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 people wait to see a specialist after an urgent referral from a GP, or the time people wait for diagnostic tests. It can also be improved through public health interventions, such as screening programmes and education campaigns. In this indicator we look at the proportion of cancers diagnosed at an early stage, for eight common cancers.
There are differences in cancer survival rates between countries. This may result from differences in access to care, and delays in diagnosis and treatment, but it may also be due to population-level factors. We have 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.
The most recent data presented here for cancer stage at diagnosis are from December 2020, but the latest data for cancer survival rates are from before the coronavirus (Covid-19) pandemic. The pandemic caused considerable disruption to cancer services, which is likely to affect cancer survival, but estimating the impact is difficult.
Here we look at the five-year net survival estimates for adults (aged 15-99 years) in England diagnosed with one of the 27 most common cancers between 2014 and 2018, and followed up to 2019.
The cancers with the lowest five-year survival estimates are mesothelioma (7.2%), pancreatic cancer (7.3%) and brain cancer (12.8%). The highest five-year survival estimates are seen in patients with testicular cancer (97%), melanoma of skin (92.3%) and prostate cancer (88%).
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, with stage 1 as the earliest stage. At both stage 1 and 2, the cancer has not spread to anywhere else in the body, although stage 2 indicates that the cancer has grown. If cancer is diagnosed at a later stage, once it has spread, then chances of survival decrease as effective treatment becomes more difficult.
In 2018 and 2019, the number of eight common cancers diagnosed at each stage remained roughly constant, with an average of 44% of cancers diagnosed at stage 1 or 2. Between March and May 2020, following the onset of the Covid-19 pandemic, the total number of cancers diagnosed fell by 47% from 18,183 to 9,710. While the number diagnosed at stage 1 or 2 fell by 60% over them same time period (from 8,151 to 3,707), the proportion diagnosed at stage 1 or 2 decreased from 45% to 38%.
Since then, the number of cancers diagnosed has increased but remains slightly below levels seen before the pandemic. In December 2020, 15,783 cancers were diagnosed, 4% lower than in December 2019, and 37% were diagnosed at stage 1 or 2. Caution should be taken when interpreting data for more recent months as it may be less complete (see ‘About this data’ for more information).
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, and in March 2021 the target was set which states that 75% of patients should be told whether or not they have cancer within 28 days of 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
Public Health England 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 information, please see the Public Health England website.
National Cancer Registration and Analysis Service data
Stage at diagnosis is based on the TNM staging system. The cancers included in the measure are prostate, breast, lung, colorectal, urological, gynaecological, melanoma and oesophago-gastric. Figures are based on rapid processing of cancer registration data and may not be complete, particularly for diagnoses in recent months. For more information, please see the Rapid Cancer Registration Dataset website.
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.