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. This has now been superseded by the Improving Outcomes: A Strategy for Cancer, which was published in 2011.
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.
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.
- Department of Health. The NHS cancer plan. London: Department of Health; 2000.
- Department of Health. Improving Outcomes: A Strategy for Cancer. London: Department of Health; 2011.
- 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.
- 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.
- 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.
- 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.
- 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.
- Coleman MP, Babb P, Sloggett A, et al. Socioeconomic inequalities in cancer survival in England and Wales. Cancer 2001;91(1 Suppl):208-16.
- Coates AS. Breast cancer: delays, dilemmas, and delusions. Lancet 1999;353(9159):1112-3.
- 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.
- 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.
- 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.
- 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.