Dr Heather O Dickinson Department of Child Health University of Newcastle Cancer trends in England and Wales

Deaths by cause (all ages), England & Wales, 1998 cancer 25% diseases of circulatory system 41% diseases of respiratory system 16% other 18%

Age 1-4 yrs congenital anomalies Age 5-24 yrs accidents nervous system Age yrsOver 75 yrs cancer respiratory system circulatory system other Deaths by cause and age group, 1998

5-year survival 0%20%40%60%80% breast lung colon rectum prostate bladder stomach Affluent Deprived Adult cancer, diagnosed

5-year survival 0%20%40%60%80% breast lung colon ALL CANCERS rectum prostate bladder stomach Affluent Deprived Adult cancer, diagnosed

Target In July 1999, the UK government set a ‘tough but attainable’ target: to reduce the death rate from cancer in people under 75 by at least a fifth by 2010 (compared with 1997) - saving up to 100,000 lives

Cancer mortality, under age 75 yrs Year Annual mortality per 100,000

05,00010,00015,00020,000 stomach lung prostate colorectal bladder oesophagus Male deaths from cancer, 1998

05,00010,00015,00020,000 ovary breast lung colorectal pancreas stomach Female deaths from cancer, 1998 oesophagus

colorectal prostate Year Cancer mortality, males, age yrs +  Annual mortality per 100,000 lung stomach  

colorectal breast Year   o + Cancer mortality, females, age yrs Annual mortality per 100,000 lung stomach

Death rates from cancer depend on: l incidence –several years ago l survival –over the past few years

l We can decrease the incidence through prevention. l We can improve survival through better treatment.

Can starting prevention strategies now affect the incidence enough to reduce the death rate by 2010?

Smoking accounts for l over one third of cancer deaths –lung, mouth, larynx, oesophagus and other cancers l about one fifth of other deaths –mainly from circulatory and respiratory disease

l Survival has improved. l If it continues to improve, roughly 24,000 deaths will be avoided by 2010 l If survival for everyone were as good as survival of the most affluent, about 41,500 deaths would be avoided.

Eliminating social class differences - in both incidence and survival - would almost certainly save more lives in the next decade than innovative treatments.

Cancer mortality, children 0-14 years Year Annual mortality per 100,000

0%20%40%60%80% 5-year survival Brain and spinal tumours Acute lymphoblastic leukaemia Children’s cancer, diagnosed Affluent Deprived

Children’s cancer - a success story Why? l many childhood malignancies are chemosensitive - and among the first for which curative chemotherapy was developed l rare disease - so a manageable problem

Why? l treatment at regional centres l cross-speciality communication l evidence-based treatment l national collaboration in treatment protocols l most patients entered into clinical trials Children’s cancer - a success story

l Can adult cancer be treated as successfully as children’s cancer? l Can we give everyone the best care, irrespective of their social status?

Good statistics are the crucial underpinning of government policy.

Statistics are needed for: l valid target setting l planning service delivery l audit of performance

High quality statistics: l accurate l complete l timely

What sort of statistics? l incidence} { age l mortality} by { sex l survival} { tumour type

How do we use the statistics? l to analyse trends l to analyse factors affecting trends l to predict the effects of these factors as the age structure of the population changes

Health care has taken the lead in calling for evidence based decisions; government policy likewise needs to be determined by a firm knowledge base.

I work on the epidemiology of children’s cancer. I previously taught English to people from other countries - mainly Bangladesh and Pakistan - who had settled in England. I integrated health education into my English teaching. This work made me more aware of the inequalities in society, both within England and between different countries. Heather Dickinson

l Learning objectives - to understand:  factors influencing cancer incidence and survival  stratifying by age, sex, social class  national statistics on disease l Performance objectives - to assess:  national trends in disease rates  targets for reduction in mortality