Scientific article
OA Policy
English

The impact of cancer survivors’ extra risk of noncancer mortality on net survival estimation

Published inAmerican journal of epidemiology, vol. 194, no. 11, p. 3316-3324
Publication date2025-11-04
First online date2025-08-19
Abstract

Relative survival (RS) with the general population as the reference is commonly used to estimate net survival (NS). However, cancer patients may face an increased risk of noncancer death compared to cancer-free individuals. We evaluate the impact of considering this relative risk (RR) on NS estimation. First, we compared selected NS values to generated RS under various theoretical scenarios, considering different RR, NS, age at diagnosis, time since diagnosis, and sex. Then, differences between NS and RS for 3 cancers were analyzed from cure model-based estimates using EUROCARE-6 data. We observed differences between RS and the true value of NS, larger for longer time since diagnosis, older patients, and higher NS. For head and neck cancer, the smallest differences were for young female patients at 5 years from diagnosis (4%) and the highest (32%) for older patients. For colorectal cancer, differences were <7% for all ages, both sexes, and times since diagnosis and for breast cancer, differences were <5% except for older patients after 5 years. If RR > 1, RS underestimates NS. Our findings aim to correctly interpret the differences between RS and NS, and contextualize the possible biases of assuming RS as a proxy for cancer-specific survival.

Keywords
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / mortality
  • Cancer Survivors / statistics & numerical data
  • Colorectal Neoplasms / mortality
  • Female
  • Head and Neck Neoplasms / mortality
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / mortality
  • Survival Analysis
  • Young Adult
Funding
  • Italian Association for Cancer Research [28893]
  • French Institut National du Cancer [2018-178]
  • Italian Association of Cancer Research [2020 ID.24933]
  • Innovative Partnership for Action Against Cancer [801520 HP-JA-2017]
Citation (ISO format)
BOTTA, Laura et al. The impact of cancer survivors’ extra risk of noncancer mortality on net survival estimation. In: American journal of epidemiology, 2025, vol. 194, n° 11, p. 3316–3324. doi: 10.1093/aje/kwaf148
Main files (1)
Article (Published version)
Identifiers
Journal ISSN0002-9262
9views
26downloads

Technical informations

Creation13/04/2026 13:02:38
First validation21/04/2026 07:56:03
Update29/04/2026 12:37:48
Status update29/04/2026 12:37:48
Last indexation29/04/2026 12:37:49
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack