Download Cancer Factsheet - Wiltshire Intelligence Network

Wiltshire cancer fact-sheet
Introduction
This fact-sheet provides information for a number of major cancers:
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all cancers (aggregated) (section1 – page 4)
all cancers (compared) (section 2 – page 12)
lung (section 3 –page 15);
breast (section 4 – page 18);
colorectal (section 5 – page 21);
prostate (section 6 – page 24);
cervical (section 7 – page 27);
oesophageal (section 8 – page 30);
stomach (section 9 – page 33); and,
malignant melanoma (section 10 – page 36)
Information is given for a range of measures:
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screening uptake/coverage (registered population);
incidence (resident population);
prevalence (registered population);
inpatient admissions (registered & resident population);
survival (resident population); and,
mortality (resident population)
Data is provided for Wiltshire and where possible compared to the South West
and England (often using directly standardised rates per 100,000 population).
Some measures are broken down at the sub-Wiltshire level and many show
differences between genders but a full health equity audit of any area is beyond
the scope of this report.
Most recent obtainable data is provided where possible to show the current
position along with data showing the trends over recent years.
Page 1 of 39
Summary
All cancers
Incidence has generally reduced in Wiltshire and is no longer statistically higher
than England or South West averages. However inequalities exist and there is
wide variation within Wiltshire.
QOF registers show that the unadjusted prevalence for Wiltshire was similar to
the prevalence for the South West but higher than for England as a whole.
Wiltshire’s (and the South West’s) higher prevalence figures may reflect the fact
that it has a relatively older population than the England average and/or that
people in Wiltshire are living longer with diagnosed cancer than in other areas
(for a range of reasons that may include better treatment or earlier presentation).
Wiltshire had statistically significant lower cancer mortality rates for all ages and
for under 75s than England. However, 3,490 Wiltshire residents died in the years
2008 to 2010 from cancer and 1,655 of them were under 75. Overall rates of
mortality from Cancer are increasing slightly but remain around or below the
average in England and the South West.
If all of Wiltshire had the same mortality rate as the least deprived quintile there
would have been approximately 80 deaths fewer per year; a reduction of around
7%.
Site specific cancers
Lung cancer incidence in under 75s was statistically significantly lower in
Wiltshire than it was in England. The mortality rate from lung cancer for males
and females under 75 was statistically significantly lower in Wiltshire than in
England.
Incidence of breast cancer in Wiltshire is higher than England or the South West
which may reflect the success of the screening programme locally. Wiltshire had
a similar (i.e. not statistically significantly different) mortality rate to England and
the South West.
Wiltshire had a statistically significantly higher incidence rate for bowel cancer in
females than England. The mortality rates for males and females were not
statistically significantly different to those for the South West or England.
Wiltshire had a statistically significantly higher rate of incidence for prostate
cancer than England and the South West. This may be because more males in
Wiltshire are asking to be tested for prostate cancer. Wiltshire had a similar
mortality rate to England and the South West (i.e. not statistically significantly
different.
The incidence and mortality rates due to cervical cancer in Wiltshire were not
statistically significantly different to those for England or the South West.
Page 2 of 39
The incidence and mortality rates of oesophageal cancer in Wiltshire were not
statistically significantly different to those for England or the South West.
The incidence and mortality rates of stomach cancer in Wiltshire were not
statistically significantly different to those for England or the South West. The
relative survival rate in the Central South Coast Cancer Network is substantially
higher that the rate seen in the Avon, Somerset and Wiltshire Cancer Network
area.
The incidence of malignant melanoma for males and females in Wiltshire is very
similar to the South West but higher than England, and statistically significantly
so for females. The mortality rates of malignant melanoma in Wiltshire were not
statistically significantly different to those for England or the South West. It is
worth noting that while incidence rates were generally similar to the South West
mortality rates were higher, nearly significantly in the case of females.
Deaths from cancer 2008-10 (for selected cancers)
Cancer
Age group
All cancers
All cancers
Lung
Breast
Colorectal
Prostate
Cervical
Oesophageal
Stomach
Malignant melanoma
All ages
Under 75s
Under 75s
Under 75s
Under 75s
Under 75s
Under 75s
Under 75s
Under 75s
Under 75s
Number of deaths in
2008-10
3,490
1,655
310
151
194
68
21
85
39
45
Page 3 of 39
Average deaths
per year
1163
552
103
50
65
23
7
28
13
15
1. All cancers (aggregate)
Incidence
Incidence of cancer in females under 75 in 2008/10 in Wiltshire is similar to the
rate in 2004/06 but is now not significantly different to the England and South
West averages. This is also true for males under 75.
Page 4 of 39
Incidence of cancer (all ages) between 2008 and 2010 in Wiltshire has reduced
from the rates seen in 2004-06 for both males and females and they are now not
statistically significantly different to the South West or England rates. Further
investigation by cancer site and age specific rates will help identify the reasons
for the improvement in Wiltshire. The trend in male all age cancer incidence has
been slowly rising from 2006 to 2010 following a substantial drop in 2006. The
trend in female all age cancer incidence is more erratic with large swings in the
last few years.
Page 5 of 39
Prevalence
The Quality Outcomes Framework (QOF) requires GPs to register any of their
patients with cancer. At the end of 2011/12, 10,080 people in Wiltshire were
registered; a prevalence of 2.2%. The unadjusted prevalence for Wiltshire was
similar to the prevalence for the South West and higher than the England
prevalence of 1.8%.
Data source: NHS Information Centre
Wiltshire’s (and the South West’s) higher prevalence figures may reflect the fact
that it has a relatively older population than the England average and/or that
people in Wiltshire are living longer with diagnosed cancer than in other areas
(for a range of reasons that may include better treatment or earlier presentation).
Page 6 of 39
The unadjusted (for age, gender, deprivation) prevalence data for 2010/11
ranged across the practices from 1.0% to 4.2% and also varied by CCG from
2.0% to 2.4%.
Cancer prevalence by GP Clinical Commissioning Group locality (QOF
2011/12)
Page 7 of 39
Inpatient admissions
Admissions reflect local activity and are not necessarily indicative of incidence or
prevalence.
Hospital Admissions for Cancer, Directly Standardised Rate, 2011-12
Royal Wootton Bassett and Cricklade
Malmsbury
Calne
Pewsey
Marlborough
Bradford
Wiltshire
Chippenham
Devizes
Trowbridge
Corsham
Melksham
Southern Wiltshire
Westbury
Tidworth
Warminster
Salisbury
Wilton
Mere
Amesbury
Tisbury
100
600
1100
1600
2100
2600
3100
Directly Standardised Rate per 100,000 population
Admissions for cancer are highest in NEW where QOF prevalence is also lowest.
SNHSA has the lowest admission rate and the highest QOF Prevalence, the
differences in QOF are small but looking at outcomes in these areas may help
with understating variation in treatment and outcomes.
Admissions for Cancer Directly Standardised Rate, 2011-12
NEW
WWYKD
SNHSA
0
200
400
600
800
1000
1200
1400
1600
Directly standardised rate of admissions per 100,000
Page 8 of 39
1800
2000
Mortality
Under 75 Mortality from Cancer in Wiltshire for 2008-10 has risen marginally from
the rates in 2006-08 while rates in England and the South West have reduced,
consequently Wiltshire is now not statistically significantly different to England or
the South West. In Wiltshire 1,655 residents died from cancer during 2008-10;
that is an average of about 552 people each year
All Cancers: deaths per 100,000 (under 75) in England,
South West and Wiltshire, 2008-2010
140
England
South West
Wiltshire
122
120
112
112
99
DSR per 100,000
100
93
92
80
60
40
20
0
Males
Females
The annual trend for under 75 cancer mortality for both England and the South
West show rates generally falling. In Wiltshire the rates are also generally falling
but with more variation year on year probably due to the relatively small number
of deaths.
All Cancers: Trends in mortality per 100,000 in Wiltshire, South
West and England 1998 to 2010 (under 75)
170
England
South West
Wiltshire
130
FEMALES
110
90
MALES
70
Source: Clinical and Health Outcomes Knowledge Base
Page 9 of 39
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
50
1998
DSR per 100,000
150
All age cancer mortality rates (2008-10) in Wiltshire are not significantly different
to the South West average but are significantly lower than the England average.
In Wiltshire 3,490 residents died from cancer during 2008-10; that is an average
of 1,163 people each year. This also means just under half (47%) of all cancer
deaths occur under the age of 75.
All Cancers: deaths per 100,000 (all ages) in England,
South West and Wiltshire, 2008-2010
250
England
South West
Wiltshire
201
DSR per 100,000
200
189
188
146
150
137
135
100
50
0
Males
Females
The general trend in the annual rates for all age cancer mortality is falling. The
rate of reduction in Wiltshire seems to be slower than that seen in the South
West and England. This may reflect Wiltshire starting from a better overall
position and the increasing older population.
All Cancers: Trends in mortality per 100,000 in Wiltshire, South
West and England 1998 to 2010 (all ages)
260
England
South West
Wiltshire
240
200
FEMALES
180
160
MALES
140
120
Source: Clinical and Health Outcomes Knowledge Base
Page 10 of 39
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
100
1998
DSR per 100,000
220
Directly standardised mortality rates from cancer for in the under 75s in 2007 to
2009 varied among the Community Areas from 79.2 per 100,000 for Wilton to
116.0 per 100,000 for Westbury. However, because of the small numbers
involved no areas actually had rates that were statistically significantly different
than Wiltshire’s overall rate.
Mortality from all Cancers (under 75) 2007-09
WILTON
SOUTHERN WILTSHIRE
TISBURY
MALMESBURY
CHIPPENHAM
DEVIZES
BRADFORD
PEWSEY
TROWBRIDGE
MERE
CALNE
MARLBOROUGH
WOOTTON BASSETT & CRICKLADE
WARMINSTER
CORSHAM
AMESBURY
SALISBURY
MELKSHAM
TIDWORTH
WESTBURY
0
20
40
60
80
100
120
140
Rate per 100,000 Population (age standardised)
Inequality – mortality
If all of Wiltshire had the same all age mortality rate as the least deprived quintile
there would have been 243 fewer deaths from cancer during 2007-09; i.e. 81 per
year. This would have been a reduction of 6.96%. The following table shows the
number of excess deaths due to cancer (those which would not have occurred if
all of Wiltshire had the same mortality rate as the least deprived quintile).
Mortality count
Q1 Least deprived
Q2 Below average
Q3 Average
Q4 Above average
Q5 Most deprived
558
708
680
697
763
Standardised
mortality ratio
85.8
94.0
90.4
90.3
95.6
Source: Dr Foster (ONS mortality database)
Page 11 of 39
Excess
deaths
0
72
40
40
91
2. All cancers (comparison)
Survival
Survival rates in the Cancer Networks which cover Wiltshire show some
variation. This is generally not significantly different but some further analysis on
the reasons for the differences may allow for the sharing of practice between
treatment centres.
One Year Relative Survival Rates by Cancer Site and Cancer Network for
patients diagnosed between 2003-05
Relative Survival Rate
100
90
Avon, Somerset &
Wiltshire
80
Central South Coast
70
60
50
40
30
20
10
0
Stomach - Females
Stomach - Males
Prostate - Males
Oesophageal - Females
Oesophageal - Males
Lung - Females
Lung - Males
Colorectal - Females
Colorectal - Males
Cervical - Females
Breast - Females
Data source: Clinical and Health Outcomes Knowledge Base
Five Year Relative Survival Rates by Cancer Site and Cancer Network for
patients diagnosed between 2003-05
100
Avon, Somerset &
Wiltshire
90
Central South Coast
Relative Survival Rate
80
70
60
50
40
30
20
10
0
Stomach - Females
Stomach - Males
Prostate - Males
Page 12 of 39
Oesophageal - Females
Oesophageal - Males
Lung - Females
Lung - Males
Colorectal - Females
Colorectal - Males
Cervical - Females
Breast - Females
Data source: Clinical and Health Outcomes Knowledge Base
Mortality
The lung cancer mortality rates for males and females aged under 75s in
Wiltshire were significantly lower than the national average. For all other cancers
the rates are not significantly different to the England average.
35
Wiltshire
England
30
25
20
15
10
Lung
Malignant
Melanoma
Leukaemia
Stomach
Skin cancers (not
malignant
melanoma)
Prostate
Oesophageal
Hodgkin's
Disease
0
Colorectal
5
Bladder
Directly Standardised Rate per 100,000
Male deaths from cancers: deaths per 100,000 < 75 years
England and Wiltshire (2008 to 2010)
25
Wiltshire
England
20
15
10
Page 13 of 39
Lung
Malignant
Melanoma
Leukaemia
Stomach
Skin cancers (not
malignant
melanoma)
Oesophageal
Hodgkin's
Disease
Colorectal
Cervical
0
Breast
5
Bladder
Directly Standardised Rate per 100,000
Female deaths from cancers: deaths per 100,000 < 75 years
England and Wiltshire (2008 to 2010)
For most cancers changes in the mortality rates in Wiltshire have mirrored the
national picture. The exception is skin cancer where the mortality rate from
malignant melanomas and non-malignant melanomas has increased more
quickly in Wiltshire compared to England. These calculations are based on a
very small number of deaths especially for Wiltshire (see the malignant
melanoma section for further details). It must be noted that the mortality rate for
all types of skin cancer remains low in comparison with the other cancers shown.
Change in DSR Mortality rates (1997-99 to 2008-10) for cancer
(Rates are for all ages apart from all cancers and lung cancer which are for under 75s)
120%
100%
80%
England
Wilts
60%
% change
40%
20%
0%
-20%
-40%
Data source: Clinical and Health Outcomes Knowledge Base
Page 14 of 39
Colorectal
Breast
Skin (not MM)
Malignant Melanoma
Prostate
Stomach
Lung
All Cancers
-60%
3. Lung cancer
Incidence
Lung cancer incidence in under 75s was statistically significantly lower in
Wiltshire than it was in England for males and females. It was also statistically
significantly lower than the South West but not statistically significantly so.
The trend in all age incidence is generally declining in males, however, the
Wiltshire rate for 2010 showed a sudden increase which will need to be
monitored closely in the next few years. For females the all age incidence rate is
generally flat in Wiltshire; which is different to England and the South West were
rates are rising.
Page 15 of 39
Survival
In Wiltshire the 1 year survival rate is around a third of the general population
and by 5 years this has dropped to less than a tenth. The relative survival rate
generally around or better than the England average and is higher for females at
both 1 and 5 years. Females in the Avon, Somerset and Wiltshire Cancer
network area see better relative survival than those in the Central South Coast
Cancer network area. For males the Central South Coast cancer network has
better relative survival but for 5 years survival this the position has reversed.
40
Lung Cancer: 1 & 5 year survival rate in England, South West and Avon,
Somerset & Wiltshire Cancer Network , 2003-2005
35
ENGLAND
SOUTH WEST
30
Avon, Somerset & Wiltshire CN
Relative Survival Rate
Central South Coast CN
25
20
15
10
5
0
Males - 1 yr
Males - 5 yrs
Females - 1 yr
Females - 5 yrs
Data source: Clinical and Health Outcomes Knowledge Base
Notes:
The relative survival rate is the ratio of the survival rate actually observed among the cancer patients and the
survival rate that would have been expected if they had only had the same overall mortality rates as the
general population. This includes diagnosis for higher order malignancies.
Page 16 of 39
Mortality
The mortality rate from lung cancer for males and females under 75 was
statistically significantly lower in Wiltshire than in England and while lower than
the South West average this was not statistically significant. Although lower
rates are welcome about 310 Wiltshire residents aged under 75 died from lung
cancer during 2008-10; that is an average of about 103 people each year.
Lung Cancer: deaths per 100,000 (under 75) in England,
South West and Wiltshire, 2008-2010
35
England
South West
Wiltshire
31
30
25
DSR per 100,000
25
23
21
20
16
15
15
10
5
0
Males
Females
The trend in all age lung cancer mortality is rising for both males and females. In
2010 there was a substantial increase in the rate from around 20 per 100,000
population in 2009 to around 30 per 100,000 population in 2010. In females the
rise in rates has been consistent, except in 2010 which saw a large fall. Further
investigation should provide insight into the age groups and localities affected.
Lung Cancer: Trends in incidence per 100,000 in Wiltshire, South
West and England 1998 to 2010 (all ages)
50
England
45
South West
Wiltshire
35
30
FEMALES
25
20
MALES
15
10
5
Source: Clinical and Health Outcomes Knowledge Base
Page 17 of 39
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
0
1998
DSR per 100,000
40
4. Breast cancer
Screening
This is covered in the Health and Wellbeing JSA Screening reporti. Screening
rates for breast cancer are higher than the England and South West averages.
There are challenges ahead to maintain uptake in the wider age ranges now
considered for screening.
Incidence
The incidence rate in Wiltshire is higher than the England and South West rates
but not statistically significantly – this may reflect a screening programme with a
higher uptake rate than nationally.
The annual trend in rate of breast cancer incidence in Wiltshire is variable but
seems to be falling following a peak in 2005. In 2009 the incidence was the
lowest seen in Wiltshire over the time period analysed.
Page 18 of 39
Survival
Relative survival is around 5% at 1 year and 15% lower at 5 years than the
general population. The one year relative survival is similar in both the cancer
network areas which cover Wiltshire and these are similar to the England and
South West averages. The 5 year relative survival is higher in the South West
and the Avon, Somerset and Wiltshire Cancer Network area than the England
and Central South Coast cancer network.
100
Breast Cancer: 1 & 5 year survival rate in England, South West and
Avon, Somerset & Wiltshire Cancer Network , 2003-2005
ENGLAND
95
SOUTH WEST
Avon, Somerset & Wiltshire CN
Relative Survival Rate
Central South Coast CN
90
85
80
75
Females - 5 yrs
Females - 1 yr
Data source: Clinical and Health Outcomes Knowledge Base
Notes:
The relative survival rate is the ratio of the survival rate actually observed among the cancer patients and the
survival rate that would have been expected if they had only had the same overall mortality rates as the
general population. This includes diagnosis for higher order malignancies.
Page 19 of 39
Mortality
Wiltshire had a similar (i.e. not statistically significantly different) mortality rate to
England and the South West. However, 151 Wiltshire residents aged under 75
died from breast cancer during 2008-10; that is an average of about 51 people
each year.
Breast Cancer: deaths per 100,000 (under 75) in England,
South West and Wiltshire, 2008-2010
19.5
England
South West
Wiltshire
DSR per 100,000
19.3
19.0
18.8
18.5
18.4
18.0
Females
The annual trend in breast cancer mortality is falling but did rise in 2010. This
maybe a one off due to the small number of deaths but should be examined
again when the 2011 data is available.
Breast Cancer: Trend in mortality per 100,000 in Wiltshire,
South West and England 1998 to 2010 (all ages)
36
England
South West
Wiltshire
34
30
28
26
24
22
Source: Clinical and Health Outcomes Knowledge Base
Page 20 of 39
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
20
1998
DSR per 100,000
32
5. Colorectal (bowel) cancer
Screening
This is covered in the Health and Wellbeing JSA Screening report1. Screening
uptake for colorectal cancer have increased in the 4 years since its introduction
and in Wiltshire is now higher than the national standard of 60%. The challenge
is to increase uptake further particularly in more deprived areas.
Incidence
In 2008 to 2010 Wiltshire had a statistically significantly higher incidence rate in
females than England. The rate for males was higher than the South West and
England but not statistically significantly.
In Wiltshire the trend in the annual incidence rate is rising for males and flat, if
erratic, for females.
Page 21 of 39
Survival
Relative survival rates are about 70% at one year and around half of the general
population. Rate are similar for both males and females. Rates in the South
west and the cancer networks are generally a little higher than the England
average. Of the 2 cancer networks which cover Wiltshire the Central South
Coast area has higher relative survival and particularly for males than the Avon,
Somerset & Wiltshire network area.
80
Colon Cancer: 1 & 5 year survival rate in England, South West and Avon,
Somerset & Wiltshire Cancer Network , 2003-2005
ENGLAND
70
SOUTH WEST
Avon, Somerset & Wiltshire CN
Central South Coast CN
Relative Survival Rate
60
50
40
30
20
10
0
Males - 1 yr
Males - 5 yrs
Females - 1 yr
Females - 5 yrs
Data source: Clinical and Health Outcomes Knowledge Base
Notes:
The relative survival rate is the ratio of the survival rate actually observed among the cancer patients and the
survival rate that would have been expected if they had only had the same overall mortality rates as the
general population. This includes diagnosis for higher order malignancies.
Page 22 of 39
Mortality
Wiltshire had a mortality rate for males and females that was higher than the
England and South West averages but not statistically significantly. However,
about 194 Wiltshire residents aged under 75 died from colorectal cancer during
2008-10; that is an average of 65 people each year.
Colorectal Cancer: deaths per 100,000 (under 75) in
England, South West and Wiltshire, 2008-2010
16
15.1
14
13.1
England
South West
Wiltshire
12.8
DSR per 100,000
12
10
8.9
8.1
8.0
8
6
4
2
0
Males
Females
The general trend in all age colorectal cancer mortality is generally flat for males
with wide variation year on year. In females the trend is down but in the last
couple of years the rates have increased.
Colorectal Cancer: Trends in mortality per 100,000 in Wiltshire,
South West and England 1998 to 2010 (all ages)
35
England
South West
Wiltshire
25
FEMALES
20
MALES
15
Source: Clinical and Health Outcomes Knowledge Base
Page 23 of 39
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
10
1998
DSR per 100,000
30
6. Prostate cancer
Incidence
Wiltshire had a statistically significantly higher rate of incidence than England or
the South West. This may be because more males in Wiltshire are asking to be
tested for prostate cancer possibly because this is a request made more often by
males from more affluent areas, like Wiltshire.
In Wiltshire, the annual rate of prostate cancer incidence was higher than the
South West and England between 1999 and 2009. In 2010 is fell below the
South West rate and nearly as low as the England rate.
Page 24 of 39
Survival
Relative Survival rates are around 95% at 1 year and 80% at 5 years of the
general population. Relative survival is generally lower than the England and
South West averages in the Avon, Somerset and Wiltshire network area while it
is higher in the Central South Coast network area.
100
Prostate Cancer: 1 & 5 year survival rate in England, South West and
Avon, Somerset & Wiltshire Cancer Network , 2003-2005
ENGLAND
SOUTH WEST
Avon, Somerset & Wiltshire CN
Central South Coast CN
Relative Survival Rate
80
60
40
20
0
Males - 1 yr
Males - 5 yrs
Data source: Clinical and Health Outcomes Knowledge Base
Notes:
The relative survival rate is the ratio of the survival rate actually observed among the cancer patients and the
survival rate that would have been expected if they had only had the same overall mortality rates as the
general population. This includes diagnosis for higher order malignancies.
Page 25 of 39
Mortality
Wiltshire had a similar mortality rate to England and the South West (i.e. not
statistically significantly different. However, 68 Wiltshire residents aged under 75
died from prostate cancer during 2008-10; that is an average of about 23 people
each year.
Prostate Cancer: deaths per 100,000 (under 75) in England,
South West and Wiltshire, 2008-2010
8.5
England
South West
Wiltshire
DSR per 100,000
8.3
8.3
8.2
8.0
Males
The annual all age prostate cancer mortality rate has fallen from a peak in 2004
of over 30 per 100,000 to a rate of around 24 per 100,000 population in 2010.
Page 26 of 39
7. Cervical cancer
Screening
This is covered in the Health and Wellbeing JSA Screening report1. Screening
rates for cervical cancer are higher than the England and South West averages
and well above target. There are challenges ahead to reduce the percentage of
women who have not been screened for 5 years.
Incidence
The incidence of cervical cancer in Wiltshire for 2008-10 was not statistically
significantly different to that for England or the South West.
The annual trend has been generally flat between 2003 and 2010.
Page 27 of 39
Survival
The relative survival rate at 1 years is around 80% of the general population. At
5 years this has dropped to around two thirds with the exception of the Avon,
Somerset and Wiltshire cancer network area which see little change in relative
survival.
100
90
Cervical Cancer: 1 & 5 year survival rate in England, South West and
Avon, Somerset & Wiltshire Cancer Network , 2003-2005
80
ENGLAND
SOUTH WEST
Avon, Somerset & Wiltshire CN
Central South Coast CN
Relative Survival Rate
70
60
50
40
30
20
10
0
Females - 1 yr
Females - 5 yrs
Data source: Clinical and Health Outcomes Knowledge Base
Notes:
The relative survival rate is the ratio of the survival rate actually observed among the cancer patients and the
survival rate that would have been expected if they had only had the same overall mortality rates as the
general population. This includes diagnosis for higher order malignancies.
Page 28 of 39
Mortality
Wiltshire has a higher mortality rate to England and the South West but not
statistically significantly so. However, 21 Wiltshire residents aged under 75 died
from cervical cancer during 2008-10; that is an average of 7 people each year.
Cervical Cancer: deaths per 100,000 (under 75) in England,
South West and Wiltshire, 2008-2010
3.5
England
South West
Wiltshire
2.9
3.0
DSR per 100,000
2.5
2.0
1.9
2.0
1.5
1.0
0.5
0.0
Females
The annual trend in cervical cancer mortality shows wide variation but rates are
generally similar year on year.
Cervical Cancer: Trends in mortality per 100,000 in Wiltshire,
South West and England 1998 to 2010 (all ages)
4.5
England
4.0
South West
Wiltshire
3.0
2.5
2.0
1.5
1.0
0.5
Source: Clinical and Health Outcomes Knowledge Base
Page 29 of 39
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
0.0
1998
DSR per 100,000
3.5
8. Oesophageal cancer
Incidence
The incidence of oesophageal cancer in Wiltshire between 2008 and 2010 was
not statistically significantly different to that for England or the South West.
The annual all age trend for oesophageal cancer is generally similar to the
England and South West trend which is flat, possibly decreasing slightly.
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Survival
One year relative survival is less than half the general population rate and by 5
years this has dropped to around a tenth of the general population. For both
males and females the relative survival at 1 years is higher in the Central South
coast network area. The 5 year relative survival is highest in the Avon, Somerset
and Wiltshire network area while for females it is highest in the Central South
Coast network area.
45
Oesophogeal Cancer: 1 & 5 year survival rate in England, South West and
Avon, Somerset & Wiltshire Cancer Network , 2003-2005
40
ENGLAND
SOUTH WEST
Avon, Somerset & Wiltshire CN
35
Central South Coast CN
Relative Survival Rate
30
25
20
15
10
5
0
Males - 1 yr
Males - 5 yrs
Females - 1 yr
Females - 5 yrs
Data source: Clinical and Health Outcomes Knowledge Base
Notes:
The relative survival rate is the ratio of the survival rate actually observed among the cancer patients and the
survival rate that would have been expected if they had only had the same overall mortality rates as the
general population. This includes diagnosis for higher order malignancies.
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Mortality
Wiltshire had a similar mortality rate to England and the South West (i.e. not
statistically significantly different). However, about 85 Wiltshire residents aged
under 75 died from oesophageal cancer during 2008-10; that is an average of
about 28 people each year. Mortality rates (in Wiltshire and elsewhere) are
about 3 times higher for males than they are for females. This in part reflects the
fact that more males smoke and drink more heavily than females.
Oesophageal Cancer: deaths per 100,000 (under 75) in
England, South West and Wiltshire, 2008-2010
12
England
South West
Wiltshire
10
DSR per 100,000
9.0
8.6
8.2
8
6
4
2.6
2.6
2.4
2
0
Males
Females
The annual all age trend in oesophageal cancer is generally flat.
Oesophageal Cancer: Trends in mortality per 100,000 in Wiltshire,
South West and England 1998 to 2010 (all ages)
18
England
16
South West
Wiltshire
12
MALES
FEMALES
10
8
6
4
2
Source: Clinical and Health Outcomes Knowledge Base
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2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
0
1998
DSR per 100,000
14
9. Stomach cancer
Incidence
Incidence of stomach cancer in males in Wiltshire in 2008 to 2010 was not
statistically significantly to the England or South West averages. Gastric cancer
shows a male predominance in its incidence as up to three males are affected for
every female.
Nationally and in the South West the all age stomach cancer incidence rates
have continued to fall. However, in Wiltshire the incidence rates have risen
between 2008 and 2010, albeit from already very low rates.
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Survival
One year relative survival is less than half the general population and 5 year
relative survival is around a fifth of the general population. There is a substantial
difference between the cancer networks which cover Wiltshire with the Central
South Cost network having higher relative survival for both males and females.
45
Stomach Cancer: 1 & 5 year survival rate in England, South West and Avon,
Somerset & Wiltshire Cancer Network , 2003-2005
ENGLAND
40
SOUTH WEST
Avon, Somerset & Wiltshire CN
35
Central South Coast CN
Relative Survival Rate
30
25
20
15
10
5
0
Males - 1 yr
Males - 5 yrs
Females - 1 yr
Females - 5 yrs
Data source: Clinical and Health Outcomes Knowledge Base
Notes:
The relative survival rate is the ratio of the survival rate actually observed among the cancer patients and the
survival rate that would have been expected if they had only had the same overall mortality rates as the
general population. This includes diagnosis for higher order malignancies.
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Mortality
The Wiltshire mortality rate is not significantly different to the England or South
West Averages for both males and females. However 39 Wiltshire residents
aged under 75 died from stomach cancer during 2008-10; that is an average of
about 13 people each year.
Stomach Cancer: deaths per 100,000 (under 75) in England,
South West and Wiltshire, 2008-2010
6
England
South West
Wiltshire
5
DSR per 100,000
4.1
4
3.7
3.3
3
1.8
2
1.4
1.2
1
0
Males
Females
While the all age rate for stomach cancer mortality has been falling since 1998, in
2010 the rate in both males and females saw an increase.
Stomach Cancer: Trends in mortality per 100,000 in Wiltshire,
South West and England 1998 to 2010 (all ages)
18
England
16
South West
Wiltshire
12
MALES
FEMALES
10
8
6
4
2
Source: Clinical and Health Outcomes Knowledge Base
Page 35 of 39
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
0
1998
DSR per 100,000
14
10. Malignant Melanoma
Incidence
The 3 year average incidence of malignant melanoma for males and females in
Wiltshire is very similar to the South West but higher than England, and
statistically significantly so for females.
When observing single year incidence rates, incidence of malignant melanoma in
males in Wiltshire appears generally risen from 1997 to 2010, although there is a
great deal of variation between years. An increasing trend is also observed for
the South West and England over this period.
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Inpatient admissions
Over 2005/06 to 2010/11 inclusive, Wiltshire’s Standardised Admissions Ratio for
malignant melanoma has been significantly higher than what would be expected
from overall admissions for England, although it has reduced since 2008/09. The
number of spells in hospital has similarly increased since 2001/02. In 2011/12
the admissions ratio is not significantly different to the national average.
160
Standardised Admissions for Malignant Melanoma for England and Wiltshire,
2001-02 to 2011-12
Standardised Admission Ration (Adjusted for Age & Gender)
140
120
100
80
60
40
Wiltshire
20
England Average
0
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
Source: Dr Foster Intelligence, PHM Tool
Mortality
Wiltshire’s 3 year mortality rate is higher than that of the South-West and
England, although not significantly so. In real terms 45 people, 23 female and 22
males, died of malignant melanoma in Wiltshire over 2008-10.
Malignant Melanoma: deaths per 100,000 (under 75) in
England, South West and Wiltshire, 2008-2010
5
England
South West
Wiltshire
5
4
DSR per 100,000
4
3.1
3.0
3
3
2.4
2.5
2.3
2
1.6
2
1
1
0
Males
Females
Page 37 of 39
The single year trend shows substantial variation between years, although the
overall pattern is of a slightly increasing mortality rate in both males and females
over 2001 to 2010. Rates have been similar to the South West as a region and
consistently higher than the England average in males, although in females the
pattern is more variable.
Malignant Melanoma: Trends in mortality per 100,000 in Wiltshire,
South West and England 1998 to 2010 (all ages)
6
England
South West
Wiltshire
MALES
4
FEMALES
3
2
1
Source: Clinical and Health Outcomes Knowledge Base
Page 38 of 39
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
0
1998
DSR per 100,000
5
Version history
Version 1 – 2009
Version 2 – 2010
Version 3 – 2011
Version 4 – 2012
Draft Cancer factsheet 2012 v1 – Published in original 2012/13 HW JSA
Cancer factsheet 2012 v3 – 2011/12 QOF updates.
Version 5 – 2013 – 2010 incidence data added
iwww.intelligencenetwork.org.uk/EasysiteWeb/getresource.axd?AssetID=52775&
servicetype=Attachment
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