CANCER IN YORKSHIRE 1989-93

EXECUTIVE SUMMARY  

 
Incidence & Mortality - Survival - Management - Health of the Nation -
Smoking Related Cancers - Breast - Cervix - Colon and Rectum -
Prostate - Childhood Cancer - Cancer in the Elderly


Incidence & Mortality

In the period 1989-93, there were 18,000 cancer registrations and 10,000 cancer deaths each year in Yorkshire. A further 3,000 registrations were made annually for borderline malignancies, in-situ cancers and benign disease. Cancer accounted for 25% of all deaths. Although the overall cancer incidence rates have risen by over 30% since the late 1970s, they have changed relatively little during the period of this report. An average GP is likely to see 10 new patients with invasive cancer each year and, of these, one third will be over 75 years.

The most common fatal cancers in Yorkshire men were lung (20% of all male cancers), prostate (12%), colon (7%), bladder (6%), stomach (5%) and rectum (5%). In women the commonest fatal cancers were breast (22% of all female cancers), lung (10%), colon (7%), ovary (4%), rectum (4%) and cervix (4%).

Cancers that had increased substantially in incidence were skin, kidney and non-Hodgkin's lymphoma in both sexes; prostate, testis, and brain in men and lung in women. The increase in female breast cancer is one of the anticipated effects of the national screening programme.

Overall cancer incidence rates were higher in areas of relative social deprivation and significantly above the regional average for residents of Hull, Bradford and Leeds.


Survival

Survival from cancer was 44% at two years and 36% at five years. These figures varied widely with age (five year survival in children was 66% and in those over 75 years was 26%) and with type of cancer (five year survival for pancreatic cancer was 3% and for testicular cancer was 90%).


Management

Half of all cancer patients were initially treated with surgery, a quarter with radiotherapy and 12% had chemotherapy. Almost one third received no definitive treatment. The average time between first referral from a General Practitioner to a hospital appointment was two weeks with a further three weeks between the first hospital visit and receipt of treatment. These intervals varied considerably by anatomical site.


Health of the Nation

The targets for breast and cervical cancer reductions are likely to be met in Yorkshire partly as a result of the implementation of the breast mammography and cervical cytology screening programmes. The adoption of behavioural changes that are required to meet the targets for lung and skin cancer, i.e. reductions in smoking and exposure to sunlight, are more difficult to predict. In females, the increase in lung cancer incidence and mortality is of particular concern.


Smoking-Related Cancers

Smoking affects cancers other than lung; notably, head and neck, bladder and pancreatic cancers. Incidence rates for all of these were higher in the socio-economically deprived areas. Trends over time varied from anatomical site to site, presumably with the interaction of risk factors other than smoking.


Breast

There was an overall improvement in survival with rates of 68% at five years. Slightly higher incidence and survival rates were evident among the more affluent. Most women (82%) were treated surgically, nearly half received radiotherapy and chemotherapy was given increasingly, especially to pre-menopausal women (43%). Hormone therapy was given to the majority, particularly the elderly. The average time between referral from a General Practitioner to a hospital appointment was less than two weeks with a further two weeks to treatment.


Cervix

The cervical screening programme appears to have lead to a 25% decline in incidence and a fall in mortality since the middle of the last decade. Rates were much higher in the more deprived areas and occurred predominantly in younger women. These women had considerably better survival than older patients (80% at 5 years), probably as a result of diagnosis at an earlier stage.


Colon & Rectum

Incidence rates remained stable with mortality rates showing a slight decline. Survival was 40% at five years and age dependant. Most patients received surgery (78%) and a minority were given radiotherapy (more likely so for rectal cancer). The proportion given no definitive treatment was 20%, mainly among the elderly. Patients were seen at hospital within two weeks of referral and treated within a further three weeks.


Prostate

Incidence rates increased consistently and substantially while mortality rates increased but to a lesser extent. There was a trend towards elevated rates among the more affluent. Survival at five years was 45% and this did not vary with age. Most patients were seen at hospital within four weeks of referral by a General Practitioner and treated within a further four weeks.


Childhood Cancer

Less than 100 cancers were diagnosed in children each year, of which leukaemias (34%) and brain tumours (20%) were the most frequently diagnosed. Almost all patients received definitive treatment and survival from all childhood malignancies was 66% at five years. Chemotherapy was used in the treatment of many of these diseases (78%). The majority were treated within two weeks of first referral from a General Practitioner.


Cancer in the Elderly

Over a third of cancers were diagnosed in those over 75 years and the proportion has risen steadily. Their tumours were less likely to be investigated histologically (69% compared to 88% in the under 75s). In general, the proportion receiving no definitive treatment was much greater in this age group (48% compared to 23%) & survival rates tended to be worse (26% at five years compared to 39%).

David Forman
Director of Yorkshire Cancer Registry
Professor of Cancer Epidemiology, University of Leeds


contents - foreword - introduction - executive summary - acknowlegements -
activities of the registry - key site analysis (graphics) - more graphics - statistical tables - statistical methods - population tables - registration form