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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; there are two main reasons for this. First, the level of identification of Indigenous people in cancer notifications is known to be incomplete [3][4]. Identification in the cancer registries has been improving [5] but due to incompleteness of Indigenous identification for cancer notifications in several jurisdictions, currently there is no overall national information on cancer incidence among Indigenous people. Provision for the identification of Indigenous people is not yet included on all pathology forms and when it is recorded the information may not always be transferred to cancer registries [4][6]. Second, cancer has often been reported in terms of the proportions of deaths it causes rather than by rates; the comparison of proportions of deaths under-estimates the relative impact of cancer on Indigenous people.

Extent of cancer among Indigenous people
Incidence

In the five-year period 2005-2009, an average of 840 Indigenous people living in NSW, Qld, WA and the NT were diagnosed with cancer each year [7]. After age-adjustment, the cancer incidence rate was slightly lower for Indigenous people than for non-Indigenous people (421 and 443 per 100,000 people, respectively).1

Details are available for males and females for the five year period 2004-2008. Cancer incidence rates were significantly higher for males than for females for both the Indigenous and non-Indigenous populations [6]. After age-adjustment, the rates for Indigenous 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). These rates were significantly different for females, but not for males.

For 2005-2009 in NSW, Qld, WA and NT, after age-adjustment, the incidence rates were significantly higher for Indigenous 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) [7]. The incidence of pancreatic cancer was also higher for Indigenous people than non-Indigenous people (rate ratio 1.3). After age-adjustment, cancer incidence rates were lower for Indigenous people than non-Indigenous people for: colorectal cancer (rate ratio 0.8); breast cancer in females (rate ratio 0.7); non-Hodgkin lymphoma (0.7); and prostate cancer (0.6).

For 2005-2009, detailed information is available for the incidence of cervical and breast cancers for Indigenous people living in NSW, Qld, WA and NT. After age-adjustment, the rate for cervical cancer among Indigenous women was higher than for non-Indigenous women (16.9 and 6.5 per 100,000 respectively) [8], and for breast cancer significantly lower than for non-Indigenous women (85 and 105 per 100,000 respectively) [9]. Despite the lower rate for breast cancer it is still the most common cancer diagnosed for Indigenous women in NSW, Qld, WA and NT.

More details are available for 2004-2008 where the most common cancer diagnosed among Indigenous people living in NSW, Qld, WA and the NT was lung cancer (average of 121 cases per year), followed by breast cancer (females only) (average of 88 cases per year), bowel cancer (average of 70 cases per year) and prostate cancer (males only) (average of 58 per year) [6]. The highest Indigenous:non-Indigenous rate ratios were for liver cancer (rate ratio 3.0), cancer of the cervix (2.8), lung cancer (1.9) and cancer of unknown site (1.9) (Table 19).

Table 19: Age-standardised incidence rates for selected cancers, by Indigenous status, and Indigenous:non-Indigenous rate ratios, NSW, Qld, WA and the NT, 2004-2008
Site of primary cancerIndigenous peopleNon-Indigenous peopleRate ratio
Source: AIHW and Australasian Association of Cancer Registries, 2013 [6]
Notes:
  1. Cancers are ordered by numbers among Indigenous people (not shown in table)
  2. Rates per 100,000 population, age-standardised to the Australian population at 30 June 2001
  3. Ratio is the Indigenous rate divided by the non-Indigenous rate
  4. Due to the incomplete identification of Indigenous status, these figures probably under-estimate the true difference between Indigenous and non-Indigenous rates
Lung 80 43 1.9
Breast (females) 82 104 0.8
Bowel 48 59 0.8
Prostate (males) 105 148 0.7
Unknown primary site 24 12 1.9
Non-Hodgkin lymphoma 14 16 0.9
Cervix (females) 18 7 2.8
Uterus (females) 24 15 1.6
Liver 15 5 3.0
Pancreas 15 10 1.5
All cancers 461 434 1.1

For all types of cancer combined, incidence rates were higher for Indigenous people living in NSW, Qld, WA and the NT in 2004-2008 than for their non-Indigenous counterparts for all age-groups except for people aged less than 45 years [6].

Hospitalisation

There were 3,490 hospital separations for cancer among Indigenous people in 2012-13 [10]. The age-standardised hospitalisation rates for cancer for Indigenous people were lower than for their non-Indigenous counterparts (10 and 15 per 1,000, respectively).

In terms of specific cancers, the age-standardised hospitalisation rate for lung cancer and cervical cancer for Indigenous people in 2012-13 were 1.8 and 1.6 times respectively higher than those for their non-Indigenous counterparts [10]. Hospitalisation rates for lung cancer were similar for Indigenous males and females (1.3 per 1,000) and higher for non-Indigenous males than females (0.9 per 1,000 and 0.5 per 1,000 respectively).

Mortality

Cancer was responsible for one-in-five deaths (524 deaths) of Indigenous people living in NSW, Qld, SA, WA and the NT in 2012 [11]. After age-adjustment, the death rate for Indigenous people was 1.5 times higher than for their non-Indigenous counterparts. Cancers of the trachea, bronchus and lung cancers were the third leading cause of death for Indigenous people (138 deaths: 77 males and 61 females), with the overall death rate 2.3 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 Indigenous people living in NSW, Qld, WA, SA and the NT [7]. After age-adjustment, the mortality rate of all cancers combined for Indigenous 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 Indigenous people with 115 deaths per year (25% of all Indigenous 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 Indigenous 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) [7]. Mortality rates for uterine cancer (rate ratio 1.6), pancreatic cancer (1.2), and breast cancer in females (1.1) were also higher for Indigenous people than non-Indigenous people but the differences were not statistically significant [7]. Mortality rates were lower for Indigenous 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), but the differences were not statistically significant.

More details are available for 2007-2011 when, in terms of specific cancers, the annual average numbers of cancer-related deaths among Indigenous people living in NSW, Qld, WA, SA and the NT in 2007-2011 were: 110 from lung cancer; 29 from liver cancer; 28 from breast cancer (among women); 26 from cancer of unknown site; and 24 from bowel cancer [6]. The highest Indigenous:non-Indigenous death rate ratios were for cancer of the cervix (rate ratio 3.9), liver cancer (3.3), cancer of the oesophagus (2.3), lung cancer (1.9), and stomach cancer (1.7) (Table 20). After age-adjustment, the death rate for cancer was 1.5 times higher for Indigenous people than for their non-Indigenous counterparts.

Table 20: Age-standardised death rates for selected cancers, by Indigenous status, and Indigenous:non-Indigenous rate ratios, NSW, Qld, WA, SA and the NT, 2007-2011
Site of primary cancerIndigenous peopleNon-Indigenous peopleRate ratio
Source: AIHW and National Mortality Database, 2013 [6]
Notes:
  1. Cancers are ordered by numbers among Indigenous people (not shown in table)
  2. Rates per 100,000 population, age-standardised to the Australian population at 30 June 2001
  3. Ratio is the Indigenous rate divided by the non-Indigenous rate
  4. Due to the incomplete identification of Indigenous status, these figures probably under-estimate the true difference between Indigenous and non-Indigenous rates
  5. Rates for 2007-2009 are final, 2010 are revised and 2011 are preliminary
Lung 64 33 1.9
Liver 17 5 3.3
Breast (female) 28 21 1.3
Unknown primary site 16 10 1.6
Bowel 13 16 0.8
Pancreas 13 9 1.4
Oesophagus 11 5 2.3
Prostate (males) 31 30 1.0
Stomach 7 4 1.7
Cervix (females) 7 2 3.9
All cancers 252 172 1.5

The patterns of Indigenous cancer incidence and mortality are largely explained by the higher level of risk factors, most notably tobacco use [12][13][14]. For example, high rates of smoking are the likely cause of a high incidence of cancers of the lung, mouth and throat.

The higher Indigenous:non-Indigenous rate ratio for deaths from cancer than for cancer incidence could be due to a number of factors:

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. Cunningham J, Rumbold AR, Zhang X, Condon JR (2008) Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia. Lancet Oncology; 9(6): 585-595
  4. Australian Institute of Health and Welfare (2013) Towards better Indigenous health data. Canberra: Australian Institute of Health and Welfare
  5. 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
  6. 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
  7. Australian Institute of Health and Welfare (2014) Cancer in Australia: an overview 2014. Canberra: Australian Institute of Health and Welfare
  8. Australian Institute of Health and Welfare (2014) Cervical screening in Australia 2011-2012. Canberra: Australian Institute of Health and Welfare
  9. Australian Institute of Health and Welfare (2014) BreastScreen Australia monitoring report 2011-2012. Canberra: Australian Institute of Health and Welfare
  10. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  11. Australian Bureau of Statistics (2014) Causes of death, Australia, 2012. Canberra: Australian Bureau of Statistics
  12. 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
  13. 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
  14. Condon J (2004) Cancer, health services and Indigenous Australians. Canberra: Office for Aboriginal and Torres Strait Islander Health, Cooperative Research Centre for Aboriginal and Tropical Health
  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. 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

Endnotes

  1. The ABS has revised upwards the estimated population of Indigenous Australians leading to an apparent decrease in incidence rates from Cancer in Australia: an overview 2012 [7].
 

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    Last updated: 11 May 2015
     
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