World Cancer Day 2022 Part 1

Thinking Globally, Acting Locally

World Cancer Day falls on 4th February 2022, the campaign theme “Close the Care Gap” has been chosen to highlight and tackle the significant issue of cancer inequalities across the globe.

Sadly, the burden of cancer is not shared equally.

Cancer Research Wales believes strongly in the need to eliminate the inequalities of cancer incidence and mortality, so much so it’s one of our strategic aims. Over the course of this week, our blog posts are dedicated to the issue of cancer inequalities and the research we fund across Wales to take on the problem.

Today we will direct our focus on the main types of cancer inequalities experienced in Wales. On Friday 4th we’ll delve into some of the research studies we are funding to help ease the cancer burden.

The number of people diagnosed with cancer in Wales has been steadily increasing over the last 15-20 years, from around 16,000 in 2002 to more than 20,000 in 2018, the most recent year for which data is available. Improvements in detection, diagnosis and treatment have meant that cancer survival rates have also increased over that same period. However, there is still more work to be done, as currently only around 3 out of 5 patients survive for 5 years after their diagnosis.

Our genetics have a strong influence on our risks of developing different types of cancer and there is a huge amount of research into how different genes play their role in cancer development and progression. However, it is important to remember that our lifestyles also play a critical role in determining the likelihood of getting and surviving cancer. Many people are at an increased risk of cancer and worse survival rates due to factors outside of their control, such as where they were born, grew up and live.

The Covid-19 pandemic has also had a significant ongoing impact on healthcare, with the cancer pathway across Wales being severely disrupted. Though the official data will take time to collate, analyse and publish, there are grave concerns that prolonged delays in people speaking to their GP; cancer diagnosis; treatment, and care, will compound cancer inequalities concerning incidence and survival that existed prior to March 2020.

Across Wales the impact of cancer is not evenly distributed, in this blog we will explore some of the contributing factors.

Deprivation

As is the case in many countries, the distribution of wealth and opportunity across Wales is not even. There are stark contrasts to be found between the affluent areas of a modern city like Cardiff and areas such as Rhyl West, which was named as the most deprived area in Wales in the 2019 Wales Index of Multiple Deprivation.

Unfortunately, this wide gap in deprivation status is reflected in cancer statistics too. Across all cancer types in Wales 1-year survival in 2018 was 79% in the least deprived areas vs just 68% in the most deprived areas. The 5-year survival gap across all cancer types widens even further (67% in least deprived areas vs 50% in the most deprived areas).

For lung cancer, which represents the greatest burden on the Welsh NHS, the number of people diagnosed in 2018 from the most deprived areas of Wales was more than double the number from the least deprived areas.

The reasons why deprivation leads to such large differences for cancer patients are complex, involving poor lifestyle choices, lack of education and reduced access to healthcare services, among others. Investment in a wide-ranging and holistic approaches to tackling deprivation are critical if we are to address the unacceptable cancer inequalities it causes.

Geography

Wales is a small country of around 3.1 million people and many of these are concentrated in just a few areas, leaving large swathes of the country with a very low population density. Over two thirds of the population live in South Wales and accordingly, funding and service provision also tend to be concentrated in these areas, leaving rural communities lagging behind.

Looking at recently published cancer incidence data, there is a clear distinction between North and South Wales, with the 5 local authorities with the highest rate of cancer cases all found in North Wales. In fact, in 2018 the cancer incidence rate in Conwy (the highest) was 1.6 times greater than in Cardiff (the lowest). Similarly, Cardiff and Vale Health Board had the highest 5 year survival rate for cancer in 2018, at 61% compared to the national average of 58% – although not a huge difference, several hundred people could still be alive today if every Health Board matched Cardiff and Vale.

The NHS in Wales is under constant pressure to deliver better services and difficult decisions will always need to be made around where to attribute stretched resources. However, the regional inequalities demonstrated above represent an unacceptable state of affairs, whereby where you live has a major bearing on your risk of developing and surviving cancer. Funding and resources will be required to fully redress the balance between North and South.

Other Inequalities

Deprivation status and regional differences represent the two strongest causes of inequality for cancer in Wales. However, that is not to say that other inequalities do not play a role as well. There are significant disparities in cancer incidence between men and women, particularly in the under 50s age group, although it is difficult to demarcate between genetic differences vs the impact of inequality. There are also differences observed between ethnic groups – the causes of this are complex and further research is required to shed light on the cultural, socioeconomic and structural reasons behind these differences. Furthermore, there is increasing evidence that disabilities, especially learning disabilities, also cause avoidable cancer inequalities.

More recently, the covid-19 pandemic and the subsequent impact on the cost of living are delivering the sorts of economic, social and health-related “shocks” that are more likely to increase, than reduce, inequalities.

Over the longer term, the picture for cancer in Wales is generally positive and research has played a significant part. Improvements in early diagnosis and treatment are driving better survival rates and quality of life for cancer patients. However, not everyone is sharing in these improvements equally and the burden of cancer weighs more heavily on some groups. Closing the gaps between the best and worst groups for cancer outcomes is achievable and would save hundreds of lives each year.

Look out for our follow-up blog on World Cancer Day, where we will demonstrate the work Cancer Research Wales is funding to fight and address these inequalities.