Cancer Reform Strategy - NHS Cancer Screening Programmes

86 CANCER REFORM STRATEGY6.9 The Department of Health will alsowork through the National Cancer EqualityInitiative with Strategic Health Authorities(SHAs) and Primary Care Trusts (PCTs) toagree challenging goals for reducing cancermortality in every cancer network areaby 2012. These goals will pay particularattention to tackling the different forms ofinequality set out in this chapter, as ameans to reducing overall mortality. Theprogress made by each PCT, cooperatingthrough the cancer network, in meetingthese goals will form an important part ofour ongoing action to reduce cancerinequalities.6.10 The National Audit Office is funding adedicated post in the Cancer Action Team todrive forward equity issues. This person willwork closely with the National Cancer Directorin developing the National Cancer EqualityInitiative.6.11 The Department of Health will alsocontinue to encourage innovation intackling inequalities through its Section 64grant programme. Currently 36 percent ofgrants on cancer programmes address equalityissues. 346.12 The UK National Screening Committee isconducting an equality review within thenational screening programmes, including thosefor cancer. As a result of this review, the UKNational screening Committee will considerwhat initiatives could be undertaken to improveaccess to screening in vulnerable populations.Types of cancer inequality andrecommendations for local action6.13 Local action will also be necessary totackle inequalities. As part of the measureswe are introducing to ensure strongercommissioning, PCTs, in association withtheir cancer network, will wish toundertake a local equality impactassessment and take appropriate steps toaddress local issues.6.14 This assessment should include assessingscreening coverage rates amongst groups withparticularly poor cancer outcomes and settingout plans to improve screening coverage.6.15 If inequalities in cancer are to be reduced, itwill be important to understand the nature of theinequalities that different groups face. Furtherresearch into this will be a priority but goodcommissioners should take into account theexisting evidence, which is summarised below.Socio economic deprivationand cancer6.16 Socio economic deprivation has a markedimpact on cancer outcomes. Cancer mortality ismore than 15% higher in ‘spearhead’ PCTs thanthe national average. Although mortality fromcancer is falling across the country as a wholeand in spearhead PCTs, the gap remains wide.6.17 The increased mortality in deprived groupscan largely be attributed to:●●Higher smoking rates. Research has shownthat the substantial social inequalities in adultmale mortality during the 1990s were due tothe effects of smoking. Stopping smokingcould eventually halve this difference. 35Smoking leads to higher mortality rates frompoor prognosis cancers such as lung andoesophagus; andLow awareness of cancer and the benefits ofearly detection, leading to lower uptake ofscreening opportunities and later presentationwith symptoms when cancer develops. 366.18 The actions set out in chapters 2 and 3 ofthis strategy are intended to help address theseunderlying causes of inequality.6.19 The government has a Public ServiceAgreement ‘to reduce inequalities in healthoutcomes by ten percent by 2010 as measured byinfant mortality and life expectancy at birth’. Forlife expectancy this means ‘by 2010 to reduce byat least ten per cent the gap between the fifth oflocal authority areas with the lowest lifeexpectancy at birth and the population as awhole’. Reducing inequalities in cancer will play amajor part in achieving this goal. The Departmentof Health will continue to monitor the gap in