Cancer
Cancer is a leading public health challenge. Along with cardiovascular diseases it is the main cause of death in Bury and a main cause of the gap in life expectancy between Bury’s most and least deprived areas.
In all forms, it is a condition that is likely to affect one in two of us during our lifetime. The 4 most common types of cancer are breast, lung, prostate and bowel. Making some simple changes to our lifestyle can significantly reduce the risk of developing cancer. (Cancer - NHS (www.nhs.uk)
Incidence of common cancers:
Incidence of breast, lung, prostate and bowel cancers in Bury, based on data from 2015-2019, are presented in Figure 1 below as standardised incidence ratio (SIR). The SIR is an indirectly standardised ratio per 100, which adjusts for differences in age, sex, and year to allow fair comparisons between local areas and the national average. An SIR of 100 represents the expected number of new cancer cases based on England’s rates. Values above 100 indicate a higher-than-expected incidence, while values below 100 suggest a lower-than-expected incidence. This measure helps identify areas with potentially elevated cancer risks and informs local public health planning.
In Bury, the incidence of lung cancer was significantly higher than expected, with an SIR of 122.8, indicating 22.8% more cases than the national average. Colorectal cancer also exceeded the national average with an SIR of 105.1. In contrast, breast cancer (SIR 94.9) and prostate cancer (SIR 94.2) were slightly below the national average. Overall, the combined SIR for all cancers in Bury was 104, suggesting a modestly higher incidence of cancer compared to England as a whole. It is important to note that this data covers the period from 2015 to 2019 and may not reflect more recent trends in cancer incidence (Figure 1).
Figure 1: Incidences of the most common cancers, standardised incidence ratio. Indirectly standardised ratio per 100 for 2015-19 (Fingertips, 2022).
Please note: This indicator is for Bury ICB and presents data for Bury registered population.
New cancer cases (Crude incidence rate)
This indicator gives the total number of new cases and incidence rate of malignant cancer (excluding non-melanoma skin cancer) in the practice population, as estimated from cancer registry data for the financial year. This is divided by the registered population (based on the practice list size) and multiplied by 100,000 to give the crude incidence rate. These diagnoses may result from an urgent suspected cancer referral, other GP referral or via other (non-GP) routes. Rates are likely to reflect the underlying risk of cancer among the population.
New cancer cases for 2022/23 (crude rate) per 100,000 population for Bury was 566 statistically similar to England average of 548 (Cancer Services Profile, 2023). Trend data for Bury suggests that the rate increased from 470 in 2020/21 to 566 in 2023/23. Rates for England increased from 456 in 2020/21 to 540 in 2021/22 and then stabilised with a slight rise to 548. The trend in Bury for the most recent data points has shown no significant change in Bury (Figure 2).
Figure 2: New cancer cases (crude incidence rate per 100,000) for Bury and England from the year 2020/21 to 2022/23 (Cancer Services Profile, 2024)
No data on inequities are available for this indicator.
Please note: This indicator is for Bury ICB and presents data for Bury registered population.
Cancer QOF Prevalence:
This indicator presents the percentage of patients with cancer, as recorded on practice disease registers (register of patients with a diagnosis of cancer excluding non-melanotic skin cancers from 1st April 2003). QOF register data provides valuable insight into the recorded prevalence of long-term conditions in general practice. However, there are important caveats to consider when interpreting this data. QOF registers reflect only those individuals who have been diagnosed and recorded by their GP practice, meaning the data may underestimate true prevalence, particularly for conditions that are underdiagnosed or where patients do not regularly engage with primary care. Additionally, QOF is designed primarily for performance monitoring and incentivisation, not epidemiological surveillance, so variations in coding practices, patient registration, and data completeness can affect comparability between areas. Finally, QOF data is practice-based, not residence-based, so figures may not align perfectly with local authority boundaries.
Cancer QOF prevalence in Bury for the year 2023/24 was 3.8%, statistically above England average of 3.6%. Trend data for Bury suggests that cancer prevalence steadily increased from 2.6% in 2017/18 to 3.8% in 2023/24. England also followed a similar trend with the prevalence increasing from 2.7% in 2017/18 to 3.6% in 2023/24 (Figure 3). Trend data for this indicator is not available.
Figure 3: Cancer QOF prevalence (%) in Bury and England from 2017/18 to 2023/24 (Cancer Services Profile, 2024)
No data on inequities are available for this indicator.
Please note: This indicator is for Bury ICB and presents data for Bury registered population.
Percentage of cancers diagnosed at stage 1 and 2:
Stage at diagnosis is a measure of how much a cancer has grown and spread, with advanced stages meaning the cancer is bigger or has spread to other parts of the body (metastasis) and consequentially patient outcomes are worse for later stages.
The data can be used to provide information to a wide range of patient and professional groups; plan services aimed at early detection and diagnosis of cancer and inform cancer research. Additionally, as there are often different treatment options at an advanced stage at diagnosis these data can inform understanding of cancer treatment services.
The percentage of cancers diagnosed at stages 1 and 2 for the year 2021 for Bury was 53.6%. This was statistically similar to England average of 54.4%. Trend data for Bury suggests that the proportions of cancers diagnosed at stages 1 and 2 in Bury increased from 51.3% in 2013 to a peak of 57.5% in 2016. The proportion remained fairly stable with slight fluctuations to 57.3% in 2019. This was followed by a decline to 53.6% in 2021. The trend in England stayed fairly stable from 54.8% in 2013 to 54.4% in 2021 (Figure 4). There has been no significant change in the trend for Bury based on the 5 most recent data points (Public Health Outcomes Framework, 2021).
Figure 4: Percentage (%) of cancers diagnosed at stage 1 and 2 in Bury and England from 2013-2021 (Public Health Outcomes Framework, 2021).
Bury ranks 9th in its group of 16 similar local authorities, with the highest proportion of cancers diagnosed at stages 1 and 2 in Rochdale (59.3%) and lowest in Calderdale (46.5%). No data on inequities are available for Bury. National data from 2021 presents data by ethnic groups and deprivation. Asian ethnic groups have the highest proportion of cancers diagnosed at stages 1 and 2 (56.4%) and white ethnic groups have the lowest proportion (54.2%). Data by deprivation suggests a deprivation gradient with lower proportion of cancers diagnosed at stages 1 and 2 with increasing levels of deprivation. The highest proportion of cancers diagnosed at stages 1 and 2 were in the least deprived decile (57.9%) and lowest in the most deprived decile (52.3%).
Cancer screening coverage
Cancer screening programmes can help to diagnose cancer or risk of cancer earlier and improve the likelihood of successful treatment. There are three national cancer screening programmes in England: cervical screening, breast screening and bowel screening (NHS England). Data on cancer screening coverage measures access and system performance i.e how well the programme is reaching the target population.
Please note: Indicators in this section are for Bury ICB and presents data for Bury registered population.
Breast screening coverage (%) - aged 53 to 70 years old:
Breast screening supports early detection of cancer and is estimated to save 1,400 lives in England each year. This indicator provides an opportunity to incentivise screening promotion and other local initiatives to increase coverage of breast screening. Improvements in coverage would mean more breast cancers are detected at earlier, more treatable stages.
This indicator presents 3-year screening coverage proportion calculated as the number of eligible women who have had a breast screening test result recorded in the past 36 months divided by the total number of eligible women, for those registered to the practice on last day of the review period.
Breast screening coverage in Bury for the period 2023/24 was 73.8% statistically above England average of 69.9%. This represents an improvement from the previous period (2022/23), when coverage in Bury was 68.8% and the national average was 69.9%. Trend (based on the five most recent data points) for this indicator is not available. No data on inequalities are present for Bury or England.
Cervical screening coverage (%):
Cervical screening supports detection of cell abnormalities that may become cancer and is estimated to save 4,500 lives in England each year. This indicator provides an opportunity to incentivise the promotion of age-appropriate cervical screening and other local initiatives to increase coverage of cervical screening. Improvements in coverage would mean more cervical cancer is prevented or detected at earlier, more treatable stages.
The NHS cervical screening programme in England is offered to women aged from 25 to 64 years of age. Routine screening is offered every three years up to 49 years of age and every five years from 50 to 64 years of age. Depending on the result of the screen, they may be recalled earlier than these routine intervals.
Coverage for 25-49 years old:
This indicator presents 3.5-year cervical screening coverage (%) calculated as the number of eligible women aged 25 to 49 who had an adequate cervical screening test recorded in the previous 42 months divided by the total number of eligible women aged 25 to 49, for those registered to the practice on last day of the review period.
According to the latest data from 2023/24, cervical cancer screening coverage among women aged 25-49 years in Bury stands at 69.1%, which is significantly above the England average of 67.5%. (Cancer Services Profile, 2024). Trend data in Bury suggests that the proportion screened in Bury has steadily decreased with slight fluctuations from 77.1% in 2009/10 to 69.1% in 2023/24 (Figure 5). Similar pattern has been observed in England, where the proportion declined from 73.8 in 2009/10 to 67.5% in 2023/24. Throughout this period, the proportion in Bury has remained higher (statistically significant) than England average. Trend (based on the five most recent data points) for this indicator is not available.
Figure 5: Cervical screening coverage (%) aged 25 to 49 years old for Bury and England from the year 2009/10 to 2023/24 (Cancer Services Profile, 2024)
No data on inequities are available for this indicator.
Coverage for 50-64 years old:
This indicator presents 5.5-year cervical screening coverage (%) calculated as the number of eligible women aged 50 to 64 who had an adequate cervical screening test recorded in the previous 66 months divided by the total number of eligible women aged 50 to 64, for those registered to the practice on the last day of the review period.
According to the latest data from 2023/24, cervical cancer screening coverage among women aged 50-64 years in Bury was 73.6%, below (statistically significant) the England average of 74.9%. (Cancer Services Profile, 2024). Trend data in Bury suggests that the proportion screened in Bury increased from 71.8% in 2009/10 to a peak of 80.8 in 2011/12. This was followed by a period of steady decline from 80.4% in 2012/13 to 69.1% in 2023/24 (Figure 5). Similar pattern has been observed in England, where the proportion increased from 78.7% in 2009/10 to 80% in 2011/12, this was followed by a period of steady decline to 74.9% in 2023/24 (Figure 6). Trend (based on the five most recent data points) for this indicator is not available.
Figure 6: Cervical screening coverage (%) aged 25 to 49 years old for Bury and England from the year 2009/10 to 2023/24 (Cancer Services Profile, 2024)
No data on inequalities are present for Bury or England.
Bowel cancer screening coverage (%) for 60 to 74 years old:
Bowel cancer survival is improving and has more than doubled in the last 40 years in the UK. If diagnosed early, more than 90% of bowel cancer cases can be treated successfully. Screening programmes test to see if people show any early signs of cancer. By detecting bowel cancer at an early stage, treatment has a better chance of working. As part of the NHS Bowel Cancer Screening Programme, men and women aged 60-74 are sent a home testing kit every two years. This indicator provides an opportunity to incentivise screening promotion and other local initiatives to increase coverage of bowel cancer screening. Improvements in coverage would mean more bowel cancers are detected at earlier, more treatable stages, and more polyps are detected and removed, reducing the risk of bowel cancer developing.
According to the latest data from 2023/24, bowel cancer screening coverage in Bury was 70.5%, below (statistically significant) the England average of 71.8% (Cancer Services Profile, 2024). Trend data for Bury suggests that the proportion screened in Bury increased from 52.5% in 2013/14 to 71.1% in 2022/23 before declining slightly to 70.5% in 2023/24. Similar pattern has been observed in England with the coverage increasing from 56% to 72% in 2022/23, before slightly declining to 71.8% in 2023/24 (Figure 7). Although the rate is increasing in Bury, it has remained significantly below the England rate for the last two time periods (Cancer Services Profile, 2024). Trend (based on the five most recent data points) for this indicator is not available.
Figure 7: Bowel cancer screening coverage (%) aged 60 to 74 years old for Bury and England from the year 2013/14 to 2023/24 (Cancer Services Profile, 2024)
No data on inequalities are present for Bury or England.
Urgent suspected cancer referral
Urgent suspected cancer referrals are a managed route to secondary care, for investigation of possible cancer symptoms, with the intention to efficiently investigate the symptoms and, when a cancer is diagnosed, ensure the patient's cancer treatment and care is well managed within the system. This indicator reports the total number of urgent suspected cancer referrals, for all suspected cancer types and whether or not cancer is subsequently diagnosed.
Please note: Below indicators are for Bury ICB and presents data for Bury registered population.
Urgent suspected cancer referrals (Indirectly age-gender standardised referral ratio):
The indirectly age-gender standardised rate provides an adjusted measure to account for age and gender differences in the rate of referrals. It provides information on whether there were more or fewer referrals than expected, based on national age-gender specific referral rates and the age-gender structure of the practice's registered population.
This indicator is calculated as the number of urgent suspected cancer referrals observed the registered population divided by the number expected based on the practice's age-gender specific population and the age-gender specific rates for England. A value of 100 means the number of referrals is exactly as expected; values above 100 indicate more referrals than expected, while values below 100 suggest fewer.
In the latest data for 2023/24, Bury recorded a rate of 112, which is significantly above the England average of 100 (Cancer Services Profile, 2024). This means Bury made 12% more urgent suspected cancer referrals than expected based on its population structure. The previous year, 2022/23, saw an even higher rate of 117, indicating a 17% increase above the national benchmark. In 2021/22, Bury’s rate was exactly 100, matching the national average (Figure 8). Trend (based on the five most recent data points) for this indicator is not available.
Figure 8: Urgent suspected cancer referrals (Indirectly age-gender standardised referral ratio) in Bury from the year 2021/22 to 2023/24 (Cancer Services Profile, 2024)
No data on inequalities are present for Bury or England.
Urgent suspected cancer referrals (Indirectly age-gender standardised referral ratio) - Five years combined data:
This indicator combines five years of data and is presented as a complement to above, which uses one year of data. It is provided for comparison, which can be based on small numbers when using only one year of data and, as such, can exhibit higher variation due to random chance.
Urgent suspected cancer referrals (Indirectly age-gender standardised referral ratio) for 5 years combined data (2019/20 – 2023/24) was 110.6 for Bury. This means that Bury made 10.6% more urgent suspected cancer referrals than expected, based on its population structure and national referral pattern (Cancer Services Profile, 2024). Over the three overlapping five-year periods, Bury consistently recorded higher-than-expected rates of urgent suspected cancer referrals compared to the national average. From 2017/18 to 2021/22, the indirectly age-gender standardised referral ratio for Bury was 107.6, indicating 7.6% more referrals than expected based on its population structure. This increased further in the 2018/19 to 2022/23 period, reaching 110.3, and remained elevated at 110.6 in the most recent five-year span from 2019/20 to 2023/24 (Figure 9). Trend (based on the five most recent data points) for this indicator is not available.
Figure 9: Urgent suspected cancer referrals (Indirectly age-gender standardised referral ratio)- five years combined data in Bury from the year 2021/22 to 2023/24
No data on inequalities are present for Bury or England.
Urgent suspected cancer referrals resulting in a diagnosis of cancer (Conversion rate: as % of all USC referrals)
Urgent suspected cancer referrals are a managed route to secondary care, for investigation of possible cancer symptoms, with the intention to efficiently investigate the symptoms and, when a cancer is diagnosed, ensure the patient's cancer treatment and care is well managed within the system. This indicator reports the number of urgent suspected cancer referrals which resulted in a diagnosis of cancer, for all suspected cancer types. When presented as a proportion of all USC referrals, this is defined as the conversion rate which provides information on how often the referrals have resulted in a cancer diagnosis.
This indicator is defined as the number of urgent suspected cancer referrals resulting in a diagnosis of cancer in the registered population. This is divided by the total number of urgent suspected cancer referrals in the registered population (based on practice list size) to give the conversion rate.
For the year 2023/24, urgent suspected cancer referrals resulting in a diagnosis of cancer, (Conversion rate: as % of all USC referrals) was 5.2% for Bury, significantly below England average of 6% (Cancer Services Profile, 2024). The proportion in Bury for 2022/23 was similar at 5.2%, which was also significantly below England average of 6%. Trend (based on the five most recent data points) for this indicator is not available. No data on inequalities are present for Bury or England.
New cancer cases treated resulting from an urgent suspected cancer referral (Detection rate: % of all new cancer cases treated)
This indicator shows the proportion of new cancer cases treated that were first diagnosed following an urgent suspected cancer referral. It is calculated as the number of new cancer cases treated in the year who were referred through the urgent suspected cancer referral route divided by the total number of patients registered at the practice who have a date of first treatment in the financial year on the Cancer Waiting Times system.
The detection rate in Bury for the year 2023/24 was 54.5% statistically similar compared to England average of 55.7% (Cancer Services Profile, 2024).
Trend data for Bury suggests that the detection rate gradually increased with some fluctuations from 40.7% in 2009/10 to a peak of 58.3% in 2022/23, before slightly declining to 54.5% in 2023/24. England saw a steady increase with the rate increasing from 42.4% in 2009/10 to a peak of 55.7% in 2023/24 (Figure 10). Trend (based on the five most recent data points) for this indicator is not available.
Figure 10: Urgent suspected cancer referrals resulting in a diagnosis of cancer (Conversion rate: as % of all USC referrals) for Bury and England from the year 2009/10 to 2023/24
No data on inequalities are present for Bury or England.
Cancer
In the UK, 367,000 people are diagnosed with cancer annually. Around 40% of those cancers are caused by behavioural risk factors including smoking and alcohol and overweight and obesity (CRUK, 2020). Annual NHS costs for cancer services are £5 billion, but the cost to society as a whole – including costs for loss of productivity – is £18.3 billion (HM Government, 2015).
Premature or under 75 years of age mortality from cancer (Persons) in Bury for 2023 (142.6 per 100,000 population in those aged under 75 years) is statistically higher than England average (120.8 per 100,000). Amongst Bury’s statistical neighbours, Bury has the highest premature mortality rate from cancer, with the lowest rate in Bracknell Forest (102.5 per 100,000).
Data on inequalities are only available by sex for Bury with higher premature mortality from cancer being seen in 2023 in males (152 per 100,000) compared with females (133.7 per 100,000). Data on deprivation are only available at England level, where a social gradient is observed with higher mortality (146.5 per 100,000) in decile 1 compared with decile 10 (102.4 per 100,000) for 2023.
Directly standardised mortality rate from all cancers:
The directly standardised mortality rate from all cancers, all ages in Bury was 270.8 per 100,000 population for the year 2023, higher (statistically significant) than the England average of 246.7 per 100,000. (Mortality Profile, 2023). Mortality rate in Bury declined steadily from a peak of 354.6 in 2001 to 266.9 in 2014. This was followed by a sharp increase to 324.8 before another period of decline (with some fluctuations) to the current rate of 270.8 in 2023. England saw a more gradual decline from a peak of 309.1 in 2001 to the lowest rate of 246.7 in 2023 (Figure 11). There are no trend data available based on the 5 most recent data points
Figure 11: Directly standardised mortality rate from all cancers per 100,000 population, all ages in Bury and England from the year 2001 to 2023.
Bury has the third highest rate for cancer mortality for all ages in its group of 16 statistical neighbours, with the lowest rate in Sutton of 213.1 per 100,000
Data on inequalities in mortality rate from all cancers, all ages in Bury are only available by sex, where cancer mortality in males in 2023 is higher (333.9 per 100,000) compared with females (226.3 per 100,000). Mortality rates for males are similar to the England average of 296.6 per 100,000, and Bury is the second highest amongst its’ statistical neighbours for 2023. Bury is also similar for mortality rate for all cancers for females to the England average of 209.4 per 100,000, and is third highest amongst Bury group of similar local authorities. Data by deprivation are available for England only and shows a deprivation gradient where individuals in the most deprived decile (247.1 per 100,000) have higher cancer mortality rates compared with the least deprived decile (186 per 100,000) (Mortality Profile, 2023).
Directly standardised mortality rate from lung cancer:
The mortality rate from lung cancer, all ages (Persons) per 100,000 population for 2021-23 in Bury (60.7 per 100,000) was statistically higher than England average (47.5 per 100,000). The mortality rate from lung cancer declined steadily from a peak of 81.9 per 100,000 to the lowest rate of 58.8 per 100,000 in 2017-19, before rising to 63 per 100,000 in 2019-21 and then declining once again to 62.2 in 2020-22 and 60.7 in 2021-23. England saw a more gradual decline from a peak of 60.3 in 2011-13 to the lowest rate of 47.5 in 2021-12 (Figure 11). There are no trend data available based on the 5 most recent data points. Bury has the fourth highest mortality from lung cancer in its group of 16 statistical neighbours, with the lowest mortality in Havering of 40.5 per 100,000.
Figure 12: Directly standardised mortality rate from lung cancer, all ages per 100,000 population for Bury and England from 2011-13 to 2021-23 (Mortality Profile, 2023)
Bury has the fourth highest mortality from lung cancer in its group of 16 statistical neighbours, with the lowest mortality in Havering of 40.5 per 100,000.
Data on inequalities in mortality rates from lung cancer for all ages in Bury are only available by sex. For the period 2021-23, cancer mortality in females (59.4 per 100,000) is slightly lower compared to males (63.9 per 100,000) in Bury. Compared with England, the mortality rate for males in Bury is statistically similar to the England average (54.7 per 100,000) and is the fifth highest amongst Bury’s statistical neighbours. In contrast, the rate for females in Bury is higher (statistically significant) than the England average for females (41.9 per 100,000) and is second highest amongst its group of similar local authorities.
Data by deprivation are available for England only and for 2021-23 it shows a steep deprivation gradient where individuals in the most deprived decile (69.3 per 100,000) have nearly two times higher cancer mortality rates compared with the least deprived decile (35.6 per 100,000).
Directly standardised mortality rate from breast cancer:
Directly standardised mortality rate from breast cancer for females of all ages in Bury, for the period 2021-23, is 31.9 per 100,000 population. This rate is statistically similar to the England average of 30.5 per 100,000 (Figure 13). In Bury, the rate rose from 31.8 in 2011-2013 to 33.1 in 2012-2014, before dropping to a low of 28.0 in 2014–2016. This was followed by a steady increase, reaching a peak of 35.1 in 2017-2019. Subsequently, the rate declined to 31.9 in 2021-2023, with some fluctuations observed during this period. In contrast, England experienced a relatively consistent downward trend, decreasing from 36.5 in 2011-2013 to its lowest rate of 30.5 in 2021-2023. Bury has the sixth highest mortality from breast cancer in females in its group of statistical neighbours, with the lowest mortality in Tameside of 24.2 per 100,000.
Figure 13: Directly standardised mortality rate from breast cancer (3 year range), per 100,000 population, for females of all ages for Bury and England from 2011-13 to 2021-23 (Mortality Profile, 2023)
Data on inequalities in mortality rates from breast cancer for females of all ages in Bury are not present. Data by deprivation are available for England only, and they show a slight deprivation gradient. The mortality rate from breast cancer in the most deprived decile (31.5 per 100,000) is slightly higher compared to the mortality rate in the least deprived decile (28.8 per 100,000) for the period 2021-23.
Directly standardised mortality rate from colorectal cancer:
Directly standardised mortality rate from colorectal cancer, per 100,000 population, for all ages (persons) in Bury of 27 per 100,000 for 2021-23 is statistically similar to England average of 25.6 per 100,000. Trend data for Bury indicates a decline from a peak rate of 27.5 in 2011-2013 to a low of 20.3 in 2016-2018. This was followed by a modest increase to 23.5 in 2018-2020, and then a sharper rise to 27.1 in 2019-2021. The rate then stabilised, remaining relatively steady at 26.8 in 2020-2022 and 27.0 in 2021-2023. For England, the mortality rate declined more steadily from a peak of 27.4 in 2011-12 to the lowest rate of 25.6 in 2021-23 (Figure 14).
Figure 14: Directly standardised mortality rate from colorectal cancer, per 100,000 population, for all ages (persons) for Bury and its statistical neighbours, 2021-23 (Mortality Profile, 2023)
Comparing Bury to its statistical neighbours, Bury has the sixth highest mortality rate, with the lowest mortality rate in Sutton of 21 per 100,000 (Figure 17).
Data on inequalities in mortality rates from colorectal cancer, all ages in Bury are only available by sex. Cancer mortality in males for the period 2021-23 is higher (32.1 per 100,000) compared with females (22.5 per 100,000). Compared with England, mortality rates for males and females in Bury are similar to England average of 31.4 per 100,000 for males and 20.9 per 100,000 for females. Data by deprivation are available for England only and shows a slight deprivation gradient for 2021-23, where individuals in the most deprived decile (27.7 per 100,000) have higher colorectal cancer mortality rates compared with the least deprived decile (24.3 per 100,000).
Support
There are a variety of groups and organisations in place for information and support with cancer. They include: