Leading article: The puzzles of our postcode lottery

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The Independent Online

Take cervical cancer. If you are the parent of a teenage girl just embarking on her sexual career, and you live in Liverpool or Hull or any of the towns between, you may begin to worry. The atlas shows that the chances of getting cervical cancer are 50 per cent higher than average in the narrow area running from the Mersey to the Humber, and more than twice as high as in Essex.

No explanation is offered for this geographical quirk. It could be related to the incidence of human papilloma virus, it could be linked with smoking or it could be a reflection of the higher deprivation in the area, all of which are known to increase the risk of cervical cancer. One clear conclusion can nevertheless be drawn. There is an urgent need for sexual health awareness campaigns in the region with the promotion of condom use (which protects against cervical cancer) and regular cervical screening.

Many similar puzzles lurk in this fascinating atlas. The highest rates of the skin cancer, melanoma, in England are in the sunny counties of the South-west. Yet in Kent, which is hardly less sunny, the rate is less than half as high. The explanation may lie with the pale-skinned Celtic population of Devon and Cornwall who are more vulnerable to the effects of the sun. Conclusion: a drive to promote skin cancer awareness is needed in England's south-westerly peninsula.

There are questions for the NHS, too. Why is there a strong north-south divide in death rates from bowel cancer, but no similar divide in the incidence of the disease? It seems that men, especially, in the North and Scotland who develop bowel cancer are more likely to die of it. The likeliest explanation is that men in the North are diagnosed later, when the disease is more advanced and survival is lower. The cause may be a lack of awareness of the symptoms, embarrassment about reporting them, or delays in referring patients for a specialist opinion. Wherever the bottleneck is occurring, it needs urgent correction.

The value of the cancer atlas is in highlighting patterns of the disease that reveal causes and point to remedies. As Mike Quinn, its chief author, pointed out, it is people that get cancer, not places. Up to half of all cancers could be avoided by changes in behaviour. A pessimist will view the atlas as showing where the Grim Reaper will strike - but an optimist will see it as revealing how he can be held at bay.