cancer in wales...welsh cancer intelligence and surveillance unit ofﬁ cial statistics 2012 data....

Welsh Cancer Intelligence and Surveillance Unit Offi cial Statistics 2012 data. Published 10 April 2014 1

People living longer increases the number of new cancer casesThe trend in the number of new cancer cases each year is still going up (Figure 1).

There were just over 18,000 new cases of cancer diagnosed in the residents of Wales in 2012. That’s around ten per cent more in 2012 - or almost 1,700 extra cases - compared to ten years before in 2003.

Figure 1 Annual number of new cancer cases in Wales. All persons, all ages. 2003-2012

Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registry www.wcisu.wales.nhs.uk

SummaryOur report highlights how the ageing population of Wales, along with socioeconomic inequalities and deprivation, are increasing the large burden of ill-health and mortality from cancer in society. The types of cancers that are common (such as bowel, lung, breast and melanoma) suggest that prevalent health-risk behaviours in Wales are also contributing to the population cancer burden. The main risk behaviours are smoking, alcohol drinking, physical inactivity, obesity and a poor diet, along with more sun and UV exposure with sunburns. They are all infl uenced by many factors in society, rather than just in the individual.Although air pollution is now known to be a risk for lung cancer, smoking remains the major problem. The large increase in cancer incidence in women appears to be mainly due to lung cancer.Despite recent improvements, such as for age-adjusted lung cancer incidence in men and age-adjusted breast cancer incidence in women, trends in these and other cancers may yet change depending on current and future risk factors. Population cancer surveillance will need to continue to inform public health and health service responses.Cancer survival is improving overall, but from a low level and with lower survival in deprived areas. Survival from lung cancer remains low and, in common with most UK countries, survival for most smoking-related cancers is far from the best in Europe. Better understanding of the causes of low survival in Wales will remain challenges alongside cancer prevention.

Welsh Cancer Intelligence and Surveillance Unit, Health Intelligence Division, Public Health Wales

Am y fersiwn Gymraeg ewch i www.wcisu.wales.nhs.uk

Iechyd Cyhoeddus Cymru

Public HealthWales

How many people get cancer?

Cancer in WalesA summary report of population cancer incidence, mortality and survival – includes new 2012 data released as Offi cial Statistics on 9 April 2014www.wcisu.wales.nhs.uk

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Nu

mb

er o

f n

ew c

ance

r ca

ses

in W

ales

Year of diagnosis

Welsh Cancer Intelligence and Surveillance Unit Offi cial Statistics 2012 data. Published 10 April 2014

Cancer in Wales Published 10 April 2014

2

Two-thirds of all new cancer cases in 2012 were in people aged 65 and overWe examined the overall 2003-2012 trend more closely by looking at the trends in cancer numbers for different age groups (Figure 2). The number of cases in 2012 were higher than 2003 for all age groups from 60 years and older, except for the 80-84 years group, which was only marginally lower. The largest rise of 34 per cent was in the 65 to 69 age group. By 2012, two-thirds of all cancer cases were diagnosed in people aged 65 and over.

Figure 2 Trends in annual numbers of cancers by age group. Wales, all persons. 2003-2012


But, during the same period, there was little change in most age-specifi c cancer rates per 100,000 with no clear trends (Figure 3). This suggests that the increase in number of cases we observed is partly explained by people living longer and the ageing of the population.

However, it is not yet clear why the numbers and rates in the 85 and over group, and the 80 to 84 years group, dropped sharply in 2012 from their peaks in 2011.

Figure 3 Age-specifi c cancer incidence rates in Wales. All persons, 2003-2012


Cancer still more common in men, but rate is going up in women, down in menIn Wales, the rate of cancer in men is about 18 per cent more than in women – that’s around 70 extra cases for every 100,000 men compared to the rate in women. Although cancer is more common in men, the incidence is coming down slowly (Figure 4 and Table 1), but increasing in women.

Figure 4 Cancer incidence rates in Wales by sex, 2003-2012


The reasons for the differences include the historic patterns of male smoking and alcohol use being different to those in women. Naturally there are also many sex-specifi c cancers such as prostate, breast, and cervix, for example. We highlight the different trends in the most common cancer types in men and women later.

Table 1 Difference in cancer incidence between men and women in Wales. All ages. 2012

Total Cases Incidence rate per 100,000

EASR

Lower Confi dence

Limit

Upper Confi dence

Limit

Men 9417 443.0 433.8 452.4

Women 8612 374.2 365.7 382.8


0

50

100

150

200

250

300

350

400

450

500

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

EASR

per

100

,000

pop

ulat

ion

Year of diagnosis

Males Females Persons

0

500

1000

1500

2000

2500

3000

3500

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Age

spe

cifi

c in

cide

nce

rate

per

100

,000

pop

ulat

ion

Year of diagnosis

40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

0

500

1000

1500

2000

2500

3000

2003 2004 2005 2006

Year of diagnosis

Ann

ual n

umbe

r of

cas

es

2007 2008 2009 2010 2011 2012

40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+


Cancer gets more common the more deprived an area getsMany diseases or health conditions show a health gradient, becoming increasingly more common as socioeconomic deprivation increases. Overall, cancer is no exception. The incidence rate of cancer is 20 per cent higher in the most deprived areas of Wales, compared to the least deprived – that’s around 80 extra cancer cases for every 100,000 people living in the most deprived areas (Figure 5). But not all cancers follow this pattern, notably breast cancer, which is more common amongst more affl uent women.

Figure 5 Cancer incidence rate (EASR) for areas with increasing deprivation (fi fths) in Wales. All persons, all ages. 2008-2012


Lowest health board cancer incidenceis 8% below the incidence for WalesCancer incidence for six of the seven local health boards is similar to that for Wales (Figure 6) – the differences are within a range we might expect from chance alone. But the incidence for the Powys population is nearly eight per cent lower than the Wales incidence, and is lower than would be expected from chance alone.

Figure 6 Cancer incidence rate (EASR) per 100,000 people by local health board of residence. Wales, persons, all ages. 2010-2012

Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registry www.wcisu.wales.nhs.uk©Crown Copyright and database right 2014. Ordnance Survey 100044810

0

50

100

150

200

250

300

350

400

450

500

1 (Least deprived) 2 3 4 5 (Most deprived)

EASR

per

100

,000

pop

ulat

ion

Deprivation fifth

384.7 – 393.3

393.3 – 401.9

401.9 – 410.4

410.4 – 419.0

419.0 – 427.6

Defi nitionsAge-standardised rates and EASRAge-standardisation adjusts rates to take into account how many old or young people are in the population being looked at. When rates are age-standardised, you know that differences in the rates over time or between geographical areas do not simply refl ect variations or changes in the age structure of the populations. This is important when looking at cancer rates because cancer mainly affects older people. Throughout this report we use European Age Standardised Rates (EASR) unless otherwise specifi ed.

Statistical signifi canceIf a difference between rates or survival between populations is statistically signifi cant, it means that that difference is unlikely to have occurred due to chance alone, and that we can be more

confi dent that we are observing a ‘true’ difference. In this report we use the conventional arbitrary cut-off of less than a 5% chance to mean statistically signifi cant. Just because a difference is statistically signifi cant doesn’t necessarily mean that it is large or important - that can depend on our judgment and other things.

Relative survivalThis is a way of comparing the survival of people who have a specifi c disease – in our case, cancer -with the survival experienced by the general population, over a certain period of time. It is calculated by dividing the percentage of patients with the disease who are still alive at the end of the period of time (e.g. one or fi ve years after diagnosis) by the percentage of people in the general population of the same sex and age who are alive at the end of the same time period. The relative survival rate shows whether the disease shortens life. We use relative survival in this report.

All cancersWhen we use the phrase ‘all cancers’ or ‘all malignancies’ in this report, by convention, we always mean all cancers excluding non-melanoma skin cancer.



Highest local authority cancer incidence is 17% more than lowestCeredigion’s cancer incidence is the lowest of the 22 local authority areas (Figure 7). It’s about eight per cent below the Wales incidence. Torfaen’s rate is nearly eight per cent higher than Wales’. It is the highest in Wales. That means that, on average, there’s a difference of 67 new cases of cancer per 100,000 people each year between Ceredigion and Torfaen. The differences between local authority areas are in part due to variation in deprivation.

Figure 7 Annual cancer incidence by local authority populations. Wales, persons, all ages. 2008-2012

Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registrywww.wcisu.wales.nhs.uk

Which are the most common cancers?Over 18,000 cases of cancer in residents of Wales were diagnosed during 2012. The relative number of the different types are shown in Figure 8.

Figure 8 Number and proportion of the fi ve most common types of cancer diagnosed in Wales. All persons, all ages. 2012


Bowel cancer is the most common cancer in Wales for fi rst timeThere were 474 more cases of bowel cancer in 2012 than in 2003, making bowel cancer the most common cancer in Wales in 2012. This is the fi rst time this has happened since our records began. The ageing of the population during this time played a part (Figure 9). Increased awareness and the introduction of bowel screening may also be responsible, but we’re not yet clear about this.

Figure 9 Bowel cancer incidence (EASR) in Wales by sex, all ages. 2003-2012


0

50

Wales Not statistically significant Statistically significant

100

150

200

250

300

350

400

450

500

Cere

digi

on

Pow

ys

Mon

mou

thsh

ire

Isle

of A

ngle

sey

Swan

sea

Carm

arth

ensh

ire

Brid

gend

Gw

yned

d

Pem

brok

eshi

re

Nea

th P

ort T

albo

t

WAL

ES

Conw

y

Card

iff

Vale

of G

lam

orga

n

New

port

Wre

xham

Rhon

dda

Cyno

n Ta

ff

Caer

phill

y

Mer

thyr

Tyd

fil

Blae

nau

Gw

ent

Flin

tshi

re

Den

bigh

shire

Torfa

en

EASR

per

100

,000

pop

ulat

ion

Local authority of residence

Bowel, 2444, 14%

Prostate, 2419, 13%

Lung, 2370, 13%

Female Breast, 2362, 13% Melanoma, 693, 4%

Other, 7741, 43%

0

10

20

30

40

50

60

70

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

EASR

per

100

,000

pop

ulat

ion

Year of diagnosis



Prostate cancer incidence rate changes little, but actual numbers go upThe fi ve most common cancers in men during 2012 were

● prostate (2,419 cases)

● bowel (1,405)

● lung (1,249)

● head and neck (427)

● bladder (391)

The number of cases of prostate cancer diagnosed in 2012 was 376 more than in 2003. The ageing population probably explains most of this modest rise because the rate standardised for age has remained almost constant over the ten year period.

Breast cancer incidence steadily coming down since 2010The fi ve most common cancers in women in 2012 were

● breast (2,362 cases)

● lung (1,121)

● bowel (1,039)

● ovary (452)

● uterus (449)

In 2012 the number of cases of breast cancer was marginally lower than in 2003. Once the effect of population age is considered, the rate was over eight per cent lower in 2012 than ten years previously, after peaking in 2010.

Number of lung cancer cases increases by more than a third over 10 years in women, but hardly changes in menThere have been major changes in lung cancer numbers in men and women. The number of cases in men remained similar between 2003 and 2012, but the number in women increased by over a third. The number of cases in women is now approaching that in men.

This means that cancer incidence per 100,000 men has dropped in that time, once age is considered, but the incidence rate has increased in women (Figure 10). The combined rate for men and women has stopped coming down, and is now fl at-lining.

Different historic smoking patterns in men and women account for most of these changes, but we also now know that some forms of air pollution are increasingly recognised as risk factors for lung cancer.

Figure 10 Lung cancer incidence (EASR) in Wales by sex, all ages. 2003-2012


During 2014-2015 we will be analysing information on lung cancer in more detail.

0

10

20

30

40

50

60

70

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

EASR

per

100

,000

pop

ulat

ion

Year of diagnosis




How many die from cancer?

The overall cancer mortality rate has decreased in ten years...The general trend in cancer mortality rate is coming down, once changes in population age structure are taken into account. By 2012, mortality was around 174 per 100,000 people - that’s 11 per cent less than ten years before (Figure 11).

Figure 11 Cancer mortality (EASR) rate in Wales. All persons, all ages. 2003-2012


… but, the number of cancer deaths increased by almost one third in people aged 85 and overEven though the age-adjusted mortality rate is going down, the trend in the annual number of deaths from cancer is still increasing due to population changes. There were 8,654 deaths in 2012 compared to 8,370 in 2003. But this general three per cent increase is small in comparison to the 31 per cent increase in deaths in the 85 years and older age group, where most cancer deaths occur (Figure 12).

Figure 12 Annual number of cancer deaths by age group. Wales, all persons. 2003-2012


0

20

40

60

80

100

120

140

160

180

200

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

EASR

per

100

,000

pop

ulat

ion

Registered year of death

0

200

400

600

800

1000

1200

1400

1600

1800

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Ann

ual n

umbe

r of

can

cer

deat

hs

Registered year of death


Cancer mortality rate is one third higher in men than womenWe know that cancer is more common in men, but men have a higher death rate from cancer too. Cancer incidence is around 16% higher in men than women, but mortality is over a third higher. This is consistent with lower cancer survival in men (Figure 13).

Figure 13 Cancer mortality (EASR) in men and women. Wales, all ages. 2010-2012


Cancer mortality rate is over 50% higher in most deprived areas of Wales compared to the least deprivedCancer mortality is higher in more deprived areas. Whereas cancer incidence is 20 per cent higher in the most deprived areas compared to the least deprived, mortality is 50 per cent higher, which refl ects the gradient in survival (Figure 14).

Figure 14 The gradient of cancer mortality rate (EASR) for areas with increasing deprivation (fi fths). Wales, persons, all ages. 2007-2011


0

50

100

150

200

250


EASR

per

100

,000

pop

ulat

ion

Deprivation fifth

Women 0.0

50.0

100.0

150.0

200.0

250.0

EASR

per

100

,000

pop

ulat

ion

Sex Men



8

Highest health board cancer mortality is 6% more than for WalesThe cancer mortality rate between the populations of the seven health boards varies (Figure 15). The mortality rates of the populations of the Hywel Dda and Powys areas are lower than the Wales mortality, and Cwm Taf and Aneurin Bevan populations are higher. These differences are greater than might be expected from chance alone. The Cwm Taf population has a cancer mortality rate six per cent higher than the Wales mortality.

Figure 15 Cancer mortality rate (EASR) by local health board populations. Persons, all ages, 2008-2012


Difference between local authority area with highest and lowest mortality is over 47 deaths per 100,000 peopleThere is wider variation between the cancer mortality rates of local authority populations (Figure 16). The lowest is in Ceredigion which is 13 per cent below the Wales mortality, and Blaenau Gwent has the highest mortality by the same percentage. The variation between local authority areas is partly explained by deprivation, and broadly follows the same pattern as cancer incidence.

Figure 16 Cancer mortality rate (EASR) by local authority populations. Persons, all ages, 2008-2012


0

40

80

120

160

200

240

Cere

digi

on

Mon

mou

thsh

ire

Pow

ys

Vale

of G

lam

orga

n

Carm

arth

ensh

ire

Pem

brok

eshi

re

Swan

sea

Conw

y

Wre

xham

Brid

gend

WAL

ES

Gw

yned

d

Card

iff

Isle

of A

ngle

sey

Caer

phill

y

Den

bigh

shire

Flin

tshi

re

New

port

Rhon

dda

Cyno

n Ta

ff

Nea

th P

ort T

albo

t

Torfa

en

Mer

thyr

Tyd

fil

Blae

nau

Gw

ent

EASR

per

100

,000

pop

ulat

ion

Local authority of residence

Wales Not statistically significant Statistically significantBet

si C

adw

alad

r U

nive

rsity

Hyw

el D

da U

nive

rsity

Aber

taw

e B

roM

orga

nnw

g U

nive

rsity

Car

diff

& Va

le U

nive

rsity

Cw

m T

af U

nive

rsity

Aneu

rin B

evan

Uni

vers

ity

Pow

ys T

each

ing

Wal

es

Wales Not statistically significant Statistically significant

0

20

40

60

80

100

120

140

160

180

200

EASR

per

100

,000

pop

ulat

ion

Health board of residence


Deaths from lung cancer more than bowel and breast cancers combinedLung cancer accounted for almost 22 per cent of all cancer deaths in 2012 (Figure 17). At 1,894 deaths, it accounts for most cancer deaths, ahead of other common cancers such as bowel, breast and prostate, and more than bowel and breast combined. These cancers also have the highest mortality rates (Figure 18).

Figure 17 Number of deaths from different types of cancer, 2012


Figure 18 Mortality rate (EASR) for different cancer types. Wales, persons, all ages 2010-2012


0

5

10

15

20

25

30

35

40

45

Lung

Fem

ale

Brea

st

Pros

tate

Colo

rect

al

Ova

ry

Panc

reas

Oes

opha

gus

Stom

ach

Urin

ary

Trac

t exc

Bla

dder

Blad

der

Brai

n &

CNS

Leuk

aem

ia

Non

-Hod

gkin

s Ly

mph

oma

Live

r

Hea

d &

Nec

k

Ute

rus

Mel

anom

a

Cerv

ix

Lary

nx

Thyr

oid

& En

docr

ine

Hod

gkin

s

Test

is

EASR

per

100

,000

pop

ulat

ion

Cancer type

All cancer deaths

8654

Lung1894

Bowel912

Breast594

Prostate

556Pancreas

440

Other cancers4258


What are the chances of survival?

Survival from cancer is steadily improving, but remains low compared to the best in EuropeOn average, almost 70 per cent of Welsh residents diagnosed with cancer can expect to survive at least one year. It’s improving, but progress is slow. The latest available fi gures for 2007-11 are only four per cent higher than the fi gures for the period 2003-2007 (Table 2).

Table 2 One year relative survival from cancer in Wales. Persons, all ages.

Period of diagnosis One year relative survival %

2007-2011 69.9

2006-2010 69.2

2005-2009 68.6

2004-2008 67.9

2003-2007 67.2


It takes longer before we can report on fi ve year survival because we have to wait to see what happens to people diagnosed with cancer. But we know that for the latest available period, fi ve year survival increased by nearly eight per cent compared to the period 1999-2003 (Table 3).

Table 3 Five year relative survival from cancer in Wales. Persons, all ages.

Period of diagnosis Five year relative survival %

2003-2007 52.5

2002-2006 51.5

2001-2005 50.5

2000-2004 49.6

1999-2003 48.7


Increasing survival can be due to a combination of changing pattern of cancer types in the population; better treatments available and accessed by all who need them; earlier diagnosis and screening; age at diagnosis; as well as an improvement of health generally across the population, so that if people are diagnosed with cancer, they will have fewer other illnesses that may affect their treatment. It is not yet clear to what extent these different factors have combined to infl uence survival.

The improving survival in Wales needs to be considered in the context of better survival in many European countries, especially for smoking-related cancers (Eurocare 5 study).

Women have higher cancer survival rates than menEven though cancer is much more common in men, one year survival is four per cent higher in women than men. Five year survival has a wider gap, being ten per cent higher in women than men (Table 4).

Table 4 Relative cancer survival in men and women in Wales. Persons, all ages.

Five year survival (2003-2007)

One year survival (2007-2011)

Men 50.0% 68.5%

Women 55.0% 71.5%


Cancer survival is lower in more deprived areasIn more deprived areas the chance of survival gets worse for both one year and fi ve year relative survival.

In Wales, one year survival in the most deprived areas is 17 per cent less than in least deprived areas - there is a steep gradient.

For fi ve year survival the difference is wider – the chance of survival is 28 per cent less in the most deprived areas compared to the least deprived (Figure 19).

Figure 19 Five year cancer survival gradient for areas with increasing deprivation (fi fths). Wales, persons, all ages. 2003-2007


0

10

20

30

40

50

60

70

80

90

100


Rela

tive

Sur

viva

l (%

)

Deprivation fifth



Variation in cancer survival between health board populations is smallOn average, almost 70 per cent of Welsh residents diagnosed with cancer can expect to survive at least one year. The variation in one year survival between health board for 2007-2011 is small, but the Betsi Cadwaldr and the Powys health board populations both have one year survival around two percentage points above that for Wales, and Cwm Taf by about the same below it. These differences are more than can be expected by chance alone (Figure 20). Other factors, such as deprivation or the prevalence of other illnesses, that can affect survival may explain part of these differences.

Figure 20 One year relative cancer survival by health board. Wales, 2007-2011

Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registrywww.wcisu.wales.nhs.uk©Crown Copyright and database right 2014. Ordnance Survey 100044810

On average, almost 53 per cent of Welsh residents diagnosed with cancer can expect to survive at least fi ve years. The variation in fi ve year survival for 2003-2007 is again small, although the difference between the Wales fi gure and three of the health boards are more than can be expected by chance – Cwm Taf is over four percentage points below, with Powys and Cardiff and Vale above the Wales survival by about four and 2.5 percentage points, respectively (Figure 21).

Figure 21 Five year relative cancer survival by health board. Wales, 2003-2007

Source: Welsh Cancer Intelligence and Surveillance Unit’s Cancer Registrywww.wcisu.wales.nhs.uk©Crown Copyright and database right 2014. Ordnance Survey 100044810

67.6 – 68.5

68.5 – 69.4

69.4 – 70.3

70.3 – 71.2

71.2 – 72.1

48.3 – 49.9

49.9 – 51.5

51.5 – 53.2

53.2 – 54.8

54.8 – 56.4



12

Cancers of the liver, lung and pancreas have the lowest survivalAccording to 2007-2011 survival data, the three cancers with the lowest one year survival in Wales are liver and lung - with survival rates of well under 30 per cent - and, lowest of all, cancer of the pancreas with only an 18 per cent survival (Figure 22). Cancers of the testis (testicles), breast, melanoma and prostate have the highest one year survival, at over 95 per cent. But, bowel cancer one year survival is around 75 per cent.

Figure 22 One year relative survival from different types of cancer in Wales. 2007-2011


Liver, lung and pancreas also have the lowest fi ve year survival for the latest available fi gures 2003-2007. Survival is less than four per cent for pancreas, and below seven per cent for lung cancer and liver cancer (Figure 23).

Cancers with the highest fi ve year survival are testis (96%), prostate (86%), breast (85%) and melanoma (84%).

We will look at survival from lung cancer in much more detail in our reports during 2014-15.

Figure 23 Five year relative survival from different types of cancer in Wales. 2003-2007


ISBN 978-0-9928835-1-5

© 2014 Public Health Wales NHS Trust

All tables, charts and maps were produced by the Welsh Cancer Intelligence and Surveillance Unit. Data sources are shown under each graphic. Material contained in this document may be reproduced without prior permission provided it is done so accurately and is not used in a misleading context. Acknowledgement to Public Health Wales NHS Trust to be stated.

Copyright in the typographical arrangement, design and layout belongs to Public Health Wales NHS Trust.Images reproduced with permission

0 10 20 30 40 50 60 70 80 90 100

Testis Breast (Female only)

Melanoma Prostate

Uterus Thyroid & Endocrine

Hodgkins Cervix Larynx

Rectum Head & Neck

Non-Hodgkins Lymphoma Colorectal

Bladder Colon

Urinary Tract exc Bladder Ovary

Leukaemia Oesophagus

Stomach Brain & CNS

Liver Lung

Pancreas

Relative Survival (%)

Canc

er t

ype

0 10 20 30 40 50 60 70 80 90 100

Testis Breast (Female only)

Melanoma Prostate

Uterus Thyroid & Endocrine

Hodgkins Cervix Larynx

Rectum Head & Neck

Non-Hodgkins Lymphoma Colorectal

Bladder Colon

Urinary Tract exc Bladder Ovary

Leukaemia Oesophagus

Stomach Brain & CNS

Liver Lung

Pancreas

Relative Survival (%)

Canc

er t

ype

cancer in wales...welsh cancer intelligence and surveillance unit ofﬁ cial statistics 2012 data....

Documents