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EALING PCT

By Debbie Sullivan,2014-06-26 20:07
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EALING PCT ...

3.3.4 Cancers

In England I in every 3 people will be diagnosed with cancer in their lifetime. Cancer is a

    major cause of death in men and women. People from deprived backgrounds are more

    likely to get some types of cancers and are more likely to die once diagnosed.

People diagnosed with cancer in the past 10 years who are still alive represent just over

    1% of the total population. Since 1950, deaths from major causes such as heart disease,

    stroke and infectious diseases have all declined dramatically but cancer mortality has

    remained fairly stable in both men and women.

Cancer became the most common cause of death in females in 1969 and in males in 1995.

    Since the 1970s, five year survival has improved for some cancers particularly for those

    of the bladder, breast, large bowel, melanoma of skin, and testicle, and for Hodgkin’s

    disease, non-Hodgkin’s lymphoma and childhood leukaemia but not for some of the

    most common and highly fatal ones such as cancers of the liver, lung, oesophagus and

    pancreas which represent about one third of cancers in men and one fifth in women.

There is overwhelming evidence that cancer survival is generally lower among patients in

    the most deprived groups than in the affluent. And for the vast majority of cancers, survival

    in England and Wales, and in Scotland, is well below the rates in other western European

    countries and in the USA.

The government has set a target (for England) of reducing the cancer death rate in people

    aged under 75 by 20% over the years to 2010.

5.1 SMRs for all cancers, all ages by LCG

    In 2005 there were 536 deaths from all cancers in Ealing PCT. The standardised mortality

    ratio was 96 where England as a whole = 100. The chart below compares mortality rates

    for all ages between the local commissioning groups. The rates for England, London and

    North West London are also indicated. Ealing PCT has comparatively lower rates of

    mortality from cancer in all ages. Southall with a standardised rate of below 80 has the

    lowest of the local commissioning groups

    Standardised Mortality Ratio, Cancer, All Ages, Ealing PCT PBC

    120.0 Groups, 2001-05

    100.0

    80.0

    60.0

    40.0

    20.0

    0.0

    West Ealing Northolt & EACG Southall Ealing PCT

    Greenford PBC

    SMR North West London London England

There can be significant variation between groups of populations within LCGs. More

    detailed data is available of cancer deaths by electoral wards. The chart below identifies

    Dormers Wells, Norwood Green and Southall Broadway has having examining the highest

    rates within Ealing PCT at 121 & 118 compared to the lowest rates in North Greenford and

    Southfield ward 67 and 66 respectively. (England SMR = 100).

5.2 SMRs for all cancers under 75 yrs by LCG

The trend identified with deaths from cancer in all ages is evident when examining cancer

    mortality ratio for the under 75 years. London, North West and Ealing PCT has a lower

    rate than England.

The chart below indicates SMRs by local commissioning groups. Southall at 78 is

    significantly lower. The highest rate of 95 is West Ealing.

    Standardised Mortality Ratio, Cancer, <75s, Ealing PCT

    PBC Groups, 2001-05

    120.0

    100.0

    80.0

    60.0

    40.0Lady Margaret

    Walpole20.0

    Southall Green0.0Ealing BroadwayEACGWest EalingNortholt &SouthallEaling Norwood GreenGreenford PBCNorth Greenford

    Southall BroadwaySMRNorth WestLondonEngland

     Dormers Wells Elthorne East Acton

    Standardised Mortality Ratio, Cancer, <75s, Ealing PCT Wards, 2001-2005Perivale

    Hanger Hill

    Ealing Common120.0

    Cleveland100.0

    Southfield80.0

    60.0South Acton40.0Northolt Mandeville

    20.0Greenford Broadway

    0.0Greenford Green

    Northfield

    Hobbayne

    Acton Central

    Northolt West End

As there is variance between populations within local commissioning groups it is valuable

    to scrutinise the data by electoral wards. The chart above shows Northolt West End and

    Acton central as having the highest rates for under 75year olds at 112 and 109

    respectively. The lowest are in Southall Green (76), Walpole (75) and Lady Margaret (73)

The table below details the cancer SMRs for under 75 years by each electoral ward within

    Ealing.

    Standardised Mortality Ratio, Cancer, Ages under 75, 2001-05

    Ward Name Observed Expected SMR LL UL Acton Central 69 63 109 85 138 Cleveland 65 72 91 70 116 Ealing Broadway 47 61 77 57 103 Ealing Common 59 65 90 69 121 East Acton 59 70 84 64 112 Hanger Hill 69 78 88 68 111 South Acton 63 66 95 73 121 Southfield 59 62 95 72 127 Walpole 44 59 75 55 101 EACG 534 597 89 68 117 Elthorne 52 62 84 63 110 Hobbayne 74 73 102 80 128 Northfield 62 63 99 76 127 West Ealing 188 197 95 73 122 Greenford Broadway 74 77 96 75 120 Greenford Green 71 73 97 76 122 North Greenford 57 73 78 59 102 Northolt Mandeville 68 72 95 74 121 Northolt West End 78 70 112 88 140 Perivale 62 74 84 64 107 Northolt & Greenford

    PBC 410 439 93 73 119 Dormers Wells 55 66 83 63 108 Lady Margaret 49 67 73 54 97 Norwood Green 44 57 78 56 104 Southall Broadway 48 60 80 59 106 Southall Green 42 56 76 54 102 Southall 238 305 78 57 103

    Ealing 1,370 1,539 89 84 94

    Ward Name Observed Expected SMR LL UL EACG 534 597 89 68 117 West Ealing 188 197 95 73 122 Northolt & Greenford PBC 410 439 93 73 119 Southall 238 305 78 57 103

    Ealing 1,370 1,539 89 84 94

    North West 8,519 9,348 91 89 93

    London 36,960 37,742 98 97 99 England 100 100 100

    317,655 317,655

5.3 Trends in all cancers mortality, by sex, Ealing, England 1995 - 2007

Most cancers take many years to develop before being diagnosed, and cancer incidence

    and mortality generally exhibit only slowly increasing or decreasing trends. For some

    cancers, the trends for many years to come will be determined to a great extent by

    people’s earlier exposure to various risk factors for example, lung cancer rates depend on smoking habits 20 or more years previously. So with the exception of cancers for which

    there have been major public health interventions such as screening for breast cancer

    past trends are a good guide to the future.

Over the 50 year period 19501999, age-standardised mortality from all causes of death

    fell by around 45% in both males and females. There were large declines in mortality from

    heart disease, stroke and infectious diseases. In contrast, age-standardised mortality from

    cancer (malignant and nonmalignant neoplasms) in both males and females changed

    relatively little during the 50 year period. With the large reductions in mortality from the

    other major causes described above, the proportion of deaths due to cancer rose over the

    period from 15% to 27% in males and from 16% to 23% in females. Cancer became the

    most common cause of death in females in 1969 and in males in 1995.

Cancer is predominantly a disease of the elderly. The overall crude annual rates of cancer

    incidence in 1997, 423 per 100,000 population for males and 426 for females, conceal

    wide differences between the sexes and across the age-groups. For adults, rates

    increased continuously across the age range from around the age of 30 for both males

    and females. Rates of cancer rose more quickly with age in females than in males. In

    the 4044 agegroup, the rate in females was double that for males. Subsequently, the

    overall rates rose more rapidly for males and were broadly similar to those for females in

    the 6064 agegroups. After this, the rates rose much more rapidly for males they were

    about 45% higher than those for females in the 6569 agegroup and almost double in

    those aged 8084.

Deaths from the three most common cancers (lung, prostate/breast, colo-rectal) in 1999

    constituted just under half of all cancer deaths.

The chart below compares Ealing PCT SMRs from 1993 - 2005 for all cancers and all

    ages with NW SHA, London and England. As would be expected there is more variance

    between the years for Ealing as the population size is smaller. There is an overall

    downward trend and Ealing PCT has the lowest rates; however the rate of decrease has

    been least for Ealing.

    Indirectly Standardised Mortality Ratios for All Cancers, All ages, males & females,

    1993-2005 (annual trends)

    140

    120

    100

    80

    SMR60

    40

    20EnglandLondonNorth West SHAEaling01993199419951996199719981999200020012002200320042005

Differences in male and female cancer mortality.

    Nationally the trends in cancer mortality in females are different from those in males.

Female cancer mortality

    The patterns reflect the lower overall risk for women born towards the end of the 19th

    century and the relatively high risk for women born in the mid1920s.

This is largely due to the increase in smoking in the latter group during the second world

    war (and afterwards). Mortality decreased during the 1950s in women aged 5584, but

    then rose steadily for the next 20 to 30 years. Mortality began to decline again from the

    mid1970s in women aged 4554, from the mid1980s in those aged 5564, and in the

    mid1990s in those aged 6574. Mortality in very elderly women has not risen as fast as in very elderly men.

Although the risk of being diagnosed with breast cancer has increased continuously from

    women born in the 1880s up to those born in the 1960s, the corresponding mortality has

    been more stable, with the highest risk being for women born in the mid1920s .This is

    consistent with the observed long term improvements in fiveyear survival of 45% points

    every five years since the early 1970s.

Male cancer mortality

    The incidence of cancer of the large bowel (colon and rectum) rose gradually from 1971 in

    males, but not in females. The risks by birth cohort rise in males and (slightly faster) in

    females up to the 1930s and early 1940s and then decline.

The incidence of prostate cancer first exceeded that of colorectal cancer in men in 1993.

    The increase in incidence in the 1980s may have resulted partly from the detection of

    latent carcinoma following operations for enlarged prostate, or at post mortem in men who

    had died from other causes. In more recent years, the availability of prostate specific

    antigen (PSA) testing probably accounts for the very sharp rise since 1991. Incidence rose

    by 82% between 1986 and 1991.

Fall in mortality

     Mortality has fallen more or less continuously since 1950, and in all cohorts since those

    born in the mid1860s. Mortality in England and Wales fell very slightly in both 1998 and

    1999 following a consistent rise during the 1980s and early 1990s.

As shown by the data below this national trend was reflected within Ealing.

    Mortality from all cancers (ICD9 140-208 adjusted, ICD10 C00-C97): Indirectly standardised ratios

    (SMR) All ages 1993-2005 (Annual trends) England 2005 = 100 (Standard rates are England annual age-specific rates 2005)

    North West

     England London SHA Ealing

     SMR OBS SMR OBS SMR OBS SMR OBS 1993 119 134213 120 17073 128 20222 103 568 1994 118 133160 118 16737 126 19973 105 577 1995 116 132644 116 16416 125 19857 109 606 1996 115 132289 115 16242 125 20051 107 596 1997 112 129923 112 15874 121 19503 99 545 1998 111 130363 113 15937 120 19375 106 586 1999 109 128024 108 15202 120 19358 102 568 2000 106 126773 105 14841 117 19170 95 531 2001 106 127359 105 14885 117 19204 99 554 2002 105 128379 104 14719 115 19136 92 514 2003 103 127286 102 14425 111 18625 94 526 2004 101 126048 99 14018 110 18556 89 495 2005 100 126246 96 13795 111 18942 96 536

The chart below compares Ealing SMR for all cancers, all ages between male and female

    1993-2005. There is a small downward trend in SMRs for cancers which is more evident

    for males.

    Indirectly Standardised Mortality Rates for All Cancers, All ages, 1993-2005

    (annual trends)

    120

    100

    80

    SMR60

    40

    20MalesFemales01993199419951996199719981999200020012002200320042005

The table below shows SMRs and actual numbers of deaths for all cancers for both male

    and female between 1993 - 2005.

Ealing Males Females

     SMR OBS SMR OBS

    1993 101 280 104 289

    1994 105 290 104 288

    1995 109 302 110 304

    1996 112 313 103 282

    1997 93 259 105 286

    1998 109 308 102 278

    1999 99 281 106 287

    2000 95 272 96 260 2001 99 287 99 267 2002 96 279 88 235 2003 96 281 92 245 2004 84 247 94 248 2005 92 272 100 264

5.4 Cervical Cytology Screening

    The effectiveness of the cervical screening programme can be judged by coverage. This is

    the percentage of women in the target age group (25 to 64) who have been screened in

    the last five years. If overall coverage of 80 per cent; can be achieved, the evidence

    suggests that a reduction in death rates of around 95 per cent; is possible in the long term.

    Nationally over the last ten years the percentage of eligible women who have been

    screened at least once in the previous 5 years has been declining slightly to 79.5 per cent

    in 2006 compared with 80.3 per cent in 2005 and 82 per cent in 1996.

    Coverage was 80 per cent or higher in 194 of the 303 Primary Care Organisations

    (PCOs). A drop compared to last year when 207 PCOs reached this level.

    London has some of the lowest uptake rates for cervical screening in England and Ealing

    PCT is one that not only fails to reach the 80% target but has seen gradual decline in the

    number of women attending since June 2004. The chart below shows the downward trend

    which has occurred in Ealing PCT.

Ealing PCT uptake rates June 2004 - March 2006

    Ealing PCT100%

    90%

    80%

    70%

    60%

    50%

    40%% smeared non GMS

    30%% smeared GMS

    20%% smeared10%

    0%Jun-04Sep-04Dec-04Mar-05Jun-05Sep-05Dec-05Mar-06

    8.4%8.3%8.4%8.4%8.5%8.4%8.2%8.1%% smeared non GMS

    69.3%68.8%68.3%68.1%67.9%67.4%67.4%67.3%% smeared GMS

    77.7%77.1%76.7%76.4%76.3%75.7%75.6%75.4%% smeared

The table below shows that the fall in uptake is reflected in the number of practices

    attaining 80% in 2006. Ealing PCT has seen a decline from 45 to 15. Within Ealing PCT,

    Central Ealing does not have any practice that has reached 80% whilst Acton, Southall

    and North NAG had between 13-25% of their practices attaining the target.

    Percentage of practices attaining 80% national target 2005 - 06

     No. > No. > No. Total % > % > % < PCT Locality 80% 50% < no. 80% 50% 50%

    50%

    EALING Acton 2 14 0 16 13% 88% 0%

     Central 0 12 0 12 0% 100% 0%

    Ealing

     Hanwell 1 9 0 10 10% 90% 0%

     North 2 10 0 12 17% 83% 0%

    Southall

     North NAG 3 9 0 12 25% 75% 0%

     South 2 8 0 10 20% 80% 0%

    Southall

     South NAG 5 5 0 10 50% 50% 0% EALING 15 67 0 82 18% 82% 0% Total

The worrying underlying trend is the gradual fall in coverage rates seen in women below

    50 and particularly below 35. This is a trend that began a few years ago and is continuing

    despite improvements to the programme.

Mortality rates from invasive cervical cancer have been dramatically reduced since the

    introduction of the national screening programme. There were 4 deaths in Ealing PCT in

    2005. There are concerns that since 2004, which coincided with the new contractual

    arrangements and a change in the age of first invitation, the small but significant

    downward trend in uptake and coverage of the programme will impact on the

    number of invasive cancers developing undetected.

The population of Ealing PCT is economically very diverse. Deprivation scores range from

    10 to 36 across the primary care trust. When comparing uptake rates with the areas of

    deprivation it is surprising to identify that the area with one of the highest screening uptake

    rates for the PCT at 75.2%, South Northolt and Greenford, has the highest deprivation

    scores. However, here as is all areas across the PCT, the percentage of women attending

    has fallen. North Northolt and Greenford had the highest uptake rate of 78.4%.

The chart below compares uptake rates in December 2006 for local commissioning groups

    in Ealing PCT.

    Percentage Cervical Screening Uptake, Dec 2006, ealing LCGs

    79.0%

    78.0%

    77.0%

    76.0%

    75.0%

    Percentage74.0%

    73.0%

    72.0%

    71.0%

    EACGWest EalingNorth PBCSouthallEaling PCT

     Quarter ending December 2006 Screening Uptake (Screening status ending

    June 06)

    % of Eligible women smeared Local Commissioning

    Groups (LCG's) % Uptake EACG 73.8% West Ealing 75.8% North PBC 78.0% Southall 74.0% Ealing PCT 75.2%

Interestingly, South Southall with deprivation scores of 30-36, compounded by a very high

    ethnic population, actually achieved 73%, a similar rate of uptake to Central Ealing. This

    area has seen a slighter greater fall in the percentage of women attending for screening

    than more deprived areas.

The data would suggest that the targeted work undertaken over several years with

    practices in areas of high levels of ethnicity and deprivation has been effective in reducing

    inequalities. Support and initiatives in other areas of healthcare, as well as screening, do

    impact on practice administrational systems within primary care. The screening

    programme requires effective practice administrative systems as well as clinical

    competencies to reach high levels of uptake.

5.5 Breast Screening

The incidence of breast cancer in females increased throughout the 1980s and peaked in

    1992. The rise from 1988 onwards occurred principally in women aged 5064 years which was associated with the NHS breast screening programme.

The incidence of carcinoma in situ of the breast rose sharply with the introduction of

    screening in 1990. Mortality from breast cancer rose to its highest level in the mid1980s, when the rate was among the highest in the world.

By 1999, mortality had fallen by just over 20% since 1989. In addition to cohort effects,

    mortality in the 1990s will have been affected directly by screening, and by the

increasingly widespread use of tamoxifen, improvements in chemotherapy, earlier

    presentation of cases outside the screening programme, and structural changes in the

    NHS following the CalmanHine report.

     It is estimated that by 1998 about one third of the reduction in breast cancer

    mortality since 1990 was due directly to the screening programme.

The increase in the incidence of breast cancer In England (28,902 to 34,286) between

    1993 - 1999 has been reflected in London and within Ealing PCT. There were 174 cases

    in 1999 compared with 102 in 1994.

Breast Screening Coverage

    The coverage of the breast screening programme in London is the lowest in the country.

    Ealing has one of the lowest rates in London.

Coverage rates indicate the percentage of eligible women resident in the PCT who have

    attended for breast screening. The data in the table below indicates that there has been a

    continual increase in the percentage of women aged between 53 - 64 in Ealing PCT who

    have been screened. (Coverage data is not available at LCG level).

KC63 Breast Coverage - Annual

    Trends 53-64yrs 00/01 01/02 02/03 03/04 04/05 05/06 06/07 Ealing 58.3% 41.6% 48.3% 52.0% 57.1% 64.2% 68.3%

    KC63 Coverage By Year 53-64yrs

    1Ealing0.9H&F0.8Hounslow0.7

    0.6

    0.5

    0.4% coverage0.3

    0.2

    0.1

    0

    00/0101/0202/0303/0404/0505/0606/07

    Years

The screening programme invites women from the age of 50 to attend for a

    mammography. However women may be invited at anytime between 50 - 53 years for a

    screen. This will depend on when the practice with which they are registered are

    scheduled to be offered screening. Chart below indicates quarterly coverage rates which

    include all women aged 50 - 64 years. Although rates fluctuate there is a small significant

    increasing trend.

    Jan-Oct-50-64 Apr-Jul-Mar Apr-Jun Jul-Dec yrs Jun 05 Sept 05 Oct-Dec 05 06 06 Sept 06 06 Ealing 59.1% 57.3% 57.6% 57.5% 54.6% 61.3% 62.5%

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