Report shows low rate of cancer surgery in middle aged people

BMJ 2011; 342 doi: (Published 22 March 2011) Cite this as: BMJ 2011;342:d1872
  1. Helen Mooney
  1. 1London

People in their 50s are missing out on cancer surgery, according to the findings of a new report on cancer surgery rates across England.

The report, published last week by the National Cancer Intelligence Network, found that surgical rates fall off steeply with the age of the patient treated.

Its lead author, Michael Peake, clinical lead with the network, said that although the reduction in cancer surgery with age was not “intrinsically surprising,” what was “a cause for concern” was that the drop began in age groups as young as people in their 50s.

“Crucially, it raises questions about the underlying reasons for these variations and, in turn, what can be done to reduce them,” he said.

The number of patients having surgery for ovarian, kidney, and cervical cancer was much lower in older age groups. In patients aged 40-49 the proportion having surgery was 82% for ovarian cancer, 78% for kidney cancer, and 58% for cervical cancer, whereas in patients aged 80 or over the proportions were 26%, 29%, and 10% respectively.

The data also show that for cancers of the oesophagus, stomach, bladder, prostate, lung, pancreas, and liver less than 16% of patients had surgery as part of their treatment. For liver cancer, only 6% of all patients were recorded as having undergone surgery, and, with the exception of stomach cancer, less than 2% of patients aged over 80 received surgery for any of these cancers.

“For most types of cancer, surgery to remove a tumour is by far the most likely way to cure the disease compared to any other type of treatment. Surgery can also play a key role in relieving symptoms, even when the chances of long term survival are low,” Dr Peake said in a blog for Cancer Research UK (

He added that the findings raise questions about the underlying reasons for cancer surgery variations and what could be done to reduce them.

The report also showed regional variations in rates of cancer surgery. Lung cancer treatment rates are much higher in the East Midlands, Birmingham, and Merseyside than in Lancashire, Sussex, and Essex.

Sarah Woolnough, director of policy at Cancer Research UK, told the BMJ that surgery was the treatment that cured more cancers that any other. “The analysis shows surgery rates vary considerably depending on the type of cancer, a patient’s age, where they live, and whether they have a deprived or affluent background.

“These data mean we need to ask serious questions about whether ageism exists in cancer surgery. The government and the surgical community must now urgently investigate why there are such marked variations by age and region.”

Commenting on the findings, the care services minister, Paul Burstow, said, “Our population is ageing as more of us live longer—and there can be no place for age discrimination in the NHS . . . Commissioners, providers, and staff in the NHS have a responsibility to look beyond a person’s date of birth and meet the needs of older people as individuals.

“Eliminating inequalities in access to surgery is vital if we are to improve cancer survival rates. Giving clinicians access to data on variations in cancer treatment so that they can benchmark against other services is an important tool to drive service improvement,” he added.


Cite this as: BMJ 2011;342:d1872


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