bu hey p o ide a leas some popula ion-based cance su i al es ima es o 67 coun ies (26 o low o middle income) ha a e home o wo- hi ds o he wo ld’s popula ion, including na ional da a o 40 coun ies. The es ima es a e de i ed om analysis o aw da a on he su i al o indi idual cance pa ien s up o 5 yea s a e diagnosis. Un il now, o compa ison o global o con inen al su i al, esea che s gene ally needed o in e p e sca e ed epo s p oduced wi h di e se cance defi ni ions, quali y-con ol c i e ia, and su i al es ima o s, o diff e en calenda pe iods, and age-s anda dised o diff e en se s o weigh s.46 Mo e specula i e compa isons ha e been based on modelling o mo ali y-incidence a ios, some imes wi h da a om neighbou ing egions o coun ies,47 wi h all he a endan assump ions.48 E en a e adjus men o he wide in e na ional a ia ion in le els o mo ali y om o he causes, and wi h due allowance o a ia ion in quali y o da a, he A icles www. helance .com Vol 385 Ma ch 14, 2015 1001 global ange in 5-yea su i al om en cance s in adul s and acu e lymphoblas ic leukaemia in child en is e y wide. Fo mos cance s, su i al in A ica, Asia, and Cen al and Sou h Ame ica is lowe , and he ange in su i al much wide , han in Eu ope, No h Ame ica, and Oceania. The wide ange is only pa ly a ibu able o he ac ha no all cance egis ies could p o ide da a co e ing he 15 yea s om 1995 o 2009; o example, many o he Chinese egis ies con ibu ed da a o 2000–04 bu no 2005–09. In No h Ame ica and Oceania, popula ion co e age was highe han 80% and he same egis ies gene ally p o ided da a o he en i e pe iod 1995–2009 (fi gu e 4; appendix pp 163–73): su i al o mos cance s was high on a global scale, wi h a ai ly na ow ange in es ima es be ween egis ies. 5-yea ne su i al om s omach cance is gene ally in he ange 25–30%, bu i is e y high (50–60%) in Japan, Sou h Ko ea, and, o a lesse ex en , Taiwan. High su i al om s omach cance in Japan,49 Sou h Ko ea,50 and Taiwan51 is well known, and is likely o be a ibu able o in ensi e diagnos ic ac i i y, ea ly s age a diagnosis, and adical su ge y. Su i al a ies acco ding o sub-si e, mo phological ype, and s age. Types o cance wi h be e p ognosis migh also be mo e common in Japan and Sou h Ko ea, bu he s iking wo ldwide diff e ences in su i al sugges impo an lessons could be lea n om hese coun ies abou diagnosis and ea men . 5-yea su i al has isen o colon and ec al cance s in mos de eloped coun ies and egions, including No h Ame ica, Eu ope, Oceania, and pa s o eas Asia (Sou h Ko ea and u ban a eas in China); inc eases in b eas cance su i al ha e also been no ed in hese egions and in pa s o Cen al and Sou h Ame ica. These ends a e likely o be a ibu able o ea lie diagnosis, educ ion in pos ope a i e mo ali y,52 and mo e eff ec i e ea men .53,54 Fo ec al cance , p eope a i e adio he apy and o al meso ec al excision educe local ecu ence and ex end su i al,55–57 which could accoun o imp o emen s no ed in Canada, Finland, he Ne he lands, No way, Sweden, and he USA, whe e su i al was al eady high (55–60%) o pa ien s diagnosed in 1995–99 and ose u he o hose diagnosed du ing 2005–09 (62–65%). These ends acco d wi h hose epo ed om he Ne he lands,58 Sco land, he No dic coun ies,59 and elsewhe e in Eu ope.60 Li e and lung cance emain le hal in bo h de eloping and de eloped coun ies, wi h 5-yea su i al gene ally lowe han 20%, indica ing ha mos pa ien s a e s ill diagnosed when hey a e inope able. P ima y p e en ion aimed a educing obacco and alcohol consump ion, and p e en ion o ch onic hepa i is, will be especially impo an o hese cance s. The e y low su i al es ima e o li e cance in The Gambia (5%) is based on a sample o only 85 pa ien s diagnosed du ing 1995–97 who we e ollowed up o less han 5 yea s, o he end o 1998; i is no age-s anda dised, bu i is unlikely o be a w ong: pa ien s in The Gambia end o p esen wi h e y ad anced disease and ci hosis and a e no amenable o su ge y.61 O e all comple eness o egis a ion is low, bu he incidence o li e cance is compa able wi h ha o o he wes A ican popula ions.62 Da a om he na ional cance egis y o The Gambia, se up in 1986 o suppo he IARC’s Gambia Hepa i is In e en ion S udy,63 ha e been analysed p e iously,64 bu mo e ecen da a we e una ailable, so we cleaned and analysed hem he e alongside all o he da ase s, wi h pe mission om IARC. The global ange in 5-yea su i al om ce ical cance is e y wide, om less han 40% o mo e han 70%. The o e all decline in su i al om 66% o 61% in F ance be ween 1995–99 and 2000–04 was seen in all nine egis ies (appendix p 105). The dec ease migh be a ibu able o emo al o less agg essi e umou s by mo e in ensi e ce ical sc eening o p ein asi e lesions.65,66 Su i al om ce ical cance in he No dic coun ies was s able o ose sligh ly o e he same pe iod.67 By compa ison, lowe su i al in low-income and middle-income coun ies is s iking, since in asi e ce ical cance is po en ially cu able wi h ea ly de ec ion by sc eening and app op ia e su ge y.68 5-yea su i al om o a ian cance is gene ally in he ange 30–40% in mos pa s o he wo ld, bu he o e all ange is much wide . Di e si y in in e na ional su i al migh be a ibu able pa ly o a ia ions in he p opo ion o umou s classifi ed as ype I ( ypically ea ly-s age and slow-g owing) and ype II ( ypically la e-s age and agg essi e).69 Diff e ences in s age a diagnosis and ea men a e also likely o be impo an .70 Diff e en ial Panel: Resea ch in con ex Sys ema ic e iew In he fi s global compa ison o popula ion-based cance su i al (CONCORD),6 wide a ia ions in su i al om cance s o he b eas (women), colon, ec um, and p os a e we e epo ed among 1·9 million adul s diagnosed du ing 1990–94 and ollowed up o 1999 in 31 coun ies (16 coun ies had na ional co e age). Mo e ecen s udies ha e diff e ed wi h espec o geog aphic and popula ion co e age, calenda pe iod, and analy ical me hods, and hey do no enable wo ldwide compa ison o su i al ends.7–9 Wi h CONCORD-2, we ha e ex ended co e age o 25·7 million cance pa ien s diagnosed du ing he 15-yea pe iod 1995–2009 in one o 67 coun ies (26 o low o middle income), o which 40 coun ies had na ional co e age. In e p e a ion The en index cance s we selec ed o analysis ep esen wo- hi ds o he o e all cance bu den in bo h low-income and high-income coun ies. 5-yea su i al om colon, ec al, and b eas cance s has inc eased in mos de eloped coun ies. Li e and lung cance emain le hal in bo h de eloping and de eloped coun ies. S iking inc eases in p os a e cance su i al ha e occu ed in many coun ies, bu ends a y widely. The ange in ce ical and o a ian cance su i al is e y wide, bu imp o emen s ha e been sligh . In eas Asia, s omach cance su i al is e y high, sugges ing lessons could be lea n , whe eas su i al o adul and childhood leukaemia is ema kably low. The global ange in su i al om p ecu so -cell acu e lymphoblas ic leukaemia in child en is e y wide, sugges ing majo defi ciencies in he managemen o wha is now a la gely cu able disease. The fi ndings o ou s udy can be used o assess he ex en o which in es men in heal h-ca e sys ems is imp o ing hei eff ec i eness. A icles 1008 www. helance .com Vol 385 Ma ch 14, 2015 7 De Angelis R, San M, Coleman MP, e al, and he EUROCARE-5 Wo king G oup. Cance su i al in Eu ope 1999–2007 by coun y and age: esul s o EUROCARE-5—a popula ion-based s udy. Lance Oncol 2014; 15: 23–34. 8 Sanka ana ayanan R, Swamina han R, B enne H, e al. Cance su i al in A ica, Asia, and Cen al Ame ica: a popula ion-based s udy. Lance Oncol 2010; 11: 165–73. 9 Coleman MP, Fo man D, B yan H, e al, and he ICBP Module 1 Wo king G oup. Cance su i al in Aus alia, Canada, Denma k, No way, Sweden, and he UK, 1995–2007 ( he In e na ional Cance Benchma king Pa ne ship): an analysis o popula ion-based cance egis y da a. Lance 2011; 377: 127–38. 10 Depa men o Heal h. Imp o ing ou comes: a s a egy o cance . London: Depa men o Heal h, 2011. 11 Rache B, Ma inge C, Nu U, e al. Popula ion-based cance su i al ends in England and Wales up o 2007: an assessmen o he NHS cance plan o England. Lance Oncol 2009; 10: 351–69. 12 Rache B, Ellis L, Ma inge C, e al. Socioeconomic inequali ies in cance su i al in England a e he NHS Cance Plan. B J Cance 2010; 103: 446–53. 13 Na ional Audi Offi ce. Deli e ing he cance e o m s a egy (HC 568, session 2010–2011). London: S a ione y Offi ce, 2010. 14 UICC. Wo ld cance decla a ion 2013. h p://www.uicc.o g/wo ld- cance -decla a ion (accessed May 1, 2014). 15 Cu ado MP, Edwa ds BK, Shin HR, e al, eds. Cance incidence in fi e con inen s, ol IX (IARC scien ifi c publica ions no 160). Lyon: In e na ional Agency o Resea ch on Cance , 2007. 16 IARC. CI5: cance incidence in fi e con inen s. 2010. h p://ci5.ia c. (accessed May 1, 2014). 17 UN. Composi ion o mac o geog aphical (con inen al) egions, geog aphical sub- egions, and selec ed economic and o he g oupings. Oc 31, 2013. h p://uns a s.un.o g/unsd/me hods/m49/ m49 egin.h m (accessed May 1, 2014). 18 Hijmans R. GADM da abase o global adminis a i e a eas ( e sion 2.0). Janua y, 2012. h p://www.gadm.o g/ (accessed Oc 1, 2013). 19 F i z AG, Pe cy C, Jack A, e al, eds. In e na ional Classifi ca ion o Diseases o Oncology (ICD-O), 3 d edn. Gene a: Wo ld Heal h O ganiza ion, 2000. 20 San M, Allemani C, Te eanu C, e al. Incidence o hema ologic malignancies in Eu ope by mo phologic sub ype: esul s o he HAEMACARE p ojec . Blood 2010; 116: 3724–34. 21 San M, Ka jalainen-Lindsbe g ML, Maynadié M, e al, and he HAEMACARE Wo king G oup. Manual o coding and epo ing haema ological malignancies. Tumo i 2010; 96: i-A32. 22 Swe dlow SH, Campo E, Ha is NL, e al. WHO classifi ca ion o umou s o haema opoie ic and lymphoid issues, 4 h edn (WHO classifi ca ion o umou s, ol 2). Gene a: Wo ld Heal h O ganisa ion, 2008. 23 Woods LM, Rache B, Ellis L, Coleman MP. Full da es (day, mon h, yea ) should be used in popula ion-based cance su i al s udies. In J Cance 2012; 131: E1120–24. 24 Su eillance Epidemiology and End Resul s p og am. Mul iple p ima y and his ology coding ules. Jan 1, 2007. h p://see .cance . go / ools/mph ules/2007_mph ules_manual_08242012.pd (accessed Aug 18, 2014). 25 Eu opean Ne wo k o Cance Regis ies. Recommenda ions o coding mul iple p ima ies. July 31, 2011. h p://www.enc .eu/images/docs/ ecommenda ions/MP ules_july2004.pd (accessed No 14, 2014). 26 Capocaccia R, Ga a G, Roazzi P, e al. The EUROCARE-3 da abase: me hodology o da a collec ion, s anda disa ion, quali y con ol and s a is ical analysis. Ann Oncol 2003; 14 (suppl 5): 14–27. 27 Li R, Abela L, Moo e J, e al. Con ol o da a quali y o popula ion-based cance su i al analysis. Cance Epidemiol 2014; 38: 314–20. 28 De Angelis R, F ancisci S, Baili P, e al. The EUROCARE-4 da abase on cance su i al in Eu ope: da a s anda disa ion, quali y con ol and me hods o s a is ical analysis. Eu J Cance 2009; 45 (suppl 6): 909–30. 29 Fe lay J, Bu kha d C, Whelan S, Pa kin DM. Check and con e sions p og ams o cance egis ies: IARC/IACR ools o cance egis ies. Lyon: In e na ional Associa ion o Resea ch on Cance , 2005. 30 Lakhani SR, Ellis IO, Schni SJ, Tan PH, an de Vij e MJ, eds. WHO classifi ca ion o umou s o he b eas , 4 h edn. Gene a: Wo ld Heal h O ganiza ion, 2012. 31 Ku man RJ, Ca cangiu ML, He ing on CS, Young RH, eds. WHO classifi ca ion o umou s o emale ep oduc i e o gans, 4 h edn. Gene a: Wo ld Heal h O ganiza ion, 2014. 32 Bosman FT, Ca nei o F, H uban RH, Theise ND, eds. WHO classifi ca ion o umou s o he diges i e sys em, 4 h edn. Gene a: Wo ld Heal h O ganiza ion, 2010. 33 B enne H, Ge elle O. An al e na i e app oach o moni o ing cance pa ien su i al. Cance 1996; 78: 2004–10. 34 Poha Pe me M, Hende son R, S a e J. An app oach o es ima ion in ela i e su i al eg ession. Bios a is ics 2009; 10: 136–46. 35 Cle c-U mès I, G zebyk M, Hédelin G. Ne su i al es ima ion wi h s ns. S a a J 2014; 14: 87–102. 36 S a aCo p. STATA s a is ical so wa e, e sion 13. College S a ion, TX: S a a Co po a ion, 2013. 37 Uni e si y o Cali o nia, Max Planck Ins i u e o Demog aphic Resea ch. Human mo ali y da abase. h p://www.mo ali y.o g (accessed May 1, 2014). 38 Micheli A, Baili P, Mugno E, e al. Li e expec ancy and cance su i al in he EUROCARE-3 cance egis y a eas. Ann Oncol 2003; 14 (suppl 5): 28–40. 39 Ewbank DC, Gomez de Leon JC, S o o MA. A educible ou - pa ame e sys em o model li e ables. Popul S ud (Camb) 1983; 37: 105–29. 40 UN Popula ion Di ision. Wo ld popula ion p ospec s: he 2012 e ision— ol I, comp ehensi e ables (ST/ESA/SER.A/336). New Yo k: UN Depa men o Economic and Social Aff ai s, 2013. 41 Eland -Johnson RC, Johnson NL. Su i al models and da a analysis (Wiley se ies in p obabili y and ma hema ical s a is ics). Indianapolis: John Wiley & Sons, 1980. 42 Co azzia i I, Quinn MJ, Capocaccia R. S anda d cance pa ien popula ion o age s anda dising su i al a ios. Eu J Cance 2004; 40: 2307–16. 43 S ille CA, Bunch KJ. T ends in su i al o childhood cance in B i ain diagnosed 1971–85. B J Cance 1990; 62: 806–15. 44 G eenwood M. The na u al du a ion o cance ( epo on public heal h and medical subjec s no 33). London: S a ione y Offi ce, 1926. 45 UN Popula ion Di ision. Mo ali y and he demog aphic impac o HIV/AIDS. In: Wo ld popula ion p ospec s: he 2004 e ision. New Yo k: UN Depa men o Economic and Social Aff ai s, 2005: pp 54–82. 46 Youlden DR, C amb SM, Dunn NA, Mulle JM, Pyke CM, Baade PD. The desc ip i e epidemiology o emale b eas cance : an in e na ional compa ison o sc eening, incidence, su i al and mo ali y. Cance Epidemiol 2012; 36: 237–48. 47 Jönsson B, Wilking N. A global compa ison ega ding pa ien access o cance d ugs. Ann Oncol 2007; 18 (suppl 3): 1–74. 48 Ellis L, Woods LM, Es è e J, Elo an a S, Coleman MP, Rache B. Cance incidence, su i al and mo ali y: explaining he concep s. In J Cance 2014; 135: 1774–82. 49 Ma suda T, Ajiki W, Ma ugame T, Ioka A, Tsukuma H, Sobue T. Popula ion-based su i al o cance pa ien s diagnosed be ween 1993 and 1999 in Japan: a ch onological and in e na ional compa a i e s udy. Jpn J Clin Oncol 2011; 41: 40–51. 50 Na ional Cance Cen e . Cance ac s and fi gu es 2010 in he Republic o Ko ea. Seoul: Minis y o Heal h and Wel a e, 2010. 51 Wang CS, Hsieh CC, Chao TC, e al. Resec able gas ic cance : ope a i e mo ali y and su i al analysis. Chang Gung Med J 2002; 25: 216–27. 52 Mi y E, Bou ie AM, Es è e J, Fai e J. Benefi o ope a i e mo ali y educ ion on colo ec al cance su i al. B J Su g 2002; 89: 1557–62. 53 Chawla N, Bu le EN, Lund J, Wa en JL, Ha lan LC, Yab off KR. Pa e ns o colo ec al cance ca e in Eu ope, Aus alia, and New Zealand. J Na l Cance Ins Monog 2013; 46: 36–61. 54 Innos K, Soplepmann J, Suu oja T, Melnik P, Aa eleid T. Su i al o colon and ec al cance in Es onia: ole o s aging and ea men . Ac a Oncol 2012; 51: 521–27. 55 Allemani C, Rache B, Wei HK, e al. Colo ec al cance su i al in he USA and Eu ope: a CONCORD high- esolu ion s udy. BMJ Open 2013; 3: e003055. 56 Kapi eijn E, Ma ijnen CA, Nag egaal ID, e al. P eope a i e adio he apy combined wi h o al meso ec al excision o esec able ec al cance . N Engl J Med 2001; 345: 638–46. A icles www. helance .com Vol 385 Ma ch 14, 2015 1009 57 Mi y E, Bou ie AM, Es è e J, Fai e J. Imp o emen in colo ec al cance su i al: a popula ion-based s udy. Eu J Cance 2005; 41: 2297–303. 58 El e ink MA, an S eenbe gen LN, K ijnen P, e al. Ma ked imp o emen s in su i al o pa ien s wi h ec al cance in he Ne he lands ollowing changes in he apy, 1989-2006. Eu J Cance 2010; 46: 1421–29. 59 Folkesson J, Engholm G, Eh n oo h E, e al. Rec al cance su i al in he No dic coun ies and Sco land. In J Cance 2009; 125: 2406–12. 60 B enne H, Bou ie AM, Foschi R, e al. P og ess in colo ec al cance su i al in Eu ope om he la e 1980s o he ea ly 21s cen u y: he EUROCARE s udy. In J Cance 2012; 131: 1649–58. 61 Umoh NJ, Lesi OA, Mendy M, e al. Ae iological diff e ences in demog aphical, clinical and pa hological cha ac e is ics o hepa ocellula ca cinoma in The Gambia. Li e In 2011; 31: 215–21. 62 Shimakawa Y, Bah E, Wild CP, Hall AJ. E alua ion o da a quali y a he Gambia na ional cance egis y. In J Cance 2013; 132: 658–65. 63 Vi iani S, Ca ie i P, Bah E, e al. 20 yea s in o he Gambia Hepa i is In e en ion S udy: assessmen o ini ial hypo heses and p ospec s o e alua ion o p o ec i e eff ec i eness agains li e cance . Cance Epidemiol Bioma ke s P e 2008; 17: 3216–23. 64 Sanka ana ayanan R, Black RJ, Pa kin DM, eds. Cance su i al in de eloping coun ies (IARC scien ifi c publica ions no 145). Lyon: In e na ional Agency o Resea ch on Cance , 1998. 65 Bossa d N, Vel en M, Remon e L, e al. Su i al o cance pa ien s in F ance: a popula ion-based s udy om he Associa ion o F ench Cance Regis ies (FRANCIM). Eu J Cance 2007; 43: 149–60. 66 Ga a G, Capocaccia R, Hakulinen T, e al. Va ia ions in su i al o in asi e ce ical cance among Eu opean women, 1978–89. Cance Causes Con ol 1999; 10: 575–81. 67 Klin A, T ygg ado i L, B ay F, e al. T ends in he su i al o pa ien s diagnosed wi h cance in emale geni al o gans in he No dic coun ies 1964–2003 ollowed up o he end o 2006. Ac a Oncol 2010; 49: 632–43. 68 Fa me P, F enk J, Knaul FM, e al. Expansion o cance ca e and con ol in coun ies o low and middle income: a call o ac ion. Lance 2010; 376: 1186–93. 69 Ku man RJ, Shih IM. The o igin and pa hogenesis o epi helial o a ian cance : a p oposed uni ying heo y. Am J Su g Pa hol 2010; 34: 433–43. 70 Ma inge C, Wal e s S, Bu le J, e al. S age a diagnosis and o a ian cance su i al: e idence om he In e na ional Cance Benchma king Pa ne ship. Gynecol Oncol 2012; 127: 75–82. 71 Mi enbe gs U, Taube M, Misins J, e al. La ia: heal h sys em e iew 2012. Heal h Sys T ans 2012; 14: 1–191. 72 T e li S, Engeland A, Haldo sen T, e al. P os a e cance : look o Denma k? J Na l Cance Ins 1996; 88: 128. 73 Coleman MP, Ga a G, Ve decchia A, e al. EUROCARE-3 summa y: cance su i al in Eu ope a he end o he 20 h cen u y. Ann Oncol 2003; 14 (suppl 5): 128–49. 74 B asso K, I e sen P. P os a ic cance 2006: s a us and new challenges. Ugesk Læge 2006; 168: 1243 (in Danish). 75 Wu SJ, Chiang CJ, Lin CT, Tien HF, Lai MS. Imp o ing bu in e io su i al in pa ien s wi h ch onic lymphocy ic leukemia in Taiwan: a popula ion-based s udy, 1990–2004. PLoS One 2013; 8: e62930. 76 Chen X-C, Chen X-Z. Epidemiological diff e ences in haema ological malignancies be ween Eu ope and China. Lance Oncol 2014; 15: e471–72. 77 Zeng H, Zheng R, Guo Y, e al. Cance su i al in China, 2003–2005: a popula ion-based s udy In J Cance 2014; published online Oc 3. h p://dx.doi.o g/10.1002/ijc.29227. 78 Pui CH, E ans WE. A 50-yea jou ney o cu e childhood acu e lymphoblas ic leukemia. Semin Hema ol 2013; 50: 185–96. 79 Mos e S, A o a RS, A eola M, e al. Abandonmen o ea men o childhood cance : posi ion s a emen o a SIOP PODC Wo king G oup. Lance Oncol 2011; 12: 719–20. 80 Be ino F, Es è e J, Coleman MP. Basic issues in he es ima ion and compa ison o cance pa ien su i al. In: Be ino F, San M, Ve decchia A, Capocaccia R, Hakulinen T, Es è e J, eds. Su i al o cance pa ien s in Eu ope: he EUROCARE s udy (IARC scien ifi c publica ions no 132). Lyon: In e na ional Agency o Resea ch on Cance , 1995: pp 1–14. 81 Lau en P. The wo his ological main ypes o gas ic ca cinoma: diff use and so-called in es inal- ype ca cinoma—an a emp a a his o- clinical classifi ca ion. Ac a Pa hol Mic obiol Scand 1965; 64: 31–49. 82 Ma inge C, Wal e s S, Rache B, e al. S age a diagnosis and colo ec al cance su i al in six high-income coun ies: a popula ion- based s udy o pa ien s diagnosed du ing 2000–7. Ac a Oncol 2013; 52: 919–32. 83 Wal e s S, Ma inge C, Bu le J, e al. B eas cance su i al and s age a diagnosis in Aus alia, Canada, Denma k, No way, Sweden and he UK, 2000–2007: a popula ion-based s udy. B J Cance 2013; 108: 1195–208. 84 Wal e s S, Ma inge C, Coleman MP, e al. Lung cance su i al and s age a diagnosis in Aus alia, Canada, Denma k, No way, Sweden and he Uni ed Kingdom: a popula ion-based s udy, 2004–2007. Tho ax 2013; 68: 551–64. 85 Allemani C, San M, Wei HK, e al. B eas cance su i al in he US and Eu ope: a CONCORD high- esolu ion s udy. In J Cance 2013; 132: 1170–81. 86 Allemani C, S o m H, Voogd AC, e al. Va ia ion in ‘s anda d ca e’ o b eas cance ac oss Eu ope: a EUROCARE-3 high esolu ion s udy. Eu J Cance 2010; 46: 1528–36. 87 Minicozzi P, Bou ie AM, Fai e J, San M, on behal o he s udy wo king g oup. Managemen o ec al cance s in ela ion o ea men guidelines: a popula ion-based s udy compa ing I alian and F ench pa ien s. Dig Li e Dis 2014; 46: 645–51. 88 Wal e s S, Ma inge C, Bu le J, B ie ley JD, Rache B, Coleman MP. Compa abili y o s age da a in cance egis ies in six coun ies: lessons om he In e na ional Cance Benchma king Pa ne ship. In J Cance 2013; 132: 676–85. 89 Sobin LH, Gospoda owicz M, Wi ekind C, eds. TNM classifi ca ion o malignan umou s, 7 h edn. New Yo k: John Wiley & Sons, 2009. 90 Dickman PW, Hakulinen T. The accu acy o index da es and calcula ion o su i al ime om cance egis y da a. J Epidemiol Bios a 1997; 2: 87–94. 91 Ru he o d MJ, Mølle H, Lambe PC. A comp ehensi e assessmen o he impac o e o s in he cance egis a ion p ocess on 1- and 5-yea ela i e su i al es ima es. B J Cance 2013; 108: 691–98. 92 Johnson CJ, Wei HK, Fink AK, e al. The impac o Na ional Dea h Index linkages on popula ion-based cance su i al a es in he Uni ed S a es. Cance Epidemiol 2013; 37: 20–28. 93 Johnson CJ, Wei HK, Yin D, Niu X. The impac o pa ien ollow-up on popula ion-based su i al a es. J Regis y Manage 2010; 37: 86–103. 94 Swamina han R. Lack o ac i e ollow-up o cance pa ien s in Chennai, India: implica ions o popula ion-based su i al es ima es. Bull Wo ld Heal h O gan 2008; 86: 509–15. 95 B ay F, Pa kin DM. E alua ion o da a quali y in he cance egis y: p inciples and me hods—pa I, compa abili y, alidi y and imeliness. Eu J Cance 2009; 45: 747–55. 96 Pa kin DM, B ay F. E alua ion o da a quali y in he cance egis y: p inciples and me hods—pa II, comple eness. Eu J Cance 2009; 45: 756–64. 97 Ga a G, Bo a L, Rossi S, e al, and he EUROCARE Wo king G oup. Childhood cance su i al in Eu ope 1999–2007: esul s o EUROCARE-5—a popula ion-based s udy. Lance Oncol 2014; 15: 35–47. 98 Ellison LF. Measu ing he eff ec o including mul iple cance s in su i al analyses using da a om he Canadian Cance Regis y. Cance Epidemiol 2010; 34: 550–55. 99 Wei HK, Johnson CJ, Thompson TD. The eff ec o mul iple p ima y ules on popula ion-based cance su i al. Cance Causes Con ol 2013; 24: 1231–42. 100 Rosso S, De Angelis R, Ciccolallo L, e al. Mul iple umou s in su i al es ima es. Eu J Cance 2009; 45 (suppl 6): 1080–94. 101 Cu is RE, F eedman DM, Ron E, e al. New malignancies among cance su i o s: SEER cance egis ies 1973–2000 (NIH publica ion no 05-3302). Be hesda: Na ional Cance Ins i u e, 2006. 102 Ma io o AB, Rowland JH, Ries LA, Scoppa S, Feue EJ. Mul iple cance p e alence: a g owing challenge in long- e m su i o ship. Cance Epidemiol Bioma ke s P e 2007; 16: 566–71. 103 B enne H, Hakulinen T. Pa ien s wi h p e ious cance should no be excluded in in e na ional compa a i e cance su i al s udies. In J Cance 2007; 121: 2274–78. A icles 1010 www. helance .com Vol 385 Ma ch 14, 2015 104 Danieli C, Remon e L, Bossa d N, Roche L, Belo A. Es ima ing ne su i al: he impo ance o allowing o in o ma i e censo ing. S a Med 2012; 31: 775–86. 105 B enne H, Ge elle O, Hakulinen T. Pe iod analysis o ‘up- o-da e’ cance su i al da a: heo y, empi ical e alua ion, compu a ional ealisa ion and applica ions. Eu J Cance 2004; 40: 326–35. 106 B ay F, Jemal A, G ey N, Fe lay J, Fo man D. Global cance ansi ions acco ding o he Human De elopmen Index (2008–2030): a popula ion-based s udy. Lance Oncol 2012; 13: 790–801. 107 Pa kin DM. The e olu ion o he popula ion-based cance egis y. Na Re Cance 2006; 6: 603–12. 108 B ay F, Znao A, Cue a P, e al. Planning and de eloping popula ion-based cance egis a ion in low- and middle-income se ings (IARC echnical publica ion no 43). Lyon: In e na ional Agency o Resea ch on Cance , 2014. 109 Se el PW, Mac a lane SB, Sz e e S, e al, on behal o he Moni o ing o Vi al E en s (MoVE) w i ing g oup. A scandal o in isibili y: making e e yone coun by coun ing e e yone. Lance 2007; 370: 1569–77. 110 Uni ed Na ions. Poli ical decla a ion o he high-le el mee ing o he gene al assembly on he p e en ion and con ol o non- communicable diseases (A/RES/66/2). Jan 24, 2012. h p://www. who.in /nmh/e en s/un_ncd_summi 2011/poli ical_decla a ion_ en.pd ?ua=1 (accessed May 1, 2014). 111 Sankila R, Black R, Coebe gh JWW, e al. E alua ion o clinical ca e by cance egis ies. Lyon: IARC P ess, 2003. 112 Ande sen MR, S o m HH, on behal o he Eu ocou se Wo k Package 2 G oup. Cance egis a ion, public heal h and he e o m o he Eu opean da a p o ec ion amewo k: abandoning o imp o ing Eu opean public heal h esea ch? Eu J Cance 2013; published online Oc 10. h p://dx.doi.o g/10.1016/j. ejca.2013.09.005. 113 Casali PG. Risks o he new EU da a p o ec ion egula ion: an ESMO posi ion pape endo sed by he Eu opean oncology communi y. Ann Oncol 2014; 25: 1458–61. 114 Ho on R. Offl ine: he hi d e olu ion in global heal h. Lance 2014; 383: 1620. 115 Ka anikolos M, Ellis L, Coleman MP, McKee M. Heal h sys ems pe o mance and cance ou comes. J Na l Cance Ins Monog 2013; 46: 7–12. 116 Aa eleid T, B enne H. T ends in cance pa ien su i al in Es onia be o e and a e he ansi ion om a So ie Republic o an open-ma ke economy. In J Cance 2002; 102: 45–50. 117 K ila iciu e A, Smaily e G, B enne H, Gondos A. Cance su i al in Li huania a e he es o a ion o independence: apid imp o emen s, bu pe sis ing majo gaps. Ac a Oncol 2014; 53: 1238–44. 118 Jansen L, Gondos A, Ebe le A, e al. Cance su i al in Eas e n and Wes e n Ge many a e he all o he i on cu ain. Eu J Epidemiol 2012; 27: 689–93. 119 Beniaiche K. La défi cience de no e sys ème de san é es à l’o igine du aux de su ie si bas. No 30, 2012. h p://www.elwa an.dz/ ac uali e/la-defi cience-de-no e-sys eme-de-san e-es -a-l-o igine-du- aux-de-su ie-si-bas-30-11-2012-194147_109.php (accessed Jan 5, 2013). 120 Schmid MI, Duncan BB, Aze edo e Sil a G, e al. Ch onic non-communicable diseases in B azil: bu den and cu en challenges. Lance 2011; 377: 1949–61. 121 Minis é io da Saúde. Plano de ações es a égicas pa a o en en amen o de doenças c ônicas não- ansmissí eis (DCNT) no B asil 2011–2022. B asília: Minis é io da Saúde, 2011. 122 Pé ez-Cue as R, Doubo a SV, Zapa a-Ta es M, e al. Scaling up cance ca e o child en wi hou medical insu ance in de eloping coun ies: he case o Mexico. Pedia Blood Cance 2013; 60: 196–203. 123 Goss PE, S asse -Weippl K, Lee-Bychko sky BL, e al. Challenges o eff ec i e cance con ol in China, India, and Russia. Lance Oncol 2014; 15: 489–538. 124 Toma is L. Inequali ies in su i al om cance . Tumo i 1997; 83: 505–07. 125 Be ino F, De Angelis R, San M, e al, and he EUROCARE Wo king g oup. Su i al o eigh majo cance s and all cance s combined o Eu opean adul s diagnosed in 1995–99: esul s o he EUROCARE-4 s udy. Lance Oncol 2007; 8: 773–83. 126 O ganisa ion o Economic Co-ope a ion and De elopmen . Cance ca e: assu ing quali y o imp o e su i al. Pa is: OECD, 2013. 127 Gondos A, B enne H, Wabinga H, Pa kin DM. Cance su i al in Kampala, Uganda. B J Cance 2005; 92: 1808–12. 128 Gondos A, Chokunonga E, B enne H, e al. Cance su i al in a sou he n A ican u ban popula ion. In J Cance 2004; 112: 860–64. 129 Samiei M. Challenges o making adio he apy accessible in de eloping coun ies. In: Mag a h I, ed. Cance ca e in eme ging heal h sys ems. B ussels: In e na ional Ne wo k o Cance T ea men and Resea ch, 2013: pp 87–96. 130 Ga a G, T ama A, Capocaccia R. Va ia ions in cance su i al and pa e ns o ca e ac oss Eu ope: oles o weal h and heal h-ca e o ganiza ion. J Na l Cance Ins Monog 2013; 46: 79–87. 131 Sulli an R, Peppe co n J, Siko a K, e al. Deli e ing aff o dable cance ca e in high-income coun ies. Lance Oncol 2011; 12: 933–80. 132 Kelly RJ, Smi h TJ. Deli e ing maximum clinical benefi a an aff o dable p ice: engaging s akeholde s in cance ca e. Lance Oncol 2014; 15: e112–18. 133 Knaul FM, F enk J, Shulman LN. Closing he cance di ide: a bluep in o expand access in low and middle income coun ies. Bos on: Ha a d Global Equi y Ini ia i e, 2011. 134 Knaul FM, G alow J, A un R, Bhadelia A. Closing he cance di ide: an equi y impe a i e. Bos on: Ha a d Uni e si y P ess, 2011. 135 Langmui AD. The su eillance o communicable diseases o na ional impo ance. N Engl J Med 1963; 268: 182–92.