March 2012: Review September 2012

Transcription

1 10. Cancer This section of the JSNA explores the incidence, prevalence, mortality and survival rates of cancer, to inform target setting and commissioning. Approximately 1200 Trafford residents are diagnosed with cancer each year and about 500 die from cancer. The number of Trafford residents who have been diagnosed with cancer and who are still alive in a year is estimated at 6,900. Of these 36% are aged 75 years or over. The risk of cancer increases with age. Lifestyle factors that lead to greater risk include smoking, excess alcohol and obesity. The proportion of deaths due to cancer has increased since 1995 whilst the proportion of deaths due to heart disease has decreased. More than a quarter of deaths in persons under 75 years of age in Trafford are due to cancer making it the most common cause of premature death. Incidence and mortality of all cancers in all ages Trafford has a higher rate of incidence of all cancers than the North West, England and its ONS area classification group. Incidence from all cancers combined is increasing, and the trend indicates it is increasing at a slightly higher rate than England Incidence of all cancers (ICD exc 173, ICD10 C00 C99 exc C44): DSR per 100,000 European Standard Population All ages (3 year rolling average) Rate per 100,000 population Trafford PCT ONS Classification NORTH WEST ENGLAND Source: NHS Information Centre, Compenium of Clinical and Health Indicators The mortality rate from all cancers in persons of all ages is decreasing, as it is regionally and nationally. 1

2 Mortality from all cancers in persons of all ages (ICD adjusted, ICD10 C00 C97): Directly age standardised rates per 100,000 population rolling 3 year average Trafford PCT ONS Classification area North West England The mortality rate from all cancers in persons of all ages in Trafford is significantly lower than the North West and in line with the national average. The rate for Trafford is higher than the rate for its ONS Area Classification group, which are similar areas in the country to Trafford. This indicates there is further potential to reduce cancer mortality in Trafford. Mortality from all cancers (ICD10 C00-C97) - DSR per 100,000 population - All ages ( ) Rate per 100,000 pop Trafford PCT North West SHA ENGLAND ONS Classification Source: NHS Information Centre, Compenium of Clinical and Health Indicators 2

3 Incidence and mortality from cancer in persons under 75 years The incidence rate of all cancers in Trafford is significantly higher than the national rate for both males and females under 75 years of age. This means that we are identifying and recording more cancers in Trafford. This can be a good thing as we may be better at identifying cancers and enabling earlier treatment which usually means better chances of survival Incidence of all cancers (ICD10 C00 C99 exc C44): DSR per 100,000 population Less than 75 years (Pooled) Males Females ENGLAND North West SHA PROSPERING SMALLER TOWNS Trafford PCT The incidence rate in Trafford for all cancers combined in people under 75 is rising, and the trend suggests that the rate of increase is higher in Trafford than in the North West. Incidence of All Tumor Types cancer 0 74yrs : 3 year rolling average ( ) Trafford PCT North West SHA England Rate per 100,000 pop Cancer is the most common cause of death in persons under 75 years of age, accounting for 38% of deaths in , although the trend shows that premature mortality from cancer is decreasing. 3

4 Mortality from all cancers (ICD adjusted, ICD10 C00 C97): DSR per 100,000 European Standard Population Persons less than 75 years (3 year rolling average) Trafford PCT PROSPERING SMALLER TOWNS NORTH WEST ENGLAND Source: NHS Information Centre, National Compendium of Clinical and Health Indicators Premature mortality from all cancers combined in Trafford wards The rate of premature mortality from all cancers is highest in the wards of Gorse Hill, Longford and Bucklow-St-Martins. The rate in Davyhulme West is significantly lower than for Trafford PCT Mortality from cancer (ICD10 C00-C97) in Trafford DSR per 100,000 population Under 75 years of age By ward 0.0 Davyhulme West Bowdon Priory Timperley Broadheath Altrincham Brooklands Ashton upon Mersey Hale Central Flixton Davyhulme East Stretford Hale Barns St Mary's Village Urmston Sale Moor Clifford Bucklow-St Martins Longford Gorse Hill Trafford Deprivation Premature mortality from all cancers in males is significantly higher in the two most deprived quintiles than in the two least deprived quintiles. The rate for females is higher in the most deprived quintile than in the least deprived quintile, but not statistically significant, and the social gradient is less clear than in males. 4

5 Mortality from all cancers (ICD10 C00 C97) in males and females under 75 years of age ( ) Directly age standardised rates per 100,000 population under 75 years of age By deprivation quintile (with 95% confidence intervals) Males Females Rate per 100,000 pop Least deprived Trafford Deprivation Quintile Most deprived The incidence rates of cancer in Trafford appear to be higher. However, as the mortality is comparatively lower, there are more people living with cancer in Trafford. In addition to the cancer itself, many people being treated for cancer experience some of the unpleasant side effects e.g. gastrointestinal problems following radiotherapy to the pelvic area. Living with cancer for many people is similar to living with chronic disease. 5

6 Specific cancers in persons under 75 years of age Females Cancer of the lung and chest was the most common cause of premature mortality from cancer in females (25% of deaths caused by cancer) in Trafford during the period , followed by breast cancer (22%). Mortality from cancer in females in Trafford under 75 years Cancer of respiratory and intratheracic organs Breast cancer 5% 12% 25% Cancer of digestive organs 7% Cancer of female genital organs 11% 18% 22% Ill defined/secondary/unspecified cancer Lymphoid, haematopoietic and related tissue Other Males Cancer of the digestive organs was the most common cause of premtaure mortality from cancer in males (35% of deaths caused by cancer) in the period , followed by cancer of the lung and chest (26%). Mortality from cancer in males in under 75 years of age in Trafford Cancer of digestive organs 5% 6% 6% 6% 7% 9% 26% 35% Cancer of respiratory and intratheracic organs Cancer male genital organs Cancer of eye, brain and other parts of central nervous system Cancer of lymphoid, haematopoietic and related tissue Ill defined/secondary/unspecified cancer Cancer of urinary tract Other 6

7 Lung cancer - incidence and mortality In 2009 the incidence rate of lung cancer per 100,000 population of all ages in Trafford was higher than the national average, but lower than the rate for the North West overall. Incidence of Lung cancer (ICD10 C33 C34) Age: All Ages: 3 year rolling average ( ) 8 7 Trafford PCT North West SHA England Rate per 100,000 pop Source: Cancer Commissioning Toolkit The three year rolling average of incidence of lung cancer in males of all ages in Trafford is decreasing, and reflects the national picture. The trend in incidence of lung cancer in females of all ages, although lower than in males, remains steady. 12 Incidence of lung cancer (ICD9 162, ICD10 C33 C34): Directly age standardised registration rates (DSR) per 100,000 population All ages (rolling 3 year average) Rate per 100,000 population of all ages Trafford PCT MALES Trafford PCT FEMALES North West SHA MALES North West SHA FEMALES ENGLAND MALES ENGLAND FEMALES Source: NHS Information Centre, Compendium of Clinical and Health Indicators Incidence of lung cancer in all ages in Trafford is lower than in the North West, in both males and females; and in both sexes is higher than in Trafford s ONS Area Classification. 7

8 Incidence of lung cancer (ICD10 C33-C34): DSR per 100,000 population All ages (Pooled) 8 7 Males Females Trafford PCT North West SHA ONS Classification ENGLAND Source: NHS Information Centre, Compenium of Clinical and Social Indicators The projected trend in incidence of lung cancer in persons under 75 years of age suggests the rate of incidence may be starting to rise again in , and remains above the national average. Incidence of Lung cancer (ICD10 C33 C34) Age: 0 74yrs: 3 year rolling average ( ) 6 Trafford PCT North West SHA England 5 Rate per 100,000 pop Source: Cancer Commissioning Toolkit 8

9 Mortality from lung cancer The five year rolling mortality rate from lung cancer in persons of all ages has decreased overall, over a ten year period, although the annual trend in the last three years shows an increase. 5 year rolling age standardised mortality rate per 100,000 population: Lung cancer: Age group: All Ages 7 Trafford PCT England North West SHA Mortality Rate/1000' Cancer Commissioning Toolkit There is a different trend in mortality from lung cancer in men and women. The trends show that mortality from lung cancer in males of all ages is decreasing, whilst the trend for females, although lower than for males, remains relatively steady. 10 Mortality from lung cancer (ICD9 162 adjusted, ICD10 C33 C34): Directly age standardised rates (DSR) per 100,000 population: All ages (3 year rolling average) Rate per 100,000 population of all ages Trafford PCT MALES Trafford PCT FEMALES North West SHA MALES North West SHA FEMALES ENGLAND MALES ENGLAND FEMALES 9

10 Premature mortality from lung cancer Premature mortality from lung cancer has decreased in Trafford, although the rate of decrease is not as steep as in the North West. 5 year rolling age standardised mortality rate per 100,000 population: Lung cancer: Age group: 0 74yrs 7 Trafford PCT North West SHA England 6 Mortality Rate/1000' Premature mortality from lung cancer by deprivation quintile in Trafford There is a clear trend in premature mortality from lung cancer by deprivation quintile rates increase with increasing levels of deprivation. Rate per 100,000 pop Mortality from lung cancer (ICD10 C33 C34) in persons under 75 years of age ( ) Age standardised rates per 100,000 population under 75 years of age By deprivation quintile in Trafford (with 95% confidence intervals) Least deprived Fourth most deprived Third most deprived Second most deprived Most deprived Trafford deprivation quintile The rate of premature mortality from lung cancer is significantly higher in the most deprived quintile in Trafford than in the least deprived quintile, for both males and females, although the difference is greater in males. 10

11 Mortality from lung cancer (ICD10 C33 C34) in males and females under 75 years of age ( ) Directly age standardised rates per 100,000 population under 75 years of age By deprivation quintile in Trafford (with 95% confidence intervals) Males Females Rate per 100,000 pop Least deprived Trafford Deprivation Quintile Most deprived Survival rates from lung cancer The survival rate is calculated from patients diagnosed over a period of time and followed up to a given date after this period. Relative survival is defined as the ratio of the observed survival and the survival that would have been expected if the cancer patients had only experienced the background mortality seen in the general population. Survival rates from lung cancer are increasing; Trafford has the highest one-year survival rate of 7.1% above the national average, and has also shown the highest increase in the North West compared with England over a ten year period (NWCIS 2010). Trafford PCT has the highest percentage of patients diagnosed with lung cancer who underwent surgery in the six months following diagnosis (14.7%) out of North West PCTs, the regional average being 9.7%. 11

12 % of patients 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Survival rates for lung cancer All ages March 2012: Review September Period of diagnosis Trafford 1yr survival Greater Manchester and Cheshire 1 yr survival England 1 yr survival Trafford 5 yr survival Greater Manchester and Cheshire 5 yr survival England 5 yr survival Lung cancer survival rates are higher the earlier cancer is diagnosed. Early lung cancers are also more suitable for surgery. This suggests that lung cancer is picked up early in Trafford overall. Risk factors for lung cancer Smoking causes around 86% of lung cancer deaths. 1 in 10 lung cancer cases occur in non-smokers. 1 in 5 adults still smoke cigarettes. Stopping smoking before middle age avoids most of the risk of smoking related lung cancer. Living with someone who smokes increases the risk of lung cancer in non-smokers. A small proportion of lung cancer cases are related to occupation, caused by heavy exposure to industrial carcinogens and air pollutants including diesel exhaust, asbestos, non-ferrous metals, silica, polycyclic aromatic hydrocarbons and nitrogen oxides. It is estimated that around 21% of lung cancers in men and 4% in women are related to occupational exposure. 12

13 Female breast cancer Incidence and mortality in females of all ages Incidence of breast cancer is rising. Trafford has a higher rate of incidence than England, and the trend in Trafford shows a higher increase compared to England. Incidence of Breast cancer (ICD10 ICD10 50) Age: 0 74yrs: 3 year rolling average ( ) Trafford PCT North West SHA England Rate per 100,000 pop Source: Cancer Commissioning Toolkit The general trend in mortality from breast cancer in women of all ages in Trafford is a decrease, despite a higher number of deaths from breast cancer in The pooled rate in in Trafford was 27.4 per 100,000 population, higher than the North West rate of 25.0 and the national average of 25.3 per 100,000 population, however this was not significant at the 95% confidence level. 5 year rolling age-standardised mortality rate per 100,000 population: Breast cancer: Age group: All Ages Trafford PCT England North West SHA 3 Mortality Rate/1000' Source: CancerCommissioning Toolkit 13

14 Incidence and mortality from breast cancer in under 75s The trend in incidence of breast cancer in women under 75 years of age shows a simliar pattern to that in all ages Trafford has a higher incidence than the North West and England, and shows a higher increase compared to England. Incidence of Breast cancer (ICD10 ICD10 50) Age: 0 74yrs: 3 year rolling average ( ) Trafford PCT North West SHA England Rate per 100,000 pop Source: Cancer Commissioning Toolkit Premature mortality from breast cancer in females is decreasing. 5 year rolling age-standardised mortality rate per 100,000 population: Breast cancer: Age group: 0-74yrs 3 Trafford PCT England North West SHA Linear (Trafford PCT) Mortality Rate/1000' Source: CancerCommissioning Toolkit 14

15 Deprivation There is no clear trend in premature mortality rates from breast cancer by level of deprivation, though women from more deprived backgrounds have lower incidence (NWCIS 2010) Mortality from breast cancer (ICD10 C50) in females under 75 years of age ( ) Directly age standardised rates per 100,000 female population under 75 years of age By deprivation quintile (with 95% confidence intervals) 35.0 Rate per 100,000 pop < 75 yrs Least deprived Fourth most deprived Third most deprived Second most deprived Most deprived Trafford deprivation quintile Premature mortality from female breast cancer in Trafford wards The rate of mortality from breast cancer in females under 75 years of age in the period was highest in the ward of Ashton-upon-Mersey Mortality from breast cancer (ICD10 C50) in Trafford DSR per Female 100,000 population Under 75 years of age By ward 0.0 Longford Priory St Mary's Davyhulme West Stretford Bucklow St Martins Clifford Gorse Hill Bowdon Davyhulme East Brooklands Hale Barns Timperley Urmston Sale Moor Altrincham Village Broadheath Flixton Hale Central Ashton upon Mersey Trafford 15

16 Survival from breast cancer The five year survival rate from breast cancer in women of all ages in Trafford diagnosed with breast cancer in is 85.4%, an improvement of 10.6% from women diagnosed in year Survival rate for Breast cancer: All Ages 100% 90% 80% Trafford PCT North West SHA Survival Rate % 70% 60% 50% 40% 30% 20% 10% 0% Cancer Commissioning Toolkit The biggest preventable risk for breast cancer is being overweight, followed by alcohol consumption. Hormone Replacement Therapy (HRT) can slightly increase the risk of breast cancer; as does not breastfeeding. The NHS Breast Screening Programme provides breast screening every three years for all women in the UK aged 50 to 70. Breast screening of eligible women aged 50 to 70 years in Trafford varies widely between practices, ranging from 40% to 80% in The increase in incidence of breast cancer in Trafford is partly related to an older population and the impact of breast screening which is picking up more cancers. It is encouraging to see mortality rates falling. This is probably due to picking up breast cancer earlier through screening. In addition, any woman with any breast symptoms can now be seen within two weeks. We are therefore picking up breast cancers early. 16

17 Cancer of the digestive system Cancers of the digestive system account for 35% of deaths caused by cancer in males under 75 and 18% of deaths caused by cancer in females under 75 years of age. Upper GastrointestinaI (Upper GI) cancers (oesophagus, stomach and pancreas) account for over 50% of the deaths from cancer of the digestive system, in persons under 75 years of age whilst colorectal cancer (lower GI) accounts for 28% of deaths from digestive cancers in persons under 75 years of age. Deaths from cancer of the digestive organs in persons under 75 years of age in Trafford ( ) 8% 13% 11% 28% Colorectal cancer Oesophageal cancer Pancreatic cancer Liver cancer Stomach cancer Other 19% 21% Source:ONS Annual deaths file Incidence and mortality from upper GI cancer (includes oesophagus, stomach and pancreas) in all ages Incidence of Upper GI cancer in Trafford is above the national average, and has shown a higher increase in incidence than England. Incidence of Upper GI cancer (ICD10 C15 16; C22 25) All Ages : 3 year rolling average ( ) Rate per 100,000 pop Trafford PCT North West SHA England Source: Cancer Commissioning Toolkit 17

18 Mortality from Upper GI cancer in Trafford in all ages is higher than the national average, and has increased, whilst the national rate has decreased. 5 year rolling age standardised mortality rate per 100,000 population: Upper GI cancer: Age group: All Ages 4 Trafford PCT England North West SHA Mortality Rate/1000' Cancer Commissioning Toolkit The number of deaths from Upper GI cancer in Trafford during increases with age. 30% of deaths due to upper GI cancer are in the year age group; with 49% in the over 75 years age group. In the under 65s age group, and in the year age group, there are a significantly higher number of deaths in men. In the over 75 years age group there is no such gender difference. 70 Deaths from Upper GI Cancer (ICD10 C15 16;C25) in Trafford ( ) By age group Males Females Number of deaths I J K L M N O P Q R S 85+ Source: SUS Age Group 18

19 Mortality from Upper GI cancers in Trafford wards The mortality rate from upper GI cancers (oesophagueal, stomach and pancreatic cancers) in the wards of Trafford ranged from 14.2 per 100,000 population of all ages in Flixton to 39.7 in Gorse Hill in the five year period The mortality rate from upper GI cancers in Gorse Hill is significantly higher than the rate for Trafford at the 95% confidence level. Mortality from Upper GI Cancer (includes oesophagus, stomach and pancreas - ICD10 C15, C16,C25) in Trafford -All Ages - Directly Age Standardised Rate per 100,000 population - By ward ( ) With 95% confidence intervals 70.0 Rate per 100,000 populatioin Source: ONS Ashton upon Mersey Flixton Bowdon Hale Central Davyhulme West Brooklands Timperley Urmston Village Broadheath Hale Barns Clifford Altrincham Priory Bucklow-St Martins Stretford St Mary's Davyhulme East Sale Moor Longford Gorse Hill TRAFFORD Deprivation Incidence and mortality rise with increasing levels of deprivation (NWCIS 2010). In Trafford the most deprived quintile has a significantly higher mortality rate from upper GI cancers than the least deprived quintile. The social gradient is clearer in the male population. 19

20 Mortality from Upper GI Cancers (including oesophagus, cancer and pancreas) DSR per 100,000 population All Ages ( ) By deprivation quintile in Trafford (with 95% confidence intervals) Rate per 100,000 population Males Females Least deprived Fourth most deprived Third most deprived Deprivation quintile Second most deprived Most deprived Source: ONS; English Indices of Deprivation 2010, Local Communities and Government 20

21 Oesophageal cancer Incidence of oesophageal cancer in persons of all ages is rising in Trafford. Incidence of oesophageal cancer (ICD9 150, ICD10 C15): Directly age-standardised registration rates (DSR) All ages per 100,000 European Standard population Trafford North West England ONS Classification Rate per 100,000 population Source: NHS Information Centre, Compendium of Clinical and Health Indicators There is a marked difference between the trend in males and females, with incidence increasing in males, but decreasing in females Incidence of oesophageal cancer (ICD9 150, ICD10 C15): Directly age-standardised registration rates (DSR) All ages per 100,000 European Standard population Trafford - Males Trafford - Females Rate per 100,000 population Incidence of oesophageal cancer in males in Trafford is increasing at a greater rate than in England and the North West. 21

22 Incidence of oesophageal cancer (ICD9 150, ICD10 C15): Directly age standardised registration rates (DSR) 3 year rolling average ( ) per 100,000 European Standard Population Males of all ages in Trafford, North West and England Trafford Males England Males North West Males Source: NHS information Centre, Compendium of Clinical and Health Indicators In Trafford the incidence of oesophageal cancer is significantly higher in males than females, reflecting the regional and national picture. In (pooled) the incidence of oesophageal cancer in males of all ages in Trafford was significantly higher than both the national average and Trafford s ONS Classification group. The incidence of oesophageal cancer in females is significantly lower than the regional average, and lower than the national average, although not statistically significant. Rate per 100,000 population Incidence of oesophageal cancer (ICD10 C15): Directly age-standardised registration rates : DSR per 100,000 population All ages ( pooled) Males Females Trafford PCT NORTH WEST ONS Classification ENGLAND Source: NHS Information Centre, Compendium of Clinical and Health Indicators Incidence of oesophageal cancer in males under 75 years of age in Trafford in was significantly higher than in England and in its ONS classification area. Incidence of oesophageal cancer in females in in Trafford was lower than the national and regional rate, although this was not significant at the 95% confidence level.. 22

23 Incidence of oesophageal cancer (ICD10 C15): dirctly age standardised rates (DSR) per 100,000 European Standard Population Males and females less than 75 years of age (pooled) With 95% confidence intervals MALES FEMALES Rate per 100,000 population ENGLAND NORTH WEST ONS Classification Trafford PCT The trend in mortality rates (five year rolling average) from oesophageal cancer in males of all ages overall shows an increase. In contrast mortality from oesophageal cancer in females has decreased. Mortality from oesophageal cancer (ICD9 150 adjusted, ICD10 C15): DSR per 100,000 population ( ) All ages 5 year rolling average ( ) MALES Trafford North West England ONS Classification rate per 100,000 pop Source: NHS Information Centre, Compendium of Clinical and Health Indicators Female graph? Risk factors for oesophageal cancer The biggest modifiable risk for oesophageal cancer is tobacco, followed by a low fruit and vegetable diet, being overweight and alcohol consumption. 23

24 Lower GI cancer - incidence and mortality Incidence of lower GI cancer in persons of all ages in Trafford is higher than the national average and is increasing. Incidence of Lower GI cancer All Ages : 3 year rolling average ( ) 7 Trafford PCT North West SHA England Rate per 100,000 pop The mortality rate from lower GI cancers in persons of all ages in Trafford is decreasing and has dropped below the national mortality rate. 5 year rolling age standardised mortality rate per 100,000 population: Lower GI cancer: Age group: All Ages 3 Trafford PCT England North West SHA Mortality Rate/1000'000 Cancer Commissioning Toolkit Mortality from Lower GI cancers in Trafford wards The wards of Gorse Hill, Village, Urmston, Hale Barns, St Mary s and Timperley have a higher rate of mortality from lower GI cancers (colorectal cancer) in than Trafford overall. However due to the relatively small numbers, the confidence intervals are wide and this is not statistically significant at the 95% level. The rate in the wards of Gorse Hill, Village, Urmston, Hale Barns, St Mary s and Timperley is significantly higher than the mortality rate from lower GI cancers in the ward of Priory, which had the lowest mortality rate from colorectal cancer in Trafford in the period

25 March 2012: Review September 2012 Mortality from Lower GI Cancers (ICD10 C18-C20) in Trafford in All Ages - Directly Age Standardised Rate per 100,000 population - By ward (With 95% confidence intervals) Rate per 100,000 populatioin Priory Clifford Broadheath Davyhulme West Stretford Source: ONS Annual deaths file Altrincham Bowdon Bucklow-St Martins Hale Central Flixton Ashton upon Mersey Longford Davyhulme East Sale Moor Brooklands Timperley St Mary's Hale Barns Urmston Village Gorse Hill TRAFFORD Deprivation Mortality and incidence rates rise with increasing levels of deprivation (NWCIS 2010). In Trafford mortality from lower GI during the period is highest in the most deprived quintile. This is not statistically significant at the 95% level, which may be due to the comparatively small numbers at this geographical level. Mortality from Lower GI Cancers (ICD10 C18-C20) Age standardised rates per 100,000 population - persons of all ages By deprivation quintile (with 95% confidence intervals) 30.0 Rate per 100,000 population Least deprived Fourth most deprived Third most deprived Second most deprived Most deprived Source: ONS; English Indices of Deprivation 2010, Local Communities and Government Survival rates In the North West, Trafford has made the second highest improvement in five year survival rates from colorectal cancer, and now has the highest five year survival rate in the North West for patients diagnosed in , at 61.5%. This is higher than the national average of 52.5%. 25

26 Risk factors for colorectal cancer are a high-fat, low-fibre diet; obesity and alcohol consumption. Bowel screeening varies in Trafford, ranging from 24% to 64%. Urological cancer - incidence and mortality Incidence of urological cancer in all ages is increasing in Trafford, reflecting the regional and national trend, and remaining above incidence in the North West and in England. Incidence of Urology cancer All Ages : 3 year rolling average ( ) 12 Trafford PCT North West SHA England 10 Rate per 100,000 pop Source: Cancer Commissioning Toolkit Mortality from urological cancer is decreasing and is below the regional and national average. 5 year rolling age standardised mortality rate per 100,000 population: Urology cancer: Age group: All Ages 3 Trafford PCT England North West SHA Mortality Rate/1000' Cancer Commissioning Toolkit Tobacco is the biggest modifiable risk factor in incidence of bladder cancer, followed by occupational exposure to polycyclic aromatic hydrocarbons, paints, the rubber industry 26

27 and other sources of exposure to aromatic amines. Research indicates 7% of deaths from bladder cancer in men and 2% in women may be caused by occupational exposure. Five year survival rates for urological cancer are increasing and the rate in Trafford remains above the regional average. 5 year Survival rate for Urology cancer: All Ages 120% 100% Trafford PCT North West SHA 80% 60% 40% 20% 0% Survival Rate % Source: Cancer Commissioning Toolkit Prostate cancer - incidence and mortality Incidence of prostate cancer in males is increasing and the incidence rate in Trafford is significantly higher than the regional and national average. This may be due to it being identified more Incidence of prostate cancer in males (ICD9 185, ICD10 C61): Directly agestandardised rates per 100,000 population All ages (3 year rolling average) DSR per 100,000 population England North West ONS Prospering smaller towns Trafford *dotted line indicates projected trend Source: NHS Information Centre Compendium of Population Health Indicators Mortality from prostate cancer is decreasing and is mortality rate in Trafford is lower than the regional and national average, although this is not significant at the 95% confidence level. 27

28 Mortality from prostate cancer (ICD9 185 adjusted, ICD10 C61): Directly agestandardised rates per 100,000 population All ages Males (3 yr averages) DSR per 100,000 population England North West ONS Prospering smaller towns Trafford *dotted line indicates projected trend Source: NHS Information Centre Compendium of Population Health Indicators The risk of prostate cancer increases with age and incidence is highest in the years age group. According to Cancer Research UK there is no evidence yet of preventable cases. Mortality from prostate cancer in Trafford wards Mortality from prostate cancer in persons of all ages is higher in the wards of Village, Clifford and Sale Moor, than in Trafford overall. However at ward level there are no statistically significant differences. Mortality from prostate cancer (ICD10 C61) in Trafford -All Ages - Directly Age Standardised Rate per 100,000 population - By ward ( ) With 95% confidence intervals 70.0 Rate per 100,000 populatioin Priory Broadheath Hale Central Davyhulme West Timperley Source: ONS Annual deaths file Longford Flixton Hale Barns Bowdon Bucklow-St Martins Ashton upon Mersey Davyhulme East Urmston Brooklands Altrincham St Mary's Gorse Hill Stretford Sale Moor Clifford Village TRAFFORD 28

29 Summary Incidence is rising and mortality falling in most cancers. The rise in incidence could suggest that cancers are being detected earlier and this is contributing to the decrease in mortality from cancer. Upper GI cancers however show an increase in both incidence and mortality. North West data shows that mortality and incidence rates rise with increasing levels of deprivation, although there is no clear trend in five and one-year survival by level of deprivation (NWCIS 2010). Smoking is the single biggest preventable factor for cancer followed by obesity (Cancer Research UK 2012). After smoking and obesity, alcohol is one of the most important modifiable risk factors for cancer. Even moderate alcohol consumption can increase the risk of mouth, throat, liver, breast and bowel cancer. There is increasing evidence that increased physical activity during and after treatment may improve survival for breast, colon and other cancers. Public awareness nationally of the signs and symptoms of cancer is low and this may contribute to late presentation. This in turn leads to late referral and to the disease being at a more advanced stage when it is diagnosed there is a direct link between stage at diagnosis and survival outcome (Department of Health 2012). Measuring the public s awareness of the signs and symptoms of cancer could help understand patterns of awareness and the reasons why awareness is slow. This could then help reduce the variance in breast, cervical and bowel screening in Trafford. References North West Cancer Intelligence Service Cancer in the North West: Inequalities by PCT of residence and socio-economic status October 2010 Cancer Research UK Department of Health Improving Outcomes A Strategy for Cancer

30 Appendix 1: Incidence of specific cancers in Trafford, North West and England Rate per 100,000 population Incidence rate per 100,000 population All cancers All ages (2009) Rate per 100,000 population Incidence rate per 100,000 population Lung cancer All ages (2009) Rate per 100,000 population Incidence ratesper 100,000 population Breast cancer All ages (2009) Trafford PCT North West SHA England 0 Trafford PCT North West SHA England 0 Trafford PCT North West SHA England Rate per 100,000 population Incidence rate per 100,000 population Cancer of Lower GI All ages (2009) Rate per 100,000 population Incidence rate per 100,000 pouplation Cancer of Upper GI All ages (2009) Rate per 100,000 population Incidence rate per 100,000 population Urgological cancer All ages (2009) Trafford PCT North West SHA England 0 Trafford PCT North West SHA England 0 Trafford PCT North West SHA England Source: Cancer Commissioning Toolkit 30