5-Yr. Cancer Survival Rates: US Dominates Europe
Based upon period survival data for 2000-02 from 47 European cancer registries, 5-year survival rates were found to be higher in the U.S. than in a European composite for cancer at all major sites (see table above, click to enlarge). For men (all sites combined), 47.3% of Europeans survived 5 years, compared to 66.3% of Americans. For women, the contrast was 55.8% vs. 62.9%. The male survival difference was much greater than the female primarily because of the very large difference in survival rates from prostate cancer. Thus, the US appears to screen more vigorously for cancer than Europe and people in the US who are diagnosed with cancer have higher 5-year survival probabilities.
From a new NBER working paper "Low Life Expectancy in the United States: Is the Health Care System at Fault?" (abstract here and full paper here), by Univ. of Pennsylvania professors Samuel Preston and Jessica Ho.
Originally posted at Carpe Diem.
16 Comments:
Mark-
You should start adding tags to your posts. It would be extremely helpful if people would like to see all posts pertaining to a certain category (healthcare, taxes, etc.) at once. Just a thought, keep up the excellent blogging!
Second the tagging idea.
But also would like to know which countries comprise Europe? Is this just Western Europe or also the poorer Eastern countries? If its the latter the comparison might not be as apples to apples as comparing two sets of rich countries.
Richard and Colin:
I've thought about tagging posts by subject, and might start doing it.
In the meantime, you can always search CD by keyword or key phrase using: a) the "Search Blog" option at the top left of the screen, or b) the Google search option on the right side under the "Links" section.
Ya gotta be careful with these statistics. There's some research indicating that 5-year survival rates for "catching it early" are misleading, and that we simply know about the cancer longer than we used to.
It's entirely possible that we simply know about our cancer longer than the Europeans. I find this unlikely given the stats posted earlier about longer life expectancy after accounting for Americans being more likely to die from "death by misadventure," but it's possible.
If the data is uncorrected for stage of disease at diagnosis, all it means is that the US finds cancers earlier. It doesn't mean that cancer survival is better. Example: two 60-year-old men have undiagnosed prostate cancer of exactly the same severity. USAguy gets screened today, gets started on treatment, and lives for 7 years. Euroguy gets screened three years later, gets started on treatment, but only lives for 4 years. The USAguy had >5 year survival, while Euroguy only lived 4 years after diagnosis. However, the outcome is identical: USAguy and Euroguy both died at age 67.
If you don't correct for this problem, you cannot compare the overall effectiveness of cancer detection and treatment. For many cancers, US physicians put unneeded resources into early detection (because later detection yields equally good treatment effects). I suspect that the USA has both better detection and better treatment, but the cited paper doesn't prove that.
Colin and Dr.T, Google cancer survival rates of USA vs. UK, Canada, Italy, Germany, and France. You don't want to get prostate cancer and live in the UK or Canada for that matter. (Yes, I know Canada is not in Europe.) In fact all you have to do is read the titles of articles in European medical journals to find your answer. If you get cancer your odds of survival are much better in the USA.
Regarding the study, Dr. "T" claims that"all it means is that the US finds cancer earlier". Obviously, he does not have a clue how cancer diagnosis and treatment work in real life. CANCER PREVENTATION MEANS TO FIND CANCER EARLIER (LOW STAGE). Patients with low stage cancer (small size tumor, no metastases) have a sigificantly better chance to survive than patients with high grade cancer. I have worked as a physician in cancer center for many years in Europe and since 1997in the US, and have no doubts that the US health care system is much better that the one in the EU: service is provided by experts, no waiting lists for diagnosis and treatment, patient can schedule appointment (convenient time), make a decision and talk to a physician of his/her choice. The cancer patient in the US will get the best medigations available, unlike in the EU. That is not all but you got the idea. Last but not least, healthcare in EU is not free. You pay very high income (40-50%) and sale (17.5%) taxes too. It does not look good does it?
Do these US figures include survival rates of people who are not covered by insurance? (or do they go untreated?) No, cancer treatment is not 'free' in Europe, but it doesn't stop when your insurance company bails on you! I would say the big disadvantage is (as a UK citizen, resident) that sometimes you have to be forceful about wanting to push through diagnostics, whereas in the US you can have all manner of tests done and go straight to source (if your insurance covers it). Don't be fooled though - there are NOT waiting lists for treatment where there is an urgent need for treatment. My mother got ovarian cancer and was seen / treated extremely rapidly by exactly the same oncologist and at the same speed as if she had seen this professor privately. Frankly the fact my US sister-in-law has to pay the first $5,000 when one of her kids needs to go to ER, as well as horrendous ongoing insurance premiums, makes the higher taxes in Europe all worthwhile!!
I'm wondering if aggressive screening may have something to do with the discrepancy:
i.e. it's known that higher resolution X-rays can detect more breast cancer. However, a lot of these small breast cancers would have gone into remission spontaneously or would've become stabile disease.
If you perform surgery on all these women, you'll remove a lot of tumors that would never have killed the woman, and thereby you're raising the average 5-year survival. So, higher resolution X-rays may artificially raise the 5-year survival.
Dr. J Thompson here. I will be looking into these statistics and how they were derived but in the mean time I propose these questions. Does this include those in the US that have no insurance and die of cancer? I am a cancer researcher and work with doctors who have practiced oncology in Europe (Germany and the Netherlands) and find little difference in quality or type of treatment they provide. We collaborate quite a bit and have mirror studies ongoing. So I ask "anonymous" in what country did you practice? Also finding cancer early does improve survivability in most cases but not all and in the case of prostate cancer and Breast cancer (Both of which I work with), diet and race may play a huge role in survival that may be independant of quality of treatment. I would also like to see the incidence of cancer per capita comparison. Lack of primary care can lead to failure to treat many chronic conditions and there is a strong link between chronic inflammation and cancer. Therefore If we are going to examine survivability we must also look at incidence. I personally think that we must continue to fund research more than other countries and pay our medical experts well instead of CEOs; insure all people so the incidence of cancer is lower, then we will have both the best care and prevention.
What countries are included in the researchers statistics on "Europe"? Certainly we should hold the United States to a higher standard of cancer treatment than a nation like Bulgaria ($7k GDP per capita) or Romania ($4k GDP per capita).
Great information! Thank you.
"Regarding the study, Dr. "T" claims that"all it means is that the US finds cancer earlier". Obviously, he does not have a clue how cancer diagnosis and treatment work in real life. CANCER PREVENTATION MEANS TO FIND CANCER EARLIER (LOW STAGE). Patients with low stage cancer (small size tumor, no metastases) have a sigificantly better chance to survive than patients with high grade cancer. I have worked as a physician in cancer center for many years in Europe and since 1997in the US, and have no doubts that the US health care system is much better that the one in the EU: service is provided by experts, no waiting lists for diagnosis and treatment, patient can schedule appointment (convenient time), make a decision and talk to a physician of his/her choice. The cancer patient in the US will get the best medigations available, unlike in the EU. That is not all but you got the idea. Last but not least, healthcare in EU is not free. You pay very high income (40-50%) and sale (17.5%) taxes too. It does not look good does it?"
Odd, then, that it has apparently never occurred to you that a lot of the differences in overall mortality and in five year survivals between the U.S. and Europe can be accounted for largely by overdiagnosis and lead time bias, respectively:
http://scienceblogs.com/insolence/2009/07/overdiagnosis_of_breast_cancer_due_to_ma.php
http://scienceblogs.com/insolence/2007/04/detecting_cancer_early_part_1_more_compl.php
It is logical that if you are screening more aggressively, you will find cancers earlier, which means you will have a higher 5-year survival rate. But this may reflect the stage in disease progression and not necessarily the effectiveness of treatment. A better comparison would be breast cancer (or other) survival rates by stage.
You need better sources: http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-cancer
I freely admit my ignorance on the subject; can I just point out to all the posters who say things like 'ABC says blah blah blah so showing he knows nothing about this' should READ exactly what ABC has said BEFORE posting, because otherwise you just look extremely foolish. I think you know who you are.
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