Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222 120 individuals

Articles www.thelancet.com Vol 385 March 14, 2015 977 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) Claudia Allemani, Hannah K Weir, Helena Carreira, Rhea Harewood, Devon Spika, Xiao-Si Wang, Finian Bannon, Jane V Ahn, Christopher J Johnson, Audrey Bonaventure, Rafael Marcos-Gragera, Charles Stiller, Gulnar Azevedo e Silva, Wan-Qing Chen, Olufemi J Ogunbiyi, Bernard Rachet, Matthew J Soeberg, Hui You, Tomohiro Matsuda, Magdalena Bielska-Lasota, Hans Storm, Thomas C Tucker, Michel P Coleman, and the CONCORD Working Group* Summary Background Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the eff ectiveness of health systems, and to inform global policy on cancer control. Methods Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15–99 years) and 75 000 children (age 0–14 years) diagnosed with cancer during 1995–2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. Findings 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005–09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15–19% in North America, and as low as 7–9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10–20% between 1995–99 and 2005–09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995–99 and 2005–09 have generally been slight. For women diagnosed with ovarian cancer in 2005–09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005–09 was high (54–58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18–23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major defi ciencies in the management of a largely curable disease. Interpretation International comparison of survival trends reveals very wide diff erences that are likely to be attributable to diff erences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems. Funding Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA). Copyright ©Allemani et al. Open Access article distributed under the terms of CC BY. Introduction The global burden of cancer is growing, particularly in countries of low and middle income. The need to implement eff ective strategies of primary prevention is urgent.1,2 Prevention is crucial but long term. If WHO’s global target of a 25% reduction in deaths from cancer and other non-communicable diseases in people aged 30–69 years is to be achieved by 2025 (referred to as Lancet 2015; 385: 977–1010 Published Online November 26, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)62038-9 See Comment page 926 This online publication has been corrected. The corrected version fi rst appeared at thelancet.com on Dec 8, 2014 See Online/Comment http://dx.doi.org/10.1016/ S0140-6736(14)62251-0 *Members listed at end of report Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK (C Allemani PhD, H Carreira MPH, R Harewood MSc, D Spika MSc, X-S Wang PhD, J V Ahn MSc, A Bonaventure MD, B Rachet FFPH, Prof M P Coleman FFPH); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA (H K Weir PhD); Northern Ireland Cancer Registry, Centre for Public Health, Queen’s University Belfast, Belfast, UK (F Bannon PhD); Cancer Data Registry of Idaho, Boise, ID, USA (C J Johnson MPH); Unitat d’Epidemiologia i Registre de Càncer de Girona, Departament de Salut, Institut d’Investigació Biomèdica de Girona, Girona, Spain (R Marcos-Gragera PhD); South East Knowledge and Intelligence Team, Public Health England, Oxford, UK (C Stiller MSc); Department of Epidemiology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil (Prof G Azevedo e Silva MD); National Offi ce for Cancer Prevention and Control and National Central Cancer Registry, National Cancer Articles 978 www.thelancet.com Vol 385 March 14, 2015 25 × 25),3 we will need not only more eff ective prevention (to reduce incidence) but also more eff ective health systems (to improve survival).4 In the fi rst international comparison of cancer survival, a transatlantic study of patients diagnosed during 1945–54, survival for 12 cancers in three US states was typically higher than in six European countries.5 In 2008, a global comparison of population-based cancer survival (CONCORD) showed very wide variations in survival from cancers of the breast (women), colon, rectum, and prostate.6 That analysis included 1·9 million adults (age 15–99 years) diagnosed with cancer during 1990–94 and followed up until 1999 from 31 countries (16 with 100% population coverage) on fi ve continents. Three large international comparisons of cancer survival have been published since 2008. The European cancer registry study on survival (EUROCARE)-5 provided survival estimates for all cancers for patients diagnosed during 2000–07 in 29 countries in Europe.7 In SurvCan (cancer survival in Africa, Asia, the Caribbean, and Central America), relative survival estimates were reported for patients diagnosed during 1990–2001 in 12 low-income and middle-income countries.8 The International Cancer Benchmarking Partnership published survival estimates for four common cancers for patients diagnosed during 1995–2007 in six highincome countries.9 These three studies diff er with respect to geographic and population coverage, calendar period, and analytical methods and do not enable worldwide comparison of cancer survival. Surveillance of cancer survival is seen as important by national and international agencies, cancer patient advocacy groups, departments of health, politicians, and research agencies. Cancer survival research is being used to formulate cancer control strategies,9 to prioritise cancer control measures,10 and to assess both the eff ectiveness11,12 and cost-eff ectiveness13 of those strategies. We designed CONCORD-2 to initiate long-term worldwide surveillance of cancer survival on the broadest possible basis. Our aim is to analyse progress toward the overarching goal in the Union for International Cancer Control’s World Cancer Declaration 2013: “there will be major reductions in premature deaths from cancer and improvements in quality of life and cancer survival”.14 Methods Cancer registries We identifi ed population-based cancer registries that were operational in 2009 and had either published reports on survival or were known to follow up registered cancer patients to establish their vital status. Many registries had met quality criteria for inclusion in either the quinquennial compendium Cancer Incidence in Five Continents,15,16 published by the International Association of Cancer Registries (IACR) and the International Agency for Research on Cancer (IARC), or similar compendia; other registries were established more recently. We invited all these registries to contribute data for patients diagnosed during all or part of the 15-year period 1995–2009, including data on their vital status at least 5 years after diagnosis, or at Dec 31, 2009, or a later year. Of 395 registries invited, 306 (77%) agreed to participate: of these, 24 (8%) did not submit data, either because of resource constraints (n=4), legal constraints (1) or reversal of the original decision (3), or because they could not provide complete follow-up data (6) or did not respond to further communication (10). We excluded three registries because they provided data that did not adhere to the protocol and could not be rectifi ed, leaving 279 participating registries (71% of those invited). Among the cancers suggested by participating registries, the ten we prioritised for study (referred to as index sites) accounted collectively for almost two-thirds of the estimated global cancer burden in 2008, both in developed and developing countries.4 They comprised cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults (age 15–99 years), and leukaemia in adults, and precursor-cell acute lymphoblastic leukaemia in children (age 0–14 years). Ethics approval We obtained approval for CONCORD-2 from the Ethics and Confi dentiality Committee of the UK’s statutory National Information Governance Board (now the Health Research Authority; ECC 3-04(i)/2011) and the National Health Service (NHS) research ethics service (southeast; 11/LO/0331). We obtained separate statutory or ethics approval (or both) in more than 40 other jurisdictions to secure the release of data. Registries in all other jurisdictions obtained their own ethics approval locally. We applied strict security constraints to the transmission of data fi les. We gave every registry a set of unique numeric codes for the name of every fi le; these codes have no meaning outside the CONCORD-2 study. All data fi elds were numeric or coded. We developed a fi le transmission utility deploying 256-bit advanced encryption security, with random, strong, one-time passwords that were generated automatically at the point of data transmission but sent separately, thus eliminating the need for email or telephone exchanges to confi rm passwords. We also provided free access to a similar commercial utility (HyperSend; Covisint, Detroit, MI, USA) that complies with US federal law on the secure transmission of sensitive health data. Protocol We fi nalised the protocol (in which we defi ned the data structure, fi le transmission procedures, and statistical analyses) after a 2-day meeting in Cork, Ireland, in September, 2012, with 90 members of the CONCORD Working Group from 48 countries (the protocol was revised by October, 2012). English poses a communication barrier in many countries; therefore, native speakers Center, Beijing, China (W-Q Chen PhD); Ibadan Cancer Registry, University City College Hospital, Ibadan, Nigeria (Prof O J Ogunbiyi FWACP); New South Wales Central Cancer Registry, Australian Technology Park (M J Soeberg PhD), and Cancer Institute NSW (H You MAppStats), Sydney, NSW, Australia; Population-Based Cancer Registry Section, Division of Surveillance, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan (T Matsuda PhD); Department of Health Promotion and Postgraduate Education, National Institute of Public Health and National Institute of Hygiene, Warsaw, Poland (Prof M Bielska-Lasota MD); Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark (H Storm MD); and Kentucky Cancer Registry, University of Kentucky, Lexington, KY, USA (Prof T C Tucker PhD) Correspondence to: Prof M P Coleman, Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK [email protected] For the protocol see http:// www.lshtm.ac.uk/eph/ncde/ cancersurvival/research/concord/ protocol/index.html Articles www.thelancet.com Vol 385 March 14, 2015 979 translated the protocol into Chinese (Mandarin), Portuguese, and Spanish, and other native speakers did back-translation to check the translation against the English original. We made the protocol available in all four languages. We held protocol workshops in Argentina (for Spanish-speaking South American researchers), Brazil, China, India, Japan, Puerto Rico, Russia, and the USA (for North America), which we followed up with conference calls and online seminars. We responded to telephone or email queries in Chinese, English, French, Italian, Portuguese, and Spanish. We defi ned countries, states, and world regions by their UN names and codes (as of 2007).17 Only Cuba and Puerto Rico provided data from the Caribbean and Central America so we grouped them with South America as America (Central and South). We wrote this Article and prepared the maps without prejudice to the status, boundaries, or name of any country, territory, or region. We have shortened some names for convenience (eg, Korea for South Korea), which does not have any political signifi cance. We created world maps and 27 regional maps in ArcGIS version 10, using digital boundaries (shapefi les) of countries and subnational regions from the Database of Global Administrative Areas (GADM 2.0).18 We obtained national populations for 2009 from the UN Population Database17 or national authorities (Canada, Portugal, and the UK) and subnational populations from the relevant registries. We defi ned solid tumours by anatomical site (topography) and leukaemia by morphology (table 1). We coded topography and morphology according to the International Classifi cation of Diseases for Oncology (3rd edn; ICD-O-3).19 For ovarian cancer, we included the fallopian tube, uterine ligaments, and adnexa, and the peritoneum and retroperitoneum, where high-grade serous ovarian carcinomas are often detected. We excluded Kaposi’s sarcoma and solid tumours with lymphoma morphology. The classifi cation of leukaemias and lymphomas has changed since the mid-1990s. To minimise diff erences in the range of leukaemia subtypes included in our analyses, we asked registries to provide data for all haemopoietic malignant diseases in adults and children, as defi ned by the ICD-O-3 morphology code range 9590–9989. In consultation with specialists in the cancer registrybased project on haematologic malignancies (HAEMACARE) group,20 we selected subtypes of adult leukaemia from nine morphology groups,21 excluding myelodysplastic and myeloproliferative neoplasms such as chronic myeloid leukaemia (appendix p 2). Precursorcell acute lymphoblastic leukaemia is the most common form of leukaemia in children; we included HAEMACARE group 15—a relatively homogeneous group comprising precursor-cell lymphoblastic lymphoma and precursor-cell lymphoblastic leukaemia (B-cell, T-cell, and not otherwise specifi ed), and we refer to these six entities as acute lymphoblastic leukaemia.22 For survival analyses, we included only invasive primary malignant diseases (ICD-O-3 behaviour code 3). To facilitate quality control and comparisons of the intensity of early diagnostic and screening activity, however, we asked registries to submit data for all solid tumours at each index site, including those that were benign (behaviour code 0), of uncertain or borderline malignancy (1), or in situ (2). We asked registries to submit full dates (day, month, year) for birth, diagnosis, and death or last known vital status, both for quality control and to enable comparable estimation of survival.23 When the day of diagnosis or the day or month of birth or last known vital status were missing, we developed an algorithm to standardise the imputation of missing dates for all populations (details available on request). Participating registries completed a detailed question naire on their methods of operation, including data defi nitions, data collection procedures, coding of anatomical site, morphology and behaviour, the tracing of registered cancer patients to ascertain their vital status, and how tumour records are linked with data on vital status. We included patients who were diagnosed with two or more primary cancers at diff erent index sites during 1995–2009 in the analyses for each cancer—eg, colon cancer in 2000, breast cancer in 2005. We measured survival from the date of diagnosis until the date of death, or loss to follow-up, or censoring. When two or more See Online for appendix Topography or morphology codes* Description Stomach C16·0–C16·6, C16·8–C16·9 Stomach Colon C18·0–C18·9, C19·9 Colon and rectosigmoid junction Rectum C20·9, C21·0–C21·2, C21·8 Rectum, anus, and anal canal Liver C22·0–C22·1 Liver and intrahepatic bile ducts Lung C34·0–C34·3, C34·8–C34·9 Lung and bronchus Breast (women) C50·0–C50·6, C50·8–C50·9 Breast Cervix C53·0–C53·1, C53·8–C53·9 Cervix uteri Ovary† C48·0–C48·2, C56·9, C57·0–C57·4, C57·7–C57·9 Ovary, fallopian tube, and uterine ligaments, other and unspecifi ed female genital organs, peritoneum and retroperitoneum Prostate C61·9 Prostate gland Leukaemia (adults)‡ 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 (children)‡ 9727, 9728, 9729, 9835, 9836, 9837 Precursor-cell acute lymphoblastic leukaemia *International Classifi cation of Diseases for Oncology, 3rd edn (ICD-O-3).19 We defi ned solid tumours with topography (anatomical site) codes. †Includes peritoneum and retroperitoneum (C48·0–C48·2), where ovarian cancers of high-grade serous morphology are frequently detected; also includes the fallopian tube, uterine ligaments, and adnexa (C57·0–C57·4), and other and unspecifi ed female genital organs (C57·7–C57·9). ‡We defi ned adult leukaemia subtypes with morphology codes in HAEMACARE groups 6, 11, 15, 17, 18, 19, 20, 21, and 22 (appendix p 2).20 The six morphology codes used to defi ne precursor-cell acute lymphoblastic leukaemia (referred to as acute lymphoblastic leukaemia) in children are those in HAEMACARE group 15 only. Table 1: Defi nition of malignant diseases Articles 980 www.thelancet.com Vol 385 March 14, 2015 primary malignant diseases occurred at the same index site during 1995–2009, we included the fi rst cancer only. We retained the most complete record for patients with synchronous primary cancers in the same organ. North American registries defi ne multiple primary cancers under the rules of the Surveillance, Epidemiology and End Results (SEER) programme,24 whereas registries in the European Network of Cancer Registries (ENCR) and elsewhere generally use the rules of the IACR,25 which are more conservative. The North American Association of Central Cancer Registries (NAACCR) prepared a program to enable all North American registries to recode their entire incidence databases to the IACR multiple primary rules, before their datasets for 1995–2009 were extracted for CONCORD-2. Quality control The quality and completeness of cancer registration data can aff ect both incidence and survival estimates and, thus, the reliability of international comparisons.26 We developed a suite of quality control programs,27 extending the checks used in the fi rst CONCORD study,6 cross-checked with those used in the EUROCARE study,28 IARC/IACR tools for cancer registries,29 and WHO’s classifi cation of tumours.22,30–32 We applied these checks systematically in three phases and sent registries a detailed report on how to revise and resubmit their data, if needed, after every phase. First, we sent registries a protocol adherence report that showed, for every cancer, the proportion of tumour records that were coded in compliance with the protocol. Second, we checked the data in every tumour record for logical coherence against 20 sets of criteria, including eligibility (eg, age, tumour behaviour), defi nite errors (eg, sex-site errors and invalid dates or date sequence), and possible errors including a wide range of inconsistencies between age, tumour site, and morphology.27 We sent registries exclusion reports that showed, for every index cancer and calendar period, the number of tumour records in each category of defi nite or possible error, the number of tumours registered from a death certifi cate only or detected at autopsy, and the number of patients whose data could be included in survival analyses. When we identifi ed errors in classifi cation, coding, or pathological assignment, we asked registries to correct and resubmit their data. Finally, we analysed: the proportion of tumour records with morphological verifi cation or non-specifi c morphology; distributions of the day and month of birth, diagnosis, and last known vital status; and proportions of patients who died within 30 days, were reported as lost to follow-up, or were censored within 5 years of diagnosis. Follow-up for vital status Cancer registries use various methods to ascertain the vital status (alive, dead, emigrated, lost to follow-up) of registered cancer patients. In countries with limited administrative infrastructure, so-called active follow-up can be used to establish vital status via direct contact with the patient, the family, or a local authority (eg, a village headman), or by home visit. Many registries in both high-income and low-income countries also seek information from the hospital or the treating clinician in hospital or primary care. Most registries link their database with a regional or national index of deaths, using identifi ers such as name, sex, date of birth, and identity number. Tumour records that match to a death record are updated with the date of death. Many registries also use other offi cial databases (eg, hospital and primary care databases, social insurance, health insurance, drivers’ licences, and electoral registers) to establish the date on which a patient was last known or believed to have been alive, to have migrated within the country, or to have emigrated to another country. Cancer registrations are updated with the vital status and the date of last known vital status. These methods are typically summarised as passive follow-up. Some registries receive information on the vital status of all registered patients on an almost continuous basis, or at least every month or every 3 months. Other registries seek to trace the vital status of patients registered in a particular calendar year only, 1 year or even 5 years after the end of that year: this approach can increase the proportion of patients lost to follow-up. It also means that 5-year survival estimates for more recently diagnosed patients cannot be obtained, even with the period approach. We asked all 279 participating registries how they ascertained the vital status of registered cancer patients. Of 243 registries that responded to the question, 147 (60%) stated that they used only passive follow-up, 92 (38%) that they used both passive and active follow-up, and four (2%) only active follow-up. Statistical analysis Most registries submitted data for patients diagnosed from 1995 to 2009, with follow-up to 2009 or later; some registries only began operation after 1995 or provided data for less than 15 years. We were able to estimate 5-year survival using the cohort approach for patients diagnosed in 1995–99 and 2000–04, because in most datasets, all patients had been followed up for at least 5 years. We used the period approach33 to estimate 5-year survival for patients diagnosed during 2005–09, because 5 years of follow-up data were not available for all patients (appendix p 174). We estimated net survival up to 5 years after diagnosis for both adults and children. Net survival represents the cumulative probability that the cancer patients would have survived a given time, say 5 years or more after diagnosis, in the hypothetical situation that the cancer was the only possible cause of death. Net survival can be interpreted as the proportion of cancer patients who survive up to that time, after eliminating other causes of Articles www.thelancet.com Vol 385 March 14, 2015 981 death (background mortality). We used the recently developed Pohar Perme estimator34 of net survival implemented with the program stns35 in Stata version 13.36 This estimator takes unbiased account of the fact that older patients are more likely than younger patients to die from causes other than cancer—ie, that the competing risks of death are higher for elderly cancer patients. To control for the wide diff erences in background mortality between participating jurisdictions and over time, we constructed 6514 life tables of all-cause mortality in the general population of each country or the territory covered by each participating registry, by age (single year), sex, and calendar year of death, and by race or ethnic origin in Israel (Arab, Jewish), Malaysia (Chinese, Malay, Indian), New Zealand (Māori, non-Māori), and the USA (Black, White). The method of life table construction depended on whether we received raw data (numbers of deaths and populations) or mortality rates, and on whether the raw data or the mortality rates were by single year of age (so-called complete) or by 5-year or 10-year age group (abridged). We checked the life tables by examination of age-sex-mortality rates, life expectancy at birth (appendix p 175), the probability of death in the age bands 15–59 years, 60–84 years, and 85–99 years and, where necessary, the model residuals. Of the 279 participating registries, 21 provided complete life tables that did not need interpolation or smoothing, for each calendar year. For 172 registries, we obtained raw data from either the registry, the relevant national statistical authority, or the Human Mortality Database.37 We derived life tables for 1996 and 2010 if possible, each centred on three calendar years of data (eg, 1995–97, 2009–11) to increase the robustness of the rates. We modelled raw mortality rates with Poisson regression and fl exible functions to obtain smoothed complete life tables extended up to age 99 years. We then created life tables for every calendar year from 1997 to 2009 by linear interpolation between the 1996 and 2010 life tables.38 Rather than extrapolate, we used the 1996 life table for 1995. 62 of 279 registries provided abridged mortality rates, or complete mortality rates that were not smoothed. We used the Ewbank relational model39 with three or four parameters to interpolate (if abridged) and smooth the mortality rates for the registry territory against a high-quality smooth life table for a country with a similar pattern of mortality by age. We could not obtain reliable data on all-cause mortality for 24 registries. We took national life tables published by the UN Population Division40 and interpolated and extended them to age 99 years with the Elandt-Johnson method.41 For each country and registry, we present estimates of age-standardised net survival for each cancer at 5 years after diagnosis. We report cumulative survival probabilities Figure 1: Participating countries and regions (adults) National registries in smaller countries are shown in boxes at diff erent scales. 28 regional maps and a world map for childhood acute lymphoblastic leukaemia are in the appendix (pp 112–40). National coverage Regional coverage Regional territory (no data) No coverage 5000 10 000 km0 Cuba Puerto Rico Gibraltar Malta Cyprus Israel Jordan Qatar Mauritius Hong Kong The Gambia Taiwan Articles 982 www.thelancet.com Vol 385 March 14, 2015 as percentages. For adults, we used the International Cancer Survival Standard (ICSS) weights, with age at diagnosis categorised into fi ve groups: 15–44 years, 45–54 years, 55–64 years, 65–74 years, and 75–99 years for eight solid tumours and leukaemia in adults; and 15–54 years, 55–64 years, 65–74 years, 75–84 years, and 85–99 years for prostate cancer.42 For children, we estimated survival for the age groups 0–4 years, 5–9 years, and 10–14 years; we obtained age-standardised estimates by assigning equal weights to the three age-specifi c estimates.43 We derived CIs for both unstandardised and age-standardised survival estimates assuming a normal distribution, truncated to the range 0–100. We derived SEs with the Greenwood method44 to construct the CIs We did not estimate survival if fewer than ten patients were available for analysis. If between ten and 49 patients were available for analysis in a given calendar period (1995–99, 2000–04, 2005–09), we merged data for two consecutive periods. For less common cancers in the smallest populations, we sometimes needed to merge data for all three periods. When between ten and 49 patients in total were available, we only estimated survival for all ages combined. If 50 or more patients were available, we attempted survival estimation for each age group. If an age-specifi c estimate could not be obtained, we merged data for adjacent age groups and assigned the combined estimate to both age groups. If two or more age-specifi c estimates could not be obtained, we present only the unstandardised estimate for all ages combined. Role of the funding sources The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all data in the study and had fi nal responsibility for the decision to submit for publication. Results 279 cancer registries from 67 countries provided data for this study (fi gure 1; appendix pp 112–40). Nine African countries took part (ten registries), eight countries were in Central and South America (27 registries), Canada and the USA comprised North America (57 registries), 16 countries were in Asia (50 registries), 30 European countries participated (128 registries), and New Zealand and Australia represented Oceania (seven registries). For countries with less than 100% coverage of the population, the country name is used for brevity in the text (eg, Libya, the USA), but a more accurate term is used in the tables (eg, Libya [Benghazi], US registries). Some registries provided data for only part of their territory. We examined records for 28 685 445 patients diagnosed with cancer of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults (age 15–99 years), leukaemia in adults, and precursor-cell acute lymphoblastic leukaemia in children (age 0–14 years) during the period 1995–2009 (table 2). Of these, 1 682 081 (5·9%) records were for an in situ cancer, mostly of the cervix, breast, colon, or prostate. The proportions of in situ cancer are not comparable directly because some registries do not record in situ cancer, others did not submit data for index sites in which in situ malignant disease is common, and screening programmes in which in situ cancers are frequently detected were introduced in some countries during 1995–2009. The variation between continents is still of interest: for example, a little over 1% of cervical cancers in African registries were in situ, compared with 20% in Central and South American registries and 81% in Oceania. For breast cancer in situ, the variation was from 0·1% in African registries to 16% in North American registries and about 4–5% in other regions of the world (appendix pp 3–63). Patients with in situ cancer were not included in survival analyses. We excluded a further 360 773 (1·3%) patients either because their year of birth, month or year of diagnosis, or year of last vital status were unknown, or because the tumour was not primary invasive malignant disease (behaviour code 3) or the morphology was that of Kaposi’s sarcoma or lymphoma in a solid organ, or for other reasons (table 2). The proportion of patients with an unknown date of last vital status ranged from 0% to 40% or more for some cancers in some African registries. Proportions are presented in the appendix (pp 3–63) for each registry, for all cancers combined, and for each cancer separately. Of 26 642 591 patients eligible for inclusion in the survival analyses, 905 841 (3·4%) were excluded because their cancer was registered from a death certifi cate only or discovered at autopsy (table 2), and 59 863 (0·2%) were excluded for other reasons, including defi nite errors (eg, unknown vital status or sex, sex-site error, or invalid dates or sequence of dates) or possible errors (eg, apparent inconsistencies between age, cancer site, and morphology) for which the record was not later confi rmed as correct by the relevant registry. Of 25 676 887 patients available for survival analyses (96·4% of those eligible), pathological evidence of malignant disease (histological, cytological, or haematological fi ndings) was available for 23 338 015 patients for all cancers combined (91·1%; table 2), ranging from 83·1% in Asian registries, 85·5% in African registries, and 87·4% in Central and South American registries to 90–95% in Europe, Oceania, and North America. The range of pathological evidence at a national level was very wide, from 15% in The Gambia, 36% in Mongolia, and 66% in Chinese registries, up to 99% or more in Belgium, Mauritius, and Sweden. For 938 703 (3·7%) patients, morphological features were poorly specifi ed (eg, malignant neoplasm or tumour, ICD-O-3 codes 8000–8005): this proportion also varied widely, from around 1% in North American registries to 17% for all African registries combined and as high as 59% in The Gambia. Data for every registry are shown in the appendix (pp 3–63). Articles www.thelancet.com Vol 385 March 14, 2015 983 Calendar period Patients submitted (n) Ineligible patients¶ Eligible patients (n) Exclusions|| Available for analysis (n) Data quality indicators†† In situ (%) Other (%) DCO (%) Other (%) MV (%) Non-specifi c morphology (%) Lost to followup (%) Censored (%) Africa 23 325 0·2% 39·5% 14 048 1·4% 9·6% 12 509 85·5% 17·0% 10·2% 28·8% Algerian registries 1995–2009 6919 <0·1% 5·8% 6515 0·3% 17·4% 5358 93·8% 12·3% 0·0% 21·5% Lesotho (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% Mauritius* 2005–2005 855 0·0% 0·6% 850 0·0% 0·9% 842 100·0% 24·1% 0·0% NA Nigeria (Ibadan) 1998–2007 2192 2·1% 60·1% 830 0·6% 3·6% 795 70·8% 0·0% 8·9% 65·1% South Africa (Eastern 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 (Central) 1995–2007 7841 0·1% 84·1% 1237 NA 1·6% 1217 99·1% 1·0% 0·7% 51·2% America (Central and South) 467 456 3·0% 8·0% 416 140 13·7% 0·7% 356 173 87·4% 7·7% 0·1% 2·9% Argentinian registries 1995–2009 40 482 5·0% 7·6% 35 377 11·1% 0·5% 31 244 97·9% 3·7% <0·1% 14·6% Brazilian registries 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 registries 1998–2008 8920 8·2% 0·7% 8121 10·7% 0·5% 7213 90·3% 4·1% 0·5% 0·0% Colombian registries 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% Ecuadorian registries 1995–2009 35 395 1·3% 5·7% 32 924 9·7% 4·3% 28 314 92·0% 3·7% 0·0% <0·1% Puerto 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% Uruguay* 2002–2009 24 462 0·4% 0·3% 24 281 23·4% 0·0% 18 603 80·6% 20·9% 0·0% 0·0% America (North) 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 registries 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 registries 1995–2009 241 044 0·1% 1·3% 237 656 1·6% <0·1% 233 736 66·4% 38·7% 3·5% 0·1% Cyprus* 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 registries 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 (Jakarta) 2005–2007 3830 0·0% 18·1% 3138 1·3% 0·2% 3091 75·4% 23·0% 0·0% NA Israel* 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 registries 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% Jordan* 2000–2009 19 191 0·0% 0·6% 19 081 <0·1% 0·9% 18 896 99·3% 1·5% 54·9% 0·0% Korea*‡ 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 Qatar* 2002–2009 780 0·8% 0·1% 773 2·7% 0·4% 749 90·0% 6·4% 0·0% 5·1% Saudi Arabia* 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 registries 1995–2009 47 263 1·4% 0·7% 46 279 4·0% 0·1% 44 406 58·5% 38·4% 0·1% 23·4% Turkey (Izmir) 1995–2009 64 749 3·3% 3·4% 60 451 3·0% 0·2% 58 551 92·9% 2·1% <0·1% 30·7% Europe 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% Austria * 1995–2009 353 194 6·9% 0·6% 326 730 0·1% 0·9% 323 432 97·6% 2·5% 0·0% 0·0% Belarus (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% Bulgaria* 1995–2009 255 768 <0·1% 0·2% 255 158 11·2% <0·1% 226 566 81·4% 1·3% 0·1% 0·0% Croatia* 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% Denmark* 1995–2009 251 533 0·0% 0·2% 250 931 0·4% 0·0% 249 943 93·2% 8·0% 0·1% 0·0% Estonia* 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 continues on next page) Articles 984 www.thelancet.com Vol 385 March 14, 2015 Morphological confi rmation for each cancer varied widely between continents and countries. Overall, 48·2% of liver cancers had morphological data available compared with 84·4% of lung cancers, at least 90% of other solid tumours and adult leukaemia, and 99% of childhood acute lymphoblastic leukaemia (appendix pp 3–63). Morphological confi rmation was available for 100% of acute lymphoblastic leukaemias in all the specialist childhood cancer registries, including the national registries in Lesotho and Belarus. The 279 participating cancer registries represented an estimated total population of about 896 210 000 people in 2009, or 18·6% of the combined national populations of the 67 countries (4·8 billion total population; table 3); details by registry are provided in the appendix (pp 64–80). 100% coverage of the national population was provided by 40 countries. Population coverage in Australia was 91%, and in the USA it was 83%. In the remaining 25 countries, population coverage ranged from 0·5% to 47%. In China, 21 participating registries covered 37·7 million people (2·8% of 1·35 billion total population), whereas the four registries in India covered 5·9 million people (0·5% of 1·19 billion total population). China and India apart, data from 254 registries covered 37% of the combined population of 2·3 billion people in 65 countries. Life expectancy at birth in 2009 varied widely between the 279 registry populations: for females, the range was 46–87 years and for males it was 45–81 years (appendix, p 175). Life expectancy rose slightly from 1995 to 2009 Calendar period Patients submitted (n) Ineligible patients¶ Eligible patients (n) Exclusions|| Available for analysis (n) Data quality indicators†† In situ (%) Other (%) DCO (%) Other (%) MV (%) Non-specifi c morphology (%) Lost to followup (%) Censored (%) (Continued from previous 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% French registries† 1995–2009 227 210 <0·1% 0·3% 226 622 <0·1% 0·2% 226 234 96·3% 2·6% 3·9% 4·1% German registries 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% Gibraltar* 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% Ireland* 1995–2009 169 818 14·9% 1·4% 142 134 2·4% 0·1% 138 602 91·0% 1·1% 0·0% 0·0% Italian registries 1995–2009 877 272 2·7% 0·5% 849 556 2·1% 0·2% 830 162 87·5% 12·5% 0·8% 1·0% Latvia* 1995–2009 78 334 0·1% 0·2% 78 141 6·1% 0·5% 72 992 81·5% 0·5% 0·0% 0·0% Lithuania* 1995–2009 132 425 2·8% 0·5% 127 999 3·6% 0·0% 123 380 84·9% 2·0% 1·0% 0·0% Malta* 1995–2009 11 630 0·0% 0·9% 11 526 2·6% 0·5% 11 173 96·3% 7·9% 0·0% <0·1% Netherlands* 1995–2009 716 617 2·9% 0·9% 688 714 0·3% 0·3% 684 601 97·0% 3·1% 0·5% 0·0% Norway* 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% Portugal* 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 (Arkhangelsk) 2000–2009 23 609 0·0% <0·1% 23 602 3·3% 0·7% 22 643 82·4% 3·5% 1·1% 0·0% Slovakia* 2000–2007 92 942 0·0% 0·3% 92 655 9·9% <0·1% 83 449 95·3% 5·5% 0·0% 0·0% Slovenia* 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 registries 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 registries 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% Australian registries 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% Total 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=not available. *100% coverage of the national population. †100% coverage of the national population for childhood leukaemia only. ‡South Korea. ¶In situ malignant disease (ICD-O-3 behaviour code 2): some registries do not register in situ cancers, other registries did not submit them. Other: records with incomplete data; or tumours that are benign (behaviour code 0), of uncertain behaviour (1), metastatic from another organ (6), or unknown if primary or metastatic (9); or patients falling outside the age range 0–14 years (children) or 15–99 years (adults); or other conditions. ||DCO=tumours registered from a death certifi cate only or detected solely at autopsy. Other: vital status or sex unknown; or invalid sequence of dates; or inconsistency of sex-site, site-morphology, age-site, age-morphology, or age-site-morphology. †† MV=microscopically verifi ed. Non-specifi c morphology (solid tumours only): ICD-O-3 morphology code in the range 8000–8005. Censored: patients diagnosed during 1995–2004, with last known vital status “alive” but less than 5 years of follow-up. Table 2: Data quality indicators for patients diagnosed during 1995–2009, by continent and country (all cancers combined) Articles www.thelancet.com Vol 385 March 14, 2015 985 Population covered¶ Stomach (n) Colon (n) Rectum (n) Liver (n) Lung (n) Breast|| (n) Cervix (n) Ovary (n) Prostate (n) Leukaemia (n) Total (n) n% Adults Children Africa Total 15 983 791 5·8% 830 958 756 445 1833 3202 2357 346 1 085 592 105 12 509 Algerian registries 2 099 478 5·8% 551 406 343 177 908 1582 514 153 364 327 33 5358 Lesotho (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 Mauritius* 1 226 840 100·0% 65 81 65 23 84 290 93 52 58 31 ·· 842 Nigeria (Ibadan) 1 853 300 1·2% ·· 70 108 ·· ·· ·· 315 ·· 263 39 ·· 795 South Africa (Eastern 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 (central) 4 840 657 46·1% 52 136 97 1 287 370 61 27 49 102 35 1217 America (Central and South) Total 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 Argentinian registries† 5 123 973 12·8% 1742 4172 1308 14 2463 9886 2189 1076 4883 15 3496 31 244 Brazilian registries 11 012 413 5·7% 3689 3457 1681 672 4192 52 198 3209 1203 8292 1117 403 80 113 Chilean registries 931 477 5·5% 1333 614 270 181 878 1174 562 229 1653 257 62 7 213 Colombian registries 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 Ecuadorian registries 4 987 086 33·8% 4821 1880 907 815 1698 5627 3957 1207 5333 1484 585 28 314 Puerto Rico* 3 718 810 100·0% 3226 11 930 3115 1653 5222 15 394 1951 1404 23 869 1820 161 69 745 Uruguay* 3 360 430 100·0% ·· 7667 3124 ·· 7812 ·· ·· ·· ·· ·· ·· 18 603 America (North) Total 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 registries 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 Total 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 registries 37 688 165 2·8% 47 580 17 894 15 261 37 555 65 320 27 667 5251 5316 5597 6025 270 233 736 Cyprus* 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 registries 5 877 408 0·5% 1942 147 138 242 1746 2691 2960 631 128 426 184 11 235 Indonesia (Jakarta) 9 607 787 4·0% 67 229 142 301 406 1004 459 235 137 97 14 3091 Israel* 7 273 800 100·0% 10 161 34 810 9595 2291 23 739 49 458 2887 5928 30 921 9339 792 179 921 Japanese registries 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 Jordan* 6 181 310 100·0% 1217 2653 1069 303 2 518 6674 373 691 1457 1451 490 18 896 Korea*‡ 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 continues on next page) Articles 992 www.thelancet.com Vol 385 March 14, 2015 Stomach Colon Rectum Liver Lung Breast Cervix Ovary Prostate Leukaemia (adult) ALL (children) (Continued from previous page) America (Central and South) Argentinian registries† 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) Brazilian registries 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 registries 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 registries 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) ·· Ecuadorian registries 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) Puerto 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) Uruguay* 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 continues on next page) Articles www.thelancet.com Vol 385 March 14, 2015 993 Stomach Colon Rectum Liver Lung Breast Cervix Ovary Prostate Leukaemia (adult) ALL (children) (Continued from previous page) America (North) 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 registries 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 registries 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) Cyprus* 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 registries 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 (Jakarta) 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) Israel* 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 continues on next page) Articles 994 www.thelancet.com Vol 385 March 14, 2015 Stomach Colon Rectum Liver Lung Breast Cervix Ovary Prostate Leukaemia (adult) ALL (children) (Continued from previous page) Japanese registries 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) Jordan* 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) Korea*‡ 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) Qatar* 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 Arabia* 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 registries 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 continues on next page) Articles www.thelancet.com Vol 385 March 14, 2015 995 Stomach Colon Rectum Liver Lung Breast Cervix Ovary Prostate Leukaemia (adult) ALL (children) (Continued from previous 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) Turkey (Izmir) 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) Europe Austria* 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) Belarus (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) Bulgaria* 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) Croatia* 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) ·· Denmark* 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 continues on next page) Articles 996 www.thelancet.com Vol 385 March 14, 2015 Stomach Colon Rectum Liver Lung Breast Cervix Ovary Prostate Leukaemia (adult) ALL (children) (Continued from previous page) Estonia* 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) French registries† 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) German registries 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) Gibraltar* 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) Ireland* 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) Italian registries 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 continues on next page) Articles www.thelancet.com Vol 385 March 14, 2015 997 Stomach Colon Rectum Liver Lung Breast Cervix Ovary Prostate Leukaemia (adult) ALL (children) (Continued from previous page) Latvia* 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) Lithuania* 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) Malta* 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) Nether 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) Norway* 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) .. Portugal* 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 continues on next page) Articles 998 www.thelancet.com Vol 385 March 14, 2015 5-year survival was in the range 60–69%. In general, cervical cancer survival was 50% or higher in all other countries, except for Libya (Benghazi, 39%) and India (Karunagappally, 46%). Survival estimates for northeast India (Guwahati, 32%; Sikkim, 53%) are fl agged as less reliable because up to 30% of women could not be traced despite active follow-up (appendix pp 39–43). Survival for cervical cancer is stable or has increased slightly in most countries (appendix p 158). For example, in Central and South America, survival was stable at around 60% in Brazil, Cuba, Ecuador, and Puerto Rico. In the 10 years between 1995–99 and 2005–09, 5-year net survival increased from 42% to 51% in Chile and from 46% to 51% in Argentina. In France, the decline in survival Stomach Colon Rectum Liver Lung Breast Cervix Ovary Prostate Leukaemia (adult) ALL (children) (Continued from previous page) Russia (Arkhan 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) ·· Slovakia* 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) Slovenia* 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 registries† 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 registries† 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 continues on next page) Articles www.thelancet.com Vol 385 March 14, 2015 999 between 1995–99 and 2000–04 (from 66% to 61%) was based on around 1700 women in each period; the survival estimate for women diagnosed during 2005–09 (59%) includes data for only 139 women from two registries (Calvados, 76%; Loire-Atlantique, 49%); the other registries could not provide follow-up data for women diagnosed with cervical cancer after 2004 (appendix pp 64–80). The striking increase in 5-year survival from cervical cancer in China (from 40% to 60%) should be interpreted with caution: the estimate for 1995–99 is based on data for only 71 women in Changle, Jiashan, and Zhongshan, whereas the estimates for 2000–04 (56%) and 2005–09 (60%) are based on data for more than 1200 women (18 registries) and 3900 women (21 registries), respectively (appendix pp 64–111). Data for ovarian cancer are available for 779 302 women (table 3). 191 registries in 48 countries contributed data for 1995–99, 243 registries in 57 countries had data available for 2000–04, and 241 registries in 61 countries provided data for 2005–09 (appendix pp 64–80). For women diagnosed with ovarian cancer during 2005–09, age-standardised 5-year net survival was 40% or higher in Ecuador, the USA, nine countries in Asia, and eight countries in Europe (table 4; appendix p 148). Survival in other countries was mostly in the range 30–40%, except for Libya (22%). The high survival estimate for Gibraltar (59%) is based on data for only 13 women; it is not age-standardised and the CI is wide (table 4); similarly, the very high estimate for Mauritius (83%) is based on 52 women diagnosed in 2005. 5-year survival for ovarian cancer rose by more than 10% between 1995–99 and 2005–09 in Ecuador (from 35% to 47%), Estonia (from 28% to 39%), and Japan (from 26% to 37%), and by 5–10% in Bulgaria, Denmark, France, Hong Kong, Iceland, Latvia, and Portugal (appendix p 159). More modest increases (2–4%) were seen in several countries in South America, Asia, and Europe. We were unable to assess any trend in Africa because of scant reliable data covering the entire period 1995–2009. For women diagnosed with ovarian cancer since 2000, data were available from 60 registries in Asia and Central and South America (appendix p 170). The range in 5-year survival was very wide. The range is much narrower for the 160 registries in Europe, North America, and Oceania that provided data for the same period. Data for prostate cancer are available for 4 999 267 men (table 3). 189 registries in 48 countries contributed data for 1995–99, 241 registries in 57 countries provided data for 2000–04, and 240 registries in 60 countries had data for 2005–09 (appendix pp 64–80). Among the 61 countries that provided data on prostate cancer, the range in age-standardised 5-year net survival is very wide, from less than 40% to greater than 95%. For men diagnosed during 2005–09, survival was 90% or higher in Austria, Belgium, Brazil, Canada, Cyprus, Ecuador, Finland, France, Germany, Israel, Italy, Lithuania, Puerto Rico, and the USA (table 4; appendix p 149). In the USA, where widespread prostate-specifi c antigen (PSA) testing was introduced around 1990, 5-year survival has been higher than 90% since 1995–99. Prostate cancer survival was 80–89% in 19 countries in Central and South America, Asia, Europe, and Oceania. In 18 other countries, survival ranged widely (50–79%), but in Libya and Mongolia it was 40–41%. Striking and persistent Stomach Colon Rectum Liver Lung Breast Cervix Ovary Prostate Leukaemia (adult) ALL (children) (Continued from previous page) Oceania Australian registries 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) Data are net survival estimates (%) with 95% CI. Italics denote survival estimates that are not age-standardised. When too few patients were available for analysis in any calendar period, data were merged and the survival estimates are underlined. Follow-up was shorter than 5 years for six registries: Libya (Benghazi); The Gambia; Argentina (Mendoza); China (Lianyungang); Indonesia (Jakarta); and Colombia (Manizales: stomach, colon, breast, cervix, and prostate). ALL=acute lymphoblastic leukaemia. *100% coverage of the national population. †100% coverage of the national population for childhood leukaemia only. ‡South Korea. §Survival estimate considered less reliable. Table 4: 5-year age-standardised net survival for adults (aged 15–99 years) diagnosed with one of ten common malignant diseases and children (aged 0–14 years) with ALL, by continent, country, and calendar period of diagnosis Articles 1000 www.thelancet.com Vol 385 March 14, 2015 increases in prostate cancer survival were seen in many countries between 1995–99 and 2005–09 (appendix p 160). Survival rose by 10–20% in 22 countries in Central and South America, Asia, and Europe; smaller increases (less than 10%) were seen in 15 countries. Data for leukaemia in adults are available for 873 588 patients (table 3). 185 registries in 47 countries provided data for 1995–99, 234 registries in 56 countries contributed data for 2000–04, and 232 registries in 60 countries provided data for 2005–09 (appendix pp 64–80). For adults diagnosed with leukaemia during 2005–09, age-standardised 5-year net survival was 50–60% in 21 countries in North America, west Asia, Europe, and Oceania (table 4; appendix p 150). The estimate in Mauritius (57%) is based on 31 patients diagnosed in 2005; it is not age-standardised and has a wide CI. Similarly, the estimate for Cuba (60%) is based on only 97 patients diagnosed during 1998–2006. 5-year net survival from adult leukaemia is generally much lower in the 15 participating Asian countries than in other regions of the world (appendix pp 163–73). With a few exceptions, survival seems to be low in east Asia (eg, from 19% in Japan to 23% in South Korea and Taiwan), high in west Asia (eg, from 33% in Turkey to 53% in Qatar), with a mixed picture in other Asian countries (eg, from 7% in Jordan to 40% in Indonesia). Survival estimates for adult leukaemia from Jordan, India, and Saudi Arabia might be less reliable for international comparison, but the overall pattern of leukaemia survival in Asia is still informative. Survival increases of 10–16% for adult leukaemia were seen in China, Denmark, Germany, Iceland, Latvia, Sweden, and New Zealand. Smaller rises of 5–9% were noted in North America, Israel, Japan, South Korea, and ten European countries. In Malta, 5-year survival fell from 39% in 1995–99 (based on 142 adults) to 19% for 2005–09 (128 adults; appendix p 161). This pattern is surprising, because data quality is very high (appendix pp 54–58) and survival trends for all solid tumours seem to be normal. Smaller declines were seen in several countries, such as Slovakia (from 41% to 37%) and Slovenia (from 44% to 38%). Data for acute lymphoblastic leukaemia in children are available for 74 343 patients (table 3). 173 registries in 42 countries contributed data for 1995–99, 215 registries in 50 countries provided data for 2000–04, and 213 registries in 53 countries provided data for 2005–09. In Romania (Cluj), data were only available for eight children and survival was not estimated. Of 53 countries, 32 provided data with 100% national population coverage. The geographic range in survival for acute lymphoblastic leukaemia in children was very wide. For patients diagnosed during 2005–09, age-standardised 5-year net survival was 90% or higher in Austria, Belgium, Canada, Germany, and Norway and 80–89% in 21 countries on various continents (table 4; appendix p 151). In many countries, however, 5-year net survival is still lower than 60%, even after adjustment for the very high background mortality in childhood. Survival was less than 50% in Indonesia, Mongolia, and Lesotho, although these estimates are based on very small numbers. The range of survival estimates for childhood acute lymphoblastic leukaemia in Central and South America (16 registries) and Asia (23 registries) is much lower than the range in North America (48 registries), Europe (83 registries), and Oceania (seven registries; appendix p 173). 5-year survival for childhood acute lymphoblastic leukaemia rose by 10% or more between 1995–99 and 2005–09 in Belarus, Belgium, Bulgaria, China, Colombia, Lithuania, Norway, Portugal, South Korea, Spain, Taiwan, and the UK. The estimate of 11% from China for 1995–99 is based on only 23 children, but the increase from 50% for 2000–04 to 61% for 2005–09 is more reliable. Increases in survival of up to 9% were seen in 16 other countries. 5-year survival in Argentina, Ecuador, and Slovakia was in the range 60–79%, with little or no change over time. Survival seemed to fall in Brazil (from 72% to 66%), Malaysia (from 77% to 69%), and Slovenia (from 83–86% in 1995–2004 to 76% for 2005–09). Survival trends could not be assessed in Africa. Discussion With CONCORD-2, we have initiated worldwide surveillance of trends in cancer survival. In the fi rst CONCORD study,6 comparable estimates of cancer survival worldwide were provided: the study included 1·9 million patients diagnosed with breast, colorectal, or prostate cancer during 1990–94 and followed up to 1999 in 31 countries (panel). CONCORD-2 extends coverage to 25·7 million patients diagnosed with an invasive primary cancer during the 15-year period 1995–2009 in 67 countries. The ten index cancers represent about two-thirds of the overall cancer burden in both low-income and highincome countries.4 Individual patient data provided by 279 population-based cancer registries were prepared with standardised quality-control procedures and subjected to centralised analysis with the latest statistical methods. The fi ndings do not cover all countries, but they provide at least some population-based cancer survival estimates for 67 countries (26 of low or middle income) that are home to two-thirds of the world’s population, including national data for 40 countries. The estimates are derived from analysis of raw data on the survival of individual cancer patients up to 5 years after diagnosis. Until now, for comparison of global or continental survival, researchers generally needed to interpret scattered reports produced with diverse cancer defi ni tions, quality-control criteria, and survival estimators, for diff erent calendar periods, and age-standardised to diff erent sets of weights.46 More speculative comparisons have been based on modelling of mortality-incidence ratios, sometimes with data from neighbouring regions or countries,47 with all the attendant assumptions.48 Even after adjustment for the wide international variation in levels of mortality from other causes, and with due allowance for variation in quality of data, the Articles www.thelancet.com Vol 385 March 14, 2015 1001 global range in 5-year survival from ten cancers in adults and acute lymphoblastic leukaemia in children is very wide. For most cancers, survival in Africa, Asia, and Central and South America is lower, and the range in survival much wider, than in Europe, North America, and Oceania. The wider range is only partly attributable to the fact that not all cancer registries could provide data covering the 15 years from 1995 to 2009; for example, many of the Chinese registries contributed data for 2000–04 but not 2005–09. In North America and Oceania, population coverage was higher than 80% and the same registries generally provided data for the entire period 1995–2009 (fi gure 4; appendix pp 163–73): survival for most cancers was high on a global scale, with a fairly narrow range in estimates between registries. 5-year net survival from stomach cancer is generally in the range 25–30%, but it is very high (50–60%) in Japan, South Korea, and, to a lesser extent, Taiwan. High survival from stomach cancer in Japan,49 South Korea,50 and Taiwan51 is well known, and is likely to be attributable to intensive diagnostic activity, early stage at diagnosis, and radical surgery. Survival varies according to sub-site, morphological type, and stage. Types of cancer with better prognosis might also be more common in Japan and South Korea, but the striking worldwide diff erences in survival suggest important lessons could be learnt from these countries about diagnosis and treatment. 5-year survival has risen for colon and rectal cancers in most developed countries and regions, including North America, Europe, Oceania, and parts of east Asia (South Korea and urban areas in China); increases in breast cancer survival have also been noted in these regions and in parts of Central and South America. These trends are likely to be attributable to earlier diagnosis, reduction in postoperative mortality,52 and more eff ective treatment.53,54 For rectal cancer, preoperative radiotherapy and total mesorectal excision reduce local recurrence and extend survival,55–57 which could account for improvements noted in Canada, Finland, the Netherlands, Norway, Sweden, and the USA, where survival was already high (55–60%) for patients diagnosed in 1995–99 and rose further for those diagnosed during 2005–09 (62–65%). These trends accord with those reported from the Netherlands,58 Scotland, the Nordic countries,59 and elsewhere in Europe.60 Liver and lung cancer remain lethal in both developing and developed countries, with 5-year survival generally lower than 20%, indicating that most patients are still diagnosed when they are inoperable. Primary prevention aimed at reducing tobacco and alcohol consumption, and prevention of chronic hepatitis, will be especially important for these cancers. The very low survival estimate for liver cancer in The Gambia (5%) is based on a sample of only 85 patients diagnosed during 1995–97 who were followed up for less than 5 years, to the end of 1998; it is not age-standardised, but it is unlikely to be far wrong: patients in The Gambia tend to present with very advanced disease and cirrhosis and are not amenable to surgery.61 Overall completeness of registration is low, but the incidence of liver cancer is comparable with that of other west African populations.62 Data from the national cancer registry for The Gambia, set up in 1986 to support the IARC’s Gambia Hepatitis Intervention Study,63 have been analysed previously,64 but more recent data were unavailable, so we cleaned and analysed them here alongside all other datasets, with permission from IARC. The global range in 5-year survival from cervical cancer is very wide, from less than 40% to more than 70%. The overall decline in survival from 66% to 61% in France between 1995–99 and 2000–04 was seen in all nine registries (appendix p 105). The decrease might be attributable to removal of less aggressive tumours by more intensive cervical screening for preinvasive lesions.65,66 Survival from cervical cancer in the Nordic countries was stable or rose slightly over the same period.67 By comparison, lower survival in low-income and middle-income countries is striking, since invasive cervical cancer is potentially curable with early detection by screening and appropriate surgery.68 5-year survival from ovarian cancer is generally in the range 30–40% in most parts of the world, but the overall range is much wider. Diversity in international survival might be attributable partly to variations in the proportion of tumours classifi ed as type I (typically early-stage and slow-growing) and type II (typically late-stage and aggressive).69 Diff erences in stage at diagnosis and treatment are also likely to be important.70 Diff erential Panel: Research in context Systematic review In the fi rst global comparison of population-based cancer survival (CONCORD),6 wide variations in survival from cancers of the breast (women), colon, rectum, and prostate were reported among 1·9 million adults diagnosed during 1990–94 and followed up to 1999 in 31 countries (16 countries had national coverage). More recent studies have diff ered with respect to geographic and population coverage, calendar period, and analytical methods, and they do not enable worldwide comparison of survival trends.7–9 With CONCORD-2, we have extended coverage to 25·7 million cancer patients diagnosed during the 15-year period 1995–2009 in one of 67 countries (26 of low or middle income), of which 40 countries had national coverage. Interpretation The ten index cancers we selected for analysis represent two-thirds of the overall cancer burden in both low-income and high-income countries. 5-year survival from colon, rectal, and breast cancers has increased in most developed countries. Liver and lung cancer remain lethal in both developing and developed countries. Striking increases in prostate cancer survival have occurred in many countries, but trends vary widely. The range in cervical and ovarian cancer survival is very wide, but improvements have been slight. In east Asia, stomach cancer survival is very high, suggesting lessons could be learnt, whereas survival for adult and childhood leukaemia is remarkably low. The global range in survival from precursor-cell acute lymphoblastic leukaemia in children is very wide, suggesting major defi ciencies in the management of what is now a largely curable disease. The fi ndings of our study can be used to assess the extent to which investment in health-care systems is improving their eff ectiveness. Articles 1008 www.thelancet.com Vol 385 March 14, 2015 7 De Angelis R, Sant M, Coleman MP, et al, and the EUROCARE-5 Working Group. Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5—a population-based study. Lancet Oncol 2014; 15: 23–34. 8 Sankaranarayanan R, Swaminathan R, Brenner H, et al. Cancer survival in Africa, Asia, and Central America: a population-based study. 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