Old, poor and urban dwellers worst hit by cancer

Cancer hits the poor, the old and those living in urban areas the hardest, a new report has revealed.

Both the chances of a person developing cancer and whether they survive it vary according to how well off they are, their age and where they live, according to the report by the National Cancer Registry.

The incidence of some cancers is up to 38 per cent higher in urban areas than in rural parts of the country.

The report identifies poorer survival rates for older patients for all cancer types, as well as lower use of treatment aimed at reducing tumours.

"The patterns seen – in particular, in relation to variation in cancer risk by deprivation status, variation in survival by deprivation and by age and variation in treatment by age – do point up striking inequalities that need to be targeted for improvement," said Dr Harry Comber, director of the registry.

Previous reports have identified how cancer can be a “postcode lottery” stacked against those in more deprived areas, but this report based on people diagnosed with cancer between 2008 and 2012 spells out the inequalities involved in greater detail.

The incidence of cancer in the most deprived 20 per cent of the population is 10 per cent greater for men, and 4 per cent higher for women, than in the best-off 20 per cent segment.

Cervical cancer

For certain cancers, however, the gap is far larger. The incidence of cervical cancer is 120 per cent higher in the most deprived section of the population compared to the most affluent, 60 per cent higher for lung cancer and 40 per cent higher for stomach cancer.

The findings, while not unexpected, reinforce work previously done by the registry and internationally, Dr Comber said. “This is a very complex area, given that we don’t fully understand all the factors involved and how they interact.”

Higher rates of smoking in deprived areas account for much of the disparity in lung cancer rates. Smoking is also a risk factor for cervical cancer, as is the prevalence of the HPV virus.

Disparity

He said the disparity in stomach cancer rates was multifactorial but may be linked to a higher incidence of

H. pylori gut

bacteria.

In contrast, the incidence of breast cancer was 15 per cent lower among deprived groups than in the most affluent, and melanoma rates were 30 per cent lower for the poorer segment.

Patients from the most deprived groups were 40 per cent more likely to die within five years of diagnosis; their survival rates were worse for seven of the nine cancer types examined – stomach, colorectal, lung, breast and prostate cancers, lymphoma and leukaemia.

Poorer patients were up to 19 per cent less likely to use surgery to treat their cancer.

Survival variation

Other serious health conditions are more frequent in older and more deprived patients and can influence their treatment and survival, Dr Comber said. “Survival variation may not simply be explained by some patient groups presenting at a later stage or receiving less treatment.”

The risk of developing cancer in urban populations, as opposed to rural areas, was about 10 per cent higher overall and higher for six out of the nine cancer types. For lung cancer, it was 38 per cent higher.

Overall, patients aged over 75 years when they were diagnosed were four times more likely to die from their cancer compared to those aged 45-54 years. The differences in survival rates were greatest for breast and prostate cancers and lymphoma, and least for stomach, colorectal and lung cancers.