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Original article
Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study, 2004–2007
  1. Sarah Walters1,
  2. Camille Maringe1,
  3. Michel P Coleman1,
  4. Michael D Peake2,3,
  5. John Butler4,
  6. Nicholas Young5,
  7. Stefan Bergström6,
  8. Louise Hanna7,
  9. Erik Jakobsen8,
  10. Karl Kölbeck9,
  11. Stein Sundstrøm10,
  12. Gerda Engholm11,
  13. Anna Gavin12,
  14. Marianne L Gjerstorff13,
  15. Juanita Hatcher14,
  16. Tom Børge Johannesen15,
  17. Karen M Linklater16,
  18. Colleen E McGahan17,
  19. John Steward18,
  20. Elizabeth Tracey19,
  21. Donna Turner20,
  22. Michael A Richards21,
  23. Bernard Rachet1,
  24. the ICBP Module 1 Working Group
  1. 1Cancer Research UK Cancer Survival Group, Department of Non Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  2. 2National Cancer Intelligence Network, London, UK
  3. 3Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
  4. 4Royal Marsden Hospital, London, UK
  5. 5School of Social and Community Medicine, University of Bristol, Bristol, UK
  6. 6Department of Oncology, Gävle Hospital, Gävle, Sweden
  7. 7Velindre NHS Trust, Cardiff, UK
  8. 8Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
  9. 9Department of Respiratory Medicine and Allergology, Karolinska University Hospital Stockholm Sweden
  10. 10Department of Oncology, St Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway
  11. 11Department of Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark
  12. 12Northern Ireland Cancer Registry, Belfast, UK
  13. 13Danish Cancer Registry, Statens Serum Institut—National Institute for Health Data and Disease Control, Copenhagen, Denmark
  14. 14Alberta Health Services, Edmonton, Alberta, Canada
  15. 15Norwegian Cancer Registry, Oslo, Norway
  16. 16Thames Cancer Registry, London, UK
  17. 17Cancer Surveillance and Outcomes, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
  18. 18Cancer Intelligence and Surveillance Unit, Cardiff, UK
  19. 19Cancer Institute New South Wales, Sydney, New South Wales, Australia
  20. 20Cancer Care Manitoba, Winnipeg, Manitoba, Canada
  21. 21Department of Health, National Cancer Action Team, London, UK
  1. Correspondence to Dr Sarah Walters, Cancer Research UK Cancer Survival Group, Department of Non Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; sarah.walters{at}


Background The authors consider whether differences in stage at diagnosis could explain the variation in lung cancer survival between six developed countries in 2004–2007.

Methods Routinely collected population-based data were obtained on all adults (15–99 years) diagnosed with lung cancer in 2004–2007 and registered in regional and national cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK. Stage data for 57 352 patients were consolidated from various classification systems. Flexible parametric hazard models on the log cumulative scale were used to estimate net survival at 1 year and the excess hazard up to 18 months after diagnosis.

Results Age-standardised 1-year net survival from non-small cell lung cancer ranged from 30% (UK) to 46% (Sweden). Patients in the UK and Denmark had lower survival than elsewhere, partly because of a more adverse stage distribution. However, there were also wide international differences in stage-specific survival. Net survival from TNM stage I non-small cell lung cancer was 16% lower in the UK than in Sweden, and for TNM stage IV disease survival was 10% lower. Similar patterns were found for small cell lung cancer.

Conclusions There are comparability issues when using population-based data but, even given these constraints, this study shows that, while differences in stage at diagnosis explain some of the international variation in overall lung cancer survival, wide disparities in stage-specific survival exist, suggesting that other factors are also important such as differences in treatment. Stage should be included in international cancer survival studies and the comparability of population-based data should be improved.

  • Clinical Epidemiology
  • Non-Small Cell Lung Cancer
  • Small Cell Lung Cancer

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