Study shows ‘astounding inequality’ in cancer death risk across England

People who live in poorer neighbourhoods in England have a significantly higher risk of dying from cancer compared to those in wealthier areas, a new study shows.

Researchers suggested that cuts to public health services, such as smoking cessation support, could have contributed to “astounding inequality” in cancer death risk.

They said that the widest inequalities were for cancers where a person’s risk can be reduced with lifestyle changes – such as losing weight or stopping smoking – and for cancers where there is screening available to help cut the odds of dying from the disease.

The study, published in the journal Lancet Oncology, saw experts analyse data from the Office for National Statistics on deaths from 10 cancers which cause the most deaths, including cancers of the lung, bowel, pancreas, stomach and certain blood cancers, as well as prostate in men and breast and ovarian cancers in women.

The researchers looked at deaths across 314 different areas of England which took place between 2002 and 2019.

The team, led by academics at Imperial College London, found that the risk of cancer deaths were highest in northern cities, including Liverpool, Manchester, Hull and Newcastle, and in coastal areas to the east of London.

For women, the risk of dying from cancer before they turn 80 ranged from one in 10 in Westminster to one in six in Manchester.

And one in eight men in Harrow are expected to die from cancer before they turn 80, this is compared to one in five in Manchester.

But the academics found that the odds of dying from a cancer before the age of 80 declined from 2002 to 2019 in every district for both sexes.

Overall, some one in eight women across England died from cancer in 2019, compared to one in six men – a reduction compared to 2002.

But some regions saw significantly larger declines in deaths compared to others.

For instance, the risk of dying from cancer before the age of 80 reduced by 30.1% between 2002 and 2019 for women in Camden, but the risk only reduced by 6.6% in Tendring, Essex.

For men, the largest reduction in risk was seen in Tower Hamlets, where researchers noted a 36.7% reduced risk over the period studied, compared to a 12.8% reduced risk in Blackpool.

“Although our study brings the good news that the overall risk of dying from cancer has decreased across all English districts in the last 20 years, it also highlights the astounding inequality in cancer deaths in different districts around England,” said Professor Majid Ezzati, senior author of the study from Imperial College London.

Areas were assessed on their wealth based on the proportion of the population who claim income-related benefits due to being out of work or having low earnings.

The academics said that the odds of dying from a cancer – particularly lung cancer – were linked to poverty for both men and women.

Lung cancer was the leading cause of cancer death across both sexes, but people in the north-west and the north-east of England were most likely to die from lung cancer.

Knowsley in Merseyside was named as the place where women were most likely to die from lung cancer, where the team observed a three-fold increased risk compared to women in Waverley, Surrey.

Men in Manchester have three-fold increased odds of dying from lung cancer before they turn 80 compared to men in Guildford.

Theo Rashid, first author of the study and PhD student at Imperial College London, said: “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. 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.”

Amanda Cross, study author and professor of cancer epidemiology at Imperial, added: “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.

“Those who are more deprived are less likely to be able to access and engage with cancer screening.

“To change this, 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.”

David Fothergill, chairman of the Local Government Association’s Community Wellbeing Board, said: “This report clearly illustrates the disparities in cancer survival rates across the country.

“We need to ensure that cancer screening services can be accessed by all communities and that everyone, regardless of their social and personal circumstance, has an opportunity to make an informed personal choice about cancer screening.”

A Department of Health and Social Care spokesperson said: “Reducing inequalities and variation in cancer treatment is a priority for this government.

“Smoking is the cause of around one in four cancer deaths, and the Government has pledged to introduce a new law to stop children who are 14 this year or younger from ever legally being sold cigarettes, to create the first smoke-free generation.

“Cancer is being diagnosed at an earlier stage, more often, with survival rates improving across almost all types.

“Our Major Conditions Strategy sets out how we will improve cancer prevention, diagnosis and treatment, and we have opened 136 community diagnostic centres offering over five million additional tests, including for cancer.

“We are also establishing a National Targeted Lung Cancer Screening Programme in England that when fully rolled out in 2030 will detect around 9,000 cases earlier each year.”

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