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Cancer survival is higher in Australia, Canada and Sweden, intermediate in Norway, and lower in Denmark and the UK. Differences between the countries in the proportion of patients diagnosed with the cancer at an early stage, suggest that differences in the period prior to diagnosis contribute to the international variation in cancer survival, along with other potential factors, such as access to treatment and the quality of treatments.

Public awareness of signs and symptoms, and beliefs about cancer, appear to be quite similar across jurisdictions and are therefore unlikely to account for much of the variation seen between countries. However, differences in perceived barriers to seeing the general practitioner (GP) have been reported. Differences in the way cancer symptoms are recognised and managed in primary care may contribute to the observed survival differences. For example, European intercountry differences in clinical diagnostic practice have been reported for gastrointestinal disorders. A stronger ‘gatekeeper’ role—whereby primary care physicians (PCPs) manage entry to specialist care and investigations—is also associated with worse cancer survival.

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