Scottish Government

CANCER IN SCOTLAND SUSTAINING CHANGE

01 CANCER IN SCOTLAND - WHERE WE ARE NOW - FACTS AND FIGURES

CANCER CONTINUES AS THE LEADING CAUSE OF DEATH FOR PEOPLE UNDER 75

Understanding patterns of care in Scotland's population is an important first step in designing policies to reduce risks of getting cancer and improving outcomes for those who are diagnosed with the disease.

Survival continues to improve for most cancer types. The greatest improvements have been seen in blood, lymphatic and testis cancers, but common cancers such as bowel, breast and prostate have also seen greater than 10% absolute survival benefits.

Cancers of the lung, pancreas, oesophagus and head and neck have shown little or no improvement. The high frequency of lung cancer in Scotland is partly responsible for our position when comparing survival rates with other countries. Even with other recognised factors affecting interpretation of reported survival results, such as differences in completeness and quality of data, the consistency of international survival comparisons suggests that other factors such as late presentation or organisation and delivery of services may play a role.

Breast cancer remains as the commonest cancer in women with over 3,600 patients diagnosed each year, followed by cancers of the lung and large bowel. The commonest cause of cancer death in women is now lung cancer reflecting the poor survival and increasing frequency of this disease amongst Scottish women. For men, lung cancer predominates both in the number of new cases each year and the number of deaths, followed by cancers of the prostate and large bowel.

Time trends

Until the late 1990s the numbers of new cases of cancer diagnosed in Scotland increased every year since the start of the national registration system in 1959. This is partly due to the ageing population, but individual risks of many common cancers have also increased. Incidence trends for the most common cancers are shown in Figures 4 and 5.

Cancer Scenarios projected rising incidence of cancer, up to 33,000 new cases each year by 2014, accompanied by significant reductions in numbers of deaths from cancer (for the period 1995-99 to 2010-14) of 17% for men and 11% for women under 75. The main influence here is lung cancer, which is declining in men. There is a potential for earlier diagnosis and improved treatment services to further enhance the reductions in mortality to 24% for men and 18% for women and acts as an impetus for current and future service reforms to maximise this potential for current and future patients.

Figure 1: Absolute difference¹in relative survival²at 5 years by cancer and sex: patients diagnosed in 1996-99 compared to those diagnosed in 1971-75 (patients aged 15-99) ³

1 Absolute differences in relative survival between the time periods 1971-75 and 1996-99 have been shown: so, for example, the % survival for Leukaemia in males was 14.7% (1971-75) and 56.2% (1996-99), which by subtraction gives a difference of 41.5%.
2 These rates are directly standardised to the 'World standard cancer patient population'.
3 For some cancer sites (testis, thyroid and Hodgkin's disease in males) there were less than 9 cases in the 85-99 age group in any time period. For these sites the comparison was made using standardised rates for the age group 15-74. For some cancer sites (Prostate in males; Larynx in females) there were less than 9 cases in the 15-44 age group in any time period. For these sites the comparison was made using standardised rates for the age group 44-99.
4 A change in coding of bladder cancers during this time period has resulted in an artificial decline in survival from this tumour compared to earlier time periods.

Figure 2: The most frequently diagnosed malignancies in men in Scotland in 2000, along with mortality in 2002

Figure 3: The most frequently diagnosed malignancies in women in Scotland in 2000, along with mortality in 2002

Geographical and socio-economic variations within Scotland

The risk of getting cancer is unevenly distributed in the population. High incidence rates are seen in the central belt, particularly in Greater Glasgow and Lothian NHS Board areas. For men, this is due to historical patterns of exposure to the main risk factors for cancer, predominantly smoking. For women, the distribution of incidence is more even, due to the combination of breast and some other female gender-specific cancers, and tobacco-related cancers. While the latter are more common in lower socio-economic groups, breast cancer is commonest in higher socio-economic groups. Thus, the geographical distribution of cancer in women masks important differences in risks for particular types of cancer across the country. The overall gradients in incidence, survival and mortality according to Carstairs' deprivation score are presented in Figure 6.

This indicates that people living in the most deprived areas have the highest risk of cancer and the lowest probability of survival. These gradients are steepest for cancers with a strong relationship to tobacco and alcohol consumption.

Constituency profiles published by NHS Health Scotland in March 2004 showed that Scotland's overall health has improved gradually over the decade 1991-2001 but a persistent health gap between the most affluent and most deprived communities continues. As an example, 28% of adults are unable to work due to incapacity or illness in Glasgow Shettleston compared to 4% in West Aberdeenshire and Kincardine.

Figure 4: Incidence of the most common cancers in Scotland in 1975-2000: Females

Figure 5: Incidence of the most common cancers in Scotland in 1975-2000: Males

It is against this background that Cancer in Scotland: Action for Change was launched in July 2001 backed by an additional investment of 60 million. It set out a programme designed to transform the way cancer services are delivered in Scotland through improved access to quality assured services, increased patient involvement and real and lasting improvements in outcomes and experiences for patients.

Table 1: Five-year relative survival¹(%) for patients diagnosed in the period 1996-99 ages 15-99: by cancer and sex

1 These rates are directly standardised to the 'World standard cancer patient population'.
2 ICD-10 C00-C96 excluding non-melanoma skin (ICD-10 C44)

Note: For some cancer sites (testis, thyroid and Hodgkin's disease in males) there were less than 9 cases in the 85-99 age group in any time period. For these sites the comparison was made using standardised rates for the age group 15-74. For some cancer sites (Prostate in males; Larynx in females) there were less than 9 cases in the 15-44 age group in any time period. For these sites the comparison was made using standardised rates for the age group 44-99.

Figure 6: Cause-specific survival¹at 5 years, incidence²and mortality²by deprivation quintile including test for trend⁴across deprivation categories. Patients diagnosed 1996-99³

1 Adjusted for age and sex.
2 Age-standardised rates per 100 000 person-years at risk (European standard population).
3 Cases diagnosed 1994 and 1995 do not have 5 years' follow-up.
4 Linear regression on log rates for incidence and mortality; Cox regression for survival.