Cancer and deprivation: Incidence, diagnosis, mortality

The fact that both the future Queen and the current King have been diagnosed with condition in the space of a few months certainly proves that royalty is not immune.

Since her death in 2022, it has also come to light that the late Queen Elizabeth had actually been suffering from a form of bone cancer towards the end of her life as opposed to the vague "mobility issues" conjured up by Palace spokesmen.

So, yes, cancer can strike anyone from any walk of life and any bereavement from cancer would be equally devastating to loved ones, whatever their background.

Cancer incidence rates (blue) and mortality rates (red) by most to least deprived, age-standardised per 100,000 (Image: PHS)

However, it is also true that your likelihood of ever getting cancer - or dying from it - is substantially higher the further you are down the rich-poor spectrum.

In Scotland, the most recent statistics show that cancer incidence is 32% higher for people living in the most deprived fifth of postcode areas, compared to the most affluent 20% of neighbourhoods.

In 2021, there were 754 diagnoses for every 100,000 people living in the most deprived areas compared to 571 per 100,000 in the least deprived.

This is after adjusting for the different age profiles of these populations, so the gulf remains even after accounting for the fact that people in wealthier areas live longer and therefore increase their probability of developing cancer through old age alone.

The mortality gap is even more stark. In 2021, the death rate from cancer was 67% higher in the most deprived communities compared to the least.

For both incidence and mortality, the gradient forms a steady upward trend in line with increasing deprivation.

And this is only based on splitting the population into fifths - or "quintiles".

Were you to repeat the analysis by splitting the population into tenths, or hundredths, the curve would become even steeper.

Wealth, in effect, is health.

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Some of this can be explained by differing lifestyle risks.

Rates of cigarette smoking are more than three times higher among the most compared to the least deprived Scots (25% versus 7%) and the proportion of adults considered obese is nearly twice as high (36% compared to 19%).

Alcohol-related hospital admissions - a proxy for harmful drinking - are also seven-fold higher among people living in the poorest areas.

You might argue that people can choose not the smoke, to lose weight, and not to drink to excess.

But the odds are stacked unfairly.

Off-licences and fast food outlets cluster disproportionately in poorer areas; fresh fruit and vegetables are scarcer and comparatively more expensive; and negative life experiences - from poverty-related stress to trauma - are more common, pushing people towards cigarettes, alcohol, and junk food as coping mechanisms.

Nearly one in three cancer patients in Scotland are waiting more than two months between an urgent referral for tests due to a suspicion of cancer and subsequently starting treatment following a diagnosis (Image: PA)

Having developed cancer, people in poorer areas are also less likely to be diagnosed at an early stage.

Uptake of breast, bowel, and cervical screening is lower, and there are fewer GPs per head.

As a result, someone worried about possible cancer symptoms will probably wait longer to see their GP, and thus longer for a subsequent referral onto a consultant for hospital tests.

Statistics published on Tuesday revealed that 2023 was the worst year on record for cancer waiting times on NHS Scotland.

By the end of last year, nearly 29% of cancer patients were waiting more than 62 days between being sent for tests and starting treatment. The figure is not supposed to exceed 5%.

For those able to afford private healthcare the route to diagnosis - and even treatment - can be quicker.

The last time the 62-day/31-day standards (respectively, the maximum time 95% of cancer patients should wait between being sent for tests/a decision to treat being made, and treatment starting) were both met in the same quarter was in 2012 (Image: PHS)

In 2022/23, there were 1,745 self-funded chemotherapy treatments carried out in private hospitals in Scotland, and demand for scans and scopes is also increasing.

It is also notable that the diagnoses of both the King and Princess of Wales were "incidental" following planned procedures at The London Clinic. Cancer was not suspected.

Had they been ordinary NHS patients, therefore, there would have been no reason to fast-track their treatment for, respectively, an enlarged prostate and abdominal surgery.

Currently, the median waiting times on NHS Scotland for a planned urological procedure is 209 days, while for general or gynaecological surgery (it is unclear which category the Princess' surgery falls under) it is 170 and 223 days.

We can reasonably suppose that neither Charles nor Catherine waited anywhere near this long.

In this sense, then, patients wealthy enough to skip the NHS queue for top-tier private medicine are going to be in a better position to have cancers detected unexpectedly, as a result of routine treatment, and before the disease has had a chance to spread.

This hugely improves survival chances.

The King is known to have travelled to and from London hospital appointments in the State Bentley (pictured prior to the Coronation in 2023) (Image: Getty)

While details about the types and stages of the royals' cancers have not been divulged by the Palace, Prime Minister Rishi Sunak told the BBC that the King's disease had been "caught early".

In her own statement last Friday, the Princess said she was having "preventative chemotherapy" - a precautionary course of treatment which aims to mop up any cancer cells which may have spilled out from the source tissue removed during surgery, which subsequently tested positive for cancer.

The practical and financial experiences of cancer can also vary hugely depending on people's personal circumstances.

Research by Macmillan Cancer Support previously found that 80% of cancer patients were on average £570 a month worse off following diagnosis due to loss of income and increased expenditure, including on heating and travel to hospital appointments.

While the King has been airlifted by private helicopter or chauffeur-driven in the State Bentley to his cancer treatment sessions in London, there are NHS cancer patients in Scotland who are regularly travelling 200 miles on buses or trains from the Highlands to Glasgow because they cannot see a specialist locally.

So, yes, cancer can affect us all; but, no, the experience does not fall on all of us equally.