The fourth study, on the survival of people with cancer in mainland France, provides updated estimates for the most recent period (2010 to 2015) of 1-year, 5-year, and 10-year survival following diagnosis, as well as trends for 73 types of solid tumors and hematologic malignancies. The new statistical analysis method allows for a more accurate representation of the complex variations in net survival and excess mortality rates, depending on the person’s age and/or the year of diagnosis.

The result of a collaborative effort 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 sub-locations—such as gallbladder and bile duct cancers or glioblastoma—as well as survival estimates 20 years after 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. The publication of the summary follows the online release of reports, each dedicated to a specific cancer site, on the websites of the National Cancer Institute and Santé publique France. This work will be supplemented by a survival study in the overseas departments and regions and by an analysis of survival by stage.

Survival data1 that are generally more favorable for hematologic malignancies and more heterogeneous for solid tumors

The data analysis covered 50 solid tumors and 23 hematologic malignancies.

For solid tumors, the results show a wide disparity in 5-year survival rates, ranging from a very favorable prognosis for thyroid cancer (96%) to the most unfavorable prognosis for glioblastoma (a subtype of central nervous system tumor) and small cell lung cancer (both at 7%). The fight against cancers with a poor prognosis, which include these two subtypes, is a priority of the 10-year cancer control strategy. Specific measures are being implemented to improve prevention and detection and to offer new treatments.

Regarding malignant hematological diseases, ten of them (accounting for 44% of new cases diagnosed each year) have a 5-year net survival rate exceeding 80%. Nearly 50% of new cases of malignant hematological diseases have an intermediate prognosis (33% to 65%). Acute myeloid leukemia (7% of new annual cases of malignant hematological diseases) has the poorest prognosis, with a 5-year survival rate of 27%.

Survival differences favoring women in nearly all cancer sites

Whether for solid tumors or malignant hematologic diseases, the study shows sex-based survival differences favoring women for nearly all cancers studied.

The largest gap is observed for cancers of the lip, mouth, and pharynx (+15 percentage points for women), followed by myelodysplastic syndrome (+10 points) and chronic myelomonocytic leukemia (+10 points), stomach cancer (+8 percentage points), and lung cancer (+6 percentage points).

Only cancers of the bladder and nasal cavities² show less favorable survival in women (by -6 percentage points and -5 percentage points, respectively).

These differences can be explained in particular by:

• greater awareness among women regarding prevention and screening, leading to earlier diagnoses;

• greater exposure of men to the main cancer risk factors (particularly tobacco and alcohol), resulting in a higher prevalence of certain anatomical sub-locations or certain histological types of cancer with a poorer prognosis.

Although survival rates are improving for several sites, certain cancers with a poor prognosis continue to have low 5-year survival rates in both men and women. This is particularly the case for cancers associated with tobacco and alcohol (lung, esophagus, liver) in both sexes. Only stomach cancer in women is a cancer with an intermediate prognosis, whereas it remains a cancer with a poor prognosis in men.

Preventing avoidable cancer risk factors, as well as research aimed at improving treatments for these sites, remain essential and are among the four priority areas of the 10-year cancer control strategy.

Significant variability in survival rates based on age at diagnosis

Survival rates decrease as age at diagnosis increases, with a more pronounced difference for certain hematologic malignancies.

The largest gap is seen in acute myeloid leukemias, where the 5-year survival rate is 69% for the youngest patients (age 30) versus 6% for the oldest (age 80).

A diagnosis of the disease at a more advanced stage in older individuals may, in part, explain these age-related differences. The presence of comorbidities in older individuals also limits access to certain curative treatments or may cause post-treatment complications and lead to lower survival rates.

Regarding breast and prostate cancers, younger individuals have lower survival rates than middle-aged individuals due to a higher frequency of more aggressive tumors.

A marked improvement in survival for the majority of hematologic malignancies; more variable trends by age for solid tumors

Analysis of net survival trends over the entire study period³ shows an improvement in 5-year net survival for 35 solid tumor sites (out of 41 studied) and 10 hematologic malignancies (out of 18 subtypes studied). These improvements vary in magnitude depending on age.

For example, among myeloid malignancies, a particularly significant improvement in 5-year net survival was observed for chronic myeloid leukemia between 1990 and 2015 (from 47% to 86%), regardless of age at diagnosis. Over the shorter period from 1995 to 2015, survival rates improved significantly for three lymphoid blood cancers: follicular lymphoma (from 64% to 89%, particularly among older patients), diffuse large B-cell lymphoma (from 39% to 63% regardless of age at diagnosis), and multiple myeloma / plasmacytoma (from 42% to 63%, particularly among younger patients).

Only essential thrombocythemia shows a decrease in net 5-year survival (-6 percentage points), particularly among those diagnosed at age 60 or older. A shift in the profile of diagnosed patients, driven by changes in diagnostic criteria (thereby increasing their incidence), may have impacted their prognosis.

Regarding solid tumors, the most significant improvement in 5-year net survival since 1990 is observed for prostate cancer (+21 percentage points), which is the most common cancer in men (with an estimated 50,430 new cases in 2018), sarcoma (+17 percentage points), and cancers of the thyroid, ovary, rectum, and small intestine (+14 percentage points).

Survival rates vary by age; a more marked improvement is observed among younger individuals at the time of diagnosis for sarcoma or cancers of the lips, mouth, and pharynx, and among older individuals for thyroid cancer.

Finally, among the most common cancers, there has been a significant increase in 5-year net survival of +9 percentage points, +11 percentage points, and +12 percentage points, respectively, for:

• breast cancer (the ^most common cancer among women, with 58,459 cases in 2018);

• lung cancer (the second most common cancer, with 46,363 cases in 2018 among men and women);

• colon and rectal cancers (the third most common cancer, with 43,336 cases in 2018 among men and women).

The favorable trends in survival rates can be explained by:

• earlier diagnoses, particularly thanks to screening programs, although it is difficult to quantify their contribution;

• more targeted therapies thanks to improved diagnostic tools (imaging, cytogenetic and molecular biology techniques);

• the introduction of innovative treatments such as targeted therapies for liver cancer, combination therapies for central nervous system cancers, and hormone therapy and targeted treatments for breast cancer;

• increased patient monitoring (particularly in geriatric oncology and through multidisciplinary team meetings), which is widely supported as part of the Cancer Plans’ initiatives.

However, certain cancer sites show a decline in 5-year net survival. This is the case for:

• bladder cancer (-5 points), with a more pronounced decrease among those diagnosed at a young age, likely a consequence of changes in tumor classification over the years of diagnosis;

• cervical cancer (-3 points), particularly among women over 50. This represents a “paradoxical” effect of screening. Indeed, screening allows for the detection of precancerous lesions (leading to a decrease in the incidence of invasive cancers) and cancers at an earlier, and therefore curable, stage, thereby improving the chances of recovery (which is observed in women under 50). With the decrease in the number of invasive cancers, the proportion of cancers diagnosed at advanced stages (in women who have not undergone screening)—and thus more aggressive—increases.

First 20-year survival data

The long history of French registries makes it possible, for the first time, to present long-term survival data with a follow-up period of up to 20 years after diagnosis. These data pertain to individuals diagnosed between 1989 and 2000 and under the age of 75 at the time of diagnosis (35 sites for solid tumors and 6 for malignant hematologic diseases).

Thus, for cancers with a favorable prognosis 5 years after diagnosis, net survival at 20 years remains relatively stable regardless of age. This is the case for testicular cancer (net survival at 20 years exceeding 90%), cutaneous melanoma (>80%), and breast cancer (>63%). For others, such as thyroid and endometrial cancers, a decline in net survival between 5 and 20 years is observed for individuals aged 70 at diagnosis.

Furthermore, certain malignant hematological diseases, which had a favorable 5-year prognosis, show a 20-year net survival rate that decreases, depending on age, by 10 to 25 survival points; These include chronic lymphocytic leukemia (CLL)/lymphocytic lymphoma (net survival at 20 years between 36% and 55% depending on age) and Hodgkin lymphoma (between 22% and 91%).

Certain cancers with an intermediate prognosis show a significant decline in net survival between 5 and 20 years. These include cancers of the head and neck (-25 to -30 points). Thus, the lip-mouth-pharynx group has a 20-year net survival rate of 10% (vs. 44% at 5 years).

Finally, cancers with a poor 5-year prognosis show a 20-year survival probability that varies significantly by age, ranging from 2% to 27%.

All of these data represent a crucial contribution to ongoing efforts to combat cancer. They help identify the areas where efforts must be intensified. Thus, the priority areas defined in the ten-year cancer control strategy include focusing research efforts on cancers with poor prognoses, as well as continuing and intensifying prevention efforts—whether primary, secondary, or tertiary. The goal is to reduce the burden of the disease on the daily lives of every citizen.