Transcript Cancer in the UK

Cancer talk for HAZ
• Basic descriptive epidemiology
- concepts
- information on patterns
• Policy Context (inequalities)
• Problems faced (determinants & solutions)
What is cancer?
• Different types of malignant neoplasm
(tumour, neoplasm, new growth)
• Strictly speaking applies only to organs with
an epithelial surface
• Often understood to include luekaemia,
melanoma, lymphoma, sarcoma of bone,
brain tissue
Cancer in the UK
• Major public health problem
• Will afflict 1 in 3 before 75th birthday
• 250,000 new cases each year
• 140,000 deaths each year (25% of all deaths)
Cancer Survival
• Reduce mortality by either
• Preventing new cases from occurring
• Increasing chances of survival once diagnosed
• Contrary to popular belief survival is not a
lottery
• Inequalities in incidence, diagnosis and
treatment and survival/outcome exist
National Policy - OHN
• Improve health and reduce health gap
• Reduce mortality from cancer in persons
under 75 by at least 20% by year 2010
(saving 100,000 lives in total??)
• will largely be achieved by the cumulative effect
of a range of interventions, each targeting a
specific cancer type (see later).
Cancer Epidemiology
• What factors influence risk
–
–
–
–
–
Age (after childhood increase with age)
Sex
Affluence/deprivation -> wider determinants
Geography
Lifestyles
• How do we measure impact
– Incidence of cancer and death from cancer over time
– Survival (usually at 5 years – Not ‘Cure Rate’)
Determinants of Health
Age specific Death rates for All cancers (1996-1998 pooled) in North Staffs
10000
2560
1360
1310
731
1000
Rate
196 163
Males
100
Females
9
10
10
6
3
3
2
1
1-4
5-14
15-34
35-64
Age Group
65-74
75+
Incidence of lung cancer
Indirectly standardised ratios (SRRs) - significance levels
for females (all ages), 1991 to 1993
Greater Manchester
West Midlands
Metropolitan County
Greater London
Significance and percentile distribution
(No. of HAs)
Sig.low & in lowest tenth
(10)
Sig.low & not in lowest tenth (24)
Not sig.low & in lowest tenth (0)
Others
(37)
Not sig.high & in highest tenth (0)
Sig.high & not in highest tenth(18)
Sig.high & in highest tenth (10)
Incidence of breast cancer
Indirectly standardised ratios (SRRs) - significance levels
(all ages), 1991 to 1993
Greater Manchester
West Midlands
Metropolitan County
Greater London
Significance and percentile distribution
(No. of HAs)
Sig.low & in lowest tenth
(10)
Sig.low & not in lowest tenth (14)
Not sig.low & in lowest tenth (0)
Others
(61)
Not sig.high & in highest tenth (0)
Sig.high & not in highest tenth (4)
Sig.high & in highest tenth (10)
Deaths attributable to smoking (1996-2000)
Area of deprivation based on Townsend Index at ED level
25
20
15
10
Most Deprived
Band 2
Band 3
Percentage of all deaths attributable to smoking
Least Deprived
All cancers All ages (1996-2000)
Mortality by sex and level of deprivation
350
Male
300
Cancer Mortality
250
200
Female
150
100
50
0
Band 1 - Most
Deprived
Band 2
Band 3
Band 4 - Most
Affluent
Band 1 - Most
Deprived
Townsend Deprivation Band
Band 2
Band 3
Band 4 - Most
Affluent
Breast vs Lung Cancer
Breast
• Most common cancer in
women (20%)
• 5yr Survival 20%-80%
depending on stage,
deprivation, age…
• Survival has improved but
significant inequalities
exist
• North Staffs 5yr survival
worst in country
Lung
• Most common cancer
in men (25%), 3rd in
women (11%)
• Poor survival at 5
years (6%)
• Smaller deprivation
effect on survival
200
160
140
120
England & Wales
100
West Midlands
80
North Staffordshire
60
N Staffs Projection (1999-2010)
40
Our Healthier Nation Target
20
Year
20
10
20
09
20
08
20
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
19
99
19
98
19
97
19
96
19
95
19
94
19
93
19
92
19
91
19
90
0
19
89
Mortality Rate per 100,000 persons
180
Incidence of Breast Cancer - 1984-1993
120
Standardised registration rate
100
80
ENGLAND AND WALES
WEST MIDLANDS
North Staffordshire
60
40
20
0
1984
1985
1986
1987
1988
1989
Year
1990
1991
1992
1993
Incidence of breast cancer
Indirectly standardised ratios (SRRs) - significance levels
(all ages), 1991 to 1993
Greater Manchester
West Midlands
Metropolitan County
Greater London
Significance and percentile distribution
(No. of HAs)
Sig.low & in lowest tenth
(10)
Sig.low & not in lowest tenth (14)
Not sig.low & in lowest tenth (0)
Others
(61)
Not sig.high & in highest tenth (0)
Sig.high & not in highest tenth (4)
Sig.high & in highest tenth (10)
Breast screening uptake rates for
GP practices called to Hanley BSC
(Only practices with 100 or more invites)
100
90
80
% Uptake
70
60
50
40
30
20
10
0
GP practices
BREAST SCREENING UPTAKE RATES BY GP PRACTICE WITH 100 OR MORE INVITES
FOR THE THREE YEARS PREVIOUS TO DECEMBER 1997
Breast Screening Uptake Rates by GP Practice
(Only includes GP practices with more than 100 invites)
70 to 100 (76)
0 to 70 (11)
Townsend Score by Ward
3 to 6.9
-0.3 to 3
-2.5 to -0.3
-6.2 to -2.5
(18)
(16)
(19)
(18)
Hanley Breast Screening Centre
Source: Exeter database (uptake rates)
1991 Census (deprivation scores)
Public Health Dept. Sept 1998
GP PRACTICES WITH BREAST SCREENING UPTAKE RATES BELOW 70% (AND >=100 INVITES) BY DEPRIVATION
Butt Lane Kidsgrove
Townsend Score by Ward
Brown Edge
3 to 6.9
-0.3 to 3
-2.5 to -0.3
-6.2 to -2.5
Chell
Talke
Tunstall North
Norton and Bradeley
Endon and Stanley
(18)
(16)
(19)
(18)
Audley and Bignall End
Burslem Central
Porthill
Chesterton
Bradwell
Halmerend
Burslem Grange
Holditch
Wolstanton
May Bank
Silverdale
East Valley
Abbey
Shelton
Cross Heath
Thistleberry
Berryhill
Werrington
Brookhouse
Source:
Exeter database (uptake rates)
1991 Census (deprivation scores)
Hartshill
Westlands Stoke West
Clayton
Seabridge
Hanley Breast
Screening Centre
Hanley Green
Town
Keele
Wetley Rocks
Fenton Green
Weston
Public Health Dept. Sept 1998
Great Fenton
Longton South
Trentham Park Blurton
GP Practices below 70%
breast screening uptake
with at least 100 invites
Meir Park
Forsbrook
Lung cancer mortality in men & women 1989-1998
90
England & Wales
80
North Staffordshire
Directly Age-Standardised Mortality Rate
(per 100,000 persons)
70
Males
60
50
40
30
Fem ales
20
10
0
1989
1990
1991
1992
1993
1994
Year
1995
1996
1997
1998
Lung Cancer – What is the problem?
• 85%+ deaths from Ca Lung due to smoking
• By 2011 as many women as men diagnosed
with Ca lung (5-year survival 6%)
• Cohort Effect – reduction in smoking rates
have been slower in women
• Need to target smoking cessation
programmes particularly at women in
deprived areas?
Cancer Epidemiology
TABLE 1 – CANCER DEATHS IN 1996 FOR COMMONER SITES BY
GENDER AND AGE
MALE
FEMALE
L64
65-74
Total
L65
65-74
Total
Oesophagus
917
1410
4241
(339)
(562)
(2268)
Stomach
917
1470
4241
(341)
(552)
(2515)
Colorectal
1947
2556
7820
1595
1595
9474
Pancreas
810
919
2826
527
827
3022
Lung
4542
7563
19777
2377
4159
11033
Breast
4463
2780
12179
Cervix
655
270
1315
Ovary
1516
1244
4060
Prostate
616
2359
8742
Bladder
447
946
3101
(147)
(339)
(1501)
Brain
875
440
1531
603
339
1201
NHL
825
580
2062
495
478
1864
Leukaemia
575
522
1861
432
351
1603
All Maligs
17470
23663
71538
16337
17924
65921
Total of 1 to 10
12594
72.1%
18585
78.5%
55528
77.6%
12663
77.5%
12789
71.3%
45751
69.4%
• 75% of all deaths from
cancer caused by top 10
• Action should be focused
on these causes
• A 20% overall reduction
can be achieved by
specific ‘interventions’
• Two thirds of this
reduction will come from
primary prevention
How do we reduce the impact of Cancer
Possibilities for Reduction in Cancer Mortality under age 65 by 2010
Primary Prevention
Type of Cancer
% Reduction in mortality if target
is achieved (in both sexes
combined unless stated otherwise)
15% in male
5% in female
% Reduction in total cancer
mortality
50% in male
negligible in female
1%
Increase in fruit and vegetable
consumption
30% in both sexes
1%
Stomach
Increase in fruit and vegetable
consumption
30%
1%
Colorectal
Increase in fruit and vegetables
consumption, increase in dietary
fibre
Tobacco smoking reduction
20%
2%
15%
0.5%
Tobacco smoking reduction
30%
6%
Oesophageal
Intervention
Tobacco smoking reduction
Reduction in prevalence of heavy
alcohol consumption
Pancreas
Lung
Breast
Cervix
0.3%
Cont ……………………….2
1.
2.
3.
4.
5.
6
7
8.
Reduction in tobacco consumption
Improvement in provision of treatment services
Increase in fruit and vegetable consumption
Breast screening, with incremental improvement
in quality
Reduction in heavy alcohol consumption
Cervical screening, with incremental
improvements in quality
Colorectal screening, phased introduction of
new modalities
Reduction in domestic radon levels
7.3%
4.0%
4%
2%
1%
1%
0.5%
0.2%
TOTAL
20.3%
(Source: Nick Day)
For all the intervention targets listed above, the present
situation is less favourable for the more deprived sections of
the population
How do we reduce the impact of Cancer
Type of Cancer
Intervention
% Reduction in mortality if target
is achieved (in both sexes
combined unless stated otherwise)
% Reduction in total cancer
mortality
Tobacco smoking reduction
15%
0.5%
Ovary
Prostate
Bladder
Brain
Non Hodgkin’s Lymphoma
Leukaemia
12.5%
Total
How do we reduce the impact of Cancer
Possibilities for Reduction in Cancer Mortality under age 65 by 2010
Secondary Prevention and Screening
Type of Cancer
Oesophagus
Stomach
Colorectal
Pancreas
Lung
Breast
Cervix
Intervention
Phased Introduction of FOBT
Screening
National Screening Programme
Incremental improvements in
quality
National Screening Programme
Incremental improvements in
quality
% Reduction in mortality if target
is achieved
Reduction in total cancer
mortality
5%
0.5%
15% (female only)
2%
50% (female only
1%
Ovary
Prostrate
Bladder
Brain
Non Hodgkin’s Lymphoma
Total
5
4%
How do we reduce the impact of Cancer
Table 4c
Possibilities for Reduction in Cancer Mortality under age 65 by 2010
Improvements in Treatment and Services
Type of Cancer
Oesophagus
Stomach
Colorectal
Pancreas
Lung
Breast
Cervix
Ovary Prostate
Bladder
Brain
Non Hodgkin’s Lymphoma
Leukaemia
Total
Intervention
% Reduction in mortality if target
is achieved
%reduction in
Total Cancer Mortality
Improved provision of cancer
treatment services
10%
1%
Improved provision of cancer
treatment Services
“
“
“
“
Improved provision of cancer
treatment services
“
10%
1.3%
“
“
“
“
“
0.2%
0.5%
0.2%
0.2%
0.2%
“
0.2%
3.8%
Summary
• Cancer is many different diseases grouped
together
• Different Causal/Risk factors
• Different Treatments/Solutions
• Requires a focus on prevention/screening
• Inequalities are significant