1. Key findings

  • One- and five-year net survival continued to improve for cancers of the oesophagus, stomach, colon, lung, breast (women) and cervix for adults diagnosed in England 1997-2012. The smallest improvement in one-year survival was for cervical cancer (from 82.3% to 85.0%) and the greatest improvement was for oesophageal cancer in men (from 28.4% to 46.1%)
  • For adults diagnosed in 2012, the range in one-year survival between NHS England Area Teams was widest for women with oesophageal cancer (ranging from 34.3% to 48.9%), and narrowest for women with breast cancer (ranging from 95.7% to 97.3%)
  • For the period 1997 to 2012, the range in one-year survival between NHS England Area Teams narrowed for cancers of the colon (both sexes), oesophagus (men), breast (women) and cervix
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2. Summary

This report presents one-year and five-year age-standardised net survival estimates for the 25 NHS England Area Teams, for adults who were diagnosed with a cancer of the oesophagus, stomach, colon, lung, breast (women) or cervix during 1997–2012 and followed up to 31 December 2013 (see background notes 1 and 2). One-year survival estimates are reported for adults diagnosed in 1997, 2002, 2007 and 2012, and five-year survival estimates for those diagnosed in 1997, 2002 and 2007 to show trends over time.

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3. Collaboration

This publication is produced in partnership with the Cancer Research UK Cancer Survival Group, at the London School of Hygiene and Tropical Medicine.

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4. Results

The 25 NHS England Area Teams were created on 1 April 2013 (see Figure 2, NHS England Area Team boundaries). For the purpose of these analyses, patients have been assigned to the Area Team that currently includes their residence when they were diagnosed between 1997 and 2012.

Estimates of one-year and five-year age-standardised net survival (%) are presented for each of the six cancers in tables and charts for each NHS England Area Team, sex and calendar period. The survival estimates are age-standardised to compensate for differences in the age profile of cancer patients between Area Teams, and for changes in these age profiles over time (see Background Note 4). Differences between survival estimates for the two periods are taken as the arithmetic difference: for example, 12% is shown as 2% (not 20%) higher than 10%.

One-year survival is above 60% for cancers of the colon, breast and cervix, and five-year survival is above 45% (Figures 1A and 1B). For cancers of the oesophagus, stomach and lung however, one-year survival is below 50% and five-year survival below 20%.

At a national level, an upward trend in net survival was observed for all six cancers. The largest improvement in one-year survival between 1997 and 2012 among men occurred for cancers of the oesophagus (17.7%) and stomach (14.2%), while five-year survival for men with colon cancer increased by 8.4% between 1997 and 2007. For women, the largest improvement in one-year survival was for cancer of the oesophagus (14.2%), while five-year survival for women with breast and colon cancer increased by 8.2% and 8.1% respectively. The smallest increase at the national level for one-year survival was cervical cancer (2.7%) and for five-year survival was lung cancer in men (2.3%).

The range in one-year survival between NHS England Area Teams with the highest and lowest survival was widest for women with oesophageal cancer in 2012 (14.6%), and the narrowest was for women with breast cancer (1.6%) (Table 1A). In general, the range in one-year net survival across the 25 NHS England Area Teams is widest (8.9% or more) for the cancers where one-year survival is below 50% (oesophagus, stomach and lung). For five-year survival, the range between NHS England Area Teams was widest for women diagnosed in 2007 with colon cancer (13.9%) and narrowest for men diagnosed with lung cancer (3.7%) (Table 1B).

These estimates should not be used to rank NHS England Area Teams by their survival, because a change of just 1 or 2% may radically alter the ranking of a given Area Team, especially where the range of estimates is very narrow.

The geographic range in colon cancer survival has narrowed considerably for both sexes since 1997, especially for one-year survival: from 14.1% in 1997 to 7.2% in 2012 for men, and 17.1% in 1997 to 7.9% in 2012 for women.

The geographic patterns of one-year survival (adults diagnosed in 2012) and five-year survival (adults diagnosed in 2007) are mapped in Figures 3A-8.

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5. NHS England Area Team boundaries

Figure 2: NHS England Area Team boundaries, 2014

Source: Office for National Statistics, Ordnance Survey
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6. Oesophageal cancer

One-year age-standardised net survival improved considerably for adults diagnosed between 1997 and 2012. However, one-year survival for adults diagnosed in 2012 was still low and ranged between 37.4% and 49.7% for men and between 34.3% and 48.9% for women. One-year net survival more than doubled in two NHS England Area Teams for men: Durham, Darlington and Tees (increased from 24.5% to 49.6%) and Greater Manchester (increased from 19.1% to 48.2%). One-year age-standardised net survival more than doubled in two NHS England Area Teams for women: Greater Manchester (from 19.2% to 48.9%) and Lancashire (from 19.2% to 39.0%) (Tables and Figures: A1 and A2). The range of five-year age-standardised net survival between NHS England Area Teams in 2007 was 6.8% in men and 5.1% in women (Table 1B).

Figure 3A: One-year age-standardised net survival (%) from oesophageal cancer for adults diagnosed 2012, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

Figure 3B: Five-year age-standardised net survival (%) from oesophageal cancer for adults diagnosed 2007, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine
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7. Stomach cancer

One-year age-standardised net survival ranged from between 40.8% and 50.5% in men and between 33.7% and 46.5% in women (Tables and Figures: B1 and B2). Five-year age-standardised net survival doubled in two NHS England Area teams for men between 1997 and 2007: Lancashire and Cumbria, Northumberland, Tyne and Wear (Tables and Figures: B3 and B4). The range of five-year age-standardised net survival between NHS England Area Teams in 2007 was 8.0% in men and 6.5% women (Table 1B).

Figure 4A: One-year age-standardised net survival (%) from stomach cancer for adults diagnosed 2012, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

Figure 4B: Five-year age-standardised net survival (%) from stomach cancer for adults diagnosed 2007, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine
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8. Colon cancer

One-year age-standardised net survival of NHS England Area Teams ranged between 73.2% and 80.4% in men, and between 68.1% and 76.0% in women (Tables and Figures: C1 and C2). All NHS England Area Teams saw improvements in survival for those diagnosed in 2012 compared to those diagnosed in 1997. Five-year age-standardised net survival ranged between 52.0% and 59.3% in men, and between 45.3% and 59.2% in women (Tables and Figures: C3 and C4).

Figure 5A: One-year age-standardised net survival (%) from colon cancer for adults diagnosed 2012, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

Figure 5B: Five-year age-standardised net survival (%) from colon cancer for adults diagnosed 2007, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine
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9. Lung cancer

One-year age-standardised net survival improved during 1997-2012. However, one-year net survival remains low ranging between 29.3% and 38.2% in men and between 32.8% and 42.8% in women (Tables and Figures: D1 and D2). Five-year age-standardised net survival for men has doubled between 1997 and 2007 in Greater Manchester, and survival for women has doubled in four NHS Area Teams: Lancashire, South Yorkshire and Bassetlaw, Bristol, North Somerset, Somerset and South Gloucestershire and Kent and Medway (Tables and Figures: D3 and D4). The range of five-year age-standardised net survival between NHS England Area Teams was 3.7% in men and 5.8% in women (Table 1B).

Figure 6A: One-year age-standardised net survival (%) from lung cancer for adults diagnosed 2012, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

Figure 6B: Five-year age-standardised net survival (%) from lung cancer for adults diagnosed 2007, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine
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10. Breast cancer (women)

One-year age-standardised net survival was above 95% in all NHS England Area Teams, with a narrow range between the highest and the lowest survival among Area Teams (Table and Figure: E1). Five-year age-standardised net survival was above 82%, with a range of 3.8% between NHS England Area Teams (Table and Figure: E2).

Figure 7: One-year and five-year age-standardised net survival (%) from breast cancer (women) for adults diagnosed 2012 and 2007 respectively, by NHS England Area Team

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine
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11. Cervical cancer

One-year age-standardised net survival improved between 1997 and 2012, for most of the NHS England Area Teams. The largest improvement was in Leicestershire and Lincolnshire (8.9%). For five-year survival, the largest improvement between 1997 and 2007 was in Merseyside (9.5%). However one-year survival declined slightly between 1997 and 2012 in four NHS England Area Teams: Essex, East Anglia, Thames Valley and Birmingham and the Black Country. Five-year survival declined between 1997 and 2007 in three NHS England Area Teams: Essex, Birmingham and the Black Country and Thames Valley (Tables and Figures: F1 and F2).

Figure 8: One-year and five-year age-standardised net survival (%) from cervical cancer for adults diagnosed 2012 and 2007 respectively, by NHS England Area Team

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine
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12. Data quality information

All adults (15-99 years) who were diagnosed with a first, invasive, primary, malignancy during the period 1997-2012 were eligible for inclusion in the analyses. Patients were excluded if they were diagnosed with a tumour that was benign (behaviour code 0), in situ (2) or of uncertain behaviour (1). Patients were also excluded if their cancer was only registered from a death certificate. Patients with zero recorded survival time were included in the analyses with one day added to their survival. Table 2 shows the number of patients excluded and Table 3 shows the final number of patients in each NHS England Area Team who were included in the analyses.

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13. Users and uses

Key users of cancer survival estimates include the Department of Health, academics and researchers, cancer charities, cancer registries, other government organisations and researchers within ONS, the media, and the general public. The Department of Health uses cancer survival figures to brief government ministers, and as part of the evidence base to inform cancer policy and programmes, for example in drives to improve survival. Cancer survival estimates published by ONS are also included as indicators in the NHS Outcomes Framework 2013 to 2014 and the Clinical Commissioning Group Indicator Set, which are used to hold the NHS and commissioners to account. Academics and researchers use the figures to inform their research. Similarly Public Health England and other government organisations use the figures to carry out individual and collaborative projects. Charities use the data to 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.

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14. 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) (OECD website). 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 focuses on measuring health outcomes includes one- and five-year cancer survival indicators for all cancers combined, and for colorectal, breast and lung cancers combined.

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15. Authors

Ula Nura, Michel P Colemana, Neil Bannisterb, Rose Drummondb, Stephen Rowlandsb, Paul Brownb, Bernard Racheta

a Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine

b Cancer Analysis Team, Office for National Statis

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16. 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 National Cancer Registration Service in England, which provided the raw data for these analyses.

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17 .Additional information

Further information about cancer survival estimates published by ONS can be found in the Cancer Survival Quality and Methodology Information paper. These are overview notes containing key qualitative information on the quality of statistics and a summary of the methods used to compile the output.

Statistics on cancer are produced:

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18 .References

Akaike H (1974) 'A new look at statistical-model identification', IEEE Transactions on Automatic Control 19, pp 716-723

Cancer Research UK Cancer Survival Group (2009) Life tables for England and Wales by sex, calendar period, region and deprivation (02/12/2014)

Danieli C, Remontet L, Bossard N, Roche L, Belot A (2012) 'Estimating net survival: the importance of allowing for informative censoring', StatMed 31, pp 775-786

Lambert PC, Royston P (2009) 'Further development of flexible parametric models for survival analysis', Stata Journal 9, pp 265-290

Statacorp (2013) STATA statistical software. College Station, TX: Stata Corporation

World Health Organization (1994) International statistical classification of diseases and related health problems. Tenth revision. Geneva: WHO

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19 .Background notes

  1. National cancer registration data for England were received from the National Cancer Registry at ONS, which collates cancer registrations submitted by the National Cancer Registration Service in England. The Health and Social Care Information Centre (HSC IC) updates these records with the date of death or emigration. The data used in these analyses were extracted from the live database at ONS on 22 May 2014 and provided to the Cancer Research UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine on 20 June 2014.

  2. Net survival in a population of cancer patients is their survival from the cancer of interest in the absence of other causes of death. It was estimated at one and five years after diagnosis for each cancer, sex and year of diagnosis. Net survival was estimated with an excess hazard model in which the all-cause mortality is modelled as the sum of the excess (cancer-related) mortality hazard and the expected (or background) mortality. The background mortality is defined by life tables from the general population. This approach enables population-level cancer survival to be estimated without data on the cause of death. To obtain an unbiased estimation of net survival, age is modelled to account for the informative censoring associated with age (Danieli et al, 2012).

    We used flexible parametric models (Lambert and Royston, 2009) with age and year of diagnosis as main effects and an interaction between age and year of diagnosis. We also examined interactions between year and follow-up time, and between age and follow-up time, to deal with potential non-proportionality of the excess hazards over time since diagnosis. The Akaike Information Criterion (AIC) (Akaike, 1974) was used to select the best-fitting statistical model using the relative goodness of fit.

    The publicly available program, stpm2, was used to estimate net survival (Lambert and Royston, 2009). Analyses were performed in Stata 13 (Statacorp, 2013).

  3. Life tables were constructed for the years 1997, 2002, and 2007 using the mid-year population estimates and the mean annual number of deaths in the three years centred on those index years (Cancer Research UK Cancer Survival Group, 2009). Life tables for each year from 1997 to 2005 were created by linear interpolation. The life table for 2005 was used for 2006-13. Background mortality changes with time and varies by sex, age, socio-economic status and region, so life tables were created by single year of age, sex, region and deprivation quintile for each calendar year of death.

  4. The age distribution of cancer patients at diagnosis changes with time and varies between NHS England Area Teams. Since survival also varies with age at diagnosis, robust summary comparisons of survival require control for these differences. The directly standardised overall survival figure for each cancer is a weighted average of the age-specific survival estimates, with standard weights taken from the proportionate distribution by age and sex of patients diagnosed in England and Wales during 1996-99.

    Age-standardisation requires a set of survival estimates for each age group. It is not always possible to obtain an estimate for each combination of cancer, age group, sex and calendar year of diagnosis in geographic units with small populations because of the limited number of cases. In this situation, the missing estimate was replaced by the equivalent age-specific estimate for England.

  5. A 95% confidence interval is a measure of the uncertainty around an estimate. It provides a range of values which contains the true population value with a 95% level of confidence.

  6. NHS England was established on 1 April 2013, when the Health and Social Care Act 2012 came into force. There are 25 NHS England Area Teams. The role of the Area Teams includes commissioning of primary care services (such as GP, dental and pharmacy services), supporting and developing Clinical Commissioning Groups, and working with local NHS and public health organisations. The NHS England Area Team boundaries were applied to the whole period 1997-2012, enabling geographic trends to be charted over time (Figure 1). NHS England Area Team populations range from 1.1 to 7.7 million (2011 figures) (Office for National Statistics, 2013) which makes them more suitable for detailed statistical comparison of survival than smaller health geographies such as Clinical Commissioning Groups.

  7. Cancers were defined by codes in the International Classification of Diseases, Tenth Revision (ICD-10) and International Classification of Diseases for Oncology, Second Edition (ICD-O-2), (World Health Organization, 1994) see Table 2.

  8. The six cancer sites presented in this bulletin were chosen in collaboration with Department of Health in order to represent a variety of cancer types. In particular these six cancers vary in terms of prognosis and contain some cancers for which there is a screening programme for diagnosis in England, and others for which there is no screening programme.

  9. Differences between survival estimates are taken as the arithmetic difference: for example, 12% is shown as 2% (not 20%) higher than 10%. Survival figures are rounded to one decimal place, but the differences are based on the exact underlying figures.

  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: Cancer survival by NHS England Area Team: adults diagnosed 1997-2012, followed up to 2013. 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
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    Newport
    NP10 8XG
    Tel: +44 (0)1633 455704
    Email: cancer.newport@ons.gsi.gov.uk

  12. We would welcome feedback on the content, format and relevance of this release. Please contact cancer.newport@ons.gsi.gov.uk.

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  14. Next publication date: December 2015.

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Contact details for this Statistical bulletin

Neil Bannister
cancer.newport@ons.gsi.gov.uk
Telephone: +44 (0)1633 455704