Poorer people more likely to get and die from cancer

Cancer Research UK

Why is inequality linked to 19,000 cancer deaths a year? - Cancer Research UK

The poorer you are, the more likely you are to get and die from cancer, with more than 19,000 cancer deaths every year linked to lower levels of income according to new research* published today (Thursday).

"These shocking data raise many questions as to why cancer is having a greater impact among those who earn less" - Harpal Kumar, Cancer Research UK's chief executive

There are more than 15,000 people diagnosed with cancer every year partly as a result of their economic deprivation.

The new report compiled by Cancer Research UK and Public Health England’s National Cancer Intelligence Network also reveals there has been virtually no improvement in narrowing the gap in the number of cases between the most and the least deprived people during the last 15 years.

In men the gap between cancer cases among the most and least affluent closed in just two types of cancer over 15 years – stomach cancer, and those cancers found somewhere in the body but where the original cancer cannot be found (cancer of unknown primary).

There was little change in the gap between richer and poorer women over time.

But among both men and women it widened for five cancer types. For men this was the kidney, oesophageal and non-Hodgkin lymphoma and for women kidney, the throat and the back of the mouth (oropharynx) and vulva.

More than half of the most common cancers have incidence rates linked to levels of income; in nearly all cancers the lower the income the higher the number of cases and deaths. However, of the 19,000 ‘excess deaths’ associated with deprivation, over 11,000 are in patients with lung cancer.

Researchers divided England into five groups according to the level of income in different areas. They then calculated cancer rates in the groups to work out the number of cancer cases and deaths. This revealed the differences expected if rates for the more deprived groups had been the same as the least deprived.

Smoking is likely to be the main cause of the difference in cases and deaths between the groups. Other lifestyle factors likely to play a part are diet and obesity, with the higher income group having healthier diets that reduce the risk of cancer.

Professor Julia Verne, Strategic Public Health Lead of PHE’s National Cancer Intelligence Network, said: "These results build on our existing work on cancer and socio-economic deprivation with Cancer Research UK, which has expanded to include a wider range of cancer sites. While we've been able to improve the collection and understanding of cancer data from across England, and we now better understand why variations exist in new cancer cases and deaths between the lowest and highest income groups, and unfortunately these differences have not improved over time. However, by working closely with organisations, such as NHS England, we can improve earlier diagnosis and survival rates – regardless of where the person lives.

"In most recent periods, lung cancer had the largest number of excess cases - 11,700 persons per year; and deaths, 9,900 persons per year. Our Be Clear on Cancer (BCOC) campaign which launched nationally last year is designed to help raise awareness of the early signs and symptoms of cancer and get more people diagnosed earlier. Importantly the national campaign led to an extra 700 lung cancer patients being diagnosed at an earlier stage and we want to increase this. We are doing more to target awareness programmes to help more deprived areas introducing pilot regional BCOC campaigns, as well as other national campaigns such as SmartSwaps, to encourage the population to make positive changes to their lifestyle and diets which may hopefully close the gap between these groups."

Sara Hiom, Cancer Research UK’s director of early diagnosis, said: “This report is a wakeup call about the magnitude of cancers linked to levels of wealth. It’s unacceptable that such a large group of people are being penalised, effectively because of their income group and that little has worked to narrow the gap over the years.

“This inequality remains despite years of effort to reduce it and demands action. Given that the vast proportion of the extra cases and deaths occur in smoking related cancers, the continued roll out of comprehensive tobacco control measures is all the more vital. Standardised packaging for tobacco products and sufficient investment in Stop Smoking Services are two vital measures that will help reduce the tobacco toll.”

Harpal Kumar, Cancer Research UK’s chief executive, said: “These shocking data raise many questions as to why cancer is having a greater impact among those who earn less. Tobacco is clearly the main factor and must remain a focus for preventing cancer. But beyond smoking, we need to clarify if the least well off are losing out on access to services, whether the health service can be made more accessible or if we can do more to effectively target awareness programmes to benefit those at higher risk.

“It isn’t right that someone’s income level should be a marker for their chances of getting and dying from cancer. It’s time to find some answers and act on them.”



Notes to Editor

The income deprivation index measures the proportion of the population in an area experiencing deprivation related to low income.

The report can be viewed here.

See https://www.gov.uk/government/collections/english-indices-of-deprivation for further information.

For ‘all cancers combined’, in the latest period examined, the deprivation gap was not statistically significantly different between males and females.  But where the deprivation gap was significantly different between males and females it was larger in males. This occurred in seven sites (colorectal, oesophagus, larynx, bladder, liver, oral cavity and oropharynx), for both incidence and mortality, and in stomach cancer for incidence and chronic myeloid leukaemia (albeit with a low overall magnitude) for mortality alone.