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Cancer survival data emphasise importance of early diagnosis

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l408 (Published 25 January 2019) Cite this as: BMJ 2019;364:l408
  1. Nigel Hawkes
  1. London

Robust cancer survival estimates according to stage at diagnosis have been published by the Office for National Statistics for the first time.1

They show, as expected, that for most cancers survival at one and five years is much higher if the cancer is detected early (at stage 1) than if it is detected later. This re-emphasises the need for early diagnosis.

For some cancers, however, the stage of detection is less important. Prostate cancer, for example, has extremely high one year survival rates (around 100%) whether it is detected in stages 1, 2, or 3, falling to 87.6% if detected in stage 4. Five year survival follows a similar but steeper decline—100% or near for stages 1, 2, and 3, but down to 47.7% for stage 4.

For Hodgkin lymphoma, survival is generally high regardless of stage. Even when detection is at stage 4, one year survival is 86.7%.

At the other extreme is colorectal cancer, where one year survival if detected at stage 1 is 97.7%, falling to only 43.9% if detected at stage 4. Lung cancer follows the same pattern, with one year survival reaching 87.3% for stage 1 disease, but only 18.7% for stage 4.

Liver cancer follows an unusual pattern, with a large drop in one year survival between stages 2 and 3. Survival of stage 2 cancers is 69.1%, but for stage 3, it is only 39.3%.

Sarah Caul, head of cancer analysis at the Office for National Statistics, said: “This is the first time we have been able to look at this in more detail to examine how estimates for five year survival can change depending on what stage the disease is at when detected. The research shows a mixed picture but does stress the need for awareness and early detection.”

The data cover adults diagnosed with cancer between 2012 and 2016 and followed up to 2017. In general, Caul said, they show an increase in survival when compared with estimates made for the period 2006 to 2010. Melanoma, prostate cancer, and breast cancer have the highest survival rates, partly accounted for by the high percentage of prostate and breast cancers being detected at an early stage.

The statistical bulletin is a collaboration between the National Cancer Registration and Analysis Service, which is part of Public Health England, and the Office for National Statistics. Survival by stage is not available for all 29 common cancers because data are incomplete either by reason of small numbers or because staging systems do not exist for all cancers.

Ruth Thorlby, assistant director of policy at the Health Foundation, said: “The continuing trend of improvement in cancer survival reflects sustained effort and investment over the past two decades to improve cancer care in England.

“However, today’s data show that too many cancers are still being diagnosed too late—almost half of all lung cancers are diagnosed at the most advanced stage. The prime minister has made an ambitious commitment to improve survival through earlier diagnosis, so that an extra 55 000 people survive cancer for at least five years after diagnosis by 2028. But there is much more to be done if England is to improve survival in line with this pledge.

“Delivering the prime minister’s commitment will require three things: capital investment for additional diagnostic equipment, such as MRI and CT scanners, significant increases in the cancer workforce to diagnose, treat, and support cancer patients, and help for staff to improve complex services and get the most out of new advances in cancer care.”

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