Cancer survival is one of the key measures of the effectiveness of cancer services. Survival rates capture both how good the system is in detecting the disease and whether people have rapid access to effective treatment. There is currently a huge variation in survival between cancer types, resulting from a range of patient-level, treatment and biological factors.
Diagnosis at an earlier stage of a cancer’s development is associated with improved outcomes and increased survival chances. Early diagnosis can be improved through reducing cancer waiting times, such as the time waited to see a specialist after an urgent referral from a GP, or the time waited for diagnostic tests. It can also be improved through public health interventions, such as screening programmes and education campaigns. Here we look at the proportion of ten common cancers diagnosed at an early stage.
There are differences in cancer survival rates between countries. This may result from differences in access, and delays in diagnosis and treatment, but it may also be due to population-level factors. We used data from the Organisation for Economic Co-operation and Development (OECD) to compare the UK's five-year survival rates for breast, cervical and colon cancer with 17 other countries.
Here we look at the five-year net survival estimates for adults (aged 15-99 years) in England diagnosed with one of the 29 most common cancers between 2013 and 2017, and followed up to 2018.
The cancers with the lowest five-year survival estimates are mesothelioma (6.5%), pancreatic cancer (7.3%) and brain cancer (12.2%). The highest five-year survival estimates can be seen in patients with testicular cancer (95.3%), melanoma of skin (91.3%) and thyroid cancer (87.4%).
The stage at which a cancer is diagnosed describes the size of a tumour and how far it has spread from where it originated. The numerical staging system classifies cancers into four stages, from 1 to 4, where stage 1 is the earliest stage. Stages 1 and 2 are considered to be early stages at diagnosis, where stage 1 indicates that the cancer is small, while stage 2 indicates that the cancer has grown. At both stage 1 and 2, the cancer has not spread to anywhere else in the body. If cancer is diagnosed at a later stage, once it has spread, then chances of survival decrease as effective treatment becomes more difficult.
Between 2011/12 and 2015/16, the percentage of cancers diagnosed at early stages increased. In Q4 2011/12, 44% of cancers were diagnosed at stage 1 or 2, and this increased to a high of 53% in Q2 2015/16. Since then, the percentage has remained relatively constant. In Q1 2018/19, 52% of cancers were diagnosed at an early stage. There were 59,133 new cases of cancer diagnosed and 30,626 of these were diagnosed at stage 1 or 2.
The NHS Long Term Plan set a target to increase the percentage of cancers diagnosed at stage 1 or 2 to 75% by 2028. To meet this goal, early diagnosis will have to increase considerably. In April 2020, a new faster diagnosis standard was introduced, which measures a maximum 28-day wait for patients to be told whether or not they have cancer after an urgent referral from their GP or a cancer screening programme.
Breast cancer is the most prevalent cancer in women worldwide. Survival is related to advances in treatment, detection through screening programmes and a greater awareness of the disease. Five-year survival for breast cancer has been improving in the UK over time, reaching 85.6% in 2010-2014. However, despite the relatively high breast cancer screening coverage when compared to several other OECD countries, the UK continues to lag behind in terms of survival. The United States reached the highest five-year breast cancer survival rate of 90.2% in 2010-2014, followed closely by Australia at 89.5% and Japan at 89.4%.
Cervical cancer is highly preventable if detected and treated before progression occurs. The main cause of cervical cancer is sexual exposure to human papilloma virus (HPV). About half of OECD countries have cervical screening programmes and around half have implemented HPV vaccination programmes.
In England, all girls aged 12 to 13 are offered the HPV vaccination, and from the 2019-20 school year the programme has been extended to all boys aged 12 to 13 years old. In recent years, uptake of the first dose of the vaccine has fluctuated around 89% and uptake of the second dose is slightly lower at around 84%.
International trends in five-year cervical cancer survival show more variation between countries over time than for five-year breast cancer survival. While survival has been improving in the UK, the country is still one of the worst performers compared to other OECD countries, with a five-year survival of only 63.8% in 2010-2014. This is despite relatively high cervical cancer screening coverage. In comparison, survival in Denmark in the same time period was 69.5% while survival in Japan reached 71.4%.
Bowel cancer is the third most commonly diagnosed cancer worldwide. The disease has a higher prevalence in America and Europe compared to Asia, however in countries where people are adopting western diets, such as Japan, the incidence of colon cancer is increasing. There are multiple screening methods available including the faecal occult blood test, colonoscopy and flexible sigmoidoscopy. Advances in diagnosis and treatment of colon cancer have led to increased survival over the last decade.
While the five-year colon cancer survival rate in the UK has been increasing over time, in 2010-2014 survival reached only 60%. This is the lowest five-year survival rate out of the 18 OECD countries that we included. Over the same time period in Australia it was as high as 70.6%, and Belgium reached a five-year colon cancer survival rate of 67.9%.
About this data
Office for National Statistics data:
Net survival is an estimate of the probability of survival from the cancer alone. It can be interpreted as the survival of cancer patients after taking into account the background mortality that the patients would have experienced if they had not had the cancer. Background mortality is derived from life tables of all-cause mortality rates in the general population. Net survival varies with age, and the age profile of cancer patients can vary with time and between geographical areas, so the estimates are age-standardised to facilitate comparison. Estimates are shown with their 95% confidence intervals. For convenience, net survival is expressed as a percentage in the range 0–100 per cent.
For more detailed information on this data source, please see the Office for National Statistics website.
Public Health England data:
The percentage of cancers diagnosed at an early stage is calculated as the number of cases of ten cancers diagnosed at stage 1 or 2 divided by the number of new cases diagnosed at any stage or unknown stage. The ten cancers included in the measure are invasive malignancies of the breast, prostate, colorectal, lung, bladder, kidney, ovary and uterus, non-Hodgkin lymphomas, and melanomas of the skin. For more information, please see the Cancer Outcome Metric: Stage at Diagnosis.
Five-year net survival is the cumulative probability that cancer patients survive their cancer for at least five years, after controlling for the risks of death from other causes. Net survival is expressed as a percentage. Net survival for patients diagnosed during 2000-2004 is based on a cohort approach, since all patients had been followed up for at least five years by the end of 2014. For patients diagnosed during 2010-2014, the period approach is used, which allows estimation of five-year survival, though five years of follow-up are not available for all patients. Cancer survival estimates are age-standardised with the International Cancer Survival Standard (ICSS) weights.
For further information please see: OECD Definitions for Health Care Quality Indicators and Health at a Glance 2019: OECD Indicators.