Cancer survival by NHS England Area Team- Adults diagnosed: 1997-2012, followed up to 2013

• One- and five-year net survival continued to improve for cancers of the oesophagus, stomach, colon, lung, breast (women) and cervix for adults diagnosed in England 1997-2012. The smallest improvement in one-year survival was for cervical cancer (from 82.3% to 85.0%) and the greatest improvement was for oesophageal cancer in men (from 28.4% to 46.1%)
• For adults diagnosed in 2012, the range in one-year survival between NHS England Area Teams was widest for women with oesophageal cancer (ranging from 34.3% to 48.9%), and narrowest for women with breast cancer (ranging from 95.7% to 97.3%)
• For the period 1997 to 2012, the range in one-year survival between NHS England Area Teams narrowed for cancers of the colon (both sexes), oesophagus (men), breast (women) and cervix

This report presents one-year and five-year age-standardised net survival estimates for the 25 NHS England Area Teams, for adults who were diagnosed with a cancer of the oesophagus, stomach, colon, lung, breast (women) or cervix during 1997–2012 and followed up to 31 December 2013 (see background notes 1 and 2). One-year survival estimates are reported for adults diagnosed in 1997, 2002, 2007 and 2012, and five-year survival estimates for those diagnosed in 1997, 2002 and 2007 to show trends over time.

This publication is produced in partnership with the Cancer Research UK Cancer Survival Group, at the London School of Hygiene and Tropical Medicine.

The 25 NHS England Area Teams were created on 1 April 2013 (see Figure 2, NHS England Area Team boundaries). For the purpose of these analyses, patients have been assigned to the Area Team that currently includes their residence when they were diagnosed between 1997 and 2012.

Estimates of one-year and five-year age-standardised net survival (%) are presented for each of the six cancers in tables and charts for each NHS England Area Team, sex and calendar period. The survival estimates are age-standardised to compensate for differences in the age profile of cancer patients between Area Teams, and for changes in these age profiles over time (see Background Note 4). Differences between survival estimates for the two periods are taken as the arithmetic difference: for example, 12% is shown as 2% (not 20%) higher than 10%.

One-year survival is above 60% for cancers of the colon, breast and cervix, and five-year survival is above 45% (Figures 1A and 1B). For cancers of the oesophagus, stomach and lung however, one-year survival is below 50% and five-year survival below 20%.

At a national level, an upward trend in net survival was observed for all six cancers. The largest improvement in one-year survival between 1997 and 2012 among men occurred for cancers of the oesophagus (17.7%) and stomach (14.2%), while five-year survival for men with colon cancer increased by 8.4% between 1997 and 2007. For women, the largest improvement in one-year survival was for cancer of the oesophagus (14.2%), while five-year survival for women with breast and colon cancer increased by 8.2% and 8.1% respectively. The smallest increase at the national level for one-year survival was cervical cancer (2.7%) and for five-year survival was lung cancer in men (2.3%).

The range in one-year survival between NHS England Area Teams with the highest and lowest survival was widest for women with oesophageal cancer in 2012 (14.6%), and the narrowest was for women with breast cancer (1.6%) (Table 1A). In general, the range in one-year net survival across the 25 NHS England Area Teams is widest (8.9% or more) for the cancers where one-year survival is below 50% (oesophagus, stomach and lung). For five-year survival, the range between NHS England Area Teams was widest for women diagnosed in 2007 with colon cancer (13.9%) and narrowest for men diagnosed with lung cancer (3.7%) (Table 1B).

These estimates should not be used to rank NHS England Area Teams by their survival, because a change of just 1 or 2% may radically alter the ranking of a given Area Team, especially where the range of estimates is very narrow.

The geographic range in colon cancer survival has narrowed considerably for both sexes since 1997, especially for one-year survival: from 14.1% in 1997 to 7.2% in 2012 for men, and 17.1% in 1997 to 7.9% in 2012 for women.

The geographic patterns of one-year survival (adults diagnosed in 2012) and five-year survival (adults diagnosed in 2007) are mapped in Figures 3A-8.

Figure 2: NHS England Area Team boundaries, 2014

Source: Office for National Statistics, Ordnance Survey

One-year age-standardised net survival improved considerably for adults diagnosed between 1997 and 2012. However, one-year survival for adults diagnosed in 2012 was still low and ranged between 37.4% and 49.7% for men and between 34.3% and 48.9% for women. One-year net survival more than doubled in two NHS England Area Teams for men: Durham, Darlington and Tees (increased from 24.5% to 49.6%) and Greater Manchester (increased from 19.1% to 48.2%). One-year age-standardised net survival more than doubled in two NHS England Area Teams for women: Greater Manchester (from 19.2% to 48.9%) and Lancashire (from 19.2% to 39.0%) (Tables and Figures: A1 and A2). The range of five-year age-standardised net survival between NHS England Area Teams in 2007 was 6.8% in men and 5.1% in women (Table 1B).

Figure 3A: One-year age-standardised net survival (%) from oesophageal cancer for adults diagnosed 2012, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

Figure 3B: Five-year age-standardised net survival (%) from oesophageal cancer for adults diagnosed 2007, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

One-year age-standardised net survival ranged from between 40.8% and 50.5% in men and between 33.7% and 46.5% in women (Tables and Figures: B1 and B2). Five-year age-standardised net survival doubled in two NHS England Area teams for men between 1997 and 2007: Lancashire and Cumbria, Northumberland, Tyne and Wear (Tables and Figures: B3 and B4). The range of five-year age-standardised net survival between NHS England Area Teams in 2007 was 8.0% in men and 6.5% women (Table 1B).

Figure 4A: One-year age-standardised net survival (%) from stomach cancer for adults diagnosed 2012, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

Figure 4B: Five-year age-standardised net survival (%) from stomach cancer for adults diagnosed 2007, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

One-year age-standardised net survival of NHS England Area Teams ranged between 73.2% and 80.4% in men, and between 68.1% and 76.0% in women (Tables and Figures: C1 and C2). All NHS England Area Teams saw improvements in survival for those diagnosed in 2012 compared to those diagnosed in 1997. Five-year age-standardised net survival ranged between 52.0% and 59.3% in men, and between 45.3% and 59.2% in women (Tables and Figures: C3 and C4).

Figure 5A: One-year age-standardised net survival (%) from colon cancer for adults diagnosed 2012, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

Figure 5B: Five-year age-standardised net survival (%) from colon cancer for adults diagnosed 2007, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

One-year age-standardised net survival improved during 1997-2012. However, one-year net survival remains low ranging between 29.3% and 38.2% in men and between 32.8% and 42.8% in women (Tables and Figures: D1 and D2). Five-year age-standardised net survival for men has doubled between 1997 and 2007 in Greater Manchester, and survival for women has doubled in four NHS Area Teams: Lancashire, South Yorkshire and Bassetlaw, Bristol, North Somerset, Somerset and South Gloucestershire and Kent and Medway (Tables and Figures: D3 and D4). The range of five-year age-standardised net survival between NHS England Area Teams was 3.7% in men and 5.8% in women (Table 1B).

Figure 6A: One-year age-standardised net survival (%) from lung cancer for adults diagnosed 2012, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

Figure 6B: Five-year age-standardised net survival (%) from lung cancer for adults diagnosed 2007, by NHS England Area Team and sex

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

One-year age-standardised net survival was above 95% in all NHS England Area Teams, with a narrow range between the highest and the lowest survival among Area Teams (Table and Figure: E1). Five-year age-standardised net survival was above 82%, with a range of 3.8% between NHS England Area Teams (Table and Figure: E2).

Figure 7: One-year and five-year age-standardised net survival (%) from breast cancer (women) for adults diagnosed 2012 and 2007 respectively, by NHS England Area Team

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

One-year age-standardised net survival improved between 1997 and 2012, for most of the NHS England Area Teams. The largest improvement was in Leicestershire and Lincolnshire (8.9%). For five-year survival, the largest improvement between 1997 and 2007 was in Merseyside (9.5%). However one-year survival declined slightly between 1997 and 2012 in four NHS England Area Teams: Essex, East Anglia, Thames Valley and Birmingham and the Black Country. Five-year survival declined between 1997 and 2007 in three NHS England Area Teams: Essex, Birmingham and the Black Country and Thames Valley (Tables and Figures: F1 and F2).

Figure 8: One-year and five-year age-standardised net survival (%) from cervical cancer for adults diagnosed 2012 and 2007 respectively, by NHS England Area Team

Source: Office for National Statistics, London School of Hygiene and Tropical Medicine

All adults (15-99 years) who were diagnosed with a first, invasive, primary, malignancy during the period 1997-2012 were eligible for inclusion in the analyses. Patients were excluded if they were diagnosed with a tumour that was benign (behaviour code 0), in situ (2) or of uncertain behaviour (1). Patients were also excluded if their cancer was only registered from a death certificate. Patients with zero recorded survival time were included in the analyses with one day added to their survival. Table 2 shows the number of patients excluded and Table 3 shows the final number of patients in each NHS England Area Team who were included in the analyses.

Key users of cancer survival estimates include the Department of Health, academics and researchers, cancer charities, cancer registries, other government organisations and researchers within ONS, the media, and the general public. The Department of Health uses cancer survival figures to brief government ministers, and as part of the evidence base to inform cancer policy and programmes, for example in drives to improve survival. Cancer survival estimates published by ONS are also included as indicators in the NHS Outcomes Framework 2013 to 2014 and the Clinical Commissioning Group Indicator Set, which are used to hold the NHS and commissioners to account. Academics and researchers use the figures to inform their research. Similarly Public Health England and other government organisations use the figures to carry out individual and collaborative projects. Charities use the data to provide reliable and accessible information about cancer to a wide range of groups, including patients and health professionals via health awareness campaigns and cancer information leaflets/web pages. Researchers within ONS use the data to support further research and to publish alongside other National Statistics.

In ‘Improving Outcomes: A Strategy for Cancer’ (January 2011), the Department of Health stated that although improvements have been made in the quality of cancer services in England, a significant gap remains in survival compared with the European average. Survival estimates for cervical, colorectal and breast cancer are some of the lowest among Member States of the Organisation for Economic Co-operation and Development (OECD) (OECD website). The strategy document sets out how the Department of Health aims to improve outcomes for all cancer patients and improve cancer survival, with the aim of saving an additional 5,000 lives every year by 2014/15.

Outcomes strategies set out how the NHS, public health and social care services will contribute to the ambitions for progress agreed with the Secretary of State in each of the high-level outcomes frameworks. The indicator set for the NHS Outcomes Framework 2013 to 2014 focuses on measuring health outcomes includes one- and five-year cancer survival indicators for all cancers combined, and for colorectal, breast and lung cancers combined.

Ula Nur^a, Michel P Coleman^a, Neil Bannister^b, Rose Drummond^b, Stephen Rowlands^b, Paul Brown^b, Bernard Rachet^a

^a Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine

^b Cancer Analysis Team, Office for National Statis

The National Cancer Registry at the Office for National Statistics and the London School of Hygiene and Tropical Medicine wish to acknowledge the work of the National Cancer Registration Service in England, which provided the raw data for these analyses.