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1. THE CHALLENGE FOR SCOTLAND
Introduction
Every year, about 27,000 people in Scotland are diagnosed with cancer. This number continues to increase and despite advances in our ability to treat many forms of the disease, cancer remains the leading cause of mortality in Scotland amongst people under the age of 75.
Since the launch of Cancer in Scotland: Action for Change in 2001, significant improvements have been made in the quality of care we are able to provide with better access, greater use of new technologies and advances in the training and development of those who work to combat cancer. Our challenge now is to build upon these achievements and ensure that Scotland's approach to tackling cancer continues to reflect the needs of our patients and takes advantage of the opportunities that are open to a modern, efficient system of healthcare.
Incidence
For men, the most common cancers are prostate, lung and colorectal (bowel). These account for 53% of cancers (Figure 1).
Figure 1: Most frequently diagnosed malignancies in men in Scotland 2004
Source: ISD Scotland
For women, the most common cancers are breast, lung and colorectal (bowel). These account for 55% of cancers (Figure 2).
Figure 2: Most frequently diagnosed malignancies in women in Scotland 2004
Source: ISD Scotland
Beating Cancer
Since the 1980s, almost all cancers showed improvement in survival five years after diagnosis (Figure 3) and, for some cancers, this improvement was marked. For example, for malignant melanoma of the skin, male survival increased from 61% in the period 1980-1984 to 86% in the period 2000-2004, an absolute increase of 25%. Over the same period the increase for females was 12%.
Figure 3: Absolute difference 1 in relative survival at five years by cancer and sex: patients diagnosed in 2000-2004 compared to those diagnosed in 1980-1984
(patients aged 15-99) 2
Males
Females
1 The change over the whole period is calculated as the difference between relative survival at 5 years in 1980-1984 and 2000-2004
2 The recent decrease in survival from bladder cancer is an artefact of classification. Over the period 1996-1999 there were fewer registrations of invasive bladder carcinoma, reflecting a change in coding practice recommended by the European Network of Cancer Registries ( ENCR) and subsequently by the United Kingdom Association of Cancer Registries ( UKACR).
We are on track to meet the national target of reducing the mortality rate from cancer by 20% in the under 75s between 1995 and 2010, with the overall reduction standing at 18.1% by 2006. In addition, we are also on track to achieve a further 10% reduction in mortality rates in the most deprived sectors of our population. With a 7.5% decrease in the period 2003 to 2006 (Figure 4).
Figure 4: Cancer Mortality (Under 75s)
Drivers of Progress
This solid record of achievement in recent years has resulted from a number of factors:
- A more comprehensive approach to cancer prevention - including, most notably, the leadership shown by the introduction of a ban on smoking in public places in 2005
- Expansion of screening programmes - the upper age limit for breast cancer screening was raised to 74 and a national bowel cancer screening programme for men and women aged 50 to 74 is now being rolled out across Scotland
- Faster access to services - updated guidelines for the referral of patients with suspected cancer were issued in 2007. A £50 million diagnostics programme has seen waiting times for eight diagnostics tests including CT, MRI and endoscopy reduced significantly
- Access to new technologies - more and better equipment such as linear accelerators, CT, MRI, endoscopy and a new clinical PET service
- Expanded workforce - at least 300 additional staff working across cancer and related services, including more doctors (for example surgeons, radiologists, oncologists), nurses, pharmacists and other healthcare professionals
- Significant additional investment - Cancer in Scotland was backed up by an additional investment of £25 million each year. In addition, a £40 million capital equipment programme has transformed radiotherapy services in all five cancer centres, £100 million has been provided for the new Beatson West of Scotland Cancer Centre and £27.5 million has been invested through the New Opportunities Fund (now the Big Lottery Fund) in a range of prevention, patient support and palliative care facilities and services.
Going Forward
Better Health, Better Care Action Plan (2007) set out Scotland's national strategy for helping people to sustain and improve their health, particularly in disadvantaged communities, providing better, faster and more local access to healthcare. In doing so, it confirmed that cancer remained a national clinical priority and challenged patients, carers and NHS staff to work together to build on past achievements and develop a new action plan for tackling cancer in the years ahead.
This discussion document aims to stimulate a debate about future priorities for cancer. In particular it follows the direction of Better Health, Better Care in challenging us to think about what more can be done to:
- Improve cancer prevention through the creation of healthy environments and supporting healthy choices in our lives
- Tackle health inequalities in terms of outcomes and access to services
- Improve the quality of services across the six dimensions of healthcare quality (patient centredness, safety, effectiveness, efficiency, timeliness, equity)
- Ensure that our approach is developed and implemented in a mutual partnership between Government, NHS staff, patients and the general public.
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