Mj Quinn

Trends and socioeconomic inequalities in cancer survival in England and Wales up to 2001.

We examined national trends and socioeconomic inequalities in cancer survival in England and Wales during the 1990s, using population-based data on 2.2 million patients who were diagnosed with one of the 20 most common cancers between 1986 and 1999 and followed up to 2001. Patients were assigned to one of five deprivation categories (from ‘affluent’ to ‘deprived’) using characteristics of their electoral ward of residence at diagnosis. We estimated relative survival up to 5 years after diagnosis, adjusting separately in each deprivation category for background mortality by age, sex and calendar period. We estimated trends in survival and in the difference in survival between deprivation categories (‘deprivation gap’) over the periods 1986–90, 1991–95 and 1996–99. We used period analysis to examine likely survival rates in the near future. Survival improved for most cancers in both sexes during the 1990s, and appears likely to continue improving for most cancers in the near future. The deprivation gap in survival between rich and poor was wider for patients diagnosed in the late 1990s than in the late 1980s. Increases in cancer survival in England and Wales during the 1990s are shown to be significantly associated with a widening deprivation gap in survival.

Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part II: individual countries

Part I of this paper (p. 162 in this issue) contains an Introduction and a Methods section which includes the definitions and explanations of the epidemiological terms used, and comparisons of international patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part II of the review concentrates on detailed results for individual countries and includes the Discussion.

Cancer survival in England and Wales at the end of the 20th century

Survival has risen steadily since the 1970s for most cancers in adults in England and Wales, but persistent inequalities exist between those living in affluent and deprived areas. These differences are not seen for children. For many of the common adult cancers, these inequalities in survival (the ‘deprivation gap’) became more marked in the 1990s. This volume presents extended analyses of survival for adults diagnosed during the 14 years 1986–1999 and followed up to 2001, including trends in overall survival in England and Wales and trends in the deprivation gap in survival. The analyses include individual tumour data for 2.2 million cancer patients. This article outlines the structure of the supplement – an article for each of the 20 most common cancers in adults, followed by an expert commentary from one of the leading UK clinicians specialising in malignancies of that organ or system. The available data, quality control and methods of analysis are described here, rather than repeated in each of the 20 articles. We open the discussion between clinicians and epidemiologists on how to interpret the observed trends and inequalities in cancer survival, and we highlight some of the most important contrasts in these very different points of view. Survival improved substantially for adult cancer patients in England and Wales up to the end of the 20th century. Although socioeconomic inequalities in survival are remarkably persistent, the overall patterns suggest that these inequalities are largely avoidable.

Trends in prostate cancer incidence, mortality and survival in England and Wales 1971-1998.

Objectives To examine trends in prostate cancer incidence and mortality in England and Wales between 1971 and 1998, using a newly developed and validated national cancer database and the national mortality database.

Variations in survival from breast cancer in Europe by age and country, 1978–1989

The objective of this study, part of the wider EUROCARE II collaborative project, was to examine variations by age and country in the relative survival of women from breast cancer in Europe, based on data fro 145,000 cases in 1985-1989 and trends based on (245,000) cases for 1978-1989. Data were supplied by 42 cancer registries in 17 countries to a common protocol. Results for some countries where the participating registries covered only small proportions of the total population may not be representative of the whole country. In 1985-1989 there were wide differences among the 17 countries: survival was above the European average in Iceland, Finland, Sweden, Switzerland, France and Italy; around average in Denmark, The Netherlands, Germany and Spain; below average in Scotland, England and Slovenia; and well below average in Slovakia, Poland and Estonia. In France, Spain and Italy, but not in the U.K., there were wide differences in survival among the participating registries. Survival generally declined with age, particularly in the elderly (75 years and over)--this was most marked in Denmark, Scotland and England. Over the period 1978-1989, 1-year survival improved by 2% overall and 5-year survival by 6%. There were improvements in 5-year survival in all countries except Iceland, Germany, Switzerland and Estonia, and in all age groups except the youngest (15-44 years). It is likely that differences in the access to and quality of care in the various countries played a large part in explaining the differences in survival.

Trends in oesophageal and gastric cancer incidence, mortality and survival in England and Wales 1971–1998/1999

Background : In England and Wales, 7% of cancers diagnosed in 1997 were oesophageal or gastric cancer.

Trends in the subsite and morphology of oesophageal and gastric cancer in England and Wales 1971-1998.

Background : The incidence of adenocarcinoma of the oesophagus and gastric cardia has increased in many countries.

Risk of mortality, cancer incidence, and stroke in a population potentially exposed to cadmium

OBJECTIVES To follow up mortality and cancer incidence in a cohort potentially exposed to cadmium and to perform a geographical (ecological) analysis to further assess the health effects of potential exposure to cadmium. METHODS The English village of Shipham has very high concentrations of cadmium in the soil. A previous cohort study of residents of Shipham in 1939 showed overall mortality below that expected, but a 40% excess of mortality from stroke. This study extends the follow up of the cohort for mortality to 1997, and includes an analysis of cancer incidence from 1971 to 1992, and a geographical study of mortality and cancer incidence. Standardised mortality and incidence ratios (SMRs and SIRs) were estimated with regional reference rates. Comparisons were made with the nearby village of Hutton. RESULTS All cause cohort mortality was lower than expected in both villages, although there was excess cancer incidence in both Shipham (SIR 167, 95% confidence interval (95% CI) 106 to 250) and Hutton (SIR 167, 95% CI 105 to 253). There was an excess of mortality from hypertension, cerebrovascular disease, and nephritis and nephrosis, of borderline significance, in Shipham (SMR 128, 95% CI 99 to 162). In the geographical study, all cause mortality in Shipham was also lower than expected (SMR 84, 95% CI 71 to 100). There was an excess in genitourinary cancers in both Shipham (SIR 160, 95% CI 107 to 239) and Hutton (SIR 153, 95% CI 122 to 192). CONCLUSION No clear evidence of health effects from possible exposure to cadmium in Shipham was found despite the extremely high concentrations of cadmium in the soil.

Pancreatic cancer in England and Wales 1975-2000: patterns and trends in incidence, survival and mortality.

Background  Rates and time trends in mortality from pancreatic cancer vary considerably between countries.

Survival from breast cancer among South Asian and non-South Asian women resident in South East England.

Ethnic differences in breast cancer survival have been observed in the USA but have not been examined in Britain. We aimed to investigate such differences between South Asian (i.e. those with family roots in the Indian subcontinent) and non-South Asian (essentially British-native) women in England. Primary breast cancer cases incident in 1986 –1993 and resident in South East England were ascertained through the Thames Cancer and Registry and followed up to the end of 1997. Cases of South Asian ethnicity were identified on the basis of their names by using a previously validated computer algorithm. A total of 1037 South Asian and 50 201 non-South Asian breast cancer cases were included in the analysis; 30% of the South Asian (n=312) and 44% (n=22 201) of the non-South Asian cases died during follow-up. South Asian cases had a higher relative survival than non-South Asians throughout the follow-up period. The 10-year relative survival rates were 72.6% (95% confidence interval: 69.0, 75.9%) and 65.2% (64.5, 65.8%) for South Asians and non-South Asians, respectively. The excess mortality rates experienced by South Asians were 82% (72, 94%) of those experienced by non-South Asians (P=0.004). The magnitude of this effect was slightly reduced with adjustment for differences in age at diagnosis, but was strengthened with further adjustment for differences in stage at presentation and socioeconomic deprivation (excess mortality rates in South Asians relative to non-South Asians=72% (63, 82%), P<0.001). These findings indicate that the higher survival from breast cancer in the first 10 years after diagnosis among South Asian was not due to differences in age at diagnosis, socioeconomic deprivation or disease stage at presentation.