Cancer

Summary

There are over 200 different types of cancer, each with its own methods of diagnosis and treatment. Apart from infectious diseases, most illnesses (including cancer) can be linked to many different factors and there is no single cause for any one type of cancer. Some of the known causes of cancer are an unhealthy diet, excessive alcohol consumption, physical inactivity, being overweight or obese, being exposed to natural and man-made radiation, smoking and tobacco use, ultraviolet light (including sun exposure and use of sun beds), exposure to asbestos and viruses such as human papilloma virus (HPV).

Prevalence

Prevalence refers to the number of cases of a disease that are present in a particular population at a given time. In the case of cancer, the population is the total GP registered population. The latest figures (2015/16) taken from the Quality and Outcomes Framework (QOF), indicate 2.7% of the GP registered population (31,848 persons) are living with cancer in Lancashire-12, significantly above the England average of 2.4%.

At a clinical commissioning group (CCG) level, it was found that four of the six CCGs in Lancashire-12 have a recorded cancer prevalence significantly above the England average: Fylde and Wyre (3.5%, 5,265), Chorley and South Ribble (2.9%, 5,126), West Lancashire (2.8%, 3,149) and Lancashire North (2.6%, 4,210).

Looking at the prevalence for the CCGs of the neighbouring unitary authorities, Blackpool (2.8%, 4,727) recorded a prevalence significantly above the national average, whilst Blackburn with Darwen (1.9%, 3,331) recorded a similar prevalence.

Incidence

Incidence refers to the total number of new confirmed cases of a disease in a population at a given period of time. For cancer, the population refers to the estimated population of an area i.e. a county or a district. The figures include all new diagnoses of malignant cancer (ICD10 C00-C97), excluding skin cancers other than malignant melanoma.

Between 2012 and 2014 there were 21,259 newly diagnosed cases of malignant cancer across Lancashire-12, giving the area a directly standardised rate (DSR) per 100,000 of 622.8, in line with the England average of 615.3. Figures for the neighbouring unitary authorities show that Blackburn with Darwen (624.8) was in line with England, whilst Blackpool's rate was significantly higher (695.3).

Benchmarking the all-age DSR (per 100,000) of some of the more common cancers against the England national incidence rates, it was found that Lancashire-12 has significantly higher rates for the following:

  • lung cancer - all-person (87.0), female (94.0) and male (99.0), England (79.8, 75.1 and 65.5 respectively);
  • bladder cancer - all-person (22.8), female (11.7) and male (33.9), England (19.7, 8.9 and 30.6);
  • oesophagus cancer - all-person (19.3), female (10.7) and male (27.9), England (15.7, 9.0 and 22.5);
  • skin cancer - all-person (28.2) and female (28.8), England (25.2 & 23.5); and
  • cervical cancer (11.4), England (9.6).

Cancer survival

The latest CCG level one-year cancer survival figures refer to adults (aged 15-99) diagnosed between 1999 and 2014 and followed up to 2015. They show that in 2014, the average survival rate across the eight CCGs of the Lancashire-14 was 69.3%, below the national average of 70.4%. The survival rate varies between the different CCGs, with Chorley & South Ribble CCG recording a survival rate of 70.8% and Blackburn with Darwen a rate of 67.7%. 

Benchmarking the CCG rates against the England national average shows that four of eight CCGs within the Lancashire-14 area have a survival rate significantly below the national average, these being; Blackburn with Darwen (67.7%), Blackpool (68.1%), Greater Preston (68.9%) and East Lancashire (69.0%). While the remaining CCGs have all recorded rates in line with the national average; Lancashire North (69.3%), Fylde & Wyre (69.8%), West Lancashire (70.7%) and Chorley & South Ribble (70.8%).

Trend line analysis shows that all eight CCGs continue to see improvements in their one-year survival rates and on average the CCGs are reporting figures that are 8.2 percentage points above what they were 10 years ago in 2005.

All-age mortality

During the three-year period 2012-14, a total of 9,890 persons from the Lancashire-12 area died from malignant cancer (ICD10 C00-C97), giving the area an all-age mortality rate (directly standardised) of 285.4, significantly above the England average of 276.8. The neighbouring authorities of Blackburn with Darwen (299.4) and Blackpool (323.6) also recorded rates significantly above the national average.

Just over two-thirds (68%) of cancer deaths across Lancashire-12 can be grouped to just four different cancer types: cancers of the digestive organs (C15-C26), which includes colorectal cancer, pancreatic cancer and stomach cancer (2,829 deaths); cancers of the respiratory and intrathoracic organs (C30-C39), which includes lung cancer and cancer of the larynx (2,435 deaths); cancers of the lymphoid, haematopoietic and related tissue (C81-C96) which includes non-Hodgkin's lymphoma and leukaemia (733 deaths); and breast cancer (C50) with 640 deaths.

Benchmarking the all-age DSR per 100,000 of some of the more common cancers against the England rates, shows that Lancashire-12 has significantly higher all-age mortality rates for the following:

  • lung cancer - all-persons (69.7), female (58.7) and male (80.7), England (61.3, 48.5 and 74.2 respectively); and
  • oesophagus cancer - all-person (15.5) and male (22.9), England (13.7, 20.0).

Premature mortality

Reducing premature mortality, referred to as mortality in persons aged 74 or under, is a major priority of both Public Health England and the NHS, with many deaths caused by diseases and illnesses that are considered avoidable[1]. During the period 2013-15, there were 4,645 premature deaths across Lancashire-12 giving the area a DSR of 143.4 per 100,000, significantly above the England average of 138.8. The neighbouring authorities of Blackburn with Darwen (169.5) and Blackpool (190.8), also recorded rates that were significantly above the national average.

[1] Department of Health 'Living well for longer: a call to action to reduce avoidable premature mortality' 2013.

Further analysis

Page updated May 2017