Cancer Survival in England- Adults Diagnosed: 2009 to 2013, followed up to 2014

• The highest 1- and 5- year survival estimate was for testicular cancer and melanoma of skin cancer (women); the lowest 1- and 5- year estimate was for pancreatic cancer

• The largest gender difference in 1-year survival was for bladder cancer, where 78.6% of men were expected to survive at least one year from their cancer compared with 67.1% of women

• For patients diagnosed between 2009 and 2013, 1-year survival continued to improve for most of the 24 cancers examined when compared with the 2008 to 2012 estimate

• For cancers of the brain, liver, lung, mesothelioma, oesophagus, pancreas and stomach 5-year survival remains below 25%

• For breast cancer (women), Hodgkin lymphoma, melanoma of skin, prostate cancer, testis and thyroid cancer 5-year survival is over 80%

• Age-specific cancer survival is usually higher for the younger age-groups compared with the older; however, breast and prostate cancer are examples where 5-year survival is higher for some older age groups than the younger age groups

This bulletin presents estimates of 1-year and 5-year net survival (%) for all adults (aged 15 to 99 years) diagnosed with one of the most common cancers in England between 2009 and 2013 and followed up to 2014. Net survival is estimated for 24 common cancers (based on the number of cancer diagnoses in England (ONS, 2015)), of which 5 are sex-specific common cancers. These cancers comprise over 92.4% of all newly diagnosed cancers among adults eligible for analysis.

Data are presented for men, women and both sexes, by age group and, for all ages combined, both un-standardised and age-standardised. Survival is age-standardised to take into account any changes in the age profile of the cancer patients. Confidence intervals are included in the reference tables, and can be used to give an indication of how accurate the survival estimate is. Further information on the methods used to estimate 1- and 5- year survival can be found in the background notes.

ONS publish rolling estimates of 1- and 5-year survival. The survival estimates reported here are for patients diagnosed between 2009 and 2013 and followed up to 31 December 2014. The previous bulletin (ONS, 2014) presented survival estimates for cancer patients diagnosed between 2008 and 2012 and followed up to 31 December 2013. Differences based on this and last year’s survival estimates are likely to be small as many of the same patients are included in analyses.

In the previous bulletin (ONS, 2014) predicted survival was included for the first time. In this bulletin predicted survival estimates have not been included, as feedback suggested that these estimates be included in a separate experimental statistics publication (to be published in 2016).

Figure 1 (men) and Figure 2 (women) show age-standardised 1-year net survival estimates for adults diagnosed with one of the most common cancers between 2009 and 2013. As in previous years survival from pancreatic cancer was the lowest, at 20.4% for men and 22.0% for women. The highest 1-year survival estimate was for testicular cancer at 98.3% and melanoma of the skin at 98.4% (women).

The largest gender difference¹ (11.5%) in survival is for bladder cancer, where 78.6% men were expected to survive at least one year from their cancer compared with 67.1% of women. The gender inequality in bladder cancer survival has been reported worldwide, and a number of reasons such as tumour biology, sex hormones, and earlier diagnosis in men than in women might explain the difference (Ristau & Davies, 2013; Lyratzopoulos, Abel, McPhail, et al., 2013).

For the majority of common cancers 1-year survival has continued to improve. When comparing the 2008 to 2012 survival estimate with the 2009 to 2013 estimate (reference table 1 (241.5 Kb Excel sheet)) the largest increase (2.3%) for men was for myeloma cancer, increasing from 76.0% to 78.3%. For women, the largest increase (1.9%) was for kidney cancer, increasing from 74.3% to 76.2%.

Notes for 1-year survival

1. Differences are calculated using unrounded survival estimates.

Figure 3 (men) and Figure 4 (women) show age-standardised 5-year net survival estimates, for adults diagnosed with one of the most common cancers between 2009 and 2013. Survival is below 25% for 7 cancers (brain, liver, lung, mesothelioma, oesophagus, pancreas and stomach). Survival estimates are above 80% for adults diagnosed with hodgkin lymphoma, thyroid cancer, melanoma of skin, breast cancer (women), and for men diagnosed with prostate and testicular cancer.

The lowest estimate of 5-year survival was for men (5.2%) and women (5.6%) diagnosed with pancreatic cancer. The highest 5-year survival estimate among men was for testicular cancer at 97.0%, and among women for melanoma of skin at 92.8%. In general 5-year survival was higher for women than men - with a notable exception of bladder cancer, with a 10.6% difference between men (58.6%) and women (47.9%).

The largest increases¹ in 5-year survival among men were for kidney cancer, and myeloma for women (when comparing 5-year survival in 2008 to 2012 to the estimate for 2009 to 2013; reference table 2 (241.5 Kb Excel sheet)). For men the kidney cancer survival estimate slightly increased (0.9%), from 56.7% to 57.6%. For women, myeloma cancer survival increased by 2.8%, from 46.2% to 49.0%.

For a few cancers 5-year survival estimates for the period 2009 to 2013 were slightly lower than the estimates for the period 2008 to 2012 (reference table 2 (241.5 Kb Excel sheet)). For men, the largest decrease (1.2%) in 5-year survival was for thyroid cancer, decreasing from 81.8% to 80.5%. Whereas for women the largest decrease (1.5%) in 5-year cancer survival was for mesothelioma, from 13.1% to 11.7%.

Notes for 5-year survival

1. Differences are calculated using unrounded survival estimates.

Reference table 3 (241.5 Kb Excel sheet) presents age-specific net survival at 1- and 5- years after diagnosis for each of the most common cancers. There are distinct patterns in survival by age group, with generally lower survival among older patients and higher survival among younger patients, even after taking account that the elderly are also more likely to die of other causes.

Breast cancer (Figure 5) is a well-known exception to this pattern; 5-year survival is lower for women aged 15 to 39 years at diagnosis (84.9%) than for women aged 40 to 69 years (ranging from 90.0% to 92.4%). These differences are probably explained by breast screening in women aged 50 to 70, and by the National Health Service introducing an age extension trial in 2009 (Public Health England, 2015), where some younger women aged 47 to 49 and some older women aged 71 to 73 are invited for screening. Screening aims to detect a tumour at an earlier stage of cancer, which helps improve survival chances.

Similarly, for prostate cancer (Figure 6), 5-year survival is slightly higher for men aged 50 to 69 years than for men aged 15 to 49 years. This might be due to more widespread (but not national) use of the prostate-specific antigen (PSA) test in older men.

Overall, cancer survival has been improving steadily in England but is still lower than in comparably wealthy countries. Findings from the CONCORD-2 study have shown that 5-year survival for adult patients in England diagnosed between 2005 and 2009 with leukaemia and cancers of the stomach, colon, rectum, liver, lung, breast, cervix, ovary and prostate is still lower than in Australia, Canada, Denmark, Norway and Sweden (Allemani, Weir, Carreira, Harewood, Spika, Wang, et al., 2015). A study (Walters, Benitez-Majano, Muller, Coleman, Allemani, Butler, et al., 2015) using more recent data has shown that England is not closing the international gap with survival from cancers of the stomach, colon, rectum, lung, breast, ovary remaining lower than in particular in Australia, Canada, Norway and Sweden.

Health policy-makers use population-based cancer survival statistics to plan services aimed at cancer prevention and treatment. Cancer survival estimates feed in to national cancer plans, such as: ‘Achieving world-class cancer outcomes: A Strategy for England 2015 to 2020’. The report recommends 6 strategic priorities to help improve cancer survival in England by 2020.

Cancer survival estimates also feed into outcomes strategies that set out how the NHS, public health and social care services will contribute to the progress agreed with the Secretary of State, in each of the high-level outcomes frameworks. The indicators set for the National Health Service (NHS) Outcomes Framework include 1- and 5- year survival from colorectal, breast and lung cancers.

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Aimilia Exarchakoua, Bernard Rachet^a, Emma Nash^b, Neil Bannister^b, Michel P Coleman^a, Stephen Rowlands^b
a Cancer Research UK Cancer Survival Group, London School of Hygiene & Tropical Medicine
^b Cancer Analysis Team, Office for National Statistics

The National Cancer Registry at the Office for National Statistics and the London School of Hygiene & Tropical Medicine wish to acknowledge the work of the National Cancer Registration Service (NCRS) in England, which provided the raw data for these analyses.