Relative survival (RS) estimates are widely used by cancer registries, mainly because they do not rely on the well-documented deficiencies of cause of death information. The aim of our study was to compare 5-year cause-specific survival (CSS) estimates and 5-year RS estimates for different cancer sites by age and time since diagnosis, and discuss possible reasons for observed differences. Using data from the Cancer Registry of Norway, we identified 200,008 patients diagnosed with cancer at one of the 48 sites included in this analysis during the period 1996-2005, and followed them up until the end of 2010. CSS estimates were calculated (i) considering cause of death to be the cancer that was originally diagnosed and (ii) considering the cause of death to be a cancer within the same organ system. For most cancer sites the difference between CSS and RS estimates was small (
Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Section of Cancer Information, International Agency for Research on Cancer, Lyon, France. Electronic address: Patricia.Valery@menzies.edu.au.
Although the cancer burden in indigenous children has been reported in some countries, up to now, no international comparison has been made. We therefore aimed to assess the available evidence of the burden of childhood cancer in indigenous populations. We did a systematic review of reports on cancer incidence, mortality, and survival in indigenous children worldwide. Our findings highlight the paucity of accessible information and advocate the pressing need for data by indigenous status in countries where population-based cancer registries are established. The true extent of disparities between the burden in the indigenous community needs to be measured so that targeted programmes for cancer control can be planned and implemented.
To examine differences in the relative survival and excess death rates of patients with colorectal cancer in Norway, Sweden and England.
All individuals diagnosed with colorectal cancer (ICD10 (International Classification of Diseases, 10th revision) C18-C20) between 1996 and 2004 in England, Norway and Sweden were included in this population-based study of patients with colorectal cancer. The main outcome measures were 5-year cumulative relative period of survival and excess death rates stratified by age and period of follow-up.
The survival of English patients with colorectal cancer was significantly lower than was observed in both Norway and Sweden. Five-year age-standardised colon cancer relative survival was 51.1% (95% CI 50.1% to 52.0%) in England compared with 57.9% (95% CI 55.2% to 60.5%) in Norway and 59.9% (95% CI 57.7% to 62.0%) in Sweden. Five-year rectal cancer survival was 52.3% (95% CI 51.1% to 53.5%) in England compared with 60.7% (95% CI 57.0% to 64.2%) and 59.8% (95% CI 56.9% to 62.6%) in Norway and Sweden, respectively. The lower survival for colon cancer in England was primarily due to a high number of excess deaths among older patients in the first 3 months after diagnosis. In patients with rectal cancer, excess deaths remained elevated until 2 years of follow-up. If the lower excess death rate in Norway applied in the English population, then 890 (13.6%) and 654 (16.8%) of the excess deaths in the colon and rectal cancer populations, respectively, could have been prevented at 5 years follow-up. Most of these avoidable deaths occurred shortly after diagnosis.
There was significant variation in survival between the countries, with the English population experiencing a poorer outcome, primarily due to a relatively higher number of excess deaths in older patients in the short term after diagnosis. It seems likely, therefore, that in England a greater proportion of the population present with more rapidly fatal disease (especially in the older age groups) than in Norway or Sweden.
Evidence from clinical, population-based and molecular studies has shown that human papillomavirus (HPV) infection can be a causal risk factor for a subset of head and neck squamous cell carcinomas (HNSCC). It is proposed that HPV-associated oropharyngeal cancer is a new disease entity that requires treatment and prevention strategies distinct from present recommendations.
In our population-based study we estimated incidence and survival trends in 8270 patients with HPV-related HNSCC (HPV(+)HNSCC) and HPV-unrelated HNSCC (HPV(-)HNSCC) in Norway over the past three decades.
In the period 1981-1995, patients with HPV(+)HNSCC had poorer survival than HPV(-)HNSCC (adjusted hazard ratio (HR) 1.3, 95% confidence interval (CI): 1.14-1.44). By 1996-2007, survival had increased in both groups, but the increase was significantly greater among HPV(+)HNSCC patients (HR 0.57, 95% CI: 0.48-0.67). During the same period, incidence also increased, but only for HPV(+)HNSCCs. From 1981-1995 to 1996-2007, median age at diagnosis for HPV(+)HNSCC decreased from 63.2 to 59.8 years, while for HPV(-)HNSCC median age at diagnosis of 66.6 years remained unchanged.
We demonstrate a population level improvement in survival among patients with oropharyngeal squamous cell cancers commonly related to infection with HPV. In contrast, patients with HNSCC not related to HPV only showed a modest improvement in survival in the period 1981-2007. A concomitant increase in incidence and survival was observed for HPV-related cancers only. This trend cannot be explained by changes in treatment, cancer registration nor screening, but is most likely due to an increased prevalence of HPV-positive tumours.
Survival from breast cancer is lower in the UK than in some other European countries. We compared survival in England and Norway by age and time from diagnosis.
We included 303,648 English and 24,919 Norwegian cases of breast cancer diagnosed 1996-2004 using flexible parametric relative survival models, enabling improved quantification of differences in survival. Crude probabilities were estimated to partition the probability of death due to all causes into that due to cancer and other causes and to estimate the number of "avoidable" deaths.
England had lower relative survival for all ages with the difference increasing with age. Much of the difference was due to higher excess mortality in England in the first few months after diagnosis. Older patients had a higher proportion of deaths due to other causes. At 5 years post diagnosis, a woman aged 85 in England had probabilities of 0.35 of dying of cancer and 0.32 of dying of other causes, whilst in Norway they were 0.26 and 0.35. By eight years the number of "avoidable" all-cause deaths in England was 1020 with the number of "avoidable" breast cancer related deaths 1488.
Lower breast cancer survival in England is mainly due to higher mortality in the first year after diagnosis. Crude probabilities aid our understanding of the impact of disease on individual patients and help assess different treatment options.
Differences in Nordic cancer patient survival observed today originate from the 1970s, but were first identified in a mortality prediction from 1995. This paper provides timely comparisons of survival using NORDCAN, a database with comparable information from the Nordic cancer registries. Elucidation of the differences is important when monitoring cancer care generally and evaluating the impact of cancer plans. MATERIAL AND METHODS: The NORDCAN database 1964-2003 with follow-up for death through 2006, was used to analyse incidence, mortality, and survival for all NORDCAN cancer sites. We analysed 5-year relative survival and excess mortality rates in the first three months and 2-5 years after diagnosis. RESULTS: The time trends in survival 1989-2003 were largely similar between the Nordic countries with increases in 14 sites among men and 16 among women. In all countries the excess mortality rates were highest in the first three months after diagnosis, but decreased to similar levels across all countries 2-5 years after diagnosis. Comparing countries excess mortality was highest in Denmark irrespective of follow-up period. Lower survival was observed for Danish cancer patients in 23 of the 33 cancer sites in men and 26 of 35 sites in women. Low and similar levels of survival were observed for cancers of the oesophagus, lung, liver and pancreas, while an 8-10 percentage point difference in survival was found between countries for colorectal cancer. CONCLUSION: The notable differences in Nordic cancer patient survival can be linked to national variations in risk factors, co-morbidity, and the implementation of screening. Improved treatment and primary prevention, in particular the targeting of tobacco and alcohol use, is required to improve cancer control. The recently-initiated cancer plans in Denmark and Norway are yet to show an observable effect on the corresponding cancer survival.
Cancers of the digestive organs (including the oesophagus, stomach, small intestine, colon, rectum and anus, liver, gallbladder, and pancreas) constitute one-fifth of all cancer cases in the Nordic countries and is a group of diseases with diverse time trends and varying consequences for public health. In this study we examine trends in relative survival in relation to the corresponding incidence and mortality rates in the Nordic countries during the period 1964-2003. MATERIAL AND METHODS: Data were retrieved from the NORDCAN database for the period 1964 to 2003, grouped into eight 5-year periods of diagnosis. The patients were followed up until the end of 2006. Analysis comprised trends in 5-year relative survival, excess mortality and age-specific relative survival. RESULTS: Survival following cancers of the colon and rectum has increased continuously over the observed period, yet Danish patients fall behind those in the other Nordic countries. The largest inter-country variation is seen for the rare cancers in the small intestine. There has been little increase in prognosis for patients diagnosed with cancers of the liver, gallbladder or pancreas; 5-year survival is generally below 15%. Survival also remains consistently low for patients with oesophageal cancer, while minor increases in survival are seen among stomach cancer patients in all countries except Denmark. The concomitant incidence and mortality rates of stomach cancer have steadily decreased in each Nordic country at least since 1964. CONCLUSION: While the site-specific variations in mortality and survival largely reflect the extent of changing and improving diagnostic and clinical practices, the incidence trends highlight the importance of risk factor modification. Alongside the ongoing clinical advances, effective primary prevention measures, including the control of alcohol and tobacco consumption as well as changing dietary pattern, will reduce the incidence and mortality burden of digestive cancers in the Nordic countries.
BACKGROUND: Diagnoses of cancer of the brain, thyroid, eye, bone, and soft tissues are categorised by heterogeneity in disease frequency, survival, aetiology and prospects for curative therapy. In this paper, temporal trends in patient survival in the Nordic countries are considered. MATERIAL AND METHODS: Age-standardised incidence and mortality rates, 5-year relative survival, and excess mortality rates for varying follow-up periods are presented, as are age-specific 5-year relative survival by country, sex and 5-year diagnostic period. RESULTS: Brain cancer incidence rates have been rising but mortality has been relatively stable, with 5-year survival uniformly increasing from the early-1970s, particularly in younger patients. Five-year survival from brain cancer among men varies between 45% and 50% for men and 60% to 70% in women, with excess deaths decreasing with time in each of the Nordic populations. Age-standardised incidence rates of thyroid cancer have been mainly increasing during the 1960s and 1970s, although trends thereafter diverge, with 5-year relative survival increasing 20-30 percentage points over the last 40 years to around 80-90%. Thyroid cancer survival is consistently lower in Denmark, particularly in patients diagnosed aged over 60, while there is less geographic variation in excess deaths three months beyond initial diagnosis. Relative survival from eye cancer increased with time from approximately 60% in 1964-1968 to 80% 1999-2003, while for bone sarcoma, incidence rates remained stable, mortality rates declined, and 5-year survival increased slightly to around 55-65%. Soft tissue sarcoma incidence and survival have been slowly increasing since the 1960s, with little variation in survival (around 65%) for the most recent period. CONCLUSIONS: There have been some notable changes in survival that can be linked to epidemiological and clinical factors in different countries over time. Time-varying proportions of the major histological subtypes might however have affected the survival estimates for a number of the cancer forms reviewed here.
BACKGROUND: Prostate, testicular and penile cancer constitute about one-third of the cancer incidence burden among Nordic males, but less than one-fifth of the corresponding mortality. The aim of this study is to describe and interpret trends in relative survival and excess mortality in the five Nordic populations. MATERIAL AND METHODS: Age-standardised incidence and mortality rates, 5-year relative survival, and excess mortality rates for varying follow-up periods are presented, as are age-specific 5-year relative survival by country, sex and 5-year diagnostic period. RESULTS: The vast majority of male genital cancer incident cases and deaths are prostate cancers, with 5-year and 10-year survival trends resembling the diagnostic-led increasing incidence over the past 25 years. Five-year prostate cancer survival is estimated at 53% in Denmark compared to 78% or above in the other Nordic populations for patients diagnosed 1999-2003. Excess mortality has declined over time, with Denmark having a greater excess of deaths compared to the other countries, irrespective of time of diagnosis. Concomitant with the declines in testicular cancer mortality, testicular cancer survival has increased since the 1970s in each Nordic country. Men diagnosed with testicular cancer in recent decades have had, on average, a continually better prognosis with time, with relative 5-year survival for patients diagnosed 1999-2003 ranging from 88% in Finland to 94% in Sweden. For the few patients diagnosed with cancer of the penis and other male genital organs, survival trends have been rather stable over time, with recent 5-year relative survival estimates ranging from 62% in Finland to 80% in Norway. CONCLUSIONS: There are intriguing country-specific and temporal variations in male genital cancer survival in the Nordic countries. Prognosis varies widely by cancer site and relates to both changing diagnostic and clinical practices. The increasing PSA detection and biopsy makes interpretation of the prostate cancer survival trends particularly difficult.
AIM: Overall survival after cancer is frequently used when assessing the health care service performance as a whole. While used by the public, politicians, and the media, it is often discarded by clinicians and epidemiologists due to the heterogeneous mix of different cancers, risk factors and treatment modalities. We studied the trend in the Nordic 5-year relative survival and excess mortality for all cancers combined to see if the impact of case-mix and variations between countries in diagnostic methods such as breast screening and PSA testing could explain the lower survival in Denmark. MATERIAL AND METHODS: From the NORDCAN database 1964-2003, we defined two cohorts of cancer patients, one excluding non-melanoma skin cancer and another also excluding breast and prostate cancer. We estimated age-standardised incidence and mortality rates, 5-year relative survival, and excess mortality rates for varying follow-up periods, and age-specific 5-year relative survival by country, sex and 5-year diagnostic period. RESULTS: Prostate cancer is the main driver of the incidence increase in men, as do breast cancer in women, whereas cancer mortality in all Nordic countries is declining. The 5-year relative survival ratios are increasing in each Nordic population, but less so in Denmark. Country differences in survival stem mainly from follow-up periods immediately after diagnosis. Adjusting for the case-mix of diagnoses diminished differences a little while exclusion of breast and prostate cancer reduced the gap between countries in survival and excess mortality more considerably, yet post-adjustment, Danish patients still fare worse during the first three months after diagnosis. CONCLUSION: Adjustment for case-mix and exclusion of sites where diagnostic procedures change the pattern of incidence is important when comparing overall cancer survival across countries, but the correction only explains part of the observed differences in survival. Other factors such as stage at presentation, co-morbidity, tobacco and alcohol consumption are likely contributors.