Produção Nacional
Revisado por pares
Cancer survival: the CONCORD-2 study
2015; Elsevier BV; Volume: 386; Issue: 9992 Linguagem: Inglês
10.1016/s0140-6736(15)61441-6
ISSN1474-547X
AutoresRuffo Freitas‐Júnior, Leonardo Ribeiro Soares, Carlos H. Barrios,
Tópico(s)Cancer Risks and Factors
ResumoWe were surprised to read the findings of the CONCORD-2 study published in The Lancet (March 14, p 977),1Allemani C Weir HK Carreira H et al.the CONCORD Working GroupGlobal 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).Lancet. 2015; 385: 977-1010Summary Full Text Full Text PDF PubMed Scopus (421) Google Scholar specifically with respect to the 5-year cancer survival rate presented for the city of Goiânia, Brazil.1Allemani C Weir HK Carreira H et al.the CONCORD Working GroupGlobal 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).Lancet. 2015; 385: 977-1010Summary Full Text Full Text PDF PubMed Scopus (421) Google Scholar The net survival rate presented for patients diagnosed with breast cancer between 1995 and 1999 was 79·4%, 63·9% between 2000 and 2004, and 59·2% between 2005 and 2009.1Allemani C Weir HK Carreira H et al.the CONCORD Working GroupGlobal 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).Lancet. 2015; 385: 977-1010Summary Full Text Full Text PDF PubMed Scopus (421) Google Scholar We believe that these data might not be reliable since they do not accord with previous studies done with the Goiânia population-based cancer registry.2Abreu E Koifman RJ Fanqueiro AG Land MGP Koifman S Ten-year population-based female breast cancer survival in Goiânia (GO), Brazil, 1988–1990.Cad Saúde Colet. 2012; 20 (in Spanish).: 305-313Google Scholar, 3Coleman MP Quaresma M Berrino F et al.Cancer survival in five continents: a worldwide population-based study (CONCORD).Lancet Oncol. 2008; 9: 730-756Summary Full Text Full Text PDF PubMed Scopus (985) Google Scholar The temporal trends in 5-year overall survival rates from breast cancer for women living in the city of Goiânia have been evaluated in different studies using data from the Goiânia cancer registry (table). These studies included women diagnosed between 1988 and 1990 (57% survival rate),2Abreu E Koifman RJ Fanqueiro AG Land MGP Koifman S Ten-year population-based female breast cancer survival in Goiânia (GO), Brazil, 1988–1990.Cad Saúde Colet. 2012; 20 (in Spanish).: 305-313Google Scholar between 1990 and 1994 (65·4% survival rate),3Coleman MP Quaresma M Berrino F et al.Cancer survival in five continents: a worldwide population-based study (CONCORD).Lancet Oncol. 2008; 9: 730-756Summary Full Text Full Text PDF PubMed Scopus (985) Google Scholar and between 1995 and 2003 (72·1% survival rate; unpublished). This increase in overall survival rate between studies could have been related to improvements in local screening and early diagnosis of breast cancer, resulting in a reduction in the proportion of advanced cases in parallel with an increase in the proportion of early cases.4Nunes RD Martins E Freitas-Júnior R Curado MP Freitas NMA Oliveira JC Descriptive study of breast cancer cases in Goiânia between 1989 and 2003.Rev Col Bras Cir. 2011; 38: 212-216Crossref PubMed Scopus (9) Google Scholar, 5Corrêa RS Freitas Júnior R Peixoto JE et al.Estimated mammogram coverage in Goiás State, Brazil.Cad Saude Publica. 2011; 27: 1757-1767Crossref PubMed Scopus (15) Google Scholar The inclusion of new drugs and targeted therapies might also have contributed to the improvement in this outcome.TableTemporal trends in breast cancer 5-year survival in women living in the city of Goiânia, BrazilPeriod of timeOverall survival (%)Net survival*Net survival represents the cumulative probability that the patients with cancer would have survived at 5 years after diagnosis, in the hypothetical situation that the cancer was the only possible cause of death. It was interpreted as the proportion of patients with cancer who survive up to that time, after the elimination of other causes of death (background mortality).1 (%)Abreu et al (2012)2Abreu E Koifman RJ Fanqueiro AG Land MGP Koifman S Ten-year population-based female breast cancer survival in Goiânia (GO), Brazil, 1988–1990.Cad Saúde Colet. 2012; 20 (in Spanish).: 305-313Google Scholar1988–9057·0%..Coleman et al (2008)3Coleman MP Quaresma M Berrino F et al.Cancer survival in five continents: a worldwide population-based study (CONCORD).Lancet Oncol. 2008; 9: 730-756Summary Full Text Full Text PDF PubMed Scopus (985) Google Scholar1990–9465·4%..Freitas-Junior et al (unpublished)1995–200372·1%..Allemani et al (2015)1Allemani C Weir HK Carreira H et al.the CONCORD Working GroupGlobal 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).Lancet. 2015; 385: 977-1010Summary Full Text Full Text PDF PubMed Scopus (421) Google Scholar1995–99..79·4%Allemani et al (2015)1Allemani C Weir HK Carreira H et al.the CONCORD Working GroupGlobal 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).Lancet. 2015; 385: 977-1010Summary Full Text Full Text PDF PubMed Scopus (421) Google Scholar2000–04..63·9%Allemani et al (2015)1Allemani C Weir HK Carreira H et al.the CONCORD Working GroupGlobal 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).Lancet. 2015; 385: 977-1010Summary Full Text Full Text PDF PubMed Scopus (421) Google Scholar2005–09..59·2%Data for all studies were sourced from the Goiânia Population-Based Cancer Registry.* Net survival represents the cumulative probability that the patients with cancer would have survived at 5 years after diagnosis, in the hypothetical situation that the cancer was the only possible cause of death. It was interpreted as the proportion of patients with cancer who survive up to that time, after the elimination of other causes of death (background mortality).1Allemani C Weir HK Carreira H et al.the CONCORD Working GroupGlobal 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).Lancet. 2015; 385: 977-1010Summary Full Text Full Text PDF PubMed Scopus (421) Google Scholar Open table in a new tab Data for all studies were sourced from the Goiânia Population-Based Cancer Registry. The CONCORD-2 study1Allemani C Weir HK Carreira H et al.the CONCORD Working GroupGlobal 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).Lancet. 2015; 385: 977-1010Summary Full Text Full Text PDF PubMed Scopus (421) Google Scholar evaluated cancer-specific survival, in which the endpoint for the analysis of survival consisted exclusively of breast cancer-related death, with deaths related to other causes being censored at the time of the patient's death. Whereas, previous studies done with the Goiânia cancer registry2Abreu E Koifman RJ Fanqueiro AG Land MGP Koifman S Ten-year population-based female breast cancer survival in Goiânia (GO), Brazil, 1988–1990.Cad Saúde Colet. 2012; 20 (in Spanish).: 305-313Google Scholar, 3Coleman MP Quaresma M Berrino F et al.Cancer survival in five continents: a worldwide population-based study (CONCORD).Lancet Oncol. 2008; 9: 730-756Summary Full Text Full Text PDF PubMed Scopus (985) Google Scholar, 4Nunes RD Martins E Freitas-Júnior R Curado MP Freitas NMA Oliveira JC Descriptive study of breast cancer cases in Goiânia between 1989 and 2003.Rev Col Bras Cir. 2011; 38: 212-216Crossref PubMed Scopus (9) Google Scholar evaluated overall survival, in which all patient deaths were regarded as endpoints. Therefore, the CONCORD-2 study1Allemani C Weir HK Carreira H et al.the CONCORD Working GroupGlobal 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).Lancet. 2015; 385: 977-1010Summary Full Text Full Text PDF PubMed Scopus (421) Google Scholar would be expected to report higher overall survival rates than those actually presented. The survival rates reported for the city of Goiânia also differed in relation to those from other Brazilian registries included in the CONCORD-2 study,1Allemani C Weir HK Carreira H et al.the CONCORD Working GroupGlobal 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).Lancet. 2015; 385: 977-1010Summary Full Text Full Text PDF PubMed Scopus (421) Google Scholar which showed an increase in net survival during the period analysed. For example, the São Paulo registry, where survival rates increased from 77·0% to 90·9%, and the Curitiba registry, where rates increased from 82·8% to 88·6%.1Allemani C Weir HK Carreira H et al.the CONCORD Working GroupGlobal 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).Lancet. 2015; 385: 977-1010Summary Full Text Full Text PDF PubMed Scopus (421) Google Scholar In view of the importance of studies on survival from a public health view-point insofar as the assessment of care and the distribution of resources in a given population are concerned, it is essential to read the results presented in the CONCORD-2 study for the city of Goiânia with a critical eye and to carefully discuss these findings. The data on survival in the city of Goiânia should be reviewed to verify the consistency of the results presented in the CONCORD-2 study. This online publication has been corrected. The corrected version first appeared at thelancet.com on August 21, 2015 This online publication has been corrected. The corrected version first appeared at thelancet.com on August 21, 2015 We declare no competing interests. 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)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. Full-Text PDF Open AccessDepartment of ErrorFreitas-Junior R, Ribeiro Soares L, Henrique Barrios C. Cancer survival: the CONCORD-2 study. Lancet 2015; 386: 428–29—The title for this Letter (Aug 1) should have read “Cancer survival: the CONCORD-2 study”. This correction has been made to the online version as of Aug 21, 2015. Full-Text PDF Cancer survival: the CONCORD-2 study – Authors' replyRuffo Freitas-Junior and colleagues ask if the data from Goiânia, Brazil, are reliable. We paid obsessive attention to documenting the quality of data and survival estimates. The estimates for Goiânia were flagged as less reliable than would be preferred for breast cancer and for eight of the other nine cancers examined in adults (see p 84 and p 99 in the appendix of our Article1). We agree that the flagged estimates for Goiânia are not optimal; improvement in data quality is in progress. Data from flagged survival estimates were not included in pooled national estimates. Full-Text PDF
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