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Analytic and Research Output at the Welsh Cancer Intelligence and Surveillance Unit

Analytic and Research Output at the Welsh Cancer Intelligence and Surveillance Unit. Ceri White. Welsh Health Analysts Network 14 th October 2008. Outline. Background to WCISU Outputs/Research at WCISU Triennial Report. UKACR. FULL MEMBERS. ASSOCIATE MEMBERS.

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Analytic and Research Output at the Welsh Cancer Intelligence and Surveillance Unit

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  1. Analytic and Research Output at the Welsh Cancer Intelligence and Surveillance Unit Ceri White Welsh Health Analysts Network 14th October 2008 Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  2. Outline • Background to WCISU • Outputs/Research at WCISU • Triennial Report Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  3. UKACR FULL MEMBERS ASSOCIATE MEMBERS Office for National Statistics (ONS) National Cancer Registry of Ireland English Registries (8 in total) Cancer Research UK Welsh Cancer Intelligence & Surveillance Unit Childhood Cancer Research Group ISD Scotland Marie Curie Cancer Care N Ireland Registry CRC Paediatric & Familial Cancer Research Group Northern Region Children & Young Persons Malignant Disease Registry West Midlands Regional Children’s Tumour Registry Yorkshire Specialist Register of Cancer in Children & Young People United Kingdom Association of Cancer Registries Specialist Childhood/Young Person Registries Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  4. Cancer Registry Boundaries in England and Wales Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  5. Statistics/Outputs • Types of data available • Incidence (database covers 1974 – present, data complete to 2006, earlier years unreliable) • Mortality • Survival (1 year, 3 years, 5 years) • Prevalence • Publications available from website • www.wcisu.wales.nhs.uk Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  6. Request & Analysis Service Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  7. Outputs/Research at WCISU Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  8. General Public Researchers/students Clinicians Local Health Boards Welsh Assembly NPHS Cancer Networks European & International Studies ONS Cancer Research UK Cancer Charities Project work Audit Collaborative Studies Cluster Investigations Resource Allocation Service Planning Genetic Queries Cancer Trends Screening Effectiveness Relationships with geographical/socio-economic factors Users Uses Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  9. Effect of Breast Screening Status on Survival 1990-1999 Kaplan Meier survival estimates by screening category Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  10. Standardised Incidence Ratios by Local Health Board in Wales 1997-2006 PROSTATE CANCER SIR significantly below 1 SIR below 1 SIR above 1 SIR significantly above 1 Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  11. Survival Differences between Males and Females(Diagnosis period: 1994-1998, 5yr survival rates) Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  12. Relative Survival by Age in Wales 1992-2001 e.g. Bladder Cancer • Survival rates decreases with age in both males and females • Survival is generally lower in females than males for all age groups Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  13. Factors that affect survival when comparing by country: • Case ascertainment • Coding • Screening • Treatment • Age, Sex, Deprivation • Method of calculation • Country coverage not 100% • Incomplete death linkage • Co-morbidity Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  14. Cluster Analysis Is there an increased risk of Non-Hodgkin’s lymphoma in the South Wales Rhondda Valleys? Factors: Confounders – Age, sex, deprivation, ……. Time frame – Diagnosis years, case ascertainment Area – radius, area, point source, …. Geography – wards, output areas, local health boards, ….. Population – interpolation? Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  15. Hypothetical Example NHL cases within 2.5km of the point source Wales age standardised rates per 100,000 population Relative Risks (=no. of observed cases/no. of expected cases) Conclusion: No significant evidence of increased risks in study area. Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  16. SatScan Version 6.0 • Analyses Bernoulli and Poisson models • Spatial scan statistic imposes a circular window on the map. • For each location and size of the scanning window, the alternative hypothesis is that there is an elevated rate within the window compared to outside. • Likelihood function maximised over all windows identifying the window that constitutes the most likely cluster. • P-value obtained by repeating the same analytic exercise on a large number of random replications in a Monte Carlo simulation • Most likely clusters and secondary clusters ordered by their likelihood ratio Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  17. Purely Spatial Analysis Scanning For Clusters With High Rates Using the Poisson Model – Prostate Cancer 1990-1997 (Ages 45+) MOST LIKELY CLUSTER Population : 22177 Number Of Cases : 595 Radius : 13.35km Annual Cases/100000 : 335.4 Overall Relative Risk : 1.521 Log Likelihood Ratio : 8.567 P-Value : 0.084 Maximum Cluster Size : 5% Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  18. 0-62.4 62.4-109.4 109.4-163.4 163.4-246.3 246.3-468.5 73.5-92.5 92.5-104.4 104.4-116.9 116.9-131.8 131.8-177.7 Bayesian Smoothing of SIR for NHL in Wales 1988-2001 Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  19. Triennial ReportCancer in Wales: A Comprehensive Report Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  20. Triennial Report 20 major cancer sites All malignancies exc NMSC Incidence: Wales Local Health Board World Comparisons Mortality: Wales Local Health Board World Comparisons Prevalence: 1 year, 1-5 years, 5-10 years, 10-20 years Survival : Crude Survival Relative Survival Socioeconomic Status Eurocare 4 results Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  21. Crude rates and age standardised rates, all malignancies exc NMSC in Wales 1992-2006 Males Females EASR – European Age Standardised Rate per 100,000 population WASR – World Age Standardised Rate per 100,000 population Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  22. Incidence – most common cancers in Wales, 1992-2006 Males Females • Prostate (20.4%) • Trachea, Bronchus & Lung (17.2%) • Colon (8.2%) • Bladder (7.9%) • Rectum (5.6%) • Stomach (5.1%) • Head & Neck (4.0%) • Leukaemia (3.3%) • Non-Hodgkins Lymphoma (3.2%) • Oesophagus (3.1%) • Other cancers (22.0%) • Breast (28.8%) • Trachea, Bronchus & Lung (10.7%) • Colon (8.1%) • Ovary (5.0%) • Corpus Uteri (4.1%) • Rectum (3.6%) • Bladder (3.2%) • Stomach (3.1%) • Non-Hodgkins Lymphoma (2.9%) • Pancreas (2.8%) • Other cancers (27.7%) Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  23. Incidence – most common cancers in Wales, males, European Age Standardised Rate per 100,000 population Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  24. Incidence – most common cancers in Wales, females, EASR Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  25. Incidence Trends in Wales, 1992-2006 Increasing (>1% annual increase in EASR) Prostate (4.6%) Malignant Melanoma of skin (4.6% males, 4.5% females) Corpus Uteri (3.1%) Urinary Tract excluding Bladder (1.7% males, 2.8% females) Non Hodgkins Lymphoma (1.4% males, 2.7% females) Oesophagus (1.5% males) Lung (1.2% females) Decreasing (>1% annual decrease in EASR) Stomach (4.2% males, 3.5% females) Larynx (2.4% males, 3.2% females) Lung (2.5% males) Cervix (2.2%) Hodgkins Disease (1.1% males) Colon (1.0% females) Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  26. Trends by Local Health Board in Wales, Males, All Malignancies excluding non melanoma skin cancer, Wales Age Standardised Rate per 100,000 population 1992-1996 1997-2001 2002-2006 Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  27. Trends by Local Health Board in Wales, Females, All Malignancies excluding non melanoma skin cancer, Wales Age Standardised Rate per 100,000 population 1992-1996 1997-2001 2002-2006 Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  28. Incidence comparisons around the World *, All malignancies excluding non melanoma skin cancer Males Females * Figures for Wales are for the diagnosis year 2000, figures for other countries are between 1997 and 2000 depending on completeness. Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  29. Mortality – cancers with the largest number of deaths in Wales, 1992-2006 Males Females • Trachea, Bronchus & Lung (26.2%) • Prostate (12.1%) • Colon (7.7%) • Stomach (6.3%) • Oesophagus (5.4%) • Rectum (4.2%) • Pancreas (3.9%) • Bladder (3.8%) • Leukaemia (2.8%) • Head and Neck (2.7%) • Other cancers (24.9%) • Breast (17.9%) • Trachea, Bronchus & Lung (16.8%) • Colon (8.3%) • Ovary (5.9%) • Pancreas (4.7%) • Stomach (4.3%) • Oesophagus (3.7%) • Rectum (2.8%) • Non-Hodgkins Lymphoma (2.6%) • Leukaemia (2.4%) • Other cancers (30.6%) Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  30. Mortality Trends in Wales, 1992-2006 Increasing (>1% annual increase in EASR) Malignant Melanoma (1.5% males, 1.9% females) Corpus Uteri (1.3%) Urinary Tract excluding Bladder (1.0% males) Bladder (1.9% males, 1.7% females) Decreasing (>1% annual decrease in EASR) Stomach (5.2% males, 4.6% females) Colon (2.3% males, 3.2% females) Rectum (1.6% males, 2.1% females) Larynx (1.5% males, 5.1% females) Hodgkins Disease (8.9% males, 1.9% females) Head and Neck (1.2% males) Lung (2.9% males) Breast (2.3% females) Cervix (4.2%) Non Hodgkins Lymphoma (1.6% males) Leukaemia (1.2% females) Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  31. Mortality comparisons around the World *, All malignancies excluding non melanoma skin cancer Females Males * Figures for Wales are for the diagnosis year 2000, figures for other countries are between 1997 and 2000 depending on completeness. Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  32. Prevalence in Wales, 1992-2006 All Malignancies excluding non melanoma skin cancer Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  33. Relative Survival in Wales, 1992-1996 and 1997-2001 (followed up to 31/12/2006) Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  34. Median Survival in Wales, 1992-1996 and 1997-2001 (number of years) Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  35. Percentage point difference in 5 year relative survival between affluent (Q1) and deprived (Q5) Males Females The difference between affluent and deprived has increased between the two periods – survival gap is increasing. The difference between affluent and deprived has decreased between the two periods – survival gap is decreasing. Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  36. Five year relative survival for ovarian cancer by deprivation quintile in Wales Note it may not be the case that the highest and lowest quintiles are the deprived and affluent categories. Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  37. Percentage point difference in 5 year relative survival between highest quintile survival (HQ) and lowest quintile survival (LQ) Males Females The difference between highest and lowest quintile has increased between the two periods. The difference between the highest and lowest quintile has decreased between the two periods. Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  38. EUROCARE 4 results – Five year relative survival by country in Europe, All malignancies excluding non melanoma skin cancer • Factors to consider when comparing survival by country: • Coverage • Affluent v Deprived • Treatment • Screening Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  39. Summary - Incidence • Incidence continues to increase year on year for all cancers • - 7845 males per year, 7638 females per year • Most common cancers diagnosed in Wales: • - Males: Prostate cancer (Min: 1017, Max: 2279, Mean: 1604) • - Females: Breast cancer (Min: 1993, Max: 2426, Mean: 2199) • Largest increases in incidence (EASR): • - Prostate cancer • - Malignant melanoma of skin • - Corpus Uteri • Largest decreases in incidence (EASR): • - Stomach cancer • - Laryngeal cancer • - Male lung cancer Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  40. Summary - Mortality • Mortality has slowly decreased in number over the period for all cancers • EASR decreased by 19% in males • EASR decreased by 12% in females • Most common cancer deaths: • Males: Trachea, Bronchus and Lung • Females: Breast • Largest increases in mortality (EASR): • - Malignant melanoma of skin • - Corpus Uteri • - Urinary tract (excluding bladder) • Largest decreases in mortality (EASR): • - Stomach Cancer • - Colon Cancer • - Rectal Cancer Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  41. Summary – Prevalence and Survival • 53,610 males (3.7%) and 62,476 females (4.1%) were still alive at the end of 2006 that were diagnosed in the previous 20 years. • Survival has increased for the majority of cancers in Wales • Largest improvements in 5 year relative survival between 92-96 and 97-01 • - Prostate cancer ~ 14 percentage points (25% improvement) • - Colon cancer ~ 6 percentage points (13% -15% improvement) • - Breast cancer ~ 5 percentage points (6% improvement) • 5 year survival rates for most common cancers: • - Prostate (69%) • - Breast (80%) Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

  42. Sources of Further Information • Website • www.wcisu.wales.nhs.uk • Publications on incidence, mortality & survival • Research reports • Phone (Statistics Team) • 029 2037 3500 Welsh Cancer Intelligence & Surveillance Unit Uned Arolygiaeth a Gwybodaeth Cancr Cymru

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