Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis

Background Long-term survival rates for many types of cancer have substantially improved in past decades because of advances in early detection and treatment. However, much of this improvement is only seen many years later with traditional cohort-based methods of survival analysis. I aimed to assess achievements in cancer patients' survival by an alternative method of survival analysis, known as period analysis, which provides more up-to-date estimates of long-term survival rates than do conventional methods. Methods The 1973-98 database of the Surveillance, Epidemiology, and End Results (SEER) programme of the US National Cancer Institute was analysed by period analysis. Findings Estimates of 5-year, 10-year, 15-year, and 20-year relative survival rates for all types of cancer were 63%, 57%, 53%, and 51%, respectively, by period analysis. These estimates were 1%, 7%, 11%, and 11% higher, respectively, than corresponding estimates by cohort-based survival analysis. By period analysis, 20-year relative survival rates were close to 90% for thyroid and testis cancer, exceeded 80% for melanomas and prostate cancer, were about 80% for endometrial cancer, and almost 70% for bladder cancer and Hodgkin's disease. A 20-year relative survival rate of 65% was estimated for breast cancer, of 60% for cervical cancer, and of about 50% for colorectal, ovarian, and renal cancer. Interpretation Timely detection of improvements in long-term survival rates might help to prevent clinicians and their patients from undue discouragement or depression by outdated and often overly pessimistic survival expectations. It also adds to the value of cancer surveillance as a basis for appropriate public-health decisions.