Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK.

摘要

The paper on cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK by M P Coleman and colleagues (Jan 8, p 127) reports that survival in the UK is worse than in all but one of the other countries, and it attracted a lot of media coverage. I found the paper curiously impenetrable, but I did find some of the media comment-even that by professional commentators-potentially misleading. Much was made of the central finding that the length of survival from diagnosis is greater when the diagnosis is made earlier in the natural history of the cancer. This is-and always has been-entirely self-evident; but the strongly emphasised implication that earlier diagnosis does the patient any favours is not. That is true only where there is evidence that early intervention improves outcome. For many, but not all, tumours there is good evidence that this is so. In those for which such evidence is less than overwhelming-including some subtypes of lung cancer such as mesothelioma and small-cell lung cancer-early diagnosis might do more harm than good. This topic surely deserves discussion in the paper and in the media comments, not least because it was in lung cancer that Coleman and colleagues found substantial differences in survival.