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. Data will still be available at CCG level for some time after July 2022 so this page continues to refer to CCGs and Hull CCG, and continues to present data at the CCG geographical level. Six local CCGs were also combined to form the Humber, Coast and Vale geographical area, which has also ceased to exist. It has been replaced by the Humber and North Yorkshire ICS. However, data will still be available at Humber, Coast and Vale geographical level, and will be presented within our JSNA.

Headlines

• One in two people will develop some form of cancer during their lifetime.
• 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.
• In Hull, during the three year period 2017-19, there were 2,321 new cases of cancer which were diagnosed among men and 2,152 new cases of cancer diagnosed among women. Among men, prostate cancer accounted for the most new cancers diagnosed (552) followed by lung cancer (400) and colorectal cancer (267). Among women, new cases of breast cancer was the highest (574) followed by lung cancer (402) 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 stomach (74% higher than England), lung (71% higher than England), kidney (24% higher than England) and oesophagus (20% higher than England). For 2014-18, the rate of new cancers diagnosed was statistically significantly higher for nine of Hull’s 21 wards compared to England for all cancers, but 15 wards had a significantly higher new cancer rate compared to England for lung cancer.
• Over the last 16 years, cancer incidence rates have been increasing in Hull, and whilst new cases of lung and colorectal cancers have been decreasing among men in Hull, they have been increasing among women. Rates of breast cancer among women and rates of prostate cancer have also increased over the last 16 years. The same pattern in the change in incidence has occurred across England, although the increases for women have been greater than England (with the exception of breast cancer) and increases have been greater in Hull compared to England for prostate cancer.
• Over the three period 2017-19, there were 570 men and 418 women who died under the age of 75 years from cancer. Overall, 477 of these premature deaths from cancer were considered to be preventable. The mortality rates were considerably higher than England being around 30% higher in Hull but 50% higher for deaths considered to be preventable. This could be associated with the high incidence of lung cancer in Hull and its high mortality rate.
• Over the same three year period, there were 529 deaths from lung cancer (308 men and 284 women) for deaths for all ages. The mortality rate was 73% higher in men and 93% higher in women in Hull compared to England.
• Under 75 mortality rates from colorectal cancer are 26% higher among men in Hull compared to England, although only slightly higher for women (5%) with 85 deaths in total which occurred under the age of 75 years (55 men and 30 women). Under 75 mortality rates from breast cancer are slightly higher in Hull compared to England (20.6 versus 20.0 deaths per 100,000 women) with 63 deaths in total over the three years.
• Mortality rates are statistically significantly higher than England in the majority of Hull’s 21 wards for both mortality at all ages and under 75 years.
• One year cancer survival is available for cancers diagnosed between 2003-18 with one year follow-up. Survival rates have increased over the period from 62.8% to 70.7%. 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 from 27.4% for cancers diagnosed in 2003 to 43.7% for cancers diagnosed in 2018 although between 2003 and 2014 one year lung cancer survival was higher in Hull compared to England and for the last four years it has been slightly lower. One year survival from colorectal cancer has also improved from 69.9% in 2003 to 76.2% in 2018, but has been consistently lower than England over the entire 15 years. One year survival from breast cancer diagnosed in 2018 is high at 94.9% having increased from 93.3% since 2003, but the survival rate has been consistently lower than England and furthermore the increase in survival from breast cancer has been higher in England so the inequalities gap between Hull and England has increased.

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

Overall Across Hull

From the National Cancer Registration and Analysis Service, the table below gives the total number of new cancers diagnosed over the three year period 2017-19 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 2017-19, there were 4,473 new cases of cancer that were diagnosed giving an average of 1,491 new cases each year.

Lung, breast, prostate and colorectal cancers were the most common cancers in Hull in terms of absolute numbers of new cases diagnosed over the three year period.

Cancer site	ICD 10 code	Males	Females	Persons
Oesophagus	C15	70	40	110
Stomach	C16	74	35	109
Colorectal	C18-C20	267	221	488
Liver and intrahepatic bile ducts	C22	43	20	63
Pancreas	C25	55	51	106
Trachea, bronchus and lung	C33-C34	400	402	802
Malignant melanoma of skin	C43	72	54	126
Breast	C50		574
Cervix uteri	C53		39	39
Uterus	C54-C55		100	100
Ovary	C56-C57		72	72
Prostate	C61	552		552
Kidney, except renal pelvis	C64	95	56	151
Bladder	C67	90	35	125
Multiple myeloma and plasma cell neoplasms	C90	38	31	69
Leukaemia	C91-C95	68	44	112
All cancers	C00-C97 excl C44	2,321	2,152	4,473

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 rates are given as the number of new cancers diagnosed within the three year period 2017-19 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 62% higher than England for men, 79% higher for women and 71% higher for men and women combined. Rates are also substantially higher for stomach cancer (74% higher than England), kidney cancer (24% higher than England) and oesophagus cancer (20% higher than England) with rates also higher for colorectal and cervical cancers, multiple myeloma and malignant plasma cell neoplasms, and leukaemia. The only cancer sites where Hull had a lower rate (by 5% or more) than England were for malignant melanoma of the skin (Hull’s rate was 35% lower than England) and ovarian cancer (Hull’s rate was 10% lower than England).

Overall, the incidence of all cancers in Hull compared to England is 15% higher for both men and women.

Cancer site	ICD 10 code	Gender	Hull	England
Oesophagus	C15	Persons	17.7	14.8
Stomach	C16	Persons	17.6	10.1
Colorectal	C18-C20	Males	90.1	83.7
Colorectal	C18-C20	Females	65.3	56.5
Colorectal	C18-C20	Persons	77.2	69.0
Liver and intrahepatic bile ducts	C22	Persons	9.9	10.3
Pancreas	C25	Persons	17.0	17.3
Trachea, bronchus and lung	C33-C34	Males	139.8	86.5
Trachea, bronchus and lung	C33-C34	Females	121.5	67.7
Trachea, bronchus and lung	C33-C34	Persons	129.8	75.9
Malignant melanoma of skin	C43	Persons	18.2	27.9
Breast	C50	Females	165.7	170.2
Cervix uteri	C53	Females	10.4	9.7
Uterus	C54-C55	Females	29.8	29.4
Ovary	C56-C57	Females	20.7	23.1
Prostate	C61	Males	189.3	191.7
Kidney, except renal pelvis	C64	Persons	23.1	18.6
Bladder	C67	Persons	20.5	16.8
Multiple myeloma and plasma cell neoplasms	C90	Persons	11.1	10.0
Leukaemia	C91-C95	Persons	17.3	16.4
All cancers	C00-C97 excl C44	Males	784.5	682.9
All cancers	C00-C97 excl C44	Females	630.5	549.4
All cancers	C00-C97 excl C44	Persons	698.3	607.5

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 data presented below relates to the five year period 2014-18 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 for the period 2014-18 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 2014-18, 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. This occurs for Central, Ings, Longhill & Bilton Grange, Marfleet, North Carr, Orchard Park, St Andrew’s & Docklands, Sutton and West Carr for all cancers. Holderness is the only ward with a statistically significantly higher incidence rate compared to England for colorectal cancer. Most of the wards in Hull have significantly higher incidence rates for lung cancer with the exception of Avenue, Beverley & Newland, Boothferry, Bricknell, Holderness and Kingswood. The lower 95% confidence limit for both Central and Marfleet are very high suggesting that the incidence rate for lung cancer is at least twice as high as England. Incidence rates for breast cancer are statistically significantly lower then England in Ings, Orchard Park and Southcoates. The incidence rate for prostate cancer is statistically significantly lower than England in St Andrew’s & Docklands. The number of new cases of prostate cancer were low in Kingswood and University and the data is not presented.

Trends Over Time

All Cancers

Over the last 16 years, the incidence rate of all cancers has increased by 4.6% for men and by 16.6% for women. Some of the increase could be due to better detection.

Over the last 16 years, the cancer incidence among men has been consistently statistically significantly higher than that for women (the 95% confidence intervals are shown by the dotted lines in the chart). In 2001-03, the cancer incidence rate was 39% higher for men compared to women, but in 2017-19, the cancer incidence rate was 24% higher. Thus the gap between men and women in terms of cancer incidence has reduced over time.

In 2017-19, the standardised incidence rate for all cancers was 15% higher in Hull compared to England for both men and women. The increase in the cancer incidence rate in Hull has been mirrored across England too. The standardised incidence rate for all cancers has been statistically significantly higher in Hull compared to England for both men and women over the last 16 years with the only exception being for 2014-16 for women.

Lung Cancer

For lung cancer among Hull men, the incidence rate has fallen (by 17% over the 16 year period) although among women in Hull, lung cancer incidence rates have steadily increased with an overall increase of 32% over the 16 year period. From 2001-03 until 2015-17, the cancer incidence rate among Hull men was statistically significantly higher than the rate for Hull women, but in the last couple of years there has been no statistically significant difference between the incidence rates for lung cancer.

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 69% higher in Hull compared to England (61% higher for men and 80% higher for women). The rate of decrease over the last 16 years among men has been similar in Hull compared to England (-17% versus -16%), but the rate of increase among women in Hull has been slightly higher than in England (+32% versus +28%).

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 16 year period, there has been a reduction of 17% in the incidence rate for colorectal cancer for men. For women, between 2001-03 and 2016-18 the rate had increased by 1%, but as the rate increased substantially in 2017-19 to a high of 65 per 100,000 population this means that over the entire 16 year period to 2017-19 the increase for women has been 23%.

There has been no statistically significant difference in the incidence rate for colorectal cancer between Hull and England over the last 16 years with the exception of men for 2001-03 and 2002-04, although the difference in 2017-19 is verging on being statistically significantly higher for women.

The rate of decrease in the incidence rate among men has been much greater in Hull compared to England (-17% versus -2%) and among women the increase in the incidence rate in Hull to 2016-18 had been slightly lower than the increase across England (+1% versus +3%). However, with the large increase in the incidence rate for Hull women in 2017-19, over the entire 16 year period, the increase in Hull has been 23% compared to a increase of 5% for women in England.

Breast Cancer

The incidence rate for breast cancer among women has varied between 140 and 160 per 100,000 population over the last 16 years, but the rate in 2017-19 reached a new high of 166 per 100,000 population.

Between 2007-09 and 2010-12, there was no statistically significant difference in the age standardised incidence rate for breast cancer between Hull and England, but from 2011-13 onwards, the incidence has been statistically significantly higher in England compared to Hull, although the degree of significance has decreased in the last four years, because the incidence rate in England has remained relatively unchanged whilst the incidence rate in Hull has increased. The rate of increase over the last 16 years has been similar in Hull (+10%) as it has been for England (+12%). Despite the recent increase in the incidence in the last four years in Hull, the rate in 2017-19 is slightly lower in Hull than England (166 versus 170 per 100,000 population).

Prostate Cancer

Over the last 16 years, the incidence of prostate cancer has increased in Hull by 33%, and the incidence rate in 2017-19 is the highest it has been since 2001-03.

There is also currently no significant difference between the age standardised incidence rate for prostate cancer between Hull and England with the rate being virtually identical (189 versus 192 per 100,000 population respectively).

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 some of the indicators relating to the two week wait for Clinical Commissioning Groups (CCGs).

In 2020/21, Hull had a lower number of two week wait referrals per 100,000 population. The percentage of cancers diagnoses from the two week wait referrals was slightly higher than England, but percentage of cancers treated out of those two week wait referrals was lower.

As the number of two week wait referrals increased as the service become more established, the percentage of cancer diagnoses from those referrals decreased as the majority of those urgent referrals do not result in a cancer diagnosis. However, unsurprisingly the two-week wait referral rate decreased between 2019/20 and 2020/21 due to the COVID-19 pandemic.

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.

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

For 2020/21, the referral rate in Hull was 7% lower than England for breast cancer, 20% lower for lower gastrointestinal cancers, 12% lower for lung cancer and 5% 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 are similar for Hull and England. 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. As mentioned above, for 2017-19, the lung cancer incidence rate was over 70% higher in Hull compared to England. This means that the two week wait referrals for lung cancer in Hull should be much higher than it actually is. Indeed the referral rates for lung cancer in Hull are among the lowest across Humber, Coast and Vale.

The rate of two week wait referrals for breast and lower gastrointestinal cancers has been consistently lower than England over the last eight years, although for lower gastrointestinal cancers the increase in the number of referrals over time has not been as high as England so the inequalities gap has increased. Whilst the rate of referrals for skin cancer has been lower in Hull compared to England, the difference is not as marked as for breast or lower gastrointestinal cancers.

Whilst the rate of two week wait referrals for lung cancer in Hull was higher than England for the period 2012/13 to 2016/17, the rate in the last four years has been similar to England or lower for the latest year. Even at the peak of the difference when two week wait referral rates for lung cancer in Hull were 56% higher than England in 2014/15 and 49% higher than England in 2016/18, it is likely that the difference should have been even higher given Hull’s very high incidence rate of lung cancer compared to 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 2019, just over half of cancers were diagnosed at stages 1 or 2 in Hull (53.0%) which was slightly lower than England (55.1%).

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 over the last seven years but around 50% for the first six years increasing slightly to 53% for 2019.

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 Clinical Commissioning Groups (CCGs). For 2020/21, the rates of emergency admissions relating to cancer and the rate of cancers diagnosed through an emergency route in Hull are considerably higher than England, but the rate of cancers diagnosed through a non-emergency route in Hull are slightly lower than England.

The fact that a higher proportion of people in Hull are diagnosed with cancer through an emergency route means that fewer people are being diagnosed through primary care and non-emergency routes, 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 has since been a sharp fall to 481 per 100,000 population for 2020/21 and it is likely that the COVID-19 pandemic is influential in the change in the rate.

Whilst the rate of emergency presentations for cancer in Hull has decreased since 2009/10, the rate has remained relatively unchanged since 2015/16 including the most recent year 2020/21 which one might have anticipated to have been affected due to the COVID-19 pandemic.

The rate of non-emergency presentations for cancer had increased slightly since 2009/10 although the increase was slight and not a smooth trend, but the rate fell between 2019/20 and 2020/21 likely associated with the COVID-19 pandemic.

The number of inpatient or day-case colonoscopy, sigmoidoscopy and upper gastrointestinal endoscopy procedures per 100,000 GP registered population are all lower in Hull than England.

The rate of colonoscopy procedures had been consistently increasing in Hull, but fell for the most recent year 2020/21 due to the COVID-19 pandemic. The decrease between 2019/20 and 2020/21 represents a significant fall of 41%, and the number of colonoscopy procedures per 100,000 population in 2020/21 is the lowest it has been since 2009/10.

The rate of sigmoidoscopy produces had been increasing between 2009/10 and 2014/15 to a high of 824 procedures per 100,00 population but fell quite sharply to 427 in 2017/18. The rate since increased slightly to 482 per 100,000 population in 2019/20 before falling very sharply by 66% to 173 in 2019/20. Some of the changes could be in the way services are administered locally and the differences in the types of procedures undertaken, but latest sharp fall is likely associated with the COVID-19 pandemic.

The number of upper gastrointestinal endoscopy procedures per 100,000 population increased gradually in Hull between 2009/10 and 2019/20 by 5%, but fell sharply between 2019/20 and 2020/21 by 54% due to the COVID-19 pandemic.

Mortality

Overall Across Hull

Percentage of Deaths Due to Cancer

For 2020, the percentage of deaths with an underlying cause of cancer in Hull is similar to England for all ages, and among the lowest in Yorkshire and Humber for those aged under 65 years.

All Cancers

Fingertips gives the under 75 year mortality rate from cancer. For 2017-19, the age standardised mortality rate per 100,000 population (standardised to the European Standard Population) for Hull is 165.6 which is 28% higher than England (129.2) and highest across Yorkshire and Humber (6% higher than the second highest local authority of Rotherham).

For 2017-19, compared to England, under 75 mortality rates from cancer are 35% higher for men and 19% higher for women in Hull.

Fingertips also present the standardised mortality ratios for cancer both for deaths for all ages and deaths which occurred prior to the age of 75 years. In 2015-19, cancer mortality rates in Hull are 30% higher than England for all ages and 29% higher for those aged under 75 years.

Over the three year period 2017-19, there were 988 deaths from cancer among Hull residents that occurred under the age of 75 years (average 329 per year).