1. Insert name of presentation on Master Slide December 2014 Lung Cancer in Wales A detailed analysis of population trends of incidence and stage at diagnosis up to and including 2012 This is the first publication in our series on lung cancer in Wales

2. Lung Cancer in Wales Lung cancer in Wales This is the first report in our series of lung cancer in Wales. The report details population trends of incidence and stage at diagnosis up to and including 2012

3. Lung Cancer in Wales Using these slides These slides accompany the Lung Cancer in Wales report. These slides are a resource to demonstrate findings from the Lung Cancer in Wales report. The presentation can be used as a whole or as individual slides. Please acknowledge the work of the Welsh Cancer Intelligence and Surveillance Unit when using these slides.

4. Lung Cancer in Wales Index Slides 7 - 13: Lung cancer incidence in Wales and the world Slides 14 - 16:W hat’s behind the lung cancer incidence trends in Wales? Slides 17 - 18:Lung cancer incidence and area d eprivation Slides 19 - 23: Geographic inequalities in lung cancer incidence within Wales Slides 24 - 28: Stage at diagnosis

5. Lung Cancer in Wales Instructions to copy a slide To copy a slide for use in a presentation: 1. Right-click on the slide you wish to copy from the list on the left-hand side (the ‘slides’ tab) when in normal view and select ‘Copy’ from the list. 2.Go to your presentation and right-click where you want the copied slide to appear in the ‘slides’ tab and select ‘paste’ from the list. 3.On being pasted into your presentation a small clipboard icon with a black arrow will appear near the bottom right-hand corner of the newly pasted slide. Click on the arrow to show the drop-down menu and select “Keep Source Formatting” from the list. The slide will then appear as seen in the original presentation.

6. Lung Cancer in Wales Acknowledgements Project team Dr Dyfed Wyn Huws, Dr Ceri White, Rebecca Thomas, Tamsin Long, Ciaràn Slyne, Julie Howe, Helen Crowther Acknowledgements A special thanks to the Welsh Cancer Registration team without whom the data used within this report would not be produced. Thanks to the following people for their help with this publication: Huw Brunt, Hugo Cosh, Dr Ciaràn Humphreys, Isabel Puscas, Joy McRae, David Rees (PHE), and Janet Warlow

7. Lung Cancer in Wales Lung cancer incidence in Wales and the world Figure 1: Cancer incidence in European men and women: Estimates for 40 countries in 2012 EASR per 100,000 population calculated using the 1976 European standard population. Source: J. Ferlay, E. Steliarova-Foucher, J. Lortet- Tieulent, S. Rosso, J.W.W. Coebergh, H. Comber, D. Forman, F. Bray. European Journal of Cancer. Volume 49, Issue 6, Pages 1374- 1403 (April 2013) DOI: 10.1016/j.ejca.2012.12.027. Copyright © 2013 Elsevier

8. Lung Cancer in Wales Lung cancer incidence in Wales and the world Figure 2: UK country lung cancer incidence rates continue to fall in men and rise in women from 2003 to 2012 Source: Welsh Cancer Intelligence Surveillance Unit’s Cancer Registry and from the Office for National Statistics, Scottish Cancer Registry and Northern Ireland Cancer Registry.

9. Lung Cancer in Wales Lung cancer incidence in Wales and the world Table 1: The five most common cancer sites in men and women in Wales 2012 by number of cases Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

10. Lung Cancer in Wales Lung cancer incidence in Wales and the world Figure 3: Rising number x rate of lung cancer in women in Wales while men’s rate falls

11. Lung Cancer in Wales Lung cancer incidence in Wales and the world Figure 5: Lung cancer incidence rate rises with age in men and women then falls-off in oldest women in 2012 – number of cases close to men most ages Figure 4: Rising lung cancer incidence rates in oldest women in Wales with decreasing or little change in men Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

12. Lung Cancer in Wales Lung cancer incidence in Wales and the world Figure 6: Non-small cell lung cancer incidence trends mirror overall lung cancer trends with a decline in men’s and a steeper increase in women Figure 7: Small cell lung cancer incidence rate similar in men and women Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

13. Lung Cancer in Wales Lung cancer incidence in Wales and the world Figure 8: Small cell lung cancer rate increases less with age and peaks earlier than no-small cell in 2012 Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

14. Lung Cancer in Wales What’s behind the lung cancer incidence trends in Wales? Figure 10: The decline in percentage of smokers who reported smoking daily in Wales Figure 9: Estimated annual consumption of cigarettes in UK men peaked in late 1940s and in the late 1970s for women Source: Tobacco Advisory Council Source: General Lifestyle Survey (Office for National Statistics) (a)Weighting applied by ONS to compensate for non-response. Technical reports from the survey show that weighted percentage of smokers has been around one per cent higher than the unweighted percentage from1998 onwards.

15. Lung Cancer in Wales What’s behind the lung cancer incidence trends in Wales? Figure 11: Gradient of the proportion of children in households with adult smokers by household socioeconomic classification in Wales 2009-2010 Figure 12: Percentage of 11-16 year-olds exposed to smoke in cars by health board, 2009 Source: Welsh Health Survey (Welsh Government) Source: Health Behaviour in School-Aged Children Survey (World Health Organization/ Welsh Government)

16. Lung Cancer in Wales What’s behind the lung cancer incidence trends in Wales? Figure 13: Radon Map of Wales and England Source: Public Health England and British Geological Survey

17. Lung Cancer in Wales * Figures are updated on an ongoing basis due to the dynamic database held at the cancer registry. Hence the difference in the numbers of cases analysed for staging and deprivation data compared to previous analysis. Lung cancer incidence and area deprivation Figure 14: Lung cancer incidence rate by area deprivation in Wales. Table 2: Most lung cancer cases are diagnosed in residents of the most deprived areas of Wales Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

18. Lung Cancer in Wales Lung cancer incidence and area deprivation Figure 15: Lung cancer incidence rate deprivation gap is widest of all common cancers and is widening Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

19. Lung Cancer in Wales Geographic inequalities in lung cancer incidence within Wales Figure 16: Wide variation in health board population lung cancer incidence rates Figure 17: Wide variation in health board population lung cancer incidence rates Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

20. Lung Cancer in Wales Geographic inequalities in lung cancer incidence within Wales Table 3: Wide variation in health board population lung cancer incidence rates even wider in women than men Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

21. Lung Cancer in Wales Geographic inequalities in lung cancer incidence within Wales Figure 18: Wider variation in lung cancer incidence rates by local authority of residence, 2008-2012 Figure 19: Wider variation in lung cancer incidence rates by local authority of residence2008-2012 Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

22. Lung Cancer in Wales Geographic inequalities in lung cancer incidence within Wales Table 4: Local authorities’ incidence inequality is wider for women than men Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

23. Lung Cancer in Wales Geographic inequalities in lung cancer incidence within Wales Figure 20: Smaller sub-local authority geographic areas show even wider variation in lung cancer incidence rates 2008-2012 Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

24. Lung Cancer in Wales Stage at diagnosis Figure 21: Most cases of lung cancer in Wales diagnosed at a late stage of disease in 2012 Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry * Figures are updated on an ongoing basis due to the dynamic database held at the cancer registry. Hence the difference in the numbers of cases analysed for staging and deprivation data compared to previous analysis.

25. Lung Cancer in Wales Stage at diagnosis Table 5: Increase in proportion of each stage at lung cancer diagnosis with a decrease in unknown stage from 2010 to 2012 Table 6: Absolute and proportionate change in number of lung cancer cases in each stage at diagnosis (including unknown stage) from 2010 to 2012 Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

26. Lung Cancer in Wales Stage at diagnosis Figure 22: Most new cases of lung cancer are diagnosed at a late stage in men and women with stage distribution slightly more favourable in women than in men Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

27. Lung Cancer in Wales Stage at diagnosis Figure 23: As the age of people presenting with lung cancer increases, cases with stage 1 or 2 at diagnosis become slightly more common Figure 24: There is a slightly more favourable stage distribution in more deprived areas 2010- 2012 Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry

28. Lung Cancer in Wales Stage at diagnosis Figure 25: Distribution of stage at diagnosis varies considerably between health board populations – the most favourable is in Cwm Taf Figure 26: Differences in stage at diagnosis between men and women varies between each health board of residence 2010-2012 Source: Welsh Cancer Intelligence and Surveillance Unit’s National Cancer Registry