Cancer

Breast, lung, prostate and bowel cancers are the most common cancers in the UK. Together account for over half of all new cases of cancer each year (Cancer Research UK).

A government policy paper published in 2013 sets out the key actions for tackling cancer as: reducing the risk of cancer, earlier diagnosis of cancer and improving treatment and access to treatment for cancer.

What do we know?

Risk of most cancer increases with age; as Slough has a younger population profile than England rates of cancer in Slough are predictably lower than the national average. Even when differences in age of the population are accounted for, however, Slough’s cancer incidence is still lower than the national average.

The most common cancers in the UK are breast, lung, prostate and bowel cancers which together account for over half of all new cancers each year. While not the most common cancer, lung cancer is responsible for more cancer deaths than any other, followed by bowel cancer (Source: Cancer Research UK).

Risk factors vary according to the site of cancer, however, there are some overlapping lifestyle risk factors that can be changed to reduce your risk e.g. alcohol, smoking, obesity, levels of physical activity and diet. In Slough, there are other important lifestyle risk factors that need to be considered including chewing tobacco products and chewing herbal stimulants such as Khat.

Facts, figures, trends

Incidence

There are approximately 500 people newly diagnosed with cancer each year in Slough per 100,000 population which is lower than the national average of cancer diagnoses. This is also the lowest rate in the Thames Valley region. Nationally, there is a general steady increase in the incidence of cancer. Though the local trend shows more fluctuation due to smaller numbers, there also appears to be a general increase in incidence.

Figure 1. Standardised incidence of all cancers in Slough (per 100,000 population)

The commonest cancers in Slough are breast cancer, followed by lung cancer then colorectal cancer. This reflects the national picture. There is a significantly lower rate of urological cancers (including kidney, bladder and prostate) in Slough than the England average.

Mortality

Of those diagnosed with cancer in Slough, two thirds will survive a year following diagnosis. This is slightly lower than the national average of 68%. There were 301 cancer deaths per 100,000 people in Slough in 2012. This is similar to the England average (290 per 100,000 people).

Nationally the trend in cancer deaths is decreasing. The local trend in cancer mortality shows that over the last ten years, death from cancer in Slough has increased from its lowest point to a plateau and has in the last five years seen a slight reduction (Figure 3).

Figure 2. Premature (under 75) mortality rate due to cancer from 2001 to 2012

Figure 2

Cancer mortality by site shows a slightly different pattern in Slough than the national average. Though bowel cancer is the third commonest diagnosed cancer in Slough, it represents the highest rate of mortality. (Source: CancerData 2012)

Figure 3 below illustrates how mortality rate due to cancer varies across wards in Slough with the highest rate of cancer deaths being in Britwell and the lowest in Cippenham.

Figure 3. Premature (under 75) mortality rate due to cancer by Slough ward (2010-14)

Figure 3

Source: Health and Social Care Information Centre

Treatment/Services

There are several national cancer targets that NHS services work towards, including waiting times for appointments. According to these targets, people referred by their GP with suspected cancer should be seen by a specialist within two weeks. In Slough in Q1 of 2014/15, 92.5% of people referred by their GP with suspected cancer were seen within two weeks. This is similar to the national average.

As well as waiting times for a specialist referral, targets also cover waiting times for treatment, requiring that treatment is started within 31 days of the decision to treat (or within 62 days of the initial GP referral). In Slough 97% of people received their first course of treatment within 31 days of the decision being made, though for only 80% of people this meant being treated within 62 days of initially being referred by their GP. These figures are similar to the national average.

Patient experience

In terms of patient experience, of those receiving cancer treatment 81% in Slough rate their overall care as excellent or very good. The patient experience survey questions that scored highest in Slough were around doctors having all the correct documents and information about patients, whereas the lowest scoring areas involved patients receiving enough information about help available –from financial help to health and social care services.(Source: Cancer Patient Experience Survey 2013.)

National and local strategies (current best practices)

An independent Cancer Taskforce was convened in January 2015 under the chairmanship of Harpal Kumar, Chief Executive of Cancer Research UK to define a new cancer strategy for the NHS. This was published later that year under the title "Achieving World - Class Cancer Outcomes: A Strategy for the NHS 2015-2020".

A government policy paper published in 2013 sets out the key actions for tackling cancer as:

  • reducing the risk of cancer,
  • earlier diagnosis of cancer and;
  • improving treatment and access to treatment for cancer.

Reducing the risk

About a third of all cancers are caused by lifestyle factors such as smoking, unhealthy diet, alcohol and obesity. Tackling these issues are therefore priorities in helping reduce people’s risk of cancer. Other ways of reducing cancer risk include encouraging people to be careful in the sun to avoid skin cancer and vaccinating young women against the human papillomavirus (HPV) to prevent cervical cancer.

Smoking is not only a major risk factor for cancer, but is also the most preventable cause of death in the UK (Action on Smoking and Health 2013). This is described separately under the Joint Strategic Needs Assessment (JSNA) section entitled ‘smoking’.

Early Diagnosis

Earlier diagnosis of cancer can be achieved through two main routes: screening for cancer to identify disease before it causes any symptoms, and making people aware of the warning signs of cancer so that they know to speak to their GP as soon as symptoms are present.

There are three national cancer screening programmes currently in operation; cervical screening, breast cancer screening and bowel cancer screening. These programmes are covered in another chapter of the JSNA ( see cancer screening).

Be Clear on Cancer is a campaign led by Public Health England in partnership with NHS England, Department of Health and Cancer Research UK to increase awareness of 8 common cancers and their symptoms through national media advertising and online support.

Access to treatment

Lastly, it is important that when symptoms or signs of cancer are identified, diagnosis and treatment occurs in a timely fashion to ensure that patients have the best chance of recovery. In order to ensure this process happens as swiftly as possible, the government has introduced waiting times targets to limit the time people wait for cancer tests and treatment. In addition to this, the government in England in 2011 established a Cancer Drugs Fund (CDF) in order to fund certain cancer treatments that had not met the required criteria for cost-effectiveness as required by the National Institute for Health and Care Excellence.

What is this telling us?

While, generally, Slough follows national trends in cancer showing that the incidence of disease is increasing while the risk of death due to cancer is decreasing, there are local patterns which differ from the national picture. This includes bowel cancer being the leading cause of cancer death locally.

The data also shows that there is significant difference in risk of cancer death according to where in Slough you live. This suggests that tackling cancer through reducing risk factors and improving awareness and diagnosis will serve to reduce local health inequalities which is an important outcome.

What are the unmet needs and service gaps?

  • Disparity in cancer survival across the borough wards suggest that there are unmet needs in terms of early diagnosis and management of cancer. The potential causes of this, including lack of awareness of signs or fear/stigma of reporting, need to be explored further.
  • Reducing lifestyle risk factors for developing cancer (which also overlap with other chronic diseases) remains a challenge and a priority both nationally and locally in Slough.

What are the key inequalities?

It is well known that there are significant inequalities in risk of cancer and chance of survival following cancer between the highest and lowest socioeconomic groups.

The rates of cancer incidence are generally lower in people from black and minority ethnic (BME) groups, however, cancer awareness and help seeking behaviours including uptake of screening are low across all minority ethnic groups (Source: Macmillan).

Older people are less likely to receive the most clinically effective treatment for their cancer, but also face inequalities in their experience of care. Older people with cancer diagnoses are less likely to be provided with information about side effects of treatments and less likely to be directed to sources of support and self-help groups as well as sources of financial help. (Source: Cancer Services Coming of Age (2012) Macmillan, Age UK, Department of Health).

Recommendations

  • To continue to raise awareness of signs of cancer using the PHE Campaign “Be Clear On Cancer”
  • To continue work towards improving lifestyle and reducing lifestyle risk factors for chronic diseases including cancer
  • To target work towards vulnerable groups at risk of cancer

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