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Cancer in NSW: Incidence and Mortality 2008

Cancer in New South Wales: Incidence and Mortality 2008 provides information for incidence, mortality and survival figures for cancer in NSW.

Please note:  More recent data is now available in the Cancer Incidence and Mortality Report 2010

Cancer is a major public health problem in NSW and Australia and many parts of the world. If a person lives to 85 years of age there is a one is two chance that they will have a diagnosis of cancer in their lifetime if they are male and a one in three chance if they are female. The absolute number of cases of cancer is increasing as our population ages and grows, and because of the lifestyle choices we make.

The number of men and women diagnosed with cancer has increased to 36,611 new cases. Incidence rates have increased in men by 11 per cent over the past 10 years.

There is a significant downward trend in incidence rates of cancer in women for the most recent seven-year period. This downward trend in incidence observed in NSW is consistent with findings in the USA.

Prostate cancer, our most common cancer overall, increased from 18 per cent in 2007 to 19 percent of total cancers in 2008 or 33 per cent of all cancers in men. The lifetime risk of prostate cancer is now one in four if a man lives to the age of 85 years. The most recent five year survival is 90 per cent for males diagnosed between 2002 and 2006 and followed to the end of 2007.

Australia has the highest rates of melanoma in the world and this has continued to increase over the last 10 years by 15 per cent in males and 11 per cent in females. Most of the increase in melanoma is seen in older people with no increases in those aged less than fifty years.

Mortality rates from all causes of cancer death have declined in NSW since 1989 in males and females. In the last ten years mortality rates declined by 13.2 per cent in males and 7.8 per cent in females. Cancer is still responsible for 28 per cent of all deaths in NSW and is the leading cause in people aged between 35 and 84 years in 2008.

The absolute number of cases of cancer is increasing as our population ages and grows, and because of the lifestyle choices we make.

There has been a more rapid decline in mortality rates in NSW since 2005 in males and 2004 in females. The decline in overall mortality rates in males is most influenced by declines in lung, bowel and prostate cancer mortality rates.

The most likely explanation for more rapid reduction in mortality rates in NSW in women since 2004 is the decline in breast and bowel cancer mortality rates. Unfortunately, lung cancer and pancreatic cancer mortality rates continue to increase in women. Reductions in mortality rates for the majority of cancer sites are considered to result from a combination of earlier detection, changes in risk factors and improved treatments.

Of concern is the statistically significant 11 per cent increase in male mortality rates from melanoma for the most recent ten year period. This is the first time a statistically significant increase in mortality from melanoma is reported in NSW. Increasing mortality from melanoma has also been reported in the USA, UK, Canada and Nordic countries. Melanoma is treatable if diagnosed early. Mortality rates also continue to increase for liver cancer in males.

Overall, the cancer survival in NSW are as good as or better than anywhere in the world. Around 65 percent of people diagnosed with cancer in NSW are alive five years later. It is particularly pleasing that survival has increased by two percent for males from 61 per cent to 63 since the last time survival was measured between 1999 and 2003 and has remained at 66 per cent for women.

Cancers with 80 per cent or better survival five years after the diagnosis include prostate, breast, melanoma and lymphoma.

The most prevalent cancer with a five year survival of between 30 per cent and 70 per cent is bowel cancer. Bowel cancer survival will be expected to improve as bowel cancer screening becomes more established, given the evidence from large Australian pilot studies and the success of established screening programs like breast and cervical cancer.

Cancers with 20 per cent or worse survival at five years include lung cancer, brain, oesophagus, liver and pancreas cancers and mesothelioma. Cancers with less than 20 per cent survival five years after a diagnosis require additional focus, new research and better methods of early diagnosis as well as a better understanding of the molecular nature of the cancer leading to more specific and targeted therapies.

New cases of cancer in NSW for 2008

New cases in 2008, excludes non-melanoma (basal and squamous cell) skin cancers, which are estimated to account for 154,693 cases in 2008.
All people 36,611
Males 20,873
Females 15,738

Most common cancers in NSW for 2008

All people
RankTypeCases% of total
1. Prostate 6,905 19%
2. Bowel 4,741 13%
3. Breast 4,418 12%
4. Melanoma 3,591 10%
5. Lung 3,260 9%
Males
RankTypeCases% of total
1. Prostate 6,905 33%
2. Bowel 2,606 12%
3. Melanoma 2,127 10%
4. Lung 1,906 9%
5. NHL 758 4%
Females
RankTypeCases% of total
1. Breast 4,376 28%
2. Bowel 2,135 14%
3. Melanoma 1,464 9%
4. Lung 1,354 9%
5. NHL 633 4%
  • 36,611 people (20,873 males and 15,738 females) were diagnosed with invasive cancer in NSW.
  • Cancers of the prostate, bowel, breast, melanoma and lung cancer were the most common and were responsible for 63 per cent of all new cancers.
  • Males were 1.5 times more likely to be diagnosed with cancer than females.
  • Prostate cancer as a proportion of all cancer increased by 1 per cent compared to 2007.
  • Bowel cancer as a proportion of all cancer declined by 1 per cent compared with 2007.
  • There were 300 additional cases of prostate cancer in 2008 compared with 2007.
  • Breast and lung cancer in females increased by 1 per cent compared to the proportional representation in 2007.
Figure 1: New cases of cancer in persons, NSW, 2008
New cases of cancer in persons, NSW, 2008
Melanoma refers to melanoma of the skin only.
Cancers of the colon and rectum are presented separately to allow comparison with other epidemiological publications and also presented together as bowel cancer.

 

Cancer deaths in 2008

Total deaths caused by cancer in NSW for 2008

All people:

13,213

Males:

7,391

Females:

5,822

  • There were 14 fewer cancer deaths than reported in 2007.
  • Cancer represented 28 per cent of all NSW deaths and 29 per cent of all deaths in Australia1 in 2008.
  • Cancer was the leading cause of death in NSW people aged 35 to 84 years.
  • The top five cancers caused 53 per cent of all cancer deaths in 2008.
  • Lung cancer as a proportion of total cancer deaths increased by 2 per cent compared to 2007.

Most common causes of cancer deaths in 2008

All people

Rank

Type

Deaths

% of total

1.

Lung:

2,664

20%

2.

Bowel:

1,716

13%

3.

Prostate:

930

7%

4.

Breast:

909

7%

5.

Pancreas:

749

6%

Males

Rank

Type

Deaths

% of total

1.

Lung

1,666

23%

2.

Bowel:

935

13%

3.

Prostate:

930

13%

4.

Pancreas:

381

5%

5.

CUP:

364

5%

Females

Rank

Type

Deaths

% of total

1.

Lung:

998

17%

2.

Breast:

904

16%

3.

Bowel:

781

13%

4.

CUP1:

384

7%

5.

Pancreas:

368

6%

Figure 2: Cancer deaths in persons, NSW, 2008
cim2008-fig2.png

Differences by age

New cases by age group in 2008

Age Group

New cases

% of total

less than 15 years:

172

0.5%

15 to 29 years:

555

1.5%

30 to 64 years:

14,928

40.8%

65 years and older

20,956

57.2%

  • The risk or likelihood of being diagnosed with cancer increases with age.
  • 70 per cent of lung cancers, 66 per cent of bowel cancers, 63 per cent of prostate cancers and 38 per cent of breast cancers were diagnosed in people aged 65 years and older.
  • 49 per cent of all melanomas were found in males and females aged 30 years to 64 years.
  • The majority of female breast cancer cases (2,247 or 51 per cent) were aged between the BreastScreen target age range of 50 and 69 years of age at diagnosis.

Trends

Figure 3: Trends in overall cancer incidence 1999 to 2008
Figure 3: Trends in overall cancer incidence 1999 to 2008
  • Prostate cancer is responsible for a third of all new cases in males (33 per cent), therefore changes in the rates of all cancer in males will be most influenced by changes in prostate cancer rates.
  • Rates for all cancer in males were also influenced by changes in rates of the high volume cancers of bowel, melanoma and lung. Bowel cancer incidence rates have remained stable, melanoma rates have continued to increase and lung cancer rates continued to decrease.
  • There was no statistically significant change in female cancer incidence rates over the 10 year period. However, there was a significant decline in incidence rates for the most recent seven year period.
  • Incidence rates were stable for breast and bowel cancer in females.
  • Lung, melanoma, liver and thyroid cancer in females increased.
  • Head and neck, oesophagus, stomach and cervix cancer rates in females declined.
  • Compared with the previous 10-year period the percentage change in incidence rates of pancreatic cancer is no longer statistically significant.
Figure 4: Trends in overall cancer mortality 1999 to 2008
Trends in overall cancer mortality 1999 to 2008
  • During the period 1999 to 2008 age standardised mortality rates for all cancers declined by 13.2 per cent in males and 7.8 per cent in females . The rate of decline in mortality rates is steeper from 2005 in males and 2004 in females.
  • Mortality rates declined for the majority of cancer sites including bowel cancers, non-Hodgkin's lymphoma, head and neck cancers, leukaemia and cancer of unknown primary (CUP).
  • Mortality rates increased for liver cancer (males and females), pancreatic cancer and melanoma in males and lung cancer in females.
  • All other mortality rate differences were similar in the 1999 to 2008 period to those reported in the previous ten year period.

 

Survival in NSW

Figure 5: Survival in NSW
Survival in NSW
  • Five-year relative survival from cancer in NSW improved to 65 per cent in 2002 - 2006, from 63 per cent in 1999 - 2003.
  • Relative survival for males increased to 63 per cent from 61 percent and survival in females remained at 66 per cent.
  • For males diagnosed with prostate cancer, the five-year relative survival was 90 per cent up from 88 per cent.
  • The five-year relative survival was 65 per cent for males and 66 per cent for females diagnosed with bowel cancer.
  • For females diagnosed with breast cancer, the five-year relative survival was 88 per cent in both periods.
  • The five-year relative survival was 89 per cent for males and 93 per cent for females diagnosed with melanoma in both periods.
  • Survival five-years after diagnosis exceeded 80 per cent for cancers of the uterus, and was greater than 95 per cent for cancers of the thyroid, testis, and lip.
  • Five-year relative survival was less than 22 per cent for, stomach lung and brain cancer; and less than 10 per cent for the poor prognosis cancers of mesothelioma and pancreatic cancer.
  • Once confidence limits were considered there was a statistically significantly higher survival from all cancer and cancer unknown primary.
  • Bladder cancer survival was statistically significantly lower in males compared to the earlier period 1999-2003.
  • All other cancer sites were not statistically significantly different between the two time periods.
  • Survival was significantly higher in females than males for most cancer sites.

Key Findings

Incidence

  • Incidence rates in males increased by 11 per cent for the most recent 10-year period but declined in females for the most recent seven-year period.
  • Prostate cancer increased as a proportion of total cancers from 18 per cent in 2007 to 19 per cent in 2008 and for males from 32 per cent to 33 percent for the same time period.
  • Lung cancer incidence rates in females continue to increase at a more rapid rate with a 29 per cent increase compared with a 23 per cent increase for the previous 10 year period.
  • Uterine cancer incidence rates increased by 19 per cent compared to 17 per cent in the previous 10 year period.
  • In all people, incidence rates for head and neck cancer fell by 10 per cent and mortality rates fell by 23 per cent.
  • Pancreatic cancer incidence in all people and mortality rates in males continue to increase. As survival is poor for pancreatic cancer trends in incidence and mortality rate mirror one another.

Mortality

  • Lung cancer was responsible for 23 per cent of deaths in males in 2008 accounting for an increase in the proportion of total cancer deaths in males from 21 per cent in 2007. Mortality rates in males have been declining since the 1980s. However, the rate of the decline has slowed in the last four years.
  • Death rates in males and females have declined since 1989 but have dropped more steeply from 2005 and 2004 respectively to 2008.
  • Mortality rate declines in females for all cancer are most influenced by changes in breast cancer mortality rates.
  • Mortality rates for melanoma in males increased for the first time by 12 percent in the most recent ten year period.
  • Cervical cancer mortality rates increased in 2008. This increase is mainly in females aged 80 years and older and those aged 50 to 55 years compared to earlier time periods. Investigation by country of birth group shows similar patterns over time, indicating that the increase in death rates is not related to a particular migrant group. Further monitoring of mortality is required to determine the significance of this change.

Survival

  • Five-year relative survival was 64% in 2002-2006, compared to 63% in 1999-2003. This was a statistically significant improvement.
  • Survival increased in males from 61 per cent to 63 per cent and remained higher in females at 66 per cent.

Related information:

This report contains the most up to date cancer data for NSW. Projections of cancer incidence and mortality are provided in the Cancer incidence and mortality projections 2011-2021 report.