More people are surviving cancer than ever before in history. Advances in cancer treatments and diagnostic tools mean we're able to catch cancer earlier on and treat even aggressive forms of the disease.
Authors
- Ahmed Elbediwy
Senior Lecturer in Cancer Biology & Clinical Biochemistry, Kingston University
- Nadine Wehida
Senior Lecturer in Genetics and Molecular Biology, Kingston University
But a major new study has shown that the steady increase in cancer survival rates that we've seen in England and Wales over the last 50 years has plateaued.
The researchers looked at data from over 10 million adults diagnosed with cancer over an almost 50-year period (1971-2018) in England and Wales. They found that the ten-year survival rate for patients has doubled in the past 50 years - from around 23% to 50%. That's obviously fantastic news. But they also found that the overall increase in survival rates has begun to plateau in the past few decades.
Some cancers, including breast, bowel and cervical cancers, have seen huge improvements in diagnosis and ten-year survival rates. But other types of cancer, including pancreatic, brain, lung, stomach and oesophageal, historically have a much lower survival rate. For these cancers, there has hardly been any change in survival rate observed in the past 50 years .
There are a few key reasons that may explain why survival rates from these types of cancer have not improved.
One is lifestyle changes. Over the past 50 years, the average person's diet has changed significantly - with ultra-processed foods making up a greater proportion of peoples' diets. These foods tend to be high in calories and low in nutritional value.
This shift has contributed to a startling increase in global obesity rates . This obesity increase has coincided with a substantial increase in risk of obesity-related cancers, including pancreatic, kidney, colorectal, ovarian and gallbladder cancer.
Moreover, UK research has found a link between ultra-processed foods and cancer - finding that the more ultra-processed foods a person consumes, the greater their risk of developing many types of cancer, including ovarian.
Meanwhile, although smoking rates have declined over the past 50 years in England, air pollution has now become a significant concern when it comes to lung cancer. Exposure to air pollution causes around one in ten cases of lung cancer in the UK. It's estimated that almost 6,000 people who have never smoked die of lung cancer every year in the UK.
Another possible reason for survival rates not improving is location. Some areas of the UK have better access to drugs, cancer specialists and advanced screening programmes. This "cancer postcode lottery" means that two people with the same cancer may have very different outcomes depending on where they live. Patients who live in lower socioeconomic areas face longer waits for treatment, receive poorer care, and have lower cancer survival rates .
A recent report from the Macmillan Cancer Trust found that up to 40% of UK residents have struggled to get cancer treatment and care because of where they live.
This disparity is a historic issue, which has been documented as far back as 1981 . Despite measures put in place to address it , socioeconomic inequalities in cancer survival continue to be observed .
Another potential factor is investment in treatments and treatment costs. In these respects, pancreatic, brain, lung, stomach and oesophageal cancers have historically been underfunded compared to other types of cancer. According to the World Cancer Research Fund, these types of cancer only receive 16% of the research investment that goes to other more common types of cancer (such as breast cancer). This means we're still behind when it comes to effectively diagnosing and treating these conditions.
Treatment cost is another significant factor. Newer cancer treatments are expensive. In order to be approved for NHS use, the drug cannot cost more than £20,000-£30,000 per patient and it must give a patient at least one year in good health after using it.
This criteria has meant that some effective cancer treatments have been rejected in the past because they didn't meet these requirements . Given the lack of investment some types of cancers have historically seen, rejecting them for being too costly could mean that patients living with these types of cancer may have missed out on important treatments.
Improving cancer survival rates
Many of the cancers which have seen little improvement in survival rates are difficult to screen because signs and symptoms often don't appear until the later stages of the disease . This makes it difficult to catch them earlier on, when they might be more easily treated.
So the first and most important way of increasing survival rates is by establishing more effective screening programmes. This will allow for earlier diagnosis and increase the chances of treatments working.
Media advocacy could also be used to improve awareness of these types of cancer and improve uptake of existing screening programmes. Celebrity cancer stories have brought greater awareness to many common types of cancer - such as breast, bowel and cervical cancer. This has resulted in more people seeking out diagnoses and treatment, which may partly explain why these types of cancer have seen continued improvements in survival rates over the past 50 years.
Encouragingly, research is advancing in the field of hard-to-treat cancers. Greater investment will only further help us understand these difficult to treat cancers and develop more effective treatments for them.
Greater investment into the NHS is also vital. This will help us to reduce waiting times for diagnosis and treatment, which is critical for effective treatment and cancer survival . The UK government plans to release their national cancer plan later this year, which will outline the key ways they plan to improve cancer care and survival rates.
On the whole, we're better able to treat and diagnose cancer than we were 50 years ago. With continued investment and research, it's hoped we can further improve the prospects for those types of cancer whose survival rates have lagged behind.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
