The risk of dying from cancer in England “varies massively” depending on where a person lives, according to a study that experts say exposes “astounding” health inequalities. Researchers who analysed data spanning two decades found staggering geographical differences. In the poorest areas, the risk of dying from cancer was more than 70% higher than the wealthiest areas. The findings were published in the Lancet Oncology. Overall, the likelihood of dying from cancer has fallen significantly over the last 20 years thanks to greater awareness of signs and symptoms, and better access to treatment and care. The proportion dying from cancer before the age of 80 between 2002 and 2019 fell from one in six women to one in eight, and from one in five men to one in six. However, some regions enjoyed a much larger decline in risk than others, and the new analysis has revealed that alarming gaps in outcomes remain. “Although our study brings the good news that the overall risk of dying from cancer has decreased across all English districts in the last 20 years, it also highlights the astounding inequality in cancer deaths in different districts around England,” said Prof Majid Ezzati, from Imperial College London, who is a senior author of the study. Researchers suggested that poverty and cuts to public health services, such as smoking cessation support, probably contributed to the acute differences in cancer death risk. The widest inequalities were for cancers where a person’s risk can be reduced with lifestyle changes – such as losing weight or stopping smoking – and for cancers where screening is available to help cut the odds of dying from the disease. Experts analysed data from the Office for National Statistics on deaths from 10 cancers that cause the most deaths, including cancers of the lung, bowel, pancreas, stomach and certain blood cancers, as well as prostate in men and breast and ovarian cancers in women. They looked at deaths in 314 different areas of England that took place between 2002 and 2019. The team found that the risk of cancer deaths were highest in northern cities, including Liverpool, Manchester, Hull and Newcastle, as well as in coastal areas to the east of London. For women, the risk of dying from cancer before they turned 80 ranged from one in 10 in Westminster to one in six in Manchester. The data showed that for men in Harrow the risk was one in eight men compared with one in five in Manchester. Theo Rashid, the first author of the study, who is a PhD student at Imperial, said: “The greatest inequality across districts was for the risk of dying from cancers where factors such as smoking, alcohol and obesity have a large influence on the risk of getting cancer. “Due to funding cuts, many local authorities have reduced their budgets for smoking cessation since 2010. Our data shows we cannot afford to lose these public health programmes and are in urgent need of the reintroduction and strengthening of national and local policies which combat smoking and alcohol.” Amanda Cross, one of the study’s authors and a professor of cancer epidemiology at Imperial, said: “Access to cancer screening and diagnostic services which can prevent cancer or catch it early are key in reducing some of the inequalities our study highlights. “Those who are more deprived are less likely to be able to access and engage with cancer screening. To change this, there needs to be investment into new ways to reach under-served groups, such as screening ‘pop-ups’ in local areas like supermarkets and working with community organisations and faith groups.” David Fothergill, chair of the Local Government Association’s community wellbeing board, who was not involved with the research, said: “This report clearly illustrates the disparities in cancer survival rates across the country. We need to ensure that cancer screening services can be accessed by all communities and that everyone, regardless of their social and personal circumstance, has an opportunity to make an informed personal choice about cancer screening.”