July 30, 2020

Comparative Analysis of Chronic Diseases in the Southeastern United States vs. the United Kingdom: Focus on Cancer

This is the second in a series of comparative investigations into the prevention and management of the main chronic diseases and causes of death in the United Kingdom versus those in the Southeastern United States.

The series continues with cancer, a group of over 200 different diseases in which cells in a specific part of the body grow and reproduce uncontrollably. Cancerous cells can invade and destroy surrounding healthy tissue, including organs.

About half of the population will develop some form of cancer during their lifetime. In the UK, the four most common types of cancer are breast, lung, prostate, and bowel cancer. Together these comprise about 53% of all new cancer diagnoses in the UK.

In total, there are around 367,000 new cancer cases in the UK every year, or about 1,000 every day. More than a third of cancer cases in the UK are diagnosed in people aged 75 and over, with the highest rates for all cancers in people aged 85 years and above.

In terms of mortality from cancer in the UK, there are around 165,000 cancer deaths per year, or around 450 every day, accounting for 28% of all deaths in the UK. The four main cancer types together account for 45% of all deaths from cancer in the UK. Again, rates are higher in people aged 75 and above, with the highest mortality in people aged 90 or above.

In the US, as in the UK, the top causes of cancer are breast, lung, prostate, and bowel cancer. In terms of mortality, lung cancer poses the highest risk, followed by breast, prostate and bowel cancer.

About 1,700,000 new cases of cancer are diagnosed in the US annually, and there are about 600,000 deaths from cancer, about 1,640 per day. This accounts for one in every four deaths in the US, a similar rate to the UK.

Cancer rates are measured for each state by the Centers for Disease Control and Prevention. The highest rate for cancer overall is seen in Kentucky, both in number of diagnoses and number of deaths. 10,135 people died of cancer in 2018 in the state, the last year of record. That comes out to 181.6 deaths per 100,000 people per year being caused by cancer.

The four next highest rates - all of those with more than 170 deaths per 100,000 people - are also in the Southeastern states.  The state of Mississippi follows up Kentucky with a mortality rate of 179.7. Next is West Virginia with 179.5, then Oklahoma at 178.1, and Alabama with 170.4.

Below these, the states with the next three highest cancer mortality are also in the Southeast: Louisiana, Arkansas and Tennessee.

Cancer prevention in the UK is largely focused on giving the public advice and support on how to reduce risk factors: quit smoking, reduce alcohol, stay safe in the sun, improve diet, exercise more and keep within a healthy body mass index. This information is provided by initiatives from the Government’s Department of Health as well as several cancer charities. 

The largest cancer-related charity, Cancer Research UK, is a household name and funds a very wide range of research every year. Their leaflets are a common sight at many healthcare providers, both within the National Health Service and the much smaller private healthcare sector.

The NHS gives universal health coverage free at the point of use, funded via taxation. Its Long Term Plan, created in 2019, aims for 55,000 more people every year to reach five-year survival by 2028. It also aims to diagnose 75% of people with cancer at an early stage (stage one or two) by 2028.

In order to reach these aims, more investment is being made in the NHS national screening programmes. These include cervical screening at 3-5 year intervals for women aged 25 to 64, breast screening for women aged 50 to 70, and bowel cancer screening for men and women aged 60 to 74. There is no national screening programme for lung cancer in the UK.

Screening programmes are overseen by separate organisations in each of the four nations of the UK. These are Public Health England, Public Health Wales, Public Health Scotland, and Northern Ireland’s Public Health Agency.

Local primary care providers called general practitioners administrate these services from their practices. If possible cancer symptoms are found, the patient is referred by their general practitioner to an oncology consultant who is based at a nearby hospital. The consultant will carry out clinical Investigations, leading to a diagnosis and treatment when necessary. Alternatively a patient might attend a hospital’s accident and emergency department with symptoms that require urgent assessment. 

Once diagnosed, cancer treatment in the UK - most often surgery, chemotherapy and/or radiation therapy - is also usually provided by the NHS. Patients can access cancer treatment from private providers which charge fees, but usually treatments for cancer are the same under both systems. Some tests or treatments can be done more quickly in private practice, with shorter waiting lists. But some cancer treatments which specialised equipment, such as radiotherapy, may not be available in private hospitals.

The NHS sets out detailed standard treatment pathways for each type of cancer. It also sets a range of performance targets, for example, a maximum two week wait before being seen by a specialist after urgent referral for suspected cancer by their GP. In 2018-19, this target was met in 92% of cases.

In addition, 97% of NHS patients began cancer treatment within 31 days of diagnosis. One further national target is a maximum delay of 62 days for treatment following referral from an NHS cancer screening service. This rate was 88% in 2018-19.

In the US, the Centres for Disease Control and Prevention encourages cancer prevention by providing support and prevention over a lifetime. It gives advice on how to completely or partially avoid the modifiable risk factors, for example, avoiding or quitting smoking, not drinking or limiting alcohol intake, and using sun protection.

The CDC encourages screening for breast, cervical, colorectal, and lung cancers as recommended by the US Preventive Services Task Force. It suggests that women who are 50 to 74 years old get a mammogram every two years, and a pap smear test every three years from age 30 to 65. Some women will be eligible for free or low-cost mammograms under the CDC’s National Breast and Cervical Cancer Early Detection Program. 

The CDC also recommends regular screening for colorectal cancer from 50 to 75 years, and yearly lung cancer screening for current or former smokers aged 55 to 80 years. In addition, HPV vaccination is recommended for preteens aged 11 to 12 years.

The National Cancer Institute - the federal government's main agency for cancer research - released its latest Annual Report to the Nation on the Status of Cancer on March 12, 2020. It explains that deaths from cancer continue to decrease in men, women and children, and their ‘Healthy People 2020’ targets were met for lung, prostate, breast, and colorectal cancer mortality.

Unfortunately, national improvements in the cancer statistics have not reached the individual states equally. The southeastern states continue to show higher than average rates of cancer diagnoses and mortality. Where healthcare is geographically accessible in very rural states such as Texas, barriers related to care can still exist. Such barriers often relate to finances, transportation, cultural and language differences, lack of insurance and family support.

However, state-level comprehensive cancer control plans created by the CDC are in place, and renewed every five years. These “blueprints for action” identify how the burden of cancer in each geographic area can be addressed in ways specific to each region.

Much remains to be accomplished, but in the United States overall, cancer rates are declining nationally for the first time in history, as a result of risk reduction, education, early detection advances, and novel treatments based on good quality research.

About the Author

Jane Collingwood is a medical journalist with 17 years experience reporting on all areas of medical research for online and print publications. Jane has also worked on a range of medical studies funded by the UK National Health Service within the University of Bristol in the South West of England. Jane has an academic background in psychology and has authored books on stress management and respiratory infections. Currently she is combining journalism with a national coordinating role on the UK's largest surgical research trial.

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