Poor staging and treatment are likely to be behind low bowel cancer survival in UK

BMJ 2013; 346 doi: (Published 17 April 2013) Cite this as: BMJ 2013;346:f2485
  1. Zosia Kmietowicz
  1. 1BMJ

Lower survival among people with bowel cancer in the United Kingdom than among those in similar countries is likely to be because of poor staging and unequal access to the best treatment, new findings indicate.

A study led by the London School of Hygiene and Tropical Medicine was carried out in Australia, Canada, Denmark, Norway, Sweden, and the UK for the International Cancer Benchmarking Partnership. It included more than 310 000 patients whose bowel cancer was diagnosed between 2000 and 2007.

The researchers used population based cancer registries to examine how far the patients’ cancer had spread at the time of diagnosis and to look at the proportion of patients at each stage of disease who survived for one year and three years after diagnosis. Their findings were published in Acta Oncologica.1

These showed that two thirds (67%) of colon cancer patients in the UK survived for at least one year, compared with 72% in Denmark, 75% in Norway, 77% in Canada, and 80% in Sweden and Australia. At 75%, one year survival after diagnosis of rectal cancer was also the lowest in the UK; in the other countries it ranged from 79% in Denmark to 84% in Sweden and Australia.

The proportion of cases of colon cancer diagnosed at the earliest stage (stage A) was lowest in the UK at only 8%, whereas elsewhere the proportion was 11-17%. But UK patients were also less likely to be given a diagnosis at the most advanced stage (20% at stage D, compared with 24-31% elsewhere).

Survival among UK patients whose colon or rectal cancer was diagnosed at the earliest stage was similar to that in the other five countries (96%, compared with 92-98% elsewhere), but survival in the UK was consistently lower among those whose cancer was diagnosed at a more advanced stage (5-11% lower than elsewhere). For example, one year survival among patients with Duke’s stage C colon cancer was 71% in the UK but 82% in Sweden and Australia.

The researchers concluded that the differences in survival could be partly explained by differences in stage at diagnosis. In turn, these differences could be a result of poor awareness of symptoms, delays in diagnosis, and a lack of thoroughness during staging. Poor survival at all stages of disease in the UK also indicates that not all patients were getting the best treatments.

Camille Maringe, the study’s lead author, who is based at the London School of Hygiene and Tropical Medicine, said, “We observed international differences in survival at each stage of disease. These differences are wider for older patients and for patients whose disease is very advanced when they are diagnosed.

“Improvements are urgently needed in the quality and thoroughness of the medical tests that are used to assess the stage at diagnosis for each patient. The data collected by cancer registries on stage at diagnosis also need to be more accurate and complete. This will enable more accurate international comparisons of survival at each stage of disease.

“In turn, it will enable patients, doctors, and healthcare planners to see which countries are setting the best standards and what improvements are required to reach the highest levels of survival.”


Cite this as: BMJ 2013;346:f2485