Rectal cancer survival in the United States by race and stage, 2001 to 2009: Findings from the CONCORD‐2 study

Abstract

Background In the first CONCORD study, overall 5-year survival for rectal cancers diagnosed between 1990 and 1994 was below 60%, with large racial disparities in most participating states. We have updated these findings to 2009 by examining population-based survival by stage at diagnosis, race, and calendar period. Methods We used data from the CONCORD-2 study to compare survival among people (age 15-99 years) diagnosed in 37 states covering up to 80% of the U.S. population. Survival was adjusted for background mortality (net survival) using state- and race-specific life tables and age-standardized using the International Cancer Survival Standard weights. Survival up to five years is presented by race (all, black and white) for 2001-2003 and 2004-2009 to account for changes in collecting SEER Summary Stage 2000. Results There was a small increase in 1-, 3- and 5-year net survival between the two time periods (84.6%, 70.7% and 63.2% respectively in 2001-2003; 85.1%, 71.5%, and 64.1% respectively in 2004-2009). Blacks had lower 1-, 3-, and 5-year survival than whites in both periods; the absolute difference in survival between blacks and whites declined only for 5-year survival. Blacks had lower 5-year survival than whites for each stage at diagnosis in both time periods. Conclusions There was little improvement in net survival for rectal cancer, with persistent, but narrowing disparities between blacks and whites. Additional investigation is needed to identify and implement effective interventions to ensure consistent and equitable use of high-quality screening, diagnosis, and treatment to improve survival for rectal cancer.

Population‐based cancer survival (2001 to 2009) in the United States: Findings from the CONCORD‐2 study

“…A description of the data from the 37 participating cancer registries, and the rigorous and advanced statistical methods used to evaluate and analyze the data, are presented in an accompanying article by Allemani et al We focused on patients diagnosed during 2 calendar periods (2001‐2003 and 2004‐2009) because the method used by US cancer registries to collect and report anatomic stage (SEER Summary Stage 2000) changed beginning on January 1, 2004. We observed 5‐year survival to be high (≥80%) for breast cancer in women, prostate cancer, and acute lymphoblastic leukemia (ALL) in children; moderate (50%‐80%) for cancers of the colon, rectum, and cervix; and low (<50%) for cancers of the stomach, liver, lung, and ovary (Table ) . These observations are consistent with those of long‐term trends in survival in the United States for many leading cancers in both males and females and children .…”

“…The comparison of survival by calendar period in the cancer‐specific articles in this supplement shows that even over this relatively short time period, survival has improved for cancers that were highly lethal (stomach, liver, lung, and ovary). However, less progress was observed for cancers for which survival already was moderate to high, likely reflecting previous gains achieved from screening (colon, rectum, breast, and cervix) or those for which treatment already was highly effective (ALL) . The high survival for patients with prostate cancer likely reflects the use of the prostate‐specific antigen test for the early detection of cancer, which was recommended by the American Cancer Society during this time period .…”

“…The overall high percentage of microscopically verified cancers observed for all cancers, and the relatively low percentage of patients with solid tumors for whom stage at diagnosis was unknown, suggests that detailed clinical investigation at the time of diagnosis was performed for the majority of patients with cancer diagnosed during this time period. However, the large and consistent racial disparities described herein are likely due to the fact that cancers diagnosed in black men and women tended both to be diagnosed at a later stage and to have lower survival at each stage of diagnosis . These disparities often appeared within the first year after diagnosis, suggesting that additional factors, such as comorbidities and socioeconomic factors related to limited access to screening, diagnosis, treatment, and follow‐up care, may be relevant.…”

Lung cancer survival in the United States by race and stage (2001‐2009): Findings from the CONCORD‐2 study

“…We observed that age-standardized 5-year net survival for lung cancer (19.0%) was 4.2% higher than that for liver cancer (14.8%) 18 but lower than for the other cancers addressed in this Supplement, including stomach cancer (29.0%), 19 ovarian cancer (41.0%), 20 cervical cancer (62.8%), 21 rectal cancer (64.0%), 22 colon cancer (64.6%), 23 acute lymphoblastic leukemia in children (88.1%), 24 breast cancer (88.6%), 25 and prostate cancer (96.9%). 26 …”

Population‐based cancer survival in the United States: Data, quality control, and statistical methods

“…If an age‐specific estimate could not be obtained, we merged data for adjacent age groups and assigned the combined estimate to both age groups. If 2 or more age‐specific estimates could not be obtained, we present only the pooled, unstandardized estimates for all ages combined: these estimates are italicized in Supporting Tables 2 and 3 in other articles of this supplement …”