“Astounding” regional inequalities in cancer deaths across England

Cancer death rates vary hugely across different regions of England, with people living in some Northern cities roughly twice as likely to die from cancer before the age of 80 compared to some areas in London, according to new research.

The study, published in The Lancet Oncology, found that, in 2019, one in 10 women in Westminster died from cancer before the age of 80 compared to one in six in Manchester.

For men, the lowest rates were found in Harrow (one in eight), with the highest rates in Manchester (one in five).

Prof Majid Ezzati, senior author of the study says the results highlight “the astounding inequality in cancer deaths in different districts around England.”

Overall risk of dying from cancer has decreased over last two decades

To conduct the study, researchers used death records in England across nearly two decades (2002-2019) to measure the number of deaths caused by 10 cancers with the highest death toll. They then used a statistical model to estimate the risk of dying before the age of 80 from these cancers across 314 regions in England.

The study is the first to estimate how much the risk of dying from cancer in England has changed from 2002 to the onset of the Covid-19 pandemic across small geographical areas.

Promisingly, the research reveals that the overall risk of dying from cancer has decreased across all English districts in the last 20 years from one in six to one in eight for women and from one in five to one in six for men.

However, while some areas saw significant declines of roughly a third, which were most commonly found in London, in other areas, cancer deaths rates only improved minimally.

Deaths from lung cancer rising in women in some districts

The researchers found that the highest risk of dying occurred in northern cities such as Liverpool, Manchester, Hull and Newcastle, and in coastal areas to the east of London, with the risk of dying from cancer higher in districts with more poverty.

For example, the Tower Hamlets district in London saw a 37% reduction in cancer deaths among men, while the number of cancer deaths only decreased by 7% in the Tendring district in Essex.

While lung cancer deaths in men decreased across all district of England, in women, the rate of death in women stayed the same or increased across some areas in the East of England. The researchers say this may be due to the rise and fall in female smoking lagging behind men by about 20-30 years.

In fact, lung cancer was found to be the leading cause of cancer deaths for both sexes. Theo Rashid, first author and PhD student at Imperial College London, says increasing deaths due to lung cancer may be partly due to cuts to smoking cessation programmes.

“The greatest inequality across districts was for the risk of dying from cancers where factors such as smoking, alcohol and obesity have a large influence on the risk of getting cancer. Due to funding cuts, many local authorities have reduced their budgets for smoking cessation since 2010,” he said.

“Our data shows we cannot afford to lose these public health programmes and are in urgent need of the reintroduction and strengthening of national and local policies which combat smoking and alcohol,” he added.

People living in most deprived areas need better access to cancer screening

The authors of the study are now calling on the government to improve access to screening programmes as well as amping up efforts to stop smoking.

This comes after the research revealed that those who live in the most deprived are less likely to be able to access and engage with cancer screening.

“Access to cancer screening and diagnostic services which can prevent cancer or catch it early are key in reducing some of the inequalities our study highlights,” said Prof Amanda Cross, study author and Professor of Cancer Epidemiology at Imperial College London.

“There needs to be investment into new ways to reach under-served groups, such as screening ‘pop-ups’ in local areas like supermarkets and working with community organisations and faith groups,” she added.

More research now needed to look at cancer death rates post-pandemic

The authors say further research is now needed which looks at more recent cancer death rates post-pandemic, as the risks may have now changed as the NHS continues to deal with the fallout of the pandemic.

They also caution that they only analysed deaths from the 10 cancers with the highest death toll and did not separate the remaining group of cancer deaths into more specific cancer groups.

Furthermore, the correlations with poverty were reported at the district level, but there are variations in both risk of dying from cancer and levels of poverty within each district.

Writing in a linked Comment, Dr Karri Seppä and Prof Janne Pitkäniemi, Finnish Cancer Registry, Finland, said the data may identify differences “that are important for the prevention of new cancers and the improvements in early detection and cancer survival.”