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Author Notes:

Corresponding author: Claudia Allemani, Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; claudia.allemani@lshtm.ac.uk.

AUTHOR CONTRIBUTIONS: Claudia Allemani: Conceptualization, methodology, writing–original draft, supervision and funding acquisition. Rhea Harewood: Data validation, formal analysis and visualization. Christopher J. Johnson: Writing–review and editing. Helena Carreira: Data validation, formal analysis and visualization. Devon Spika: Life tables, data validation, formal analysis, and visualization.

Audrey Bonaventure: Writing–review and editing. Kevin Ward: Writing–review and editing. Hannah K. Weir: Writing–review and editing. Michel P. Coleman: Conceptualization, methodology, writing–review and editing, and funding acquisition.

The findings and conclusions in this report are those of the authors and do not necessarily reflect the official position of the CDC.

CONFLICT OF INTEREST DISCLOSURES: The authors made no disclosures.


Research Funding:

This study was funded by the US Centers for Disease Control and Prevention (12FED03123 and ACO12036).


  • cancer
  • National Program for Cancer Registries (NPCR)
  • population-based survival
  • statistical methods
  • Surveillance
  • Epidemiology
  • End Results (SEER)

Population-based cancer survival in the United States: Data, quality control, and statistical methods


Journal Title:



Volume 123


, Pages 4982-4993

Type of Work:

Article | Post-print: After Peer Review


BACKGROUND Robust comparisons of population-based cancer survival estimates require tight adherence to the study protocol, standardized quality control, appropriate life tables of background mortality, and centralized analysis. The CONCORD program established worldwide surveillance of population-based cancer survival in 2015, analyzing individual data on 26 million patients (including 10 million US patients) diagnosed between 1995 and 2009 with 1 of 10 common malignancies. METHODS In this Cancer supplement, we analyzed data from 37 state cancer registries that participated in the second cycle of the CONCORD program (CONCORD-2), covering approximately 80% of the US population. Data quality checks were performed in 3 consecutive phases: protocol adherence, exclusions, and editorial checks. One-, 3-, and 5-year age-standardized net survival was estimated using the Pohar Perme estimator and state- and race-specific life tables of all-cause mortality for each year. The cohort approach was adopted for patients diagnosed between 2001 and 2003, and the complete approach for patients diagnosed between 2004 and 2009. RESULTS Articles in this supplement report population coverage, data quality indicators, and age-standardized 5-year net survival by state, race, and stage at diagnosis. Examples of tables, bar charts, and funnel plots are provided in this article. CONCLUSIONS Population-based cancer survival is a key measure of the overall effectiveness of services in providing equitable health care. The high quality of US cancer registry data, 80% population coverage, and use of an unbiased net survival estimator ensure that the survival trends reported in this supplement are robustly comparable by race and state. The results can be used by policymakers to identify and address inequities in cancer survival in each state and for the United States nationally.
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