Understanding Statistics Used to Guide Prognosis and Evaluate Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board,
02/2014
Key Messages
Survival statistics can help estimate a patients prognosis (chance of recovery) and
determine the treatment options.
Survival statistics are different based on the type of cancer, the stage, a patients
age, and length of time after diagnosis.
Although statistics can provide an estimate of survival, they are based on large
groups of patients and cannot tell a person exactly how long he or she will live after a
cancer diagnosis.
When people are diagnosed with cancer, one of the first things they may want to know is
their chance of survival and recovery. Understanding survival statistics becomes
extremely important, yet it can also be confusing. Read below to learn more about how
survival statistics can be used to estimate a patients prognosis and determine the
treatment options.
Estimating how long people live after a cancer diagnosis
Survival statistics, usually given as rates, describe the percentage of people with a certain
type of cancer who will be alive a certain time after the cancer is detected. Survival rates
can be given for any length of time. Cancer statistics are usually given as a five-year
relative survival rate; this describes the percentage of people with cancer who will be
alive five years after diagnosis, excluding those who die from other diseases.
Sometimes, survival statistics are calculated to include all people with a specific type of
cancer, regardless of stage. This is called an overall rate:
Example: Overall, the five-year relative survival rate for women with cervical cancer is
68%, which means that about 68 out of every 100 of women with cervical cancer will still
be living five years after diagnosis.
Other survival statistics are calculated for specific cancer stages (the stage is an indication
of the size of the tumor, and whether and how far the cancer has spread) as survival
statistics can vary by stage.
Example: The five-year relative survival rate for early-stage cervical cancer is 91%. This
means that 91 out of every 100 women diagnosed with early-stage cervical cancer will be
living five years after diagnosis.
Calculating how many people are cancer free or have cancer that is not growing or

spreading
Five-year relative survival rates include all people who are alive five years after a cancer
diagnosis, including those who are in remission (temporary or permanent absence of
disease) or still being treated. Disease-free survival (sometimes abbreviated as DFS)
statistics and progression-free survival statistics (sometimes abbreviated as PFS) are more
specific survival statistics that are often used when evaluating cancer treatments.
Disease-free survival rates refer only to the percentage of people who experience a
complete remission after finishing treatment.
Progression-free survival rates describe the percentage of people who do not experience
any new tumor growth or cancer spread during or after treatment, including those whose
disease has either completely or partially responded to treatment, or those whose disease
is stable (the cancer is still present but not growing or spreading).
The concept of cure
In medicine, a disease is considered cured when its been successfully treated and does
not return. The concept of cure is difficult to apply to cancer because undetected cancer
cells can sometimes remain in the body after treatment, causing the cancer to return later
(referred to as a recurrence or relapse). Many cancers are considered cured when there
is no cancer detected five years after diagnosis. However, recurrence after five years is
still possible.
Determining prognosis
Among the first questions often asked when a person is diagnosed with cancer is whether
the cancer can be treated successfully. This is called a prognosisthe likely course and
outcome of the cancer and the chances of recovery. Doctors use survival statistics to
make predictions about prognosis.
Example: A man diagnosed with testicular cancer may be said to have a favorable
prognosis, as the overall five-year relative survival rate for testicular cancer is 95%.
Similar to survival statistics, prognosis also depends on the stage of the cancer at
diagnosishow early the cancer is detected and if or how far it has spread.
Example: If detected early, the five-year relative survival rate for colorectal cancer is
90%. For advanced stage colorectal cancer that has spread to distant parts of the body, the
five-year relative survival rate is about 13%.
Points to remember
Statistics are estimates that describe trends in large numbers of people. Statistics
cannot be used to predict what will actually happen to an individual.

 Survival statistics for different cancer types, stages of cancer, age groups, or time
periods can vary dramatically. People are encouraged to ask their doctor for the most
appropriate statistics based on their individual medical condition.
As with any medical information, ask your doctor for clarification if cancerrelated statistics seem unclear.
Evaluating treatment options
Five-year relative survival rates are commonly used as a way to evaluate and compare
different treatment options. Although someone who has survived five years after a cancer
diagnosis is not necessarily cured, the five-year relative survival statistic is considered
a good indication that the cancer is responding to treatment and that the treatment is
successfully extending the life of the person with cancer. Survival statistics help doctors
determine which treatments provide the most benefit to people with cancer and whether
the benefits outweigh any risks (such as unpleasant side effects) associated with the
treatment. Learn about.
Points to remember
Because five-year survival statistics are based on patients who were treated at
least five years ago, they may not reflect the most recent advances in treatment.
Although survival statistics provide useful information when deciding among
treatment options, they should be used as only one factor in a comprehensive
treatment plan designed by a doctor who is familiar with a persons individual
situation.
Cancer survival for common cancers
Survival statistics for the most common cancers are presented here. There are data
showing survival at one-, five- and ten-years, as well as trends over time.
One-, five- and ten-year survival
There is huge variation in survival between cancer types. Ten-year age-standardised net
survival for patients diagnosed during 2010-2011 in England and Wales ranges from 98%
for testicular cancer to just 1% for pancreatic cancer (Figure 2.1).1 Of the 21 most
common cancers, 12 have ten-year survival of 50% or more, and four types - testicular
cancer, malignant melanoma, prostate cancer and Hodgkin lymphoma - have survival in
excess of 80%. Some cancer types, however, remain difficult to diagnose and/or treat, and
survival is less than 20% for stomach, brain, oesophageal, lung and pancreatic cancers.

Figure 2.1: Age-Standardised One-, Five- and Ten-Year Net Survival, Selected

Cancers, Adults (Aged 15-99), England and Wales, 2010-2011

Survival for the ten most common cancers in males

Of the ten most common cancers in males, age-standardised ten-year net survival is
highest for malignant melanoma at 86% and lowest for lung cancer at just 4% (Figure
2.2). Prostate, lung and bowel cancers together account for over half (53%) of all new
cases in males in the UK in 2011 - ten-year survival for these three cancer types varies
considerably at 84%, 4% and 56% respectively (Figure 2.3).

Figure 2.2: Age-Standardised One-, Five- and Ten-Year Survival for the 10 Most
Common Cancers in Males, England and Wales, 2010-2011

Figure 2.3: Age-Standardised Ten-Year Net Survival for the Most Common Cancers
in Males, England and Wales, 2010-2011

Testicular
cancer has
the highest
ten-year
survival in
men at 98%,
and five year
survivors of
this disease
may be
considered
'cured'.
Pancreatic
cancer has
the lowest
ten-year
survival in

men at just 1%.

Survival for the ten most common cancers in females
Of the ten most common cancers in females, age-standardised ten-year net survival is
highest for malignant melanoma at 92%, and lowest for pancreatic cancer at just 1%
(Figure 2.4). Malignant melanoma and pancreatic cancer also have the highest and
lowest ten-year survival out of all of the cancer types occurring in females, respectively.
Breast, lung and bowel cancers together account for over half (53%) of all new cases in
females in the UK in 2011 - ten-year survival for these three cancer types varies
considerably, at 78%, 7% and 57%, respectively (Figure 2.5).
Figure 2.4: Age-Standardised One-, Five- and Ten-Year Survival for the 10 Most
Common Cancers in Females, England and Wales, 2010-2011

Figure 2.5: Age-Standardised Ten-Year Net Survival for the Most Common Cancers

in Females, England and Wales, 2010-2011

Malignant
melanoma
shows one of
the biggest
differences in
survival
between the
sexes, with
86% of men
and 92% of
women
predicted to
survive for
ten years or
more (an
absolute
survival
difference of
6 percentage
points); some of this difference may be explained by a higher proportion of thicker
tumours in men, combined with other morbidity and health-related behaviours.
Trends over time
Survival for most cancer types is improving (Figure 2.6).1 This progress can generally be
attributed to faster diagnosis and advances in treatment. However, there is still scope for
improvement and some cancers have shown very little improvement since the early
1970s. Increasing cancer survival remains a major priority of Improving Outcomes: A
Strategy for Cancer,2 resulting in initiatives such as the National Awareness and Early
Diagnosis Initiative (NAEDI), which is a public sector/third sector partnership between
the Department of Health, National Cancer Action Team, and Cancer Research UK. The
role of NAEDI is to promote the earlier diagnosis of cancer, and this will involve
researching ways to further improve survival from cancer.
Prostate cancer has shown the largest improvement in age-standardised ten-year net
survival since the early 1970s, from 25% in 1971-1972 to 84% in 2010-2011 (an absolute
survival difference of almost 60 percentage points). However, interpretation of survival
trends for prostate cancer is made difficult as the types of prostate cancers diagnosed have
changed over time due to PSA testing. The next largest increases in ten-year survival are
for malignant melanoma, non-Hodgkin lymphoma and leukaemia, with absolute survival

differences of 43, 41 and 39 percentage points, respectively, between 1971-1972 and

2010-2011. Bowel cancer and female breast cancer have also shown large improvements
in survival over the last forty years, with absolute survival differences of 35 and 38
percentage points, respectively. between 1971-1972 and 2010-2011.
There has been very little improvement in age-standardised ten-year net survival since the
early 1970s for the four lowest surviving cancers in men and women: cancers of the
brain, oesophagus, and lung have all shown absolute increases of less than 10%
percentage points since 1971-1972, while pancreatic cancer has had no change.
Figure 2.6: Age-Standardised Ten-Year Net Survival Trends, Adults (Aged 15-99),
Selected Cancers, England and Wales, 1971-2011

References for cancer survival for common cancers

Cancer Research UK Cancer Survival Group, London School of Hygiene and
Tropical Medicine. Personal communication, 2014.