H11 More cancer, better counting or better at diagnosis? The history of skin cancer registration

Abstract

Abstract Cancer registries help us to understand skin cancer cause, prevalence, treatment and prevention. They provide evidence to gain new healthcare resources. This paper studies the evolution of cancer registries and their relevance to dermatology. In the 16th century, ‘Bills of Mortality’, the first English healthcare registry, catalogued the number and causes of death in London parishes. Originally set up to track bubonic plague, it expanded to cover other diseases, including cancer. The 1728 London ‘General Census of Cancer’ was an early systemic study of cancer. In the 19th and early 20th centuries, hospital censuses often monitored cancers. These were superseded by population-based cancer registries, allowing continuous data collection. An early example is the Hamburg Cancer Registry (1926), which recorded names on a card-based registry and compared them with death certificates. The first national cancer registry was the Danish national cancer registry, formed in 1942. In the UK, the Scottish Cancer Registry was formed in 1958, the Welsh Cancer Intelligence & Surveillance Unit in 1972 and the Northern Ireland Cancer Registry in 1994. In England, eight regional registries were created, with the South West being the first in 1945. The Calman–Hine report (1995) highlighted a desire for a national cancer registry. In 2008, the National Cancer Intelligence Network enabled the assimilation and analysis of data sets from English registries. They merged in 2013, forming the National Cancer Registry and Analysis Service (NCRAS), England. Critically, the 2006 National Health Service act (section 251) allowed cancer data collection without formal consent. Although melanoma data were generally good quality, the inclusion and quality of nonmelanoma skin cancers (NMSCs) were historically less reliable, with improvement since 2013. Historically, the exclusion of NMSCs from published cancer data is common. Wales is the last UK registry to not routinely report NMSC. However, this is due to change in 2024. The ‘global burden of disease tool’ (1990) utilizes various sources, including cancer registry data, to model incidence, mortality and health implications of disease globally, including melanoma and NMSCs. In 2022, the British Association of Dermatologists joined with the NCRAS to develop the Get Data Out skin tool, an annually updated website featuring more granular epidemiological data on skin cancers. High-quality epidemiological data are essential to understanding skin cancer’s regional and chronological variations, and to ensure that resources for healthcare and research are allocated appropriately.