Skip to content

Statistical bulletin: Geographic Patterns of Cancer Survival in England: Patients followed up to 2011

Released: 18 April 2013 Download PDF

Key findings

  • One-year and five-year net survival increased for eight common cancers in England for adults (aged 15–99 years) diagnosed during the period 2002–2006.
  • For men, the largest increase was 0.9% per year in one-year survival for cancers of the colon and oesophagus, and 1.4% per year in five-year survival for cancer of the prostate.
  • For women, the largest increase was for cancer of the cervix (1.1% per year for one-year survival and 1.5% per year for five-year survival).
  • Wide geographic disparities in net survival were observed for patients diagnosed during 2004–2006.

Summary

This bulletin presents estimates of age-standardised one- and five-year net survival for adults diagnosed with one of eight cancers in England during 2004–2006 and followed up to 2011 (see Background Notes 1–4). Annual trends in unstandardised net survival during 2002–2006 are also presented (see Background Note 5). Results are presented by Region, Strategic Health Authority, Cancer Network and by sex.

Figure 1: One-year age-standardised net survival (%) for adults diagnosed during 2004–2006 and followed up to 2011: England, eight common cancers, by sex

Figure 1: One-year age-standardised net survival (%) for adults diagnosed during 2004–2006 and followed up to 2011: England, eight common cancers, by sex
Source: Office for National Statistics

Notes:

  1. Survival estimates were age-standardised using a standard population of cancer patients (see Background Note 4)
  2. Adults aged 15–99 years

Download chart

Figure 2: Five-year age-standardised net survival (%) for adults diagnosed during 2004–2006 and followed up to 2011: England, eight common cancers, by sex

Figure 2: Five-year age-standardised net survival (%) for adults diagnosed during 2004–2006 and followed up to 2011: England, eight common cancers, by sex
Source: Office for National Statistics

Notes:

  1. Survival estimates were age-standardised using a standard population of cancer patients (see Background Note 4)
  2. Adults aged 15–99 years

Download chart

 

Results

One- and five-year net survival estimates are presented for patients diagnosed with cancer of the oesophagus, stomach, colon, lung, breast (women), cervix, prostate or bladder in England during 2004–2006 and followed up to 2011 (see Background Notes 1–3). These survival estimates are age-standardised to correct for changes in the age profile of cancer patients (see Background Note 4). We also present the unstandardised survival estimates for each year of the period 2002–2006, together with the annual percentage change (see Background Note 5).

For cancers of the colon, breast, cervix, prostate and bladder, survival is reasonably good: one-year survival is above 65% and five-year survival is above 45% (Figures 1 and 2). For cancers of the oesophagus, stomach and lung, however, survival remains very low: one-year survival is below 40% and five-year survival is below 20%.

At national level an upward trend in net survival was observed for all eight cancers. Some sub-national variation in bladder cancer survival remained; this reflects progressive completion of changes in coding and classification by the regional cancer registries in England (see Background Note 6).

Among men, the largest annual improvement in one-year survival occurred for cancers of the colon and oesophagus (both 0.9% per year). Five-year survival for men with prostate cancer increased by 1.4% per year; this improvement is largely attributable to the increasing use of the Prostate-Specific Antigen (PSA) test for diagnosis (see Background Note 7). For women, the largest improvement in survival was for cancer of the cervix (1.1% per year for one-year survival and 1.5% per year for five-year survival).

Wide and persistent differences between the 28 Cancer Networks in both one- and five-year net survival were seen for all cancers diagnosed during 2004–2006. For women with stomach cancer, the difference between the highest and lowest estimates was almost 20% for both one- and five-year net survival; the corresponding ranges for men were 17.4% for one-year survival and 14.4% for five-year survival. The smallest difference between the 28 Networks was seen for one-year net survival among women with breast cancer (3.5% maximum difference). Five-year survival for cancers of the breast and cervix was much lower in the North East London Network than in the other Networks (76.6% for breast cancer, 6.7% below the national level; 52.3% for cervical cancer, 11.0% below the national level).

Table 1: Range in one-year net survival (%) across the 28 Cancer Networks in England: adults diagnosed during 2004–2006 and followed up to 2011, eight common cancers, by sex

Age-standardised net survival (%)
  Men  Women  Persons
Cancer Mean Min Max Mean Min Max Mean Min Max
Oesophagus  37.3 30.8 46.6 35.8 30.2 42.4 36.5 30.4 43.0
Stomach  38.6 29.2 46.6 38.6 29.4 49.0 38.6 32.8 47.0
Colon 70.1 64.6 76.9 69.1 65.4 75.0 69.6 65.3 76.0
Lung  27.2 21.7 32.2 30.5 23.5 36.7 28.6 22.5 34.1
Breast  -- -- -- 94.7 92.3 95.8 -- -- --
Cervix -- -- -- 80.5 72.6 86.6 -- -- --
Prostate 91.8 85.5 95.2 -- -- -- -- -- --
Bladder  77.0 73.8 82.7 66.5 58.9 75.8 74.2 70.6 79.7

Table source: Office for National Statistics

Table notes:

  1. Adults aged 15-99 years
  2. Survival estimates were age-standardised using a standard population of cancer patients (see Background Note 4 of statistical bulletin)
  3. The symbol “--” means not available

Download table

The detailed results are displayed in the reference tables that accompany this statistical bulletin. The tables include estimates for England and for each of nine 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 certain age categories was too small to enable age-standardisation, so the unstandardised estimate is given instead. A similar limitation was sometimes encountered for unstandardised survival for one or more calendar years. In these cases no survival estimate is presented, and this prevents estimation of the time trend in survival.

Additional Information

Further information about cancer survival estimates published by the Office for National Statistics (ONS) can be found in the Cancer Survival Quality and Methodology Information paper. Quality and Methodology Information papers 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. Information about key users of these statistics is also provided.

The Scottish Cancer Registry produces statistics on cancer in Scotland.

Statistics on cancer in Wales are produced by the Welsh Cancer Intelligence and Surveillance Unit.

The Northern Ireland Cancer Registry produces statistics on cancer in Northern Ireland.

Under the Health and Social Care Act 2012, all Strategic Health Authorities ceased to exist from 1 April 2013. In line with recent changes to the NHS, the functions, accountability and form of Cancer Networks will also change during 2013. These changes are yet to be finalised but it is likely that there will be fewer Cancer Networks, each covering a larger geographical area, and that the Networks will cover a broad range of conditions in addition to cancer. ONS plan to review the format and content of the Geographic Patterns of Cancer Survival in England publication in line with these changes before the next annual update.

Users and uses

Key users of cancer survival estimates include the Department of Health, academics and researchers, cancer charities, cancer registries, other government organisations, researchers within ONS, the media, and the general public. The Department of Health uses cancer survival figures to brief parliamentary ministers, and as part of the evidence base to inform cancer policy and programmes, for example in drives to improve survival rates. Cancer survival estimates will also be used to measure progress against NHS Outcomes Framework indicators. Academics and researchers use the figures to inform their own research. Similarly cancer registries and other government organisations use the figures to carry out individual and collaborative projects to apply subject knowledge to practice. Charities use the data so they can provide reliable and accessible information about cancer to a wide range of groups, including patients and health professionals via health awareness campaigns and cancer information leaflets/web pages. Researchers within ONS use the data to support further research and to publish alongside other National Statistics.

Policy context

In ‘Improving Outcomes: A Strategy for Cancer’ (January 2011), the Department of Health stated 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 estimates 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 from the OECD website). Survival for colon, lung and breast cancer in the England, Northern Ireland and Wales was confirmed to be low compared to Australia, Canada, Norway and Sweden in a recent study (Coleman et al., 2011). The strategy document sets out how the Department of Health aims to improve outcomes for all cancer patients and improve cancer survival, with the aim of saving an additional 5,000 lives every year by 2014/15.

Outcomes strategies set out how the 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 2013 to 2014 – focus on measuring health outcomes include one- and five-year cancer survival indicators for all cancers combined, and for colorectal, breast and lung cancers combined.

References

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 in Medical and Population Subjects no. 61. London: The Stationery Office.

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

Coleman MP, Forman D, Bryant H, 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), 127-138.

Danieli C, Remontet L, Bossard N, Roche L and Belot A (2012). Estimating net survival: the importance of allowing for informative censoring. Statistics in Medicine, 31, 775-786.

Pohar Perme M, Stare J and Estève J (2012). On estimation in relative survival. Biometrics, 68, 113-120.

StataCorp (2011). STATA statistical software, Version 12. College Station, Texas, Stata Corporation.

Authors

Milena Falcaro1, Michel P. Coleman1, Sarah Whitehead2, and Bernard Rachet1

Notes for Authors

  1. Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine
  2. Cancer Analysis Team, Office for National Statistics

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 and 99 years with a primary, invasive, malignant neoplasm at one of the eight specified sites. Records of patients registered only from a death certificate or diagnosed with a benign or in situ tumour or a tumour that could not be classified as definitely malignant were excluded. For further details of the exclusion criteria see Coleman et al. (2004).

  2. There has been a change in the statistical methods used to calculate survival estimates, with net survival estimates replacing relative survival estimates for patients followed up to 2011. For further information on this change in methods, see the Cancer survival in England: patients diagnosed 2006-2010 and followed up to 2011 statistical bulletin.

  3. Net survival is the survival that we would observe if cancer were the only cause of death. It is estimated by assuming the all-cause mortality to be the sum of the excess mortality due to cancer and the background or expected mortality. Expected mortality is derived from general population life tables stratified by age, sex, calendar year, deprivation and geographic region. Patients who were known to have died on the same day as they were diagnosed were included in the analyses with a survival time of one day. Estimation of net survival was carried out with the non-parametric Pohar-Perme estimator (Pohar Perme et al., 2012) as implemented in Stata 12 (Statacorp, 2011) using the ‘stns’ command. This method adjusts for the informative censoring that arises when, for example, the death from cancer of elderly patients is less likely to be observed because of a higher competing risk of death from other causes (Danieli et al., 2012). For convenience, net survival is expressed as a percentage in the range 0–100%.

  4. Net survival varies with age at diagnosis and the age profile of patients can vary with time and between geographical areas. To enable comparison of overall survival (survival for all ages combined) over long periods of time or between geographical areas, age-standardised estimates are calculated as a weighted sum of the age-specific survival estimates, weighted by a standard age distribution. Here, we used the weights from the age distribution of cancer patients diagnosed during 1986–1990 in England and Wales, as presented in Coleman et al. (1999). This enables direct comparison with survival figures over the last 20 years. 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).

  5. Net survival is estimated for each year during the period 2002–2006 (these results are not age-standardised). The annual trend in survival is calculated using variance-weighted least squares regression and is reported only if at least three annual survival estimates are available and the absolute difference in survival between two consecutive years is not higher than 20%.

  6. Transitional-cell papillomas of the bladder diagnosed from 2000 onwards were reclassified from malignant to non-malignant. Non-malignant tumours are excluded from these analyses. Survival from transitional-cell papillomas is high. Excluding them from the analysis reduces the overall estimate of survival from bladder cancer. Geographic variation in the speed with which the changes in pathological classification were applied affects the geographic pattern of survival.

  7. 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.

  8. Previous analyses for Government Office Regions (now named Regions), Strategic Health Authorities and Cancer Networks have been published on the ONS website. These analyses used the relative survival method and not the net survival approach taken for this statistical bulletin.

  9. Under the Health and Social Care Act 2012, all Strategic Health Authorities ceased to exist from 1 April 2013. In line with recent changes to the NHS, the functions, accountability and form of Cancer Networks will also change during 2013. These changes are yet to be finalised but it is likely that there will be fewer Cancer Networks, each covering a larger geographical area, and that the Networks will cover a broad range of conditions in addition to cancer. ONS plan to review the format and content of the Geographic Patterns of Cancer Survival in England publication in line with these changes before the next annual update.

  10. A list of the names of those given pre-publication access to the statistics and written commentary is available in Pre-release Access List: Geographic Patterns of Cancer Survival in England. The rules and principles which govern pre-release access are featured within the Pre-release Access to Official Statistics Order 2008.

  11. Special extracts and tabulations of cancer data for England are available to order for a charge (subject to legal frameworks, disclosure control, resources and agreement of costs, where appropriate). Such enquiries should be made to:

    Cancer and End of Life Care Analysis Team
    Life Events and Population Sources Division
    Office for National Statistics
    Government Buildings
    Cardiff Road
    Newport
    NP10 8XG
    Tel: +44 (0)1633 456021
    Email: cancer.newport@ons.gsi.gov.uk

    The ONS Charging Policy is available on the ONS website.

  12. We welcome feedback from users on the content, format and relevance of this release. The Health and Life Events User Engagement Strategy and Plan is available to download from the ONS website.

  13. Follow ONS on Twitter and Facebook.

  14. The next publication date is still to be confirmed, but is provisionally March/April 2014.

  15. Details of the policy governing the release of new data are available from the UK Statistics Authority website or from the Media Relations Office.

    The UK Statistics Authority has designated these statistics as National Statistics, in accordance with the Statistics and Registration Service Act 2007 and signifying compliance with the Code of Practice for Official Statistics.

    Designation can be broadly interpreted to mean that the statistics:

    • meet identified user needs;

    • are well explained and readily accessible;

    • are produced according to sound methods; and

    • are managed impartially and objectively in the public interest.

    Once statistics have been designated as National Statistics it is a statutory requirement that the Code of Practice shall continue to be observed.

    © Crown copyright 2013
    You may use or re-use this information (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this license visit The National Archives or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email psi@nationalarchives.gsi.gov.uk.
     
    Issued by:
    Office for National Statistics, Government Buildings, Cardiff Road, Newport NP10 8XG
     
    Media contact:
    Tel:  Media Relations Office    +44 (0)845 6041858
    Emergency on-call    +44 (0)7867 906553
    Email:  media.relations@ons.gsi.gov.uk

    Produced in partnership with

     
     

  16. 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

Statistical contacts

Name Phone Department Email
Sarah Whitehead +44 (0)1633 456021 Cancer Analysis Team cancer.newport@ons.gsi.gov.uk
Get all the tables for this publication in the data section of this publication .
Content from the Office for National Statistics.
© Crown Copyright applies unless otherwise stated.