title: Stage at diagnosis and colorectal cancer survival in six high-income countries: a population-based study of patients diagnosed during 2000-2007.
abstract: BACKGROUND
  Large international differences in colorectal cancer survival exist, even between countries with similar healthcare. We investigate the extent to which stage at diagnosis explains these differences.
  
  
  METHODS
  Data from population-based cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK were analysed for 313 852 patients diagnosed with colon or rectal cancer during 2000-2007. We compared the distributions of stage at diagnosis. We estimated both stage-specific net survival and the excess hazard of death up to three years after diagnosis, using flexible parametric models on the log-cumulative excess hazard scale.
  
  
  RESULTS
  International differences in colon and rectal cancer stage distributions were wide: Denmark showed a distribution skewed towards later-stage disease, while Australia, Norway and the UK showed high proportions of 'regional' disease. One-year colon cancer survival was 67% in the UK and ranged between 71% (Denmark) and 80% (Australia and Sweden) elsewhere. For rectal cancer, one-year survival was also low in the UK (75%), compared to 79% in Denmark and 82-84% elsewhere. International survival differences were also evident for each stage of disease, with the UK showing consistently lowest survival at one and three years.
  
  
  CONCLUSIONS
  Differences in stage at diagnosis partly explain international differences in colorectal cancer survival, with a more adverse stage distribution contributing to comparatively low survival in Denmark. Differences in stage distribution could arise because of differences in diagnostic delay and awareness of symptoms, or in the thoroughness of staging procedures. Nevertheless, survival differences also exist for each stage of disease, suggesting unequal access to optimal treatment, particularly in the UK.
authors.affiliation: Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK. camille.maringe@lshtm.ac.uk
authors.forename: Camille
authors.initials: C
authors.lastname: Maringe
authors.forename: Sarah
authors.initials: S
authors.lastname: Walters
authors.forename: Bernard
authors.initials: B
authors.lastname: Rachet
authors.forename: John
authors.initials: J
authors.lastname: Butler
authors.forename: Tony
authors.initials: T
authors.lastname: Fields
authors.forename: Paul
authors.initials: P
authors.lastname: Finan
authors.forename: Roy
authors.initials: R
authors.lastname: Maxwell
authors.forename: Bjørn
authors.initials: B
authors.lastname: Nedrebø
authors.forename: Lars
authors.initials: L
authors.lastname: Påhlman
authors.forename: Annika
authors.initials: A
authors.lastname: Sjövall
authors.forename: Allan
authors.initials: A
authors.lastname: Spigelman
authors.forename: Gerda
authors.initials: G
authors.lastname: Engholm
authors.forename: Anna
authors.initials: A
authors.lastname: Gavin
authors.forename: Marianne L
authors.initials: ML
authors.lastname: Gjerstorff
authors.forename: Juanita
authors.initials: J
authors.lastname: Hatcher
authors.forename: Tom B
authors.initials: TB
authors.lastname: Johannesen
authors.forename: Eva
authors.initials: E
authors.lastname: Morris
authors.forename: Colleen E
authors.initials: CE
authors.lastname: McGahan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tracey
authors.forename: Donna
authors.initials: D
authors.lastname: Turner
authors.forename: Michael A
authors.initials: MA
authors.lastname: Richards
authors.forename: Michel P
authors.initials: MP
authors.lastname: Coleman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D003718:Denmark / Q000453:epidemiology; D019049:Developed Countries; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009664:Norway / Q000453:epidemiology; D011379:Prognosis; D012042:Registries; D013548:Sweden / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult