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Cancer

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Cancer

Cancer is the term used for a variety of diseases that cause damage to the DNA (genetic blueprint) 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) and they are known as malignant. Cancerous cells can arise from almost any cell, so cancer can occur almost anywhere in the body.

There is limited evidence or data available on cancer to inform initiatives to improve outcomes for Aboriginal and Torres Strait Islander peoples [3]. Inconsistent Indigenous identification in cancer notifications in several jurisdictions is an issue [4]. The National Aboriginal and Torres Strait Islander cancer framework highlights the need for improved Indigenous identification, including on pathology requests and reports [3]. It also expresses a need for routine national data collection, access and linkage, to allow national monitoring, reporting and informing strategies to improve cancer outcomes.

Extent of cancer among Aboriginal and Torres Strait Islander people
Incidence

For 2006-2010, an average of 934 Aboriginal and Torres Strait Islander people living in NSW, Qld, WA and the NT were diagnosed with cancer each year [5]. 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 (446 and 450 per 100,000 people respectively), however incidence and rate ratios differ depending on the type of cancer. For example, after age-adjustment, the incidence rates were higher for Aboriginal and Torres Strait Islander people than non-Indigenous people for: liver cancer (rate ratio 2.7); gynaecological cancer (females) (rate ratio 2.0); cancer of unknown primary site (rate ratio 1.8); lung cancer (rate ratio 1.8); head and neck cancer (rate ratio 1.8) and uterine cancer (females) (rate ratio 1.7). After age-adjustment, cancer incidence rates were lower for Aboriginal and Torres Strait Islander people than non-Indigenous people for: colorectal (bowel) cancer (rate ratio 0.8); breast cancer in females (rate ratio 0.8); lymphoma (rate ratio 0.7); and prostate cancer (males) (rate ratio 0.6) (Table 17).

Table 17. Age-standardised incidence rates for selected cancers, by Indigenous status, and Aboriginal and Torres Strait Islander:non-Indigenous rate ratios, NSW, Qld, WA and the NT, 2006-2010

Primary site

Aboriginal and Torres Strait Islander age-standardised rates

Non-Indigenous age-standardised rates

Rate ratio

Lung

77

44

1.8

Breast (females)

86

110

0.8

Colorectal (bowel)

47

60

0.8

Gynaecological cancer (females)

51

26

2.0

Prostate (males)

98

161

0.6

Head and neck

28

16

1.8

Uterine (females)

27

16

1.7

Unknown primary site

19

11

1.8

Lymphoma

14

19

0.7

Liver

16

5.7

2.7

All cancers

446

450

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 underestimate the true difference between Aboriginal and Torres Strait Islander and non-Indigenous rates
  5. Rounding may result in inconsistencies in calculated ratios
  6. Rate ratios less than one indicate that non-Indigenous people experience higher rates of the disease

Source: AIHW, 2016 [5]

For 2006-2010, detailed information is available for the incidence of cervical and breast cancers for Aboriginal and Torres Strait Islander females living in NSW, Qld, WA and NT. After age-adjustment, the rate for cervical cancer for Aboriginal and Torres Strait Islander females aged 20-69 was almost 2.4 times higher than for non-Indigenous females of the same age (21 per 100,000 and 8.8 per 100,000 respectively) [6]. For breast cancer, the age-adjusted-rate was lower than for non-Indigenous females aged 50-69 (214 per 100,000 and 278 per 100,000 respectively) [7]. Despite this, breast cancer is still the most common cancer diagnosed for Aboriginal and Torres Strait Islander females in NSW, Qld, WA and NT [8].

For 2006-2010, detailed information for cancer incidence is available for Aboriginal and Torres Strait Islander males and females living in NSW, Qld, WA and the NT. For all cancers combined, the number of new cases were slightly higher for females (2,366 new cases) than for males (2,303 new cases) [5]. After age-adjustment, the rates for Aboriginal and Torres Strait Islander males were lower than those for non-Indigenous males (508 per 100,000 and 543 per 100,000 respectively) and higher for Aboriginal and Torres Strait Islander females than non-Indigenous females (401 per 100,000 and 373 per 100,000 respectively).

Hospitalisation

There were 6,632 hospital separations with a principal diagnosis of neoplasms21 among Aboriginal and Torres Strait Islander people in 2014-15 [9], representing 3% of all separations among Aboriginal and Torres Strait Islander people (excluding dialysis) (Derived from [9]). After age-adjustment, Aboriginal and Torres Strait Islander people were less likely to be hospitalised for neoplasms than non-Indigenous people (17 per 1,000 and 25 per 1,000 respectively) [9].

In terms of specific cancers, the age-standardised hospitalisation rates for lung cancer and cervical cancer for Aboriginal and Torres Strait Islander people in 2014-15 were 2.0 and 3.0 times higher respectively than for their non-Indigenous counterparts [10]. Hospitalisation rates for lung cancer were slightly higher for Aboriginal and Torres Strait Islander males than females (1.4 per 1,000 and 1.3 per 1,000 respectively), but higher for non-Indigenous males than females (0.8 per 1,000 and 0.5 per 1,000 respectively).

Mortality

In 2015, cancers of the trachea, bronchus and lung were the fourth leading cause of death for Aboriginal and Torres Strait Islander people (154 deaths: 88 males and 66 females) living in NSW, Qld, WA, SA and the NT, with the overall age-adjusted death rate 1.8 times higher than for non-Indigenous people [11].

In the five-year period 2009-2013, cancer was responsible for the deaths of 2,417 Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT [5]. After age-adjustment, the mortality rate for all cancers combined for Aboriginal and Torres Strait Islander people was 1.3 times higher than for non-Indigenous people (221 per 100,000 and 170 deaths per 100,000 respectively). The age-standardised mortality rates were higher for Aboriginal and Torres Strait Islander people than non-Indigenous people for cancers of the head and neck (rate ratio 3.5); liver (rate ratio 2.8); oesophagus (rate ratio 1.8); lung (rate ratio 1.7); gynaecological cancers (rate ratio 1.6); unknown primary sites (rate ratio 1.5) and pancreas (rate ratio 1.2). Rates were about the same or lower for breast (rate ratio 1.0) and bowel cancer and prostate cancer (rate ratio 0.8) (Table 18).

Table 18. 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, 2009-2013

Primary cancer

Aboriginal and Torres Strait Islander age-standardised rates

Non-Indigenous standardised rates

Rate ratio

Lung

57

33

1.7

Head and neck

14

4.0

3.5

Liver

16

5.6

2.8

Unknown primary site

17

11

1.5

Breast (female)

22

21

1.0

Gynaecological (female)

19

12

1.6

Bowel (colorectal)

13

16

0.8

Pancreas

12

9.5

1.2

Oesophagus

8.4

4.7

1.8

Prostate (male)

25

29

0.8

All cancers

221

170

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 underestimate the true difference between Aboriginal and Torres Strait Islander and non-Indigenous rates
  5. Rounding may result in inconsistencies in calculated ratios
  6. Rate ratios less than one indicate that non-Indigenous people experience higher rates of the disease 

Source: AIHW, 2016 [5]

In 2009-2013, the age-standardised Aboriginal and Torres Strait Islander: non-Indigenous cancer mortality rate was 1.4 times higher for females (193 per 100,000 and 134 per 100,000 respectively) and 1.2 higher for males (260 per 100,000 and 217 per 100,000 respectively) [5]. The age-standardised mortality rates were higher for Aboriginal and Torres Strait Islander people in all age-groups 20-79 years, compared with non-Indigenous people. The biggest disparity in the mortality rates between the populations occurred in the 40-44 years age-group (rate ratio 1.9) followed by the 50-54 years age-group (rate ratio 1.8). Aboriginal and Torres Strait Islander children and adolescents 0-19 years had age-standardised mortality rates lower than those for non-Indigenous people rate ratios ranging from 0.3 (10-14 years) to 0.9 (5-9 years).

Burden of disease

Cancer and other neoplasms22 were responsible for 9.4% of the total burden of disease among Aboriginal and Torres Strait Islander people in 2011, comprising 17% of all fatal burden and 0.5% of all non-fatal burden [12]. Lung (24%), bowel (8%), liver (7%), breast (7%) and mouth and pharyngeal (throat) (6%) cancers contributed to over half (51%) of this cancer burden.

The patterns of Aboriginal and Torres Strait Islander cancer incidence and mortality can be explained by the higher level of risk factors, most notably tobacco use [13]. For example, high rates of smoking are the likely cause of a high incidence of cancers of the lung and oral cavity (lip, mouth and tongue). High incidence rates of liver cancer are consistent with heavy alcohol consumption.

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. Cancer Australia (2015) National Aboriginal and Torres Strait Islander cancer framework. Sydney: Cancer Australia
  4. Australian Institute of Health and Welfare (2013) Towards better Indigenous health data. Canberra: Australian Institute of Health and Welfare
  5. Australian Institute of Health and Welfare (2016) Cancer in Aboriginal and Torres Strait Islander people of Australia. Retrieved 29 April 2016 from http://www.aihw.gov.au/cancer/indigenous-australians/
  6. Budd A, Tanevska B, Prosselkova G, Harvey J (2016) Cervical screening in Australia 2013 - 2014. Canberra: Australian Institute of Health and Welfare
  7. Australian Institute of Health and Welfare (2016) BreastScreen Australia monitoring report 2013 - 2014. Canberra: Australian Institute of Health and Welfare
  8. Australian Institute of Health and Welfare (2014) Cancer in Australia: an overview 2014. Canberra: Australian Institute of Health and Welfare
  9. Australian Institute of Health and Welfare (2016) Admitted patient care 2014-15: Australian hospital statistics. Canberra: Australian Institute of Health and Welfare
  10. Steering Committee for the Review of Government Service Provision (2016) Overcoming Indigenous disadvantage: key indicators 2016 report. Canberra: Productivity Commission
  11. Australian Bureau of Statistics (2016) Causes of Death, Australia, 2015: Deaths of Aboriginal and Torres Strait Islander Australians. Retrieved 28 September 2016 from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2015~Main%20Features~Summary%20of%20findings~1
  12. Australian Institute of Health and Welfare (2016) Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Canberra: Australian Institute of Health and Welfare
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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

Footnotes

21. Neoplasms are an abnormal tissue growth that may be either malignant (cancerous) or benign (non-cancerous) [12].

22. Cancer and other neoplasms include malignant neoplasms (cancer) and benign and uncertain neoplasms [12].

 

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    Last updated: 3 March 2017
     
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