The pattern of British illness has changed out of all recognition over the past few generations as new diseases have replaced killer infections, and new treatments and knowledge help keep us from death’s door for longer
Last week was one of considerable medical hype. According to doctors gathered in Chicago at the American Society for Clinical Oncology conference, a new phase had been entered in the battle against cancer, thanks to drugs that could boost the immune system’s ability to attack tumours.
The bid to conquer cancer, and disease in general, is a highly complicated, unpredictable business, as mortality statistics in the UK reveal. Cancer, so feared today, was not a pressing concern a century ago. Men and women had a very different health concern to consider: infectious disease.
In the early 20th century, tuberculosis, influenza and pneumonia accounted for more than a quarter of all deaths in Britain: 25.9% in 1911. Heart conditions accounted for 14%, cancer 6%. “Death tended to come in a very different form in those days,” said Dr Carsten Timmermann, of Manchester University.
Four decades later the picture had changed remarkably. Improved sanitation and nutritional advice, vaccination programmes, antibiotics and the birth of the National Health Service produced dramatic reductions in the spread of infectious diseases. By 1951, they accounted for only 4.3% of deaths.
Around 95 out of every 1,000 children born in 1911 died before their first birthday. By 1951, the figure was nearer 30, a reduction brought about by that success with infectious diseases, and by with improvements in midwifery and neonatal intensive care. Today, four in 1,000 die before their first birthday.
In 1901, life expectancy was around 45 for men and 49 for women. By 1951, it was 66 for men and 70 for women. Effectively, an extra year of life expectancy was added for every 30 months that passed during the first half of the 20th century in Britain.
That rise, driven partially by improvements in child mortality, continued more slowly over the rest of the century as medical improvements shifted from aiding infant survival to boosting adult health, a trickier task. Nevertheless, by 2010 life expectancy in the UK was 78 for men and 82 for women, and it continues to rise.
The vanquishing of infectious disease in Britain had another effect. The lives claimed by other conditions – in particular cancer and heart disease – increased, said John Williams, of the Wellcome Trust. “If you don’t die of an infectious disease, you will still die of something else” he says. “It’s one of the certainties in life. So those who survived tuberculosis and flu eventually succumbed to something else – and very often that was cancer or cardiovascular disease, including stroke and heart attack.”
Rates of heart disease deaths between 1911 and 1951 jumped from 14% to around 45%, while cancer death rates went from 6% to 16%. In the case of heart disease, mortality rates peaked, in around 1971, to a figure of about 50% of all deaths. Today they account for around 28% of deaths, a drop that has become particularly steep in recent years.
This last trend was illustrated in a 2012 study, which found that deaths from heart attacks in England halved between 2002 and 2010, a drop attributed to healthier lifestyles, better prevention for those at risk and improved medical treatment for patients after they had suffered a heart attack – the British Heart Foundation points to the soaring use of bypass surgery and medicines to control blood pressure and cholesterol levels.
And then there is cancer, now the UK’s major killer. Today it accounts for 29% of all deaths, a remarkable transformation from 1911 when it was not even among the top five causes of death. The widespread take-up of cigarette smoking last century has certainly played a key role in this rise, triggering millions of cases of lung cancer, which are only now tapering off for men but still continue to rise for women.
There is another issue hidden in statistics, however, as Paul Workman, head of the Institute of Cancer Research, makes clear. “Cancer deaths overall may be high but we should note that 50% of cancer patients today are still alive 10 years after their condition was first spotted. Forty years ago that figure was around 25%.”
There is considerable variation among cancers, of course. Prostate and lung cancer survival rates have improved very little in the past 40 years. By contrast, childhood leukaemia has seen a vast improvement. Survival rates for acute lymphoblastic leukaemia are now around 90%. Sixty years ago, very few children survived the condition. Breast cancer has also shown a huge improvement, the five-year survival rate for women having risen from 53% in 1971 to 87% in 2011.
Workman identified a sequence of breakthroughs that have brought about these improvements. “A century ago, we relied on surgery and radiotherapy. Then chemotherapy was introduced in the 1950s. That was a significant breakthrough. Then, in the 1990s, another significant step was taken with the development of targeted therapies, that tackle specific aspects of tumour cells – aspects which they possess and normal cells do not. Used in combination with existing therapies – in particular radiotherapy – these drugs have led to dramatic improvements in cancer survival rates.”
Nor is Workman in any doubt about the value of the new immunotherapy techniques. “Like radiotherapy and targeted therapies, immunotherapy is going to be a game-changer. It has already showed great promise in treating advanced melanomas.”
The only issue is that of cost. At £100,000, these new drug regimes are too costly for even the US health system to support. “There will have to be a discourse between governments and drug companies very soon to get this right,” Workman concluded.
In the battle against killer diseases, we are making progress. But it comes at a high price and, as we live even longer, with new challenges attached.
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