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Cancer Inequalities in Wales (Part 2)

In the first of these two blogs, we discussed the inequalities in cancer statistics across Wales and how disparities in primary care services contribute to these inequalities. In this second blog, we will cover some of the lifestyle factors highlighted in the Cross-Party Group on Cancer report and other areas of healthcare services where inequalities exist, along with some of the other measures suggested by Cancer Research Wales to enact positive change.

The cancer statistics discussed in our first blog paint a clear picture of the inequalities across Wales. The explanation for this situation is multi-faceted and complex, with different factors having greater or lesser influence in different areas. The Cross-Party Group on Cancer report highlights two key lifestyle factors that account, at least in part, for the discrepancies between high and low deprivation areas.

Smoking has long been acknowledged as one of the biggest risk factors for developing a range of cancers, most pertinently lung cancer. In fact, it is estimated that smoking is the direct cause of around 3100 cancer cases in Wales each year, representing over 15% of all cases. The impact of smoking-related cancer is felt most keenly in deprived areas, where the rate of smoking is 4 times higher than in the least deprived areas. Encouraging changes to smoking behaviours in deprived communities would help to prevent many cancer cases each year and start to reduce the stark inequality in cancer incidence. Key to this will be the proposed lung cancer screening programme, due to begin a pilot in Cwm Taf Morgannwg University Health Board this year, which is targeted to high-risk individuals and will incorporate smoking cessation advice into its delivery.

Obesity is an increasingly common phenomenon in Wales, with around a quarter of adults currently classified as obese – if the current trend continues, there will be as many obese people as those of healthy weight in around 20 years’ time. Being overweight or obese is linked to an increased risk of cancer development and it is estimated that obesity is directly responsible for around 1000 cancer cases each year in Wales, a number that will rise if current trends persist. The proportion of people who are obese is higher in the most deprived areas of Wales, with a difference of 9% compared to the least deprived areas, meaning these preventable cancer cases are contributing to the huge inequality.

Screening programmes exist in Wales for bowel, breast and cervical cancers, and represent an important way to diagnose these cancers as early as possible. However, screening can only detect cancer if people attend their appointments and have the appropriate tests conducted. Between the most deprived and the least deprived areas of Wales, there is significant variation in the proportion of people who attend their screening appointments, with those from highly deprived communities less likely to attend – this is most clearly seen for breast cancer screening, where there is a difference of almost 20% in screening uptake. The reduced number of screenings conducted mean that early cancers are missed and cancer is more likely to be diagnosed at an advanced stage, decreasing the chance of surviving. 
Cancer Research Wales believes that GP practices should take more of an active in role in supporting national cancer screening programmes through targeted letters sent to people who have missed their initial screening appointment. This simple measure, if employed across Wales, would help to increase engagement with screening programmes and begin to close the gap between most deprived and least deprived areas.

Once cancer is suspected, diagnosis must be confirmed by appropriate tests. However, access to these diagnostic tests has become increasingly delayed, with a backlog exacerbated by the COVID-19 pandemic. One key example is colonoscopy services, which are the gold-standard diagnostic tool for bowel cancer – as of May 2023, over 8100 people are waiting for a colonoscopy in Wales and shockingly around 3500 of those people have been waiting for over 14 weeks, with some waiting considerably longer. Such delays lead to more advanced cancers being diagnosed and worse outcomes for patients. With bowel cancer incidence and mortality both highest in deprived communities, these delays are exacerbating an already established inequality. 
Cancer Research Wales calls on Welsh Government to provide more targeted support for diagnostic services in areas of the highest deprivation to begin to address the waiting list backlog.

Outcomes for cancer patients have been steadily improving for a number of decades, thanks to improvements both in diagnosis and treatments. These improvements are driven by research – in universities, hospitals and commercial settings, cancer research brings about new developments that save lives. For the cancer patients of today, research can most clearly be seen in the form of clinical trials, which offer access to innovative treatments that can have dramatic benefits for some patients. It is well-established that health boards which conduct more research have better patient outcomes, even for those patients not taking part in the research themselves. However, access to clinical trials and other research work is limited or non-existent for many people in Wales.
Therefore, Cancer Research Wales calls for Welsh Government to provide the necessary resources for recruitment centres and trials units to increase capacity and offer more patients access to clinical trials. Furthermore, Cancer Research Wales calls for the full adoption of the One Wales Approach, in which hospitals across Wales can enrol patients to a clinical trial, which has previously been successfully implemented in the SYMPLIFY study.

Across these two blogs, we have discussed the inequalities that exist for cancer in Wales. From incidence to healthcare access, the issues are multi-faceted and will take a significant amount of time and resources to address. However, there is reason to be hopeful – Cancer Research Wales and others have proposed a raft of measures that offer the chance of making positive changes.
The Cross-Party Group on Cancer’s report brings together the evidence that the burden of cancer is not shared equally in Wales. The stark reality can be condensed into a single shocking sentence: people from deprived communities are more likely to develop cancer and less likely to survive it. This situation is unacceptable and it is incumbent on Welsh Government to prioritise addressing cancer inequalities.