CANCER IN TASMANIA INCIDENCE AND MORTALITY 1996

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1 CANCER IN TASMANIA INCIDENCE AND MORTALITY 1996

2 CANCER IN TASMANIA INCIDENCE AND MORTALITY 1996 Menzies Centre For Population Health Research Editors: Dace Shugg, Terence Dwyer and Leigh Blizzard Publication Date: February 1999 Tasmanian Cancer Registry Menzies Building 17 Liverpool Street, Hobart Postal Address: GPO Box Hobart, Tasmania, Australia 7001 Telephone (03) Facsimile (03)

3 ACKNOWLEDGEMENTS The Department of Health and Human Services in Tasmania provided financial support to the Registry. The work of collecting and collating cancer registry data would be much more difficult and time consuming without the continuing assistance of a number of people. These include staff members of: Medical Records departments of all Tasmanian hospitals WP Holman Clinics in Launceston and Hobart Private and public pathology laboratories The Registry of Births, Deaths and Marriages The Australian Bureau of Statistics A special acknowledgment is due to doctors in private practice who respond to our written queries for additional information. During 1997 and 1998, the successful conduct of the prostate cancer and skin cancer case control studies has been greatly assisted by the co-operation of Tasmanian doctors, and we are most appreciative of this. We are also encouraged by the response of Tasmanians diagnosed with prostate cancer and skin cancer and their willingness to participate in the Tasmanian cancer case control studies. The clerical staff of the registry are commended for their commitment and efforts towards achieving 100% accuracy. This requires unremitting attention to detail. The composition of the Tasmanian Cancer Registry Advisory Committee has been changed during 1998 and a smaller committee has been co-opted to meet more frequently and assist the registry with strategic directions. The registry would like to thank the members of the retiring committee who have contributed so much to the registry for the past 21 years. Dace Shugg Registrar 2

4 CONTENTS Page Acknowledgements 2 Members of the Advisory Committee; Members of Staff; Data Release Committee 4 Demography of Tasmania 5 Methods and Calculations 6 Key to ICD-9 Classifications for Individual Sites 7 Ten Most Frequently Diagnosed Cancers Incidence and Mortality Regional Distribution of Incidence Report 9 Cervical Cancer in Tasmania Twenty Year Trend Analyses Incidence and Mortality Tables 17 Summary of Incidence Table 40 Summary of Mortality Table Inside back cover 3

5 THE TASMANIAN CANCER REGISTRY Members of the Advisory Committee Professor T Dwyer Convenor Mrs D Shugg Secretariat Dr M Jacobs Department of Health and Human Services Ms V Gardner Department of Health and Human Services Professor P Stanton Surgery Dr R Young Oncology Mrs M Ramsden Cancer Council of Tasmania Members of Staff Professor T Dwyer Medical Director Mrs D Shugg Registrar Mrs K Jackman and Mrs V Webb Medical Clerks Mr L Blizzard Biostatistician ComputerLand Computing Consultant Dr C Shugg Data Systems Consultant Mrs H Brettingham-Moore Clerical Assistance Mrs P Vallance Library Data Release Committee Dr R Kimber Dr M Baikie Dr S Gauden Dr R Kelsall 4

6 Population Demographics of Tasmania at 30 June 1996 Estimated Resident Population of Tasmania by Age as at 30 June 1996 Years Males Females Persons & over All ages The ageing population of Tasmania Following the 1996 census, it was estimated that the median age had increased to 34.3 years in males (33.8 years in 1995/96, and to 35.8 years in females (35.3 in 1995/96). In , the life expectancy of Tasmanians was lower than the life expectancy of all Australians. Life Expectancy in Tasmania in At birth At age 60 At age 80 Males 74.1 yrs 18.7yrs 6.6 yrs Females 80.0yrs 23.0 yrs 8.7 yrs Life Expectancy in Australia in At birth At age 60 At age 80 Males 75.2 yrs 19.6 yrs 7.0 yrs Females 81.1 yrs 23.8 yrs 8.9 yrs 5

7 METHODS AND CALCULATIONS The 1996 report contains numbers of new cases and deaths, and crude, cumulative, and age standardised incidence and mortality rates of Tasmanian residents diagnosed with cancer. Trends in cancer of the cervix are presented in more detail. In addition 20 year time trends are presented for a number of sites where there have been significant changes. Incidence Cancer incidence is defined as the number of new cases of cancer in a population during a specific period. The incidence data in this report relate to cancer cases first diagnosed between January 1996 and December 1996 in persons who were residents of Tasmania at the time of diagnosis. Mortality The mortality data in this report relate to deaths from cancer, of people who were first diagnosed as having cancer while they were residents of Tasmania. The Registrar of Births, Deaths and Marriages provides the Tasmanian cancer registry with copies of death certificates of all people who have died in Tasmania. Tasmanian cancer patients who die elsewhere in many instances are notified to the Tasmanian cancer registry by other State or Territory cancer registries. Details of patients diagnosed interstate who die in Tasmania are forwarded to the relevant cancer registry. Non cancer deaths of Tasmanian cases are also recorded so that survival rates can be calculated. Deaths from non-melanocytic skin cancers (NMSC) are reported but incidence is not. In 1996, four deaths were attributed to NMSC in Tasmania checked against the NDI. This procedure alerted us to a considerable number of deaths of persons dying interstate that had slipped through our net. All these deaths have now been added to our database. Calculation of rates Incidence and mortality rates were calculated per 100,000 population using the estimated Tasmanian population by age and sex for 1996 (Table 1) as supplied by the Australian Bureau of Statistics (ABS), Cat No Age-sex specific rates These are calculated by dividing the numbers of cases in each 5 year age and sex specific stratum by the ABS population estimate for that stratum and then multiplying the result by 100,000. Age standardised rates These calculations are based on the World ard Population Strata. Cumulative rates The cumulative rate (which is expressed as a percentage) is a good approximation of the risk which an individual would have of developing the disease in question if no other cause of death were to intervene. A cumulative incidence rate of cervical cancer of say, 0.9 would mean that one out of every 111 Tasmanian women would be expected to get cervical cancer by the age of 75 if she were not to die of another disease before that age. The corresponding cumulative mortality rate for cervical cancer from the 1996 data is one in 333. National Death Index (NDI) During 1997 and 1998, cases notified to the Tasmanian Cancer Registry between 1978 and 1996 and still thought to be living, were 6

8 Key to ICD-9 Classifications for Individual Sites 7

9 8 The Most Frequently Diagnosed Cancers Incidence and Mortality 1996

10 Regional Distribution of Incidence Report January 1996 December 1996 Regional Distribution of Incidence for all Sites with a minimum of 20 New Cases ICD-9 Site South North Mersey-Lyell Total Population * (49%) (28%) (23%) (100%) 185. Prostate 175 (53%) 100 (30%) 53 (16%) Lung 122 (50%) 68 (28%) 53 (22%) Breast 106 (47%) 69 (31%) 51 (22%) Colon 100 (47%) 58 (27%) 56 (26%) Melanoma of Skin 99 (53%) 52 (28%) 36 (19%) Rectum 51 (46%) 32 (29%) 29 (26%) Unspecified Site 51 (55%) 17 (18%) 24 (26%) All Lymphomas 41 (45%) 31 (34%) 19 (21%) Bladder 38 (49%) 25 (32%) 15 (19%) Pancreas 31 (58%) 10 (19%) 12 (23%) Stomach 19 (40%) 17 (35%) 12 (25%) Lip 20 (43%) 12 (26%) 14 (30%) Kidney 21 (47%) 8 (18%) 16 (36%) Brain 27 (63%) 7 (16%) 9 (21%) All Leukaemias 21 (51%) 11 (26%) 10 (23%) Oesophagus 23 (59%) 10 (26%) 6 (15%) Corpus Uteri 13 (37%) 14 (40%) 8 (23%) Ovary 15 (43%) 10 (29%) 10 (29%) Multiple Myeloma 15 (50%) 6 (20%) 9 (30%) Cervix Uteri 13 (48%) 6 (22%) 8 (30%) Thyroid 12 (44%) 6 (22%) 9 (33%) Soft Tissue 8 (36%) 6 (27%) 8 (36%) 22 * Estimated Resident Population at June 1996 (ABS) Statistical Division Boundary 9

11 CERVICAL CANCER IN TASMANIA Cervical cancer rates are reviewed in the context of a national cervical cancer screening program which was introduced in Tasmania in May The Department of Health and Human Services operates the program in Tasmania and the Tasmanian Cancer Registry and the Cervical Cytology Register have close and cooperative links. During this 20 year period, 596 cases of invasive cancer of the cervix were diagnosed in Tasmanian women. This total includes cases with micro-invasion but does not include in-situ cancer of the cervix. The histological types of the lesions are grouped as follows: Cell type number percentage Squamous cell cancer (SCC) % Micro invasive SCC 84 14% Adenocarcinoma 59 10% All other 39 7% TOTAL % Invasive cervical cancer incidence rates are decreasing. In 1978 invasive cervical cancer was the third most frequently diagnosed malignancy in Tasmanian women. In 1996 it was the eleventh most frequently diagnosed. The age standardised incidence of cancer of the cervix fell from 12.5 in the first decade ( ) to 10/100,000 in the most recent decade ( ). The decline in the overall incidence rate is mostly due to decreasing rates in women aged years at diagnosis. Rates in the under 35 year age group showed very little change over time. Cervical Cancer Incidence, Mortality and Micro-Invasive Disease Trends in Tasmania Year of incidence or death from cervical cancer 10 Progress in reducing mortality has not been as encouraging. The mortality rate fell from 4.4 in the first decade to 4.0 in the latest decade, but the decrease of about 12% was not statistically significant. The modest decrease in mortality appears to be almost entirely due to a fall in death rates in the 50+ age group which has occurred in the last ten years.

12 Cervical Cancer in Tasmania A likely indicator of the success of screening programs is an increase in the rate of microinvasive cancer over time because screening enables earlier detection. Our data indicate that there has been little change in the rate of micro-invasive cases during the 20 years. We would expect it only after 1994 and our data suggests that the downward trend has been arrested. In-situ carcinoma of the cervix An increasing rate of in-situ cervical cancer is an even better indicator of the success of early detection. New cases of In-Situ cervical cancer and CIN III in Tasmania Number of cases Age ardised Rate In-situ carcinoma of the cervix includes cases of the most severe grade of Cervical Intra Epithelial Neoplasia (CIN III). The cervical cytology register was set up in Tasmania in 1994, and has supplied data for the most recent complete three years, (1995, 1996 and 1997). The Cancer Registry also has data for its first three years of operation, (1978, 1979 and 1980). A total of 304 cases were diagnosed in the early period, compared to 613 in the most recent three year period. This corresponds to an age standardised rate of 47.2/100,000 compared to 83.8/100,000 in the later period, which is a statistically significant increase. Age specific incidence and mortality rates These have been plotted in five year age groups with two cases aged less than 20 at diagnosis and seven cases aged 85 or more at the time of diagnosis. Age Specific Incidence and Mortality Rates of Invasive Cervical Cancer in Tasmania Age at diagnosis or death The gap between the age specific incidence and mortality rate narrowed with increasing age. Women over the age of 75 are more likely to be diagnosed with fatal cervical cancer than are younger women. 11

13 TWENTY YEAR TREND ANALYSES Twenty Year Trend Analyses Some trend analyses covering the 20 year period for which there is complete data at the Tasmanian Cancer Registry have been plotted below for several cancer sites. Lung Cancer Incidence in Tasmania Year of diagnosis Male lung cancer incidence has been gradually declining since the late 1980s. Female rates appear to have levelled at a rate of approximately 20/100,000. Cutaneous Malignant Melanoma Incidence in Tasmania Year of diagnosis 12 There has been a threefold, highly significant increase in cutaneous melanoma incidence rates for men and women during this 20 year period, with the age standardised rate rising from 10 to above 30/100,000.

14 Twenty Year Trend Analyses Prostate Cancer and Breast Cancer Incidence in Tasmania Year of diagnosis Prostate cancer incidence peaked in the 1994/1995 period. In females, breast cancer incidence rates show a peak in the same period, most probably associated with the advent of populationbased mammography screening in Colon Cancer Incidence in Tasmania Year of diagnosis Colon cancer rates in males peaked between 1990 and 1995 after increasing in earlier years. Female rates ended the period higher in 1996/97 than 1978/79 but the trend was not significant. 13

15 Twenty Year Trend Analyses Non Hodgkin s Lymphoma Incidence in Tasmania Year of diagnosis There has been an increase in NHL rates for both males and females Cervical and Uterine Cancer Incidence in Tasmania Year of diagnosis The incidence rate of cervical cancer decreased during the 20 year period while uterine cancer rates increased and are now higher than cervical cancer rates. 14

16 Twenty Year Trend Analyses Oesophageal Cancer Incidence in Tasmania Year of diagnosis Oesophageal cancer rates appear to have plateaued in the last decade Gastric Cancer Incidence in Tasmania Year of diagnosis By way of contrast gastric cancer rates have been in decline since the late 1980s 15

17 16

18 CANCER INCIDENCE AND MORTALITY TABLES January 1996 December 1996 Numbers of New Cases and Deaths Cumulative Rates Crude and Age ardised Rates are presented as a rate /100,00 persons 17

19 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 140. LIP M F M F M M TONGUE M F M F M M SALIVARY GLAND M F 1 1 M F M M

20 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 143. GUM M 0 M M 0 F 1 1 M F FLOOR OF MOUTH M M M M OTHER MOUTH M 1 1 F M F M 1 1 M

21 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 146. OROPHARYNX M M M M NASOPHARYNX M F 1 1 M F M F 1 1 M F HYPOPHARYNX M F 1 1 M F M 1 1 M

22 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 149. OTHER PHARYNX M 0 F 1 1 M F M F 1 1 M F OESOPHAGUS M F M F M F M F STOMACH M F M F M F M F

23 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 152. SMALL INTESTINE M F M F M 1 1 F M F COLON M F M F M F M F RECTUM M F M F M F M F

24 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 155. LIVER M F M F M F M F GALL BLADDER M F M F M F M F PANCREAS M F M F M F M F

25 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 160. NASAL CAVITIES M 1 1 F M F M M LARYNX M F M F M M LUNG M F M F M F M F

26 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 163. PLEURA M F 1 1 M F M F 1 1 M F THYMUS M 1 1 F 1 1 M F M 0 F M F BONE M F 1 1 M F M 0 F M F

27 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 171. SOFT TISSUES M F M F M F M F MELANOMA OF SKIN M F M F M F M F SKIN M 0 M F Incidence of nonmelanocytic skin cancer is not reported M F 1 1 M F

28 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group BREAST M 1 1 F M F M 0 F M F CERVIX UTERI F F F F PLACENTA

29 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 182. CORPUS UTERI F F F F OVARY F F F F VAGINA F F F 1 1 F

30 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group VULVA F F F 1 1 F PROSTATE M M M M TESTIS M M M 1 1 M

31 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 187. PENIS M M M 0 M BLADDER M F M F M F M F KIDNEY M F M F M F M F

32 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 190. EYE M 1 1 F M F M F 1 1 M F BRAIN M F M F M F M F OTHER CNS M 0 M M 0 M

33 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 193. THYROID M F M F M 0 F 1 1 M F OTHER ENDOCRINE M 1 1 F M F M 0 M UNSPECIFIED SITE M F M F M F M F

34 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group ALL LYMPHOMAS M F M F M F M F DIFFUSE NON-HODGKIN'S LYMPHOMAS M F M F M F M F HODGKINS DISEASE M F M F M M

35 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group NODULAR LYMPHOMAS M F M F M 1 1 M OTHER LYMPHOMAS M F M F M F M F TUMORS OF HISTIOCYTIC TISSUE M 0 M M 0 M

36 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group 203. MULTIPLE MYELOMA M F M F M F M F ALL LEUKAEMIAS M F M F M F M F ACUTE LYMPHATIC LEUKAEMIA M F 1 1 M F M F 1 1 M F

37 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group CHRONIC LYMPHATIC LEUKAEMIA M F 1 1 M F M 0 M ACUTE MYELOID LEUKAEMIA M F M F M F M F CHRONIC MYELOID LEUKAEMIA M F M F M F 1 1 M F

38 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group CHRONIC MONOCYTIC LEUKAEMIA M 0 M M 0 M OTHER SPECIFIED LEUKAEMIAS M F M F M 1 1 F M F UNSPECIFIED CELL LEUKAEMIAS M 0 M M 0 M

39 ICD No. (9th Rev.) New Cases, Deaths, Crude, Cumulative and Age ardised Rates by Site, Sex and Age Group TOTAL M F M F M F M F

40 INCIDENCE Summary Table Tasmanian Cancer Incidence

41 MORTALITY Summary Table Tasmanian Cancer Mortality 1996

CANCER IN TASMANIA INCIDENCE AND MORTALITY 1995

CANCER IN TASMANIA INCIDENCE AND MORTALITY 1995 ACKNOWLEDGEMENTS The Department of Community and Health Services in Tasmania is acknowledged for financial support to the Registry. The work of collecting