Cancer services in Scotland

People’s identities, and the circumstances that shape their behaviours and experiences, are complex. Many people will belong to multiple demographic groups, and this may mean they face numerous barriers to good health, resulting in health inequalities. This report, released in November 2022, focuses on inequalities in relation to deprivation across the cancer pathway in Scotland. It is one of the most influential factors in driving differences in cancer incidence, diagnosis and outcomes in the UK.

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Smoking is the biggest cause of cancer in Scotland, being responsible for nearly 1 in 5 cases (1). smoking rates in the most deprived populations have consistently been much higher than in the least deprived (2). A ‘tobacco-free’ target of less than 5% of adults smoking by 2034 has been set in Scotland (3). This target will not be met without sustained efforts to reduce smoking in more deprived groups. In 2019, 32% of people in the most deprived quintile smoked, compared to 6% in the least deprived (4). Unless bold action is taken, smoking prevalence for the most deprived groups may not reach even 10% in the next 25 years.

rates_of_smoking_by_deprivation_for_adults_scotland_2003_-_2018_projected_to_2040.png

Overweight and obesity is the second biggest risk factor for cancer in Scotland after smoking, with nearly 7% of cancer cases each year in Scotland caused by excess weight (1). Current projections indicate that the adult obesity prevalence is likely to decrease from 22% in 2019 to 19% by 2040 for the least deprived quintile but increase from 36% to 41% over the same time period for the most deprived.

obesity_bmi_30_prevalence_by_deprivation_for_adults_scotland_2003-2019_projected_to_2040.png

Our Recommendations:

The Scottish Government must ensure that its next tobacco strategy includes bold measures to reduce smoking and inequalities. We need more government action to ensure young people don’t start smoking, and more funding for the measures and services needed to help people quit. A Smokefree Fund – making the tobacco industry pay for the harm it causes, but without their influence on how the money is spent – is needed. We encourage the Scottish Government to work with the UK Government to make this happen.

Reducing obesity levels requires a comprehensive approach that addresses its environmental causes, improves the availability of healthy food and drink options, empowers people to make and maintain healthier habits and provides evidence-based interventions to those who need it. The Scottish Government must fully implement the measures outlined in its obesity strategy, including the forthcoming legislation restricting price promotion offers on unhealthy food and drink.

References

1. Brown KF, Rumgay H, Dunlop C, Ryan M, Quartly F, Cox A, et al. The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015. Br J Cancer. 2018;118(8):1130–41.
2. Cancer Research UK. Smoking prevalence projections for England, Scotland, Wales, and Northern Ireland, based on data to 2018/19. 2020 Feb. https://main.int.cruk.org/20 sites/default/files/cancer_research_uk_smoking_prevalence_projections_february_2020_ final.pdf
3. Scottish Government. Creating a tobacco-free generation: A tobacco control strategy for Scotland. 2013. https://www.gov.scot/binaries/content/documents/govscot/ publications/strategy-plan/2013/03/tobacco-control-strategy-creating-tobacco-freegeneration/documents/creating-tobacco-free-generation-tobacco-control-strategyscotland/creating-tobacco-free-generation-tobacco-control-strategy-scotland/ govscot%3Adocument/00417331.pdf
4. Scottish Government. Scottish Health Survey 2019. 2020 Sep. http://www.gov.scot/ publications/scottish-health-survey-2019-volume-1-main-report/

The Strategy’s 10-year vision for health service is that more cancers are prevented, and our compassionate and consistent cancer service provides excellent treatment and support throughout the cancer journey, and improves outcomes and survival for people with cancer.

There are 11 ambitions of this Strategy, split into Pathway:

1. Preventing More Cancers
2. Earlier and Faster Diagnosis
3. Best Preparation for Treatment
4. Safe, Realistic and Effective Treatment
5. Excellent Care and Support after Treatment

And Cross-cutting:

6. Sustainable and Skilled Workforce
7. Person-Centred Care for All
8. Tackling Inequalities
9. Mental Health as part of Basic Care
10. Flourishing Research and Innovation
11. Cancer Information and Intelligence-led Services

There are also 7 outcomes:

1. Reduced relative population burden of disease
2. Reduced later stage diagnosis
3. Timely access to treatment
4. More people receiving curative treatment
5. Improved experience of services, across all areas of care
6. Optimised quality of life for each individual
7. Embedded research, innovation & data capture in all services

Which all contribute to tackling inequalities, with the overall Strategic Aim being to Improve cancer survival and provide excellent, equitably accessible, care.

scotland_cancer_stats.png

Every day, 94 people are diagnosed with cancer in Scotland and around 45 people die from the disease. (1) The number of cases is projected to rise by more than a quarter, to around 42,100 new cases per year in 2040. (2)

Smoking levels are at their lowest recorded point – around 16% of the Scottish adult population smoke. (3)  But levels are not declining fast enough. Scotland is not on track to be smoke-free (less than 5% smoking prevalence) by the 2034 target. It will not reach 5% average adult smoking prevalence until after 2050 (4). Meanwhile, overweight and obesity is at its highest recorded level – almost 7 in 10 (66%) adults are overweight or obese. (5) If current trends continue, by 2040, 3.2 million people will be overweight or obese. (6)

The Scottish Government needs to commit to:

• Funding: the strategy must be backed up with significant funding to help ensure it delivers the meaningful improvements people affected by cancer deserve, as well as gain the confidence of the cancer community and wider public. Investment is needed to improve patient outcomes and unlock the benefits of innovative approaches and increased efficiency.
• Action on workforce: the Scottish Government must set out long-term plans to deliver a sustained expansion of the cancer workforce to meet future demand for cancer services and tackle the chronic shortages in the workforce specialities key to diagnosing and treating cancer. This must be matched with sufficient and sustainable capital funding to ensure diagnostic and treatment capacity is meaningfully expanded across Scotland.
• Better use of data: data is fundamental to driving our progress against cancer. The Scottish Government should prioritise making improvements in the collection and reporting of datasets to unlock better intelligence and data-driven action in the years to come.

Find the report here: https://main.int.cruk.org/health-professional/our-reports-and-publications#cancerUK

References

1. Public Health Scotland (2021) Cancer incidence in Scotland. [Cited January 2023]. Available from: https://publichealthscotland.scot/publications/cancer-incidence-in-scotl...
2. Cancer Intelligence Team, Cancer Research UK. February 2023. Cancer incidence and mortality projections for UK and constituent nations, using data to 2018.
3. Scottish Government. The Scottish Health Survey, 2019. [Cited January 2023]. Available from: https://www.gov.scot/ collections/scottish-health-survey/
4. Cancer Research UK (2020) Smoking prevalence projections for England, Scotland, Wales and Northern Ireland, based on data to 2018/19. Available from: https://main.int.cruk.org/sites/default/files/cancer_research_uk_...
5. Adults aged 16+. Overweight or obese is defined as Body Mass Index (BMI) 25 or above. Based on overweight and obesity prevalence in Scotland Scottish Government. The Scottish Health Survey, 2019. Available from: https://www.gov. scot/collections/scottish-health-survey/
6. Cancer Research UK (2022) Overweight and obesity prevalence projections for the UK, England, Scotland, Wales and Northern Ireland, based on data to 2019/20. Available from: https://main.int.cruk.org/sites/default/files/cancer-stats/adult_... projections_18-05.pdf