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UK health inequalities: 20,000 more cancer cases a year in the most deprived areas

by Katie Roberts | Analysis

30 September 2020

16 comments 16 comments

A crowd of people

The last few months have shone a stark light on our health in the UK, with the COVID-19 pandemic exposing the deep inequalities running through our society.

But inequalities in the UK affect more than our risk from COVID-19, they’re intricately entwined with all aspects of our health, including cancer. New figures released today reveal that there are around 20,000 extra cancer cases each year in more deprived areas of the UK. And if we exclude the few cancer types where deprivation is associated with lower incidence – the exceptions that prove the rule, as we explain below – that figure is around 30,000.

It’s a sobering figure, with those 20,000 annual cases equating to around 60 cancer cases a day that could be avoided. And what’s worse is that this figure is just one of many.

People from more deprived areas are not only more likely to get cancer, they’re more likely to be diagnosed at a late stage for certain cancer types, and have trouble accessing cancer services. And, sadly, they’re more likely to die from the disease.

It’s an unacceptable reality in 2020. And one that government must urgently address.

Preventing cancer

When it comes to cancer cases, the starkest differences between the most and least deprived areas of the UK are in smoking-related cancer, like lung and laryngeal cancer. Rates of smoking related cancers are 3 times higher for the most deprived populations compared to the least deprived.

Smoking rates have been falling across the UK for decades, but there’s a big difference in smoking rates between the most and least deprived communities. In Northern Ireland, around 3 in 10 adults in the most deprived communities will smoke in 2020, compared with 1 in 10 people in the least deprived communities. A picture that’s mirrored in other parts of the UK.

Smoking rates Northern Ireland

Copy this link and share our graphic. Credit: Cancer Research UK

Children from the most deprived areas are also twice as likely to be obese in Scotland. Children who are obese are 5 times more likely to be obese as adults, putting them at higher risk of developing 13 different types of cancer.

A small number of risk factors are more common in less deprived people – such as excess sun exposure, which drives their higher melanoma skin cancer rates.

The number of people who take part in cancer screening also varies depending on where people live. In Scotland, 52% of eligible adults in the most deprived areas take part in bowel screening, much lower than the 73% of people living in the least deprived areas. Screening uptake differences are a key driver of inequality for breast and prostate cancers, where more deprived people have higher incidence rates partly because they are less likely to take up breast screening and prostate-specific antigen (PSA) testing. Screening can detect cancers at an early stage, as well as helping to prevent cancers developing in the case of cervical and bowel screening.

By identifying theses cancers early, treatment is more likely to be successful and people are more likely to survive their cancer. Because how and when someone is diagnosed matters.

Cancer diagnosis and treatment

For some cancer types, people from more deprived communities are more likely to be diagnosed at a later stage, giving them fewer treatment options. They’re also 50% more likely to be diagnosed through emergency routes like A&E when looking at all cancers together. Higher proportions of emergency presentations in more deprived groups is particularly clear for bowel, lung, bladder and pancreatic cancers and it’s a bad sign – people diagnosed in this way have worse survival, even when you take into account their cancer stage.

It’s difficult to pinpoint the reasons why more people are diagnosed through emergency routes, but we’re constantly surveying the public to try and understand barriers people face. Data suggests that people from the most deprived communities are less aware of cancer symptoms and report more barriers to seeking help – the most common being difficulties getting an appointment with a particular doctor or at a time that works. Because of these barriers, people may find it difficult to seek help or put off doing so until the disease reaches a crisis point.

Symptom recognition

Copy this link and share our graphic. Credit: Cancer Research UK

And for people from deprived communities, health concerns might not come that high up their list of priorities, with more pressing things like money and family security taking precedence.

The differences don’t just stop at diagnosis. In England, we’re starting to learn that there are differences in treatment between the least and most deprived. We still need to understand the causes of these differences, which are complex and could well be associated with comorbidities caused by poorer general health. And while patient choice is key, it’s vital that everyone has access to the best treatment options, regardless of where they live.

With so many differences in prevention, diagnosis, care and treatment, the sobering reality is that people in more deprived areas have worse cancer survival.

Survival graphs

Copy this link and share our graphic. Credit: Cancer Research UK

This must change.

Scratching the surface

Most of the data in our latest report isn’t new, for years pockets of this information have been available. But by bringing it together, we hope to start a conversation that will lead to real change.

But we’re just scratching the surface when it comes to health inequalities, which stem from a range of social, environmental and economic factors, known as the wider determinants of health. Understanding how these underlying factors affect cancer risk and outcomes, and taking action to mitigate them, is key to closing the gap between advantaged and disadvantaged groups.

We focused solely on social and financial (socio-economic) deprivation in our latest report. We did so because it’s one of the most influential factors driving differences in the number of people being diagnosed with cancer as well as cancer survival and it’s uniquely intertwined with many other factors. But it’s also one of the most well-researched aspects of cancer inequalities.

But socio-economic deprivation is one of many factors that drive health inequalities in the UK. How long we live, and how long we live in good health, varies depending on a range of factors, including ethnicity, gender, sexual orientation and whether we have any disabilities.

Each of these factors, and the impact they have on health inequalities, must be untangled. And to do that we need better data collection so that we can understand how different groups experience differences in health. This will allow researchers to identify inequalities so that we can then work collectively to reduce or eradicate them.

A catalyst for change

But while it’s important to collect more data, we’ve got enough data to know that governments across the UK must act to reduce inequalities. Fortunately, the UK Government has the perfect opportunity to do so in England in the next few months, with the upcoming comprehensive spending review.

Government must pay close attention to the widening gap between richer and poorer areas, injecting much needed money into public health funding, including stop smoking services, to help reduce this inequality.

– Michelle Mitchell, chief executive, Cancer Research UK

To do this, they need to invest in stop smoking services, creating protected funding for these vital services, ideally through a levy on the tobacco industry. And this money must be used in a way that helps more people quit across the board but, crucially, lessens the gap in smoking rates between the most and least deprived communities.

The other lies in reducing childhood obesity. The UK Government launched a new strategy to tackle obesity in July, which includes a raft of commitments. But the detail has yet to be finalised – the UK Government will be consulting with industry and others on how to introduce the measures, and then the UK Parliament will have to pass legislation. There’s a real risk they’ll be watered down or delayed further.

We need the UK and devolved governments to fully implement their obesity plans, including restricting advertising and price promotion offers on unhealthy food and drink.

Supporting tobacco control measures and introducing measures to help reduce obesity are important steps forward. But they’re just one part of the solution.

As the NHS and society adapt and recover from the effects of COVID-19, we must use this opportunity as a catalyst for change.

Tackling inequalities has been an ambition for the UK’s health services for some time, but we’re still not seeing the level of progress we need. Ensuring that no-one is disadvantaged because of where they live be central when decisions about health are at stake. And it must start now.

One of the UK Government’s priorities for the upcoming comprehensive spending review includes ‘levelling up economic opportunities across all nations and regions of the country’. The wealth of the nation is linked to and depends on the health of the nation. If the UK is to tackle inequalities and make sure no community is left behind, if we’re to improve cancer survival in every part of the country, then health must be hardwired into the Government’s ‘levelling up’ agenda.

Now is the time for the government to show its commitment to the NHS. In the upcoming Comprehensive Spending Review, further investment is urgently required to support cancer prevention and to make sure the NHS has the staff and equipment it needs to clear the mounting backlog of patients, improving and transforming cancer services for everyone.

– Michelle Mitchell, Cancer Research UK’s chief executive.

Katie

Reference

Cancer in the UK 2020: Socio-economic deprivation. Cancer Research UK. Published 30 September 2020.

    Comments

  • ROSALIND BEVERIDGE
    12 January 2021

    my husband has just been told he has cancer the bio was inconclusive but my husband feels to weak for chemo so they are just giving him painkillers i known he does not want chemo but surly there must be something else they can try

  • reply
    Katie Roberts
    13 January 2021

    Hi Rosalind,

    Thanks for your message and I’m sorry to hear about your husband’s diagnosis. If you have any questions about cancer our nurses are here to help. They’re available Monday to Friday, 9-5pm, on freephone 0808 800 4040.

    Best wishes,

    Katie

  • Glynn Scholefield
    11 January 2021

    I have cancer and have never got a penny off you people so why should I donate

  • Glynn Scholefield
    11 January 2021

    I have cancer don’t approach me to donate.Never got a penny in my life 😡

  • Neil ellis
    11 December 2020

    Save lives and sign

  • MaryEllen Dalton
    25 November 2020

    We in UK seem to be badly behind other countries with early diagnosis This gap needs to be looked into

  • Kathryn Davenport Dunn FRSA
    11 October 2020

    I found this report very informative and opens your eyes to all the issues involved regarding early diagnosis. Thank you for your update it makes me realise that there are many issues to be solved if possible.

  • Richard White
    11 October 2020

    Government. must act now

  • Amanda
    10 October 2020

    This report does reflect the reality, sadly in my current experience. My brother went into hospital a week ago with a suspected COVID-19 case. It turned out he has lung and liver cancer and has 3 months to live. He is only 59 but smoked since he was a teenager and has a poor diet and does not carry out exercise. The focus needs to be on lifestyle changes, that way, future generations increase their chance to beat cancer.

  • Alan Dowsett
    9 October 2020

    Not impressed – another over paid executive £244000/year, Michelle Mitchell telling donors like me to lobby the Government to spend spend and spend again at a time when no government in the last 75 years has spent more trying to support so many people and maintain employment! Now knowing what she gets paid does NOT encourage me to continue to support your charity. Equality is sadly never going to happen and how ever much education there is, too many people will ignore the warning about smoking and obesity. I assumed that any money I gave to Cancer Research Ltd was spent on research into curing cancer and not on expensive surveys which often only confirm the obvious. The NHS does amazing work – I worked within it for my working lifetime but it is not the perfect. People such as Ms Mitchell should be aware that “the government” has no money to fund anything and that all its money comes from taxation mostly from people earning far less than she is so fortunate enough to be paid.
    Please spare us the politics and get back to funding proper cancer research.

  • Jash Patel
    9 October 2020

    You are doing a great job. We should all highlight the Government to acknowledge the importance of PREVENTING cancer by funding requirement.

  • Paul Giles
    9 October 2020

    Much more must be spent on cancer research to improve the lives of us all. Cancer is blighting the lives of so many and without funding it will continue to do so.

  • Maisie lodge
    9 October 2020

    Cancer HAS to GO!
    BUT HOW?

  • Ann
    9 October 2020

    We need to concentrate more on lifestyle changes. A great many people Are not aware of for example lung cancer . It is only in most cases that You are made aware of all the support available. We need media coverage to enlighten us on breathing , diet , more cancer awareness. I did not know that we have over 140 different types of cancer. I am doing now what I should have been doing years ago. With the right of more preventative and self help information we can get. It will allow us to recognise symptoms in early stages. And prompt us to contact our doctors sooner. And as important we can educate and influence our children’s lifestyle . My heart goes out to the people awaiting treatment, the agony and anxiety for patients and carers in lots of cases is unbearable. Creating unnecessary stress which must aggravate the conditions that can be avoided. The waiting time for treatment especially with the number patients needing treatment puts again unnecessary strain on our ruling workers and resources.

  • Patricia le Gallez
    8 October 2020

    where are these deprived areas that you keep mentioning? I am very keen to know.

  • Sayeed Syed
    8 October 2020

    Absolutely right it is us to make aware to theGovt to bring the same standard for every citizen of our country

  • Euan Holt
    8 October 2020

    Obesity is of epidemic proportions. Food suppliers must be continually persuaded to reduce the fat ,salt and sugar in their products. Changing dietry habits is a challenge ; small portions on small plates ; people allow their craving for sugar and fat to have precedence over their bloated appearance .

    Comments

  • ROSALIND BEVERIDGE
    12 January 2021

    my husband has just been told he has cancer the bio was inconclusive but my husband feels to weak for chemo so they are just giving him painkillers i known he does not want chemo but surly there must be something else they can try

  • reply
    Katie Roberts
    13 January 2021

    Hi Rosalind,

    Thanks for your message and I’m sorry to hear about your husband’s diagnosis. If you have any questions about cancer our nurses are here to help. They’re available Monday to Friday, 9-5pm, on freephone 0808 800 4040.

    Best wishes,

    Katie

  • Glynn Scholefield
    11 January 2021

    I have cancer and have never got a penny off you people so why should I donate

  • Glynn Scholefield
    11 January 2021

    I have cancer don’t approach me to donate.Never got a penny in my life 😡

  • Neil ellis
    11 December 2020

    Save lives and sign

  • MaryEllen Dalton
    25 November 2020

    We in UK seem to be badly behind other countries with early diagnosis This gap needs to be looked into

  • Kathryn Davenport Dunn FRSA
    11 October 2020

    I found this report very informative and opens your eyes to all the issues involved regarding early diagnosis. Thank you for your update it makes me realise that there are many issues to be solved if possible.

  • Richard White
    11 October 2020

    Government. must act now

  • Amanda
    10 October 2020

    This report does reflect the reality, sadly in my current experience. My brother went into hospital a week ago with a suspected COVID-19 case. It turned out he has lung and liver cancer and has 3 months to live. He is only 59 but smoked since he was a teenager and has a poor diet and does not carry out exercise. The focus needs to be on lifestyle changes, that way, future generations increase their chance to beat cancer.

  • Alan Dowsett
    9 October 2020

    Not impressed – another over paid executive £244000/year, Michelle Mitchell telling donors like me to lobby the Government to spend spend and spend again at a time when no government in the last 75 years has spent more trying to support so many people and maintain employment! Now knowing what she gets paid does NOT encourage me to continue to support your charity. Equality is sadly never going to happen and how ever much education there is, too many people will ignore the warning about smoking and obesity. I assumed that any money I gave to Cancer Research Ltd was spent on research into curing cancer and not on expensive surveys which often only confirm the obvious. The NHS does amazing work – I worked within it for my working lifetime but it is not the perfect. People such as Ms Mitchell should be aware that “the government” has no money to fund anything and that all its money comes from taxation mostly from people earning far less than she is so fortunate enough to be paid.
    Please spare us the politics and get back to funding proper cancer research.

  • Jash Patel
    9 October 2020

    You are doing a great job. We should all highlight the Government to acknowledge the importance of PREVENTING cancer by funding requirement.

  • Paul Giles
    9 October 2020

    Much more must be spent on cancer research to improve the lives of us all. Cancer is blighting the lives of so many and without funding it will continue to do so.

  • Maisie lodge
    9 October 2020

    Cancer HAS to GO!
    BUT HOW?

  • Ann
    9 October 2020

    We need to concentrate more on lifestyle changes. A great many people Are not aware of for example lung cancer . It is only in most cases that You are made aware of all the support available. We need media coverage to enlighten us on breathing , diet , more cancer awareness. I did not know that we have over 140 different types of cancer. I am doing now what I should have been doing years ago. With the right of more preventative and self help information we can get. It will allow us to recognise symptoms in early stages. And prompt us to contact our doctors sooner. And as important we can educate and influence our children’s lifestyle . My heart goes out to the people awaiting treatment, the agony and anxiety for patients and carers in lots of cases is unbearable. Creating unnecessary stress which must aggravate the conditions that can be avoided. The waiting time for treatment especially with the number patients needing treatment puts again unnecessary strain on our ruling workers and resources.

  • Patricia le Gallez
    8 October 2020

    where are these deprived areas that you keep mentioning? I am very keen to know.

  • Sayeed Syed
    8 October 2020

    Absolutely right it is us to make aware to theGovt to bring the same standard for every citizen of our country

  • Euan Holt
    8 October 2020

    Obesity is of epidemic proportions. Food suppliers must be continually persuaded to reduce the fat ,salt and sugar in their products. Changing dietry habits is a challenge ; small portions on small plates ; people allow their craving for sugar and fat to have precedence over their bloated appearance .