title: Changes in cancer incidence and mortality in England and Wales and a comparison of cancer deaths in the major developed countries by age and sex 1979-2002 in context of GDP expenditure on health.
abstract: BACKGROUND
  The successful treatment of cancer is a major health and political issue for England and Wales and the major developed countries (MDCs). All malignancy deaths by age and sex are analysed to determine how successful the MDCs were in reducing cancer mortality between the end points of 1979-81 and 2000-2, and whether there was any association between each nations 'gross domestic product expenditure on health' (GDPEH) and the reduction in their cancer deaths.
  
  
  METHODS
  Incidence of cancer in England and Wales was examined for 1979-80 to 2003-4 to highlight the extent of the problem. The cancer mortality rates for England and Wales were compared with each MDC by age and sex, using 'WHO all malignancies mortality rates' for the periods of 1979-81 and 2000-2, and tests of significance were made. The GDPEH for each MDC was examined for 1980-2002, and Spearman rank-order correlations calculated to explore any association between declining cancer deaths and the GDPEH of each MDC.
  
  
  RESULTS
  Men's All Age malignancy incidence in England and Wales rose 48% and women's 51%, with notable rises for females aged 15-34 and 55-74 years.Every MDC increased its GDPEH substantially; it rose to 9.3% in the United Kingdom, but the United Kingdom still remains eighth of the ten MDCs and below the MDC average (9.85%).The average number of cancer related deaths for men in England and Wales (15-74 years) was third highest in 1979-81, but fell to eighth by 2000-2. This decline was significantly greater than in seven other MDCs. Average female death rates in England and Wales were highest both in 1979-81 and in 2000-2, but declined significantly more than most MDCs in every age band from 35 to 74 years.There was a significant correlation between reduced deaths and the level of GDPEH of each nation.Male death rates declined significantly more than that of female in each MDC, with the exception of Japan and Spain.
  
  
  CONCLUSIONS
  The rising incidence in cancer-related deaths poses a problem for every MDC, and the poorer women's results should be a matter of concern for most MDCs. The reduction in cancer deaths reflects well on frontline services, and the significant association between reduced cancer mortality and increased GDPEH is encouraging, but still a challenge for governments, especially if the incidence continues to rise.
authors.affiliation: Professor in Psychiatric Social Work, School of Health & Social Care, Bournemouth University, UK, and Emeritus Professor, School of Medicine, University of Southampton, UK. cpritchard@bournemouth.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Pritchard
authors.forename: T
authors.initials: T
authors.lastname: Hickish