title: Geographical variation in cancer survival in England, 1991-2006: an analysis by Cancer Network.
abstract: BACKGROUND
  Reducing geographical inequalities in cancer survival in England was a key aim of the Calman-Hine Report (1995) and the NHS Cancer Plan (2000). This study assesses whether geographical inequalities changed following these policy developments by analysing the trend in 1-year relative survival in the 28 cancer networks of England.
  
  
  METHODS
  Population-based age-standardised relative survival at 1 year is estimated for 1.4 million patients diagnosed with cancer of the oesophagus, stomach, colon, lung, breast (women) or cervix in England during 1991-2006 and followed up to 2007. Regional and deprivation-specific life tables are built to adjust survival estimates for differences in background mortality. Analysis is divided into three calendar periods: 1991-5, 1996-2000 and 2001-6. Funnel plots are used to assess geographical variation in survival over time.
  
  
  RESULTS
  One-year relative survival improved for all cancers except cervical cancer. There was a wide geographical variation in survival with generally lower estimates in northern England. This north-south divide became less marked over time, although the overall number of cancer networks that were lower outliers compared with the England value remained stable. Breast cancer was the only cancer for which there was a marked reduction in geographical inequality in survival over time.
  
  
  CONCLUSIONS
  Policy changes over the past two decades coincided with improved relative survival, without an increase in geographical variation. The north-south divide in relative survival became less pronounced over time but geographical inequalities persist. The reduction in geographical inequality in breast cancer survival may be followed by a similar trend for other cancers, provided government recommendations are implemented similarly.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. sarah.walters@lshtm.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Walters
authors.forename: Manuela
authors.initials: M
authors.lastname: Quaresma
authors.forename: Michel P
authors.initials: MP
authors.lastname: Coleman
authors.forename: Emma
authors.initials: E
authors.lastname: Gordon
authors.forename: David
authors.initials: D
authors.lastname: Forman
authors.forename: Bernard
authors.initials: B
authors.lastname: Rachet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D005843:Geography; D054624:Health Status Disparities; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D012042:Registries; D016019:Survival Analysis; D055815:Young Adult