Cancer Survival Rates Improving Across Europe, But Still Lagging Behind United States

Zosia Chustecka

August 22, 2007

August 22, 2007 — New reports from EUROCARE suggest that cancer care in Europe is improving and that the gaps between countries are narrowing. However, comparisons with US statistics suggest that cancer survival in Europe is still lagging behind the United States. The reports are published online August 21 in Lancet Oncology and scheduled for the September issue .

One of the main messages from both reports is that in Europe, "for most cancers, survival has increased and between-country survival differences have decreased over time," notes an accompanying commentary by Mike Richards, CBE, from the United Kingdom's Department of Health. However, the differences between countries are not trivial, and "many more lives could be saved if the outcomes of all countries were brought up to the standards of the best" (ie, Norway, Sweden, and Finland), he comments. The United Kingdom in particular comes out badly in the tables, showing cancer survival rates that are among the worst in Europe. The findings suggest that the national cancer plan for England, which began in 2000, is not working, a second editorial comments.

Survival Rates Significantly Higher in United States Than in Europe

One of the reports compares the statistics from Europe with those from the United States and shows that for most solid tumors, survival rates were significantly higher in US patients than in European patients. This analysis, headed by Arduino Verdecchia, PhD, from the National Center for Epidemiology, Health Surveillance, and Promotion, in Rome, Italy, was based on the most recent data available. It involved about 6.7 million patients from 21 countries, who were diagnosed with cancer between 2000 and 2002.

The age-adjusted 5-year survival rates for all cancers combined was 47.3% for men and 55.8% for women, which is significantly lower than the estimates of 66.3% for men and 62.9% for women from the US Surveillance, Epidemiology, and End Results (SEER) program ( P < .001).

Survival was significantly higher in the United States for all solid tumors, except testicular, stomach, and soft-tissue cancer, the authors report. The greatest differences were seen in the major cancer sites: colon and rectum (56.2% in Europe vs 65.5% in the United States), breast (79.0% vs 90.1%), and prostate cancer (77.5% vs 99.3%), and this "probably represents differences in the timeliness of diagnosis," they comment. That in turn stems from the more intensive screening for cancer carried out in the United States, where a reported 70% of women aged 50 to 70 years have undergone a mammogram in the past 2 years, one-third of people have had sigmoidoscopy or colonoscopy in the past 5 years, and more than 80% of men aged 65 years or more have had a prostate-specific antigen (PSA) test. In fact, it is this PSA testing that probably accounts for the very high survival from prostate cancer seen in the United States, the authors comment.

Further analysis of these figures shows that, in the case of men, more than half of the difference in survival between Europe and United States can be attributed to prostate cancer. When prostate cancer is excluded, the survival rates decreased to 38.1% in Europe and 46.9% in the United States. For women, the survival rate of 62.9% for all cancers in the United States is comparable to that seen in the wealthiest European countries (eg, 61.7% in Sweden, 59.7% in Europe), and the slightly higher survival in the United States was largely due to better survival for colorectal and breast cancer, the authors comment.

The differences in survival are due to a variety of reasons, Dr. Verdecchia and colleagues write. They include factors related to cancer services — for example, organization, training, and skills of healthcare professionals; application of evidence-based guidelines; and investment in diagnostic and treatment facilities — as well as clinical factors, such as tumor stage and biology.

For hematological malignancies, except for non-Hodgkin's lymphoma, the survival rates in Europe and the United States were comparable. The authors suggest that the reason may be that "these malignancies are usually referred to specialist centers for treatment, in accordance with evidence-based guidelines, and they are frequently included in international clinical trials."

Wide Variations Across Europe Are Narrowing

Dr. Verdecchia and colleagues comment that their analysis of the most recent cancer survival data available in Europe suggests that the wide variations across countries, which have persisted for many years, "might be on the verge of decreasing."

The authors of the other report, which considered earlier data, from 1995–1999 (the EUROCARE-4 study), are more positive in their conclusions. Franco Berrino, MD, from the Fondazione Istituto Nazionale dei Tumori, in Milan, Italy, and colleagues say their findings show that "the gap in cancer survival in Europe is narrowing . . . and suggests substantial improvement in cancer care in countries with poor survival."

Nevertheless, both reports show that survival is worst in Eastern Europe and best in Western and Northern countries. Dr. Berrino et al comment that a consistent finding of all of the EUROCARE studies is that between-country survival differences are small for relatively uncommon treatable cancers, such as testicular cancer and Hodgkin's disease, and also for cancers with a very poor prognosis. By contrast, for cancers with an intermediate prognosis — for which early diagnosis is typically an important determinant of outcome — the survival rates "still differ markedly, and probably unacceptably, between countries in Europe."

"Understanding the reasons for these persistent (but diminishing) differences is important for the public health response to cancer in Europe," Dr. Berrino and colleagues write. The EUROCARE approach to disentangling these possible determinants of survival includes high-resolution studies, which use information accessed from clinical records. So far, these studies suggest that most of the survival differences for breast and colorectal cancer are attributable to differences in disease stage at diagnosis, while survival differences for testicular cancers seem to be due mostly to differences in access to appropriate treatment.

Lancet Oncol. Published online August 21, 2007.

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