Colorectal cancer survival in the USA and Europe: A CONCORD high-resolution study

Claudia Allemani, Bernard Rachet, Hannah K. Weir, Lisa C. Richardson, Côme Lepage, Jean Faivre, Gemma Gatta, Riccardo Capocaccia, Milena Sant, Paolo Baili, Claudio Lombardo, Tiiu Aareleid, Eva Ardanaz, Magdalena Bielska-Lasota, Susan Bolick, Rosemary D Cress, Marloes Elferink, John P. Fulton, Jaume Galceran, Stanislaw GóźdźTimo Hakulinen, Maja Primic-Žakelj, Jadwiga Rachtan, Chakameh Safaei Diba, Maria José Sánchez, Maria J. Schymura, Tiefu Shen, Giovanna Tagliabue, Rosario Tumino, Marina Vercelli, Holly J. Wolf, Xiao Cheng Wu, Michel P. Coleman

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Objectives: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. Design: A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. Setting and participants: 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998. Outcome measures: Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. Results: The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours. Conclusions: The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.

Original languageEnglish (US)
Article numbere003055
JournalBMJ Open
Issue number9
StatePublished - 2013
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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