An overview of cancer survival in Africa, Asia, the ... · treatments and clinical follow-up care...

Chapter 32

An overview of cancer survival in Africa,Asia, the Caribbean and Central America: the case for investment in cancer healthservicesSankaranarayanan R, Swaminathan R, Jayant K and Brenner H

Introduction

Population-based cancer survival data from 27population-based cancer registries in 14 countries inAfrica, Asia, the Caribbean and Central America arebriefly described and discussed in this publication(Table 1). Survival data for 40 cancer sites aredescribed in this chapter, although the number ofregistries reporting for each cancer site varied from 2to 26 (Table 2). The countries contributing data in ourstudy have variable levels of economic development,as indicated by the varying gross national income(GNI) per capita, and development of health services.The levels of development of health services andtheir efficiency in providing early diagnosis,treatments and clinical follow-up care have aprofound impact on survival from cancer. Poorlydeveloped and inaccessible health services obviouslyresult in great disparity in early diagnosis, adequatetreatment and follow-up care. We discuss theobserved survival patterns and inter- as well as intra-country variations in this chapter, in the backgroundof basic and effective early detection, diagnosis and

treatment requirements for selected cancer sites,taking into account data quality issues, the widedifferences in awareness, socio-economicdevelopment, human resources, health servicesinvestment, development and accessibility in thecountries included in this study.

Case-finding and follow-up

The methods used by each cancer registry to identifyand register all diagnosed cases from the various datasources in their geographical regions have beendescribed in the individual chapters. In brief, theregistries used a mix of both passive notification ofcases and active registration by visiting andabstracting data on cases from different data sourcesto register all incident cancer cases in the populationsthey covered. They used quality assurance proceduresas advocated by the International Agency for Researchon Cancer (IARC) to validate the quality andcompletion of cancer registration in their targetpopulations [1]. Uniform criteria [2] described indetail in Chapter 4 were adopted for inclusion of

257

Abstract

Population-based cancer survival data, a key indicator for monitoring progress against cancer, are reportedfrom 27 population-based cancer registries in 14 countries in Africa, Asia, the Caribbean and Central America.In China, Singapore, the Republic of Korea, and Turkey, the 5-year age-standardized relative survival rangedfrom 76−82% for breast, 63−79% for cervical, 71−78% for bladder, and 44−60% for large-bowel cancer. Survivaldid not exceed 22% for any cancer site in The Gambia, or 13% for any cancer site except breast (46%) inUganda. For localized cancers of the breast, large bowel, larynx, ovary, urinary bladder and for regionaldiseases at all sites, higher survival rates were observed in countries with more rather than less developedhealth services. Inter- and intra-country variations in survival imply that the levels of development of healthservices and their efficiency to provide early diagnosis, treatment and clinical follow-up care have a profoundimpact on survival from cancer. These are reliable baseline summary estimates to evaluate improvements incancer control and emphasise the need for urgent investment to improve awareness, population-based cancerregistration, early detection programmes, health-services infrastructure, and human resources in thesecountries in the future.

http://survcan.iarc.fr

cases for survival analysis and the disease codes ofthe International Classification of Diseases andRelated Health Problems, tenth revision (ICD-10) [3]were used for coding the collected data.

A mix of active and passive follow-up methods wereemployed by participating registries in eliciting thevital status of patients at or within five years from theincidence date. Twelve registries used active follow-up methods only, two registries used passive methodsonly, and the remaining 13 used a mix of bothmethods (Table 1). Active follow-up methods includedrepeated visits to data sources including hospitals toscrutinise clinical follow-up notes and death registryoffices, churches and mosques to collect deathinformation by scrutinising their death registers;telephone or reply-paid postal enquiries;investigations in workplaces or the neighbourhoodand house visits for personal enquiries. Passivefollow-up relied on matching cancer cases with all-cause death information collected from deathregistration systems and hospital records by usingunique person numbers or by using a combination ofpersonal identifiers from the national populationregisters, such as the first and last name, address anddate of birth, etc., for record linkage.

Outcome measures and 5-year survival

Death, irrespective of the cause, was the end-pointstudied. Survival experiences for each cancer site andparticipating registries are described in terms of 5-year age-standardized relative survival (ASRS).Comparison of 5-year ASRS by countries (Figures 1a−1w) and registries (Table 3; Figures 2a−2s) areprovided for all cancers. Observed survival by clinicalextent of disease categories at five years fromdiagnosis is described for eight cancer sites usinginformation from eight to 16 registries in four to ninecountries for different sites (Tables 4a−4h). Thedifferent categories of clinical extent of disease aredefined as follows:

• Localized: cancer was confined to the organ oforigin without invasion into the surroundingtissue/organ and without involvement of anyregional or distant lymph nodes or organs;

• Regional: cancer had invaded into thesurrounding tissue/organ, with or without theinvolvement of the regional lymph nodes but notinvolving or spread to the non-regional lymphnodes or organs;

• Distant metastasis: cancer that had spread tothe non-regional lymph nodes or distant organs;

• Unknown: when clinical extent of disease couldnot be categorised.

It is important to consider data quality issues wheninterpreting the results. Mortality ascertainment in apassive follow-up environment may be sub-optimal ifthe data linkage is not based on a unique personalidentification number backed by a good deathregistration system. Hence, an unknown degree ofunder-ascertainment of deaths cannot be ruled out insome of the populations included in our study, despiteof our best and active efforts to ascertain suchevents.

An earlier study addressing the impact of the lack ofactive follow-up in Chennai registry in India hadshown an upward bias in population-based survivalranging between three and 13 percent units in thepresence of 5-21% of random losses to follow-up fordifferent cancers [4]. This bias was estimated byassuming that the lost to follow-up cases were aliveat the closing date of follow-up. Using the sameanalogy for registries that used predominantly passivefollow-up, when such misclassification of cases asalive at closing date does not exceed one in fivecases, the over-estimation of five-year agestandardized relative survival is unlikely to exceed 13percent units. On the other hand, studies employingloss-adjusted survival methods with such data haveclearly shown that over-estimation of population-based survival was minimal [5,6].

We have made considerable efforts to improve dataquality for each registry; hence the survival estimatesfrom our study are reliable and are more likely toreflect the impact of varying levels of awareness,early diagnosis and treatment and development ofcancer health care services in the different countriesand populations included in our study. Thus, they arereliable baseline summary estimates for anycomparison and for future improvements in survivaloutcome. The observed differences in survivalbetween the countries and populations in our studyseem to be largely caused by the wide differences inawareness, socio-economic development, humanresources, availability of and accessibility to earlydiagnosis and treatment due to the different levels ofdevelopment of health services, on-going healthservice investments and, to a lesser extent, to dataquality and reliability issues.

Variation in survival and levels of development ofhealth services

We have classified the health services of countriesincluded in the study into three groups, namely well-, moderately- and least-developed based on

Chapter 32

258


Cancer survival in Africa, Asia, the Caribbean and Central America: An overview

259

selected indicators as shown in Table 5. We have alsoattempted to classify the countries included in ourstudy into three tiers, based on the variations insurvival rates: the countries or regions showing thehighest survival in our study include Hong KongSpecial Administrative Region (SAR) and metropolitanareas of China, Republic of Korea, Singapore andTurkey, which have well-developed health services asindicated by large numbers of well-developeddiagnostic and treatment centres across the countriesand high per-capita gross national income (GNI)values (http://web.worldbank.org/WBSITE/EXTERNAL/DATASTATISTICS/0,,contentMDK:20535285~menuPK:1192694~pagePK:64133150~piPK:64133175~theSitePK:239419,00.html) (Table 5). Those withintermediate survival experience include rural areasin mainland China, Costa Rica, Cuba, India, Pakistan,the Philippines and Thailand, which have moderately-developed cancer health services as indicated bydiagnostic and treatment facilities centred in andaround metropolitan or urban cities and medium per-capita GNI values; the lowest survival rates wereobserved in the Gambia, Uganda and Zimbabwe,which have poorly-developed health services asindicated by very limited availability of cancerdiagnostic and treatment facilities and low per capitaGNI values (Table 5).

The classification of three tiers of survival was usedto obtain further insight by comparing five-yearobserved survival and the proportion of casespresenting in different categories of clinical extent ofdisease for six cancer sites (Figures 3a−8b). Data onclinical extent of disease were not available from anycountry in Africa. Among the countries having thehighest survival, data on clinical extent of diseasewas available from Singapore for all sites, Turkey formost sites and Hong Kong (SAR) for breast only; theavailable data on clinical extent of disease from thesecountries were pooled together for each site andclassified as "More-developed health services".Similarly, data on respective categories of extent ofdisease from countries having intermediate survivalwere pooled together as "Less-developed healthservices". A decreasing survival with advancing stagesof disease was observed for all cancers in bothgroups. For localized cancers of the breast, largebowel, larynx, ovary and urinary bladder and for allregional diseases at all sites, higher survival rateswere observed in countries with more-developed thanin less-developed health services. This seems to beclearly related to the capability of health services toprovide early diagnosis and adequate treatment fortreatable forms of cancers.

Inter- and intra-country comparison of survivalrates for individual cancer sites

Head and neck cancers (Tables 3, 4a−4c; Figures 1a−1e, 2a−2d, 2i, 3a−3b)

Five-year survival rates for oral cavity and pharyngealtumours varied markedly by anatomical site,countries and populations. The 5-year survival fortongue cancer varied from 12% in Barshi in India tomore than 60% in China. Survival rates were lowerthan 30% in India and most of Thailand. The survivalrates for advanced disease (regional and distantmetastasis) were less than 20%, and that for localizedcancers exceeded 45% in most countries. The survivalrates for oral cavity cancers were generally higherthan that of tongue and varied from 22% in ChiangMai, Thailand to 71% in Shanghai, China. Survival forlocalized oral cavity cancer exceeded 50% in mostcountries, whereas it was less than 25% for regionaland distant metastatic disease in most countries.Early cancers (stages I and II) of the tongue and oralcavity are curable by surgery or by radiation therapy,and the choice of treatment is dictated by theanticipated functional and cosmetic results oftreatment as well as by the availability of specificfacilities. Patients with stage III or IV tongue and oralcancers are candidates for treatment by acombination of surgery and radiation therapy andlocal and regional recurrences are common in thisgroup of patients. It is well established that tonguecancers carry much poorer prognosis than oral cavitycancers and, once the disease involves regional lymphnodes, survival prospects are very poor for head andneck cancers [7].

The survival for oropharyngeal cancers, includingtonsil, ranged 16−20% in Chennai and Mumbai in Indiato 68% in Tianjin, China. Survival for hypopharyngealcancers was less than 25% in most populationsstudied. Oropharyngeal and hypopharyngeal cancersoften present in advanced stages and treatmentoutcomes for advanced disease are poor for thesecancer sites [8]. The survival for nasopharyngealcancer exceeded 59% in Singapore and Hong Kong.Survival rates for laryngeal cancer exceeded 60% inChina, Singapore, Republic of Korea and Turkey, whilesurvival rates did not exceed 40% in India, Harare inZimbabwe, rural Qidong district in China and someregions of Thailand, indicating an advanced clinicalpresentation.

Prognosis for small laryngeal cancers with no lymphnode spread is very good, with cure rates rangingfrom 75 to 95% depending on the site, tumour bulkand degree of infiltration. The 5-year survival forboth localized and regionally spread laryngeal cancerwas 16 to 19 percentage points higher in countries


with well-developed health services, such asSingapore and Turkey, than in other countries,underlining the importance of both early diagnosisand appropriate treatment (Figure 3a). Survival ratesfor the above cancer sites were lower in ruralcompared to urban areas of India and China, whereasthe survival differences were minimal across Republicof Korea and Thailand.

The poor survival outcomes for most patients withhead and neck cancer in our study and elsewhere[2,9] underscore the importance of primaryprevention and early detection of these cancers. Mosthead and neck cancers are caused by tobacco use inany form [10,11] and alcohol drinking [12], andavoiding these risk factors has a substantial impact onpreventing these cancers. A 35% reduction in oralcancer mortality following three rounds of oral visualscreening among tobacco and/or alcohol users wasdocumented in a randomized trial in Southern India[13]. Routine visual screening of such high-riskpopulations will improve survival and reduce oralcancer mortality.

Digestive tract cancers (Tables 3, 4d, 4e; Figures 1f−1j, 2e−2h and 4a−4b)

Five-year survival prospects of patients with liver,pancreas, gall bladder, oesophagus and stomachcancers were generally poor, not exceeding 15% inmost populations studied, indicating the poorprognosis of cancers in these organs and theimportance of primary prevention in controlling thesetumours. Most of the cancers arising in these sites arerarely curable. The overall 5-year survival rate inpatients amenable for radical definitive treatment bysurgery or radiotherapy for oesophageal cancerranges from 5% to 30%. Cytological and endoscopicscreening have been evaluated in countries with ahigh incidence of oesophageal cancer. Although theseefforts have shown that it is possible to detectcancers in an early asymptomatic stage, and thosewith very early disease have a better chance ofsurvival, screening is unlikely to reduce mortalityfrom oesophageal cancer and may result in someserious side-effects associated with endoscopy suchas aspiration, perforation, bleeding andcardiopulmonary events. Improving general nutritionand controlling tobacco and alcohol consumption areimportant in the context of preventing oesophagealcancer. Symptomatic gastroesophageal reflux disease(GERD) has been identified as a risk factor ofoesophageal adenocarcinoma.

The survival outcome of patients with stomach canceris related to tumour extension beyond the gastricwall, regional lymph node involvement, and to alesser extent on tumour grade [14,15]. Screening is

unlikely to reduce mortality from stomach cancer.Overall stomach cancer incidence and mortality aredeclining across the world due to better foodpreservation using refrigerators, reducedconsumption of salted, smoked and pickled foodproducts, and wide availability of fruits andvegetables the year round. Risk factors for gastriccancer include the presence of precursor conditionssuch as chronic atrophic gastritis, intestinalmetaplasia and pernicious anaemia. There isincreasing evidence that Helicobacter pylori infectionof the stomach is associated with both the initiationand promotion of gastric carcinoma.

Most patients with stomach cancer present withmetastatic disease, either regional or in distant sitessuch as the liver. The curative treatment option forstomach cancer is radical surgery; however, thefrequency of local failure in the tumour bed andregional lymph nodes and distant failures viahaematogenous or peritoneal routes remains high.Although 30−50% of patients with localized distalstomach cancer can be cured, such disease accountsfor less than 10% of cases. On the other hand, the 5-year survival rate of patients with localizedproximal stomach cancer is less than 15%. None withdisseminated disease survive at 5 years.

Survival for colorectal (large bowel) cancer variedfrom 4% in The Gambia to 64% in Seoul, Republic ofKorea. The survival figures were less than 8% in thesub-Saharan African countries of The Gambia andUganda and less than 30% in Harare, Zimbabwe, all ofwhich have poorly-developed cancer health careinfrastructure and limited availability of andaccessibility to curative treatments for most patients.The survival prospects of patients with large bowelcancer is clearly related to the degree of penetrationof the tumour through the intestinal wall, thepresence or absence of regional lymph nodalinvolvement, and the presence or absence of distantmetastases; these three characteristics form the basisfor staging and treatment options for this cancer [16].

It is well established that screening with faecal occultblood testing reduces colorectal cancer mortality, andflexible sigmoidoscopy and colonoscopy leads toearlier detection of polyps and colorectal cancer. Thestandard treatment for patients with colon cancer hasbeen open surgical resection of the primary andregional lymph nodes for localized disease. Patientswith advanced disease may require combinedmodality therapy with chemotherapy with or withoutradiation therapy. The survival outcomes forcolorectal cancer depend on the clinical stage atpresentation and the ability of the health services toprovide prompt standard care with radical surgeryand other adjuvant therapies as indicated. Survival

Chapter 32

260



261

rates exceeding 50% reported from Hong Kong,Republic of Korea, Singapore, regions in Thailand andmainland China seem to reflect the wide availabilityof screening, endoscopy and treatment in their well-or moderately-developed health services. Theflexible sigmoidoscope permits a more completeexamination of the distal colon with more acceptablepatient tolerance than the rigid sigmoidoscope.Virtually all the screening studies using these types ofsigmoidoscopes have demonstrated an increase in theproportion of early cases and survival compared withcases diagnosed in a routine environment. It is quitelikely that the early recognition of the clinicalimportance of flat lesions detected in colonoscopy bythe endoscopy practices in east Asian countries hasalso led to earlier detection of colorectal cancersthere [17]. The survival experience of large bowelcancer patients in Hong Kong and the Republic ofKorea are similar to that reported for white patientsin the United States Surveillance Epidemiology andEnd Results (US-SEER) [9].

The 5-year survival rates of localized and regionallarge bowel cancer were 64% and 46%, respectively inSingapore and Izmir, Turkey, as compared to 50% and32%, respectively in countries with less-developedhealth services such as Thailand, India and thePhilippines (Figure 4a). It is interesting to note thatthe survival experience of localized colorectal cancerpatients in countries with less-developed healthservices and that of patients with regional disease incountries such as Singapore and Turkey with well-developed health services were almost similar (Figure 4b). The higher survival in Singapore andTurkey seems to be a reflection of both earlier stagesof clinical presentation and the capability of thehealth services to promptly respond with earlydiagnosis and comprehensive management. On theother hand, the wide difference in the outcomebetween localized and regional cancers (18percentage points) indicates the potential for earlydetection to prevent more deaths from colorectalcancer (Figure 4a).

The vast majority of patients with liver cancer diewithin a year, although a small fraction of those withlocalized cancers can be potentially cured by surgicalresection. However, screening for liver cancer withultrasonography and/or alpha fetoprotein (AFP)estimation does not reduce liver cancer mortality[18,19]. A vast majority of liver cancers are caused bychronic infection with Hepatitis B (HBV) or C (HCV)viruses, ingestion of foods contaminated withaflatoxins and alcohol consumption. Controlling theserisk factors has a major impact on liver cancerprevention. A 69% reduction in the incidence of livercancer among the vaccinated cohort has beenrecently demonstrated after the introduction of HBV

vaccination in the national immunization programmeof Taiwan [20].

Cancer of the pancreas is rarely curable, althoughcomplete surgical excision in patients with localizeddisease and small cancers (<2 cm) with no lymph nodemetastases and no extension beyond the capsule ofthe pancreas can result in 5-year survival rates around20%. It is quite likely that survival rates exceeding 15−20% for these poor-prognosis cancers in our seriessuffer from over-estimation due to under-ascertainment of death events in many patients whomight have been misclassified as alive at the closingdate.

Lung cancer (Table 3; Figures 1l and 2j)

The 5-year survival from lung cancer was less than15% in most countries and populations in our study(Table 3). Surgery is the most potentially curativetherapeutic option for most localized non-small celllung cancers (NSCLC). Radiation therapy, combinedwith chemotherapy, can produce a cure in a smallnumber of patients and can provide palliation in mostpatients. Regardless of clinical stage andimprovements in diagnosis and therapy made duringthe past 25 years, treatment outcomes are notsatisfactory for most patients with lung cancer.Although a small proportion of NSCLC patients withsurgically resectable disease may be cured, themajority of patients with lung cancer die of theirtumour even with the best available therapy.

Small-cell lung cancer (SCLC) accounts forapproximately 15−20% of lung cancers; withouttreatment, SCLC has the most aggressive clinicalcourse of any type of lung cancer, with mediansurvival less than 4 months. Although SCLC is moreresponsive to chemotherapy and radiotherapy, long-term survival and cure are difficult to achieve due toits tendency to disseminate early and widely.However, for patients with limited stage SCLC(confined to the hemithorax of origin), a mediansurvival up to 24 months and 5-year survivals around15−20% can be achieved [21]. Comparatively, a higher5-year survival rates around 20% observed in HongKong and Republic of Korea may be a reflection of thewider accessibility to curative treatments in theirhealth services, although some over-estimationcannot be ruled out.

The single most important risk factor for thedevelopment of lung cancer is tobacco smoking, asreflected by the fact that the risk for lung cancer ison an average tenfold higher than in lifetime non-smokers (defined as a person who has smoked <100cigarettes in their lifetime). The risk increases withthe quantity of cigarettes or smoking products (such


as bidis or cigars), duration of smoking, and startingage. Smoking cessation results in a decrease inprecancerous lesions and a reduction in the risk ofdeveloping lung cancer. However, former smokerscontinue to have an elevated risk for lung cancer foryears after quitting.

Screening does not reduce mortality from lung cancerand would lead to false-positive tests andunnecessary invasive diagnostic procedures andtreatments. Given the poor prospects for screening,early diagnosis and treatment to cure lung cancers,tobacco control offers the most cost-effective way ofcontrolling it. Significant reductions in lung cancermortality in developed countries such as the US, UKand Nordic countries have been due to their successin reducing consumption of tobacco by a variety oftobacco control measures including education, ban ontobacco advertisements, legislation, taxation andpricing. The incidence of and mortality from lungcancer is showing an increasing trend in many low-and medium-resourced countries due to failure tocontrol tobacco use, and this trend should bereversed. Every effort should be taken to keep lungcancer incidence rates as low as possible indeveloping countries.

Breast cancer (Tables 3, 4f; Figures 1n, 2k, 5a−5b)

Five year survival rates exceeded 75% in Hong KongSAR, Shanghai and Tianjin in mainland China,Singapore, the Republic of Korea, and Izmir in Turkey,indicating better care in terms of early diagnosis aswell as availability and accessibility to surgery,radiotherapy and systemic hormone andchemotherapeutic treatments (Table 3). The survivalexperience in Hong Kong was similar to that reportedfor US-SEER White patients [9] and that of Singaporeand the Republic of Korea are similar to figuresreported from Europe [2]. There is considerablediagnostic mammography and ultrasonographyactivity in the health services in the Republic ofKorea, Hong Kong, Singapore and Turkey, which wouldhave led to much earlier detection of breast cancersin these health services. Screening mammography inwomen aged 40 to 70 years decreases breast cancermortality, although to a higher extent in women aged50−70 years [22]. The value of mass screeningprogrammes using clinical and breast self-examination remain unclear.

Survival ranged between 65% and 70% in Costa Rica,Cuba, Saudi Arabia and in some regions of Thailand.The lowest survival, around 13%, was reported fromThe Gambia, which has no cancer-directed treatmentavailable in the health services. The five-year survivalobserved in the capital cities of Uganda (46%) andZimbabwe (58%), even with the limited cancer

surgery, radiotherapy and chemotherapy availablethere, indicates the good prognosis from breastcancer that can be achieved with basic local (primarytumour directed) and systemic treatment. Survivalrates ranged between 31% and 54% in differentregions of India and 57% and 65% in Thailand (Table 3).

The 5-year survival for localized breast cancer was90% in the more-developed health services ofSingapore and Turkey, whereas it was 76% in the less-developed health services in Thailand, India andCosta Rica, among other countries (Figure 5a).However there was a wide difference (29 percentagepoints) between the survival outcomes for regionaldisease (indicating larger tumours or local spread toskin or chest wall or lymph nodes) between the twohealth care settings. In fact, the survival experienceof patients with regional disease in Singapore andTurkey are similar to that of localized breast cancerpatients in India and Thailand among other countries,and the two survival curves superimpose on eachother (Figure 5b). Although some misclassificationbetween localized and regional disease cannot beruled out, inter-country differences in the availabilityand accessibility to early detection and appropriatetreatment are predominantly responsible for thisobservation.

Breast cancer incidence rates are increasing steadilyin all low- and medium-resource countries, and it isthe most common cancer among women in manycountries. The cause of breast cancer is not known,although risk factors such as family history of breastor ovarian cancer (particularly first-degree relativeson either the mother's or father's side); early age atmenarche and late age at first childbirth, menopausalhormone use, obesity, and alcohol intake have beenidentified to increase the risk. Early detection andappropriate treatment are the currently availablemethods of preventing breast cancer deaths. Theprognostic factors affecting survival outcome includethe clinical stage of disease, menopausal status of thepatient, histology and grade of the tumour, oestrogen(ER) and progesterone receptor (PR) status, andhuman epidermal growth factor receptor (HER2/neu)gene amplification status, all of which influence thechoice of treatments.

Patients with breast cancer require a multimodalapproach to curative treatment. Surgery is central toits management, and surgical options for breastcancer include breast-conserving surgery plusradiation therapy or mastectomy plus reconstructionor mastectomy alone. The axillary lymph nodesshould be explored and histologically studied to aid indetermining treatment and prognosis. Axillary nodedissection, in the presence of clinically negativenodes, is a necessary staging procedure; controversy

Chapter 32

262



263

exists as to the extent of the procedure because oflong-term morbidity (e.g., arm discomfort andswelling) associated with it. Lymphatic mapping andsentinel lymph node biopsy may be used in womenwith invasive breast cancer to decrease the morbidityof axillary lymphadenectomy while maintainingaccurate staging. Radiation therapy is regularlyemployed after breast-conservation surgery. Adjuvantradiotherapy for post-mastectomy patients may beused to eradicate residual disease, thus reducing localrecurrence. Approximately 5 years of adjuvanthormone therapy with tamoxifen is indicated inpatients with ER positive cancers, and reduces theannual breast cancer death rate by 31%, irrespectiveof the use of chemotherapy and of age, progesteronereceptor status, or other characteristics [23]. Ovarianablation is another useful and feasible adjuvantsystemic treatment option in premenopausal women.Adjuvant combination chemotherapy reduces annualrisk of relapse and death by 37% and 30%,respectively, which translates into a 10% absoluteimprovement in 15-year survival (hazard ratio = 42%vs. 32%) in women under 50 years; for women over of50 years, these values were 19%, 12% and 3%,respectively [23]. The 15-year cumulative reductionin mortality from 6 months of an anthracycline-basedregimen (e.g. fluorouracil, doxorubicin,cyclophosphamide [FAC] or fluorouracil, epirubicin,cyclophosphamide [FEC]) was 38% in women youngerthan 50 years, and 20% in those aged 50 to 60 years.

The wide variation in breast cancer survival (from 13%to 90%) in our study indicates the vast potential forimproving survival outcomes by ensuring earlydetection, resulting in the diagnosis of very smalltumours (<2 cms) without axillary node metastasis,adequate staging and combined modality treatmentand follow-up care. We believe that the highersurvival rates in countries with well-developed healthservices are direct consequences of the abovefactors. Investing in improving breast awareness aswell as the infrastructure and efficiency of healthservices is vital to achieve such cure rates as high as90% 5-year survival.

Genital tract cancers in women (Tables 3, 4g-4h;Figures 1o-1p, 2l, 2m and 6a−7b)

Five-year survival rates exceeded 75% for cervicalcancer in Hong Kong and the Republic of Korea, and65% in Singapore. On the other hand, survival was lessthan 25% in The Gambia and Uganda (Table 3). Theprognosis for patients with cervical cancer dependson the clinical extent of disease at the time ofdiagnosis. Early stage (stage I) cervical cancers maybe treated by radical surgery or radical radiotherapycombining external beam therapy and intracavitaryradiation. Surgery and radiation therapy are equally

effective for early-stage small-volume disease,whereas locally advanced disease (stages II and III)are treated by a concurrent combination ofradiotherapy and chemotherapy with cisplatinumcontaining combinations. Although clinical trialsdemonstrate significant survival benefit and reducedrisk of death from cervical cancer for the concurrentchemoradiation therapy in regional disease,radiotherapy alone is still used for treating locallyadvanced regional disease due to the cost and limitedavailability of chemotherapeutic agents in many low-resource countries.

The 5-year survival for localized cervix cancerpatients in our study was 70% in countries with well-developed health services and 73% in those less-developed services (Figure 6a). The lack of variationin the survival outcome of localized cervix cancerpatients and the minimal difference in the outcomefor locally advanced regional disease in these twogroups of countries is interesting (Figure 6b). Thisprobably indicates that facilities for cervical cancertreatment were not found wanting in these countries.Cervical cancer screening with Pap smear iswidespread in Hong Kong, Singapore, the Republic ofKorea and Costa Rica. Cervical cancer cases in thesecountries are more likely to be diagnosed in thosewho did not participate in screening and such casesmay have a poor prognosis.

Cervical cancers are caused by persistent infectionwith one of the oncogenic human papilloma virus(HPV) types, and HPV vaccination is an emergingprevention option. While Pap smear screening hasalready reduced cervical cancer mortality indeveloped countries, new screening approaches suchas HPV testing seem to be a more effective way ofpreventing cervical cancer [24,25] particularly in low-resource settings, with the eventual availability ofaffordable and rapid HPV tests [26] and when HPVvaccination becoming widespread, thereby reducingthe prevalence of cervical precancerous lesions. Incountries where HPV testing is not feasible due tocosts and infrastructure, visual screening may providean alternative screening option [27], but thesubjective nature of the test, variations in testpositivity and sensitivity, quality assurance and lowspecificity may pose challenges to obtaining optimumcost-effectiveness in routine health care settings. Thecommercial availability of affordable HPV tests suchas the careHPV test [26] may make HPV testingfeasible as a primary screening approach for cervicalcancer in low- and medium-resource settings.

Five-year survival of ovarian cancer patients was lessthan 30% in India and Uganda and was above 60% inHong Kong, Singapore and the Republic of Korea withwell-developed health services (Table 3). The case


mix between epithelial, germ cell and borderlineovarian malignancies, as well as the diagnosticpractices, should be taken into account wheninterpreting overall survival from ovarian cancer.There was 20 percentage points difference in the 5-year survival outcome for localized ovarian cancerbetween countries with well developed healthservices and others with less developed services(Figure 7a). On the other hand, there were no majorsurvival differences between these countries forlocally advanced regional disease (Figure 7b).

Most patients with ovarian cancer have widespreaddisease at presentation due to early spread of tumourand symptoms such as abdominal pain and swelling,gastrointestinal symptoms, and pelvic pain oftengoing unrecognized, leading to diagnostic delays. Themost favourable prognostic factors for epithelialovarian cancer include early stage (stage I), youngage, cell types other than mucinous and clear cell,well-differentiated tumour, smaller disease volumeprior to surgical debulking, absence of ascites andsmaller disease volume following cytoreductivesurgery.

Stages IA and IB ovarian cancer patients are treatedwith total abdominal hysterectomy and bilateralsalpingo-oophorectomy with omentectomy. However,those with high-grade or adherent stage I or ICtumours will require systemic chemotherapy based onplatinum compounds or in combination withalkylating agents. Patients with locally advancedovarian cancer are treated with debulkingcytoreductive surgery and platinum containingchemotherapy regimes. Surgery should include totalabdominal hysterectomy and bilateral salpingo-oophorectomy with omentectomy and debulking of asmuch gross tumour as can be safely performed.

Germ cell tumours of the ovary are diagnosed mostoften in young women or adolescent girls. They aremostly unilateral and are highly curable if found andtreated early. Use of combination chemotherapy afterinitial surgery has dramatically improved theprognosis for most ovarian germ cell tumours.

Urinary tract cancers (Table 3, Figures 1r, 2o and 8a−8b)

The 5-year survival exceeded 55% for kidney cancer inHong Kong, Singapore, the Republic of Korea, andurban mainland China while it was less than 40% inIndia, Thailand and rural China (Qidong) which mightbe related to the ability of the health services toprovide prompt diagnostic and surgical services (Table 3). This is again reflected by survival ratesexceeding 70% observed for bladder cancer in HongKong, Singapore, the Republic of Korea, and urban

mainland China as compared to less than 50% survivalin other countries (Table 3). There was a 17percentage point difference in the 5-year survivalrate of localized bladder cancer and a 10 percentagepoint difference for regional disease betweencountries with highly developed and less developedhealth services (Figure 8a). Radical surgery is themainstay of curative treatment for both kidney andbladder cancers. Five-year survival exceeded 85% fortesticular cancer in Hong Kong, Singapore and theRepublic of Korea (Table 3). Testicular cancers aretreated by both surgery and chemotherapy, and thesustained availability of such services ensure highcure rates. The survival outcome for testicular cancerin countries such as India, Thailand and mainlandChina are highly encouraging and reflect the goodprognosis for testicular cancer using currentlyavailable treatment options.

Lymphomas (Table 3; Figures 1t, 1u, 2p-2q and 9a−10b)

The 5-year survival rate exceeded 75% for Hodgkinlymphoma (HL) in Hong Kong, urban mainland China,Singapore and Republic of Korea, whereas it rangedbetween 37% and 58% in Cuba, India and half of theregions in Thailand (Table 3). HL is predominantlytreated with radiotherapy (in early stages: non-bulkyIA or IIA disease) and/or combination chemotherapy(in advanced stages: stages III and IV, bulky disease,presence of B-symptoms). These high survival figuresreinforce the fact that more than 75% of all newlydiagnosed patients with adult HL can be cured withcombination chemotherapy and/or radiation therapy.The prognosis depends upon the stage of disease,presence or absence of symptoms, presence orabsence of large masses, absolute sites of nodalinvolvement, extent of abdominal involvement andthe quality of treatment.

There are 27-29 percentage points difference in the5-year survival of HL between countries categorizedas "High" with well-developed and as "Low" with less-developed health services (Figure 9a). On the otherhand, the survival difference between countriesclassified as "Intermediate" with moderately-developed health services in India, mainland China,Thailand, and Cuba and less-developed services insub-Saharan Africa are minimal, possibly indicatingthat sub-optimal treatments may have similaroutcomes given the generally good prognosis for HL(Figure 9b).

The non-Hodgkin lymphomas (NHL) are characterizedby a heterogeneous group of lymphoproliferativemalignancies with variable clinical behaviour andresponses to treatment. The clinical course of NHL ismuch less predictable than HL, and has high tendency

Chapter 32

264



265

to disseminate to extra nodal sites. The prognosisdepends on the histologic type, stage, and treatment.The 5-year survival for NHL is much lower than for HL.The overall survival from NHL depends upon the casemix between indolent and aggressive NHL. IndolentNHL types have a relatively good prognosis, with amedian survival as long as 10 years. Early-stage(stages I and II) indolent NHL can be effectivelytreated with radiation therapy alone, but NHL isusually not curable in advanced clinical stages. Theaggressive type of NHL has a shorter natural history,but a significant number of these patients can becured with intensive combination chemotherapyregimens. Aggressive lymphomas are common in HIV-positive patients, and treatment of these patientsrequires special consideration. Thus NHL assumes aspecial significance in regions with high prevalence ofHIV infection such as sub-Saharan Africa. In general,with modern treatment of patients with NHL, overallsurvival at 5-years is approximately 50% to 60%. Thesurvival for NHL ranges between 49% to 65% in HongKong, Singapore and the Republic of Korea, is lowerthan 50% in other Asian countries and less than 25% inthe Gambia, Uganda and Zimbabwe (Table 3). Thedifferences in outcome for NHL between thesecountries are striking (Figures 10a-b), and are possiblyexplained by the capacity of the health services toprovide diagnosis, histological typing, accuratestaging and appropriate treatment.

Conclusion

In summary, our results imply that the levels ofdevelopment of health services and their efficiency inproviding early diagnosis, treatment and clinicalfollow-up care have a profound impact on survivalfrom cancer. Survival outcomes were higher incountries with highly-developed health services thanin countries with less-developed services. The criticalconcentration of trained human resources for cancercontrol is definitely higher in developed health careservices.

The large variation in survival observed withinpopulations in different regions of China, India andThailand reflects the varying levels of development ofcancer health services and the availability of trainedpersonnel within these countries, particularly inurban vs. rural areas. All three regions in the Republicof Korea showed no major differences in survival forany cancer, possibly reflecting equitably developedand accessible health care services across thecountry. The poor survival rates observed in TheGambia, Uganda and Zimbabwe emphasize theimportance and urgent need for direct verticalinvestments to improve health services and togenerate sufficient trained human resources bynational governments of sub-Saharan African and

other developing countries. It is quite likely that thesurvival rates in many low- and medium-resourcedcountries that were not included in this study,particularly those from sub-Saharan Africa, would belower than those reported in our study.This study would not have been possible without theavailability of reliable population-based cancerregistries. It is important to organize such informationsystems in the regions/countries that lack them.However, the registries must collect more reliableinformation on clinical stages, particularly in terms ofcomposite clinical stages and Tumour, Node,Metastasis (TNM) categories according tointernationally-accepted stage classifications andsummary treatment data to explain the observedsurvival patterns and differences between differentpopulations in a convincing manner. The staginginformation in terms of composite stages and/or TNMcategories should be collected at least for treatableforms of cancers such as oral cavity, larynx, breast,cervix, ovary, lymphomas and childhood cancers.Treatment information in terms of proportions ofpatients completing prescribed treatment will be animportant measure of health service efficiency andwill be useful to describe observed survival variations.

Striking differences in cancer survival betweencountries reflect the large inequality in accessibleand available cancer health services for populationsacross the world, and such inequality is clearlyunacceptable. Health services need to be upgradedfor cancers where there exist marked differences insurvival for localized cancer between well-developedand less-developed countries. Urgent and adequateinvestment by countries in comprehensive cancercontrol, including improving public and professionalawareness, early detection, prompt treatment usinglocally feasible yet effective regimens, healthservices infrastructure, human resourcesdevelopment and referral pathways, will reduce suchinequality and ensure improved and equitableaccessibility to health services. The current data canserve as a baseline to evaluate improvements incancer control and cancer health services in thefuture.

References

1. Jensen OM, Parkin DM, Maclennan R, Muir CS, Skeet RG.Cancer Registration Principles and Methods: IARCScientific Publications No. 95. IARCPress, Lyon, 1999.

2. Sant M, Allemani C, Santaquilani M, Knijn A, Marchesi F,Capocaccia R; EUROCARE Working Group. EUROCARE-4.Survival of cancer patients diagnosed in 1995-1999.Results and commentary. Eur J Cancer. 2009;45:


931−991.

3. World Health Organization. International StatisticalClassification of Diseases and Related HealthProblems, Tenth Revision (ICD-10), Volume 1. WorldHealth Organization, Geneva, 1992.

4. Swaminathan R, Rama R, Shanta V. Lack of active fol-low-up of cancer patients in Chennai, India: implica-tions for population based survival estimates. BullWorld Health Organ. 2008;86:509−515.

5. Sriamporn S, Swaminathan R, Parkin DM, Kamsa-Ard S,Hakama M. Loss-adjusted survival of cervix cancer inKhon Kaen, Northeast Thailand. Br J Cancer. 2004;91:106−110.

6. Swaminathan R, Sankaranarayanan R, Hakama M, ShantaV. Effect of loss to follow-up on population based can-cer survival rates in developing countries. Int J CancerSuppl. 2002; 13:172 (18th UICC Cancer Congress, 30June - 5 July 2002, Oslo - Norway - abstract book).

7. Harrison LB, Sessions RB, Hong WK, eds. Head and NeckCancer: A Multidisciplinary Approach. Lippincott-Raven, Philadelphia, 1999.

8. Cummings CW, Fredrickson JM, Harker LA, Krause CJ,Schuller DE, eds. Otolaryngology - Head and NeckSurgery. Mosby-Year Book, Inc., Saint Louis, 1998.

9. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA,Feuer EJ, Clegg L, Eisner MP, Horner MJ, Howlader N,Hayat M, Hankey BF and Edwards BK (eds). SEER CancerStatistics Review, 1975-2003. National Cancer Institute.Bethesda, MD, 2006. http://seer.cancer.gov/csr/1975_2003/

10. World Health Organization. International Agency forResearch on Cancer. IARC Monographs on theEvaluation of Carcinogenic Risks to Human. IARCMonographs, Volume 83. Tobacco Smoke andInvoluntary Smoking. IARCPress, Lyon, 2004.

11. World Health Organization. International Agency forResearch on Cancer. IARC Monographs on theEvaluation of Carcinogenic Risks to Human. IARCMonographs, Volume 85. Betel-quid and Areca-nutChewing and Some Areca-nut derived Nitrosamines.IARCPress, Lyon, 2004.

12. World Health Organization. International Agency forResearch on Cancer. IARC Monographs on theEvaluation of Carcinogenic Risks to Humans. IARCMonographs Vol. 44. Alcohol Drinking. IARCPress, Lyon,1988.

13. Sankaranarayanan R, Ramadas K, Thomas G, MuwongeR, Thara S, Mathew B, Rajan B Trivandrum Oral CancerScreening Study Group. Effect of screening on oral can-cer mortality in Kerala, India: a cluster-randomisedcontrolled trial. Lancet. 2005;365:1927−1933.

14. Siewert JR, Böttcher K, Stein HJ, Roder JD. Relevantprognostic factors in gastric cancer: ten-year results ofthe German Gastric Cancer Study. Ann Surg.1998;228:449−461.

15. Nakamura K, Ueyama T, Yao T, Xuan ZX, Ambe K, AdachiY, Yakeishi Y, Matsukuma A, Enjoji M. Pathology andprognosis of gastric carcinoma. Findings in 10,000patients who underwent primary gastrectomy. Cancer.1992;70:1030−1037.

16. Compton CC, Greene FL. The staging of colorectal can-cer: 2004 and beyond. CA Cancer J Clin. 2004;54:295−308.

17. Soetikno RM, Kaltenbach T, Rouse RV, Park W,Maheshwari A, Sato T, Matsui S, Friedland S. Prevalenceof nonpolypoid (flat and depressed) colorectal neo-plasms in asymptomatic and symptomatic adults.JAMA. 2008;299:1027−1035.

18. Zhang BH, Yang BH, Tang ZY. Randomized controlled trialof screening for hepatocellular carcinoma. J Cancer ResClin Oncol. 2004;130:417−422.

19. Chen JG, Parkin DM, Chen QG, Lu JH, Shen QJ, ZhangBC, Zhu YR. Screening for liver cancer: results of a ran-domised controlled trial in Qidong, China. J MedScreen. 2003;10:204−209.

20. Chang MH, You SL, Chen CJ, Liu CJ, Lee CM, Lin SM, ChuHC, Wu TC, Yang SS, Kuo HS, Chen DS; TaiwanHepatoma Study Group. Decreased incidence of hepa-tocellular carcinoma in hepatitis B vaccinees: a 20-yearfollow-up study. J Natl Cancer Inst. 2009;101:1348−1355.

21. Jänne PA, Freidlin B, Saxman S, Johnson DH, LivingstonRB, Shepherd FA, Johnson BE. Twenty-five years of clin-ical research for patients with limited-stage small celllung carcinoma in North America. Cancer.2002;95:1528−1538.

22. World Health Organization. International Agency forResearch on Cancer. IARC Handbook of CancerPrevention, Volume 7. Breast Cancer Screening.IARCPress, Lyon, 2002.

23. Early Breast Cancer Trialists' Collaborative Group(EBCTCG). Effects of chemotherapy and hormonal ther-

Chapter 32

266



267

apy for early breast cancer on recurrence and 15-yearsurvival: an overview of the randomised trials. Lancet.2005;365:1687−1717.

24. Denny L, Kuhn L, De Souza M, Pollack AE, Dupree W,Wright TC Jr. Screen-and-treat approaches for cervicalcancer prevention in low-resource settings: a random-ized controlled trial. JAMA. 2005;294:2173−2181.

25. Sankaranarayanan R, Nene BM, Shastri SS, Jayant K,Muwonge R, Budukh AM, Hingmire S, Malvi SG, ThoratR, Kothari A, Chinoy R, Kelkar R, Kane S, Desai S, KeskarVR, Rajeshwarkar R, Panse N, Dinshaw KA. HPV screen-ing for cervical cancer in rural India. N Engl J Med.2009;360:1385−1394.

26. Qiao YL, Sellors JW, Eder PS, Bao YP, Lim JM, Zhao FH,Weigl B, Zhang WH, Peck RB, Li L, Chen F, Pan QJ,Lorincz AT. A new HPV-DNA test for cervical-cancerscreening in developing regions: a cross-sectional studyof clinical accuracy in rural China. Lancet Oncol.2008;9:929−936.

27. Sankaranarayanan R, Esmy PO, Rajkumar R, Muwonge R,Swaminathan R, Shanthakumari S, Fayette JM, CherianJ. Effect of visual screening on cervical cancer inci-dence and mortality in Tamil Nadu, India: a cluster-ran-domized trial. Lancet. 2007;370:398−406.


Table 1. An overview of follow-up methods practised by the registries and countries

Follow-up of incident cancer cases carried out by

Active method only Predominantly active Predominantly passive Passive method onlymethod method

ChinaQidong

PhilippinesManilaRizal

ThailandKhon Kaen

ChinaShanghaiTianjin

Costa Rica

Cuba

Saudi ArabiaRiyadh

Republic of KoreaBusanIncheonSeoul

ThailandLampang

ChinaHong Kong SAR

Singapore

The Gambia

IndiaBarshiBhopalChennaiKarunagappallyMumbai

PakistanSouth Karachi

ThailandChiang MaiSongkhla

TurkeyIzmir

UgandaKampala

ZimbabweHarare

Chapter 32

268


Table 2. Major cancer sites/types by number of registries and countries reported

Major cancer site/type ICD-10 code Number of registries Number of countries

Tongue

Oral cavity

Tonsil

Nasopharynx

Hypopharynx

Oesophagus

Stomach

Colon

Rectum

Liver

Gall bladder

Pancreas

Nose/Sinuses

Larynx

Lung

Bone

Skin melanoma

Skin others

Mesothelioma

Kaposi sarcoma

Connective tissue

Breast

Cervix uteri

Corpus uteri

Ovary

Penis

Prostate

Testis

Kidney/Renal pelvis

Bladder

Eye

Brain & nervous

Thyroid

Adrenal/Other endocrine

Hodgkin lymphoma

Non-Hodgkin lymphoma

Multiple myeloma

Lymphoid leukaemia

Myeloid leukaemia

C01-02

C03-06

C09-10

C11

C12-13

C15

C16

C18

C19-20

C22

C23-24

C25

C30-31

C32

C33-34

C40-41

C43

C44

C45

C46

C47; C49

C50

C51

C54

C56

C60

C61

C62

C64-66

C67

C69

C70-72

C73

C74

C81

C82-85; C96

C90

C91

C92-94

18

19

14

14

15

18

19

19

22

15

11

14

11

20

19

11

12

13

5

2

11

26

24

11

19

11

14

9

12

19

7

12

13

7

16

22

11

16

17

7

7

7

6

5

7

8

10

11

7

4

5

4

8

8

4

5

5

3

2

4

13

12

4

8

5

6

5

5

8

4

5

6

3

8

10

6

6

6


269


Table 3. Comparison of 5-year age-standardized relative survival of major cancer sites/types between all registries

5-year age-standardized relative survival (0-74 years), %

Cancer site/type China Costa Rica Cuba The Gambia

Hong Kong SAR Qidong Shanghai Tianjin

1996−2001 1992−2000 1992−1995 1991−1999 1995−2000 1994−1995 1993−1997

TongueOral cavityTonsilOropharynxNasopharynxHypopharynxOesophagusStomachColonRectumLiverGall bladderPancreasNose/SinusesLarynxLungBoneSkin melanomaSkin othersMesotheliomaKaposi sarcomaConnective tissueBreastCervix uteriCorpus uteriOvaryPenisProstateTestisKidneyRenal pelvisUreterBladderEyeBrain & nervousThyroidAdrenal glandHodgkin lymphomaNon-Hodgkin lymphomaMultiple myelomaLymphoid leukaemiaMyeloid leukaemiaUnspecified leukaemia

64.064.547.8$

74.024.126.441.563.263.4#

24.629.719.970.273.425.170.161.7

100.138.1

66.589.679.585.167.386.878.292.170.5@

81.251.948.795.171.2+

87.464.737.859.142.336.8

43.8

36.4

6.120.142.134.55.4

17.56.7

22.348.76.4

15.226.637.3

36.258.347.962.235.1

36.3

26.7

47.3

11.176.8

13.410.95.46.07.1

66.970.962.1

57.631.020.636.054.051.09.8

21.09.5

52.467.218.034.061.785.9

62.979.463.586.947.990.754.281.760.371.273.074.579.151.191.269.577.645.628.130.430.014.6

68.269.268.3

57.682.340.344.261.958.125.850.331.061.669.732.329.862.886.758.1

78.785.670.591.364.479.068.476.465.793.977.981.1

100.349.589.169.281.953.246.164.968.022.0

69.653.5

38.943.751.255.8

46.450.7

58.1

70.456.3

68.8

57.550.3

2.8

3.2

19.7

12.521.8

25.5

$ includes oropharynx; # includes anus; @ includes renal pelvis; + includes other endocrine

Chapter 32

270


Table 3 (Continued).


Cancer site/type India Pakistan Philippines Saudi SingaporeArabia

Barshi Bhopal Chennai Karuna- Mumbai South Manila Rizal Riyadhgappally Karachi

1993-00 1991-95 1990-99 1991-97 1992-99 1995-99 1994-95 1996-97 1994-96 1993-97

TongueOral cavityTonsilOropharynxNasopharynxHypopharynxOesophagusStomachColonRectumLiverGall bladderPancreasNose/SinusesLarynxLungBoneSkin melanomaSkin othersMesotheliomaKaposi sarcomaSoft tissue sarcomaBreastCervix uteriCorpus uteriOvaryPenisProstateTestisKidneyRenal pelvisUreterBladderEyeBrain & nervousThyroidAdrenal glandHodgkin lymphomaNon-Hodgkin lymphomaMultiple myelomaLymphoid leukaemiaMyeloid leukaemiaUnspecified leukaemia

11.826.1

10.05.36.0

14.70.0

15.75.3

75.3

52.735.7

64.1

25.9

19.5

23.436.715.620.7

15.08.6

10.3

8.7

38.07.1

47.759.6

28.5

32.0

37.823.2

16.414.911.2

29.736.016.620.424.723.116.215.230.331.1

15.2

36.013.4

51.646.4

22.953.342.356.235.2

45.6

52.237.1

15.515.27.1

39.340.932.3

43.530.6

55.037.4

39.7

44.349.244.7

59.211.912.127.452.552.16.5

18.34.8

50.465.79.3

38.544.595.211.4

57.176.465.779.662.474.864.388.255.043.9

71.9

29.691.232.175.452.026.042.922.612.9

64.5

13.137.5

2.03.63.85.26.5

15.71.0

30.634.5

18.9

9.7

9.9

12.614.2

29.645.3

15.518.54.1

32.64.5

4.3

28.37.8

83.7

54.457.8

27.8

32.6

48.4

16.290.0

39.813.445.68.2



271

Table 3 (Continued).

TongueOral cavityTonsilOropharynxNasopharynxHypopharynxOesophagusStomachColonRectumLiverGall bladderPancreasNose/SinusesLarynxLungBoneSkin melanomaSkin othersMesotheliomaKaposi sarcomaConnective tissueBreastCervix uteriCorpus uteriOvaryPenisProstateTestisKidneyRenal pelvisUreterBladderEyeBrain & nervousThyroidAdrenal glandHodgkin lymphomaNon-Hodgkin lymphomaMultiple myelomaLymphoid leukaemiaMyeloid leukaemiaUnspecified leukaemia

52.848.457.920.953.223.520.546.557.057.310.021.87.4

39.358.913.739.748.189.417.0

40.880.675.874.354.573.059.572.264.154.668.172.859.337.593.032.3+

76.949.014.532.727.56.1

59.651.658.342.847.131.322.849.265.761.520.330.317.150.975.619.739.849.592.640.8

55.778.679.281.762.277.570.293.970.371.157.579.558.138.994.431.676.358.032.038.526.316.8

32.441.9

34.6

44.342.8

26.5

65.653.9

58.1

59.7

67.739.3

33.237.243.4

39.932.826.820.439.436.811.918.515.050.749.112.119.946.285.4

52.663.363.374.446.373.158.361.129.028.0

49.5

43.473.1

56.444.3

44.135.012.9

31.435.313.5

47.424.09.98.8

52.831.92.5

14.415.925.944.68.6

27.553.876.6

32.062.461.372.548.764.632.7

37.0

45.9

31.186.9

55.947.732.336.515.417.0

52.252.0

71.4

77.263.5

59.7

70.7

65.850.631.150.134.2

12.322.828.630.33.7

29.711.4

77.4

4.4

57.839.1

34.0

37.269.9

46.526.0

0.0

3.00.08.2

10.11.4

0.0

35.6

45.813.1

8.6

47.2

35.7

10.8

25.1

52.054.448.4

53.638.325.950.057.457.616.825.314.263.461.620.646.971.585.4

55.678.579.572.358.7

69.498.367.972.391.076.1

41.092.678.482.857.429.040.336.0

24.322.030.6

41.530.06.4

12.132.530.43.36.4

10.630.828.04.88.5

23.359.2

44.657.360.064.444.736.735.0

23.1

33.2

16.465.4

73.128.1

15.410.911.0


Cancer site/type Republic of Korea Thailand Turkey Uganda Zimbabwe

Busan Incheon Seoul Chiang Khon Lampang Songkhla Izmir Kampala Harare$

Mai Kaen

1996-01 1997-01 1993-97 1993-97 1993-97 1990-00 1990-99 1995-97 1993-97 1993-97

$ all races together; + includes other endocrine glands

Chapter 32

272


Table 4a. Frequency and 5-year absolute survival by clinical extent of disease for all registries: cancer of the tongue

Country/ Period of Frequency (%) 5-year absolute survival (%)

registry registration L R D U L R D U

Cuba

IndiaBhopalChennaiKarunagappallyMumbai


Singapore

ThailandLampangSongkhla

1994−1995

1991−19951990−19991991−19971992−1999

1995−1999

1993−1997

1990−20001990−1999

35.5

39.44.4

30.230.5

37.8

25.8

23.619.9

39.8

55.986.847.758.4

50.6

25.0

68.430.6

2.2

0.02.6

10.57.1

0.6

4.2

4.07.1

22.5

4.76.2

11.64.1

11.0

45.0

4.042.3

46.7

16.059.248.758.4

57.4

48.4

32.640.0

27.3

5.617.315.412.0

11.7

23.3

36.227.9

20.0

-15.40.00.0

0.0

20.0

0.026.0

16.8

0.014.747.429.1

47.6

33.1

33.326.0

L: localized; R: regional; D: distant metastasis; U: unknown

Table 4b. Frequency and 5-year absolute survival by clinical extent of disease for all registries: cancer of the oral cavity



Cuba



Singapore

ThailandLampang

1994−1995

1991−19951990−19991991−19971992−1999

1995−1999

1993−1997

1990−2000

44.2

40.73.5

14.632.6

36.3

28.1

21.2

34.6

55.888.765.955.8

53.0

22.2

66.1

0.4

0.62.7

12.26.9

0.5

1.5

4.2

20.8

2.95.07.34.6

10.2

48.1

8.5

52.6

45.754.983.062.5

58.3

52.2

35.6

22.2

17.730.028.518.0

18.6

26.3

30.7

0.0

0.010.00.01.1

-

0.0

0.0

24.4

20.030.938.235.5

18.3

28.9

40.0



273


Table 4c. Frequency and 5-year absolute survival by clinical extent of disease for all registries: cancer of the larynx



Cuba

IndiaChennaiKarunagappallyMumbai

Singapore

ThailandChiang MaiLampangSongkhla

TurkeyIzmir

1994−1995

1990−19991991−19971992−1999

1993−1997

1993−19971990−20001990−1999

1995−1997

51.3

6.630.433.2

35.7

11.817.321.0

32.1

23.0

85.545.751.1

12.2

82.461.739.9

23.0

1.3

3.613.09.7

2.3

3.87.48.7

7.5

24.5

4.310.96.1

49.8

2.013.630.4

37.4

65.5

44.355.657.1

63.6

52.453.459.5

74.8

34.5

30.319.016.5

28.6

21.431.631.9

45.1

10.0

-0.00.5

14.3

16.725.042.4

47.6

22.2

34.1-

23.2

41.8

0.045.521.9

65.8


Table 4d. Frequency and 5-year absolute survival by clinical extent of disease for all registries: cancer of the colon



Cuba

IndiaBhopalMumbai

PhilippinesManila

Singapore

ThailandChiang MaiLampang

TurkeyIzmir

1994−1995

1991−19951992−1999

1994−1995

1993−1997

1993−19971990−2000

1995−1997

28.0

37.538.7

33.8

27.0

1.38.4

8.9

20.3

27.126.7

33.1

22.4

65.844.2

43.7

9.6

18.825.9

17.9

18.8

31.633.7

19.9

42.1

16.78.7

15.2

31.9

1.313.7

27.5

64.7

11.151.8

68.9

66.5

66.760.0

59.8

45.0

7.719.1

34.3

43.2

40.856.8

54.1

20.5

0.01.6

0.0

6.6

6.02.1

20.8

14.6

0.027.5

29.2

40.6

0.037.5

43.0


Chapter 32

274


Table 4e. Frequency and 5-year absolute survival by clinical extent of disease for all registries:cancer of the rectum



Cuba

IndiaBhopalMumbai

PhilippinesManila

Singapore

ThailandChiang MaiLampang

TurkeyIzmir

1994−1995

1991−19951992−1999

1994−1995

1993−1997

1993−19971990−2000

1995−1997

38.8

41.046.2

34.0

30.2

3.79.2

14.2

25.4

33.326.0

27.2

27.0

74.259.8

40.8

7.2

15.420.3

15.5

16.8

20.017.7

21.2

28.6

10.37.5

23.3

25.9

2.113.3

23.8

58.5

12.546.5

56.0

61.6

71.442.3

51.8

38.0

7.719.8

26.4

44.9

31.241.8

50.3

25.0

0.01.6

-

6.6

5.94.5

20.4

27.7

0.032.4

23.1

41.9

..48.5

49.2


Table 4f. Frequency and 5-year absolute survival by clinical extent of disease for all registries:cancer of the breast



ChinaHong Kong SAR

Costa Rica

Cuba


PhilippinesManilaRizal

Saudi ArabiaRiyadh

Singapore

ThailandChiang MaiKhon KaenLampangSongkhla

TurkeyIzmir

1996−2001

1995−2000

1994−1995

1991−19951990−19991991−19971992−1999

1994−19951996−1997

1994−1996

1993−1997

1993−19971993−19971990−20001990−1999

1995−1997

12.2

31.2

43.5

42.91.7

18.439.6

31.617.5

30.9

30.6

14.35.3

22.517.1

20.5

34.6

34.0

33.3

44.167.953.241.5

46.543.7

32.6

22.5

70.041.652.934.7

34.3

1.5

20.3

4.9

5.713.012.112.8

12.89.9

20.8

4.8

11.921.114.214.4

4.7

51.7

14.5

18.3

7.317.516.36.2

9.228.9

15.7

42.1

3.832.010.433.8

40.5

94.9

89.9

81.6

41.170.878.674.2

73.565.3

70.4

85.9

79.382.384.182.8

85.5

79.1

77.1

58.9

22.648.943.132.8

42.035.0

55.7

66.3

63.766.965.266.2

65.4

31.8

31.0

30.2

0.012.37.83.8

3.211.9

56.7

18.8

24.832.88.2

27.0

35.1

82.7

29.9

43.3

42.146.653.448.1

42.234.8

62.3

71.2

49.467.982.559.6

72.3



275


Table 4g. Frequency and 5-year absolute survival by clinical extent of disease for all registries: cancer of the cervix



Costa Rica

Cuba


PhilippinesManila

Singapore


TurkeyIzmir

1995−2000

1994−1995

1991−19951990−19991991−19971992−1999

1994−1995

1993−1997

1993−19971993−19971990−20001990−1999

1995−1997

22.4

41.3

28.36.4

15.327.9

21.5

45.5

26.117.331.222.3

41.8

40.5

34.3

70.586.060.656.8

30.5

5.7

69.753.853.954.6

41.8

4.0

1.7

0.33.78.88.6

10.3

5.0

3.76.35.85.8

6.1

33.1

22.7

0.93.9

15.36.7

37.7

43.8

0.522.69.2

17.3

23.2

89.5

73.9

60.669.172.168.3

63.1

69.7

81.265.178.781.2

67.7

43.1

41.5

22.755.343.535.7

29.9

48.0

52.748.757.956.3

54.6

11.3

33.3

0.012.423.13.4

7.1

20.4

12.230.66.5

15.4

9.3

43.2

45.0

0.043.444.340.7

28.2

55.7

75.057.070.661.3

69.1


Table 4h. Frequency and 5-year absolute survival by clinical extent of disease for all registries: cancer of the ovary




Singapore


TurkeyIzmir

1991−19951990−19991991−19971992−1999

1993−1997

1993−19971993−19971990−20001990−1999

1995−1997

66.71.5

17.128.6

45.7

24.129.622.824.3

22.6

8.762.511.411.4

3.9

43.821.434.728.9

5.2

13.019.454.349.9

19.8

30.229.630.112.7

47.4

11.616.617.110.1

30.6

1.919.412.434.1

24.8

21.773.4

100.059.7

83.3

88.288.886.292.1

89.4

33.330.80.0

27.5

35.4

48.360.656.630.0

51.1

0.06.08.83.0

24.5

16.917.50.0

19.8

33.6

12.538.144.426.4

55.2

0.066.675.043.0

62.3


Chapter 32

276


Tabl

e 5.

Cla

ssifi

catio

n of

hea

lth s

ervi

ces

deve

lopm

ent b

ased

on

a fe

w in

dica

tors

A. W

ell

deve

lope

d

Hon

g Ko

ng S

AR

Saud

i Ara

bia

Sing

apor

e

Repu

blic

of

Kore

a

Turk

ey

9220

-34

760

31 4

20

15 5

00

34 7

60

21 5

30

9340

Adeq

uate

Adeq

uate

Adeq

uate

Adeq

uate

Adeq

uate

Adeq

uate

Rou

tine

lyav

aila

ble

Exis

t

No

Exis

t

Exis

t

Exis

t

7.0

24.6

4.8

48.6

73.9

87-9

9

95 78 94 99 87

Adeq

uate

lyav

aila

ble;

wid

ely

dist

ribu

ted

Adeq

uate

lyav

aila

ble;

wid

ely

dist

ribu

ted

Exte

nsiv

ely

avai

labl

e;w

idel

y di

stri

bute

d

Exte

nsiv

ely

avai

labl

e;w

idel

y di

stri

bute

d

Adeq

uate

lyav

aila

ble;

wid

ely

dist

ribu

ted

MeV

: 9

Adeq

uate

lyav

aila

ble;

wid

ely

dist

ribu

ted

Exte

nsiv

ely

avai

labl

e an

dw

idel

y di

stri

bute

d

Exte

nsiv

ely

avai

labl

e; w

idel

ydi

stri

bute

d

Adeq

uate

and

wid

ely

dist

ribu

ted

Exte

nsiv

ely

avai

labl

e; w

idel

ydi

stri

bute

d

Exte

nsiv

ely

avai

labl

e; w

idel

y di

stri

bute

dM

eV:

10

Exte

nsiv

ely

avai

labl

e; w

idel

y di

stri

bute

dM

eV:

69Adeq

uate

and

wid

ely

dist

ribu

ted

MeV

: 27

* G

NI:

Gro

ss N

atio

nal

Inco

me

per

capi

ta 2

008,

Atl

as m

etho

d. W

orld

Dev

elop

men

t In

dica

tors

Dat

abas

e, W

orld

Ban

k, 7

, 20

09.

http

://w

eb.w

orld

bank

.org

/WBS

ITE/

EXTE

RNA

L/D

ATA

STAT

ISTI

CS/0

,,co

nten

tMD

K:20

5352

85~m

enuP

K:11

9269

4~pa

gePK

:641

3315

0~pi

PK:6

4133

175~

theS

iteP

K:23

9419

,00.

htm

l$W

orld

Hea

lth

Stat

isti

cs 2

008

(WH

O);

UN

DP

Repo

rt 2

009,

Pg

171;

MeV

: M

egav

olt

mac

hine

s to

tal

Ove

rall

grad

ing

ofhe

alth

ser

vice

s de

velo

pmen

t -

Coun

trie

s/ r

egio

ns

GN

I*(i

n U

SD)

Popu

lati

on*

(mill

ions

)A

dult

lit

erac

y$

(%)

Dia

gnos

tic

serv

ices

Trea

tmen

t se

rvic

esPo

pula

tion

-ba

sed

scre

enin

g se

rvic

es

Palli

ativ

e se

rvic

esIm

agin

gPa

thol

ogy

Radi

atio

n(M

eV)a-

c

Surg

ery

Chem

o

Exte

nsiv

ely

or a

dequ

atel

y av

aila

ble

and

wid

ely

dist

ribu

ted

Sour

ce:

a Ta

tsuz

aki

and

Levi

n (2

001)

. Ra

diot

hera

py a

nd O

ncol

ogy;

60:

81−

89b

Zubi

zarr

eta,

Poi

tevi

n an

d Le

vin

(200

4).

Radi

othe

rapy

and

Onc

olog

y; 7

3: 9

7 −10

0c

Levi

n, G

uedd

ari

and

Meg

hzif

ene

(199

9).

Radi

othe

rapy

and

Onc

olog

y; 5

2: 7

9 −84

.


277


Tabl

e 5.

Cla

ssifi

catio

n of

hea

lth s

ervi

ces

deve

lopm

ent b

ased

on

a fe

w in

dica

tors

(con

tinue

d)

B. M

oder

atel

yde

velo

ped

Chin

a (M

ainl

and)

Cost

a Ri

ca

Cuba

Indi

a

Paki

stan

Phili

ppin

es

Thai

land

980-

6060

2940

6060

>385

6

1070

980

1890

2840

Vari

ably

deve

lope

d

Adeq

uate

in

urba

n;

inad

equa

te i

nru

ral

Adeq

uate

Adeq

uate

in

urba

n;

inad

equa

te i

nru

ral

Adeq

uate

in

urba

n;

inad

equa

te i

nru

ral

Adeq

uate

Adeq

uate

Not

rou

tine

lyav

aila

ble

Avai

labl

e in

sele

cted

met

ropo

litan

area

s

Avai

labl

e

No

No

No

Avai

labl

e

1325

.6

4.5

11.2

1140

.0

166.

0

90.3

67.4

50-9

9

91 95 99 61 50 93 93

Adeq

uate

in

urba

n;

inad

equa

te i

nru

ral

Adeq

uate

lyav

aila

ble;

Adeq

uate

Adeq

uate

in

met

ropo

litan

area

s; n

ot i

not

hers

Adeq

uate

Adeq

uate

ly

avai

labl

e;

Exte

nsiv

e

Adeq

uate

in

urba

n;

inad

equa

te i

nru

ral

Adeq

uate

in

urba

n; i

nade

-qu

ate

in r

ural

MeV

: 66

7

Adeq

uate

lyav

aila

ble;

MeV

: 6

Adeq

uate

MeV

: 12

Adeq

uate

in

met

ropo

litan

area

s; n

ot i

not

hers

MeV

: 29

1

Adeq

uate

in

urba

n;

inad

equa

te i

n ru

ral

Adeq

uate

in

urba

n;

inad

equa

te i

n ru

ral

Adeq

uate

ly a

vaila

ble;

w

idel

y di

stri

bute

d Adeq

uate

in

urba

n; i

nade

quat

e in

rur

alM

eV:

34

Ove

rall

grad

ing

ofhe

alth

ser

vice

s de

velo

pmen

t -

Coun

trie

s/ r

egio

ns

GN

I*(i

n U

SD)

Popu

lati

on*

(mill

ions

)A

dult

lit

erac

y$

(%)

Dia

gnos

tic

serv

ices

Trea

tmen

t se

rvic

esPo

pula

tion

-ba

sed

scre

enin

g se

rvic

es

Palli

ativ

e se

rvic

esIm

agin

gPa

thol

ogy

Radi

atio

n(M

eV)a-

c

Surg

ery

Chem

o

Vari

ably

dev

elop

ed e

ven

betw

een

urba

n ar

eas;

ina

dequ

ate

in r

ural

Adeq

uate

Adeq

uate

Adeq

uate

in

met

ropo

litan

area

s; n

ot i

not

hers

Adeq

uate

in

urba

n;

inad

equa

te i

nru

ral

Adeq

uate

in

urba

n; i

nade

quat

e in

rur

alM

eV:

17

Adeq

uate

in

urba

n; i

nade

quat

e in

rur

alM

eV:

50

* G

NI:

Gro

ss N

atio

nal

Inco

me

per

capi

ta 2

008,

Atl

as m

etho

d. W

orld

Dev

elop

men

t In

dica

tors

Dat

abas

e, W

orld

Ban

k, 7

, 20

09.

http

://w

eb.w

orld

bank

.org

/WBS

ITE/

EXTE

RNA

L/D

ATA

STAT

ISTI

CS/0

,,co

nten

tMD

K:20

5352

85~m

enuP

K:11

9269

4~pa

gePK

:641

3315

0~pi

PK:6

4133

175~

theS

iteP

K:23

9419

,00.

htm

l$W

orld

Hea

lth

Stat

isti

cs 2

008

(WH

O);

UN

DP

Repo

rt 2

009,

Pg

171;

MeV

: M

egav

olt

mac

hine

s to

tal

a Ta

tsuz

aki

and

Levi

n (2

001)

. Ra

diot

hera

py a

nd O

ncol

ogy;

60:

81−

89;

b Zu

biza

rret

a, P

oite

vin

and

Levi

n (2

004)

. Ra

diot

hera

py a

nd O

ncol

ogy;

73:

97−

100

c Le

vin,

Gue

ddar

i an

d M

eghz

ifen

e (1

999)

. Ra

diot

hera

py a

nd O

ncol

ogy;

52:

79 −

84.

Chapter 32

278


Tabl

e 5.

Cla

ssifi

catio

n of

hea

lth s

ervi

ces

deve

lopm

ent b

ased

on

a fe

w in

dica

tors

C. L

east

de

velo

ped

The

Gam

bia

Uga

nda

Zim

babw

e

390-

975

390

420

<975

Inad

equa

te

Inad

equa

te

Inad

equa

te

Inad

equa

te

No

No

No

No

1.7

31.7

12.5

69-8

9

n.a. 67 89

Not

wid

ely

dist

ribu

ted

Inad

equa

te

Adeq

uate

in

capi

tal;

in

adeq

uate

in

othe

rs

Avai

labl

e in

capi

tal

city

Adeq

uate

in

capi

tal

city

Adeq

uate

in

capi

tal;

in

adeq

uate

in

othe

rs

Not

ava

ilabl

e

Avai

labl

e in

capi

tal

city

MeV

: 2

Adeq

uate

in

capi

tal;

ina

de-

quat

e in

oth

ers

MeV

: 5

Inad

equa

tely

dev

elop

ed

* G

NI:

Gro

ss N

atio

nal

Inco

me

per

capi

ta 2

008,

Atl

as m

etho

d. W

orld

Dev

elop

men

t In

dica

tors

Dat

abas

e, W

orld

Ban

k, 7

, 20

09.

http

://w

eb.w

orld

bank

.org

/WBS

ITE/

EXTE

RNA

L/D

ATA

STAT

ISTI

CS/0

,,co

nten

tMD

K:20

5352

85~m

enuP

K:11

9269

4~pa

gePK

:641

3315

0~pi

PK:6

4133

175~

theS

iteP

K:23

9419

,00.

htm

l$W

orld

Hea

lth

Stat

isti

cs 2

008

(WH

O);

UN

DP

Repo

rt 2

009,

Pg

171;

MeV

: M

egav

olt

mac

hine

s to

tal

Ove

rall

grad

ing

ofhe

alth

ser

vice

s de

velo

pmen

t -

Coun

trie

s/ r

egio

ns

GN

I*(i

n U

SD)

Popu

lati

on*

(mill

ions

)A

dult

lit

erac

y$

(%)

Dia

gnos

tic

serv

ices

Trea

tmen

t se

rvic

esSc

reen

ing

serv

ices

Palli

ativ

e se

rvic

esIm

agin

gPa

thol

ogy

Radi

atio

n(M

eV)a-

c

Surg

ery

Chem

o

Inad

equa

tely

dev

elop

ed a

nd n

ot w

idel

ydi

stri

bute

d

Inad

equa

te a

ndno

t w

idel

y di

stri

bute

d

Inad

equa

te

Adeq

uate

in

capi

tal;

in

adeq

uate

in

othe

rs

Not

ava

ilabl

e

Avai

labl

e in

capi

tal

city

Adeq

uate

in

capi

tal;

in

adeq

uate

in

othe

rs

Sour

ce:

a Ta

tsuz

aki

and

Levi

n (2

001)

. Ra

diot

hera

py a

nd O

ncol

ogy;

60:

81−

89b

Zubi

zarr

eta,

Poi

tevi

n an

d Le

vin

(200

4).

Radi

othe

rapy

and

Onc

olog

y; 7

3: 9

7 −10

0c

Levi

n, G

uedd

ari

and

Meg

hzif

ene

(199

9).

Radi

othe

rapy

and

Onc

olog

y; 5

2: 7

9 −84

.


279


Figure 1. 5-year age-standardized relative survival (ASRS%; 0-74 years) by country and cancer site/type(median {minimum-maximum} of values if more than one registry is contributing)

0 20 40 60 80 100

India

Thailand

Cuba

Pakistan

Singapore

Republic of Korea

China

Median 5-year ASR% (0-74 years) value {Range}

{64-68}

{52-59}

{24-33}

{11-29}

0 20 40 60 80 100

Thailand

India

Pakistan

Cuba

Singapore

Republic of Korea

China


{43-70}

{48-54}

{26-45}

{22-41}

0 20 40 60 80 100

India

Thailand

Pakistan

Singapore

Cuba

Republic of Korea

China


{47-68}

{48-58}

{13-43}

{15-16}

0 20 40 60 80 100

India

Thailand

Republic of Korea

China

Singapore


{36-74}

{47-53}

{34-47}

0 20 40 60 80 100

Singapore

India

Thailand

China

Republic of Korea


{23-38}

{24-82}

{24-32}

{02-23}

0 20 40 60 80 100

Uganda

India

Thailand

Singapore

Zimbabwe

Republic of Korea

China


{06-40}

{20-25}

{06-26}

{03-18}

Figure 1a. Tongue Figure 1d. Nasopharynx

Figure 1e. HypopharynxFigure 1b. Oral cavity

Figure 1c. Tonsil Figure 1f. Oesophagus

Chapter 32

280


Figure 1 (Continued).

0 20 40 60 80 100

Uganda

The Gambia

India

Thailand

Zimbabwe

Singapore

China

Republic of Korea


{46-50}

{20-44}

{08-20}

{03-15}

0 20 40 60 80 100

Uganda

India

Zimbabwe

Thailand

Philippines

Cuba

Turkey

Singapore

Republic of Korea

China


{42-63}

{57-65}

{32-52}

{5-30}

0 20 40 60 80 100

Uganda

India

Zimbabwe

Philippines

Thailand

Cuba

Turkey

Singapore

China

Republic of Korea


{57-61}

{34-63}

{30-42}

{6-32}

0 20 40 60 80 100

Uganda

India

The Gambia

Thailand

Zimbabwe

Singapore

Republic of Korea

China


{05-25}

{10-20}

{02-11}

{00-04}

0 20 40 60 80 100

India

Zimbabwe

Thailand

Cuba

Republic of Korea

Singapore

China

Turkey


{48-73}

{58-75}

{26-49}

{15-38}

0 20 40 60 80 100

Uganda

India

Thailand

Singapore

Zimbabwe

The Gambia

Republic of Korea

China


{06-21}

{13-20}

{04-12}

{01-13}

Figure 1g. Stomach Figure 1j. Liver

Figure 1k. LarynxFigure 1h. Colon

Figure 1i. Rectum Figure 1l. Lung


281



0 20 40 60 80 100

Thailand

India

China

Republic of Korea

Singapore


{85-92}

{37-100}

{75-83}

{59-85}

0 20 40 60 80 100

The Gambia

UgandaPhilippines

India

Zimbabwe

Thailand

Saudi ArabiaCosta Rica

Cuba

Singapore

TurkeyRepublic of Korea

China


{58-89}{78-80}

{57-65}

{30-54}{39-55}

0 20 40 60 80 100

Uganda

The Gambia

Philippines

Zimbabwe

India

Costa Rica

Cuba

Thailand

Turkey

Singapore

China

Republic of Korea


{75-79}

{47-79}

{53-63}

{34-59}

0 20 40 60 80 100

Uganda

India

Zimbabwe

Thailand

China

Republic of Korea

Turkey

Singapore


{54-62}

{44-58}

{35-61}

{18-28}

0 20 40 60 80 100

Thailand

India

Uganda

China

Singapore

Republic of Korea


{59-70}

{32-42}

{36-78}

{32-58}

0 20 40 60 80 100

Zimbabwe

India

Thailand

Cuba

Turkey

Singapore

Republic of Korea

China


{47-81}

{33-59}

{72-79}

{09-48}

Figure 1m. Non-melanoma skin Figure 1p. Ovary

Figure 1q. ProstateFigure 1n. Breast

Figure 1o. Cervix Figure 1r. Urinary bladder

Chapter 32

282



0 20 40 60 80 100

Uganda

Thailand

India

China

Singapore

Republic of Korea


y

{92-94}

{65-86}

{76-95}

0 20 40 60 80 100

India

Zimbabwe

Cuba

Thailand

Turkey

Singapore

Republic of Korea

China


{47-81}

{55-73}

{72-79}

{37-52}

0 20 40 60 80 100

Uganda

The Gambia

India

Zimbabwe

Thailand

China

Cuba

Turkey

Singapore

Republic of Korea


{49-58}

{28-47}

{13-64}

{09-39}

0 20 40 60 80 100

India

Thailand

Republic of Korea

Singapore

China

Turkey


{05-64}

{32-40}

{15-44}

{12-45}

0 20 40 60 80 100

India

Thailand

Singapore

Republic of Korea

Turkey

China


{06-68}

{26-36}

{10-35}

{08-19}

Figure 1s. Thyroid Figure 1v. Lymphoid leukaemia

Figure 1w. Myeloid leukaemiaFigure 1t. Hodgkin lymphoma

Figure 1u. Non-Hodgkin lymphoma


283


Figure 2. 5-year age-standardized relative survival (ASRS%; 0-74 years) of selected cancers by all registries (ranked on ASRS)

11.8

13.1

23.4

24.3

29.6

29.7

31.4

32.4

33.2

38.9

39.3

44.3

52.0

52.8

59.6

64.0

66.9

68.2

0 20 40 60 80 100

Barshi

Bhopal

Chennai

Chiang Mai

Karunagappally

Mumbai

Songkhla

Khon kaen

Lampang

Cuba

South Karachi

Singapore

Incheon

Busan

Seoul

Hong Kong SAR

Shanghai

Tianjin

5-year ASRS (0-74 years) %

22.0

26.1

35.3

36.0

36.7

37.2

37.5

40.9

41.9

43.7

43.8

45.3

48.4

49.2

51.6

54.4

64.5

69.2

70.9

0 20 40 60 80 100

Chiang Mai

Barshi

Songkhla

Mumbai

Chennai

Lampang

Bhopal

South Karachi

Khon Kaen

Cuba

Qidong

Karunagappally

Busan

Singapore

Seoul

Incheon

Hong Kong SAR

Tianjin

Shanghai


Figure 2a. Tongue (ICD-10: C01-C02)

Figure 2b. Oral cavity (ICD-10: C03-06)

0.0

24.7

34.6

36.4

39.9

41.5

47.1

47.4

53.2

53.6

57.6

59.2

74.0

0 20 40 60 80 100

Kampala

Mumbai

Khon Kaen

Qidong

Lampang

Chiang Mai

Seoul

Songkhla

Busan

Incheon

Shanghai &Tianjin

Singapore

Hong Kong SAR


2.0

10.0

11.9

15.0

15.5

23.1

23.5

24.0

24.1

30.0

31.0

31.3

32.8

38.3

82.3

0 20 40 60 80 100

Bhopal

Barshi

Singapore

Chennai

Karunagappally

Mumbai

Busan

Songkhla

Hong Kong SAR

Chiang Mai

Shanghai

Seoul

Lampang

Incheon

Tianjin


Figure 2c. Nasopharynx (ICD-10: C11)

Figure 2d. Hypopharynx (ICD-10: C12-13)

Chapter 32

284



3.0

3.6

5.3

6.1

6.4

8.6

9.9

12.1

12.3

16.2

18.5

20.5

20.6

22.8

25.9

26.4

26.8

40.3

0 20 40 60 80 100

Kampala

Bhopal

Barshi

Qidong

Chiang Mai

Chennai

Songkhla

Singapore

Harare

Mumbai

Karunagappally

Busan

Shanghai

Seoul

Incheon

Hong Kong SAR

Lampang

Tianjin


0.0

2.8

3.8

4.1

6.0

8.8

10.3

12.1

15.2

20.1

20.4

22.8

27.4

36.0

41.5

44.2

46.5

49.2

50.0

0 20 40 60 80 100

Kampala

The Gambia

Bhopal

Karunagappally

Barshi

Songkhla

Chennai

Chiang Mai

Mumbai

Qidong

Lampang

Harare

Singapore

Shanghai

Hong Kong SAR

Tianjin

Busan

Seoul

Incheon


Figure 2e. Oesophagus (ICD-10: C15)

Figure 2f. Stomach (ICD-10: C16)

5.2

8.2

28.6

30.3

32.5

39.4

42.1

43.5

44.3

46.4

52.2

52.5

52.8

54.0

57.0

57.4

61.9

63.2

65.7

0 20 40 60 80 100

Bhopal

Kampala

Harare

Mumbai

Chiang Mai

Lampang

Qidong

Manila

Khon Kaen

Cuba

Izmir

Singapore

Songkhla

Shanghai

Busan

Incheon

Tianjin

Hong Kong SAR

Seoul


6.5

10.1

14.7

30.3

30.4

30.6

31.1

31.9

32.6

34.5

36.8

42.8

50.7

51.0

52.0

52.1

57.3

57.6

58.1

61.5

63.4

0 20 40 60 80 100

Bhopal

Kampala

Barshi

Harare

Chiang Mai

Manila

Mumbai

Songkhla

Karunagappally

Qidong

Lampang

Khon Kaen

Cuba

Shanghai

Izmir

Singapore

Busan

Incheon

Tianjin

Seoul

Hong Kong SAR


Figure 2g. Colon (ICD-10: C18)

Figure 2h. Rectum (ICD-10: C19-20)


285



15.7

26.5

28.0

28.3

29.7

36.0

38.0

44.6

48.7

49.1

58.1

58.9

61.6

65.7

67.2

69.7

71.4

73.4

75.6

0 20 40 60 80 100

Barshi & Bhopal

Khon Kaen

Chiang Mai

Karunagappally

Harare

Mumbai

Chennai

Songkhla

Qidong

Lampang

Cuba

Busan

Incheon

Singapore

Shanghai

Tianjin

Izmir

Hong Kong SAR

Seoul


0.0

1.0

4.8

5.3

6.4

7.1

7.8

8.6

9.3

11.4

12.1

13.4

13.7

18.0

19.7

19.7

20.6

25.1

32.3

0 20 40 60 80 100

Kampala

Bhopal

Chiang Mai

Barshi

Qidong

Chennai

Karunagappally

Songkhla

Singapore

Harare

Lampang

Mumbai

Busan

Shanghai

Seoul

The Gambia

Incheon

Hong Kong SAR

Tianjin


Figure 2i. Larynx (ICD-10: C32)

Figure 2j. Lung (ICD-10: C33-34)

12.5

30.6

39.7

45.8

47.751.6

52.7

54.4

55.0

57.3

57.8

58.3

62.4

63.364.5

65.6

69.6

70.4

76.4

77.2

78.5

78.679.4

80.6

85.6

89.6

0 20 40 60 80 100

The Gambia

Bhopal

Rizal

Kampala

Chennai

Mumbai

Barshi

Karunagappally

Manila

Chiang Mai

Harare

Qidong

Songkhla

Lampang

Riyadh

Khon Kaen

Costa Rica

Cuba

Singapore

Izmir

Incheon

Seoul

Shanghai

Busan

Tianjin

Hong Kong SAR


13.1

21.8

34.5

35.7

37.4

39.1

46.4

47.9

53.5

53.9

56.3

57.8

59.6

60.0

61.3

63.3

63.5

65.7

70.5

75.8

79.2

79.5

0 20 40 60 80 100

Kampala

The Gambia

Bhopal

Barshi

Manila

Harare

Mumbai

Qidong

Costa Rica

Khon Kaen

Cuba

Karunagappally

Chennai

Chiang Mai

Songkhla

Lampang

Shanghai & Izmir

Singapore

Tianjin

Busan

Seoul

Hong Kong SAR & Incheon


Figure 2k. Breast (ICD-10: C50)

Figure 2l. Cervix uteri (ICD-10: C53)

Chapter 32

286



8.6

18.9

22.9

27.8

28.5

34.0

35.1

44.7

46.3

47.9

48.7

54.5

58.1

58.7

59.7

62.2

62.4

64.4

67.3

0 20 40 60 80 100

Kampala

Bhopal

Mumbai

Karunagappally

Chennai

Harare

Qidong

Chiang Mai

Lampang

Shanghai

Songkhla

Busan

Khon Kaen

Incheon

Izmir

Seoul

Singapore

Tianjin

Hong Kong SAR


32.6

32.7

35.0

36.3

42.3

47.2

54.2

58.3

59.5

64.3

68.4

69.4

70.2

78.2

0 20 40 60 80 100

Karunagappally

Songkhla

Chiang Mai

Qidong

Mumbai

Kampala

Shanghai

Lampang

Busan

Singapore

Tianjin

Incheon

Seoul

Hong Kong SAR


Figure 2m. Ovary (ICD-10: C56)

Figure 2n. Prostate (ICD-10: C61)

9.7

32.0

33.2

37.2

45.6

45.9

47.3

48.4

49.5

59.7

68.8

70.7

71.9

72.8

74.5

76.1

79.5

81.1

81.2

0 20 40 60 80 100

Bhopal

Chennai

Chiang Mai

Harare

Mumbai

Songkhla

Qidong

Karunagappally

Lampang

Khon Kaen

Cuba

Izmir

Singapore

Busan

Shanghai

Incheon

Seoul

Tianjin

Hong Kong SAR


37.8

46.5

52.2

55.9

56.4

57.5

65.8

67.7

73.1

75.4

76.3

76.9

77.6

81.9

82.8

87.4

0 20 40 60 80 100

Chennai

Harare

Mumbai

Songkhla

Lampang

Cuba

Izmir

Khon Kaen

Chiang Mai

Singapore

Seoul

Busan

Shanghai

Tianjin

Incheon

Hong Kong SAR


Figure 2o. Urinary bladder (ICD-10: C67)

Figure 2p. Hodgkin lymphoma (ICD-10: C81)


287



9.9

13.4

23.2

25.1

25.5

25.9

26.0

28.1

37.1

39.3

39.8

44.3

45.6

47.7

49.0

50.3

50.6

52.0

53.2

57.4

58.0

64.7

0 20 40 60 80 100

Bhopal

Qidong

Chennai

Kampala

The Gambia

Barshi

Harare

Chiang Mai

Mumbai

Khon Kaen

Karunagappally

Lampang

Shanghai

Songkhla

Busan

Cuba

Izmir

Singapore

Tianjin

Incheon

Seoul

Hong Kong SAR


5.4

12.6

15.4

15.5

16.4

30.4

32.7

36.5

38.5

40.3

42.9

44.1

45.6

50.1

59.1

64.9

0 20 40 60 80 100

Qidong

Bhopal

Chiang Mai

Mumbai

Chennai

Shanghai

Busan

Songkhla

Seoul

Incheon

Singapore

Lampang

Karunagappally

Izmir

Hong Kong SAR

Tianjin


Figure 2q. Non-Hodgkin lymphoma (ICD-10: C82-85; C96)

Figure 2r. Lymphoid leukaemia (ICD-10: C91)

6.0

8.2

10.9

14.2

14.9

15.2

15.4

19.5

22.6

26.3

27.5

30.0

34.2

35.0

36.0

42.3

68.0

0 20 40 60 80 100

Qidong

Karunagappally

Chiang Mai

Bhopal

Chennai

Mumbai

Songkhla

Barshi

Singapore

Seoul

Busan

Shanghai

Izmir

Lampang

Incheon

Hong Kong SAR

Tianjin


Figure 2s. Myeloid leukaemia (ICD-10: C92-94)

Chapter 32

288


Figure 3. Localized and regional extent of disease among more and less developed health services, larynx cancer

40.7

69.6

22.3

54.4

0 20 40 60 80 100

Regional

Localized

Survival %

Less developed health services - Thailand, India etc.

More developed health services (Singapore & Turkey)

Figure 3a. 5-year absolute survival

0

20

40

60

80

100

0 1 2 3 4 5Year

Sur

viva

l %Localized - more developedLocalized - less developedRegional - more developedRegional - less developed

60.025.019.034.0% cases

RegionalLocalizedRegionalLocalized

Less developedMore developed

Figure 3b. Absolute survival

Figure 4. Localized and regional extent of disease among more and less developed health services, large bowel cancer

45.7

64.1

32.0

49.8

0 20 40 60 80 100

Regional

Localized

Survival %

Less developed health services - Thailand, India, Philippines etc.



0

20

40

60

80

100

0 1 2 3 4 5Year

Surv

ival

%

Localized - more developedLocalized - less developedRegional - more developedRegional - less developed

34.029.027.026.0% cases





289


Figure 5. Localized and regional extent of disease among more and less developed health services, breast cancer

75.4

89.6

47.4

76.3

0 20 40 60 80 100

Regional

Localized

Survival %

Less developed health services - Thailand, India, Costa Rica etc.



0

20

40

60

80

100

0 1 2 3 4 5Year

Surv

ival

%


47.026.032.017.0% cases




Figure 6. Localized and regional extent of disease among more and less developed health services, cervix cancer

52.2

69.5

47.2

73.2

0 20 40 60 80 100

Regional

Localized

Survival %

Less developed health services - Thailand, India, Costa Rica etc.



0

20

40

60

80

100

0 1 2 3 4 5Year

Surv

ival

%


64.020.013.042.0% cases




Chapter 32

290


Figure 7. Localized and regional extent of disease among more and less developed health services, ovary cancer

39.7

84.1

34.5

63.8

0 20 40 60 80 100

Regional

Localized

Survival %




0

20

40

60

80

100

0 1 2 3 4 5Year

Surv

ival

%


27.022.04.040.0% cases




Figure 8. Localized and regional extent of disease among more and less developed health services, bladder cancer

34.8

61.3

24.9

43.8

0 20 40 60 80 100

Regional

Localized

Survival %




0

20

40

60

80

100

0 1 2 3 4 5Year

Surv

ival

%


33.042.07.053.0% cases





291


Figure 9. Survival among grouped countries with varied development of health services, Hodgkin lymphoma

73.6

47.1

45.4

0 20 40 60 80 100

Hodgkinlymphoma

Survival %Low- Zimbabwe, Uganda and The Gambia

Intermediate-Mainland China, Thailand, India, Cuba, etc.

High-Hong Kong SAR, Republic of Korea, Singapore and Turkey


0

20

40

60

80

100

0 1 2 3 4 5Year

Surv

ival

%

High Intermediate Low


Figure 10. Survival among grouped countries with varied development of health services, non-Hodgkin lymphoma

49.0

33.5

26.5

0 20 40 60 80 100

Non-Hodgkin

lymphoma

Survival %Low- Zimbabwe, Uganda and The Gambia

Intermediate-Mainland China, Thailand, India, Cuba, etc.

High-Hong Kong SAR, Republic of Korea, Singapore and Turkey


0

20

40

60

80

100

0 1 2 3 4 5Year

Surv

ival

%

High Intermediate Low


An overview of cancer survival in Africa, Asia, the ... · treatments and clinical follow-up care...

Documents

Transcript of An overview of cancer survival in Africa, Asia, the ... · treatments and clinical follow-up care...