Cancer

Healthy People

Physical Health Conditions

Cancer

Introduction

Cancer is when abnormal cells divide in an uncontrolled way. There are more than 200 different types of cancer and some cancers may eventually spread to other parts of the body. 1 in 2 people in the UK will get cancer in their lifetime. Cancer and its treatments can affect body systems, such as the blood circulation, lymphatic and immune systems, and the hormone system.

The 4 most common types of cancer are:

Breast cancer
Lung cancer
Prostate cancer
Bowel cancer

Changes to your body’s normal processes or unusual, unexplained symptoms can sometimes be an early sign of cancer. Symptoms that need to be checked by a doctor include:

A lump that suddenly appears on your body
Unexplained bleeding
Changes to your bowel habits

In many cases your symptoms will not be related to cancer and may be caused by other, non-cancerous health conditions.

You should not have to wait more than 2 weeks to see a specialist if your GP suspects you have cancer and urgently refers you.

In cases where cancer has been confirmed, you should not have to wait more than 31 days from the decision to treat to the start of treatment.

The NHS provides screening services for certain types of cancer to help find cancers early in people who might not be showing any signs or symptoms. There are three cancer screening programmes (breast, bowel, cervical) which are targeted in accordance with who is most at risk. Screening is not a diagnostic test, therefore further testing may be required in the event of an abnormal screening result.

You can find more information about the universal screening programmes online, please visit:

There are some general risk factors for developing cancer and some that increase the risk of developing a specific type of cancer.

Having one or more risk factors does not mean you will definitely get cancer. Some risk factors mean you have a much higher risk of getting cancer, for example if you are a smoker. You can still develop cancer even if you do not have any known risk factors.

About 4 in 10 cancers (40%) could be prevented. Living a healthier lifestyle can help reduce your risk (see below) but you cannot reduce your risk of cancer completely. General risk factors for cancer include the following:

Age – the risk of developing cancer increases as you get older
Lifestyle factors:
- Smoking
- Your weight
- Your diet
- How active you are
- Sun exposure and sunbed use
- How much alcohol you drink
Family history – some cancers are more common in some families. We have more information for people with a family history of cancer.

Other Risk Factors:

Workplace and environmental factors: Exposure to harmful substances in the environment or workplace can cause cancer. Substances that cause cancer are called carcinogens. Some of these carcinogens can cause cancer years after you have been exposed to them. Environmental risk factors such a life-long exposure to radon gas can also contribute to a person’s risk of developing lung cancer.

Low immunity: People with a lower immunity may have:

Had a transplant and take drugs to suppress the immune system – these drugs stop the body rejecting the transplant
HIV (human immunodeficiency virus)
A medical condition that lowers their immunity

If you have low immunity, you may be more likely to develop some cancers.

Pre-cancerous conditions: Having a pre-cancerous condition does not mean that you have cancer, or that you will definitely develop cancer. But pre-cancerous conditions are diseases or syndromes that might develop into a cancer, so it is important to monitor your health.

Why is it important to Population Health?

Leading Cause of Morbidity and Mortality: In 2020 over 390,000 people were diagnosed with cancer in England¹. The number of deaths has increased by 6% since 2001. But after accounting for the fact that England’s population is both growing and ageing, the rate of cancer deaths has fallen. In 2021 over 134,000 people died from cancer in England, accounting for just over a quarter of deaths².

Life After Cancer: Cancer has short and long-term consequences for those who have received treatment and include both mental and physical effects, such as chronic fatigue, sexual difficulties, mental health problems, pain, urinary and gastrointestinal problems, and lymphoedema (persistent tissue swelling caused by fluid retention). Cancer can also have implications for survivors beyond physical and mental health issues and can include social isolation and financial worries caused by disruption to work³. Population health efforts should be targeted both at preventing cancer and supporting people to manage the effects of cancer.

Health Inequalities: Health inequalities are avoidable differences in health between different groups of people. Cancer Research UK estimate that in the UK an extra 30,000 cases of cancer each year are related to health inequalities, including nearly 15,000 lung cancers each year. Incidence rates are 17% higher in the most versus least deprived areas in England⁴^,⁵.

Where you live can affect how likely you are to survive cancer. Living in lower income communities is associated with a 53% higher mortality rate for men and 55% higher mortality rate for women compared to higher income communities⁶.

Around 5% of all cancer cases are diagnosed through the breast, bowel and cervical screening programmes in England. Bowel screening uptake varies hugely by socio-economic group in England, with people in lower income communities less likely to access screening services.

For some signs and symptoms such as ‘unexplained lump or swelling’ or ‘change in appearance of a mole’, people from the most deprived areas are half as likely to recognise these as a potential symptom for cancer. People in routine and manual occupations are also more likely to put off going to the doctor than other professional groups and are more likely to be worried about going for tests, or worried about wasting the doctor’s time.

This is important as around 1 in 5 cancers in England and Northern Ireland are diagnosed through an Emergency Presentation, with later stage disease and worse survival than those diagnosed through other routes. The likelihood of presenting through an Emergency Presentation route is 50% higher for people in the most deprived populations compared to the least deprived⁷.

Modifiable Risk Factors: An estimated 38% of all cancers can be prevented with smoking and overweight and obesity causing 15% and 6% of all cancers respectively⁸.

Other modifiable risk factors include:

Too much unprotected exposure to sunlight
Excessive alcohol consumption
Eating a low fibre diet
Eating lots of processed meats
Lack of exercise

These modifiable risk factors can increase a person’s risk of developing cancer. However, population health efforts to support people to make lifestyle changes can empower people to reduce their risk of developing cancer, improve health outcomes and reduce the long-term pressures on the NHS.

NHS/Healthcare Burden: There has been an increase in waits for cancer care in 2022–23, with the weekly backlog more than twice the targeted level in August 2022, and with 8,100 people (11% of the total) waiting more than 104 days for treatment following an urgent GP referral between April and August 2022. Only 62% of patients were treated within 62 days in the first five months of 2022–23, against a performance standard of 85%⁹.

It is estimated that NHS healthcare costs due to preventable cancers currently stands at £3.7bn per year, of which lung cancer makes up 35% of that total cost¹⁰.

Preventing people developing cancer through robust approaches to tackling the causes of cancer can help reduce the long-term pressure the NHS is experiencing.

Economic Impact: The personal impact of cancer can be significant. In a 2012 survey by Macmillan Cancer Support a third (33%) of people stopped working permanently or temporarily, and 8% worked reduced hours or took unpaid leave. People may spend more time at home and feel the cold more because of their cancer, which can result in energy bills rising. They may also need to change their diets and buy more expensive foods to help them cope with the effects of cancer and its treatment¹¹.

It is estimated that the wider economic impact for the treatment of preventable cancers is £78bn or the equivalent of 3.50% of GDP for the UK¹².

The Derbyshire Population Health Approach

The Derbyshire Population Health Approach focuses on prevention, population health, evidence-informed practices, causes, and collaboration. It emphasises proactive measures to prevent health issues, tailors interventions to specific populations, incorporates evidence-informed practices, addresses underlying causes, and promotes collaboration for effective action.

When considering the topic of cancer within The Derbyshire Population Health Approach:

Preventing people developing cancer and supporting early diagnosis through the recognition of symptoms and access to appropriate screening is important in supporting improved outcomes for people, especially those in communities most affected by cancer and where there is currently lower uptake of prevention services. Supporting access to lifestyle services such weight management and stop smoking through Live Life Better Derbyshire, helping people to reduce the amount of alcohol they consume, cancer screening programmes, access to the HPV vaccine and breastfeeding support and the NHS Health Check can support people to improve their health whilst reducing future risk of developing cancer.

There are differences in the risk of developing cancer, the impact that cancer has on a person and the likelihood of that person surviving depending upon where they live. People living in areas of high levels of income inequality are more likely to exhibit lifestyle factors that may increase cancer risk such as smoking and are less likely to access cancer screening programmes. Targeted interventions to support communities who experience high levels of cancer can be developed to support the specific needs of those communities.

There is strong evidence why people develop cancer and the communities most likely to be affected. The NHS in their Long-Term Plan¹³ set an ambition that by 2028 we will dramatically improve cancer survival, partly through increased early diagnosis. It also established an ambition to reduce levels of obesity, smoking and excessive alcohol consumption. Population health practitioners work closely with NHS and other partners to implement evidence-informed activity to prevent cancer developing, including supporting access to appropriate cancer screening, access to the HPV vaccine, stop smoking and weight management and support to reduce alcohol consumption.

Understanding the causes and risk factors associated with cancer are important in informing population health approaches to prevention and early diagnosis on cancer. Understanding the impact of cancer on people’s physical and mental health in addition to the wider impact that cancer may have on a person’s financial security is also important in developing the population health response to cancer risk. Working with stakeholders in the NHS, and community and voluntary sector, population health can respond to the complex nature of cancer to support health outcomes for people at risk of developing cancer in Derbyshire.

Working with our colleagues across NHS, local authority and community, voluntary and independent sector is essential to embed a population health approach to early identification and prevention of cancer risk. Our partners are essential in supporting the development and implementation of strategies, plans and services including lifestyle services through Live Life Better Derbyshire, support to manage execessive alcohol intake and screening programmes across Derbyshire and within at-risk communities.

Latest Derbyshire Data

Trend Data

Derbyshire Quilt

Prevalence Maps of Derbyshire

The maps below illustrate Lower Super Output Areas (LSOAs) and Middle Super Output Areas (MSOAs) for Derbyshire. LSOAs and MSOAs are geographical divisions used for statistical purposes, allowing for more detailed analysis of local data. In these maps, you can explore various health indicators and data for Derbyshire, providing valuable insights into the area’s health and wellbeing.

LSOA
MSOA

In the top right of the map, you’ll find the ‘Layer Control’ icon. This is an easy way to customise what you see on the map visualisation. Click the ‘Layer Control’ to choose which information is displayed on the map. Pick the indicator that interests you the most, and the map will transform accordingly.

Slope Index

This chart illustrates the differences in health and lifestyle factors across areas in Derbyshire, from the most deprived (decile 1, red) to the least deprived (decile 10, green). As you move from left to right on the chart (from more deprived to less deprived areas), the line shows whether these factors are becoming more or less common. Essentially, it’s a way to see how living in wealthier or poorer areas affects the prevalence of these factors.

Further Analysis & Assessments

Derbyshire Joint Strategic Needs Assessment (JSNA) involves a thorough examination of a specific health problem, exploring its causes, consequences, and underlying factors. It combines various data sources, collaboration with stakeholders, and rigorous analysis to generate insights for evidence-informed interventions and policy changes.

Coming soon…

More Information & Resources

Here is a list of useful resources and information to help prevent issues related to cancer These materials are meant to provide individuals, healthcare professionals, and communities with the knowledge and tools they need as part of efforts to address cancer.

NHS Health Check - Live Life Better Derbyshire - You are eligible for a free NHS Health Check every five years if you are aged between 40 and 74 and not already being treated for certain long term conditions.
Live Life Better Derbyshire - This free service provides help and advice to increase physical activity, quit smoking, and lose weight.
Derbyshire Sport - Active Derbyshire supports people to increase their activity levels in a way that works for them.
NHS Breast screening (mammogram) - Anyone registered with a GP as female will be invited for NHS breast screening every 3 years between the ages of 50 and 71.
NHS Bowel cancer screening - NHS bowel cancer screening is available to everyone aged 60 to 74 years.
NHS Cervical screening - Also known as a smear test, cervical screening checks the health of the cervix. It is offered to women and people with a cervix aged 25 to 64.

Contributors

Ben Cooper, Advanced Public Health Practitioner, Healthcare Public Health