Comparison of cancer deaths in England and Wales and the developed world by age and gender 1973-92, and, new malignancies in England and Wales 1971-88.

Cancer deaths in England and Wales and the developed world were examined by age and gender between 1973-1992. Whilst over-all mortality levels increased, this was mainly linked to extended longevity, as the rate fell substantially for people under 55 in the majority of countries, possibly as a result of improved treatment and prevention outcomes. Whilst England and Wales had above average reductions in cancer deaths, especially for children, there were considerable rises in new malignancies, 1971-88, particularly amongst women under 35 years, and in certain selected sites. These over-all changes do not appear to be the result of improved diagnosis, thus, despite evidence of more effective therapeutic and preventative measures the incidence of new malignancies is increasing. The possible implications are briefly discussed, in the context of "medical audit', which increasing uses mortality rates as "indicators of effectiveness'.