Cancer

This topic area covers statistics and information relating to cancer in Hull including local strategic need and service provision. Further information relating to the national screening programmes to detect breast, cervical and colorectal cancer are given within Screening and the NHS Health Check under Prevention within Adults.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

In July 2022, Clinical Commissioning Groups (CCGs) ceased to exist and were replaced by the Integrated Care System. The sub Integrated Care Board areas which include Hull are within the Humber and North Yorkshire Integrated Care Board. In Fingertips, the sub-ICB area referenced by 03F relates to Hull (see Integrated Care Board for the codes relating to the other local sub-ICB areas). For some indicators on Fingertips and other data given elsewhere, data is still being presented at CCG level (and for Humber, Coast and Vale) and has not yet been updated for sub-ICBs. However, for Hull the geographical area for the CCG and the sub-ICB area (03F) are the same so the information can still be examined and compared to understand the health needs within Hull.

Headlines

• One in two people will develop some form of cancer during their lifetime.
• The high current and historical prevalence of smoking, and increased levels of poor diet, physical inactivity and obesity result in higher levels of cancer in Hull.
• People in Hull are more likely to present with their cancer in an emergency setting rather than through their GP or through an elective procedure, and a slightly higher percentage of cancers in Hull are diagnosed at a later stage at diagnosis compared to people throughout the rest of England which impacts on survival and mortality rates. Urgent referrals for cancer (two week wait) are lower in Hull compared to England particularly when considered in relation to the incidence rate of some cancers for Hull. A higher percentage of the two week wait referrals also result in a cancer diagnosis in Hull which may suggest delays in diagnosis.
• In Hull, during the three year period 2018-20, there were 2,261 new cases of cancer which were diagnosed among men and 2,133 new cases of cancer diagnosed among women. Among men, prostate cancer accounted for the most new cancers diagnosed (501) followed by lung cancer (411) and colorectal cancer (254). Among women, new cases of breast cancer was the highest (549) followed by lung cancer (372) and colorectal cancer (221). The incidence rate of new cases of cancer in Hull is significantly higher than England particularly so for cancers of the lung (70% higher than England), stomach (60% higher than England) and kidney (34% higher than England). Overall, the cancer incidence in Hull was 15% higher than England for 2018-20.
• North Carr, West Carr, Orchard Park, Ings, Longhill & Bilton Grange, Sutton, Marfleet, St Andrew’s & Docklands, Pickering and Central all have statistically significantly higher incidence rates compared to England, and 16 out of Hull’s 21 wards have statistically significantly higher incidence rates for lung cancer with North Carr, Orchard Park, Marfleet, St Andrew’s & Docklands and Central having more than twice the rate of new lung cancer cases compared to England. Only Holderness has a statistically significantly higher rate of new colorectal cancers, and only Marfleet has a statistically significantly higher rate of new prostate cancer cases compared to England.
• In Hull, over the last 18 years between 2001-03 and 2018-20, the rate of new cancers diagnosed has decreased by 1% among men and increased by 15% among women. Over the same period, new cases of lung cancer reduced by 16% for men but increased by 21% for women, and new cases of colorectal cancer have reduced by 21% for men but increased by 24% for women. The rate of new cases of breast cancer has increased slightly among women in Hull by 5%, and the number of new cases of prostate cancer diagnosed has increased by 5% among men over the 18 year period.
• In 2020, just under one-quarter of all deaths were due to cancer in Hull, although this was higher in previous years and it is likely that the percentage is lower in 2020 due to the higher percentage of deaths that were due to COVID-19.
• For deaths registered during the three year period 2020-22, the premature (under 75 years) mortality rates were 34% higher in Hull compared to England for both men and women with a total of 1,062 premature cancer deaths over the three year period (582 men and 480 women).
• Whilst premature mortality rates for cancer had been gradually reducing in Hull between 2001-03 and 2017-19, there were small increases between 2017-19 and 2019-21, likely associated with the pandemic, although no such increase was observed for either England or across the region. The rate for Hull decreased slightly in 2020-22.
• Mortality rates were statistically significantly higher than England in the majority of Hull’s 21 wards for both mortality at all ages and under 75 years. There was a very strong association with deprivation with under 75 year cancer mortality 1.7 times higher among people living in the most deprived areas compared to the least deprived areas of Hull (and two times higher for cancer deaths considered to be preventable).
• Whilst there is an inequalities gap in relation to premature cancer mortality between Hull and England, the inequalities gap for premature cancer from causes considered to be preventable is greater.
• In Hull for 2018-20, the highest proportion of cancer deaths were due to lung cancer for both men (28%) and women (27%) followed by breast cancer deaths for women (15%), prostate cancer deaths for men (13%) and colorectal cancer deaths for men (10%) and women (9%).
• Compared to England for 2018-20, mortality in Hull was particularly high for cancers of the lung (72% higher), stomach (66% higher), breast (29% higher) and oesophagus (22% higher).
• For 2020-22, compared to other local authorities within the region, the mortality rate for lung cancer was particularly high in Hull (22% higher than North East Lincolnshire that had the second highest mortality rate in the region).
• Whilst the mortality rate from both lung cancer and colorectal cancer has reduced among Hull men over the last two decades, the rate has remained relatively unchanged among Hull women. The under 75 mortality rate for breast cancer among women had reduced, although the all age rate had not. The mortality rate for prostate cancer among Hull men has decreased slightly since 2001-03, but only after increasing to its highest level of 62 per 100,000 in 2017-19.
• One year cancer survival is available for cancers diagnosed between 2004-19 with one year follow-up to the end of 2020. Survival rates have increased over the period from 64.4% to 74.6%. It is difficult to directly compare to survival rates for England as the incidence and survival rates differ by cancer site and the percentage of different cancers by site differs between Hull and England. Nevertheless for the specific cancers of lung cancer survival rates have improved in Hull increasing by 49% from 30.4% for cancers diagnosed in 2004 to 45.2% for cancers diagnosed in 2019, although survival is higher in England for cancers diagnosed in 2019 (47.2%) and the increase in survival over the entire period has been higher in England (increased by 70%). One year survival from colorectal cancer has also improved from 70.8% in 2004 to 77.3% in 2019, but has been consistently lower than England over the period with a 3.6 percentage point difference for 2019 (England 80.9%), although the improvement in Hull over the entire period has been higher than the increase for England (increases of 9% and 7% respectively). One year survival from breast cancer diagnosed in 2019 is high at 94.1% having increased by 0.6% from 93.5% since 2004. However, the rate of increase for England has been much higher having increased by 3.2% from 94.3% to 97.3%. Thus the inequalities gap in one year survival between Hull and England has increased in relation to lung and breast cancers as well as the index measure which includes most cancers.

The Population Affected – Why Is It Important?

All Cancers

Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably destroying healthy tissue including organs and can spread to other parts of the body (metastasis). There are over 200 different types of cancer, each with its own methods of diagnosis and treatment. One in two people will develop some form of cancer during their lifetime. In the UK, the four most common types of cancer are: lung cancer; breast cancer; prostate cancer; and bowel cancer. Treatment is often simpler and more likely to be effective when cancer is diagnosed at an early stage, so finding cancer early can make a real difference. There are two major components of early detection of cancer: education to promote early diagnosis and screening. With the ageing population, it is likely that the incidence and prevalence of cancer will increase.

Healthy eating, taking regular exercise, maintaining a healthy weight, and not smoking helps lower the risk of developing cancer. Changing lifestyle behaviours can have a dramatic effect.

Cancer Research UK have an infographic which illustrates the risk of cancer.

Screening programmes are in place for cancers of the breast, cervical and bowel (colorectal). Uptake rates for screening can be found in Screening and the NHS Health Check under Prevention within Adults.

Lung Cancer

The majority of lung cancer cases are preventable as it is estimated that 81% of all cases of lung cancer are directly attributable to smoking, and risk of developing lung cancer reduces over time once a smoker quits smoking.

Nationally, lung cancer has the fifth highest disability adjusted life years and thus has a substantial impact on the quality of people’s lives.

Prostate Cancer

The causes of prostate cancer are largely unknown. Prostate cancer can be slow to develop. So there are many men die with prostate cancer, not because of it. Despite this, there are still considerable numbers that do die from prostate cancer, and it is the most frequent cancer among men.

Breast Cancer

Whilst the causes of breast cancer are not fully understood, it is not possible to know if it can be prevented altogether. However, although not definitive, there are benefits for women who maintain a healthy weight, exercise regularly and who have a low intake of saturated fat and alcohol. Being overweight or obese, particularly after the menopause, causes more oestrogen to be produced which can increase the risk of breast cancer. Family history is also an important risk factor for breast cancer. Screening for breast cancer is the single biggest factor that allows for early diagnosis. Among women, breast cancer is the most frequently occurring cancer.

Colorectal Cancer

There is an increased risk of bowel cancer among those aged 60+ years, who eat a diet high in red or processed meats and low in fibre, who are overweight or obese, physical inactive or smokers, have a high alcohol intake, have a family history of bowel cancer, or have another medical conditions such as severe ulcerative colitis or Crohn’s disease.

The Hull Picture

Screening

Further information relating to the national screening programmes to detect breast, cervical and colorectal cancer are given within Screening and the NHS Health Check within Prevention under Adults.

Incidence

By Cancer Site

From the National Cancer Registration and Analysis Service, the table below gives the total number of new cancers diagnosed over the three year period 2018-20 for Hull Clinical Commissioning Group (CCG) by cancer site for men and women separately. The International Classification of Disease version 10 codes has been included for each cancer site for reference. Not all cancer sites are included (most have too smaller numbers to present including male cases of breast cancer) so the figures for each individual cancer site do not sum to the total.

Over the three year period 2018-20, there were 4,349 new cases of cancer excluding non-melanoma skin cancer (NMSC) that were diagnosed giving an average of 1,450 new diagnoses each year.

Lung, breast, prostate and colorectal cancers were the most commonly occurring cancers in Hull over the three year period.

Cancer site	ICD 10 code	Males	Females	Persons
Oesophagus	C15	63	39	102
Stomach	C16	66	32	98
Colorectal	C18-C20	254	221	475
Liver and intrahepatic bile ducts	C22	42	26	68
Pancreas	C25	62	52	114
Trachea, bronchus and lung	C33-C34	411	372	783
Breast	C50		549
Cervical	C53		39	39
Uterus	C54-C55		111	111
Ovary	C56-C57		76	76
Prostate	C61	501		501
Kidney, except renal pelvis	C64	93	64	157
Bladder	C67	81	37	118
Non-Hodgkin lymphoma	C82-C86	91	66	157
Multiple myeloma and plasma cell neoplasms	C90	35	26	61
Leukaemia	C91-C95	57	34	91
All cancers excluding NMSC	C00-C97 excl C44	2,261	2,133	4,349

The table below gives the standardised incidence rate so compares the number of new cases in Hull with England after adjusting for the age structure of Hull’s population. The incidence rates are given as the number of new cancers diagnosed within the three year period 2018-20 per 100,000 person-years. For most cancers, the numbers are relatively small so it is not possible to examine incidence for males and females separately.

The rates are substantially higher in Hull for lung cancer, being 71% higher than England for men and 69% higher for women. Rates are also substantially higher for stomach cancer (60% higher than England) and kidney cancer (34% higher than England). Incidence rates are also higher in Hull compared to England for cancers of the oesophagus, colon and rectum, liver and intrahepatic bile ducts, pancreas, cervical, uterus and bladder as well as non-Hodgkin’s lymphoma.

Compared to England, the age-standardised incidence rate was lower in Hull for cancers of the skin, breast, ovary and prostate as well as multiple myeloma and malignant plasma cell neoplasms, and leukaemia.

Overall, the incidence of all cancers in Hull compared to England is 15% higher for men and women combined (13% higher for men and 17% higher for women).

Cancer site	ICD 10 code	Gender	Hull	England
Oesophagus	C15	Persons	16.2	14.3
Stomach	C16	Persons	15.7	9.8
Colorectal	C18-C20	Males	85.5	81.6
Colorectal	C18-C20	Females	65.6	55.5
Colorectal	C18-C20	Persons	75.0	67.5
Liver and intrahepatic bile ducts	C22	Persons	10.6	10.3
Pancreas	C25	Persons	18.0	17.3
Trachea, bronchus and lung	C33-C34	Males	142.1	83.1
Trachea, bronchus and lung	C33-C34	Females	111.5	65.9
Trachea, bronchus and lung	C33-C34	Persons	125.5	73.4
Malignant melanoma of skin	C43	Persons	17.4	26.6
Breast	C50	Females	157.7	161.3
Cervical	C53	Females	10.5	9.3
Uterus	C54-C55	Females	32.7	28.8
Ovary	C56-C57	Females	21.5	22.6
Prostate	C61	Males	171.2	181.2
Kidney, except renal pelvis	C64	Persons	24.2	18.1
Bladder	C67	Persons	19.1	16.5
Non-Hodgkin lymphoma	C82-C86	Persons	24.1	21.1
Multiple myeloma and plasma cell neoplasms	C90	Persons	9.6	9.8
Leukaemia	C91-C95	Persons	14.0	15.2
All cancers	C00-C97 excl C44	Males	742.8	658.3
All cancers	C00-C97 excl C44	Females	622.5	531.0
All cancers	C00-C97 excl C44	Persons	674.9	586.6

Over the last 17 years between 2001-03 and 2017-19, the incidence rate of all cancers has increased by 5% for men and by 17% for women, although between 2017-19 and 2018-20 there has been a decrease in the incidence of 6% for men and 2% for women which might be associated with fewer new cases of cancers being detected between March and December 2020 because of the COVID-19 pandemic.

Overall, between 2001-03 and 2018-20, there has been a decrease in cancer incidence of 1% among men, but an increase of 15% among women.

In 2018-20, the standardised incidence rate for all cancers was 12% higher in Hull compared to England for men and 17% higher for women. For men, the cancer incidence rate in Hull has followed a reasonably similar pattern to that for England. For women, the incidence rate increased gradually in both Hull and England to the period 2011-13 to 2013-15, but the latest rate for 2018-20 is higher than 2011-13 for Hull whereas for England has decreased in the last five years.

Lung Cancer

For lung cancer among Hull men, the incidence rate has fallen by 16% over the last 18 years between 2001-03 and 2018-20.

Among Hull women, over the 17 years between 2001-03 and 2017-19, the lung cancer incidence rate increased by more than one-third (34%). However, the rate decreased by 9% in the latest year which could be associated with the COVID-19 pandemic and fewer new cancers being diagnosed. Therefore, over the entire 18 year period between 2001-3 and 2018-20, the lung cancer incidence rate had increased by more than one-fifth for Hull women (21%).

The lung cancer incidence rate was 83% higher among Hull men compared to Hull women in 2001-03, but the rate is only 27% higher in 2018-20.

The age standardised incidence rate per 100,000 population for lung cancer is statistically significantly higher than England with the rate being very much higher in Hull. The latest incidence rate is 71% higher in Hull compared to England (71% higher for men and 69% higher for women).

There is more variability in the lung cancer incidence rate in Hull, but there has been a reasonably similar rate of change with England for both men (-16% versus -20%) and women (+21% versus +24%).

Colorectal Cancer

For colorectal cancer, the age standardised incidence rates among Hull men have been consistently and statistically significantly higher than the rates among Hull women. Over the 18 year period, there has been a reduction of 21% in the incidence rate for colorectal cancer for men, but for women the incidence of colorectal cancer has increased by 24%.

In Hull, the rate of new cases of colorectal diagnosed among men within 2001-03 was more than double the rate in women, but for cancers diagnosed within 2018-20, the rate was only 30% higher among men compared to women.

There has been no statistically significant difference in the incidence rate for colorectal cancer between Hull and England over the last 18 years with the exception of men for 2001-03 and 2002-04.

The rate of decrease in the incidence rate has been much greater in Hull compared to England among men (-21% versus -3%) and among women the increase in the incidence rate in Hull has been much greater than England (+24% versus +2%).

Breast Cancer

The incidence rate for breast cancer among women has varied between 140 and 160 per 100,000 population over the last 18 years, but the rate in 2017-19 reached a new high of 166 per 100,000 population, although decreased to 158 per 100,000 population for 2018-20.

The incidence of breast cancer has generally been lower than England over the 18 year period. The latest rate for Hull for 2018-20 is similar to England (158 versus 161 per 100,000 population). The rate of change over the last 17 years has also been similar for Hull (+5%) and England (+4%).

Prostate Cancer

Over the last 17 years between 2001-03 and 2018-20, the incidence of prostate cancer has increased in Hull by 33%, although there was a fall of 10% in the last year, so the overall change over the entire period is 20%.

The incidence rate for prostate cancer has been reasonably similar in Hull to the rate in England over the entire 18 year period, and the rate in Hull is currently slightly lower than England (171 versus 181 per 100,000 population respectively).

Rates Across Hull’s Wards

Within the Office for Health Improvement & Disparities’ Local Health, the standardised incidence ratios are given for each electoral ward for all cancers, colorectal cancer, lung cancer, breast cancer and prostate cancer. The incidence ratio gives the rate of new cases of cancers that have been diagnosed within the time period for Hull compared to England. The data presented below relates to the five year period 2015-19 and the standardised incidence ratios are given together with 95% confidence intervals (which gives a range of values where the true value is likely to fall taking into account random variation). The standardised incidence ratios are standardised to England with the ratio for England being 100 for the period 2015-19. So that any ratio above 100 denotes that the ward has a higher incidence rate for the specific cancer compared to England for the period 2015-19, and a ratio below 100 denotes a lower incidence rate.

If the 95% confidence interval does not contain the value of 100, this means that the incidence rate for the ward is statistically significantly different from England after allowing for differences in the age structure between Hull and England.

All Cancers

The lower 95% confidence limit for Central, North Carr, Orchard Park, West Carr, Ings, Longhill & Bilton Grange, Sutton, Marfleet, St Andrew’s & Docklands and Pickering wards were all higher than 100 so the cancer incidence rate – after adjusting for the age distribution of the ward – was statistically significantly higher than England.

Marfleet and Central had the highest new rate of cancers diagnosed in 2015-19 in Hull which were more than 20% higher than the incidence rate in England.

Lung Cancer

The cancer incidence rate for lung cancer was statistically significantly higher than England after adjusting for the age structure of the local population for 16 of Hull’s 21 electoral wards. The 95% confidence interval contains the value of 100 for only Avenue, Beverley & Newland, Bricknell, Kingswood and Holderness wards.

The rate of new lung cancer cases was more than twice as high as England for Central, North Carr, Orchard Park, Marfleet and St Andrew’s & Docklands wards.

Colorectal Cancer

For the majority of wards in Hull, the number of new cases of colorectal cancer was not statistically significantly different than England with the only exception being Holderness ward, where the rate was 44% higher than England.

Breast Cancer

The rate of new cases of breast cancer was lower than England for the majority of wards in Hull with Ings and Southcoates wards also having statistically significantly lower incidence rates of breast cancer compared to England. None of Hull’s wards have a statistically significantly higher rate of new breast cancer cases compared to England.

Prostate Cancer

The incidence rate for prostate cancer was also lower than England for the majority of Hull’s wards and was statistically significantly lower for St Andrew’s & Docklands ward. In contrast, Marfleet ward had a statistically significantly higher rate of new prostate cancers compared to England. There were too few cases of new prostate cancer for Kingswood and University wards over the five year period 2015-19 so the standardised incidence ratio is not presented for these two wards.

Prevalence

The Office for Health Improvement & Disparities’ Fingertips gives the percentage of patients registered with Hull GPs who are have been diagnosed with cancer since the 1 April 2004. For 2023/24, 3.1% of Hull’s (03F) registered population had had a cancer diagnosis since 1 April 2004 which was considerably lower than the Humber and North Yorkshire Integrated Care Board average and England.

Whilst the incidence of cancer is much higher in Hull, survival rates are lower, so this would account for the discrepancy between incidence and prevalence in Hull.

The percentage of patients who have had a cancer diagnosis since April 2004 has gradually increased over time which is what would be expected given that the indicator measures cancer diagnoses since a specific point in time. The cumulative total of patients should increase, particularly for cancers with a high survival rate.

The rate of increase in the indicator for Hull has shown a similar pattern to that of England and the Humber and North Yorkshire Integrated Care Board, although the percentage has been consistently lower in Hull. The number of registered patients with a cancer diagnosis since the 1 April 2004 has almost doubled between 2012/13 from 5,081 (1.7%) to 9,895 (3.1%) in Hull.

From the local analysis of the national Quality and Outcomes Framework datasets, there was a statistically significant association between average age of the practice patients and the percentage of patients who have had a cancer diagnosis since 1 April 2004 across the 28 practices in Hull for 2022/23. If the practices were divided into five approximately equal sized groups based on average age of patients (with each fifth having approximately one-fifth of the total registered patients in Hull) then the prevalence increased from 1.6% for the practices serving the youngest practice patients to 4.0% for the practices serving the oldest practice patients. For every increase in the average age of the patients of 10 years, the percentage of patients who have had a cancer diagnosis since April 2004 increased by 2.3 percentage points. Further analysis of diagnosed disease by the average age of practice patients is within the file above and within Local Analysis of Quality and Outcomes Framework Data.

There was no statistically significant association between the percentage of patients who have had a cancer diagnosis since 1 April 2004 and the average deprivation score of registered patients (using the Index of Multiple Deprivation 2019) across the 28 practices.

Two week wait

The two week wait appointment system was introduced so that any patient with symptoms that might indicate cancer could be seen by a specialist as soon as possible. The Office for Health Improvement & Disparities’ Fingertips presents indicators relating to the two week wait for the sub Integrated Care Board areas which include Hull within the Humber and North Yorkshire Integrated Care Board. The sub-ICB area referenced by 03F relates to Hull (see Integrated Care Board for the codes relating to the other local sub-ICB areas).

In 2022/23, Hull had a lower number of two week wait referrals per 100,000 population compared to England (3,522 versus 4,619), although the percentage of cancers diagnosed from the two week wait referrals was higher than England (7.1% versus 6.0%). For 2022/23, the percentage of cancers treated out of those two week wait referrals was lower in Hull compared to England (47.8% versus 55.6%).

The number of two week wait referrals per 100,000 population has increased over time for Hull, England and across the region, with a similar pattern of increase between 2009/10 and 2022/23, although the rate of increase has been slightly lower in Hull.

The number of referrals per 100,000 population decreased between 2019/20 and 2020/21 due to the COVID-19 pandemic, although there was a greater increase between 2020/21 and 2021/22 likely due to a backlog of patients coming forward in 2020/21.

The majority of referrals do not result in a cancer diagnosis, and with the increasing number of referrals, the percentage resulting in a diagnosis of cancer has reduced over time.

If there were many more referrals for a geographical area compared to England, then it might be expected that the percentage resulting in a cancer diagnosis and subsequently requiring treatment could be lower. However, there are fewer referrals in Hull, and with a higher incidence rate of cancer this suggests that people are not visiting their GP when they have symptoms that may signify cancer and/or that GPs when they see such symptoms in their patients are not using the two week wait referral system. It is more common for people living in more deprived areas to delay visiting their GP, so it is perhaps not surprising that the rate of two week wait referrals is lower in Hull.

The percentage of new cases treated resulting from two week wait referral had been increasing in Hull as it has in England and the region, but the percentage has been more variable in Hull, and from 2016/17 onwards has been lower than England, with the percentage decreasing in the past two years.

Information is also available on Fingertips for the specific cancer sites of breast, lower gastrointestinal, lung and skin.

For 2022/23, the referral rate in Hull (03F) was similar to England for lung cancer, but lower for breast cancer and lower gastrointestinal cancers, and much lower for skin cancer.

It is possible that the incidence of these cancers differs between Hull and England, but it is also possible that the relatively low two week wait referral rate in Hull means that residents are not accessing cancer treatment as quickly as others do across other geographical areas. The rate of two week wait referrals for lung cancer is the only one similar to England for Hull. However, because residents in Hull have very high rates of smoking both historically and currently compared to England, the incidence of lung cancer is considerably higher. For 2018-20, the lung cancer incidence rate was 70% higher in Hull compared to England which perhaps means that the two week wait referrals for lung cancer in Hull should be much higher than it actually is.

The rate of two week wait referrals for breast has been consistently lower in Hull compared to England over the last decade, although the referral rate has been increasing in the last two years at a faster rate in Hull, and for the first time – since 2012/13 – the rate of two week wait referrals for breast cancer was similar to England for 2021/22, although has fallen for 2022/23 so the rate in Hull is again lower than England.

The rate of two week wait referrals for breast cancer does not appear to have been adversely affected by the COVID-19 pandemic.

The rate of two week wait referrals for lower gastrointestinal cancers has been consistently lower than England over the last eight years, although the rate in Hull has been following a similar pattern to England. The rate has increased between 2017/18 and 2019/20, but decreased in 2020/21 due to the COVID-19 pandemic. The rate increased between 2020/21 and 2022/23 to the same extent that it had done so just prior to the pandemic.

The rate of two week wait referrals for lung cancer has been consistently higher or similar in Hull compared to England over the last decade, although the rate of referrals has been decreasing in Hull since 2016/17. Furthermore, from 2017/18 onwards, the rate – in general – in Hull has been comparable to the rate in England.

The rate of two week wait referrals for lung cancer appears to have been significantly adversely affected by the COVID-19 pandemic with a sharp fall between 2019/20 and 2020/21, although there has been a sharp increase in 2021/22 so that the rate in 2021/22 was similar to the rate in 2019/20. The rate remained relatively unchanged between 2021/22 and 2022/23.

Given that current and historical patterns of smoking in Hull and the increased prevalence of lung cancer compared to England, it would appear that the two week wait is significantly lower than it should be if people were approaching or referred by their GP as readily as in England.

The rate of two week wait referrals for skin cancer in Hull has been consistently lower compared to England. Between 2012/13 and 2017/18, the rate in Hull was around 10-30% lower than England, but reduced to 5% lower (or less) for 2018/19 and 2019/20. The rate decreases for both Hull and England between 2019/20 due to the COVID-19 pandemic, with the same difference remaining (around 5%).

However, since the pandemic, the rate in England increased sharply in 2021/22 to a much higher level than that seen prior to the pandemic, and the rate further increased in 2022/23. In contrast, the rate in Hull increased by a much smaller margin with the rate in 2021/22 lower than the rate prior to the pandemic. Furthermore, there has been a relatively sharp decrease in the referral rate in Hull between 2021/22 and 2022/23, and as a result the referral rate in Hull is now half that of England.

Cancer Stage at Diagnosis

The Office for Health Improvement & Disparities’ Fingertips gives the percentage of cancers diagnosed at an early stage (stages 1 and 2). For 2021, for cancers where staging was possible and recorded, just under half of cancers were diagnosed at stages 1 or 2 in Hull (48.1%) which was lower than England (54.4%).

The percentage is given out of the total number of new cases whose stage is known (1, 2, 3 and 4) for the following cancer sites: invasive malignancies of lung, oesophagus, stomach, colorectal, pancreas, invasive melanomas of the skin, breast, cervix, uterus, ovary, prostate, testis, kidney, bladder, Hodgkin Lymphoma, thyroid, larynx, oropharynx, oral cavity and non-Hodgkin lymphoma.

The percentage in Hull has been quite variable between 2013 and 2017 at around 50%, although the percentage increased to 53% for 2019. The decrease for 2020 and 2021 could be associated with the COVID-19 pandemic, and reduced access or perceived access to primary and secondary care resulting in later diagnosis for a small percentage of patients.

NHS Digital also provide information on the percentage of cancers diagnosed at stage 1 and 2.

However, some cancers are more likely to be detected at an early stage, so the percentage of cancers diagnosed at a late stage can be depend on the distribution of the types of cancer. NHS Digital provides an estimate of the percentage of cancers diagnosed at an early stage adjusted for the differing case mix of patients with regard to diagnosis, socio-economic factors, and other variables.

NHS Digital include staging information on oropharynx, oral cavity, oesophagus, colorectal, pancreas, lung, melanoma of the skin, breast, uterus, ovary, prostate, testis, kidney, bladder, Hodgkin lymphoma and non-Hodgkin lymphoma.

For all years, the percentage of these cancers diagnosed at an early stage is lower in Hull compared to England. However, once the difference in the case-mix of the patients is taken into consideration, then the percentage of cancers diagnosed at an early stage is generally higher or comparable to England.

Hospital Activity

Fingertips gives the number of emergency admissions for cancer per 100,000 population as well as the number of people diagnosed with cancer via an emergency route per 100,000 GP practice population (“number of emergency presentations”) and diagnosed via a non-emergency route per 100,000 GP practice population (“number of other presentations”) for the sub Integrated Care Board areas which include Hull within the Humber and North Yorkshire Integrated Care Board. The sub-ICB area referenced by 03F relates to Hull (see Integrated Care Board for the codes relating to the other local sub-ICB areas).

For 2022/23, the rates of emergency admissions relating to cancer and the rates of cancers diagnosed through an emergency route and other (non-emergency) routes in Hull are higher than England. The number of emergency cancer admissions is 37% higher in Hull (688 versus 502 per 100,000 population) whereas the number of cancers diagnosed through an emergency route is 20% higher in Hull compared to England (110 versus 91 per 100,000 population). There are also more people being diagnosed with cancer through non-emergency routes in Hull compared to England.

The fact that a higher proportion of people in Hull are diagnosed with cancer through an emergency route likely means that fewer people are being diagnosed through primary care, which has an impact on stage of diagnosis and the commencement of treatment, with the potential to affect mortality and survival rates.

The rate of emergency admissions with cancer had been between 500 and 600 per 100,000 population between 2009/10 and 2017/18, but increased sharply to 691 and to 760 for 2018/19 and 2019/20 respectively. There was since been a sharp fall to 486 per 100,000 population for 2020/21 and it is likely that the COVID-19 pandemic is influential in the change in the rate. However, the rate has increased considerably between 2020/21 and 2021/22 with a smaller increase between 2021/22 and 2022/23. Whilst the latest rate in 2022/23 is lower than it was in 2019/20 prior to the pandemic, the rate in 2019/20 was particularly high.

The rate for England has been more constant increasing gradually from 529 to 559 cancer emergency admissions per 100,000 population between 2012/13 and 2019/20. The rate in England also fell in 2020/21 due to the pandemic and the subsequent rates for 2021/22 and 2022/23 are both lower than the rate in 2019/20.

Whilst the rate of emergency presentations for cancer in Hull has decreased between 2009/10 and 2015/16, the rate remained relatively unchanged between 2015/16 and 2020/21 (despite the pandemic). The rate increased sharply between 2020/21 and 2021/22 which is likely associated with a backlog (despite the relatively unchanged rate between 2019/20 and 2020/21), although the rate decreased sharply between 2021/22 and 2022/23. Despite the recent decrease, the rate for 2022/23 is higher than the five years prior to the pandemic.

Between 2014/15 and 2019/20, the rate of non-emergency presentations for cancer has been relatively static at around 320-340 presentations per 100,000 population. The rate fell to 287 per 100,000 population in 2020/21 likely associated with the pandemic. However, in the last two years the rate has increased sharply and the rate in Hull is the highest it has been at 441 cases of cancer diagnosed through non-emergency presentations per 100,000 population. Furthermore, for the first time since at least 2012/13, the rate in Hull is higher than England.

The number of inpatient or day-case colonoscopy, sigmoidoscopy and upper gastrointestinal endoscopy procedures per 100,000 GP registered population are given on Fingertips.

For 2022/23, the rate of colonoscopy procedures in Hull (03F) is higher than England (767 versus 746), but the rates of sigmoidoscopy (293 versus 324) and upper gastrointestinal endoscopy (1,064 versus 1,121) procedures are both lower in Hull.

The rate of colonoscopy procedures had been consistently and gradually increasing in Hull prior to the COVID-19 pandemic with a decrease in 2020/21 due to the pandemic, although has increased since then. A similar pattern in the rate of colonoscopies occurred for England and the region, although the rate across the region has been consistently higher than the rate in Hull.

The rate of sigmoidoscopy procedures had been increasing between 2009/10 and 2014/15 to a high of 824 procedures per 100,00 population but fell quite sharply over the next three years to 450 in 2017/18. The rate then increased slightly to 507 in 2019/20. The rate fell to one-third what is was in 2020/21 due to the pandemic with only a relatively small increase between 2020/21 and 2022/23. The latest rate in 2022/23 is 42% lower than it was prior to the pandemic in 2019/20.

Since 2016/17, the rate in Hull has followed a similar pattern of change to that of England and the region, although the rate in Hull has been consistently lower than England and the region over this time period.

The number of upper gastrointestinal endoscopy procedures per 100,000 population showed a similar pattern to that observed for sigmoidoscopy procedures with a gradual increase prior to the pandemic, a sharp decrease (of 54%) followed by an increase in the last two years. However, for the case of upper gastrointestinal endoscopy, the rate in 2022/23 is 8% lower than it was in 2019/20 compared to 42% lower for sigmoidoscopy.

The pattern of change for England and the region was reasonably similar to Hull, although the rate in Hull has been consistently lower than the region throughout the entire period 2012/13 to 2022/23 and consistently lower than England between 2015/16 and 2022/23.

Mortality

Percentage of Deaths Due to Cancer

For 2020, the percentage of deaths with an underlying cause of cancer in Hull is the same for England for all ages, but lower for most age groups with the exception of those aged 85+ years.

Overall, just under one-quarter (24.0%) of all deaths to Hull residents registered in 2020 were due to cancer.