Surviving cancer in the UK and other places

Over the years a number of surveys have concluded that, despite progressive improvements, the UK five-year survival rates for common cancers are worse than the European average by 5 to 15%. The most recent of these has just emerged, comparing survival from four of the most important cancers – breast, bowel, lung and ovarian – at one and five years following diagnosis between 1995 and 2007 in the UK, Denmark, Norway, Sweden, Australia and Canada. Their conclusion was that, despite improvements in survival rates, the disparities remain and that the life expectancy of cancer patients in the UK is shorter than in other countries.

Before we get too downcast by these facts we should note that the UK five-year survival rate for breast cancer, for example, has now reached 82% whereas 40 years ago it was 40%. However, the UK clearly has a problem for which there might be three broad causes: (1) later diagnosis, (2) more aggressive forms of the disease, (3) variable standard of treatment.  It seems probable that all three play a part.

Where you live in the UK bears significantly on your cancer risk.  The National Cancer Intelligence Centre has produced a Cancer Atlas that compares incidence and death rate from the 21 most common cancers in different counties of the UK.  The differences reflect levels of smoking, drinking, poor diet and social deprivation and show that regions of northern England and Scotland are cancer ‘hot spots’.  Their estimate is that if the worst areas could be converted to the best there would be 25,000 fewer new cases and 17,000 fewer deaths a year: with about 156,000 cancer deaths per year that would represent an 11% decrease.

One sensible plan might be to concentrate cancer care into a smaller number of centres of expertise, along the lines of what has been proposed for heart disease.

World, USA and UK cancer deaths 2008.

Reference

Coleman, M.P., Forman, D., Bryant, H., Butler, J., Rachet, B., Maringe, C., Nur, U., Tracey, E., Coory, M., Hatcher, J., McGahan, C.E., Turner, D., Marrett, L., Gjerstorff, M.L., Johannesen, T.B., Adolfsson, J., Lambe, M., Lawrence, G., Meechan, D., Morris, E.J., Middleton, R., Steward, J., Richards, M.A. and the ICBP Module 1 Working Group. (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, 127–138.

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2 comments on “Surviving cancer in the UK and other places

  1. I guess concentrating cancer care into fewer centres of excellence would address the variable standards of treatment, but how do we deal with earlier diagnosis and why do we think the uk has more aggressive forms of cancer? I, like many of my fellow bowel cancer sufferers and pretty narked to put it mildly on the incidences if late diagnosis of bowel cancer and can only draw conclusions that the rest if the world have made greater progress here. I was told that we should not expect doctors to be up to speed on all the warning signs of up to 200 cancers and it is therefore up to us as patients to get to know our bodies and be aware and prompt our docs into action! Is this a general shift in the medical profession, in which case with 2 out of 3 of us predicted to get cancer, shouldnt we all be doing GCSEs or degrees to be on red alert? And how do we avoid hypochondria setting in from an early age? Sorry, you prompted so many questions!

    • First, I don’t know of any evidence that more aggressive forms of the common cancers in localized areas affect the general stats, in the UK or elsewhere. It’s just a formal possibility that could, say, distort the figures in a given region. Much clearer is that the UK does lag behind most European countries and the USA in survival rates. For breast cancer there is evidence that the standard of both diagnosis and treatment varies from region to region in the UK, so the local variation is even greater. There are several factors that could contribute to this but overall it does seem to be an argument for fewer, more specialized centres, as has been proposed for heart disease. On the point about not expecting doctors to be ‘up to speed’ I was a bit horrified – I don’t know who’s said that but I don’t think it reflects what medics think. If they’re saying ‘we should all know something about how our bodies work and act on any changes that we note’ I couldn’t agree more – it’s one of the reasons for writing Betrayed by Nature! But the argument that all cancers are different so we can’t expect medics to know what they’re doing is just silly and indefensible.

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