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									Calculating Lifetime Risk

Prepared by Cancer Research UK and the National Cancer Intelligence Network

Methods
Adjusted for Multiple Primary


Current Probability


Provided data sources
UK Population
UK All Cause Mortality




This workbook enables the calculation of the lifetime risk of cancer using two methods – the "Current Probability" and the adjuste
(AMP) method.

Population and all-cause mortality data for the UK (2008) has already been entered in the blue and green cells, respectively. This d
from the Office for National Statistics but could be replaced with data for alternative geographies/years if required. Note if you on
numbers, then use 100,000 for every cell of the populations.

Cancer specific incidence and mortality data should be entered into the empty purple and grey cells.

The lifetime risk of cancer is presented in two ways for each method. For both methods, the percentage risk is shown together wit
population.

Advice as to which method to use is provided in the summary of methods worksheet.




Last updated 26/07/2011




Life Time Risk Template. Prepared by Cancer Research UK/NCIN, 7th July 2011.
r Research UK and the National Cancer Intelligence Network


                     Sasieni PD, Shelton J, Ormiston-Smith N, Thomson CS, Silcocks PB. What is the lifetime risk of developing cancer?: The effect of adj
                     BJC 2011; doi:10.1038/bjc.2011.250

                     Goldberg ID, Levin ML, Gerhardt PR, Handy VH, Cashman RE (1956). The probability of developing cancer. J Natl Cancer Inst 17
                     Esteve J, Benhamou E and Raymond L (1994). Descriptive Epidemiology (IARC Scientific Publications No.128), Lyon, International A


                     Office for National Statistics. Mid Year Population Estimates. http://www.statistics.gov.uk/statbase/Product.asp?vlnk=15106
                     Office for National Statistics. Death registration by sex and single year of age 1961 to 2009. http://www.statistics.gov.uk/STATBAS




bles the calculation of the lifetime risk of cancer using two methods – the "Current Probability" and the adjusted for multiple primary


cause mortality data for the UK (2008) has already been entered in the blue and green cells, respectively. This data has been downloaded
 National Statistics but could be replaced with data for alternative geographies/years if required. Note if you only have rates and not
 100,000 for every cell of the populations.

dence and mortality data should be entered into the empty purple and grey cells.

cancer is presented in two ways for each method. For both methods, the percentage risk is shown together with an equivalent 1 in X


method to use is provided in the summary of methods worksheet.




                    Life Time Risk Template. Prepared by Cancer Research UK/NCIN, 7th July 2011.
eloping cancer?: The effect of adjusting for multiple primaries.


ng cancer. J Natl Cancer Inst 17: 155-173
ns No.128), Lyon, International Agency for Research on Cancer, pp67-68


e/Product.asp?vlnk=15106
/www.statistics.gov.uk/STATBASE/Product.asp?vlnk=14409




                     Life Time Risk Template. Prepared by Cancer Research UK/NCIN, 7th July 2011.
Prepared by Cancer Research UK and the National Cancer Intelligence Network

Lifetime risk of developing cancer – a summary

The lifetime risk of cancer is an estimation of the risk that a new born child has of developing cancer at some point during its life. It is based on
assumption that the current rates (at all ages) will remain constant during the life of the new born child.

Lifetime risk is a useful summary of risk in the population but it should be remembered that a large range of genetic and lifestyle factors affect

Various methods exist in order to estimate the lifetime risk of developing cancer. One of the first commonly used methods is known as “cumu
(incidence) and the population estimates for each age. 1 While simple to calculate, this method over-estimates the risk of developing cancer du
other causes at different ages before a cancer is diagnosed.

Due to the limitations of the “cumulative risk” method, a new calculation was proposed by Goldberg et al in 1956 2 and termed “Current Proba
the risk of developing cancer, and takes into account the likelihood of dying from other causes. In addition to population and cancer incidence
age-group. This method subsequently gives a more likely estimate of the lifetime risk of cancer. However, where cancer incidence data include
estimation of the lifetime risk of cancer. (For example, females treated for non-Hodgkin lymphoma at young ages are at higher risk of develop

A new method has recently been derived in 2011 by Sasieni et al, 5 which seeks to address the recording of subsequent primary tumours, eithe
incidence data. Most commonly available cancer incidence data includes subsequent primary tumours for the same individual. The Sasieni me
developing a new primary diagnosis of cancer is the same for an individual who has not had a previous diagnosis as it is for an individual who h
method to take this into account and therefore this method does not over-estimate the risk of developing cancer. When calculating lifetime ri
primary tumours are likely (e.g. bowel cancer) this avoids over estimating the lifetime risk of developing any cancer or the site-specific cancer,

For cancer sites, such as prostate, where the occurrence of subsequent primary tumours is uncommon, the "Current Probability" method shou

Some cancer registries are able to supply cancer incidence data excluding second and subsequent primary tumours that occur in the same indi




                         Data available



                         Only population and cancer incidence


                         Population, all cause death, cancer death, cancer
                         incidence (excluding multiple primary tumours)

                         Population, all cause death, cancer incidence
                         (including multiple primary tumours)

                         Population, all cause death, cancer death, cancer
                         incidence (including multiple primary tumours)



References:

1 Day NE (1987). Cumulative rates and cumulative risk. In: Muir C, Waterhouse J, Mack T, Powell J and Whelan S eds, Cancer In
Lyon, International Agency for Research on Cancer

2 Goldberg ID, Levin ML, Gerhardt PR, Handy VH, Cashman RE (1956). The probability of developing cancer. J Natl Cancer Inst 1

3 Esteve J, Benhamou E and Raymond L (1994). Descriptive Epidemiology (IARC Scientific Publications No.128), Lyon, Internatio
Life Time Risk Template. Prepared by Cancer Research UK/NCIN, 7th July 2011.
4 Ng AK, LaCasce A and Travis LB. Long-Term Complications of Lymphoma and Its Treatment. J Clin Oncol 2011;29:1885-1892
1 Day NE (1987). Cumulative rates and cumulative risk. In: Muir C, Waterhouse J, Mack T, Powell J and Whelan S eds, Cancer In
Lyon, International Agency for Research on Cancer

2 Goldberg ID, Levin ML, Gerhardt PR, Handy VH, Cashman RE (1956). The probability of developing cancer. J Natl Cancer Inst 1

3 Esteve J, Benhamou E and Raymond L (1994). Descriptive Epidemiology (IARC Scientific Publications No.128), Lyon, Internatio

4 Ng AK, LaCasce A and Travis LB. Long-Term Complications of Lymphoma and Its Treatment. J Clin Oncol 2011;29:1885-1892

5 Sasieni PD, Shelton J, Ormiston-Smith N, Thomson CS, Silcocks PB. What is the lifetime risk of developing cancer?: The effect

6 Storm HH, Jensen OM, Ewertz M et al (1985). Summary: multiple primary cancers in Denmark, 1943-80. National cancer institut




Last updated 29/09/2011




Life Time Risk Template. Prepared by Cancer Research UK/NCIN, 7th July 2011.
 r Intelligence Network




w born child has of developing cancer at some point during its life. It is based on current incidence and mortality rates and therefore is calculated under the
 ant during the life of the new born child.

 should be remembered that a large range of genetic and lifestyle factors affect the risk of cancer and the risk for every individual is different.

  eveloping cancer. One of the first commonly used methods is known as “cumulative risk”. This method only requires two sets of data; the number of cases of cancer
 simple to calculate, this method over-estimates the risk of developing cancer during one’s lifetime because it does not take into account that some people die from



 alculation was proposed by Goldberg et al in 1956 2 and termed “Current Probability” by Esteve et al in 1994.3 This method uses a life-table approach for calculating
 ood of dying from other causes. In addition to population and cancer incidence data, this method also requires deaths from all causes data to be available for each
 ate of the lifetime risk of cancer. However, where cancer incidence data includes multiple primary tumours in the same individual, this method still produces an over
 treated for non-Hodgkin lymphoma at young ages are at higher risk of developing breast cancer when they are older). 4

al, 5 which seeks to address the recording of subsequent primary tumours, either at the same cancer site or at different cancer sites, for an individual in cancer
a includes subsequent primary tumours for the same individual. The Sasieni method (adjusted for multiple primaries – AMP) works on the assumption that the risk o
n individual who has not had a previous diagnosis as it is for an individual who has had a previous diagnosis of cancer. 6 An adjustment is therefore made in the AMP
es not over-estimate the risk of developing cancer. When calculating lifetime risk for “all cancers” combined or for individual sites or groups where subsequent
estimating the lifetime risk of developing any cancer or the site-specific cancer, and so the AMP method should generally be used.

 sequent primary tumours is uncommon, the "Current Probability" method should be used.

  excluding second and subsequent primary tumours that occur in the same individual. Where this is possible, the “Current Probability” method should be used.




                       Cancer Sites                           Recommended method



                       Any                                    "Cumulative risk"



                       Any                                    "Current Probability"


                       Sites where multiple primary
                                                              "Current Probability"
                       tumours are not likely

                       All cancers combined, sites
                       where multiple primary tumours         "Adjusted for Multiple Primaries"
                       are likely




 : Muir C, Waterhouse J, Mack T, Powell J and Whelan S eds, Cancer Incidence in Five Continents, Volume V (IARC Scientific Publications No. 88).


man RE (1956). The probability of developing cancer. J Natl Cancer Inst 17: 155-173

 ive Epidemiology (IARC Scientific Publications No.128), Lyon, International Agency for Research on Cancer, pp67-68
                   Life Time Risk Template. Prepared by Cancer Research UK/NCIN, 7th July 2011.
ations of Lymphoma and Its Treatment. J Clin Oncol 2011;29:1885-1892
 : Muir C, Waterhouse J, Mack T, Powell J and Whelan S eds, Cancer Incidence in Five Continents, Volume V (IARC Scientific Publications No. 88).


man RE (1956). The probability of developing cancer. J Natl Cancer Inst 17: 155-173

 ive Epidemiology (IARC Scientific Publications No.128), Lyon, International Agency for Research on Cancer, pp67-68

ations of Lymphoma and Its Treatment. J Clin Oncol 2011;29:1885-1892

  Silcocks PB. What is the lifetime risk of developing cancer?: The effect of adjusting for multiple primaries. BJC 2011; doi:10.1038/bjc.2011.250

 : multiple primary cancers in Denmark, 1943-80. National cancer institute monograph 1985 Dec; 68:411-30




                     Life Time Risk Template. Prepared by Cancer Research UK/NCIN, 7th July 2011.
nd therefore is calculated under the


 ndividual is different.

o sets of data; the number of cases of cancer
ake into account that some people die from



 hod uses a life-table approach for calculating
rom all causes data to be available for each
individual, this method still produces an over-



cancer sites, for an individual in cancer
 MP) works on the assumption that the risk of
An adjustment is therefore made in the AMP
idual sites or groups where subsequent
y be used.




nt Probability” method should be used.




 (IARC Scientific Publications No. 88).




pp67-68
                           Life Time Risk Template. Prepared by Cancer Research UK/NCIN, 7th July 2011.
(IARC Scientific Publications No. 88).




pp67-68



C 2011; doi:10.1038/bjc.2011.250




                   Life Time Risk Template. Prepared by Cancer Research UK/NCIN, 7th July 2011.
    Data: UK 2008

Males

                               All cause    Cancer         Cancer           AMP         Current
                Populations     deaths      deaths       incidence         method      Probability
          0-4      1,895,013        2,442                                       0.0%          0.0%
          5-9      1,735,468          211                                       0.0%          0.0%
        10-14      1,871,517          218                                       0.0%          0.0%
        15-19      2,048,820          955                                       0.0%          0.0%
        20-24      2,167,566        1,487                                       0.0%          0.0%
        25-29      2,068,814        1,688                                       0.0%          0.0%
        30-34      1,917,267        2,030                                       0.0%          0.0%
        35-39      2,199,146        3,108                                       0.0%          0.0%
        40-44      2,333,639        4,411                                       0.0%          0.0%
        45-49      2,142,100        6,145                                       0.0%          0.0%
        50-54      1,883,713        8,275                                       0.0%          0.0%
        55-59      1,787,951       12,331                                       0.0%          0.0%
        60-64      1,780,145       19,075                                       0.0%          0.0%
        65-69      1,324,938       23,492                                       0.0%          0.0%
        70-74      1,123,694       31,953                                       0.0%          0.0%
        75-79        873,037       42,142                                       0.0%          0.0%
        80-84        579,392       48,225                                       0.0%          0.0%
          85+        421,612       68,557                                       0.0%          0.0%


                                                     Lifetime Risk (%)          0.0%          0.0%
                                                Lifetime Risk (1 in ...)   #DIV/0!       #DIV/0!



Persons

                               All cause    Cancer         Cancer           AMP         Current
                Populations     deaths      deaths       incidence         method      Probability
          0-4      3,699,978        4,360            0                0         0.0%          0.0%
          5-9      3,393,742          369            0                0         0.0%          0.0%
        10-14      3,656,972          379            0                0         0.0%          0.0%
        15-19      3,987,037        1,385            0                0         0.0%          0.0%
        20-24      4,233,304        2,031            0                0         0.0%          0.0%
        25-29      4,079,376        2,362            0                0         0.0%          0.0%
        30-34      3,827,800        3,023            0                0         0.0%          0.0%
        35-39      4,440,646        4,774            0                0         0.0%          0.0%
        40-44      4,708,311        7,191            0                0         0.0%          0.0%
        45-49      4,351,733       10,122            0                0         0.0%          0.0%
        50-54      3,810,682       13,978            0                0         0.0%          0.0%
        55-59      3,634,293       20,541            0                0         0.0%          0.0%
        60-64      3,641,318       31,925            0                0         0.0%          0.0%
        65-69      2,757,639       39,339            0                0         0.0%          0.0%
        70-74      2,399,379       55,602            0                0         0.0%          0.0%
        75-79      1,985,656       78,773            0                0         0.0%          0.0%
        80-84      1,454,994      101,053            0                0         0.0%          0.0%
85+   1,335,366   202,490        0                0         0.0%        0.0%


                                 Lifetime Risk (%)          0.0%        0.0%
                            Lifetime Risk (1 in ...)   #DIV/0!     #DIV/0!
Females

                         All cause    Cancer          Cancer           AMP         Current
          Populations     deaths      deaths        incidence         method      Probability
   0-4       1,804,965        1,918                                        0.0%          0.0%
   5-9       1,658,274          158                                        0.0%          0.0%
  10-14      1,785,455          161                                        0.0%          0.0%
  15-19      1,938,217          430                                        0.0%          0.0%
  20-24      2,065,738          544                                        0.0%          0.0%
  25-29      2,010,562          674                                        0.0%          0.0%
  30-34      1,910,533          993                                        0.0%          0.0%
  35-39      2,241,500        1,666                                        0.0%          0.0%
  40-44      2,374,672        2,780                                        0.0%          0.0%
  45-49      2,209,633        3,977                                        0.0%          0.0%
  50-54      1,926,969        5,703                                        0.0%          0.0%
  55-59      1,846,342        8,210                                        0.0%          0.0%
  60-64      1,861,173       12,850                                        0.0%          0.0%
  65-69      1,432,701       15,847                                        0.0%          0.0%
  70-74      1,275,685       23,649                                        0.0%          0.0%
  75-79      1,112,619       36,631                                        0.0%          0.0%
  80-84        875,602       52,828                                        0.0%          0.0%
   85+         913,754      133,933                                        0.0%          0.0%


                                                Lifetime Risk (%)          0.0%          0.0%
                                           Lifetime Risk (1 in ...)   #DIV/0!       #DIV/0!



Summary


                AMP Method            Current Probability
            Risk (%)      1 in ...    Risk (%)         1 in ...

Males             0.0%    #DIV/0!           0.0%      #DIV/0!

Females           0.0%    #DIV/0!           0.0%      #DIV/0!

Persons           0.0%    #DIV/0!           0.0%      #DIV/0!
          Data: UK 2008
Persons

                              All cause    Cancer         Cancer                    AMP
               Populations     deaths      deaths       incidence                  method
     0-4          3,699,978        4,360            0                0     100%         0.0%
     5-9          3,393,742          369            0                0    99.41%        0.0%
    10-14         3,656,972          379            0                0    99.36%        0.0%
    15-19         3,987,037        1,385            0                0    99.31%        0.0%
    20-24         4,233,304        2,031            0                0    99.13%        0.0%
    25-29         4,079,376        2,362            0                0    98.90%        0.0%
    30-34         3,827,800        3,023            0                0    98.61%        0.0%
    35-39         4,440,646        4,774            0                0    98.22%        0.0%
    40-44         4,708,311        7,191            0                0    97.70%        0.0%
    45-49         4,351,733       10,122            0                0    96.95%        0.0%
    50-54         3,810,682       13,978            0                0    95.83%        0.0%
    55-59         3,634,293       20,541            0                0    94.09%        0.0%
    60-64         3,641,318       31,925            0                0    91.47%        0.0%
    65-69         2,757,639       39,339            0                0    87.55%        0.0%
    70-74         2,399,379       55,602            0                0    81.52%        0.0%
    75-79         1,985,656       78,773            0                0    72.60%        0.0%
    80-84         1,454,994      101,053            0                0    59.54%        0.0%
     85+          1,335,366      202,490            0                0    42.07%        0.0%


                                                    Lifetime Risk (%)                   0.0%
                                               Lifetime Risk (1 in ...)            #DIV/0!
                                     Age
Probability   Number    Person     Specific        Current
 of Dying      Alive     Years      Rate          Probability
       0.6%    100.0%    498.5%          0.0%            0.0%
       0.1%     99.4%    496.9%          0.0%            0.0%
       0.1%     99.4%    496.7%          0.0%            0.0%
       0.2%     99.3%    496.1%          0.0%            0.0%
       0.2%     99.1%    495.1%          0.0%            0.0%
       0.3%     98.9%    493.8%          0.0%            0.0%
       0.4%     98.6%    492.1%          0.0%            0.0%
       0.5%     98.2%    489.8%          0.0%            0.0%
       0.8%     97.7%    486.6%          0.0%            0.0%
       1.2%     97.0%    482.0%          0.0%            0.0%
       1.8%     95.8%    474.8%          0.0%            0.0%
       2.8%     94.1%    463.9%          0.0%            0.0%
       4.3%     91.5%    447.5%          0.0%            0.0%
       6.9%     87.5%    422.6%          0.0%            0.0%
      11.0%     81.5%    385.3%          0.0%            0.0%
      18.0%     72.6%    330.2%          0.0%            0.0%
      29.6%     59.5%    253.4%          0.0%            0.0%
                41.9%    276.2%          0.0%            0.0%


                             Lifetime Risk (%)           0.0%
                         Lifetime Risk (1 in X)     #DIV/0!

								
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