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National comparisons of lung cancer survival in England, Norway and Sweden 2001–2004: differences occur early in follow-up
  1. Lars Holmberg1,
  2. Fredrik Sandin2,
  3. Freddie Bray4,
  4. Mike Richards5,
  5. James Spicer1,
  6. Mats Lambe3,
  7. Åsa Klint6,
  8. Mick Peake7,
  9. Trond-Eirik Strand4,
  10. Karen Linklater1,
  11. David Robinson1,
  12. Henrik Møller1
  1. 1Division of Cancer Studies, King's College London, School of Medicine, London, UK
  2. 2Regional Oncological Centre, Uppsala/Örebro Region, Uppsala, Sweden
  3. 3Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  4. 4Norwegian Cancer Registry, Oslo, Norway
  5. 5Department of Palliative Medicine, St Thomas' Hospital, London, UK
  6. 6Swedish Cancer Registry, National Board of Health and Welfare, Stockholm, Sweden
  7. 7Department of Respiratory Medicine, Glenfield Hospital, Leicester, UK
  1. Correspondence to Professor Lars Holmberg, Division of Cancer Studies, King's College London, School of Medicine, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, London SE1 9RT, UK; lars.holmberg{at}


Background Countries with a similar expenditure on healthcare within Europe exhibit differences in lung cancer survival. Survival in lung cancer was studied in 2001–2004 in England, Norway and Sweden.

Methods Nationwide cancer registries in England, Norway and Sweden were used to identify 250 828 patients with lung cancer from England, 18 386 from Norway and 24 886 from Sweden diagnosed between 1996 and 2004, after exclusion of patients registered through death certificate only or with missing, zero or negative survival times. 5-Year relative survival was calculated by application of the period approach. The excess mortality between the countries was compared using a Poisson regression model.

Results In all subcategories of age, sex and follow-up period, the 5-year survival was lower in England than in Norway and Sweden. The age-standardised survival estimates were 6.5%, 9.3% and 11.3% for men and 8.4%, 13.5% and 15.9% for women in the respective countries in 2001–2004. The difference in excess risk of dying between the countries was predominantly confined to the first year of follow-up. The relative excess risk ratio during the first 3 months of follow-up comparing England with Norway 2001–2004 varied between 1.23 and 1.46, depending on sex and age, and between 1.56 and 1.91 comparing England with Sweden.

Conclusion Access to healthcare and population awareness are likely to be major reasons for the differences, but it cannot be excluded that diagnostic and therapeutic activity play a role. Future improvements in lung cancer management may be seen early in follow-up.

  • Early diagnosis
  • lung cancer
  • management
  • survival

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  • Funding This study was supported by the Department of Health, London, UK.

  • Competing interests None.

  • Provenance and peer review Not commissioned; not externally peer reviewed.