Cancer survival and deprivation statistics

The results show that cancer survival for adults in England and Wales is generally lower among patients in more deprived groups, even after allowance is made for the higher mortality from all causes of death in the more deprived groups ( Table 6.1).

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Possible explanations 1-10 for the lower survival in more deprived groups include differences in:

• diagnosis (delays, advanced stage of disease);
• treatment (delays, poorer access to optimal care and lower compliance);
• worse general health and type of disease (histological type or more aggressive disease).

The deprivation gap in survival for patients diagnosed 1996-1999 was statistically significant for 8 out of 16 cancers in men and 5 out of 17 in women.

For some cancers the differences in survival between the most affluent and the most deprived groups are small (e.g. 1% for lung cancer) but the difference is still significant because large numbers of patients are involved.

Over the period 1986-1999 the deprivation gaps in survival between rich and poor became more marked for 12 out of 16 male cancers and 9 out of 17 female cancers examined.

For other cancers the deprivation gap in survival either did not change or reduced between 1986-1990 and 1996-1999. There was a significant reduction in the deprivation gap in survival for testicular and brain tumours in men and for melanoma of the skin in women.

When survival rates are high, as they are for both melanoma in women and testicular cancer in men, then there is less room for improvement, especially in the more affluent groups where rates are highest. Most of the gains in survival are experienced in the most deprived groups where there remains more scope for improvement.

The increase in the survival gap between the most affluent and most deprived groups for prostate cancer appears to be largely the result of socio-economic differences in access to PSA testing.

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Avoidable deaths

Having identified the gap in survival between the most affluent and most deprived, an estimate was made of the number of avoidable deaths. Among 682,350 adults of known deprivation status who were diagnosed with one of the 20 cancers analysed in England and Wales during 1996-1999, there were 3,200 avoidable deaths a year.

The corresponding figure for patients diagnosed during 1986-1990 with one of the same cancers was 2,050 a year.

The exceptional increase in the survival gradient for prostate cancer accounts for less than half of this increase in avoidable deaths.

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Background to survival statistics

These survival data are based on the analysis of cancer incidence and mortality data produced by the Office for National Statistics.

Survival rates covering all cancers arising in adults and children were published in Cancer Survival Trends in England and Wales in 1999. This publication included one-, five- and ten-year relative survival for patients diagnosed in England and Wales during 1971-1990 by geographic region and deprivation.

The analysis has recently been updated to include data on 2.2 million patients diagnosed during 1986-1999 with one of twenty common adult cancers and followed up to December 2001. 9

For patients diagnosed during 1991-1996 cohort analysis was used, as at least five years’ follow-up was available for all patients. For patients diagnosed more recently (1997-1999) five years follow-up were not available and complete analysis was used.

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Cancer Survival Summary

One of the aims of the NHS Cancer Plan, published in September 2000, is to reduce inequalities in cancer survival between rich and poor 8. Survival has improved for most cancers in both sexes during the 1990s. However, the gap between affluent and deprived groups has also increased for many cancers, with the important exceptions of breast cancer and melanoma in women and testicular cancer in men. Elimination of these gaps would prevent over 3,000 premature deaths in England and Wales each year.

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