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Geographical variation in cancer survival in England, 1991–2006: an analysis by Cancer Network
  1. Sarah Walters1,
  2. Manuela Quaresma1,
  3. Michel P Coleman1,
  4. Emma Gordon2,
  5. David Forman3,
  6. Bernard Rachet1
  1. 1London School of Hygiene and Tropical Medicine, London, UK
  2. 2Office for National Statistics, Newport, UK
  3. 3National Cancer Intelligence Network, London, UK
  1. Correspondence to Dr Sarah Walters, CRUK Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E, UK; sarah.walters{at}


Background Reducing geographical inequalities in cancer survival in England was a key aim of the Calman–Hine Report (1995) and the NHS Cancer Plan (2000). This study assesses whether geographical inequalities changed following these policy developments by analysing the trend in 1-year relative survival in the 28 cancer networks of England.

Methods Population-based age-standardised relative survival at 1 year is estimated for 1.4 million patients diagnosed with cancer of the oesophagus, stomach, colon, lung, breast (women) or cervix in England during 1991–2006 and followed up to 2007. Regional and deprivation-specific life tables are built to adjust survival estimates for differences in background mortality. Analysis is divided into three calendar periods: 1991–5, 1996–2000 and 2001–6. Funnel plots are used to assess geographical variation in survival over time.

Results One-year relative survival improved for all cancers except cervical cancer. There was a wide geographical variation in survival with generally lower estimates in northern England. This north–south divide became less marked over time, although the overall number of cancer networks that were lower outliers compared with the England value remained stable. Breast cancer was the only cancer for which there was a marked reduction in geographical inequality in survival over time.

Conclusion Policy changes over the past two decades coincided with improved relative survival, without an increase in geographical variation. The north–south divide in relative survival became less pronounced over time but geographical inequalities persist. The reduction in geographical inequality in breast cancer survival may be followed by a similar trend for other cancers, provided government recommendations are implemented similarly.

  • Cancer
  • deprivation
  • geography FQ
  • health policy
  • survival

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  • Funding This study was funded by the National Cancer Intelligence Network, National Cancer Research Institute (NCRI), 18th Floor, Portland House, Bressenden Place, London SW1E 5RS.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the ONS Medical Research Service (MR1101, 20 November 2007). Patient Information Advisory Group (PIAG; now the Ethics and Confidentiality Committee of the National Information Governance Board) under Section 61 of the Health and Social Care Act 2001 (PIAG 1-05(c)/2007, 31 July 2007).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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