Deprivation doubles cervical cancer risk

Women living in the most deprived areas of England are nearly twice as likely to be diagnosed with cervical cancer than their affluent counterparts – according to a report presented by national cancer director Professor Mike Richards at the Britain Against Cancer conference today, in London.

The report, published by the National Cancer Intelligence Network (NCIN), reveals a ‘deprivation gap’ that researchers believe is mainly fuelled by a lower uptake of cervical screening in deprived areas.

All cases of cancer diagnosed between 1995 and 2004 were included in this nation-wide analysis of the effect of deprivation on cancer incidence, including more than 25,000 cases of cervical cancer.

In the most deprived areas* of England, there were 12 women per 100,000 diagnosed with cervical cancer between 2000 and 2004. In the most affluent areas, only 6 per 100,000 women were diagnosed with the disease during the same time period.

Professor David Forman, NCIN information lead who is based at the University of Leeds, said: “These striking figures show there is still much more that needs to be done to tackle cancer in low-income communities.

“Cervical cancer is a largely preventable disease – the national screening programme will pick up most cases before they even develop into cancer. Our figures suggest that women living in poorer areas are less likely to attend cervical screening than women who are better-off, so they are more likely to develop the disease.

“Higher rates of smoking in most deprived areas and the earlier onset of sexual activity also contribute to the higher rates of cervical cancer.”

Currently, women in England aged 25 to 64 are invited for cervical screening every three to five years. In 2006, around 20 per cent of women in England invited for cervical screening did not attend, and previous research** has shown that women in deprived areas are around 40 per cent less likely to attend. Screening can pick up on important changes to cells before cervical cancer develops.

Sara Hiom, director of health information at Cancer Research UK, said: “It’s extremely worrying that your income and where you live can have such a significant effect on your risk of cancer. It’s clear that much more needs to be done to encourage women from low-income communities to attend cervical screening.”

Women living in deprived areas were 129 per cent more likely to be diagnosed with cervical cancer between 1995 and 1999. This figure was 106 per cent between 2000 and 2004. Although this drop is not statistically significant, doctors hope this downwards turn will continue.

Professor Mike Richards, who will present the report on behalf of the NCIN, said: “Reducing inequalities in cancer incidence and uptake of cancer services is a key aim set out in the Cancer Reform Strategy. Collecting and understanding data like this is a crucial first step in achieving this goal. The NHS Cancer Screening Programme is working with the Improvement Foundation, to improve the uptake of cervical screening in poor areas through targeted pilot programmes. The lessons learnt from this work due in 2009, will be shared with Strategic Health Authorities and local screening programmes to develop best practice.”

Professor Julietta Patnick CBE, director of NHS Cancer Screening Programmes, said: "This is a helpful report shedding light on the relationship between cancer and deprivation. Over recent years we have seen a downward trend in women taking up their screening invitation, especially younger women and those in deprived inner city areas, and the reasons for this are difficult to determine. Cervical screening saves around 4,500 lives a year, and it is important for women to consider this when deciding whether or not to accept their invitation."

Sara Hiom added: “Most cases of cervical cancer are caused by HPV – a sexually transmitted virus – and smoking increases the chances of the virus causing cancer. Greater awareness of the link with smoking and, most importantly, of cervical screening are all key to reducing the risk of cervical cancer in deprived areas. Cancer Research UK is investing in research to understand how to improve public health and cervical screening coverage in low-income groups.”