1. Cancer in Wales Population incidence of stage at diagnosis Official statistics Published 09:30 hrs 24 November Dr Dyfed Wyn Huws Cyfarwyddwr / Director Uned Gwybodaeth a Gwyliadwriaeth Canser Cymru Welsh Cancer Intelligence and Surveillance Unit
First ever in Wales – population-based. Cancer reg data

2. Setting the stage
Why is population-level stage at diagnosis important?
Stage by cancer type in Wales diagnoses in 2015
Stage by age 2015
Trends in stage by area deprivation
Wales vs England at the Principality Stadium
Geography lessons
Known unknowns and unknown unknowns
So what?

3. Why is stage at diagnosis important?
International variation in cancer survival
ICBP Module 1

4. International variation in cancer survival Eurocare 5
Why is stage at diagnosis important?
International variation in cancer survival Eurocare 5
One year relative survival for lung cancer EUROCARE 5 Men
15-99 years,

5. Why is stage at diagnosis important?
Earlier stage at diagnosis strongly associated with overall survival
A statistically significant association was found between stage at diagnosis and one year survival in patients with NSCLungCancer in Wales (NLCA data).
After adjusting for age, sex, diagnosis year, performance status, and treatment, patients diagnosed at stage III/IV were 82% less likely to survive to one year than those diagnosed at stage I/II.
(OR 0.18 [95% CI 0.16, 0.20], p<0.0001).
Cushen et al, 2017
Welsh Cancer Intelligence and Surveillance Unit

6. Why is stage at diagnosis important
Why is stage at diagnosis important? International variation in stage at diagnosis
ICBP Module 1
Copyright © BMJ Publishing Group Ltd & British Thoracic Society. All rights reserved.

7. 92.8% 34.0% 6.1 times more likely to survive to 1 year if had surgery
Figure 13: Kaplan-Meier one-year survival curve for patients with NSCLC and surgical resection
92.8%
6.1 times more likely
to survive to 1 year if
had surgery
34.0%
Here we can see the 1yr observed survival of nsclc patients that received surgery (represented here by the red line) to those that didn’t receive surgery (represented by the blue line).
In patients with NSCLC, 92.8% of those that had surgery survived to one year, compared with only 34.0% of those that hadn’t had surgery
After adjusting for diagnosis year, age, gender, stage and performance status, those that had surgery were 6.1 times more likely to survive to one year than those who did not have surgery and this was statistically significantly OR 6.13 (CI: 4.66, 8.07)
After adjusting for case-mix (diagnosis year, age, gender, stage and performance status), no individual MDT had a statistically significant different one year survival to the all Wales survival.

8. Melanoma and cancers of the uterus and breast have the highest proportion of early stage at diagnosis, whereas cancers of the lung, stomach, pancreas and liver have the lowest
Proportion (%) of early and late stage at diagnosis for common cancer types for people resident in Wales, diagnosed in 2015
Source: Welsh Cancer Intelligence and Surveillance Unit's National Cancer Registry

9. Older people tend to have higher proportions of unknown stage at diagnosis for most cancer types

10. For breast, prostate and bowel cancers – but not lung - older people 75+ have lowest % of stage 1 disease

11. Bowel
Lung
Here trends in stage at diagnosis distribution 2011 to 2015 by area deprivation for e.g. bowel and lung . Colours stages 1-4 and unknown
Proportion of people in each stage at diagnosis does not vary according to area deprivation for the most common cancers for 2015 – lung, bowel, (prostate and breast not shown) cancers
Between 2011 ands 2015, trends in proportions of lung cancer early stage at diagnosis increased whilst unknown stage decreased - trends in the proportion of lung cancer diagnoses at stage 1 increased across areas of all deprivation levels, and was largest in least deprived areas *** beware creating/widening inequals***
Little change in bowel stage distribution, and same across all deprivation areas.
There has been little change in breast cancer early stage
Trends in proportions of prostate cancer early stage at diagnosis increased whilst unknown stage decreased

12. Stage at diagnosis (%) for lung cancer in Wales and England, 2015
Source Wales: Welsh Cancer Intelligence and Surveillance Unit's National Cancer Registry
Source England:
Lung cancer stage at diagnosis was similar in Wales and England apart from a higher level of stage 4 in England, and a higher level of unknown stage in Wales
There is no significant variation between health boards in the proportion of stage 1 breast cancer at diagnosis
The health board population with the highest proportion of stage 1 lung cancer - Cwm Taf – at 22.5% is just above Cardiff and the Vale, and twice the proportion of the lowest health board. Cardiff and Vale also has on ofthe lowest unknown lung cancer stage proportions, along with Hywel Dda and Cwm Taf.
No significant variation in bowel cancer stage distribution compared to Wales as a whole.

13. WCISU cancer registry stage unknown
Cancer registration system limitations and hierarchy of data sources used
Insufficient clinical data available to derive cancer registry stage
Data on cancer patients from Wales diagnosed or treated in England often did not include staging data
Patients and clinical decisions for not proceeding with staging diagnostics or biopsies
Further information about cancer registry data completeness and quality
WCISU cancer registry stage unknown
Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

14. Final scene Why is population-level stage at diagnosis important?
Stage by cancer type in Wales diagnoses in 2015
Stage by age 2015
Trends in stage by area deprivation
Wales vs England at the Principality Stadium
Geography lessons
Known unknowns and unknown unknowns
So what?

15. Acknowledgements
Colleagues at Welsh Cancer Intelligence and Surveillance Unit and rest of Public Health Wales
Data providers – clinical teams and patients and PHE

16. Statistics available now at
Uned Gwybodaeth a Gwyliadwriaeth Canser Cymru Welsh Cancer Intelligence and Surveillance Unit
Cymraeg
English