Cancer Prevention, Screening and Treatment
KEY MESSAGES
Mortality from cancer accounts for 19% of the male life expectancy gap and 13% of the
female life expectancy gap between Lewisham and England.
There is a clear downward trend in premature mortality from cancer in Lewisham but the
relative gap between Lewisham and England has increased from 9.35 in 1995-97 to
11.6% in 2006-08.
The largest number of deaths is from Lung cancer in Lewisham followed by Breast,
Colon and Prostate cancer.
The estimated smoking prevalence in Lewisham is significantly higher than England.
The estimated smoking prevalence in 2006 in Lewisham was 26.8% -seventh highest in
London –compared with an England prevalence of 24.1%.
There is a need to understand the excess cancer mortality in both men and women aged
65+ in Lewisham compared to England.
There is a need to investigate why Lewisham is in the lowest quartile nationally for oneyear survival for colon cancer.
There is a need to role out the learning from the Health Community Collaborative Cancer
Project across Lewisham. There is a need to have a greater focus on raising awareness
and early diagnosis across GP practices in Lewisham. This will require support and
training in primary care.
There is a need to consider what are the most effective interventions to promote
awareness of cancer symptoms and the benefits of screening to the diverse populations
in Lewisham.
There is a need to negotiate and implement a Cancer screening specification in primary
care to increase the uptake of cancer screening programmes.
There is a need to spread best practice in cervical screening across all practices in
Lewisham to reduce variability in coverage.
Work with partners to maintain and “industrialise” i.e. increase in scale, primary
prevention interventions in particular reducing smoking prevalence, the promotion of
healthy eating and physical activity, promote sensible drinking and to sustain the skin
campaign.
Work in partnership with South East Cancer Network (SELCN) to implement the Model
of Care for London cancer services.
Cancer Prevention, Screening and Treatment
1.
Introduction
There are more than 293,000 new cases of cancer (excluding non-melanoma skin
cancer) diagnosed each year in the UK, and more than 1 in 3 people will develop some
form of cancer during their lifetime. There are more than 200 different types of cancer,
but four of them - breast, lung, large bowel (colorectal) and prostate - account for over
half (54%) of all new cases. Breast cancer is the most common cancer in the UK even
though it is rare in men.
The development of a cancer involves a series of complex and interwoven mechanisms
relating to a persons genetic make up and their exposure to certain risks. Understanding
what causes cancer is essential in order to prevent, detect and successfully treat the
disease. An individual's risk of developing cancer depends on many factors, including
age, lifestyle and genetic make-up.
Research suggests that up to half of all cancers in the UK could be avoided if people
made changes to their lifestyle, such as stopping smoking, moderating alcohol intake,
maintaining a healthy bodyweight and avoiding excessive sun exposure.
Cigarette smoking has been identified as the single most important cause of preventable
death in the UK: overall, more than a quarter of all deaths from cancer (including almost
90% of lung cancer deaths)
It is estimated that, in the UK, current levels of overweight and obesity could lead to
around 19,000 cases of cancer each year.
Research suggests that each of the following increase the risk of certain cancers:
alcohol consumption, a low fiber diet, low consumption of fruit and vegetables, high
consumption of red and processed meats and higher intake of salt or saturated fats.
Excessive exposure to UV radiation (from the sun or sun beds) is the most important
modifiable risk factor for skin cancers.
A small number of infectious agents, especially certain viruses, play a key role in
causing certain types of cancer.
It is estimated that inherited factors cause up to 10% of all cancers.
Factors such as the age at which a women has her first child and number of children,
affect risk of the most common female cancers.
2
2.
What do we know?
Facts and figures
Main Causes of Death
The three main causes of death in Lewisham in 2008-2009 were circulatory diseases
(33%), cancers (26%) and respiratory diseases (15%). This is similar to the main causes
of death nationally. The total number of deaths from cancer in Lewisham in 2008-09 was
469. Lung cancer is the main cause of cancer deaths in Lewisham.
Table 1: Deaths from cancer type 2008-09
Cancer
Lung
Breast Colon Prostrate Oesph Pancreas Stomach Other
type
23.9%
6.6% 5.8%
5.1%
4.9%
4.9%
4.7%
44.6%
(110)
(31)
(27)
(24)
(23)
(23)
(22)
(209)
Source: PH Mortality Files
Incidence
Directly standardised rates of incidence of cancer for males in Lewisham is significantly
higher than those for London and England. Rates for females in Lewisham are lower
than England but not for London. The differences are not statistically significant. For
persons rates are higher than those for London and England but only significantly higher
than London.
Table 2: Incidence of all cancers (ICD10 C00-C99 ex C44) All ages, per 100,000 pop
(2004-06)
England
London
Lewisham
Males
407.89
387.47
451.78
Females
351.18
320.34
333.48
Persons
372.43
347.23
382.88
Source: NCHOD
Prevalence
Lewisham has a lower recorded prevalence of cancer on GP registers than that of
England and London.
Table 3: Number of patients and percent of patients on GP cancer registers,
England, London and Lewisham 2008/09
England
London
Lewisham
Denominator
Numerator
No of all registered
patients
No of patients on
cancer register
excluding with nonmelatonic cancers
54,310,660
8,462,684
296, 735
680,749
79,573
2,474
3
Per cent
1.3%
0.9%
0.8%
Source. NHS Information Centre
Trends
Similar to England premature mortality from all cancers has improved in recent history in
Lewisham, however the mortality rate remains higher in Lewisham than England.
Figure 1:
160
150
140
130
120
110
100
Le wis ha m
-0
8
20
06
-0
7
20
05
-0
6
20
04
-0
5
20
03
-0
4
20
02
-0
3
20
01
-0
2
20
00
-0
1
19
99
-0
0
19
98
-9
9
19
97
19
96
19
95
-9
8
90
-9
7
Directly age-standardised rate/100,000
Trends in mortality from all cancers: Lewisham compared to England.
Directly age standardised rate per 100,000 persons aged under 75 years.
E ngla nd
Source: NCHOD
The premature mortality rate of cancer for men in Lewisham for the period, 2005-2007,
was significantly higher than the London and England rates.
Table 4: Premature Mortality Rates of Cancer in Males - 2005-2007
Number
Directly AgeStandardised Mortality
Rates per 100,000
population
95%
Confidence
Interval (Lower
Limit)
95%
Confidence
Interval (Upper
Limit)
402
156.6
141.2
172.0
London
11120
126.3
124.0
128.7
England
100350
128.3
127.5
129.1
Local Authority
Lewisham
Source: NCHOD
The premature mortality rate of female cancer in Lewisham has generally been above
the rate for England. However the most recent data 2005-2007 shows that this rate was
not significantly different from that of England or London.
4
Table 5: Premature Mortality Rates of Cancer in Females - 2005-2007
Number
Directly AgeStandardised Mortality
Rates per 100,000
population
95%
Confidence
Interval (Lower
Limit)
95%
Confidence
Interval (Upper
Limit)
Lewisham
330
111.5
99.4
123.7
London
9664
99.4
97.4
101.4
England
85670
103.9
103.2
104.6
Local Authority
Source: NCHOD
Target
Cancer Mortality
The target for cancer mortality (ages under 75) is by 2010 to reduce mortality rates for
England by at least 20% and the absolute gap in mortality rates between England and
the Spearhead Group by at least 6%, from a 1995-97 baseline.
Performance
Premature Mortality
Three-year average mortality rates for cancer (ages under 75) for England have fallen
for each period since the baseline, from 141.2 deaths per 100,000 population in 1995-97
to 114.0 deaths per 100,000 population in 2006-08, and are now 19.3% below the
baseline rate. If the trend of the last ten years were to continue, the target would be met.
Three-year average mortality rates for cancer (ages under 75) for Lewisham have also
fallen for each period since the baseline from 154.4 per 100,000 population to 127.2 per
100,000. The absolute gap in mortality rates between England and Lewisham is
unchanged from baseline to 2006-08 and remains at 13.2 per 100,000.
Over the same period, the relative gap – i.e. percentage difference – in mortality rates
between England and Lewisham has increased from 9.3% in 1995-97 to 11.6% in 200608).
However Lewisham’s premature mortality rates for cancer are lower than those of the
Spearhead Group as a whole. In 2006-08 the relative gap for the Spearhead Group as a
whole was 16.3% compared to the Lewisham gap of 11.6%.
One year survival rates
One-year survival rates are generally accepted as a good proxy for early/late diagnosis.
The National Cancer Intelligence Network has developed benchmarks of good
performance on one-year survival rates for the four commonest cancers, based on the
EUROCARE-4 findings for patients diagnosed in 1995–99. “Average” is based on the
average one-year survival rate for Europe in 1995–99. “Good practice” is based on the
average achieved across a whole country by the best performing countries in
EUROCARE-4.
As can be seen from Table 6, the range of one-year survival performances observed for
cancer networks in England in 1999–2001 fell below the consensus benchmark on all
four major cancers (i.e. no single network achieved “good practice”). For colon and lung
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cancers, no single network achieved even the European average. This shows the major
scope for improvement. Performance at individual PCT level is shown in Table 7.
Table 6: Consensus benchmarks for one-year survival rates for the four
commonest cancers
EUROCARE-4
EUROCARE-4
English cancer
average1
“good practice”2
networks (range)3
Breast
93.8
97
90.0-95.8
Colon
74.2
79
63.0-72.2
Lung
36.0
37
21.5-29.7
Prostate
92.7
96
84.1-92.9
1 EUROCARE-4: age-adjusted one-year relative survival rates, adults diagnosed 1995–99.
2 “Good practice” is based on the highest one-year survival rates of countries with 100% cancer registration in
EUROCARE-4, rounded down to the nearest whole number. For all four tumour types, Sweden was among the highest in
Europe.
3 The cancer network range is based on patients diagnosed in 1991–2001 (from the National Centre for Health Outcomes
Development).
Table 7: Lewisham PCT one year survival rates for Breast, Colon and Lung cancer
Lewisham PCT
Breast
94.3%
Colon
65.6%!
Lung
32.9%*
! Indicates lowest quartile-England
*Indicates highest quartile- England
National Cancer Screening Programmes
Breast Screening
The NHS Breast Screening programme provides free breast screening every three years
for all women aged 50 and over. The programme is extending the age range of women
eligible for screening to ages 47-73 by 2012.
The indicator used in the breast screening programme is coverage. Coverage is defined
as the proportion of eligible women that has had a test with a recorded result at least
once in the previous 3 years. Currently coverage is best assessed using the 53-64 age
groups as women may be invited for screening at any time between their 50th and 53rd
birthdays. The national coverage target is 70%.
The national coverage rate has increased by nearly 3% (from 74.9% to 77%) between
2003-04 and 2008-09.
Coverage in Lewisham in 2008-09 was (65.7%), just above London (65.1%) but below
the England (77%) average.
Coverage varies considerably by GP practice in Lewisham, in 2008-09 there were:
- 1 (2%) out of 49 practices had a coverage of 70%.
- 6 (12%) practices with coverage of between 65% and 69%.
The lowest coverage was one practice at 35%.
Cervical Cancer Screening
The NHS cervical screening programme is population-based programme and offers
screening to women between the ages of 25 to 64 years. All women aged 25-49
6
years are screened on a three yearly basis and women between the ages of 50 and
64 years are screened every five years.
The effectiveness of the cervical screening programme is judged by its coverage.
Coverage is defined as the percentage of eligible women between the ages of 25 and 64
years who have had an adequate test result in the last five years.
The target for five-year coverage is 80% .The national coverage rate dropped from
80.6% to 78.6% between 2003-04 to 2008-09.
In Lewisham the coverage rates has dropped in the same period from 75.5% to 74.5% in
2008.09.
Coverage varies considerably by GP practice, in 2008-09 there were:
- 5 (10%) out of 49 practices achieved coverage of 80%.
- 19 (38%) practices with coverage of between 75% and 79%.
- One practice had the lowest coverage of 55%.
Bowel Cancer
The national bowel cancer screening programme was introduced in England in 2006. It
offers screening every two years to all men and women aged 60-69. People over 70 can
request a screening kit. The programme is to be extended to include people aged up to
75. In Lewisham it is expected the extension will start in 2010. The national target for
bowel screening is 60% uptake. At a national level the uptake at end of December 2009
was 53%, for London 40.26%.
In Lewisham the programme was launched in January 2008. Since that time there have
been nearly twenty thousand invites sent out, 7,820 kits return, resulting in an uptake of
39.24%.There have been sixteen bowel cancers detected in Lewisham patients since
the inception of the programme.
South East London Cancer Network (SELCN)
The NHS Cancer Plan (2000) requires the SELCN to agree, implement and monitor local
plans to improve the outcomes of cancer treatment, as evidenced by increasing
compliance with NICE Improving Outcomes Guidance (IOG) and the associated national
cancer standards. The section below summarises the SELCN progress to date and
proposed action to implement the published guidance to improve outcomes in
Haematological cancers (Oct 2003) and Palliative and Supportive Care (March 2004),
Head and Neck cancers (Nov 2004), Children and Young People with Cancer (August
2005), skin including melanoma (Feb 2006), Sarcoma (March 2006) and Brain (June
2006).
Haematological Cancers
The NCAT has now indicated that the Network meets the IOG although this will need to
be validated through peer review. Staffing ratios in all Trusts remains an issue to achieve
peer review requirements.
Head & Neck Cancer
The Network has established the new community based support team, which became
operational in September 2009.The Network is now fully compliant with this IOG.
Children and Young People with Cancer (C&YP)
Good Progress is being made with the implementation of the IOG.
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Skin Cancer
Skin services have been peer reviewed and Trusts and the network are producing action
plans to ensure compliance with the IOG and to meet peer review requirements.
Brain and Central Nervous System
The National Cancer Action have tasked each MDT to update MDT activity and
workforce against the IOG for submission by the February 2010
Supportive and Palliative Care
A final Stock take is currently being undertaken for submission to NCAT by March 2010.
The Cancer Action Team along with an SHA lead will be visiting networks in 2010 to
offer further support.
The Network along with the majority of other networks will be red lighted on
psychological care and rehabilitation where further work and investment is still needed.
3. What is this telling us?
Local Views
The South East London Cancer Network model for user partnership was established in
2005. A revised South East London Cancer Network (SELCN) user partnership strategy
(2008-2012) has been developed building on the work of the previous strategy.
The overall aim of this strategy is to embed user partnership working and user
involvement in policy development, service planning and service delivery of high quality,
user centered cancer services in SELCN.
In addition to this overarching framework there is current active user involvement in
many but not all of the tumour working groups, supportive care groups and generic
working groups. Users are also involved in one-off projects, focus groups and in peer
review.
NHS Lewisham has been recently recognized by the DH and NHS London for the work
carried out through the Pacesetters programme, working with local women from Black
and minority ethnic communities to promote attendance for breast screening.
The Healthy Communities Collaborative Cancer Project works with a team of lay
volunteers to organise and facilitate cancer awareness workshops, presentations,
festival or group meetings, which attract a diverse population in terms of age and
ethnicity.
Interim results from a Cancer Awareness Survey carried out in a neighbouring borough
in South East London with a similar population profile to Lewisham found that there was:







Low knowledge of “persistent cough and hoarseness” and “sore that does not
heal” as warning signs of cancer
Knowledge of warning signs for cancer lower among non-white and
economically inactive people
Low knowledge of HPV, low intake of fruit and vegetables and low physical
activity as risk factors for cancer
Underestimation of personal risk of cancer
Low knowledge of frequency of bowel cancer
Low knowledge of frequency of lung cancer in women
Low knowledge of existence of bowel screening programme
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
Lower knowledge of existence of NHS screening programmes in people who
are non-white, economically inactive and living in poorer areas. Also
particularly low for the Black African subgroup.
National and Local Strategies
The Cancer Reform Strategy, published in 2007, builds on the progress made since the
publication of Cancer Plan (2000) and strives to close the gap in cancer outcomes
between the UK and the rest of Western Europe. The key aims are to:






Prevent cancer by tackling the lifestyle factors that increase the risk of
developing the disease.
Diagnose cancer earlier by increasing coverage of cancer screening and
increasing awareness of cancer symptoms.
Ensure that patients have access to high quality cancer care.
Support and empowering patients through their ‘cancer journey’
Reduce inequalities in cancer incidence, mortality and access to care.
Bring cancer care closer to home where appropriate.
Healthcare for London: A Framework for Action was published in July 2007. Led by
Professor Lord Darzi it made a compelling case for change in health and healthcare
services across London. To support the implementation of this policy in cancer services
a “Case for Change” was published in March 2010 which provided a set of arguments for
the need to improve cancer services in London. This has been followed by the
publication of a Model of Care for London cancer services.
The South East London Cancer Network has developed its strategic vision covering all
aspects of cancer services- prevention, screening, diagnosis, treatment (surgery,
radiotherapy and systemic therapy) and supportive palliative care which has been
published is Collaborative Commissioning Initiatives 2008-09 to 2010-013.
NHS Lewisham’s Commissioning Strategy Plan (2009-2015) “Improving Health and
Well-being” has Reducing Premature Mortality from Cancer as one of its seven strategic
goals.
Current Activity and Services
Primary Prevention
Prevention remains the best form of tackling cancer, reducing the human suffering
caused by the disease and improving outcomes. There is also a strong economic case
for investing more in prevention, therefore reducing the pressure on services in the long
term.
Reducing smoking prevalence
Smoking is the single largest preventable risk factor for cancer.
The key actions of the Lewisham Tobacco Control Plan are:

Reducing availability to children - vending machines/ supply of tobacco to minors
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Reducing attractiveness of tobacco products - removal of display/ reducing
promotion/ limiting exposure to tobacco use in media/ reducing promotion
through tobacco accessories
Taking action on illicit tobacco
Counterfeit Tobacco Seizures
NHS intervention- Stop Smoking services
Smoking and Pregnancy.
Healthier nutrition /increasing physical activity
The evidence linking poor diet and obesity to cancer has become much stronger. In
Lewisham there is a Promoting Health Weight for Lewisham Children, Young People
and their Families Strategy and an action plan. The action plan includes the following:
 Promotion of Healthy Weight for all children, including measuring of children in R
and year 6, linking with schools nurses, Maternity, Early years, schools (linking
with Healthy Schools)
 Leisure Sports and Environment- including the promotion of free swimming, and
the adoption of Change for Life to promote local activities and projects, the
development of a Physical Activity Strategy and action plan in 2010.
 Lewisham Food Strategy, which includes improving food access through the
development of Food Co-ops, food growing through Community gardens and
allotments , Schools Food Policy and Schools meals
 Workforce training and communications
 Development of targeted and specialist weight management services for children
and adults.
Alcohol
Excessive alcohol consumption is strongly linked to an increased risk of several cancers.
Lewisham has published an Alcohol Strategy 2009-2012. The strategy aims to promote
sensible drinking and to reduce the impact of alcohol misuse. Priorities for the coming
year include the revision and development of the Council and PCT’s workplace alcohol
polices, to run seasonal campaigns, to continue and develop the primary care based
Directed and Local Enhanced Services and to develop an alcohol prevention pathway
as part of the Health Checks programme.
Skin Campaign
The skin campaign was launched in April 2009 and ran until September 2009 across the
six boroughs covered by the South East London Cancer Network. The campaign used
innovative evidence-based social marketing techniques to produce measured behaviour
change amongst residents, who are most at risk of skin cancer. Three ‘behavioural’
groups were targeted using a range of communication channels including a bespoke
website, nightclub posters and on-the-ground engagement, supplemented with an
education programme.
The budget for the research and campaign implementation was jointly funded by the
South East London Cancer Network (SELCN) and six PCTs. The results showed that
22% of South East London residents had remembered seeing the campaign, and of
those who had seen it 36% said they had taken action as a result, including checking
their skin more often and using higher level sun protection.
10
Human Papilloma Virus (HPV) vaccination for cervical cancer
Vaccination now presents a further opportunity in cancer prevention, specifically for
cervical cancer. The government has introduced a national vaccination programme for
young girls against the human papillomavirus. This will protect against the strains of the
virus which cause around seven out of ten cases of cervical cancer. In the academic
year 2008-09 Lewisham achieved an uptake of 72.6%, lower than the national target of
80%.
Increasing awareness and earlier presentation
Healthy Communities Collaborative Cancer project
A two-year community-based cancer initiative was launched in Lewisham September
2008 and completed in September 2010 The Healthy Communities Collaborative aimed
to raise awareness and promote the earlier presentation of cancer symptoms. The
project was focusing on three wards in Lewisham that have high deprivation with, high
mortality and poor survival rates for cancer. These are Evelyn, New Cross and
Bellingham and it included working with fourteen general practices in these wards. The
focus was on breast, bowel and lung cancer.
Earlier diagnosis - Increasing the coverage/uptake of cancer screening
A key objective for NHS Lewisham and partners in reducing health inequalities is to
improve cervical, breast and bowel screening uptake. Central to this is the involvement
of primary care to promote screening. A specification for cancer screening and primary
care is being developed. Health Equity Audits are currently being carried out on the
breast and cervical screening progrmammes to assess issues of access.
Cervical cancer screening
Uptake rates for cervical screening will be analyzed by practice and poor performing
practices will be targeted with support and best practice shared.
Breast Screening
A breast screening action plan has been developed and submitted to the London
Strategic Health Authority. Key actions to implement this include, validation of practice
lists, supporting and involving primary care to promote breast cancer screening and
awareness raising and health promotion activities to women in the community.
Bowel cancer
A health promotion specialist has been appointed in South East London by the Bowel
Cancer Screening Programme to promote bowel cancer screening, to work closely with
Primary Care Services and to develop strategies to increase the uptake rate. Southwark
PCT has developed a ‘bowel screening action pack’ to raise awareness of the
programme among GP practices which will be promoted in Lewisham. Training and
health promotion sessions have been and will continue to be carried out for health and
social care professionals and a wide range of community and voluntary groups in
Lewisham.
An application for NAEDI funding for South East London sector to develop an integrated
programme of awareness raising of bowel cancer symptoms and the screening
programme was submitted at end of April 2010 and was successful. A campaign to raise
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awareness of bowel cancer signs and symptoms in the members of the community most
at risk and in selected GPs practices is being planned for summer of 2011.
Secondary and tertiary care services
NHS Lewisham commissions for its patients access to a comprehensive range of
diagnostic and treatment services for cancer, including tertiary care, primarily provided in
the SELCN area.
SELCN Strategic Commissioning Priorities for 2009-2013

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Bring cancer mortality in line with National target of 20% reduction over 10 years.
Increase levels of awareness of cancer and causes.
Improve continuously towards meeting National Targets and increase coverage.
Breast - 70% Minimum - 80% Target. Cervical - 80%. Reduce Delays in reporting
cervical cancer to 2 weeks. Implement Bowel Cancer Screening programme
including age extension.
Undertake National Audit in Primary Care for all newly diagnosed patients with
cancer.
Implement National Chemotherapy and Radiotherapy Guidance to improve
access to treatment.
Reduce inpatient bed days for cancer patients and increase ambulatory care.
Reconfigure services in South London Healthcare, UHL and AHSC to deliver
safe services locally where possible and centralise where necessary.
Establish clear arrangements for the commissioning and provision of NICE
approved drugs.
Transform the Cancer Network management into clearly focused support for
commissioning.
.
What is this telling us?
What are the key inequalities?
There is now a range of evidence about the nature and extent of inequalities which occur
in cancer, including:
 Cancer incidence and mortality are generally higher in deprived groups
compared with affluent groups, older compared with younger people and men
compared with women. Conversely, breast cancer has higher incidence in more
affluent groups, but mortality is actually higher in less affluent women. The
picture for ethnic minority groups varies according to cancer type and ethnic
group. In general, incidence is lower amongst ethnic minority groups, although
there are some important exceptions (incidence of prostate cancer is greater
amongst Black African and Black African-Caribbean men, liver cancer in South
Asians, and mouth cancer in Bangladeshis);
 Levels of public awareness of cancer signs and symptoms are generally low, but
even lower in some groups, such as deprived communities, some BME groups
and men. This may contribute to lower uptake of screening and later presentation
when symptoms arise;
 Lifestyle factors (such as smoking, obesity, alcohol consumption and physical
inactivity) almost certainly account for most of the variance in cancer incidence
between the most and least deprived;
 Poorer experience of care is reported by black and minority ethnic groups, men
with prostate cancer, and people living in London;
 Part of the variance in mortality rates can be attributed to delayed diagnosis
amongst deprived groups, older people (at least for breast cancer) and certain
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BME groups (at least for breast cancer). The contribution of delayed diagnosis to
poorer survival rates and higher mortality amongst men than women is still
uncertain;
Improvements in mortality have been slower in older people than in younger
people. Older people with cancer receive less intensive treatment than younger
people. In many cases this may be clinically appropriate. However, there is
increasing evidence that under-treatment of older people may occur.

Cancer mortality is the third major contributor for both men and women to the gap in life
expectancy between Lewisham and England. Circulatory disease followed by respiratory
disease are the first and second contributors respectively. In 2006-08 cancer mortality
accounted for 19% of the gap in male life expectancy in Lewisham compared to England
and 13% of the gap in female life expectancy in Lewisham compared to England.
In Lewisham lung cancer deaths for both men and women is the major contributor to the
“cancer” gap.
Table 8: Causes of death from cancer and their contribution to the gap in life
expectancy between Lewisham and England 2006-08
Oesophageal
cancer
Stomach cancer
Colorectal cancer
Lung cancer
Breast cancer
Other cancers
Men
4.4%
Women
2.3%
2.2%
..
8.3%
..
4.5%
1.5%
0.5%
8.2%
..
..
Source:http://www.lho.org.uk
Age-specific Death Rates from Cancer
The following tables and charts show age-specific death rates per 100,000 people for
males and females separately, during the period 2005-7, for Lewisham, with
comparative data for England, London overall, and the ONS London Cosmopolitan
comparator group1. The charts use a logarithmic scale for ease of readability.
Figure 2: Age-specific death rates per 100,000, cancer, Males 2005-7
Age Specific Death Rates 2005-7, Cancer, Males
Deaths/100,000 males
10000
1000
100
10
1
1-4
5-14
15-34
35-64
65-74
age-band
ENGLAND
LONDON
LONDON COSMOPOLITAN
Source: NCHOD
1
Source: NCHOD Compendium of Public Health Indicators
13
Lewisham LB
75+
Figure 3: Age-specific death rates, cancer, Females 2005-7
Age Specific Death Rates 2005-7, Cancer, Females
Deaths/100,000 females
10000
1000
100
10
1
1-4
5-14
15-34
35-64
65-74
75+
age-band
ENGLAND
LONDON
LONDON COSMOPOLITAN
Lewisham LB
Source: LHO
The following observations can be made:
-
-
Lewisham’s cancer death rate for pre-school age boys is around three times
as high as the England and London rates. This may be a statistical “blip”, as
absolute numbers (which are not included in the source data) are very small.
Lewisham’s rates in school-age children are low for both sexes (again,
absolute values will be low).
Lewisham death rates from cancer in younger working-age people of both
sexes are less than half the national rates.
Lewisham’s cancer death rates in older working age people of both sexes are
below national rates, and closely comparable to the other comparators.
In males aged 65-74, Lewisham’s cancer death rates are 29% higher than
England’s.
In males aged over 75 and over, Lewisham’s death rate from cancer are 6%
higher than the national rate.
In females age 65-74, Lewisham’s death rate from cancer is 12% higher than
England’s.
In females aged 75 and over, Lewisham’s death rate from cancer is 3%
higher than the national rate.
Deprivation
There are significant inequalities in cancer mortality within Lewisham. Bellingham and
New Cross wards have the highest mortality rates for 2003-07. These wards are the
second and fourth most deprived in the Borough respectively.
14
Figure 4: Standardised Mortality Ratios for Cancer, Lewisham Wards, Aged <75,
2003-2007
Mortality from all cancers: persons, less than 75 years, indirectly standardised
ratios (SMR, 100 = England) with 95% confidence intervals by ward, 5 year
average, 2003-07
230
210
SMR (100 = England)
190
170
150
130
110
90
70
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Source: LHO
What are the key gaps in knowledge/services?


Further detailed information analysis to understand the excess cancer mortality in
older people in Lewisham compared to England.

Further detailed analysis to understand 1 –year survival for colon cancer.

Roll out the learning from the HCC cancer project across Lewisham practices.

Effective interventions to increase uptake of screening services and awareness
of symptoms and signs of cancer in the population as a whole and in specific
population groups.

The need to increase the scale of primary prevention interventions to reducing
smoking prevalence, the promotion of healthy eating and physical activity,
promote sensible drinking and to sustain the skin campaign.
What are the risks of not delivering our targets?
The primary target for cancer is a minimum 20% reduction in cancer mortality by 2010
from the 1995/97 rate and that fewer people will die prematurely from cancer, heart
disease and stroke before the age of 75. Thus the risks of not delivering in other areas,
such as smoking and physical activity and diet obesity, will have an impact on cancer
outcomes. In particular,
 Smoking prevalence remains higher than the national average – reflecting
Lewisham’s socioeconomic landscape;
 The socioeconomic and ethnic diversity of Lewisham population impacts on late
presentation of cancer and uptake of screening programmes. Innovative social
15
marketing combined with community engagement approaches are required
otherwise this will impact on early diagnosis;
Is what we are doing working?
Deaths from cancer are affected by a wide range of factors including all aspects of
cancer care; prevention, screening, diagnosis, and treatment. Considerable progress
has been made both nationally and locally. There has been a decline in cancer mortality
both nationally and locally, nationally cancer survival rates for breast, colon, rectum and
prostate cancer has improved since 2000. The HPV vaccination programme has been
implemented. The bowel cancer screening programme has been rolled out. Lewisham
NHS successfully complied with the original waiting standards and is making good
progress with the extended waiting time standards.
What is coming on the horizon?
Greater demand from health services related to cancer due to
 Improved detection through screening programmes, which will increase
screening activity and the proportion of cancers requiring active, curative and
intensive treatment.
 Increased demand for adjuvant therapy
 Improved survival rates will lead to increased workload in monitoring and
treatment of recurrence
 Increased demand for emotional support.
Greater focus on Awareness and early diagnosis requiring the development of skills and
knowledge in primary care.
Shift in the focus of care from a hospital setting to a community based setting where
appropriate.
The implementation of the Healthcare for London “Case for change” and the Cancer
model of care.
What should we be doing next?

Increase the scale of primary prevention interventions to reducing smoking
prevalence, the promotion of healthy eating and physical activity, promote
sensible drinking and to sustain the skin campaign.

Role out the learning from the Health Community Collaborative Cancer Project
across Lewisham. There is a need to have a greater focus on raising awareness
and early diagnosis across GP practices in Lewisham. This will require support
and training in primary care.

Consider what are the most effective interventions to promote awareness of
cancer symptoms and the benefits of screening to the diverse populations in
Lewisham.

Negotiate and implement a Cancer screening specification in primary care to
increase the uptake of cancer screening programmes.

Spread best practice in cervical screening across all practices in Lewisham to
reduce variability in coverage.
16

Further analysis to understand excess cancer mortality in older age population
compared to England and the 1-year colon cancer survival rates.
17