Statistical bulletin: Geographic patterns of cancer survival in England, patients followed to 2010

Headline Figures

• At national level, an upward trend in five-year relative survival was observed for all of the eight studied cancers diagnosed during 2001–2005, except cancers of the oesophagus (women), stomach (women), cervix and bladder (both sexes)
• For men, the largest increase in relative survival over the period of diagnosis 2001–2005 in England was for cancer of the oesophagus (one-year survival) and for cancer of the colon (five-year survival), both at 1.0 per cent per year
• For women, the largest increase in relative survival over the period of diagnosis 2001–2005 in England was for cancer of the lung (one-year survival, at 0.9 per cent per year) and for cancer of the colon (five-year survival, at 0.6 per cent per year)
• Wide geographical disparities in relative survival were observed for patients diagnosed during 2003–2005

Summary

This bulletin presents estimates of one-year and five-year relative survival for adult patients diagnosed with one of eight cancers in England during 2003–2005 and followed up to 2010 [Background notes 1, 2 and 3]. Annual trends in relative survival during 2001–2005 are also presented [Background note 4]. Results are presented by region, Strategic Health Authority, Cancer Network and by sex.

Figure 1. One-year relative survival for patients diagnosed in 2003–2005 and followed to 2010

England

Source: Office for National Statistics

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Figure 2. Five-year relative survival for patients diagnosed in 2003–2005 and followed to 2010

England

Source: Office for National Statistics

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Results

One-year and five-year relative survival estimates are presented for patients diagnosed with cancer of the oesophagus, stomach, colon, lung, breast (women), cervix, prostate or bladder in England during 2003–2005 and followed up to 2010 [Background notes 1 and 2]. These survival estimates are age-standardised [Background note 3]. We also present the unstandardised annual estimates for each year of the period 2001-2005 together with the annual percentage change in relative survival [Background note 4].

For the patients diagnosed with one of the eight studied cancers in 2001–2005, both one-year and five-year survival in England either continued to increase or did not show any improvement. Among men, one-year and five-year survival increased for all cancers except for bladder. Among women, one-year survival increased for cancers of colon, lung, breast and cervix, and remained stable for cancers of oesophagus, stomach and bladder; trends in five-year survival were the same except for cervix for which five-year survival remained stable.

Five-year relative survival from bladder cancer stabilised at England level, but some variations remained at sub-national level as a result of progressive completion of changes in coding and classification by individual English cancer registries [Background note 5].

The largest increase in one-year relative survival in England was for men diagnosed with cancer of the oesophagus (1.0 per cent per year) in 2001–2005. Over the same period, five-year relative survival for men with colon cancer increased by 1.0 per cent per year. However, between 2001 and 2005, five-year survival for men with prostate cancer increased by 1.4 per cent per year, although this improvement in survival is considered somewhat artificial since it is largely attributable to the increasing use of the Prostate-Specific Antigen (PSA) test for diagnosis [Background note 6]. For women, the largest improvement in survival was 0.9 per cent per year in one-year relative survival from cancer of the lung, and 0.6 per cent per year in five-year relative survival from cancer of the colon.

Wide, persistent variations in both one-year and five-year relative survival were seen for all cancers diagnosed in 2003–2005 between the 28 Cancer Networks.

Table 1. Range in one-year relative survival (per cent) across the 28 cancer networks in England

Patients diagnosed in 2003–2005 and followed up to 2010

Table source: Office for National Statistics

Table notes:

1. The symbol '..' refers to not available.
2. Data were obtained from English cancer registries and collated by the Office for National Statistics and include patients aged 15–99 years.
3. Relative survival can be interpreted as the survival of cancer patients after other causes of death are taken into account.
4. Relative survival estimates are age-standardised using a standard population of cancer patients (see background note 3 of statistical bulletin).

Additional Information

The detailed results are displayed in tables that can be downloaded from the Office for National Statistics website at:

www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-258237

The tables include estimates for England and for each of 9 regions, 10 Strategic Health Authorities and 28 Cancer Networks. Results are presented separately by sex and for both sexes combined. In some cases the number of deaths in each age category was too small to enable age-standardisation, so the unstandardised result is given instead. A similar limitation was sometimes encountered for unstandardised survival for one or more calendar years, preventing estimation of the time trend in survival.

Further information about the cancer survival estimates published by the Office for National Statistics (ONS) can be found in the Summary Quality Report for cancer survival at:

www.ons.gov.uk/ons/guide-method/method-quality/quality/quality-information/social-statistics/summary-quality-report-for-cancer-survival-statistical-bulletin.pdf

Summary Quality Reports are overview notes which pull together key qualitative information on the various dimensions of the quality of statistics as well as providing a summary of the methods used to compile the output.

Policy Context

In ‘Improving Outcomes: A Strategy for Cancer’ (January 2011), the Department of Health states that although improvements have been made in the quality of cancer services in England, a significant gap remains in survival compared with the European average. Survival rates for cervical, colorectal and breast cancer are some of the lowest among member states of the Organisation for Economic Co-operation and Development (OECD) (figures for cancer survival in OECD countries are available here: http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT). Survival for colon, lung and breast cancer in the UK (England, Northern Ireland and Wales only) was confirmed to be low compared with Australia, Canada, Norway and Sweden in a recent study (Coleman et al, 2011). 

The Outcomes Strategy sets out how the Department of Health aims to improve outcomes for all cancer patients and improve cancer survival rates, with the aim of saving an additional 5,000 lives every year by 2014/15. Further details about the ‘Improving Outcomes: A Strategy for Cancer’ publication can be found at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123371

Outcomes strategies set out how the National Health Service (NHS), public health and social care services will contribute to the ambitions for progress agreed with the Secretary of State in each of the high-level outcomes frameworks. The indicator set for the NHS Outcomes Framework includes one- and five-year relative survival from colorectal, breast and lung cancers. Further details about the NHS Outcomes Framework 2012/13 can be found at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131700

Figures on cancer survival in Scotland are produced by ISD Scotland and are available here: www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/

Survival for cancer in Wales is produced by the Welsh Cancer Intelligence and Surveillance Unit (www.wales.nhs.uk/sites3/page.cfm?orgid=242&pid=48578).

References

1. Coleman MP, Rachet B, Woods LM, Mitry E, Riga M, Cooper N, Quinn MJ, Brenner H, Estève J. (2004) Trends and socio-economic inequalities in cancer survival in England and Wales up to 2001. Br J Cancer 90:1367-1373

2. Cancer Research UK Cancer Survival Group. (2006) Strel computer program version 1.2 for cancer survival analysis. London School of Hygiene and Tropical Medicine. www.lshtm.ac.uk/ncdeu/cancersurvival/tools.htm.

3. Coleman MP, Babb P, Damiecki P, Grosclaude P, Honjo S, Jones J, Knerer G, Pitard A, Quinn MJ, Sloggett A, De Stavola BL. (1999) Cancer survival trends in England and Wales 1971-1995: deprivation and NHS Region. Studies on Medical and Population Subjects No. 61. London: The Stationery Office, pp1-695

4. Coleman MP et al (2011) 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. The Lancet 377 (9760): p127-138

5. ONS. Cancer survival by region, SHA and Cancer Network www.ons.gov.uk/ons/publications/all-releases.html?definition=tcm%3A77-228284

Authors

Bernard Rachet^a, Emma Gordon^b, Kat Pegler^b, Michel P Coleman^a

This report was produced in collaboration between the London School of Hygiene and Tropical Medicine^a (LSHTM) and the National Cancer Registry at the Office for National Statistics^b (ONS).

Acknowledgements

The National Cancer Registry at the Office for National Statistics and the London School of Hygiene and Tropical Medicine wish to acknowledge the work of the regional cancer registries in England, which provide the raw data for these analyses.

Background notes

1. Data were obtained from cancer registries and collated by the Office for National Statistics (ONS). Patients were included for analysis if they were diagnosed between the ages of 15–99 years with a primary, invasive, malignant neoplasm at one of the eight specified sites. Records of patients diagnosed with benign or in situ tumours and those with tumours which could not be classified as definitely malignant were excluded [for further exclusion criteria see Reference 1].
2. Relative survival is an estimate of the probability of survival from the cancer alone. Some cancer patients will die from other causes (for example an accident), as do people in the general population. Relative survival is defined as the ratio of the observed survival and the survival that would have been expected if the cancer patients had only experienced the background mortality seen in the general population. Background mortality was taken from general population life tables of age- and sex-specific death rates, specific for calendar year, socioeconomic status and geographic region. This is done because the risk of death from causes other than cancer also varies with these factors. Relative survival can be interpreted as the survival of cancer patients after other causes of death are taken into account. The STATA algorithm strel was used to estimate relative survival [Reference 2].
3. Relative survival varies with age at diagnosis and the age profile of patients can vary with time and between geographical areas. To enable comparison of survival figures over long periods of time or between geographical areas, the estimates were age standardised using the method of direct age standardisation wherein age-specific survival estimates are weighted by a standard age distribution. In this case we used the standard age weights of the England and Wales population of cancer patients during 1986–1990, as presented in the monograph Cancer Survival Trends [Reference 3]. Age standardisation requires an estimate of survival to be available for each age group. Age-specific estimates may not be obtained if there are too few events (deaths) in a given age group. That can happen because survival is very high (there are very few deaths) or because it is very low (most of the patients die early in the five-year period of follow-up).
4. Relative survival is estimated for each year during the period 2001–2005, these results are not age-standardised. The annual trend is presented. This is calculated using variance-weighted least squares regression.
5. The decline in survival from bladder cancer arises because transitional-cell papillomas were reclassified from malignant to non-malignant tumours from 2000. Non-malignant tumours are excluded from our analysis. Survival from transitional-cell papillomas is high, and excluding them from the analysis reduces the overall estimate of survival from bladder cancer.
6. The introduction of the Prostate-Specific Antigen (PSA) test during the 1990s increased the diagnosis of asymptomatic prostate cancers. Men with these tumours have higher survival.
7. Previous analyses for Government Office Region (now named Region), Strategic Health Authority and Cancer Network have been published [Reference 5].
8. ONS publishes cancer survival for England only. Figures for cancer survival in Scotland are produced by ISD Scotland and are available here: www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/

   Survival for cancer in Wales is produced by the Welsh Cancer Intelligence and Surveillance Unit (www.wales.nhs.uk/sites3/page.cfm?orgid=242&pid=48578).

9. Details of the policy governing the release of new data are available by visiting www.statisticsauthority.gov.uk/assessment/code-of-practice/index.html or from the Media Relations Office email: media.relations@ons.gsi.gov.uk

   These National Statistics are produced to high professional standards and released according to the arrangements approved by the UK Statistics Authority.

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