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BRIEFING PAPER

Number SN02677, 30 September 2015

Cancer Statistics: In Detail

By Alex Bate, Carl Baker

Inside: 1. Incidence: All Cancers 2. Mortality: All Cancers 3. Survival Rates: All Cancers 4. Specific Cancer Sites 5. Performance and Waiting

Times 6. Screening 7. International Data

Number SN02677, 30 September 2015 2

Contents Summary 3

Incidence 3 Mortality 3 Survival 3 Screening 3

1. Incidence: All Cancers 4 1.1 Explaining Age-Standardised Rates 4 1.2 Trends over Time 5 1.3 Cancer Incidence by Age 6 1.4 Gender 9 1.5 England, Wales, Scotland, Northern Ireland 10 1.6 Regions 10 1.7 Deprivation 12

2. Mortality: All Cancers 14 2.1 Trends over Time 14 2.2 Age 14 2.3 UK Countries and Local Authorities 15 2.4 Mortality-Incidence Ratio 17

3. Survival Rates: All Cancers 18 3.1 Trends over Time in England and Wales 18 3.2 Scotland 19 3.3 Northern Ireland 20

4. Specific Cancer Sites 21 4.1 Breast Cancer 21 4.2 Lung Cancer 22 4.3 Colorectal Cancer 24 4.4 Prostate Cancer 26 4.5 Skin Cancer 28 4.6 HPV-Related Cancers 29 4.7 Other Cancer Sites 30

5. Performance and Waiting Times 31 5.1 14-Day Wait from Referral to Specialist Appointment 31 5.2 31-Day Wait from Diagnosis to Treatment 31 5.3 62-Day Wait from Urgent GP Referral to Treatment 31

6. Screening 32 6.1 Breast 32 6.2 Cervix 33

7. International Data 35 7.1 Incidence and Mortality 35 7.2 Survival 37

Cover page image copyright: Untitled by Penn State. Licensed under CC BY-NC 2.0 / image cropped.

3 Cancer Statistics: In Detail

Summary Incidence • Age-standardised cancer incidence has grown steadily since 1995. • The most common cancers are prostate (men), breast (women),

and lung and colorectal (both genders). These cancers account for over half of all cancers in each gender.

• Cancer incidence rates are substantially higher among older people.

• Between the ages of 20 and 59, women are more likely to contract cancer than men. After this the balance shifts: from age 60 onwards, men become increasingly more likely to contract cancer than women.

• Scottish male cancer incidence rates are the lowest in the UK, whilst female rates are the highest. Wales has the highest male incidence rates, whilst Northern Ireland has the lowest female rates.

Mortality • Cancer death rates have steadily fallen in the last twenty years.

Rates among men are approximately 38% higher than among women.

• Cancer accounts for more than 50% of deaths among women between the ages of 50 and 69.

• Cancer mortality rates are highest in Scotland, without much difference between the rates of other UK countries.

Survival • Around half of adult cancer patients diagnosed in England in

Wales in 2010-11 are expected to survive for 10 years or more. • Survival rates vary vastly between specific types of cancer. 87% of

breast cancer patients survive for five years after diagnosis, but around 10% of lung cancer patients survive this period.

• Survival rates are much lower for patients diagnosed through emergency presentation. Of major cancers, colorectal (25%) and lung (38%) have particularly high rates of diagnosis through emergency presentation.

Screening • 76% of women aged 53-64 have undergone a breast screening

test in the past three years. 13% of eligible women – half a million – have never had a screening.

• 78% of eligible women aged 25-64 have had a cervical screening test in the past five years.

Number SN02677, 30 September 2015 4

1. Incidence: All Cancers1

1.1 Explaining Age-Standardised Rates Cancer incidence rates in this document are given as ‘age-standardised incidence rates’. These summarise the incidence rate that a population would have if it had a standard age structure. Age-standardised rates differ from crude rates in that they take into account the age structure of the population being examined. This is very important for cancer, which is far more prevalent among the elderly than the young, meaning that variation among crude rates over time and between geographical areas would likely only reflect a higher or lower proportion of elderly people in the population.

There is more than one ‘standard population’ used for calculating these rates. The ONS cancer incidence statistics use the European Age-Standardised Population. Sections 1-6 of this document use European Age-Standardised Rates. Section 7, however, involves comparison with countries outside of Europe, so uses the World Age-Standardised Population. As such, the rates reported in sections 1-6 are not comparable with those in section 7.

A further complication is that the European Age-Standardised Population was updated in 2013. However, not all cancer data has been updated to reflect this change. This means some data reported before 2013 may not be directly comparable with data reported after this date.

The ONS Cancer Registration data release contains a detailed description of how these rates are calculated.

1 Unless otherwise stated, all data in this section is sourced from the ONS Cancer

Statistics Registrations (Series MB1), No. 44, 2013. http://www.ons.gov.uk/ons/rel/vsob1/cancer-statistics-registrations--england--series-mb1-/no--44--2013/stb-cancer-registration-2013.html

5 Cancer Statistics: In Detail

1.2 Trends over Time In 2013, 293,000 people were diagnosed with cancer in England2. This is 24% higher than the number diagnosed in 2003. Chart 1 shows changes in directly age-standardised rates per 100,000 population since 1995. Male age-standardised cancer rates have increased by 5% over the period, while rates among women have increased by 15%.

Table 1 and Chart 2 (below) show the most common cancers among men and women respectively. For both genders, the three most common cancers account for over half of all cancers. Lung and colorectal cancer make up over 10% of cancers in both genders, while prostate and breast cancer comprise over a quarter of cancers in men and women respectively.

Table 1: Most common cancers, England 2013

2 Figures for ‘all cancers’ in this document refer to ICD-10 classification codes C00-

C97, excluding C44 (non-melanoma skin cancer) as is customary. Data on non-melanoma skin cancer is not considered to be reliable. A useful explanation of why is available here: http://www.ncri.ie/faqs/using-cancer-data/why-are-data-non-melanoma-skin-cancer-sometimes-excluded

Men Site Registrations % of total registrationsProstate 40,372 26.9%Lung 19,830 13.2%Colorectal 18,839 12.6%Total 79,041 52.8%

Women Site Registrations % of total registrationsBreast 44,540 31.2%Lung 16,823 11.8%Colorectal 14,926 10.4%Total 76,289 53.4%

0

100

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Chart 1: Age-standardised incidence rate per 100,000 population,

England, 2013

Male

Female

Number SN02677, 30 September 2015 6

Chart 2: Most common cancers as a proportion of all cancers, England, 2013

Among men, prostate cancer has increased its share of total male cancers from 24.6% to 26.9% since 2005. Among women, breast cancer as a proportion of all cancers has fallen, although the number registrations of breast cancer has risen in absolute terms.

Table 2, below, shows how incidence rates of selected cancers have changed from 1995-2013. Sites are listed by ICD-10 disease category.

Table 2: Cancer sites with large changes in incidence: % change3

These figures compare directly age-standardised rates from 1995 with those from 2013 and includes some minor and rare categories of cancer. Liver cancer incidence has doubled over the time period and is now the eighteenth most common cancer in England. Rates of stomach and bladder cancer have fallen notably since 1995.

While skin cancer rates have risen markedly in both men and women, the rise among men has been much higher. See section 4.5 for more data on skin cancer.

1.3 Cancer Incidence by Age Cancer rates are much higher among older people than among young people. Chart 3, below, illustrates the scale of this difference.

A man aged 80-84 is approximately 27 times more at risk from cancer than a man aged 40-44. On the other hand, a woman aged 80-84 is eight times more at risk from cancer than a woman aged 40-44.

3 ‘x’ indicates an incidence rate that has fallen from or risen to less than 5

Prostate

Lung

Colorectal

Other

Men

Breast

Lung

Colorectal

Other

Women

Rising Rates Male Female Falling rates Male Female

Thyroid gland x +175 Secondary (respiratory/ digestive) -62 -49Skin +162 +91 Stomach -48 -47Liver +130 +122 Bladder -41 -36Kidney +73 +86 Lung -28 -25Lip, oral cavity & pharynx +65 +65 Larynx -19 x

7 Cancer Statistics: In Detail

To further illustrate the extent to which cancer registration is higher among older people, Chart 4 (below) shows the cumulative percentage of cancer registrations among all age groups. Among men, over 81% of cancers are among those aged over 60. Among women, the equivalent figure is 70%.

Cancers common amongst older people

Chart 5 (below) highlights the cancers most common among older people aged 80 and above: Unsurprisingly, given that cancer in general is most common in the elderly, the most common cancers below are the same as those listed in Table 1 (above).

0

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Chart 3: Cancer incidence by age group: rates per 100,000 population, newly diagnosed cases England 2013

Men

Women

Age 0-59

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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Men

Women

Chart 4: Cumulative percentage of all cancer registrations by age, England 2013

Number SN02677, 30 September 2015 8

Chart 5: Rates per 100,000 population for specific cancer sites among those aged 80+, England 2013

Most common cancers amongst adolescents and young people

Chart 6 (below) highlights the cancers most common among young people aged 15-29. Although cancer is very rare in the young, the distribution of specific sites is notably different than in older people. For instance, testicular cancer is one of the most common sites in young men, and Hodgkin’s disease is one of the most common cancers in the young of both genders. Cervical cancer among women aged 25-29 has increased notably over the past decade, as discussed by the National Cancer Intelligence Network in their document on Cervical Cancer.4

It is important to remember the difference in scale between Chart 5 (above) and Chart 6 (below). Above, male breast cancers are so low as to be almost invisible on the scale. But the rate of male breast cancers

4 NCIN, Cervical Cancer Incidence and Screening Coverage, February 2011

Male Age Age Female112.0 80-84 Oesophagus 80-84 47.9116.8 85-89 85-89 61.8116.2 90+ 90+ 62.8117.6 80-84 Stomach 80-84 47.7136.7 85-89 85-89 52.9114.7 90+ 90+ 48.0463.1 80-84 Colorectal 80-84 311.8503.6 85-89 85-89 340.2494.0 90+ 90+ 306.7520.1 80-84 Lung 80-84 323.5575.9 85-89 85-89 322.7523.1 90+ 90+ 248.2105.3 80-84 Skin 80-84 61.1115.4 85-89 85-89 65.6128.8 90+ 90+ 61.66.7 80-84 Breast 80-84 432.16.2 85-89 85-89 458.93.9 90+ 90+ 459.9738.6 80-84 Prostate 80-84775.9 85-89 85-89932.3 90+ 90+195.0 80-84 Bladder 80-84 51.9236.4 85-89 85-89 69.4272.6 90+ 90+ 78.3123.3 80-84 Non-Hodgkin's 80-84 82.1129.5 85-89 Lymphoma 85-89 82.9116.2 90+ 90+ 67.257.4 80-84 Unspecified 80-84 55.089.4 85-89 site 85-89 81.7138.2 90+ 90+ 117.9

9 Cancer Statistics: In Detail

among those aged 80-89 is higher than all male cancer sites except testicular cancer among ages 20-29.

Chart 6: Rates per 100,000 population for specific cancer sites among those aged 15-29, England 2013

1.4 Gender The age-standardised rate of cancer incidence is higher in men than in women. However, this gender gap has fallen over the past two decades. In 1995 male rates were 38% higher than female rates, but by 2013 this had fallen to 26%.

Chart 7 (below) shows the gender distribution of cancer rates in different age groups. This chart does not represent the magnitude of rates at different ages – this is given above in Chart 3 – but instead the gender balance of rates for each age group. A 50% value represents equal rates among men and women for that age group, and a 75% value represents rates being three times as high for men as for women (i.e. male rates totalling 75% of the summed rates).

Male Age Age Female1 15-19 Colorectal 15-19 2.51.6 20-24 20-24 2.33.3 25-29 25-29 3.10.7 15-19 Skin 15-19 1.62 20-24 20-24 4.74.6 25-29 25-29 10.3

15-19 Breast 15-1920-24 20-24 1.525-29 25-29 9.615-19 Cervix 15-19 0.220-24 20-24 3.725-29 25-29 21.415-19 Ovary 15-19 2.120-24 20-24 3.825-29 25-29 5.5

3 15-19 Testis 15-199.7 20-24 20-2417.2 25-29 25-290.4 15-19 Thyroid gland 15-19 1.70.9 20-24 20-24 12.2 25-29 25-29 23 15-19 Hodgkin's 15-19 3.84.2 20-24 Disease 20-24 4.64.3 25-29 25-29 3.72.2 15-19 Non-Hodgkin's 15-19 1.32.4 20-24 Lymphoma 20-24 2.32.8 25-29 25-29 2.23.3 15-19 Leukaemia 15-19 1.72.5 20-24 20-24 1.72.7 25-29 25-29 1.71.4 15-19 Brain 15-19 1.72.2 20-24 20-24 13.2 25-29 25-29 2

Number SN02677, 30 September 2015 10

Rates are fairly even between genders until age 25, when there is a large jump in female rates which is not matched in male rates. In the 40-44 and 45-49 age groups, female rates are more than double male rates. The gender balance changes gradually in higher age groups, plateauing from age 70 onwards.

1.5 England, Wales, Scotland, Northern Ireland

Table 3 (below) details the rates in the various constituent countries of the UK. Since 2003, all rates have risen except male rates in Scotland and Wales, which have fallen by 8% and 3% respectively.

Table 3: Age-standardised incidence rates per 100,000 in UK countries, 2013

Source: ONS, WCISU, ISD Scotland, Northern Ireland Cancer Registry

In Scotland, the gender gap has narrowed over the past two decades. In 1997 rates among Scottish men were 34% higher than among women, but this has reduced to a 17% gap in the 2013 data. This is lower than the English and Welsh gender gaps (both 26%). The largest gender gap is in Northern Ireland, where male cancer rates are 29% higher than female cancer rates.

1.6 Regions Chart 8 (below) shows variance in cancer incidence rates across English regions. Rates tend to be higher in the North and lower in the South, especially in the South East. These differences vary between specific cancer sites – for instance, skin cancer incidence is highest in the south.

MAL

EFE

MAL

E

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Und

er 1 1-4

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485

-89

90+

Chart 7: Gender distribution of cancer rates per age group, 2013

England Wales Scotland N. IrelandMale 683 708 679 694Female 542 563 581 539

11 Cancer Statistics: In Detail

Further instances of this regional variation will be explored in section 4, where data on specific cancer sites is discussed.

The highest male cancer rates are found in the North West -- 10% above the rates of men in London, where the lowest rates are registered. Among women, the highest rates are in the North East, 14% higher than in London.

Wales

Incidences rates between 2009 and 2013 were lower than average in Ceredigion and Powys, and higher than average in Merthyr Tydfil, Torfaen and Newport. The highest local authority cancer incidence rate in Merthyr Tydfil was almost 20 per cent higher than the lowest in Ceredigion. Other local authorities did not vary notably from the Welsh average.5

Scotland

Scottish rates by NHS health board are shown in Chart 9 (below). Areas such as Shetland, Western Isles and Orkney have low populations and therefore low numbers of cancer registrations, which gives them very large 95% confidence intervals.6 As a result, their positions at the top or bottom of the rankings should take this into consideration.

5 Welsh Cancer Intelligence and Surveillance Unit, Cancer in Wales, 3 February 2015 6 That is, we can be 95% sure that the true incidence rate lies within the given

interval

FemaleMale

0 100 200 300 400 500 600 700

London

East

East Midlands

South East

ENGLAND

South West

West Midlands

Yorks & Humber

North East

North West

Chart 8: Cancer rates per 100,000 population in English regions, 2013

Number SN02677, 30 September 2015 12

Source: ISD Scotland, Detailed Cancer Data7

The rates for Greater Glasgow & Clyde, Lanarkshire, Ayrshire & Arran, Lothian and Shetland are higher than Scottish rates as a whole among both sexes. Male and female rates are both lower than the Scottish rates as a whole in Orkney, Dumfries & Galloway, Grampian, Tayside, Borders, Highland & Argyll and Fife.

Northern Ireland

When analysed by Health and Social Care Trust area, Belfast has a higher rate of cancer incidence than the Northern Ireland average, whereas the South Eastern trust area has a lower than average incidence.8

1.7 Deprivation Chart 10 presents data from the National Cancer Intelligence Network’s Cancer by Deprivation in England, 1996-20119, showing that – when accounting for age – those who are more deprived are more likely to develop cancer.

7 ISD Scotland, Cancer Statistics, last accessed 30 September 2015 8 Queen’s University Belfast, Northern Ireland Cancer Registry, last accessed 24

September 2015 9 NCIN, Cancer by Deprivation in England, May 2014

0 200 400 600 800 1000

Orkney

Dumfries & Galloway

Forth Valley

Grampian

Tayside

Borders

Highland & Argyll

Fife

SCOTLAND

Lanarkshire

Ayrshire & Arran

Lothian

Greater Glasgow & Clyde

Western Isles

Shetland

Chart 9: Age-standardised incidence rates by NHS Health Areas, Scotland 2013

Male Female

13 Cancer Statistics: In Detail

These figures are calculated by breaking down using the income domain scores of the Indices of Multiple Deprivation10. The document linked above contains deprivation breakdowns for specific cancer sites.

10 DCLG, English Indices of Deprivation, last accessed 30 September 2015

0 100 200 300 400 500

Least deprived

2nd quintile

3rd quintile

4th quintile

Most deprived

Chart 10: Age-standardised incidence rates by deprivation quintile, England 2006-10

Male

Female

Number SN02677, 30 September 2015 14

2. Mortality: All Cancers

2.1 Trends over Time Despite the rise in incidence rates described above, mortality rates from cancer in England and Wales have fallen in recent years. As Chart 11 shows, male mortality rates from cancer fell by 30% between 1994 and 2013. Female mortality rates also fell by 22%. Although male mortality rates remain higher than rates among women, the ratio between the two fell from 1.67 in 1994 to 1.49 in 2013.

Source: ONS Mortality Statistics11

According to the ONS, the figure for Standardised Years of Life Lost (SYLL) to cancer has not fallen as quickly as mortality rates.12 Between 2001 and 2013, SYLL fell by around 8% in both men and women. Over the same period, mortality rates fell by 12% among women and 18% among men.

2.2 Age Chart 12 shows the mortality rate from cancer broken down by age group. Between ages 25 and 54, mortality rates are higher among women than men; among all other age groups, rates are higher for men.

11 ONS, Mortality Statistics: Deaths Registered in England and Wales, 2013 12 ONS, Avoidable mortality in England and Wales, 2013

Male

Female

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Chart 11: Mortality rates for men and women, England and Wales 1994-2013

15 Cancer Statistics: In Detail

Source: ONS Mortality Statistics

Chart 13 (below) shows mortality from cancer as a proportion of all deaths for each age group, broken down by gender. While cancer deaths are about 25-35% of all deaths for ages 5-14, this drops for ages 15-24. After this, the proportion steadily rises, peaking at over 50% for women among 50-69 year olds. At age 75, the proportion of cancer deaths for men rises above that of women for the first time.

Source: ONS Mortality Statistics

2.3 UK Countries and Local Authorities Cancer mortality rates are highest in Scotland, as Chart 14 shows. Male rates are 13% above the UK-wide rate, and female rates are 18% above the UK rate. The male and female rates for England, Wales and Northern Ireland are all less than 5% above or below the UK-wide rate.

11 30 23 33 82 236

894 3,

221 8,

026

17,3

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38,6

73

22 21 32 101

339

981 2,66

2

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<1 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85-89 90+

Chart 12: Cancer mortality rates per million population, 2013

Male Female

0%

10%

20%

30%

40%

50%

60%

Chart 13: Deaths from cancer as a percentage of all deaths, per age group

Male Female

Number SN02677, 30 September 2015 16

Source: Cancer Research UK13

Table 4 and Figure 1 display a breakdown of local authorities in terms of premature deaths to cancer. Many of the lower-ranked authorities are in the north of England. Northern areas perform worse than Southern areas in general, even when controlling for deprivation. The London Boroughs of Newham, Brent, Waltham Forest and Haringey all rank in the upper half (lower rates) of the premature deaths table despite also being in the highest rank for deprivation. York is the only least deprived area in the lower half (higher rates) of the premature deaths table.

The highest premature death rates in less-deprived areas were found in Thurrock, Milton Keynes, Northamptonshire and Warrington. The lowest premature death rates in more-deprived areas were found in Enfield, Camden, Torbay and Bolton. The full ranking of local authorities can be found on the Longer Lives PHE website.14

Table 4: Highest & lowest rates of premature deaths to cancer by local authority

13 Cancer Research UK, Cancer mortality for all cancers combined 14 Public Health England, Mortality rankings, last accessed 30 September 2015

199 196 225 198 206147 143 174 152 147

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UK England Scotland Wales NorthernIreland

Chart 14: Age-Standardised Cancer Mortality Rates in UK Countries, 2012

Male

Premature deaths per 100,0001 Harrow 104.0 150 Manchester 198.92 Kensington & Chelsea 116.3 149 Liverpool 195.23 Barnet 118.0 148 Middlesbrough 194.44 Rutland 119.3 147 Kingston upon Hull 192.25 Buckinghamshire 120.0 146 South Tyneside 192.06 Wokingham 120.3 145 Salford 190.37 Herefordshire 120.7 144 Knowsley 190.38 Windsor and Maidenhead 121.1 143 Halton 188.09 Surrey 121.1 142 Stoke-on-Trent 183.9

10 Kingston upon Thames 122.1 141 Blackpool 182.811 Dorset 122.2 140 Barking and Dagenham 179.712 Westminster 122.4 139 Doncaster 179.013 Redbridge 123.2 138 Nottingham 177.214 Richmond upon Thames 123.5 137 Redcar and Cleveland 176.015 Bath and North East Somerset 124.8 136 Hartlepool 175.916 South Gloucestershire 125.2 135 Oldham 174.917 Bromley 126.0 134 Newcastle upon Tyne 173.618 Cheshire East 127.0 133 Tameside 173.319 Hampshire 127.8 132 North Tyneside 172.820 Brent 128.4 131 Gateshead 172.8

17 Cancer Statistics: In Detail

Figure 1: Locations of highest and lowest rates of premature deaths to cancer by local authority

Source: LongerLives

2.4 Mortality-Incidence Ratio The mortality-incidence ratio (MIR) compares mortality rates with incidence rates. This ratio is obtained by dividing the number of deaths by the number of incidences. In England in 2013, the MIR was 0.47 for men and 0.44 for women.15 The MIR was highest in the North East (0.52 for men, 0.47 for women) and lowest in London (0.44 for men, 0.40 for women).

Some variation in this ratio is evident between specific cancer sites:

• The MIR for colorectal cancer is higher among women than in men in every region (except the South West, where it is equal). It is also higher or equal for stomach cancer in 5 of 9 English regions.

• The skin cancer MIR is lowest for men and women in Yorkshire and the Humber. In the East Midlands, the male MIR (0.24) is more than 1.5 times as high as the female ratio (0.15).

• The breast and lung cancer MIRs do not vary much between regions.

• The prostate cancer MIR is highest in the North East and East Midlands (0.26) and lowest in London (0.20).

• The Leukaemia MIR is 13% higher in women than in men, whilst the MIR for bladder cancer is 29% higher in women. In the South East, the bladder cancer MIR (0.69) is 53% higher than the male rate (0.45)

15 ONS, Cancer Statistics Registrations, England, 2013

Number SN02677, 30 September 2015 18

3. Survival Rates: All Cancers According to Cancer Research UK, around 50% of adult cancer patients diagnosed in England and Wales in 2010-2011 are expected to survive for 10 years or more. Specifically, the figure is 46% for men and 54% for women.

Source: Cancer Research UK16

There is, however, large variation between different types of cancer, with 78% of breast cancer patients surviving for 10 years or more but only 4% of male and 7% of female lung cancer patients surviving this period. Survival rates for specific cancer sites are explored in Section 4.

One key issue concerning cancer survival is the contribution of routes to diagnosis to cancer survival prospects. The National Cancer Intelligence Network’s publication Routes to Diagnosis17 shows that those who are diagnosed through presentation at emergency departments are significantly less likely to survive their cancer – an effect which is visible in all cancer sites and all groups. The issue is explored in more detail in the Commons Library briefing paper, Cancer: Waiting Times for Diagnosis and Treatment.

3.1 Trends over Time in England and Wales Male five-year survival rates have almost doubled over the past 40 years, as Chart 16 (below) shows. Female rates have remained higher than male rates, with almost 60% now surviving for at least five years after diagnosis.

16 Cancer Research UK, Cancer mortality for all cancers combined 17 NCIN, Routes to Diagnosis: Exploring Emergency Presentations, 2013

66.7%

49.3% 45.8%

74.1%

59.2% 53.7%

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80%

1-Year Survival 5-Year Survival 10-Year Survival

Chart 15: Survival rates for all cancers, England and Wales

Male Female

19 Cancer Statistics: In Detail

Source: Cancer Research UK

The ONS Cancer Survival Index for Clinical Commissioning Groups (CCGs) found that one-year net survival improved from 59.7% for patients diagnosed in 1997 to 69.3% for patients diagnosed in 2012. Between 1997 and 2012, one-year survival rates have improved most in Greater Manchester, Lancashire, and South Yorkshire & Bassetlaw.18 Information on cancer survival rates for specific sites by NHS area team can be found in the relevant ONS document.19

3.2 Scotland Of those diagnosed between 2007 and 2011, 66% of men and 70% of women survived one year from diagnosis. The corresponding five-year survival rates were 48% for men and 54% for women. These rates are below those of England and Wales in Chart 16 (above), although the gap is greater for women than for men.

Source: ISD Scotland

18 ONS, Index of cancer survival for Clinical Commissioning Groups in England, Adults

diagnosed 1997-2012 and followed up to 2013, 2014 19 ONS, Cancer survival by NHS England Area Team: Adults diagnosed 1997-2012,

followed up to 2013, 2014

25.1% 29.6% 34.8%42.0% 45.8% 49.3%

34.3%40.9%

47.1% 52.7% 55.9% 59.2%

0%

10%

20%

30%

40%

50%

60%

70%

1971-1972 1980-1981 1990-1991 2000-2001 2005-2006 2010-2011

Chart 16: Five-year net cancer survival rates, England and Wales

Men Women

66.2%48.1%

69.5%53.9%

0%10%20%30%40%50%60%70%80%

1-Year Survival 5-Year Survival

Chart 17: Cancer survival rates, Scotland, diagnosis 2007-2011

Male Female

Number SN02677, 30 September 2015 20

3.3 Northern Ireland Of those diagnosed between 2004 and 2008, 68% of men and 70% of women survived at least one year from diagnosis. The corresponding five-year survival rates were 52% for men and 55% for women. The male rates are broadly in line with the rates from England and Wales as presented above, whilst the female rates are lower than the English and Welsh equivalents. However, data for the equivalent time period for Northern Ireland (up to 2011) is not available, so direct comparison is not possible.

Source: Northern Ireland Cancer Registry

67.5%

51.5%

70.3%55.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

1-Year Survival 5-Year Survival

Chart 18: Cancer survival rates, Northern Ireland, diagnosis 2004-2008

Male Female

21 Cancer Statistics: In Detail

4. Specific Cancer Sites

4.1 Breast Cancer 44,540 cases of breast cancer were registered among women in the UK in 2013.20 20% of cases were among women aged under 50.

Incidence of breast cancer among women rose by 23% between 1995 and 2003.

Source: ONS Cancer Registration 2013

In 2011, rates of breast cancer were around 5% lower in Northern Ireland than in the UK as a whole. The Welsh rate was just below the UK rate, whilst the incidence rate for Scotland was around 4% higher than those for the UK.21

Rates of breast cancer are highest in the South West and South East, which are 4% and 5% respectively above rates for England as a whole.

20 Men can contract breast cancer, but it is very rare. 291 cases were registered in the

UK in 2013 and 86 men are recorded as dying from breast cancer. Cancer Research UK has more information here: http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/about/types/breast-cancer-in-men

21 Cancer Research UK, Statistics by Cancer Type, last accessed 30 September 2015

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Chart 19: Incidence of Breast Cancer among women, England 1995-2013

Age 0-59 60-64 65-69 70-74 75-79 80-84 85-8990+

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Chart 20: Cumulative percentage of breast cancer registrations by age group

Number SN02677, 30 September 2015 22

Rates are lowest in London and the North East, which 6% and 5% below the English rate. However, compared to other cancer sites, breast cancer does not display much regional disparity.

Mortality 10,144 women died from breast cancer in 2013.22 10% of these deaths were among women aged under 50, whereas 36% were among women aged 80 or over. The age-standardised female death rate from breast cancer was 353 per million population. For those aged 90 and over, the rate was 3,494 per million.

Survival Breast cancer survival rates are high relative to other cancer sites. For women diagnosed between 2010 and 2011 the one-year survival rate was 96% while the five-year survival rate was 87%.

Source: Cancer Research UK

4.2 Lung Cancer 36,653 cases of lung cancer were registered in the UK in 2013. 54% of cases were in men, and 77% were in people aged 65 or over. Only 2.5% of cases were in people aged under 50.

Incidence of lung cancer among males fell by 28% between 1995 and 2013. By contrast, female rates rose by 26% over the same time period. Male rates of lung cancer remained 43% higher among men than women in 2013, but this is a notable change from 1995 when male incidence was 2.5 times that of women.

Lung cancer incidence is below that of breast cancer. For women, the risk of breast cancer is over 2.5 times as high.

22 ONS Mortality Statistics.

2010-2011

2010-2011

2005-2006

2005-2006

2000-2001

2000-2001

70% 75% 80% 85% 90% 95% 100%

Five-year

One-year

Chart 21: Breast cancer survival rates by year of diagnosis, England and Wales

23 Cancer Statistics: In Detail

Source: ONS Cancer Registration 2013

UK Countries In 2012 rates of male lung cancer were 26% higher in Scotland than in the UK as a whole. For Scottish women, the rate is 38% above the UK-wide rate, and indeed are almost as high as the male rate for the UK as a whole. The lowest rates are found among Northern Irish women, at 64.4 per 100,000.23

English Regions Rates of lung cancer are highest in the North East and North West. Male rates for both regions are 26% higher than rates for England as a whole, whilst for women rates are 59% and 33% respectively above the English rates. The lowest rates are found in the South East and South West.

23 Cancer Research UK.

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Chart 22: Incidence of Lung Cancer, England 1995-2013

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Chart 23: Cumulative percentage of lung cancer registrations by age group

Number SN02677, 30 September 2015 24

Mortality 30,437 people died of lung cancer in 2013, of which 55% were men.24 2% of deaths were among people under age 50, while 80% were of people aged 65 or over. The age-standardised death rate from lung cancer was 746 per million for men and 485 per million for women. Among those aged 90 and over, age-standardised male rates are more than double the equivalent female rate.

Survival Survival rates from lung cancer are low relative to other cancer sites. Age-standardised one-year survival rates for 2010-11 are 30% in men and 35% in women, up from 24% and 25% respectively among those diagnosed in 2000-2001. Five year rates for 2010-11 are 8% for men and 12% for women.

Source: Cancer Research UK

4.3 Colorectal Cancer 33,765 cases of colorectal cancer were registered in 2013. 56% of cases were among men. This gender difference is particularly evident in rectal cancer (64% male) and cancer of the rectosigmoid junction (60% male). 72% of colorectal cancers were in people aged 65 or over, while 6% were in people younger than 50.

Unlike breast and lung cancers, rates of colorectal cancer have risen only slightly since 1995, with a rise of 3% for men and 2% for women. In both men and women, rates of colorectal cancer are similar to those of lung cancer.

24 ONS Mortality Statistics.

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0% 10% 20% 30% 40%

Chart 24: Lung cancer survival rates by year of diagnosis, England and Wales

25 Cancer Statistics: In Detail

Source: ONS Cancer Registration 2013

UK Countries In 2011, male rates of colorectal cancer were around 15% higher in Scotland and Northern Ireland than in the UK as a whole. Among women, Northern Irish, Scottish and Welsh rates were above the UK-wide rate (14%, 11% and 8% respectively).25

English Regions Among English regions, patterns of colorectal cancer differ between genders. Male rates in the East are the lowest in England, whilst female rates are the second highest behind the South West. The highest male rates are in the North East, 12% above the rates for England as a whole. The lowest female rates are in London, where the second lowest male rates are also found.

Mortality 5,839 people died of colorectal cancer in 2013, of which 58% were men.26 5% of deaths were in those aged under 50, while 78% were among those aged over 65.

25 Cancer Research UK. 26 ONS Mortality Statistics.

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Chart 25: Incidence of Colorectal Cancer, England 1995-2013

MaleFemale

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Chart 26: Cumulative percentage of colerectal cancer registrations by age group

Number SN02677, 30 September 2015 26

Survival Colorectal cancer one-year survival rates for 2010-11 are 77% for men and 74% for women, rising from 71% and 68% in those diagnosed in 2000-2001. Five-year survival rates for 2010-11 are 58% for women and 59% for men.

Source: Cancer Research UK

4.4 Prostate Cancer 40,372 cases of prostate cancer were registered in 2013. Only 1% of these cases were in men aged under 50, whereas 76% were in men aged 65 or over.

Rates of prostate cancer among men were 43% higher in 2013 than in 1995. A major rise occurred between 1998 and 2001.

Prostate cancer in men is slightly more common than breast cancer in women, and has markedly higher incidence than either colorectal or lung cancer among men. Rates of prostate cancer are just over twice as high as those of lung cancer in men.

2010-2011

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Chart 27: Colorectal cancer survival rates by year of diagnosis, England & Wales

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Chart 28: Incidence of Prostate Cancer, England 1995-2013

27 Cancer Statistics: In Detail

Source: ONS Cancer Registration 2013

Prostate cancer rates were lowest in Scotland in 2011, at 20% lower than the UK as a whole. Northern Ireland also has incidence below the UK-wide rate, with Welsh rates higher than the UK as a whole.27

In the English regions, rates of prostate cancer are markedly lower in the North East than any other region, 17% lower than the England average. The three regions with the highest incidence are, in descending order, the South West, the East, and the West Midlands.

Mortality 9,726 people died of prostate cancer in 2013.28 Less than 0.5% of these deaths were among men under 50. 94% of deaths were among men aged 65 or over. The age-standardised death rates were 479 per million among men.

Survival Prostate cancer survival rates are high relative to other cancer sites. 94% of patients diagnosed between 2010 and 2011 survived for one year, and 85% survived for five years. This is an improvement from 2000-01, where rates were 89% for one-year survival and 73% for five-year survival.

Source: Cancer Research UK

27 Cancer Research UK. 28 ONS Mortality Statistics.

Age 0-59 60-64 65-69 70-74 75-79 80-84 85-8990+

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Chart 29: Cumulative percentage of prostate cancer registrations by age group

2010-2011

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Five-year

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Chart 30: Prostate cancer survival rates by year of diagnosis, England and Wales

Number SN02677, 30 September 2015 28

4.5 Skin Cancer 12,246 cases of skin cancer were registered in 2013, with an almost even gender distribution. 24% of these cases were among people aged under 50 – much higher than most cancers. Among women, 29% of cases were in those aged under 50 and 14% were in those aged under 40. Overall, 50% of cases were among people aged 65 or over.

Rates of skin cancer among men are more than 2.5 times higher than in 1995. Incidence among women has also risen, albeit at a slower rate, having risen by 91% since 1995. Male incidence became larger than female incidence in 2005.

Skin cancer is rarer than lung, prostate or colorectal cancer. Men are just under seven times more likely to contract prostate cancer than skin cancer, and women are over seven times more likely to contract breast cancer than skin cancer. As for lung cancer, male rates are approximately 3.5 times that of skin cancer, whereas female rates are almost three times as high for lung cancer.

Source: ONS Cancer Registration 2013

UK Countries In 2011 incidence rates for Welsh and Scottish men were 5% higher than the UK rate, whilst the rate for Northern Irish men is 26% below the UK rate. The rates for Scottish and Welsh women are similar to their

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Chart 31: Incidence of Skin Cancer, England 1995-2013

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Chart 32: Cumulative percentage of skin cancer registrations by age group

29 Cancer Statistics: In Detail

male equivalents, whilst the rates for Northern Irish women is 8% below that of the UK.29

English Regions Incidence rates of skin cancer are highest in the South West, at 41% (men) and 27% (women) above the English rate. The South East also has high incidence. London’s rates are markedly below those of any other region for men and women – male rates there are less than half of those in the South West. The gender gap also differs between regions. In London, male rates are only 1% higher than female rates, whereas in the East Midlands the gap is 24%.

Mortality 2,641 people died of skin cancer in 2013, of which 57% were men. 14% of deaths were among those aged under 50. 72% of deaths were among those aged 65 or over. The age-standardised death rates were 51 per million among men and 32 per million among women.30

Survival Skin cancer survival rates are high relative to other cancer sites. 97% of men and 98% of women diagnosed between 2010 and 2011 survive one year, and 92% of women survive for five years. For men, the five-year survival rate is 88%.

Source: Cancer Research UK

4.6 HPV-Related Cancers Some incidences of human papillomaviruses (HPVs), known as high-risk or oncogenic HPVs, can cause cancer. The most well-known HPV-related cancer is cervical cancer, but HPV can also lead to cancers of the vulva, vagina, anus, penis and the lining of the mouth and throat.

29 Cancer Research UK. 30 ONS Mortality Statistics.

2010-2011

2010-2011

2010-2011

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0% 20% 40% 60% 80% 100%

Chart 33: Skin cancer survival rates by year of diagnosis, England and Wales

Number SN02677, 30 September 2015 30

Table 5: Incidence, mortality and survival data for HPV-related cancers

More information on HPV-related cancer can be found on Macmillan Cancer Support’s website.

4.7 Other Cancer Sites Data on other cancer sites can be obtained from the ONS and Cancer Research UK publications sourced above. Alternatively, please contact the relevant specialists at the House of Commons Library who will be happy to provide data relating to any other cancer site.

1-year 5-yearCervix F 2,639 9.8 28 82.8% 67.4%Lip, mouth and pharynx M 4,958 19.6 62 - -

F 2,326 8.9 27 - -Anus M 369 1.6 - - -

F 646 2.5 - - -Vulva F 1,061 4.0 - - -Vagina F 179 0.7 - - -Penis M 486 2.2 - - -

Incidence: age-s tandardised rate per 100,000 population

Morta l i ty: age-s tandardised rate per mi l l ion population

Entries marked with a dash are unavai lable

Source: ONS Cancer Regis tration, ONS Morta l i ty Statis tics , and Cancer Research UK.

SurvivalMortalityIncidenceCasesGenderSite

31 Cancer Statistics: In Detail

5. Performance and Waiting Times

The NHS monitors performance for cancer treatment on a number of key standards.31 These include:

• 14-day wait from urgent GP referral to first specialist appointment • 31-day wait from diagnosis to first definitive treatment • 62-day wait from urgent GP referral to first definitive treatment

5.1 14-Day Wait from Referral to Specialist Appointment

In April-June 2015, 93.6% of patients received their first specialist appointment within two weeks of referral. This was down slightly from the high of 95.5% for the same quarter in 2013-14. The operational standard (target) for this measure is 93%.

The performance rate varies between cancers. For gastrointestinal cancers the rate is below 93%. However, for haematological malignancies (excluding acute leukaemia) and testicular cancer the rates are above 96%.

5.2 31-Day Wait from Diagnosis to Treatment Of admitted patients, 97.5% received their first treatment within 31 days of diagnosis in April-June 2015. This was down slightly from the high of 98.4% for the same quarter in 2012-13. The operational standard for this measure is 96%.

Breast and lung cancer patients fared best on this measure, with over 98% receiving treatment within 31 days. For urological cancer patients the rate was 94.1%.

5.3 62-Day Wait from Urgent GP Referral to Treatment

Overall, 82% of admitted cancer patients receive treatment within 62 days of urgent GP referral in April-June 2015. This was down from the high of 87.5% for the same quarter in 2012-13. The operational standard for this measure is 85%.

The figure is over 95% for breast and skin cancer. Of lung cancer patients, only 70.9% were treated within 62 days of referral. Urological and lower gastrointestinal cancer patient treatment rates within this measure are also below 75%.

31 All data in this section is taken from the relevant NHS England statistical work areas:

http://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/

Number SN02677, 30 September 2015 32

6. Screening

6.1 Breast The NHS Breast Screening Programme offers free breast screening every three years for all women aged 50 to 70. In 2013-14, 76% of women aged 53-64 had undergone a breast screening test in the past three years. Coverage has fluctuated between 75% and 77% since 2004. 13% of eligible women aged 53-64 – about half a million – had never had a screening test.32

The highest rate of women never screened was in London, at 18%, while the lowest was in the East Midlands, at 10%. Correspondingly, these two areas had the lowest and highest rates (respectively) of women screened within the past three years.

At the English local authority level, most of the authorities with lower coverage were London boroughs. The exceptions in the lowest twenty authorities were Manchester, Blackburn with Darwen, Oldham, Liverpool, Slough and Southend-on-Sea.

Table 6: Breast screening coverage, highest and lowest local authorities, 2013-14

32 Health & Social Care Information Centre, Breast Screening Programme, England

2013-14, 2015

1 Leicestershire 83.6% 150 Islington 58.2%2 Rutland 82.5% 149 Kensington and Chelsea 59.3%3 Shropshire 81.9% 148 Manchester 60.5%4 Cumbria 81.7% 147 Hammersmith and Fulham 61.0%5 Nottinghamshire 81.6% 146 Camden 61.0%6 Wokingham 81.5% 145 Westminster 61.3%7 Derbyshire 81.5% 144 Hackney & City of London 61.9%8 West Berkshire 81.4% 143 Tower Hamlets 62.8%9 Northumberland 81.2% 142 Lambeth 63.3%

10 Barnsley 80.6% 141 Wandsworth 64.3%11 York 80.5% 140 Kingston upon Thames 64.4%12 South Gloucestershire 80.5% 139 Southwark 64.6%13 Dorset 80.4% 138 Blackburn with Darwen 65.2%14 Gloucestershire 80.3% 137 Lewisham 65.7%15 Cornwall & Isles of Scilly 80.3% 136 Merton 66.3%16 North Yorkshire 80.2% 135 Croydon 66.5%17 Poole 80.2% 134 Oldham 67.0%18 Isle of Wight 80.1% 133 Liverpool 67.8%19 Wiltshire 80.0% 132 Slough 67.8%20 Northamptonshire 80.0% 131 Southend-on-Sea 67.8%

% in last 3 years, age 53-64

33 Cancer Statistics: In Detail

6.2 Cervix All women between the ages of 25 and 64 are eligible for a free cervical screening test every three to five years. 78% of eligible women have been screened at least once in the last five years. This is a slight fall from 2004, when the figure was 81%.33 Table 7, Figure 1 and Chart 35 (below) show breakdowns by both local authority and age group.

At a local level, London once again has low coverage rates, with half of the bottom 20 local authorities – although coverage for the lowest areas is higher than for the areas with the lowest breast cancer screening coverage. The coverage for the highest areas is broadly similar to that of the best performing authorities for breast cancer screening.

Table 7: Cervical screening coverage, highest and lowest local authorities, 2013-14

33 HSCIC, Cervical Screening Programme, England 2013-14, 2015

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Chart 34: Breast screening coverage by age (% in last 3 years), England 2013-14

1 Nottinghamshire 82.6% 150 Kensington and Chelsea 67.8%2 Derbyshire 82.6% 149 Hammersmith and Fulham 68.6%3 North East Lincolnshire 82.4% 148 Westminster 69.5%4 East Riding of Yorkshire 82.0% 147 Camden 69.9%5 South Gloucestershire 81.9% 146 Manchester 71.1%6 Rutland 81.8% 145 Harrow 71.2%7 Bexley 81.8% 144 Ealing 72.0%8 Bromley 81.7% 143 Liverpool 72.1%9 Wokingham 81.7% 142 Blackburn with Darwen 72.2%

10 Northumberland 81.3% 141 Birmingham 72.2%11 Dorset 81.3% 140 Hounslow 72.4%12 Leicestershire 81.3% 139 Leicester 72.6%13 Havering 81.3% 138 Middlesbrough 73.2%14 Bracknell Forest 81.3% 137 Blackpool 73.4%15 West Berkshire 81.2% 136 Wandsworth 73.4%16 Barnsley 81.1% 135 Brent 73.5%17 Central Bedfordshire 81.1% 134 Slough 73.5%18 Poole 81.0% 133 Luton 73.5%19 North Yorkshire 81.0% 132 Hillingdon 73.6%20 Calderdale 81.0% 131 Portsmouth 73.8%

% in last 5 years, age 25-64

Number SN02677, 30 September 2015 34

Figure 2: Locations of highest and lowest rates of cervical screening coverage by local authority

Coverage increases sharply from age 20 to 30, when it stays at around 75-80% until women stop being eligible for free screenings at age 65.

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Chart 35: Cervical screening coverage by age (% in last 5 years), England 2013-14

35 Cancer Statistics: In Detail

7. International Data Figure 3: Incidence, age-standardised rates per 100,000 population

Figure 4: Mortality, age-standardised rates per 100,000 population

Source: GLOBOCAN 2012

7.1 Incidence and Mortality International comparisons in this section are taken from the GLOBOCAN 201234 report, which estimates incidence and mortality for major cancer

34 World Health Organization, Globocan 2012: Estimated Cancer Incidence, Mortality

and Prevalence Worldwide in 2012, last accessed 30 September 2015

Number SN02677, 30 September 2015 36

types across the world. The incidence rates reported below are calculated using the World Age-Standardised Population rather than the European Age-Standardised Population, so are not comparable or consistent with those discussed in previous sections.

Chart 36 (below) shows incidence and mortality in selected countries. Recorded cancer incidence varies greatly across countries, from 91 per 100,000 in Saudi Arabia to 338 per 100,000 in Denmark. The UK’s incidence rate of 273 is relatively high. However, mortality rates are much more uniform between countries, as the upper section of the chart shows. One should be cautious about interpreting these wide variations in registered incidence as indicators of the scale of variation in cancer prevalence, since in some cases low incidence rates may reflect low quality cancer registration data (and vice versa for high rates).

Source: GLOBOCAN 2012

Because of the mortality-incidence anomaly, it is useful to look at the ratio between mortality rates and incidence rates in each country. Assuming equivalent data quality, a high mortality-incidence ratio suggests either that few cancers beyond those which are terminal are detected, or that the quality of medical care is such that few of those with cancer survive. A low ratio suggests either that many non-fatal cancers are detected, or that the quality of medical care is such that many detected cancers can be treated.

Chart 37 (below) compares mortality-incidence ratio with the raw incidence data found above. There is a negative relationship (r2=0.674) between the two variables, suggesting that countries with high incidence rates are likely to have low mortality-incidence ratios, while countries with low incidence rates are likely to have high incidence-mortality ratios. As such, even though countries like India have very low incidence rates, their mortality rates are high, at around 70% of

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Chart 36: Cancer incidence and mortality rates (age-standardised) per 100,000, selected countries

Incidence Mortality

37 Cancer Statistics: In Detail

incidence. By contrast, the figure for the UK is closer to 40%, despite the UK’s incidence being around three times that of India.

Source: GLOBOCAN 2012

7.2 Survival Detailed data on survival rates is given in EUROCARE-535, an epidemiological study of patients diagnosed between 2000 and 2007. The table on the following page shows in detail the performance of European nations for key cancers, with colour coding denoting performance relative to other European countries for that particular cancer, gender and survival measure.

The data in Table 8 (below) suggests that the UK and Ireland perform slightly below the European average for many cancers. This discrepancy is particularly evident in cancers of the pancreas and lung. On the other hand, the performance of Ireland, Northern Ireland and Scotland on skin cancer survival is above the European average.

Similar findings were published in The Lancet in 2011, finding that between 1995 and 2007 relative cancer survival was lower in the UK and Denmark than in Norway, Canada, Australia and Sweden.36

35 European Cancer Registry, EUROCARE-5, last accessed 30 September 2015 36 The Lancet, ‘Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995—2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data’, 377:9760, January 2011

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Chart 37: Correlation between incidence and mortality-incidence ratio

Number SN02677, 30 September 2015 38

Table 8: Cancer survival rate (%), Europe 2007

M1 = male one-year survival rate, % F1 = female one-year survival rate, %

M5 = female five-year survival rate, % F5 = female five-year survival rate, %

Source: Eurocare 5

F1 F5 F1 F5 F1 F5 M1 M5 F1 F5 F1 F5 M1 M5 F1 F5 M1 M5 F1 F5 M1 M5 M1 M5 F1 F5 M1 M5European average 94.8 81.8 84.1 62.4 79.1 57.7 78.7 55.8 90.5 76.2 42.8 15.9 37.6 12.0 78.8 61.9 77.4 57.2 27.9 7.9 24.7 6.3 94.6 83.4 96.1 86.6 93.9 79.2Central

Austria 93.6 82.1 83.9 66.1 81.4 62.3 80.8 60.8 90.3 77.9 46.7 20.4 41.4 14.9 78.1 62.6 76.6 59.7 30.3 9.0 26.7 7.3 94.7 90.2 93.4 86.0 90.1 80.4Belgium 95.7 82.7 86.3 66.5 84.9 63.4 83.9 61.3 92.3 78.6 48.5 18.7 43.6 14.3 82.8 67.0 81.9 63.7 36.8 11.7 32.8 9.3 97.1 89.5 97.0 86.2 95.1 79.1France 96.6 86.1 85.6 61.4 83.4 60.7 81.7 57.8 90.2 73.0 48.3 16.5 42.1 13.1 84.6 68.4 83.3 63.9 36.1 9.2 30.3 6.4 97.5 88.8 98.1 89.3 97.6 84.4Germany 95.3 83.6 84.3 63.5 82.9 62.9 82.2 61.0 93.0 81.3 46.6 18.5 41.3 14.5 81.8 66.0 81.1 61.3 33.8 9.5 30.6 8.4 96.4 89.3 97.7 91.5 96.4 86.9Netherlands 96.5 84.5 84.6 65.8 80.0 59.3 79.6 58.2 91.1 78.5 40.5 13.9 39.5 13.0 79.2 61.7 77.5 57.3 19.4 4.0 18.8 4.1 96.5 83.3 98.7 91.5 97.2 84.4Switzerland 96.8 84.6 85.1 63.9 84.5 62.3 84.7 61.9 92.6 78.5 48.8 17.5 42.5 14.2 83.4 69.1 82.9 63.2 33.2 8.0 30.7 5.4 97.2 86.6 99.0 91.4 97.6 89.2

EasternBulgaria 91.4 71.7 77.4 51.0 67.8 43.2 65.7 41.6 86.4 69.6 27.7 10.0 22.6 5.5 64.9 43.7 60.9 32.8 14.6 4.9 13.9 5.4 79.3 50.5 83.6 58.8 74.7 40.7Czech Republic 92.0 78.0 83.6 63.0 73.9 52.0 73.5 50.2 89.7 76.9 38.1 14.4 33.0 10.5 76.2 59.2 76.3 55.9 19.7 6.4 17.1 5.0 92.0 78.1 96.4 85.3 95.0 81.2Estonia 91.3 72.1 84.6 64.2 72.1 52.0 72.5 48.2 84.4 70.0 37.0 15.6 33.1 10.4 76.6 56.2 74.6 47.2 20.1 6.2 20.1 4.6 90.5 72.8 94.1 77.3 92.8 60.6Latvia 88.3 69.3 74.6 51.0 66.2 39.9 66.6 40.2 86.1 69.8 36.6 19.3 31.0 10.5 68.1 50.6 68.3 43.7 17.0 15.4 6.3 85.3 65.6 88.8 68.2 83.2 59.9Lithuania 87.2 66.7 77.4 56.0 67.7 45.3 66.3 45.4 87.0 73.4 32.0 13.1 28.2 8.0 73.0 53.8 69.3 44.9 24.4 6.4 19.9 5.5 91.3 82.8 90.2 73.5 86.1 61.7Poland 90.9 71.6 79.9 53.6 70.1 46.5 71.4 44.9 88.4 70.8 43.4 18.6 36.8 12.9 70.9 48.8 67.5 39.8 24.4 8.3 20.0 7.8 87.8 66.6 87.6 66.8 81.7 55.4Slovakia 91.5 73.9 81.4 60.4 73.1 49.4 72.5 48.1 88.0 71.0 40.4 13.8 34.3 9.4 72.3 52.4 69.9 44.7 19.5 6.5 17.8 5.4 86.7 65.3 94.2 80.3 89.8 67.6

NorthernDenmark 94.9 81.5 82.8 64.6 76.9 55.7 75.7 52.7 90.5 78.3 36.5 11.3 32.6 9.4 81.2 64.9 80.2 62.5 19.6 4.5 18.0 4.0 92.9 69.2 97.6 91.6 96.2 82.9Finland 96.3 85.7 87.2 67.3 81.9 62.7 80.3 58.7 92.6 83.2 44.1 15.6 36.8 9.7 77.7 62.7 75.8 56.9 27.8 5.9 22.2 3.8 97.8 90.1 97.6 89.3 94.3 81.4Iceland 96.7 87.2 90.6 69.6 83.8 65.9 81.7 65.6 90.3 80.8 41.9 14.4 40.8 13.2 86.8 78.9 85.7 68.8 25.0 24.1 4.4 96.6 82.4 98.8 84.7 94.6 83.5Norway 96.4 84.7 87.8 71.0 81.8 62.6 80.5 58.7 93.0 82.9 39.8 14.5 35.6 12.0 82.8 66.0 79.8 61.8 22.2 4.8 21.2 5.4 96.5 83.4 98.1 90.6 96.1 81.5Sweden 97.3 86.0 87.1 66.8 83.8 63.3 83.4 59.3 94.6 85.5 44.7 17.0 39.2 12.6 83.0 66.5 83.2 62.9 25.6 5.2 23.6 5.8 98.0 87.5 98.7 92.3 97.9 86.2

SouthernCroatia 89.8 76.3 81.8 65.1 69.5 50.5 68.1 48.0 86.3 75.5 37.9 17.1 34.2 14.4 69.2 51.2 66.0 44.0 21.1 10.8 21.2 10.6 86.3 71.2 87.7 76.0 82.0 65.0Italy 96.7 85.5 88.3 67.5 81.8 60.5 81.8 59.5 91.4 76.1 46.2 17.3 41.0 13.2 79.3 62.9 79.1 60.9 30.7 8.6 26.7 6.2 96.4 88.4 97.1 88.9 95.7 81.9Malta 95.7 80.8 74.8 76.7 54.2 78.4 58.9 90.4 80.2 34.4 18.0 28.0 8.4 73.0 56.6 63.5 41.2 22.7 18.1 93.9 85.0 98.0 87.5 99.5 88.5Portugal 95.3 83.3 85.8 61.3 79.9 58.6 79.4 56.6 88.2 72.1 45.2 17.5 35.4 9.6 73.3 55.7 72.3 52.8 28.7 11.3 24.9 6.9 95.5 89.2 95.3 84.3 91.1 74.3Slovenia 93.9 78.7 84.9 68.2 76.3 53.0 74.1 51.9 91.0 78.6 41.3 12.8 34.9 10.1 78.2 58.7 76.7 51.5 20.8 6.2 19.2 4.7 91.8 74.3 96.4 83.9 94.8 77.0Spain 95.1 82.8 85.9 63.9 78.9 57.6 78.7 56.4 89.0 74.4 42.1 14.7 37.0 10.1 78.6 63.3 76.2 58.2 24.6 7.0 22.7 5.2 95.0 84.6 97.4 88.9 94.4 79.1

UK & IrelandEngland 93.5 79.3 79.9 59.6 74.1 53.2 74.5 51.3 89.1 75.7 32.1 9.9 29.0 8.0 76.1 59.1 74.5 54.8 20.5 5.1 18.8 4.3 93.9 80.3 97.1 89.1 95.0 80.7Ireland 93.7 79.0 81.9 58.9 75.8 56.4 76.6 52.5 89.2 74.2 36.4 14.5 28.3 10.0 79.0 65.1 78.0 61.6 24.1 9.8 17.9 4.8 95.2 85.5 98.3 90.3 95.2 80.7Northern Ireland 94.4 81.9 83.2 61.1 76.2 55.6 76.7 52.6 87.1 73.6 32.3 12.0 29.8 10.5 77.0 63.6 74.6 54.6 15.3 15.5 1.5 94.8 83.3 98.7 94.6 96.0 85.6Scotland 93.8 78.5 80.8 57.9 75.8 54.9 76.3 53.1 89.9 76.9 33.3 9.5 29.1 8.0 78.1 62.4 77.5 58.3 18.2 16.4 3.6 93.4 78.8 97.8 92.1 96.0 84.5Wales 91.9 78.2 77.9 58.1 73.1 52.3 73.8 50.0 87.9 73.7 31.3 9.5 26.7 7.9 76.7 59.8 74.5 53.9 20.4 6.9 17.6 4.3 91.3 78.0 95.0 84.6 92.3 74.1

Cancer Pancreas Prostate SkinBreast Cervix Colorectal Uterus LungNon-Hodgkin's

Lymphoma

Worse Better

(Relative to European average)

BRIEFING PAPER Number SN02677, 30 September 2015

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