title: National comparisons of lung cancer survival in England, Norway and Sweden 2001-2004: differences occur early in follow-up.
abstract: BACKGROUND Countries with a similar expenditure on healthcare within Europe exhibit differences in lung cancer survival. Survival in lung cancer was studied in 2001-2004 in England, Norway and Sweden. METHODS Nationwide cancer registries in England, Norway and Sweden were used to identify 250 828 patients with lung cancer from England, 18 386 from Norway and 24 886 from Sweden diagnosed between 1996 and 2004, after exclusion of patients registered through death certificate only or with missing, zero or negative survival times. 5-Year relative survival was calculated by application of the period approach. The excess mortality between the countries was compared using a Poisson regression model. RESULTS In all subcategories of age, sex and follow-up period, the 5-year survival was lower in England than in Norway and Sweden. The age-standardised survival estimates were 6.5%, 9.3% and 11.3% for men and 8.4%, 13.5% and 15.9% for women in the respective countries in 2001-2004. The difference in excess risk of dying between the countries was predominantly confined to the first year of follow-up. The relative excess risk ratio during the first 3 months of follow-up comparing England with Norway 2001-2004 varied between 1.23 and 1.46, depending on sex and age, and between 1.56 and 1.91 comparing England with Sweden. CONCLUSION Access to healthcare and population awareness are likely to be major reasons for the differences, but it cannot be excluded that diagnostic and therapeutic activity play a role. Future improvements in lung cancer management may be seen early in follow-up.
authors.affiliation: Division of Cancer Studies, King's College London, School of Medicine, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, London SE1 9RT, UK. lars.holmberg@kcl.ac.uk
authors.forename: Lars
authors.initials: L
authors.lastname: Holmberg
authors.forename: Fredrik
authors.initials: F
authors.lastname: Sandin
authors.forename: Freddie
authors.initials: F
authors.lastname: Bray
authors.forename: Mike
authors.initials: M
authors.lastname: Richards
authors.forename: James
authors.initials: J
authors.lastname: Spicer
authors.forename: Mats
authors.initials: M
authors.lastname: Lambe
authors.forename: Asa
authors.initials: A
authors.lastname: Klint
authors.forename: Mick
authors.initials: M
authors.lastname: Peake
authors.forename: Trond-Eirik
authors.initials: TE
authors.lastname: Strand
authors.forename: Karen
authors.initials: K
authors.lastname: Linklater
authors.forename: David
authors.initials: D
authors.lastname: Robinson
authors.forename: Henrik
authors.initials: H
authors.lastname: Møller
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015986:Confounding Factors, Epidemiologic; D004739:England / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D017678:Sex Distribution; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult