Scotland: Cancer cases 'will increase 22 per cent by 2040'

The increase is mostly driven by the ageing population.

Male cancer incidence is projected to increase more rapidly, by 31%, to 22,658 new cases per year.

The number of cancer cases in Scotland is projected to climb by 22 per cent, with males seeing the steepest increase (Image: PHS)

Around a quarter of cancer cases in men - 5,885 per year - are projected to be caused by prostate, meaning that it will continue to be the most common form of the disease for males.

Among females, cancer incidence is projected to increase by around 13%, to 19,414 cases per year by the end of next decade.

Breast cancer is expected to remain the most common form of the disease for women, causing 5,068 new cases per year, while female lung cancer cases are projected to increase from 2,859 to 3,163.

READ MORE: What's happened to life expectancy in Scotland - and why? 

Bowel cancer incidence is predicted to level off but will remain one of the most common cancers in Scotland, resulting in 3,540 new diagnoses per year in total compared to 3,566 currently.

PHS said that while "welcome reductions in smoking prevalence have occurred in Scotland, there remains considerable potential to prevent cancers through further reductions in smoking, reducing overweight and obesity, improving diet and reducing alcohol consumption".

Some rarer cancers are forecast to see sharp increases in incidence.

These include melanoma skin cancers, with a projected increase of 60% to 2,525 case annually; kidney cancer up 113% to 3,237; myeloma up 37% to 721 cases; and gallbladder cancer up 106% to 235 cases per year.

The cancer incidence rate - age-adjusted per 100,000 - is projected to remain stable, at levels of the 1990s (Image: PHS)

The age-adjusted cancer rate, which accounts for changing demographics - particularly the growing share of people over 65 in the population who are most likely to develop cancer - is forecast to remain largely stable, at 640 cases per 100,000 people compared to 629 per 100,000 now.

This has remained almost unchanged since the mid-1990s.

The sheer increase in cancer incidence as a result of the ageing population has major implications for the NHS, however, as it will mean growing demand for screening services, diagnostics, and treatment.

The latest waiting times statistics for Scotland indicate that while more than 95% of newly-diagnosed cancer patients started treatment within the target time of 31 days, diagnostic pathways are continuing to struggle.

The 62-day waiting time target was last achieved at the end of 2012 (Image: PHS)

Kate Seymour, Head of Advocacy (Geographies) at Macmillan Cancer Support, said Scotland's cancer system must "mirror" the patients of the future, who will be "older and with more complex needs – otherwise the situation will only get worse, with more services struggling to cope and an inevitably worsening impact on the level of care".

She added: “The same demographic challenges are hitting the cancer workforce, with vacancies left unfilled due to many of our professionals reaching retirement age and staffing levels already stretched to breaking point."

The 62-day target stipulates that 95% patients should wait no longer than two months between being referred for tests and scans with an "urgent suspicion of cancer" - for example, by their GP due to worrying symptoms or as a result of possible disease detected through routine screening.

However, the 62-day target has not been achieved in more than a decade and stood at 73.7% in April-June this year.

It was missed by all health board regions, but ranged from 61.8% in Western Isles to 90% in NHS Borders.

The major bottleneck is in demand for key diagnostic tests, including MRI or CT scans, diagnostic ultrasound, endoscopies, and colonoscopies.

READ MORE: Cancer screening and an ageing population - the dilemma for the NHS

By the end of June this year, there were 152,606 people waiting for one of the eight 'key diagnostic tests', compared to 88,301 at the end of February 2020.

Not all patients referred for these tests have a suspicion of cancer - and suspected cancer patients are prioritised - but turnaround times are complicated by factors such as staff shortages in radiology.

The waiting list for 'key diagnostic tests' has increased substantially compared to 2019, but the size of the workforce and resources has not kept pace with growing demand (Image: PHS)

Scottish Labour Health spokesperson Jackie Baillie said: “Scotland’s cancer treatment wait times are a ticking timebomb and one that must be stopped in its tracks.

“There are already far too many avoidable and unnecessary deaths from cancer each year.

“Scotland’s cancer waiting times have already skyrocketed and this is only going to get worse unless real steps are taken to address the crisis by the SNP."

Scottish Conservative deputy health spokesperson Tess White MSP said: “This projection is deeply alarming both for the public and those who work in the NHS.

Tess White, the Scottish Conservative deputy health spokeswoman, said cancer waiting times are "out of control" with patients "continuing to suffer due to dire workforce planning by successive SNP health secretaries".

READ MORE: Why are cancer deaths in Scotland lower in 2022 than before the pandemic?

By number, there have been nearly 400 excess cancer deaths in Scotland so far this year but so far there is no sign that mortality rates have increased.

Between January and July this year, the age-adjusted cancer mortality rate averaged 293.3 deaths per 100,000 compared to 299.5 per 100,000 for the five-year average which covers 2017, 2018, 2019, 2021, 2022.

This suggests that there were around six fewer cancer deaths per 100,000 than might be expected based on the size and age of the population and historic trends.

The Scottish Government's 10-year cancer strategy, published in June this year, aims to halve the percentage of cancer cases detected at stages III or IV from 42% to 24% by 2033, as well as focusing on prevention. 

A spokesman for the Scottish Government said: "The plan recognises that approximately 40% of cancers remain preventable, due to risk factors such as smoking, obesity, physical activity and alcohol consumption, and there is a clear focus in the action plan to address these.

"The earlier cancer is diagnosed the easier it is to treat. This is why we continue to invest in our detect cancer earlier programme, which adopts a whole systems approach to diagnosing and treating cancer as early as possible.

"We continue to redesign services through optimal cancer diagnostic pathways, establishing rapid cancer diagnostic services and urology diagnostic hubs."

Ellie Wagstaff, senior policy manager at Marie Curie Scotland, said its own research indicates that 95% of all people who die in Scotland may need palliative care by 2040.

She added: "The number of people dying from more than one terminal condition will rise by 80% come 2040.

"Cancer deaths themselves are expected to increase by 20% in this time. This means palliative care needs will be greater, and more complex."