Cancer rates jump by 20 per cent among the UK’s middle aged – but why?

We launched our new advertising campaign today. The campaign aims to raise awareness about cancer and the work we do to prevent and treat the disease, and to help raise funds to keep our crucial support flowing to the UK’s best cancer researchers.

You can watch the ad, and hear the stories of the people involved, on our website.

As part of our work behind the scenes for this campaign, we looked in-depth at the latest cancer statistics. One thing we noticed from the mass of data was that cancer rates in middle-aged men and women in Britain have gone up by nearly 20 per cent in a single generation.

To put it another way, more men and women between the ages of 40 and 59 years are hearing the words ‘you have cancer’ than ever before.

Figures are for all cancers among people in Great Britain aged 40-59 years old (excluding non-melanoma skin cancer)

That’s not to say that cancer rates haven’t also increased in other age groups – they have.

But while most people are aware that cancer is common in old age, and that it also affects younger people (particularly because of media coverage of celebrities such as Jade Goody and Kylie Minogue), not much attention has been focused on the middle aged.

For this reason, we’ve dedicated this article to lifting the lid on our stats story – in particular, which cancers are driving this jump in incidence rates among the middle-aged?

Cancer in middle-aged men

Just because cancer incidence rates in middle-aged people have gone up by nearly 20 per cent in a generation, it doesn’t mean that all cancers are on the rise. Rates of some cancers have increased, while others have fallen. So how has the picture changed?

In 1979, the top three cancers in middle-aged men were lung, bowel and bladder cancers. Whilst bowel cancer has remained the second most common cancer, lung cancer has dropped to third, and prostate cancer has now risen from ninth place to become the most common cancer in middle-aged men.

Most commonly diagnosed cancers in men aged 40-59 in 1979 vs 2008 in Great Britain. Incidence rates are age-standardised to the European population. Bowel includes anal cancer.

It may therefore be no surprise that prostate cancer has been the fastest rising cancer in middle-aged men – rates have increased by over 550 per cent since 1979, rising from 7.7 per 100,000 40-59 year old males to 51.0 per 100,000 in 2008. But why?

On their own, the bare statistics don’t explain the reasons for this increase. To understand the trend, you need to know a little bit about how prostate cancer is diagnosed at the moment.

Although there’s no national prostate screening programme in the UK, men can ask their GP to have a PSA test. This is because men with prostate cancer often have higher levels of the PSA protein in their blood.

Unfortunately, men with raised PSA levels don’t always have prostate cancer, while men with lower level sometimes do; and on top of this, PSA tells doctors nothing about whether a tumour will grow quickly enough to cause problems or become life-threatening (Many prostate cancers grow so slowly they wouldn’t cause problems if left untreated).

This means that, since PSA testing was introduced, many more men have been diagnosed with prostate cancer – and are recorded in the official statistics as such – despite not having aggressive disease.

So increasing use of PSA testing is likely to be responsible for a large part of this increase, as men have asked for PSA testing for symptoms of prostate cancer. Just over 3,900 cases of prostate cancer were diagnosed in men aged 40-59 in Britain in 2008, compared with around 540 in 1979.

There’s a bigger picture here – a pressing need to discover a better way to test for prostate cancer, in order to diagnose those cancers that are most likely to progress into more advanced, dangerous disease. Thankfully, our scientists are on the case.

‘Rates’ versus ‘cases’

At this point we need to take a little detour, and explain how cancer stats are often measured – in particular the difference between increases in ‘rates’ and ‘cases’.

‘Cases’ are the raw number of people being diagnosed with cancer over a given time period. ‘Rates’, on the other hand, are a little more sophisticated – they describe the number of people being diagnosed among every hundred thousand people over a given time period. (To get briefly technical, all the rates in this blog post are age-standardised rates).

The problem with comparing cases is that they don’t reflect changes the population size or age structure.

Let’s say, for the sake of argument, that there were 100,000 40-59 year olds alive in the UK in 1979 , and by 2008 this had risen to 200,000.

If the number of cases of prostate cancer appeared to double during this time, this would simply be because the population doubled. But prostate cancer rates wouldn’t change at all, even though there had been an apparent doubling of cases.

What cancers are falling in men?

Lung cancer, the most common cancer in middle-aged men in the late 1970s, is now the third most common cancer in this age group. But does this reflect a fall in cases and rates?

Despite still being in the top three, lung cancer is one of the fastest falling male cancers in this age group. In fact, rates have fallen by about 60 per cent since the late 70s – from 93.2 per 100,000 middle-aged males to 35.1 per 100,000 in 2008. Cases have also fallen from around 6,300 a year in the late 70s to around 2,700 a year now.

Incidence rates per 100,000 men aged 40-59 in Great Britain by cancer type. Incidence rates are age-standardised to the European population.*Bowel including anal cancer.

This is a direct result of people giving up smoking – the percentage of men who smoke has fallen from 45 per cent in the late 1970s to 22 per cent in 2009. Given that smoking causes 9 out of 10 cases of lung cancer (not to mention increases the risk of several other cancers), it’s no surprise that we’re seeing such dramatic drops in lung cancer rates, as more men give up.

Whilst most people now know that smoking causes lung cancer, this wasn’t always the case. Cancer Research UK has been heavily involved in studying the link between smoking and cancer, and other life-threatening diseases, and in promoting the benefits of quitting – helping to save millions of lives across the world.

Our work in this area has ranged from ground-breaking research into the effects of smoking through to informing and influencing many governments on tobacco control. And following several years of dedicated groundwork and campaigning by the charity, MPs voted in 2006 to ban smoking in public places – one of the most significant advances in public health in a generation.

What about women?

In middle-aged women, the top three cancers are the same now as was the case in 1979. Breast cancer is by far the most common cancer in this age group, followed by lung and bowel cancers.

But this apparently static picture isn’t quite a reflection of what’s been going on. Breast cancer rates in middle-aged women have increased by around 60 per cent since the late 70s – from around 134 women per 100,000 to almost 215. Why?

Most commonly diagnosed cancers in women aged 40-59 in 1979 vs 2008 in Great Britain. Incidence rates are age-standardised to the European population. Bowel includes anal cancer.

The introduction of the national breast screening programme in 1988 is partly responsible for this increase, as many cancers that would previously have been left undiagnosed have been picked up.

The breast screening programme now invites all UK women between the ages of 50 and 70 for mammography every three years and has saved thousands of lives. Our scientists have been at the heart of studying and refining how best to screen women, and how often.

But screening’s only part of the story – changes in women’s lifestyles have also played a role too. Increased use of the contraceptive Pill, changes to average bodyweight, increased alcohol consumption and having children later in life all increase breast cancer risk. As these phenomena become more common, so we’re seeing more cases, and increased rates, of breast cancer.

Cancer Research UK has been instrumental in unpicking the true causes of breast cancer and separating out the myth from the reality.

But despite this large rise in breast cancer, the fastest rising common cancer in women in this age group is actually malignant melanoma, the most serious form of skin cancer.

Percentage change in incidence rates per 100,000 population from 1979 to 2008 in women aged 40-59 in Great Britain. Incidence rates are age-standardised to the European population. *Excludes non-melanoma skin cancer. **Bowel includes anal cancer.

Melanoma rates have increased by over 200 per cent – from around 9 women per 100,000 in 1979, to almost 25 women per 100,000 in 2008. Every year, around 1,930 women aged 40-59 are diagnosed with malignant melanoma in Britain.

This isn’t just a problem in women – after prostate cancer, malignant melanoma is the next fastest-rising common cancer in middle-aged men – rates have more than quadrupled since the late 70s from 4.2 to 19.2 per 100,000 40-59 year old males in 2008. In the late 70s, over 250 men aged 40-59 years were diagnosed each year in Britain compared to around 1,500 now.

In fact, the increase in melanoma rates is a problem across the board, and is also seen in younger age groups – melanoma is one of the commonest cancers in 15-34 year olds.

Most skin cancers, including melanoma, are caused by too much exposure to ultraviolet (UV) radiation from the sun and sunbeds.

People’s changing behaviour in the sun is behind these worrying trends in melanoma incidence. This is why – as well as being the largest funder of skin cancer research in the UK – we also raise awareness of how people can protect themselves by avoiding sunburn, through our SunSmart campaign.

The good news

So that’s a quick tour of some of the reasons why we’re seeing increases in cancer rates.

The good news is that even though more people than ever before are developing cancer, the chances of surviving the disease at least 10 years has doubled over the last 40 years to almost 50 per cent:

10-year relative survival in England and Wales. *Survival rates in 2007 are predicted.

There are many reasons for this, including earlier diagnosis of some cancers, better surgery, more effective radiotherapy and new drugs, many of which have been developed using the knowledge that our laboratory research has uncovered.

All of this is underpinned by the scientific research that we’re helping fund.

And we know that getting cancer is not always down to bad genes, fate or bad luck. Experts estimate that up to half of all cancers could be prevented by lifestyle changes. This too is good news. There are many ways that people can reduce the risk, such as not smoking; cutting back on alcohol; keeping active and maintaining a healthy body weight; eating a healthy, balanced diet; and enjoying the sun safely.

None of these are a cast-iron guarantee against cancer. But they can help to reduce the risk of developing the disease and heavily stack the odds of avoiding it in our favour.

What the future holds

As we said earlier, we started looking at the latest cancer statistics as part of the work behind our new ad campaign. The campaign is hugely important to us – allowing us to work with some incredible people affected by cancer to raise awareness of the work we do.

And we know from past experience that these campaigns help to draw attention to our life-saving work and encourage support.

And that’s really the point of all of this. The story of the last few decades is of success and tragedy in equal part.

Thanks to scientific research, for some cancers the outlook has transformed beyond recognition.

And yet for others, there’s barely been any progress.

We need to raise all the boats to the same level – and to do that we need your continued support and backing so that we can continue to invest in cutting-edge scientific research, and realise our vision: that together we will beat cancer.

– Oliver Childs, in collaboration with the Cancer Research UK Statistical Information Team

• Information about how you can support us is available on our website