1. Risk of skin cancer following phototherapy for neonatal jaundice: retrospective cohort study David H Brewster, 1,2 Janet S Tucker, 3,4 Michael Fleming, 1 Carole Morris, 1 Diane L Stockton, 1 David J Lloyd, 3,4 Sohinee Bhattacharya, 3,4 James WT Chalmers 1,2 1 Information Services Division, NHS National Services Scotland 2 University of Edinburgh 3 University of Aberdeen 4 Aberdeen Maternity Hospital Colorectal Cancer Study Day Stirling 13 September 2012 How Scotland compares to other countries

2. Outline Risk factors Mortality Incidence Survival

3. Risk factors / protective factors (1) Family history and inherited conditions Familial adenomatous polyposis (FAP) Hereditary non polyposis colorectal cancer (HNPCC or Lynch syndrome) Ashkenazi Jewish background Other medical conditions Ulcerative colitis Crohn's disease Diabetes mellitus Acromegaly PMH of large bowel cancer, endometrial cancer, testicular cancer, or lymphoma PMH of cholecystectomy PMH of organ transplant

4. Risk factors / protective factors (2) Diet Red and processed meat increase risk Fruit, vegetable, fibre decrease risk Calcium may reduce risk Other factors Age Excess weight increases risk Alcohol probably increases risk Smoking (long-term) may increase risk Physical activity decreases risk Aspirin (and other NSAIDs) probably decrease risk HRT and OC may decrease risk Vitamin D may decrease risk Screening reduces risk of dying from colorectal cancer (and endoscopic screening reduces incidence)

9. PopulationAge-standardised incidence rate Slovakia (1998-2002) 52.5 France, Bas-Rhin (1998-2002) 48.7 Australia, Victoria (1998-2002) 48.3 Singapore: Chinese (1998-2002) 46.0 Italy, Varese Province (1998-2000) 43.4 UK, Scotland (1998-2002) 43.1 Canada (1998-2002) 42.6 Norway (1998-2002) 40.7 The Netherlands (1998-2002) 39.8 Spain, Navarra (1998-2002) 39.4 Denmark (1998-2002) 39.3 USA, SEER (9 Registries): White (1998-2002) 37.9 Japan, Osaka Prefecture (1998-2002) 37.4 Sweden (1998-2002) 30.0 Finland (1998-2002) 25.6 Source: Cancer Incidence in Five Continents, Volume IX Colorectal cancer (males)

10. PopulationAge-standardised incidence rate Australia, Victoria (1998-2002) 33.1 Norway (1998-2002) 32.7 Singapore: Chinese (1998-2002) 31.7 Denmark (1998-2002) 29.8 Canada (1998-2002) 29.4 The Netherlands (1998-2002) 28.7 USA, SEER (9 Registries): White (1998-2002) 27.9 Italy, Varese Province (1998-2000) 27.5 UK, Scotland (1998-2002) 27.5 Slovakia (1998-2002) 26.7 France, Bas-Rhin (1998-2002) 26.1 Switzerland, Geneva (1998-2002) 24.9 Sweden (1998-2002) 23.4 Spain, Navarra (1998-2002) 22.1 Japan, Osaka Prefecture (1998-2002) 21.7 Finland (1998-2002) 19.5 Source: Cancer Incidence in Five Continents, Volume IX Colorectal cancer (females)

13. Age-standardised relative survival from colorectal cancer by survival time and period of diagnosis 1-year 3-year 5-year 10-year

14. Some factors to consider in population-based survival comparisons Data quality factorsTumour-related factors Population coverageExtent of disease Completeness of ascertainmentSite (and sub-site) of tumour Accuracy of registrationTumour morphology Completeness of follow-upTumour biology ‘Death certificate only’ registrations Host factorsHealth care-related factors AgeScreening SexDiagnostic facilities Socio-economic status Treatment facilities Race/EthnicityQuality of treatment Co-morbidityFollow-up care Mortality from other causes Behaviour

19. Colorectal cancer diagnosed 2002: the delay-survival paradox

20. The waiting time paradox: the colorectal cancer example… Source: Torring ML et.al. Time to diagnosis and mortality in colorectal cancer: a cohort study in primary care.Br J Cancer 2011;104:934–40.

24. Risk of skin cancer following phototherapy for neonatal jaundice: retrospective cohort study David H Brewster, 1,2 Janet S Tucker, 3,4 Michael Fleming, 1 Carole Morris, 1 Diane L Stockton, 1 David J Lloyd, 3,4 Sohinee Bhattacharya, 3,4 James WT Chalmers 1,2 1 Information Services Division, NHS National Services Scotland 2 University of Edinburgh 3 University of Aberdeen 4 Aberdeen Maternity Hospital Our statistics on incidence, survival, and mortality, and on the prevalence of lifestyle risk factors suggest that we can So how does Scotland compare to other countries, and can we do better?