WCISU ANNUAL PUBLICATION No. SA 10 /0 1 - NHS Wales

WCISU ANNUAL PUBLICATION

No. SA10/01

Cancer Incidence in Wales 2004-2008

21st January 2010

Welsh Cancer Intelligence & Surveillance Unit – Uned Arolygiaeth a Gwybodaeth Cymru

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TABLE OF CONTENTS

1. FOREWORD ............................................................................................................ 2

2. REGISTRATION OF CANCER IN WALES .............................................................. 3

2.1 ONS SUBMISSION ........................................................................................... 4

2.2 DATA QUALITY ................................................................................................ 4

3. DEFINITIONS AND STATISTICAL METHODS ....................................................... 5

3.1 CALCULATION OF INCIDENCE RATES AND AGE STANDARDISATION ...... 5

3.2 STANDARD POPULATIONS ............................................................................ 5

4. INCIDENCE FIGURES IN WALES BY SEX AND FIVE YEAR AGE GROUP 2008 7

4.1 MALES .............................................................................................................. 7

4.2 FEMALES ......................................................................................................... 8

5. TRENDS IN WALES 2004-2008 .............................................................................. 9

6. CRUDE RATES PER 100,000 POPULATION IN WALES 2004-2008 .................. 10

7. EASR PER 100,000 POPULATION IN WALES 2004-2008 .................................. 11

8. TRENDS BY CANCER NETWORK IN WALES 2004-2008 .................................. 12

9. EASR PER 100,000 POPULATION BY CANCER NETWORK IN WALES 2004-

2008 .............................................................................................................................. 13


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1. FOREWORD

The Welsh Cancer Intelligence & Surveillance Unit (WCISU) has published the latest

incidence data for the calendar year 2008 with incidence 2004-2008. We hope that these

data will be useful to clinicians and service planners. More details of incidence, mortality

and survival can be found on our website http://www.wcisu.wales.nhs.uk in our triennial

report, “Cancer in Wales 1992-2006: A Comprehensive Report” which was published on

September 25th 2008. As always we are grateful for the data supplied by Trusts and

clinicians in Wales.

I thank all members of the team in WCISU for their diligence and hard work in meeting

this ambitious deadline.

J A Steward MBBCh BA MSc PhD CStat FFPH


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2. REGISTRATION OF CANCER IN WALES

The Welsh Cancer Intelligence and Surveillance Unit (WCISU) is tasked under its Performance Level Agreement (PLA) with the Welsh Assembly Government to register all incidence of cancer for the resident population of Wales wherever they are treated. It is essential therefore to ensure completeness of registration that all possible sources of data collection are used. The use of multiple sources of data means that information relating to the same cancer incidence is received, and this also enhances the data quality as different data items are brought together to form a single record. WCISU benefits from a sophisticated computer package and a highly trained workforce to ensure that duplicate registrations are avoided. For the most recent year reported (2008) multiple notifications were received from:-

• PEDW * records : Trusts throughout Wales : NHS Clearing Service

• Pathology records : 13/14 Trusts

• Extra Regional Notification

• ONS ** : Cancer Deaths : Non Cancer Deaths

* Patient Episode Database Wales ** Office of National Statistics Table 1 illustrates the number of records processed for the calendar year 2008. Electronic processing and manual intervention by registration officers provide the resulting registrations for 2008 incidence.

Table 1: Notification received by WCISU 2008

SOURCE NUMBER OF RECORDS RECEIVED

PEDW - Wales data - English data Pathology Other Registries Death Certificates: Cancer Non Cancer

327059 10846 78961 2872

9566 5545

Total Records Received Resulting in: Total Registrations All Malignancies ex. skin

434849

25293 (All C, D, O and Q codes) 17674 (All C codes exc C44)


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2.1 ONS SUBMISSION During the first years after being established WCISU’s emphasis was concentrated on timeliness. However since the inherited backlog of data has been cleared more time and resource has been given to ensuring the quality, not only of the data currently being registered, but also of previous registrations. Registrations are submitted to ONS to enable flagging on the National Health Service Central Register (NHSCR) which in turn enables cancer registries to receive Death Certificate Information. Cancer Registries are expected to have no more than 0.5% status 3 records (ie. records containing serious errors) for each year submitted. Good quality record submission enables a high percentage of records to be traced on NHSCR. Table 2 shows WCISU submission to ONS and also is an indicator of the work that has been undertaken to assure its quality.

Table 2: WCISU submissions to ONS

Year of Diagnosis Registrations* Status 3 % Traced records %

2004 2005 2006 2007 2008

17088 16969 17356 19074 17864

0.0% 0.0% 0.0% 0.0% 1.7%

100.0% 100.0% 100.0% 100.0% 98.3%

* All malignancies ex. Skin (C44) and all D codes Source: ONS Management Report, September 2009

2.2 DATA QUALITY The quality of the information produced by WCISU can only be maintained at the highest level if all staff are involved in ensuring data quality at every process undertaken.

• Validation rules are embedded into the software used for registration and these are reviewed in conjunction with the United Kingdom association of Cancer Registries and the Office for National Statistics and updated as necessary.

• Quality checks are run on incoming data to identify any quality issues.

• Multiple sources of data are used for registration and any discrepancies between data sources are investigated to ensure data quality.

• Regular data validation is undertaken by the Unit’s staff who access original source documentation at hospitals by accessing medical records and verifying data received.


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• Analysis of data in response to requests for information and in preparation of publications includes analysis staff in the quality program by highlighting any anomalies in the data that are then passed for further validation.

In an effort to maintain good standards of incoming data, WCISU has developed and delivered training packages to cancer information staff across Wales. Staff from the Unit who have been trained as Clinical Coding Tutors also participate in the delivery of basic clinical coding to staff across Wales and jointly develop, with the All Wales Coding Tutor, neoplasm workshops as further training for coding staff.

3. DEFINITIONS AND STATISTICAL METHODS

3.1 CALCULATION OF INCIDENCE RATES AND AGE STANDARDISATION Crude Rate: This is the total number of cases registered per year as a proportion of the total population. It is usually quoted per 100,000 population. Rates for older age groups are in general, much higher than those for younger people, so that the crude rate for an area is very much influenced by the age structure of the population of that area. This means that comparisons of the crude rates between populations with different age structures can be misleading. For this reason, methods have been developed to age-standardise cancer incidence rates. Direct Standardisation: Age specific incidence rates from the population under study are applied to a standard reference population to obtain the number of cases that would arise in the standard population in each group. These are summed to obtain the overall directly standardised incidence rate expressed per 100,000 population. The standard hypothetical population used in this report – the "European Standard Population" is shown in Table 3:

3.2 STANDARD POPULATIONS The European Age Standardised Rate (E.A.S.R.) for Wales per 100,000 population is calculated by applying age specific rates for Wales to the relevant standard European population shown above. These are then summed across all age groups to obtain the overall E.A.S.R. Because the age structure of the Welsh population differs from that of the European standard population, the standardised rate for Wales, for any particular type of cancer will differ from the crude rate. In general, because the Welsh population is slightly older than the European standard, the effect will be to lower the crude rate.


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Table 3: European Standard Population

Age Group European Age Group European

Under 5 8000 50-54 7000

5-9 7000 55-59 6000

10-14 7000 60-64 5000

15-19 7000 65-69 4000

20-24 7000 70-74 3000

25-29 7000 75-79 2000

30-34 7000 80-84 1000

35-39 7000 85 and over 1000

40-44 7000

45-49 7000 All ages 100,000

3.3 CANCER NETWORKS IN WALES Cancer Statistics are presented by Cancer Network in Wales for the most common cancers in Wales for both males and females. Figure 1 shows the Cancer Networks in Wales.

Figure 1: Cancer Networks in Wales.

NA

NC

NENG

NJ

NL

NN

NQ

NS NU

NX

NZ

PB

PF

PH

PK

PL

PM

PP

PR

PT

PD

NORTH WALES CANCER NETWORK

Code Local Authority

NA Anglesey

NC Gwynedd

NE Conwy

NG Denbighshire

NJ Flintshire

NL Wrexham

SOUTH WEST WALES CANCER NETWORK


NN Powys

NQ Ceredigion

NS Pembrokeshire

NU Carmarthenshire

NX Swansea

NZ Neath & Port Talbot

SOUTH EAST WALES CANCER NETWORK


PB Bridgend

PD Vale of Glamorgan

PF Rhondda Cynon Taff

PH Merthyr Tydfil

PK Caerphilly

PL Blaenau Gwent

PM Torfaen

PP Monmouthshire

PR Newport

PT Cardiff


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4. INCIDENCE FIGURES IN WALES BY SEX AND FIVE YEAR AGE GROUP 2008

4.1 MALES

NMSC – Non-melanoma skin cancer


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4.2 FEMALES



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5. TRENDS IN WALES 2004-2008

Incidence figures (all ages)


Note that new bladder cancer coding rules have been implemented for cases diagnosed from 2007 to be in line with those of the

United Kingdom Association of Cancer Registries (UKACR), hence the much lower number of cases in 2007 and 2008. Figures for

bladder cancer for 2007 are lower than that published last year due to an exercise being carried out to search for further pathology

information for those cases that we had not routinely processed pathology for, resulting in a further decrease following the new

bladder coding rules.


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6. CRUDE RATES PER 100,000 POPULATION IN WALES 2004-2008



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7. EASR PER 100,000 POPULATION IN WALES 2004-2008

EASR – European Age Standardised Rate per 100,000 population



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8. TRENDS BY CANCER NETWORK IN WALES 2004-2008

Incidence figures (all ages)

Males

ICD 10 codes Cancer Site 2004 2005 2006 2007 2008 2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

C15 Oesophagus 65 64 82 86 84 86 70 80 88 91 106 124 135 130 129

C18-C20 Colorectal 304 307 299 313 328 332 346 392 362 403 480 483 497 565 541

C25 Pancreas 59 42 44 49 39 58 65 69 62 69 91 107 101 106 88

C33-C34 Trachea, Bronchus and Lung 357 318 314 332 322 343 355 402 384 388 618 556 610 610 625

C43 Malignant Melanoma of Skin 46 48 69 75 58 56 70 79 101 95 105 97 99 106 154

C61 Prostate 536 558 561 594 658 673 633 666 751 702 1077 1057 957 1133 1122

C64-C66,C68 Kidney 69 64 73 71 84 79 87 104 98 82 122 134 136 145 174

C67 Bladder 178 154 181 106 91 209 179 231 146 147 277 284 296 187 188

C82-C85 Non-Hodgkin's Lymphoma 60 76 89 88 93 94 93 112 113 128 128 116 134 150 134

C91-C95 Leukaemia 72 63 73 49 53 101 80 76 106 70 126 138 149 126 123

All C exc C44 All excluding NMSC 2226 2090 2249 2239 2277 2583 2530 2794 2775 2762 3961 3958 3913 4145 4140

Females


C15 Oesophagus 40 43 46 40 51 43 42 45 50 50 72 72 71 68 65

C18-C20 Colorectal 236 222 252 243 229 270 271 289 298 294 386 354 389 429 424

C25 Pancreas 52 48 64 57 58 73 74 64 69 74 104 101 98 105 94

C33-C34 Trachea, Bronchus and Lung 242 226 217 185 246 231 269 302 258 318 476 431 480 484 485

C43 Malignant Melanoma of Skin 71 69 68 67 69 79 88 87 94 77 98 109 111 104 149

C50 Breast 591 624 642 601 680 723 712 759 775 704 1060 1044 1049 1078 1208

C54 Corpus Uteri 92 99 95 113 98 130 108 135 159 171 168 176 178 206 199

C56 Ovary 83 88 99 85 98 129 129 115 112 122 154 191 166 176 172

C64-C66,C68 Kidney 38 36 49 35 42 53 49 52 45 64 78 76 86 102 83

C67 Bladder 52 86 60 46 35 80 61 87 62 55 119 112 112 75 59

C82-C85 Non-Hodgkin's Lymphoma 56 74 61 56 69 76 71 94 90 84 112 122 140 121 135

C91-C95 Leukaemia 52 40 37 39 52 72 65 76 56 45 86 99 88 105 67

All C exc C44 All excluding NMSC 1998 2072 2100 1977 2136 2469 2435 2582 2535 2504 3648 3615 3670 3798 3855

NORTH WALES CANCER NETWORK SOUTH WEST WALES CANCER NETWORK SOUTH EAST WALES CANCER NETWORK



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9. EASR PER 100,000 POPULATION BY CANCER NETWORK IN WALES 2004-2008

Males


C15 Oesophagus 14.67 13.73 17.48 17.83 18.32 14.09 11.38 13.84 14.58 14.08 12.73 15.01 15.77 15.48 15.16

C18-C20 Colorectal 66.81 65.83 63.41 63.38 67.04 52.60 56.80 60.68 57.20 61.20 56.70 56.45 58.08 64.85 60.80

C25 Pancreas 12.85 9.15 9.13 9.95 7.83 9.90 10.17 10.95 9.50 10.67 10.63 13.13 11.76 12.34 10.01

C33-C34 Trachea, Bronchus and Lung 76.65 66.28 65.58 68.24 62.97 56.07 56.06 63.48 58.85 57.63 73.62 65.44 70.32 68.34 68.85

C43 Malignant Melanoma of Skin 11.92 11.94 17.53 17.64 13.95 10.27 12.78 14.79 18.60 16.91 13.71 12.37 12.78 13.10 19.25

C61 Prostate 111.14 113.96 113.34 119.05 129.04 105.88 97.89 103.17 116.88 105.86 126.72 124.24 111.04 130.06 125.22

C64-C66,C68 Kidney 15.57 14.68 16.03 15.92 17.41 13.76 15.09 17.74 16.89 13.31 15.53 16.48 16.37 17.18 20.48

C67 Bladder 38.95 33.37 38.69 20.75 17.91 34.00 28.54 35.96 21.79 22.26 32.60 32.33 33.67 20.35 19.66

C82-C85 Non-Hodgkin's Lymphoma 14.50 17.64 21.11 20.36 20.53 17.90 16.51 19.65 19.80 21.34 16.10 14.65 16.02 18.79 16.44

C91-C95 Leukaemia 16.25 14.84 16.93 10.95 12.27 17.87 13.71 13.19 17.61 12.40 14.87 16.99 17.94 14.84 14.69

All C exc C44 All excluding NMSC 490.94 451.41 487.03 468.84 469.73 433.67 417.09 455.96 450.02 434.39 478.10 473.91 461.25 484.02 473.39

Females


C15 Oesophagus 6.77 6.90 7.88 7.08 8.01 5.53 5.06 5.83 5.78 6.57 5.70 6.15 6.13 5.80 5.44

C18-C20 Colorectal 38.37 35.91 41.72 39.27 38.35 34.06 35.31 37.78 38.71 36.45 36.04 32.43 35.56 39.69 37.14

C25 Pancreas 8.44 7.16 9.64 8.31 9.45 8.80 9.31 7.79 7.70 9.38 9.11 7.99 8.57 9.26 8.64

C33-C34 Trachea, Bronchus and Lung 41.93 39.92 39.00 31.62 40.95 31.01 36.87 39.58 34.08 41.53 46.94 41.81 44.11 44.43 43.52

C43 Malignant Melanoma of Skin 15.99 15.64 15.12 16.02 15.42 14.40 15.43 15.08 15.71 13.44 11.51 12.43 12.73 12.56 16.30

C50 Breast 128.49 130.55 132.73 125.99 135.64 120.70 118.92 126.13 128.07 113.75 118.42 119.27 119.33 118.97 132.43

C54 Corpus Uteri 18.64 20.78 20.26 22.79 18.79 20.36 16.65 21.57 23.86 25.79 18.84 19.12 19.58 21.76 21.41

C56 Ovary 16.57 18.05 21.23 16.38 19.40 21.23 20.94 17.22 17.22 21.29 16.37 20.27 17.96 19.32 18.18

C64-C66,C68 Kidney 7.72 6.60 8.51 6.25 8.14 7.44 7.64 7.18 6.64 9.65 8.22 7.47 8.57 10.33 8.39

C67 Bladder 8.36 12.30 9.87 6.97 4.97 9.66 8.45 11.30 7.41 6.18 11.19 10.03 9.98 6.13 5.19

C82-C85 Non-Hodgkin's Lymphoma 10.06 14.00 10.85 10.76 12.53 11.13 10.84 13.12 13.45 12.45 11.06 12.14 14.27 11.78 13.69

C91-C95 Leukaemia 11.02 7.22 7.55 7.02 10.60 10.17 8.61 10.38 8.26 6.11 8.50 9.62 8.30 10.03 6.65

All C exc C44 All excluding NMSC 382.82 392.98 401.16 374.86 399.86 368.24 366.81 384.77 374.41 364.36 374.63 371.72 376.27 382.50 389.74



EASR – European Age Standardised Rate per 100,000 population

WCISU ANNUAL PUBLICATION No. SA 10 /0 1 - NHS Wales

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