Cancer in Wales. People living longer increases the number of new cancer cases

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1 Welsh Cancer Intelligence and Surveillance Unit, Health Intelligence Division, Public Health Wales Iechyd Cyhoeddus Cymru Public Health Wales Am y fersiwn Gymraeg ewch i Cancer in Wales A summary report of population cancer incidence, mortality and survival includes new 212 data released as Official Statistics on 9 April 214 How many people get cancer? People living longer increases the number of new cancer cases The trend in the number of new cancer cases each year is still going up (Figure 1). There were just over 18, new cases of cancer diagnosed in the residents of Wales in 212. That s around ten per cent more in or almost 1,7 extra cases - compared to ten years before in 23. Figure 1 Annual number of new cancer cases in Wales. All persons, all ages Number of new cancer cases in Wales Year of diagnosis Summary Our report highlights how the ageing population of Wales, along with socioeconomic inequalities and deprivation, are increasing the large burden of ill-health and mortality from cancer in society. The types of cancers that are common (such as bowel, lung, breast and melanoma) suggest that prevalent health-risk behaviours in Wales are also contributing to the population cancer burden. The main risk behaviours are smoking, alcohol drinking, physical inactivity, obesity and a poor diet, along with more sun and UV exposure with sunburns. They are all infl uenced by many factors in society, rather than just in the individual. Although air pollution is now known to be a risk for lung cancer, smoking remains the major problem. The large increase in cancer incidence in women appears to be mainly due to lung cancer. Despite recent improvements, such as for age-adjusted lung cancer incidence in men and age-adjusted breast cancer incidence in women, trends in these and other cancers may yet change depending on current and future risk factors. Population cancer surveillance will need to continue to inform public health and health service responses. Cancer survival is improving overall, but from a low level and with lower survival in deprived areas. Survival from lung cancer remains low and, in common with most UK countries, survival for most smoking-related cancers is far from the best in Europe. Better understanding of the causes of low survival in Wales will remain challenges alongside cancer prevention. Welsh Cancer Intelligence and Surveillance Unit Official Statistics 212 data. Published 1 April 214 1

2 Cancer in Wales Published 1 April 214 Two-thirds of all new cancer cases in 212 were in people aged 65 and over We examined the overall trend more closely by looking at the trends in cancer numbers for different age groups (Figure 2). The number of cases in 212 were higher than 23 for all age groups from 6 years and older, except for the 8-84 years group, which was only marginally lower. The largest rise of 34 per cent was in the 65 to 69 age group. By 212, two-thirds of all cancer cases were diagnosed in people aged 65 and over. Cancer still more common in men, but rate is going up in women, down in men In Wales, the rate of cancer in men is about 18 per cent more than in women that s around 7 extra cases for every 1, men compared to the rate in women. Although cancer is more common in men, the incidence is coming down slowly (Figure 4 and Table 1), but increasing in women. Figure 4 Cancer incidence rates in Wales by sex, Figure 2 Trends in annual numbers of cancers by age group. Wales, all persons Annual number of cases EASR per 1, population Year of diagnosis Males Females Persons Year of diagnosis But, during the same period, there was little change in most age-specifi c cancer rates per 1, with no clear trends (Figure 3). This suggests that the increase in number of cases we observed is partly explained by people living longer and the ageing of the population. However, it is not yet clear why the numbers and rates in the 85 and over group, and the 8 to 84 years group, dropped sharply in 212 from their peaks in 211. Figure 3 Age-specific cancer incidence rates in Wales. All persons, The reasons for the differences include the historic patterns of male smoking and alcohol use being different to those in women. Naturally there are also many sex-specifi c cancers such as prostate, breast, and cervix, for example. We highlight the different trends in the most common cancer types in men and women later. Table 1 Difference in cancer incidence between men and women in Wales. All ages. 212 Total Cases Incidence rate per 1, EASR Lower Confi dence Limit Upper Confi dence Limit Men Women Age specific incidence rate per 1, population Year of diagnosis Welsh Cancer Intelligence and Surveillance Unit Official Statistics 212 data. Published 1 April 214

3 Defi nitions Age-standardised rates and EASR Age-standardisation adjusts rates to take into account how many old or young people are in the population being looked at. When rates are age-standardised, you know that differences in the rates over time or between geographical areas do not simply refl ect variations or changes in the age structure of the populations. This is important when looking at cancer rates because cancer mainly affects older people. Throughout this report we use European Age Standardised Rates (EASR) unless otherwise specifi ed. Statistical significance If a difference between rates or survival between populations is statistically signifi cant, it means that that difference is unlikely to have occurred due to chance alone, and that we can be more confi dent that we are observing a true difference. In this report we use the conventional arbitrary cut-off of less than a 5% chance to mean statistically signifi cant. Just because a difference is statistically signifi cant doesn t necessarily mean that it is large or important - that can depend on our judgment and other things. Relative survival This is a way of comparing the survival of people who have a specifi c disease in our case, cancer -with the survival experienced by the general population, over a certain period of time. It is calculated by dividing the percentage of patients with the disease who are still alive at the end of the period of time (e.g. one or fi ve years after diagnosis) by the percentage of people in the general population of the same sex and age who are alive at the end of the same time period. The relative survival rate shows whether the disease shortens life. We use relative survival in this report. All cancers When we use the phrase all cancers or all malignancies in this report, by convention, we always mean all cancers excluding non-melanoma skin cancer. Lowest health board cancer incidence is 8% below the incidence for Wales Cancer gets more common the more deprived an area gets Many diseases or health conditions show a health gradient, becoming increasingly more common as socioeconomic deprivation increases. Overall, cancer is no exception. The incidence rate of cancer is 2 per cent higher in the most deprived areas of Wales, compared to the least deprived that s around 8 extra cancer cases for every 1, people living in the most deprived areas (Figure 5). But not all cancers follow this pattern, notably breast cancer, which is more common amongst more affl uent women. Cancer incidence for six of the seven local health boards is similar to that for Wales (Figure 6) the differences are within a range we might expect from chance alone. But the incidence for the Powys population is nearly eight per cent lower than the Wales incidence, and is lower than would be expected from chance alone. Figure 6 Cancer incidence rate (EASR) per 1, people by local health board of residence. Wales, persons, all ages Figure 5 Cancer incidence rate (EASR) for areas with increasing deprivation (fifths) in Wales. All persons, all ages EASR per 1, population (Least deprived) (Most deprived) Deprivation fifth Crown Copyright and database right 214. Ordnance Survey Welsh Cancer Intelligence and Surveillance Unit Official Statistics 212 data. Published 1 April 214 3

4 Cancer in Wales Published 1 April 214 Highest local authority cancer incidence is 17% more than lowest Ceredigion s cancer incidence is the lowest of the 22 local authority areas (Figure 7). It s about eight per cent below the Wales incidence. Torfaen s rate is nearly eight per cent higher than Wales. It is the highest in Wales. That means that, on average, there s a difference of 67 new cases of cancer per 1, people each year between Ceredigion and Torfaen. The differences between local authority areas are in part due to variation in deprivation. Which are the most common cancers? Over 18, cases of cancer in residents of Wales were diagnosed during 212. The relative number of the different types are shown in Figure 8. Figure 8 Number and proportion of the five most common types of cancer diagnosed in Wales. All persons, all ages. 212 Bowel, 2444, 14% Figure 7 Annual cancer incidence by local authority populations. Wales, persons, all ages Other, 7741, 43% Prostate, 2419, 13% EASR per 1, population Ceredigion Powys Monmouthshire Isle of Anglesey Swansea Carmarthenshire Bridgend Gwynedd Pembrokeshire Neath Port Talbot WALES Conwy Cardiff Vale of Glamorgan Newport Wrexham Rhondda Cynon Taff Caerphilly Merthyr Tydfil Blaenau Gwent Flintshire Local authority of residence Wales Not statistically significant Statistically significant Denbighshire Torfaen Melanoma, 693, 4% Female Breast, 2362, 13% Lung, 237, 13% Bowel cancer is the most common cancer in Wales for fi rst time There were 474 more cases of bowel cancer in 212 than in 23, making bowel cancer the most common cancer in Wales in 212. This is the fi rst time this has happened since our records began. The ageing of the population during this time played a part (Figure 9). Increased awareness and the introduction of bowel screening may also be responsible, but we re not yet clear about this. Figure 9 Bowel cancer incidence (EASR) in Wales by sex, all ages EASR per 1, population Males Females Persons Year of diagnosis 4 Welsh Cancer Intelligence and Surveillance Unit Official Statistics 212 data. Published 1 April 214

5 Number of lung cancer cases increases by more than a third over 1 years in women, but hardly changes in men There have been major changes in lung cancer numbers in men and women. The number of cases in men remained similar between 23 and 212, but the number in women increased by over a third. The number of cases in women is now approaching that in men. This means that cancer incidence per 1, men has dropped in that time, once age is considered, but the incidence rate has increased in women (Figure 1). The combined rate for men and women has stopped coming down, and is now fl at-lining. Different historic smoking patterns in men and women account for most of these changes, but we also now know that some forms of air pollution are increasingly recognised as risk factors for lung cancer. Prostate cancer incidence rate changes little, but actual numbers go up The fi ve most common cancers in men during 212 were prostate (2,419 cases) bowel (1,45) lung (1,249) head and neck (427) bladder (391) The number of cases of prostate cancer diagnosed in 212 was 376 more than in 23. The ageing population probably explains most of this modest rise because the rate standardised for age has remained almost constant over the ten year period. Breast cancer incidence steadily coming down since 21 The fi ve most common cancers in women in 212 were breast (2,362 cases) lung (1,121) bowel (1,39) ovary (452) uterus (449) In 212 the number of cases of breast cancer was marginally lower than in 23. Once the effect of population age is considered, the rate was over eight per cent lower in 212 than ten years previously, after peaking in 21. Figure 1 Lung cancer incidence (EASR) in Wales by sex, all ages EASR per 1, population Year of diagnosis During we will be analysing information on lung cancer in more detail. Males Females Persons Welsh Cancer Intelligence and Surveillance Unit Official Statistics 212 data. Published 1 April 214 5

6 Cancer in Wales Published 1 April 214 How many die from cancer? The overall cancer mortality rate has decreased in ten years... The general trend in cancer mortality rate is coming down, once changes in population age structure are taken into account. By 212, mortality was around 174 per 1, people - that s 11 per cent less than ten years before (Figure 11). Figure 11 Cancer mortality (EASR) rate in Wales. All persons, all ages but, the number of cancer deaths increased by almost one third in people aged 85 and over Even though the age-adjusted mortality rate is going down, the trend in the annual number of deaths from cancer is still increasing due to population changes. There were 8,654 deaths in 212 compared to 8,37 in 23. But this general three per cent increase is small in comparison to the 31 per cent increase in deaths in the 85 years and older age group, where most cancer deaths occur (Figure 12). Figure 12 Annual number of cancer deaths by age group. Wales, all persons EASR per 1, population Registered year of death Annual number of cancer deaths Registered year of death 6 Welsh Cancer Intelligence and Surveillance Unit Official Statistics 212 data. Published 1 April 214

7 Cancer mortality rate is one third higher in men than women We know that cancer is more common in men, but men have a higher death rate from cancer too. Cancer incidence is around 16% higher in men than women, but mortality is over a third higher. This is consistent with lower cancer survival in men (Figure 13). Figure 13 Cancer mortality (EASR) in men and women. Wales, all ages EASR per 1, population Women Sex Men Cancer mortality rate is over 5% higher in most deprived areas of Wales compared to the least deprived Cancer mortality is higher in more deprived areas. Whereas cancer incidence is 2 per cent higher in the most deprived areas compared to the least deprived, mortality is 5 per cent higher, which refl ects the gradient in survival (Figure 14). Figure 14 The gradient of cancer mortality rate (EASR) for areas with increasing deprivation (fifths). Wales, persons, all ages EASR per 1, population (Least deprived) (Most deprived) Deprivation fifth Welsh Cancer Intelligence and Surveillance Unit Official Statistics 212 data. Published 1 April 214 7

8 Cancer in Wales Published 1 April 214 Highest health board cancer mortality is 6% more than for Wales The cancer mortality rate between the populations of the seven health boards varies (Figure 15). The mortality rates of the populations of the Hywel Dda and Powys areas are lower than the Wales mortality, and Cwm Taf and Aneurin Bevan populations are higher. These differences are greater than might be expected from chance alone. The Cwm Taf population has a cancer mortality rate six per cent higher than the Wales mortality. Figure 15 Cancer mortality rate (EASR) by local health board populations. Persons, all ages, Difference between local authority area with highest and lowest mortality is over 47 deaths per 1, people There is wider variation between the cancer mortality rates of local authority populations (Figure 16). The lowest is in Ceredigion which is 13 per cent below the Wales mortality, and Blaenau Gwent has the highest mortality by the same percentage. The variation between local authority areas is partly explained by deprivation, and broadly follows the same pattern as cancer incidence. Figure 16 Cancer mortality rate (EASR) by local authority populations. Persons, all ages, EASR per 1, population EASR per 1, population Powys Teaching Hywel Dda University Cardiff & Vale University Abertawe Bro Morgannwg University Wales Health board of residence Wales Not statistically significant Statistically significant Betsi Cadwaladr University Aneurin Bevan University Cwm Taf University Ceredigion Monmouthshire Powys Vale of Glamorgan Carmarthenshire Pembrokeshire Swansea Conwy Wrexham Bridgend WALES Gwynedd Cardiff Isle of Anglesey Caerphilly Denbighshire Flintshire Local authority of residence Wales Not statistically significant Statistically significant Newport Rhondda Cynon Taff Neath Port Talbot Torfaen Merthyr Tydfil Blaenau Gwent 8 Welsh Cancer Intelligence and Surveillance Unit Official Statistics 212 data. Published 1 April 214

9 Deaths from lung cancer more than bowel and breast cancers combined Lung cancer accounted for almost 22 per cent of all cancer deaths in 212 (Figure 17). At 1,894 deaths, it accounts for most cancer deaths, ahead of other common cancers such as bowel, breast and prostate, and more than bowel and breast combined. These cancers also have the highest mortality rates (Figure 18). Figure 17 Number of deaths from different types of cancer, 212 Bowel 912 Lung 1894 Breast 594 All cancer deaths 8654 Prostate 556 Pancreas 44 Other cancers 4258 Figure 18 Mortality rate (EASR) for different cancer types. Wales, persons, all ages EASR per 1, population Lung Female Breast Prostate Colorectal Ovary Pancreas Oesophagus Stomach Urinary Tract exc Bladder Bladder Brain & CNS Leukaemia Non-Hodgkins Lymphoma Liver Cancer type Head & Neck Uterus Melanoma Cervix Larynx Thyroid & Endocrine Hodgkins Testis Welsh Cancer Intelligence and Surveillance Unit Official Statistics 212 data. Published 1 April 214 9

10 Cancer in Wales Published 1 April 214 What are the chances of survival? Survival from cancer is steadily improving, but remains low compared to the best in Europe On average, almost 7 per cent of Welsh residents diagnosed with cancer can expect to survive at least one year. It s improving, but progress is slow. The latest available fi gures for are only four per cent higher than the fi gures for the period (Table 2). Table 2 One year relative survival from cancer in Wales. Persons, all ages. Period of diagnosis One year relative survival % It takes longer before we can report on fi ve year survival because we have to wait to see what happens to people diagnosed with cancer. But we know that for the latest available period, fi ve year survival increased by nearly eight per cent compared to the period (Table 3). Table 3 Five year relative survival from cancer in Wales. Persons, all ages. Period of diagnosis Five year relative survival % Women have higher cancer survival rates than men Even though cancer is much more common in men, one year survival is four per cent higher in women than men. Five year survival has a wider gap, being ten per cent higher in women than men (Table 4). Table 4 Relative cancer survival in men and women in Wales. Persons, all ages. Five year survival (23-27) Men 5.% 68.5% Women 55.% 71.5% Cancer survival is lower in more deprived areas One year survival (27-211) In more deprived areas the chance of survival gets worse for both one year and fi ve year relative survival. In Wales, one year survival in the most deprived areas is 17 per cent less than in least deprived areas - there is a steep gradient. For fi ve year survival the difference is wider the chance of survival is 28 per cent less in the most deprived areas compared to the least deprived (Figure 19). Figure 19 Five year cancer survival gradient for areas with increasing deprivation (fifths). Wales, persons, all ages Increasing survival can be due to a combination of changing pattern of cancer types in the population; better treatments available and accessed by all who need them; earlier diagnosis and screening; age at diagnosis; as well as an improvement of health generally across the population, so that if people are diagnosed with cancer, they will have fewer other illnesses that may affect their treatment. It is not yet clear to what extent these different factors have combined to infl uence survival. Relative Survival (%) (Least deprived) (Most deprived) Deprivation fifth The improving survival in Wales needs to be considered in the context of better survival in many European countries, especially for smoking-related cancers (Eurocare 5 study). 1 Welsh Cancer Intelligence and Surveillance Unit Official Statistics 212 data. Published 1 April 214

11 Variation in cancer survival between health board populations is small On average, almost 7 per cent of Welsh residents diagnosed with cancer can expect to survive at least one year. The variation in one year survival between health board for is small, but the Betsi Cadwaldr and the Powys health board populations both have one year survival around two percentage points above that for Wales, and Cwm Taf by about the same below it. These differences are more than can be expected by chance alone (Figure 2). Other factors, such as deprivation or the prevalence of other illnesses, that can affect survival may explain part of these differences. Figure 2 One year relative cancer survival by health board. Wales, Figure 21 Five year relative cancer survival by health board. Wales, Crown Copyright and database right 214. Ordnance Survey Crown Copyright and database right 214. Ordnance Survey On average, almost 53 per cent of Welsh residents diagnosed with cancer can expect to survive at least fi ve years. The variation in fi ve year survival for is again small, although the difference between the Wales fi gure and three of the health boards are more than can be expected by chance Cwm Taf is over four percentage points below, with Powys and Cardiff and Vale above the Wales survival by about four and 2.5 percentage points, respectively (Figure 21). Welsh Cancer Intelligence and Surveillance Unit Official Statistics 212 data. Published 1 April

12 Cancer in Wales Published 1 April 214 Cancers of the liver, lung and pancreas have the lowest survival According to survival data, the three cancers with the lowest one year survival in Wales are liver and lung - with survival rates of well under 3 per cent - and, lowest of all, cancer of the pancreas with only an 18 per cent survival (Figure 22). Cancers of the testis (testicles), breast, melanoma and prostate have the highest one year survival, at over 95 per cent. But, bowel cancer one year survival is around 75 per cent. Figure 22 One year relative survival from different types of cancer in Wales Figure 23 Five year relative survival from different types of cancer in Wales Relative Survival (%) Relative Survival (%) Cancer type Testis Breast (Female only) Melanoma Prostate Uterus Thyroid & Endocrine Hodgkins Cervix Larynx Rectum Head & Neck Non-Hodgkins Lymphoma Colorectal Bladder Colon Urinary Tract exc Bladder Ovary Leukaemia Oesophagus Stomach Brain & CNS Liver Lung Pancreas Cancer type Testis Breast (Female only) Melanoma Prostate Uterus Thyroid & Endocrine Hodgkins Cervix Larynx Rectum Head & Neck Non-Hodgkins Lymphoma Colorectal Bladder Colon Urinary Tract exc Bladder Ovary Leukaemia Oesophagus Stomach Brain & CNS Liver Lung Pancreas Liver, lung and pancreas also have the lowest fi ve year survival for the latest available fi gures Survival is less than four per cent for pancreas, and below seven per cent for lung cancer and liver cancer (Figure 23). Cancers with the highest fi ve year survival are testis (96%), prostate (86%), breast (85%) and melanoma (84%). We will look at survival from lung cancer in much more detail in our reports during ISBN Public Health Wales NHS Trust All tables, charts and maps were produced by the Welsh Cancer Intelligence and Surveillance Unit. Data sources are shown under each graphic. Material contained in this document may be reproduced without prior permission provided it is done so accurately and is not used in a misleading context. Acknowledgement to Public Health Wales NHS Trust to be stated. Copyright in the typographical arrangement, design and layout belongs to Public Health Wales NHS Trust. Images reproduced with permission 12 Welsh Cancer Intelligence and Surveillance Unit Official Statistics 212 data. Published 1 April 214

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