Cancer care in Wales

How does cancer care in Wales measure up? Shane Doheny looks at the statistics.

With population ageing one in every two of us can expect to be diagnosed with cancer at some point in our lives. Caring for people with cancer is as important as ever. So how does cancer care in Wales compare with the rest of the UK?

Cancer incidence and mortality

According to a report by the Office for National Statistics (ONS), there is a higher incidence of cancer (excluding non-melanoma skin cancer) in Wales and Scotland than in the UK as a whole. Compared with the UK as a whole, between 2008 and 2010, 6% more men in both Wales and Scotland were registered as suffering from cancer. In Scotland 10% more women were registered compared with 3.5% more in Wales.

But looking at mortality rates (adjusted for the age profiles of the different populations), the ONS shows that mortality was highest in Scotland where 15% more men and 16% more women died from cancer, than in the rest of the UK. In Wales, mortality rates were 2% higher for men and 3% higher for women. So while relatively large proportions of the population are diagnosed with cancer in Wales, deaths caused by cancer is not so high.

Cancer screening

Diagnosing cancer early is among the most effectives ways of dealing with cancer. Following the advice of the UK National Screening Committee and the Welsh Screening Committee, NHS Wales operates three cancer screening programmes – cervical screening, breast cancer screening and bowel cancer screening. Comparing screening coverage across the UK, none of the four countries has been achieving their targets. The NHS in England achieves the highest rates of coverage for both bowel and breast cancer screening, the NHS in Wales achieved the highest rate in cervical screening.

Cancer screening uptake/coverage rates in the UK




Northern Ireland

Bowel Screening Uptake (aged 60-74, tested within 2 years) Target: 60%

52.6% (2013-14)

58.5% (2012-13)

56.1% (2011-2013)


Breast Screening Uptake (aged 50-70, tested within 3 years) Minimum Standard 70% Target 80%

72.1% (2013-14)

76.4% (March 2013)

73.5% (2010-13)

72.3% (Sept 2012)

Cervical Screening coverage (aged 25-64, tested within 5 years) Target 80%

78.4% (2014)

78.3% (March 2013)

70.7%1 (March 2014)

78.0% (2011-12)

1 In Scotland, cervical screening is offered to eligible women aged 20-60 every three years. This figure shows the proportion of eligible women screened in the previous 3.5 years.

2 In Northern Ireland, the Ministerial target for Bowel Cancer screening coverage is 55%

Recent work by the NHS in Wales has aimed to increase the rate at which cancers are diagnosed quickly.

Waiting for cancer care

A key question for cancer patients is how long they must wait to be treated by the NHS. All four countries use a 62 day and a 31 day target. The 62 day target is aimed at GP referrals of patients with suspected cancer. The 31 day target is for the time between receiving a confirmed diagnosis of cancer and the start of cancer treatment for all patients.

Comparing the performance of health services in the UK on these targets, it is clear that the NHS in Scotland and England are close to, or exceed, their 62 and 31 day targets. The NHS in Wales is doing better than the health service in Northern Ireland but it falls well short of its 62 day target. The NHS in Wales is actually outperforming NHS England on the 62 day target, but as NHS Wales sets a higher target, its performance looks worse.

62 day target

31 day target


83.9% (quarter ending March 2015 – target 95%)

96.1% (quarter ending March 2015 – target 98%)


83.4% (2014/15 – target 85%)

97.7% (2014/15 – target 96%)


94.2% (quarter ending December 2014 – target 95%)

97.5% (quarter ending December 2014 – target 95%)

Northern Ireland

62.5% (September 2014 – target 95%)

95.1% (September 2014 – target 98%)

The Cancer Drugs Fund

There have been calls to introduce a Cancer Drugs Fund in Wales since the Conservative Liberal Democrat Coalition Government introduced one in England in 2010. The Cancer Drugs Fund is expected to provide £340m to the NHS in England in 2015/16. This is to enable access to drugs not currently funded by the NHS. These are drugs that have not yet been appraised by the National Institute for Health and Care Excellence (NICE), or that NICE have concluded are not cost effective for use in the NHS.

In Wales the focus has been on making it easier to get funding for medicines for rare diseases and end of life care. The All Wales Medicines Strategy Group (AWMSG) has developed a Patient Access Scheme to provide Welsh patients access to drugs that have not been approved by NICE by improving the cost-effectiveness of the medicine. The AWMSG is also piloting a process which provides patients with medicines for rare diseases.

Still, the main way cancer patients in Wales access high cost drugs is by making an Individual Patient Funding Request. Each Health Board operates its own process. The Welsh Government rejected a recommendation from the National Assembly’s Health and Social Care Committee to establish a national panel to consider such funding requests. This means that access to some drugs will continue to depend on where people live.

Overall, the numbers suggest that NHS Wales is managing care for cancer patients quite well. Surveys of cancer patients add to this positive picture. But there is room for improvement.

Let’s talk cancer, which launched on Monday, is an online project where cancer patients and their loved ones are being asked to post their experiences and their ideas for making care better in Wales. The project aims to get patients and their loved ones to suggest the areas where there is room for improvement and how to make it happen. To take part visit

Dr Shane Doheny is a Research Associate at the Institute for Medical Genetics at Cardiff University.

8 thoughts on “Cancer care in Wales

  1. ‘Surveys of cancer patients add to this positive picture.’

    How many of those that died were included within this survey?

    Wales cannot keep subjecting its citizens to myth upon myth just because it suits ‘the narrative’. It’s time we woke up and smelt the coffee …….. no matter what we got taught in school!

  2. I wish people on the payroll would stop talking about cancer as if it is one disease.

  3. Everybody probably generates ‘cancer’ cells that have the ability to evolve/mutate into ‘tumours’ all the time, every minute of the day, all through your life even though they aren’t detected or mopped up by the immune system. Cancer is not a ‘disease’ as such if you want to use exact terminology. Cancer cells are just not recognised by your own immune system because they are still ‘you’ and are thus ‘autoimmune’.
    Abnormally functioning mutated cells, which are generated all the time in small numbers, have defects (in their DNA) that means they don’t live very long in the relatively hostile environment of the blood stream (too much oxygen) but some, if they find or drift into, in the few minutes after mutation, a small corner of your body that has the right environment for them to ‘get a grip’, may go on to form a tumour. The conditions that favour the cancer cells (anaerobic) to ‘get a grip’ may often be related to the condition of your blood and its ability to coagulate. Thus drinking alcohol, smoking, obesity, and other delightful habits that we all indulge in all affect the ability of your blood to coagulate and cancer cells will thrive in small little microclots in stressed parts of your vital organs. They get stuck into you by what is known as ‘angiogenesis’ which is how cancerous cells will develop its own blood supply to create a protective cocoon around itself. That is why so much ‘research’ is going into ‘anti-angiogenesis’ drugs by BigPharma. This is despite the knowledge (to haematologists) that the most effective ‘anti-angiogenesis’ (and thus anti-cancer) drug is… wait for it, aspirin! This anti-factor XIIIa agent is of no interest to BigPharma because they can’t make any money out of it.
    So can you avoid cancer? No. Most people’s lifestyle, in this country, mitigates against the eventuality/certainty that a cancer cell will find a cosy little microclot to sit in and evolve. This is why they keep telling us that one in two people will have cancer at sometime in their lives usually at the end where autopsies find that older cadavers are often riddled with tumours. The actual cause of death is usually something else like a viral infection, or heart/organ failure.
    So do I have hope and expectation that we can ‘conquer’ cancer? No. But I am very hopeful that it can be ‘treated’, ameliorated and we can live with it often to an age as long as we would normally live. Might be a good idea though to cut down on the chip butties.

  4. When do facts become myths Karen? When they don’t fit your prejudices?

    This is of course a partial picture. The Welsh NHS is relatively good at many sorts of cancer treatment. It is relatively poor at some other stuff.

  5. Correction to my earlier comment. Cancer is not an ‘autoimmune’ condition. Cancer cells are generally ‘immune’ because they are recognised as ‘self’. MS and similar are ‘autoimmune’. My bad.

  6. My husband died of lung cancer 3 years ago and so I am commenting from one, subjective experience of one type of cancer and its treatment in Wales. What was not so good was the process of diagnosis; hospital based treatment, once you were ‘in the system’ was excellent and access to chemotherapy locally was a great bonus; support and back up services in the community/home were less well organised but were very good when you could access them; there is a great reliance on voluntary sector services – MacMillan in hospital and hospice organisations for end of life care and it is unclear how the system would survive without them.

  7. I had an early stage invasive breast cancer diagnosed and treated last year after a suspicious mammogram.
    I nearly didn’t bother to go for the scan, because mammograms are uncomfortable and the advice about whether they are beneficial or not is fatally hesitant and confusing. Certainly my GP would never have detected it because I had no symptoms, other than unexplained tiredness, and no “lump”. But even I could see it on the screen, and a biopsy was done within an hour after a check mammogram.

    All the tests and treatments, as well as the patient care, at Singleton Hospital were excellent, especially the availability of the patient hostel during radiotherapy, but the timetable slipped quite a lot, which was scary.

    Most people in Wales are completely unaware that diet and lifestyle are implicated in around 40% of cancers, and that essentially the same evidence-based dietary and lifestyle advice will lower your risk of developing many cancers, cardiovascular disease, diabetes AND dementia. There is still terrible fatalism around cancer. Better public health advice and better ways of delivering it – are needed, as well as the inclusion of dieticians in GP and oncology teams, not just in self-help centres such as Maggie’s, excellent though they are – but stable doors come to mind….

  8. Agree with many of Chris and Alayne’s comments. After a year of to-ing and fro-ing to various docs with a persistent tickly throat (diagnosis – “some sort of allergy”) I finally saw a GP who actually took the time to read my notes and ask questions. She said she thought she knew what it might be – as did I by that time – and advised paying privately to immediately access a certain Oncologist to avoid what she considered to be a further dangerous delay, which I did. Within a week I’d seen him and had a biopsy at UHW which revealed a carcinoma on the vocal cord. 7 weeks radiotherapy and Cetuximab treatment commenced shortly after at Velindre. I have to say the care and teamwork from everyone involved was absolutely exemplary and I felt in VERY safe hands. The problems only started occurring once I had stopped treatment and was out of Velindre. I had a severe reaction to the Cetuximab and many side effects which were difficult to deal with, and it was quickly apparent that I appeared to fall between health boards (Bro Taf and Cardiff) due to my postcode as regards needing a community nurse to visit. There was no consistency of information, when I needed a nurse to come out it was sometimes impossible to get through or I was told I was not in their region, calls were either not returned or returned days later and the information systems didn’t seem to talk to each other so I was often given conflicting advice – if any. The two Macmillan nurses were wonderful, but so overstretched that again it was usually difficult to get hold of them. Had my partner, who lives 25 miles away, not been given compassionate leave by her employer (the NHS!) to stay and look after me I would have quickly sunk. The UHW speech therapists were fantastic, but dieticians advice I think questionable – only focussing on putting back weight lost via any means possible, which included additive and sugar laden foods such as McDonalds milk shakes, with no regard to the role inflammation has been shown to play in cancer. When I finally read the ingredients of the sickly drinks I was prescribed I threw them away and stuck to home made veg soups made by my partner, although for the next few months it took me over an hour to get a small bowl down as swallowing was extremely painful – I refused to have Fresubin pumped into me via a stoma, which is what they recommended. There was zero awareness of and no advice given on the benefits of organic and natural cancer killing foods such as turmeric, green leaf veg and green tea – which I found extraordinary – and although the subsequent bimonthly checkups have generally been thorough, it is only on the rare occasions when I get to actually see my oncologist that my questions are adequately answered, some lateral thinking is applied without the usual array of prescription drugs being doled out to treat the symptoms and not address the possible causes, futher treaments are proposed, and I again feel I am in the best pair of hands. It is only through my own research that I have identified and eat the best foods I can to avoid the possibility of recurrence in the future, and have a pretty healthy anti-cancer food regime going. I’m very aware I’m lucky to have had a partner to look after me otherwise the story would have been very different, but I do think aftercare can be very random and there is zero advice on how to remain as healthy as possible post-treatment as regards diet and lifestyle. The only actual “advice” I was given was “avoid smoky places”…not particularly helpful.

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