Welsh Cancer Intelligence and Surveillance Unit … Official... · Welsh Cancer Intelligence and Surveillance Unit ... Julie Howe, Helen Crowther, Dr Dyfed Wyn Huws ... Welsh Cancer

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Welsh Cancer Intelligence and Surveillance Unit Official Statistics 2013 data

Published 4 February 2015

Welsh Cancer Intelligence and Surveillance Unit

Health Intelligence Division, Public Health Wales Uned Deallusrwydd a Gwyliadwriaeth Canser Cymru

Cyfadran Deallusrwydd Iechyd, Iechyd Cyhoeddus Cymru

Cancer in Wales A summary report of the population cancer incidence,

mortality and survival – includes new 2013 data

released as Official Statistics on 3 February 2015

www.wcisu.wales.nhs.uk

View the Official Statistics using the interactive dashboard to conduct your own analysis according to cancer type, health board or all Wales level, by incidence,

mortality or survival for the time period 2001-2013 at www.wcisu.wales.nhs.uk

http://www.wcisu.wales.nhs.uk/

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Project team

Dr Ceri White, Rebecca Thomas, Tamsin Long, Ciarán Slyne, Julie Howe, Helen Crowther, Dr Dyfed Wyn Huws

Acknowledgements A special thanks to all the Welsh Cancer Intelligence and Surveillance Unit’s staff, especially the registration team without whom the data used within this report would not be produced.

Thanks to the following people for their help with this publication: Dr Clare Elliot, Gwenllian Evans, Dr Judith Greenacre, Dr Ciarán Humphreys, Isabel Puscas, Hannah Thomas and Janet Warlow

Publication Details Title: Cancer in Wales, A summary report of the population cancer incidence, mortality and survival – includes new

2013 data released as Official Statistics

Date: This commentary published 4 February 2015 based on Official Statistics released on 3 February 2015 ISBN: 978-1-910768-00-6

Contact:

Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales 16 Cathedral Road

Cardiff CF11 9LJ Email: [email protected] Website: www.wcisu.wales.nhs.uk

© 2015 Public Health Wales NHS Trust

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.

Definitions 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 reflect 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) using the 2013 European Standard Population (ESP) unless otherwise specified.

Statistical significance If a difference between rates or survival between populations is statistically significant, it means that that difference is unlikely to have occurred due to chance alone, and that we can be more confident 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 significant. Just because a difference is statistically significant 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 specific 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 five 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” in this report, by convention, we always mean all cancers excluding non-melanoma skin cancer.

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Key findings

All cancers combined – number of new cases and incidence rates

The number of new cases of cancer in residents

of Wales continues to rise in men and women –

there were 19,026 new cases in 2013, up by

over 12 per cent compared to 2004

The largest increases in numbers in men and

women were in the 65-69 and 70-74 year-old

age groups

In general, cancer becomes more common with

increasing age, except for the 90+ age group in

women – the age specific cancer rate rises

more steeply in men than women with

increasing age, and for ages 70 years and over,

rates in men are over 50 per cent higher than

women

Age-specific all cancer incidence rates in older

age groups reduced dramatically in men from

2004 to 2013 whereas in women there was little

change.

All cancers combined – number of cancer deaths and mortality rates

The increase in the number of cancer deaths

over the ten years up to and including 2013

was small, especially in women - there were

small changes in the majority of age groups,

but with a large increase in both sexes for those

aged 85 years and over

Cancer mortality rates increase with age,

similar for both sexes up to 55-59 years they

then diverge - in men aged 90 years and over

the age-specific cancer mortality rate was twice

that for women in 2013

The age-specific cancer mortality rates

decreased for the majority of age groups

between 2004 and 2013, and these decreases

were generally smaller in women than men

There were slight increases in mortality rate

amongst 85-89 year old women and 90 years

and over men, with little change for 90+

women

All cancers combined – survival Survival from all cancers combined steadily

improved – for the first time we saw over 70

per cent of people diagnosed with cancer

surviving at least one year

Women have better survival than men but the

gap is decreasing

All cancers combined – variations between geographic areas

The incidence rate for all cancers combined

varies greatly between health board and local

authority populations - the highest local

authority cancer incidence rate in Merthyr Tydfil

is almost 20 per cent higher than the lowest in

Ceredigion in 2009-2013

All cancer mortality rates are highest in some

local authorities in the south east Wales valleys

and north east Wales - the highest is in Blaenau

Gwent which is 12 per cent higher than Wales,

whereas the rate in Monmouthshire is 16 per

cent lower than Wales

One year survival from all cancers combined is

very similar in all health board populations

All cancers combined – inequalities by area deprivation The gap in all cancers incidence rate between

the least and most deprived areas of Wales

continues to increase

The gap in mortality rate between least and

most deprived areas has slightly increased

Survival from all cancers combined is lower in

more deprived areas, but the gap between most

and least deprived areas has decreased

Number of new cases for different cancer types In 2013 the most common cancers in Wales in

terms of numbers were female breast cancer,

prostate, lung and bowel cancer

Prostate, bowel, female breast, melanoma and

lung cancer had the largest increases in

numbers over 10 years

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Almost all the increase in lung cancer numbers

occurred in women because the number of new

cases diagnosed in women increased by almost

a third, compared to only two per cent in men

Almost two thirds of the increase in bowel

cancer numbers was in men because bowel

cancer cases increased by a quarter in men and

by almost a fifth in women

Around two thirds of the increase in melanoma

was in men because the number of cases in

men nearly doubled, and in women increased

by nearly a half

Cervical (neck of the womb), oesophageal

(gullet) and stomach cancers showed decreases

in numbers

Liver cancer in men showed the largest

percentage increase in numbers, doubling over

10 years, and for women the percentage

increase in liver cancer numbers was as much

as 70 per cent

Uterine cancer (cancer of the womb), head and

neck cancer, and urinary tract excluding

bladder cancer in men also showed increases in

numbers of nearly a half

Mortality rates of different cancers

Lung cancer had the highest age-adjusted

mortality rate in Wales in 2013 followed by

prostate and female breast cancer

The liver cancer mortality rate in men increased

by over a half, and melanoma mortality rate in

men increased by nearly a third

Lung cancer had the largest absolute increase

in mortality rate in women, but liver cancer had

the largest percentage increase of nearly two

thirds

The gap in mortality rate between the least and

most deprived areas of Wales is very large for

lung cancer and it has widened, although the

modest gap in bowel cancer mortality rate

narrowed slightly

Survival from different cancer types There was some improvement in one-year

survival for the majority of cancer types, but

survival from pancreas, lung and liver cancer is

still very poor - testicular cancer has the

highest one year survival rate followed closely

by melanoma, prostate and female breast

cancers

One year survival for all cancers combined

varies little between health board populations,

but for some cancer types, such as oesophageal

cancer, there is wide variation

Lung cancer one year survival is lowest in the

most deprived areas, although the gap is much

less than for incidence rate, and unlike

incidence, the deprivation gap in survival has

decreased. Our recent report on lung cancer

survival is available at

http://www.wcisu.wales.nhs.uk/lung-cancer-

overview

Bowel cancer has a deprivation gap in incidence

and one year survival, worse in the most

deprived areas - the gap in incidence is much

smaller than lung cancer, but the deprivation

gap in one year survival is wider

http://www.wcisu.wales.nhs.uk/lung-cancer-overview

http://www.wcisu.wales.nhs.uk/lung-cancer-overview

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1Incidence, mortality

and survival for all cancers combined

Number of new cancer cases continues to increase in Wales among both men and women

Over the ten years up to and including 2013 the

number of cancer cases slowly increased. In 2013 a

total of 2,105 - or over 12 per cent - more people

living in Wales were diagnosed with cancer

compared to 2004. The increase separately

happened in both men and women.

There were 19,026 new cases of cancer

diagnosed among residents of Wales in 2013

compared with 16,921 new cases in 2004.

9,808 (or 11.5 per cent more) new cases of

cancer were diagnosed in men and 9,218

(or 13.4 per cent more) new cases were

diagnosed in women in 2013 compared with

8,795 cases in men and 8,126 cases in

women in 2004.

Incidence (numbers or rates of new cancer

cases) varies between cancer type and

gender over time (see section 4).

The increase in the number of cancer deaths is small, especially in women and despite the rise in the number of new cases

Over the last ten years the number of cancer

deaths registered in Wales shows small fluctuations

year on year. In 2013 the number of cancer

deaths showed a small increase compared to 2012.

There were 8,688 cancer deaths registered

among residents of Wales in 2013 compared

with 8,484 cancer deaths in 2004 – a rise of

2.4 per cent.

4,579 cancer deaths were registered in men

with 4,109 cancer deaths registered in

women in 2013 compared with 4,462 cancer

deaths in men and 4,022 cancer deaths in

women in 2004.

Cancer mortality (numbers or rates of

cancer deaths) varies between cancer type

and gender over time.

Cancer survival is steadily improving in Wales

One year survival from all cancers combined is

continuing to increase, although the increase in

more recent years is slower than earlier years

(figure 1). For the first time, over 70% of people

diagnosed with cancer within the latest time period

of 2008-2012 in Wales are now surviving for at

least one year. However, there are wide variations

between different types of cancer and inequalities

in survival across population groups and

geographies in Wales (section 2).

Five year survival (for patients diagnosed 2004-

2008) is also increasing but more slowly than in

previous years. This increase is still encouraging,

as over half of people diagnosed with cancer can

expect to survive for at least five years. To allow

for all patients to be followed up for five years,

survival calculations are only available for

diagnoses made up to 2008 at present.

There are numerous factors that may affect

survival, including type of cancer, early diagnosis

and stage at diagnosis, general health, patient age,

improvements in effective treatments and fair

access to effective treatment, through to

participation in effective population screening

programmes for some cancers such as breast,

bowel and cervical cancers.

Risk factors for many cancers are known but

vary by cancer type. More than 40% of all cancers in the UK are linked to risk factors

such as tobacco, alcohol, being overweight, diet, physical inactivity, infection, radiation, occupation and post-menopausal hormones.

Smoking causes nearly a fifth of all cancers in the UK including over 80% of lung

cancers.

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Figure 1: Gradual increase in one and five year relative survival (%) for all cancers in Wales over time

Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registry www.wcisu.wales.nhs.uk

Cancer incidence by age and sex

The number of people registered with a new

diagnosis of cancer in Wales in 2013 remains low

up to age 40 years in women and 45 years in men.

From then on the annual number of cases starts

increasing steeply with age for both men and

women (figure 2). At younger ages the numbers

are similar for each gender.

More women than men are diagnosed with cancers

between the ages of 30 to 54, and at 90 years and

over. The increase starts earlier in women due to

women specific cancers such as breast and cervical

cancer. For older age groups there are increasingly

more women than men alive. More men than

women were diagnosed with cancer between age

bands 60-64 years and 80-84 years.

The largest increase in numbers has occurred in

65-69 age groups in both men and women, as well

as the 70-74 groups. The 50-54 and 90+ age

groups also show notable increases in women.

These shifts have resulted in the most common age

at diagnosis for both men and women in 2013

occurring between 65 and 69 years (1,688 men,

1,362 women). This is about 10 years younger

than it was a decade previously. Demographics

explain most of these changes in the number of

people diagnosed with cancer in specific age groups

in men and women.

Figure 2: The most common age at diagnosis has fallen from 75-79 years in 2004 to 65-69 years in 2013 for both men and women


Cancer incidence rates

The rate takes into account the differing sizes of

the population in each age group.

Age-specific cancer incidence rates are very low for

those aged under 40 years in 2013. After this age

the rates start rising slowly in men and slightly

more steeply in women. The increase continues

steadily with age in women. Women however, show

a decrease in the rate for those aged 90 years and

over. In men after 50 the rates rise steeply with no

decrease at very old age. However, the rate of

increase does become less steep from age 75

onwards. Women have higher rates than men up to

the age of 59 years. From age 60 years onwards,

the incidence rates are higher in men compared to

women and the gap continues to increase for all

remaining ages. For ages 70 years and over, rates

in men are over 50% higher than women (figure

3).

In men there has been a dramatic reduction in age-

specific rates in the older age groups in 2013

compared with 2004 which is probably due to lung

cancer (see section 4). In women there has been

little change over time although there has been a

small increase in some age groups. For example,

age-specific incidence rates have markedly

decreased in men for all age groups 75 and older,

whereas in women there have been small to

modest increases in rates in the 50-54, 65-69, 80-

84 and 85-89 age groups.

Different cancer types have reduced or increased in

age-specific rates by different amounts in men and

women.

... in general cancer becomes more

common with increasing age.

However, there are exceptions for

certain cancer types like childhood

cancers and those predominantly

affecting younger adults....”

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Figure 3: The age-specific cancer rate rises more steeply for men than for women with increasing age


Cancer deaths by age and sex

The number of cancer deaths registered amongst

Wales’ residents in 2013 remained low up to age 45

years. Numbers then increased substantially with

increasing age for both men and women (figure 4).

The peak for men was at 75-79 years whereas the

peak for women was 80-84 years.

Comparing the numbers of deaths in 2013 over the

previous ten years, there have been small changes

in the majority of age groups, but a large increase

was seen in both sexes for those aged 85 years

and over (figure 4). This is largely due to an

increase in the number of people in these older age

groups due to demographic changes, in part

leading to an increase in the number of new cancer

cases in men and women (see previously). This has

occurred despite the corresponding fall in incidence

rate in the oldest men and the incidence rate

remaining static in the oldest women.

Figure 4: The number of registered cancer deaths by age group shows small fluctuations over time in both men and women


Taking into account the demographic changes in

the number of men and women in each age group

between 2004 and 2013 there are different

patterns for trends in mortality rate compared to

the change in the number of deaths.

For men and women cancer mortality rates

increase with age (figure 5). Rates are similar for

both sexes up to 55-59 years but then diverge with

men having much higher rates compared to women

thereafter. The rate in men for those aged 90

years and over in 2013 is twice that for women.

The age-specific cancer mortality rate for men

decreased for the majority of age groups between

2004 and 2013, although there was a slight

increase in the rate for men aged 90 years and

over. The decreases in rate that occurred for most

age groups for women were much smaller than

those seen in most age groups in men. There was

also a slight increase in the mortality rate amongst

85-89 year old women and little change for the

90+ year old women.

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Figure 5: The age specific cancer mortality rates show little change over time in men and women


Women have better survival than men but the gap is decreasing

One year and five year relative cancer survival for

all cancer combined is increasing in both sexes.

Survival in women is higher than in men, partly

reflecting the mortality figures seen earlier in this

report (table 1). This is most likely due to the high

survival rates for female breast cancer patients.

The gap between both sexes has decreased over

time, possibly due to the improving survival for

prostate cancer in recent years. Relative survival

in men has increased by nearly seven percentage

points for one year and nearly five percentage

points for five years. Five year survival has shown

a relative improvement of 10.4% for men and

4.7% for women over time.

Table 1: Increases for one and five year relative survival from cancer for men and women over time, with the increases greater in men

One year relative survival (%)

Five year relative survival (%)

2000-2004

2008-2012

2000- 2004

2004-2008

Men 62.3 69.1 46.1 50.9

Women 67.3 71.8 53.1 55.6


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2 Cancer geography in

Wales

Cancer incidence by geography

The main determinants of the number of new

cancer cases in a defined population each year is

the size of the population and its age structure –

cancer incidence in general increases with age. The

change in the number of cases between 2004 and

2013 in each local authority or health board

population are largely explained by changes in

these two factors (figure 6).

Cancer incidence rates show great

variation between health boards and local authorities in Wales

Once we take account of the differences in

population size and age structure between

geographic areas of Wales, we see that there is

considerable variation in the age-adjusted cancer

incidence rates per 100,000 population (figure 7).

The incidence for Powys Teaching health board is 8

per cent lower than the incidence for Wales, and is

lower than would be expected by chance alone.

Similarly, the rate in Cwm Taf University health

board is 4 per cent higher than the incidence for

Wales, and is higher than would be expected by

chance alone. This accounts for a difference of

around 74 new cancer cases per 100,000

population between the highest and lowest

incidence rate health boards in Wales for the period

2009-2013.

Figure 6: Change in the number of new cancer cases diagnosed in Wales at local authority and health board level over time

Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registry www.wcisu.wales.nhs.uk ©Crown Copyright and database right 2015. Ordnance Survey 100044810

2004 2013

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Figure 7: The cancer incidence rate (EASR) per 100,000 populations is statistically significantly higher than Wales for two health boards in 2009-

2013


Figure 8: The highest local authority cancer

incidence rate in Merthyr Tydfil is almost 20 per cent higher than the lowest in Ceredigion in 2009-2013

Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registry www.wcisu.wales.nhs.uk ©Crown Copyright and

database right 2015. Ordnance Survey 100044810

Cancer incidence at small geographic area shows

greater variation (figures 8 and 9). The highest

rates are in the Merthyr Tydfil, Newport and

Torfaen local authority areas whereas the lowest

rates are in Powys and Ceredigion. Although not

the highest, there are also areas of high incidence

rates in the north east and south east of Wales.

Smaller areas with the highest rates are found

across much of the south Wales valleys, deprived

inner city areas and across many parts of north

east Wales. There are also several areas of

moderate or high incidence across parts of

Anglesey and Gwynedd and other areas of north

Wales as well as Carmarthenshire and

Pembrokeshire. There are also pockets of high

incidence rates in many rural towns.

Areas of lower incidence exist in some more

affluent urban areas of south Wales, but are few in

number across most rural areas apart from a small

number of affluent rural areas, and across the less

affluent rural areas of Ceredigion. Chance plays a

role in the large variations in cancer incidence at all

geographic levels, as well as past and present

socioeconomic inequalities. Areas of deprivation

and former industrialisation, in addition to many

associated health risk behaviours such as smoking,

obesity, diet and nutrition, alcohol and physical

activity account for a considerable amount of the

cancer incidence rates and their variation.

Figure 9: The cancer incidence rate at Middle Super Output Area (MSOA) shows considerable variation across Wales

Source: Welsh Cancer Intelligence and Surveillance Unit’s

Cancer Registry www.wcisu.wales.nhs.uk ©Crown Copyright and database right 2015. Ordnance Survey 100044810

582.6

613.6

619.0

630.9

633.9

635.7

650.5

656.8

Powys Teaching

Abertawe Bro Morgannwg University

Hywel Dda University

Wales

Betsi Cadwaladr University

Cardiff & Vale University

Aneurin Bevan University

Cwm Taf University

Statistically significantly different to Wales Not statistically significantly different to Wales Wales

569.3 – 591.6591.7 – 614.0614.1 – 636.3636.4 – 658.7658.8 – 681.0

Wales = 630.9

EASR per 100,000 population

72.076001 - 72.830000

71.322001 - 72.076000

70.568001 - 71.322000

69.814001 - 70.568000

69.060000 - 69.814000

457.2 – 552.1552.2 – 647.0647.1 – 741.9742.0 – 836.8836.9 – 931.7

Wales = 630.9

EASR per 100,000

population

72.076001 - 72.830000

71.322001 - 72.076000

70.568001 - 71.322000

69.814001 - 70.568000

69.060000 - 69.814000

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Cancer deaths by geography

Cancer mortality varies considerably between

health board populations (figure 10). Powys

Teaching health board has a mortality rate 10 per

cent lower than Wales as a whole, and this is lower

than would be expected by chance alone. Cwm Taf

University health board has a mortality rate which

is nearly 8 per cent higher relative to Wales and is

higher than would be expected by chance alone.

The difference between these two health boards is

54 deaths per 100,000 population, making the rate

in Cwm Taf University health board 20 per cent

higher than that in Powys Teaching health board

Betsi Cadwaladr University health board had the

largest number of cancer deaths in 2004 and 2013

due to this health board having the largest

population of all health boards in Wales and a large

proportion of older people, amongst other factors,

contributing to a higher recent and past cancer

incidence (figure 11). The local authority of Cardiff

has the largest number of cancer deaths in Wales

with Merthyr Tydfil having the lowest number of

deaths mainly due to their respective population

sizes.

Figure 10: The cancer mortality rate (EASR) per 100,000 population is statistically significantly

higher than Wales in Cwm Taf university health board for 2009-2013


Figure 11: Variation seen in the number of cancer deaths registered in Wales at local authority and health board level over time


2004 2013

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Cancer mortality rates are highest in some local

authorities in the south east Wales valleys and

north east Wales. The highest mortality rate is in

Blaenau Gwent which is 12 per cent higher than

Wales, whereas the rate in Monmouthshire (figure

12) is 16 per cent lower than Wales.

Figure 12: The highest local authority mortality rate in Blaenau Gwent is over a third higher than the lowest in Monmouthshire in 2009-2013

Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registry www.wcisu.wales.nhs.uk ©Crown Copyright and

database right 2015. Ordnance Survey 100044810

Cancer mortality shows great variation between

neighbouring areas at small area level in part due

to small numbers and small populations (figure

13). Mortality shows a similar pattern to incidence

with the south Wales valleys tending to show

higher rates along with the deprived inner city

areas.

Figure 13: The cancer mortality rate at Middle Super Output Area shows pockets of high and low mortality in Wales with great variation between

some neighbouring areas


One year survival from cancer is very similar in all health boards

Over 70 per cent of Welsh residents can now

expect to survive at least one year after being

diagnosed with cancer. The one year relative

survival is similar across the seven health board

populations (figure 14).

Powys Teaching health board has the best relative

survival which is over 3 per cent higher (2.4

percentage points) than the rate for Wales. The

health board with the worst survival rate is Cwm

Taf University health board which is nearly 2 per

cent lower (or 1.3 percentage points) than the rate

for Wales. Cardiff and Vale University health board

along with Powys Teaching health board have one

year survival rates higher than Wales as a whole,

and higher than can be expected by chance alone.

251.4 – 268.4268.5 – 285.3285.4 – 302.2302.3 – 319.1319.2 – 336.1

Wales = 299.8

EASR per 100,000

population

72.076001 - 72.830000

71.322001 - 72.076000

70.568001 - 71.322000

69.814001 - 70.568000

69.060000 - 69.814000

191.9 – 257.2257.3 – 322.6322.7 – 387.9388.0 – 453.3453.4 – 518.6

Wales = 299.8

EASR per 100,000

population

72.076001 - 72.830000

71.322001 - 72.076000

70.568001 - 71.322000

69.814001 - 70.568000

69.060000 - 69.814000

13



Figure 14: One year relative survival is similar across the seven health boards of Wales in 2008-2012


Variation between health boards is larger for five year relative survival

Over a half of all Welsh residents diagnosed with

cancer survive for at least five years. There is

more variation for five year relative survival

compared with one year relative survival. Cwm Taf

University health board shows a higher proportion

of deaths between one and five years post

diagnosis compared to other health board, nearly 8

per cent lower compared to the five-year survival

rate for Wales (figure 15). Four of the health

boards have a better survival rate than Wales with

Powys Teaching health board having the best

survival (5 per cent higher than the rate for

Wales). Cwm Taf University health board and

Abertawe Bro Morgannwg University health board

have rates lower than can be expected by chance

alone, whereas Cardiff and Vale University health

board and Powys Teaching health board have rates

higher than can be expected by chance alone.

Figure 15: Cwm Taf University health board has the lowest five year relative survival of all health boards in Wales in 2004-2008


69.1 – 69.869.9 – 70.670.7 – 71.371.4 – 72.172.2 – 72.8

Wales = 70.4%

72.076001 - 72.830000

71.322001 - 72.076000

70.568001 - 71.322000

69.814001 - 70.568000

69.060000 - 69.814000

71.4

72.8

70.0

69.569.1

69.4

71.8

49.1 – 50.550.6 – 51.851.9 – 53.253.3 – 54.554.6 – 55.9

Wales = 53.2%

72.076001 - 72.830000

71.322001 - 72.076000

70.568001 - 71.322000

69.814001 - 70.568000

69.060000 - 69.814000

54.0

55.9

54.1

51.849.1

52.9

55.2

14



3 Incidence, mortality

and survival by area deprivation

The gap in incidence rate between least and most deprived areas continues to increase

The incidence rate for all cancer combined

decreased in the least deprived fifth in Wales from

2002-2006 to 2009-2013, while the incidence rate

increased in the most deprived fifth. This resulted

in the gap between the least and most deprived

fifths widening (figure 16).

The gap increased from 97 new cancer cases per

100,000 population per year in 2002-2006 to 131

new cancer cases per 100,000 population in 2009-

2013 - an increase of over a third. Put another

way, the incidence rate in the most deprived areas

was 16.3 per cent higher than in the least deprived

areas for 2002-2006 and increased to 22.5 per cent

higher in 2009-2013.

Figure 16: The difference between the cancer incidence rate (EASR) per 100,000 population in the least deprived fifth compared to the most

deprived fifth has increased over time


The gap in mortality rate between least and most deprived has slightly increased

The all cancers combined mortality rate decreased

in all deprivation fifths during the same interval.

The decrease in the least deprived fifth was larger

than the decrease in the most deprived fifth (figure

17). Thus the gap between the least and most

deprived fifths increased slightly from 113.3 per

100,000 population in 2002-2006 to 119.9 per

100,000 population in 2009-2013, or nearly a 6 per

cent increase. So the mortality rate in the most

deprived areas was 40.8 per cent higher than in

the least deprived areas for 2002-2006 which

increased to 48.0 per cent higher in 2009-2013. Figure 17: The difference between the cancer mortality rate (EASR) per 100,000 population in

the least deprived fifth compared to the most deprived fifth has slightly increased over time


Cancer survival is lower in deprived areas but the gap is larger for some cancers

One year relative survival for all cancers combined

has improved in all deprivation fifths over time

(figure 18). However, the increase is greater in the

most deprived fifth than in the least deprived fifth

in Wales. This has narrowed the gap between the

least and most deprived fifth from 13.5 percentage

points in 1999-2003 to 12.1 percentage points in

2008-2012, or by approximately 10 per cent.

The most recent one year relative survival in the

most deprived fifth remains on a par with that of

the middle deprived fifth a decade before, and

seven percentage points below what the least

deprived fifth experienced a decade before.

Five year relative survival has improved in all

deprivation fifths over time (figure 19). However,

the increase is greater in the least deprived fifth

than the most deprived fifth giving a widening gap.

The deprivation gap increased from 16.2

percentage points in 1999-2003 to 17.1 percentage

points in 2004-2008, or by approximately 6 per

cent.

15



The most recent five year relative survival in the

most deprived fifth is now on a par with the next

most deprived fifth experienced a decade before

and 12 percentage points below what was

experienced a decade before in the least deprived

fifth. In the latest time period a 17 percentage

point difference is seen between the least and most

deprived fifth.

Figure 18: One year relative survival (%) for all cancers combined has improved in all deprivation fifths over time but the increase is greater in the most deprived fifth than the least deprived fifth thus narrowing the gap


Figure 19: A greater increase in five year survival (%) is seen in the least deprived fifth compared to the most deprived fifth over time, widening the gap


16



4 Incidence, mortality

and survival of different cancer types

Incidence by cancer type

In 2013 the most common cancers in Wales in

terms of numbers were female breast cancer,

prostate, lung and bowel cancer (figure 20).

Figure 20: The most common cancers in men and women in Wales in 2013


Prostate cancer accounted for over a quarter of all

new cancers diagnosed in men (figure 21). Bowel

and lung cancer each accounted for one in seven

cancers for men.

Figure 21: Over a quarter of all cancers in men was

prostate cancer in 2013


Breast cancer accounted for nearly a third of all

cancers in women (figure 22). Lung cancer was the

second most common, approaching 12 per cent of

cases. One in ten new cancers in women was bowel

cancer.

Figure 22: Nearly a third of all cancers in women were breast cancer in 2013

Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registrywww.wcisu.wales.nhs.uk

The majority of the most common cancers in Wales

had an absolute increase in numbers between

2001-2003 and 2011-2013 (figure 23). Prostate,

bowel, female breast, melanoma and lung cancer

had the largest increases in numbers. Almost two

thirds of the increase in bowel cancer numbers was

in men. A similar proportion of the increase in

melanoma cases was also in men. Almost all the

increase in lung cancer numbers occurred in

women. Cervical, oesophageal and stomach

cancers showed decreases in numbers.

Although prostate cancer had the largest absolute

increase in numbers, liver cancer in men showed

the largest percentage increase(figure 24),

doubling over the time periods. For women the

percentage increase in liver cancer numbers was as

much as 70 per cent. Melanoma showed the second

largest percentage increase, with the number of

cases in men nearly doubling, and in women

increasing by nearly a half over the periods

examined. Uterine cancer (cancer of the womb)

also increased by nearly a half. Head and neck

cancer and urinary tract excluding bladder cancer

in men also showed increases of nearly a half.

The four most common cancers also showed at

least modest percentage increases. There was a

very large difference between men and women for

lung cancer. The number of new cases diagnosed in

women increased by almost a third, compared to

only 2 per cent in men. Prostate cancer numbers

increased by almost a third. Bowel cancer cases

increased by a quarter in men and by almost a fifth

in women. Apart from lung cancer in men, the

17



commonest cancer with the smallest percentage

increase in numbers, of 15 per cent, was breast .

cancer

Figure 23: Average change in the number of new cancer cases by cancer type in Wales shows large variation in 2011-2013 compared with 2001-2003

*Bladder cancer not shown due to a coding change in 2007 Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registry www.wcisu.wales.nhs.uk

A large percentage increase occurred in the

number of thyroid and endocrine cancer cases in

men, with women also showing a slight increase.

Caution is advised in the interpretation since

small numbers are involved in this large

percentage increase.

Taking account of changing population size and

age structure, the cancers with the highest age-

adjusted incidence rates in 2013 were prostate

cancer and female breast cancer, with rates over

twice as high compared to lung and bowel

cancers (figure 25). The first two cancers are of

course gender-specific so the denominator figure

is different to lung and bowel cancers that could

affect the whole population.

18



Figure 24: The percentage change of new cancer cases varies by cancer type in Wales, 2011-2013 compared with 2001-2003

*Bladder cancer not shown due to a coding change in 2007 Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registry. www.wcisu.wales.nhs.uk

Figure 25: Age adjusted incidence rates of cancer types in Wales, 2013 compared with 2004

* Bladder cancer not shown due to a coding change in 2007. Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer

Registry www.wcisu.wales.nhs.uk

19



The largest increases in age-adjusted incidence

rates in men from 2001-2003 to 2011-2013

occurred for melanoma, head and neck, urinary

tract excluding bladder, liver, prostate and bowel

cancer (figure 26). The more than 70 per cent

increase in melanoma incidence rate was the

largest percentage increase in men. Liver cancer

increased by two-thirds. There were also large

percentage increases in thyroid and endocrine (but

based on small numbers), urinary tract excluding

bladder and head and neck cancer. There were

large percentage decreases in stomach,

oesophageal and lung cancer (figure 27). Figure 26: The average change in the incidence rate (EASR) per 100,000 population shows a large

increase in melanoma and a large decrease in lung

cancer in men in Wales, 2011-2013 compared with 2001-2003

* Bladder cancer not shown due to a coding change in 2007. Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registry www.wcisu.wales.nhs.uk

Figure 27: The percentage change in the cancer

incidence rate (EASR) per 100,000 population by cancer type for men in Wales shows an increase of nearly three quarters for melanoma and two thirds increase for liver cancer in 2011-2013 compared with 2001-2003


For women, lung cancer shows the largest absolute

increase in rate over the same time period (figure

28). The next largest increases were for breast,

uterus, melanoma, bowel, urinary tract (excluding

bladder) and liver cancer.

In women, liver cancer showed the largest

percentage increase (figure 29), followed by

urinary tract (excluding bladder), melanoma,

uterine, thyroid and endocrine, head and neck, and

lung cancers. There were notable percentage

decreases in stomach, oesophageal, cervical and

brain and CNS cancers .

Figure 28: The change in the incidence rate (EASR)

per 100,000 population by cancer type for women in Wales shows a large increase in lung cancer in

2011-2013 compared with 2001-2003


Figure 29: The percentage change in the cancer

incidence rate (EASR) per 100,000 population by cancer type for women shows an increase of over a half for liver cancer in Wales in 2011-2013 compared with 2001-2003


20



The deprivation gap is showing small

increases in incidence for some cancer types

...Cancer incidence is higher in the most deprived

areas for lung cancer and colorectal cancer but the

opposite pattern is true for female breast cancer

and prostate cancer where the lower rates are seen

in the most deprived areas.

The gap between the higher incidence rate in the

most deprived fifth in Wales and lower incidence

rate in the least deprived area is widest for lung

cancer, compared to other common cancers in

Wales (figure 30). This very large gap for lung

cancer has increased due to a decrease in the

incidence rate for the least deprived fifth and a

small increase in the most deprived fifth. The

deprivation gap has slightly increased for colorectal

cancer.

Figure 30: The cancer incidence rate (EASR) per 100,000 population for areas with increasing deprivation (fifths) by cancer type


0

50

100

150

200

250

2002-2006 2009-2013 2002-2006 2009-2013 2002-2006 2009-2013 2002-2006 2009-2013

Lung Female Breast Prostate Bowel (Colorectal)

EA

SR

per

10

0,0

00

pop

ula

tion

Least deprived Next least deprived Middle deprived Next most deprived Most Deprived

21



Deaths from different types of

cancer

The most common cancer related death in Wales

was lung cancer with 1,842 deaths registered in

2013 (figure 31). Bowel cancer was the second

most common cancer death with 907 deaths and

female breast cancer was the third most common

with 573 deaths. Lung cancer deaths accounted for

more deaths than both bowel cancer and female

breast cancer combined. There were three deaths

from testicular cancer in Wales in 2013.

Figure 31: Lung cancer is the most common cancer death in Wales in 2013


1011

486

529

223

285

186

203

159

143

149

160

128

115

69

48

10

10

3

831

421

573

223

117

117

96

114

119

95

243

54

83

88

56

90

6

50

14

5

Lung

Bowel (Colorectal)

Female Breast

Prostate

Pancreas

Oesophagus

Stomach

Bladder

Liver

Non-Hodgkin Lymphoma

Leukaemia

Ovary

Head & Neck

Brain & CNS

Urinary Tract exc Bladder

Melanoma

Uterus

Larynx

Cervix

Thyroid & Endocrine

Hodgkin Lymphoma

Testis

Men WomenNumber of

22



Over a fifth of all cancer deaths among men in

Wales were lung cancer in 2013 (figure 32). Over

10 per cent of all cancer deaths were for prostate

cancer and a similar proportion were for colorectal

cancer. Oesophageal cancer was the cause of

approximately one in 16 cancer deaths. These four

cancer types accounted for just over half of all

cancer deaths in men. Figure 32: Over a fifth of all cancer deaths in men in Wales were from lung cancer in 2013


Over a fifth of all cancer deaths among women in

Wales were lung cancer in 2013 (figure 33). Nearly

one in seven cancer deaths were breast cancer in

women and over 10 per cent were bowel cancer.

Ovarian cancer was the fourth most common

cancer death in women and these four cancers

accounted for just over half of all cancer deaths in

women in 2013.

Figure 33: Over a fifth of all cancer deaths in women in Wales were from lung cancer in 2013


The largest change in the absolute number of

deaths in men was liver cancer which also showed

the largest percentage increase (figures 34 and

35). Pancreatic cancer also showed an increase in

the number of deaths resulting in a 28 per cent

increase in terms of numbers for men. Melanoma

and testicular cancer also showed large percentage

increases in men; however note that testicular

cancer is based on very small numbers. Stomach

cancer has showed a large percentage decrease.

For women, the largest change in the numbers was

lung cancer. This number was nearly the same as

the total increase in all other cancer deaths in

women. The largest percentage increase for women

was for liver cancer followed by Hodgkin lymphoma

and uterine cancer. However, the numbers for

Hodgkin lymphoma are very small so caution is

advised in terms of the interpretation. Large

percentage decreases are seen for stomach,

cervical and thyroid and endocrine cancer.

23



Figure 34: The largest change in the average number of cancer deaths is for lung cancer in women in 2011-2013 compared with 2001-2003


Figure 35: The largest percentage change in the average number of cancer deaths is for liver cancer for both men and women in Wales in 2011-2013 compared with 2001-2003


24



Lung cancer has the highest age adjusted mortality

rate in Wales in 2013, compared to other cancer

types. This rate had decreased by 12.3 per cent

compared to ten years previously. Prostate cancer

was the second most common cancer death rate,

and this had decreased by nearly a third compared

to 2004. Female breast cancer mortality rates

were the third highest in 2013 (figure 36).

Figure 36: The cancer mortality rate (EASR) per 100,000 population is highest for lung cancer in Wales in 2013 and 2004 compared to other cancer

types


Liver cancer in men shows the largest increase in

mortality rate between the time periods examined

(figure 37), and the largest percentage increase for

men, increasing by over a half. Testicular cancer

shows the second largest percentage increase,

however, numbers are low for this cancer type

(figure 38). Melanoma shows the third largest

percentage increase of nearly a third. The mortality

rate for all cancers combined has shown a large

decrease of over 12 per cent.

Figure 37: Prostate and lung cancers show the largest absolute decreases in cancer mortality (EASR) rate per 100,000 men in Wales from 2001-

2003 to 2011-2013


Figure 38: The largest percentage increase in the cancer mortality rate (EASR) per 100,000 men is for liver cancer from 2001-2003 to 2011-2013


Lung cancer in women shows the largest increase

in the mortality rate over time but liver cancer has

the largest percentage increase of nearly two thirds

(figure 39 and 40). Hodgkin lymphoma and uterine

cancer also show large percentage increases but

the numbers are very small for Hodgkin lymphoma.

The mortality rate for all cancers combined has

shown a decrease of nearly 8 per cent.

... Liver cancer in men shows the

largest increase in mortality rate between 2004 and 2013 but for

women its lung cancer which shows the largest increase in the

mortality rate over time. Liver cancer has the largest percentage

increase by nearly two thirds...”

25



Figure 39: Breast cancer has the largest absolute decrease in cancer mortality (EASR) rate per 100,000 women in Wales from 2001-2003 to 2011-

2013


Figure 40: The largest percentage increase in the

cancer mortality rate (EASR) per 100,000 women is for liver cancer from 2001-2003 to 2011-2013


Large differences exist between least deprived and most deprived fifths for

lung cancer mortality

Cancer mortality is higher in the most deprived

fifths for lung cancer and bowel cancer with a

gradient in between (figure 41). The gap is very

large for lung cancer and has widened between

2002-2006 and 2009-2013. The modest gap in

bowel cancer mortality rate narrowed slightly.

There is a small degree of variation for female

breast cancer and prostate cancer mortality rate

between deprivation fifths of areas, but no clear

gradients.

Figure 41: The cancer mortality rate (EASR) per 100,000 shows the difference between the least deprived and most deprived fifth for lung cancer is

increasing in Wales


Survival from pancreas, lung and liver cancer is still very poor

The cancers with the lowest one year survival are

pancreas, lung and liver for both time periods we

examined (figure 42). Despite this, these three

cancers have shown improvements in one year

survival. Testicular cancer has the highest one year

survival rate of 98 per cent, followed closely by

melanoma, prostate cancer and female breast

cancer (all over 96 per cent) in 2008-2012. Three

quarters of people diagnosed with bowel cancer

now survive for at least one year.

26



Figure 42: Improvements in one-year survival (%) are seen for the majority of cancer types

*There was a bladder coding change in 2007, hence the large change in survival. Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registry www.wcisu.wales.nhs.uk

Similar to one year survival, the lowest five year

survival rates are for cancers of the pancreas, liver

and lung (figure 43) for both time periods

examined. Five year survival from liver cancer is

now just under 6 per cent, a slight decrease

compared to 2000-2004. For lung cancer the

figures remain unchanged over time. Five year

survival for testicular cancer is again high at 96 per

cent for the latest period of 2004-2008. Five year

survival for prostate cancer and female breast

cancer is over 85 per cent each for 2004-2008. For

bowel cancer, only a small improvement occurred,

rising to 52 per cent in 2004-2008.

Variation in survival between health boards for some cancers

Although one year survival for all cancers combined

varies little between health board population, for

some cancer types there is wide variation, for

example, oesophageal cancer (figure 44), whereas

all health boards tend to have similar one year

survival rates for prostate cancer (95 per cent and

over).

27



Figure 43: Improvements in five-year survival (%) are seen for the majority of cancer types

*There was a bladder coding change in 2007, hence the change in survival. Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registry www.wcisu.wales.nhs.uk

Figure 44: Large variation is seen for one year survival from oesophageal cancer by health board


However, the five year survival for prostate cancer

shows wide variation between health boards (from

78.4 per cent in Powys Teaching health board to

91.5 per cent in Cardiff and Vale University health

board)(figure 45). There is also wide variation for

head and neck cancer and leukaemia. Further

information on cancer survival rates for each health

board can be found on the Welsh Cancer

Intelligence and Surveillance Unit’s interactive

dashboard1. Figure 45: There is a large variation in five year survival by health board population for prostate cancer


1 http://www.wcisu.wales.nhs.uk/cancer-statistics

http://www.wcisu.wales.nhs.uk/cancer-statistics

28



An improvement is seen in all deprivation fifths for one year

survival

Lung cancer has a wide gap in incidence between

the most deprived fifth in Wales compared to the

least deprived – with the highest incidence in the

most deprived areas (see previously). The one-year

survival from lung cancer is also lowest in the most

deprived areas, although the gap is much less than

for the incidence rate, and the deprivation gap in

survival has decreased (figure 46). Our recent

detailed report on lung cancer survival that

included 2012 data is available at

http://www.wcisu.wales.nhs.uk/lung-cancer-

overview.

Like lung cancer, female breast cancer and prostate

cancer incidence has a deprivation gap, but unlike

lung cancer, the higher incidence is in the least

deprived areas. Despite this, one-year survival

from these cancers is still lowest in the most

deprived areas, but gaps have narrowed.

Bowel cancer has a deprivation gap in one year and

five year survival, both worse in the most deprived

areas. While the gap in incidence is much smaller

than for lung cancer, the deprivation gap in one

year survival for bowel cancer is wider.

Figure 46: Lung, female breast and prostate cancer show decreases in the deprivation gap for one year relative survival over time in Wales


Little improvement is seen by deprivation fifth for five year relative

survival for some cancer types

The least deprived fifths have the best survival and

the most deprived fifths have the worst survival for

five year relative survival for all cancer types.

Excluding lung cancer, the majority of deprivation

fifths show an increase in five year relative survival

over time.

For lung cancer there has been very little change in

five year relative survival over time with a slight

widening of the gap (figure 47). The deprivation

gap for five year relative survival shows a larger

gap than in one year relative survival for all other

cancer types excluding lung cancer; the gap for

lung cancer is smaller than one year relative

survival for some time periods. The deprivation

gap has slightly increased over time for bowel

cancer and female breast cancer but has slightly

decreased for prostate cancer. Figure 47: Wide variation exists between the least

and most deprived fifths for five year relative survival (%) in Wales for female breast, prostate and bowel cancer


... the least deprived fifths have the best survival and the most

deprived fifths have the worst survival for five year relative

survival for all cancer types...”

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Welsh Cancer Intelligence and Surveillance Unit … Official... · Welsh Cancer Intelligence and Surveillance Unit ... Julie Howe, Helen Crowther, Dr Dyfed Wyn Huws ... Welsh Cancer