ICBP findings and impact

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The ICBP has pioneered a range of methods and research tools to enable robust international comparisons, resulting in 13 high quality peer reviewed papers published to date, with more in the pipeline. An international survival benchmark is underpinned by additional research modules which each explore different aspects of the cancer pathway.

The ICBP publishes showcase reports highlighting findings, impacts and ongoing research. We also produce information brief to report additional insights or to highlight key information.

ICBP findings have impacted on policy and practice across the partnership. Learning from the experience of others, sharing ideas and good practice are key benefits of the partnership. To date, the ICBP has provided evidence which has informed cancer plans, identified priorities for new cancer control initiatives, provided evidence for public awareness campaigns and improved cancer data completeness across several jurisdictions.


New South Wales

  • Underpinned projects improving cancer data completeness and availability.
  • Improved cancer registry practices based on findings from the partnership.
  • Insights informed the choice of cancers with special emphasis in the New South Wales cancer plan, starting 2016.


  • Informed the Victorian Cancer Plan (2016-2020).
  • Prompted a review of ovarian cancer treatment practices and the cancer registration process.
  • Supported state-wide implementation of an ovarian cancer optimal care pathway.



  • Underpinned projects improving cancer data completeness and availability.
  • Further analyses have validated findings using administrative data and deepened understanding.
  • Provided local evidence to the Cancer Care Ontario Clinical Council which develops cancer system strategy and the provincial cancer plan.


  • Provided evidence to support the establishment of a Rapid Access Clinic for lung cancer.


  • Prompted a programme of research into ovarian cancer.
  • Increased engagement within the primary care community on topics related to cancer, particularly differences in referral to specialists.
  • Confirmed evidence underpinning Manitoba’s ‘InSixty’ initiative aimed at reducing the time cancer is first suspected to the time it is treated to 60 days or less.
  • Provided a patient voice to the local cancer patient journey initiative, hearing how patients describe their successes and challenges with the system.

United Kingdom


  • Provided new evidence for cancer plans and identified priorities for new initiatives.
  • Confirmed evidence underpinning public awareness campaigns.
  • Contributed evidence for the ACE (accelerate, coordinate, evaluate) programme, exploring innovative diagnostic referral pathways.
  • Underpinned projects improving cancer data completeness and availability.


  • Provided evidence for Scotland’s new cancer strategy.
  • Provided evidence to the Scottish Primary Care Cancer Group and the Scottish Clinical Imaging Network to improve direct access to imaging for primary care practitioners.


  • Prompted a lung cancer initiative to improve outcomes by taking a cross pathway approach.
  • Led to a study tour to Denmark to learn more about improvements in access to diagnostics which provided additional evidence to establish pilots to improve diagnosis in Wales.
  • Ovarian cancer awareness evidence in Wales contributed to the development of the equivalent English regional ‘Be Clear on Cancer’ campaign.

Northern Ireland

  • Developed a mechanism for the cancer registry to receive data on comorbidities that have caused hospital admissions for cancer patients.
  • Provided insights for public awareness campaigns.



  • Supported more user-oriented cancer care, improving diagnostic capacity and early cancer prevention as part of the Norwegian Cancer Plan (2013-2017).
  • Confirmed evidence from the Norwegian Board of Health Supervision that late diagnosis is a key issue in cancer care in Norway.
  • Provided new evidence of the need for improved and targeted initiatives to enhance public awareness about melanoma.


  • Provided evidence towards a major effort to reduce waiting times, with additional funding from the national government.
  • Provided a stimulus for a continuous focus on improvement around breast cancer and led to the development of a colorectal cancer patient reported experience questionnaire.
  • Provided insights which initiated discussion about public awareness campaigns.
  • Contributed to a renewed assessment of data quality in the Swedish cancer register, in particular around death certificate only cases.


  • Provided evidence about stage registration and stage at treatment which underpinned a focus on earlier and faster cancer diagnosis. This is a shared priority for politicians, policymakers, clinicians and patient advocates.
  • Provided insights for public awareness campaigns and highlighted the impact of social inequalities.
  • Provided evidence for initiatives in the third and fourth national cancer action plans.
  • Provided evidence to support the Danish 3-legged strategy highlighting that primary care practitioners need better and faster access to investigations.

Analysis of 2.4 million cancer patient records showed that relative survival improved in all jurisdictions over this period. Survival is higher in Australia, Canada, and Sweden, intermediate in Norway and lower in Denmark and the UK (England, Northern Ireland and Wales).

5 year conditional survival for ICBP cancer types from 1995-2007[1]

ICBP 5-year relative survival graphs

The survival ‘gap’ between the best performing countries and the lowest remains largely unchanged – except for breast cancer, where the UK is narrowing the gap. The patterns were consistent with later stage at diagnosis or differences in treatment, particularly in Denmark and the UK, and in older patients (those aged 65 or over).

A new algorithm was created so that different staging systems could be compared. It demonstrated significant differences in stage distribution and stage-specific survival between age groups. Missing stage information was highlighted as a particular issue for older age groups. The analysis emphasised the importance of having consistent and high quality data on stage at diagnosis to enable further insights to be generated.

Cancer survival benchmark using population-based registry data

Comparability of stage data in ICBP cancer registries

Breast cancer survival and stage at diagnosis

Colorectal cancer survival and stage at diagnosis

Lung cancer survival and stage at diagnosis

Ovarian cancer survival and stage at diagnosis


[1] Coleman MP, Forman D, Bryant H, et al. 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. Lancet 2011;377(9760):127-138.

The aim of this research topic was to investigate the general public’s awareness and attitudes towards cancer to see if this could explain the differences in cancer survival rates between the jurisdictions. People with low awareness of cancer symptoms or negative beliefs about cancer outcomes may delay going to the doctor when they have suspicious symptoms.

The study found similar levels of awareness of cancer symptoms and generally positive beliefs about cancer across all jurisdictions. There was low awareness across all jurisdictions that age is a risk factor for cancer. Respondents in the UK more often reported barriers to seeing their primary care physician (PCP).

Awareness of age as a risk factor across ICBP jurisdictions[1]

ICBP awareness graph

These findings support the continued need for public awareness campaigns around patients, specifically older patients who are more at risk of having cancer, going to their doctors with potential cancer symptoms.

Awareness, attitudes and beliefs about cancer across ICBP jurisdictions

Find out more on the Cancer Research UK Science Blog

Read summaries of research articles using data from this study

The Awareness and Beliefs about Cancer (ABC) questionnaire is an internationally validated tool which was used to survey 19,079 respondents. The tool was tested in all participating countries with minor variations included to allow for differences in cultural and health systems.

The ABC tool is available for use by interested researchers. For more information please contact the ICBP team.

Read about the development of the ABC tool

Download the ABC tool


[1] Forbes LJL, Simon AE, Warburton F, et al. 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? BJC 2013;108:292-399.

This study explored differences in how primary care physicians (PCP) manage symptomatic patients in participating jurisdictions. A survey was sent to PCPs with direct questions about the local health economy and hypothetical patient scenarios to identify what actions respondents would take.

PCPs in England, Northern Ireland, and Wales (having the lowest cancer survival rates of the ICBP jurisdictions) consistently reported a lower readiness to refer or investigate patients with potential cancer symptoms compared to PCPs in other jurisdictions. The results also suggested that differences in how PCPs access diagnostics and interact with different services within the local health economy may be having an impact on that actions taken by clinicians. 

A health systems ‘mapping’ exercise confirmed that there are many common features of health care systems between partner jurisdictions, with some subtle differences needing further research. Examples include understanding differences in the nature of a patient’s contribution to health care costs and the ease with which patients can move freely between primary care providers. Both of these examples may impact on patient or doctor behaviour and so could contribute to differences in cancer outcomes.

Likelihood to refer at first presentation may be linked to survival outcomes

How might healthcare systems influence the speed of cancer diagnosis?

Development of the online survey used to assess primary care factors affecting cancer diagnosis

Find out more on the Cancer Research UK Science Blog

Showcasing our findings and impacts

Showcase reports provide an update on progress within the partnership, including findings the impacts of our research and ongoing studies. These reports provide an overview of the partnership at certain points in time.

ICBP: Evidence for policy and practice (October 2016)

ICBP: Showcasing our findings and impacts (December 2014)

ICBP posters and presentations

Our findings are being reported at conferences around the world. Some of our latest posters and presentations can be found here:

ICBP summary slides (September 2016)

Providing evidence for cancer survival differences poster (September 2016)

External reports

ICBP work often feeds in to other reports, a selection of which are found below:

How to improve cancer survival: Exploring England’s relatively poor rates (The King’s Fund 2011) 

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