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Research Letter
Less Is More
December 9, 2019

Characterizing Relative and Disease-Specific Survival in Early-Stage Cancers

Author Affiliations
  • 1Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
  • 2Weill Cornell Breast Center, Divisions of Breast and Endocrine Surgery, Department of Surgery, New York Presbyterian/Weill Cornell Medical Center, New York, New York
  • 3Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
  • 4The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
JAMA Intern Med. Published online December 9, 2019. doi:10.1001/jamainternmed.2019.6120

When explaining cancer survival statistics to patients, physicians may use net measures such as disease-specific survival—the proportion of patients not dying of their cancer in a given time frame. Another complementary statistic is relative survival, which compares survival of a cancer population to a similar population without cancer, matched for age, race, and sex.1 These measures are often numerically similar, although relative survival also incorporates characteristics—beyond cancer—that distinguish these patients. If patients with particular cancers often also tend to engage in lifestyle or health behaviors that impair survival, such as smoking, their relative survival will be lower. The converse is also true: patients with certain cancers might have higher relative survival, if the cancer is primarily detected incidentally or through screening, because patients receiving preventive care also engage in other healthy behaviors (the healthy-user effect).2,3 This phenomenon has been recognized in early-stage breast, prostate, thyroid, and skin (melanoma) cancers.4 Our objective was to characterize disease-specific and relative survival rates for patients with early-stage cancers, to better understand which cancers may be of lower risk and more likely to be diagnosed in otherwise healthy, health-conscious individuals.

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