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In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. A Corrigendum to this article was published on 09 December There are wide international differences in 1-year cancer survival. The UK and Denmark perform poorly compared with other high-income countries with similar health care systems: Australia, Canada and Sweden have good cancer survival rates, Norway intermediate survival rates. The objective of this study was to examine the pattern of differences in cancer awareness and beliefs across these countries to identify where these might contribute to the pattern of survival.
Symptom awareness was no lower in the UK and Denmark than other countries. The UK had low awareness of age-related risk and the highest perceived barriers to symptomatic presentation, but symptom awareness in the UK did not differ from other countries. Denmark had higher awareness of age-related risk and few perceived barriers to symptomatic presentation. This suggests that other factors must be involved in explaining Denmark's poor survival rates.
In the UK, interventions that address barriers to prompt presentation in primary care should be developed and evaluated. International comparisons show wide differences in cancer survival between high-income countries with good cancer registration systems and good access to health care Berrino et al, ; Coleman et al, For cancers of the lung, breast, bowel and ovary diagnosed in β, Australia, Canada and Sweden had the highest survival and Denmark and the UK the lowest; Norway had intermediate survival Coleman et al, Survival differences between these countries were largely explained by differences in 1-year survival Coleman et al, , which may be a marker of late stage at diagnosis for some cancers.
High-resolution studies of survival suggest that international differences are partly explained by differences in stage at diagnosis for some cancers Gatta et al, ; Sant et al, , ; Bouvier et al, Although there is emerging evidence that differences in stage distribution do not explain all the variation in short-term survival Maringe et al, and Michel Coleman, personal communication , patient delay in presentation with symptoms and health care system delay in referral or diagnosis are, nevertheless, considered likely to contribute to later stage at diagnosis Richards et al, There is evidence for an important role for patient delay Neal et al, ; Neal, Systematic reviews have found that low awareness of symptoms is associated with patient delay for a range of common cancers Ramirez et al, ; Macleod et al, Other potential influences on time to presentation include negative beliefs about cancer outcomes von Wagner et al, or barriers to symptomatic presentation Robb et al, ; Forbes et al, and poor awareness of the risk of cancer.
