Cancer

Introduction

Cancer is a condition where cells in the body grow and reproduce uncontrollably. These cells can invade and destroy surrounding healthy tissues.

There are over 200 types of cancer. The four most common types in the UK are: breast cancer, lung cancer, prostate cancer, and bowel cancer. These account for 53% of all new cases of cancer.  Thyroid cancer has shown the fastest increase in incidence in both males and females over the past decade in the UK and liver, oral, and kidney cancers, and malignant melanoma have also increased markedly over the past decade.

One in two people born after 1960 in the UK will be diagnosed with some form of cancer during their lifetime although 42% of cancer cases in the UK each year are linked to lifestyle factors and could be preventable. Cancer causes more than one in four of all deaths in the UK.

Early stage diagnosis is one of the most important factors that affect cancer outcomes and patients with cancers that present as an emergency suffer significantly worse outcomes.  Promoting earlier stage at diagnosis is one of the key aims of the National Awareness and Early Diagnosis Initiative led by The Department of Health, Cancer Research UK, and Public Health England.

Key inequalities and risk factors

Cancer Research UK (accessed 27 May 2016) states 4 in 10 (42%) of cancer cases in the UK each year are linked to lifestyle factors.  They outline the following lifetstyle risk factors for preventable cancers:

• Smoking – is the largest single cause of cancer in the UK, linked to an estimated 19% of cancer cases in the UK each year. Lung cancer has the highest proportion of smoking-linked cases
• Diet – (too little fruit, vegetables and fibre; too much red and processed meat and salt) is linked to an estimated 9% of cancer cases in the UK each year. Upper aero-digestive tract cancers (oral cavity and pharynx, oesophageal, and larynx) have the highest proportion of diet-linked cases
• Overweight and obesity – is linked to an estimated 5% of cancer cases in the UK each year. Uterine, kidney and oesophageal cancers have the highest proportions of bodyweight-linked cases
• Alcohol – is linked to an estimated 4% of cancer cases in the UK each year. Upper aero-digestive tract cancers (oral cavity and pharynx, larynx, and oesophageal) have the highest proportion of alcohol-linked cases
• Medical history and treatment – Certain medical conditions or immune system problems, and some medicines or treatments, may relate to higher risk of some cancer types

Cervical, mesothelioma, oral, larynx, oesophageal and lung cancers have the highest proportions of cases linked to lifestyle factors. Prostate and testicular cancers have no established lifestyle factor links.

In terms of awareness of preventation and lifestyle risk factors, men were less aware than women and people from BME groups were less aware than people in white categories.

Statistics show that some groups are more vulnerable than others

• Age – Half (50%) of all cancer cases in the UK each year are diagnosed in people aged 70 and over (2011-2013). Since the late 1970s, incidence rates for all cancers have increased for all the broad age groups in Great Britain. The increase is largest in people aged 0-24 where rates have increased by more than two-fifths (43%), and smallest in people aged 50-74 where rates have increased by more than a quarter (29%)
• Ethnicity – Cancer is more common in white and black males than in Asian males and more common in white females than in Black or Asian females
• Gender – For lung and oesophageal cancers, and leukaemia, the incidence trend differs between the sexes

The Cancer and Health inequalities report (Cancer UK, 2006) gives an in depth assessment of health inequalities across a range of cancer types and populations.  Key highlights include:

• People with learning disabilities – experience high rates of unmet need and poorly managed conditions, including cancers and were far less likely to be aware of the lifestyle risk factors in relation to preventable cancers.  Women with learning difficulties have been identified as a group with consistently low uptake of screening programmes.
• Deprivation – Cancer in England is more common in people living in the most deprived areas and there are around 15,000 extra cases of cancer, per year in England, because of socio-economic variation
• Literacy levels and educational attainment – The majority of health information is text based, with promotional materials and correspondence in complex and inaccessible language that people find difficult to understand.  This should be considered when communicating with people with low literacy levels (16% of England population with an average reading age of 11), people whose first language is not English, people with learning disabilities and people from more deprived areas if initial and continued engagement with health services is to deliver positive health outcomes

Facts, figures and trends

In England, 292,680 people received a new diagnosis of cancer during 2013. This is a rate of over 600 people per 100,000.

Cancer death rates in the UK have fallen by around a fifth over the last forty years and by 10% over the last decade.

In the UK there were around 162,000 deaths from cancer in 2012, that’s more than 440 people every day. More than one person dies from cancer every four minutes in the UK.

The Public Health England Cancer data dashboard provides the most recent annual release (2013, accessed 27 May 2016) for Bracknell Forest CCG and NHS Trust level on all cancers, breast, lung, colorectal (bowel) and prostate cancers covering:

• cancer incidence
• survival at one and five years
• experience of care
• diagnosis rates
• operational performance
• and other measures at local authority level

The Public Health England Healthier Lives portal provides latest mortality data on a three year aggregate basis (2012-2014, accessed 27 May 2016) so it not directly comparable.

The following graphs taken from the Health and Social Care Information Centre show the annual age-standardised incidence rates for breast, lung, colorectal and prostate cancers between 2011-2013 per 100,000 population.  The figures are directly standardised against the European population profile 2013.

The original data sets cover the period 1995-2013 and show the rate of cancer diagnosis has increased year on year. For the 4 most common cancer types; rates of breast cancer diagnosis are increasing slightly as are rates of prostate cancer;  rates of bowel cancer diagnosis have remained fairly static though have shown some decline in more recent years; whilst lung cancer diagnosis in males is declining, it is increasing in females. The South East of England is also seeing a rise in diagnosis of melanoma skin cancer.  Rates for Bracknell Forest show fluctuation because they are expressed as a rate per 100,000 whilst the observed numbers are small and relatively consistent over time.

Breast cancer

Lung cancer

Colorectal cancer

Prostate cancer

Emergency hospital presentations

Early stage diagnosis and reducing the number of patients with cancers presenting as an emergency are key national priorities.

The Public Health England Cancer Services profile includes a measure of the crude rate per 100,000 of people diagnosed with cancer via an emergency route.  In Bracknell Forest, the rate is similar to the England average but is falling faster:

Mortality from cancer

In Bracknell Forest, the death rate from all cancers for all people aged 74 or under is falling faster than the England average.  Whilst the death rate varies by gender (the rate of males under 75 is greater than females), the rates are similar to the South East and national averages.

The Public Health Outcomes Framework also shows that between 2012 and 2014, 72.3 in every 100,000 people aged less than 75 years in Bracknell Forest died from cancer where their death was considered preventable. This figure has reduced more than the England average in the same period, but it nevertheless statistically similar:

Mortality from lung cancer in Bracknell Forest is statistically similar to the England average:

Mortality data for individual Bracknell Forest wards calculated by the Berkshire Public Health Team shows mortality rates in Bracknell Forest wards ranked from highest (Great Hollands: South) to lowest (Warfield Harvest Ride). This information should be read alongside the ward profiles for each area:

Prevention and treatment of cancer

Prevention of cancer and reducing premature deaths from cancers are key objectives in the Improving Outcomes a Cancer Strategy published in 2011.  The NHS runs three national cancer screening programmes aimed at detecting early symptoms of breast cancer, cervical cancer, and bowel cancer.

In March 2016, Cancer Research Cancer UK published a useful poster setting out the age, frequency and uptake of cancer screening programmes. A number of short videos from the Gov.UK website show the purpose of screening:

Breast cancer screening

Breast screening supports early detection of cancer and is estimated to save 1,400 lives in England each year.  To ensure more breast cancers are detected at earlier, more treatable stages, the Public Health Outcomes Framework measures the percentage of women aged 47-70 years in Bracknell Forest eligible for breast screening who were screened adequately within the previous three years on 31 March.  A greater proportion of women in Bracknell Forest were screened for breast cancer than had been nationally:

Colon cancer screening

About one in 20 people in the UK will develop bowel cancer during their lifetime. It is the third most common cancer in the UK, and the second leading cause of cancer deaths, with over 16,000 people dying from it each year. Regular bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16%.

The rate of eligible people per 100,000 people aged 60–74 in Bracknell Forest screened for bowel cancer is 58 which is slightly above the national average of 57.1 but still below the 60% national target.

Evidence research on how to increase uptake of bowel cancer is available from the Cancer Research UK website.  Specific resources, including guidance for GPs with supporting materials and templates for communicating for awareness and screening take up as well as current awareness campaigns are also available.

Cervical cancer

Cervical cancer screening supports detection of symptoms that may become cancer and is estimated to save 4,500 lives in England each year. The national target is 80%. Monitoring for adequate cervical screening is age dependent and records the percentage of women screened adequately within:

• the previous 3.5 years for women aged 25-49
• the previous 5.5 years for women aged 50-64

Survival rate

The survival rate is a measure of all adults (15–99 years) still living within 12 months of a diagnosis with a first, primary, invasive malignancy.  The CancerData dashboard gives the following survival rates for Bracknell Forest:

	Bracknell Forest	England
All cancers	70.2	68.9
Breast	96.7	96.5
Colorectal	77.1	78.4
Lung	35.4	31.2

Want to know more?

CancerData dashboard (Public Health England) – an aggregate of annual data at Bracknell Forest CCG and NHS Trust level on all cancers, breast, lung, colorectal (bowel) and prostate cancers covering incidence, mortality, survival, experience of care, diagnosis rates and operational performance.

Cancer Research UK – a host of information and statistics relating to cancer, including evidence research on how to increase uptake of bowel cancer is available from the Cancer Research UK website.  Specific resources, including guidance for GPs with supporting materials and templates for communicating for awareness and screening take up as well as current awareness campaigns are also available.

Cancer Services profile (Public health England) – a tool containing data on cancer services at GP and CCG level collated by The National Cancer Intelligence Network (NCIN). It replaces the GP Cancer Profiles that were previously contained within the Cancer Commissioning Toolkit.  The profiles are for commissioners and health professionals when assessing the impact of cancer on their local population and making decisions about services. They include data on cancer screening, Two Week Wait referrals, diagnostic services, and emergency presentations and admissions.

Health matters: getting every adult active every day (Public Health England, 2016) – summary facts and figures, descriptions of  physical activity and how benefits extend beyond physical health to include mental wellbeing, and how it can be used in a number of care pathways for cancers, diabetes, dementia, cardiovascular disease, falls and hip fractures.

Longer Lives portal (Public Health England) – extensive mortality data sets on cancer, its causes and interventions for the public and professionals.

ONS cancer datasets – detailed information on mortality and survival statistics for cancer.

The likely impact of earlier diagnosis of cancer on costs and benefits to the NHS (Department of Health, 2011) – Analysis of the positive financial implications of earlier cancer diagnosis.

This page was created on 27 February 2014 and updated on 21 June 2016.  Next review date December 2016.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Cancers. Available at: jsna.bracknell-forest.gov.uk/living-working-well/health-conditions/cancers (Accessed: dd Mmmm yyyy)

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