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UK still behind in cancer survival despite advances

Thursday 12 September 2019

"UK ranks BOTTOM for cancer survival rates for 5 types of tumour including lung and pancreatic, major study finds," reports the Mail Online.

Other UK media outlets also raise fears about the UK's cancer performance, with The Independent stating: "Britain sits at bottom of global league table" and The Guardian reporting: "UK still behind in cancer survival despite recent surge."

But are the headlines fair? Does the UK really perform so badly on cancer care compared to other nations?

What is the basis for these current reports?

The headlines are based on a report from the International Cancer Benchmarking Partnership (ICBP), which includes academics and doctors from several institutions, led by the International Agency for Research on Cancer in France.

The report, published in the peer-reviewed medical journal Lancet Oncology, compared the survival rates of people diagnosed with cancer in 7 high-income countries: the UK, Australia, Canada, Denmark, Ireland, New Zealand and Norway. So although it did compare the UK with other countries, it's not a "global league" – for example it does not include the US, France, Germany, Spain, Italy or any countries from Asia or Africa.

It looked at 7 types of cancer: cancers of the oesophagus (the tube that carries food from the mouth to the stomach), stomach, colon (bowel), rectum (bottom), pancreas, lung and ovary. Some common cancers, such as breast and prostate cancer, were not included.

The report used data from cancer registries to estimate how likely people diagnosed with each cancer were to live for another 1 year or 5 years, assuming they did not die of anything else during that period. This is known as "net survival". The figures were adjusted to take account of people's age, as younger people are more likely to survive cancer than older people.

The researchers looked at changes in cancer survival over a 20-year period, using 4 diagnosis periods:

  • 1995 to 1999
  • 2000 to 2004
  • 2005 to 2009
  • 2010 to 2014

How does the UK compare overall?

The good news is that the UK has improved its survival rates for all types of cancer over the time periods studied – in some cases doubling the numbers who survived for 5 years or more.

But the bad news is that, compared to some other countries, the UK's survival rates are still lower. The UK ranks lowest of the 7 countries for 5 of the 7 cancers measured. And although the gap between countries has narrowed for 1-year survival, it has not changed so much for 5-year survival.

Australia, Norway and Canada generally had better survival rates than New Zealand, Denmark, Ireland and the UK.

Where is the UK doing well?

The UK has shown big improvements in some areas. For example, the 5-year survival rate for oesophageal cancer for people diagnosed in 1995 to 1999 was 8.6%. By 2010 to 2014, that had almost doubled, to 16.2%. However, that's still a lower rate than every other country in the study except for Denmark (14.7%). The best of the countries was Australia with a 23.5% survival rate.

Colon and rectal cancer 5-year survival rates also improved markedly between 1999 and 2014, from around 47% to:

  • 59% for colon cancer
  • 62% for rectal cancer

But the UK still lagged behind all other countries in the study, which had survival rates ranging between 62% and 71% for the 2 cancers.

The 5-year survival for ovarian cancer has also seen a big improvement in the UK, from 27.3% to 37.1%. The improvement puts the UK 5th in the table of 7 countries.

Where is the UK lagging behind?

The cancers where the UK has the lowest 5-year survival rates of the 7 countries are stomach, colon, rectal, pancreas and lung cancer.

Across the board, Australia had the highest survival rates. For example, people diagnosed with colon cancer in Australia have a 70.8% 5-year survival rate, compared to a 58.9% rate in the UK.

Why is this the case?

The study does not tell us why the UK has lower 5-year survival rates than many of the other countries. However, it does point to some areas that the researchers think may have led to the biggest increases in cancer survival since 1995.

They say the big improvements seen across all areas in Denmark "have partly resulted from national healthcare reforms", which has sped up diagnosis and treatment of cancers, as well as investment in services such as radiotherapy. They also point to new and improved methods of surgery in all countries.

The researchers say that other studies are looking at the possible impact on cancer survival of "international differences in access to diagnostic services, screening practices, treatments, patient pathways and healthcare systems".

They say improvements were greatest in relative terms for cancers that previously had a poorer outlook, such as oesophagus, and for younger patients, who may be more able to benefit from aggressive new drugs and treatment.

What does this mean for UK cancer patients?

It's not possible to draw conclusions for individual patients from average figures about survival. There are many factors that can affect how long someone diagnosed with cancer is likely to live, including their age, general state of health, how quickly it's diagnosed, the specific type of tumour, and how well it responds to treatment.

In addition, net survival data is not a reflection of the real world, as it assumes people who do not die from cancer during the period studied will not die of anything else. The survival rates are estimates, not actual figures of how many people survived for 1 or 5 years.

There may also be differences in the way that the data was collected – for example about the date of diagnosis, or the stage of cancer when diagnosed – which might have affected the results when comparing 1- and 5-year survival rates.

Overall, this means people should not use the information from the study to conclude, for example, that they might live longer if they had been diagnosed in Australia instead of the UK. With any cancer, predicted survival rates are always estimates and it's difficult to give a definite outlook for any individual person with cancer, no matter where they live.

John Butler, the lead clinical advisor for the ICBP, tells charity Cancer Research UK: "The UK health system is under great pressure, with increasing demands on cancer diagnostics and more urgent referrals". This was likely to affect the ability of the UK to further improve its cancer survival rates across all cancer, he warned.

Analysis by Bazian
Edited by NHS Website