Trying to understand statistics, especially when we are trying to make decisions about treatment choices, is very hard. We know that statistics are never an absolute predictor of what will happen to one individual. Instead, they are information gained from observation of a large pool of people in similar circumstances. The truth for each of us is that our cancer experience will be either 0% or 100%--no one's cancer recurs at 78%. We stay well or we don't; that is the bottom line.
But we often read and talk and obsess over these numbers. Should I do treatment X that will lower my recurrence risk by 5% or can I live with doing (easier) treatment Y which lowers the risk by 3%? Many sleepless nights have been spent in these calculations.
This is an excellent explanation from ASCO's Cancer Net about statistics:
Understanding Statistics Used to Guide Prognosis and Evaluate
Last Updated: June 25, 2010
This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/10
Survival statistics can help estimate a patient's prognosis (chance of recovery) and determine the treatment options.
Survival statistics are different based on the type of cancer, the stage, a patient's age, and length of time after diagnosis. Although statistics can provide an estimate of survival, they are based on large groups of patients and cannot tell a person exactly how long he or she will live after a cancer diagnosis. When people are diagnosed with cancer, one of the first things they may want to know is their chance of survival and recovery. Understanding survival statistics becomes extremely important, yet it can also be confusing. Read below to learn more about how survival statistics can be used to estimate a patient's prognosis and determine the treatment options.
Estimating how long people live after a cancer diagnosis
Survival statistics, usually given as rates, describe the percentage of people with a certain stage and/or type of cancer who will be alive a certain time after the cancer is detected. Survival rates can be given for any length of time. Cancer statistics are usually given as a five-year relative survival rate; this describes the percentage of people with cancer who will be alive five years after diagnosis (NOTE FROM HESTER: ALTHOUGH STATISTICS USE THE 5 YEAR MARK, REMEMBER THAT 5 YEARS HAS NO PARTICULAR MAGIC OR RELEVANCE FOR BREAST CANCER. ALTHOUGH MOST RECURRENCES HAPPEN IN THE EARLY YEARS AFTER DIAGNOSIS, BREAST CANCER CAN RECUR ANY TIME, EVEN YEARS AND YEARS LATER.), excluding those who die from other diseases.
Example: The five-year relative survival rate for cervical cancer is around 71%, which means that about 71% of women with cervical cancer will still be living five years after diagnosis.
Survival statistics are usually calculated for specific cancer stages (the stage is an indication of the size of the tumor, and whether and how far the cancer has spread) as survival statistics can vary by stage.
Example: The five-year relative survival rate for early-stage bladder cancer is 74%. If, however, the cancer is diagnosed at a later stage, the five-year relative survival rate is 6%.
Survival statistics for all stages of a cancer combined are referred to as an overall rate, such as the overall five-year relative survival rate for all prostate cancer cases, which, regardless of stage, is nearly 100%.
Calculating how many people are cancer free or have cancer that is not growing or spreading
Five-year relative survival rates include all people who are alive five years after a cancer diagnosis, including those who are in remission (temporary or permanent absence of disease) or still being treated.
Disease-free survival (sometimes abbreviated as DFS) statistics and progression-free survival statistics (sometimes abbreviated as PFS) are more specific survival statistics that are often used when evaluating cancer treatments.
Disease-free survival rates refer only to the percentage of people who experience a complete remission ( NOTE FROM HESTER: "REMISSION" IS RARELY USED IN DISCUSSIONS OF BREAST CANCER. INSTEAD, DOCTORS MAY TELL YOU THAT EVERYTHING LOOKS FINE, OR THAT THERE IS NO SIGN OF THE CANCER, OF THAT YOU ARE "NED" (NO EVIDENCE OF DISEASE) ).after finishing treatment.
Progression-free survival rates describe the percentage of people who do not experience any new tumor growth or cancer spread during or after treatment, including those whose disease has either completely or partially responded to treatment, or those whose disease is stable (the cancer is still present but not growing or spreading).
The concept of "cure"
In medicine, a disease is considered cured when it's been successfully treated and does not return. The concept of "cure" is difficult to apply to cancer because undetected cancer cells can sometimes remain in the body after treatment, causing the cancer to return later (referred to as a recurrence or relapse). Many cancers are considered "cured" when there is no cancer detected five years after diagnosis. However, recurrence after five years is still possible.
Among the first questions often asked when a person is diagnosed with cancer is whether the cancer can be treated successfully. This is called a prognosis—the likely course and outcome of the cancer and the chances of recovery. Doctors use survival statistics to make predictions about prognosis.
Example: A man diagnosed with testicular cancer may be said to have a favorable prognosis, as the overall five-year relative survival rate for testicular cancer is 95%.
Similar to survival statistics, prognosis also depends on the stage of the cancer at diagnosis—how early the cancer is detected and if or how far it has spread.
Example: If detected early, the five-year relative survival rate for colorectal cancer is 91%. For advanced stage colorectal cancer that has spread to distant parts of the body, the five-year relative survival rate is about 11%.
Points to remember
Statistics are estimates that describe trends in large numbers of people. Statistics cannot be used to predict what will actually happen to an individual.
Survival statistics for different cancer types, stages of cancer, age groups, or time periods can vary dramatically. People are encouraged to ask their doctor for the most appropriate statistics based on their individual medical condition.
As with any medical information, ask your doctor for clarification if cancer-related statistics seem unclear.
Evaluating treatment options
Five-year relative survival rates are commonly used as a way to evaluate and compare different treatment options. Although someone who has survived five years after a cancer diagnosis is not necessarily "cured," the five-year relative survival statistic is considered a good indication that the cancer is responding to treatment and that the treatment is successfully extending the life of the individual with cancer. Survival statistics help doctors determine which treatments provide the most benefit to people with cancer, and whether the benefits outweigh any risks (such as unpleasant side effects) associated with
the treatment. Learn about making decisions about cancer treatment.
Points to remember
Because five-year survival statistics are based on patients who were treated at least five years ago, they may not reflect the most recent advances in treatment.
Although survival statistics provide useful information when deciding among treatment options, they should be used as only one factor in a comprehensive treatment plan designed by a doctor who is familiar with a person's individual situation.