Potential for Cure by Stage across the Cancer Spectrum in the United States - Research and Findings

Sep 21, 2026

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The study assesses cure fraction—the long-term proportion of patients considered cured—across cancer stages while accounting for lead-time bias. Using a mixture cure model, cure fraction is estimated for 21 cancer types plus subtypes. Cause-specific survival for 2.4 million incident cancers is derived from 17 SEER registries for adults aged 40–84 diagnosed between 2006 and 2015, followed through 2020.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Impact

Introduction

Cure fraction definition

Rationale for stage-stratified analysis

Materials and Methods

Data source

Potential for Cure by Stage across the Cancer Spectrum in the United States Earl Hubbell1, Christina A. Clarke1, Karin E. Smedby2,3, Hans-Olov Adami4,5, and Ellen T. Chang1 ABSTRACT ◥ Background: Cure fraction—the proportion of persons considered cured of cancer after long-term follow-up—reﬂects the total impact of cancer control strategies, including screening, without lead-time bias. Previous studies have not reported stage-stratiﬁed cure fraction across the spectrum of cancer types. Methods: Using a mixture cure model, we estimated cure fraction across stages for 21 cancer types and additional subtypes. Cause-speciﬁc survival for 2.4 million incident cancers came from 17 US Surveillance, Epidemiology, and End Results registries for adults 40 to 84 years at diagnosis in 2006 to 2015, followed through 2020 . Results: Across cancer types, a substantial cure fraction was evident at early stages, followed by either a sharp drop from stages III to IV or a steady decline from stages I to IV. For example, estimated cure fractions for colorectal cancer at stages I, II, III, and IV were 62%(95% conﬁdence interval: 59%–66%), 61%(58%– 65%), 58% (57%–59%), and 7%(7%–7%), respectively. Corresponding estimates for gallbladder cancer were 50%(46%–54%), 24%(22%–27%), 22%(19%–25%), and 2%(2%–3%) . Differences in 5-year cause-speciﬁc survival between early-stage and stage IV cancers were highly correlated with between-stage differences in cure fraction, indicating that survival gaps by stage are persistent and not due to lead-time bias. Conclusions: A considerable fraction of cancer is amenable to cure at early stages, but not after metastasis. Impact: These results emphasize the potential for early detection of numerous cancers, including those with no current screening modalities, to reduce cancer death. Introduction Cancer can be a survivable disease, especially when detected at an early stage. Cancer survivors currently comprise approximately 5% of the entire population in several western nations (1–4), and the percentage is expected to increase substantially in the coming years due to population aging (5, 6), advances in early detection and treatment (7), reduction of competing risks such as cardiovascular mortality (8), and overdiagnosis of nonlethal cancer (9) . Cure fraction is deﬁned statistically as the proportion of diagnosed patients with cancer in a population who survive past the early peak in cancer-speciﬁc mortality to the point of attaining virtually the same risk of death as the age- and sex-matched general population with similar competing risks (10) . Statistically, cured patients are those who achieve stable long-term survival with minimal risk of mortality from their initial cancer. For cancer types for which long-term risk of cancer death does not reach zero, cure fraction can still characterize the proportion of patients with this asymptotic level of risk(11–13). When used to evaluate cancer screening, cure fraction has the advantage of avoiding lead-time bias by virtue of its basis on long-term mortality data, as opposed to survival duration. By providing a measure of the 1GRAIL, LLC, Menlo Park, California. 2Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 3Department of Hematology, Karolinska University Hospital, Stockholm, Sweden. 4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 5Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway. Corresponding Author: Earl Hubbell, Research & Development, GRAIL, LLC, Menlo Park, CA 94025 . E-mail: [ehubbell@grailbio.com](ehubbell@grailbio.com) [Cancer Epidemiol Biomarkers Prev 2024](Cancer Epidemiol Biomarkers Prev 2024);[33:206](33:206)–[14](14) [doi:](doi: 10.1158/1055-9965.EPI-23-1018)[ 10.1158/1055-9965.EPI-23-1018](doi: 10.1158/1055-9965.EPI-23-1018) This open access article is distr

FAQs

What is cure fraction and why is it important in cancer screening?

Cure fraction is the proportion of diagnosed patients who survive past the early peak in cancer-specific mortality to a level of risk similar to the general population with comparable competing risks. It helps avoid lead-time bias because it is based on long-term mortality rather than survival duration.

How were cure fraction estimates calculated across stages?

A mixture cure model estimated cure fraction by stage across 21 cancer types and additional subtypes. The analysis uses cause-specific survival data from SEER registries for adults diagnosed in 2006–2015 and followed through 2020.

What patterns of cure fraction were observed across cancer stages?

A substantial cure fraction was seen at early stages across cancer types, followed either by a sharp drop from stages III to IV or a steady decline from stages I to IV. Stage IV showed markedly lower estimated cure fractions for example colorectal and gallbladder cancers.

Sep 21, 2026

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