annual publication no. sa11/01 · j a steward mbbch ba msc phd cstat csci ffph . welsh cancer...

Welsh Cancer Intelligence & Surveillance Unit

Annual Publication

No. SA11/01

Cancer Incidence in Wales 2005-2009

27th

January 2011

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

3.3 CANCER NETWORKS IN WALES ................................................................... 6

4. INCIDENCE FIGURES IN WALES BY SEX AND FIVE YEAR AGE GROUP 2009 7

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

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

5. TRENDS IN WALES 2005-2009 .............................................................................. 9

6. CRUDE RATES PER 100,000 POPULATION IN WALES 2005-2009 .................. 10

7. EASR PER 100,000 POPULATION IN WALES 2005-2009 .................................. 11

8. TRENDS BY CANCER NETWORK IN WALES 2005-2009 .................................. 12

9. EASR PER 100,000 POPULATION BY CANCER NETWORK IN WALES 2005-

2009 .............................................................................................................................. 13


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1. FOREWORD

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

Annual Report on cancer incidence for the calendar year 2009 with incidence 2005-

2009. Further details of incidence, mortality and survival and various other reports can

be found on our website http://www.wcisu.wales.nhs.uk.

As always we are grateful for the source data supplied by local health boards, hospitals

and ultimately from cancer clinicians in Wales. I would like to thank all members of the

team in WCISU for their diligence and hard work in meeting this ambitious deadline of

publishing no more than one year in arrears.

J A Steward MBBCh BA MSc PhD CStat CSci FFPH


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2. REGISTRATION OF CANCER IN WALES

The Welsh Cancer Intelligence and Surveillance Unit (WCISU) is part of Public Health Wales as of October 2009 and 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 (2009) multiple notifications were received from:-

PEDW 1 records : Trusts throughout Wales : NHS Clearing Service

Pathology records : Data received from 13 of 14 laboratories

Extra Regional Notification

ONS2 : Cancer Deaths : Non Cancer Deaths

1 Patient Episode Database Wales 2 Office for National Statistics Table 1 illustrates the number of records processed for the calendar year 2009. Electronic processing and manual intervention by registration officers provide the resulting registrations for 2009 incidence.

Table 1: Notification received by WCISU 2009

SOURCE NUMBER OF RECORDS RECEIVED

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

273779 11478 82306 2872

9669 5366

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

385470

26253 (All C, D, O and Q codes) 17928 (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 %

2005 2006 2007 2008 2009

17009 17457 18838 18137 16892

0.0% 0.0% 0.0% 0.0% 0.3%

99.6% 99.9% 99.9% 99.8% 94.4%

* All malignancies excluding skin (C44) and all D codes Source: ONS Management Report, December 2010

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 Standard Population Age Group Standard Population

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.

NORTH WALES CANCER NETWORK

Code Local Authority

00NA Anglesey

00NC Gwynedd

00NE Conwy

00NG Denbighshire

00NJ Flintshire

00NL Wrexham

SOUTH WALES CANCER NETWORK

Code Local Authority

00NN Powys

00NQ Ceredigion

00NS Pembrokeshire

00NU Carmarthenshire

00NX Swansea

00NZ Neath and Port Talbot

00PB Bridgend

00PD Vale of Glamorgan

00PF Rhondda Cynon Taff

00PH Merthyr Tydfil

00PK Caerphilly

00PL Blaenau Gwent

00PM Torfaen

00PP Monmouthshire

00PR Newport

00PT Cardiff

PM

NJ

NL

NG

NE

NC

NA

PF

PL

PK

PR

PPPH

PT

PB

PD

NNNQ

NU

NX

NZ

NS

Figure 1: Cancer Networks in Wales.


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4. INCIDENCE FIGURES IN WALES BY SEX AND FIVE YEAR AGE GROUP 2009

4.1 MALES

NMSC – Non-melanoma skin cancer


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4.2 FEMALES



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5. TRENDS IN WALES 2005-2009

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 to 2009.


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6. CRUDE RATES PER 100,000 POPULATION IN WALES 2005-2009



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7. EASR PER 100,000 POPULATION IN WALES 2005-2009

EASR – European Age Standardised Rate per 100,000 population



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8. TRENDS BY CANCER NETWORK IN WALES 2005-2009

Incidence figures (all ages)

Males

ICD 10 codes Cancer Site 2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

C15 Oesophagus 63 82 85 82 96 194 215 219 224 192

C18-C20 Colorectal 306 298 313 331 309 829 887 930 956 1039

C25 Pancreas 42 44 51 39 55 173 171 168 163 183

C33-C34 Trachea, Bronchus and Lung 318 316 331 326 346 913 1015 998 1034 948

C43 Malignant Melanoma of Skin 48 69 76 57 79 166 180 208 250 232

C61 Prostate 558 561 595 661 672 1692 1633 1892 1823 1734

C64-C66,C68 Urinary Tract excluding Bladder 64 73 72 87 75 221 241 242 262 260

C67 Bladder 154 181 107 94 122 462 524 329 335 319

C82-C85 Non-Hodgkin's Lymphoma 77 89 88 90 68 209 245 264 258 243

C91-C95 Leukaemia 64 74 48 50 81 219 228 237 199 233

All C exc C44 All excluding NMSC 2090 2251 2237 2291 2354 6493 6722 6940 6981 6862

Females


C15 Oesophagus 43 46 41 49 46 115 116 118 115 129

C18-C20 Colorectal 222 252 244 228 255 625 679 730 729 758

C25 Pancreas 48 64 58 59 49 175 162 175 178 185

C33-C34 Trachea, Bronchus and Lung 226 219 182 248 226 700 783 745 821 741

C43 Malignant Melanoma of Skin 69 68 68 71 77 199 198 197 230 258

C50 Breast 623 644 600 687 610 1757 1813 1847 1941 1975

C54 Corpus Uteri 99 95 113 101 87 284 313 368 368 355

C56 Ovary 89 100 84 100 107 320 281 287 296 296

C64-C66,C68 Urinary Tract excluding Bladder 36 49 34 43 60 125 139 146 151 171

C67 Bladder 86 60 48 36 29 173 198 136 117 145

C82-C85 Non-Hodgkin's Lymphoma 74 61 57 71 58 193 235 210 224 206

C91-C95 Leukaemia 41 38 40 46 45 167 166 168 109 161

All C exc C44 All excluding NMSC 2071 2105 1977 2145 2031 6055 6260 6341 6428 6681

NORTH WALES CANCER NETWORK SOUTH WALES CANCER NETWORK



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9. EASR PER 100,000 POPULATION BY CANCER NETWORK IN WALES 2005-2009

Males


C15 Oesophagus 13.59 17.48 17.50 17.88 19.84 13.53 14.90 15.12 15.05 12.40

C18-C20 Colorectal 65.61 63.19 63.30 67.69 62.01 56.51 59.22 61.72 61.65 66.23

C25 Pancreas 9.15 9.13 10.49 7.85 10.76 11.91 11.49 11.19 10.67 11.65

C33-C34 Trachea, Bronchus and Lung 66.28 65.95 68.11 63.91 66.38 61.63 67.59 64.51 65.36 58.89

C43 Malignant Melanoma of Skin 11.94 17.53 17.82 13.99 19.43 12.52 13.70 15.30 18.30 16.11

C61 Prostate 113.83 113.34 119.27 129.72 129.93 113.31 108.40 125.03 116.88 108.84

C64-C66,C68 Urinary Tract excluding Bladder 14.68 16.03 16.06 18.22 16.45 15.90 17.00 16.86 17.97 17.22

C67 Bladder 33.37 38.69 20.98 18.54 22.93 30.67 34.52 20.63 20.66 19.51

C82-C85 Non-Hodgkin's Lymphoma 17.97 21.11 20.36 19.88 14.48 15.44 17.36 19.22 18.07 16.75

C91-C95 Leukaemia 15.06 17.06 10.82 11.54 17.18 15.63 16.13 16.36 14.02 15.36

All C exc C44 All excluding NMSC 451.47 487.12 468.42 473.48 477.32 450.40 459.86 470.56 461.63 446.53

Females


C15 Oesophagus 6.90 7.88 7.16 7.72 7.01 5.77 6.01 5.79 5.88 6.23

C18-C20 Colorectal 35.91 41.77 39.46 38.03 39.65 33.52 36.49 39.44 37.49 39.73

C25 Pancreas 7.16 9.64 8.62 9.61 6.69 8.53 8.23 8.68 9.30 9.20

C33-C34 Trachea, Bronchus and Lung 39.92 39.17 31.31 41.15 36.89 39.71 42.30 40.19 43.51 38.79

C43 Malignant Melanoma of Skin 15.64 15.12 16.32 16.00 17.81 13.83 13.67 13.74 15.38 17.52

C50 Breast 130.33 133.08 125.76 137.00 120.80 119.12 122.15 121.92 125.86 128.75

C54 Corpus Uteri 20.78 20.26 22.77 19.69 16.63 18.08 20.37 22.74 23.15 21.93

C56 Ovary 18.23 21.44 16.20 19.42 20.75 20.47 17.67 18.39 19.24 18.40

C64-C66,C68 Urinary Tract excluding Bladder 6.60 8.51 6.16 8.32 9.73 7.52 8.02 8.79 9.09 10.13

C67 Bladder 12.30 9.87 7.19 5.28 4.21 9.35 10.43 6.63 5.77 7.25

C82-C85 Non-Hodgkin's Lymphoma 14.00 10.85 10.84 13.14 10.05 11.56 13.88 12.29 13.34 12.43

C91-C95 Leukaemia 7.44 7.78 7.27 9.72 7.76 9.37 9.25 9.67 6.33 8.88

All C exc C44 All excluding NMSC 392.84 401.96 374.84 402.08 371.25 369.53 379.42 378.85 382.15 395.59



EASR – European Age Standardised Rate per 100,000 population

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