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A population-based comparison of the survival of patients with colorectal cancer in England, Norway and Sweden between 1996 and 2004
  1. Eva J A Morris1,
  2. Fredrik Sandin2,
  3. Paul C Lambert3,4,
  4. Freddie Bray5,6,
  5. Åsa Klint7,
  6. Karen Linklater8,
  7. David Robinson8,
  8. Lars Påhlman9,
  9. Lars Holmberg10,
  10. Henrik Møller8
  1. 1Cancer Epidemiology Group, Centre for Epidemiology & Biostatistics, University of Leeds, NYCRIS, St James's University Hospital, Leeds, UK
  2. 2Regional Oncology Centre, Uppsala/Örebro Region, University Hospital, Uppsala, Sweden
  3. 3Centre for Biostatistics and Genetic Epidemiology, Department of Health Sciences, University of Leicester, Leicester, UK
  4. 4Department of Medical Epidemiology and Biostatistics, Karolinska Instituet, Stockholm, Sweden
  5. 5Cancer Information Section, International Agency for Research on Cancer, Lyon Cedex, France
  6. 6Department of Clinical and Registry-Based Research, Cancer Registry of Norway, Oslo, Norway
  7. 7Swedish Cancer Registry, National Board of Health and Welfare, Stockholm, Sweden
  8. 8King's College London, School of Medicine, Division of Cancer Studies, Thames Cancer Registry, London, UK
  9. 9Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
  10. 10Kings College London, Department of Research Oncology, Guy's Hospital, London, UK
  1. Correspondence to Dr Eva Morris, University of Leeds, NYCRIS, St James's Institute of Oncology, St James's University Hospital, Leeds LS9 7TF, UK; eva.morris{at}


Objective To examine differences in the relative survival and excess death rates of patients with colorectal cancer in Norway, Sweden and England.

Methods All individuals diagnosed with colorectal cancer (ICD10 (International Classification of Diseases, 10th revision) C18–C20) between 1996 and 2004 in England, Norway and Sweden were included in this population-based study of patients with colorectal cancer. The main outcome measures were 5-year cumulative relative period of survival and excess death rates stratified by age and period of follow-up.

Results The survival of English patients with colorectal cancer was significantly lower than was observed in both Norway and Sweden. Five-year age-standardised colon cancer relative survival was 51.1% (95% CI 50.1% to 52.0%) in England compared with 57.9% (95% CI 55.2% to 60.5%) in Norway and 59.9% (95% CI 57.7% to 62.0%) in Sweden. Five-year rectal cancer survival was 52.3% (95% CI 51.1% to 53.5%) in England compared with 60.7% (95% CI 57.0% to 64.2%) and 59.8% (95% CI 56.9% to 62.6%) in Norway and Sweden, respectively. The lower survival for colon cancer in England was primarily due to a high number of excess deaths among older patients in the first 3 months after diagnosis. In patients with rectal cancer, excess deaths remained elevated until 2 years of follow-up. If the lower excess death rate in Norway applied in the English population, then 890 (13.6%) and 654 (16.8%) of the excess deaths in the colon and rectal cancer populations, respectively, could have been prevented at 5 years follow-up. Most of these avoidable deaths occurred shortly after diagnosis.

Conclusions There was significant variation in survival between the countries, with the English population experiencing a poorer outcome, primarily due to a relatively higher number of excess deaths in older patients in the short term after diagnosis. It seems likely, therefore, that in England a greater proportion of the population present with more rapidly fatal disease (especially in the older age groups) than in Norway or Sweden.

  • Colorectal neoplasms
  • survival
  • colorectal cancer

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  • This paper is a contribution from the National Cancer Intelligence Network (; and is based on the information collected and quality assured by the regional cancer registries in England, the Cancer Registry of Norway and the Swedish Cancer Registry.

  • Funding Cancer Research UK Bobby Moore Fund.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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