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‘Dramatic decreases’ in cancer mortality in middle-aged people despite rising incidence

Fewer middle-aged people are dying of cancer in the UK than at any point over the last 25 years, despite a rise in cases of cancer, new research has revealed.

The study, conducted by Cancer Research UK and published in the BMJ, shows that mortality rates for both men and women aged 35-69 years fell by over a third between 1998 and 2018.

This was due to improvements in screening programmes, more effective treatment options, and the introduction of smokefree policies, the researchers said.

The fall in mortality rates was seen across nearly all of the 23 specific cancer types examined; only liver, oral, and uterine cancers showed an increase, together with melanoma skin cancer in men and pancreatic cancer in women.

Cancer incidence varied with cancer type, but overall, the researchers noted a modest increase in cancer incidence of 15% in men and 16% in women over the 25-year timeframe.

David Forman, visiting professor at the University of Leeds and co-author of the research, said: ‘This study was designed to look at the rates at which middle-aged people across the UK develop and die from cancer over the 25 years leading up to the Covid pandemic. We clearly see dramatic decreases in the death rates from cancer in both men and women.’

He added: ‘In contrast, a modest increase in the rates at which people are being diagnosed with cancer over the same time period and the increases in some specific types of cancer, such as skin melanoma, oral, liver and kidney, are of particular concern.’

To examine the trends in cancer incidence and mortality between 1993 and 2018, the researchers conducted a retrospective secondary data analysis using cancer registration data, cancer mortality and national population data collected from a variety of sources.

These included the Office for National Statistics, Public Health Wales, Public Health Scotland, Northern Ireland Cancer Registry, NHS England, and the General Register Office for Northern Ireland. All participants were aged between 35 and 69 years of age and were diagnosed with, or died from, cancer between 1993 and 2018.

The researchers included both single site cancers (such as breast and prostate) and site groups (such as oral) in the study. The estimated annual percentage change was calculated using a quasi-Poisson link function giving an age-standardised cancer (incidence or mortality) rate per 100,000, and a three-year rolling average of age-standardised rates was used to account for yearly variations.

The number of cancer cases seen in adults between the ages of 35 and 69 increased significantly within the study period. For men, cancer cases went from 55,014 registered cases in 1993 to 86,297 in 2018, a rise of 57%. Prostate cancer cases predominantly drove the increase.

For women, there was a 48% rise (60,187 to 88,970), mainly driven by increases in breast cancer cases. Taking prostate and breast cancer cases out of the analysis, cancer trends in age-standardised incidence rates remained relatively stable.

For a small number of less common cancers, such as melanoma skin, liver, oral and kidney cancers, the researchers found that incident rates increased for both sexes, which they noted was ‘concerning’.

Cancer deaths decreased over the 25-year period by 20% in men (from 32,878 to 26,322) and 17% in women (28,516 to 23,719). The most significant decreases in mortality were noted for stomach, mesothelioma and bladder cancers in men and stomach and cervical cancers and non-Hodgkin lymphoma in women.

When corrected for age, the rate of mortality decline was −2.0% per year in men and −1.6% per year in women, although the main decrease in the number of deaths per year occurred before the year 2000. Since then, the mortality rate for both sexes has remained relatively constant, the researchers found.

In addition, the researchers stated that most incidence and mortality changes were statistically significant even when the change was relatively small.

Cancer Research UK’s head of cancer intelligence and lead author of the study, Jon Shelton, said that while the study highlights the progress made in cancer treatment, challenges remain to maintain this.

‘This research is a useful benchmarking tool for the next 25 years and beyond so that we can take action to save more lives from cancer. We must continue to prevent as many cancer cases as possible, diagnose cancers sooner and develop kinder treatments,’ he said.

Mr Shelton added: ‘With cancer cases on the rise and improvements in survival slowing, it’s vital that the UK Government takes bold action to keep momentum up. Now is the time to go further and faster, building on the successes of decades of research and improvements in healthcare.’

In February, the World Health Organization warned that both the global cancer burden and inequity in cancer and palliative care services are growing across the world and highlighted a growing need for more cancer-related health services worldwide.