title: A population-based comparison of the survival of patients with colorectal cancer in England, Norway and Sweden between 1996 and 2004.
abstract: OBJECTIVE
  To examine differences in the relative survival and excess death rates of patients with colorectal cancer in Norway, Sweden and England.
  
  
  METHODS
  All individuals diagnosed with colorectal cancer (ICD10 (International Classification of Diseases, 10th revision) C18-C20) between 1996 and 2004 in England, Norway and Sweden were included in this population-based study of patients with colorectal cancer. The main outcome measures were 5-year cumulative relative period of survival and excess death rates stratified by age and period of follow-up.
  
  
  RESULTS
  The survival of English patients with colorectal cancer was significantly lower than was observed in both Norway and Sweden. Five-year age-standardised colon cancer relative survival was 51.1% (95% CI 50.1% to 52.0%) in England compared with 57.9% (95% CI 55.2% to 60.5%) in Norway and 59.9% (95% CI 57.7% to 62.0%) in Sweden. Five-year rectal cancer survival was 52.3% (95% CI 51.1% to 53.5%) in England compared with 60.7% (95% CI 57.0% to 64.2%) and 59.8% (95% CI 56.9% to 62.6%) in Norway and Sweden, respectively. The lower survival for colon cancer in England was primarily due to a high number of excess deaths among older patients in the first 3 months after diagnosis. In patients with rectal cancer, excess deaths remained elevated until 2 years of follow-up. If the lower excess death rate in Norway applied in the English population, then 890 (13.6%) and 654 (16.8%) of the excess deaths in the colon and rectal cancer populations, respectively, could have been prevented at 5 years follow-up. Most of these avoidable deaths occurred shortly after diagnosis.
  
  
  CONCLUSIONS
  There was significant variation in survival between the countries, with the English population experiencing a poorer outcome, primarily due to a relatively higher number of excess deaths in older patients in the short term after diagnosis. It seems likely, therefore, that in England a greater proportion of the population present with more rapidly fatal disease (especially in the older age groups) than in Norway or Sweden.
authors.affiliation: Cancer Epidemiology Group, Centre for Epidemiology & Biostatistics, University of Leeds, NYCRIS, St James's University Hospital, Leeds, UK. eva.morris@nycris.leedsth.nhs.uk
authors.forename: Eva J A
authors.initials: EJ
authors.lastname: Morris
authors.forename: Fredrik
authors.initials: F
authors.lastname: Sandin
authors.forename: Paul C
authors.initials: PC
authors.lastname: Lambert
authors.forename: Freddie
authors.initials: F
authors.lastname: Bray
authors.forename: Asa
authors.initials: A
authors.lastname: Klint
authors.forename: Karen
authors.initials: K
authors.lastname: Linklater
authors.forename: David
authors.initials: D
authors.lastname: Robinson
authors.forename: Lars
authors.initials: L
authors.lastname: Påhlman
authors.forename: Lars
authors.initials: L
authors.lastname: Holmberg
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; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality*; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult