Variation in prostate cancer mortality rates in England


According to a report in the Daily Telegraph this morning, there is significant variation is prostate cancer mortality rates across England.

In Barnsley, a a former industrial town in the north of the country, built on coal mining and glassmaking during the Industrial Revolution, the annual rate of death from prostate cancer is 37/100,000 population. By contrast, in Waltham Cross, a largely middle-class town just to the north-east of London, the annual mortality rate is only 10/100,000.

Now there is a multitude of possible reasons for this variance in mortality rates across England, and it would be completely misguided to simply think that people in Waltham Cross are — for some reason — getting better care for prostate cancer than their peers in Barnsley. However, this degree of variance does prompt questions about why it is occurring, and The “New” Prostate Cancer InfoLink thinks that these data actually suggest some possibility to study and report on the potential reasons for this variation.

The article in the Daily Telegraph states that the average annual prostate cancer mortality rate across all of the primary health trusts in England is actually 24/100,000. This mortality rate is actually slightly lower than the 25.6/100,000 reported for men in the US between 2002 and 2006. The fact that the two mortality rates are so similar does, of course, have some relevance to the constant question regarding the over-treatment of men with prostate cancer in the USA.

11 Responses

  1. I can’t see any reason to find these figures unusual – the average between the two is 24 which crudely ties in with the average for the country as a whole.

    The figures for the US is 25.6. It wouldn’t surprise me at all if you took the highest figure for a US city/state/whatever and took the lowest figure in the US, you would have a similar difference, if not a wider difference.

    To cherry-pick stats is a misleading journalistic annoyance for their readers.

  2. Richard:

    Of course there is variation. That isn’t the issue. The issue is whether there are correctable reasons for the degree of variation. For example, are there specific environmental or other reasons why mortality rates in Barnsley are more than 50% higher than the national average? And no one is “cherry picking” statistics here. This is about the range of the mortality rate — from a low of 10/100,000 in Waltham Cross to a high of 37/100,000 in Barnsley.

    And just so that we are clear, there are certainly similar ranges in the US, and in the US we know that at least part of the reason for that range is because of significant variation in treatment patterns.

  3. Mike, I wonder if the article reports the source of the data. The WHO data for the UK in 2006 (last year reported) reports a rate of 33.9/100K with 10,052 deaths.

    For the USA, the WHO database reports 19.8/100K with 28,905 deaths reported during 2005 (last year reported). There seems to be a great discrepancy in these figures.

    By the way, the WHO database reports a rate of 21.5/100K for the USA in 2001.

  4. The article in the newspaper did not give the data source.

    You have to be very careful with incidence and mortality data. Look at this page (just as an example) and you will see that there is a critical distinction between crude mortality rates per 100,000 men and age-adjusted mortality rates per 100,000 men using a standardized European model for computation. I have no idea whether the European age-adjustment model is the same as the age-adjustment model used in the USA.

  5. All of which goes to show why population-based figures can accurately be described as “elastic.”

    Any chance of Barnsley being the local medical centre for the country around the town and no large hospital in Waltham Cross? At a guess I’d say that the mortality rate reported in the area of London where the largest prostate cancer-treating hospital is located would have a higher death rate.

  6. Barnsley is closer to the Sellafield nuke power station than Waltham Cross. Radiation is a cause of prostate cancer.

    It may be the cause of the discrepancy.

  7. I can’t address the rates in England but in the US the rates tend to be higher in the south and in Virginia they tend to be higher in areas with a higher Black population or in rural areas. Race, access to care, and education/income seem to be the three factors that impact on these rates. It would be interesting to know if the same three factors are in play in these two regions in the UK.

  8. Terry:

    As explained to us at a recent meeting by the person responsible for the numbers in Virginia, looking at gross death rates is meaningful for large groups (e.g, the US, England, Australia, Virginia) but when looking at smaller areas with less population (e.g., Essex County, Virginia), the gross rate loses meaning and in those area the meaningful statistic is the age-adjusted mortality rate.

    It is an attempt to make the statistic more relevant and less elastic.

  9. The Telegraph article says that “one in three men who develop the disease will go on to die from it.” I’m certainly not an expert on this, only a patient, but that figure does seem very high and I wonder if it is correct.

  10. It certainly is NOT the case in the USA, where only about 2 or 3 men in 100 who are diagnosed with cancer actually die from it. My suspicion is that it may be slightly higher in the UK, but probably nothing like 1 in 3. In fact 10-year survival rates for prostate cancer in England alone rose from 21% in the mid-1970s to around 60% for men diagnosed in 1996-2000 and are still believed to be rising. (See information on the Cancer Research UK web site.)

    What is certainly true is that there are around 35,000 new cases of prostate cancer diagnosed in the UK each year and that about 10,000 men die from prostate cancer each year, but of the 35,000 men being diagnosed in 2010, most aren’t going to die of prostate cancer at all, and many of the 10,000 that will die this year were diagnosed > 10 years ago.

  11. That is why the elasticity in the numbers is avoided when using prostate cancer deaths vs male population in a given year. Men diagnosed with prostate cancer in the UK do not die at a 25% rate. The rate is one third of that or 5/100.

    Using round, rough numbers:

    • UK male population: 30MM
    • UK prostate cancer deaths: 10,000
    • US male population: 150 MM
    • US prostate cancer deaths: 30,000

    Therefore:

    • UK mortality rate = 10,000/30MM x 100 = 3.33%
    • US mortality rate = 30,000/150MM x 100 = 2%

    If 2/100 die of prostate cancer in the US, then 3.33/100 die in the UK, i.e., the US mortality rate is 60% of the mortality rate in the UK, using this method of calculation.

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