Introduction to cancer epidemiology basics mr es021012
1. The Christie NHS Foundation Trust
Introduction to Cancer
Epidemiology Basics
Dr Chris Harrison
Medical Director, The Christie
Clinical Director (Cancer), NHS London
3. The Christie NHS Foundation Trust
Definition of Epidemiology
• “The study of the occurrence and distributions of
health related states or events in specified
populations, including the study of the
determinants influencing such states, and the
application of this knowledge to control health
problems”
• A Dictionary of Epidemiology
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Alternatively
• “Epidemiology is the study of the health of
human communities”
Prof Alwyn Smith
Descriptive v Analytic Epidemiology
Uses of Epidemiology
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Key Terms
• Incidence
• Mortality
• Survival
• Prevalence
6. The Christie NHS Foundation Trust
Key Terms
• Incidence – rate of new cases in a defined
period
• Mortality – rate of death in the total population in
a defined period
• Prevalence – proportion of total population who
have had a cancer diagnosis and are still alive
• Survival – proportion of cases surviving a
defined period of time
11. The Christie NHS Foundation Trust
Incidence Key Messages
• Cancer Incidence is increasing
• About 320,000 cases per year in the UK
• In both men and women 4 cancers make up
about 70% of cases
• Cancer gets more common with increasing age
13. The Christie NHS Foundation Trust
Mortality
England Scotland Wales Northern Ireland UK
Male
Deaths 68,207 7,807 4,388 2,079 82,481
Crude Rate 264.8 308.5 298.3 235.1 269.2
AS Rate 198.4 232 200.8 209.3 201.6
AS Rate - 95% LCL* 196.9 226.9 194.9 200.3 200.3
AS Rate - 95% UCL* 199.9 237.2 206.8 218.2 203
Female
Deaths 61,316 7,516 4,088 1,874 74,794
Crude Rate 231.6 279.2 266.2 204.8 236.5
AS Rate 143.9 170.7 152.2 146.7 146.8
AS Rate - 95% LCL* 142.8 166.9 147.6 140 145.8
AS Rate - 95% UCL* 145.1 174.6 156.9 153.3 147.9
Persons
Deaths 129,523 15,323 8,476 3,953 157,275
Crude Rate 248 293.4 281.9 219.7 252.6
AS Rate 167.1 195.9 172.7 172.5 170
AS Rate - 95% LCL* 166.2 192.8 169 167.1 169.2
AS Rate - 95% UCL* 168 199 176.4 177.8 170.9
14. The Christie NHS Foundation Trust
Key Messages - Mortality
• Population Mortality has been falling
• Cancer is 28% of all deaths in UK
15. The Christie NHS Foundation Trust
Survival – Cancer Types
2%
6%
8%
13%
15%
22%
34%
36%
43%
45%
48%
52%
61%
68%
76%
79%
83%
90%
3%
6%
7%
12%
13%
24%
38%
45%
45%
46%
51%
61%
67%
71%
78%
84%
95%
Pancreas
Lung
Oesophagus
Stomach
Brain
Multiple myeloma
Ovary
Leukaemia
Kidney
Colon
Rectum
NHL
Bladder
Cervix
Uterus
Breast
Hodgkin's lymphoma
Melanoma
Pancreas
Lung
Oesophagus
Stomach
Brain
Multiple myeloma
Leukaemia
Kidney
Rectum
Colon
NHL
Prostate
Larynx
Bladder
Melanoma
Hodgkin's lymphoma
Testis
WomenMen
Five-year relative survival
10-50% survival:
29% of cases diagnosed
More than 50% survival:
38% of cases diagnosed
less than 10% survival:
24% of cases diagnosed
More than 50% survival:
50% of cases diagnosed
10-50% survival:
27% of cases diagnosed
less than 10% survival:
15% of cases diagnosed
16. The Christie NHS Foundation Trust
5 Year Survival – All Cancers
• People – 50%
• Men – 43%
• Women – 56%
• National (CRUK) and Manchester Target is 66%
17. The Christie NHS Foundation Trust
Survival - Trends
-4 -2 0 2 4 6 8 10 12
Pancreas
Larynx
Brain
Bladder
Cervix
Lung
Oesophagus
Stomach
Multiple myeloma
Uterus
Testis
NHL
Leukeamia
Ovary
Colon
Melanoma
Kidney
Breast
Rectum
Prostate
Average % change every five years
Men
Women
18. The Christie NHS Foundation Trust
Survival – Key Messages
• Survival for most cancers has been increasing
• Beware artefacts of change in diagnosis
• Survival does vary across the UK but not as
much as mortality
• UK survival compares poorly with Europe
19. The Christie NHS Foundation Trust
Prevalence - UK
1 year prevalence 5 year prevalence 10 year prevalence
Males 98,726 339,971 507,840
Females 101,796 382,030 622,875
Persons 200,522 722,001 1,130,715
20. The Christie NHS Foundation Trust
Prevalence – Key Messages
• Prevalence increasing due to higher incidence
and better survival
• Much higher prevalence then previous estimates
and expected to grow
21. The Christie NHS Foundation Trust
North and East
CMO: Kathy Pritchard-Jones
Director: Charlotte Williams
South and West
Interim CMO:
Arnie Purushotham
Project manager: Claire Dowling
21
Two integrated cancer systems
22. The Christie NHS Foundation Trust
Largest and most complex network
• 3.2 million population
• 11 primary care trusts
• 11 acute trusts
• 15 hospitals
• Secondary care referrals
• 1 tertiary cancer centre
24. The Christie NHS Foundation Trust
The Organisation of European Cancer
Centres
Mission
• To bring together cancer
research, care and educational
institutes within Europe to
create a critical mass of
expertise and competence
• Founded in 1977 now has 81
cancer centre members from
across Europe
25. The Christie NHS Foundation Trust
WP 12
EurocanPlatform
MEMBERS
Données cartographique
MEMBERS
Données cartographique
26. The Christie NHS Foundation Trust
Key Points
• Cancer Services need to be organised across
large populations
• No single organisation has the critical mass
required
• The epidemiology of cancer is a key factor in
driving how services, research and education
are organised
