Geographical variation in the standardized years of potential life lost ratio (SYPLR) in women dying from malignancies of the breast in England and Wales

Abstract

Summary Geographical variation in the standardized years of potential life lost ratio (SYPLR) in women aged dying from breast cancer has been mapped by local authority district in England and Wales and compared with the variation as described by the standardized mortality ratio (SMR). The geographical distribution of areas of low and high SMRs is similar to that observed some 15 years earlier, showing an increase from north to south. In contrast, the pattern of SYPLRs shows a less obvious trend. Years of life lost because of breast cancer mortality were particularly high in eight of the 401 county districts (SYPLR 1.22-1.48) and particularly low in nine (0.60-0.86 In England, the prevention and early detection of breast cancer in women is one of the five key areas for the Health of the Nation, an initiative put forward by the British government with the strategic goal of improving health through prevention and promotion (Department of Health, 1992). In England and Wales, 1 in 12 women develops breast cancer and, in 1988 alone, almost 27 000 new cases were diagnosed. This is approximately double the number of new cases of the next most common tumours, i.e. colorectal and lung, which affect both sexes (Thames Cancer Registry, 1994). Of the 13 663 women who died from breast cancer in 1992, 60% were under 75 years of age (Office of Population Censuses and Surveys, 1994).In setting up objectives and target outcome for cancer as one of the key areas for Health of the Nation action, mortality and cancer incidence data were used to obtain age-standardized indicators However, there has been some concern over the use of the standardized mortality ratio (SMR) in this context.Thus, the use of years of potential life lost (YPL) has been prop.osed (Dempsey, 1947; Greville, 1948;Haesnzel, 1950). This measure provides an indicator which gives more weight to deaths occurring at younger ages, thus emphasizing the impact of premature mortality (Romeder and McWhinnie, 1977). Such a measure reflects, in some sense, consequent social, family and economic burdens. It has been employed to investigate variation in accidents (Centres for Disease Control, 1991) and AIDS/HIV (Saunders et al, 1990) as well as cancer (Stocks, 1953;Horm and Sondik, 1989 Mapping of disease indicators has always been an important tool for epidemiologists, public health physicians and health care planners, especially when examining the geographic variation in cancers (Howe, 1989;Stocks, 1936) for clues to aetiology or to facilitate allocation of resources.In this paper, we use the standardized years of potential life lost ratio (Haesnzel, 1950) (SYPLR), denoted the SYLL ratio by Marlow (1995), as a summary measure of the impact of premature mortality from breast cancer in women aged 20-74 years and investigate its geographical variation in England and Wales among 403 local authority districts. This age group was chosen as death from breast cancer in women under 20 is rare and the majority of women remain independent (healthwise) up to the age of 75. We also ...

Geographical variation in cancer survival in England, 1991-2006: an analysis by Cancer Network

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“…This broadly confirms the findings of previous studies that have pointed to the north–south divide in cancer survival in England. 5 6 27 28 …”

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