ArticlesCancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5—a population-based study
Introduction
Over the past 20 years, EUROCARE has provided systematic, quality-controlled, robustly comparable estimates of population-based cancer survival in Europe.1, 2, 3, 4, 5 These studies have shown large and sometimes unexpected differences in survival between European populations; they have also shown that survival has improved, although the pace of improvement has varied. EUROCARE's findings have affected the organisation of cancer care in several European countries, contributing to the design of national cancer plans and the evaluation of their effectiveness.6, 7
Cancer diagnosis and treatment have changed greatly in recent decades. Screening for breast cancer and cervical cancer, and to a lesser extent colorectal cancer, has been widely adopted.8 Opportunistic screening for prostate cancer has become widespread, and early diagnosis initiatives have been introduced for melanoma, thyroid cancer, lung cancer, and other cancers.9, 10 Advances have also been made in diagnostic imaging, genetic profiling, and treatments,11 including the introduction of targeted drugs, multidisciplinary care,12 and a growing concentration of treatment in specialist centres.13, 14
EUROCARE-5 provides updates of cancer survival for Europe. The EUROCARE-5 database contains about 22 million records of patients diagnosed from 1978 to 2007 and followed up to Dec 31, 2008. The participation of additional countries, especially from eastern Europe, has increased coverage. Here, we present survival estimates for adult patients (age ≥15 years) diagnosed in Europe during 2000–07. We also present survival trends by age and over time (1999–2007) by European region for ten common cancers.
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Study design and data collection
Data for adults with cancer were provided by 107 population-based cancer registries from 29 countries grouped into five regions: Denmark, Finland, Iceland, Norway, Sweden (northern Europe); England, Ireland, Northern Ireland, Scotland, Wales (UK and Ireland); Austria, Belgium, France, Germany, Netherlands, Switzerland (central Europe); Croatia, Italy, Malta, Portugal, Slovenia, Spain (southern Europe); and Bulgaria, Czech Republic, Estonia, Latvia, Lithuania, Poland, Slovakia (eastern Europe).
Results
For both datasets, only 0·3% of records were excluded for major errors that could not be corrected: this proportion was less than 1% in most registries but 2–4% in Poland and Portugal (table 1). Roughly 3–4% of cases were excluded because they were identified from death certificate only or were discovered at autopsy. Overall, 2·9% of cases were death certificate only, ranging from 0–9·6% (table 1). Overall, only 0·5% of valid cancer cases were incidentally discovered at autopsy. Proportions
Discussion
The EUROCARE project provides the largest European population-based dataset for comparison of cancer survival with a unique standardised protocol for data collection, checking, and analysis. The survival differences by region and time period were not systematic but varied both by cancer type and by age group, and were consistent with the range of variation reported previously.3, 25 The proportion of the European population monitored was larger in this study than in previous EUROCARE studies.
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