Increasing cancer prevalence – the story behind the projections - Our blog

In this joint blog, two of our Consultants in Public Health Medicine, Professor David Morrison, Director of the Scottish Cancer Registry and Dr Fatim Lakha, explore the seemingly paradoxical good news within Scotland’s rising cancer statistics – and what it means for our future health and care system.

Cancer rates in Scotland are projected to rise significantly over the next two decades. But what lies behind these numbers? Is this entirely bad news, or does it reflect some positive developments in our healthcare system?

The numbers: what’s on the horizon?

New reports from the Scottish Burden of Disease study paint a striking picture of the potential cancer landscape by 2044. By examining historic trends alongside projected changes in our population’s size and shape, we can estimate how many people we would expect to be living with these cancers in the future.

Our analysis projects that Scotland could see an increase in the number of people* living with the following cancers by 2044:

Lung cancer - 58% increase (from 10,600 to 16,800 people)
Breast cancer – 30% increase (from 54,500 to 71,000 people)
Bowel cancer – 44% increase (from 29,000 to 41,700 people

The paradox explained – Professor David Morrison

These projections tell a complex story. There are three factors contributing to the increase in cancer prevalence in Scotland. Firstly - and this is genuinely positive – cancer survival rates in Scotland are continuing to increase over time. More people are living longer after diagnosis. Early detection is key to this success. That’s why it’s so important to seek advice from your doctor if you’re worried about your health, and to attend screening if you’re eligible. Advancements in treatment are also contributing to better survival rates. It’s also important to note that once an individual is diagnosed with cancer, they’re always considered to be a case, even when their cancer is in remission.

A second factor is demographics: Scotland’s population is ageing. With cancer risk increasing as we age, a larger older population naturally means more cancer cases overall.

The third factor is more concerning – the underlying risk of developing certain cancers may be increasing for some. Around two in every five cancers are caused by something that might be avoided – this is where prevention becomes crucial.

What’s driving these trends?

These reports found that the increasing size of the older population in Scotland is an important part of the explanation for future increases in prevalence of these cancers. For lung cancer, smoking remains an important and avoidable risk. Much progress has been made in Scotland to reduce the number of people who smoke, and smoking-related illness have improved as a result. But further reductions in smoking are needed.

Bowel cancer projections reveal a particularly intriguing pattern. While most of the predicted increase in future prevalence can be explained by our ageing population, we’re seeing more cases in people under 50 years old – a trend observed internationally, not just in Scotland. Public Health Scotland (PHS) is collaborating with researchers to understand this trend.

For breast cancer, about half the projected increase stems from improved survival rates. While the overall risk of developing breast cancer hasn’t changed significantly in recent years, further work is needed to understand whether certain women face changing risk profiles.

Prevention: The path forward – Dr Fatim Lakha

While it’s encouraging that people are living for longer and advances in cancer detection and treatments continue to improve outcomes, we must also place equal emphasis on preventing avoidable cancers in the first place.

Scotland has led the way in implementing world leading public health measures, such as the ban on smoking in enclosed public places and minimum unit pricing for alcohol. However, addressing health-harming products alone is not enough. To truly improve the population’s health, we need to address the underlying causes of poor health and inequality, including the circumstances in which we’re born, live and work.

The recently published Population Health Framework by the Scottish Government and COSLA recognises this. It sets out a whole-system, whole-person approach that sees health not only as the absence of illness, but as something shaped by housing, income, education, work and community. PHS contributed extensively to the Framework and will work with partners across the system to deliver on its ambitions. Prevention, alongside NHS reform, offers the most effective path to meeting the healthcare demands of an ageing population, while reducing inequalities and supporting wellbeing.

Next steps

We’ll continue to use the Scottish Burden of Disease study to monitor and project changes in the health of Scotland’s population. This evidence-base will inform policy, guide service design and support coordinated action across sectors, helping us to promote health, prevent illness and enabling a fairer, more sustainable health and care system for the future.

The numbers: what’s on the horizon?

The paradox explained – Professor David Morrison

What’s driving these trends?

Prevention: The path forward – Dr Fatim Lakha

Next steps

Further information