INFORMATION TO SUPPORT THE DEVELOPMENT OF THE LINCOLNSHIRE CANCER STRATEGY Final draft January 212 Ann Ellis, Health Improvement Principal, NHS Lincolnshire Leanne Goulsbra, Senior Information Analyst, NHS Lincolnshire
CONTENTS Page No. Chapter 1 Introduction 4 1.1 Context 4 1.2 What is this chapter telling us? 11 Chapter 2 Profile of Cancer within Lincolnshire 12 2.1 Prevalence 12 2.2 Premature Mortality 13 2.3 First Presentation of Cancer 14 2.4 What is this chapter telling us? 15 Chapter 3 Profile of Breast Cancer 16 3.1 Incidence 16 3.2 First Presentation of Breast Cancer in Females 18 3.3 Premature Mortality of Breast Cancer 27-29 21 3.4 Breast Cancer Stage at Diagnosis 23 3.5 Breast Cancer Referral Rates 25 3.6 Breast Cancer conversion and Detection Rates 26 3.7 Breast Cancer Survival 27 3.8 What is this chapter telling us? 32 Chapter 4 Profile of Colorectal Cancer 33 4.1 Incidence of Colorectal Cancer across Cancer Networks 33 4.2 First Presentation of Colorectal Cancer 36 4.3 Premature Mortality Colorectal Cancer 27-29 41 4.4 Colorectal Cancer Stage at Diagnosis 46 4.5 Colorectal Cancer Referral Rates 49 4.6 Colorectal Cancer Conversion and Detection Rates 5 4.7 Colorectal Cancer Survival 51 4.8 NHS Bowel Cancer Screening Programme Performance as of September 21 53 4.9 What is this chapter telling us? 55 Chapter 5 Profile of Lung Cancer 56 5.1 First Presentation of Lung Cancer 56 5.2 Premature Mortality of Lung Cancer (under age of 75) 64 5.3 Lung Cancer Referral Rates 72 5.4 Lung Cancer Conversion and Detection Rates 73 5.5 Lung Cancer Survival 74 5.6 What is this chapter telling us? 76 Chapter 6 Profile of Prostrate Cancer 77 6.1 Incidence of Prostrate Cancer 77 6.2 First Presentation of Prostrate Cancer 8 2
6.3 Premature Mortality for Prostrate Cancer 27-29 82 6.4 Urology Cancer Referral Rates 83 6.5 Urology Cancer Conversion and Detection Rates 84 6.6 Urology Cancer Survival 85 6.7 What is this chapter telling us? 87 3
Chapter 1 Introduction 1.1 Context Cancer affects around one in three people at some point in their lives. It is largely a disease of life style. According to the Cancer Reform Strategy (27), over half of all cancers can be prevented by changes in lifestyle. Smoking, obesity, excessive alcohol consumption and too much exposure to the sun are examples of this. 84% of lung cancer deaths are attributable to smoking. Cancer is also a disease of ageing. Lincolnshire has an ageing population therefore it is to be expected to see a large number of cancers diagnosed each year. Cancer incidence is generally positively correlated with deprivation the exceptions being breast, ovary, melanoma and kidney cancers. Cancer screening remains an important way to detect early and in some cases such as cervical screening prevent cancers. The three key areas are recognised nationally: Prevention Awareness and early presentation Prompt diagnosis In Lincolnshire the Early Presentation of Cancer Programme (EPOC) is the vehicle for these three areas to be driven forward. The information contained in this document shows the picture of where we are today so that we can understand the here and now and enable Lincolnshire to move forward to meet the challenges of tomorrow. Definitions First presentation The definition of first presentation is the first identified presentation of cancer whilst the patient is registered with NHS Lincolnshire as an inpatient at hospital. Incidence The incidence is the number of new cases of disease that develop in a population during a specified time period. 4
Prevalence Prevalence is the total number of cases of disease in a population at one point in time, taken as a proportion of the total number of persons in that population. Indices of Multiple Deprivation (IMD) Areas of multiple deprivation are identified at the smallest area level and based on a methodology developed by the Social Disadvantage Research Centre at the University of Oxford, separate indices have been constructed for England, Northern Ireland, Scotland and Wales. Though not directly comparable, each index is based on the concept that distinct dimensions of deprivation such as income, employment, education and health can be identified and measured separately. These dimensions, sometimes referred to as 'domains' are then aggregated to provide an overall measure of multiple deprivation and each individual area is allocated a deprivation rank and score. The indices are used to help target policies and funding, and reinforce a common goal to improve the quality of life in disadvantaged communities. 1.1(i) Lincolnshire Cancer Mortality by Age and Deprivation Quintiles 27 29 Proportion of Cancer Mortality by Age and Deprivation Quintiles 27-29 Proportion 75 and Over Proportion Under 75 3% 25% 2% 15% 28% 26% 21% 21% 14% 15% 12% 13% 24% 24% 1% 5% % Most Deprived Deprived Average Not Deprived Least Deprived Source: Public Heath Mortality File Deprivation quintiles: IMD21 When looking at the proportion of cancer deaths for these two age groups during 27 29 (under and over 75 years) by deprivation quintiles, which ever quintile is analysed there is hardly any difference in both age groups for cancer mortality. The most deprived quintile has the highest proportion for both age groups 5
The next few maps/charts depict: all age all cancer mortality in number of deaths first presentation of cancer as a proxy measure for incidence also expressed as a number broken down to ward level within individual consortium multiple Indices of Deprivation. age sex population break down (Skegness and Coast included as an example) 6
1.1(ii) Mortality From all Cancer in Lincolnshire April 27 to March 21 7
1.1(iii) First Presentation of all Cancers in Lincolnshire April 27 to March 21 8
1.1(iv) Index of Multiple Deprivation 21 Overall Score 9
Age and Sex Population Breakdown of NHS Lincolnshire compared to Skegness & Coast as at 1st April 211 Each bar represents the percentage in that age/sex group of the total population for. Foreground (light-coloured) bars are for Skegness & Coast. Background (darker) bars show NHS Lincolnshire for comparison. 1
1.2 What is this chapter telling us? Cancer is largely a disease of life style. According to the cancer reform strategy (27.) over half of all cancers can be prevented by changes in lifestyle. Smoking, obesity, excessive alcohol consumption and too much exposure to the sun are examples of this. 84% of lung cancer deaths are attributable to smoking. The first presentation map shows us that the incidence of all cancers is high across most of Lincolnshire. Looking at the consortium, incidence is high across most of them. Cancer is also a disease of ageing. Lincolnshire has an ageing population therefore it is to be expected to see a large number of cancers diagnosed each year. For Example Skegness has a higher proportion of its population between 6 and 8 years of age than Lincolnshire overall. The map of cancer mortality across Lincolnshire clearly shows us that Skegness and coast, Boston and East Lindsey have high numbers of deaths per ward during the period of April 27 to March 21. Mortality from all cancers is high across the consortium with the exceptions of South Holland, parts of Lincolnshire West and Welland. The IMD map shows us areas of deprivation. The deprived and very deprived areas all have higher numbers of cancer deaths. For example Boston, and Skegness and coast. 11
Chapter 2 Profile of Cancer within Lincolnshire This chapter looks at the profile of cancer within Lincolnshire. Definition The definition of prevalence is The number of people alive who have had a diagnosis of cancer at some point. 2.1 Prevalence Figure 2.1(i) Patients on GP Cancer Register Patients on Cancer Register since 1/4/23, 29/1 2.5% 2.% Line = England Rate 1.5% 1.%.5%.% Consortium Consortium Sum of Numerator Sum of Denominator % Boston 1234 8625 1.53% East Lindsey 162 8792 1.82% Lincolnshire South West 2269 127834 1.77% Lincolnshire West 3696 222198 1.66% Skegness & Coast 133 7238 1.81% South Holland 128 73215 1.65% Wellcomm 1466 8418 1.82% NHS Lincolnshire 12778 74423 1.72% England 928163 74423 1.42% Source: Information Centre, QOF 12
Practices within NHS Lincolnshire can produce a register of all cancer patients defined as a register of living patients with a diagnosis of cancer excluding non-melanotic skin cancer from 1 April 23. The above shows that the percentage of registered patients diagnosed with Cancer at a Consortium level is higher compared to the percentage for England. Figure 2.1(ii) Prevalence of Cancer Percentage Change Consortium 26/7 27/8 28/9 29/1 % Change Boston 1.15% 1.26% 1.44% 1.53%.39% East Lindsey 1.12% 1.22% 1.51% 1.82%.71% Lincolnshire South West 1.9% 1.4% 1.59% 1.77%.68% Lincolnshire West.98% 1.24% 1.48% 1.66%.68% Skegness & Coast 1.1% 1.41% 1.57% 1.81%.71% South Holland 1.11% 1.42% 1.59% 1.65%.54% Wellcomm 1.12% 1.33% 1.59% 1.82%.7% NHS Lincolnshire 1.7% 1.31% 1.53% 1.72% Source: Information Centre, QOF.64% The above depicts prevalence for individual consortium. NHS Lincolnshire overall prevalence has increased year on year. 2.2 Premature Mortality (Under 75 Year Olds) 27-29 Figure 2.2(i) Directly Aged Standardised Rates (per 1,) Cancer Type NHS Lincolnshire DSR England DSR Bladder Cancer 2.8 2.33 Breast Cancer 18.88 2.5 Cervical Cancer 1.88 1.96 Colorectal Cancer 1.43 1.62 Hodgkins Disease.33.32 Leukaemia 2.76 3.12 Lung Cancer 24.72 25.95 Malignant Melanoma 2.52 2.3 Oesophageal Cancer 7.11 5.75 Prostate Cancer 9.27 8.51 Skin Cancer other than Malignant Melanoma.19 Stomach Cancer 2.49 Source: http://www.nchod.nhs.uk/ 3.4 The above depicts premature deaths (deaths under the age of seventy five) from the above cancer types comparing Lincolnshire and England by directly standardised rates (DSR). There are no large differences. The Lincolnshire rates compare favourably with the England. 13
2.2(ii) Cancer Mortality Rates 29 Cancer Mortality 3 25 2 NHS Lincolnshire DSR England DSR DSR 15 1 5 Cancer Type Source: http://www.nchod.nhs.uk/ The above depicts all age cancer mortality in Directly Standardised Rate. There are no large differences. Lincolnshire on the whole is comparable to England. Breast and Lung cancer mortality rates stand out nationally and for Lincolnshire 2.3 First Presentation of Cancer Consortium 26/7 27/8 28/9 29/1 21/11 Change % Change Boston 489 51 579 641 538 49 1.% East Lindsey 63 69 617 619 625 22 3.6% Lincolnshire South West 786 861 762 878 763-23 -2.9% Lincolnshire West 1345 1369 145 1323 1358 13 1.% Skegness & Coast 565 564 64 69 656 91 16.1% South Holland 54 594 66 581 651 111 2.6% Wellcomm 41 51 65 67 563 153 37.3% NHS Lincolnshire 4738 517 5178 5339 5154 416 Source: Secondary User Service 8.8% The above depicts first presentation of cancer as a proxy measure for incidence over time. The incidence is increasing in East Lindsey, Lincolnshire West and South Holland consortium. 14
2.4 What is this chapter telling us? The number of patients on GP cancer registers is higher than the national average. Prevalence of all cancers across Lincolnshire is rising year on year. This may well fit in with the fact that Lincolnshire has an older population structure than England. In Lincolnshire Lung (25.25) and Breast (21.29) cancer premature mortality rates are the highest but are comparable to the national average. All cancer type s premature mortality rates are comparable to the national average. First presentation (incidence) in the following consortium East Lindsey, Lincolnshire West and South Holland is on the rise. 15
CHAPTER 3 Profile of Breast Cancer 3.1 Incidence Three year average incidence rates have been calculated to lessen the effect of random variation. Figure 3.1(i) Source Trent Cancer Registry 16
There is no statistically significant difference in breast cancer incidence rates between the cancer networks and the national average. The highest rate is in North Derbyshire with 152.6 per 1, female population. Both Derbyshire County PCT and Lincolnshire PCT are statistically significantly higher than the England average of 14. per 1, female population with around 15 per 1, female, respectively. The following two figures show the incidence of Breast Cancer utilising funnel plots Figure 3.1(ii) Female Breast Cancer Incidence by PCT 27-29 The above shows the incidence of female breast cancer for Lincolnshire against the national average depicting in Pct s across the North Trent and East Midlands region. The incidence of breast cancer in Lincolnshire is above the average and above the rates of most of its peers. It is three standard deviations above the norm. 17
Figure 3.1(iii) Female Breast Cancer Incidence by Cancer Networks 27-29 The above depicts female breast cancer incidence across the cancer networks in North Trent and East Midlands. East Midlands is above the average, two standard deviations above 3.2 First Presentation of Breast Cancer in Females First Presentation (incidence) represents the first identified presentation of Breast Cancer, whilst the patient is registered with NHS Lincolnshire as an inpatient at hospital. 18
Figure 3.2(i) NHS Lincolnshire First Presentation of Breast Cancer 75 and Over Under 75 35 3, 1 25 r e P 2 te a 15 R e 1 d ru C 5 25/6 26/7 27/8 28/9 29/1 Financial Year Source: Secondary User Service The above depicts first presentation of breast cancer (incidence) at NHS Lincolnshire level by age groups. It clearly shows that across all years the incidence is higher in patients aged 75 and over. However in 29/1 the incidence is not as high for both age groups. 19
Figure 3.2(ii) Consortium First Presentation of Breast Cancer 27/8 29/1 Under 75 NHS Lincolnshire Crude Rate Per 1, 6 5 4 3 2 1 Consortium Source: Secondary User Service The above depicts first presentation of female breast cancer in the under 75 age group as a proxy measure for incidence per Consortium. Lincolnshire South West Consortium has the highest crude rate per 1, of patients under the age of 75. East Lindsey and South Holland are slightly above the Lincolnshire average. 2
3.3 Premature Mortality Breast Cancer 27 29 Figure 3.3(i) NHS Lincolnshire Directly Aged Standardised Rates (per 1,) 25 Premature Mortality from Breast Cancer 2 15 DSR 1 5 Organisation Breast Cancer DSR England Organisation Breast Cancer DSR Lincolnshire Teaching PCT 18.88 Herefordshire PCT 2.16 Shropshire County PCT 21.4 North Yorkshire and York PCT 2.2 East Riding of Yorkshire PCT 21.95 East Sussex Downs and Weald PCT 18.27 Norfolk PCT 22.88 Suffolk PCT 21.54 North East Essex PCT 21.7 Gloucestershire PCT 2.43 Somerset PCT 17.46 Northumberland Care Trust 15.97 ENGLAND 2.5 Source: http://www.nchod.nhs.uk/ 21
The previous figure depicts premature mortality from breast cancer across our family of PCT s. Lincolnshire at 18.88 per 1, comparing well with the other PCTs. Figure 3.3(ii) Consortium Directly Aged Standardised Rates (per 1,) 27-29 Breast Cancer Premature Mortality DASR NHS Lincolnshire DASR Per 1, 12 1 8 6 4 2 Consortium Source: Public Heath Mortality File The above depicts breast cancer premature mortality rates ie deaths under 75 years of age per consortium. Half of the Consortium are above the Lincolnshire average (Boston, Lincolnshire West and South Holland). 22
3.4 Breast Cancer Stage at Diagnosis The following tables and charts show information on stage at diagnosis for new cases of breast cancer between 29 and 21 broken down by Cancer Network and PCT. Results for East Staffordshire were unavailable. Figure 3.4(i) Stage of Diagnosis for New Cases of Breast Cancer 29 21 Source: Trent Cancer Registry 23
Source: Trent Cancer Registry According to this information, most cases of breast cancer in Lincolnshire are detected in stages one and two of the disease which is comparable to the rest of the cancer networks and to the East Midlands as a whole. 24
3.5 Breast Cancer Referral Rates The chart shows age standardised referral rates for April 29 to March 21 by PCT. There are notable proportions of TWW/Urgent Referrals in Sheffield, Derbyshire County, Derby City, Nottinghamshire County and Lincolnshire PCTs. Figure 3.5(i) Referral Rates by PCT 29 21 Source: Trent Cancer Registry 25
3.6 Breast Cancer Conversion and Detection Rates Definitions The detection Rate is the percentage of breast cancers that were referred through a TWW referral. The conversion rate is the percentage of TWW referrals which went on to be diagnosed with breast cancer. It varies from 12% for Doncaster, Derbyshire County and Lincolnshire to 19% for Northamptonshire Figure 3.6(i) Conversion and Detection Rates by PCT 29 21 Source: Trent Cancer Registry Looking at Lincolnshire approx 75% of breast cancers are diagnosed via the TWW the remaining are diagnosed via other routes. 26
3.7 Breast Cancer Survival Definition of survival Survival is the proportion of people surviving after a given interval (such as one or five years). Relative survival is the definition most used that adjusts for other non cancer related causes of death. Survival rates in general in England vary between different geographical areas, socio-economic groups, ages and ethnic backgrounds. This partly reflects differences in incidence and mortality rates. According to Rachet et al 28 for most cancers survival is worse for deprived groups and this gap tends to have increased as survival rates have increased overall with the exception of breast cancer in women. The following depicts information on one and five-year relative survival rates for women with breast cancer diagnosed in 1997-2, 21-24 and 25-28 (one year survival only) by PCT and cancer network. Breast cancer survival increased across all PCTs and cancer networks over the time period analysed. The improvement in one-year relative survival is statistically significant for all cancer networks. There is also statistically significant improvement in the majority of PCTs. For five-year relative survival, there is also a statistically significant increase over the time period analysed for North Trent, Mid Trent, LNR and the East Midlands as a whole. There is statistically significant improvement since 1997-2 for the following PCTs: Sheffield PCT, from 77.1% to 82.7%; Lincolnshire PCT from 77.3% to 82.7%; Leicester City PCT from 68.7% to 79.2%; Leicestershire County & Rutland PCT, from 79.2% to 85.3%. 27
Figure 3.7(i) Trends in one year relative survival for females aged 15-99 years diagnosed with breast cancer * Data for East Staffordshire is unavailable due to missing date of diagnosis in a substantial number of records RSR Relative survival rate LCI 95% lower confidence interval UCI 95% Upper confidence interval Source: Trent cancer Registry One year relative survival rate for breast cancer has increased in Lincolnshire over time. Lincolnshire compares favourably with other PCT s in the cancer networks and in the East Midlands and England. 28
Figure 3.7(ii) Trends in five year relative survival for females aged 15 99 years diagnosed with breast cancer RSR Relative survival rate LCI 95% lower confidence interval UCI 95% Upper confidence interval Source: East Midlands EMPHO Public Health Observatory Trent Cancer Registry Five year relative survival rate for breast cancer has increased in Lincolnshire over time. Lincolnshire compares favourably with other PCTs in the cancer networks but lags a little behind East midlands. 29
Figure 3.7(iii) NHS Breast Screening programme performance The following consists of data from Open Exeter. EXTENDED COHORT: AGED 47-49 AND 71-73 Target: The NHS Operating Framework 211/12 requires PCTs to commission the extension of breast screening programmes to cover women aged 47-49 and 71-73. The table below shows the proportion of women aged 47-49 and 71-73 invited for breast cancer screening in the last 36-months. Organisation Breast Cancer Screening Jun-11 Aged 47-49 Aged 71-73 Aged 47-49 & 71-73 Invited Invited Invited Vital Eligible Eligible Eligible <36mths <36mths <36mths Signs % England 1,246,771 9.3% 728,393 47.6% 1,975,164 23.4% 46.8% East Midlands 12,75 8.7% 71,172 48.1% 191,922 23.3% 46.6% Derby City 1,893 8.8% 6,775 41.4% 17,668 21.3% 42.6% Derbyshire County 27,875 12.4% 19,16 44.7% 46,891 25.5% 5.9% Leicester City 6,577 1.% 3,116 49.3% 9,693 16.5% 33.1% Leicestershire County & Rutland 15,461 2.7% 8,81 42.3% 24,271 17.1% 34.2% Lincolnshire 16,874 3.8% 11,451 5.7% 28,325 22.8% 45.5% Milton Keynes 5,72 3.3% 2,15 49.3% 7,852 15.9% 31.8% Northamptonshire 15,887 15.6% 7,694 55.1% 23,581 28.5% 56.9% Nottingham City 5,898 21.1% 2,89 58.2% 8,788 33.3% 66.6% Nottinghamshire County 15,583 6.8% 9,27 52.5% 24,853 23.8% 47.6% 3.8% of Lincolnshire women aged 47 to 49 year olds and 5.7% of 71 to 73 year olds have been invited for screening within the last 36-months. EXISTING COHORT: AGED 5-7 Target: The Operating Framework does not set a definitive target for the existing age cohort but does demand that the 36 month round length should be sustained throughout the roll-out period of the age extension and thereafter. The proportion of women aged 5 to 7 tested within the last 3 years is shown in the table on the next page. Uptake rates relate to the proportion of women screened within 6 months of invite, where the invite was issued within the 12 months to the end of December 21. 3
Organisation Eligible Breast Cancer Screening Dec-1 Standard Age Range 5-7 Invited Screened <36mths Uptake % 36mth Coverage % England 6,459,722 2,287,35 4,64,785 74.2% 71.8% East Midlands 577,266 197,68 443,359 79.1% 76.8% Derby City 32,437 11,866 24,93 79.7% 76.9% Derbyshire County 95,71 31,526 73,47 8.1% 76.8% Leicester City 32,543 1,332 23,312 71.7% 71.6% Leicestershire County & Rutland 87,262 33,548 69,858 82.8% 8.1% Lincolnshire 13,19 35,218 8,433 78.8% 78.1% Milton Keynes 27,853 9,97 2,757 73.2% 74.5% Northamptonshire 84,11 26,957 64,51 78.5% 76.2% Nottingham City 27,951 4,726 19,81 68.1% 68.3% Nottinghamshire County 87,2 34,338 67,89 8.7% 78.% 78.1% of Lincolnshire registered women have been screened for breast cancer within the last 3 years. This compares to 76.8% within the East Midlands and 71.8% nationally. THE TABLE BELOW SHOWS BREAST SCREENING COVERAGE AND UPTAKE RATES AT GP CONSORTIA LEVEL. Organisation Eligible Breast Cancer Screening Dec-1 Standard Age Range 5-7 Screened 36mth Screened Invited 6mths of <36mths Uptake % Coverage invitation % Boston 1,472 3,275 2,546 7,791 77.7% 74.4% East Lindsey 13,781 8,637 6,926 11,38 8.2% 82.1% Lincolnshire South West 17,774 4,541 3,389 13,836 74.6% 77.8% Lincolnshire West 27,732 7,296 5,798 21,269 79.5% 76.7% Skegness & Coast 11,833 1,136 81 8,973 7.5% 75.8% South Holland 1,118 6,893 5,489 8,191 79.6% 81.% Wellcomm 11,276 3,431 2,785 9,59 81.2% 8.3% Lincolnshire 13,19 35,218 27,737 8,433 78.8% 78.1% Boston Consortia has the lowest coverage rate with 74.4% of women aged 5 to 7 screened within the last 36 months. 31
3.8 What is this chapter telling us?. There is no statistically significant difference in breast cancer incidence rates between the cancer networks or when compared to the national average. However Lincolnshire PCT is statistically higher than the national average of 14. per 1, female population with around 15 per 1, female. Breast cancer incidence is related to age. The first presentation of breast cancer (incidence) in Lincolnshire is higher amongst patients aged 75 and over. Looking at consortium, Lincolnshire South West has the highest rate of breast cancer per 1, of patients under the age of 75. Incidence of breast cancer is usually higher in areas that are not deprived. Lincolnshire South West Consortium has a low deprivation score and a higher incidence of breast cancer. For breast cancer premature mortality across our family of PCTs, Lincolnshire compares well with its peer s but is slightly above the national average. Premature mortality from breast cancer across the consortium gives a mixed picture, half of the Consortium being above the Lincolnshire average of (Boston, Lincolnshire West and South Holland). Theses areas all score differently on the deprivation map. Most cases of breast cancer in Lincolnshire are detected in stage one and two of the disease which is comparable to the rest of the cancer network. One year relative survival rate for breast cancer has increased in Lincolnshire over time. Lincolnshire compares favourably with other PCT s in the cancer networks and with the East Midlands. Five year relative survival rate for breast cancer has increased in Lincolnshire over time. Lincolnshire compares favourably with other PCTs in the cancer networks but lags a little behind East Midlands. 3.8% of Lincolnshire women aged 47 to 49 year olds and 5.7% of 71 to 73 year olds have been invited for screening within the last 36-months. 8.1% of Lincolnshire registered women have been screened for breast cancer within the last 3 years. This compares to 76.8% within the East Midlands and 71.8% nationally. Boston Consortia has the lowest coverage rate with 74.4% of women aged 5 to 7 screened within the last 36 months. 32
Chapter 4 Profile of Colorectal Cancer 4.1 Incidence of colorectal cancer across cancer networks Three year average incidence rates have been calculated to lessen the effect of random variation. Figure 4.1(i) Source Trent cancer Registry 33
There are no statistically significant differences in the rates of colorectal cancer incidence across the cancer networks and when compared to the England average. Lincolnshire compares well with its peers and the national average standing at 48 per 1,. The following two figures show the incidence of Colorectal Cancer utilising funnel plots Figure 4.1(ii) Colorectal Cancer Incidence by PCT 27-29 The above shows the incidence of colorectal cancer for Lincolnshire against the national average depicting other PCT s in the North Trent and East midlands region as well for comparison. Lincolnshire compares well to its peers. 34
Figure 4.1(iii) Colorectal Cancer Incidence by Cancer Network 27-29 The above depicts the incidence of colorectal cancer across the North Trent and East Midlands Cancer Network. East Midlands is just above the average and compares well to its peers. 35
4.2. First Presentation of Colorectal Cancer As stated earlier first presentation represents the first identified presentation of Colorectal Cancer. It is being used in this document as a proxy measure for incidence. 4.2(i) NHS Lincolnshire First Presentation of Colorectal Cancer Male and Female 75 and Over Under 75 6 5, 1 4 r e P 3 te a R 2 e d ru 1 C 25/6 26/7 27/8 28/9 29/1 Financial Year Source: Secondary User Service The above clearly depicts that across all years there was a higher incidence of patients aged 75 and over. In 29/1 it shows a slight decline 36
4.2(ii) NHS Lincolnshire First Presentation of Colorectal Cancer Male 75 and Over under 75 35 3, 25 1 r e 2 P te a 15 R e 1 d ru 5 C 25/6 26/7 27/8 28/9 29/1 Financial Year Source: Secondary User Service The above clearly depicts that across all years there was a higher incidence in male patients aged 75 and over. In 29/1 it shows a slight rise for both over and under 75 year olds. 4.2(iii) NHS Lincolnshire First Presentation of Colorectal Cancer Female 75 and Over under 75 16 14, 12 1 r 1 e P 8 te a R 6 e d 4 ru C 2 25/6 26/7 27/8 28/9 29/1 Financial Year Source: Secondary User Service 37
Figure 4.2(iii) clearly depicts that across all years there was a higher incidence in female patients aged 75 and over. In 29/1 it shows a decrease for over 75 year olds. 4.2(iv) Consortium First Presentation of Colorectal Cancer 27/8 to 29/1 Male and Female Under 75 NHS Lincolnshire Crude Rate Per 1, 3 25 2 15 1 5 Consortium Source: Secondary User Service Source: The above depicts first presentation of colorectal cancer in males and females across all Consortium. Skegness and coast have the highest incidence of 28 per 1, population, followed by Boston. Most of the consortium are at or below the Lincolnshire average. 38
4.2(v) Consortium First Presentation of Colorectal Cancer 27/8 to 29/1 Male under 75 NHS Lincolnshire, 1 r e P te a R e d ru C 3 25 2 15 1 5 Consortium Source: Secondary User Service Source: The above depicts first presentation of colorectal cancer in males across all Consortium. Boston is the highest at 25, per 1, compared with the Lincolnshire average of 15 per 1, population followed by Skegness and coast. Most of the consortium are at or below the Lincolnshire average. 39
4.2(vi) Consortium First Presentation of Colorectal Cancer 27/8 to 29/1 Female under 75 NHS Lincolnshire, 1 r e P te a R e d ru C 16 14 12 1 8 6 4 2 Consortium Source: Secondary User Service Source: The above depicts first presentation of colorectal cancer in females across all Consortium. Skegness and coast is the highest at 125, per 1, compared with the Lincolnshire average of 85 per 1, population. Most of the consortium are at or below the Lincolnshire average. 4
4.3 Premature Mortality Colorectal Cancer 27 29 Figure 4.3(i) NHS Lincolnshire Directly Standardised Rates (per 1,) Males and Females 14 Premature Mortality from Colorectal Cancer 12 1 DSR 8 6 4 2 Organisation Colorectal Cancer DSR England Organisation Colorectal Cancer DSR Lincolnshire Teaching PCT 1.43 Herefordshire PCT 12.65 Shropshire County PCT 12.59 North Yorkshire and York PCT 1.37 East Riding of Yorkshire PCT 11.43 East Sussex Downs and Weald PCT 9.43 Norfolk PCT 1.27 Suffolk PCT 9.94 North East Essex PCT 9.23 Gloucestershire PCT 1.83 Somerset PCT 9.86 Northumberland Care Trust 1.93 ENGLAND 1.62 Source: http://www.nchod.nhs.uk/ Lincolnshire compares favourably to the national average and to most of its peers at 1.43 per 1.. 41
Figure 4.3(ii) NHS Lincolnshire Directly Standardised Premature Mortality Rates for Colorectal Cancer (per 1,) Males 27-29 DSR 18 16 14 12 1 8 6 4 2 Premature Mortality from Colorectal Cancer - Male Organisation Colorectal Cancer DSR England Organisation Colorectal Cancer DSR Lincolnshire Teaching PCT 12.89 Herefordshire PCT 13.54 Shropshire County PCT 13.4 North Yorkshire and York PCT 12.65 East Riding of Yorkshire PCT 15.53 East Sussex Downs and Weald PCT 9.75 Norfolk PCT 12.34 Suffolk PCT 12.65 North East Essex PCT 11.5 Gloucestershire PCT 12.55 Somerset PCT 12.91 Northumberland Care Trust 13.23 ENGLAND 13.21 Source: http://www.nchod.nhs.uk/ Male colorectal cancer in Lincolnshire compares favourably to the national average and to most of its peers at 12.89 per 1.. 42
Figure 4.3(iii) NHS Lincolnshire Directly Standardised Premature Mortality Rates for Colorectal Cancer (per 1,) Females 27-29 14 Premature Mortality from Colorectal Cancer - Female 12 1 DSR 8 6 4 2 Organisation Colorectal Cancer DSR England Organisation Colorectal Cancer DSR Lincolnshire Teaching PCT 8.6 Herefordshire PCT 11.79 Shropshire County PCT 11.8 North Yorkshire and York PCT 8.24 East Riding of Yorkshire PCT 7.49 East Sussex Downs and Weald PCT 9.15 Norfolk PCT 8.32 Suffolk PCT 7.34 North East Essex PCT 7.58 Gloucestershire PCT 9.17 Somerset PCT 7 Northumberland Care Trust 8.78 ENGLAND 8.21 Source: http://www.nchod.nhs.uk/ Female Colorectal cancers Lincolnshire compares favourably to the national average and to most of its peers at 8.6 per 1.. 43
Figure 4.3(iv) Consortium Colorectal Cancer Premature Mortality Directly Aged Standardised Rates (per 1,) Males and Females 27-29 Colorectal Cancer Premature Mortality DASR NHS Lincolnshire DASR Per 1, 14 12 1 8 6 4 2 Consortium Source: Public Heath Mortality File Lincolnshire South West Consortium have the highest premature death rate at 12 per 1,.The lowest being the Skegness and coast consortium. 44
Figure 4.3(v) Consortium Colorectal Cancer Premature Mortality Directly Aged Standardised Rates (per 1,) Males 27-29 Colorectal Cancer Premature Mortality Total NHS Lincolnshrie 16 14 12 1 R S 8 D 6 4 2 Consortium Source: Public Heath Mortality File Lincolnshire South West and Lincolnshire West Consortium have the highest premature death rate at 15 per 1,.The lowest being the Skegness and coast consortium 45
Figure 4.3(vi) Consortium Colorectal Cancer Premature Mortality Directly Aged Standardised Rates (per 1,) Females 27-29 Colorectal Cancer Premature Mortality Total NHS Lincolnshire R S D 12 1 8 6 4 2 Consortium Source: Public Heath Mortality File Lincolnshire South West has the highest premature death rate at just over 1 per 1,. The lowest being South Holland 4.4 Colorectal Cancer Stage at Diagnosis The following tables and charts show information on stage at diagnosis for new cases of colorectal cancer between 26 and 28 broken down by Cancer Network and PCT. Results for East Staffordshire were unavailable. 46
Figure 4.4(i) Stage of Diagnosis for New Cases of Colorectal Cancer 26-28 47
Source: East Midlands EMPHO Public Health Observatory Across the networks many cases of lower colorectal cancer are diagnosed at a later stage with the bulk being in stages two and three. Lincolnshire is no exception. 48
4.5 Colorectal Cancer Referral Rates The chart shows age standardised referral rates for April 29 to March 21 by PCT. Referrals may be TWW (two week wait with suspected Lower GI cancer), routine, TWW/Urgent (flagged as TWW or Urgent but with no suspected cancer coded) or unknown (incorrectly coded), and may result in a diagnosis of no cancer, the same cancer as that suspected or a different cancer. Figure 4.5(i) Referral Rates by PCT 29-21 Source: Trent Cancer Registry 49
4.6 Colorectal Cancer Conversion and Detection Rates Definitions The detection Rate is the percentage of lower GI cancers that were referred through a TWW referral. The conversion rate is the percentage of TWW referrals which went on to be diagnosed with lower GI cancer. Figure 4.6(i) Conversion and Detection Rates by PCT 29 21 Source: Trent Cancer Registry Conversation rates are low across all the PCTs. Lincolnshire is no exception. 5
4.7 Colorectal Cancer Survival The following contains information on one and five year relative survival rates for people with colorectal cancer diagnosed in 1996 1999, 2 23 and 24 27 (one year survival only) by PCT and Cancer Network. Figure 4.7(i) Trends in one year relative survival for all persons aged 15 99 years diagnosed with colorectal cancer RSR Relative survival rate LCI 95% lower confidence interval UCI 95% Upper confidence interval Source: East Midlands EMPHO Public Health Observatory Lincolnshire is comparable in one year survival rates for colorectal cancer across the networks. 51
Figure 4.7(ii) Trends in five year relative survival for all persons aged 15 99 years diagnosed with colorectal cancer *Data for East Staffordshire is unavailable due to missing date of diagnosis in a substantial number of records RSR Relative survival rate LCI 95% lower confidence interval UCI 95% Upper confidence interval Source: East Midlands EMPHO Public Health Observatory Lincolnshire is comparable across the cancer networks and East Midlands for five year survival rates for colorectal cancer. 52
4.8 NHS Bowel cancer screening programme performance as of September 21 The following data is from the open Exeter system and the East Midlands Bowel Cancer Screening Hub. Figure 4.8(i) NHSL trend performance - Patients aged 6-69 NHSL Patients aged 6-69 Invite Month Indicator Jan-1 Feb-1 Mar-1 Apr-1 May-1 Jun-1 Jul-1 Aug-1 Sep-1 Oct-1 Nov-1 Dec-1 Planned Screening < 6 months of invite 2% 4% 5% 5% 51% 51% 52% 52% 53% 53% 54% 54% Eligible 98,335 98,51 98,638 98,86 98,893 99,126 99,173 99,34 99,499 99,617 99,743 Invited in the last 12 months 13,247 17,494 22,95 25,579 29,826 33,85 38,57 42,23 45,798 49,619 53,78 Screened < 6 mths invitation 7,833 1,313 13,99 15,24 17,828 2,245 22,811 25,296 27,533 29,798 31,972 Eligible Screened < 3 mths 5,152 7,388 9,497 12,179 14,997 17,595 19,819 22,774 25,977 28,519 3,257 % screened < 6 months invite 59.1% 59.% 59.3% 59.6% 59.8% 59.8% 59.9% 6.2% 6.1% 6.1% 6.2% % eligible screened < 3 months 5.2% 7.5% 9.6% 12.3% 15.2% 17.8% 2.% 22.9% 26.1% 28.6% 3.3% Bowel Cancer screening uptake - 6 to 69 65% 6% 55% 5% 45% 4% 35% 3% 25% 2% Planned Screening < 6 months of invite % screened < 6 months invite Jan-1 Feb-1 Mar-1 Apr-1 May-1 Jun-1 Jul-1 Aug-1 Sep-1 Oct-1 Nov-1 Dec-1 Source NHS Lincolnshire s Performance Team Until the full 2 year screening round has been completed for 6 to 69 year olds, screening is unable to be offered to the extended age group 7-74. In the interim, NHSL have submitted local plans to the SHA for the delivery of the 6% target for the 6-69 year olds by December 211. The chart shows the latest published monthly performance is still well above the local plan and consistently over 6%. 4.8(ii) CCG level performance The following table shows the latest NHSL performance broken down to a CCG level. For each age cohort the following information is shown: Number of people in the area eligible for screening Number of people in the area invited for screening in the previous 12 months Number of people who are screened within six months of receiving an invitation Number of people who have been screened in the previous 3 months The proportion of invited people who are screened within six months The proportion of eligible people screened within the last 3 months 53
Organisation Eligible Invited Last Year Bowel Cancer Screening Dec-1 Standard Age Range 6-69 Screened <6mths of Invite Screened <3mths Uptake % 2.5yr Coverage % Lincolnshire 99,743 53,78 31,972 3,257 6.2% 3.3% Boston 9,836 5,192 3,86 2,692 59.4% 27.4% East Lindsey 13,8 7,222 4,444 4,779 61.5% 34.6% Lincolnshire South West 17,69 9,136 5,536 4,795 6.6% 28.1% Lincolnshire West 26,184 13,898 8,446 7,297 6.8% 27.9% Skegness & Coast 12,545 6,642 3,686 3,384 55.5% 27.% South Holland 9,839 5,225 3,172 2,77 6.7% 28.2% Wellcomm 1,47 5,763 3,62 4,54 62.5% 43.4% Source NHS Lincolnshire s Performance Team 2 CCGs are below the 6% uptake target, although all are above the interim 54% plan for Dec-1. Note East Lindsey and Wellcomm have higher coverage rates as a few of their practices (3 and 4 respectively) use out of county services that started the screening program before the January 21 start date for the in county program. 54
4.9 What does this chapter tell us? Colorectal cancer is strongly associated with age. There are no statistically significant differences in the rates of colorectal cancer incidence across the cancer networks and when compared to the England average. The incidence of colorectal cancer is highest in the over 75 year age group. Skegness and coast consortium have an older population profile and a higher incidence of colorectal cancer. Premature mortality rates from colorectal cancer in Skegness and coast consortium area are the lowest. Lincolnshire South West Consortium has a lower incidence but have the highest premature mortality rate for colorectal cancer. Premature mortality rates for colorectal cancer is higher in males (15 per 1,) than in females (1 per 1,). Skegness and coast consortium is a deprived area and has the highest incidence of colorectal cancer but it has the lowest premature mortality rates. However the area of Lincolnshire South West Consortium is one of the least deprived areas in Lincolnshire but has a higher premature mortality rate from colorectal cancer. Across our family of PCTs, Lincolnshire compares favourably to the national average and to most of its peers for colorectal cancer premature mortality Across the networks many cases of colorectal cancer are diagnosed at a later stage with the bulk being in stages two and three. Lincolnshire is no exception. Lincolnshire is doing better than most across the cancer networks and East Midlands for five year survival rates for colorectal cancer. The NHS Bowel Cancer screening programme shows the latest published monthly performance and it is still well above the local plan and consistently over 6%. Boston and Skegness and coast are below the 6% uptake target. 55
Chapter 5 Profile of Lung Cancer 5.1 First Presentation of Lung Cancer Incidence Three year average incidence rates have been calculated to lessen the effect of random variation. Figure 5.1(i) 56
The incidence of lung cancer in North Trent (6.1 per 1, population) is statistically significantly higher than the other cancer networks and the national average of 48.2 per 1, population. At approximately 46 per 1, Lincolnshire s incidence of lung cancer is below the national average of 48.2 per 1, population Lung cancer rates are notably highest in Barnsley and Nottingham City PCT with 73.4 and 72.9 per 1, population respectively. These higher rates of lung cancer are generally seen in the inner city PCTs across the region, these being areas where deprivation may be higher. Rates of lung cancer are strongly associated with deprivation, attributable to the higher smoking prevalence among such deprivation groups. As stated earlier first presentation is being used as a proxy measure for incidence within Lincolnshire. The following two figures show the incidence of Lung Cancer utilising funnel plots Figure 5.1(ii) Lung Cancer Incidence by PCT 27 29 The above shows the incidence of lung cancer for Lincolnshire against the national average depicting other PCT s in the North Trent and East Midlands region as well for comparison. The incidence of lung cancer in Lincolnshire is low compared to most PCT s. 57
Figure 5.1(iii) Lung Cancer Incidence by Cancer Network 27-29 The above depicts lung cancer incidence across the cancer networks in North Trernt and East Midlands. East Midlands is the same as the national average. 58
Figure 5.1(iv) NHS Lincolnshire First Presentation of Lung Cancer Male and Female 35 3, 25 1 r e 2 P te a 15 R e d1 ru C 5 75 and Over Under 75 25/6 26/7 27/8 28/9 29/1 Financial Year Source: Secondary User Service The above depicts incidence within NHS Lincolnshire. The above clearly shows that there is a higher incidence in the over 75 age group and that it is slowly declining. The incidence in the under 75 year olds remains fairly constant. Figure 5.1(v) NHS Lincolnshire First Presentation of Lung Cancer Males 75 and Over Under 75 45 4, 35 1 3 r e P 25 te 2 a R 15 e d 1 ru C 5 25/6 26/7 27/8 28/9 29/1 Financial Year Source: Secondary User Service 59
Figure 5.1 (v) depicts incidence within NHS Lincolnshire. It shows that there is a higher incidence in males over 75 years of age and that there was a slight increase in 29/1. The incidence in the under 75 year old males has declined slightly. Figure 5.1(vi) NHS Lincolnshire First Presentation of Lung Cancer Females 75 and Over Under 75 25, 2 1 r e 15 P te a 1 R e d 5 ru C 25/6 26/7 27/8 28/9 29/1 Financial Year Source: Secondary User Service The above depicts incidence within NHS Lincolnshire. The above clearly shows that there is a higher incidence in females over 75 years of age and that there was a decrease in 29/1. The incidence in the under 75 year old females has remained static. 6
Figure 5.1(vii) Consortium First Presentation of Lung Cancer 27/8 to 29/1 Males and Females Under 75 NHS Lincolnshire Crude Rate Per 1, 3 25 2 15 1 5 Consortium Source: Secondary User Service The above figure depicts first presentation (incidence) under the age of 75 years old with lung cancer for each of the Consortium. Skegness & Coast Consortium has a high incidence. It is almost double the Lincolnshire rate. South Holland also is above the Lincolnshire average. 61
Figure 5.1(viii) Consortium First Presentation of Lung Cancer 27/8 to 29/1 Males under 75 NHS Lincolnshire, 1 r e P te a R e d ru C 35 3 25 2 15 1 5 Consortium Source: Secondary User Service The above figure depicts first presentation (incidence) for males under the age of 75 years old with lung cancer for each of the Consortium. Skegness & Coast Consortium has a high incidence 3 per 1, population. It is almost double the Lincolnshire rate. South Holland is also above the Lincolnshire average. 62
Figure 5.1(ix) Consortium First Presentation of Lung Cancer 27/8 to 29/1 Females under 75 NHS Lincolnshire, 1 r e P te a R e d ru C 25 2 15 1 5 Consortium Source: Secondary User Service The above figure depicts first presentation (incidence) for females under the age of 75 years old with lung cancer for each of the Consortium. Skegness & Coast Consortium has a high incidence, 2 per 1, population. It is almost double the Lincolnshire rate. Boston is also above the Lincolnshire average. 63
5.2 Premature Mortality for Lung Cancer (under the age of 75) 27-29 Figure 5.2(i) NHS Lincolnshire Directly Standardised Rates (per 1,) for Lung cancer premature mortality Males and Females 3 Premature Mortality from Lung Cancer 25 2 DSR 15 1 5 Organisation Lung Cancer DSR England Organisation Lung Cancer DSR Lincolnshire Teaching PCT 24.72 Herefordshire PCT 19.85 Shropshire County PCT 22.23 North Yorkshire and York PCT 21.92 East Riding of Yorkshire PCT 23.1 East Sussex Downs and Weald PCT 19.7 Norfolk PCT 2.7 Suffolk PCT 18.27 North East Essex PCT 22.6 Gloucestershire PCT 2.85 Somerset PCT 18.13 Northumberland Care Trust 28.22 ENGLAND 25.95 Source: http://www.nchod.nhs.uk/ Lincolnshire PCT at 24.72 per 1, compares favourably to its family of PCTs and to the national average of 25.95 per 1, for lung cancer. 64
Figure 5.2(ii) NHS Lincolnshire Directly Standardised Rates (per 1,) for Lung cancer premature mortality Males 27-29 35 Premature Mortality from Lung Cancer - Males 3 25 DSR 2 15 1 5 Organisation Lung Cancer DSR England Organisation Lung Cancer DSR Lincolnshire Teaching PCT 29.55 Herefordshire PCT 25.2 Shropshire County PCT 26.82 North Yorkshire and York PCT 26.2 East Riding of Yorkshire PCT 25.98 East Sussex Downs and Weald PCT 22.58 Norfolk PCT 26.11 Suffolk PCT 22.94 North East Essex PCT 28.6 Gloucestershire PCT 24.88 Somerset PCT 25.9 Northumberland Care Trust 31.66 ENGLAND 31.32 Source: http://www.nchod.nhs.uk/ Lincolnshire PCT at 29.55 per 1, compares favourably to its family of PCTs for male lung cancer and to the national average of 31.32 per 1,. 65
Figure 5.2(iii) NHS Lincolnshire Directly Standardised Rates (per 1,) for Lung cancer premature mortality Females 27-29 3 Premature Mortality from Lung Cancer - Females 25 2 DSR 15 1 5 Organisation Lung Cancer DSR England Organisation Lung Cancer DSR Lincolnshire Teaching PCT 2.9 Herefordshire PCT 14.73 Shropshire County PCT 17.92 North Yorkshire and York PCT 17.96 East Riding of Yorkshire PCT 2.36 East Sussex Downs and Weald PCT 15.91 Norfolk PCT 14.34 Suffolk PCT 13.78 North East Essex PCT 16.47 Gloucestershire PCT 17.4 Somerset PCT 11.59 Northumberland Care Trust 25.3 ENGLAND 2.97 Source: http://www.nchod.nhs.uk/ Lincolnshire PCT at 2.9 per 1, compares favourably to its family of PCTs for female lung cancer and to the national average of 2.97 per 1,. 66
Figure 5.2 (iv) Consortium Directly Aged Standardised Rates (per 1,) for premature mortality from Lung cancer 27-29 Lung Cancer Premature Mortality DASR NHS Lincolnshire DASR Per 1, 5 45 4 35 3 25 2 15 1 5 Consortium Source: Public Heath Mortality File Skegness and Coast Consortium have the highest premature mortality rate (deaths under 75 years) from lung cancer compared with the NHS Lincolnshire rate. 67
Figure 5.2(v) Consortium Directly Aged Standardised Rates (per 1,) for premature mortality Males 27-29 Lung Cancer Premature Mortality Total NHS Lincolnshire 45 4 35 3 R25 S D2 15 1 5 Consortium Source: Public Heath Mortality File Skegness and Coast Consortium have the highest premature mortality rate (deaths under 75 years) from lung cancer in males compared with the NHS Lincolnshire rate. 68
Figure 5.2(vi) Consortium Directly Aged Standardised Rates (per 1,) for premature mortality Females 27-29 Lung Cancer Premature Mortality Total NHS Lincolnshrie 3 25 2 R S15 D 1 5 Consortium Source: Public Heath Mortality File Skegness and Coast Consortium have the highest premature mortality rate (deaths under 75 years) from lung cancer in females followed by Lincolnshire West and Boston compared with the NHS Lincolnshire rate. 69
Figure 5.2(vii) Stage at Diagnosis Non-Small Cell Lung Cancer (NSCLC) At cancer network level, the proportion of NSCLC cases diagnosed in 26-28, with insufficient information to allocate stage, ranges from 43% in North Trent to 58% in Mid Trent. East Staffordshire has the lowest proportion of cases with missing stage information with 26%; Lincolnshire PCT has the highest with 87%. Figure 5.2 (viii) Stage of diagnosis of non small cell lung cancer (numbers) Source Trent Cancer Registry 7
Figure 5.2(ix) Stage of diagnosis of non small cell lung cancer (percentages) Source Trent Cancer Registry As stated earlier Lincolnshire has 87% of its staging data missing. Looking at the data that is present most lung cancers are diagnosed at stage 4. This is comparable to the other PCTs in the networks. 71
5.3 Lung Cancer Referral Rates The chart shows age standardised referral rates for April 29 to March 21 by PCT. Barnsley, Doncaster, Derbyshire County, Derby City, Nottinghamshire County, Lincolnshire and Northamptonshire PCTs all have a notable proportion of TWW/Urgent Referrals. Figure 5.3(i) Referral Rates by PCT 29-21 72
5.4 Lung Cancer Conversion and Detection Rates Definitions The detection Rate is the percentage of lower GI cancers that were referred through a TWW referral. The conversion rate is the percentage of TWW referrals which went on to be diagnosed with lower GI cancer. Figure 5.4(i) Conversion and Detection Rates by PCT 29 21 Source: Trent Cancer Registry There is approximately 3% conversation rate for Lincolnshire. 73
5.5. Lung Cancer Survival The following contains information on one and five-year relative survival rates for people with lung cancer diagnosed in 1997-2, 21-24 and 25-28 (one year survival only) by PCT and cancer network against the England average. Lung cancer is difficult to treat and is often diagnosed very late. Because of these factors, it has one of the lowest survival outcomes of any type of cancer. However, in the twelve year period between 1997-2 and 25-28, one-year relative survival has statistically significantly improved across the cancer networks. Figure 5.5(i) Trends in one year relative survival for all persons aged 15 99 years diagnosed with lung cancer RSR Relative survival rate LCI 95% lower confidence interval UCI 95% Upper confidence interval Source: Trent Cancer Registry Lincolnshire s one year relative survival rates for lung cancer have improved over time and compare well with their peers and the East Midlands. 74
Figure 5.5(ii) Trends in five year relative survival for all persons aged 15 99 years diagnosed with lung cancer RSR Relative survival rate LCI 95% lower confidence interval UCI 95% Upper confidence interval Source: Trent Cancer Registry Lincolnshire has a very low five year relative survival rate compared with its peers East Midlands and the National average. 75
5.6 What is this chapter telling us? Lung cancer incidence is associated with age. Incidence of lung cancer is highest in the over 75 year age group. Skegness and coast consortium have an older population profile and the highest incidence of lung cancer across the county. Lung cancer is strongly associated with deprivation. Skegness and coast is a deprived area featuring highly on the IMD score and has the highest incidence of lung cancer and premature mortality rates. Premature mortality rates from lung cancer in Skegness and coast consortium area are the highest male rates are higher than females Lincolnshire compares favourably to most of its peers across our family of PCTs in the cancer networks and to the national average for lung cancer premature mortality. Many people with lung cancer present in the later stages of the disease process usually stages three and four leading to less favourable outcomes. Lincolnshire s one year lung cancer survival rates compares favourably to East Midlands and to the national figures. Unfortunately five year survival rate for Lincolnshire are poor.. 76
Chapter 6 Profile of Prostate Cancer 6.1 Incidence of Prostate cancer Three year average incidence rates have been calculated to lessen the effect of random variation. Care is needed when comparing variations in prostate cancer as detection is influenced by varying uptake rates of prostate-specific antigen (PSA) testing in different areas. Figure 6.1(i) Prostate cancer Incidence rates 26.28 Source: Trent Cancer Registry 77
At PCT level, Rotherham has the lowest rate of prostate cancer with 71.4 per 1, male population, whilst Lincolnshire and Northamptonshire have the highest rates with 116.2 and 117. per 1, male population. The following two figures show the incidence of Prostate Cancer utilising funnel plots Figure 6.1(ii) Prostate cancer incidence by PCT 27-29 The above shows the incidence of prostate cancer for Lincolnshire against the national average depicting other PCT s in the North Trent and East Midlands region as well for comparison. The incidence for prostate cancer in Lincolnshire is above the national average and above the rates of most of its peers. It is three standard deviations above the norm. 78
Figure 6.1(iii) Prostate Cancer Incidence by Cancer Networks 27-29 The above depicts prostate cancer incidence across the cancer networks in North Trent and East Midlands. North Trent and Derby- Burton are well below the average for prostate cancer. East Midlands compares well with its peers 79
Figure 6.1(iv) Stage at Diagnosis Non-Small Cell Lung Cancer (NSCLC) At cancer network level, the proportion of NSCLC cases diagnosed in 26-28, with insufficient information to allocate stage, ranges from 43% in North Trent to 58% in Mid Trent. East Staffordshire has the lowest proportion of cases with missing stage information with 26%; Lincolnshire PCT has the highest with 87%. 6.2 First Presentation of Prostate Cancer As stated earlier first presentation is being used as a proxy for incidence Figure 6.2(i) NHS Lincolnshire First Presentation of Prostate Cancer, 1 r e P te a R e d ru C 12 1 8 6 4 2 75 and Over Under 75 25/6 26/7 27/8 28/9 29/1 Financial Year Source Secondary User Service The above clearly shows that there is a higher incidence of prostate cancer in men over the age of 75. In the under 75 year age group it has remained fairly static. 8
6.2(ii) Consortium First Presentation of Prostate Cancer 27/8 to 29/1 Under 75 NHS Lincolnshire Crude Rate Per 1, 45 4 35 3 25 2 15 1 5 Consortium Sourced: Secondary User Service The above depicts first presentation of prostate cancer in males over the age of seventy five across all PBC Consortium. The incidence in East Lindsey Consortium is higher than the Lincolnshire average. Skegness and coast, South Holland and Wellcomm are slightly higher than the Lincolnshire average. 81
6.3 Premature Mortality for Prostate Cancer 27-29 The following depicts premature mortality (deaths under 75 years of age) from Prostate cancer across its family of PCTs. Figure 6.3(i) Premature Mortality Directly Standardised Rates (per 1,) 27-29 DSR 1 9 8 7 6 5 4 3 2 1 Premature Mortality from Prostate Cancer Organisation Prostate Cancer DSR England Organisation Prostate Cancer DSR Lincolnshire Teaching PCT 9.27 Herefordshire PCT 8.73 Shropshire County PCT 8.59 North Yorkshire and York PCT 7.42 East Riding of Yorkshire PCT 8.92 East Sussex Downs and Weald PCT 6.81 Norfolk PCT 8.39 Suffolk PCT 6.89 North East Essex PCT 7.2 Gloucestershire PCT 7.74 Somerset PCT 7.4 Northumberland Care Trust 8.25 ENGLAND 8.51 Source: http://www.nchod.nhs.uk/ 82
Lincolnshire s premature mortality rate of 9.27 per 1, for prostate cancer is above the national average of 8.51 per 1, and higher than most of its family of PCT s Figure 6.3(ii) Consortium Directly Standardised Rates (Per 1,) 27-29 The following depicts prostate premature mortality rate (deaths under 75 years of age) for consortium Prostate Cancer Premature Mortality DASR NHS Lincolnshire DASR Per 1, 14 12 1 8 6 4 2 Consortium Source: Public Health Mortality Files Lincolnshire South West and Boston Consortium have very slightly higher rates than the NHS Lincolnshire average. Staging Data Staging data not available for prostate cancer/urology cancers 6.4 Urology Cancer Referral Rates The chart shows age standardised referral rates for April 29 to March 21 by PCT.. Referrals may be TWW (two week wait with suspected Urological cancer), routine, TWW/Urgent (flagged as TWW or Urgent but with no suspected cancer coded) or unknown (incorrectly coded), and may result in a diagnosis of no cancer, the same cancer as that suspected or a different cancer. 83
Figure 6.4(i) Referral Rates by PCT 29-21 Source: Trent Cancer Registry 6.5 Urology Cancer Conversion and Detection Rates Definitions The detection Rate is the percentage of lower GI cancers that were referred through a TWW referral. The conversion rate is the percentage of TWW referrals which went on to be diagnosed with lower GI cancer. 84
Figure 6.5(i) Conversion and Detection Rates by PCT 29-21 Source: Trent Cancer Registry There is a just over 2% conversation rate 6.6 Urology Cancer Survival The following contains information on one and five year relative survival rates for men with prostate cancer diagnosed in 1996-1999, 2-23 and 24-27 (one year survival only) by PCT and Cancer Network. As with incidence, care is needed when comparing variations in prostate cancer survival as detection is influenced by varying uptake rates of prostate-specific antigen (PSA) testing in different areas. 85
Figure 6.6(i) Trends in one year relative survival for males aged 15 99 years diagnosed with prostate cancer Data for East Staffordshire is unavailable due to missing date of diagnosis in a substantial number of records RSR Relative survival rate LCI 95% lower confidence interval UCI 95% Upper confidence interval Source: Trent Cancer Registry One year survival rates in Lincolnshire for Prostate cancer have risen over time. Lincolnshire has one of the better relative survival rates across the cancer networks and it is higher than East Midlands. 86