1Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, RenminNanlu 3-17, Chengdu 610041, China
2Center for Disease Control and Prevention of Chenghua District, NO.6 Xinhong Road, Chengdu 610051, China
3Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College,Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan 430032, China
4Johns Hopkins University School of Medicine, 733 North Broadway Street, Baltimore, MD, 21205, USA
5Department of Clinical Laboratory, Tianjin Medical University General Hospital, NO.154, Anshan Road, Heping Strict, Tianjin 300052, China
6Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, 5 Dong Dan San Tiao, Beijing 100005, China
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.