Transcript Slide 1

Cancer Intelligence
Cancer screening & early diagnosis
24th July 2014
Postgraduate Centre, RSCH
Current population profile
• Relative to England
(dark outlines),
Guildford and Waverley
CCG has:
– Fewer children aged 0-4
– More young people aged 1019
– Fewer young adults aged
25-34
– Slightly more older adults
45-64
– More adults 75+
Population projections (65yrs)
• 19.7% of the
population of Guildford
and Waverley CCG is
projected to be over
the age of 65 by 2020
• 3.7% of the population
of Guildford and
Waverley CCG is
projected to be over
the age of 85 by 2020
20.5%
20.0%
19.5%
19.0%
18.5%
18.0%
17.5%
17.0%
16.5%
16.0%
15.5%
2013 2014 2015 2016 2017 2018 2019 2020 2021
Guildford and Waverley CCG
Surrey
England
Life expectancy at birth by ward
Specific groups in Guildford and
Waverley CCG
•
Specific groups requiring a targeted approach in Guildford and Waverley
CCG include:
– Carers: more than 18,700 people of all ages provide unpaid care; more than 1,300
are over 65 providing >20 hours a week
– Older people: the need to maintain healthy life expectancy as population ages and
good management of long term conditions.
– Gypsy, Roma and Traveller community: Surrey has the 4 th largest GRT community in
the country. Guildford and Waverley CCG has around 14 authorised GRT sites
– Armed service personnel and veterans: large number of army personnel and family at
Pirbright, Deepcut and Keogh barracks and veterans and reservists in the local area,
with particular health needs
– Offenders serving community sentences, those on probation and ex-offenders that
remain in the community may remain hard to reach.
Most prevalent conditions –
Guildford and Waverley CCG:
QOF 2012-13
5,000
10,000
Number
15,000
Hypertension
12,721
Obesity (ages 16+)
11,290
Depression (ages 18+)
9,133
Diabetes Mellitus (ages 17+)
7,519
Hypothyroidism
7,326
Chronic Kidney Disease (CKD) (ages
18+)
6,720
Coronary Heart Disease (CHD)
Atrial Fibrillation (AF)
25,000
30,000
27,072
Asthma
Cancer
20,000
5,728
5,052
3,651
Cancer in context
Deaths - All Ages
Other
Mental
Health
Respirat
ory
disease
Cardiovascular
Cancer
Deaths - Under 75s
Mental
Health
Respirat
ory
disease
Other
Cardiovascular
Cancer
• 28% of all deaths in CCG caused by cancer
• 46% of deaths in under 75s due to cancer
Cancer Prevalence by CCG
CCG Name
NHS EAST SURREY
CCG
NHS GUILDFORD
AND WAVERLEY
CCG
NHS NORTH
WEST SURREY
CCG
NHS SURREY
DOWNS CCG
NHS SURREY
HEATH CCG
NHS NORTH EAST
HAMPSHIRE AND
FARNHAM CCG
Number of
Practices
Sum of List Sizes
Sum of Cancer
Register
Cancer
Prevalence (%)
18
172,367
3,619
2.1
21
216,037
5,052
2.3
43
353,222
7,021
2.0
33
293,020
6,516
2.2
9
91,427
1,974
2.2
24
218,868
3,987
1.8
Source: Quality and Outcomes Framework (QOF), 2012/13
Lung cancer
Incidence:
• 2010 data shows that Surrey has lower incidence than
the South East and England.
• Similar to the trend nationally lung cancer incidence is
declining in Men and increasing in Women across Surrey
• Both Guildford and Waverley are lower than Surrey
average with higher incidence in men then women.
Mortality:
• Higher in men than in women but rates have risen by 73%
in women over the last 40 years (cancer research UK)
• Surrey is below both the England and South East average
• Waverley has the lowest mortality rate within Surrey from
lung cancer
Breast cancer
Incidence:
• Historically higher in Surrey than South East and England
• Higher in Guildford than Waverley and Guildford higher
than Surrey average.
Mortality:
• Surrey is similar to England and South East average
• The mortality rate for women with breast cancer in
Guildford and Waverley CCG is 22.62/100,000
population.(2009/11)
• Guildford has a similar rate of death from breast cancer
compared to the Surrey average.
Bowel cancer
Incidence:
• Surrey is similar to both the South East and England
rates
• No clear difference between Guildford and Waverley in
terms of new bowel cancer cases.
Mortality:
• Surrey lower mortality rate for 2010/12 compared to the
South East and England.
• Mortality rate in Guildford and Waverley is lower or similar
to the Surrey average and there is similar mortality rate
from bowel cancer in men across the two boroughs.
Malignant Melanoma
Incidence
• Nationally skin cancer has been increasing from 1993 through
to 2011
• Higher in Surrey than the England and the South East rates
• In Surrey the rate of new cases is higher in women than men
• Slightly higher rate in Waverley then Guildford.
Mortality
• Higher for men and women in Surrey compared to Nationally.
• Similar picture at borough level where death from skin cancer
is higher in men then women in both boroughs.
Liver cancer
•
•
•
Liver cancer incidence in England has increased by 70%
for males and 60% for females from 2003 to 2012.
It has been estimated that 1.3% of all new cancer cases
in Guildford and Waverley were for liver cancer. The rate
of which is slightly higher in Waverley than Guildford.
Approximately 2.6% of all cancer deaths in Guildford and
Waverley were due to liver cancer.
Awareness and early
Diagnosis
Guildford and Waverley
2009/10
2010/11
2011/12
2012/13
Two week wait referrals
(number per 100,000
population)
1534
1739
1455
1554
Emergency admissions with
all cancer
631
577
510
434
Two week wait referrals with
cancer (breast cancer)
303
351
299
283
Two week wait referrals with
cancer (lower GI cancer)
273
290
239
288
Two week wait referrals with
cancer (lung cancer)
53
66
45
53
Two week wait referrals with
cancer (skin cancer)
307
362
286
335
Source : Strategic Clinical Network cancer dashboard
Routes to diagnosis
breast: ASR - 2006-10
80
70
60
50
40
30
20
10
Guildford &
CCG 1
Waverley
Other
Emergency
Managed
Screen
0
ENG
Routes to diagnosis
colorectal: ASR - 2006-10
35
30
25
20
15
10
5
Other
Emergency
Managed
Screen
0
Guildford &
CCG 1
Waverley
ENG
Routes to diagnosis
lung: ASR - 2006-10
30
25
20
15
10
5
Other
Emergency
Managed
Screen
0
Guildford &
Waverley
CCG 1
ENG
Screening programmes
Screening uptake - 2012-13
80%
70%
60%
50%
40%
30%
20%
10%
Breast
Cervical
Bowel
0%
Guildford &
Waverley
CCG 1
ENG
Lifestyle Choices
It is estimated that half of all cancers could be
prevented by positive lifestyle choices. These
measures include
•
•
•
•
Not smoking
Reducing alcohol intake
Maintaining a healthy body weight
Eating a healthy and balanced diet high in fruit and
vegetables
• Keeping active
• Safe sun exposure
APHR: Smoking in G&W
APHR: Alcohol in G&W
APHR: Healthy weight in G&W
What stands out for G&W
-
-
-
Nearly half of all deaths under 75 years of age are due to cancer
G&W has the highest proportion of cancer cases on register by list
size
Higher incidence of skin cancer in Surrey, especially in Women.
Higher mortality from skin cancer in Surrey, for men and this is
similar at the borough level.
Higher incidence of breast cancer in Guildford compared to Surrey
Similar incidence trend in lung cancer to that seen nationally with
decrease in men and increase in women.
Lung cancer mortality is lowest in Waverley although has highest
smoking prevalence
Lowest 2 week wait referral numbers out of all Surrey CCGs.
Nearly a fifth of adults are obese.
More than a third of adults are not physically active enough.
Be Clear on Cancer & other
PH campaigns
• C4L – summer –
physical activity
• Sept/Oct - Stoptober
• Nov – BCOC
Oesophageal &
gastric /Ovarian
Cancer (TBC)
• New Year – C4L
• February 2015 –
BCOC ovarian
cancer