The validity of the mortality to incidence ratio as a proxy for site-specific cancer survival

Eur J Public Health. 2011 Oct;21(5):573-7. doi: 10.1093/eurpub/ckq120. Epub 2010 Sep 2.


Background: The complement of the cancer mortality to incidence ratio [1-(M/I)] has been suggested as a valid proxy for 5-year relative survival. Whether this suggestion holds true for all types of cancer has not yet been adequately evaluated.

Methods: We used publicly available databases of cancer incidence, cancer mortality and relative survival to correlate relative survival estimates and 1-(M/I) estimates from Denmark, Finland, Iceland, Norway, Sweden, the USA and the Netherlands. We visually examined for which tumour sites 5-year relative survival cannot simply be predicted by the 1-(M/I) and evaluated similarities between countries.

Results: Country-specific linear regression analyses show that there is no systematic bias in predicting 5-year relative survival by 1-(M/I) in five countries. There is a small but significant systematic underestimation of survival from prognostically poor tumour sites in two countries. Furthermore, the 1-(M/I) overestimates survival from oral cavity and liver cancer with >10% in at least two of the seven countries. By contrast, the proxy underestimates survival from soft tissue, bone, breast, prostate and oesophageal cancer, multiple myeloma and leukaemia with >10% in at least two of the seven countries.

Conclusion: The 1-(M/I) is a good approximation of the 5-year relative survival for most but not all tumour sites.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Cause of Death
  • Databases, Factual
  • Europe / epidemiology
  • Health Services Research
  • Humans
  • Incidence
  • Neoplasms / mortality*
  • Registries
  • Regression Analysis
  • Reproducibility of Results
  • Survival Rate
  • United States / epidemiology