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Australian Indigenous HealthBulletin
 

Cancer

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Cancer

Cancer is the term used for a variety of diseases that cause damage to the genetic blueprint (DNA) of the cells resulting in uncontrolled growth (cells normally grow and multiply in a controlled manner) [1][2]. If damaged cells spread into surrounding areas, or to different parts of the body (metastasise), they are known as malignant. Cancerous cells can arise from almost any cell, so cancer can occur almost anywhere in the body.
Until recently, the impact of cancer on Aboriginal and Torres Strait Islander people has attracted much less attention than it deserves, due in part to incomplete Indigenous identification in cancer notifications in several jurisdictions. There have been improvements for identification in cancer registries [3]but currently there are no nation-wide incidence data for cancer.

Extent of cancer among Aboriginal and Torres Strait Islander people
Incidence

For 2005-2009, an average of 840 Aboriginal and Torres Strait Islander people living in NSW, Qld, WA and the NT were diagnosed with cancer each year [4]. After age-adjustment, the cancer incidence rate for all cancers combined was slightly lower for Aboriginal and Torres Strait Islander people than for non-Indigenous people (421 and 443 per 100,000 people, respectively).1 After age-adjustment, the incidence rates were significantly higher for Aboriginal and Torres Strait Islander people than non-Indigenous people for: liver cancer (rate ratio 2.8); cervical cancer (rate ratio 2.3); cancer of unknown primary site (rate ratio 1.8); lung cancer (rate ratio 1.7); and uterine cancer (rate ratio 1.6). The incidence of pancreatic cancer was also higher for Aboriginal and Torres Strait Islander people than non-Indigenous people (rate ratio 1.3). After age-adjustment, cancer incidence rates were lower for Aboriginal and Torres Strait Islander people than non-Indigenous people for: colorectal cancer (rate ratio 0.8); breast cancer in females (rate ratio 0.7); non-Hodgkin lymphoma (rate ratio 0.7); and prostate cancer (rate ratio 0.6) (Table 18).

Table 18. Age-standardised incidence rates for selected cancers, by Aboriginal and Torres Strait Islander status, and Aboriginal and Torres Strait Islander:non-Indigenous rate ratios, NSW, Qld, WA and the NT, 2005-2009

Primary cancer

Aboriginal and Torres Strait Islander people

Non-Indigenous people

Rate ratio

Lung

74

43

1.7

Breast (females)

78

107

0.7

Colorectal

45

59

0.8

Prostate (males)

95

156

0.6

Unknown primary site

20

11

1.8

Uterine (females)

25

15

1.6

Liver

15

5

2.8

Non-Hodgkin lymphoma

12

16

0.7

Cervical (females)

16

7

2.3

Pancreatic

13

11

1.3

All cancers

421

443

1.0

Notes:

  1. Cancers are ordered by numbers among Aboriginal and Torres Strait Islander people (not shown in table)
  2. Rates per 100,000 population, age-standardised to the Australian population at 30 June 2001
  3. Rate ratio is the Aboriginal and Torres Strait Islander rate divided by the non-Indigenous rate
  4. Due to the incomplete identification of Aboriginal and Torres Strait Islander status, these figures probably under-estimate the true difference between Aboriginal and Torres Strait Islander and non-Indigenous rates
  5. Rounding may result in inconsistencies in calculated ratios

Source: AIHW and Australasian Association of Cancer Registries, 2013 [4]

For 2005-2009, detailed information is available for the incidence of cervical and breast cancers for Aboriginal and Torres Strait Islander women living in NSW, Qld, WA and NT. After age-adjustment, the rate for cervical cancer for Aboriginal and Torres Strait Islander women aged 20-69 was higher than for non-Indigenous women of the same age (20 and 8.7 per 100,000 respectively) [5], and for breast cancer, significantly lower than for non-Indigenous women aged 50-69 (203 and 271 per 100,000 respectively) [6]. Despite this, breast cancer is still one of the most common cancers diagnosed for Aboriginal and Torres Strait Islander women in NSW, Qld, WA and NT [4].

For 2004-2008, detailed information for cancer incidence rates is available for Aboriginal and Torres Strait Islander males and females living in NSW, Qld, WA and the NT [7]. For all cancers combined, incidence rates were significantly higher for males than for females for both the Aboriginal and Torres Strait Islander and non-Indigenous populations. After age-adjustment, the rates for Aboriginal and Torres Strait Islander people were slightly higher than those for non-Indigenous people for both males (549 and 525 per 100,000, respectively) and females (400 and 361 per 100,000, respectively).

Hospitalisation

There were 6,126 hospital separations for cancer among Aboriginal and Torres Strait Islander people in 2013-14 [8]. In 2012-2013, the age-standardised hospitalisation rate for cancer for Aboriginal and Torres Strait Islander people was lower than for non-Indigenous people (10 and 15 per 1,000, respectively).

In terms of specific cancers, the age-standardised hospitalisation rates for lung cancer and cervical cancer for Aboriginal and Torres Strait Islander people in 2012-13 were 1.8 and 1.6 times higher respectively than for their non-Indigenous counterparts [9]. Hospitalisation rates for lung cancer were similar for Aboriginal and Torres Strait Islander males and females (1.3 per 1,000), but higher for non-Indigenous males than females (0.9 per 1,000 and 0.6 per 1,000 respectively).

Mortality

Cancer was responsible for one-in-five deaths (541 deaths) of Aboriginal and Torres Strait Islander people living in NSW, Qld, SA, WA and the NT in 2013 [10]. After age-adjustment, the cancer death rate for Aboriginal and Torres Strait Islander people was 1.3 times higher than for their non-Indigenous counterparts. Cancers of the trachea, bronchus and lung were the fourth leading cause of death for Aboriginal and Torres Strait Islander people (140 deaths: 64 males and 76 females), with the overall death rate 1.8 times higher than for non-Indigenous people.

In the five-year period 2008-2012, there was an average of 459 deaths from cancer per year among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT [4]. After age-adjustment, the mortality rate for all cancers combined for Aboriginal and Torres Strait Islander people was significantly higher than for non-Indigenous people (221 and 172 per 100,000 respectively, rate ratio 1.3). Lung cancer accounted for the highest average number of cancer-related deaths for Aboriginal and Torres Strait Islander people with 115 deaths per year (25% of all Aboriginal and Torres Strait Islander deaths from cancer), followed by liver cancer with 34 deaths (7%), breast cancer in females with 30 deaths (6%) and cancer of unknown primary site with 27 deaths (6%).

For 2008-2012, after age-adjustment, mortality rates in NSW, Qld, WA, SA and the NT were significantly higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people for: cervical cancer (rate ratio: 3.4); liver cancer (rate ratio: 3.0); lung cancer (rate ratio: 1.7); and cancer of unknown primary site (rate ratio: 1.5) [4]. Mortality rates for uterine cancer (rate ratio: 1.6), pancreatic cancer (rate ratio: 1.2), and breast cancer (in females) (rate ratio: 1.1) were also higher for Aboriginal and Torres Strait Islander people than non-Indigenous people. Mortality rates were lower for Aboriginal and Torres Strait Islander people than non-Indigenous people for non-Hodgkin lymphoma (rate ratio: 0.9), colorectal cancer (rate ratio: 0.8) and prostate cancer (rate ratio: 0.8) (Table 19).

Table 19. Age-standardised death rates for selected cancers, by Indigenous status, and Aboriginal and Torres Strait Islander:non-Indigenous rate ratios, NSW, Qld, WA, SA and the NT, 2008-2012

Primary cancer

Aboriginal and Torres Strait Islander people

Non-Indigenous people

Rate ratio

Lung

56

33

1.7

Liver

16

5

3.0

Breast (females)

24

21

1.1

Colorectal

13

16

0.8

Unknown primary site

14

9

1.5

Pancreatic

11

10

1.2

Prostate (males)

24

30

0.8

Cervix (females)

7

2

3.4

Non-Hodgkin lymphoma

5

6

0.9

Uterine (females)

5

3

1.6

All cancers

221

172

1.3

Notes:

  1. Cancers are ordered by numbers among Aboriginal and Torres Strait Islander people (not shown in table)
  2. Rates per 100,000 population, age-standardised to the Australian population at 30 June 2001
  3. Rate ratio is the Aboriginal and Torres Strait Islander rate divided by the non-Indigenous rate
  4. Due to the incomplete identification of Aboriginal and Torres Strait Islander status, these figures probably under-estimate the true difference between Aboriginal and Torres Strait Islander and non-Indigenous rates
  5. Rounding may result in inconsistencies in calculated ratios

Source: AIHW and National Mortality Database, 2013 [4]

The patterns of Aboriginal and Torres Strait Islander cancer incidence and mortality are largely explained by the higher level of risk factors, most notably tobacco use [11][12]. For example, high rates of smoking are the likely cause of a high incidence of cancers of the lung, mouth and throat. High incidence rates of liver cancer are associated with heavy alcohol consumption [4].

Other contributing factors to the patterns of cancer incidence and mortality among, Aboriginal and Torres Strait Islander people include:

References

  1. Australian Cancer Research Foundation (2014) What is cancer?. Retrieved 1 December 2014 from http://www.acrf.com.au/on-cancer/
  2. Cancer Council Australia (2014) What is cancer?. Retrieved 1 December 2014 from http://www.cancer.org.au/about-cancer/what-is-cancer/
  3. Zhang X, Condon JR, Rumbold AR, Cunningham J, Roder DM (2011) Estimating cancer incidence in Indigenous Australians. Australian and New Zealand Journal of Public Health; 35(5): 477-485
  4. Australian Institute of Health and Welfare (2014) Cancer in Australia: an overview 2014. Canberra: Australian Institute of Health and Welfare
  5. Australian Institute of Health and Welfare (2015) Cervical screening in Australia 2012-2013. Canberra: Australian Institute of Health and Welfare
  6. Australian Institute of Health and Welfare (2015) BreastScreen Australia monitoring report 2012-2013. Canberra: Australian Institute of Health and Welfare
  7. Australian Institute of Health and Welfare, Cancer Australia (2013) Cancer in Aboriginal and Torres Strait Islander peoples of Australia: an overview. Canberra: Australian Institute of Health and Welfare
  8. Australian Institute of Health and Welfare (2015) Australia’s hospitals 2013-14 at a glance. Canberra: Australian Institute of Health and Welfare
  9. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  10. Australian Bureau of Statistics (2015) Causes of death, Australia, 2013. Canberra: Australian Bureau of Statistics
  11. Condon JR, Barnes T, Cunningham J, Armstrong BK (2004) Long-term trends in cancer mortality for Indigenous Australians in the Northern Territory. Medical Journal of Australia; 180(10): 504-511
  12. Australian Bureau of Statistics, Australian Institute of Health and Welfare (2008) The health and welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008. Canberra: Australian Bureau of Statistics and Australian Institute of Health and Welfare
  13. Valery PC, Coory M, Stirling J, Green AC (2006) Cancer diagnosis, treatment, and survival in Indigenous and non-Indigenous Australians: a matched cohort study. The Lancet; 367(9525): 1842-1848
  14. Condon JR, Cunningham J, Barnes T, Armstrong BK, Selva-Nayagam S (2006) Cancer diagnosis and treatment in the Northern Territory: assessing health service performance for Indigenous Australians. Internal Medicine Journal; 36(8): 498-505
  15. Moore SP, Green AC, Bray F, Garvey G, Coory M, Martin J, Valery PC (2014) Survival disparities in Australia: an analysis of patterns of care and comorbidities among Indigenous and non-Indigenous cancer patients. BMC Cancer; 14: 517 Retrieved 18 July 2014 from http://dx.doi.org/10.1186/1471-2407-14-517
  16. Cunningham J, Rumbold AR, Zhang X, Condon JR (2008) Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia. The Lancet Oncology; 9(6): 585-595

Endnotes

1. The ABS has revised upwards the estimated population of Indigenous Australians leading to an apparent decrease in cancer incidence rates [4].

 

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    Last updated: 17 March 2016
     
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