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      Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data

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          Summary

          Background

          Cancer survival is a key measure of the effectiveness of health-care systems. Persistent regional and international differences in survival represent many avoidable deaths. Differences in survival have prompted or guided cancer control strategies. This is the first study in a programme to investigate international survival disparities, with the aim of informing health policy to raise standards and reduce inequalities in survival.

          Methods

          Data from population-based cancer registries in 12 jurisdictions in six countries were provided for 2·4 million adults diagnosed with primary colorectal, lung, breast (women), or ovarian cancer during 1995–2007, with follow-up to Dec 31, 2007. Data quality control and analyses were done centrally with a common protocol, overseen by external experts. We estimated 1-year and 5-year relative survival, constructing 252 complete life tables to control for background mortality by age, sex, and calendar year. We report age-specific and age-standardised relative survival at 1 and 5 years, and 5-year survival conditional on survival to the first anniversary of diagnosis. We also examined incidence and mortality trends during 1985–2005.

          Findings

          Relative survival improved during 1995–2007 for all four cancers in all jurisdictions. Survival was persistently higher in Australia, Canada, and Sweden, intermediate in Norway, and lower in Denmark, England, Northern Ireland, and Wales, particularly in the first year after diagnosis and for patients aged 65 years and older. International differences narrowed at all ages for breast cancer, from about 9% to 5% at 1 year and from about 14% to 8% at 5 years, but less or not at all for the other cancers. For colorectal cancer, the international range narrowed only for patients aged 65 years and older, by 2–6% at 1 year and by 2–3% at 5 years.

          Interpretation

          Up-to-date survival trends show increases but persistent differences between countries. Trends in cancer incidence and mortality are broadly consistent with these trends in survival. Data quality and changes in classification are not likely explanations. The patterns are consistent with later diagnosis or differences in treatment, particularly in Denmark and the UK, and in patients aged 65 years and older.

          Funding

          Department of Health, England; and Cancer Research UK.

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          Most cited references32

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          The relative survival rate: a statistical methodology.

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            Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s.

            We present a comprehensive overview of most recent European trends in population-based incidence of, mortality from and relative survival for patients with cancer since the mid 1990s. Data on incidence, mortality and 5-year relative survival from the mid 1990s to early 2000 for the cancers of the oral cavity and pharynx, oesophagus, stomach, colorectum, pancreas, larynx, lung, skin melanoma, breast, cervix, corpus uteri, ovary, prostate, testis, kidney, bladder, and Hodgkin's disease were obtained from cancer registries from 21 European countries. Estimated annual percentages change in incidence and mortality were calculated. Survival trends were analyzed by calculating the relative difference in 5-year relative survival between 1990-1994 and 2000-2002 using data from EUROCARE-3 and -4. Trends in incidence were generally favorable in the more prosperous countries from Northern and Western Europe, except for obesity related cancers. Whereas incidence of and mortality from tobacco-related cancers decreased for males in Northern, Western and Southern Europe, they increased for both sexes in Central Europe and for females nearly everywhere in Europe. Survival rates generally improved, mostly due to better access to specialized diagnostics, staging and treatment. Marked effects of organised or opportunistic screening became visible for breast, prostate and melanoma in the wealthier countries. Mortality trends were generally favourable, except for smoking related cancers. Cancer prevention and management in Europe is moving in the right direction. Survival increased and mortality decreased through the combination of earlier detection, better access to care and improved treatment. Still, cancer prevention efforts have much to attain, especially in the domain of female smoking prevalence and the emerging obesity epidemic.
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              Socioeconomic inequalities in cancer survival in England after the NHS cancer plan

              Background: Socioeconomic inequalities in survival were observed for many cancers in England during 1981–1999. The NHS Cancer Plan (2000) aimed to improve survival and reduce these inequalities. This study examines trends in the deprivation gap in cancer survival after implementation of the Plan. Materials and method: We examined relative survival among adults diagnosed with 1 of 21 common cancers in England during 1996–2006, followed up to 31 December 2007. Three periods were defined: 1996–2000 (before the Cancer Plan), 2001–2003 (initialisation) and 2004–2006 (implementation). We estimated the difference in survival between the most deprived and most affluent groups (deprivation gap) at 1 and 3 years after diagnosis, and the change in the deprivation gap both within and between these periods. Results: Survival improved for most cancers, but inequalities in survival were still wide for many cancers in 2006. Only the deprivation gap in 1-year survival narrowed slightly over time. A majority of the socioeconomic disparities in survival occurred soon after a cancer diagnosis, regardless of the cancer prognosis. Conclusion: The recently observed reduction in the deprivation gap was minor and limited to 1-year survival, suggesting that, so far, the Cancer Plan has little effect on those inequalities. Our findings highlight that earlier diagnosis and rapid access to optimal treatment should be ensured for all socioeconomic groups.
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                Author and article information

                Contributors
                Journal
                Lancet
                Lancet
                Lancet
                Lancet Publishing Group
                0140-6736
                1474-547X
                8 January 2011
                8 January 2011
                : 377
                : 9760
                : 127-138
                Affiliations
                [a ]Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
                [b ]Section of Cancer Information, International Agency for Research on Cancer, Lyon, France
                [c ]Canadian Partnership Against Cancer, Toronto, ON, Canada
                [d ]Department of Health, London, UK
                [e ]Cancer Institute New South Wales, Sydney, NSW, Australia
                [f ]Cancer Council Victoria, Melbourne, VIC, Australia
                [g ]Alberta Health Services, Edmonton, AB, Canada
                [h ]British Columbia Cancer Agency, Vancouver, BC, Canada
                [i ]CancerCare Manitoba, Winnipeg, MB, Canada
                [j ]Cancer Care Ontario, Toronto, ON, Canada
                [k ]Danish Cancer Registry, National Board of Health, Copenhagen, Denmark
                [l ]Norwegian Cancer Registry, Oslo, Norway
                [m ]The Oncological Centre, Karolinska University Hospital and the CLINTEC Department Karolinska Institutet, Stockholm, Sweden
                [n ]Regional Oncological Centre, Uppsala University Hospital, Uppsala, Sweden
                [o ]The Karolinska Institutet, Stockholm, Sweden
                [p ]West Midlands Cancer Intelligence Unit, Birmingham, UK
                [q ]Trent Cancer Registry, Sheffield, UK
                [r ]Northern and Yorkshire Cancer Registration and Information Service, Leeds, UK
                [s ]Northern Ireland Cancer Registry, Belfast, UK
                [t ]Welsh Cancer Intelligence and Surveillance Unit, Cardiff, UK
                [u ]National Cancer Action Team, Department of Health, London, UK
                Author notes
                [* ]Correspondence to: Prof M P Coleman, Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK michel.coleman@ 123456lshtm.ac.uk
                [‡]

                Members listed at end of Article

                Article
                LANCET62231
                10.1016/S0140-6736(10)62231-3
                3018568
                21183212
                7ea8d32b-2cbd-4ce6-94b2-7fba7698711f
                © 2011 Elsevier Ltd. All rights reserved.

                This document may be redistributed and reused, subject to certain conditions.

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