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The Christie NHS Foundation Trust
Introduction to Cancer
Epidemiology Basics
Dr Chris Harrison
Medical Director, The Christie
Clinical Director (Cancer), NHS London
The Christie NHS Foundation Trust
What is Epidemiology?
• ?
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
The Christie NHS Foundation Trust
Alternatively
• “Epidemiology is the study of the health of
human communities”
Prof Alwyn Smith
Descriptive v Analytic Epidemiology
Uses of Epidemiology
The Christie NHS Foundation Trust
Key Terms
• Incidence
• Mortality
• Survival
• Prevalence
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
The Christie NHS Foundation Trust
Cancer Incidence
The Christie NHS Foundation Trust
Cancer Incidence
England Wales Scotland
Northern
Ireland
UK
Male
Cases 134,636 9,130 14,271 4,260 162,297
Crude Rate 527.7 623 567.4 484.9 534.3
AS Rate 424.3 449.6 451.7 451.1 428.7
AS Rate - 95% LCL* 422 440.3 444.3 437.6 426.7
AS Rate - 95% UCL* 426.6 458.8 459.2 464.7 430.8
Female
Cases 130,043 8,623 15,295 4,209 158,170
Crude Rate 494.6 562.2 571 462.4 503.4
AS Rate 366.9 385.7 407.1 386.7 372.1
AS Rate - 95% LCL* 365 377.6 400.7 375.1 370.3
AS Rate - 95% UCL* 368.9 393.8 413.6 398.4 373.9
Persons
Cases 264,679 17,753 29,566 8,469 320,467
Crude Rate 510.9 591.9 569.2 473.4 518.6
AS Rate 389.8 411.3 423.6 410.9 394.5
AS Rate - 95% LCL* 388.4 405.3 418.7 402.2 393.2
AS Rate - 95% UCL* 391.3 417.4 428.4 419.7 395.9
The Christie NHS Foundation Trust
Incidence - Common Cancers
The Christie NHS Foundation Trust
Incidence - Age
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
The Christie NHS Foundation Trust
Mortality - Trends
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
The Christie NHS Foundation Trust
Key Messages - Mortality
• Population Mortality has been falling
• Cancer is 28% of all deaths in UK
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
The Christie NHS Foundation Trust
5 Year Survival – All Cancers
• People – 50%
• Men – 43%
• Women – 56%
• National (CRUK) and Manchester Target is 66%
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
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
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
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
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
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
The Christie NHS Foundation Trust
The North West
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
The Christie NHS Foundation Trust
WP 12
EurocanPlatform
MEMBERS
Données cartographique
MEMBERS
Données cartographique
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

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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
  • 2. The Christie NHS Foundation Trust What is Epidemiology? • ?
  • 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
  • 4. The Christie NHS Foundation Trust Alternatively • “Epidemiology is the study of the health of human communities” Prof Alwyn Smith Descriptive v Analytic Epidemiology Uses of Epidemiology
  • 5. The Christie NHS Foundation Trust 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
  • 7. The Christie NHS Foundation Trust Cancer Incidence
  • 8. The Christie NHS Foundation Trust Cancer Incidence England Wales Scotland Northern Ireland UK Male Cases 134,636 9,130 14,271 4,260 162,297 Crude Rate 527.7 623 567.4 484.9 534.3 AS Rate 424.3 449.6 451.7 451.1 428.7 AS Rate - 95% LCL* 422 440.3 444.3 437.6 426.7 AS Rate - 95% UCL* 426.6 458.8 459.2 464.7 430.8 Female Cases 130,043 8,623 15,295 4,209 158,170 Crude Rate 494.6 562.2 571 462.4 503.4 AS Rate 366.9 385.7 407.1 386.7 372.1 AS Rate - 95% LCL* 365 377.6 400.7 375.1 370.3 AS Rate - 95% UCL* 368.9 393.8 413.6 398.4 373.9 Persons Cases 264,679 17,753 29,566 8,469 320,467 Crude Rate 510.9 591.9 569.2 473.4 518.6 AS Rate 389.8 411.3 423.6 410.9 394.5 AS Rate - 95% LCL* 388.4 405.3 418.7 402.2 393.2 AS Rate - 95% UCL* 391.3 417.4 428.4 419.7 395.9
  • 9. The Christie NHS Foundation Trust Incidence - Common Cancers
  • 10. The Christie NHS Foundation Trust Incidence - Age
  • 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
  • 12. The Christie NHS Foundation Trust Mortality - Trends
  • 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
  • 23. The Christie NHS Foundation Trust The North West
  • 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