title: When do changes in cancer survival mean progress? The insight from population incidence and mortality.
abstract: BACKGROUND
  It is often assumed that increases in cancer survival reflect true progress against cancer. This is true when these increases are accompanied by decreased burden of disease: Fewer people being diagnosed or dying from cancer (ie, decreased incidence and mortality). But increased survival can also occur even when incidence is increasing and mortality is unchanged.
  
  
  OBJECTIVE
  To use trends in cancer burden-incidence and mortality-to illustrate when changes in survival reflect true progress.
  
  
  METHODS
  Using data from 1975 to 2010 collected by the Surveillance, Epidemiology, and End Results Program (incidence, survival) and the National Center for Health Statistics (mortality), we analyzed US trends in five-year relative survival, age-adjusted incidence, and mortality for selected cancers to identify patterns that do and do not reflect progress.
  
  
  RESULTS
  Among the nine common cancers examined, survival increased in seven, and changed little or not at all for two. In some cases, increased survival was accompanied by decreased burden of disease, reflecting true progress. For example, from 1975 to 2010, five-year survival for colon cancer patients improved (from 48% to 68%) while cancer burden fell: Fewer cases (incidence decreased from 60 to 41 per 100,000) and fewer deaths (mortality decreased from 28 to 16 per 100,000), a pattern explained by both increased early detection (with removal of cancer precursors) and more effective treatment. In other cases, however, increased survival did not reflect true progress. In melanoma, kidney, and thyroid cancer, five-year survival increased but incidence increased with no change in mortality. This pattern suggests overdiagnosis from increased early detection, an increase in cancer burden.
  
  
  CONCLUSIONS
  Changes in survival must be interpreted in the context of incidence and mortality. Increased survival only represents progress when accompanied by a reduction in incidence, mortality, or ideally both.
authors.affiliation: Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (HC, ABM); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover NH, Veterans Affairs Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT (LMS, SW); Information Management Services, Inc., Calverton, MD (JL). hscho@ncc.re.kr hyunsoon.cho@gmail.com.
authors.forename: Hyunsoon
authors.initials: H
authors.lastname: Cho
authors.affiliation: Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (HC, ABM); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover NH, Veterans Affairs Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT (LMS, SW); Information Management Services, Inc., Calverton, MD (JL).
authors.forename: Angela B
authors.initials: AB
authors.lastname: Mariotto
authors.affiliation: Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (HC, ABM); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover NH, Veterans Affairs Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT (LMS, SW); Information Management Services, Inc., Calverton, MD (JL).
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Schwartz
authors.affiliation: Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (HC, ABM); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover NH, Veterans Affairs Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT (LMS, SW); Information Management Services, Inc., Calverton, MD (JL).
authors.forename: Jun
authors.initials: J
authors.lastname: Luo
authors.affiliation: Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (HC, ABM); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover NH, Veterans Affairs Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT (LMS, SW); Information Management Services, Inc., Calverton, MD (JL).
authors.forename: Steven
authors.initials: S
authors.lastname: Woloshin
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality*; D018426:SEER Program / Q000706:statistics & numerical data; D015996:Survival Rate / Q000639:trends*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology