Two cancer inequalities we're working to close in Wales

Cancer inequalities is a term we use to refer to the unfair and avoidable differences in how cancer affects diverse groups of people, whether accessing cancer screening and diagnostic services or receiving treatment in a timely manner.

Frequently, diverse types of inequalities co-exist, making the situation worse than it already is for certain groups, with the result that these groups have worse cancer outcomes than others. 

This is why Cancer Research Wales has set reducing cancer inequalities as one of its key strategic aims.

Cancer inequalities come in many different forms and have been a long-standing issue in Wales. Worryingly, the problem seems to be increasing, with health differences in society getting worse instead of better.

Addressing cancer inequalities in neuro-diverse populations

Autism affects about 3% of the population. We know from other countries that women with autism are less likely to engage with cervical screening services. Over half of autistic women have reported never having had a cervical screen.

Engagement with screening services can identify pre-malignant changes and early-stage cancers, so that the chance of the condition ever becoming life-threatening is reduced. 

In fact, full uptake of cervical screening can reduce deaths from cervical cancer by up to 83%.

Several studies have shown that people with autism may perceive pain and the anticipation of pain differently, and that autistic people also suffer from greater anxiety when engaging with health care services.

This is why we are excited by this new funded study. By working with the autism community, we hope to identify the barriers that autistic women experience in relation to cervical screening in Wales.

These findings will inform the creation of an intervention that, when put in place, will improve existing screening pathways and services, which as a result will capture more autistic women who may be at risk of developing aggressive cervical cancer, thereby reducing deaths in the group.

Closing the gender cancer inequality gap

The above is an example of research that addresses health inequalities affecting neuro-diverse populations; however, Cancer Research Wales has also focussed on other types of cancer inequalities with lasting impact, namely cancer inequalities of gender.

Throughout the 1990s and early 2000s, it was noticed that cases of a type of head and neck cancer seemed to be increasing in younger males who did not have any of the associated risk factors, such as smoking and increased alcohol intake.

Evidence began to emerge from other countries that this type of cancer, called oropharyngeal cancer, and known to affect the tonsils, base of the tongue and soft palate at the back of the mouth, could be caused by the human papillomavirus (HPV), the causative agent of cervical cancer.

In 2008, the UK introduced the HPV vaccine for the prevention of cervical cancer, although at the time it was mainly only made available for schoolgirls between the ages of 12 and 14 years.

Cancer Research Wales funded a major initiative that set out to provide the necessary evidence needed to show that the increased cases of head and neck cancer in Wales were indeed caused by HPV.

The research, led by Professor Mererid Evans (Velindre Cancer Centre) and Dr Ned Powell (Cardiff University), was the first UK study to reveal the scale of HPV-related head and neck cancers. Their findings showed:

• Cases had trebled over 25 years, with HPV now causing more than half.
• These cancers predominantly affect younger men aged 30 to 60.
• Including other HPV-related cancers in men, such as penile and anal cancers, over 240 HPV-related cancers occur in Welsh men annually, a figure expected to rise.
• This compared to a similar number of women affected by HPV-related cancers, mainly cancers of the cervix and vulva.

Yet the availability of the HPV vaccine for schoolgirls only meant that a gender cancer inequality was created, exposing males who could and should otherwise be protected.

The evidence from the study helped transform HPV vaccination policy across the UK, as it was used to inform several parliamentary and Senedd debates over the years.

 Upon final review by the Joint Committee on Vaccination and Immunisation, which eventually recommended HPV vaccination for boys as well as girls, the study contributed to Wales becoming the first UK nation to vaccinate schoolboys against HPV, soon followed by the rest of the UK.

In our next blog we will be looking at geographical cancer inequalities and how these affect the people of Wales. You can help us continue the fight against cancer inequalities in Wales by kindly donating to our research.