NCRI public lecture: International survival trends and comparisons – impact on UK cancer care

Are we really the “sick man of Europe”?

Professor Michel Coleman, one of the world’s leading experts on cancer statistics and population studies, opened the NCRI conference with a quote from Disraeli. Not “Lies, damned lies and statistics” (often misattributed to the 19th Century prime minister) but this:

The health of the people is really the foundation upon which their happiness and all their powers as a state depend.

Back in 1877, when Disraeli penned those words, cancer was not the major threat to public health – around 4 in ten UK deaths were due to infectious diseases, while only one in ten was down to cancer. Today, nearly a third of all deaths in the UK are the result of cancer, while fewer than one in a hundred die from infections.

During his talk, Professor Coleman discussed the four Eurocare studies – large analyses of cancer stats from many European countries. The UK has tended to perform poorly in these, with our average survival rates in many cancers coming out below par. In footballing terms, we’re not quite in the relegation zone (that dubious honour belongs to eastern European countries) but we’re certainly languishing at the bottom of the league.

Although there are some justifiable criticisms of the Eurocare results (particularly Eurocare 3), it is broadly true that we lag behind many European countries in terms of cancer survival. But why? Is our healthcare really any worse than that of Spain, Denmark or Germany?

It’s all history

The first thing to point out is that the Eurocare studies are based on relatively old figures. The most recent study, Eurocare 4, only covers people diagnosed with cancer from 1995-2002. Here in the UK, we’ve only seen significant political action on cancer since 2000, with the implementation of the NHS Cancer Plan. Therefore we might not expect to see a significant dent in the figures until the publication of Eurocare 5, due out within the next year.

So while it’s true to say that the UK hasn’t performed well in the past, we certainly expect to put in a better showing in future reports.

Early diagnosis is the key

Professor Coleman demonstrated that one of the overlooked – yet significant – factors affecting our survival rates in the UK is late diagnosis. If you look at five year survival rates across Europe for breast cancer, but take out all the women who die within a year of diagnosis (whose cancers were likely to have been diagnosed at a very advanced stage), then our survival rates fall into line with the European average.

Furthermore, if you look at our survival rates for cancers where delays in diagnosis aren’t so critical, such as testicular or childhood cancer, then the UK is doing as well, if not better, than most European countries.

So if we could improve early diagnosis of cancer – by educating the population about symptoms, reducing delays in GP referrals, investing in more CT and MRI scanners, and ensuring faster access to treatment – then we would do a lot to boost our standing in the Eurocare league table.

Postcode lottery?

Another area that Professor Coleman touched on was socioeconomic inequalities across the UK, which have a big impact on survival rates. The bottom line is that poorer people generally have worse outcomes for most types of cancer than richer people. The reasons for this aren’t entirely clear, and it’s something that the National Cancer Intelligence Network will be looking at.

In Coleman’s words, “It’s not a lottery – a lottery is fair. This is systemic inequality.” He estimated that more than 12,000 premature deaths could have been avoided if socioeconomic inequalities had been ironed out when they were first identified, and called for more money to be put into prevention research.

It’s not all about the drugs

The session ended with a Q&A session, and perhaps one of the most illuminating statements from Professor Coleman, in answer to a woman with ovarian cancer who was being denied a drug that is available in Europe.

He pointed out that we should not assume that all drugs are available in other countries, and that drugs and drug availability are not the be-all and end-all of cancer treatment. In fact, prevention, early diagnosis, surgery and radiotherapy make very significant contributions to cancer survival – something that the media often forget.

Kat