Leukemia Report on Cancer Statistics in Alberta. December Cancer Care. Cancer Surveillance

Similar documents
Liver Cancer Report on Cancer Statistics in Alberta. December Cancer Care. Cancer Surveillance

Kidney Cancer Report on Cancer Statistics in Alberta. December Cancer Care. Cancer Surveillance

Colorectal Cancer Report on Cancer Statistics in Alberta. December Cancer Care. Cancer Surveillance

2012 Report on Cancer Statistics in Alberta

2012 Report on Cancer Statistics in Alberta

Summary Report Report on Cancer Statistics in Alberta. December Cancer Care. Cancer Surveillance

Childhood Cancer Report on Cancer Statistics in Alberta. December Cancer Care. Cancer Surveillance

Report on Cancer Statistics in Alberta. Kidney Cancer

Report on Cancer Statistics in Alberta. Melanoma of the Skin

Report on Cancer Statistics in Alberta. Breast Cancer

Summary Report Report on Cancer Statistics in Alberta. February Surveillance and Health Status Assessment Cancer Surveillance

2012 Report on Cancer Statistics in Alberta

Report on Cancer Statistics in Alberta. Childhood Cancer

version. original the for publisher the contact Cancer in Alberta: Please A Regional Picture 2007 only. purposes archival for is copy This

Cancer in Alberta: A Regional Picture 2005

An Overview of Survival Statistics in SEER*Stat

Cancer in Halton. Halton Region Cancer Incidence and Mortality Report

Cancer survival and prevalence in Tasmania

Cancer in Ontario. 1 in 2. Ontarians will develop cancer in their lifetime. 1 in 4. Ontarians will die from cancer

Alberta Health. Seasonal Influenza in Alberta Season Summary

Saskatchewan Cancer Control Report. Profiling Cancer in Regional Health Authorities

Cancer projections National Cancer Registry

Trends in Cancer CONS Disparities between. W African Americans and Whites in Wisconsin. Carbone Cancer Center. July 2014

Trends in colorectal cancer incidence in younger Canadians,

Canadian Cancer Statistics

Calibrating Time-Dependent One-Year Relative Survival Ratio for Selected Cancers

Annual Statistical Update: HIV and AIDS

Estimated Minnesota Cancer Prevalence, January 1, MCSS Epidemiology Report 04:2. April 2004

Methodology for the Survival Estimates

Annual Statistical Update: HIV and AIDS

Estimating relative survival: An analysis of bias introduced by outdated life tables. Larry Ellison Health Statistics Division Ottawa, June 24, 2014

COLLABORATIVE STAGE TRAINING IN CANADA

Cancer Disparities in Arkansas: An Uneven Distribution. Prepared by: Martha M. Phillips, PhD, MPH, MBA. For the Arkansas Cancer Coalition

Nutrition and Physical Activity Situational Analysis

Cancer in the Northern Territory :

Cancer in New Brunswick

ALBERTA. Population, Socioeconomics and Health Summary. are we? FEBRUARY How healthy

Cancer prevalence. Chapter 7

Cancer in First Nations People in Ontario:

Annual Statistical Update on HIV and AIDS 2013

Overview of 2010 Hong Kong Cancer Statistics

Overview of Hong Kong Cancer Statistics of 2015

Trends in Irish cancer incidence with predictions to 2020

DIABETES MORTALITY IN NOVA SCOTIA FROM 1998 TO 2005: A DESCRIPTIVE ANALYSIS USING BOTH UNDERLYING AND MULTIPLE CAUSES OF DEATH

Trends in the Lifetime Risk of Developing Cancer in Ontario, Canada

Appendix 1 (as supplied by the authors): Supplementary data

My talk will focus on cancer incidence rates in Lambton County, incidence being the number of new cases of a disease diagnosed in a given population

Cancer Control - the role of Surveillance. Anthony B. Miller Department of Public Health Sciences University of Toronto, Canada

2018 Texas Cancer Registry Annual Report

Diabetes in Manitoba 1989 to 2006 R E P O R T O F D I A B E T E S S U R V E I L L A N C E

Cancer in Ireland : Annual Report of the National Cancer Registry

Overview of 2009 Hong Kong Cancer Statistics

Diabetes in Manitoba: Trends among Adults

Lung Cancer in First Nations People in Ontario: Incidence, Mortality, Survival and Prevalence

Alberta Health. Seasonal Influenza in Alberta. 2016/2017 Season. Analytics and Performance Reporting Branch

AN EMPIRICAL EVALUATION OF PERIOD SURVIVAL ANALYSIS USING DATA FROM THE CANADIAN CANCER REGISTRY. Larry F. Ellison MSc, Statistics Canada

All-Cause Mortality, Waterloo Region and Ontario, 2010, 2011 and 2012

Person-Centred Perspective Indicators in Canada:

Immunization Report Public Health September 2013

Cervical Cancer and Pap Test Utilisation in Manitoba

CANCER. in the Northwest Territories March 2014

Cancer Trends in Northern Ireland: D. Fitzpatrick, A. Gavin, D. Donnelly

Alberta Health. Seasonal Influenza in Alberta Season. Analytics and Performance Reporting Branch

Public Health Observatories: An introduction to the London Health Observatory in England and recent developments in Alberta. Learning objectives

Macmillan-NICR Partnership: GP Federation Cancer Profiles (with Prevalence )

Cancer survival. Chapter 6

Health Promotion, Screening, & Early Detection

National Cervical Screening Programme. Annual Report 2014

2017/18 Influenza Season Summary

UK Complete Cancer Prevalence for 2013 Technical report

Cancer Facts & Figures for African Americans

Estimating Testicular Cancer specific Mortality by Using the Surveillance Epidemiology and End Results Registry

Background. Opportunity. The Proposed Study of e-mh for Youth and Young Adults

The number of newly identified HIV cases decreased. There was a sharp drop in both male and female HIV rates in 2013.

ONTARIO CANCER PLAN

Strategic Operational Research Plan February 13, Scientific Office Digestive Health Strategic Clinical Network

TIME SINCE LAST MAMMOGRAM, AGE 35 YEARS AND OLDER KEY MESSAGES

Trends in the incidence of human papillomavirus-related noncervical and cervical cancers in Alberta, Canada: a population-based study

DEMENTIA IN CANADA, INCLUDING ALZHEIMER S DISEASE

Adjuvant Multi-agent Chemotherapy and Tamoxifen Usage Trends for Breast Cancer in the United States

Cancer in Rural Illinois, Incidence, Mortality, Staging, and Access to Care. April 2014

69,200 people in Nottinghamshire will be living with cancer by 2030

How Cost-Effective Are New Cancer Drugs in the U.S.?

The Impact of Relative Standards on the Propensity to Disclose. Alessandro Acquisti, Leslie K. John, George Loewenstein WEB APPENDIX

Cancer in Utah: An Overview of Cancer Incidence and Mortality from

Cancer Incidence in Fort Chipewyan, Alberta Alberta Cancer Board Division of Population Health and Information Surveillance

Trends of Diabetes in Alberta

Trends in Cancer Survival in NSW 1980 to 1996

Health Interventions in Ambulatory Cancer Care Centres DRAFT. Objectives. Methods

Downloaded from:

Prediction of Cancer Incidence and Mortality in Korea, 2018

MAJOR RELEASES OTHER RELEASES PUBLICATIONS RELEASED 5

Health and Wellness Alberta Health Care Insurance Plan Statistical Supplement 2006/2007

Cancer in Australia: Actual incidence data from 1982 to 2013 and mortality data from 1982 to 2014 with projections to 2017

Health Status: Communicable Diseases

Overview of 2013 Hong Kong Cancer Statistics

Cancer in Huron County

New HIV diagnoses in Ontario: Preliminary update, 2016

INFORMATION AND SUPPORTIVE CARE NEEDS OF INDIVIDUALS WITH BLADDER CANCER

A Glance at Cancer in Waterloo Region

Transcription:

December 212 21 Report on Cancer Statistics in Alberta

Report on Cancer Statistics in Alberta Acknowledgements 2 This report was made possible through Alberta Health Services,, and the many contributions of staff and management across Alberta Health Services as well as external agencies and individuals. The authors wish to thank individuals working in the following AHS departments and partner agencies for their contributions to this report: Alberta Cancer Registry, Surveillance and Health Status Assessment, Alberta Health and Statistics Canada. Contributions included provision of information, analysis and interpretation, and assistance with consultation sessions and communication of the report. Report Editor: Dr. Juanita Hatcher, Director, Project Coordinator: Barry Obondo, Information Dissemination Coordinator Analysis and Review: Amy Colquhoun, Epidemiologist Halim Elamy, Surveillance Analyst Li Huang, Senior Surveillance Analyst Anthony Karosas, Surveillance Analyst Dr. Fengxiao Li, Survey Analyst Andrew Min, Assistant Programmer Analyst Chris Normandeau, Project Lead Tyler Pittman, Survey Analyst Dr. Zhenguo Qiu, Biostatistician Marjan Rekabdar, Surveillance Analyst Janine Schouten, Environmental Exposure Analyst Mengzhe Wang, Manager, Analytical Team Jing Yang, Clinical Data Analyst Yufei Zheng, Surveillance Analyst Practicum Student Design Assistance: Ashley Lakusta, Administrative Support III Suggested Citation: : 21 Report on Cancer Statistics in Alberta. Edmonton:, Alberta Health Services, 212. For More Information: Visit our website: http://www.albertahealthservices.ca/173.asp

Report on Cancer Statistics in Alberta Table of Contents 3 Purpose of the Report 4 Navigating the Report 4 Data Notes 4 Summary 5 Probability of Developing and Dying from Prostate Cancer 6 Potential Years of Life Lost 7 Prevalence 8 Incidence and Mortality 9 Relative Survival 16 Further Information 18 References 19 Contact Information 19

Report on Cancer Statistics in Alberta 4 Purpose of the Report is a specialized team within Alberta Health Services,, that actively contributes to Alberta Health Service s goal of creating the best-performing publicly funded health system in Canada. This is accomplished by conducting cancer surveillance through the collection, integration, analysis and dissemination of cancer related data and information. The report is designed to provide comprehensive and detailed information regarding cancer in Alberta. It will help support health professionals, researchers and policy makers in the planning, monitoring and evaluation of cancer-related health programs and initiatives. It will also be a useful education tool for the general public and media. Data Notes In this document, the term cancer refers to invasive cancers unless otherwise specified. It is important to note that this document contains both actual and estimated data; distinctions are made where applicable. The numbers published in this report should be considered provisional, as a few cases and deaths may be registered in subsequent years. The data in this report reflect the state of the Alberta Cancer Registry as of July 31, 212. For detailed descriptions about data sources and how they affect data presented in this report, please see the Appendix document. Navigating the Report This document provides information on leukemia statistics in Alberta. Details about other individual cancer types are available within separate documents. The words highlighted in dark blue are terms described in detail in the Glossary within the Appendix document.

Report on Cancer Statistics in Alberta 5 Summary Approximately 1 in 46 men and 1 in 63 women will develop invasive leukemia within their lifetime. In 21, 2,651 potential years of life were lost due to leukemia. As of December 31, 21, approximately 4,15 Albertans were alive who had previously been diagnosed with leukemia. From 199 to 21*, male and female incidence rates have remained stable. From 2 to 21*, male leukemia mortality rates have decreased while female leukemia mortality rates have remained stable over the period 199 to 21*. In 21, there were 59 new cases of leukemia in Alberta and 18 deaths due to the disease. Approximately 63 cases of leukemia are expected to be diagnosed in 215. The five-year relative survival ratio for leukemia in Alberta is approximately 7% for those diagnosed between 28 and 21. In 21, there were 59 new cases of leukemia in Alberta and 18 deaths due to the disease. The five-year relative survival ratio for leukemia in Alberta is approximately 7% for those diagnosed between 28 and 21. *Year range represents the period over which the most recent significant trend was observed.

Report on Cancer Statistics in Alberta 6 Probability of Developing and Dying from The probability of developing or dying of cancer measures the risk of an individual in a given age range developing or dying of cancer, and is conditional on the person being leukemia-free prior to the beginning of that age range. It is important to note that the probabilities of developing and dying of cancer represent all of Alberta s population on average and should be interpreted with caution at the individual level as the probabilities will be affected by the risk behaviours of the individual. In addition, someone diagnosed with cancer has a higher probability of developing another cancer in the future. 1 The probability of developing leukemia increases with age, after an initial peak as a child, and varies by sex (Table 9-1). Approximately 1 in 46 males and 1 in 63 females will develop invasive leukemia in their lifetime. Males have a higher chance of developing leukemia than females. On a population basis the probability of developing leukemia by the end of the age range for a leukemia-free individual at the beginning of the age range are shown in the bottom eight rows of Table 9-1. For instance, a leukemiafree female representative of the general population at age 4 has a 1 in 1,611 chance of developing leukemia by the time she is 5. The probability of dying from leukemia increases with age and varies by sex (Table 9-2). Approximately 1 in 15 males and 1 in 136 females will die of invasive leukemia. Males have a higher chance of dying from leukemia than females. On a population basis the probability of a cancer-free individual at the beginning of the age range dying from leukemia by the end of the age range are shown in the bottom eight rows of Table 9-2. For example, a cancer-free female representative of the general population at age 4 has a 1 in 6,534 chance of dying from leukemia by the time she is 5. Table 9-1: Probability of Developing by Age and Sex, Alberta, 26-21 Age Group (Years) Males Females Lifetime Risk (all ages) 1 in 46 1 in 63 2 1 in 927 1 in 1,231 2-3 1 in 2,883 1 in 4,7 3-4 1 in 2,971 1 in 2,627 4-5 1 in 1,27 1 in 1,611 5-6 1 in 412 1 in 699 6-7 1 in 2 1 in 313 7-8 1 in 124 1 in 181 8+ 1 in 91 1 in 144 Data Sources: Alberta Cancer Registry, Alberta Health Table 9-2: Probability of Dying from by Age and Sex, Alberta, 26-21 Age Group (Years) Males Females Lifetime Risk (all ages) 1 in 15 1 in 136-2 1 in 5,79 Less than 1 in 1, 2-3 Less than 1 in 1, Less than 1 in 1, 3-4 Less than 1 in 1, Less than 1 in 1, 4-5 1 in 5,449 1 in 6,534 5-6 1 in 2,331 1 in 3,513 6-7 1 in 62 1 in 935 7-8 1 in 261 1 in 418 8+ 1 in 136 1 in 188 Data Sources: Alberta Cancer Registry, Alberta Health

Potential Years of Life Lost (PYLL) Report on Cancer Statistics in Alberta Potential Years of Life Lost One frequently used measure of premature death is potential years of life lost (PYLL). PYLL due to cancer is an estimate of the number of years that people would have lived had they not died from cancer. PYLL due to cancer has been calculated by multiplying the number of deaths in each age group and the absolute difference between the mid-point age of an age group and the age-specific life expectancy. The age-specific life expectancy is calculated by determining the age to which an individual would have been expected to live had they not died from cancer. PYLL is one way to measure the impact, or burden, of a disease on a population. In 21, 2,651 potential years of life were lost due to leukemia, which constitutes about 3% of PYLL for all cancers (Figure 9-1). Figure 9-1: Potential Years of Life Lost (PYLL) from Compared with Lung, Colorectal, Breast and Prostate Cancers, Alberta, 21 25, 2, 15, 1, 5, Lung Colorectal Breast Prostate 7 Male and Female Female only Cancer Type Data Source: Alberta Cancer Registry

Report on Cancer Statistics in Alberta Prevalence The prevalence of a disease is defined as the number of people alive at a given time point who had been previously diagnosed with that disease. Limited-duration leukemia prevalence represents the number of people alive on a certain day who had previously been diagnosed with leukemia within a specified time period (e.g. 2, 5, 1 or 2 years) while complete leukemia prevalence represents the number of people alive on a certain day who had previously been diagnosed with leukemia, regardless of how long ago the diagnosis was. 2 In this section of the report, both limited-duration and complete leukemia prevalence are presented; the latter describing the number of people alive as of December 31, 21 who had ever been diagnosed with leukemia. Prevalence is a useful indicator of the impact of cancer on individuals, the healthcare system and the community as a whole. Although many cancer survivors lead healthy and productive lives, the experience can have a strong impact on the physical and emotional well-being of individuals and their families. The cancer experience can also result in the continued use of the healthcare system through rehabilitation or support services, as well as loss of work productivity that can affect the whole community. As of December 31, 21, approximately 4,15 Albertans were alive who had previously been diagnosed with leukemia (Table 9-3) out of which approximately 76 Albertans were alive on the same date who had been diagnosed with leukemia in the previous two years, the period during which cases are more likely to receive definitive treatments. Table 9-3: Limited-Duration and Complete Prevalence for, Both Sexes Combined, Alberta, 21 Duration Data Source: Alberta Cancer Registry Prevalence 2-Year 761 5-Year 1,721 1-Year 2,758 2-Year 3,638 Complete 4,174 8

Report on Cancer Statistics in Alberta 9 Incidence and Mortality Incidence counts are the number of new cancer cases diagnosed during a specific time period in a specific population. In this section of the report, incidence counts refer to the number of new leukemia diagnoses in Albertan residents in a calendar year. Incidence rates are the number of new leukemia cases diagnosed per 1, population in a specific time period. Mortality counts describe the number of deaths attributed to cancer during a specific period of time in a specific population. In this section of the report, mortality refers to the number of deaths due to leukemia in Albertan residents in a calendar year, regardless of date of diagnosis. Mortality rates are the number of deaths per 1, population in a specific time period. In order to compare cancer incidence or cancer mortality over time or between populations, age-standardized incidence rates (ASIRs) or agestandardized mortality rates (ASMRs) are presented. These are weighted averages of age-specific rates using a standard population to determine the weights. These rates are useful because they are adjusted for differences in age distributions in a population over time, which permit comparisons of cancer incidence or mortality among populations that differ in size, structure and/or time period. ASIRs and ASMRs give the overall incidence and mortality rates that would have occurred if the population of Alberta had been the same as the standard population. In this report the Canadian 1991 population is used as the standard population. Three-year moving averages are used to smooth out year-to-year fluctuations so that the underlying trend may be more easily observed. They are calculated based on aggregating three years of data by age group. Agestandardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) are presented as three-year moving averages. This smoothing of trends is especially important when the number of cancer cases per year is relatively small, where year-to-year variability can be quite large. Incidence and mortality can be affected by a variety of factors; implementation of public health prevention or screening strategies that either prevent disease or find cancer in its early stages when treatment is generally more successful, the development of cancer treatment programs that may impact chances of survival and research innovations. The following figures show incidence and mortality trends for leukemia in Alberta. Separate analyses for both incidence and mortality are shown in subsequent sections. The statistical significance of the trends was determined by using Joinpoint 3 method and is described in the text accompanying each graph. Joinpoint models are based on yearly rates; hence there may be slight differences in the rates presented in the text (from Joinpoint model) and the graphs (where ASIRs and ASMRs are shown as three-year moving averages).

Rate per 1, Rate per 1, Report on Cancer Statistics in Alberta 1 Figure 9-2: Age-Standardized Incidence Rates (ASIRs) * and Mortality Rates (ASMRs) * and 95% Confidence Intervals (CI) for, Both Sexes Combined, Alberta, 199-21 25 Figure 9-3: Age-Standardized Incidence Rates (ASIRs) * and Mortality Rates (ASMRs) * and 95% Confidence Intervals (CI) for, Males, Alberta, 199-21 25 2 2 15 ASIR 15 ASIR ASMR ASMR 1 1 5 5 199 1992 1994 1996 1998 2 22 24 26 28 21 199 1992 1994 1996 1998 2 22 24 26 28 21 Year Year * Three-year moving average. Standardized to 1991 Canadian population. * Three-year moving average. Standardized to 1991 Canadian population. Data Sources: Alberta Cancer Registry, Alberta Health ASIRs in both sexes combined increased significantly since 199 (Figure 9-2). Between 199 and 21, leukemia ASIRs in both sexes combined increased significantly by.7% annually. In 21, the ASIR for leukemia in both sexes combined was 13 per 1, population. mortality rates are lower than incidence rates (Figure 9-2). ASMRs in both sexes combined remained stable between 199 and 2, but decreased significantly between 2 and 21 by 3.2% annually. In 21, the ASMR for leukemia in both sexes combined was 4 per 1, population. Data Sources: Alberta Cancer Registry, Alberta Health Male leukemia ASIRs have not increased significantly since 199 (Figure 9-3). In 21, the ASIR for leukemia in males was 17 per 1, male population. Male leukemia mortality rates are lower than incidence rates (Figure 9-3). Male leukemia AMSRs remained stable between 199 and 2. Over the period 2 to 21, male leukemia ASMRs decreased significantly by 3.9% annually. In 21, the ASMR for leukemia in males was 5 per 1, male population.

Rate per 1, Report on Cancer Statistics in Alberta 11 Figure 9-4: Age-Standardized Incidence Rates (ASIRs) * and Mortality Rates (ASMRs) * and 95% Confidence Intervals (CI) for, Females, Alberta, 199-21 25 2 15 1 5 199 1992 1994 1996 1998 2 22 24 26 28 21 * Three-year moving average. Standardized to 1991 Canadian population. Data Sources: Alberta Cancer Registry, Alberta Health Female leukemia ASIRs have not increased significantly since 199 (Figure 9-4). In 21, the ASIR for leukemia in females was 9 per 1, female population. Year ASIR ASMR Incidence The following three figures (Figures 9-5 to 9-7) provide information on leukemia incidence in Alberta. The number of new cancer cases in Alberta is affected not only by changes in the incidence rates, but also by the changes in the age structure and growth of the population. In order to compare trends over time, age-standardized incidence rates (ASIRs) are also provided. In Figures 9-5 and 9-6 observed age standardized incidence rates are shown for 199-29, and projected rates for 21-215, and observed numbers of new leukemia cases are shown for the years 199-21 and projected numbers for 211-215 The projected cancer numbers were calculated by applying the estimated age-specific cancer incidence rates to the projected age-specific population figures provided by Alberta Health. 4 These were observed up to 29 and estimated for 21-215. Caution should be exercised when comparing Canada 5 and Alberta rates as Canadian rates are yearly rates while Alberta rates are three-year moving averages. The estimated leukemia incidence rates were calculated by extrapolating the historical trends in age-specific rate based on data for 1985-29. Female leukemia mortality rates are lower than incidence rates (Figure 9-4). Female leukemia ASMRs have not changed significantly since 199. In 21, the ASMR for leukemia in females was 4 per 1, female population.

Rate per 1, Rate per 1, Report on Cancer Statistics in Alberta Figure 9-5: Actual and Projected Number of New Cases and Age-Standardized Incidence Rates (ASIRs) * for, Males, Alberta, 199-215 Figure 9-6: Actual and Projected Number of New Cases and Age-Standardized Incidence Rates (ASIRs) * for, Females, Alberta, 199-215 12 2 6 2 6 18 16 5 18 16 5 14 12 1 8 6 4 2 343 353 364 316 322 332 32 286 283 231 237 257 262 258 245 231 195 198 28 222 185 171 179 156 157 126 4 3 2 1 New Cases 14 12 1 8 6 4 2 231 219 22 24 18 189 192 193 172 162 172 125 133 133 133 133 139 145 13 114 114 97 24 25 26 27 4 3 2 1 New Cases 199 1992 1994 1996 1998 2 22 24 26 28 21 212 214 199 1992 1994 1996 1998 2 22 24 26 28 21 212 214 Year Year Alberta New Cases Alberta 3-Year Moving Average ASIR Canada ASIR Alberta Projected New Cases Alberta Projected ASIR Canada Projected ASIR Alberta New Cases Alberta 3-Year Moving Average ASIR Canada ASIR Alberta Projected New Cases Alberta Projected ASIR Canada Projected ASIR * Three-year moving average. Standardized to 1991 Canadian population. * Three-year moving average. Standardized to 1991 Canadian population. Data Sources: Alberta Cancer Registry, Alberta Health, Canadian Cancer Society In 21, 316 cases of male leukemia were diagnosed in Alberta (Figure 9-5). Alberta ASIRs for male leukemia were generally higher than those in Canada. Approximately 36 cases of male leukemia will be diagnosed in Alberta in 215. Data Sources: Alberta Cancer Registry, Alberta Health, Canadian Cancer Society In 21, 193 cases of female leukemia were diagnosed in Alberta (Figure 9-6). Alberta ASIRs for female leukemia were generally higher than those in Canada. Approximately 27 cases of female leukemia will be diagnosed in Alberta in 215.

Rate per 1, Report on Cancer Statistics in Alberta 13 Figure 9-7: Age-Specific Incidence Rates for by Sex, Alberta, 26-21 14 12 1 8 6 4 2 2 4 6 8 1 Data Sources: Alberta Cancer Registry, Alberta Health Age (Years) Male Female Incidence rates of leukemia change with age in males and females (Figure 9-7). Age-specific incidence rates for leukemia are somewhat elevated in those under 15 years of age then remain low in both males and females until the age of 4. Female rates are similar to male rates until about the age of 45, after which females have lower incidence rates. Mortality The following three figures (Figures 9-8 to 9-1) provide information on leukemia mortality in Alberta. The number of deaths in Alberta is affected not only by changes in the mortality rates, but also by the changes in the age structure and growth of the population. In order to compare trends over time, age-standardized mortality rates (ASMRs) are also provided. In Figures 9-8 and 9-9 observed age standardized mortality rates are shown for 199-29, and projected rates for 21-215, and observed numbers of cancer deaths are shown for the years 199-21 and projected numbers for 211-215. The projected numbers of cancer deaths were calculated by applying the estimated age-specific cancer mortality rates to the age-specific population figures provided by Alberta Health. 4 These were observed up to 29 and estimated for 21-215. Caution should be exercised when comparing Canada 5 and Alberta rates as Canadian rates are yearly rates while Alberta rates are three-year moving averages. The estimated leukemia mortality rates were calculated by extrapolating the historical trends in age-specific rate based on data in 1985-29.

Rate per 1, Rate per 1, Report on Cancer Statistics in Alberta Figure 9-8: Actual and Projected Number of Deaths and Age-Standardized Mortality Rates (ASMRs) * for, Males, Alberta, 199-215 Figure 9-9: Actual and Projected Number of Deaths and Age-Standardized Mortality Rates (ASMRs) * for, Females, Alberta, 199-215 14 1 35 1 35 9 8 3 9 8 3 7 6 5 4 3 2 1 67 88 81 93 86 99 99 88 12 13 17 114 115 97 99 16 112 122 12 15 1 114 114 115 115 116 25 2 15 1 5 Deaths 7 6 5 4 3 2 1 67 44 55 63 67 63 76 65 7 78 83 59 73 98 83 68 73 75 86 88 8 83 85 86 88 9 25 2 15 1 5 Deaths 199 1992 1994 1996 1998 2 22 24 26 28 21 212 214 199 1992 1994 1996 1998 2 22 24 26 28 21 212 214 Year Year Alberta Deaths Alberta 3-Year Moving Average ASMR Canada ASMR Alberta Projected Deaths Alberta Projected ASMR Canada Projected ASMR Alberta Deaths Alberta 3-Year Moving Average ASMR Canada ASMR Alberta Projected Deaths Alberta Projected ASMR Canada Projected ASMR * Three-year moving average. Standardized to 1991 Canadian population. * Three-year moving average. Standardized to 1991 Canadian population. Data Sources: Alberta Cancer Registry, Alberta Health, Canadian Cancer Society In 21, 1 males died of leukemia in Alberta (Figure 9-8). Alberta ASMRs for male leukemia were similar to those in Canada. Approximately 12 males are expected to die from leukemia in Alberta in 215. Data Sources: Alberta Cancer Registry, Alberta Health, Canadian Cancer Society In 21, 8 females died of leukemia in Alberta (Figure 9-9). Alberta ASMRs for female leukemia cancer were similar to those in Canada. Approximately 9 females are expected to die from leukemia in Alberta in 215.

Rate per 1, Report on Cancer Statistics in Alberta 15 Figure 9-1: Age-Specific Mortality Rates for by Sex, Alberta, 26-21 12 1 Male and female leukemia mortality rates differ by age and sex (Figure 9-1). Age-specific mortality rates for leukemia are low in both males and females until about the age of 4 when they begin to increase. Female rates are lower than male rates after 45 years of age. The highest leukemia mortality rates occur in the older age groups. 8 Male 6 Female 4 2 2 4 6 8 1 Age (Years) Data Sources: Alberta Cancer Registry, Alberta Health

Relative Survival (%) Report on Cancer Statistics in Alberta 16 Survival Cancer survival ratios indicate the proportion of people who will be alive at a given time after they have been diagnosed with cancer. Survival is an important outcome measure and is used for evaluating the effectiveness of cancer control programs. Survival depends on several factors including the cancer type (most importantly site, morphology and stage at diagnosis), sex, age at diagnosis, health status and available treatments for that cancer. While relative survival ratios (RSRs) give a general expectation of survival over the whole province, these ratios may not apply to individual cases. Individual survival outcomes depend on the stage at diagnosis, treatment and other individual circumstances. Relative survival ratios are estimated by comparing the survival of cancer patients with that expected in the general population of Albertans of the same age, sex and in the same calendar year. In this section of the report, RSRs are standardized by the age structure in the standard cancer patient population (i.e. all persons who were diagnosed with that cancer in Canada between 1992 and 21) to permit RSRs to be compared over time, independent of differences in age distribution of cancer cases. RSRs are estimated by the cohort method 6 when complete follow-up data (e.g., at least five years of follow-up to estimate five-year rate) after diagnosis are available. For recently diagnosed cases, whose complete follow-up data are not available, the up-to-date estimates are computed using the period method. 7 However, comparison between cohort and period RSRs should be interpreted with caution because of the two different methods used to derive the respective ratios. The relative survival ratio is usually expressed as a percentage (%) and the closer the value is to 1%, the more similar the survival pattern is to the general population. Figure 9-11: Age-Standardized One, Three and Five-Year Relative Survival Ratios and 95% Confidence Intervals (CI) for, Both Sexes Combined, Alberta, 1991-1993 *, 1998-2 * and 28-21 1 9 8 7 6 5 4 3 2 1 1 year 3 year 5 year Years After Diagnosis * Ratios calculated by cohort method, where complete follow-up data are available. Ratios calculated by period method, where complete follow-up data are not available. Data Sources: Alberta Cancer Registry, Statistics Canada 1991-1993 1998-2 28-21 The five-year relative survival ratio for individuals diagnosed with leukemia in the period 28-21 is an estimated 7% indicating that out of individuals diagnosed with this cancer between 28 and 21, around 7% are as likely to be alive five years after diagnosis as individuals from the general population of the same age. The five-year relative survival ratio for individuals diagnosed with leukemia in Alberta has improved in 28-21 compared to those diagnosed in 1991-1993 (Figure 9-11).

Relative Survival (%) Relative Survival (%) Report on Cancer Statistics in Alberta 17 Figure 9-12: Age-Standardized One, Three and Five-Year Relative Survival Ratios and 95% Confidence Intervals (CI) for, Males, Alberta, 1991-1993 *, 1998-2 * and 28-21 Figure 9-13: Age-Standardized One, Three and Five-Year Relative Survival Ratios and 95% Confidence Intervals (CI) for, Females, Alberta, 1991-1993 *, 1998-2 * and 28-21 1 1 9 9 8 8 7 6 1991-1993 7 6 1991-1993 5 4 3 1998-2 28-21 5 4 3 1998-2 28-21 2 2 1 1 1 year 3 year 5 year 1 year 3 year 5 year Years After Diagnosis Years After Diagnosis * Ratios calculated by cohort method, where complete follow-up data are available. Ratios calculated by period method, where complete follow-up data are not available. * Ratios calculated by cohort method, where complete follow-up data are available. Ratios calculated by period method, where complete follow-up data are not available. Data Sources: Alberta Cancer Registry, Statistics Canada The five-year relative survival ratio for males diagnosed with leukemia in the period 28-21 is an estimated 71% indicating that out of males diagnosed with this cancer between 28 and 21, around 71% are as likely to be alive five years after diagnosis as males from the general population of the same age. The five-year relative survival ratio for males diagnosed with leukemia in Alberta has improved in 28-21 compared to those diagnosed in 1991-1993 (Figure 9-12). Data Sources: Alberta Cancer Registry, Statistics Canada The five-year relative survival ratio for females diagnosed with leukemia in the period 28-21 is an estimated 69% indicating that out of females diagnosed with this cancer between 28 and 21, around 69% are as likely to be alive five years after diagnosis as females from the general population of the same age. The five-year relative survival ratio for females diagnosed with leukemia in Alberta has improved in 28-21 compared to those diagnosed in 1991-1993 (Figure 9-13).

Report on Cancer Statistics in Alberta Further Information Further information is available on a separate document, the Appendix: Appendix 1: Glossary Appendix 2: Cancer Definitions Appendix 3: Data Notes 18

Report on Cancer Statistics in Alberta References 19 1. Okamoto N, Morio S, Inoue R, Akiyama K. The risk of a second primary cancer occurring in five-year survivors of an initial cancer. Jpn. J Clin Oncol. 1987;17(3):25-213. 2. National Cancer Institute - Surveillance Epidemiology and End Results [Internet]. USA. National Institutes of Health; c21.cancer Prevalence Statistics Overview; 21 [cited 21 Nov 23]; Available from: http://surveillance.cancer.gov/prevalence/] 3. Kim H-J, Fay M, Feuer E. Permutation tests for JoinPoint regression with applications to cancer rates. Stat. Med. 2; 19:335-351. 4. 21 Alberta Population Data [Excel Spreadsheet]. Edmonton (Alberta): Alberta Health; 29. 5. Canadian Cancer Society s Steering Committee: Canadian Cancer Statistics 212. Toronto: Canadian Cancer Society, 212. 6. Ederer F, Axtell LM and Cutler SJ. The relative survival rate: a statistical methodology. Natl Cancer Inst Monogr, 1961; 6: 11 121 7. Brennera H, Gefellerb O and Hakulinen T. Period analysis for up-to-date cancer survival data: theory, empirical evaluation, computational realisation and applications. European Journal of Cancer, 24; 4: 326 335 Contact Information If further information is required, please contact, Alberta Health Services as follows: Mailing Address: Alberta Health Services 14-1123-99 Street Edmonton, AB, Canada T5J 3H1 Phone: 78-643-4347 Fax: 78-643-438 Email: ACB.surveillance@albertahealthservices.ca