Newsletter No. 5 – 15 October, 2012

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Funding and resources

Resources provided by Swiss Re have been deployed to support Natalia Sanz, the CONCORD Programme Manager, since February 2012. The University of Kentucky has provided a contract for US$192,000, part of which supports Dr Claudia Allemani, Lecturer in Epidemiology. The US Centers for Disease Control (CDC) has provided a competitively awarded contract for US$350,000 a year for three years from June 2012, via an Inter-Agency Agreement with the US National Cancer Institute (NCI). Cancer Institute New South Wales has agreed to deploy a half-time analyst for the lifetime of the programme: arrangements are in progress.

The Canadian Partnership Against Cancer has agreed to deploy CDN$200,000 to support the programme from December 2012. Cancer Focus Northern Ireland is likely to deploy an experienced cancer survival analyst to London for one year from November 2012.

An application for £2.4 M over four years is under peer review with Cancer Research UK. A decision will be available in November 2012. Applications to three other foundations are under discussion.

We will shortly:

  • Recruit a Research Fellow and Data Manager, in addition to the Lecturer (Dr Claudia Allemani) and Programme Manager (Natalia Sanz)
  • Issue the call for registries to submit their data between November 2012 and the deadline of 31 March 2013
  • Analyse responses to the questionnaires on cancer registration practice
  • Refine the data preparation routines and develop the planned outputs

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Endorsements

Prof Coleman visited Washington DC in March 2012 to meet Dr Ted Trimble, Director of the NCI Center for Global Health, with Dr Marcus Plescia, Director of CDC’s Division of Cancer Prevention and Control, and Dr Brenda Edwards, NCI (also CONCORD Steering Committee). Dr Trimble agreed that the Centre for Global Health would endorse CONCORD, collaborate in the scientific programme, and help to leverage funding from other agencies, in collaboration with CDC.

CONCORD has now been endorsed by many national and international organisations, including the WHO Regional Office for Europe (Copenhagen); the Organisation for Economic Co-operation and Development (Paris); the International Atomic Energy Agency (Vienna); the Union for International Cancer Control (Geneva); the Canadian Association of Provincial Cancer Agencies (Toronto); Swiss Re (London); Members of the European Parliament Against Cancer (Brussels); the Jolanta Kwaśniewska Foundation (Warsaw); the Danish Cancer Society (Copenhagen); the Spanish Cancer Society (Madrid); the European CanCer Organisation (ECCO, Brussels); the European Cancer Leagues (Brussels); the North American Association of Central Cancer Registries (NAACCR) (Springfield IL), the US National Cancer Institute’s Center for Global Health (Washington DC); the Centers for Disease Control and Prevention (CDC) (Atlanta GA); and the Consumer Liaison Group (cancer patient body) of the UK National Institute for Health Research (Leeds).

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Progress

More than 190 population-based cancer registries in 58 countries have signed up to participate in the CONCORD-2 study. Handling a huge volume of data from cancer registries around the world in a robust and comparable manner is a major challenge. Each registry has been asked to provide a detailed set of standardised information about their registration practices that relate directly to cancer survival. The questionnaire can be completed on-line, or as a Word file, or submitted by post. Over 100 questionnaires have been received.

We have set up the first few pages of a CONCORD website. After entry of the cancer registry name and e-mail address, the site provides access to the protocol, annexes and questionnaire. It also gives access to a recent article on why cancer registries should provide full dates for survival analyses: (Woods LM et al. Full dates (day, month, year) should be used in population-based cancer survival studies. International Journal of Cancer 2012; 131:E1120-E1124, doi: 10.1002/ijc.27545). Handling partial dates in survival analysis causes problems for quality control and the analysis of short-term survival. It is becoming more difficult for some cancer registries to provide full dates because of concerns about confidentiality. In some cases, local laws or regulations actually prohibit this. We believe this article will help cancer registries to obtain approval to provide full dates for international survival analysis.

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CONCORD Steering Committee and Working Group – 35 travel fellowships

Fifteen of the 24 members of the CONCORD Steering Committee met in Cork, Ireland, on 19 September 2012 to discuss strategic plans for the programme.

A full meeting of the CONCORD Working Group was held during 20-21 September, immediately after the International Association of Cancer Registries (IACR) conference. The meeting brought together 90 representatives from cancer registries in 48 countries. CDC funding enabled us to provide full fellowships for 35 scientists from cancer registries in low- and middle-income countries to attend both the IACR and CONCORD meetings. The Working Group discussed a wide range of methodological issues arising from the CONCORD-2 protocol; the protocol is now being finalised with the changes agreed at the meeting.

concord steering committee

Photo: Yuki Alencar, LSHTM

 

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Professor Timo Hakulinen

prof timo hakulinen

Timo Hakulinen is a world-renowned biostatistician and a specialist in cancer survival methodology. He will shortly retire from his post as Director of the Finnish Cancer Registry, and he has now decided to step down from the CONCORD Steering Committee, on which he has provided invaluable expertise and advice from the start of the study in 1999. All the members of the Steering Committee join in wishing him well, and offer their warmest congratulations for his award of an honorary membership of the International Association of Cancer Registries, received for more than 40 years of commitment to cancer registration and cancer epidemiology at the IACR 2012 conference in Cork, Ireland, in September 2012.

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International conferences

The CONCORD study has been presented at five international meetings in 2012, and two further presentations are planned:

  • Group for the Registration and Epidemiology of cancer in Latin Language countries (GRELL), Porto (Portugal), May 2012
  • North American Association of Central Cancer Registries, Portland OR (USA), June 2012
  • CDC National Cancer Congress, Washington DC (USA), 20-23 August 2012
  • UICC World Cancer Congress, Montreal (Canada), 27-30 August 2012
  • IACR 34th Annual Conference, Cork (Ireland), 17-19 September 2012
  • Northern State Medical University, Arkhangelsk, (Russian Federation), 15-17 November 2012
  • National Cancer Registration Programme, Trivunananthapuram, Kerala (India), December 2012

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Publication

The first of three CONCORD high-resolution studies, on transatlantic differences in breast cancer survival, has been published in the International Journal of Cancer [1].

The study was designed to explain some of the survival differences seen in the first CONCORD study. Population-based data on stage at diagnosis, diagnostic procedures, treatment and follow-up were collected for about 20,000 women diagnosed with breast cancer aged 15–99 years during 1996–98 in 7 US states and 12 European countries. Age-standardized net survival and the excess hazard of death up to 5 years after diagnosis were estimated by jurisdiction (registry, country, European region), age and stage with flexible parametric models. Breast cancers were generally less advanced in the US than in Europe. Stage varied less between US states than between European jurisdictions. Early, node-negative tumours were more frequent in the US (39%) than in Europe (32%), while locally advanced tumours were twice as frequent in Europe (8%), and metastatic tumours of similar frequency (5–6%). Net survival in Northern, Western and Southern Europe (81–84%) was similar to that in the US (84%), but lower in Eastern Europe (69%). For the first 3 years after diagnosis, the mean excess hazard was higher in Eastern Europe than elsewhere: this difference was most marked for women aged 70–99 years, and it was mainly confined to women with locally advanced or metastatic tumours. Differences in breast cancer survival between Europe and the US in the late 1990s were mainly explained by lower survival in Eastern Europe, where low healthcare expenditure may have constrained the quality of treatment.

Articles on the high-resolution studies of colorectal and prostate cancer are in preparation.

Michel Coleman and Natalia Sanz
on behalf of the CONCORD Steering Committee

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[1] Allemani C, Sant M, Weir HK, Richardson LC, Baili P, Storm H, Siesling S, Torrella-Ramos A, Voogd AC, Aareleid T, Ardanaz E, Berrino F, Bielska-Lasota M, Bolick S, Cirilli C, Colonna M, Contiero P, Cress RD, Crocetti E, Fulton JP, Grosclaude P, Hakulinen T, Izarzugaza I, Malmström P, Peignaux K, Primic-Žakelj M, Rachtan J, Safaei Diba C, Sanchez M-J, Schymura MJ, Shen T, Traina A, Tryggvadóttir L, Tumino R, Velten M, Vercelli M, Wolf HJ, Woronoff A-S, Wu X, Coleman MP. Breast cancer survival in the US and Europe: a CONCORD high-resolution study [Epub ahead of print]. Int J Cancer 2012 doi: 10.1002/ijc.27725

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