Suggested citation Thursfield V, Farrugia H. Cancer in Victoria: Statistics & Trends Cancer Council Victoria, Melbourne 2016

Transcription

1 CANCER IN VICTORIA STATISTICS & TRENDS 2015

2 Cancer Council Victoria 2016 November 2016, Cancer Council Victoria, Melbourne Editors: Vicky Thursfield and Helen Farrugia Suggested citation Thursfield V, Farrugia H. Cancer in Victoria: Statistics & Trends Cancer Council Victoria, Melbourne 2016 Published by Cancer Council Victoria 615 St Kilda Road Melbourne Victoria 3004 Australia T: F: E: enquiries@cancervic.org.au W: For enquiries or more detailed data contact: Vicky Thursfield, Reporting and Quality Assurance Manager, Victorian Cancer Registry T: E: vicky.thursfield@cancervic.org.au

3 Cancer in Victoria Statistics & Trends 2015 This report is a compilation of the latest available Victorian cancer statistics. Included in the report are detailed tables on cancer incidence, mortality and survival, and projections of incidence and mortality to The early pages of the report include a brief overview of cancer in Victoria in 2015, and a selection of easily interpretable graphs which may be reproduced in your own reports and presentations. This information is published in electronic and hard copy form every 12 months. The Victorian Cancer Registry (VCR) plays a vital role in providing cancer data, trends and analysis to stakeholders and the Victorian community.

4 Table of contents Message from the Director 8 Key messages 9 Demography Population Age and sex Ethnicity Vital statistics Incidence and mortality overview Incidence Age and sex Mortality Most common cancers Trends in cancer incidence and mortality Colorectal cancer in Victoria Bowel cancer in Victoria in 2015 Bowel cancer incidence trends by age group Bowel cancer incidence and trends by anatomical sub site Bowel cancer incidence by region of residence. Bowel cancer by registry assigned stage at diagnosis Bowel cancer survival trends Survival from bowel cancer in Bowel cancer survival by region Bowel cancer survival by stage Assessment of node sampling for bowel cancer Development and validation of Registry-derived stage Cancers in Aboriginal and Torres Strait Islander Victorians Incidence Mortality Cancer survival Cancer type Sex Age at diagnosis Tumour morphology Regional variation Trends in survival Methods Cancer projections All cancer Prostate cancer Breast cancer Methods Appendices A1: The Victorian Cancer Registry 40 A2: Cancer incidence reporting 41 A3: Cancer types and groups used in report by ICD-10 codes Haematological malignancies groups used in this report A4: Statistical glossary 44 A5: Mortality coding 45 A6: In situ cancers A7: Detailed tables of cancer incidence 2015 by age, sex and cancer type A8: Indices of data quality 61 A9: References & Victorian Cancer Registry publications 62

5 Figures Figure 1: Map of Victoria 11 Figure 2: Percent of population (and numbers of persons) by sex and age, Victoria Figure 3: Proportions of all deaths and years of potential life lost (YPLL) for each of the leading causes 13 of death, Victoria 2015 Figure 4: Trends in cancer incidence and mortality rates by sex, Victoria Figure 5: Leading cancer types by sex, Victoria 2015 Percent of total, and number, of new cases (incidence) and deaths (mortality) for the ten most common cancers by cancer type and sex 14 Figure 6: Leading cancer types by age group and sex, Victoria 2015 Percentage of new cancers and number of cases for most common cancers by sex and age 15 Figure 7: Trends in incidence and mortality for the 5 most common cancers by sex, Victoria (annual age-standardised rates per 100,000 persons) 20 Figure 8: Trends in incidence and mortality for other selected cancers by sex, Victoria (annual age-standardised rates per 100,000 persons) 21 Figure 9 Trends in bowel cancer incidence for Victorians less than 50 years of age 22 Figure 10 The relative incidence of bowel cancer in Victoria by region Figure 11 Trends in bowel cancer incidence for Victorians greater than 50 years of age 23 Figure 12 Trends in bowel cancer incidence by sex and anatomical location 23 Figure 13 Five-year relative survival from bowel cancer for those diagnosed in by RD-stage for Victorian Integrated Cancer Services regions 25 Figure 14 Five-year relative survival by stage at diagnosis 25 Figure 15: Most common types of cancer for Aboriginal and non-aboriginal Victorians, Figure 16: Age-specific cancer incidence rates by sex for Aboriginal and non-aboriginal Victorians, Figure 17: Survival by cancer type for Victorian men and women with cancer in Figure 18: Figure 19: Survival in the five years following diagnosis for all cancers, and the most common cancers, Victoria Trends in survival for all cancers, Victoria five-year relative survival in each of the five-year periods from to Figure 20: All cancer incidence and mortality by sex, with projections to , Victoria 35 Tables Table 1: Table 2: Table 3: Table 4: Table 5: Cancer incidence, Victoria 2015 by cancer type and sex Number (N) of new cases, crude rates (CR), cumulative rate to age 75 years (CR%) and age-standardised rate (ASR) per 100,000 (standardised to World Standard Population) Cancer mortality, Victoria 2015 by cancer type and sex Number (N) of deaths, crude rate (CR), years of potential life lost to age 75 years (YPLL) and age-standardised rate (ASR) per 100,000 (standardised to World Standard Population) Survival by sex, age group, tumour morphology and region of usual residence for Victorians with cancer in Actual and projected incidence and incidence rate (age-standardised rate per 100,000 males/ females) for selected common cancers to by sex, Victoria Actual and projected mortality and mortality rate (age-standardised rate per 100,000 males/ females) for selected common cancers to by sex, Victoria 38-39

6 Acknowledgement The Victorian Cancer Registry could not function effectively without the recurrent funding from the Department of Health and Human Services, Victoria and The Cancer Council Victoria. Their ongoing support is gratefully acknowledged.

7 Victorian Cancer Registry staff Helen Farrugia Annette McCormack Jodi Nicholls Jonathan Yue Kelli Anderson Kris Ivanova Loretta Costa Vicky Thursfield Director Coding Team Leader Data Capture Manager Programmer Coding Team Leader Quality Assurance Coordinator Electronic Notifications Coordinator Reporting and Quality Assurance Manager Medical Coders Annette Luvisetto Belinda Phillips Bhawna Sehgal Cherry Wolfe Jeanette Huybers Jenette McKenzie Karen Williams Kris Camm Mira Mitic Ranjeni Murugesan Ricklin Le Rossignol Roselyn Santos Suzanne Robson Registry Assistant Jacqueline Martinec Download VCR publications Request a printed publication or join our list VCR@cancervic.org.au Online statistics Customised data requests For enquiries or more detailed data contact: Vicky Thursfield Reporting and Quality Assurance Manager, Victorian Cancer Registry Phone: vicky.thursfield@cancervic.org.au

8 Message from the Director I am delighted to present Cancer In Victoria: Statistics & Trends 2015, a report of statewide cancer statistics for 2015, compiled by the Victorian Cancer Registry. This report includes cancer incidence and mortality data for , along with survival estimates for 2014 and projections to It also includes cancer statistics for Aboriginal and Torres Strait Islander Victorians for the period , and a more detailed analysis of colorectal cancer. For the first time information on survival by stage at diagnosis has been included for colorectal and breast cancers. The Victorian Cancer Registry has once again been able to publish its incidence data within 12 months of the diagnosis year, making our data among the most current in the world. Our ability to make current and high quality data available for cancer control efforts in Victoria is a result of ongoing changes, including greater engagement between the registry and its stakeholders, to support quality and technological improvements including the more recent implementation of an E-Path Reporter in Victorian pathology laboratories. These changes have supported our efforts to continuously improve on the accuracy and completeness of our data. Victorian Cancer Registry staff are also to be praised for their patience, hard work and diligence in ensuring the quality of the data upon which these reports are based. I would also like to thank the Department of Health and Human Services for the support they have shown in ensuring the Victorian Cancer Registry remains a world-leader in providing data to inform improvements in cancer outcomes. The work of collecting and collating cancer registry notifications would not be possible without the ongoing effort and support of a number of people. I would like to thank each notifying hospital, pathology laboratory and radiotherapy service for their contributions, without which the registry would not exist. I am also grateful to the Registrar of Births, Deaths and Marriages for continued and valuable assistance. I also acknowledge the valuable contribution given by a wide variety of clinical experts who have been willing to make their time and expertise available to the registry. I would also like to acknowledge my appreciation of the support given by other Australian State and Territory cancer registries. The surveillance of cancer extends beyond State boundaries and we rely on their cooperation to resolve duplication issues and value their contribution to enable standardised cancer classification. More than thirty years of cancer incidence and mortality data are held by the Victorian Cancer Registry. This is a valuable resource to support those working to achieve improved cancer outcomes. Helen Farrugia, Director, Victorian Cancer Registry 8 Victorian Cancer Registry, Cancer Council Victoria 2016

9 Key messages Incidence Cancer is a leading burden of disease in Victoria with 87 new diagnoses each day. In 2015, 31,628 Victorians were diagnosed with cancer. Since 1982, cancer incidence has steadily increased (with annual rate increases of 0.7% for men and 0.6% for women). Whilst the increase in cancer rates is small, the growth and ageing of the Victorian population result in a much larger (3%) annual increase in numbers diagnosed. Nearly half (45%) of cancers diagnosed are in Victorians aged over 70 years. Mortality An average of 30 Victorians die from cancer every day in Victoria, with 10,937 deaths from cancer in Death rates have declined steadily since 1982 (falling by 1.5% per year for males and 1.2% for females). This reflects earlier detection of cancers through screening, reductions in tobacco use, especially in males, and improvements in treatment. In 2015, cancer deaths in Victoria resulted in the premature loss of nearly 60,000 years of life. This is more than four times the number of years lost from other major causes of death. Most common cancers The five most common cancers in Victoria are prostate, breast, bowel, melanoma, and lung, collectively accounting for 57% of all new cancers and half of all cancer deaths. Survival Between 1985 and 2014, five-year survival increased from 47% to 67%. Projections It is estimated that by the average annual incidence of cancer will have climbed to over 41,000, an increase of 36% from Over the same period, deaths from cancer are projected to increase to over 13,000 per year. This is largely due to the growth and ageing of the Victorian population. Kendall B, Wilson L, Olsen C et al. Cancers in Australia in 2010 attributable to overweight and obesity. Aust N Z J Public Health Oct; 39(5): Cancer mortality in Victorian Aboriginal and Torres Strait Islander peoples Aboriginal Victorians had higher incidence rates than non-aboriginal Victorians for bowel cancer (men only), cervix and lung cancer. Mortality rates were significantly higher for Aboriginal than for non-aboriginal Victorians, for both men and women. Obesity-related cancers It was estimated that 3.4% of all cancers diagnosed in Australia in 2010 were attributable to overweight/obesity 1. This would equate to more than 1,000 of the cancers diagnosed in Victoria in Several cancers, for which obesity is a known risk factor, show increasing trends in incidence in Victoria, including kidney, uterus, oesophagus (adenocarcinomas) and breast (post-menopausal women) cancers. Kidney cancer incidence rates continue to increase by 2% per year in both men and women. Changing prevalence of risk factors, in particular obesity, is implicated in this increase. Uterus cancer incidence rates continue to increase by >1% per year. Though 90% of these cancers occur in women aged over 50, incidence is increasing more steeply in younger women. The obesity epidemic is thought to be a major factor in this increase. Oesophageal adenocarcinoma incidence is increasing by 2.8% per year in men and by 2.2% per year in women. Breast cancer incidence is increasing in post-menopausal Victorian women (aged over 55 years) by 1.3% per year. Special feature: Colorectal Cancer Incidence rates for colorectal cancer have shown consistent downward trends in Victorian men and women in all age groups over 50 years. There has been a recent increase in incidence in both men and women aged under 50 years. Colorectal cancer incidence generally shows higher incidence with increasing distance from the Melbourne metropolitan area. Factors contributing to this may include variations in ethnic mix which may affect lifestyle factors such as diet, physical activity and obesity. Five-year survival from colorectal cancer by Stage shows a decrease from 97% survival in those with Stage 1 disease to 15% for those diagnosed with distant metastatic disease (Stage 4). Five-year survival from bowel cancer shows variations by region of residence. Cancer in Victoria Statistics & Trends

10 Demography This section describes the people of Victoria - where they live, where they were born, and selected vital statistics. This provides some background context to the information about the cancer experience of Victorians which is covered in the rest of this report. Population In 2015, the population of Victoria was 5,940,942 persons, making it the second most populous state of Australia. One in four Australians live in Victoria, with nearly three-quarters of these resident in metropolitan Melbourne. Most of the remainder live in small provincial cities with only 0.1% in remote areas. The estimated Aboriginal and/or Torres Strait Islander population of Victoria in 2011 was 47,333 persons, making up 0.7% of the Victorian population, and 7% of the national Aboriginal and Torres Strait Islander population. Victoria has an area of 227,420 km 2 and makes up less than 3% of the Australian continent (Figure 1). It is the most densely populated state with an average population density of 25 persons per km 2 (compared with the Australian density of 3 persons per km 2 ). Age and sex The age-sex distribution of the Victorian population is illustrated in Figure 2. The state s population distribution is as expected for a community in late demographic transition, having a declining birth rate and a steadily ageing population. In 2015, 18% of Victorians were aged under 15 years and 15% over 65 years. By 2021, these proportions are expected to be 16% aged less than 15 years and 19% over 65 years. Ethnicity At the 2011 census, 24% of the Victorian population (1,304,701 persons) was described as overseas born. Of these, 41% were from Asia (India 9%, China 7%, Vietnam 5%, Sri Lanka 3%, Malaysia 3%), 18% from Southern Europe (Italy 6%, Greece 4%), 17% from Great Britain, 10% from the rest of Europe and the former USSR, 7% from the Middle East and smaller proportions from South and North America, Africa and Oceania. Vital statistics* The birth rate steadily declined in Victoria from the early 1970s to early 2000s. Since that time, rates have been stable with the crude rate in 2014 of 12.7 births per 1,000 persons being the same as that of In 2014, life expectancy at birth was 81.1 years for males and 84.7 years for females. Over the last decade, life expectancy has increased by nearly 3 years for males and 2 years for females. There were 39,904 deaths of Victorian residents in The number of male deaths (20,034) was slightly higher than female deaths (19,870). Between 2004 and 2014, the median age at death for Victorian males increased from 77.3 to 79.9 years, and for Victorian females from 82.9 to 85.4 years. Cancer caused, in 2015, 28% of all deaths; ischaemic heart disease 12%, cerebrovascular disease 7%, chronic lower respiratory disease 5%, diabetes 3%, suicide 2% and transport accidents 1%. *Statistics are the latest available data from the Australian Bureau of Statistics. 10 Victorian Cancer Registry, Cancer Council Victoria 2016

11 Figure 1 Map of Victoria Melbourne WA NT SA QLD VIC NSW Greater Melbourne N Figure 2 Percent of population (and numbers of persons) by sex and age, Victoria , ,354 Male 49,431 67, ,559 78,717 Female 91, , , ,47 145, ,62 163, ,62 182, ,50 185, ,10 202, ,30 193, ,18 203, ,24 218, ,02 209, ,22 181, ,19 169, ,12 174, ,73 184, , Percent of population Source: Australian Bureau of Statistics. Population by age and sex: Australian States and Territories. (Cat. No ) Cancer in Victoria Statistics & trends

12 Incidence and mortality overview In 2015, 31,628 Victorians were diagnosed with cancer, and 10,937 died from cancer. Cancer statistics for Aboriginal and Torres Strait Islander Victorians are presented on pages During , an average of 120 Aboriginal and/or Torres Strait Islander Victorians were diagnosed with cancer, and 54 died from cancer each year. Incidence Each year, over 31,000 Victorians develop cancer 1, and there are nearly 11,000 cancer related deaths. In 2015, 16,977 men and 14,651 women were diagnosed with new cancers and 6,081 men and 4,856 women died from cancer. The standardised incidence rates (per 100,000 persons) were for males and for females. The cumulative percentage rates, to 75 years of age, were 40% for males and 32% for females. At least one in three Victorians will develop a cancer by the age of 75, with risks of over 1 in 3 for men and 1 in 4 for women. See Table 1 (pages 16-17) for a summary of incidence rates, and Appendix 7 (pages 47-60) for age-specific incidence rates, by sex and cancer type. Age and sex Cancer was strongly related to age, with less than 1% of tumours occurring before age 15 and almost 60% occurring in persons older than 65 years. More men than women developed cancer: 116 males for every 100 females. The predominance of males was associated with prostate and tobacco-related cancers. Mortality Age-standardised mortality rates for cancer were per 100,000 males and 72.5 per 100,000 females. Cancer death rates for men and women continue to decrease - 1.5% per year in men and 1.2% per year in women since The years of potential life lost (YPLL) to age 75 were 30,782 for men and 29,190 for women. A comparison of deaths caused by cancer, and YPLL, with other leading causes is shown in Figure 3. A summary of mortality rates by sex and cancer type is given in Table 2 (pages 18-19). In 2015, there were 42 deaths from the less common skin cancers, including Merkel cell tumours, dermatofibrosarcoma protuberans, malignant fibrous histiocytoma and skin appendage tumours (reported as other skin in Table 2). Deaths from the common non-melanoma skin cancers (basal and squamous cell carcinomas) are not recorded by the Victorian Cancer Registry and therefore not included in this report. See Appendix 5 (page 45) for an explanation of the coding of cancer mortality. Most common cancers The most commonly occurring cancers in Victoria are shown in Figures 5 and 6 (pages 14 and 15). Prostate cancer resumes its position in 2015 as the most common cancer in Victoria, and leading cancer in men (4,355 cases, 14% of all cancers and 26% of all cancers for men). Incidence rates rose steeply between 1987 and 1995, largely due to the uptake of Prostate Specific Antigen (PSA) testing to detect early asymptomatic cancers. Rates increased rapidly again between 1999 and 2009, but then showed a steep decline. Though the incidence rate in 2015 was slightly higher than in 2014, it remains just 65% of that in Prostate cancer was the third ranking cause of cancer death for men (710 deaths, 12% of total) in 2015 with rates continuing to decrease at 1.1% per year. Breast cancer is the second most common new cancer in Victoria. Breast cancer accounts for 13.7% (4,341, of which 42 were in men) of all new cases and 29% of all cancers for women. It was the second ranking cause of cancer death for Victorian women (722 deaths, 15% of total). Incidence rates continue to increase slowly, after a decade of more rapid increase, largely due to mammographic screening. Breast cancer mortality rates have shown a downward trend since 1994 of almost 2% per year. 1 All malignant tumours = all tumours with a behaviour code /3 in ICD-O-3 (Ref 1) EXCEPT the common non-melanoma skin cancers (NMSC): basal and squamous cell carcinomas. This INCLUDES Myelodysplastic syndromes (MDS) and Myeloproliferative disorders (MPD) that are classified as malignant neoplasms in ICD-O-3 (the classification used by IARC - International Association for Research on Cancer) but not in ICD-10-AM (Ref 2) (as reported in Australian Bureau of Statistics publications). 12 Victorian Cancer Registry, Cancer Council Victoria 2016

13 Figure 3 Proportions of all deaths and years of potential life lost (YPLL) for each of the leading causes of death, Victoria % 40 Proportion of all deaths % % 6.7% 5.1% % Proportion of total deaths (%) 1.6% 0.8% 0 Cancer IHD CVD CLRD Diabetes Suicide Transport accidents Other causes Years of potential life lost (to age 78 years) Years of potential life lost ('000s) YPLL measures the extent of premature mortality, assumed to be any death between 1 and 78 years and is a measure of the relative significance of specific causes of premature death. IHD=Ischaemic heart disease; CVD=Cerebrovascular disease (stroke); CLRD=Chronic lower respiratory disease (asthma and emphysema). Source: Causes of Death, Australia Australian Bureau of Statistics Cat. No ) Bowel or colorectal (colon and rectum) cancer was the third most common new cancer in Victoria in 2015, with 3,810 cases (12% of all cancers). It was the second ranking site of fatal cancer (1,389 deaths, 13% of total). The decline in rates observed over recent years continues in 2015, though it is too early to infer that this change is associated with the National Bowel Cancer Screening Program. See Pages for a special report on colorectal cancer in Victoria. Melanoma has overtaken lung as the fourth ranking new cancer in Victoria (2,712 cases, 9% of total) and was the ninth cause of cancer death (379 deaths, 3.5% of total). Mortality rates are stable, and incidence rates show a slight increase in both men and women after a period of decline from Rates continue to increase in older Victorians, but have decreased for younger age groups who have lived during the SunSmart era. Lung cancer was the fifth most common new cancer (2,680 new cases) in 2015, and remains the leading cause of cancer death (2,103 deaths, 19% of all cancer deaths). Incidence and mortality rates continue to decline for males, and rates for females appear to have reached a plateau. Cancers of unspecified primary site (CUP) form a substantial, and very heterogeneous, group of new cancers with 421 (1%) diagnoses in These cancers do not rank amongst the top ten cancer sites for incidence but, because they are often advanced or widespread at the time of diagnosis, rank seventh for mortality with 386 deaths (4% of all cancer deaths). There are estimated to be over 40,000 new diagnoses in Victoria each year of the common types of nonmelanoma skin cancers (basal and squamous cell carcinomas). These skin cancers are not reported to the registry, and therefore are not included in this report. However, incidence of the less common nonmelanoma skin cancers (including Merkel cell tumours, dermatofibrosarcoma protuberans and malignant fibrous histiocytoma) is reported as other skin cancer. The difference in order of ranking between incidence and mortality reflects the differing survivorship of patients with different cancers. For example, lung cancer is both common and quickly fatal and, therefore, ranks highly in both new cancers and cancer deaths. Pancreatic cancer is not common but is usually rapidly lethal, so its mortality ranking is higher than its incidence ranking. Trends in cancer incidence and mortality The trends in age-standardised rates of incidence and mortality for all cancers in Victoria by sex from are shown in Figure 4 (page 14). Figures 7 and 8 (pages 20-21) show trends for selected cancer types. Although cancer incidence rates increased, from , by an average of 0.6% for women and 0.7% for men per year, rates in men have shown a marked decline since 2009 due to falling prostate cancer incidence. Death rates have declined steadily since 1982 with average decreases of 1.5% per year for males and 1.2% for females. Cancer in Victoria Statistics & trends

14 Figure 4 Trends in cancer incidence and mortality rates by sex, Victoria Rate per 100,000 persons Year of diagnosis / death Key Males Incidence Mortality Females Incidence Mortality Figure 5 Leading cancer types by sex, Victoria Percent of total, and number, of new cases (incidence) and deaths (mortality) for the ten most common cancers by cancer type and sex Incidence Mortality Males All cancer Incidence 16,977 Mortality 6,081 Prostate Bowel Melanoma Lung Lymphoma Leukaemia Head & Neck Kidney Bladder Pancreas 4,355 2,101 1,542 1, Lung Bowel Prostate Pancreas Melanoma Stomach Liver Leukaemia Bladder Lymphoma 1, Females All cancer Incidence 14,651 Mortality 4,856 Breast Bowel Melanoma Lung Uterus Lymphoma Thyroid Leukaemia Pancreas Ovary 4,299 1,709 1,170 1, Lung Breast Bowel Pancreas Ovary CUP Leukaemia Lymphoma Brain & CNS Stomach Persons All cancer Incidence 31,628 Mortality 10,937 Prostate Breast Bowel Melanoma Lung Lymphoma Leukaemia Head & Neck Kidney Pancreas 4,355 4,341 3,810 2,712 2,680 1,618 1, Lung Bowel Breast Prostate Pancreas Leukaemia CUP Stomach Melanoma Liver 2,103 1, % of cases % of deaths 14 Victorian Cancer Registry, Cancer Council Victoria 2016

15 Figure 6 Leading types of new cancer by age group and sex, Victoria Percentage of new cancers and number of cases for most common cancers by sex and age Male Female 0-14 years All cancer incidence Male 88 Female 78 Leukaemia 32 Lymphoma 16 Brain & CNS Germ cell Neuroblastoma Leukaemia Lymphoma Soft tissue Brain & CNS Neuroblastoma Retinoblastoma Kidney Epithelial years All cancer incidence Male 129 Female 129 Testis Lymphoma Leukaemia Melanoma Bone Thyroid Bowel Ovary Leukaemia Brain & CNS years All cancer incidence Male 3,889 Female 4,784 Prostate Melanoma Bowel Breast Melanoma Bowel ,859 Lymphoma 258 Thyroid 304 Head & Neck 206 Uterus years All cancer incidence Male 7,332 Female 5,287 Prostate Bowel Lung 2, Breast Bowel Lung 1, Melanoma 619 Melanoma 364 Lymphoma 328 Uterus years All cancer incidence Male 5,539 Female 4,373 Prostate Bowel Lung Melanoma 1, Breast Bowel Lung Melanoma Bladder 308 Lymphoma % of cases % of cases Notes: For cancers occurring in children aged under 15 years, the International Classification of Childhood Cancer, Third Edition(Ref 8) groups are used. All other age groups are grouped according to ICD10 codes as described in Appendix 3. CUP = Cancer of unknown primary site For the purpose of this report, head and neck cancer (See Figure 5 page 14) includes cancers of the oral cavity and pharynx (ICD10 C01-C14), nasal cavities, middle ear and accessory sinuses (C30,C31) and larynx (C32). Other groupings are available on request. Cancer in Victoria Statistics & trends

16 Table 1 Cancer incidence, Victoria 2015 Number of new cases, crude rates (CR), cumulative rate to age 75 years (CR%) and age-standardised rate (ASR) per 100,000 (standardised to World Standard Population) by cancer type (See Appendix 3) and sex Male Female ICD-10 group Site Cases CR CR% ASR Cases CR CR% ASR C00 Lip C01,C02 Tongue C07,C08 Salivary glands C03 Gum C04 Floor of mouth C05, C06 Other mouth C01-C06 Oral cavity C09, C10 Oropharynx C11 Nasopharynx C12, C13 Hypopharynx C09-C13 Pharynx C14 Other oral C15 Oesophagus C16 Stomach C17 Small Intestine C18 Colon 1, , C19-C21 Rectum C18-C20 Bowel 2, , C21 Anus & anal canal C22 Liver C23, C24 Gallbladder C25 Pancreas C30, C31 Nasal Cavities C32 Larynx C33, C34 Lung 1, , C37, C38 Thymus etc C40, C41 Bone C43 Melanoma 1, , C44 Other skin C45 Mesothelioma C46 Kaposi Sarcoma C48 Peritoneum C47, C49 Connective Tissue C50 Breast , C53 Cervix C54, C55 Uterus C56 Ovary C58 Placenta C51, C52, C57 Vulva etc C61 Prostate 4, C62 Testis C60, C63 Penis etc C64 Kidney C67 Bladder C65, C66, C68 Renal pelvis etc Victorian Cancer Registry, Cancer Council Victoria 2016

17 Table 1 Cancer incidence, Victoria continued Male Female ICD-10 group Site Cases CR CR% ASR Cases CR CR% ASR C69 Eye C70 Meninges C71 Brain C72 Other CNS C70-C72 Brain & CNS C73 Thyroid C74, C75 Other endocrine C26, C39, C76-C79 Ill-defined site C80 Unspecified site C81 Hodgkin lymphoma C82 Nodular NHL C83 Diffuse NHL C84 Mature T/NK-cell lymphoma C85-86 Other NHL C82-C86 Non-Hodgkin lymphoma C88 Immunoproliferative C90 Multiple myeloma C91 Lymphoid leukaemia C91.0 Acute lymphatic leukaemia C91.1 Chronic lymphatic leukaemia C92 Myeloid leukaemia C92.0 Acute myeloid leukaemia C92.1 Chronic myeloid leukaemia C93 Monocytic leukaemia C94 Other leukaemia C95 Unspecified Leukaemia C91-C95 All leukaemia D45-D47 Myeloproliferative C96 Other haematopoietic C00-C96, D45-D47 All malignant tumours 16, , Haematological malignancies (See Appendix 3) Male Female Group Cases CR CR% ASR Cases CR CR% ASR Lymphoid neoplasms Hodgkin lymphomas Mature B-cell: CLL/small lymphocytic lymphoma Diffuse large B-cell lymphoma Follicular lymphoma Plasma cell disorders Other Mature T- and NK--cell neoplasms Acute lymphoblastic leukaemia Myeloid neoplasms Acute Myeloid leukaemias Chronic Myeloid leukaemia Other chronic myeloproliferative diseases Myelodysplastic syndromes Myelodysplastic/myeloproliferative diseases Cancer in Victoria Statistics & trends

18 Table 2 Cancer mortality, Victoria 2015 Number of deaths, crude rate (CR), years of potential life lost to age 75 years (YPLL) and age-standardised rate (ASR) per 100,000 (standardised to World Standard Population) by cancer type and sex (See Appendix 3) Male Female ICD-10 group Site Deaths CR YPLL ASR Deaths CR YPLL ASR C00 Lip C01,C02 Tongue C07,C08 Salivary glands C03 Gum C04 Floor of mouth C05, C06 Other mouth C01-C06 Oral cavity C09, C10 Oropharynx C11 Nasopharynx C12, C13 Hypopharynx C09-C13 Pharynx C14 Other oral C15 Oesophagus C16 Stomach , C17 Small Intestine C18 Colon , , C19-C21 Rectum , , C18-C20 Bowel , , C21 Anus & anal canal C22 Liver , C23, C24 Gallbladder C25 Pancreas , , C30, C31 Nasal Cavities C32 Larynx C33, C34 Lung 1, , , C37, C38 Thymus etc C40, C41 Bone C43 Melanoma , C44 Other skin C45 Mesothelioma C46 Kaposi Sarcoma C48 Peritoneum C47, C49 Connective Tissue C50 Breast , C53 Cervix C54, C55 Uterus C56 Ovary , C58 Placenta C51, C52, C57 Vulva etc C61 Prostate , C62 Testis C60, C63 Penis etc C64 Kidney C67 Bladder C65, C66, C68 Renal pelvis etc Victorian Cancer Registry, Cancer Council Victoria 2016

19 Table 2 Cancer mortality, Victoria 2015 continued Male Female ICD-10 group Site Deaths CR YPLL ASR Deaths CR YPLL ASR C69 Eye C70 Meninges C71 Brain , , C72 Other CNS C70-C72 Brain & CNS , , C73 Thyroid C74, C75 Other endocrine C26, C39, C76-C79 Ill-defined site C80 Unspecified site C81 Hodgkin lymphoma C82 Nodular NHL C83 Diffuse NHL C84 Mature T/NK-cell lymphoma C85-86 Other NHL C82-C86 Non-Hodgkin lymphoma C88 Immunoproliferative C90 Multiple myeloma C91 Lymphoid leukaemia C91.0 Acute lymphatic leukaemia C91.1 Chronic lymphatic leukaemia C92 Myeloid leukaemia C92.0 Acute myeloid leukaemia C92.1 Chronic myeloid leukaemia C93 Monocytic leukaemia C94 Other leukaemia C95 Unspecified Leukaemia C91-C95 All leukaemia , , D45-D47 Myeloproliferative C96 Other haematopoietic C00-C96, D45-D47 All malignant tumours 6, , , , Haematological malignancies (See Appendix 3) Male Female ICD-10 group Site Deaths CR YPLL ASR Deaths CR YPLL ASR Lymphoid neoplasms Hodgkin lymphomas Mature B-cell: CLL/small lymphocytic lymphoma Diffuse large B-cell lymphoma Follicular lymphoma Plasma cell disorders Other Mature T- and NK--cell neoplasms Acute lymphoblastic leukaemia Myeloid neoplasms Acute Myeloid leukaemias Chronic Myeloid leukaemia Other chronic myeloproliferative diseases Myelodysplastic syndromes Myelodysplastic/myeloproliferative diseases Cancer in Victoria Statistics & trends

20 Figure 7 Trends in incidence and mortality (annual age-standardised rates per 100,000 persons) for the 5 most common cancers by sex, Victoria Prostate cancer Female breast cancer Bowel cancer Lung cancer Melanoma Key Males Incidence Mortality Females Incidence Mortality Year of diagnosis / death Vertical axis shows annual age-standardised incidence/mortality rates per 100,000 Victorian males/females 20 Victorian Cancer Registry, Cancer Council Victoria 2016

21 Figure 8 Trends in incidence and mortality (annual age-standardised rates per 100,000 persons) for other selected cancers by sex, Victoria Kidney cancer Uterus cancer Oesophagus cancer Note: for this cancer all lines are incidence solid=adenocarcinoma dotted line=other cancers Liver cancer Thyroid cancer Key Males Incidence Mortality Females Incidence Mortality Year of diagnosis / death Vertical axis shows annual age-standardised incidence/mortality rates per 100,000 Victorian males/females. Cancer in Victoria Statistics & trends

22 Colorectal cancer in Victoria OVERVIEW - In this section we present a selection of the latest Victorian population-based descriptive statistics on colorectal cancer (hereafter referred to as bowel cancer). These statistics demonstrate the range of data available from the Victorian Cancer Registry, and are presented with minimal interpretation. Bowel cancer in Victoria in 2015 In 2015, 3,810 Victorians were diagnosed with bowel cancer, 55% of whom were men. Bowel cancer accounted for 12% of all cancers diagnosed and 13% of cancer deaths in Victoria, ranking third for incidence and second for cancer mortality. Bowel cancer incidence trends by age group In Victoria, bowel cancer is one of the three most commonly diagnosed cancers in each ten-year age group from to over 80 years. It is rare in younger Victorians with 358 new cases (9% of total) in 2015 diagnosed in those aged less than 50 years. Figure 11 shows trends in incidence of bowel cancer from by sex and age group from age 50 years. Generally, incidence rates have been declining over the past twenty years or more, and there is a recent suggestion of an increasing downward trend in all age groups, but it is premature to ascribe this to the National Bowel Cancer Screening Program (NBCSP). Incidence in those aged less than 50 years has been increasing in recent years. This is partly due to the increasing incidental diagnosis of carcinoid tumours of the appendix, which are now the 8th most common cancer in those aged years. Carcinoid tumours now comprise 42% of all bowel cancers in Victorians aged under 40 years (compared with less than 5% in 2005), 8% in those aged 40-59, and less than 2% of those in older Victorians (4.3% overall). Figure 9 shows that even when carcinoid tumours are excluded, bowel cancer incidence in Victorians aged less than 50 is increasing in recent years. Figure 9: Trends in bowel cancer incidence for Victorians less than 50 years of age Rate per 100,000 men/women Carcinoid men Carcinoid women Other cancers men Other cancers women Figure 10 The relative incidence of bowel cancer in Victoria by region of usual residence (see Page 24) Standardised Ratio Colorectal cancer by SA3 5-15% below state average State average +/- 5% 5-15% above state average > than 15% above state average 22 Victorian Cancer Registry, Cancer Council Victoria 2016

23 Figure 11: Trends in bowel cancer incidence for Victorians greater than 50 years of age Male Female Rate per 100,000 men Rate per 100,000 women Year of diagnosis Year of diagnosis Figure 12: Trends in bowel cancer incidence by sex and anatomical location Male Female Rectum Not specified Rate per 100,000 men Rate per 100,000 women Descending Ascending Transverse Year of diagnosis Year of diagnosis Bowel cancer incidence and trends by anatomical sub site Figure 12 show the trends in incidence of bowel cancer from by sex and anatomical sub site of tumour. The pattern of incidence differs between men and women. For men, rectum tumours predominate with rates 50% higher than those for the descending (left) colon and ascending (right) colon. The two sides of the colon had similar rates in 2015 having converged cover the past 30 years - in 1982, descending colon rates were almost double those for ascending colon. Rates for rectum and descending colon cancers have declined steadily from the early 2000s whilst those for the ascending colon appear to have stabilised during this time. For women, rates for rectum and descending colon cancers are more similar and both show downward trends across the whole 34 year period. Rates of rectum cancers for women are about two-thirds of those seen for men, though rates for other sites are closer. Rates of ascending colon cancer for women have shown a similar temporal pattern to those for men, but actually now exceed those for any of the other bowel sub-sites. Rates for cancers of the transverse colon have remained stable over time, and are similar for men and women. Those for unspecified colon sites have decreased consistently for both sexes reflecting improvements in diagnosis and pathology reporting. Cancer in Victoria Statistics & trends

24 Bowel cancer incidence by region of residence Figure 10 (Page 22) displays the relative incidence (standardised incidence ratios with the state average as reference) of bowel cancer for Victoria in , by region of usual residence at the time of diagnosis. The regions used are the SA3 regions defined in the Australian Bureau of Statistics Australian Statistical Geography Standard (ASGS) 1. In order to minimise the effects of discrepancies between neighbouring areas, and variation due to small numbers, a Bayesian smoothing method has been applied (See page 44 for details). The most striking feature of this map is the generally increasing incidence of bowel cancer with increasing distance from the Melbourne metropolitan area. The lowest incidences (10-15% below average) are observed in south-east Melbourne and the Mornington Peninsula, and the highest (15-25% above average) in the South-West and Wimmera and parts of the Mallee and Murray River regions. In this report, no attempt has been made to interpret these differences. Age has already been taken into account. Additional factors that are likely to contribute to these geographic variations include differences in ethnic mix as well as possible differences in lifestyle factors, such as diet and physical activity, or prevalence of obesity. Bowel cancer by registry-derived stage at diagnosis A brief description of the development and validation of Registry-derived stage (RD-Stage) is given on page 25. RD-stage at diagnosis is available for bowel carcinomas diagnosed in Victoria from In 2015, the proportions of bowel carcinomas by RD-stage at diagnosis were: RD-Stage % of 2015 tumours Stage 1 24% Stage 2 24% Stage 3 23% Stage 4 18% Unknown stage 11% The proportion of early Stage (Stages 1 and 2) bowel carcinomas has changed very little over time - in the three time periods , and , the proportion was 46%, 44% and 46% respectively. The proportion of Stage 4 disease is higher for younger patients - 28% of those aged less than 40 years, 25% of those aged years but less than 20% of older patients. A similar pattern of stage by age group is seen in the period prior to NBCSP (% Stage 4-25% in those aged under 40, 20% in those aged and less than 20% in all older groups). Bowel cancer survival trends Overall survival from bowel cancer has improved consistently and significantly over the past thirty years. Five-year period relative survival increased from 48% in to 68% in , with ongoing gains - the increase between and is statistically significant. Five-year period relative survival for Victorians over time was: Years % survival with 95% confidence interval (47-50) (50-52) (55-57) (59-61) (63-65) (67-69) (See Page 29 for description of survival methodology). Survival from bowel cancer in There was no significant difference in survival between men and women, and a significant trend for decreasing survival with increasing age at diagnosis. For those diagnosed at age < 45 years, five-year survival was 74%, whilst for those aged over 75 years at diagnosis, survival was 62%. These figures have not been adjusted for stage at diagnosis so the better survival in younger patients is in spite of a higher proportion of advanced tumours. Bowel cancer survival by region in Those residing in the Melbourne metropolitan region experienced higher survival (69%) from bowel cancer than those from the rest of Victoria (66%), and the survival between the eight Victorian Integrated Cancer Services (ICS) regions showed significant differences, as shown below. Region % survival with 95% confidence interval Southern 70 (69-72) West & Central 66 (64-68) North Eastern 70 (68-72) Barwon 66 (63-70) Grampians 64 (59-68) Loddon-Mallee 67 (64-71) Hume 65 (61-69) Gippsland 67 (63,71) Though there was an overall significant difference across regions, the confidence intervals for less populous regions are wide making individual comparisons difficult Victorian Cancer Registry, Cancer Council Victoria 2016