Cancer



Cancer Prevention, Screening and Treatment

KEY MESSAGES

Mortality from cancer accounts for 19% of the male life expectancy gap and 13% of the female life expectancy gap between Lewisham and England.

There is a clear downward trend in premature mortality from cancer in Lewisham but the relative gap between Lewisham and England has increased from 9.35 in 1995-97 to 11.6% in 2006-08.

The largest number of deaths is from Lung cancer in Lewisham followed by Breast, Colon and Prostate cancer.

The estimated smoking prevalence in Lewisham is significantly higher than England. The estimated smoking prevalence in 2006 in Lewisham was 26.8% -seventh highest in London –compared with an England prevalence of 24.1%.

There is a need to understand the excess cancer mortality in both men and women aged 65+ in Lewisham compared to England.

There is a need to investigate why Lewisham is in the lowest quartile nationally for one-year survival for colon cancer.

There is a need to role out the learning from the Health Community Collaborative Cancer Project across Lewisham. There is a need to have a greater focus on raising awareness and early diagnosis across GP practices in Lewisham. This will require support and training in primary care.

There is a need to consider what are the most effective interventions to promote awareness of cancer symptoms and the benefits of screening to the diverse populations in Lewisham.

There is a need to negotiate and implement a Cancer screening specification in primary care to increase the uptake of cancer screening programmes.

There is a need to spread best practice in cervical screening across all practices in Lewisham to reduce variability in coverage.

Work with partners to maintain and “industrialise” i.e. increase in scale, primary prevention interventions in particular reducing smoking prevalence, the promotion of healthy eating and physical activity, promote sensible drinking and to sustain the skin campaign.

Work in partnership with South East Cancer Network (SELCN) to implement the Model of Care for London cancer services.

Cancer Prevention, Screening and Treatment

1. Introduction

There are more than 293,000 new cases of cancer (excluding non-melanoma skin cancer) diagnosed each year in the UK, and more than 1 in 3 people will develop some form of cancer during their lifetime. There are more than 200 different types of cancer, but four of them - breast, lung, large bowel (colorectal) and prostate - account for over half (54%) of all new cases. Breast cancer is the most common cancer in the UK even though it is rare in men.

The development of a cancer involves a series of complex and interwoven mechanisms relating to a persons genetic make up and their exposure to certain risks. Understanding what causes cancer is essential in order to prevent, detect and successfully treat the disease. An individual's risk of developing cancer depends on many factors, including age, lifestyle and genetic make-up.

Research suggests that up to half of all cancers in the UK could be avoided if people made changes to their lifestyle, such as stopping smoking, moderating alcohol intake, maintaining a healthy bodyweight and avoiding excessive sun exposure.

Cigarette smoking has been identified as the single most important cause of preventable death in the UK: overall, more than a quarter of all deaths from cancer (including almost 90% of lung cancer deaths)

It is estimated that, in the UK, current levels of overweight and obesity could lead to around 19,000 cases of cancer each year.

Research suggests that each of the following increase the risk of certain cancers: alcohol consumption, a low fiber diet, low consumption of fruit and vegetables, high consumption of red and processed meats and higher intake of salt or saturated fats.

Excessive exposure to UV radiation (from the sun or sun beds) is the most important modifiable risk factor for skin cancers.

A small number of infectious agents, especially certain viruses, play a key role in causing certain types of cancer.

It is estimated that inherited factors cause up to 10% of all cancers.

Factors such as the age at which a women has her first child and number of children, affect risk of the most common female cancers.

2. What do we know?

Facts and figures

Main Causes of Death

The three main causes of death in Lewisham in 2008-2009 were circulatory diseases (33%), cancers (26%) and respiratory diseases (15%). This is similar to the main causes of death nationally. The total number of deaths from cancer in Lewisham in 2008-09 was 469. Lung cancer is the main cause of cancer deaths in Lewisham.

Table 1: Deaths from cancer type 2008-09

|Cancer type |Lung |Breast |Colon |

|England |407.89 |351.18 |372.43 |

|London |387.47 |320.34 |347.23 |

|Lewisham |451.78 |333.48 |382.88 |

Source: NCHOD

Prevalence

Lewisham has a lower recorded prevalence of cancer on GP registers than that of England and London.

Table 3: Number of patients and percent of patients on GP cancer registers, England, London and Lewisham 2008/09

| |Denominator |Numerator |Per cent |

| |No of all registered patients |No of patients on cancer | |

| | |register excluding with | |

| | |non-melatonic cancers | |

|England |54,310,660 |680,749 |1.3% |

|London |8,462,684 |79,573 |0.9% |

|Lewisham |296, 735 |2,474 |0.8% |

Source. NHS Information Centre

Trends

Similar to England premature mortality from all cancers has improved in recent history in Lewisham, however the mortality rate remains higher in Lewisham than England.

Figure 1:

[pic]

Source: NCHOD

The premature mortality rate of cancer for men in Lewisham for the period, 2005-2007, was significantly higher than the London and England rates.

Table 4: Premature Mortality Rates of Cancer in Males - 2005-2007

|Local Authority |Number |Directly Age-Standardised Mortality |95% Confidence Interval |95% Confidence Interval |

| | |Rates per 100,000 population |(Lower Limit) |(Upper Limit) |

|Lewisham |402 |156.6 |141.2 |172.0 |

|London |11120 |126.3 |124.0 |128.7 |

|England |100350 |128.3 |127.5 |129.1 |

Source: NCHOD

The premature mortality rate of female cancer in Lewisham has generally been above the rate for England. However the most recent data 2005-2007 shows that this rate was not significantly different from that of England or London.

Table 5: Premature Mortality Rates of Cancer in Females - 2005-2007

|Local Authority |Number |Directly Age-Standardised Mortality |95% Confidence Interval |95% Confidence Interval |

| | |Rates per 100,000 population |(Lower Limit) |(Upper Limit) |

|Lewisham |330 |111.5 |99.4 |123.7 |

|London |9664 |99.4 |97.4 |101.4 |

|England |85670 |103.9 |103.2 |104.6 |

Source: NCHOD

Target

Cancer Mortality

The target for cancer mortality (ages under 75) is by 2010 to reduce mortality rates for England by at least 20% and the absolute gap in mortality rates between England and the Spearhead Group by at least 6%, from a 1995-97 baseline.

Performance

Premature Mortality

Three-year average mortality rates for cancer (ages under 75) for England have fallen for each period since the baseline, from 141.2 deaths per 100,000 population in 1995-97 to 114.0 deaths per 100,000 population in 2006-08, and are now 19.3% below the baseline rate. If the trend of the last ten years were to continue, the target would be met.

Three-year average mortality rates for cancer (ages under 75) for Lewisham have also fallen for each period since the baseline from 154.4 per 100,000 population to 127.2 per 100,000. The absolute gap in mortality rates between England and Lewisham is unchanged from baseline to 2006-08 and remains at 13.2 per 100,000.

Over the same period, the relative gap – i.e. percentage difference – in mortality rates between England and Lewisham has increased from 9.3% in 1995-97 to 11.6% in 2006-08).

However Lewisham’s premature mortality rates for cancer are lower than those of the Spearhead Group as a whole. In 2006-08 the relative gap for the Spearhead Group as a whole was 16.3% compared to the Lewisham gap of 11.6%.

One year survival rates

One-year survival rates are generally accepted as a good proxy for early/late diagnosis.

The National Cancer Intelligence Network has developed benchmarks of good performance on one-year survival rates for the four commonest cancers, based on the EUROCARE-4 findings for patients diagnosed in 1995–99. “Average” is based on the average one-year survival rate for Europe in 1995–99. “Good practice” is based on the average achieved across a whole country by the best performing countries in EUROCARE-4.

As can be seen from Table 6, the range of one-year survival performances observed for cancer networks in England in 1999–2001 fell below the consensus benchmark on all four major cancers (i.e. no single network achieved “good practice”). For colon and lung cancers, no single network achieved even the European average. This shows the major scope for improvement. Performance at individual PCT level is shown in Table 7.

Table 6: Consensus benchmarks for one-year survival rates for the four commonest cancers

| |EUROCARE-4 average1 |EUROCARE-4 “good practice”2 |English cancer networks (range)3|

|Breast |93.8 |97 |90.0-95.8 |

|Colon |74.2 |79 |63.0-72.2 |

|Lung |36.0 |37 |21.5-29.7 |

|Prostate |92.7 |96 |84.1-92.9 |

1 EUROCARE-4: age-adjusted one-year relative survival rates, adults diagnosed 1995–99.

2 “Good practice” is based on the highest one-year survival rates of countries with 100% cancer registration in EUROCARE-4, rounded down to the nearest whole number. For all four tumour types, Sweden was among the highest in Europe.

3 The cancer network range is based on patients diagnosed in 1991–2001 (from the National Centre for Health Outcomes Development).

Table 7: Lewisham PCT one year survival rates for Breast, Colon and Lung cancer

| |Lewisham PCT |

|Breast |94.3% |

|Colon |65.6%! |

|Lung |32.9%* |

! Indicates lowest quartile-England

*Indicates highest quartile- England

National Cancer Screening Programmes

Breast Screening

The NHS Breast Screening programme provides free breast screening every three years for all women aged 50 and over. The programme is extending the age range of women eligible for screening to ages 47-73 by 2012.

The indicator used in the breast screening programme is coverage. Coverage is defined as the proportion of eligible women that has had a test with a recorded result at least once in the previous 3 years. Currently coverage is best assessed using the 53-64 age groups as women may be invited for screening at any time between their 50th and 53rd birthdays. The national coverage target is 70%.

The national coverage rate has increased by nearly 3% (from 74.9% to 77%) between 2003-04 and 2008-09.

Coverage in Lewisham in 2008-09 was (65.7%), just above London (65.1%) but below the England (77%) average.

Coverage varies considerably by GP practice in Lewisham, in 2008-09 there were:

- 1 (2%) out of 49 practices had a coverage of 70%.

- 6 (12%) practices with coverage of between 65% and 69%.

The lowest coverage was one practice at 35%.

Cervical Cancer Screening

The NHS cervical screening programme is population-based programme and offers

screening to women between the ages of 25 to 64 years. All women aged 25-49

years are screened on a three yearly basis and women between the ages of 50 and

64 years are screened every five years.

The effectiveness of the cervical screening programme is judged by its coverage. Coverage is defined as the percentage of eligible women between the ages of 25 and 64 years who have had an adequate test result in the last five years.

The target for five-year coverage is 80% .The national coverage rate dropped from 80.6% to 78.6% between 2003-04 to 2008-09.

In Lewisham the coverage rates has dropped in the same period from 75.5% to 74.5% in 2008.09.

Coverage varies considerably by GP practice, in 2008-09 there were:

- 5 (10%) out of 49 practices achieved coverage of 80%.

- 19 (38%) practices with coverage of between 75% and 79%.

- One practice had the lowest coverage of 55%.

Bowel Cancer

The national bowel cancer screening programme was introduced in England in 2006. It offers screening every two years to all men and women aged 60-69. People over 70 can request a screening kit. The programme is to be extended to include people aged up to 75. In Lewisham it is expected the extension will start in 2010. The national target for bowel screening is 60% uptake. At a national level the uptake at end of December 2009 was 53%, for London 40.26%.

In Lewisham the programme was launched in January 2008. Since that time there have been nearly twenty thousand invites sent out, 7,820 kits return, resulting in an uptake of 39.24%.There have been sixteen bowel cancers detected in Lewisham patients since the inception of the programme.

South East London Cancer Network (SELCN)

The NHS Cancer Plan (2000) requires the SELCN to agree, implement and monitor local plans to improve the outcomes of cancer treatment, as evidenced by increasing compliance with NICE Improving Outcomes Guidance (IOG) and the associated national cancer standards. The section below summarises the SELCN progress to date and proposed action to implement the published guidance to improve outcomes in Haematological cancers (Oct 2003) and Palliative and Supportive Care (March 2004), Head and Neck cancers (Nov 2004), Children and Young People with Cancer (August 2005), skin including melanoma (Feb 2006), Sarcoma (March 2006) and Brain (June 2006).

Haematological Cancers

The NCAT has now indicated that the Network meets the IOG although this will need to be validated through peer review. Staffing ratios in all Trusts remains an issue to achieve peer review requirements.

Head & Neck Cancer

The Network has established the new community based support team, which became operational in September 2009.The Network is now fully compliant with this IOG.

Children and Young People with Cancer (C&YP)

Good Progress is being made with the implementation of the IOG.

Skin Cancer

Skin services have been peer reviewed and Trusts and the network are producing action plans to ensure compliance with the IOG and to meet peer review requirements.

Brain and Central Nervous System

The National Cancer Action have tasked each MDT to update MDT activity and workforce against the IOG for submission by the February 2010

Supportive and Palliative Care

A final Stock take is currently being undertaken for submission to NCAT by March 2010. The Cancer Action Team along with an SHA lead will be visiting networks in 2010 to offer further support.

The Network along with the majority of other networks will be red lighted on psychological care and rehabilitation where further work and investment is still needed.

3. What is this telling us?

Local Views

The South East London Cancer Network model for user partnership was established in 2005. A revised South East London Cancer Network (SELCN) user partnership strategy (2008-2012) has been developed building on the work of the previous strategy.

The overall aim of this strategy is to embed user partnership working and user involvement in policy development, service planning and service delivery of high quality, user centered cancer services in SELCN.

In addition to this overarching framework there is current active user involvement in many but not all of the tumour working groups, supportive care groups and generic working groups. Users are also involved in one-off projects, focus groups and in peer review.

NHS Lewisham has been recently recognized by the DH and NHS London for the work carried out through the Pacesetters programme, working with local women from Black and minority ethnic communities to promote attendance for breast screening.

The Healthy Communities Collaborative Cancer Project works with a team of lay volunteers to organise and facilitate cancer awareness workshops, presentations, festival or group meetings, which attract a diverse population in terms of age and ethnicity.

Interim results from a Cancer Awareness Survey carried out in a neighbouring borough in South East London with a similar population profile to Lewisham found that there was:

• Low knowledge of “persistent cough and hoarseness” and “sore that does not heal” as warning signs of cancer

• Knowledge of warning signs for cancer lower among non-white and economically inactive people

• Low knowledge of HPV, low intake of fruit and vegetables and low physical activity as risk factors for cancer

• Underestimation of personal risk of cancer

• Low knowledge of frequency of bowel cancer

• Low knowledge of frequency of lung cancer in women

• Low knowledge of existence of bowel screening programme

• Lower knowledge of existence of NHS screening programmes in people who are non-white, economically inactive and living in poorer areas. Also particularly low for the Black African subgroup.

National and Local Strategies

The Cancer Reform Strategy, published in 2007, builds on the progress made since the publication of Cancer Plan (2000) and strives to close the gap in cancer outcomes between the UK and the rest of Western Europe. The key aims are to:

• Prevent cancer by tackling the lifestyle factors that increase the risk of developing the disease.

• Diagnose cancer earlier by increasing coverage of cancer screening and increasing awareness of cancer symptoms.

• Ensure that patients have access to high quality cancer care.

• Support and empowering patients through their ‘cancer journey’

• Reduce inequalities in cancer incidence, mortality and access to care.

• Bring cancer care closer to home where appropriate.

Healthcare for London: A Framework for Action was published in July 2007. Led by Professor Lord Darzi it made a compelling case for change in health and healthcare services across London. To support the implementation of this policy in cancer services a “Case for Change” was published in March 2010 which provided a set of arguments for the need to improve cancer services in London. This has been followed by the publication of a Model of Care for London cancer services.

The South East London Cancer Network has developed its strategic vision covering all aspects of cancer services- prevention, screening, diagnosis, treatment (surgery, radiotherapy and systemic therapy) and supportive palliative care which has been published is Collaborative Commissioning Initiatives 2008-09 to 2010-013.

NHS Lewisham’s Commissioning Strategy Plan (2009-2015) “Improving Health and Well-being” has Reducing Premature Mortality from Cancer as one of its seven strategic goals.

Current Activity and Services

Primary Prevention

Prevention remains the best form of tackling cancer, reducing the human suffering caused by the disease and improving outcomes. There is also a strong economic case for investing more in prevention, therefore reducing the pressure on services in the long term. 

Reducing smoking prevalence

Smoking is the single largest preventable risk factor for cancer.

The key actions of the Lewisham Tobacco Control Plan are:

• Reducing availability to children - vending machines/ supply of tobacco to minors

• Reducing attractiveness of tobacco products - removal of display/ reducing promotion/ limiting exposure to tobacco use in media/ reducing promotion through tobacco accessories

• Taking action on illicit tobacco

• Counterfeit Tobacco Seizures

• NHS intervention- Stop Smoking services

• Smoking and Pregnancy.

Healthier nutrition /increasing physical activity

The evidence linking poor diet and obesity to cancer has become much stronger. In Lewisham there is a Promoting Health Weight for Lewisham Children, Young People and their Families Strategy and an action plan. The action plan includes the following:

• Promotion of Healthy Weight for all children, including measuring of children in R and year 6, linking with schools nurses, Maternity, Early years, schools (linking with Healthy Schools)

• Leisure Sports and Environment- including the promotion of free swimming, and the adoption of Change for Life to promote local activities and projects, the development of a Physical Activity Strategy and action plan in 2010.

• Lewisham Food Strategy, which includes improving food access through the development of Food Co-ops, food growing through Community gardens and allotments , Schools Food Policy and Schools meals

• Workforce training and communications

• Development of targeted and specialist weight management services for children and adults.

Alcohol

Excessive alcohol consumption is strongly linked to an increased risk of several cancers. Lewisham has published an Alcohol Strategy 2009-2012. The strategy aims to promote sensible drinking and to reduce the impact of alcohol misuse. Priorities for the coming year include the revision and development of the Council and PCT’s workplace alcohol polices, to run seasonal campaigns, to continue and develop the primary care based Directed and Local Enhanced Services and to develop an alcohol prevention pathway as part of the Health Checks programme.

Skin Campaign

The skin campaign was launched in April 2009 and ran until September 2009 across the six boroughs covered by the South East London Cancer Network. The campaign used innovative evidence-based social marketing techniques to produce measured behaviour change amongst residents, who are most at risk of skin cancer. Three ‘behavioural’ groups were targeted using a range of communication channels including a bespoke website, nightclub posters and on-the-ground engagement, supplemented with an education programme.

The budget for the research and campaign implementation was jointly funded by the South East London Cancer Network (SELCN) and six PCTs. The results showed that 22% of South East London residents had remembered seeing the campaign, and of those who had seen it 36% said they had taken action as a result, including checking their skin more often and using higher level sun protection.

Human Papilloma Virus (HPV) vaccination for cervical cancer

Vaccination now presents a further opportunity in cancer prevention, specifically for cervical cancer. The government has introduced a national vaccination programme for young girls against the human papillomavirus. This will protect against the strains of the virus which cause around seven out of ten cases of cervical cancer. In the academic year 2008-09 Lewisham achieved an uptake of 72.6%, lower than the national target of 80%.

Increasing awareness and earlier presentation

Healthy Communities Collaborative Cancer project

A two-year community-based cancer initiative was launched in Lewisham September 2008 and completed in September 2010  The Healthy Communities Collaborative aimed to raise awareness and promote the earlier presentation of cancer symptoms.  The project was focusing on three wards in Lewisham that have high deprivation with, high mortality and poor survival rates for cancer. These are Evelyn, New Cross and Bellingham and it included working with fourteen general practices in these wards. The focus was on breast, bowel and lung cancer. 

Earlier diagnosis - Increasing the coverage/uptake of cancer screening

A key objective for NHS Lewisham and partners in reducing health inequalities is to improve cervical, breast and bowel screening uptake. Central to this is the involvement of primary care to promote screening. A specification for cancer screening and primary care is being developed. Health Equity Audits are currently being carried out on the breast and cervical screening progrmammes to assess issues of access.

Cervical cancer screening

Uptake rates for cervical screening will be analyzed by practice and poor performing practices will be targeted with support and best practice shared.

Breast Screening

A breast screening action plan has been developed and submitted to the London Strategic Health Authority. Key actions to implement this include, validation of practice lists, supporting and involving primary care to promote breast cancer screening and awareness raising and health promotion activities to women in the community.

Bowel cancer

A health promotion specialist has been appointed in South East London by the Bowel Cancer Screening Programme to promote bowel cancer screening, to work closely with Primary Care Services and to develop strategies to increase the uptake rate. Southwark

PCT has developed a ‘bowel screening action pack’ to raise awareness of the

programme among GP practices which will be promoted in Lewisham. Training and health promotion sessions have been and will continue to be carried out for health and social care professionals and a wide range of community and voluntary groups in Lewisham.

An application for NAEDI funding for South East London sector to develop an integrated programme of awareness raising of bowel cancer symptoms and the screening programme was submitted at end of April 2010 and was successful. A campaign to raise awareness of bowel cancer signs and symptoms in the members of the community most at risk and in selected GPs practices is being planned for summer of 2011.

Secondary and tertiary care services

NHS Lewisham commissions for its patients access to a comprehensive range of diagnostic and treatment services for cancer, including tertiary care, primarily provided in the SELCN area.

SELCN Strategic Commissioning Priorities for 2009-2013

• Bring cancer mortality in line with National target of 20% reduction over 10 years.

• Increase levels of awareness of cancer and causes.

• Improve continuously towards meeting National Targets and increase coverage. Breast - 70% Minimum - 80% Target. Cervical - 80%. Reduce Delays in reporting cervical cancer to 2 weeks. Implement Bowel Cancer Screening programme including age extension.

• Undertake National Audit in Primary Care for all newly diagnosed patients with cancer.

• Implement National Chemotherapy and Radiotherapy Guidance to improve access to treatment.

• Reduce inpatient bed days for cancer patients and increase ambulatory care.

• Reconfigure services in South London Healthcare, UHL and AHSC to deliver safe services locally where possible and centralise where necessary.

• Establish clear arrangements for the commissioning and provision of NICE approved drugs.

• Transform the Cancer Network management into clearly focused support for commissioning.

.

What is this telling us?

What are the key inequalities?

There is now a range of evidence about the nature and extent of inequalities which occur in cancer, including:

• Cancer incidence and mortality are generally higher in deprived groups compared with affluent groups, older compared with younger people and men compared with women. Conversely, breast cancer has higher incidence in more affluent groups, but mortality is actually higher in less affluent women. The picture for ethnic minority groups varies according to cancer type and ethnic group. In general, incidence is lower amongst ethnic minority groups, although there are some important exceptions (incidence of prostate cancer is greater amongst Black African and Black African-Caribbean men, liver cancer in South Asians, and mouth cancer in Bangladeshis);

• Levels of public awareness of cancer signs and symptoms are generally low, but even lower in some groups, such as deprived communities, some BME groups and men. This may contribute to lower uptake of screening and later presentation when symptoms arise;

• Lifestyle factors (such as smoking, obesity, alcohol consumption and physical inactivity) almost certainly account for most of the variance in cancer incidence between the most and least deprived;

• Poorer experience of care is reported by black and minority ethnic groups, men with prostate cancer, and people living in London;

• Part of the variance in mortality rates can be attributed to delayed diagnosis amongst deprived groups, older people (at least for breast cancer) and certain BME groups (at least for breast cancer). The contribution of delayed diagnosis to poorer survival rates and higher mortality amongst men than women is still uncertain;

• Improvements in mortality have been slower in older people than in younger people. Older people with cancer receive less intensive treatment than younger people. In many cases this may be clinically appropriate. However, there is increasing evidence that under-treatment of older people may occur.

Cancer mortality is the third major contributor for both men and women to the gap in life expectancy between Lewisham and England. Circulatory disease followed by respiratory disease are the first and second contributors respectively. In 2006-08 cancer mortality accounted for 19% of the gap in male life expectancy in Lewisham compared to England and 13% of the gap in female life expectancy in Lewisham compared to England.

In Lewisham lung cancer deaths for both men and women is the major contributor to the “cancer” gap.

Table 8: Causes of death from cancer and their contribution to the gap in life expectancy between Lewisham and England 2006-08

| |Men |Women |

|Oesophageal cancer |4.4% |2.3% |

|Stomach cancer |2.2% |1.5% |

|Colorectal cancer |.. |0.5% |

|Lung cancer |8.3% |8.2% |

|Breast cancer |.. |.. |

|Other cancers |4.5% |.. |

Source:

Age-specific Death Rates from Cancer

The following tables and charts show age-specific death rates per 100,000 people for males and females separately, during the period 2005-7, for Lewisham, with comparative data for England, London overall, and the ONS London Cosmopolitan comparator group[1]. The charts use a logarithmic scale for ease of readability.

Figure 2: Age-specific death rates per 100,000, cancer, Males 2005-7

[pic]

Source: NCHOD

Figure 3: Age-specific death rates, cancer, Females 2005-7

[pic]

Source: LHO

The following observations can be made:

- Lewisham’s cancer death rate for pre-school age boys is around three times as high as the England and London rates. This may be a statistical “blip”, as absolute numbers (which are not included in the source data) are very small.

- Lewisham’s rates in school-age children are low for both sexes (again, absolute values will be low).

- Lewisham death rates from cancer in younger working-age people of both sexes are less than half the national rates.

- Lewisham’s cancer death rates in older working age people of both sexes are below national rates, and closely comparable to the other comparators.

- In males aged 65-74, Lewisham’s cancer death rates are 29% higher than England’s.

- In males aged over 75 and over, Lewisham’s death rate from cancer are 6% higher than the national rate.

- In females age 65-74, Lewisham’s death rate from cancer is 12% higher than England’s.

- In females aged 75 and over, Lewisham’s death rate from cancer is 3% higher than the national rate.

Deprivation

There are significant inequalities in cancer mortality within Lewisham. Bellingham and New Cross wards have the highest mortality rates for 2003-07. These wards are the second and fourth most deprived in the Borough respectively.

Figure 4: Standardised Mortality Ratios for Cancer, Lewisham Wards, Aged ................
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