Cover Image


View/Hide Left Panel

States has a higher prevalence than Europe of the major adult diseases, including cancer, heart disease, and diabetes (Avendano et al., 2009; Thorpe, Howard and Galactionova, 2007a). But higher prevalence could reflect higher incidence, better detection, or longer survival resulting from more successful treatment. Because of these limitations of data and interpretation, our review focuses primarily on disease identification and treatment, elements that are customarily considered to be the provenance of health care systems.

A valuable but not unimpeachable indicator of the effectiveness of treatment is the comparative survival rate of individuals once a disease has been detected. Relatively high survival rates imply either that the disease has been detected unusually early or that treatment is unusually successful. Early detection is valuable to the extent that it permits better therapy. However, if early detection did not alter the clinical course of a disease but only increased the expected length of time from detection to death (socalled lead-time bias), then it would not be associated with reductions in mortality at the population level despite raising 5-year survival rates (e.g., Gatta et al., 2000).

Because they are not subject to this potential bias, we pay special attention to mortality rates. In particular, in the second half of the chapter we investigate comparative mortality trends for prostate cancer and breast cancer. We document that:

  • effective methods of screening for these diseases have been developed relatively recently;

  • these diagnostic methods have been deployed earlier and more widely in the United States than in most comparison countries;

  • effective methods are being used to treat these diseases; and

  • the United States has had a significantly faster decline in mortality from these diseases than comparison countries.


The United States does well in international comparisons of the frequency of cancer screening. The OECD (2006, 2007) provides 2000-2005 data on the percentage of women ages 20-69 in 15 countries who had been screened for cervical cancer during the preceding 3 years. The United States has the highest percentage of women who have been screened in both tabulations.1 We present evidence below that the United States also


Ages vary somewhat, but the variation is thought to be a “minor threat” to the validity of comparisons (Organisation for Economic Co-operation and Development, 2006, p. 69). The 15 countries include 6 for whom the recall period is greater than 3 years, the period used in the United States.

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement