France has high cancer survival rate

COPENHAGEN, Denmark -- When it comes to the chance of surviving cancer in Europe, France and Austria are the best places to be, according to new research that tracks cancer survival patterns across the region.

The analysis, to be presented Thursday at the close of a European Cancer Conference, involved statistics on 42 types of cancer in 1.8 million adults and 24,000 children from 22 countries in Europe.

The largest international cancer survival study to date, it found the chances of surviving for at least five years after being diagnosed with cancer ranged from a low of 25.2 percent for men in Poland to 57.9 percent for women in France. Regionally, Scandinavia came out best and Eastern Europe worst.

That compares with a survival rate of 62 percent for men and 63.5 percent for women in the United States. Comparable statistics for other areas of the world were not immediately available.

Michel Coleman, one of the study's leaders, said the main conclusion of the survey is that although cancer survival is improving across Europe, differences between Eastern and Western Europe are widening. The pattern also differs depending on the type of cancer.

Coleman, a professor of epidemiology and vital statistics at the London School of Hygiene and Tropical Medicine, said the EUROCARE findings cannot be interpreted as an assessment of health-care systems across Europe because of other factors, including how soon patients go to their doctors in the first place, determine the likelihood of surviving cancer.

However, Kathy Redmond, a patients' advocate based in Milan, Italy, said the survey is likely to influence national health policies. Earlier versions prompted Britain, which ranks lower than other countries in Western and southern Europe, but just above those in Eastern Europe, to greatly increase its investment in cancer services, Redmond said.

"It was the embarrassment. EUROCARE named and shamed governments to start to do something to change the status quo," said Redmond, who was not involved with the research. "There are clear controversies around EUROCARE, but it flags the differences. That's very important for us, because it's the start of a process to ask why."

The main criticism of the study is that it does not comprehensively track differences in the severity, or stage, of cancer at diagnosis -- something that greatly influences survival, -- and that information from some countries is patchy and may not give a national picture.

Dr. Peter Boyle, director of the European Oncology Institute in Milan and incoming chief of the U.N. International Agency for Research on Cancer, said the study does not pay enough attention to differences among countries in how severe the tumors are when they are diagnosed. European cancer registries generally do not collect information on severity of the disease at diagnosis.

"Stage-dependent survival doesn't change through time, so compared to 20 years ago, survival from breast cancer is now higher because we are catching it earlier. We are catching more stage 1s and stage 2s," he said.

"I don't think you can use EUROCARE to say whether somebody would be better off in one country or another if they are diagnosed with cancer," said Boyle, who was not involved with the study. "It's useful to see ... changes in trends in survival, but it's complicated to interpret."

One problem is that many countries do not follow all their cancer patients, so if someone is diagnosed in a town that has a registry but then moves to another town that doesn't and they die, they have been lost to the follow-up, which could distort the national picture, Boyle said.

Coleman acknowledged the registries are not perfect, but said they provide a clearer picture than any other study and the missing information on severity of disease could not totally account for the differences in survival.

The main influences of cancer survival are the severity of the disease at diagnosis, the quality of treatment and the amount of money a country spends on health care, Coleman said.

He said health care spending varies sixfold between Poland and Switzerland, and the proportion of gross national product that countries allot to health spending varies from 6 percent in Poland to 11 percent in Germany. The per capita spending varied from $420 in Poland to $2,555 in Switzerland.

EUROCARE, which was founded in 1989, is funded by the European Union.

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