Cancer survival can be used as an indicator of cancer prognosis at a population level as well as indicate the effectiveness of treatments provided.1
Relative survival refers to the probability of being alive for a given amount of time after diagnosis, compared with the corresponding probability for the general population of similar demographic characteristics. The measure ‘10-year relative survival at diagnosis’ (hereafter referred to as ‘10-year survival’) answers the question: "what is the probability that an individual will survive for at least 10 years after a cancer diagnosis compared with the corresponding probability for the general population?”.
About this measure
Survival from cancer varies depending on many factors, such as demographic characteristics, tumour type, stage of the cancer at diagnosis, co-morbidities, other prognostic indicators and treatment. Cancer survival refers to the proportion of patients alive at a specified point after diagnosis of the cancer, or from some other designated point after diagnosis (conditional survival). Survival is commonly presented as the probability of surviving all causes of death after a specified time point, e.g. 5 years or 10 years, compared with the corresponding probability for the general population.1, 2
The measure ‘10-year relative survival at diagnosis’ is defined as the ratio of the proportion of people who are still alive at 10 years after diagnosis of their cancer (observed survival) divided by the proportion of people in the general population expected to survive the same time interval (expected survival) after matching by age, sex and calendar year. Observed survival is calculated for Australia using data from population-based cancer registries. Expected survival is calculated from life tables for the Australian population. 1, 2
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 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
Current status
10-year relative survival for all cancers combined
In the period 2013–2017, 10-year relative survival was 64% for all cancers combined. This meant that among people with cancer, the likelihood of surviving for at least 10 years after diagnosis was 64% of the corresponding expected survival for the general population.1
Age and sex
10-year relative survival for all cancers combined:
- Was highest among persons aged 15-24 years and 25–34 years (between 87.5% and 86.5%).
- Decreased with increasing age from 87.5% among those aged 15-24 years to 32% among those aged 85 years and over. Similar patterns among males and females respectively were observed across age groups.
- Was higher among females than males for age groups 0-14 years (83.5% and 82% respectively), 15-24 years (89% and 86% respectively), 25-34 years (87% and 86% respectively), 35-44 years (84% and 80%, respectively), 45-54 years (80% and 73%, respectively), 55-64 years (73% and 71% respectively) and 85+ years (34% and 30%, respectively).
- Was higher among males aged 65–74 years than females (65% compared to 63% respectively).
- Was the same for both males and females in the 75–84-year age group (48% for males and females).
The difference in survival by age may be influenced by factors such as cancer stage at diagnosis, differences in treatment, and an increased likelihood of co-morbidities among older persons.1
This difference in cancer survival by age and sex may be influenced by differences in outcomes for high-incidence, sex-specific cancers such as prostate cancer in males and female breast cancer (see ‘10-year survival by cancer type’ below).
Aboriginal and Torres Strait Islander peoples
For Aboriginal and Torres Strait Islander Australians, 10-year survival data are presented for observed survival rather than for relative survival due to limited access to relevant life tables at the time of publication.
In the period 2013–2017, 10-year observed survival for all cancers combined was:
- Lower among Aboriginal and Torres Strait IslanderAustralians (38%) than non-Indigenous Australians (48%).
- Lower among Aboriginal and Torres Strait Islander males (33.5%) than Aboriginal and Torres Strait Islander females (42.5%). A similar pattern occurred among non-Indigenous Australians, with a lower 10-year observed survival among males (45%) than females (53%).
- Lower among Aboriginal and Torres Strait Islander females than non-Indigenous females (42.5% than 53%, respectively).
- Lower among Aboriginal and Torres Strait Islander males than non-Indigenous males (33.5% than 45%, respectively).
Differences in survival by Aboriginal and Torres Strait Islander status may be influenced by factors such as cancer stage at diagnosis, treatment, and prevalence of co-morbidities.1
Remoteness
Survival data by remoteness area are presented using observed rather than relative survival due to limited access to relevant life tables.
In the period 2013–2017, 10-year observed survival for all cancers combined was:
- Slightly higher in Major Cities for both males and females (48% and 55%, respectively) than in other remoteness areas.
Socioeconomic status (SES)
Survival data by SES area are presented using observed rather than relative survival due to limited access to relevant life tables.
In the period 2013–2017, 10-year observed survival for all cancers combined across SES areas:
- Increased with increasing socioeconomic status, from 44% in the lowest SES areas (SES 1) to 57% in the highest SES areas (SES 5). This pattern applied to both males and females.
10-year relative survival by cancer type
In the period 2013–2017, 10-year relative survival for the 18 cancer types reported in this analysis (see Table 1 in ‘About the Data’) was:
- Highest for prostate cancer (92%), followed by melanoma (89%), and female breast cancer (86%).
- Lowest for pancreatic cancer (9%), followed by cancers of unknown primary site (11%), lung (14%), liver (15%), brain (17%), and oesophagus (18%).
Age and sex
In the period 2013–2017, 10-year relative survival for the 18 cancer types reported was:
- Generally decreased with increasing age for all cancer types. The ages at which survival began to decrease, and the extent of this decrease, varied by cancer type.
- Higher among females than among males for cancers of brain (19% compared to 16%), colon (66% compared to 64%), head and neck (including lip) (66% compared to 61%), lung (18% compared to 12%), melanoma of the skin (92% compared to 87%), and Non-Hodgkin lymphoma (70% compared to 66%).
- Higher among males than females for cancers of the bladder (48.5% compared to 40% females), and unknown primary site (13% compared to 8.5%).
- Survival estimates were similar in both sexes for cancer of the colorectum (66% for females compared to 63% for males), liver (15% for males compared to 14% for females), oesophagus (18.5% for females compared to 18% for males), pancreas (9.5% for females compared to 9% for males), and rectum (65% for females compared to 63% for males).
Aboriginal and Torres Strait Islander peoples
In the period 2013–2017, 10-year observed survival for the 18 cancer types reported was:
- Lower among Aboriginal and Torres Strait Islander persons than non-Indigenous persons for cancers of the unknown primary site (4% compared to 7%), head and neck (including lip) (26.5% compared to 47%), lung (7% compared to 11%), and rectum (39% compared to 48%).
- Lower among Aboriginal and Torres Strait Islander males than non-Indigenous males for cancers of the head and neck (including lip) (28% compared to 46%), lung (5.5% compared to 8%respectively), and prostate (58.5% compared to 68% respectively). and lower among Aboriginal and Torres Strait Islander than non-Indigenous females for cancers of the breast (64% compared to 74%), cervix (50% compared to 64%), head and neck (including lip) (24% compared to 51%), and lung (8% compared to 14%).
- Similar among Aboriginal and Torres Strait Islander Australians and non-Indigenous Australian for cancers of the bladder, colon, colorectal, melanoma of the skin, non-Hodgkin lymphoma[BJ2] and uterus.
- Not presented for cancers of the bladder (females only), brain (by sex), liver, oesophagus, pancreas, and ovary due to small numbers, confidentiality, and/or reliability concerns.
Remoteness
In the period 2013–2017, 10-year observed survival across remoteness areas for the 18 cancer types reported was:
- Higher among persons living in Major Cities than those living in more remote areas for cancers of the brain, colon, head and neck (including lip), liver, lung, oesophagus, and pancreas.
- Lower among persons living in Major Cities than those living in other remoteness areas for bladder cancer, unknown primary site, colorectal, non-Hodgkin lymphoma, melanoma of the skin, and rectum.
- Higher among males living in Major Cities than males living in more remote areas for cancers of the brain, head and neck (including lip), liver, lung oesophagus, pancreas, and prostate.
- Lower among males living in Major Cities than males living in Remote and Very Remote areas for unknown primary site (9.5% compared to 12%), melanoma of the skin (66% compared to 71.5%) and rectum (47% compared to 49%).
- Higher among females living in Major Cities than females living in Inner Regional areas for pancreatic cancer (8% compared to 5.5%).
- Lower among females living in Major Cities than females living in Remote and Very Remote areas for colon (46.5% compared to 51%), colorectal (48% compared to 51%), melanoma of the skin (76% compared to 80%), and ovarian cancer (33% compared to 47%).
Socioeconomic status (SES)
In the period 2013–2017, 10-year observed survival for the 18 cancer types reported was higher among persons in the highest SES areas (SES 5) than in other SES areas for the selected cancer types analysed.
- While 10-year observed survival was higher among males living the highest SES areas, these differences were attributable to chance for cancers of the brain, liver, and oesophagus.
- While 10-year observed survival was higher among females living the highest SES areas, these differences were attributable to chance for cancers of the bladder, unknown primary site, liver, oesophagus, ovary, pancreas, and uterus.
Note: these differences were based on small numbers and therefore attributable to chance.
Trends
Trend data for 10-year relative survival are not available.
About the data
Methodology:
Relative survival following diagnosis is defined as a ratio of the proportion of people who survive a specified amount of time (e.g., 1, 5 or 10 years after diagnosis of cancer) (observed survival) to the proportion of people in the general population who survive the same time interval (expected survival) matched by 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 10 years after their diagnosis (observed survival of 0.6) and 9 in 10 matched people from the general population survive the same 10 years (expected survival of 0.9), the relative survival of people with cancer would be 0.67 (0.6 divided 0.9). This means that individuals with cancer are 67% as likely to be alive 10 years after diagnosis compared as 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 estimates are 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 difficult, due to differences in cancer collection, coding and reporting practices, as well as 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–C96, D45–D46, D47.1, D47.3–D47.5, except for basal and squamous cell carcinomas of the skin |
|
Bladder |
C67 |
|
Brain |
C71 |
|
Breast in females |
C50 |
|
Cancer of unknown primary site |
C80 |
|
Cervix |
C53 |
|
Colon |
C18 |
|
Colorectal |
C18–20 |
|
Head and neck |
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 |
C19–20 |
|
Uterus |
C54-C55 |
Data source:
- 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 groupings. These cancer types and groupings are classified using ICD–10 codes.1
Data caveat:
- 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.
- Relative survival was calculated using the period method for the period 2013-17. Estimated records are not included in calculating the relative survival estimates presented, i.e., incidence estimates for the Northern Territory in 2017, death-certificate-only cases for New South Wales in 2017, and late registrations for Australia in 2017 and the Northern Territory in 2016.
- Records with unknown age at the date of diagnosis were excluded from the analysis.
- 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.
- Relative survival data by Indigenous status, and SES and Remoteness of residential area are presented using observed rather than relative survival due to limited access to life tables.
- Data presented for Aboriginal and Torres Strait Islander Australians, non-Indigenous and Total are for NSW, Vic, Qld, WA and NT combined, only.
- All figures were rounded to the nearest whole numbers where relevant.
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 2019. Cancer in Australia 2021. Cancer series no.133.Cat. no. CAN 144. Canberra: AIHW.
-
Institute NC. Population-based Cancer Survival Statistics Overview. Bethesda: NCI; 2015 [Accessed February 2020]; Available at: https://surveillance.cancer.gov/survival/
