Cancer survival by socio-economic group

Since the 1970s, there have been well-documented inequalities in cancer survival in England. The NHS Cancer Plan, which was published in September 2000, aimed to reduce inequalities in cancer survival between rich and poor.[1] This has now been superseded by the Improving Outcomes: A Strategy for Cancer, which was published in 2011.[2]

During the 1990s cancer survival improved significantly for almost all the common cancers. However, for many cancers, survival improved more for patients living in more affluent areas than for those in more deprived areas.[3]

Possible explanations for the lower survival in people living in more deprived areas include differences in:

  • diagnosis (delays, advanced stage of disease);
  • treatment (delays, poorer access to optimal care and lower compliance);
  • worse general health (worse in more deprived) and type of disease (histological type or more aggressive disease).[1,4-12]

When one-year survival is high, as it is for malignant melanoma and cancers of the female breast, prostate and testis, then there is less room for improvement, especially in the people living in more affluent areas, in whom survival is highest. Most of the gains in survival are experienced in people living in the most deprived areas where there remains more scope for improvement. The increase in the survival gap between people living in the most affluent and most deprived areas for prostate cancer appears to be largely the result of socio-economic differences in access to prostate specific antigen (PSA) testing.[13]

References

  1. Department of Health. The NHS cancer plan. London: Department of Health; 2000.
  2. Department of Health. Improving Outcomes: A Strategy for Cancer. London: Department of Health; 2011.
  3. Rachet B, Ellis L, Maringe C, et al. Socioeconomic inequalities in cancer survival in England after the NHS Cancer Plan. Brit J Cancer 2010;103(4):446-53.
  4. Pollock AM, Vickers N. Deprivation and emergency admissions for cancers of colorectum, lung, and breast in south east England: ecological study. BMJ 1998: 317(7153): 245-52.
  5. Carnon AG, Ssemwogerere A, Lamont DW, et al. Relation between socioeconomic deprivation and pathological prognostic factors in women with breast cancer. BMJ 1994:309(6961):1054-7.
  6. Auvinen A, Karjalainen S. Possible explanations for social class differences in cancer patient survival. In: Kogevinas M, Pearce N, Susser M, et al, eds. Social inequalities and cancer. Lyon: IARC Scientific Publications, 1997: 377-97.
  7. Leon DA, Wilkinson RG, Inequalities in prognosis: socioeconomic differences in cancer and heart disease survival. In Fox J, ed. Health inequalities in European countries. Aldershot: Gower, 1989, 280-300.
  8. Coleman MP, Babb P, Sloggett A, et al. Socioeconomic inequalities in cancer survival in England and Wales. Cancer 2001;91(1 Suppl):208-16.
  9. Coates AS. Breast cancer: delays, dilemmas, and delusions. Lancet 1999;353(9159):1112-3.
  10. Richards MA, Westcombe AM, Love SB, et al. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet 1999;353(9159):1119-26.
  11. Coleman MP, Rachet B, Woods LM, et al. Trends and socioeconomic inequalities in cancer survival in England and Wales up to 2001. Brit J Cancer 2004;90(7):1367-73.
  12. Coleman, M.P, Babb P, Damiecki P, et al. Cancer Survival Trends in England and Wales, 1971-1995: Deprivation and NHS Region. London: ONS; 1999.
  13. Williams N, Hughes LJ, Turner EL, et al. Prostate-specific antigen testing rates remain low in UK general practice: a cross-sectional study in six English cities. BJU Int 2011;108(9):1402-8.
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One-year cancer survival for adults in England is generally lower among patients living in more deprived areas.[1] Overall, between 1996 and 2006, the deprivation gap in one-year survival narrowed for 8 cancers in men and 13 in women, but widened for 9 cancers in men and 5 in women. The largest observed deprivation gap increase between 1996 and 2006 was for female oesophageal cancer where the deprivation gap increased by 6.5 percentage points over this period. The largest decrease was observed for Hodgkin lymphoma in males where the deprivation gap decreased by 8.7 percentage points over the same period.

Deprivation Gap in One-Year Relative Survival (%) by Sex in 1996 and 2006

Cancer Type Sex 1996 2006
Survival in most affluent Deprivation gap (%) Survival in most affluent Deprivation gap (%)
Oesophagus Male
Female
30
25.3
-4.8
-0.9
43.9
38.2
-8.4
-7.4
Stomach Male
Female
34.9
33.6
-5
-4.8
43.3
40.4
-4.4
-3.7
Colon Male
Female
72.1
69.2
-8
-7.2
76.6
75.4
-7.7
-10.6
Rectum Male
Female
79.0
77.7
-8.9
-8.7
82.6
82.2
-6.8
-9.4
Pancreas Male
Female
14.9
14.2
-2.5
-3.9
19.4
17.5
-4.9
-2.6
Larynx Male 89.2 -6.6 90 -7.4
Lung Male
Female
24.8
24.7
-3.3
-1.5
27.4
30.9
-1.6
-3.1
Malignant melanoma Male
Female
95.6
97.8
-3.5
-1.4
97.1
98
-2.9
-0.4
Breast Female 95.8 -4 97.8 -2.6
Cervix Female 88.9 -7.7 90.3 -6
Uterus Female 88.9 -4.1 92.8 -3.8
Ovary Female 67.9 -4.6 71.9 -3.4
Prostate Male 89.6 -3.6 97 -2.9
Testis Male 98.9 -1.5 99.5 -1.7
Kidney Male
Female
68
63.8
-6.9
-6.6
71.8
70.9
-7
-4.2
Bladder Male
Female
86.1
77.1
-7
-9.9
80.2
71.6
-7.1
-14.2
Brain Male
Female
30.2
31.6
0.6
-7.6
36.4
30.6
-1.5
-1
Hodgkin lymphoma Male
Female
92.8
94.7
-1.3
-6.1
86.5
86.4
7.4
2.0
Non-Hodgkin lymphoma Male
Female
73.2
75
-7.8
-10.7
77.6
77.7
-5.7
-4.3
Myeloma Male
Female
67.1
64
-6.1
-4.2
71.5
68.5
-9
0.4
Leukaemia Male
Female
66.9
63.1
-4.2
-5.1
65.2
61.1
-6.6
-1.2

Rectum includes anus (C19-C21). Ovary excludes overlapping lesion of female genital organs and unspecified female genital organs (C56,C57.0-C57.7). Brain includes malignant brain tumours only (C71).

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Three-year cancer survival for adults in England is also generally lower among patients living in more deprived areas.[1] Overall, between 1996 and 2000, a significant deficit in three-year survival among patients living in the more deprived areas was observed for 33 of the 35 cancer-sex combinations examined.[1] During 2001-2003 a deficit was observed for 26 of the 35, and during 2004-2006 it was observed for 24 of the 35 cancer-sex combinations examined. Brain cancers in men, where more deprived groups have higher survival, is the only site where the deprivation gap was consistently positive throughout the period 1996-2006.[1]

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A 2011 study aimed to quantify the public health impact of inequalities in cancer survival between most and least deprived, by estimating the number of cancer-related deaths that would have been avoidable if all patients were to have the same cancer survival as those living in the most affluent areas.[1]

For patients diagnosed with one of 21 common cancers in England during 2004-2006, a total of 7,122 of the 64,940 excess (cancer-related) deaths a year would have been avoidable within three years since diagnosis if survival for all patients had been as high as in patients living in the most affluent areas.

Last reviewed:

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