Cancer Survival in Wales, Goroesi Cancr yng Nghymru,

Transcription

1 Cancer Survival in Wales, Goroesi Cancr yng Nghymru, Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

2 DIRECTOR S INTRODUCTION I am pleased to present the fifth report produced by the NHS in Wales by the Welsh Cancer Intelligence & Surveillance Unit. This report is concerned with the survival of residents of Wales who were diagnosed with cancer in the period and followed up to the end of 21. One of the overall measures of progress in cancer control is reduction in mortality rates. The two basic strategies used to achieve this are reduction in the incidence of the disease, by prevention, and improved survival, by the creation of more effective cancer services. Our last publication dealt with incidence, this one survival. In fact measures of mortality, incidence and survival are all essential indicators for measuring progress in cancer control as they are all related. In essence, population based survival provides a bottom line indicator of the overall effect of cancer services in Wales. Randomised controlled trials have been instrumental in achieving improvements in survival, but usually include a selected fraction of patients. The advantage of population based survival is that it helps quantify the effectiveness of cancer services in the population as a whole. Population based cancer registries were set up to produce statistics of this kind. Interpretation is not a simple matter however as a number of factors such as ascertainment, early diagnosis, screening, as well as treatment, can influence the results. There are clear indications of improvements in survival between and and to a large extent this reflects improved treatment and better organisation of services. The comparison between the three areas of Wales approximates the three cancer networks. The differences are generally not huge but may raise interesting questions about health inequalities. In comparison with our previous survival analysis based upon patients diagnosed , considerable further work has been undertaken on validating the data and improving the quality of the linkage with ONS. Unfortunately NHS policy on retention and destruction of medical records limits what can be done, but as always we are indebted to Medical Directors and Trust medical records staff for their help. The statistical methods have been documented. For example, the maximum likelihood technique has been used to estimate survival rather than the more traditional actuarial spreadsheet previously used. Hopefully the clinically richer data in the new cancer datasets will enable WCISU to delve into some of the factors influencing these results in a future publication. Finally I would like to acknowledge all the work that has gone into this publication by my colleagues at WCISU. The major burden of painstaking calculation fell on the statistical section, but without the critical work on data quality by the peripatetic, registration and IT sections this would not have been so successful. As always in WCISU, it is a team effort. Dr John Steward Director MBBCh BA MSc PhD FFPHM

3 CONTENTS CYNNWYS Page 1. INTRODUCTION 1 1. CYFLWYNIAD 1.1 Data Data 1.2 Definitions and Methods Diffiniadau a Dulliau 2. RESULTS 5 2. CANLYNIADAU 2.1 Oral Cavity Ceudod Geneuol 2.2 Lip, Oral Cavity & Pharynx Gwefus, Ceudod Geneuol a Ffaryncs 2.3 Head & Neck Pen a Gwddf 2.4 Oesophagus Y Sefnig 2.5 Stomach Y Stumog 2.6 Colon Colon 2.7 Rectum Rectwm 2.8 Colorectal Colorectal 2.9 Liver Afu 2.1 Pancreas Y Cefndedyn 2.11 Larynx Laryncs 2.12 Trachea, Bronchus & Lung Yr Ysgyfaint 2.13 Bone Asgwrn 2.14 Melanoma Melanoma 2.15 Female Breast Y Fron Fenywaidd 2.16 Cervix Uteri Ceg y Groth 2.17 Corpus Uteri Corffyn y Groth 2.18 Ovary Wygell 2.19 Prostate Y Brostad 2.2 Testis Ceilliau 2.21 Urinary Tract excluding Bladder Y Llwbr Troethol Ac Eithrio r Bledren 2.22 Bladder Y Bledren 2.23 Brain & CNS Yr Ymennydd a r CNS 2.24 Thyroid Thyroid 2.25 Hodgkin s Disease Clefyd Hodgkin 2.26 Non-Hodgkin s Lymphoma Lymffoma nad yw n Hodgkin 2.27 Multiple Myeloma Myeloma Ymledol 2.28 Leukaemia Lewcemia 2.29 All Malignancies excluding skin Pob cancr ac eithrio Cancr y Croen 3. APPENDICES ATODIADAU 4. REFERENCES 1 4. CYFEIRIADAU

4 1. INTRODUCTION Survival analysis is concerned with the analysis of times to the occurrence of an event. In cancer studies this is frequently the time period between diagnosis and death for each patient. Cancer registries in the UK hold population based databases and follow up the patients held on this from diagnosis until death. Observational studies therefore, can provide the actual survival rates being achieved in the entire population and are a very important public health tool. 1

5 1.1 DATA The Welsh Cancer Intelligence and Surveillance Unit (WCISU) is tasked under its Service Level Agreement (SLA) with the Welsh Assembly Government (WAG) to register all incidence of cancer for the resident population of Wales wherever they are treated. Multiple sources of data are used to ensure completeness of registration and to enhance data quality. Sources include Patient Episode Database Wales (PEDW), Pathology records (received from 12 out of the 14 Welsh Trusts), Extra Regional Notification and the Office of National Statistics (ONS). A frozen copy of the WCISU database was created on 6 th May 23. From this file, the data for this publication was extracted. All first malignant tumours (apart from non-melanoma skin - ICD1 C44) diagnosed during the period 1 st January 1989 to 31 st December 1998 were extracted for analysis. The follow-up period was until death or the end of the study period, defined as 31 st December 21 (i.e. follow-up period was a minimum of 3 years). Subjects who emigrated were censored at their date of emigration. Whenever possible, the analyses were stratified by the two five year diagnosis periods, and The analysis was restricted to adults diagnosed between the ages of 15 and 99. It is well documented that accuracy of diagnosis in the very elderly is poor. A separate publication planned for next year will cover childhood survival. Subjects who were still alive and aged 1 years old or greater at the end of the follow up period were excluded from the analysis if they had never been traced by ONS. Information obtained from PEDW and the Welsh National Health Service Administrative Register (NHSAR) frequently provides details of death and emigration for subjects who could not be traced by ONS. It is therefore neither necessary nor appropriate to exclude all such subjects. Only cancers in Welsh residents were considered. Cases with missing or bucket postcodes were not included as it is likely these patients are not Welsh residents. Any cases first discovered from a death certificate were excluded as date of diagnosis and therefore follow up duration are unknown. Care was taken however not to exclude cases who truly experienced a zero survival time (for example, it is possible for patients to present as an emergency with a bowel obstruction and die during surgery. If the diagnosis is cancer, the date of diagnosis will be the same as the date of death). Any subjects with the bucket date of birth, 3 th June 19, were excluded from the analysis. 2

6 1.2 DEFINITIONS AND METHODS Survival definitions There are several approaches to estimating cancer survival in population studies. In this publication, observed (crude) survival and relative survival are presented. Estimates of median survival time are also calculated. Observed survival is simply the probability of survival at a given time since diagnosis, irrespective of cause of death. It is usually expressed as the percentage alive at the given time point, e.g. 1 year, 5 years etc. since diagnosis. Problems with this method arise if comparisons are to be made between populations with different age distributions. Observed survival is likely to be lower in an older population, as they are more likely to die not just of the cancer, but also of other causes. Relative survival is the most widely used method in population studies. It is the ratio of the survival observed in the group of cancer patients to the survival that would be expected if they were subject to the same overall mortality rates by age, sex and calendar period as the general population. The expected probabilities are obtained from life tables for Wales that provide the life expectancy of persons for a given year by age and sex. The problems arising with crude survival are therefore overcome. Life tables were obtained from the Government Actuary Department (GAD) 1. These tables are by sex and single year of age up to 1 and based on 3 years of data, e.g , up to Each of these tables are based on the revised (in the light of the 21 census) mid year population estimates and deaths data for a three year period. For the first five year diagnosis period examined life tables were used. For the second period tables were used. Median observed survival time is defined as the length of time after diagnosis until half the patients have died, regardless of their cause of death. Thus by definition, it is usually highest in cancers that have a good prognosis and those that are diagnosed in younger people. Methods Twenty-eight cancer sites were examined in addition to all malignancies (excluding non melanoma skin cancer). Of these, 23 occur in both men and women, 4 only in women and 2 only in men. For the period of diagnosis concerned ( ) the cancers studied accounted for approximately 92% of all malignant cancers diagnosed in Wales. All cases have been followed up until 31 st December 21, thus allowing a minimum follow up period of 3 years after diagnosis for all patients included in the analysis. For each cancer site 1,3,5 and 1 year observed and relative survival are presented for both the and diagnosis periods. 3

7 Analysis by age-group was also carried out. Due to small numbers, these are based on the entire study period Estimates are not provided in instances where there are very few cases in a particular age group. Finally, estimates were calculated for each of the three NHS Wales Regional Office boundaries (North Wales, Mid & West Wales, South Wales) for the diagnosis period. Care should be taken in comparing the 3 regions. Although relative survival estimates take into account age and sex-specific differences in background mortality, cancer survival is also dependent on age at diagnosis and is in general likely to be lower in older patients. Therefore if the age distribution of the general population at risk and cancer patients varies between different populations, comparing relative survival across these populations can be misleading. Age standardised relative survival is often presented to overcome this. In these analyses however, numbers were frequently too small to calculate reliable age-sex specific rates. Tables showing the age and sex distribution of each cancer site for each region are provided instead as an aid to interpretation. Software Relative survival was computed using a STATA algorithm 2 based on the maximum likelihood method of Esteve et al 3. As zero survival times are not accepted by STATA, a follow up duration of 1 day is imputed where necessary. The following time intervals were generally used:- 1 month for the first 6 months; 3 months for the remainder of the first year; 6 months until 5 years; 1 year until 1 years. For rare cancers, fewer time intervals were used. The usual set used were:- 6 months for the first 3 years, then intervals of 2 years and 5 years up to 5 and 1 years respectively. Regrouping of time intervals was sometimes necessary for age specific analysis and analysis by region. Note that for patients diagnosed in the period, 1 year survival estimates are not available and so the relevant omissions were made from the intervals listed above. 1. Government Actuary's Department, London strel command for estimation of relative survival written by Slogett A, Hills M, de Stavola B, Mander A. (1999). 3. Estève J, Benhamou E, Croasdale M, Raymond L. Relative survival and the estimation of net survival: elements for further discussion. Stat Med 199; 9:

8 2. RESULTS In total patients were included in the analyses contained in this publication and these patients have been split into two time periods of diagnosis, and There were slightly more patients in the later diagnosis period. Figures 1 to 4 provide a summary of relative survival at five years, by sex and period of diagnosis, for each of the cancer sites studied. Table 1: Number of patients included in survival analysis by cancer site and diagnosis period Cancer Site Period of diagnosis (period 1) (period 2) Oral Cavity Lip, Oral Cavity & Pharynx Head & Neck Oesophagus Stomach Colon Rectum Colorectal Liver Pancreas Larynx Trachea, Bronchus & Lung Bone Melanoma Female Breast Cervix Uteri Corpus Uteri Ovary Prostate Testis Urinary Tract excl Bladder Bladder Brain & CNS Thyroid Hodgkin s Disease Non-Hodgkin s Lymphoma Multiple Myeloma Leukaemia All Malignancies excl Skin

9 Relative Survival Fig 1: 5 year relative survival for males in period 1 Testis Hodgkin's Disease Bladder Larynx Thyroid Melanoma Bone Head & Neck Prostate Lip, Oral Cavity & Pharynx Non-Hodgkin's Lymphoma Colon Oral Cavity Urinary Tract excluding Colorectal Leukaemia Rectum Multiple Myeloma BrainCNS Stomach Trachea, Bronchus & Lung Oesophagus Liver Pancreas All Malignancies excluding Skin % Relative Survival Fig 2: 5 year relative survival for males in period 2 Testis Hodgkin's Disease Bladder Thyroid Melanoma Larynx Prostate Bone Head & Neck Colon Lip, Oral Cavity & Pharynx Urinary Tract excluding Non-Hodgkin's Lymphoma Colorectal Oral Cavity Rectum Leukaemia Multiple Myeloma BrainCNS Stomach Oesophagus Trachea, Bronchus & Lung Liver Pancreas All Malignancies excluding Skin Fig 3: 5 year relative survival for females in period 1 % Relative Survival 6

10 Fig3: 5 year relative survival for females in period 1 Melanoma Hodgkin's Disease Corpus Uteri Thyroid Female Breast Bladder Cervix Uteri Oral Cavity Head & Neck Non-Hodgkin's Lymphoma Larynx Lip, Oral Cavity & Pharynx Rectum Colorectal Colon Leukaemia Urinary Tract excluding Bladder Bone Ovary Multiple Myeloma BrainCNS Stomach Liver Trachea, Bronchus & Lung Pancreas Oesophagus All Malignancies excluding Skin Fig 4: 5 year relative survival for females in period 2 % Relative Survival Fig4: 5 year relative survival for females in period 2 Melanoma Corpus Uteri Female Breast Hodgkin's Disease Thyroid Bone Larynx Bladder Cervix Uteri Oral Cavity Lip, Oral Cavity & Pharynx Head & Neck Non-Hodgkin's Lymphoma Rectum Colorectal Colon Urinary Tract excluding Bladder Leukaemia Ovary Multiple Myeloma BrainCNS Stomach Oesophagus Trachea, Bronchus & Lung Liver Pancreas All Malignancies excluding Skin % Relative Survival 7

11 2.1 ORAL CAVITY (ICD-1: C1-C6) There are around 13 cases of cancer of the oral cavity diagnosed each year in Wales with a male to female ratio of 8:5. Females had higher survival with 5 year relative survival being 57%, compared to 46% in men. Survival in women was fairly constant across age groups until 85, whereas in men there appeared to be more of a decline with age. Quality One subject was excluded from period 1 as they he never traced at ONS and was over 1 years of age by the end of the follow up period. Another subject was excluded in this period due to a missing or invalid postcode. There were 21 DCO registrations in the first diagnosis period and 19 in the second. Descriptive Information The number of cases analysed, classified according to age at diagnosis are shown in the chart below. Fig 1. Age Distribution of Cases: Oral Cavity Cancer By Diagnosis Period: Males By Diagnosis Period: Females

12 2.1 ORAL CAVITY (ICD-1: C1-C6) Survival estimates Table 1. Observed and relative survival by sex and period of diagnosis 1yr survival 3yr survival 5 yr survival 1 yr survival Period Sex obs rel obs rel obs rel obs rel Males Males Females Females Both Both Fig 2. Relative survival (95% confidence interval) by age-group and sex for subjects diagnosed between 1989 and year 5 year Male Female 6 4 Male Female 2 2 9

13 2.1 ORAL CAVITY (ICD-1: C1-C6) Table 2. Number of registrations and proportions (italics) by NHS Wales Regional Office Boundary and age at diagnosis for subjects diagnosed between 1989 and MALES FEMALES South North Mid & West Total South North Mid & West Total Total Total Fig 3. Relative Survival by NHS Wales Regional Office Boundary for subjects diagnosed between 1989 and 1998 ONE YEAR RELATIVE SURVIVAL NORTH MID & WEST MALES 95% L 95% U FEMALES 95% L 95% U 67.6 ( 58.26, 75.3 ) 8.3 ( 69.57, ) ( 69.5, ) ( 7.41, 86.7 ) 66.5 ( 59.49, ) 76.8 ( 66.64, ) FIVE YEAR RELATIVE SURVIVAL SOUTH MALES 95% L 95% U FEMALES 95% L 95% U 42.6 ( 31.94, ) 57.4 ( 44.96, 68.2 ) ( 39.32, ) 49.2 ( 37.4, ) 44.8 ( 37.3, 5.89 ) 6.36 ( 49.47, ) 1

14 2.2 LIP, ORAL CAVITY & PHARYNX (ICD-1: C-C14) Cancer of the lip, oral cavity and pharynx is far more common in males. Around half of subjects were still alive after 5 years and 45% after 1 years. Survival of men in Mid and West Wales was slightly higher compared to the other 2 areas. Differences in the age at presentation across the regions doesn t seem to explain this. Quality Three subjects were excluded from period 1 as they was never traced at ONS and were over 1 years of age by the end of the follow up period. An additional 1 were excluded from this period because of a missing or invalid postcode. There were 49 DCOs in the diagnosis period and 35 in the period. There were 3 true zero survivors. Descriptive Information The number of cases analysed, classified according to age at diagnosis are shown in the chart below. Fig 1. Age Distribution of Cases: Lip, Oral Cavity & Pharyngeal Cancer By Diagnosis Period: Males By Diagnosis Period: Females

15 2.2 LIP, ORAL CAVITY & PHARYNX (ICD-1: C-C14) Survival estimates Table 1. Observed and relative survival by sex and period of diagnosis 1yr survival 3yr survival 5 yr survival 1 yr survival Period Sex obs rel obs rel obs rel obs rel Males Males Females Females Both Both Fig 2. Relative survival (95% confidence interval) by age-group and sex for subjects diagnosed between 1989 and year 5 year Male Female Male Female 12

16 2.2 LIP, ORAL CAVITY & PHARYNX (ICD-1: C-C14) Table 2. Number of registrations and proportions (italics) by NHS Wales Regional Office Boundary and age at diagnosis for subjects diagnosed between 1989 and MALES FEMALES South North Mid & West Total South North Mid & West Total Total Total Fig 3. Relative Survival by NHS Wales Regional Office Boundary for subjects diagnosed between 1989 and 1998 ONE YEAR RELATIVE SURVIVAL NORTH MALES 95% L 95% U FEMALES 95% L 95% U 66.2 ( 6.33, ) ( 72.73, ) ( 7.35, 78.1 ) ( 71.64, ) ( 61.55, ) ( 66.28, ) MID & WEST SOUTH FIVE YEAR RELATIVE SURVIVAL MALES 95% L 95% U FEMALES 95% L 95% U ( 37.99, 5.87 ) 6.2 ( 51.8, ) ( 47.45, 57.2 ) ( 44.14, 58.2 ) 43.6 ( 38.94, ) ( 52.35, ) 13

17 2.3 HEAD & NECK (ICD-1: C-14, C3-C32) Head and Neck cancer is far more common in males than females. Survival estimates for males appeared to be higher in Mid and West Wales compared to the South particularly. Median survival time was around 3 years. Quality Two subjects were excluded from period 1 as they were never traced at ONS and were over 1 years of age by the end of the follow up period. A further 9 were excluded due to missing or invalid postcodes. One subject was excluded in period 2 for a missing or invalid postcode. There were 75 DCOs in the diagnosis period and 53 in the period. There were 7 true zero survivors. Descriptive Information The number of cases analysed, classified according to age at diagnosis are shown in the chart below. Fig 1. Age Distribution of Cases: Head & Neck Cancer By Diagnosis Period: Males By Diagnosis Period: Females

18 2.3 HEAD & NECK (ICD-1: C-14, C3-C32) Survival estimates Table 1. Observed and relative survival by sex and period of diagnosis 1yr survival 3yr survival 5 yr survival 1 yr survival Period Sex obs rel obs rel obs rel obs rel Males Males Females Females Both Both Fig 2. Relative survival (95% confidence interval) by age-group and sex for subjects diagnosed between 1989 and year 5 year Male Female 6 4 Male Female

19 2.3 HEAD & NECK (ICD-1: C-C14, C3-C32) Table 2. Number of registrations and proportions (italics) by NHS Wales Regional Office Boundary and age at diagnosis for subjects diagnosed between 1989 and MALES FEMALES South North Mid & West Total South North Mid & West Total Total Total Fig 3. Relative Survival by NHS Wales Regional Office Boundary for subjects diagnosed between 1989 and 1998 ONE YEAR RELATIVE SURVIVAL NORTH MALES 95% L 95% U FEMALES 95% L 95% U ( 68.88, ) ( 67.61, ) 79.5 ( 76.53, ) 76.6 ( 71.73, 8.74 ) ( 69.72, ) ( 7.89, 8.2 ) MID & WEST FIVE YEAR RELATIVE SURVIVAL SOUTH MALES 95% L 95% U FEMALES 95% L 95% U 53. ( 47.83, ) ( 46.28, 6.78 ) 58.5 ( 54.54, ) 54.3 ( 48.23, ) 5.82 ( 47.12, 54.4 ) ( 53.66, ) 16

20 2.4 OESOPHAGUS (ICD-1: C15) Cancer of the oesophagus, along with pancreas, lung and liver, is one of the sites with the poorest survival. Five year relative survival was only 6% in the first time period examined and 9% in the second. Median survival time was around 4 months. Quality Eleven subjects were excluded due to a missing or invalid postcode, 1 of these in the diagnosis period. Cancer of the oesophagus has a fairly high DCO rate 15% in period 1 and 9% in period 2. There were 2 true zero survivors. Descriptive Information The number of cases analysed, classified according to age at diagnosis are shown in the chart below. Fig 1. Age Distribution of Cases: Oesophageal Cancer By Diagnosis Period: Males By Diagnosis Period: Females

21 2.4 OESOPHAGUS (ICD-1: C15) Survival estimates Table 1. Observed and relative survival by sex and period of diagnosis 1yr survival 3yr survival 5 yr survival 1 yr survival Period Sex obs rel obs rel obs rel obs rel Males Males Females Females Both Both Fig 2. Relative survival (95% confidence interval) by age-group and sex for subjects diagnosed between 1989 and year 5 year Male Female 6 4 Male Female

22 2.4 OESOPHAGUS (ICD-1: C15) Table 2. Number of registrations and proportions (italics) by NHS Wales Regional Office Boundary and age at diagnosis for subjects diagnosed between 1989 and MALES FEMALES South North Mid & West Total South North Mid & West Total Total Total Fig 3. Relative Survival by NHS Wales Regional Office Boundary for subjects diagnosed between 1989 and 1998 ONE YEAR RELATIVE SURVIVAL NORTH MALES 95% L 95% U FEMALES 95% L 95% U ( 19.94, ) ( 18.86, 28. ) ( 22.24, 3.27 ) ( 21.73, 31.2 ) ( 19.25, 26.1 ) ( 15.41, ) MID & WEST SOUTH FIVE YEAR RELATIVE SURVIVAL MALES 95% L 95% U FEMALES 95% L 95% U 7.59 ( 4.78, ) 8.57 ( 5.66, ) 8.83 ( 6.19, 12.2 ) 5.68 ( 3.36, 8.87 ) 6.92 ( 4.85, 9.47 ) 5.56 ( 3.57, 8.17 ) 19

23 2.5 STOMACH (ICD-1: C16) Stomach cancer is more common in men than women. The prognosis is poor with 5 year relative survival being around 13%. The median survival time was approximately 4 months. Mid and West Wales showed higher survival rates, particularly compared to males in South Wales. The age distribution of the cancer patients at diagnosis doesn t appear to explain the difference. Five year relative survival was 14% and 9% respectively. Quality In the diagnosis period, 4 subjects were excluded as they were never traced at ONS and were over 1 years of age by the end of the follow up period; 2 had missing or invalid postcodes. In the first diagnosis period 2% of registrations were DCOs. This reduced to 12% in the second period. There were 29 true zero survivors. Descriptive Information The number of cases analysed, classified according to age at diagnosis are shown in the chart below. Fig 1. Age Distribution of Cases: Stomach Cancer By Diagnosis Period: Males By Diagnosis Period: Females

24 2.5 STOMACH (ICD-1: C16) Survival estimates Table 1. Observed and relative survival by sex and period of diagnosis 1yr survival 3yr survival 5 yr survival 1 yr survival Period Sex obs rel obs rel obs rel obs rel Males Males Females Females Both Both Fig 2. Relative survival (95% confidence interval) by age-group and sex for subjects diagnosed between 1989 and year 5 year Male Female 6 4 Male Female

25 2.5 STOMACH (ICD-1: C16) Table 2. Number of registrations and proportions (italics) by NHS Wales Regional Office Boundary and age at diagnosis for subjects diagnosed between 1989 and MALES FEMALES South North Mid & West Total South North Mid & West Total , , Total ,177 3,53 Total , Fig 3. Relative Survival by NHS Wales Regional Office Boundary for subjects diagnosed between 1989 and 1998 ONE YEAR RELATIVE SURVIVAL NORTH MID & WEST MALES 95% L 95% U FEMALES 95% L 95% U ( 25.83, ) ( 2.1, ) 33.1 ( 3.23, ) ( 27.39, ) ( 24.13, ) ( 26.27, ) FIVE YEAR RELATIVE SURVIVAL SOUTH MALES 95% L 95% U FEMALES 95% L 95% U ( 9.48, ) 1.72 ( 7.86, 14.7 ) ( 11.52, 16.1 ) ( 12.3, ) 9.1 ( 7.36, 1.86 ) ( 11.39, ) 22

26 2.6 COLON (ICD-1: C18) Colon cancer is the third most common cancer in both males and females 1. There was some improvement in survival across the 2 time periods an increase in 5 year relative survival from 41% to 47%. Median survival time increased from 1.6 years to 2.1 years. Quality In the diagnosis period, 4 subjects were excluded as they were never traced at ONS and were over 1 years of age by the end of the follow up period; 36 had missing or invalid postcodes. In the second period only 1 subject was excluded. This was due to a missing or invalid postcode. 16.7% of registrations were DCOs in the first period and 9.9% in the second. There were 45 true zero survivors. Descriptive Information The number of cases analysed, classified according to age at diagnosis are shown in the chart below. Fig 1. Age Distribution of Cases: Colon Cancer By Diagnosis Period: Males By Diagnosis Period: Females Cancer Incidence in Wales, (22). Welsh Cancer Intelligence & Surveillance Unit 23

27 2.6 COLON (ICD-1: C18) Survival estimates Table 1. Observed and relative survival by sex and period of diagnosis 1yr survival 3yr survival 5 yr survival 1 yr survival Period Sex obs rel obs rel obs rel obs rel Males Males Females Females Both Both Fig 2. Relative survival (95% confidence interval) by age-group and sex for subjects diagnosed between 1989 and year 5 year Male Female 6 4 Male Female

28 2.6 COLON (ICD-1: C18) Table 2. Number of registrations and proportions (italics) by NHS Wales Regional Office Boundary and age at diagnosis for subjects diagnosed between 1989 and MALES FEMALES South North Mid & West Total South North Mid & West Total Total Total Fig 3. Relative Survival by NHS Wales Regional Office Boundary for subjects diagnosed between 1989 and 1998 ONE YEAR RELATIVE SURVIVAL NORTH MALES 95% L 95% U FEMALES 95% L 95% U ( 61.57, ) ( 56.44, ) ( 63.25, ) ( 58.94, 64.6 ) ( 6.25, ) ( 59.44, ) MID & WEST SOUTH FIVE YEAR RELATIVE SURVIVAL MALES 95% L 95% U FEMALES 95% L 95% U ( 43.48, 5.91 ) 4.2 ( 36.88, ) ( 45.81, 52.2 ) ( 4.19, 46.5 ) ( 4.78, ) ( 4.59, 46.1 ) 25

29 2.7 RECTUM (ICD-1: C19-C21) Rectal cancer was the 5 th most common cancer in both men and women for the diagnosis period There are around 75 new cases per year. The median survival time was 2 years in the diagnosis period and 2.6 years in the period. Quality One subject was excluded from period 1 as he was never traced at ONS and was over 1 years of age by the end of the follow up period. Twenty-five subjects were excluded due to a missing or invalid postcode in the first period and 1 in the second. There were 255 DCO registrations in the first period and 167 in the second. Descriptive Information The number of cases analysed, classified according to age at diagnosis are shown in the chart below. Fig 1. Age Distribution of Cases: Rectal Cancer By Diagnosis Period: Males By Diagnosis Period: Females Cancer Incidence in Wales, (22). Welsh Cancer Intelligence & Surveillance Unit 26

30 2.7 RECTUM (ICD-1: C19-C21) Survival estimates Table 1. Observed and relative survival by sex and period of diagnosis 1yr survival 3yr survival 5 yr survival 1 yr survival Period Sex obs rel obs rel obs rel obs rel Males Males Females Females Both Both Fig 2. Relative survival (95% confidence interval) by age-group and sex for subjects diagnosed between 1989 and year 5 year Male Female 6 4 Male Female

31 2.7 RECTUM (ICD-1: C19-C21) Table 2. Number of registrations and proportions (italics) by NHS Wales Regional Office Boundary and age at diagnosis for subjects diagnosed between 1989 and MALES FEMALES South North Mid & West Total South North Mid & West Total Total Total Fig 3. Relative Survival by NHS Wales Regional Office Boundary for subjects diagnosed between 1989 and 1998 ONE YEAR RELATIVE SURVIVAL NORTH MALES 95% L 95% U FEMALES 95% L 95% U 7.87 ( 67.49, ) ( 65.18, 72.8 ) ( 69.6, ) ( 66.52, 72.9 ) ( 66.1, 71.6 ) ( 66.5, ) MID & WEST SOUTH FIVE YEAR RELATIVE SURVIVAL MALES 95% L 95% U FEMALES 95% L 95% U ( 39.54, ) ( 39.2, ) ( 4.96, ) 44.6 ( 4.73, ) ( 35.69, ) ( 4.14, ) 28

32 2.8 COLORECTAL (ICD-1: C18-C21) There are around 2, new cases of colorectal cancer diagnosed every year in Wales 1. One year relative survival was 68% for the most recent time period. Five year relative survival was 47%. Quality Five cases were excluded in the first diagnosis period as they could not be traced at ONS and were over 1 years of age by the end of the follow up period. A further 63 cases were excluded for having a missing or bucket postcode, 61 of these from the first diagnosis period. 174 cases were DCOs in the period out of an eligible 8335 (12.9%). In the diagnosis period , 75 cases were DCOs out of an eligible 8775 (8.%). There were 66 true zero survivors. Descriptive Information The number of cases analysed, classified according to age at diagnosis are shown in the chart below. Fig 1. Age Distribution of Cases: Colorectal Cancer By Diagnosis Period: Males By Diagnosis Period: Females Cancer Incidence in Wales, (22). Welsh Cancer Intelligence & Surveillance Unit 29

33 2.8 COLORECTAL (ICD-1: C18-C21) Survival estimates Table 1. Observed and relative survival by sex and period of diagnosis 1yr survival 3yr survival 5 yr survival 1 yr survival Period Sex obs rel obs rel obs rel obs rel Males Males Females Females Both Both Fig 2. Relative survival (95% confidence interval) by age-group and sex for subjects diagnosed between 1989 and year 5 year Male Female 6 4 Male Female 2 2 3

34 2.8 COLORECTAL (ICD-1: C18-C21) Table 2. Number of registrations and proportions (italics) by NHS Wales Regional Office Boundary and age at diagnosis for subjects diagnosed between 1989 and MALES FEMALES South North Mid & West Total South North Mid & West Total Total Total Fig 3. Relative Survival by NHS Wales Regional Office Boundary for subjects diagnosed between 1989 and 1998 ONE YEAR RELATIVE SURVIVAL NORTH MALES 95% L 95% U FEMALES 95% L 95% U ( 65.19, ) ( 6.52, ) ( 67.2, 7.68 ) ( 62.53, ) ( 63.67, 67.1 ) ( 62.76, ) MID & WEST SOUTH FIVE YEAR RELATIVE SURVIVAL MALES 95% L 95% U FEMALES 95% L 95% U ( 42.61, ) ( 38.75, 44.1 ) ( 44.36, ) ( 41.29, ) ( 39.8, ) ( 41.35, ) 31

35 2.9 LIVER (ICD-1: C22) Cancer of the liver is a fairly rare cancer with very poor survival. The median survival time was under 2.5 months. Relative survival in females was higher than in men in the first period, but this evened out in the 2 nd period. Males in North Wales seemed to have poorer survival than the other regions, particularly Mid and West Wales. North Wales had a higher proportion of males aged 75+ at diagnosis however. Quality 4 subjects were excluded for having a missing or invalid postcode, all of which were from period 1. There were 135 DCOs in the diagnosis period (21%) and 96 (17%) in the period. There were 15 true zero survivors. Descriptive Information The number of cases analysed, classified according to age at diagnosis are shown in the chart below. Fig 1. Age Distribution of Cases: Liver Cancer By Diagnosis Period: Males By Diagnosis Period: Females

36 2.9 LIVER (ICD-1: C22) Survival estimates Table 1. Observed and relative survival by sex and period of diagnosis 1yr survival 3yr survival 5 yr survival 1 yr survival Period Sex obs rel obs rel obs rel obs rel Males Males Females Females Both Both Fig 2. Relative survival (95% confidence interval) by age-group and sex for subjects diagnosed between 1989 and year 5 year Male Female 6 4 Male Female

37 2.9 LIVER (ICD-1: C22) Table 2. Number of registrations and proportions (italics) by NHS Wales Regional Office Boundary and age at diagnosis for subjects diagnosed between 1989 and MALES FEMALES South North Mid & West Total South North Mid & West Total Total Total Fig 3. Relative Survival by NHS Wales Regional Office Boundary for subjects diagnosed between 1989 and 1998 ONE YEAR RELATIVE SURVIVAL NORTH MALES 95% L 95% U FEMALES 95% L 95% U ( 7.55, ) ( 11.11, 25.7 ) ( 13.12, ) ( 11.12, 23.4 ) ( 1.46, ) 17.3 ( 12.11, ) MID & WEST SOUTH FIVE YEAR RELATIVE SURVIVAL MALES 95% L 95% U FEMALES 95% L 95% U 1.53 (.24, 5.54 ) 7.52 ( 3.23, ) 1.7 ( 5.96, ) 5.26 ( 2.23, 1.23 ) 5.63 ( 3.11, 9.22 ) 5.98 ( 2.92, 1.56 ) 34

38 2.1 PANCREAS (ICD-1: C25) Pancreatic cancer has a very poor prognosis. This site had the lowest survival of the sites investigated for this publication. In the most recent time period, 1 year relative survival was 13% and 5 year relative survival, 4%. The median survival time was around two and a half months. Survival in South Wales seemed slightly lower when compared to the rest of Wales. Quality One subject was excluded from period 1 due to never being traced at ONS and being over 1 years of age by the end of the follow up period. A further 9 were excluded because of missing or invalid postcodes. Pancreatic cancer has the largest percentage of DCO registrations 25% in period 1 and 17% in period 2. Descriptive Information The number of cases analysed, classified according to age at diagnosis are shown in the chart below. Fig 1. Age Distribution of Cases: Pancreatic Cancer By Diagnosis Period: Males By Diagnosis Period: Females

39 2.1 PANCREAS (ICD-1: C25) Survival estimates Table 1. Observed and relative survival by sex and period of diagnosis 1yr survival 3yr survival 5 yr survival 1 yr survival Period Sex obs rel obs rel obs rel obs rel Males Males Females Females Both Both Fig 2. Relative survival (95% confidence interval) by age-group and sex for subjects diagnosed between 1989 and year 5 year Male Female 6 4 Male Female

40 2.1 PANCREAS (ICD-1: C25) Table 2. Number of registrations and proportions (italics) by NHS Wales Regional Office Boundary and age at diagnosis for subjects diagnosed between 1989 and MALES FEMALES South North Mid & West Total South North Mid & West Total Total Total Fig 3. Relative Survival by NHS Wales Regional Office Boundary for subjects diagnosed between 1989 and 1998 ONE YEAR RELATIVE SURVIVAL NORTH MALES 95% L 95% U FEMALES 95% L 95% U ( 13.79, 22.1 ) ( 9.19, ) ( 13.48, 2.61 ) ( 11.6, 17.7 ) ( 8.94, 14.7 ) ( 8.78, 14.1 ) MID & WEST SOUTH FIVE YEAR RELATIVE SURVIVAL MALES 95% L 95% U FEMALES 95% L 95% U 6.77 ( 4.12, 1.3 ) 4.16 ( 2.35, 6.74 ) 6.15 ( 3.97, 8.99 ) 5.97 ( 3.76, 8.87 ) 3.57 ( 2.8, 5.69 ) 4.1 ( 2.5, 6.6 ) 37

41 2.11 LARYNX (ICD-1: C32) Cancer of the larynx is a fairly rare cancer with the number of cases in males being nearly 4 times that of females 1. Relative survival in females was lower than in men in the first period, but improvement in female survival was seen in the second period. Survival in females was low in North Wales. Note the small number of cases however and the higher proportion of women presenting over the age of 75. Quality One subject was excluded from period 1 as he was never traced at ONS and was over 1 years of age by the end of the follow up period. A further 3 subjects were excluded for having a missing or invalid postcode, 2 of these from period 1. There were 21 DCOs in the diagnosis period (3.4%) and 17 (3.1%) in the period. There were 4 true zero survivors. Descriptive Information The number of cases analysed, classified according to age at diagnosis are shown in the chart below. Fig 1. Age Distribution of Cases: Laryngeal Cancer By Diagnosis Period: Males By Diagnosis Period: Females Cancer Incidence in Wales, (22). Welsh Cancer Intelligence & Surveillance Unit 38

42 2.11 LARYNX (ICD-1: C32) Survival estimates Table 1. Observed and relative survival by sex and period of diagnosis 1yr survival 3yr survival 5 yr survival 1 yr survival Period Sex obs rel obs rel obs rel obs rel Males Males Females Females Both Both Fig 2. Relative survival (95% confidence interval) by age-group and sex for subjects diagnosed between 1989 and year 5 year Male Female 6 4 Male Female

43 2.11 LARYNX (ICD-1: C32) Table 2. Number of registrations and proportions (italics) by NHS Wales Regional Office Boundary and age at diagnosis for subjects diagnosed between 1989 and MALES FEMALES South North Mid & West Total South North Mid & West Total Total Total Fig 3. Relative Survival by NHS Wales Regional Office Boundary for subjects diagnosed between 1989 and 1998 ONE YEAR RELATIVE SURVIVAL NORTH MALES 95% L 95% U FEMALES 95% L 95% U 83.8 ( 76.49, ) ( 38.4, 69.7 ) ( 83.9, ) ( 68.12, ) ( 78.61, 87.1 ) ( 71.4, ) MID & WEST SOUTH FIVE YEAR RELATIVE SURVIVAL MALES 95% L 95% U FEMALES 95% L 95% U ( 56.4, ) ( 17.72, ) 67.7 ( 6.62, ) ( 51.65, ) ( 54.68, ) ( 43.98, ) 4