Over half of people born in the UK since 1960 will be diagnosed with cancer at some point in their lifetime. While cancer survival rates in the UK are improving, they still lag behind in international comparisons. The NHS Long Term Plan set a goal that, from 2028, 55,000 more people each year will survive cancer for at least five years after diagnosis. Achieving this will require access to timely and effective diagnosis and treatment, and action on cancer waiting times.
Here at QualityWatch, we continue to monitor the quality of health and social care during this unprecedented time for the health service as far as possible. As part of the response to the coronavirus (Covid-19) outbreak, NHS England told trusts that essential cancer treatment must continue. However, concerns have been raised about the impact of the outbreak on cancer diagnosis and treatment, as screening services have been paused, urgent GP referrals have fallen, and treatment has been disrupted.
With more than four in ten cases of cancer caused by lifestyle factors, this month we’ve looked at trends in smoking, obesity and alcohol use. We’ve also updated our indicators looking at the quality of care along the cancer pathway, including screening, diagnosis and treatment, as well as survival and mortality rates. The latest data presented here for risk factors, vaccination rates, screening, survival rates, and mortality rates are for before the Covid-19 outbreak. Data on cancer waiting time targets and diagnostic test waiting times include March 2020, and reflect changes in access and service use as a result of the outbreak.
Please find a summary below of our cancer indicators. Click on the links for more detailed content and analysis.
- The percentage of people using NHS Stop Smoking Services who self-reported that they were successful in quitting at four weeks has remained relatively steady over time, fluctuating at around 50%.
- The number of people using NHS Stop Smoking Services who set a quit date has fallen for seven consecutive years.
- In 2018, 18% of people aged 18 and over in the most deprived areas were current smokers compared with only 10% of people in the least deprived areas.
Alcohol-related harm and drinking behaviour
- Out of the four UK countries, Scotland has had the highest alcohol-related death rate since the dataset began in 2011, while England has had the lowest.
- The rate of hospital admissions that were primarily due to alcohol consumption in England increased from 630 admissions per 100,000 people in 2017/18 to 660 admissions per 100,000 people in 2018/19.
- According to the Health Survey for England, since 2006 heavy drinking has fallen for people aged 16 to 54 years old but has increased for people aged 55 and over.
- Health Survey for England data shows that the proportion of adults who are overweight and obese has increased substantially over the last two decades. In 1993, 15% of adults were obese and this increased to 28% in 2018.
- Data from the National Childhood Measurement Programme shows that the proportion of children in Reception (aged 4-5 years) who are obese has remained relatively unchanged since 2006/07. However, obesity in children in Year 6 (aged 10-11 years) has increased by 2.7 percentage points over the same time period.
HPV vaccination coverage
- Uptake of the human papilloma virus (HPV) vaccine, which helps protect against cervical cancer, has declined slightly over the last two years, with 89% coverage for the first dose and 84% for two doses in 2018/19.
- Breast screening coverage in England increased from 64% in 2002 to 77% in 2009, where it remained stable until 2012 when it gradually began to decrease. In 2019, breast screening coverage was 75%.
- Cervical screening coverage for the total target age group (25 to 64 years) fell from 76% in 2011 to 72% in 2019.
- Bowel screening coverage in England increased from 35% in 2009/10 to 61% in 2018/19.
- While England, Wales and Northern Ireland (grouped) outperform many OECD countries including France and Germany, breast screening coverage is higher in the Netherlands and Finland.
- Compared to other countries, the UK has one of the highest cervical screening rates. Austria has the highest screening rate of the comparator countries, while Italy has the lowest.
Cancer waiting time targets
- Between Q4 2008/09 and Q4 2019/20, the percentage of people with suspected cancer having their first consultant appointment within two weeks of an urgent GP referral decreased from 94.5% to 91.6%. The two-week standard has been missed for the last two years.
- The proportion of patients waiting less than 31 days for a first treatment for cancer following a decision to treat decreased from 98.2% in Q4 2008/09 to 95.9% in Q4 2019/20. The 96% threshold was breached for the first time in Q4 2019/10.
- The proportion of patients waiting less than two months to start cancer treatment following an urgent GP referral has decreased considerably over time. In Q4 2008/09, 86.7% of patients started treatment within 62 days compared to 75.6% in Q4 2019/20.
Diagnostic test waiting times
- The proportion of patients waiting six weeks or more for a diagnostic test increased from 0.7% in February 2010 to 2.8% in February 2020. In March 2020, this increased dramatically to 10.2%, following a reduction in the number of diagnostic tests performed.
- Since 2008, the waiting list for a diagnostic test has been steadily increasing. However, in March 2020, the waiting list fell to 838,569 (22% lower than in March 2019). Although the number of tests carried out decreased due to a reduction in hospital activity, there was also a drop in the number of tests being requested, resulting in an overall reduction of the waiting list.
Cancer survival rates
- The cancers with the lowest five-year survival estimates are mesothelioma (7%), pancreatic cancer (7%) and brain cancer (12%). The cancers with the highest five-year survival rates are testicular cancer (95%), melanoma of skin (91%) and thyroid cancer (87%).
- Between Q2 2011/12 and Q2 2015/16, the percentage of cancers diagnosed at early stages increased from 45% to 53%. Since then, it has remained relatively constant. In Q1 2018/19, 52% of cancers were diagnosed at stages 1 or 2.
- Five-year survival for breast cancer has been improving in the UK over time, reaching 86% in 2010-2014. However, the UK lags behind several other OECD countries.
- While cervical cancer survival has been improving in the UK, the country is still one of the worst performers compared to other OECD countries, with a five-year survival of only 64% in 2010-2014.
- The five-year colon cancer survival rate in the UK has also been increasing over time, but in 2010-2014 survival reached only 60%. This is the lowest survival rate of the 18 OECD comparator countries.
Cancer mortality rates
- Breast cancer mortality has been declining in the UK, falling from 38 deaths per 100,000 women in 2001 to 28 deaths per 100,000 women in 2016. However, the UK consistently has a relatively high breast cancer mortality rate compared to other countries.
- In 2001, the UK had one of the highest cervical cancer mortality rates of all the comparator countries, but by 2016, the UK’s ranking had improved to about average.
- Colorectal cancer mortality has been slowly decreasing over time in the UK, falling from 26 deaths per 100,000 population in 2001 to 22 deaths per 100,000 population in 2016. The UK’s performance is about average for the comparator countries.