Cancer survival can be used as an indicator of cancer prognosis at a population level and of effectiveness of treatments.1
Relative survival refers to the probability of being alive for a given amount of time after diagnosis, compared with the experience of the general population. The measure ‘5-year relative survival at diagnosis’ (hereafter referred to as ‘5-year survival’) answers the question: "what is the probability that an individual will survive their cancer for 5 years after a cancer diagnosis”.
Charts
About this measure
Survival from cancer can be influenced by various factors including demographic characteristics, tumour type, stage of the cancer at diagnosis, other prognostic indicators, and ready availability of treatment. Cancer survival refers to the proportion of patients expected to survive their cancer at a specified point subsequent to the diagnosis, or from some designated point after diagnosis (conditional survival). It is commonly presented as the probability of surviving their cancer at a specified time after diagnosis, e.g., as 5-year or 10-year survival. 1,3
The measure ‘5-year relative survival at diagnosis’ is defined as the ratio of the proportion of people who are alive for 5 years after their diagnosis of cancer (observed survival), to the proportion of people in the general population who are alive over the same time interval (expected survival). Those in the general population are normally matched for age, sex and calendar year to those with cancer. Observed survival is calculated for Australia, using data from population-based cancer registries. Expected survival is calculated from life tables for the entire Australian population. 1,3
All Australian states and territories have legislation that makes cancer a notifiable disease. Various designated bodies – such as hospitals, pathology laboratories and registries of births, deaths and marriages – are required to report cancer and cancer deaths to the relevant state or territory cancer registry.
Cancer survival statistics are made available by the Australian Institute of Health and Welfare (AIHW) for individual cancer types and cancer groupings. These cancer types and groupings are classified using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).1 Generally Australian cancer registries do not record non-melanoma cancers of the skin (basal and squamous cell lesions).
Current status
5-year relative survival for all cancers combined
In the period 2013–2017, 5-year survival was 70% for all cancers combined. This means that among people with cancer, the likelihood of surviving for at least five years after diagnosis was 70% of that expected for the overall population.1
Age and sex
In the period 2013–2017, 5-year survival for all cancers combined was:
- Higher for persons aged under 44 years (ranging from 85% to 90%), but gradually decreased with increasing age to less than 40% for those aged 85 years and over. Similar patterns across age groups were observed for both males and females.
- Higher for females than males in age groups between 15 and 64 years. This difference was most pronounced for those aged between 35 and 54 years, where 5-year survival ranged from 85% to 99% for females and 77% to 83% for males.
The difference in survival by age may be influenced by a number of factors, such as cancer stage at diagnosis, differences in treatments received, and extent of comorbidity (especially among older persons).4
This difference in cancer survival by age and sex may be influenced by differences in survival outcomes for high-incidence, sex-specific cancers such as prostate cancer in males and female breast cancer (see ‘5-year survival by cancer type’ below).
Aboriginal and Torres Strait Islander peoples
For Aboriginal and Torres Strait Islander people, 5-year survival data are presented as observed survival rather than relative survival due to limited availability of relevant life tables. Survival data for the period 2013–2017 for Aboriginal and Torres Strait Islander people and non-Indigenous persons are available from the Australian Cancer Database 2017 (ACD 2017).
In the period 2013–2017, 5-year observed survival for all cancers combined was:
- 49% for Aboriginal and Torres Strait Islander people (compared to 60% for non-Indigenous Australians (ACD 2017).
- Higher for Aboriginal and Torres Strait Islander females (53%) than males (45%). A similar pattern occurred for non-Indigenous Australians, with females having a higher 5-year observed survival (64%) than males (58%) (ACD 2017).
The difference in survival by Aboriginal and Torres Strait Islander status may be influenced by a number of factors, such as cancer stage at diagnosis, differences in treatments received, and extent of co-morbidity. 2
For more information about the Aboriginal and Torres Strait Islander population see the Aboriginal and Torres Strait Islander Cancer Control Indicators ‘5-year survival’.
Remoteness
Survival data by remoteness area are presented using observed survival rather than relative survival due to the limited availability of relevant life tables.
In the period 2013–2017, 5-year observed survival across remoteness areas for all cancers combined was:
- Lower with increasing remoteness, ranging from 63% in Major Cities to 59% in Remote and Very Remote areas. This was largely due to decreasing 5-year survival for males living in areas with increasing remoteness.
Socioeconomic status (SES)
Survival data by SES areas are presented using observed survival rather than relative survival due to the absence of relevant life tables.
In the period 2013–2017, 5-year observed survival across SES areas for all cancers combined was:
Higher with increasing socioeconomic status, ranging from 56.5% in the lowest SES areas (SES 1) to 68% in the highest SES areas (SES 5). Similar patterns across SES areas were observed for both males and females.
Higher for females than males living in increasing socioeconomic areas. (i.e., 60% for females, 54% for males in the lowest SES areas (SES 1), and 70% for females, 67% for males in the highest SES areas (SES 5))
5-year relative survival by cancer type
In the period 2013–2017, 5-year survival for the 18 cancer types reported in this analysis (see Table 1 in ‘About the Data’) was:
- Highest for prostate cancer (95.5%), followed by melanoma of the skin (92%), and female breast cancer (91.5%).
- Lowest for pancreatic cancer (11.5%), followed by cancers of unknown primary site (13%), lung cancer (20%), liver (21%), brain (22%) and oesophagus (22.5%).
Age and sex
In the period 2013–2017, 5-year survival by age for the 18 cancer types reported was:
- Generally decreased with increasing age across all cancer types. The ages at which survival began to decrease, and the extent of this decline, varied for each cancer type.
- Higher for females than males for cancers of the head and neck (including lip) (71% for males, 74.5% for females), lung (17% for males, 25% for females), melanoma (91% for males, 94% for females), and non-Hodgkin lymphoma (74% for males, 77.9% for females).
- Higher for males than females for cancers of the bladder (58% for males, 47.5% for females) and unknown primary site (16% for males, 10% for females).
Aboriginal and Torres Strait Islander peoples
For Aboriginal and Torres Strait Islander people , 5-year survival data are presented as observed survival rather than as relative survival due to the limited availability of relevant life tables at the time of publication.
In the period 2013–2017, 5-year observed survival for the 18 cancer types reported was:
- Lower for Aboriginal and Torres Strait Islander people than non-Indigenous Australians for cancers of the head and neck (including lip) (42% for Aboriginal and Torres Strait Islander persons compared to 63% for non-Indigenous persons), bladder (33% for Aboriginal and Torres Strait Islander persons compared to 44% for non-Indigenous persons), unknown primary site (4% for Aboriginal and Torres Strait Islander persons compared to 10% for non-Indigenous persons), liver (11% for Aboriginal and Torres Strait Islander persons compared to 19% for non-Indigenous persons), and lung (12% for Aboriginal and Torres Strait Islander persons compared to 18% for non-Indigenous persons)
- Higher for Aboriginal and Torres Strait Islander people (39.5%)than non-Indigenous Australians (21%) for brain cancer.
- Lower for Aboriginal and Torres Strait Islander males than non-Indigenous males for prostate cancer (78% compared to 83% respectively).
- Lower for Aboriginal and Torres Strait Islander females than non-Indigenous females for cancers of the breast (78%, 85% respectively), and cervix (58%, 71% respectively).
Differences in survival by Aboriginal and Torres Strait Islander status may be influenced by a number of factors, such as cancer stage at diagnosis, differences in treatments received and co-morbidities. 2
For more information about the Aboriginal and Torres Strait Islander population see the Aboriginal and Torres Strait Islander Cancer Control Indicators ‘5-year survival’.
Remoteness
Survival data by remoteness area are presented using 5-year observed survival rather than relative survival due to the limited availability of relevant life tables. 2
In the period 2013–2017, 5-year observed survival across remoteness areas for the 18 cancer types analyzed was:
- Higher for persons living in Major Cities than for those living in other remoteness areas for brain (23% compared to 19% for persons living in Inner Regional areas), lung (19% compared to 16% for persons living in Inner Regional areas), liver (21% compared to 15% for persons living in Inner Regional areas) and pancreatic (11% compared to 9% for persons living in Inner Regional areas) cancers.
- Marginally Lower for persons living in Major Cities than for those living in Remote and Very Remote areas for melanoma (82% compared to 85%, respectively), unknown primary site (11% compared to 13% respectively), colorectal (61% compared to 61.5% respectively) and rectal cancer (63% compared to 64% respectively).
- Higher for males living in Major Cities than for males living in other remoteness areas for liver (22% compared to 14.5% for bother Inner & Outer regional areas), lung (16% compared to 10% for males living in Remote and Very Remotes areas), colon (59% compared to 57.5% for males living in Remote and Very Remotes areas), head and neck (including lip)(65% compared to 56% for males living in Remote and Very Remotes areas), oesophagus (21% compared to 17% for males living in Remote and Very Remotes areas), pancreas (10% compared to 7% for males living in Remote and Very Remotes areas), and prostate cancers (85% compared to 82% for males living in Outer Regional areas).
- Lower for males living in Major Cities than for males living in Remote and Very Remote areas for bladder (46% compared to 47%), unknown primary site (13% compared to 17%), melanoma (80% compared to 82%, respectively), non-Hodgkin lymphoma (67% compared to 68% respectively) and rectum (62% compared to 63% respectively).
- Higher for females living in Major Cities than for females living in other remoteness areas for brain (24% compared to 19% for females living in Outer Regional areas), breast (86% compared to 84% for females living in Inner Regional & Remote and Very Remotes areas), cervix (73% compared to 64% for females in Remote and Very Remotes areas), liver (18% compared to 13% for females living in Outer Remotes areas), lung (23% compared to 17% for females in Remote and Very Remotes areas), non-Hodgkin lymphoma (70% compared to 67% for females living in Inner Regional areas), pancreas (11% compared to 9% for females living in Inner & Outer Regional areas) and uterus (78% compared to 74% for females living in Outer Regional areas).
Socioeconomic status (SES)
Survival data by SES areas are presented using 5-year observed survival rather than relative survival due to the limited availability of relevant life tables. 2
In the period 2013–2017, 5-year observed survival across SES areas for the 18 cancer types reported was:
- Highest for persons living in the higher SES areas (SES 4 and SES 5) than for those living in the lowest SES areas (SES 1) for each of the selected cancer types analysed.
- Higher for persons living in either of the highest SES areas (SES 4 or 5) than for those living in either of the lowest SES areas (SES 1 or 2) for all 18 selected cancer types.
- Higher for males living in the highest SES areas (SES 5) than for males living in the lowest SES areas (SES 1) for each of the selected cancer types analysed.
- The highest survival for males was found in the highest SES areas (SES 5) except for bladder (SES 4, 49% compared to 48.5% in SES 5 areas) and brain cancers (SES 4, 25.5% compared to 20% in SES 5 areas).
- Higher for females living in the highest SES areas (SES 5) than for females living in the lowest SES areas (SES 1) for each of the selected cancer types analysed.
- The highest survival estimates for females were found in the highest SES areas (SES 5) except for liver (SES 4, 21.5% compared to 17% in SES 5 areas), oesophagus (SES 4, 24% compared to 20% in SES 5 areas) and rectum (SES 4, 67% compared to 65% in SES 5 areas).
Trends
5-year relative survival for all cancers combined
From 1987–1991 to 2013–2017, 5-year survival increased from 51% to 70% for all cancers combined. The increases in 5-year survival occurred for both males and females, although males had a larger increase in survival over this period (from 45% to 68.5%, an absolute increase of 23.5 percentage points) compared to females (from 56% to 71%; an absolute increase of 14 percentage points). Several factors may have contributed to this increase, including advances in diagnostic methods, earlier and increased detection through screening programs, and improvements in treatment.1
5-year relative survival by cancer type
Between 1987–1991 and 2013–2017, 5-year survival for most cancer types increased, but the extent of change varied across cancer types. For the selected cancer types examined in this analysis, the largest absolute increases were observed for prostate cancer (a 35.5 percentage point increase), non-Hodgkin lymphoma (a 26 percentage point increase for persons), colorectal cancer (an 18 percentage point increase for persons), colon cancer (an 18 percentage point increase), liver cancer (a 15 percentage point increase for persons and a 17 percentage point increase for males), rectal cancer (a 19 percentage point increase for persons) and breast cancer for females, where 5-year survival increased by more than 16 percentage points. Other cancer types, such as brain cancer and melanoma of the skin, showed little or no improvement in survival over this period. There was also a notable decrease in 5-year survival for bladder cancer (from 68% to 58%), which is thought to reflect changes in coding practices and age at diagnosis over time.1
About the data
Methodology:
Relative survival at diagnosis is defined as a ratio of the proportion of people surviving following a specified amount of time (e.g., 1 year, 5 years or 10 years) from diagnosis of the cancer (observed survival) to the proportion of people in the general population surviving over the same time interval (expected survival), generally matched for age, sex and calendar year. Observed survival has been calculated from population-based cancer data. Expected survival has been calculated from life tables for the Australian population.1,2
For example, if 6 in 10 people with cancer survive 5 years from their diagnosis (observed survival of 0.6) and 9 in 10 matched people from the general population survive the same 5 years (expected survival of 0.9), the relative survival of people with cancer would be calculated by 0.6 divided 0.9 which equates to 0.67. This means that individuals with cancer are 67% as likely to be alive for at least 5 years after their diagnosis compared with their counterparts in the general population.1
Relative survival was calculated using the period method for all reported time periods. This method calculates survival from a given follow-up or at-risk period. Survival is based on the survival experience of people who were diagnosed before or during this period, and who were at risk of dying during this period.1 As estimates of relative survival may vary, confidence intervals are calculated for these estimates to specify a range of values that are likely to contain the true relative survival for the population.
International comparisons on cancer survival are generally not available, due to the culmination of differences in cancer collection, coding, and reporting practices, and differences in the methodologies used for calculating survival.1
Table 1 presents relevant ICD-10 codes for all cancers combined and individual cancer types reported in this analysis.
|
Cancer site/type |
ICD-10 codes |
|
All cancers combined |
C00-C97, D45-D46, D47.1, D47.3-D47.5, except for basal and squamous cell carcinomas of the skin which are part of C44 |
|
Bladder |
C67 |
|
Brain |
C71 |
|
Breast in females |
C50 |
|
Cancer of unknown primary site |
C80 |
|
Cervix |
C53 |
|
Colon |
C18 |
|
Colorectal |
C18-20 |
|
Head and neck (including lip) |
C00-C14, C30-C32 |
|
Liver |
C22 |
|
Lung |
C33-C34 |
|
Melanoma of the skin |
C43 |
|
Non-Hodgkin Lymphoma |
C82-C86 |
|
Oesophageal |
C15 |
|
Ovary |
C56 |
|
Pancreas |
C25 |
|
Prostate |
C61 |
|
Rectum |
C19-C20 |
|
Uterus |
C54-C55 |
Data sources:
- All Australian states and territories have legislation that makes cancer a notifiable disease. Various designated bodies, e.g., hospitals, pathology laboratories and registries of births, deaths and marriages, are required to report cancer and cancer deaths to their jurisdictional cancer registries.
- Cancer survival statistics are made available by the Australian Institute of Health and Welfare (AIHW) for individual cancer types and cancer groupings. These cancer types and groupings are classified using ICD-10 codes.1
Data caveats:
- All cancers combined include ICD-10 codes C00-C96, D45-D46, D47.1, D47.3-D47.5, except basal and squamous cell carcinomas of the skin which are part of C44.
- A small number of records with unknown age at the date of diagnosis were excluded from the analysis.
- Relative and observed survivals were calculated with the period method, using the periods 2013-20171,2 Note that this period does contains estimates of incidence for the Northern Territory in 2017, death-certificate-only cases for NSW in 2017, and estimates for late registration for Australia in 2017 and the Northern Territory in 2016.
- Remoteness areas are classified according to the 2016 Australian Statistical Geography Standard (ASGS) Remoteness Areas. Disaggregation by remoteness area is based on Statistical Area Level 2 (SA2) of usual residence at time of diagnosis. The accuracy of these classifications decreases over time due to changes in infrastructure within SA2 boundaries since 2016.
- Socioeconomic groups are classified according to the SEIFA quintile using the Index of Relative Socioeconomic Disadvantage (IRSD). Disaggregation by SEIFA quintile is based on 2016 classifications of Statistical Areas Level 2 (SA2) of usual residence at time of diagnosis. The accuracy of these classifications decreases over time due to changes in infrastructure within SA2 boundaries since 2016. The “Total” group for Socioeconomic groupings exclude records where geographical information was unknown or not available.
- Aboriginal and Torres Strait Islander data are for the 2013-2017 period in New South Wales, Victoria, Queensland, Western Australia, and Northern Territory only. The ‘Total’ group in Aboriginal and Torres Strait Islander data excludes those records where Indigenous status was not stated or inadequately described.
References
Activity in this area
Australian Institute of Health and Welfare (AIHW) 2021. Cancer Data in Australia. Canberra: AIHW. https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/ .
Australian Institute of Health and Welfare 2021. Cancer in Australia 2021. Cancer series no.133. Cat. no. CAN 144. Canberra: AIHW.
References
- Australian Institute of Health and Welfare (AIHW) 2021. Cancer Data in Australia. Canberra: AIHW. https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/.
- Australian Institute of Health and Welfare 2021. Cancer in Australia 2021. Cancer series no.133. Cat. no. CAN 144. Canberra: AIHW.
- National Cancer Institute. Population-based Cancer Survival Statistics Overview. Bethesda: NCI; 2020 [Accessed February 2020]; Available at: https://surveillance.cancer.gov/survival/.
- Australian Institute of Health and Welfare. Tong, B and Stevenson C 2007. Comorbidity of cardiovascular disease, diabetes and chronic kidney disease in Australia. Cat. no. CVD 37. Canberra: AIHW.
