Cancer survival and prevalence in Tasmania

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1 Cancer survival and prevalence in Tasmania

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3 Cancer survival and prevalence in Tasmania Tasmanian Cancer Registry University of Tasmania Menzies Research Institute Tasmania 17 Liverpool Street Hobart Tasmania Australia 7000 Postal address: Private Bag 23 Hobart Tasmania Australia 7001 Telephone: (03) Facsimile: (03) URL: Editors: Otahal P, Venn A, Dalton M, Blizzard L. Publication date: July

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5 CONTENTS OVERVIEW...5 GUIDE TO THIS REPORT...7 SURVIVAL ESTIMATES FOR ALL CANCERS AND SELECTED CANCERS...9 ALL CANCERS COMBINED...11 LUNG CANCER...16 COLORECTAL CANCER...18 BREAST CANCER (Female)...20 PROSTATE CANCER...22 MELANOMA...24 BLADDER CANCER...26 STOMACH CANCER...28 KIDNEY CANCER...30 ALL LYMPHOMAS...32 NON-HODGKIN S LYMPHOMA...34 ALL LEUKAEMIAS...36 THYROID CANCER...38 LIMITED-DURATION PREVALENCE AS AT APPENDIX I METHODOLOGY...42 Data...42 Relative Survival...42 Prevalence...44 APPENDIX II RELATIVE SURVIVAL SUMMARY AND ALTERNATIVE ESTIMATES...45 APPENDIX III INCIDENCE AND MORTALITY SUMMARY...47 REFERENCES

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7 OVERVIEW This report describes cancer survival and prevalence in Tasmanians diagnosed with cancer in 2004 to Survival is presented as the proportion (%) of Tasmanians surviving up to 5 years after a diagnosis of cancer, relative to other Tasmanians of the same age and sex. Many of those surviving at 5 years will survive more years, but we have not presented longer-term survival proportions in this report. Survival is reported for all cancers combined and for twelve selected cancer types that are the most common or of specific local interest (thyroid cancer). Cancer survival is presented for males and females separately, and for those aged under 65 years or 65 years and older at the time of cancer diagnosis. Only selected cancers and broad age-groupings are presented; the small size of the Tasmanian population means that survival estimates for less common cancers or smaller age groups are unreliable. Survival for Tasmanians diagnosed with cancer in is compared with survival in those diagnosed in earlier 5-year periods since It is important to note that survival figures reported here do not take into account important clinical factors that may affect an individual s likelihood of surviving following a diagnosis of cancer. These include the stage of cancer at diagnosis (how advanced the disease is), the sub-type of cancer, the type of treatment provided, and other health problems a person may have. Rather, these figures give a summary picture of survival for groups of Tasmanians with selected cancers by sex and age. Individuals with cancer should seek expert medical advice to determine their likely prognosis given all other relevant clinical information. Key findings of the report are as follows: Cancer survival at 5 years for all cancers diagnosed in was 62.0%. The highest survival was seen for thyroid cancer (97.9%) and melanoma (91.6%) in men and women, prostate cancer in men (96.5%) and breast cancer in women (89.1%). Cancers with the lowest 5-year survival were lung (12.5%) and stomach cancer (23.4%). Survival was generally similar in males and females. Tasmanians diagnosed with cancer under the age of 65 years had higher 5-year survival than those diagnosed at older ages. Survival for most cancers reported here was markedly higher in than in earlier time periods with the exception of lung and stomach cancer for which survival remained low. Survival for Tasmanians diagnosed with melanoma has been consistently high since Tasmanians living in areas of least socio-economic disadvantage at the time of diagnosis had higher cancer survival than those living in areas of most socio-economic disadvantage. Almost 20,000 Tasmanians with cancer diagnosed in the previous 31 years were believed to be still living at the end of In general, cancer survival in Tasmania was similar to Australia as a whole 1. 5

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9 GUIDE TO THIS REPORT This report on cancer survival and prevalence in Tasmania uses data collected by the Tasmanian Cancer Registry (TCR) which was established in The TCR publishes reports on cancer incidence and mortality in Tasmania annually. The annual reports can be found at and include details regarding the sources of cancer data, data collection and coding, and quality assurance. This report and the annual statistical reports of the TCR exclude cases of non-melanoma skin cancer. Cancer survival and prevalence in Tasmania can be compared with figures for Australia as a whole published by the Australian Institute of Health and Welfare (Cancer Survival and Prevalence in Australia: Cancers diagnosed from 1982 to 2004; Cancer Survival in Australia 2001: Parts 1, 2 and 3; Cancer Survival in Australia ) The type of analysis used to calculate cancer survival in this report is known as the Relative Survival method. Details are provided in Appendix I. Put simply, this method gives an estimate of survival following a diagnosis of cancer relative to expected survival for a person without cancer of the same age and sex in the same calendar year. Other types of analysis use the Period and Modelled methods to calculate cancer survival. These are less suited to the analysis of Tasmanian data because our population size, number of cancers and cancer-related deaths are relatively small. However, for comparison with other Australian reports using this method, survival estimates using the Period and Modelled methods are presented in Appendix II. The numbers of new cancer cases and cancer deaths used for this report, as well as relevant age-standardised incidence and mortality rates, appear in Appendix III. In the following sections presenting cancer survival, tables show the number of deaths and percent survival from one to five years after diagnosis for all Tasmanians diagnosed with cancer between 2004 and Survival figures are presented for males and females separately and by age at diagnosis (less than 65 years, or 65 years and over). Tables present 5-year survival for cancers diagnosed in compared with survival for cancers diagnosed in , , and The results presented in the tables also appear as graphs in the figures. For all cancers combined, 5-year survival is presented by categories of socio-economic disadvantage based on place of residence at diagnosis. The report concludes with estimates of limited-duration prevalence of all cancers in Tasmania. These estimates are of the number of people alive at December 2008 who had been diagnosed with cancer in Tasmania at any time in the previous 1, 3, 5, 10, 20 or 31 years. 7

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11 Survival Estimates for all Cancers and Selected Cancers 9

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13 ALL CANCERS COMBINED Figure 1 presents the 5-year survival for all cancers and selected cancers for males and females and shows that for cancers diagnosed in , survival was highest for thyroid cancer in females and prostate cancer in males. For both males and females, survival was lowest for lung cancer. The 5-year survival for all Tasmanians with cancer diagnosed in was 64.2%, which showed marked improvement from the 42.3% seen for cancers diagnosed in Survival was slightly higher in males than females, and higher in those aged under 65 years at diagnosis than in those aged 65 years or over. Figure 1: 5-year relative survival for selected cancers and all cancers combined for persons diagnosed from (bars represent 95% confidence intervals) Thyroid Melanoma Breast Kidney All Lymphomas NHL All Cancers Bladder Colorectal All Leukaemias Stomach Lung Female year relative survival (%) 5-year relative survival (%) 5-year rela ve survival (%) Prostate Thyroid Melanoma All Lymphomas NHL Kidney Bladder All Cancers Colorectal All Leukaemias Stomach Lung Male 5-year rela ve survival (%) 11

14 Table 1: Survival by years after diagnosis for all persons combined, diagnosed between 2004 and 2008 Years after diagnosis Number of deaths Survival (%) Lower Table 2: 5-year survival by sex, and by age group, diagnosed between 2004 and 2008 Number of deaths 5-year Survival (%) Lower Sex Female Male Age at diagnosis Table 3: 5-year survival by period of diagnosis for all persons combined Period of diagnosis Number of deaths 5-year Survival (%) Lower

15 Figure 2: Survival by period of diagnosis Figure 3: Survival by sex Figure 4: Survival by age group 13

16 Table 4: 5-year survival for all persons combined by fifths of the index of relative socio-economic disadvantage (IRSD), diagnosed between 2004 and 2008 IRSD Number of deaths Survival (%) Lower 1 (Most Disadvantaged) (Least Disadvantaged) Table 5: 5-year survival for women by fifths of the index of relative socio-economic disadvantage (IRSD), diagnosed between 2004 and 2008 IRSD Number of deaths Survival (%) Lower 1 (Most Disadvantaged) (Least Disadvantaged) Table 6: 5-year survival for men by fifths of the index of relative socio-economic disadvantage (IRSD), diagnosed between 2004 and 2008 IRSD Number of deaths Survival (%) Lower 1 (Most Disadvantaged) (Least Disadvantaged)

17 Figure 5: 5-year survival for all persons combined by region, diagnosed between 2004 and 2008 MERSEY- LYELL 63% NORTHERN 63% SOUTHERN 66% 15

18 LUNG CANCER The 5-year survival for all Tasmanians with lung cancer diagnosed in was 12.5%, which showed an improvement from the 9.6% seen for lung cancers diagnosed in Survival was slightly lower in males than females, and higher in those aged under 65 years at diagnosis than in those aged 65 years or over. Table 7: Survival by years after diagnosis for all persons combined, diagnosed between 2004 and 2008 Years after diagnosis Number of deaths Survival (%) Lower Table 8: 5-year survival by sex, and by age group, diagnosed between 2004 and 2008 Number of deaths 5-year Survival (%) Lower Sex Female Male Age at diagnosis Table 9: 5-year survival by period of diagnosis for all persons combined Period of diagnosis Number of deaths 5-year Survival (%) Lower

19 Figure 6: Survival by period of diagnosis Figure 7: Survival by sex Figure 8: Survival by age group 17

20 COLORECTAL CANCER The 5-year survival for all Tasmanians with colorectal cancer diagnosed in was 61.6%, which showed marked improvement from the 40.8% seen for colorectal cancers diagnosed in Survival was slightly higher in males than females, and higher in those aged under 65 years at diagnosis than in those aged 65 years or over. Table 10: Survival by years after diagnosis for all persons combined, diagnosed between 2004 and 2008 Years after diagnosis Number of deaths Survival (%) Lower Table 11: 5-year survival by sex, and by age group, diagnosed between 2004 and 2008 Number of deaths 5-year Survival (%) Lower Sex Female Male Age at diagnosis Table 12: 5-year survival by period of diagnosis for all persons combined Period of diagnosis Number of deaths 5-year Survival (%) Lower

21 Figure 9: Survival by period of diagnosis Figure 10: Survival by sex Figure 11: Survival by age group 19

22 BREAST CANCER (FEMALE) The 5-year survival for all Tasmanian females with breast cancer diagnosed in was 89.1%, which showed marked improvement from the 70.3% seen for breast cancers diagnosed in Survival was higher in those aged under 65 years at diagnosis than in those aged 65 years or over. Table 13: Survival by years after diagnosis for females diagnosed between 2004 and 2008 Years after diagnosis Number of deaths Survival (%) Lower Table 14: 5-year survival by age group, diagnosed between 2004 and 2008 (females) Number of deaths 5-year Survival (%) Lower Age at diagnosis Table 15: 5-year survival by period of diagnosis (females) Period of diagnosis Number of deaths 5-year Survival (%) Lower

23 Figure 12: Survival by period of diagnosis Figure 13: Survival by age group 21

24 PROSTATE CANCER The 5-year survival for all Tasmanian males with prostate cancer diagnosed in was 96.5%, which showed marked improvement from the 58.1% seen for prostate cancers diagnosed in Survival was higher in those aged under 65 years at diagnosis than in those aged 65 years or over. Table 16: Survival by years after diagnosis for all males diagnosed between 2004 and 2008 Years after diagnosis Number of deaths Survival (%) Lower Table 17: 5-year survival by age group, diagnosed between 2004 and 2008 Number of deaths 5-year Survival (%) Lower Age at diagnosis Table 18: 5-year survival by period of diagnosis Period of diagnosis Number of deaths 5-year Survival (%) Lower

25 Figure 14: Survival by period of diagnosis Figure 15: Survival by age group 23

26 MELANOMA The 5-year survival for all Tasmanians with melanoma diagnosed in was 91.6%, which showed improvement from the 88.3% seen for melanomas diagnosed in Survival was slightly lower in males than females, and higher in those aged under 65 years at diagnosis than in those aged 65 years or over. Table 19: Survival by years after diagnosis for all persons combined, diagnosed between 2004 and 2008 Years after diagnosis Number of deaths Survival (%) Lower Table 20: 5-year survival by sex, and by age group, diagnosed between 2004 and 2008 Number of deaths 5-year Survival (%) Lower Sex Female Male Age at diagnosis Table 21: 5-year survival by period of diagnosis for all persons combined Period of diagnosis Number of deaths 5-year Survival (%) Lower

27 Figure 16: Survival by period of diagnosis Figure 17: Survival by sex Figure 18: Survival by age group 25

28 BLADDER CANCER The 5-year survival for all Tasmanians with bladder cancer diagnosed in was 64.6%, which was poorer than the survival of greater than 73.8% seen between This difference is largely explained by the lower proportion of bladder cancers being diagnosed in younger people in recent years. The drop in bladder cancer incidence in younger people (who typically have better survivals) may be a consequence of reduced exposure to occupational chemical hazards. Survival was slightly higher in males than females, and higher in those aged under 65 years at diagnosis than in those aged 65 years or over. Table 22: Survival by years after diagnosis for all persons combined, diagnosed between 2004 and 2008 Years after diagnosis Number of deaths Survival (%) Lower Table 23: 5-year survival by sex, and by age group, diagnosed between 2004 and 2008 Number of deaths 5-year Survival (%) Lower Sex Female Male Age at diagnosis Table 24: 5-year survival by period of diagnosis for all persons combined 26 Period of diagnosis Number of deaths 5-year Survival (%) Lower

29 Figure 19: Survival by period of diagnosis Figure 20: Survival by sex Figure 21: Survival by age group 27

30 STOMACH CANCER The 5-year survival for all Tasmanians with stomach cancer diagnosed in was 23.4%, which showed marked improvement from the 11.4% seen for stomach cancers diagnosed in Survival was higher in males than females, and in those aged under 65 years at diagnosis than in those aged 65 years or over. Table 25: Survival by years after diagnosis for all persons combined, diagnosed between 2004 and 2008 Years after diagnosis Number of deaths Survival (%) Lower Table 26: 5-year survival by sex, and by age group, diagnosed between 2004 and 2008 Number of deaths 5-year Survival (%) Lower Sex Female Male Age at diagnosis Table 27: 5-year survival by period of diagnosis for all persons combined Period of diagnosis Number of deaths 5-year Survival (%) Lower

31 Figure 22: Survival by period of diagnosis Figure 23: Survival by sex Figure 24: Survival by age group 29

32 KIDNEY CANCER The 5-year survival for all Tasmanians with kidney cancer diagnosed in was 70.7%, which showed marked improvement from the 24.6% seen for kidney cancers diagnosed in Survival was slightly lower in males than females, and higher in those aged under 65 years at diagnosis than in those aged 65 years or over. Table 28: Survival by years after diagnosis for all persons combined, diagnosed between 2004 and 2008 Years after diagnosis Number of deaths Survival (%) Lower Table 29: 5-year survival by sex, and by age group, diagnosed between 2004 and 2008 Number of deaths 5-year Survival (%) Lower Sex Female Male Age at diagnosis Table 30: 5-year survival by period of diagnosis for all persons combined Period of diagnosis Number of deaths 5-year Survival (%) Lower

33 Figure 25: Survival by period of diagnosis Figure 26: Survival by sex Figure 27: Survival by age group 31

34 ALL LYMPHOMAS The 5-year survival for all Tasmanians with lymphoma diagnosed in was 72.8%, which showed marked improvement from the 54.2% seen for lymphomas diagnosed in Survival was slightly higher in males than females, and higher in those aged under 65 years at diagnosis than in those aged 65 years or over. Table 31: Survival by years after diagnosis for all persons combined, diagnosed between 2004 and 2008 Years after diagnosis Number of deaths Survival (%) Lower Table 32: 5-year survival by sex, and by age group, diagnosed between 2004 and 2008 Number of deaths 5-year Survival (%) Lower Sex Female Male Age at diagnosis Table 33: 5-year survival by period of diagnosis for all persons combined Period of diagnosis Number of deaths 5-year Survival (%) Lower

35 Figure 28: Survival by period of diagnosis Figure 29: Survival by sex Figure 30: Survival by age group 33

36 NON-HODGKIN S LYMPHOMA The 5-year survival for all Tasmanians with Non-Hodgkin s lymphoma diagnosed in was 72.3%, which showed marked improvement from the 50.9% seen for Non-Hodgkin s lymphomas diagnosed in Survival was higher in males than females, and higher in those aged under 65 years at diagnosis than in those aged 65 years or over. Table 34: Survival by years after diagnosis for all persons combined, diagnosed between 2004 and 2008 Years after diagnosis Number of deaths Survival (%) Lower Table 35: 5-year survival by sex, and by age group, diagnosed between 2004 and 2008 Number of deaths 5-year Survival (%) Lower Sex Female Male Age at diagnosis Table 36: 5-year survival by period of diagnosis for all persons combined Period of diagnosis Number of deaths 5-year Survival (%) Lower

37 Figure 31: Survival by period of diagnosis Figure 32: Survival by sex Figure 33: Survival by age group 35

38 ALL LEUKAEMIAS The 5-year survival for all Tasmanians with leukaemia diagnosed in was 59.4%, which showed marked improvement from the 39.3% seen for leukaemias diagnosed in Survival was slightly higher in males than females, and higher in those aged under 65 years at diagnosis than in those aged 65 years or over. Table 37: Survival by years after diagnosis for all persons combined, diagnosed between 2004 and 2008 Years after diagnosis Number of deaths Survival (%) Lower Table 38: 5-year survival by sex, and by age group, diagnosed between 2004 and 2008 Number of deaths 5-year Survival (%) Lower Sex Female Male Age at diagnosis Table 39: 5-year survival by period of diagnosis for all persons combined Period of diagnosis Number of deaths 5-year Survival (%) Lower

39 Figure 34: Survival by period of diagnosis Figure 35: Survival by sex Figure 36: Survival by age group 37

40 THYROID CANCER The 5-year survival for all Tasmanians with thyroid cancer diagnosed in was 97.9%, which showed marked improvement from the 80.2% seen for thyroid cancers diagnosed in Survival was slightly lower in males than females, and lower in those aged under 65 years at diagnosis than in those aged 65 years or over. Table 40: Survival by years after diagnosis for all persons combined, diagnosed between 2004 and 2008 Years after diagnosis Number of deaths Survival (%) Lower Table 41: 5-year survival by sex, and by age group, diagnosed between 2004 and 2008 Number of deaths 5-year Survival (%) Lower Sex Female Male Age at diagnosis Table 42: 5-year survival by period of diagnosis for all persons combined Period of diagnosis Number of deaths 5-year Survival (%) Lower

41 Figure 37: Survival by period of diagnosis Figure 38: Survival by sex Figure 39: Survival by age group 39

42 LIMITED-DURATION PREVALENCE AS AT 2008 Limited duration prevalence for invasive cancers relates to the number of persons alive at the end of 2008 after a diagnosis of cancer in the preceding years. The tables below show statistics for all cancer types combined and each selected individual cancer type. For example, 10-year limited duration prevalence reports the number of persons alive by the end of 2008 that had a cancer diagnosis in the preceding 10-years (i.e. from 1 January 1999 to 31 December 2008). The 31-year limited-duration prevalence is a good estimate of the complete prevalence or total numbers of persons living with a prior diagnosis of cancer this represents the total number of persons diagnosed and living with cancer since the beginning of data collection in the Tasmanian Cancer Registry in Table 43: Limited-duration prevalence for persons Duration Cancer site 1 year 3 year 5 year 10 year 20 year 31 year All Lung Colorectal Breast (female only) Prostate (male only) Melanoma Bladder Stomach Kidney All lymphomas NHL All leukaemias Thyroid

43 Table 44: Limited-duration prevalence for females Duration Cancer site 1 year 3 year 5 year 10 year 20 year 31 year All Lung Colorectal Breast Melanoma Bladder Stomach Kidney All lymphomas NHL All leukaemias Thyroid Table 45: Limited-duration prevalence for males Duration Cancer site 1 year 3 year 5 year 10 year 20 year 31 year All Lung Colorectal Prostate Melanoma Bladder Stomach Kidney All lymphomas NHL All leukaemias Thyroid

44 APPENDIX I METHODOLOGY Data The primary data source for this report was the Tasmanian Cancer Registry (TCR). The TCR was established in 1977 and is a population-based registry covering the whole of Tasmania. The registry stores detailed information for each diagnosis of cancer incidence and mortality. This report used data for age, sex, and site covering a period from 1978 to 2008 for incidence and 1978 to 2009 for mortality. The registry collects mortality statistics from a number of sources, including pathology centres, public and private hospitals, radiotherapy centres, and Births, Deaths and Marriages. In addition, data linkage with the National Death Index (NDI) was performed in 2008 to update mortality statistics. Estimated residential population, mortality, and life table data for Tasmania were supplied by the Australian Bureau of Statistics (ABS) for the period as was required for survival analyses. ABS life tables were only available for the most recent time period, so population and mortality data were used to calculate the remaining periods as specified below. TCR records marked as death certificate only (DCO), where diagnosis is made at time of death or autopsy, were excluded from analysis. Persons diagnosed with multiple cancers, e.g. melanoma and lung cancer, were included as separate cancers for cancer-specific survival analyses, i.e. once for melanoma survival and once for lung cancer survival. In multi-site cancer classifications (e.g. All cancers, Colorectal), only the first incident case was included in survival calculations for each person. Persons of age greater than 100 years are grouped with persons aged 100 years due to the unavailability of life table data the number of persons affected is extremely small, less than 0.02% of total cases, and inclusion or exclusion makes no measureable difference to survival estimates. Estimates are also calculated in age groupings for persons under 65 years and persons 65 years and over. Finer age divisions could not be used due to insufficient cases. The Index of Relative Socio-economic Disadvantage (IRSD) is collected by the Australian Bureau of Statistics (ABS) for each Collection District (CD). Persons registered on the Cancer Registry database were identified to Statistical Local Area (SLA) and an estimate of the IRSD was obtained by averaging the CD indices within each SLA. SLAs were then ranked by IRSD and grouped according to population fifths for analysis. Relative Survival Relative survival is an objective measure of the survival probability from cancer, separate to other causes of death. Where certainty of the cause of death is known, such as in a clinical setting, estimated survival probability would be calculated using a cause-specific survival analysis. However, in a population-based setting the relative survival technique is used due to the unavailability and/or unreliability of cause-of-death information obtained from death certificates, which are the standard method of notification of death for cancer registries. The key assumption in relative survival analysis is that individuals diagnosed with cancer die of causes other than cancer at the same rate as the general population. Relative survival is defined as the proportion of persons surviving after diagnosis of cancer relative to the expected survival of a group of similar cancer-free persons. The expected survival is computed from population life tables. 42

45 Population life tables from 2003 to 2009 were supplied directly from the ABS (cat. no ); life tables prior to 2003 were computed from mortality and estimated residential population data supplied on special request from the ABS. Life tables calculated from the supplied mortality and population data were smoothed in order to match the life tables supplied by the ABS from the latter time periods. This smoothing consisted of averaging data for three years and then applying lowess (moving average) smoothing over ages within each year, e.g. the estimate for 2002 is an average of data. A further adjustment to the life tables was done when survival probability was calculated for all cancer types combined. Since cancer is a relatively common cause of death (particularly in later life), the life tables were adjusted by removing the deaths due to all cancers; this adjustment was unnecessary for analysis of specific cancer types as the proportion of deaths from individual cancer types is relatively small when compared to all deaths (including deaths from cancers other than the particular one being analysed). Survival was calculated on a monthly basis, as data from the TCR were originally only recorded to monthly diagnosis level of accuracy. Calculations used a nominal day of diagnosis, and deaths that occurred within one month were imputed to have a 2 week survival time. Expected survival was computed from life tables for the Tasmanian population using Ederer II methodology 2. Theoretically, calculations based at the monthly level rather than daily level could be less accurate, but practically the differences are unperceivable. A number of methods are available for calculating relative survival. This report presents survival estimates calculated using the more traditional Actuarial method. This method has been chosen to enable comparison to survival estimates calculated by the AIHW 1. Estimates using two contemporary methods, Period method and Modelled method, are also presented in appendices for comparison with estimates calculated by other registries. Further explanations of each method follow. Actuarial (multiple-year cohort) method Provides estimates which are relatively accurate (with narrow confidence intervals), but are not as up-to-date as newer methods (see below), vis-à-vis the true survival proportion is underestimated if survival shows an increasing trend over time. This method is also known as the multiple-year cohort method as used by SEER registries 5 this makes data from this report comparable with data produced from other sources using SEER methodology. Survival estimates were calculated for persons diagnosed in a defined calendar period, the most recent being (inclusive) with follow-up information (mortality status) complete to the end Earlier calendar intervals (diagnostic periods) were analysed in a similar manner (i.e. censoring applied even though full follow up information was available). Period method A contemporary method developed by Brenner and Gefeller 3, uses persons diagnosed in the most recently available calendar periods to calculate survival estimates. This reduces the error in estimating survival for cancers showing increasing (or decreasing) trends with time, but since less data is included in the calculation estimates are less precisely computed (having wider confidence intervals). 43

46 Persons diagnosed in 2008 contributed to estimates for 1 st and 2 nd years of follow-up (death ascertainment was until the end of 2009), persons diagnosed in 2007 contributed to estimates for 2 nd and 3 rd years of follow-up, etc. Modelled method A further extension of the Period method applies statistical modelling techniques to estimates this method, developed by Brenner and Hakulinen 4, produces up-to-date estimates with smaller confidence intervals. Period-type estimates were formed for a five-year modelling window, each n th year of follow-up contained estimates from five calendar years. For example, the 1 st year of follow-up was estimated from persons diagnosed in , the 2 nd year of follow-up from persons diagnosed in , etc. Poisson regression modelling was then applied to estimate current survival. Prevalence This report presents estimated limited-duration prevalence estimates at 1, 3, 5, 10, 20, and 31-years post diagnosis. Limited-duration prevalence represents the number of persons alive on the 31 of December 2008 diagnosed with cancer in the past X years (including 2008). The Tasmanian Cancer Registry does not have sufficient records to calculate complete prevalence (all persons alive following cancer diagnosis), but since cancer is a disease most prevalent in the last third of life, the 31-year limited duration prevalence estimate is a reasonable approximation. 44

47 APPENDIX II RELATIVE SURVIVAL SUMMARY AND ALTERNATIVE ESTIMATES The tables below show survival estimates as presented throughout this report using the Actuarial method, and for comparison, estimates from two alternative methods for calculating relative survival; the Period method and the Modelled method. Actuarial method Age Group Cancer Type Persons Females Males All 64.2 ( ) 62.4 ( ) 65.5 ( ) 74.6 ( ) 55.3 ( ) Lung 12.5 ( ) 13.6 ( ) 11.7 ( ) 14.9 ( ) 11.4 ( ) Colorectal 61.6 ( ) 58.7 ( ) 64.2 ( ) 64.2 ( ) 60.3 ( ) Breast 89.1 ( ) 91.8 ( ) 84.6 ( ) Prostate 96.5 ( ) 99.2 ( ) 95.2 ( ) Melanoma 91.6 ( ) 94.5 ( ) 88.9 ( ) 93.1 ( ) 88.5 ( ) Bladder 64.6 ( ) 60.8 ( ) 65.8 ( ) 76.9 ( ) 61.1 ( ) Stomach 23.4 ( ) 15.5 ( ) 27.8 ( ) 30.8 ( ) 19.6 ( ) Kidney 70.7 ( ) 72.5 ( ) 69.7 ( ) 78.7 ( ) 60.7 ( ) All Lymphomas 72.8 ( ) 69.9 ( ) 75.2 ( ) 81.5 ( ) 64.8 ( ) NHL 72.3 ( ) 69.0 ( ) 74.7 ( ) 80.2 ( ) 65.8 ( ) All Leukaemias 59.4 ( ) 56.6 ( ) 61.0 ( ) 77.9 ( ) 46.4 ( ) Thyroid 97.9 ( ) ( ) 93.3 ( ) 97.6 ( ) 98.7 ( ) Five-year relative survival estimate and 95% confidence interval in brackets. 45

48 Period method Age Group Cancer Type Persons Females Males All 67.6 ( ) 65.6 ( ) 68.9 ( ) 77.0 ( ) 59.0 ( ) Lung 11.9 ( ) 13.4 ( ) 10.9 ( ) 12.2 ( ) 11.8 ( ) Colorectal 68.2 ( ) 66.0 ( ) 70.1 ( ) 68.2 ( ) 68.4 ( ) Breast 88.4 ( ) 92.1 ( ) 81.6 ( ) Prostate 96.3 ( ) 98.5 ( ) 95.1 ( ) Melanoma 90.0 ( ) 92.1 ( ) 88.2 ( ) 92.8 ( ) 85.4 ( ) Bladder 64.1 ( ) 60.2 ( ) 65.2 ( ) 69.1 ( ) 62.8 ( ) Stomach 23.8 ( ) 11.0 ( ) 29.4 ( ) 28.8 ( ) 20.8 ( ) Kidney 80.3 ( ) 83.3 ( ) 78.3 ( ) 90.8 ( ) 67.4 ( ) All Lymphomas 74.6 ( ) 76.0 ( ) 73.4 ( ) 80.6 ( ) 68.9 ( ) NHL 73.8 ( ) 75.4 ( ) 72.4 ( ) 79.0 ( ) 70.0 ( ) All Leukaemias 61.7 ( ) 54.8 ( ) 65.0 ( ) 88.7 ( ) 40.3 ( ) Thyroid 99.7 ( ) 99.0 ( ) ( ) 99.5 ( ) ( ) Five-year relative survival estimate and 95% confidence interval in brackets. Modelled method Age Group Cancer Type Persons Females Males All 65.9 ( ) 65.2 ( ) 66.2 ( ) 76.6 ( ) 56.0 ( ) Lung 8.9 ( ) 10.2 (7-13.4) 8.0 ( ) 12.0 ( ) 7.6 (5.1-10) Colorectal 70.2 ( ) 67.8 ( ) 72.3 ( ) 74.2 ( ) 66.6 ( ) Breast 87.1 ( ) 91.2 ( ) 84.7 ( ) Prostate 98.6 ( ) 99.4 ( ) 98.0 (96-100) Melanoma 92.8 ( ) 95.8 ( ) 90.4 ( ) 94.3 ( ) 90.8 ( ) Bladder 65.5 ( ) 62.9 ( ) 66.5 ( ) 76.5 ( ) 62.0 ( ) Stomach 21.8 ( ) 11.7 (3.5-20) 26.8 ( ) 30.5 ( ) 17.2 ( ) Kidney 78.0 ( ) 79.4 ( ) 77.2 ( ) 84.9 ( ) 68.1 ( ) All Lymphomas 75.3 ( ) 73.2 ( ) 76.7 ( ) 83.7 ( ) 65.9 ( ) NHL 74.6 ( ) 71.6 ( ) 76.5 ( ) 82.2 ( ) 67.8 ( ) All Leukaemias 57.3 ( ) 56.1 ( ) 58.3 ( ) 74.3 ( ) 43.4 ( ) Thyroid 96.1 ( ) 98.6 ( ) 95.2 ( ) 98.8 ( ) * * Five-year relative survival estimate and 95% confidence interval in brackets. * Not able to be estimated as model did not converge. 46

49 APPENDIX III INCIDENCE AND MORTALITY SUMMARY Incident cases used in the calculation of relative survival in this report ICD-10 Site N ASR N ASR N ASR N ASR N ASR C00-C96 All Cancers C33,C34 Lung C18-C21 Colorectal C50 Breast (females) C61 Prostate (males) C43 Melanoma C67 Bladder C16 Stomach C64 Kidney C81-C85 All lymphomas C82-C85 NHL C91-C95 All leukaemias C73 Thyroid ASR Age standardised rate (incidence per 100,000), standardised to the Australian 2001 population Figures may not match TCR annual reports due to updated information and exclusion of death certificate only (DCO) cases. Deaths used in the calculation of relative survival in this report ICD-10 Site N ASR N ASR N ASR N ASR N ASR C00-C96 All Cancers C33,C34 Lung C18-C21 Colorectal C50 Breast (females) C61 Prostate (males) C43 Melanoma C67 Bladder C16 Stomach C64 Kidney C81-C85 All lymphomas C82-C85 NHL C91-C95 All leukaemias C73 Thyroid ASR Age standardised rate (incidence per 100,000), standardised to the Australian 2001 population Figures may not match TCR annual reports due to updated information and exclusion of death certificate only (DCO) cases. 47

50 REFERENCES 1. Australian Institute of Health and Welfare, Cancer Australia & Australasian Association of Cancer Registries, Cancer survival and prevalence in Australia: Cancers diagnosed from 1982 to Cancer Series No. 40, Cat. no. CAN 38., Canberra: AIHW. 2. Ederer F, Axtell LM and Cutler SJ, The Relative Survival Rate: a Statistical Methodology. National Cancer Institute Monograph, 6: p Brenner H and Gefeller O, An Alternative Approach to Monitoring Cancer Patient Survival. Cancer, 78(9): p Brenner H and Hakulinen T, Up-to-date and Precise Estimates of Cancer Patient Survival: Model-based Period Analysis. American Journal of Epidemiology, 164(7): p National Cancer Institute, Cancer Survival Statistics: Cohort Definition Using Diagnosis Year. Retrieved 25 th May 2012 from 48

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