Elsevier

The Lancet Oncology

Volume 15, Issue 1, January 2014, Pages 23-34
The Lancet Oncology

Articles
Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5—a population-based study

https://doi.org/10.1016/S1470-2045(13)70546-1Get rights and content

Summary

Background

Cancer survival is a key measure of the effectiveness of health-care systems. EUROCARE—the largest cooperative study of population-based cancer survival in Europe—has shown persistent differences between countries for cancer survival, although in general, cancer survival is improving. Major changes in cancer diagnosis, treatment, and rehabilitation occurred in the early 2000s. EUROCARE-5 assesses their effect on cancer survival in 29 European countries.

Methods

In this retrospective observational study, we analysed data from 107 cancer registries for more than 10 million patients with cancer diagnosed up to 2007 and followed up to 2008. Uniform quality control procedures were applied to all datasets. For patients diagnosed 2000–07, we calculated 5-year relative survival for 46 cancers weighted by age and country. We also calculated country-specific and age-specific survival for ten common cancers, together with survival differences between time periods (for 1999–2001, 2002–04, and 2005–07).

Findings

5-year relative survival generally increased steadily over time for all European regions. The largest increases from 1999–2001 to 2005–07 were for prostate cancer (73·4% [95% CI 72·9–73·9] vs 81·7% [81·3–82·1]), non-Hodgkin lymphoma (53·8% [53·3–54·4] vs 60·4% [60·0–60·9]), and rectal cancer (52·1% [51·6–52·6] vs 57·6% [57·1–58·1]). Survival in eastern Europe was generally low and below the European mean, particularly for cancers with good or intermediate prognosis. Survival was highest for northern, central, and southern Europe. Survival in the UK and Ireland was intermediate for rectal cancer, breast cancer, prostate cancer, skin melanoma, and non-Hodgkin lymphoma, but low for kidney, stomach, ovarian, colon, and lung cancers. Survival for lung cancer in the UK and Ireland was much lower than for other regions for all periods, although results for lung cancer in some regions (central and eastern Europe) might be affected by overestimation. Survival usually decreased with age, although to different degrees depending on region and cancer type.

Interpretation

The major advances in cancer management that occurred up to 2007 seem to have resulted in improved survival in Europe. Likely explanations of differences in survival between countries include: differences in stage at diagnosis and accessibility to good care, different diagnostic intensity and screening approaches, and differences in cancer biology. Variations in socioeconomic, lifestyle, and general health between populations might also have a role. Further studies are needed to fully interpret these findings and how to remedy disparities.

Funding

Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation, Cariplo Foundation.

Introduction

Over the past 20 years, EUROCARE has provided systematic, quality-controlled, robustly comparable estimates of population-based cancer survival in Europe.1, 2, 3, 4, 5 These studies have shown large and sometimes unexpected differences in survival between European populations; they have also shown that survival has improved, although the pace of improvement has varied. EUROCARE's findings have affected the organisation of cancer care in several European countries, contributing to the design of national cancer plans and the evaluation of their effectiveness.6, 7

Cancer diagnosis and treatment have changed greatly in recent decades. Screening for breast cancer and cervical cancer, and to a lesser extent colorectal cancer, has been widely adopted.8 Opportunistic screening for prostate cancer has become widespread, and early diagnosis initiatives have been introduced for melanoma, thyroid cancer, lung cancer, and other cancers.9, 10 Advances have also been made in diagnostic imaging, genetic profiling, and treatments,11 including the introduction of targeted drugs, multidisciplinary care,12 and a growing concentration of treatment in specialist centres.13, 14

EUROCARE-5 provides updates of cancer survival for Europe. The EUROCARE-5 database contains about 22 million records of patients diagnosed from 1978 to 2007 and followed up to Dec 31, 2008. The participation of additional countries, especially from eastern Europe, has increased coverage. Here, we present survival estimates for adult patients (age ≥15 years) diagnosed in Europe during 2000–07. We also present survival trends by age and over time (1999–2007) by European region for ten common cancers.

Section snippets

Study design and data collection

Data for adults with cancer were provided by 107 population-based cancer registries from 29 countries grouped into five regions: Denmark, Finland, Iceland, Norway, Sweden (northern Europe); England, Ireland, Northern Ireland, Scotland, Wales (UK and Ireland); Austria, Belgium, France, Germany, Netherlands, Switzerland (central Europe); Croatia, Italy, Malta, Portugal, Slovenia, Spain (southern Europe); and Bulgaria, Czech Republic, Estonia, Latvia, Lithuania, Poland, Slovakia (eastern Europe).

Results

For both datasets, only 0·3% of records were excluded for major errors that could not be corrected: this proportion was less than 1% in most registries but 2–4% in Poland and Portugal (table 1). Roughly 3–4% of cases were excluded because they were identified from death certificate only or were discovered at autopsy. Overall, 2·9% of cases were death certificate only, ranging from 0–9·6% (table 1). Overall, only 0·5% of valid cancer cases were incidentally discovered at autopsy. Proportions

Discussion

The EUROCARE project provides the largest European population-based dataset for comparison of cancer survival with a unique standardised protocol for data collection, checking, and analysis. The survival differences by region and time period were not systematic but varied both by cancer type and by age group, and were consistent with the range of variation reported previously.3, 25 The proportion of the European population monitored was larger in this study than in previous EUROCARE studies.

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    Members of the EUROCARE-5 Working Group are listed in the appendix

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