Five-year net survival is highest in the youngest adults for nearly all cancers, with survival generally decreasing with increasing age. This is likely to be due to better general health, more effective response to treatment and earlier diagnosis in younger people overall. For some cancers, such as ovarian cancer, a higher proportion of chemo-sensitive tumours in younger women also contribute to the pattern. The notable exceptions to this are breast, bowel and prostate cancers, for which five-year survival is highest in middle age. For breast cancer less favourable tumour characteristics may explain some of the lower survival in younger women, while breast screening is likely to increase survival in women of screening age (though some of the increase will be due to lead time bias). Similarly, screening for bowel cancer is also likely to have contributed to the higher survival in 60-69 year olds. The reasons for the disparity for prostate cancer are unclear, but variation in prostate specific antigen (PSA) testing by age may explain some of the difference, as well as differences in underlying tumour biology.
The lowest five-year survival is seen in 80-99 year-olds for all cancers, even though net survival allows for higher mortality from other causes in the older age groups. Poorer cancer outcomes in the elderly is the subject of much research and is likely to be influenced by many factors, including under-representation in clinical trials, inability to tolerate more aggressive treatments, underlying differences in tumours biology and presenting at later stages.[2-6] For some cancers, such as Hodgkin lymphoma, specific treatment protocols for the elderly are being developed.
Five-Year Net Survival, Selected Cancers, By Age, England, 2007-2011
Breast is for female only. Laryngeal is for male only Five-year survival is predicted using an excess hazard statistical model.
- Quaresma M, Coleman MP, Rachet B2. 40-year trends in an index of survival for all cancers combined and survival adjusted for age and sex for each cancer in England and Wales, 1971-2011: a population-based study. Lancet 2014 pii: S0140-6736(14)61396-9.
- Twenty-year survival data for 2001-2003. Office for National Statistics (ONS). Cancer survival rates, Long-term Breast Cancer Survival, England and Wales. London: ONS; 2005.
- ISD Scotland. Trends in Cancer Survival 1983-2007.
- Northern Ireland Cancer Registry. Incidence & Survival 1993-2012.
- Office for National Statistics. Statistical Bulletin: Cancer survival in England: Patients diagnosed 2007-2011 and followed up to 2012. Newport: ONS; 2013.
- The National Cancer Registration Service, Eastern Office. Personal communication.