Page last updated: 29-MAY-2007
Cancer
Statistical Publication Notice
29th May 2007
Cancer Incidence (2004)
INTRODUCTION:
The Scottish Cancer Registry has been collecting information on cancer since 1958. Data collected by the Registry are published by ISD and are used for a wide variety of purposes including: public health surveillance; health needs assessment, planning and commissioning cancer services; evaluation of the impact of interventions on incidence and survival; clinical audit and health services research; epidemiological studies; and providing information to support genetic counselling and health promotion.
Data on cancer incidence were previously published from 1975 onwards and data on cancer mortality from 1979 onwards. Data for both incidence and mortality are now published from 1980 onwards. Earlier data are available on request.
KEY POINTS:
Taking all cancers combined, in recent years the age-standardised incidence rate has fallen slightly for men and remained relatively stable for women. However the figures show considerable variation between cancers, with substantial increases in melanoma of the skin and other skin cancers (both sexes), and decreases in stomach (both sexes) and lung (males only). Actual numbers of cases of cancer have risen, largely due to an ageing population.
INTERPRETATION:
The updated figures show cancer incidence (1980-2004) for each major cancer and replace information previously available on the ISD Scotland website. Cancer registrations are believed to beessentially complete (>95%) for the year 2004, but it is important to note that the cancer registration database is dynamic. In common with cancer registries in other countries, cancer incidence rates in Scotland can take up to five years after the end of a given calendar year to reach 100% completeness and stability due to the continuing accrual of late registrations coming to light, for example through death certification.
At this stage, it may be misleading to focus too much attention on any apparent changes in incidence between 2003 and 2004. It is more informative to examine trends in incidence observed over a number of years. Striking changes from one year to the next may occur in the case of rare cancers, but these are likely to reflect random fluctuation caused by small numbers of cases - in such cases, it is even more important to examine incidence rates for a number of years aggregated together, rather than focusing on a single year of incidence.
All ten-year changes in incidence have been estimated using Poisson regression.
DETAILED SUMMARY:
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13,164 males and 13,949 females were diagnosed with cancer (excluding non-melanoma skin cancer) in 2004. These figures are higher than in 2003 and are expected to increase slightly due to the continuing accrual of late registrations.
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Over the last decade (1994-2004) the age-standardised incidence rate of cancer has fallen steadily in men (a 9% decrease) and remained stable in women. Note however that due to an ageing population, the actual number of cases of cancer diagnosed has risen.
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Lung cancer is the most common cancer overall, and is the second most common cancer in both men and women. The long-term decline in men has continued with a significant fall in the incidence rate of 25% in the last ten years. Incidence rates in women have increased by 6% over the same period. To a large extent, these trends reflect historic trends in the prevalence of smoking, which have differed between men and women.
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Breast cancer is the most common cancer in women. Incidence rates continue to rise with a significant 11% increase in the last ten years. This is partly due to increased detection by the Scottish Breast Screening Programme, which has seen a rise in attendance over the same period and an extension of the age range invited for screening to include women up to the age of 70 years, phased in over the 3-year period beginning 1st April 2003. However, increases in the incidence of breast cancer might also be anticipated, in the context of changes in the prevalence of known risk factors, such as age at birth of first child, and alcohol consumption.
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Prostate cancer has now overtaken lung cancer as the most common cancer in men. Incidence rates continue to rise with a significant 16% increase in the last decade. At least in part, this may represent an increase in detection through use of the prostate specific antigen (PSA) test rather than a genuine increase in the risk of developing the disease.
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Colorectal cancer is the third most common cancer in both men and women. Incidence rates in males remain unchanged over the past ten years, whilst in women they have fallen by a significant 10%. Although patterns of diet and physical activity have been associated with the risk of developing colorectal cancer, the explanation for the recent trend in incidence is unclear. The Colorectal Cancer Screening Pilot Project, which began in April 2000, is likely to have led to increases in detection and incidence among the age group (50-69 years) invited for screening in the NHS Boards selected for the project (Fife, Grampian, and Tayside). However, this is unlikely to have had a major impact on incidence rates at national level and across all age groups.
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Melanoma of the skin is now the ninth most common cancer in men and the sixth most common in women. Incidence rates are continuing to rise significantly, with a steep increase of 46% in men and an increase of 21% in women over the last decade. The main recognised risk factor for melanoma of the skin is exposure to solar radiation, especially but not exclusively in childhood.
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Non-melanoma skin cancer is not routinely included in cancer incidence figures as there is a degree of under-recording. Around 4,100 cases were recorded in men in 2004 and 3,600 cases in women. Incidence rates are rising steeply in both men and women with increases of 28% and 31% respectively over the last ten years (both significant). These cancers have been associated with chronic exposure to solar radiation.
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Other sites where the incidence rates of cancer have risen significantly over the past ten years include the liver (increases of 26% in men and 42% in women), the uterus (an increase of 19%) and, for men, the thyroid and the tongue (increases of 56% and 36% respectively).
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Cancers for which incidence rates have fallen significantly over the past ten years include the stomach (decreases of 27% and 28% in men and women respectively), chronic myeloid leukaemia (decreases of 44% and 48% in men and women respectively) and, for women, the cervix (a decrease of 30%) and the oesophagus (a decrease of 12%).
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The decline in bladder cancer incidence since 1997 is an artefact due to a change in coding practice across cancer registries in the UK. Around a quarter of bladder tumours are no longer coded as invasive bladder cancers. This also impacts on the figures for all cancers.
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MAIN CONTACT:
David Brewster
Director of the Scottish Cancer Registry
Tel: 0131 275 6092
E mail: David.Brewster@isd.csa.scot.nhs.uk
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PRE-RELEASE ACCESS TO THIS PUBLICATION WAS GIVEN TO:
Scottish Executive Health Department, Chief Executives of the NHS Health Boards
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HISTORY OF THIS PUBLICATION
Last published: 07/06/2006
Next due: May 2008
Data available since: Data on cancer incidence were previously published from 1975 onwards but are now published from 1980 onwards. Earlier data are available on request.
Main contact: 
Susan Jensen
Susan Jensen
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