ICBP publications

Measuring and comparing cancer survival in different countries using international data

The first results of the ICBP have recently been published in the medical journal the Lancet. This epidemiology study is looking at cancer survival rates of four cancer types: breast, colorectal, lung and ovarian cancer. It shows that cancer survival improved over the time of the study in all jurisdictions. But survival remains lowest in England, Denmark, Northern Ireland and Wales. Australia, Canada and Sweden show consistently higher survival while Norway has intermediate levels. These differences were greatest in the first year after diagnosis and for patients aged 65 and older.

If you are interested in reading the full article, Cancer survival in Australia, Canada, Denmark, Norway, Sweden and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data, you can find it free of charge on the Lancet's webpage.

For a more general take on what the results mean, have a look at the Cancer Research UK Science blog

A new way to compare information about cancer that's collected differently around the world 

The stage of a cancer describes the size of a cancer, how far it has grown and whether it has spread to other parts of the body. Staging a cancer is very important as it helps the doctor decide what the best type of treatment is likely to be. Internationally there a number of different ways of defining and recording stage. This means that comparing information on stage between different countries and regions is very challenging.

This paper, published in the International Journal of Cancer, describes the development of a new method to turn different ways of defining and recording stage data into a single system. This lets researchers directly compare stage data from around the world. ICBP researchers are now using this method to compare how many people are surviving their cancer, taking account of how early it was diagnosed, in different countries. They are looking at ovarian, lung, breast and bowel cancers. This paper highlights the need for a single staging system that will be used worldwide. So in the future, when stage data is recorded, it will follow the same rules whether this happens in the UK, or internationally. This means it will be more straightforward to make accurate comparisons about stage data between different countries.

If you are interested in reading the abstract of this paper, ‘Comparability of stage data in cancer registries in six countries: lessons from the International Cancer Benchmarking Partnership’, you can find it on the PubMed webpage.

Does diagnosing cancer earlier help explain why people are more likely to survive cancer in some countries?

This paper compared survival rates in different regions by the point at which a woman was diagnosed with ovarian cancer. This point, or stage, is a very important piece of information. It helps the doctor decide what the best treatment is likely to be. Doctors stage ovarian cancers by describing the size of the cancer, looking at how far the cancer has grown and whether it has spread to other parts of the body. The earlier the stage, the smaller the cancer is and the less likely it is to have spread. The stage of a cancer when it is diagnosed can make a big difference to how successfully it can be treated and several studies have suggested that differences in how early cancer is diagnosed could partly explain why some countries do better than others in terms of how likely people are to survive their cancer.

This is the first scientific study to compare ovarian cancer survival by stage internationally. It was published in the cutting edge gynaecological cancer research journal, ‘Gynaecologic Oncology’. Five countries - Australia, Canada, Denmark, Norway and the UK – took part in this in-depth comparison. The study looked at the proportion of women who were still alive one year after their ovarian cancer diagnosis (one-year survival) in each country and also compared information on what stage the women’s cancers had been diagnosed at.

Researchers found that differences in stage at diagnosis may only partially explain the differences between countries in the proportion of women who survive ovarian cancer.  The study found that the UK and Denmark had the lowest one-year ovarian cancer survival of the five countries. Denmark also had the fewest women diagnosed at earlier stages which could partly explain why their ovarian cancer survival is lower than in some other countries. Overall, the UK had similar proportions of women diagnosed at each stage of the disease as in the other participating countries. But women who were diagnosed at later stages of the disease were less likely to survive ovarian cancer in the UK. This suggests that treatment or access to treatment is poorer in the UK for women diagnosed at later stages, than in the other countries in the study. Future ICBP studies will explore the issue of access to treatment in more detail. Work is underway to look at how surgery, radiotherapy and chemotherapy could help explain differences in how many people survive cancer between countries.

This study also found that there was a large difference in how many records were missing information on stage at diagnosis for ovarian cancer.  The UK was the worst at recording stage at diagnosis. Three out of ten ovarian cancer tumours reported in the UK had no information on stage at diagnosis recorded. This is compared to less than one out of ten ovarian cancer tumours in Norway.  It isn’t clear if this is because fewer women are staged by doctors in the UK or because the transfer process of stage data to the cancer registries is less complete in the UK than in the other countries.  Survival in the UK was also lower among those whose stage at diagnosis had not been recorded.The paper highlights the need for routine recording and transferring of stage data to cancer registries in all countries.

If you are interested in reading the paper, ‘Stage at diagnosis and ovarian cancer survival: Evidence from the International Cancer Benchmarking Partnership’, you can find it on the London School of Hygiene and Tropical Medicines web page. If you are interested in reading a more in-depth analysis of the research, you can find it at the Science Update Blog.

Do people in different countries have different thoughts and feelings about cancer? And does that affect how those countries do when it comes to the number of people who survive cancer?

This study looked at whether differences between countries in what people know about cancer and what people believe about cancer outcomes could help explain differences in their cancer survival rates. The study asked people about things like what increases the risk of cancer, whether a symptom could be caused by cancer, how likely they are to visit the doctor with a symptom and what might put them off and how they feel about the chances of surviving cancer. Countries with populations that have lower cancer awareness and more negative beliefs about cancer outcomes may be more likely to delay seeing their doctor about any symptoms they may have. This may lead to more cancers being diagnosed at a later stage and, in turn, poorer survival.

ICBP researchers developed and used a new research tool, the Awareness and Beliefs about Cancer (ABC) measure, to study people’s awareness and beliefs. Nearly 20,000 men and women aged 50 and older were interviewed in Australia, Canada, Denmark, Norway, Sweden and the UK – resulting in the strongest international comparison of awareness and beliefs about cancer in the general population yet.

The study suggested that international differences in cancer survival, as highlighted in previous ICBP research, are not likely to be explained by differences in awareness and beliefs about cancer and cancer outcomes. The results showed that the public awareness of cancer symptoms and beliefs about cancer outcomes was similar internationally. All of the countries reported that around eight out of eleven cancer symptoms were recognised by members of the public. In all of the countries, people had positive beliefs about cancer with around nine out of ten people agreeing that ‘cancer can often be cured’ and seven out of ten disagreeing that ‘a diagnosis of cancer is a death sentence’.

More people in the UK than in other countries said that there were specific reasons they wouldn’t go to their GP, even with a symptom that worried them. People in the UK mentioned that embarrassment and not wanting to waste the doctor’s time would put them off seeing their doctor. Across all countries, the knowledge that the risk of cancer increases with age was low, particularly in the UK. Low one year cancer survival in the UK and Denmark does not seem to be explained by poor awareness and negative beliefs about cancer. This paper calls for continued research into why international cancer survival differences exist.

If you are interested in reading the paper, ‘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?’ you can find it on the British Journal of Cancer’s web page free of charge.

If you are interested in reading a more in-depth analysis of the research, you can find it at the Science Update Blog. 

How researchers developed a survey to measure people’s awareness and beliefs about cancer in different countries.

This paper describes the development and testing of the Awareness and Beliefs about Cancer measure, or ABC measure. ICBP researchers created this tool to measure cancer awareness and beliefs about cancer outcomes across six different countries in five different languages.

Existing studies of knowledge and beliefs have focused on individual countries, so this tool is important to let us measure what happens in different countries and compare the results. Different factors influence public awareness and beliefs about cancer, including cultural attitudes to cancer, how much public education is provided about cancer and how health care is organised and delivered. Researchers took these things into account when developing the ABC. They also made sure that questions were culturally sensitive and had the same meaning across all jurisdictions. The team developed six versions of the ABC, to be used across Australia, Canada, Denmark, Norway, Sweden and the UK as part of an ICBP study. The ABC measure can also now be used by researchers in other countries outside of the ICBP to study their population’s awareness and beliefs about cancer. In addition, researchers interested in creating surveys can use the developmental and testing methods described in this paper to create new research tools.

If you are interested in reading the paper, ‘An International Measure of Awareness and Beliefs about Cancer: Development and Testing of the ABC’ you can find it on the BMJ Open’s web page free of charge.

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How to improve cancer survival: Explaining England's relatively poor rates

In June, ICBP Programme Director Catherine Foot, together with her colleague Tony Harrison at The King's Fund, published a briefing paper outlining the evidence to date on international differences in cancer survival and the evidence for what may be driving those differences. "How to improve cancer survival: Explaining England's relatively poor rates" sets out how the ICBP studies are already and will continue to add to this evidence base.

If you are interested in reading the full article, you can find it free of charge on the King's Fund webpage.

ICBP partners: Cancer plan comparison report

As part of a six month project with the ICBP management team, Cancer Research UK’s Penny Sellers reviewed all of the ICBP partner jurisdictions’ cancer plans. She identified the key aspects in each strategy as well as areas of overlap and significant differences between jurisdictions. Her summary report is just being reviewed and finalised and will be available online shortly.

The ICBP Programme Director and the ICBP Clinical advisor both gave a presentation at the inaugural National Awareness and Early Diagnosis Initiative (NAEDI) conference. You can find their presentations on the NAEDI research conference page.