title: Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study.
abstract: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe.
  
  
  
  A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis.
  
  
  
  21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998.
  
  
  
  Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models.
  
  
  
  The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours.
  
  
  
  The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.
authors.affiliation: Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Allemani
authors.forename: Bernard
authors.initials: B
authors.lastname: Rachet
authors.forename: Hannah K
authors.initials: HK
authors.lastname: Weir
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Richardson
authors.forename: Côme
authors.initials: C
authors.lastname: Lepage
authors.forename: Jean
authors.initials: J
authors.lastname: Faivre
authors.forename: Gemma
authors.initials: G
authors.lastname: Gatta
authors.forename: Riccardo
authors.initials: R
authors.lastname: Capocaccia
authors.forename: Milena
authors.initials: M
authors.lastname: Sant
authors.forename: Paolo
authors.initials: P
authors.lastname: Baili
authors.forename: Claudio
authors.initials: C
authors.lastname: Lombardo
authors.forename: Tiiu
authors.initials: T
authors.lastname: Aareleid
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.forename: Magdalena
authors.initials: M
authors.lastname: Bielska-Lasota
authors.forename: Susan
authors.initials: S
authors.lastname: Bolick
authors.forename: Rosemary
authors.initials: R
authors.lastname: Cress
authors.forename: Marloes
authors.initials: M
authors.lastname: Elferink
authors.forename: John P
authors.initials: JP
authors.lastname: Fulton
authors.forename: Jaume
authors.initials: J
authors.lastname: Galceran
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Gózdz
authors.forename: Timo
authors.initials: T
authors.lastname: Hakulinen
authors.forename: Maja
authors.initials: M
authors.lastname: Primic-Zakelj
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Rachtan
authors.forename: Chakameh Safaei
authors.initials: CS
authors.lastname: Diba
authors.forename: Maria-José
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Schymura
authors.forename: Tiefu
authors.initials: T
authors.lastname: Shen
authors.forename: Giovanna
authors.initials: G
authors.lastname: Tagliabue
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Marina
authors.initials: M
authors.lastname: Vercelli
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Wolf
authors.forename: Xiao-Cheng
authors.initials: XC
authors.lastname: Wu
authors.forename: Michel P
authors.initials: MP
authors.lastname: Coleman
keywords: Epidemiology; Public Health; Statistics & Research Methods
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