Improvements in cancer survival in Northern Ireland

There have been improvements in cancer survival in Northern Ireland between 1993 and 2004, according to a new report from the Northern Ireland Cancer Registry (NICR), launched at Queen’s.

According to the report, during 1993-2003 there was significant and continuous improvement in both one and five-year relative survival for the category ‘all cancers’. Estimates using period analysis also suggest that five-year survival will improve further for patients diagnosed in 2001 to 2004.

Welcoming the report, Dr Anna Gavin, Director of the NICR said: “This publication will play a significant part in the future development of cancer care in Northern Ireland. The study is also included in Eurocare 4 which allows comparison of information between 83 cancer registries in 22 European countries. This in itself is a very important development for Northern Ireland.

“The report also emphasises the impact of smoking in the changing patterns of cancer incidence. While tobacco use in males and females is now similar, we are still seeing the effects of tobacco use in the population 20 to 30 years ago when men smoked at least twice as much as women.

“This has resulted in levels of lung, stomach and oesophageal cancer in males, which is one and a half times those in females. Unfortunately, these cancers have poor relative survival - lung cancer at 5 years is 9 per cent, stomach 17 per cent and oesophagus 13 per cent. In addition people with a tobacco related cancer tend also to have other tobacco related diseases, especially heart disease, which reduces the chance of a full recovery.

“People in Northern Ireland are reluctant to bother their GP and so often neglect the early signs of cancer: a lump, change in bowel habit, weight loss, a sore which does not heal, a cough which does not clear up, unusual bleeding or pain. These may indicate an early cancer and a simple check up could save a person’s life. Breast and cervical cancers may be picked up early by screening and so women invited for such programmes should attend.

“There are ongoing moves within the Health Service to improve services for cancer patients and reduce waiting times. This should improve the treatment of cancer patients and survival. Prevention is, however, still better than cure and people are urged to take simple lifestyle steps to reduce their risk of ever getting cancer.”

Vice-Chancellor of Queen’s, Professor Peter Gregson said: “Timely, detailed and accurate statistical information is crucial in the fight against cancer. As this comprehensive report illustrates, the work of Dr Gavin and her team in the Northern Ireland Cancer Registry plays a vital and valued role in this respect by providing key information to support research, planning and education.

“It is the close working relationship between the Northern Ireland Cancer Registry and the Centre for Cancer Research and Cell Biology led by Professor Paddy Johnston, coupled with Queen's links with the National Health Service, which places Northern Ireland at the forefront of worldwide initiatives to relieve the human suffering of cancer.”

Professor Roy Spence, Consultant Surgeon and Chairman of the Council of Northern Ireland Cancer Registry added: “There have been many recent changes to Cancer Services in Northern Ireland such as advice on alarm symptoms, screening for breast and cervical cancer and the re-organisation of cancer services.

“These survival statistics provide a window through which we can measure the impact of change and even though the time of follow up is short it is pleasing to note detectable improvements. While measuring these improvements, this data also highlights areas where survival has remained unchanged and where we need to concentrate our efforts. Much has been achieved and there is still much to do.”

The Northern Ireland Cancer Registry (NICR) is a population-based registry for the £1.7million people usually resident in Northern Ireland. Established in 1994 it is the principal source of information on cancer in Northern Ireland.

The Registry is part of the Centre for Clinical and Population Sciences (CCPS) in the School of Medicine and Dentistry at Queen’s University Belfast. It is funded by the Department of Health and Social Services, Northern Ireland (DHSSPSNI). The Registry is a member of the UK Association of Cancer Registries (UKACR) and has collaborative working links with the National Cancer Registry of Ireland (NCRI) and the National Cancer Institute USA (NCI). Northern Ireland also has data included in the EUROCARE study.

Most common cancers
In Northern Ireland, non-melanoma skin cancer (NMSC) made up 26.4 per cent of all male and 24.3 per cent of all female cancers between 1993 and 2004. Excluding this cancer type, the most commonly diagnosed male cancers, in descending order, were prostrate (12.9 per cent), lung
(12.8 per cent) and colorectal (11.3 per cent). In females, they were breast (20.8 per cent), colorectal (10.2 per cent) and lung (7.6 per cent).

Cancer deaths
During the same time period, the same cancers (with the exception of NMSC), were the most common causes of cancer death but in a different order. Amongst males, lung cancer was the most common cause of cancer death, while among females breast cancer was the most common cause.

During 1993 to 2004 there were on average 4,318 male and 4,414 female cases of cancer diagnosed each year in Northern Ireland. Excluding NMSC, there were 1,863 male and 1,746 female deaths from cancer each year.

Improvements in relative survival
During the 1993 to 2003 period covered by the report, one year relative survival improved for all patients with non-Hodgkins lymphoma, colorectal or lung cancer, for females with oral or breast cancer and for males with prostate cancer.

Five year relative survival also improved between 1993 and 2000 for males with oesophageal or prostate cancer and females with colorectal or breast cancer.

Cancer trends
Amongst males, trends highlighted in the report show that incidences and mortality of oral, stomach and lung cancer have decreased, while incidence of prostate cancer has risen due to increased use of prostate specific antigen or PSA testing. The need to take care in the sun and particularly to avoid sunburn in childhood and sunbeds is also highlighted, as figures show an increase in incidences and mortality from melanoma in males.

In the Northern Ireland female population, deaths from melanoma, leukaemia, colorectal and breast cancers have fallen, as have rates of stomach, cervical and colorectal cancer. The report also shows though, that among females, incidence rates of melanoma, breast, uterus and ovarian cancer have increased.

Relative survival and gender
Significant differences also occurred between female and male relative survival during 1993-2004 according to the report. Overall, relative survival was significantly better among females than males, a fact attributed to males having a higher percentage of cancers which have poor survival, such as lung cancer. The more common female cancers, such as breast cancer, have higher survival than prostrate cancer.

Explaining further, Dr Anna Gavin, Director of the Northern Ireland Cancer Registry said: “Overall there is a five year relative survival of 51 per cent among females compared to 39 per cent in males. This may be explained by the differences in the types of cancer most commonly experienced by women compared with men. For example, 996 women are diagnosed with breast cancer annually and its five year relative survival is 80 per cent compared with the male disease, prostate cancer with 656 cases annually and the five year relative survival is only 64.5 per cent.”

Relative survival from bladder cancer was better among males than females, with 83.9 per cent of males, compared to 58.2 per cent of females diagnosed in 2001 to 2003, alive after one year.

Regarding five year relative survival from melanoma for patients diagnosed in 2001-2004, this was 14.7 per cent better for females than males.

Geographic variations
Increasing incidences of cancer and deaths in certain areas of Northern Ireland are shown in the report to be in line with deprivation. The 20 per cent most deprived areas in Northern Ireland have significantly higher levels of cancer. According to Dr Gavin, “If levels of cancer in Northern Ireland equalled that of the most affluent areas, there would be 16 per cent less cancer cases in Northern Ireland each year.”

Survival is also influenced by affluence with better survival among affluent groups than deprived for breast, lung and colorectal cancers.

Belfast, Derry and Newry and Mourne District Councils had higher than expected levels of cancer cases and deaths. This was driven by high incidence of lung (in Belfast and Derry), stomach (in Belfast and Newry and Mourne) and colorectal cancer (in Derry and Newry and Mourne). The report states that this is likely to be linked to the higher levels of deprivation experienced within these areas and the associated higher levels of tobacco usage.

Dr Gavin added: “If the rates of lung cancer experienced by those in the most deprived groups were the same as the most affluent there would be 1/3 (300 cases) less of lung cancer each year. Also there were detectable differences in survival by deprivation group with those in the most deprived fifth of the population experiencing poorer survival for lung and breast cancers.”

Relative survival and age
Relative survival for all cancers (excluding NMSC), between 1993 and 2000, varied by age. In particular for the category “all cancer” sites, except melanoma, one year relative survival among 15-64 year olds was significantly higher than for 65-99 year olds.

Childhood cancer
Data gathered for the report regarding childhood cancer, showed 24 cases per year among boys and 21 among girls between 2000 and 2004. There were no significant trends in incidence rates between 1993 and 2004. Likewise, there were no significant trends in mortality rates between 1993 and 2004.

Among boys and girls, survival rates were similar with 74 per cent of boys and 75.5 per cent of girls alive after five years. There were no significant changes in survival between 1993 to 1996 and 1997 to 2000.

Those patients who survived at least one year from diagnosis had improved long-term survival compared with the total group of patients. For‘all cancers’five year survival improved from 46 per centto 72 per cent and was 64 per centat 7 years.