Variations in survival for invasive cervical cancer among European women, 1978-89

Objectives: To analyze cervical cancer survival trends in 10 European countries using models that estimate the proportion of cured patients (having the same life expectancy as the general population) and the survival of fatal cases (who die from cervical cancer). Methods: We considered 40,906 cases diagnosed over 12 years (1978-89) collected from cancer registries participating in EUROCARE. Results: From 1978 to 1989, 5-year relative survival in Europe improved (60%--> 63%). The proportion of cured patients increased slightly but significantly (53%--> 55%, p = 0.05). For countries with poorer survival at the end of the 1970s the proportion of cured patients increased faster than average, particularly evident in England (49%--> 56%) and Scotland (44%--> 53%). By contrast, in Finland, Sweden and Germany with organized screening, 5-year survival and cure rate did not improve, but incidence declined to very low levels. Conclusions: Cervical screening can explain the trends in cervical cancer survival: this identifies premalignant lesions, reduces incidence and selectively prevents less aggressive cancers. The decreased proportion of the latter means that survival does not improve in countries with low incidence of cervical cancer. The increased proportion of cured patients with time shows that survival improvement was not due simply to earlier diagnosis with no patient advantage.