Part of: Ill Health and Disability,Cancer

Related to: Lung Cancer, Breast Cancer, Cervical Cancer, Skin Cancer (Melanoma),Prostate Cancer, Ageing Population, Births and Fertility, Mental Health and Illness, [[Health Checks]], Major Causes of Mortality, Smoking, End of Life Care

Key Facts:

  • The incidence of colorectal cancer in Bath and North East Somerset is similar to comparator areas and has risen slightly between 1993 and 2009.
  • There have been an increase in mortality rate from Gastro-Intestinal cancer in men in BANES of 7.4% over a two-year period from 2007-2009.
  • premature deaths (in terms of potential years of life lost) from malignant neoplasm (cancer) of the pancreas is significantly lower in B&NES compared to the national average.
  • Bowel screening uptake in Bath and North East Somerset in 2010/2011 was average for the South West at about 55%.
  • High incidence could represent high numbers of people with a condition or good detection and screening of a condition.

Bowel (Colorectal) Cancer 1

Colorectal cancer is another name for bowel cancer, the general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon cancer or rectal cancer

Upper Gastrointestinal (GI) Cancer 2

Upper Gastrointestinal (GI) Cancer is defined as cancer of the oesophagus, stomach and duodenum (small intestine). However, most research includes the pancreas and excludes the duodenum.

Oesophageal Cancer occurs as two main types, squamous cell carcinoma and adenocarcinoma, each accounting for around 50% of incidence. Squamous cell carcinomamainly occurs in the upper two thirds of the oesophagus, while adenocarcinoma usually occurs in the lower third.

95% of stomach cancers originates from the glandular cells of the stomach lining and are adenocarcinomas.

Pancreatic Cancers are most commonly adenocarcinomas which form in the head and neck of the pancreas (nearest to the duodenum). Cancers of the body or “tail” of the pancreas are very rare by comparison.

What does the data say?

Bowel (Colorectal) Cancer

In England, bowel cancer is the third most common type of cancer. In 2009, there were 41,142 new cases of bowel cancer registered in the UK:

  • 18,431 cases were diagnosed in women, making it the second most common cancer in women after breast cancer
  • 22,711 cases were diagnosed in men, making it the third most common cancer after prostate and lung cancer
  • Approximately 72% of bowel cancer cases develop in people who are 65 or over.
  • Two-thirds of bowel cancers develop in the colon, with the remaining third developing in the rectum. 3

The incidence of colorectal cancer in Bath and North East Somerset is similar to comparator areas and has risen slightly between 1993 and 2009:

  • The Bath and North East Somerset rate was originally slightly lower than comparators and is now equivalent to them and slightly higher than the national rate (2009 national rate 48.32 per 100,000)
  • In 1993 the rate was 42.81 per 100,000 residents and in 2009 it was 52.02 per 100,000 residents. 4
  • High incidence could represent high numbers of people with a condition or good detection and screening of a condition. Incidence of colorectal cancers is likely to increase with the age extension to the bowel screening service.

Figure 1: Directly standardised rates for mortality by colorectal cancer (all ages) (1993-2010)

Mortality from colorectal cancer is decreasing, although the rate in Bath and North East Somerset has not decreased at the same rate as comparator areas. Moreover, since 2004 it has remained at a similar rate and pre 2004 it was lower:

  • In 1993 the rate was 22.59 per 100,000 (53) and in 2010 it was 20.62 per 100,000 (62)
  • There is significant year on year variation in the B&NES rate with a low of 11.69 per 100,000 in 1999 and a high of 24.21 in 2005
  • Mortality rate is currently higher than regionally and nationally (16.9 per 100,000 nationally and 17.2 per 100,000 regionally (2010) compared with 20.6 for Bath and North East Somerset) 5

Mortality rates from bowel (colorectal) cancers for under 75 year olds were similar across the four Avon PCTs during 2005/09 (figure 2). 6

 

Figure 2: Mortality from colorectal cancer in under 75s in Avon PCTs vs. England, 2007-09 7

Source: National Compendium of Health Outcomes Data (NCHOD)

Upper Gastrointestinal (GI) Cancer 8

Research has found that stomach and oesophageal cancers are twice as common in men than in women, and that upper GI cancers are generally rare in persons under 50 years old.

There is strong evidence to suggest that smoking and heavy alcohol consumption (especially in combination), increase the risk of oesophageal and pancreatic cancers.

Estimates suggest:

  • that 40% of all oesophageal cancers can be related to smoking, and that smokers are 2-3 times more likely to develop
  • pancreatic cancer than non-smokers. Debate is divided as to whether alcohol and smoking can be linked to an increased
  • risk of stomach cancer.

The chances of developing an upper GI cancer increase with certain pre-existing conditions. Damage to the oesophagus caused by acid reflux, known as Barrett’s oesophagus, can increase the risk of oesophageal cancer fifty times. Chronic pancreatitis and diabetes mellitus are shown to increase the risk of pancreatic cancer.

An estimated 6% of pancreatic cancer sufferers will have a family history of pancreatic cancer. There is also an increased risk of stomach cancer where family members have suffered from polyps. This suggests a genetic factor for some pancreatic and stomach cancers.

In 2000 stomach cancer was the 8th most common cancer, oesophageal was the 9th most common cancer and pancreatic was the 10th most common cancer in the South West .There were 2973 upper GI cancer registrations in the South West in 2000,1721 men and 1252 women.

In 2000 stomach cancer was the 10th most common cause of cancer death, oesophageal was the 7th and pancreatic was the 8th most common cause of cancer death in the South West.

In terms of potential Years of Life Lost (YLL), B&NES CCG has a significantly lower rate of annual years of life lost to malignant neoplasm (cancer) of the pancreas compared to the comparable rate for England - see Major Causes of Mortality (Premature Mortality) for further information.

The mortality rates of upper gastrointestinal cancer for Avon PCTs in 2005-09, in under 75s, using a directly standardised age rate, was 13 per 100,000 of the GP registered population. Gastrointestinal (GI) cancer mortality rates in all four local PCTs were similar to the Avon average (figure 2). 9

 

Figure 3: Mortality rates from upper gastrointestinal cancer under 75 years, Avon PCTs, 2005-09. 10

Source: National Compendium of Health Outcomes Data (NCHOD)

Despite the similar mortality rate in GI cancer mortality across the four PCTs, it is worth noting an increase in mortality rate in men in Bristol and BANES of 15.5% and 7.4%, respectively over a two-year period from 2007-2009. These changes are somewhat offset by a concurrent decrease in GI cancers in women over the same period. Mortality rates for oesophageal and stomach cancers (2007-09) were slightly lower but not statistically different to the England average. 11

Are we meeting the needs?

Bowel screening

The NHS Bowel Cancer Screening Programme offers screening every two years to all men and women aged 60 to 69. The B&NES area commenced this screening programme in February 2009, delivered in conjunction with Swindon and Wiltshire. 12 An age extension is currently being implemented in B&NES and this will take the upper screening age to 74. Older and younger people can still request to be screened. 13

Bowel screening uptake in Bath and North East Somerset in 2010/2011 was average for the South West at about 55%. 14

In 2010/11 99% of people were offered an appointment within 14 days of being referred for an assessment, and 87% were seen within 14 days between assessment and 1st colonoscopy. 15

What can we realistically change?

Bath and North East Somerset Clinical Commissioning Groups Commissioning Intentions for the cancer programme for 2013/14 16

The Bath and North East Somerset Clinical Commissioning Groups have developed a draft paper outlining their Intentions for the cancer programme for 2013/14; to be used in conjunction with the Cancer Mortality Report for Bath and North East Somerset (July 2012). This paper is a guide to prioritising commissioning of cancer services in the Bath and North East Somerset area. It is key objective is to improve cancer outcomes (including premature mortality and 1 and 5 year survival) through a targeted approach to cancer inequalities.

The changes to Bath and North East Somerset’s Bowel Screening Programme it outlines are:

  • National guidance requires introducing age extension as soon as possible, with a minimum of two years of a programme operating. Bath and North East Somerset, Wiltshire and Swindon programme to consider age extension; when implemented it will result on increased activity for treatment and surveillance within bowel cancer / Gastrointestinal (eg colonoscopies) services.

National Institute for Health and Clinical Excellence (NICE) guidance

  • 1. NHS choices (2012) Bowel cancer, http://www.nhs.uk/conditions/cancer/pages/introduction.aspx (viewed on 01/02/13)
  • 2. South West Cancer Intelligence Service (2000) Factsheet No. 14: Upper Gastro-Intestinal Cancer in the South West ICD-10*: C15, C16, C25, www.swpho.nhs.uk/resource/view.aspx?RID=9106 (viewed 02/04/2013)
  • 3. NHS choices (2012) Bowel cancer, http://www.nhs.uk/conditions/cancer/pages/introduction.aspx (viewed on 01/02/13)
  • 4. NHS Information Centre Indicator Portal (1993-2009) Incidence of colorectal cancer (ICD9 152-154, ICD10 C17-C21): Directly age-standardised registration rates (DSR) All ages; annual trends; MFP (downloaded 02/04/2012) https://indicators.ic.nhs.uk/webview/
  • 5. NHS Information Centre Indicator Portal (1993-2009) Incidence of colorectal cancer (ICD9 152-154, ICD10C17-C21): Directly age-standardised registration rates (DSR) All ages; annual trends; MFP (downloaded 02/04/2012) https://indicators.ic.nhs.uk/webview/
  • 6. Gjini. A (2012) Cancer mortality in Bath and North East Somerset and the rest of Avon: its burden and inequalities, NHS Bath and North East Somerset
  • 7. Gjini. A (2012) Cancer mortality in Bath and North East Somerset and the rest of Avon: its burden and inequalities, NHS Bath and North East Somerset
  • 8. South West Cancer Intelligence Service (2000) Factsheet No. 14: Upper Gastro-Intestinal Cancer in the South West ICD-10*: C15, C16, C25, www.swpho.nhs.uk/resource/view.aspx?RID=9106 (viewed 02/04/2013)
  • 9. Gjini. A (2012) Cancer mortality in Bath and North East Somerset and the rest of Avon: its burden and inequalities, NHS Bath and North East Somerset
  • 10. Gjini. A (2012) Cancer mortality in Bath and North East Somerset and the rest of Avon: its burden and inequalities, NHS Bath and North East Somerset
  • 11. Gjini. A (2012) Cancer mortality in Bath and North East Somerset and the rest of Avon: its burden and inequalities, NHS Bath and North East Somerset
  • 12. Gjini. A (2012) Cancer mortality in Bath and North East Somerset and the rest of Avon: its burden and inequalities, NHS Bath and North East Somerset
  • 13. http://www.cancerscreening.nhs.uk/bowel/eligible-bowel-cancer-screening.html
  • 14. OBIEE (Dec 2010-Nov 2011) QA Dashboard
  • 15. OBIEE (Dec 2010-Nov 2011) QA Dashboard
  • 16. Bath and North East Somerset Clinical Commissioning Groups (2012), Bath and North East Somerset Clinical Commissioning Groups Commissioning Intentions for the cancer programme for 2013/14