Study reveals full extent of cancer across Ireland

Survival rates for cancer are continuing to rise even though the number of cases being diagnosed is increasing, an all-Ireland report launched today reveals.

 The report entitled Cancer incidence, mortality, treatment and survival in the North and South of Ireland: 1994-2004, was compiled by the Northern Ireland Cancer Registry, based at Queen’s University, and the National Cancer Registry of Ireland, in Cork.

This is the third collaborative report between the NICR and the NCRI and examines more information, including treatment patterns, than ever before.

 The report reveals that each year over 21,000 people across Ireland are diagnosed with some form of cancer, with the most common being breast, colorectal, prostate and lung cancers.

 Among men the most common cancers were prostate, colorectal and lung cancers and lymphoma, while among women breast, colorectal, lung and ovarian cancers were most often diagnosed.

 Its authors say that people can take action to prevent some forms of cancer including stopping smoking, reducing their alcohol intake, following a healthy diet, exercising and taking care in the sun.

 Total incidence rates were 10% lower for males and 2.2% lower for females in Northern Ireland compared with the Republic of Ireland. The difference, for men, was mainly due to differences in prostate cancer diagnosis.

The report also showed that mortality rates were around 4% lower in Northern Ireland for men and women.

While the overall number of cancers has increased due to population growth and ageing and for some cancers such as prostate and breast cancer, increased detection, the number of cancer deaths has fallen.

Improvements in survival for breast, colorectal and prostate cancer were recorded over the last decade and for no cancer are survival rates falling.

The report also documents an additional 8,000 cases of the rarely fatal non-melanoma skin cancer each year.(relevance?)

Dr Anna Gavin, director of NICR said: “This is the first time we have been able to compare treatment differences in addition to the usual incidence, mortality and survival.

“Surprisingly, even though we are dealing with two different health care systems there is remarkably little variation in treatment, with improvements over time in both jurisdictions. Cancer is a significant burden on health and this comparative analysis will point to areas for further research to improve cancer prevention and standardise care for patients.”

 Dr David Donnelly, co-author of the report, said some of the major cancers in Ireland were preventable: “Lung, oesophageal, stomach, head and neck, kidney, bladder and cervical cancer all have a common risk factor in tobacco use.

“Most of these cancers especially lung, oesophagus and stomach have very poor survival.

“Tobacco use is also a major factor in explaining higher rates of cancer in the urban areas of Belfast, Dublin, Cork and Derry and in the most deprived geographic areas in Ireland compared to the most affluent. Fortunately incidence of several smoking related cancers has fallen among males, although incidence of lung cancer among females in Ireland is increasing.

“Poor diet and obesity also increase the risk of several cancers, including breast cancer and colorectal cancer, two of the major cancers in Ireland. Improvements in diet and increased physical exercise would likely result in a reduction in the levels of colorectal cancer, and help reverse the increases in breast cancer seen over the last decade.”

Harry Comber, Director of the NCRI, said testing for prostate cancer in the Republic of Ireland had made a difference to the figures: “Comparing survival between the North and South of Ireland reveals that five-year survival for men was higher in the Republic of Ireland than in Northern Ireland by 5.2%, while there was no difference for women.

“The difference for men is a result of greater survival from prostate cancer in the Republic of Ireland, a side effect of increased tests to diagnose it. Excluding this cancer, male survival is the same in each country.

“Survival is the real test of countries’ programmes of prevention, early detection and treatment.”

Key Findings

Incidence and Mortality

  • Each year an average of 10,999 male and 10,510 female cancers (excluding non-melanoma skin cancer) were diagnosed between 2000 and 2004 with 5,921male and 5,340 female cancer deaths annually.
  •  Incidence rates were lower in Northern Ireland  by 10% for males, the difference a result of higher levels of prostate  cancer in the Republic of Ireland.  Female rates were 2.2% lower in Northern Ireland than the Republic of Ireland.
  •  The most common male cancers were prostate cancer, colorectal cancer, lung cancer and lymphoma, while among women they were breast cancer, colorectal  cancer, lung cancer and ovarian cancer.
  •  Incidence rates increased for males by 1.8% per year during 1999-2004 and for females by 0.8% per year during 1994-2004. The number of cases diagnosed increased by an average of 255 male and 217 female cases per year. The largest increases were in prostate cancer, liver cancer and malignant melanoma.
  • Incidence rates were lower in Northern Ireland than in the Republic of Ireland for pancreatic cancer, bladder cancer, brain cancer and leukaemia among both sexes, for colorectal and prostate cancers among males and melanoma, breast cancer and cervical cancer among females. They were higher in Northern Ireland than in the Republic of Ireland for male lung and female uterine cancers.
  •  Incidence rates were highest in counties/councils with large urban areas and in areas of deprivation.
  •  Incidence rates among males were 4.6% lower than in the EU (15 countries) while female rates were 2.1% higher.
  •  Cancer death rates fell between 1994 and 2004 by 1.4% per year for males and 1.0% per year for females.
  •  Cancer death rates were 3.9% lower for males and 3.6% lower for females in Northern Ireland than in the Republic of Ireland during 2000-2004.

 Treatment

  • During 2001 surgery was the most common form of treatment for stomach, colorectal, breast, cervical and ovarian cancer, with hormone therapy most commonly used for prostate cancer and radiotherapy the most common treatment for oesophageal and lung cancer.
  •  From 1996 to 2001 chemotherapy and radiotherapy use increased for oesophageal, stomach, colorectal, lung and breast cancer with chemotherapy use also increasing for cervical cancer and radiotherapy use increasing for prostate cancer. Surgery use increased for breast and ovarian cancers and decreased for oesophageal, lung and prostate cancers. Hormone therapy use decreased for breast cancer and increased for prostate cancer.
  •  During 2001 Northern Ireland had a higher proportion of oesophageal, cervical and prostate cancer patients receiving no tumour directed treatment, while the proportion was      higher in the Republic of Ireland for colon cancer.

 Survival

  • Five-year survival was higher for females (51.6%) than males (46.8%) for patients diagnosed in 2000-2004.
  •  Five-year survival ranged from 5.4% for pancreatic cancer to 96.9% for testicular cancer among males, and from 6.8% for pancreatic cancer to 91.6% for melanoma among females.
  •  Five-year survival improved by 3.9% for males and 1.9% for females between 1994-1996 and 1997-1999.
  •  Five year survival was best at earlier disease stage and better in younger than older people.
  •  Five-year survival for males diagnosed in 2000-2004 was 5.2% higher in the Republic of Ireland than Northern Ireland.   There was no significant difference between the two countries for females  or for males when prostate cancer is excluded.
  •  Five-year  survival from male prostate and bladder cancers was higher in the Republic of Ireland than in Northern Ireland. Among females five-year survival from pancreatic cancer, leukaemia and bladder cancer was higher in the Republic of Ireland, while survival from malignant melanoma  was better in Northern Ireland.
  •  Despite survival improvements five-year survival for all cancers combined was lower in Northern Ireland and the Republic of Ireland than in the EU for males and females.
  •  94,062 people diagnosed with cancer during 1994-2004 were alive at the end of 2004. This increased to 158,541 if the easily treated non-melanoma skin cancer is included.
  •  At the end of 2004 the number of people living with cancer diagnosed since  2000 per 100.000 people was 3.7% greater in Northern Ireland than the Republic of Ireland.   This can be attributed to the higher proportion of older people resident in Northern Ireland.

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