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                             Mount Vernon Cancer Network

                                   Baseline Cancer Assessment

                  Local Awareness and Early Diagnosis Initiative



Introduction ............................................................................................. 2
1. All Cancers ......................................................................................... 3
  1.1 Summary .......................................................................................................... 3
  1.2 Mortality ............................................................................................................ 3
  1.3 Referral Rates................................................................................................... 4
  1.4 Emergency Admissions .................................................................................... 5
2. Breast Cancer ..................................................................................... 5
  2.1 Summary .......................................................................................................... 5
  2.2 Survival ............................................................................................................. 6
  2.3 Incidence .......................................................................................................... 8
3. Cervical Cancer ................................................................................ 10
  3.1 Summary ........................................................................................................ 10
  3.2 Screening Coverage ....................................................................................... 10
4. Colorectal Cancer ............................................................................. 11
  4.1 Summary ........................................................................................................ 11
  4.2 Survival ........................................................................................................... 12
  4.3 Incidence ........................................................................................................ 13
5. Lung Cancer ..................................................................................... 14
  5.1 Summary ........................................................................................................ 14
  5.2 Survival ........................................................................................................... 14
  5.3 Incidence ........................................................................................................ 16
6. Prostate Cancer ................................................................................ 17
  6.1 Summary ........................................................................................................ 17
  6.2 Survival ........................................................................................................... 17
  6.3 Incidence ........................................................................................................ 19
Acronyms .............................................................................................. 24


Annex A

Annex B




                                                                                                                            1
Introduction

This report was produced by the Herts PCTs Public Health Department using
guidance provided by the National Cancer Action Team and National Cancer
Intelligence Network1. The purpose of this baseline cancer assessment is to help
local networks to identify differences at Cancer Network, Primary Care Trust and
Practice Based Commissioning Group, and (in one area) international level. All
information needs to be interpreted carefully and the intention is to inform further
discussion which in turn will help inform local strategy to improve cancer services
provided to residents of the Mount Vernon Cancer Network.

Information on incidence, mortality, survival, referral rates and emergency hospital
admissions is presented for all cancers. Further information is given on breast, lung,
colorectal and prostate cancers - the rationale in choosing these specific cancers for
this report is that numbers are large enough to provide more robust analysis at
Primary Care Trust level. Information is also given on breast and cervical cancer
screening.

Much of the information included within this report is drawn from public information
available from the National Cancer Intelligence Network (NCIN)2 and associated
resources (National Cancer Information Service, Cancer e-Atlas and Cancer
Commissioning toolkit). The NCIN was launched in June 2008 to bring together
cancer registries, clinical champions, health service researchers and a range of other
interested parties (including the Office for National Statistics; National Clinical Audit
Support Programme; NHS Information Centre) under the auspices of the National
Cancer Research Institute.

Key findings:

         Screening for cancer - overall good coverage but pockets of low coverage

         Incidence of lung cancer is below national level

         Overall cancer mortality improving and better than National figures

Areas of concerns include:

         Lung cancer survival local trend is flat compared with slight improving trend
          nationally

         Although improving, prostate cancer survival is generally below national trend
          especially for West Herts PCT

         Breast cancer 1 year survival is low especially in West Herts & Luton PCTs

         Colorectal survival is below national figures especially for Luton and West
          Herts PCTs




1
    http://www.ncin.org.uk/docs/LAEDI_Baseline_Guide_May_2009.pdf
2
    http://www.ncin.org.uk/index.shtml
                                                                                          2
1. All Cancers
1.1 Summary
When investigating the mortality rate for all cancers Mount Vernon Cancer Network (MVCN)
and its constituent areas perform well, being consistently below the national average. For
cancer referrals and utilisation of the two-week wait (2WW) system MVCN and the majority
of its constituent areas exhibit a similar experience to England. East and North
Hertfordshire PCT displays the lowest number of emergency admissions per cancer
registration which is in accordance with improving patient care when compared to the
national average of 1.8.

1.2 Mortality

                                                                                                            All cancers
                                                                                               Mortality rates, all persons under 75
                                           180
   Mortality rate per 100,000 population




                                           170

                                           160

                                           150

                                           140

                                           130

                                           120

                                           110

                                           100

                                            90
                                                 85

                                                       86

                                                             87

                                                                   88

                                                                         89

                                                                               90

                                                                                     91

                                                                                           92

                                                                                                 93

                                                                                                       94

                                                                                                             95

                                                                                                                   96

                                                                                                                         97

                                                                                                                               98

                                                                                                                                     99

                                                                                                                                           00

                                                                                                                                                 01

                                                                                                                                                       02

                                                                                                                                                             03

                                                                                                                                                                   04

                                                                                                                                                                         05

                                                                                                                                                                               06

                                                                                                                                                                                     07

                                                                                                                                                                                                        08

                                                                                                                                                                                                          9
                                                                                                                                                                                                         et
                                                                                                                                                                                              tio 200
                                                                                                                                                                                                      rg
                                            19

                                                      19

                                                            19

                                                                  19

                                                                        19

                                                                              19

                                                                                    19

                                                                                          19

                                                                                                19

                                                                                                      19

                                                                                                            19

                                                                                                                  19

                                                                                                                        19

                                                                                                                              19

                                                                                                                                    19

                                                                                                                                          20

                                                                                                                                                20

                                                                                                                                                      20

                                                                                                                                                            20

                                                                                                                                                                  20

                                                                                                                                                                        20

                                                                                                                                                                              20

                                                                                                                                                                                    20

                                                                                                                                                                                          20


                                                                                                                                                                                                   ta
                                                                                                                                                                                                 n




                                                  East and North Hertfordshire PCT                               West Hertfordshire PCT
                                                                                                                                                                                                  c
                                                                                                                                                                                               du
                                                                                                                                                                                              re




                                                  Luton PCT                                                      Bedfordshire PCT
                                                                                                                                                                                          %
                                                                                                                                                                                         20
                                                                                                                                                                                     10




                                                  Mount Vernon Cancer Network                                    England
                                                                                                                                                                                    20




Source: NCIS 2010
Figure 1: Mortality rates for all cancers in all persons under 75 years of age
        There is an improvement in mortality over time.
        There are unexplained year on year fluctuations experienced by all PCTs and this
           is most evident in Luton PCT.
        All PCTs, with the exception of Luton, appear to be on course to meet their 2010
           reduction target.
        There is a requirement for further investigation to explain the severe fluctuations
           experienced by Luton PCT.




                                                                                                                                                                                                              3
1.3 Referral Rates

                                              % of patients     % of all cancer
                         Referrals/10,000     referred via      patients
PCT                      pop via 2WW          2WW with          diagnosed via
                         (Q1,2009/10)         Cancer (Q3,       2WW (Q3,
                                              2008/09)          2008/09)
 East and North
 Hertfordshire              148                      13             43
 West Hertfordshire         168                      10             41
 Luton                      93                       9              75
 Bedfordshire               158                      11             46
 England                    160                      12             45
Source: CCT
Figure 2: Referral rates for all cancers in all persons of all ages
Referrals/10,000 pop via 2WW
     West Hertfordshire PCT GPs made 168 urgent referrals per 10,000 population, which
       is the most in the MVCN.
     There is wide variation in the uptake of 2WW referral route between PCTs. Luton
       PCT has the lowest number of 2WW referrals compared to West Hertfordshire PCT
       which has the highest number of 2WW referrals.

Percentage of patients referred via 2WW with Cancer
    This describes the proportion of patients referred through the two-week wait route
      who were subsequently found to have cancer.
    The percentage diagnosed through the 2WW referrals across the MVCN varied
      between 9% to 13%
    The England conversion rate (for patients referred through the 2WW route who
      were subsequently found to have cancer) is 12%
    A low referral rate combined with a high conversion rate may indicate significant
      under-utilisation of the 2WW referral route by GPs

Percentage of all cancer patients diagnosed via 2WW
    This describes the proportion of patients diagnosed via the 2WW out of all the
      patients diagnosed with cancer. Other cancer patients will have been diagnosed
      through other screening, emergency admissions or routine referrals.
    Across England 45% of cancers were diagnosed through the 2WW route (Q1,
      2009/10).
    Luton PCT exhibits a proportion much higher than those found both locally and
      nationally.
    All the data collected for Luton PCT is far beyond the national average and this
      requires further verification and investigation.




                                                                                     4
1.4 Emergency Admissions


                           Admissions per         Bed Days per       Average length
PCT
                           registration           registration       of stay-total

 East and North
 Hertfordshire              1.1                  8.6                  7.7
 West Hertfordshire         1.7                  10.6                 6.3
 Luton                      1.9                  10.8                 5.6
 Bedfordshire               1.6                  9.6                  6.1
 England                    1.8                  11.3                 6.5
Source: HES Data 2008/09
Figure 3: Emergency admissions for all cancers in all persons of all ages
Admissions per registration
     East and North Hertfordshire PCT has the lowest number of emergency admissions
       per registration (1.1).
     Luton PCT has the highest number of emergency admissions per registration (1.9)
       however this is comparable to the national average of 1.8.

Bed days per registration
    The average across England of 11.3 is higher than any of the local data.
    East and North Hertfordshire PCT has the lowest number of emergency bed days per
      registration (8.6).

Average length of stay-total
    East and North Hertfordshire PCT has the highest average length of stay of 7.7 days.
    Luton PCT has the lowest average length of stay (5.6).
    Average length of stay for emergency cancer-related admissions was 6.5 days across
      England.
    For cost and efficiency reasons we aim to reduce the average number of bed days
      per registration and also the number of emergency admissions per registration.

2. Breast Cancer
2.1 Summary
In common with England, MVCN and its constituent areas show an improvement in survival
over time for both one-year and five-year survival rates for breast cancer. However MVCN is
continuously below the national average for survival. There are considerable fluctuations in
the incidence rate and, where previously MVCN experienced a rate above that found
nationally, recently it has had rates below the national average. The PBC level data for
breast screening coverage shows there is considerable variation both within PBC groups
over time and between groups. When looking at the PCT level data for breast screening
coverage it is evident that only West Hertfordshire PCT consistently falls short of the target
where as MVCN has exceeded the 70% coverage target for both 2007 and 2008. Breast
cancer has only been investigated in females due to the very small number of male cases at
PCT level.

                                                                                            5
2.2 Survival
                                                                                        Breast cancer
                                                                            One-year survival rates, females, all ages

                             100
                                                                                                                                                         East and North Hertfordshire
                                                                                                                                                         PCT
                              95
                                                                                                                                                         West Hertfordshire PCT
  Relative survival rate %




                              90
                                                                                                                                                         Luton PCT

                              85
                                                                                                                                                         Bedfordshire PCT

                              80
                                                                                                                                                         Mount Vernon Cancer Network

                              75
                                                                                                                                                         England

                              70
                                        9
                                        0
                                        1
                                        2
                                        3
                                        4
                                        5
                                        6
                                        7
                                        8
                                        9
                                        0
                                        1
                                        2
                                        3
                                        4
                                        5
                                        6
                              19 -198
                              19 -199
                              19 -199
                              19 -199
                              19 -199
                              19 -199
                              19 -199
                              19 -199
                              19 -199
                              19 -199
                              19 -199
                              19 -200
                              19 -200
                              19 -200
                              20 -200
                              20 -200
                              20 -200
                                      00
                                   -2
                                85
                                86
                                87
                                88
                                89
                                90
                                91
                                92
                                93
                                94
                                95
                                96
                                97
                                98
                                99
                                00
                                01
                                02
                             19




                                                                                              Year


Source: NCIS 2010
Figure 4: Breast cancer one-year survival rates in females of all ages
     The trend shows improvement in survival over time.
     PCTs and MVCN are closely grouped and currently display similar performance
       however they are continuously below the national average.
     Bedfordshire PCT is performing well with a rate (96.67% (95%CI 95.42-97.92) above
       that found nationally (95.21% (95%CI 95.08-95.33) for the period 2002-2006.
     Conversely MVCN displays a rate of 92.81% (95%CI 91.88-93.73) which is below
       found nationally (95.21% (95%CI 95.08-95.33) for the period 2002-2006.



                                                                                        Breast cancer
                                                                           Five-year survival rates, females, all ages

                              90
                                                                                                                                                         East and North Hertfordshire
                              85                                                                                                                         PCT
  Relative survival rate %




                                                                                                                                                         West Hertfordshire PCT
                              80
                                                                                                                                                         Luton PCT
                              75

                              70                                                                                                                         Bedfordshire PCT

                              65                                                                                                                         Mount Vernon Cancer Network

                              60                                                                                                                         England

                              55
                                    89

                                              90

                                                      91

                                                               92

                                                                       93

                                                                                94

                                                                                        95

                                                                                                 96

                                                                                                         97

                                                                                                                  98

                                                                                                                          99

                                                                                                                                   00

                                                                                                                                           01

                                                                                                                                                    02
                                     9

                                             9

                                                      9

                                                              9

                                                                       9

                                                                               9

                                                                                        9

                                                                                                9

                                                                                                         9

                                                                                                                 9

                                                                                                                          9

                                                                                                                                  0

                                                                                                                                           0

                                                                                                                                                   0
                                  -1

                                          -1

                                                   -1

                                                           -1

                                                                    -1

                                                                            -1

                                                                                     -1

                                                                                             -1

                                                                                                      -1

                                                                                                              -1

                                                                                                                       -1

                                                                                                                               -2

                                                                                                                                        -2

                                                                                                                                                -2
                              85

                                         86

                                                 87

                                                          88

                                                                  89

                                                                           90

                                                                                   91

                                                                                            92

                                                                                                    93

                                                                                                             94

                                                                                                                     95

                                                                                                                              96

                                                                                                                                      97

                                                                                                                                               98
                             19

                                    19

                                              19

                                                      19

                                                               19

                                                                       19

                                                                                19

                                                                                        19

                                                                                                 19

                                                                                                         19

                                                                                                                  19

                                                                                                                          19

                                                                                                                                   19

                                                                                                                                           19




                                                                                             Year


Source: NCIS 2010
Figure 5: Breast cancer five-year survival rates in females of all ages


                                                                                                                                                                                        6
           Positive trend shows improvement in survival over time.
           PCTs and MVCN grouped closely and currently display similar performance.
           Bedfordshire PCT is performing well with a rate slightly above that found nationally.
           The most recent data from 1998-2002 shows that neither the PCTs nor MVCN
            (80.39% (95%CI 78.72-82.06)) are experiencing a different survival rate to that of
            England (82.03% (95%CI 81.78-82.3)) as indicated by the over lapping confidence
            intervals.


                                                                             Breast cancer
                                                                 One-year survival rates, females, all ages

                                         100
                                                                                                                                                                       Highest Eurocare 1995-99
                                          98
              Relative survival rate %




                                                                                                                                                                       Consensus target
                                          96

                                          94                                                                                                                           England 2002-06

                                          92
                                                                                                                                                                       East and North Hertfordshire
                                          90                                                                                                                           PCT 2002-06
                                                                                                                                                                       West Hertfordshire PCT
                                          88                                                                                                                           2002-06
                                          86                                                                                                                           Luton PCT 2002-06
                                                      9                t                             6              6                                             06
                                                 -9             rg
                                                                   e
                                                                                   -0
                                                                                      6           -0             -0                06           -0
                                                                                                                                                   6
                                                                                                                                                             2-
                                               95            ta                 02             02             02              2-             02            00          Bedfordshire PCT 2002-06
                                          19             s                 20             20             20             2   00          20             2
                    re                       d        su T          T            T           T                                                   or
                                                                                                                                                   k
                 ca           en         an         PC           PC         PC            PC                                                   tw                      Mount Vernon Cancer
               ro          ns         gl         re
             u         C
                         o         En          hi          hi
                                                              re
                                                                       to
                                                                          n          ir e        Ne                                                                    Network 2002-06
           tE                                ds         ds          Lu            sh          er
      he
         s
                                        tfo
                                            r         r                        rd           nc
                                                   tfo                      fo           Ca
   ig                                er         er                       ed
 H                                 H          tH                       B           on
                                th        es                                    rn
                            N or       W                                     Ve
                          d                                              nt
                       an                                             ou
                    st                                             M
                 Ea

Source: NCIS 2010, Eurocare-4 study and LAEDI guidelines
Figure 6: Breast cancer one-year survival rate comparison in females of all ages
     The most recent survival rate for the PCTs and MVCN is below both the international
        benchmarks and the consensus target.
     Only Bedfordshire PCT has a rate similar to the consensus target.
     There is a disparity between rates both locally and nationally.
West Hertfordshire PCT has the lowest current rate however the over lapping confidence
intervals of the local data do not allow us to state that the difference in the survival
experience between PCTs and MVCN is statistically significant.




                                                                                                                                                                                                      7
2.3 Incidence

                                                                                                  Breast cancer
                                                                                         Incidence rates, females under 75
                                          180
  Incidence rate per 100,000 population




                                          160


                                          140


                                          120


                                          100


                                          80


                                          60
                                                85

                                                      86

                                                            87

                                                                  88

                                                                        89

                                                                              90

                                                                                    91

                                                                                          92

                                                                                                93

                                                                                                       94

                                                                                                             95

                                                                                                                   96

                                                                                                                         97

                                                                                                                               98

                                                                                                                                     99

                                                                                                                                           00

                                                                                                                                                 01

                                                                                                                                                       02

                                                                                                                                                             03

                                                                                                                                                                   04

                                                                                                                                                                         05

                                                                                                                                                                               06
                                            19

                                                     19

                                                           19

                                                                 19

                                                                       19

                                                                             19

                                                                                   19

                                                                                         19

                                                                                               19

                                                                                                     19

                                                                                                            19

                                                                                                                  19

                                                                                                                        19

                                                                                                                              19

                                                                                                                                    19

                                                                                                                                          20

                                                                                                                                                20

                                                                                                                                                      20

                                                                                                                                                            20

                                                                                                                                                                  20

                                                                                                                                                                        20

                                                                                                                                                                              20
                                                East and North Hertfordshire PCT                    West Hertfordshire PCT                            Luton PCT

                                                Bedfordshire PCT                                    Mount Vernon Cancer Network                       England

Source: NCIS 2010
Figure 7: Breast cancer incidence rates in females under 75 years of age
     The national trend shows slightly increased incidence over time.
     Due to considerable fluctuations it is unclear if there is a similar trend across the
       PCTs and MVCN.
     Currently MVCN has a rate of 100.92 per 100,000 (95%CI 92.95-108.89) which is
       below the national rate of 111.67 per 100,000(95%CI 110.38-112.96)
     Increase in incidence related to a number of factors. The introduction of the national
       screening program meant undiagnosed prevalent cancers were detected, which
       contributed to an increase in incidence.
     The use of HRT and an increased age at first parity is also thought to have
       contributed to the rise in incidence.




                                                                                                                                                                                    8
2.4 Screening Coverage

                                                                          Breast Screening Coverage (% )
                                                                         Females aged 50-70yrs, 2006-2008
                            100



                            90



                            80
               % Coverage




                                                                                                                                  2006
                            70                                                                                                    2007
                                                                                                                                  2008
                                                                                                                                  70% (National Target)
                            60



                            50



                            40

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                                                                                  PBC group


Source: NHAIS (Exeter) system
Figure 8: Breast screening coverage in females aged 50-70 years, by PBC
     Again there is no clear year on year trend in the PBCs.
     Most current data indicates six PBCs (South Locality, Stevenage, Luton Collaborative,
       Hertsmere, Red House and WatCom) have not met the national target in 2008.
     The remaining PBCs and MVCN have currently met the target although MVCN sees a
       slight reduction between 2007-08.
     Hertsmere, Red House and WatCom are of particular concern.
     It should be noted that Puckeridge Health Centre and Red House are stand alone
       GPs.



                                                                          Breast Screening Coverage (% )
                                                                         Females aged 50-70yrs, 2006-2008

              100


              95


              90


              85


              80
 % Coverage




                                                                                                                                  2006
                                                                                                                                  2007
              75
                                                                                                                                  2008
                                                                                                                                  70% (National Target)
              70


              65


              60


              55


              50
                             East and North     West Hertfordshire PCT     South Bedfordshire   Luton PCT   Mount Vernon Cancer
                            Hertfordshire PCT                                                                     Network


Source: NHAIS (Exeter) system
                                                                                                                                                          9
Figure 9: Breast screening coverage in females ages 50-70 years, by PCT
     There is no clear year on year trend across PCTs and MVCN.
     Most recent data for 2008 shows only West Hertfordshire PCT does not meet the
       70% national target.
     All other PCTs and MVCN either meet (Luton PCT) or exceed the national target.
     South Bedfordshire, West Hertfordshire PCT, Luton PCT and MVCN show a slight
       reduction in coverage between 2007-08.
     South Bedfordshire performs well exceeding the national target three years running.



3. Cervical Cancer
3.1 Summary
Only screening coverage data is investigated for cervical cancer. Both at PBC level and PCT
level there are fewer areas reaching the national target of 80% coverage than compared
with breast cancer screening. In particular looking at PCT level data only the region of South
Bedfordshire exceeds the target for three years running, all other PCTs and MVCN do not
meet the target in any of the years studied.

3.2 Screening Coverage

                                       Cervical Screening Coverage (%)
                                        Women aged 25-64yrs 2006-2008

                      100%

                      95%

                      90%

                      85%

                                                                          2006
  % Coverage




                      80%
                                                                          2007
                      75%
                                                                          2008
                      70%                                                 80% (National Target)

                      65%

                      60%

                      55%

                      50%
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                                              PBC group



Source: NHAIS (Exeter) system
Figure 10: Cervical screening coverage in females ages 25-64 years, by PBC
     MVCN has not met the target for the period 2006-08.
     The most current data for 2008 indicates eight PBCs (South Locality, Stevenage,
       Welwyn Hatfield Locality, Chiltern Phoenix Group, Luton Collaborative, Hertsmere,
       Red House and WatCom) do not meet the national target of 80% coverage.
     Luton Collaborative exhibits the lowest coverage over the three year period.
     It should be noted that Puckeridge Health Centre and Red House are stand alone
       GPs.



                                                                                                  10
                                                              Cervical Screening Coverage (% )
                                                              Females aged 25-64yrs, 2006-2008

              100%


              95%


              90%


              85%


              80%
 % Coverage




                                                                                                                        2006

              75%                                                                                                       2007
                                                                                                                        2008
                                                                                                                        80% (National Target)
              70%


              65%


              60%


              55%


              50%
                     West Hertfordshire  East and North     Luton PCT   South Bedfordshire    Mount Vernon    England
                           PCT          Hertfordshire PCT                                    Cancer Network


Source: NHAIS (Exeter) system and HSCIC
Figure 11: Cervical screening coverage in females ages 25-64 years, by PCT
     South Bedfordshire performs consistently and has exceeded the target for three
       years running.
     All the other PBCs and MVCN have not met the target for the period 2006-2008.
     England exhibits reduced coverage over the period 2007-08.



4. Colorectal Cancer
4.1 Summary
Despite an overall improvement in survival, MVCN and its constituent PCTs are continuously
below the national average for both one-year and five-year survival for colorectal cancer.
Whilst there is a very slight (<2 per 100,000 population) increase in incidence nationally
there is no appreciable trend at local level and incidence rates appear to remain static
despite fluctuations. Luton PCT displays the greatest variation in incidence.




                                                                                                                                                11
4.2 Survival
                                              Colorectal cancer
                                  One-year survival rates, all persons, all ages

                             80
                                                                                   East and North Hertfordshire
                                                                                   PCT
                             75
  Relative survival rate %




                                                                                   West Hertfordshire PCT
                             70
                                                                                   Luton PCT

                             65
                                                                                   Bedfordshire PCT

                             60
                                                                                   Mount Vernon Cancer Network

                             55
                                                                                   England

                             50
                               86 89
                               87 90
                               88 91
                               89 92
                               90 93
                               91 94
                               92 95
                               93 96
                               94 97
                               95 98
                               96 99
                               97 00
                               98 01
                               99 02
                               00 03
                               01 04
                               02 05
                                     6
                                   00
                             19 -19
                             19 -19
                             19 -19
                             19 -19
                             19 -19
                             19 -19
                             19 -19
                             19 -19
                             19 -19
                             19 -19
                             19 -19
                             19 -20
                             19 -20
                             19 -20
                             20 -20
                             20 -20
                             20 -20
                                 -2
                               85
                             19




                                             Year

Source: NCIS 2010
Figure 12: Colorectal cancer one-year survival rates in all persons of all ages
     There is an increase in survival over time however there is a trend for the local areas
       to be consistently below the national average.
     However this is some fluctuation particularly in Bedfordshire PCT and East and North
       Hertfordshire PCT.
     Most recent data shows Luton PCT has the lowest rate of 65.12% (95%CI 59.96-
       70.29).
     MVCN currently has a rate of 69.13% (95%CI 67.32-70.95) which is below that found
       nationally of 72.41% (95%CI 72.14-72.68) for the period 2002-2006.


Source: NCIS 2010
Figure 13: Colorectal cancer five-year survival rates in all persons of all ages
     There is an increase in survival rate over time however from 1994-1998 onwards
       there is a trend for the local PCTs to be continuously below the national average.
     This is evident in the most current data for 1998-2002 where MVCN experiences a
       rate of 47.31% (95%CI 44.93-49.69) which is lower than the rate of 52.05% (95%CI
       51.69-52.41) found nationally.




                                                                                                                  12
                                                                                                          Colorectal cancer
                                                                                              One-year survival rates, all persons, all ages
                                                                                 85                                                                                   Highest Eurocare 1995-99
                                                 Relative survival rate %        80
                                                                                                                                                                      Consensus target
                                                                                 75
                                                                                                                                                                      England 2002-06
                                                                                 70

                                                                                 65                                                                                   East and North Hertfordshire
                                                                                                                                                                      PCT 2002-06
                                                                                 60                                                                                   West Hertfordshire PCT 2002-06

                                                                                 55
                                                                                                                                                                      Luton PCT 2002-06
                               -9
                                   9          et           6          -0
                                                                         6
                                                                                 -0
                                                                                    6          6       6        -0
                                                                                                                  6
                                           rg           -0                                  -0      -0       02
                             95        ta           02             02 002                02 002
                         19 sus                  20 T 2
                                                                 0         2          20        2         20                                                          Bedfordshire PCT 2002-06
                       e                    nd PC                       T          T                   rk
                   car        se
                                 n
                                          a                         PC           C          CT two
                 ro        on          gl         re
                                                                               P          P
              Eu                    E n sh i                 hi
                                                                re        to
                                                                             n         re        Ne                                                                   Mount Vernon Cancer Network
                        C                                                           hi        er
            t                                d         rd
                                                           s           Lu rds                                                                                         2002-06
       he
          s
                                        tfo
                                            r                                              nc
                                                    tfo                       fo        Ca
  H
    ig                               er          er                        ed        n
                                   H          tH                        B
                                th                                                no
                             or           es                                   er
                            N         W                                      V
                         d                                                nt
                      an                                              ou
                   st                                               M
               Ea

Source: NCIS 2010, Eurocare-4 study and LAEDI guidelines
Figure 14: Colorectal cancer one-year survival rate comparison in all persons of all ages
     MVCN experiences a survival rate lower than both Bedfordshire PCT and East and
       North Hertfordshire PCT however the overlapping confidence intervals surrounding
       the local data are indicative of no real difference in the survival experience.
     Luton PCT has the lowest survival rate.
     All PCTs and MVCN experience rates greatly below those of the consensus target and
       the international benchmarks.


4.3 Incidence

                                                                                                                        Colorectal cancer
                                                                                                                Incidence rates, all persons under 75
                                            50
    Incidence rate per 100,000 population




                                            45


                                            40


                                            35


                                            30


                                            25


                                            20


                                            15
                                                 85

                                                                             86

                                                                                   87

                                                                                         88

                                                                                               89

                                                                                                     90

                                                                                                           91

                                                                                                                 92

                                                                                                                       93

                                                                                                                              94

                                                                                                                                    95

                                                                                                                                          96

                                                                                                                                                97

                                                                                                                                                      98

                                                                                                                                                            99

                                                                                                                                                                  00

                                                                                                                                                                        01

                                                                                                                                                                              02

                                                                                                                                                                                    03

                                                                                                                                                                                          04

                                                                                                                                                                                                05

                                                                                                                                                                                                      06
                                             19

                                                                            19

                                                                                  19

                                                                                        19

                                                                                              19

                                                                                                    19

                                                                                                          19

                                                                                                                19

                                                                                                                      19

                                                                                                                             19

                                                                                                                                   19

                                                                                                                                         19

                                                                                                                                               19

                                                                                                                                                     19

                                                                                                                                                           19

                                                                                                                                                                 20

                                                                                                                                                                       20

                                                                                                                                                                             20

                                                                                                                                                                                   20

                                                                                                                                                                                         20

                                                                                                                                                                                               20

                                                                                                                                                                                                     20




                                                 East and North Hertfordshire PCT                                          West Hertfordshire PCT                            Luton PCT

                                                 Bedfordshire PCT                                                          Mount Vernon Cancer Network                       England

Source: NCIS 2010
Figure 15: Colorectal cancer incidence rates in all persons under 75 years of age
                                                                                                                                                                                                           13
                               There is no appreciable change in incidence and a similar trend is seen in all PCTs.
                               Again considerable variation is seen in Luton PCT.
                               With reference to the most current data for 2006 MVCN exhibits a rate of 27.42 per
                                100,000 (95%CI 24.51-30.34) which is below that of England (31.35 per 100,000
                                (95%CI 30.88-31.83)).


5. Lung Cancer
5.1 Summary
Whilst there is some improvement in one-year survival exhibited by MVCN and its
constituent areas, the rates are consistently below the national average and in recent years
MVCN has experienced a plateau in its one-year survival rates. For five-year survival
although an improvement is shown nationally, MVCN shows no appreciable change in
survival over the time period studied. However a steady decrease in incidence is show both
nationally and locally and MVCN experiences an incidence rate which is continuously below
the national average.

5.2 Survival

                                                               Lung cancer
                                                One-year survival rates, all persons, all ages

                                30
                                28                                                         East and North Hertfordshire
                                                                                           PCT
 Relative survival rate %




                                26
                                                                                           West Hertfordshire PCT
                                24
                                22                                                         Luton PCT
                                20
                                                                                           Bedfordshire PCT
                                18
                                16                                                         Mount Vernon Cancer Network
                                14
                                12                                                         England
                                10
                            19 6 -1 9
                            19 7 -1 0
                            19 8 -1 1
                            19 9 -1 2
                            19 0 -1 3
                            19 1 -1 4
                            19 2 -1 5
                            19 3 -1 6
                            19 4 -1 7
                            19 5 -1 8
                            19 6 -2 9
                            19 7 -2 0
                            19 8 -2 1
                            20 9 -2 2
                            20 0 -2 3
                            20 1 -2 4
                                 -2 5
                                      6
                              8 98
                              8 99
                              8 99
                              8 99
                              9 99
                              9 99
                              9 99
                              9 99
                              9 99
                              9 99
                              9 99
                              9 00
                              9 00
                              9 00
                              0 00
                              0 00
                              02 00
                                   00
                            19 5 -1
                              8
                            19




                                                        Year

Source: NCIS 2010
Figure 16: Lung cancer one-year survival rates in all persons of all ages
     Overall improvement in survival experience by the PCTs and MVCN however the
       current rates are not equal to the national rate.
     Considerable fluctuations across all PCTs and MVCN, the cause of which is unknown.
     Luton PCT has lowest rate over the period 1995 - 2005.
     Bedfordshire PCT has the highest rate recently.
     In the period 2002-2006 MVCN had a rate of 22.94 % (95% CI 21.39-24.47) which is
       different to the national rate of 28.29% (95% CI 28.04-28.55).




                                                                                                                          14
                                                Lung cancer
                                 Five-year survival rates, all persons, all ages


                            10
                            9                                                      East and North Hertfordshire
                                                                                   PCT
 Relative survival rate %



                            8
                                                                                   West Hertfordshire PCT
                            7
                            6                                                      Luton PCT
                            5
                                                                                   Bedfordshire PCT
                            4
                            3                                                      Mount Vernon Cancer Network
                            2
                            1                                                      England

                            0
           9
           0
           1
           2
           3
           4
           5
           6
           7
           8
           9
           0
           1
           2
 19 198
 19 199
 19 199
 19 199
 19 199
 19 199
 19 199
 19 199
 19 199
 19 199
 19 199
 19 200
 19 200
        00
      -2
      -
      -
      -
      -
      -
      -
      -
      -
      -
      -
      -
      -
      -
   85
   86
   87
   88
   89
   90
   91
   92
   93
   94
   95
   96
   97
   98
 19




                                         Year
                                                                                                                  Source
: NCIS 2010
Figure 17: Lung cancer five-year survival rates in all persons of all ages
     There is no clear trend across the PCTs, although there is considerable fluctuation
        the rate is static. There is a slight improvement in the national rate of approximately
        1% over the 17 year period.
     Current survival rates for PCTs and MVCN are below the national rate.
     Bedfordshire PCT experience lowest survival rates historically, however now all PCTs
        and MVCN are experiencing similar rates.
     East and North Hertfordshire has a current (1998-2002) rate of 5.57% (95%CI 4.12-
        7.04) which is below to the national rate of 7.56% (95%CI 7.39-7.72). In addition
        MVCN also experiences a rate of 6.065 (95%CI 5.08-7.05) which is lower than the
        national rate.




                                                                                                                      15
                                                                                                                Lung cancer
                                                                                                 One-year survival rates, all persons, all ages

                                                                                 45                                                                                                                          Highest Eurocare 1995-99

                                                                                 40
                                                      Relative survival rate %                                                                                                                               Consensus target
                                                                                 35
                                                                                 30                                                                                                                          England 2002-06
                                                                                 25
                                                                                 20                                                                                                                          East and North Hertfordshire
                                                                                                                                                                                                             PCT 2002-06
                                                                                 15
                                                                                                                                                                                                             West Hertfordshire PCT 2002-06
                                                                                 10
                                                                                  5                                                                                                                          Luton PCT 2002-06
                                                                                  0
                                                                                            9               t                            6             6                                    06               Bedfordshire PCT 2002-06
                                                                                        9            rg
                                                                                                        e
                                                                                                                        -0
                                                                                                                           6          -0            -0            06          -0
                                                                                                                                                                                 6
                                                                                                                                                                                       2-
                                                                                     5-         ta                  2             2             2            2-           2
                                                                                  99                             00            00            00            00          00            00
                          1         us           2        T
                                                             2         2             2         2   rk
                                                                                                      2
                                                                                                                                                                                                             Mount Vernon Cancer Network
                     ar
                        e         ns         nd         C          C
                                                                     T
                                                                                C
                                                                                  T
                                                                                           CT two
                   c           se       gl
                                           a          P           P          P           P                                                                                                                   2002-06
                 ro         on                     re          re          n          re        Ne
              Eu          C          En          hi         hi          to          hi
            t                                 ds          s         L u           s          er
          s                                  r         rd                      rd         nc
       he                                tfo        tfo                     fo         Ca
  H
    ig                                er         er                      ed         n
                                    H          tH                     B
                                 th                                             no
                               or         es                                 er
                             N         W                                   V
                          d                                            nt
                       an                                           ou
                    st                                            M
                Ea

Source: NCIS 2010, Eurocare-4 study and LAEDI guidelines
Figure 18: Lung cancer one-year survival rate comparison in all persons of all ages
     Both England and local PCTs experience rates lower than the consensus target and
       the international benchmark.
     Again Bedfordshire PCT performs best out of the selected PCTs and West
       Hertfordshire has the lowest rate however the over lapping confidence intervals do
       not allow us to state that this difference is statistically significant or couldn’t have
       occurred by chance.
     However MVCN displays a rate of 22.93% (95%CI 21.39-24.47) which is different to
       that of England which is 28.29% (95%CI 28.04-28.55).


5.3 Incidence
                                                                                                                                              Lung cancer
                                                                                                                                  Incidence rates, all persons under 75
                                           90


                                           80
   Incidence rate per 100,000 population




                                           70


                                           60


                                           50


                                           40


                                           30


                                           20


                                           10


                                           0
                                                85

                                                          86

                                                                                  87

                                                                                        88

                                                                                                 89

                                                                                                                 90

                                                                                                                          91

                                                                                                                                 92

                                                                                                                                             93

                                                                                                                                                       94

                                                                                                                                                              95

                                                                                                                                                                        96

                                                                                                                                                                                 97

                                                                                                                                                                                       98

                                                                                                                                                                                                  99

                                                                                                                                                                                                        00

                                                                                                                                                                                                               01

                                                                                                                                                                                                                       02

                                                                                                                                                                                                                             03

                                                                                                                                                                                                                                   04

                                                                                                                                                                                                                                         05

                                                                                                                                                                                                                                               06
                                           19

                                                     19

                                                                                 19

                                                                                       19

                                                                                                19

                                                                                                                19

                                                                                                                        19

                                                                                                                                19

                                                                                                                                         19

                                                                                                                                                     19

                                                                                                                                                            19

                                                                                                                                                                       19

                                                                                                                                                                                19

                                                                                                                                                                                      19

                                                                                                                                                                                                 19

                                                                                                                                                                                                       20

                                                                                                                                                                                                             20

                                                                                                                                                                                                                    20

                                                                                                                                                                                                                            20

                                                                                                                                                                                                                                  20

                                                                                                                                                                                                                                        20

                                                                                                                                                                                                                                              20




                                                     East and North Hertfordshire PCT                                                         West Hertfordshire PCT                                         Luton PCT

                                                     Bedfordshire PCT                                                                         Mount Vernon Cancer Network                                    England



                                                                                                                                                                                                                                                    16
Source: NCIS 2010
Figure 19: Lung cancer incidence rates in all persons under 75 years of age
     A steady decrease in incidence is observed across all PCTs and nationally.
     The decreasing incidence observed for lung cancer is due to a decrease in smoking
       prevalence.
     Again large fluctuations are seen in Luton and Bedfordshire PCT and this needs to be
       investigated further.
     MVCN has consistently displayed a lower incidence than found nationally and this is
       evident for the most recent data whereby MVCN has a rate of 27.58 per 100,000
       (95%CI 24.64-30.52) and England has a rate of 33.61 per 100,000 (95%CI 33.11-34.1).


6. Prostate Cancer
6.1 Summary
There is a strong trend showing improvement in both one-year and five-year survival for
prostate cancer both locally and nationally. MVCN experiences rates which are close to, but
continuously below the national average. The data shows that the one-year survival rate for
prostate cancer in West Hertfordshire PCT seems particularly low. There has also been a
steady increase in incidence of prostate cancer, although from 2001 onwards there has
been considerable fluctuation seen locally. The most recent data shows MVCN has an
incidence rate below that of England.

6.2 Survival

                                                                                             Prostate cancer
                                                                                   One-year survival rates, males, all ages

                             100
                                                                                                                                                                East and North Hertfordshire
                              95                                                                                                                                PCT
                                                                                                                                                                West Hertfordshire PCT
  Relative survival rate %




                              90

                              85                                                                                                                                Luton PCT

                              80
                                                                                                                                                                Bedfordshire PCT
                              75

                              70                                                                                                                                Mount Vernon Cancer Network

                              65                                                                                                                                England
                              60
                                    89

                                           90
                                                  91

                                                         92

                                                                93
                                                                       94

                                                                              95
                                                                                     96

                                                                                            97
                                                                                                   98

                                                                                                          99
                                                                                                                 00

                                                                                                                        01

                                                                                                                               02
                                                                                                                                      03

                                                                                                                                             04
                                                                                                                                                    05

                                                                                                                                                           06
                                     9

                                            9
                                                   9

                                                          9

                                                                 9
                                                                        9

                                                                               9
                                                                                      9

                                                                                             9
                                                                                                    9

                                                                                                           9
                                                                                                                  0

                                                                                                                         0

                                                                                                                                0
                                                                                                                                       0

                                                                                                                                              0
                                                                                                                                                     0

                                                                                                                                                            0
                                  -1

                                         -1
                                                -1

                                                       -1

                                                              -1
                                                                     -1

                                                                            -1
                                                                                   -1

                                                                                          -1
                                                                                                 -1

                                                                                                        -1
                                                                                                               -2

                                                                                                                      -2

                                                                                                                             -2
                                                                                                                                    -2

                                                                                                                                           -2
                                                                                                                                                  -2

                                                                                                                                                         -2
                              85

                                     86
                                            87

                                                   88

                                                          89
                                                                 90

                                                                        91
                                                                               92

                                                                                      93
                                                                                             94

                                                                                                    95
                                                                                                           96

                                                                                                                  97

                                                                                                                         98
                                                                                                                                99

                                                                                                                                       00
                                                                                                                                              01

                                                                                                                                                     02
                             19

                                   19
                                          19

                                                 19

                                                        19
                                                               19

                                                                      19
                                                                             19

                                                                                    19
                                                                                           19

                                                                                                  19
                                                                                                         19

                                                                                                                19

                                                                                                                       19
                                                                                                                              19

                                                                                                                                     20
                                                                                                                                            20

                                                                                                                                                   20




                                                                                                  Year


Source: NCIS 2010
Figure 20: Prostate cancer one-year survival rates in males of all ages
     Strong positive trend denotes improvement in survival over time across all PCTs and
       MVCN. However West Hertfordshire falls away from the national average.
     Bedfordshire PCT and Luton PCT have lowest rates historically (1990-2003), however
       in recent years West Hertfordshire PCT has experienced the lowest rate of 82.53%
       (95% CI 79.87-85.19).
     For the most current (2002-2006) data MVCN exhibits a rate of 88.92% (95%CI
       87.49-90.35) which is below the national rate of 94.29% (95%CI 94.12-94.47).

                                                                                                                                                                                               17
                                                                                       Prostate cancer
                                                                            Five-year survival rates, males, all ages

                              90
                                                                                                                                                         East and North Hertfordshire
                              80                                                                                                                         PCT
  Relative survival rate %




                                                                                                                                                         West Hertfordshire PCT
                              70
                                                                                                                                                         Luton PCT
                              60
                                                                                                                                                         Bedfordshire PCT

                              50
                                                                                                                                                         Mount Vernon Cancer Network

                              40
                                                                                                                                                         England

                              30
                                    89

                                              90

                                                      91

                                                               92

                                                                       93

                                                                                94

                                                                                        95

                                                                                                 96

                                                                                                         97

                                                                                                                  98

                                                                                                                          99

                                                                                                                                   00

                                                                                                                                           01

                                                                                                                                                    02
                                     9

                                             9

                                                      9

                                                              9

                                                                       9

                                                                               9

                                                                                        9

                                                                                                9

                                                                                                         9

                                                                                                                 9

                                                                                                                          9

                                                                                                                                  0

                                                                                                                                           0

                                                                                                                                                   0
                                  -1

                                          -1

                                                   -1

                                                           -1

                                                                    -1

                                                                            -1

                                                                                     -1

                                                                                             -1

                                                                                                      -1

                                                                                                              -1

                                                                                                                       -1

                                                                                                                               -2

                                                                                                                                        -2

                                                                                                                                                -2
                              85

                                         86

                                                 87

                                                          88

                                                                  89

                                                                           90

                                                                                   91

                                                                                            92

                                                                                                    93

                                                                                                             94

                                                                                                                     95

                                                                                                                              96

                                                                                                                                      97

                                                                                                                                               98
                             19

                                    19

                                              19

                                                      19

                                                               19

                                                                       19

                                                                                19

                                                                                        19

                                                                                                 19

                                                                                                         19

                                                                                                                  19

                                                                                                                          19

                                                                                                                                   19

                                                                                                                                           19
                                                                                             Year


Source: NCIS 2010
Figure 21: Prostate cancer five-year survival rates in males of all ages
     Strong positive trend shows improvement in survival over time across all PCTs and
       MVCN.
     Luton PCT consistently exhibits the lowest survival rates with the current data
       suggesting there is a true difference between the survival experience of Luton PCT
       (61.69% (95%CI 53.03-70.36) 2002-2006) and England (78.96% (95%CI 78.55-79.37)
       2002-2006).
     Bedfordshire PCT also experiences rates lower than those of the other PCTs and
       MVCN.
     Currently East and North Hertfordshire PCT is performing well with a rate (80.445
       (95%CI 76.45-84.42)) above that found nationally (78.96% (95%CI 78.55-79.37)
       however the overlapping confidence intervals do not allow us to state that this
       difference is statistically significant or couldn’t have occurred by chance.




                                                                                                                                                                                        18
                                                                      Prostate cancer
                                                            One-year survival rates, males, all ages

                                    100
                                                                                                               Highest Eurocare 1995-99
               Relative survival rate %   95
                                                                                                               Consensus target
                                          90
                                                                                                               England 2002-06
                                          85

                                          80                                                                   East and North Hertfordshire
                                                                                                               PCT 2002-06
                                          75                                                                   West Hertfordshire PCT 2002-06

                                          70                                                                   Luton PCT 2002-06
                                                                 t            06                          06
                                                 -9
                                                      9
                                                            ge         06            06  -0
                                                                                            6        6
                                                                                                       2-
                                                          ar         2-     2-     2-             -0
                                       t       95    0          00         0          02        02 200         Bedfordshire PCT 2002-06
                         19 sus                  20          2          20         20         20 rk
                       e                                   T         T
                    ar          en         a nd        P C
                                                                  PC           C
                                                                                 T
                                                                                         CT two
                  c           s         gl                                  P          P
                ro         on                      ire         re        on         re         Ne              Mount Vernon Cancer Network
             Eu          C          En          sh          hi         ut         hi
           t                                  d           ds         L           s         er                  2002-06
      he
         s
                                         tfo
                                             r          r                     rd        nc
                                                     tfo                   fo        Ca
   ig                                 er          er                     ed
 H                                  H          tH                      B         on
                                 th        es                                 rn
                            N or       W                                   Ve
                        nd                                              nt
                     ta                                             ou
                   s                                               M
               Ea

Source: NCIS 2010, Eurocare-4 study and LAEDI guidelines
Figure 22: Prostate cancer one-year survival rate comparison in males of all ages
     Large disparities both within and between local and international rates.
     West Hertfordshire PCT displays the lowest rate of 82.53% (95%CI 79.87-85.18) and
       as can be seen from the graph this does not overlap with any of the other local data.
     Bedfordshire PCT has a rate which is in agreement with the consensus target and
       also approaching the international benchmark. It also has a statistically higher rate
       that most PCTs (excluding East and North Hertfordshire PCT) and MVCN.


6.3 Incidence




                                                                                                                                                19
                                                                                                Prostate cancer
                                                                                         Incidence rates, males under 75
                                          90

                                          80
  Incidence rate per 100,000 population


                                          70

                                          60

                                          50

                                          40

                                          30

                                          20

                                          10

                                          0
                                               85

                                                     86

                                                           87

                                                                 88

                                                                       89

                                                                             90

                                                                                   91

                                                                                         92

                                                                                               93

                                                                                                     94

                                                                                                           95

                                                                                                                 96

                                                                                                                       97

                                                                                                                             98

                                                                                                                                   99

                                                                                                                                         00

                                                                                                                                               01

                                                                                                                                                      02

                                                                                                                                                            03

                                                                                                                                                                  04

                                                                                                                                                                        05

                                                                                                                                                                              06
                                           19

                                                    19

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                                                                19

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                                                                                                                                  19

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                                                                                                                                                                             20
                                           East and North Hertfordshire PCT                    West Hertfordshire PCT                               Luton PCT

                                           Bedfordshire PCT                                    Mount Vernon Cancer Network                          England

Source: NCIS 2010
Figure 23: Prostate cancer incidence rates in males under 75 years of age
     A large increase in incidence is seen in all PCTs and also nationally however from
       2001 the local PCTs and MVCN are consistently below the national average.
     There is considerable variation, in particular in Luton, West Hertfordshire and East
       and North Hertfordshire PCTs.
     The increase in incidence is not reflected in an increase in mortality and is partly
       explained by increased efficiency in reporting of cases. In particular by incidental
       discovery during transurethral resection of the prostate (TURP) and more recently
       due to availability of prostate specific antigen (PSA) testing.
     For the most current data from 2006 MVCN has a rate of 59.92 per 100,00 (95%CI
       53.75-66.09) which is below the national rate of 71.55 per 100,00 (95%CI 70.53-
       72.57).




                                                                                                                                                                                   20
Annex A: Data sources and geographical description
Data for survival, incidence and mortality has been extracted from the NCIS database to
provide cancer network and PCT level data. The NCIS is a national web-based reporting tool
and utilises data held by the cancer registries of England. The data base uses the ICD-10
codes to classify the different types of cancer and therefore throughout the document the
following apply:
     All cancers refers to ICD-10 codes C00-C97 exc C44.
     Breast cancer refers to ICD-10 code C50.
     Cervical cancer refers to ICD-10 code C53.
     Colorectal cancer refers to ICD-10 codes C18-C20.
     Lung cancer refers to ICD-10 codes C33-C34.
     Prostate cancer refers to ICD-10 code C61.

Data for referral rates was taken from the Cancer Reform Strategy document and was
generated from the CCT.
Emergency admissions data was also taken from the Cancer Reform Strategy document and
was generated from HES data for 2008/09.
Screening coverage data was taken from the NHAIS (Exeter) system. For breast cancer the
local data is grouped into differing age bands from the national data available from HSCIC,
for this reason there is no comparison with England for the breast screening data.
Throughout this document four PCTs are referenced; East and North Hertfordshire, West
Hertfordshire, Luton and Bedfordshire. It should be noted that MVCN does not
geographically cover the whole of Bedfordshire, only South Bedfordshire and Luton.




                                                                                        21
Annex B: Glossary and Acronyms
2010 reduction target
    This is a national target for a reduction in death rates from cancer by 20% in people
       under 75 years of age. The reduction is measured from the 1995-1997 baseline.

Age Standardisation
    The rates from the population of interest are averaged using the age distribution of
       the specified standard European population as weights.

Average length of stay
    This is the average length of stay in hospital in days for emergency admissions for
      cancer patients.

Bed days per registration
    This is the average of the total number of bed days for emergency admissions for
      each cancer registration.


Cancer mortality rate
    An estimate of the proportion of the population that dies of cancer during a
       specified period.
    The numerator is the number of persons dying of cancer and the denominator is the
       resident population in the geographic area of interest.
    The rate is age standardised (European) and is expressed per 100,000 persons.
    Cancer specific mortality information is gathered from death certificates.

Cancer relative survival rate
    The survival rate is the proportion of patients surviving in a cohort of cancer patients
       over a specified time frame. The specified time frames within this document are
       one-year and five-year relative survival rates.
    The relative survival rate is a survival rate that has been adjusted for independent
       cause of death. The relative survival rate takes into account the mortality from all
       other causes which permits a better comparison of survival between populations
       with different life expectancies.
    The one-year survival rate describes the proportion of patients diagnosed with
       cancer that survive up to one year post diagnosis.
    The five-year survival rate describes the proportion of patients diagnosed with
       cancer that survive up to five years post diagnosis.




Confidence Interval
    This puts a range around an estimate that allows for uncertainty. The range is
       bounded by the upper and lower confidence limits.
    When confidence intervals of different estimates overlap this is indicative of there
       being no true difference between the observed values.


                                                                                          22
      Confidence intervals alone do not determine the likelihood of a statistical difference
       between values.
      The notation in the text for confidence intervals is 95%CI.
                Upper
           confidence limit




                Point                         Confidence
                estimate                       interval



                Lower
           confidence limit


Consensus target
    A figure derived from the 1995-1999 EUROCARE data for the purpose of the LAEDI
      guide to provide a target for survival rates in breast, colorectal, lung and prostate
      cancer.

Coverage
    This is a measure of how the services rendered cover the potential need for these
      services in the community.
    The screening coverage is the proportion of persons eligible for a screen in the
      registered population who have a screen test result recorded.

Death Certificate
    Records all diseases, morbid conditions or injuries that either resulted in or
      contributed to death.
    The underlying cause of death is recorded and coded to calculate cause-specific
      mortality.
    With reference to this document the underlying cause would denote the type of
      cancer the patient was suffering from at time of death.

Emergency admissions
   This is when admission is unpredictable and at short notice because of clinical need.
   Emergency admissions are expressed per cancer patient registration.




EUROCARE
    This is a study on the survival and care of cancer patients from the European Cancer
     Registry. The figures quoted in this document represent the highest survival figures
     for specific cancers in Europe. These figures are used as international benchmarks.


Incidence rate
     The rate at which new events, in this instance diagnoses of cancer, occur in the
       population within a set period of time.
     The rate is age standardised (European) and is expressed per 100,000 persons.
                                                                                          23
Quartiles
    The distribution of values is divided into four equal, ordered subgroups.
    Dividing the data into quartiles sorts the values.
    The lowest 25% of values are contained within the lower quartile.
    The highest 25% of values are contained within the upper quartile.

Referral rate
    This is the number of patients with a new referral to a specialist physician. It is
       expressed per 10,000 population.

Two Week Wait
   This is the two week maximum wait for assessment by a hospital consultant for
     patients referred urgently by their GP with suspected cancer.
   The notation in the text is 2WW.

Uptake
    The uptake of a screening programme is the proportion of women invited for
      screening for whom a test result is recorded.

Acronyms

PCT Primary Care Trust
GP General Practitioner
PCB Practice Based Commissioning
MVCN Mount Vernon Cancer Network
SHA Strategic Health Authority
NCIS National Cancer Information Service
CCT Cancer Commissioning Toolkit
HES Hospital Episode Statistics
TURP Transurethral resection of the prostate
PSA Prostate-specific antigen
HRT Hormone replacement therapy




                                                                                     24

				
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