More than 17 400 deaths a year in the United Kingdom from
cancer could be prevented if all areas of the
country matched those with the lowest mortality,
says a new cancer atlas published this week.
Lifestyle rather than where people live contributes most
to the national variation in incidence of cancer,
the atlas produced by the Office for National
Statistics shows, but a north-south divide exists
for some cancers.
The comprehensive picture of rates of the 21 most common
cancers between 1991 and 2000 across the UK as
well as Ireland confirms that areas with high
levels of socioeconomic deprivation tend to be
the places with the highest cancer incidence and mortality.
The atlas shows a strong link between several cancers
and smoking or drinking alcohol. It shows "distinct
geographical patterns" in numbers of cases of
cancer and deaths over the period studied.
Each year during the 1990s an average of 270 000 new cases
of cancer were diagnosed (excluding non-melanoma
skin cancer), and almost 165 000 people a year
died from cancer related causes.
A band across the north of England and across central
Scotland had a generally higher than average
incidence and mortality for cancers of the lung,
larynx, lip, mouth, and pharynx, and rates were
lower than average in the south and Midlands of England.
But cancers of the breast, ovary, and prostate showed
little geographical variation.
Mike Quinn, director of the National Cancer Intelligence
Centre at the Office for National Statistics,
said: "In theory it should be possible to reduce
the rates for cancers everywhere to those in
the areas with among the lowest rates, and if that were
done we would prevent just over 25 000 cases
of cancer and over 17 000 deaths from cancer.
"Can I emphasise that places do not get cancer, people
do. The reason that areas have high rates of
cancer is that people in them are exposed to
the relevant risk factors for those cancers."
Melanomas had the fastest growth in incidence of any cancer
since the 1970s, said the report. The incidence has
increased threefold to fourfold in that time.
The geographical distribution of the disease
shows that the highest incidence among women occurs
in the south of Scotland, southwest England, southwest
Ireland and part of Northern Ireland (see map); the
incidence is similar for men.
The incidence of melanomas was higher than average in
central Scotland, despite this area having less
sunshine than other parts of the UK, which the
authors admitted may be surprising at first.
Dr Quinn said, "The reason, partly, is due to public health
awareness campaigns, and in particular there is a
Scottish melanoma group. Also in Scotland you
do have a higher proportion of the population
with risk factors for melanoma: very pale skin, freckles,
and red hair.
"The main risk factor is exposure to UV [ultraviolet radiation],
and the main problem seems to be people who get sunburned...
mostly on holidays abroad."
The report also found "very wide" geographical variation
in the incidence of cervical cancer, which was
not related to local differences in the uptake
or efficiency of the cervical screening programme
but was related to patterns in sexual behaviour and
infection with human papillomavirus.
Mike Richards, the national cancer director for England,
said: "Better recognition and understanding of
the geographical patterns in cancer incidence
and mortality will assist in ensuring that resources
can be appropriately targeted."