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Introduction
More than a third of the population develops cancer at some point in their life. There are over 220,000 new cases each year in England, and 128,000 deaths. Cancer is easily the biggest killer in England, accounting for a quarter of all deaths. Those in deprived parts of England tend to die more frequently from cancer, and survive for a shorter time once diagnosed, than those in more affluent areas.
Since 1971 the rate of incidence (the number of new cancer cases per 100,000 population) in England has increased by nearly one third. Although patterns of incidence vary for individual cancers, incidence is likely to continue rising because of the ageing population. During the same period the cancer mortality rate (the number of deaths from cancer per 100,000 of the population) has fallen by one eighth in the last 30 years. Smoking related cancers remain particularly lethal however.
For some cancers, screening is improving early detection of people with the disease but without symptoms. Screening women over 50 for breast cancer is effective, with extension of the programme underway for women aged 65-70. After successful piloting, bowel cancer screening is due to be introduced in 2006. The Department will extend screening programmes only where it is clear they will save lives, because they increase pressure on diagnostic and treatment resources.
People with symptoms in some other countries have their cancer diagnosed at an earlier stage than is the case in England. This reflects a number of factors, including patient delay in coming forward, difficulties for GPs in recognising symptoms early enough and waits for diagnostic tests within the hospital. How much each of these factors contributes to overall delays is not known. The NHS in England is meeting its targets for urgent referral of those with suspected cancer but, once in the system, patients' waits for diagnostic services such as colonoscopies and scans are often too long.
The NHS has done much to improve the quality of cancer treatment through multidisciplinary team-working but the "postcode lottery" for chemotherapy treatment has yet to be tackled decisively though action is now in hand and waiting times for radiotherapy treatment are too long. The NHS is addressing these problems by greatly increasing capacity through increased staff and equipment. Service re-design is underway in some radiotherapy departments.
On the basis of a Report from the Comptroller and Auditor General,[1] we examined the Department of Health on: improving the prevention and early detection of cancer; improving the quality of cancer treatments; and reducing the variations in cancer survival and mortality rates between different parts of England.
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