Monday, July 21, 2008

Cancer Survival Rates

THE ECONOMIST -- A study in the Lancet Oncology journal compares cancer survival rates across five continents for the first time. Afer adjusting country data from the 1990s, for differences in both age and death rates in the general population, Americans were found to have the best chance of survival for two of the five cancers that the reasearchers considered: breast cancer in women and prostate cancer. (Cuba had impressive survival rates, but these were probably over-estimated, say researchers). Europe lags behind America, with wide differences in survival rates, ranging from 10% for breast cancer to 34% for prostate cancer. Money appears to be an important factor: America spends a greater proportion of national income on health than the other countries.


At 7/21/2008 2:31 PM, Blogger juandos said...

I can't help but wonder if Canada's standing regarding protrate and breast cancer survival rates has something to do with its proximity to the US...

For a Canadian stricken a short drive or flight to the US might have something to do with it...

How many of those other countries listed below the US have socialized medicine?

At 7/21/2008 2:53 PM, Anonymous Anonymous said...

Also, it strikes me that much of Europe benefits from drugs and medical technology developed in the United States. If all countries could only use technology developed in their own country, the difference would likely be far more pronounced.

At 7/21/2008 3:08 PM, Anonymous Anonymous said...

think however that few European countries obtain almost the same results with less than 70% of spending per capita.

think also that US that has a younger population than Japan, France, Sweden or UK has 1/3 more deaths by cardiovascular diseases than these countries. and think that we are thoroughly beaten even by ex-communist countries regarding the number of infants dying each year per 1000 births. and that in average we die a few years younger than they do (even though the Europeans smoke more and drink more alcohol than we do but also eat healthier and exercise more).

US health spending is way bigger than the results. we spend a lot more caring for the prostate cancer of a wealthy octogenarian than preventing an obese poor 40 year old to become biologically 80year old in 5-10 years.

tax the gas (more expensive gas is already leading to increase in Bike use and walking), tax the junk food, tax more the tobacco and spend it on health prevention.

At 7/21/2008 3:25 PM, Blogger juandos said...

"think however that few European countries obtain almost the same results with less than 70% of spending per capita"...

Where did you get your, '70%' number anon @ 3:08 PM and does your, "per capita" really take into account the higher tax rates on individuals over in those European countries?

At 7/21/2008 3:59 PM, Anonymous Anonymous said...

data in excel here:,3343,en_2649_34631_2085200_1_1_1_1,00.html

they pay taxes but do not pay much of private health insurance premiums (although the rich ones do pay some). here instead of taxes most of us pay insurance premiums. if you add public and private spending on healthcare we spend alot more per capita.

I do not necesarilly claim that the public system is better than the mostly private system we have in the US. it is false to say we have a free market system as almost 45% is federal spending and there are price controls on the public programmes - Medicaid and Medicare - and risk manipulation from the insurance companies ( they offer affordable insurance only to healthy consumers). however in this case and on the whole US spends more money for less health.

At 7/21/2008 4:42 PM, Blogger juandos said...


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At 7/21/2008 5:22 PM, Anonymous Anonymous said...

try again:,3343,en_2649_34631_2085200_1_1_1_1,00.html

At 7/21/2008 5:23 PM, Anonymous Anonymous said...

sorry won't let me put the whole link.

google OECD health data 2008. it will be the first link.

At 7/21/2008 7:15 PM, Anonymous Anonymous said...

Whoops. Survival rate should not be confused with mortality rate.

What are the mortality rates in say...Canada, the U.K. and the U.S. for these cancers?

Lets play with numbers! Assume the five year mortality rate from prostate cancer is ummm 25/100,000 in Canada, the U.K. and the U.S. But the incidence of prostate cancer is 50/100,000 in Canada and the U.K. but 100/100,000 in the U.S. It follows that 50% of Canadians and U.K. residents die of prostate cancer within five years of being diagnosed but only 25% of Americans in with the same diagnosis die in the same period so American health care must be better even though the mortality rates are nearly the same.

The fact is that the U.S. diagnoses more prostate cancer per capita than anyone else so with nearly the same mortality rates as many other western nations the survival rate is higher and that is not better just a trick of analysis.

At 7/21/2008 7:32 PM, Anonymous Anonymous said...

as far as cancer mortality goes US is situated a lot better than it is in other health areas among OECD countries.

however, about prostate cancer you are right. most men die with it and not from it. probably in most other developed countries men over 75 are not even tested for it unless there are advanced stages that have complications. on autopsy series ( all deceased men in that age group) men above 75 of age have 60-80% incidence of microscopic prostate cancers. so if the urologists are well payed for prostate biopsies ( and they indeed are in the US) they will do a lot of them and diagnose a lot of cancers that may be very early stage.

the situation is a bit different with other cancers. for example lung or breast cancer survival is also better in the US. and these cancers are a lot more aggresive and potentially deadly diseases.

At 7/21/2008 7:35 PM, Blogger Matt S said...

I hear so much about non-US countries not doing any of their own medical research. Where does this come from? I know for a fact that Dalhousie university in Canada is a very respectable med school and usually med schools have a lot of research going on as well.
Also, aren't some of the major US pharma companies based in Sweden?

At 7/21/2008 10:47 PM, Anonymous Anonymous said...

With regard to prostate cancer, here are some facts from a seminar I attended at Sunnybrook Hospital:

1. 1 in 7 caucasian men will get prostate cancer; men with a family history of prostate cancer have a 1 in 4 chance of getting prostate cancer; incidence of prostate cancer among Asian men is about 1 in 100 with the level rising slightly with the adoption of a western diet; once you get beyond 70 years old, you are likely home free

2. All men over the age of 50 have prostate cancer cells but few will develop prostate cancer; a sudden rise in PSA test is what physicians are looking for

3. incidence of prostate cancer rises as one travels north due to lower levels of vitamin D (ie. sun exposure)

4. a heart smart diet is also a prostate friendly diet; Asian diet is particularly good for prostate prevention

5. researchers at Sunnybrook Hospital in Toronto have found that a combination of lycopene, vitamin D, selenium and green tea extract lowers risk for prostate cancer; ProVantex makes this formulation under the name of Silexin or you can just take them separately

6. There are several different kinds of prostate cancer; some types are more agressive than others; researchers have found heavier doses of radiation are more effective than lower doses over a longer period of time; new radiation equipment can pinpoint the target area without exposing adjacent organs to radiation thereby minimizing side effects

Bon sante, mes cher amis.

At 7/22/2008 7:58 AM, Anonymous Anonymous said...

The European systems tend to focus more on prevention, as well as having different lifestyles, diets, etc. This could be a factor in that the people who do get cancer in these societies are worse cases than in the US. Just a thought.

You might also point out that the US has one of the highest infant mortality rate in the developed world, while Sweden enjoys the lowest.

What's a better indicator? How well your society brings in new life, or how long it prolongs it? (I honestly don't know, but I lean towards the former).

At 7/22/2008 8:45 AM, Anonymous Anonymous said...

To the poster who suggested that Europe gets more bang for its buck.

You say, "Sure the U.S. has a greater survival rate but at what cost?" and I reply "Money".

I say "Sure Europe spends less but at what cost?" and you reply "human lives".

So now I ask, how much is your life worth to you?

And to those who bring up infant mortality. Infant mortality in developed nations has more to do with health habits than with health care quality. All developed nations have very good prenatal care.

At 7/22/2008 1:50 PM, Blogger OBloodyHell said...

Not sure I'd trust anything at all the Lancet has to say on anything. Theey're the ones who put up bald-faced claims of Iraqi war deaths 6-10x what virtually every other organization was quoting.

At 7/22/2008 1:55 PM, Blogger OBloodyHell said...

> and risk manipulation from the insurance companies ( they offer affordable insurance only to healthy consumers).

I challenge that claim. While independent HI searchers may pay higher premiums when they seek insurance with a bad background (no surprise -- don't bad drivers pay more for auto insurance?), most Americans get their HI through their employer, and most of them use an open enrollment period which accepts all comers... hence, other than adjustments over time as to premiums, most insurers don't have a lot of control over whom they insure.

At 7/22/2008 2:08 PM, Blogger OBloodyHell said...

> You might also point out that the US has one of the highest infant mortality rate in the developed world, while Sweden enjoys the lowest.

This is an apples-to-oranges comparison. Different nations use different methods to identify their infant mortality rates.

Different stats for different states: The U.S. defines "live births" more broadly than most European countries (The OECD definition says the U.S., Canada and the Nordics use the same measurements, but the rest of Europe doesn't); in particular low birth weight babies who figure into American, but likely not Continental statistics. This lowers U.S. rankings but not our standard of care. As Bruce McQ observes, "ironically, US statistics are, in a way, a result of our technological advances, advances that have given more marginal babies a chance for survival than they have had at any other time in our history

(Note: the original contains numerous attributions, if you are wont to check them out, as well as a much wider discussion of differing mortality stats -- well worth the read)

As far as Cuban healthcare goes:

Regarding 'Sicko'

Granted, it's editorial commentary from MTV, take it with a grain of salt, but its points are rationally valid, regardless:

As the Caribbean sun sank down on Moore's breathtakingly meretricious movie, I couldn't help recalling that when Fidel Castro became gravely ill last year, he didn't put himself in the hands of a Cuban surgeon. No. Instead, he had a specialist flown in — from Spain.

I think that's a very interesting point.

At 7/22/2008 3:25 PM, Blogger juandos said...

Hey Anonymous @ 5:22 PM, yet the url came through just fine and I thank you sir or madam...

Hey obloodyhell, you can see why Fidel didn't want his health to be left to the socialist medical practices of sunny Cuba...:-)

At 8/24/2008 12:37 AM, Anonymous Anonymous said...

You need to address more kinds of cancer. Breat and prostate cancers are common and well treated. Expand this to include pancreatic, colo-rectal, and other more deadly cancers.

At 7/22/2009 11:07 PM, Blogger Unknown said...

Sorry to be late to the party but I'm a board-certified physician in preventive medicine and work in a Division of Preventive Medicine. My penchant for arguing health policy led me to carefully read this paper in full (it's called the Concord study). It's well written and very carefully done, and the authors appropriately did not attempt to draw the kinds of inferences about health care systems that many readers subsequently did.

I have not come up with an ideal explanation for the limitations of the data, but there really are serious problems to citing the apparent superiority of the US in 5-year survival rates for the cancers studied as evidence of US health care superiority.

The most important is that the available US databases reflected only 43% of Americans, and were drawn mostly from US states that we know, from other data, have the lowest cancer mortality among states in the USA. In essence, while several countries compared to the US (in this report) offered unbiased samples (Denmark, Finland, Cuba, Australia, Sweden, and United Kingdom all reported on 100% of the cancers), the US did as well as better than most of these in a comparison in which only the US states with lower cancer mortality were reported. The authors did not consider this issue, but to be fair, they also were careful to avoid drawing the inference that countries with seemingly lower 5-year cancer mortality had better health care systems.

The second issue of note is really the combination of lead time bias (I'll define it) and overdiagnosis. The authors acknowledge both problems and report that they have no way to address it with their data.

Lead time bias is what happens when extensive early testing (a particularly strong feature of US practice) leads to the impression of "enhanced survival" not because of the life-prolonging treatment following early diagnosis, but because a cancer found earlier has a longer "lead time" until it produces death in those persons it was going to kill no matter what. In essence, a subset of cancers take a certain time to kill a person. If the person finds out about it early, then the statistics will show a longer survival. If a person finds out about the cancer later, perhaps because they live in a country that doesn't use high tech screening as intensively, a shorter survival is recorded. Epidemiological research can address this challenge by adjusting and controlling for how advanced the cancers were (this is termed "controlling for stage"). This Concord study admits that it could not control for stage, although a future study will do so. This particular report, however, does offer citations of several studies in which apparently superior US outcomes in colorectal cancer go away after stage of diagnosis is controlled for. Finally, there is the related problem of overdiagnosis. If diagnostic screening is so intensive that many non-dangerous "cancers" are found and treated alongside a few dangerous ones, then the country that finds all those non-dangerous cancers tends to have the best looking survival numbers. This is a problem for the prostate cancer comparisons in particular, and may be a problem for the breast cancer comparison as well.

I don't wish to impugn the original study-- it's a strong piece of work. But it should not used to advance the political arguments that are being advanced here, and the writers of the original paper clearly understood and tried (but failed) to mitigate the improper citation of their data.

Stefan Kertesz, MD
University of Alabama at Birmingham

At 10/31/2012 3:31 AM, Anonymous Anonymous said...

the fear of cancer kills let alone the disease itself..

A country like Nigeria, many people can die there and the doctors won't even suspect cancer unless you go to a bigger hospital and that is not for those who do not have what it takes.

the world should work on medicines on deadly diseases.. not just the cure but make it generally affordable. health should be cheap so we all can survive.


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