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  • Writer's pictureLighthouse
    • 8 min read

Why Cancer Survival in the US Is Better Than in the UK

Summary in Thirty Seconds

  • The cancer mortality rate in the US is lower than that in the UK, whether using raw data or age-standardized rates. Similarly, the survival rates for the four most common cancers—prostate, breast, colorectal, and lung—are better at both 1-year and 5-years in the US versus the UK.

  • Cancer screening in the US consistently outpaces rates in the UK for prostate, breast, and colorectal cancers. High screening rates allow for earlier cancer detection and initiation of treatment, leading to better survival.

  • Research shows faster approval rates of new cancer medicines in the US compared to the UK; it has been argued that delays in access to new medicines can notably affect survival rates.

  • Similarly, people in the US with cancer have access to a wider variety of oncologic treatments compared to the UK.

  • These three factors—higher rates of cancer screening, faster and better access to cutting-edge novel medications, and access to a wider variety of treatments—may help explain the better US cancer mortality rates.

Cancer Mortality Rates in the US vs. UK

The American healthcare system has been criticized as over-expensive, under-inclusive, and poorly performing.[1] However, when evaluating cancer mortality, residents of the United States are less likely to die of cancer than their UK counterparts. While it's important to note that comparing US and UK health data is challenging given that data are sometimes recorded differently in the two countries,[2] the US has consistently better cancer outcome data across various datasets and measures. Data from the International Agency for Research on Cancer (IARC) shows that in 2020, the cancer mortality rate in the United States was 185.0/100,000 people, whereas the rate in the UK was 264.6/100,000.[3] Similarly, 2020 data from the World Cancer Research Fund (WCRF) shows the US cancer mortality rate of 183.1/100,000 while the UK rate is 263.8/100,000.[4]


Survival Rates for the Four Most Common Cancers

Drilling down a bit deeper, WCRF data show that the 1-year and 5-year survival rates for the four most common cancers in the US and UK (excluding skin cancer)[5] consistently favor the US over the UK, as shown in the following chart.[6]


These notable differences in cancer mortality and survival raise questions as to how and why the US outpaces the UK. Before exploring these questions, it is important to look at some statistical/demographic differences between the US and UK populations that may at least partially explain this gap.


Age

An axiom in oncology is that cancer is a disease of aging. According to the American Cancer Society, 80.2% of cancer cases are diagnosed in people older than 55.[7] Looked at another way, cancer incidence in people over 65 is 10 times greater than in younger people, and the cancer mortality rate is 16 times greater in people over 65 compared to younger people.[8] In the US, 16.8% of the population is 65 or older[9] compared to 18.6% of the UK population.[10] Thus, using age-adjusted cancer data is important to compensate for age variances between countries. Yet, adjusting for age lessens the mortality gap but does not eliminate it. Using age-standardized rates (ASR, which equalizes the age distribution for countries) from the IARC for cancer mortality yields a rate of 86.3/100,000 in the US compared to 100.5/100,00 in the UK.[11] Using data from a different source, the World Cancer Research Fund (WCRF),[12] yields similar numbers: US mortality = 85.7/100,000; UK mortality = 99.6/100,000.

Incidence

Is it possible that cancer is diagnosed more often in the US than in the UK? According to WCRF data, the ASR incidence of cancer in the US is 297.3, and in the UK 296.1.[13] However, using a different set of data from the World Health Organization in 2020 suggests higher incidence rates and a difference in the US vs. the UK with ASR cancer mortality rates of 362.2 vs. 319.9.[14]


Comparing incidence rates of specific cancers using IARC data for the US vs. the UK in 2020 reveals the following results:[15]

​

Prostate Cancer

Breast Cancer

Colorectal Cancer

Lung Cancer

United States

72.0

90.3

25.6

33.1

United Kingdom

79.9

87.7

34.1

32.3

Thus, there is some variance in the incidence of specific cancers, with the UK having somewhat higher incidence rates of prostate and colorectal cancer but not breast or lung cancer.


Smoking

The similar lung cancer incidence rates are somewhat surprising given the differences in rates of smoking between the US and the UK. The percentage of adults in the US who smoked in 2020 is 12.5% (about half the percentage who did so in 2005 at 20.9%[16]); whereas in the UK in 2020, the smoking rate was slightly higher at 13.8%, and this represents a similar-sized decline compared with the US, with the UK smoking rate at 24% in 2005.[17] Smoking-adjusted cancer mortality in 2020 in the US was 69.0/100,000 while in the UK it was 76.5/100,000.[18] Thus, adjusting for different smoking rates still does not eliminate the cancer mortality gap between the US and the UK.


Cancer Screening

Beyond these demographic and lifestyle issues, another important factor in reducing cancer mortality is undergoing recommended cancer screenings.[19] The UK NHS offers wellness checks, which include breast, cervical, and colorectal screenings, for people 40-74 every five years, and people 75 and over can request a health check.[20] In contrast, Medicare offers annual wellness checks, which include free screenings for some of the most common cancers, and the Affordable Care Act mandates cancer screenings for breast, cervical, and colorectal cancer.[21],[22],[23] Given that early detection is the key to cancer survival,[24] these more frequent checkups for older people, which include screening tests, may account for some of the different US vs. UK cancer mortality rates.


Breast and Colorectal Screening

Looking at various screening rates for specific cancers reveals US rates that are consistently ahead of those in the UK. For breast cancer, the US screening rate from 2003-2018 has remained consistent at about 88%, whereas in the UK, this rate has remained consistent at 75%. Similarly, for colorectal cancer (CRC) screening, the US rate for people on Medicare between 50 and 75 steadily improved from 61% in 2012 to 71% in 2020. In the UK, the CRC screening rate for people 60-74 (age range variances may affect direct comparisons but provide a general comparison) improved from 52% in 2012 to 66% in 2020.[25],[26]


Prostate Screening

There is a huge gap in prostate cancer screening in the US versus the UK, as the UK’s National Health Service (NHS) does not support PSA testing as a standard of care.[27] The benefit of PSA screening has been a matter of controversy; thus, in the US, the rate of testing has declined while still remaining far higher than in the UK. Prostate cancer screening rates have declined from 44.8% in 2005 to 37.1% in the US.[28] In the UK, the rate has climbed from 2% in 2000 to 6% in 2020.[29]


Differences in screening rates may at least partially account for the survival gap in the US vs. UK for all three cancers where screening is commonly provided, and most notably, for prostate cancer at 5 years. A 2020 review of prostate cancer mortality in the US vs. UK concluded, “The higher incidence rate for locoregional disease [compared to distant, metastatic and more lethal disease] among US men is likely attributable to greater PSA test use in the US compared with the UK.”[30] Comparing 5-year survival and screening rates for three cancers in the US vs. the UK yields the following chart:

Speed of Access to Oncology Therapies

A 2022 study found that 89 new oncology therapies were approved by both the FDA and European Medicines Agency (EMA) from 2010 to 2019; furthermore, the FDA approved 95% of therapies first, with a median delay to market authorization in Europe of 241 days.[31] It is well established that cancer outcomes are significantly improved by faster access to effective therapy. Between 2012 and 2021, 86% of novel medicines (not specifically cancer drugs) were approved by the FDA prior to the EMA or the UK’s Medicines and Healthcare products Regulatory Agency (MHRA), and the average lag for MHRA approval was 348 days.[32] With the FDA fast-track approval designation, a decision can be made within 60 days.[33] In contrast, the UK’s MHRA’s fast-track process takes at least nine months.[34]


A 2020 retrospective database study published in Cancers looked at 12 cancer drugs in 28 European countries between 2011 and 2018. Similar to the study listed above, marketing approval for cancer drugs came an average of 242 days later in Europe than in the US. The average time-to-market delay in Europe was 403 days (range 17–1,187 days). [35]


Looking at two drugs, ipilimumab and abiraterone, as examples of the differences between US and UK approval times is revealing. Ipilimumab was first approved by the FDA in March 2011[36] while the NICE approved it in December 2012 (about 640 days delay).[37] Abiraterone was FDA-approved in April 2011[38] but was initially rejected by NICE. This decision was reconsidered in July 2016 (more than a 5-year delay).[39] The 2020 Cancer publication authors cited above estimated that the delay in patient access to these two drugs may have led to a potential loss of more than 30,000 life years.[40]


Access to a Wider Variety of Oncology Therapies

A study of 93 oncologic drug indication pairs that received accelerated approval from the FDA between 1992 and 2017 found that 6 drug indications were withdrawn from the US market, and 42 drug indications were not routinely available through the UK’s NHS. Of these 42 unavailable drugs, 12 were not recommended by European regulators or the UK’s National Institute for Health and Care Excellence (NICE) due to insufficient safety, efficacy, or cost-effectiveness, and 30 drug indications were not reviewed at all.[41] A study comparing the number of novel medicines (new active substances, but not specifically cancer drugs) approved in the US versus the UK found that in 2021, the FDA approved 52 medicines while the MHRA approved 35.[42]


Cancer clinical trials can give participants access to new, cutting-edge therapies they would not otherwise be able to get. In the US, the rate of actively recruiting cancer clinical trials is 23.1/100,000; while in the UK, that rate is notably less than the US rate, at 14.45/100,000.[43] And fewer cancer clinical trials are being conducted in the UK. According to a 2023 editorial in The Lancet, “the number of clinical trials done in the UK is decreasing due to the cost and administrative benefits of globalized patient recruitment.”[44]


The Bottom Line

While the American healthcare system has often been criticized on several grounds, when it comes to cancer care and mortality rates, people with cancer in the US fare better consistently than their UK counterparts. Differences in the percentage of people over 65 (which can be adjusted for), and cancer incidence and smoking rates (which are not large) do not seem to fully account for the better cancer mortality rate in the US. Three factors may help explain the better US cancer mortality rates—higher rates of cancer screening, faster and better access to cutting-edge novel medications, and access to a wider variety of treatments. Undoubtedly, other factors, such as quicker access to care, may also contribute to the better cancer survival rates in the US compared to the UK.

[14] worldpopulationreview.com/country-rankings/cancer-rates-by-country [15] Cancer Today (iarc.fr) [16] www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/ [17]www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2021 [18] JAMA Health Forum. 2022;3(5):e221229 [19]Prev Chronic Dis 2022;19:220063 [20] www.nhs.uk/conditions/nhs-health-check/what-is-an-nhs-health-check/ [21] www.medicareinteractive.org/get-answers/medicare-covered-services/preventive-services/annual-wellness-visit [22] preventive services (medicare.gov) [23] www.cancer.org/research/acs-research-news/aca-effect-on-access-to-cancer-screening-care.html [24] Science. 2022; 18(375):6586 [25] www.nuffieldtrust.org.uk/resource/breast-and-cervical-cancer-screening [26] National Colorectal Cancer Roundtable [27] J Urol 2013; 190: 419 [28] progressreport.cancer.gov/detection/prostate_cancer [29] British J of Cancer. 2020; 123:487–494 [30] ibid [31] JAMA Netw Open. 2022; 5(6):e2216183 [32] Front. Med. 2022; 9:1011082 [33] www.fda.gov/patients/fast-track-breakthrough-therapy-accelerated-approval-priority-review/fast-track [34] The Lancet Oncol. 2023; 24(5):145 [35] Cancers (Basel). 2020; 12(8):2313 [36] www.drugs.com/history/yervoy.html [37] www.nice.org.uk/guidance/ta268 [38] www.drugs.com/history/zytiga.html [39] www.nice.org.uk/guidance/TA259 [40] Cancers (Basel). 2020; 12(8):2313 [41] JAMA Intern Med. 2021; 181(4): 1–9 [42] Front. Med. 2022; 9:1011082 [43] classic.clinicaltrials.gov/ct2/resources/trends [44] The Lancet Oncol. 2023; 24(5):145

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