Improved Cancer Survival Research Articles

Vocational rehabilitation services for patients with cancer: design of a feasibility study incorporating a pilot randomised controlled trial among women with breast cancer following surgery

BackgroundDue to improvements in cancer survival the number of people of working age living with cancer across Europe is likely to increase. UK governments have made commitments to reduce the number of working days lost to ill-health and to improve access to vocational rehabilitation (VR) services. Return to work for people with cancer has been identified as a priority. However, there are few services to support people to remain in or return to work after cancer and no associated trials to assess their impact. A pilot randomised controlled trial among women with breast cancer has been designed to assess the feasibility of a larger definitive trial of VR services for people with cancer.MethodsPatients are being recruited from three clinical sites in two Scottish National Health Service (NHS) Boards for 6 months. Eligible patients are all women who are: (1) aged between 18 and 65 years; (2) in paid employment or self-employed; (3) living or working in Lothian or Tayside, Scotland, UK; (4) diagnosed with an invasive breast cancer tumour; (5) treated first with surgery. Patients are randomly allocated to receive referral to a VR service or usual care, which involves no formal employment support. The primary outcome measure is self-reported sickness absence in the first 6 months following surgery. Secondary outcome measures include changes in quality of life (FACT-B), fatigue (FACIT-Fatigue) and employment status between baseline and 6- and 12-months post-surgery. A post-trial evaluation will be conducted to assess the acceptability of the intervention among participants and the feasibility of a larger, more definitive, trial with patients with lung and prostate cancer.DiscussionTo our knowledge this is the first study to determine the feasibility of a randomised controlled trial of the effectiveness of VR services to enable people with cancer to remain in or return to employment. The study will provide evidence to assess the relevance and feasibility of a larger future trial involving patients with breast, prostate or lung cancer and inform the development of appropriate VR services for people living with cancer.Trial RegistrationISRCTN: ISRCTN29666484Registration date: 07/10/10; Randomisation of first patient: 03/12/10

Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries

Improvements in cancer survival have made the long-term risks from treatments more important, including the risk of developing a second cancer after radiotherapy. We aimed to estimate the proportion of second cancers attributable to radiotherapy in adults with data from the US Surveillance, Epidemiology and End Results (SEER) cancer registries. We used nine of the SEER registries to systematically analyse 15 cancer sites that are routinely treated with radiotherapy (oral and pharynx, salivary gland, rectum, anus, larynx, lung, soft tissue, female breast, cervix, endometrial, prostate, testes, eye and orbit, brain and CNS, and thyroid). The cohort we studied was composed of patients aged 20 years or older who were diagnosed with a first primary invasive solid cancer reported in the SEER registries between Jan 1, 1973, and Dec 31, 2002. Relative risks (RRs) for second cancer in patients treated with radiotherapy versus patients not treated with radiotherapy were estimated with Poisson regression adjusted for age, stage, and other potential confounders. 647,672 cancer patients who were 5-year survivors were followed up for a mean 12 years (SD 4.5, range 5-34); 60,271 (9%) developed a second solid cancer. For each of the first cancer sites the RR of developing a second cancer associated with radiotherapy exceeded 1, and varied from 1.08 (95% CI 0.79-1.46) after cancers of the eye and orbit to 1.43 (1.13-1.84) after cancer of the testes. In general, the RR was highest for organs that typically received greater than 5 Gy, decreased with increasing age at diagnosis, and increased with time since diagnosis. We estimated a total of 3266 (2862-3670) excess second solid cancers that could be related to radiotherapy, that is 8% (7-9) of the total in all radiotherapy patients (≥1 year survivors) and five excess cancers per 1000 patients treated with radiotherapy by 15 years after diagnosis. A relatively small proportion of second cancers are related to radiotherapy in adults, suggesting that most are due to other factors, such as lifestyle or genetics. US National Cancer Institute.

Breast Cancer, Sickness Absence, Income and Marital Status. A Study on Life Situation 1 Year Prior Diagnosis Compared to 3 and 5 Years after Diagnosis

BackgroundImproved cancer survival poses important questions about future life conditions of the survivor. We examined the possible influence of a breast cancer diagnosis on subsequent working and marital status, sickness absence and income.MaterialsWe conducted a matched cohort study including 4,761 women 40–59 years of age and registered with primary breast cancer in a Swedish population-based clinical register during 1993–2003, and 2,3805 women without breast cancer. Information on socioeconomic standing was obtained from a social database 1 year prior and 3 and 5 years following the diagnosis. In Conditional Poisson Regression models, risk ratios (RRs) and 95% confidence intervals (CIs) were estimated to assess the impact of a breast cancer diagnosis.FindingsThree years after diagnosis, women who had had breast cancer more often had received sickness benefits (RR = 1.49, 95% CI 1.40–1.58) or disability pension (RR = 1.47, 95% CI 1.37–1.58) than had women without breast cancer. We found no effect on income (RR = 0.99), welfare payments (RR = 0.98), or marital status (RR = 1.02). A higher use of sickness benefits and disability pension was evident in all stages of the disease, although the difference in use of sickness benefits decreased after 5 years, whereas the difference in disability pension increased. For woman with early stage breast cancer, the sickness absence was higher following diagnosis among those with low education, who had undergone mastectomy, and had received chemo- or hormonal therapy. Neither tumour size nor presence of lymph nodes metastasis was associated with sickness absence after adjustment for treatment.InterpretationEven in early stage breast cancer, a diagnosis negatively influences working capacity both 3 and 5 years after diagnosis, and it seems that the type of treatment received had the largest impact. A greater focus needs to be put on rehabilitation of breast cancer patients, work-place adaptations and research on long-term sequelae of treatment.

The potential role of echocardiographic strain imaging for evaluating cardiotoxicity due to cancer therapy

Refinements to conventional treatment and the development of new therapies have led to significant improvements in cancer survival. Yet, many frontline cancer treatments continue to be hindered by their significant side effects, amongst which cardiotoxicity is particularly important. Therefore, the focus of cancer management has changed; treatment is no longer aimed solely at overcoming malignancy, but emphasises early identification and treatment of potential side effects. In this regard, the cardiotoxic potential of certain anticancer agents mandate close monitoring of cardiac function, and the method of choice for monitoring is transthoracic echocardiography. Whilst this method has its limitations, a newer echocardiographic technique called myocardial strain imaging has the potential to detect early sub-clinical changes in cardiac function due to cardiotoxicity. Strain analysis has been the subject of several recent studies to evaluate its potential in monitoring cardiotoxicity, and this article reviews the recent literature and explores the potential role of myocardial strain imaging in cancer management and avenues for future research.

Population-based Survival of Cancer Patients Diagnosed Between 1993 and 1999 in Japan: A Chronological and International Comparative Study

The purpose of the present study was to collect data from population-based cancer registries and to calculate relative 5-year survival of cancer patients in Japan. We also sought to determine time trends and to compare the results with international studies. We asked 11 population-based cancer registries to submit individual data for patients diagnosed from 1993 to 1999, together with data on outcome after 5 years. Although all these registries submitted data (491 772 cases), only six met the required standards for the quality of registration data and follow-up investigation. The relative 5-year survival calculated by pooling data from 151 061 cases from six registries was taken as the survival for cancer patients in Japan. Relative 5-year survival (1997-99) was 54.3% for all cancers (males: 50.0%, females: 59.8%). Survival figures for all sites changed slightly over the 7-year period, from 53.2% for the first 4 years of the study (1993-96) to 54.3% for the last 3 years (1997-99), however, a major improvement was observed in several primary sites. Some overall survival was lower in Japan than in the USA, but similar to that in European countries. Specifically, survival for uterine cancer, prostate cancer, testis cancer, lymphoma and leukemia was much lower in Japan than in other countries. However, survival was better in Japan mainly for cancers of the esophagus, stomach, colon, liver and gallbladder. The study suggests an improvement in cancer survival in several primary sites in Japan, which is consistent with the development of treatments and early detection.

Inequalities in cancer survival and the NHS cancer plan: evidence of progress?

Inequalities in cancer survival and the NHS cancer plan: evidence of progress?

Decreased cancer survival in individuals separated at time of diagnosis: Critical period for cancer pathophysiology?

: It long has been recognized that married patients have improved cancer survival when compared with unmarried patients. This has been postulated as being due to increased support, potentially leading to better compliance with therapy. Conversely, some data exist pointing to a relationship between marital discord and decreased immunity. We examined whether unmarried patients have a different prognosis by whether they are 1) never married, 2) divorced, 3) widowed, or 4) separated at time of diagnosis.: The public access data of the Surveillance, Epidemiology and End Results (SEER) registry were queried for cancer survival across all 17 registries between 1973 and 2004. SEER last updated data in April 2007. Records of 3.79 million patients were included in the analysis. We specifically analyzed 5-year and 10-year relative survival (RS; 5yRS, 10yRS), defined as observed survival divided by observed survival of an age-matched, race-matched, and gender-matched population without disease, for all cancer patients by marital status, with specific subset analyses as indicated.: Among unmarried patients, those separated at time of diagnosis had the lowest survival, followed by widowed, divorced, and never married patients. 5-year and 10-year RS of separated patients was 72% and 64% than that of married patients, respectively. This relationship persists when data are analyzed by gender.: Separated marital status is associated with a significant decrement in cancer survival, even in comparison with other unmarried groups. While other socioeconomic variables could contribute to this phenomenon, further research into the immunologic correlates of the acutely stressful condition of marital separation should be conducted. Cancer 2009. (c) 2009 American Cancer Society.

The economics of improved cancer survival rates: better outcomes, higher costs

In 2006, over three million new cases of cancer were diagnosed in Europe. This number will increase in the coming years as a result of an aging population and population growth. Advances in the diagnosis and treatment of cancer have resulted in increased survival rates. Simultaneously, increasing costs of screening, diagnosis and the treatment of cancer could threaten the ability to ensure high-quality care and provide access to care for all patients. New genetic tests and biomarkers may help to identify those subtypes of patients that would be most likely to benefit from new cancer drugs. In our opinion, there is still much to gain in cancer diagnosis and treatment but these gains should be worth the costs.

Cancer survival as a function of age at diagnosis: A study of the Surveillance, Epidemiology and End Results database

Background: Recent research suggested that cancer survival has improved in recent cohorts. Improvement in cancer survival is considered a valid indicator of the quality of care introduced to the patients. The aim of this study is to investigate the changes in the survival profile over age for patients with the most incident cancers. Methods: Survival data of 3.94 million patients diagnosed with 23 primary-site cancers within the periods of 1979–1983, 1989–1993, and 1999–2003 were adopted from the Surveillance, Epidemiology and End Results database. Gender and cause-specific survival probabilities were estimated at one, three, and five years after diagnosis using the Kaplan–Meier survival estimate. Survival was presented for each of the studied cancers, cohorts, and sexes in the form of line graphs as a function of age at diagnosis. Error bars demonstrated the probability of error at 95% confidence level. Results: The graphs demonstrated that cancer survival was improved over the successive cohorts for most cancers, with several exceptions such as brain and lung cancers. The relation between survival and the age at diagnosis was generally described in the form of a gradual decline phase and a rapid fall-off phase at 70–80 years of age, with few exceptions as in leukemia and Hodgkin lymphoma. Patients who survived for three years were more likely to live for five years after diagnosis, but this prediction could not be extrapolated to the one-year survivors. Conclusion: Further studies on tumor-specific characteristics and treatment modalities of these patients are suggested for clarification of the possible causes of variations in patient's survival profile over age.

Comprehensive miRNA profiling of surgically staged endometrial cancer

We sought to determine a microRNA (miRNA) profile of surgically staged endometrial cancers. RNA was extracted from archival primary endometrial cancers, and an miRNA profile was established using a microarray and confirmed with real-time polymerase chain reaction. Targets of differentially expressed miRNAs were explored using real-time polymerase chain reaction and Western blot in endometrial cell lines. Endometrial cancer has an miRNA profile distinct from normal endometrium, even in patients with stage IA grade 1 tumors. This miRNA cancer profile was able to correctly assign a specimen as a malignancy with a sensitivity of 92%. Overexpressed miRNAs were predicted to target PTEN, and transfection of cell lines with these miRNAs led to down-regulation of PTEN expression. In advanced disease, an miRNA pattern distinct from early-stage disease was seen, and overexpression of mir-199c predicted improved cancer survival in this population. Endometrial cancer has a distinct miRNA profile, and miRNAs can be used as a predictive biomarker.

Preliminary results from The Ovarian Nutrition Education (ONE) study

Guidelines for cancer prevention suggest that a diet high in fruit and vegetables and low in animal protein is associated with a reduction of risk for most cancers and may improve cancer survival. The aim of this study was to determine if fruit/vegetable concentrate supplementation is associated with similar improvements in plasma biomarkers and anthropometric indicators than a diet high in fiber and low in fat among a sample of ovarian cancer survivors. Initially there were a total of 52 women (85% White; Mean age = 53 years) participants with an adherence rate of roughly 73%. Twenty‐seven women were randomized to Juice Plus diet and 24 were randomized to the WHEL study diet. Mixed‐effects regression models revealed that there were no significant between‐group changes in anthropometric measures (i.e., BMI, weight, hip, waist, upper arm) (all p > 0.05), whereas, significant between‐group differences were observed for improvements in Serum Albumin and TIBC levels (all p < 0.05). Near significant between‐group differences were observed for vitamin B12 (p < 0.10). These improvements were observed among Juice Plus participants. More research is needed to determine if the improvements observed by Juice Plus participants translates into meaningful clinical outcomes such as reductions in recurrence and survival. Support: NSA (TN, USA)

An economic evaluation of the war on cancer

For decades, the US public and private sectors have committed substantial resources towards cancer research, but the societal payoff has not been well-understood. We quantify the value of recent gains in cancer survival, and analyze the distribution of value among various stakeholders. Between 1988 and 2000, life expectancy for cancer patients increased by roughly four years, and the average willingness-to-pay for these survival gains was roughly $322,000. Improvements in cancer survival during this period created 23 million additional life-years and roughly $1.9 trillion of additional social value, implying that the average life-year was worth approximately $82,000 to its recipient. Health care providers and pharmaceutical companies appropriated 5–19% of this total, with the rest accruing to patients. The share of value flowing to patients has been rising over time. In terms of economic rates of return, R&D investments against cancer have been a success, particularly from the patient's point of view.

The Contributions of Improved Therapy and Earlier Detection to Cancer Survival Gains, 1988-2000

Prior literature has documented improvements in cancer survival over time. However, ambiguity remains over the relative contributions of improved treatment and earlier detection to survival gains. Using registry data, we developed a novel framework to estimate the relative contributions of advances in treatment and detection. Our approach compares changes in the probability of early detection, which we interpret as the effects of advances in detection, to improvements in stage-conditional survival, which we interpret as the effects of treatment. We applied this methodology using SEER data to estimate probabilities of early detection and stage-conditional survival curves for several cancers, by race, between 1988 and 2000. Survival increased for all of the cancers we examined, with blacks experiencing larger survival gains than whites for all cancers combined. Our baseline analysis found that treatment advances account for the vast majority of survival gains for all the cancers examined: breast cancer (83%), lung cancer (85%), colorectal cancer (76%), pancreatic cancer (100%), and non-Hodgkin’s lymphoma (96%). Compared to whites, treatments appear to explain a lower percentage of survival gains for blacks for all cancers combined; breast cancer, NHL, and pancreatic cancer show a higher percentage of survival gains than lung cancer; and roughly the same percentage for the colorectal cancer. These results are robust to sensitivity analyses examining potential length and lead time bias. Overall, our results suggest that while improved treatment and early detection both contributed to the recent gains in survival, the majority of gains from 1988 to 2000 appear to have been driven by better treatment, manifested by improved stage-conditional survival. These results have important policy implications regarding investment in research and development and the evaluation of efforts to improve cancer screening.

Estimation du coût de la prise en charge du cancer invasif du col de l'utérus en Tunisie

In Tunisia, cervical cancer incidence is about 4.8 per 100,000, but the diagnosis is often made too late, with 5-year survival rates of 35% or less. Given the budgetary constraints facing the health system, and taking into account the low incidence of cervical cancer in Tunisia, the comparative cost effectiveness analysis of screening programs must be strongly considered by policy and decision-makers. A retrospective study to estimate the average direct cost of managing cervical cancer during the first year after diagnosis was conducted among patients with cervical cancer diagnosed in 2003 at the Salah Azaiez Cancer Institute in Tunis. The study included 64 patients with cervical cancer. The direct medical cost is equal to the sum of the respective consumable costs related to hospitalization, ambulatory care, diagnostic tests, surgical procedures, chemotherapy and radiation. Regarding the in-patient hospital stay, the overall cost of a hospital day is a macro-cost including the accommodation expenses themselves, as well as staff costs and non-specific drugs. An extrapolation of the cost of care has been done at the national level; the method used consisted in multiplying the mean of the direct medical costs according to the FIGO stage by the number of incident cases at national level, for the corresponding stage. The distribution by FIGO stage was derived from the Cancer Registry of the northern region of the country. This extrapolation is an estimate, It assumes that the costs of care are similar in other health facilities, and secondly, it assumes that the distribution by FIGO stage according to that of the northern region's registrar is approximately the same at the national level. The results showed that the direct medical care cost of cervical cancer ranged from 777 to 7458 DT (431 to 4143 euro) with an average of 3180 +/- 1390 DT (1766 +/- 772 euro). The national cost was estimated at 877,680 DT (486,847 euro). Although, the cost of care for cervical cancer in Tunisia does not represent a considerable burden for health system, cervical cancer screening remains the best intervention to improve cancer survival rates.

Mathematical modelling and simulation of colorectal cancer

To understand cancer pathology and develop effective treatment strategies play significant roles in improving cancer survival rates. In this paper, evaluations of mathematical modelling and simulation were studied and presented. Colorectal system was investigated from gene and cell levels. The Hardware Descriptive Language (HDL) package and codes were developed to simulate the cancer models. Representative codes and figures were illustrated. Results suggest that the HDL is an effective method to conduct the modelling and simulation of cancers. It is essential to develop advanced technology such as HDL modelling and simulation to improve our understandings to fight cancer and save lives.

Immediate postmastectomy reconstruction is associated with improved breast cancer‐specific survival

Although immediate breast reconstruction is increasingly offered as part of postmastectomy psychosocial rehabilitation, concerns remain that it may delay adjuvant therapy or impair detection of local recurrence. No single population-based study has examined the relationship between immediate breast reconstruction and breast cancer-specific survival. By using data from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries, breast cancer-specific survival was compared for female unilateral mastectomy patients who did or did not undergo immediate breast reconstruction. Cox proportional hazards models were fitted, adjusting for known demographic and disease severity variables and stratifying on reconstruction type (implant or autologous) and age. Improved breast cancer-specific survival was observed among all immediate breast reconstruction patients compared with patients who underwent mastectomy alone (hazard ratio [HR]=0.74; 95% confidence interval [CI], 0.68 to 0.80). Implant reconstruction patients below 50 years of age demonstrated the greatest apparent survival benefit (HR=0.47; 95% CI 0.28 to 0.80). Similarly, autologous reconstruction was associated with improved cancer-specific survival among patients below the age of 50 (HR=0.58; 95% CI, 0.42 to 0.80) and between ages 50 to 69 (HR=0.61; 95% CI, 0.43 to 0.85). Immediate breast reconstruction is associated with decreased breast cancer-specific mortality, particularly among younger women. We believe this association is more likely attributable to imbalances in socioeconomic factors and access to care than to inadequate adjustment for tumor characteristics and disease severity. Further research is needed to identify additional prognostic factors responsible for the improved cancer survival among women undergoing immediate postmastectomy reconstruction.

Decreased cancer survival in individuals separated at time of diagnosis

AbstractBACKGROUND:It long has been recognized that married patients have improved cancer survival when compared with unmarried patients. This has been postulated as being due to increased support, potentially leading to better compliance with therapy. Conversely, some data exist pointing to a relationship between marital discord and decreased immunity. We examined whether unmarried patients have a different prognosis by whether they are 1) never married, 2) divorced, 3) widowed, or 4) separated at time of diagnosis.METHODS:The public access data of the Surveillance, Epidemiology and End Results (SEER) registry were queried for cancer survival across all 17 registries between 1973 and 2004. SEER last updated data in April 2007. Records of 3.79 million patients were included in the analysis. We specifically analyzed 5‐year and 10‐year relative survival (RS; 5yRS, 10yRS), defined as observed survival divided by observed survival of an age‐matched, race‐matched, and gender‐matched population without disease, for all cancer patients by marital status, with specific subset analyses as indicated.RESULTS:Among unmarried patients, those separated at time of diagnosis had the lowest survival, followed by widowed, divorced, and never married patients. 5‐year and 10‐year RS of separated patients was 72% and 64% than that of married patients, respectively. This relationship persists when data are analyzed by gender.CONCLUSIONS:Separated marital status is associated with a significant decrement in cancer survival, even in comparison with other unmarried groups. While other socioeconomic variables could contribute to this phenomenon, further research into the immunologic correlates of the acutely stressful condition of marital separation should be conducted. Cancer 2009. © 2009 American Cancer Society.

A ‘Catch Up’ Plan for radiotherapy in New South Wales to 2012

In New South Wales (NSW) from 1996 to 2006, only 34-37% of newly diagnosed cancer patients were treated with radiotherapy instead of the 50% proposed by NSW Health in Radiotherapy Plans released in 1991, 1995 and 2003. As a consequence, over 50 000 cancer patients were not treated and has resulted in the estimated premature death of over 8000 patients and over 40 000 years of life lost. In 2008, there were 42 linear accelerators in NSW rather than the 62 recommended. Based on cancer incidence projections, NSW will require 69 linear accelerators in 2012--a shortfall of 27 linear accelerators. Already 15 linear accelerators have been approved. NSW Health has funding for seven extra linear accelerators, and eight extra linear accelerators are to be funded by the private sector. To make up the shortfall, a 'Catch Up' Plan is proposed for an additional 12 linear accelerators by the end of fiscal year 2012. This is estimated to cost $200 million over 4 years for one-off establishment costs for buildings and equipment plus $50 million per year for recurrent operating costs such as staff salaries. The 'Catch Up' Plan will create five new departments of radiation oncology in country hospitals and three new departments in metropolitan hospitals. These will be in addition to those already approved by NSW Health and will markedly improve access for treatment and result in an improvement in cancer survival. This significant increase in departments and equipment can only be achieved by the creation of an NSW Radiotherapy Taskforce similar to that proposed in the Baume report of 2002, 'A vision for radiotherapy'. Even if the 'Catch Up' Plan bridges the gap in service provision, forward planning beyond 2012 should commence immediately as 76 linear accelerators will be required for NSW in 2015 and 81 linear accelerators in 2017.

Factors influencing in-hospital length of stay and mortality in cancer patients suffering from febrile neutropenia

e20716 Background: Febrile neutropenia (FN) is a major complication of chemotherapy, costly in terms of morbidity, mortality and associated financial expenditure. The present study was conducted with the goal of highlighting FN as a serious problem in Pakistan, with the longer term objective of improved cancer survival, reduction in length of stay (LOS) in hospital, morbidity, mortality and costs in our existing developing country scenario. Methods: A cross-sectional descriptive study was conducted on patients, >18 years, admitted with FN as a consequence of chemotherapy at a referral hospital in Karachi from 1st September 2006 to 30th April 2007. Results: A total of 80 patients [43 (53.8%) males and 37 (46.2%) females] were selected. The mean age was 47.4 (SD ±16.6; range 18–79) years. Sixty eight patients (86%) were < 65 years, 50% were < 50 years. Overall, in hospital mortality was 11%; 4% for patients on granulocyte colony stimulating factor (G-CSF) prophylaxis as against 20% for those without. The cause of death was either pneumonia or septic shock. Mean LOS was 7.53 (SD ±3.8; range 2–17) days. Hematological malignancies, older age, severity of dehydration, pneumonia and culture positivity were significantly associated with LOS and death. Those above 50 years of age were 1.5 times as likely to be hospitalized longer and > three times as likely to die. Bacteremia conferred a 5-fold and pneumonia an 8-fold increase in the risk of death. Conclusions: The results of this study indicate that age, vital instability, dehydration, high creatinine, culture positivity and hematological malignancies are high risk factors in chemotherapy induced FN. Identification of FN risk factors with poor outcomes may help in devising protocols for modified dosage or including GCFs initially. This may help reduce the cost of cancer care as well as mortality and morbidity. Prospective studies of FN in multiple centers in Pakistan may be beneficial in evaluating these risk factors further. No significant financial relationships to disclose.

Survival trends in European cancer patients diagnosed from 1988 to 1999

We analysed data from 49 cancer registries in 18 European countries over the period 1988–1999 to delineate time trends in cancer survival. Survival increased in Europe over the study period for all cancer sites that were considered. There were major survival increases in 5 year age-adjusted relative survival for prostate (from 58% to 79%), colon and rectum (from 48% to 54% men and women), and breast (from 74% to 83%). Improvements were also significant for stomach (from 22% to 24%), male larynx (from 62% to 64%), skin melanoma (from 78% to 83%), Hodgkin disease (from 77% to 83%), non-Hodgkin lymphoma (from 49% to 56%), leukaemias (from 37% to 42%), and for all cancers combined (from 34% to 39% in men, and from 52% to 59% in women). Survival did not change significantly for female larynx, lung, cervix or ovary. The largest increases in survival typically occurred in countries with the lowest survival, and contributed to the overall reduction of survival disparities across Europe over the study period. Differences in the extent of PSA testing and mammographic screening, and increasing use of colonscopy and faecal blood testing together with improving cancer care are probably the major underlying reasons for the improvements in survival for cancers of prostate, breast, colon and rectum. The marked survival improvements in countries with poor survival may indicate that these countries have made efforts to adopt the new diagnostic procedures and the standardised therapeutic protocols in use in more affluent countries.