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More people being cured of cancer

[Posted: Tue 24/03/2009 by Deborah Condon www.irishhealth.com]

The number of people in Europe who are being cured of cancer – rather than just surviving for at least five years after diagnosis – is rising steadily, new data has found.

The findings are based on a long running study of cancer in Europe, known as EUROCARE-4. They provide, for the first time, an estimate of the proportions of patients who are cured of their cancer and who therefore have a life expectancy equal to that of the rest of the population.

The analysis divides patients into two groups – the proportion who may be considered cured of their disease and who are likely to die of something else, and those who will die of their cancer.

The study compared two periods – 1988-1990 and 1997-1999. It found that between these two periods, the proportion of patients estimated to be cured of lung cancer rose from 6% to 8%. Those estimated to be cured of stomach cancer rose from 15% to 18%, while with colorectal cancer, the cure rate increased from 42% to 49%.

“Increases between 1988-1990 and 1997-1999 in the estimated proportion of European patients cured of lung, stomach and colorectal cancers are noteworthy. The proportion cured is not affected by ‘lead time’ (earlier diagnosis without improvement in life expectancy), so these trends suggest genuine progress in cancer control,” explained Dr Riccardo Capocaccia of the National Centre for Epidemiology, Surveillance and Health Promotion in Rome.

However the research found that there were significant differences between countries in Europe. For all cancers combined, the highest number of men (47%) were cured in Iceland, while the highest number of women (59%) were cured in France and Finland.

The least number of men (21%) and women (38%) were cured in Poland.

“Geographic variation in the estimated proportion of patients diagnosed in 1988-1999 who were cured ranged from about 4% to 10% for lung cancer, from 9% to 27% for stomach cancer, from 25% to 49% for colon and rectum cancer, and from 55% to 73% for breast cancer,” Dr Capocaccia pointed out.

For example, Denmark, the Czech Republic and Poland had the lowest proportion of cured lung cancer patients, at less than 5%, while France and Spain had the highest, at more than 10%. For colorectal cancer, less than 30% were cured in Poland, the Czech Republic and Slovenia but 49% were cured in France.

For prostate cancer, the proportion of men cured was associated more with the intensity of PSA testing activity than with the efficacy of treatments. (PSA stands for prostate specific antigen, which is a protein produced by cells in the prostate gland. The PSA test involves taking a blood sample, which is then measured to determine the quantity of PSA in the blood. A high PSA does not necessarily mean a man has prostate cancer but, does indicate a need for further testing.)

France led the way with more than 60% of men cured, while only 14% were cured in Denmark. This difference was largely due to cases diagnosed earlier through the PSA test.
For breast cancer, the results showed a gap between Poland, the Czech Republic and Slovenia and other western European countries of about 10%.

“Part of this difference has been attributed to the introduction of breast cancer screening from the mid-1990s in several western European countries. If this is true, the implication is that early diagnosis saves the lives of women with breast cancer by rendering their disease more curable,” said Dr Capocaccia.

Details of these findings are published in a special edition of the European Journal of Cancer. This edition also contained data relating to the survival of various age groups.

Not surprisingly, survival of older people (70-99 years) was lower than for middle-aged people (55-69). According to Dr Capocaccia, who was guest editor of this journal’s edition, this is probably due to ‘more advanced stage of disease at diagnosis, other serious conditions and more difficult access to, or lack of availability of, appropriate care’.

Overall, women have longer life expectancy than men and better survival from chronic diseases like cardiovascular disease and cancer. Age-adjusted five-year relative survival was higher in women than men for 21 out of 26 types of cancer for which survival was estimated in both sexes.

Particularly marked differences were found for cancers of the head and neck, bone, thyroid and stomach, and for melanoma of the skin. Women had significantly lower survival only for cancers of the biliary tract, bladder and larynx.

“This suggests that sex hormone patterns may play a role in the consistently higher survival seen for women,” said Dr Capocaccia.

In relation to young people, five-year survival for all cancers combined was 81% in children (0-14 years) and 87% in adolescents and young adults (15-24 years). From 1995-1999 to 2000-2002, the risk of death within five years of diagnosis fell significantly for young patients - by 8% in children and 13% in adolescents and young adults.

Survival improved over time for all the main cancer types affecting the young. The improvement was statistically significant for acute lymphoid leukaemia and central nervous system tumours in children and for non-Hodgkin lymphoma in adolescents and young adults.

Welcoming the findings, Prof Alexander Eggermont, president of ECCO (the European CanCer Organisation), pointed out that without this information, ‘it would be impossible to assess whether improvements in cancer diagnosis, treatment and care are actually having an effect on the outcome for patients’.

“The good news is that, for most cancers, survival has increased during the 1980s and 1990s. Europe is changing, with more countries joining the EU, and cancer medicine is also changing and improving. This means that more people have higher expectations of the medical profession. We must do our best to meet these expectations and help both patients and colleagues by disseminating information about better diagnostics, treatments and cures as widely as possible across the whole of Europe, and, indeed, the world,” Prof Eggermont said.

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