The Big Question: Why do our cancer survival rates trail the rest of the developed world?

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The Independent Online

Why are we asking this now?

The latest statistics on cancer survival across Europe and the United States show that Britain is among the worst in the developed world in terms of the proportion of cancer patients who are still alive five years after being diagnosed. Scotland comes bottom of the league table alongside the Czech Republic, Slovenia and Poland - who spend far less on cancer prevention, diagnosis and treatment than Britain. England, Wales and Northern Ireland are also ranked among the lowest survival rates - again on a par with Eastern Europe.

Which countries do best?

The top country is the United States with 62.9 per cent of female cancer patients and 66.3 per cent of male patients surviving five years after diagnosis. Cancer survival rates in England by comparison are 52.7 per cent for women and 44.8 per cent for men. Nordic countries are also high on the list, with Sweden, Norway, Iceland and Finland leading the way. Switzerland, Italy, Spain, Germany and Austria all fare significantly better than cancer patients in Britain.

How reliable are these statistics?

They are supposed to be. For many years doctors and oncologists have suspected that some countries do better then others in terms of the successful treatment of patients with cancer, but the data were not particularly reliable because of differences in the way the information was collected. This is why it was decided to standardise the procedure as part of the Eurocare survey - the largest population-based co-operative study on survival of patients with cancer. The specific aim of Eurocare is to monitor and analyse survival trends in different countries, as well as explaining any differences.

What trends do they reveal?

There have been three previous reports, in 1995, 1999 and in 2003. The data of the latest report comes from 83 cancer registries in 23 countries. The overall conclusion is that cancer survival varies greatly across Europe.

However, it appears that the difference between western Europe and eastern Europe has begun to narrow, with countries such as Poland and the Czech Republic doing better now than five or ten years ago. While cancer survival in general is improving across the world, however, it does not seem to be improving as fast in Britain as in other countries, despite the UK spending more on cancer treatment.

What is Britain doing to improve its record?

Previous Eurocare reports have led to a public outcry over Britain's low rank on the cancer league table. As a result, the Department of Health convened an international workshop in 2000 to help to develop a cancer plan for England - other parts of the UK were left to come up with their own solutions. The workshop concluded that the Eurocare statistics were credible and so a cancer plan was devised and enacted. The aim was to come up with better methods of prevention, early detection and treatment - and more money was spent to make this happen.

So why hasn't it worked?

Some people say that it has not been given enough time. The cancer plan was, after all, meant to be a 10-year strategy aimed at rejuvenating cancer treatment in Britain by 2010. However, other experts believe there has been enough time to produce an effect. An editorial in The Lancet this week, for instance, says that the latest Eurocare report shows that the UK's cancer plan has not worked. "... the reports show survival for gastric, colorectal, lung, breast, ovarian, kidney and prostate cancer in England is lower than the European average," The Lancet says. "In other parts of the UK, survival for melanoma and for colorectal, lung, breast, ovarian and prostate cancer is also lower than the European average, and in some cases among the lowest in Europe. "Overall, survival for all cancers combined in the UK as a whole is not only below the European average, it is also noticeably similar to some eastern European countries that spend less than one-third of the UK's per capita healthcare budget," the journal says.

Could there be other reasons for Britain's performance?

The cancer charity Cancer Research UK suggests that the statistics themselves may not be comparing like with like. In other words, the reason that Britain always falls below the European average may have something to do with the way cancer survival data is collected here compared with other countries.

Ruth Yates, head of statistical information at Cancer Research UK, said: "The importance of treatment in explaining differences in survival will depend on the type of cancer and the methods of data collection that the country in question uses. There are a number of factors other than the quality of treatment that can influence cancer survival rates."

Cancer Research UK points out that cancer registries in some countries, notably those in southern Europe, cover only small sections of the population and could therefore suffer from selection bias. However, most Scandinavian countries have national rather than regional cancer registries - like Britain - yet they still fare far better than the UK in terms of cancer survival rates.

Could anything else explain the findings?

One factor may be the point at which a cancer is diagnosed. Early detection is critical if a patient is to be successfully treated - a woman diagnosed in the earliest stages of breast cancer is 26 times more likely to survive than a woman who is diagnosed later. Many people may be leaving it too late to go to a GP, perhaps worried that their concerns may not be treated seriously by family doctors who constantly complain of being overworked. Another problem is that GPs may not be referring their patients to a specialist oncologist as quickly as in other countries - despite hospital waiting lists being allegedly shorter.

But don't the figures suggest cancer treatment in the UK is a national disgrace?

In simple terms, yes. There is no denying that Britain's cancer survival rates are abysmal compared to the rest of Europe, despite the Government ploughing billions into the NHS - much of which has gone on hefty increases to the salaries and pensions of highly paid GPs and consultants.

Yet, Cancer Research UK points out that the statistics should be seen in a wider context. "In interpreting results it is more important to discern a pattern than to look at isolated data from individual registries or countries," said Dr Yates. "There is little to be gained by continually presenting over-simplified league tables of cancer survival which undermine progress being made in the UK and cause anxiety among cancer patients," she said.

Nothing to be gained, perhaps, other than knowing whether the extra money being spent by the NHS on improving cancer treatment is having any impact.

Is our cancer treatment as bad as it appears?

Yes...

* The figures speak for themselves - we are bottom of the league of developed countries for cancer survival rates

* Cancer survival has improved faster in eastern Europe than in the UK

* We are seven years into a national cancer plan and there are no signs of improvements

No...

* The figures may not reflect was is truly happening in some countries

* European data has yet to reflect improvements since the cancer plan was enacted in 2000

* There may still be differences in data gathering which makes Britain look worse than it is

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