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Cancer

Introduction

Cancer is the most common cause of premature death in Reading and disproportionately affects socio-economically deprived populations. A considerable proportion of cancer cases are related to lifestyle, especially smoking. Rates of cancer incidence and mortality from cancer are similar to the England and South-East averages, but incidence rates are considerable and increasing nationally.

What do we know?

A cancer is an abnormal growth in otherwise normal tissue. Cells that in usual circumstances divide to replace old or damaged cells, divide in an uncontrolled way. Both primary and secondary cancer growths (those in the place in the body where a cancer starts and those in places in the body into which that cancer then spreads) impede and inhibit body functions, often leading to serious weakness and death (Cancer Research, 2016a; NHS Choices, 2016).

296,863 cancers were registered in the UK in 2014, equivalent to 813 registrations a day, with breast (15.6%), prostate (13.4%), lung (12.6%) and colorectal (11.5%) cancers accounting for more than half of all registrations. There were slightly more registrations amongst men than women (ONS, 2016). Incidence of cancers increases with age (figure 1), with rates per 100,000 population increasing steadily from the 55-59 age group until the group aged 85-89.

An estimated 42% of cancer cases are linked to lifestyle and environmental factors (Cancer Research, 2016c), including some 64,500 cases a year (19% of all cancer cases) linked to smoking.

Figure 1: Average number of new cases per year and incidence rates per 100,000 (all cancers excluding non-melanoma skin cancer)

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Source: Cancer Research UK

Incidence of all cancers is higher amongst the most deprived socio-economic groups than the least deprived; the European age-standardised incidence rate in England for 2006-2010 was 432.1 for the most deprived, compared to 366.3 for the least deprived (Cancer Research, 2016b). The difference in incidence between the most and least deprived is more pronounced for certain types of cancer. Cancers of the larynx and lung - strongly linked with smoking and alcohol use (see Chan et al, 2015) - show the largest percentage deprivation gaps (Figure 2).

Figure 2: Percentage Deprivation Gap in European Age-Standardised Incidence Rates, statistically significant cancers, males (left) and females (right) 2006-2010

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Source: Cancer Research UK (Acronyms: CUP= Cancer of Unknown Primary, AML = Acute Myeloid Leukaemia, ALL =Acute Lymphoblastic Leukaemia, NHL = Non-Hodgkin Lymphoma)

Cancer incidence rates in South Reading CCG (597.1 per 100,000) and North & West Reading CCG (571.6 per 100,000) are similar to or lower than the England average of (606.7 per 100,000) (NCIN Cancer Data, 2015).

Cancers are the most common cause of premature death in Reading (PHE, 2015), responsible for 142 deaths in every 100,000 people aged under 75 in Reading.The under 75 mortality rate from cancer reported in the Public Health Outcome Framework (PHOF) is similar to the England average and the rate of premature deaths from cancers in Reading is ranked 72nd out of 150 local authorities and can therefore be considered similar to the national picture.

The incidence rate in Reading has varied over the last twenty years, but is not significantly different to the national or regional averages and is increasing in Reading, as elsewhere. Locally, prevalence of cancer cases is lower than elsewhere in Berkshire (Figures 3 and 4), which is likely to be linked to the younger age profile of Reading's population compared to its neighbours. However, one year cancer survival in Reading appears to be slightly lower than the England average (Cancer Research, 2016c) suggesting that diagnosis may occur later than elsewhere.

Figure 3: Cancer incidence per 100,000 standardised population - all cancers

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Source: NHS Indicator Portal

Figure 4: Cancer prevalence - Quality and Outcomes Framework (QOF) for April 2014 - March 2015, England

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Source: Health and Social Information Centre

As elsewhere, rates of premature mortality from cancer tend to be more pronounced amongst the more deprived populations within Reading. Rates are highest in three of the wards that include very high areas of deprivation (see Figure 5); Abbey (around the town centre, this area is particularly affected by poor living environment and high crime); Norcot (the Dee Road area is particularly affected by deprivation related to income and employment); and Whitley (the most deprived ward in Reading, particularly affected by income, employment, and education deprivation). Patterns of deprivation in Reading are complex (See Deprivation by Ward and LSOA section), but there is a clear relationship in rates of premature mortality from cancer between the most and least deprived in Reading (see Figure 6). Screening for breast, bowel and cervical cancers is lower than average in Reading, suggesting that more could be done to prevent harm from cancer, especially in areas with high deprivation, or where smoking and alcohol use are known to be higher (PHE, 2016, Cancer Research, 2016d).

Figure 5: Premature Mortality Rate (aged under 75) From All Cancers

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Source: Primary Care Mortality Database

Figure 6: Premature Mortality Rate per 100,000 from All Cancers - Reading deprivation quintiles (based on 2015 ward deprivation- 5 is most deprived)

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Source: Primary Care Mortality Database

What is this telling us?

While the chances of being diagnosed with cancer or dying from cancer in Reading are similar to elsewhere in England, cancers are still the most common cause of premature deaths in Reading. Rates of incidences of cancers and mortality from cancers are increasing and cancer incidence increases with age and those from more deprived socio-economic groups. Screening for cancers in Reading appears to be lower than the England average, suggesting that more could be done locally to prevent harm from cancer.

What are the key inequalities?

As described above, cancers are more likely to affect those from the most deprived socio-economic groups, especially those cancers linked to smoking and alcohol use.

What are the unmet needs/ service gaps?

Increased screening and prevention services (widespread smoking cessation and alcohol screening and brief intervention).

This section links to the following sections in the JSNA:

Deprivation by Ward and Lower Super Output Area

Common causes of death & disability

Smoking

Drugs & Alcohol

References

Cancer Research. What is Cancer? Available at: http://www.cancerresearchuk.org/about-cancer/what-is-cancer [Accessed 10th March 2016a]

Cancer Research. Cancer Incidence by Socio-Economic Group for All Cancers Combined. Available at: http://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/socio-economic-group  [Accessed 14th March 2016b].

Cancer Research. Local Cancer Statistics. http://www.cancerresearchuk.org/cancer-info/cancerstats/local-cancer-statistics/  [Accessed 15th March 2016c].

Cancer Research. Statistics on Preventable Cancers. Available at: http://www.cancerresearchuk.org/health-professional/cancer-statistics/risk/preventable-cancers  [Accessed 15th March 2016d].

Chan,KKW, Glennie, A, Weldon, JC, Furness, S, Worthington, HV, and Wakeford, H. (2015). Interventions for the treatment of oral and oropharyngeal cancers: targeted therapy and immunotherapy. Cochrane Database of Systematic Reviews, Issue 12, Art no.CD010341, DOI 10.1002/14651858.CD010341.pub2.  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010341.pub2/full

NHS Choices. Cancer - Information and Useful Links. Available at:  http://www.nhs.uk/Conditions/Cancer/Pages/Introduction.aspx [Accessed 10th March 2016].

Office for National Statistics (ONS). (2016). Cancer Registration Statistics, England: First release, 2014.ONS, London.

Public Health England. Longer Lives. Available at: http://healthierlives.phe.org.uk/topic/mortality (Accessed 18th December 2015)

Public Health England. Public Health Outcomes Framework. (Accessed 15th March 2016).

    

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