Cancer survival in England and Wales at the end of the 20th century

Abstract

Survival has risen steadily since the 1970s for most cancers in adults in England and Wales, but persistent inequalities exist between those living in affluent and deprived areas. These differences are not seen for children. For many of the common adult cancers, these inequalities in survival (the 'deprivation gap') became more marked in the 1990s. This volume presents extended analyses of survival for adults diagnosed during the 14 years 1986-1999 and followed up to 2001, including trends in overall survival in England and Wales and trends in the deprivation gap in survival. The analyses include individual tumour data for 2.2 million cancer patients. This article outlines the structure of the supplement - an article for each of the 20 most common cancers in adults, followed by an expert commentary from one of the leading UK clinicians specialising in malignancies of that organ or system. The available data, quality control and methods of analysis are described here, rather than repeated in each of the 20 articles. We open the discussion between clinicians and epidemiologists on how to interpret the observed trends and inequalities in cancer survival, and we highlight some of the most important contrasts in these very different points of view. Survival improved substantially for adult cancer patients in England and Wales up to the end of the 20th century. Although socioeconomic inequalities in survival are remarkably persistent, the overall patterns suggest that these inequalities are largely avoidable.

Figure 1

Attenuation of the deprivation gradient in 1- and 5-year survival (%) by the use of larger geographic units to assign the deprivation category: Carstairs scores on the basis of census Enumeration Districts (ED) and electoral wards, women diagnosed with breast cancer, England and Wales, during 1991–1995. (Census Enumeration Districts have populations of approximately 500 persons (200 households); electoral wards have populations that are approximately ten times larger (see text).)

Figure 2

Observed and fitted mortality rates per 100 000 (log scale) by age, and by deprivation category based on the income domain of the Indices of Multiple Deprivation 1998: males and females, England and Wales, 1998. (Data points – observed mortality rates by 5-year age group (abridged life tables); only the data points for the most affluent and the most deprived categories are shown. Continuous lines – fitted mortality rates by single year of age (complete life tables); all five deprivation categories.)

Figure 3

Schema to show how the follow-up data contributed by cancer patients diagnosed in each year during 1986–1999 contribute to the survival estimates for successive calendar periods using cohort, complete and hybrid approaches (see text).

Figure 4

Schema to show how trends in the ‘deprivation gap’ in survival are evaluated: 5-year relative survival, rectal cancer, women diagnosed 1986–1999, England and Wales.