CANCER IN YORKSHIRE 1989-93

INTRODUCTION  

It is a privilege to present this latest quinquennial Report of the Yorkshire Cancer Registry (YCR) covering the period 1989 to 1993. Information on approximately 90,000 cancer registrations is tabulated and graphically displayed, representing a formidable undertaking by those responsible for collecting, recording, checking and analysing the data. The Report will be a fitting valedictory tribute to Charles Joslin, from whom I took over as Director in 1994 and who was responsible for guiding the YCR during the reporting period. The YCR has long maintained a reputation for the completeness, quality and range of its data and in any league table of registry performance, national or international, the YCR would be confident at being positioned close to the top. This achievement is a record that I have inherited from my predecessors and is something for which I cannot claim any personal responsibility. The credit is due to the staff of the YCR who, at every level, are all highly committed and dedicated to maintaining its high standards.

The following pages show summary tables and graphics relating to all of the most frequently diagnosed sites and types of cancer, together with a number of aggregate groupings of particular interest i.e. cancers in the elderly, cancers in children and head and neck cancers. Yorkshire data concerning the four cancers that are featured in the Government's Health of the Nation initiative are also presented. Detailed tabulations provide the registration numbers and rates for the 1989-93 period for every specific site of cancer by individual year, sex, age and health district of residence (both before and after their reorganisation in 1993). Tabulations on survival provide five-year rates for the common cancers diagnosed in 1986-90 by sex, age group and health district of residence.

We hope that this compendium of cancer information will satisfy many of the requirements of our data users, whether involved with health service planning, resource allocation, audit or research. The team involved in producing the Report have endeavoured to present the graphics and tables in a clear, concise and user-friendly form in the hope that this will facilitate use and comprehension.

We are, of course, all too aware of deficiencies which are inevitable in a report such as this. The first of these is timeliness in that, as we go to press, the data in the Report will be almost three years out of date. The second is that any written report has to be selective in its contents and many possible tabulations have to be excluded. For the future, we hope to start to overcome these problems by making use of appropriate information technology. During 1997, YCR QuickData will become available. This will be a user-friendly Windows package which will be circulated to our data users on diskette and will permit rapid and detailed outputs to be produced from our data using a wide range of tables and graphics. This will allow data users to find exactly the information they want with a much more extensive range of outputs than is possible in this Report. QuickData can also be regularly updated as new data become available. A further development is the establishment of a YCR site on the World Wide Web (WWW). Initially this will consist of presenting the site-specific tables and graphs from this Report but we hope to develop our WWW site to provide the same type of flexible facilities as will be available in QuickData.

A different type of problem is the absence of information about cancer stage. If valid comparisons are to be made, especially concerning survival rates, then it is vital that there is adequate control over case-mix factors especially stage of the disease at presentation. When numbers are large, much can be gained from comparing survival rates even without stage information. In this context, many of the survival rates published in this Report pose urgent questions concerning why residents of certain health districts or in relatively deprived areas appear to have poorer outcomes than the regional average. The YCR also contributed to the EUROCARE study (Berrino F et al (1995) Survival of cancer patients in Europe: the EUROCARE Study. IARC Sci Pub 132. IARC: Lyon) within which similar questions were raised concerning variation between countries in terms of survival. Complete answers to these questions will only be provided with the addition of staging data. While the YCR collects this when available in the patient's clinical notes, it has frequently been unrecorded. Histopathologists throughout Yorkshire, organised within the Yorkshire Cancer Organisation's Histopathology Working Group, are now working together to provide a comprehensive and consistent reporting process for several of the major cancers. As a result, the YCR is set to collect some of the most complete population-based stage-specific datasets in the country.

At the time of writing, the national organisation of cancer treatment services is about to undergo a major reformation with the creation of "Calman/Hine" Cancer Centres and Units which will provide equality of access to appropriate specialist care for cancer patients across the country. It is expected that cancer registries will play a crucial role in implementing and monitoring this change. Not only do registries provide the only geographically based statistics to estimate future patient numbers but they also will make available many of the process and outcome measures against which the performance of Centres and Units can be assessed at the population level. The YCR has already provided much relevant data to both Purchasing Authorities and Hospital Trusts involved in developing these new services. The research activities of the YCR have also played a role in contributing to the debate about appropriate standards of care for cancer patients. Our work on breast cancer (Sainsbury et al (1995) Lancet 345:1265 and BJ Cancer 71:1275) has been particularly cited in this respect. Developing from this has been a major research project, funded by the NHS National Cancer Research Programme, to look at variation in treatment for all the major cancers in Yorkshire and the effect of such variation on survival rates. This "17 Sites Project", being conducted by the YCR with the University of Leeds, commenced in early 1996 and should start producing results by 1997.

Cancer registries themselves are also the subject of change. Formerly organised within and funded by the Regional Health Authorities, registries are now having to find new "homes" and funding mechanisms, following the abolition of these Authorities in March 1996. The YCR will almost certainly be based within a hospital trust in the near future and, as with other registries, will be looking for funding from negotiations with the new district based Purchasing Authorities. Alongside this, the Department of Health has developed a model core contract for cancer registry services which outlines several achievement targets and performance indicators that will need to be met. The YCR is confident of meeting these targets and providing a sound quality service that will be worthy of purchase by cash conscious Authorities. Nothing can, however, be taken for granted and all the staff of the YCR are aware of the demands and expectations being placed upon it in the next quinquennium.

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 - CR2 form (37k)