Report: Cancer survival in England improving using cancer staging data
Cancer survival in England for breast, lung, prostate, colorectal and ovarian cancer continues to improve, according to new data published in a report from Public Health England’s National Cancer Intelligence Network (NCIN).
This work draws on the huge advances in the quality and completeness of cancer staging data and the timeliness of the information gathered through the National Cancer Registration Service. High-quality, comparable staging data on more than 80% of all cases of the most common cancers now is available for the whole of the country, making England’s National Cancer Registration Service one of the most advanced anywhere in the world.
The report based on this data describes the one-year survival analysis for patients in England first diagnosed in 2012 and sets a new benchmark for timely, robust stage-specific cancer survival analysis as a way of monitoring cancer care in England.
A comparison of all-stage relative survival in 2012 with a baseline of 2004 to 2007 shows increasing survival across all cancer types. Lung cancer survival has risen from 28% to 36.3%, ovarian cancer survival from 68.1% to 74.7%, colorectal cancer survival from 71.5% to 77.7%, prostate cancer survival from 93.1% to 96.6% and breast cancer survival from 94.8% to 96.4%.
Accurate staging data on so many cases has permitted a more robust analysis of stage-specific survival. Survival always is poorer in cancers diagnosed at a later stage. The improvements in stage-specific survival in breast and colorectal cancer have been most marked in later stage cancers, while earlier stage survival improved in lung cancer. Relative survival is worse in older patients, who tend to have their cancer diagnosed at a later stage; in addition, comorbidity and poor general health in older people is likely to have an adverse impact on their cancer survival.
Survival for breast, colorectal, lung and ovarian cancer declines with increasing socio-economic deprivation, while there is no such difference for prostate cancer. These differences also are associated with later stage diagnoses in more deprived patients as well as lower stage-specific survival, which may again be due to higher levels of co-morbidity and poorer general health.
Jem Rashbass, director for disease registration at Public Health England’s National Cancer Registration Service, said, “It is only by having data of this quality that we can hope to understand where we are making progress on cancer diagnosis and treatment and where to focus our efforts, but we are not complacent as there is still more to be done.”
One-year survival calculations can only be performed a year or more after the date of diagnosis of the cancer. Therefore this report is based on 2012 data as that is the most recent that could be used.
The NCIN was established in June 2008 to coordinate the collection, analysis and publication of comparative national statistics on diagnosis, treatment and outcomes for all types of cancer. The NCIN is a U.K. wide partnership funded by multiple stakeholders. The NCIN will drive improvements in the standards of care and clinical outcomes through exploiting data. The NCIN will support audit and research programs by providing cancer information and patient care will be monitored through expert analyses of up-to-date statistics.
For breast, prostate and colorectal cancer, one-year survival is above 90% for stage one to three tumors with a lower survival for stage four. For lung and ovarian tumours, the one-year survival reduced substantially with each increase in stage at diagnosis. Across all cancer types examined, except prostate, there is a modest (6% or less) but statistically significant reduction in one-year survival in the most income-deprived compared to the most affluent.
Central registration of cancer stage at diagnosis has been achieved on over 80% of cases for all these individual cancer sites. It is never possible to stage all cases because some patients are too ill, decline staging investigations or do not live long enough to be investigated.