Substantial progress has been made in cancer diagnosis and treatment, resulting in a steady improvement in cancer survival. The degree of improvement by age, race and sex remains unclear.
to quantify the degree of survival improvement over time by age, race and sex in the United States.
Longitudinal analyses of cancer follow-up data.
Cancer diagnosis data for 1990–2009 and follow-up data to 2010 from nine population-based registries, part of the NCI Surveillance, Epidemiology, and End Results (SEER) program.
Approximately 1.02 million patients from SEER registries diagnosed with cancer of the colon/rectum, breast, prostate, lung, liver, pancreas, or ovary from 1990–2009.
MAIN OUTCOME MEASURES
Hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer-specific death were estimated for patients diagnosed with any of these cancers during, 1995–1999, 2000–2004, and 2005–2009, compared diagnoses in 1990–1994.
Significant improvements in survival were found for cancers of the colon/rectum, breast, prostate, lung, and liver. Improvements were more pronounced for younger patients. For example, for patients aged 50–64 and diagnosed between 2005–2009, adjusted HRs (95%CI) were 0.57 (0.55–0.60), 0.48 (0.45–0.51), 0.61 (0.57–0.68), and 0.32 (0.30–0.36), for cancer of the colon/rectum, breast, liver and prostate, respectively, compared with the same age group of patients diagnosed during 1990–94. However, the corresponding HRs (95% CIs) for elderly patients (aged 75–85) were only 0.88 (0.84–0.82), 0.88 (0.84–0.92), 0.76 (0.69–0.84), and 0.65 (0.61–0.70), for the same four cancer sites, respectively. A similar, although weaker, age-related period effect was observed for lung and pancreatic cancers. The adjusted HRs (95%CIs) for lung cancer were 0.75 (95%CI, 0.73–0.77) and 0.84 (95%CI, 0.81–0.86), respectively, for patients aged 50 to 64 years and 75 to 85 years diagnosed between 2005 and 2009, compared with the same age groups of patients diagnosed between 1990 and 1994 (0.73 [95%CI, 0.69–0.77] and 0.90 [95%CI, 0.85–0.95], respectively. Compared with whites or Asians, African Americans experienced greater improvement in prostate cancer survival. From 1990 to 2009, ovarian cancer survival declined among African Americans, but improved among whites. No apparent sex difference in the degree of improvement was noted.
CONCLUSIONS AND RELEVANCE
Younger patients experienced greater benefit from recent oncology advances than elderly patients. African Americans experienced poorer survival than whites for all cancers, and the racial difference in cancer survival decreased for prostate cancer but increased for ovarian cancer. Identifying factors associated with varied improvement in cancer survival can inform future improvements in cancer care for all.