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)

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 effectiveness 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 deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences 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

How farm management influences the longevity of dairy cows: a comparative study of Swiss dairy farms

Increasing the productive lifespan of dairy cows is an important means to lowering the environmental impact of dairy production. Farm characteristics, such as location, production type and breed are fix characteristics for most farms. However, farm management strategies can influence the longevity of their dairy herds in the medium- and short term. Within the framework of the research project ‘Longevity of Swiss Dairy Cows’ (Nutzungsdauer Schweizer Milchkühe), we aimed at identifying management choices that affect the productive lifespan of dairy cows. Based on data from the Swiss census and the major breeding organizations, we built a database of 142 farms. We defined 15 farm types that best represent the diversity of Swiss dairy production with regard to geographic regions, production zone, breed and production type (organic vs conventional). We allocated 10 dairy farms per farm type. Five of the 10 farms were chosen for having a low average productive lifespan (APL) of their dairy herd. The other five farms were chosen for having a high APL. APL was defined as the average lactation number of all cows culled 5 years in retrospective. From the initial 142 farms, 68 farms participated in a survey to assess the differences in management practices. From these participating farms, 30 were further clustered into matched pairs and were visited on-farm. Farms with low APL did not differ from those with high APL regarding their milk production and average dairy herd size. However, they significantly differed with regard to their APL, thus confirming a successful selection strategy of matched pairs. On average, dairy cows from farms with low APL were culled 2 lactations earlier than cows from farms with comparable characteristics, but with a high APL. Compared to farms with low ALP, farms with high APL were characterized by a higher percentage of loose housing systems, a higher percentage of energy rich feed rations, better fertility and more animals being inseminated with meat breeds. No statistical differences were found in relation to antibiotic treatment incidences and other health parameters