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

Why Information Retrieval Needs Cognitive Science: A call to arms

Much of today’s success in Information Retrieval (IR) comes from a hard approach: employing blazingly fast machines, ever more refined statistics, and increasingly powerful classification schemes. In recent years, however, the hard approach has entered a phase of diminishing returns. This paper explores a softer alternative which, we argue, is still in the phase of increasing returns. As the quality of an IR system is ultimately decided by its users, the approach starts from how these users structure information. Interestingly, for this approach many useful principles are readily available in the psychological literature. We illustrate the approach with three examples. The first applies the cognitive status of ‘complex nominals’ to improve search results by automatically constructing specialized queries. The second shows how the connection between language and imagery at the ‘basic level’ can be used for multimedia retrieval on the World Wide Web. The final example employs the notion of ’semantic space’ to make retrieval more effective especially for large scale corpora. In each example the results were substantial. The cases we studied illustrate how an approach to information retrieval based on cognitive principles can lead to significant, immediate, and fundamental results. It shows how prolific the application of cognitive science to the core of IR can be, and we believe that both disciplines stand to benefit from this approach

Is a Confirmatory Tendency to Blame for Poor Diagnostic Decisions?

In diagnostic reasoning, especially in a clinical setting, practitioners often widely disagree about the causal explanation for a given case. Most studies have assumed that such disagreements result from judgmental mistakes due to biased reasoning, especially the tendency to seek confirmation for a theory or hypothesis they already entertain. Alternative explanations for these mistakes are: confusion about the type of requested diagnosis and a difference in knowledge available to the practitioner. The present paper introduces a method to control the latter two factors, for the first time enabling a study of the influence of the first factor in isolation. In the experiment, eighteen advanced postgraduate practitioners made a diagnosis in interaction with a computer program simulating various reading impairments. We found two surprising results: First, the confirmatory tendency was not as prevalent as commonly assumed and second, more important, that where it was employed it was conducive to sound diagnostic decisions