Latest data on CUP incidence and mortality

January 3, 2017

Cancer Research UK do a great job in presenting cancer data drawn from the Office of National Statistics. The data on CUP is now presented in a very visible way. You can view it here. You need to remember that the data are for the latest year available and this is 2014.

The main points are:

• UK CUP incidence is down in comparison with 2013 from 9274 to 8930. That is 24 cases diagnosed every day accounting for 3% of all new cancer cases in the UK (2014).  There were around 4,300 males and 4,600 females diagnosed with CUP in the UK in 2014.  Almost 6 in 10 (56%) CUP cases in the UK each year are diagnosed in people aged 75 and over (2012-2014). The good news is that over the last decade CUP incidence rates have decreased by more than a third (35%) in the UK. The decrease is slightly larger in males (38%, almost two-fifths) than in females (34%, around a third).  CUP in England is more common in people living in the most deprived areas.
• UK CUP mortality is down only slightly at 10142 compared with 10406 the previous year. This represents 28 deaths a day and 6% of all cancer deaths in the UK (2014).  In males in the UK, there were around 4,900 CUP deaths in 2014; in females in the UK, there were around 5,300 CUP deaths in 2014.  More than 4 in 10 (44%) of CUP deaths in the UK each year are in people aged 80 and over (2012-2014). Since the mid 1990s CUP mortality rates have decreased by more than two-fifths (42% decrease) in the UK. The decrease is larger in males (48%), than in females (37%).  In the last decade CUP mortality rates have decreased by almost a third (31%) in the UK. The decrease is similar in males (33%) and females (30%). CUP deaths in England are more common in females living in the most deprived areas.

Comment. Based on the 2014 figures, 1 in 64 people in the UK will be diagnosed with CUP during their lifetime. It is a much bigger ‘problem’ than many clinicians and the general public recognise.  CUP remains as the 5th highest attributed cause of UK cancer deaths after Lung, Bowel, Breast and Prostate cancers. There is positive news in that incidence and mortality are declining and we would expect this trend to continue and, in the case of incidence, accelerate. The discrepancy where mortality exceeds incidence each year is probably unique to CUP. There are various possible explanations but one logical explanation is that for elderly patients, presenting with an uncertain cancer and co-morbidities, it is inappropriate to try and determine site specificity through invasive or uncomfortable testing. Therefore, it may be a ‘diagnosis of convenience’  for death certificate recording. The advent of the NICE Guideline on CUP in 2010, that has led to improved diagnostic processes, is probably having an impact on the decline in incidence as are improved imaging techniques. Our view is that the decline is far too slow and that the use of multidimensional tumour profiling  – histopathology + molecular profiling  – early in the patient pathway would be cost effective and reduce CUP to all but the most intractable cases very rapidly.  The standard treatment for the UK patient is based on the pathology of the tumour (from the biopsy) plus the clinical features. Molecular Profiling (presently not funded by the NHS) is increasingly viewed as a valid indicator of the cancer’s characteristics helping to target therapy where there is uncertainty in the standard work-up.

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