Channel Islands Cancer Report 2013.

Channel Islands Cancer Report 2013

Incorporating data up to 2011

Produced by the Public Health England Knowledge and Intelligence Team (South West), for the Guernsey and Jersey Medical Officers of Health

PUBLIC REPORT (numbers less than 5 are suppressed for confidentiality)

1

R.10/2014

Prepared by: Luke Hounsome, Principal Cancer Intelligence Analyst, Public Health England Knowledge and Intelligence Team (South West).

For queries relating to this document, please contact: +44 (0) 11 7970 6474.

Published .. 2013

The National Cancer Intelligence Network (NCIN) is a UK-wide partnership operated by Public Health England. The NCIN coordinates and develops analysis and intelligence to drive improvements in prevention, standards of cancer care and clinical outcomes for cancer patients.

Contents

Introduction ............................................................................................................................................ 5 Methods .................................................................................................................................................. 5 Data sources........................................................................................................................................ 5 Data quality ......................................................................................................................................... 6 Methods .............................................................................................................................................. 6 Populations ......................................................................................................................................... 7 Key results ............................................................................................................................................... 8 Guernsey ............................................................................................................................................. 9 Incidence ......................................................................................................................................... 9 Mortality ......................................................................................................................................... 9 Jersey ................................................................................................................................................ 10 Incidence ....................................................................................................................................... 10 Mortality ....................................................................................................................................... 11

All Cancers (C00-C97 excluding C44) - INCIDENCE ............................................................................ 17 All Cancers (C00-C97 excluding C44) - MORTALITY .......................................................................... 18 Bladder Cancer (C67) - INCIDENCE.................................................................................................... 19 Bladder Cancer (C67) - MORTALITY .................................................................................................. 20 Brain and CNS Cancer (C70-72) - INCIDENCE .................................................................................... 21 Brain and CNS Cancer (C70-72) - MORTALITY ................................................................................... 22 Breast Cancer (females) (C50) - INCIDENCE ...................................................................................... 23 Breast Cancer (females) (C50) - MORTALITY .................................................................................... 24 Colorectal Cancer (C18-C21) - INCIDENCE ........................................................................................ 25 Colorectal Cancer (C18-C21) - MORTALITY ....................................................................................... 26 Head and Neck Cancer (C00-C14, C30-C32, C73) - INCIDENCE ......................................................... 27 Head and Neck Cancer (C00-C14, C30-C32, C73) - MORTALITY........................................................ 28 Hepatobiliary Cancer (C22-C23) - INCIDENCE ................................................................................... 29 Hepatobiliary Cancer (C22-C23) - MORTALITY.................................................................................. 30 Kidney and Ureter Cancer (C64-C68) - INCIDENCE ........................................................................... 31 Kidney and Ureter Cancer (C64-C68) - MORTALITY .......................................................................... 32 Leukaemia (C91-C95) - INCIDENCE ................................................................................................... 33 Leukaemia (C91-C95) - MORTALITY .................................................................................................. 34 Lung Cancer (C33-C34) - INCIDENCE ................................................................................................. 35 Lung Cancer (C33-C34) - MORTALITY ................................................................................................ 36 Lymphoma (C81-C85, C96) - INCIDENCE ........................................................................................... 37 Lymphoma (C81-C85, C96) - MORTALITY ......................................................................................... 38 Male Urogenital Cancer excl. Prostate (C60-C63 excl. C61) - INCIDENCE ........................................ 39 Male Urogenital Cancer excl. Prostate (C60-C63 excl. C61) - MORTALITY ....................................... 40

Malignant Melanoma (C43) - INCIDENCE ......................................................................................... 41 Malignant Melanoma (C43) - MORTALITY ........................................................................................ 42 Other Cancers (other C' codes excl. C44) - INCIDENCE .................................................................... 43 Other Cancers (other C' codes excl. C44) - MORTALITY .................................................................. 44 Other Gynaecological Cancers (C51-C53, C57-C58) - INCIDENCE ..................................................... 45 Other Gynaecological Cancers (C51-C53, C57-C58) - MORTALITY .................................................... 46 Other Skin Cancers (C44) - INCIDENCE.............................................................................................. 47 Other Skin Cancers (C44) - MORTALITY ............................................................................................ 48 Ovarian Cancer (C56) - INCIDENCE ................................................................................................... 49 Ovarian Cancer (C56) - MORTALITY .................................................................................................. 50 Prostate Cancer (C61) - INCIDENCE .................................................................................................. 51 Prostate Cancer (C61) - MORTALITY ................................................................................................. 52 Upper Gastrointestinal Cancers (C15-C16, C25) - INCIDENCE .......................................................... 53 Upper Gastrointestinal Cancers (C15-C16, C25) - MORTALITY ......................................................... 54 Uterine Cancer (C54-C55) - INCIDENCE ............................................................................................ 55 Uterine Cancer (C54-C55) - MORTALITY ........................................................................................... 56 Staging completeness ........................................................................................................................... 57 Appendix – ICD-10 codes ...................................................................................................................... 58

Introduction

Public Health England's Knowledge and Intelligence Team (KIT) South West (formerly the South West Public Health Observatory) analyses data on cancers diagnosed in residents of the Channel Islands, on behalf of their Public Health departments. As part of this process it produces an annual report on the basic statistics on cancer in the Channel Islands.

KIT South West hold cancer incidence data for the Channel Islands and the South West of England to 2011, plus data for England to 2010. Data on deaths from cancer and other causes are available to 2011 for all areas.

Methods

Data sources

Data on incidence are supplied by the health departments of Jersey and Guernsey from hospital records and pathology laboratories. Data from Guernsey are supplemented by data from the hospital Multi-Disciplinary Team (MDT), for staging of cancers. Guernsey figures include cancer deaths in residents of Alderney and incident cancers in residents of Alderney and Sark.

Cancers are coded according to the International Classification of Diseases v10 (ICD-10) coding system. The cancers are grouped according to the table below. A full list of ICD codes and descriptions is in the appendix. The data available are for 1999 to 2011 inclusive, except for data for the whole of England which is only available until 2010.

Cancer groups and ICD-10 codes

Data on deaths are supplied from deaths registers on each island. The registered causes of death are processed by the Office for National Statistics (ONS) according to their rules to find a single underlying cause of death. This underlying cause is used to identify those dying from cancer. The data available are for 2001 to 2011 inclusive.

Data quality

The quality of cancer registration data in the UK is amongst the highest in the world, and a substantial amount of time is spent ensuring data are accurate. The introduction of electronic pathology feeds to the cancer registry has brought a higher level of accuracy in diagnosis to the registration process. However, the unique situation regarding registration of data for the Channel Islands does cause some difficulties. Because the health systems in Jersey and Guernsey do not use NHS number it is not possible to link patients who have been diagnosed or had previous cancers when living on the UK mainland, and subsequently moved to the Channel Islands, and vice versa. This means that some cancers which are technically recurrences of a previous cancer; cancers diagnosed many years previously and detected at death; and secondary cancers from previously diagnosed primary cancers, may be registered as if they were new cases. The recurrence rate of many cancers is low which makes this an uncommon occurrence, whilst better pathology reporting makes it easier to determine if cancers are secondary to another cancer, therefore this is likely to be a relatively small problem.

Data on deaths are based on those living in the Channel Islands at time of death and hence have none of the problems described above. The quality of data will only be affected by the accuracy of the death certificate completed by the doctor certifying the death.

Methods

The risk of developing or dying from cancer is strongly influenced by age and sex, and so the makeup of the population in an area will affect the number of cases/deaths. To allow a fair comparison between different areas, or the same area through time, directly age-standardised rates (ASRs) are calculated. This method looks at the occurrence of cancer/death in the population of interest, and calculates what the rate would be in a pre-determined population (known as the standard population), controlling for age. If the same standard population is used for all populations analysed, then the rates are directly comparable with each other to measure whether there are any differences of significance. Rates in this report are standardised to the 1976 European Standard Population.

When ASRs are reported, the 95% confidence intervals are also reported (Lower Confidence Interval: LCI, Upper Confidence Interval: UCI). The confidence interval is a statistical concept which defines the degree of variation in a rate which can be considered normal. Occurrence of, or death from, a disease depends on complicated relationships between a multitude of risk factors, so there are fluctuations over time or geography which do not necessarily reflect a real increase or decrease in a rate. As the population of interest becomes smaller, an increase or decrease of just one or two cases/deaths has a larger effect on the rate. Hence the smaller the population and the smaller the number of cases/deaths, the larger the confidence interval.

Generally speaking, if the confidence interval of two ASRs overlap it is not possible to say that there is a statistically significant difference between the area investigated and the comparison area. 95% confidence intervals mean that out of 100 comparisons/tests we could expect five to show a significant difference when none exists, or vice versa.

For some data, more sophisticated statistical tests are used. These report the likelihood that two rates are not significantly different (for example, that the observed differences could have occurred by chance) as a p-value. It is convention to accept a p-value of 0.05 or less as evidence that the rates are significantly different.

The maximum and minimum values in England are calculated for the former Government Office Regions (of which South West is one). The former GORs are: North East, North West, Yorkshire and the Humber, East Midland, West Midlands, East of England, London, South East and the South West.

Unless otherwise specified, counts and rates are for those aged 20 years and older.

Populations

Populations used for England and the South West are mid-year estimates supplied by the Office for National Statistics (ONS), based on the 2001 Census and taking into account births, deaths and migration.

Populations used for Guernsey are supplied by the Guernsey Health Department. They are estimated by Guernsey's central policy unit based on social security data and data from the education department.

Populations used for Jersey are supplied by the Jersey Health Department. They are end-of-year estimates produced by the States of Jersey Statistics Unit, who use a population model based on baseline figures from the 2011 Jersey Census and adjusted for population changes by administrative data, such as Social Security and Education department data, and migration information from the Census.

Key results

This section highlights those cancers which have a high or low rate compared to the South West or England. All comparisons are based on aggregated data for 2007-2011 (except England data which are for 2006-10). Risk factors for those cancers are listed.

In all these comparisons, the number of cases/deaths should be taken into account as well as the comparison of rates. As numbers for some cancers are small, a large relative incidence/mortality rate may only reflect a few extra cases/deaths each year and hence are clinically less important.

Where a rate is described as higher or lower, it means that it is statistically significant i.e. the differences seen are unlikely to be just a chance variation. If differences are likely to be only by chance, they are described as similar'.

Unless otherwise specified, counts and rates are for those aged 20 years and older.

In tables, - indicates that there were no cases/deaths in that time-period for that cancer. <5 indicates that there were less than 5 caes/deaths in that time-period for that cancer.

Top 10 incident cancers by age-standardised rate, for Guernsey (2007-2011), Jersey (2007-2011) South West (2007-2011) and England (2006-2010)

Note:

All cancers and other' cancers excluded from list. NMSC is non-melanoma skin cancer.

Top 10 cancer causes of death by age-standardised rate, for Guernsey , Jersey, South West and England (2007-2011)

Note:

All cancers and other' cancers excluded from list.

Guernsey

Incidence

The rate of breast cancer in Guernsey is lower than in the South West, but similar to the England average. The age-standardised rate (ASR) is 153 per 100,000. The rate in the South West is 186 per 100,000. The rate in Guernsey is similar to the lowest ASR in the England regions, which is 166 per 100,000. Around 45 new cases of breast cancer are diagnosed each year. Excessive alcohol intake, hormone replacement therapy and genetic/family links, and are some of the main risks for breast cancer.

The rate of prostate cancer in Guernsey is lower than in the South West, but similar to the England average. The ASR is 134 per 100,000. The rate in the South West is 160 per 100,000. The rate is similar to the lowest ASR in the England regions, which is 124 per 100,000. Around 40 new cases of prostate cancer are diagnosed each year. No major environmental/lifestyle risks for prostate cancer are known; risks are increased in those having a family member with the disease, and in black men.

The rate of malignant melanoma in Guernsey is higher than in the South West or England. The ASR is 51 per 100,000. The rate in the South West is 30 per 100,000, and in England is 22 per 100,000. The South West has the highest incidence of malignant melanoma in England. Around 27 new cases of malignant melanoma are diagnosed each year, and it is one of the most common cancers in those aged under 40. The major risk factor is UV exposure through sunlight or sunbeds.

The rate of bladder cancer in Guernsey is higher than in the South West or England. The ASR is 31 per 100,000. The rate in the South West is 15 per 100,000, and in England is 16 per 100,000. It is higher than the highest ASR in the England regions, which is 20 per 100,000. Around 20 new cases of bladder cancer are diagnosed each year. The main risk factors are smoking and industrial exposures.

The rate of head and neck cancers in Guernsey is higher than in the South West or England. The ASR is 31 per 100,000. The rate in the South West is 22 per 100,000, and in England is 22 per 100,000. It is similar to the highest ASR in the England regions, which is 26 per 100,000. Around 17 new cases of head and neck cancer are diagnosed each year. The main risk factors are smoking and excessive alcohol use, especially in combination.

The rate of non-melanoma skin cancers in Guernsey is higher than the recorded rate in the South West or England. However, care must be taken as not all parts of England record non-melanoma skin cancer comprehensively. The data registration in the Channel Islands and the South West is comparable, so we can be confident that the ASR is higher than in the South West. The ASR in Guernsey is 379 per 100,000 and in the South West is 249 per 100,000. Around 242 new cases in Guernsey are diagnosed each year. The risk factors are the same as those for malignant melanoma.

Mortality

The death rate from all cancers (excluding non-melanoma skin) in Guernsey is lower than the England average. The ASR is 219 per 100,000. The rate in England is 237 per 100,000. It is similar to the lowest ASR in the England regions, which is 221 per 100,000. Around 156 people in Guernsey die from cancer each year.

The death rate from prostate cancer in Guernsey is higher than the England average The ASR is 44 per 100,000. The rate in England is 34 per 100,000. It is similar to the highest ASR in the England regions, which is 36 per 100,000. Around 15 men die from prostate cancer each year.

The death rate from breast cancer in Guernsey is lower than in the South West and in England as a whole. The ASR is 22 per 100,000. The rate in the South West is 35 per 100,000 and in England is 36 per 100,000. The South West has the lowest mortality from breast cancer in England. Around 8 women in Guernsey die from breast cancer each year

Jersey

Incidence

The rate of all cancers in Jersey is similar to the South West, but higher than the England average. The age-standardised rate (ASR) is 571 per 100,000. The rate in England is 544 per 100,000. Non- melanoma skin cancers are excluded from this comparison due to data issues (see below). The ASR in Jersey is comparable to the highest ASR in the England regions; which is 578 per 100,000. Around 488 new cancers (excluding non-melanoma skin cancer) are diagnosed each year in Jersey.

The rate of prostate cancer in Jersey is similar to the South West, but higher than the England average. The ASR is 176 per 100,000. The rate in England is 148 per 100,000. The South West has the highest incidence of prostate cancer in England. Around 71 new cases of prostate cancer are diagnosed each year in Jersey. No major environmental/lifestyle risks for prostate cancer are known; risks are increased in those having a family member with the disease, or in black men.

The rate of lung cancer in Jersey is higher than in the South West, but similar to the England average. The ASR is 63 per 100,000. The rate in the South West is 55 per 100,000. It is lower than the highest ASR in the England regions, which is 96 per 100,000. Around 54 new cases of lung cancer are diagnosed each year. Smoking is responsible for about 85% of lung cancers.

The rate of malignant melanoma in Jersey is higher than in the South West or England. The ASR is 48 per 100,000. The rate in the South West is 30 per 100,000, and in England is 22 per 100,000. The South West has the highest incidence of malignant melanoma in England. Around 39 new cases of malignant melanoma are diagnosed each year, and it is one of the most common cancers in those aged under 40. The major risk factor is UV exposure through sunlight or sunbeds.

The rate of head and neck cancers in Jersey is higher than in the South West or England. The ASR is 36 per 100,000. The rate in the South West is 22 per 100,000, and in England is 22 per 100,000. It is higher than the highest ASR in the England regions, which is 26 per 100,000. Around 28 new cases of head and neck cancer are diagnosed each year. The main risk factors are smoking and excessive alcohol use, especially when in combination.

The rate of leukaemia in Jersey is similar to the South West, but higher than the England average. The ASR is 18 per 100,000. The rate in England is 13 per 100,000. The ASR in Jersey is similar to the highest ASR in the England regions; which is 16 per 100,000. Around 14 new cases of leukaemia are diagnosed each year in Jersey. The risk factors for leukaemia vary depending on the exact type but can include smoking, exposure to chemicals and exposure to radiation far in excess of background levels.

The rate of kidney and ureter cancer in Jersey is lower than in the South West, but similar to the England average. The ASR is 12 per 100,000. The rate in the South West is 17 per 100,000. It is similar to the lowest ASR in the England regions, which is 13 per 100,000. Around 10 new cases of kidney and ureter cancer are diagnosed each year in Jersey. The risk of kidney cancer is increased by being overweight or obese, by smoking and by certain genetic conditions.

The rate of uterine cancer in Jersey is lower than in the South West, but similar to the England average. The ASR is 21 per 100,000. The rate in the South West is 29 per 100,000. It is similar to the lowest ASR in the England regions, which is 20 per 100,000. Around 9 new cases of uterine cancer are diagnosed each year in Jersey. The risk of uterine cancer is increased by being overweight or obese, but decreased by having children and/or by use of the contraceptive pill.

The rate of ovarian cancer in Jersey is lower than in the South West, but similar to the England average. The ASR is 17 per 100,000. The rate in the South West is 24 per 100,000. It is lower than the lowest ASR in the England regions, which is 24 per 100,000. Around 8 new cases of ovarian cancer are diagnosed each year in Jersey. No major environmental/lifestyle risks for ovarian cancer have been well demonstrated, but there are genetic risks.

The rate of non-melanoma skin cancers in Jersey is higher than the recorded rate in the South West or England. However, care must be taken as not all parts of England record non-melanoma comprehensively. The data registration in the Channel Islands and the South West is comparable, so we can be confident that the ASR is higher than in the South West. The ASR in Jersey is 362 per 100,000 and the rate in the South West is 249 per 100,000. Around 318 new cases are diagnosed each year. The risk factors are the same as those for malignant melanoma

Mortality

The death rate for lung cancer in Jersey is higher than in the South West but similar to the England average. The age-standardised rate (ASR) is 56 per 100,000. The rate in the South West is 43 per 100,000. It is lower than the highest ASR in the England regions, which is 77 per 100,000. Around 48 people in Jersey die from lung cancer each year. The high death rate is likely to be reflective of the high incidence.

The death rate for head and neck cancers in Jersey is higher than in the South West and England. The ASR is 13 per 100,000. The rate in the South West is 5 per 100,000, and in England is 6 per 100,000. It is higher than the highest ASR in the England regions, which is 7 per 100,000. Around 8 people in Jersey die from a head and neck cancer each year. The high death rate is likely to be reflective of the high incidence.

The death rate for hepatobiliary cancer in Jersey is higher than in the South West but similar to the England average. The ASR is 9 per 100,000. The rate in the South West is 6 per 100,000. It is similar to the highest ASR in the England regions, which is 8 per 100,000. Around 8 people in Jersey die from hepatobiliary cancer each year.

The death rate for kidney and ureter cancers in Jersey is higher than in the South West and England. The ASR is 11 per 100,000. The rate in the South West is 6 per 100,000, and in England is 6 per 100,000. It is higher than the highest ASR in the England regions, which is 7 per 100,000. Around 7 people in Jersey die from a kidney or ureter cancer each year. The high death rate is in contrast to the low incidence.

The death rate for malignant melanoma in Jersey is similar to the South West but higher than the England average. The ASR is 8 per 100,000. The rate in England is 4 per 100,000. It is similar to the highest ASR in the England regions, which is 5 per 100,000. Around 4 people in Jersey die from malignant melanoma each year. The high death rate is likely to be reflective of the high incidence.

The death rate from other' cancers in Jersey is lower than the South West and the England average. The ASR is 24 per 100,000. The rate in the South West is 31 per 100,000, and in England is 34 per 100,000. It is lower than the lowest ASR in the England regions, which is 32 per 100,000. Around 21 people in Jersey die from other' cancers each year.

The death rate from other gynaecological' cancers in Jersey is lower than the South West and the England average. The ASR is 2 per 100,000. The rate in the South West is 5 per 100,000, and in England is 5 per 100,000. It is similar to the lowest ASR in the England regions, which is 4 per 100,000. Only 1 women in Jersey dies from other gynaecological' cancers each year, on average, so these figures should be interpreted in that context.

All Cancers (C00-C97 excluding C44) - INCIDENCE

Incidence rates in males, 1999-2011  Incidence rates in females, 1999-2011

800 600 700

500 600

500 400 400 300

300 200 200

100 100 0 0

Diagnosis Period Diagnosis Period

Jersey Guernsey South-West England Jersey Guernsey South-West England

Incidence rates in males, latest five years  Incidence rates in females, latest five years

800 600 700 500

600 400 500

400 300 300 200

200 100 100

0 0

Area Area

Age-standardised incidence rates (per 100,000 population), 1999-2011

Age at diagnosis, 2007-2011 combined data (2006-2010 for England)

All Cancers (C00-C97 excluding C44) - MORTALITY

Mortality rates in males, 2001-2011

350 300 250 200 150 100 50 0

Year of Death

Jersey Guernsey South-West England

Mortality rates in females, 2001-2011

250 200 150 100 50 0

Year of Death

Jersey Guernsey South-West England

Mortality rates in males, 2007-2011  Mortality rates in females, 2007-2011

350 250 300

200 250

200 150 150 100

100

50 50

0 0

Area Area

Age-standardised mortality rates (per 100,000 population), 2001-2011