London School of Hygiene & Tropical Medicine

Remarkable improvements in cancer survival mean that half of all people diagnosed with cancer today (2010-11) in England and Wales are expected to survive from their cancer for at least 10 years, compared to just a quarter of people diagnosed 40 years ago (1971-72), according to a new index of survival for all cancers combined [1], published in The Lancet.

However, although some cancers have a good prognosis, the outlook for others remains extremely poor. For example, while 98% of men with testicular cancer survive from their cancer for at least a decade after diagnosis, up from 69% 40 years ago, just 1% of pancreatic cancer patients diagnosed today are expected to survive from their cancer 10 years.

Led by the Cancer Research UK Cancer Survival Group at the London School of Hygiene & Tropical Medicine, the researchers analysed survival trends for more than seven million adults (aged 15 to 99 years) diagnosed with one of 21 common cancers in England and Wales between 1971 and 2011, and followed up to the end of 2012.

The 21 cancers clearly divided into three groups with either high, moderate, or low survival. The groups have remained much the same for 40 years.

For cancers of the brain, stomach, lung, oesophagus, and pancreas, 10-year survival after diagnosis is still below 15%. There has been little or no improvement in long-term survival from these diseases since the early 1970s. Even today, only 5% of those diagnosed with lung cancer are expected to survive from their cancer for 10 years after diagnosis. Despite more than doubling in the last 40 years, 10-year survival for people diagnosed with a brain tumour also remains very low at 14%.

Study author, Dr Bernard Rachet, Reader in Cancer Epidemiology at the London School of Hygiene & Tropical Medicine, said: "These five cancers impose a huge public health burden, both because they are common and because they are often diagnosed at a late stage, when they are much harder to treat.

"For three of these cancers (lung, stomach, and oesophagus), surgery is often the key treatment, but patients are often diagnosed too late for surgery with a realistic prospect of cure. Even for those patients who are diagnosed early, surgery is not always performed. We should be carrying out surgical treatment for many more patients than is currently the case. When it comes to lung cancer, for example, almost all patients diagnosed at an early stage of disease should be operated on with curative intent."

Survival to ten or more years after diagnosis is generally above 70% for cancers of the breast, prostate, testis, and uterus, and for melanoma and Hodgkin's disease, and improvement in survival is greatest for these cancers. For example, more than three-quarters (78%) of women with breast cancer are now surviving from their cancer for at least 10 years after diagnosis, up from 40% in the early 1970s. For people diagnosed with melanoma, 10-year survival has almost doubled in the last 40 years, rising from 46% to 90%.

The analysis also confirms a persistent "age gap" in survival between younger and older patients for all cancers. Dr Rachet said: "Even after we have adjusted for the fact that older people have much higher death rates from other diseases than younger people, elderly cancer patients are doing worse for all cancers. This problem is particularly marked in the UK-in other countries, the age gap in cancer survival has become much narrower over the last 15-20 years than in England and Wales."

Co-author Manuela Quaresma, Research Fellow in statistics at the School, said: "Although survival for some cancers has improved dramatically over the past 40 years, others are lagging far behind. More investment is urgently needed to improve early diagnosis and provide the best treatment, including more specialist surgeons, for poor-prognosis cancers like lung cancer, which have shown little or no evidence of improvement in long-term survival (five and 10 years after diagnosis) over the past 40 years."

The study was funded by Cancer Research UK. Sarah Woolnough, the charity's Executive Director of Policy and Information, said: "More people than ever are surviving cancer thanks to research, which has made the breakthroughs in radiotherapy, surgery and drugs that are all reducing the impact of cancer. But these figures also show there is much more to be done - with survival still too low for a number of cancers including oesophageal, brain, lung and pancreatic cancers."

The preliminary cancer survival statistics from the new Lancet paper were published by Cancer Research UK when they launched their new strategy earlier this year. The charity's strategy aims to accelerate progress with the ambition that three-quarters of all cancer patients diagnosed in 20 years' time will survive at least 10 years.

[1] The index of net survival for all cancers combined (49•8%) is a single number that reflects progress in the overall effectiveness of cancer management in England and Wales, including earlier diagnosis, more thorough investigation, and improved treatment and care. The index is designed to be independent of changes over time in the age profile of cancer patients, and changes in the proportion of cancers with high and low survival.

Publication:

• Manuela Quaresma, Michel P Coleman, Bernard Rachet 40-year trends in an index of survival for all cancers combined and survival adjusted for age and sex for each cancer in England and Wales, 1971-2011: a population-based study, The Lancet. DOI:10.1016/S0140-6736(14)61396-9

Related links:

• Short course: Cancer Survival: Principles, Methods and Applications