the 2002 healthcare conference surviving or thriving ? 29 september-1 october 2002 scarman house,...
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The 2002 Healthcare ConferenceSurviving or Thriving ?
29 September-1 October 2002
Scarman House, The University of Warwick, Coventry
Session A1 : Trends in CI - Cancer
Trends in incidence and mortality rates
Working Party / Research Sub-party Progress Report
Neil Robjohns & Richard Morris
Critical Illness Trends Research Group
Our Aims : To examine underlying trends in the factors influencing UK
Insured Critical Illness claim rates, and from these, to assess : The historic trend in incidence and death rates for the major CI’s Any pointers for future trends in Standalone CI, Mortality and hence
Accelerated CI.
Formed in March 2001
Cancer Sub-Group Members
ActuariesAzim Dinani
Richard Morris
Neil Robjohns
Medical ExpertsProfessor Rubens - Consultant Oncologist
Cancer Trends
England & Wales population trends - recap Variation by deprivation category International comparisons Incidence versus mortality Lung cancer / modelling impact of smoking Future trends
Cancer Incidence and Mortality Rates, 1971 - 97All Ages
0
100
200
300
400
500
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
Ra
tes
pe
r 1
00
,00
0
Male Incidence Female Incidence
Male Mortality Female Mortality
Cancer Incidence and Mortality Rates, 1971 - 97"Key Insurance Ages"
0
100
200
300
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
Ra
tes
pe
r 1
00
,00
0
Male Incidence Female Incidence
Male Mortality Female Mortality
Possible Reasons Behind Observed Trends
Issues with Data Recording Cancer Screening Initiatives Behavioural changes Treatment
of Cancer of other illnesses
Awareness Other ?
Breast CancerChanges in Incidence Rates, by age band, over 1971 - 97
0
50
100
150
200
250
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
45-49 50-54 55-59 60-64 65-69
Prostate CancerChanges in Incidence Rates, by age band, over 1971 - 97
0
50
100
150
200
250
300
350
400
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Lung CancerChanges in Incidence Rates, by age band, over 1971 - 97
Males
-
100
200
300
1971 1975 1979 1983 1987 1991 1995
35-39 45-49 55-59
65-69 75-79 85+
Females
-
100
200
300
1971 1975 1979 1983 1987 1991 1995
35-39 45-49 55-59
65-69 75-79 85+
Malignant MelanomaChanges in Incidence Rates for Males, by age band, over 1971 - 97
0
100
200
300
400
500
600
700
800
900
1000
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
35-39 45-49 55-59 65-69 75-79 85+
Breast CancerChanges in Mortality Rates, by age band, over 1971 - 97
0
20
40
60
80
100
120
140
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
35-39 40-44 45-49 50-54 55-59 60-64
Stomach CancerChanges in Incidence Rates for Males, by age band, over 1971 - 97
0
20
40
60
80
100
120
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
45-49 50-54 55-59 60-64 65-69
Testicular CancerChanges in Incidence Rates, by age band, over 1971 - 97
0
50
100
150
200
250
300
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
20-24 25-29 30-34 35-39 40-44
Cancer Incidence Rates by Site of CancerFemales, 1997
Key Insured Ages
Breast47%
Colorectal6%
Lung6%
Uterus4%
Cervix5%
Ovary6%
Stomach1%
NHL3%
Bladder & Pancreas
2%
Malignant melanoma
4%Other16%
All Ages
Breast29%
Colorectal12%
Lung11%
Uterus4%
Cervix2%
Ovary5%
Stomach3%
NHL3%
Bladder & Pancreas
6%
Malignant Melanoma
3%
Other22%
Cancer Incidence Rates by Site of CancerMales, 1997
All Ages
Lung19%
Prostate17%
Colorectal14%
Bladder & Pancreas
9%
Stomach5%
NHL3%
Mouth & Oesophagus
5%
Kidney3%
Testis1%
Leukaemia3%
Malignant Melanoma
2% Other19%
Key Insured Ages
Lung15%
Prostate6%
Colorectal13%
Bladder & Pancreas8%
Stomach4%
NHL6%
Mouth & Oesophagus
8%
Kidney4%
Testis5%
Leukaemia3%
Malignant melanoma5%
Other23%
Summary of Trends in Cancer Incidence and MortalityAverage Change % pa, for Females, aged 40 - 59, over 1971 - 97
Size of Balls Indicates Relative Importance of Cancer Site, measured by Incidence Rates in 1997.
-6.0%
-4.0%
-2.0%
0.0%
2.0%
4.0%
6.0%
-6.0% -4.0% -2.0% 0.0% 2.0% 4.0%
Change in Mortality, %pa
Ch
ang
e in
In
cid
ence
, %
pa
Breast
Other
Uterus & Ovary
Colorectal
Lung
Cervix
Malignant melanoma
NHL
Pancreas & Bladder
Mouth & Oesophagus
Kidney
Stomach
Summary of Trends in Cancer Incidence and MortalityAverage Change % pa, for Males, aged 40 - 59, over 1971 - 97
Size of Balls Indicates Relative Importance of Cancer Site, measured by Incidence Rates in 1997.
-6.0%
-4.0%
-2.0%
0.0%
2.0%
4.0%
6.0%
-6.0% -4.0% -2.0% 0.0% 2.0% 4.0%
Change in Mortality, %pa
Ch
ang
e in
In
cid
ence
, %
pa
Other
Lung
Colorectal
Pancreas & Bladder
Mouth & Oesophagus
Prostate
NHL
Stomach
Kidney
Malignant melanoma
Testis
Some Thoughts Looking Forwards
Tentative Initial Views :
Cancer Mortality : “Good News” ? “Continuing Reductions, at least for ages below 65” ?
Cancer Incidence : “Bad News” ? “Underlying, steady increase, plus jumps up” ? !
Cancer Trends
England & Wales population trends - recap Variation by deprivation category International comparisons Incidence versus mortality Lung cancer / modelling impact of smoking Future trends
Variation by deprivation category
Scottish data Carstairs & Morris deprivation categories:
Postcode based
Categories 1-7 (1=“affluent”; 7=“deprived”) Classes 1-3 = Insured class? Key Sites (data limited)
Split of Scottish Population by Deprivation Category
6%
14%
22%
24%
15%
11%
7%2%
1
2
3
4
5
6
7
Unassigned
1991 Data
Link with deprivation category
Inception Rates
Mortality Rates
Positive Negative InconclusiveLung Breast Colo-rectal
Cervix Prostate KidneyBladder Brain LeukaemiaLarynx Malignant melanoma
Oesphagus TestisPancreas Ovary
Positive Negative InconclusiveLung Prostate Colo-rectal
Cervix Brain KidneyBladder Malignant melanoma LeukaemiaLarynx Ovary Breast
Oesphagus TestisPancreas
Link with deprivation code: Lung Cancer
Mortality & Incidence: Positive correlation Lagged link to smoker prevalence
Causes? Smoking Air pollution?
Cohort effect (e.g. cigarette smoking) Temporal effect (e.g. air pollution, cigarette
composition (tar content), new treatment) Sharp fall in mortality over next 5-10 years?
Smoker Prevalence 1974-1998: Females
0
5
10
15
20
25
30
35
40
45
50
1974 1978 1982 1986 1990 1994 1998
Prev
alen
ce (%
)
I II
IIINM IIIM
IV V
0
20
40
60
80
100
120
1974 1978 1982 1986 1990 1994 1998In
dex
I II
IIINM IIIM
IV V
England & Wales: General Household Survey 2000
Smoker Prevalence 1974-1998: Males
0
10
20
30
40
50
60
70
1974 1978 1982 1986 1990 1994 1998
Prev
alen
ce (%
)
I II
IIINM IIIM
IV V
0
20
40
60
80
100
120
1974 1978 1982 1986 1990 1994 1998In
dex
I II
IIINM IIIM
IV V
England & Wales: General Household Survey 2000
Annualised change in inception rate: 1982-2000:Lung Cancer - Males Ages:40-59
(4%)
(2%)
0%
1 2 3 4 5 6 7
Deprivation Code
An
nu
alised
Rate
of
Ch
an
ge (
%)
Annualised change in inception rate: 1982-2000:Lung Cancer - Females Ages:40-59
(4%)
(2%)
0%
2%
1 2 3 4 5 6 7
Deprivation Code
An
nu
alised
Rate
of
Ch
an
ge (
%)
Scottish Population Data : Trends by Deprivation Category, 1982-2000Rates per 10,000
Incidence, I See LegendLung Cancer 40-59 standardisedMenCritical Illness Sex Event Deprivation Category Age Band
-
0,5
1,0
1,5
2,0
2,5
3,0
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Ins_
All_
Scottish Population Data : Trends by Deprivation Category, 1982-2000Index (1982 = 100)
40-59 standardisedLung Cancer Men Incidence, I See LegendCritical Illness Sex Event Deprivation Category Age Band
0
20
40
60
80
100
120
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Ins_
All_
Scottish Population Data : Trends by Deprivation Category, 1982-2000Rates per 10,000
Incidence, I See LegendLung Cancer 40-59 standardisedWomenCritical Illness Sex Event Deprivation Category Age Band
-
0,2
0,4
0,6
0,8
1,0
1,2
1,4
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Ins_
All_
Scottish Population Data : Trends by Deprivation Category, 1982-2000Index (1982 = 100)
40-59 standardisedLung Cancer Women Incidence, I See LegendCritical Illness Sex Event Deprivation Category Age Band
0
20
40
60
80
100
120
140
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Ins_
All_
Link with deprivation code: Breast Cancer
Incidence: negative correlation Screening related difference? Social / environmental differences Reproductive history
Mortality: link inconclusive Differences in treatment? Differences in stage of presentation?
Scottish Population Data : Trends by Deprivation Category, 1982-2000Rates per 10,000
Incidence, I See LegendBreast Cancer All - StandardisedWomenCritical Illness Sex Event Deprivation Category Age Band
-
2,0
4,0
6,0
8,0
10,0
12,0
14,0
16,0
18,0
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Cat1_
Cat2_
Cat3_
Cat4_
Cat5_
Cat6_
Cat7_
All_
Scottish Population Data : Trends by Deprivation Category, 1982-2000Rates per 10,000
Incidence, I See LegendBreast Cancer 40-59 standardisedWomenCritical Illness Sex Event Deprivation Category Age Band
-
1,0
2,0
3,0
4,0
5,0
6,0
7,0
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Ins_
All_
Scottish Population Data : Trends by Deprivation Category, 1982-2000Index (1982 = 100)
40-59 standardisedBreast Cancer Women Incidence, I See LegendCritical Illness Sex Event Deprivation Category Age Band
0
20
40
60
80
100
120
140
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Ins_
All_
Scottish Population Data : Trends by Deprivation Category, 1982-2000Rates per 10,000
Mortality, Q See LegendBreast Cancer 40-59 standardisedWomenCritical Illness Sex Event Deprivation Category Age Band
-
0,2
0,4
0,6
0,8
1,0
1,2
1,4
1,6
1,8
2,0
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Ins_
All_
Scottish Population Data : Trends by Deprivation Category, 1982-2000Index (1982 = 100)
40-59 standardisedBreast Cancer Women Mortality, Q See LegendCritical Illness Sex Event Deprivation Category Age Band
0
20
40
60
80
100
120
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Ins_
All_
Link with deprivation code: Prostate Cancer
Incidence & mortality: negative correlation Screening related? Hormonal factors? Diet?
Annualised change in inception rate: 1982-2000:Prostate Cancer - Males Ages:40-59
(6%)
(4%)
(2%)
0%
2%
4%
6%
1 2 3 4 5 6 7
Deprivation Code
An
nu
alis
ed
Ra
te o
f C
ha
ng
e (
%)
Scottish Population Data : Trends by Deprivation Category, 1982-2000Rates per 10,000
Incidence, I See LegendProstate Cancer All - StandardisedMenCritical Illness Sex Event Deprivation Category Age Band
-
1,0
2,0
3,0
4,0
5,0
6,0
7,0
8,0
9,0
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Ins_
All_
Scottish Population Data : Trends by Deprivation Category, 1982-2000Index (1982 = 100)
All - StandardisedProstate Cancer Men Incidence, I See LegendCritical Illness Sex Event Deprivation Category Age Band
0
20
40
60
80
100
120
140
160
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Ins_
All_
Link with deprivation code: Cervical Cancer
Incidence & mortality: Positive correlation Causes?
Sexual activity Smoking Parity
Scottish Population Data : Trends by Deprivation Category, 1982-2000Rates per 10,000
Incidence, I See LegendCervical Cancer 40-59 standardisedWomenCritical Illness Sex Event Deprivation Category Age Band
-
0,5
1,0
1,5
2,0
2,5
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Ins_
All_
Scottish Population Data : Trends by Deprivation Category, 1982-2000Index (1982 = 100)
40-59 standardisedCervical Cancer Women Incidence, I See LegendCritical Illness Sex Event Deprivation Category Age Band
0
20
40
60
80
100
120
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Ins_
All_
Link with deprivation code: Colo-rectal Cancer
Incidence & mortality: No clear link Causes?
High-fat diet Low physical activity Reproductive history
Cancer by Deprivation Code: Trends
Lung cancer Smoker-related trend to emerge?
Breast cancer No identifiable difference in trend
Prostate cancer Reflection of trend in screening?
Cervical cancer No identifiable difference in trend
Colo-rectal cancer Inconclusive link to deprivation code
Cancer Trends
England & Wales population trends - recap Variation by deprivation category International comparisons Incidence versus mortality Lung cancer / modelling impact of smoking Future trends
International ComparisonsAll Cancers ; All Ages
See Legend All CISee Legend
Rates per 10,000
All - StandardisedSee Legend
Cancer Trends 1971 - 1998
Country Sex Event Cancer Site Age Band
Can_F_Q_Can_M_Q_EandW_M_Q_ EandW_F_Q_ Scot_M_Q_ Scot_F_Q_ USA_M_Q_ USA_F_Q_
USA_M_I_ USA_F_I_ Can_M_I_ Can_F_I_EandW_M_I_ EandW_F_I_ Scot_M_I_ Scot_F_I_
-
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
International ComparisonsAll Cancers ; Ages 40 - 59
See Legend All CISee Legend
Rates per 10,000
40-59 standardisedSee Legend
Cancer Trends 1971 - 1998
Country Sex Event Cancer Site Age Band
Can_F_Q_Can_M_Q_EandW_M_Q_ EandW_F_Q_ Scot_M_Q_ Scot_F_Q_ USA_M_Q_ USA_F_Q_
USA_M_I_ USA_F_I_ Can_M_I_ Can_F_I_EandW_M_I_ EandW_F_I_ Scot_M_I_ Scot_F_I_
-
10.0
20.0
30.0
40.0
50.0
60.0
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
International ComparisonsLung Cancer ; Ages 40 - 59
See Legend LungSee Legend
Rates per 10,000
40-59 standardisedSee Legend
Cancer Trends 1971 - 1998
Country Sex Event Cancer Site Age Band
Can_F_Q_Can_M_Q_EandW_M_Q_ EandW_F_Q_ Scot_M_Q_ Scot_F_Q_ USA_M_Q_ USA_F_Q_
USA_M_I_ USA_F_I_ Can_M_I_ Can_F_I_EandW_M_I_ EandW_F_I_ Scot_M_I_ Scot_F_I_
-
2.0
4.0
6.0
8.0
10.0
12.0
14.0
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
International ComparisonsProstate Cancer ; All Ages
See Legend ProstateSee Legend
Rates per 10,000
All - StandardisedSee Legend
Cancer Trends 1971 - 1998
Country Sex Event Cancer Site Age Band
Can_F_Q_Can_M_Q_EandW_M_Q_ EandW_F_Q_ Scot_M_Q_ Scot_F_Q_ USA_M_Q_ USA_F_Q_
USA_M_I_ USA_F_I_ Can_M_I_ Can_F_I_EandW_M_I_ EandW_F_I_ Scot_M_I_ Scot_F_I_
-
5.0
10.0
15.0
20.0
25.0
30.0
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
Prostate Cancer “Screening”
See Legend ProstateUSA
Rates per 10,000
See LegendMen
Cancer Trends 1971 - 1998
Country Sex Event Cancer Site Age Band
Not in UseQ_75-79Q_50-54 Q_55-59 Q_60-64 Q_65-69 Not in Use Q_70-74
Not in Use I_70-74 I_75-79 Not in UseI_50-54 I_55-59 I_60-64 I_65-69
-
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0
180.0
200.0
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
International ComparisonsBreast Cancer ; All Ages
See Legend BreastSee Legend
Rates per 10,000
All - StandardisedSee Legend
Cancer Trends 1971 - 1998
Country Sex Event Cancer Site Age Band
Can_F_Q_Can_M_Q_EandW_M_Q_ EandW_F_Q_ Scot_M_Q_ Scot_F_Q_ USA_M_Q_ USA_F_Q_
USA_M_I_ USA_F_I_ Can_M_I_ Can_F_I_EandW_M_I_ EandW_F_I_ Scot_M_I_ Scot_F_I_
-
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
International ComparisonsMalignant Melanoma ; All Ages
See Legend MelanomaSee Legend
Rates per 10,000
All - StandardisedSee Legend
Cancer Trends 1971 - 1998
Country Sex Event Cancer Site Age Band
Can_F_Q_Can_M_Q_EandW_M_Q_ EandW_F_Q_ Scot_M_Q_ Scot_F_Q_ USA_M_Q_ USA_F_Q_
USA_M_I_ USA_F_I_ Can_M_I_ Can_F_I_EandW_M_I_ EandW_F_I_ Scot_M_I_ Scot_F_I_
-
0.5
1.0
1.5
2.0
2.5
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
Cancer Trends
England & Wales population trends - recap Variation by deprivation category International comparisons Incidence versus mortality Lung cancer / modelling impact of smoking Future trends
Ratio of Mortality Rate to Incidence RateMales ; England & Wales ; 1998
Ages 40 - 59 All Ages
All CI Cancers 51% 62%
Stomach 58% 71%Colorectal 41% 49%Lung 86% 92%Malignant Melanoma 26% 31%Prostate 17% 42%Testis 6% 5%Bladder 20% 37%
Ratio of Mortality Rate to Incidence RateFemales ; England & Wales ; 1998
Ages 40 - 59 All Ages
All CI Cancers 34% 55%
Stomach 57% 79%Colorectal 38% 50%Lung 80% 89%Malignant Melanoma 16% 25%Breast 22% 34%Cervix 42% 42%Ovary 52% 76%
Ratio of Mortality Rate to Incidence RateMales ; Ages 40 - 59 ; 1998
E&W Scotland USA
All CI Cancers 51% 49% 35%
Stomach 58% 59% 52%Colorectal 41% 43% 31%Lung 86% 79% 86%Malignant Melanoma 26% 26% 15%Prostate 17% 17% 3%Testis 6% 5% 6%Bladder 20% 21% 10%
Ratio of Mortality Rate to Incidence RateFemales ; Ages 40 - 59 ; 1998
E&W Scotland USA
All CI Cancers 34% 34% 26%
Stomach 57% 64% 58%Colorectal 38% 37% 30%Lung 80% 70% 70%Malignant Melanoma 16% 19% 9%Breast 22% 24% 16%Cervix 42% 26% 32%Ovary 52% 41% 35%
Cancer Trends
England & Wales population trends - recap Variation by deprivation category International comparisons Incidence versus mortality Lung cancer / modelling impact of smoking Future trends
Observed Lung Cancer Incidence and Mortality RatesEngland & Wales
I_40-44 I_50-54 I_60-64 I_65-69 I_70-74 I_75-79 I_80-84 I_85+
Q_85+Q_80-84Q_40-44 Q_50-54 Q_60-64 Q_65-69 Q_70-74 Q_75-79
Cancer Trends 1971 - 1998
Country Sex Event Cancer Site Age BandSee Legend LungEngland & Wales
Rates per 10,000
See LegendMen
-
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
Trend in Smoker Proportions in England And WalesAll Adult Ages
0
10
20
30
40
50
60
1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998
Men Women
Trend in Smoker Proportions in England And WalesBy Age Group
15
20
25
30
35
40
45
50
55
60
1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998
Men, 16-19 Men, 20-24 Men, 25-34 Men, 35-49 Men, 50-59 Men, 60+
Women, 16-19 Women, 20-24 Women, 25-34 Women, 35-49 Women, 50-59 Women, 60+
Modelling the Impact of Smoking
Build model to simulate population distribution by smoking habit, over time
Use Doll & Peto style formula
Adjust parameters to seek a good fit against observed lung cancer rates over time For Males, England & Wales, 1974 - 1998
Then project forward by making assumptions on trend in smoking habits
Modelling the Impact of Smoking
Doll & Peto Studied mortality / morbidity effects of cigarette
smoking by following a cohort of British Doctors Modelled relationship between lung cancer incidence
and level and duration of smoking habit 1951 – 1971
Rate = 0.273 * 10 –12 (dose + 6)2 * (age – 22.5)4.5
Fit of Model against Actual
0.000
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0.008
0.009
0.010
1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998
50-54, P 55-59, P 60-64, P 65-69, P 70-74, P 75-79, P 80-84, P 85+, P
50-54, A 55-59, A 60-64, A 65-69, A 70-74, A 75-79, A 80-84, A 85+, A
Fit of Actual Rates against Model
0%
20%
40%
60%
80%
100%
120%
140%
1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Fit of Actual Rates against Model
0%
20%
40%
60%
80%
100%
120%
140%
35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85plus
1974-1978 1979-1983 1984-1988 1989-1993 1994-1998 1974-1998
Model Projection to 2010Assuming current rates of change in smoker status remain constant
0.000
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0.008
0.009
0.010
1974 1977 1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010
Male 40-44 Male 45-49 Male 50-54 Male 55-59 Male 60-64
Male 65-69 Male 70-74 Male 75-79 Male 80-84 Male 85-89
The next challenge !!
I_40-44 I_50-54 I_60-64 I_65-69 I_70-74 I_75-79 I_80-84 I_85+
Q_85+Q_80-84Q_40-44 Q_50-54 Q_60-64 Q_65-69 Q_70-74 Q_75-79
Cancer Trends 1971 - 1998
Country Sex Event Cancer Site Age BandSee Legend LungEngland & Wales
Rates per 10,000
See LegendWomen
-
5.0
10.0
15.0
20.0
25.0
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
Cancer Trends
England & Wales population trends - recap Variation by deprivation category International comparisons Incidence versus mortality Lung cancer / modelling impact of smoking Future trends
Future Cancer TrendsImpact of Medical Advances :
Prevention Reduce Smoking ; Dietary Advice ; Protect from UV light Overall, effect positive but likely to be relatively small
Detection Rapid advance in screening / tests Questionable value for widespread screening But tests likely to be commercially available Potential for significant step-increases in “incidence”
Treatment Expect reductions in morbidity, plus slow gains on mortality
Session A1 : Trends in CI - Cancer
Trends in incidence and mortality rates
Working Party / Research Sub-party Progress Report
Neil Robjohns & Richard Morris