As well as covering the incidence and mortality rates for different cancers, PHE's report also looks at how the risk factors for particular cancers vary from area to area and how the incidence of different types of cancer and the stage at which they are diagnosed can differ according to deprivation. Indeed, the impact of deprivation is a clear theme, with the report stating that “not only are you more likely to develop cancer if you’re in the most deprived socioeconomic quintile, but that once detected cancers in these groups are less likely to be treatable”.
Cancer rates across the West Midlands
Over the past 10 years the incidence of all cancers has increased in the West Midlands and across England. On the positive side, it seems that the region has a rate “significantly” below the England rate. However, less positively, the region’s mortality rate, although declining, is “significantly” higher than the England average.
In bare figures in 2014, over 31,000 people were diagnosed with cancer in the West Midlands with just short of 8,000 deaths. As might be expected there are variations from place to place. For example, the incidence rate of new cancers ranges from 543 cases per 100,000 population in Shropshire through to 678 in Stoke-on-Trent. This gave Stoke-on-Trent along with Solihull rates that were significantly higher than the England average. On the other hand, Shropshire together with Herefordshire, Staffordshire and Warwickshire all had rates significantly lower than the England average.
Age is an important factor, with the over 65s accounting for nearly two thirds of all diagnosis. Bearing in mind the ageing population, improving rates of early diagnosis and better treatments it seems that more and more people are living with, or beyond cancer, so much so that by 2030 it is estimated that there may well be around 135,000 people living with or beyond cancer in the region. That figure being well in excess of the 89,000 people in 2014.
Risk factors and preventative action
The connection between smoking and lung cancer is well know and PHE note the decline in smoking along side the falling incidence of lung cancers. Even so, smoking still accounts for many diagnosis and the report highlights the need to investigate and tackle the variations in smoking rates across the region.
Perhaps less well appreciated by the public are the impacts of alcohol consumption and of being overweight or obese on cancer incidence. Bearing in mind the “high alcohol consumption” levels in the West Midlands, PHE highlights the need to address the regional variations in alcohol related cancers. Taken together with the significantly higher proportion of overweight and obese people in the region, the report suggested that “unless preventative action is taken … there will be a significant increase in cancers associated with alcohol and obesity” in the coming years.
Deprivation and cancer
In respect to those risk factors, it seems that “the burden of excess alcohol consumption, low physical activity and increased overweight and obesity prevalence are disproportionately carried by those in the most deprived socioeconomic quintiles”. As such, it seems that some types of cancer are “strongly associated” with deprivation. For example, compared to the least deprived groups for both sexes, the most deprived groups have higher rates of lung, liver and stomach cancers, while oral and pancreatic cancers have higher rates among the most deprived males and cervical cancer rates are higher among the most deprived females. On the other hand, prostrate cancer, breast cancer and skin cancer were all found to be more common in the least deprived groups.
Across all types of cancers, PHE expresses concern that the gap in overall one-year cancer survival rates between the least and most deprived groups of the West Midlands’ population increased between 2005 and 2014.
Early diagnosis by area
As might be expected, the stage a cancer is diagnosed is important in helping determine treatments and indicates the severity of the disease at the time the patient sought medical help. Again deprivation is an important factor, with PHE commenting on the “strong relationship” between the stage cancer is diagnosed and deprivation.
Looking more closely, in 2014, across the West Midlands 41% of cancers were diagnosed relatively early on, where the cancer had not spread to other parts of the body (stages 1 and 2).
Viewed in relation to deprivation, it appears that for the least deprived quintile 47% of cancers were diagnosed at stage 1 or 2 compared to 40% for the most deprived. Conversely, for the least deprived, 19% were diagnosed at stage 4 compared to 26% for the most deprived.
For specific Clinical Commissioning Group areas, the highest proportion of early diagnosis were in Solihull, while the lowest were in East Staffordshire and South Warwickshire. The report also covers the performance of different areas in terms of cancer screening, meeting referral targets and patient satisfaction among other things.
Preventing ill health from alcohol and tobacco use
Bearing in mind the relationship between alcohol and smoking and cancer, it’s perhaps worth noting PHE’s recently published guidance on its Preventing ill health by risky behaviours - alcohol and tobacco CQUIN (Commissioning for Quality and Innovation). PHE suggest that CCGs and councils should implement the scheme, which aims to identify and support inpatients who are smokers or at-risk drinkers, by including it locally in all NHS Standard Contracts with eligible providers.
Department of Health and NHS made simple
Those interested in a short guide to the Department of Health and NHS, may find the National Audit Office’s new publication useful. Part of their “A Short Guide to…” series, it sets “what the Department of Health and NHS England do, how much they spend, recent and planned changes and what to look out for across their main business areas and services”. The guide is organised into several sections including overview, commissioning, NHS primary care services, NHS hospital and specialist care services and regulation and oversight.
Public Health England, Cancer in the West Midlands, August and October 2017
Public Health England, Health Matters: preventing ill health from alcohol and tobacco use, October 2017
National Audit Office, A short guide to the Department of Health and NHS England, September 2017