Cancer in Cumbria · Cancer occurs predominantly in older people as shown by the differences between the above cohorts. For example a woman’s risk of developing breast cancer by

Cancer in Cumbria

2

3

Table of contents: Summary…………………………...…………………………………………………………5 Introduction …………………………………………………………………………………..7 Cancer Incidence ……………………………………………………………………………8 Cancer Mortality …………………………………………………………………...……….14 Cancer Survival …………………………………………………………………………… 23 Appendices Appendix 1 ………………………………………………………………………………… 26 Appendix 2…………………………………………………………………………………. 27 Appendix 3 ………………………………………………………………………………… 30 Appendix 4 ………………………………………………………………………………… 32 Appendix 5 ………………………………………………………………………………… 38

4

5

Summary On average each year in Cumbria:

• 2,600 people are diagnosed with cancer • 1,500 people die from cancer • 6,000 people are living with cancer • Projected annual increase of 500 registrations (incidence) in population aged 65

and over by 2015 increasing by a further 900 by 2031 Cumbria has statistically significantly higher levels of:

• Stomach cancer • Colo-rectal cancer • Prostate cancer • Bladder cancer (men) • Brain cancer (women)

Cancer mortality:

• Is the second major cause of death after coronary heart diseases • Causes one in four deaths • Lung cancer is the major cause of cancer deaths accounting for almost one in

four deaths from cancer • Projected 10% growth in male deaths from cancer by 2017 • One third of all cancer deaths are to someone aged below 75 years • 160 premature deaths will be averted should Cumbria achieve its Saving Lives

target • Premature cancer mortality is statistically significantly higher in the most

deprived parts of Cumbria • Annually cancer accounts for 8,000 years of lost life – the equivalent of 106

people • On average 11 years of life are lost to cancer

Cumbria has statistically higher levels of mortality from:

• Cancer in men • Colo-rectal cancer • Mesothelioma (men) • Testis • Ovary

Cancer survival in Cumbria:

• 38% of men are alive 5 years after diagnosis • 51% of women are alive 5 years after diagnosis • Over 80% of women are alive 5 years after being diagnosed with breast cancer • Nationally pancreatic cancer has the worst survival rate at 3% • Nationally testicular cancer has the highest survival rate at 97% • People living in the most deprived areas are less likely to survive cancer • There is a 53.3% cancer survival rate for the more affluent parts of Cumbria • Cancer survival in the most deprived areas of Cumbria is 39.2%

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7

Introduction On average each year in Cumbria:

• 2,600 people are diagnosed with cancer • 1,500 people die from cancer

An individual’s risk of developing cancer depends on many factors, including age, lifestyle and genetic make-up. It is estimated that up to half of all cancers cases diagnosed in the UK could be avoided if people made changes to their lifestyles, such as stopping smoking, moderate alcohol intake, maintaining a health bodyweight and avoiding excessive sun exposure. More than a quarter of all deaths from cancer (including almost 90% of lung cancer deaths) are linked to tobacco smoking. Estimates suggest that, in the UK, up to 13,000 cases of cancer could be avoided if no-one exceeded a body mass index (BMI) of 25. Research suggests that each of the following increase the risk of certain cancers: alcohol consumption, a low fibre diet, low consumption of fruit and vegetables, high consumption of red and processed meats and higher intake of salt or saturated fats. Excessive exposure to UV radiation (from the sun or sun beds) is the most important modifiable risk factor for skin cancers. A small number of infectious agents, especially certain viruses, play a key role in causing certain types of cancer. It is estimated that inherited factors cause up to 10% of all cancers. Factors such as the age at which a woman has her first child and number of children, affect the risk of the most common female cancers (Cancer Research UK). This is the second report examining cancer within Cumbria. The data used has been collated from several sources including: the Office for National Statistics, North West Cancer Registry, National Cancer e-Atlas and Cancer Research UK. Cancer incidence (new cases), mortality and survival will be detailed, with particular emphasis being placed on those cancer sites targeted within World Class Commissioning where better detection and treatment will impact on premature mortality from: lung, breast and colo-rectal cancer. There are over two hundred different types of cancer. These can be malignant or benign. This report will be looking at those cancers classed as malignant and will be referred to as cancer(s) or malignant neoplasm(s) (MN). Cancers are coded using the International Classification of Diseases (ICD10) system with malignant neoplasms falling within the range C00 to C97. Due to the under reporting nationally of non-melanoma skin cancer (C44), this grouping has been excluded from the incidence analysis.

8

Cancer Incidence Overall it is estimated that more than one in three people will develop some form of cancer during their lifetime. This compares to an estimated risk of 1 in 27 for people aged up to 50 years. Estimates of the life time risk of developing some of the most common cancers are shown in table 1. These estimates assume no change in the current incidence rates and should be used as an approximate guide only. Table 1: Risk of being diagnosed with cancer by age 65and over a lifetime, England & Wales 1997

% of cohort that develop cancer Males Females by age

65over

lifetimelifetime

riskby age

65over

lifetime lifetime

riskBladder 0.7 3.3 1 in 30 0.2 1.3 1 in 79Brain and CNS 0.4 0.7 1 in 147 0.3 0.5 1 in 207Breast … … … 5.6 10.9 1 in 9Cervix … … … 0.6 0.9 1 in 116Kidney 0.4 1.1 1 in 89 0.2 0.6 1 in 162Large bowel 1.4 5.7 1 in 18 1.1 4.9 1 in 20Leukaemia 0.4 1.0 1 in 95 0.3 0.8 1 in 127Lung 1.7 8.0 1 in 13 1.0 4.3 1 in 23Melanoma 0.4 0.7 1 in 147 0.5 0.9 1 in 117Multiple myeloma 0.1 0.6 1 in 177 0.1 0.5 1 in 204Non-Hodgkin lymphoma 0.6 1.4 1 in 69 0.4 1.2 1 in 83Oesophagus 0.4 1.3 1 in 75 0.2 1.1 1 in 95Ovary … … … 0.9 2.1 1 in 48Pancreas 0.3 1.0 1 in 96 0.2 1.1 1 in 95Prostate 0.9 7.3 1 in 14 … … …Stomach 0.5 2.3 1 in 44 0.2 1.2 1 in 86Uterus … … … 0.6 1.4 1 in 73Source: Cancer Research UK

Cancer occurs predominantly in older people as shown by the differences between the above cohorts. For example a woman’s risk of developing breast cancer by age 65 is less than 6% but the overall lifetime risk is 11%. For men there is a less than 2% risk of developing lung cancer by age 65; this increases to 8% over a lifetime. Bearing in mind that life expectancy is increasing with more elderly people alive today than ever before Cumbria can expect to see an increase in the number of cancers diagnosed each year as a result of the aging population. Cancer data are collected by nine independent regional registries in England. Due to the pattern of patient referral within Cumbria the Primary Care Trust deals two registries. These are: the Northern and Yorkshire Registry, collecting details of patients residing in the north of the county, whilst the North Western Registry deals with those patients in the south of Cumbria. Registry data are dynamic – the files are always open and records may be amended when more accurate data becomes available. Consequently figures can change over time so there may well be small discrepancies especially when comparing data from earlier reports. The timeliness of Registry data are affected by the many checks carried out on an individual record, therefore the latest data available are for 2005. The Northern and Yorkshire Registry share data for North Cumbria with their colleagues in the North Western Registry enabling them to present data for the North West Region in its entirety.

9

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

0-4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85+

Age group

Age

spe

cific

inci

denc

e ra

te/1

00,0

00Males Females

Cumbria Population projections: persons aged 65 and over(2006 based)

164.7

94.980.090.0

100.0110.0120.0130.0140.0150.0160.0170.0

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

2021

2022

2023

2024

2025

2026

2027

2028

2029

2030

2031

Num

ber (

000'

s)

2755

2354

2100

2200

2300

2400

2500

2600

2700

2800

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Reg

istr

aitio

ns (n

umbe

r) Figure 1: Cumbria cancer incidence trend

Figure I shows the cancer incidence trend for Cumbria. Over the ten year period there has been a 17% increase in the number of reported cases rising from 2,354 cases in 1996 to 2,755 for 2005. Average annual age specific incidence rates for Cumbria are shown for the period, 2003 to 2005 in figure 2. This clearly illustrates the association of cancer with an older population. Men aged 65 and over account for 70% of all new registrations. This gives a crude rate of 2,205.3 per 100,000 males aged 65 plus whereas their younger counterparts aged below 65 years have

a rate of 186.3 per 100,000. Figure 2: Cumbria, average annual age specific cancer incidence rate, 2003-2005 Women aged over 65 years account for 60% of all new registrations. This gives a crude rate of 1,516.3 per 100,000 females aged 65 and over. This compares with a rate of 272.3 per 100,000 women for the younger cohort. The national cervical and breast screening programmes have lead to the earlier detection of these cancers and account for the higher incidence rate in the younger female population. Screening coverage as at 31st March 2007 reveals that 82% of women in Cumbria aged between 25 and 64 years have been checked for cervical cancer, this compares to 79% nationally. Figures for breast cancer show that 79% of women locally aged between 53 and 64 years have been screened, this is above the national average of 76%. Figure 3: Cumbria population (65+) projection

The projected increase in the elderly population must be of concern to those planning services for the future. Figure 3 illustrates the projected growth in the Cumbria population aged over 65 years. This is not an exact science but projections suggest that by 2031 the older population in Cumbria will have grown by some 74%. Even just looking ahead to 2016 there may well be a growth of 28% for this

cohort. Looking again to the future, projecting what will happen with regards to the number of new cancer cases is difficult. Applying current rates (based on 1,811 registrations) to the projected growth in the population aged 65 plus suggests an additional 500 cases by 2015, increasing by a further 900 registrations by 2031 as illustrated in figure 4.

10

Figure 4: Projected growth in cancer registrations, population aged 65 and over

3173

2859

2574

2343

2021

1,5001,7001,9002,1002,3002,5002,7002,9003,1003,300

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

2021

2022

2023

2024

2025

2026

2027

2028

2029

2030

2031

Num

ber

Moving on from the incidence of cancer, figure 6 examines the prevalence (new and existing cases) of cancer in the community. The introduction of the Quality and Outcomes Framework (QOF) gives for the first time the number of people living with a specific condition. Unfortunately QOF data are not available for specific age groups so figure 5 shows the projected prevalence for the total population. Latest figures for 2007/08 show that 1.2% of the population of Cumbria were living with a cancer. Applying this rate to the projected populations shows a 13% increase on current numbers by 2031. Figure 5: Projected cancer prevalence, total population

Projected cancer prevalence in Cumbria population(based on 2007/08 QOF rate of 1.2%) 6,722

5,9545,8005,9006,0006,1006,2006,3006,4006,5006,6006,7006,800

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

2021

2022

2023

2024

2025

2026

2027

2028

2029

2030

2031

Num

ber

The data used in figure 5 can be found in appendix 1. Table 2 shows the standardised registration ratios (SRRs) for Cumbria for the period 2001 to 2005. These allow local incidence to be compared with the average rate for England (normally 100). A statistical calculation (confidence interval) is applied to the resulting SRR which indicates if the figure is higher or lower than would be expected. Those sites that are statistically significantly higher or lower when compared to England are indicated by the use of sad (bad) or happy (good) faces. The table shows that cancer registrations for women are significantly higher: this can be interpreted as women in Cumbria having a statistically significant higher incidence rate for all cancers which is 3% greater than expected. On the other hand men in Cumbria have a significantly lower rate: this would be interpreted as a statistically significant lower rate which is 4% lower than expected.

11

Table 2: Cumbria Standardised Registration Ratios, 2001-2005 Cumbria 2001-2005 Males Females

Site ICD10 Registrations SRR Registrations SRR

All cancers ex nmsc C00-C97xC44 3823 96 ☺ 4067 103

MN Oesophagus C15 135 96 76 99

MN Stomach C16 180 123 104 128

MN Colon/Rectum C18-C20 617 113 501 113

MN Pancreas C25 103 99 99 91

MN Trachea, Bronchus, Lung C33-C34 586 95 398 92

Mal Melanoma Skin C43 97 88 135 104

Mesothelioma C45 68 127 6 60

MN Female Breast C50 1254 101

MN Cervix Uteri C53 72 104

MN Uterus C54 191 108

MN Ovary C56

208 114

MN Prostate C61 762 115

MN Testis C62 68 106

MN Kidney ex Renal Pelvis C64 108 79 ☺ 74 116

MN Bladder C67 196 122 80 98

Brain C71 81 118 63 132

Non-Hodgkin's Lymphoma C82-C85 129 86 125 96

Leukaemia C91-C95 82 73 ☺ 56 69 ☺

Note: 1. ☺ Significant at p<0.05. This means we can be 95% certain that the particular SRR is higher or lower than the national level. 2. ".." denotes that data have been suppressed where the number of events is less than 5 or where subtraction from total may be disclosive. Source: Calculated in-house by Performance & Intelligence Section

Cumbria has significantly higher incidence of:

• Stomach cancer • Colo-rectal cancer • Prostate cancer • Bladder cancer (men) • Brain cancer (women)

Looking towards the district councils that constitute Cumbria table 3 shows those cancers that are significantly higher or lower. A more detailed breakdown of the data can be found in appendix 2. The National Cancer-Atlas can be found at: http://www.ncin.org.uk/eatlas/ this resource can be used to obtain trend data for local authorities and uses directly standardised rates (DSRs) to compare areas. The use of DSRs allows comparisons to be made between different populations. Direct standardisation takes account of age differences between different populations.

http://www.ncin.org.uk/eatlas/

12

All cancers

24%

32%

9%

46%

49%

41%

31%

0% 10% 20% 30% 40% 50%

Allerdale

Barrow in Furness

Carlisle

Copeland

Eden

South Lakeland

Cumbria

Table 3: Statistically significant SRRs, 2001-2005

Allerdale

Barrow in

Furness Carlisle Copeland Eden South

Lakeland Significantly higher M F M F M F M F M F M F All cancers - - - - - - - - - - - Stomach - - - - - - - - Colo-rectal - - - - - - - - - Mesothelioma - - - - - - - - - - - Uterus - - - - - - - - -

Ovary - - - - - - - - - - Prostate - - - - - - - - - - Kidney - - - - - - - - - - - Significantly lower All cancers ☺ - - - - - - - - - - - Lung - - - - - - - - ☺ - ☺ ☺

Mal Melanoma Skin ☺ - - ☺ - - - - - - - - Cervix - - - - - - - - - ☺ - ☺

Kidney ☺ - - - - - - - - - - - Leukaemia ☺ ☺ - - - - - - - - - -

Figure 6: Projected increase in cancer incidence by 2015

Earlier the report looked at the projected number of new cancer registrations in the older population. Figure 6 shows the projection for all cancers in the population. Again caution should be used when quoting these figures as they are merely a projection of current numbers. By 2015 Cumbria may see a 31% increase in the number of registrations. The spread of these is not equally divided across the county. Eden may well see a 50% increase in the number of cases. Currently Eden does have a greater

proportion of older residents. At the other end Carlisle is projected to have the lowest increase at 9%. For those cancers featured in the World Class Commissioning document figures 7 and 8 show the projections for colo-rectal cancer and female breast cancer. With the exception of Allerdale projections for lung cancer show a decline in the number of registrations and are not shown here. Increases are projected for both cancers with Barrow in Furness carrying the highest increase for colo-rectal cancer with an anticipated growth of 64%. Breast cancer shows the most startling increase – probably due to the breast screening programme with a 76% increase overall, Copeland is projected to have a massive increase of 162%.

13

Figure 7: Projected increase in colo-rectal cancer by 2015 Colo-rectal cancer

36%

64%

26%

52%

50%

4%

33%

-3% 17% 37% 57% 77%

Allerdale

Barrow in Furness

Carlisle

Copeland

Eden

South Lakeland

Cumbria

Figure 8: Projected increase in breast cancer by 2015

Female breast cancer

71%

76%

71%

162%

84%

53%

76%

Allerdale

Barrow in Furness

Carlisle

Copeland

Eden

South Lakeland

Cumbria

The figures the projections are based on can be found in appendix 3.

14

Cancer Mortality Cancer is the second major cause of death accounting for 26% of all deaths locally; 1,462 people were registered as dying from cancer in 2007. This is just below the national average of 27% of all deaths. Figure 9 illustrates the top 5 cancer sites within Cumbria accounting for over half of all cancer deaths. Lung cancer is responsible for the greatest proportion of cancer deaths with one in four men and one in five women dying from the disease. In the female population breast cancer is the second major cause of death from cancer and is responsible for almost one fifth of deaths in this group. For men colo-rectal cancer is the next major cause of death and is responsible for 12% of male cancer deaths. Figure 9: Cumbria - major cancer sites

Females

21%

18%8%5%3%

44%

LungBreastColo-rectalPancreasOesophagusOther sites

Males

25%

12%8%7%5%

44%

LungColo-rectalProstateOesophagusPancreasOther sites

The cancer mortality trend is show in figure 10. Slightly more men die from cancer compared to women. Looking ahead projections suggest a 10% increase in the number of male deaths by 2017 with a small increase of 1% for women. Figure 10: Cumbria cancer mortality trend

Cumbria : Cancer mortality trend

500

550

600

650

700

750

800

850

Dea

th (n

umbe

r)

Male 747 715 734 773 743 678 815 823 749 742

Female 721 694 659 704 684 704 695 701 712 720

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Figure 11 compares the cancer incidence and mortality rate trend. A person diagnosed with cancer may not necessarily die from cancer, if they do, it may not be in the same year of diagnosis.

15

Cumbria: comparison between cancer incidence and mortality

200250300350400450500550600

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

rate

per

100

,000

IncidenceDeaths

2005-2007: Cancer deaths by age group - as a percentage of all deaths

6% 14% 24% 36% 48% 42%27%

14%27%

41%

0%

20%

40%

60%

80%

100%

<25 25-34 35-44 45-54 55-64 65-74 75-84 85+ Allages

<75Age group

Cancer death Other cause

Figure 11: cancer trends – crude rate, persons The table shows that more people are diagnosed each year with some form of cancer than die from a cancer. On average each year there are 1,000 more cancer registrations than deaths. When looking at age at death, in Cumbria on average one third of all deaths are to people aged below 75 years of age. Of these cancer is responsible for two fifths as shown in figure 12. Cancer deaths are more or less equally split 50/50 when

looking at deaths below/above 75 years. The Government set a target through “Saving Lives, Our Healthier Nation” to reduce the number of deaths from cancer for persons aged under 75 years by 20%. Figure 12: Cumbria - age at death Table 4 shows baseline data, progress to date and target rates for reducing premature mortality from cancer. The table is supported by graphs shown in figure 13 displaying the yearly directly standardised mortality rate. If current trends continue all districts within Cumbria will achieve their target rate and 160 lives will have been saved. Eden has already exceeded its target rate of 106 deaths per 100,000 people. Table 4: Saving Lives, Our Healthier Nation Target

Baseline Progress Target

1995/97 2004-2006 2010

Area DSR

Average Annual Deaths

Number DSR


Number DSR


Number Cumbria 142.7 804 119.8 743 114.1 643Allerdale 148.2 163 125.8 151 118.5 130Barrow-in-Furness 162.4 127 145.4 121 130.0 101Carlisle 155.9 179 130.2 159 124.7 143Copeland 139.0 108 124.7 106 111.2 86Eden 132.7 77 93.6 64 106.2 62South Lakeland 120.3 151 100.5 142 96.2 121

16

Figure 13: Premature mortality trend for cancer

Cumbria

116.5114.1

70.090.0

110.0130.0150.0170.0

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

DSR

/100

,000

Eng & Wales Cumbria Target

Allerdale131.9

118.5

70.090.0

110.0130.0150.0170.0

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

DSR

/100

,000

Eng & Wales Cumbria Allerdale Target

Barrow in Furness

139.2130.0

70.090.0

110.0130.0150.0170.0190.0

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

DSR

/100

,000

Eng & Wales Cumbria Barrow-in-Furness Target

Carlisle134.9

124.7

60.080.0

100.0120.0140.0160.0180.0

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

DSR

/100

,000

Eng & Wales Cumbria Carlisle Target

Copeland

113.8111.2

60.080.0

100.0120.0140.0160.0180.0

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

DSR

/100

,000

Eng & Wales Cumbria Copeland Target

Eden

80.2106.2

60.080.0

100.0120.0140.0160.0

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

DSR

/100

,000

Eng & Wales Cumbria Eden Target

South Lakeland

92.6 96.270.090.0

110.0130.0150.0170.0

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

DSR

/100

,000

Eng & Wales Cumbria South Lakeland Target

To give some idea of cause of death table 14 shows premature mortality from cancer by broad ICD10 headings. More detailed discussion re individual sites will be discussed later within the report.

17

Figure 14: Cancer mortality by chapter heading, Cumbria 2005-2007

0%10%20%30%40%50%60%70%80%90%

100%

Digesti

ve

Respir

atory

Unspe

cified

Lymph

oid &

bloo

dBrea

st

Male ge

nital

Urinary

Female

genit

alBrai

n

Mesoth

elial

Skin

Mouth

and t

hroat

Indep

ende

nt

Thyroi

d/end

ocrin

eBon

e

All can

cers

<75 75+

Deprivation and lifestyle contributes to the risk of developing cancer when looking at health inequalities across Cumbria. Figure 15 shows the directly standardised premature mortality rate for selected cancers by deprivation quintile (IMD 2007) within Cumbria. Figure 15: Health inequalities and premature mortality – selected cancer sites

All cause premature mortality 2003-2007

50.0

70.0

90.0

110.0

130.0

150.0

170.0

190.0

1 2 3 4 5Quintile

DSR/

100,

000

Lung cancer, premature mortality 2003-2007

10.0

20.0

30.0

40.0

50.0

60.0

70.0

1 2 3 4 5Quintile

DSR/

100,

000

Colo-rectal cancer, premature mortality 2003-2007

5.07.09.0

11.013.015.017.019.021.023.0

1 2 3 4 5Quintile

DSR/

100,

000

Female breast cancer, premature mortality 2003-2007

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

1 2 3 4 5Quintile

DSR/

100,

000

When compared to the Cumbria average those people living in the worst deprivation (quintiles one and two) have a statistically significantly higher mortality rate from cancer when compared to their more affluent neighbours who have a significantly lower rate. The same pattern is echoed in the lung cancer chart. Undoubtedly this re-enforces the link between smoking and those living in the poorer areas. Deaths from colo-rectal cancer and female breast cancer are significantly higher in quintile 1. Another way of looking at premature mortality is to examine the number of years of lost life (YLL). Table 5 examines the number of years by chapter heading. Cancer is responsible for one third of all deaths when looking at mortality in this manner. For the period 2005 to 2007

18

there were 2,186 cancer deaths in people aged below 75 years of age. In this cohort each person looses an average of 11 years of life. Converting the 24,000 years to actual people would result in 320 lives. These figures are broken down by localities in figure 6. Of the districts Carlisle fares worst with the greatest number of deaths and highest average years of lost life. Table 5: Cumbria premature mortality 2005-2007

Chapter YLL Equates to (people)Malignant neoplasm 24,032 34% 320Diseases of the circulatory system 15,190 22% 203External cause 12,510 18% 167Diseases of the digestive system 5,166 7% 69Diseases of the respiratory system 4,008 6% 53Diseases of the nervous system 2,844 4% 38Other causes 6,588 9% 88Total 70,337 938

Table 6: Premature mortality from cancer 2005-2007

Area Deaths YLL Average YLL Equates to (people) Allerdale 453 5,111 11 68Barrow in Furness 337 3,654 11 49Carlisle 469 5,420 12 72Copeland 333 3,731 11 50Eden 187 1,914 10 26South Lakeland 407 4,205 10 56Cumbria 2,186 24,032 11 320

In terms of individual cancer sites figures 16 and 17 show the years of lost life for males and females. Here the total numbers of years of lost life for the period 2005 to 2007 are divided by the total number of deaths, resulting in an average number of years of lost life for every death.

Figure 16: Cumbria – average number of YLL, males

Premature mortality from cancer : Males 2005-07

0 5 10 15 20

MN Prostate

MN Bladder

Mesothelioma

Pancreas

MN Colon/Rectum

MN Stomach

MN Trachea, Bronchus & Lung

All cancers

MN Oesophagus

Leukaemia

MN Kidney ex Renal Pelvis

Other cancer

Non-Hodgkin's Lymphoma

MN Brain

MM Skin

MN Testis

Average number of years of lost life

19

Although the number of deaths from testicular cancer is low (less than five) those deaths have resulted in the maximum loss of life - average of 18 years.

Figure 17: Cumbria – average number of YLL, females

Premature mortality from cancer : Females 2005/2007

0 5 10 15 20 25

MN Bladder

MN Uterus

MN Stomach

Pancreas

Mesothelioma

MN Trachea, Bronchus & Lung

MN Kidney ex Renal Pelvis

Other cancer

MN Oesophagus

MN Colon/Rectum

Non-Hodgkin's Lymphoma

MN Ovary

All cancers

Leukaemia

MN Female Breast

MN Brain

MM Skin

MN Cervix Uteri

Average number of years of lost life

Cervical cancer is responsible for the maximum loss of life in women - average of 23 years. In both instances this can be interpreted as the cancer developing in a younger person, resulting in an increase in the number of years of lost life or in other words - dying younger. Ironically both diseases are treatable and curable. This should serve as a reminder for men of the importance of self examination and, for women to attend their cervical screening examination. In second place another preventable and treatable disease: malignant melanoma of the skin in both men and women, results in an average of 18 years of lost life for each death. Grouping together total number of years of lost life from cancer, reveals that lung cancer accounts for some 23% of the total in men, whilst breast cancer at 24% is the major cause of lost life in women. Listed below are those sites with the greatest number of years of lost life:

• Lung cancer : 4,854 years • Female breast cancer : 2,899 years • Colo-rectal cancer : 2,226 years • Oesophageal cancer : 1,159 years • Brain cancer : 1,129 years • Ovarian cancer : 958 years • Pancreatic cancer : 941 years • Other sites : 9,867 years

20

Moving on from this topic a more in depth analysis of cancer mortality was undertaken. Similar to standardised registration ratios, standardised mortality ratios (SMRS) have been calculated. Table 7 shows the rates for Cumbria by sex; those sites that are statistically significantly higher or lower when compared to England and Wales are again indicated by the use of sad or happy faces. At the time these rates were calculated detailed national data for 2007 were not available. Cumbria has significantly higher mortality rates for:

All ages –

• All causes (men) • Colo-rectal cancer • Mesothelioma (men) • Testis • Ovary

Under 75 years –

• Mesothelioma (men) • Colo-rectal cancer (women)

21

Table 7: Cumbria Standardised Mortality Ratios, 2002-2006 Males All ages Under 75 years Site ICD No. Deaths SMR Deaths SMR

All cancers C00-C97 2,387 105 1,224 102 MN Oesophagus C15 145 106 83 102

MN Stomach C16 95 98 48 100 MN Colon/Rectum C18-C20 279 116 146 116

MN Pancreas C25 103 101 55 90 MN Trachea, Bronchus, Lung C33-C34 565 103 313 101

Mal Melanoma Skin C43 32 112 22 110 Mesothelioma C45 59 179 43 206

MN Prostate C61 297 103 94 107 MN Testis C62 6 319 5 307

MN Kidney ex Renal Pelvis C64 65 107 34 90 MN Bladder C67 78 87 34 99

MN Brain C71 70 123 50 109 Non-Hodgkin's Lymphoma C82-C85 74 110 40 102

Leukaemia C91-C95 72 104 40 108

Females All cancers C00-C97 2,108 101 1,004 102 MN Oesophagus C15 76 106 33 122 MN Stomach C16 73 123 28 137 MN Colon/Rectum C18-C20 227 134 81 131 MN Pancreas C25 109 101 55 115 MN Trachea, Bronchus, Lung C33-C34 394 102 203 102 Mal Melanoma Skin C43 26 114 16 117 Mesothelioma C45 7 81 5 7 ☺ MN Female Breast C50 308 88 ☺ 185 96 MN Cervix Uteri C53 33 118 25 140 MN Uterus C54 34 102 15 90 MN Ovary C56 147 119 79 105 MN Kidney ex Renal Pelvis C64 46 127 17 94 MN Bladder C67 45 96 12 91 MN Brain C71 42 108 26 92 Non-Hodgkin's Lymphoma C82-C85 64 107 23 87 Leukaemia C91-C95 42 79 16 73 Note: 1. ☺ Significant at p<0.05. This means we can be 95% certain that the particular SRR is higher or lower than the national level. Source: Calculated in-house by Performance & Intelligence Section

Statistically significant SMRs for district councils are found in table 8. A more detailed breakdown of the data can be found in appendices 4 and 5.

22

Table 8: Statistically significant SMRS, 2004-2006

Allerdale

Barrow in

Furness Carlisle Copeland Eden South

Lakeland All ages M F M F M F M F M F M F Significantly higher All cancers - - - - - - - - Stomach - - - - - - - - - - - Colon/Rectum

Trachea, Bronchus, Lung - - - - - - - - - - Mesothelioma - - - - - - - - - - - Cervix Uteri - - - - - - - - - - - Prostate - - - - - - - - - - - Testis - - - - - - - - - - - Kidney ex Renal Pelvis - - - - - - - - Significantly lower All cancers - - - - - - - - - - ☺ ☺

Pancreas - - - - - - - ☺ - - - - Trachea, Bronchus, Lung - - - - - - - - ☺ ☺ ☺

Leukaemia - - - - - - - - - - - ☺

Under 75 years Significantly higher All cancers - - - - - - - - - Oesophagus - - - - - - - - - - - Stomach - - - - - - - - - - - Colon/Rectum - - - - - - - - - - - Pancreas - - - - - - - - - - - Trachea, Bronchus, Lung - - - - - - - - - - - Mesothelioma - - - - - - - - - - - Testis - - - - - - - - - - - Significantly lower All cancers - - - - - - - - - ☺ ☺ ☺

Trachea, Bronchus, Lung - - - - - - - - ☺ - ☺ ☺

Bladder ☺ - - - - - -

23

Cancer Survival Nationally half of all people diagnosed with cancer now survive for more than five years. Figure 17 shows the relative survival for selected cancers in England. Relative survival takes into account that some cancer patients will die from causes other than their cancer. As cancer survival varies with age at diagnosis, rates have been standardised to control for changes in the age profile of cancer patients over time. Figure 17: Five-year age-standardised relative survival (%) for adults (15-99 years) diagnosed during 1999-2003 and followed up to 2004 - 21 common cancers by sex, England

Men

97

80

80

74

64

62

52

51

50

45

40

27

13

12

9

7

3

0 20 40 60 80 100

Testis

Melanoma of skin

Hodgkin's disease

Prostate

Larynx

Bladder

Rectum

Non-Hodgkin's lymphoma

Colon

Kidney

Leukaemia

Myeloma

Stomach

Brain*

Oesophagus

Lung

Pancreas

5-year relative survival (%) Women

89

83

81

76

63

57

55

53

51

46

40

39

27

16

16

12

8

3

0 20 40 60 80 100

Melanoma of skin

Hodgkin's disease

Breast

Uterus

Cervix

Non-Hodgkin's lymphoma

Rectum

Bladder

Colon

Kidney

Leukaemia

Ovary

Myeloma

Brain

Stomach

Oesophagus

Lung*

Pancreas

5-year relative survival (%)

Source: ONS (*It was not possible to produce an age-standardised five-year survival rate for brain cancer in men and lung cancer in women; therefore, these figures refer to the un-standardised survival estimate). Unfortunately comparable local survival data are not available from the cancer registry. Local five year survival data are for the period 1997 to 2001 and are presented at former PCT level: Carlisle and District, Eden Valley, West Cumbria and Morecambe Bay. Morecambe Bay PCT consisted of Barrow in Furness, South Lakeland and North Lancashire. Figure 18: Five year relative survival – All cancers, 1997-2001

Survival: All cancers - Males

3 5 .1

3 5 .6

3 7 .5

3 8 .1

4 0 .2

4 0 .6

4 0 .9

4 1.0

4 1.5

4 1.8

4 2 .3

4 4 .5

4 5 .5

4 6 .1

4 6 .4

30 35 40 45 50

Carlisle and Distric t

West Cumbria

Blackburn with Darwen

Blackpool

Morecambe Bay

North West

Cumbria & Lancashire

Burnley, Pendle and Rossendale

Chorley and South Ribble

Wyre

Eden Valley

Hyndburn and Ribble Valley

West Lancashire

Preston

Fylde

Survival (%)

Survival: All cancers - Females

4 5 .2

4 7 .9

4 9 .8

5 0 .7

5 1.1

5 1.3

5 1.5

5 1.7

5 2 .0

5 2 .8

5 3 .4

5 4 .8

5 5 .0

5 5 .0

5 5 .4

40 45 50 55 60

Blackpool

Carlisle and District


W est Cumbria

North W est

Preston

W est Lancashire


W yre

Morecambe Bay



Fylde


Eden Valley

Survival (%)

Source: North West Cancer Registry Survival for all cancers by gender is shown in figure 18. A varying picture across the county is shown here, with men and women living in Eden Valley Primary Care Trust having the best survival rates within Cumbria at 42.3% and 55.4% respectively. Women living in Eden Valley have the best survival rate within the former Strategic Health Authority of Cumbria and

24

Lancashire. Compare this with their opposite numbers in Carlisle and District Primary Care Trust where men have a survival rate of 35.1% – the worst in Cumbria and Lancashire. Carlisle women fare no better with a survival rate of 47.9 % placing them second from the bottom. Averaged out, the male survival rate in Cumbria is 38.4%, placing it below the Strategic Health Authority average of 40.9%. Cumbrian women are on par with the district average of 51.7%. Figure 19 examines survival (persons) for selected cancers. Where survival is based on figures of less than 20, the registry does not publish the data therefore survival figures for lung cancer in Eden Valley PCT are not available. Data are presented for those PCTs that constituted Cumbria and Lancashire SHA. Figure 19: Five year relative survival – selected cancers, 1997-2001

Breast cancer survival - Females

75.778.479.079.3

79.979.980.681.081.081.782.382.3

83.483.483.5

60 65 70 75 80 85

Blackpool

Preston


West Lancashire

Morecambe Bay




North West



Wyre

Fylde

Eden Valley

West Cumbria

Survival (%)

Colo-rectal cancer survival - Persons

47.249.349.650.651.051.852.052.252.353.854.054.656.056.1

59.0

40 45 50 55 60

Blackpool


West Cumbria

North West

Morecambe Bay

Preston



Wyre


Eden Valley


West Lancashire

Fylde


Survival (%)

Lung cancer survival - Persons

4.25.55.65.76.36.46.56.6

6.77.98.18.58.88.8

0 2 4 6 8 10


West Cumbria



Wyre


Blackpool


Morecambe Bay


North West

West Lancashire

Fylde

Preston

Eden Valley

Survival (%)

No data

Source: North West Cancer Registry Just over half of people diagnosed with colo-rectal cancer survive for at least five years after diagnosis. Research suggests over 80% of bowel cancer patients will survive for more than five years if diagnosed at the earliest stage. The NHS Bowel Screening Programme began in England in 2006 and in Scotland in 2007. Figure 19 shows survival ranges between 49.6% and 54% within Cumbria giving an average of 52.1% placing it below the Strategic Health Authority average of 62.2%. Diet and lifestyle contribute to the risk of developing this type of cancer.

25

Most deprived

Least deprived

Difference in Cancer Survival rates between deprivation quintiles (IMD2004)

Lung cancer survival rates are higher the earlier the cancer is diagnosed; however more than two-thirds of lung cancers are diagnosed at a late stage so survival rates for these patients are lower. Only 7% of lung cancer patients survive for at least five years after diagnosis. Carlisle and District has the worst lung cancer survival rates within Cumbria and Lancashire SHA at only 4.2%. Survival rates within Cumbria vary between 4.2% and 6.7% and average out at 5.5%, again placing local survival below the district average of 6.4%. The link between tobacco and cancer was established more than 50 years ago. Smoking causes almost 90% of lung cancer deaths. More women are surviving breast cancer than ever before. Over 80% of patients survive for at least 5 years after diagnosis. Breast cancer survival rates are significantly higher among women from the most affluent areas compared to women living in the most deprived areas. Survival rates are better the earlier the cancer is diagnosed. Women living in the former West Cumbria PCT have the highest survival rate within the Strategic Health Authority at 83.6%. Average out breast cancer survival within Cumbria is 81.7% placing it above the district average of 80.6%. Heredity, obesity and certain hormonal medications may contribute to a woman’s risk of developing breast cancer. People living in the most deprived parts of England are less likely to survive common cancers according to figures published by the Office for National Statistics (http://www.statistics.gov.uk/statbase/Product.asp?vlnk=14821). Figure 20: Cumbria - difference in cancer survival (all cancers)

Figure 20 shows the difference in survival between the best and worst areas in Cumbria. A person diagnosed with cancer and living in a more affluent part of Cumbria has a survival rate of 53.3% compared with a rate of 39.2% for their opposite numbers living in the most deprived areas. The “Spearhead Group” of local authorities was selected by the Government in 2004 to focus on interventions to reduce inequalities in

health and life expectancy – one selected area of health is cancer. Barrow in Furness and Carlisle are designated locally as “Spearheads”. Latest analyses published by ONS show that those patients diagnosed with cancers and living in the most deprived Primary Care Trusts during 1998 to 2003 had significantly lower one year and five year survival rates. (http://www.statistics.gov.uk/downloads/theme_health/Spearhead_survival_1998_2003.xls). According to Cancer Research UK cancer is “the number one fear for the British public, topping the list over Alzheimer's, heart attack and terrorism”. Earlier detection and treatment will lead to improvements in survival rates. Hopefully this will contribute towards alleviating the publics’ fear of cancer. However the general public has their own part to play –major lifestyles changes must be made – particularly for those cancers that are preventable, if cancer rates are to reduce amongst the future generations.

http://www.statistics.gov.uk/statbase/Product.asp?vlnk=14821

http://www.statistics.gov.uk/downloads/theme_health/Spearhead_survival_1998_2003.xls

26

Appendix 1: Cumbria – projected population aged 65+ with projected increase in cancer incidence

Population Registrations

Year Aged 65+

(000's) Increase from

2005 (%)Increase from

2005 (number)Estimated

number 2005 94.0 1,811 2006 94.9 1.0 17 1,828 2007 96.3 2.4 44 1,855 2008 98.0 4.3 77 1,888 2009 100.3 6.7 121 1,932 2010 102.3 8.8 160 1,971 2011 104.9 11.6 210 2,021 2012 109.0 16.0 289 2,100 2013 112.8 20.0 362 2,173 2014 115.9 23.3 422 2,233 2015 118.8 26.4 478 2,289 2016 121.6 29.4 532 2,343 2017 123.9 31.8 576 2,387 2018 126.3 34.4 622 2,433 2019 128.9 37.1 672 2,483 2020 131.2 39.6 717 2,528 2021 133.6 42.1 763 2,574 2022 136.3 45.0 815 2,626 2023 139.1 48.0 869 2,680 2024 142.2 51.3 929 2,740 2025 145.4 54.7 990 2,801 2026 148.4 57.9 1,048 2,859 2027 151.7 61.4 1,112 2,923 2028 154.9 64.8 1,173 2,984 2029 158.3 68.4 1,239 3,050 2030 161.6 71.9 1,302 3,113 2031 164.7 75.2 1,362 3,173

27

Appendix 2: Standardised Registration Ratios, 2001-2005 Males Females Site ICD10 Registrations SRR Registrations SRR Allerdale All cancers ex nmsc C00-C97xC44 684 89 ☺ 779 104

MN Oesophagus C15 29 107 .. ..

MN Stomach C16 45 160 25 163

MN Colon/Rectum C18-C20 105 100 98 116 MN Pancreas C25 23 114 19 92

MN Trachea, Bronchus, Lung C33-C34 117 98 80 97 Mal Melanoma Skin C43 10 47 ☺ 28 112

Mesothelioma C45 .. .. .. ..


MN Cervix Uteri C53 24 120 MN Uterus C54 30 109

MN Ovary C56 27 77 MN Prostate C61 109 86

MN Testis C62 9 72 MN Kidney ex Renal Pelvis C64 13 49 ☺ 13 106

MN Bladder C67 39 126 19 123 Brain C71 18 135 11 120

Non-Hodgkin's Lymphoma C82-C85 27 94 27 108 Leukaemia C91-C95 10 46 ☺ 6 39 ☺

Barrow in Furness All cancers ex nmsc C00-C97xC44 565 107 597 111

MN Oesophagus C15 16 86 .. ..

MN Stomach C16 18 94 14 125

MN Colon/Rectum C18-C20 93 130 74 122 MN Pancreas C25 10 73 12 81

MN Trachea, Bronchus, Lung C33-C34 97 119 59 101 Mal Melanoma Skin C43 8 54 9 50 ☺

Mesothelioma C45 26 367 ¨


MN Cervix Uteri C53 9 64 MN Uterus C54 22 113

MN Ovary C56 26 105 MN Prostate C61 117 135

MN Testis C62 13 147 MN Kidney ex Renal Pelvis C64 21 116 16 185

MN Bladder C67 26 124 10 89 Brain C71 9 96 11 168

Non-Hodgkin's Lymphoma C82-C85 18 90 20 113 Leukaemia C91-C95 8 53 9 80

28

Males Females Site ICD10 Registrations SRR Registrations SRR

Carlisle All cancers ex nmsc C00-C97xC44 743 95 819 103 MN Oesophagus C15 32 117 .. ..



Mal Melanoma Skin C43 22 101 36 135 Mesothelioma C45 .. .. .. ..

MN Female Breast C50 238 95 MN Cervix Uteri C53 18 85

MN Uterus C54 45 156 MN Ovary C56 56 152

MN Prostate C61 135 104 MN Testis C62 8 61


Brain C71 17 124 10 103 Non-Hodgkin's Lymphoma C82-C85 26 88 17 64

Leukaemia C91-C95 13 59 13 78

Copeland All cancers ex nmsc C00-C97xC44 525 101 546 107 MN Oesophagus C15 18 99 .. ..



Mal Melanoma Skin C43 17 114 19 109 Mesothelioma C45 .. .. .. ..

MN Female Breast C50 146 89 MN Cervix Uteri C53 11 79

MN Uterus C54 16 85 MN Ovary C56 35 147

MN Prostate C61 70 81 MN Testis C62 13 146


Brain C71 13 138 12 190 Non-Hodgkin's Lymphoma C82-C85 15 76 19 112

Leukaemia C91-C95 16 109 6 57

29

Males Females Site ICD10 Registrations SRR Registrations SRR Eden All cancers ex nmsc C00-C97xC44 401 91 417 100 MN Oesophagus C15 17 110 .. .. MN Stomach C16 17 106 9 105 MN Colon/Rectum C18-C20 75 125 56 119 MN Pancreas C25 13 113 8 70 MN Trachea, Bronchus, Lung C33-C34 49 72 ☺ 38 83 Mal Melanoma Skin C43 11 91 11 80 Mesothelioma C45 .. .. .. .. MN Female Breast C50 137 103 MN Cervix Uteri C53 4 37 ☺ MN Uterus C54 24 156 MN Ovary C56 19 98 MN Prostate C61 81 111 MN Testis C62 8 114 MN Kidney ex Renal Pelvis C64 7 46 ☺ 9 133 MN Bladder C67 22 125 7 82 Brain C71 9 119 6 119 Non-Hodgkin's Lymphoma C82-C85 12 73 12 87 Leukaemia C91-C95 7 57 7 81

South Lakeland All cancers ex nmsc C00-C97xC44 905 98 909 97 MN Oesophagus C15 23 71 .. .. MN Stomach C16 29 85 14 71 MN Colon/Rectum C18-C20 134 106 103 95 MN Pancreas C25 30 124 24 89 MN Trachea, Bronchus, Lung C33-C34 101 70 ☺ 75 71 ☺ Mal Melanoma Skin C43 29 120 32 107 Mesothelioma C45 .. .. .. .. MN Female Breast C50 300 103 MN Cervix Uteri C53 6 26 ☺ MN Uterus C54 54 157 MN Ovary C56 45 105 MN Prostate C61 250 165 MN Testis C62 17 122 MN Kidney ex Renal Pelvis C64 36 114 16 105 MN Bladder C67 47 127 17 84 Brain C71 15 99 13 118 Non-Hodgkin's Lymphoma C82-C85 31 92 30 97 Leukaemia C91-C95 28 110 15 76 Note: 1. ☺ Significant at p<0.05. This means we can be 95% certain that the particular SRR is higher or lower than the national level. 2. ".." denotes that data have been suppressed where the number of events is less than 5 or where subtraction from total may be disclosive. Source: Calculated in-house by Performance & Intelligence Section

30

Appendix 3: Trend for selected cancers (numbers)

Allerdale

Barrow in

Furness Carlisle Copeland EdenSouth

Lakeland Cumbria All cancers 1996 452 345 503 292 225 537 2,354 1997 449 358 483 296 219 524 2,329 1998 410 384 518 311 254 520 2,397 1999 410 323 523 315 226 556 2,353 2000 471 336 533 292 275 606 2,513 2001 491 377 501 294 239 611 2,513 2002 453 424 498 302 268 616 2,561 2003 512 379 498 350 285 539 2,563 2004 430 389 530 358 266 599 2,572 2005 521 394 534 363 267 676 2,755 2006 498 403 525 358 284 647 2716 Projected2007 505 409 528 366 290 659 2757 Projected2008 512 415 530 373 296 672 2798 Projected2009 519 421 533 381 301 684 2839 Projected2010 526 427 535 388 307 697 2880 Projected2011 533 433 538 396 313 709 2921 Projected2012 540 439 540 403 319 722 2962 Projected2013 547 445 542 411 325 734 3003 Projected2014 554 451 545 418 330 747 3044 Projected2015 561 457 547 425 336 759 3085 ProjectedColo-rectal cancer 1996 64 41 61 45 35 84 330 1997 57 45 68 46 36 86 338 1998 61 57 69 43 48 68 346 1999 55 44 77 50 48 84 358 2000 80 41 63 47 44 89 364 2001 72 43 59 47 30 101 352 2002 67 40 68 35 46 85 341 2003 65 52 68 57 50 67 359 2004 62 57 70 59 46 83 377 2005 81 60 75 57 41 90 404 2006 74 55 71 56 46 85 388 Projected2007 76 57 72 57 47 85 394 Projected2008 77 58 73 59 48 86 400 Projected2009 79 59 73 60 48 86 405 Projected2010 80 61 74 61 49 86 411 Projected2011 81 62 74 63 50 86 417 Projected2012 83 63 75 64 50 87 422 Projected2013 84 65 76 66 51 87 428 Projected2014 86 66 76 67 52 87 434 Projected2015 87 67 77 68 52 87 440 Projected

31

Allerdale

Barrow in

Furness Carlisle Copeland EdenSouth

Lakeland Cumbria Lung cancer 1996 64 58 79 43 25 67 336 1997 68 51 80 55 32 74 360 1998 62 55 90 32 28 67 334 1999 62 54 77 47 35 62 337 2000 77 43 96 40 38 45 339 2001 66 49 97 46 28 64 350 2002 72 61 77 35 29 66 340 2003 67 53 84 51 28 55 338 2004 54 45 74 40 25 60 298 2005 76 58 75 44 34 61 348 2006 69 52 79 42 30 56 328 Projected2007 69 52 79 42 30 55 327 Projected2008 69 52 78 42 30 54 325 Projected2009 70 51 77 42 30 53 323 Projected2010 70 51 77 42 30 52 322 Projected2011 70 51 76 41 30 51 320 Projected2012 71 51 75 41 30 49 318 Projected2013 71 51 75 41 31 48 316 Projected2014 71 51 74 41 31 47 315 Projected2015 72 51 73 41 31 46 313 ProjectedBreast female 1996 63 52 60 26 34 83 318 1997 58 44 65 37 33 78 315 1998 61 54 68 41 35 83 342 1999 71 45 81 37 33 79 346 2000 82 48 69 43 56 101 399 2001 86 68 66 34 30 82 366 2002 65 64 79 37 45 86 376 2003 80 65 74 41 47 89 396 2004 65 67 82 62 44 103 423 2005 93 63 82 43 46 108 435 2006 86 70 84 51 49 104 443 Projected2007 88 72 86 53 50 106 456 Projected2008 91 75 88 55 52 109 469 Projected2009 93 77 90 57 53 111 482 Projected2010 95 80 92 58 55 114 495 Projected2011 98 82 94 60 57 117 508 Projected2012 100 84 96 62 58 119 520 Projected2013 103 87 98 64 60 122 533 Projected2014 105 89 100 66 61 125 546 Projected2015 108 91 102 68 63 127 559 Projected

Source: N&Y Cancer Registry, NW Cancer Registry, Performance & Intelligence Team

32

Appendix 4: SMRs trend, all ages Cumbria Deaths SMR Site ICD No. 02-04 03-05 04-06 02-04 03-05 04-06 Males

All cancers C00-C97 2,236 2,316 2,387 99 102 105

MN Oesophagus C15 133 143 145 101 106 106 MN Stomach C16 99 106 95 94 104 98

MN Colon/Rectum C18-C20 251 264 279 105 110 116 MN Pancreas C25 98 104 103 101 105 101

MN Trachea, Bronchus, Lung C33-C34 531 541 565 96 98 103 Mal Melanoma Skin C43 24 29 32 91 107 112

Mesothelioma C45 60 68 59 201 219 179 MN Prostate C61 294 310 297 101 107 103

MN Testis C62 .. .. 6 .. .. 319 MN Kidney ex Renal Pelvis C64 54 55 65 96 95 107

MN Bladder C67 83 71 78 90 78 ☺ 87 MN Brain C71 67 62 70 124 112 123

Non-Hodgkin's Lymphoma C82-C85 68 68 74 98 100 110 Leukaemia C91-C95 63 63 72 93 91 104

Allerdale All cancers C00-C97 409 457 474 93 105 108



MN Trachea, Bronchus, Lung C33-C34 105 116 130 98 110 123 Mal Melanoma Skin C43 6 6 .. 118 114 ..


MN Testis C62 .. .. .. .. .. .. MN Kidney ex Renal Pelvis C64 7 11 13 64 99 111

MN Bladder C67 13 14 19 73 80 109 MN Brain C71 9 10 14 86 93 127


Barrow in Furness All cancers C00-C97 352 342 349 116 115 118

MN Oesophagus C15 22 17 20 125 96 112 MN Stomach C16 6 7 7 43 ☺ 52 55


MN Trachea, Bronchus, Lung C33-C34 96 94 89 130 130 124 Mal Melanoma Skin C43 .. .. .. .. .. ..


33

Deaths SMR

Site ICD No. 02-04 03-05 04-06 02-04 03-05 04-06 MN Testis C62 .. .. .. .. .. ..

MN Kidney ex Renal Pelvis C64 10 6 11 132 78 138 MN Bladder C67 18 13 16 147 110 138

MN Brain C71 11 10 10 148 133 130 Non-Hodgkin's Lymphoma C82-C85 6 8 11 64 89 125

Leukaemia C91-C95 8 7 7 88 77 77

Carlisle

All cancers C00-C97 461 460 491 102 103 110 MN Oesophagus C15 34 34 31 131 129 116

MN Stomach C16 27 19 14 129 94 73 MN Colon/Rectum C18-C20 49 53 52 103 112 110

MN Pancreas C25 14 16 19 73 82 95 MN Trachea, Bronchus, Lung C33-C34 114 126 139 104 117 129

Mal Melanoma Skin C43 5 6 8 96 112 142 Mesothelioma C45 9 10 9 101 110 96

MN Prostate C61 67 66 69 115 114 120 MN Testis C62 .. .. .. .. .. ..

MN Kidney ex Renal Pelvis C64 13 13 15 117 115 126 MN Bladder C67 10 12 10 54 ☺ 67 64


Leukaemia C91-C95 11 11 17 82 80 124

Copeland




Mal Melanoma Skin C43 .. 5 6 .. 137 155 Mesothelioma C45 7 8 6 118 131 93

MN Prostate C61 31 38 37 88 108 103 MN Kidney ex Renal Pelvis C64 12 9 6 163 119 74

MN Bladder C67 8 7 8 70 62 70

MN Brain C71 9 12 11 121 158 139

Non-Hodgkin's Lymphoma C82-C85 7 7 9 77 79 101

Leukaemia C91-C95 10 13 13 115 146 143

Eden All cancers C00-C97 237 236 229 96 95 91



MN Trachea, Bronchus, Lung C33-C34 48 42 36 79 69 ☺ 59 ☺ Mal Melanoma Skin C43 6 4 3 209 133 95

Mesothelioma C45 .. .. .. .. .. ..

34

Deaths SMR

Site ICD No. 02-04 03-05 04-06 02-04 03-05 04-06 MN Prostate C61 37 49 50 119 156 157

MN Kidney ex Renal Pelvis C64 .. 5 5 .. 78 74 MN Bladder C67 7 6 7 70 61 70 MN Brain C71 .. .. .. .. .. .. Non-Hodgkin's Lymphoma C82-C85 6 7 8 79 94 107

Leukaemia C91-C95 7 6 6 96 80 79

South Lakeland

All cancers C00-C97 484 494 506 89 ☺ 90 ☺ 92 ☺ MN Oesophagus C15 23 29 29 74 90 89


MN Pancreas C25 21 29 28 90 122 114 MN Trachea, Bronchus, Lung C33-C34 104 93 94 78 ☺ 70 ☺ 71 ☺


MN Prostate C61 64 71 67 88 98 92 MN Testis C62 .. .. .. .. .. ..



Leukaemia C91-C95 20 17 16 124 103 96

Females

Cumbria

All cancers C00-C97 2083 2100 2108 90 ☺ 101 101


MN Colon/Rectum C18-C20 207 225 227 86 ☺ 119 134 MN Pancreas C25 92 99 109 80 ☺ 94 101

MN Trachea, Bronchus, Lung C33-C34 397 394 394 101 105 102 Mal Melanoma Skin C43 10 17 26 41 ☺ 73 114

Mesothelioma C45 10 8 7 8 ☺ 7 ☺ 81 MN Female Breast C50 322 298 308 83 ☺ 85 ☺ 88 ☺

MN Cervix Uteri C53 26 24 33 81 82 118 MN Uterus C54 36 35 34 107 109 102

MN Ovary C56 139 136 147 103 109 119 MN Kidney ex Renal Pelvis C64 53 48 46 138 134 127


Non-Hodgkin's Lymphoma C82-C85 64 62 64 95 103 107 Leukaemia C91-C95 43 43 42 69 ☺ 80 79

35

Deaths SMR

Site ICD No. 02-04 03-05 04-06 02-04 03-05 04-06 Allerdale





MN Female Breast C50 57 58 53 77 87 80 MN Cervix Uteri C53 5 7 11 82 125 207

MN Uterus C54 8 6 5 125 98 79 MN Ovary C56 21 14 18 81 59 ☺ 77

MN Kidney ex Renal Pelvis C64 15 12 8 205 176 117 MN Bladder C67 .. 11 11 .. ☺ 124 126


Leukaemia C91-C95 8 7 8 68 69 80

Barrow in Furness

All cancers C00-C97 299 313 324 94 110 115 MN Oesophagus C15 10 .. 7 88 .. 72



Mal Melanoma Skin C43 .. .. .. .. .. .. Mesothelioma C45 5 4 2 440 356 174

MN Female Breast C50 47 51 51 88 105 107 MN Cervix Uteri C53 .. .. .. .. .. ..

MN Uterus C54 5 6 4 108 137 89 MN Ovary C56 21 16 21 114 95 126



Leukaemia C91-C95 5 9 11 58 121 150

Carlisle


MN Stomach C16 21 19 17 142 153 143 MN Colon/Rectum C18-C20 30 39 43 63 ☺ 103 126


Mal Melanoma Skin C43 .. 5 7 .. 106 151 Mesothelioma C45 .. .. .. .. .. ..

MN Female Breast C50 59 55 59 77 ☺ 78 84

36

Deaths SMR

Site ICD No. 02-04 03-05 04-06 02-04 03-05 04-06 MN Cervix Uteri C53 .. 5 10 .. 84 176




Leukaemia C91-C95 9 8 6 73 74 56

Copeland



MN Pancreas C25 18 14 4 127 106 30 ☺ MN Trachea Bronchus, Lung C33-C34 57 52 60 115 109 123

Mal Melanoma Skin C43 .. .. 7 .. .. 238 Mesothelioma C45 .. .. .. .. .. ..


MN Uterus C54 .. .. .. .. .. .. MN Ovary C56 14 19 19 81 118 120

MN Kidney ex Renal Pelvis C64 .. .. .. .. .. .. MN Bladder C67 .. 6 .. .. 104 ..

MN Brain C71 7 9 10 135 179 196 Non-Hodgkin's Lymphoma C82-C85 .. .. 6 .. .. 80

Leukaemia C91-C95 8 7 6 105 104 91

Eden


MN Stomach C16 10 6 .. 128 92 .. MN Colon/Rectum C18-C20 25 22 21 100 111 117


Mal Melanoma Skin C43 .. .. .. .. .. .. Mesothelioma C45 .. .. .. .. .. ..

MN Female Breast C50 35 29 37 86 78 99 MN Cervix Uteri C53 3 .. .. 89 .. ..



MN Brain C71 4 .. .. 96 .. .. Non-Hodgkin's Lymphoma C82-C85 7 8 7 100 126 111

Leukaemia C91-C95 7 7 6 108 124 107

37

Deaths SMR

Site ICD No. 02-04 03-05 04-06 02-04 03-05 04-06 South Lakeland

All cancers C00-C97 452 445 446 79 ☺ 88 ☺ 88 ☺ MN Oesophagus C15 19 18 17 91 101 95

MN Stomach C16 10 7 8 53 ☺ 46 ☺ 54 MN Colon/Rectum C18-C20 50 57 57 83 122 135

MN Pancreas C25 21 24 30 74 93 113 MN Trachea, Bronchus, Lung C33-C34 71 71 69 74 ☺ 78 ☺ 74 ☺


MN Female Breast C50 84 70 71 89 83 84 MN Cervix Uteri C53 7 5 .. 93 74 ..




Leukaemia C91-C95 6 5 5 39 ☺ 38 ☺ 38 ☺

38

Appendix 5: SMRs trend, under 75 years Cumbria Deaths SMR Site ICD No. 02-04 03-05 04-06 02-04 03-05 04-06

Males




Mal Melanoma Skin C43 18 20 22 97 104 110 Mesothelioma C45 38 43 43 194 216 206

MN Prostate C61 81 88 94 91 99 107 MN Testis C62 .. .. 5 .. .. 307



Leukaemia C91-C95 36 37 40 99 100 108

Allerdale




Mal Melanoma Skin C43 5 5 3 138 134 77 Mesothelioma C45 .. .. 2 .. .. 33



Non-Hodgkin's Lymphoma C82-C85 5 6 8 60 76 105 Leukaemia C91-C95 .. .. 6 .. .. 83

Barrow in Furness All cancers C00-C97 195 191 198 118 117 121


MN Colon/Rectum C18-C20 26 27 29 149 157 170 MN Pancreas C25 5 .. 7 63 .. 84

MN Trachea, Bronchus, Lung C33-C34 51 54 52 118 128 123 Mal Melanoma Skin C43 .. .. .. .. .. ..


MN Testis C62 .. .. .. .. .. .. MN Kidney ex Renal Pelvis C64 9 .. 7 185 .. 135


39

Deaths SMR Site ICD No. 02-04 03-05 04-06 02-04 03-05 04-06 Non-Hodgkin's Lymphoma C82-C85 5 .. 5 85 .. 93

Leukaemia C91-C95 6 5 .. 120 99 ..

Carlisle






MN Bladder C67 .. .. .. .. .. .. ☺ MN Brain C71 14 7 8 160 79 95


Copeland All cancers C00-C97 154 178 182 93 108 110



MN Trachea, Bronchus, Lung C33-C34 40 45 46 93 106 108 Mal Melanoma Skin C43 .. 5 6 .. 186 213

Mesothelioma C45 .. .. 5 .. .. 119 MN Prostate C61 11 13 17 92 108 142

MN Kidney ex Renal Pelvis C64 7 .. .. 144 .. .. MN Bladder C67 .. .. .. .. .. ..

MN Brain C71 6 7 6 97 111 93 Non-Hodgkin's Lymphoma C82-C85 .. 5 6 .. 89 110

Leukaemia C91-C95 5 7 7 100 137 136

Eden


MN Stomach C16 .. 7 7 68 .. 131 MN Colon/Rectum C18-C20 17 17 17 119 120 122

MN Pancreas C25 8 8 9 124 120 133 MN Trachea, Bronchus, Lung C33-C34 30 24 21 85 69 61 ☺

Mal Melanoma Skin C43 5 .. .. 243 .. .. Mesothelioma C45 .. .. .. .. .. ..

MN Prostate C61 8 10 10 80 101 102 MN Kidney ex Renal Pelvis C64 .. .. .. .. .. ..

MN Bladder C67 6 5 4 150 128 104 MN Brain C71 .. .. .. .. .. ..

Non-Hodgkin's Lymphoma C82-C85 .. 5 .. .. 110 ..

40

Deaths SMR Site ICD No. 02-04 03-05 04-06 02-04 03-05 04-06 Leukaemia C91-C95 5 6 6 124 147 146

South Lakeland All cancers C00-C97 225 228 233 82 ☺ 84 ☺ 85 ☺



MN Trachea, Bronchus, Lung C33-C34 54 50 45 74 ☺ 70 ☺ 63 ☺ Mal Melanoma Skin C43 .. .. .. .. .. ..


MN Testis C62 .. .. .. .. .. .. MN Kidney ex Renal Pelvis C64 5 6 8 62 73 93



Females Cumbria




Mal Melanoma Skin C43 6 9 16 46 ☺ 66 117 Mesothelioma C45 10 6 5 15 ☺ 9 ☺ 7 ☺

MN Female Breast C50 191 174 185 99 90 96 MN Cervix Uteri C53 15 16 25 79 86 140




Leukaemia C91-C95 23 17 16 98 76 73

Allerdale





MN Female Breast C50 30 32 29 79 85 77

41

Deaths SMRs Site ICD No. 02-04 03-05 04-06 02-04 03-05 04-06 MN Cervix Uteri C53 .. .. 8 .. .. 230

MN Uterus C54 .. .. .. .. .. .. MN Ovary C56 9 7 12 59 47 ☺ 82

MN Kidney ex Renal Pelvis C64 11 9 5 313 254 143 MN Bladder C67 .. .. .. .. .. ..

MN Brain C71 6 7 .. 107 127 .. Non-Hodgkin's Lymphoma C82-C85 8 5 .. 148 95 ..

Leukaemia C91-C95 5 .. .. 110 .. ..

Barrow in Furness

All cancers C00-C97 155 161 165 116 123 126 MN Oesophagus C15 .. .. .. .. .. ..

MN Stomach C16 .. .. .. .. .. .. MN Colon/Rectum C18-C20 14 12 14 133 129 170





MN Kidney ex Renal Pelvis C64 6 5 5 248 207 209 MN Bladder C67 .. .. .. .. .. ..

MN Brain C71 6 8 .. 152 208 .. Non-Hodgkin's Lymphoma C82-C85 5 .. 5 134 .. 141

Leukaemia C91-C95 .. 5 5 .. 165 170

Carlisle


MN Stomach C16 11 10 8 243 227 193 MN Colon/Rectum C18-C20 8 12 12 50 ☺ 85 96



MN Female Breast C50 28 27 35 72 69 90 MN Cervix Uteri C53 .. .. 7 .. .. 191

MN Uterus C54 .. .. 5 .. .. 149 MN Ovary C56 15 21 19 95 136 126

MN Kidney ex Renal Pelvis C64 .. .. .. .. .. .. MN Bladder C67 .. .. .. .. .. ..

MN Brain C71 7 6 6 120 104 107 Non-Hodgkin's Lymphoma C82-C85 .. .. 6 .. .. 111

Leukaemia C91-C95 .. .. .. .. .. ..

42

Deaths SMRs Site ICD No. 02-04 03-05 04-06 02-04 03-05 04-06

Copeland

All cancers C00-C97 138 130 135 104 98 102 MN Oesophagus C15 .. .. .. .. .. ..


MN Pancreas C25 9 8 .. 150 128 .. MN Trachea, Bronchus, Lung C33-C34 29 23 27 113 89 101





MN Brain C71 5 6 6 127 155 155 Non-Hodgkin's Lymphoma C82-C85 .. .. .. .. .. ..

Leukaemia C91-C95 .. .. .. .. .. ..

Eden

All cancers C00-C97 107 84 76 102 79 ☺ 71 ☺ MN Oesophagus C15 5 .. .. 172 .. ..


MN Pancreas C25 .. .. .. .. .. .. MN Trachea, Bronchus, Lung C33-C34 20 22 19 98 105 88



MN Uterus C54 5 .. .. 318 .. .. MN Ovary C56 6 .. .. 72 .. ..

MN Kidney ex Renal Pelvis C64 6 .. .. 313 .. .. MN Bladder C67 .. .. .. .. .. ..

MN Brain C71 .. .. .. .. .. .. Non-Hodgkin's Lymphoma C82-C85 .. .. .. .. .. ..

Leukaemia C91-C95 .. .. .. .. .. ..

South Lakeland

All cancers C00-C97 212 201 194 94 90 87 ☺ MN Oesophagus C15 7 6 .. 111 98 ..


MN Pancreas C25 9 10 13 87 94 118 MN Trachea, Bronchus, Lung C33-C34 35 30 27 79 68 ☺ 59 ☺


MN Female Breast C50 54 44 41 123 101 95

43

Deaths SMRs Site ICD No. 02-04 03-05 04-06 02-04 03-05 04-06 MN Cervix Uteri C53 .. .. .. .. .. ..

MN Uterus C54 6 5 .. 176 136 .. MN Ovary C56 19 19 24 106 109 141


MN Brain C71 7 5 .. 109 79 .. Non-Hodgkin's Lymphoma C82-C85 5 7 5 79 114 83

Leukaemia C91-C95 .. .. .. .. .. ..

44

Contact details: Name: Jennifer Clay Title: Public Health Intelligence Analyst Address: NHS Cumbria, 4 Wavell Drive, Rosehill, Carlisle, Cumbria CA1 2SE Tel: 01228 603988 Email: [email protected] Web: www.cumbria.nhs.uk : www.cumbriaobservatory.org.uk November 2008

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Cancer in Cumbria · Cancer occurs predominantly in older people as shown by the differences between the above cohorts. For example a woman’s risk of developing breast cancer by