Lower awareness isn’t behind the UK’s poorer survival

Does ‘awareness’ of cancer affect survival rates?

It has long been known that people in the UK have a lower chance of surviving breast, lung, bowel and ovarian cancer than people in some other developed countries, but the question still remains – why?

There are quite a few possibilities.

Do we diagnose and treat people with cancer swiftly enough in the UK? Do all cancer patients in this country get the best and most appropriate treatments? Do we recognise the symptoms for cancer and go to our GP about them? Do GPs’ attitudes or knowledge play a role?

That list contains some difficult questions – questions that the International Cancer Benchmarking Partnership (ICBP) – which Cancer Research UK is coordinating – is trying to answer.

This week, a team of the Partnership’s researchers published a new paper*, which takes us a small but important step closer to understanding what’s going on.

An international partnership

The ICBP is an international collaboration of doctors, scientists and policymakers who are comparing cancer trends, beliefs, knowledge and health services across six countries – the UK, Denmark, Norway, Canada, Sweden and Australia.

The ICBP has five parts, or modules, each focusing on one or more of the questions listed above, and each run by different teams of researchers.

The task isn’t easy. Not only are there quite a few practical challenges to working in a group spanning the globe, but also it’s unlikely that there’s a single, simple explanation for the survival differences. A combination of factors will probably be responsible – the trick to improve things is to tease them apart and work out what’s going on.

The story so far

Regular readers will remember that – at least for ovarian cancer – the ICBP team is already getting answers.  A paper published last year by the Cancer Research UK survival group, led by Professor Michel Coleman, showed that late diagnosis isn’t likely to be the main reason for the UK’s lower ovarian cancer survival rates (findings we discussed extensively in this blog post).

But the paper did highlight that UK women with advanced ovarian cancer had worse survival than those in other countries. This poor survival may – at least in part – be down to differences in treatment given to women with ovarian cancer in the UK, compared to the treatment given in other countries.

So the ICBP may have found one possible reason for poorer survival, for one cancer type.

But it’s very unlikely that differences in treatment fully explain the lower ovarian cancer survival in the UK.

And while this study suggests that international differences in survival can’t entirely be explained by late diagnosis, it’s still true that many people in the UK are diagnosed at a late stage.

But let’s be clear – getting cancer diagnosed earlier in the UK would help improve survival, no matter what’s happening in other countries. So we’ve been working hard to promote earlier diagnosis, and inform people that spotting cancer at an early stage means the chances of recovering are better.

New findings

More answers are revealed this week in a new ICBP paper published in the British Journal of Cancer.

This looked at international differences in what people know about cancer symptoms, and in what they believe about cancer – and whether this could explain international cancer survival differences.

The good news is that people in this country were just as aware of the key symptoms of cancer as people in other countries. On average people in each country in the study recognised eight out of 11 of the most common cancer symptoms.

People were also asked what they might expect to happen after a cancer diagnosis.

Researchers asked them to say whether they agreed with statements like, ‘cancer can often be cured’ or ‘is cancer a death sentence’. This is important because there is evidence to suggest negative attitudes can be linked to being diagnosed later.

Encouragingly more than nine out of 10 people in the UK thought that cancer ‘can often be cured’, while more than seven out of 10 disagreed with the statement that, ‘cancer is a death sentence’. Again this is similar to what people believe in other countries. These findings broadly reflect reality, as over the last 40 years cancer survival rates have doubled in the UK.

Although it may not seem like it at first glance, these findings are valuable, because they show us that the differences in cancer survival internationally aren’t likely to be explained solely by differences in people’s knowledge or attitudes.

There were also several other thought-provoking findings from the same study, which give the ICBP team more leads to investigate.

Worried about wasting the doctor’s time?

People in the UK are more worried about wasting GPs’ time

Substantially more people in the UK than in other countries said that there were specific reasons why they would not go to their doctor – even if they had a symptom they thought was serious.

‘I worry about wasting the doctor’s time’ was the most common issue that prevented people going to see their GP.

More than three out of 10 people in the UK, compared with fewer than one in 10 in Sweden, said this would stop them making an appointment.

It’s hardly surprising that people responded this way, as it’s been a widely held view of the public and the media that doctors are overworked. Whether or not this is true, many of us believe it, and a knock-on effect is likely to be that some of us are reluctant to add to GPs’ workload.

People also said that they would be ‘embarrassed’, ‘worried over what the doctor may find’ or ‘too busy’, and that this may stop them going to their doctor.

At Cancer Research UK we’re working hard to let people know that if there is something different about their body that’s concerning them, their doctor will want to know.

And the ‘Be Clear on Cancer’ campaigns run by the Department of Health aim to encourage people to visit their GP sooner rather than later, across a range of different cancer types and symptoms. Cancer Research UK is providing advice and support to the Department in the development of the campaigns, and coordinating the evaluation of all of this year’s activity.

Age not identified as a risk factor

Another intriguing finding was that very few people seem to think that age is a risk factor for cancer. In fact, only 14 per cent of people in the UK knew that people over 70 were at a greater risk of developing cancer. This is similar to what other studies, like the Cancer Awareness Measure have shown. And when asked what might affect a person’s chance of getting cancer, fewer than four per cent of people said older age. So why might this be?

With public focus on younger celebrities who have had cancer, such as Jade Goody and Kylie Minogue – it might make it seem that cancer most often affects people in their youth or early middle age.

The truth is that nine out of 10 cases of cancer are in people aged 50 or older. Although anyone can develop cancer and it’s important to remember that it’s far more common in older people.

This highlights the wide reach that the ICBP will have – its focus is on answering the cancer survival questions, but the other information it is uncovering is making a big stride forward in uncovering what people think about cancer overall.

The next focus

Next up from the ICBP will be a study looking into how doctors’ attitudes and beliefs may affect cancer survival in the UK. Researchers will also compare how the health systems are structured in the different countries, to highlight the differences and similarities and to see if they have an effect on cancer survival rates. Results are eagerly awaited and expected in late 2013.

The ICBP team is also investigating the possible reasons for the UK’s lower breast, bowel and lung cancer survival rates – similar to the work that was done on ovarian cancer survival.  We can expect these results very soon.

Looking ahead

So are we closer to understanding why the UK has lower cancer survival rates?

The simple answer is yes.

By answering these questions, eliminating possible causes, and discovering more about cancer, we can gradually advance what we already know about what affects survival. And this information is vital if we’re to help improve outcomes for cancer patients and support, manage and treat cancer in a better, more comprehensive way.

Sam

• Samantha Harrison is a programme officer for the International Cancer Benchmarking Partnership.

Reference

Forbes L.J.L. et al. (2013). Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival?, British Journal of Cancer, DOI: 10.1038/bjc.2012.542