thematic dossier
Cancers
Les cancers représentent en France la première cause de décès chez l’homme et la deuxième chez la femme. Santé Publique France copilote la surveillance épidémiologique et participe à leur prévention.
Survival rates for cancer patients between 1989 and 2018 have improved for the vast majority of cancer sites
Santé publique France, the Biostatistics and Bioinformatics Department of the Hospices Civils de Lyon, the Francim cancer registry network, and the National Cancer Institute have published the results of survival estimates for people with cancer in mainland France between 1989 and 2018.
Cancer survival is a key indicator for assessing the overall improvement in prognosis, resulting from both therapeutic advances and efforts to diagnose cancers at an earlier stage and improve their management. The fourth study, on the survival of people with cancer in mainland France, provides updated estimates of survival at 1, 5, and 10 years after diagnosis, as well as trends for 73 sites of solid tumors and malignant hematological diseases.
These collaborations illustrate the continuum of our institutions’ missions and actions in the service of the health of the French people. It is a fine example of collaboration combining expertise, surveillance, and research, leading to a very concrete result: objectifying cancer data, guiding research efforts to improve diagnosis and treatment methods, and targeting prevention efforts to reduce preventable diseases.
The result of a partnership between the Francim network of cancer registries, the biostatistics department of the Hospices Civils de Lyon, Santé publique France, and the National Cancer Institute, this study includes, for the first time, survival estimates for 22 anatomical or histological subtypes—such as gallbladder and bile duct cancers or glioblastoma—as well as 20-year survival estimates following diagnosis.
These new results show an overall improvement in prognosis for nearly all cancer sites, as well as significant variability in survival depending on age at diagnosis. This improvement in survival is particularly evident for hematologic malignancies. This work will be supplemented by a survival study in France’s overseas departments and regions, covering about ten cancer sites, and by an analysis of survival by stage at diagnosis for several cancers.
The survival indicator is essential for assessing the impact of cancer control policies
The survival indicator estimates the survival rate that would be observed if cancer were the sole cause of death. It cannot be interpreted at the individual patient level, but it has great epidemiological value because it allows for comparisons over time (trends), as well as between countries and by age. It is also indispensable to us, complementing incidence and mortality indicators, for developing our prevention strategies. Furthermore, survival analysis also allows us to guide and target specific age groups in particular.
Encouraging results, but a reminder of the need for action
Since the implementation of the Cancer Plans and now the ten-year strategy to combat cancer—in which Santé publique France has always been particularly involved—we have observed an improvement in survival for most cancers. These new results show an overall improvement in prognosis for nearly all cancer sites, as well as significant variability in survival rates based on age at diagnosis. This improvement in survival is particularly evident for hematologic malignancies.
The main reasons are: improvements in early screening, multidisciplinary care, and advances in treatment.
Nevertheless, the burden of cancer remains very high (382,000 new cases and 157,400 cancer deaths in France in 2018). For women, breast cancer remains the leading cause of death (12,146 deaths in 2018), and lung cancer for men (22,761 deaths in 2018). Thus, cancers with poor prognoses, such as those associated with tobacco and alcohol, remain so. The incidence of lung cancer is also rising sharply among women (+5.3% per year on average between 1990 and 2018).
These results highlight the need to continue and intensify cancer prevention efforts, as well as to promote organized screening programs to reduce the burden of these diseases. Estimates of the disease burden and its determinants show us that these factors are indeed preventable. Indeed, a number of risk factors remain major determinants of these cancers, including tobacco, alcohol, and nutritional factors such as diet and physical activity.
Thus, continuing our primary prevention efforts is essential because it helps reduce exposure to these risk factors. In practice, these efforts take the form of prevention strategies and social marketing as part of population-based approaches. Regulations regarding prevention also serve as an important lever for reducing risk exposure.
The fight against cancer at the heart of Santé publique France’s programming
Responsible for the cancer surveillance program and the evaluation of organized cancer screening programs, Santé Publique France oversees this surveillance in the general population as well as in relation to environmental or occupational exposures and infectious causes.
The 2020 participation indicators for organized colorectal cancer screening programs were published in 2021, and those for breast cancer will be published shortly. Regarding cervical cancer screening coverage for the 2018–2020 period, the results will be available in the second half of 2021.
Work is also underway to assess changes in cancer mortality in 2020 compared to previous years, as well as to publish trends in long-term serious illnesses (ALD) related to cancer through 2020. Other studies are underway to estimate the impact of the health crisis on people with cancer. A “COVID and Cancer” study covering both screening and surveillance is part of our program.
