Cancers are one of the most important health problems for Londoners. Deaths from cancer account for around one third of deaths in London. Targets to reduce mortality rates from cancer are included in the National Health Strategy, Saving Lives Our Healthier Nation, the Priorities and Planning Framework, the Cancer Plan, and other attempts to reduce health inequalities.

Information about cancer incidence (new cases of cancer) is collected in a series of national registries. For London this role is undertaken by the Thames Cancer Registry who can supply detailed information about the incidence and outcomes of a wide range of cancers.

In 2001 just under 26,000 new cases of cancer were recorded in London by the Thames Cancer Registry. Cancers can be of many different types, with different causes and risk factors as well as treatment regimes. The most common cancers in London are shown in Table 1. Certain cancers are particularly associated with certain age groups, with most cancers becoming more common with advancing age. Around two-thirds of new cases are in people over 65.

There has been a general decline in recent years in reported incidences by cancer site. A major exception is prostate cancer, which has now overtaken lung cancer to become the most frequently reported cancer amongst men. Breast cancer remains by far the most commonly reported malignancy amongst women.

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The age standardised incidence rates for cancer in London in 2001 were 392 per 100,000 for men and 315 per 100,000 for women.

The standardised incidence of male prostate cancer rose during this period by about 10% to 85 cases per 100,000. This is due, to some extent, to diagnosis from screening tests of men who would not necessarily have developed symptoms. During the same period, there were falls in incidence of cancers of the bladder (by 12%), lung (by 9%), head/neck and colon (both by 6%) in men.

No clear trends were discernible for most cancers in women. However breast cancer rates fell by 5%; the most conspicuous reductions in incidence during this period were bladder cancer (30%), ovarian cancer (18%) and cervical cancer (14%).

The fall in the number of men smoking, two decades previously, is a key factor in explaining the fall in male lung cancer, and may also explain part of the reduction in bladder cancer.

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The general increase in prostate cancer incidence noted above is not by any means uniform across London boroughs. In some boroughs there has been no discernible increase at all. Bromley recorded the lowest incidence rate throughout this period, beginning at 48 per 100,000 and staying below 55. The next lowest incidence rates in recent years are to be found in Hounslow (52 per 100,000 in 1999-2001), an actual fall of 15% on previous figures; whilst in Richmond there has been a slight drop throughout this period from 79 to below 69 per 100,000.

At the other extreme, Wandsworth had in 1999-2001 the highest incidence in London, having recorded continually increasing incidence from 77 (1993-5), whilst Lewisham almost doubled its incidence rate in the same period (58 to 109). In 1993-95, only Camden had an incidence of over 90 in 100,000; in 1999-2001 this figure was exceeded by 13 boroughs.

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Between 1993-95 and 1999-2001, there was evidence of a reduction in the incidence rate for male lung cancer in most boroughs, although it occurred unevenly and was not sustained. Only Richmond showed a continuous reduction throughout this period (from 69 to 52 per 100,000), whilst there was no reduction at all in Islington, which in 1999-2001 had the highest incidence at 108, and Hillingdon. The reduction in incidence was not confined to boroughs with comparatively high rates, and the gap between boroughs with lowest and highest rates remained marked.

Haringey was the only borough to show a continuous reduction in female lung cancer incidence (from 32 to 27 per 100,000). Elsewhere the picture is rather mixed. The overall reduction noted for male incidence is less evident for female rates. The gender gap is closing - for example, in 1993-95, in 26 boroughs female incidence was less than half the male rate, but by 1999-2001 this held true in only 15 boroughs. Tower Hamlets had the highest female incidence in 1999-2001, with 60 per 100,000.

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Incidence rates tended to rise in London boroughs between 1993-95 and 1995-97, but since then there has not been a uniform picture, with some borough rates levelling out, and others even falling. In 1999-2001 the highest incidence was recorded in Kingston upon Thames (127 per 100,000), followed by Bexley and Bromley (121); Newham (87) and Tower Hamlets (93) had the lowest incidence.

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Male bladder cancer incidence tended to fall, with four boroughs achieving a continuous trend throughout this period: Havering (35 to 21 per 100,000), Harrow (32 to 18), Hillingdon (35 to 13) and Richmond (38 to 15). However in other boroughs there was either no change, or even evidence of a rising incidence. Hammersmith & Fulham had the highest rate in London in 1999-2001 (30).

Enfield (from 10 per 100,000 to 3), Hillingdon (11 to 4) and Richmond (9 to 5) saw a continuous fall in female incidence. In most other boroughs, female incidence tended to fall but progress was uneven. In a few boroughs, however, incidence was unchanged overall. In 1999-2001, Islington had the highest incidence (8).

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Incidence tended to fall, although no borough showed a continuous downward trend. The highest incidence in London in 1999-2001 was in Barking & Dagenham (15 per 100,000).

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Kingston showed a steadily rising trend of male incidence, from 49 per 100,000 in 1993-95 to 67 in 1999-2001, but no pan-London trend was really discernible. In 1999-2001 the lowest male incidence was in Hounslow and in Lambeth (40 per 100,000).

Female incidence also showed no trend over this period. Camden and City of Westminster had the highest rates in 1999-2001 (39 per 100,000), with Hounslow and Redbridge having the lowest (26).

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Redbridge uniquely had a continuous fall in male incidence, from 21 per 100,000 in 1993-95 to 15 in 1999-2001, whilst elsewhere although incidence fell generally, the trend was uneven and interrupted. For example, Richmond had the lowest incidence in 1999-2001 (12 per 100,000), but this was an increase on its two previous figures.

Only Brent saw a continuously falling female incidence rate, from 10 per 100,000 in 1993-95 to 8 in 1999-2001, but this trend could be discerned in less clear-cut fashion in some other boroughs. In 1999-2001, the lowest incidence was in Richmond (3 per 100,000), while the highest was in Tower Hamlets (13).

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There are many different causes of cancer of which the most important are:

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In 2001 there were 7,771 male and 7,114 female deaths of all ages from cancer in London.

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In 2001, there were 4,204 male deaths under the age of 75 in London from cancer, compared with 5,005 in 1993. The mortality rate from all cancers fell from 167 per 100,000 in 1993-95 to 144 for the period 1999-2001, almost identical with the overall England trend. Rates for Tower Hamlets (242 to 184 per 100,000) and Sutton (183-153) fell in the same proportional terms, although the biggest proportional reductions were found in Hackney (194 to 145, 25%) and Kensington & Chelsea (170 to 114, 33%). In most other boroughs, there was evidence of a downward trend, but it was not continuous over the whole period. However, there was no evidence of a downward trend over this period for Islington, Redbridge or Merton. In 1999-2001, Barking & Dagenham had the highest mortality rate from all cancers (189) and Kensington & Chelsea the lowest (114).

In 2001, 3,562 women under the age of 75 died from cancer in London, compared with 4,379 for the same age group in 1993. Overall cancer mortality in London fell from 129 per 100,000 in 1993-95 to 114 in 1999-2001, again closely mirroring the overall England trend. Hammersmith & Fulham (151 to 102), Harrow (116 to 96) and Westminster (133 to 103) were the only boroughs to show a continuous fall in mortality. There was no evidence of any fall during this period in Lewisham, Richmond, Sutton, Camden or Waltham Forest. Waltham Forest had the highest mortality rate in 1999-2001 (138), and Kensington & Chelsea the lowest (88).

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In England, more women die from breast cancer than from any other form of cancer; high mortality rates tend to be found in the most affluent parts of the country. There is little known about the prevention of the condition, but early diagnosis and prompt treatment through a national screening program are critical factors in improving mortality rates. The local coverage of breast screening programmes is an important consideration when looking at mortality rates.

As borough data is only available for 1999 and 2001, longer-term trend analysis is not possible.

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Between 1993-95 and 1999-2001, male mortality from lung cancer fell in London from 50 per 100,000 to 40, in line with the overall England trend. However, this fall was not evenly distributed throughout London. Some boroughs with relatively high initial rates did show a reduction (Tower Hamlets from 89 per 100,000 to 57; Southwark from 69 to 54). However, Ealing, Kensington & Chelsea, Bromley, Croydon and Richmond, all below 50 in 1993-95, also reduced their rates to less than 35. Rates for Islington, Barking & Dagenham and Hillingdon were unchanged. In 1999-2001 Barking & Dagenham had the highest mortality rate in London (67); the lowest rate was in Harrow (27).

Female mortality rates fell - but not continuously, unlike male rates - from 23 per 100,000 in 1993-95 to 21 in 1999-2001. Although there was evidence of a trend in reduction, no borough managed to achieve a continuous reduction in mortality rates. Several showed no evidence of reduction at all. Tower Hamlets had the highest mortality in 1999-2001 (36 per 100,000), whilst the lowest mortality was found in Kingston upon Thames and Richmond upon Thames (16).

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Strategies for reducing the harm caused by cancers can take different forms.

A national strategy specifically for cancer was published in September 2000: (Department of Health: The NHS Plan) - which sets out plans for investment in preventive, diagnostic and treatment services.

Hospital inpatient systems records information about people with diagnosed cancer. It is important to remember that records are only available for inpatient stays and not out-patients. Similarly the records are based on hospital episodes and not individual patients. Any one patient may have more than one inpatient stay during the course of treatment.

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• Incidence, treatment and outcome: The primary data source for information on cancer incidence is the Thames Cancer Registry. Their prime source of data is from patients' case notes and pathology reports identified in NHS trusts. Information on deaths, from the Office of National Statistics, and data on screening programmes for breast and cervical cancer supplement these records. Together these elements go to form a record that tracks individual patients through their treatment. This enables analysis of relative incidence, comparison of treatment modalities and assessment of outcome (in terms of 5 and 10 year survival rates). Summary data at cancer network level are available from the TCR web site.
• Information about breast screening: Standard returns are produced by the Department of Health on the national breast screening programme
• Data are recorded at PCT level and based on two returns: KC62 (from the screening units) and KC63 on the population coverage from PCTs. The national screening programme applies to the target age range of 50-64. Coverage tends to be lower in inner city areas and in London.
• Cervical Screening: The programmes for cervical screening is co-ordinated through reports from cytology laboratories and GP records. Quality assurance programmes are managed at a regional level. Information on cervical cytology uptake and coverage is recorded in a standard DoH return KC53, available from the DoH (not electronically).
• Health and Lifestyle Surveys: Information about risk factors for cancers is included in some health and lifestyle surveys. (See Smoking, Physical Activity, Diet & Nutrition and Obesity pages).
• Mortality data: ONS vital statistics record mortality by cause of death and use either ICD9 or ICD10 classification systems.

Date	Title	Format	View
21 Jul 2008	Cancer e-atlas
9 Aug 2006	Local variations in NHS spending priorities
Feb 2005	Breast Screening Programme, England 2003-04
28 Feb 2004	Cervical Screening Programme, England 2003-04

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• The Thames Cancer Registry (TCR) is situated in the South East of England, covering the London region, part of Eastern and South East regions, with a population of 14 million. From this population there are around 70,000 new cancer cases each year. The wealth of collected data allows the production of information on cancer incidence, prevalence, survival, treatment types, and comparative and trend analysis. Much of this information is published in the Annual Report. They also act to provide information on an ad-hoc basis following individual requests.
• The Department of Health Website has many pages of information and statistics on cancer treatment rates, waiting times etc. The Progress Report is a recent publication showing how Government targets addressed in the National Cancer Plan are being met.
• Saving Lives: Our Healthier Nation National strategy for health, with cancer one of the key national targets.
• Cancerweb is one of the major UK web resources, providing information about causes and risk factors, screening, prevention, detection and diagnosis of cancer, as well as its treatment. The site has sections tailored for patients & their families, health care professionals, and scientific researchers.
• Committee on Carcinogenicity of Chemicals in Food, Consumer Products and the Environment (COC) is an independent advisory committee that provides advice to Government Departments and Agencies on matters concerning the potential carcinogenicity of chemicals ranging from natural products to new synthetic chemicals used in pesticides or pharmaceuticals.
• Guide to Internet Resources for Cancer (UK) - maintained by the North of England Children's Cancer Research Unit, indexes over 2,700 cancer related websites/pages sorted by disease type, medical speciality, and country, and has a page dedicated to screening and prevention. The site contains over 50 pages of links to cancer related information, and has separate sections for health professionals and members of the public.
• The Cancer Research UK website gives information to help understand more about cancer. It provides helpline numbers for sufferers and their families, and also gives up-to-date news on some of their research.
• The Institute of Cancer Research, in partnership with The Royal Marsden NHS Trust, is one of Europe's largest comprehensive cancer centres. This website provides information about the Centre's history, campaigns and research.
• Strategies to reduce smoking are discussed on Smoking and to encourage healthy eating on (http://www.foodstandards.gov.uk/healthiereating/, and Diet & Nutrition).

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