Cancer in Wales, 1992 -2006: A Comprehensive Report

Microsoft Word - final_document_with_clinician_commentsSurveillance Unit
Data Analysis:
Mr Lloyd Evans Statistician/Research Officer Miss Julie Howe Statistician/Research Officer Mrs Rebecca Thomas Senior Statistician Mr Ceri White Principal Statistician
Additionally, many thanks to the following people who have made this report possible.
Mrs Judith Chadd Registration/Validation Officer Mr David Chung Senior Software Developer Miss Bethan Davies Registration Supervisor Miss Michelle Davies IM&T Officer Mrs Carol Gould Registration/Validation Officer Mr Paul Lewis Clerical Assistant Mrs Joy McRae Classification Specialist Mrs Linda Morgan Registration/Validation Officer Mrs Jayne Mumford Registration/Validation Officer Mr Michael Pollard Data Validation Officer (Peripatetic) Mrs Carol Rees Registration/Validation Officer Mrs Rachel Rees Data Validation Officer (Peripatetic) Mrs Shelagh Reynolds General Manager Mrs Julie Rogers Business Support Manager Dr John Steward Director Mrs Lisa Vipond IM&T Officer Mr Anthony Williams Senior Software Developer Mr Christopher Williams Registration/Validation Officer
Table of Contents
1 Foreword……………………………………….………………………………………... 1
3 Data Quality………………………………….………………………………………….. 3
6 Executive Summary……………………….…………………………………………… 13
7.2 Oesophageal Cancer………………………………………………………………. 29
7.3 Stomach Cancer……………………………………………………………………. 43
7.4 Colon Cancer………………….……….……………………………………………. 57
7.5 Rectal Cancer……………………………………………………………………….. 70
7.6 Pancreatic Cancer…………….……………………………………………………. 83
7.7 Laryngeal Cancer……………………..……………………………………………. 96
7.10 Female Breast Cancer……….…………………….………………………………. 134
7.11 Cervical Cancer……………………………….……………………………………. 145
7.13 Ovarian Cancer …………………………………………………………………….. 167
7.14 Prostate Cancer…………………………….………………………………………. 178
7.16 Bladder Cancer……………..………………………………………………………. 202
7.18 Hodgkin’s Disease…………………………………………………………………. 228
7.19 Non-Hodgkin’s Lymphoma..………………………………………………………. 237
7.20 Leukaemia…………………………………..………………………………………. 250
8 Appendices……………………………………………………………………………… 276
10 References………………………………………………………………………………. 279
Table of Contents
W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page i
Foreword 1
W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 1
1 Foreword
On behalf of the Welsh Cancer Intelligence and Surveillance Unit (WCISU), I am pleased to present
the latest in the series of Triennial Reports on cancer statistics in Wales, covering incidence and
mortality for the period 1992-2006, prevalence and survival for patients diagnosed during the period
1992-2001 and followed up to 31st December 2006. It is a comprehensive report covering some
twenty separate cancer sites as well as all malignancies.
It is over a decade since the Calman & Hine report was published in 1995, and the subsequent
Cameron report in 1996, which outlined a new policy blueprint for cancer services in Wales. The
important role of cancer registries in providing accurate population based statistics on risk and
outcome was clearly identified in these reports. WCISU took over responsibility for cancer registration
in April 1997.
The policy blueprint has been developed with the guidance of cancer clinicians under the auspices of
the Cancer Services Coordinating Group (CSCG). The latest version of the National Standards for
Cancer Services in 2005 lays out the requirements for good cancer services. These include a generic
standard to ensure the supply of timely accurate data to the national cancer registry, WCISU.
Population based incidence and survival analysis provides a “bottom line” global audit and a yardstick
to measure progress and benchmark our cancer services against those elsewhere in the United
Kingdom and Europe. Phase 2 of the 2008-2011 Strategic Framework Document, “Designed to
Tackle Cancer In Wales” includes ambitious targets which will require the population based
information from WCISU.
More detailed clinical audit and health service research is required to progress cancer services. An
increasing amount of work is carried out under the auspices of the three Regional Cancer Networks in
Wales. The Cancer Dataset and the Cancer Networks Information System Cymru (CaNISC) have
been developed under the direction of the Cancer Information Framework Project. WCISU contribute
expertise in cancer information, statistical analysis and specialised health intelligence.
I would like to thank all colleagues in WCISU for their hard work and diligence in producing this report.
I am pleased to be able to include the valuable commentary from those clinical colleagues, the Chairs
of the CSCG Site Specific Groups that provided comments. This reflects the fact that WCISU staff
work closely with clinicians on the analysis and interpretation of cancer data including clinical audit.
Dr John Steward MBBCh BA MSc PhD CStat FFPH
Registration of Cancer in Wales 2
2 Registration of Cancer in Wales
The Welsh Cancer Intelligence and Surveillance Unit (WCISU) is tasked under its Service
Level Agreement (SLA) with the Welsh Assembly Government (WAG) to register all
incidences of cancer for the resident population of Wales wherever they are treated. It is
essential therefore to ensure completeness of registration that all possible sources of data
collection are used. The use of multiple sources of data means that information relating to
the same cancer incidence is received, and this also enhances the data quality as different
data items are brought together to form a single record. WCISU benefits from a
sophisticated computer package and a highly trained workforce to ensure that duplicate
registrations are avoided.
For the most recent year reported (2006) multiple notifications were received from:-
• PEDW* records :Trusts throughout Wales
:NHS Clearing Service
*Patient Episode Database Wales
**Office of National Statistics
The table below illustrates the number of records processed for the calendar year 2006.
Electronic processing and manual intervention by registration officers provide the resulting
registrations for 2006 incidence.
PEDW - Wales Data 459419
PEDW - England Data 25666
All Malignancies excl NMSC 17165
Data Quality 3
3 Data Quality
One of the most important elements of the work undertaken at WCISU is ensuring data
quality. It is for this reason that every member of staff contributing to any element of the
registration or analysis of that data has an important part to play in ensuring that data quality
is maintained.
Monthly quality checks are undertaken by Information Technology (IT) and analysis staff on
the completeness of data items received from PEDW and these are discussed and
appropriate action taken. A recent report was submitted to the PEDW Steering group
outlining some of the issues causing concern. More specific problems are addressed
directly with Trusts.
The addition of pathology to our source of data for registration not only compliments
ascertainment of our register but enables one source of data to validate other data received.
The software used for cancer registration has embedded rules based on National and
International principles and methods to ensure the consistency of our data and that WCISU’s
data is comparable with output by other countries. Examples of these embedded rules are:
• Site of cancer compatible with morphology
• Date of diagnosis earlier than date of treatment
The Unit also employs two Data Validation Officers (DVOs) who work on a peripatetic basis,
visiting all hospitals in Wales ensuring that data held on WCISU database accurately reflects
information in the medical record. Their work can be categorised as:-
• Office validations – queries raised by registration staff during the registration process.
• Routine validation – This is validation of certain sites e.g. childhood, brain, liver,
bone, unknown primary cancers.
• Sampling – under the terms of our SLA with the WAG the unit has to demonstrate
that it has undertaken validation of a 5% sample of case notes of patients with a
diagnosis of cancer.
of a report.
Data Quality 3
In addition, these staff will as necessary undertake scoping exercises prior to changes in
coding rules which help to identify how changes will impact on reporting.
As part of the cancer surveillance role, analytical staff identifies anomalies in data and
instigate investigation into data quality, ensuring that the quality of data is robust for analysis
and publication. On completion of registrations, IT staff ensures that data quality is
maintained to agreed standards for submission to Office for National Statistics (ONS). This
ensures that:
• Records are accepted by ONS in the required format. The requirement of < 0.5%
status 3 records i.e. records not deemed suitable for registration purposes, is the
gold standard for cancer registration in England and Wales.
• The best possible matching rate is achieved with the NHS Central Register ensuring
that cancer records are flagged and WCISU is able to receive information on deaths
etc, which in turn provides information for survival analysis. The higher % of
matched records indicates the quality of data submitted.
Registrations are submitted to ONS to enable flagging on the National Health Service
Central Register (NHSCR) which in turn enables cancer registries to receive Death
Certificate Information. Cancer Registries are expected to have no more than 0.5% status 3
records (i.e. records containing serious errors) for each year submitted. Good quality record
submission enables a high percentage of records to be traced on NHSCR. The tables below
show WCISU submissions to ONS and are an indicator of the work which has been
undertaken to ensure its quality.
WCISU Submissions to ONS
Year Registrations* Status 3% Traced Records % Year Registrations* Status 3% Traced Records %
1992 14762 0.1 99.0 2000 15511 0.1 99.8
1993 14494 0.0 99.4 2001 15762 0.0 99.8
1994 15225 0.0 99.7 2002 15881 0.0 99.7
1995 14673 0.0 99.7 2003 16394 0.0 99.8
1996 14661 0.0 99.7 2004 17057 0.1 99.8
1997 14978 0.0 99.8 2005 16943 0.2 99.4
1998 14801 0.0 99.7 2006 17241 0.7 99.1
1999 15801 0.0 99.7
* All malignancies excluding non melanoma skin cancer (ICD10 code C44) and all D codes
Source : ONS Management Report, June 2008
Traced records are based on all ICD10 C and D codes
Definitions and Statistical Methods 4
4 Definitions and Statistical Methods
Twenty cancer sites were examined in addition to “all malignancies” (excluding non
melanoma skin cancer). Of these, 16 occur in both men and women, 4 only in women and 1
only in men.
For incidence and mortality data the period of diagnosis 1992-2006 has been examined.
Tables are presented showing the number of cases by sex, 5 year age band and year of
diagnosis, along with crude and age standardised rates. Figures are also presented by sex
at Local Health Board (LHB) level with Wales Age Standardised Rates and European Age
Standardised Rates. Mortality data for Wales is sourced from the ONS. Note that age
standardised rates are not produced for mortality of cancer of the larynx and Hodgkin’s
disease at LHB level due to the very small number of deaths.
For survival analysis the period of diagnosis considered is 1992-2001, split into two periods
1992-1996 (Period 1) and 1997-2001 (Period 2) to allow comparison. All cases have been
followed up until 31st December 2006, thus allowing a minimum follow up period of 5 years
after diagnosis for all patients included in the analysis.
For each cancer site 1, 3 and 5 year observed and relative survival estimates are presented
for both diagnosis periods and overall ten year period. Median observed survival is also
calculated by diagnosis period, 1992-1996 and 1997-2001 (Section 8).
Survival from cancer is known to be related to socioeconomic factors. Relative survival by
deprivation category (from the least deprived to most deprived) has been calculated for
cancers in Wales. Each case of cancer was allocated a deprivation category according to
their postcode of residence at the time of diagnosis. The postcode of residence was used to
allocate a ward to each case as of the 1998 classification in Wales. Each ward was given a
deprivation score based on the income domain from the Welsh Index of Multiple Deprivation
(WIMD) 2000. The wards were divided into five equal categories (quintiles) from least
deprived (quintile 1) to most deprived (quintile 5). Relative survival was calculated for each
quintile of deprivation for males and females for each cancer excluding Hodgkin’s disease
due to the very small numbers of cases.
Although relative survival estimates take into account age and sex-specific differences in
background mortality, cancer survival is also dependent on age at diagnosis and is in
general likely to be lower in older patients. Therefore if the age distribution of the general
population at risk and cancer patients varies between different populations, comparing
relative survival across these populations can be misleading. Age standardised relative
survival is often presented to overcome this. In these analyses however, numbers were
frequently too small to calculate reliable age-sex specific rates.
Life tables were obtained from the Government Actuary Department1. These tables are by
sex and single year of age up to 100 and based on 3 years of data, e.g. 1980-1982, 1981-
1983 up to 1999-2001. Each of the tables is based on the latest revised mid year population
estimates and deaths data for a three year period. For those patients that died between
1992 and 1999 (or only followed up to the end of 1999), life tables for 1995-1997 were used
whereas life tables for 2002-2004 were used for all other patients.
Relative survival was computed using a STATA algorithm2 based on the maximum likelihood
method of Esteve et al3. As zero survival times are not accepted by STATA, a follow up
duration of 1 day is imputed where necessary.
The following time intervals were generally used:- 1 month for the first 6 months; 3 months
for the remainder of the first year; 3 months for the remainder of the first year and yearly until
5 years. For rare cancers, fewer time intervals were used. The usual set used were:- 6
months for the first 3 years, then intervals of 1 year up to 5 years. Regrouping of time
intervals was necessary for analysis by deprivation to enable at least 10 deaths in a
calculation.
http://www.gad.gov.uk/Demography_Data/Life_Tables/Historical_Interim_life_tables.asp
2. ‘strel’ command for estimation of relative survival written by Slogett A, Hills M, de Stavola B, Mander A. (1999).
3. Estève J, Benhamou E, Croasdale M, Raymond L. Relative survival and the estimation of net survival: elements for further discussion.
Stat Med 1990; 9: 529-538.
Summary Statistics
Relative Frequency
This is the number of cases registered with a specific cancer expressed as a percentage of
the total number of cancers registered. For example, if over the period 1992-2006 there
were 117,676 malignant neoplasms (excluding non-melanoma skin cancer) registered in
Wales for men, of which 3,868 were for leukaemia, then the relative frequency would be
3.3%.
Rank
This gives a crude measure of the 'importance' of a particular cancer site in terms of
numbers of registrations. For example, there were more cases of breast cancer registered
for women in Wales over the period of 1992-2006 than for any other site, and it is therefore,
ranked first. Non-melanoma skin cancer is not to be included in the ranking because of the
poor level of ascertainment for this site.
Cumulative Rate
This can be interpreted as the chance of developing a disease during a particular life span.
Thus a cumulative rate (0-64) for lung cancer in men of 2.0% means that a man in Wales
has an approximate 1 in 50 chance of developing lung cancer before he is 65.
Calculation of Incidence Rates and Age Standardisation
Crude Rate
This is the total number of cases registered per year as a proportion of the total population.
It is usually quoted per 100,000 population. For example, the crude incidence rate of
cervical cancer for women in Wales in 2004 was 11.13 per 100,000 population: that is
calculated from 169 cases out of a population of 1,518,150.
Rates for older age groups are in general, much higher than those for younger people, so
the crude rate for an area is very much influenced by the age structure of the population of
that area. This means that comparisons of the crude rates between populations with
different age structures can be misleading. For this reason, methods have been developed
to age-standardise cancer incidence rates.
Direct Standardisation
There are two standard hypothetical populations in general use – the "European Standard
Population" and the "World Standard Population", as shown below:
Standard Populations
20-24 7000 8000
35-39 7000 6000
50-54 7000 5000
65-69 4000 3000
80-84 1000 500
85 and over 1000 500 100,000 100,000
The European Age Standardised Rate (EASR) for Wales per 100,000 population is
calculated by applying age specific rates for Wales to the relevant standard European
population shown above. These are then summed across all age groups to obtain the
overall EASR.
The age structure of the Welsh population differs from that of the European standard
population, and as such the standardised rate for Wales, for any particular type of cancer will
differ from the crude rate. In general, because the Welsh population is slightly older than the
European standard, the effect will be to lower the crude rate. For example, for colon cancer
in 2002, the crude rate for men in Wales is 42.58 per 100,000 population, whereas the
EASR is 32.32 per 100,000 population.
The World standard population is even younger than the European standard, so that the
World Age Standardised Rate for male colon cancer in Wales in 2002 is lower at 21.13 per
100,000 population.
Percentage Change in E.A.S.R. 1992-2006
The percentage change in the European age-standardised rates (E.A.S.R.) for a cancer site
is estimated by fitting a linear regression line to the annual age standardised rates for the
period in question. The statistical significance of the fitted regression lines are indicated by
the 'p' values.
Geographical variation within Wales
To compare variation in rates between the 22 LHBs of Wales, age standardised rates are
calculated using Wales and European standard populations for three five-year periods,
1992-1996, 1997-2001 and 2002-2006. 95% confidence intervals are calculated to assess
statistical significance. Rates highlighted in red are significantly higher compared with Wales
as a whole and rates highlighted blue are significantly lower compared with Wales as whole.
Prevalence
Prevalence is defined as the number of people still alive at 31st December 2006 that were
diagnosed with cancer previously. The column shown with “Number” is the number of
people still alive at 31st December 2006 and diagnosed up to 1 year ago, between 1 and 5
years ago, between 5 and 10 years ago and between 10 and 20 years ago. The rate per
100,000 population represents the prevalence rate using population figures from 2006. The
percentage of population in 2006 that were still alive and diagnosed earlier is also given
along with the percentage of prevalence in each of the time intervals.
World Age Standardised Rates per 100,000 population throughout the
World (2002)
World Age Standardised Rates per 100,000 population are provided for various countries in
the world for incidence and mortality in order of decreasing World Age Standardised Rate
using the software package Globocan (2002). Note that the figures for incidence and
mortality are generally not those for the year 2002, but from the most recent data available,
generally 2-5 years earlier. The figures for Wales were taken for the diagnosis year and
death year of 2002 from the results presented in this publication. For some cancer sites, the
ICD 10 codes used were different to those used by the Welsh Cancer Intelligence and
Surveillance Unit. If this was the case, then the ICD 10 codes used by Globocan 2002 are
stated and the Welsh figures adjusted to take into account the revised definition.
Relative Survival in Europe (using Eurocare 4)
Relative survival is presented for various countries in Europe using age standardisation from
Eurocare 4 for the period 1995-1999 for all persons. The relative survival rates are split into
those countries that register on a national basis and those countries that do not have 100%
coverage in decreasing order of relative survival.
Survival Analysis
Life Tables
A life table provides a summary description of mortality, survivorship and life expectancy for
a specified population. In demography a complete life table is a mortality schedule showing
detail for each single year of age and continuing until the last member of the synthetic cohort
dies. An abridged table usually shows detail for grouped ages, usually 5 year groups, and
typically ends with an open ended age group such as 85+. Complete life tables were used
for the analysis presented in this report.
Observed and Relative Survival
Survival analysis is concerned with the analysis of times to the occurrence of an “event”. In
cancer studies this is frequently the time period between diagnosis and death for each
patient. Cancer registries in the UK hold population based databases and follow up the
patients held on this from diagnosis until death. Observational studies therefore, can provide
the actual survival rates being achieved in the entire population and are a very important
public health tool.
There are several approaches to estimating cancer survival in population studies. We
consider observed (crude) survival and relative survival. Estimates of median survival time
are also estimated.
Observed (crude) survival is simply the probability of survival at a given time since
diagnosis, irrespective of cause of death. It is usually expressed as the percentage alive at
the given time point, e.g. 1 year, 5 years etc. since diagnosis. Problems with this method
arise if comparisons are to be made between populations with different age distributions.
Observed survival is likely to be lower in an older population as they are more likely to die
not just of the cancer, but also of other causes.
Relative survival is the most widely used method in population studies. It is the ratio of the
survival observed in the group of cancer patients to the survival that would be expected if
they were subject to the same overall mortality rates by age, sex and calendar period as the
general population. The expected probabilities are obtained from life tables for Wales that
provide the life expectancy of persons for a given year by age and sex. The problems
arising with crude survival are therefore overcome. It enables one to measure variations in
cancer survival (or its complement, mortality) independently of variations in expected
(background) mortality associated with age, geographic region, deprivation and calendar
time.
Although relative survival estimates take into account age and sex-specific differences in
background mortality, cancer survival is also dependent on age at diagnosis and is in
general likely to be lower in older patients. Therefore if the age distribution of the general
population at risk and cancer patients varies between different populations, comparing
relative survival across these populations can be misleading. Age standardised relative
survival needs to be presented to overcome this. To do this, age and sex-specific survival
rates are multiplied by the corresponding sex and group weight for a standard, reference
population. These are summed to obtain a standardised rate.
Median observed survival time is defined as the length of time after diagnosis until half the
patients have died, regardless of their cause of death. Thus by definition, it is usually
highest in cancers that have a good prognosis and those that are diagnosed in younger
people.
Health Geographies of Wales 5
5 Health Geographies of Wales
Local Health Boards (LHB) - Boundaries
1 Isle of Anglesey 12 Neath & Port Talbot
2 Gwynedd 13 Bridgend
4 Denbighshire 15 Cardiff
6 Wrexham 17 Merthyr Tydfil
7 Powys 18 Caerphilly
9 Pembrokeshire 20 Torfaen
10 Carmarthenshire 21 Monmouthshire
11 Swansea 22 Newport
Executive Summary 6
6 Executive Summary
Over the fifteen year period 1992-2006 in Wales, incidence of all cancers (excluding non
melanoma skin cancer) has increased in both males and females by 22% and 12%
respectively. However, if the European Age Standardised Rates (EASR) are compared,
these figures are increases of 3% for males and 4% for females, indicating that although
there has been a large increase in numbers, the increase is mainly down to an increase in
diagnosis in the elderly. A man has an approximate 1 in 3 chance of being diagnosed with
cancer before his 75th birthday, compared with an approximate 2 in 7 chance for women.
There are a number of Local Health Boards (LHBs) in Wales that have significantly higher or
lower rates compared with Wales as a whole, especially for the later five year period 2002-
2006. Merthyr Tydfil has the highest incidence rates for both males and females for this time
period. The number of deaths has slightly decreased by 1% in males and by 2% in females
in Wales. However, there has been a larger decrease in the EASR by 19% for males and
12% for females. Approximately 3.7% of the male population in Wales had been previously
diagnosed with cancer up to 20 years ago but was still alive as at 31st December 2006. This
figure was 4.1% for females. Five year relative survival has increased from 1992-1996 to
1997-2001 by nearly 7 percentage points (to 41.5%) for males and by over 3 percentage
points (to 50.5%) for females closing the “survival” gap between males compared with
females in Wales. However, relative survival by deprivation for all cancers shows that there
has been no improvement between the affluent quintile compared with the most deprived
quintile when comparing between the two periods 1992-1996 and 1997-2001. Comparing
World Age Standardised Rates with other countries in the World, Wales is in the top third of
those presented in this report for incidence.
Female breast cancer is the highest ranked cancer in women in terms of the number of
diagnoses over the fifteen year period (nearly 29% of all female malignancies excluding non
melanoma skin cancer). For males, prostate cancer took over lung cancer as the highest
ranked cancer in 1998 and was ranked 1st over the entire fifteen year period (just over 20%
of all male malignancies excluding non melanoma skin cancer). It is interesting to note that
the incidence of male lung cancers has decreased by 16% over the period. However, for
females (ranked 2nd), this figure has increased by over 35%. Corresponding EASRs for
male and female lung cancer have decreased by 29% and increased by 23% respectively
with lung cancer mortality EASRs falling by nearly 30% for males but increasing by 9% for
females. Relative survival rates have only slightly increased for both periods examined.
Executive Summary 6
Of the highest ranked cancers in males and females, female breast cancer relative survival
has increased by 2.3 percentage points to 92.5% (in 1997-2001 compared with 1992-1996)
for one year survival and by 4.2 percentage points to 79.8% (in 1997-2001 compared with
1992-1996) for five year survival, whereas prostate cancer survival is a lot lower but has
showed greater improvement from 79.1% (1992-1996) to 85.3% (1997-2001) for one year
survival and an improvement of 14.1 percentage points to 69.3% in 1997-2001 compared to
1992-1996. The corresponding mortality figures for the highest ranked cancers have
decreased by 18% for female breast cancer but increased by 19% for prostate cancer.
However, the EASRs have decreased by a greater amount for female breast cancer at 27%
compared with 8% for prostate cancer. This is due to a decrease in deaths in the older age
bands for female breast cancer compared with an increase in deaths in the older age bands
for prostate cancer.
The third highest ranked cancer in Wales for the fifteen year period was colon cancer for
both males and females. Males show a continuing increasing trend in incidence over the
fifteen year period whereas females show a general constant or slightly decreasing trend in
incidence in Wales. However, more females tend to get diagnosed in later life (over 80
years of age) compared with males. The Isle of Anglesey has been highlighted as being of a
significant increase in incidence compared with Wales as a whole for the later time period
2002-2006 for males. Trends in mortality for both sexes show a decreasing trend in Wales.
Five year relative survival has increased in both sexes by approximately 6 percentage points
from 1992-1996 to 1997-2001 with males tending to have slightly better survival rates. The
World Age Standardised Rates per 100,000 population place Wales mid-table when
comparing these rates with other countries in the World for those countries that have 100%
coverage in their country. Just under 9000 people who were diagnosed with colon cancer
up to 20 years ago were still alive as at 31st December 2006, with nearly a third of those
diagnosed between 1 and 5 years before this date.
Incidence for ovarian cancer and cancer of the corpus uteri have continually increased over
the fifteen year period classing them as the 4th and 5th highest ranked female cancers in
Wales for the fifteen year period accounting for 9% of all female cancer registrations
(excluding non melanoma skin cancer) in Wales for the period 1992-2006. Although
incidence has increased for both these cancers, mortality has generally remained stable
over the period. However, five year relative survival rates for cancer of the corpus uteri are
over twice that of ovarian cancer for the period 1997-2001 (79.3% and 35.7% respectively).
Executive Summary 6
Bladder cancer and rectal cancer are placed as the 4th and 5th most common cancers in men
for the fifteen year period examined. Bladder cancer shows an increasing trend in incidence
in males with a slight decrease in mortality. Five year relative survival of bladder cancer in
males has increased by 3.7 percentage points when comparing the two periods examined
(1992-1996 and 1997-2001). Rectal cancer in males shows a generally constant trend in
incidence over the period with a constant trend in mortality with an approximate 8
percentage point increase in five year relative survival when comparing both periods.
For other cancers examined (excluding the most common five cancers), there appears to be
increasing incidence trends in cancers such as malignant melanoma and non-Hodgkins’s
lymphoma for both sexes whereas there appears to be a decreasing trend in incidence for
stomach cancer for both sexes. Cervical cancer incidence has also decreased over the
period along with male brain and central nervous system cancer. All other cancers generally
remained constant in terms of incidence. Regarding trends in mortality for other cancers
examined, cancers such as malignant melanoma of the skin show increasing numbers of
deaths over the period for both sexes whereas there have been decreases in the numbers of
deaths for stomach cancer (both sexes), Hodgkin’s disease (males) and cervical cancer. All
other cancers examined show generally constant mortality rates over the period. Survival, in
general has continued to increase between the two periods. However, there was a slight
decrease in survival for cancers such as laryngeal cancer (probably due to the small
numbers of cases) and female malignant melanoma.
It should be noted that bladder cancer in Wales is defined slightly different to other countries
in that the coding in Wales includes those non invasive papillary Transitional Cell
Carcinoma’s (TCCs) as malignant cancers whereas other countries class these as in-situ.
Hence, the incidence figures in Wales will be higher compared with other countries. Bladder
cancer registrations as of 2008 will take into account this discrepancy and are being coded
manually to code these non invasive papillary TCCs as in-situ.
Head and Neck Cancer 7.1
7 Results
7.1 Head and Neck (ICD-10: C00-C14, C30-C32)
Clinician Comments – Mr Simon C Hodder There has been fluctuation in the number of cases on an annual basis but the trend for head
and neck cancer is up over the last 5 years and down slightly for laryngeal. There is also still
a large difference in incidence with some LHB areas to others which are related to social
deprivation levels. Mortality appears not to have changed in the region and we are still
behind England in crude survival rates. The reorganisation of the Multi Disciplinary Teams
(MDTs) has as yet not shown a difference but it is early days and we will have to wait to see
if all the changes to MDT’s and networks does improve outcome. This is again reflected in
the LHB’s with the same LHB’s having worse outcomes, due to late presentation and all the
known social factors.
Wales does not perform well in the national league tables, with higher incidences of oral and
laryngeal cancers (crude rates of 13.3 (head and neck) and 8.7 (larynx) for males).
The Statistics in Wales are likely to change due to the changes that have occurred in the last
5 years and are occurring. The MDT’s will have an effect as cases are centralised.
Outcome driven treatment protocols will also start to impact on the statistics especially the
mortality. Life style changes with the smoking ban will also bring about changes.
Summary
Relative Frequency 4.0% 1.9%
Cumulative Rate (0-64 years) 0.9% 0.3%
Percentage Annual Change in EASR (incidence) -0.6% 0.6%
Percentage Annual Change in EASR (mortality) -1.2% -0.7%
Percentage Death Certificate Only 2.7% 3.2%
Average deaths per annum (1992-2006) 118 51
Mortality:Incidence Ratio (1992-2006) 37.8% 35.8%
* Significant at 5% level ** Significant at 1% level
Trends in Incidence, 1992-2006 Males
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1
15-19 0 0 0 0 0 1 0 0 1 0 0 0 1 0 1
20-24 1 0 0 0 0 0 2 3 1 0 3 0 0 2 1
25-29 1 0 0 1 1 1 0 1 1 1 0 0 0 1 0
30-34 4 0 0 3 2 2 3 3 1 1 0 2 2 0 3
35-39 5 1 3 6 7 4 4 4 2 4 3 2 2 3 3
40-44 8 8 10 8 11 12 8 4 9 7 12 7 13 8 10
45-49 11 14 29 19 22 28 20 28 20 20 14 19 26 23 28
50-54 29 31 29 29 25 42 41 43 39 27 32 34 41 29 40
55-59 37 28 37 36 41 40 43 37 42 38 45 48 41 52 56
60-64 41 49 36 41 46 42 49 39 49 43 48 40 51 48 57
65-69 58 40 48 49 47 37 47 44 41 37 42 42 46 46 38
70-74 57 54 52 46 48 51 46 33 42 50 50 30 30 37 41
75-79 40 33 33 36 38 32 39 37 48 37 32 27 25 27 38
80-84 16 24 11 34 12 22 13 17 11 17 23 14 20 31 13
85+ 8 11 12 15 14 12 16 9 16 12 9 13 18 18 13
Total 316 293 300 323 314 326 331 303 323 294 313 280 316 325 343
Crude Rate 22.69 20.99 21.45 23.07 22.41 23.22 23.52 21.53 22.94 20.87 22.14 19.64 22.03 22.60 23.74
EASR 20.23 18.62 19.35 20.23 20.00 20.62 20.74 18.88 19.75 17.58 18.47 16.74 18.75 18.41 19.93
WASR 14.12 12.87 13.61 14.00 14.12 14.64 14.66 13.56 13.92 12.37 13.10 11.95 13.45 13.02 14.31 Females
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0
10-14 0 1 1 0 0 0 0 1 0 1 0 1 1 0 2
15-19 1 0 1 0 0 0 2 0 0 1 1 1 0 0 1
20-24 1 1 0 0 0 0 0 0 0 1 2 0 0 1 1
25-29 1 3 0 1 1 0 0 2 1 1 0 2 0 1 0
30-34 1 1 0 3 0 2 1 2 0 2 4 3 2 2 0
35-39 2 2 2 2 3 2 0 1 0 4 2 3 3 2 5
40-44 4 4 5 1 3 7 6 5 4 2 3 4 6 8 10
45-49 6 5 7 8 9 12 6 7 3 4 5 9 11 6 7
50-54 10 6 8 6 3 10 14 11 15 10 10 14 11 13 14
55-59 5 11 7 12 27 14 17 21 17 18 19 14 13 15 22
60-64 16 16 13 18 15 18 8 14 16 20 17 14 21 19 17
65-69 20 13 23 14 23 19 12 14 16 15 16 12 12 19 18
70-74 21 26 14 18 18 29 18 17 17 21 16 14 12 16 23
75-79 13 17 15 22 19 19 23 24 20 21 21 7 15 17 18
80-84 13 12 10 20 12 17 8 12 12 10 16 13 10 10 12
85+ 19 9 21 19 20 24 23 8 21 16 13 10 15 16 17
Total 133 127 127 144 154 173 138 139 143 147 145 121 132 145 167
Crude Rate 8.95 8.54 8.53 9.67 10.33 11.60 9.25 9.31 9.54 9.79 9.61 8.00 8.69 9.53 10.98
EASR 6.53 6.36 6.22 6.72 7.81 8.38 6.69 7.15 6.87 7.29 7.04 6.33 6.60 7.13 8.18
WASR 4.70 4.61 4.46 4.66 5.53 5.92 4.67 5.11 4.80 5.25 5.03 4.74 4.82 5.14 5.95 Persons
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0
5-9 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0
10-14 0 1 1 0 0 0 0 2 0 1 0 2 1 0 3
15-19 1 0 1 0 0 1 2 0 1 1 1 1 1 0 2
20-24 2 1 0 0 0 0 2 3 1 1 5 0 0 3 2
25-29 2 3 0 2 2 1 0 3 2 2 0 2 0 2 0
30-34 5 1 0 6 2 4 4 5 1 3 4 5 4 2 3
35-39 7 3 5 8 10 6 4 5 2 8 5 5 5 5 8
40-44 12 12 15 9 14 19 14 9 13 9 15 11 19 16 20
45-49 17 19 36 27 31 40 26 35 23 24 19 28 37 29 35
50-54 39 37 37 35 28 52 55 54 54 37 42 48 52 42 54
55-59 42 39 44 48 68 54 60 58 59 56 64 62 54 67 78
60-64 57 65 49 59 61 60 57 53 65 63 65 54 72 67 74
65-69 78 53 71 63 70 56 59 58 57 52 58 54 58 65 56
70-74 78 80 66 64 66 80 64 50 59 71 66 44 42 53 64
75-79 53 50 48 58 57 51 62 61 68 58 53 34 40 44 56
80-84 29 36 21 54 24 39 21 29 23 27 39 27 30 41 25
85+ 27 20 33 34 34 36 39 17 37 28 22 23 33 34 30
Total 449 420 427 467 468 499 469 442 466 441 458 401 448 470 510
Crude Rate 15.60 14.57 14.79 16.17 16.19 17.24 16.18 15.24 16.03 15.15 15.67 13.65 15.17 15.89 17.20
EASR 13.38 12.49 12.79 13.47 13.91 14.50 13.72 13.01 13.31 12.43 12.75 11.53 12.67 12.77 14.05
WASR 9.41 8.74 9.03 9.33 9.83 10.28 9.66 9.34 9.36 8.81 9.07 8.35 9.13 9.08 10.13
Incidence by Local Health Board in Wales, 1992-2006
Number of incident cases and age-specific rates, 1992-2006
0
10
20
30
40
50
60
70
80
90
100
0
100
200
300
400
500
600
700
800
Under 5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
A g
e S
Age Groups
Male Cases Female Cases Male ASR Female ASR
Wales Age Standardised Rates by Local Health Board in Wales, 1992-2006 North Wales Cancer Network, 1992-2006
0 5 10 15 20 25 30
Isle of Anglesey
L o
South West Wales Cancer Network, 1992-2006
0 5 10 15 20 25 30
Powys
Ceredigion
Pembrokeshire
Carmarthenshire
Swansea
L o
0 5 10 15 20 25 30
Bridgend
L o
Trends in Mortality, 1992-2006 Males
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 0 0 0 0 0 0 0 2 0 0 0 0 1 0 0
20-24 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0
25-29 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0
30-34 0 0 0 0 0 0 0 2 0 1 1 0 0 0 1
35-39 1 0 2 1 2 0 0 0 1 1 1 1 0 1 2
40-44 2 1 1 0 1 3 4 2 1 1 3 0 1 1 1
45-49 8 1 7 5 6 5 7 6 2 5 4 7 7 5 14
50-54 10 11 7 9 16 5 15 19 17 13 11 6 17 8 6
55-59 13 11 10 10 16 16 18 16 5 18 8 15 13 14 15
60-64 23 15 14 9 15 9 11 15 16 22 17 12 19 17 17
65-69 26 21 16 16 17 23 14 16 14 18 16 16 27 19 17
70-74 23 15 15 22 21 17 21 14 13 17 19 22 7 14 21
75-79 20 14 20 18 13 23 17 20 16 16 13 11 10 6 17
80-84 16 8 8 16 17 12 6 4 10 8 10 9 9 14 10
85+ 7 3 11 5 4 7 10 6 9 9 9 7 6 9 11
Total 150 100 111 111 128 120 124 122 104 130 112 107 117 108 132
Crude Rate 10.77 7.16 7.94 7.93 9.14 8.55 8.81 8.67 7.39 9.23 7.92 7.51 8.16 7.51 9.14
EASR 9.41 6.29 7.03 6.57 7.89 7.12 7.66 7.51 6.08 7.78 6.47 6.08 6.83 5.93 7.25
WASR 6.43 4.28 4.67 4.32 5.39 4.73 5.25 5.28 4.10 5.40 4.46 4.20 4.87 4.10 5.05 Females
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-24 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0
25-29 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
30-34 0 0 1 0 1 0 1 0 1 1 1 0 0 1 0
35-39 0 1 0 1 1 1 0 1 1 1 1 0 0 0 0
40-44 2 0 1 0 0 2 2 2 0 0 0 0 0 3 1
45-49 2 1 0 1 2 0 2 1 2 1 2 2 1 1 1
50-54 1 1 3 2 2 2 0 5 2 2 2 2 1 0 3
55-59 3 2 4 3 4 3 4 4 5 4 7 6 3 5 4
60-64 6 9 3 2 8 3 6 9 5 5 3 10 5 9 7
65-69 8 8 8 4 4 6 4 2 5 8 3 6 4 7 5
70-74 8 14 6 16 5 4 9 9 7 6 6 7 1 5 6
75-79 7 6 3 7 4 8 11 9 6 8 7 7 5 9 4
80-84 10 4 5 4 3 6 4 8 7 8 8 7 3 8 6
85+ 7 7 11 11 8 12 8 15 12 12 8 12 10 9 8
Total 55 53 47 51 42 47 52 65 53 57 48 60 33 57 45
Crude Rate 3.70 3.56 3.16 3.43 2.82 3.15 3.48 4.35 3.54 3.80 3.18 3.97 2.17 3.75 2.96
EASR 2.44 2.39 2.18 2.10 2.07 1.96 2.33 2.81 2.29 2.42 2.05 2.62 1.33 2.40 1.93
WASR 1.71 1.65 1.53 1.37 1.46 1.29 1.65 1.89 1.55 1.66 1.37 1.82 0.89 1.65 1.33 Persons
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 1 0 0 0 0 0 0 2 0 0 0 0 1 0 0
20-24 0 0 1 0 0 0 1 0 0 2 0 1 0 0 0
25-29 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0
30-34 0 0 1 0 1 0 1 2 1 2 2 0 0 1 1
35-39 1 1 2 2 3 1 0 1 2 2 2 1 0 1 2
40-44 4 1 2 0 1 5 6 4 1 1 3 0 1 4 2
45-49 10 2 7 6 8 5 9 7 4 6 6 9 8 6 15
50-54 11 12 10 11 18 7 15 24 19 15 13 8 18 8 9
55-59 16 13 14 13 20 19 22 20 10 22 15 21 16 19 19
60-64 29 24 17 11 23 12 17 24 21 27 20 22 24 26 24
65-69 34 29 24 20 21 29 18 18 19 26 19 22 31 26 22
70-74 31 29 21 38 26 21 30 23 20 23 25 29 8 19 27
75-79 27 20 23 25 17 31 28 29 22 24 20 18 15 15 21
80-84 26 12 13 20 20 18 10 12 17 16 18 16 12 22 16
85+ 14 10 22 16 12 19 18 21 21 21 17 19 16 18 19
Total 205 153 158 162 170 167 176 187 157 187 160 167 150 165 177
Crude Rate 7.12 5.31 5.47 5.61 5.88 5.77 6.07 6.45 5.40 6.43 5.47 5.68 5.08 5.58 5.97
EASR 5.93 4.34 4.60 4.33 4.98 4.54 5.00 5.16 4.18 5.10 4.26 4.35 4.08 4.16 4.59
WASR 4.07 2.97 3.10 2.84 3.42 3.01 3.45 3.59 2.82 3.53 2.91 3.01 2.88 2.88 3.19
Mortality by Local Health Board in Wales, 1992-2006
Wales Age Standardised Mortality Rates by Local Health Board in Wales, 1992-2006 North Wales Cancer Network, 1992-2006
0 2 4 6 8 10 12 14
Isle of Anglesey
L o
0 2 4 6 8 10 12 14
Powys
Ceredigion
Pembrokeshire
Carmarthenshire
Swansea
L o
South East Wales Cancer Network, 1992-2006
0 2 4 6 8 10 12 14
Bridgend
L o
1992-1996 1997-2001 2002-2006 Prevalence Statistics (at 31st December 2006) in Wales Males
Number Rate per 100,000 % prev in pop % in each time interval
Up to 1 year 291 20.14 0.02 10.13
>1 to 5 years 783 54.20 0.05 27.24
>5 to 10 years 772 53.43 0.05 26.86
>10 to 20 years 1028 71.15 0.07 35.77
Total up to 20 years 2874 198.92 0.20 100.00 Females
Up to 1 year 148 9.73 0.01 10.78
>1 to 5 years 358 23.54 0.02 26.07
>5 to 10 years 385 25.31 0.03 28.04
>10 to 20 years 482 31.69 0.03 35.11
Total up to 20 years 1373 90.26 0.09 100.00 Persons
Up to 1 year 439 14.80 0.01 10.34
>1 to 5 years 1141 38.47 0.04 26.87
>5 to 10 years 1157 39.01 0.04 27.24
>10 to 20 years 1510 50.91 0.05 35.55
Total up to 20 years 4247 143.20 0.14 100.00
World Age Standardised Rates per 100,000 population, 2002 (ICD10 codes C00-C14) INCIDENCE - Males INCIDENCE - Females Countries with 100% coverage for incidence Countries with 100% coverage for incidence
Crude Rate ASR (World) Cases Crude Rate ASR (World) Cases
Croatia 33.0 23.5 765 Iceland 6.9 4.9 9
Slovenia 26.4 18.7 254 Malta 7.7 4.7 16
Ukraine 23.3 17.8 5226 Denmark 7.5 4.5 202
Estonia 18.8 14.3 119 Sweden 7.3 4.0 325
Malta 17.8 13.1 35 Croatia 6.6 3.9 160
Czech Republic 17.0 12.0 846 Wales 7.5 3.7 112
Denmark 16.6 11.0 439 United Kingdom 6.4 3.7 1936
Ireland 10.4 8.3 201 Norway 5.8 3.6 133
Wales 13.3 8.2 187 Finland 6.0 3.3 159
United Kingdom 11.6 7.9 3425 Slovenia 4.9 3.3 51
Norway 11.7 7.7 260 Czech Republic 5.1 2.9 270
Sweden 11.7 6.9 508 Estonia 5.1 2.8 36
Finland 10.4 6.9 261 Ukraine 4.4 2.4 1134
Iceland 7.5 5.9 9 Ireland 3.3 2.2 63
Countries not with 100% catchment of incidence Countries not with 100% catchment of incidence
France 44.1 31.3 12797 France 8.9 5.4 2703
Portugal 31.5 22.8 1521 USA 6.7 4.4 9782
Spain 32.8 22.3 6389 Portugal 5.5 3.1 288
Poland 17.4 13.9 3243 Spain 5.9 3.0 1212
USA 16.2 12.8 23089 Italy 5.6 2.9 1653
Italy 19.9 12.1 5527 Greece 4.7 2.6 254
Japan 10.0 5.5 6279 China 2.7 2.5 16837
Greece 9.0 5.5 469 Japan 4.8 2.3 3065
China 5.3 5.2 35550 Poland 3.5 2.3 708 MORTALITY - Males MORTALITY - Females Countries with 100% catchment of mortality Countries with 100% catchment of mortality
Crude rate ASR (World) Cases Crude rate ASR (World) Cases
Croatia 15.5 11.0 350 Denmark 3.4 1.7 93
Ukraine 13.7 10.5 3088 Malta 3.0 1.5 7
Slovenia 14.0 10.0 134 Czech Republic 2.4 1.3 128
Estonia 12.8 9.7 81 Norway 2.4 1.3 55
Czech Republic 9.6 6.7 475 United Kingdom 2.3 1.3 712
Malta 6.4 4.8 15 Slovenia 2.3 1.3 27
Ireland 5.7 4.7 111 Wales 2.7 1.2 40
Denmark 6.8 4.3 180 Estonia 2.5 1.2 17
Norway 4.7 3.1 104 Ireland 1.8 1.2 36
United Kingdom 4.5 2.9 1335 Finland 2.3 1.0 60
Finland 3.7 2.4 93 Sweden 2.1 1.0 95
Sweden 4.3 2.3 186 Croatia 1.9 1.0 46
Wales 4.0 2.3 56 Ukraine 1.8 0.9 443
Iceland 2.6 2.1 5 Iceland 0.7 0.4 1
Countries not with 100% catchment of mortality Countries not with 100% catchment of mortality
France 14.6 10.2 4255 France 2.4 1.4 740
Portugal 9.6 6.8 461 China 1.5 1.4 9690
Spain 9.8 6.6 1913 Italy 2.4 1.1 719
Poland 7.5 6.0 1404 USA 1.9 1.1 2612
Italy 8.3 4.9 2311 Poland 1.7 1.1 347
Japan 5.9 3.3 3709 Japan 2.2 1.0 1452
China 3.0 3.0 20170 Portugal 1.8 0.9 94
USA 3.6 2.8 5261 Spain 1.7 0.9 345
Greece 3.1 1.9 162 Greece 1.4 0.7 76
Five year relative survival rates for Europe, 1995-1999
Countries with 100% coverage % Rel Surv
Finland 50.6
Sweden 49.2
Norway 45.1
England 44.8
Scotland 42.5
Malta 41.0
Wales 40.4
Denmark 40.2
Austria 36.8
Netherlands 51.2
Germany 49.4
Italy 41.7
Switzerland 40.3
Spain 39.4
Poland 34.0
France 33.9
1 year survival 3 year survival 5 year survival
One year and five year relative survival rates in Wales by socioeconomic status, 1992- 2006 Diagnosis period: 1992-1996, followed up to 31st December 2006
0
10
20
30
40
50
60
70
80
90
100
iv a l
Q 1 Q 2 Q 3 Q 4 Q 5 Diagnosis period: 1997-2001, followed up to 31st December 2006
0
10
20
30
40
50
60
70
80
90
100
Q 1 Q 2 Q 3 Q 4 Q 5
Diagnosis period: 1992-2001, followed up to 31st December 2006
0
10
20
30
40
50
60
70
80
90
100
Q 1 Q 2 Q 3 Q 4 Q 5
Oesophageal Cancer 7.2
7.2 Oesophagus (ICD-10: C15)
Similar to other Western Countries, the incidence of oesophageal cancer continues to rise.
This is especially true in males. Although likely related to an increase in gastro-oesophageal
reflux disease, the true aetiological factors involved here are unknown.
There has been an improvement in 5 year survival in Wales for patients with oesophageal,
and to a lesser extent, stomach cancer.
The relative improvement in outcome for patients with oesophageal cancer sees it leading
the European leader board in patients with 100% coverage.
The incidence of Upper Gastro-intestinal Cancer in Wales appears to be mirroring the trend
elsewhere in the Western world with an increase in cancers of the lower oesophagus and
gastro-oesophageal junction, especially adenocarcinomas in Caucasian males.
There would appear to have been a continued improvement for patients with oesophageal
cancer in Wales, possibly due to better patient selection and the availability of non surgical
treatment options but a relatively poor outcome for patients with gastric cancer.
The reasons for this are unknown, whilst there has been a steady improvement in the
organisation of Upper GI Services (painfully slow and a long way to go), there has until
recently been no effective adjuvant therapy to account for these relative differences between
European countries. Investigation is needed therefore to investigate these differences, if
real, to focus efforts on improving outcomes. It is likely that these will come from
improvements in public health and earlier diagnosis rather than advances in therapy.
Summary
Percentage Annual Change in EASR (incidence) 1.5%** -0.1%
Percentage Annual Change in EASR (mortality) 0.3% -0.5%
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25-29 0 1 0 0 0 2 0 0 0 0 0 0 0 0 0
30-34 0 0 1 0 1 1 1 0 0 0 0 1 0 0 0
35-39 1 1 0 4 4 1 2 2 2 2 2 2 3 1 3
40-44 4 2 3 2 4 5 4 0 5 3 1 6 3 3 5
45-49 3 4 4 6 5 9 6 10 13 5 9 2 12 7 7
50-54 11 8 16 9 12 20 18 11 19 22 12 16 8 17 23
55-59 17 25 17 25 14 23 16 23 31 34 26 31 23 27 31
60-64 19 27 14 32 22 17 34 20 31 28 33 35 31 28 49
65-69 25 26 39 43 30 34 29 29 33 43 29 52 36 41 34
70-74 46 36 47 40 42 49 42 40 43 48 41 46 37 34 49
75-79 29 34 25 30 30 53 43 45 46 52 46 36 37 44 38
80-84 21 20 21 21 24 16 28 22 24 34 28 30 41 35 41
85+ 6 13 21 13 18 18 15 25 19 21 26 17 23 20 27
Total 182 197 208 225 206 248 238 227 266 292 253 274 254 257 307
Crude Rate 13.07 14.11 14.87 16.07 14.70 17.67 16.91 16.13 18.89 20.73 17.89 19.22 17.71 17.87 21.25
EASR 11.01 12.17 12.70 13.69 12.25 14.65 13.77 13.04 15.47 16.35 14.00 15.06 13.42 13.50 16.16
WASR 7.28 8.01 8.30 9.26 8.13 9.72 9.19 8.47 10.40 10.77 9.21 10.19 8.93 8.94 10.87
Females
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25-29 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0
30-34 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0
35-39 0 1 0 0 0 1 1 1 0 1 0 0 0 0 1
40-44 0 1 2 0 1 1 0 1 2 1 0 0 2 0 2
45-49 0 1 1 1 3 3 3 1 3 5 1 2 2 3 1
50-54 7 1 10 2 6 7 8 2 6 10 6 6 5 3 6
55-59 8 8 8 5 13 7 8 7 8 8 8 5 8 14 13
60-64 12 12 7 11 14 10 11 12 13 11 12 15 15 12 13
65-69 17 19 12 27 16 15 19 17 27 21 19 13 15 20 22
70-74 31 23 25 30 29 34 28 29 36 24 39 22 20 21 28
75-79 30 23 34 22 32 27 22 33 29 32 32 28 23 24 27
80-84 32 23 33 26 34 36 28 23 24 21 43 34 31 38 22
85+ 24 24 30 35 36 36 38 37 43 32 28 34 33 20 28
Total 162 137 162 160 184 177 166 163 191 166 188 159 155 155 163
Crude Rate 10.91 9.21 10.88 10.75 12.35 11.87 11.12 10.92 12.74 11.06 12.45 10.51 10.21 10.19 10.72
EASR 6.54 5.56 6.41 6.18 7.36 6.79 6.58 6.21 7.65 6.83 7.07 5.86 5.91 5.93 6.55
WASR 4.17 3.62 4.01 4.00 4.73 4.35 4.28 3.97 5.02 4.50 4.51 3.74 3.88 3.85 4.30 Persons
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25-29 0 1 0 0 0 2 0 0 0 0 0 0 1 0 0
30-34 1 1 1 1 1 1 1 0 0 0 0 1 0 0 0
35-39 1 2 0 4 4 2 3 3 2 3 2 2 3 1 4
40-44 4 3 5 2 5 6 4 1 7 4 1 6 5 3 7
45-49 3 5 5 7 8 12 9 11 16 10 10 4 14 10 8
50-54 18 9 26 11 18 27 26 13 25 32 18 22 13 20 29
55-59 25 33 25 30 27 30 24 30 39 42 34 36 31 41 44
60-64 31 39 21 43 36 27 45 32 44 39 45 50 46 40 62
65-69 42 45 51 70 46 49 48 46 60 64 48 65 51 61 56
70-74 77 59 72 70 71 83 70 69 79 72 80 68 57 55 77
75-79 59 57 59 52 62 80 65 78 75 84 78 64 60 68 65
80-84 53 43 54 47 58 52 56 45 48 55 71 64 72 73 63
85+ 30 37 51 48 54 54 53 62 62 53 54 51 56 40 55
Total 344 334 370 385 390 425 404 390 457 458 441 433 409 412 470
Crude Rate 11.95 11.58 12.81 13.33 13.49 14.68 13.93 13.45 15.72 15.74 15.09 14.74 13.85 13.93 15.85
EASR 8.77 8.86 9.56 9.94 9.81 10.72 10.18 9.63 11.56 11.59 10.53 10.46 9.66 9.72 11.35
WASR 5.73 5.82 6.15 6.63 6.43 7.03 6.73 6.22 7.71 7.64 6.86 6.96 6.40 6.39 7.59
0
20
40
60
80
100
120
140
0
100
200
300
400
500
600
700
Under 5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
A g
e S
Age Group
Male Cases Female Cases Male ASR Female ASR Wales Age Standardised Rates by Local Health Board in Wales, 1992-2006 North Wales Cancer Network, 1992-2006
0 5 10 15 20 25
Isle of Anglesey
L o
o a rd
1992-1996 1997-2001 2002-2006
0 5 10 15 20 25
Powys
Ceredigion
Pembrokeshire
Carmarthenshire
Swansea
L o
0 5 10 15 20 25
Bridgend
L o
o a rd
1992-1996 1997-2001 2002-2006
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25-29 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0
30-34 0 0 3 0 1 1 1 1 0 0 1 0 1 0 0
35-39 1 1 1 0 4 1 3 2 1 1 2 2 2 3 0
40-44 4 3 4 2 5 4 4 2 0 5 0 4 4 0 2
45-49 5 5 2 7 8 8 5 10 8 9 6 4 8 8 7
50-54 17 11 13 12 7 19 10 15 11 19 5 17 6 11 17
55-59 28 17 25 26 16 23 15 19 22 18 24 27 25 25 30
60-64 24 26 24 33 31 18 25 26 24 24 35 35 25 32 27
65-69 33 29 41 29 38 27 32 18 27 43 38 36 31 34 40
70-74 42 36 41 43 40 44 42 45 38 42 40 39 41 29 46
75-79 35 39 32 29 36 49 57 40 52 44 55 48 30 52 46
80-84 20 18 20 29 16 22 24 21 21 42 30 31 39 43 34
85+ 9 11 18 13 14 19 15 20 23 20 23 25 23 20 27
Total 218 196 224 223 216 236 233 219 227 267 259 268 235 257 276
Crude Rate 15.66 14.04 16.02 15.93 15.42 16.81 16.56 15.56 16.12 18.95 18.32 18.80 16.38 17.87 19.10
EASR 13.68 11.99 13.85 13.46 12.96 13.90 13.14 12.66 12.78 14.76 14.04 14.60 12.35 13.14 14.28
WASR 9.11 7.90 9.16 8.97 8.81 9.10 8.60 8.36 8.27 9.75 9.18 9.62 8.15 8.58 9.36 Females
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25-29 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30-34 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0
35-39 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0
40-44 0 0 1 0 0 1 0 0 1 1 1 0 1 0 2
45-49 0 1 2 1 2 3 1 1 1 2 2 2 3 1 2
50-54 3 4 8 1 2 7 7 5 4 3 4 3 2 2 2
55-59 3 8 7 6 10 8 5 6 2 7 8 6 7 5 8
60-64 7 11 10 8 15 3 5 8 12 9 11 10 17 7 13
65-69 17 16 11 13 17 15 16 15 16 23 17 13 8 13 14
70-74 23 24 24 15 31 27 23 21 19 33 25 20 11 26 19
75-79 34 27 25 19 35 31 29 25 32 27 23 33 34 26 20
80-84 29 31 30 24 34 37 23 18 25 27 31 37 39 34 28
85+ 26 26 33 30 33 36 41 36 38 36 28 26 35 24 34
Total 143 150 151 117 180 169 150 135 151 168 150 150 157 138 142
Crude Rate 9.63 10.08 10.14 7.86 12.08 11.33 10.05 9.04 10.08 11.19 9.94 9.92 10.34 9.07 9.34
EASR 5.28 5.94 5.96 4.33 6.97 6.27 5.48 5.11 5.54 6.45 5.75 5.35 5.46 4.85 5.16
WASR 3.26 3.79 3.77 2.71 4.44 3.91 3.41 3.24 3.51 4.15 3.72 3.34 3.42 3.02 3.33 Persons
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25-29 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0
30-34 1 1 3 0 2 1 1 1 0 0 1 0 1 0 0
35-39 1 2 1 0 4 2 3 2 2 1 2 2 2 3 0
40-44 4 3 5 2 5 5 4 2 1 6 1 4 5 0 4
45-49 5 6 4 8 10 11 6 11 9 11 8 6 11 9 9
50-54 20 15 21 13 9 26 17 20 15 22 9 20 8 13 19
55-59 31 25 32 32 26 31 20 25 24 25 32 33 32 30 38
60-64 31 37 34 41 46 21 30 34 36 33 46 45 42 39 40
65-69 50 45 52 42 55 42 48 33 43 66 55 49 39 47 54
70-74 65 60 65 58 71 71 65 66 57 75 65 59 52 55 65
75-79 69 66 57 48 71 80 86 65 84 71 78 81 64 78 66
80-84 49 49 50 53 50 59 47 39 46 69 61 68 78 77 62
85+ 35 37 51 43 47 55 56 56 61 56 51 51 58 44 61
Total 361 346 375 340 396 405 383 354 378 435 409 418 392 395 418
Crude Rate 12.54 12.00 12.99 11.77 13.70 13.99 13.21 12.20 13.00 14.95 13.99 14.23 13.28 13.35 14.09
EASR 9.48 8.96 9.90 8.90 9.96 10.08 9.31 8.89 9.16 10.60 9.89 9.97 8.90 9.00 9.72
WASR 6.18 5.84 6.47 5.84 6.63 6.51 6.00 5.80 5.89 6.95 6.45 6.48 5.79 5.80 6.34
0 4 8 12 16 20 24 28
Isle of Anglesey
L o
0 4 8 12 16 20 24 28
Powys
Ceredigion
Pembrokeshire
Carmarthenshire
Swansea
L o
o a rd
1992-1996 1997-2001 2002-2006
0 4 8 12 16 20 24 28
Bridgend
L o
Up to 1 year 216 14.95 0.01 21.05
>1 to 5 years 308 21.32 0.02 30.02
>5 to 10 years 259 17.93 0.02 25.24
>10 to 20 years 243 16.82 0.02 23.68
Up to 1 year 111 7.30 0.01 16.49
>1 to 5 years 185 12.16 0.01 27.49
>5 to 10 years 198 13.02 0.01 29.42
>10 to 20 years 179 11.77 0.01 26.60
Up to 1 year 327 11.03 0.01 19.25
>1 to 5 years 493 16.62 0.02 29.02
>5 to 10 years 457 15.41 0.02 26.90
>10 to 20 years 422 14.23 0.01 24.84
Total up to 20 years 1699 57.28 0.06 100.00
World Age Standardised Rates per 100,000 population, 2002 INCIDENCE - Males INCIDENCE - Females Countries with 100% coverage for incidence Countries with 100% coverage for incidence
Wales 18.9 10.4 266 Wales 12.7 5.0 191
United Kingdom 15.9 9.6 4663 United Kingdom 9.7 4.4 2921
Ireland 10.3 8.1 199 Ireland 5.9 3.8 116
Croatia 8.7 5.9 195 Denmark 3.9 2.0 106
Ukraine 7.9 5.9 1783 Sweden 2.9 1.3 128
Denmark 9.5 5.8 252 Finland 2.7 1.2 70
Slovenia 8.0 5.5 77 Croatia 2.0 1.1 47
Estonia 7.4 5.5 47 Iceland 2.0 1.1 3
Czech Republic 7.6 5.3 380 Norway 2.0 1.0 44
Iceland 7.0 5.3 11 Czech Republic 1.5 0.8 78
Malta 5.5 3.8 12 Slovenia 1.5 0.8 16
Norway 6.0 3.7 133 Malta 1.4 0.8 3
Sweden 6.6 3.6 287 Estonia 1.4 0.6 11
Finland 5.7 3.5 144 Ukraine 1.2 0.6 317
Countries not with 100% catchment of incidence Countries not with 100% catchment of incidence
China 26.2 27.4 173802 China 12.7 12.0 79950
France 16.5 11.0 4799 France 2.8 1.5 868
Japan 19.0 10.0 11805 Japan 3.0 1.3 1928
Portugal 9.6 6.5 464 USA 2.2 1.3 3228
Spain 9.5 6.1 1845 Portugal 2.2 1.0 112
Poland 7.5 6.0 1408 Poland 1.6 0.9 305
USA 7.8 5.9 11123 Italy 1.9 0.8 548
Italy 7.3 4.1 2025 Spain 1.3 0.6 261
Greece 2.9 1.6 150 Greece 1.2 0.5 64 MORTALITY - Males MORTALITY - Females Countries with 100% coverage for mortality Countries with 100% coverage for mortality
United Kingdom 15.1 9.0 4441 United Kingdom 9.1 4.1 2753
Wales 16.1 8.3 227 Ireland 6.4 4.0 125
Ireland 10.2 7.9 196 Wales 10.1 3.5 151
Denmark 11.6 7.0 307 Denmark 4.0 1.9 107
Croatia 8.6 5.8 192 Iceland 3.0 1.6 4
Ukraine 7.0 5.3 1576 Finland 3.0 1.2 78
Slovenia 7.0 4.8 67 Sweden 2.2 0.9 98
Czech Republic 6.8 4.7 337 Norway 1.9 0.9 43
Iceland 6.7 4.7 10 Slovenia 1.8 0.9 18
Estonia 6.3 4.6 39 Croatia 1.6 0.8 37
Sweden 6.0 3.3 263 Czech Republic 1.4 0.7 72
Norway 5.4 3.3 119 Ukraine 1.1 0.5 284
Finland 4.0 2.5 103 Malta 0.8 0.5 2
Malta 3.4 2.3 7 Estonia 1.0 0.4 7
Countries not with 100% coverage for mortality Countries not with 100% coverage for mortality
China 20.5 21.6 135634 China 10.3 9.6 64458
France 13.2 8.6 3824 France 2.4 1.2 722
Japan 14.6 7.5 9059 USA 2.0 1.2 2967
Portugal 8.5 5.6 412 Japan 2.5 1.1 1651
Spain 8.1 5.1 1577 Portugal 2.1 0.9 108
USA 6.8 5.1 9722 Poland 1.3 0.8 260
Poland 6.0 4.7 1113 Italy 1.7 0.7 499
Italy 6.3 3.4 1752 Spain 1.2 0.5 247
Greece 2.5 1.3 132 Greece 0.9 0.4 50
Five year relative survival rates for Europe, 1995-1999
Countries with 100% coverage % Rel Surv
Wales 13.3
Sweden 12.7
Germany 19.2
Switzerland 12.8
France 12.4
Poland 11.8
Netherlands 11.7
Italy 11.2
Spain 9.7
Period Sex Obs Rel Obs Rel Obs Rel
1992-1996 Males 22.92 24.03 8.24 9.46 5.64 7.15
1997-2001 Males 33.95 35.62 11.97 13.63 9.33 11.48
1992-2001 Males 29.23 30.66 10.37 11.84 7.75 9.64
1992-1996 Females 20.37 21.50 7.50 8.70 5.09 6.13
1997-2001 Females 28.19 29.83 12.02 13.96 9.08 11.37
1992-2001 Females 24.40 25.79 9.82 11.40 7.14 8.79
1992-1996 Persons 21.77 22.91 7.91 9.12 5.39 6.68
1997-2001 Persons 31.68 33.35 11.97 13.73 9.22 11.41
1992-2001 Persons 27.21 28.63 10.14 11.65 7.49 9.27
1 year survival 3 year survival 5 year survival
One year and five year relative survival rates in Wales by socioeconomic status, 1992- 2006 Diagnosis period: 1992-1996, followed up to 31st December 2006
0
10
20
30
40
50
60
70
80
90
100
Q 1 Q 2 Q 3 Q 4 Q 5
0
10
20
30
40
50
60
70
80
90
100
Q 1 Q 2 Q 3 Q 4 Q 5
0
10
20
30
40
50
60
70
80
90
100
Q 1 Q 2 Q 3 Q 4 Q 5
Stomach Cancer 7.3
7.3 Stomach (ICD-10: C16)
Clinician Comments – Dr Tom Crosby
In contrast to oesophageal cancer, over this period the incidence of stomach cancer has
fallen significantly. Given the migration of oesophago-gastric cancer to the gastro-
oesophageal junction, one needs to be cautious that these changes are not related to subtle
changes in the classification of the cancers ie a migration from proximal gastric to lower
oesophageal diagnoses.
There has been an improvement in 5 year survival in Wales for patients with oesophageal,
and to a lesser extent, stomach cancer. However it would appear that the relative survival
with gastric cancer is twice as good in leading similar European countries compared to
Wales and the UK. The reasons for this are uncertain but unlikely to be related to treatment
rather than incidence and presentation.
Whilst there has been a significant fall in the incidence of distal gastric cancers, there has
been a rise in proximal gastric cancers, which often present with more advanced disease,
and maybe coded with lower oesophageal disease.
There would appear to have been a continued improvement for patients with oesophageal
cancer in Wales, possibly due to better patient selection and the availability of non surgical
treatment options but a relatively poor outcome for patients with gastric cancer.
The reasons for this are unknown, whilst there has been a steady improvement in the
organisation of Upper GI Services (painfully slow and a long way to go), there has until
recently been no effective adjuvant therapy to account for these relative differences between
European countries. Investigation is need therefore to investigate these differences, if real,
to focus efforts on improving outcomes. It is likely that these will come from improvements in
public health and earlier diagnosis rather than advances in therapy.
Stomach Cancer 7.3
Summary
Percentage Annual Change in EASR (incidence) -4.2%** -3.5%**
Percentage Annual Change in EASR (mortality) -5.2%** -4.6%**
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-24 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0
25-29 2 0 1 1 1 0 2 0 1 1 0 0 0 0 0
30-34 1 2 1 1 0 1 1 4 2 1 0 0 0 0 1
35-39 3 0 2 0 1 6 0 1 3 2 3 1 5 2 5
40-44 4 3 5 4 2 3 8 9 0 3 1 8 0 4 3
45-49 7 6 21 17 8 14 10 9 7 10 8 6 8 6 7
50-54 21 16 18 19 11 20 8 17 9 18 10 16 17 10 11
55-59 27 24 40 27 20 30 25 26 22 28 27 25 25 27 19
60-64 58 41 55 62 49 51 34 41 33 39 29 33 33 36 36
65-69 88 82 65 86 59 73 55 62 52 60 50 60 41 39 49
70-74 91 91 117 93 82 88 89 89 77 57 60 58 47 64 51
75-79 89 65 89 88 87 84 94 76 90 67 73 71 41 61 53
80-84 53 41 75 59 59 44 53 60 45 47 51 63 53 36 44
85+ 43 28 30 35 36 35 23 43 32 37 35 33 38 31 34
Total 487 400 520 492 416 449 402 437 373 370 347 374 308 316 313
Crude Rate 34.97 28.65 37.18 35.14 29.69 31.98 28.57 31.05 26.49 26.27 24.54 26.23 21.47 21.98 21.66
EASR 29.76 23.80 30.62 28.92 23.75 26.11 22.20 24.63 20.28 20.59 18.43 19.58 16.20 16.31 15.93
WASR 19.32 15.61 20.01 19.06 15.27 17.26 14.41 16.02 13.01 13.53 11.80 12.67 10.55 10.62 10.48
Stomach Cancer 7.3
Females
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-24 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
25-29 1 0 0 0 0 0 0 1 0 0 0 2 0 0 0
30-34 0 0 1 1 1 0 2 0 0 0 0 1 0 0 0
35-39 1 1 1 0 2 1 1 1 2 2 1 0 0 1 1
40-44 0 1 0 4 3 1 3 0 2 2 0 4 1 2 3
45-49 1 2 5 2 3 1 2 7 2 3 5 0 6 4 3
50-54 6 9 7 7 4 10 3 8 7 5 8 3 6 3 2
55-59 17 14 9 14 11 12 10 8 6 7 7 6 7 7 7
60-64 26 15 23 15 13 21 14 13 14 15 15 15 11 7 11
65-69 36 20 32 25 28 26 20 26 25 27 20 21 18 14 13
70-74 36 44 47 56 55 48 42 25 42 30 31 40 35 28 23
75-79 56 35 55 38 48 57 43 44 51 35 41 43 38 31 39
80-84 43 47 61 59 40 49 35 55 43 38 36 44 57 38 36
85+ 60 49 53 56 48 47 59 50 43 55 38 35 38 42 38
Total 283 237 294 277 256 273 234 238 237 219 202 214 217 178 176
Crude Rate 19.05 15.93 19.75 18.61 17.18 18.31 15.68 15.94 15.81 14.58 13.38 14.15 14.29 11.70 11.57
EASR 11.45 9.39 11.37 10.62 9.97 10.64 8.80 8.92 8.95 8.26 7.78 8.02 7.78 6.31 6.21
WASR 7.33 5.96 7.25 6.77 6.41 6.80 5.60 5.72 5.71 5.34 5.02 5.21 4.92 4.00 3.89 Persons
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-24 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0
25-29 3 0 1 1 1 0 2 1 1 1 0 2 0 0 0
30-34 1 2 2 2 1 1 3 4 2 1 0 1 0 0 1
35-39 4 1 3 0 3 7 1 2 5 4 4 1 5 3 6
40-44 4 4 5 8 5 4 11 9 2 5 1 12 1 6 6
45-49 8 8 26 19 11 15 12 16 9 13 13 6 14 10 10
50-54 27 25 25 26 15 30 11 25 16 23 18 19 23 13 13
55-59 44 38 49 41 31 42 35 34 28 35 34 31 32 34 26
60-64 84 56 78 77 62 72 48 54 47 54 44 48 44 43 47
65-69 124 102 97 111 87 99 75 88 77 87 70 81 59 53 62
70-74 127 135 164 149 137 136 131 114 119 87 91 98 82 92 74
75-79 145 100 144 126 135 141 137 120 141 102 114 114 79 92 92
80-84 96 88 136 118 99 93 88 115 88 85 87 107 110 74 80
85+ 103 77 83 91 84 82 82 93 75 92 73 68 76 73 72
Total 770 637 814 769 672 722 636 675 610 589 549 588 525 494 489
Crude Rate 26.76 22.09 28.19 26.62 23.24 24.94 21.93 23.27 20.98 20.24 18.78 20.01 17.78 16.70 16.49
EASR 20.61 16.60 21.00 19.77 16.86 18.37 15.50 16.78 14.61 14.42 13.10 13.80 11.99 11.31 11.07
WASR 13.33 10.79 13.63 12.91 10.84 12.03 10.01 10.87 9.36 9.43 8.41 8.94 7.73 7.31 7.19
Stomach Cancer 7.3
Stomach Cancer 7.3
0
40
80
120
160
200
240
0
200
400
600
800
1000
1200
1400
Under 5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
A g
e S
Age Group
Male Cases Female Cases Male ASR Female ASR Wales Age Standardised Rates by Local Health Board in Wales, 1992-2006 North Wales Cancer Network, 1992-2006
0 4 8 12 16 20 24 28 32 36 40
Isle of Anglesey
L o
o a rd
1992-1996 1997-2001 2002-2006
Stomach Cancer 7.3
0 4 8 12 16 20 24 28 32 36 40
Powys
Ceredigion
Pembrokeshire
Carmarthenshire
Swansea
L o
1992-1996 1997-2001 2002-2006 South East Wales Cancer Network, 1992-2006
0 4 8 12 16 20 24 28 32 36 40
Bridgend
L o
o a rd
1992-1996 1997-2001 2002-2006
Stomach Cancer 7.3
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-24 0 0 2 0 1 0 0 0 0 0 0 0 0 0 0
25-29 0 0 0 2 0 1 2 0 0 1 0 0 0 0 0
30-34 0 2 0 1 0 0 0 1 1 0 0 0 0 0 0
35-39 2 0 2 1 1 1 0 0 1 2 0 0 1 3 2
40-44 3 4 3 2 3 0 8 3 0 1 2 2 1 3 1
45-49 3 5 7 11 6 3 3 4 6 3 2 4 4 3 3
50-54 8 13 9 8 9 5 5 8 5 10 10 10 6 9 4
55-59 15 18 17 18 18 16 16 19 10 14 8 12 16 14 8
60-64 44 31 37 36 28 22 26 24 21 25 19 21 15 14 19
65-69 67 69 63 53 53 34 43 37 29 30 26 39 30 31 21
70-74 63 73 74 58 56 64 66 55 54 37 46 37 28 39 44
75-79 60 61 55 74 61 58 55 57 59 57 44 36 46 34 35
80-84 53 40 47 52 45 42 41 48 37 37 49 40 52 26 37
85+ 36 27 28 25 27 39 25 35 19 30 26 38 28 32 35
Total 354 343 344 341 308 285 290 291 242 247 232 239 227 208 209
Crude Rate 25.42 24.57 24.60 24.35 21.98 20.30 20.61 20.67 17.19 17.53 16.41 16.76 15.83 14.47 14.47
EASR 21.28 20.34 20.19 19.66 17.66 15.99 16.17 16.10 12.90 13.31 11.94 12.65 11.24 10.76 10.16
WASR 13.58 13.15 13.16 12.67 11.36 9.93 10.49 10.13 8.18 8.44 7.47 8.05 6.97 6.90 6.37 Females
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
25-29 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
30-34 0 0 1 1 0 1 1 0 0 0 0 1 0 0 0
35-39 1 2 0 0 3 1 1 0 1 1 0 0 0 0 0
40-44 3 0 1 2 2 0 3 0 2 2 1 0 1 1 3
45-49 1 3 4 0 1 2 2 3 0 2 6 1 4 0 1
50-54 4 4 2 3 3 3 3 3 4 3 4 3 2 1 1
55-59 4 11 6 9 7 5 7 9 6 5 4 2 5 2 4
60-64 18 13 19 11 7 13 11 4 8 6 7 8 6 3 5
65-69 31 14 25 19 13 14 13 15 15 18 19 13 10 7 8
70-74 28 42 34 38 32 25 26 22 21 22 25 20 19 24 14
75-79 43 31 43 32 33 38 39 29 39 29 31 33 27 19 28
80-84 44 37 42 48 33 35 27 41 24 30 36 25 44 36 29
85+ 46 51 48 43 38 30 50 42 40 40 35 34 33 34 32
Total 223 208 225 206 172 167 183 168 160 158 168 140 151 128 126
Crude Rate 15.01 13.98 15.11 13.84 11.54 11.20 12.26 11.25 10.68 10.52 11.13 9.26 9.95 8.42 8.28
EASR 8.53 7.98 8.57 7.58 6.38 6.22 6.75 5.93 5.82 5.72 6.18 4.94 5.05 4.08 4.18
WASR 5.43 5.03 5.45 4.74 4.01 3.94 4.25 3.63 3.62 3.61 3.95 3.06 3.11 2.48 2.58 Persons
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-24 0 0 2 0 1 0 0 0 0 0 0 0 0 0 1
25-29 0 0 0 2 0 1 2 0 0 1 0 0 0 1 0
30-34 0 2 1 2 0 1 1 1 1 0 0 1 0 0 0
35-39 3 2 2 1 4 2 1 0 2 3 0 0 1 3 2
40-44 6 4 4 4 5 0 11 3 2 3 3 2 2 4 4
45-49 4 8 11 11 7 5 5 7 6 5 8 5 8 3 4
50-54 12 17 11 11 12 8 8 11 9 13 14 13 8 10 5
55-59 19 29 23 27 25 21 23 28 16 19 12 14 21 16 12
60-64 62 44 56 47 35 35 37 28 29 31 26 29 21 17 24
65-69 98 83 88 72 66 48 56 52 44 48 45 52 40 38 29
70-74 91 115 108 96 88 89 92 77 75 59 71 57 47 63 58
75-79 103 92 98 106 94 96 94 86 98 86 75 69 73 53 63
80-84 97 77 89 100 78 77 68 89 61 67 85 65 96 62 66
85+ 82 78 76 68 65 69 75 77 59 70 61 72 61 66 67
Total 577 551 569 547 480 452 473 459 402 405 400 379 378 336 335
Crude Rate 20.05 19.11 19.71 18.94 16.60 15.61 16.31 15.82 13.83 13.92 13.68 12.90 12.80 11.36 11.30
EASR 14.90 14.16 14.38 13.62 12.02 11.11 11.46 11.01 9.36 9.51 9.06 8.80 8.15 7.42 7.17
WASR 9.51 9.09 9.30 8.71 7.68 6.93 7.37 6.88 5.90 6.02 5.71 5.55 5.04 4.69 4.48
Stomach Cancer 7.3
Stomach Cancer 7.3
0 4 8 12 16 20 24 28 32
Isle of Anglesey
L o
Powys
Ceredigion
Pembrokeshire
Carmarthenshire
Swansea
L o
o a rd
1992-1996 1997-2001 2002-2006
Stomach Cancer 7.3
0 4 8 12 16 20 24 28 32
Bridgend
L o
Up to 1 year 199 13.77 0.01 12.62
>1 to 5 years 401 27.76 0.03 25.43
>5 to 10 years 433 29.97 0.03 27.46
>10 to 20 years 544 37.65 0.04 34.50
Up to 1 year 112 7.36 0.01 11.44
>1 to 5 years 269 17.68 0.02 27.48
>5 to 10 years 260 17.09 0.02 26.56
>10 to 20 years 338 22.22 0.02 34.53
Up to 1 year 311 10.49 0.01 12.17
>1 to 5 years 670 22.59 0.02 26.21
>5 to 10 years 693 23.37 0.02 27.11
>10 to 20 years 882 29.74 0.03 34.51
Total up to 20 years 2556 86.18 0.09 100.00
Stomach Cancer 7.3
World Age Standardised Rates per 100,000 population, 2002 INCIDENC

Documents

Cancer in Wales, 1992 -2006: A Comprehensive Report