Abstract
Danish lung cancer patients diagnosed during 1983-1987 experienced 5-yr relative survival rates 2-7% inferior to patients in the other Nordic countries, despite the similarity of cancer registration and healthcare systems in the Nordic countries. Is the inferior relative survival in Denmark due to differences in morphology or stage of lung cancers? The present study compared in detail the survival of 92,719 patients diagnosed with lung cancer during 1978-1992 in Denmark, Finland, and Norway. In particular, differences in morphology and extent of disease were studied. A poor survival rate for small cell anaplastic lung carcinoma compared with all other morphologies was confirmed. However, this could not explain the relative survival differences observed between countries. Extent of disease was the most important predictor of survival. Part of the observed survival differences could be explained by a less favourable stage distribution in Denmark, combined with a slightly lower relative survival rate for those with metastatic disease. Differences in treatment are unlikely to explain the findings, although delays in diagnosing and treating patients in Denmark compared with neighbouring countries could partially explain the lower patient survival in Denmark. In conclusion, the main factor in the lower survival rate in Denmark is unfavourable stage distribution.
Highlights
A poor survival rate for small cell anaplastic lung carcinoma compared with all other morphologies was confirmed
It has long been known that the aetiology of almost all lung cancers is tobacco smoking [4], and prevention through control of tobacco smoking should be given the highest priority in order to lower the incidence of, and the mortality from, this disease
Five-yr relative survival rates following a diagnosis of lung cancer were studied in three Nordic countries by morphology and stage
Summary
A poor survival rate for small cell anaplastic lung carcinoma compared with all other morphologies was confirmed This could not explain the relative survival differences observed between countries. Part of the observed survival differences could be explained by a less favourable stage distribution in Denmark, combined with a slightly lower relative survival rate for those with metastatic disease. Stage of disease and morphological type are known predictors of survival, with small cell anaplastic carcinomas and nonlocalized cases (the most common presentation of this cancer) experiencing the least favourable survival [3]. Yr relative survival to that of the general population and found overall survival following lung cancer in Denmark, Scotland, and England to be 40±50% lower than the relative survival seen in Switzerland, the Netherlands, and Finland Biases such as heterogeneity in registration methods could not be ruled out as explanations for the findings. The differences in stage and/or morphology of small cell anaplastic carcinoma were studied to determine whether or not they contributed to the lower patient survival in Denmark
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