Nearly 5000 cancer extra cases a year in linked to poverty

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The report - 'Deprivation and Cancer Inequalities in Scotland' - has been published today by Cancer Research UK to coincide with the Scottish Cancer Conference in Edinburgh.

Speakers at the event, which is being held in-person for the first time since 2019, include Health Secretary Humza Yousaf and public health expert Professor Linda Bauld.

Michelle Mitchell, chief executive of Cancer Research UK, said: "Cancer inequalities – unfair, avoidable and systemic differences between population groups – are present at every stage of the cancer pathway, including the prevalence of cancer risk factors, screening uptake and barriers to seeking help.

"Together, these factors contribute to stark differences in cancer incidence and outcomes between the most and least deprived populations across Scotland.

"It is unacceptable that today, cancer-related deaths are 74 per cent higher in the most deprived population than the least deprived in Scotland.

"Scotland has the highest proportion of cancers attributable to preventable risk factors in the UK, with smoking alone responsible for nearly one in five cancer cases.

"Smoking and excess weight, the two biggest causes of cancer, remain persistently high among Scotland’s more deprived populations, which leads to a higher incidence of cancer amongst these groups.

"We need bold government action that enables all people to live healthier lives if we are to reduce cancer inequalities."

The report provides the first comprehensive picture of deprivation and cancer in Scotland, from diagnosis to treatment.

It notes that the Covid pandemic has "exacerbated the pre-existing health inequalities" and that an estimated 4,900 cases annually - or 13 per day - "could be avoided if the rates of cancer in sites where it is higher for the most deprived were the same rates as for the least deprived".

Nearly half of these extra cases - 2,400 - are due to lung cancer being more common in deprived communities.

The report also warns that the current 'tobacco-free' Scotland target, which aims to see fewer than 5% of adults smoking by 2034, "will not be met without sustained efforts to reduce smoking in more deprived groups".

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Excluding old age, smoking is the leading preventable cause of cancer in Scotland - responsible for one in five cases.

The report adds: "In 2019, 32% of people in the most deprived quintile smoked, compared to 6% in the least deprived.

"Projections indicate smoking prevalence will still be 20% in 2034 for the most deprived groups, far short of the tobacco-free target.

"Unless bold action is taken, smoking prevalence for the most deprived groups may not reach even 10% in the next 25 years.

"These differences will manifest in a higher risk of getting and dying from cancer for many decades to come."

Nearly 7% of cancer cases each year in Scotland are also linked to excess weight, with current forecasts predicting that adult obesity rates will shrink among the least deprived - from 22% in 2019 to 19% by 2040 - but increase over the same period from 36% to 41% among the most deprived.

Obesity rates are also twice as high for children living in the most compared to the least deprived areas, potentially storing up a "greater burden of cancer amongst more deprived groups in the future".

Survival from cancer is worse in more deprived areas, with Scots living in the poorest areas 10% less likely to be alive five years on from a diagnosis of bowel cancer compared to patients in the most affluent areas.

For both breast and bowel screening uptake is 20% lower in the most deprived populations compared to the least deprived. For cervical screening, the deficit is 11%.

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The report also found that people in routine and manual occupations - a proxy for deprivation - were more than twice as likely to report difficulties in getting a GP appointment compared to those in managerial or professional occupations.

Research has consistently shown higher numbers of GPs per head in more affluent areas compared to deprived postcodes where need is greatest.

People in manual jobs were also significantly more likely to mistake symptoms for an existing condition, or to struggle to access healthcare via phone or email as remote consultations increase.

While no data on emergency cancer referrals by deprivation level are available in Scotland, one in five cancer cases in Scotland is detected after patients present at A&E.

Such diagnoses are more common in the West of Scotland region, where high deprivation is more concentrated, than in the north or east of the country.

The report also suggests that the disproportionate impact of Covid on the poorest Scotland may have temporarily skewed the picture on cancer, noting that while the deprivation gap in cancer mortality "appears to have slightly reduced over the Covid-19 period" this "may be because people from more deprived areas were more likely to die from Covid-19 than those in less deprived areas".

People living in Scotland's most deprived neighbourhoods were 2.4 times more likely to have died from Covid than the most affluent.

Meanwhile, the report also highlights discrepancies in accessing treatment, including people in more deprived areas tending to live further from treatment centres or being reliant on public transport.

The report adds: "Some patients have reportedly chosen, or have been prescribed, treatment modes that are less optimal to avoid having to travel."

Access to clinical trials - which can offer a last-ditch option when conventionally available treatments have failed - also tends be uneven.

The report states: "The barriers can include frequent travel, which can deter patients with disabilities, and healthcare professionals discounting elderly and disabled patients as research participants despite them being eligible."

A Scottish Government spokeswoman said: “We know that the earlier cancer is diagnosed the easier it is to treat and even cure which is why we continue to invest in our Detect Cancer Early (DCE) Programme, initially launched in 2012.

“We recognise that the impact from the Covid-19 pandemic may have exacerbated inequalities within screening. A key Ministerial priority is reducing inequalities in access to and uptake of screening programmes.

"That is why we committed up to £2.45 million to the Screening Inequalities Fund over the next two years to build a programme of evidence-based, sustainable and scalable projects that tackle inequalities in a systemic way.

“Last month we announced that the next two Rapid Cancer Diagnostic Services (RCDS) will be established in NHS Lanarkshire and NHS Borders to add to RCDSs in NHS Ayrshire and Arran, NHS Dumfries and Galloway and NHS Fife.

“Addressing obesity remains a public health priority to ensure Scotland is a place where we eat well, have a healthy weight and are physically active. Our Diet and Healthy Weight Delivery Plan sets out ambitious and wide ranging action to address this challenge, including our aim to halve childhood obesity by 2030.

“Our goal is a tobacco-free generation of Scots by 2034 and a number of new strategies are currently being considered as part of our refreshed Tobacco Action Plan including improved support for people who want to quit.”

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