title: Five-Year Survival is Not a Useful Measure for Cancer Control in the Population: an Analysis Based on UK Data
abstract: Background: Five-year survival is an important metric for progress in cancer control broadly used both in the
  cancer literature and by the public. In order to assess its validity and relation to other common metrics, we analyzed
  the relationship between 5-year survival, incidence and mortality using publicly available cancer registry data from
  England and Wales. Methods: Five-year survival, incidence and mortality data were obtained from the online database
  of a registered charity, Cancer Research UK. We extracted sex-specific age-standardized mortality, incidence, and
  5-year survivalfor16 types of cancer over the period from 1976 to 1995. The relationships between 5-year survival,
  incidence and mortality were estimated using both Pearson and Spearman correlation coefficients. Results: All 16cancer
  types showed an increase in 5-year survival for both genders from 1976 to 1995, ranging from 0.2% (pancreas and
  lung cancer) to 16.6% (prostate cancer) for males and 0.2% (pancreas cancer) to 16.6% (leukemia) for females. From
  1976 to 1995, there was no significant correlation between changes in 5-year survival and cancer mortality for either
  sex (males, Pearson r=0.16, Spearman r=-0.06; females, Pearson r=-0.33, Spearman r=-0.43). A positive relationship
  between 5-year survival and incidence was noted among males, but not among females (males, Pearson r=0.61,
  Spearman r=0.53; females, Pearson r=0.03, Spearman r=0.11). However, after excluding breast and prostate cancer,
  the positive association became weaker and became statistically non-significant for males (Pearson r=0.47; Spearman
  r=0.41). Conclusions: Our findings suggest that there are no reliable relationships between changes in 5-year survival
  and cancer incidence or mortality. Increases in 5-year survival might therefore represent poor indicators of progress in
  cancer control at the population level. In the absence of over-diagnosis, 5-year survival might only indicate improved
  diagnosis and treatment in clinical practice.
authors.affiliation: Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, RenminNanlu 3-17, Chengdu 610041, China|Center for Disease Control and Prevention of Chenghua District, NO.6 Xinhong Road, Chengdu 610051, China. Email: chunxia815@aliyun.com
authors.forename: Si Qi
authors.initials: SQ
authors.lastname: Li
authors.forename: Xiong Fei
authors.initials: XF
authors.lastname: Pan
authors.forename: Michael Saheb
authors.initials: MS
authors.lastname: Kashaf
authors.forename: Qing Ping
authors.initials: QP
authors.lastname: Xue
authors.forename: Hui Jing
authors.initials: HJ
authors.lastname: Luo
authors.forename: Yan Yan
authors.initials: YY
authors.lastname: Wang
authors.forename: Ying
authors.initials: Y
authors.lastname: Wen
authors.forename: Chun Xia
authors.initials: ChX
authors.lastname: Yang
keywords: Cancer control; surveillance; incidence; mortality; 5-year survival