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Friday, April 23, 1999 Published at 13:07 GMT 14:07 UK


Cancer more likely to kill poor

Thousands of poor people are dying from cancer because they do not have the same chances as the rich, says the first major study of cancer and socio-economic factors.

The Cancer Research Campaign (CRC) says more than 12,700 deaths could have been avoided in patients diagnosed between 1986 and 1990 if inequalities in cancer care did not exist in England and Wales.

The BBC's Susan Watts on the cancer divide
And there is no evidence the gap between rich and poor is narrowing.

Research suggests that the reasons may be that poorer patients go to the doctor when their cancer is more advanced, have worse overall health than the rich, worse access to treatment and are less likely to comply with treatment.

They also tend to get more aggressive forms of cancer, possibly because of poor diet and because they are more likely to smoke.

The report, by the Office for National Statistics, the CRC and the London School of Hygiene and Tropical Medicine, also shows that men have a worse survival rate than women for many cancers, including bowel cancer, leukaemia and non-Hodgkin lymphoma.

Eighty-two per cent of women with malignant melanoma diagnosed between 1986 and 1990 survived for five years, compared with 68% of men.

The CRC believes this is partly because women are likely to be more health conscious, but it says biological factors, such as hormones, may also be involved.

It also finds that there is only a minor difference in survival rates across the NHS regions for those diagnosed between 1986 and 1990.

Cancer rates around the world

Gordon McVie: "It's a difficult issue"
The report found that England and Wales had a worse survival rate for most cancers than the USA and Europe.

Women especially had worse rates than their European counterparts.

[ image: Professor Gordon McVie: report shows 'terrible injustices']
Professor Gordon McVie: report shows 'terrible injustices'
However, the most affluent people in England and Wales had similar survival rates to the European average.

Professor Gordon McVie, director general of the CRC, said: "This report highlights what appears to be a catalogue of terrible injustices - we cannot afford to rest until they are remedied."

Professor Michael Coleman is lead author of the report, entitled Cancer survival trends in England and Wales, 1971-1995: deprivation and NHS Region.

He said: "Because some of these cancers are so common, even small gaps in survival rates represent hundreds, even thousands of lives."

Professor Coleman: "We need to ensure that everybody has the ready access to the best treatment available"
The report looks at survival rates for 47 adult and 11 children's cancers.

It studied three million adults and 18,000 children in England and Wales who had been diagnosed with cancer between 1971 and 1990 and followed their progress until 1995.

It found that the disparity in survival rates between rich and poor was between 5% and 16% for 14 adults cancers, including breast, bowel and malignant melanoma.

The rich were 16% more likely than the poor to survive for five years after getting tongue cancer.

The more affluent also had a 5% higher chance of survival for seven other cancers, such as lung, prostate, ovarian and cervical cancer.

Access and attitudes to healthcare

The CRC says more than 2,800 breast cancer deaths, more than 2,300 bowel cancer deaths and more than 1,300 lung cancer deaths could be avoided if all people had equal chances of survival.

Children, on the other hand, have similar survival rates across the economic divide.

This could be because there has been new treatments are widely available.

European men had at least a 5% higher survival rate for 10 out of 38 cancers, including prostate cancer (14% higher), kidney (9% higher) and colon (8% higher).

In 19 other cancers, European men have a less than 5% higher chance of survival than English and Welsh men.

In only nine cases UK men have the same or a higher chance of survival than their European counterparts.

English and Welsh women had a poorer survival rate than men in comparison with Europe.

European women's five-year survival rate was at least 5% higher for 17 out of 29 cancers, including kidney cancer (14% higher) and breast cancer (5% higher).

The CRC says survival rates for many cancers is improving, thanks to new treatments and earlier diagnosis.

However, there has been little improvement for cancers such as lung and pancreatic cancer.

Professor Mike Richards of the Imperial Cancer Research Fund called for more research into the reasons for the survival gap, saying the fund is looking at treatment differences.

'NHS is to blame too'

Health Secretary Frank Dobson told BBC 2's Newsnight a factor in inequality was the generally worse health, and higher smoking rates, of poorer people.

"But the NHS is also failing," he.

He said the government was seeking to establish measures to monitor what was happening.

"But we are also putting a huge amount of extra effort into the most deprived areas so the most attention goes to the people who need it most."

He said health authorities not meeting cancer screening targets, often in deprived areas, had promised him they would act after he told them about a month ago "in a rather straight way they had to pull their socks up".

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